[Senate Hearing 110-]
[From the U.S. Government Publishing Office]
DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND
RELATED AGENCIES APPROPRIATIONS FOR FISCAL YEAR 2008
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U.S. Senate,
Subcommittee of the Committee on Appropriations,
Washington, DC.
NONDEPARTMENTAL WITNESSES
[Clerk's note.--The subcommittee was unable to hold
hearings on nondepartmental witnesses. The statements and
letters of those submitting written testimony are as follows:]
Prepared Statement of the Academy of Radiology Research
This statement is submitted on behalf of the Academy of Radiology
Research, an alliance of 23 scientific and professional societies with
a membership of more than 40,000 radiologists, imaging scientists, and
allied professionals. The Academy is also supported by national
organizations representing more than 100,000 radiologic technologists.
In addition, I am also representing the Coalition for Imaging and
Biomedical Engineering Research (CIBR). CIBR is a permanent coalition
of radiology, imaging, and bioengineering societies; imaging equipment
and medical device manufacturers; and patient advocacy groups. What
unites all of these diverse groups is the common recognition that new
imaging and biomedical engineering techniques and technologies can
transform medical science and produce dramatic improvements in the
detection, diagnosis, and treatment of a broad range of diseases and
conditions.
The purpose of my statement is to urge the Appropriations Committee
and Congress to make an investment this year that will foster
innovation in imaging and produce a new revolution in medical science
and health care driven by technology development. Recognizing the
significant budgetary challenges we face at present, it is critical
that the Federal Government take full advantage of the scientific
opportunities that offer the best prospects for improving the
capability of physicians to diagnose and treat a broad range of
diseases and conditions. Imaging is one such area of scientific
opportunity. For that reason, we request that the committee increase
the appropriation in fiscal year 2008 to $350 million for the National
Institute of Biomedical Imaging and Bioengineering (NIBIB), the newest
Institute at the National Institutes of Health and the primary home for
basic research in imaging at the NIH.
The NIBIB is not the sole home for imaging research at the NIH.
Indeed, the National Cancer Institute was the primary supporter of
imaging in the years before the NIBIB was established. With strong
support from NCI Director John E. Niederhuber and leadership from Dr.
Dan Sullivan, the NCI Cancer Imaging Program continues to grow and push
the boundaries of knowledge. I hope that the committee will support the
growth of NCI initiatives in areas such as imaging as a biomarker for
drug development, the development of new image-guided ablative
therapies, and computer-assisted methods of combining imaging and other
clinical data.
While the extramural community strongly supports imaging research
programs at the NCI and other Institutes, the NIBIB is the Institute
charged with developing new imaging techniques and technologies with
broad clinical and research applications. Investing in the NIBIB yields
dividends for all of the other Institutes in the form of new tools for
studying the specific diseases that constitute the missions of those
Institutes. It also pays large dividends for patients, who will benefit
from new imaging techniques that improve medical care and reduce the
need for more invasive, painful, and expensive procedures.
A good example is the first grant made by the NIBIB in 2002--a
Bioengineering Research Partnership award to a multi-institutional
group led by Dr. James Duncan of Yale University. With this support
from the NIBIB, Dr. Duncan and his team have been developing new,
image-guided surgical techniques for treating patients with certain,
severe forms of epilepsy. The results have been dramatic. A patient who
has undergone this surgery recently told the House Medical Technology
Caucus that the number of seizures she suffered daily dropped from more
than 30 to zero. After years enduring a severe disability that affected
virtually every area of activity, she was suddenly given her life back.
As with many imaging research projects, however, the longer-term
payoff will be much greater. This research is producing data from the
brain that is helping scientists to understand brain structure and
function in general. Moreover, this new information about the brain
will improve our understanding of Parkinson's Disease, autism,
Alzheimer's Disease, dementia, and other disorders. Finally, the
techniques developed with this grant could have much broader
applications, such as the use of imaging to guide cancer therapy to
destroy tumors or to deliver drugs to precise locations in the brain in
order to treat a variety of neurological disorders. Thus, a project to
improve the lives of epilepsy patients will eventually produce new
treatments for many more people with a range of neurological disorders.
This is typical of NIBIB and imaging initiatives.
The NIBIB, is different from other Institutes. As NIBIB Director
Roderic I. Pettigrew has observed, ``In other Institutes they utilize
tools. In this Institute, we discover tools.'' These tools are used by
investigators at the other Institutes both to improve our understanding
of disease processes and as a principal component in new therapies.
Optical imaging, for example, is an emerging technology that uses light
waves to produce high-quality images. Based on early research, the use
of optical imaging to diagnose and treat breast cancer appears to be
especially promising. This technology may allow physicians to
investigate large sections of tissue rapidly for cancerous growths, to
guide surgery to remove tumors, and to scan effectively for additional
disease. As optical imaging develops, physicians and scientists will
have a new tool with applications to a wide spectrum of diseases. It
also promises to be safer and less expensive than earlier technologies.
The last Congress overwhelmingly approved the National Institutes
of Health Reform Act of 2007, which called for a renewed emphasis on
trans-NIH research and a special focus on research at the nexus of the
physical and life sciences. NIBIB is well positioned to make good on
Congress's intent in both areas. The NIBIB, by its nature, is perhaps
the most collaborative and interdisciplinary of all the Institutes and
Centers at the NIH. In its first years, the NIBIB has pioneered
collaborative projects with other Institutes to develop new techniques
with applications to specific diseases. NIBIB is also NIH's most
prominent ``bridge'' to the physical sciences. Three examples clearly
illustrate NIBIB's unique collaborative roll.
IMAGE GUIDED INTERVENTION
Despite its prominence in modern-day medicine, surgery remains in a
relatively primitive state. Although improvements in surgical
techniques abound, costs are high, invasive procedures are still the
norm, and surgeons continue to rely on pre-operative images.
Significant improvements to the current state of surgery are well
within our reach. Highly exacting image-guided intervention could
potentially minimize invasiveness, greatly reducing patient recovery
time and the costs associated with it. With the acquisition and use of
real-time (moving) 3D images, surgeons will move far beyond pre-op
images to observe blood flow patterns, identify clot risks and ``see''
brain, nervous and electrical functions during surgery. Other advances
bridging nano and imaging technologies together could permit surgeons
to visualize and operate at the cellular level. In general, with
additional research, surgical tools will be smaller, less expensive,
and easier to manipulate.
The field of image-guided interventions is at a critical juncture.
The NIBIB leads the Interagency IGI Group, a trans-agency special
interest group including representation from seven Federal agencies as
well as 13 NIH Institutes and Centers. The need to support further
research and development in IGI was documented at a January 2006
retreat of the Interagency IGI group. NIBIB-support has already led to
major advances in this area and the Institute is poised to lead the
technological advances that will revolutionize IGI in the future.
IMAGING AT THE POINT OF PATIENT CARE
Medical imaging is critical for quality health care. Yet,
sophisticated imaging services remain widely unavailable to many
patients in small clinics and hospitals in rural and low-income
communities. The development of low cost, portable imaging devices
could extend point of care , modern diagnostic imaging techniques to
millions of underserved Americans. Recent advances in miniaturization
of electronic hardware and improved software may allow the development
of widely available low-cost ultrasound devices to diagnose
complications of pregnancy, hemorrhage associated with trauma, renal
obstructions and other significant medical conditions. Similar advances
in optical imaging may herald wider access to optical probes capable of
early detection of cervical cancers. Additionally, advances in the
electronic transmission of images can allow specialists located
thousands of miles away to evaluate these point of care images and
prescribe appropriate clinical treatment for millions of underserved
patients.
Reduction of health disparities through new and affordable medical
technologies is an explicit goal in NIBIB's Strategic Plan, and the
Institute was established with this as one of its primary research
initiatives. NIBIB has been a steady proponent of this research and
recently launched a new initiative to develop low-cost imaging
subsystems which attracted the attention of the Gates Foundation, as
low-cost technologies are mutual priorities for both organizations.
NIBIB is also spearheading the creation of a network of point-of-care
research centers. Given NIBIB's strategic priority for developing low-
cost imaging technologies, its leadership in this field, and its focus
on point-of-patient-care technologies, NIBIB is ideally suited to lead
a new major program to bring the benefits of advanced imaging
technologies to all Americans.
TISSUE ENGINEERING
The rapid development of transplant medicine along with the aging
of the baby boomer generation have caused increased demand for tissues
and organs far exceeding the available donor organs. As of May 2006,
there were over 90,000 people on the waiting list for donor organs.
Many of these individuals will die before a suitable organ can be
found. By providing tissues and organs ``on demand,'' regenerative
medicine will improve the quality of life for individuals and reduce
healthcare costs. A recent report by the Department of Health and Human
Services (2020: A New Vision--A Future for Regenerative Medicine http:/
/www.hhs.gov/reference/newfuture.shtml) underscores the need for a
cohesive Federal initiative in this area. The NIBIB is poised to lead
this initiative into the future.
Tissue Engineering is the cornerstone of regenerative medicine. It
involves the growth and engineering of living, functional, tissues and
organs. The long-range goal of tissue engineering is to use these
tissues and organs to restore, maintain, or enhance function lost due
to age, disease, damage or congenital defects. Tissue engineering has
already seen some spectacular human successes, including nearly-
complete regeneration of a severed finger and a functional bladder
grown ex-vivo, as well as animal studies where motor function has been
largely restored in a rat with a damaged spinal cord. Despite these
successes, much still needs to be done to better understand why tissue
regeneration starts and stops and to develop technologies to grow and
preserve larger quantities of tissue.
Clearly tissue engineering is an emerging multidisciplinary field
at the interface of the life and physical sciences. Thus, it is no
surprise that NIBIB exerts a leadership role in the Multi-Agency Tissue
Engineering working group for the President's National Science and
Technology Council. Given its pivotal role in this area, NIBIB requires
additional resources to fund the science necessary to accelerate
advances in this critical area of biomedical science.
The current budget proposals for fiscal year 2008 do not measure up
to the scientific opportunities in imaging. To be sure, these are
stringent budgetary times. In such circumstances, the unique
collaborative role of NIBIB offers the valuable potential for synergies
with other NIH Institutes and other agencies of government that will
stretch the value of scarce research dollars and expand the
translational potential of the joint studies that are undertaken.
Surely this is what Congress had in mind when it placed so much
emphasis on breaking down the barriers separating the various
Institutes, and disciplines at NIH. The NIBIB can only realize its vast
collaborative and translational potential if it grows at a reasonable
rate. As the newest of the NIH Institutes, it did not share in the
doubling of the NIH budget that ended just as the new century began.
Failure to invest adequately in the NIBIB will have at least two
negative consequences. First, scientific opportunities to improve
diagnosis and treatment of a wide range of diseases will be, at best,
delayed and could be lost. NIBIB Director Rod Pettigrew has proposed a
program of ``quantum'' projects designed to produce major breakthroughs
in health care and medical science. Without additional resources, this
initiative will surely be postponed or scaled back. Moreover, advanced
research in other Institutes aimed at specific diseases will be set
back by the delay in developing leading-edge imaging techniques that
enable advanced research.
Second, it will discourage the large group of researchers who have
been attracted to the NIH for the first time. Scientists in fields such
as physics, mathematics, and computer science have been drawn to the
NIBIB as a home for research that ties together the physical and
biological sciences. Congress clearly sees such interdisciplinary
research as the future of biomedical science, but that future could be
delayed significantly if top scientists are discouraged from even
submitting applications because funds are not available to support good
research.
For these reasons, I hope that the committee will increase the 2008
appropriation for the NIBIB to $350 million and consider a multi-year
plan to build toward a budget that will enable the Institute to fulfill
its collaborative mission.
The Congress created the NIBIB in 2000 to be different from the
other Institutes. It is different because its primary mission is
technology development. It is different because it does not focus on a
single disease or organ system; instead, it is charged with developing
new technologies with broad applications to many diseases and
conditions. It is different because its foundation in the physical
sciences separates it from the Institutes based on the biological
sciences.
To a significant extent because of these differences, the NIBIB
represents the future of interdisciplinary, team-driven biomedical
science that is changing health care. I hope that the Congress will
provide the resources needed to fulfill its promise.
______
Prepared Statement of the AIDS Action Council
I am pleased to submit this testimony to the members of this
committee on the importance of increased funding for the fiscal year
2008 HIV/AIDS portfolio. Since 1984, AIDS Action Council has worked to
enhance HIV prevention programs, research protocols, and care and
treatment services at the community, State, and Federal level. AIDS
Action's goals are to ensure effective, evidence-based HIV care,
treatment, and prevention services; to encourage the continuing pursuit
of a cure and a vaccine for HIV infection; and to support the
development of a public health system which ensures that its services
are available to all those in need. On behalf of AIDS Action Council's
diverse membership, comprising community-based HIV/AIDS service
organizations, prevention services, public health departments, and
education and training programs, I bring your attention to issues
impacting funding for fiscal year 2008.
Despite the good news of improved treatments, which have made it
possible for people with HIV disease to lead longer and healthier
lives, stark realities remain:
--There are between 1.1 and 1.2 million people living with HIV in the
United States.
--Half a million HIV positive people in the United States do not
receive regular medical care including treatment for their
disease.
--Between 200,000 and 300,000 people in the United States do not know
that they are HIV positive.
--There are at least 40,000 preventable, new HIV infections each
year. Approximately half of these infections occur in youth
aged 13-24
--Between 14,000-16,000 people die from HIV related causes each year.
--While African Americans comprise only 12 percent of the United
States population, they account for approximately half (49
percent) of those infected with HIV/AIDS and 70 percent of new
HIV infections each year.
--HIV was the #1 cause of death for Black women, aged 25-34, in 2004
the most recent year we for which have data.
--According to a CDC study released in 2005, 46 percent of urban
African American men who have sex with men (MSM) were HIV-
positive.
--70 percent of HIV positive people depend on Federal programs to
receive HIV treatment, care, and services.
The Federal Government's commitment to funding research,
prevention, and care and treatment for those living with HIV is
critical. Despite this commitment, we are not doing enough. We need
more prevention, more treatment and care and more research to slow and
eventually reverse this epidemic.
AIDS Action Council concurs with many in the HIV community that
increased support for HIV care and treatment, research, and prevention
are critical. The community has come together under the umbrella of the
AIDS Budget and Appropriations Coalition with the community funding
request for the HIV domestic portfolio for fiscal year 2008. The
numbers requested represent that community work. These requests have
been submitted to the committee.
The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act,
administered by the Health Resources and Services Administration (HRSA)
and funded by this subcommittee, provides services to more than 533,000
people living with and affected by HIV throughout the United States and
its territories. It is the single largest source of Federal funding
solely focused on the delivery of HIV services. CARE Act programs have
been critical to reducing the impact of the domestic HIV epidemic. Yet
in recent years, CARE Act funding has decreased through across-the-
board rescissions. The rescissions in fiscal year 2005 and fiscal year
2006 that were executed on all non-defense and non-homeland security
discretionary spending during the final negotiations of the bills had a
devastating impact on the HIV/AIDS portfolio in general, and on the
Ryan White CARE Act in particular.
Now in its 17th year, the Ryan White CARE Act was reauthorized by
the 109th Congress. The changes made by reauthorization, combined with
the late enactment of fiscal year 2007 funding, has created the
potential for crisis within the CARE Act. It is AIDS Action's hope that
this subcommittee will recognize and address the true funding needs of
the care programs within the domestic HIV/AIDS portfolio and make
significant increases in all aspects of the HIV funding portfolio.
Five new jurisdictions were added to Ryan White CARE Act's Title I
as transitional grant areas (TGAs), but no new funding was added for
the Title I grantees in fiscal year 2007. Some of the services provided
under Title I include physician visits, laboratory services, case
management, home-based and hospice care, and substance abuse and mental
health services. With the new reauthorization these services will be
even more dedicated towards funding core medical services and to
ensuring the ability of patients to adhere to treatment. These services
are critical to ensuring patients have access to, and can effectively
utilize, life-saving therapies. AIDS Action along with the HIV/AIDS
community recommends funding Title I at $840.4 million.
Title II of the CARE Act ensures a foundation for HIV related
health care services in each State and territory, including the
critically important AIDS Drug Assistance Program (ADAP) and Emerging
Communities Program. Title II base grants (excluding ADAP and Emerging
Communities) was the only program to receive an increase from
$331,000,000 in fiscal year 2006 to $406,000,000 in fiscal year 2007
for a total increase of $75,800,000. AIDS Action along with the HIV/
AIDS community recommends funding for Title II base grants at $463.4
million.
The AIDS Drug Assistance Program (ADAP) provides medications for
the treatment of individuals with HIV who do not have access to
Medicaid or other health insurance. According to the National ADAP
Monitoring Project, approximately 96,404 clients received medications
through ADAP in June 2005. The President recommends an increase of
$25.4 million for the critical AIDS Drug Assistance Program (ADAP) in
his fiscal year 2008 budget. However this amount is far too low. AIDS
Action along with the HIV/AIDS community recommends an increase of
$232.9 million for ADAP for fiscal year 2008. This request is derived
from a pharmacoeconomic model to estimate the amount of funding needed
to treat ADAP eligible individuals in upcoming Federal and State fiscal
years.
Title III of the Ryan White CARE Act awards grants to community-
based clinics and medical centers, hospitals, public health
departments, and universities in 22 States and the District of Columbia
under the Early Intervention Services program. These grants are
targeted toward new and emerging sub-populations impacted by the HIV
epidemic in urban and rural settings. Title III funds are particularly
needed in rural areas where the availability of HIV care and treatment
is still relatively new. AIDS Action, along with the HIV/AIDS
community, requests is an increase of $87,800,000.
Title IV of the Ryan White CARE Act awards grants under the
Comprehensive Family Services Program to provide comprehensive care for
HIV positive women, infants, children, and youth, as well as their
affected families. These grants fund the planning of services that
provide comprehensive HIV care and treatment and the strengthening of
the safety net for HIV positive individuals and their families. AIDS
Action and the HIV/AIDS community request is an increase of
$46,400,000.
Under Part F, the AIDS Education and Training Centers (AETCs) are
the training arm of the Ryan White CARE Act; they train the healthcare
providers, including the doctors, advanced practice nurses, physicians'
assistants, nurses, oral health professionals, and pharmacists. The
role of the AETCs is invaluable in ensuring that such education is
available to healthcare providers who are being asked to treat the
increasing numbers of HIV positive patients who depend on them for
care. Additionally, the AETCs have been tasked with providing training
on Hepatitis B and C to CARE Act grantees and to ensure inclusion of
culturally competent programs for and about HIV and Native Americans
and Alaska Natives. However no funding was added for additional
materials, training of staff, or programs. AIDS Action and the HIV/AIDS
community request a $15.3 million increase for this program.
Also under Part F, Dental care is another crucial part of the
spectrum of services needed by people living with HIV disease.
Unfortunately oral health is one of the first aspects of health care to
be neglected by those who cannot afford, or do not have access to,
proper medical care removing an opportunity to catch early infections
of HIV. AIDS Action and the HIV/AIDS community request a $5.9 million
increase for this program.
AIDS Action and the HIV/AIDS community estimate that the entire
Ryan White CARE Act portfolio needs $2,794,300,000 for fiscal year 2008
to address the true needs of the over 1 million people that the Centers
for Disease Control and Prevention (CDC) estimates are living with HIV
in the United States. The fiscal year 2007 funding that was allocated
was just over $2 billion ($2,112,000,000). This is a significant
shortfall from the actual needs of people living with HIV.
The Minority AIDS Initiative directly benefits racial and ethnic
minority communities with grants to provide technical assistance and
infrastructure support and strengthen the capacity of minority
community based organizations to deliver high-quality HIV health care
and supportive services. HIV/AIDS in the United States continues to
disproportionately affect communities of color. The Minority AIDS
Initiative provides services across every service category in the CARE
Act and was authorized for inclusion within the CARE Act for the first
time in the 2006 CARE Act reauthorization. It additionally funds other
programs throughout HHS. AIDS Action and the HIV/AIDS community request
a total of $610 million for the Minority AIDS Initiative.
The Housing Opportunities for People with AIDS (HOPWA) program,
administered by the U.S. Department of Housing and Urban Development
(HUD), is another integral program in the HIV care system. Stable
housing is absolutely critical to the ability of people living with HIV
to access and adhere to an effective HIV treatment plan. Stable housing
plays a key role in HIV prevention; lack of housing is a known risk
factor for HIV. Although HOPWA is not part of the Labor, Health and
Human Services Appropriations bill, AIDS Action urges all
Appropriations Committee members to support this critical program. AIDS
Action requests that $454,000,000 should be appropriated to the HOPWA
program for fiscal year 2008.
According to CDC estimates contained in the agency's December 2005
HIV/AIDS Surveillance Report, 956,019 cumulative cases of AIDS have
been diagnosed in the United States, with a total of 518,037 deaths
since the beginning of the epidemic. As funding has remained
essentially flat for more than 6 years, new infections also have
stubbornly remained at the level of 40,000 per year. Dr. David
Holtgrave, chair of the Johns Hopkins Bloomberg School Department of
Health, Behavior and Society, has convincingly shown that there is a
strong correlation between the lack of funding increases and the
failure to reduce the number of new HIV infections. Therefore, AIDS
Action Council estimates that the CDC HIV/AIDS, STD, and TB prevention
programs will need $1,597.3 million in fiscal year 2008 to address the
true unmet needs of prevention in HIV/AIDS, STDs, and TB.
Research on preventing, treating and ultimately curing HIV is vital
to the domestic control of the disease. The United States must continue
to take the lead in the research and development of new medicines to
treat current and future strains of HIV. Primary prevention of new HIV
infections must remain a high priority in the field of research. It is
essential that NIH continues its groundbreaking research to secure a
prevention vaccine and continue to research promising treatment
vaccines that may help HIV positive people maintain optimal health.
Research on microbicides [gels, creams or other substances that prevent
the sexual transmission of HIV and other sexually transmitted
infections (STIs) when applied topically] for vaginal and anal sexual
intercourse is also critical. Continued research on new medications for
drug resistant strains of HIV is also critical. Finally, behavioral
research to increase knowledge of sexual behavior and research to help
individuals delay the initiation of sexual relations, limit the number
of sexual partners, limit high-risk behaviors related to alcohol and
substance use and move from drug use to drug treatment are all
critically important. NIH's Office of AIDS Research is critical in
supporting all of these research arenas. AIDS Action requests that the
National Institutes of Health AIDS portfolio be funded at $3.2 billion
for fiscal year 2008 an increase of $300 million over fiscal year 2007.
HIV is a continuing health crisis in the United States. On behalf
of all HIV positive Americans, and those affected by the disease, AIDS
Action Council urges you to increase funding in each of these areas of
the domestic HIV/AIDS portfolio. Help us save lives by allocating
increased funds to address the HIV epidemic in the United States.
______
Prepared Statement of the Alpha-1 Foundation
Agency Recommendations:
1. NIH: The Alpha-1 Foundation requests an allocation in the budget
to enable the NIH, NHLBI to focus additional research leading to a
better understanding of Alpha-1, including improved management and
therapeutic approaches. The Foundation observes that much can be
learned by studying the biology of Alpha-1, a human model of
environment-gene interaction, which will inform Chronic Obstructive
Pulmonary Disease (COPD) and liver cirrhosis, both of which are major
public health concerns. The Foundation requests cooperation between
NHLBI, NIDDK, NHGRI, and other institutes to enhance targeted
detection, raise public awareness about Alpha-1 and provide appropriate
information to health professionals. The Foundation recommends
achieving these goals through use of the NHLBI Rare Lung Diseases
Consortium and the COPD Clinical Research Network.
2. NIH: The Foundation commends NHLBI for their national launch of
the COPD Awareness and Education Campaign titled ``COPD Learn More
Breathe Better'' and recommends that NHLBI continue to enhance its
portfolio of research and education on the fourth leading cause of
death in the United States, Chronic Obstructive Pulmonary Disease
(COPD), including genetic risk factors such as Alpha-1 Antitrypsin
Deficiency.
3. NIH: The Alpha-1 Foundation notes that the severe adult-onset
lung disease caused by Alpha-1 stems directly from the protein
secretion abnormality in the livers and lungs of affected individuals.
Alpha-1 has also been shown to be a risk factor for hepatitis C and B
infection. The Foundation requests that NIDDK collaborate with NHLBI,
NCI and other institutes to enhance its research portfolio, encourage
detection, raise public awareness and provide appropriate information
to health professionals. The Foundation encourages the use of the NIDDK
Cholestatic Liver Disease Consortium to achieve these goals.
4. NIH: The Foundation notes that given the link between
environmental factors and the onset of Alpha-1 related COPD, the
committee encourages NIEHS to develop research initiatives to explore
gene environment interaction research and develop support for public
private partnerships.
5. CDC: The Foundation requests that CDC develop a program to
promote early detection of Alpha-1 so that individuals can engage in
preventative health measures and receive appropriate therapies which
significantly improve their health status. The Foundation requests a
public private partnership to actively support Alpha-1 targeted
detection efforts that utilize public and professional education
regarding chronic obstructive lung disease, both genetic and tobacco
related.
DISCLOSURE
Title: Rare Lung Disease Clinical Research Network Grant #1 U54
RR019498-01
Principal Investigator: Bruce C. Trapnell, M.D., University of
Cincinnati Medical School
Dates: 09/01/03 through 08/31/08
Total Costs--$5,520,790
The Foundation receives a small percentage of this grant as the
coordinating center.
Thank you for the opportunity to submit testimony for the record on
behalf of the Alpha-1 Foundation.
the alpha-1 foundation
The Alpha-1 Foundation is a national not-for-profit organization
dedicated to providing the leadership and resources that will result in
increased research, improved health, worldwide detection and a cure for
Alpha-1 Antitrypsin (Alpha-1) Deficiency. The Foundation has built the
research infrastructure with private investment, funding over
$28,000,000 in grants from basic to social science, establishing a
national patient registry, tissue and Biobank, translational
laboratory, assisting in fast track development of new therapeutics,
and stimulating the involvement of the scientific community. The
Foundation has invested the resources to support clinical research
uniquely positioning ourselves for a perfect private public
partnership. There is a lack of awareness of the insidious nature of
the early symptoms of the lung and liver disease associated with this
genetic condition by both medical care providers and the public. It is
our hope that the Federal Government will leverage the Foundation's
investment with support for a national Alpha-1 targeted detection
program.
ALPHA-1 IS SERIOUS AND LIFE THREATENING
Alpha-1 is the leading genetic risk factor for Chronic Obstructive
Pulmonary Disease (COPD) and is often misdiagnosed as such. Alpha-1
afflicts an estimated 100,000 individuals in the United States with
fewer than 5 percent accurately diagnosed. These are people who know
they are sick and as yet have not put a name to their malady. Although
Alpha-1 testing is recommended for those with COPD this standard of
care is not being implemented. In addition, an estimated 20 million
Americans are the undetected carriers of the Alpha-1 gene and may pass
the gene on to their children. Of these 20 million carriers, 7-8
million may be at risk for lung or liver disease.
The pulmonary impairment of Alpha-1 causes disability and loss of
employment during the prime of life (20-40 years old), frequent
hospitalizations, family disorganization, and the suffering known only
to those unable to catch their breath. Fully half of those diagnosed
require supplemental oxygen. Lung transplantation, with all its
associated risks and costs, is the most common final option. Alpha-1 is
the primary cause of liver transplantation in infants and an increasing
cause in adults. Alpha-1 liver disease currently has no specific
treatment aside from transplantation. The cost to these families in
time, energy and money is high and often devastating. Alpha-1 also
causes liver cancer.
Alpha-1 is a progressive and devastating disorder that in the
absence of proper diagnosis and therapy leads to premature death; in
spite of the availability of therapeutics for lung disease and
preventative health measures that can be life-prolonging. It is
estimated that untreated individuals can have their life expectancy
foreshortened by 20 or more years. Yet early detection, the avoidance
of environmental risk factors and pulmonary rehabilitation can
significantly improve health.
ALPHA-1 AND COPD
As the forth leading cause of death, COPD is a major public health
concern. Data indicates that not all individuals who smoke develop lung
disease leading many to conclude that COPD has significant genetic and
environmental risk factors. As the most significant genetic risk factor
for COPD, Alpha-1 has much to tell us about the pathogenesis of lung
disease. Discoveries and advances made in Alpha-1 will impact the
larger 12-24 million individuals living with COPD.
DETECTION
The Alpha-1 Foundation conducted a pilot program in the State of
Florida where we garnered the knowledge and experience necessary to
launch an awareness and National Targeted Detection Program (NTDP). The
goals of the NTDP are to educate the medical community and people with
COPD and liver disease, alerting them that Alpha-1 may be an underlying
factor of their disease; and stimulating testing for Alpha-1. This
effort will uncover a significant number of people who would benefit
from early diagnosis, treatment and preventative health measures.
The Foundation distributes the American Thoracic Society/European
Respiratory Society (ATS/ERS) ``Standards for the Diagnosis and
Management of Individuals with Alpha-1 Antitrypsin Deficiency'' to
physicians, nurses and respiratory therapists. Additionally, health
care practitioners and the COPD community are being targeted through
press releases, newsletter articles and various website postings.
The national implementation of the NTDP is enhanced through the 7
Clinical Resource Network Centers of the National Heart, Lung, Blood
Institute of the National Institutes of Health; 51 Foundation
affiliated Clinical Resource Centers; large pulmonary practices and
various teaching hospitals and universities. The NTDP also employs a
direct to consumer approach targeted to people with COPD.
The Alpha-1 Foundation's Ethical Legal and Social Issues (ELSI)
Working Group endorsed the recommendations of the ATS/ERS Standards
Document which recommends testing symptomatic individuals or siblings
of those who are diagnosed with Alpha-1. Early diagnosis in Alpha-1 can
significantly impact disease outcomes by allowing individuals to seek
appropriate therapies, and engage in essential life planning.
Unfortunately, seeking a genetic test may lead to discrimination
against individuals who have no control over their inherited condition.
The absence of Federal protective legislation has caused the ELSI to
recommend against population screening and genetic testing in the
neonatal population. The Foundation is encouraged that the House has
passed the Genetic Information Nondiscrimination Act of 2007 out of
committee and may soon take this measure up on the House floor.
The Alpha-1 Coded Testing (ACT) Trial, funded by the Alpha-1
Foundation and conducted at the Medical University of South Carolina
offers a free and confidential finger-stick test that can be completed
at home. The results are mailed directly to the participants. The ACT
Trial has offered individuals the opportunity to receive confidential
test results since September 2001.
ALPHA-1 RESEARCH
The Alpha-1 Foundation believes that significant Federal investment
in medical research is critical to improving the health of the American
people and specifically those affected with Alpha-1. The support of
this subcommittee has made a substantial difference in improving the
public's health and well-being.
The Foundation requests that the National Institutes of Health
increase the investment in Alpha-1 Antitrypsin (AAT) Deficiency and
that the Centers for Disease Control and Prevention initiate a Federal
partnership with the Alpha-1 community to achieve the following goals:
--Promotion of basic science and clinical research related to the AAT
protein and AAT Deficiency;
--Funding to attract and train the best young clinicians for the care
of individuals with AAT Deficiency;
--Support for outstanding established scientists to work on problems
within the field of AAT research;
--Development of effective therapies for the clinical manifestations
of AAT Deficiency;
--Expansion of awareness and targeted detection to promote early
diagnosis and treatment.
______
Prepared Statement of the Alzheimer's Association
Chairman Harkin, ranking member Specter and members of the
subcommittee, thank you for the opportunity to submit testimony
regarding funding for key programs that address the enormous
demographic and economic impact that Alzheimer's disease presents to
our society.
Last month, the Alzheimer's Association released a comprehensive
report indicating that Alzheimer's is much more pervasive than we
thought. The report confirms that more than 5 million people in the
United States are living with Alzheimer's disease today, including
200,000 or more under the age of 65. This is a 10 percent increase from
previous estimates, but it is only the tip of the iceberg. By mid-
century, as many as 16 million Americans will have the disease. We will
see half a million new cases of Alzheimer's this year alone. That means
someone in America is developing Alzheimer's disease every 72 seconds!
The report also sheds new light on dramatic shift in mortality
among Americans. A diagnosis of Alzheimer's is a death sentence and
death rates for Alzheimer's a rising dramatically, up nearly 33 percent
in just 4 years while other leading causes of death--heart disease,
stroke, breast and prostate cancer--are declining. Alzheimer's is the
seventh leading cause of death for people of all ages and the fifth
leading cause of death for people age 65 and older. The absence of
effective disease modifying drugs, coupled with the aging of the baby
boomers, makes Alzheimer's the health care crisis of the 21st century.
Alzheimer's already costs the Nation $148 billion a year. Medicare
alone spent $91 billion on beneficiaries with the disease in 2005 and
Medicaid spent another $21 billion. By 2015 those two programs will be
spending more than $210 billion just on people with Alzheimer's. The
disease is also overwhelming health and long term care systems: 25
percent of elderly hospital patients, 47 percent of nursing home
residents, and at least 50 percent of people in assisted living and
adult day care have Alzheimer's or another dementia.
The impact of Alzheimer's on American families is just as
devastating. Today at least 10 million family members provide unpaid
care. In Iowa, these caregivers are providing nearly 81 million hours
of care a year; in Pennsylvania, almost 375 million hours. Nationwide,
the work Alzheimer caregivers are doing is valued at nearly $83 billion
and consumes 8.5 billion hours annually.
Alzheimer's disease is exploding into an epidemic that will
undermine all of our best efforts to control health care costs, assure
access to quality care, and protect the retirement security of
generations to come. This is the reality of Alzheimer's disease. It is
not a pretty picture. But it is a picture that we can change. Today,
there is real hope that we can get Alzheimer's under control, that we
will find the ways to prevent millions from ever getting the disease,
and that for those who do get it; we can change it from a death
sentence to a manageable chronic illness.
Today, the Alzheimer research community can report genuine,
tangible, quantifiable hope for effective prevention and treatment of
Alzheimer's disease. Within the next 3 years, it is very likely that we
will have disease-modifying drugs that could fundamentally change the
nature of Alzheimer's. If we succeed, for millions of Americans, a
diagnosis of Alzheimer's disease will no longer be a death sentence but
the beginning of a manageable chronic illness.
The drugs being tested are very different from the ones now on the
market. Current drugs treat the symptoms of Alzheimer's but leave the
underlying disease untouched. While they do help some patients
temporarily, the predictable progression to death continues along the
cruel path we know too well. The new drugs are designed to attack the
disease directly. Results to date are very encouraging. These drugs are
safe. Patients tolerate them well. And they appear to show significant
positive impact, slowing the progression of the disease. Higher doses
or combination drugs might arrest the process completely. One of the
drugs currently in clinical trials could go to the Food and Drug
Administration for review as early as this fall.
The other exciting news is that scientists are rapidly gaining
knowledge about genetic and other risk factors of Alzheimer's disease,
and developing techniques to detect early changes in the brain well
before symptoms appear. These discoveries will let the medical
community identify persons at risk of Alzheimer's, diagnose pre-
symptomatic disease, and begin treatment in time to prevent development
of dementia altogether.
All of this good news is the direct result of your decision to
double funding for the National Institutes of Health. The influx of
resources moved Alzheimer research from a backwater of obscurity to
perhaps the single most visible, most competitive, and most exciting
field in the neurosciences. This is the key to drug discovery. Drug
development does not start or end with pharmaceutical companies. It
begins at NIH-funded laboratories at academic health centers, where
scientists uncover the molecular basis of disease, identify treatment
strategies, and develop the research methods and techniques that make
clinical investigation possible. Clinical trials depend on the
expertise of NIH-funded investigators, and many require direct NIH
funding because the drugs under investigation are not protected by
patent.
The emphasis on the fundamental role of NIH funding is critical
because there is still so much work to be done. We are right to be
excited about treatments that attack the amyloid plaques, one of the
primary hallmarks of Alzheimer's disease. But they will not likely be
the complete answer. Like cancer and heart disease, Alzheimer's is a
complex puzzle. Solving it will involve multiple strategies. There are
already a number of other potential targets for intervention--including
the chemical basis of the tangles in the brain that are the other
hallmark of Alzheimer's, the relationship between heart and vascular
disease and Alzheimer's, the connection to Type 2 diabetes, the role of
nerve growth factors, and the interaction of environment, life style
choices, and genetics in the development of disease.
If science can validate the prevailing wisdom about amyloid, and if
researchers can refine these other theories, then every major
pharmaceutical company will begin bringing new drugs into human
clinical trials. That will not happen, however, unless Congress
provides the funds to sustain the Alzheimer research enterprise.
Despite its devastating consequences, research on Alzheimer's disease
remains seriously under-funded.
In 2003, annual NIH funding of Alzheimer research peaked at $658
million. The scientific community is living off the results of that
investment, but we now risk losing that momentum. Since 2003, there has
been a slow, steady decline in funding--down to $643 million this year
and even less if Congress approves the President's fiscal 2008 budget
request. In constant dollars, the drop is devastating--a 14 percent
decline in overall funding at the National Institute on Aging (NIA)
alone.
This is happening at a time when the scientific opportunities have
never been greater. There are more highly promising avenues of inquiry
to explore than ever before. And researchers now have research tools at
their disposal, involving genetics and imaging, that can help get
better, quicker answers. But scientists cannot use those tools without
adding funds to existing projects.
The slow down in funding is already having an impact in the
Alzheimer research community. NIA is funding less than 18 percent of
the most highly rated investigator-initiated projects it receives--down
from a 30 percent success rate in 2003. What is more, the first-year
grants that are awarded are funded at 18 percent below the level
recommended by NIA's own independent review panels. There are no
inflationary adjustments in the out-years or for existing projects.
This means that most scientific opportunities are left on the table,
and the successful ones are being seriously under-funded. It also means
that some of the most promising clinical trials--the way to translate
basic research findings into effective treatments--will be delayed or
scrapped altogether. Conversations within the Alzheimer research
community confirm that we are at risk of losing a generation of
scientists, young investigators who are either choosing less
traditional careers or are leaving research altogether. These brilliant
minds are our greatest resource, and we should be applying them to our
most difficult problems. Only money will bring them back.
These budget cuts are not just killing research projects. They are
killing the minds of millions of Americans. And they are killing our
chances of getting health care spending under control. If we let the
disease continue on its current trajectory, in less than 25 years
Medicare will be spending almost $400 billion on 10 percent of its
beneficiaries--those with Alzheimer's. That is almost as much as we are
spending in the entire Medicare program for all beneficiaries today.
We can cut that spending dramatically--saving over $50 billion
annually--within just 5 years of even modest breakthroughs that would
delay the onset of Alzheimer's and slow its progression. And we can
also save millions of families from devastation. Within 20 years of a
breakthrough, there would be 3.7 million fewer cases of Alzheimer's in
the United States than there are today--in spite of the rapid aging of
the baby boomers. And among those who would still develop the disease,
most would never progress beyond the mild stages of the disease and
could continue to live productively with their families in the
community.
We cannot win this fight against Alzheimer's without an all-out
commitment from Congress and from every relevant part of the Federal
Government--especially NIH and the Food and Drug Administration (FDA).
The Alzheimer's Association is working closely with all these agencies
to maximize our mutual efforts within the limits imposed by existing
law and resources. We are proud of our longstanding partnership with
the National Institute on Aging and the tremendous commitment of Dr.
Richard Hodes and his dedicated staff. We are also gratified by the
response of the Food and Drug Administration to our Effective
Treatments Initiative, to increase its focus on Alzheimer's and to
bring patients and caregivers into the drug review process.
Mr. Chairman and subcommittee members--we are in a race against
time. With every year that passes, we risk losing that race. The
Alzheimer's Association respectfully requests that you provide
sufficient resources for NIH in the fiscal year 2008 Labor/HHS/
Education Appropriations bill so that funding for Alzheimer research
can be increased by $125 million. The Association also seeks continued
support for proven programs that are serving hundreds of thousands of
Alzheimer families, including $1 million for the 24/7 Alzheimer's Call
Center and $12 million for the Alzheimer's Disease Matching Grants to
States Program administered by the Administration on Aging. Services
provided by the Call Center include access to professional clinicians
who provide decision-making support, crisis assistance and education on
issues caregivers face every day. The Call Center also provides
referrals to local community programs and services. The Alzheimer's
Disease Matching Grants to States Program provides funds to States for
the development of innovative and cost effective programs that
influence broader healthcare systems and provide community-based
services for those with Alzheimer's and their caregivers. The program
has a special emphasis on reaching hard-to-reach and underserved people
such as minorities, low income persons, and those living in rural/
frontier communities. 38 States, including Iowa, are currently
participating in the program.
In addition, we urge you to increase funding for the Centers for
Disease Control & Prevention (CDC) Brain Health Initiative to $3
million. Since fiscal year 2005, Congress has provided approximately
$1.6 million annually to the CDC to develop and implement the first
single-focused effort on brain health promotion. As a result of this
initial support, the CDC and the Alzheimer's Association have begun
collaborating on a multi-faceted approach to brain health that includes
both programmatic and public health research components. This
Initiative is currently focused on four primary activities: development
of a Roadmap to Maintaining Cognitive Health, implementation of
community demonstration programs, creation of communication linkages
with the public, and elevation of brain health research. Increasing
support for this Initiative to $3 million would allow for broader
dissemination of the Roadmap to Maintaining Cognitive Health, provide
funds to expand the community demonstration projects to other high
risk, underserved populations, specifically the Hispanic/Latino
population and support the development of a strategic initiative for
early detection and secondary prevention of Alzheimer's disease,
including consideration of appropriate screening/diagnostic tools,
needed education strategies, and appropriate follow up to diagnosis.
We urge Congress to add the funding we need to break through the
finish line ahead of the baby boomers who are nipping at our heels. The
funding for Alzheimer research and care programs that we seek requires
a modest investment in total Federal budget terms but it has the
potential for enormous returns--in reduced health and long-term care
costs to Federal and State budgets and in improved quality of life for
millions of American families.
Thank you again for the opportunity to submit this testimony for
the record.
______
Prepared Statement of the American Academy of Family Physicians
The 93,800 members of the American Academy of Family Physicians are
grateful for this opportunity to submit for the record our
recommendations for Federal fiscal year 2008 to the Senate
Appropriations Subcommittee on Labor, Health and Human Services, and
Education.
The American Academy of Family Physicians (AAFP) is one of the
largest national medical organizations, representing family physicians,
family medicine residents, and medical students nationwide. Founded in
1947, our mission has been to preserve and promote the science and art
of family medicine and to ensure high-quality, cost-effective health
care for patients of all ages. We believe that Federal spending policy
can help to transform health care to achieve optimal health for
everyone.
We recommend that, as an essential part of that policy, the fiscal
year 2008 Appropriations bill to fund the Departments of Labor, Health
and Human Services and Education should restore funding for health
professions training programs, increase our investment in the Agency
for Healthcare Research and Quality and continue support for rural
health programs.
health resources & services administration--health professions
For the last 40 years, the health professions training programs
authorized under Title VII of the Public Health Services Act have
evolved in order to meet our Nation's changing health care workforce
needs.
Section 747 of Title VII, the Primary Care Medicine and Dentistry
Cluster, is aimed at increasing the number of primary care physicians
(family physicians, general internists and pediatricians) as well as
the number of highly-skilled health care professionals to provide care
to the underserved. Section 747 offers competitive grants for family
medicine training programs in medical schools and in residency
programs.
The value of these grants extends far beyond the medical schools
that receive them. The United States lags behind other countries in its
focus on primary care. However, the evidence shows that countries with
primary care-based health systems have population health outcomes that
are better than those of the United States at lower costs.\1\ Health
Professions Grants are one important tool to help refocus this Nation's
health system on primary care.
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\1\ Starfield B, et al. The effects of specialist supply on
populations' health: assessing the evidence. Health Affairs. 15 March
2005.
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Disease Prevention
First of all, Federal support of Title VII, section 747 for primary
care training is critical to increase the number of family physicians
whose specialty emphasizes a broad range of skills in caring for the
whole patient regardless of age, gender or medical condition. Primary
care provided by family physicians looks to a patient's total health
needs and is strongly oriented toward preventing illness and injury.
Chronic Care Management
Second, primary care is ideally suited to managing chronic disease.
Regrettably, nearly one in five Americans lacks access to primary
medical care for regular and on-going care. A recent study ``found 56
million Americans of all income levels, race and ethnicity, and
insurance status have inadequate access to a primary care physician due
to shortages of these physicians in their communities.'' \2\
---------------------------------------------------------------------------
\2\ National Association of Community Health Centers, The Robert
Graham Center. Access Denied: A Look at America's Medically
Disenfranchised. March 2007.
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Lower Costs
Americans with a ``medical home'' to provide primary care for such
basic needs as treating ear infections, controlling high blood
pressure, or managing diabetes have better health outcomes at a lower
cost of care.\3\ Without adequate numbers and distribution of primary
care physicians, we cannot provide the quality of preventive care
designed to avoid costlier services in hospital emergency departments.
---------------------------------------------------------------------------
\3\ Ibid.
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Primary Care Physician Shortages
Support for family medicine training programs is needed to address
insufficient access to primary care services which is caused by both an
overall shortage and an uneven distribution of physicians. Family
medicine is a critical part of the solution to providing high-quality,
affordable and accessible health care to everyone.
On March 15, 2007, the annual National Resident Matching Program
announced results showing the number of medical students choosing
careers in family medicine remains stagnant, raising concerns the
primary care physician workforce will not be adequate to meet the needs
of an aging population with an increased prevalence of chronic disease.
The AAFP's 2006 Family Physician Workforce Reform report called for
a workforce of 139,531 family physicians, or a ratio of 41.6 family
physicians per 100,000 U.S. population by 2020. To meet that demand,
our medical education system must produce 4,439 new family physicians
annually.
In the 2007 National Resident Matching Program 2,313 applicants
matched to family medicine residency positions compared with 2,318 in
2006. Also down was the total number and percentage of U.S. students
who match to family medicine: 1,107 or 7.8 percent of participating
U.S. graduates matched to family medicine this year, compared to 1,132
or 8.1 percent in 2006. This year, there were 106 fewer family medicine
residency positions offered than in 2006.
Last fall, the AAFP Congress of Delegates, in recognition of the
need for more family physicians to meet the escalating health care
needs of the American people, called for preferential funding for
section 747 as well as those training programs that produce physicians
from underrepresented minorities, or those whose graduates practice in
underserved communities or serve rural and inner-city populations.
In opposition to funding for Health Professions Grants, the
administration cited an Office of Management and Budget 2002 Program
Assessment Rating Tool (PART) assessment of Title VII that called the
program ineffective. In fact, data show that medical schools and
primary care residency programs funded by Title VII section 747 do
disproportionately serve as the medical education pipeline that
produces physicians who go on to work in Community Health Centers and
participate in the National Health Service Corps to treat underserved
populations.\4\
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\4\ University of California, San Francisco.
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In order to achieve a valid OMB PART analysis, the Health
Professions program must be given clear goals and objectives. The
Advisory Committee on Training in Primary Care Medicine and Dentistry
called for by the Health Professions Education Partnership Act of 1998
has proposed steps to clarify, in the authorizing law, the purpose and
objectives of Title VII, section 747. AAFP is working with the
authorizing committees to ensure that the reauthorization addresses
these recommendations.
Although the Title VII programs intended to support the preparation
of an effective, diverse primary care workforce have been repeatedly
targeted for elimination in Presidential budget requests, the committee
has provided appropriations for these important accounts. The final
spending resolution for fiscal year 2007 provided $184.75 million, a
27.2 percent increase above the fiscal year 2006 level for all of Title
VII. The Primary Medicine and Dentistry Cluster, section 747, received
an increase of 19.6 percent from the fiscal year 2006 level to $48.85
million. However, this level falls far short of the appropriation of
$92 million provided in fiscal year 2003.
The AAFP is committed to a high level of support for education in
family medicine residency programs and family medicine departments and
divisions in medical schools.
We hope that the committee will make an adequate investment in a
well-prepared primary care workforce in order to provide improved
health care at a reduced cost.
AAFP recommends an increase in the fiscal year 2008 appropriation
bill for the Health Professions Training Programs authorized under
Title VII of the Public Health Services Act. We respectfully suggest
that the committee provide at least $300 million for Title VII,
including $92 million for the section 747, the Primary Care Medicine
and Dentistry Cluster, which will restore this vital program to its
fiscal year 2003 level.
AGENCY FOR HEALTHCARE RESEARCH AND QUALITY
The mission of the Agency for Healthcare Research and Quality
(AHRQ)--to improve the quality, safety, efficiency, and effectiveness
of health care for all Americans--closely mirrors AAFP's own mission.
AHRQ has a unique responsibility for research to inform decision-making
and improve clinical care. In addition to AHRQ's charge to evaluate
health care practice cost-effectiveness, the agency is engaged in the
effort to advance personalized health care with the Health Information
Technology Initiative.
Health Information Technology
The initial work by AHRQ to facilitate the adoption of health
information technology is important to improve patient safety by
reducing medical errors and to avoid costly duplication of services.
AAFP recognizes that health information technology, used effectively,
can transform health care. It is vital that AHRQ, as the lead Federal
agency, have the necessary resources to promote standards for
portability and interoperability which ensure that health data is
appropriately available and privacy protected.
Comparative Clinical Effectiveness Research
According to the Centers for Medicare and Medicaid Services'
National Health Statistics Group, health care spending will double to
$4.1 trillion and account for 20 percent of every dollar spent by 2016.
Our Nation must invest in the study of health care practice in order to
improve outcomes and minimize unnecessary costs. One important tool to
accomplish this is AHRQ's analysis of clinical effectiveness and
appropriateness of health services and treatments. This practical
research will improve Federal programs such as Medicare, Medicaid and
SCHIP as well as privately-financed health care.
AAFP recommends an increase in the fiscal year 2008 appropriation
bill for the Agency for Healthcare Research and Quality (AHRQ). We
respectfully suggest that the committee provide at least $350 million
for AHRQ, an increase of $31 million above the fiscal year 2007 level.
RURAL HEALTH PROGRAMS
Family physicians provide the majority of care for America's
underserved and rural populations.\5\ Despite efforts to meet
shortages in rural areas, there continues to be a shortage of
physicians. Studies, whether they be based on the demand to hire
physicians by hospitals and physician groups or based on the number of
individuals per physician in a rural area, all indicate a need for
additional physicians in rural areas. Continued funding for rural
programs is vital to provide adequate health care services to America's
rural citizens. We support the Federal Office of Rural Health Policy;
Area Health Education Centers; the Community and Migrant Health Center
Program; and the NHSC. State rural health offices, funded through the
National Health Services Corps budget, help States implement these
programs so that rural residents benefit as much as urban patients.
---------------------------------------------------------------------------
\5\ U.S. Department of Health and Human Services, Centers for
Disease Control and Prevention, National Center for Health Statistics,
Division of Data Services. National ambulatory medical care survey.
---------------------------------------------------------------------------
______
Prepared Statement of the American Academy of Pediatrics
This statement is endorsed by: Ambulatory Pediatric Association and
Society for Adolescent Medicine.
There can be no denying that there have been numerous and
significant successes in improving the health and well-being of
America's children and adolescents, from even just decades ago. Infant
and child mortality rates have been radically lowered. The number of 2-
year-olds who have received the recommended series of immunizations is
at an all-time high, while vaccine-preventable diseases such as
measles, pertussis, and diphtheria have decreased by over 98 percent.
Teen pregnancy rates have declined by 28 percent over the last decade.
Still, despite these successes, far too many children and adolescents
in America continue to suffer from disease, injury, abuse, racial and
ethnic health disparities, or lack of access to quality care. In
addition, more than 9 million children and adolescents through the age
18 remain uninsured. Clearly there remains much work to do.
As clinicians we not only diagnose and treat our patients, we must
also promote strong preventive interventions to improve the overall
health and well-being of all infants, children, adolescents and young
adults. The AAP, SAM and APA have identified three key priorities
within this committee's jurisdiction that are at the heart of improving
the health and well-being of America's children and adolescents: access
to health care, quality of health care, and immunizations. A chart at
the end of this statement will offer funding recommendations for other
programs of importance to the child and adolescent community.
ACCESS
We believe that all children, adolescents and young adults should
have full access to comprehensive, age-appropriate, quality health
care. From the ability to receive primary care from a pediatrician
trained in the unique needs of children and adolescents, to timely
access, to pediatric medical subspecialists and pediatric surgical
specialists, America's children and adolescents deserve access to
quality pediatric care in a medical home. Given the recent cuts to the
Medicaid program and fiscal belt-tightening in the States,
discretionary programs now more than ever provide a vital health care
safety net for America's most vulnerable children and youth.
Maternal and Child Health Block Grant.--The Maternal and Child
Health (MCH) Block Grant Program at the Health Resources and Services
Administration (HRSA) is the only Federal program exclusively dedicated
to improving the health of all mothers and children. Nationwide, the
MCH Block Grant Program provides preventive and primary care services
to over 32 million women, infants, children, adolescents and children
with special health care needs. In addition, the MCH Block Grant
Program supports community programs around the country in their efforts
to reduce infant mortality, prevent injury and violence, expand access
to oral health care, and address racial and ethnic health disparities.
Moreover, the MCH Block Grant Program includes efforts dedicated to
addressing interdisciplinary training, services and research for
adolescents' physical and mental health care needs, and supports
programs for vulnerable adolescent populations, including health care
initiatives for incarcerated and minority adolescents, and violence and
suicide prevention. It also plays an important role in the
implementation of the State Children's Health Insurance Program
(SCHIP). One of the many successful MCH Block Grant programs is the
Healthy Tomorrows Partnership for Children Program, a public/private
collaboration between the MCH Bureau and the American Academy of
Pediatrics. Established in 1989, Healthy Tomorrows has supported over
150 family-centered, community-based initiatives in almost all States,
including Ohio, Wisconsin, New York, California, Rhode Island, and
Maryland. These initiatives have addressed issues such as access to
oral and mental health care, obesity, injury prevention, and enhanced
clinical services for chronic conditions such as asthma. To continue to
foster these and other community-based solutions for local health
problems, in fiscal year 2008 we strongly support an increase in
funding for the MCH Block Grant Program to $750 million.
Family Planning Services.--The family planning program, Title X of
the Public Health Services Act, ensures that all teens have
confidential access to valuable family planning resources. For every
dollar spent on family planning through Title X, $3 is saved in
pregnancy-related and newborn care costs to Medicaid. Title X--which
does not provide funding for abortion services--provides critically
needed preventive care services like pap tests, breast exams, and STI
tests to millions of adolescents and women. But over 9.5 million cases
of sexually transmitted infection (STIs) (almost half the total number)
are in 15-24 year olds, and over 30 percent of women will become
pregnant at least once before age 20. Teen pregnancy rates continue to
vary between racial and ethnic groups, and nearly half (48 percent) of
all teens say that they want more information from--and increased
access to--sexual health care services. Responsible sexual decision-
making, beginning with abstinence, is the surest way to protect against
sexually transmitted infections and pregnancy. However, for adolescent
patients who are already sexually active, confidential contraceptive
services, screening and prevention strategies should be available. We
therefore support a funding level in fiscal year 2008 of $385 million
for Title X of the Public Health Service Act.
Mental Health.--It is estimated that over 13 million children and
adolescents have a mental health problem such as depression, ADHD, or
an eating disorder, and for as many as 6 million this problem may be
significant enough to impact school attendance, interrupt social
interactions, and disrupt family life. Despite these statistics, the
National Institute of Mental Health (NIMH) estimates that 75-80 percent
of these children fail to receive mental health specialty services, due
to stigma and the lack of affordability of care and availability of
specialists. Grants through the Children's Mental Health Services
program have been instrumental in achieving decreased utilization of
inpatient services, improvement in school attendance and lower law
enforcement contact for children and adolescents. We recommend that
$112 million be allocated in fiscal year 2008 for the Mental Health
Services for Children program to continue these improvements for
children and adolescents with mental health problems.
Child Abuse and Neglect.--Recent research from the CDC's Adverse
Childhood Experiences study and others demonstrates that childhood
trauma may contribute significantly to the development of numerous
adult health conditions, including alcoholism, drug abuse, heart
disease and more. However, few Federal resources are dedicated to
bringing the medical profession into full partnership with law
enforcement, the judiciary, and social workers, in preventing,
detecting, and treating child abuse and neglect. We urge the
subcommittee to provide an increase of $10 million in fiscal year 2008
for the Center for Disease Control and Prevention's National Center for
Injury Prevention and Control to establish a network of consortia to
link and leverage health care professionals and resources to address--
and ultimately prevent--child maltreatment. We also support the
recommendation of the National Child Abuse Coalition to fund the Child
Abuse Prevention and Treatment Act program at $200 million.
Health Professions Education and Training.--Critical to building a
pediatric workforce to care for tomorrow's children and adolescents are
the Training Grants in Primary Care Medicine and Dentistry, found in
Title VII of the Public Health Service Act. These grants are the only
Federal support targeted to the training of primary care professionals.
They provide funding for innovative pediatric residency training,
faculty development and post-doctoral programs throughout the country.
For example, a pediatrician in New Jersey stated the following:
``Reduction in Title VII funding would negatively impact all areas of
our current activities, including recruitment of under-represented
minority trainees and faculty, cultural competency initiatives,
clinical experiences for aspiring health professionals and patient care
for thousands of underserved urban infants, children and adolescents.''
Through the continuing efforts of this subcommittee, Title VII has
provided a vital source of funding for critically important programs
that educate and train tomorrow's generalist pediatricians in a variety
of settings to be culturally competent and to meet the special health
care needs of their communities. We recommend fiscal year 2008 funding
of at least $40 million for General Internal Medicine/General
Pediatrics. We also join with the Health Professions and Nursing
Education Coalition in supporting an appropriation of at least $550
million in total funding for Titles VII and VIII. We support the
administration's increase in funding for Community Health Centers, a
key component with Title VII to ensuring an adequate distribution of
health care providers across the country; but we emphasize the need for
continued support of the training and education opportunities through
Title VII for health care professionals, including pediatricians, who
provide care for our Nation's communities.
Independent Children's Teaching Hospitals.--Equally important to
the future of pediatric education and research is the dilemma faced by
independent children's teaching hospitals. In addition to providing
critical care to the Nation's children, independent children's
hospitals play a significant role in training tomorrow's pediatricians
and pediatric subspecialists. Children's hospitals train 30 percent of
all pediatricians, half of all pediatric subspecialists, and the
majority of pediatric researchers. However, children's hospitals
qualify for very limited Medicare support, the primary source of
funding for graduate medical education in other inpatient environments.
As a bipartisan Congress has recognized in the last several years,
equitable funding for Children's Hospitals Graduate Medical Education
(CHGME) is needed to continue the education and research programs in
these child- and adolescent-centered settings. Since 2000, CHGME
hospitals accounted for nearly 87 percent of the growth in pediatric
subspecialty training programs and 68 percent of the growth in
pediatric subspecialty fellows trained. We are extremely disappointed
in the 63 percent reduction in funding proposed by the administration
for the CHGME program, and join with the National Association of
Children's Hospitals to restore funding to $330 million for the CHGME
program in fiscal year 2007. The support for independent children's
hospitals should not come, however, at the expense of valuable Title
VII and VIII programs, including grant support for primary care
training.
QUALITY
Access to health care is only the first step in protecting the
health of all children and youth. We must ensure that the care provided
is of the highest quality. Robust Federal support for the wide array of
quality improvement initiatives, including research, is needed if this
goal is to be achieved.
Emergency Services for Children.--One program that assists local
communities in providing quality care to children in distress is the
Emergency Medical Services for Children (EMSC) grant program. There are
approximately 30 million child and adolescent visits to the Nation's
emergency departments every year. Children under the age of 3 years
account for most of these visits. Up to 20 percent of children needing
emergency care have underlying medical conditions such as asthma,
diabetes, sickle-cell disease, low birth weight, and bronchopulmonary
dysplasia. In 2006, the Institute of Medicine's report Emergency Care
for Children: Growing Pains acknowledged the many achievements of the
EMSC program in improving pediatric emergency care and recommended that
it be funded at $37.5 million. In order to assist local communities in
providing the best emergency care to children, we once again reject the
administration's proposed elimination of the EMSC program and strongly
urge that the EMSC program be maintained and adequately funded at $25
million in fiscal year 2008
Agency for Healthcare Research and Quality.--Quality of care rests
on quality research--for new detection methods, new treatments, new
technology and new applications of science. As the lead Federal agency
on quality of care research, the Agency for Healthcare Research and
Quality (AHRQ) provides the scientific basis to improve the quality of
care, supports emerging critical issues in health care delivery and
addresses the particular needs of priority populations, such as
children. Substantial gaps still remain in what we know about health
care needs for children and adolescents and how we can best address
those needs. Children are often excluded from research that could
address these issues. The AAP and endorsing organizations strongly
support AHRQ's objective to encourage researchers to include children
and adolescents as part of their research populations. We also support
increasing AHRQ's efforts to build pediatric health services research
capacity through career and faculty development awards and strong
practice-based research networks. Additionally, AHRQ is focusing on
initiatives in community and rural hospitals to reduce medical errors
and to improve patient safety through innovative use of information
technology--an initiative that we hope would include children's
hospitals as well. Through its research and quality agenda, AHRQ
continues to provide policymakers, health care professionals and
patients with critical information needed to improve health care and
health disparities. We join with the Friends of AHRQ to recommend
funding of $350 million for AHRQ in fiscal year 2008.
National Institutes of Health.--Over the years, NIH has made
dramatic strides that directly impact the quality of life for infants,
children and adolescents through biomedical and behavioral research.
For example, NIH research has led to successfully decreasing infant
death rates by over 70 percent, increasing the survival rates from
respiratory distress syndrome, and dramatically reducing the
transmission of HIV from infected mother to fetus and infant from 25
percent to just 1.5 percent. NIH is engaged in a comprehensive research
initiative to address and explain the reasons for a major public health
dilemma--the increasing number of obese and overweight children and
adults in this country. Today U.S. teenagers are more overweight than
young people in many other developed countries. And the Newborn
Screening Initiative is moving forward to improve availability,
accessibility, and quality of genetic tests for rare conditions that
can be uncovered in newborns. The pediatric community applauds the
prior commitment of Congress to maintain adequate funding for the NIH.
We remain concerned, however, that the cumulative effect of several
years of flat funding will stall or even set back the gains that were
made under the years of the NIH's budget doubling. We urge you to begin
to restore the funding lost over these last years. We support the
recommendation of the Ad Hoc Group for Medical Research for a funding
level in fiscal year 2008 of $30.8 billion an increase of 6.7 percent
over the fiscal year 2007 joint resolution for the NIH In addition, to
ensure ongoing and adequate child and adolescent focused research, such
as the National Children's Study (NCS) led by the National Institute
for Child Health and Human Development (NICHD), we join with the
Friends of NICHD Coalition in requesting $1,337.8 billion in fiscal
year 2008. Moreover we recommend that the NCS be adequately funded in
fiscal year 2008 at $110.9 million to allow for the continued
implementation of the NCS and bring us closer to the first results from
this landmark study. We are greatly disappointed by the
administration's failure to include the NCS in its budget proposal
2008. This large longitudinal study, authorized in the Children's
Health Act of 2000, will provide critical research and information on
major causes of childhood illnesses such as premature birth, asthma,
obesity, preventable injury, autism, development delay, mental illness,
and learning disorders.
We commend this committee's ongoing efforts to make pediatric
research a priority at the highest level of the NIH. We urge continued
Federal support of NIH efforts to increase pediatric biomedical and
behavioral research, including such proven programs as targeted
training and education opportunities and loan repayment. We recommend
continued interest in and support for the Pediatric Research Initiative
in the Office of the NIH Director and sufficient funding to continue
the pediatric training grant and pediatric loan repayment programs both
enacted in the Children's Health Act of 2000. This would ensure that we
have adequately trained pediatric researchers in multiple disciplines
that will not come at the expense of other important programs.
Finally, as clinicians, we know first-hand the considerable
benefits for children and society in securing properly studied and
dosed medications. Proper pediatric safety and dosing information
reduces medical errors and adverse events, ultimately improving
children's health and reducing health care costs. But there is little
market incentive for drug companies to study generic or off-patent
drugs--older drugs that are widely used therapies for children. The
Research Fund for the Study of Drugs, created as part of the Best
Pharmaceuticals for Children Act of 2002, provides support for these
critical pediatric testing needs, but unfortunately is currently funded
at an amount sufficient to test only a fraction of the NIH and FDA-
designated ``priority'' drugs. Therefore, we urge the subcommittee to
provide the NIH with sufficient funding to fund the study of generic
(off-patent) drugs for pediatric use.
IMMUNIZATION
Pediatricians, working alongside public health professionals and
other partners, have brought the United States its highest immunization
coverage levels in history--over 92 percent of children received all
vaccinations by school age in 2004-2005. We attribute this, in part, to
the Vaccines for Children (VFC) Program, and encourage Congress to
maintain its commitment to ensuring the program's viability. The VFC
program combines the efforts of public health and private pediatricians
and other health care professionals to accomplish and sustain vaccine
coverage goals for both today's and tomorrow's vaccines. It removes
vaccine cost as a barrier to immunization for some and reinforces the
concept of vaccine delivery in a ``medical home.'' Additional section
317 funding is necessary to provide the pneumococcal conjugate vaccine
(PCV-7), a vaccine that prevents an infection of the brain covering,
blood infections and approximately 7 million ear infections a year, to
those remaining States that currently do not provide it. Increased
section 317 funding also is needed to purchase the influenza vaccine--
now recommended for children between the ages of 6 months and 5 years
of age. This age cohort is increasingly susceptible to serious
infection and the risk of hospitalization. And an increase in funding
is needed to purchase the recently recommended rotavirus vaccine,
tetanus-diptheria-pertussis (Tdap) vaccine for adolescents and the
meningococcal conjugate vaccine (MCV). Meningococcal disease is a
serious illness, caused by bacteria, with 10-15 percent of cases fatal
and another 10-15 percent of cases resulting in permanent hearing loss,
mental retardation, or loss of limbs. And additional funding is
important to provide the HPV vaccine recommended by the ACIP.
The public health infrastructure that now supports our national
immunization efforts must not be jeopardized with insufficient funding.
For example, adolescents continue to be adversely affected by vaccine-
preventable diseases (e.g., chicken pox, hepatitis B, measles and
rubella). Comprehensive adolescent immunization activities at the
national, State, and local levels are needed to achieve national
disease elimination goals. States and communities continue to be
financially strapped and therefore, many continue to divert funds and
health professionals from routine immunization clinics in order to
accommodate anti-bioterrorism initiatives or now pandemic influenza.
Moreover, continued investment in the CDC's immunization activities
must be made to avoid the reoccurrence of childhood vaccine shortages
by providing and adequately funding a national 6 month stockpile for
all routine childhood vaccines--stockpiles of sufficient size to insure
that significant and unexpected interruptions in manufacturing do not
result in shortages for children.
While the ultimate goal of immunizations clearly is eradication of
disease, the immediate goal must be prevention of disease in
individuals or groups. To this end, we strongly believe that CDC's
efforts must be sustained. In fiscal year 2008, we recommend an overall
increase in funding to $802.4 million $257.5 million over the
President's request to ensure that the CDC's National Immunization
Program has the funding necessary to accommodate vaccine price
increases, new disease preventable vaccines coming on the market,
global immunization initiatives--including funds for polio eradication
and the elimination of measles and rubella--and to continue to
implement the recommendations developed by the IOM.
CONCLUSION
We appreciate the opportunity to provide our recommendations for
the coming fiscal year. As this subcommittee is once again faced with
difficult choices and multiple priorities we know that as in the past
years, you will not forget America's children and adolescents.
______
Prepared Statement of the American Academy of Physician Assistants
On behalf of the more than 60,000 clinically practicing physician
assistants in the United States, the American Academy of Physician
Assistants is pleased to submit comments on fiscal year 2008
appropriations for Physician Assistant (PA) educational programs that
are authorized through Title VII of the Public Health Service Act.
A member of the Health Professions and Nursing Education Coalition
(HPNEC), the Academy supports the HPNEC recommendation to provide at
least $300 million for Title VII programs in fiscal year 2008,
including a minimum of $7 million to support PA educational programs.
This would fund the programs at the 2005 funding level, not accounting
for inflation.
The Academy believes that the recommended restoration in funding
for Title VII health professions programs is well justified. A review
of PA graduates from 1990-2004 reveals that graduates from Title VII
supported programs were 67 percent more likely to be from
underrepresented minority backgrounds and 49 percent more likely to
work in a Rural Health Clinic than graduates of programs that weren't
supported by Title VII funding.
Title VII safety net programs are essential to the training of
primary health care professionals and provide increased access to care
by promoting health care delivery in medically underserved communities.
Title VII funding for PA programs is especially important since it is
the only Federal funding available to these programs, on a competitive
application basis.
The Academy is extremely concerned with the administration's
proposal to eliminate funding for most Title VII programs, including
training programs in primary care medicine and dentistry. These
programs are designed to help meet the health care delivery needs of
the Nation's Health Professional Shortage Areas (HPSAs). By definition,
the Nation's more than 5,500 HPSAs experience shortages in the primary
care workforce that the market alone can't address. In addition, the
Health Resources and Services Administration (HRSA) predicts that there
will be a need for over 11,000 health care professionals to implement
the President's Community Health Center (CHC) Initiative. The increased
funding for these CHCs will provide medical care to approximately 6
million people in the United States. Title VII serves as crucial
funding for the pipeline of health professionals that serve CHCs today.
We wish to thank the members of this subcommittee for your
historical role in supporting funding for the health professions
programs, and we hope that we can count on your support to restore
funding to these important programs in fiscal year 2008 to the fiscal
year 2005 funding level.
OVERVIEW OF PHYSICIAN ASSISTANT EDUCATION
The typical PA program consists of 26 months of instruction, and
the typical student has a bachelor's degree and about 4 years of prior
health care experience. The first phase of the program consists of more
than 400 hours in classroom and laboratory instruction in the basic
sciences, over 75 hours in pharmacology, approximately 175 hours in
behavioral sciences, and almost 580 hours of clinical medicine.
The second year of PA education consists of clinical rotations,
which typically includes more than 2,000 hours or 50-55 weeks of
clinical education, divided between primary care medicine and various
specialties. During clinical rotations, PA students work directly under
the supervision of physician preceptors, participating in the full
range of patient care activities, including patient assessment and
diagnosis, development of treatment plans, patient education, and
counseling. All PA educational programs are accredited by the
Accreditation Review Commission on Education for the Physician
Assistant.
After graduation from an accredited PA program, physician
assistants must pass a national certifying examination jointly
developed by the National Board of Medical Examiners and the
independent National Commission on Certification of Physician
Assistants. To maintain certification, PAs must log 100 continuing
medical education credits every 2 years, and they must take a
recertification exam every 6 years.
PHYSICIAN ASSISTANT PRACTICE
Physician assistants are licensed health care professionals
educated to practice medicine as delegated by and with the supervision
of a physician. In all States, physicians may delegate to PAs those
medical duties that are within the physician's scope of practice and
the PA's training and experience and are allowed by law. Physicians may
also delegate prescriptive privileges to the PAs they supervise. PAs
are located in almost all health care settings and medical and surgical
specialties. Sixteen percent of all PAs practice in non-metropolitan
areas where they may be the only full-time providers of care (State
laws stipulate the conditions for remote supervision by a physician).
Approximately 48 percent of PAs work in urban and inner city areas.
Approximately 38 percent of PAs are in primary care. In 2006, an
estimated 231 million patient visits were made to PAs and approximately
286 million medications were prescribed or recommended by PAs.
CRITICAL ROLE OF TITLE VII PUBLIC HEALTH SERVICE ACT PROGRAMS
A growing number of Americans lack access to primary care either
because they are uninsured, underinsured, or they live in a community
with an inadequate supply or distribution of providers. The growth in
the uninsured U.S. population increased from approximately 32 million
in the early 1990s to almost 47 million today. The role of Title VII
programs is to alleviate these problems by supporting educational
programs that train more health professionals in fields experiencing
shortages, improving the geographic distribution of health
professionals, and increasing access to care in underserved
communities.
Title VII programs are the only Federal educational programs that
are designed to address the supply and distribution imbalances in the
health professions. Since the establishment of Medicare, the costs of
physician residencies, nurse training, and some allied health
professions training have been paid through Graduate Medical Education
(GME) funding. However, GME has never been available to support PA
education. Furthermore, GME was not intended to generate a supply of
providers who are willing to work in the Nation's medically underserved
communities. That is the purpose of the Title VII Public Health Service
Act programs.
In addition, as evidence indicates that race and ethnicity
correlate to persistent health disparities among U.S. populations, it
is essential to increase the diversity of health care professionals.
Title VII programs seek to recruit students who are from underserved
minority and disadvantaged populations. This is particularly important,
as studies have found that those from disadvantaged regions of the
country are three to five times more likely to return to underserved
areas to provide care.
TITLE VII SUPPORT OF PA EDUCATIONAL PROGRAMS
Targeted Federal support for PA educational programs is authorized
through section 747 of the Public Health Service Act. The program was
reauthorized in the 105th Congress through the Health Professions
Education Partnerships Act of 1998, Public Law 105-392, which
streamlined and consolidated the Federal health professions education
programs. Support for PA education is now considered within the broader
context of training in primary care medicine and dentistry.
Public Law 105-392 reauthorized awards and grants to schools of
medicine and osteopathic medicine, as well as colleges and
universities, to plan, develop, and operate accredited programs for the
education of physician assistants with priority given to training
individuals from disadvantaged communities. The funds ensure that PA
students from all backgrounds have continued access to an affordable
education and encourage PAs, upon graduation, to practice in
underserved communities. These goals are accomplished by funding PA
educational programs that have a demonstrated track record of (1)
placing PA students in health professional shortage areas; (2) exposing
PA students to medically underserved communities during the clinical
rotation portion of their training; and (3) recruiting and retaining
students who are indigenous to communities with unmet health care
needs.
The PA programs' success is linked to their ability to creatively
use Title VII funds to enhance existing educational programs. For
example, PA programs in Texas use Title VII funds to create new
clinical rotation sites in rural and underserved areas, including new
sites in border communities, and to establish non-clinical rural
rotations to help students understand the challenges faced by rural
communities. One Texas program uses Title VII funds for the development
of Web based and distant learning technology, so students can remain at
clinical practice sites. A PA program in New York, where over 90
percent of the students are ethnic minorities, uses Title VII funding
to focus on primary care training for underserved urban populations by
linking with community health centers, which expands the pool of
qualified minority role models that engage in clinical teaching,
mentoring, and preceptorship for PA students. Several other PA programs
have been able to use Title VII grants to leverage additional resources
to assist students with the added costs of housing and travel that
occur during relocation to rural areas for clinical training.
Without Title VII funding, many of these special PA training
initiatives would not be possible. Institutional budgets and student
tuition fees simply do not provide sufficient funding to meet the
special, unmet needs of medically underserved areas or disadvantaged
students. The need is very real, and Title VII is critical in meeting
that need.
need for increased title vii support for pa educational programs
Increased Title VII support for educating PAs to practice in
underserved communities is particularly important given the market
demand for physician assistants. Without Title VII funding to expose
students to underserved sites during their training, PA students are
far more likely to practice in the communities where they were raised
or attended school. Title VII funding is a critical link in addressing
the natural geographic maldistribution of health care providers by
exposing students to underserved sites during their training, where
they frequently choose to practice following graduation. Currently, 31
percent of PAs met their first clinical employer through their clinical
rotations.
The supply of physician assistants is inadequate to meet the needs
of society, and the demand for PAs is expected to increase. A 2006
article in the Journal of the American Medical Association (JAMA)
concluded that the Federal Government should augment the use of
physician assistants as physician substitutes, particularly in urban
CHCs where the proportional use of physicians is higher. The article
suggested that this could be accomplished by adequately funding Title
VII programs. Additionally, the Bureau of Labor Statistics projects
that the number of available PA jobs will increase 49 percent between
2004 and 2014. Title VII funding has provided a crucial pipeline of
trained PAs to underserved areas.
Despite the increased demand for PAs, funding has not
proportionately increased for Title VII programs that are designed to
educate and place PAs in underserved communities. Nor has Title VII
support for PA education kept pace with increases in the cost of
educating PAs. A review of PA program budgets from 1984 through 2004
indicates an average annual increase of 7 percent, a total increase of
256 percent over the past 20 years, yet Federal support has decreased.
RECOMMENDATIONS ON FISCAL YEAR 2008 FUNDING
The American Academy of Physician Assistants urges members of the
Appropriations Committee to consider the inter-dependency of all public
health agencies and programs when determining funding for fiscal year
2008. For instance, while it is important to fund clinical research at
the National Institutes of Health (NIH) and to have an infrastructure
at the Centers for Disease Control and Prevention (CDC) that ensures a
prompt response to an infectious disease outbreak or bioterrorist
attack, the good work of both of these agencies will go unrealized if
HRSA is inadequately funded. HRSA administers the ``people'' programs,
such as Title VII, that bring the results of cutting edge research at
NIH to patients through providers such as PAs who have been educated in
Title VII-funded programs. Likewise, training is the key to emergency
preparedness, and Title VII, section 747, is the ideal mechanism for
educating primary care providers in public health competencies that
ensures the CDC has an adequate supply of health care providers to
report, track, and contain disease outbreaks.
The Academy respectfully requests that Title VII health professions
programs receive $300 million in funding for fiscal year 2008,
including a minimum of $7 million to support PA educational programs.
Thank you for the opportunity to present the American Academy of
Physician Assistants' views on fiscal year 2008 appropriations.
______
Prepared Statement of the American Association for Cancer Research
EXECUTIVE SUMMARY
The American Association for Cancer Research (AACR) would like to
thank Members for their support of National Institutes of Health (NIH)
and National Cancer Institute (NCI) research on the biology, treatment
and prevention of the more than 200 diseases called cancer. The AACR,
with more than 25,000 members worldwide, represents and supports
scientists by publishing respected, peer-reviewed scientific journals,
hosting international scientific conferences, and awarding millions of
dollars in research grants. Together, we have made great strides in the
war on cancer, but much remains to be done. One in four deaths in
America this year will be caused by cancer. Cancer-related deaths will
increase dramatically as the baby boom generation ages, and we must be
prepared to prevent, treat, and manage the impending wave of new
cancers.
Cancer is no longer a death sentence thanks to decades of research
and development made possible by strong commitments from Congress and
the American people, but now that commitment is wavering. After
expanding capacity during the NIH budget doubling, researchers at
hospitals and universities across the country now face shrinking
budgets. Promising young researchers, unable to secure grants, turn to
other careers. This disruption of the research pipeline will slow the
development of new treatments and set back America's biomedical
leadership for decades to come.
We are at the vanguard of a revolution in healthcare, where
personalized treatment will improve health, reduce harmful side
effects, and lower costs. We have the opportunity to build upon our
previous investments and accelerate the research process. Now is the
time to face the Nation's growing healthcare needs, reaffirm our role
as world leaders in science, and renew our commitment to the research
and development that brings hope to millions of suffering Americans.
The AACR urges the U.S. Senate to support the following appropriations
funding levels for cancer research in fiscal year 2008:
--$30.8 billion for the National Institutes of Health, a 6.7 percent
increase over fiscal year 2007.
--$5.8 billion for the National Cancer Institute (the NCI
Professional Judgment budget level), or, at a minimum, $5.1
billion, a 6.7 percent increase over fiscal year 2007.
The American Association for Cancer Research (AACR) recognizes and
expresses its thanks to the United States Congress for its longstanding
support and commitment to funding cancer research. The completion of
the 5-year doubling of the budget of the National Institutes of Health
(NIH) in 2003 was a stunning accomplishment that is already showing
impressive returns and benefits to patients with cancer. Recently,
however, budgets for cancer research have declined; this commitment
appears to be wavering. Budget doubling enabled a significant expansion
of infrastructure and scientific opportunities. Budget cuts prevent us
from capitalizing on them.
Unquestionably, the Nation's investment in cancer research is
having a remarkable impact. Cancer deaths in the United States have
declined for the second year in a row. Last year's decline was the
first such decrease in the total number of annual cancer deaths since
1930 when record-keeping began. This progress occurred in spite of an
aging population and the fact that more than three-quarters of all
cancers are diagnosed in individuals aged 55 and older. Yet this good
news will not continue without sustained and substantial Federal
funding for critical cancer research priorities. The American
Association for Cancer Research joins the broader biomedical research
community in urging the United States Senate to support the following
appropriations funding levels for cancer research in fiscal year 2008:
--$30.8 billion for the National Institutes of Health, a 6.7 percent
increase over fiscal year 2007.
--$5.8 billion for the National Cancer Institute (the NCI
Professional Judgment budget level), or, at a minimum, $5.1
billion, a 6.7 percent increase over fiscal year 2007.
AACR: FOSTERING A CENTURY OF RESEARCH PROGRESS
The American Association for Cancer Research has been moving cancer
research forward since its founding 100 years ago in 1907. Celebrating
its Centennial Year, the AACR and its more than 25,000 members
worldwide strive tirelessly to carry out its important mission to
prevent and cure cancer through research, education, and communication.
It does so by:
--fostering research in cancer and related biomedical science;
--accelerating the dissemination of new research findings among
scientists and others dedicated to the conquest of cancer;
--promoting science education and training; and
--advancing the understanding of cancer etiology, prevention,
diagnosis, and treatment throughout the world.
FACING AN IMPENDING CANCER ``TSUNAMI''
Over the past 100 years, enormous progress has been made toward the
conquest of the Nation's second most lethal disease (after heart
disease). Thanks to discoveries and developments in prevention, early
detection, and more effective treatments, many of the more than 200
diseases called cancer have been cured or converted into manageable
chronic conditions while preserving quality of life. The 5-year
survival rate for all cancers has improved over the past 30 years to
more than 65 percent. The completion of the doubling of the NIH budget
in 2003 is bearing fruit as many new and promising discoveries are
unearthed and their potential realized. However, there is much left to
be done, especially for the most lethal and rarer forms of the disease.
We recognize that the underlying causes of the disease and its
incidence have not been significantly altered. The fact remains that
men have a 1 in 2 lifetime risk of developing cancer, while women have
a 1 in 3 lifetime risk. The leading cancer sites in men are the
prostate, lung and bronchus, and colon and rectum. For women, the
leading cancer sites are breast, lung and bronchus, and colon and
rectum. And cancer still accounts for 1 in 4 deaths, with more than
564,830 people expected to die from their cancer in 2006. Age is a
major risk factor--this Nation faces a virtual ``cancer tsunami'' as
the baby boomer generation reaches age 65 in 2011. A renewed commitment
to progress in cancer research through leadership and resources will be
essential to dodge this cancer crisis.
FEDERAL INVESTMENT FOR LOCAL BENEFIT
Nearly half of the NCI budget is allocated to research project
grants that are awarded to outside scientists who work at local
hospitals and universities throughout the country. More than 5,400
research grants are funded at more than 150 cancer centers and
specialized research facilities located in 49 States. Over half the
States receive more than $15 million in grants and contracts to
institutions located within their borders. Many AACR member scientists
are engaged in this rewarding work. But too many of them have had their
long-term research jeopardized by grant reductions caused by the flat
and declining overall funding for the NCI since 2003. The AACR
recommends, at a minimum, a 6.7 percent increase in funding for the
National Cancer Institute to enable it to continue and expand its work
on focused research questions.
UNDERSTANDING THE CAUSES AND MECHANISMS OF CANCER
Basic research into the causes and mechanisms of cancer is at the
heart of what the NCI and many of AACR's member scientists do. Basic
research is the engine that drives scientific progress. The outcomes
from this fundamental basic research--including laboratory and animal
research in addition to population studies and the deployment of state-
of-the-art technologies--will inform and drive the cancer research
enterprise in ways and directions that will lead to unparalleled
progress in the search for cures.
ACCELERATING PROGRESS IN CANCER PREVENTION
Preventing cancer is far more cost-effective and desirable than
treating it. The NCI uses multidisciplinary teams and a systems biology
approach to identify early events and how to modify them. More than
half of all cancers are related to modifiable behavioral factors,
including tobacco use, diet, physical inactivity, sun exposure, and
failure to get cancer screenings. The NCI supports research to
understand how people perceive risk, make health-related decisions, and
maintain healthy behavior. Prevention is the keystone to success in the
battle against cancer.
DEVELOPING EFFECTIVE AND EFFICIENT TREATMENTS
The future of cancer care is all about developing individualized
therapies tailored to the specific characteristics of a patient's
cancer. Noteworthy recent advances in this area have included the
development of oral versions of medicines that were formerly only
available by injection, thus improving patients' quality of life; and
the discovery of intraperitoneal (IP) chemotherapy--delivering drugs
directly to the abdominal cavity--that can add more than a year to
survival for some women with ovarian cancer.
OVERCOMING CANCER HEALTH DISPARITIES
Some minority and underserved population groups suffer
disproportionately from cancer. Solving this issue will contribute
significantly to reducing the cancer burden. Successful achievements in
this important area include the development and dissemination of the
patient navigator program that assists patients and caregivers to
access and chart a course through the healthcare system, and the NCI
Cancer Information Services Partnership Program that provides
information and education about cancer in lay language to the medically
underserved through community organizations.
AACR'S INITIATIVES AUGMENT SUPPORT FOR THE NCI
The NCI is not working alone or in isolation in any of these key
areas. NCI research scientists reach out to other organizations to
further their work. The AACR is engaged in scores of initiatives that
strengthen, support, and facilitate the work of the NCI, including:
--sponsoring the largest meeting of cancer researchers in the world,
with more than 17,000 scientists and 6,000 abstracts featuring
the latest scientific advances;
--publishing more than 3,400 original research articles each year in
five prestigious peer-reviewed scientific journals, including
Cancer Research;
--sponsoring the annual International Conference on Frontiers of
Cancer Prevention Research, the largest such prevention meeting
of its kind in the world;
--raising and distributing more than $5 million in awards and
research grants.
training and career development for the next generation of researchers
Of critical importance to the viability of the long-term cancer
research enterprise is supporting, fostering, and mentoring the next
generation of investigators. The NCI devotes approximately 4 percent of
its budget to multiple strategies to training and career development,
including sponsored traineeships, a Medical Scientist Training Program,
special set-aside grant programs and bridge grants for early career
cancer investigators. Increased funding for these foundational
opportunities is essential to retain the scientific workforce that is
needed to continue the fight against cancer.
INCREASE RESEARCH FUNDING NOW
Remarkable progress is being made in cancer research, but much more
remains to be done. Cancer costs the Nation more than $209 billion in
direct medical costs and lost productivity due to illness and premature
death. Respected University of Chicago economists Kevin Murphy and
Robert Topel have estimated that even a modest 1 percent reduction in
mortality from cancer would be worth nearly $500 billion in social
value. Investments in cancer research have huge potential returns.
Thanks to successful past investments, promising research opportunities
abound and must not be lost. To maintain our research momentum, the
American Association for Cancer Research (AACR) urges the United States
Senate to support the following appropriations funding levels for
cancer research in fiscal year 2008:
--$30.8 billion for the National Institutes of Health, a 6.7 percent
increase over fiscal year 2007.
--$5.8 billion for the National Cancer Institute (the NCI
Professional Judgment budget level), or, at a minimum, $5.1
billion, a 6.7 percent increase over fiscal year 2007.
______
Prepared Statement of the American Association of Colleges of Nursing
The American Association of Colleges of Nursing (AACN) respectfully
submits this statement highlighting funding priorities for nursing
education and research programs in fiscal year 2008. AACN represents
more than 600 schools of nursing at public and private universities and
senior colleges with baccalaureate and graduate nursing programs that
educate over 240,000 students and employ over 12,000 faculty members.
These institutions are responsible for educating almost half of our
Nation's registered nurses (RNs) and all of the nurse faculty and
researchers. Nursing represents the largest health profession, with
approximately 2.9 million dedicated, trusted professionals delivering
primary, acute, and chronic care to millions of Americans.
NATIONWIDE NURSING SHORTAGE
For nearly a decade, our country's health care system has been
negatively impacted by a shortage of RNs. In 2002, the Joint Commission
on Accreditation of Healthcare Organizations noted that the nursing
shortage contributed to nearly a quarter of all unexpected incidents
that adversely affect hospitalized patients. A more recent
comprehensive analysis published in the March 2006 issue of Nursing
Economic$ found that the majority of nurses reported that the RN
shortage is negatively impacting patient care and undermining the
quality of care goals set by the Institute of Medicine and the National
Quality Forum. Unfortunately, reports reveal that the nursing shortage
is not expected to diminish in the foreseeable future. The Bureau of
Labor Statistics projects that more than 1.2 million new and
replacement nurses will be needed by 2014. Government analysts further
project that more than 703,000 new RN positions will be created through
2014, which will account for two-fifths of all new jobs in the health
care sector.
A number of contributing factors add to the complexity and duration
of the shortage. Within the next 20 years, there will be a wave of
nurses retiring from the profession. According to the 2004 National
Sample Survey of Registered Nurses released in February 2007 by the
Federal Division of Nursing, the average age of the RN population in
March 2004 was 46.8 years of age, up from 45.2 in 2000. With many
nurses nearing the age of retirement, more nurses must enter the
pipeline. However, the nursing profession is not growing to meet the
demand of the shortage. While The National Sample Survey of Registered
Nurses has indicated that the total RN population has increased at
every 4-year interval since 1980, the growth from 2000 to 2004 was
relatively low. The total RN population increased by only 7.9 percent
in 2004. Earlier report intervals noted that the RN population grew by
14.2 percent between 1992 and 1996.
The approximately 1,500 schools of nursing nationwide have been
working diligently to expand enrollments. AACN's 2006-2007 annual
survey of 722 nursing schools with baccalaureate and graduate programs
reveals that enrollments increased by 7.6 percent in entry-level
baccalaureate nursing programs.
This makes the sixth consecutive year of enrollment increases that
can be attributed to a combination of Federal support, private sector
marketing efforts, public-private partnerships providing additional
resources to expand capacity of nursing programs, and State legislation
targeting funds towards nursing scholarships and loan repayment. While
essential and important, these efforts have not fully met the
increasing demand for RNs.
Health Resources and Services Administration (HRSA) officials
stated in an April 2006 report that there must be a 90 percent increase
in graduations from U.S. nursing programs in order to meet the demand
for RN services. Yet, the inability of nursing schools to educate more
RNs is the most urgent contributing factor that must be addressed in
order to reverse the shortage and ensure that every patient receives
the safest, highest quality health care. According to AACN's report on
2006-2007 Enrollment and Graduations in Baccalaureate and Graduate
Programs in Nursing, U.S. nursing schools turned away 42,866 qualified
applicants to baccalaureate and graduate programs due to an
insufficient number of faculty, clinical sites, classroom space,
clinical preceptors, and budget constraints. Almost three quarters of
the nursing schools responding to the AACN survey pointed to faculty
shortages as a reason for not accepting all qualified applicants into
nursing programs. Federal support must continue to play an integral
role in our Nation's efforts to address the nursing and nurse faculty
shortage as well as the constraints encountered by nursing's
educational system.
nursing workforce development programs: addressing the shortage
Acknowledging the severity of the Nation's nursing shortage,
Congress passed The Nurse Reinvestment Act of 2002. This legislation
created new programs and expanded existing Nursing Workforce
Development authorities. Administered by HRSA under Title VIII of the
Public Health Service Act, these programs focus on the supply and
distribution of RNs across the country. The programs support individual
students in their nursing studies through scholarships and loan
repayment programs. Title VIII programs stimulate innovation in nursing
practice and bolster nursing education throughout the continuum, from
entry-level preparation through graduate study. They are the largest
source of Federal funding for nursing education assisting students,
schools of nursing, and health systems in their efforts to educate,
recruit, and retain RNs and nurse faculty. In fiscal year 2006, these
programs helped to educate over 48,000 nursing students and nurses
through individual and programmatic support.
However, funding for these authorities is insufficient to address
the severity of the nursing and nurse faculty shortage. Currently,
Nursing Workforce Development Programs receive $149.68 million, the
same funding level as in fiscal year 2006. During the nursing shortage
in 1974, Congress appropriated $153 million for nursing education
programs. Translated into today's dollars, that appropriation would
total $632 million, more than four times the current level. To fully
meet the educational and practice demands of today's nursing shortage
it would take billions of dollars.
AACN respectfully requests $200 million for Title VIII Nursing
Workforce Development Programs in fiscal year 2008, an additional
$50.32 million over the fiscal year 2007 level. New monies would expand
nursing education, recruitment, and retention efforts to help resolve
all aspects adding to the nursing shortage.
Nurse Faculty Shortage
AACN believes that the most effective strategy to resolve the
nursing shortage is addressing the underlying nurse faculty shortage.
The demand for nurse faculty far exceeds the rate at which nursing
schools can educate them. HRSA reports that just 13 percent of the RN
workforce holds either a master's or doctoral degree, the credentials
required to teach. A Special Survey on Vacant Faculty Positions
released by AACN in July 2006, reported a total of 637 faculty
vacancies (8 percent vacancy rate) were identified at 329 nursing
schools with baccalaureate and/or graduate programs across the country
(almost two vacancies at each school of nursing). Most of the vacancies
(53.7 percent) were faculty positions requiring a doctoral degree.
Besides the vacancies, schools cited the need to create an additional
55 faculty positions to accommodate student demand. The ability to
increase the pool of educators becomes increasingly difficult when
3,306 qualified applicants were turned away from master's programs and
299 qualified applicants were turned away from doctoral programs in
2006.
The inability of nursing schools to educate, recruit, and retain
qualified teachers is fueling the nurse faculty shortage. Potential
faculty members graduating from schools of nursing are slow to rise. In
2006, graduations from research-focused doctoral nursing programs were
up by only 1.4 percent or six graduates from the 2005-2006 academic
year. Complicating the problem further, those that are graduating from
schools of nursing with a graduate degree are not choosing a career in
education. An unpublished AACN study on employment plans found that
almost a quarter of all graduates from doctoral nursing programs do not
plan to work in academic settings. Higher compensation in clinical and
private sector settings lures current and potential nurse educators
away from the classroom.
Furthermore, the demand for nurse faculty will continue to grow in
the very near future as schools of nursing will experience an increase
in faculty retirement. According to an article published in the March/
April 2002 issue of Nursing Outlook titled The Shortage of Doctorally
Prepared Nursing Faculty: A Dire Situation, the average age of nurse
faculty at retirement is 62.5 years. With the average age of
doctorally-prepared faculty currently 53.5 years, a wave of retirements
is expected within the next 10 years. Without sufficient nurse faculty,
schools of nursing cannot expand enrollments, and the nursing shortage
will continue to cripple our Nation's health care delivery system.
reversing the nurse faculty shortage and nursing educational barriers
The Nursing Workforce Development programs are essential in not
only educating nurses, but more critically, in funding the education of
additional nurse faculty. In fiscal year 2008, AACN recommends
increasing funding for graduate education through the Advanced
Education Nursing (AEN) Grants (Sec. 811) and bolstering funds for the
Nurse Faculty Loan Program (Sec. 846A) as well as the Nurse Education,
Practice, and Retention Grants (Sec. 831). These programs are essential
in educating nurses, but more importantly in funding the education of
nurse faculty, which allow schools of nursing to increase their student
capacity.
Advanced Education Nursing Program (Sec. 811).--These grants
support the majority of nursing schools preparing graduate-level
nurses, many of whom become faculty. Receiving $57.06 million in fiscal
year 2007, this grant program helps schools of nursing, academic health
centers, and other nonprofit entities improve the education and
practice of nurse practitioners, nurse-midwives, nurse anesthetists,
nurse educators, nurse administrators, public health nurses, and
clinical nurse specialists. Out of the 114 applications reviewed for
program grants in fiscal year 2006, 45 new grants were awarded and 112
previously awarded grants were continued, totaling 157--the same number
as in fiscal year 2004 and fiscal year 2005. In addition, 564 schools
of nursing received traineeship grants, which in turn directly
supported 9,000 individual student nurses. In fact, 2,105 nurses who
received support from AEN grants in fiscal year 2006 are now practicing
in underserved areas.
Nurse Faculty Loan Program (Sec. 846A).--Designed to increase the
number of nurse faculty, schools of nursing receive grants to create a
loan fund through the Nurse Faculty Loan Program. To be eligible for
these loans, students must pursue full-time study for a master's or
doctoral degree. In exchange for teaching at a school of nursing, loan
recipients will have up to 85 percent of their educational loans
cancelled over a 4-year period. In fiscal year 2006, 67 new grants and
26 continuing grants were awarded to schools of nursing. These grants
are projected to assist 475 future nurse educators. Unfortunately, in
fiscal year 2006 schools of nursing requested over three times the
funds available to educate additional nurse faculty. In fiscal year
2007, $4.77 million was appropriated. If the current funding was
doubled to almost $10 million, based on fiscal year 2006 projections,
nursing schools could educate over 900 future faculty members. Further,
with an average faculty to student ratio of 1:10, those 900 faculty
members could teach an additional 9,000 nurses each year.
Nurse Education, Practice, and Retention Grants (Sec. 831).--These
grants help schools of nursing, academic health centers, nurse-managed
health centers, State and local governments, and health care facilities
strengthen programs that provide nursing education. In particular, the
Education Grants expand enrollments in baccalaureate nursing programs.
In addition, they develop internship and residency programs to enhance
mentoring and specialty training as well as provide for new technology
in education, including distance learning.
NATIONAL INSTITUTE OF NURSING RESEARCH
One of the 27 Institutes and Centers at the National Institutes of
Health, the National Institute of Nursing Research (NINR) works to
improve patient care and foster advances in nursing and other health
professions' practice. The outcomes-based findings derived from NINR
research are important to the future of the health care system and its
ability to deliver safe, cost-effective, and high quality care. Through
grants, research training, and interdisciplinary collaborations, NINR
addresses care management of patients during illness and recovery,
reduction of risks for disease and disability, promotion of healthy
lifestyles, enhancement of quality of life in those with chronic
illness, and care for individuals at the end of life. To advance this
research, AACN respectfully requests a funding level of $150 million in
fiscal year 2008, an additional $12.66 million over the $137.34
million, NINR received in fiscal year 2007,
NINR Addresses the Shortage of Nurse Researchers and Faculty
NINR allocates 7 percent of its budget, a high proportion when
compared to other NIH institutes, to research training to help develop
the pool of nurse researchers. In fiscal year 2005, NINR training
dollars supported 80 individual researchers and provided 155
institutional awards, which in turn supported a number of nurse
researchers at each institution. Since nurse researchers often serve as
faculty members for colleges of nursing, they are actively educating
our next generation of RNs.
CONCLUSION
AACN acknowledges the fiscal challenges that the subcommittee and
the entire Congress must work within. However, the nursing shortage can
no longer be explained by the need to simply increase the number of
nurses in the workforce. A demand for nurse educators weighs heavily on
the ability to increase the pool of future nurses. This element of the
shortage has created a negative chain reaction--without more nurse
faculty, additional nurses cannot be educated, and without more nurses
the shortage will continue. Ultimately, this chain reaction will
continue to place the health care delivery system at risk. Title VIII
programs can help to break this chain. These authorities provide a
dedicated, long-term vision for supporting the education of the new
nursing workforce. Yet, they must receive additional funding to be
effective. AACN respectfully requests $200 million for Title VIII
programs in fiscal year 2008. Additional funding for these programs
will assist schools of nursing to expand their programs, educate more
nurse faculty, increase the number of practicing RNs, and ultimately
improve the patient care provided in our health care system. AACN also
requests $150 million for NINR so that nurse researchers can continue
their work to improve the nursing care provided to all patients.
______
Prepared Statement of the American Association of Colleges of
Osteopathic Medicine
On behalf of the American Association of Colleges of Osteopathic
Medicine (AACOM), which represents the administrations, faculties, and
students of all twenty-three colleges of osteopathic medicine in the
United States, I am pleased to present our views on the fiscal year
2008 appropriations for Health Professions Education Programs under
Title VII of the Public Health Service Act.
First, we want to express our profound concern at the devastating
cuts sustained by the Title VII programs in appropriations for the last
two fiscal years. The fiscal year 2006 Labor, Health and Human
Services, Education and Related Agencies Appropriations bill cut Title
VII programs from the fiscal year 2005 level by 51.5 percent.
Unfortunately, the fiscal year 2007 funding level restored only a small
fraction of these cuts.
Health Professions Education Programs under Title VII are essential
components of America's health care safety net. An adequate, diverse,
well-distributed and culturally competent health workforce is
indispensable to meeting our current and especially our future health
service delivery needs. The Title VII programs have been especially
valuable in our efforts to ensure continuation of this commitment. In
Public Law 105-392, the Health Professions Education Partnership Act of
1998, forty-four different Federal health professions training programs
were consolidated into seven clusters. These clusters provide support
for training of primary care medicine and dental providers; the
establishment and operation of interdisciplinary community-based
training activities; health professions workforce analysis; public
health workforce development; nursing education; and student financial
assistance. These programs are designed to meet the health care
delivery needs of over 2,800 Health Professions Shortage Areas in the
country. Many rural and disadvantaged populations depend on the health
professionals trained by these programs as their only source of health
care. For example, without the practicing family physicians who are
currently in place, an additional 1,332 of the United States' 1,082
urban and rural counties would qualify for designation as primary care
Health Professions Shortage Areas.
Title VII programs have had a significant impact in reducing the
Nation's Health Professions Shortage Areas. Indeed, a 1999 study
estimated that if funding for Title VII program were doubled, the
effect would be to eliminate the Nations' Health Professions Shortages
Areas in as little as 6 years. (Politzer, RM, Hardwick, KC, Cultice,
JM, Bazell, C. ``Eliminating Primary Care Health Professions Shortage
Areas: The Impact of Title VII Generalist Physician Education,'' The
Journal of Rural Health, 1999: 15(1): 11-19).
A study by the Robert Graham Center showed that receipt of Title
VII family medicine grants by medical schools produced more family
physicians and more primary care doctors serving in rural areas and
Health Professions Shortage Areas. Over 69 percent of Title VII funded
internal medicine graduates practice primary care after graduation.
This rate is nearly twice that of programs not receiving Title VII
funding.
Among the programs within these clusters that have been especially
important to enhancing osteopathic medical schools' ability to train
the highest quality physicians are: General Internal Medicine
Residencies; General Pediatric Residencies; Family Medicine Training;
Preventive Medicine Residencies; Area Health Education Centers (AHECs);
Health Education and Training Centers (HETCs); Health Careers
Opportunity Programs (HCOP); Centers of Excellence (COE) programs; and
Geriatric Training Authority.
Accordingly, Mr. Chairman and Members of the subcommittee, AACOM
recommends that the fiscal year 2008 funding for Title VII Health
Professions Education Programs and the equally important programs under
Title VIII, Nursing Education be at least $550 million. This figure is
consistent with the fiscal year 2008 level recommended by the Health
Professions and Nursing Education Coalition (HPNEC) for Titles VII and
VIII.
AACOM also strongly urges continuation of funding for the Council
on Graduate Medical Education (COGME). Since its inception, COGME's
diverse membership has given the health policy community an opportunity
to discuss national workforce issues. The fifteen formal reports and
multiple ancillary materials provided by COGME have offered important
findings and observations in the rapidly changing health care
environment and have argued for a system of graduate medical education
that develops a physician workforce to meet the healthcare needs of the
American people.
Some of the more significant recommendations include:
--Community-based education with an emphasis on primary care;
--Continued progress toward a more representative participation of
minorities in medicine;
--The development and maintenance of a workforce planning
infrastructure to improve the understanding, need and demand
forces;
--The development of Federal-State partnerships to further workforce
planning; and
--Encouragement and support for medical education and health care
delivery programs that increase the flow of physicians to rural
areas, with an emphasis on the smaller, more remote
communities.
With a projected physician workforce shortage looming, the
activities of COMGE have never been more important.
Mr. Chairman and members of the subcommittee, we appreciate the
opportunity to submit this statement. If you have any questions or
require additional information, please contact me at (301) 968-4141 or
sshannon@aacom.org, or Michael J. Dyer, AACOM's Vice President for
Government Relations at (301) 968-4152 or mdyer@aacom.org.
______
Prepared Statement of the American Association of Colleges of Pharmacy
HHS SUPPORTED PROGRAMS AT COLLEGES AND SCHOOLS OF PHARMACY
AACP and its member colleges and schools of pharmacy appreciate the
continued support of the House Appropriations Subcommittee on Labor,
Health and Human Services, and Education. The 97 accredited colleges
and schools of pharmacy are engaged in a wide-range of programs that
are supported by grants and funding administered through the agencies
of the Department of Health and Human Services (HHS). We also
understand the difficult task you face annually in your deliberations
to do the most good for the Nation and remain fiscally responsible to
the same. AACP respectfully offers the following recommendations for
your consideration as you undertake your deliberations.
AGENCY FOR HEALTHCARE RESEARCH AND QUALITY
AACP supports the Friends of AHRQ recommendation of $350 million
for AHRQ programs in fiscal year 2008.
AACP also recommends that the committee direct AHRQ to reestablish
the provider-based research network grant program.
The Institute of Medicine (IOM) published two reports in 2006
regarding the reduction of medication use errors and how we can improve
medication safety http://www.nap.edu/catalog/11623.html#toc and http://
www.nap.edu/catalog/11750.html#toc. Faculty at colleges and schools of
pharmacy are actively engaged in teaching, research, and service to
their communities that addresses nearly every one of these report
recommendations. Our schools have significant community partnerships
that can be furthered enhanced through congressional restoration of the
provider-based research network program at AHRQ.
AACP members are active grantees in AHRQ Effective Health Care
Program, providing advice on how pharmacy and pharmaceutical technology
reduce medical errors and provide for greater patient safety.
CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC)
The fiscal 2008 funding for the CDC should be increased to $6.44
billion to restore funding for the preventive health and health
services block grants, to restore the health promotion line item to at
least fiscal year 2005 levels, and to allow the CDC to continue to
focus on keeping our Nation well and healthy. AACP also supports the
Friends of the National Center for Health Statistics (NCHS)
recommendation that fiscal year 2008 funding be $117 million.
The curriculum of the Nation's colleges and schools of pharmacy now
includes significant focus on public health. Much of this focus is
supported by research, information, and programs developed by the
Centers for Disease Control and Prevention (CDC). For example, the
public health elective offered by the University of Montana School of
Pharmacy requires students to purchase the CDC's ``Epidemiology and
Prevention of Vaccine-Preventable Diseases.''
HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA)
AACP supports the Friends of HRSA recommendation of at least $7.65
billion for HRSA in fiscal year 2008.
Many research, education, and service activities at our Nation's
colleges and schools are supported by HRSA. Over the last 6 years, HRSA
and academic pharmacy have forged a much closer working relationship.
This strengthened tie is increasing access to comprehensive pharmacy
services, including better utilization of the 340B drug assistance
program, for patients served by HRSA grantees and programs. Working
more closely with academic pharmacy has also improved the care provided
by HRSA supported providers as evidenced in the clinical pharmacy
demonstration projects implemented in 18 community health centers
across the country. The recognition of U.S colleges and schools of
pharmacy as a resource to the public health safety-net providers can
play a significant role in improving programs such as the Ryan White
AIDS programs, including the AIDs Drug Assistance Programs, rural
health and telemedicine programs, just as it has the community health
centers program. We would encourage you to request that HRSA continue
to utilize the academy as a resource for program improvement.
As mentioned above, AACP members are actively engaged with many
HRSA programs or with HRSA grantees. The following are examples of that
engagement.
COMMUNITY HEALTH CENTERS
AACP recommends that the subcommittee provide $100 million within
the total funding appropriations to CHCs for the development of new
comprehensive pharmacy programs. AACP further recommends that $50
million be made available within the total CHC appropriation for the
creation of shared teaching positions between CHCs and colleges and
schools of pharmacy to develop and support comprehensive pharmacy
services programs. Another option for integrating comprehensive
pharmacy services into CHC services would be to place the cost
associated with this integration into the base budget of CHC grants.
Relationships between CHCs and academic pharmacists could decrease
the gap between the ``bench'' and the ``bedside'' in medication
management, resulting in more effective, cost-efficient medication
therapy. CHCs and academic pharmacy institutions continue to forge an
essential link towards improving the health care provided to patients.
As the recognized key link in America's health safety net CHCs should
be encouraged to improve or develop comprehensive pharmacy services
within their institutions.
TITLE VII HEALTH PROFESSIONS EDUCATION PROGRAMS
AACP supports the Health Professions and Nursing Education
coalition (HPNEC) recommendation of $300 million for Title VII programs
in fiscal year 2008.
For nearly every health profession tracked by the U.S. Bureau of
Labor Statistics, high demand will remain for the foreseeable future.
Interprofessional education has the potential to help improve health
care quality and create greater efficiencies by allowing health
professionals to work productively together. NIH has also recognized
the growing acceptance of interprofessional research through the ``Road
Map,'' including allowing multiple primary investigators. Colleges and
schools of pharmacy are taking a leadership role in the creation of
interprofessional approaches to health professions education. Faculty
are working across disciplines to develop interprofessional programs
and assess their effectiveness through: federally supported programs
such as Area Health Education Centers across the country; organizations
such as the Institute for Healthcare Improvement and the Association of
Academic Health Center; and university level mandates such as that of
the University of Minnesota. It is essential that Federal support for
interprofessional education be maintained.
NATIONAL HEALTH SERVICES CORPS
AACP recommends that funding for these programs continue to
increase, at least at a rate that takes into account inflation, and
waiting lists.
As integral as the CHCs are, they require health professionals to
provide the care. While the Title VII programs are essential in
creating the education programs that create culturally competent health
professionals able to provide team-based, patient-centered care, the
NHSC is the program that gets those providers to the community in
greatest need. Annual appropriations for the NHSC continue to increase
in recognition of the role this program plays in helping to improve
access to care in medically underserved and health professions shortage
areas.
OFFICE OF RURAL HEALTH POLICY
AACP recommends that the subcommittee fully restore funding to
Rural Health Care Programs. The ORHP supported Rural Health Research
Centers grant program is the only source of rural-specific health
services research supported by the HHS. Rural Health Research Centers
collaborate with schools and colleges of pharmacy in rural health
research and dissemination. A paper published by the Upper Midwest
Rural Health Center (UMRHC) identified pharmacist staffing, finance,
and access to technology as barriers to medication safety in rural
hospitals. Through a nationwide survey, the UMRHC found a significant
positive relationship between pharmacist staffing and the presence and
quality of medication safety initiatives in rural hospitals. Better
access to pharmacists in rural hospitals is necessary for reducing
medication errors and implementing medication safety systems.
OFFICE OF TELEHEALTH ADVANCEMENT
AACP recommends that the subcommittee increase the fiscal year 2008
appropriation for telehealth to $7 million. AACP further recommends
that the subcommittee direct the HRSA Office for the Advancement of
Telehealth to include development of telepharmacy programs as an
explicit grant funding option.
Colleges and schools of pharmacy, including North Dakota State
University College of Pharmacy, Washington State University College of
Pharmacy, and Texas Tech University have developed successful
telepharmacy programs that are assisting rural providers and their
patients improve the management of their medications. The North Dakota
Telepharmacy Program has restored, retained, or established pharmacy
services to approximately 40,000 rural citizens in North Dakota and
Minnesota. The project has not only increased access to medically
underserved areas, but has also added approximately $12 million in
economic development to the local rural economies. Duquesne University
Mylan School of Pharmacy, located in Pittsburgh, Pennsylvania, has
developed and implemented a telepharmacy program that is assisting
hospice providers in rural southeastern Pennsylvania, Ohio, West
Virginia.
NATIONAL INSTITUTES OF HEALTH
AACP, as a member of the Ad Hoc Group for Biomedical Research
Funding recommends that fiscal year 2008 NIH funding be increased by
6.7 percent and this same increase be continued for the next 2 years.
AACP would also ask the Congress to commend the NIH for its
development of the ``PharmD Gateway to NIH'' and support efforts for
NIH to create opportunities for the development of new clinical
pharmacy faculty research.
Our Nation benefits greatly from both intra and extramural NIH
research. Our Nation's colleges and schools of pharmacy play an
important part in that research agenda. Academic pharmacy supports the
NIH Director's Road Map initiative and is especially pleased with
recent decisions to allow multiple primary investigators on grants and
the support of interdisciplinary research. According to 2006 NIH data,
colleges and schools of pharmacy rank fourth after medicine, public
health and biomedical engineering in total extramural grant funding.
AACP is pleased to recognize the committee for its important role in
doubling the NIH budget, however there is growing concern that without
continued increases to the NIH budget that work will have been negated.
In fiscal year 2006 biomedical research conducted by faculty at U.S.
colleges and schools of pharmacy was supported by $239.7 million.
Biomedical research is our Nation's best opportunity for finding cures
for disease and reducing the economic burden of illness and chronic
illness. The research of academic pharmacy faculty in discovery and
application is essential at a time when we grow more dependent on
medications to reduce the impact of chronic and acute illness and
unexpected threats to our public health.
U.S. DEPARTMENT OF EDUCATION
AACP is pleased that the President continues to recognize the
importance of higher education to America's global competitiveness.
What is of growing concern is that the priorities of the administration
frequently come at the expense of existing programs of importance to
students attending colleges and schools of pharmacy and the other
institutions of higher learning they attend in preparation. The ability
of students to be fully prepared to begin pharmacy studies has been
heightened through participation in college preparation courses for
high school students, summer programs for graduated high school
students, and students entering their professional education through
programs such as GEAR UP and TRIO. We support the recommendation of the
Student Aid Alliance that fiscal year 2008 program funding be $350
million and $1 billion respectively.
Academic pharmacy is a leader among the health professions
education community in regard to the development of objective,
measurable, terminal educational outcomes. Because of growing concern
about the assessment of student learning and the value-added aspects of
higher education, faculty at our Nation's colleges and schools of
pharmacy are ideal resources to work beyond the politics of the
Spellings Commission on Higher Education. Academic pharmacy is
committed to improving and demonstrating the value of pharmacy
education. This commitment led to the creation of AACP's Center for the
Advancement of Pharmaceutical Education (CAPE). CAPE has established
and recently redefined and expanded educational outcomes. The CAPE
outcomes are intended to guide individual institutions in curriculum
development. The Accrediting Council on Pharmaceutical Education (ACPE)
has adapted these educational outcomes into its recently revised
standards and guidelines.
______
Prepared Statement of the American Association for Dental Research
(AADR) and the American Dental Education Association (ADEA)
Discoveries stemming from dental research have reduced the burden
of oral disease, have led to better oral health for tens of millions of
Americans, and have uncovered important associations between oral and
systemic health. Now, dental researchers and educators are poised to
make new breakthroughs that can result in dramatic progress in medicine
and health, such as repairing natural form and function to faces
destroyed by disease, accident, or war injuries; diagnosing systemic
disease from saliva instead of blood samples; and deciphering the
complex interactions and causes of oral health care disparities
involving social, economic, cultural, environmental, racial/ethnic, and
biological factors. Dental research in large part takes place in
academic dental institutions where the future oral health workforce
receives education and training and provides oral health care that
improves the health of the public. Dental research and education are
the underpinning of the profession; they enhance the quality of the
Nation's oral and overall health. This testimony will cover the
following programs and issues:
1. Oral Health Research--The National Institutes of Health (NIH)
and the National Institute of Dental and Craniofacial Research
(NIDCR)--
a. Elimination of America's most prevalent infectious disease,
b. Saliva as a diagnostic tool,
c. Understanding factors that cause disparities in oral health,
d. Emerging Possibilities from Dental Researchers,
2. Dental Education--Title VII General Dentistry and Pediatric
Dentistry and Workforce Training Programs.
3. Access to Dental Care--
a. State Children's Health Insurance Program (SCHIP),
b. Dental Health Improvement Act,
c. Centers for Disease Control and Prevention: Division of Oral
Health,
d. and Ryan White CARE Act: Dental Reimbursement and Community-
based Partnerships Programs
INTRODUCTION
The American Association for Dental Research (AADR) represents the
oral health research community within the United States, and the
American Dental Education Association (ADEA) represents over 120
academic dental institutions as well as all of the educators,
researchers, residents and students training at these institutions.
Together our organizations represent over 21,000 members in academic
dental and dental research institutions throughout the Nation. The
joint mission of AADR and ADEA is to enhance the quality and scope of
oral health, advance research and increase knowledge for the
improvement of oral health, and increase opportunities for scientific
innovation. Academic dental institutions play an essential role in
conducting research and educating and training the future oral health
workforce. Academic dental institutions provide dental care to
underserved low-income populations, including individuals covered by
Medicaid and the State Children's Health Insurance Program.
We thank the committee for this opportunity to submit testimony
regarding the exciting advances in oral health sciences. There are
extraordinary opportunities being created through oral health research
and education. Herein we submit our fiscal year 2008 budget
recommendations for the National Institute of Dental and Craniofacial
Research (NIDCR), Title VII Health Professions Education and Training
Programs administered by the Health Resources and Services
Administration (HRSA), the Dental Health Improvement Act, the State
Children's Health Insurance Program (SCHIP), the Centers for Disease
Control and Prevention's Oral Health Programs, and the Ryan White CARE
Act, HIV/AIDS Dental Reimbursement Program and the Community Based
Dental Partnership Program.
ORAL HEALTH RESEARCH
Dental research is concerned with the prevention, causes,
diagnosis, and treatment of diseases and disorders that affect the
teeth, mouth, jaws, and related systemic diseases. Dental health is an
important, vital part of health throughout life, and through dental
research and education, we can enhance the quality and scope of oral
health. Dental research has produced tremendous benefits for the health
and well-being of our Nation and the world. Nonetheless, much remains
to be done as identified in the Surgeon General's Report of 2000--Oral
Health in America \1\ and in the 2003--National Call to Action to
Promote Oral Health.\2\
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\1\ Oral Health in America: A Report of the Surgeon General, U.S.
Department of Health and Human Services, 2000.
\2\ National Call to Action to Promote Oral Health, U.S. Department
of Health and Humans Services, 2003.
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We applaud Congress for demonstrating its overwhelming bipartisan
support for NIH by passing the NIH Reform Act of 2006. This
reauthorization legislation is an affirmation of the importance of NIH
and its vital role in advancing biomedical research to improve the
health of the Nation. A renewed national commitment to research and
fighting disease, through increased support for the NIH, will allow us
to capitalize on new and unprecedented scientific opportunities in oral
health research.
Eliminating American's most prevalent infectious disease
America's most prevalent infectious disease is dental decay
(caries)! It is five times more common than asthma and seven times more
common than hay fever in school children. Americans spend millions of
dollars annually in dental caries treatments and tooth restoration.
Over the past 50 years, discoveries stemming from dental research have
reduced the burden of dental caries (tooth decay) for many Americans.
Now, the burden of the disease, in terms of both extent and severity,
has shifted dramatically to a subset of our population. About a quarter
of the population now accounts for about 80 percent of the disease
burden. Dental caries remains a significant problem for vulnerable
populations of children and people who are economically disadvantaged,
elderly, chronically ill, or institutionalized.
Dental caries is a chronic, infectious disease process that occurs
when a relatively high proportion of bacteria within dental plaque
begin to damage tooth structure. Most infectious diseases are treated
through medications, not surgery. But, it has been difficult to treat
caries this way because our existing diagnostic techniques lack the
sensitivity to catch it early enough. New strategies for the
prevention, diagnosis, cure and repair of dental caries are being
studied and developed by scientists funded through the NIDCR. If caries
can be diagnosed before irreversible loss of tooth structure occurs, it
can be reversed using a variety of approaches that ``remineralize'' the
tooth. In addition to improved diagnostics, some researchers are
working to develop a vaccine to prevent tooth decay, while others use
new methods to specifically target and kill the decay-causing bacteria.
Saliva as a Diagnostic Tool
The development of new diagnostic tests based on the analysis of
biomarkers in saliva will allow clinicians to more reliably diagnose
disease and monitor health conditions much earlier than is currently
possible. Salivary diagnostics is already being used for rapid, non-
invasive HIV screening, and saliva-based tests will soon be available
for oral cancer screening. Oral cancers and cancer of the larynx are
diagnosed in 41,000 individuals accounting for 12,500 deaths per year
in the United States. The death rate associated with this cancer is
especially high due to delayed diagnosis. Now, scientists funded by the
NIDCR have taken a major step forward in using saliva to detect oral
cancer. Elevated levels of distinct, cancer-associated molecules in
saliva can be used to distinguish between healthy people and those with
cancer. Soon, with further research, commercial diagnostic tests will
be developed for oral squamous cell carcinoma with the 99+ percent
accuracy expected for such tests.
Using saliva may also be possible for diagnosing and monitoring
many other systemic health conditions as well as exposure to chemical
and biological agents. Early diagnosis could potentially save thousands
of lives.
Understanding Factors that Cause Disparities in Oral Health
Despite tremendous improvements in the Nation's oral health over
the past decades, the benefits have not been equally shared by millions
of low-income and underserved Americans. High-risk populations,
including poor, inner-city, elderly, rural, and groups with special
health-care needs, all suffer a disproportionate and debilitating
amount of oral disease. Research is needed to identify the factors that
determine disparities in oral health and disease. These factors may
include proteomic, genetic, environmental, social, and behavioral
aspects and how they influence oral health singly or in combination.
Translational and clinical research is underway to analyze the
prevalence, etiology, and impact of oral conditions on disadvantaged
and underserved populations and on the systemic health of these
populations. In addition, community- and practice-based disparities
research, funded by the NIDCR and the Centers for Disease Control and
Prevention's Oral Health Programs, can help to identify and reduce
risks, enhance oral health-promoting behaviors, and help integrate
research findings directly into oral health care practice.
Other Emerging Exciting Areas in Dental Research
Looking towards the future--imagine a time when you won't need x-
rays to diagnose tooth decay; instead a molecular or electronic probe
will do the job. Or imagine teeth being restored to health, not with
fillings, but with simple mineral rinses or bioengineering techniques.
This is closer to reality than you might envision!
--Tissue engineering.--Tissue engineering holds great potential to
repair the ravages of orofacial disease, trauma, war injuries,
and birth defects, including the bioengineering of complete,
fully functional replacement teeth.
--Stem cells.--Isolating stem cells from the ligament around third
molars (wisdom teeth) and from human exfoliated deciduous teeth
(baby teeth) holds the distinct possibility that one day--in
the near future--we may be able to repair dental and
craniofacial defects by growing new tissues.
--System-oral health linkages.--There is strong evidence of an
association between gum (periodontal) disease and systemic
events such as cardiovascular disease, diabetes, and adverse
pregnancy outcomes. Continued oral health research will provide
insight into the prevention and treatment of these and other
systemic conditions with links to oral health.
--Practice Based Research Networks.--By connecting practitioners with
experienced clinical investigators, Practice Based Research
Networks (PBRNs) can enhance the utility of clinical research
funded by NIDCR by developing data and new techniques that may
be immediately relevant to practitioners and their patients.
DENTAL EDUCATION
Title VII Programs, Public Health Service Act
Title VII Education and Training Programs are critical. Support for
these programs is essential to expanding existing or establishing new
general dentistry and pediatric dentistry residency programs. Title VII
general and pediatric dental residency training programs have shown to
be effective in increasing access to care and enhancing dentists'
expertise and clinical experiences to deliver a wide range of oral
health services to a broad patient pool, including geriatric,
pediatric, medically compromised patients, and special needs patients.
Title VII support increases access to care for Medicaid and SCHIP
populations. The value of these programs is underscored by reports of
the Advisory Committee on Training in Primary Care Medicine and
Dentistry and the Institute of Medicine. Without adequate funding for
general dentistry and pediatric dentistry training programs it is
anticipated that access to dental care for underserved populations will
worsen.
AADR/ADEA also supports the funding requests advanced by National
Council for Diversity in the Health Professions for the Health
Resources and Services Administration's diversity programs, namely the
Scholarship for Disadvantaged Students, Health Careers Opportunity
Program, Centers of Excellence, and the Faculty Loan Repayment Program.
ACCESS TO DENTAL CARE
State Children's Health Insurance Program
Reauthorization of the State Children's Health Insurance Program
(SCHIP) represents a singular opportunity to move closer to the widely-
shared goal of ensuring that all of America's children have health care
coverage. Congress has taken a significant step in that direction by
signaling in the House and Senate budget resolutions a willingness to
provide $50 billion in new funding for SCHIP reauthorization. Now,
relying on the bipartisan support for SCHIP, Congress must work to
ensure in a timely manner that SCHIP reauthorization legislation is
fully funded and that it includes policies that will support States'
efforts to cover more children.
Minority, low-income, and geographically isolated children suffer
disproportionately from dental conditions. Dental care tops the list of
parent reported unmet needs, with parent reports of unmet dental needs
three times as often as medical care and four times that of vision
care. For children with special needs, dental care is the most
prevalent unmet health care need surpassing mental health, home health,
hearing aids and all other services. Despite the magnitude of need,
dental coverage has remained an optional benefit in SCHIP. All States
have recognized that poor oral health affects children's general health
and have opted to provide dental coverage. However, dental coverage is
often the first benefit cut when States seek budgetary savings. SCHIP
lacks a stable and consistent dental benefit that would provide a
comprehensive approach to children's health while reducing costly
treatments caused from advanced dental disease. Congress can help
stabilize access to oral health care services to underserved children
by improving funding for the SCHIP program. It is vital that Congress
deliver on its pledge for children's health coverage of $50 billion in
new funds for SCHIP and Medicaid as indicated in the congressional
budget resolutions. This level of funding is the minimum amount needed
to allow States to sustain their existing SCHIP programs, reach a
significant share of the uninsured children already eligible for SCHIP
and Medicaid, and support ongoing State efforts to expand oral health
care coverage.
Dental Health Improvement Act
The recent reports of tragic deaths of Deamonte Driver, a 12-year-
old from Maryland, and Alexander Callender, a 6-year-old from
Mississippi, as a result of unmet dental needs tragically illustrate
that all children regardless of resources or economic status should
have access to oral health care.
Congress provided first-time funding of $2 million in fiscal year
2006 for the Dental Health Improvement Act, a program established in
2001, to assist States in developing innovative dental workforce
programs. The first grants were awarded to States last Fall and are
being used for a variety of important initiatives including: increasing
hours of operation at clinics caring for underserved populations,
recruiting and retaining dentists to work in these clinics, prevention
programs including water fluoridation, dental sealants, nutritional
counseling, and augmenting the State dental offices to coordinate oral
health and access issues.
Centers for Disease Control and Prevention (CDC) Division of Oral
Health
The Centers for Disease Control and Prevention Oral Health Program
expands the coverage of effective prevention programs by building basic
capacity of State oral health programs to accurately assess the needs
in their State, organize and evaluate prevention programs, develop
coalitions, address oral health in State health plans, and effect
allocation of resources to the programs. CDC's funding and technical
assistance to States is essential to help oral health programs build
capacity.
An additional $4 million over fiscal year 2007 funding of $11.6
million is necessary so additional States requesting support to improve
their capacity to validate, build, and sustain effective preventive
interventions to reduce health disparities among their citizens can be
funded. Funding for current grantees expires at the end of fiscal year
2007. Twenty-four States have previously applied for these grants but
due to limited funding only 12 States were awarded. Increasing CDC
funding will help to ensure that all States that apply may be awarded
an oral health grant.
Dental Reimbursement and Community-based Dental Partnership Program
Congress designated dental care as a ``core medical service'' when
it reauthorized the Ryan White program in 2006. The Dental
Reimbursement Program provides access to quality dental care to people
living with HIV/AIDS while simultaneously providing educational and
training opportunities to dental residents, dental students, and dental
hygiene students who deliver the care. The Dental Reimbursement Program
is a cost-effective Federal/institutional partnership that provides
partial reimbursement to academic dental institutions for costs
incurred in providing dental care to people living with HIV/AIDS. The
Community-Based Dental Partnership Program fosters partnerships between
dental schools and communities lacking academic dental institutions to
ensure access to dental care for HIV/AIDS patients living in those
areas.
AADR/ADEA FISCAL YEAR 2008 FUNDING RECOMMENDATIONS SUMMARY
To maintain support for the biomedical research at the NIH AADR/
ADEA recommends $31.3 billion for the National Institutes of Health
(NIH) including $425 million for the National Institute of Dental and
Craniofacial Research (NIDCR).
Support the development of innovative dental workforce programs
specific to States' needs and increase access to dental care for
underserved populations. AADR/ADEA recommends $10 million for the
Dental Health Improvement Act.
Help build basic capacity of State oral health programs. AADR/ADEA
recommends $15.6 million for the CDC Dental Block Grants.
Support education and training of the dental workforce for the
future. AADR/ADEA recommends $450.2 million for the full complement of
Title VII health professions programs including:
--$89 million for the primary care medicine and dentistry cluster to
assure:
--$10 million for General and Pediatric Dental Residency Training.
--$118 million for the diversity and student assistance cluster:
--$33.6 million for Centers of Excellence;
--$35.6 million for Health Careers Opportunity Program;
--$1.3 million for the Faculty Loan Repayment Program; and
--$47.1 million for Scholarships for Disadvantaged Students.
Help provide access to oral health care services in SCHIP. AADR/
ADEA recommends $50 billion in new funds for SCHIP and Medicaid.
Assist people with HIV/AIDS, whose immune systems are weakened, to
have access to quality dental care. AADR/ADEA recommends $19 million
for of the Ryan White HIV/AIDS Treatment and Modernization Act, the
Dental Reimbursement Program and the Community-based Dental
Partnerships Program.
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Prepared Statement of the American Association for Geriatric Psychiatry
The American Association for Geriatric Psychiatry (AAGP)
appreciates this opportunity to present its recommendations on issues
related to fiscal year 2008 appropriations for mental health research
and services. AAGP is a professional membership organization dedicated
to promoting the mental health and well being of older Americans and
improving the care of those with late-life mental disorders. AAGP's
membership consists of approximately 2,000 geriatric psychiatrists as
well as other health professionals who focus on the mental health
problems faced by senior citizens.
AAGP appreciates the work this subcommittee has done in recent
years in support of funding for research and services in the area of
mental health and aging through the National Institutes of Health (NIH)
and the Substance Abuse and Mental Health Services Administration
(SAMHSA). Although we generally agree with others in the mental health
community about the importance of sustained and adequate Federal
funding for mental health research and treatment, AAGP brings a unique
perspective to these issues because of the elderly patient population
served by our members.
DEMOGRAPHIC PROJECTIONS AND THE MENTAL DISORDERS OF AGING
With the baby boom generation nearing retirement, the number of
older Americans with mental disorders is certain to increase in the
future. By the year 2010, there will be approximately 40 million people
in the United States over the age of 65. Over 20 percent of those
people will experience mental health problems.
Current and projected economic costs of mental disorders alone are
staggering. It is estimated that total costs associated with the care
of patients with Alzheimer's disease is over $100 billion per year in
the United States. Psychiatric symptoms (including depression,
agitation, and psychotic symptoms) affect 30 to 40 percent of people
with Alzheimer's and are associated with increased hospitalization,
nursing home placement, and family burden. These psychiatric symptoms,
associated with Alzheimer's disease, can increase the cost of treating
these patients by more than 20 percent.
Depression is another example of a common problem among older
persons. Of the approximately 32 million Americans who have attained
age 65, about 5 million suffer from depression, resulting in increased
disability, general health care utilization, and increased risk of
suicide. Depression is associated with poorer health outcomes and
higher health care costs. Co-morbid depression with other medical
conditions affects a greater use and cost of medications as well as
increased use of health services (e.g., medical outpatient visits,
emergency visits, and hospitalizations). For example, individuals with
depression are admitted to the emergency room for hypertension,
arthritis, and ulcers at nearly twice the rate of those without
depression. Those individuals with depression are more likely to be
hospitalized for hypertension, arthritis, and ulcers than those without
depression. Those with depression experience almost twice the number of
medical visits for hypertension, arthritis and ulcers than those
without depression. Finally, the cost of prescriptions and number of
prescriptions for hypertension, arthritis, and ulcers were more than
twice than those without depression.
Older adults have the highest rate of suicide compared to any other
age group. Comprising only 13 percent of the U.S. population,
individuals age 65 and older account for 19 percent of all suicides.
The suicide rate for those 85 and older is twice the national average.
More than half of older persons who commit suicide visited their
primary care physician in the prior month--a truly stunning statistic.
THE CHALLENGE OF MEETING THE MENTAL HEALTH NEEDS OF THE AGING
POPULATION--PROPOSAL FOR IOM STUDY ON MENTAL HEALTH WORKFORCE NEEDS OF
OLDER AMERICANS
The Institute of Medicine (IOM) of the National Academy of Sciences
is currently undertaking a study of the readiness of the Nation's
healthcare workforce to meet the needs of its aging population. IOM has
recommended in discussions with AAGP that, because this study will not
delve deeply into the composition of the mental health workforce needed
to meet future needs of the elderly, a complementary study be
undertaken to consider specifically this vital area of concern. This
complementary study will focus on the mental health professional
workforce that will be needed to meet the demands of the aging
population in this country. IOM is extremely supportive of this
proposed study and feel that it would complement their current study on
broad health needs of older adults. IOM has advised AAGP that $1
million would be needed to undertake this complementary mental health
study.
In discussions with AAGP, the senior staff of IOM suggested the
following language for inclusion in the fiscal year 2008 Labor HHS
Appropriations bill:
``The committee provides $1,000,000 for a study by the Institute of
Medicine of the National Academy of Sciences to determine the multi-
disciplinary mental health workforce needed to serve older adults. The
initiation of this study should be not later than 60 days after the
date of enactment of this act, whereby the Secretary of Health and
Human Services shall enter into a contract with the Institute of
Medicine to conduct a thorough analysis of the forces that shape the
mental health care workforce for older adults, including education,
training, modes of practice, and reimbursement.''
This proposal for funding for an IOM study on mental health
workforce needs of older Americans is supported by the IOM, and AAGP
strongly urges its inclusion in the fiscal year 2008 Labor HHS
Appropriations bill.
NATIONAL INSTITUTE OF MENTAL HEALTH
In his fiscal year 2008 budget, the President again proposed
decreased funding for the National Institutes of Health (NIH). This
decline in funding would have a devastating impact on the ability of
NIH to sustain the ongoing, multi-year research grants that have been
initiated in recent years.
AAGP would like to call to the subcommittee's attention the fact
that, even in the years in which funding was increased for NIH and
NIMH, these increases did not always translate into comparable
increases in funding that specifically address problems of older
adults. Data supplied to AAGP by NIMH indicates that while extramural
research grants by NIMH increased 59 percent during the 5-year period
from fiscal year 1995 through fiscal year 2000 (from $485,140,000 in
fiscal year 1995 to $771,765,000 in fiscal year 2000), NIMH grants for
aging research increased at less than half that rate: only 27.2 percent
during the same period (from $46,989,000 to $59,771,000).
Despite the fact that over the past 6 years Congress, through
committee report language, has specifically urged NIMH to increase
research grant funding devoted to older adults, this has not occurred.
The critical disparity between Federally funded research on mental
health and aging and the projected mental health needs of older adults
is continuing. If the mental health research budget for older adults is
not substantially increased immediately, progress to reduce mental
illness among the growing elderly population will be severely
compromised. While many different types of mental and behavioral
disorders occur in late life, they are not an inevitable part of the
aging process, and continued and expanded research holds the promise of
improving the mental health and quality of life for older Americans.
CENTER FOR MENTAL HEALTH SERVICES
It is also critical that there be adequate funding for the mental
health initiatives under the jurisdiction of the Center for Mental
Health Services (CMHS) within SAMHSA. While research is of critical
importance to a better future, the patients of today must also receive
appropriate treatment for their mental health problems. SAMHSA provides
funding to State and local mental health departments, which in turn
provide community-based mental health services to Americans of all
ages, without regard to the ability to pay. AAGP was pleased that the
final budgets for the last 5 years have included $5 million for
evidence-based mental health outreach and treatment to the elderly.
AAGP worked with members of this subcommittee and its Senate
counterpart on this initiative, which is a very important program for
addressing the mental health needs of the Nation's senior citizens.
However, AAGP is extremely alarmed to see that this program was
eliminated in President Bush's fiscal year 2008 budget proposal.
Restoring and increasing this mental health outreach and treatment
program must be a top priority, as it is the only Federally funded
services program dedicated specifically to the mental health care of
older adults.
The greatest challenge for the future of mental health care for
older Americans is to bridge the gap between scientific knowledge and
clinical practice in the community, and to translate research into
patient care. Adequate funding for this geriatric mental health
services initiative is essential to disseminate and implement evidence-
based practices in routine clinical settings across the States.
Consequently, we would urge that the $5 million for mental health
outreach and treatment for the elderly included in the CMHS budget for
fiscal year 2007 be increased to $20 million for fiscal year 2008. Of
that $20 million appropriation, AAGP believes that $10 million should
be allocated to a National Evidence-Based Practices Program, which will
disseminate and implement evidence-based mental health practices for
older persons in usual care settings in the community. This program
will provide the foundation for a longer-term national effort that will
have a direct effect on the well-being and mental health of older
Americans.
HEALTH RESOURCES AND SERVICES ADMINISTRATION
Despite growing evidence of the need for more geriatric specialists
to care for the Nation's elderly population, a critical shortage
persists. AAGP appreciates the work of this subcommittee in providing
for the restoration of funding for the geriatric health professions
programs under Title VII of the Public Health Service Act, which was
eliminated for fiscal year 2006. The restoration of this programs has
prevented a devastating impact on physician workforce development over
the next decade, with would have dangerous consequences for the growing
population of older adults who will need access to appropriate
specialized care. The administration has again proposed eliminating
most Title VII programs, including geriatrics. We urge the subcommittee
to fund them at the final fiscal year 2007 level. The geriatric health
professions program supports three important initiatives. The Geriatric
Faculty Fellowship trains faculty in geriatric medicine, dentistry, and
psychiatry. The Geriatric Academic Career Award program encourages
newly trained geriatric specialists to move into academic medicine. The
Geriatric Education Center (GEC) program provides grants to support
collaborative arrangements that provide training in the diagnosis,
treatment, and prevention of disease.
CONCLUSION
Based on AAGP's assessment of the current need and future
challenges of late life mental disorders, we submit the following
fiscal year 2008 funding recommendations:
1. An Institute of Medicine study on the future mental health
workforce needs for older adults should be funded at $1 million. This
proposed report is fully supported by IOM.
2. The current rate of funding for aging grants at NIMH and CMHS is
inadequate and should be increased to at least three times their
current funding levels. In addition, the substantial projected increase
in mental disorders in our aging population should be reflected in the
budget process in terms of dollar amount of grants and absolute number
of new grants.
3. To help the country's elderly access necessary mental health
care, previous years' funding of $5 million for evidence-based mental
health outreach and treatment for the elderly within CMHS must be
increased to $20 million.
4. Funding for the geriatric health professions program under Title
VII of the Public Health Service Act should be continued at fiscal year
2007 levels.
AAGP looks forward to working with the members of this subcommittee
and others in Congress to establish geriatric mental health research
and services as a priority at appropriate agencies within the
Department of Health and Human Services.
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Prepared Statement of the American Association of Immunologists
The American Association of Immunologists (``AAI''), a not-for-
profit professional society representing more than 6,500 of the world's
leading experts on the immune system, appreciates having this
opportunity to submit testimony regarding fiscal year 2008 funding for
the National Institutes of Health (NIH). The NIH budget is of great
concern to our members--research scientists and physicians who work in
academia, government, and industry--many of whom depend on NIH funding
to support their work.\1\ With approximately 83 percent of NIH's $28.9
billion budget awarded to more than 325,000 scientists throughout the
United States and around the world, NIH's funding level drives not only
the advancement of immuno-logical and biomedical research, but also the
economic activity that fuels local and national economies.\2\
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\1\ The majority of AAI members are medical school and university
professors and researchers who receive research grants from NIH, and in
particular from the National Institute of Allergy and Infectious
Diseases (NIAID), the National Cancer Institute (NCI), and the National
Institute on Aging (NIA).
\2\ NIH funding ``supports peer-reviewed . . . research at more
than 3,000 universities, medical schools, hospitals, and research
institutions throughout the 50 States and over-
seas . . . . Additionally, NIH supports 6,000 intramural scientists in
its own laboratories.'' Fiscal Year 2008 Director's Budget Request
Statement: Fiscal Year 2008 Budget Request, Witness appearing before
the House Subcommittee on Labor-HHS-Education Appropriations, Elias A.
Zerhouni, M.D., Director, National Institutes of Health (March 6,
2007).
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WHY IMMUNOLOGY?
Basic research on the immune system provides a foundation for the
discovery of ways to prevent, treat, and cure disease through the
development of diagnostics, vaccines, and therapeutics.\3\
Immunologists use animal models to test theories about immune system
function and treatments; \4\ if successful, treatments are then tested
on human subjects through clinical trials before being approved for use
by the Food and Drug Administration (``FDA'') and made available to the
general population.
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\3\ The immune system works by recognizing and attacking ``foreign
invaders'' (i.e., bacteria and viruses) inside the body and by
controlling the growth of tumor cells. A healthy immune system can
protect its human or animal host from illness or disease either
entirely--by attacking and destroying the virus, bacterium, or tumor
cell--or partially, resulting in a less serious illness. It will also
reject transplanted organs and bone marrow. The immune system can
malfunction, allowing the body to attack itself instead of an invader
(resulting in an ``autoimmune'' disease like Type 1 diabetes, multiple
sclerosis, or rheumatoid arthritis).
\4\ Without animal experimentation, immunologists and other
researchers would have to use human subjects, an ethically unacceptable
alternative. Despite the clear necessity for animal research,
scientists continue to be threatened by people and organizations that
oppose such research.
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Immunological research focuses on many of the diseases that most
threaten life and health: infectious diseases like HIV/AIDS, influenza
and avian flu, and malaria; and chronic diseases, like diabetes,
cancer, and autoimmune diseases. In recent years, immunologists have
also been studying the immune response to natural infectious organisms
that may be modified for use as agents of bioterrorism, including
plague, smallpox, and anthrax. As described below, this crucial work is
already bearing fruit.
RECENT SCIENTIFIC DISCOVERIES: BLOCKBUSTERS AND HOPE
The past year has brought tremendous advances in vaccine
development, with promising results in preliminary clinical trials of a
vaccine for HIV/AIDS. The vaccine has been shown to be safe and to
stimulate cellular immune responses against HIV in more than half of
the subjects. Scientists have also discovered that the chickenpox
vaccine can be given to adults in order to prevent the occurrence of
painful shingles in later years. The hallmark of recent vaccine
research was the final FDA approval of the first vaccine against
cancer, a vaccine for HPV (Human Papillomavirus). HPV infects over 8
percent of women aged 15-50 and can cause cervical cancer; the new
vaccine is efficacious both in preventing primary infection and
importantly, in reducing the incidence of cervical cancer.
Immunologists have also made novel insights into understanding
``innate'' or ``natural'' immune responses (those that do not require
immunization or prior exposure) and the role of soluble factors in
inflammation; this has helped scientists discover what appears to have
made the 1918 influenza strain so deadly. This discovery may lead to
more effective life-saving treatments for influenza patients and will
also have broader implications for diseases caused by pandemic
influenza, other viruses and bacteria. This and other such advances
depend on substantial, reliable, and sustained public investment in
basic immunological research.
but the nih budget has gone down, threatening ongoing progress
AAI is very grateful to this subcommittee and the Congress for its
successful bipartisan effort to double the NIH budget from fiscal year
1999 to fiscal year 2003. This unprecedented commitment by the Federal
Government to biomedical research allowed scientists to grow the
research enterprise and train new young investigators. Researchers had
begun to capitalize on many important advances, leading to increased
translational and clinical applications. Unfortunately, this momentum
has already been hampered by sub-inflationary budget increases since
fiscal year 2003.\5\ As a result, although the NIH budget has slightly
increased (from $27.067 billion in fiscal year 2003 to $28.931 billion
in fiscal year 2007), NIH has already lost about 8.5 percent in
purchasing power since fiscal year 2003. This loss in purchasing power,
which would grow to about 13.3 percent if the President's fiscal year
2008 budget were approved,\6\ is already having a devastating effect:
---------------------------------------------------------------------------
\5\ NIH funding increases since the doubling period ended [fiscal
year 2004 (3.03 percent), fiscal year 2005 (2.18 percent) and fiscal
year 2006 (-.12 percent)] have all been below the ``Biomedical Research
and Development Price Index (``BRDPI''), a U.S. Department of Commerce
annual estimate of the cost of inflation for biomedical research. U.S.
Department of Health and Human Services memo dated February 5, 2007:
``Biomedical Research and Development Price Index: Fiscal Year 2006
Update and Projections for Fiscal Year 2007-2012.'' http://
officeofbudget.od.nih.gov/PDF/BRDPI_letter_25_07.pdf http://
officeofbudget.od.nih.gov/BRDPI_2_5_07.pdf
\6\ The President's fiscal year 2008 budget cuts the NIH budget by
about $529 million.
---------------------------------------------------------------------------
1. Key NIH Institutes have already had to drop their RO1 paylines
to 10-14 percent, significantly below the approximately 22 percent
funded during the doubling. With funding so low, even outstanding grant
applications are not being funded on their first submission, forcing
even the most successful senior investigators to spend valuable time on
revising and resubmitting their applications.
2. The President's budget would provide no inflationary increases
for direct, recurring costs in non-competing Research Project Grants
(RPGs), for the 3rd straight year.
3. Although the fiscal year 2007 Joint Funding Resolution provides
$91 million to fund 1,500 first-time investigators, the President's
fiscal year 2008 budget will either be unable to sustain that promising
new effort, or will do so at the expense of funding established
investigators.
4. The President's budget would not permit increases in already
inadequate stipends and benefits for post-doctoral fellows, whose work
is critical to today's established investigators and who will be the
principal scientists of tomorrow.
The President's fiscal year 2008 budget would have rapid and long-
term adverse repercussions on Americans' health and the national
economy: in addition to their terrible human toll, disease and
disability cost society trillions of dollars annually in medical care,
lost wages and benefits, and lost productivity.\7\ The President's
budget would also jeopardize the future of the biomedical research
enterprise: our brightest young people will be deterred from pursuing
biomedical research careers if their chances of receiving an NIH grant,
or of being able to sustain a career as an NIH-funded scientist, do not
improve. If we are unable to attract and retain the best young minds,
the United States will lose more of its senior scientists, as well as
its preeminence in medical research, science, and technology, to
nations (including India, Singapore, and China) that are already
investing heavily in this essential economic sector.
---------------------------------------------------------------------------
\7\ National health expenditures cost $3.28 trillion in 2006 and
are projected to rise to $4.1 trillion in 2016. U.S. Department of
Health and Human Services--Centers for Medicare and Medicaid Services
National Health Expenditure Data http://www.cms.hhs.gov/
NationalHealthExpendData/downloads/proj2006.pdf http://www.cms.hhs.gov/
NationalHealthExpendData/downloads/highlights.pdf
---------------------------------------------------------------------------
AAI RECOMMENDS A 6.7 PERCENT BUDGET INCREASE FOR FISCAL YEAR 2008
AAI urges the subcommittee to increase the NIH budget by 6.7
percent ($1.9 billion) in fiscal year 2008, to $30.8 billion. This
increase, which is only 3 percent above the projected rate of
biomedical research inflation,\8\ would begin to restore the loss in
purchasing power that has occurred since the NIH budget doubling ended
in fiscal year 2003. (Full restoration will require that NIH also
receive 6.7 percent increases in fiscal year 2009 and fiscal year
2010.)
---------------------------------------------------------------------------
\8\ See Footnote 5, supra. The BRDPI for fiscal year 2008 is
projected to be 3.7 percent.
---------------------------------------------------------------------------
real and immediate threats: influenza and bioterrorism
Seasonal influenza leads to more than 200,000 hospitalizations and
about 36,000 deaths nationwide in an average year. Moreover, an
influenza pandemic as serious as the one that occurred in 1918 could
result in the illness of almost 90 million Americans and the death of
more than 2 million, at a projected cost of $683 billion.\9\ And yet,
while one potential pandemic influenza strain, H5N1 (avian influenza),
has already killed more than 150 people around the world, the
President's fiscal year 2008 NIH budget will permit NIAID to devote
only $223.2 million to influenza ($11.5 million more than fiscal year
2007). This is an insufficient increase for the agency with primary
responsibility for both the scientific research and clinical trials
needed to develop vaccines, antiviral drugs, and diagnostic tools to
combat both seasonal and pandemic influenza.\10\
---------------------------------------------------------------------------
\9\ A report issued by Trust for America's Health (``Pandemic Flu
and the Potential for U.S. Economic Recession'') predicts that a severe
pandemic flu outbreak could result in the second worst recession in the
United States since World War II, resulting in a drop in the U.S. Gross
Domestic Product of over 5.5 percent.
\10\ The Department of Health and Human Services Pandemic Influenza
Preparedness and Response Plan gives primary responsibility to NIH, and
specifically to NIAID.
---------------------------------------------------------------------------
AAI is also concerned that the President's fiscal year 2008 NIH
budget leaves inadequate funding for biodefense research; the $1.7
billion allocated represents a net decrease of 0.4 percent (4.1 percent
after accounting for projected inflation) from fiscal year 2007.
Although the availability of non-recurring construction costs will
allow NIAID to devote an additional $17 million to this research, this
inadequate increase is restricting research into the human response to
the many natural and man-made pathogens that could be used for
nefarious purposes.
AAI strongly believes that the best preparation for a pandemic or
bioterrorism is to focus on basic research: for a pandemic, the focus
should be on seasonal flu, including building capacity, pursuing new
production methods (cell based), and seeking optimized flu vaccines and
delivery methods. For bioterrorism, the focus should be on identifying
new pathogens, understanding the immune response, and developing tools
(including new and more potent vaccines) to protect against the
pathogen.\11\
---------------------------------------------------------------------------
\11\ The President's fiscal year 2008 HHS budget requests only $211
million for the Biomedical Advanced Research and Development Agency
(``BARDA''), a new agency established to foster the translation of NIH
research into development of medical and bioterrorism countermeasures.
AAI is concerned that if BARDA's budget is inadequate to support its
work, NIH may be forced to assume either duties or costs for BARDA.
---------------------------------------------------------------------------
The new ``National Institutes of Health (NIH) Reform Act of 2006''
The NIH Reform Act of 2006 calls for the establishment of a
Division of Portfolio Analysis and Strategic Initiatives to better
analyze NIH's portfolio, provide leadership and coordination for trans-
NIH research initiatives (including the NIH ``Roadmap for Medical
Research''), and fund new trans-NIH initiatives through a ``Common
Fund''. Although AAI supports this effort to improve NIH analysis and
management, AAI urges (1) that the funds allocated to the Common Fund
not grow faster than the overall NIH budget, and (2) that all Common
Fund awards/grants be awarded through a rigorous peer review process.
The NIH effort to require all grantees to give NIH author manuscripts
AAI strongly opposes any effort to require NIH grantees to submit
to NIH manuscripts reporting research funded by NIH. Rather, AAI
believes that NIH should partner with not-for-profit scientific
publishers to provide public access to NIH-funded research results
rather than to duplicate, at great cost to NIH and taxpayers, services
which are already provided cost-effectively and well by the private
sector. AAI urges the subcommittee to require NIH to work with the not-
for-profit scientific publishing community to develop a plan to enhance
public access that addresses publishers' concerns, including ensuring
journals' continued ability to provide high quality, independent peer
review of NIH-supported research.
Preserving high quality peer review and ensuring the independence of
science
Millions of lives--as well as the prudent use of taxpayer dollars--
depend on the independence of scientists and the willingness of
government officials to accept the best, most independent scientific
advice available. AAI urges this subcommittee to ensure that funds
expended enhance the ability of scientists to provide independent
scientific advice (particularly on government advisory panels) and to
ensure the vigor of peer review, whether through the NIH peer review
system or by supporting the vitality of independent scientific journals
which provide independent, expert peer review of taxpayer funded
research.
Ensuring NIH operations and oversight
AAI is concerned that the President's fiscal year 2008 budget
proposal for Research, Management and Services (RM&S), which supports
the management, monitoring, and oversight of all research activities
(including NIH's peer review process), receives an increase of only $10
million (89 percent). AAI urges the subcommittee to explore whether
this sub-inflationary increase will harm NIH's ability to supervise a
portfolio of increasing size and complexity, and to ensure that NIH
funds are well and properly spent.
CONCLUSION
AAI greatly appreciates this opportunity to submit testimony and
thanks the members of the subcommittee for their strong support for
biomedical research, the NIH, and the scientists who devote their lives
to preventing, treating, and curing disease.
______
Prepared Statement of the American Association of Museums
Chairman Harkin, Senator Specter and distinguished members of the
subcommittee, the American Association of Museums (AAM) appreciates the
opportunity to submit testimony on the fiscal year 2008 budget for the
museum program at the Institute of Museum and Library Services (IMLS).
This agency is the primary Federal entity devoted to assisting museums
in fulfilling their role as centers for lifelong learning for all
Americans. We respectfully request your approval of the
administration's budget request of $39.897 million for grants to
museums administered through the Office of Museum Services and the
agency's overall budget request of $271.246 million, which reflects a
strong endorsement of the vital public service role museums play in
their communities.
The American Association of Museums has been bringing museums
together since 1906, helping to develop standards and best practices,
gathering and sharing knowledge, and providing advocacy on issues of
concern to the entire museum community. AAM currently represents more
than 15,000 individual museum professionals and volunteers, 3,000
institutions, and 300 corporate members.
Our Nation's museums are vital community assets. With more than
17,000 institutions collectively holding our Nation's cultural and
natural heritage, they serve as a catalyst for our citizens to pursue a
greater understanding of the world around them. Every day museums save
the memories of our civilization and help create new memories for our
visitors. We feed preschoolers' imaginations at children's museums;
engage elementary school students in learning about art, history and
science; provide teenagers and college students with opportunities to
share new found knowledge as tour guides and floor staff; stimulate
adult learning with lectures on wide array of topics; and offer
grandparents a place to share memories and stories with their
grandchildren.
Within your own State, you could easily name with pride the many
museums in the communities you serve such as the Dubuque County
Historical Society's Mississippi River Museum and Aquarium in Iowa or
the Franklin Institute in Philadelphia. The vast majority of museums
operate as private nonprofit organizations with nominal government
funding unlike other community assets such as schools and libraries.
According to our most recent financial survey, nonprofit museums
receive approximately 16 percent of their budget from local, State, and
the Federal Government. The bulk of their income is derived from
private philanthropy in the form of donations, grants and corporate
sponsorships and earned income from admission and gift shop sales.
It is critical, therefore, that the Federal Government continue to
show leadership by supporting investments to advance America's museums
in four important areas--caring for and conserving our collections,
improving museum programs and operations, supporting museum
professional's development, and conducting research and collecting data
to help policymakers, museum trustees and leaders make smart decisions.
CARING FOR AND CONSERVING OUR COLLECTIONS
The Heritage Health Index, an example of IMLS-supported research,
documented the condition of America's collections held in our Nation's
museums, libraries, archives, historical societies and scientific
research organizations. It is the first comprehensive survey ever
conducted of the condition and preservation needs of our Nation's
collections. Through the survey we learned that more than 630 million
artifacts--works of art, historic objects, photographs, natural science
specimens, books and periodicals--are at risk and require immediate
attention and care.
As a result of this study, IMLS has made a commitment to increase
public awareness and support for collections care. A national
conservation summit will be held here in Washington this spring with
future forums planned in four cities across the country to discuss this
issue. We are excited at the prospect of increasing attention to this
issue, as museums are responsible for the care of hundreds of millions
of works of art, artifacts, and scientific specimens, which continue to
grow in numbers.
Information related to collections stewardship continues to be the
most frequently requested area where AAM members seek guidance on
professional standards and best practices. Resources for collections
care are often limited, especially in our small and mid-size
institutions, due in part to the behind-the-scenes nature of the work.
It is not well understood by the public and private funders. We are
hopeful that a renewed commitment to and increased public awareness
will bring new resources to museums to address the preservation and
conservation needs that make public exhibitions possible.
IMLS assists museums with collections issues by providing
consultation services through the Conservation and Museum Assessment
Programs and financial assistance through the Conservation Project
Support program to help ensure some basic safekeeping of museum
collections. The demand for this support regularly exceeds the funds
available. In fiscal year 2006, IMLS received 144 grant applications
and funded only 40 projects. Recipients matched the nearly $2.8 million
IMLS awarded with an additional $4.6 million. The grants are helping
these museums examine, document, treat, stabilize, and restore their
collections. For example, IMLS supported a detailed conservation survey
by the Putnam Museum of History and Natural Science in Davenport, Iowa
of its approximately 800 lacquered and wood objects in their Japanese
and Chinese collections.
IMPROVING MUSEUM PROGRAMS AND OPERATIONS
Since its inception, AAM has served as a forum for discussing,
developing, disseminating, and measuring museum performance standards.
In 1967, President Lyndon B. Johnson asked the U.S. Federal Council on
the Arts and Humanities to conduct a study on the status of American
museums and recommend ways to support and strengthen them. From this
study, America's Museums: The Belmont Report, the AAM accreditation
program was born. In 1971 AAM first recognized the achievement of 16
museums in meeting the highest standards of the profession. The
Accreditation program continues to evolve. Over the past three decades,
the program has been a critical tool in advancing the entire museum
field, insured transparency and good governance to help museums operate
in the best interest of the public.
As our partner in helping museums achieve excellence, IMLS has
supported the Museum Assessment Program (MAP). MAP helps museums
maintain and improve their operations. Museums participating in the
program learn their strengths and weaknesses, receive guidance on how
to improve their operations and set institutional priorities. The
public benefits by having museums that are striving to improve their
operations so they are in a better position to serve them through their
public programs and fulfilling their collections stewardship
responsibilities.
IMLS also supports museums in their efforts to continue to improve
and expand their public service through the Museums for America
program. In the program's first 3 years, fiscal year 2004-fiscal year
2006, more than 500 grants totaling $50.2 million have been awarded.
The flexibility of the program has been invaluable to our museums. It
allows them to apply for funds to address those high-priority
activities that advance their institution's strategic plans. Grants
have helped museums deal with a range of issues such as behind-the-
scenes collections management projects and staff training, investments
in digital technology to broaden public access, planning new public
programs, and improving visitor experiences. In fiscal year 2006, the
agency received 425 eligible grant applications and only 177 awards
could be made.
Among those who were successful, the Children's Museum of
Pittsburgh received support for improving its ``Real Stuff'' exhibits
which are at the heart of the museum. The museum is seeking to make
changes to areas which have low levels of visitor engagement.
Modifications and new exhibits will be based on evaluations from its
partnership with the University of Pittsburgh Center for Learning in
Out-of-School Environments.
SUPPORTING MUSEUM PROFESSIONAL DEVELOPMENT
While museums have long supported the public pursuit of lifelong
learning, the staff of museums must also continue to learn. Building
the 21st century museum workforce is critical to ensure that museums
have both intellectual leadership and financial stability to carry out
their mission. The skills required of today's museum directors have
changed. In the past, trustees sought individuals with a scholarly
knowledge in the area of the museum's collection. Today museum boards
are primarily looking for strategic thinkers, excellent communicators,
and outstanding fundraisers who have energy, creativity, and an
entrepreneurial focus. Museum operations have grown more complex and
their leaders need much broader business skills.
Successful museum directors also need capable professionals who
have the skills and knowledge to both move the institution forward and
attend to the daily operations of running a museum. According to AAM's
most recent financial survey, the median number of employees in a
museum is 6 full-time and 4 part-time paid staff with 60 volunteers.
This includes curators, educators, registrars, accountants, marketing
and development professionals with some wearing more than one hat.
Unlike our business counterparts, nonprofit museums are not investing
time and money to develop and train their staff. Unfortunately,
resources for training and career development are scarce. We see this
as a looming problem as museums compete with other nonprofits to find
and hire future leaders from a shrinking pool of qualified applicants.
In creating the 21st Century Museum Professionals program, IMLS is
just beginning to help our field identify strategies for addressing
these challenges. In the first year of the program, IMLS received 55
applications but only had the resources to award four grants. There is
much work to be done. We urge you to provide the $2.14 million request
by the agency and to consider increasing future investment in workforce
development substantially.
CONDUCTING RESEARCH AND COLLECTING DATA
It is critical for IMLS to conduct research that assists museum
professionals in making critical decisions about their daily
operations, demonstrating their public value, ensuring their long-term
viability and most effectively meet the needs of the diverse
communities they serve. We need basic census data about museums, such
as how many museums there are in the United States, how many people
work in museums (both paid, professional staff and volunteers), and how
many people visit museums annually. A commitment to regular data
collection is critical to identifying trends that would inform
decision-making by IMLS and the museum community.
For example the 2002 IMLS study, ``True Needs, True Partners'',
about museums serving schools, documented not only the growth in the
number of schools, students and teachers served, but also the changing
nature of the services provided by museums. This research has helped
museum professionals and their school partners understand the evolving
nature of their work and documented the growing financial commitment
museums have made to public education and how museums have expanded the
learning experience for K-12 students.
A number of other topics should be the subject of future research,
such as: measuring the social contributions of museums at the national
level; studying the skills necessary to be a 21st century museum
professional; supporting field research that collects core data, such
as financial benchmarks and attendance figures; and examining areas of
special interest to segments of the museum field. We need this
information and data so that museum leaders and trustees, policy makers
at all levels of government and private funders can make informed
decisions about the future of our Nation's more than 17,000 museums.
CONCLUSION
We recognize that you face difficult choices in allocating
resources. Our appeal is to ask you to consider what we lose if we do
not continue to invest in our Nation's museums. The public places a
great trust in our ability to preserve not only physical artifacts, but
more importantly the stories and memories of our people and our Nation.
We need museums where you can learn about the past and dream of the
future, explore the smallest bugs to the vast expanses of our universe,
and experience awe and wonder in the beauty of our world. We cannot do
this alone. Working together we can and will continue to inspire future
generations of citizens to become thoughtful leaders, creative
entrepreneurs, scientists, artists and educators.
______
Prepared Statement of the American Association of Nurse Anesthetists
The AANA is the professional association for more than 36,000
Certified Registered Nurse Anesthetists (CRNAs) and student nurse
anesthetists representing over 90 percent of the nurse anesthetists in
the United States. Today, CRNAs are directly involved in delivering 27
million anesthetics given to patients each year in the United States.
CRNA services include administering the anesthetic, monitoring the
patient's vital signs, staying with the patient throughout the surgery,
as well as providing acute and chronic pain management services. CRNAs
provide anesthesia for a wide variety of surgical cases and are the
sole anesthesia providers in almost 70 percent of rural hospitals,
affording these medical facilities obstetrical, surgical, and trauma
stabilization, and pain management capabilities. CRNAs work in every
setting in which anesthesia is delivered including hospital surgical
suites and obstetrical delivery rooms, ambulatory surgical centers
(ASCs), pain management units and the offices of dentists, podiatrists
and plastic surgeons.
Nurse anesthetists are experienced and highly trained anesthesia
professionals whose record of patient safety in the field of anesthesia
was bolstered by the Institute of Medicine report that found in 2000,
that anesthesia is 50 times safer than 20 years previous. (Kohn L,
Corrigan J, Donaldson M, ed. To Err is Human. Institute of Medicine,
National Academy Press, Washington, DC, 2000.) Nurse anesthetists
continue to set for themselves the most rigorous continuing education
and re-certification requirements in the field of anesthesia. Relative
anesthesia patient safety outcomes are comparable among nurse
anesthetists and anesthesiologists, with Pine having recently
concluded, ``the type of anesthesia provider does not affect inpatient
surgical mortality.'' (Pine, Michael MD et al. Surgical mortality and
type of anesthesia provider. Journal of American Association of Nurse
Anesthetists. Vol. 71, No. 2, p. 109-116. April 2003.) Even more
recently, obstetrical anesthesia, whether provided by Certified
Registered Nurse Anesthetists (CRNAs) or anesthesiologists, is
extremely safe, and there is no difference in safety between hospitals
that use only CRNAs compared with those that use only
anesthesiologists, according to the results of a new study published in
the January/February issue of Nursing Research (Vol. 56, No. 1, pp. 9-
17). In addition, a recent AANA workforce study's data showed that
CRNAs and anesthesiologists are substitutes in the production of
surgeries. Through continual improvements in research, education, and
practice, nurse anesthetists are vigilant in their efforts to ensure
patient safety.
CRNAs provide the lion's share of the anesthesia care required by
our U.S. Armed Forces through active duty and the reserves, from here
at home to the leading edge of the field of battle. In May 2003, at the
beginning of ``Operation Iraqi Freedom'' 364 CRNAs were deployed to the
Middle East to ensure military medical readiness capabilities. For
decades, CRNAs have staffed ships, remote U.S. military bases, and
forward surgical teams without physician anesthesiologist support.
IMPORTANCE OF TITLE VIII NURSE ANESTHESIA EDUCATION FUNDING
The nurse anesthesia profession's chief request of the subcommittee
is for $4 million to be reserved for nurse anesthesia education and $76
million for advanced education nursing from the Title VIII program.
This sustained funding is justified by two facts. First, there is a
vacancy rate of nurse anesthetists in the United States impacting
people's healthcare. Second, the Title VIII program, which has been
strongly supported by members of this subcommittee in the past, is an
effective means to help address the nurse anesthesia workforce demand.
This demand for CRNAs is something that the nurse anesthesia profession
addresses every day with success, and with the critical assistance of
Federal funding through HHS' Title VIII appropriation.
The administration's 2008 budget eliminates funding for Advanced
Education Nursing. We believe that nursing and nursing education
workforce needs are such that this funding must not be eliminated, but
preserved and increased for 2008 to meet patient care needs.
The increase in funding for advanced education nursing from $58
million to $76 million is necessary to meet the continuing demand for
nursing faculty and other advanced education nursing services
throughout the United States. Only a limited number of new programs and
traineeships can be funded each year at the current funding levels. The
program provides for competitive grants and contracts to meet the costs
of projects that support the enhancement of advanced nursing education
and practice and traineeships for individuals in advanced nursing
education programs. This funding is critical to the efforts to meet the
nursing workforce needs of Americans who need healthcare.
In 2003, the AANA conducted a nurse anesthesia workforce study that
found a 12 percent vacancy rate in hospitals for CRNAs, and a lower
vacancy rate in ambulatory surgical centers. The supply has increased
in recent years, stimulated by increases in the number of CRNAs
trained. However, there is a reasonable question of whether these
increases are enough to offset the number of CRNAs intending to retire
over the next few years. The retirement of baby boomers, both among
patients and CRNAs alike, requires a continuous growth in the number of
nurse anesthesia graduates to meet anticipated demand for anesthesia
services.
The problem is not that our 105 accredited programs of nurse
anesthesia are failing to attract qualified applicants. They have to
turn them away by the hundreds, because the capacity of nurse
anesthesia educational programs to educate qualified applicants is
limited by the number of faculty, the number and characteristics of
clinical practice educational sites, and other factors. A qualified
applicant to a CRNA program is a bachelor's educated registered nurse
who has spent at least 1 year serving in an acute care healthcare
practice environment. Nurse anesthesia educational programs are located
all across the country including the following:
------------------------------------------------------------------------
No. of
Accredited
State Nurse
Anesthesia
Programs
------------------------------------------------------------------------
PA...................................................... 12
FL...................................................... 8
OH...................................................... 5
TX...................................................... 5
IL...................................................... 5
NY...................................................... 4
CA...................................................... 3
CT...................................................... 3
MD...................................................... 3
RI...................................................... 2
WI...................................................... 1
------------------------------------------------------------------------
Recognizing the importance of nurse anesthetists to quality
healthcare, the AANA has been working with the 105 accredited programs
of nurse anesthesia to increase the number of qualified graduates. In
addition, the AANA has worked with nursing and allied health deans to
develop new CRNA programs.
The Council on Certification of Nurse Anesthetists (CCNA) reports
that in 1999, our schools produced 948 new graduates. In 2005, that
number had increased to 1,790, an 89 percent increase in just 5 years.
This growth is expected to continue. The CCNA projects CRNA programs to
produce over 2,000 graduates in 2007.
To truly meet the nurse anesthesia workforce challenge, the
capacity and number of CRNA schools must continue to expand. With the
help of competitively awarded grants supported by Title VIII funding,
the nurse anesthesia profession is making significant progress,
expanding both the number of clinical practice sites and the number of
graduates.
The AANA is pleased to report that this progress is extremely cost-
effective from the standpoint of Federal funding. Anesthesia can be
provided by nurse anesthetists, physician anesthesiologists, or by
CRNAs and anesthesiologists working together. As mentioned earlier, the
study by Pine et al confirms, ``the type of anesthesia provider does
not affect inpatient surgical mortality.'' Yet, for what it costs to
educate one anesthesiologist, several CRNAs may be educated to provide
the same service with the same optimum level of safety. Nurse
anesthesia education represents a significant educational cost/benefit
for supporting CRNA educational programs with Federal dollars vs.
supporting other models of anesthesia education.
To further demonstrate the effectiveness of the Title VIII
investment in nurse anesthesia education, the AANA surveyed its CRNA
program directors in 2003 to gauge the impact of the Title VIII
funding. Of the eleven schools that had reported receiving competitive
Title VIII Nurse Education and Practice Grants funding from 1998 to
2003, the programs indicated an average increase of at least 15 CRNAs
graduated per year. They also reported on average more than doubling
their number of graduates, who provide care to patients during and
following their education. Moreover, they reported producing additional
CRNAs that went to serve in rural or medically underserved areas. Under
both of these circumstances, an increased number of student nurse
anesthetists and CRNAs are providing healthcare to the people of
medically underserved America.
We believe it is important for the subcommittee to allocate $4
million for nurse anesthesia education for several reasons. First, as
this testimony has documented, the funding is cost-effective and well
needed. Second, the Title VIII authorization previously providing such
a reserve expired in September 2002. Third, this particular funding is
important because nurse anesthesia for rural and medically underserved
America is not affected by increases in the budget for the National
Health Service Corps and community health centers, since those
initiatives are for delivering primary and not surgical healthcare.
Lastly, this funding meets an overall objective to increase access to
quality healthcare in medically underserved America.
TITLE VIII FUNDING FOR STRENGTHENING THE NURSING WORKFORCE
The AANA joins a growing coalition of nursing organizations,
including the Americans for Nursing Shortage Relief (ANSR) Alliance and
representatives of the nursing community, and others in support of the
subcommittee providing a total of $200 million in fiscal year 2008 for
nursing shortage relief through Title VIII. This amount is
approximately $51 million over the fiscal year 2007 level and $95
million above the President's fiscal year 2008 budget.
Every district in America is familiar with the importance of
nursing. The AANA appreciates the support for nurse education funding
in fiscal year 2007 and past fiscal years from this subcommittee and
from the Congress.
The need for strengthening nurse educational funding to strengthen
our healthcare is clear. According to the Office of the Actuary at the
Centers for Medicare & Medicaid Services, America spent about $2
trillion on healthcare in the most recent year for which the agency had
records, the year 2005. About $342 billion of that was from Medicare
outlays. Medicaid spending was $313 billion. The Congressional Budget
Office States that Medicare directs about $8.7 billion of its outlays
to Graduate Medical Education (GME), of which $2.3 billion was Direct
GME. Approximately 99 percent of that educational funding helps to
educate physicians and allied health professionals, and about 1 percent
is allocated to help educate nurses.
In the interest of patients past and present, particularly those in
rural and medically underserved parts of this country, we ask Congress
to reject cuts from Federal investments in CRNA and nursing educational
funding programs, and to provide these programs the sustained increases
required to help ensure Americans get the healthcare that they need and
deserve. Quality anesthesia care provided by CRNAs saves lives,
promotes quality of life, and makes fiscal sense. This Federal support
for nurse education will improve patient access to quality services and
strengthen the Nation's healthcare delivery system.
Thank you.
______
Prepared Statement of the American Brain Coalition
INTRODUCTION
The National Institutes of Health (NIH) is the world's leader in
medical discoveries that improve people's health and save lives. NIH-
funded scientists investigate ways to prevent, treat, and even cure the
complex diseases of the brain. Because there is much work still to be
done, the American Brain Coalition writes to ask for your support for
biomedical research funding at NIH.
WHAT IS THE AMERICAN BRAIN COALITION?
The American Brain Coalition (ABC) is a nonprofit organization that
seeks to reduce the burden of brain disorders and advance the
understanding of the functions of the brain. The ABC, made up of nearly
50 member organizations, brings together afflicted patients, the
families of those that suffer, the caregivers, and the professionals
that research and treat diseases of the brain.
The brain is the center of human existence, and the most complex
living structure known. As such, there are thousands of brain diseases
from Rett Syndrome and autism to dystonia and Parkinson's disease. ABC,
unlike any other organization, brings together people affected by all
diseases of the brain.
The ABC is working toward the same level of public awareness and
support for diseases of the brain that has been achieved by the
American Heart Association and the American Cancer Society. Fifty
million Americans--our relatives, friends, neighbors, and your
constituents--are affected by diseases of the brain. Our goal is to be
a united voice for these patients, and to work with Congress to
alleviate the burden of brain disease. A large part of that goal
involves support for NIH research.
THANK YOU FOR PAST SUPPORT
The American Brain Coalition would like to thank the members of
this subcommittee for their past support, which resulted in the
doubling of NIH budget between 1998 and 2003.
In addition, we are extremely grateful that the fiscal year 2007
Joint Resolution included an additional $620 million for NIH above the
fiscal year 2006 funding level. This additional money will allow NIH to
award an extra 500 research grants. It will also create a new program
to support innovative, outside-the-box research, as well as to provide
grants to first-time investigators.
The doubling of the NIH budget produced advances in the Nation's
health. Since 2003, however, many policymakers have mistakenly come to
think that NIH ``has been taken care of.'' As a result, NIH has been
relatively flat funded since that time.
Despite the doubling of the budget and the many advances in
scientific knowledge, there is still much work to be done to uncover
the mysteries of the brain. The recent start-stop funding approach has
made efficient research planning extremely difficult, has disrupted
steady progress, and must be reversed.
NIH-FUNDED RESEARCH SUCCESSES
Today, scientists have a greater understanding of how the brain
functions due to NIH-funded research. The following are just a few
areas where research efforts have improved the health of the American
public:
--Post Traumatic Stress Disorder (PTSD).--Experiencing or witnessing
a crime, terrorist attack, being a victim of sexual abuse, or
military combat can lead to a form of stress that can last a
life-time. Termed, PTSD, the condition afflicts 5.2 million
Americans aged 18 to 54 each year. Its social and economic
costs can be devastating. Almost half of the Vietnam veterans
with PTSD have been arrested or jailed. With the ongoing wars
in Iraq and Afghanistan, the incidence of PTSD is rising.
For years it was thought that those who survived or witnessed a
trauma should be able to tough it out and move on. But NIH-
funded studies helped reveal that PTSD is a serious brain
disorder with biological underpinnings. For example, scientists
determined that the part of the brain involved in learning,
memory, and emotion appears to be smaller in people with PTSD
and that levels of some brain chemicals are altered. These
changes are believed to be caused by increased stress hormones
from a traumatic event and by the constant reliving of the
event.
New understanding of the disorder paved the way for use selective
serotonin reuptake inhibitors in treating PTSD. Studies funded
by NIH found that these drugs ease the symptoms of depression
and anxiety and improve the memory of patients with PTSD,
helping them better deal with traumatic memories. Talking with
a counselor or therapist can also help PTSD victims to cope.
--Multiple Sclerosis.--Multiple sclerosis (MS) strikes people during
the prime of their lives, right as they are settling into their
careers and families. About 400,000 Americans have multiple
sclerosis, and every week an estimated 200 more are diagnosed.
Multiple sclerosis costs Americans $9.5 billion in medical care
and lost productivity each year.
In multiple sclerosis, the immune system for unknown reasons
mistakenly destroys the protective myelin covering around
nerves. Without myelin, electrical signals are transmitted more
slowly or not at all from the brain to the body, causing
weakness, tremors, pain, and loss of feeling.
Fortunately, research funded by the NIH and others over the past
two decades has led to many advances that allow physicians to
diagnose MS earlier and better track its progress so that
treatments can be more effective. Imaging techniques such as
magnetic resonance imaging and magnetic resonance spectroscopy
provide a window on the brain that allows physicians to better
predict relapses and thus plan for patients' care.
In addition to steroids used in the past to reduce the duration
and severity of attacks, there are now other drugs like
interferon, glatiramer acetate, and mitoxantrone that can
decrease disease severity. Studies have shown that these drugs
can make relapses less frequent and severe and delay further
damage from the disease.
--Alcoholism.--Excess consumption of alcohol can ruin a person's
health, family life, and career. It also makes the world more
dangerous for the rest of society. Many accidents, assaults,
and robberies involve alcohol use by the offender. Society also
pays a high financial price. Alcohol-related problems cost the
country an estimated $185 billion per year.
Until recently, there were not many options to help keep problem
drinkers off alcohol. Fortunately, the outlook is improving
steadily with the development of new medications and therapies.
NIH-funded scientists discovered evidence that alcohol acts on
several chemical systems in the brain to create its alluring
effects. On the basis of these studies, the drug naltrexone--
which targets one of these systems, called the opioid system--
was approved as a treatment for alcoholism in the mid-1990s.
Alcohol's effect on the opioid system is thought to produce the
euphoric feelings that make a person want to drink again.
Naltrexone can block this reaction and help cut cravings for
alcohol in some alcoholic individuals.
Congressional investments in research have lead to significant
improvements in patient care.
RESEARCH IMPROVES HEALTH AND FUELS THE ECONOMY
Diseases of the nervous system pose a significant public health and
economic challenge, affecting nearly one in three Americans at some
point in life. Improved health outcomes and positive economic data
support the assertion that biomedical research is needed today to
improve public health and save money tomorrow.
Research drives innovation and productivity, creates jobs, and
fuels local and regional economies. In fiscal year 2003, the University
of Wisconsin Madison brought over $228 million into the State from NIH-
funded research.
Not only does research save lives and fuel today's economy, it is
also a wise investment in the future. For example, 5 million Americans
suffer from Alzheimer's disease today, and the cost of caring for these
people is staggering. Medicare expenditures are $91 billion each year,
and the cost to American businesses exceeds $60 billion annually,
including lost productivity of employees who are caregivers. As the
baby boom generation ages and the cost of medical services increases,
these figures will only grow. Treatments that could delay the onset and
progression of the disease by 5 years could save $50 billion in
healthcare costs each year. Research funded by the NIH is critical for
the development of such treatments. The cost of investing in NIH today
is minor compared to both current and future healthcare costs.
PRESIDENT'S BUDGET NEGATIVELY IMPACTS RESEARCH
Mr. Chairman, inflation has eaten into the NIH budget. The NIH now
projects the Biomedical Research and Development Price Index (BRDPI)
may increase by 3.7 percent for both fiscal year 2007 and fiscal year
2008; 3.6 percent for fiscal year 2009 and 2010; and 3.5 percent for
fiscal year 2011 and fiscal year 2012.
Unfortunately, the President's fiscal year 2008 budget request for
NIH did not factor in the increases in biomedical research inflation.
In fact, his budget proposes to cut funding for the National Institutes
of Health by more than a half billion dollars in fiscal year 2008.
FISCAL YEAR 2008 RECOMMENDATION
The American Brain Coalition supports a 6.7 percent increase in
funding for the National Institutes of Health in fiscal year 2008.
Additionally, ABC supports a 6.7 percent increase in funding in per
year in fiscal years 2009 and 2010.
This sustained increase is necessary to make-up for lost purchasing
power that has occurred in the past 3 years. In addition, it will help
the NIH to achieve its broad research goals and provide hope for those
people affected with neurological and psychiatric disorders.
Mr. Chairman, thank you for the opportunity to submit testimony
before this subcommittee.
______
Prepared Statement of the American College of Cardiology
The American College of Cardiology (ACC) appreciates the
opportunity to provide the subcommittee with recommendations for fiscal
year 2008 funding for life-saving cardiovascular research and public
education. The ACC is a 34,000 member non-profit professional medical
society and teaching institution whose mission is to advocate for
quality cardiovascular care through education, research promotion,
development and application of standards and guidelines, and to
influence health care policy.
THE NEED FOR A FEDERAL INVESTMENT IN CARDIOVASCULAR DISEASE RESEARCH
Cardiovascular disease continues to be the leading cause of death
for both women and men in the United States, killing more than 870,000
Americans each year. While the number of deaths due to cardiovascular
disease is on the decline, more than one in three Americans lives with
some form of heart disease. The economic impact of cardiovascular
disease on the U.S. health care system continues to grow as the
population ages and as the prevalence of it increases, costing the
Nation an estimated $430 billion in 2007 alone due to medical expenses
and lost productivity.\1\
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\1\ American Heart Association. Heart Disease and Stroke
Statistics--2007 Update. Dallas, Texas: American Heart Association;
2007.
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The ACC is extremely concerned that the cuts proposed in the
administration's fiscal year 2008 budget for many critical health
agencies, particularly the National Institutes of Health (NIH), will
negatively impact cardiovascular care. The doubling of the NIH budget
from 1999 to 2003 resulted in a surge in demand for research grants. In
recent years, the combination of inflation and stagnant Federal funding
has threatened the laboratories and continuing research of established
investigators and, by signaling a lack of Federal commitment to
consistent funding, will discourage new investigators and new research
initiatives.
The ACC encourages Congress to provide a strong Federal investment
in research and public education that addresses cardiovascular disease.
Federal research is providing for breakthrough advances that
fundamentally change our understanding of the prevention and treatment
of cardiovascular disease, leading to better outcomes, decreased costs,
and increased quality of life for patients.
FUTURE CARDIOVASCULAR DISEASE RESEARCH NEEDS
As the health system continues its move toward using performance
measurement to foster the delivery of the highest quality of care to
patients, the need for meaningful clinical guidelines, from which
performance measures are developed, becomes even more critical.
The performance measures that will be used to determine whether
patients are receiving the most effective, efficient, and highest
quality cardiovascular care are derived from clinical guidelines
developed by the ACC and the American Heart Association (AHA). The ACC
strives to produce the preeminent medical specialty practice
guidelines, with more than 15 guidelines on a range of cardiovascular
topics. They are developed through a rigorous, evidence-based
methodology employing multiple layers of review and expert
interpretation of the evidence on an ongoing, regular basis. Many
clinical research questions remain unanswered or understudied, however.
In fact, the percent of guideline recommendations that are based on
expert opinion rather than clinical data vary by cardiovascular topic
from only 20 percent for coronary bypass surgery to over 70 percent for
valvular heart disease.
To this end, through its clinical policy development process, the
ACC has identified knowledge gaps for cardiovascular disease. These
unresolved issues, if addressed, have great potential to impact patient
outcomes, costs, and the efficiency of care delivery. The ACC strongly
supports and stands committed to assist the National Heart, Lung and
Blood Institute (NHLBI) in fulfilling its strategic plan by helping to
promote the development and speedy implementation of evidence-based
clinical guidelines in a manner that impacts health outcomes. All
medicine includes a degree of uncertainty about the ability of a
particular procedure, device, or therapy to benefit a patient. Yet, an
investment in answering the following scientific questions through the
NIH, and in particular the NHLBI, as well as through the Agency for
Healthcare Research and Quality (AHRQ), will help to better narrow the
target population who can benefit from treatment and therefore increase
the efficacy and efficiency of the care delivered.
1. What is the effect of common cardiovascular therapies on elderly
populations whose metabolism and kidney function is lower and may not
respond to medications in the same way as the younger patients
typically included in clinical trials?
2. What is the effect of common cardiovascular therapies on
patients with multiple other diseases/conditions?
3. What are the best approaches to increasing patient compliance
with existing therapies?
4. What screening and risk models (existing or new) could further
define who will benefit from various therapies?
5. What are the optimal management strategies for anticoagulation
and antiplatelet agents in heart attack patients, patients with stents,
and atrial fibrillation patients to maximize benefit and reduce
bleeding risks?
6. What are the best approaches to managing complex but
understudied cardiovascular topics such as congenital heart disease and
valvular heart disease? Both congenital heart disease and valvular
heart disease have become areas of higher research interest as
techniques have developed to extend the lives of these patients.
7. What are the risks and benefits of common off-label uses of
widely used therapies and procedures, such as drug eluting stents?
8. What are the best catheter-based techniques to increase
treatment success and reduce complications for both coronary and
cardiac rhythm procedures?
The list of topics above is not exhaustive but provides an overview
of some of the general themes of the evidence gaps that exist across
the ACC's current guidelines. In addition to specific clinical research
topics, the ACC recommends funding to help address two structural
issues that could help identify, prioritize, and interpret research
findings over the long term:
1. The NHLBI should work with the clinical cardiology community to
proactively design clinical trials to address unanswered clinical
questions and identify methods that allow for greater comparability
among studies. NHLBI should work with ACC and the AHA to develop an
evidence model that would drive future research initiatives based on
current evidence gaps in the guidelines; and
2. NIH should fund the development of a robust informatics
infrastructure across Institutes to process research evidence. Studies
should be designed such that their results could be ``fed'' into a
computer model that would provide additional insights for developers of
clinical recommendations.
COLLABORATING TO IMPROVE CARDIOVASCULAR CARE AND OUTCOMES
Facilitating the transfer of new knowledge to health care
professionals, patients and the public is an important aspect of
Federal research efforts. One example of NHLBI's success in this area
is the launch last year of the new Peripheral Arterial Disease (P.A.D.)
national campaign to increase public and health care provider awareness
of P.A.D. and its association with other cardiovascular diseases. As
the leader in developing the P.A.D. Guidelines, the ACC is proud to
collaborate with the NHLBI on the ``Stay in Circulation: Take Steps to
Learn about P.A.D.'' campaign. The ACC is promoting this important
campaign through our membership and has formed a P.A.D. Guidelines
Implementation Task Force that has developed tools--including wall
charts, webcasts, and slide sets--to help physicians diagnose and treat
the more than 8 million Americans affected by the disease.
NHLBI and AHRQ also have been important supporters of the ``D2B: An
Alliance for Quality'' program. The D2B Alliance is a Guidelines
Applied in Practice (GAP) program launched by the ACC to save time and
save lives by reducing the door-to-balloon times in U.S. hospitals
performing primary percutaneous coronary intervention (PCI) by
providing hospitals with key evidence-based strategies and supporting
tools needed to begin reducing their D2B times.
Through its Centers for Education and Research on Therapeutics
(CERT), AHRQ has been crucial in helping fund research by ACC on its
clinical policy development process. The CERT grant provided resources
to help ACC better understand and adapt how its guidelines and
performance measures are developed and disseminated. It also provided
resources to support the development of a framework for ACC to address
appropriateness of medical technology. This evaluation of ACC processes
for the development of clinical policy has been an essential part of
translating research from bench to bedside.
Recently, ACC leadership met with the NHLBI Director and senior
staff to discuss opportunities to collaborate on current and future
efforts. One initiative identified as a unique opportunity to make a
positive impact on health care quality involves enhancing the NHLBI's
Center for the Application of Research Discoveries (CARD) through the
use of health information technology--namely by drawing on the ACC's
substantial expertise, from the National Cardiovascular Data Registry,
in developing and operating electronic data registries. Bringing the
latest discoveries in cardiovascular care to the bedside is a critical
mission of the NHLBI and is shared by the ACC. Sufficient funding from
Congress can foster such efforts by the NHLBI and its partners to
provide patients with effective cutting-edge care that also holds the
promise of reducing health care costs.
ACC FUNDING RECOMMENDATIONS
As the subcommittee considers its appropriations for programs
within the Department of Health and Human Services, the ACC urges
support of the following fiscal year 2008 funding recommendations:
National Institutes of Health
The ACC, along with the broad medical community, supports an fiscal
year 2008 NIH budget of $30.869 billion that would help get the NIH
``back on track.'' Research conducted through the NIH has resulted in
better diagnosis and treatment of cardiovascular disease, thereby
improving the quality of life for those living with the disease and
lowering the number of deaths attributable to it. Adequate funding
through the NIH is necessary for basic, clinical, and translational
research that facilitates the delivery of new discoveries to the
bedside.
National Heart Lung and Blood Institute
The ACC recommends $3.1 billion for the NHLBI in fiscal year 2008
for continuing its critical research into the causes, treatment, and
prevention of cardiovascular disease. Congress must maintain its
investment in NHLBI to continue the great strides already being made in
fighting cardiovascular disease. If accepted without an increase, the
administration's budget request for NHLBI would critically impact the
institute's ability to fund valuable initiatives and would further harm
its ability to attract young investigators.
Agency for Healthcare Research and Quality
The ACC supports $350 million for the AHRQ. At a time when great
focus is being put on comparative effectiveness research as a means to
improve health quality, continuing and increasing the Federal
investment in AHRQ health services research is critical.
Centers for Disease Control and Prevention's (CDC) Division for Heart
Disease and Stroke Prevention
The ACC recommends $55 million for the CDC Division for Heart
Disease and Stroke Prevention, whose public education efforts are
making strides in the prevention of and early intervention in treating
cardiovascular disease--thereby potentially reducing future care costs
significantly.
Health Resources and Services Administration (HRSA) Rural and Community
Access to Emergency Defibrillation (AED) Program
The ACC supports $8.9 million in fiscal year 2008 for the HRSA
Rural and Community AED program, an important initiative that saves
lives by placing external defibrillators in public facilities.
The ACC urges Congress to provide a strong fiscal year 2008
investment in the cardiovascular research and education programs
described above to continue fostering the great strides being made in
the fight against all cardiovascular disease. If you have any
questions, please contact Jennifer Brunelle at jbrunell@acc.org or
(202) 375-6477.
______
Prepared Statement of the American College of Obstetricians and
Gynecologists
The American College of Obstetricians and Gynecologists (ACOG),
representing 51,000 physicians and partners in women's health care, is
pleased to offer this statement to the Senate Committee on
Appropriations, Subcommittee on Labor, Health and Human Services, and
Education. We thank Chairman Harkin, ranking member Specter, and the
entire subcommittee for their leadership to continually address
maternal and child health care services.
The Nation has made important strides to improve women and
children's health over the past several years, and ACOG is grateful to
this committee for its commitment to ensure that vital research
continues to eliminate disease and to ensure valuable new treatment
discoveries are implemented. The NIH has examined and determined many
disease pathways, while the Health Resources and Services
Administration (HRSA) and the Centers for Disease Control and
Prevention (CDC) have been successful in translating research findings
into valuable public health policy solutions. This dedicated commitment
to elevate, promote and implement medical research faces an uncertain
future at a time when scientists are on the cusp of new cures.
We urge the committee to support a 6.7 percent increase for the
National Institutes of Health (NIH), and a 6.7 percent increase for the
National Institute of Child Health and Human Development (NICHD) in
fiscal year 2008. We also continue to support efforts to secure
adequate funds for important public health programs at HRSA ($7.5
billion) and the CDC ($10.7 billion including funding for the Agency
for Toxic Substances and Disease Registry, and the Vaccines for
Children Program).
NATIONAL INSTITUTES OF HEALTH--RESEARCH LEADING THE WAY
Ob-Gyn Research at the NICHD
The NICHD conducts research that holds great promise to improve
maternal and fetal health and safety. With the support of Congress, the
Institute has initiated research addressing the causes of cerebral
palsy, gestational diabetes and pre-term birth. However, much more
needs to be done to reduce the rates of maternal mortality and
morbidity in the United States. More research is needed on such
pregnancy-related issues as the impact of chronic conditions during
pregnancy, racial and ethnic disparities in maternal mortality and
morbidity, drug safety with respect to pregnancy, and preventing
unintended pregnancies.
A commitment to research in women's health sheds light on a breadth
of issues that save women's lives. Important research examining the
following issues must continue:
Reducing High Risk Pregnancies
NICHD's Maternal Fetal Medicine Unit Network, working at 14 sites
across the United States (University of Alabama, University of Texas-
Houston, University of Texas-Southwestern, Wake Forest University,
University of North Carolina, Brown University-Women and Infant's
Hospital, Columbia University, Drexel University, University of
Pittsburgh-Magee Women's Hospital, University of Utah, Northwestern
University, Wayne State University, Case Western University, and Ohio
State University), will help reduce the risks of cerebral palsy,
caesarean deliveries, and gestational diabetes. This Network discovered
that progesterone reduces preterm birth by one-third.
Reducing the Risk of Perinatal HIV Transmission
In the last 10 years, NICHD research has helped decrease the rate
of perinatal HIV transmission from 27 percent to 1.2 percent. This
advancement signals the near end to mother-to-child transmission of
this deadly disease.
Reducing the Effects of Pelvic Floor Disorders
The Institute has made recent advancements in the area of pelvic
floor disorders. The NICHD is investigating whether women that have
undergone cesarean sections have fewer incidences of pelvic floor
disorder than women who have delivered vaginally.
Reducing the Prevalence of Premature Births
NICHD is helping our Nation understand how adverse conditions and
health disparities increase the risks of premature birth in high-risk
racial groups.
Drug Safety During Pregnancy
The NICHD recently created the Obstetric and Pediatric Pharmacology
Branch to measure drug metabolism during pregnancy.
Contraceptive Research
The United States has one of the highest unintended pregnancy rates
of the industrialized nations. Of the approximately 6 million
pregnancies each year, an estimated one half are unintended. It is
critical that women have access to safe and effective contraceptives,
to help them time and space their pregnancies. The NICHD conducts
valuable research on both male and female contraceptives that can help
reduce the number of unintended pregnancies and improve women's health.
The Challenge of the Future: Attracting New Researchers
Despite the NICHD's critical advancements, reduced funding has made
it difficult for research to continue, largely due to the lack of new
investigators. Congressional programs such as the loan repayment
program, and the NIH Mentored Research Scientist Development Program
for reproductive health, all attract new researchers, but low pay lines
make it difficult for the NICHD to maintain them. We urge the committee
to significantly increase funding for ob-gyn research at the NICHD to
maintain a high level of research innovation and excellence, in turn
reducing the incidence of maternal morbidity and mortality and
discovering cures for other chronic conditions.
We encourage the committee, too, to realize and fund ob-gyn
research possibilities in other Institutes within NIH. While pediatric
and ob-gyn research are the two main areas of research in NICHD, ob-gyn
research is very centralized in that Institute, with 56.7 percent of
all NIH ob-gyn research funding occurring in NICHD in 2005. Pediatrics
funding, on the other hand, is diversified throughout many Institutes.
While 21.7 percent of pediatrics funding occurs in NICHD, 19 percent is
in the National Heart, Lung and Blood Institute (NIHLB), 16 percent is
in National Institute of Diabetes and Digestive and Kidney, (NIDDK),
13.5 percent in the National Institute of Aging (NIA), and 7 percent is
in the National Cancer Institute (NCI). Altogether, pediatrics research
at NIH totaled $520.7 million in 2005, compared with $156.8 million in
ob-gyn research.
The future of women's health, including, reducing preterm labor,
ensuring drug safety during pregnancy, and reducing the effects of
pelvic floor disorders, depends on research conducted at the NIH. We
encourage the committee to increase and expand ob-gyn research funding
in NICHD and throughout the National Institutes of Health.
HRSA AND CDC: TURNING RESEARCH INTO PUBLIC HEALTH SOLUTIONS
It is critical that we rapidly transform women's health research
findings into public health solutions. The Health Resources and
Services Administration (HRSA) has created women and children's health
outreach programs based on research conducted on prematurity, high risk
pregnancies, gestational diabetes, and a variety of other health
issues. The National Fetal Infant Mortality Review and the Provider's
Partnership are two examples of the successful programs under the
Healthy Start Initiative.
National Fetal Infant Mortality Review
The Fetal and Infant Mortality Review (FIMR) is a cooperative
Federal agreement between ACOG and the Maternal Child Health Bureau at
HRSA. FIMR uses the expertise of ob-gyns and local health departments
to find solutions to problems related to infant mortality. In light of
the recent increase in the infant mortality rate for 2002, the FIMR
program is vital to develop community-specific, culturally appropriate
interventions. Today 220+ local programs in 42 States are implementing
FIMR and finding it is a powerful tool to bring communities together to
address the underlying problems that negatively affect the infant
mortality rate. We urge this committee to recognize the many positive
contributions of the FIMR program and ensure it remains a fully funded
program within HRSA.
Title X Family Planning Program
Since 1970, the Title X Family Planning program at HRSA has
provided low income women with timely screenings, education, and
contraception. Access to these services can be vital to preventing
breast and cervical cancer, sexually transmitted infections (STIs), and
unintended pregnancies.
Title X clinics serve more than 5 million low-income women at 4,500
clinics nationwide, helping women plan the number and timing of their
pregnancies and stay healthy. Title X clinics are serving increasing
numbers of patients without commensurate increases in funding. We urge
you to increase funding for this vital program to $375 million for
fiscal year 2008.
The National Breast and Cervical Cancer Early Detection Program
(NBCCEDP)
The National Breast and Cervical Cancer Early Detection Program
(NBCCEDP) administered by the CDC is an indispensable health program in
helping underserved women gain access to screening programs for early
detection of breast and cervical cancers. The NBCCEDP has served over
2.5 million women and provided 5.8 million screening examinations.
Early detection and treatment of breast and cervical cancers greatly
increase a woman's odds of conquering these diseases. We strongly urge
the committee to continue saving women's lives and to prevent cuts to
this vital program.
National Center on Birth Defects and Developmental Disabilities
(NCBDDD)
Birth defects affect about one in every 33 babies born in the
United States each year. Babies born with birth defects have a greater
chance of illness and long term disability than babies without birth
defects. According to the CDC, a great opportunity for further
improvement lies in prevention strategies that, if implemented prior to
conception, would result in further improvement of pregnancy outcomes.
A cooperative agreement between the NCBDDD and ACOG has resulted in
increased provider knowledge of genetic screening and diagnostic tests,
technical guidance on routine preconception care and prenatal genetic
screening, and improved access to care for women with disabilities.
Again, we would like to thank the committee for its continued
support of interagency cooperation to address the multiple factors that
affect maternal and child health. We strongly urge this subcommittee to
support increased ob-gyn research funding for the NICHD and throughout
NIH, and renewed appropriations for the maternal child health programs
at the CDC and HRSA. By continuing to translate research done at the
NICHD into positive outreach programs such as the Title X program and
the NBCCEDP, we can further improve our Nation's overall health.
______
Prepared Statement of the American Diabetes Association
Thank you for the opportunity to submit testimony on the importance
of Federal funding for diabetes programs at the Centers for Disease
Control and Prevention (CDC) and diabetes research at the National
Institutes of Health (NIH).
As the Nation's leading nonprofit health organization providing
diabetes research, information and advocacy, the American Diabetes
Association feels strongly that Federal funding for diabetes prevention
and research efforts is critical not only for the 20.8 million
Americans who currently have diabetes, but also for the 54 million who
have a condition known as pre-diabetes.
Diabetes is a serious disease, and is a contributing cause of many
of the chronic conditions on which the Federal Government spends the
most health care dollars. In 2002, the direct and indirect costs spent
solely on diabetes were $132 billion. In addition, diabetes is a
significant cause of heart disease, stroke, and a leading cause of
kidney disease, which combine to cost our Nation $356.7 billion a year.
Diabetes is also the leading cause of adult-onset blindness and lower
limb amputations.
Between 1990 and 2001 diabetes cases increased 60 percent and they
have continued to increase by 8 percent a year. Every 21 seconds,
another individual is diagnosed with diabetes. Diabetes is the single
most prevalent chronic illness among children. Because of the systemic
havoc that diabetes wreaks throughout the body, it is no surprise that
the life expectancy of a person with the disease averages 10-15 years
less than that of the general population.
As the statistics listed above illustrate, we are facing an
epidemic of diabetes in this country, which if left unchecked could
have significant health and economic implications for many future
generations. Every 24 hours there are: 4,100 individuals diagnosed with
diabetes, 230 amputations in people with diabetes, 120 people who enter
end-stage kidney disease programs and 55 people who go blind.\1\
According to the NIH, approximately 225,000 people died in 2002 from
diabetes. Nearly a quarter of a million Americans! Please keep these
numbers in mind as you look at the chart below. It tracks the Federal
investment in fighting diabetes since fiscal year 2005--a period in
which the prevalence of diabetes has grown by approximately 32 percent.
In the case of the CDC budget for their Division of Diabetes
Translation (DDT), funding has been relatively flat since fiscal year
2003. A change in formula makes it appear that there was a major
decrease of 4 percent in fiscal year 2005, when in actuality there was
a minor increase.
---------------------------------------------------------------------------
\1\ Frank Vinicor, Associate Director for Public Health Practice at
the Centers for Disease Control, qtd. in N.R. Kleinfield, ``Diabetes
and Its Awful Toll Quietly Emerges as a Crisis,'' The New York Times, 9
January 2006.
----------------------------------------------------------------------------------------------------------------
Percent increase
Funding Difference -------------------------
DDT at CDC Level from prior From prior
year year In diabetes
----------------------------------------------------------------------------------------------------------------
Fiscal year:
2005.................................................... $63.457 -2.59 -4.09 +8
2006.................................................... 63.119 -9.34 -.54 +8
2007.................................................... 62.806 -.31 -.50 +8
2008 administration..................................... 62.806 ........... ........... +8
----------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------
Percent increase
Funding Difference -------------------------
DDK at NIH level from prior From prior
years year In diabetes
----------------------------------------------------------------------------------------------------------------
Fiscal year:
2005.................................................... $1,864 +43 +2.31 +8
2006.................................................... 1,855 -9 -.49 +8
2007.................................................... 1,854 -1 -.05 +8
2008 administration..................................... 1,858 +4 +.22 +8
----------------------------------------------------------------------------------------------------------------
Diabetes has become the greatest public health crisis of the 21st
century. To stem the tide of this epidemic diabetes prevention and
outreach efforts must expand, and at the same time scientists and
researchers must continue their work towards finding a cure. Therefore,
we are requesting:
--A $20.8 million increase for the CDC's Division of Diabetes
Translation (DDT), only one dollar for each American suffering
from diabetes. This program was left at flat funding in the
recently-passed joint funding resolution, although it had been
slated for an increase in both the House and Senate passed
bills.
--An 8 percent increase over fiscal year 2007 funding at NIH's
National Institute for Diabetes, Digestive and Kidney Diseases
(NIDDK), the amount included in last year's NIH Reauthorization
package. These funds would make up for previous cuts and allow
for the ongoing cost of biomedical inflation, which continues
to eat into the purchasing power of research funding.
DIABETES INTERVENTIONS AT THE CENTERS FOR DISEASE CONTROL & PREVENTION
The CDC's Division of Diabetes Translation is critical to our
national efforts to prevent and manage diabetes because DDT literally
translates research into real interventions at the community level.
Currently, for every dollar that diabetes costs this country, the
Federal Government invests less than one cent to help Americans prevent
and manage this deadly disease. This dynamic must be changed. Our
request of $20.8 million will allow these critical programs to expand
to more adequately meet the growing demands of the diabetes epidemic.
In 2006, DDT provided support for more than 50 State, and
territorial, based Diabetes Prevention and Control Programs (DPCPs) to
increase outreach and education, and to reduce the complications
associated with diabetes. However, due to funding constraints, DDT is
able to provide full support to only 28 States. The remaining 22
States, 8 territories, and the District of Columbia are given no more
than partial support. This level of funding, referred to as ``capacity
building,'' allows a State to do surveillance, but is not enough for
the State to do much--or in some cases, anything--in the way of
intervention. Even more alarming, DDT's current funding level only
allows for prevention activities in five States. While we know from
clinical trials \2\ that the onset of type 2 diabetes can be delayed or
prevented in most cases, this dismal funding for primary prevention
falls far short of the resources needed to address the 54 million
Americans with pre-diabetes.
---------------------------------------------------------------------------
\2\ The Diabetes Prevention Program (DPP) was a major clinical
trial, or research study, aimed at discovering whether either diet and
exercise or the oral diabetes drug metformin (Glucophage) could prevent
or delay the onset of type 2 diabetes in people with impaired glucose
tolerance.
---------------------------------------------------------------------------
For those 28 States DDT was able to provide a higher level of
support called basic implementation. At this level, States are able to
devise and execute community based programs. Without adequately funded
diabetes programs and projects in all parts of the country, it will be
exceedingly difficult--if not impossible--to control the escalating
costs associated with diabetes-associated complications and to stem the
epidemic rise in diabetes rates. State DPCPs, when provided with enough
funding, are proven to have been extremely successful in helping
Americans prevent and manage their diabetes. In the Division of
Diabetes Translation Program Review fiscal year 2004, the CDC stated,
``The Basic Implementation DPCPs serve as the backbone for our growing
primary prevention efforts. These State programs are the key elements
to our success in meeting the challenges of controlling and preventing
diabetes.''
For example, the Pennsylvania DPCP provides funding to support two
of the Commonwealth's eight community-based Diabetes Nurse Consultants
which provide information and consultation services to patients and
their families, health care providers, schools, nursing homes and
countless others in all 67 counties. These programs have demonstrated
success in promoting physical activity, weight and blood pressure
control, and smoking cessation for those with diabetes. Americans in
every State should have access to such quality programs. Unfortunately,
States such as Iowa and Mississippi are currently funded at levels that
don't allow for basic implementation. The Division's fiscal year 2007
budget of $63 million had no increase from fiscal year 2006 and the
President has requested flat funding again for fiscal year 2008.
In addition to DPCP activities, the CDC's Division of Diabetes
Translation conducts other activities to help people currently living
with diabetes. To put research into action, CDC works with NIH to
jointly sponsor the National Diabetes Education Program (NDEP), which
seeks to improve the treatment and outcomes of people with diabetes,
promote early detection, and prevent the onset of diabetes. The CDC is
also currently working to develop a National Public Health Vision Loss
Prevention Program that will investigate the economic burden and
strengthen the surveillance and research of this all-to-common
complication of diabetes. In addition, CDC funds work at the National
Diabetes Laboratory to support scientific studies that will improve the
lives of people with diabetes. In fiscal year 2005, the Division of
Diabetes Translation alone published 53 manuscripts on the care,
prevention, and science of diabetes, including 17 abstracts.
DIABETES RESEARCH AT THE NATIONAL INSTITUTES FOR HEALTH
While there is not yet a cure for diabetes, researchers at NIH are
working on a variety of projects that represent hope for the millions
of individuals with type 1 and type 2 diabetes. The list of advances in
treatment and prevention is thankfully a long one, but it is important
to understand what has been, and what can be, achieved for Americans
with diabetes. For example, the Diabetes Control and Complications
Trial (DCCT), a clinical trial of 1,441 people with type 1 diabetes,
demonstrated that tight control of blood glucose through intensive
insulin therapy could significantly reduce or delay many complications
due to diabetes. This landmark finding spurred a shift in the daily
management of type 1 diabetes and energized research in the field.
Subsequent funding has allowed research to continue on topics like risk
factors, genetics, and complications that provide new approaches to
improve therapy of diabetes.
Obesity is a strong risk factor for type 2 diabetes, especially in
minority populations. Recognizing the growing problem of obesity and
its increasing prevalence among youth, the NIDDK is focusing on paths
to prevention. One example of this focus is the HEALTHY study, which is
led by the NIDDK and co-sponsored by the American Diabetes Association.
This study is testing a middle school-based intervention to reduce
students' risk factors for type 2 diabetes, such as obesity.
Additionally, based on NIH-funded research, scientists have made
great progress in developing methods that slow the onset and
progression of kidney disease in people with diabetes, such as
employing drugs that are typically used to lower blood pressure. These
antihypertensive drugs can slow the progression of kidney disease
significantly. Two types of drugs, angiotensin-converting enzyme (ACE)
inhibitors and angiotensin receptor blockers (ARBs), have proven
effective in slowing the progression of kidney disease.
A generation ago, 20 percent of individuals diagnosed with type 1
diabetes died within 20 years of diagnoses and 30 percent died within
25 years. Thanks to research at NIDDK, patients now use a variety of
insulin formulations, including rapid-acting, intermediate acting,
long-acting insulin, and even insulin pumps, to control their blood
glucose with much better precision. When it comes to diabetes, real-
life results from research do not merely represent potential advances;
the advances are happening now and they are improving and saving lives.
The Association strongly encourages you to provide at least an 8
percent increase to the NIH to build upon and fulfill this promise of
scientific research. Unfortunately, while the death rate due to
diabetes has increased by 45 percent since 1987, diabetes research
funding has not kept pace. Indeed, from 1987 to 2001, appropriated
diabetes funding as a share of the overall NIH budget has dropped by
more than 20 percent (from 3.9 percent to 2.9 percent). While Congress
had initially begun to address this discrepancy, the fiscal year 2007
Joint Funding Resolution essentially maintained the cuts of recent
years, although NIDDK did not have to contribute to the new Common
Fund. Still, this does not account for even the cost of biomedical
inflation. The Association believes that NIH research and CDC
translational programs go hand in hand in the effort to combat the
diabetes epidemic.
The Association, and the millions of individuals with diabetes it
represents, firmly believes that we could rapidly move toward curing,
preventing, and managing this disease by increasing funding for
diabetes programs and research at both CDC and NIH. Your leadership is
essential to accomplishing this goal. As you are considering fiscal
year 2008 funding, we ask you to remember that chronic diseases,
including diabetes, account for nearly 70 percent of all health care
costs as well as 70 percent of American deaths annually. Unfortunately,
less than $l.25 per person is directed toward public health
interventions focused on preventing the debilitating effects associated
with chronic diseases, demonstrating that Federal investment in chronic
disease prevention remains grossly inadequate. We cannot ignore those
Americans who are currently living with diabetes and other diseases.
In closing, the American Diabetes Association strongly urges the
subcommittee and the Senate to provide a $20.8 million increase for the
CDC's Division of Diabetes Translation. Providing this funding would be
an important step towards empowering the effort fight diabetes at the
community and national levels. Additionally, we urge the subcommittee
to increase NIH funding by 8 percent, the level that was authorized in
the bipartisan NIH Reauthorization legislation that passed both the
House and Senate last year by overwhelming margins. These funding
levels would allow for an increased commitment to diabetes research.
An important question has been raised, ``Where will we be in 10
years?'' For diabetes, the answer to that question is truly in your
hands. The disease is growing at a rate of 8 percent annually, but the
government has not increased the resources to prevent, treat or find a
cure for diabetes in over 4 years. In 2002, the United States spent
$132 billion in direct and indirect costs for diabetes. If these trends
continue for the next 10 years, the costs--in human life and
economics--will be truly unimaginable.
On behalf of the 20.8 million Americans with diabetes--a disease
that crosses gender, race, ethnicity and political party; a disease
that is among the most costly, debilitating, deadly and prevalent in
our Nation; and a disease that is unnecessarily on the rise--I thank
you for the opportunity to submit this testimony. The American Diabetes
Association is prepared to answer any questions you might have on these
important issues.
______
Prepared Statement of the American Heart Association
Over the past 50 years, we have made enormous progress against
heart disease, stroke and other forms of cardiovascular disease (CVD).
According to the National Institutes of Health, 1.6 million lives have
been saved since the 1960s that would have been lost to CVD. Americans
can expect to live 4 years longer from a drop in heart disease deaths.
In spite of progress, we have not declared victory, and we may be
losing ground. An estimated 80 million American adults suffer from CVD.
Despite educational efforts, increased rates of diabetes, obesity and
other risk factors may undo four decades of declining mortality. And,
we are often not reaching those at most risk, like those with lower
socioeconomic status.
The morbidity and mortality rates still startle. Nearly 2,400
Americans die from CVD each day--an average of one death every 36
seconds. Heart disease and stroke remain the No. 1 and No. 3 killers,
respectively, for both men and women in the United States today and two
of three men and one of two women will develop CVD during their
lifetime.
To make matters worse, a perfect storm is taking shape fueled by
demographics. As the baby boomers age, the number of Americans
developing CVD will increase radically. CVD can strike at any age, but
the odds increase with age. A report estimates that heart disease
deaths will increase 130 percent from 2000 and 2050.
Beyond the toll in suffering and death, CVD comes with a steep
price tag. It costs Americans an estimated $432 billion in medical
expenses and lost productivity in 2007--more than any other disease. We
will soon be facing a CVD crisis of staggering proportions and
implications for health care costs and quality of care. We ignore it at
our collective peril.
budget recommendations: investing in the health of our nation
Although progress has been made in the prevention and treatment of
CVD, there is still no cure and more Americans than ever are at risk.
The most prudent way to address this looming crisis is to
simultaneously invest in research, prevention and treatment.
Regretfully, the funding levels proposed by the administration in its
fiscal year 2008 budget undermine these efforts.
Now is not the time to reduce our investment in programs that
prevent and treat America's leading and most costly killer. Solving a
problem of this magnitude requires a major public investment. If we
fail to take aggressive and deliberate action now--we will pay later in
health care expenditures and lives. The American Heart Association's
recommendations that follow address this problem in a comprehensive but
fiscally responsible way.
Increase Funding for the National Institutes of Health (NIH)
NIH research has revolutionized patient care and holds the key to a
cure for CVD. NIH research also fuels innovation that generates
economic growth and preserves our Nation's role as the world leader in
the pharmaceutical and biotechnology industries. The President's
request is $511 million below fiscal year 2007 and the gap between the
levels achieved during the doubling of the NIH budget and the request,
when adjusted for biomedical research inflation, exceeds 13 percent.
AHA Recommendation.--AHA advocates for a fiscal year 2008
appropriation of $30.8 billion for NIH. It represents the first year of
a 3-year campaign to get NIH funding ``Back on Track.'' A 6.7 percent
funding increase for each of the next 3 years would restore and protect
the past investment made by the Congress in doubling the resources of
the NIH.
Increase Funding for NIH Heart and Stroke Research: A Proven Investment
From 1994-2004, death rates from cardiovascular diseases, coronary
heart disease and stroke have fallen respectively by 25 percent, 33
percent and 20 percent. Much of this progress can be attributed to NIH
heart and stroke research which has improved health outcomes and in
some cases, lowered health care costs. Examples of recent NIH research
accomplishments include:
--CVD Research a Good Value.--NIH's cumulative investment in CVD
research over the past 30 years has resulted in a 63 percent
decrease in heart disease deaths at a projected value of $1.5
trillion per year from 1970 to 1990 due to increase in life
expectancy.
--Stroke Trials Benefit Economy.--The original NIH tPA trial resulted
in a 10-year net reduction in healthcare costs of $6.47
billion. The Stroke Prevention in Atrial Fibrillation Trial 1
resulted in a 10-year net benefit of $1.27 billion, with a
savings of 35,000 quality-adjusted life years.
--Stroke Rehabilitation.--Constraint-Induced Movement Therapy, a
rehabilitative method involving forced use of a paralyzed arm,
can help stroke survivors regain arm function.
--Late Angioplasty No Advantage.--An international study found that
stable heart attack survivors who received angioplasty and
stenting three to 28 days after the attack did no better than
patients receiving, primarily drug treatment. These findings
could reduce unnecessary interventions and lower health care
costs.
In spite of these and other successes, NIH heart and stroke
research budget remains disproportionately under-funded compared to the
disease burden. CVD meets NIH's priority setting criteria (public
health needs, scientific quality of research, scientific progress
potential, portfolio diversification and adequate infrastructure
support), yet only 7 percent of the NIH budget is invested in heart
research and a mere 1 percent is devoted to stroke.
Cardiovascular Disease Research
Relative to the amount needed to keep pace with medical research
inflation, proposed funding for cardiovascular research will decline by
15 percent since fiscal year 2003. These limited resources cannot
adequately support and expand current activities or allow investments
in promising initiatives to aggressively advance the fight against
heart disease and stroke--the first and third causes of death among
Americans. Additional funds could be used in the following areas:
--Atherosclerosis Prevention Trial.--Atherosclerosis is a main risk
factor for heart disease and stroke. With increased funding,
the National Heart, Lung, and Blood Institute (NHLBI) could
initiate a clinical trial to determine if reducing low-density
lipoprotein cholesterol, so-called ``bad'' cholesterol, to a
level lower than currently recommended, reduces major CVD
events in healthy patients at high risk of heart disease and or
stroke.
--Systolic Blood Pressure Intervention Trial.--High blood pressure is
a major risk factor for heart disease, heart failure and
stroke. Additional funding would allow the NHLBI to conduct a
multi-center clinical trial to determine whether reducing
systolic blood pressure to a lower level than currently
recommended could prevent heart attacks and strokes.
--Preventing Weight Gain in Young Adults.--With additional resources,
NHLBI could support small-scale studies to develop and evaluate
promising, innovative practical, cost-effective ways for young
adults to reduce their risk for CVD by preventing weight gain.
Stroke Research
Stroke is the No. 3 killer of Americans and a major cause of
permanent disability. In addition to the elderly, stroke also strikes
newborns, children and young adults. An estimated 700,000 Americans
will suffer a stroke this year, and nearly 150,000 will die. Many of
America's 5.7 million stroke survivors face debilitating physical and
mental impairment, emotional distress and huge medical costs; about 1
in 4 survivors are permanently disabled.
As a result of fiscal year 2001 congressional report language, the
National Institute of Neurological Disorders and Stroke (NINDS)
convened a Stroke Progress Review Group (PRG). Their report provided a
long-range strategic plan for stroke research. The PRG was reconvened
last year and took stock of interim progress and re-evaluated
recommendations for future research. Since the issuance of the initial
report, multiple scientific programs have been undertaken; but, more
funding is needed to fully implement the strategic plan. The fiscal
year 2008 request for NINDS stroke research falls 56 percent short of
the strategic plan's target for that year. Additional funding could be
used to conduct stroke research in the following areas:
--Stroke Translational Research.--Translational studies are vital to
providing cutting-edge stroke treatment and prevention. Due to
budget shortfalls, the NINDS has been forced to compress its
Specialized Programs of Translational Research in Acute Stroke
(SPOTRIAS) from the planned 10 extramural centers to the five
currently funded. SPOTRIAS researchers facilitate translation
of basic research into patient care and evaluate and treat
victims rapidly after the onset of stroke symptoms.
--Neurological Emergencies Treatment Trials Network.--Limited
resources will also force the NINDS to scale back its
Neurological Emergencies Treatment Trials Network. This
initiative is designed to develop a clinical research network
of emergency medicine physicians, neurologists and
neurosurgeons to develop through clinical trials more and
improved treatments for acute neurological emergencies, such as
stroke.
--Stroke Education.--In partnership with CDC, NINDS launched a
grassroots program called ``Know Stroke in the Community.'' It
includes enlisting the aid of ``Stroke Champions'' who teach
communities about signs and symptoms. The goal is to shift
stroke treatment from supportive care to early brain-saving
intervention. But, more funding is needed to teach the public
and health providers.
AHA Recommendation.--AHA recommends an fiscal year 2008
appropriation of $2.2 billion for NIH heart research; $3.1 billion for
the NHLBI; $362 million for NIH stroke research; and $1.6 billion for
the NINDS. These figures represent a 6.7 percent increase over fiscal
year 2007--commensurate with the Association's recommended funding
increase for the NIH.
Increase Funding for the Centers for Disease Control and Prevention
(CDC)
Basic research must be translated into easy-to-understand guidance
so people can apply it in their daily lives. Prevention is the best way
to protect Americans' health and ease the financial burden of disease.
While literature indicates that increased and improved CVD
interventions can be highly successful, investigators have also
concluded that effective strategies for combating CVD are often not
being implemented. A study suggests that not smoking, maintaining a
healthy weight, and avoiding diabetes, high blood pressure and high
cholesterol may add 10 years to life.
AHA commends Congress for supporting CDC's Division for Heart
Disease and Stroke Prevention which funds 33 States to create or
implement programs to prevent first and second instances of heart
disease and stroke. These state-tailored programs aide collaboration
among public and private sectors to help people lower blood pressure
and cholesterol, learn signs and symptoms, call 9-1-1, improve
emergency response and quality care, and end treatment disparities.
Many of these programs have reduced risk, like high blood pressure.
In fiscal year 2007, only 14 States receive funding to implement
these prevention programs. The remaining 19 receive funds for planning;
which is now largely complete. Because cardiovascular disease is the
No. 1 killer in every State, each State needs basic implementation
money for this program; however, current funding levels are
insufficient for its expansion.
AHA Recommendation.--For fiscal year 2008, AHA recommends an
appropriation of $10.7 billion (including funding for ATSDR, and the
current funding level for the Vaccines for Children Program) for CDC,
with increases targeted for programs within the National Center for
Chronic Disease Prevention and Health Promotion. Within that total, we
recommend $64.3 million for the Division for Heart Disease and Stroke
Prevention, allowing CDC to: (1) add up to 12 States to the program to
conduct state-tailored plans; (2) elevate up to 6 States from planning
to program implementation; (3) support the Paul Coverdell National
Acute Stroke Registry; (4) start development of a state-based cardiac
arrest registry; and (5) explore establishment of a National Heart
Disease and Stroke Surveillance Unit to monitor data, identify grave
gaps, and offer modifications to existing components to fill the gaps.
Restore Funding for Rural and Community Access to Emergency Devices
(AED) Program
About 94 percent of cardiac arrest victims die outside of a
hospital. Immediate CPR and early intervention using AEDs can more than
double a victim's chance of survival. Small, easy-to-use AEDs can shock
the heart back into normal rhythm. Placing AEDs in more public settings
could save thousands of lives each year. Communities with comprehensive
AED programs that include training of anticipated rescuers have
achieved survival rates of 40 percent or higher.
The Rural and Community AED Program provides grants to States to
train lay rescuers and first responders to use AEDs and buy and place
them where sudden cardiac arrests are likely to occur. During the first
year of the program, 6,400 AEDs were purchased and 38,800 individuals
were trained. AEDs have been placed in schools, faith-based and
recreation facilities, nursing homes, and other locations in
communities across our Nation. In spite of this success, the Rural and
Community AED Program is terminated in the President's fiscal year 2008
budget.
AHA Recommendation.--For fiscal year 2008, AHA recommends
restoration of HRSA's Rural and Community AED Program to its fiscal
year 2005 level of $8.927 million.
Increase funding for the Agency for Healthcare Research and Quality
(AHRQ)
AHRQ is a key partner of the public and private health care
sectors. AHRQ helps develop evidence-based information needed by
consumers, providers, health plans and policymakers to improve health
care decision making. Through its Effective Health Care Program, AHRQ
supports research focusing on outcomes, comparative clinical
effectiveness, and appropriateness of pharmaceuticals, devices and
health care services for conditions like ischemic heart disease,
stroke, and high blood pressure. The research and comparative
effectiveness reviews conducted and funded address issues raised in the
Institute of Medicine's Crossing the Quality Chasm.
Their initiative on health information technology is key to our
Nation's strategy to bring health care into the 21st century. It
includes more than $166 million in grants. Through these and other
projects, AHRQ and its partners help identify challenges to HIT
adoption and use, solutions and best practices, and tools that help
hospitals and clinicians incorporate HIT.
AHA Recommendation.--AHA joins with Friends of AHRQ in advocating
for an appropriation of $350 million for AHRQ, restoring the agency to
its fiscal year 2005 level to advance health care quality, cut medical
errors and expand availability of health outcomes information.
Although heart disease, stroke and other cardiovascular diseases
are largely preventable, they continue to exact a deadly and costly
toll. And as baby boomers age, our Nation faces an expanding
cardiovascular crisis that threatens to overwhelm us unless significant
and meaningful steps are taken. But, adequate funding of research,
treatment and prevention programs will save lives and reduce rising
health care costs. We urge Congress to consider the Association's
recommendations during its deliberations on the fiscal year 2008
budget.
______
Prepared Statement of the American Indian Higher Education Consortium
Summary of Requests.--Summarized below are the fiscal year 2008
recommendations for the Nation's 34 Tribal Colleges and Universities
(TCUs), covering three areas within the Department of Education and one
in the Department of Health and Human Services, Administration for
Children and Families' Head Start Program.
DEPARTMENT OF EDUCATION PROGRAMS
A. Higher Education Act Programs
Strengthening Developing Institutions.--Section 316 of Title III
Part A, specifically supports TCUs through two separate grant programs:
(a) basic development grants, and (b) facilities/construction grants
designed to address the critical facilities needs at TCUs. The TCUs
urge the subcommittee to restore the funding cut proposed in the
President's fiscal year 2008 Budget and increase funding to $32.0
million and that report language be restated clarifying that funds in
excess of those needed to support continuation grants or new planning
or implementation grants shall be used for facilities, renovation, and
construction grants.
Pell Grants.--TCUs urge the subcommittee to fund the Pell Grants
Program at the highest possible level.
B. Perkins Career and Technical Education Programs
The TCUs support $8.5 million for Sec. 117 of the Carl D. Perkins
Career and Technical Education Improvement Act and request language
reaffirming that this program remains specific to the two Tribally
Controlled Postsecondary Vocational Institutions: United Tribes
Technical College and Navajo Technical College. Additionally, TCUs
strongly support the Native American Career and Technical Education
Program (NACTEP) authorized under Sec. 116 of the act.
C. Relevant Title IX Elementary and Secondary Education Act (ESEA)
Programs
Adult and Basic Education.--Although Federal funding for tribal
adult education was eliminated in fiscal year 1996, TCUs continue to
offer much needed adult education, GED, remediation and literacy
services for American Indians, yet their efforts cannot meet the
demand. The TCUs request that the subcommittee direct $5.0 million of
the Adult Education State Grants appropriated funds to make awards to
TCUs to support their adult and basic education programs.
American Indian Teacher and Administrator Corps.--The American
Indian Teacher Corps and the American Indian Administrator Corps offer
professional development grants designed to increase the number of
American Indian teachers and administrators serving their reservation
communities. The TCUs request that the subcommittee support these
programs at $10.0 and $5.0 million, respectively.
DEPARTMENT OF HEALTH & HUMAN SERVICES PROGRAM
D. Tribal Colleges and Universities Head Start Partnership Program
(DHHS-ACF)
Tribal Colleges and Universities are ideal partners to help achieve
the goals of Head Start in Indian Country. The TCUs are working to meet
the mandate that Head Start teachers earn degrees in Early Childhood
Development or a related discipline. The TCUs request that $5.0 million
be designated for the TCU-Head Start partnership program, to ensure the
continuation of current TCU programs and the funds necessary for
additional TCU-Head Start partnership programs.
Mr. Chairman and members of the subcommittee, on behalf of this
Nation's 34 Tribal Colleges and Universities (TCUs), which comprise the
American Indian Higher Education Consortium (AIHEC), thank you for the
opportunity to share our fiscal year 2008 funding recommendations for
programs within the U.S. Department of Education and the U.S.
Department of Health and Human Services--Head Start program.
I. BACKGROUND ON TRIBAL COLLEGES AND UNIVERSITIES:
The vast majority of tribal colleges is accredited by independent,
regional accreditation agencies and like all institutions of higher
education, must undergo stringent performance reviews on a periodic
basis to retain their accreditation status. In addition to college
level programming, TCUs provide much needed high school completion
(GED), basic remediation, job training, college preparatory courses,
and adult education. Tribal colleges fulfill additional roles within
their respective reservation communities functioning as community
centers, libraries, tribal archives, career and business centers,
economic development centers, public meeting places, and child care
centers. Each TCU is committed to improving the lives of its students
through higher education and to moving American Indians toward self-
sufficiency.
Tribal Colleges and Universities provide access to higher education
for American Indians and others living in some of the Nation's most
rural and economically depressed areas. The average family income for a
student first entering a TCU is $14,000, which is 27 percent below the
Federal poverty threshold for a family of four. In addition to serving
their students, TCUs serve their communities through a variety of
community outreach programs.
These institutions, chartered by their respective tribal
governments, were established in response to the recognition by tribal
leaders that local, culturally based institutions are best suited to
help American Indians succeed in higher education. TCUs combine
traditional teachings with conventional postsecondary curricula. They
have developed innovative ways to address the needs of tribal
populations and are overcoming long-standing barriers to success in
higher education for American Indians. Since the first TCU was
established on the Navajo Nation, these vital institutions have come to
represent the most significant development in the history of American
Indian higher education, providing access to and promoting achievement
among students who may otherwise never have known postsecondary
education success.
II. JUSTIFICATIONS
A. Higher Education Act
The Higher Education Act Amendments of 1998 created a separate
section within Title III, Part A, specifically for the Nation's Tribal
Colleges and Universities (Section 316). Programs under Titles III and
V of the act support institutions that enroll large proportions of
financially disadvantaged students and have low per-student
expenditures. Although TCUs, which are truly developing institutions,
are providing access to quality higher education opportunities to some
of the most rural and impoverished areas of the country, the
President's fiscal year 2008 budget proposes a 20 percent cut to the
TCU Title III grants program. A clear goal of the Higher Education Act
Title III programs is ``to improve the academic quality, institutional
management, and fiscal stability of eligible institutions, in order to
increase their self-sufficiency and strengthen their capacity to make a
substantial contribution to the higher education resources of the
Nation.'' The TCU Title III program is specifically designed to address
the critical, unmet needs of their American Indian students and
communities, in order to effectively prepare them for the workforce of
the 21st Century. The TCUs urge the subcommittee to reject the
substantial cut proposed in the President's budget and fund Title III-A
section 316 at $32.0 million in fiscal year 2008, an increase of $8.2
million over fiscal year 2007 and $13.5 million over the President's
request to afford these developing institutions the resources necessary
to address the needs of their historically underserved students and
communities. Additionally, we request that report language be restated
clarifying that funds in excess of those needed to support continuation
grants or new planning or implementation grants shall be used for
single year facilities, renovation, and construction grants to ensure
TCUs will be able to operate in adequate and safe facilities.
The importance of Pell grants to TCUs students cannot be
overstated. U.S. Department of Education figures show that the majority
of TCU students receive Pell grants, primarily because student income
levels are so low and our students have far less access to other
sources of aid than students at State funded and other mainstream
institutions. Within the tribal college system, Pell grants are doing
exactly what they were intended to do--they are serving the needs of
the lowest income students by helping them gain access to quality
higher education, an essential step toward becoming active, productive
members of the workforce. The TCUs urge the subcommittee to fund this
critical grants program at the highest possible level.
B. Carl D. Perkins Career and Technical Education Act
Tribally-Controlled Postsecondary Vocational Institutions.--Section
117 of the Perkins Act provides basic operating funds for two of our
member institutions: United Tribes Technical College in Bismarck, North
Dakota, and Navajo Technical College in Crownpoint, New Mexico. The
TCUs urge the subcommittee to fund this program at $8.5 million.
Native American Career and Technical Education Program.--The Native
American Career and Technical Education Program (NACTEP) under Sec. 116
of the act reserves 1.25 percent of appropriated funding to support
Indian vocational programs. The TCUs strongly urge the subcommittee to
continue to support NACTEP, which is vital to the survival of
vocational education programs being offered at Tribal Colleges and
Universities.
C. Greater Support of Indian Education Programs
American Indian Adult and Basic Education (Office of Vocational and
Adult Education).--This program supports adult basic education programs
for American Indians offered by TCUs, State and local education
agencies, Indian tribes, institutions, and agencies. Despite a lack of
funding, TCUs must find a way to continue to provide basic adult
education classes for those American Indians that the present K-12
Indian education system has failed. Before many individuals can even
begin the course work needed to learn a productive skill, they first
must earn a GED or, in some cases, even learn to read. The number of
students needing remedial educational programs before embarking on
their degree programs is considerable at TCUs. There is a wide need for
basic adult educational programs and TCUs need adequate funding to
support these essential activities. Tribal colleges respectfully
request that the subcommittee direct $5.0 million of the Adult
Education State Grants appropriated funds to make awards to TCUs to
help meet the ever increasing demand for basic adult education and
remediation program services.
American Indian Teacher/Administrator Corps (Special Programs for
Indian Children).--American Indians are severely under represented in
the teaching and school administrator ranks nationally. These
competitive programs are designed to produce new American Indian
teachers and school administrators for schools serving American Indian
students. These grants support recruitment, training, and in-service
professional development programs for Indians to become effective
teachers and school administrators and in doing so become excellent
role models for Indian children. We believe that the TCUs are the ideal
catalysts for these two initiatives because of their current work in
this area and the existing articulation agreements they hold with 4-
year degree awarding institutions. The TCUs request that the
subcommittee support these two programs at $10.0 million and $5.0
million, respectively, to increase the number of qualified American
Indian teachers and school administrators in Indian Country.
DEPARTMENT OF HEALTH AND HUMAN SERVICES/ADMINISTRATION FOR CHILDREN AND
FAMILIES/HEAD START
Tribal Colleges and Universities (TCU) Head Start Partnership
Program.--The TCU-Head Start Partnership has made a lasting investment
in our Indian communities by creating and enhancing associate degree
programs in Early Childhood Development and related fields. Graduates
of these programs help meet the degree mandate for all Head Start
program teachers. More importantly, this program has afforded American
Indian children Head Start programs of the highest quality. A clear
impediment to the ongoing success of this partnership program is the
erratic availability of discretionary funds made available for the TCU-
Head Start Partnership. In fiscal year 1999, the first year of the
program, some colleges were awarded 3-year grants, others 5-year
grants. In fiscal year 2002, no new grants were funded at all. In
fiscal year 2003, funding for eight new TCU grants was made available,
but in fiscal year 2004, only two new awards could be made because of
the lack of adequate funds. The President's fiscal year 2008 budget
includes a total request of $6,788,571,000 for Head Start Programs. The
TCUs request that the subcommittee direct the Head Start Bureau to
designate a minimum of $5.0 million of the $6.8 billion recommended for
the TCU-Head Start Partnership program, to ensure that this critical
program can continue and expand so that all TCUs have the opportunity
to participate in the TCU-Head Start Partnership program.
III. CONCLUSION
Tribal Colleges and Universities provide access to higher education
opportunities to many thousands of American Indians, and essential
community services and programs to many more. The modest Federal
investment in TCUs has already paid great dividends in terms of
employment, education, and economic development, and continuation of
this investment makes sound moral and fiscal sense. Tribal colleges
need your help if they are to sustain and grow their programs and
achieve their missions to serve their students and communities.
Thank you again for this opportunity to present our funding
recommendations. We respectfully ask the members of the subcommittee
for their continued support of the Nation's Tribal Colleges and
Universities and full consideration of our fiscal year 2008
appropriations needs and recommendations.
______
Prepared Statement of the American Lung Association
SUMMARY: FUNDING RECOMMENDATIONS
[In millions of dollars]
------------------------------------------------------------------------
Amount
------------------------------------------------------------------------
National Institutes of Health........................... 30,537
National Heart, Lung, and Blood Institute........... 3,114
National Cancer Institute........................... 5,111
National Institute of Allergy and Infectious Disease 4,675
National Institute of Environmental Health Sciences. 683
National Institute of Nursing Research.............. 146
Fogarty International Center........................ 70
Centers for Disease Control and Prevention.............. 10,700
National Institute for Occupational Safety and 285
Health.............................................
Office on Smoking and Health........................ 145
Environmental Health: Asthma Activities............. 70
Tuberculosis Control Programs....................... 252
Influenza Pandemic...................................... 2,652
------------------------------------------------------------------------
The American Lung Association is pleased to present our
recommendations to the Labor Health and Human Services and Education
Appropriations Subcommittee. These programs will make a difference in
the lives of millions of Americans who suffer from lung disease.
The American Lung Association is one of the oldest voluntary health
organizations in the United States, with a National Office and local
associations around the country. Founded in 1904 to fight tuberculosis,
the American Lung Association today fights lung disease in all its
forms.
THE TOLL OF LUNG DISEASE
Each year, close to 400,000 Americans die of lung disease. Lung
disease is America's number three killer, responsible for one in every
six deaths. More than 35 million Americans suffer from a chronic lung
disease. Each year lung disease costs the economy an estimated $157.8
billion. Lung diseases include: asthma, chronic obstructive pulmonary
disease, lung cancer, tuberculosis, pneumonia, influenza, sleep
disordered breathing, pediatric lung disorders, occupational lung
disease and sarcoidosis.
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Chronic Obstructive Pulmonary Disease, or COPD, is a growing health
problem. Yet, it remains relatively unknown to most Americans and much
of the research community. COPD refers to a group of largely
preventable diseases, including emphysema and chronic bronchitis that
generally gradually limit the flow of air in the body. COPD is the
fourth leading cause of death in the United States and worldwide. In
2004, the annual cost to the Nation for COPD was $37.2 billion. This
includes $20.9 billion in direct health care expenditures, $8.9 billion
in indirect morbidity costs and $7.4 billion in indirect mortality
costs. Medicare expenses for COPD beneficiaries were nearly 2.5 times
that of the expenditures for all other patients.
It has been estimated that 11.4 million patients have been
diagnosed with some form of COPD and as many as 24 million adults may
suffer from its consequences. In 2004, 120,104 people in the United
States died of COPD. Women have exceeded men in the number of deaths
attributable to COPD since 2000. Over the past 30 years, the death rate
due to COPD has doubled while the death rates for heart disease, cancer
and stroke have decreased by over 50 percent.
Today, COPD is treatable but not curable. Fortunately, promising
research is on the horizon for COPD patients. Research on the genetic
susceptibility underlying COPD is making progress. Research is also
showing promise for reversing the damage to lung tissue caused by COPD.
Despite these promising research leads, the American Lung Association
believes that research resources committed to COPD are not commensurate
with the impact COPD has on the United States and the world.
The American Lung Association strongly recommends that the NIH and
other Federal research programs commit additional resources to COPD
research programs. We support increasing the National Heart, Lung and
Blood Institute budget to $3,114 billion. The Lung Association supports
the CDC in gathering more information about COPD as part of the
National Health and Nutrition Examination Survey, the Behavioral Risk
Factor Surveillance System and other health surveys. This information
will help public health professionals and researchers understand the
disease better and lead to possible control of the disease.
TOBACCO USE
Tobacco use is the leading preventable cause of death in the United
States, killing more than 438,000 people every year. Smoking is
responsible for one in five U.S. deaths. The direct health care and
lost productivity costs of tobacco-caused disease and disability are
also staggering, an estimated $167 billion each year.
The CDC's Office on Smoking and Health provides significant
technical assistance to States to develop comprehensive and effective
tobacco prevention programs, in addition to providing a small, yet
essential, amount of Federal assistance directly to State tobacco
control and prevention programs. Funds for tobacco prevention at CDC
also are used to maintain comprehensive information on smoking and
health and to support ongoing research on tobacco-related issues.
We believe Congress should fund the type of youth tobacco
prevention programs that science tells us are essential to counter the
impact of tobacco company marketing to our kids. The American Lung
Association strongly supports a minimum level of $145 million in fiscal
year 2008 funding for the Office on Smoking and Health.
ASTHMA
Asthma is a chronic lung disease in which the bronchial tubes
become swollen and narrowed, preventing air from getting into or out of
the lung. An estimated 32.6 million Americans have ever been diagnosed
with asthma by a health professional. Approximately 22.2 million
Americans currently have asthma, of which 12.2 million had an asthma
attack in 2005. Asthma prevalence rates are almost 12 percent higher
among African Americans than whites. Studies also suggest that Puerto
Ricans have higher asthma prevalence rates and age-adjusted death rates
than all other Hispanic subgroups.
Asthma is expensive. Asthma incurs an estimated annual economic
cost of $16.1 billion to our Nation. Asthma is the third leading cause
of hospitalization among children under the age of 15. It is also the
number one cause of school absences attributed to chronic conditions.
The Federal response to asthma has three components: research, programs
and planning. We are making progress on all three fronts but more must
be done:
Asthma Research
Researchers are developing better ways to treat and manage chronic
asthma. The NHLBI has shown that using corticosteroids to treat
children with mild to moderate asthma is safe and effective. Genetic
research is also providing insights into asthma. Researchers in the
NHLBI-supported Asthma Clinical Research Network have discovered that a
genetic variation determines how well asthma patients will respond to
the most common asthma medication, inhaled beta-agonists. This
discovery will help physicians better target the drugs they proscribe.
Asthma Programs
Last year, Congress provided approximately $31.9 million for the
CDC to conduct asthma programs. The American Lung Association
recommends that CDC be provided $70 million in fiscal year 2008 to
expand its asthma programs. This funding includes State asthma planning
grants, which leverage small amounts of funding into more comprehensive
State programs.
Asthma Surveillance
In addition to public education programs, the CDC has been piloting
programs to determine how to establish a nationwide health-tracking
system. Congress needs to increase funding to create a nationwide
health-tracking system, based on the localized pilots that are underway
now.
LUNG CANCER
An estimated 351,344 Americans are living with lung cancer. During
2007, an estimated 213,380 new cases of lung cancer will be diagnosed.
Also, 160,390 Americans will die from lung cancer. Survival rates for
lung cancer tend to be much lower than those of most other cancers. Men
have higher rates of lung cancer than women. However, over the past 30
years, the lung cancer age-adjusted incidence rate has decreased 9
percent in males compared to an increase of 143 percent in females.
Further, African Americans are more likely to develop and die from lung
cancer than persons of any other racial group.
Given the magnitude of lung cancer and the enormity of the death
toll, the American Lung Association strongly recommends that the NIH
and other Federal research programs commit additional resources to lung
cancer research programs. We support increasing the National Cancer
Institute budget to $5.111 billion.
INFLUENZA
Influenza is a highly contagious viral infection and one of the
most severe illnesses of the winter season. It is responsible for an
average of 200,000 hospitalizations and 36,000 deaths each year.
Further, the emerging threat of a pandemic influenza is looming. Public
health experts warn that over half a million Americans could die and
over 2.3 million could be hospitalized if a moderately severe strain of
a pandemic flu virus hits the United States. To prepare for a potential
pandemic, the American Lung Association supports funding the Federal
Pandemic Influenza Plan at the recommended level of $2.652 billion.
TUBERCULOSIS
Tuberculosis primarily affects the lungs but can also affect other
parts of the body. There are an estimated 10 million to 15 million
Americans who carry latent TB infection. Each has the potential to
develop active TB in the future. About 10 percent of these individuals
will develop active TB disease at some point in their lives. In 2005,
there were 14,097 cases of active TB reported in the United States.
While declining overall TB rates are good news, the emergence and
spread of multi-drug resistant TB pose a significant threat to the
public health of our Nation. Continued support is needed if the United
States is going to continue progress toward the elimination of TB. We
request that Congress increase funding for tuberculosis programs to
$252 million for fiscal year 2008.
The NIH also has a prominent role to play in the elimination of TB.
Currently there is no highly effective vaccine to prevent TB
transmission. However, the recent sequencing of the TB genome and other
research advances has put the goal of an effective TB vaccine within
reach. In addition, the American Lung Association encourages the
subcommittee to fully fund the TB vaccine blueprint development effort
at the NIAID.
Fogarty International Center TB Training Programs
The Fogarty International Center at NIH provides training grants to
U.S. universities to teach AIDS treatment and research techniques to
international physicians and researchers. Because of the link between
AIDS and TB infection, FIC has created supplemental TB training grants
for these institutions to train international health care professionals
in the area of TB treatment and research. However, we believe TB
training grants should not be offered exclusively to institutions that
have received AIDS training grants. The TB grants program should be
expanded and open to competition from all institutions. The American
Lung Association recommends Congress provide $70 million for FIC to
expand the TB training grant program from a supplemental grant to an
open competition grant.
ENVIRONMENTAL HEALTH
The National Institute of Environmental Health Sciences funds vital
research on the impact of environmental influence on disease. The
American Lung Association supports increasing the appropriation from
this subcommittee to $680 million.
RESEARCHING AND PREVENTING OCCUPATIONAL LUNG DISEASE
The American Lung Association recommends that the subcommittee
provide $285 million for the National Institute for Occupational Safety
and Health (NIOSH) at the CDC.
CONCLUSION
In conclusion, Mr. Chairman, lung disease is a continuing, growing
problem in the United States. It is America's number three killer,
responsible for one in seven deaths. The lung disease death rate
continues to climb. Mr. Chairman, the level of support this committee
approves for lung disease programs should reflect the urgency
illustrated by these numbers.
______
Prepared Statement of the American National Red Cross and the United
Nations Foundation
Chairman Harkin, Senator Specter, and members of the subcommittee,
the American Red Cross and the United Nations Foundation appreciate the
opportunity to submit testimony in support of measles control
activities of the U.S. Centers for Disease Control and Prevention
(CDC). The American Red Cross and the United Nations Foundation
recognize the leadership that Congress has shown in funding CDC for
these essential activities.
In 2001, CDC--along with the American Red Cross, the United Nations
Foundation, the World Health Organization, and UNICEF--became one of
the spearheading partners of the Measles Initiative, a partnership
committed to reducing measles deaths globally. When the Initiative
began, the United Nations had set the goal of reducing measles deaths
by 50 percent by 2005 compared with 1999 figures. Measles is one of the
leading causes of vaccine-preventable death worldwide, and at its
outset this partnership committed to meeting that global goal.
Thanks to your leadership in appropriating funds, the international
effort to reduce measles deaths has made tremendous progress. In
January 2007, in an article published in ``The Lancet,'' WHO announced
that this goal was not only reached, but surpassed: global measles
deaths had dropped from 873,000 in 1999 to 345,000 in 2005, a reduction
of 60 percent. In sub-Saharan Africa, the success was even greater
during those years, with measles deaths dropping by 75 percent, from
506,000 to 126,000.
How was this remarkable international public health success
achieved? Working closely with host governments, the Measles Initiative
has been the main international supporter of mass measles immunization
campaigns since 2001. The Initiative mobilized more than $300 million
and provided technical support to host governments in 48 developing
countries conducting these vaccination campaigns and improving routine
vaccination services. As a result, almost 400 million children in
Africa and Asia received measles immunizations, preventing an estimated
2.3 million child deaths.
Nearly all the measles vaccination campaigns have been able to
reach more than 90 percent of their target populations. Countries
recognize the opportunities that measles vaccination campaigns provide
in accessing mothers and young children, and have begun increasingly
``integrating'' the campaigns with other life-saving health
interventions. In addition to measles vaccine, Vitamin A (crucial for
preventing blindness in under nourished children), de-worming medicine,
and insecticide-treated bed nets (ITNs) for malaria prevention are
distributed during vaccination campaigns. The scale of these
distributions is immense. For example, more than 18 million ITNs were
distributed in vaccination campaigns in the last few years saving more
than 378,000 lives. Thus, these campaigns protect young children from
both measles and malaria, which kills an African child every 30
seconds. The delivery of multiple child health interventions during a
single campaign is far less expensive than delivering the interventions
separately, and this strategy increases the potential positive impact
on children's health from a single campaign.
Based on the success in reaching the 2005 measles mortality
reduction goal, a bold new global goal has been set: to reduce measles
deaths by 90 percent by 2010 compared with 2000 figures. In addition to
sustaining the reduction of measles cases and deaths in sub-Saharan
Africa, the Initiative will provide funds and technical support to
South Asia, where countries with the largest measles burdens are now
found. Countries such as Pakistan and India have not yet mounted
national measles vaccination campaigns due to competing health
priorities and the challenges and costs of vaccinating tens of millions
of children. Achieving this new goal will require the continued and
expanded support of CDC for the purchase of vaccine and the provision
of technical expertise in Africa and Asia.
By controlling measles cases in other countries, U.S. children are
also being protected from the disease. A major resurgence of measles
occurred in the United States between 1989 and 1991, with more than
55,000 cases reported. This resurgence was particularly severe,
accounting for more than 11,000 hospitalizations and 123 deaths. Since
then, measles control measures in the United States have been
strengthened and endemic transmission of measles cases have been
eliminated here since 2000. However, importations of measles cases into
this country continue to occur each year.
ROLE OF CDC IN GLOBAL MEASLES MORTALITY REDUCTION
From fiscal year 2001-2007, Congress provided more than $250
million in funding to CDC for global measles control activities. These
funds were used for the purchase of over 200 million doses of measles
vaccine for use in large-scale measles vaccination campaigns in 42
countries in Africa and 6 countries in Asia, and for the provision of
technical support to Ministries of Health in those countries.
Specifically, this technical support includes:
--Planning, monitoring, and evaluating large-scale measles
vaccination campaigns;
--Conducting epidemiological investigations and laboratory
surveillance of measles outbreaks; and
--Conducting operations research to guide cost-effective and high
quality measles control programs.
In addition, CDC epidemiologists and public health specialists have
worked closely with WHO, UNICEF, the United Nations Foundation, and the
American Red Cross to strengthen measles control programs at global and
regional levels.
While it is not possible to precisely quantify the impact of CDC's
financial and technical support to the Measles Initiative, there is no
doubt that CDC's support--made possible by the funding appropriated by
Congress--was essential in helping achieve the sharp reduction in
measles deaths in just 6 years.
The American Red Cross and the United Nations Foundation would like
to acknowledge the leadership and work provided by CDC and recognize
that CDC brings much more to the table than just financial resources.
The Measles Initiative is fortunate in having a partner that provides
critical personnel and technical support for vaccination campaigns and
in response to disease outbreaks. CDC personnel have routinely
demonstrated their ability to work well with other organizations and
provide solutions to complex problems that help critical work get done
faster and more efficiently.
In fiscal year 2007, Congress has appropriated approximately $43
million to fund CDC for global measles control activities. The American
Red Cross and the United Nations Foundation thank Congress for the
financial support that has been provided to CDC in the past and this
year. We respectfully request an additional $10 million increase in the
fiscal year 2008 funding for CDC's measles control activities so that
the gains made to date can continue and the 2010 goal of a 90 percent
reduction in measles deaths can be achieved.
The additional funds we are seeking for CDC are critical for:
--Sustaining the great progress in measles mortality reduction in
Africa by strengthening measles surveillance and strengthening
the delivery of measles vaccine through routine immunization
services to protect new birth cohorts;
--Conducting large-scale measles vaccination campaigns in South Asia,
thus protecting million of children;
--Conducting nationwide measles vaccination campaigns in countries,
such as the Philippines, lacking access to traditional and new
funding sources.
Your commitment has brought us unprecedented victories in reducing
measles mortality around the world. Measles can cause severe
complications and death. Your continued support for this initiative
helps prevent children from needlessly suffering from this debilitating
disease in the United States and abroad.
Thank you for the opportunity to submit testimony.
______
Prepared Statement of the American Nephrology Nurses' Association
INTRODUCTION
On behalf of the American Nephrology Nurses' Association (ANNA), I
appreciate having the opportunity to submit written testimony to the
Senate Labor, Health, and Human Services (LHHS) Subcommittee regarding
funding for nursing and nephrology related programs in fiscal year
2008. ANNA is a professional nursing organization of more than 12,000
registered nurses practicing in nephrology, transplantation, and
related therapies. Nephrology nurses use the nursing process to care
for patients of all ages who are experiencing, or are at risk for,
kidney disease.
ANNA understands that Congress has many concerns and limited
resources, but believes kidney disease is a heavy burden on our society
that must be addressed. The United States has the highest incidence
rate of late stage kidney disease in the world.\1\ The direct economic
cost for treating kidney failure is $20 billion a year in the United
States and the number of people diagnosed with kidney failure has
doubled each decade for the last 20 years. Because kidney disease
imposes such a heavy burden in the United States, we must provide
adequate funding for research and prevention programs.
---------------------------------------------------------------------------
\1\ Sources: National Kidney Disease Education Program, American
Nephrology Nurses' Association.
---------------------------------------------------------------------------
KIDNEY DISEASE AND NEPHROLOGY NURSING
Chronic kidney disease (CKD) is the slow, progressive loss of
kidney function as a result of abnormalities of the kidney. The
National Kidney Foundation estimates that around 20 million Americans
have CKD, and another 20 million are at risk. When CKD patients lose 85
percent of kidney function, it is known as end stage renal disease
(ESRD).\2\ When patients reach ESRD, they must receive replacement
therapy either in the form of dialysis or kidney transplant in order to
survive. While kidney transplant is a treatment option for many ESRD
patients, unfortunately the need for donor organs exceeds the supply,
resulting in long waiting times for those who do not have a living
donor.
---------------------------------------------------------------------------
\2\ American Nephrology Nurses' Association. (2006). Chronic Kidney
Disease Fact Sheet [Brochure]. ANNA Chronic Kidney Disease Special
Interest Group: Author.
---------------------------------------------------------------------------
CKD is often undiagnosed until the signs and symptoms related to
the loss of kidney function materialize. Risk factors for developing
CKD include increasing age, family history and diabetes. The disease is
more prevalent in men and people of African American, American Indian,
Hispanic, Asian, or Pacific Islander descent.
Since treatment of kidney patients often spans the duration of
their lifetime, nephrology nurses must be skilled in offering care for
all stages of life and disease progression. Nephrology nurses work in
dialysis clinics, hospitals, physician practices, transplant programs,
and many other settings.
To ensure that patients receive the best quality care possible,
ANNA supports Federal programs and research institutions that address
the national nursing shortage and conduct biomedical research into
kidney disease and related health problems. Therefore, ANNA
respectfully requests the Senate LHHS Appropriations Subcommittee
provide increased funding for the following programs:
nursing workforce and development programs at the health resources and
SERVICES ADMINISTRATION (HRSA)
ANNA supports efforts to resolve the national nursing shortage,
including appropriate funding to address the shortage of qualified
nursing teaching faculty. Nephrology nursing requires a high level of
education and technical expertise, and ANNA is committed to assuring
and protecting access to professional nursing care delivered by highly
educated, well-trained, and experienced registered nurses for
individuals with kidney disease or other disease processes that require
replacement therapies.
According to the Department of Health and Human Services, the
Nursing Workforce Development programs at HRSA have supported the
recruitment, education, and retention of an estimated 36,750 nurses. A
report issued by HRSA, Projected Supply, Demand, and Shortages of
Registered Nurses: 2000-2020, predicts that the nursing shortage is
expected to grow by 29 percent by 2020. The HRSA Nursing Workforce
Development Programs provide the largest source of Federal funding to
address the national nursing shortage, therefore:
ANNA strongly supports the national nursing community's request of
$200 million in fiscal year 2008 funding for Nursing Workforce
Development programs at HRSA.
NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES
(NIDDK)
As the primary professional caretakers of patients with CKD and
ESRD, ANNA members support legislative, regulatory, and programmatic
efforts that promote prevention and management of chronic kidney
disease, including early diagnosis, education and proactive creation of
native fistulae for dialysis.
NIDDK supports and conducts research on many serious diseases,
including chronic kidney disease and ESRD. Specifically, the National
Kidney Disease Education Program (NKDEP) at NIDDK is focused on
reducing the overall mortality and morbidity from kidney disease. The
programs at NKDEP were created to increase awareness about the
seriousness of kidney disease, and the importance of prevention, early
diagnosis, and appropriate management of kidney disease.
ANNA encourages Congress to support funding for research into and
prevention of kidney disease by providing the maximum possible funding
level for NIDDK in fiscal year 2008.
NATIONAL INSTITUTE OF NURSING RESEARCH (NINR)
ANNA understands that research is essential for the advancement of
nursing science, and believes new concepts must be developed and tested
to sustain the continued growth of the nephrology nursing profession.
NINR works to create cost-effective and high-quality health care by
testing new nursing science concepts and investigating how to best
integrate them into daily practice. NINR has a broad mandate that
includes seeking to prevent and delay disease and to ease the symptoms
associated with both chronic and acute illnesses. NINR's recent areas
of research focus include the following:
--End of life and palliative care in rural areas;
--Research in multi-cultural societies;
--Bio-behavioral methods to improve outcomes research; and
--Increasing health promotion through comprehensive studies.
ANNA respectfully requests $150 million in funding for NINR in
fiscal year 2008 to continue their efforts to address issues related to
nursing care for chronic and acute illnesses.
CONCLUSION
I appreciate the opportunity to share ANNA's fiscal year 2008
funding priorities for programs designed to address issues relating to
kidney disease and provide for a sustainable nursing workforce.
Providing $200 million in fiscal year 2008 funding to the HRSA Nursing
Workforce Development programs, $150 million to NINR and the largest
allocation possible for NIDDK will ensure we are providing adequate
resources for this fight. ANNA thanks the Senate LHHS Appropriations
Subcommittee for their consideration and is happy to serve as a
resource regarding these programs or other kidney disease or nursing
related issues.
______
Prepared Statement of the American Optometric Association
The American Optometric Association appreciates the opportunity to
submit written testimony to the file of the hearing of the Labor,
Health and Human Services, Education and Related Agencies Subcommittee
of the Senate Appropriations Committee in support of increased funding
the National Eye Institute (NEI), of the National Institutes of Health
(NIH).
The American Optometric Association represents over 35,000
practicing Doctors of Optometry across the Nation. As a profession
devoted to improving the vision care and health of the public, doctors
of optometry examine eyes and the visual system, treat ocular diseases
and disorders, and diagnose related systemic conditions.
Doctors of optometry (ODs) are the primary health care
professionals for the eye. Optometrists examine, diagnose, treat, and
manage diseases, injuries, and disorders of the visual system, the eye,
and associated structures, as well as identify related systemic
conditions affecting the eye.
--ODs prescribe medications, low vision rehabilitation, vision
therapy, spectacle lenses, contact lenses, and perform certain
surgical procedures.
--Optometrists counsel their patients regarding surgical and non-
surgical options that meet their visual needs related to their
occupations, avocations, and lifestyle.
--An optometrist has completed pre-professional undergraduate
education in a college or university and 4 years of
professional education at a college of optometry, leading to
the doctor of optometry (O.D.) degree. Some optometrists
complete an optional residency in a specific area of practice.
--Optometrists are eye health care professionals state-licensed to
diagnose and treat diseases and disorders of the eye and visual
system.
The American Optometric Association (AOA) requests fiscal year 2008
National Institutes of Health (NIH) funding at $31 billion, or a 6.7
percent increase over fiscal year 2007, to balance the biomedical
inflation rate of 3.7 percent and to maintain the momentum of
discovery. Although AOA commends the leadership's actions in the 110th
Congress to increase fiscal year 2007 NIH funding by $620 million, this
was just an initial step in restoring the NIH's purchasing power, which
had declined by more than 13 percent since fiscal year 2005. That power
would be eroded even further under the administration's fiscal year
2008 budget proposal. Funding would also be eroded even further under
the administration's fiscal year 2008 budget proposal. AOA commends NIH
Director, Dr. Elias Zerhouni, who has articulately described his agenda
to foster collaborative, cost-effective research and to transform the
health care research and delivery paradigm into one that is predictive,
preemptive, preventive, and personalized. NIH is the world's premier
institution and must be adequately funded so that its research can
reduce health care costs, increase productivity, improve quality of
life, and ensure our Nation's global competitiveness.
AOA requests that Congress make eye and vision health a top
priority by funding the National Eye Institute (NEI) at $711 million in
fiscal year 2008, or a 6.7 percent increase over fiscal year 2007. This
level is necessary to fully advance the breakthroughs resulting from
NEI's basic and clinical research that are resulting in treatments and
therapies to prevent eye disease and restore vision. Vision impairment/
eye disease is a major public health problem that is growing and that
disproportionately affects the aged and minority populations, costing
the United States at least $68 billion annually in direct and societal
costs, let alone the indirect costs of reduced independence and
decreased quality of life. Adequately funding the NEI is a cost-
effective investment in our Nation's health, as it can delay, save, and
prevent expenditures, especially to the Medicare and Medicaid programs.
FUNDING THE NEI AT $711 MILLION IN FISCAL YEAR 2008 WOULD ENABLE IT TO
LEAD TRANS-INSTITUTE VISION RESEARCH THAT MEETS NIH'S GOAL OF
PREEMPTIVE, PREDICTIVE, PREVENTIVE, AND PERSONALIZED HEALTH CARE
Funding NEI at $711 million in fiscal year 2008 represents the
judgment of the AOA and its partners in the eye and vision research
community as the level necessary to fully advance breakthroughs
resulting from NEI's basic and clinical research that are resulting in
treatments and therapies to prevent eye disease and restore vision.
--NEI research responds to the NIH's overall major health challenges,
as set forth by NIH Director Dr. Zerhouni: an aging population;
health disparities; the shift from acute to chronic diseases;
and the co-morbid conditions associated with chronic diseases
(e.g., diabetic retinopathy as a result of the epidemic of
diabetes). In describing the predictive, preemptive,
preventive, and personalized approach to health care research,
Dr. Zerhouni has also frequently cited NEI-funded research as a
tangible example of the value of our Nation's past and future
investment in the NIH.
Although NEI's breakthroughs came directly from the past doubling
of the NIH budget, their long-term potential to preempt, predict,
prevent, and treat disease relies on adequately funding NEI's follow-up
research. Unless its funding is increased, the NEI's ability to
capitalize on the findings cited above will be seriously jeopardized,
resulting in missed opportunities that include:
--Following up on the Age-related Macular Degeneration (AMD) gene
discovery by developing diagnostics for early detection and
developing promising therapies, as well as to further study the
impact of the body's inflammatory response on other
degenerative eye diseases.
--Fully investigating the impact of additional, cost-effective
dietary supplements in the Age-Related Eye Disease Study
(AREDS) study, singly and in combination, to determine if they
can demonstrate enhanced protective effects against progression
to advanced AMD.
In addition, NEI research into other significant eye disease
programs, such as glaucoma and cataract, will be threatened, along with
quality of life research programs into low vision and chronic dry eye.
This comes at a time when the U.S. Census and NEI-funded
epidemiological research (also threatened without adequate funding)
both cite significant demographic trends that will increase the public
health problem of vision impairment and eye disease.
vision impairment/eye disease is a major public health problem that is
INCREASING HEALTH CARE COSTS, REDUCING PRODUCTIVITY AND DIMINISHING
QUALITY OF LIFE
The 2000 U.S. Census reported that more than 119 million people in
the United States were age 40 years or older, which is the population
most at risk for age-related eye disease. The NEI estimates that,
currently, more than 38 million Americans age 40 years and older
experience blindness, low vision or an age-related eye disease such as
AMD, glaucoma, diabetic retinopathy, or cataracts. This is expected to
grow to more than 50 million Americans by 2020. The economic and
societal impact of eye disease is increasing not only due to the aging
population, but to its disproportionate incidence in minority
populations and as a co-morbid condition of other chronic, common
disease, such as diabetes.
Although the NEI estimates that the current annual cost of vision
impairment and eye disease to the United States is $68 billion, this
number does not fully quantify the impact of direct health care costs,
lost productivity, reduced independence, diminished quality of life,
increased depression, and accelerated mortality. The continuum of
vision loss presents a major public health problem and financial
challenge to both the public and private sectors.
In public opinion polls over the past 40 years, Americans have
consistently identified fear of vision loss as second only to fear of
cancer. As a result, Federal funding for the NEI is a vital investment
in the health, and vision health, of our Nation, especially our
seniors, as the treatments and therapies emerging from research can
preserve and restore vision. Adequately funding the NEI can delay,
save, and prevent expenditures, especially those associated with the
Medicare and Medicaid programs, and is, therefore, a cost-effective
investment.
AOA urges fiscal year 2008 NIH and NEI funding at $31 billion and $711
million, respectively
Of course, vision impairment and eye disease are not limited to the
middle-aged and the elderly. Public health experts recommend that
children visit an eye care professional in the first year of life--one
of the most critical stages of visual development--to identify the
potential for eye and vision problems.
In fact, current research shows us that:
--One in 10 children is at risk from undiagnosed eye and vision
problems, which, if undetected, could lead to permanent vision
impairment, and in rare cases, life-threatening health risks.
--Only 14 percent of children from infancy to age 6 have had a
comprehensive eye assessment from an eye care professional.
The NEI has funded several clinical trials in the area of
children's vision. The VIP Study (Vision in Preschoolers) evaluated the
best screening tests to identify preschool children in need of vision
care for amblyopia (``lazy'' eye), strabismus (crossed eyes) and
significant refractive errors (e.g., nearsightedness or
farsightedness). The CLEER Study (Collaborative Longitudinal Evaluation
of Ethnicity and Refractive Error) evaluated the role of ethnicity in
children's vision conditions. The CITT Study (Convergence Insufficiency
Treatment Trial) is studying the success rates of treatments for
convergence insufficiency (eye turns in). The NEI budget should be
sufficient to permit funding of grants at a high level in the areas of
strabismus, amblyopia and refractive error. Since about 60 percent of
Americans have refractive errors requiring eyeglasses or contact
lenses, research in the cause and prevention of refractive error should
continue.
The value of clinical trials to the public cannot be overestimated.
NEI has a remarkable record of scientific breakthroughs attributed to
clinical trial research, beginning with studies of diabetic retinopathy
in the 1970s. NEI clinical trials involve collaboration with many
institutions, health professionals and thousands of patients. Although
significant progress has been made, further clinical trial research is
needed to determine the causes of refractive error and amblyopia in
children and subsequent prevention of visual impairment.
In an effort to encourage early detection and treatment, the
American Optometric Association launched in 2005 a national public
health initiative to provide no-cost vision assessments for infants.
The program is called InfantSEE, and it's achieving remarkable results
for children and their families. Thanks to the more than 7,500 of my
colleagues from across the country who have volunteered their time and
expertise to make this optometry's most successful vision saving and
lifesaving public health initiative, more than 80,000 babies have
received a vision assessment at no cost from their local optometrist.
______
Prepared Statement of the American Public Health Association
The American Public Health Association (APHA) is the Nation's
oldest, largest and most diverse organization of public health
professionals in the world, dedicated to protecting all Americans and
their communities from preventable, serious health threats and assuring
community-based health promotion and disease prevention activities and
preventive health services are universally accessible in the United
States. We are pleased to submit our views on Federal funding for
public health activities in fiscal year 2008.
RECOMMENDATIONS FOR FUNDING THE PUBLIC HEALTH SERVICE
APHA's budget recommendation for overall funding for the Public
Health Service includes funding for the Centers for Disease Control and
Prevention (CDC), the Health Resources and Services Administration
(HRSA), the Substance Abuse and Mental Health Services Administration
(SAMHSA), the Agency for Healthcare Research and Quality (AHRQ), and
the National Institutes of Health (NIH), as well as agencies outside
the subcommittee's jurisdiction--the Food and Drug Administration (FDA)
and the Indian Health Service (IHS).
CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC)
APHA believes that Congress should support CDC as an agency--not
just the individual programs that it funds. We support a funding level
for CDC that enables it to carry out its mission to protect and promote
good health and to assure that research findings are translated into
effective State and local programs.
In the best professional judgment of APHA, in conjunction with the
CDC Coalition--given the challenges and burdens of chronic disease, a
potential influenza pandemic, terrorism, disaster preparedness, new and
reemerging infectious diseases, increasing drug resistance to
critically important antimicrobial drugs and our many unmet public
health needs and missed prevention opportunities--we believe the agency
will require funding of at least $10.7 billion including sufficient
funding to prepare the Nation against a potential influenza pandemic,
funding for the Agency for Toxic Substances and Disease Registry and to
maintain the current funding level for the Vaccines for Children (VFC)
program. This request does not include any additional funding that may
be required to expand the mandatory VFC in fiscal year 2008.
APHA appreciates the subcommittee's work over the years, including
your recognition of the need to fund chronic disease prevention,
infectious disease prevention and treatment, programs to combat racial,
ethnic and geographic disparities in health and health care and
environmental health programs at CDC. Federal funding through CDC
provides the foundation for our State and local public health
departments, supporting a trained workforce, laboratory capacity and
public health education communications systems.
CDC also serves as the command center for our Nation's public
health defense system against emerging and reemerging infectious
diseases. With the for an potential onset of an influenza pandemic, in
addition to the many other natural and man-made threats, CDC is the
Nation's--and the world's--expert resource and response center,
coordinating communications and action and serving as the laboratory
reference center.
CDC's budget has actually shrunk since 2005 in terms of real
dollars--by almost 4 percent. If you add inflation, the cuts are even
worse--and these are cuts to the core programs of the agency. The
current administration request for fiscal year 2008 is inadequate, with
a total cut to core budget categories from fiscal year 2005 to fiscal
year 2008 of half a billion dollars. We are moving in the wrong
direction, especially in these challenging times when public health is
being asked to do more, not less. Funding public health outbreak by
outbreak is not an effective way to ensure either preparedness or
accountability. Until we are committed to a strong public health
system, every crisis will force trade offs.
CDC serves as the lead agency for bioterrorism preparedness and
must receive sustained support for its preparedness programs in order
for our Nation to meet future challenges. APHA supports the proposed
increase for anti-terrorism activities at CDC, including the increases
for the Strategic National Stockpile. However, we strongly oppose the
President's proposed $125 million cut to the State and local capacity
grants. We ask the subcommittee to restore these cuts to ensure that
our States and local communities can be prepared in the event of an act
of terrorism.
Unfortunately, the President's budget proposes the elimination of
some very important CDC programs, like the Preventive Health and Health
Services (PHHS) Block Grant. Within an otherwise-categorical funding
construct, the PHHS Block Grant is the only source of flexible dollars
for States and localities to address their unique public health needs.
The track record of positive public health outcomes from PHHS Block
Grant programs is strong, yet so many requests go unfunded. We
encourage the subcommittee to restore the cuts and fund the Prevention
Block Grant at $131 million.
We must address the growing disparity in the health of racial and
ethnic minorities. CDC's Racial and Ethnic Approaches to Community
Health (REACH), helps States address these serious disparities in
infant mortality, breast and cervical cancer, cardiovascular disease,
diabetes, HIV/AIDS and immunizations. Please provide adequate funds for
this program.
We encourage the subcommittee to provide adequate funding for CDC's
Environmental Public Health Services Branch to revitalize environmental
public health services at the national, State and local level. As with
the public health workforce, the environmental health workforce is
declining. Furthermore, the agencies that carry out these services are
fragmented and their resources are stretched. These services are the
backbone of public health and are essential to protecting and ensuring
the health and well being of the American public from threats
associated with West Nile virus, terrorism, E. coli and lead in
drinking water. We encourage the committee to provide at least $50
million for CDC's Environmental Health Tracking Network.
We also encourage the subcommittee to provide $50 million to CDC
Environmental Health Activities to develop and enhance CDC's capacity
to help the Nation prepare for and adapt to the potential health
effects of global climate change. This new request for funding would
help prepare State and local health department to prepare for the
public health impacts of global climate change, allow CDC to fund
academic and other institutions in their efforts to research the
impacts of climate change on public health and to create a Center of
Excellence at CDC to serve as a national resource for health
professionals, government leaders and the public on climate change
science.
HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA)
HRSA programs are designed to give all Americans access to the best
available health care services. Through its programs in thousands of
communities across the country, HRSA provides a health safety net for
medically underserved individuals and families, including more than 45
million Americans who lack health insurance; 50 million Americans who
live in neighborhoods where primary health care services are scarce;
African American infants, whose infant mortality rate is more than
double that of whites; and the estimated 1 to 1.2 million people living
with HIV/AIDS. Programs to support the underserved place HRSA on the
front lines in erasing our Nation's racial/ethnic and rural/urban
disparities in health status. HRSA funding goes where needs exists, in
communities all over America. In the best professional judgment of
APHA, to respond to this challenge, the agency will require an overall
funding level of at least $7.5 billion for fiscal year 2008.
APHA is gravely concerned about a number of programs that are
slated for deep cuts or elimination under the administration's budget
proposal. Building on the HRSA programs that were cut or eliminated in
the fiscal years 2006 and 2007 appropriations bills, we strongly
suggest that this trend is moving our Nation in the wrong direction. We
urge the subcommittee to restore funding to HRSA programs that were cut
last year, as well as ensure adequate funding for fiscal year 2008 by
rejecting the proposed cuts contained in the President's budget.
We express our dismay at the eroding support from the
administration for some of HRSA's programs. On top of the $250 million
cut to the agency for fiscal year 2006, the President has proposed
another $321 million overall cut from last year's appropriated level.
Under the proposal, total cuts to HRSA since fiscal year 2005 would
reach more than $570 million, a devastating 8 percent cut in 2 years,
which has been even more severe for HRSA's core programs from which
funding has been diverted to fund other administration priorities. We
urge the subcommittee to restore the cuts delivered to these programs
in fiscal years 2006 and 2007, and reject the President's proposed cuts
for fiscal year 2008. We are again concerned that the HRSA health
professions programs under Title VII and VIII of the Public Health
Service Act have landed on the chopping block. Today our Nation faces a
widening gap between challenges to improve the health of Americans and
the capacity of the public health workforce to meet those challenges.
These programs help meet the health care delivery needs of the areas in
this country with severe health professions shortages, at times serving
as the only source of health care in many rural and disadvantaged
communities.
We believe the elimination of the Healthy Community Access Program,
the Traumatic Brain Injury program, universal newborn hearing screening
programs, and the Emergency Medical Services for Children Program, will
further undermine the availability of basic health services for those
most in need-especially children. The Healthy Community Access Program
is an example of communities building partnerships among health care
providers to deliver a broader range of health services to their
neediest residents. Elimination of the universal newborn hearing
screening programs in the administration's budget will leave hearing
impairments in infants undetected, negatively impacting speech and
language acquisition, academic achievement, and social and emotional
development. The proposed elimination of EMSC jeopardizes improvements
made to pediatric emergency care, disproportionately affecting children
eligible for Medicaid and SCHIP, but not enrolled due to State
enrollment limits and budgetary pressures, and therefore frequently use
emergency health services.
The Maternal and Child Health Block Grant is also operating for a
third year with less funds than in fiscal year 2005, yet with greater
needs among pregnant women, infants, and children, particularly those
with special health care needs.
We are pleased with the increases proposed by the President for
programs under the Ryan White CARE Act, administered by HRSA's HIV/AIDS
Bureau. The CARE Act programs are an important safety net, providing an
estimated 571,000 people access to services and treatments each year.
At a time when the number of new domestic HIV/AIDS cases is increasing,
we support increased funding for these programs.
Through its many programs, HRSA helps countless individuals live
healthier lives. APHA believes that with adequate resources, HRSA is
well positioned to meet these challenges as it continues to provide
needed health care to the Nation's most vulnerable citizens. Please
restore funds to these important public health programs.
AGENCY FOR HEALTHCARE RESEARCH AND QUALITY (AHRQ)
We request a funding level of $350 million for the AHRQ for fiscal
year 2008. This level of funding is needed for the agency to fully
carry out its congressional mandate to improve health care quality,
including eliminating racial and ethnic disparities in health, reducing
medical errors, and improving access and quality of care for children
and persons with disabilities. The cuts proposed in the administration
budget will severely hamper these efforts.
SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION (SAMHSA)
APHA supports a funding level of $3.532 billion for SAMHSA for
fiscal year 2008. This funding level would provide support for
substance abuse prevention and treatment programs, as well as continued
efforts to address emerging substance abuse problems in adolescents,
the nexus of substance abuse and mental health, and other serious
threats to the mental health of Americans.
NATIONAL INSTITUTES OF HEALTH (NIH)
APHA supports a funding level of $30.869 billion for the NIH for
fiscal year 2008. The translation of fundamental research conducted at
NIH provides some of the basis for community based public health
programs that help to prevent and treat disease.
In closing, we emphasize that the public health system requires
financial investments at every stage. Successes in biomedical research
must be translated into tangible prevention opportunities, screening
programs, lifestyle and behavior changes, and other interventions that
are effective and available for everyone. We ask you to think in a
broad and balanced way, leveraging funding whenever possible to provide
public health benefits as a matter of routine, rather than emergency.
We thank the subcommittee for the opportunity to present our views
on the fiscal year 2008 appropriations for public health service
programs.
______
Prepared Statement of the American Society of Nephrology
INTRODUCTION
The American Society of Nephrology (ASN) is pleased to submit this
statement for the record to the Senate Appropriations Subcommittee on
Labor, Health and Human Services and Education.
The ASN is a professional society of more than 10,000 researchers,
physicians, and practitioners committed to the treatment, prevention,
and cure of kidney disease. Specifically, the ASN strives to enhance
and assist the study and practice of nephrology, to provide a forum for
the promulgation of research, and to meet the professional and
continuing education needs of its members.
This ASN statement focuses on those issues and programs that most
immediately fall under the committee's jurisdiction and assist our
members to fulfill their missions. We want to express our strong
support for advancing programs supported by the National Institutes of
Health (NTH) and Agency for Healthcare Research and Quality (AHRQ). The
ASN thanks the subcommittee for its commitment and steadfast support of
these programs.
KIDNEY DISEASE: A GROWING PUBLIC HEALTH CONCERN
Kidney disease is the ninth leading cause of death in the United
States. It is estimated that at least 15 million people have lost 50
percent of their kidney function. Another 20 million more Americans are
at increased risk of developing kidney disease. The culmination of
unimpeded progression is end stage renal disease (ESRD), a condition in
which patients have permanent kidney failure, affects almost 400,000
Americans and directly causes 50,000 deaths annually. In the past 10
years, the number of patients in the United States with ESRD has almost
doubled and it is expected to reach 700,000 by 2015, according to the
United States Renal Data System (USRDS). ESRD disproportionately
affects minorities. For example, although they constitute approximately
12 percent of the U.S. Population, African Americans comprise 32
percent of the prevalent ESRD population and are nearly four times more
likely to develop kidney disease than Caucasians. Native Americans are
twice as likely. The elderly are also disproportionately affected. One
in four new ESRD patients was 75 or older in 2004. The two major
therapies for ESRD are dialysis and kidney transplantation. The number
of patients waiting for a kidney transplant increased from 9,452 in
1988 to 60,393 in 2004. Almost 50 percent of kidney transplants are
received by people aged 45-64.
ECONOMIC COSTS
Although no dollar amount can be affixed to human suffering or the
loss of human life, economic data can help to identify and quantify the
current and projected future financial costs associated with ESRD. The
2000 report of the USRDS indicates that the total Medicare ESRD program
cost will more than double, surpassing $28 billion, by 2010, as the
prevalence of kidney failure is projected to double. Currently, the
total Medicare cost for ESRD is nearly $20.1 billion. The annual
average cost per ESRD patient is approximately $58,000. These
escalating costs serve to magnify the need to investigate new, and
better apply, recently proven strategies for preventing progressive
kidney disease.
In short, we can treat and maintain patients who have lost their
kidney function but the critical need is to prevent the loss of kidney
function and its complications in the first place. Meeting this vital
goal can only be accomplished through more concerted research and
education.
MAJOR CAUSES OF END STAGE RENAL DISEASE
Diabetes, a disease that affects 18 million Americans, is the most
common cause of ESRD in the United States, accounting for 44 percent of
new cases in 2002. The time from the onset of diabetes-related kidney
disease to kidney failure is 5-7 years. With current projections that
the epidemic of obesity-related diabetes mellitus will continue to
soar, a dramatic increase in kidney disease is anticipated in the next
10 years.
Hypertension, or high blood pressure, is the next leading cause of
ESRD, accounting for 27 percent of ESRD patients. Higher rates of
hypertension can be found among certain age and ethnic groups. For
example, 35 percent of African Americans have hypertension. Among new
patients whose kidney failure was caused by high blood pressure, more
than half (51.2 percent) were African American. It is also a disease of
the aged and accounts for 37 percent of new ESRD cases in those 65
years old and above.
Despite recent progress and discoveries regarding the major causes
of ESRD, it is among many areas of disease research that remain under-
investigated. Researchers agree that significant inroads in previously
understudied sub-fields need to be made. Significant among them, more
focus and direction need to be introduced into the general field of
renal research and patient and physician education.
LACK OF PUBLIC AWARENESS
A major problem with kidney disease is that it is largely a
``Silent Disease''. In fact, of the 15 million Americans who have lost
at least half of their kidney function, the vast majority have no
knowledge of their condition. While people with chronic kidney disease
may not show any symptoms, this does not mean that they are not going
to have long-term damage to their kidney function, requiring dialysis
or a transplant. These people may also be especially vulnerable to
cardiovascular disease. If these 15 million people were identified
early, there are new therapies, particularly special blood pressure
drugs known as ACE inhibitors, which could be prescribed with
potentially significant benefits. In addition, vigorous treatment of
hypertension and other complications that cause illnesses and loss of
productivity could be administered to the patients.
Given the cost to human life and to the Federal Government caused
by the growing public health issues of CKD and ESRD, we urge this
subcommittee to provide funding increases for kidney disease research.
KIDNEY DISEASE RESEARCH
National Institutes of Health (NIH)
The ASN applauds Congress and members of the subcommittee for
leading the bipartisan effort to double our investment in promising
biomedical research supported and conducted by the NIH. NIH has served
as a vital component in improving the Nation's health through research,
both on and off the NIH campus, and in the training of research
investigators, including nephrology researchers. Strides in biomedical
discovery have had an impact on the quality of life for people with
kidney disease. If we are to sustain this momentum and translate the
promise of biomedical research into the reality of better health, this
Nation must maintain its commitment to medical research. Unfortunately,
since the doubling ended in 2003, funding for NIH has failed to keep
pace with biomedical inflation and as a result, the NIH has lost more
than 13 percent of its purchasing power. We support the recommendation
of the Ad-Hoc Group for Medical Research Funding to add 6.7 percent to
the NIH budget for a total of $30.869 in fiscal year 2008.
National Institute of Diabetes, Digestive, and Kidney Diseases (NIDDK)
Many recent advances have been made in our understanding into the
causes and progression of renal failure, such as: how diabetes and
hypertension affect the kidney and the mechanisms responsible for acute
renal failure. Despite these advances, the number of people with renal
failure and the numbers who die of renal failure continue to increase
each year. Most alarming is the significant increase in diabetes, the
most common cause of chronic kidney failure, and its relationship to
kidney disease. The ASN believes the rising incidence and prevalence of
diabetes-related kidney disease warrants additional recourses to
improve our understanding of the relationship between kidney disease
and diabetes.
The NIDDK sponsors a number of activities that researchers hope
will lead to improved detection, treatment and prevention of kidney
disease and chronic kidney failure. To ensure ongoing kidney disease
and kidney disease related research and important clinical trials
infrastructure development we recommend a 6.7 percent increase for the
NIDDK over fiscal year 2007 levels.
ASN RESEARCH GOALS & RECOMMENDATIONS FOR KIDNEY DISEASE
The ASN continues to evaluate its priorities for future kidney
disease research. In the fall of 2004, the ASN conducted a series of
research retreats to develop priorities to combat the growing
prevalence of kidney disease in the United States. The ASN joined
experts, both within and outside the renal community, and identified
five areas requiring attention: acute renal failure, diabetic
nephropathy, hypertension, transplantation, and kidney-associated
cardiovascular disease.
The final research retreat report(s) highlighted priorities and
contained three overriding recommendations. Theses include:
Development of Core Centers for kidney disease research
Expansion of the kidney research infrastructure in the United
States can be achieved by vigorous funding of a program of kidney
research core centers. Specifically, we propose that the number of
kidney centers be increased with the goal of providing core facilities
to support collaborative research on a local, regional and national
level. It should be emphasized that such a program of competitively
reviewed kidney core centers would facilitate investigator-initiated
research in both laboratory and patient-oriented investigation. This
approach is highly compatible with the collaborative research
enterprise conceived in the NIH Road Map Initiative.
Support programs/research initiatives that impact the understanding of
THE RELATIONSHIP BETWEEN RENAL AND CARDIOVASCULAR DISEASE
It is now well recognized that chronic kidney dysfunction is an
important risk factor for the development of cardiovascular disease. It
is recommended that the NIDDK and NHLBI work cooperatively to support
both basic and clinical science projects that will shed light on the
pathogenesis of this relationship and to support the exploration of
interventions that can decrease cardiovascular events in patients with
CM). Thus, we specifically propose that NHLBI should support
investigator-initiated research grants in areas of kidney research with
a direct relationship to cardiovascular disease. Similarly, NHLBI
should work collaboratively with NIDDK to support the proposed program
of kidney core research centers.
Continued support and expansion of investigator initiated research
projects
In each of the five subjects there are areas of fundamental
investigation that require the support of investigator initiated
projects, if ultimately progress is to be made in the understanding of
the basic mechanisms that underlie the diseases processes. It is
recommended that there should be an expansion of support for research
in the areas that lend themselves to this mechanism of funding, by
encouraging applications with appropriate program announcements and
requests for proposals. In addition to vigorous support for RO1 grants,
continued funding of Concept Development and R2 1/R33 grants is
essential to support development of investigator-initiated clinical
studies in these areas of high priority. Such funding is critical to
accelerate the transfer of new knowledge from the bench to the bedside.
Agency for Health Care Research and Quality (AHRO)
Complementing the medical research conducted at NIH, the AHRQ
sponsors health services research designed to improve the quality of
health care, decrease health care costs, and provide access to
essential health care services by translating research into measurable
improvements in the health care system. The AHRQ supports emerging
critical issues in health care delivery and addresses the particular
needs of priority populations, such as people with chronic diseases.
The ASN firmly believes in the value of AHRQ's research and quality
agenda, which continues to provide health care providers, policymakers,
and patients with critical information needed to improve health care
and treatment of chronic conditions such as kidney disease. The ASN
supports the Friends of AHRQ recommendation of $350 million for AHRO in
fiscal year 2008.
CONCLUSION
Currently, there is no cure for kidney disease. The progression of
chronic renal failure can be slowed, but never reversed. Meanwhile,
millions of Americans face a gradual decline in their quality of life
because of kidney disease. In many cases, abnormalities associated with
early stage chronic renal failure remain undetected and are not
diagnosed until the late stages. In sum, chronic renal failure requires
our serious and immediate attention.
As practicing nephrologists, ASN members know firsthand the
devastating effects of renal disease. ASN respectfully requests the
subcommittees' continued support to enable the nephrology community to
continue with its efforts to find better ways to treat and prevent
kidney disease.
Thank you for your continued support for medical research and
kidney disease research. To obtain further information about ASN,
please go to http://www.asn-online.org or contact Paul Smedberg, ASN
Director of Policy & Public Affairs at 202-416-0646.
______
Prepared Statement of the American Society for Pharmacology and
Experimental Therapeutics
The American Society for Pharmacology and Experimental Therapeutics
(ASPET) is pleased to submit written testimony in support of the
National Institutes of Health fiscal year 2008 budget. ASPET is a 4,500
member scientific society whose members conduct basic and clinical
pharmacological research within the academic, industrial and government
sectors. Our members discover and develop new medicines and therapeutic
agents that fight existing and emerging diseases as well as increasing
our knowledge regarding how these therapeutics work.
ASPET members are grateful for the U.S. Congress' historic support
of the NIH. However, appropriations in recent years have failed to
adequately fund the NIH to meet the scientific opportunities and
challenges to our public health. For the fourth year in a row, the NIH
research portfolio will not keep pace with the Biomedical Research and
Development Price Index. After a 5 year bipartisan plan to double the
NIH budget that ended in 2003, the budget in now going backwards. The
administration's recommended fiscal year 2008 budget, if enacted would
mean that the NIH's ability to conduct biomedical research would be cut
by more than 13 percent in inflation adjusted dollars since fiscal year
2003.
To prevent this erosion and sustain the biomedical research
enterprise, ASPET recommends that the NIH receive $30.8 billion in
fiscal year 2008. This would represent an increase of 6.7 percent ($1.9
billion) over the fiscal year 2007 Joint Funding Resolution passed by
Congress. ASPET joins other biomedical research organizations and
professional societies, including the Ad Hoc Group for Medical
Research, the Federation of American Societies for Experimental biology
(FASEB), and Research!America, in advocating for a 6.7 percent increase
in each of the next 3 years to help regain the momentum of discovery
and pre-eminent research, and to help increase NIH's purchasing power
and recover the losses caused by biomedical research inflation.
NIH IMPROVES HUMAN HEALTH AND IS AN ECONOMIC ENGINE
Recent budget levels for the NIH constitute a retraction in the
budget, sending the wrong signal to the best and brightest of American
students who will not be able to or have chosen not to pursue a career
in biomedical research. A diminished NIH research enterprise will mean
a continued reduction in research grants and the resulting phasing-out
of research programs and declining morale, an increasing loss of
scientific opportunities such as the discovery of new therapeutic
targets to develop, fewer discoveries that produce spin-off companies
that employ individuals in districts around the country. In contrast,
the requested funding level would provide the institutes with an
opportunity to raise or at least maintain their paylines, fund more
high quality and innovative research, and provide an incentive for
young scientists to continue their research careers.
Many important drugs have been developed as a direct result of the
basic knowledge gained from federally funded research, such as new
therapies for breast cancer, the prevention of kidney transplant
rejection, improved treatments for glaucoma, new drugs for depression,
and the cholesterol lowering drugs known as statins that prevent
125,000 deaths from heart attack each year. AIDS related deaths have
fallen by 73 percent since 1995 and the 5-year survival rate for
childhood cancers rose to almost 80 percent in 2000 from under 60
percent in the 1970s. And for the first time in 70 years, the number of
deaths from cancer has fallen. The link between basic research, drug
discovery and clinical applications was vividly illustrated when three
pharmacologists were awarded the 1998 Nobel Prize in Physiology or
Medicine for their research on nitric oxide. More recently, NIH funded
research for the 2005 Nobel Prize winners in chemistry. These
scientists developed metal-containing molecules that are now being used
by the pharmaceutical industry to aid in the drug discovery process.
Historically, our past investment in basic biological research has led
to innovative medicines that have virtually eliminated diphtheria,
whooping cough, measles and polio in the United States 8 out of 10
children now survive leukemia. Death rates from heart disease and
stroke have been reduced by half in the past 30 years. Molecularly
targeted drugs such as GleevecTM to treat adult leukemia do
not harm normal tissue and dramatically improve survival rates. NIH
research has developed a class of drugs that slow the progression of
symptoms of Alzheimer's disease. The robust past investment in the NIH
has provided major gains in our knowledge of the human genome,
resulting in the promise of pharmacogenetics and a reduction in adverse
drug reactions that currently represent a major, worldwide health
concern. But unless more robust funding is restored, such scientific
opportunities from the human genome investment and others will be
delayed, lost, or forfeited to biomedical research opportunities in
other countries.
The human cost of not adequately investing in the NIH impact us
all. The total economic cost to our Nation is also staggering: cancer,
$190 billion; obesity, $99 billion; heart disease, $255 billion;
diabetes, $131 billion; and arthritis, $125 billion.
Scientific inquiry leads to better medicine but there remain
challenges and opportunities that need to be addressed, including:
--The need to increase support for training and research in
integrative/whole organ science to see how drugs act not just
at the molecular level--but also in whole animals, including
human beings.
--The need to meet public health concerns over growing consumer use
of botanical therapies and dietary supplements. These products
have unsubstantiated scientific efficacy and may adversely
impact the treatment of chronic diseases, create dangerous
interactions with prescription drugs, and may cause serious
side effects including death among some users.
SUPPORT FOR INTEGRATIVE ORGAN SYSTEM SCIENCE
ASPET supports efforts to increase funding for training and
research in integrative organ system science (IOSS). IOSS is the study
of responses in organs and organisms, including intact animals.
Identification of isolated cellular and molecular components of drugs
in vitro are important for identifying mechanisms of actions but are
inadequate in determining all the complex interactions that happen in
vivo in the actual organs of species. Because of the great advances in
cellular and molecular biology over the past two decades, there has
been much less emphasis in whole organ biology such that academic
infrastructure in this area has eroded and there remain few faculty and
institutions that can provide the appropriate scientific training in
this important area of research. Too few individuals have opportunities
to be trained beyond cellular and molecular techniques. As a
consequence, the pool of talent with expertise in whole organs has
greatly diminished and the biotechnology and pharmaceutical industry
are having great difficulty finding well-trained whole organ scientists
to fill critical positions in their drug discovery departments. As a
result of this training and research deficit, a more thorough and
comprehensive examination of new therapeutic approaches may be
compromised before clinical trials begin.
The lack of training and research opportunities to develop
scientists well rounded in cellular, molecular and in vivo whole organ
biology impacts progress in medicine and the training of future
physicians. Development of preventive approaches and effective
therapeutic strategies for many disorders with devastating health
consequences and increasing incidence in an aging population will
require intensive study at all levels from molecular to whole organ.
For instance, obesity is not just a metabolic disorder. Obesity impacts
many organ functions, including the heart, circulatory system, and
brain. Similarly, clinical depression should not be viewed as just a
neurological disorder because depression affects multiple organs in a
variety of ways. And the discovery of new drugs to treat
neurodegenerative diseases such as Alzheimer's and Parkinson's will
ultimately need to look at complex whole animal systems. For these
reasons, scientists must be trained to look broadly at complex medical
problems afflicting humans. Medical progress in the post-genomic era
needs scientists or teams of scientists who can integrate the results
of studies in gene function at the molecular, cellular, organ system,
whole animal and behavioral levels to fully understand the actions of
current drugs and to facilitate the development of safe new drugs and
treatment strategies.
To reverse the decline and adequately support training and research
in integrative organ systems, integrative biology, program project
grants, and pre and post-doctoral training programs should be
implemented that support integrative training and research activities.
Multi-disciplinary institutional and individual training and research
grants on whole systems and integrative biology should be funded to
investigate disease processes. ASPET is pleased that the National
Institute of General Medical Sciences has recognized this training and
research deficit and has funded four summer workshops to train students
in integrative whole organ sciences. ASPET encourages other institutes
to explore available mechanisms to begin developing a pool of talented
scientists with the appropriate skills in integrative, whole organ
systems biology. While many industrial concerns provide limited support
for training and research at the post-doctoral level, their efforts
remain necessarily focused on drug discovery and development. It is the
role of the NIH and academic institutions to provide adequate training
opportunities to develop the next generation of integrative scientists.
Support for training and research in integrative whole organ
sciences has been affirmed in the fiscal year 2002 U.S. Senate Labor/
Health and Human Services & Related Agencies Appropriations Report
(107-84). The Senate report supports ASPET recommendation that
``Increased support for research and training in whole systems
pharmacology, physiology, toxicology, and other integrative biological
systems that help to define the effects of therapy on disease and the
overall function of the human body.'' These principles and
recommendations are also affirmed in the FASEB Annual Consensus
Conference Report on Federal Funding for Biomedical and Related Life
Sciences Research for Fiscal Year 2002.
SUPPORT FOR RESEARCH ON BOTANICALS AND HERBAL THERAPIES TO MEET PUBLIC
HEALTH NEEDS
ASPET has for years supported peer-reviewed pharmacological
examination of the mechanisms of actions of medicinal plants and is
pleased that the NIH's National Center for Complementary and
Alternative Medicine (NCCAM) continues rigorous investigations into the
basic biology of various botanical agents. ASPET continues to recommend
increased support to study the interaction of botanical remedies and
dietary supplements with prescription medications. This support is
critical to the promotion and funding of the highest quality research
in botanical medicine, will help meet urgent needs of this neglected
area of biological research, and will address a growing public health
problem. Support for highly innovative research on botanicals should be
encouraged among all institutes and centers.
The increased use of botanical and dietary supplements by consumers
to treat various ailments and diseases is a major public health
concern. One national survey reported that in 1997 an estimated 15
million adults (18.4 percent of all prescription users) took herbal
remedies concurrently with prescription medicines. Between 1990 and
1997, the use of herbal products grew by 380 percent. Although there is
little solid scientific evidence to support the therapeutic efficacy of
many botanical and dietary supplement products, the industry records
over $19 billion in annual sales. Botanical products were once
regulated as drugs and the FDA had authority to prevent the sale of
unproven herbal ingredients. However, legislative reforms in 1994
eliminated the FDA's authority to test or approve herbal products prior
to marketing. Thus, at a time when many more consumers are using more
herbal products, there is little research on either their clinical
efficacy or basic mechanisms of action. The growing use of herbal
products by consumers, their interactions with prescription drugs--and
mechanisms of such interactions--represent a serious and growing public
health problem that demands scientific attention and redress by
regulatory and legislative action.
Through the NIH, research into the safety and efficacy of botanical
products can be conducted in a rigorous and high quality manner. Sound
pharmacological studies will help determine the value of botanical
preparations and the potential for their interactions with prescription
drugs as well as chronic disease processes. This research will allow
the FDA to review the available pharmacology and review valid evidence-
based reviews to form a valid scientific foundation for regulating
these products.
CONCLUSION
The biomedical research enterprise is facing a critical moment as
funding stagnates. Reversing this trend and helping to sustain the
extraordinary scientific progress that has been made at the NIH and at
the academic institutions funded by the NIH over the past years is a
major challenge facing this subcommittee. A 6.7 percent increase for
the NIH in fiscal year 2008 will allow the NIH to make greater strides
to prevent, diagnose and treat disease, improving the health of our
Nation. A 6.7 percent increase in the fiscal year 2008 NIH budget will
begin to restore NIH's role as a national treasure that attracts and
retains the best and brightest scientists to biomedical research.
______
Prepared Statement of the American Society of Tropical Medicine and
Hygiene
OVERVIEW
The American Society of Tropical Medicine and Hygiene appreciates
the opportunity to submit written testimony to the House Labor, Health
and Human, Services, and Education Appropriations Subcommittee. With
more than 3,300 members, ASTMH is the world's largest professional
membership organization dedicated to the prevention and control of
tropical diseases. We represent, educate, and support tropical medicine
scientists, physicians, clinicians, researchers, epidemiologists, and
other health professionals from this field.
We respectfully request that the subcommittee provide the following
allocations in the fiscal year 2008 Labor, Health and Human, Services,
and Education Appropriations bill to support a comprehensive effort to
eradicate malaria:
--$18 million to the Centers for Disease and Control and Prevention
(CDC) for malaria research, control, and program evaluation
efforts with a $6 million set-aside for program monitoring and
evaluation;
--$30.8 billion to National Institutes of Health (NIH);
--$4.7 billion to the National Institute of Allergy and Infectious
Diseases (NIAID); and
--$70.8 million to the Fogarty International Center (FIC).
We very much appreciate the subcommittee's consideration our views,
and we stand ready to work with the subcommittee members and staff on
these and other important global health matters.
ASTMH
ASTMH plays an integral and unique role in the advancement of the
field of tropical medicine. Its mission is to promote world health by
preventing and controlling tropical diseases through research and
education. As such, the Society is the principal membership
organization representing, educating, and supporting tropical medicine
scientists, physicians, researchers, and other health professionals
dedicated to the prevention and control of tropical diseases. Our
members reside in 46 States and the District of Columbia and work in a
myriad of public, private, and non-profit environments, including
academia, the U.S. military, public institutions, Federal agencies,
private practice, and industry.
ASTMH aims to advance policies and programs that prevent and
control those tropical diseases which particularly impact the global
poor.
TROPICAL MEDICINE AND TROPICAL DISEASES
The term ``tropical medicine'' refers to the wide-ranging clinical
work, research, and educational efforts of clinicians, scientists, and
public health officials with a focus on the diagnosis, mitigation,
prevention, and treatment of diseases prevalent in the areas of the
world with a tropical climate. Most tropical diseases are located in
either sub-Saharan Africa, parts of Asia (including the Indian
subcontinent), or Central and South America. Many of the world's
developing nations are located in these areas; thus tropical medicine
tends to focus on diseases that impact the world's most impoverished
individuals.
The field of tropical medicine encompasses clinical work treating
tropical diseases, work in public health and public policy to prevent
and control tropical diseases, basic and applied research related to
tropical diseases, and education of health professionals and the public
regarding tropical diseases.
Tropical diseases are illnesses that are caused by pathogens that
are prevalent in areas of the world with a tropical climate. These
diseases are caused by viruses, bacteria, and parasites which are
spread through various mechanisms, including airborne routes, sexual
contact, contaminated water and food, or an intermediary or
``vector''--frequently an insect (e.g. a mosquito)--that transmits a
disease between humans in the process of feeding.
MALARIA
Malaria is a global emergency affecting mostly poor women and
children; it is an acute and sometimes fatal disease caused by the
single-celled Plasmodium parasite that is transmitted to humans by the
female Anopheles mosquito.
Malaria is highly treatable and preventable. The tragedy is that
despite this, malaria is one of the leading causes of death and disease
worldwide. According to the CDC, as many as 2.7 million individuals die
from malaria each year, with 75 percent of those deaths occurring in
African children. In 2002, malaria was the fourth leading cause of
death in children in developing countries, causing 10.7 percent of all
such deaths. Malaria-related illness and mortality extract a
significant human toll as well as cost Africa's economy $12 billion per
year perpetuating a cycle of poverty and illness. Nearly 40 percent of
the world's population lives in an area that is at high risk for the
transmission of malaria.
Fortunately, malaria can be both prevented and treated using four
types of relatively low-cost interventions: (1) the indoor residual
spraying of insecticide on the walls of homes; (2) long-lasting
insecticide-treated nets; (3) Artemisinin-based combination therapies;
and (4) intermittent preventive therapy for pregnant women. However,
limited resources preclude the provision of these interventions and
treatments to all individuals and communities in need.
requested malaria-related activities and funding levels
CDC Malaria Efforts
ASTMH calls upon Congress to fund a comprehensive approach to
malaria control, including public health infrastructure improvements,
increased availability of existing anti-malarial drugs, development of
new anti-malarial drugs and better diagnostics, and research to
identify an effective malaria vaccine. Much of this important work
currently is underway; however, additional funds and a sustaining
commitment from the Federal Government are necessary to make progress
in malaria prevention, treatment, and control.
The CDC conducts research to address pertinent questions regarding
issues related to malaria as well as engages in prevention and control
efforts, especially as a lead collaborator on the President's Malaria
Initiative. To maximize CDC's efforts and expertise, we request $18
million for the CDC for malaria research, control, and program
evaluation efforts with a $6 million set-aside for program monitoring
and evaluation. The CDC maintains several domestic activities,
international activities, and research activities, including:
--Surveillance of malaria
--Investigations of locally transmitted malaria
--Advice and consultations such as a toll-free information service
--Diagnostic assistance to State health departments on malaria
diagnosis
--Research to improve understanding of malaria
--International Activities including the President's Malaria
Initiative (PMI), the Amazon Malaria Initiative (AMI), the West
Africa Network against Malaria during Pregnancy
CDC collaborations support treatment and prevention policy change
based on scientific findings; formulation of international
recommendations through membership on World Health Organization (WHO)
technical committees; and work with Ministries of Health and other
local partners in malaria-endemic countries and regions to develop,
implement, and evaluate malaria programs. In addition, CDC has provided
direct staff support to WHO; UNICEF; the Global Fund to Fight AIDS,
Tuberculosis, and Malaria; and the World Bank--all stakeholders in the
Roll Back Malaria (RBM) Partnership.
NIH Malaria Efforts
As the Nation's and world's premier biomedical research agency, the
NIH and its Institutes and Centers play an essential role in the
development of new anti-malarial drugs, better diagnostics, and an
effective malaria vaccine. NIH estimates that its fiscal year 2007
spending on malaria research will total $101 million while malaria
vaccine efforts will receive $45 million. ASTMH urges that NIH malaria
research portfolio and budget be increased by at least 6.7 percent in
fiscal year 2008. To support a comprehensive effort to eradicate
malaria, ASTMH respectfully requests the following funding:
--$30.8 billion to NIH;
--$4.7 billion NIAID; and
--$70.8 million to the Fogarty International Center to support
training in biomedical research on behalf of the developing
nations of the world.
National Institute of Allergy and Infectious Diseases (NIAID)
NIH estimates that in fiscal year 2007 it will spend approximately
$101 million for malaria research and $45 million for research related
specifically to creating a malaria vaccine. NIAID, the lead institute
for this research, has developed an Implementation Plan for Global
Research on Malaria, which is focused on five research areas: vaccine
development, drug development, diagnostics, vector control, and
infrastructure and research capability strengthening.
--Vaccine Development.--No malaria vaccine currently exists. NIAID
introduced a research agenda for malaria vaccine development in
1997, the aim of which is to support discovery and
characterization of new vaccine candidates, production of pilot
lots, and clinical evaluation of promising candidate vaccines.
--Drug Development.--Drug-resistant malaria increasingly is being
reported around the world. NIAID is involved in improving the
monitoring of drug resistance and developing new drugs.
--Diagnostics.--Improved diagnostic tools are essential in making
early diagnosis and providing rapid treatment.
--Vector Control.--NIAID is working to create next-generation,
environmentally-friendly insecticides for public health use.
--Strengthening Infrastructure and Research Capability.--NIAID is
working with partners to strengthen research capabilities of
scientists in their own countries.
ASTMH encourages the subcommittee to increase funding for NIAID to
ensure that we do not lose ground in the fight against malaria.
Fogarty International Center (FIC)
The FIC addresses global health challenges and supports the NIH
mission through myriad activities, including: collaborative research
and capacity building projects relevant to low- and middle-income
nations; institutional training grants designed to enhance research
capacity in the developing world; the Forum for International Health,
through which NIH staff share ideas and information on relevant
programs and develop input from an international perspective on cross-
cutting NIH initiatives; the Multilateral Initiative on Malaria, which
fosters international collaboration and co-operation in scientific
research against malaria; and the Disease Control Priorities Project,
which is a partnership to develop recommendations on effective health
care interventions for resource-poor settings. ASTMH urges the
subcommittee to allocate additional resources to the FIC in fiscal year
2008 to increase these efforts, particularly as they apply to abatement
and treatment of malaria.
CONCLUSION
Thank you for your attention to these important global health
matters. We know that you face many challenges in choosing funding
priorities and we hope that you will provide the requested fiscal year
2008 resources to those agencies programs identified above. ASTMH
appreciates the opportunity to share its views, and we thank you for
your consideration of our requests.
______
Prepared Statement of the American Thoracic Society
SUMMARY.--FUNDING RECOMMENDATIONS
[In millions of dollars]
------------------------------------------------------------------------
Amount
------------------------------------------------------------------------
National Institutes of Health............................. 30,537
National Heart, Lung and Blood Institute.............. 3,114
National Institute of Allergy and Infectious Disease.. 4,675
National Institute of Environmental Health Sciences... 683
Fogarty International Center.......................... 70
National Institute of Nursing Research................ 146
Centers for Disease Control and Prevention................ 10,700
National Institute for Occupational Safety and Health. 253
Environmental Health: Asthma Activities............... 70
Tuberculosis Control Programs......................... 252.4
------------------------------------------------------------------------
The American Thoracic Society (ATS) is pleased to submit our
recommendations for programs in the Labor Health and Human Services and
Education Appropriations Subcommittee purview.
The American Thoracic Society, founded in 1905, is an independently
incorporated, international education and scientific society that
focuses on respiratory and critical care medicine. For 100 years, the
ATS has continued to play a leadership role in scientific and clinical
expertise in diagnosis, treatment, cure and prevention of respiratory
diseases. With approximately 18,000 members who help prevent and fight
respiratory disease around the globe, through research, education,
patient care and advocacy, the Society's long-range goal is to decrease
morbidity and mortality from respiratory disorders and life-threatening
acute illnesses.
LUNG DISEASE IN AMERICA
Lung disease is a serious health problem in the United States. Each
year, close to 400,000 Americans die of lung disease. Lung disease is
responsible for one in every seven deaths, making it America's number
three cause of death. More than 35 million Americans suffer from a
chronic lung disease. In 2005, lung diseases cost the U.S. economy an
estimated $157.8 billion in direct and indirect costs.
Lung diseases represent a spectrum of chronic and acute conditions
that interfere with the lung's ability to extract oxygen from the
atmosphere, protect against environmental or biological challenges and
regulate a number of metabolic processes. Lung diseases include chronic
obstructive pulmonary disease, lung cancer, tuberculosis, influenza,
sleep disordered breathing, pediatric lung disorders, occupational lung
disease, sarcoidosis, asthma and severe acute respiratory syndrome
(SARS).
The ATS is pleased that the subcommittee provided increases in the
National Institutes of Health (NIH) budget last fiscal year. However,
we are extremely concerned that the President's fiscal year 2008 budget
proposes a 1.7 percent cut for NIH and significant cuts for the Centers
for Disease Control and Prevention (CDC). We ask that this subcommittee
recommend a 6.7 percent increase for NIH so that the NIH can respond to
biomedical research opportunities and public health needs. In order to
stem the devastating effects of lung disease, research funding must
continue to grow to sustain the medical breakthroughs made in recent
years. We also ask that the CDC budget be adjusted to reflect increased
needs in chronic disease prevention, infectious disease control,
including strengthened TB control to prevent the spread of extensively
drug-resistant (XDR)-TB, and occupational safety and health research
and training. There are three lung diseases that illustrate the need
for further investment in research and public health programs: Chronic
Obstructive Pulmonary Disease, pediatric lung disease, asthma and
tuberculosis.
COPD
Chronic Obstructive Pulmonary Disease (COPD) is the fourth leading
cause of death in the United States and the third leading cause of
death worldwide. Yet, COPD remains relatively unknown to most
Americans. COPD is the term used to describe the airflow obstruction
associated mainly with emphysema and chronic bronchitis and is a
growing health problem.
While the exact prevalence of COPD is not well defined, it affects
tens of millions of Americans and can be an extremely debilitating
condition. It is estimated that 11.2 million patients have COPD while
an additional 12 million Americans are unaware that they have this life
threatening disease.
According to the National Heart, Lung and Blood Institute (NHLBI),
COPD cost the U.S. economy an estimated $37 billion per year. We
recommend the subcommittee encourage NHLBI to devote additional
resources to finding improved treatments and a cure for COPD.
Medical treatments exist to relieve symptoms and slow the
progression of the disease. Today, COPD is treatable but not curable.
Fortunately, promising research is on the horizon for COPD patients.
Despite these leads, the ATS feels that research resources committed to
COPD are not commensurate with the impact the disease has on the United
States and that more needs to be done to make Americans aware of COPD,
its causes and symptoms. The ATS commends the NHLBI for its leadership
on educating the public about COPD through the National COPD Education
and Prevention Program. As this initiative continues, we encourage the
NHLBI to maintain its partnership with the patient and physician
community.
While additional resources are needed at NIH to conduct COPD
research, CDC has a role to play as well. The ATS encourages the CDC to
add COPD-based questions to future CDC health surveys, including the
National Health and Nutrition Evaluation Survey (NHANES), the National
Health Information Survey (NHIS) and the Behavioral Risk Factor
Surveillance Survey (BRFSS). By collecting information on the
prevalence of COPD, researchers and public health professionals will be
better able to understand and control the disease.
PEDIATRIC LUNG DISEASE
Lung disease affects people of all ages. The ATS is pleased to
report that infant death rates for various lung diseases have declined
for the past 10 years. However, of the seven leading causes of infant
mortality, four are lung diseases or have a lung disease component. In
2003, lung diseases accounted for 18 percent of all deaths under 1 year
of age. It is also widely believed that many of the precursors of adult
respiratory disease start in childhood. The ATS encourages the NHLBI to
continue with its research efforts to study lung development and
pediatric lung diseases.
The pediatric origins of chronic lung disease extend back to early
childhood factors. For example, many children with respiratory illness
are growing into adults with COPD. In addition, it is estimated that
close to 20.5 million people suffer from asthma, including an estimated
6.2 million children. While some children appear to outgrow their
asthma when they reach adulthood, 75 percent will require life-long
treatment and monitoring of their condition. Asthma is the third
leading cause of hospitalization among children under the age of 15 and
is the leading cause of chronic illness among children.
ASTHMA
The ATS believes that the NIH and the CDC must play a leadership
role in assisting individuals with asthma. National statistical
estimates show that asthma is a growing problem in the United States.
Approximately 22.2 million Americans currently have asthma, of which
12.2 million had an asthma attack in 2005. African Americans have the
highest asthma prevalence of any racial/ethnic group. The age-adjusted
death rate for asthma in the African-American population is three times
the rate in whites.
ASTHMA SURVEILLANCE
There is a need for more data on regional and local asthma
prevalence. In order to develop a targeted public health strategy to
respond intelligently to asthma, we need locality-specific data. CDC
should take the lead in collecting and analyzing this data and Congress
should provide increased funding to build this these tracking systems.
In fiscal year 2007, Congress provided approximately $31.9 million
for CDC's National Asthma Control Program. The goals of this program
are to reduce the number of deaths, hospitalizations, emergency
department visits, school or work days missed, and limitations on
activity due to asthma. We recommend that CDC be provided with $70
million in fiscal year 2008 to expand the program and establish grants
to community organizations for screening, treatment, education and
prevention of childhood asthma.
SLEEP
Sleep is an essential element of life, but we are only now
beginning to understand its impact on human health. Several research
studies demonstrate that sleep illnesses and sleep disordered breathing
affect over 50 million Americans. The public health impact of sleep
illnesses and sleep disordered breathing is still being determined, but
is known to include traffic accidents, lost work and school
productivity, cardiovascular disease, obesity, mental health disorders,
and other sleep-related comorbidities. We cannot appropriately address
these problems if we do not consider how chronic sleep loss contributes
to them. Despite the increased need for study in this area, research on
sleep and sleep-related disorders has been underfunded. The ATS
recommends increased funding to support activities related to sleep and
sleep disorders at the CDC, including for the National Sleep Awareness
Roundtable (NSART), and research on sleep disorders at the Nation
Center for Sleep Disordered Research (NCSDR) at the NHLBI.
TUBERCULOSIS
Tuberculosis (TB) is a global public health crisis that remains a
concern for the United States. Tuberculosis is an airborne infection
caused by a bacterium, Mycobacterium tuberculosis. Tuberculosis
primarily affects the lungs but can also affect other parts of the
body, such as the brain, kidneys or spine. The statistics for TB are
alarming. Globally, one-third of the world's population is infected
with the TB germ, 8.8 million active cases develop each year and 1.6
million people die of tuberculosis annually. It is estimated that 9-14
million Americans have latent tuberculosis. Tuberculosis is the leading
cause of death for people with HIV/AIDS.
According to the CDC, although the overall rate of new TB cases is
declining in the United States, the annual rate of decrease in TB cases
has slowed significantly, from about 7.3 percent (1993 to 2000) to 3.8
percent currently (2000-2006). This rate represents one of the smallest
declines since 1992, when over $1 billion was spent in New York City
alone to regain control of TB. The ATS is concerned that TB rates in
African Americans remain high and that TB rates in foreign-born
Americans are growing.
The emergence of extensively drug-resistant XDR-TB has created a
global health emergency. Because it is resistant to most of the drugs
used to treat TB, XDR-TB is virtually untreatable and has an extremely
high fatality rate. In one of the latest outbreaks in South Africa from
late 2005 until early 2006, XDR-TB killed 52 out of 53 infected
patients. According to data released by the CDC in March, between 1993
and 2006, there were 49 reported XDR-TB cases in the United States.
Because of the ease with which TB can spread, XDR TB will continue to
pose a serious risk to the United States as long as it exists anywhere
else in the world.
While we urge immediate action in response to the XDR-TB emergency,
we also recognize the best way to prevent the future development of
other resistant strains of tuberculosis is through supporting effective
tuberculosis control programs in the United States and throughout the
globe. We ask the subcommittee to take the first steps to eliminating
TB in the United States and prevent further outbreaks of drug resistant
forms of TB. The ATS, in collaboration with the National Coalition for
Elimination of Tuberculosis, recommends an increase of $120 million in
fiscal year 2008 for CDC's National Program for the Elimination of
Tuberculosis.
The NIH also has a prominent role to play in the elimination of
tuberculosis. Currently there is no highly effective vaccine to prevent
TB transmission. However, the recent sequencing of the TB genome and
other research advances have put the goal of an effective TB vaccine
within reach. The National Institute of Allergy and Infectious Disease
has developed a Blueprint for Tuberculosis Vaccine Development. We
encourage the subcommittee to fully fund the TB vaccine blueprint. We
also encourage the NIH to continue efforts to develop drugs to combat
multi-drug resistant tuberculosis a serious emerging public health
threat.
Fogarty International Center TB Training Programs
The Fogarty International Center (FIC) at NIH provides training
grants to U.S. universities to teach AIDS treatment and research
techniques to international physicians and researchers. Because of the
link between AIDS and TB infection, FIC has created supplemental TB
training grants for these institutions to train international health
care professionals in the area of TB treatment and research. These
training grants should be expanded and offered to all institutions. The
ATS recommends Congress provide $70 million for FIC to expand the TB
training grant program from a supplemental grant to an open competition
grant.
RESEARCHING AND PREVENTING OCCUPATIONAL LUNG DISEASE
The National Institute of Occupational Safety and Health (NIOSH) is
the sole Federal agency responsible for conducting research and making
recommendations for the prevention of work-related diseases and injury.
In addition to conducting research, NIOSH investigates potentially
hazardous working conditions, makes recommendations and disseminates
information on preventing workplace disease, injury, and disability;
and provides training to occupational safety and health professionals.
The ATS recommends that Congress provide $253 million for NIOSH to
expand or establish the following activities: the National Occupational
Research Agenda (NORA); tracking systems for identifying and responding
to hazardous exposures and risks in the workplace; emergency
preparedness and response activities; and training medical
professionals in the diagnosis and treatment of occupational illness
and injury.
CONCLUSION
Lung disease is a growing problem in the United States. It is this
country's third leading cause of death. The lung disease death rate
continues to climb. Overall, lung disease and breathing problems
constitute the number one killer of babies under the age of 1 year.
Worldwide, tuberculosis is one of the leading infectious disease
killers. The level of support this subcommittee approves for lung
disease programs should reflect the urgency illustrated by these
numbers. The ATS appreciates the opportunity to submit this statement
to the subcommittee.
______
Prepared Statement of Americans for the Arts
Americans for the Arts and the Los Angeles County Arts Commission
respectfully request the subcommittee to adopt an appropriation of $53
million for the Arts in Education programs of the U.S. Department of
Education. We also ask that it require the U.S. Department of Education
to conduct much-needed research on the status of arts education,
including the Fast Response Statistical Survey (FRSS) and the National
Assessment of Educational Progress (NAEP).
Before considering funding levels, members of the subcommittee need
to be aware of a simple but breathtaking fact: Students with an
education rich in the arts have better grade point averages in core
academic subjects, score better on standardized tests, and have lower
drop-out rates than students without arts education. This fact is
demonstrated by an increasing amount of compelling research. It is not
seriously contested. Further, research confirms that these results
occur across the socio-economic range.
Artists believe that the arts are important for their own sake.
Educators know they are rigorous and standards-based, and they are
essential for supporting the learning styles of all students while
providing them with the unique opportunity to develop problem solving
skills, to develop critical thinking skills and to foster their
creativity. In essence, the arts help students develop skills that are
needed for the 21st century workforce. In fact, CEOs have stated that
the MFA (Masters in Fine Arts) is the new MBA and seek employees that
have had a solid arts education. You can agree or disagree with us, of
course. But you can't ignore the research, which shows that the arts
help kids do better in school And for that reason, we believe that the
Federal Government has an essential role in ensuring that all children
have access to excellent arts education.
For several decades, the U.S. Department of Education's Arts in
Education programs have provided funding for the national programs of
the John F. Kennedy Center for the Performing Arts and VSA arts
(formerly Very Special Arts). Since 2001 they have also run two
important competitive grant programs:
--The Model Development and Dissemination program identifies,
develops, documents, and disseminates models of excellence in
arts education that impact schools and communities nationwide.
These projects strengthen student learning through standards-
based arts education and integration of arts instruction into
other subject areas.
--The Professional Development grants program supports projects that
serve as national models for effective professional development
that improve instruction for arts specialists and classroom
teachers. State and local education agencies can adapt these
models to provide rigorous arts instruction for all students.
A recent Model Development grant was given to the Los Angeles
Unified School District, in partnership with Inner-City Arts, a non-
profit organization providing arts learning services to students in the
district, and the University of California, Los Angeles (UCLA) Graduate
School of Education and Information Sciences. The three-year Arts in
the Middle (AIM) Project will expand and rigorously evaluate an
innovative, cohesive model for delivery of arts-based instruction to
remedial grade six English learners. The Project's strategy will extend
community resources to under-resourced urban middle schools in order to
improve academic performance among English learners by integrating
standards-based arts education within the core Language Arts curricula
of grade six students. The Project's target population is remedial
grade six students who are at extreme high risk of academic failure due
to low levels of English Language Development. Assuming it is
successful, the goal is to replicate it within other Los Angeles
schools. This project directly supports the school district's 10-year
plan for arts education.
With increased funding, the Arts in Education programs will be able
to support additional such models that improve arts learning in high-
poverty schools, and findings from the model projects may be more
widely disseminated.
With regard to another aspect of our request: despite research
showing the positive effects of arts education, there is a serious lack
of empirical data on how much arts education is being delivered in our
Nation's schools. We do not have comprehensive, reliable information
about student access to arts instruction or student performance in the
arts. The last Fast Response Survey report was for the 1999-2000 school
year, and the next round is long overdue.
Congress has repeatedly urged the Department of Education to
implement the Fast Response Survey in the arts to no avail. In public
statements, U.S. Secretary of Education Margaret Spellings has said,
``Art, dance, music, and theater are as much a part of education as
reading, math, and science.'' And yet, the Department has told Congress
that among the ``many tough choices'' made in the area of research, the
arts survey did not rate as a priority.
The Senate included report language in the fiscal year 2007
appropriations bill that explicitly directed the Department of
Education to conduct the FRSS, and it also provided funding for that
purpose. As you know, however, the bill did not become law, and
therefore the Department of Education has been able to delay
implementing the FRSS for yet another year. We thank this subcommittee
for taking this step last year and urge you to adopt similar language
in your fiscal year 2008 bill.
Good data does exist in some localities, but only data that is
national in scope will allow Congress to make national policy. We would
like to tell you about data was gathered and used to affect policy in
Los Angeles County. The task was an essential step in helping the
County and community stakeholders such as school districts, arts
organizations, elected officials, business leaders, foundations, and
corporations strategically organize their efforts to restore K-12 arts
education. We hope the story of how the information was collected, and
the way it was used, will convince you of the need to compel the
Department of Education to collect national data.
In 2000, the Arts Commission commissioned the Arts in Focus survey,
which detailed the status of arts education for 1.7 million students in
82 school districts. These students represent 27 percent of all public
school students in the State, and 3.4 percent of all public school
students in the country. With 80 of the 82 superintendents in the
County participating, it was found that:
--54 percent of school leaders reported no adopted arts policy and 37
percent reported no defined sequential arts education in any
discipline, at any school level.
--64 percent reported no district level arts coordinator, and the
current average ratio of credentialed arts teachers to students
was 1:1,200.
--Nearly 50 percent reported ``lack of instructional time in
students' schedules'' as their most significant challenge.
--Many districts would not have arts programs without the support of
parents and partnerships with non-profit arts organizations.
Seventy-eight percent of districts allocated less than 2
percent of their budget to arts education and 82.3 percent used
partnerships with non-profit organizations to provide arts
education.
One hundred percent of superintendents who were interviewed stated
that they believe in the importance of the arts. However, what the data
revealed was the lack of an infrastructure to support arts education
and, given the three decades without sequential arts education, limited
capacity of school districts to incorporate it back into the school
day.
In response to the findings of Arts in Focus, Los Angeles County
(the Arts Commission in partnership with the Los Angeles County Office
of Education) embarked on a year-long, community-based planning
process. In 2002, the County Board of Supervisors, the County Board of
Education and the County Arts Commission unanimously adopted Arts for
All: Los Angeles County Regional Blueprint for Arts Education, which
presents a series of policy changes, educational initiatives, and
establishment of a new infrastructure to ensure all 1.7 million
students receive a high-quality K-12 arts education.
The first goal of the Blueprint is to help school districts create
a sustainable infrastructure for arts education by conducting a needs
assessment and utilizing district data to develop and adopt an arts
education policy and long-range budgeted plan with benchmarks. To date,
20 school districts are at various stages of receiving technical
assistance from a coach to strategically, and thoughtfully, identify
and implement key budgeted priorities for arts education in the areas
of standards-based curriculum, instruction and methodology, assessment,
professional development, program administration and personnel,
partnerships and collaborations, funding, resources and facilities, and
evaluation.
As a key strategy in the Blueprint, the County created the Arts
Education Performance Indicators report, or AEPI, to collect pertinent
school district data to track the status of an arts education
infrastructure based on five critical factors: an arts education policy
adopted by the school board; an arts education plan adopted by the
school board; a district level arts coordinator; an arts education
budget of at least 5 percent of the district's total budget; and a
student to credentialed arts teacher ratio of no higher than 400:1.
With these pieces in place, school districts can deliver sustainable
arts education.
The AEPI is released every other year. It is interesting to note
that for the 2005 report, those districts making the greatest progress
in achieving the five critical success factors received technical
assistance while those showing little to no improvement did not. AEPI
is an invaluable tool in providing a county-wide picture of the status
of an arts education infrastructure, target technical assistance to
help school districts plan, keep arts education visible and at the
forefront of policy discussions, provide a mechanism for school
districts to self-evaluate and reflect on their progress in providing
equal access to a quality arts education and to compare themselves to
other districts, and encourage County-wide dialogue on arts education
among diverse stakeholders in the community--from elected officials, to
educators, to parents and students.
Access to up-to-date, accurate data is imperative to drive
strategic planning and policy change. In addition, Arts for All
illustrates the importance of providing customized assistance to help
school districts effectively plan for the implementation of arts
education based on identified needs and priorities. Without this help,
we have found that it is difficult for school districts to use
available funds effectively--including, for example, Federal Title I
funds.
You may be aware that the fiscal year 2006-2007 budget for the
State of California includes $500 million in one-time funding for arts
education and physical education equipment, supplies and professional
development and $105 million in on-going funding especially for arts
education personnel, supplies, materials, and professional development.
As it turns out, the districts that have received technical assistance
and that have established policies and plans are able to effectively
and strategically utilize this funding. Seventeen County school
districts have expressed an interest in receiving arts education
planning assistance through Arts for All in light of the new State
money. With these additional school districts, 37 districts in Los
Angeles County will be planning for and implementing standards-based
arts education--close to 50 percent of County school districts--with
more school districts joining Arts for All each year.
Each level of government has its part to play, in concert with
stakeholders at each level. We have described the massive commitment of
Los Angeles County government to providing excellent arts education,
and we have touched on the increased recognition by the State of
California of its responsibility to help. The Federal Government needs
to step up as well. It has a unique role in collecting and publishing
data, and an essential role in supporting, researching and
disseminating locally developed projects. Both of these roles are the
focus of this testimony.
We would also like to ask you to encourage local districts to use
Federal education funds, such as Title I, to institute data collection
and technical assistance programs similar to what was done in Los
Angeles County. They should also use Federal funds to hire local
district-wide arts education coordinators.
Finally, we would like to mention that the NAEP--the national arts
``report card''--is scheduled to be administered in 2008, and must stay
on track. It is designed to measure students' knowledge and skills in
dance, music, theatre, and visual arts, and it provides critical
information about the arts skills and knowledge of our Nation's
students. The last arts NAEP was performed in 1997. Like the FRSS, the
next round is long overdue.
Thank you very much for the opportunity to submit this testimony.
______
Prepared Statement of the Americans for Nursing Shortage Relief (ANSR)
Alliance
The undersigned organizations of the ANSR Alliance greatly
appreciate the opportunity to submit written testimony regarding fiscal
year 2008 appropriations for Title VIII--Nursing Workforce Development
Programs. The ANSR Alliance is comprised of 52 national nursing
organizations that united in 2001 to identify and promote creative
strategies for addressing the nursing and nurse faculty shortages,
including passage of the Nurse Reinvestment Act of 2002.
The ANSR Alliance stands ready to work with lawmakers to advance
programs and policy that will sustain and strengthen our Nation's
nursing workforce. To ensure that our Nation has a sufficient and
adequately prepared nursing workforce to provide quality care to all
well into the 21st century, ANSR urges Congress to:
--Appropriate at least $200 million in funding for Nursing Workforce
Development Programs under Title VIII of the Public Health
Service Act at the Health Resources and Services Administration
(HRSA) in fiscal year 2008.
--Restore the Advanced Education Nursing program (Sec. 811) and fund
it at a level on par with the proposed fiscal year 2008
increase for the other Title VIII programs.
NURSING SHORTAGE
Nurses play a critical role in our Nation's health care system. An
estimated 2.9 million licensed registered and advanced practice
registered nurses (RNs and APRNs) represent the largest professional
occupation of all health care workers providing patient care in
virtually all locations in which health care is delivered. The
diversity of practice settings and differing scopes of practice makes
the nursing shortage an even more complex challenge. Some facts to
consider:
--The nursing workforce is aging. In 1980, 26 percent of RNs were
under the age of 30. Today, approximately 8 percent of RNs are
under the age of 30 with the average nurse being 46.8 years of
age;
--Approximately half of the RN workforce is expected to reach
retirement age within the next 10 to 15 years. The average age
of new RN graduates is almost 30 years old;
--A December 2005 Bureau of Labor Statistics report projected that
registered nursing would create the second largest number of
new jobs among all occupations within 9 years. In addition,
employment of RNs is expected to grow much faster than average
for all occupations through 2014. It is anticipated that
approximately 703,000 additional jobs, for a total of
3,096,000, will be available for RNs by that date;
--The national nursing shortage also is affecting our Nation's 7.6
million veterans who receive care through the 1,300 Department
of Veterans Affairs (VA) health care facilities. The VA, the
largest sole employer of RNs in the United States, has a 10
percent RN vacancy rate;
--The nurse faculty vacancies in the United States continued to grow
even as the numbers of full- and part-time educators increased
during the 2005-2006 academic year. According to the National
League for Nursing's 2006 Nurse Faculty Census, the estimated
number of budgeted, unfilled, full-time positions in 2006 was
1,390. This number represents a 7.9 percent vacancy rate in
baccalaureate and higher degree programs, which is an increase
of 32 percent since 2002; and a 5.6 percent vacancy rate in
associate degree programs, which translates to a 10 percent
rise in the same period.
nursing supply impacts america's emergency preparedness
The National Center for Health Workforce Analysis at the Bureau of
Health Professions in HRSA reports that the nursing shortage makes it
challenging for the health care sector to meet current service needs.
Nursing shortfalls exacerbating capacity insufficiencies throughout the
health care system have ripple effects, for example, seen in the
problems encountered by most communities' day-to-day emergency care
services. Facing a pandemic flu or other natural or man-made disaster
of significant proportions makes the nursing shortage an even greater
national concern, as well as an essential part of national preparedness
and response planning
Nurses play a critical role as front-line, first-responders. When
word of the devastation caused by Hurricanes Katrina and Rita reached
nurses across the country, they immediately volunteered in American Red
Cross shelters, medical clinics, and hospitals throughout that
widespread region. Nurses and advanced practice registered nurses
(e.g., nurse midwives, nurse practitioners, clinical nurse specialists
and certified registered nurse anesthetists) are particularly critical
national resources in an emergency, able to provide clinical nursing
care as well as primary care. During Katrina and Rita, nurse midwives
delivered babies in airplane hangars, and nurses trained in geriatric
care assisted in caring for those traumatized by their evacuation from
the comforts of their homes, assisted living facilities or nursing
homes. Nurse practitioners diligently staffed temporary and permanent
health care clinics to provide needed primary care to hurricane
victims. Many nurses contributed not just through their clinical
expertise, but also by offering psychological support as they listened
to survivors recount their stories of pain and tragedy.
These stories seem particularly relevant in demonstrating the
essential assistance nurses provide during tragedies, and reinforce the
need to ensure an adequate supply of all types of nurses. Unless steps
are taken now, the Nation's ability to respond to disasters will be
further hindered by the growing nursing shortage. An investment in the
nursing workforce is a reasonable and cost-effective investment toward
rebuilding the public health infrastructure and increasing our Nation's
health care readiness and emergency response capabilities.
DESPERATE NEED FOR NURSE FACULTY
After years of declining interest, the nursing profession is seeing
a resurgence of interest in the profession. Many people in America have
come to find nursing an attractive career because of job openings,
salary levels, and the opportunity to help others. However, the common
theme among prospective nursing students is that due to a lack of
enrollment openings, owing to faculty shortages, they can face waiting
periods of up to 3 years before matriculating. When all nursing
programs are considered, the number of qualified applications turned
away during the 2004-2005 academic year was estimated to be nearly
147,000 by the National League for Nursing. Without sufficient support
for current nurse faculty and adequate incentives to encourage more
nurses to become faculty, nursing schools will fail to have the
teaching infrastructure necessary to educate and train the next
generation of nurses that the Nation so desperately need.
The current and deepening nurse faculty shortfall is the critical
reason that the Advanced Education Nursing line item in the Title VIII
programs must be fully funded. This program supported 11,949 graduate
nursing students in fiscal year 2005. The students that are supported
by this funding are the pool of future faculty for the nursing
profession. Whether supporting students in clinical education or as
faculty in schools of nursing, it is essential that advanced education
nursing funding be restored.
FUNDING REALITY
Enacted in 2002, the Nurse Reinvestment Act (Public Law 107-205)
addressed new and expanded initiatives, including loan forgiveness,
scholarships, career ladder opportunities, and public service
announcements to advance nursing as a career. Despite the enactment of
this critical measure, HRSA fails to have the resources necessary to
meet the current and growing demands for our Nation's nursing
workforce. For example:
--Fiscal Year 2005 Nursing Education Loan Repayment Program.--Of the
4,465 applicants, 803 awards were made (599 initial 2-year
awards and 204 amendment awards) with 18 percent of applicants
receiving awards.
--Fiscal Year 2006 Nursing Education Loan Repayment Program.--Of the
4,222 applicants, 615 awards were made (373 initial 2-year
awards and 242 amendment awards). This translates to 14.6
percent of applicants receiving awards.
--Fiscal Year 2005 Nursing Scholarship Program.--This program
received 3,482 applicants and was able to provide 212 awards or
6.1 percent of the applicants received scholarships.
--Fiscal Year 2006 Nursing Scholarship Program.--3,320 applicants
were received and 218 awards made or 6.6 percent of the
applicants received scholarships.
The ANSR Alliance requests that the subcommittee provide a minimum
of $200 million in fiscal year 2008 to fund the Title VIII--Nursing
Workforce Development Programs. We also urge the restoration of the
Advanced Education Nursing program (sec. 811) funded at a level on par
with the proposed fiscal year 2008 increase for the other Title VIII
programs.
This funding can be used to restore the Advanced Education Nursing
program and fund a higher rate of Nurse Education Loan Repayment and
Nursing Scholarship applications, as well as implement other essential
endeavors to sustain and boost our Nation's nursing workforce. We thank
you for consideration of our request.
SUMMARY
----------------------------------------------------------------------------------------------------------------
President's
Programmatic area Final fiscal year budget fiscal ANSR Alliance
2007 year 2008 request
----------------------------------------------------------------------------------------------------------------
Title VIII--Nursing Workforce Development Programs at $149,679,000 $105,263,000 $200,000,000
HRSA..................................................
----------------------------------------------------------------------------------------------------------------
ANSR ALLIANCE ORGANIZATIONS
Academy of Medical-Surgical Nurses; American Academy of Ambulatory
Care Nursing; American Academy of Nurse Practitioners; American
Association of Critical-Care Nurses; American Association of Nurse
Anesthetists; American Association of Nurse Assessment Coordinators;
American Association of Occupational Health Nurses; American College of
Nurse Practitioners; American Organization of Nurse Executives;
American Radiological Nurses Association; American Society for Pain
Management Nursing; American Society of PeriAnesthesia Nurses; American
Society of Plastic Surgical Nurses; Association of periOperative
Registered Nurses; Association of Rehabilitation Nurses; Asociation of
State and Territorial Directors of Nursing; Association of Women's
Health, Obstetric and Neonatal Nurses; Emergency Nurses Association;
Infusion Nurses Society; National Association of Clinical Nurse
Specialists; National Association of Neonatal Nurses; National
Association of Nurse Practitioners in Women's Health; National
Association of Orthopaedic Nurses; National Association of Pediatric
Nurse Practitioners; National Conference of Gerontological Nurse
Practitioners; National Council of State Boards of Nursing, Inc.;
National Gerontological Nursing Association; National League for
Nursing; National Nursing Centers Consortium; National Nursing Staff
Development Organization; National Organization for Associate Degree
Nursing; National Organization of Nurse Practitioner Faculties;
National Student Nurses' Association, Inc.; Society for Vascular
Nursing; Society of Pediatric Nurses; Society of Trauma Nurses; and
Society of Urologic Nurses and Associates.
______
Prepared Statement of the Association of Academic Health Sciences
Libraries and the Medical Library Association
SUMMARY OF RECOMMENDATIONS FOR FISCAL YEAR 2008
(1) A 6.7 percent increase for the NationaL Library of Medicine at
the National Institutes of Health and support for the National Library
of Medicine's Urgent Facility construction needs.
(2) Continued support for the Medical Library community's role in
the National Library of Medicine's Outreach, Telemedicine, Disaster
Preparedness and Health Information Technology Initiatives.
Mr. Chairman, thank you for the opportunity to testify today on
behalf of the Medical Library Association (MLA) and the Association of
Academic Health Sciences Libraries (AAHSL) regarding the fiscal year
2008 budget for the National Library of Medicine (NLM). I am Marianne
Comegys, Director of the Louisiana State University (LSU) Health
Sciences Center Library in Shreveport, Louisiana.
MLA is a nonprofit, educational organization with more than 4,500
health sciences information professional members worldwide. Founded in
1898, MLA provides lifelong educational opportunities, supports a
knowledgebase of health information research and works with a global
network of partners to promote the importance of quality information
for improved health to the healthcare community and the public.
AAHSL is comprised of the directors of the libraries of 142
accredited American and Canadian medical schools belonging to the
Association of American Medical Colleges (AAMC). AAHSL's goals are to
promote excellence in academic health sciences libraries and to ensure
that the next generation of health professionals is trained in
information-seeking skills that enhance the quality of healthcare
delivery.
Together, MLA and AAHSL address health information issues and
legislative matters of importance through a joint task force.
With respect to NLM's budget for the upcoming year, I would like to
touch briefly on five issues: (1) the growing demand for NLM's basic
services, (2) NLM's outreach and education services, (3) NLM's role in
emergency preparedness and response, (4) NLM's health information
technology initiatives and (5) NLM's facility needs.
THE GROWING DEMAND FOR THE NLM'S BASIC SERVICES
Mr. Chairman, it is a tribute to NLM that the demand for its
services and expertise continues to grow. As the world's foremost
digital library and knowledge repository in the health sciences, NLM
provides the critical infrastructure in the form of data repositories
and integrated services such as GenBank and PubMed that are helping to
revolutionize medicine and advance science to the next important era--
individualized medicine based on an individual's unique genetic
differences.
As the world's largest and most comprehensive medical library,
services based on NLM's traditional and electronic collections continue
to steadily increase each year. These collections stand at more than
8.5 million items--books, journals, technical reports, manuscripts,
microfilms, photographs, and images. By selecting, organizing and
ensuring permanent access to health science information in all formats,
NLM is ensuring the availability of this information for future
generations, making it accessible to all Americans, irrespective of
geography or ability to pay, and ensuring that each citizen can make
the best, most informed decisions about their healthcare.
Mr. Chairman, simply stated NLM is a national treasure and support
for its programs and services could not be more important at the
present time. I can tell you that without NLM our Nation's medical
libraries would be unable to provide the quality information services
that our Nation's health professionals, educators, researchers and
patients have all come to expect.
Recognizing the invaluable role that NLM plays in our healthcare
delivery system, MLA and AAHSL join with the Ad Hoc Group for Medical
Research in asking for a 6.7 percent increase for NLM, and the NIH
overall, in fiscal year 2008.
OUTREACH AND EDUCATION
NLM's outreach programs are of particular interest to both MLA and
AAHSL. These activities are designed to educate medical librarians,
health professionals and the general public about NLM's services.
NLM has taken a leadership role in promoting educational outreach
aimed at public libraries, secondary schools, senior centers and other
consumer-based settings. Furthermore, NLM's emphasis on outreach to
underserved populations assists the effort to reduce health disparities
among large sections of the American public.
We applaud the success of NLM's outreach initiatives, particularly
those initiatives that reach out to medical libraries and health
consumers. We ask the committee to encourage NLM to continue to
coordinate its outreach activities with the medical library community
in fiscal year 2008.
Partners in Information Access
NLM's ``Partners in Information Access'' program is designed to
improve the access of local public health officials to information
needed to prevent, identify and respond to public health threats. With
nearly 6,000 members in communities across the country, the National
Network of Libraries of Medicine (NNLM) is well-positioned to ensure
that every public health worker has electronic health information
services that can protect the public's health. My own facility, the LSU
Health Sciences Center in Shreveport, Louisiana, participates in this
program. Through it, we are able to train public health workers on how
to access health information online.
PubMed/Medline
NLM's PubMed/Medline is the Nation's premier online bibliographic
database. PubMed/Medline makes accessing important medical information
easier and quicker, which in turn lowers healthcare costs while
improving care. For more than 10 years, PubMed/Medline has afforded
anyone with access to the Internet the opportunity to tap into the vast
resources of NLM.
The NIH Public Access policy makes use of NLM's PubMed Central
electronic archive of full-text journal articles and manuscripts. This
policy supports NLM's mission to archive and enhance access to
healthcare information. We are concerned however that the current rate
of participation in the voluntary policy is low. Even with an
increasing number of journals depositing their complete contents in
PubMed Central less than 15 percent of NIH-funded articles are
available to the public there.
We concur with the NLM Board of Regents that the NIH Public Access
policy cannot achieve its stated goals unless the deposit of
manuscripts becomes mandatory. An informal survey conducted by AAHSL of
faculty and research administrators at 19 universities illustrated that
NIH-funded researchers are aware of the NIH Public Access policy. This
finding has been confirmed by NIH focus groups. Hence, lack of
awareness does not appear to be the primary reason for the low
submission rate; rather lack of incentive is impeding the success of
this policy.
In September, NLM, NIH and the Friends of NIH, launched NIH
MedlinePlus Magazine. This new publication will be distributed in
doctors' waiting rooms, and will provide the public with access to high
quality, easily understood health information.
NLM also continues to work with medical librarians and health
professionals to encourage doctors to provide MedlinePlus ``information
prescriptions'' to their patients. This initiative has been expanded to
encourage genetics counselors to prescribe the use of NLM's Genetics
Home Reference website. ``Go Local'' is another new exciting feature of
MedlinePlus that enables local and State agencies and others to
participate by creating sites that link the MedlinePlus information
seeker to local pharmacies, doctors and other health and social
services. This service further enhances the value of NLM and
MedlinePlus, not just for medical librarians and health professionals,
but also for health consumers. It also provides a platform for
enhancing public access to the information needed to prepare for and
respond to disasters and emergencies.
Clinical Trials
NLM's clinical trials database was launched in February 2000 and
lists more than 38,000 United States and international trials for a
wide range of diseases. The clinical trials database is a free and
invaluable resource to patients and families who are interested in
participating in cutting-edge treatments for serious illnesses. MLA and
AAHSL thank NLM for its leadership in creating ClinicalTrials.gov and
looks forward to assisting NLM in advancing this important initiative.
We are aware of current proposals to mandate the submission of
clinical trial results to this or a related database. We strongly
endorse the notion of improving public access to information about the
results of clinical trials, but are concerned about the possibility of
results being posted without having been subject to some form of
external review. If such information is to be used by patients and
their physicians to make informed decisions, the information must be
trustworthy and should be held to the same standard as other publicly
available information made available on the NLM web sites.
EMERGENCY PREPAREDNESS AND RESPONSE
MLA and AAHSL support the recommendation of the NLM Board of
Regents Long Range Plan for 2006-2016 that NLM establish a Disaster
Information Management Research Center to expand NLM's capacity to
support disaster response and management initiatives. Following
Hurricane Katrina, NLM provided health professionals and the public
with access to needed health and environmental information by: (1)
quickly compiling Web pages on toxic chemicals and environmental
concerns, (2) rapidly providing funds, computers and communication
services to assist librarians in the field who were restoring health
information services to displaced clinicians and patients, and (3)
rerouting interlibrary loan requests from the afflicted regions through
the NNLM.
HEALTH INFORMATION TECHNOLOGY AND BIOINFORMATICS
Mr. Chairman, NLM has played a pivotal role in creating and
nurturing the field of medical informatics, most notably through the
creation of GenBank and a wide array of related scientific data and
analysis tools which provide critical infrastructure for the Nation's
researchers. This critical infrastructure will be key to advances in
medicine in the future.
For nearly 35 years, NLM has supported informatics research and
training and the application of advanced computing and informatics to
biomedical research and healthcare delivery including a variety of
telemedicine projects. Many of today's informatics leaders are
graduates of NLM-funded informatics research programs at universities
across the country, and many of the country's exemplary electronic
health record systems benefited from NLM grant support.
A leader in supporting, licensing, developing and disseminating
standard clinical terminologies for free United States-wide use (e.g.,
SNOWMED), NLM works closely with the Office of the National Coordinator
for Health Information Technology (ONCHIT) to promote the adoption of
interoperable electronic records.
MLA and AAHSL encourage Congress to continue their strong support
of NLM's medical informatics and genomic science initiatives, at a
point when the linking of clinical and genetic data holds increasing
promise for enhancing the diagnosis and treatment of disease. MLA and
AAHSL also support Health Information Technology initiatives at
ONCHIT and the Agency for Healthcare Research and Quality (AHRQ)
that build upon initiatives housed at NLM.
NLM'S FACILITIES NEEDS
Mr. Chairman, over the past two decades NLM has assumed many new
responsibilities, particularly in the areas of biotechnology, health
services research, high performance computing and consumer health. As a
result, NLM has had tremendous growth in its basic functions related to
the acquisition, organization and preservation of an ever-expanding
collection of biomedical literature an expanded staff. NLM now houses
1,100 staff in a facility built to accommodate only 650. This increase
in the volume of biomedical information and in the number of personnel
has led to a serious space shortage. Digital archiving--once thought to
be a solution to the problem of housing physical collections--has only
added to the challenge, as materials must often be stored in multiple
formats and as new digital resources consume increasing amounts of
storage space. As a result, the space needed for computing facilities
has also grown, further squeezing out staff. In order for NLM to
continue its mission as the world's premier biomedical library, a new
facility is urgently needed. The NLM Board of Regents has assigned the
highest priority to supporting the acquisition of a new facility.
Further, Senate Report 108-345 that accompanied the fiscal year 2005
appropriations bill acknowledged that the design for the new research
facility at NLM had been completed and the committee urged the NIH to
assign a high priority to this construction project so that NLM's
information-handling capabilities are not jeopardized.
We encourage the subcommittee to provide the resources necessary to
construct a new facility.
Mr. Chairman, thank you again for the opportunity to present the
views of the medical library community.
______
Prepared Statement of the Association of American Cancer Institutes
The Association of American Cancer Institutes (AACI), representing
89 of the Nation's premier academic and free-standing cancer centers,
appreciates the opportunity to submit this statement for consideration
as the Labor, Health and Human Services Appropriations Subcommittee
plans the fiscal year 2008 appropriations for the National Institutes
of Health (NIH) and the National Cancer Institute (NCI).
CANCER BURDEN
In 2007, there will be approximately 1.44 million new cases of
cancer in the United States.\1\ Today, lifetime cancer risk in the
United States is one in two for men and one in three for women.\2\ This
number will continue to climb as the population ages, with an estimated
18.2 million cancer survivors (those undergoing treatment, as well as
those who have completed treatment) alive in 2020. By comparison, 11.7
million survivors were living in the United States in 2005.\3\
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\1\ Cancer Statistics, 2007. CA: Cancer Journal for Clinicians
2007; 57: 43-66.
\2\ The Nations' Investment in Cancer Research; A Plan and Budget
Proposal for Fiscal Year 2008, National Cancer Institute, 2007.
\3\ Future Supply and Demand for Oncologists, Journal of Oncology
Practice 2007; 3(2): 79-86.
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RESEARCH IN JEOPARDY
A recent analysis published in the Journal of Oncology Practice
suggested that the increase in the number of cancer patients and
survivors over the next decade will be coupled with a shortage of
clinical oncologists.\3\ And there is another shortage that is all too
real now, the implications of which will be felt for generations to
come if our government's policymakers do not address the problem
immediately. Because of continuing decreases to the budgets of the NIH
and NCI (in actual dollars and as a result of biomedical inflation),
grants to support cancer researchers as they discover new treatments
for cancer and strategies to prevent and detect the disease continue to
be cut. Without these grants, fewer and fewer cancer researchers will
be able to maintain their commitment to science--a dearth of cancer
researchers is on the horizon.
CANCER RESEARCH: BENEFITING ALL AMERICANS
The cancer research enterprise in the United States is second-to-
none. Cancer research, conducted in academic laboratories across the
country saves money by reducing healthcare costs associated with the
disease, enhances the United States' global competitiveness, and has a
positive economic impact on localities that house a major research
center. While these aspects of cancer research are important, what
cannot be overstated is the impact cancer research has had on
individuals' lives--lives that have been lengthened and even saved by
virtue of discoveries made in cancer research laboratories across the
United States.
Our Nation's cancer researchers are making advances against this
disease--for the second year in a row, statistics show that the number
of people dying of cancer has declined.\2\ And for the first time ever,
coming generations may be able to prevent some cancers from occurring
at all. For instance, with the recent FDA approval of the HPV (human
papillomavirus) vaccine Gardasil, young women will be protected against
the virus that causes up to 70 percent of cervical cancer cases
worldwide.\4\ In 2007 11,150 women will develop cervical cancer and
3,670 will die as a result of the disease.\5\ Gardasil is expected to
significantly reduce the number of cases of cervical cancer as young
women begin receiving the vaccine. Also, the HPV infection may play
some role in the development of other diseases such as head and neck
cancer, suggesting that the vaccine may have wider applicability in the
future.
---------------------------------------------------------------------------
\4\ Taking Pride in an Important Achievement, The NCI Cancer
Bulletin, 2006; 3(24): 1-2.
\5\ American Cancer Society. Cancer Facts & Figures 2007, 2007, 20-
21.
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Recent headlines have linked dropping breast cancer rates with a
decrease in the use of hormone replacement therapy among millions of
older women. An NCI-funded study conducted at The University of Texas
M.D. Anderson Cancer Center explored factors that may be involved in
the 7 percent age-adjusted decline--or 14,000 fewer cases--in breast
cancer incidence between 2002 and 2003.\6\ The researchers, led by Dr.
Donald Berry, concluded that ``only the potential impact of hormone
replacement therapy was strong enough to explain the effect.'' \2\
Without a strong research infrastructure to examine this relationship,
health professionals might still routinely prescribe menopausal
hormones without knowing that the hormones may increase their patients'
risk of developing breast cancer.
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\6\ Decline in Breast Cancer Cases Likely Linked to Reduced Use of
Hormone Replacement. M.D. Anderson Cancer Center News Release, December
14, 2006.
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This and other success stories are positive news in the war on
cancer, but are only one small part of the battle. Research advances
that have led to increased cancer survivorship, prevention efforts, and
enhanced treatment and understanding of the disease are at stake with
research funding becoming more and more limited. Now is the time to
provide funding to NIH and NCI to fully capitalize on the accelerated
pace of research that was fostered by the doubling of the NIH budget
from 1998 through 2003, not to risk losing out on lifesaving
opportunities by cutting funding to the Nation's biomedical
infrastructure.
EFFECTS OF THE ``UNDOUBLING'' OF THE NIH BUDGET
During the period from 1998 through 2003 the budget of the NIH was
doubled. This doubling provided resources that allowed a greater number
of promising young investigators to enter the field of cancer research,
and also supported research into the ideas of established
investigators. In 2007, however, funding for NIH is in the process of
being ``undoubled'' through actual budget cuts and because of the
effects of biomedical inflation. This year, NIH's budget is
approximately $28.9 billion--an impressive sum to be sure. However, if
NIH's 2003 budget (the last year of the doubling period) had been
increased each year only to account for biomedical inflation, its 2007
budget would be $31.6 billion.
While the doubling of the NIH budget was an ambitious undertaking,
the effort has ultimately resulted in inconsistent funding for the
institutes that make up the NIH. The budget of the NCI alone has lost
approximately 12 percent of its purchasing power due to the effects of
biomedical inflation.\7\ The Biomedical Research and Development Price
Index (BRDPI) is calculated each year to determine how NIH expenditures
must increase to compensate for inflation. In 2005 BRDPI was estimated
at 3.9 percent, meaning that each research dollar lost 3.9 percent of
its value for the year.\8\ The NIH budget also decreased 0.5 percent
from 2005 to 2006, which caused a net loss of 4.4 percent purchasing
power for 2006. NCI Director Dr. John E. Niederhuber estimates that
because of actual cuts in funding and the effects of BRDPI, in fiscal
year 2006 NCI was unable to fund 180 grants that would otherwise have
been deemed worthy of funding.\7\ These projects would have built upon
progress made during the doubling period--progress that will now be
unrealized.
---------------------------------------------------------------------------
\7\ Cancer Research Budget Cuts Cause ``Missed Opportunities,'' NCI
Director Tells Advisors, The Cancer Letter; 33(9), 5-8.
\8\ Biomedical Research and Development Price Index (BRDPI), BRDPI
Table of Annual Values Index. Office of Budget, National Institutes of
Health, 2007. http://officeofbudget.od.nih.gov/ui/GDP_FromGenBudget.htm
---------------------------------------------------------------------------
In 2007, NCI's Clinical Trials Cooperative Group Program will have
to cut as much as 60 percent of its members' new clinical trials. This
will result in an 11 percent decrease in the number of patients accrued
into clinical trials, or approximately 3,000 eligible patients who will
be unable to enroll in a cooperative group trial.\7\ These trials would
answer questions that help lead to more effective therapies and other
interventions for cancer, as well as methods for screening and
prevention. Not only will these patients be unable to benefit from the
cutting-edge treatments available only through clinical trials,
patients for generations to come will not benefit from the results of
this research.
Additionally, NCI's Specialized Programs of Research Excellence
(SPOREs) program that promotes interdisciplinary research to move basic
research findings from the laboratory to clinical settings was cut by 8
percent, or $8 million, in fiscal year 2006, with more cuts expected
this year. NCI's Tobacco Control Research Branch has been cut by $6.5
million between fiscal year 2004 and fiscal year 2007 and its Cancer
Survivorship Program by $1 million. Patient accrual for clinical trials
at NCI's Center for Cancer Research (CCR) was at 4,210 in fiscal year
2004, but in fiscal year 2006 that number was down to 3,795.\7\
THE NATION'S CANCER CENTERS
The nexus of cancer research in the United States is the Nation's
network of cancer centers, both with and without NCI designation, that
are represented by AACI. These cancer centers are highly integrated,
multidisciplinary hubs of scientific excellence and exceptional patient
care. They are uniquely patient oriented, research intensive,
translationally adept, and clinically superb. In 2005, these academic
based institutions received 86 percent of the grant dollars available
for 2005, or 59 percent of NCI's budget as a whole. Because these
centers are networked nationally, opportunities for collaborations are
many--assuring wise and non-duplicative investment of scarce Federal
dollars.
In addition to conducting basic, clinical, and population research,
the cancer centers are largely responsible for training the cancer
workforce that will practice in the United States in the years to come.
Much of this training is dependent on Federal dollars, via training
grants and other funding from NCI. Decreasing Federal support will
significantly undermine the centers' ability to continue to train the
next generation of cancer specialists--both researchers and providers
of cancer care.
Success stories at the cancer centers are common--but are in danger
of becoming less so as research dollars are lost. For instance, a
patient at a major academic cancer center had been told he had 6 months
to live after being diagnosed with an aggressive form of brain cancer.
But through an innovative clinical trial at the center, this patient
was tumor-free 6 years later.\9\ Without the Federal funding that
supported his treatment, he may not have been so fortunate.
---------------------------------------------------------------------------
\9\ Road to Nowhere, Frontiers Magazine, Winter 2006.
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FINANCIAL IMPACT ON CANCER CENTERS
The cancer center network in the United States forms the country's
cancer research infrastructure. As the nationwide hubs of cancer-
related scientific inquiry, the negative impact of reduced Federal
funding for cancer research on these centers is enormous. The rapid
pace of cancer research at AACI centers requires that investigators and
clinicians from diverse disciplines work together to share information,
expertise and resources. These interactions yield many insights into
the cancer problem. Reduced, or--even worse--no support for even one
member of this multidisciplinary team affects the collective progress
and productivity of the entire program.
Furthermore, the grants that comprise the core funding for the NCI-
designated cancer centers have been flat for the past 3 years.\7\ This
core funding helps support academic and research institutions to
sustain coordinated interdisciplinary programs in cancer research. With
no annual adjustment for inflation, the actual purchasing power over
the course of a typical multi-year grant has decreased, essentially
resulting in a cut to funding. Stagnant funding prevents expansion at
existing centers, but also--and perhaps more importantly--prevents new
centers from achieving NCI designation. While most major metropolitan
areas in the United States have easy access to an NCI-designated cancer
center, several States and many underserved areas do not.
SOCIAL VALUE
Though cancer statistics can seem daunting, even small steps
forward will have tremendous results. Dr. Kevin M. Murphy, the George
J. Stigler Distinguished Service Professor of Economics at the
University of Chicago Graduate School of Business, estimates that even
a 1 percent reduction in cancer deaths would result in almost $500
billion in social value to the United States. Social value is
calculated in terms of improved health and longevity. Curing the
disease would be worth as much as $50 trillion in social value.\10\
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\10\ AACR Meeting: Increase Research Funding that Cuts U.S. Cancer
Mortality by 1 percent Could Provide Payback of Nearly $500 Billion,
Oncology Times, May 10, 2006.
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CONCLUSION
These are very exciting times in science and, particularly, in
cancer research. Recent discoveries in the molecular biology of cancer
have led to important advances and new approaches to the prevention and
treatment of the disease. Drug discovery often is now based on the
understanding of molecular targets unique to cancer cells compared with
normal cells. Because of the Nation's investment in this research, we
are learning how to target and treat cancer specifically, while sparing
healthy tissues, and we are helping survivors lead more vibrant lives.
Reduced or flat funding will have a grave impact on progress in
targeted therapies and other promising research endeavors that could
lead to increased cancer survivorship.
Simply put, cancer research is a marathon, not a sprint. While the
period of NIH doubling briefly helped speed the pace of cancer
research, the potential legacy of this doubling will be squandered if
the NCI and NIH budgets are not funded--at a minimum--to account for
the effects of biomedical inflation. AACI and its members urge Congress
to support an NIH budget increase for fiscal year 2008 of at least 6.7
percent to make up for recent annual inflationary shortfalls. AACI and
its members also urge Congress to appropriate $5.1 billion for NCI's
fiscal year 2008 budget, which reflects a 6.7 percent increase over
fiscal year 2007, consistent with our overall NIH request.
We must, as a Nation, commit to fully funding the budget of the NCI
and the NIH. Our generation has been fortunate--a diagnosis of cancer
is no longer the certain death sentence it was for our parents and
grandparents. We owe the same to our children and grandchildren, and we
urge your support to increase this critical funding.
______
Prepared Statement of the Association of American Publishers
I am pleased to submit the following statement for the record on
behalf of the Professional and Scholarly Publishing Division of the
Association of American Publishers (PSP/AAP) in conjunction with the
subcommittee's hearing on the fiscal year 2008 Budget for the National
Institutes of Health (NIH). The AAP represents commercial and non-
profit entities who publish scientific, technical and medical journals.
Scholarly publishers are committed to working with NIH to successfully
implement NIH's Public Access Policy and ensure that articles based on
NIH-funded research are deposited with NIH. Publishers believe that
such a proactive public-private partnership between NIH and journal
publishers is critical to the success of the NIH policy. As a result of
the voluntary efforts by publishers, the number of articles deposited
with NIH has increased significantly.
The number of articles deposited with NIH has increased well beyond
the low figures referenced by NIH. The voluntary effort initiated by
publishers to deposit manuscripts on behalf of authors has resulted in
an increase in deposits from 4 percent to over 20 percent. This
significant increase is just the beginning. We will be able to do more
as additional publishers join this effort. However, we need NIH's help
to make that happen. To date, NIH has been slow to work with publishers
to resolve key implementation issues necessary to bring on additional
publishers.
We strongly oppose any move to a mandatory policy and feel that NIH
should instead engage publishers more broadly so we may achieve our
mutual objectives. This is important to attain the maximum article
deposition rate without adversely affecting the valuable peer review
process or the stability of important scientific journals and their
publishers. Considering the immense stakes, it is prudent to work
through the outstanding issues under the voluntary policy in a way that
optimizes participation by all players to ensure the greatest benefit
to the public interest and scientific progress.
We are confident that through a cooperative approach involving the
publishing community, deposition rates for manuscripts reporting on
NIH-funded research can reach optimum levels within a period of month,
not years. We encourage Congress to direct NIH to work together with
publishers to improve the implementation of the voluntary Public Access
Policy and further increase deposit rates. We stand ready to work with
NIH to achieve this important goal.
Publishers remain committed to working with NIH to ensure the
successful implementation of the current voluntary program, while
protecting the peer review process that helps ensure the quality and
integrity of scientific and medical research. On behalf of the AAP, I
appreciate this opportunity to submit this statement and look forward
to enhanced collaboration with NIH.
______
Prepared Statement of the Association for Clinical Research Training
SUMMARY OF FISCAL YEAR 2008 RECOMMENDATIONS
A 6.7 percent increase for the National Institutes of Health,
including the National Center for Research Resources.
$462 million for the Clinical and Translational Science Awards.
$350 million for the agency for Healthcare Research and Quality.
$750 million for a Center for Comparative Effectiveness at the
agency for Healthcare Research and Quality. Of this $750 million, a
substantial portion should be for research training.
The Association for Clinical Research Training (ACRT) is committed
to improving the Nation's health by increasing the amount and quality
of clinical research through the expansion and improvement of clinical
research training. This training is funded by both the National
Institutes of Health (NIH) and the Agency for Healthcare Research and
Quality (AHRQ).
NATIONAL INSTITUTES OF HEALTH
The NIH's Clinical and Translational Science Awards (CTSAs) aim to
meet one of the profound challenges of 21st Century medicine, namely
that the ever increasing complexities involved in conducting clinical
research are making it more difficult to translate new knowledge from
the bench to the bedside. As Dr. Elias Zerhouni, the Director of the
NIH, wrote in the October 13, 2005 edition of the New England Journal
of Medicine, ``it is the responsibility of those of us involved in
today's biomedical research enterprise to translate the remarkable
scientific innovations we are witnessing into health gains for the
Nation.''
The CTSAs assist institutions in creating a home for clinical and
translational science that has the resources necessary to train and
advance a cadre of investigators. The CTSAs transform basic research
into clinical practice, advance information technology, integrate
research networks and improve workforce training.
The ACRT supports the fiscal year 2008 President's budget request
of $462 million for the CTSAs, and joins the Ad Hoc Group for Medical
Research in asking for a 6.7 percent increase in fiscal year 2008 for
the NCRR and the NIH overall.
AGENCY FOR HEALTHCARE RESEARCH AND QUALITY
AHRQ is the lead Federal agency charged with supporting research to
improve healthcare quality, reduce costs, advance patient safety,
decrease medical errors, eliminate disparities and broaden access to
essential services. AHRQ supports health services research that will
improve the quality of healthcare and improve evidence-based decision
making. The agency also transforms research into in practice in order
to facilitate wider access to effective healthcare services.
By providing funds to train clinical researchers, AHRQ ensures that
there continues to be researchers who are able to provide the Nation
with high quality, unbiased information about healthcare. Once
consumers have this information, they will then be able to make
effective, evidence based healthcare choices. A Center for Comparative
Effectiveness would help to leverage AHRQ's expertise in providing this
information to consumers. But in order to continue AHRQ's mission of
training clinical researchers, there must be ample funding for training
the investigators who will move this center forward.
The ACRT joins the Friends of AHRQ in requesting $350 million for
AHRQ in fiscal year 2008. The ACRT also joints the Society of General
Internal Medicine (SGIM) and other organizations in advocating for a
Center for Comparative Effectiveness at AHRQ. This center should have
an initial investment of $750 million, including a substantial portion
for research training.
______
Prepared Statement of the Association of Maternal and Child Health
Programs
Mr. Chairman and members of the subcommittee, I am pleased to
submit testimony on behalf of the Association of Maternal and Child
Health Programs (AMCHP) regarding the critical need for increased
funding of the Maternal and Child Health Services Block Grant, Title V
of the Social Security Act. The Maternal and Child Health Services
Block Grant is the only Federal program devoted to improving the health
of all women, children and families. The program provides funding to
State maternal and child health programs, which serve 33 million women
and children in the United States.
When our children are healthy, they are more likely to succeed.
Maternal and child health (MCH) programs help promote our children's
success by identifying emerging and urgent health needs, while
continuing to assure services like prenatal care, universal newborn
screening, immunizations and access to health services. In fact, 80
percent of all American children access or connect with one or more
programs funded by the Title V MCH Block Grant, making this program a
vital resource for families--especially those with special health care
needs.
INCREASE THE BLOCK GRANT TO $750 MILLION
The MCH Block Grant ``Works.''--The Office of Management and Budget
reported that the block grant-funded programs helped to decrease the
infant mortality rate, prevent disabling conditions, increase the
number of children immunized, increase access to care for uninsured
mothers and children, and improve the overall health of all mothers and
children. Funding for the program has decreased since fiscal year 2002,
yet participation has increased. These funding shortages have
threatened the MCH programs' ability to continue achieving successful
outcomes. As health care costs rise and the number of under- or un-
insured women and children continue to grow, block grant programs will
face a critical erosion of their successes. This erosion will impact
the health and well-being of hundreds of thousands of women and
children.
The Need for Programs for Families and Children With Special Health
Care Needs Continues to Grow.--As States face economic hardships and
limit their enrollment and benefit packages in Medicaid and State
Children's Health Insurance Programs (SCHIP), more women and children
seek and receive services through MCH programs. This is especially true
for children with special health care needs who require services that
are not covered in most health insurance plans. Block grant funds also
are used to reduce infant mortality, provide mental health care,
improve oral health, provide care coordination to children with special
health care needs and reduce racial disparities in health care.
The Block Grant Funds Improvements to Vital Health Care Systems.--
State MCH programs establish health care standards that promote
preventive health care; provide outreach and health care education to
assure that children receive services through insurance programs; and,
measure the impact of health care practices. The block grant allows
States to fund efforts to increase the quality health care, collect
data and conduct analyses. MCH programs identify factors associated
with infant mortality, inadequate immunizations, and late prenatal care
so that strategies can be developed to address these needs. Every
funding cut means the provision of fewer direct services and limits the
development of health care system improvements.
maternal and child block grant-funded programs have far-reaching impact
AND USE MONIES EFFICIENTLY AND EFFECTIVELY
Working with Efficiency and Agility, Spending Limited Resources Wisely
The care coordination of MCH programs ensures that all mothers and
children, insured, under- and un-insured, utilize available health care
coverage to receive all possible benefits. All payment sources (private
insurance, State or federally funded health care) are integrated to
deliver quality care.
Dollars invested in MCH programs yield a high return on investment.
The State of Iowa was awarded an Early Hearing Detection and
Intervention grant through 2008 to focus on reducing the number
of infants who are ``lost'' in the system, delaying the
provision of early intervention services. The States' Child
Health Specialty Clinics use the funds to screen all newborns
and enroll eligible children into early intervention programs.
The Pennsylvania Department of Health currently funds the
Pennsylvania Shaken Baby Syndrome Prevention and Awareness
Program in the amount of approximately $100,000 annually. This
program seeks to increase awareness of new parents on the
dangers of shaking a baby. Medical care over the lifetime of a
single child that suffers from Shaken Baby Syndrome can easily
surpass the million dollar mark.
In Florida, for every dollar spent on newborn screening, $17 are
saved. Newborn screening detects diseases and disorders that,
without intervention, are debilitating, costly and potentially
deadly.
Focusing on Those with the Greatest Need
Nationally, the incidence of low birth weight babies and infant
mortality for African Americans is twice the rate for whites. MCH
programs share strategies and tactics to reduce these racial and ethnic
disparities.
Nevada contracts with local agencies to serve uninsured pregnant
women with prenatal care including screening and referral for
depression during and post-pregnancy.
Many young people are at risk for serious chronic diseases and
premature death. Among 5- to 24-year-olds, nearly 75 percent of deaths
are behavior-related, as are many illness and social problems, such as
substance abuse. State MCH programs work to build the capacity of
adolescent health coordinators and child health professionals at the
State level to address adolescent health and make it a priority.
State technical assistance programs funded by the Title V MCH Block
Grant help prevent HIV transmission from mothers to babies, help women
quit smoking during pregnancy and promote safe motherhood.
A recent survey of State MCH program adolescent health coordinators
identified teen pregnancy prevention as the number one priority related
to adolescent health. State MCH programs work to raise the visibility
of teen pregnancy prevention efforts to increase State capacity to
address teen pregnancy and develop sustained and effective prevention
efforts.
Serving America's Families
MCH State programs serve more than 33 million people, striving to
improve the health of all women, infants, children and adolescents
including those with special health care needs by delivering critical
screening services, and supporting preventive, primary and specialty
care.
Montana's MCH funding was the financial basis for public health
services, especially in many small counties until recent
bioterrorism funding. Federal and State MCH funding enables
local public health to leverage small amounts of match funding
at the county level.
Eighty percent of America's children utilize one or more maternal
and child health program.
California's MCH program is collaborating with the Children's
Hospital of Los Angeles and State Epilepsy Foundation on a HRSA
grant called Improving Access to Care for Children and Youth
with Epilepsy. The overall goal is to improve access to health
and other services and supports related to epilepsy by
facilitating the development of state-wide community-based
interagency models of comprehensive, family-centered and
culturally effective statewide standards of care. The program
collaborates with Family Voices and the Children's Regional
Integrated Service Systems which comprises 14 MCH county
programs to implement integrated community systems of care for
children and youth with special health care needs.
More families are turning to MCH services. Over the last 5 years,
the number of individuals served increased by 18 percent.
The number of families served through Regional Genetics Clinics
in Washington State grew from 2,736 families to 4,406 families
in 5 years.
Touching the Lives of Women and Children from Every Walk of Life
MCH clients are as diverse as the country itself. MCH programs
serve families in urban, suburban, rural, and frontier settings.
Many MCH clients are ``special populations,'' those that face
severe health problems and access issues to needed health care. They
include children with complex health care needs, the under- and
uninsured, American Indian and Alaska Natives, migrant and seasonal
workers, immigrants, and racial and ethnic minorities.
Pennsylvania's MCH program has partnered with the Pennsylvania
Chapter of the American Academy of Pediatrics on the Educating
Practices in Community Integrated Care (EPIC-IC) Medical Home
Training Program. Between Oct. 2006 to Feb. 2007, the EPIC IC
program has prevented over 200 hospitalizations and almost 700
emergency doctor visits from. Future cost benefit modeling with
parent and insurance data can translate this savings into real
time dollars. In addition, care coordination and the EPIC IC
program has favorably impacted the quality of life of both
parents and children and youth with special health care needs
by preventing almost 400 missed school days and over 250
parental work days missed.
MATERNAL AND CHILD HEALTH PROGRAMS WORK HAND IN HAND WITH MEDICAID AND
SCHIP. THE HEALTH AND CONTINUITY OF OUR PROGRAMS ARE VITAL TO THEIR
CONTINUED EFFECTIVENESS
AMCHP represents the State public health leaders and others working
to assure that all women, children and families receive quality health
care. MCH programs provide services and supports that augment Medicaid
and SCHIP coverage and ensure eligible women and children access to
needed services. MCH programs work with other programs such as WIC,
community health providers, Head Start and schools to make referrals to
Medicaid and SCHIP programs. They also train public health workers who
inform families about the availability of Medicaid and SCHIP and how to
apply. These programs participate in the development of Medicaid and
SCHIP policies and practice standards that help providers work with
special populations, such as children and youth with special health
care needs.
Changes to Medicaid and SCHIP often have a great effect on MCH
programs and the people they serve. As some States restrict eligibility
for Medicaid and SCHIP, people in need look to MCH-funded services to
meet their health care needs. This puts an increased demand on MCH
programs to offer more services without additional funding. With the
increasing cost of health care and tighter State budgets, States are
examining ways to offer health care services with decreasing resources.
It is more important than ever to maintain the necessary services for
pregnant women, children and adolescents by using the expertise,
creativity and resources of Medicaid, SCHIP and Title V in joint
program planning and development.
CONCLUSION
After its creation, the Title V Maternal and Child Health Block
Grant grew from a $2.7 million program in fiscal year 1936 to a $731
million program in fiscal year 2002 to address the developing needs of
America's women and children. However, since then, as maternal and
child health related needs have increased, the Block Grant funding has
decreased. Title V remains vital as a source of flexible funding that
allows States to meet the needs of their most vulnerable populations
through effective, efficient and integrated programs. Increased funding
is crucial to sustain and expand these efforts to assure quality health
care for families and children with special health care needs.
Please provide $750 million for the Block Grant in fiscal year
2008. Thank you for this opportunity to provide testimony.
______
Prepared Statement of the Association of Minority Health Professions
Schools
SUMMARY OF FISCAL YEAR 2008 RECOMMENDATIONS
$300 million for the Title VII Health Professions Training
Programs, including:
--$33.6 million for the minority centers of excellence.
--$35.6 million for the health careers opportunity program.
$250 million for the National Institutes of Health's National
Center on Minority Health and Health Disparities.
Support for the National Center for Research Resources Extramural
Facilities Construction program.
--$6.7 percent increase for Research Centers for Minority
Institutions.
--$119 million for extramural facilities construction.
$65 million for the Department of Health and Human Services' Office
of Minority Health.
$65 million for the Department of Education's Strengthening
Historically Black Graduate Institutions program.
Mr. Chairman and members of the subcommittee, thank you for the
opportunity to present my views before you today. I am Dr. Barbara
Hayes, president of the Association of Minority Health Professions
Schools (AMHPS) and the dean of the school of pharmacy at Texas
Southern University. AMHPS, established in 1976, is a consortium of our
Nation's 12 historically black medical, dental, pharmacy, and
veterinary schools. The members are two dental schools at Howard
University and Meharry Medical College; four schools of medicine at The
Charles Drew University, Howard University, Meharry Medical College,
and Morehouse School of Medicine; five schools of pharmacy at Florida
A&M University, Hampton University, Howard University, Texas Southern
University, and Xavier University; and one school of veterinary
medicine at Tuskegee University. In all of these roles, I have seen
firsthand the importance of minority health professions institutions
and the Title VII Health Professions Training programs.
Mr. Chairman, time and time again, you have encouraged your
colleagues and the rest of us to take a look at our Nation and evaluate
our needs over the next 10 years. I want to say that minority health
professional institutions and the Title VII Health Professionals
Training programs address a critical national need. Persistent and
sever staffing shortages exist in a number of the health professions,
and chronic shortages exist for all of the health professions in our
Nation's most medically underserved communities. Furthermore, our
Nation's health professions workforce does not accurately reflect the
racial composition of our population. For example while blacks
represent approximately 15 percent of the U.S. population, only 2-3
percent of the Nation's health professions workforce is black. Mr.
Chairman, I would like to share with you how your committee can help
AMHPS continue our efforts to help provide quality health professionals
and close our Nation's health disparity gap.
There is a well established link between health disparities and a
lack of access to competent healthcare in medically underserved areas.
As a result, it is imperative that the Federal Government continue its
commitment to minority health profession institutions and minority
health professional training programs to continue to produce healthcare
professionals committed to addressing this unmet need.
An October 2006 study by the Health Resources and Services
Administration (HRSA), entitled ``The Rationale for Diversity in the
Health Professions: A Review of the Evidence'' found that minority
health professionals serve minority and other medically underserved
populations at higher rates than non-minority professionals. The report
also showed that; minority populations tend to receive better care from
practitioners who represent their own race or ethnicity, and non-
English speaking patients experience better care, greater
comprehension, and greater likelihood of keeping follow-up appointments
when they see a practitioner who speaks their language. Studies have
also demonstrated that when minorities are trained in minority health
profession institutions, they are significantly more likely to: (1)
serve in rural and urban medically underserved areas, (2) provide care
for minorities and (3) treat low-income patients.
As you are aware, Title VII Health Professions Training programs
are focused on improving the quality, geographic distribution and
diversity of the healthcare workforce in order to continue eliminating
disparities in our Nation's healthcare system. These programs provide
training for students to practice in underserved areas, cultivate
interactions with faculty role models who serve in underserved areas,
and provide placement and recruitment services to encourage students to
work in these areas. Health professionals who spend part of their
training providing care for the underserved are up to 10 times more
likely to practice in underserved areas after graduation or program
completion.
Institutions that cultivate minority health professionals, like the
AMHPS members, have been particularly hard-hit as a result of the cuts
to the Title VII Health Profession Training programs in fiscal year
2006 and fiscal year 2007 Funding Resolution passed earlier this
Congress. Given their historic mission to provide academic
opportunities for minority and financially disadvantaged students, and
healthcare to minority and financially disadvantaged patients, minority
health professions institutions operate on narrow margins. The cuts to
the Title VII Health Professions Training programs amount to a loss of
core funding at these institutions and have been financially
devastating.
In fiscal year 2008, funding for the Title VII Health Professions
Training programs must be restored to the fiscal year 2005 level of
$300 million, with two programs--the Minority Centers of Excellence
(COEs) and Health Careers Opportunity Program (HCOPs)--in particular
need of a funding restoration. In addition, the National Institutes of
Health (NIH)'s National Center on Minority Health and Health
Disparities (NCMHD), as well as the Department of Health and Human
Services (HHS)'s Office of Minority Health (OMH), are both in need of a
funding increase.
Minority Centers of Excellence
COEs focus on improving student recruitment and performance,
improving curricula in cultural competence, facilitating research on
minority health issues and training students to provide health services
to minority individuals. COEs were first established in recognition of
the contribution made by four historically black health professions
institutions (the Medical and Dental Institutions at Meharry Medical
College; The College of Pharmacy at Xavier University; and the School
of Veterinary Medicine at Tuskegee University) to the training of
minorities in the health professions. Congress later went on to
authorize the establishment of ``Hispanic'', ``Native American'' and
``Other'' Historically black COEs.
Presently the statute is configured in such a way that the
``original four'' institutions compete for the first $12 million in
funding, ``Hispanic and Native American'' institutions compete for the
next $12 million, and ``Other'' institutions can compete for grants
when the overall funding is above $24 million. For funding above $30
million all eligible institutions can compete for funding.
However, as a consequence of limited funding for COEs in fiscal
year 2006 and fiscal year 2007, ``Hispanic and Native American'' and
``Other'' COEs have lost their support. Out of 34 total COEs in fiscal
year 2005, only 4 now remain due to the cuts in funding. Many AMHPS
institutions lost its COE funding as well, which was a devastating blow
to our institutions.
For fiscal year 2008, I recommend a funding level of $33.6 million
for COEs.
Health Careers Opportunity Program (HCOP)
HCOPs provide grants for minority and non-minority health
profession institutions to support pipeline, preparatory and recruiting
activities that encourage minority and economically disadvantaged
students to pursue careers in the health professions. Many HCOPs
partner with colleges, high schools, and even elementary schools in
order to identify and nurture promising students who demonstrate that
they have the talent and potential to become a health professional.
Collectively, the absence of HCOPs will substantially erode the
number of minority students who enter the health professions. Over the
last three decades, HCOPs have trained approximately 30,000 health
professionals including 20,000 doctors, 5,000 dentists and 3,000 public
health workers. If HCOPs continue to lose Federal support, then these
numbers will drastically decrease. It is estimated that the number of
minority students admitted to health professional schools will drop by
25-50 percent without HCOPs. A reduction of just 25 percent in the
number of minority students admitted to medical school will produce
approximately 600 fewer minority medical students nationwide.
As a result of cuts in the fiscal year 2006 and fiscal year 2007
Labor-HHS Appropriations process, only 4 out of 74 total HCOPs
currently receive Federal funding.
For fiscal year 2008, I recommend a funding level of $35.6 million
for HCOPs.
national institutes of health (nih): extramural facilities construction
Mr. Chairman, if we are to take full advantage of the recent
funding increases for biomedical research that Congress has provided to
NIH over the past decade, it is critical that our Nation's research
infrastructure remain strong. The current authorization level for the
Extramural Facility Construction program at the National Center for
Research Resources is $250 million. The law also includes a 25 percent
set-aside for ``Institutions of Emerging Excellence'' (many of which
are minority institutions) for funding up to $50 million. Finally, the
law allows the NCRR Director to waive the matching requirement for
institutions participating in the program. We strongly support all of
these provisions of the authorizing legislation because they are
necessary for our minority health professions training schools.
Unfortunately, funding for NCRR's Extramural Facility Construction
program was completely eliminated in the fiscal year 2006 Labor-HHS
bill, and no funding was restored in the funding resolution for fiscal
year 2007. In fiscal year 2008, please restore funding for this program
to its fiscal year 2004 level of $119 million, or at a minimum, provide
funding equal to the fiscal year 2005 appropriation of $40 million.
RESEARCH CENTERS IN MINORITY INSTITUTIONS
The Research Centers at Minority Institutions program (RCMI) at the
National Center for Research Resources has a long and distinguished
record of helping our institutions develop the research infrastructure
necessary to be leaders in the area of health disparities research.
Although NIH has received unprecedented budget increases in recent
years, funding for the RCMI program has not increased by the same rate.
Therefore, the funding for this important program grow at the same rate
as NIH overall in fiscal year 2008.
STRENGTHENING HISTORICALLY BLACK GRADUATE INSTITUTIONS--DEPARTMENT OF
EDUCATION
The Department of Education's Strengthening Historically Black
Graduate Institutions program (Title III, Part B, section 326) is
extremely important to AMHPS. The funding from this program is used to
enhance educational capabilities, establish and strengthen program
development offices, initiate endowment campaigns, and support numerous
other institutional development activities. In fiscal year 2008, an
appropriation of $65 million (an increase of $7 million over fiscal
year 2007) is suggested to continue the vital support that this program
provides to historically black graduate institutions.
National Center on Minority Health and Health Disparities
The National Center on Minority Health and Health Disparities
(NCMHD) is charged with addressing the longstanding health status gap
between minority and nonminority populations. The NCMHD helps health
professional institutions to narrow the health status gap by improving
research capabilities through the continued development of faculty,
labs, and other learning resources. The NCMHD also supports biomedical
research focused on eliminating health disparities and develops a
comprehensive plan for research on minority health at the NIH.
Furthermore, the NCMHD provides financial support to health professions
institutions that have a history and mission of serving minority and
medically underserved communities through the Minority Centers of
Excellence program.
For fiscal year 2008, I recommend a funding level of $250 million
for the NCMHD.
Department of Health and Human Services' Office of Minority Health
Specific programs at OMH include:
(1) Assisting medically underserved communities with the greatest
need in solving health disparities and attracting and retaining health
professionals,
(2) Assisting minority institutions in acquiring real property to
expand their campuses and increase their capacity to train minorities
for medical careers,
(3) Supporting conferences for high school and undergraduate
students to interest them in health careers, and
(4) Supporting cooperative agreements with minority institutions
for the purpose of strengthening their capacity to train more
minorities in the health professions.
The OMH has the potential to play a critical role in addressing
health disparities. Unfortunately, the OMH does not yet have the
authority or resources necessary to support activities that will truly
make a difference in closing the health gap between minority and
majority populations.
For fiscal year 2008, I recommend a funding level of $65 million
for the OMH.
Mr. Chairman, please allow me to express my appreciation to you and
the members of this subcommittee. With your continued help and support,
AMHPS's member institutions and the Title VII Health Professions
Training programs can help this country to overcome health and
healthcare disparities. Congress must be careful not to eliminate,
paralyze or stifle the institutions and programs that have been proven
to work. The Association seeks to close the ever widening health
disparity gap. If this subcommittee will give us the tools, we will
continue to work towards the goal of eliminating that disparity
everyday.
Thank you, Mr. Chairman, and I welcome every opportunity to answer
questions for your records.
______
Prepared Statement of the Association for Psychological Science
SUMMARY OF RECOMMENDATIONS
As a member of the Ad Hoc Group for Medical Research Funding, APS
recommends $30.8 billion for NIH in fiscal year 2008, a 6.7 percent
increase.
APS requests committee support for establishing behavioral and
social science research and training as a core priority at NIH in order
to: better meet the Nation's health needs, many of which are behavioral
in nature; realize the exciting scientific opportunities in behavioral
and social science research, and; accommodate the changing nature of
science, in which new fields and new frontiers of inquiry are rapidly
emerging.
Given the critical role of basic behavioral science research and
training in addressing many of the Nation's most pressing public health
needs, we ask the committee to (1) require NIMH to coordinate its
efforts with other Institutes to ensure that these and related areas
are adequately supported at NIH; and (2) request a report from NIH
outlining a structure for basic behavioral science within NIGMS.
APS encourages the committee to review behavioral science
activities at a number of individual institutes. Examples are provided
in this testimony to illustrate the exciting and important behavioral
and social science work being supported at NIH.
Mr. Chairman, members of the committee: As our organization's name
indicates, APS is dedicated to all areas of scientific psychology, in
research, application, teaching, and the improvement of human welfare.
Our 18,000 members are scientists and educators at the Nation's
universities and colleges, conducting NIH-supported basic and applied,
theoretical and clinical research. They look at such things as: the
connections between emotion, stress, and biology and the impact of
stress on health; they look at how children grow, learn, and develop;
they use brain imaging to explore thinking and memory and other aspects
of cognition; they develop ways to manage debilitating chronic
conditions such as diabetes and arthritis as well as depression and
other mental disorders; and they address the behavioral aspects of
smoking and drug and alcohol abuse. Still others look at how genes and
the environment influence behavioral traits such as aggression and
anxiety; the development of a normative model of vision to understand
how it is used in behavior; and the study of the behavioral and neural
mechanisms of sound localization.
As a member of the Ad Hoc Group for Medical Research Funding, APS
recommends $30.8 billion for NIH in fiscal year 2008, an increase of
6.7 percent over the fiscal year 2007 Joint Funding Resolution level.
This increase would halt the erosion of the Nation's public health
research enterprise, and help restore momentum to our efforts to
improve the health and quality of life of all Americans.
Within the NIH budget, APS is particularly focused on behavioral
and social science research and the central role of behavior in health.
The remainder of this testimony concerns the status of those areas of
research at NIH.
BASIC AND APPLIED PSYCHOLOGICAL RESEARCH RELATED TO HEALTH
Behavior is an indelible part of health. Many leading health
conditions--heart disease; stroke; lung disease and certain cancers;
obesity; AIDS, suicide; teen pregnancy, drug abuse and addiction,
depression and other mental illnesses; neurological disorders;
alcoholism; violence; injuries and accidents--originate in behavior and
can be prevented or controlled through behavior. As just one example,
stress is something we all feel in our daily lives, and we now have a
growing body of research that illustrates the direct link between
stress and health: chronic stress accelerates not only the size but
also the strength of cancer tumors; mounting evidence indicates that
chronic stressors weaken the immune system to the point where the heart
is damaged, paving the way for cardiac disease; children who are
genetically vulnerable to anxiety and who are raised by stressed
parents are more likely to experience more anxiety and stress later in
life; animal research has shown that stress interferes with working
memory; and stressful interactions may contribute to systemic
inflammation in older adults which in turn may maintain negative
emotion and pain over time.
None of the conditions or diseases described above can be fully
understood without an awareness of the behavioral and psychological
factors involved in causing, treating and preventing them. Just as
there exists a layered understanding, from basic to applied, of how
molecules affect brain cancer, there is a similar spectrum for
behavioral research. For example, before you address how to change
attitudes and behaviors around AIDS, you need to know how attitudes
develop and change in the first place. Or, to design targeted therapies
for bipolar disorder, you need to know how to understand how circadian
rhythms work as disruptions in sleeping patterns have been shown to
worsen symptoms in bipolar patients.
Despite the clear central role of behavior in health, behavioral
research has not received the recognition or support needed to reverse
the effects of behavior-based health problems in this Nation. APS asks
that you continue to help make behavioral research more of a priority
at NIH, both by providing maximum funding for those institutes where
behavioral science is a core activity, by encouraging NIH to advance a
model of health that includes behavior in its scientific priorities,
and by encouraging stable support for basic behavioral science research
at NIH.
BASIC BEHAVIORAL SCIENCE RESEARCH NEEDS A STABLE INFRASTRUCTURE
Broadly defined, behavioral research explores and explains the
psychological, physiological, and environmental mechanisms involved in
functions such as memory, learning, emotion, language, perception,
personality, motivation, social attachments, and attitudes. Within
this, basic behavioral research aims to understand the fundamental
nature of these processes in their own right, which provides the
foundation for applied behavioral research that connects this knowledge
to real-world concerns such as disease, health, and life stages. We are
sorry to have to tell you that basic behavioral research is not faring
well at NIH, a circumstance that jeopardizes the success of the entire
behavioral research enterprise. Let us describe the current situation:
Traditionally, the National Institute of Mental Health (NIMH) has
been the home for far more basic behavioral science than any other
institute. Many basic behavioral and social questions were being
supported by NIMH, even if their answers could also be applied to other
institutes. Recently, NIMH has begun to aggressively reduce its support
for many areas of the most basic behavioral research, in favor of
translational and clinical research. This means that previously funded
areas now are not being supported.
NIMH's abrupt decision to narrow its portfolio came without
adequate planning and is happening at the expense of critical basic
behavioral research. We favor a broader spectrum of support for basic
behavioral science across NIH as appropriate and necessary for a vital
research enterprise. But until other Institutes have the capacity to
support more basic behavioral science research connected to their
missions, programs of research in fundamental behavioral phenomena such
as cognition, emotion, psychopathology, perception, and development,
will continue to languish. The existing conditions for basic behavioral
science research undermine the scientific community's efforts to
address many of the Nation's most pressing public health needs. We ask
the committee to require NIMH to coordinate its efforts with other
Institutes to ensure that these areas are adequately supported at NIH.
NIGMS SHOULD SUPPORT BASIC BEHAVIORAL SCIENCE RESEARCH
The situation at NIMH underscores the need for a dependable
``home'' for basic behavioral science research and training at NIH. In
fact, that is the recommendation of the NIH Director's own Working
Group on Research Opportunities in the Basic Behavioral and Social
Sciences, which also recommended the National Institute of General
Medical Sciences (NIGMS), known as NIH's ``basic research institute.''
Congress has given NIGMS a statutory mandate [TITLE 42, CHAPTER 6A,
SUBCHAPTER III, Part C, subpart 11, Sec. 285k] to support basic
behavioral research and training, but that mandate has not been
fulfilled.
As early as fiscal year 2000, this committee, along with your
colleagues in the House, has repeatedly issued report language urging
NIGMS to fund basic behavioral research and training, saying, for
example: ``There is a range of basic behavioral research and training
that the institute could support, such as the fundamental relationships
between the brain and behavior, basic cognitive processes such as
motivation, learning, and information processing, and the connections
between mental processes and health. The committee encourages NIGMS to
support basic behavioral research and training and to consult with the
behavioral science research community and other Institutes to identify
priority research and training areas.'' [House Fiscal Year 2000
Appropriations Report 106-370]
As a result of meetings between NIH Deputy Director Raynard Kington
and Representatives Kennedy and Baird, the NIH Director commissioned a
panel of outside experts in 2004 to study the matter. This Working
Group, which was convened under the auspices of the NIH Director's
Advisory Council, spent a year assessing the state of basic behavioral
research throughout NIH. In its final report to NIH, the Working Group
formally recommended the establishment of a secure and stable home for
basic behavioral science research and training at NIH. In particular,
it suggested that an Institute such as NIGMS should be that home, as
this committee, the Institute of Medicine, and the National Academy of
Sciences have recommended. NIH has deflected this request, made by
multiple entities, time and time again. In view of the fact that 8 of
the 10 leading causes of death have a significant behavioral component
and that basic research is the underpinning of advances in applied
behavioral research, the continued lack of focus of scientific
leadership at NIH for this important field of science is counter to the
interests of the Nation's health needs.
Basic behavioral research in the cognitive, psychological, and
social processes underlying substance abuse and addiction (significance
for NIDA, NIAAA, NCI and NHLBI), obesity (significance for NIDDK,
NHLBI, and NICHD) and the connections between the brain and behavior
(significance for NIMH, NINDS, and NHGRI) just to name a few, all are
within the NIGMS mission. Greater involvement between the behavioral
science community and NIGMS is an alliance that can reap enormous
benefits for NIGMS, for behavioral science, for medical science, and
for the public welfare. It is our feeling that the time is ripe for
NIGMS to provide a supportive home for the kinds of basic behavioral
science research that will be critical to fulfilling the NIGMS mission
in the coming years. Given the statutory mandate, the recommendations
of a recent Director's advisory council's task force, the strong
congressional interest, the recommendations of the National Academy of
Sciences and the Institute of Medicine, the scientific imperative, and
most important, the health needs of the Nation, APS asks the committee
to request the Office of the Director to submit to the committee a
report indicating the structure for scientific leadership for this
important field within the appropriate grant making institute, by
November 16, 2007.
BEHAVIORAL SCIENCE AT KEY INSTITUTES
In the remainder of this testimony, we highlight examples of
cutting-edge behavioral science research being supported by individual
institutes.
National Institute of Mental Health (NIMH).--In addition to our
earlier discussion of NIMH, we would like to give special recognition
to the Institute's support of the emerging field of Social
Neuroscience, which investigates the interaction of biological
mechanisms and social processes and behavior. We commend NIMH for
making this a priority. Elucidating the complex interplay between brain
and social behavior will help us better understand and treat mental
disorders such as autism and schizophrenia, and will lead to cognitive
therapies for treating the emotion dysregulation associated with post-
traumatic stress, depression, and cardiovascular disease.
National Institute on Drug Abuse (NIDA).--By supporting a
comprehensive research portfolio that stretches across basic
neuroscience, behavior, and genetics, NIDA is leading the Nation to a
better understanding and treatment of drug abuse. Risky Decision-Making
and HIV/AIDS-NIDA-funded research is examining every aspect of the
transmission of HIV/AIDS through drug abuse and addiction, including
risk-taking behaviors associated with both injection and non-injection
drug abuse, how drugs of abuse alter brain function and impair decision
making, and HIV prevention and treatment strategies for diverse groups.
The goal is to achieve a broad understanding of the multiple ways that
drug abuse and addiction affect HIV/AIDS and how research can inform
public health policy. APS asks this committee to support this and other
critical behavioral science research at NIDA, and to increase NIDA's
budget in proportion to the overall increase at NIH in order to reduce
the health, social and economic burden resulting from drug abuse and
addiction in this Nation.
It's not possible to highlight all of the worthy behavioral science
research programs at NIH. In addition to those reviewed in this
statement, many other institutes play a key role in NIH behavioral
science research enterprise. These include the National Institute on
Alcohol Abuse and Alcoholism, the National Cancer Institute, the
National Institute for Child Health and Human Development, the National
Institute on Aging, the National Heart, Lung, and Blood Institute, and
the National Institute of Diabetes and Digestive and Kidney Diseases.
Behavioral science is a central part of the mission of these
institutes, and their behavioral science programs deserve the
committee's strongest possible support.
This concludes our testimony. Again, thank you for the opportunity
to discuss NIH appropriations for fiscal year 2008 and specifically,
the importance of behavioral science research in addressing the
Nation's public health concerns. We would be pleased to answer any
questions.
______
Prepared Statement of the Association for Research in Vision and
Ophthalmology (ARVO)
EXECUTIVE SUMMARY
ARVO requests fiscal year 2008 NIH funding at $31 billion, or a 6.7
percent increase over fiscal year 2007, to balance the biomedical
inflation rate of 3.7 percent and to maintain the momentum of
discovery. Although ARVO commends the leadership's actions in the 110th
Congress to increase fiscal year 2007 NIH funding by $620 million, this
was just an initial step in restoring the NIH's purchasing power, which
has declined by more than 13 percent since the budget doubling ended in
fiscal year 2003. That power would be eroded even further under the
President's proposed fiscal year 2008 budget. ARVO commends NIH
Director Dr. Zerhouni, who has articulately described his agenda to
foster collaborative, cost-effective research and to transform the
healthcare research and delivery paradigm into one that is predictive,
preemptive, preventive, and personalized. NIH is the world's premier
institution and must be adequately funded so that its research can
reduce healthcare costs, increase productivity, improve quality of
life, and ensure our Nation's global competitiveness.
ARVO requests that Congress make vision health a top priority by
funding the NEI at $711 million in fiscal year 2008, or a 6.7 percent
increase over fiscal year 2007. This level is necessary to fully
advance the breakthroughs resulting from NEI's basic and clinical
research that are resulting in treatments and therapies to prevent eye
disease and restore vision. Vision impairment/eye disease is a major
public health problem that is growing and which disproportionately
affects aging and minority populations, costing the United States $68
billion annually in direct/societal costs, reduced independence, and
quality of life. NEI funding is a cost-effective investment in our
Nation's health, as it can delay and prevent expenditures, especially
to the Medicare and Medicaid programs.
Adequate NEI funding is also essential to a strong and vibrant
research community, which risks losing established investigators. The
flat funding in recent years may cause young investigators to pursue
other careers and thus fail to keep the research pipeline strong. ARVO
is especially concerned about the impact on clinician scientists who
have been so instrumental to the NEI's successful track record of the
translations of basic research into clinical applications that directly
benefit the American people.
ABOUT ARVO
ARVO is the world's largest association of physicians and
scientists who study diseases and disorders affecting vision and the
eye. ARVO has more than 11,700 members from the United States and 70
countries, and some 80 percent of U.S. members have grants from the
National Eye Institute. It is in that regard that ARVO submits these
comments in support of increased fiscal year 2008 NIH and NEI funding.
FUNDING THE NEI AT $711 MILLION IN FISCAL YEAR 2008 ENABLES IT TO LEAD
TRANS-INSTITUTE VISION RESEARCH THAT MEETS NIH'S GOAL OF PREEMPTIVE,
PREDICTIVE, PREVENTIVE, AND PERSONALIZED HEALTHCARE
Funding NEI at $711 million in fiscal year 2008 represents the eye
and vision research community's judgment as that necessary to fully
advance breakthroughs resulting from NEI's basic and clinical research
that are resulting in treatments and therapies to prevent eye disease
and restore vision.
NEI research responds to the NIH's overall major health challenges,
as set forth by Dr. Zerhouni: an aging population; health disparities;
the shift from acute to chronic diseases; and the co-morbid conditions
associated with chronic diseases (e.g., diabetic retinopathy). In
describing the predictive, preemptive, preventive, and personalized
approach to healthcare research, Dr. Zerhouni has frequently cited NEI-
funded research as tangible examples of the value of our Nation's past
and future investment in the NIH. These include:
--Dr. Zerhouni has cited as a breakthrough the collaborative Human
Genome Project/NEI-funded discovery of gene variants strongly
associated with an individual's risk of developing age-related
macular degeneration (AMD), the leading cause of blindness
(affecting more than 10 million Americans) which increasingly
robs seniors of their independence and quality of life. These
variants, which are responsible for about 60 percent of the
cases of AMD, are associated with the body's inflammatory
response and may relate to other inflammation-associated
diseases, such as Alzheimer's and Parkinson's disease. As NEI
Director Dr. Paul Sieving has stated, ``One of the important
stories during the next decade will be how Alzheimer's disease
and macular degeneration fit together.''
--Dr. Zerhouni has cited the NEI-funded Age-Related Eye Disease Study
(AREDS) as a cost-effective preventive measure. In 2006, NEI
began the second phase of the AREDS study, which will follow up
on initial study findings that high levels of dietary zinc and
antioxidant vitamins (Vitamins C, E and beta-carotene) are
effective in reducing vision loss in people at high risk for
developing advanced AMD--by a magnitude of 25 percent.
--NEI has funded research, along with the National Cancer Institute
(NCI) and the National Heart, Lung, and Blood Institute
(NHLBI), into factors that promote new blood vessel growth
(such as Vascular Endothelial Growth Factor, or VEGF). This has
resulted in anti-VEGF factors that have been translated into
the first generation of ophthalmic drugs approved by the Food
and Drug Administration (FDA) to inhibit abnormal blood vessel
growth in ``wet'' AMD, thereby stabilizing vision loss. Current
research is focused on using treatments singly and in
combination to improve vision or prevent further vision loss
due to AMD. As part of its Diabetic Retinopathy Clinical
Research Network, NEI is also evaluating these drugs for
treatment of macular edema associated with diabetic
retinopathy.
Although these breakthroughs came directly from the past doubling
of the NIH budget, their long-term potential to preempt, predict,
prevent, and treat disease relies on adequately funding NEI's follow-up
research. Unless its funding is increased, the NEI's ability to
capitalize on the findings cited above will be seriously jeopardized,
resulting in ``missed opportunities'' that could include:
--Following up on the AMD gene discovery by developing diagnostics
for early detection and promising therapies, as well as to
further study the impact of the body's inflammatory response on
other degenerative eye diseases.
--Fully investigating the impact of additional, cost-effective
dietary supplements in the AREDS study, singly and in
combination, to determine if they can demonstrate enhanced
protective effects against progression to advanced AMD.
--Following up with further clinical trials on patients with the
``wet'' form of AMD, as well as patients with diabetic
retinopathy, using the new anti-angiogenic ophthalmic drugs
singly and in combination to halt disease progression and
potentially restore vision.
In addition, NEI research into other significant eye disease
programs, such as glaucoma and cataract, will be threatened, along with
quality of life research programs into low vision and chronic dry eye.
This comes at a time when the U.S. Census and NEI-funded
epidemiological research (also threatened without adequate funding)
both cite significant demographic trends that will increase the public
health problem of vision impairment and eye disease.
Adequate NEI funding is also essential to a strong and vibrant
research community, which risks losing established investigators. The
flat funding in recent years may cause young investigators to pursue
other careers and thus fail to keep the research pipeline strong. ARVO
is especially concerned about the impact on clinician scientists who
have been so instrumental to the NEI's successful track record of the
translations of basic research into clinical applications that directly
benefit the American people.
vision impairment/eye disease is a major public health problem that is
INCREASING HEALTHCARE COSTS, REDUCING PRODUCTIVITY, AND DIMINISHING
QUALITY OF LIFE
The 2000 U.S. Census reported that more than 119 million people in
the United States were age 40 or older, which is the population most at
risk for an age-related eye disease. The NEI estimates that, currently,
more than 38 million Americans age 40 and older experience blindness,
low vision or an age-related eye disease such as AMD, glaucoma,
diabetic retinopathy, or cataracts. This is expected to grow to more
than 50 million Americans by year 2020. The economic and societal
impact of eye disease is increasing not only due to the aging
population, but to its disproportionate incidence in minority
populations and as a co-morbid condition of other chronic disease, such
as diabetes.
Although the NEI estimates that the current annual cost of vision
impairment and eye disease to the United States is $68 billion, this
number does not fully quantify the impact of direct healthcare costs,
lost productivity, reduced independence, diminished quality of life,
increased depression, and accelerated mortality. The continuum of
vision loss presents a major public health problem and financial
challenge to both the public and private sectors.
In public opinion polls over the past 40 years, Americans have
consistently identified fear of vision loss as second only to fear of
cancer. As a result, Federal funding for the NEI is a vital investment
in the health, and vision health, of our Nation, especially our
seniors, as the treatments and therapies emerging from research can
preserve and restore vision. Adequately funding the NEI can delay and
prevent expenditures, especially those associated with the Medicare and
Medicaid programs, and is, therefore, a cost-effective investment.
ARVO urges fiscal year 2008 NIH and NEI funding at $31 billion and
$711 million, respectively.
______
Prepared Statement of the Association of Women's Health, Obstetric and
Neonatal Nurses
The Association of Women's Health, Obstetric and Neonatal Nurses
(AWHONN) appreciates the opportunity to provide comments on the fiscal
year 2008 appropriations for nursing education, research, and workforce
development programs as well as programs designed to improve maternal
and child health. AWHONN is a membership organization of 22,000 nurses,
and our mission is to promote the health and well-being of all women
and newborns. AWHONN members are registered nurses, nurse
practitioners, certified nurse-midwives, and clinical nurse specialists
who work in hospitals and health systems, physicians' practices,
universities, and community clinics throughout the United States.
DEPARTMENT OF HEALTH AND HUMAN SERVICES (HHS)
AWHONN recommends $1 million in fiscal year 2008 funding to convene a
Surgeon General's conference on preterm birth
Premature birth is the leading cause of neonatal death. Each year,
an estimated 1 in 8 births is premature. A 2006 report by the Institute
of Medicine found that the annual economic burden associated with
preterm birth is at least $26.2 billion. This translates to $51,600 per
preterm infant. The PREEMIE Act (Public Law 109-450) authorized funding
to convene a Surgeon General's conference to establish a public-private
research and education agenda to accelerate the development of new
strategies for preventing preterm birth. This Surgeon General's
conference is a critical step in reducing this growing challenge.
HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA)
AWHONN recommends a minimum of $7.5 billion in funding for HRSA
AWHONN is deeply concerned by the President's budget request, which
eliminates 12 programs and cuts over $200 million from the Federal
funds HRSA received in 2007. Through its many programs and new
initiatives, HRSA provides for the Nation's most vulnerable citizens.
Rapid advances in research and technology promise unparalleled change
in the Nation's health care delivery system. In order to take
reasonable advantage of these opportunities, HRSA will require an
overall funding level of at least $7.5 billion for fiscal year 2008.
TITLE VIII--NURSING WORKFORCE DEVELOPMENT PROGRAMS UNDER HRSA
AWHONN recommends a minimum of $200 million in funding for Title VIII
Nursing workforce development programs authorized under Title VIII
of the Public Health Service Act, are an essential component of the
American health care safety net. Title VIII programs are the only
comprehensive Federal programs that provide annual funds for nursing
education. These funds help nursing schools and students prepare to
meet changing patient needs and provide clinical education to promote
practice in medically underserved communities and Health Professional
Shortage Areas.
The President's budget recommends a 30 percent reduction in funding
at $105 million for fiscal year 2008, despite the worsening nursing
shortage. AWHONN believes a minimum of $200 million is needed to
adequately fund in funding for Title VIII Nursing Workforce
Development. In addition, AWHONN supports funding the Advanced
Education Nursing Training Program (sec. 811) at an increased level on
par with other Title VIII programs in fiscal year 2008.
In 2002, Congress enacted the Nurse Reinvestment Act, which
provides funding for programs such as the Nurse Education Loan
Repayment Program (NELRP), internships and residencies, retention
programs, and faculty loans designed to encourage students to consider
nursing, retain nurses, and increase nurse educators. These new
programs received an initial appropriation of $20 million in fiscal
year 2003, in addition to $93 million provided for existing Title VIII
programming. Inadequate funding stunted the potential of loan and
scholarship programs and limited the support to nursing students. For
example, NELRP is a competitive program that repays 60 percent of the
qualifying loan balance of registered nurses selected for funding in
exchange for 2 years of service at a critical shortage facility. In
fiscal year 2005, the NELRP received 4,465 applications and dispersed
803 awards; an 18 percent award rate. In fiscal year 2006, NELRP
assessed 4,222 applications and gave 615 awards; only a 14 percent
award rate. The award trend is going in the wrong direction.
Increased Funding for Title VIII Will Make a Positive Impact on the
Nursing Shortage.--Recent data from the Bureau of Health Professions,
Division of Nursing's The Registered Nurse Population: National Sample
Survey of Registered Nurses, Preliminary Findings--March 2007, confirm
that of the approximately 2.9 million registered nurses in the Nation
only 83 percent of these nurses work full-time or part-time in nursing.
A dominant factor in this shortage is the impending retirement of up to
40 percent of the workforce by 2010. The average age of a nurse
according to a 2004 sample survey is 46.8 compared to 45.2 in the 2000
survey. This anticipated wave of retirement will occur as the needs of
the aging baby boomer population will markedly increase demand for
health care services and registered nurses. Also, the 2007 U.S. Bureau
of Labor and Statistics report projected that registered nurses will
have the largest 10-year job growth; about 1 million new job openings
by 2010.
The shortage of registered nurses and its effect on staffing
levels, patient safety, and quality care demands attention and a
significant increase in funding to bolster and improve these programs.
Nursing is the largest health profession, yet only .2 percent of
Federal health funding is devoted to nursing education. A significant
increase in funding for these programs can help lay the groundwork for
expanding the nursing workforce, through education, clinical training
and retention programs.
Increased Funding for Title VIII Will Help Fill the Nursing Faculty
Gap.--AWHONN supports efforts to recruit new faculty and increase
nursing faculty available to teach in nursing schools. Currently,
according to the National League for Nursing, there are fewer than
17,000 full-time faculty members. The estimated number of nurse faculty
required to meet current demand is estimated to be 40,000 nurse
educators. The Advanced Nurse Education funding in fiscal year 2005
produced 11,949 graduate nursing students, who are the primary pool for
future faculty.
Nursing faculty continues to decrease in number as nursing school
applications have surged more than 59 percent over the past decade. In
a NLN survey of the 2004-2005 academic year, nursing programs at all
degree levels turned away an estimated 147,000 qualified applications
because of the lack of faculty. This number represents a 17.6 percent
increase from last year's figures. Without sufficient support for
current nursing faculty and adequate incentives to attract future
faculty, nursing schools will fail to have the teaching infrastructure
necessary to educate and train our next generation of nurses.
While the capacity to implement faculty development is currently
available through section 811 and section 831, adequate funding and
direction is needed to ensure that these programs are fully
operational. Options to provide support for full-time doctoral study
are essential to rapidly prepare future nurse educators. AWHONN
recommends that a portion of the funds be allocated for faculty
development and mentoring.
Funding Advanced Practice Nurses Provides Needed Faculty and
Primary Care Providers.--Advanced Practice nurses such as nurse
practitioners, clinical nurse specialists, certified registered nurse
anesthetists and certified nurse midwives are essential to eliminating
the nursing shortage. As in other professions, the advanced degree has
become a necessary achievement for career advancement. Registered
nurses who pursue MSN and PhD degrees often go on to become faculty and
essential health care providers. The nursing shortage encompasses both
advanced practice and basic nursing; each must receive additional
funding but not at the expense of one another. In addition, advanced
practice nurses are critical and sometimes the only available primary
care providers, and often serve in inner city, rural and frontier
health care settings.
The entire nursing workforce needs strengthening. As a result, it
will take long-term planning and innovative initiatives at the local,
State and Federal levels to ensure an adequate supply of a qualified
nurse workforce for the Nation. Federal investment in nursing education
and retention programs is critical for meeting the health care needs of
our Nation.
TITLE V--MATERNAL AND CHILD HEALTH BUREAU (MCHB) UNDER HRSA
AWHONN recommends $731 million in funding for MCHB
The Maternal and Child Health Bureau incorporates valuable programs
like the Traumatic Brain Injury program, Universal Newborn Hearing
Screening, Emergency Medical Services for Children, and Healthy Start,
which were zeroed out, and the Maternal and Child Health Block Grant
(MCH) that saw no funding growth from the previous year. These programs
provide comprehensive, preventive care for mothers and young children,
and an array of coordinated services for children with special needs.
In fact, MCH serves over 80 percent of all infants, half of all
pregnant women and 20 percent of all children in the United States.
NATIONAL INSTITUTES OF HEALTH (NIH)
AWHONN recommends a 6.7 percent increase in appropriation funding for
NIH
Multiple institutes housed under the National Institutes of Health
(NIH) serve valuable roles in helping promote the importance of nursing
in the health care industry along with the health and well-being of
women and newborns. AWHONN calls on Congress to implement a 6.7 percent
increase in funding for NIH in each of the next 3 years. This funding
will allow scientists, including nurse scientists, to continue making
life-saving research breakthroughs and discoveries. This funding also
is the estimated amount needed to sustain the current model of NIH
research funding.
NATIONAL INSTITUTE OF NURSING RESEARCH (NINR) UNDER NIH
AWHONN recommends $150 million in funding for NINR
The National Institute of Nursing Research (NINR) engages in
significant research affecting areas such as health disparities among
ethnic groups, training opportunities for management of patient care
and recovery, and telehealth interventions in rural/underserved
populations. This research allows nurses to refine their practice and
provide quality patient care. For example, NINR research is invaluable
in contributing to improved health outcomes for women. Recent public
awareness campaigns target differences in the manifestation of
cardiovascular disease between men and women. The differing symptoms
are the source of many missed diagnostic opportunities among women
suffering from the disease, which is the primary killer of American
women. Because of the emphasis on biomedical research in this country,
there are few sources of funds for high-quality behavioral research for
nursing other than NINR. It is critical that we increase funding in
this area in an effort to optimize patient outcomes and decrease the
need for extended hospitalization. While the President's budget
recommended a decrease at $138 million, AWHONN requests $150 million
for fiscal year 2008, consistent with the overall increase for all
National Institutes of Health.
NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT (NICHD) UNDER
NIH
AWHONN recommends $1.34 billion in funding for NICHD
The National Institute of Child Health and Human Development
(NICHD) seeks to ensure that every baby is born healthy, that women
suffer no adverse consequences from pregnancy, and that all children
have the opportunity for a healthy and productive life unhampered by
disease or disability. For example, with increased funding, NICHD could
expand its use of the NICHD Maternal-Fetal Medicine Network to study
ways to reduce the incidence of low birth weight. Prematurity/low birth
weight is the second leading cause of infant mortality and the leading
cause of death among African American infants. AWHONN is directly
involved in programs to improve the health of women and newborns and
looks to NICHD to provide national initiatives that assist with the
care of pregnant women and babies. AWHONN suggests a 6.7 percent
increase in NICHD funding to $1.34 billion.
national institute of environmental health sciences (niehs) under nih
AWHONN recommends $673 million for NIEHS
Research conducted by NIEHS plays a critical role in what we know
about the relationship between environmental exposures and the onset of
diseases. Through their research, we know that Parkinson's disease,
breast cancer, birth defects, miscarriage, delayed or diminished
cognitive function, infertility, asthma and many other diseases have
confirmed environmental triggers. Our expanded knowledge, allows
policymakers and the public to make important decisions about how to
reduce toxin exposure, the risk of disease and other negative health
outcomes. As the prevalence of infertility and related reproductive
challenges continues to increase according to the CDC, the investment
in improving our understanding of environmental impacts should be
increased to $673 million.
INDIAN HEALTH SERVICE (IHS) UNDER THE DEPARTMENT OF HEALTH AND HUMANS
SERVICES (HHS)
AWHONN recommends $3.5 billion in funding for IHS
The Indian Health Service (IHS) is the principal Federal health
care provider and health advocate for the American Indian and Alaska
Native populations. The President's budget recognizes this importance
by requesting a 6.9 percent increase of $211 million to the IHS budget,
bringing the fiscal year 2008 total to $3.27 billion. While AWHONN
applauds this increase, we recommend that a total of $3.5 billion is
needed for IHS to fully achieve its legitimate goals. A recent study of
Federal health care spending per capita found that the United States
spends $5,065 per year for the general population, $3,803 per year for
a Federal prisoner, and only $1,914 for a Native American. Where health
needs continue at unprecedented levels ad the average age of nurses
(48) is higher than for the general public. The nursing shortage has
disproportionately affected Indian Health Services. Further, the
average reported vacancy rate for RNs in 2006 was 18 percent. IHS
administers three severely under-funded interrelated scholarship
programs designed to meet the health professional staffing needs of IHS
and other health programs serving Indian people. Targeted resources
need to be invested in the IHS health professions programs to recruit
and retain registered nurses.
CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) UNDER HHS
AWHONN recommends $52 million for Safe Motherhood/Infant Health to fund
activities authorized by the PREEMIE Act
This would include epidemiological studies on preterm birth,
including the relationship between prematurity, birth defects and
developmental disabilities.
AWHONN thanks you for your consideration and greatly appreciates
this opportunity to submit testimony on these critical funding areas.
______
Prepared Statement of the Autism Society of America
My name is Ruth Elaine Hane. I live in Minneapolis, Minnesota,
where I facilitate a social group, the Aspie Get-Together, for adults
with Aspergers and autism. It is a privilege to testifying on behalf of
my self and other adults on the spectrum of autism. I appreciate
sharing my story with strong advocates for autism, Senators Harkin,
Specter and Durbin. Thank you, for all you do, to improve the lives of
those affected by autism.
Several others have given testimony to this subcommittee,
emphasizing the needs of children with autism who are waiting for
essential services, and I do not deny that this is a critical issue,
but, there are others who are also waiting, adults who have aged out of
the system after 21, and are now left without support. A portion of
these adults benefited from the various programs for early intervention
in the past two decades, but are lacking employment and life skills to
live independently. Many are sitting at home in front of their parent's
computer or television screen without the quality of life they were
promised.
I was born with autism, sometimes referred to as a ``Rubella
baby,'' since my mother had a severe case of Rubella Measles during her
pregnancy with me. A delivery using forceps injured and distorted my
head. I screamed for continuously, could not swallow or tolerate touch.
My mother was advised by her doctor, not to become attached to her baby
girl, because there was little hope of my survival, and, even if I did,
I would never be normal. But, I did live, because of a community of
neighbors who problem solved, volunteered, and taught my mother how to
care for me. The bases of their practical advice came from sheep
ranching, and the methods they used to nurture baby lambs who were born
with neurological problems like mine . . . to wrap me tightly in a warm
blanket, place me in a box set on the slightly warmed oven door and to
drip goat's milk into my mouth. Since the sound of ticking clock calmed
me, it was placed near the box. I was not to be clothed, or disturbed
for 3 hours at a time. Over time, I began to grow, however I did not
acclimate to touch, or learn to coo, or respond to others.
I identified with cats and not people, and did not talk until I was
4 years old. The small town where we lived accepted me as an
``unusual'' child who was stubborn, independent, and overly active,
skipping, twirling, and singing to herself. Autism was not well-known
by the doctors at that time. My grandmother, who was a school teacher,
stepped in to give me love, taught me manners and structured learning.
I graduated with honors from college, married and had two children, who
are now grown. My second husband and I are grandparents. Presently, I
volunteer in the community and serve as First vice Chair on the
national board, of the Autism Society of America. I consult with
sensitive people, many of whom are on the spectrum of autism.
My message is that most adults with autism are greatly underserved.
Autism is sometimes called hidden, because many people like me look
normal. Some, have learned to accommodate, to pretend to be normal,
but, others have odd social communication and behaviors especially when
there are stressful situations, such as loud noise, flashing emergency
lights, florescent lighting, confusing verbal directions and poor signs
in public places. Since our brains are unable to processes the incoming
information in a timely way, we are put a risk socially, sometimes
hurt, bullied, raped or even killed. Depression is common with little
hope of living a productive independent life, even though many are
educated, with college degrees, and some with graduate and doctoral
degrees.
After I was diagnosed, as an adult, with High Functioning autism, I
became active in the local Autism Society of America, Minnesota State
Chapter. In 1999, several young adults on the spectrum asked if I would
organize and facilitate a group for people diagnosed with Aspergers and
autism. They wanted a place to socialize and meet friends. I formed the
Aspic Get-Together.
The Aspic Get-Together is an all voluntary group of mostly young
adults, run and governed by the participants. Since most of our members
are unemployed or under employed, the nominal membership dues are often
waived. We are limited in the activities that we can do because of this
lack of funding. However it is a demonstration of how people who are
often marginalized and at times, ostracized, because of a difference in
social skills, can become, productive members of a group, and, of
society at large if given structure, guidance and the opportunity to be
themselves.
Those with autism, who are living with their parents, are under a
cloud of uncertainty with parents who are aging, anguishing about the
future of their dependent adult with autism. With our population
shifting toward a nuclear family unit, we can no longer depend on the
extended family to fill in this gap. We need appropriations to fund
services to change this grave situation in America. With applied
research, job and life skills training, community building and mentors,
who could provide several hours of weekly planning and guidance, so
that the underserved people with autism could work, lead productive
lives and contribute to society in unique and beneficial ways. In
addition, there are those who are profoundly affected by autism, who
need 24 hours a day of assistance and supervision. The best and most
successful programs today, are based on empowering the individual to
make personal choices, allowing for, as much independence as is
possible. Without exception, these providers are under funded.
Although those of us with autism diagnoses are directly affected by
choices others make about and for us, our voice is seldom heard.
I dream of a society that embraces difference of all kinds,
including autism, and a society that listens to those with autism--who
can speak.
Please remember to include us so that there is . . . Nothing about
us . . . without us.
Thank you.
______
Prepared Statement of the Centers for Disease Control and Prevention
Coalition
The CDC Coalition is a nonpartisan coalition of more than 100
groups committed to strengthening our Nation's prevention programs. Our
mission is to ensure that health promotion and disease prevention are
given top priority in Federal funding, to support a funding level for
the Centers for Disease Control and Prevention (CDC) that enables it to
carry out its prevention mission, and to assure an adequate translation
of new research into effective State and local programs. Coalition
member groups represent millions of public health workers, researchers,
educators, and citizens served by CDC programs.
The CDC Coalition believes that Congress should support CDC as an
agency--not just the individual programs that it funds. In the best
judgment of the CDC Coalition--given the challenges and burdens of
chronic disease, a potential influenza pandemic, terrorism, disaster
preparedness, new and reemerging infectious diseases, increasing drug
resistance to critically important antimicrobial drugs and our many
unmet public health needs and missed prevention opportunities--we
believe the agency will require funding of at least $10.7 billion
including sufficient funding to prepare the Nation against a potential
influenza pandemic, funding for the Agency for Toxic Substances and
Disease Registry and to maintain the current funding level for the
Vaccines for Children (VFC) program. This request does not include any
additional funding that may be required to expand the mandatory VFC in
fiscal year 2008.
The CDC Coalition appreciates the subcommittee's work over the
years, including your recognition of the need to fund chronic disease
prevention, infectious disease prevention and treatment, and
environmental health programs at CDC. Federal funding through CDC
provides the foundation for our State and local public health
departments, supporting a trained workforce, laboratory capacity and
public health education communications systems.
CDC also serves as the command center for our Nation's public
health defense system against emerging and reemerging infectious
diseases. With the potential onset of a worldwide influenza pandemic,
in addition to the many other natural and man-made threats that exist
in the modern world, the CDC has become the Nation's--and the world's--
expert resource and response center, coordinating communications and
action and serving as the laboratory reference center. States and
communities rely on CDC for accurate information and direction in a
crisis or outbreak.
CDC's budget has actually shrunk since 2005 in terms of real
dollars--by almost 4 percent. If you add inflation, the cuts are even
worse--and these are cuts to the core programs of the agency. The
current administration request for fiscal year 2008 is inadequate, with
a total cut to core budget categories from fiscal year 2005 to fiscal
year 2008 of half a billion dollars. We are moving in the wrong
direction, especially in these challenging times when public health is
being asked to do more, not less. It simply does not make any sense to
cut the budget for CDC core public health programs at a time when the
threats to public health are so great. Funding public health outbreak
by outbreak is not an effective way to ensure either preparedness or
accountability. Until we are committed to a strong public health
system, every crisis will force trade offs.
CDC serves as the lead agency for bioterrorism preparedness and
must receive sustained support for its preparedness programs in order
for our Nation to meet future challenges. In the best judgment of CDC
Coalition members, given the challenges of terrorism and disaster
preparedness, and our many unmet public health needs and missed
prevention opportunities, we support the proposed increase for anti-
terrorism activities at CDC, including the increases for the Strategic
National Stockpile. However, we strongly oppose the President's
proposed $125 million cut to the State and local capacity grants. We
ask the subcommittee to restore these cuts to ensure that our States
and local communities can be prepared in the event of an act of
terrorism or other public health threat.
Public health programs delivered at the State and local level
should be flexible to respond to State and local needs. Within an
otherwise-categorical funding construct, the Preventive Health and
Health Services (PHHS) Block Grant is the only source of flexible
dollars for States and localities to address their unique public health
needs. The track record of positive public health outcomes from PHHS
Block Grant programs is strong, yet so many requests go unfunded.
However, the President's budget once again proposes the elimination of
the PHHS Block Grant. We greatly appreciate the work of the
subcommittee to at least partially restore the fiscal year 2007
elimination of the Block Grant. Nevertheless, the cut to the Block
Grant in fiscal year 2006 reduces the States' ability to tailor Federal
public health dollars to their specific needs.
ADDRESSING URGENT REALITIES
Heart disease remains the Nation's No. 1 killer. In 2004, more than
650,000 people died from heart disease, accounting for 27 percent of
all U.S. deaths. In 1998, the U.S. Congress provided funding for CDC to
initiate a national, state-based Heart Disease and Stroke Prevention
Program with funding for eight States. Now, 32 States and the District
of Columbia are funded, 19 as capacity building and 14 as basic
implementation. We must expand these efforts to continue the gains we
have made in combating heart disease and stroke.
The CDC funds proven programs addressing cancer prevention, early
detection, and care. In 2006, about 1.4 million new cases of cancer
will be diagnosed, and about 564,830 Americans--more than 1,500 people
a day--are expected to die of the disease. The financial cost of cancer
is also significant. According to the National Institutes of Health, in
2005, the overall cost for cancer in the United States was nearly $210
billion: $74 billion for direct medical costs, $17.5 billion for lost
worker productivity due to illness, and $118.4 billion for lost worker
productivity due to premature death.
Among the ways the CDC is fighting cancer, is through funding the
National Breast and Cervical Cancer Early Detection Program that helps
low-income, uninsured and medically underserved women gain access to
lifesaving breast and cervical cancer screenings and provides a gateway
to treatment upon diagnosis. CDC also funds programs to raise awareness
about colorectal, prostate, lung, ovarian and skin cancers, and the
National Program of Cancer Registries, a critical registry for tracking
cancer trends in all 50 States.
Although more than 20 million Americans have diabetes, 6.2 million
cases are undiagnosed. From 1980-2002, the number of people with
diabetes in the United States more than doubled, from 5.8 million to
13.3 million. Unfortunately funding for diabetes, along with many other
core CDC programs, has either been cut or flat funded for the past
several years. Without additional funds, most States will not be able
to create programs based on these new data. States also will continue
to need CDC funding for diabetes control programs that seek to reduce
the complications associated with diabetes.
Over the last 25 years, obesity rates have doubled among adults and
children, and tripled in teens. Obesity, diet and inactivity are cross-
cutting risk factors that contribute significantly to heart disease,
cancer, stroke and diabetes. The CDC funds programs to encourage the
consumption of fruits and vegetables, to get sufficient exercise, and
to develop other habits of healthy nutrition and activity. In order to
fully support these activities, we urge the subcommittee to provide at
least $43 million for the Steps to a Healthier U.S. program and $65
million for CDC's Division of Nutrition and Physical Activity.
Childhood immunizations provide one of the best returns on
investment of any public health program. Despite the incredible success
of the program, it faces serious financial challenges. In the past 10
years, the number of recommended childhood vaccines has jumped from 10
to 16. Even more striking, the cost of fully vaccinating an adolescent
female has increased from $285 to over $1,200 in past 8 years alone.
Despite these challenges funding for vaccine purchases under section
317 has remained stagnant. The consequence of this disconnect, is that
while 747,000 children and adolescents could potentially receive their
full series of vaccinations with 317 funds in 1999, that number has
plummeted by over 70 percent to just 218,000 in 2007.
More than 400,000 people die prematurely every year due to tobacco
use. CDC's tobacco control efforts seek to prevent tobacco addition in
the first place, as well as help those who want to quit. We must
continue to support these vital programs and reduce tobacco use in the
United States.
Almost 80 percent of young people do not eat the recommended number
of servings of fruits and vegetables, while nearly 30 percent of young
people are overweight or at risk of becoming overweight. And every
year, almost 800,000 adolescents become pregnant and about 3 million
become infected with a sexually transmitted disease. School health
programs are one of the most efficient means of correcting these
problems, shaping our Nation's future health, education, and social
well-being.
Much of CDC's work in chronic disease prevention and health
promotion is guided by its prevention research activities. Healthy
Passages is a longitudinal study that is following a cohort of children
will have to be discontinued without $6 million in additional
appropriations. If allowed to continue, the study would follow children
from birth through adulthood in order to discover critical links
between risks and protective factors and health outcomes.
CDC provides national leadership in helping control the HIV
epidemic by working with community, State, national, and international
partners in surveillance, research, prevention and evaluation
activities. CDC estimates that up to 1,185,000 Americans are living
with HIV, one-quarter of who are unaware of their infection. Prevention
of HIV transmission is our best defense against the AIDS epidemic that
has already killed over 500,000 U.S. citizens and is devastating the
populations of nations around the globe, and CDC's HIV prevention
efforts must be expanded.
The United States has the highest sexually transmitted diseases
(STD) rates in the industrialized world. More than 18 million people
contract STDs each year. Untreated STDs contribute to infant mortality,
infertility, and cervical cancer. State and local STD control programs
depend heavily on CDC funding for their operational support.
CDC conducts several surveys that help track health risks and
provide information for priority setting at the State and local levels.
The Behavioral Risk Factor Surveillance System, Youth Risk Behavior
Survey, Youth Tobacco Survey, and National Health and Nutrition
Examination Survey (NHANES) are important national sources of objective
health data. NHANES is a unique collaboration between CDC, the National
Institutes of Health (NIH), and others to obtain data for biomedical
research, public health, tracking of health indicators, and policy
development. Ensuring adequate funding for this survey is essential for
determining rates of major diseases and health conditions and
developing public health policies and prevention interventions.
We must address the growing disparity in the health of racial and
ethnic minorities. CDC's Racial and Ethnic Approaches to Community
Health (REACH), helps States address these serious disparities in
infant mortality, breast and cervical cancer, cardiovascular disease,
diabetes, HIV/AIDS and immunizations. We encourage the subcommittee to
provide adequate funds for CDC's REACH program.
CDC oversees immunization programs for children, adolescents and
adults, and is a global partner in the ongoing effort to eradicate
polio worldwide. The value of adult immunization programs to improve
length and quality of life, and to save health care costs, is realized
through a number of CDC programs, but there is much work to be done and
a need for sound funding to achieve our goals. Influenza vaccination
levels remain low for adults. Levels are substantially lower for
pneumococcal vaccination and significant racial and ethnic disparities
in vaccination levels persist among the elderly.
Injuries are the leading cause of death in the United States for
people ages 1-34. Of all injuries, those to the brain are most likely
to result in death or permanent disability. Traumatic brain injury
(TBI) is widely recognized as the signature wound of the Iraq war with
estimates of the numbers of injured service members as high as 150,000.
Each year, however, more than 50,000 civilians die and 90,000 civilians
are left with a long-term disability as a result of TBI. The Traumatic
Brain Injury Act is the Nation's only law that specifically responds to
this growing public health crisis. The Institute of Medicine found that
this law has been effective in addressing a wide variety of gaps in
service system development.
Injury at work remains a leading cause of death and disability
among U.S. workers. During the period from 1980 through 1995, at least
93,338 workers in the United States died as a result of injuries
suffered on the job, for an average of about 16 deaths per day. The
injury prevention and workforce protection initiatives of NIOSH need
continued support.
Created by the Children's Health Act of 2000 (Public Law 106-310),
the National Center on Birth Defects and Developmental Disabilities
(NCBDDD) at CDC conducts programs to protect and improve the health of
children and adults by preventing birth defects and developmental
disabilities; promoting optimal child development and health and
wellness among children and adults with disabilities. We must ensure
adequate funding for this important Center.
We also encourage the subcommittee to provide adequate funding for
CDC's Environmental Public Health Services Branch to revitalize
environmental public health services at the national, State and local.
These services are essential to protecting and ensuring the health and
well being of the American public from threats associated with West
Nile virus, terrorism, E. coli and lead in drinking water. We encourage
the committee to provide at least $50 million for CDC's Environmental
Health Tracking Network and to provide $50 million in new funding to
CDC Environmental Health Activities to develop and enhance CDC's
capacity to help the Nation prepare for and adapt to the potential
health effects of global climate change. This new request for funding
would help prepare State and local health department to prepare for the
public health impacts of global climate change, allow CDC to fund
academic and other institutions in their efforts to research the
impacts of climate change on public health and to create a Center of
Excellence at CDC to serve as a national resource for health
professionals, government leaders and the public on climate change
science.
We appreciate the subcommittee's hard work in advocating for CDC
programs in a climate of competing priorities. We encourage you to
consider our request for $10.7 billion, plus sufficient funding to
prepare for a possible influenza pandemic, for CDC in fiscal year 2008.
MEMBERS OF THE CDC COALITION
Advocates for Youth; AIDS Action; AIDS Alliance for Children, Youth
and Families; AIDS Foundation Chicago; Alliance to End Childhood Lead
Poisoning; American Academy of Ophthalmology; American Academy of
Pediatrics; American Association for Health Education; American
Association of Orthopedic Surgeons; American Cancer Society; American
College of Obstetricians and Gynecologists; American College of
Preventive Medicine; American College of Rheumatology; American
Dietetic Association; American Foundation for AIDS Research; American
Heart Association; American Indian Higher Education Consortium;
American Lung Association; American Medical Women's Association;
American Optometric Association; American Podiatric Medical
Association; American Psychological Association; American Psychological
Society; American Public Health Association; American Red Cross;
American School Health Association; American Society for Clinical
Pathology; American Society for Gastrointestinal Endoscopy; American
Society for Microbiology; American Society for Reproductive Health;
American Thoracic Society; American Urological Association c/o MARC
Assoc.; Arthritis Foundation; Assn. for Professionals in Infection
Control & Epidemiology; Association of American Medical Colleges;
Association of Maternal & Child Health Programs; Association of
Minority Health Professions Schools; Association of Public Health
Laboratories; Association of Reproductive Health Professionals;
Association of Schools of Public Health; Association of State and
Territorial Health Officials; Association of Teachers of Preventive
Medicine; Barbara Levine & Associates; Brain Injury Association; Bread
for the World Institute; Campaign for Tobacco-Free Kids; CDC
Foundation; Center for Science in the Public Interest; Coalition for
Health Funding; Coalition for Health Services Research; Commissioned
Officers Association of the U.S. Public Health Service; Consortium for
Citizens with Disabilities; Consortium of Social Science Associations;
Council of Professional Association on Federal Statistics; Council of
State and Territorial Epidemiologist; Crohn's and Colitis Foundation of
America; Environmental Defense; ESA, Inc.; Every Child By Two; GLMA;
Health and Medicine Counsel of Washington; Hepatitis Foundation
International; Immune Deficiency Foundation; Infectious Diseases
Society of America; Latino Council on Alcohol & Tobacco; Legal Action
Center; March of Dimes; NASEMSD; National Alliance of State and
Territorial AIDS Directors; National Association of Children's
Hospitals; National Association of County and City Health Officials;
National Association of Councils on Developmental Disabilities;
National Association of Local Boards of Health; National Association of
School Nurses; National Black Nurses Association; National Coalition
for the Homeless; National Coalition of STD Directors; National Council
of La Raza; National Episcopal AIDS Coalition; National Family Planning
and Reproductive Health Association; National Health Care for the
Homeless Council; National Hemophilia Foundation c/o MARC Assoc.;
National Medical Association; National Osteoporosis Foundation;
National Partnership for Immunization; National Rural Health
Association; National Safe Kids Campaign; National Association for
Public Health Statistics & Information Systems & Information Systems;
Partnership for Prevention; Planned Parenthood Federation of America;
Powers, Pyles, Sutter and Verville; Research!America; Society for
Maternal Fetal-Medicine c/o CRD Associates; Society for Public Health
Education; Society of General Internal Medicine (SGIM); Spina Bifida
Association of America; The Alan Guttmacher Institute; Trust for
America's Health; U.S. Conference of Mayors; United Cerebral Palsy;
YMCA of the USA; and YWCA of the USA/Office of Women's Health
Initiative.
______
Prepared Statement of the Charles R. Drew University of Medicine and
Science
SUMMARY OF FISCAL YEAR 2008 RECOMMENDATIONS
$300 million for the Health Resources and Services Administration
Title VII Health Professisons Training programs, including:
--$33.6 million for the Minority Centers of Excellence, and
--$35.6 million for the Health Careers Opportunity program.
Provide a 6.7 percent increase for fiscal year 2008 to the National
Institutes of Health (NIH), specifically:
--A proportional increast to the National Cancer Institute (NCI),
--$250 million for the National Center on Minority Health and Health
Disparities (NCMHD),
--Support the National Center for research resources:
--Proportional increase for Research Centers for Minority
Institutions and Institutional Development Award (IDeA)
program institutions, and
--$119 million for extramural facilities construction.
Continue to urge NCI to support the Establishment of a
Collaborative Minority Health Comprehensive Research Center at a
Historically Minority Institution in collaboration with the existing
NCI cancer centers. continue to urge NCRR and NCMHD to collaborate on
the Establishment of a Minority Health Comprehensive Research Center.
$65 million for the Department of Health and Human Services' Office
of Minority Health, and
--Urge support for the Health Professions Leadership Development and
Support program at the Charles Drew University.
$65 million for the Department of Education's Strengthening
Historically Black Graduate Institutions program.
Mr. Chairman and members of the subcommittee, thank you for the
opportunity to present you with testimony. The Charles Drew University
is distinctive in being the only dually designated Historically Black
Graduate Institution and Hispanic Serving Institution in the Nation. We
would like to thank you and your predecessors,
Mr. Chairman, for the support that this subcommittee has given to
the National Institutes of Health (NIH) and its various institutes and
centers over the years, NIH has been and continues to be invaluable to
our university and especially our community.
The Charles Drew University is located in the Watts-Willowbrook
area of South Los Angeles. Its mission is to prepare predominantly
minority doctors and other health professionals to care for underserved
communities with compassion and excellence through education, clinical
care, outreach, pipeline programs and advanced research that makes a
rapid difference in clinical practice. In our over 35 years of
enrolling students, the university has become a significant source of
Latino and African American doctors and health professionals. We have
made a measurable contribution to improving health care in this Nation
by graduating over 400 physicians, 2,000 physician assistants, 2,500
physician specialists, and numerous other health professionals--almost
all from diverse communities. Even more importantly, our graduates go
on to serve underserved communities and 10 years later, over 70 percent
of them are still working with people who are in most need and who have
the poorest access to decent health care.
The Charles Drew University has established a national reputation
for translational research that addresses the health disparities and
social issues that strike hardest and deepest among urban and minority
populations. As you can see, we are a unique institution, and we serve
a very important constituency, which regrettably, represents a growing
segment of the overall U.S. population.
Currently, The Charles Drew University is experiencing a period of
positive, dynamic growth. Though our former affiliate hospital, Martin
Luther King-Harbor, is experiencing difficulties, our institution is
transforming and continues to make an expanding contribution to the
health work force, by graduating the highest caliber of health
professionals--particularly, significant number of Latinos and African
Americans, who are highly sought after for employment and further
training positions. Many serve in our community where recent
circumstances and public health budget cuts have reduced the number of
beds and physicians back to the low level that existed in 1965, when
the voiceless community of South Los Angeles was forced to rebel in
order to get the health and social resources it deserves.
Our university continues to flourish and garner respect and support
from our colleagues, community partners and those we serve. After 30
years, in partnership with the University of California, we are
establishing our own 4-year medical school and a new School of Nursing
to prepare nurses as well as nursing faculty--particularly from
minority populations. The Charles Drew University remains a beacon of
hope for our students and our community as we have been since we began
when we rose out of the ashes of the 1965 Watts civil unrest.
HEALTH RESOURCES AND SERVICES ADMINISTRATION
Title VII Health Professions Training Programs
The health professions training programs administered by the Health
Resources and Services Administration (HRSA) are the only Federal
initiatives designed to address the longstanding under representation
of minorities in health careers. HRSA's own report, ``The Rationale for
Diversity in the Health Professions: A Review of the Evidence,'' found
that minority health professionals disproportionately serve minority
and other medically underserved populations, minority populations tend
to receive better care from practitioners of their own race or
ethnicity, and non-English speaking patients experience better care,
greater comprehension and greater likelihood of keeping follow-up
appointments when they see a practitioner who speaks their language.
Studies have also demonstrated that when minorities are trained in
minority health professions institutions, they are significantly more
likely to: (1) serve in medically underserved areas, (2) provide care
for minorities, and (3) treat low-income patients.
HRSA's Minority Centers of Excellence (COE) and Health Careers
Opportunity Program (HCOP) support health professions institutions with
a historic mission and commitment to increasing the number of
minorities in the health professions.
Mr. Chairman, in fiscal year 2006 these programs were cut by over
50 percent. Unfortunately, those cuts were sustained in the funding
resolution passed earlier in this Congress. Looking ahead a decade, as
you have encouraged your colleagues and us to do, the cuts of recent
years to these programs will seriously hamper our ability to provide
the desperately needed healthcare advances for our citizens. Those cuts
will widen the health disparities gap that is already far too wide, and
they will exacerbate the already present national physician shortage,
particularly in urban areas.
Minority Centers of Excellence
The purpose of the Minority Centers of Excellence (COE) program is
to assist schools, like Charles Drew University, that train minority
health professionals, by supporting programs of excellence. The COE
program focuses on improving student recruitment and performance;
improving curricula and cultural competence of graduates; facilitating
faculty and student research on minority health issues; and training
students to provide health services to minority individuals by
providing clinical teaching at community-based health facilities. For
fiscal year 2008, the funding level for Minority Centers of Excellence
should be $33.6 million (an increase of $21.8 million over fiscal year
2007).
Health Careers Opportunity Program
Grants made to health professions schools and educational entities
under Health Careers Opportunity Program (HCOP) enhance the ability of
individuals from disadvantaged backgrounds to improve their
competitiveness to enter and graduate from health professions schools.
HCOP funds activities that are designed to develop a more competitive
applicant pool through partnerships with institutions of higher
education, school districts, and other community based entities. HCOP
also provides for mentoring, counseling, primary care exposure
activities, and information regarding careers in a primary care
discipline. Sources of financial aid are provided to students as well
as assistance in entering into health professions schools. For fiscal
year 2008, the HCOP funding level of $35.6 million is suggested (an
increase of $31.6 million).
NATIONAL INSTITUTES OF HEALTH'S CONTRIBUTION TO FIGHTING HEALTH
DISPARITIES
Racial and ethnic disparities in health outcomes for a multitude of
major diseases in minority and underserved communities continue to
plague a Nation that was built on the premise of equality. As
articulated in the Institute of Medicine report entitled ``Unequal
Treatment: Confronting Racial and Ethnic Disparities in Health Care,''
this problem is not getting better on its own. For example, African
American males develop cancer 15 percent more frequently than their
white counterparts. While African American women are not as likely as
white women to develop breast cancer, they are much more likely to die
from breast cancer once it is detected. In fact, according to the
American Cancer Society, those who are poor, lack health insurance, or
otherwise have inadequate access to high-quality cancer care, typically
experience high cancer incidence and mortality rates. Similarly to
African American populations, Latino communities uffer much higher
incidences of heart disease, diabetes, obesity and some cancers than
white populations. These devastating statistics beg for more research
dollars and better access to quality clinical resources to address the
deep-seated problems.
In response to these and similar findings in our own community and
across the Nation, The Charles Drew University has been working to
build a new Life Sciences Research Facility on its campus. The Center
will specialize in providing not only cutting-edge research but
associated medical treatments for the community that focus on
prevention and the development of new strategies in the fight against
cancer. These strategies will be disseminated locally and nationally to
communities at risk, as well as to others engaged in comprehensive
cancer prevention programs everywhere.
Mr. Chairman, as I mentioned earlier, the support that the
subcommittee has given to the National Institutes of Health (NIH) and
its various institutes and centers has been and continues to be
critical to the effectiveness of our university and our community. The
dream of a state-of-the-art research facility to aid in the fight
against cancer and other diseases in our underserved community would be
infeasible in our disadvantaged location without the resources of NIH.
To help establish the Life Sciences Research Building and expand
our innovative translational research activities that focus on
improving the health of underserved communities, The Charles Drew
University is requesting increased congressional support for the
National Center for Research Resources (NCRR), the National Center for
Minority Health and Health Disparities (NCMHD), the National Cancer
Institute (NCI), Health Resources and Services Administration (HRSA)
and the Department of Health and Human Services' Office of Minority
Health.
National Center for Minority Health and Health Disparities
The National Center on Minority Health and Health Disparities
(NCMHD) is charged with addressing the longstanding health status gap
between under-represented minority and non minority populations. The
NCMHD helps health professional institutions to narrow the health
status gap by improving research capabilities through the continued
development of faculty, labs, telemedicine technology and other
learning resources. The NCMHD also supports biomedical research focused
on eliminating health disparities and developed a comprehensive plan
for research on minority health at NIH. Furthermore, the NCMHD provides
financial support to health professions institutions that have a
history and mission of serving minority and medically underserved
communities through the COE program and HCOP.
For fiscal year 2008, $250 million is recommended for NCMHD to
support these critical activities.
Research Centers At Minority Institutions
The Research Centers at Minority Institutions program (RCMI) at the
National Center for Research Resources (NCRR) has a long and
distinguished record of helping institutions like The Charles Drew
University develop the research infrastructure necessary to be leaders
in the area of translational research focused on reducing health
disparities research. Although NIH has received some budget increases
over the last 5 years, funding for the RCMI program has not increased
by the same rate. The new Clinical and Translational Research
Applications (CTSA) essentially preclude smaller institutions such as
RCMI and IDeA schools to compete and link to the CTSA roadmap. We
request an additional $40 million to support a CTSA-like roadmap
mechanism for RCMI and IDeA schools, and $9.5 million to support the
RCMI Translational Research Network, and alsosmall grant mechanisms to
fund pilot studies linked to the NIH Roadmap, the newly developed
Global Alliance for HIV/AIDS, and community centers of health research
and education excellence. This is a total of an additional $49.5
million in fiscal year 2008.
Extramural Facilities Construction
Mr. Chairman, one issue that sets The Charles Drew University and
many minority-dedicated institutions apart from the major universities
of this country is the facilities where research takes place. The need
for research infrastructure at our Nation's minority serving
institutions must also remain strong to maximize efforts to reduce
health disparities. The current authorization level for the Extramural
Facility Construction program at the National Center for Research
Resources (NCRR) is $250 million. The law also includes a 25 percent
set-aside for ``Institutions of Emerging Excellence'' (many of which
are minority institutions) for funding up to $50 million. Also, the law
allows the NCRR director to waive the matching requirement for
institutions participating in the program. We strongly support all of
these provisions of the authorizing legislation in order to ensure the
continued growth of relevant research from our minority health
professions training schools.
Unfortunately, funding for NCRR's Extramural Facility Construction
program was completely eliminated in the fiscal year 2006 Labor-HHS
bill, and funding was not restored in the fiscal year 2007 funding
resolution. In fiscal year 2008, we respectfully request the
restoration of funding for this program to the fiscal year 2004 level
of $119 million.
department of health and human services' office of minority health
Specific programs at OMH include:
Assisting medically underserved communities,
Supporting conferences for high school and undergraduate students
to interest them in health careers, and
Supporting cooperative agreements with minority institutions for
the purpose of strengthening their capacity to train more minorities in
the health professions.
OMH has the potential to play a critical role in addressing health
disparities. Unfortunately, OMH does not yet have the authority or
resources necessary to support activities that will truly make a
difference in closing the health gap between minority and majority
populations.
One recent OMH pilot project is the Health Professions Leadership
Development and Support Program, which is designed to enhance faculty
recruitment and retention support for academicians providing for the
supervision, instruction, and guidance of resident physicians-in-
training in underserved communities. This is a critical program for
improving the minority pipeline filling a gap outlined in the report by
a committee chaired by former Secretary of the Department of Health and
Human Services (HHS),
Dr. Louis Sullivan titled ``Missing Persons: Minorities in the
Health Professions September 20, 2004.'' This report highlights the
critical role played by institutions such as The Charles Drew
University as a major training site for minority health care
professions and biomedical scientists.
For fiscal year 2008, I recommend a funding level of $65 million
for OMH to support these critical activities.
STRENGTHENING HISTORICALLY BLACK GRADUATE INSTITUTIONS--DEPARTMENT OF
EDUCATION
The Department of Education's Strengthening Historically Black
Graduate Institutions program (Title III, Part B, section 326) is
extremely important to MMC and other minority serving health
professions institutions. The funding from this program is used to
enhance educational capabilities, establish and strengthen program
development offices, initiate endowment campaigns, and support numerous
other institutional development activities. In fiscal year 2008, an
appropriation of $65 million (an increase of $7 million over fiscal
year 2007) is suggested to continue the vital support that this program
provides to historically black graduate institutions.
CONCLUSION
Despite all the knowledge that exists about racial/ethnic, socio-
cultural and gender-based disparities in health outcomes, the gap
continues to widen. Not only are minority and underserved communities
burdened by higher disease rates, they are less likely to have access
to quality care upon diagnosis. As you are aware, in many minority and
underserved communities preventative care and research are inaccessible
either due to distance or lack of facilities and expertise. As noted
earlier, in just one underserved area, South Los Angeles, the number
and distribution of beds, doctors, nurses and other health
professionals are as parlous as they were at the time of the Watts
Rebellion, after which the McCone Commission attributed the so-named
``Los Angeles Riots'' to poor services--particularly access to
affordable, quality healthcare. The Charles Drew University has proven
that it can produce excellent health professionals who ``get'' the
mission--years after graduation they remain committed to serving people
in the most need. But, the university needs investment and committed
increased support from Federal, State, and local governments and is
actively seeking foundation, philanthropic and corporate support.
Even though institutions like The Charles Drew University are
ideally situated (by location, population, community linkages and
mission) to study conditions in which health disparities have been well
documented, research is limited by the paucity of appropriate research
facilities. With your help, the Life Sciences Research Facility will
translate insight gained through research into greater understanding of
disparities and improved clinical outcomes. Additionally, programs like
Title VII Health Professions Training programs will help strengthen and
staff facilities like our Life Sciences Research Facility.
We look forward to working with you to lessen the huge negative
impact of health disparities on our Nation's increasingly diverse
populations, the economy and the whole American community.
Mr. Chairman, thank you again for the opportunity to present
testimony on behalf of The Charles Drew University. It is indeed an
honor.
______
Prepared Statement of the Coalition for the Advancement of Health
Through Behavioral and Social Science Research
Mr. Chairman and members of the subcommittee, the Coalition for the
Advancement of Health Through Behavioral and Social Science Research
(CAHT-BSSR) appreciates and welcomes the opportunity to comment on the
fiscal year 2008 appropriations for the National Institutes of Health
(NIH). CAHT-BSSR includes 16 professional organizations, scientific
societies, coalitions, and research institutions concerned with the
promotion of and funding for research in the social and behavioral
sciences. Collectively, we represent more than 120 professional
associations, scientific societies, universities, and research
institutions.
The behavioral and social sciences regularly make important
contributions to the well-being of this Nation. Due in large part to
the behavioral and social science research sponsored by the NIH, we are
now aware of the enormous contribution behavior makes to our health. At
a time when genetic control over diseases is tantalizingly close but
not yet possible, knowledge of the behavioral influences on health is a
crucial component in the Nation's battles against the leading causes of
morbidity and mortality: obesity, heart disease, cancer, AIDS,
diabetes, age-related illnesses, accidents, substance abuse, and mental
illness. As a result of the strong congressional commitment to the NIH
in years past, our knowledge of the social and behavioral factors
surrounding chronic disease health outcomes is steadily increasing. The
NIH's behavioral and social science portfolio has emphasized the
development of effective and sustainable interventions and prevention
programs targeting those very illnesses that are the greatest threats
to our health, but the work is just beginning.
To ensure that progress is sustained, the Coalition joins the Ad
Hoc Group for Medical Research in supporting a fiscal year 2008
appropriation of $30.8 billion for the NIH, a 6.7 percent increase over
fiscal year 2007. This level of funding will provide adequate resources
to sustain the momentum of the recently completed campaign to double
the Nation's investment in the promising research supported and
conducted by the NIH. Unfortunately, the President's request does not
allow us to fully reap the research opportunities that the doubling
campaign have made available.
Nearly 125 million Americans are living with one or more chronic
conditions, like heart disease, cancer, diabetes, kidney disease,
arthritis, asthma, mental illness and Alzheimer's disease. The Centers
for Medicare and Medicaid Services (CMS) recently reported that health
care spending in the United States rose to $1.6 trillion in 2002, up
from $1.4 trillion in 2001 and $1.3 trillion in 2000. Health
expenditures per person averaged $5,440 in 2002, up from $5,021 in 2001
and $4,670 in 2000. Today, it is even more. Significant factors driving
this increase are the aging of the U.S. population, and the rapid rise
in chronic diseases, many caused or exacerbated by behavioral factors:
for example, obesity, caused by sedentary behavior and poor diet;
addictions and resulting health problems caused by tobacco and other
drug use.
Behavioral and social sciences research supported by NIH is
increasing our knowledge about the factors that underlie positive and
harmful behaviors, and the context in which those behaviors occur. NIH
supports behavioral and social science research throughout most of its
27 institutes and centers. Numerous reports by the National Academy of
Sciences (e.g. The Aging Mind, New Horizons in Health: An Integrative
Approach, and Health and Behavior) have presented cutting edge research
agendas and made eloquent cases for the applicability of the social and
behavioral scientific disciplines to the myriad, complex problems of
prevention, treatment and cure of diseases as well as the enhancement
of quality of life.
CAHT-BSSR supports an appropriation of $27.8 million for NIH Office
of Behavioral and Social Sciences Research, an increase of 6.7 percent,
commensurate with an overall increase of 6.7 percent for the NIH.
OBSSR's purpose is to serve a convening and coordinating role among the
institutes and centers at NIH. The Office was authorized by Congress in
the NIH Revitalization Act of 1993 and established in 1995.
As highlighted by NIH Director Elias Zerhouni on the occasion of
OBSSR's 10th anniversary in June 2006, ``the OBSSR has been a
tremendous asset to NIH throughout its first 10 years . . . we are
faced with an enormous and evolving national burden of disease and
disability, much of which has roots in personal behavior or
socioeconomic influences. The need for behavioral and social research
and intervention has never been greater, and its impact has never been
clearer. We need but look at recent decreases in rates of cancer,
largely due to dramatic decreases in tobacco use. We can point to a
remarkable demonstration of the pronounced benefits of diet and
exercise--more effective than drug therapy--in preventing the onset of
type 2 diabetes among high-risk individuals. These are but two among
many shining examples of the widespread benefits to public health
realized through our investment in basic and applied behavioral and
social science research, so critical to our understanding of health and
disease.
OBSSR focuses on cross-cutting behavioral and social research
issues (e.g. ``Long-term Maintenance of Behavior Change'') using its
modest budget to seed cross-institute research initiatives. OBSSR has
spurred cutting edge research in areas such as measures of community
health, socioeconomic status, and new methodology development. The
Office has been able to leverage substantive funding initiatives with a
small budget.
In fiscal year 2008, OBSSR plans to work with the 27 NIH Institutes
and Centers (ICs) to initiate two new programs. The first program is in
the area of health disparities. The Behavioral and Social Science
Contributions to Understanding and Reducing Health Disparities will be
designed to support trans-disciplinary research involving teams of
behavioral, social, and biomedical scientists, on prevention, policy,
and health care. The research program will emphasize both basic
research on the behavioral, social, and biomedical pathways, giving
rise to disparities in health and applied research on the development,
testing, and delivery of interventions to reduce disparities in the
areas of policy, prevention, and health care.
The second initiative planned by OBSSR is in the area of Genes,
Behavior and the Social Environment. OBSSR plans to work across the
institutes and centers to consider the recommendations from the
Institute of Medicine's report, Genes, Behavior, and the Social
Environment, Moving Beyond the Nature/Nurture Debate, commissioned by
OBSSR, along with the National Institute of General Medical Sciences
(NIGMS) and the National Human Genome Research Institute (NHGRI). The
report identifies gaps in knowledge and barriers that hamper the
integration of social, behavioral, and genetic research.
The IOM panel recognized ``that understanding the association
between health and interactions among social, behavioral, and genetic
factors require research that embraces the systems view and includes an
examination of the interactive pathways through which these fields
operate to affect health.'' Such research requires the participation of
scientific investigators from a variety of fields and a shift in focus
from efforts that are dominated by single disciplines to research that
involves collaborative participation of scientists from various
expertise at all stages of the research process. Below are the IOM's 14
recommendations.
1. Conduct Trans-disciplinary, Collaborative Research.--The NIH
should develop Requests for Applications (RFAs) to study the impact on
health of interactions among social, behavioral, and genetic factors
and their interactive pathways (i.e., physiological).
2. Measure Key Variables Over the Life Course and Within the
Context of Culture.--NIH should develop RFAs for studies of
interactions that incorporate measurement, over the life course and
within the context of culture, of key variables in the important
domains of social, behavioral, and genetic factors.
3. Develop and Implement New Modeling Strategies to Build More
Comprehensive, Predictive Models of Etiologically Heterogeneous
Disease.--NIH should emphasize research aimed at developing and
implementing such models (e.g., pattern recognition, multivariate
statistics, and systems-oriented approaches) for incorporating social,
behavioral, and genetic factors, and their interactive pathways in
testable models within populations, clinical settings, or animal
studies.
4. Investigate Biological Signatures.--Researchers should use
genomic, transcriptomic, proteomic, metabonomic, and other high
dimensional molecular approaches to discover new constellations of
genetic factors, biomarkers, and mediating systems through which
interactions with social environment and behavior influence health.
5. Conduct Research in Diverse Groups and Settings.--NIH should
encourage research on the impact of interactions among social,
behavioral, and genetic factors and their interactive pathways on
health that emphasizes diversity in groups and settings. NIH should
also support efforts to ensure that the findings of such research is
validated by replication in independent studies, translated to patient-
oriented research, conducted and applied in the context of public
health, and used to design preventive and therapeutic approaches.
6. Use Animal Models to Study Gene-Social Environment
Interaction.--NIH should develop RFAs that use carefully selected
animal models for research on the impact on the impact of interactions
among social, behavioral, and genetic factors and their interactive
pathways.
7. Advance the Science of Study of Interactions.--Researchers
should base testing for interaction on a conceptual framework rather
than simply the testing of a statistical model, and they must specify
the scale (e.g., additive or multiplicative) used to evaluate whether
or not interactions are present. NIH should develop RFAs for research
on developing study designs that are efficient at testing interactions,
including variation in interactions over time and development.
8. Expand and Enhance Training for Trans-disciplinary
Researchers.--NIH should use existing and modified training tools both
to reach the next generation of researchers and to enhance the training
of current researchers. Approaches include individual fellowships and
senior fellowships, trans-disciplinary institutional grants, and short
courses.
9. Enhance Existing and Develop New Datasets.--NIH should support
datasets that can be used by investigators to address complex levels of
social, behavioral, and genetic variables and their interactive
pathways. This should include enhancement of existing datasets that
already provide many, but not all of the needed measures and the
encouragement of their use. NIH should also develop new datasets that
address specific topics that have high potential for showing genetic
contribution, social variability, and behavioral contributions--topics
such as obesity, diabetes, and smoking.
10. Create Incentives to Foster Trans-disciplinary Research.--NIH
and universities should explore ways to create incentives for the kinds
of team science needed to support trans-disciplinary research.
11. Communicate with Policymakers and the Public.--Researchers
should (1) be mindful of public and policymakers' concerns; (2) develop
mechanisms to involve and inform these constituencies; (3) avoid
overstating their scientific findings; and (4) give careful
consideration to the appropriate level of community involvement and the
level of community oversight needed for such studies.
12. Expand the Research Focus.--NIH should develop RFAs for
research that elucidates how best to encourage people to engage in
health--promoting behaviors that are informed by a greater
understanding of these interactions; how best to effectively
communicate research results to the public and other stakeholders; and
how best to inform research participants about the nature of the
investigation (gene-environment interactions) and the uses of data
following the study.
13. Establish Data-Sharing Policies That Ensure Privacy.--
Institutional Review Boards and investigators should establish policies
regarding the collection, sharing, and use of data that include
information about: (1) whether and to what extent data will be shared;
(2) the level of security to be provided by all members of the research
team as well as the research and administrative process; (3) the use of
state-of-the-art security data in ways that are consistent with those
agreed to by the research participants.
14. Improve Informed Consent Process.--Researchers should ensure
that informed consent includes the following: (1) descriptions of the
individual and social risks and benefits of the research; (2) the
identification of which individual results participants will and will
not receive; (3) the definition of the procedural protections that will
be provided, including access policies and scientific oversight; and
(4) specific security, privacy, and confidentiality protections to
protect the data and samples of research participants.
Implementing the IOM's recommendations would go a long ways towards
helping to realize the ultimate goal of personalized health care, one
of Secretary Michael Leavitt's priorities. Personalization needs to
reflect genes, behaviors, and environments. Assessing behavior is
critical to helping individuals see how they can improve their health.
It is also critical to helping health care see where it needs to put
resources for behavior change. As noted by Dr. Zerhouni, ``Right now,
everyone is focused on finding the magic answer. But health care is
different from region to region across the country.'' Full
personalization needs to consider the environmental, community, and
neighborhood circumstances that govern how individuals' genes and
behavior will influence their health. For personalized health to be
realized, we need a sophisticated understanding of the interplay
between genetics and the environment, broadly defined.
CAHT-BSSR would be pleased to provide any additional information on
these issues. We have attached a list of coalition member societies to
the end of the testimony. We thank the subcommittee for its generous
support of the National Institutes of Health and for the opportunity to
present our views.
CAHT-BSSR MEMBERS
American Educational Research Association; American Psychological
Association; American Sociological Association; Association of
Population Centers; Center for the Advancement of Health; Consortium of
Social Science Associations; Gerontological Society of America;
Institute for the Advancement of Social Work Research; National
Association of Social Workers; National Council on Family Relations;
National Mental Health Association; Population Association of America;
Sex Information and Education Council of the United States; Society for
Public Health Information; Society for Research in Child Development;
and The Alan Guttmacher Institute.
______
Prepared Statement of the Coalition for American Trauma Care
The Coalition for American Trauma Care is pleased to provide its
recommendations for fiscal year 2008 appropriations for public health
programs that support trauma care, trauma care research, and injury
prevention.
The Coalition for American Trauma Care is a nonprofit association
of national health and professional organizations that seeks to improve
care for the seriously injured patient through improved delivery of
trauma care services, research and rehabilitation activities. The
Coalition also supports efforts to prevent injury from occurring.
Injury is one of the most important public health problems facing
the United States today. It is the leading cause of death for Americans
from age 1 through age 34. More than 145,000 people die each year from
injury, 88,000 from unintentional injury such as car crashes, fires,
and falls, and 56,000 from violence-related causes. Over 85 children
and young adults die from injuries in the United States every day
translating into 30,000 deaths annually. Injury is also the most
frequent cause of disability. Millions of Americans are non-fatally
injured each year leaving many temporarily disabled and some
permanently disabled with severe head, spinal cord, and extremity
injuries. Because injury so often strikes the young, injury is also the
leading cause of years of lost work productivity and, at an estimated
$224 billion in lifetime costs each year, trauma is our Nation's most
costly disease.
Trauma Care Systems.--The Coalition is extremely disappointed that
Congress failed to appropriate any funding for the Health Resources and
Services administration's Trauma-EMS program in fiscal year 2007 and
urges the subcommittee to provide $12 million in funding for fiscal
year 2008. Congress is in the process of re-authorizing the program
(H.R. 727; S. 657) at a level of $12 million for fiscal year 2008. In
recent days both the House Energy and Commerce Committee and the Senate
Health, Education, Labor and Pensions Committees approved their
respective bills unanimously. The Trauma-EMS program, administered by
HRSA for 5 years, from fiscal year 2001-2005, provided critical
national leadership which leveraged additional scarce State dollars to
strengthen trauma systems so that seriously injured individuals,
wherever they live, receive prompt emergency transport to the nearest
appropriate trauma center within the ``golden hour.'' Receiving
appropriate, quality trauma care within 1 hour of injury saves lives
and provides the best chance for a good recovery. Achieving this result
takes coordination, commitment of staff, development and implementation
of standards of care, a process for designating trauma centers, and
evaluation.
No other program in the Federal Government addresses this critical
aspect of the Nation's emergency response infrastructure. According to
the Trauma-EMS Systems Program Assessment Rating Tool (PART) released
by the OMB, ``the Trauma Care program has demonstrated success in
assisting States in adopting statewide standardized triage protocols
and designating trauma centers. Studies indicate with some consistency
that improving organized systems of trauma care, specifically States
designating trauma centers and adopting standardized triage protocols,
leads to measurable decreases in mortality due to trauma.''
Despite this progress, only 8 States have fully developed trauma
systems; 12 States do not even have the authority to designate trauma
centers. In a recent Harris Poll, large majorities of the American
public said they valued trauma centers and systems as highly as having
a police or fire department in their community. We therefore request
that you reinstate funding for this vital, life saving program.
National Center for Injury Prevention and Control.--The Coalition
supports $168 million in funding in fiscal year 2008 for the National
Center for Injury Prevention and Control which is currently funded at
$138 million. The Coalition is exceedingly pleased with the support CDC
has provided for the National Evaluation of the Effect of Trauma Center
Care on Mortality. The results of this study, published in the January
26, 2006 New England Journal of Medicine, were that care at a trauma
center lowers by 25 percent the risk of death for injured patients
compared to treatment received at non-trauma centers. The NCIPC
supports a range of injury prevention activities and through evaluation
has proven their effectiveness in many areas. Just two examples of
these: reduction of the more than 20,000 head injuries that occur every
year by encouraging the use of bicycle helmets and reduction of burn-
related injuries through smoke detector implementation programs.
Traumatic Brain Injury (TBI).--Traumatic brain injury is a leading
cause of trauma-related disability. Brain injury is a silent epidemic
that compounds every year, but about which still little is known. The
Coalition is opposed to the proposed elimination of this important
program in the President's fiscal year 2008 budget request and urges
you to provide a total of $30 million for the Traumatic Brain Injury
(TBI) Act, as follows: $9 million for CDC to strengthen State and local
data collection activities, improve linkage of persons with TBI to
services, increase public education and awareness, and conduct public
health research related to TBI. Within the $30 million, the Coalition
also supports $15 million for the HRSA TBI State Grant Program to
ensure that every State, territory and American Indian Consortia can
coordinate and maximize resources to serve their TBI population and
provide training and technical assistance to grantees. Also within the
$30 million total, $6 million is needed for the HRSA Protection and
Advocacy Program for population-based allotments to all States to
ensure adequate and appropriate assistance to individuals with brain
injury in exercisng their rights and accessing public service systems.
Children's EMS.--The Coalition is opposed to the proposed
elimination of this program in the President's fiscal year 2008 budget
request and urges you to provide $25 million in fiscal year 2008. While
this amount represents a 25 percent increase for this program, it has
been flat-funded for 6 years causing an erosion in available resources
due to inflation. Children currently account for up to 30 percent of
all emergency department visits and 10 percent of ambulance runs
annually, but many facilities lack the specialized equipment needed to
care for them. Moreover, many emergency personnel do not have the
necessary education or training to provide optimal care to children. In
order to assist local communities in providing the best emergency care
to children the Children's EMS program needs to continue and continue
at a level that allows resources to keep pace with inflation.
Preventive Health/Health Services Block Grant (PHHS).--The
Coalition is deeply disappointed that Congress cut funding in fiscal
year 2006 for this program by $32 million, or 24 percent, and that the
President has proposed to eliminate funding in fiscal year 2008. The
Coalition urges you to restore funding to the fiscal year 2005 of $131
million when the subcommittee marks up its fiscal year 2008 bill. The
PHHS Block Grant provides flexible funding to States to allow them to
address specific health problems identified under the Healthy People
2010 assessment process. The funding allows States to take innovative
approaches to address significant health issues and complements, not
duplicates, some of CDC's other program activities. In addition, the
PHHS Block Grant is the largest single source of Federal funding for
support of basic State Emergency Medical Services' (EMS)
infrastructure--the first line of defense against death and disability
resulting from severe injury.
Rural EMS Training and Equipment Program.--The Coalition urges you
to provide $900,000 in funding for the Rural EMS Training and Equipment
Program. This program was eliminated in fiscal year 2006 and needs not
only restoration, but expansion in fiscal year 2008. Rural areas are in
critical need of emergency medical services training and equipment.
Recent national events have continued to draw attention to the need for
communities to have strong emergency medical systems in place.
Unfortunately, while the need for effective emergency medical care may
have increased, the number of individuals able to provide these
services has declined. This is a particular problem in rural areas
where the majority of EMS personnel are unpaid volunteers. As rural
economies continue to suffer, it has become progressively more
difficult for rural EMS providers to recruit and retain these
personnel. As a consequence, emergency medical squads are becoming
smaller. The rural EMS training and equipment program awards
competitive grants to State EMS Offices, State Offices of Rural Health,
local government, and State or local ambulance providers to improve
emergency medical services in rural areas.
The funds can be used to:
--Recruit emergency and volunteer medical service personnel;
--Train emergency medical service personnel in emergency response,
injury prevention, safety awareness, and other topics relevant
to the delivery of emergency medical services;
--Fund specific training to meet Federal or State certification
requirements;
--Develop new ways to educate emergency health care providers through
the use of technology enhance educational methods (such as
distance learning);
--Acquire emergency medical services equipment including cardiac
defibrillators;
--Acquire personal protective equipment for emergency medical
services personnel; and
--Educate the public concerning cardiopulmonary resuscitation, first
aid, injury prevention, safety awareness, illness prevention,
and other related emergency preparedness topics.
The Coalition for American Trauma Care is both deeply disappointed
and alarmed by the President's fiscal year 2008 budget which proposes
elimination of all funding for four programs specifically designed to
build infrastructure to ensure that trauma and emergency medical
services are available and appropriate to need: HRSA's Trauma-EMS
systems program; HRSA's Traumatic Brain Injury program; HRSA's
Children's EMS program and CDC's Preventive Health and Health Services
Block Grant. If these cuts are enacted, the results would be
devastating for emergency care in the United States for everyone and
particularly for children and those who have suffered head injury. The
burden of injury in America has been well documented by numerous IOM
reports and injury facts speak for themselves: injury is the leading
cause of death and disability for children and adults up to age 44.
While much more can and needs to be done to prevent injury from
occurring at all, we will never be able to eliminate it entirely.
Cutting these programs will not lessen the injury burden in America; on
the contrary, it will significantly increase the burden of death,
disability and direct and indirect health care costs. We need to
increase our investment in these program areas, not reduce our
commitment.
The Coalition greatly appreciates the support the subcommittee has
provided to trauma related programs in the past and looks forward to
working with the subcommittee in the coming weeks and months.
______
Prepared Statement of the Coalition of EPSCoR/IDeA States
Thank you for the opportunity to submit this testimony in support
of fiscal year 2008 funding for the National Institutes of Health's
Institutional Development Award or ``IDeA'' Program. The IDeA program
is funded by NIH's National Center for Research Resources (NCRR), and
was authorized by the 1993 NIH Revitalization Act (Public Law 103-43).
My name is Dr. Peter Alfonso and I am the Vice Provost for
Research, Graduate Studies and Outreach and Dean of the Graduate School
at the University of Rhode Island. I submit this testimony on behalf of
the Coalition of EPSCoR/IDeA States.\1\ EPSCoR is the ``Experimental
Program to Stimulate Competitive Research,'' and IDeA, as previously
stated, is the NIH's Institutional Development Award program.
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\1\ Alabama, Alaska, Arkansas, Delaware, Hawaii, Idaho, Kansas,
Kentucky, Louisiana, Maine, Mississippi, Montana, Nebraska, Nevada, New
Hampshire, New Mexico, North Dakota, Oklahoma, Puerto Rico, Rhode
Island, South Carolina, South Dakota, Vermont, Virgin Islands, West
Virginia, and Wyoming. (States in italic letters are eligible for the
IDeA program. All of the States listed above are also eligible for the
EPSCoR program.)
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IDeA is an important program because it increases our Nation's
biomedical research capability by improving research in States that
have historically been less successful in obtaining biomedical research
funds. Twenty-three States and Puerto Rico are eligible.
IDeA funds only merit-based, peer-reviewed research that meets NIH
research objectives.
As previously mentioned, IDeA was authorized by the 1993 NIH
Revitalization Act (Public Law 103-43), but the program was funded at
very low levels during its early years. However, between fiscal year
2000 and fiscal year 2003, IDeA grew rapidly, due in large part to the
thoughtful actions of this subcommittee. This funding permitted the
initiation of two new program elements:
The first was COBRE or ``Centers of Biomedical Research
Excellence;'' which are research clusters targeting specific biomedical
research problems. The COBRE program is designed to increase the pool
of well-trained investigators in the IDeA States by expanding research
facilities, equipping laboratories with the latest research equipment,
providing mentoring for promising candidates, and developing research
faculty through support of a multi-disciplinary center, led by an
established, senior investigator with expertise in the research focus
area of the center.
The second was BRIN or ``Biomedical Research Infrastructure
Networks;'' which targeted key areas such as bioinformatics and
genomics and facilitated the development of cooperative networks
between research-intensive and primarily undergraduate colleges. The
BRIN grants underwent competitive renewals in 2004 under the new name
of IDeA Networks of Biomedical Research Excellence (INBRE). The INBRE
program prepares students for graduate and professional schools as well
as careers in the biomedical sciences, supports research and mentoring
of young investigators, and enhances research infrastructure at
participating institutions.
Although IDeA is relatively new, there is already objective
evidence of its success. In fiscal year 1999, the year before COBRE
grants were initiated, IDeA States received a total of $595 million
from NIH. In fiscal year 2005, NIH funding for the IDeA States had
increased to $1.556 billion, representing an increase of 162 percent in
6 years. It is important to note, however, that in the following year
as the IDeA budget started to decrease, NIH funding for the IDeA States
fell to $1.458 billion, the same level as in fiscal year 2003.
I would like to describe a few examples of how both COBRE and INBRE
(formerly BRIN) grants have changed the biomedical research landscape
of Rhode Island. The first COBRE award in Rhode Island was made to
Brown University in 2000. Prior to this award the biomedical research
infrastructure of the University was severely lacking and the
interactions between researchers at Brown and at other institutions
within the State were minimal at best.
The COBRE award allowed the PI to fund five promising junior
investigators, all of whom won subsequent major NIH grants by the end
of the award period. State-of-the-art core facilities in microscopy,
genomics, and transgenics were established and staffed with Ph.D. level
directors. Seminar series and workshops were initiated with COBRE
funding, and served as the basis for developing collaborative ties with
researchers throughout the State. COBRE funding also was directly
translated into the establishment of a ``Center for Genomics and
Proteomics'' at Brown that included the purchase and renovation of
significant new research space in an old industrial section of the
city. This area of the city has now been filled with new businesses and
is prospering.
The 2000 COBRE award was renewed for another 5 years and the focus
is now on signaling and cancer, with the long term goal of establishing
a cancer center. Since the first COBRE award to Brown University in
2000, three other COBREs have been awarded to three separate
institutions: Rhode Island Hospital, Roger Williams Hospital, and Women
and Infants Hospital. In all three cases, the awarded funds have
directly led to the establishment of critical Core Facilities that
provide new faculty with valuable access to state-of-the-art
instrumentation that they would not be able to acquire through standard
grant award mechanisms For all of these reasons, COBRE is a critical
mechanism of support for States with limited budgets for research
support.
The 3-year BRIN grant, awarded to Rhode Island in 2001 and
competitively renewed as INBRE for 5 years in 2004, provided another
mechanism for addressing both the lack of critical mass of biomedical
researchers at the University of Rhode Island and other primarily
undergraduate institutions in the States, and the lack of high-end
state-of-the-art equipment for biomedical research at these
institutions. Lack of critical mass and the necessary infrastructure to
support biomedical research meant that existing researchers were unable
to perform cutting edge research and effectively compete for research
dollars from Federal agencies such as the National Institutes of
Health. Meager startup funds available for hiring new faculty hampered
efforts to recruit quality research-oriented faculty. There were
limited opportunities for student training in faculty laboratories, and
finally, there was a lack of the type of interinstitutional cooperation
needed to create a network of biomedical researchers.
Through funding received as a result of the BRIN/INBRE awards, more
than $2 million in biomedical research equipment for genomics,
proteomics and drug development studies has been purchased and housed
in a renovated laboratory. This equipment is accessible to all
researchers from the participating institutions: University of Rhode
Island; Rhode Island College; Providence College; Roger Williams
University; Salve Regina University; and Brown University Through BRIN/
INBRE funding, the Center for Molecular Toxicology at the University of
Rhode Island was established. The Center has allowed us to leverage the
creation of new faculty positions at all participating institutions in
the related thematic areas of toxicology, cell biology and
environmental health, and helped provide competitive new faculty
startup packages. New faculty research, coupled with regularly
scheduled seminars and workshops, is generating increased student
interest in research and also greater training opportunities for
students in faculty laboratories. Greater student training in turn
translates into workforce development in the biomedical and
biotechnological fields.
The Rhode Island BRIN/INBRE awards have led to the creation of an
effective state-wide collaborative network of biomedical researchers,
which is essential for implementing an environment that will foster
collaborative research. Finally, and most importantly, this funding has
helped biomedical researchers in our State to achieve greater success
in competing for Federal research dollars. This is the ultimate goal of
the IDeA program.
Despite these successes, our task is far from complete. Funding
disparities between the States remain and may have a detrimental impact
on our national self-interest. And that is why the IDeA program is so
important. It is helping to ensure that all regions of the country
participate in biomedical research. Citizens from all States should
have the opportunity to benefit from the latest innovations in health
care, which are most readily available in centers of biomedical
research excellence.
For this reason, I am deeply concerned by the fiscal year 2008
Budget Request for the IDeA program. The fiscal year 2008 Budget
Request for the IDeA program is $210,963,000, which is a $9,023,000
decrease from the fiscal year 2006 level of funding for the program.
This is the second year in a row that the IDeA program has been cut in
the President's Budget. The fiscal year 2007 budget request was the
first time since 1993 that the budget request for IDeA was below the
previous year's appropriated level for the program.
I applaud the efforts your subcommittee has made over the years to
provide increased funding for IDeA, and hope that you will continue to
invest in this program, which is so important to almost half of our
States. The cut proposed in the fiscal year 2008 budget request will
have a crippling effect on the biomedical research centers, researchers
and students in IDeA States. The IDeA program is important to so many
in our States, but especially to the junior investigators who are
starting to become competitive for NIH funding. I think we send these
young investigators the wrong message by cutting or even possibly
eliminating funding for their research projects after encouraging them
to pursue a career in biomedical research.
For this reason, the Coalition of EPSCoR/IDeA States believe the
program should be funded at $250 million in fiscal year 2008. This
level of funding would restore and continue funding for COBRE and
INBRE, provide funding for information technoIogy (IT) infrastructure
upgrades through IDeANet, and also, some funding would be used for a
co-funding program, which would allow researchers and institutions to
merge with the overall national biomedical research community.
By any reasonable standard, an already proven ``IDeA'' for
increasing biomedical research capacity in a cohort of States which
comprise one-sixth of our population and yet still receive barely one-
twentieth of the NIH budget, deserves increased support. I am sensitive
to the tough budget environment that NIH has faced over the past 4
years. Yet, when I consider that in 2005, the top 7 States that were
recipients of NIH funding received over a $1 billion each, California
alone received over $3 billion, $250 million for 23 States and Puerto
Rico seems more than reasonable. Every region of the country has talent
and expertise to contribute to our Nation's biomedical research
efforts--and every region of the country must participate if we are to
increase our Nation's biomedical research capacity substantially. On
behalf of the Coalition of EPSCoR/IDeA States, I thank the subcommittee
for the opportunity to submit this testimony.
______
Prepared Statement of the Coalition for Health Funding
The Coalition for Health Funding is pleased to provide the
subcommittee with its testimony recommending fiscal year 2008 funding
levels for the agencies and programs of the U.S. Public Health Service.
Since 1970, the Coalition's member organizations, representing 40
million health care professionals, researchers, patients and families,
have been advocating for sufficient resources for PHS agencies and
programs to meet the changing health challenges confronting the
American people. One of the important principles that unites the
Coalition's members is that the health needs of the Nation's population
must be addressed by strong, sustained support for a continuum of
activities that includes biomedical, behavioral and health services
research; community-based disease prevention and health promotion;
health care services for vulnerable and medically underserved
populations; ensuring a safe and effective food and drug supply; and
education of a health professions workforce in adequate numbers to
address the breadth of need.
The Coalition for Health Funding believes the Bush administration,
and Congress, have undermined progress that has been made and also
missed an important opportunity to improve the health of all Americans
by reducing rather than investing more resources in the agencies and
programs of the U.S. Public Health Service. Federal spending for public
health has always been low compared to other health spending, amounting
to 3 percent of total health care spending according to the Centers for
Medicare and Medicaid, and yet an investment in public health has the
potential to slow unsustainable growth in mandatory costs, reduce lost
productivity at work, school and home, and strengthen every citizen's
contribution for a healthy, economically strong America.
Instead of investing in these proven approaches, in recent years we
have seen serious erosion of resources. Last year, through the strong
efforts of a few House and Senate Members of Congress working with the
advocacy community, the bleeding was staunched somewhat through the
addition of $7 billion in funding for the agencies and programs under
the jurisdiction of the Labor-HHS-Education Appropriations
Subcommittees. However, as the table below shows, health agencies did
not benefit across the board, with CDC, HRSA and SAMHSA funded in the
final fiscal year 2007 Joint Resolution below fiscal year 2005 by a
total of $837 million. In addition, all of the health agencies still
face shortfalls when compared with fiscal year 2005 when inflation is
accounted for. The President's fiscal year 2008 budget request cuts
even more deeply--another $1.1 billion below fiscal year 2007 and a
full $1.6 billion below fiscal year 2005.
The Coalition for Health Funding urges the subcommittee to reject
the President's proposal to reduce the Nation's investment in public
health and instead join over 400 health organizations that, in letter
dated February 26, urged Congress to make an investment in public
health of $4 billion over fiscal year 2007 levels. As that letter
states:
``The investment in disease prevention and health promotion for all
Americans needs to grow, as our Nation struggles with escalating health
care costs, growing numbers of uninsured, and the prospect of declining
health measured by overall morbidity and mortality. Over the past 4
years we have seen a decrease in that investment. The President's
budget for fiscal year 2008 continues to seriously underfund and
undermine an important part of the solution: public health activities
and programs.
While the final fiscal year 2007 funding resolution provided needed
increases to selected programs, most public health programs were held
at fiscal year 2006 funding levels. The undersigned organizations urge
you to increase funding for public health through the Function 550/
discretionary budget allocation in fiscal year 2008 by an amount that
will restore funding cuts to public health programs enacted in fiscal
year 2006, and restore lost purchasing power. It is estimated that an
additional $4 billion, 7.8 percent, will be needed in fiscal year 2008
to meet that goal and reverse the erosion of support for the continuum
of biomedical, behavioral and health services research, community-based
disease prevention and health promotion, basic and targeted services
for the medically uninsured and those with disabilities, health
professions education, and robust regulation of the Nation's food and
drug supply.''
The following is a partial list of the Coalition's fiscal year 2008
recommendations for specific U.S. Public Health Service agencies. The
Coalition developed these recommendations working with eight other
health coalitions with a more targeted focus on one agency.
NATIONAL INSTITUTES OF HEALTH (NIH)
The Coalition supports $30.869 billion in fiscal year 2008 for the
National Institutes of Health, a 6.7 percent increase over the fiscal
year 2007 funding level. This recommendation begins a 3 year process
for restoring NIH's purchasing power following 4 years of flat funding
at the end of the doubling in fiscal year 2003. The President's fiscal
year 2008 budget request, by contrast, cuts NIH $310 million below
fiscal year 2007. Enactment of the administration's proposal would mean
about a 13 percent cut in inflation-adjusted dollars in the biomedical
research capacity of our Nation. The result is NIH is funding fewer
research projects, slowing our progress against disease and disability
and discouraging talented young people from pursuing careers in medical
research. Scientific discoveries are the result of a series of
incremental steps that pave the way for future breakthroughs. This
process needs sustained support.
CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC)
The Coalition for Health Funding recommends a level of $7.7 billion
for CDC's core programs in fiscal year 2008. This amount is $1.6
billion more than the fiscal year 2007 funding level and $1.8 billion
more than the President's request for fiscal year 2008. This amount
reflects CDC's professional judgment for core CDC programs that address
prevention of chronic diseases, infectious diseases including adult and
child immunization, and support for basic public health infrastructure.
CDC is the Nation's primary investment in disease prevention and health
promotion. Since fiscal year 2005, the agency's core programs have lost
$500 million in funding. It is astounding this decline has been allowed
to occur when the Nation faces the challenge of galloping obesity and
its ensuing costly chronic disease; new and emerging infectious
diseases like West Nile virus and those caused by antimicrobial
resistant bacteria; vaccine-preventable diseases that occur every day;
still growing numbers of Americans with HIV, with an estimated 250,000
who do not know they are infected; and a public health infrastructure
that still needs shoring up after decades of neglect and that is facing
massive loss of its trained workforce. One example that summarizes the
shocking condition of core CDC programs is the National Center for
Health Statistics (NCHS). Due to a shortfall of a mere $3 million in
fiscal year 2007, NCHS does not have the funding it needs to collect
vital birth and death statistics from States for the last 3 months of
this calendar year. If this is not addressed, the United States will be
the first industrialized Nation in the world unable to collect this
information, and as Rep. Rosa DeLauro, a member of the House Labor-HHS-
Education Subcommittee on Appropriations commented, ``. . . [this will]
compromise our ability not only to target our own public health
interventions and evaluate our health standing on the international
stage, but also monitor causes of death, including infectious diseases
like influenza. As you know, death records are the first line of
defense in our preparedness system, serving as the warning bell for a
pandemic outbreak.''
HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA)
The Coalition for Health Funding recommends an overall funding
level of $7.5 billion for HRSA in fiscal year 2008. This amount is $617
million, or 8.9 percent, more than the fiscal year 2007 funding level,
and is $1.7 billion more than the President's request. This is the
amount that the Coalition believes is needed to provide adequate
resources for the important programs that HRSA administers.
The Coalition is extremely concerned about recent deep cuts in
funding to HRSA, the Federal agency whose central stated mission is to
achieve 100 percent access to health care services with zero
disparities. This is simply not achievable with a cut of over 6 percent
in fiscal year 2006 and a proposed additional cut of 8.5 percent in the
President's fiscal year 2008 budget. Chief among the cuts enacted in
fiscal year 2006, and proposed for complete elimination in the
President's budget request, are the Title VII Health Professions
education programs. In addition, the President's fiscal year 2008
budget cuts the Title VIII nursing education programs by $44 million,
or nearly 30 percent. The Title VII and the Title VIII nursing
education programs are the only Federal programs designed to train
providers in multidisciplinary settings to meet the needs of special
and underserved populations, as well as increase the minority
representation in the health care workforce. Cuts imposed in fiscal
year 2006 of 51.5 percent, including elimination of 7 Title VII
programs, will only exacerbate racial and geographic disparities.
Graduates of these programs are 3-10 times more likely to practice in
underserved areas and are 2-5 times more likely to be minorities. The
Coalition urges the subcommittee to restore funding levels for Title
VII to the fiscal year 2005 level, and not only reject proposed cuts
for Title VIII, but increase funding for this program addressing well-
documented nursing shortages.
The Coalition also rejects the proposed 63 percent cut in
Children's Hospitals Graduate Medical Education. Children's hospitals
do not have access to Medicare funds to help train physicians that care
for sick children.
The Coalition deplores the elimination of several other HRSA
programs in fiscal year 2006 including the Trauma-EMS Systems program,
which supports States in the development of systems to ensure severely
injured individuals receive quality trauma care in a timeframe that
ensures optimal outcomes, and the Healthy Community Access program and
State planning grants designed to close gaps in access to health care
for uninsured individuals. Proposed elimination in the President's
fiscal year 2008 budget of the Children's EMS program, the Traumatic
Brain Injury program, the Universal Newborn Screening program, the
Rural and Community Access to Emergency Devices program to train lay
rescuers and first responders to us Automated External Defibrillators,
and a 90 percent cut for the Office of Rural Health Policy diminish
both targeted prevention activities and health care access. Further, a
cut of $31 million in fiscal year 2006 to the Maternal and Child Health
program, followed by a hard freeze in fiscal year 2007 and a proposed
freeze in the President's fiscal year 2008 budget request, has reduced
services across the Nation to the more than 26 million pregnant women,
infants and special needs children served by the MCH Block Grant. MCH
programs increase immunizations, newborn screening, reduce infant
mortality and developmentally handicapping conditions, prevent
childhood accidents and injuries, and reduce adolescent pregnancy.
SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION
The Coalition for Health Funding recommends an overall funding
level of $3.532 billion for SAMHSA in fiscal year 2008. This amount is
$207 million, or 6.2 percent, more than the fiscal year 2007 funding
level, and $364 million more than the President's budget request, which
includes a $157 million cut for SAMHSA programs.
Despite the recent release of the Federal ``Action Agenda'' to
ensure that people with mental illness have every opportunity for
recovery, the President's fiscal year 2008 budget proposes to cut
mental health services by $77 million, or 8.7 percent, following a cut
in fiscal year 2006 of $17 million. This means that the charge from the
President's New Freedom Commission on Mental Health for transforming
the mental health system cannot occur if SAMHSA funding continually
erodes. The need to make mental health a national priority is nowhere
better illustrated than in the shocking rates of suicide and suicide
attempts in the United States despite the Commission's finding that
suicides are ``a largely preventable public health problem.'' According
to CDC, the suicide rate among U.S. residents younger than age 20
increased by 18 percent from 2003-2004, the only cause of death for
teens that increased. Up to 35,000 children displaced by Hurricane
Katrina in 2005 are having emotional, behavioral or school problems
with a fourfold increase in those diagnosed with clinical depression or
anxiety and a doubling of behavioral, or conduct problems after the
hurricane. A proposed fiscal year 2008 mental health budget that is
less than it was in fiscal year 2003 does not allow SAMHSA to meet
existing needs, let alone respond to the consequences following a
disaster.
The Coalition is disappointed that the President's fiscal year 2008
budget proposes cuts in funding for substance abuse programs by $84
million and recommends a $100 million increase for the Substance Abuse
Treatment and Prevention Block Grant and a $15 million increase for
discretionary treatment programs and a $17 million increase for
discretionary prevention programs. Substance abuse is a significant and
very costly national problem involving an estimated 21.6 million
Americans--over 9 percent of the population--and needs investment in
both treatment and prevention. Currently only 18 percent of all
Americans over the age of 12 who need treatment receive it. Emerging
trends also need specific attention: returning veterans with mental
health and substance abuse problems that are not eligible for VA
services, or will not use them due to stigma; and growing
methamphetamine addiction. Clearly, a stronger investment for this
problem, which is estimated to cost the Nation $346 billion, is needed.
The Coalition appreciates this opportunity to provide its fiscal
year 2008 recommendations and looks forward to working with the
subcommittee in the coming weeks and months.
______
Prepared Statement of the Coalition for International Education
Mr. Chairman and members of the subcommittee: We are pleased to
have the opportunity to present the views of the Coalition for
International Education on fiscal year 2008 funding for the Higher
Education Act, Title VI and the Mutual Educational and Cultural
Exchange Act, section 102(b)(6), commonly known as Fulbright-Hays. The
Coalition for International Education is an ad hoc group of over 30
national higher education organizations with interest in the Department
of Education's international and foreign language education programs.
Together the Coalition represents the Nation's 3,300 colleges and
universities, and organizations encompassing various academic
disciplines, as well as the international exchange and foreign language
communities. The urgency about United States shortfalls in
international expertise against a backdrop of enormous global
challenges is so strong within the higher education community that it
draws our different perspectives into a single consensus position.
We express our deep appreciation for the subcommittee's long-time
support for these programs. We believe that global challenges to our
Nation and its leadership continue to underscore the importance of
training specialists in foreign languages, cultures and international
business who can offer their skills to the government, the private
sector, educational institutions and the media, and who can communicate
across cultures on our behalf.
PROGRAM OVERVIEW AND FUNDING HISTORY
In 1958 at the height of the cold war, Congress created these
programs out of a sense of crisis about United States ignorance of
other countries and cultures. They have served as the lynchpin for
producing international specialists for nearly five decades. Expanding
over time to meet new global challenges, fourteen Title VI/Fulbright-
Hays programs support activities to improve our educational
capabilities, from K-12 through the graduate levels and advanced
research, with emphasis on the less commonly-taught languages and areas
of the world. Title VI largely supports the domestic side of training
and research, while Fulbright-Hays supports the overseas component. The
programs leverage a large amount of additional non-Federal resources
and are relied upon by other Federal and non-Federal programs. Outside
resources are essential incentives to develop and sustain these
interdisciplinary programs, underwrite high cost programs in the less
commonly-taught languages and areas, and provide extensive outreach and
collaboration among educational institutions, government agencies, and
corporations.
Developing the international expertise the Nation will need in the
21st Century requires educational reform and sustained financing.
International expertise cannot be produced quickly. Just as the Federal
Government maintains military reserves to be called upon when needed,
it should invest steadily in an educational infrastructure that trains
sufficient numbers and diversity of American students. Unfortunately,
historical under-funding of Title VI and Fulbright-Hays combined with
expanding needs and rising costs have contributed to the Nation's
shortfall in specialists today. A March 2007 report by the National
Research Council concludes: ``Title VI/FH funding, including staff
resources, has not kept pace with the expansion in the mission of the
programs.'' Funding for key Title VI/Fulbright-Hays programs is more
than 30 percent below the high point in fiscal year 1967. For example,
only 1,561 or 33 percent fewer Foreign Language and Area Studies
fellowships were awarded in fiscal year 2007 compared to 2,344 in
fiscal year 1967. Four years of level funding combined with across-the-
board cuts since fiscal year 2003 eroded by 10 percent in real terms
the fiscal year 2002-2003 funding increases. Our statement today speaks
to the urgent need to resume the infusion of new funds into Title VI/
Fulbright-Hays, to ensure that this expertise is readily available when
needed.
WHY INVESTING IN TITLE VI/FULBRIGHT-HAYS IS IMPORTANT
Our national security, stability and economic vitality depend, in
part, on American experts who have sophisticated language skills and
cultural knowledge about the various areas of the world.
Government Needs.--The quantity, level of expertise, and
availability of U.S. personnel with high-level expertise in foreign
languages, cultures, political, economic and social systems throughout
the world do not match our national strategic needs at home or abroad.
--``All of our efforts in Iraq, military and civilian, are
handicapped by Americans' lack of language and cultural
understanding. Our embassy of 1,000 has 33 Arabic speakers,
just six of whom are at the level of fluency. In a conflict
that demands effective and efficient communication with Iraqis,
we are often at a disadvantage. There are still far too few
Arab language--proficient military and civilian officers in
Iraq, to the detriment of the U.S. mission.'' The Iraq Study
Group: The Way Forward--A New Approach, December 2006.
--``We have begun the process to imbed language and regional
expertise as a core military skill. The need for language and
regional expertise has long been a core requirement for Special
Forces Command, but as the type of conflicts and wars in which
we engage change, and irregular operations and
counterinsurgency and stability operations increase, language
and regional expertise and cultural awareness become key skills
needed by every Soldier, Marine, Sailor, and Airman for this
century's global and ever-changing mission.'' David S.C. Chu,
Under Secretary of Defense for Personnel and Readiness, before
the Senate Armed Services Personnel Subcommittee, March 2006.
--``It is a mark of how far the FBI still has to go to remake itself
into a first-rate counter-terrorism force that 5 years after
Sept. 11, 2001, it has only 33 special agents, with one more on
the way, who speak Arabic. Most of them don't speak it very
well. Only six have a rating of ``advanced professional'' in
the language_one twentieth of 1 percent of the bureau's 12,000
agents.'' Washington Post Editorial, October 2006.
Workforce Needs.--National security is increasingly linked to
commerce, and U.S. business is widely engaged around the world with
joint ventures, partnerships, and economic linkages that require its
employees to have international expertise both at home and abroad.
--``Most of the growth potential for U.S. businesses lies in overseas
markets. Already, one in five U.S. manufacturing jobs is tied
to exports. In 2004, 58 percent of growth in the earnings of
U.S. businesses came from overseas. Foreign consumers, the
majority of whom primarily speak languages other than English,
represent significant business opportunities for American
producers, as the United States is home to less than 5 percent
of the world's population.'' Education for Global Leadership,
Committee for Economic Development, 2006.
--``A study on the internationalization of American business
education found that knowledge of other cultures, cross-
cultural communications skills, experience in international
business, and fluency in a foreign language ranked among the
top skills sought by corporations (especially small and mid-
size) involved in global business. Despite new efforts to
internationalize business education in the last decade, U.S.
business schools still fall short of fulfilling the need of
businesses for personnel who can think and act in a global
context.'' U.S. Business Needs for Employees with International
Expertise, Ben L. Kedia and Shirley Daniel, January 2003.
--The war on terrorism threatens U.S. economic prosperity--and
economic stability worldwide--in ways that are not yet entirely
understood. Businesses are re-evaluating the risks they face
for their employees, their products and services, and their
investments in domestic and global markets. The Title VI
Centers for International Business Education and Research are
mobilizing the intellectual resources of U.S. universities to
focus on homeland security and risks in global markets for
American business. See: Homeland Security & U.S. International
Competitiveness, CIBERWeb.msu.edu.
Improving our Image Abroad.--More Americans with understanding of
other cultures and proficiency in foreign languages helps to improve
the Nation's tarnished image abroad.
--Undersecretary of State for Public Diplomacy and Public Affairs
Karen Hughes in an interview with Parade magazine places some
of the responsibility for America's image abroad on the United
States. The article states: ``She talks about how--before 9/
11--people abroad perceived the United States as being
uninterested in the rest of the world. Our military, cultural
and economic power `buy resentment around the world,' she says.
`It will take all of us to address that. Any American who
travels abroad is an ambassador for our country, and I hope
you'll demonstrate the respect America has for different
countries and cultures.' She'd like more U.S. students to study
abroad and more Americans to learn a foreign language.''
Interview with Karen Hughes in PARADE MAGAZINE: ``Can the U.S.
Rebuild Its Image?'' January 28, 2007.
Language and Area Training.--Title VI/Fulbright-Hays programs
expand foreign language and area studies enrollments, train K-16
foreign language teachers, and build the training infrastructure in the
less commonly-taught languages and areas most needed by the national
security agencies, such as Chinese, Russian, Arabic, Korean, Hindi,
Urdu, among many others.
--Title VI institutions account for 3 percent of all colleges and
universities that offer language instruction, but 21 percent of
undergraduate enrollment and 56 percent of graduate enrollment
in the less commonly taught languages. For the rare languages,
Title VI institutions account for 49 percent of undergraduate
and 78 percent of graduate enrollments.
--Title VI institutions provide instruction in roughly over 130
languages and in 19 world areas, and have the capacity to teach
over 200 languages. Because of the high cost per student, many
of these languages would not be taught on a regular basis at
all but for Title VI and Fulbright-Hays support.
--The decline in foreign language enrollments in higher education
from 16 percent of total student enrollments in 1960 to just
8.7 percent today must be reversed to meet the increasing
demand for globally competent personnel, and to address
national needs.
--Only 5 percent of all higher education students taking foreign
languages study non-European languages spoken by roughly 85
percent of the world's population.
--U.S. educational institutions from K-16 face a shortage of teachers
with global competence, especially foreign language teachers of
the less commonly taught languages. Faculty in professional
disciplines require greater international expertise.
PRESIDENT'S FISCAL YEAR 2008 REQUEST AND THE COALITION'S RESPONSE
The President's fiscal year 2008 budget recommends $105.75 million
for Title VI and Fulbright-Hays. This represents the same level as
fiscal year 2006 for these programs. As part of the National Strategic
Language Initiative (NSLI), a $1 million E-learning clearinghouse for
critical need languages is proposed at the expense of existing Title VI
programs that also serve foreign language needs. The Coalition proposes
$132.6 million for fiscal year 2008. We support the creation of the E-
learning clearinghouse only if new funds are made available and a
broader spectrum of less commonly taught languages than the
administration is recommending is included.
WHAT ADDITIONAL FUNDING OF $26.9 MILLION OVER THE REQUEST WOULD
ACCOMPLISH
Strengthen foreign language, area and international business
education and research: $114 million for Title VI, Parts A&B--a $22.5
million increase.
--Fund an Additional 350 Academic Year and 200 Summer Title VI
Foreign Language (FLAS) Fellowships--35 Percent More Than the
Request.--This would restore the number of foreign language
academic year fellowships to about 85 percent of the number
funded in fiscal year 1967, and 100 percent of the number of
summer fellowships funded in that year. Cuts or level funding
since fiscal year 2003 have resulted in a cumulative loss of
over 340 academic year fellowships in the last 4 years. ($10.75
million)
--Increase the Center Grants for the National Resource Centers (NRC),
Language Resource Centers (LRCs), and Centers for International
Business Education and Research (CIBERs) to Their Fiscal Year
2003 Levels Adjusted for Inflation.--Cuts, inflation, and an
increase in the number of centers in last year's competition
have caused a 15-20 percent reduction (adjusted for inflation)
in the average grant for these vital centers. This would
restore center awards that have eroded over the last 4 years to
about 100 percent of their fiscal year 2003 levels in real
terms. The additional funding will: (1) accelerate efforts to
begin training a new generation of international/language
specialists and faculty, especially for the less commonly
taught languages, who will be needed to replace those expected
to retire over the next decade; (2) expand professional
development for teachers of critical languages at both the K-12
and higher education levels, as well as the development of
widely accessible critical language teaching materials and
assessments for students of critical languages; and (3) step up
programs in the critical languages in business education, as
well as expand research and education on homeland security and
risk management. ($8.5 million)
--Sustain and strengthen other Title VI activities, including the
undergraduate foreign language and international studies,
international research and studies, business and international
education programs, American Overseas Research Centers, and
information technology innovation. Additional funds would build
and strengthen programs in critical languages, including
advanced language training at home and abroad. It would also
increase resources for the development of curriculum materials,
assessment instruments and research, as well as obtaining from
abroad and disseminating educational information about world
regions. ($3.25 million)
Increase the diversity of U.S. students who major in international
fields: $3 million for the Institute for International Public Policy,
TVI-C--a $1.4 million increase. The Institute for International Public
Policy responds to the national need for a diverse pool of well-
trained, language-proficient professionals to enter the Foreign Service
and related careers. The additional funds would raise the number of
entering fellows by 50 percent and extend the pipeline to recruit
graduate students and those working in international affairs to focus
on strategic languages and issues. It also would restore and expand the
capacity building grants for minority serving institutions to
strengthen foreign language instruction on campus and in local
secondary schools, including collaborative efforts with other Title VI
grantee institutions.
Strengthen the overseas component of research and training of
Americans in foreign languages and international studies: $15.6 million
for Fulbright-Hays--a $3 million increase. Fulbright-Hays provides an
essential overseas component for research and training of Americans in
foreign languages and international studies. Overseas immersion is
critical to achieving high levels of foreign language proficiency. All
of the Fulbright-Hays programs require strengthening, with emphasis on
increasing the number of research abroad fellowships and group projects
abroad in intermediate and advanced language training in strategic
world areas, and expanding curriculum development and summer seminars
abroad for K-12 teachers.
APPROPRIATIONS BILL LANGUAGE
In the last 6 years, Congress has enacted language in the
appropriations bill to provide these programs with more flexibility for
overseas immersion opportunities for foreign language training, and to
permit use of Fulbright-Hays funds, in addition to teaching, in fields
including government, professional fields or international development.
It also provides a 1 percent set aside for the Department of Education
to carry out evaluation, outreach and dissemination activities. The
Coalition recommends a continuation of the following language, but with
the insert noted in bold to provide the Secretary with more flexibility
in using the 1 percent set-aside.
``Provided further, That notwithstanding any other provision of
law, funds made available in this act to carry out title VI of the
Higher Education Act of 1965, as amended, and section 102(b)(6) of the
Mutual Educational and Cultural Exchange Act of 1961 may be used to
support visits and study in foreign countries by individuals who are
participating in advanced foreign language training and international
studies in areas that are vital to United States national security and
who plan to apply their language skills and knowledge of these
countries in the fields of government, the professions, or
international development: Provided further, That up to 1 percent of
the funds referred to in the preceding proviso may be used for program
evaluation, national outreach, and information dissemination activities
[insert: that may be carried out by the Secretary or through grants and
contracts to institutions of higher education or public and private
nonprofit agencies and organizations]''
Finally, the Coalition is eager to work with the subcommittee on
several recommendations in the just released March 2007 National
Research Council's report on these programs entitled, ``International
Education and Foreign Languages: Keys to Securing America's Future.''
We consider our request to be a modest one for programs vital to
our Nation's long-term security and economic well-being. Thank you for
your consideration of our views.
______
Prepared Statement of the Coalition of Northeastern Governors
The Coalition of Northeastern Governors (CONEG) is pleased to
provide this testimony for the record to the Senate Subcommittee on
Labor, Health and Human Services, Education, and Related Agencies
regarding fiscal year 2008 appropriations for the Low Income Home
Energy Assistance Program (LIHEAP). The Governors appreciate the
subcommittee's continued support for the LIHEAP program and recognize
the difficult challenges facing the subcommittee in this time of severe
fiscal constraints. In light of the continuously increasing cost of
home energy, the Governors request that Congress provide the authorized
level of $5.1 billion in regular fiscal year 2008 funding as well as
contingency funds to address energy emergency situations. Funding at
the authorized level will restore some of the program's purchasing
power and also provide States across the country with additional
resources to help our most vulnerable citizens afford to heat their
homes.
Home energy prices--for heating oil, natural gas, propane and
electricity--have dramatically increased in recent years. According to
the Energy Information Administration, the average cost for home
heating has risen from $550 during the winter of 2001-2002 to a
projected $862 this year--a 56 percent increase. Low-income households,
whose growth in income is far below the rise in energy prices, face the
prospect of keeping their homes at unhealthy or unsafe temperatures,
using unsafe alternative heating options, or accumulating high levels
of home energy debt and the possibility of utility service shut-off.
LIHEAP is a vital safety net for the most vulnerable of these low-
income households--the elderly and disabled living on fixed incomes,
and families with small children. A recent survey by the National
Energy Assistance Directors' Association (NEADA) found that LIHEAP
eligible low-income households spent an average of 14 percent of their
annual income on residential energy before LIHEAP assistance, but 11
percent after LIHEAP benefits.
The need for home heating assistance far exceeds available Federal
and State resources. LIHEAP was able to assist 5.6 million households
in fiscal year 2006--the highest level in over a decade, but more than
80 percent of eligible households received no assistance. States across
the country in recent years have seen significant increases in their
regular LIHEAP caseloads, as well as in requests for emergency crisis
from those households in imminent danger of a utility or fuel service
cut-off. At the same time, recent price increases have caused the
purchasing power of the LIHEAP dollar to plummet, defraying only a
modest amount of a low-income household's total heating bill.
Congress provided much-appreciated additional LIHEAP funds in
fiscal year 2006, but most of these funds have already been obligated,
will be used for crisis cases this year, or are reserved for cooling
assistance for the upcoming summer. As energy prices continue to
increase the need for home energy assistance, the reduced LIHEAP
Federal funding level in fiscal year 2007 is forcing many States across
the country to reduce benefits, limit crisis assistance, or consider
closing the program early--even as winter moratoriums on utility shut-
off expire this spring.
Without additional Federal resources, the States have limited
options to assist these households in need. A continued reduction in
benefits could result in limited assistance if recipient households are
unable to purchase the required minimum delivery of home heating oil or
make the necessary payment on utility arrearages. Many States have used
State resources to supplement available LIHEAP funds. Limited
opportunities exist to squeeze more assistance dollars from the
program, since LIHEAP administrative costs are already among the lowest
of human service programs. In order to deliver maximum program dollars
to households in need, States in the Northeast have incorporated
various strategies to minimize the program's administrative costs
including using uniform application forms to determine program
eligibility, establishing a one-stop shopping approach for the delivery
of LIHEAP and related programs, sharing administrative costs with other
programs, and using mail recertification.
In spite of these State efforts to stretch Federal and State LIHEAP
dollars, the need for the program is far too great. Increased Federal
funding is vital for LIHEAP to assist the Nation's vulnerable, low-
income households faced with unaffordable home energy bills. An
increase in the regular LIHEAP appropriation to $5.1 billion for fiscal
year 2008 in addition to contingency funds will enable States across
the Nation to help mitigate the potential life-threatening emergencies
and economic hardship that confront the Nation's most vulnerable
citizens. With these additional funds, States can provide assistance to
more households in need, offer benefit levels that provide meaningful
assistance, lessen the need for emergency crisis relief, plan and
operate a more efficient program, and again make optimal use of
leveraging and other cost-effective programs.
We thank the subcommittee for this opportunity to share the views
of the Coalition of Northeastern Governors, and we stand ready to
provide you with any additional information on the importance of the
Low Income Home Energy Assistance Program to the Northeast and the
Nation.
______
Prepared Statement of the College Board
INTRODUCTION
The College Board is a national not-for-profit association of more
than 5,000 member schools, colleges, and universities. Its mission is
challenging: To connect students to college success and opportunity.
One of the College Board's most ambitious and important teaching and
learning programs is the Advanced Placement Program (AP). Comprised of
37 college-level courses taught in high school, AP represents the
highest standard of academic excellence in our Nation's schools and has
become the most influential general education program in the country. A
collaborative effort between motivated students, dedicated teachers,
expert college professors, and committed high schools, colleges, and
universities, the AP Program has allowed millions of students to take
college-level courses and exams and to earn college credit or placement
while still in high school since its inception in 1955. Ninety percent
of the colleges and universities in the United States, as well as
colleges and universities in 30 other countries, have an AP policy
granting incoming students credit, placement, or both on the basis of
their AP Exam grades. Many of these institutions grant up to a full
year of college credit (sophomore standing) to students who earn a
sufficient number of qualifying AP scores.
President Bush's request for $122 million in support for AP--
including $90 million in new funding to train AP math, science, and
world language teachers--will dramatically improve the quality of
instruction in our Nation's schools. The ultimate outcome will be a
substantial increase in the number of high school graduates who enter
college with the desire and ability to succeed in science, technology,
engineering, and mathematics (STEM) fields and compete in a global
marketplace. Moreover, increased support for an expanded AP Program
will contribute to the goal of raising standards and achievement in all
of our Nation's high schools. The AP Program benefits both the students
who take AP courses and those who do not take AP by promoting higher
standards and better teaching in all classes. As such, a significant
investment in the expansion of AP math, science, and world language
programs will have a profound effect on the overall quality of
education in our Nation's schools.
ADVANCED PLACEMENT PROGRAM
AP is a time-tested program with an existing infrastructure of tens
of thousands of teachers and a network of hundreds of training sites
across the country. Funds invested in this program will not need to be
dedicated to creating a new system for teacher professional
development, course development, or the administration and scoring of
assessments. That system already exists as a result of our efforts over
the past 50 years, and as a result of the involvement of thousands of
schools, colleges and universities in the operation of the AP Program.
Thus, new Federal dollars invested in AP can go directly into teacher
training and student preparation and support.
The principles and values of the AP Program can be stated quite
simply:
--AP supports academic excellence. AP represents a commitment to high
standards, hard work, and enriched academic experiences for
students, teachers, and schools.
--AP is about equity. The AP Program should be open to all students,
and we believe that every student should have access to AP
courses and should be given the support he or she needs to
succeed in these challenging courses.
--AP can drive school-wide academic reform. Schools that use AP as an
anchor for setting high standards and raising expectations for
all students see significant returns not just in terms of AP
participation but in terms of increasing the overall quality
and intensity of their academic programs.
Across the Nation, every State, and most school districts are
exploring ways to raise standards and ensure that all students take
challenging courses that prepare them for success in college and work.
AP is recognized as a powerful tool for increasing academic rigor,
improving teacher quality, and creating a culture of excellence in high
schools. Students who take AP courses assume the intellectual
responsibility of thinking for themselves, and they learn how to engage
the world critically and analytically--both inside and outside of the
classroom. This is an invaluable experience for students as they
prepare for college or work upon graduation from high school. Moreover,
schools in which AP is widely offered--and accessible to all students--
experience the diffusion of higher standards throughout the entire
school curriculum.
AP MATHEMATICS AND SCIENCE COURSES
Increasing rigorous math and science education in the United States
will significantly boost our high school graduates' math and science
proficiency, which will increase the number of students who enter
college ready to succeed in programs of study leading to science,
technology, engineering, and mathematics (STEM) careers. We urgently
need to create those opportunities for our students. Today, only 32
percent of American undergraduates earn degrees in science and
engineering, compared to 66 percent of undergraduates in Japan, 59
percent in China, and 36 percent in Germany. In 2004, China graduated
600,000 engineers, India graduated 350,000, and the United States
graduated 70,000.\1\
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\1\ Committee on Science, Engineering and Public Policy. Rising
Above the Gathering Storm: Energizing and Employing America for a
Brighter Economic Future. National Academies Press, 2006. This report
notes that America appears to be on a ``losing path'' today with regard
to our future competitiveness and standard of living.
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The AP Program is an important tool in this Nation's efforts to
increase its economic competitiveness. AP math and science students are
much more likely than other students to major in STEM disciplines than
students whose first exposure to college-level math and science courses
is in college. For example:
--Sixteen percent of students who take AP Chemistry go on to major in
chemistry in college. By way of contrast, only 3-4 percent of
students who take general chemistry instead of AP chemistry
major in that field in college.
--More than 25 percent of students who take AP Calculus go on to
major in a STEM field in college, and 40 percent of students
who take AP Physics major in physics in college.
Furthermore, research indicates that AP math and science courses
prepare American students to achieve a level of proficiency that
exceeds that of students from all other nations. For example, in the
most recent TIMSS assessments, U.S. Calculus students ranked No. 15
(out of 16 countries) in the international advanced mathematics
assessment. But AP Calculus students who scored a 3 or better on the AP
Calculus Exam ranked first in the world. Even AP Calculus students who
scored a 1 or 2 on the AP Calculus Exam--below ``passing''--were ranked
second in the world. AP Physics students, as compared to other U.S.
physics students and physics students internationally, were also at the
top of the ranking.
Most significantly, there are many more U.S. students who could
succeed in AP math and science courses--if given the chance. By
utilizing an existing, diagnostic tool called AP Potential, more
students could be identified as individuals who have the potential to
succeed in Advanced Placement classes but may not currently have the
opportunity to do so. This year we anticipate that more than 100,000
U.S. students will earn a 3 or above on the AP Calculus Exam--the score
typically required for college credit. But in a national analysis of
the math proficiency of students enrolled in U.S. high schools during
the 2005-2006 academic year, we can identify, by name and school, an
additional 500,000 students who have the same academic background and
likelihood of success in AP Calculus as the 100,000 students who
currently are fortunate enough to have an AP Calculus course available
to them.
If we look at Biology, we see an even larger gap; we expect that
about 74,000 students will earn exam grades of 3 or higher on the AP
Biology Exam this year, whereas we know that at least 640,000
additional U.S. students have the academic skills that would enable
them to succeed in AP Biology if they only had a course available to
them and the encouragement to take on this challenge. There are
hundreds of thousands of high school students in the United States who
are prepared and ready to succeed in rigorous high school courses such
as AP Calculus, AP Biology, AP Physics, and AP Chemistry. In many
cases, the only thing preventing them from learning at this higher
level is the lack of an AP teacher in their school or the lack of
adequate encouragement and support to take the AP course.
CONCLUSION
AP is not for the elite, it is for the prepared. The tremendous
potential of AP to drive reform in a powerful way in all of our
Nation's schools is well established, and no other program has as
strong an impact on overall student and teacher quality as AP. The
committee's support for expanded AP math, science, and world language
courses and exams will prepare many more students for the opportunity
to compete in a global environment and succeed in STEM fields in
college and work. We respectfully urge that you fully fund the
administration's AP expansion request.
______
Prepared Statement of the Cooley's Anemia Foundation
Mr. Chairman and members of the subcommittee: Thank you for the
opportunity to present this testimony to the subcommittee today. My
name is Frank Somma. I live in Holmdel, New Jersey and I am honored to
serve as the National President of the Cooley's Anemia Foundation. As
many members of this subcommittee know, Cooley's anemia, or
thalassemia, is a fatal genetic blood disorder.
I could bog you down in a detailed scientific explanation of what
happens physiologically when the human body cannot produce red blood
cells in adequate numbers and of adequate quality to sustain life. I am
not going to do that. The important thing for members of this
subcommittee to remember about Cooley's anemia is that it is a fatal
genetic blood disorder. Period.
I also understand that I can present you with five pages of
detailed single-spaced testimony. I am not going to do that either.
Instead, I am respectfully going to address the following three issues
in a clear and succinct manner.
--The first is the immediate need to retain $1.94 million in the
CDC's Division of Blood Disorders to fund the thalassemia blood
safety surveillance network. This program works for thalassemia
patients, and for all Americans, by providing a mechanism to
take immediate actions to keep the blood supply safe when a
threat emerges.
--The second issue is the equally critical need for this subcommittee
to commit our government through the NIH--and more specifically
through NHLBI--to the development of a vigorous, ethical,
progressive and focused gene therapy program that is designed
to cure gene disorders in the shortest possible time.
--The third issue is the urgent need to increase funding for the NIH
by 6.7 percent a year for the next 3 years to assure the
continuation of desperately needed research at NIDDK for the
Thalassemia Clinical Research Network at NHLBI.
BLOOD SAFETY SURVEILLANCE
Mr. Chairman, when a baby is diagnosed with Cooley's anemia, or
thalassemia major, the standard of treatment is to begin that child on
blood transfusions. I want to be very clear here that the treatment is
not to give the child a blood transfusion; it is to begin a lifetime
treatment regimen of this most invasive and dangerous intervention.
Once diagnosed, our patients will receive a blood transfusion every 2
weeks for the rest of their lives.
Because Cooley's anemia patients are transfused so regularly, they
represent an ``early warning system'' for problems in the blood supply.
If there is an emerging infection or other problem with the blood
supply, it is our patients that will get it first and, because of their
fragile health, will likely suffer more greatly from this secondary
complications.
Please understand that nearly every patient over the age of 18
today who has thalassemia major also has HIV or hepatitis C as a result
of their transfusions--or did have it while they were still alive.
Blood safety is a major national issue. Surgical and trauma
patients often have no choice but to be transfused. And, it is done on
an emergency basis many times. Nothing is more important to the patient
at the time of transfusion than that they can be confident that the
blood being pumped into their veins is free from infectious agents--
HIV, HCV, or something that none of us have yet heard and doctors have
yet to identify.
The blood safety surveillance program is currently operating very
effectively through the Division of Blood Disorders in the National
Center for Birth Defects and Developmental Disability (NCBDDD) with
about $1.94 million in funding. While the funding is currently in
place, this subcommittee and its staff are painfully aware that CDC
management attempted to eliminate it following the passage of the
fiscal year 2007 Continuing Resolution.
We are respectfully urging that the subcommittee retain this
funding at the $1.94 million level that currently exists in order to
continue to protect Americans from unnecessary infections and diseases
that may occur in the blood supply. Also, we are requesting that the
subcommittee and its staff remain vigilant in protecting this program
from unjustified and unjustifiable assaults.
GENE THERAPY
Mr. Chairman, as you know, in the last year or 2 we have begun to
see evidence of some very good news about gene therapy. After decades
of overblown promises and false starts, we can now see a pathway for
scientists to follow to help make the promise of gene therapy become
the reality of cures. The problem to this point in the long saga that
is gene therapy has not been one of science; it has been one of
expectations. As a society, we all forgot that science requires trial
and error and that experiments are just that--experiments. Sometimes
they succeed, but often they fail. And, when they fail, we need to
analyze what happened and identify how to correct it . . . and then try
again.
Today, gene therapy is advancing at a rapid pace in the rest of the
world. Exciting work is being undertaken in Japan and China, in the UK
and in France. Unfortunately, it is showing less progress the United
States of America . . . and that is not right. We are the international
leaders in scientific research and, in a field like this--fraught with
financial, scientific and ethical minefields--it is essential that
America demonstrate its continued leadership to the world. We set the
highest ethical and moral standards on every one of these issues. We
protect human subjects best. The future of gene therapy as a means of
curing disease is simply too important to leave it to anyone else.
For persons with a single cell mutation disorder like thalassemia
or sickle cell disease or severe combined immune deficiency (SCID),
gene therapy holds tremendous promise for a cure. In fact, the CAF has
recently launched the CURE Campaign: Citizens United for Research
Excellence. The theme of the campaign is ``It is Time to Cure
Something.'' We are now learning so much about how to deliver healthy
genes to unhealthy cells that we cannot turn back--nor can we as a
Nation afford to let down the scientists in this country who have such
a depth of knowledge and experience. Our friends in Europe and Asia are
leaping ahead of us in this critical area of biomedical research and
gene therapy.
We hope that this Congress--speaking through this subcommittee--
will do what we have done and dare the NIH and its grantees to ``cure
something.'' You are investing nearly $29 billion of taxpayer money in
this agency that houses the ``best and the brightest'' and that funds
``the best and the brightest.'' We as Americans must never stop
striving to reach previously unimaginable heights. If that means that
we have to shake up the status quo and create a new funding mechanism,
let's do it. But let's not continue to follow the slow going
incremental, some might say ``glacial'' path of the past.
We need to spend our tax dollars in a coordinated and focused
manner that will maximize the chances that we will unlock the secrets
of how to correct single gene defects. We are gaining direct knowledge
of how to safely proceed, with an experiment currently being
conducted--in France--that may be a breakthrough. It is time for the
United States to step up and lead the world in this life-saving area of
research.
NIH AND THE THALASSEMIA CLINICAL RESEARCH NETWORK
Mr. Chairman, 6 years ago, working closely with members of this
subcommittee from both sides of the aisle, the CAF convinced the NHLBI
of the need to create a Thalassemia Clinical Research Network. The
purpose of the Network is to create an infrastructure that would enable
the top researchers in the field to collaborate on desperately needed
research projects using common protocols. Today, the Network is up and
running and is the focal point for thalassemia research, most of which
takes place in academic medical centers, literally spread from coast to
coast.
However, there remains a cloud hanging over this, and all other,
research at NIH. As the Biomedical Research and Development Price Index
continues to escalate, the buying power of an NIH that has been flat-
funded for 4 years continues to decrease. There would be nothing wrong
with this if we had cured thalassemia, and hemophilia, and cystic
fibrosis, and all other genetic and non-genetic diseases. But that is
not the case.
There is an enormous amount of work to be done, treatments to be
developed and cures to be found. And there is no one else to do it but
our National Institutes of Health, with the support of our Congress and
President.
I urge the subcommittee to make a commitment this year in this bill
to a 6.7 percent increase per year for NIH for the next 3 years. This
level of funding will simply bring us back to where were in fiscal year
2003 at the end of the 5 year doubling. It is time to commit to undo
the damage that has been done in the last 4 years.
CONCLUSION
As I indicated at the outset, Mr. Chairman, the Cooley's Anemia
Foundation has three priorities this year:
--Funding the blood safety surveillance program at CDC at $1.94
million;
--An enhanced focus on gene therapy designed to cure something; and,
--A 6.7 percent increase in NIH funding per year for 3 years.
Mr. Chairman, every night when I watch my beautiful, smart,
talented 22 year old daughter Alicia suffer from the complications of
thalassemia such as osteoporosis and as I watch her endure daily 8-10
hours of painful drug infusions to remove the excess iron in her system
from her bi-weekly blood transfusions, I know we can do better than
what we are doing now.
Please excuse my passion, but this is the United States of America.
I know we can prevent this disease from happening in newborns. I know
we can improve the lives of those who currently have it. And, most
importantly, I know that we can cure it once and for all.
You don't need four pages of testimony from me to do that. You just
need to demand the very best from the very best--our scientists, our
government, and ourselves.
Thank you for your very kind attention and for all the support this
committee has shown to our patients and their families over the years.
______
Prepared Statement of the Consortium of Social Sciences Associations
Mr. Chairman and members of the subcommittee, the Consortium of
Social Science Associations (COSSA) appreciates and welcomes the
opportunity to comment on the fiscal year 2008 appropriations for a
number of agencies in the Department of Health and Human Services and
the Department of Education. COSSA is an advocacy group promoting
attention to and funding for social and behavioral science research. It
is supported by more than 110 professional associations, scientific
societies, universities, centers and research institutes. A list of our
members is attached.
AGENCY FOR HEALTHCARE RESEARCH AND QUALITY (AHRQ)
The mission of AHRQ is to promote health care quality improvement
by conducting and supporting health services research that improves the
outcomes, quality, access to, cost, and utilization of health care
services. As the lead Federal agency charged with supporting research
designed to improve healthcare, AHRQ-sponsored research provides
evidence-based information that empowers healthcare decisionmakers--
patients, clinicians, health system leaders, and policymakers--to make
informed decisions that impact the quality of healthcare services
delivered.
Health services research also addresses issues of organization,
financing, utilization, patient and provider behavior, quality,
outcomes, effectiveness, and costs. Since fiscal year 2005, AHRQ has
lost nearly $20 million in purchasing power due flat funding from
Congress and inflation. As a member of Friends of AHRQ, COSSA supports
the Friends' recommendation for a funding increase of at least $30
million--just .0015 percent of the $2 trillion we spent on health care
annually.
This funding level would allow AHRQ to support ongoing efforts to
improve the quality, safety, outcomes, access to and cost and
utilization of health care services. In addition, AHRQ will be able to
expand its efforts to improve patient safety, modernize health care
through health information technology, develop the next generation of
researchers, and evaluate the relative value of alternative
technologies.
CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC)
The CDC is the lead Federal agency for promoting health and safety
and providing credible health information through strong partnerships,
both nationally and internationally. As the command center for our
Nation's public health defense system against emerging and reemerging
infectious diseases, the CDC faces unprecedented challenges and
responsibilities, ranging from chronic disease prevention, eliminating
health disparities, bioterrorism preparedness, to combating the obesity
epidemic. COSSA commends the CDC for acknowledging that as human
behavior and demographics create new public health challenges, the
expertise within the social and behavioral sciences will be critical in
keeping the American public healthy. These behavioral factors--tobacco
use, poor diet, physical inactivity, risky sexual behavior and illicit
drug use--are, according to the CDC, ``the underlying causes for nearly
half of all deaths in the United States.''
As a member of the CDC Coalition, a nonpartisan coalition of more
than 100 groups committed to strengthening our Nation's prevention and
health promotion programs, COSSA supports the Coalition's
recommendation of a $10.7 billion appropriation for CDC (including
funding for the Agency for Toxic Substances and Disease Registry, and
the Vaccines for Children Program). This funding enables the agency to
carry out its mission to protect and promote good health and to assure
that research findings are translated into effective State and local
programs. CDC's programs are crucial to the health of millions of
Americans, a key to maintaining a strong public health infrastructure,
and essential in protecting us from threats to our health.
The National Center for Health Statistics (NCHS), housed within
CDC, provides critical information to guide actions and policies to
improve the health of the American people. NCHS data document the
health status of the U.S. population and identify disparities in health
status and the use of health care by race/ethnicity, socioeconomic
status, region, and other population characteristics. New demands for
health information exceed the capacity of our current data systems. At
few points in recent history has the need for information been greater.
Stagnant and reduced funding throughout most of the last decade has
forced significant reduction in some of the NCHS' most important
monitoring tools. Since fiscal year 2005, NCHS has lost $13 million in
purchasing power due to a combination of flat funding and inflation. As
a result, key NCHS programs are in jeopardy. For example, NCHS lacks
resources to collect a full year's worth of vital statistics from
States. Without at least $3 million in additional funding, we will
become the first industrialized Nation unable to continuously collect
birth, death, and other vital information. Funding shortfalls are also
preventing the collection of data on many other key health care issues.
As a member of the Friends of NCHS, COSSA supports the Friends
recommendation of a fiscal year 2008 funding level of $117 million for
the agency, an increase of just $8 million over fiscal year 2007.
THE INSTITUTE OF EDUCATION SCIENCES (IES)
Improving the education of our children may be the most widely
shared priority in the United States today. Support for other issues
may come and go, but recognition of the importance of education and the
government's opportunity to improve the state of education in our
Nation seems only to grow. Indeed, through No Child Left Behind (NCLB),
the President has made education his top domestic priority. Members
from both sides of the aisle have offered legislation to reform and
improve the educational system. Yet after the legislation passes, what
will guide the policies that underlie the education our children
receive? Most people, including the current administration, would agree
that what should guide education policy is what works best. We can
accomplish finding what works best through impartial, scientific
research that evaluates the efficacy of programs in an objective,
systematic way and subjects findings to public scrutiny and scientific
peer review.
The Education Sciences Reform Act of 2002 reauthorized the
Department's educational research, statistics, and assessment
activities and placed them in the newly created IES. A cornerstone of
the administration's NCLB initiative is investment in research to
identify effective instructional and program practices, as well as data
collection needed to track student achievement and measure education
reform. The new structural and management reforms underway at IES
insure that the Federal investment in education research is well
managed and relevant to the needs of educators and policymakers.
The $162.5 million request for research, development, and
dissemination would support IES-sponsored education research,
development, and dissemination, and the funding of discretionary grants
and contracts that support directed and field-initiated research. The
request would also include funding for the What Works Clearinghouse,
which provides evidence-based information for policymakers,
researchers, and educators on promising approaches and interventions,
the National Library of Education, and the Education Research
Information Clearinghouse (ERIC). COSSA supports increasing this amount
to $180 million. This funding increase would enable IES to continue to
support a diverse portfolio of directed and field-initiated research,
including its eight national research and development centers. To
strengthen the education research enterprise, new opportunities are
needed for investigator-initiated studies that move the field forward
with innovative methods and research ideas.
The $29 million increase for the National Center for Education
Statistics (NCES), which COSSA strongly supports, would allow it to
conduct a pilot study on the development of a postsecondary student
level data system that is essential for computing postsecondary
completion rates and measuring the true costs of higher education.
Funds also would support a new secondary school longitudinal study,
scheduled to begin in 2007, which will follow a ninth grade cohort
through high school and college.
Assessment is a critical part of the President's education plan No
Child Left Behind (NCLB). The fiscal year 2008 budget request includes
funding NAEP and the National Assessment Governing Board. The $23.5
million increase, which COSSA supports, will allow the Department to
complete preparations for implementing State-level assessments at the
12th grade level in 2009.
Part of the NCLB mission is closing the achievement gap. To this
end, the President's budget would provide awards to enhance States'
capacity for accurate reporting of high school graduation and dropout
data, and to increase the capability of States to comply with Federal
reporting requirements. The Statewide Data Systems program supports
competitive awards to State educational agencies to foster the design,
development, and implementation of longitudinal data systems that would
enable States to use individual student data to enhance the provision
of education and close achievement gaps. COSSA supports the proposed
increase of $30 million for this activity in fiscal year 2008.
TITLE VI AND FULBRIGHT-HAYS
The importance of knowing about foreign cultures, economies,
histories, and politics, and the ability to speak other languages
besides English is critical to functioning in today's world. On March
27, the National Academies' released its report: International
Education and Foreign Languages: Keys to Securing America's Future. The
report concluded that the programs supported by the Department of
Education--Title VI and Fulbright-Hays--were successful and useful and
indicated that the country was getting internationally educated people
at a small cost, because the universities are able to leverage the
money from the Education Department. However, the report also proclaims
that the funding for the Title VI and Fulbright-Hays programs has not
kept up with the expanding pace of their mission as world conditions
have changed dramatically.
The historical under-funding of Title VI and Fulbright-Hays
combined with expanding needs and rising costs have contributed to the
Nation's shortfall in specialists today. As the Coalition for
International Education (CIE), of which COSSA is a member, has pointed
out funding for key Title VI/Fulbright-Hays programs is more than 30
percent below the high point in fiscal year 1967. For example, only
1,561 or 33 percent fewer Foreign Language and Area Studies fellowships
were awarded in fiscal year 2007 compared to 2,344 in fiscal year 1967.
Four years of level funding combined with across-the-board cuts since
fiscal year 2003 have begun to erode the earlier gains. There is an
urgent need to increase funding for these programs. COSSA supports the
CIE's recommendation of a $132.6 million appropriation for fiscal year
2008.
javits fellowships and thurgood marshall legal opportunity grants
COSSA supports increasing the funding for the Jacob Javits
Fellowship Program, which provides graduate students with the funds to
pursue advanced degrees in the social sciences, arts, and humanities.
For many years the budget of this program has stagnated and in recent
years across-the-board cuts have reduced a rather small budget even
further. COSSA recommends funding at $12 million in fiscal year 2008.
Providing student support for those pursuing degrees in these fields is
important to the future of this country. America does not compete in a
rapidly changing global environment by only supporting physicists and
engineers!
COSSA also supports the restoration of funding for the Thurgood
Marshall Legal Opportunity Grants to help members of underrepresented
groups prepare for a legal education. It is imperative that the legal
profession look like the American we have become and are becoming. That
means offering opportunities to those who need a leg up to obtain a
legal education. COSSA recommends funding at $3 million in fiscal year
2008.
In conclusion, COSSA acknowledges the subcommittee's history of
support for these critical programs that promote health, prevent
disease, and help educate a new generation of students. We hope that
support will continue in fiscal year 2008.
Thank you for the opportunity to present our views.
______
Prepared Statement of the COPD Foundation
AGENCY RECOMMENDATIONS
Department of Labor--Employment and Training Administration
Training Demonstration to Employ Disabled Americans.--The
Foundation recommends that the Department provide increased emphasis
and support for training disabled Americans. The Chronic Obstructive
Pulmonary Disease (COPD) Foundation initiative that trains COPD
patients to work on a hotline that provides counseling and health
referral information to COPD patients across the country is a project
that uses technology based training, helps SSI and SDI recipients find
employment, and helps meets documented job market demand. The
Foundation urges favorable consideration of this and similar
initiatives to train disabled Americans.
Center for Disease Control and Prevention--National Center for Chronic
Disease Prevention
COPD Self Management Demonstration.--Chronic Obstructive Pulmonary
Disease (COPD) is the fourth leading cause of death and is a chronic
condition similar to diabetes that requires an aggressive self-
management in order to prevent continued deterioration,
hospitalization, and costly medical interventions. In view of the
increasing mortality, morbidity, and cost to the Nation's health care
system, the Foundation urges CDC to demonstrate and validate
intervention and training protocols that are needed to improve health
outcomes and reduce health care costs for COPD patients. The Foundation
urges CDC to work with leading health care organizations to develop and
validate self management protocols.
Center for Disease Control and Prevention--National Center for Public
Health Informatics
Increasing Awareness, Early Diagnoses, and Treatment for COPD.--The
National Institutes of Health launched an information campaign in
January, 2007 designed to increase awareness, diagnoses, and treatment
for Chronic Obstructive Pulmonary Disease (COPD). COPD is a growing
epidemic, the fourth leading cause of U.S. deaths, and affects 1 in 4
Americans over the age of 45. More that 12 million people are currently
diagnosed with COPD and it is estimated that another 12 million have it
but remain undiagnosed despite recognizable symptoms and treatments
that can control symptoms and prolong life. CDC is urged to collaborate
with leading COPD health care organizations to support the effort to
increase public awareness, early diagnosis, and treatment for COPD.
National Institutes of Health--National Heart, Lung, and Blood
Institute--Division of Lung Diseases
Chronic Obstruction Pulmonary Disease.--Chronic Obstructive
Pulmonary Disease (COPD) is a growing epidemic, the fourth leading
cause of U.S. deaths, and affects one in four Americans over the age of
45. In view of these trends, it is noted that only 10 percent of the
Division of Lung Disease research portfolio is focused on COPD. The
Foundation commends the Division of Lung Diseases for sponsoring
several COPD workshops that have recommended additional research
focused on the disease process, pathogenesis, and therapy and other
recommendations. The Foundation recommends that the NHLBI aggressively
pursue COPD research as recommended by these expert panels and convene
a panel of leading researchers from across the country to create a COPD
Research Action Plan to identify opportunities and to accelerate the
pace of research.
Mr. Chairman and members of the subcommittee thank you for the
opportunity to submit testimony for the record on behalf of the COPD
Foundation.
THE COPD FOUNDATION
Established in 2004, the COPD Foundation has a clear mission: to
develop and support programs, which improve the quality of life through
research, education, early diagnosis, and enhanced therapy for persons
whose lives are impacted by Chronic Obstructive Pulmonary Disease.
Chronic obstructive pulmonary disease (COPD) is an umbrella term for a
group of lung disorders that result in obstruction to airflow in the
lung causing breathlessness. The four diseases classified under COPD
are emphysema, chronic bronchitis, refractory asthma, and severe
bronchiectasis. The COPD Foundation was established to speed
innovations which will make treatments more effective and affordable.
It also undertakes initiatives that result in expanded services for
COPD patients and improves the lives of patients with COPD through
research and education that will lead to prevention and someday a cure
for this disease.
The COPD Foundation is led by a diverse Board of Directors that
includes patients with COPD, as well as some of the most recognized
professionals involved in COPD clinical practice, research and patient
care. Under the board's direction, the COPD Foundation has established
policies based on industry best practices from the Better Business
Bureau's Wise Giving Alliance and the National Health Council in areas
of governance, accountability and transparency. The first of the COPD
Foundation's research initiatives is a partnership with the Scarborough
family for the Richard H. Scarborough Bronchiectasis Research Fund,
aimed to support translational research to halt or reverse the airways
destruction of bronchiectasis.
COPD: FOURTH LEADING CAUSE OF DEATH AND RISING
Chronic Obstructive Pulmonary Disease (COPD) was the fourth leading
cause of death in 2003 based on the Centers for Disease Control and
Prevention's final data, which attributes 126,382 deaths to COPD for
the year. Given that figure, a person dies of COPD every 4 minutes, and
because of the mechanisms of this devastating disease, he or she slowly
suffocates to death over several years as airway obstruction and
breathlessness increase. No one knows exactly how many people in the
United States have this terrible disease, but estimates range from 12
million diagnosed with another 12 million symptomatic, undiagnosed and
at risk.
The decreased ability to breathe causes severe physical and mental
disability in afflicted individuals. In a 2004 survey, over 50 percent
of patients said that their disease limited the amount or type of work
they were able to do, and of those patients nearly 80 percent were
unable to work at all due to their breathlessness. Many of these
individuals would otherwise have the ability to continue working for
many years.
COPD cost the U.S. economy $32 billion in 2002 and it is estimated
that 600 million people worldwide have the disease.
THE MEDICAL NEEDS OF THE COPD COMMUNITY HAVE GONE UNMET
While smoking is a predominant cause of COPD it is not the only
cause. Other significant factors are second hand smoke, occupational
dusts and chemicals, air pollution, and a genetic cause called alpha-1
antitrypsin deficiency.
The other leading causes of death have seen great improvements over
the past several decades. While the mortality of COPD rose by 163
percent from 1965-1998, the mortality of coronary heart disease
decreased by 59 percent and the mortality of stroke decreased by 64
percent.
Yet this fourth leading cause of death is a hidden, silent killer.
There is a lack of awareness among the public that coughing and
breathlessness is not a normal sign of aging. Those diagnosed with this
disease are quick to blame themselves and are ashamed of their disease
because of the current societal stigma. Many lack the information for
proper disease self-management, which could easily prevent
exacerbations and thusly, many hospital and emergency room visits.
Currently, the only therapy shown to improve survival is
supplemental oxygen. There are other therapies that can improve
symptoms but they do not alter the natural history of the disease.
DETECTION
COPD is fairly easy to detect: in addition to symptoms of
breathlessness, cough and sputum production, spirometry is a
quantitative test that measures air volume and air flow in the lung and
is relatively easy and inexpensive to administer.
COPD RESEARCH
The COPD Foundation believes that significant Federal investment in
medical research is critical to improving the health of the American
people and specifically those affected with COPD. The support of this
subcommittee has made a substantial difference in improving the
public's health and well-being. While this is by no means an exhaustive
list, the Foundation wishes to recognize and appreciate the efforts of
the National Institutes of Health in creating the COPD Clinical
Research Network, for conducting a COPD state of the science
conference, and commends NHLBI for the national launch of the COPD
Awareness and Education Campaign titled ``COPD Learn More Breathe
Better''.
Chronic diseases have a profound human and economic toll on our
Nation. Nearly 125 million Americans today are living with some form of
chronic condition. The Foundation recognizes that the Centers for
Disease Control and Prevention understands that COPD is one of the only
top 10 causes of death that is on the increase, however, COPD has not
been designated the resources to be a major focus of the CDC. The
Foundation urges the subcommittee to encourage the CDC to expand its
data collection efforts and to expand programs aimed at education and
prevention of the general public and health care providers.
NIH and CDC: The Foundation requests that the National Institutes
of Health in fiscal year 2008 receive an increase of 6.7 percent over
fiscal year 2007 Joint Resolution Funding Levels. The COPD Foundation
joins the Ad Hoc Group for Medical Research Funding, a coalition of
some 300 patient and voluntary health groups, medical and scientific
societies, academic research organizations and industry in making this
recommendation. The fiscal year 2008 administration budget request for
NIH is a $511 million cut (1.7 percent) below the final fiscal year
2007 levels. If implemented, this funding level would mean NIH's
ability to conduct and support life-saving research will be cut by more
than 13 percent in inflation-adjusted dollars since fiscal year 2003.
The NIH, National Heart Lung, and Blood Institute, National Institute
of Allergy and Infectious Diseases and National Institute on Aging,
should increase the investment in Chronic Obstructive Pulmonary Disease
and the Centers for Disease Control and Prevention should initiate a
Federal partnership with the COPD community to achieve the following
goals:
--Promotion of basic science and clinical research related to COPD;
--Programs to attract and train the best young clinicians for the
care of individuals with COPD;
--Support for outstanding established scientists to work on problems
within the field of COPD research;
--Development of effective new therapies to prevent progression of
the disease and control symptoms of COPD;
--Expansion of public awareness and targeted detection to promote
early diagnosis and treatment.
______
Prepared Statement of the Corps Network
The Corps Network (formerly the National Association of Service and
Conservation Corps or NASCC) appreciates the opportunity to submit
testimony to the subcommittee about the critical need for funding
AmeriCorps and other national service programs in fiscal year 2008.
We urge you to make much needed, and long overdue, investments in
AmeriCorps and other national service programs supported by the
Corporation for National and Community Service (CNCS).
Specifically, we recommend that the subcommittee fund:
--AmeriCorps State and National Grants at $312 million;
--The National Service Trust at $143 million;
--The National Civilian Community Corps (NCCC) at $26.7 million; and
--AmeriCorps VISTA at $95 million.
We believe that these funding levels would adequately support
75,000 AmeriCorps members ands retain the historic balance between
full- and part-time service.
Established in 1985, The Corps Network is the voice of the Nation's
113 Service and Conservation Corps. Currently operating in 41 States
and the District of Columbia, Corps annually enroll more than 23,000
young men and women who contribute 13 million hours of service every
year. Corps annually mobilize approximately 125,000 community
volunteers who contributed more than 2.4 million additional hours of
service.
Service and Conservation Corps are a direct descendent of the
Civilian Conservation Corps (CCC) that built parks and other public
facilities still in use today. Like the legendary CCC of the 1930s,
today's Corps are a proven strategy for giving young men and women the
chance to change their communities, their own lives and those of their
families. Service and Conservation Corps provide a wealth of valuable
conservation, infrastructure improvement and human service projects.
Some Corps tutor and some fight forest fires. Others complete a wide
range of projects on public lands. Still others improve the quality of
life in low-income communities by renovating deteriorated housing,
engaging in environmental restoration, creating parks and gardens and
staffing after-school programs.
Service and Conservation Corps serve young people who are most in
need. Since 1985, approximately 600,000 young people have completed
service in our Nation's Service and Conservation Corps. Approximately
57 percent of our Corpsmembers are young people of color, 64 percent
come from families with income below the poverty line, at least 30
percent have had previous court involvement and at least 10 percent
have been in foster care. More than half of all Corpsmembers enroll
without a high school diploma.
Today's Corps are a proven strategy for giving young men and women,
many of whom are economically or otherwise disadvantaged and out-of-
work or out-of-school, the chance to change their own lives and those
of their families, as well as improve their communities. Corps
represent the country's largest full-time, non-federal system for youth
development.
I would like to share with you three examples of why AmeriCorps
funds are so important to our Nation. The Corps Network administers
three AmeriCorps programs, the Gulf Coast Recovery Corps, the Civic
Justice Corps and RuralResponse that address important societal
problems through service.
The AmeriCorps Gulf Coast Recovery Corps:
--Assists residents impacted by the devastation of Hurricane Katrina
and Rita in the long-term recovery efforts along the Gulf Coast
of Mississippi.
--Deploys crews of young people (ages 18-25) from the Nation's 113
Service and Conservation Corps for 4-week projects that include
rebuilding homes and structures, chopping down damaged trees
near homes, removing debris, restoring trails, replanting marsh
grass and trees, performing environmental restoration and other
projects.
--Brings a total of 300 trained and semi-skilled volunteers to the
region through the summer of 2007.
--Partners with the Hancock County Long-Term Recovery Committee,
Mississippi Commission for Volunteer Service, St. Rose Delima
Catholic Church in Bay St. Louis, Mississippi State Parks, U.S.
Fish and Wildlife Service and other local and national
organizations working in the region.
--Builds on the tradition of Corps helping communities recover from
natural disasters, including the San Francisco earthquake in
1989, Hurricane Andrew in 1992, the Mississippi River floods in
1993 and the aftermath of other major hurricanes, floods,
tornadoes, and wildfires.
--Will pave the way for a permanent Mississippi Corps, funded in part
by the Mississippi Commission for Volunteer Service, to engage
local young people in the recovery efforts.
--Is funded by the Corporation for National and Community Service's
Federal AmeriCorps program.
The Civic Justice Corps (funded by AmeriCorps and the Department of
Labor):
--Re-engages court-involved youth and young adults, not less than 50
percent who have been incarcerated, in their communities, the
workforce, education and society as a whole, with the goal of
reducing recidivism by at least 20 percent.
--Empowers Corpsmembers through a variety of service projects that
meet critical community needs.
--Creates a support system that begins in the corrections facility,
continues through the time in the Corps and extends 12 months
after the Corps experience.
--Formalizes effective working relationships with justice agencies,
employers and other partners.
--Enables Corpsmembers to earn a high school diploma or GED while
preparing for careers in high-growth industries or
opportunities in post-secondary education.
--Draws on the experience of Corps which enroll nearly 5,000 court-
involved youth each year.
--Represents a partnership between the Cascade Center for Community
Governance, the Open Society Institute, the JEHT Foundation and
The Corps Network.
--Is funded by AmeriCorps in the following sites: Bend, OR;
Charleston, SC; Washington, DC.
--Is funded by the U.S. Department of Labor in the following sites:
Austin, TX; Camden, NJ; Denver, CO; Fremont, OH; Fresno, CA;
Madison, WI; Miami, FL; Oakland, CA; Sacramento, CA; San Diego,
CA and Wheaton, MD.
The RuralResponse AmeriCorps Program:
--Enables Service and Conservation Corps to bolster homeland security
and disaster response capacity in underserved rural communities
by filling gaps in rural emergency response networks.
--Engages young people (ages 16-25) each year in disaster response as
well as traditional service and conservation projects to meet
the needs of rural communities.
--Trains Corpsmembers in specific disaster preparedness and response
activities such as first aid, adult and child CPR, mass care,
use of global positioning systems (GPS), shelter operations,
hazardous materials removal, chain saw safety and use and
wildfire suppression.
--Prepares Service and Conservation Corps for long-term engagement
with existing disaster response and preparedness efforts in
rural communities.
--Provides a minimum wage based living allowance and an AmeriCorps
Education Award (scholarship) of up to $4,725 per Corpsmember.
--Requires a 33 percent non-federal match by Service and Conservation
Corps.
--Is funded by AmeriCorps at $3.6 million over 3 years in the
following sites: Minnesota Conservation Corps, Quilter Civilian
Conservation Corps (Fremont, OH), Vermont Youth Conservation
Corps and Youth Conservation Corps, Inc. (Waukegan, IL).
Our work in the Gulf Coast Recovery Corps, the Civic Justice Corps
and Rural Response embodies many of AmeriCorps' core principles
including:
--Using service in creative ways to meet needs that would otherwise
go unmet;
--Relying on public-private partnerships and using public dollars to
attract private funds;
--A bottom-up structure in which the local community determines the
projects on which we work;
--Communities demonstrate their support for projects by helping Corps
meet AmeriCorps' matching requirements;
--Partnering with local government, State, and Federal land
management agencies and local nonprofit organizations,
including faith-based groups;
--Providing an opportunity for all Americans to serve and
reconnecting disconnected youth to their communities by
insuring that Corpsmembers learn life skills and job skills
that enhance their employability; and
--Using the AmeriCorps Education Award to make higher education
accessible to thousands of young people for whom it would
otherwise be too costly.
While it is difficult to describe the ``typical'' Corps, successful
Corps share common core elements. They:
--Rely on a model in which adult leaders serve as mentors, role
models, technical trainers and supervisors for crews of 8-12
Corpsmembers;
--Provide Corpsmembers with a minimum-wage based living allowance;
--Offer classroom training to improve basic competencies, a chance to
earn a GED or high school diploma, experiential and
environmental service-learning-based education, generic and
technical skills training, a wide range of support services,
and, in many cases, an AmeriCorps post-service educational
award of up to $4,725.
--Build on Corpsmembers' strengths to provide an environment in which
every Corpsmember can experience success. They offer consistent
contact with a caring adult, stress leadership development,
creative problem-solving, and the ability to work as a member
of a team; and
--Provide Corpsmembers a ``second chance'' to succeed in life and
focus youth on the future.
A 1997 Abt Associates/Brandeis University random assignment study
concluded that Youth Service and Conservation Corps are an invaluable
resource for young people. According to the study, Corps generate a
positive return on investment and the youth involved were positively
affected by joining a Corps. The report documents that:
--Significant employment and earnings accrue to young people who join
a Corps;
--Positive outcomes are particularly striking for African-American
men;
--Arrest rates drop by one third among all Corpsmembers; and
--Out-of-wedlock pregnancy rates drop among female Corpsmembers.
Abt Associates documents several factors to which the effectiveness
of Corps is attributed including:
--Comprehensiveness of services;
--Supportive and dedicated program staff;
--Quality of the service projects;
--Intensity of the service experience; and
--Corpsmembers have access to an expanded social network.
It is critical for CNCS to have sufficient resources to ensure that
participants in national service programs are able to continue their
crucial work. Restoring our investment in AmeriCorps State and
National, the National Service Trust, AmeriCorps*NCCC and
AmeriCorps*VISTA, will allow more Americans of all ages and backgrounds
to serve and create greater capacity to meet critical community needs.
Thank you for your consideration of these requests. If you have any
questions, please do not hesitate to contact me at (202) 737-6272 or at
sprouty@corpsnetwork.org.
______
Prepared Statement of the Council of State and Territorial
Epidemiologists
PUBLIC HEALTH WORKFORCE: INCREASING STATE AND LOCAL EPIDEMIOLOGY AND
LABORATORY CAPACITY
Recommendations
--$5 million for the Office of Workforce and Career Development to
support 65 CDC/Council of State and Territorial Epidemiology
(CSTE) first year applied epidemiology fellows.
--$2 million increase for the National Center for Infectious Diseases
to support 35 CDC/Association of Public Health Laboratories
(APHL) applied research training fellows.
Building a strong public health infrastructure, particularly a
trained public health workforce with sufficient epidemiologists and
public health laboratory scientists--core public health professionals,
will take a sustained commitment of resources over a long period of
time.
The disciplines of epidemiology and laboratory science are the
pillars of public health practice. States and local communities have
come to rely on public health epidemiologists and laboratory scientists
to investigate, monitor, and respond aggressively to public health
threats. Every State's residents have become familiar with the
``disease detectives'' who communicate risks and provide preventive
recommendations during incidents such as the recent outbreak of E. coli
in spinach, seasonal influenza, West Nile virus, and epidemics of
obesity, diabetes, HIV/AIDS and a host of other serious threats the
public has experienced during recent years. The 2006 CSTE National
Assessment of Epidemiologic Capacity shows the number and the level of
training of epidemiologists is perceived as seriously deficient in most
States. Federal funding has increased the number of epidemiologists
engaged in bioterrorism preparedness since 2002, but has done so at the
expense of State environmental health, injury and occupational health
activities--shifting epidemiologists from these activities to Federal
bioterrorism preparedness priorities. Those engaged in chronic disease
activities have increased since 2002, but are still viewed as too low
in number and training. According to the 2003 Institute Of Medicine
report, Microbial Threats to Health: Emergence, Detection, and
Response, rebuilding domestic public health capacity was among its
highest recommendations for addressing both diseases occurring
naturally and intentional release of microbial agents.
Efforts under the leadership of CDC have been made to begin
addressing these gaps. CDC is supporting training fellowship programs
for epidemiologists and laboratory scientists who are expected to
increase State capacity and provide future leadership in these
professions. CSTE applauds these efforts and proposes aggressive
expansion of existing state-focused programs to increase the number of
epidemiologists and public health laboratory scientists at State and
local health departments. The proposed fiscal year 2008 increase will
provide CSTE and APHL with the resources to accelerate much needed
expansion of the State and local workforce in these critical
disciplines.
States and localities will benefit through increased numbers of
highly trained epidemiologists and laboratory scientists entering
employment through training programs that include the following
characteristics:
--national recruiting through a partnership between CSTE and the
Association of Schools of Public Health;
--orientation and training course with CDC, CSTE, and APHL faculty;
--applicant pool for State and local positions with adequate time to
evaluate job performance;
--a structured, individualized training curriculum for each fellow;
and
--technical and administrative support for fellows and State mentors.
The capacity and leadership legacy of these state-based programs is
intended to be modeled on the success of the Epidemic Intelligence
Service and provide States and localities with epidemiology and
laboratory leadership for the future.
strengthening capacity in four critical public health program areas
Preparing for an Influenza Pandemic
Fiscal year 2006 State and Local pandemic influenza preparedness
funding is being used to: (1) create and implement, including
exercising, emergency pandemic plans; (2) conduct integrated disease
surveillance; (3) fund laboratory testing of influenza strains; (4)
inform the public; (5) manage distribution of vaccine and antiviral
medications; (6) plan for alternative facilities in the event of
hospital capacity excess; (7) track vaccine and antiviral use; (8)
document adverse outcomes from influenza-related medications. Continued
funding at the level of $250 million in fiscal year 2008 will support
these activities and help ensure that our health system is ready for
the seasonal influenza epidemics and a potentially catastrophic
influenza pandemic.
Epidemiologic-Laboratory Capacity (ELC Cooperative Grant Program)
CSTE strongly supports a $53 million increase for the
Epidemiologic-Laboratory Capacity program at the CDC for fiscal year
2008. This increase will be instrumental in implementing the CDC plan
Preventing Emerging Infectious Diseases: A Strategy for the 21st
Century. This program, which supports health departments in 50 States
and 6 highly populated cities/counties, was developed to repair the
deteriorated surveillance and response capacity for emerging infectious
diseases in health departments nationwide. Funds build capability to
detect, diagnose, and prevent diseases caused by food, water and vector
borne infections, vaccine preventable disease, and drug resistant
infections. The early detection and prompt response to West Nile virus
(WNV) in 2000 can be attributed to the foundations laid by this
cooperative grant program. Funding reductions, beginning in 1998, have
compromised the mission of this program and may contribute to a
weakened ability to detect and respond to future disease threats. CSTE
is very disappointed that the President's fiscal year 2008 budget cuts
WNV funding by 45 percent. In an effort to maintain and build public
health capacity, CSTE supports full funding ($110 million) for the ELC
cooperative grant program in fiscal year 2008.
Terrorism Preparedness
State and Local CDC Terrorism Preparedness Grants are used to
fortify health department ability to detect and investigate disease
occurrence, evaluate infectious outbreaks, and rapidly access, exchange
and disseminate relevant information. Funding also provides surge
capacity for personnel and supplies that will be needed in the event of
a terrorist attack. In fiscal year 2006, funding was cut by $100
million and remained at that level for fiscal year 2007. The
President's fiscal year 2008 budget cuts funding further by $125
million. While health departments nationwide have made good progress in
emergency preparedness, these funding cuts have led to a decreased
epidemiology and laboratory capacity due to downsized personnel that
were paid with these funds. Further staff reduction, and concomitant
reduction in surveillance performed, will leave our Nation's public
health system unable to provide bioterrorism threat surveillance and
response. CSTE recommends full funding at the fiscal year 2005 level--
$919.1 million.
Preventive Health--Health Services (PHHS) Block Grant
CSTE is disappointed that the President's fiscal year 2008 budget,
once again, eliminates all funding for the PHHS Block Grant and urges
restoration of funding to the fiscal year 2005 level of $131 million.
This grant program was developed to allow States flexible use of funds
to support objectives identified at the local level. For example, a
city with increasing incidence of whooping cough (Bordatella pertussis)
would be able to use funds to intensively track cases and prevent
spread of the disease. Other cities or States may use funds to address
their region-specific disease trends, such as injection drug related
morbidity, sexually transmitted disease, mother-to-child diseases, or
hantavirus. Because of the variation in disease prevalence across our
diverse Nation, flexible funding with local allocation capacity is
necessary to achieve detection, prevention, and community outreach
tasks for Americans. CSTE recommends restoration of the PHHS block
grant to $131 million to limit the extent of local disease epidemics
spreading to becoming national disease threats.
SURVEILLANCE ISSUES: FIVE CSTE PRIORITIES
Epidemiologists working in public health agencies are responsible
for monitoring trends in health and health problems, and devising
prevention programs that support healthy communities. Surveillance is
the foundation for developing a public health response to any disease
threat--be it infectious, chronic, environmental, occupational, or
injury. Surveillance is useful in (1) determining which segments of the
population are at highest risk; (2) identifying changes in disease
incidence rates; (3) determining modes of transmission; and (4)
planning and evaluating disease prevention and control programs. For
fiscal year 2008, CSTE urges Congress to provide the following
increased resources for expanding surveillance of key diseases, injury
and environmental health areas:
Behavioral Risk Factor Surveillance Survey (BRFSS).--Administered
by CDC's Center for Chronic Disease Prevention, Health Promotion, and
Genomics, the BRFSS is a primary source of information used to guide
intervention, policy decisions, and budget direction at the local,
State, and Federal level for multiple health conditions and chronic
diseases. An increase in funding by $10 million, to $18 million, is
needed to fully implement the survey. BRFSS is the primary source of
information for leading health indicators for 6 areas in Health People
2010. As our Nation moves towards evidence based medicine and funding,
our data source needs to be comprehensive enough to accurately reflect
the health of our population. Further congressional support will
improve data collection infrastructure, timely reporting, and
sophisticated analysis to provide data in meaningful ways to end users
nationwide.
HIV/AIDS Surveillance.--Cooperative Agreement funding to State and
Local health departments for HIV/AIDS surveillance is critical to
prevent new HIV infections, thereby saving an estimated $195,000 in
lifetime treatment costs per individual. HIV/AIDS incidence is
increasing without commensurate increases in Federal spending for
surveillance. CSTE urges an increase of $35 million, to $101.3 million,
for the surveillance cooperative agreements in CDC's HIV/AIDS
Prevention budget (total recommendation $1,049.2 million) to address
increasing HIV/AIDS incidence.
National Violent Death Reporting System (NVDRS).--Fifty thousand
deaths per year in the United States are attributable to violence. The
National Center for Injury Prevention and Control (NCIPC) has developed
the NVDRS to collect data related to these deaths for use in
development of targeted prevention and early intervention programs.
Seventeen States currently are equipped with NVDRS, however increased
funding will help distribute the program and personnel to all States
and strengthen our Nation's ability to collect the data that will
ultimately result in reduction in violent deaths. CSTE urges an
increase in funding from $3.4 million to $10 million for NVDRS,
administered by CDC's NCICP (total $168 fiscal year 2008 request).
Occupational Safety and Health State-Based Surveillance (NIOSH
Program Announcement PAR 04-106).--In fiscal year 2005 NIOSH funded 12
States to establish Occupational Safety and Health programs that use 13
occupational health indicators to measure the burden of workplace
injury and illness and make recommendations for prevention. This
successful program should be expanded to all 50 States to establish a
nationwide system to prevent major injuries and illnesses caused by
hazardous work conditions. An increase in funding to $12.5 million,
within the $300 million NIOSH budget request, will allow the expansion
of this occupational surveillance to all States.
Environmental Health Tracking Grants.--There is no national
surveillance system to investigate possible links between environmental
exposures and a number of diseases and health conditions, as noted in
the PEW Environmental Health Commission's report, America's
Environmental Health Gap: Why the Country Needs a Nationwide Health
Tracking Network. Most States have little capacity for tracking
environmental health. Since fiscal year 2002, Congress has recognized
the need for increased environmental health capacity with funding,
however a significant increase is needed to ensure that all States have
the ability to track disease occurrence and adverse health conditions
and their possible linkages to environmental toxins and hazards (such
as the link between asbestos and mesothelioma). Funding at the $100
million level will strengthen our nations resolve to identify harmful
environmental exposures and eliminate the disease burden caused by
them.
______
Prepared Statement of the Cystic Fibrosis Foundation
On behalf of the Cystic Fibrosis Foundation, and the 30,000 people
with cystic fibrosis (CF), I am pleased to submit the following
testimony regarding fiscal year 2008 appropriations for cystic
fibrosis-related research at the National Institutes of Health (NIH)
and other agencies.
ABOUT CYSTIC FIBROSIS
Cystic fibrosis is a life-threatening genetic disease for which
there is currently no cure. People with CF have two copies of a
defective gene that causes the body to produce abnormally thick, sticky
mucus, which clogs the lungs and result in fatal lung infections. The
thick mucus in those with CF also obstructs the pancreas, causing
patients difficulty in absorbing nutrients in food.
The common symptoms of CF include chronic cough, wheezing or
shortness of breath, excessive appetite but poor weight gain, and
greasy, bulky stools. CF symptoms vary from patient to patient, due to
the fact that there are more than 1,000 mutations of the CF gene.
Since its founding, the Cystic Fibrosis Foundation has maintained
its focus on promoting research and improving treatments for CF. CF has
been significantly transformed from a childhood death sentence into a
chronic disease, which requires a rigorous daily regimen of therapy.
Treatments for individuals with CF include enzymes that aid digestion,
antibiotics to treat lung infections, and daily therapy to loosen the
mucus in the lungs. Strict adherence to CF treatments improves the
health status and quality of life for those with CF, but the regimen
can be a daily challenge for patients and their families.
Through the research leadership of the Cystic Fibrosis Foundation,
the life expectancy of individuals with CF has been boosted from less
than 6 years in 1955 to nearly 37 years in 2005. Today, 43 percent of
people with CF are 18 or older. This improvement in the life expectancy
for those with CF can be attributed to research advances, which I will
discuss in some detail later, and to the teams of CF caregivers who
offer specialized care of the highest quality. This improvement in life
expectancy is important, but we continue to loose young lives to this
disease. Our progress is not nearly sufficient for those living with CF
and their families, friends, and caregivers.
The promise for those with CF is in research. In the past 5 years,
the Cystic Fibrosis Foundation has invested over $595 million in its
medical programs of drug discovery, drug development, research, care
and drug delivery aimed at life-sustaining treatments and a cure for
cystic fibrosis. But a greater investment is necessary to accelerate
the pace of discovery of CF therapies. This statement focuses on the
investment that will be required to develop new CF treatments rapidly
and efficiently and to encourage research on a cure.
SUSTAINING THE FEDERAL INVESTMENT IN BIOMEDICAL RESEARCH
This subcommittee and Congress are to be commended for their
steadfast support for biomedical research, and their commitment to the
National Institutes of Health (NIH), including the effort to double the
NIH budget between fiscal year 1999 and fiscal year 2003. This
impressive increase in funding resulted in a revolution in medical
research, fueling discoveries that benefit all Americans.
However, we risk losing the research momentum the doubling
generated if we fail to adequately fund the NIH so that they can
capitalize on scientific advances. The Cystic Fibrosis Foundation joins
the Ad Hoc Group for Medical Research to recommend increasing the NIH
budget by at least 6.7 percent in fiscal year 2008. This investment
will help maintain the NIH's ability to fund essential biomedical
research today that will provide tomorrow's care and cures.
STRENGTHEING OUR RESEARCH INFRASTRUCTURE
It is now vital to assess our ability to translate the basic
research advances of the last decade into treatment advances. The
Cystic Fibrosis Foundation has been recognized for its own research
approach to encompass many types of research, from basic research
through Phase III clinical trials, and has created the infrastructure
required to accelerate the development of new CF therapies. As a
result, we now have a pipeline of more than 25 potential therapies that
are being examined to treat people with CF. Several drugs in this
pipeline treat the basic defect of CF, while others attack the symptoms
of the disease.
The NIH Roadmap for Medical Research provides the opportunity for
the NIH to translate research into treatments for people with disease.
We applaud Congress for its leadership and support for the NIH's
Roadmap, which mirrors the Cystic Fibrosis Foundation's own approach to
support and rewards innovation throughout the research process.
Cystic fibrosis is a disease which impacts multiple systems in the
body, and as a result, several different institutes at NIH share
responsibility for CF research. Having multiple responsible institutes
presents roadblocks to CF research in that there can be imperfect
communication among the institutes regarding research in the field.
This can limit our ability to capitalize on all research opportunities.
Moreover, multidisciplinary research approaches, of the sort we believe
are most promising in CF, may be disadvantaged in the NIH system of
review and funding.
The Cystic Fibrosis Foundation applauds NIH leaders for encouraging
multidisciplinary research and Congress for directing resources to the
Common Fund to finance multidisciplinary research projects. Funding
pioneering multidisciplinary research is critical, but the Common Fund
is also important in intangible ways, such as encouraging communication
among researchers, placing a high value on trans-institute research,
and breaking down barriers to communication and collaboration between
institutes. We urge sufficient funding for such a multidisciplinary
approach, which is most responsive to the research needs of complex
diseases like CF.
FACILITATING CLINICAL RESEARCH
The Cystic Fibrosis Foundation applauds the efforts of NIH to
encourage greater efficiency in clinical research. The Foundation has
been a pioneer in creating a clinical trials network to achieve greater
efficiency in clinical investigation. Our pioneering effort in clinical
trials emerged from the necessity of a small patient population for the
number of trials we are undertaking and because our patients literally
cannot tolerate research delays. Yet we believe that our model should
be adopted and adapted by others. We have a permanent network of
clinical trial sites and have centralized and coordinated data
management and analysis functions and data safety monitoring. Among the
results of this outstanding network--called the Therapeutics
Development Network--are the ability to achieve rapid accrual to trials
and the ability to conduct multiple trials simultaneously, even in a
population of 30,000 CF patients. Since the TDN's inception, it has
conducted over 40 trials. Of course, the ultimate goal of a centralized
clinical trials system is the acceleration of the therapeutic
development process.
Although we have achieved significant efficiencies in our clinical
trials system, we still encounter substantial slowdowns in the review
of our multi-institutional trials by the institutional review boards
(IRBs) of each of the institutions participating in the trials. We
encourage Congress to urge the Department of Health and Human Services
to demonstrate more aggressive leadership in persuading academic
institutions to accept review by a central IRB--without insisting on
parallel and often duplicative review by their own IRB--at least in the
case of multi-institutional trials in rare diseases.
Pursuing New Therapies: The Cystic Fibrosis Therapeutics Development
Network
The Cystic Fibrosis Foundation requests the committee allocate $3
million in Federal funding in fiscal year 2008 to support much-needed
expansion of our clinical research program, the Therapeutics
Development Network (TDN), through the Coordinating Center at
Children's Hospital & Regional Medical Center in Seattle, Washington.
This will provide a significant investment in the Cystic Fibrosis
Foundation's ongoing efforts to meet the demand for testing of all the
promising new therapies for cystic fibrosis.
Designating Federal funding for the Cystic Fibrosis Therapeutics
Development Network will accelerate testing of new therapies for CF.
The TDN plays a pivotal role in accelerating the development of new
treatments to improve the length and quality of life for cystic
fibrosis patients. Since the Cystic Fibrosis Foundation established
this program in 1998, the TDN has evaluated 12 new products, with seven
more products now in clinical trials. Opportunities exist to pursue 10
additional trials on drug candidates in the next 18 months.
The CF Foundation has adopted an innovative business approach to
drug discovery and development that is emulated by other nonprofits.
Lessons learned from centralization of data management and analysis and
data safety monitoring in the TDN will be useful in designing clinical
trial networks in other diseases. Federal funding to support the TDN
will provide special insights regarding the most efficient means of
conducting clinical trials on orphan diseases.
National Center for Research Resources
The Institutional Clinical and Translational Science Awards program
is an initiative of particular importance to cystic fibrosis. This NIH
Roadmap program administered by the National Center for Research
Resources (NCRR) encourages novel approaches to clinical and
translational research, enhances the utilization of informatics and
strengthens the training of young investigators. The Cystic Fibrosis
Foundation has enjoyed a productive relationship with the NCRR to
support our vision for improving clinical trials capacity through its
early financial support of the TDN.
SUPPORTING ADDITIONAL RESEARCH AREAS
While much of this testimony has focused on clinical research,
these new therapies rely on solid basic research. Although the
discovery of the CF gene in 1989 was an important step forward, there
is still much to be learned about the disease. As a result, the CF
Foundation continues to invest in basic research on the disease to
deepen our knowledge of CF and to better understand how we may
intervene in the disease course. There are several research projects at
NIH that are essential to this work, and for which we express our
strong support.
Protein Misfolding and Mistrafficking
The Cystic Fibrosis Foundation urges the NIH to devote special
focus to research in protein misfolding and mistrafficking, an area
which may yield significant benefits for CF and other diseases where
misfolding is an issue. We applaud both the National Heart, Lung and
Blood Institute (NHLBI), and the National Institute of Diabetes and
Digestive and Kidney Diseases (NIDDK) for their initiatives that target
research on protein misfolding, and urge an aggressive commitment to
facilitate continue exploration in this area to build upon promising
discoveries. Additionally, we urge funding by the National Institute of
General Medical Sciences (NIGMS) for the creation of tools and reagents
and advances in techniques for precision monitoring of folding and
trafficking events and for the sharing of resulting data that would
complement the efforts of NIDDK- and NHLBI-funded investigations in
this area.
On behalf of the Cystic Fibrosis Foundation, I thank the committee
for its consideration. Congress has reason to be proud of its role in
supporting NIH, which is the world's leader in biomedical research. The
NIH has strong leadership to move into the new century, when we will
see the translation of basic research into new treatments for many
diseases. We believe the experience of the CF Foundation in clinical
research can serve as a model for research on other orphan diseases,
and we stand ready to work with NIH and congressional leaders.
______
Prepared Statement of the Endocrine Society
The Endocrine Society would like to submit the following testimony
regarding fiscal year 2008 Federal appropriations for biomedical
research, with emphasis on appropriations for the National Institutes
of Health. The Endocrine Society is the world's largest and most active
professional organization of endocrinologists representing over 14,000
members worldwide. Our organization is dedicated to promoting
excellence in research, education, and clinical practice in the field
of endocrinology. The Society is comprises thousands of researchers who
depend on Federal support for their careers and their scientific
advances.
In April 2004 the Endocrine Society testified before the House
Appropriations Committee. During this testimony the Society provided
the committee with a grim picture of what might happen to NIH-funded
research if the financial commitment made during the doubling period
(1998-2003) was not sustained. Our testimony indicated that
breakthroughs in areas of endocrine research--such as diabetes and
obesity--were on the horizon after the doubling period, but that the
breakthroughs were in jeopardy of being abandoned due to sharp
decreases in NIH funding from Congress. Unfortunately, it seems our
prognostication was correct.
Included as an addendum (Addendum A) to this testimony is an
excerpt from a compelling article that appeared in the April issue of
Men's Health magazine. Highlighted within this article is the story of
Endocrine Society member, Alan Schneyer, Ph.D. This article examines
the real life impact that reduced funding for NIH has on the Nation's
researchers and their potential breakthroughs. Dr. Schneyer has been
working in the field of endocrine research and has made promising
discoveries that could lead to future diabetes treatments. But as of
April 2007 his lab, his research, and his employees have been shut down
because his grant will no longer be funded. The great promise hoped for
in 1997, at the beginning of the doubling period, has led to closed
labs and unemployed scientists in 2007.
A simple glance at NIH funding trends over the last few years will
show how this great promise led to great disappointment. Under the
President's proposed fiscal year 2008 budget most NIH institutes and
centers would see their budgets remain flat for the fourth year in a
row. The proposed fiscal year 2008 NIH budget of $28.7 billion would be
down $230 million from the recently finalized fiscal year 2007 budget.
Worse yet, the NIH budget would fall 12 percent from 2004 to 2008 when
adjusted for biomedical research inflation.
This funding downturn not only has a drastic impact on existing
researchers such as Dr. Schneyer, but it is having a profound effect on
future researchers as well. NIH projects the success rate for new
renewal grant applications will stabilize at 20 percent in 2007 and
2008, down steeply from a high of 32 percent in fiscal year 2001.
According to the American Association for the Advancement of Science,
NIH expects to fund 1 in 5 applicants who apply for research funding in
2008. During the height of the doubling period NIH funded 1 in 3
applicants. As you can imagine, these trends send a chilling message to
young researchers who were drawn to biomedical research during the
doubling period. After years of steady support for biomedical research
over the last decade, many young people were drawn into research labs,
but now Federal funds are declining. As the funding declines, so too
does the opportunity for young researchers. NIH is trying to address
this issue with its Pathways to Independence program. This program
would provide up to 5 years of support for scientists just beginning
their research careers. We would encourage the committee to fully-fund
the Pathways to Independence program in fiscal year 2008.
The Endocrine Society recommends that the National Institutes of
Health receive $30.8 billion in fiscal year 2008. This increase of 6.7
percent will set NIH, and the researchers who depend on it for funding,
on a 3-year track to recoup the losses caused by biomedical research
inflation over the last 4 years.
While researchers will never guarantee cures from ongoing research,
we do know that without adequate sustained Federal support the chances
for breakthroughs are diminished. In fact very significant advances
have been made; for example for the first time in our history death
rates from cancer have started to decrease, which can be attributed to
NIH funded research in previous decades. We ask that Congress stop the
boom and bust funding cycles that have plagued NIH over the last 10
years and commit to a steady funding stream to keep the research of
today on track to become the breakthroughs of tomorrow.
Addendum A--Men's Health--Tons of Useful Stuff
THE BATTLE FOR YOUR HEALTH
As American soldiers fight terrorists overseas, another war is
being lost at home: The one to cure disease and, ultimately, save your
life.
Boston, MA.--The last thing Alan Schneyer, Ph.D., expected to find
when he began manipulating the reproductive genes in mice was a
possible cure for diabetes.
``We made these mice and thought they would be infertile, but they
weren't,'' Schneyer tells me as we pace his sparse laboratory at
Massachusetts General Hospital. ``So we started looking at their other
organs. Turns out, they have improved glucose tolerance and very little
visceral fat. Boom! I thought, This is great. We can address a real
disease.''
Schneyer eyes the empty beakers, vials, and tubes, the dust
beginning to gather on microscopes, tissue-holding minifridges,
computer terminals. The mood is so grim I expect Edgar Allan Poe's
valet to walk through the door. ``Then we lost our grant. Normally
you'd see six people working here. Now my fellows are gone. My
technician is leaving at the end of the month. My associate works for
someone else now.'' He looks at me and musters a half-hearted smile.
``I'm out in April,'' he says.
Schneyer's is a familiar tale. Since a doubling of the National
Institutes of Health (NIH) budget between 1997 and 2003--an increase,
incidentally, that contributed to the discovery and mapping of the
human genome--the agency's budget has flatlined at about $28 billion
for the past 3 years, outpaced by 9 percent inflation. When funds were
cut by $33 million in 2006, it marked the first time in more than 35
years that NIH appropriations actually decreased.
Schneyer, 52, is quick to note that his discovery might well have
``come to a dead end.'' Still, with 73 million Americans either having
diabetes or a high risk of it--and with the number of overweight
children in America at 9 million and growing--it's frustrating to let
any possible cure go unexplored. ``We'll never know where my research
might have led, will we?'' Schneyer says, adding that since the NIH
started issuing research grants after World War II, ``a good 75
percent'' of discovered cures have come from government-funded programs
like his--and not from drug-company labs. In fact, thanks to NIH-
sanctioned research, we know that exercise promotes weight loss, high
LDL cholesterol raises the risk of heart disease, chemotherapy kills
cancer, and fluoride prevents tooth decay.
Now, Schneyer is left hoping for a last-minute reprieve. This is
unlikely. The 2007 budget for the Department of Health and Human
Services, under which both the CDC and NIH operate, shows that grant
monies for ``Preventive Health and Health Services,'' ``Public Health
Improvement,'' and ``Children's Hospitals'' have been slashed by almost
$375 million. ``Bioterrorism'' funding, on the other hand, has
increased to $1.7 billion, up nearly tenfold in the past 5 years.
Like many medical researchers and physicians, Schneyer is angry
with the Federal Government for shifting funds away from medical
research and--``ostensibly,'' he says--into the war on terror at home
and abroad. It has not gone unnoticed in America's medical community
that as Federal grants stagnate or plunge, Washington politicos have,
as of January, authorized more than $315 billion--that's $6.5 billion a
month, $9 million an hour--to be spent in Iraq alone.
Then there are the seemingly insane items, recently reported by
Newsday, in the Department of Homeland Security's budget: $18,000 to
equip the Santa Clara, California, bomb squad with Segways; $30,000 to
ensure a defibrillator is on hand for every Lake County, Tennessee,
high-school basketball game; $500,000 worth of security gear to the
town of North Pole, Alaska, population 1,778; Kevlar vests for the
police dogs of Columbus, Ohio; the list goes on.
Sitting in Schneyer's office, I motion toward the window. What
would happen, I ask, if I walked into the tavern across the street and
queried the first five patrons about whether Federal dollars would be
better spent on body armor for soldiers, or research on the
reproductive organs of mice?
``You're not framing the question correctly,'' he says.
``Statistics indicate that two of the five men in the bar have already
developed some form of cardiovascular disease. So you ask them how they
feel about genetic research that might find a cure, so that their
children don't die of heart disease.
``It's easy to ask why we're funding work on a mouse organ, or on a
worm. Well, you take that same gene and look for a similar one in a
human, and suddenly, `Hey, it's responsible for diabetes!' It's not a
question of a cure for diabetes versus body armor for soldiers. This
isn't about medical science versus armor or, for that matter, school
lunches, fire departments, or red lights at dangerous intersections. A
smart government can fund it all.''
``Where will that money come from?'' I ask.
Schneyer's cheeks burn as he speaks of cost overruns in Iraq and
the recent tax cuts. ``Every medical-research experiment that is not
done is an opportunity lost,'' he says. ``You don't know which one is
going to bring the eureka moment.''
He smiles, rueful. ``Our country--the president, Congress--has to
decide if it's worth doing research that will lead to better health in
the long run and lower costs for the next generation of Americans.
``The catchall excuse for the funding cuts is the war on terror.
But al-Qaeda could attack New York, and that wouldn't reduce the number
of children with diabetes in Chicago and Miami and Detroit. Researchers
who are on the verge of finding cures for Alzheimer's, Parkinson's, all
kinds of cancers . . . their funding is all being cut.
``That's a strange way to protect America.''
______
Prepared Statement of the Fair Allocations in Research Foundation
The death rate in our country from AIDS has plummeted as evidenced
in 2006 by the 99 percent drop in California's newly infected AIDS
patients \1\ from just under 10,000 to 130 (as of 2/28/07) and the 93
percent drop to 100 in all of Illinois's HIV/AIDS patients for 2004.\2\
In addition, we respectfully bring to Chairman Byrd's attention that
this great success includes West Virginia where AIDS deaths have
dropped to 23 for their latest reporting period (2005).\3\ This success
against AIDS is being repeated throughout America, yet AIDS still
receives 10 percent of the entire National Institutes of Health (NIH)
disease research budget.
---------------------------------------------------------------------------
\1\ http://www.dhs.ca.gov/aids/Statistics/pdf/Stats2007/
Feb07AIDSMerged.pdf Page 2, CA Office of AIDS--patients infected in
2006 who died in 2006.
\2\ http://fairfoundation.org/states/illinois_AIDS_deaths.htm
\3\ WVA Dept of Health, Tom Light, 304-558-1748 or http://
fairfoundation.org/states/west_virginia.htm
---------------------------------------------------------------------------
Such exorbitant funding for AIDS has resulted in unfair allocations
for all non-AIDS diseases, including the sixteen \4\ that kill a
million more Americans than AIDS annually. For example, cardiovascular
disease kills almost a million Americans compared to 16,316 (2005) \5\
for AIDS, yet the NIH is spending only $40 on each CVD patient versus
$3,052 on each AIDS patient in research.\6\ Diabetes kills more
citizens than AIDS and breast cancer combined, yet only $50 is spent on
each diabetic in research. More AIDS patients are now dying of
hepatitis C than they are of AIDS,\7\ and hepatitis C (HCV) affects 4-5
times as many as AIDS yet only $25 is allocated for each HCV patient.
---------------------------------------------------------------------------
\4\ http://www.fairfoundation.org/thesixteen.htm
\5\ http://fairfoundation.org/CDC_AIDS_death_estimates_2001-
2005.pdf
\6\ http://www.fairfoundation.org/factslinks.htm
\7\ http://fairfoundation.org/specter_letter_hcv_in_aids_pts.pdf
----------------------------------------------------------------------------------------------------------------
2005 NIH
research Deaths per Dollars per Dollars per
Disease [Dollars in disease patient death patient
billions]
----------------------------------------------------------------------------------------------------------------
HIV/AIDS........................................ $2.930 16,316 $178,046 $3,052
Cardiovascular Dis.............................. 2.300 930,000 2,523 40
Diabetes........................................ 1.000 73,965 14,236 50
Alzheimer's Dis................................. .642 63,343 10,182 143
Prostate Cancer................................. .373 27,350 13,638 192
Parkinson's Dis................................. .205 17,898 12,403 148
Hepatitis C..................................... .121 12,000 10,166 25
Hepatitis B..................................... .036 5,000 6,600 32
COPD............................................ .066 126,128 500 5
West Nile Virus................................. .063 161 390,304 14,932
----------------------------------------------------------------------------------------------------------------
Regardless if the funding comparison is measured utilizing
``allocation per patient,'' ``allocation per death'' or ``total
allocation'' per disease, the great success of AIDS researchers has
resulted in funding for AIDS now being disproportionate and
inequitable.
In addition, hundreds of millions of dollars are raised for AIDS by
celebrities and non-profit organizations (amfAR, etc.) while similar
efforts do not exist for many other diseases. With the recent $37
billion stock pledge by Warren Buffett to the $29 billion Bill and
Melinda Gates Foundation and Mr. Buffett's support for the Gates's bias
in funding to combat HIV disease, the favoritism afforded this disease
has reached excessive proportions. Indeed, Melinda Gates has stated
that her fondest goal is a vaccine for HIV disease and to date the
total funding by the Gates's Foundation for all HIV programs is $6.5
billion. It is anticipated that much more of the Gates Foundation will
go towards combating HIV disease in the future.
When one reflects that the total NIH bio-medical research budget
for every disease known to man is only $28.4 billion and 10 percent of
that also goes to HIV research, one can only be dismayed at the
continual favoritism afforded this illness.
The NIH has responded to The FAIR Foundation's requests to cease
the favoritism afforded HIV/AIDS and to reallocate some of the present
AIDS dollars to other diseases by referencing global AIDS and the fact
that AIDS is communicable and destructive to the young.\8\
---------------------------------------------------------------------------
\8\ http://www.fairfoundation.org/nihletter.htm
---------------------------------------------------------------------------
What are the solutions for global AIDS--more research? No, the
answers to global AIDS are the same that have dropped the death rate
throughout America, and they have been expressed by Presidents Clinton,
Bush and the Director of the NIAID, Dr. Fauci, namely: preventive
education, the drugs which converted AIDS from an acute illness into a
chronic illness (HAART or Highly Active Anti-retroviral Therapy) and
setting up health infrastructures.
Indeed, Dr. Fauci himself recently admitted the great success in
HIV research when he stated on CNN, ``. . . the scientific advancements
that have been made in HIV [research] are breathtaking [with] highly
effective drugs to suppress HIV to the point where what was a death
sentence in the early eighties to now having patients who look and feel
well, who are leading very productive, very gratifying lives . . .''
Regarding the ``communicable'' nature of AIDS, Congress must force
realization upon the NIH that simply because an illness is
``infectious'' does not warrant disproportionate research funding.
Patients suffering from non-communicable illnesses such as prostate
disease, Alzheimer's disease, etc. should not be discriminated against
because they cannot transmit their disease to others or because its
etiology is congenital or acquired by environmental causes.
In America's youth, the CDC's 2005 report States seven deaths in
patients age <13, 63 under age of 19 and 677 deaths under age 30. The
estimated deaths from SIDS each year is 3,000. Clearly, HIV disease is
not a major factor killing our youth.
An unrecognized factor negatively impacting all non-AIDS diseases
is the ``compounding effect'' of present NIH policy. The present
funding total of each disease may be viewed as their ``principal
balance'' for this analogy. If the present effort by 100 Members of the
House to increase NIH funding by 6.7 percent is successful, the
increase in AIDS funding will be approximately $194 million whereas
Alzheimer's disease will receive only $43 million and Chronic
Obstructive Pulmonary Disease (COPD) $4.4 million even though those two
diseases kill, respectively, three and nine times more Americans than
AIDS. Each year the additional increases in the ``principle balance,''
or total funding, results in the ``compounding interest effect'' that
increases the disproportionate funding for AIDS. Consequently, the gap
in funding between AIDS and all other diseases grows even larger.
Supplying greater funding to the NIH without redistribution of present
inequities is unfair for non-AIDS illnesses.
The issue of AIDS favoritism is rapidly becoming a political issue.
Before billions more dollars are spent on yet another preventive
measure (HIV vaccine), we urge you to publicly call for a partial
redistribution of the HIV excess funding to other illnesses that do not
presently have effective treatments, including the 16 maladies [iii]
that are killing a million more Americans than HIV disease annually.
Indeed, with the budgetary limitations resulting from our
government's commitments, including supporting the war in Iraq and
restoring the areas ravaged by hurricanes Katrina and Rita, necessary
increases for bio-medical research funding have been non-existent. As
with the common citizen whose budget is pinched, it is appropriate to
reallocate existing funds, in this case some of HIV/AIDS funding to
other illnesses.
Sixty-one million voters with cardiovascular disease, 21 million
diabetics and millions of other constituents with non-AIDS illnesses
will applaud your courageous declaration, while approximately 1 million
with HIV/AIDS may be dismayed at such an announcement.
The FAIR Foundation (FAIR is an acronym for ``Fair Allocations In
Research) is a national organization representing thousands of members
and supporters--concerned citizens--who want the success of AIDS
advocates and AIDS researchers recognized with a corresponding change
in the allocation priorities of the NIH with our taxpayer dollars that
fund bio-medical research. Gay members of our country are present on
our Board, including Ray Hill, who used to be one of this country's
most strident HIV activists. Because of their great success, Ray, who
has been named Houston's gay hero by that community 7 years in a row,
now advocates for hepatitis C.
On behalf of our national membership we are respectfully requesting
that a portion of AIDS research allocations be reevaluated and
redistributed now that the existing medications and extensive
prevention programs for this illness have significantly mitigated its
threat.
______
Prepared Statement of the Families USA Global Health Initiative's
Families USA Global Health Initiative appreciates the opportunity
to submit this written testimony to the Senate Appropriations
Subcommittee on Labor, Health and Human Services, and Education
concerning Federal funding for the National Institutes of Health (NIH)
and the Centers for Disease Control and Prevention (CDC). Our statement
today speaks to the important role that NIH and CDC play in protecting
and improving health in the United States and the world.
For more than 20 years, Families USA has advocated for changes in
U.S. policies to increase access to affordable health care, especially
for low-income individuals. The Global Health Initiative was launched
in 2006 to advocate for increased U.S. investment in research and
development of medical interventions targeting infectious diseases that
disproportionately affect populations in low-income countries (``global
health'' research).
The government must step in to support global health research and
development because there is little private industry interest in
filling the current void, an overwhelming human need, a long history of
underfunding, and it's in our Nation's self-interest to do so.
OVERWHELMING HUMAN NEED AND HISTORIC UNDERFUNDING
Research addressing global health crises has been historically
underfunded. More than 500 million people contract malaria each year.
NIH spends just 0.3 percent of its budget on malaria research. CDC's
malaria extramural research program was cut.
Nine million people develop active tuberculosis (TB) each year, 2
million die from TB, and extensively drug-resistant strains poses a
substantial domestic and worldwide health threat. NIH spends just 0.5
percent of its budget on tuberculosis. The Global Health section of
CDC's Proposed fiscal year 2008 Budget, submitted to the Congress,
contains no mention of work on TB.
More than 1 billion people living in tropical and subtropical
climates around the world are stricken with devastating, debilitating
parasitic diseases that receive so little research funding that the
World Health Organization and others in the medical community refers to
these conditions as ``neglected'' tropical diseases.
Almost 40 million people around the world are currently infected
with HIV. Only 2.5 percent of NIH's budget is devoted to research on
preventative medical interventions, including vaccines and
microbicides. CDC's global HIV/AIDS activities are limited primarily to
support of the President's Emergency Plan for AIDS Relief (PEPFAR).
Although PEPFAR is expanding access to existing HIV/AIDS treatments for
many in need, PEPFAR alone will not curb the global AIDS pandemic. More
than 4 million people become newly infected each year and existing
treatments are becoming increasingly ineffective due to drug
resistance. Vaccines and microbicides, along with improved treatments,
are needed to curtail the global AIDS pandemic.
OUR NATIONAL INTEREST
When NIH and CDC are insufficiently funded, as has consistently
been the case in recent years, they are forced to fight global health
crises with one hand tied behind their back. This has serious health,
economic, and political implications--not just internationally, but
also domestically. There are also compelling diplomatic and
humanitarian reasons for funding NIH's and CDC's global health work.
First, we have a national health interest in ensuring that NIH and
CDC have all the resources that they need. Diseases can easily spread
across international borders; epidemics abroad, including lethal
strains of extremely drug-resistant TB, can lead to cases here at home.
Americans who travel abroad, including our troops, are also at risk of
contracting infectious diseases that are endemic in other countries.
Second, we have a national economic interest in providing NIH and
CDC with all the resources that they require. In regions where HIV/
AIDS, malaria, and TB prevalence are greatest, countries' entire
workforces suffer from substantially reduced productivity and economic
growth is hindered. With globalization, countries' economic health is
intertwined. The economic toll of diseases hurts world economic growth
and limits trade, and it reduces markets for U.S. goods.
Third, we have a national political interest in giving NIH and CDC
the funding needed to combat infectious diseases with a massive global
burden. In areas of the world where the infectious disease burden is
greatest, enormous numbers of people are getting sick and dying.
Populations are being decimated. The social structures of entire
countries has been unraveling, paving the way for political unrest and
the undermining of democracy in entire regions of the world.
Fourth, we have a national diplomatic interest, and there are
strong humanitarian reasons as well, for funding NIH's and CDC's work
in preventing and controlling diseases that burden millions of people
around the world. As the wealthiest country on earth, we have the means
to advance health and alleviate human suffering. Using our wealth to
improve global health improves America's image and serves as a very
effective foreign policy tool.
FUNDING RECOMMENDATIONS
All NIH Institutes and Centers
Families USA Global Health Initiative recommends 6.7 percent annual
increases to NIH's total budget from fiscal year 2008 to fiscal year
2010 (including 3.7 percent adjustments each year for annual rises in
biomedical inflation, plus an additional 3.0 percent each year to start
to correct for the failure in recent years to keep up with inflation).
In recent years, NIH funding has fallen further and further behind
the rising costs of biomedical research. This means that less research
gets funded and medical progress is delayed. Only 16.7 percent of new
grant applications were funded in 2006--an 83 percent failure rate.
Many scientists are sitting on the sidelines, unable to develop
promising ideas that could lead to an effective AIDS vaccine, improved
tuberculosis treatments, and other medical interventions that could
improve the lives of millions worldwide.
A 6.7 percent annual increase for all NIH Institutes and Centers,
for each year from fiscal year 2008 to fiscal year 2010, would adjust
NIH funding for anticipated annual rises in inflation and add a modest
3.0 percent rise to help make up for losses in inflation-adjusted
funding experienced by all of NIH in recent years.
Additional Increase for NIH Global Health Programs
Families USA Global Health Initiative recommends that Congress
begin to rectify, over a 7 year period, historic underfunding of global
health programs by increasing the National Institute of Allergy and
Infectious Diseases and Fogarty International Center budgets annually
by 2.9 percent for each year from fiscal year 2008 to fiscal year 2014.
This increased annual 2.9 percent investment in global health would
be apart from, and in addition to, the 6.7 percent increases over the
next 3 years for all NIH Institutes and Centers, and annual
inflationary adjustments provided thereafter.
The National Institute of Allergy and Infectious Diseases (NIAID)
has taken a leadership role in the bulk of global health research and
development activities undertaken at NIH. Robust funding for NIAID is
essential for addressing infectious disease crises around the globe and
in the United States.
The John E. Fogarty International Center (FIC) also plays a crucial
role in addressing global health challenges by facilitating
collaboration between United States and international researchers
through its international training and global health research capacity
building programs. FIC's programs facilitate the development of medical
discoveries worldwide.
Malaria and tuberculosis research, combined, comprise less than 1
percent of the National Institutes of Health's total budget. Last year,
cuts to the NIH budget resulted in funding being completely cut to 11
HIV/AIDS clinical trials in the United States. FIC's fiscal year 2006
funding constituted a miniscule 0.23 percent of NIH's total budget.
A 2.9 percent additional increase for NIAID and FIC, for each year
from fiscal year 2008 to fiscal year 2014--apart from and on top of the
6.7 percent annual increases for all of NIH from fiscal year 2008 to
fiscal year 2010, and inflationary increases thereafter--is badly
needed to make up for historic underfunding for global health research
and to achieve progress in the development of new interventions for
diseases devastating millions worldwide.
Centers for Disease Control and Prevention
Families USA Global Health Initiative supports the CDC Coalition's
recommendation of increasing CDC's total budget to $10.7 billion in
fiscal year 2008 and further recommends that Congress appropriate $512
million in fiscal year 2008 for CDC's global health work (4.8 percent
of CDC's $10.7 billion total budget).
CDC's global health programs are vitally important to protecting
Americans and people around the world from disease. Cuts to CDC's
budget undermine both the United States and the global public health
infrastructures that are crucial to rapidly responding to new disease
outbreaks and combating existing global pandemics.
Yet, some of CDC's global health programs have been flat-funded for
years; other global health programs can no longer carry out their
critical mission due to limited funds. For instance, CDC currently has
no appropriated budget for global tuberculosis activities and the
malaria extramural research program had to be phased out due to
insufficient funds. Moreover, failure to adequately fund CDC's global
health work has broader implications for the success of other United
States funded initiatives, including PEPFAR and the President's Malaria
Initiative (PMI).
At a global health funding level of $512 million in fiscal year
2008, CDC would be able to support crucial global disease surveillance
and control programs; perform research to improve existing medical
interventions; and develop new interventions for diseases where
interventions are currently lacking.
CALL FOR ACTION
Americans across the country, and people from around the world, are
looking to NIH and CDC for new medical advances that will lead to a
healthier tomorrow. Shortchanging NIH and CDC places America's--and the
world's--health at risk. We urge the subcommittee to fund NIH and CDC
at the levels specified above.
For additional information, please contact Janet Goldberg at 202-
628-3030 or jgoldberg@familiesusa.org.
______
Prepared Statement of Fight Crime: Invest in Kids
Mr. Chairman and members of the subcommittee: Thank you for the
opportunity to submit this written testimony. My name is Dennis Conard
and I am the Sheriff in Scott County, IA (Davenport), where I have
served in law enforcement for almost 35 years. I am also a graduate of
the FBI National Academy, the National Sheriffs' Institute and the Iowa
Law Enforcement Academy and a member of the National Sheriffs'
Association. I am also one of the 3,000 police chiefs, sheriffs,
prosecutors, and victims of violence of FIGHT CRIME: INVEST IN KIDS--a
non-profit anti-crime organization that has come together to take a
hard-nosed look at the research about what really works to keep kids
from becoming criminals.
The law enforcement leaders of FIGHT CRIME: INVEST IN KIDS know
that dangerous criminals must be prosecuted and put behind bars. But we
also know better than anyone that we cannot arrest and imprison our way
out of the crime problem. No prison can bring back a murdered wife,
mother or child, and no punishment can undo a crime victim's anguish.
Fortunately, research--and our experiences on the front lines in the
fight against crime--show that targeted investments can help kids get a
good start in life. We could be saving thousands of lives and
preventing thousands of crimes by increasing our investments in cost-
effective, proven crime-prevention programs.
Four types of proven crime-prevention approaches are outlined in
FIGHT CRIME: INVEST IN KIDS' ``School and Youth Violence Prevention
Plan'':
--quality early childhood education;
--child abuse and neglect prevention programs;
--quality after-school; and
--prevention and intervention programs to get troubled kids back on
track.
As you know, the first three areas fall within your Appropriations
Subcommittee's jurisdiction. Since both the research and my years of
experience on the front lines in the fight against crime show that
these approaches help stop crime in its tracks, I urge you to increase
our Nation's investments in these proven strategies for saving lives
and taxpayer dollars.
EARLY CHILDHOOD EDUCATION AND CARE
By now, most people know that Head Start and quality child care
help close the achievement gap. But few people are aware of the amazing
impact of early education programs on later criminality. A Journal of
the American Medical Association-published study of Chicago's
government-funded Child Parent Centers, which have served more than
100,000 3- and 4-year-olds, showed that children who did not
participate in the program were 67 percent more likely to have been
retained a grade in school and 71 percent more likely to have been
placed in special education. But equally impressive, the study showed
that kids who did not participate were 70 percent more likely to be
arrested for a violent crime by age 18. Similarly, at-risk kids who
were left out of the high-quality High/Scope Perry preschool program
were five times more likely to be chronic offenders (more than four
arrests) by age 27 than those who participated.
By improving outcomes for kids, quality early childhood education
also saves money. The High/Scope Perry Preschool program saved $17 for
every $1 spent. An analysis by Arthur Rolnick of the Federal Reserve
Bank of Minneapolis shows that the program's annual return on
investment is 16 percent after adjusting for inflation. Seventy-five
percent of that return goes to taxpayers in the form of decreased
special education expenditures, crime costs and welfare payments. In
comparison, the long-term average return on U.S. stocks is 7 percent
after adjusting for inflation. Thus, an initial investment of $1,000 in
a program like Perry Preschool is likely to return more than $19,000 in
20 years, while the same initial investment in the stock market is
likely to return less than $4,000.
However, due to lack of State and Federal financial resources,
there remains significant unmet need with only about half of eligible
poor kids nationally served by Head Start and less than 5 percent of
eligible infants and toddlers in Early Head Start. Only one in seven
kids in eligible, low-income families receives help from the Child Care
and Development Block Grant to pay for the quality child care that can
help ensure they are on the path toward being a productive, taxpaying
adult rather than a burden on taxpayers and part of our criminal
justice system. Funding has been stagnant over the last several years.
By the administration's own estimates, 150,000 fewer children receive
child care assistance now than in 2000.
I urge Congress to:
--Increase funding for Head Start by at least $750 million to restore
funding for services to kids to the fiscal year 2002 level.
--Increase discretionary funding for the Child Care and Development
Block Grant by $720 million to restore funding for services to
kids to the fiscal year 2002 level.
This is the first step toward meeting the unmet need and further
strengthening the quality of early childhood care and education.
child abuse and neglect prevention programs
The best available research indicates that, based on confirmed
cases of abuse and neglect in just 1 year, an additional 35,000 violent
criminals and more than 250 murderers will emerge as adults who would
never have become violent criminals if not for the abuse or neglect
they endured as kids.
Fortunately, quality, voluntary in-home parent coaching can help
stop this cycle of violence. Voluntary, in-home parent coaching (or
``home visiting'') programs help new parents get the information,
skills and support they need to be better parents and promote healthy
child development. One program, the Nurse Family Partnership (NFP), has
been shown to cut child abuse and neglect of at-risk children in half
and reduce kids' and moms' later arrests by about 60 percent--saving an
average of $28,000 (net) for each family in the program.
As a first step toward meeting this need, I urge Congress to
provide:
--$100 million to expand and improve in-home coaching programs like
those that would be supported under the Education Begins as
Home Act (S. 667), which is expected to be enacted this year.
--$545 million (the combined mandatory and discretionary authorized
level) for the Promoting Safe and Stable Families program to
help communities run in-home parent coaching programs,
parenting-education programs, family-strengthening services for
troubled families, adoption services, and other child abuse and
neglect prevention programs.
--$200 million (the authorized level) for the Child Abuse Prevention
and Treatment Act to help improve State child protection
services and community-based prevention services.
--$1.7 billion (rejecting the administration's proposed cuts) for the
Social Services Block Grant (SSBG), the Federal Government's
single largest support for child welfare services.
AFTER-SCHOOL PROGRAMS
In the hour after the school bell rings, violent juvenile crime
soars and the prime time for juvenile crime begins. The peak hours for
such crime are from 3:00 p.m. to 6:00 p.m. These are also the hours
when children are most likely to become victims of crime, be in an
automobile accident, smoke, drink alcohol, or use drugs. After-school
programs that connect children to caring adults and provide
constructive activities during these critical hours are among our most
powerful tools for preventing crime. For example, a study compared five
housing projects without Boys & Girls Clubs to five receiving new
clubs. At the beginning, drug activity and vandalism were the same. But
by the time the study ended, the projects without the programs had 50
percent more vandalism and scored 37 percent worse on drug activity.
Despite these proven benefits, more than 14 million children nationwide
still lack adult supervision after school.
The 21st Century Community Learning Centers program (21st CCLC)
awards grants to communities to establish after-school programs that
provide constructive activities for kids. Since being funded at $1
billion in fiscal year 2002, there have been no real funding increases
for 21st CCLC. In fiscal year 2007, the program received $981 million--
far below the program's $2.5 billion authorization under the No Child
Left Behind Act. I urge Congress to:
--Substantially increase funding for the 21st Century Community
Learning Centers to support and expand after-school programs
that offer kids constructive activities during the peak hours
of violent juvenile crime, 3:00 pm to 6:00 pm. Also, I urge you
to authorize at least an additional $500 million for programs
for at-risk middle and high school students who now experience
the greatest unmet need--and are at greatest risk of
perpetrating or being victims of crime.
LAW ENFORCEMENT LEADERS ARE UNITED
The members of FIGHT CRIME: INVEST IN KIDS, along with major
national law enforcement associations, have adopted forceful calls for
public officials to ensure access to quality early care and education,
provide adequate funding to prevent child abuse and neglect, and ensure
access to after-school programs. If we do not invest in research-proven
crime-prevention programs for America's most vulnerable kids, many of
them will grow up to become America's most wanted adults. By failing to
adequately invest in proven crime-prevention strategies, Congress is
not only failing to promote the well-being of millions of kids but is
also permitting the cultivation of criminals--jeopardizing the safety
of all Americans for years to come.
Thank you for this opportunity to present our views on how your
subcommittee can help to reduce crime and make us all safer.
______
Prepared Statement of the Foster Grandparent Program
Mr. Chairman and members of the subcommittee, thank you for the
opportunity to submit this testimony in support of fiscal year 2008
funding for the Foster Grandparent Program (FGP), the oldest and
largest of the three programs known collectively as the National Senior
Volunteer Corps, which are authorized by Title II of the Domestic
Volunteer Service Act (DVSA) of 1973, as amended and administered by
the Corporation for National and Community Service (CNS). NAFGPD is a
membership-supported professional organization whose roster includes
the majority of more than 350 directors, who administer Foster
Grandparent Programs nationwide, as well as local sponsoring agencies
and others who value and support the work of FGP.
Mr. Chairman, I would like to begin by thanking you and the
distinguished members of the subcommittee for your steadfast support of
the Foster Grandparent Program. No matter what the circumstances, this
subcommittee has always been there to protect the integrity and mission
of our programs. Our volunteers and the children they serve across the
country are the beneficiaries of your commitment to FGP, and for that
we thank you. I also want to acknowledge your outstanding staff for
their tireless work and very difficult job they have to ``make the
numbers fit''--an increasingly difficult task in this budget
environment.
ADMINISTRATION'S REQUEST FOR FGP
Although the number of older people in America eligible to serve as
Foster Grandparent volunteers is increasing by leaps and bounds as the
``Baby Boomer'' cohort ages, we were extremely disappointed to learn
that--instead of seeking an increase for FGP to enable FGP to engage
more low-income seniors in service--the administration has proposed
slashing funding for FGP by $13.387 million--a 12.1 percent cut.
IMPACT OF THE ADMINSTRATION'S PROPOSED FUNDING CUT
FGP is the only program in existence today that actively seeks out,
trains, enables, places and supports the elderly poor in contributing
to their communities by changing the lives of children who desperately
need one-on-one attention. If enacted, this request will have a
devastating effect on FGP programs nationwide:
--3,150 low-income Foster Grandparent volunteers--over 10 percent of
the current volunteer complement--will be cut permanently,
slashing the total number of Foster Grandparent volunteers from
30,550 to 27,400. This will happen at a time when the number of
FGP volunteers has not increased appreciably in 10 years!
--Local communities will lose over 3.3 million hours of volunteer
service annually.
--Approximately 35,000 fewer children with special needs will receive
the critical services provided by Foster Grandparents.
--FGP will permanently lose 3,000 Volunteer Service Years (VSYs, or
volunteer ``slots''). For each volunteer ``slot'' that is cut
from a Foster Grandparent Program, that program will lose
approximately $4,500 from its Federal grant. In addition, at
least $500 in valuable non-federal resources contributed by
communities will also be lost for every volunteer position that
is eliminated.
--Low-income Baby Boomers will be excluded from serving as Foster
Grandparents, because there will be no funds available to hire
and place new volunteers as they reach the age of 60. According
to the administration on Aging, there are currently 6,000,000
low-income seniors eligible for FGP; in 20 years, there will be
13,000,000!
This cut will take FGP back 7 years, to a funding level that is
more than $1 million less than its funding level in fiscal year 2001.
In addition, the cut will take effect at a time when the average
Federal grant for FGP has increased a miniscule $2,898--or .875 percent
(seven-eighths of 1 percent!)--since fiscal year 2003. After 4 years of
flat funding, this 12.1 percent cut will not only cut volunteer
numbers, it will also dig deeply into funds needed to sustain quality
staff and quality programs. As a result, some FGPs may actually close,
and local sponsoring agencies--short of funds themselves and unable to
contribute the funds needed to make up the cut--may simply relinquish
their sponsorship.
The Corporation for National and Community Service's Budget
Justification states that this cut can be absorbed merely through
volunteer attrition. The reality is that the majority of FGPs
nationwide will be forced to cut precious volunteers from their
volunteer rosters. Whether a volunteer leaves through attrition or
because there is no funding for his/her position, the fact is that this
budget proposal will result in 3,150 fewer low income elders serving as
Foster Grandparents.
NAFGPD respectfully requests three things of the subcommittee:
(1) to provide $115.937 million for the Foster Grandparent Program
in fiscal year 2008, an increase of $5.000 million over the fiscal year
2006 and fiscal year 2007 levels of funding for the program and an
$18.387 million increase over the administration's fiscal year 2008
Budget Request for FGP. This critical funding will ensure the continued
viability of the Foster Grandparent Program, and allow for important
expansion of this unique program. Specifically, this proposal would
fund a 3 percent cost of living increase for every Foster Grandparent
Program as well as expansion grants to existing programs that would add
370 new low-income senior volunteers to serve 3000 additional children;
(2) to maintain current appropriations statutory language that
prohibits CNCS from using funds in the bill to pay non-taxable stipend
to volunteers whose incomes exceed 125 percent of the national poverty
level. Congress has repeatedly over the last 7 years re-affirmed that
the non-taxable stipend must be reserved for low-income volunteers. We
ask that you again protect the mission of the Foster Grandparent and
Senior Companion Programs--to enable low-income older people to serve
their communities--by maintaining this important statutory language.
(3) to oppose administration proposals that would consolidate
National and Community Service Act and DVSA accounts and set aside
provisions of section 412 of the DVSA as they apply to the RSVP program
(Title II, Part A), and, instead, direct that the changes proposed
shall not be implemented prior to passage of a bill by the authorizing
committees of jurisdiction specifying such changes.
FGP: AN OVERVIEW
Established in 1965, the Foster Grandparent Program was the first
federally funded, organized program to engage older volunteers in
significant service to others. It remains today the only volunteer
program in existence that enables seniors living on very low incomes to
serve as community volunteers by providing a small non-taxable stipend
that allows volunteers to serve at little or no cost to themselves.
From the 20 original programs based totally in institutions for
children with severe mental and physical disabilities, FGP now
comprises nearly 350 programs in every State and the District of
Columbia, Puerto Rico, and the Virgin Islands. These programs are now
primarily in community-based child caring agencies or organizations--
where most special needs children can be found today--and are
administered locally through a non-profit organization or agency and
Advisory Council comprised of community citizens dedicated to FGP and
its mission. FGP represents the best in Federal partnerships with local
communities, with Federal dollars flowing directly to local sponsoring
agencies, which in turn determine how the funds are used. Through this
partnership and the flexibility of the program, FGP is able to meet the
immediate needs of the local communities. This was demonstrated by
Foster Grandparent Programs in communities that were impacted by the
influx of Hurricane Katrina evacuees. Foster Grandparents rallied to
provide services to children in shelters, child care centers, and
schools.
FGP: THE VOLUNTEERS
There are currently 30,500 Foster Grandparent volunteers who give
31 million hours annually to more than 264,000 children, including
6,300 children of prisoners through 10,200 local agencies. FGP is a
versatile, dynamic, and uniquely multi-purpose program. The program
gives Americans 60 years of age or older who are living on incomes at
or less than 125 percent of the poverty level the opportunity to serve
15 to 40 hours every week and use the talents, skills and wisdom they
have accumulated over a lifetime to give back to the communities which
nurtured them throughout their lives. FGP provides intensive pre-
service orientation and at least 48 hours of ongoing training every
year to keep volunteers current and informed on how to work with
children who have special needs.
FGP: THE CHILDREN
Through our volunteers, FGP also provides person-to-person service
to children and youth under the age of 21 who have special or
exceptional needs, many of whom face serious, often life-threatening
challenges. The Foster Grandparent is very often the only person in a
child's life who is there every day, who accepts the child, encourages
him no matter how many mistakes the child makes, and focuses on the
child's successes.
Special needs of children served by Foster Grandparents include
AIDS or addiction to crack or other drugs; abuse or neglect; physical,
mental, or learning disabilities; speech, or other sensory
disabilities; incarceration and terminal illness. Of the children
served, 7 percent are abused or neglected, 25 percent have learning
disabilities, and 10 percent have developmental delays. FGP focuses its
resources in areas where they will have the most impact: early
intervention services and literacy activities. Nationally, 90 percent
of the children served by Foster Grandparents are under the age of 12,
with 39 percent of these children age 5 or under. Foster Grandparents
work intensively with these very young children to address their
problems at as early an age as possible, before they enter school.
Nearly one-half of FGP volunteers serve nearly 12 million hours
annually addressing literacy and emergent-literacy problems with
special needs children.
Activities of the FGP volunteers with their assigned children
include teaching parenting skills to teen parents; providing physical
and emotional support to babies abandoned in hospitals; helping
children with developmental, speech, or physical disabilities develop
self-help skills; reinforcing reading and mathematics skills; and
giving guidance and serving as mentors to incarcerated or other youth.
FGP: THE VOLUNTEER SITES
The Foster Grandparent Program provides child-caring agencies and
organizations offering services to special-needs children with a
consistent, reliable, invaluable extra pair of hands 15 to 40 hours
every week to assist in providing these services. Seventy-one percent
of FGP volunteers serve in public and private schools as well as sites
that provide early childhood pre-literacy services to very young
children, including Head Start.
FGP: COST-EFFECTIVE SERVICE
Using the Independent Sector's 2005 valuation for 1 hour of
volunteer service ($18.03/hour), the value of the service given by
Foster Grandparents annually is over $503 million, and represents a 4-
fold return on the Federal dollars invested in FGP. The annual Federal
cost for one Foster Grandparent is $3,960--less than $4.00 per hour.
FGP's fiscal year 2006 Federal allocation was matched with $37.4
million in non-federal donations from States and local communities in
which Foster Grandparents volunteer. This represents a non-federal
match of 34 percent, or $.34 for every $1.00 in Federal funds
invested--well over the 10 percent local match required by law.
NAFGPD'S FISCAL YEAR 2008 BUDGET REQUEST
Given the dramatically expanding number of low-income seniors
eligible to serve and the staggering number of troubled and challenged
children in America today, we respectfully request that the
subcommittee provide $115.937 million for the Foster Grandparent
Program in fiscal year 2008, an increase of $5.000 million over fiscal
year 2006 and fiscal year 2007 funding levels. This critical funding
will ensure the continued viability of the Foster Grandparent program,
and allow for an expansion of this important program. It will generate
opportunities for approximately 370 new low-income senior volunteers to
contribute 390,000 hours of service annually to nearly 3,000 additional
children with special needs through Program of National Significance
(PNS) grants to existing FGPs. The requested increase would be
allocated for the following purposes, in order of priority: 1st: in
accordance with the Domestic Volunteer Service Act (DVSA), designate
one-third of the increase over the fiscal year 2006 and fiscal year
2007 level to fund Program of National Significance (PNS) expansion
grants to allow existing FGP programs to expand the number of
volunteers serving in areas of critical need as identified by Congress
in the DVSA.2nd: use all remaining funds to award an administrative
cost increase of at least 3 percent to each existing Foster Grandparent
Program in order to maintain quality, enable recruitment and sustain
the work already being done by programs. The last time FGPs in the
field realized any increases at all to cover the increased costs of
doing business--especially in the area of transportation costs--was in
fiscal year 2005; that increase amounted to a very small .84 percent,
when inflationary price increases have been averaging 2-3 percent
annually.
We request that no funds be provided for Senior Demonstration, and
that language that expressly prohibits the payment of a non-taxable
stipend to individuals whose incomes exceed 125 percent of the national
poverty level continue to be included in the appropriations statute as
it has been since fiscal year 2000. This important language protects
the purpose of FGP: to enable low-income elders to serve their
communities at little or no cost to themselves.
The message is clear: (1) the population of low-income seniors
available to volunteer 15 to 40 hours every week is increasing; (2)
communities need and want more Foster Grandparent volunteers and more
Foster Grandparent Programs. The subcommittee's continued investment in
FGP now will pay off in savings realized later, as more seniors stay
healthy and independent through volunteer service, as communities save
tax dollars, and as children with special needs are helped to become
contributing members of society.
Mr. Chairman, in closing I would like to again thank you for the
subcommittee's support and leadership for FGP over the years. NAFGPD
believes that you and your colleagues in Congress appreciate what our
low-income senior volunteers accomplish every day in communities across
the country.
______
Letter From the FSH Society, Inc.
January 24, 2007.
Senator Tom Harkin,
Chairman, Subcommittee on Labor, HHS, Education and Related Agencies
U.S. Senate, Washington, DC.
Dear Hon. Tom Harkin: I request the opportunity to testify in
writing or in person before your Subcommittee on Labor, Health and
Human Services, Education and Related Agencies regarding the fiscal
year 2008 appropriations to the National Institutes of Health (NIH) for
research on FSH muscular dystrophy.
The FSH Society requests the opportunity to update your committee
on the progress made by the NIH over the past several years in FSH
muscular dystrophy. Despite a growth in funding from $7 million to $75
million between 1991 and 2007 for research in muscular dystrophy across
all Federal agencies, funding for our dystrophy is still anemic. The
NIH now has perhaps a half dozen grants for FSH Dystrophy out of some
200 grants for muscular dystrophy in the NIH portfolio. FSHD is the
third most common disease of muscle.
The NIH still needs encouragement and funding to develop a
comprehensive research portfolio for FSHD. We are most appreciative of
your support in this area and for the gains made thus far. It has
always been an honor to participate in the hearing process.
The FSH Society, Inc. and the tens of thousands of patients it
represents hope you will enable us by affording us the opportunity to
present testimony to your subcommittee. It is most important to speak
this year and to provide constructive input on this issue.
Sincerely,
Daniel Paul Perez,
President & CEO, FSH Society, Inc.
______
Prepared Statement of the Friends of the Health Resources and Services
Administration
The Friends of the Health Resources and Services Administration
(HRSA) is an advocacy coalition of more than 100 national
organizations, collectively representing millions of public health and
health care professionals, academicians and consumers. Our member
organizations strongly support the programs at HRSA designed to ensure
access to health services for each person in the United States.
Through its programs in thousands of communities across the
country, HRSA provides a health safety net for medically underserved
individuals and families, including 45 million Americans who lack
health insurance; 49 million Americans who live in neighborhoods where
primary health care services are scarce; African American infants,
whose infant mortality rate is more than double that of whites; and the
estimated 850,000 to 950,000 people living with HIV/AIDS. Programs to
support the underserved place HRSA on the front lines in responding to
our Nation's racial/ethnic and rural/urban disparities in health
status. HRSA funding goes where the need exists, in communities all
over America. We support a growing trend in HRSA programs to increase
flexibility of service delivery at the local level, necessary to tailor
programs to the unique needs of America's many varied communities. The
agency's overriding goal is to achieve 100 percent access to health
care, with zero disparities. In the best professional judgment of the
members of the Friends of HRSA, to respond to this challenge, the
agency will require an overall funding level of at least $7.5 billion
for fiscal year 2008.
The Friends of HRSA are gravely concerned about the president's
budget recommendation of devastating cuts for fiscal year 2008,
including over 12 program eliminations. This is in addition to the
programs that were eliminated in the fiscal year 2006 and 2007 budget
cycles and other programs that received deep cuts in both years.
Through its many programs and initiatives, HRSA helps countless
individuals live healthier, more productive lives. In the 21st century,
rapid advances in research and technology promise unparalleled change
in the Nation's health care delivery system. HRSA could be well
positioned to meet these new challenges as it continues to provide
needed health care to the Nation's most vulnerable citizens.
The Primary Care Bureau received a $207 million increase over the
fiscal year 2007 current funding level, all of which is designated for
the Community Health Centers adding 342 new or expanded health center
service sites and bringing the number of patients served annually to
16.3 million. Community health centers, often in partnership with
National Health Service Corps clinicians, form the backbone of the
Nation's safety net. More than 4,000 of these sites across the Nation
provide needed primary and preventive care to over 15 million poor and
near-poor Americans. HRSA primary care centers include community health
centers, migrant health centers, health care for the homeless programs,
public housing primary care programs and school-based health centers.
Health centers provide access to high-quality, family-oriented,
culturally and linguistically competent primary care and preventive
services, including mental and behavioral health, dental and support
services. Nearly three-fourths of health center patients are uninsured
or on Medicaid, approximately two-thirds are people of color, and more
than 85 percent live below 200 percent of the poverty level. 2,700
clinicians in the National Health Service Corps deliver a significant
portion of the primary care services provided at health centers. Corps
members work in communities with a shortage of health professionals in
exchange for scholarships and loan repayments. While recent growth in
the health centers program has been substantial, a significant need
remains in underserved communities across the country--we encourage the
committee to continue its support of existing health centers and
efforts to expand the reach and scope of health centers into new
communities.
Health professions and nursing education programs, authorized under
Titles VII and VIII of the Public Health Service Act, are essential
components of America's health care safety net, filling the gaps in the
health professions' supply not met by traditional market forces.
Through loans, loan guarantees, scholarships to students, and grants
and contracts to academic institutions and non-profit organizations,
the Title VII and VIII health professions programs are the only Federal
programs designed to train providers in interdisciplinary settings to
meet the needs of special and underserved populations, as well as
increase minority representation in the health care workforce. The
programs provide support for the training of physicians, nurses,
dentists, physician assistants, nurse practitioners, public health
personnel, psychologists, and other allied health providers. The final
budget for fiscal year 2006 included a 51.5 percent cut to Title VII;
the $40 million increase in the recently enacted fiscal year 2007 joint
funding resolution does not fully recover the funding lost as a result
of this devastating cut. Moreover, the President's fiscal year 2008
budget proposes an additional 94.6 percent cut to Title VII and a 29.7
percent cut to Title VIII. We are concerned that cuts to the health
professions programs will exacerbate existing provider shortages in
rural, medically underserved, and federally designated health
professions shortage areas and impede recruitment of underrepresented
minorities and students of disadvantaged backgrounds into the health
professions. Adequate funding for HRSA Health Professions Programs
under Title VII and VIII will help to create a prepared national
workforce by working to reverse projected nationwide shortages of
physicians, nurses, pharmacists, and other professionals. We strongly
encourage the subcommittee to restore funding to these vital Health
Professions programs.
The Maternal and Child Health Block Grant is a source of flexible
funding for States and territories to address their unique needs, and
remains in great need of increased funding. The Title V Maternal and
Child Health Block (MCH) Grant received a $31 million cut in the fiscal
year 2006 budget and stagnant funding for fiscal year 2007. The
President's budget for fiscal year 2008 proposed level funding for the
block grant at the fiscal year 2006 level. Greater needs among pregnant
women, infants, and children, particularly those with special health
care needs present daunting challenges to the State maternal and child
health programs. Furthermore, if programs like the Traumatic Brain
Injury program, Universal Newborn Hearing Screening, and Emergency
Medical Services for Children program are eliminated, those costs will
be borne by the MCH Block Grant. Of the nearly 4 million mothers who
give birth annually, almost half receive some prenatal or postnatal
service from a MCH-funded program. MCH programs increase immunizations
and newborn screening, reduce infant mortality and developmentally
handicapping conditions, prevent childhood accidents and injuries, and
reduce adolescent pregnancy.
Research indicates that 50,000 individuals die as a result of
Traumatic Brain Injury (TBI) each year in the United States and an
additional 80,000 survive with residual long-term impairments. Today
over 5.3 million Americans are living with a TBI-related disability.
TBI can strike at anyone at any time--from falls, vehicle crashes,
sports injuries, violence, and other causes. HRSA's Traumatic Brain
Injury program makes grants to States to coordinate, expand and enhance
service delivery systems in order to improve access to services and
support for persons with TBI and their families. Despite increasing
numbers of soldiers returning from war with head injuries, increasing
numbers of children being identified as disabled due to head injuries,
and the release of an Institute of Medicine Report stating the
importance of the program to brain injury survivors and their families,
the administration's fiscal year 2008 budget eliminates the TBI State
Grant program. We encourage the subcommittee to restore funds that were
cut from the TBI State Grant program. Individuals with traumatic brain
injury have an array of protection and advocacy needs, including
assistance with returning to work; finding a place to live; accessing
needed supports and services, such as attendant care and assistive
technology; and obtaining appropriate mental health, substance abuse,
and rehabilitation services.
The Children's Health Act of 2000 authorized funding for grants and
programs to improve state-based newborn screening. Newborn screening is
a vital public health activity used to identify and treat genetic,
metabolic, hormonal and functional conditions in newborns. Screening
detects disorders in newborns that, if left untreated, can cause death,
disability, mental retardation and other serious illnesses. Parents are
often unaware that while nearly all babies born in the United States
undergo newborn screening for genetic birth defects, the number and
quality of these tests vary from State to State. The March of Dimes,
the American Academy of Pediatrics and the American College of Medical
Genetics recommend that at a minimum, every baby born in the United
States be screened for a core group of 29 treatable conditions
regardless of the State in which the infant is born. Currently, Federal
support for State newborn screening activities is provided through the
Maternal and Child Health Block Grant, Special Projects of Regional and
National Significance (SPRANS). We encourage the subcommittee to
increase funding for newborn screening to assist States in improving
their newborn screening programs and override the administration's
proposed elimination of the universal newborn hearing screening
program.
The proposed elimination of the Emergency Medical Services for
Children (EMSC) program, a national initiative designed to reduce child
and youth disability and death due to severe illness and injury, is
also of great concern, especially in light of the recent Institute of
Medicine report that highlighted significant shortcomings in pediatric
emergency care. EMSC grants fund improvements to existing emergency
medical services systems and to develop and evaluate improved
procedures and protocols for treating children. Children are not merely
small adults; they have unique and specific concerns that this programs
works to address. We request that the EMSC program be funded at $25
million in fiscal year 2008.
Although the administration proposes level funding for the hospital
preparedness program, we are concerned with the $13 million cut the
program took in fiscal year 2007. All responders, providers and
facilities must be ready to detect and respond to complex disasters,
including terrorism, and HRSA must continue to support these vital
hospital preparedness programs. Furthermore, HRSA's Trauma-EMS Systems
Program, which is critical to ensure that our response to local, State
and Federal emergencies is effective and reflects the best clinical
practice in trauma and emergency medicine, was also proposed to be
eliminated in fiscal year 2008. We request that the $3.5 million
funding level be restored.
The Office of Rural Health Policy, which serves more than 61
million people, was cut by 89 percent in the President's budget.
Although almost a quarter of the U.S. population lives in rural areas,
only an eighth of our doctors work there. Because rural families
generally earn less than urban families, many health problems
associated with poverty are more serious, including high rates of
chronic disease and infant mortality. We encourage the subcommittee to
restore funding for rural health programs. Additionally, the HRSA Rural
and Community Access to Emergency Devices Program provides grants to
States to train lay rescuers and first responders to use AEDs and
purchase and place these devices in public areas where cardiac arrests
are likely to occur. We encourage the subcommittee to restore funding
for this program to the fiscal year 2005 level of $8.927 million.
The HIV/AIDS Bureau received a $21 million increase in the
President's 2008 request over fiscal year 2007 levels for a total of
$2.1 billion. The Ryan White CARE Act programs are the largest single
source of Federal discretionary funding for HIV/AIDS health care for
low-income, uninsured and underinsured Americans. While we are pleased
with the additional funds for HIV related drug therapies, it is
insufficient to meet the needs of those seeking services. We are
concerned that the cuts across the programs since fiscal year 2003 is
diminishing the availability of services. These cuts have forced State,
local and public health clinics' HIV/AIDS programs to stretch already
thin dollars to treat existing clients while trying to provide care and
treatment to those newly diagnosed. We request an increase of $682
million for Ryan White programs in fiscal year 2008. In fiscal year
2006 the AIDS Drug Assistance Programs (ADAP) received a $2 million
increase. Unfortunately, by the end of fiscal year 2007 it is expected
that hundreds more individuals will be added to ADAP waiting lists and
that States will have had to institute other cost-containment measures
such as reduced formularies, increased cost-sharing for ADAP clients
and lowered eligibility requirements for enrollment.
Title X of the Public Health Service Act was enacted to provide
high-quality, subsidized contraceptive care to those who cannot afford
such services, to improve women's health, reduce unintended
pregnancies, and decrease infant mortality and morbidity. Title X
programs provide comprehensive, voluntary and affordable family
planning services to millions--many of whom are uninsured--at more than
4,600 clinics nationwide. People who visit Title X funded clinics
receive a broad package of preventive health services, including breast
and cervical cancer screening, blood pressure checks, anemia testing,
and STD/HIV screening.
A major source of HRSA's strength is its many linkages and
partnerships with other Federal agencies, State, national and local
organizations. For example, HRSA and the Centers for Medicare and
Medicaid Services (CMS) are jointly implementing outreach on the new
State Children's Health Insurance Program in addition to working
together to improve data sharing and coordination, particularly on
Medicaid. Work also is ongoing with the Substance Abuse and Mental
Health Services Administration (SAMHSA) to integrate behavioral health
and substance abuse screening, early intervention, referral and follow-
up into primary health care settings funded through HRSA grants. HRSA
and the Centers for Disease Control and Prevention (CDC) cooperate on a
variety of disease prevention and health promotion activities.
We urge the members of the subcommittee to restore the allocations
that were cut and fund the agency at a level that allows HRSA to
effectively implement these important programs. The members of the
Friends of HRSA are grateful for this opportunity to present our views
to the subcommittee.
______
Prepared Statement of the Friends of the NIDA Coalition
Mr. Chairman and members of the subcommittee: The Friends of the
National Institute on Drug Abuse (FoN), a burgeoning coalition of over
165 scientific and professional societies, patient groups, and other
organizations committed to preventing and treating substance use
disorders as well as understanding the causes and public health
consequences of addiction, is pleased to provide testimony in support
of the NIDA's extraordinary work. Pursuant to clause 2(g)4 of House
Rule XI, the Coalition does not receive any Federal funds.
Drug abuse is costly--to individuals and to our society as a whole.
Smoking, alcohol abuse and illegal drugs cost this country more than
$500 billion a year, with illicit drug use alone accounting for about
$180 billion in health care, crime, productivity loss, incarceration,
and drug enforcement. Beyond its monetary impact, drug and alcohol
abuse tear at the very fabric of our society, often spreading
infectious diseases and bringing about family disintegration, loss of
employment, failure in school, domestic violence, child abuse, and
other crimes. The good news is that treatment for drug abuse is
effective and recovery from addiction is real for millions of Americans
across the country. Preventing drug abuse and addiction and reducing
these myriad adverse consequences is the ultimate aim of our Nation's
investment in drug abuse research. Over the past three decades,
scientific advances resulting from research have revolutionized our
understanding of and approach to drug abuse and addiction.
Because of the critical importance of drug abuse research for the
health and economy of our Nation, we write to you today to request your
support for a 6.7 percent increase for NIDA in the fiscal year 2008
Labor, Health and Human Services, Education and Related Agencies
Appropriations bill. That would bring total funding for NIDA in fiscal
year 2008 to $1,067,389,455. Recognizing that so many health research
issues are inter-related, we also support a 6.7 percent increase for
the National Institutes of Health overall, which would bring its total
to $30.8 billion for fiscal year 2008. This work deserves continuing,
strong support from Congress. Below is a short list of significant NIDA
accomplishments, challenges, and successes.
Reducing Prescription Drug Abuse.--NIDA research has documented a
continued increase in the number of people, especially young people,
who use prescription drugs for non-medical purposes. Particular concern
revolves around the inappropriate use of opioid analgesics--very
powerful pain medications. Research targeting a reduction in
prescription drug abuse, particularly among our Nation's youth, should
continue to be a priority for NIDA.
Pain Medications and Addiction.--FoN commends NIDA for taking a
leadership role in addressing issues around pain medications and
addiction. The most powerful treatments available for most forms of
pain are opioids. However, opioid treatment can produce negative health
consequences, such as intoxication and physical dependence, and may
result in opioid abuse and addiction. The prevalence of and process of
how to prevent, reduce, and treat, these negative health consequences
in the context of pain are not well understood. FoN is pleased that
NIDA brought a focus to this important issue, in collaboration with the
American Medical Association and in conjunction with the NIH Pain
Consortium, via its Spring 2007 conference ``Pain, Opioids, and
Addiction: An Urgent Problem for Doctors and Patients.''
Genes, Environment, and Development.--FoN recognizes and commends
NIDA for its leadership role in launching the Genes, Environment, and
Development Initiative (GEDI) with the National Cancer Institute. This
initiative will support research and add to our understanding of the
contribution of genetic, environmental, and developmental factors to
the etiology of substance abuse and related phenotypes, and will
hopefully lead to improved and tailored drug abuse and addiction
prevention and treatment interventions. FoN applauds this important,
cutting-edge research.
Social Neuroscience.--Research-based knowledge about the dynamic
interactions of genes with environment confirms addiction as a complex
and chronic disease of the brain with many contributors to its
expression in individuals. FoN applauds NIDA's involvement in last
year's ``social neuroscience'' request for applications, and this
year's ``genes, environment, and development initiative'' request for
applications.
Centers of Excellence for Physician Information.--FoN is very
pleased that NIDA has created Centers of Excellence for Physician
Information, and understands that these Centers will serve as national
models to support the advancement of addiction awareness, prevention,
and treatment in primary care practices. The NIDA Centers of Excellence
will target physicians-in-training, including medical students and
resident physicians in primary care specialties (e.g., internal
medicine, family practice, and pediatrics). FoN also applauds NIDA for
developing these centers in collaboration with the American Medical
Association's Research Education Consortium.
Drug Abuse and HIV/AIDS.--NIDA understands that drug abuse and
addiction continue to fuel the spread of HIV/AIDS in the United States
and abroad, and that drug abuse prevention and treatment interventions
can be very effective in reducing HIV risk. Research should continue to
examine every aspect of HIV/AIDS, drug abuse, and addiction, including
risk behaviors associated with both injection and non-injection drug
abuse, how drugs of abuse alter brain function and impair decision
making, and HIV prevention and treatment strategies for diverse groups.
FoN applauds the Institute for holding a Spring 2007 conference titled
``Drug Abuse and Risky Behaviors: The Evolving Dynamics of HIV/AIDS.''
Medications Development.--FoN commends NIDA for its continued
leadership in working with private industry to develop anti-addiction
medications and is pleased this collaboration resulted in an effective
medication for opiate addiction. FoN encourages NIDA to continue its
efforts to engage the private sector in the development of anti-
addiction medications, particularly for cocaine, methamphetamine, and
marijuana.
Co-Occurring Disorders.--NIDA recognizes that substance abuse is a
disorder that can affect the course of many other diseases. To
adequately address co-occurring health problems, FoN encourages the
Institute to work with other agencies to stimulate new research to
develop effective strategies and to ensure the timely adoption and
implementation of evidence-based practices for the prevention and
treatment of co-occurring disorders.
Adolescent Brain Development--How Understanding the Brain Can
Impact Prevention Efforts.--FoN notes neuroimaging research by NIDA and
others showing that the human brain does not fully develop until about
age 25. This adds to the rationale for referring to addiction as a
``developmental disease.'' FoN encourages NIDA to continue its emphasis
on adolescent brain development to better understand how developmental
processes and outcomes are affected by drug exposure, the environment,
and genetics.
Translating Research Into Practice.--FoN commends NIDA for its
outreach and work with State substance abuse authorities to reduce the
current 15- to 20-year lag between the discovery of an effective
treatment intervention and its availability at the community level. In
particular, FoN applauds NIDA for continuing its work with SAMHSA to
strengthen State agencies' capacity to support and engage in research
that will foster statewide adoption of meritorious science-based
policies and practices. FoN encourages NIDA to continue this
collaboration.
Translational Research.--Ensuring Research is Adaptable and
Useable. FoN commends NIDA for its broad and varied information
dissemination programs. FoN also understands that the Institute
continues its focus on stimulating and supporting innovative research
to determine the components necessary for adopting, adapting,
delivering, and maintaining effective research-supported policies,
programs, and practices. As evidence-based strategies are developed,
FoN urges NIDA to support research to determine how these practices can
be best implemented at the community level.
Primary Care Settings and Youth.--NIDA recognizes that primary care
settings are potential key points of access to prevent and treat
problem drug use among young people. FoN encourages NIDA to continue to
support health services research on effective ways to educate primary
care providers about drug abuse and develop brief behavioral
interventions for preventing and treating drug use and related health
problems; and develop methods to integrate drug abuse screening,
assessment, prevention and treatment into primary health care settings.
Utilizing Knowledge of Genetics and New Technological Advances to
Curtail Addiction.--NIDA recognizes that not everyone who takes drugs
becomes addicted. Research has shown that genetics plays a critical
role in addiction, and that the interplay between genetics and
environment is crucial. FoN applauds the Institute's efforts to find
new and important uses for brain imaging technologies and urges the
Institute to continue work in this area.
Reducing Health Disparities.--NIDA research notes that the
consequences of drug abuse disproportionately impact minorities,
especially African American populations. FoN is pleased to learn that
NIDA continues to encourage researchers to conduct more studies in this
population and to target their studies in geographic areas where HIV/
AIDS is high and or growing among African Americans, including in
criminal justice settings.
The Clinical Trials Network--Using Infrastructure to Improve
Health.--FoN is pleased with the continued success and progress of
NIDA's National Drug Abuse Treatment Clinical Trials Network (CTN). The
CTN provides an infrastructure to test the effectiveness of new and
improved interventions in real-life community settings with diverse
populations, enabling an expansion of treatment options for providers
and patients.
Drug Treatment in Criminal Justice Settings.--NIDA is very
concerned about the well-known connections between drug use and crime.
Research continues to demonstrate that providing treatment to
individuals involved in the criminal justice system significantly
decreases future drug use and criminal behavior, while improving social
functioning. FoN strongly supports NIDA's efforts in this area,
particularly the Criminal Justice Drug Abuse Treatment Studies (CJ-
DATS).
Emerging Drug Problems.--FoN recognizes that drug use patterns are
constantly changing and is pleased with NIDA's efforts to monitor drug
use trends and to rapidly inform the public of emerging drug problems.
FoN especially encourages NIDA to continue supporting research that
provides reliable data on emerging drug trends, particularly among
youth and in major U.S. cities.
Reducing Methamphetamine Abuse.--NIDA is very concerned about the
continued abuse of methamphetamine across the United States. NIDA notes
the advances in understanding methamphetamine abuse and addiction, and
is encouraged by the growing evidence of treatment effectiveness in
these populations. FoN urges NIDA to continue supporting research to
address the broad medical consequences of methamphetamine abuse.
Reducing Inhalant Abuse.--NIDA understands and is alarmed that
inhalant use continues to be a significant problem among our youth. FoN
urges the Institute to continue its support of research on prevention
and treatment of inhalant abuse, and to enhance public awareness on
this issue.
Long-Term Consequences of Marijuana Use.--NIDA is concerned with
the continuing widespread use of marijuana. FoN urges NIDA to continue
support for efforts to assess the long-term consequences of marijuana
use on cognitive abilities, achievement, and mental and physical
health, as well as work with the private sector to develop medications
focusing on marijuana addiction.
Blending Research and Practice.--NIDA notes that it takes far too
long for clinical research results to be implemented as part of routine
patient care, and that this lag in diffusion of innovation is costly
for society, devastating for individuals and families, and wasteful of
knowledge and investments made to improve the health and quality of
people's lives. FoN applauds NIDA's collaborative approach aimed at
proactively involving all entities invested in changing the system and
making it work better.
Disseminating Drug Abuse and Addiction Research Information to the
General Public.--FoN congratulates NIDA for its collaboration with HBO
and other partners on the production of a groundbreaking documentary
film on addiction. This film details the latest scientific knowledge on
addiction and presents it in a compelling way for the lay public,
helping people to understand addiction as a brain disease that can be
successfully treated. FoN recognizes the importance of this documentary
because it shows that substance abuse happens to ordinary, every day
people, and that treatment can be very successful. The documentary
should encourage support of those who suffer from this disease, and
will reduce the stigma that so often accompanies it.
Support for Young Investigators.--NIDA recognizes the importance
of, over time, replenishing the ``pipeline'' of researchers in the
addiction field. FoN congratulates NIDA for its focus on supporting
young investigators, especially in the area of clinical research. Such
support is crucial to the future of this field, and the Institute
should continue its efforts in this area.
Thank you, Mr. Chairman, and the subcommittee, for your support for
the National Institute on Drug Abuse.
______
Prepared Statement of Gallaudet University
Mr. Chairman and members of the committee: I would like to express
my appreciation to you and to Congress for the generous support that we
received in fiscal year 2007 during what I know are difficult times for
Federal funding. I am especially grateful that Congress continues to
support us during these challenging times, and I am writing in support
of our appropriation request for fiscal year 2008. As I enter the first
months of my presidency, I would like to introduce myself to you and
discuss briefly the challenges that Gallaudet has faced during the past
year and those that it will face in the near future.
In December, 2006, I was appointed interim president of Gallaudet
following a lengthy protest, involving a broad segment of the Gallaudet
community, against the installation of the individual appointed by
Gallaudet's Board of Trustees to succeed Dr. I. King Jordan. I recently
informed the University community that the 2 months since I took office
on January 2, 2007 have been the most difficult and challenging of my
50 year career in education and government service (I have come out of
retirement for a second time to accept this challenge). At the same
time, this may be the most energized I have ever felt, as well. I do
not want to minimize the seriousness of the issues that were at the
heart of the protest, but I also want to assure you that I believe the
Gallaudet community has never been more unified in its purpose to work
together toward a future that will be worthy of Gallaudet's
distinguished past.
First though, I think it is important for you to know something
about the qualifications I bring to this task. I am a proud graduate of
Gallaudet, having received my bachelor's degree in 1953. As I have told
everyone willing to listen to my story, it was Gallaudet that prepared
me to take advantage of the opportunities that eventually became open
to me--Gallaudet made me what I am, and like many other deaf people I
will always be grateful for that. When I left Gallaudet, I became a
mathematics teacher at the New York School for the Deaf in White
Plains. After earning a Master's degree from Hunter College and a Ph.D.
in educational technology from Syracuse University, I was appointed
director of the Kendall Demonstration Elementary School and then vice
president for Pre-College Programs at Gallaudet.
Following 11 years as a Gallaudet vice president, I was appointed
by President George H. W. Bush and approved by the Senate as Assistant
Secretary of Education for Special Education and Rehabilitative
Services, where I served as the chief oversight officer for Gallaudet
and the National Technical Institute for the Deaf (NTID) until 1993.
Since then, I have served for 3 years as headmaster of the New York
School and, finally, for 8 years as vice president of the Rochester
Institute of Technology and director of NTID. I think my career
experiences have given me a unique perspective on the needs of
Gallaudet University and on its relationship with the Federal
Government.
I would like to address those needs briefly. Because of Congress's
support for Gallaudet during recent years, we have been able to
maintain a competitive pay structure for our employees while retaining
the flexibility to meet the needs of a changing student body. Given the
unique student population we serve and the communication skills our
employees are expected to possess, retaining skilled employees is
critical to our mission. Gallaudet employees received general pay
increases of 2 percent in fiscal year 2003, 3 percent in fiscal year
2004, 2 percent in fiscal year 2005, and 2 percent again in fiscal year
2006 and 2007, increases that are below what Federal employees in the
region received during the same timeframe, and somewhat below increases
in the Consumer Price Index (CPI). During the most recent 12 month
period, the national CPI-U increased by 2.1 percent and that for the
Washington, DC locality increased by 2.9 percent. Given these current
rates of inflation and a small erosion in the purchasing power or our
employee salaries in recent years, I am projecting the need for a 3
percent general pay increase in fiscal year 2008. We are also
requesting support for inflationary increases in non-salary areas,
especially in the cost of utilities and benefits. In this regard, I
need to point out that our benefits costs during the past several years
have increased by more than 2 percent of base salaries, and we have had
to fund those increases as part of our total payroll package.
The administration budget for fiscal year 2008 includes $106.998
million for Gallaudet, the same as our fiscal year 2007 and 2006
appropriations, and it would, thus, represent a second year of no
funding increase. Moreover, the administration budget proposes that
$600,000 of that base budget be used by the Department of Education for
a major evaluation of Gallaudet's programs. As a former Federal
oversight officer for Gallaudet, I understand the importance of
evaluation studies, and I would welcome working in this way with the
Federal Government, but I need to point out that taking these funds
from our existing budget would further erode our financial base. I have
carefully analyzed our fiscal year 2008 funding needs and have
determined that in order to provide a 3 percent salary increase to our
faculty and staff, and to meet other inflation-driven increases, we
need an increase of at least 3 percent, or $3.2 million, in our
appropriation for operations. I have announced a set of priorities to
the Gallaudet community that are student centered and that are designed
to restore Gallaudet's traditional reputation for excellence in the
education of deaf students. This modest increase in our appropriation
would provide substantial support for the achievement of this agenda.
In addition, I want to bring to your attention a major a problem
for Gallaudet's infrastructure. During the past several years, there
has been damage to dormitories serving the students of the Model
Secondary School for the Deaf (MSSD) as a result of instability in the
hillside site of the school's facilities. This instability is due to
the construction of the facilities on an area underlain by a layer of
marine clay, a problem that has been identified throughout the
Washington region only during the past 20 to 30 years, following the
construction of the MSSD facilities. We have discussed this problem
with officials from the Department of Education in the past, but only
with respect to the dormitories. During the past year, it has become
evident that the main MSSD academic building is now being affected and
there are threats to other buildings in the vicinity, including the
Kendall Demonstration Elementary School (KDES). We have retained soil
and structural engineers to assist us in assessing the current damage
and the future threat, and to help us estimate costs for stabilizing
the site and repairing the structural damage that has already occurred.
Because of the urgent nature of the situation we have sought the
support of the Department and are requesting funding to begin site
stabilization from Congress in fiscal year 2008. Current estimates for
stabilizing the site and repairing the existing damage are in the range
of $15 to $20 million. I am requesting $7.5 million in fiscal year 2008
to support the cost of stabilizing the site. I will be making further
requests to repair the damage to facilities in fiscal year 2009.
In making this request, I want to point out that Gallaudet has not
asked for special funding for construction for many years. The
buildings most recently constructed on the campus, the Kellogg
Conference Center and the Jordan Student Academic Center were
constructed with privately raised funds, as will be the Sorenson Center
for Language and Communication that is currently under construction.
So, I do not make this request lightly. The Model Secondary School is
operated as a public school, without charging tuition and with the full
support of the Federal Government. Therefore, I believe this request
for support is both prudent and appropriate.
FUNDING REQUEST FOR FISCAL YEAR 2008
In our budget request to the Department of Education for fiscal
year 2008, we addressed the need for inflationary increases as well as
support for program development. Given the funding issues currently
facing Congress, I am requesting support at this time only for our most
pressing inflationary needs and the need to address the infrastructure
issues I described above. Funding of our need to cover inflationary
costs will provide us some budget stability, but we will continue to
face the need for development and enhancement of our programs. Our
strategy will be to seek alternative sources of funding for some of
these program priorities and to defer development of others. We will
continue to seek support for program growth from both Federal and
private sources in the future.
--Inflationary costs at 3 percent--$3.2 million.
--MSSD site stabilization--$7.5 million.
My total request for fiscal year 2008 is, thus, $117.7 million;
$110.2 million for operations and $7.5 million for site stabilization
of the MSSD facilities.
I appreciate the challenges that Congress faces in making
appropriations decisions for fiscal year 2008, but I believe experience
has shown that Gallaudet provides an outstanding return on Federal
dollars that are invested here, in terms of the educated and productive
deaf community that the Nation enjoys as a result. Thank you.
______
Prepared Statement of the Health Professions and Nursing Education
Coalition
The members of the Health Professions and Nursing Education
Coalition (HPNEC) are pleased to submit this statement for the record
in support of the health professions education programs authorized
under Titles VII and VIII of the Public Health Service Act. HPNEC is an
informal alliance of more than 60 national organizations representing
schools, programs, health professionals, and others dedicated to
ensuring that Title VII and VIII programs continue to help educate the
Nation's health care and public health personnel. HPNEC members are
thankful for the support the subcommittee has provided to the programs,
which are essential to building a well-educated, diverse health care
workforce.
The Title VII and VIII health professions and nursing programs are
essential components of the Nation's health care safety net, bringing
health care services to underserved communities. These programs support
the training and education of health care providers with the aim of
enhancing the supply, diversity, and distribution of the workforce,
filling the gaps in the health professions' supply not met by
traditional market forces. The Title VII and VIII health professions
programs are the only Federal programs designed to train providers in
interdisciplinary settings to meet the needs of special and underserved
populations, as well as increase minority representation in the health
care workforce.
The final fiscal year 2006 Labor-HHS-Education Appropriations bill
cut Title VII & VIII programs by 34.5 percent, including a 51.5 percent
cut to Title VII programs. The $40 million increase provided for Title
VII in the recently enacted fiscal year 2007 joint funding resolution
does not restore these devastating cuts. Moreover, the President's
fiscal year 2008 budget proposes an additional 94.6 percent cut to
Title VII and a 29.7 percent cut to Title VIII.
HPNEC members recommend that the Title VII and VIII programs
receive an appropriation of at least $550 million for fiscal year 2008.
This recommendation would ensure the programs have sufficient funds to
continue fulfilling their mission of educating and training a health
care workforce that meets the public's health care needs.
During their 40-year existence, the Title VII and VIII programs
have created a network of initiatives across the country that supports
the training of many disciplines of health providers. Together, the
programs work in concert with the National Health Service Corps and
Community Health Centers (CHCs) to strengthen the health safety net for
rural and medically underserved communities. A March 2006 study
published in the Journal of the American Medical Association (JAMA)
found that CHCs report high percentages of provider vacancies,
including an insufficient supply of dentists, pharmacists,
pediatricians, family physicians, and registered nurses; these
shortages are especially pronounced in rural areas. Because Title VII
and VIII programs have a successful record of training providers who
serve underserved areas, the study recommends increased support for the
programs as its primary means of alleviating the shortages. Further,
the study serves as an important reminder that the success of CHCs is
highly dependent upon a well-trained clinical staff to provide care.
HPNEC members urge the subcommittee to consider the vital need for
these health professions education programs as demonstrated by the
passage of the Health Professions Education Partnerships Act of 1998
(Public Law 105-392), which reauthorized the programs. The
reauthorization consolidated the programs into seven general
categories:
--The purpose of the Minority and Disadvantaged Health Professionals
Training programs is to improve health care access in
underserved areas and the representation of minority and
disadvantaged health care providers in the health professions.
Minority Centers of Excellence support programs that seek to
increase the number of minority health professionals through
increased research on minority health issues, establishment of
an educational pipeline, and the provision of clinical
opportunities in community-based health facilities. The Health
Career Opportunity Program seeks to improve the development of
a competitive applicant pool through partnerships with local
educational and community organizations. The Faculty Loan
Repayment and Faculty Fellowship programs provide incentives
for schools to recruit underrepresented minority faculty. The
Scholarships for Disadvantaged Students (SDS) make funds
available to eligible students from disadvantaged backgrounds
who are enrolled as full-time health professions students.
--The Primary Care Training category, including General Pediatrics,
General Internal Medicine, Family Medicine, General Dentistry,
Pediatric Dentistry, and Physician Assistants, provides for the
education and training of primary care physicians, dentists,
and physician assistants to improve access and quality of
health care in underserved areas. The General Pediatrics,
General Internal Medicine, and Family Medicine programs provide
critical funding for primary care training in community-based
settings and have been successful in directing more primary
care physicians to work in underserved areas. They support a
range of initiatives, including medical student training,
residency training, faculty development and the development of
academic administrative units. The General Dentistry and
Pediatric Dentistry programs provide grants to dental schools
and hospitals to create or expand primary care dental residency
training programs. Recognizing that all primary care is not
only provided by physicians, the primary care cluster also
provides grants for Physician Assistant programs to encourage
and prepare students for primary care practice in rural and
urban Health Professional Shortage Areas. Additionally, these
programs enhance the efforts of osteopathic medical schools to
continue to emphasize primary care medicine, health promotion,
and disease prevention, and the practice of ambulatory medicine
in community-based settings.
--Because much of the Nation's health care is delivered in areas far
removed from health professions schools, the Interdisciplinary,
Community-Based Linkages cluster provides support for
community-based training of various health professionals. These
programs are designed to provide greater flexibility in
training and to encourage collaboration between two or more
disciplines. These training programs also serve to encourage
health professionals to return to such settings after
completing their training. The Area Health Education Centers
(AHECs) provide clinical training opportunities to health
professions and nursing students in rural and other underserved
communities by extending the resources of academic health
centers to these areas. Health Education and Training Centers
(HETCs) were created to improve the supply of health
professionals along the U.S.-Mexico border. They incorporate a
strong emphasis on wellness through public health education
activities for disadvantaged populations. Geriatric Health
Professions programs support geriatric faculty fellowships, the
Geriatric Academic Career Award, and Geriatric Education
Centers, which are all designed to bolster the number and
quality of health care providers caring for our older
generations. The Quentin N. Burdick Program for Rural Health
Interdisciplinary Training places an emphasis on long-term
collaboration between academic institutions, rural health care
agencies and providers to improve the recruitment and retention
of health professionals in rural areas. The Allied Health
Project Grants program represents the only Federal effort aimed
at supporting new and innovative education programs designed to
reduce shortages of allied health professionals and create
opportunities in medically underserved and minority areas. The
Graduate Psychology Education Program provides grants to
doctoral, internship and postdoctoral programs in support of
interdisciplinary training of psychology students with other
health professionals for the provision of mental and behavioral
health services to underserved populations, especially in rural
and urban communities.
--The Health Professions Workforce and Analysis program provides
grants to institutions to collect and analyze data on the
health professions workforce to advise future decision-making
on the direction of health professions and nursing programs.
The Health Professions Research and Health Professions Data
programs have developed a number of valuable, policy-relevant
studies on the distribution and training of health
professionals, including the Eighth National Sample Survey of
Registered Nurses (NSSRN), the Nation's most extensive and
comprehensive source of statistics on registered nurses.
--The Public Health Workforce Development programs are designed to
increase the number of individuals trained in public health, to
identify the causes of health problems, and respond to such
issues as managed care, new disease strains, food supply, and
bioterrorism. The Public Health Traineeships and Public Health
Training Centers seek to alleviate the critical shortage of
public health professionals by providing up-to-date training
for current and future public health workers, particularly in
underserved areas. Preventive Medicine Residencies provide
training in the only medical specialty that teaches both
clinical and population medicine to improve community health.
Dental Public Health Residency programs are vital to the
Nation's dental public health infrastructure. The Health
Administration Traineeships and Special Projects grants are the
only Federal funding provided to train the managers of our
health care system, with a special emphasis on those who serve
in underserved areas.
--The Nursing Workforce Development programs under Title VIII provide
training for entry-level and advanced degree nurses to improve
the access to, and quality of, health care in underserved
areas. Health care entities across the Nation are experiencing
a crisis in nurse staffing, caused in part by an aging
workforce and capacity limitations within the educational
system. Each year, nursing schools turn away between 42,000 and
92,000 qualified applicants at all degree levels due to an
insufficient number of faculty, clinical sites, classroom
space, clinical preceptors, and budget constraints. Congress
responded to this dire national need by passing the Nurse
Reinvestment Act (Public Law 107-205) in 2002, which increases
nursing education, retention, and recruitment. The Advanced
Education Nursing program awards grants to train a variety of
advanced practice nurses, including nurse practitioners,
certified nurse-midwives, nurse anesthetists, public health
nurses, nurse educators, and nurse administrators. Workforce
Diversity grants support opportunities for nursing education
for disadvantaged students through scholarships, stipends, and
retention activities. Nurse Education, Practice, and Retention
grants are awarded to help schools of nursing, academic health
centers, nurse managed health centers, State, and local
governments, and other health care facilities to develop
programs that provide nursing education, promote best
practices, and enhance nurse retention. The Loan Repayment and
Scholarship Program repays up to 85 percent of nursing student
loans and offers full-time and part-time nursing students the
opportunity to apply for scholarship funds. In return these
students are required to work for at least 2 years of practice
in a designated nursing shortage area. The Comprehensive
Geriatric Education grants are used to train RNs who will
provide direct care to older Americans, develop and disseminate
geriatric curriculum, train faculty members, and provide
continuing education. The Nurse Faculty Loan program provides a
student loan fund administered by schools of nursing to
increase the number of qualified nurse faculty. The Title VIII
nursing programs also support the National Advisory Council on
Nurse Education and Practice, which is charged with advising
the Secretary of Health and Human Services and Congress on
nursing workforce, education, and practice improvement issues.
--The loan programs in the Student Financial Assistance support needy
and disadvantaged medical and nursing school students in
covering the costs of their education. The Nursing Student Loan
(NSL) program provides loans to undergraduate and graduate
nursing students with a preference for those with the greatest
financial need. The Primary Care Loan (PCL) program provides
loans covering the cost of attendance in return for dedicated
service in primary care. The Health Professional Student Loan
(HPSL) program provides loans covering the cost of attendance
for financially needy health professions students based on
institutional determination. The NSL, PCL, and HPSL programs
are funded out of each institution's revolving fund and do not
receive Federal appropriations. The Loans for Disadvantaged
Students (LDS) program provides grants to health professions
institutions to make loans to health professions students from
disadvantaged backgrounds.
These programs work collectively to fulfill their unique, three-
pronged mission:
Title VII & VIII programs enhance the supply of the health professions
workforce
A network of 50 Geriatric Education Centers has trained over
500,000 health practitioners in 35 health-related disciplines to better
serve the burgeoning elderly population.
As the largest source of Federal funding for nursing education, the
Nursing Workforce Development programs provided loan, scholarship, and
programmatic support to 48,698 student nurses and nurses in fiscal year
2006.
Title VII & VIII programs improve the distribution of health care
providers
A study published in the Winter 2006 issue of the Journal of Rural
Health reports that up to 83 percent of family medicine residents and
80 percent of nurse practitioners who went through a program with Title
VII or VIII funding chose to practice in areas with health professions
shortages or medically underserved practice locations.
A study from the University of California, San Francisco shows that
medical schools that receive primary care training dollars produce more
physicians who work in CHCs and serve in the National Health Service
Corps compared to schools without Title VII primary care funding.
Title VII & VIII programs increase the representation of minority and
disadvantaged students in the health professions
A study published in the September 2006 issue of the JAMA finds
that post-baccalaureate programs, which rely on Title VII among other
sources of funding, are highly effective in increasing minority
representation in medical school. The study concludes that enacted
reductions in funding for Title VII may have negative consequences for
these effective programs.
A review of physician assistant graduates from 1990-2004 reveals
that graduates of Title VII supported programs were 67 percent more
likely to be from underrepresented minority backgrounds than graduates
of non-Title VII supported programs.
HPNEC members respectfully urge support for funding of at least
$550 million for the Title VII and VIII programs, an investment
essential not only to the development and training of tomorrow's health
care professions but also to our Nation's efforts to provide needed
health care services to underserved and minority communities. We
greatly appreciate the support of the subcommittee and look forward to
working with Members of Congress to achieve these goals in fiscal year
2008 and into the future.
______
Prepared Statement of the Heart Rhythm Society
The Heart Rhythm Society (HRS) thanks you and the Subcommittee on
Labor, Health and Human Services and Education for your past and
continued support of the National Institute of Health, and specifically
the National Heart, Lung and Blood Institute (NHLBI).
The Heart Rhythm Society, founded in 1979 to address the scarcity
of information about the diagnosis and treatment of cardiac
arrhythmias, is the international leader in science, education and
advocacy for cardiac arrhythmia professionals and patients, and the
primary information resource on heart rhythm disorders. The Heart
Rhythm Society serves as an advocate for millions of American citizens
from all 50 States, since arrhythmias are the leading cause of heart-
disease related deaths. Other, less lethal forms of arrhythmias are
even more prevalent, account for 14 percent of all hospitalizations of
Medicare beneficiaries.\1\ A Our mission is to improve the care of
patients by promoting research, education and optimal health care
policies and standards. We are the preeminent professional group,
representing more than 4,200 specialists in cardiac pacing and
electrophysiology.
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\1\ Heart Rhythm Foundation, Arrhythmia Key Facts, 2004 http://
www.heartrhythmfoundation.org/facts/arrhythmia.asp
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The Heart Rhythm Society recommends the subcommittee renew its
commitment to supporting biomedical research in the United States and
recommends Congress provide NIH with a 6.7 percent increase for fiscal
year 2008. This increase will enable NIH and NHLBI to sustain the level
of research that leads to research breakthroughs and improved health
outcomes. In particular, the Heart Rhythm Society recommends Congress
support research into abnormal rhythms of the heart.
HRS appreciates the actions of Congress to double the budget of the
NIH in recent years. The doubling has directly promoted innovations
that have improved treatments and cures for a myriad of medical
problems facing our Nation. Medical research is a long-term process and
in order to continue to meet the evolving challenges of improving human
health we must not let our commitment wane. Furthermore, NIH research
fuels innovation that generates economic growth and preserves our
Nation's role as a world leader in the biomedical and biotech
industries. Healthier citizens are the key to robust economic growth
and greater productivity. Economists estimate that improvements in
health from 1970 to 2000 were worth $95 trillion. During the same time
period, the United States invested $200 billion in the NIH. If only 10
percent of the overall health savings resulted from NIH-funded
research, our investment in medical research has provided a 50-fold
return to the economy.\2\
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\2\ Murphy, KM and Topel, RH, The Value of Health and Longevity,
National Bureau of Economic Research Working Paper Series, Working
Paper 11405, June 2005.
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Unfortunately, since the end of the doubling in 2003, funding for
NIH has failed to keep pace with biomedical inflation. As a result 13
percent of NIH's purchasing power has been lost. Because of this NIH
has been unable to fully fund existing multi-year grants, thus stalling
life-saving discoveries. If these vacillations in funding continue,
future generations of researchers will become discouraged from pursuing
a career in basic science and laboratories' resources could be strained
to the point of forcing lay-offs and even closure.
RESEARCH ACCOMPLISHMENTS
In the field of cardiac arrhythmias, NIH-funded research has
advanced our ability to treat atrial fibrillation and thus prevent the
devastating complications of stroke. Atrial fibrillation is found in
about 2.2 million Americans and increases the risk for stroke about 5-
fold. About 15-20 percent of strokes occur in people with atrial
fibrillation. Stroke is a leading cause of serious, long-term
disability in the United States and people who have strokes caused by
AF have been reported as 2-3 times more likely to be bedridden compared
to those who have strokes from other causes. Each year about 700,000
people experience a new or recurrent stroke and in 2002 stroke
accounted for more than 1 of every 15 deaths in the United States.
Ablation therapy however is providing a cure for individuals whose
rapid heart rates had previously incapacitated them, giving them a new
lease on life.\3\
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\3\ American Stroke Association and American Heart Association,
Heart Disease and Stroke Statistics_2005 Update, 2005 http://
www.americanheart.org/downloadable/heart/
1105390918119HDSStats2005Update.pdf
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Important advances have also been made in identifying patients with
heart failure and those who have suffered a heart attack and are at
risk for sudden death. The development, through initial NIH-sponsored
research, and implantation of sophisticated internal cardioverter
defibrillators (ICD's) in such patients has saved the lives of hundreds
of thousands and provides peace of mind for families everywhere,
including that of Vice-President Cheney's. A new generation of
pacemakers and ICDs is restoring the beat of the heart as we grow
older, permitting us to lead more normal and productive lives, reducing
the burden on our families, communities and the healthcare system.
Arrhythmias and sudden death affect all age groups and are not solely
diseases of the elderly.
Research advances in molecular genetics have provided us the root
basis for life-threatening abnormal rhythms of the heart associated
with of wide range of inherited syndromes including long and short QT,
Brugada syndromes, and hypertrophic cardiomyopathies. Inroads have been
achieved in the identification of cardiac arrhythmias as a cause of
Sudden Infant Death Syndrome (SIDS) and the genetic basis for a new
clinical entity associated with sudden death of young adults was
uncovered earlier this year. This knowledge has provided guidance to
physicians for better detection and treatment of these sudden death
syndromes reducing mortality and disability of infants, children and
young adults. Individuals who survive an instance of sudden death often
remain in vegetative states, resulting in a devastating burden on their
families and an enormous economic burden on society. These advances
have translated into sizeable savings to the health care system in the
United States. Researchers are also developing a noninvasive imaging
modality for cardiac arrhythmias. Despite the fact that more than
325,000 Americans die every year from heart rhythm disorders, a
noninvasive imaging approach to diagnosis and guided therapy of
arrhythmias, the equivalent of CT or MRI, has previously not been
available.
The NIH-funded Public Access Defibrillation (PAD) Trial was also
able to determine that trained community volunteers increase survival
for victims of cardiac arrest. It had already been known that
defibrillation, utilizing an automated external defibrillator (AED), by
trained public safety and emergency medical services personnel is a
highly effective live-saving treatment for cardiac arrest. A NIH-funded
trial however was able to conclude that placing AED's in public places
and training lay persons to use them can prevent additional deaths and
disabilities.\4\
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\4\ National Heart Lung and Blood Institute, NIH, Public Access
Defibrillation by Trained Community Volunteers Increases Survival for
Victims of Cardiac Arrest, November 2003 http://www.nhlbi.nih.gov/new/
press/03-11-11.htm
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Without NIH support, these life-saving findings may have taken a
decade to unravel. The highly focused approach utilizing basic and
clinical expertise, funded through Federal programs made these advances
a reality in a much shorter time-period.
BUDGET JUSTIFICATION
These impressive strides notwithstanding, cardiac arrhythmias
continue to plague our society and take the lives of loved ones at all
ages, nearly one every minute of every day, as well as straining an
already burdened health system. Sudden Cardiac Arrest is a leading
cause of death in the United States, claiming an estimated 325,000
lives every year, or one life every 2 minutes.\5\ The burden of
morbidity and mortality due to cardiac arrhythmias is predicted to grow
dramatically as the baby boomers age. Atrial fibrillation strikes 3-5
percent of people over the age of 65,\6\ Apresenting a skyrocketing
economic burden to our society in the form of healthcare treatment and
delivery. Cardiac diseases of all forms increase with advancing age,
ultimately leading to the development of arrhythmias. Effective drug
therapy for the management of atrial fibrillation is one of the
greatest unmet needs in our society today and additional research is
needed to address this problem. NIH research provides the basis for the
medical advances that hold the key to lowering health care costs.
---------------------------------------------------------------------------
\5\ Heart Rhythm Foundation, The Facts on Sudden Cardiac Arrest,
2004 http://www.heartrhythmfoundation.org/itsabouttime/pdf/
providerfactsheet.pdf
\6\ Heart Rhythm Society, Atrial Fibrillation & Flutter, 2005
http://www.hrspatients.org/patients/heart disorders/atrial
fibrillation/default.asp
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The above progress we have witnessed in recent years will provide
treatments for this illness, only if the resources continue to be
available to the academic scientific and medical community. However,
the budgets appropriated by Congress to the NIH in the past 3 years
were far below the level of scientific inflation. These vacillations in
funding cycles threaten the continuity of the research and the momentum
that has been gained over the years. While HRS recognizes that Congress
must balance other priorities, sustaining multi-year growth for the
biomedical research enterprise is critical. A central objective of the
doubling of the NIH budget was to accelerate solutions to human disease
and disability. NIH is now engaging in the next generation of
biomedical research to translate basic research and clinical evidence
into new cures. Our ability to bring together uniquely qualified and
devoted investigators and collaborators both at the basic science level
and in the clinical arena is a vital key to our to this success.
Funding models however show that a threshold exists, below which NIH
will not be able to maintain its current scope and number of grants,
let alone expand its programs to address new concerns and emerging
opportunities. Furthermore, the United States is in danger of losing
its leadership role in science and technology. The United States faces
growing competition from other nations, such as China and India, which
are working to invest more of their GDP's into building state-of-the
art research institutes and universities to foster innovation and
compete directly for the world's top students and researchers.\7\
---------------------------------------------------------------------------
\7\ Task Force on the Future of American Innovation, The Knowledge
Economy: Is the United States Losing it's Competitive Edge?, February
16, 2005.
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It is for this reason that we are asking for your support to
increase NIH appropriations by 6.7 percent for fiscal year 2008. The
Heart Rhythm Society recommends Congress specifically acknowledge the
need for cardiac arrhythmia research to prevent sudden cardiac arrest
and other life threatening conditions such as sudden infant death
syndrome, definitive therapeutic approaches for atrial fibrillation and
the prevention of stroke, and other genetic arrhythmia conditions.
Thank you very much for your consideration of our request.
If you have any questions or need additional information, please
contact Nevena Minor, Coordinator, Health Policy at the Heart Rhythm
Society (nminor@hrsonline.org or 202-464-3431).
Thank you again for the opportunity to submit testimony.
______
Prepared Statement of the Hepatitis Foundation International
SUMMARY OF FISCAL YEAR 2007 RECOMMENDATIONS
Continue the great strides in research at the National Institutes
of Health (NIH) by providing a 6.7 percent budget increase for fiscal
year 2008. Increase funding for the National Institute for Allergy and
Infectious Diseases (NIAID), the National Institute of Diabetes and
Digestive and Kidney Diseases (NIDDK), the National Institute on
Alcohol Abuse and Alcoholism (NIAAA), and the National Institute on
Drug Abuse (NIDA) by 6.7 percent.
Continued support for the hepatitis B vaccination program for
adults at the Centers for Disease Control and Prevention (CDC) as well
as CDC's Prevention Research Centers by providing an 8 percent increase
for CDC.
Support for the Substance Abuse and Mental Health Services
Administration (SAMHSA) by providing an 8 percent increase in fiscal
year 2007.
Urge CDC, NIAID, NIDDK, NIAAA, NIDA, and SAMHSA to work with
voluntary health organizations to promote liver wellness, education,
and prevention of both hepatitis and substance abuse.
Mr. Chairman and members of the subcommittee, thank you for your
continued leadership in promoting better research, prevention,
education, and control of diseases affecting the health of our Nation.
I am Thelma King Thiel, Chairman and Chief Executive Officer of the
Hepatitis Foundation International (HFI).
Currently, five types of viral hepatitis have been identified,
ranging from type A to type E. All of these viruses cause acute, or
short-term, viral hepatitis. Hepatitis B, C, and D viruses can also
cause chronic hepatitis, in which the infection is prolonged, sometimes
lifelong. While treatment options are available for many patients,
individuals with chronic viral hepatitis B and C represent a
significant number of the patients that require a liver transplant.
Current treatments have limited success and there is no vaccine
available for hepatitis C, the most prevalent of these diseases.
HEPATITIS B
Hepatitis B (HBV) claims an estimated 5,000 lives every year in the
United States, even though therapies exist that slow the progression of
liver damage. Vaccines are available to prevent hepatitis B. This
disease is spread through contact with the blood and body fluids of an
infected individual and from an HBV infected mother to child at birth.
Unfortunately, due to both a lack in funding to vaccinate adults and
the absence of an integrated preventive education strategy,
transmission of hepatitis B continues to be problematic. Additionally,
there are significant disparities in the occurrence of chronic HBV-
infections. For example, Asian Americans represent 4 percent of the
population; however, they account for more than half of the 1.3 million
chronic hepatitis B cases in the United States. Current treatments do
not cure hepatitis B, but appropriate treatment can help to reduce the
progression to liver cancer and liver failure. Yet, many are not
treated. Preventive education and universal vaccination are the best
defenses against hepatitis B.
HFI supports the recommendation to increase funding by $50 million
for the cost of vaccines for adults offered by the Institute of
Medicine in their report, entitled ``Calling the Shots: Immunization
Finance Policies and Practices.''
HEPATITIS C
Infection rates for hepatitis C (HCV) are at epidemic proportions.
Unfortunately, many individuals are not aware of their infection until
many years after they are infected. This creates a dangerous situation,
as individuals who are infected unknowingly continue to spread the
disease. The Center for Disease Control and Prevention estimates that
there are over 4 million Americans who have been infected with
hepatitis C, of which over 2.7 million remain chronically infected,
with 8,000-10,000 deaths each year. Additionally, the death rate is
expected to triple by 2010 unless additional steps are taken to improve
outreach and education on the prevention of hepatitis C and scientists
identify more effective treatments and cures. As there is no vaccine
for HCV, prevention education and treatment of those who are infected
serve as the most effective approach in halting the spread of this
disease.
PREVENTION IS THE KEY
The absence of information about the liver and hepatitis in
education programs over the years has been a major factor in the spread
of viral hepatitis through unknowing participation in liver damaging
activities. Adults and children need to understand the importance of
the liver and how viruses and drugs can damage its ability to keep them
alive and healthy. Many who are currently infected are unaware of the
risks they are taking that expose them to viral infections and
ultimately liver damage.
Knowledge is the key to prevention. Preventive education is
essential to motivate individuals to protect themselves and avoid
behaviors that can cause life-threatening diseases. Primary prevention
that encourages individuals to adopt healthful lifestyle behaviors must
begin in elementary schools when children are receptive to learning
about their bodies. In addition to educating individuals at a critical
age, schools provide access to one-fifth of the American population.
Individuals need to be motivated to assess their own risk
behaviors, to seek testing, to accept vaccination, to avoid spreading
their disease to others, and to understand the importance of
participating in their own health care and disease management. The NIH
needs to support education programs to train teachers and healthcare
providers in effective communication techniques, and to evaluate the
impact preventive education has on reducing the incidence of hepatitis
and substance abuse.
Therefore, HFI recommends that CDC, NIAID, NIDDK, NIAAA, NIDA, and
SAMHSA be urged to work with voluntary health organizations to promote
liver wellness, education, and prevention of viral hepatitis, sexually
transmitted diseases and substance abuse.
Only a major investment in immunization and preventive education
will bring these diseases under control. All newborns, young children,
young adults, and especially those who participate in high-risk
behaviors must be a priority for immunization, outreach initiatives,
and preventive education. We recommend that the following activities be
undertaken to prevent the further spread of all types of hepatitis:
--Provide effective preventive education in our elementary and
secondary schools so children can avoid the serious health
consequences of risky behaviors that can lead to viral
hepatitis.
--Train educators, health care professionals, and substance abuse
counselors in effective communication and counseling
techniques.
--Promote public awareness campaigns to alert individuals to assess
their own risk behaviors, motivate them to seek medical advice,
encourage immunization against hepatitis A and B, and to stop
the consumption of any alcohol if they have participated in
risky behaviors that may have exposed them to hepatitis C.
--Expand screening, referral services, medical management,
counseling, and prevention education for individuals who have
HCV, many of whom may be co-infected with HIV and Hepatitis C
and/or Hepatitis B.
CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC)
HFI recommends an increase of $12 million in fiscal year 2008 for
further implementation of CDC's Hepatitis C Prevention Strategy. Such
an increase would bring the total funding level for the Hepatitis C
Prevention Strategy to $30 million in fiscal year 2008. This increase
will support and expand the development of state-based prevention
programs by increasing the number of State health departments with CDC
funded hepatitis coordinators. The Strategy will use the most cost-
effective way to implement demonstration projects evaluating how to
integrate hepatitis C and hepatitis B prevention efforts into existing
public health programs.
CDC's Prevention Research Centers, an extramural research program,
plays a critical role in reducing the human and economic costs of
disease. Currently, CDC funds 26 prevention research centers at schools
of public health and schools of medicine across the country. HFI
encourages the subcommittee to increase core funding for these
prevention centers, as it has been decreasing since this program was
first funded in 1986. We recommend the subcommittee provide an 8
percent increase for the Prevention Research Centers program in fiscal
year 2008.
Also, HFI recommends that the CDC, particularly the Division of
Adolescent and School Health (DASH), work with voluntary health
organizations to promote liver wellness with increased attention toward
childhood education and prevention, especially through partnerships
between school districts and non-governmental organizations.
INVESTMENTS IN RESEARCH
Investment in the NIH has led to an explosion of knowledge that has
advanced understanding of the biological basis of disease and
development of strategies for disease prevention, diagnosis, treatment,
and cures. Countless medical advances have directly benefited the lives
of all Americans. NIH-supported scientists remain our best hope for
sustaining momentum in pursuit of scientific opportunities and new
health challenges. For example, research into why some HCV infected
individuals resolve their infection spontaneously may prove to be life
saving information for others currently infected. Other areas that need
to be addressed are:
--Reasons why African Americans do not respond as well as Caucasians
and Hispanics to antiviral agents in the treatment of chronic
hepatitis C.
--Pediatric liver diseases, including viral hepatitis.
--The outcomes and treatment of renal dialysis patients who are
infected with HCV and HBV.
--Co-infections of HIV/HCV and HIV/HBV positive patients.
--Hemophilia patients who are co-infected with HIV/HCV and HIV/HBV.
--The development of effective treatment programs to prevent
recurrence of HCV infection following liver transplantation.
--The development of effective vaccines to prevent HCV infection.
HFI supports a 6.7 percent increase for NIH in fiscal year 2008.
HFI also recommends a comparable increase of 6.7 percent in hepatitis
research funding at NIAID, NIDDK, NIAAA, and NIDA.
HFI is dedicated to the eradication of viral hepatitis, which
affects over 500 million people around the world. We seek to raise
awareness of this enormous worldwide problem and to motivate people to
support this important--and winnable--battle. Thank you for providing
this opportunity to present testimony.
______
Prepared Statement of the HIV Medicine Association
The HIV Medicine Association (HIVMA) of the Infectious Diseases
Society of America represents more than 3,600 physicians, scientists
and other health care professionals who practice on the frontline of
the HIV/AIDS pandemic. Our members treat people with HIV/AIDS
throughout the United States and the world, develop and implement
effective prevention interventions, and conduct research to develop
effective prevention technologies, effective vaccines and less complex
and less toxic treatment regimens for use in the United States and
abroad. They are medical providers that specialize in HIV medicine and
work in communities across the country and in more than 150 countries
outside of the United States.
The United States must sustain our three-pronged response to the
AIDS pandemic--conducting research to effectively prevent and treat HIV
disease; supporting programs that identify persons infected with HIV
and prevent or reduce HIV transmission; and providing access to
lifesaving HIV treatment to people without a reliable source of health
coverage. Our past commitments resulted in our ability to develop, and
provide access to, remarkable treatments that effectively suppress HIV
and allow people to live healthier, more productive lives here at home
and abroad. In recent years, we have been deeply concerned by our
country's failure to prioritize support for domestic discretionary
programs outside of defense and homeland security. The impact of our
failure to invest in health care programs is already being felt and
will be far-reaching and long lasting as our communities' public health
infrastructures weaken and our capacity to lead the world in
discovering new therapies for controlling deadly diseases such as HIV
erodes.
The funding requests in our testimony largely represent the
consensus of the Federal AIDS Policy Partnership (FAPP), a coalition of
HIV/AIDS organizations from across the country, and are estimated to be
the amounts necessary to sustain and strengthen our investment in
effectively combating HIV disease.
CDC'S NATIONAL CENTER FOR HIV, STD, TB PREVENTION (NCHSTP)
HIVMA strongly supports substantial increases in funding for the
National Center for HIV/AIDS, STD and TB Prevention programs at the
CDC. Programs supported by NCHSTP play a critical role in reducing the
40,000 new HIV infections that still occur annually in the United
States. Sufficient resources must be devoted to supporting efforts to
identify people with HIV earlier in the disease so that they can be
effectively linked to the medical care and treatment that prevents or
delays progression to AIDS. Tuberculosis is the major cause of AIDS-
related mortality worldwide. It is critical that we shore up our
ability as a Nation to address tuberculosis, especially drug-resistant
tuberculosis here in the United States and in the developing world.
With regard to these programs, we urge at least an increase of $93
million for domestic HIV prevention programs and a funding level of
$252.4 million for CDC's Division of Tuberculosis Elimination.
In the absence of an HIV vaccine, preventing new HIV transmissions
is our best weapon in reducing the number of people newly infected with
HIV disease each year. We strongly support the CDC guidance
recommending routine HIV testing for adults in healthcare settings, but
are gravely concerned about the absence of Federal resources to assist
State health departments and healthcare institutions in implementing
this guidance. According to the CDC, at least 25 percent of people with
HIV infection in the United States do not know it and more than 39
percent of people with HIV infection progress to AIDS within 1 year of
diagnosis. The expansion of HIV testing to identify individuals who are
infected with HIV, but not yet aware of their status, is vital so that
they can be optimally treated early in disease progression, and can
reduce risky behaviors that put others at risk for HIV transmission.
An even more robust HIV prevention budget is necessary to conduct
effective surveillance, and to target uninfected individuals who engage
in high-risk behaviors if we are to dramatically reduce the 40,000 new
HIV infections that occur each year in the United States. We also must
continue to support science-based, comprehensive programs that target
people who are not HIV positive but who are at high risk for HIV
infection. We are seriously concerned that the resources committed to
supporting a broad-based prevention agenda have diminished while
funding for unproven and unscientific abstinence-only programs has
increased. We strongly encourage Congress to halt this troubling trend.
Adequate resources are needed to address the high prevalence rates
among vulnerable populations, e.g., men and women of color and men who
have sex with men. It is short sighted to compromise these programs in
order to support newer initiatives.
Funding for HIV prevention activities at the CDC should be
increased by at least the $93 million recommended in the President's
2008 budget. These resources should be utilized to restore the $26
million cut in HIV prevention cooperative agreements with State and
local health departments, to enhance core surveillance cooperative
agreements with health departments and to expand HIV testing in
critical health care venues by funding testing infrastructure, the
purchase of approved testing devices, including rapid tests and
confirmatory testing.
Funding for tuberculosis prevention and control must increase
substantially in order to address the emerging new threat of XDR-TB.
HIVMA supports the recommendation of the Advisory Council for the
Elimination of Tuberculosis (ACET) for a funding level of $252.4
million for CDC's Division of Tuberculosis Elimination.
HIV/AIDS BUREAU OF THE HEALTH RESOURCES AND SERVICES ADMINISTRATION
HIVMA supports a total commitment of $2.79 billion, an increase of
$682 million for the Ryan White CARE Act program. This recommendation
includes a $233 million increase for the AIDS Drug Assistance Program
(ADAP) and at least an increase of $35 million for Title III (Part C).
The Health Resources and Services Administration (HRSA) oversees
programs that are vital to our communities' health care safety nets--
and to the ability of our clinician members to provide state-of-the-art
treatment and care to patients living with HIV/AIDS. Through grants to
States, cities and community clinics, CARE Act funding helps us to meet
the serious and complex needs of people with HIV/AIDS who are un- or
under-insured by supporting the delivery of primary medical care,
prescription drugs, diagnostic tests, mental health services, substance
abuse treatment, and dental services in our communities.
We strongly support a substantial increase in CARE Act funding and
would propose that the majority of new funding be targeted to HIV
medical care under Title III (Part C) and to the AIDS Drug Assistance
Program (ADAP) to ensure that uninsured and underinsured individuals
with HIV/AIDS have access to a base line of lifesaving medical care and
prescription drugs regardless of where they live. Funding increases are
urgently needed for Title III programs. After years of flat funding or
decreases in grant awards, we estimate that these programs require an
increase of $83.3 million in Federal funds. At a minimum, we urge you
to include a $35 million increase for Title III, Part C programs, with
this additional funding targeted to current Title III grantees with the
highest demonstrated increases in patient caseloads.
Many HIV clinical programs depend on funding from multiple parts of
the CARE Act to create the comprehensive services that our patients
need. We strongly encourage you to support funding increases of $65
million for Title I, and $57 million for the Title II base. Resources
for domestic HIV care and treatment have eroded dramatically and this
trend must be reversed or AIDS mortality in the United States could
increase dramatically.
NATIONAL INSTITUTES OF HEALTH (NIH)
HIVMA strongly supports at least a 6.7 percent increase for all
research programs at the National Institutes of Health (NIH) including
a 6.7 percent for the NIH Office of AIDS research for fiscal year 2007.
This level of increase, if sustained over several years, would halt the
erosion in the Nation's medical research effort, and accelerate the
pace of research that could improve the health and quality of life for
millions of Americans.
The failure in recent years to adequately invest in biomedical
research is taking its toll in deep cuts to clinical trials networks
and significant reductions in the numbers of high quality,
investigator-initiated grants that are approved. In the arena of AIDS
research, virtual flat funding leads to reductions in critical research
efforts to develop new therapeutics, to support the development of
effective prevention technologies, and to finance vaccine development.
A robust and comprehensive portfolio has been largely responsible for
the dramatic gains that have been made in our knowledge about and
response to the HIV virus, gains that have resulted in reductions in
mortality from AIDS in the United States and other developing countries
of nearly 80 percent. A continuing robust AIDS research effort is
essential if we are to continue to make progress in preventing new
infections, offering potent treatments with minimal toxicity, and
developing a vaccine that may ultimately end the deadliest pandemic in
human history. Our failure to make an adequate investment in this
lifesaving research will compromise our ability to compare and evaluate
optimum treatment and prevention strategies in resource-poor countries,
and limit our ability to understand the appropriate role of new classes
of antiretrovirals that are currently in development here at home for
treatment and prevention.
The sheer magnitude of the number of people still living with HIV/
AIDS in the United States and around the world--1,039,000 to 1,185,000
in the United States; 40 million globally--demands an increased
investment in AIDS research if we are going to truly eradicate this
devastating disease.
We also strongly support the NIH's Fogarty International Center
(FIC), and believe that its programs and funding should be expanded.
The FIC training programs play a critical role in developing self-
sustaining health care infrastructures in resource-limited countries.
By training local physicians in these countries, they are able to
develop effective research programs that best address the health care,
cultural and resource needs of residents in their respective countries.
Our Nation has made significant strides in responding to the HIV/
AIDS pandemic here at home and around the world, but we have lost
ground in recent years, particularly domestically, as funding
priorities have shifted away from public health and research programs.
This retreat on our past investments in AIDS research through NIH,
surveillance and prevention programs through the CDC, and care and
treatment through the Ryan White CARE Act program place the remarkable
advancements of the past two decades in serious jeopardy. We have an
opportunity to reverse this trend and to move forward with a budget
that prioritizes funding for scientific discovery, public health, and
care and treatment for those without resources or adequate insurance.
With the support of this Congress, we have the opportunity to further
limit the toll of this deadly infectious disease on our planet and to
save the lives of millions who are infected or at risk of infection
here in the United States and around the world.
______
Prepared Statement of the Infectious Diseases Society of America
The Infectious Diseases Society of America (IDSA) appreciates the
opportunity to provide this statement to the Senate Appropriations
Subcommittee on Labor, Health and Human Services, Education and Related
Agencies concerning fiscal year 2008 Federal funding for the Centers
for Disease Control and Prevention (CDC) and the National Institutes of
Health (NIH). IDSA's statement speaks to the value of U.S. public
health and infectious diseases research programs to the health of
people in the United States and globally as well as the need to provide
sufficient funding in fiscal year 2008 to sustain and improve these
programs. While IDSA's leadership recognizes that current fiscal
budgets are constrained due to the war in Iraq and the Federal budget
deficit, we urge the subcommittee to support appropriate investments to
protect all of us against the scourges wrought by infectious pathogens.
IDSA represents 8,400 infectious diseases physicians and scientists
devoted to patient care, education, research, prevention, and public
health. Our members care for patients of all ages with serious
infections, including antibiotic-resistant bacterial infections,
meningitis, pneumonia, tuberculosis, and those with cancer or
transplants who have life-threatening infections caused by unusual
microorganisms, food poisoning, and HIV/AIDS, as well as emerging
infections like severe acute respiratory syndrome (SARS). Housed within
IDSA is the HIV Medicine Association (HIVMA), which represents more
than 3,600 physicians working on the frontline of the HIV/AIDS
pandemic. HIVMA members conduct research, implement prevention
programs, and provide clinical services to individuals who are infected
with HIV/AIDS. IDSA and HIVMA are the principal organizations
representing infectious diseases and HIV physicians in the United
States.
Over the past several decades, the United States has made many
significant advances in the fight against infectious diseases. For
example, CDC's public health prevention and control strategies have
reduced infectious diseases morbidity and mortality rates in the United
States and globally. NIH-funded research and training has led to
critical new discoveries while at the same time supporting economic
growth in incubator sites across the country, fostering innovation and
competition, and making the United States the leader in global
biomedical research. Needless to say, much work remains to be done as
infectious diseases remain the second leading cause of death worldwide
and the third leading cause of death in the United States. Of greatest
concern:
--Avian flu is an imminent threat to the United States. Despite the
increased attention and progress that has been made in
preparing for an influenza pandemic, the Institute of Medicine
and virtually all experts conclude that the United States is
woefully unprepared to sufficiently respond to pandemic flu and
many gaps and challenges remain.
--Antimicrobial resistant infections have created a ``silent
epidemic'' in communities and hospitals across the country--
methicillin-resistant Staphylococcus aureus (MRSA), for
example, is crippling and killing a growing number of
previously healthy people including children, athletes, and
military recruits as well as many elderly people; and
--On a global scale, infectious diseases annually cause 15 million
deaths--HIV/AIDS, tuberculosis, and malaria alone account for
one third of these deaths.
PANDEMIC AND SEASONAL INFLUENZA FISCAL YEAR 2008 FUNDING RECOMMENDATION
IDSA is deeply appreciative to the committee members for your
support of increased funding for pandemic and seasonal influenza
preparedness efforts as well as for the inclusion of additional
pandemic influenza funding in the pending emergency supplemental
appropriations bill. IDSA also applauds Congress and the administration
for enacting this past December the Pandemic and All-Hazards
Preparedness Act and establishing the Biomedical Advanced Research
Development Authority (BARDA) within the Department of Health and Human
Services. We request that Congress ensure significantly increased and
sustained long-term funding to support critical activities authorized
by the act. We are deeply concerned that the Federal, State, and local
preparedness and response goals outlined in the act cannot be achieved
without significantly increased, long-term, sustainable funding.
In addition, experts and Federal Government officials agree that
the development of a pandemic vaccine is the strategy most critically
needed to protect U.S. citizens from a pandemic. IDSA has proposed the
establishment of a multinational Pandemic Influenza Vaccine Master
Program led by the United States to outline a comprehensive approach
that will systematize, coordinate, and strengthen vaccine research and
development (R&D), increase production capacity, accelerate licensure,
guarantee equitable global distribution, and monitor vaccine
performance and safety. IDSA has proposed that a U.S. commitment of
$2.8 billion is needed in fiscal year 2008 to initiate the master
program and to serve as a catalyst for additional financial support
from international partners. Included within our fiscal year 2008
master program proposal is a $750 million commitment for the new BARDA
program. BARDA will enhance and accelerate the R&D activities necessary
to produce new medical countermeasures that will protect U.S. citizens
from pandemic influenza.
OTHER FISCAL YEAR 2008 FUNDING RECOMMENDATIONS
Centers for Disease Control and Prevention
IDSA recommends a total budget level of $8.7 billion for CDC's
discretionary programs in fiscal year 2008 including an increase of at
least $686.4 million for CDC's Infectious Diseases Program.
As part of our proposed increase in CDC's total ID Program funding,
IDSA supports:
An increase of at least $50 million for CDC's Antimicrobial
Resistance Program
Antimicrobial resistance is a priority funding area for IDSA in
fiscal year 2008. Microbes' ability to become resistant to
antimicrobial drugs not only impacts individual patients, but also can
have a devastating impact on the general population as resistant
microbes pass from one individual to another. A multi-pronged approach
is essential to limit the impact of antibiotic resistance on patients
and public health. Our proposed increase in antimicrobial resistance
funding will enable CDC to strengthen programs such as the National
Healthcare Safety Network (NHSN), which generates national prevalence
data to track the spread of multi-drug-resistant organisms in health
care settings; expand its surveillance of clinical and prescribing data
that are associated with drug-resistant infections; gather morbidity
and mortality data due to resistance; educate physicians and parents
about the need to protect the long-term effectiveness of antibiotics;
and strengthen infection control activities across the United States.
Broadening the number of CDC's extramural grants in applied research at
academic-based centers also would harness the brainpower of our
Nation's researchers.
An increase of at least $281 million for CDC's Immunization
Program
Vaccines are one of the greatest public health successes ever
achieved, helping to reduce, and in some cases eliminate, the spread of
infectious diseases in the United States and abroad. In the United
States, immunization of a birth cohort, or a year's worth of children
born, saves 33,000 lives and $42 billion in costs. Important new
vaccines have been licensed for rotavirus, pertussis, zoster, and human
papillomavirus (HPV). The HPV vaccine could prevent the majority of
cases of cervical cancer. Yet these new vaccines add new costs. Without
additional funding of CDC's 317 Program, these vaccines will not be
available to under-insured children and the infrastructure to
administer vaccines and track their safety will be compromised. IDSA
also is very concerned that adult immunization rates are much too low.
Vaccines can be cost-saving, but new efforts are needed to make sure
that access is available for all age groups. We cannot afford, however,
to take scarce funds from childhood immunization to fund adult
immunization--a significant new investment is required.
For these reasons, we support a total fiscal year 2008
appropriation level of $802.4 million for CDC's discretionary
immunization program. This amount includes $387 million for the
purchase of childhood vaccines, and $200 million for childhood
immunization operations/infrastructure grants to States. In parallel
fashion, as a first step toward meeting extensive needs in the adult
arena, it includes $88 million for purchase of adult vaccines and $45
million for adult operations and infrastructure grants to States.
Finally this amount includes $82.4 million for prevention, safety, and
administrative activities.
An increase of at least $93 million for CDC's HIV
Prevention Program
These additional resources should be utilized to restore cuts in
HIV prevention cooperative agreements with State and local health
departments, to enhance core surveillance cooperative agreements with
health departments, and to expand HIV testing in critical health care
venues by funding testing infrastructure and the purchase of approved
testing devices, including rapid tests and confirmatory testing.
An increase of at least $252.4 million for CDC's TB
Elimination Program
Recent cuts of 14 percent have eroded national tuberculosis (TB)
control at a time of increased threat posed by extensively-drug
resistant TB and multi-drug resistant TB. Additionally, a total of $350
million is needed across CDC as well as at the NIH to support research
on TB vaccines, diagnostics, drugs, and related clinical research.
--An increase of $10 million for CDC's Public Health and Human
Services Block Grant
We are concerned that the President's proposed budget once again
proposes to eliminate CDC's Public Health and Human Services Block
Grants, which provide States the flexibility to respond to infectious
diseases outbreaks, among other events. IDSA opposes the termination of
this program and instead supports a healthy increase of $10 million.
national institutes of health
IDSA recommends that Congress support at least a 6.7 percent
increase for NIH research programs and particularly for the National
Institute of Allergy and Infectious Diseases' (NIAID) AIDS research;
non-AIDS, non-bioterrorism infectious diseases research, particularly
antimicrobial resistance, antimicrobial therapy, and pandemic influenza
research; and biodefense research. IDSA also supports a doubling of the
Fogarty International Center's (FIC) budget to $134 million in fiscal
year 2007.
Advancing biomedical research and maintaining the U.S. leadership
in this arena requires a consistent, long-term strategy and continued
strong investments. We must not be short-sighted in our approach. In
light of the rise in emerging and re-emerging diseases, and
particularly, the trend of previously treatable organisms evading our
best drugs, IDSA urges more aggressive, sustained scientific effort and
funding dedicated not only to understanding the fundamental mechanisms
of these diseases, but also support for clinical studies and
translational research as a stepping stone to the development of new
therapies. In addition, little research has been devoted to defining
optimal antimicrobial dosing regimens, particularly related to the
minimal duration of therapy necessary to cure many types of infections.
Such studies require a long-term commitment and are not likely to be
funded by pharmaceutical manufacturers. The consensus of many experts
is that infections are frequently treated for longer periods of time
than are necessary, needlessly increasing antimicrobial resistance. For
this reason, IDSA urges the establishment of a Clinical Trials Network
at NIH, similar to the AIDS Clinical Trials Group, devoted to defining
optimal antibacterial therapy. Well-designed, multi-center randomized
controlled trials that define the necessary length of therapy would
create an excellent basis of evidence from which coherent and
defensible recommendations could be developed.
IDSA also is concerned that NIH research project grant funding has
steadily declined after peaking in 2004--the average award would be 8.4
percent smaller in 2008 than in 2004. IDSA fears that we are
discouraging and potentially sacrificing an entire generation of young
scientists if they conclude that NIH grants are unattainable.
Sustainable and predictable funding is needed in this area. Finally,
IDSA supports a doubling of FIC's budget. FIC oversees vital programs
which train health professionals in resource-limited countries about
how best to attack AIDS, tuberculosis, malaria, and other infectious
diseases.
CONCLUSION
Today's investment in infectious disease research, prevention, and
treatments will pay significant dividends in the future by dramatically
reducing health care costs and improving the quality of life for
millions of Americans. In addition, U.S. leadership in infectious
diseases research and prevention will translate into worldwide health
benefits. We urge the subcommittee to continue to demonstrate
leadership and foresight in this area by appropriating the much-needed
resources outlined above in recognition of the lives and dollars that
ultimately will be saved.
______
Prepared Statement of the International Foundation for Functional
Gastrointestinal Disorders
SUMMARY OF FISCAL YEAR 2008 RECOMMENDATIONS
Provide a 6.7 percent increase for fiscal year 2008 to the National
Institutes of Health (NIH) budget. Within NIH, provide proportional
increases of 6.7 percent to the various institutes and centers,
specifically, the National Institute of Diabetes and Digestive and
Kidney Diseases (NIDDK) and the Office of Research on Women's Health
(ORWH).
Accelerate funding for extramural clinical and basic functional
gastrointestinal disorders (FGID) and motility disorders research at
NIDDK.
Continue to urge NIDDK to develop a strategic plan on irritable
bowel syndrome (IBS) with the purpose of setting research goals,
determining improved treatment options for IBS sufferers, and assisting
in recruitment of new investigators to conduct IBS research.
Urge the National Institute of Child Health and Human Development
(NICHD) and NIDDK to continue to support research into fecal and
urinary incontinence, including the development of a standardization of
scales to measure incontinence severity and quality of life and to
develop strategies for primary prevention of fecal incontinence
associated with childbirth.
Provide funding to NIDDK and the National Cancer Institute (NCI)
for increased research on the causes of esophageal cancer.
Thank you for the opportunity to present this written statement
regarding the importance of functional gastrointestinal and motility
disorders research. IFFGD has been serving the digestive disease
community for 15 years. We work to broaden the understanding of
functional gastrointestinal and motility disorders in adults and
children. IFFGD raises awareness on disorders and diseases that many
people are uncomfortable and embarrassed to discuss. The prevalence of
fecal incontinence and irritable bowel syndrome or IBS, as well as a
host of other gastrointestinal disorders affecting both adults and
children, is underestimated in the United States. These conditions
continue to remain hidden in our society. Not only are they
misunderstood, but the burden of illness and human toll has not been
fully recognized.
Since its establishment, IFFGD has been dedicated to increasing
awareness of functional gastrointestinal and motility disorders, among
the public, health professionals, and researchers. While maintaining a
high level of public education efforts, IFFGD has also become
recognized for our professional symposia. We consistently bring
together a unique group of international multidisciplinary
investigators to communicate new knowledge in the field of
gastroenterology. Next month IFFGD will be hosting our Seventh
International Symposium on Functional Gastrointestinal Disorders,
bringing scientists, researchers, and clinicians from across the world
together to discuss the current science and opportunities on IBS and
other functional gastrointestinal and motility disorders. Also, in
November 2002, we hosted a conference on fecal and urinary
incontinence, the proceedings of which were published in
Gastroenterology, the official journal of the American
Gastroenterological Association (AGA). The IFFGD has also been working
with the National Institute of Child Health and Human Development
(NICHD), the National Institute of Diabetes and Digestive and Kidney
Diseases (NIDDK), and the Office of Medical Applications of Research
(OMAR) in the NIH Office of the Director on the NIH State of the
Science Conference on Fecal and Urinary Incontinence to beheld in
December 2007.
The majority of the diseases and disorders we address have no cure.
We have yet to completely understand the pathophysiology of the
underlying conditions. Patients face a life of learning to manage a
chronic illness that is accompanied by pain and an unrelenting myriad
of gastrointestinal symptoms. The costs associated with these diseases
are enormous; estimates range from $25-$30 billion annually. The human
toll is not only on the individual but also on the family. Economic
costs spill over into the workplace. In essence, these diseases reflect
lost potential for the individual and society. The IFFGD is a resource
that provides hope for hundreds of thousands of people as they try to
regain as normal a life as possible.
IRRITABLE BOWEL SYNDROME (IBS)
IBS strikes people from all walks of life. It affects 25 to 45
million Americans and results in significant human suffering and
disability. This chronic disease is characterized by a group of
symptoms, which include abdominal pain or discomfort associated with a
change in bowel pattern, such as loose or more frequent bowel
movements, diarrhea, and/or constipation. Although the cause of IBS is
unknown, we do know that this disease needs a multidisciplinary
approach in research and often treatment.
IBS can be emotionally and physically debilitating. Due to
persistent bowel unpredictability, individuals who suffer from this
disorder may distance themselves from social events, work, and even may
fear leaving their home.
In the House and Senate fiscal years 2004, 2005, 2006, and 2007
Labor, Health and Human Services, and Education Appropriations bills,
Congress recommended that NIDDK develop an IBS strategic plan. The
development of a strategic plan on IBS would greatly increase the
institute's progress toward the needed research on this functional
gastrointestinal disorder, as well as serve to advance our
understanding of this disease, determine improved treatment options for
IBS sufferers, and assist in recruiting new investigators to conduct
IBS research. NIDDK is formulating an action plan for digestive
diseases through the National Commission on Digestive Diseases and has
indicated that IBS will be included as a component of this overall
plan. IBS must be given sufficient attention, however, in order to
increase the functional gastrointestinal disorders (FGID) and motility
disorders research portfolio at NIDDK.
FECAL INCONTINENCE
At least 6.5 million Americans suffer from fecal incontinence.
Incontinence is neither part of the aging process nor is it something
that affects only the elderly. Incontinence crosses all age groups from
children to older adults, but is more common among women and in the
elderly of both sexes. Often it is a symptom associated with various
neurological diseases and many cancer treatments. Yet, as a society, we
rarely hear or talk about the bowel disorders associated with spinal
cord injuries, multiple sclerosis, diabetes, prostate cancer, colon
cancer, uterine cancer, and a host of other diseases.
Damage to the anal sphincter muscles; damage to the nerves of the
anal sphincter muscles or the rectum; loss of storage capacity in the
rectum; diarrhea; or pelvic floor dysfunction can cause fecal
incontinence. People who have fecal incontinence may feel ashamed,
embarrassed, or humiliated. Some don't want to leave the house out of
fear they might have an accident in public. Most attempt to hide the
problem for as long as possible. They withdraw from friends and family,
and often limit work or education efforts. Incontinence in the elderly
burdens families and is the primary reason for nursing home admissions,
an already huge social and economic burden in our increasingly aged
population.
In November 2002, the IFFGD sponsored a consensus conference--
``Advancing the Treatment of Fecal and Urinary Incontinence Through
Research: Trial Design, Outcome Measures, and Research Priorities.''
Among other outcomes, the conference resulted in six key research
recommendations:
--More comprehensive identification of quality of life issues
associated with fecal incontinence and improved assessment and
communication of treatment outcomes related to quality of life.
--Standardization of scales to measure incontinence severity and
quality of life.
--Assessment of the utility of diagnostic tests for affecting
management strategies and treatment outcomes.
--Development of new drug compounds offering new treatment approaches
to fecal incontinence.
--Development and testing of strategies for primary prevention of
fecal incontinence associated with childbirth.
--Further understanding of the process of stigmatization as it
applies to the experience of individuals with fecal
incontinence.
The IFFGD has been working with the NICHD, NIDDK, and OMAR on a NIH
State of the Science Conference on Fecal and Urinary Incontinence that
is scheduled to take place in December 2007. The goal of this
conference will be to assess the state of the science and outline
future priorities for research on both fecal and urinary incontinence;
including, the prevalence and incidence of fecal and urinary
incontinence, risk factors and potential prevention, pathophysiology,
economic and quality of life impact, current tools available to measure
symptom severity and burden, and the effectiveness of both short- and
long-term treatment. Once the conference is completed, NIH must
prioritize implementation of the recommendations of this important
conference.
GASTROESOPHAGEAL REFLUX DISEASE (GERD)
Gastroesophageal reflux disease, or GERD, is a common disorder
affecting both adults and children, which results from the back-flow of
acidic stomach contents into the esophagus. GERD is often accompanied
by persistent symptoms, such as chronic heartburn and regurgitation of
acid. But sometimes there are no apparent symptoms, and the presence of
GERD is revealed when complications become evident. One uncommon
complication is Barrett's esophagus, a potentially pre-cancerous
condition associated with esophageal cancer. Symptoms of GERD vary from
person to person. The majority of people with GERD have mild symptoms,
with no visible evidence of tissue damage and little risk of developing
complications. There are several treatment options available for
individuals suffering from GERD.
Gastroesophageal reflux (GER) affects as many as one-third of all
full term infants born in America each year. GER results from an
immature upper gastrointestinal motor development. The prevalence of
GER is increased in premature infants. Many infants require medical
therapy in order for their symptoms to be controlled. Up to 25 percent
of older children and adolescents will have GER or GERD due to lower
esophageal sphincter dysfunction. In this population, the natural
history of GER is similar to that of adult patients, in whom GER tends
to be persistent and may require long-term treatment.
GASTROPARESIS
Gastroparesis, or paralysis of the stomach, refers to a stomach
that empties slowly. Gastroparesis is characterized by symptoms from
the delayed emptying of food, namely: bloating, nausea, vomiting or
feeling full after eating only a small amount of food. Gastroparesis
can occur as a result of several conditions, including being present in
30 percent to 50 percent of patients with diabetes mellitus. A person
with diabetic gastroparesis may have episodes of high and low blood
sugar levels due to the unpredictable emptying of food from the
stomach, leading to diabetic complications. Other causes of
gastroparesis include Parkinson's disease and some medications,
especially narcotic pain medications. In many patients the cause of the
gastroparesis cannot be found and the disorder is termed idiopathic
gastroparesis. Over the last several years, as more is being found out
about gastroparesis, it has become clear this condition affects many
people and the condition can cause a wide range of symptoms of
differing severity.
FUNCTIONAL GASTROINTESTINAL AND MOTILITY DISORDERS AND THE NATIONAL
INSTITUTES OF HEALTH
The International Foundation for Functional Gastrointestinal
Disorders recommends an increase of 6.7 percent to the budget of NIH,
and a 6.7 percent increase for NIDDK and NICHD. However, we request
that this increase for NIH does not come at the expense of other Public
Health Service agencies.
We urge the subcommittee to provide the necessary funding for the
expansion of the NIDDK's research program on FGID and motility
disorders. This increased funding will allow for the growth of new
research on FGID and motility disorders at NIDDK, a strategic plan on
IBS, and increased public and professional awareness of FGID and
motility disorders. In addition, we urge the subcommittee to continue
to support and provide adequate funding to the Office of Research on
Women's Health (ORWH) under the NIH Office of the Director,
particularly for their Specialized Centers of Research on Sex and
Gender Factors Affecting Women's Health (SCORs) program and the
Building Interdisciplinary Research Careers in Women's Health (BIRCWH)
program. The ORWH supports important research into IBS.
A primary tenant of IFFGD's mission is to ensure that clinical
advancements concerning GI disorders result in improvements in the
quality of life for those affected. By working together, this goal will
be realized and the suffering and pain millions of people face daily
will end. Thank you.
______
Prepared Statement of the Jeffrey Modell Foundation
Mr. Chairman and members of the subcommittee: Thank you for the
opportunity to testify before you today. I am Vicki Modell and, along
with my husband Fred, we created the Jeffrey Modell Foundation in 1987
in memory of our son, who died at the age of 15 as a result of a life
long battle against one of the estimated 140 primary immunodeficiency
(PI) diseases.
Today I wish to discuss with you two important initiatives for the
Congress, the CDC, and the Jeffrey Modell Foundation to collaborate on
that will achieve the following:
--Continue to educate and raise awareness about primary
immunodeficiency diseases among physicians, other health care
providers, and the public through a highly successful program
that has, to date, generated $10 private for every $1 public
invested; and
--Launch a pilot program that will extend newborn screening to Severe
Combined Immune Deficiency, the most lethal of all PI diseases,
saving lives and saving money.
The Jeffrey Modell Foundation is an international organization
located in New York City. In its 21 years of existence, the Foundation
has grown into the premier advocacy and service organization on behalf
of people afflicted with primary immunodeficiency diseases. As a
demonstration of the extent to which the JMF leads in the field, please
consider the following:
--The Foundation has established Jeffrey Modell Research and
Diagnostic Centers at 34 academic and teaching hospitals in the
United States and abroad.
--The Foundation conducts a national physician education and public
awareness campaign, currently funded with approximately $2.5
million appropriated by this committee to the Centers for
Disease Control and Prevention (CDC) and awarded to the JMF. To
date, the Foundation has leveraged the Federal money to
generate in excess of $75 million in donated media and
corporate contributions with almost 250,000 placements/airings
on television, radio, print, and other public media, as well as
a 30-minute program produced for PBS. CME physician symposia
have been held at leading academic teaching hospitals
throughout the Nation. It has also included mailings to
physicians in a variety of specialist and generalist fields,
including pediatrics and several pediatric specialties, family
practice, and internal medicine, as well as to school nurses,
clinical and registered nurses and daycare centers throughout
the United States.
--In addition, the Foundation has long been a provider of direct
patient services such as KIDS Days that give young people a
chance to meet and share experiences with others similarly
situated in their communities in a fun atmosphere that
encourages a feeling of normalcy in patients.
First and foremost, Mr. Chairman, I am here today to thank you and
all the members of this committee. Over the last 10 years that we have
been coming to Washington, we have been given the opportunity to build
a partnership with the Congress, the Centers for Disease Control and
Prevention, the National Institutes of Health, the Health Resources and
Services Administration, as well as with our own supporters in the
private sector, including the pharmaceutical and biotechnology
industries, and other concerned donors. We believe that we have
maximized the benefits for patients from the support that this
subcommittee has afforded the Foundation.
CENTERS FOR DISEASE CONTROL AND PREVENTION
This subcommittee is currently funding CDC with $2.5 million for
physician education and public awareness of primary immune
deficiencies. The Jeffrey Modell Foundation operates the program under
a contract with CDC. Since the campaign's inception, it has generated
more than $75 million in donated media, including television and radio
spots, magazine ads, billboards, airport signs and other print media,
as well as other corporate support. Every $1 provided by the committee
has been leveraged into more than $10 of private money for this
education and awareness program.
In a national survey conducted on behalf of the Foundation, funded
by a grant from the CDC, one in three Americans state that they have
heard of Primary Immunodeficiency. When 502 pediatricians and family
practice physicians were asked about PI, 85 percent of physicians
consider PI to be rare or extremely rare (1 in 5,000-10,000 patients).
However, the National Institutes of Health cites the prevalence of 1 in
500. This disparity shows how much education the medical community
still needs.
The progress being made by the campaign is significant. As reported
by the Foundation's Centers for Primary Immunodeficiencies, there has
been a 79 percent increase in the number of diagnosed patients, a 58
percent increase in the number of patients receiving treatment, and a
57 percent increase in patients referred to JMF specialized centers.
These increases are reflected on an annual basis for each year of the
campaign. The most meaningful statistic is that there has been an
annual 256 percent increase in the number of diagnostic tests
performed, showing that the campaign is raising patients' and
physicians' awareness of PI. The campaign has generated over 6 million
hits to the JMF website annually, 500,000 unique visits to the JMF
website annually and over 12,000 calls to the JMF hotline, further
evidence of the campaign's effectiveness.
Two years ago the subcommittee increased the CDC funding for the
campaign by approximately $500,000 in order to expand the campaign to
target the underserved minority population. Research shows that the
incidence of PI does not vary between races or among ethnic groups. To
reach its intended audience, the minority campaign must run ads on
different radio stations and television networks and have space in
different print media. Since the program's launch, the campaign has
leveraged the $1 million in Federal funds to generate over $17 million
in donated media and has had almost 60,000 airings/placements.
We respectfully request that this subcommittee continue to fund
this program at $2.5 million in fiscal year 2008 (the level requested
in the President's budget), allowing the Foundation to continue both
the original education and awareness program and the targeted minority
campaign.
QUALITY OF LIFE AND ECONOMIC IMPACT STUDY
In 2006, the Foundation set out to examine the impact of early
diagnosis in a rigorous manner. Physician experts at the 118 Jeffrey
Modell Diagnostic and Referral Centers were contacted. Each of the
Centers was asked to examine patient records 1 year prior to diagnosis
and for the year following diagnosis and treatment. The data, which
included 532 patient records, was collected by the Foundation and
reviewed by members of the Foundation's Medical Advisory Board.
The results of the study clearly demonstrate that the quality of
life of undiagnosed patients is significantly lower than that of
diagnosed patients. Undiagnosed patients suffer from chronic infections
an average of 44.7 days per year compared to 12.6 days for diagnosed
patients. On average, undiagnosed patients are treated with antibiotics
166.2 days per year compared to 72.9 days per year. Undiagnosed
patients spend 14.1 more days of the year in hospitals than diagnosed
patients. Also, the study found that undiagnosed patients missed 33.9
days of work or school compared to only 8.9 days missed by diagnosed
patients.
Besides being sicker, requiring more care, and more time out of the
workforce, ultimately, an undiagnosed patient costs the healthcare
system $102,552 per year compared to $22,610; diagnosing a patient with
PI saves $79,942 per year. According to NIH, there are as many as
500,000 undiagnosed patients in this country; these undiagnosed
patients cost the healthcare system approximately $40 billion annually.
These costs underscore the important of early identification and
treatment for PI patients.
NEWBORN SCREENING PROGRAM
Mr. Chairman, our dedication to the importance of early diagnosis
has led us to field of newborn screening. And here we have an
opportunity for the action of this subcommittee to save lives,
literally. Severe combined immune deficiency (SCID) is the most severe
form of PI and is fatal, if an infant is not diagnosed and treated
within the first year of life. Within the first few months of life, the
infant will suffer from one or more serious infections, including
pneumonia, meningitis or bloodstream infections.
Newborn screening is the solution to this life-threatening
condition. Last fall the Foundation sponsored a meeting in conjunction
with the CDC Foundation to examine the state of the science regarding
newborn screening for SCID. We learned at that meeting that doctors can
diagnose SCID with 99 percent accuracy; and we learned that they can
treat it with a 95 percent success rate using bone marrow
transplantation to restore the immune system before the infant develops
any serious infections. If a diagnosis of SCID is made within the
infant's first 2 months of life, treating SCID costs under $10,000.
However, by the 9th or 10th month of life, if the infant survives that
long, the costs of transplantation and other medical complications are
over $1 million and the success rate falls dramatically.
Based on discussions at last fall's meeting at the CDC, both
Wisconsin and New York are prepared to begin a pilot program to screen
newborns for SCID. In Wisconsin, a collaboration between the Children's
Hospital of Wisconsin, the Medical College of Wisconsin and the
Wisconsin State Laboratory of Hygiene has been established to begin the
program by replicating the State's current screening model for cystic
fibrosis. The Wisconsin State Laboratory of Hygiene currently runs 300-
500 tests per day, 6 days a week, easily accommodating all the newborns
in the State. Screening tests are conducted between the 3rd and 7th day
of life, and a report is delivered by the lab to the pediatrician
within 7 days. New York State health officials are going to monitor
Wisconsin's program to determine how the screen needs to be altered to
handle New York's 250,000 live births a year.
To start this pilot, both the Children's Hospital of Wisconsin and
the Foundation each contributed to this effort. The Foundation has
estimated that it will cost approximately $560,000 per State to begin
screening for SCID. Once the pilot program demonstrates efficacy, SCID
screening will cost a maximum of between $6.50 and $7 per child.
To support the efforts of Wisconsin and New York, we respectfully
request that this subcommittee increase funding for CDC's Environmental
Health Laboratory program by $750,000, specifically to fund the pilot
program to screen newborns for SCID in Wisconsin and New York. We
anticipate that this will be a one-time cost. Once the pilot is
evaluated and methods are proven, States will be able to add this test
to their screening panel.
CONCLUSION
With the support the Jeffrey Modell Foundation has received from
this subcommittee, we have been able to increase significantly the
public's awareness of PI and most importantly, thanks to your support,
we have been able to save lives. The Federal Government's investment in
this campaign is producing results far beyond anything that even we had
anticipated. Many more children are being tested and treated; lives are
being saved.
We understand that the subcommittee must make difficult decisions
in this fiscal environment. However, the Foundation's education and
awareness campaign has been recognized as a model collaborative program
that has successfully leveraged Federal dollars in a manner rarely
seen. We now know the financial burden an undiagnosed patient places on
the healthcare system; there is no reason to spend $40 billion annually
on the treatment of undiagnosed patients. For every Federal dollar
spent on the campaign and research, the potential to save lives
increases exponentially. This is precisely the kind of public-private
partnership that should be encouraged. It works. It saves lives. And,
it is the best example of bringing scientific advances to every citizen
regardless of their station in life.
After 5 years of funding for the campaign, we believe it is time
for this subcommittee to take the next step with us and financially
support newborn screening for SCID. The science shows the screening is
accurate and the treatment is successful and cost effective.
Diagnosing, transplanting and curing just one baby will make the all of
our efforts worthwhile; but, there is no reason to stop at one. We will
continue to advocate for the expansion of this pilot program and
eventually the inclusion of the screen for SCID on every State's list
of required newborn screening.
Thank you, Mr. Chairman, for the opportunity to present this
testimony to the subcommittee.
______
Prepared Statement of the Lupus Foundation of America
SUMMARY
The Lupus Foundation of America (LFA) is the Nation's leading non-
profit voluntary health organization dedicated to improving the
diagnosis and treatment of lupus, supporting individuals and families
affected by the disease, increasing awareness of lupus among health
professionals and the public, and finding the causes and cure. LFA
respectfully calls upon Congress to provide the following allocations
in the fiscal year 2008 Labor-Health and Human Services-Education
(LHHS) appropriations measure to reduce and prevent suffering from
lupus:
--$3.25 million for the National Lupus Patient Registry (NLPR) at the
National Center for Chronic Disease Prevention and Health
Promotion within the Centers for Disease Control and Prevention
(CDC) to sustain current epidemiological efforts and expand the
registry to seven sites. Such an expansion would ensure that
the registry includes all forms of lupus and all affected
populations, particularly African Americans, Hispanics, and
Asian Americans, who are disproportionately at-risk for--and
have worse outcomes associated with--lupus.
--$30.8 billion (a 6.7 percent increase) for the National Institutes
of Health (NIH) to support lupus research. Specifically, we
urge the subcommittee to provide a 6.7 percent increase to each
of the following institutes and centers, which play an integral
role in lupus research: NCMHD, NHGRI, NHLBI, NIAID, NIAMS,
NIDDK, NIEHS, and NINDS. Moreover, we respectfully call on
Congress to move to provide a 33 percent increase for lupus
research for each of the next three fiscal years.
--$1 million in new funding for the HHS Office on Women's Health to
support a sustained national lupus education and awareness
campaign. These educational efforts would be directed toward
healthcare professionals who diagnose and treat people with
lupus, with an emphasis on reaching those individuals at
highest risk--women of color--a health disparity that remains
unexplained.
BACKGROUND ON LUPUS
As you may know, lupus--a debilitating, chronic autoimmune disease
that causes inflammation and tissue damage to virtually any organ
system--affects as many as 2 million Americans. Since lupus is a
systemic disease, it can cause significant disability and even death.
Lupus can be particularly difficult to diagnose because its symptoms
are similar to those of many other diseases, and major gaps exist in
understanding the causes and consequences of the disease. Lupus affects
women nine times more often than men and disproportionately impacts
women of color. Our scientific advisors note that lupus is the
prototypical autoimmune disease and indicate that finding answers to
questions about lupus also may provide understanding about other
autoimmune diseases affecting 22 million Americans. Tragically, there
have been no new drugs approved by the Food and Drug Administration
specifically for lupus in nearly 40 years. Currently, there is no cure
for lupus; available treatments can lead to damaging side effects and
can adversely impact quality of life. LFA maintains that the Nation
must significantly increase its attention to--and investment in--lupus
research, education, and awareness to help ensure that much-needed
progress is made in lupus diagnosis and treatment--eventually achieving
a cure.
CDC NATIONAL LUPUS PATIENT REGISTRY
LFA respectfully requests that the subcommittee provide $3.25
million in fiscal year 2008 to the CDC National Lupus Patient Registry
(NLPR). The NLPR plays an integral role in lupus epidemiological
studies which provide important insight into the disease. The
establishment of the NLPR was the first nationwide step in the CDC's
effort to assess the prevalence and incidence of lupus. The NLPR serves
as a conduit for the collection of valid and reliable data for
epidemiological studies to better understand and measure the burden of
illness, assess the social and economic impact of the disease, and
stimulate additional private investment by industry in the development
of new, safe, and effective therapies--and hopefully a cure--for lupus.
Currently, the NLPR involves two study sites--in Georgia and
Michigan. The information collected through the Emory University School
of Medicine and the Michigan Department of Community Health (in
collaboration with the University of Michigan) stems from a multi-
pronged approach using data from laboratory tests, interviews with
physicians who treat lupus patients, hospital data, and other sources.
While the data gleaned from the current sites are important and useful,
unfortunately--due to limited resources--the NLPR does not include
information on all forms of lupus and all populations affected by the
disease. This constrained scope, depth, and breadth of the NLPR limits
its utility to researchers and does not allow for adequate exploration
of the health disparities apparent among those diagnosed with lupus.
Existing epidemiological data on lupus are decades old and no
longer reliable. Population-based epidemiological studies of lupus must
be conducted at strategically-located sites throughout the Nation that
will provide accurate data on all forms of lupus (i.e. systemic lupus,
primary discoid lupus, drug-induced lupus, neonatal lupus,
antiphospholipid antibodies) and the disparity among the various racial
and ethnic populations. The LFA and its scientific and medical advisors
recommend that the NLPR be expanded to an additional five sites, which
should represent the populations that are disproportionately affected
by lupus--principally African Americans, Hispanics, Asian Americans,
and Native Americans. To that end, LFA urges the subcommittee to
provide $3.25 million in fiscal year 2008 and to include language in
the report accompanying the fiscal year 2008 LHHS measure that
encourages the CDC to create a common data entry and management system
across all study sites, to collaborate with a consortium of academic
health centers with an expertise in lupus epidemiology, and ensure
adequate numbers and locations of study sites and sufficient numbers of
individuals of all racial and ethnic backgrounds.
RESEARCH FOR BETTER TREATMENTS AND A CURE
The LFA has long been concerned about the inadequate levels of
Federal investment in lupus research. Unfortunately, during the
doubling of NIH funding, lupus did not receive its proportional
increase; now that NIH funding has flattened, lupus research is in
danger of falling even further behind. However, after a tragic 40 year
dearth of specific new treatments to manage this debilitating and
devastating disease, lupus researchers are on the brink of major
discoveries that could substantially advance lupus research, leading to
better treatments, and possibly a cure.
To achieve these much-needed breakthroughs, LFA maintains that
Federal research funding must be increased significantly. It is
important to note that level or decreased NIH funding could bring to a
standstill clinical trials and large observational studies, and could
curtail research on those at highest risk for lupus, women of color.
Furthermore, insufficient Federal funding also could slow much-needed
genetic research, when we are just discovering the critical components
that may contribute to lupus and its adverse effects. Therefore, it is
critical that biomedical researchers be provided the necessary
resources to continue seeking answers to the questions that will lead
to safer and more effective lupus treatments. To that end, LFA has
joined with the broader public health and research communities in
supporting an overall 6.7 percent increase for the NIH in fiscal year
2008. LFA has identified a number of NIH institutes and centers whose
research activities are critical to identifying improved treatments and
a cure for lupus, and as noted above, we urge that each of these
entities receive a 6.7 percent increase in fiscal year 2008: NCMHD,
NHGRI, NHLBI, NIAID, NIAMS, NIDDK, NIEHS, NIDDK and NINDS. We urge
Congress to move to provide a 33 percent increase for lupus research
for each of the next 3 fiscal years.
NIAMS.--Lupus affects the skin, bones, joints, and connective
tissue. NIAMS is integral to making gains in lupus treatment and
identifying a cure. LFA asks that the subcommittee encourage NIAMS to
significantly expand research related to lupus, with a particular focus
on understanding the underlying mechanisms of disease, gene-gene and
gene-environmental interactions, lupus and kidney disease, biomarkers,
pediatric research, environmental factors, and factors related to
health disparities and comorbidities associated with lupus.
NIAID.--Lupus is a dysfunction of the immune system which warrants
greater examination. LFA's scientific and medical advisors maintain
that NIAID has an integral and more significant role to play in lupus
research. To that end, LFA respectfully requests that the subcommittee
urge NIAID to take a leadership role in lupus research and expand and
intensify genetic, clinical, and basic research related to lupus, with
a particular focus on gene-gene and gene-environmental interactions,
biomarkers, pediatric research, environmental factors, and factors
related to health disparities and comorbidities associated with lupus.
NCMHD.--Nine out of 10 people with lupus are women; lupus is two to
three times more common among women of color than Caucasian women.
Lupus mortality has increased over the past 3 years and is higher among
older African American women. We urge the subcommittee to encourage
NCMHD to collaborate with extra-mural researchers and LFA to ensure
that these terrible disparities receive the attention--and
interventions--they deserve.
NHGRI.--Lupus likely is a polygenetic disease. As such, LFA asks
the subcommittee to encourage NGHRI to undertake efforts to help
identify the gene(s) associated with lupus.
NHLBI.--Lupus attacks the heart, lungs, blood, and blood vessels.
LFA encourages the subcommittee to urge NHLBI to expand and intensity
research on lupus, with a special emphasis on lupus and early onset of
cardiovascular disease.
NIEHS.--Lupus disease activity can be triggered by certain
environmental factors. LFA encourages the subcommittee to urge NIEHS to
undertake additional lupus related research activities to help identify
environmental factors, biomarkers, and gene-environmental interactions
associated with the disease.
NIDDK.--Lupus causes lupus nephritis--inflammation of the kidneys.
LFA asks the subcommittee to urge NIDDK to undertake studies into this
condition, which is one of the most serious manifestations of lupus.
NINDS.--Lupus attacks the blood vessels in the brain, causing
seizures, psychosis, and stroke. LFA urges the subcommittee to
encourage NINDS to expand its research related to lupus.
INCREASED AWARENESS AND EDUCATION FOR BETTER OUTCOMES
Too many affected individuals and their health professionals remain
unaware of the signs and symptoms of lupus, delaying correct diagnoses
and often leading to poorer outcomes. Therefore, the LFA's medical
advisors recommend a sustained national lupus education campaign to
improve awareness and education of the public and health professionals
to reduce and prevent suffering from lupus. LFA respectfully requests
the subcommittee provide $1 million in new fiscal year 2008 funding to
the Office on Women's Health to support this important endeavor. LFA
welcomes the opportunity to work with HHS staff and others to ensure
the campaign's success.
SUMMARY
LFA very much appreciates the opportunity to submit written
testimony on fiscal year 2008 funding for lupus research,
epidemiological studies, education and awareness efforts. We understand
that the Nation faces unprecedented fiscal challenges; however, LFA has
serious concerns that without new Federal investments, we will not make
the necessary progress in lupus-related biomedical research and
epidemiology at such a promising time. LFA stands ready to work with
the subcommittee and others in Congress to reduce and prevent suffering
from lupus.
______
Prepared Statement of the Lymphoma Research Foundation
I am Melanie Smith, director of Public Policy and Advocacy for the
Lymphoma Research Foundation (LRF). On behalf of the lymphoma
survivors, researchers, and caregivers who are represented by LRF, I
would like to express our appreciation for the opportunity to submit a
statement to the House Appropriations Subcommittee for Labor, Health
and Human Services, and Education. We will focus our remarks on the
opportunities and challenges in lymphoma research and the potential for
extending and improving the lives of those who are diagnosed with
lymphoma.
LRF is the Nation's largest lymphoma-focused voluntary health
organization devoted exclusively to funding lymphoma research and
providing patients and healthcare professionals with critical
information on this disease. LRF's mission is to eradicate lymphoma and
serve those touched by this disease. To that end, we have developed a
research program through which we fund leading lymphoma researchers at
outstanding academic institutions. LRF-funded research focuses on
understanding the basic mechanisms of lymphoma as well as enhancing the
available treatments for the disease. To date, LRF has funded more than
$34.7 million in lymphoma research.
LRF is especially proud of its 3-year initiative to provide more
than $21 million for a special mantle cell lymphoma program comprised
of eighteen clinical and/or laboratory-based projects in North America
and Europe. The program is aimed at identifying curative therapies for
mantle cell lymphoma. Because mantle cell lymphoma is a form of
lymphoma for which treatment options have been limited and survival
much too short, this intensive and aggressive research effort is
critically important.
THE BURDEN OF LYMPHOMA AND NEED FOR NEW TREATMENTS
Lymphoma is the most commonly diagnosed hematologic cancer and the
third most common childhood cancer. Although lymphoma experts hail the
lymphoma therapeutic advances of the last decade for dramatically
changing lymphoma treatment and care, these new treatments do not
eliminate the pressing need for additional therapeutic research. The
numbers underscore the need for a continued commitment to lymphoma
research. In 2007, approximately 71,380 Americans will be diagnosed
with lymphoma. It is estimated that 63,190 will be diagnosed with non-
Hodgkin lymphoma (NHL), and that 18,660 will die from NHL. Also in
2007, it is expected that 8,190 cases of Hodgkin lymphoma will be
diagnosed, and 1,070 Americans will die from the disease. Nearly half a
million Americans are living with lymphoma.
The treatment advances of recent years have not boosted the
survival rate for NHL as dramatically as we had hoped. The 5-year
survival rate is 63 percent and the 10-year survival rate is only 49
percent. The 5-year survival rate for Hodgkin lymphoma is 86 percent
and the 10-year survival rate is 81 percent.
Still another issue must be remembered when we are evaluating the
progress that has been made in the fight against Hodgkin lymphoma and
NHL. There is an increasing body of knowledge about the long-term
effects of treatment for cancer, but there is a need for additional
research to understand the effects of cancer therapies, develop
strategies to minimize or address these effects, and develop therapies
that are accompanied by fewer side effects. A study published in a
recent edition of the Journal of the National Cancer Institute
underscored the challenges facing Hodgkin lymphoma patients; according
to the report of a British research team, Hodgkin lymphoma patients may
have an increased rate of myocardial infarction for up to 25 years
after undergoing treatment. The cardiotoxicity can be attributed to the
radiotherapy, anthracyclines, and vincristine used in Hodgkin lymphoma
therapy.
ADVANCES IN LYMPHOMA RESEARCH
In the last decade, there have been a number of significant
advances in lymphoma research that have contributed to deeper
understanding of the disease and its progression and fostered the
development of new treatments. Knowledge about the diversity of
lymphoma has contributed to the effort to target treatment regimens to
specific forms of the disease. In addition, we are learning more about
the link between environmental factors and infections--chemicals,
toxins, drugs, infectious agents such as hepatitis C and Epstein Barr
virus, and the gastric pathogen Helicobacter pylori--and many forms of
lymphoma.
Recent lymphoma treatment advances are a monoclonal antibody
(rituximab) that blocks a specific protein on B lymphocytes and a
radioactively labeled monocolonal antibody (tositumomab) that may
prolong remission in follicular lymphoma patients. Studies suggest that
bortezomib, which inhibits an enzyme complex that plays a role in
regulating cell function and growth, will shrink tumors in patients
with mantle cell lymphoma. Finally, research is underway on additional
immunotherapies, including therapeutic vaccines for lymphoma.
One of the key areas of inquiry is the identification of the best
combinations of treatments, including rituximab. Investigators are also
considering whether to treat low-grade follicular lymphoma immediately
or to continue the current approach of ``watch and wait.'' Stem cell
transplantation remains an important part of lymphoma treatment, but
additional research may contribute to refinements in the procedure and
better results for lymphoma patients.
There are a number of new therapies in development with the hope of
prolonging life and providing a better quality of life. In addition,
long-term and late effects of treatment are a concern. Lymphoma
patients may be at risk for developing second cancers, and
investigation of these risks is critical and may contribute to better
management of currently available therapies.
ROLE OF LRF IN LYMPHOMA RESEARCH
By supporting outstanding investigators considering a wide range of
topics in lymphoma research, LRF contributes significantly to progress
in the field. In 2003, LRF made a determination that it would tackle
one of the most challenging forms of non-Hodgkin lymphoma, mantle cell
lymphoma, with an aggressive and well-coordinated research program that
focuses on this rare form of non-Hodgkin lymphoma (NHL) affecting only
6-10 percent of NHL patients.
Since 2003, LRF has dedicated more than $21 million to the Mantle
Cell Lymphoma Research Initiative, and with those funds has supported a
range of critical research efforts, including:
--Hosting the preeminent scientific meeting focused exclusively on
mantle cell lymphoma.
--Formation of the Mantle Cell Lymphoma Consortium to stimulate
collaboration among its members to accelerate the pace of
finding cures for the disease.
--Launching of an MCL web site and awarding the first set of
correlative clinical trials grants.
--Inclusion of nearly 100 scientists in the network of mantle cell
researchers.
The Mantle Cell Lymphoma Consortium may serve as a research model
for focusing on other forms of lymphoma, and LRF is moving ahead with
additional targeted initiatives.
ROLE OF NIH IN LYMPHOMA RESEARCH
LRF will continue to play a strong and creative role in funding
lymphoma research, fostering cutting edge initiatives that hold the
promise of making a meaningful and positive change in the lives of
those living with lymphoma. Although the Foundation's efforts will
continue and even expand, its work must be undertaken in collaboration
with NIH. This is not only because of the magnitude of the NIH cancer
research budget but also because of the potential for NIH to provide
leadership among all elements of the research and development
community, including NIH intramural researchers, academic researchers,
private foundations, industry, and the Food and Drug Administration
(FDA).
We understand that the substantial increases in NIH funding that
Congress approved between 1999 and 2003 will not be replicated in the
foreseeable future. However, we urge that Congress provide an increase
of 6.7 percent for NIH in fiscal year 2008, an increase that will
simply protect the recent investment in NIH and permit additional
research progress. Advances in cancer research have contributed to
improvements in survival, but these advances have generally been
incremental and have required a sustained funding commitment.
We urge that Congress protect NIH funding and strive to provide an
increase in funding to allow researchers to pursue promising avenues of
research. LRF recommends that NIH strengthen its lymphoma research
program by several actions:
--The National Cancer Institute (NCI) should boost its support for
translational and clinical lymphoma research. NCI should
support research efforts aimed at evaluating the most
appropriate utilization of new therapies, including the best
possible combinations of therapies.
--NCI should also enhance its support for correlative studies of
tumor biology and treatment response, as well as its investment
in research on the late and long-term effects of lymphoma
treatments.
--NCI should expand its research effort focused on understanding the
complex interaction among environmental, viral, and
immunogenetic factors that are involved in the initiation and
promotion of lymphoma.
--Although NCI has historically been the lead institute in funding
lymphoma research, other institutes, including the National
Heart, Lung, and Blood Institute (NHLBI), National Institute on
Aging (NIA), and National Institute of Environmental Health
Sciences (NIEHS), should also evaluate and improve their
lymphoma research programs. A lymphoma-focused initiative to
investigate environmental/viral links is warranted.
NCI is developing a plan for the implementation of the
recommendations of its Clinical Trials Working Group. To date, most
implementation efforts have concentrated on the planning and management
of NCI-sponsored clinical trials. We urge NCI to act on recommendations
of the Working Group that focused on strengthening patient
participation in clinical trials. Increasing the rate of participation
in clinical trials is a key element in accelerating the pace of cancer
clinical research and the development of new treatments.
We also recommend that NCI consider actions that would encourage
the utilization of a centralized institutional review board (IRB), an
effort that could contribute to a streamlining of the review of new
clinical trials and minimize delays in the clinical trials process. NCI
has tested a central IRB, and that IRB or another might be utilized by
cancer researchers for review and approval of their protocols.
Encouragement from NCI regarding the utilization of a centralized IRB
could contribute to a more rapid acceptance among researchers.
We have detailed some impressive advances in lymphoma treatment,
but the research task is far from complete. Much more research must be
undertaken to ensure proper utilization of existing therapies, and new
therapies are needed for a number of different forms of lymphoma. We
look forward to the continued commitment of Congress to lymphoma
research. As we seek to strengthen our private sector investment in
research, we hope that the public-private lymphoma research partnership
will continue.
______
Prepared Statement of the March of Dimes Foundation
The 3 million volunteers and 1,400 staff members of the March of
Dimes Foundation appreciate the opportunity to submit the Foundation's
Federal funding recommendations for fiscal year 2008. The March of
Dimes is a national voluntary health agency working to improve the
health of mothers, infants and children by preventing birth defects,
premature birth and infant mortality through research, community
services, education, and advocacy.
The volunteers and staff of the March of Dimes urge the
subcommittee to provide the funding increases recommended below. Of
particular note, one of the last actions of the 109th Congress was
unanimous approval of the PREEMIE Act (Public Law 109-450). The March
of Dimes commends Congress for recognizing the growing health crisis of
preterm birth and calls on the subcommittee to fund two major
provisions of the act: (1) expansion of CDC activities related to
preterm birth, which are outlined in the CDC section of this testimony
and (2) a Surgeon General's Conference and report on preterm birth. In
order to convene a Surgeon General's conference on preterm birth and
produce a widely disseminated report, $1,000,000 in fiscal year 2008
funding is needed. The conference and report will establish a public-
private research and education agenda to accelerate the development of
new strategies for preventing preterm birth.
NATIONAL INSTITUTES OF HEALTH (NIH)
The March of Dimes joins the larger research community in
recommending a 6.7 percent increase in funding for the NIH bringing
total Federal support to just over $30 billion. The 6.7 percent
increase was calculated by the biomedical inflator of 3.7 percent and
lost purchasing power which is 3 percent. Since the doubling of NIH's
budget was completed in 2003, the agency has lost 13 percent of its
purchasing power. With all the threats to children's health it is
imperative to increase the overall investment in medical research.
Office of the Director
The March of Dimes was extremely pleased that Congress included $69
million for the National Children's Study (NCS) in the fiscal year 2007
Joint Funding Resolution, allowing for implementation of the next phase
of the study. The Foundation urges the subcommittee to include within
the Office of the Director $111 million ($42 million in new funding)
for the NCS in fiscal year 2008. While the amount may seem substantial,
it is dwarfed by the cost of treating the diseases and conditions the
study is designed to address. Approximately 1 year after the full study
is underway researchers will begin a thorough review of data pertaining
to premature birth and pregnancy outcomes and, using this data, will
focus on an array of serious pediatric health problems. This landmark
study holds the potential to dramatically enhance understanding of the
causes of preterm birth, birth defects, and infant mortality as well as
numerous other childhood diseases and conditions.
National Institute of Child Health and Human Development (NICHD)
The March of Dimes recommends a 6.7 percent increase for NICHD in
fiscal year 2008 and an increase of at least $100 million over the next
5 years to boost prematurity-related research. In recent years, the
NICHD has made a major commitment to enhance our understanding of the
factors that result in premature birth and to develop strategies to
prolong pregnancy so that infants are not born too soon. But additional
research is needed.
Since 1981, the preterm birth rate has increased 30 percent
resulting in more than half a million premature births in 2005--or 1 in
8. Preterm birth is the leading cause of death in the first month of
life and, for those babies who do survive, 1 in 5 experience life long
health problems including cerebral palsy, mental retardation, chronic
lung disease, and vision and hearing loss. Preterm labor can happen to
any pregnant woman, and the causes of nearly half of all premature
births are not yet known.
This growing problem of preterm births was brought into sharp focus
by the 2006 Institute of Medicine (IOM) report entitled, ``Preterm
Birth: Causes, Consequences and Prevention.'' The IOM found that the
annual economic burden associated with preterm birth in the United
States was at least $26.2 billion, or $51,600 per infant born preterm.
In 2003, the national hospital bill alone for the care of these babies
exceeded $18 billion, half of which was borne by Medicaid and other
public programs and the remainder was charged to employers and
families.
CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC)
Safe Motherhood/Infant Health
The National Center for Chronic Disease Prevention and Health
Promotion, Division of Reproductive Health works to promote optimal
reproductive and infant health. The March of Dimes recommends an $8
million increase, as authorized in the PREEMIE Act, for CDC to increase
epidemiological research on preterm labor and delivery, which is vital
to ultimately preventing preterm birth.
Specifically, these additional funds will enable CDC to conduct
additional epidemiological studies on preterm birth, including the
relationship between prematurity, birth defects and developmental
disabilities. These new funds will also make possible the establishment
of systems for the collection of maternal-infant clinical and
biomedical information that is linked with the Pregnancy Risk
Assessment Monitoring System (PRAMS). Increasing CDC's research
activities related to preterm birth will bring the Nation closer to
improving screening and early detection and finding new interventions
for women at risk for preterm labor.
National Center on Birth Defects and Developmental Disabilities
(NCBDDD)
Of particular interest to the March of Dimes is NCBDDD's birth
defects program that includes surveillance, research and prevention
activities. For fiscal year 2008, the March of Dimes requests an
increase of $10 million to support surveillance and research and an
additional $2 million for folic acid education. In the March of Dimes
professional judgment, these modest increases are vital to making
progress in reducing the incidence of birth defects.
In the United States, about 3 percent of all babies are born with a
major birth defect. Birth defects are the leading cause of infant
mortality accounting for more than 20 percent of all infant deaths
every year. Children with birth defects who survive may experience
lifelong physical and mental disabilities, and are at increased risk
for developing other health problems. In fact, birth defects contribute
substantially to the Nation's health care costs. According to CDC, the
lifetime economic cost of caring for infants born each year with 1 of
the 18 most common birth defects exceeds $8 billion.
The causes of nearly 70 percent of birth defects are unknown and it
is therefore critical that the subcommittee increase funding for the
National Birth Defects Prevention Study. This groundbreaking CDC
initiative is being carried out by 9 regional Centers for Birth Defects
Research and Prevention located in Arkansas, California, Georgia, Iowa,
Massachusetts, New York, North Carolina, Texas, and Utah. Each of these
centers identify infants with major birth defects; interview mothers
about medical history, environmental exposures, and lifestyle before
and during pregnancy; and collect DNA samples to study gene-environment
interactions. This study has nearly 11 years worth of data and DNA
samples collected. Due to funding limitations, CDC has yet to be able
to analyze the DNA samples to identify genetic risk factors. In
addition, without increased funding the CDC will be forced to decrease
the number of centers participating in the study.
NCBDDD also provides funding to assist States with community-based
birth defects tracking systems, programs to prevent birth defects and
improve access to health services for children with birth defects.
Surveillance forms the backbone of a vital, functional and responsive
public health network. Additional resources are sorely needed to help
States seeking assistance.
Finally, NCBDDD is conducting a national public and health
professions education campaign designed to increase the number of women
taking folic acid. CDC estimates that up to 70 percent of neural tube
defects (NTDs), serious birth defects of the brain and spinal cord
including anencephaly and spina bifida could be prevented if all women
of childbearing age consume 400 micrograms of folic acid daily,
beginning before pregnancy. Since 1996, the rate of NTDs in the United
States has decreased by 26 percent. Unfortunately, according to a
recent analysis conducted by CDC folate concentrations among non-
pregnant women of child bearing age decreased by 16 percent from 1999-
2000 through 2003-2004. Clearly, women are still not receiving an
adequate level of folic acid and increased resources to CDC for the
expansion of its folic acid education campaign is needed.
National Center for Health Statistics
The National Center for Health Statistics (NCHS) provides data
essential for both public and private research and programmatic
initiatives. The National Vital Statistics System and the National
Survey on Family Growth, for example, is the principal source of
information on the utilization of prenatal care and on birth outcomes,
including preterm delivery, low birthweight and infant mortality. The
current funding level threatens the collection of vital information and
more specifically NCHS lacks the resources to collect a full year's
worth of vital statistics from States. Without at least $3 million in
additional funding we will become the first industrialized Nation
unable to collect birth, death and other vital statistics. The March of
Dimes supports a funding level of $117 million, an increase of $8
million over fiscal year 2007, to ensure that NCHS continues its role
in monitoring our Nation's health.
HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA)
Newborn Screening
Newborn screening is a vital public health activity used to
identify and treat genetic, metabolic, hormonal and functional
conditions in newborns. Screening detects disorders in newborns that,
if left untreated, can cause death, disability, mental retardation and
other serious illnesses. Parents are often unaware that while nearly
all babies born in the United States undergo newborn screening for
genetic birth defects, the number and quality of these tests vary from
State to State. The March of Dimes, the American Academy of Pediatrics
and the American College of Medical Genetics recommend that at a
minimum, every baby born in the United States be screened for a core
group of 29 treatable conditions regardless of the State in which the
infant is born. Only 11 States and the District of Columbia currently
screen for all 29 of these conditions.
Currently, Federal support for State newborn screening activities
is provided through the Maternal and Child Health Block Grant, Special
Projects of Regional and National Significance (SPRANS). The March of
Dimes recommends full funding of the MCH Block Grant at the authorized
level of $850 million. In addition, the Foundation urges that $9
million of SPRANS funding be set-aside for newborn screening activities
(an increase of $3 million over fiscal year 2007). In the March of
Dimes professional judgment, this funding will allow for the
continuation of the Regional Genetic Service and Newborn Screening
Collaboratives that focus on the maldistribution of genetic services
and resources and bring services closer to local communities. It would
also enable HRSA to improve the capacity of States to: (1) provide
screening, counseling, testing, and special services for newborns and
children at risk for heritable disorders; (2) educate health
professionals and parents on the availability and importance of newborn
screening; and (3) support States with technical assistance on the
acquisition and use of new technologies and newborn screening services.
FISCAL YEAR 2008 FEDERAL FUNDING RECOMMENDATIONS
[In millions of dollars]
------------------------------------------------------------------------
March of Dimes
Fiscal year fiscal year
Program 2007 2008
funding recommendation
------------------------------------------------------------------------
National Institutes of Health (Total)...... 28,879 30,813
National Children's Study.................. 69 111
National Institute of Child Health & Human 1,253 1,337
Development...............................
National Human Genome Research Institute... 486 519
National Center on Minority Health and 199 212
Disparities...............................
Center for Disease Control and Prevention 6,095 7,800
(CDC).....................................
Save Motherhood/Infant Health (NCCDPHP).... 44 52
Birth Defects Research & Surveillance...... 15 25
Folic Acid Education Campaign.............. 2 4
Immunization............................... 520 802.4
Polio Eradication.......................... 101 101
National Center for Health Statistics...... 109 117
Health Resources and Services 6,884 7,500
Administration (Total)....................
Maternal and Child Health Block Grant...... 693 850
Newborn Screening.......................... 6 9
Newborn Hearing Screening.................. 10 10
Consolidated (Community) Health Centers.... 1,988 2,188
Healthy Start.............................. 102 102
Agency for Healthcare Research and Quality. 319 350
------------------------------------------------------------------------
______
Prepared Statement of Meharry Medical College
SUMMARY OF FISCAL YEAR 2008 RECOMMENDATIONS
$300 million for the Title VII Health Professions Training
programs, including:
--$33.6 million for the Minority Centers of Excellence.
--$35.6 million for the Health Careers Opportunity program.
$250 million for the National Institutes of Health's National
Center on Minority Health and Health Disparities.
$169 million for the National Center for Research Resources
Extramural Facilities Construction program.
--$6.7 percent increase for Research Centers for Minority
Institutions.
--$119 million for Extramural Facilities construction.
$65 million for the Department of Health and Human Services' Office
of Minority Health.
$65 million for the Department of Education's Strengthening
Historically Black Graduate Institutions program.
Mr. Chairman and members of the subcommittee, thank you for the
opportunity to present my views before you today. I am Dr. Wayne J.
Riley, president and CEO of Meharry Medical College in Nashville,
Tennessee. I have previously served as vice-president and vice dean for
health affairs and governmental relations and associate professor of
medicine at Baylor College of Medicine in Houston, Texas and as
assistant chief of medicine and a practicing general internist at
Houston's Ben Taub General Hospital. In all of these roles, I have seen
firsthand the importance of minority health professions institutions
and the Title VII Health Professions Training programs.
Mr. Chairman, time and time again, you have encouraged your
colleagues and the rest of us to take a look at our Nation and evaluate
our needs over the next 10 years. I want to say that minority health
professional institutions and the Title VII Health Professionals
Training programs address a critical national need. Persistent and
sever staffing shortages exist in a number of the health professions,
and chronic shortages exist for all of the health professions in our
Nation's most medically underserved communities. Furthermore, our
Nation's health professions workforce does not accurately reflect the
racial composition of our population. For example while blacks
represent approximately 15 percent of the U.S. population, only 2-3
percent of the Nation's health professions workforce is black. If you
take minorities as a whole, Minority health professional institutions
and the Title VII Health Professions Training programs address this
critical national need. Persistent and severe staffing shortages exist
in a number of the health professions, and chronic shortages exist for
all of the health professions in our Nation's most medically
underserved communities. Our Nation's health professions workforce does
not accurately reflect the racial composition of our population. For
example, African Americans represent approximately 15 percent of the
U.S. population while only 2-3 percent of the Nation's healthcare
workforce is African American.
There is a well established link between health disparities and a
lack of access to competent healthcare in medically underserved areas.
As a result, it is imperative that the Federal Government continue its
commitment to minority health profession institutions and minority
health professional training programs to continue to produce healthcare
professionals committed to addressing this unmet need.
An October 2006 study by the Health Resources and Services
Administration (HRSA), entitled ``The Rationale for Diversity in the
Health Professions: A Review of the Evidence'' found that minority
health professionals serve minority and other medically underserved
populations at higher rates than non-minority professionals. The report
also showed that; minority populations tend to receive better care from
practitioners who represent their own race or ethnicity, and non-
English speaking patients experience better care, greater
comprehension, and greater likelihood of keeping follow-up appointments
when they see a practitioner who speaks their language. Studies have
also demonstrated that when minorities are trained in minority health
profession institutions, they are significantly more likely to: (1)
serve in rural and urban medically underserved areas, (2) provide care
for minorities and (3) treat low-income patients.
As you are aware, Title VII Health Professions Training programs
are focused on improving the quality, geographic distribution and
diversity of the healthcare workforce in order to continue eliminating
disparities in our Nation's healthcare system. These programs provide
training for students to practice in underserved areas, cultivate
interactions with faculty role models who serve in underserved areas,
and provide placement and recruitment services to encourage students to
work in these areas. Health professionals who spend part of their
training providing care for the underserved are up to 10 times more
likely to practice in underserved areas after graduation or program
completion.
Institutions that cultivate minority health professionals have been
particularly hard-hit as a result of the cuts to the Title VII Health
Profession Training programs in fiscal year 2006 and fiscal year 2007
Funding Resolution passed earlier this Congress. Given their historic
mission to provide academic opportunities for minority and financially
disadvantaged students, and healthcare to minority and financially
disadvantaged patients, minority health professions institutions
operate on narrow margins. The cuts to the Title VII Health Professions
Training programs amount to a loss of core funding at these
institutions and have been financially devastating.
Mr. Chairman, I feel like I can speak authoritatively on this issue
because I received my medical degree from Morehouse School of Medicine,
a historically black medical school in Atlanta. I give credit to my
career in academia, and my being here today, to Title VII Health
Profession Training programs' Faculty Loan Repayment Program. Without
that program, I would not be the president of my father's alma mater,
Meharry Medical College, another historically black medical school
dedicated to eliminating healthcare disparities through education,
research and culturally relevant patient care.
In fiscal year 2008, funding for the Title VII Health Professions
Training programs must be restored to the fiscal year 2005 level of
$300 million, with two programs--the Minority Centers of Excellence
(COEs) and Health Careers Opportunity Program (HCOPs)--in particular
need of a funding restoration. In addition, the National Institutes of
Health (NIH)'s National Center on Minority Health and Health
Disparities (NCMHD), as well as the Department of Health and Human
Services (HHS)'s Office of Minority Health (OMH), are both in need of a
funding increase.
MINORITY CENTERS OF EXCELLENCE
COEs focus on improving student recruitment and performance,
improving curricula in cultural competence, facilitating research on
minority health issues and training students to provide health services
to minority individuals. COEs were first established in recognition of
the contribution made by four historically black health professions
institutions (the Medical and Dental Institutions at Meharry Medical
College; The College of Pharmacy at Xavier University; and the School
of Veterinary Medicine at Tuskegee University) to the training of
minorities in the health professions. Congress later went on to
authorize the establishment of ``Hispanic'', ``Native American'' and
``Other'' Historically black COEs.
Presently the statute is configured in such a way that the
``original four'' institutions compete for the first $12 million in
funding, ``Hispanic and Native American'' institutions compete for the
next $12 million, and ``Other'' institutions can compete for grants
when the overall funding is above $24 million. For funding above $30
million all eligible institutions can compete for funding.
However, as a consequence of limited funding for COEs in fiscal
year 2006 and fiscal year 2007, ``Hispanic and Native American'' and
``Other'' COEs have lost their support. Out of 34 total COEs in fiscal
year 2005, only 4 now remain due to the cuts in funding.
For fiscal year 2008, I recommend a funding level of $33.6 million
for COEs.
HEALTH CAREERS OPPORTUNITY PROGRAM (HCOP)
HCOPs provide grants for minority and non-minority health
profession institutions to support pipeline, preparatory and recruiting
activities that encourage minority and economically disadvantaged
students to pursue careers in the health professions. Many HCOPs
partner with colleges, high schools, and even elementary schools in
order to identify and nurture promising students who demonstrate that
they have the talent and potential to become a health professional.
Collectively, the absence of HCOPs will substantially erode the
number of minority students who enter the health professions. Over the
last three decades, HCOPs have trained approximately 30,000 health
professionals including 20,000 doctors, 5,000 dentists and 3,000 public
health workers. If HCOPs continue to lose Federal support, then these
numbers will drastically decrease. It is estimated that the number of
minority students admitted to health professional schools will drop by
25-50 percent without HCOPs. A reduction of just 25 percent in the
number of minority students admitted to medical school will produce
approximately 600 fewer minority medical students nationwide.
As a result of cuts in the fiscal year 2006 and fiscal year 2007
Labor-HHS Appropriations process, only 4 out of 74 total HCOPs
currently receive Federal funding. As president of Meharry, I feel this
loss as we were one of the 70 institutions who lost their HCOP grants.
For fiscal year 2008, I recommend a funding level of $35.6 million
for HCOPs.
national institutes of health (nih): extramural facilities construction
Mr. Chairman, if we are to take full advantage of the recent
funding increases for biomedical research that Congress has provided to
NIH over the past decade, it is critical that our Nation's research
infrastructure remain strong. The current authorization level for the
Extramural Facility Construction program at the National Center for
Research Resources is $250 million. The law also includes a 25 percent
set-aside for ``Institutions of Emerging Excellence'' (many of which
are minority institutions) for funding up to $50 million. Finally, the
law allows the NCRR Director to waive the matching requirement for
institutions participating in the program. We strongly support all of
these provisions of the authorizing legislation because they are
necessary for our minority health professions training schools.
Unfortunately, funding for NCRR's Extramural Facility Construction
program was completely eliminated in the fiscal year 2006 Labor-HHS
bill, and no funding was restored in the funding resolution for fiscal
year 2007. In fiscal year 2008, please restore funding for this program
to its fiscal year 2004 level of $119 million, or at a minimum, provide
funding equal to the fiscal year 2005 appropriation of $40 million.
RESEARCH CENTERS IN MINORITY INSTITUTIONS
The Research Centers at Minority Institutions program (RCMI) at the
National Center for Research Resources has a long and distinguished
record of helping our institutions develop the research infrastructure
necessary to be leaders in the area of health disparities research.
Although NIH has received unprecedented budget increases in recent
years, funding for the RCMI program has not increased by the same rate.
Therefore, the funding for this important program grow at the same rate
as NIH overall in fiscal year 2008.
STRENGTHENING HISTORICALLY BLACK GRADUATE INSTITUTIONS--DEPARTMENT OF
EDUCATION
The Department of Education's Strengthening Historically Black
Graduate Institutions program (Title III, Part B, section 326) is
extremely important to MMC and other minority serving health
professions institutions. The funding from this program is used to
enhance educational capabilities, establish and strengthen program
development offices, initiate endowment campaigns, and support numerous
other institutional development activities. In fiscal year 2008, an
appropriation of $65 million (an increase of $7 million over fiscal
year 2007) is suggested to continue the vital support that this program
provides to historically black graduate institutions.
National Center on Minority Health and Health Disparities
The National Center on Minority Health and Health Disparities
(NCMHD) is charged with addressing the longstanding health status gap
between minority and nonminority populations. The NCMHD helps health
professional institutions to narrow the health status gap by improving
research capabilities through the continued development of faculty,
labs, and other learning resources. The NCMHD also supports biomedical
research focused on eliminating health disparities and develops a
comprehensive plan for research on minority health at the NIH.
Furthermore, the NCMHD provides financial support to health professions
institutions that have a history and mission of serving minority and
medically underserved communities through the Minority Centers of
Excellence program.
For fiscal year 2008, I recommend a funding level of $250 million
for the NCMHD.
Department of Health and Human Services' Office of Minority Health
(OMH)
Specific programs at OMH include:
(1) Assisting medically underserved communities with the greatest
need in solving health disparities and attracting and retaining health
professionals,
(2) Assisting minority institutions in acquiring real property to
expand their campuses and increase their capacity to train minorities
for medical careers,
(3) Supporting conferences for high school and undergraduate
students to interest them in health careers, and
(4) Supporting cooperative agreements with minority institutions
for the purpose of strengthening their capacity to train more
minorities in the health professions.
The OMH has the potential to play a critical role in addressing
health disparities. Unfortunately, the OMH does not yet have the
authority or resources necessary to support activities that will truly
make a difference in closing the health gap between minority and
majority populations.
For fiscal year 2008, I recommend a funding level of $65 million
for the OMH.
Mr. Chairman, please allow me to express my appreciation to you and
the members of this subcommittee. With your continued help and support,
Meharry Medical College along with other minority health professions
institutions and the Title VII Health Professions Training programs can
help this country to overcome health and healthcare disparities.
Congress must be careful not to eliminate, paralyze or stifle the
institutions and programs that have been proven to work. Meharry and
other minority health professions schools seek to close the ever
widening health disparity gap. If this subcommittee will give us the
tools, we will continue to work towards the goal of eliminating that
disparity as we have done for 1,876.
Thank you, Mr. Chairman, for this opportunity.
______
Prepared Statement of the Morehouse School of Medicine
SUMMARY OF FISCAL YEAR 2008 RECOMMENDATIONS
$300 million for the Title VII Health Professions Training
programs, including:
--$33.6 million for the Minority Centers of Excellence.
--$35.6 million for the Health Careers Opportunity program.
$250 million for the National Institutes of Health's National
Center on Minority Health and Health Disparities.
Support for the National Center for Research Resources Extramural
Facilities Construction program.
--$6.7 percent increase for Research Centers for Minority
Institutions.
--$119 million for Extramural Facilities Construction.
$65 million for the Department of Health and Human Services' Office
of Minority Health.
$65 million for the Department of Education's Strengthening
Historically Black Graduate Institutions program.
Mr. Chairman and members of the subcommittee, thank you for the
opportunity to present my views before you today. I am Dr. John E.
Maupin, president of Morehouse School of Medicine (MSM) in Atlanta,
Georgia. I have previously served as President of Meharry Medical
College, executive vice-president at Morehouse School of Medicine, as
director of a community health center in Atlanta, and deputy director
of health in Baltimore, Maryland. In all of these roles, I have seen
firsthand the importance of minority health professions institutions
and the Title VII Health Professions Training programs.
Mr. Chairman, time and time again, you have encouraged your
colleagues and the rest of us to take a look at our Nation and evaluate
our needs over the next 10 years. I want to say that minority health
professional institutions and the Title VII Health Professionals
Training programs address a critical national need. Persistent and
sever staffing shortages exist in a number of the health professions,
and chronic shortages exist for all of the health professions in our
Nation's most medically underserved communities. Furthermore, our
Nation's health professions workforce does not accurately reflect the
racial composition of our population. For example while blacks
represent approximately 15 percent of the U.S. population, only 2-3
percent of the Nation's health professions workforce is black.
Morehouse is a private school with a very public mission of educating
students from traditionally underserved communities so that they will
care for the underserved. Mr. Chairman, I would like to share with you
how your committee can help us continue our efforts to help provide
quality health professionals and close our Nation's health disparity
gap.
There is a well established link between health disparities and a
lack of access to competent healthcare in medically underserved areas.
As a result, it is imperative that the Federal Government continue its
commitment to minority health profession institutions and minority
health professional training programs to continue to produce healthcare
professionals committed to addressing this unmet need.
An October 2006 study by the Health Resources and Services
Administration (HRSA), entitled ``The Rationale for Diversity in the
Health Professions: A Review of the Evidence'' found that minority
health professionals serve minority and other medically underserved
populations at higher rates than non-minority professionals. The report
also showed that; minority populations tend to receive better care from
practitioners who represent their own race or ethnicity, and non-
English speaking patients experience better care, greater
comprehension, and greater likelihood of keeping follow-up appointments
when they see a practitioner who speaks their language. Studies have
also demonstrated that when minorities are trained in minority health
profession institutions, they are significantly more likely to: (1)
serve in rural and urban medically underserved areas, (2) provide care
for minorities and (3) treat low-income patients.
As you are aware, Title VII Health Professions Training programs
are focused on improving the quality, geographic distribution and
diversity of the healthcare workforce in order to continue eliminating
disparities in our Nation's healthcare system. These programs provide
training for students to practice in underserved areas, cultivate
interactions with faculty role models who serve in underserved areas,
and provide placement and recruitment services to encourage students to
work in these areas. Health professionals who spend part of their
training providing care for the underserved are up to 10 times more
likely to practice in underserved areas after graduation or program
completion.
Institutions that cultivate minority health professionals, like
MSM, have been particularly hard-hit as a result of the cuts to the
Title VII Health Profession Training programs in fiscal year 2006 and
fiscal year 2007 Funding Resolution passed earlier this Congress. Given
their historic mission to provide academic opportunities for minority
and financially disadvantaged students, and healthcare to minority and
financially disadvantaged patients, minority health professions
institutions operate on narrow margins. The cuts to the Title VII
Health Professions Training programs amount to a loss of core funding
at these institutions and have been financially devastating.
Mr. Chairman, I feel like I can speak authoritatively on this issue
because I received my medical degree from Meharry Medical College, a
historically black medical and dental school in Nashville, Tennessee. I
have seen first hand what Title VII funds have done to minority serving
institutions like Morehouse and Meharry. I compare my days as a student
to my days as president, without that Title VII, our institutions would
not be here today. However, Mr. Chairman, since those funds have been
cut in the last 2 fiscal years, we are standing at a cross roads. This
committee has the power to decide if our institutions will go forward
and thrive, or if we will continue to try to just survive. We want to
work with you to eliminate health disparities and produce world class
professionals, but we need your assistance.
In fiscal year 2008, funding for the Title VII Health Professions
Training programs must be restored to the fiscal year 2005 level of
$300 million, with two programs--the Minority Centers of Excellence
(COEs) and Health Careers Opportunity Program (HCOPs)--in particular
need of a funding restoration. In addition, the National Institutes of
Health (NIH)'s National Center on Minority Health and Health
Disparities (NCMHD), as well as the Department of Health and Human
Services (HHS)'s Office of Minority Health (OMH), are both in need of a
funding increase.
MINORITY CENTERS OF EXCELLENCE
COEs focus on improving student recruitment and performance,
improving curricula in cultural competence, facilitating research on
minority health issues and training students to provide health services
to minority individuals. COEs were first established in recognition of
the contribution made by four historically black health professions
institutions (the Medical and Dental Institutions at Meharry Medical
College; The College of Pharmacy at Xavier University; and the School
of Veterinary Medicine at Tuskegee University) to the training of
minorities in the health professions. Congress later went on to
authorize the establishment of ``Hispanic'', ``Native American'' and
``Other'' Historically black COEs.
Presently the statute is configured in such a way that the
``original four'' institutions compete for the first $12 million in
funding, ``Hispanic and Native American'' institutions compete for the
next $12 million, and ``Other'' institutions can compete for grants
when the overall funding is above $24 million. For funding above $30
million all eligible institutions can compete for funding.
However, as a consequence of limited funding for COEs in fiscal
year 2006 and fiscal year 2007, ``Hispanic and Native American'' and
``Other'' COEs have lost their support. Out of 34 total COEs in fiscal
year 2005, only 4 now remain due to the cuts in funding. MSM lost its
COE funding as well, which was a devastating blow to our School.
For fiscal year 2008, I recommend a funding level of $33.6 million
for COEs.
HEALTH CAREERS OPPORTUNITY PROGRAM (HCOP)
HCOPs provide grants for minority and non-minority health
profession institutions to support pipeline, preparatory and recruiting
activities that encourage minority and economically disadvantaged
students to pursue careers in the health professions. Many HCOPs
partner with colleges, high schools, and even elementary schools in
order to identify and nurture promising students who demonstrate that
they have the talent and potential to become a health professional.
Collectively, the absence of HCOPs will substantially erode the
number of minority students who enter the health professions. Over the
last three decades, HCOPs have trained approximately 30,000 health
professionals including 20,000 doctors, 5,000 dentists and 3,000 public
health workers. If HCOPs continue to lose Federal support, then these
numbers will drastically decrease. It is estimated that the number of
minority students admitted to health professional schools will drop by
25-50 percent without HCOPs. A reduction of just 25 percent in the
number of minority students admitted to medical school will produce
approximately 600 fewer minority medical students nationwide.
As a result of cuts in the fiscal year 2006 and fiscal year 2007
Labor-HHS Appropriations process, only 4 out of 74 total HCOPs
currently receive Federal funding. As president of MSM, I am proud to
say we competed well enough to be one of those four; however, those who
have the same mission as ours must have this funding as well.
For fiscal year 2008, I recommend a funding level of $35.6 million
for HCOPs.
national institutes of health (nih): extramural facilities construction
Mr. Chairman, if we are to take full advantage of the recent
funding increases for biomedical research that Congress has provided to
NIH over the past decade, it is critical that our Nation's research
infrastructure remain strong. The current authorization level for the
Extramural Facility Construction program at the National Center for
Research Resources is $250 million. The law also includes a 25 percent
set-aside for ``Institutions of Emerging Excellence'' (many of which
are minority institutions) for funding up to $50 million. Finally, the
law allows the NCRR Director to waive the matching requirement for
institutions participating in the program. We strongly support all of
these provisions of the authorizing legislation because they are
necessary for our minority health professions training schools.
Unfortunately, funding for NCRR's Extramural Facility Construction
program was completely eliminated in the fiscal year 2006 Labor-HHS
bill, and no funding was restored in the funding resolution for fiscal
year 2007. In fiscal year 2008, please restore funding for this program
to its fiscal year 2004 level of $119 million, or at a minimum, provide
funding equal to the fiscal year 2005 appropriation of $40 million.
RESEARCH CENTERS IN MINORITY INSTITUTIONS
The Research Centers at Minority Institutions program (RCMI) at the
National Center for Research Resources has a long and distinguished
record of helping our institutions develop the research infrastructure
necessary to be leaders in the area of health disparities research.
Although NIH has received unprecedented budget increases in recent
years, funding for the RCMI program has not increased by the same rate.
Therefore, the funding for this important program grow at the same rate
as NIH overall in fiscal year 2008.
STRENGTHENING HISTORICALLY BLACK GRADUATE INSTITUTIONS--DEPARTMENT OF
EDUCATION
The Department of Education's Strengthening Historically Black
Graduate Institutions program (Title III, Part B, Section 326) is
extremely important to MMC and other minority serving health
professions institutions. The funding from this program is used to
enhance educational capabilities, establish and strengthen program
development offices, initiate endowment campaigns, and support numerous
other institutional development activities. In fiscal year 2008, an
appropriation of $65 million (an increase of $7 million over fiscal
year 2007) is suggested to continue the vital support that this program
provides to historically black graduate institutions.
National Center on Minority Health and Health Disparities
The National Center on Minority Health and Health Disparities
(NCMHD) is charged with addressing the longstanding health status gap
between minority and nonminority populations. The NCMHD helps health
professional institutions to narrow the health status gap by improving
research capabilities through the continued development of faculty,
labs, and other learning resources. The NCMHD also supports biomedical
research focused on eliminating health disparities and develops a
comprehensive plan for research on minority health at the NIH.
Furthermore, the NCMHD provides financial support to health professions
institutions that have a history and mission of serving minority and
medically underserved communities through the Minority Centers of
Excellence program.
For fiscal year 2008, I recommend a funding level of $250 million
for the NCMHD.
Department of Health and Human Services' Office of Minority Health
(OMH)
Specific programs at OMH include:
(1) Assisting medically underserved communities with the greatest
need in solving health disparities and attracting and retaining health
professionals,
(2) Assisting minority institutions in acquiring real property to
expand their campuses and increase their capacity to train minorities
for medical careers,
(3) Supporting conferences for high school and undergraduate
students to interest them in health careers, and
(4) Supporting cooperative agreements with minority institutions
for the purpose of strengthening their capacity to train more
minorities in the health professions.
The OMH has the potential to play a critical role in addressing
health disparities. Unfortunately, the OMH does not yet have the
authority or resources necessary to support activities that will truly
make a difference in closing the health gap between minority and
majority populations.
For fiscal year 2008, I recommend a funding level of $65 million
for the OMH.
Mr. Chairman, please allow me to express my appreciation to you and
the members of this subcommittee. With your continued help and support,
Morehouse School of Medicine along with other minority health
professions institutions and the Title VII Health Professions Training
programs can help this country to overcome health and healthcare
disparities. Congress must be careful not to eliminate, paralyze or
stifle the institutions and programs that have been proven to work. MSM
and other minority health professions schools seek to close the ever
widening health disparity gap. If this subcommittee will give us the
tools, we will continue to work towards the goal of eliminating that
disparity as we have since our founding day.
Thank you, Mr. Chairman, and I welcome every opportunity to answer
questions for your records.
______
Prepared Statement of the National Alliance to End Homelessness
The National Alliance to End Homelessness (the Alliance) is a
nonpartisan, nonprofit organization that has several thousand partner
agencies and organizations across the country. These partners are local
faith-based and community-based nonprofit organizations and public
sector agencies that provide homeless people with shelter, transitional
and permanent housing, and services such as substance abuse treatment,
job training, and physical health and mental health care. In addition,
we have supported over 160 State and local entities who have completed
10 year plans to end homelessness. The Alliance represents a united
effort to address the root causes of homelessness and challenge
society's acceptance of homelessness as an inevitable by-product of
American life.
Overview--Our recent research report, Homelessness Counts,
estimates that 744,313 people are homeless on any given night. This
includes 98,452 families. Fifty-six percent of the total were living in
shelters or transitional housing and 44 percent were unsheltered. This
report illustrates that far too many people are homeless and many are
not being reached by existing programs. This is inexcusable given that
we know what interventions work and several communities are making
progress toward ending homelessness. These interventions, such as
housing first for families and permanent supportive housing, couple
housing with an appropriate level of services for the family or
individual. Therefore, not only does the Department of Housing and
Urban Development play a role in ending homelessness, so do the
Departments of Labor, Health and Human Services, and Education. We call
on Congress and all Federal agencies to adequately fund the programs
that assist States and local entities in developing permanent housing
and the necessary social services to once and for all end homelessness
for all Americans.
GOALS
1. Moving Forward to End Homelessness.--Communities across America
are working toward ending homelessness. Communities are using Federal,
State, and local funds to help homeless persons maintain housing. It is
important that this progress not be undermined. To this end, the
Alliance recommends the following:
--Allocate an additional $80 million for services in permanent
supportive housing within SAMHSA's Center for Mental Health
Services.
--Increase funding to Projects for Assistance in Transition from
Homelessness (PATH) to $58.3 million.
--Increase the Runaway and Homeless Youth Act Programs to $140
million.
--Provide a $200 million increase in the Community Health Center
program within Health Resource Services Administration. This
would result in the Health Care for the Homeless programs
receiving $190 million.
--Fund Education for Homeless Children and Youth services at its full
authorized level of $70 million.
--Increase funding for the Homeless Veterans Reintegration Program to
$50 million.
2. Connecting Homeless Families, Individuals, and Youth to
Mainstream Services.--People experiencing homelessness also depend on
mainstream programs such as the ones below to live day to day and once
housed, remain housed. The Alliance recommends the following to meet
this goal:
--Fund the Social Services Block Grant at $1.7 billion, the same
funding level as fiscal year 2006.
--Reject cuts and fund the Community Services Block Grant at $700
million
--Appropriate $60 million in education and training vouchers for
youth exiting foster care under the Safe and Stable Families
Program.
GOAL 1--MOVING FORWARD TO END HOMELESSNESS
Support Services for Permanent Supportive Housing Projects
The Alliance recommends allocating an additional $80 million for
services in permanent supportive housing within SAMHSA's Center for
Mental Health Services. The administration has set a goal of ending
chronic homelessness by 2012 and joined with Congress to set a goal of
creating 150,000 additional units of permanent supportive housing.
According to the Alliance's report, Homelessness Counts, 23 percent of
those who are homeless on any given night meet the chronic homelessness
definition of being homeless for long periods of time or repeatedly.
These people need access to housing and support services. The Alliance
and our partners believe the Department of Health and Human Services
needs to raise its commitment to provide the services necessary to end
homelessness. Therefore, we are proposing this increase in SAMHSA
funding to help communities provide services to 16,000 new units of
permanent supportive housing.
PROJECTS FOR TRANSITION ASSISTANCE FROM HOMELESSNESS (PATH)
The Alliance recommends that Congress increase PATH funding to
$58.3 million and adjust the funding formula to increase allocation for
small States and territories.
The PATH program provides access to mental health services for
homeless people with serious mental illnesses. PATH focuses on outreach
to eligible consumers, followed by help in ensuring that those
consumers are connected with mainstream services, such as Supplemental
Security Income (SSI), Medicaid and welfare programs. Under the PATH
formula grant, approximately 30 States share in the program's annual
appropriations increases. The remaining States and territories receive
the minimum grant of $300,000 for States and $50,000 for territories.
These amounts have not been raised since the program was authorized in
1991. To account for inflation, the minimum allocation should be raised
to $600,000 for States and $100,000 for territories. Amending the
minimum allocation requires a legislative change. If the authorizing
committees do not address this issue, we hope that appropriators will
explore ways to make the change through appropriations bill language.
RUNAWAY AND HOMELESS YOUTH PROGRAMS
The Alliance recommends funding the Runaway and Homeless Youth Act
(RHYA) programs at $140 million. RHYA programs support cost-effective,
community and faith-based organizations that protect youth from the
harms of life on the streets. The problems of homeless and runaway
youth are addressed by the Administration for Children and Families
within HHS, which operates coordinated competitive grant programs like
RHYA. The RHYA programs can either reunify youth safely with family or
find alternative living arrangements. RHYA programs end homelessness
by: engaging youth living on the street with Street Outreach Programs,
quickly providing emergency shelter and family crisis counseling
through the Basic Centers, or providing supportive housing that helps
young people develop lifelong independent living skills through
Transitional Living Programs. Recently, the Congressional Research
Service issued a report complimenting the good work of RHYA programs
but detailing the gaps in services due to limited funding. It is
essential that Congress increase this program.
COMMUNITY HEALTH CENTERS AND HEALTH CARE FOR THE HOMELESS (HCH)
PROGRAMS
The Alliance recommends a $200 million increase to the Community
Health Centers Program which would result in funding the HCH programs
at $190 million.
Persons living on the street suffer from health problems resulting
from or exacerbated by the condition of being homeless, such as
hypothermia, frostbite, and heatstroke. In addition, they often have
infections of the respiratory and gastrointestinal systems,
tuberculosis, vascular diseases such as leg ulcers, and
hypertension.\1\ Health care for the homeless programs are vital to
prevent these conditions from becoming fatal. Congress allocates 8.7
percent of the Consolidated Health Centers account for Health Care for
the Homeless (HCH) projects. The HCH program has achieved significant
success since its inception in 1987, but the health care needs of
Americans experiencing homelessness each year far exceed the service
capacity of Health Care for the Homeless grantees.
---------------------------------------------------------------------------
\1\ Harris, Shirley N, Carol T. Mowbray and Andrea Solarz. Physical
Health, Mental Health and Substance Abuse Problems of Shelter Users.
Health and Social Work, Vol. 19, 1994.
---------------------------------------------------------------------------
EDUCATION FOR HOMELESS CHILDREN AND YOUTH
The Alliance recommends funding Education for Homeless Children and
Youth (EHCY) at its full authorized level of $70 million. The most
important potential source of stability for homeless children is
school. The mission of the Education for Homeless Children and Youth
program is to ensure that these children can continue to attend school
and thrive. The Education for Homeless Children and Youth program,
within the Department of Education's Office of Elementary and Secondary
Education, removes obstacles to enrollment and retention by
establishing liaisons between schools and shelters and providing
funding for transportation, tutoring, school supplies, and the
coordination of statewide efforts to remove barriers.
HOMELESS VETERANS REINTEGRATION PROGRAM (HVRP)
The Alliance recommends that Congress increase HVRP funding to $50
million.
HVRP, within the Department of Labor's Veterans Employment and
Training Service (VETS), provides competitive grants to community-
based, faith-based, and public organizations to offer outreach, job
placement, and supportive services to homeless veterans. HVRP is the
primary employment services program accessible by homeless veterans and
the only targeted employment program for any homeless subpopulation. It
is estimated that this program only reaches about two percent of the
overall homeless veteran population. An appropriation at the authorized
level of $50 million would enable HVRP grantees to reach approximately
19,866 homeless veterans.
GOAL 2--CONNECTING HOMELESS FAMILIES, INDIVIDUALS AND YOUTH TO
MAINSTREAM SERVICES
Social Services Block Grant (SSBG)
The Alliance recommends that Congress fully restore SSBG funding to
its fiscal year 2006 level of $1.7 billion. SSBG funds are essential
for programs dedicated to ending homelessness. In particular, youth
housing programs and permanent supportive housing providers often
receive State, county, and local funds which originate from the SSBG.
As the U.S. Department of Housing and Urban Development has focused its
funding on housing, programs that provide both housing and social
services have struggled to fund the service component of their
programs. This gap is often closed using Federal programs such as SSBG.
Community Services Block Grant (CSBG)
The Alliance recommends that Congress fully restore CSBG funding to
its fiscal year 2006 level of $630 million. Funding cuts for the CSBG
will destabilize the progress communities have made toward ending
homelessness by not only ending services directly provided by CSBG
funds but limiting a community's ability to access other Federal
dollars such as those provided by HUD. Community Action Agencies (CAAs)
are directly involved in housing and homelessness services. In several
communities, CAAs lead the Continuum of Care (CoC). CoCs coordinate
local homeless service providers and the community's McKinney-Vento
Homeless Assistance Grant application process with the Department of
Housing and Urban Development.
In the fiscal year 2004 Community Services Block Grant Information
Systems report published by the U.S. Department of Health and Human
Services, CAAs reported administering $207.4 million in section 8
vouchers, $30 million in section 202 services \2\ and $271.1 million in
other Department of Housing and Urban Development (HUD) programs which
includes homeless program funding.\3\
---------------------------------------------------------------------------
\2\ Section 202 is dedicated to housing from elderly and disabled
individuals and families.
\3\ U.S. Department of Health and Human Services, Administration of
Children and Families. The Community Services Block Grant fiscal year
2004 Statistical Report. Prepared by the National Association for State
Community Services Programs.
---------------------------------------------------------------------------
Foster Youth Education and Training Vouchers
The Alliance recommends that Congress appropriate $60 million in
education and training vouchers for youth exiting foster care under the
Safe and Stable Families Program. The Education and Training Voucher
Program offers funds to foster youth and former foster youth to enable
them to attend colleges, universities and vocational training
institutions. Students may receive up to $5,000 a year for college or
vocational training education. The funds may be used for tuition,
books, housing, or other qualified living expenses. Given the large
number of people experiencing homelessness who have a foster care
history, it is important to provide assistance such as these education
and training vouchers to stabilize youth, prevent economic crisis, and
prevent possible homelessness.
CONCLUSION
Homelessness is not inevitable. As communities implement plans to
end homelessness, they are struggling to find funding for the services
homeless and formerly homeless clients need to maintain housing. The
Federal investments in mental health services, substance abuse
treatment, employment training, youth housing, and case management
discussed above will help communities create stable housing programs
and change social systems which will end homelessness for millions of
Americans.
______
Prepared Statement of the National Alliance for Eye and Vision Research
(NAEVR)
EXECUTIVE SUMMARY
NAEVR requests fiscal year 2008 NIH funding at $31 billion, or a
6.7 percent increase over fiscal year 2007, to balance the biomedical
inflation rate of 3.7 percent and to maintain the momentum of
discovery. Although NAEVR commends the leadership's actions in the
110th Congress to increase fiscal year 2007 NIH funding by $620
million, this was just an initial step in restoring the NIH's
purchasing power, which has declined by more than 13 percent since
fiscal year 2005. That power would be eroded even further under the
President's proposed fiscal year 2008 budget. NAEVR commends NIH
Director Dr. Zerhouni who has articulately described his agenda to
foster collaborative, cost-effective research and to transform the
healthcare research and delivery paradigm into one that is predictive,
preemptive, preventive, and personalized. NIH is the world's premier
institution and must be adequately funded so that its research can
reduce healthcare costs, increase productivity, improve quality of
life, and ensure our Nation's global competitiveness.
NAEVR requests that Congress make vision health a top priority by
funding the NEI at $711 million in fiscal year 2008, or a 6.7 percent
increase over fiscal year 2007. This level is necessary to fully
advance the breakthroughs resulting from NEI's basic and clinical
research that are resulting in treatments and therapies to prevent eye
disease and restore vision. Vision impairment/eye disease is a major
public health problem that is growing and which disproportionately
affects the aging and minority populations, costing the United States
$68 billion annually in direct and societal costs, let alone reduced
independence and quality of life. Adequately funding the NEI is a cost-
effective investment in our Nation's health, as it can delay, save, and
prevent expenditures, especially to the Medicare and Medicaid programs.
FUNDING THE NEI AT $711 MILLION IN FISCAL YEAR 2008 ENABLES IT TO LEAD
TRANS-INSTITUTE VISION RESEARCH THAT MEETS NIH'S GOAL OF PREEMPTIVE,
PREDICTIVE, PREVENTIVE, AND PERSONALIZED HEALTHCARE
Funding NEI at $711 million in fiscal year 2008 represents the eye
and vision research community's judgment as that necessary to fully
advance breakthroughs resulting from NEI's basic and clinical research
that are resulting in treatments and therapies to prevent eye disease
and restore vision.
NEI research responds to the NIH's overall major health challenges,
as set forth by Dr. Zerhouni: an aging population; health disparities;
the shift from acute to chronic diseases; and the co-morbid conditions
associated with chronic diseases (e.g., diabetic retinopathy as a
result of the epidemic of diabetes). In describing the predictive,
preemptive, preventive, and personalized approach to healthcare
research, Dr. Zerhouni has frequently cited NEI-funded research as
tangible examples of the value of our Nation's past and future
investment in the NIH. These include:
--Dr. Zerhouni has cited as a breakthrough the collaborative Human
Genome Project/NEI-funded discovery of gene variants strongly
associated with an individual's risk of developing age-related
macular degeneration (AMD), the leading cause of blindness
(affecting more than 10 million Americans) which increasingly
robs seniors of their independence and quality of life. These
variants, which are responsible for about 60 percent of the
cases of AMD, are associated with the body's inflammatory
response and may relate to other inflammation-associated
diseases, such as Alzheimer's and Parkinson's disease. As NEI
Director Dr. Paul Sieving has stated, ``One of the important
stories during the next decade will be how Alzheimer's disease
and macular degeneration fit together.''
--Dr. Zerhouni has cited the NEI-funded Age-Related Eye Disease Study
(AREDS) as a cost-effective preventive measure. In 2006, NEI
began the second phase of the AREDS study, which will follow up
on initial study findings that high levels of dietary zinc and
antioxidant vitamins (Vitamins C, E and beta-carotene) are
effective in reducing vision loss in people at high risk for
developing advanced AMD--by a magnitude of 25 percent.
--NEI has funded research, along with the National Cancer Institute
(NCI) and the National Heart, Lung, and Blood Institute
(NHLBI), into factors that promote new blood vessel growth
(such as Vascular Endothelial Growth Factor, or VEGF). This has
resulted in anti-VEGF factors that have been translated into
the first generation of ophthalmic drugs approved by the Food
and Drug Administration (FDA) to inhibit abnormal blood vessel
growth in ``wet'' AMD, thereby stabilizing vision loss. Current
research is focused on using treatments singly and in
combination to improve vision or prevent further vision loss
due to AMD. As part of its Diabetic Retinopathy Clinical
Research Network, NEI is also evaluating these drugs for
treatment of macular edema associated with diabetic
retinopathy.
Although these breakthroughs came directly from the past doubling
of the NIH budget, their long-term potential to preempt, predict,
prevent, and treat disease relies on adequately funding NEI's follow-up
research. Unless its funding is increased, the NEI's ability to
capitalize on the findings cited above will be seriously jeopardized,
resulting in ``missed opportunities'' that could include:
--Following up on the AMD gene discovery by developing diagnostics
for early detection and promising therapies, as well as to
further study the impact of the body's inflammatory response on
other degenerative eye diseases.
--Fully investigating the impact of additional, cost-effective
dietary supplements in the AREDS study, singly and in
combination, to determine if they can demonstrate enhanced
protective effects against progression to advanced AMD.
--Following up with further clinical trials on patients with the
``wet'' form of AMD, as well as patients with diabetic
retinopathy, using the new anti-angiogenic ophthalmic drugs
singly and in combination to halt disease progression and
potentially restore vision.
In addition, NEI research into other significant eye disease
programs, such as glaucoma and cataract, will be threatened, along with
quality of life research programs into low vision and chronic dry eye.
This comes at a time when the U.S. Census and NEI-funded
epidemiological research (also threatened without adequate funding)
both cite significant demographic trends that will increase the public
health problem of vision impairment and eye disease.
VISION IMPAIRMENT/EYE DISEASE IS A MAJOR PUBLIC HEALTH PROBLEM THAT IS
INCREASING HEALTHCARE COSTS, REDUCING PRODUCTIVITY, AND DIMINISHING
QUALITY OF LIFE
The 2000 U.S. Census reported that more than 119 million people in
the United States were age 40 or older, which is the population most at
risk for an age-related eye disease. The NEI estimates that, currently,
more than 38 million Americans age 40 and older experience blindness,
low vision or an age-related eye disease such as AMD, glaucoma,
diabetic retinopathy, or cataracts. This is expected to grow to more
than 50 million Americans by year 2020. The economic and societal
impact of eye disease is increasing not only due to the aging
population, but to its disproportionate incidence in minority
populations and as a co-morbid condition of other chronic disease, such
as diabetes.
Although the NEI estimates that the current annual cost of vision
impairment and eye disease to the United States is $68 billion, this
number does not fully quantify the impact of direct healthcare costs,
lost productivity, reduced independence, diminished quality of life,
increased depression, and accelerated mortality. The continuum of
vision loss presents a major public health problem and financial
challenge to both the public and private sectors.
In public opinion polls over the past 40 years, Americans have
consistently identified fear of vision loss as second only to fear of
cancer. As a result, Federal funding for the NEI is a vital investment
in the health, and vision health, of our Nation, especially our
seniors, as the treatments and therapies emerging from research can
preserve and restore vision. Adequately funding the NEI can delay,
save, and prevent expenditures, especially those associated with the
Medicare and Medicaid programs, and is, therefore, a cost-effective
investment.
NAEVR urges fiscal year 2008 NIH and NEI funding at $31 billion and
$711 million, respectively.
ABOUT NAEVR
Founded in 1997, NAEVR is a non-profit advocacy organization
comprised of a coalition of 55 professional, consumer, and industry
organizations (see list below) involved in eye and vision research.
NAEVR's goal is to achieve the best vision for all Americans through
advocacy and public education about the value and cost-effectiveness of
eye and vision research sponsored by the NIH, NEI, and other Federal
research entities.
Advanced Medical Optics; Alcon Laboratories, Inc.; Allergan, Inc.;
AMD Alliance International; American Academy of Ophthalmology;
American Academy of Optometry; American Association for
Pediatric Ophthalmology and Strabismus; American Assoc. of
Ophthalmic Pathologists; American Diabetes Association;
American Glaucoma Society; American Ophthalmological Society;
American Society of Retina Specialists; American Optometric
Association; American Society of Cataract and Refractive
Surgery; American Uveitis Society; Association for Research in
Vision and Ophthalmology; Association of Schools and Colleges
of Optometry; Association of University Professors of
Ophthalmology; Association of Vision Science Librarians; Bausch
& Lomb; Blinded Veterans Association; Discovery Eye Foundation;
Eli Lilly & Company; Eye Bank Association of America; EyeSight
Foundation of Alabama; Fight for Sight; Foundation Fighting
Blindness; Genentech, Inc.; Glaucoma Research Foundation;
Inspire Pharmaceuticals, Inc.; ISTA Pharmaceuticals, Inc.;
Juvenile Diabetes Research Foundation Intl.; Lighthouse
International; Lions Clubs Intl. Foundation; Macular
Degeneration Partnership; Natl. Vision Rehabilitation Assoc.;
Novartis; Ocular Microbiology and Immunology Group; Pfizer
Inc.; Prevent Blindness America; Prevention of Blindness
Society of Metropolitan Washington; Research to Prevent
Blindness; Santen, Inc.; Second Sight; Sjogren's Syndrome
Foundation; Tear Film and Ocular Surface Society; The Cornea
Society; The Glaucoma Foundation; The Macula Society; The
Retina Society; Vision Council of America; Vision Share, The
Consortium of Eye Banks; Vistakon, Johnson & Johnson Vision
Care, Inc.; Women in Ophthalmology; and Women's Eye Health Task
Force.
______
Prepared Statement of the National Area Health Education Centers
Organization
SUMMARY OF FISCAL YEAR 2008 RECOMMENDATIONS
$300 million for the Title VII Health Professions Training
programs.
$33 million for area Health Education Centers.
$4.371 million for Health Education and Training Centers.
The National Area Health Education Centers Organization (NAO) is
the professional organization representing Area Health Education
Centers (AHECs) and Health Education and Training Centers (HETCs).
AHECs and HETCs are two of the Title VII Health Professions
Training programs. The Title VII Health Professions Training programs
are focused on improving the quality, geographic distribution and
diversity of the healthcare workforce and eliminating the disparities
in our Nation's healthcare system. These programs help address
healthcare disparities by employing strategies such as providing
training for students in rural and underserved areas, interaction with
faculty role models who serve in rural and underserved areas and
placement services to foster and encourage students to work in these
areas.
AHECs develop and support the community based training of health
professions students, particularly in rural and underserved areas. They
also provide continuing education and other services that improve the
quality of community-based healthcare. HETCs use the infrastructure of
AHECs to address the needs of diverse populations with persistent and
severe unmet health needs. In 5 border and 6 non-border States, HETCs
train and support Community Health Workers (CHWs) to provide healthcare
services and information to their communities.
Nationwide, AHECs and HETCs support health professional training in
almost 25,000 community based practice settings, and over 47,000 health
professional students receive training at these sites. Furthermore,
over 339,000 health professionals receive continuing education through
AHECs and HETCs. AHECs and HETCs perform these education and training
services through collaborative partnerships with Community Health
Centers (CHCs) and the National Health Service Corps (NHSC).
COMMUNITY HEALTH CENTERS AND THE NATIONAL HEALTH SERVICE CORPS
CHCs are dedicated to providing preventative and ambulatory
healthcare to uninsured and underinsured populations. A March 2006
study published in the Journal of the American Medical Association
(JAMA) found that CHCs report high percentages of provider vacancies,
including an insufficient supply of dentists, pharmacists,
pediatricians, family physicians and registered nurses. These shortages
are particularly pronounced in CHCs that serve rural areas. Because the
Title VII Health Professions Training programs (including AHECs and
HETCs) have a successful record of training providers to work in
underserved areas, the study recommends increased support for the Title
VII Health Professions Training programs as the primary means of
alleviating the health professions shortage in rural CHCs. The study
serves as an important reminder that the success of CHCs is highly
dependent upon a well-trained clinical staff to provide care. Thirty-
eight percent of AHEC training sites are CHCs, and 26 percent of the
health professionals who receive continuing education through HETCs are
employed at CHCs. Another 36 percent are employed at NHSC sites.
AHECs and HETCs also undertake a variety of programs related to the
placement and support of NHSC scholars and loan repayment recipients.
NHSC scholars and loan repayment recipients commit to practicing in an
underserved area, and are focused on improving health by providing
comprehensive team-based healthcare that bridges geographic, financial
and cultural barriers. As contractors of the NHSC Student/Resident
Experiences and Rotations in Community Health (SEARCH) program, AHECs
and HETCs help to expand the NHSC by placing students and residents in
rotations in rural areas. These students and residents are then far
more likely to return to the rural area as a NHSC scholar or loan
repayment recipient. This is because health professionals who spend
part of their training providing care for rural and underserved
populations are 3 to 10 times more likely to practice in rural and
underserved areas after graduation or program completion.
COMMUNITY HEALTH WORKERS
Like NHSC scholars and loan repayment recipients, CHWs aim to
respond to local health problems with effective and culturally
sensitive strategies. They provide health services in their communities
and specifically address healthcare disparities by working to improve
health literacy. CHWs are uniquely suited to these tasks because they
come from, and live in, the same communities as their patients. They
also speak the same language as their non-English speaking patients.
An October 2006 study by the Health Resources and Services
Administration (HRSA) entitled ``The Rationale for Diversity in the
Health Professions: A Review of the Evidence'' shows the importance of
the CHWs. This study found that minority health professionals
disproportionately serve minority and other medically underserved
populations, minority populations tend to receive better care from
practitioners of their own race or ethnicity, and non-English speaking
patients experience better care, greater comprehension and greater
likelihood of keeping follow-up appointments when they see a
practitioner who speaks their own language.
HETCs are the only Federal program mandated to recruit, train and
support CHWs. In 2004-2005 HETCs provided the initial training and
continuing education for over 5,000 CHWs. But the Fiscal Year 2006 and
Fiscal Year 2007 Labor-Health and Human Services (HHS)-Education
Appropriations bills zeroed out the funding for HETCs. Unless funding
is restored, HETCs will no longer be able to recruit, train or support
CHWs.
JUSTIFICATION FOR FUNDING RECOMMENDATIONS
By improving the quality, geographic diversity and diversity of the
healthcare workforce, the United States can eliminate healthcare
disparities. In order to continue the progress that the Title VII
Health Professions Training programs (including AHECs and HETCs) have
already made towards this goal, an additional Federal investment is
required. NAO recommends that the Title VII Health Professions Training
programs are funded at $300 million in fiscal year 2008, including $33
million for AHECs and $4.371 million for HETCs.
______
Prepared Statement of the National Association of Children's Hospitals
The National Association of Children's Hospitals thanks the
subcommittee for the opportunity to submit a statement for the hearing
record in support of the Children's Hospitals' Graduate Medical
Education (CHGME) Program in the Health Resources and Services
Administration.
On behalf of the Nation's 60 independent children's teaching
hospitals, N.A.C.H. very much appreciates the subcommittee's early
commitment to provide Federal GME funding for these hospitals. In 1999,
2000, and 2006, Congress authorized and reauthorized the CHGME program
to give independent children's teaching hospitals a level of Federal
support for their teaching programs, which seeks to be comparable to
what adult teaching hospitals receive from Medicare.
We appreciate very much the continuation of $297 million for CHGME
in the final Fiscal Year 2007 Continuing Resolution, the same level as
Congress appropriated for fiscal year 2006. The fiscal year 2007
appropriation marks the first time since Congress first agreed to
appropriate $305 million for CHGME in fiscal year 2004 that the
program's funding has not been reduced due to across-the-board spending
cuts in health and human services.
CHGME has Been a Success.--CHGME support to children's hospitals
now approaches about 80 percent of the level of Medicare GME support to
adult hospitals. CHGME has made it possible for children's hospitals to
strengthen their training of pediatric physicians at a time of national
shortages, without having to sacrifice the hospitals' clinical or
research programs. And it has enabled the hospitals to achieve strong
financial positions, which are essential to their ability to fulfill
their capital intensive missions.
For fiscal year 2008, we respectfully request $330 million, the
annual authorization level that Congress enacted and the president
signed into law last year. It would make up for the erosion in funding
for the CHGME program over the last 4 years and address the cost of
inflation. It is important in a program with both wage-related and
medical teaching costs. Full funding would ensure the hospitals will
have the resources necessary to train and educate the Nation's
pediatric workforce.
N.A.C.H. AND CHILDREN'S HOSPITALS
N.A.C.H. is a not-for-profit trade association, representing more
than 135 children's hospitals. They include independent acute care
children's hospitals, children's hospitals within larger medical
centers, and independent children's specialty and hospitals. N.A.C.H.
helps its members fulfill their missions of clinical care, education,
research and advocacy for all children.
Children's hospitals are regional and national centers of
excellence for children with serious and complex conditions. They are
centers of biomedical and health services research for children and are
the major training centers for pediatric researchers, as well as a
significant number of children's doctors. They also are major safety
net providers, serving a disproportionate share of children from low-
income families, and they are advocates for the public health of all
children.
Although they represent less than 5 percent of all hospitals in the
country, the three major types of children's hospitals provide 41
percent of the inpatient care for all children, 42 percent of the
inpatient care for children assisted by Medicaid, and most hospital
care for children with serious conditions.
BACKGROUND: THE NEED FOR CHGME
While they account for less than 1 percent of all hospitals,
independent children's teaching hospitals alone train 35 percent of all
pediatricians, half of all pediatric specialists and the majority of
pediatric researchers. They provide required pediatric rotations for
many other residents and train more than 4,800 resident FTEs annually.
Shortages of pediatric specialists across the Nation only heighten the
importance of these hospitals.
Prior to initial funding of the CHGME program for fiscal year 2000,
the eligible hospitals were facing enormous challenges to their ability
to maintain their training programs. The increasingly price competitive
medical marketplace was resulting in more and more payers failing to
cover the costs of care, including the costs associated with teaching.
Because they see few if any Medicare patients, independent
children's hospitals were essentially left out of Medicare GME, which
had become the one major source of GME financing for other teaching
hospitals. They received only 1/200th (or less than 0.5 percent) of the
Federal GME support that all other teaching hospitals received under
Medicare. This lack of GME financing, combined with financial
challenges stemming from their other missions, threatened their
teaching programs, as well as other services.
Safety Net Institutions.--Independent children's hospitals are a
significant part of the health care safety net for low-income children,
which puts them at financial risk. In fiscal year 2005 children
assisted by Medicaid were, on average, 55 percent of all inpatient days
of care. Yet, Medicaid average, paid only 78 percent of costs. Without
disproportionate share hospital payments, Medicaid would pay even less.
Medicaid payment shortfalls for outpatient and physician care are even
greater.
The independent children's hospitals also are essential providers
of care for seriously and chronically ill children. They devote more
than 75 percent of their care to children with one or more chronic or
congenital conditions. They provide the majority of inpatient care to
children with many serious illnesses--from children with cancer or
cerebral palsy, for example, to children needing heart surgery or organ
transplants. In some regions, they are the only source of pediatric
specialty care. The severity and complexity of illness and the services
these institutions must maintain to assure access to this quality care
for all children are often poorly reimbursed.
Lastly, many of the independent children's hospitals are a vital
part of the emergency and critical care services in their regions. They
are part of the emergency response system that must be in place for
public health emergencies. Expenses associated with disaster
preparedness add to their continuing costs in meeting children's needs.
Mounting Financial Pressures.--The CHGME program, and its
relatively quick progress to full funding in fiscal year 2002, came at
a critical time. In 1997, when Congress first considered establishing
CHGME, a growing number of independent children's hospitals had
financial losses; many more faced mounting financial pressures. More
than 10 percent had negative total margins, more than 20 percent had
negative operating margins, and nearly 60 percent had negative patient
care margins. Some of the Nation's most prominent children's hospitals
were at financial risk. Thanks to CHGME, these hospitals have been able
to maintain and strengthen their training programs.
Pediatric Workforce.--The important role CHGME plays in the
continual development of our Nation's pediatric workforce is not lost
on the larger pediatric community, including the American Academy of
Pediatrics and Association of Medical School Pediatric Department
Chairs. They support CHGME and recognize it is critical not only to the
future of the individual hospitals but also to provision of children's
health care and advancements in pediatric medicine. This year, the
chairs of more than 40 medical school pediatric departments have
endorsed full funding for the program, regardless of whether they are
affiliated with a CHGME hospital. For example, the pediatric leadership
of Iowa has endorsed full funding for CHGME, even though Iowa's own
children's hospitals do not receive CHGME funding, because it is so
important to the institutions around the country from which Iowa
recruits pediatric subspecialists.
CONGRESSIONAL RESPONSE
In the absence of movement toward broader GME financing reform,
Congress in 1999 authorized the Children's Hospitals' GME discretionary
grant program to address the existing inequity in GME financing for the
independent children's hospitals. The legislation was reauthorized in
2000 through fiscal year 2005 and provided $285 million for fiscal year
2001 and such sums as necessary in the years beyond. Congress passed
the initial authorization as part of the ``Healthcare Research and
Quality Act of 1999.'' It passed the first 5-year reauthorization as
part of the ``Children's Health Act of 2000.'' Last year, it passed the
second 5-year reauthorization as part of the ``Children's Hospital GME
Support Reauthorization Act of 2007,'' which authorized $330 million
for each of the 5 years, through fiscal year 2011.
With this subcommittee's support, Congress appropriated initial
funding for CHGME in fiscal year 2000, before the enactment of its
authorization. Following enactment, Congress moved substantially toward
full funding for the program in fiscal year 2001 and completed that
goal, providing $285 million in fiscal year 2002, $290 million in
fiscal year 2003, $303 million in fiscal year 2004, $301 million in
fiscal year 2005, $297 million in fiscal year 2006, and $297 million in
fiscal year 2007. (In the fiscal year 2004, 2005, 2006, the funding
levels are net of across-the-board cuts in discretionary funding. For
example, Congress appropriated $305 million for fiscal year 2004; the
net appropriation, after cut, was $303 million.)
Health Resources and Services Administration.--The CHGME funding is
distributed through HRSA to 60 children's hospitals according to a
formula based on the number and type of full-time equivalent residents
trained, in accordance with Medicare rules, as well as the complexity
of care and intensity of teaching the hospitals provide. Consistent
with the authorization, HRSA allocates the annual appropriation in
monthly payments to eligible hospitals.
CHGME'S SUCCESS
The annual CHGME appropriations represent an extraordinary
achievement for the future of children's health and the Nation's
independent children's teaching hospitals:
--Thanks to CHGME, the Federal Government has made substantial
progress in providing more equitable Federal GME support to
independent children's hospitals. They now receive about 80
percent of the level of Federal GME support that Medicare
provides to other teaching hospitals. It is still not equity,
but it is dramatic improvement from the 0.5 percent of 1998.
--Thanks to CHGME, children's hospitals have been able to make a
substantial improvement in their contribution to the Nation's
pediatric workforce, without having to sacrifice their clinical
or research missions. Between 2000 and 2004, without the CHGME
hospitals being able to increase the numbers of general
pediatric residents they trained, the Nation would have
experienced a net decline in the number of new pediatricians.
During the same period, CHGME hospitals also accounted for more
than 80 percent of the new pediatric subspecialty programs and
more than 60 percent of the new pediatric subspecialists
trained.
--Thanks to CHGME, children's hospitals have been able to achieve
strong, financial positions. According to Moody's Investor
Services, before 2000, children's hospitals tended to have
negative to break-even financial margins. Since then, they have
improved their margins and CHGME is one of the major reasons.
FISCAL YEAR 2008 REQUEST
N.A.C.H. respectfully requests that the subcommittee provide
equitable GME funding for independent children's hospitals by providing
$330 million in fiscal year 2008, the full authorization level. Such
funding is vital for a program that has wage-related and medical
teaching costs and experienced 3 years of reductions due to across-the-
board cuts before fiscal year 2007.
Adequate, equitable funding for CHGME is an ongoing need.
Children's hospitals train new pediatric residents and researchers
every year. Children's hospitals have appreciated very much the support
they have received, including the attainment of the program's
authorized full funding level in fiscal year 2002 and continuation of
full funding with an inflation adjustment in fiscal year 2003 and
fiscal year 2004. Congress can restore this progress by providing $330
million in fiscal year 2008.
Continuing equitable CHGME funding is more important than ever in
light of continued budget pressures in many States for reductions in
Medicaid spending. Because children's hospitals devote a substantial
portion of their care to children from low-income families, they are
especially affected by Medicaid. Support for a strong investment in GME
at children's hospitals is also consistent with the concern Congress
has expressed for the health and well-being of children--through
education, health and social welfare programs. And it is consistent
with the subcommittee's emphasis on the importance of investment in the
National Institutes of Health for which we are grateful.
The CHGME funding has been essential to the ability of the
independent children's hospitals to sustain their GME programs. At the
same time, it has enabled them to do so without sacrificing support for
other critically important services that also rely on hospital subsidy,
such as many specialty and critical care services, child abuse
prevention and treatment services, services to low-income children with
inadequate or no coverage, mental health and dental services, and
community advocacy, such as immunization and motor vehicle safety
campaigns.
In conclusion, CHGME is a success. It is an invaluable investment
in children's health. The future of pediatric medicine and children's
access to pediatric care depends on it. N.A.C.H. is joined by the
American Academy of Pediatrics, American Hospital Association and
others in recommending $330 million for fiscal year 2008.
______
Prepared Statement of the National Association of Community Health
Centers
On behalf of more than 1,000 Health Center organizations across the
country serving more than 16 million patients, the National Association
of Community Health Centers (NACHC) is pleased to submit this statement
for the record, and to thank the subcommittee for its continued support
and investment in the Health Centers program.
ABOUT HEALTH CENTERS
Over more than 40 years, the Health Centers program has grown from
a small demonstration project providing desperately needed primary care
services in underserved communities to one of the fundamental elements
of our Nation's health care safety net. Funding was approved in 1965
for the first two Neighborhood Health Center demonstration projects,
one in Boston, Massachusetts, and the other in Mound Bayou,
Mississippi.
Today, Health Centers serve as the primary health care safety net
for many communities across the country and the Federal grant program
enables more low-income and uninsured patients to receive care each
year. Health Centers currently serve as the family doctor for one in
eight uninsured individuals, and one in every five low-income children.
Health Centers are helping thousands of communities address a range of
increasing (and costly) health problems, including prenatal and infant
health development, chronic illnesses including diabetes and asthma,
mental health, substance addiction, domestic violence and HIV/AIDS.
Federal law requires that every Health Center be governed by a
community board with a patient majority--a true patient democracy.
Health Centers are required to be located in a federally designated
Medically Underserved Area (MUA), and must provide a package of
comprehensive primary care services to anyone who comes in the door,
regardless of their ability to pay. Because of these characteristics,
the insurance status of Health Center patients differs dramatically
from other primary care providers. As a result, the role of public
dollars is substantial. Federal grant dollars, which make up roughly
one-quarter of Health Centers' operating revenues, are intended to
cover the costs of serving uninsured patients; just over 40 percent of
revenues are from reimbursement through Federal insurance programs,
principally Medicare and Medicaid. The balance of the revenues are from
State and community partnerships, privately insured individuals, and
patient's ability to pay.
The Health Centers program is administered by the Bureau of Primary
Health Care (BPHC) at the Health Resources and Services Administration
(HRSA), within the U.S. Department of Health and Human Services (HHS).
FUNDING BACKGROUND
We greatly appreciate that the subcommittee has approved
substantial funding increases for the Health Centers program over the
past several years, the result of which has been a broad expansion
effort enabling Health Centers to serve many of those that remain
underserved in our country. Since 2001, in addition to the overall
funding increase, the subcommittee has provided specific increases in
funding to stabilize existing centers, as well as to meet the goals of
the President's initiative--to significantly impact health care
delivery in 1,200 communities through new or expanded Health Centers.
With the funding provided in fiscal year 2007, that goal will be met
this year.
The Health Centers program has succeeded in expanding access to
primary and preventive care services in underserved communities across
the country. The Office of Management and Budget rated the Health
Centers program as one of the top 10 Federal programs, and the best
competitive grant program within all of HHS.
Yet despite this record expansion, hundreds of communities have
submitted applications since fiscal year 2002 that received high
ratings, but could not be funded due to lack of funds. There is clearly
a tremendous need and a tremendous desire to expand Health Center
services to new communities. With additional resources, Health Centers
stand ready to provide low-cost, highly effective care to millions more
uninsured and underserved individuals and families.
FISCAL YEAR 2008 AND BEYOND: TOWARD 30 MILLION PATIENTS BY 2015
In his fiscal year 2008 budget proposal, President Bush requested a
total funding level of $1.988 billion for the Health Centers program.
While this represents a slight increase over the President's request in
fiscal year 2007, it is essentially the same as the enacted level for
fiscal year 2007, as Congress funded the program above the President's
request last year. NACHC is requesting an increase of $200 million for
fiscal year 2008, for a total funding level of $2.188 billion.
In order to truly serve those in need across the country, Health
Centers must expand their operations and develop new centers in areas
of need. This request represents the next step, an investment in a
longer-term plan to provide a health care home in a Health Center to 30
million Americans by 2015, and to eventually bring access to care in a
Health Center to every American who needs it within 15 years. We hope
to work with the subcommittee to guide this investment around several
priorities. First, in the face of rising costs of care and a rising
percentage of new patients without insurance coverage, a significant
and strategic investment in existing Health Centers is needed to allow
them to meet the demand for their services in the communities they
serve today. Second, new and expanded Health Centers should be brought
to communities with little or no access to care through planning grants
and new access point funding targeted to those communities most in
need. Lastly, in order to make a comprehensive range of necessary
services available at every Health Center, funding should be made
available to add mental health, oral health and pharmacy services in
high need communities.
In 2005, President Bush called for ``a Community Health Center in
every poor county'' in America. NACHC supports the goal of bringing
care to those areas of the country with high poverty and no current
access to a Health Center. However, NACHC has expressed the preference
that such an expansion address the lack of access in the neediest
communities of the country, and that eligibility for new funding not be
limited to certain geographic areas such as counties. Further, the
President's budget includes proposed legislative language waiving the
statutorily designated proportionality requirements for Migrant, Public
Housing and Homeless Health Centers in order to implement this second
expansion initiative. NACHC strongly opposes this change.
In addition to the expansion efforts, it is critical that Federal
funding for Health Centers keep pace with the growing cost of
delivering care. NACHC requests that the subcommittee designate $59
million of any increase in funding to be used to make base grant
adjustments for existing centers, allowing an average increase of 3
percent in current Health Center grants. Under the subcommittee's
leadership, Congress has provided base grant adjustments for existing
centers in 6 out of the 8 previous fiscal years, including $25 million
in fiscal year 2007. A recent study by NACHC found that in the 2 years
that these adjustments were not included in the Health Centers
appropriation, the number of patient visits per grantee actually
decreased.
NACHC appreciates the subcommittee's leadership in stabilizing the
Federal Tort Claims Act (FTCA) judgment fund for Health Centers in past
years. For fiscal year 2008, the President has requested that
$44,000,000 be appropriated for this purpose. This is $500,000 below
last year's level. NACHC supports maintaining the judgment fund at a
total funding level of $44,500,000.
In 1997, Congress authorized and began funding the HRSA Loan
Guarantee Program (LGP) for the construction, renovation, and
modernization of Health Centers. Demand for this guarantee program has
accelerated significantly in the last several years. NACHC expects that
at the current rate of usage, the remaining credit subsidy will be
entirely used during calendar year 2008. In response that the success
of this program, NACHC is requesting an additional $5 million be
provided until expended for additional loan guarantees. The LGP has
proven to be a vital resource for Health Centers across the country--in
particular, those on the Gulf Coast--as they seek financing to fund the
facilities necessary to accommodate the growth in patient visits
resulting from recent expansion efforts.
Finally, in addition to increased funding for the Health Centers
program, expanding access to vital preventive and primary health care
in underserved communities will also depend on commensurate growth in a
number of high-priority programs, including:
--$150 million for the National Health Service Corps, the largest
single source of health professionals for Health Centers. Such
an increase will enable the NHSC to place an additional 800
medical professionals;
--$450 million for Health Professions Training Programs under Title
VII/VIII, including $30 million for Area Health Education
Centers (AHECs); and
--$250 million for Title III of the Ryan White AIDS Program, which
provides grants to Health Centers and other primary care
providers for outpatient early intervention services.
CONCLUSION
America's Health Centers are grateful to the subcommittee for its
ongoing efforts to support and stabilize the Health Centers program and
to expand health centers' reach into more than 5,000 communities
nationwide. As a result of those efforts, more than 16 million people
have access to the affordable, effective primary care services that our
Nation's Health Centers provide.
We respectfully ask that the subcommittee continue that investment,
as the work of caring for our uninsured and medically underserved is
far from complete. A recent NACHC study found that some 56 million
Americans are still without regular access to primary care. America's
Health Centers look forward to meeting that need and rising to the
challenge of providing a health care system that works for all
Americans. We look forward to working with you over the coming year to
move toward that goal.
If you need any additional information or have any questions
related to Health Centers or NACHC, please do not hesitate to contact
me or John Sawyer, Assistant Director of Federal Affairs, at (202) 331-
4603, or via email at jsawyer@nachc.com.
______
Prepared Statement of the National Center for Victims of Crime
The National Center for Victims of Crime submits this testimony to
urge members of the Subcommittee on Labor, Health and Human Services,
Education, and Related Agencies to fully fund the Rape Prevention and
Education (RPE) Grant program at $80 million. Rape crisis centers rely
on this money to educate their communities about the prevention of
sexual abuse and assault. RPE Grant funds provide the foundation for
crucial efforts to end sexual violence.
As the leading national resource and advocacy organization for
victims of crime, the National Center understands the vital necessity
of sexual assault education and outreach programs for victims and their
communities. Every day, our Helpline staff speaks to sexual assault
victims and connects them with local services. We also work with rape
crisis centers and State sexual assault coalitions across the country
who have all described to us their desperate struggles to meet their
communities' needs. They report that without greater RPE Grant program
funding, they cannot continue their education and prevention efforts.
PREVALENCE OF RAPE AND SEXUAL ASSAULT
The incidence of sexual assault in this country remains
unconscionably high. The latest National Crime Victimization Survey
reports that 191,670 people were raped or sexually assaulted in
2005.\1\ The crime of sexual violence affects people of all backgrounds
and ages--children and adults, males and females. Approximately 1 in 6
women and 1 in 33 men in America have experienced an attempted or
completed rape as a child or adult.\2\ Young adults and teens are
particularly at risk, with people aged 16 to 24 being raped at
significantly higher rates than any other age group,\3\ and nearly 5
percent of college women being sexually assaulted during any given
calendar year.\4\
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\1\ Bureau of Justice Statistics, U.S. Dept. of Justice, Criminal
Victimization 2005 (Sept. 2006).
\2\ Id.
\3\ Id.
\4\ Fisher, Cullen, & Turner, Nat'l Inst. of Justice & Bureau of
Justice Statistics, the Sexual Victimization of College Women (2000).
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IMPACT ON VICTIMS, FAMILIES, AND COMMUNITIES
Sexual assault exacts a terrible cost on individual victims, their
families, and our Nation. The annual cost of sexual assault to victims
is approximately $26 million.\5\ Moreover, victims of sexual violence
experience higher rates of depression, anxiety disorders, mental
illness, addiction, eating disorders, and self-esteem problems than
non-victims. Rape survivors are six times more likely to commit suicide
than victims of other crimes.\6\
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\5\ Bureau of Justice Statistics, U.S. Dept. of Justice, Criminal
Victimization 2005 (Sept. 2006).
\6\ Arthur H. Green, M.D., Sexual Abuse: Immediate and Long-Term
Effects and Intervention, 32 J. AM. ACAD. Child Adolescent Psychiatry.
5, (Sept. 1993).
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Workplaces and communities are also affected when victims suffer.
Rape victims face a loss of economic productivity through unemployment,
underemployment, and absence from work. According to the Centers for
Disease Control and Prevention (CDC), 21 percent of victims who have
been raped by an intimate partner report losing time from work as a
result of their victimization.\7\
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\7\ Nat'l Ctr. for Injury Prevention and Control, Costs of Intimate
Partner Violence Against Women in the United States (Atlanta, Ga.,
2003).
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PURPOSES OF THE RAPE PREVENTION AND EDUCATION GRANT PROGRAM
Understanding the far-reaching impact of sexual violence and the
importance of prevention, Congress established the CDC's Rape
Prevention and Education Program through the Violence Against Women Act
of 1994. RPE funding provides formula grants to States and territories
to support rape prevention and education programs conducted by rape
crisis centers, State sexual assault coalitions, and other public and
private nonprofit entities. Funding is used for:
--Educational seminars for professionals, the public, schools,
colleges, and universities;
--Hotline operations;
--Education and training programs aimed at preventing sexual violence
at colleges and universities; and,
--Education about date rape drugs.
These education and outreach activities are crucial not only to
help change public attitudes and behaviors, but also to train allied
professionals on issues related to sexual violence so they can better
understand victims and make appropriate referrals.
RPE funding also supports the National Sexual Violence Resource
Center (NSVRC), a project operated by the Pennsylvania Coalition
Against Rape (PCAR). NSVRC provides information, materials, and
resources on sexual violence to policy makers, Federal, and State
agencies, college campuses, State, territory and tribal sexual assault
coalitions, the media, and the public.
EDUCATIONAL SEMINARS AND TRAININGS
Rape prevention and education efforts make crucial contributions to
ending sexual violence by helping to change attitudes about rape and
reduce the isolation of victims. Educational efforts around the country
include:
--Kansas: During the 2005 fiscal year, RPE Grant-funded projects
provided 2,212 educational sessions to 15,010 students and 267
professionals.
--Mississippi: Over the past 5 years, RPE projects conducted a total
of 1,923 community education sessions with 66,422 participants.
In addition, the Mississippi Coalition Against Sexual Assault
offered a training program for home health workers, nursing
home employees, and others in contact with the elderly
population to help them identify and respond to signs of abuse
and assault.
--Pennsylvania: During the 2006 fiscal year, the PCAR provided 24,213
sexual assault education programs to students and 3,469
prevention education programs to the community.
Many of these educational sessions and trainings, like those
conducted in Mississippi, focused on increasing awareness of sexual
violence in underserved and at-risk communities. Such outreach also
consistently results in an increased number of victims contacting local
rape crisis centers for services and support. However, as operation
costs increase and funding levels have stagnated, such remarkable
efforts cannot expand and grow to reach these vulnerable populations.
HOTLINE OPERATIONS
The RPE Grant program also provides crucial support for State and
local hotlines, which offer 24-hour crisis intervention, referrals, and
information about sexual violence. Importantly, hotline operations
allow trained advocates and rape crisis counselors to reach more
physically or culturally isolated communities. Recent successes
include:
--Massachusetts: Funds from the RPE Grant program permit rape crisis
centers across Massachusetts to provide 24-hour hotline
services for victims of sexual assault and their families. The
program also supports Llamanos, a Spanish-language, toll-free,
sexual assault hotline for Latino survivors and their families.
Llamanos also provides training for 13 rape crisis centers,
five community health organizations, and eight additional
community-based agencies serving the Latino population.
Together, these hotline services received more than 12,000
calls in the past fiscal year.
--Louisiana: Since Hurricane Katrina struck in 2005, the RPE Grant-
funded Louisiana Foundation Against Sexual Assault (LaFASA) has
provided hotline services specifically for hurricane victims
who were sexually assaulted in the aftermath of the storm.
Witnesses, survivors, and their families can call and receive
support, counseling, and referral information.
PREVENTING SEXUAL VIOLENCE IN SCHOOLS AND ON COLLEGE CAMPUSES
Recognizing that attitudes and beliefs regarding sexual violence
are formed early in life, many RPE grantees emphasize education and
prevention programs for young people. As youths become aware of the
frequency of acquaintance rape, they can and do broaden their efforts
to protect themselves, from merely locking doors against strangers to
taking precautions with those they know. RPE-funded programs, in
collaboration with students and campus personnel, have developed and
continue to implement sexual violence prevention programs for schools
across the Nation. These programs aim to reduce first-time male
perpetration of sexual violence, address norms and beliefs that support
or condone sexual violence, and empower bystanders to respond
constructively when they recognize abusive relationships. Examples of
these programs include:
--Iowa.--During the 2006 fiscal year, community prevention
specialists conducted 4,599 educational sessions for a total of
71,521 students in grades pre-K through 12. In addition, 244
sexual violence prevention sessions were offered to 14,128
students at Iowa colleges and State universities. After one
Iowa event, some female students who had repeatedly endured
degrading harassment from fellow classmates came forward to
report the incidents to campus authorities, who intervened.
--California.--The RPE Grant program funds MyStrength, California's
innovative statewide social marketing campaign. This program,
which follows a national evidence-based model targeting 14- to
18-year-old males, aims to help prevent first-time perpetration
of sexual violence.\8\
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\8\ Learn more about the MyStrength campaign at http://
www.mystrength.org (accessed March 28, 2007).
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--Indiana.--The Communities Against Rape Initiative (CARe) is a
statewide collaboration supported by the RPE Grant program that
helps develop and implement rape prevention curricula for
rural, urban, and suburban schools. Since its founding in 1997,
CARe has trained more than 1,000 Indiana teachers to use the
curricula. Pre- and post-test results from more than 4,600
students show positive changes in students' knowledge and
attitudes about rape.\9\
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\9\ For more information about the CARe initiative, visit http://
www.four-h.purdue.edu/care/main.html (accessed March 28, 2007).
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All these remarkable programs and initiatives report that even with
such successes, much more could be done to raise awareness about sexual
violence in local communities if RPE funding were increased. For
instance, the California Coalition Against Sexual Assault (CALCASA)
reports that if the national RPE Program were fully funded, the
MyStrength campaign could saturate the State with marketing materials,
and MyStrength clubs could be sustained in hundreds of high schools
throughout California. Such efforts would advance our fight to end
sexual violence against men, women, and children.
DRUG-FACILITATED SEXUAL VIOLENCE
Drug-facilitated rape is staggeringly pervasive in this country. A
recent report from the National Institute on Alcohol Abuse and
Alcoholism (NIAAA) shows that more than 70,000 students between the
ages of 18 and 24 survive an alcohol or drug-related sexual assault
each year.\10\ Drugs are used to render victims incapable of providing
consent for sexual activity or defending themselves against rape.
Because detection and prosecution remain difficult, the best means to
prevent these crimes is education. The RPE Grant program funds efforts
to raise public awareness of the risk and symptoms associated with
Rohypnol, gamma-hydroxybutyrate (GHB), and other common date rape
drugs.
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\10\ Task Force of the Nat'l Advisory Council on Alcohol Abuse and
Alcoholism, National Institutes of Health, A Call to Action: Changing
the Culture of Drinking at U.S. Colleges (2002).
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RAPE PREVENTION AND EDUCATION FUNDING MUST BE INCREASED
Program after program has told the National Center that due to lack
of funding they are unable to expand their outreach efforts, staff and
volunteers have been taxed to the limit, and they are unable to reprint
popular educational materials. Without full funding, these programs
cannot make continued progress against sexual violence. Although the
Violence Against Women Act of 2005 (VAWA) reauthorized the Rape
Prevention and Education Grant program at $80 million, funding for the
past several years has remained at approximately $42 million.\11\
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\11\ Passed as part of the Violence Against Women Act 2005
Reauthorization, Public Law 109-162.
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When Congress reauthorized the Rape Prevention and Education Grant
program as part of VAWA, it recognized the importance of this program
in reducing sexual victimization. The National Center calls on Congress
to honor its commitment to preventing rape by providing full funding
for the Rape Prevention and Education Grant program for the 2008 fiscal
year.
______
Prepared Statement of the National Child Abuse Coalition
The National Child Abuse Coalition, committed to strengthening the
Federal response to the protection of children and the prevention child
abuse and neglect, urges fiscal year 2008 funding for the Child Abuse
Prevention and Treatment Act (CAPTA) programs at the authorized level
of $200 million:
--CAPTA basic State grants at $84 million;
--CAPTA community-based prevention grants at $80 million; and
--CAPTA research and demonstration grants at $36 million.
Basic State Grants.--At current funding, child protection agencies
are unable to serve close to half the abused and neglected children in
their caseloads.
CAPTA funds programs have not kept pace with the needs of
communities for supporting families and protecting children. States are
hard pressed to treat children or protect them from further harm. In
2004, according to the most recent HHS data, an estimated 3 million
reports of possible abuse and neglect were made to States, and almost
900,000 of these reports were substantiated. In 2004, just over 40
percent of the child victims received no services following a
substantiated report of maltreatment: suspected abuse reported, report
investigated, report substantiated, case closed. Almost 1,500 children
died as a result of abuse or neglect. The most endangered are the
youngest: more than 80 percent of children who were killed were under
age 4.
CAPTA's Basic State Grants help States protect children. The
Nation's child welfare system has long been stretched beyond capacity.
No State passed the test when measured against the HHS Child and Family
Service Reviews to evaluate a State's performance in protecting
children. Federal officials repeatedly cited States for certain
deficiencies: significant numbers of children suffering abuse or
neglect more than once in a 6-month period; caseworkers not visiting
children often enough to assess needs; and not providing promised
medical and mental health services.
Funding CAPTA State grants at $84 million would enable State child
protective services to expand post-investigative services for child
victims, shorten the time to the delivery of services, and increase
services to other at-risk families.
Community-Based Prevention Grants.--For every Federal dollar spent
on foster care and adoption subsidies, we spend less than 13 cents in
Federal child welfare funding on preventing and treating child abuse
and neglect.
Annual direct costs of child abuse and neglect in the United States
total over $24 billion in hospitalizations, chronic health and mental
health care, child welfare services, law enforcement, and courts.
Indirect costs from special education, other health and mental health
care, crime, and lost productivity, total more than $94 billion
annually.\1\ Community services to prevent child abuse are far less
costly than the damage inflicted on children from abuse and neglect. A
GAO evaluation of child abuse prevention efforts found ``total Federal
costs of providing prevention programs for low-income populations were
nearly offset after 4 years.'' \2\
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\1\ Fromm, S. (2001). Total Estimated Cost of Child Abuse and
Neglect in the United States. Prevent Child Abuse America.
\2\ U.S. General Accounting Office (1992). Child Abuse: Prevention
Programs Need Greater Emphasis (GAO/HRD-92-99).
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CAPTA's Prevention Grants help States to develop community-based
prevention services, including parenting education, home visiting
services, and respite care. We spend billions of dollars every year on
foster care to protect the children who have been the most seriously
injured; we can do a much better job at protecting children before the
damage is so bad that we have no other choice than to remove them from
their homes. Funding CAPTA prevention grants at $80 million would help
communities support proven, cost-effective approaches to preventing
child abuse and neglect.
Discretionary Research and Demonstration Grants.--Current funding
levels short-change community efforts to develop innovative programs to
serve children and families and to improve our knowledge about child
maltreatment.
We urge Congress to approve the President's proposed increase of
$10 million to support home visitation programs, with funds available
to promote an array of research- and evidence-based home visitation
models that enable communities to provide the most appropriate services
suited to the families needing them.
The U.S. Advisory Board on Child Abuse and Neglect recommended as
the highlight of its 1991 report, Creating Caring Communities, the
establishment of universal voluntary home visitor services. The Centers
for Disease Control (CDC) Task Force on Community Preventive Services
in its 2003 report evaluating the effectiveness of strategies for
preventing child maltreatment ``recommends early childhood home
visitation for prevention of child abuse and neglect in families at
risk for maltreatment, including disadvantaged populations and families
with low-birth weight infants.'' \3\
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\3\ Hahn, R.A., Bilukha, O.O., Crosby, A., Fullilove, M.T.,
Liberman, A., Moscicki, E.K., et al. (2003). First reports evaluating
the effectiveness of strategies for preventing violence: Early
childhood home visitation. Center for Disease Control, Morbidity and
Mortality Weekly Report, 52, 109.
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Research evidence supports the value of a range of early childhood
home visitation models using professionals, nurses, paraprofessionals,
and trained volunteers from the community in improving parenting and
family health and preventing child maltreatment.
For example, results from the randomized trial of the Healthy
Families New York program based on the Healthy Families America model
using Family Support Workers (specially trained paraprofessionals who
live in the target community and share the same language and cultural
background as program participants) showed that the program had
positive effects in the areas of parenting and child abuse and neglect,
birth outcomes, and health care. According to the research team
analyzing the Healthy Families program in New York, the results for the
subgroup of participants who resemble the clients typically served by
the Nurse Family Partnership (NFP) model of home visiting by nurses are
similar to those found in randomized trials of NFP.\4\
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\4\ DuMont, K., et al. (2006). Healthy Families New York Randomized
Trial: Impacts on Parenting After the First Two Years. New York State
Office of Children and Families. Working Paper Series.
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In another randomized trial, adolescent mothers who received case
management services and Parents as Teachers (PAT) home visitors were
significantly less likely to be subjected to child abuse investigations
than control group mothers who received neither case management nor PAT
home visitation.\5\ Randomized trials of the Parent-Child Home Program,
a home visitation early literacy and parenting program model, show
significant ongoing positive effects on parents' interaction with their
children, in contrast to control group families examined before and
after completion of the program.\6\
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\5\ Wagner, M.M. & Clayton, S.L. (1999). The Parents as Teachers
Program: Results from Two Demonstrations. The Future of Children: Home
Visiting: Recent Program Evaluations, 9(1), 91-115.
\6\ Joint Dissemination Review Panel of U.S. Department of
Education. (1978). Unanimous Approval of Research Findings, 1967-1978,
Mother-Child Home Program of Verbal Interaction Project. Freeport, NY:
Verbal Interaction Project.
O'Hara, J.M. & Levenstein, P. (1981). Second Year Progress Report:
9/15/80-9/14/81: Tracing the Parent-Child Network. Final Report, Grant
No. NIEG 800042, National Institute of Education, U.S. Department of
Education.
Levenstein, P., O'Hara, J.M., & Madden, J. (1983) , ``The Mother-
Child Home Program of the Verbal Interaction Project'', in Consortium
for Longitudinal Studies, ed., As the Twig is Bent Hillsdale, NJ:
Lawrence Erlbaum Associates.
Levenstein, P. & O'Hara, J.M., (1993) ``The necessary lightness of
mother-child play'', in K.B. MacDonald, eds., Parents and Children
Playing Albany, NY: State University of New York Press.
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In another study of home visiting models funded by CDC, researchers
concluded from a literature review of evaluations of home visitation
programs that where randomized trials might not always be feasible,
non-randomized studies are important to validate research or provide
stronger evidence when the randomized trial is compromised. In its
review of evaluations of various models, the report found that the
evaluated programs reduced child maltreatment by approximately 39
percent, overall.\7\
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\7\ Hahn, R., et al. (2005). Home Visiting Programs to Prevent
Child Abuse: Taking Silver and Bronze Along With Gold. U.S. Centers for
Disease Control and Prevention. Child Abuse and Neglect: The
International Journal. Vol. 29, p. 215-218.
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Funding research and program innovations at $36 million, as the
President requests, would provide support for a diversity of home
visitation models, as well as the field-initiated research, training,
technical assistance, and data collection also authorized by CAPTA out
of this money.
CHILD WELFARE SPENDING: A FAILURE TO INVEST
Our failure to invest in our child protective service system and
community-based programs for preventing child maltreatment has created
a spending gap of almost $17 billion in services to intervene on behalf
of children. Current available data peg Federal, State, and local
dollars for child protective services and preventive services at only
about $3.1 billion of the estimated $20.2 billion total cost of what we
ought to be spending.
According to the Urban Institute, States reported spending $22
billion on child welfare in 2002, and they could categorize how $17.4
billion of the funds were used.\8\ Of that amount, $10 billion was
spent for out-of-home placements, $1.7 billion on administration, $2.6
billion on adoption, and $3.1 billion (about 18 percent) on all other
services, including prevention, family preservation and support
services, and child protective services.
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\8\ Scarcella, C.A. (2004). The Cost of Protecting Vulnerable
Children IV: How Child Welfare Funding Fared during the Recession,
Washington, DC. Urban Institute.
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Failure to invest in a working child protection system results in a
national failure to keep children free from harm. The cost to child
protective services in 2002 of investigating the 1.745 million children
who were screened in for investigations, plus the expense that would
have been incurred if services had been provided to all of the 896,000
substantiated child victims (as well as to the 708,000 children in
unsubstantiated reports who also received some services), totals $7.2
billion. Second, consider the cost of preventive services--$13 billion
if offered to the 3 million child maltreatment victims identified in
the HHS National Incidence Study III. That's a total cost of $18.4
billion. Yet, in 2002, States spent only $3.1 billion in Federal,
State, and local funds on protective and preventive services for
children. Our national child welfare policy represents a morally
unacceptable failure to invest in this system.
These are conservative cost figures. When adjusted to account for
inflation, data indicate that investigations by child protective
service agencies cost approximately $1,011 per case. The cost per case
to provide basic in-home services such as homemaker assistance or
family counseling is $3,360.\9\ These costs are low to start with. Pay
scales in child welfare are generally low and noncompetitive--
significantly lower, for example, than salaries for teachers, school
counselors, nurses and public-health social workers \10\--which brings
these costs in at a low level.
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\9\ Courtney, M.E. (1998). ``The Costs of Child Protection in the
Context of Welfare Reform''. The Future of Children, Vol. 8, No. 1.
\10\ U.S. General Accounting Office (2003). HHS Could Play a
Greater Role in Helping Child Welfare Agencies Recruit and Retain Staff
(GAO-03-357).
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What does the spending gap mean? States report having difficulty in
recruiting and retaining child welfare workers,\11\ because of issues
like low salaries, high caseloads, insufficient training and limited
supervision, and the turnover of child welfare workers--estimated to be
between 30 and 40 percent annually nationwide.\12\ The average caseload
for child welfare workers is double the recommended level, and
obviously much higher in many jurisdictions.\13\ Because our system is
weighted toward protecting the most seriously injured children, we wait
until it gets so bad that we have to step in. Far less attention in
policy or funding is directed at preventing harm to children from ever
happening in the first place or providing the appropriate services and
treatment needed by families and children victimized by abuse or
neglect.
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\11\ U.S. General Accounting Office (1995). Child Welfare: Complex
Needs Strain Capacity to Provide Services (GAO/HEHS-95-208).
\12\ U.S. General Accounting Office (2003). HHS Could Play a
Greater Role in Helping Child Welfare Agencies Recruit and Retain Staff
(GAO-03-357).
\13\ Alliance for Children and Families, American Public Human
Services Association, Child Welfare League of America (2001). The child
welfare workforce challenge: Results from a preliminary study. Dallas.
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Increasing funding for CAPTA's basic State grants and community-
based prevention grants will help to begin to address the current
imbalance. It is time to invest additional resources to work in
partnership with the States to help families and prevent children from
being abused and neglected.
THE CASE FOR PREVENTION
Our present system of treating abused and neglected children and
offering some help to troubled families is overworked and inadequate to
the task. Hundreds of thousands of children are currently identified as
having been abused, but receive no services to prevent further abuse.
We must focus attention on children and families known to the system in
order to prevent reoccurrence of abuse, as well as provide services to
families earlier, before problems become severe. Putting dollars aside
for prevention is sound investing, not luxury spending.
We know that child abuse prevention fights crime, because research
has shown us that victims of child abuse are more likely to engage in
criminality later in life, and that childhood abuse increases the odds
of future delinquency and adult criminality overall by 40 percent.\14\
We know that preventing child maltreatment helps to prevent failure in
school. Typically abused and neglected children suffer poor prospects
for success in school, exhibiting poor initiative, language and other
developmental delays, and a disproportionate amount of incompetence and
failure.\15\ Ensuring that children are ready to learn means ensuring
that children are safe at home. We know that preventing child abuse can
help to prevent disabling conditions in children. Physical abuse of
children can result in brain damage, mental retardation, cerebral
palsy, and learning disorders.\16\
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\14\ C.S. Widom (1992). The Cycle of Violence. Washington, DC:
National Institute of Justice.
\15\ S.R. Morgan (1976). The Battered Child in the Classroom.
Journal of Pediatric Psychology.
\16\ H.P. Martin & M.A. Rodeheffer (1980). The Psychological Impact
of Abuse in Children. In: G.J. Williams. Traumatic Abuse and Neglect of
Children at Home. Baltimore, MD: Johns Hopkins University Press.
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Research conducted by CDC in collaboration with Kaiser Permanente
shows us that childhood abuse is linked with behaviors later in life
which result in the development of chronic diseases that cause death
and disability, such as heart disease, cancer, chronic lung and liver
diseases, and skeletal fracture, and that the adult victims of child
maltreatment are more likely suffer from depression and suicide
attempts.\17\
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\17\ V.J. Felitti, R.F. Anda, et al. (1998). Relationship of
Childhood Abuse and Household Dysfunction to Many of the Leading Causes
of Death in Adults. The Adverse Childhood Experiences (ACE) Study.
American Journal of Preventive Medicine.
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Community-based services to overburdened families are far less
costly than the damage inflicted on children that leads to outlays for
child protective services, law enforcement, courts, foster care, health
care and the treatment of adults recovering from child abuse. A range
of services, such as voluntary home-visiting, family support services,
parent mutual support programs, parenting education, and respite care
contribute to a community's successful strategy to prevent child abuse
and neglect.
National Child Abuse Coalition Member Organizations: Alliance for
Children and Families, American Academy of Pediatrics, American Bar
Association, American Humane Association, American Professional Society
on the Abuse of Children, American Psychological Association,
Association of University Centers on Disabilities, Boys and Girls Clubs
of America, CHILD Inc., Child Welfare League of America, Children's
Defense Fund, First Star, General Federation of Women's Clubs, National
Alliance of Children's Trust and Prevention Funds, National Association
of Children's Hospitals, National Association of Counsel for Children,
National Association of Social Workers, Nat'l. Center for Child
Traumatic Stress, National Center for State Courts, National CASA
Association, National Education Association, National Exchange Club
Foundation, National PTA, National Respite Coalition, Parents
Anonymous, Prevent Child Abuse America, Voices for America's Children.
______
Prepared Statement of the National Coalition for Osteoporosis and
Related Bone Diseases
Mr. Chairman and members of the committee: The National Coalition
for Osteoporosis and Related Bone Diseases (Bone Coalition) is pleased
to have the opportunity to present our views on the fiscal year 2008
budget for the National Institutes of Health (NIH). We are appreciative
of your continued support of the NIH. The Federal investment made to
date has allowed for new research opportunities to be pursued that hold
the potential to prevent and one day possibly cure diseases such as
osteoporosis, osteogenesis imperfecta and Paget's disease of bone.
The leaders of the Coalition are the National Osteoporosis
Foundation, the Amerian Society for Bone and Mineral Research, the
Osteogenesis Imperfecta Foundation and the Paget Foundation for Paget's
Disease of Bone and Related Disorders. Throughout our existence, the
Coalition has remained committed to reducing the impact of bone disease
through expanded biomedical, clinical, epidemiological and behavioral
research.
Bone health is integral to the overall health and well being of the
Nation's population. The bony skeleton is a remarkable organ that not
only serves a structural function, providing mobility, support, and
protection for the soft tissues, but also functions as a reservoir or
storehouse for essential minerals and growth factors. It may even
potentially act as an endocrine organ.
The 2004 Surgeon General's Report on Bone Health and Osteoporosis
calls bone health an ``often overlooked aspect of physical health'' and
further States that ``[a] healthy skeletal system with strong bones is
essential to overall health and quality of life. Yet, today, far too
many Americans suffer from bone diseases and fractures.''
Bone diseases such as osteoporosis, osteogenesis imperfecta, and
Paget's disease of bone remain a major public health problem in this
country and the financial, physical and psychosocial consequences of
bone diseases significantly diminish quality of life and burden
society.
Osteoporosis.--Is a disease characterized by low bone mass and
structural deterioration of bone tissue, leading to bone fragility and
an increased susceptibility to fractures, particularly of the hip,
spine, and wrist. This is due to several factors such as the aging of
our population, increased use of steroids and other drugs that have
deleterious affects on bone, and increased immobilized patients and
nursing home populations. Over 10 million Americans have osteoporosis,
the majority of whom (80 percent) are women; 34 million more have low
bone mass and are at increased risk for the disease. The estimated
national direct expenditures for osteoporosis and related fractures
total $18 billion each year in 2002 dollars.
Paget's Disease of Bone.--The second most prevalent bone disease
after osteoporosis--is a chronic skeletal disorder that may result in
enlarged or deformed bones in one or more regions of the skeleton.
Excessive bone breakdown and formation can result in bone that is
dense, but fragile. Complications may include arthritis, fractures,
bowing of limbs, neurological complications, and hearing loss if the
disease affects the skull. Prevalence in the population ranges from 1.5
percent to 8 percent depending on the person's age and geographical
location. Paget's disease primarily affects people over 50.
Osteogenesis Imperfecta.--Causes brittle bones that break easily
due to a problem with collagen production. For example, a cough or
sneeze can break a rib, rolling over can break a leg. Besides fragile
bones, people with OI may have hearing loss, brittle teeth, short
stature, skeletal deformities, and respiratory difficulties. OI affects
between 20,000 to 50,000 Americans. In severe cases fractures occur
before and during birth. In some cases, an affected child can suffer
repeated fractures before a diagnosis can be made. Undiagnosed OI may
result in accusations of child abuse.
Cancer Metastasis to Bone.--A frequent complication of cancer is
its spread to bone (bone metastasis) that occurs in up to 80 percent of
patients with myeloma and 70 percent of patients with either breast or
prostate cancer--causing severe bone pain and pathologic fractures.
Only 20 percent of breast cancer patients and 5 percent of lung cancer
patients survive more than 5 years after discovery of bone metastasis.
Musculoskeletal Trauma and Skeletal Pain.--Of the 60 million
Americans injured annually, more than one-half incur injuries to the
musculoskeletal system. In the United States, back pain is a major
reason listed for lost time from work and sports injuries are
increasing in ``weekend warriors'' of both sexes. In our military, bone
trauma is now accounting for over 50 percent of all combat injuries.
HOW HAS BONE RESEARCH HELPED PEOPLE?
NIH-supported research in bone health has led to important
discoveries and has generated new treatments and pharmaceutical
products.
--Research has taught us that those with low bone mass are at risk
for osteoporosis. These individuals can then address their risk
with exercise, diet, other behavioral and lifestyle changes,
and medication.
--Research has decreased fracture risk and extended the lifespan to
normal for people with OI.
--Research has identified drugs which improve the quality of life of
people whose cancer has metastasized to bone.
--Research has led us to develop simple, non-invasive and accurate
tests that can determine bone mass and help predict fracture
risk.
--Research has identified and demonstrated a variety of drugs that
can reduce bone loss and fractures, and even build new bone.
Thirty years ago, there was no treatment for osteoporosis.
--Research has helped us to understand the need for weight-bearing
exercise to build and maintain bone in order to reduce fracture
risk. Falling can be reduced by strength-building exercise that
increases balance and flexibility.
--Research has led to the discovery of a recessive form of
osteogenesis imperfecta, providing new possibilities for
prevention, treatment and a cure. But much remains to be done.
FUTURE OPPORTUNITIES FOR BONE RESEARCH
Osteoporosis.--Research has the potential to add important new
information to our understanding of osteoporosis.
--Therapies such as calcium supplementation and physical activity
need to be explored to help chronically ill children reach and
maintain peak bone mass.
--Data on the beneficial and/or adverse effects of bone therapies
such as bisphosphonates in children as well as adults with many
chronic diseases such as diabetes, inflammatory arthritis and
osteogenesis imperfecta are almost non-existent and are sorely
needed.
--The pathophysiology of bone loss in diverse populations needs to be
studied in order to develop targeted therapies to improve bone
density and bone quality.
--Racial differences in bone and the origin of racial differences in
fracture patterns need to be identified to understand important
determinants of fracture and their underlying biology.
--Patients at risk for fracture who do not meet current criteria for
osteoporosis need to be identified. In addition, the effects of
current and developing osteoporosis treatments on these
patients need to be studied.
--Research into gene targeting which could cure osteogenesis
imperfecta is a few short years away from human trials.
Continued research into drug therapies is needed to improve
bone quality, allowing people with osteogenesis imperfecta to
live independently.
Congenic and Genetic Disease of Bone.--Thousands of children and
adolescents nationwide suffer from musculoskeletal disorders and
malformations, many of which have devastating effects on mortality and
disability. Diseases such as osteogenesis imperfecta, fibrous
dysplasia, osteopetrosis, and Paget's disease are caused by poorly
understood genetic mutations. In Paget's disease, underlying genetic
defects can also be exacerbated by environmental factors. Increased
research on the role of the environmental and genetic factors in the
development of Paget's disease could lead to the identification of new
therapeutic targets for the disease. The science of genetics has led to
tremendous advances in our understanding of numerous systems that
affect bone health, but little of this technology is being applied to
bone research. Knowledge of complex gene pathways must be used to
deepen our understanding of bone biology to gain better insight into
the causes of these debilitating diseases. Research is needed that:
--Focuses on mechanisms of preventing fractures and improving bone
quality and correcting malformations, on innovations in
surgical and non-surgical approaches to treatment, on physical
factors that affect growth, and on genetic defects that cause
bone disease.
--Expands research on skeletal stem cell biology and the genetics and
pathophysiology of rare disorders such as fibrous dysplasia,
melhoreostosis, XLinked hypophosphatemic rickets and
fibrodysplasia ossificans progressiva.
Cancer Metastasis to Bone.--Immune response plays a role in cancer
metastasis. Osteoimmunology--the study of the relationships between the
immune system and bone homeostasis--is an emerging area of research and
may help scientists prevent and treat the spread of cancer to bone.
Research is needed to:
--Determine mechanisms and to identify, block and treat cancer
metastasis to bone.
--Expand research on osteosarcoma to improve survival and quality of
life and to prevent metastatic osteosarcoma in children and
teenagers who develop this cancer.
--Expand research on tumor dormancy as it relates to bone metastasis.
Musculoskeletal Trauma and Skeletal Pain.--Research is needed to
better understand the epidemiology of back pain, improve on existing
diagnostic techniques for back pain, as well as to develop new ones.
Furthermore, expanded research is needed to improve diagnostic and
therapeutic approaches to significantly lower the impact of
musculoskeletal traumas, and on research on accelerated fracture
healing, the use of biochemical or physical bone stimulation, the role
of hematopoietic niches to preserve bone stem cells, the use of
mesenchymal bone stem cells, and biomaterials and biologicals in bone
repair and regeneration, and research into repair of nonunion fractures
in osteogenesis imperfecta.
Bone Strength.--Research is also needed in the area of bone
strength. Although bone mineral density has been a useful predictor of
susceptibility to fracture, other properties of the skeleton contribute
to bone strength, such as geometry and composition. At this time,
little is understood as to how these properties influence bone
strength. However, research clearly indicates that exercise that causes
mechanotransduction plays a key role in the maintenance of bone; and
loss of bone due to immobilization as occurs in patients in hospitals
and nursing homes may be preventable with therapies that mimic
mechanotransduction. Bone strength is also influenced by the amount of
mineral, however, how the bone becomes mineralized is not well
understood. Understanding this process should assist in prevention of
pathologic mineralization as occurs in hardening of the arteries that
causes heart attacks. Research, including research on bone structure
and periosteal biology, is needed which will achieve identification of
the parameters that influence bone strength and lead to better
prediction for prevention and treatment of bone diseases such as
osteoporosis, osteogenesis imperfecta, bone loss due to kidney disease,
and hardening of the arteries.
To move this research forward, Congress must provide sufficient
funding to the National Institutes of Health to sustain the robust
research atmosphere in which to address the challenges in the bone
field. Research must continue to be accelerated in order to improve the
health of the Nation.
RECOMMENDATION
The National Coalition for Osteoporosis and Related Bone Diseases
supports:
--a 6.7 percent increase in funding for the National Institutes of
Health as recommended by the Ad Hoc Group for Medical Research,
the Campaign for Medical Research, the Federation of American
Societies for Experimental Biology, the National Health
Council, and Research!America.
--a 6.7 percent increase for the National Institute of Arthritis and
Musculoskeletal and Skin Diseases, the lead institute for bone
research.
--increased funding for NIA, NIDCR, NIDDK, NCI and NICHD, other
Institutes that also fund bone-related research, as well as
additional support for bone programs at NIBIB and NCAM.
Thank you for the opportunity to submit our statement regarding the
fiscal year 2008 budget for the National Institutes of Health.
______
Prepared Statement of the National Consumer Law Center on Behalf of Our
Low-Income Clients \1\
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\1\ Mass Union of Public Housing Tenants and Pennsylvania Utility
Law Project.
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The Federal Low Income Home Energy Assistance Program (LIHEAP) \2\
is the cornerstone of government efforts to help needy seniors and
families avoid hypothermia in the winter and heat stress (even death)
in the summer. We are in a sustained period of much higher household
energy prices and expenditures and the demand for this program is
growing as increases in energy prices far outstrip the ability of low
income households to pay. In light of the crucial safety net function
of this program in protecting the health and well-being of low-income
seniors, the disabled and families with very young children, we
respectfully request that LIHEAP be fully funded at its authorized
level of $5.1 billion for fiscal year 2008 and that advance funding of
$5.1 billion be provided for the program in fiscal year 2009.
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\2\ 42 U.S.C. Sec. Sec. 8621 et seq.
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COST OF HOME ENERGY REMAINS AT RECORD HIGH LEVELS
Residential heating expenditures remain at record high levels.
According to the Department of Energy's Energy Information
Administration's March 2007 Short-Term Energy Outlook, this winter's
average residential heating expenditures are projected to be 53 percent
higher for heating oil, 29.6 percent higher for natural gas, 39.4
percent higher for propane, and 18.6 percent higher for electricity
than the averaged expenditures for 2000-2005. This U.S. Department of
Energy short-term forecast of residential heating expenditures shows
that, on average, residential bills are still among the highest on
record. The cost of electricity, used for both heating and cooling, has
been increasing rapidly due, in part, to increases in the price of
natural gas used to generate electricity in many power plants and the
lifting of price caps in States that restructured their electric
markets.
In a brief span of time, energy bills have walloped low-income
households. In 2008, LIHEAP eligible households are predicted to spend,
depending on the type of heating fuel used, 63 percent more on their
total residential energy bills than in 2001 if they used heating oil,
36 percent more if they used natural gas, 47 percent more if they used
propane and 34 percent more if they use electricity. The effect of
these continually rising prices on low-income households is
devastating.
STATES' DATA ON ELECTRIC AND NATURAL GAS DISCONNECTIONS AND ARREARAGES
SHOW THAT MORE HOUSEHOLDS ARE FALLING BEHIND
Not surprisingly, the steady and dramatic rise in residential
energy costs has resulted in increases in electric and natural gas
arrearages and disconnections. For example, utility service
disconnections in Rhode Island increased by over 92 percent between the
years 2000 and 2006. Similarly, the gap between service disconnections
and reconnections increased, suggesting increased durations of service
loss and greater numbers of households that do not regain access to
service under their own accounts.\3\
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\3\ Calculated from data provided by the Rhode Island Public
Utilities Commission.
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Although there are winter utility shut-off moratoria in place for
many States, not every home is protected against energy shut-offs in
the middle of winter. As we approach the lifting of winter shut-off
moratoria, we expect to see a wave of disconnections as households are
unable to afford the cost of the energy bills.
Iowa.--Despite milder winter temperatures this winter, the
continued high cost of natural gas has set back a record number of low-
income households in Iowa. In February 2007, the number of low-income
households with past due energy accounts was the second highest on
record for this time of year since these data have been tracked. As an
indication of the effect of long term effect of rising home energy
prices, the total number of LIHEAP households in arrears in February
2007 was 80 percent higher than 5 years ago at this point in time and
151 percent higher than in February 1999. The total amount of
arrearages of LIHEAP households has also grown sharply due to the
increase in prices. By February 2007, the total amount of LIHEAP
household arrears had increased 42 percent from the same period 5 years
ago and 163 percent compared to arrears in February 1999. The total
number of LIHEAP households served in fiscal year 2007 is expected to
remain at the record high level of fiscal year 2006, yet the program
received $16 million less under the fiscal year 2007 appropriations. In
order to serve the increased demand for LIHEAP this heating season the
program reduced benefits by 30 percent and redirected LIHEAP funds
normally dedicated to the summer pre-purchase of deliverable fuels (a
program component that maximizes purchasing power).\4\
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\4\ Iowa Bureau of Energy Assistance, National Energy Assistance
Directors' Association's ``LIHEAP Survey Results--Status of fiscal year
2007 Program Funding (March 7, 2007) and the National Energy Assistance
Directors' Association, ``The Low Income Home Energy Assistance
Program: Providing Heating and Cooling Assistance to Low-Income
Families During a Period of High Energy Prices (February 9, 2007).
NEADA documents are available at www.neada.org.
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Ohio.--In Ohio, the number of households entering into the State's
low-income energy affordability program, the Percentage of Income
Payment Program (PIPP), increased 13 percent from January 2006 to
January 2007. The increase is an even more dramatic 64 percent between
January 2002 and January 2007. The total dollar amount owed (arrearage)
by low-income PIPP customers increased 8 percent from January 2006 to
January 2007 and 62 percent when comparing PIPP customer arrears from
January 2002 to January 2007. The National Energy Assistance Directors
Association estimates that the number of households applying for energy
assistance in fiscal year 2007 is likely to remain at fiscal year 2006
levels, for Ohio that would mean an estimated 30 percent more
households when compared to Ohio households that received heating
assistance in fiscal year 2002.\5\
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\5\ Public Utilities Commission of Ohio, National Energy Assistance
Directors' Association's ``LIHEAP Survey Results--Status of Fiscal Year
2007 Program Funding (March 7, 2007), the National Energy Assistance
Directors, ``Est. Total Households Receiving LIHEAP Heating Assistance
by State--Projected Applications for Fiscal Year 2006 (2/13/06) and
``Estimated Total Households Receiving LIHEAP Heating Assistance by
State Actuals in 2002, 2003; Projected in 2004.'' NEADA documents are
available at www.neada.org.
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Pennsylvania.--Utilities in Pennsylvania that are regulated by the
Pennsylvania Public Utility Commission (PA PUC) have established
universal service programs that assist utility customers in paying
bills and reducing energy usage. Even with these programs, electric and
natural gas utility customers find it difficult to keep pace with their
energy burdens. The PA PUC estimates that more than 19,700 households
entered the current heating season without heat-related utility
service--this number includes about 3,700 households who are heating
with potentially unsafe heating sources such as kerosene or electric
space heaters and kitchen ovens. In mid-December 2006 an additional
9,000 residences where electric service was previously terminated were
vacant and over 7,500 residences where natural gas service was
terminated were vacant. In 2006, the number of terminations increased
32 percent compared with terminations in 2004. As of February 2007,
18.9 percent of residential electric customers and 16.3 percent of
natural gas customers were overdue on their energy bills. The National
Energy Assistance Directors Association estimates that the number of
households applying for energy assistance in fiscal year 2007 is likely
to remain at fiscal year 2006 levels, for Pennsylvania that would mean
an estimated increase of over 354,065 LIHEAP households from in fiscal
year 2005 levels. However, in fiscal year 2007 Pennsylvania is
experiencing a 34 percent reduction in LIHEAP funding compared to
levels in fiscal year 2006. This reduction in funding has resulted in a
32 percent cut to the average LIHEAP crisis benefit from $422 in fiscal
year 2006 to $285 in fiscal year 2007 (year to date).\6\
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\6\ Pennsylvania Public Utility Commission Bureau of Consumer
Services, National Energy Assistance Directors' Association's ``LIHEAP
Survey Results--Status of Fiscal Year 2007 Program Funding (March 7,
2007) and National Energy Assistance Directors' Association, ``The Low
Income Home Energy Assistance Program: Providing Heating and Cooling
Assistance to Low-Income Families During a Period of High Energy Prices
(February 9, 2007). NEADA documents are available at http://
www.neada.org.
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LIHEAP IS A CRITICAL SAFETY NET PROGRAM FOR THE ELDERLY, THE DISABLED
AND HOUSEHOLDS WITH YOUNG CHILDREN
In fiscal year 2006, 5.7 million households received LIHEAP heating
assistance, the highest number of households served in 13 years.
Preliminary estimates by the National Energy Assistance Directors'
Association are that fiscal year 2007 participation rates will remain
near the same record levels as in fiscal year 2006.\7\ Yet, energy
prices have been on a continued upward climb. These two trends cut into
the ability of the LIHEAP program to help protect our most vulnerable
citizens from extreme weather conditions that cause illness, physical
harm and even death.
---------------------------------------------------------------------------
\7\ National Energy Assistance Directors' Association, Talking
Points in Support of Additional Federal and State Grant Funding for
Energy Assistance (Jan. 19, 2007) available at www.NEADA.org.
---------------------------------------------------------------------------
Recent national studies have documented the dire choices low-income
households are faced with when energy bills are unaffordable. Because
adequate heating and cooling are tied to the habitability of the home,
low-income families will go to great lengths to pay their energy bills.
Low-income households faced with unaffordable energy bills cut back on
necessities such as food, medicine and medical care.\8\ The U.S.
Department of Agriculture recently released a study that shows the
connection between low-income households, especially those with elderly
persons, experiencing very low food security and heating and cooling
seasons when energy bills are high.\9\ A pediatric study in Boston
documented an increase in the number of extremely low weight children,
age 6 to 24 months, in the 3 months following the coldest months, when
compared to the rest of the year.\10\ Clearly, families are going
without food during the winter to pay their heating bills, and their
children fail to thrive and grow.
---------------------------------------------------------------------------
\8\ See e.g., National Energy Assistance Directors' Association,
2005 National Energy Assistance Survey, Tables in section IV,G
(September 2005) (To pay their energy bills, 20 percent of LIHEAP
recipients went without food, 35 percent went without medical or dental
care, 32 percent did not fill or took less than the full dose of a
prescribed medicine). Available at http://www.neada.org/comm/surveys/
NEADA_2005_National_Energy_Assistance_Survey.pdf.
\9\ Mark Nord and Linda S. Kantor, Seasonal Variation in Food
Insecurity Is Associated with Heating and Cooling Costs Among Low-
Income Elderly Americans, The Journal of Nutrition, 136 (Nov. 2006)
2939-2944.
\10\ Deborah A. Frank, MD et al., Heat or Eat: The Low Income Home
Energy Assistance Program and Nutritional and Health Risks Among
Children Less Than 3 years of Age, AAP Pediatrics v.118, no.5 (Nov.
2006) e1293-e1302. See also, Child Health Impact Working Group,
Unhealthy Consequences: Energy Costs and Child Health: A Child Health
Impact Assessment Of Energy Costs And The Low Income Home Energy
Assistance Program (Boston: Nov. 2006).
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When people are unable to afford paying their home energy bills,
dangerous and even fatal results occur. Families resort to using unsafe
heating sources, such as space heaters, ovens and burners, all of which
are fire hazards.\11\ In the summer, the inability to afford cooling
bills can result in heat-related deaths and illness. The loss of
essential utility services can be devastating, especially for poor
families that can find themselves facing hypothermia in the winter,
hyperthermia in the summer, eviction, property damage from frozen
pipes, the use of dangerous alternative sources of heat.
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\11\ John R. Hall, Jr., Home Heating Fire Patterns and Trends (In
2003 there were over 53,000 heating-equipment related home fires
resulting in 260 deaths (73 percent of the deaths involved portable
space heaters) and 1,260 injuries and $494 million in property damage),
National Fire Protection Association (Nov. 2006).
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LIHEAP is an administratively efficient and effective targeted
health and safety program that works to bring fuel costs within a
manageable range for vulnerable low-income seniors, the disabled and
families with young children. LIHEAP must be fully funded at its
authorized level of $5.1 billion in fiscal year 2008 in light of the
steady increase in home energy costs and the increased need for
assistance to protect the health and safety of low income families by
making their energy bills more affordable. In addition, fiscal year
2009 advance funding would facilitate the efficient administration of
the State LIHEAP programs. Advanced funding provided certainty of
funding levels to States to set income guidelines and benefit levels
before the start of the heating season. States can also plan the
components of their program year (e.g., amounts set aside for heating,
cooling and emergency assistance, weatherization, self-sufficiency and
leveraging activities).
______
Prepared Statement of the National Council of Social Security
Management Associations
Chairman Harkin, Senator Specter and members of the subcommittee,
my name is Richard Warsinskey and I represent the National Council of
Social Security Management Associations (NCSSMA). I have been the
manager of the Social Security office in Downtown Cleveland, Ohio for
nearly 12 years and have worked for the Social Security Administration
for 31 years. On behalf of our membership, I am pleased to have the
opportunity to submit this written testimony to the subcommittee.
The NCSSMA is a membership organization of nearly 3,400 Social
Security Administration (SSA) managers and supervisors who provide
leadership in over 1,300 Field Offices and Teleservice Centers
throughout the country. We are the front-line service providers for SSA
in communities all over the Nation. We are also the Federal employees
with whom many of your staff members work to resolve problems and
issues for your constituents who receive Social Security retirement
benefits, survivors or disability benefits, or Supplemental Security
Income. From the time our organization was founded over 36 years ago,
the NCSSMA has been a strong advocate of efficient and prompt locally
delivered services nationwide to meet the variety of needs of
beneficiaries, claimants, and the general public. We consider our top
priority to be a strong and stable Social Security Administration, one
that delivers quality and prompt community based service to the people
we serve--your constituents.
IMPACT OF SSA'S APPROPRIATED FUNDING LEVEL ON SSA FIELD OFFICES &
TELESERVICE CENTERS
For fiscal year 2008, the President has proposed an increase for
SSA of approximately $304 million over the final level of funding for
fiscal year 2007. And yet, staffing levels in offices across the
country are being cut. In fact, SSA will lose about 4,000 positions
from the beginning of fiscal year 2006 to fiscal year 2008. The most
significant staffing losses in SSA have occurred in the agency's Field
Offices. Field Offices have lost about 2,300 positions in the past 18
months and about 1,200 positions since September 2006. The vast
majority of these losses have been in the most critical positions in
the Field: Claims Representatives and Service Representatives. All of
this comes after 5 years of reductions to the President's Budget
Requests, which total $720.0 million, and about 8,000 work years. It is
interesting to note that while total Executive Branch Employment is
expected to increase 2.1 percent from fiscal year 2006 to fiscal year
2008, SSA's employment is expected to decrease by 6.2 percent.
In 2007, an average of 858,000 people are visiting Social Security
Administration Field Offices every week. At the same time, Field
Offices are also being overwhelmed by business-related telephone calls.
SSA Field Offices are receiving approximately 68 million business
related phone calls a year. This is in addition to the 44 million phone
calls handled by live agents that are received by SSA's 1-800 number on
an annual basis. The fact that the public can't get through to SSA on
the telephone is creating an overwhelming amount of walk-in traffic in
many Field Offices. Waiting times in many Field Offices are running 2
to 3 hours long. Some visitors are even experiencing wait times of over
4 hours.
SSA is also facing a retirement wave as many of its employees were
hired around the time SSA took over the Supplemental Security Income
(SSI) program in 1974. It is important for the agency to be able to
replace this wealth of experience. It can take up to 4 years before
newly hired Claims Representatives become fully proficient in the very
complicated programs SSA administers.
The impact of inadequate resources in recent years is apparent in
the severe cutbacks in processing Continuing Disability Review cases
and SSI Redeterminations. For every $1 spent on a Continuing Disability
Review, $10 is saved. SSA currently has a backlog of 1.3 million
Continuing Disability Review cases. The agency also saves $7 for every
$1 spent on an SSI redetermination. SSA was unable to process over 2.0
million of these cases in the past few years due to the lack of
resources.
In recent months I have received hundreds of messages from SSA
Field Office management describing how the stress in their offices is
incredible. Health problems are growing. It truly is a dire situation.
I would like to share with you part of a communication I received from
a member of Field Office management:
``We have lost five employees recently. Two had strokes in the
office in the last month and it may have been due to all the stress.
Another employee is retiring next month. We are simply being hammered
with work. The number of people visiting our office is well beyond our
capacity to handle them. About 30.0 percent of our visitors live
outside our service area. We don't receive staff for these extra
visitors and the loss of staff has made it an impossible situation.
``We really have a very dedicated and wonderful staff. But so many
are about to have a breakdown. We are just desperate to get help.''
Even if SSA receives the funding increase recommended by the
President for fiscal year 2008, staffing will be cut because SSA's
expenditures continue to increase in several areas. Salaries and
benefit costs, including those for the Disability Determination
Services, rent, and security costs, are totaling more than the annual
increases in appropriated funds. And for fiscal year 2007, SSA's final
level of funding was just enough to avoid an agency-wide furlough.
Although a furlough was avoided, the agency will be faced with limited
hiring for the entire year after only being able to replace one out of
three staffing losses last year.
As a result, the fiscal year 2008 President's budget request will
provide fewer, not additional, resources for SSA. Therefore, we are in
strong support of the additional funding recommended in the Fiscal Year
2008 Senate Budget Resolution. These additional funds would be a major
step in restoring SSA's service to appropriate levels.
SURVEY OF OUR MEMBERS
Our association just completed a survey of our members. Over 2,000
responded. The gravity of the losses in the Field Offices can be seen
in an answer to one question. The question was: `` Do you have enough
staff to keep workloads current?'' Only 3.2 percent answered ``yes'' to
this question.
The losses in staff in Field Offices are having a significant
impact on our ability to provide good service. In answer to the
question: ``What percent of the time are Field Offices able to provide
prompt telephone service?'' nearly 63 percent said they can only do
this 50 percent or less of the time. Nearly a third said they can
provide prompt telephone service less than 25 percent of the time. The
impact of these staffing losses can also be seen in the increased
waiting times for the public. In answer to the question as to whether
waiting times had increased in the past 2 years, 80 percent said
``yes'' and nearly a third said the waiting times were significantly
longer.
DISABILITY BACKLOGS
It is also important to note that receiving prompt service is not
the case for hundreds of thousands of claimants that have filed for
Social Security and SSI Disability benefits. There are currently over
three quarter of a million hearings pending. And at the moment, it is
taking 510 days, on average, for a hearings decision. Nearly 300,000
hearings have been pending over a year. SSA estimates that the hearings
backlog could grow to 1 million cases by 2010 if additional resources
are not provided for SSA.
SSA also has a total of about 1.4 million disability cases pending
at the initial claims, reconsideration, and hearings levels. We
estimate about 125,000 of these cases belong to veterans and about half
of these are pending at the hearings level.
Every day SSA Field Offices and Teleservice Centers throughout the
country are being contacted by people regarding the status of their
hearings as I am sure most congressional offices are. Many of these
people are desperate and have insufficient funds to live on and the
delays only add to their sense of hopelessness.
At the beginning of this decade there were only about 311,000
hearings pending, and the average time for processing was just 274
days. So the pending cases have grown 130.0 percent in 6 years, and the
average time to process a case has increased by 234 days. These long
waits occur after most claimants have passed the first two stages of
their claim, having received an initial decision and a reconsideration.
By this point, over 200 days on average have already passed by.
THE IMPACT OF THE BABY BOOMERS RETIRING
Next year, in 2008, the first of 78 million baby boomers will be
eligible for Social Security retirement. So there will be a steady rise
in retirement claims with SSA--along with an increasing number of
contacts by these retirees with SSA once they start receiving benefits.
At the end of 2006, there were 40.3 million people receiving
retirement and survivor benefits. This figure is expected to rise by
about 1 million a year over the next 10 years and accelerate after
this. SSA took about 3.3 million retirement and survivor claims last
year. So we are looking at a significant increase in work for SSA
offices.
THE COMMISSIONER'S BUDGET
Because SSA is an independent agency, the Commissioner is required
by law to prepare an annual budget request for SSA, which is submitted
by the President to Congress without revision, together with the
President's budget request for SSA. This budget request reflects what
the Commissioner has evaluated as the level of funding necessary to
meet the agency's service delivery improvements and fiscal stewardship
responsibilities through 2012. The Commissioner's budget request also
factors in that SSA has received less than the President's recommended
level of funding in recent years, thus leading to the need for
additional resources in the future to meet the full service delivery
plan. The budget amount submitted by the Commissioner of Social
Security for fiscal year 2008 is $10.44 billion. This $10.44 billion is
$843 million more than what the President requested. The difference
between these proposed funding levels is significant. Of more
significance is the difference between the final funding levels
approved by Congress for SSA in comparison to the budget requests
submitted in recent years by the Commissioner. Inadequate levels of
resources have contributed to the growing inability of SSA to provide
adequate levels of service.
SOCIAL SECURITY TRUST FUND
The Social Security Trust Fund currently totals approximately $2.0
trillion. The Social Security Trust Fund is intended to pay benefits to
future beneficiaries and finance the operations of the Social Security
Administration. The additional funding for SSA proposed in the fiscal
year 2008 Senate Budget Resolution represents about 1/65th of 1 percent
of $2 trillion. Don't the workers who have paid into this trust fund
with their taxes deserve to receive due consideration and the very
benefits they have paid for in a timely manner?
The Social Security Trust Fund contains the necessary resources to
make up the difference between the level requested by SSA's
Commissioner and the President. Yet, because of the levels of service
that SSA and its various components that process disability claims are
currently able to provide, many of these taxpayers must wait so long
for service that they die before a decision is made on their case. They
never receive the benefits that they have paid for. This also applies
to receiving good service in Social Security Administration Field
Offices--it currently is not at the level it ought to be and people are
not receiving what they have paid for and what they deserve.
CONCLUSION
The NCSSMA believes that the American public wants and deserves to
receive good and timely service for the tax dollars they have paid to
receive Social Security. We urge approval of at least the amount
included in the Fiscal Year 2008 Senate Budget Resolution, and
encourage you to consider providing the level of funding requested by
the Commissioner of Social Security. This additional funding would
certainly begin the necessary process to restore the levels of service
that the public deserves from SSA.
On behalf of the members of the NCSSMA, I thank you again for the
opportunity to submit this written testimony to the subcommittee. Our
members are not only dedicated SSA employees, but they are also
personally committed to the mission of the agency and to providing the
best service possible to the American public. We respectfully ask that
you consider our comments and would appreciate any assistance you can
provide in ensuring that the American public receives the necessary
service that they deserve from the Social Security Administration.
______
Prepared Statement of the National Federation of Community Broadcasters
Thank you for the opportunity to submit testimony to this
subcommittee regarding the appropriation for the Corporation for Public
Broadcasting (CPB). As the president and CEO of the National Federation
of Community Broadcasters, I speak on behalf of 250 community radio
stations and related organizations across the country. Nearly half our
members are rural stations and half are controlled by people of color.
In addition, our members include many of the new Low Power FM stations
that are putting new local voices on the airwaves. NFCB is the sole
national organization representing this group of stations which provide
service in the smallest communities of this country as well as the
largest metropolitan areas.
In summary, the points we wish to make to this subcommittee are
that NFCB:
--Requests $440 million in funding for CPB for fiscal year 2010;
--Requests $40 million in fiscal year 2008 for conversion of public
radio and television to digital broadcasting;
--Requests $27 million in fiscal year 2008 for replacement of the
radio interconnection system;
--Requests that advance funding for CPB is maintained to preserve
journalistic integrity and facilitate planning and local
fundraising by public broadcasters;
--Reject the administration's proposal to rescind $107.35 million of
already-appropriated 2008 CPB funds;
--Supports CPB activities in facilitating programming and services to
Native American, African American and Latino radio stations;
--Supports CPB's efforts to help public radio stations utilize new
distribution technologies and requests that the subcommittee
ensure that these technologies are available to all public
radio services and not just the ones with the greatest
resources.
Community Radio fully supports $440 million in Federal funding for
the Corporation for Public Broadcasting in fiscal year 2010. Federal
support distributed through CPB is an essential resource for rural
stations and for those stations serving communities of color. These
stations provide critical, life-saving information to their listeners
and are often in communities with very small populations and limited
economic bases, thus the community is unable to financially support the
station without Federal funds.
In larger towns and cities, sustaining grants from CPB enable
Community Radio stations to provide a reliable source of noncommercial
programming about the communities themselves. Local programming is an
increasingly rare commodity in a Nation that is dominated by national
program services and concentrated ownership of the media.
For over 30 years, CPB appropriations have been enacted 2 years in
advance. This insulation has allowed pubic broadcasting to grow into a
respected, independent, national resource that leverages its Federal
support with significant local funds. Knowing what funding will be
available in advance has allowed local stations to plan for programming
and community service and to explore additional non-governmental
support to augment the Federal funds. Most importantly, the insulation
that advance funding provides ``go[es] a long way toward eliminating
both the risk of and the appearance of undue interference with and
control of public broadcasting.'' (House Report 94-245.)
For the last few years, CPB has increased support to rural stations
and committed resources to help public radio take advantage of new
technologies such as the Internet, satellite radio and digital
broadcasting. We commend these activities which we feel provide better
service to the American people but want to be sure that the smaller
stations with more limited resources are not left out of this
technological transition. We ask that the subcommittee include language
in the appropriation that will ensure that funds are available to help
the entire public radio system utilize the new technologies,
particularly rural and minority stations.
NFCB commends CPB for the leadership it has shown in supporting and
fostering the programming services to Latino stations and to Native
American stations. For example, Satelite Radio Bilingue provides 24
hours of programming to stations across the United States and Puerto
Rico addressing issues in Spanish of particular interest to the Latino
population. At the same time, Native Voice One (NV1) is distributing
programming for the Native American stations. There are now over 33
stations controlled by and serving Native Americans.
Two years ago CPB funded the establishment of the Center for Native
American Public Radio (CNAPR). After 2 years in operation, CNAPR has
helped with the renewal of licenses and expansion of the
interconnection system to all Native stations and has raised the
possibility of Native Nations owning their own, locally controlled
station. In the process of this work, it was recognized that radio
would not be available to all Native Nations and broadband and other
new technologies would be necessary. CNAPR has been repositioned as
Native Public Media and is working hard to double the number of Native
stations within the next 3 years. These stations are critical in
serving local isolated communities (all but one are on Indian
Reservations) and in preserving cultures that are in danger of being
lost. CPB's 2003 assessment recognized that ``. . . Native Radio faces
enormous challenges and operates in very difficult environments.'' CPB
funding is critical to these rural, minority stations. CPB's funding of
the Intertribal Native Radio Summit in 2001 helped to pull these
isolated stations together into a system of stations that can support
each other. The CPB assessment goes on to say ``Nevertheless, the
Native Radio system is relatively new, fragile and still needs help
building its capacity at this time in its development.'' Native Public
Media promises to leverage additional, new funding to ensure that these
stations can continue to provide essential services to their
communities.
CPB also funded a Summit for Latino Public Radio which took place
in September 2002 in Rohnert Park, California, home of the first Latino
Public Radio station. These Summits have expanded the circle of support
for Native and Latino Public Radio and identified projects that will
improve efficiency among the stations through collaborations and
explore new ways of reaching the target audiences.
CPB plays a very important role for the public and Community Radio
system; they are the convener of discussions on critical issues facing
us as a system. They support research so that we have a better
understanding of how we are serving listeners, and they provide funding
for programming, new ventures, expansion to new listeners, and projects
that improve the efficiency of the system. This is particularly
important at a time when there are so many changes in the radio and
media environment with new distribution technologies and media
consolidation. An example of this support is the grant that NFCB
received to update and publish our Public Radio Legal Handbook online.
This provides easy-to-read information to stations about complying with
governmental regulations so that stations can function legally and use
their precious resources for programming instead of legal fees.
Finally, Community Radio supports $40 million in fiscal year 2008
for conversion to digital broadcasting by public radio and television.
It is critical that this digital funding be in addition to the on-going
operational support that CPB provides. The President's proposal that
digital money should be taken from the fiscal year 2008 CPB
appropriation would effectively cut stations' grants by over 25
percent. This would have a devastating impact on stations trying to
recover from hard economic times. And it would come at a time when the
local voices of community and public radio are especially important to
notify and support people during emergency situations and to help
communities deal with the loss of loved ones--things that commercial
radio is no longer able to do because of media consolidation.
While public television's digital conversion needs are mandated by
the FCC, public radio is converting to digital to provide more public
service and to keep up with commercial radio. The Federal
Communications Commission has approved a standard for digital radio
transmission and to allow multicasting. CPB has provided funding for
554 transmitters to convert to digital and is working with radio
transmitter and receiver manufacturers to build in the capacity to
provide a second channel of programming. Most exciting to public and
community radio is the encouraging results of tests that National
Public Radio has conducted, with funding from CPB, that indicate that
stations can broadcast at least three high-quality signals, even while
they continue to provide the analog signal. The development of second
and third audio channels will potentially double or triple the service
that public radio can provide, particularly in service to unserved and
underserved communities. This initial funding still leaves nearly 250
radio transmitters that will ultimately need to convert to digital or
be left behind.
Federal funds distributed by the CPB should be available to all
public radio stations eligible for Federal equipment support through
the Public Telecommunications Facilities Program (PTFP) of the National
Telecommunications and Information Agency of the Department of
Commerce. In previous years, Federal support for public radio has been
distributed through the PTFP grant program. The PTFP criteria for
funding are exacting, but allow for wider participation among public
stations. Stations eligible for PTFP funding and not for CPB funding
include small-budget, rural and minority controlled stations and the
new Low Power FM service.
Community Radio strongly supports funding for the public radio
interconnection system. Public Radio pioneered the use of satellite
technology to distribute programming. The new ContentDepot system that
the Public Radio Satellite System is launching continues this tradition
of cutting edge technology. The satellite capacity that supports this
system must be renewed and upgrades are necessary at the stations and
the network operations level. Interconnection is vital to the delivery
of the high quality programming that public broadcasting provides to
the American people.
This is a period of tremendous change. Digital is transforming the
way we do things; new distribution avenues like digital satellite
broadcasting and the Internet are changing how we define the business
we are in; and, the concentration of ownership in commercial radio
makes public radio in general, and Community Radio in particular, more
important as a local voice than we have ever been. New Low Power FM
stations are providing new local voices in their communities. Community
radio is providing essential local emergency information, programming
about the local impact of the major global events taking place,
culturally appropriate information and entertainment in the language of
the native culture, as well as helping to preserve cultures that are in
danger of dying out. During the natural disasters of the last couple of
years, radio proved once again to be the most dependable and available
medium to get emergency information to the public.
During these challenging times, the role of CPB as a convener of
the system becomes even more important. The funding that it provides
will allow the smaller stations to participate along with the larger
stations which have more resources, as we move into a new era of
communications.
Thank you for your consideration of our testimony.
______
Prepared Statement of the NIH Task Force of the Bioengineering Division
The NIH Task Force of the Bioengineering Division of the Basic
Engineering Group of the Council on Engineering of ASME (``Task
Force''), is pleased to provide comments on the bioengineering-related
programs in the National Institutes of Health (NIH) fiscal year 2008
budget request. The ASME Bioengineering Division is focused on the
application of mechanical engineering knowledge, skills and principles
to the conception, design, development, analysis and operation of
biomechanical systems.
IMPORTANCE OF BIOENGINEERING
Bioengineering is an interdisciplinary field that applies physical,
chemical and mathematical sciences and engineering principles to the
study of biology, medicine, behavior, and health. It advances knowledge
from the molecular to the organ systems level, and develops new and
novel biologics, materials processes, implants, devices, and
informatics approaches for the prevention, diagnosis, and treatment of
disease, for patient rehabilitation, and for improving health.
Bioengineers have employed mechanical engineering principles in the
development of many life-saving and life-improving technologies, such
as the artificial heart, prosthetic joints and numerous rehabilitation
technologies.
BACKGROUND
The NIH is the world's largest and most eminent organization
dedicated to improving health through medical science. During the last
50 years, NIH has played a leading role in the major breakthroughs that
have increased average life expectancy by 15 to 20 years.
The NIH is comprised of different Institutes and Centers that
support a wide spectrum of research activities including basic
research, disease- and treatment-related studies, and epidemiological
analyses. The missions of individual Institutes and Centers focus on
either a particular organ (e.g. heart, kidney, eye), a given disease
(e.g. cancer, infectious diseases, mental illness), or a stage of life
(e.g. childhood, old age), or may encompass crosscutting needs (e.g.,
sequencing of the human genome and the National Institute of Biomedical
Imaging and Bioengineering (NIBIB)).
The total fiscal year 2008 NIH budget request is $28.85 billion,
which represents a $330 million (1.1 percent) reduction from the $29.18
billion approved in the fiscal year 2007 continuing joint resolution.
While the Task Force is grateful to Congress for the unexpected $600
million boost to NIH as it wrapped up the fiscal year 2007
appropriations, we are greatly concerned about the decrease in funding
for fiscal year 2008. Research and development is expected to account
for 97 percent of the total fiscal year 2008 NIH budget, or $28.3
billion. With this, the administration estimates that a total of 10,188
new, competing research project grants (RPGs) could be supported, which
is an increase of 566 RPGs over fiscal year 2007. While the overall
fiscal year 2008 budget decreased compared to fiscal year 2007, the
budgets allotted to some institutes and centers actually increased,
while all others decreased. The largest increase went to the National
Institute of Allergy and Infectious Disease (NIAID), which will receive
$4.59 billion, a total that includes a $200 million contribution to the
Global Fund for HIV/AIDS.
The NIH Roadmap for biomedical research will receive $486 million
in fiscal year 2008, which is an increase of $3 million from fiscal
year 2007. Each institute and center will be required to contribute 1.3
percent of its fiscal year 2008 budget to the NIH Roadmap initiative.
Since all institutes and centers were freed of their obligation to
transfer 1.2 percent of their budgets to this initiative in fiscal year
2007, an effective 2.5 percent reduction in the budget of each will
hence result.
NIBIB RESEARCH FUNDING
The administration's fiscal year 2008 budget requests $300 million
for the NIBIB, an increase of $4 million or 1.3 percent from the fiscal
year 2007 continuing joint resolution. Taking into account the 3.7
percent inflation rate (as estimated by the Bureau of Economic
Analysis) this effectively amounts to a decrease in funding by 2.4
percent. However, the number of research project applications to NIBIB
continues to grow (a 5 percent increase was noted in fiscal year 2006
over fiscal year 2005, for example). The decrease in the NIBIB budget
combined with the increase in the number of NIBIB extramural research
grant applications will result in a sharp decrease in the success rate
for bioengineering-related grants. In fact, the success rate for
applications to the NIBIB is already one of the lowest among all NIH
institutes and centers (17 percent in fiscal year 2006 versus 20
percent in fiscal year 2005).
TASK FORCE RECOMMENDATIONS
The Task Force is concerned that bioengineering-based research
continues to constitute a small portion of the total NIH budget. Yet
there is an increasing need for advanced engineering concepts to be
applied to basic and translational biomedical problems for the
potential of recent biological advances to be realized. Moreover, the
United States is rapidly falling behind our counterparts in the
European Union and Pacific Rim with regards to bioengineering advances.
Our request for increased bioengineering funding addresses these
critical issues. The Task Force wishes to emphasize that, in many
cases, bioengineering-based solutions to health care problems result in
a reduction in health care costs. Therefore, we strongly urge Congress
to provide increased funding for bioengineering within the NIBIB and
across NIH.
The NIBIB requires exceptional and urgent consideration for funding
increases in the coming years due to its fiscal year 2006 application
success rate of only 17 percent, which is sure to decrease even further
for fiscal year 2007 and fiscal year 2008 given the proposed budget
estimates. This rate is below average with respect to the NIH as a
whole and is a direct manifestation of the continued growth of the
bioengineering field outpacing funding increases to the NIBIB.
While the Task Force supports new Federal proposals that seek to
double Federal research and development in the physical sciences over
the next decade, we believe that strong Federal support for
bioengineering and the life sciences is especially essential to the
health and competitiveness of the United States. The disturbing trend
in the inflation rate outpacing the NIBIB budget increase rate will
begin to reverse the tremendous gains the United States has made in the
bioengineering field over the last decade. Four years of falling
budgets are a sharp contrast from the 15 percent annual increases
during the NIH doubling period and will have a long-lasting,
deleterious impact.
ASME International is a non-profit technical and educational
organization with 125,000 members worldwide. The Society's members work
in all sectors of the economy, including industry, academic, and
government. This statement represents the views of the ASME NIH Task
Force of the Bioengineering Division and is not necessarily a position
of ASME as a whole.
______
Prepared Statement of the National League for Nursing
The National League for Nursing is the sole organization
representing leaders in nursing education and nurse faculty across all
the types of nursing programs in the United States. With more than
1,100 nursing schools and health care agencies, some 20,000 individual
members comprising nurses, educators, administrators, public members,
and 18 constituent leagues, the National League for Nursing is the
premier organization--established 114 years ago--dedicated to
excellence in nursing education that prepares the nursing workforce to
meet the needs of our diverse populations in an ever-changing health
care environment. The NLN appreciates this opportunity to discuss the
status of nursing education and the damage that could ensue to patients
and our Nation's health care by the ill-considered cuts aimed at Title
VIII.
The NLN endorses the subcommittee's past policy strategies for
health care capacity-building through nursing education. We likewise
respect your recognition of the requisite role nurses play in the
delivery of cost-efficient health care services and the generation of
quality health outcomes.
We are disturbed, however, that the 7-year and counting nursing
shortage is outpacing the level of Federal resources and investments
that have been expended by Congress to help alleviate the nationwide
nursing scarcity. The NLN is gravely concerned that the
administration's proposed fiscal year 2008 appropriations for nursing
education are inconsistent with the health care reality facing our
Nation. The President's budget proposes a decrease of funding of $44
million (or 29 percent) for the Title VIII--Nursing Workforce
Development Programs. This budget cut will diminish training and
development, a shortsighted and hazardous course of action that
potentially further jeopardizes the delivery of health care for the
people in the United States.
As the nursing community has pointed out many times before, more
than three decades ago during another less serious nursing shortage,
Congress appropriated $153 million for nurse education programs. In
today's dollars, that amount would be worth more than $615 million--
four times the amount the Federal Government currently is spending on
Title VIII programs.
The National League for Nursing contends that the Federal strategy
should be to broaden, not curtail, Title VIII initiatives by increasing
investments to be consistent with national demand. We urge the
subcommittee to fund the Title VIII programs at a minimum level of $200
million for fiscal year 2008. The NLN also advocates that section 811
of Title VIII--Advanced Education Nursing Program--be restored and
funded at an augmented level equal to the other Title VIII programs.
NURSE SHORTAGE AFFECTED BY FACULTY SHORTAGE
The subcommittee is well aware that today's nursing shortage is
real and unique from any experienced in the past with an aging
workforce and too few people entering the profession at the rate
necessary to meet growing health care requirements. NLN research
provides evidence of a strong correlation between the shortage of nurse
faculty and the inability of nursing programs to keep pace with the
demand for new registered nurses (RNs). Without faculty to educate our
future nurses, the shortage cannot be resolved.
The NLN's Nursing Data Review 2004-2005.--Baccalaureate, Associate
Degree, and Diploma Program revealed that graduations from RN programs
contributed an estimated 84,878 additional prospective nurses to the RN
labor supply falling far short of the Nation's demands. In its biennial
10-year employment projections for 2004-2014, the U.S. Department of
Labor's Bureau of Labor Statistics (BLS) reported that over the next 10
years, about 70,000 new RN jobs and 50,000 replacement jobs will accrue
each year, for a total of 120,000 RN job openings per year. Multiply
that annual sum by 10 years, and BLS's model-based findings estimate
that 1.2 million new RN workers will be needed from 2004-2014. This
growth represents a 29 percent projected change over the next 10 years.
The NLN's 2004-2005 data review shows that nursing school
applications surged in recent years, rising more than 59 percent over
the past decade. The 2004-2005 academic year was no exception as almost
25,000 additional applications were submitted to nursing schools at all
degree levels. Nonetheless, an estimated 147,000 qualified applications
were turned away owing in large part to the lack of faculty necessary
to teach additional students. Alarmingly too, this NLN review
determined that new admissions fell by more than 27 percent in 2004-
2005 after 2 years of reported increases. The significant dip in
admissions seems to mark a turning point, reinforcing that a key
priority in tackling the nurse shortage has to be scaling up the
capacity to accept qualified applicants.
TRENDS STRESSING FACULTY SHORTAGE
It is not surprising that the problem of nurse faculty vacancies
often is described as acute and as exacerbating the national nurse-
workforce shortfall. The NLN's research, reported in its Nurse
Educators 2006: A Report of the Faculty Census Survey of RN and
Graduate Programs, indicated that the nurse faculty vacancies in the
United States continued to grow even as the numbers of full- and part-
time educators increased. The estimated number of budgeted, unfilled,
full-time positions countrywide in 2006 was 1,390. This number
represents a 7.9 percent vacancy rate in baccalaureate and higher
degree programs, which is an increase of 32 percent since 2002; and a
5.6 percent vacancy rate in associate degree programs, which translates
to a 10 percent rise in the same period.
The data in the 2006 faculty census survey describe several trends,
of which the following three are critical:
AGING OF THE FACULTY POPULATION
Nursing programs responding to the survey indicated that almost
two-thirds of all full-time nurse faculty members were 45- to 60-years
old and likely to retire in the next 5 to 15 years. A mean of 1.4 full-
time faculty members per program left their positions in 2006, with 24
percent of these departures due to retirement. It is an open question
where schools of nursing will find replacements for these experienced
individuals.
DECREASE IN DOCTORALLY PREPARED FACULTY
Data show that nurse faculty are less well-credentialed in 2006
than they were 4 years earlier when the last NLN faculty census was
conducted. A little over 43 percent of full-time baccalaureate and
higher degree program faculty hold earned doctorates; whereas only 6.6
percent of associate degree program full-time faculty and 0.7 percent
of diploma program full-time faculty are doctorally prepared. The
overwhelming majority of the full-time faculty in associate degree (83
percent) and diploma (92.6 percent) programs hold the master's degree
as their highest earned credential. The master's degree was the most
common credential among part-time faculty members.
INCREASE IN PART-TIME FACULTY
Nearly 45 percent of the estimated mean number of faculty full-time
equivalents are part-time faculty. Nationwide, the mean number of
faculty members per institution had grown to 14.9 full-time and 12.1
part-time faculty in 2006, compared to 12.3 full-time and 7.4 part-time
in 2002. The estimated number of part-time baccalaureate faculty has
grown 72.5 percent since 2002. Over 58 percent of baccalaureate and
higher degree programs and almost half of associate degree programs
(47.5 percent) reported hiring part-time faculty as their primary
strategy to compensate for unfilled, budgeted, full-time positions.
While the use of part-time faculty allows for greater flexibility,
often they are not an integral part of the design, implementation, and
evaluation of the overall nursing program.
THE FEDERAL FUNDING REALITY
Today's undersized supply of appropriately prepared nurses and
nursing faculty does not bode well for our Nation, where the shortages
are deepening health disparities, inflated costs, and poor quality of
health care outcomes. Congress moved in the right policy direction in
passing the Nurse Reinvestment Act in 2002. That act made Title VIII
programs a comprehensive system of capacity-building strategies to
develop nurses by providing schools of nursing with grants to
strengthen programs, through such activities as faculty recruitment and
retention efforts, facility and equipment acquisition, clinical lab
enhancements, and loans, scholarships and services that enable students
to overcome obstacles to completing their nursing education programs.
Yet, as the HRSA Title VIII data show, it is abundantly clear that
Congress must step up in providing critical attention and significantly
more funding to this ongoing systemic problem.
Nursing Education Loan Repayment Program.--In fiscal year 2005,
with 4,465 applicants to the Title VIII Nursing Education Loan
Repayment Program, 803 awards were made (599 initial 2-year awards and
204 amendment awards), or 18 percent of applicants received awards. In
fiscal year 2006, there were 4,222 applicants to the program; 615
awards were made (373 initial 2-year awards and 242 amendment awards)
with 14.6 percent of applicants receiving awards.
Nursing Scholarship Program.--In fiscal year 2005, 3,482
applications were submitted to the Nursing Scholarship Program, and 212
awards, or 6.1 percent of the applicants received scholarships. In
fiscal year 2006, there were 3,320 applicants to the same program and
218, or 6.6 percent, awards were.
Advanced Education Nursing (AEN) Program.--This program supports
the graduate education that is the foundation to professional
development of advanced practice nurses, whether with clinical
specialties or with a specialty in teaching. In fiscal year 2005, AEN
supported 11,949 graduate nursing students across the specialties. The
President's proposed fiscal year 2008 budget eliminates this program,
which is fundamental to appropriately preparing future nursing faculty,
the engine of the workforce pipeline. AEN must be restored and fully
funded in order to prevent the Nation from losing ground in the effort
to remedy the nurse and nurse faculty shortages.
NATIONAL INSTITUTE OF NURSING RESEARCH (NINR)
We would be remiss in not acknowledging that nursing research is an
integral part of the effectiveness of nursing care. NINR provides the
knowledge base for improving the quality of patient care and reducing
health care costs and demands. Critical to enhancing research within
the nursing profession is the infrastructure development that increases
the pool of nurse investigators and nurse educators, expands programs
to develop partnerships between research-intensive environments and
smaller colleges and universities, and promotes career development for
minority researchers. Yet, as noted by the expanding list of non-
nursing journals that publish the investigator findings of NINR-
sponsored research, an investment in NINR goes far beyond just the
nursing community and produces research results for all health care
providers.
The relatively small investment made by the Federal Government in
NINR is well justified for the outcomes received. For example, NINR has
supported research that:
--Led to nursing intervention enabling excellent metabolic control in
diabetic adolescents;
--Devised ways to sustain reduced high blood pressure in young
African-American men;
--Reduced the burdens of caregivers of persons with dementia or other
chronic care needs; and
--Developed a successful, national model for Spanish speakers in a
community-based Arthritis Self-Management Program.
As the only organization that collects data across all levels of
the nursing education pipeline, the NLN can state with authority that
the nursing shortage in this country will not be reversed until the
concurrent shortage of qualified nurse educators is addressed. Without
adequate faculty, there are simply too few spots in nursing education
programs to train all the qualified applicants out there. This
challenge requires millions of dollars of increased funding for the
professional development of nurses. The NLN urges Congress to
strengthen existing Title VIII nurse education programs by funding them
at a minimum level of $200 million for fiscal year 2008.
Your support will help ensure that nurses exist in the future who
are prepared and qualified to take care of you, your family, and all
those in this country who will need our care.
______
Prepared Statement of the National Marfan Foundation
Chairman Harkin, ranking member Specter, and members of the
subcommittee, the National Marfan Foundation thanks you for the
opportunity to submit testimony regarding the fiscal year 2008 budget
for the National Heart, Lung and Blood Institute, the National
Institute of Arthritis, Musculoskeletal and Skin Diseases, and the
Centers for Disease Control and Prevention. We are extremely grateful
for the subcommittee's strong support of the NIH and CDC, particularly
as it relates to life threatening genetic disorders such as Marfan
syndrome. Thanks to your leadership, we are at a time of unprecedented
hope for Marfan syndrome patients and their families.
It is estimated that 200,000 people in the United States are
affected by the Marfan syndrome or a related disorder. Marfan syndrome
is a genetic disorder of the connective tissue that manifests itself in
many areas of body, including the heart, eyes, skeleton, lungs and
blood vessels. It is a progressive condition that can cause
deterioration in each of these body systems. The most serious and life-
threatening aspect of the syndrome however, is a weakening of the
aorta. The aorta is the largest artery that takes oxygenated blood to
the body from the heart. Over time, many Marfan syndrome patients
experience a dramatic weakening of the aorta which can cause the vessel
to dissect and tear.
Fortunately, early surgical intervention can prevent a dissection
and strengthen the aorta and the aortic valves. If preventive surgery
is performed before a dissection occurs, the success rate of the
procedure is over 95 percent. Unfortunately, if surgery is initiated
after a dissection has occurred, the success rate drops below 50
percent. Aortic dissection is a leading killer in the United States,
and 20 percent of the people it affects have a genetic predisposition,
like Marfan syndrome, to developing the complication.
Fortunately, new research offers hope that a commonly prescribed
blood pressure medication, losartan, might be effective in preventing
this frequent and devastating event.
NATIONAL HEART LUNG AND BLOOD INSTITUTE
As NHLBI Director Dr. Elizabeth Nabel told the subcommittee during
her appearance at the April 20th hearing on the ``Burden of Chronic
Disease'' there is landmark clinical trial underway sponsored by
NHLBI's Pediatric Heart Network to determine the effects of losartan on
aortic growth:
``After the discovery that Marfan syndrome is associated with the
mutation in the gene encoding a protein called fibrillin-1, researchers
tried for many years, without success, to develop treatment strategies
that involved repair of replacement of fibrillin-1. Recently, a major
breakthrough occurred with the discovery that one of the functions of
fibrillin-1 is to bind to another protein, TGF-beta, and regulate its
effects. After careful analysis revealed aberrant TGF-beta activity in
patients with Marfan syndrome, researchers began to concentrate on
treating Marfan syndrome by normalizing the activity of TGF-beta.
Losartan, which is known to affect TGF-beta activity, was tested in a
mouse model of Marfan syndrome. The results, published only last April,
showed that drug was remarkably effective in blocking the development
of aortic aneurysms, as well as lung defects associated with the
syndrome.
Based on this promising finding, the NHLBI Pediatric Heart Network,
is now undertaking a clinical trial of losartan in patients with Marfan
syndrome. About 600 patients aged 6 months to 25 years will be enrolled
and followed for 3 years. This development illustrates the outstanding
value of basic science discoveries, and identifying new directions for
clinical applications. Moreover, the ability to organize and initiate a
clinical trial within months of such a discovery is testimony to
effectiveness of the NHLBI Network in providing the infrastructure and
expertise to capitalize on new findings as they emerge.''
Dr. Hal Dietz, the Victor A. McKusick professor of genetics in the
McKusick-Nathans Institute of Genetic Medicine at the Johns Hopkins
University School of Medicine, and the director of the William S.
Smilow Center for Marfan Syndrome Research, is the driving force behind
this groundbreaking research. Dr. Dietz uncovered the role that
fibrillin-1 and TGF-beta play in aortic enlargement, and demonstrated
the benefits of losartan in halting aortic growth in mice. He is the
reason we have reached this time of such promise, and we are proud to
have supported his cutting-edge research for many years.
We are also extremely grateful to Dr. Nabel and her colleagues at
NHLBI for their leadership in advancing the losartan clinical trial.
The Pediatric Heart Network, lead by Dr. Lynn Mahony and Dr. Gail
Pearson, has demonstrated tremendous skill and dedication in
facilitating this complex trial in a very short time-frame. We deeply
value their hard work and commitment. NMF is a proud partner with NHLBI
in supporting this promising research. The Foundation is actively
supporting patient travel costs, and funding ancillary studies to the
trial focused on additional manifestations of the Marfan syndrome that
might be impacted losartan.
Finally, we are excited that NHLBI has formed a ``Working Group on
Research in Marfan Syndrome and Related Conditions'' jointly sponsored
by the NMF. The panel is chaired by Dr. Dietz and comprised of experts
in all aspects of basic and clinical science related to the syndrome.
The mission of the Working Group is to identify current research
opportunities and challenges with a 5-10 year horizon, and to make
recommendations for areas that require leadership by the NHLBI in order
to move forward. We look forward to partnering with NHLBI to advance
the goals outlined by the Working Group.
In order to support the important mission of the NHLBI, and its
activities related to Marfan syndrome, NMF joins with the Ad Hoc Group
for Medical Research, the Campaign for Medical Research, the Federation
of American Societies for Experimental Biology, the National Health
Council, and Research!America in recommending a 6.7 percent for NIH
overall and NHLBI specifically in fiscal year 2008.
national institute of arthritis and musckuloskeletal and skin diseases
NMF is proud of its longstanding partnership with the National
Institute of Arthritis and Musculoskeletal and Skin Diseases. Dr.
Steven Katz has been a strong proponent of basic research on Marfan
syndrome during his tenure as NIAMS director and has generously
supported several ``Conferences on Heritable Disorders of Connective
Tissue.'' Moreover, the Institute has provided invaluable support for
Dr. Dietz's mouse model studies. The discoveries of fibrillin-1, TGF-
beta, and their role in muscle regeneration and connective tissue
function were made possible in part through collaboration with NIAMS.
As the losartan clinical trail moves forward, we hope to expand our
partnership with NIAMS to support ancillary studies that fall under the
mission and jurisdiction of the Institute. One of the areas of great
interest to researchers and patients, is the role that losartan may
play in strengthening muscle tissue in Marfan patients. In response to
our request for proposals for ancillary studies grants, NMF received
applications focused on this area that scored extremely well under the
peer review of our Scientific Advisory Board. We appreciate the
subcommittee's ongoing support of NIAMS and our collaboration with the
Institute on these emerging research opportunities.
To support the mission of the Institute in fiscal year 2008, NMF
recommends a 6.7 percent increase for NIAMS.
CENTERS FOR DISEASE CONTROL AND PREVENTION
We are grateful for the subcommittee's encouragement last year of
collaborations between the CDC and the Marfan syndrome community. One
of the most important things we can do to prevent untimely deaths from
aortic aneurysms is to increase awareness of Marfan syndrome and
related connective tissue disorders. Education and prevention are two
of the cornerstone missions of the Foundation. However, despite our
efforts to raise awareness among the general public and the health care
community, we know of too many families who have lost a loved one
because they did not know that they were affected.
Recently, the NMF leadership traveled to Atlanta to visit with the
Centers for Disease Control and Prevention to explore potential
partnerships in the area of awareness and prevention of aortic
dissections. We look forward to working with the National Center on
Birth Defects and Developmental Disabilities (NCBDD) to prevent
needless loss of life from the cardiovascular complications associated
with Marfan syndrome. We applaud the leadership of the NCBDD's Division
of Human Development and Disability for their interest in this area and
appreciate the subcommittee's support of this partnership. We have
discussed a number of potential collaborations with the CDC focused on
the need for early diagnosis and treatment of Marfan syndrome, in order
to enhance the quality and length of life for patients.
In order to support the important work of the CDC, NMF joins with
the ``CDC Coalition'' in recommending an appropriation of $10.7 billion
for the agency in fiscal year 2008. We would also encourage a
corresponding percentage increase for the NCBDD and its Division of
Human Development and Disability.
ABOUT THE NATIONAL MARFAN FOUNDATION
The NMF is a non-profit voluntary health organization founded in
1981. NMF is dedicated to saving lives and improving the quality of
life for individuals and families affected by the Marfan syndrome and
related disorders. The Foundation has three major goals: (i) to provide
accurate and timely information about the Marfan syndrome to affected
individuals, family members, physicians and other health professionals;
(ii) to provide a means for those with Marfan syndrome and their
relatives to share in experiences, to support one another and to
improve their medical care and (iii) to support and foster research.
______
Prepared Statement of the ARCH National Respite Coalition
Mr. Chairman, I am Jill Kagan, Chair of the ARCH National Respite
Coalition, a network of respite providers, family caregivers, State and
local agencies and organizations across the United States who support
respite. This statement is presented on behalf of the undersigned
organizations, many of which are members of the Lifespan Respite Task
Force, a coalition of over 80 national and more than 100 State and
local groups who supported the passage of the Lifespan Respite Care Act
(Public Law 109-442). Together, we are requesting that the subcommittee
include funding for the newly enacted Lifespan Respite Care Act in the
fiscal year 2008 Labor, HHS and Education Appropriations bill at its
modestly authorized level of $40,000,000. We join the 17 Members of the
Senate who, along with Senator Hillary Rodham Clinton (D-NY) and
Senator John Warner (R-VA), are sending a letter to the subcommittee
making this same request.
WHO NEEDS RESPITE?
A national survey found that 44 million family caregivers are
providing care to individuals over age 18 with disabilities or chronic
conditions (National Alliance for Caregiving [NAC] and AARP, 2004). In
2001, the last year Federal data were collected, 9,400,000 children
under age 18 were identified with chronic or disabling conditions
(National Survey of Children with Special Health Care Needs, U.S.
Health Resources and Services Administration, 2001). These surveys
suggest that a conservative estimate of the Nation's family caregivers
probably exceeds 50 million.
Compound this picture with the growing number of caregivers known
as the ``sandwich generation'' caring for young children as well as an
aging family member. It is estimated that between 20 and 40 percent of
caregivers have children under the age of 18 to care for in addition to
a parent or other relative with a disability. And in the United States,
6,700,000 children, with and without disabilities, are in the primary
custody of an aging grandparent or other relative other than their
parents.
These family caregivers are providing about 80 percent of all long-
term care in the United States. It has been estimated that in the
United States these family caregivers provide $306,000,000,000 in
uncompensated care, an amount comparable to Medicare spending in 2004
and more than twice what is spent nationwide on nursing homes and paid
home care combined (Presentation by P.S Arno, PhD, Albert Einstein
College of Medicine, January 2006).
WHAT IS RESPITE NEED?
State and local surveys have shown respite to be the most
frequently requested service of the Nation's family caregivers,
including the most recent study, ``Evercare Study of Caregivers in
Decline'' (Evercare and NAC, 2006). Yet respite is unused, in short
supply, inaccessible, or unaffordable to a majority of the Nation's
family caregivers. The 2004 survey of caregivers found that despite the
fact that the most frequently reported unmet needs were ``finding time
for myself,'' (35 percent), ``managing emotional and physical stress''
(29 percent), and ``balancing work and family responsibilities'' (29
percent), only 5 percent of family caregivers were receiving respite
(NAC and AARP, 2004).
Barriers to accessing respite include reluctance to ask for help,
fragmented and narrowly targeted services, cost, and the lack of
information about how to find or choose a provider. Even when respite
is an allowable funded service, a critically short supply of well
trained respite providers may prohibit a family from making use of a
service they so desperately need.
Twenty of 35 state-sponsored respite programs surveyed in 1991
reported that they were unable to meet the demand for respite services.
In the last 15 years, we suspect that not too much has changed. A
recent study conducted by the Family Caregiver Alliance identified 150
family caregiver support programs in all 50 States and Washington, DC
funded with State-only or State/Federal dollars. Most of the funding
comes through the Federal National Family Caregiver Support Program. As
a result, programs are administered by local area agencies on aging and
primarily serve the elderly. And again, some programs provide only
limited respite, if at all. Only about one-third of these 150
identified programs serve caregivers who provide care to adults age 18-
60 who must meet stringent eligibility criteria. As the report
concluded, ``State program administrators see the lack of resources to
meet caregiver needs in general and limited respite care options as the
top unmet needs of family caregivers in the States.''
The 25 State respite coalitions and other National Respite Network
members confirm that long waiting lists or turning away of clients
because of lack of resources is still the norm.
While most families take great joy in helping their family members
to live at home, it has been well documented that family caregivers
experience physical and emotional problems directly related to their
caregiving responsibilities. Three-fifths of family caregivers age 19-
64 surveyed recently by the Commonwealth Fund reported fair or poor
health, one or more chronic conditions, or a disability, compared with
only one-third of non-caregivers (Ho, Collins, Davis and Doty, 2005). A
study of elderly spousal caregivers (aged 66-96) found that caregivers
who experience caregiving-related stress have a 63 percent higher
mortality rate than noncaregivers of the same age (Schulz and Beach,
December 1999).
Supports that would ease their burden, most importantly respite
care, are too often out of reach or completely unavailable. Even the
simple things we take for granted, like getting enough rest or going
shopping, become rare and precious events. One Massachusetts mother of
a seriously ill child spoke to the demands of constant caregiving: ``I
recall begging for some type of in-home support. It was during this
period when I fell asleep twice while driving on the Massachusetts
Turnpike on the way to appointments at Children's Hospital. The lack of
respite put our lives and the lives of everyone driving near me at
risk.''
Restrictive eligibility criteria also preclude many families from
receiving services or continuing to receive services they once were
eligible for. A mother of a 12-year-old with autism was denied
additional respite by her State DD (Developmental Disability) agency
because she was not a single mother, was not at poverty level, wasn't
exhibiting any emotional or physical conditions herself, and had only
one child with a disability. As she told us, ``Do I have to endure a
failed marriage or serious health consequences for myself or my family
before I can qualify for respite? Respite is supposed to be a
preventive service.''
For the millions of families of children with disabilities, respite
has been an actual lifesaver. However, for many of these families,
their children will age out of the system when they turn 21 and they
will lose many of the services, such as respite, that they currently
receive. In fact, 46 percent of U.S. State units on aging identified
respite as the greatest unmet need of older families caring for adults
with lifelong disabilities. An Alabama mom of a 19-year-old-daughter
with multiple disabilities who requires constant care recently told us
about her fears at a respite summit in Alabama. ``My daughter Casey has
cerebral palsy, she does not communicate, she is incontinent she eats a
pureed diet, she utilizes a wheelchair, she is unable to bathe or dress
herself. At 5 feet 5 inches and 87 pounds I carry her from her bedroom
to the bathroom to bathe her, and back again to dress her. Without
respite services, I do not think I could continue to provide the
necessary long-term care that is required for my daughter. As I age, I
do wonder how much longer I will be able to maintain my daily ritual as
my daughter's primary caregiver.''
Disparate and inadequate funding streams exist for respite in many
States. But even under the Medicaid program, respite is allowable only
through State waivers for home and community-based care. Under these
waivers, respite services are capped and limited to narrow eligibility
categories. Long waiting lists are the norm.
Respite may not exist at all in some States for adult children with
disabilities still living at home, or individuals under age 60 with
conditions such as ALS, MS, spinal cord or traumatic brain injuries, or
children with serious emotional conditions. In Tennessee, a young woman
in her twenties gave up school, career and a relationship to move in
and take care of her 53 year-old mom with MS when her dad left because
of the strain of caregiving. She went for years providing constant care
to her mom with almost no support. Now 31, she wrote, ``And I was
young--I still am--and I have the energy, but--it starts to weigh.
Because we've been able to have respite care, we've developed a small
pool of people and friends that will also come and stand in. And it has
made all the difference.''
RESPITE BENEFITS FAMILIES AND IS COST SAVING
Respite has been shown to improve the health and well-being of
family caregivers that in turn helps avoid or delay out-of-home
placements, such as nursing homes or foster care, minimizes the
precursors that can lead to abuse and neglect, and strengthens
marriages and family stability.
The budgetary benefits that accrue because of respite are just as
compelling, especially in the policy arena. Delaying a nursing home
placement for just one individual with Alzheimer's or other chronic
condition for several months can save government long-term care
programs thousands of dollars. Moreover, data from an ongoing research
project of the Oklahoma State University on the effects of respite care
found that the number of hospitalizations, as well as the number of
medical care claims decreased as the number of respite care days
increased (fiscal year 1998 Oklahoma Maternal and Child Health Block
Grant Annual Report, July 1999). A Massachusetts social services
program designed to provide cost-effective family-centered respite care
for children with complex medical needs found that for families
participating for more than 1 year, the number of hospitalizations
decreased by 75 percent, physician visits decreased by 64 percent, and
antibiotics use decreased by 71 percent (Mausner, S., 1995).
In the private sector, a study by Metropolitan Life Insurance
Company and the National Alliance for Caregivers found that U.S.
businesses lose from $17,100,000,000 to $33,600,000,000 per year in
lost productivity of family caregivers (MetLife and National Alliance
for Caregiving, 2006). In an Iowa survey of parents of children with
disabilities, a significant relationship was demonstrated between the
severity of a child's disability and their parents missing more work
hours than other employees. They also found that the lack of available
respite care appeared to interfere with parents accepting job
opportunities. (Abelson, A.G., 1999) Offering respite to working family
caregivers could help improve job performance and employers could
potentially save billions.
LIFESPAN RESPITE CARE PROGRAM WILL HELP
The Lifespan Respite Care Act is based on the success of statewide
Lifespan Respite programs in four States: Oregon, Nebraska, Wisconsin
and Oklahoma. Michigan passed State Lifespan Respite legislation in
2004 but has not provided the funding to implement the program, and a
State Lifespan Respite bill is currently pending in the Arizona State
legislature.
Lifespan Respite, which is a coordinated system of community-based
respite services, helps States use limited resources across age and
disability groups more effectively, instead of each separate State
agency or community-based organization being forced to constantly
reinvent the wheel or beg for small pots of money. Pools of providers
can be recruited, trained and shared, administrative burdens can be
reduced by coordinating resources, and the savings used to fund new
respite services for families who may not currently qualify for any
existing Federal or State program.
The State Lifespan Respite programs provide best practices on which
to build a national respite policy. The programs have been recognized
by prominent policy organizations, including the National Conference of
State Legislatures, which recommended the Nebraska program as a model
for State solutions to community-based long-term care. The National
Governors Association and the President's Committee for People with
Intellectual Disabilities also have highlighted lifespan respite
systems as viable solutions. And most recently, the White House
Conference on Aging recommended enactment of the Lifespan Respite Care
Act to Congress.
The purpose of the new law is to expand and enhance respite
services, improve coordination, and improve respite access and quality.
Under a competitive grant program, States would be required to
establish State and local coordinated Lifespan Respite care systems to
serve families regardless of age or special need, provide new planned
and emergency respite services, train and recruit respite workers and
volunteers and assist caregivers in gaining access to services. Those
eligible would include family members, foster parents or other adults
providing unpaid care to adults who require care to meet basic needs or
prevent injury and to children who require care beyond that required by
children generally to meet basic needs.
The Federal Lifespan Respite program would be administered by the
U.S. Department of Health and Human Services [HHS], which would provide
competitive grants to statewide agencies through Aging and Disability
Resource Centers working in collaboration with State respite coalitions
or other State respite organizations. The program is authorized at
$40,000,000 in fiscal year 2008 rising to $95,000,000 in fiscal year
2011.
No other Federal program mandates respite as its sole focus. No
other Federal program would help ensure respite quality or choice, and
no current Federal program allows funds for respite start-up, training
or coordination or to address basic accessibility and affordability
issues for families. We urge you to include $40,000,000 in the fiscal
year 2008 Labor, HHS, Education appropriations bill so that Lifespan
Respite Programs can be replicated in the States and more families,
with access to respite, will be able to continue to play the
significant role in long-term care that they are fulfilling today.
NATIONAL ORGANIZATIONS
American Association of People with Disabilities; American
Association on Intellectual and Developmental Disabilities; American
Dance Therapy Association;American Network of Community Options and
Resources; American Psychological Association; Association of
University Centers on Disabilities; Autism Society of America; Bazelon
Center for Mental Health Law; Christopher and Dana Reeve Foundation;
Chronic Illness Coalition; Easter Seals; Epilepsy Foundation; Family
Voices; Generations United; National Association of Councils on
Developmental Disabilities; National Association for Home Care and
Hospice; National Association of Social Workers; National Association
of State Head Injury Administrators; National Council on Aging;
National Down Syndrome Congress; National Down Syndrome Society;
National Family Caregivers Association; National Gerontological Nursing
Association; National Multiple Sclerosis Society; National Organization
For Empowering Caregivers; National Rehabilitation Association;
National Respite Coalition; National Spinal Cord Injury Association;
Older Women's League; Paralyzed Veterans of America; The ALS
Association; The Arc of the United States; United Cerebral Palsy; Well
Spouse Association; Wilson's Disease Association.
STATE AND LOCAL ORGANIZATIONS
Alabama Lifespan Respite Resource Network; Allegheny County Respite
Care Coalition, Pittsburgh, PA; Arizona Lifespan Respite Coalition (in
formation); Catholic Family and Child Services, Yakima, WA; East
Central Alabama United Cerebral Palsy; Easter Seals of Southern
Georgia; Families Together, Inc., Wichita, Kansas; Family Voices
Vermont; Illinois Respite Coalition; Iowa Respite and Crisis Care
Coalition; Kansas Respite Coalition; Louisiana Developmental
Disabilities Council; Maryland Respite Care Coalition; Michigan Respite
Resource Network; Nebraska Respite Coalition; New Jersey Family Support
Center; New Jersey Lifespan Respite Task Force; North Carolina Respite
and Crisis Care Coalition; Oklahoma Respite Resource Network; Parent to
Parent of Vermont; Partnership for People with Disabilities, Virginia
Commonwealth University; Pennsylvania Respite Coalition; Respite and
Crisis Care Coalition of Washington; Respite Care Association of
Wisconsin; South Carolina Respite Coalition; Tennessee Respite
Coalition; Tennessee Voices for Children; The Arc of King County, WA;
United Cerebral Palsy of Huntsville and Tennessee Valley, Huntsville,
AL; United Cerebral Palsy of Pennsylvanial; and Virginia Respite
Resource Project.
______
Prepared Statement of the National Sleep Foundation
SUMMARY OF FISCAL YEAR 2008 RECOMMENDATIONS
Provide a $10,000,000 increase in funding in fiscal year 2008 to
the Centers for Disease Control and Prevention (CDC) to undertake data
collection activities and create awareness and training programs
related to sleep, sleep disorders and the consequences of sleep
deprivation to improve public health and safety.
Encourage CDC to continue to take a leadership role in partnering
with other Federal agencies and voluntary health organizations in the
National Sleep Awareness Roundtable to create collaborative sleep
education and public awareness initiatives. In view of CDC's success
with similar initiatives, encourage the CDC to financially support the
Roundtable and its initiatives.
Provide direction and funding of $1,000,000 to United States
Surgeon General to develop and implement steps leading to the
development of a report on sleep and sleep disorders in order to call
attention to the public health impact of inadequate and disorder sleep
in order to protect and advance the health and safety of the Nation.
Mr. Chairman and members of the subcommittee, thank you for
allowing me to submit testimony on behalf of the National Sleep
Foundation (NSF). I am Dr. Barbara Phillips, Chair of the NSF Board of
Directors and professor at the University of Kentucky College of
Health, Department of Preventive Medicine. NSF is an independent, non-
profit organization that is dedicated to improving public health and
safety by achieving understanding of sleep and sleep disorders, and by
supporting sleep-related education, research, and advocacy. We work
with sleep specialists and other health care professionals,
researchers, patients and drowsy driving victims throughout the country
as well as collaborate with many government, voluntary organizations
and corporations to prevent health and safety problems related to sleep
deprivation and untreated sleep disorders.
Sleep problems, whether in the form of medical disorders or related
to work schedules and a 24/7 lifestyle, are ubiquitous in our society.
It is estimated that sleep-related problems affect 50 to 70 million
Americans of all ages and socioeconomic classes. Sleep disorders are
common in both men and women; however, important disparities in
prevalence and severity of certain sleep disorders have been identified
in minorities and underserved populations. Despite the high prevalence
of sleep disorders, the overwhelming majority of sufferers remain
undiagnosed and untreated, creating unnecessary public health and
safety problems, as well as increased health care expenses. Surveys
conducted by the National Sleep Foundation show that more than 60
percent of adults have never been asked about the quality of their
sleep by a physician, and fewer than 20 percent have ever initiated
such a discussion.
Additionally, Americans are chronically sleep deprived as a result
of demanding lifestyles and a lack of education about the impact of
sleep loss. Sleepiness affects vigilance, reaction times, learning
abilities, alertness, mood, hand-eye coordination, and the accuracy of
short-term memory. Sleepiness, as a result of untreated disorders or
sleep deprivation, has been identified as the cause of a growing number
of on-the-job accidents and automobile crashes.
According to the National Highway Traffic Safety Administration's
2002 National Survey of Distracted and Drowsy Driving Attitudes and
Behaviors, an estimated 1.35 million drivers have been involved in a
drowsy driving crash in the past 5 years. According to NSF's 2006 Sleep
in America poll, 51 percent of all adolescents who drive report that
they have driven drowsy at least once in the past year. In fact, 15
percent of drivers in 10th to 12th grades say they drive drowsy once a
week or more! A large number of academic studies have linked work
accidents, absenteeism, and poor school performance to sleep
deprivation and circadian effects.
The recent Institute of Medicine (IOM) report, Sleep Disorders and
Sleep Deprivation: An Unmet Public Health Problem, found the cumulative
effects of sleep loss and sleep disorders represent an under-recognized
public health problem and have been associated with a wide range of
negative health consequences, including hypertension, diabetes,
depression, heart attack, stroke, and at-risk behaviors--all of which
represent long-term targets of the Department of Health and Human
Services (HHS). Moreover, the personal and national economic impact is
staggering. The IOM estimates that the direct and indirect costs
associated with sleep disorders and sleep deprivation total hundreds of
billions of dollars annually.
Sleep science and government reports have clearly demonstrated the
importance of sleep to health, safety, productivity and well-being, yet
studies continue to show that millions of Americans are at risk for
serious health and safety consequences of untreated sleep disorders and
inadequate sleep. Unfortunately, despite recommendations in numerous
Federal reports, there are no on-going national educational programs
regarding sleep and fatigue issues aimed at the general public, health
care professional, underserved communities or at-risk groups.
NSF believes that every American needs to understand that good
health includes healthy sleep, just as it includes regular exercise and
balanced nutrition. We must elevate sleep to the top of the national
health agenda. We need your help to make this happen.
Our biggest challenge is bridging the gap between the outstanding
scientific advances we have seen in recent years and the level of
knowledge about sleep held by health care practitioners, educators,
employers, and the general public. Because resources are limited and
the challenges great, we think creative and new partnerships are needed
to fully develop sleep awareness, education, and training initiatives.
Consequently, the NSF is spearheading two important initiatives to
raise public and physician awareness of the importance of sleep to the
health, safety and well-being of the Nation.
First, for the last 3 years, Congress has recommended that the CDC
support activities related to sleep and sleep disorders. As a result,
CDC's National Center for Chronic Disease Prevention and Health
Promotion has been collaborating with more than twenty voluntary
organizations and Federal agencies to form the National Sleep Awareness
Roundtable (NSART), which was officially launched in March of this
year. NSART is currently working through four task forces--public
awareness, research, patient access to care, and public policy--to
develop a National Action Plan. This document will address what is
required to organize a successful collaboration to implement effective
public and professional awareness and education initiatives to improve
sleep literacy and healthy sleep behaviors. NSART is seeking to expand
its membership by reaching out to new organizations and State and
Federal agencies that are interested in raising awareness of sleep
issues and implementing NSART's National Action Plan.
The CDC has taken initial steps to begin to consider how sleep
affects public health issues, but it needs appropriate resources to
take additional actions, as recommended by the IOM and other
governmental reports. Currently, the CDC budget does not include a line
item for sleep-related activities.
With adequate resources, the CDC could:
--Add sleep-related items to established surveillance systems to
build the evidence base for the prevalence of sleep disorders
and their co-morbidities in order to increase awareness of
these issues on the national, State, and local levels.
--Support the development of targeted approaches for delivering
messages to promote sleep, along with exercise and nutrition,
as a healthy behavior, and for increasing public and
professional education and awareness regarding the public
health impact of untreated sleep disorders and chronic sleep
loss.
--Develop training materials for health care professionals regarding
the signs and symptoms of sleep disorders, as well as
countermeasures for drowsy driving and workplace accidents
related to sleep loss, shift work, and long work hours.
--Increase and enhance fellowship opportunities to attract promising
researchers at universities and colleges across the country to
conduct epidemiological activities and health cost assessments
regarding sleep.
NSF and members of the National Sleep Awareness Roundtable believe
that a partnership with CDC is critical to address the public health
impact of sleep and sleep disorders. We hope that the committee will
provide funding of $10,000,000 to the CDC to begin programs as outlined
here and to support efforts developed by NSART through a cooperative
agreement similar to other roundtables in which CDC participates.
Second, at the National Institutes of Health's Frontiers of
Knowledge in Sleep and Sleep Disorders conference in 2004, the U.S.
Surgeon General acknowledged widespread illiteracy in our country
regarding sleep loss and untreated sleep disorders. He emphasized that
sleep problems are easily related to the three top areas of the
national health agenda: prevention, preparedness, and health
disparities. Prevention of some of our Nation's most pressing health
problems would be fostered by attending to sleep disorders. Sleep
deprivation and fatigue are major barriers to maximizing preparedness
and response in times of crisis. Finally, like many health and safety
concerns, access to knowledge and medical care for sleep problems is
beyond the reach of many Americans.
For the last 2 years, Congress has directed the Office of the
Surgeon General to help promote sleep as a public health concern
through the development of a Surgeon General's Report on Sleep and
Sleep Disorders, in order to call attention to the importance of sleep
and develop strategies to protect and advance the health and safety of
the Nation. The Surgeon General has expressed interest in addressing
this issue through the development of a conference or workshop on how
sleep impacts public health, but currently lacks the funding to
proceed.
Therefore, NSF respectfully requests that the committee provide
direction and $1,000,000 in funding to the Office of the Surgeon
General to develop a workshop and a call to action related to sleep and
public health, in preparation for a Report on Sleep and Sleep
Disorders.
The IOM report includes important recommendations that support the
sprit of these efforts and other specific actions to be taken by the
CDC and the Office of the Surgeon General to raise awareness of sleep
health and sleep disorders and to collect surveillance data to evaluate
future education and intervention initiatives. CDC and the Surgeon
General must receive direction and appropriate funding in order to
continue partnering with voluntary health organizations and State and
Federal agencies to increase support for initiatives that help ensure
the health and safety of all Americans.
Thank you again for the opportunity to present you with this
testimony.
______
Prepared Statement of the National Technical Institute for the Deaf
Mr. Chairman and members of the committee: I am pleased to present
the fiscal year 2008 budget request for the National Technical
Institute for the Deaf, one of eight colleges of the RIT, in Rochester,
NY. We serve the university needs of approximately 1,100 deaf/hard-of-
hearing students from across the nation and 150 hearing students, on a
campus of over 14,000 students. Created by Congress, we provide
postsecondary technical education to prepare deaf/hard-of-hearing
students for successful employment.
NTID has fulfilled this mandate with distinction for 39 years.
BUDGET REQUEST
NTID's fiscal year 2008 request is $60,757,000. This consists of
$59,052,000 for continuing operations and $1,705,000 for construction
projects initiating replacement of aging mechanical systems. The NTID
request and the President's are shown below.
----------------------------------------------------------------------------------------------------------------
Operations Construction Total
----------------------------------------------------------------------------------------------------------------
NTID request........................................... $59,052,000 $1,705,000 $60,757,000
President's Request.................................... 55,349,000 913,000 56,262,000
--------------------------------------------------------
Difference....................................... 3,703,000 792,000 4,495,000
----------------------------------------------------------------------------------------------------------------
We are respectfully requesting that the committee restore the
appropriation to the NTID requested level. Our operations request does
not include additional funding for new academic programs or headcount.
Instead, we are committed to fund all program improvements and
increases in headcount, if any, through the reallocation of existing
resources.
We commit because we have consistently minimized requests. From
fiscal year 2003 to fiscal year 2007 we saved of $6.2 million by
increasing revenues and reducing/reallocating headcounts. These
difficult savings controlled budget requests while allowing expansion
in areas such as speech-to-test services for deaf/hard-of-hearing
students who do not know sign language.
We are proud of those accomplishments; however, those actions leave
limited flexibility regarding what we respectfully submit is inadequate
funding proposed in the President's budget. Significant reductions
threaten our vitality, and leave us with options such as the following:
1. Not Funding Technology Needs.--Student curricula demand state-
of-the-art technology updates to prepare students for jobs. For deaf/
hard-of-hearing students, technology to support the delivery of
instruction is critical. We spend $1,000,000/year for technology;
eliminating that would reduce programming development and quality.
2. Not Supporting Endowment Allocations.--The Education of the Deaf
Act authorizes matching private donations from appropriations, to
reduce dependence on Federal funds. In fiscal year 2006, NTID matched
over $900,000; we do not want to stop this practice.
3. Not Supporting Outreach Efforts, Which Impact Future
Enrollment.--Approximately $542,000 supports six programs designed to:
attract junior/senior high school students to NTID; create a Community
College Referral Program; and establish a Summer English Institute. All
are designed to increase future enrollments.
4. It Does Not Include a Fair Labor Standards Act (FLSA) Lawsuit
Against RIT With a $2.5 Million Settlement Proposal Announced in March,
2007.--It affects 170 current RIT employees including about 140 NTID
employees (mostly sign language interpreters), and others who have
worked for NTID within the last 6 years. A proportion of the settlement
may be paid by NTID in fiscal year 2008; the exact amount is to be
determined.
With the reclassification of positions from exempt-from-overtime to
non-exempt-from-overtime, we expect an increase in our compensation
expenses. The financial impact is to be determined; however, its impact
is immediate, beginning April 16, 2007.
5. It Does Not Recognize the Effect of Inflation and the Impact of
Freezing Positions.--NTID budgeted a 3 percent salary increase in
fiscal year 2007, but the RIT increase was 3.5 percent; we follow RIT
per our Department of Education agreements. At level fiscal year 2008
funding we will consider freezing open positions, including those we
have aggressively filled such as speech-to-text services which expanded
in response to an Office of Civil Rights ruling.
NTID expenses are driven by inflationary pressures. We must fund
salary, health care, and energy costs increases, and the rising costs
of RIT services, which are subject to the same pressures. Taken
together, these costs represent over 80 percent of NTID's total
expenditures.
The President's request for fiscal year 2008 ignores inflationary
increases and returns to fiscal year 2006 levels. Our requested
increase of $3,703,000 in fiscal year 2008 operations over that fiscal
year 2006 level is the equivalent of having obtained an increase of 3.3
percent both from fiscal year 2006 to fiscal year 2007 (which we did
not receive) and from fiscal year 2007 to fiscal year 2008. We believe
these requests are supported by the rationale above on the negative
impact of various potential reductions.
Regarding construction, the President's request partially funds the
$1.7 million needed to replace mechanical heating, ventilation, and
air-conditioning systems (well past their expected lives in 40 year old
buildings) and the delivery of energy to NTID buildings. The systems
have been well maintained but on-going maintenance difficulties dictate
replacement at this time.
ENROLLMENT
Total enrollment is at 1,250 for school year 2006-2007 (fiscal year
2007), and was 1,256 students last year. NTID anticipates maintaining
or increasing enrollment for school year 2007-2008 (fiscal year 2008).
A 5-year summary of student enrollment follows.
NTID ENROLLMENTS--5 YEAR NUMBERS
--------------------------------------------------------------------------------------------------------------------------------------------------------
Deaf/Hard-of-Hearing Students Hearing Students
-------------------------------------------------------------------------------- Grand
School Year Interpreting Total
Undergrad Grad RIT MSSE Subtotal Program MSSE Subtotal
--------------------------------------------------------------------------------------------------------------------------------------------------------
2002-3....................................................... 1,093 29 16 1,138 65 28 93 1,231
2003-4....................................................... 1,064 45 41 1,150 92 28 120 1,270
2004-5....................................................... 1,055 42 49 1,146 100 35 135 1,281
2005-6....................................................... 1,013 53 38 1,104 116 36 152 1,256
2006-7....................................................... 1,017 47 31 1,095 130 25 155 1,250
--------------------------------------------------------------------------------------------------------------------------------------------------------
The number of students studying in our interpreting program has
grown substantially, the number in our graduate secondary teacher
preparation program--MSSE--has fluctuated (totaling both MSSE columns
above), and the sub-total of deaf/hard-of-hearing students has declined
from 1,138 in 2002-2003 to 1,095 in 2006-2007, a decline of 43
students. However, the decline in enrollment of deaf/hard-of-hearing
students parallels almost one-for-one the drop in international
students from 90 enrolled in 2002-2003 to 42 enrolled in 2006-2007, a
decline of 48 students. A change in the Education of the Deaf Act
increased the surcharge on tuition for international students from 50
percent to 100 percent, resulting in the significant decline.
INCREASING NUMBERS OF STUDENTS WITH SECONDARY DISABILITIES
NTID is working with significantly increased numbers of students
with disabilities in addition to deafness. The table shows the number
and percent of students receiving services from the RIT Disability
Services Office, which serves students with physical or mental
impairments that limit one or more major life activities. Their
services assure equal access to education based upon legal foundations
established by Federal law--the Rehabilitation Act of 1973 including
section 504, and the Americans with Disabilities Act of 1990.
NUMBER AND PERCENT OF STUDENTS RECEIVING SECONDARY DISABILITY SERVICES
------------------------------------------------------------------------
Year Number Percent
------------------------------------------------------------------------
1998-1999..................................... 33 3.0
1999-2000..................................... 57 5.0
2000-2001..................................... 82 7.6
2001-2002..................................... 78 7.2
2002-2003..................................... 97 8.6
2003-2004..................................... 95 8.7
2004-2005..................................... 110 10.3
2005-2006..................................... 129 12.7
------------------------------------------------------------------------
While we are unable to calculate the additional budgetary costs, it
is clear that services are increasing significantly year-by-year, with
associated increased costs.
STUDENT ACCOMPLISHMENTS
Our recently reported placement rate indicates that 95 percent of
NTID's fiscal year 2005 graduates in the labor force were employed
(using the methodology of the Bureau of Labor Statistics) in jobs
commensurate with the level of their academic training. Over the last 5
years, a large proportion (83 percent) were employed in science,
engineering, business, and visual communications.
In fiscal year 2005, new research conducted with the Social
Security Administration and Cornell University examined 10,196
graduates and withdrawals spanning 25 years. It shows that graduation
from NTID has significant economic benefits over a lifetime of work.
Baccalaureate graduates earn, on average during their peak earning
years, $12,020 more per year than students who attend, but withdraw
without a degree; sub-baccalaureate graduates earn $4,762 more.
Students who withdraw experience twice the rate of unemployment as
graduates.
NTID clearly makes a significant, positive difference in the
earnings, and in turn in the lives of those who graduate.
While 60 percent of students attending NTID receive benefits
through the Supplemental Security Income program (SSI), by the time
they are at age 50, less than 3 percent of graduates continue to draw
SSI benefits. Graduates also access Social Security Disability
Insurance (SSDI), fundamentally an unemployment benefit, at far lesser
rates than withdrawals. By age 50, withdrawals were twice as likely to
be receiving SSDI as degree graduates.
A large percentage of non-graduates will continue to depend heavily
on Federal income support throughout their lives. But NTID graduation
significantly reduces dependence on welfare programs. Considering the
added taxes graduates pay as a result of their increased earnings, and
the savings derived from reduced dependency on the Federal income
support programs, the Federal investment in NTID returns significant
societal dividends.
NTID BACKGROUND
Academic Programs.--NTID offers high quality, career-focused,
associate degree programs that lead to placement in well-paying
technical careers. A cooperative education component ties closely to
high demand employment opportunities. We are expanding transfer
associate degree programs to better serve the higher achieving segment
of our student population who seek bachelors and masters degrees in an
increasingly demanding marketplace. These transfer programs provide for
seamless transition to baccalaureate studies. Finally, we support
students in RIT baccalaureate programs. One of NTID's greatest
strengths is its outstanding track record of assisting high-potential
students to gain admission to and to graduate from the other colleges
of RIT at rates that are better than their hearing peers.
Research.--The research program and agenda are guided and organized
according to these general research areas: Language and Literacy,
Teaching and Learning, Socio-cultural Influences, Career Development,
Technology Integration, and Institutional Research. All benefit
enrolled students as well as deaf/hard-of-hearing adults throughout the
country.
Outreach.--Extended outreach activities to junior and senior high
school students, expand their horizons regarding a college education.
Student Life.--The new Student Development Center, funded by a $2.0
million gift from a private individual and $1.5 million fiscal year
2005 Federal appropriations has been occupied. Our activities foster
student leadership and community service, and providing opportunities
to explore other educational interests.
SUMMARY
The fiscal year 2008 request will allow NTID to continue its
mission of preparing deaf/hard-of-hearing people to enter the workplace
and society and compete with their hearing peers. Our alumni have
demonstrated that they can achieve full independence and become
contributing members of society; they can earn a living and live a
satisfying life as a result of the postsecondary education received at
NTID. Collaborative research between NTID and the Social Security
Administration shows that NTID graduates over their lifetimes are
employed at a much higher rates, earn substantially more (therefore
paying significantly more in taxes), and participate at a much lower
rate in Federal welfare programs.
We are hopeful that the members of the committee will agree that
NTID, with its outstanding record of service to deaf/hard-of-hearing
people, remains deserving of their support and confidence.
______
Prepared Statement of the National Tuberculosis Controllers Association
The National Tuberculosis Controllers Association (NTCA) is pleased
to submit our recommendations for TB control programs in the Labor
Health and Human Services and Education Appropriations subcommittee
purview.
The National Tuberculosis Controllers Association (NTCA) is a
membership organization composed of persons who are working, or have
worked in Tuberculosis Control programs in the United States and it's
Pacific Affiliated Islands. Membership is also extended to our partners
in other TB-related organizations and to any other persons who have
interest in Tuberculosis control issues.
The United States is now facing unprecedented threats in our
progress towards the goal of eliminating TB and even our fundamental
responsibility to control TB, due to regressive cuts to programs that
are essential to contain the disease and prevent the creation of new
highly dangerous strains of drug resistance.
PREVALENCE OF TB IN THE UNITED STATES
Tuberculosis (TB) is a disease caused by a bacterium that is spread
through the air--that is, it is spread from person-to-person by sharing
the air that we breathe. Infection affects some people immediately, but
for many, it becomes ``dormant,'' to become active at a later time. It
is estimated that one-third of the world's population is infected with
TB in this latent form, and indeed, these people form a reservoir of a
disease that kills more than 2 million adults and children each year
(1 every 15 seconds) and remains the leading cause of human death from
an infectious disease today.
In the United States, efforts to control the disease following its
resurgence in the early 1990's have created a public health
infrastructure that has been able to achieve that goal in many sectors.
At the heart of this endeavor is the Centers for Disease and Control's
(CDC) Division of TB Elimination (DTBE), which coordinates prevention
and control activities to States through cooperative agreement awards
to support categorical infrastructure. Following interim analyses, the
Institute of Medicine (IOM) declared in its 2000 report, Ending
Neglect, the Elimination of Tuberculosis in the United States, that TB
could be eliminated as a public health problem in the United States by
2010. The 13,767 cases reported in 2006 represent the lowest absolute
number of cases ever recorded in our country. But we are far from TB
elimination. The lower numbers have again lulled us into a false sense
of security, and as Federal support once again is being withdrawn, we
are facing another potential and more dangerous challenge to our
public's health.
The majority of U.S. TB cases come from outside U.S. borders.
Fifty-five percent of 2006 TB cases were non-U.S. born, but the
majority of these individuals have resided in the United States for
more than 5 years and are citizens. Twenty States reported increases in
TB cases in 2006 over 2005, with the District of Columbia recording the
highest TB case rate (12.6/100,000) in the Nation.
White, U.S.-born people no longer make up the majority of TB cases
in the United States--TB now embraces racial and ethnic minorities as
never before. African Americans have 8 times the risk of developing TB
as whites; Hispanics and Asians have 8 and 21 times the risk,
respectively. Our health systems have been slow to adapt to the needs
of these populations.
CHALLENGES TO TB CONTROL
In its November 2005 statement, CDC recognized 5 critical
challenges to controlling TB in the United States. Addressing each
challenge requires intact and fully functional local public health
systems that are able to reach people at-risk, unique to populations in
individual States and to the disease. Our State and local TB programs
are losing the front-line, experienced staff that provide adequate case
management to persons with active (and infectious) TB and ensure safe
completion of treatment (at least 6-9 months of multiple medications),
preventing the emergence of drug resistance among those who do not take
medications appropriately. As programs lose funding, it is these
essential, ``core'' services that are being compromised, or even
eliminated entirely.
The Division of TB Elimination has been level-funded for at least
12 years; in 2006, our State and local programs were asked to absorb a
real cut of 4.8 percent in Federal funding. The impact has been
stealthy, but clear. These are examples:
In Massachusetts, 77 percent of reported TB cases are foreign-born,
and among this group, about 95 percent are drug-resistant. The State
also has fewer staff resources to handle these cases since nine field
staff positions (21 percent of the work force) have been lost since
2002.
In New York City, 1,185 patients had to be managed by 26 fewer
nurses and field staff (an 18 percent cut).
California has more than 20 percent of our national cases, 2,800,
of whom 78 percent are foreign-born. California reports an 11 percent
rate of drug resistance and yet had to deal with a 9 percent reduction
in its Federal support versus 2005.
California and New York both reported cases of the new Extensively
Drug-Resistant (XDR)-TB strain in 2006. These strains are virtually
resistant to current treatment regimens and are associated high levels
of mortality.
In December, Dr. Michael Fleenor, Chair of the National Advisory
Committee on the Elimination of Tuberculosis, wrote to Secretary
Leavitt and to CDC Director Gerberding to express concerns of the
Council concerning the current negative impact of these funding
reductions and to point out the urgent need to address these concerns
in light of the new strains of XDR-TB. XDR-TB is produced by the
failure to effectively treat individuals with other multidrug resistant
TB (MDR TB) strains. Each of the 118 MDR TB cases reported in the
United States in 2005 has the potential to become XDR TB without the
expertise and infrastructure to cure the disease through directly
observed treatment. Make no mistake--XDRTB is already in the United
States and only our public health infrastructure prevents the
production of more cases!
The resurgence of tuberculosis and the emergence of Multi-Drug
Resistant TB (MDRTB), organisms resistant to the two most effective
drugs in the 1990's resulted from a collapse of the same infrastructure
that we have since struggled to re-create, and are in the process of
disassembling once again at this very moment. In short, we are being
set up to fail. Earlier this year, U.S. Assistant Surgeon General and
DTBE Director, Dr. Kenneth Castro warned the TB control community to
anticipate a further reduction of 25 percent in Federal support for TB
control over the next 5 years. Such a reduction bodes poorly for
sustained efforts to control the disease, and, in the face of emerging
XDR-TB, is a potential disaster.
There is another lethal disease, to which governmental response
was, on balance, both swift and appropriate, and from which we can
learn: SARS. XDR-TB is, in many ways imminently more dangerous than
SARS. While both are virtually untreatable, have extremely high death
rates and are transmissible from person to person, TB unlike SARS, has
both a human reservoir and a state of Latent Infection. TB, both
regular and XDR, can lie dormant, only to emerge months or years later
and spread person to person. Yet today we are facing funding cutbacks
rather than vitally needed increases to keep our defensive
infrastructure intact against TB.
In order to put our domestic situation in proper context. Basic and
applied research is sorely needed to help us understand the complex
interactions between the TB organism and human beings which gives rise
to latent and active disease. Research will provide insights as to how
we might reduce the length, complexity, and toxicity of our currently
limited drugs; it will provide us with tools to diagnose TB disease and
dormant infection quickly; and it will help us understand how to reach
people at-risk to prevent TB from developing. Laboratories must have
better tools to identify and report drug resistance cheaply and
quickly. And we must use our understanding and our resources to assist
other countries in controlling the disease and preventing the emergence
of active disease in those with dormant infection--for the world's
problem truly is our problem too.
The CDC DTBE clearly has demonstrated its ability to work closely
with State and local public health TB programs to address issues of TB
control. This association and cooperative partnership is responsible
for the successes we have achieved over the past 15 years and it should
be reinforced by assuring adequate support for the unprecedented
challenges we are now facing. The current funding level of $137.4
million for DTBE actually represents a 23 percent decrease over the
past decade, adjusted for inflation. The NTCA recommends that the
committee adopt the National Coalition for the Elimination of
Tuberculosis's recommendation of an increase of $390.6 million in
project funding for the CDC's Division of Tuberculosis Elimination for
a total of $528 million in fiscal year 2008. This includes:
--To Maintain Control of Core Activities and Regional Medical
Training and Consultation Centers (RTMCC's)--$185 million
--Preparedness & Outbreak Response Capacity for XDR TB--$45 million.
--Accelerating the Decline--$75 million.
--For Research and Development of New Tools, Drugs and Diagnostics--
$110 million.
--For Intensified Support for Action to Accelerate Control (ISAAC).
Includes Enhancements to Surveillance, Laboratory, Border
Health, Health Disparities, Evaluation, and Research
Translation (Turning Research Into Practice)--$113 million.
CONCLUSION
Clearly, the responsibility for TB control is a shared one. The CDC
DTBE has an excellent track record of working closely with State and
local health departments, providers and communities; the successful
control of TB among residents of New Orleans during the hurricane is a
recent example. Without the expertise and public health infrastructure
that was in place, the 130 TB cases that were distributed from New
Orleans to emergency shelters across the United States would have led
to multiple outbreaks of TB. However, the ongoing budget cuts at the
CDC directly impair TB prevention and control core activities within
the States and seriously compromise a remarkable successful
relationship. We have seen this pattern before. We know this will leave
us once again at risk of an even more deadly epidemic of tuberculosis.
The NCTA appreciates the opportunity to submit this statement to the
subcommittee.
______
Prepared Statement of the NephCure Foundation
SUMMARY OF RECOMMENDATIONS FOR FISCAL YEAR 2008
A 6.7 percent increase for the National Institutes of Health (NIH)
and the National Institute of Diabetes and Digestive and Kidney
Diseases (NIDDK).
Continue to expand the NIDDK's Nephrotic Syndrome (NS) and Focal
Segmental Glomerularsclerosis (FSGS) research portfolios by
aggressively supporting grant proposals in this area and creating a
Glomerular Diesease Registry.
Encourage the National Center for Minority Health and Health
Disparities (NCMHD) to initiate studies into the incidence and cause of
NS and FSGS in minority populations.
Mr. Chairman and members of the subcommittee, the NephCure
Foundation (NCF) is grateful for the opportunity to present testimony
before you. NCF is a non-profit organization that is driven by a panel
of respected medical experts and a dedicated band of patients and
families that work together to save kidneys and also lives. NCF is the
only non-profit organization exclusively devoted to fighting idiopathic
nephrotic syndrome (NS) and focal segmental glomerulosclerosis (FSGS).
Now in our sixth year, the NephCure Foundation continues to work
tirelessly to support glomerular disease research.
FSGS: ONE FAMILY'S STORY
Bradly Grizzard, was diagnosed with focal segmental
glomerulosclerosis (FSGS) in 2002. In May of 2005, his mother donated
one of her kidneys to him.
FSGS is one of a cluster of glomerular diseases that attack the
tiny filtering units contained in each human kidney, known as nephrons.
Glomerular disease attacks the portion of the nephron called the
glomerulus, scarring and often destroying these filters. Currently,
scientists do not know why glomerular injury occurs, and there is no
known cure for these diseases.
Upon diagnosis, an FSGS patient's health often takes a rapid
downward plunge at and it is extremely difficult to make a comeback.
Bradly was a star football player at his high school and was being
recruited by college football coaches before FSGS attacked his body.
When his kidneys failed, he was forced to give up football, as well as
juggle college classes with several hours of dialysis a day. He was
lucky that his mother's kidney was a match, but even so, the first few
hospitals that they approached refused to perform the transplant. They
were eventually able to find a doctor and a hospital that was willing
to perform the operation, and the transplanted kidney is now working
well. Even though Bradly is now feeling much stronger, he must remain
on costly immunosuppressant drugs for the rest of his life. These drugs
cause many unpleasant side effects and medical complications.
Sadly, Bradly's story is far from unique. There are thousands of
people in this country who have had their lives disrupted due to the
sudden onset of FSGS. Furthermore, although kidney transplants have
been very successful for thousands of FSGS patients, many patients end
up rejecting the transplanted kidney. A large percentage of patients
even see the FSGS comes back and attacks the transplanted kidney. In
either case, the patient must then again rely on daily dialysis as a
means of survival. There are thousands of young people who are in a
race against time, hoping for a treatment that will save their lives.
The NephCure Foundation today raises its voice to speak for them all,
asking you to take specific actions that will aid our mission to find
the cause and cure of NS/FSGS.
First and foremost, we join the Ad Hoc Group for Medical Research
Funding in asking for a 6.7 percent increase for the National
Institutes of Health (NIH) and the National Institute of Diabetes and
Digestive and Kidney Diseases (NIDDK).
MORE RESEARCH IS NEEDED
Little progress has been made on finding the cause of or the cure
for FSGS. Scientists tell NCF that much more research needs to be done
on the basic science behind the disease.
NCF is thankful that the NIDDK is continuing to work with us on the
FSGS clinical trial. Currently, 150-175 patients nationwide are
enrolled in the trial. Recently, the steering committee charged with
providing programmatic direction to the trial decided on several
changes which would accelerate progress. NCF is also working with the
NIDDK to cosponsor ancillary basic biological material studies of the
enrolled patients.
NCF is pleased to learn that the NIDDK is intending to re-release
the program announcement (PA) entitled, ``Exploratory Basic Research in
Glomerular Disease'' (PA-06-228). After being originally introduced as
a R21 PA in March of 2006, PA-06-228 was rescinded along with all other
non-clinical R21 programs when they were folded into the general NIH
wide solicitation. NCF is optimistic that re-issuing this PA under the
RO1 mechanism, as intended, will stimulate significant research into
glomerular diseases.
As health information technology continues to advance, disease
registries and databases are fast becoming a crucial resource and vital
source of information. The basic understanding of numerous conditions
has been greatly improved by compiling patient information and disease
data. At this time, no such registry exists for glomerular diseases.
NCF has been informed by researchers and scientists that such a
registry would greatly increase the clinical knowledge of NS and FSGS.
We ask the committee to encourage the NIDDK to help find the cause
and the cure for glomerular disease by continuing its support for the
FSGS clinical trial and the ancillary basic biological material
studies. We also ask the NIDDK to continue to add glomerular disease to
program announcements. Additionally, we would like the committee to
recommend that the NIDDK place a high priority on any initiatives that
seek to establish a glomerular disease registry.
TOO LITTLE EDUCATION ABOUT A GROWING PROBLEM
When glomerular disease strikes, the resulting nephrotic syndrome
causes a loss of protein in the urine and edema. The edema often
manifests itself as puffy eyelids, a symptom that many parents and
physicians mistake as allergies. With experts projecting a substantial
increase in nephrotic syndrome in the coming years, there is a clear
need to educate pediatricians and family physicians about glomerular
disease and its symptoms.
NCF has conducted numerous education programs. A national FSGS
conference was held in Philadelphia from June 3-4, 2006. This
conference sought to provide attendees with the most up to date
information on this disease. Through speakers, information sessions,
and informal conversations with other patient families, attendees
realized that they are not alone and will be further energized for the
effort to find a cause and a cure for FSGS.
Also, last summer, the NIDDK sponsored a working group scientific
conference. This working group advised NIDDK on animal models,
reagents, and other resources for the study of glomerular disease.
NCF also applaud the work of the NIDDK in establishing the National
Kidney Disease Education Program (NKDEP), and we seek your support in
urging the NIDDK to make sure that glomerular disease remains a focus
of the NKDEP.
We ask the committee to encourage the NIDDK to have glomerular
disease receive high visibility in its education and outreach efforts,
and to continue these efforts in conjunction with the NephCure
Foundation's work. These efforts should be targeted towards both
physicians and patients.
GLOMERULAR DISEASE STRIKES MINORITY POPULATIONS
Nephrologists tell NCF that glomerular disease strikes a
disproportionate number of African-Americans. No one knows why this is,
but some studies have suggested that a genetic sensitivity to sodium
may be partly responsible. DNA studies of African Americans who suffer
from FSGS may lead to insights that would benefit the thousands of
African Americans who suffer from kidney disease.
NCF asks that the NIH pay special attention to why this disease
affects minority populations to such a large degree. NCF wishes to work
with the NIDDK and the National Center for Minority Health and Health
Disparities (NCMHD) to encourage the creation of programs to study the
high incidence of glomerular disease within the African-American
population.
There is also evidence to suggest that the incidence of glomerular
disease is higher among Hispanic-Americans than in the general
population. An article in the February 2006 edition of the NIDDK
publication Recent Advances and Emerging Opportunities, discussed the
case of Frankie Cervantes, a 6 year old boy of Mexican and Panamian
descent. Frankie has FSGS, and like Bradly, received a transplanted
kidney from his mother. We applaud the NIDDK for highlighting FSGS in
their publication, and for translating the article about Frankie into
both English and Spanish. Only through similar efforts at cross-
cultural education can the African-American and Hispanic-American
communities learn more about glomerular disease.
We ask the committee to join with us in urging the NIDDK and the
National Center for Minority Health and Health Disparities (NCMHD) to
collaborate on research that studies the incidence and cause of this
disease among minority populations. We also ask that the NIDDK and the
NCMHD undertake culturally appropriate efforts aimed at educating
minority populations about glomerular disease.
Thank you again for this opportunity and please contact us if you
have any questions or require additional information.
______
Prepared Statement of NTM Info and Research
AGENCY RECOMMENDATIONS
CDC: NTMIR requests a $7,000,000 allocation in the budget to enable
CDC, Infectious Diseases HIV/AIDS, STD and TB Prevention Program to
launch an external partnership to develop and implement a public health
education and outreach initiative to promote NTM education for health
care providers and the general public. Further NTMIR requests that CDC
develop specific epidemiology studies regarding prevalence, geographic,
demographic and host specific data regarding NTM infection in the
population.
NIH: NTMIR requests an allocation in the budget to enable NIH,
NHLBI to advance diagnostics and treatments for patients suffering from
pulmonary Nontuberculous Mycobacteria (NTM) disease. NTMIR further
requests that NHLBI issue a program announcement or other appropriate
mechanism to ensure the initiation of grant proposals
NIH: NTMIR requests an allocation in the budget to enable NIH,
NIAID to collaborate further with NHLBI, the advocacy community and
other Federal agencies to advance the understanding of NTM by
establishing a national registry of patients and to issue a program
announcement, an NIH partnership funding program or other appropriate
mechanism to ensure the initiation of grant proposals and other
activities in NTM.
Thank you for the opportunity to submit a statement on behalf of
NTM Info & Research and all the patients suffering with pulmonary NTM
disease.
WHAT IS PULMONARY NONTUBERCULOUS MYCOBACTERIAL DISEASE (NTM)?
NTM is an infectious disease considered to be of environmental
origin as these bacteria are ubiquitous in the water and soil that
surround us. Although NTM is diagnosed by the same basic test used to
diagnose traditional tuberculosis (TB), it is significantly more
difficult to treat. NTM progressively diminishes lung capacity, with
all the attendant negative consequences in life.
Unfortunately, even though TB has a significantly high profile, NTM
does not because education and awareness have been lacking.
Furthermore, there is growing evidence that NTM is many times more
prevalent than TB in the United States. For example, the State of
Florida Infectious Disease Laboratory reports receiving over twice as
many specimens that are NTM positive for every one that is positive for
TB. Even more startling, the Agency for Health Care Administration for
Florida hospital patient discharges shows almost 9 times the number of
patients with the primary diagnosis of NTM versus those with TB.
Doctors in leading treating facilities are reporting that even
though NTM is not reportable, they are seeing more NTM patients than TB
patients. A current report from Toronto, Ontario indicates that the
prevalence may be six times higher than the older data we have in the
United States.
NTM is not limited to one strain and has certain strains that are
inherently resistant to drug therapy, and in all cases multiple drugs
are required on a lengthy to permanent basis. A significant number of
patients require short- to long-term intravenous medication and this is
a particular hardship for the elderly because Medicare does not cover
in-home therapy. Medicare recipients must be hospitalized one to three
times a week driving treatment costs significantly higher than in
alternate settings.
NTM INFO & RESEARCH (NTMIR)
NTMIR was founded through a partnership of concerned patients and
interested physicians who see increasing numbers of people affected by
this devastating disease. NTMIR was created to expand professional
awareness, diagnosis and treatment, facilitate research and provide
patient support. Our mission is a public/private partnership to advance
the science and the outcomes for countless patients with NTM disease.
NTMIR has already demonstrated a track record of success since it
commenced its activities just 3 years ago. These include, successful
implementation of the NTMInfo.org website and online support group,
patient education throughout the country through the replication of an
NTM information pamphlet, initiating professional education and Grand
Round lectures to increase professional education both for specialists
and family physicians, establishment of a partnership of cooperation
with public health in the State of Florida and with the American Lung
Association of Florida. NTMIR negotiated an agreement between a major
pharmaceutical company, the FDA and a division of HRSA to provide an
urgently needed drug for patients who could not otherwise obtain it,
some of whom might have died without it.
Fern Leitman's Story
In September 1996, shortly after lung surgery, Fern's health
deteriorated to the point where her doctors suggested that her children
be called. Fern was rushed to a procedure room to put a bronchoscope
into her lungs to see what was happening.
NTM can affect any one of us . . . but for some unknown reason it
affects more women than men.
Fern's normal morning routine starts with pulmonary therapy to
clear her airways. Then there is a sinus wash. With breakfast, Fern
takes five different oral drugs and IV medicines. In addition, there
are inhaled medicines. The total time from awakening to being able to
leave the house is usually 4 hours.
THE NEEDS OF NTM PATIENTS HAVE GONE UNMET--MORE CAN BE DONE NOW!
While tuberculosis is often known to appear in inner cities and
immigrant populations, NTM knows no such boundaries. However, current
epidemiologic data is not available. The latest data that we have from
the Centers for Disease Control was collected in the 1980's and we
urgently need newer data. Current data from the University of Toronto
suggests that the prevalence may be six times higher than our older
information. We have no reason to believe that Toronto is any different
than Chicago, Miami or any other major U.S. city.
______
Prepared Statement of the Oncology Nursing Society
OVERVIEW
The Oncology Nursing Society (ONS) appreciates the opportunity to
submit written comments for the record regarding fiscal year 2008
funding for cancer and nursing related programs. ONS, the largest
professional oncology group in the United States, composed of more than
35,000 nurses and other health professionals, exists to promote
excellence in oncology nursing and the provision of quality care to
those individuals affected by cancer.
This year more than 1,444,920 Americans will be diagnosed with
cancer, and more than 565,000 will lose their battle with this terrible
disease. Despite these grim statistics, significant gains in the War
Against Cancer have been made through our Nation's investment in cancer
research and its application. Research holds the key to improved cancer
prevention, early detection, diagnosis, and treatment, but such
breakthroughs are meaningless, unless we can deliver them to all
Americans in need. Moreover, a recent survey of ONS members found that
the nursing shortage is having an adverse impact in oncology physician
offices and hospital outpatient departments. Some respondents indicated
that when a nurse leaves their practice, they are unable to hire a
replacement due to the shortage--leaving them short-staffed and posing
scheduling challenges for the practice and the patients.
To ensure that all people with cancer have access to the
comprehensive, quality care they need and deserve, ONS advocates
ongoing and significant Federal funding for cancer research and
application, as well as funding for programs that help ensure an
adequate oncology nursing workforce to care for people with cancer. The
Society stands ready to work with policymakers at the local, State, and
Federal levels to advance policies and programs that will reduce and
prevent suffering from cancer and sustain and strengthen the Nation's
nursing workforce. We thank the subcommittee for its consideration of
our fiscal year 2008 funding request detailed below.
SECURING AND MAINTAINING AN ADEQUATE ONCOLOGY NURSING WORKFORCE
Oncology nurses are on the front lines in the provision of quality
cancer care for individuals with cancer--administering chemotherapy,
managing patient therapies and side-effects, working with insurance
companies to ensure that patients receive the appropriate treatment,
providing counseling to patients and family members, and engaging in
myriad other activities on behalf of people with cancer and their
families. Cancer is a complex, multifaceted chronic disease, and people
with cancer require specialty-nursing interventions at every step of
the cancer experience. People with cancer are best served by nurses
specialized in oncology care, who are certified in that specialty.
Overall, age is the number one risk factor for developing cancer.
Approximately 77 percent of all cancers are diagnosed at age 55 and
older.
As the overall number of nurses will drop precipitously in the
coming years, we likely will experience a commensurate decrease in the
number of nurses trained in the specialty of oncology. With an
increasing number of people with cancer needing high-quality health
care, coupled with an inadequate nursing workforce, our Nation could
quickly face a cancer care crisis of serious proportion, with limited
access to quality cancer care, particularly in traditionally
underserved areas. A study in the New England Journal of Medicine found
that nursing shortages in hospitals are associated with a higher risk
of complications--such as urinary tract infections and pneumonia,
longer hospital stays, and even patient death. Without an adequate
supply of nurses, there will not be enough qualified oncology nurses to
provide the quality cancer care to a growing population of people in
need, and patient health and well-being could suffer.
Further, of additional concern is that our Nation also will face a
shortage of nurses available and able to conduct cancer research and
clinical trials. With a shortage of cancer research nurses, progress
against cancer will take longer because of scarce human resources
coupled with the reality that some practices and cancer centers
resources could be funneled away from cancer research to pay for the
hiring and retention of oncology nurses to provide direct patient care.
Without a sufficient supply of trained, educated, and experienced
oncology nurses, we are concerned that our Nation may falter in its
delivery and application of the benefits from our Federal investment in
research.
ONS has joined with others in the nursing community in advocating
$200 million as the fiscal year 2008 funding level necessary to support
implementation of the Nurse Reinvestment Act and the range of nursing
workforce development programs housed at the U.S. Health Resources and
Services Administration (HRSA). Enacted in 2002, the Nurse Reinvestment
Act (Public Law 107-205) included new and expanded initiatives,
including loan forgiveness, scholarships, career ladder opportunities,
and public service announcements to advance nursing as a career.
Despite the enactment of this critical measure, HRSA fails to have the
resources necessary to meet the current and growing demands for our
Nation's nursing workforce. For example, in fiscal year 2006 HRSA
received 4,222 applications for the Nurse Education Loan Repayment
Program, but only had the funds to award 615 of those applications.
Also, in fiscal year 2006 HRSA received 3,320 applications for the
Nursing Scholarship Program, but only had funding to support 218
awards.
While a number of years ago one of the biggest factors associated
with the shortage was a lack of interested and qualified applicants,
due to the efforts of the nursing community and other interested
stakeholders, the number of applicants is growing. As such, now one of
the greatest factors contributing to the shortage is that nursing
programs are turning away qualified applicants to entry-level
baccalaureate programs, due to a shortage of nursing faculty. According
to the American Association of Colleges of Nursing (AACN), U.S. nursing
schools turned away 42,866 qualified applicants from baccalaureate and
graduate nursing programs in 2006, due to insufficient number of
faculty. The nurse faculty shortage is only expected to worsen with
time, as half of the RN workforce is expected to reach retirement age
with in the next 10 to 15 years. At the same time, significant numbers
of faculty are expected to retire in the coming years, with
insufficient numbers of candidates in the pipeline to take their
places. If funded sufficiently, the components and programs of the
Nurse Reinvestment Act will help address the multiple factors
contributing to the nursing shortage.
The nursing community opposes the President's fiscal year 2008
budget proposal that decreases nursing workforce funding by $44
million--a cut which eliminates all funding for advanced nursing
education programs. With additional funding in fiscal year 2008, these
important programs will have much-needed resources to address the
multiple factors contributing to the nationwide nursing shortage,
including the shortage of faculty--a principal factor contributing to
the current shortage. Advanced nursing education programs play an
integral role in supporting registered nurses interested in advancing
in their practice and becoming faculty. As such, these programs must be
adequately funded in the coming year.
ONS strongly urges Congress to provide HRSA with a minimum of $200
million in fiscal year 2008 to ensure that the agency has the resources
necessary to fund a higher rate of nursing scholarships and loan
repayment applications and support other essential endeavors to sustain
and boost our Nation's nursing workforce. Nurses--along with patients,
family members, hospitals, and others--have joined together in calling
upon Congress to provide this essential level of funding. One Voice
Against Cancer (OVAC), a collaboration of more than 45 national
nonprofit organizations representing millions of Americans, and the
National Coalition for Cancer Research (NCCR), is a non-profit
organization comprised of 26 national organization, also advocate $200
million for the Nurse Reinvestment Act in fiscal year 2008. ONS and its
allies have serious concerns that without full funding, the Nurse
Reinvestment Act will prove an empty promise, and the current and
expected nursing shortage will worsen, and people will not have access
to the quality care they need and deserve.
SUSTAIN AND SEIZE CANCER RESEARCH OPPORTUNITIES
Our Nation has benefited immensely from past Federal investment in
biomedical research at the National Institutes of Health (NIH). ONS has
joined with the broader health community in advocating a 6.7 percent
increase ($32.831 billion) for NIH in fiscal year 2008. This will allow
NIH to sustain and build on its research progress, resulting from the
recent doubling of its budget, while avoiding the severe disruption to
that progress that would result from a minimal increase. Cancer
research is producing extraordinary breakthroughs--leading to new
therapies that translate into longer survival and improved quality of
life for cancer patients. We have seen extraordinary advances in cancer
research, resulting from our national investment, which have produced
effective prevention, early detection and treatment methods for many
cancers. To that end, ONS calls upon Congress to allocate $5.131
billion to the National Cancer Institute (NCI) in fiscal year 2008 to
support the battle against cancer.
The National Institute of Nursing Research (NINR) supports basic
and clinical research to establish a scientific basis for the care of
individuals across the life span--from management of patients during
illness and recovery, to the reduction of risks for disease and
disability and the promotion of healthy lifestyles. These efforts are
crucial in translating scientific advances into cost-effective health
care that does not compromise quality of care for patients.
Additionally, NINR fosters collaborations with many other disciplines
in areas of mutual interest, such as long-term care for older people,
the special needs of women across the life span, bioethical issues
associated with genetic testing and counseling, and the impact of
environmental influences on risk factors for chronic illnesses, such as
cancer. ONS joins with others in the nursing community in advocating a
fiscal year 2008 allocation of $150 million for NINR.
BOOST OUR NATION'S INVESTMENT IN CANCER PREVENTION, EARLY DETECTION,
AND AWARENESS
Approximately two-thirds of cancer cases are preventable through
lifestyle and behavioral factors and improved practice of cancer
screening. Although the potential for reducing the human, economic, and
social costs of cancer by focusing on prevention and early detection
efforts remains great, our Nation does not invest sufficiently in these
strategies. In 2005, the United States spend over $2.0 trillion in
healthcare--$6,683 for every man, woman, and child; however we only
allocate approximately 1 percent of that amount for population-based
prevention efforts. The Nation must make significant and unprecedented
Federal investments today to address the burden of cancer and other
chronic diseases, and to reduce the demand on the healthcare system and
diminish suffering in our Nation both for today and tomorrow.
As the Nation's leading prevention agency, the Centers for Disease
Control and Prevention (CDC) plays an important role in translating and
delivering, at the community level, what is learned from research.
Therefore, ONS joins with our partners in the cancer community--
including OVAC--in calling on Congress to provide additional resources
for the CDC to support and expand much-needed and proven effective
cancer prevention, early detection, and risk reduction efforts.
Specifically, ONS advocates the following fiscal year 2008 funding
levels for the following CDC programs: $250 million for the National
Breast and Cervical Cancer Early Detection Program; $65 million for the
National Cancer Registries Program; $25 million for the Colorectal
Cancer Prevention and Control Initiative; $50 million for the
Comprehensive Cancer Control Initiative; $25 million for the Prostate
Cancer Control Initiative; $5 million for the National Skin Cancer
Prevention Education Program; $10 million for the Ovarian Cancer
Control Initiative; $6 million for the Geraldine Ferraro Blood Cancer
Program; $145 million for the National Tobacco Control Program; and $65
million for the Nutrition, Physical Activity, and Obesity Program.
CONCLUSION
ONS maintains a strong commitment to working with Members of
Congress, other nursing societies, patient organizations, and other
stakeholders to ensure that the oncology nurses of today continue to
practice tomorrow, and that we recruit and retain new oncology nurses
to meet the unfortunate growing demand that we will face in the coming
years. By providing the fiscal year 2008 funding levels detailed above,
we believe the subcommittee will be taking the steps necessary to
ensure that our Nation has a sufficient nursing workforce to care for
the patients of today and tomorrow and that our Nation continues to
make gains in our fight against cancer.
______
Prepared Statement of Parent Project Muscular Dystrophy
Chairman Harkin, ranking member Specter, and members of the
committee: I want to thank you for this opportunity to submit testimony
for the written record. My name is Pat Furlong, Co-Founder and CEO of
Parent Project Muscular Dystrophy (PPMD) and the mother of two sons who
battled Duchenne Muscular Dystrophy (DMD).
The past year has been historical for PPMD and the entire Duchenne
and Becker Muscular Dystrophy (DBMD) Community. Right now, a drug that
holds tremendous potential for a percentage of patients suffering not
only from Duchenne but from other neurological conditions, like Cystic
Fibrosis, is in a Phase 2 clinical trial, and has received Fast Track
designation from the Food and Drug Administration (FDA). We all waited
anxiously and were relieved when PTC Therapeutics reported an increase
presence of dystrophin in Duchenne patients involved in the initial
Phase 2 clinical trial, and we are very hopeful more good news will be
on the way. While the drug in question--PTC 124--is being developed by
a private entity, I can say with confidence that we would not have
reached this milestone if not for the significant investments made into
DMD research by the National Institutes of Health (NIH).
It is for this very reason that NIH's investments into Duchenne and
Becker research must not only be sustained but strengthened. All six
Senator Paul Wellstone MD Research Centers of Excellence are in
operation, and the Muscular Dystrophy Coordinating Committee (MDCC) is
working to advance the government-wide MD agenda.
At the Centers for Disease Control and Prevention (CDC), active
surveillance of Duchenne is taking place in five States, and we are
making progress toward developing a DMD Patient Registry, replete with
evidence-based care considerations, In addition, PPMD has partnered
with the CDC on an education and outreach initiative that has produced
materials that help explain Duchenne to children, enable doctors to
offer accurate and timely diagnoses, and help parents ensure their
children get the care they need and deserve. Through the pilot work in
Mississippi, CDC and PPMD have taken concrete steps to educate people
on the early warning signs of DBMD so patients get the earliest
diagnosis possible.
I want to continue to urge the committee to support Federal funding
for DBMD. Specifically, we are seeking:
--A $2.5 million increase in MD activities at the CDC. Of this
increase:
--$2.25 million should be dedicated to advancing efforts to develop
and launch an International DBMD Patient Registry.
--$250,000 should be used to continue the successful joint CDC/PPMD
Education & Outreach initiative, bringing the total for
this project to $1 million.
--Increased funding at the NIH to ensure the continued support of the
six MD Centers of Excellence and other research initiatives
focused on DBMD.
We are very well aware of the significant budgetary pressures--both
internal and external--that you will be dealing with this year. That's
why we believe we have put forth a reasonable request that seeks the
funding necessary to sustain and advance the successes attained to
date. Without such an investment, we fear we will lose ground and not
receive the greatest return on investment possible.
On behalf of all families impacted by Duchenne and Becker MD, I
thank you for your past support. I urge your panel and the entire
Senate to continue to lead the way in providing critically needed
dollars to support DBMD research at the NIH and patient support and
related initiatives at the CDC.
______
Prepared Statement of the People for the Ethical Treatment of Animals
Chairman Harkin, ranking member Specter, and members of the
subcommittee: People for the Ethical Treatment of Animals (PETA) is the
world's largest animal rights organization, with 1.6 million members
and supporters. We greatly appreciate the opportunity to submit
testimony regarding the fiscal year 2008 appropriations for the
Interagency Coordinating Committee on the Validation of Alternative
Methods (ICCVAM). The following national animal and health protection
organizations support these comments: The American Anti-Vivisection
Society, the Alternatives Research and Development Foundation, In
Defense of Animals, and the Physicians Committee for Responsible
Medicine.
As you are aware, Federal regulatory agencies require most
chemicals and many other products to undergo tests that measure their
toxicity levels. Unfortunately, most of these tests involve the
suffering and death of animals. Other problems include agencies
needlessly duplicating each other's tests, lack of innovation (e.g.,
relying on outdated and flawed test methods developed decades ago), and
underutilization of scientific expertise outside of the U.S. Government
(e.g., ignoring better methods used in other countries).
ICCVAM was created in 1997 to solve the three regulatory testing
problems of animal suffering, wasteful duplication, and lack of
innovation. It was made a permanent committee under the National
Institute of Environmental Health Sciences in 2000.
Contrary to its ostensible purpose, however, ICCVAM has become a
major obstacle to the adoption of more sophisticated and accurate test
methods--in many cases, methods that have been widely adopted by the
rest of the industrialized world. Instead, ICCVAM is clinging to
decades-old animal-poisoning tests that were never proven relevant to
humans to begin with.
This causes two major problems. First, animals are being harmed
needlessly when non-animal tests could be adopted instead. Second,
public health is being undermined, as non-animal test methods have been
demonstrated to be more accurate, more sensitive, and more protective
of public health.\1\
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\1\ For example, in 1971, scientists Weil and Scala examined the
reliability of data from eye irritancy tests--in which chemicals are
dripped into rabbits' eyes--and concluded that, because of significant
variability in test results from day to day and lab to lab, this test
should not be used as a standard regulatory toxicity study (Weil CS and
Scala RA. 1971. Toxicol. Appl. Pharmacol. 17: 276-360). In 1986,
Freeberg and colleagues studied 281 cases of accidental human eye
exposure to 14 household products and compared the outcome with the
results of rabbit eye irritation tests. They found that the animal test
failed to correctly predict the human eye response more than half (52
percent) of the time (Freeberg FE and others. 1986. J. Toxicol.
Cutaneous & Ocular Toxicol. 5: 115-23). A few years later, Koch and
colleagues at the U.S. Food and Drug Administration stated that there
was no clear relationship between the rabbit eye response and the
exposure of the human eye to chemicals or products and that the Draize
test is ``plagued'' with a lack of reproducibility. (Koch WH. 1989.
Cutaneous & Ocular Toxicol. 8: 17-22). The Multicenter Evaluation of In
Vitro Cytotoxicity (MEIC) study examined the results of rat and mouse
``lethal dose'' toxicity studies--in which groups of animals are force-
fed massive doses of a chemical until half of them convulse and die.
The researchers found that rodent lethal dose tests were, at best, 65
percent predictive of acute toxicity in humans. By contrast, the MEIC
study found that a ``battery'' of four non-animal tests using human
cells was able to predict human toxicity with 84 percent accuracy (U.S.
National Toxicology Program Interagency Centre for the Evaluation of
Alternative Toxicological Methods. 2000 Sep. The Multicenter Evaluation
of In Vitro Cytotoxicity (MEIC)--Summary).
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In addition, test methods that use animals render our Federal
agencies impotent in their efforts to regulate health and environmental
hazards because the fact that these methods are not human-relevant
leads to continual--and successful--court challenges on the part of
industry.
ICCVAM's counterpart in Europe--the European Centre for the
Validation of Alternative Methods (ECVAM)--has developed and validated
a number of non-animal methods. Yet ICCVAM fails to even adopt the
ECVAM-validated methods, becoming a bottleneck for the adoption of new
methods in the United States.\2\
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\2\ In its 10-year history, it has validated only one non-animal
test method that originated in the United States.
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Worse, ICCVAM and its lead agency, the U.S. Environmental
Protection Agency (EPA), have repeatedly and blatantly violated both
the letter and the spirit of a major tenet of the Organization for
Economic Cooperation and Development (OECD) Council Decision, of which
the United States is a member. The OECD's 1981 Mutual Acceptance of
Data in the Assessment of Chemicals provides that: ``[D]ata generated
in the testing of chemicals in an OECD Member country in accordance
with OECD Test Guidelines and OECD Principles of Good Laboratory
Practice shall be accepted in other Member countries for purposes of
assessment and other uses relating to the protection of man and the
environment.''
Presented below are five specific recent examples:
1. Skin Corrosion Testing.--Two types of non-animal tests for skin
corrosion, the Transcutaneous Electrical Resistance method (OECD 430)
and human skin model studies (OECD 431), were successfully validated in
partnership with ECVAM and endorsed by ECVAM's Scientific Advisory
Committee (ESAC) in 1998, accepted by EU regulators in June 2000, and
published as OECD Test Guidelines in April 2004. The OECD specifically
accepts the tests as part of a strictly non-animal weight-of-evidence
assessment of skin corrosion. Yet ICCVAM arbitrarily insists on
confirmatory testing in rabbits of any negative results.
2. Phototoxicity Testing.--The cell-based 3T3 Neutral Red Uptake
Phototoxicity Test is also ECVAM validated, ESAC endorsed, and codified
in both EU regulations and as an OECD Test Guideline (OECD 432).
However, the regulatory acceptance of this method in the United States
remains uncertain.
3. Ocular Testing.--In 2005, ICCVAM reviewed several non-animal
methods to replace the infamous Draize test, in which chemicals are
dripped into the eyes of restrained (though not anesthetized) rabbits.
These methods (which use actual animal eyes from slaughterhouses) have
been accepted by some countries for more than a decade and are
currently accepted throughout the EU through mutual acceptance of data.
Nevertheless, ICCVAM has placed severe restrictions on their use.
4. Acute toxicity testing.--ICCVAM convened an international
workshop in 2000 to discuss a non-animal (cell-based) method that had
the potential to replace acute toxicity testing in animals. Acute
toxicity testing, otherwise known as lethal poisoning, means taking a
group of animals and forcing them to ingest or inhale a toxic substance
in increasing amounts until half of the animals die. Although this
method is almost universally recognized as an extremely cruel, crude,
and imprecise test method that causes a tremendous amount of animal
suffering, it remains the backbone of regulatory testing.
The workshop resulted in a report stating that that the cell-based
methods could be used immediately to reduce the numbers of animals
killed and that, within 3 years--given the proper funding and effort--
the method could be validated as a full replacement measure. It is now
7 years later, and ICCVAM has made no progress in implementing the
cell-based methods even as a reduction measure and has cynically
ignored its potential as a replacement measure.
5. Pyrogenicity (Fever-Inducing) Testing.--According to a March
2006 European Union press release, ECVAM ``approved six new alternative
testing methods that will reduce the need for certain drugs and
chemicals to be tested on animals. The new tests use cell cultures
rather than animals to establish the toxicity of cancer drugs and
identify contaminated drugs.'' Five of the tests replace the use of
animals in pyrogenicity testing (for fever-inducing bacteria) for which
hundreds of thousands of rabbits are currently used every year.
Despite the fact that these methods were less expensive than animal
tests and that, as stated in the news release, ``the tests approved . .
. will not only reduce the number of animals needed for testing, but
will also increase the accuracy of the tests, thereby making the
products concerned safer'' (emphasis added), ICCVAM's peer review panel
concluded that the methods were not valid as replacements for the
rabbit test.
RECOMMENDATIONS
ICCVAM follows a double standard that sets ever-increasing hurdles
for every non-animal method while accepting every animal test as the
unquestioned gold standard. Companies are now attempting to circumvent
ICCVAM, submitting their data from non-animal test methods directly to
the relevant agency to consider, knowing that it is pointless to send a
non-animal method to ICCVAM for review.
If Congress is to continue funding ICCVAM, the agency must be held
accountable for its failures to date and be required to fulfill its
mandate ``to establish, wherever feasible, guidelines, recommendations,
and regulations that promote the regulatory acceptance of new or
revised scientifically valid toxicological tests that protect human and
animal health and the environment while reducing, refining, or
replacing animal tests and ensuring human safety and product
effectiveness'' (Public Law 106-545). At the very least, there should
be reciprocity between ECVAM and ICCVAM and ICCVAM should be required
to expeditiously adopt non-animal test methods developed and validated
in Europe.
In its 2007 appropriations, Congress included report language that
required ICCVAM to develop a 5-year plan to ``identify areas of high
priority for new and revised non-animal and alternative assays or
batteries of those assays to create a path forward for the replacement,
reduction and refinement of animal tests'' by November 15, 2007 (House
Report 109-15). In December 2006, PETA, The Humane Society of the
United States, and other national animal protection organizations
submitted extensive comments to NIEHS regarding essential components of
this plan.
We respectfully request that the committee include the following
report language for fiscal year 2008: ``The committee understands that
the American animal protection community has submitted recommendations
for items to be included in ICCVAM's 5-year plan to identify areas of
high priority for new and revised non-animal and alternative assays or
batteries of those assays to create a path forward for the replacement,
reduction and refinement of animal tests. The committee requests that
these recommendations be adopted by ICCVAM or, upon presentation of the
plan to the committee by November 15, 2007, an explanation of any
exclusions of the aforementioned recommendations be included.''
Thank you for your consideration of our request.
______
Prepared Statement of the Population Association of America/Association
of Population Centers
INTRODUCTION
Thank you, Chairman Harkin, ranking member Specter, and other
distinguished members of the subcommittee, for this opportunity to
express support for the National Institutes of Health (NIH) and the
National Center for Health Statistics (NCHS)--two agencies important to
our organizations.
BACKGROUND ON THE PAA/APC AND DEMOGRAPHIC RESEARCH
The PAA is a scientific organization comprised of over 3,000
population research professionals, including demographers,
sociologists, statisticians, and economists. The APC is a similar
organization comprised of over 30 universities and research groups that
foster collaborative demographic research and data sharing, translate
basic population research for policy makers, and provide educational
and training opportunities in population studies.
Demography is the study of populations and how or why they change.
Demographers, as well as other population researchers, collect and
analyze data on trends in births, deaths, and disabilities as well as
racial, ethnic, and socioeconomic changes in populations. Major policy
issues population researchers are studying include the demographic
causes and consequences of population aging, trends in fertility,
marriage, and divorce and their effects on the health and well being of
children, and immigration and migration and how changes in these
patterns affect the ethnic and cultural diversity of our population and
the Nation's health and environment.
The NIH mission is to support research that will improve the health
of our population. The health of our population is fundamentally
intertwined with the demography of our population. Recognizing the
connection between health and demography, the NIH supports population
research programs primarily through the National Institute on Aging
(NIA) and the National Institute of Child Health and Human Development
(NICHD).
NATIONAL INSTITUTE ON AGING
According to the Census Bureau, by 2029, all of the baby boomers
(those born between 1946 and 1964) will be age 65 years and over. As a
result, the population age 65-74 years will increase from 6 percent to
10 percent of the total population between 2005 and 2030. This
substantial growth in the older population is driving policymakers to
consider dramatic changes in Federal entitlement programs, such as
Medicare and Social Security, and other budgetary changes that could
affect programs serving the elderly. Further, the macroeconomic and
global impact of population aging on competitiveness in the world
economy is becoming a bigger issue--as illustrated during the recent
Global Summit on Aging sponsored by NIA and the State Department. To
inform this debate, policymakers need objective, reliable data about
the antecedents and impact of changing social, demographic, economic,
and health characteristics of the older population. The NIA Behavioral
and Social Research (BSR) program is the primary source of Federal
support for research on these topics.
In addition to supporting an impressive research portfolio, that
includes the prestigious Centers of Demography of Aging Program, the
NIA BSR program also supports several large, accessible data surveys.
Two such surveys, the National Long-Term Care Survey (NLTCS) and the
Health and Retirement Study (HRS) have become seminal sources of
information to assess the health and socioeconomic status of older
people in the United States.
By using NLTCS data, investigators identified the declining rate of
disability in older Americans first observed in the mid-1990s. In 2006,
an analysis of the latest data found the prevalence of chronic
disability among people 65 and older fell from 26.5 percent in 1982 to
19 percent in 2004/2005. The findings suggest that older Americans'
health and function continue to improve at a critical time in the aging
of the population. If it continues, this trend could have momentous
impact on reducing the need for costly long-term care.
In 2006, NIA announced a 6-year renewal of the HRS. The HRS, now
entering its 15th year, has tracked 27,000 people, and has provided
data on a number of issues, including the role families play in the
provision of resources to needy elderly and the economic and health
consequences of a spouse's death. The Social Security Administration
recognizes and funds the HRS as one of its ``Research Partners'' and
posts the study on its home page to improve its availability to the
public and policymakers. HRS is particularly valuable because its
longitudinal design allows researchers: (1) the ability to immediately
study the impact of important policy changes such as Medicare Part D;
and (2) the opportunity to gain insight into future health-related
policy issues that may be on the horizon, such as recent HRS data
indicating an increase in pre-retirees self-reported rates of
disability.
With additional support in fiscal year 2008, the NIA BSR program
could fully fund its existing centers and support its ongoing surveys.
Additional support would allow NIA to expand the centers' role in
understanding the domestic macroeconomic as well as the global
competitiveness impact of population aging and fully fund initiatives
in fiscal year 2008 addressing financial challenges faced by older
Americans.
NIA could also use additional resources to support individual
investigator awards by precluding an 18 percent cut in competing
awards, improving its funding payline, and sustaining training and
research opportunities for new investigators.
NATIONAL INSTITUTE ON CHILD HEALTH AND HUMAN DEVELOPMENT
Since its establishment in 1968, the NICHD Center for Population
Research has supported research on population processes and change.
Today, this research is housed in the Center's Demographic and
Behavioral Sciences Branch (DBSB). The Branch encompasses research in
four broad areas: family and fertility, mortality and health, migration
and population distribution, and population composition. In addition to
funding research projects in these areas, DBSB also supports a highly
regarded population research infrastructure program and a number of
large database studies, including the Fragile Families and Child Well
Being Study and National Longitudinal Study of Adolescent Health.
NICHD-funded demographic research has consistently provided
critical scientific knowledge on issues of greatest consequence for
American families: work-family conflicts, marriage and child bearing,
childcare, and family and household behavior. However, in the realm of
public health, demographic research is having an even larger impact,
particularly on issues regarding adolescent and minority health. For
example, in 2006, researchers with the National Longitudinal Study of
Adolescent Health, reported findings illustrating that by the time they
reach early adulthood (age 19-24), a large proportion of American youth
have begun the poor practices contributing to three leading causes of
preventable death in the United States: smoking, poor diet and physical
inactivity, and alcohol abuse. This study is striking in that it found
the health situation of young people--in terms of behavior, health
conditions, and access to and use of care--deteriorates markedly
between the teen and young adult years. The study reinforces the
importance of educating young people about adopting healthy lifestyles
after they leave high school and the parental home.
Understanding the role of marriage and stable families in the
health and development of children is another major focus of the NICHD
DBSB. Consistently, research has shown children raised in stable family
environments have positive health and development outcomes. Therefore,
NICHD supports research to elucidate factors that contribute to family
formation and strong partnerships. Recent findings have identified
factors that can destabilize relationships between new parents. These
factors include serious health or developmental problems of the
parents' child, lower earnings, less education, and a father who has
other children with different mothers. A new study published in 2006
produced the first measures of multi-partnered fertility (having
children by more than one partner) in U.S. urban areas. The study found
that in 59 percent of unmarried couples with a new baby, at least one
parent had a child from another relationship. Previous research
demonstrates multi-partnered fertility has potentially serious
implications for both child well-being and marriage promotion efforts
because of the demands of existing commitments and relationships.
Policymakers and community programs can use these findings to support
unstable families and improve the health and well being of children.
With additional support in fiscal year 2008, NICHD could restore
full funding to its large-scale surveys, which serve as a resource for
researchers nationwide. Furthermore, the Institute could apply
additional resources toward improving its funding payline, which has
gone from the 20th percentile range in 2003 to the 15th percentile in
January 2007. Additional support could be used to preclude cuts of 17
percent to 22 percent in applications approved for funding and to
support and stabilize essential training and career development
programs necessary to prepare the next generation of researchers.
NATIONAL CENTER FOR HEALTH STATISTICS
Located within the Centers for Disease Control (CDC), the National
Center for Health Statistics (NCHS) is the Nation's principal health
statistics agency, providing data on the health of the U.S. population
and backing essential data collection activities. Most notably, NCHS
funds and manages the National Vital Statistics System, which contracts
with the States to collect birth and death certificate information.
NCHS also funds a number of complex large surveys to help policy
makers, public health officials, and researchers understand the
population's health, influences on health, and health outcomes. These
surveys include the National Health and Nutrition Examination Survey,
National Health Interview Survey, and National Survey of Family Growth.
Together, NCHS programs provide credible data necessary to answer basic
questions about the State of our Nation's health.
The President's fiscal year 2008 budget requests $109.9 million in
program funds for National Center for Health Statistics. This
recommendation represents an increase of $900,000 over the fiscal year
2007. Despite this modest increase, if enacted, the President's request
would only allow NCHS to purchase 10 months of vital statistics data.
Recently, PAA and APC joined 150 other organizations in sending a
letter (http://www.chsr.org/nchsletterhouse031507.pdf) to the House and
Senate Appropriations Committees expressing concern about this matter
and asking that NCHS receive $117 million in fiscal year 2008, an $8
million increase over its fiscal year 2007 level. Without at least $3
million in additional funding, the United States will become the first
industrialized Nation unable to continuously collect birth, death, and
other vital information. The full $8 million increase is necessary to
not only restore integrity and stability to the vital statistics
program, but also to restore other important data collection and
analysis initiatives and to modernize systems NCHS uses to manage and
protect its data.
RECOMMENDATIONS
PAA and APC join the Ad Hoc Group for Medical Research in
supporting an fiscal year 2008 appropriation of $30.8 billion, a 6.7
percent increase over the fiscal year 2007 appropriation, for the NIH.
We also urge the subcommittee to include language in the fiscal year
2008 bill allowing the National Children's Study to continue and to
appropriate $111 million for NCS in fiscal year 2008 through the NIH
Office of the Director.
PAA and APC, as members of the Friends of NCHS, support a fiscal
year 2008 appropriation of $117 million, a 7 percent increase over the
fiscal year 2007 appropriation, for the NCHS. This funding is needed to
maintain the Nation's vital statistics system and to sustain and update
the agency's major survey operations.
Thank you for considering our requests and for supporting Federal
programs that benefit the field of demographic research.
______
Prepared Statement of Project R&R: Release and Restitution for
Chimpanzees in U.S. Laboratories
Project R&R, whose advisory board of chimpanzee experts includes 12
organizations with a combined membership of 500,000, respectfully
submits testimony on our funding priority.
We request that Federal funding for breeding chimpanzees for
research, or for projects that require breeding, be terminated. We do
so for the following reasons:
--A ``surplus'' of chimpanzees has resulted from over-breeding in the
1980s for HIV/AIDS research and later findings that they are a
poor HIV/AIDS model.\1\
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\1\ National Research Council (1997) Chimpanzees in research:
strategies for their ethical care, management and use. National
Academies Press: Washington, D.C.
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--There are enough chimpanzees to address existing federally funded
research.\2\
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\2\ Report of the Chimpanzee Management Plan Working Group to the
National Advisory Research Resources Council; May 18, 2005.
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--As a result of the ``surplus,'' the government funds a national
sanctuary system.\3\
---------------------------------------------------------------------------
\3\ http://www.ncrr.nih.gov/compmed/cm_chimp.asp
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--The current population costs in excess of about $11 million Federal
per year.
--Breeding more chimpanzees increases taxpayers' financial burden.
--Expansion of the population compounds existing concerns about their
quality of care.
--While there is a breeding moratorium, NIH still funds research
projects requiring breeding.\4\
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\4\ Ibid.
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--The public is concerned about the use of chimpanzees in research.
BACKGROUND
Of an estimated 1,300 chimpanzees in laboratories in the United
States today, approximately 850 are federally owned or supported. In
the mid-1990s, the National Research Council (NRC) made recommendations
to address the ``surplus'' that included a moratorium on breeding
federally-owned or supported chimpanzees for at least 5 years \5\
(implemented in 1995). The National Advisory Research Resources
Council, which advises NCRR on funding activities, policies, and
program, met on 09/15/05 and recommended that NCRR extend the
moratorium to 12/07. The recommendation was accepted \6\--reasons
included the high costs associated with care and the fact that
chimpanzees are a poor model for human HIV research.\7\ \8\
---------------------------------------------------------------------------
\5\ National Research Council (1997) Chimpanzees in research:
strategies for their ethical care, management and use. National
Academies Press: Washington, D.C.
\6\ http://www.ncrr.nih.gov/compmed/cm_chimp.asp
\7\ Muchmore, E., (2001) Chimpanzee models for human disease and
immunobiology, Immunological Reviews, 183, 86-93.
\8\ Reynolds, V., (1995) Moral issues in relation to chimpanzee
field studies and experiments, Alternatives to Laboratory Animals, 23,
621-625.
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CIRCUMVENTING THE MORATORIUM
Despite the moratorium, NIH funds research projects requiring
breeding. For example, the National Institute of Allergy and Infectious
Diseases (NIAID) maintains a contract with the New Iberia Research
Center (NIRC) to provide 10 to 12 infants annually for research. The 10
year contract entitled ``Leasing of chimpanzees for the conduct of
research'' was allotted over $22 million (some $3.9 million plus has
been spent since 2002).\9\
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\9\ Source: http://dcis.hhs.gov/nih/nih_daily_active_web.html (See
contract No. 272022754)
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NIRC has also received $5.47 million from 09/00 to 08/05 for a
grant from NCRR to maintain 138 chimpanzees for breeding. NIH/NCRR
spends more than $1 million annually to maintain the NIRC breeding
colony.\10\ These grants result in $9 million going to breeding-
related activities at NIRC alone since 2000.
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\10\ http://nirc.louisiana.edu/divisions/nihgrants.html
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Such expenditures circumvent the intent of the breeding moratorium,
compelling the need to prevent the growing financial burden of
increasing numbers of chimpanzees, particularly since, by the
government's own admission, a ``surplus'' already exists.
COSTS FOR CHIMPANZEE MAINTENANCE
The cost of care for chimpanzees is a major concern, particularly
with NIH's tightening budget. In 1995, the Institute for Laboratory
Animal Research (ILAR) published a study that projected the future
costs of maintaining chimpanzees in U.S. research.\11\ ILAR, a division
of the National Academies of Science, functions as ``an advisor to the
Federal Government, the biomedical research community, and the
public.'' \12\
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\11\ Dyke, B., Williams-Blangero, S. et al, 1995 ``Future costs of
chimpanzees in U.S. research institutions,'' ILAR Journal V37(4) http:/
/dels.nas.edu/ilar_n/ilarjournal/37_4/37_4Future.shtml
\12\ Institute for Laboratory Animal Research, website at http://
dels.nas.edu/ilar_n/ilarhome/about.shtml
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The ILAR study examined the per diem costs of the existing
population of chimpanzees at six facilities. Taking into account a
variety of factors such as longevity, distribution of sex, and
complexity of care, it projected costs of maintaining the present
colony over the next 60 years. To account for inflation, an annual 4
percent increase was incorporated, corresponding approximately to the
Biomedical Research and Development Price Index.
The results of the study indicated that the lifetime cost of
maintaining chimpanzees over the next 60 years--the approximate
lifespan of chimpanzees in captivity--will exceed $3.14 billion. The
1995 projection, however, was based on a population of 1,447
chimpanzees. The present population of federally owned or supported
chimpanzees in 2007, due to factors such as the implementation of the
partial breeding moratorium in 1995, the end of the Air Force's use of
chimpanzees and the close of the Coulston Foundation in 2002 (to which
the majority of Air Force chimpanzees were sent), stands closer to 850.
This represents approximately 59 percent of the 1,447 number used in
ILAR's projection. Thus we can estimate the Federal cost of the
existing colony to be $1.85 billion. The remainder of the original
estimated $3.14 billion figure will now be carried by the U.S. public
which contributes to the private sanctuaries caring for formerly
federally owned or supported chimpanzees (minus a slight decrease in
this estimate due to mortality). Thus, the caring American public has
been burdened with the ethical obligation of some estimated $1.29
billion to care for chimpanzees from laboratories, without any further
obligation for this care placed on the laboratories themselves and with
none of these privately funded sanctuaries having, at this time, access
to Federal dollars for their chimpanzee care. Given the American
public's deep and growing concern over the use of chimpanzees in
research, the NIH's history of breeding has created a hidden, even if
self-assumed, ``tax'' for that faction of the public concerned about
the humane and ethical treatment of chimpanzees from research for which
NIH no longer assumes any financial responsibility.
The ILAR projection also concluded that the 2006 annual costs would
be approximately $18.8 million. Adjusting this number by 59 percent
results in $11 million spent in 2006 alone to maintain chimpanzees for
research.
It is important to note that $11 million represents only a partial
estimate of the entire Federal expenditure for chimpanzee research. The
total population of U.S. chimpanzees available for research is
estimated at 1,300. Approximately 500 of these chimpanzees are
privately owned. Privately owned chimpanzees are also partially funded
by Federal research dollars. Therefore, the 2006 estimate of annual
expenditure actually exceeds $11 million by an undetermined amount.
DELIVERY OF CARE
USDA inspection reports indicate that facilities housing
chimpanzees for research are not adequately meeting basic housing
needs. Inspection reports for the NIRC 2004 showed some chimpanzees
being housed in less than the minimal space requirements. The facility
was given 1 year to correct the non-compliance, which needed to be
further extended as construction of new housing facilities was still
not completed. NIRC was also cited 7 times during its 12/04 inspection
for improperly sanitizing cages and living quarters, as well as for
failing to provide adequate environment enhancement.
Inspection reports filed on the Southwest Foundation for Biomedical
Research and the Yerkes Primate Facility, both National Primate
Research Centers, also demonstrate multiple non-compliant items for
failing to keep chimpanzee areas in well-maintained condition, and
failing to maintain safe facilities free of dangers due to disrepair.
A POOR MODEL
It is widely agreed within the scientific community that
chimpanzees are a poor model for HIV. Years of research demonstrated
that HIV-infected chimpanzees do not develop AIDS. Similarly, while
chimpanzees are used in current hepatitis C research, they do not model
the course of the human disease. The decoding of the chimpanzee genome
pointed out similarities as well as differences between humans and
chimpanzees. Some of those greatest differences relate to the immune
system.\13\ Such differences question the validity of using chimpanzees
in infectious disease research, further arguing the need to curb
populations and costs.
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\13\ The Chimpanzee Sequencing and Analysis Consortium/Mikkelsen,
TS, et al., (1 September 2005) Initial sequence of the chimpanzee
genome and comparison with the human genome, Nature 437, 69-87.
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ETHICAL CONCERNS
The U.S. public is concerned about the use of chimpanzees in
research because of their intellectual, emotional and social
similarities to humans. A 2005 poll conducted by the Humane Research
Council revealed that 4 out of 5 (83 percent) of the U.S. public
recognize chimpanzees as highly intelligent, social individuals who
have an extensive capacity to communicate. A full 71 percent of
Americans support the release of chimpanzees if they have been used in
research for more than 10 years.\14\ A 2001 poll conducted by Zogby
International showed that 90 percent of Americans believe it is
unacceptable to confine chimpanzees in government-approved cages.\15\
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\14\ U.S. Public Opinion of Chimpanzee Research, Support for a Ban,
and Related Issues, Prepared for the New England Anti-Vivisection
Society, by the Humane Research Council, 2005.
\15\ Public Opinion Poll, Prepared for the Chimpanzee
Collaboratory, by Zogby International, 2001.
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CONCLUSION
We respectfully request that the following language appear in the
Senate Labor, Health and Human Services, Education and Related Agencies
Appropriations Subcommittee Report for fiscal year 2008:
``None of these funds shall be used for the breeding of chimpanzees
or research projects that require the breeding of chimpanzees.''
We hope the committee will accommodate this modest request that
will save the government substantial money, benefit chimpanzees, and
allay some concerns and financial responsibilities of the public at
large. Thank you for your consideration.
______
Prepared Statement of the Pulmonary Hypertension Association
Mr. Chairman, thank you for the opportunity to submit testimony on
behalf of the Pulmonary Hypertension Association (PHA).
I am honored today to represent the hundreds of thousands of
Americans who are fighting a courageous battle against a devastating
disease. Pulmonary hypertension (PH) is a serious and often fatal
condition where the blood pressure in the lungs rises to dangerously
high levels. In PH patients, the walls of the arteries that take blood
from the right side of the heart to the lungs thicken and constrict. As
a result, the right side of the heart has to pump harder to move blood
into the lungs, causing it to enlarge and ultimately fail.
PH can occur without a known cause or be secondary to other
conditions such as: collagen vascular diseases (i.e., scleroderma and
lupus), blood clots, HIV, sickle cell, or liver disease. PH does not
discriminate based on race, gender, or age. Patients develop symptoms
that include shortness of breath, fatigue, chest pain, dizziness, and
fainting. Unfortunately, these symptoms are frequently misdiagnosed,
leaving patients with the false impression that they have a minor
pulmonary or cardiovascular condition. By the time many patients
receive an accurate diagnosis, the disease has progressed to a late
stage, making it impossible to receive a necessary heart or lung
transplant.
PH is chronic and incurable with a poor survival rate. Fortunately,
new treatments are providing a significantly improved quality of life
for patients. Recent data indicates that the length of survival is
continuing to improve, with some patients managing the disorder for 20
years or longer.
Seventeen years ago, when three patients who were searching to end
their own isolation founded the Pulmonary Hypertension Association,
there were less than 200 diagnosed cases of this disease. It was
virtually unknown among the general population and not well known in
the medical community. They soon realized that this was unacceptable,
and formally established PHA, which is headquartered in Silver Spring,
Maryland.
Today, PHA includes:
--Over 7,000 patients, family members, and medical professionals as
members and an additional 28,000 supporters and friends.
--A network of over 140 patient support groups.
--An active and growing patient-to-patient telephone helpline.
--Three research programs that, through partnerships with the
National Heart, Lung and Blood Institute and the American
Thoracic Society, will have directed more than $6 million
toward PH research as of December, 2007.
--Numerous electronic and print publications, including the first
medical journal devoted to pulmonary hypertension--published
quarterly and distributed to all cardiologists, pulmonologists,
and rheumatologists in the United States.
--A website dedicated to providing educational and support resources
to patients, medical professionals, and the public that, over
the past 9 years, has grown from receiving 600 visitors a month
to 220,000 visitors a month.
THE PULMONARY HYPERTENSION COMMUNITY
Mr. Chairman, I am privileged to serve as the president of the
Pulmonary Hypertension Association and to interact daily with the
patients and family members who are seeking to live their lives to the
fullest in the face of this deadly, incurable disease. I would like to
share with you the stories of two remarkable PH patients, Emily Stibbs
and Charity Tillemann-Dick. Emily's and Charity's stories illustrate
the impact of pulmonary hypertension not only on PH patients, but also
on everyone who care about them.
When their daughter Emily was 5, Jack and Marcia Stibbs noticed
that she could not keep up with the other children in the neighborhood.
She seemed to lack the energy and strength to run and play. This
condition worsened to the point where she would have to stop and rest
after coming down the steps in the morning. Jack and Marcia noticed
that when she was sitting on the bottom step in the morning, Emily's
lips appeared to have a bluish color.
Jack and Marcia pressed for an answer to these problems for several
months, and Emily was finally diagnosed with pulmonary hypertension.
Doctors told the Stibbs family that Emily's probable remaining lifespan
was 3 years.
Charity Tillemann-Dick's diagnosis with pulmonary hypertension took
not months, but years. When Charity was in her late-teens, she had the
opportunity to travel abroad and share her considerable talents as a
budding opera singer at her grandfather's 75th birthday party in
Budapest. Just before the performance, Charity collapsed, but the
episode was explained away as a case of nerves.
Over the next few years, Charity continued to have occasional
fainting spells as well as a progressive loss in energy. She was
diagnosed as being everything from out of shape to anemic. When Charity
finally received an accurate diagnosis, her PH had progressed further,
and was therefore more difficult to treat, than it would have been if
she had been diagnosed while the disease was in its early stages.
I am happy to report that, with treatment, Charity has continued to
live a full and accomplished life, including performances at several
world capitals. Emily, too, has outlived her 3-year prognosis by 7
years and continues to thrive. There is, however, no cure for pulmonary
hypertension. Each day, courageous patients of every age lose their
battle with PH.
Thanks to congressional action, and to advances in medical research
largely supported by the NHLBI and other government agencies, Emily and
Charity have an increased chance of living with their pulmonary
hypertension for many more years. However, additional support is needed
for research and related activities to continue to develop treatments
that will extend the life expectancy of PH patients beyond the NIH
estimate of 2.8 years after diagnosis.
FISCAL YEAR 2008 APPROPRIATIONS RECOMMENDATIONS
National Heart, Lung and Blood Institute
Mr. Chairman, PHA commends the National Heart, Lung and Blood
Institute for its strong support of PH research, particularly through
the creation of the Specialized Centers of Clinically Oriented Research
in PH. We are very excited about the promise these Centers hold for the
development of new treatments and for progress on the road to a cure.
In addition, we applaud the NHLBI and the National Institutes of Health
Office of Rare Diseases for their co-sponsorship a two-day scientific
conference on pulmonary hypertension in December 2006. This important
event provided an opportunity for leading PH researchers from the
United States and abroad to discuss the State of the science in
pulmonary hypertension and future research directions.
According to these leading researchers, we are on the verge of
significant breakthroughs in our understanding of PH and the
development of new and advanced treatments. Twelve years ago, a
diagnosis of PH was essentially a death sentence, with only one
approved treatment for the disease. Thanks to advancements made through
the public and private sector, patients today are living longer and
better lives with a choice of five FDA approved therapies. Recognizing
that we have made tremendous progress, we are also mindful that we are
a long way from where we want to be in (1) the management of PH as a
treatable chronic disease, and (2) a cure.
One crucial step in continuing the progress we have made in the
treatment of PH is the creation of a pulmonary hypertension research
network. Such a network would link leading researchers around the
United States, providing them with access to a wider pool of shared
patient data. In addition, the network would provide researchers with
the opportunities to collaborate on studies and to strengthen the
interconnections between basic and clinical science in the field of
pulmonary hypertension research. Such a network is in the tradition of
the NHLBI, which, to its credit and to the benefit of the American
public, has supported numerous similar networks including the Acute
Respiratory Distress Syndrome Network and the Idiopathic Pulmonary
Fibrosis Clinical Research Network.
In order to maintain the important momentum in pulmonary
hypertension research that has developed over the past few years, and
to create a much needed pulmonary hypertension research network, the
Pulmonary Hypertension Association encourages the subcommittee to
provide the National Institutes of Health, particularly the NHLBI, with
a 6.7 percent increase in funding in fiscal year 2008.
Centers for Disease Control and Prevention
PHA applauds the subcommittee for its leadership over the years in
encouraging the Centers for Disease Control and Prevention to initiate
a Pulmonary Hypertension Education and Awareness Program. We know for a
fact that Americans are dying due to a lack of awareness of PH, and a
lack of understanding about the many new treatment options. This
unfortunate reality is particularly true among minority and underserved
populations. However Mr. Chairman, you don't have to rely solely on our
word regarding the need for additional education and awareness
activities. On November 11, 2005 the CDC released a long-awaited
Morbidity and Mortality Report on pulmonary hypertension. In that
report, the CDC states:
(1) ``More research is needed concerning the cause, prevention, and
treatment of pulmonary hypertension. Public health initiatives should
include increasing physician awareness that early detection is needed
to initiate prompt, effective disease management. Additional
epidemiologic initiatives also are needed to ascertain prevalence and
incidence of various pulmonary hypertension disease entities.'' (Page
1, MMWR Surveillance Summary--Vol. 54 No. SS-5)
(2) ``Prevention efforts, including broad based public health
efforts to increase awareness of pulmonary hypertension and to foster
appropriate diagnostic evaluation and timely treatment from health care
providers, should be considered. The science base for the etiology,
pathogenesis, and complications of pulmonary hypertension disease
entities must be further investigated to improve prevention, treatment,
and case management. Additional epidemiologic activities also are
needed to ascertain the prevalence and incidence of various disease
entities.'' (Page 7, MMWR Surveillance Summary--Vol. 54 No. SS-5)
Mr. Chairman, we are grateful to the CDC for their recent support
of a DVD highlighting the proper diagnosis of PH. However, despite
repeated encouragement from the subcommittee over the past 5 years, CDC
has not taken any steps to establish an education and awareness program
on PH. Therefore, we respectfully request that you provide $250,000 in
fiscal year 2008 for the establishment of a PH awareness initiative
through the Pulmonary Hypertension Association.
``Gift of Life'' Donation Initiative at HRSA
Mr. Chairman, PHA applauds the success of the Health Resources and
Services Administration's ``Gift of Life'' Donation Initiative. This
important program is working to increase organ donation rates across
the country. Unfortunately, the only ``treatment'' option available to
many late-stage PH patients is a lung, or heart and lung,
transplantation. This grim reality is why PHA established ``Bonnie's
Gift Project.''
``Bonnie's Gift'' was started in memory of Bonnie Dukart, one of
PHA's most active and respected leaders. Bonnie battled with PH for
almost 20 years until her death in 2001 following a double lung
transplant. Prior to her death, Bonnie expressed an interest in the
development of a program within PHA related to transplant information
and awareness. PHA will use ``Bonnie's Gift'' as a way to disseminate
information about PH, transplantation, and the importance of organ
donation, as well as organ donation cards, to our community.
PHA has had a very successful partnership with HRSA's ``Gift of
Life'' Donation Program in recent years. Collectively, we have worked
to increase organ donation rates and raise awareness about the need for
PH patients to ``early list'' on transplantation waiting lists. For
fiscal year 2008, PHA recommends an appropriation of $25 million (an
increase of $2 million) for this important program.
Mr. Chairman, once again thank you for the opportunity to present
the views of the Pulmonary Hypertension Association. We look forward to
continuing to work with you and the subcommittee to improve the lives
of pulmonary hypertension patients.
______
Prepared Statement of the Ryan White Title III Medical Providers
Coalition
The members of the Ryan White Title III Medical Providers Coalition
are pleased to submit this statement for the record in strong support
of a $35 million increase to Title III (Part C) of the Ryan White
Program for the fiscal year 2008 appropriations cycle. The Title III
Coalition was founded to ensure that the voices of the HIV clinicians
working on the frontlines of the AIDS epidemic in rural and urban
communities across the Nation are represented in policy and program
discussions that affect their ability to meet the medical needs of
their patients with HIV/AIDS, including the national debate over the
appropriate funding levels for the Ryan White CARE Act programs.
We formed our coalition in part to garner attention to the daily
challenges we face in finding the necessary resources to ensure that
our patients receive the comprehensive and complex medical care and
services needed to sustain their health.
Title III of the Ryan White CARE Act provides grants to support
outpatient medical services to HIV-positive individuals in underserved
communities with no other source of care and treatment. Many Title III
grants are in communities in which they are the only service providers
accessible to un- and under-insured individuals. Our clinics use Title
III funds to provide the range of services required to effectively
manage and treat HIV disease, including physician care, medications,
adherence counseling, laboratory testing, nutrition counseling and in
some cases, mental health and substance abuse treatment.
Our clinical programs are seeing increasing numbers of patients
with HIV/AIDS, with many of them presenting with serious, complex
conditions in addition to HIV disease, such as hepatitis C. We expect
this trend to increase as States implement the Centers for Disease
Control and Prevention's (CDC) recommendations for making HIV testing a
more routine component of medical care. Additional resources for
medical care, drug treatments and critical enabling services are
essential if we are to continue providing state-of-the-art HIV care to
our current patients and those newly identified with HIV disease.
As you finalize the funding recommendations for fiscal year 2008,
we urge you to provide an urgently needed increase in funding for Title
III (Part C) medical programs. After years of flat funding or decreases
in grant awards, we estimate that the true need for these programs is
an increase of at least $83.3 million over fiscal year 2007. This
amount is based on the estimated annual cost of delivering HIV-related
outpatient care ($2,414) multiplied by the current Title III caseload
(191,229) plus the number of new patients that the Health Resources and
Services Administration (HRSA) estimates will enter Title III programs
in 2008 (36,333).
We appreciate the funding constraints that the committee is facing
in determining fiscal year 2008 funding levels for a whole range of
critical health programs. Therefore, at a minimum, we urge you to
include a nominal $35 million increase for Title III housed under the
Ryan White Program, with a prioritization of increases within that $35
million to current programs with the highest increases of patient
burden. This proposed $35 million increase, albeit inadequate to
respond to the flat funding and growing caseloads that have
characterized our programs for a number of years, will help us to
continue to provide our patients with the essential medical care
necessary to preserve health and prevent disease progression.
While Title III (Part C) funds are critical to our ability to meet
the medical needs of low-income people with HIV/AIDS in our
communities, the other Titles now referred to as Parts of the Ryan
White CARE Act also are vital to supporting our HIV care systems. Many
of us receive funding from multiple parts of the Ryan White CARE Act
and use these resources to patch together a comprehensive system of
care for our patients. We strongly support the Ryan White funding
requests put forward by organizations representing other members of the
HIVAIDS community.
The HIV Medicine Association (HIVMA) and the American Academy of
HIV Medicine (AAHIVM)--together representing most HIV clinical
providers in the country--have joined forces to help assemble the Title
III Coalition. Leadership of the Coalition includes providers from a
wide range of settings, from New York City to New Orleans to Oakland,
California.
If you have questions about the coalition, please contact Andrea
Weddle at 703-299-1215 or Greg Smiley at 202-659-0699.
______
Prepared Statement of the Society for Investigative Dermatology
SUMMARY OF THE SOCIETY FOR INVESTIGATIVE DERMATOLOGY'S FISCAL YEAR 2008
RECOMMENDATIONS
A 6.7 percent increase for all of the National Institutes of Health
(NIH) and for the National Institute of Arthritis and Musculoskeletal
and Skin Diseases (NIAMS).
Establish a skin disease clinical trials network that will collect
baseline data for specific orphan diseases and facilitate the exchange
of scientific data across disciplines and institutes.
Encourage NIAMS to develop collaborative funding mechanisms with
other NIH institutes and private foundations that leverage skin biology
studies as a developmental model that will serve for the advancement of
research across a multitude of diseases and specialties.
Encourage NIAMS to sponsor studies that capture general and skin-
disease specific measures in order to generate incidence, prevalence
and quality of life data attributable to skin diseases.
Increase the number of training awards through the NIH designed to
facilitate the entry of more individuals into careers in skin disease
research.
BACKGROUND
The Society for Investigative Dermatology (SID) was founded in
1938. Its 2,000 members represent over 40 countries worldwide,
including scientists and physician researchers working in universities,
hospitals and industry.
Along with our colleagues from the American Academy of Dermatology
Association (AADA), members of the SID are dedicated to the advancement
and promotion of the sciences relevant to skin health and disease
through education, advocacy and the scholarly exchange of scientific
information.
This collective commitment to research is evidenced in the
scientific journal published by the SID, the Journal of Investigative
Dermatology (JID). The JID is a catalyst for the exchange of scientific
information pertaining to the 3,000 skin diseases that afflict nearly
80 million Americans annually.
The purpose of submitting testimony is to increase awareness of the
need for more skin research, based on the burden attributable to skin
disease. It will also highlight some of the advancements that past
support has enabled.
We join with the Ad Hoc Group for Medical Research Funding in
asking for a 6.7 percent increase for the National Institutes of Health
(NIH) and the National Institute of Arthritis and Musculoskeletal and
Skin Diseases (NIAMS).
BURDEN OF SKIN DISEASE
Prior bill report language directed NIAMS to ``consider supporting
the development of new tools to measure the burden of skin diseases,
and the training of researchers in this important area''. There are
only a handful of researchers working on NIH-sponsored research that
will provide such measures.
Skin disease impacts our citizens more than previously estimated. A
report released in 2004 by the SID and the AADA, ``The Burden of Skin
Disease'', compiled data from only 21 of the known 3,000 skin diseases
and disorders. The estimated economic costs to society each year from
those 21 diseases totaled nearly $39 billion.
The true impact extends far beyond mere economics. These patients
encounter discomfort and pain, physical disfigurement, disability,
dependency and death. Skin conditions affect an individual's ability to
interact with others and compromise the self-confidence of those
inflicted.
One of the most striking findings in the study was the lack of
general and skin-disease specific measures that are needed to generate
data surrounding the incidence, prevalence, economic burden, quality of
life and handicaps attributable to these diseases.
We ask the committee to devote the resources needed to develop
components of national health surveys that capture dermatological data
above and beyond skin cancer incidence and prevalence.
RESEARCH ADVANCES
Skin is the body's largest organ and serves as the primary barrier
to external pathogens and toxins. Researchers at the NIH campus and
institutions around the country are working diligently to define how
the skin functions to protect us, how this fails in disease, and how
compromised functions in disease can be restored.
Cell biology allows scientists to understand the life cycle of skin
and hair-producing cells and identify the causes of disease, leading to
better treatments and preventative measures. Advances in wound healing
and skin ulcers are helping the elderly, veterans and patients with
diabetes and burns. Lasers continue to provide less invasive options
for patients requiring surgery.
Fundamental discoveries resulting from skin biology and
translational research have yielded advances that are broadly
applicable to human development and disease. Continued investment is
required to fully capitalize on these ground-breaking advances.
Important new research findings include the following:
--The genes responsible for skin cancer and inherited skin diseases
have been identified, making targeted therapy possible.
--The molecular mechanisms of auto-immune and inflammatory skin
diseases are better understood, allowing for the use of
focused, selective immunosuppressive therapy with greater
safety and efficacy.
--Oral medications to treat and prevent viral and fungal diseases
have become available.
--Lasers have made possible the removal of disfiguring skin
malformations.
--Modern phototherapy and photochemotherapy allow for more effective
treatment of inflammatory skin disease, lymphoma, depigmenting
disorders and auto-immune diseases.
--Retinoids and sunscreens have reduced the risk of skin cancer in
the elderly, in transplant patients, and in other populations.
--Painless transdermal drug delivery has become available.
Recent developments in the areas of clinical epidemiology,
biostatistics, economics and the quantitative social sciences have
begun to provide objective evaluation measures, although additional and
improved measures are still desperately needed. These measures will
help to identify effective interventions and allow us to better
quantify contributions to the quality of life and health of Americans.
We ask the NIH to work to identify additional biomarkers in order
to better understand skin disease pathways and interaction with other
diseases and environmental factors.
TRANSLATING DISCOVERY TO TREATMENTS FOR AMERICANS
The goal of skin disease research is to improve the quality of life
for the one in three Americans that suffer from skin disease. That goal
is embedded in the collective missions of the SID and the intramural
and extramural scientists funded through the skin portfolios of many of
the 27 institutes and centers of the NIH.
Medical research organizations such as the SID are the direct
recipients of the awards made possible through the rigorous peer-
reviewed grant system in place at the NIH. The ultimate beneficiaries
are the nearly 80 million Americans that stand to benefit from the
discoveries resulting from research grants.
Inadequate levels of Federal funding have forced the institute
administrators to reduce certain types of the available funding
mechanisms currently in place at the NIH, to decrease success rates, to
increase administrative cost reductions, to consider decreasing the
number of awards and to cut award levels in existing programs.
Unfortunately, this reality impairs the ability of hypothesis-
driven research to drive the research system. Adequate funding levels
will allow the peer-review system to work at full potential, leading to
findings that translate into better care for those suffering from
debilitating diseases. Without sufficient funding provided specifically
for skin research, nearly one third of the Nation would be denied any
hope for a better quality of life.
We are grateful for the past support that has been given to the NIH
and ask you to look for innovative ways to avoid flat or decreased
funding levels for the institutes that are charged with improving the
health of all Americans.
______
Prepared Statement of the Society for Maternal-Fetal Medicine
Mr. Chairman and members of the committee: The Society for
Maternal-Fetal Medicine is pleased to have the opportunity to testify
on behalf of the fiscal year 2008 budget for the National Institute of
Child Health and Human Development and to extend to the committee our
appreciation for the support you have provided over the years to the
National Institutes of Health, and in particular the National Institute
of Child Health and Human Development.
Established in 1977, the Society for Maternal-Fetal Medicine (SMFM)
is a not-for-profit organization of over 2,000 members that are
dedicated to improving perinatal care through research and education.
Maternal-fetal medicine doctors have advanced knowledge of the
obstetrical, medical, genetic and surgical complications of pregnancy
and their effects on both the mother and fetus. The many advances in
research have allowed the maternal-fetal medicine physician to provide
the direct care needed to treat the special problems that high risk
mothers and fetuses face.
Having a high-risk pregnancy means that a woman has a greater
chance of complications because of conditions in her pregnancy, her own
medical status or lifestyle, or due to external factors. Many times,
complications are unexpected and may occur without warning. Other
times, there are certain risk factors that make problems more likely.
For example:
--Preterm Birth.--Preterm birth is defined as births occurring before
37 weeks of gestation. Prematurity is the leading cause of
newborn death and an estimated 20 percent of infants who
survive suffer long term consequences, including cerebral
palsy, mental retardation, and developmental delays that affect
the child's ability to do well in school. The rate of preterm
births has increased 30 percent since 1981 and in 2004, 508,000
babies were born prematurely.
Due to the growing problem of preterm birth, expanded research is
needed on the underlying causes of preterm delivery and the
development of treatments for the prevention of premature
birth. SMFM recommends that the NIH Common Fund be utilized as
a mechanism to fund research on preterm birth. As reported in
the 2006 Institute of Medicine report, ``Preterm Birth: Causes,
Consequences, and Prevention,'' a multidisciplinary research
approach is needed to better understand premature birth.
--Adverse Pregnancy Outcome in Nulliparous Women.--A recent national
study showed that the rate of preterm births among first
pregnancies has increased over 50 percent over the past decade
and comprise about 40 percent of pregnant women in the United
States. The rate of adverse pregnancy outcomes is unpredictable
and substantial. For example, at least 12 percent of these
women will have a preterm delivery, with associated high rate
of neonatal mortality and long term morbidity. The data also
revealed that women in their first pregnancy are at highest
risk for developing pre-eclampsia, which puts them at risk for
devastating maternal complications, fetal death, and preterm
delivery. Once one of these adverse outcomes has occurred,
these women are considered at increased risk in their next
pregnancy. In addition, the study also showed a racial
disparity with Black women at a two-fold higher risk than white
women. The prediction and prevention of the first adverse
outcome is problematic and there is a paucity of research on
the etiology, mechanism, and potential preventive interventions
for poor pregnancy outcomes in this population.
SMFM recommends that NICHD launch an intensive research study of
first pregnancy women in order to fill the major gap in our
knowledge for the prevention of these complications.
--Outcomes of Assisted Reproductive Technology.--The increasing use
of assisted reproductive technology (ART) over the past two
decades has allowed thousands of infertile couples to have
children, currently accounting for 1.1 percent of the total
U.S. births and 17.1 percent of U.S. multiple births (CDC,
2002). ART includes all fertility treatments in which both eggs
and sperm are handled in vitro such as in vitro fertilization
with transcervical embryo transfer, gamete and zygote
intrafallopian transfer, frozen-embryo transfer, and donor
embryo transfer. Between 1996 and 2002, the number of births
after ART treatment in the United States increased by 120
percent. ART is a significant contributor to preterm delivery
and associated risks of prematurity. There is recent evidence
of higher rates of adverse pregnancy outcomes even in singleton
pregnancies associated with ART including increased preterm and
term low birth weight, very low birth weight, preterm delivery,
fetal growth restriction, genetic disorders, and congenital
anomalies. The risks of birth defects are two times higher in
ART babies as compared with naturally conceived singleton
babies.
There is a lack of research on the mechanism for this increase in
the adverse pregnancy outcomes. There is also insufficient
research to date concerning the prevalence of adult chronic
conditions, learning and behavioral disorders, and other
reproductive effects in ART babies. Given the data for more
proximal outcomes, these long-term outcomes should also receive
further study. Preliminary results indicate that there may be
an increase incidence of autism in ART offspring.
SMFM recommends a multi-center observational prospective cohort
study on ART be conducted that would emphasize pregnancy
outcomes--short- and long-term effects on children--to
determine if the increase in adverse pregnancy outcomes are
specifically related to the ART procedures versus underlying
factors within the couple, such as coexisting maternal disease,
the causes of infertility, or differences in behavioral risk
and examine each step in the ART process to understand the
mechanism for increased adverse pregnancy outcomes.
The National Institute of Child Health and Human Development is to
be congratulated for its efforts to advance our understanding of the
magnitude of complications related to pregnancy and for its efforts to
sustain the investment in research during this time of tight budget
constraints.
--A recent study found that molecules in blood can foretell the
development of preeclampsia, a life-threatening complication of
pregnancy. This finding appears to be an important step in
developing a cure for preeclampsia.
--Researchers have developed an experimental vaccine that reduces
stillbirths among rodents born to mothers infected with
cytomegalovirus (CMV)--a common virus that can also cause
mental retardation and hearing loss in newborn children who
were infected in early fetal life.
According to NIH Director Elias Zerhouni, ``medical science has
dramatically improved our ability to help very small and premature
babies survive. But as the rate of premature births continue to rise,
it is even more critical that we develop ways to prevent many of the
complications related to prematurity so that these children can lead
healthy, robust lives.''
RECOMMENDATIONS
SMFM urges this committee to continue to provide NICHD with
sufficient funds so that the Institute can continue to make momentous
advances in research that will result in improved health of mothers and
children. We recommend:
--Fund NIH at the amount authorized for fiscal year 2008 in the NIH
Reform Act of 2006.
--Provide $1,448,544,000 for NICHD in fiscal year 2008.
--Full funding for the--
--Maternal Fetal Medicine Units Network so that it can continue to
address issues pertaining to preterm births and low birth-
weight deliveries.
--Genomics and Proteomics Network for Premature Birth, which will
hasten a better understanding behind the pathophysiology of
premature birth, discover novel diagnostic biomarkers and
ultimately aid in formulating more effective interventional
strategies to prevent premature birth.
--Stillbirth Collaborative Research Network which is addressing
stillbirth, a major public health issue with morbidity
equality to that of all infant deaths.
Thank you for allowing SMFM the opportunity to present our views to
the committee.
______
Prepared Statement of the Society for Neuroscience
INTRODUCTION
Mr. Chairman and members of the subcommittee, I am David Van Essen,
PhD, president of the Society for Neuroscience (SfN) and the Edison
Professor of Neurobiology and Head of the Department of Anatomy and
Neurobiology at Washington University in St. Louis, MO. I also
currently serve on the Advisory Council of the National Institute of
Neurological Disorders and Stroke.
I am writing in my capacity as SfN president to request your
support for biomedical research funding at the National Institutes of
Health (NIH). During the past several decades, NIH funding has allowed
the neuroscience community to improve health outcomes and the quality
of life for millions of Americans.
WHAT IS THE SOCIETY FOR NEUROSCIENCE?
SfN is a nonprofit membership organization made up of more than
36,500 basic scientists and physicians who study the brain and nervous
system. Recognizing the tremendous potential for the study of the brain
and nervous system as a separate field, the Society was formed in 1969.
Since then, SfN has grown from 500 members to the world's largest
organization of scientists devoted to the study of the brain. Today,
there are more than 300 training programs in neuroscience in the United
States alone.
Neuroscience includes the study of how the brain senses and
perceives our world, how it learns and remembers, how it controls our
movements and our emotions, how it regulates sleep and responds to
stress, how it develops and ages, and how it malfunctions in countless
neurological and psychological disorders. Neuroscience also involves
studies of the molecules, cells and genes responsible for proper
nervous system functioning.
SfN's primary goal is to advance the understanding of the brain and
the nervous system in health and disease. As such, each fall, some
30,000 scientists from around the world gather to exchange ideas about
cutting-edge research on the brain, spinal cord, and nervous system at
the Society's annual meeting.
THANK YOU FOR PAST SUPPORT
SfN would like to thank the members of this subcommittee for their
past support, which resulted in the doubling of NIH budget between 1998
and 2003. In particular, we are extremely grateful that the fiscal year
2007 Joint Resolution included an additional $620 million for NIH above
the fiscal year 2006 funding level. This additional money will allow
NIH to award an extra 500 research grants. It will also create a new
$40 million program to support innovative, outside-the-box research, as
well as $91 million for grants to first-time investigators.
MY RESEARCH
Currently, my research focuses on the structure and function of the
cerebral cortex in humans and nonhuman primates. The cerebral cortex is
the dominant structure of the human brain. It plays a key role in
mediating our perceptions of the world around us, our cognitive
capabilities, our emotions, and the control of our movements. It is
highly variable from one individual to the next and is largely
responsible for our unique personalities. Many neurological and
psychiatric disorders arise from abnormalities of the cerebral cortex
that are caused by hereditary or developmental factors or by injuries
to cortical gray matter or to the underlying white matter.
My laboratory has developed novel methods of computerized brain
mapping that allow accurate mapping of the complex convolutions of the
cerebral cortex and accurate comparisons between individuals. Using
these methods, we have worked with many collaborators to characterize
patterns of cortical development in prematurely born human infants and
abnormalities of cortical folding in specific disorders, including
William's Syndrome, autism, and schizophrenia. We have compared humans
and in macaque monkeys (an intensively studied nonhuman primate), in
order to better understand the differences that reflect the dramatic
evolution of the human brain as well as the similarities that reflect
common principles of cortical structure and function. In addition, my
laboratory is active in the newly emerging field of neuroinformatics;
we have developed a database and related tools to help neuroscientists
communicate their discoveries and share their experimental data more
effectively, thereby accelerating the pace of discovery and the
efficiency of the neuroscience research enterprise.
NIH-FUNDED RESEARCH SUCCESSES
Today, scientists have a greatly improved understanding of how the
brain functions thanks to NIH-funded research. To illustrate this
progress SfN has created a 36-part series, called Brain Research
Success Stories, which discuss some of the progress that has resulted
from Federal funding for biomedical research. The following are just a
few areas where our research efforts have helped the American public:
(1) Down Syndrome.--About one out of every 800 babies is born with
Down Syndrome (DS) a disorder that includes a combination of birth
defects such as mental retardation, certain physical distinctions, and
an increased risk of several medical conditions, including heart
problems, intestinal malformations, and visual or hearing impairments.
DS often results in high medical and non-medical costs, such as
special education, rehabilitation, and other services. Data from 1992
suggests that each new case of DS costs over $450,000 each year.
NIH-funded research has led to the development of several medical
tests that help identify whether a pregnant woman is carrying a baby
with DS. These tests allow parents to prepare themselves mentally and
financially, and give them time to secure intervention programs that
can aid in their child's development.
Once a child is born, research shows that early intervention
programs can benefit those with DS. For example, adolescents with DS
who received intervention programs early in life had significantly
higher scores on measures of intellectual functioning than a comparison
group. Such improvements might help those with DS live more
independently and maintain a job later in life.
(2) Schizophrenia.--This disease affects nearly 2 million
Americans, and costs the United States over $32 billion a year in lost
productivity and treatment. This devastating brain disorder torments
sufferers with hallucinations, delusions, disordered thinking patterns,
and memory deficits.
In the past, many individuals with schizophrenia became permanently
lost to the social withdrawal and other behavioral problems
characteristic of this disease, which is rooted in abnormal biology of
the brain. However, thanks to NIH-funded research, new treatments, such
as clozapine, have been developed.
Today's medications have fewer side effects and are more effective
than older treatments. They help to quell the psychotic symptoms of
schizophrenia, allowing patients to function more effectively in
society. The medications also appear to cut the financial burden of the
disease, decreasing hospital stays and treatment costs.
(3) Amyotrophic Lateral Sclerosis.--Each year, 5,000 Americans are
diagnosed with the progressive neurological disease, called amyotrophic
lateral sclerosis (ALS), also known as Lou Gehrig's disease. The cost
of treating these people is $300 million annually. ALS takes a quick
toll on sufferers. Affected individuals may first notice muscle
weakness, twitching, or cramping. The disease then progressively
disables a person's ability to walk, talk, or swallow and, ultimately,
to breathe. Many spend their last days completely unable to move, while
their minds remain alert. ALS usually occurs in midlife and kills
patients within 3 to 5 years of occurrence.
Government-funded ALS research produced a number of important
findings in the early 1990s. First, researchers were able to start
pinning down how the disease progresses by identifying the role of the
potentially toxic amino acid glutamate. ALS sufferers tend to have
higher levels of this chemical messenger in certain parts of their
body, and scientists have noted that nerve cells exposed to high
concentrations of glutamate over a long time start to die.
Researchers were able to use this basic research discovery to
develop riuzole, an anti-glutamate drug that extends the lives of ALS
patients. The first drug shown to change the course of ALS, it was
approved by the Food and Drug Administration in 1995. In 1993,
researchers supported by NIH identified a genetic component of the
hereditary form of ALS and subsequently developed an animal model for
ALS. This has allowed researchers to advance their study of the disease
and to test dozens of potential treatments.
RESEARCH IMPROVES HEALTH AND FUELS THE ECONOMY
Diseases of the nervous system pose an enormous public health and
economic challenge, as they directly affect nearly one in three
Americans at some point in life, and indirectly affect nearly everyone
by the adverse impact on family and friends. Understanding how the
brain and nervous system develops, works, and ages--in health and
disease--is the goal of neuroscientists. Improved health outcomes and
positive economic data support the assertion that biomedical research
is needed today to improve public health and save money tomorrow.
Research drives innovation and productivity, creates jobs, and fuels
local and regional economies.
Not only does research save lives and fuel today's economy, it is
also a wise investment in the future. For example, 5 million Americans
suffer from Alzheimer's disease today, and the cost of caring for these
people is staggering. Medicare expenditures are $91 billion each year,
and the cost to American businesses exceeds $60 billion annually,
including lost productivity of employees who are caregivers. As the
baby boom generation ages and the cost of medical services increases,
these figures will only grow. Treatments that could delay the onset and
progression of the disease by 5 years could save $50 billion in
healthcare costs each year. Research funded by the NIH is critical for
the development of such treatments. The cost of investing in NIH today
is minor compared to both current and future healthcare costs.
PRESIDENT'S BUDGET NEGATIVELY IMPACTS RESEARCH
SfN is disappointed that the Bush administration's fiscal year 2008
budget proposes to cut funding for the National Institutes of Health by
more than a half billion dollars in fiscal year 2008.
Mr. Chairman, inflation has eaten into the NIH budget. The NIH now
projects the Biomedical Research and Development Price Index (BRDPI)
may increase by 3.7 percent for both fiscal year 2007 and fiscal year
2008; 3.6 percent for fiscal year 2009 and 2010; and 3.5 percent for
fiscal year 2011 and fiscal year 2012. Unfortunately, the President's
budget for NIH did not factor in the increases in biomedical research
inflation.
Several years of funding for NIH that are well below inflation
rates has made efficient research planning difficult, led to a slower
rate of research progress, and delayed the payoffs from recent
scientific advances. As you know, basic research projects take years
from conception to completion. Many excellent research projects have
been curtailed in recent years because of the low percent age of grants
receiving funding. In order to have maximum impact in our search to
understand and treat disorders, we need a consistent, adequate level of
funding. Without such a strategy, the Federal Government runs the great
risk of spending many more dollars later on in medical costs and time
lost from work. In recent months, we have been speaking with leaders in
the biotechnology and pharmaceutical industries, who depend on NIH-
funded discoveries a vital prelude to and driver of their product
development efforts. They agree that rather than considering funding
for NIH an expense, it should be considered an investment to address
problems our country will face tomorrow.
We need a funding stream that keeps pace with the potential for
advances that will help people lead healthier, more productive lives.
NIH became the premier biomedical research institution it is today only
through sustained support from congressional leaders, like you, to
invest in the best facilities, research, and projects selected through
a non-political, rigorous, and competitive peer review system that is
envied and is now being emulated around the world.
FISCAL YEAR 2008 BUDGET REQUEST
NIH funded research saves lives and fuels the U.S. economy.
Further, sustained investment in the NIH will lead to more effective
treatments that will lessen future healthcare costs for the baby boom
generation. Unfortunately, inflation and relatively flat funding have
eaten into the NIH budget.
The Society for Neuroscience supports a 6.7 percent increase in
funding for NIH per year for each of the next 3 fiscal years. This
increase translates to an additional $1.9 billion for NIH in fiscal
years 2008, 2009, and 2010.
This sustained increase is necessary to make-up for lost purchasing
power that has occurred in the past 3 years. In addition, increased
funding will help NIH to achieve future research goals by, among other
things, helping to ensure that our best and brightest young people will
enter the field and continue to make neuroscience research advances
that are so vital to achieving a healthier Nation and a robust economy.
Mr. Chairman, thank you for the opportunity to submit testimony
before this subcommittee.
______
Prepared Statement of the Society of Teachers of Family Medicine;
Association of Departments of Family Medicine; Association of Family
Medicine Residency Directors; and North American Primary Care Research
Group
HEALTH PROFESSIONS: PRIMARY CARE MEDICINE AND DENTISTRY (TITLE VII,
SECTION 747)
We request that this committee fund the Primary Care Medicine and
Dentistry Cluster (section 747 of Title VII) at no less than the fiscal
year 2005 level of $88.8 million. This cluster received $48.9 million
in the final fiscal year 2007 spending resolution, but the President's
budget for fiscal year 2008 eliminates Title VII Health Professions
Grants, except for $10 million in Scholarships for Disadvantaged
Students.
In fiscal year 2006, funding for the health professions programs
was cut dramatically. The primary care medicine and dentistry cluster
was cut by 54 percent. The effect was to prevent any new competitive
grant applications for that year and to cut the funding of those grants
that were continuing in their second or third year. This year, instead
of providing the committee with national studies regarding the
effectiveness of these programs, we would like to put a human face to
the impact of the cuts in fiscal year 2006. Below are anecdotes
received from across the country showing, in their own words, how the
institutions that apply for and receive these grants were affected by
the loss of almost $50 million of Federal funding.
University of Iowa, Department of Family Medicine.--At Iowa, we
furloughed 5 individuals (that means let them go) related to our
educational and academic mission. We have had to shift funding from
other core areas and reduce or eliminate programs that focused mostly
on primary care fellowship training, academic development, preceptor
education development and travel support to rural Iowa communities. Our
department had consistently received about $800,000 to $1,000,000 a
year over the last 30 years and now we have none of that support. Paul
James, MD, Chair, Department of Family Medicine
University of Buffalo, Department of Family Medicine.--Here at the
University at Buffalo we have laid off a PhD Clinical Psychologist who
had been with the Department for 9 years. He participated actively in
our clerkship training and in our residency training. He taught both
students and residents about helping patients change behaviors (quit
smoking, etc) and trained residents in dealing with difficult or non-
compliant patients as well as the more difficult and time consuming
issues of long term family therapy. We also laid off a master degree
medical education specialist. We are the only medical school department
to have had a person like this on our staff but she assured that our
exams measured the goals of our training and our curriculum taught to
these goals. Tom Rosenthal, MD, Chair, Department of Family Medicine
Tufts University, Division of Family Medicine.--At Tufts, we hired
three minority faculty to increase the diversity of our faculty and now
we will have to let go of one of them and reduce the time significantly
of the other two because of our loss of funding. We also have an
educational program that teaches students how to interview patients who
do not speak English through a medical interpreter. We will have to cut
that program as well. Wayne Altman, MD FAAFP
Montana Family Medicine Residency.--Many of our successes,
including the integration of a top notch primary care mental illness
management and collaborative program and a Northern Plains Indian
cultural education program, have been possible only through Title VII
funding. Our growth as a rather isolated residency--the only one in the
State in any specialty, and remote from our affiliated University--is
dependent on grant programs that are specifically designed for family
medicine resident training . . . Geographically isolated programs like
ours in Montana and also Alaska, and Wyoming also need to develop their
own infra-
structure . . . Roxanne Fahrenwald MD, Director, Montana Family
Medicine Residency.
University of North Carolina, Department of Family Practice.--We
cut one of our objectives [in our continuation grant] because there was
not enough money to pay for it. It was a session on health disparities
that we intended to introduce to all of our clerkship students, and
then have them look at the issue during their clinical experience in a
practice. The money we had intended to pay for the faculty involved was
eliminated and she had to make it up from patient care time. Bob
Gwyther, MD
Thomas Jefferson University, Department of Family and Community
Medicine.--. . . . Predoctoral--Unable to expand our rural Physician
Shortage Area Program (which has successfully increased the rural
physician supply in Pennsylvania) to the State of Delaware; and unable
to develop and implement new curricula focusing on vulnerable
populations in the areas of health literacy, oral health, domestic
violence, and medical professionalism. Howard Rabinowitz, MD [This
entry was extracted from a longer list of six program areas that were
deeply affected by these cuts]
WWAMI (a Partnership Between the University of Washington School of
Medicine and the States of Wyoming, Alaska, Montana, and Idaho).--We
have had some programmatic impacts on the faculty development
fellowship program across the five WWAMI States. For us the impact of
the funding cut was having to eliminate the support for a second year
of training that would have exported fellows' projects to other
programs and nationally. This was the opportunity to make use of what
they had gained in the fellowship year in a way that solidified their
learning and spread that learning to others. These changes meant the
discipline, the region, and BHP [Bureau of Health Professions] didn't
get to reap the benefit of these physicians' activities. In a sense
they lost the public good beyond the training of the individual
faculty. [emphasis added] Finally we lost the chance to see if that new
model worked. Ardis Davis, MSW
THE AGENCY FOR HEALTH CARE RESEARCH AND QUALITY (AHRQ)
We request funding of $350 million for AHRQ in fiscal year 2008.
This is an increase of $31 million over fiscal year 2007, and $20
million more than the President's fiscal year 2008 budget request. It
should be noted however that a much larger investment should be made,
as recommended by The Institute of Medicine's report, Crossing the
Quality Chasm: A New Health System for the 21st Century (2001). It
recommended $1 billion a year for AHRQ to ``develop strategies, goals,
and actions plans for achieving substantial improvements in quality in
the next 5 years . . .'' The report looked at redesigning health care
delivery in the United States. AHRQ is a linchpin in retooling the
American health care system.
For the last several years, funding for AHRQ has remained
relatively stagnant, while it's portfolio of work has increased
dramatically. Our researchers are finding that investigator-initiated
grants are very difficult to obtain. In their own words, this is the
status of AHRQ funding:
Brown University, Department of Family Medicine.--AHRQ funds so
little new research we discourage people from applying to them. They
could fund practice innovation; networks; new models of care; guideline
research; doctor-patient communication research; electronic health
record research. Jeffrey Borkan, MD, Chair
University of Connecticut, Department of Family Medicine.--A
general plea for more ``investigator initiated'' research at AHRQ is
very important. Most of their funds recently have been targeted to
special initiatives and the new or experienced health services
researcher is getting discouraged because there is no money to fund
good ideas that develop a line of research. When I was on the study
section I saw a lot of good, fundable research go unfunded because of
pay lines. This will dry up the pipeline of HSR researchers. The
agency's funding level needs to be re-expanded . . . to enable the REAL
health services research and quality-of-care/outcomes research to
proceed (especially as there is, more than ever, a huge need to
restructure the delivery of healthcare, and a need to measure the
outcomes of those changes) Rob Cushman, MD Chair, and Judith Fifield,
PhD
Oregon Health and Sciences University, Department of Family
Medicine.--Lately, I know AHRQ has had a difficult time funding K-award
for junior researchers. Last year, they went three cycles without
funding anyone. This lack of funding will have a grave affect on
building the research infrastructure for primary care and health
services research. Specific to R03 and R01 awards, they have been
unable to fund countless worthy projects. In Oregon, we've had a lot of
State policy experiments that desperately need further study, but
applications to AHRQ have been rejected. Jennifer E. DeVoe, MD, DPhil
NATIONAL INSTITUTES OF HEALTH (NIH)
This is the first time that our organizations have made a request
for funding for the NIH. Historically, much of the work that has been
done at NIH hasn't been open to the kinds of questions that family
medicine researchers have been concerned about. We are encouraged by
the development of the NIH Roadmap and the Clinical and Translational
Science Awards (CTSA), along with the establishment, in statute, of a
funding stream for the common fund that NIH is moving to becoming a
more fertile arena for family medicine and other primary care research.
Hence, we support the Ad Hoc Group for Medical Research and others'
call for an increase in NIH funding by 6.7 percent in each of the next
3 years. However, there are major strides we believe NIH needs to make
to ensure that the promise of bench to bedside research truly becomes
bench to bedside to community--and back. What do we mean by that? In
their own words:
University of Connecticut, Department of Family Medicine.--Adding
more ``action research'', in which the community (including, but not
exclusively, the community clinicians) participates more in the
definition of the problem, the design of the solution, and the
dissemination and management of the results as they evolve, could
augment the impactfulness of the eventual findings. Rob Cushman, MD,
Chair
University of Buffalo, Department of Family Medicine.--I think
Family Medicine would like to see more opportunities for PBRN and
community based participatory research approaches to further the
translation of research from bedside to patient. In parallel, current
study sections are heavily weighted with bench and clinical trial
researchers. Having more family medicine researchers participate on
review boards will help get more of these types of grants funded. Tom
Rosenthal, MD, Chair
University of Massachusetts, Department of Family Medicine and
Community Health.--As for NIH, trying to sell real-world interventions
that may not be scientifically pure but answer relevant questions for
improving care to study sections remains a challenge. Many editorials
have been written about the lack of applicability of much RCT evidence
to real-world practice situations because the populations have been so
carefully selected that they are not remotely representative of primary
care patients. Furthermore, for primary care researchers, the need to
choose a disease or organ and focus narrowly to succeed at NIH is quite
problematic--research affecting primary care needs to focus on
patients, providers, and processes . . . Barry Saver, MD, MPH
CONCLUSION
We hope that the committee will be able, with the more generous
figures included in the fiscal year 2008 House and Senate Budget
Resolutions this year, to fund increases in these three important
programs: health professions primary care medicine and dentistry
training, AHRQ, and NIH. Certainly, at a minimum, we request that
funding cuts to the health professions primary care medicine and
dentistry training program be restored to at least fiscal year 2005
levels of $88.8 million. As a reminder however, these programs were
funded at a historic high of $93 million in fiscal year 2002, and we
support a return to that figure.
______
Prepared Statement of the Society for Women's Health Research and
Women's Health Research Coalition
On the behalf of the Society for Women's Health Research and the
Women's Health Research Coalition, we are pleased to submit the
following testimony in support of Federal funding of biomedical
research at NIH and, more specifically, an investment into women's
health research.
The Society for Women's Health Research is the only national non-
profit women's health organization whose mission is to improve the
health of women through research, education, and advocacy. Founded in
1990, the Society brought to national attention the need for the
appropriate inclusion of women in major medical research studies and
the need for more information about conditions affecting women
disproportionately, predominately, or differently than men. In 1999,
the Women's Health Research Coalition was created by the Society as a
grassroots advocacy effort consisting of scientists, researchers, and
clinicians from across the country that are concerned and committed to
improving women's health research.
The Society and Coalition are committed to advancing the health of
women through the discovery of new and useful scientific knowledge. We
believe that sustained funding for biomedical and women's health
research programs conducted and supported across the Federal agencies
is absolutely essential if we are to meet the health needs of the
population and advance the Nation's research capability.
NATIONAL INSTITUTES OF HEALTH
From decoding the human genome to elucidating the scientific
components of human physiology, behavior, and disease, scientists are
unearthing exciting new discoveries which have the potential to make
our lives and the lives of our families longer and healthier. The
National Institutes of Health (NIH) has facilitated these advances by
conducting and supporting our Nation's biomedical research.
Congressional investment and support for NIH has made the United States
the world leader in medical research and has provided a direct and
significant impact on women's health research and the careers of women
scientists over the last decade.
Great strides and advancements have been made since the doubling of
the NIH budget from $13.7 billion in 1998 to $27 billion in 2003.
However, we are concerned that the momentum driving new research has
been eroded under the current budgetary constraints. Medical research
must be considered an essential investment--an investment in thousands
of newly trained and aspiring scientists; an investment to remain
competitive in the global marketplace; and an investment in our
Nation's health. A large majority of Americans believe they are
receiving the highest quality and latest advancements in health care
and they depend upon Congress to make a strong investment in biomedical
research at NIH to continue that expectation.
Unfortunately, the administration's fiscal year 2008 budget request
of $28.6 billion for NIH is unraveling the successes gained from the
doubling of NIH's budget. NIH only truly receives $28.3 billion in the
proposed budget due to the transfer of $300 million to the Global Fund
to Fight HIV/AIDS. Further, the proposed budget actually represents a
decrease of $511 million when compared to the amount provided for NIH
research activities in the fiscal year 2007 continuing resolution. Not
only does the proposed decrease not keep pace with the inflation rate,
but it is lower than that of the Biomedical Research and Development
Price Index.
Without a robust budget, NIH will be forced to reduce the number of
grants it is able to fund. In this current fiscal year, 500 fewer
grants would have been funded by NIH had it not received additional
funding under the fiscal year 2007 continuing resolution. The number of
new grants funded by NIH has already been dropping steadily since
fiscal year 2003 and this trend must stop. This shrinking pool of
available grants has a significant impact on scientists who depend upon
NIH support to cover their salaries and laboratory expenses to conduct
high quality biomedical research. Failure to obtain a grant results in
reduced likelihood of achieving tenure. This means that new and less
established researchers will be forced to consider other careers, with
the end result being the loss of the critical workforce so desperately
needed to sustain America's cutting edge in biomedical research.
In order to continue the momentum of scientific advancement and
expedite the translation of research from the laboratory to the
patient, the Society calls for a 6.7 percent increase over fiscal year
2007 actual budget for the NIH for fiscal year 2008. In addition, we
request that Congress strongly encourage the NIH to assure that women's
health research receives resources sufficient to meet the health needs
of all women.
Scientists have long known of the anatomical differences between
men and women, but only within the past decade have they begun to
uncover significant biological and physiological differences. Sex-based
biology, the study of biological and physiological differences between
men and women, has revolutionized the way that the scientific community
views the sexes. Sex differences play an important role in disease
susceptibility, prevalence, time of onset and severity and are evident
in cancer, obesity, coronary heart disease, immune dysfunction, mental
health disorders, and other illnesses. Congress recognizes the
importance of this research and should support NIH at an appropriate
level of funding and direct NIH to continue expanding research into
sex-based biology.
OFFICE OF RESEARCH ON WOMEN'S HEALTH
The NIH Office of Research on Women's Health (ORWH) has a
fundamental role in coordinating women's health research at NIH,
advising the NIH Director on matters relating to research on women's
health; strengthening and enhancing research related to diseases,
disorders, and conditions that affect women; working to ensure that
women are appropriately represented in research studies supported by
NIH; and developing opportunities for and support of recruitment,
retention, re-entry and advancement of women in biomedical careers.
ORWH has a pivotal role within the NIH structure and beyond to maintain
and advance not only biomedical research in women's health but also
careers of women in science and medicine. ORWH co-chaired a task force
with the Director of NIH examining a report by the National Academies
of Science regarding women in medicine and science. It is through ORWH
that many initiatives can be achieved to strengthen the position of
women scientists. Further, ORWH strives to address sex and gender
perspectives of women's health and women's health research, as well as
differences among special populations of women across the entire life
span, from birth through adolescence, reproductive years, menopausal
years and elderly years.
Two highly successful programs supported by ORWH that are critical
to furthering the advancement of women's health research are Building
Interdisciplinary Research Careers in Women's Health (BIRCWH) and
Specialized Centers of Research on Sex and Gender Factors Affecting
Women's Health (SCOR). These programs benefit the health of both women
and men through sex and gender research, interdisciplinary scientific
collaboration, and provide tremendously important support for young
investigators in a mentored environment.
The BIRCWH program is an innovative, trans-NIH career development
program that provides protected research time for junior faculty by
pairing them with senior investigators in an interdisciplinary mentored
environment. What makes BIRCWH so unique is that it bridges advanced
training with research independence across scientific disciplines. It
is expected that each scholar's BIRCWH experience will culminate in the
development of an established independent researcher in women's health.
The BIRCWH has released four RFAs (1999, 2001, 2004, and 2006). Since
2000, 287 scholars have been trained (76 percent women) in the 24
centers resulting in over 882 publications, 750 abstracts, 83 NIH
grants and 85 awards from industry and institutional sources. Each
BIRCWH receives approximately $500,000 a year, most of which comes from
the ORWH budget.
The SCOR program, administered by the National Institute of
Arthritis and Musculoskeletal and Skin Diseases, was developed by ORWH
in 2000 through an initial RFA that resulted in 11 SCOR Centers out of
36 applications. SCORs are designed to increase the transfer of basic
research findings into clinical practice by housing laboratory and
clinical studies under one roof. The program was designed to complement
other federally supported programs addressing women's health issues
such as BIRCWH. The eleven SCOR programs are conducting
interdisciplinary research focused on major medical problems affecting
women and comparing gender difference to health and disease. Each SCOR
works hard to transfer their basic research findings into the clinical
practice setting. A second RFA is due to be funded in 2007 with
virtually no hope of expanding or matching the number of current SCOR
programs, due to anticipated budget shortfalls. Each program costs
approximately $1 million per year.
Despite the advancement of women's health research and ORWH's
innovative programs to advance women scientists, it received a $15,000
decrease for fiscal year 2007 after having also received a cut of
$249,000 for fiscal year 2006 from the Office of the Director. It is
unconscionable to cut the funds from this critical program at NIH. This
research is vital to women and men and we implore Congress to direct
NIH to continue its support of ORWH and its programs.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
The Department of Health and Human Services (HHS) has several
offices that enhance the focus of the government on women's health
research. Agencies with offices, advisors or coordinators for women's
health or women's health research are the Department of HHS, the Food
and Drug Administration, the Centers for Disease Control and
Prevention, the Agency for Healthcare Quality and Research, the Indian
Health Service, the Substance Abuse and Mental Health Services
Administration, the Health Resources and Services Administration, and
the Centers for Medicare and Medicaid Services. These agencies need to
be funded at levels adequate for them to perform their assigned
missions. We ask that the committee report clarify that Congress
supports the permanent existence of these various offices and would
like to see them appropriately funded to insure that their programs can
continue and be strengthened in the coming fiscal year.
HHS OFFICE OF WOMEN'S HEALTH
The HHS Office of Women's Health (OWH) is the Government's champion
and focal point for women's health issues. It works to redress
inequities in research, health care services, and education that have
historically placed the health of women at risk. The OWH coordinates
women's health efforts in HHS to eliminate disparities in health status
and supports culturally sensitive educational programs that encourage
women to take personal responsibility for their own health and
wellness. An extraordinary program initiated by the OWH is the National
Centers of Excellence in Women's Health (CoEs).
Developed in 1996, the CoE's offer a new model for university-based
women's health care. Selected on a competitive basis, the current
twenty CoEs throughout the country seek to improve the health of all
women across the lifespan through the integration of comprehensive
clinical health care, research, medical training, community outreach
and public education, and medical school faculty leadership
development. The CoEs are able to reach a more diverse population of
women, including more women of color and women beyond their
reproductive years. However, CoEs are vulnerable to pressures of
obtaining adequate funding and having to compete for scarce resources.
A CoE designation by the OWH is critical not only to patients and
surrounding communities but also to establishing foundation and other
non-government funding. The CoEs must continue to exist and must have
their funding assured if women are to be able to continue to access
quality care through the life cycle. It is our understanding that the
funding for CoEs is being cut in fiscal year 2007 and 2008. This must
not happen.
In fiscal year 2006, OWH received a $1 million decrease in its
budget, bringing it to $28 million, and in fiscal year 2007 under the
continuing resolution it was flat funded at the fiscal year 2006 level.
The President's proposed fiscal year 2008 budget decreases OWH funding
by $1 million again, bringing the budget down to $27 million. We urge
Congress to provide an increase of $2 million for the HHS OWH, to bring
funding back up to the fiscal year 2005 level. This will allow OWH to
continue and to sustain and expand the National Centers of Excellence
in Women's Health.
AGENCY FOR HEALTHCARE AND RESEARCH QUALITY
The Agency for Healthcare Research and Quality (AHRQ) is the lead
Public Health Service Agency focused on health care quality, including
coordination of all Federal quality improvement efforts and health
services research. AHRQ's work serves as a catalyst for change by
promoting the results of research findings and incorporating those
findings into improvements in the delivery and financing of health
care. This important information provided by AHRQ is brought to the
attention of policymakers, health care providers, and consumers who can
make a difference in the quality of health care that women receive.
AHRQ has a valuable role in improving health care for women.
Through AHRQ's research projects and findings, lives have been saved
and underserved populations have been treated. For example, women
treated in emergency rooms are less likely to receive life-saving
medication for a heart attack. AHRQ funded the development of two
software tools, now standard features on hospital electrocardiograph
machines that have improved diagnostic accuracy and dramatically
increased the timely use of ``clot-dissolving'' medications in women
having heart attacks.
While AHRQ has made great strides in women's health research, the
administration's budget for fiscal year 2008 could threaten such life-
saving research. Even with the administration's proposed budget for
fiscal year 2008, which includes an $11 million increase, this does not
address the major shortfall which this Agency has been operating under
for years. Furthermore, this budget increase is targeted for a specific
program and does not help to address the lack of funding that the
women's health office has experienced for years. If instead a budget of
$319 million were enacted, AHRQ would be virtually flat funded for the
fifth year in a row at fiscal year 2007 levels. Flat funding seriously
jeopardizes the research and quality improvement programs that Congress
demands or mandates from AHRQ.
We encourage Congress to fund AHRQ at $443 million for fiscal year
2008. This will ensure that adequate resources are available for high
priority research, including women's health care, gender-based
analyses, Medicare, and health disparities.
In conclusion, Mr. Chairman, we thank you and this committee for
its strong record of support for medical and health services research
and its unwavering commitment to the health of the Nation through its
support of peer-reviewed research. We look forward to continuing to
work with you to build a healthier future for all Americans.
______
Prepared Statement of the Spina Bifida Association
SUMMARY
On behalf of the more than 70,000 individuals and their families
who are affected by Spina Bifida--the Nation's most common, permanently
disabling birth defect--the Spina Bifida Association (SBA) appreciates
the opportunity to submit written testimony for the record regarding
fiscal year 2008 funding for the National Spina Bifida Program and
other related Spina Bifida initiatives.
SBA respectfully requests that the subcommittee provide the
following allocations in fiscal year 2008 to help improve quality-of-
life for people with Spina Bifida:
(1) $7 million to the National Spina Bifida Program at the National
Center on Birth Defects and Developmental Disabilities at the Centers
for Disease Control and Prevention (CDC) to support existing program
initiatives and allow for the further development of the National Spina
Bifida Patient Registry; and
(2) $200,000 to the Agency for Healthcare and Quality to support
its validation of quality patient treatment data measures for the
National Spina Bifida Patient Registry.
As you may know, these funding requests are supported by a broad
bipartisan group of Members of Congress, including congressional Spina
Bifida caucus leaders, Representatives Bart Stupak, Chris Smith, Ileana
Ros-Lehtinen, and Dan Burton, among many others.
COST OF SPINA BIFIDA
It is important to note that the lifetime costs associated with a
typical case of Spina Bifida--including medical care, special
education, therapy services, and loss of earnings--are as much as $1
million. The total societal cost of Spina Bifida is estimated to exceed
$750 million per year, with just the Social Security Administration
payments to individuals with Spina Bifida exceeding $82 million per
year. Moreover, tens of millions of dollars are spent on medical care
paid for by the Medicaid and Medicare Programs. Our Nation must do more
to help reduce the emotional, financial, and physical toll of Spina
Bifida on the individuals and families affected. Efforts to reduce and
prevent suffering from Spina Bifida help to save money and save lives.
IMPROVING QUALITY-OF-LIFE THROUGH THE NATIONAL SPINA BIFIDA PROGRAM
SBA has worked with Members of Congress to ensure that our Nation
is taking all the steps possible to prevent Spina Bifida and diminish
suffering for those currently living with this condition. With
appropriate, affordable, and high-quality medical, physical, and
emotional care, most people born with Spina Bifida likely will have a
normal or near normal life expectancy. The National Spina Bifida
Program at the CDC works on two critical levels--to reduce and prevent
Spina Bifida incidence and morbidity and to improve quality-of-life for
those living with Spina Bifida. The program seeks to ensure that what
is known by scientists is practiced and experienced by the 70,000
individuals and families affected by Spina Bifida. Moreover, the
National Spina Bifida Program works to improve the outlook for a life
challenged by this complicated birth defect--principally identifying
valuable therapies from in-utero throughout the lifespan and making
them available and accessible to those in need.
The National Spina Bifida Program serves as a national center for
information and support to help ensure that individuals, families, and
other caregivers, such as health professionals, have the most up-to-
date information about effective interventions for the myriad primary
and secondary conditions associated with Spina Bifida. Among many other
activities, the program helps individuals with Spina Bifida and their
families learn how to treat and prevent secondary health problems, such
as bladder and bowel control difficulties, learning disabilities,
depression, latex allergy, obesity, skin breakdown and social and
sexual issues. Children with Spina Bifida often have learning
disabilities and may have difficulty with paying attention, expressing
or understanding language, and grasping reading and math. All of these
problems can be treated or prevented, but only if those affected by
Spina Bifida--and their caregivers--are properly educated and taught
what they need to know to maintain the highest level of health and
well-being possible. The National Spina Bifida Program's secondary
prevention activities represent a tangible quality-of-life difference
to the 70,000 individuals living with Spina Bifida with the goal being
living well with Spina Bifida.
One way to increase research in Spina Bifida, improve quality and
save precious resources is to establish a patient registry for Spina
Bifida. Plans are underway to create the National Spina Bifida Patient
Registry intended to determine both the best practices clinically and
the cost effectiveness of treatment of Spina Bifida and the support the
creation of quality measures to improve care overall. It is only
through research towards improved care that we can truly save lives
while realizing a significant cost savings.
In fiscal year 2007, SBA requested $6 million be allocated to the
National Spina Bifida Program to support and expand the National Spina
Bifida Program. Although the House version o the fiscal year 2007 LHHS
appropriations bill provided the $6 million request; the fiscal year
2007 Continuing Appropriations Resolution provided $5.025 million
(level funding) for this program. SBA understands and appreciates that
the Congress and the Nation face difficult budgetary challenges.
However, the progress being made by the National Spina Bifida Program
must be sustained and expanded to ensure that people with Spina
Bifida--over the course of their lifespan--have the support and access
to quality care they need and deserve. To that end, SBA advocates that
Congress allocate $7 million in fiscal year 2008 to the National Spina
Bifida Program it can continue its current scope of the work and
increase its folic acid awareness and Spina Bifida prevention efforts,
further develop the National Spina Bifida Patient Registry, and sustain
the National Spina Bifida Clearinghouse and Resource Center. Increasing
funding for the National Spina Bifida Program will help ensure that our
Nation continues to mount a comprehensive effort to prevent and reduce
suffering from Spina Bifida.
PREVENTING SPINA BIFIDA
While the exact cause of Spina Bifida is unknown, over the last
decade, medical research has confirmed a link between a woman's folate
level before pregnancy and the occurrence of Spina Bifida. Sixty-five
million women are at-risk of having a child born with Spina Bifida and
each year approximately 3,000 pregnancies in this country are affected
by Spina Bifida, resulting in 1,500 births. The consumption of 400
micrograms of folic acid daily prior to becoming pregnant and
throughout the first trimester of pregnancy can help reduce incidence
of Spina Bifida up to 75 percent. There are few public health
challenges that our Nation can tackle and conquer by three-fourths in
such a straightforward fashion. However, we must still be concerned
with addressing the 25 percent of Spina Bifida cases that cannot be
prevented by folic acid consumption, as well as ensuring that all women
of childbearing age--particularly those most at-risk for a Spina Bifida
pregnancy--consume adequate amounts of folic acid prior to becoming
pregnant.
The good news is that progress has been made in convincing women of
the importance of folic acid consumption and the need to maintain diet
rich in folic acid. Since 1968, the CDC has led the Nation in
monitoring birth defects and developmental disabilities, linking these
health outcomes with maternal and/or environmental factors that
increase risk, and identifying effective means of reducing such risks.
This public health success should be celebrated, but it is only half of
the equation as approximately 3,000 pregnancies still are affected by
this devastating birth defect. The Nation's public education campaign
around folic acid consumption must be enhanced and broadened to reach
segments of the population that have yet to heed this call--such an
investment will help ensure that as many cases of Spina Bifida can be
prevented as possible.
SBA works collaboratively with CDC, the March of Dimes and the
National Council on Folic Acid to increase awareness of the benefits of
folic acid, particular for those at elevated risk of having a baby with
neural tube defects (those who have Spina Bifida themselves or those
who have already conceived a baby with Spina Bifida). With additional
funding in fiscal year 2008 these activities could be expanded to reach
the broader population in need of these public health education, health
promotion, and disease prevention messages. SBA advocates that Congress
provide additional funding to CDC to allow for a particular public
health education and awareness focus on at-risk populations (e.g.
Hispanic-Latino communities) and health professionals who can help
disseminate information about the importance of folic acid consumption
among women of childbearing age.
In addition to a $7 million fiscal year 2008 allocation for the
National Spina Bifida Program, SBA supports a fiscal year 2008
allocation of $137.6 million for the NCBDDD so the agency can enhance
its programs and initiatives to prevent birth defects and developmental
disabilities and promote health and wellness among people with
disabilities.
IMPROVING HEALTH CARE FOR INDIVIDUALS WITH SPINA BIFIDA
The mission of the Agency for Healthcare Research and Quality
(AHRQ) is to improve the outcomes and quality of health care; reduce
its costs; improve patient safety; decrease medical errors; and broaden
access to essential health services. The work conducted by the agency
is vital to the evaluation of new treatments in order to ensure that
individuals and their families living with Spina Bifida continue to
receive the high quality health care that they need and deserve--SBA
urges the subcommittee to allocate $200,000 in fiscal year 2008 to AHRQ
so the agency can continue to support and expand the development of a
National Spina Bifida Patient Registry. This funding will allow AHRQ to
direct and lead the effort to validate quality patient treatment data
measures for the National Spina Bifida Patient Registry, which will
help improve the quality of care provided throughout the Nation's
system of Spina Bifida Clinics. In addition, SBA recommends that AHRQ
receive an overall funding allocation of $350 million in fiscal year
2008 so that it can continue to conduct follow-up efforts to evaluate
Spina Bifida treatments and sustain and expand its myriad initiatives
to improve quality of health care throughout the Nation.
SUSTAIN AND SEIZE SPINA BIFIDA RESEARCH OPPORTUNITIES
Our Nation has benefited immensely from our past Federal investment
in biomedical research at the National Institutes of Health (NIH). SBA
joins with the rest of the public health and research community in
advocating that NIH receive a 6.7 percent increase ($30.869 billion) in
fiscal year 2008. This funding will support applied and basic
biomedical, psychosocial, educational, and rehabilitative research to
improve the understanding of the etiology, prevention, cure and
treatment of Spina Bifida and its related conditions. In addition, SBA
requests that the subcommittee include language in the report
accompanying the fiscal year 2008 LHHS measure to:
--Urge the National Institute of Child Health and Human Development
(NICHD)--expansion of its role--and support of--a more
comprehensive Spina Bifida research portfolio;
--Commend the National Institute of Diabetes and Digestive and Kidney
Diseases (NIDDK) for its interest in exploring issues related
to the neurogenic bladder and to encourage the institute to
forge ahead with its work in this important topic area; and
--Encourage the National Institute of Neurological Diseases and
Stroke (NINDS) to continue and expand its research related to
the treatment and management of hydrocephalus.
CONCLUSION
SBA stands ready to work with the subcommittee and other Members of
Congress to advance policies that will reduce and prevent suffering
from Spina Bifida. Again, we thank you for the opportunity to present
our views on funding for programs that will improve the quality-of-life
for the 70,000 Americans and their families living with Spina Bifida
and stand ready to answer any questions you may have.
______
Prepared Statement of The AIDS Institute
The AIDS Institute, a national public policy research, advocacy,
and education organization, is pleased to comment in support of
critical HIV/AIDS and Hepatitis programs as part of the fiscal year
2008 Labor, Health, and Education and Related Services appropriation
measure. We thank you for your consistent support of these programs
over the years, and trust you will do your best to adequately fund them
in the future in order to provide for, and protect the health of many
Americans.
HIV/AIDS
HIV/AIDS remains one of the world's worst health pandemics in
history. In the United States, according to the CDC, an estimated 1.2
million people have been infected, 40,000 new infections each occur
each year, and 531,000 people have died.
Persons of minority races and ethnicities are disproportionately
affected by HIV/AIDS. African Americans, who make up approximately 13
percent of the United States population, account for half of the HIV/
AIDS cases. HIV/AIDS also disproportionately affects the poor, and
about 70 percent of those infected rely on public health care
financing.
The U.S. Government has played a leading role in fighting AIDS,
both here and abroad. The vast majority of the discretionary programs
supporting HIV/AIDS efforts domestically and a portion of our Nation's
contribution to the global AIDS effort are funded through your
subcommittee. The AIDS Institute, working in coalition with other AIDS
organizations, have developed funding request numbers for each of these
domestic and global AIDS programs. The AIDS Institute asks that you do
your best to adequately fund these programs at the requested level.
We are keenly aware of budget constraints and competing interests
for limited dollars. Unfortunately, despite the growing need, almost
all domestic HIV/AIDS programs in recent years have experienced funding
decreases, and in fiscal year 2007 all programs except one part of the
Ryan White program were flat funded by the Joint Resolution.
This year, the President has proposed increases to three new
domestic HIV/AIDS programs: $25 million for the AIDS Drug Assistance
Program (ADAP); $6.3 million for early treatment Ryan White programs;
and $63 million for HIV testing. The AIDS Institute applauds this and
encourages the committee to fund them. The President has proposed a $6
million decrease for Ryan White AIDS Education and Treatment Centers
(AETCs) and $30 million to implement the Early Diagnosis Grant Program.
The AIDS Institute opposes these proposals and asks you to as well.
RYAN WHITE CARE ACT
[In millions of dollars]
------------------------------------------------------------------------
Amount
------------------------------------------------------------------------
Fiscal year:
2007................................................ 2,112
2008 President's Request............................ 2,133
2008 Community Request.............................. 2,794
------------------------------------------------------------------------
The centerpiece of the government's response to caring and treating
low-income individuals with HIV/AIDS are those programs funded under
the Ryan White CARE Act. CARE Act programs currently reach over 571,000
low-income, uninsured, and underinsured people each year. Providing
care and treatment for those who have HIV/AIDS is not only
compassionate, but is cost-effective in the long run, and serves as a
tool in prevention of HIV/AIDS.
In fiscal year 2007, all programs except Part B base funding, were
flat funded. This is on top of many years of funding decreases, except
for minor increases for ADAP. It is now time to reverse these funding
decreases and provide these vitally important programs with the
community requested level of funding. Consider the following:
(1) Caseload levels are increasing. People are living longer due to
lifesaving medications; there are 40,000 new infections each year; and
the CDC has recommended routine voluntary HIV testing in all healthcare
settings for everyone from the ages of 13 to 64. CDC estimates its
proposed $63 million testing initiative will result in 31,000 new
infections being diagnosed. All of this will necessitate the need for
more CARE Act services and medications.
(2) The price of healthcare, including medications, is increasing
and Medicaid benefits are being scaled-back at both the State and
Federal levels.
(3) Funding under the recently reauthorized CARE Act is being
distributed through a different formula which, without additional
funding, will result in many cities and States losing funding. While
some jurisdictions are experiencing increases, others are receiving
decreases. Congress can help limit the drastic funding losses caused by
formula changes by increasing the overall funding levels.
(4) ADAP funding shortfalls are causing States to place clients on
waiting lists, limiting drug formularies, and increasing eligibility
requirements. In January 2007, four States reported having waiting
lists, totaling 558 people. In the State of South Carolina there are
540 people on its waiting list. Six other ADAPs reported other cost
containment measures, including three with capped enrollment and others
with formulary reductions, eligibility restrictions and limiting annual
client expenditures. Since ADAP received no increase last year and a
mere $2.2 million the year before, severe restrictions are anticipated
in many States across the country.
(5) Two reports conclude there are a staggering number of people in
the United States who are not receiving life-saving AIDS medications.
The Institute of Medicine report ``Public Financing and Delivery of
HIV/AIDS Care, Securing the Legacy of Ryan White'' concluded that
233,069 people in the United States who know their HIV status do not
have continuous access to antiretrovirals. A study by the CDC titled,
``Estimated number of HIV-infected persons eligible for and receiving
antiretroviral therapy, 2003 United States'', reached similar
conclusions. According to the CDC, 212,000, or 44 percent of eligible
people living with HIV/AIDS, aged 15-49 in the United States, are not
receiving antiretroviral therapy.
Fiscal Year 2007 Administration Proposals.--While we appreciate the
$25 million increase for ADAP proposed by the administration, it is far
from the $233 million that is truly needed. As we seek to provide
lifesaving medications to those abroad, we must ensure we are providing
medications to our own in the United States. The administration has
also proposed to increase funding for Part C (Title III) early
treatment programs by $6.3 million. Again, while this increase is
appreciated, it is far short of the increased need of $88 million for
funding over 360 community-based primary health clinics and public
health providers.
The President has proposed an unprecedented decrease of $6 million
for AIDS Education and Treatment Centers (AETCs), which train more than
100,000 people per year. The new CARE Act now requires them to add
trainings on Hepatitis B and C and culturally competent training for
Native American and Alaska Native populations. To meet current needs,
AETCs require a $15.3 million increase.
Funding increases for other Ryan White CARE Act programs are also
urgently needed. While patient caseloads increase, over the past 5
years, Part A (Title I) has been cut by $15 million, over the past 4
years Part C (Title III) has been cut by $5 million, and Part D (Title
IV) by $2 million.
Part A, which used to cover 51 urban areas most affected by HIV/
AIDS, now includes 56 areas, but received no increased funds, meaning
there will be less money to go around. They are requesting an increase
of $236 million. Part B Base, which provides funds to the States
received an increase of $70 million in fiscal year 2007, but still
lacks the adequate levels and is requesting an increase of $57 million.
Title IV, which funds HIV care, psychosocial and other essential
services to women, infants, children and youth, is requesting an
increase of $46 million. The AIDS Institute also supports an increase
of $6 million to Dental Reimbursement and Partnerships Programs.
The AIDS Institute supports continued and increased funding for the
Minority AIDS Initiative (MAI). MAI funds services nationwide that
address the disproportionate impact that HIV has on communities of
color.
CENTERS FOR DISEASE CONTROL AND PREVENTION--HIV PREVENTION AND
SURVEILLANCE
[In millions of dollars]
------------------------------------------------------------------------
Amount
------------------------------------------------------------------------
Fiscal year:
2007................................................... 652
2008 President's Request............................... 745
2008 Community Request................................. 1,049
------------------------------------------------------------------------
While the number of new HIV infections in the United States has
greatly decreased since the 1980's, there are still an estimated 40,000
new infections each year. As with other domestic AIDS programs,
prevention funding is severely lagging and CDC's AIDS funding has
declined in the last 5 years. It is not surprising given the budget
decreases, the goal of reducing the infection rate in half by 2005 was
not reached.
Fiscal Year 2008 Administration Proposals.--The AIDS Institute is
in strong support of the President's proposed increase of $63 million
to support HIV testing of more than 2 million people, mostly African-
Americans, in 10 jurisdictions with the highest rates of new
infections, as well as the incarcerated and injecting drug users.
Knowledge of one's HIV status, particularly for high risk individuals,
is an effective prevention tool. Approximately one-quarter of the over
1 million people living with HIV in the United States (252,000 to
312,000 persons) are unaware of their HIV status. This initiative
should help prevent future infections and bring more people into
lifesaving treatment and care. The AIDS Institute urges the committee
to fund this extremely worthy program.
The administration is also proposing $30 million to implement the
Early Diagnosis Grant Program, as called for by the new CARE Act. No
State currently meets the grant conditions, which go beyond current CDC
testing recommendations. We recommend that this funding be spent on
other CDC HIV/AIDS prevention programs.
While The AIDS Institute supports increased testing programs, we do
not support funding these efforts at the expense of prevention
intervention programs, which are already under funded.
Efforts to improve prevention methods and weed out non-effective
programs should be a constant undertaking and be guided by science and
fact based decision-making. It is for these reasons The AIDS Institute
opposes abstinence-only until marriage programs, for which the
President requested a $28 million increase. While we support
abstinence-based prevention programs as part of a comprehensive
prevention message, there is no scientific proof that abstinence-only
programs are effective. On the contrary, they reject proven prevention
tools, such as condoms, and fail to address the needs of homosexuals,
who can not marry, and who remain greatly impacted by HIV/AIDS.
NATIONAL INSTITUTES OF HEALTH--AIDS RESEARCH
[In millions of dollars]
------------------------------------------------------------------------
Amount
------------------------------------------------------------------------
Fiscal year:
2007................................................... 2,903
2008 President's Request............................... 2,905
2008 Community Request................................. 3,200
------------------------------------------------------------------------
Through the NIH, research is conducted to understand the AIDS virus
and its complicated mutations; discover new drug treatments; develop a
vaccine and other prevention programs such as microbicides; and
ultimately, a cure. Much of this work at the NIH is done in cooperation
with private funding. The critically important work performed by the
NIH not only benefits those in the United States, but the entire world.
This research has already helped in the development of many highly
effective new drug treatments, prolonging the lives of millions of
people. As neither a cure nor a vaccine exists, and patients continue
to build resistance to existing medications, additional research must
continue. We ask the committee to fund critical AIDS research at the
community requested level of $3.2 billion.
SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION
Many persons infected with HIV also experience drug abuse and/or
mental health problems, and require the programs funded by SAMHSA.
Given the growing need for services, we are disappointed by proposed
funding cuts at SAMHSA, including $47 million for the Center for
Substance Abuse Treatment, $36 million for the Center for Substance
Abuse Prevention, and $76 million for the Center for Mental Health
Services. We ask the committee to reject these cuts, and adequately
fund these programs
VIRAL HEPATITIS
Viral Hepatitis, whether A, B, or C, is an infectious disease that
also deserve increased attention by the Federal Government. According
to the CDC, there are an estimated 1.25 million Americans chronically
infected with Hepatitis B, and 60,000 new infections each year.
Although there is no cure, a vaccine is available, and a few treatment
options are available. An estimated 4.1 million (1.6 percent) Americans
have been infected with Hepatitis C, of whom 3.2 million are
chronically infected. Currently, there is no vaccine and very few
treatment options. It is believed that one-third of those infected with
HIV are co-infected with Hepatitis C.
Given these numbers, we are disappointed the administration is
calling for continued level funding of $17.5 million for Viral
Hepatitis at the CDC. This amount is less than what was funded in
fiscal year 2003 and falls short of the $50 million that is needed.
These funds are needed to establish a program to lower the incidence of
Hepatitis through education, outreach, and surveillance, and to support
such initiatives as the CDC National Hepatitis C Prevention Strategy
and the 2002 NIH Consensus Statement on the Management of Hepatitis C
and accompanying recommendations.
The administration is proposing to cut the 317 Immunization Grant
Program funds that serve as the major source in the public sector for
at-risk adult immunizations. Instead of facing cuts, this cost-
effective program should be significantly enhanced in order to protect
people from Hepatitis A and B. We recommend funding the 317 Program at
$802 million for fiscal year 2008 in order to fully realize the public
health benefits of immunization.
The AIDS Institute asks that you give great weight to our testimony
and remember it as you deliberate over the fiscal year 2008
appropriation bill. Should you have any questions or comments, feel
free to contact Carl Schmid, Director of Federal Affairs, The AIDS
Institute, 1705 DeSales Street, NW, Washington, DC 20036; (202) 462-
3042; cschmid@theaidsinstitute.org. Thank you very much.
______
Prepared Statement of The Humane Society Legislative Fund
The Humane Society Legislative Fund (HSLF) supports a strong
commitment by the Federal Government to research, development,
standardization, validation and acceptance of non-animal and other
alternative test methods. We are also submitting our testimony on
behalf of The Humane Society of the United States and The Procter &
Gamble Company. Thank you for the opportunity to present testimony
relevant for the fiscal year 2008 budget request for the National
Institute of Environmental Health Sciences (NIEHS) for the fiscal year
2008 activities of the National Toxicology Program Center for the
Evaluation of Alternative Toxicological Test Methods (NICEATM), the
support center for the Interagency Coordinating Committee for the
Validation of Alternative Test Methods (ICCVAM).
In 2000, the passage of the ICCVAM Authorization Act into Public
Law 106-545, created a new paradigm for the field of toxicology. It
requires Federal regulatory agencies to ensure that new and revised
animal and alternative test methods be scientifically validated prior
to recommending or requiring use by industry. An internationally agreed
upon definition of validation is supported by the 15 Federal regulatory
and research agencies that compose the ICCVAM, including the EPA. The
definition is: ``the process by which the reliability and relevance of
a procedure are established for a specific use.''
FUNCTION OF THE ICCVAM
The ICCVAM performs an invaluable function for regulatory agencies,
industry, public health and animal protection organizations by
assessing the validation of new, revised and alternative toxicological
test methods that have interagency application. After appropriate
independent peer review of the test method, the ICCVAM recommends the
test to the Federal regulatory agencies that regulate the particular
endpoint the test measures. In turn, the Federal agencies maintain
their authority to incorporate the validated test methods as
appropriate for the agencies' regulatory mandates. This streamlined
approach to assessment of validation of new, revised and alternative
test methods has reduced the regulator burden of individual agencies,
provided a ``one-stop shop'' for industry, animal protection, public
health and environmental advocates for consideration of methods and set
uniform criteria for what constitutes a validated test methods. In
addition, from the perspective of animal protection advocates, ICCVAM
can serve to appropriately assess test methods that can refine, reduce
and replace the use of animals in toxicological testing. This function
will provide credibility to the argument that scientifically validated
alternative test methods, which refine, reduce or replace animals,
should be expeditiously integrated into Federal toxicological
regulations, requirements and recommendations.
HISTORY OF THE ICCVAM
The ICCVAM is currently composed of representatives from the
relevant Federal regulatory and research agencies. It was created from
an initial mandate in the NIH Revitalization Act of 1993 for NIEHS to
``(a) establish criteria for the validation and regulatory acceptance
of alternative testing methods, and (b) recommend a process through
which scientifically validated alternative methods can be accepted for
regulatory use.'' In 1994, NIEHS established the ad hoc ICCVAM to write
a report that would recommend criteria and processes for validation and
regulatory acceptance of toxicological testing methods that would be
useful to Federal agencies and the scientific community. Through a
series of public meetings, interested stakeholders and agency
representatives from all 14 regulatory and research agencies, developed
the NIH Publication No. 97-3981, ``Validation and Regulatory Acceptance
of Toxicological Test Methods.'' This report, and subsequent revisions,
has become the sound science guide for consideration of new, revised
and alternative test methods by the Federal agencies and interested
stakeholders.
After publication of the report, the ad hoc ICCVAM moved to
standing status under the NIEHS' NICEATM. Representatives from Federal
regulatory and research agencies and their programs have continued to
meet, with advice from the NICEATM's Advisory Committee and independent
peer review committees, to assess the validation of new, revised and
alternative toxicological methods. Since then, several methods have
undergone rigorous assessment and are deemed scientifically valid and
acceptable. In addition, the ICCVAM is working to streamline assessment
of methods from the European Union (EU) that have already been
validated for use within the EU. The open public comment process, input
by interested stakeholders and the continued commitment by the Federal
agencies has led to ICCVAM's success. It has resulted in a more
coordinated review process for rigorous scientific assessment of the
validation of new, revised and alternative test methods.
REQUEST FOR COMMITTEE REPORT LANGUAGE
In 2006, the NICEATM/ICCVAM at the request of the U.S. Congress
began a process of developing a 5-year roadmap for assertively setting
goals to prioritize ending the use of antiquated animal tests for
specific endpoints. The HSLF and other national animal protection
organizations provided extensive comments on the process and priorities
for the roadmap.
While the stream of methods forwarded to the ICCVAM for assessment
has remained relatively steady, it is imperative that the ICCVAM take a
more proactive role in isolating areas where new methods development is
on the verge of replacing animal tests. These areas should form a
collective call by the Federal agencies that compose ICCVAM to fund any
necessary additional research, development, validation and validation
assessment that is required to eliminate the animal methods. We also
strongly urge the NICEATM/ICCVAM to closely coordinate research,
development and validation efforts with its European counterpart, the
European Centre for the Validation of Alternative Methods (ECVAM) to
ensure the best use of available funds and sound science. This
coordination should also reflect a willingness by the Federal agencies
comprising ICCVAM to more readily accept validated test methods
proposed by the ECVAM to ensure industry has a uniform approach to
worldwide chemical safety evaluation.
We respectfully request the subcommittee consider the following
report language for the Senate Labor, Health and Human Services,
Education and Related Agencies Appropriations bill to ensure that the
5-year roadmap is completed in a timely manner:
``The committee commends the National Interagency Center for the
Evaluation of Alternative Methods/Interagency Coordinating Committee on
the Validation of Alternative Methods (NICEATM/ICCVAM) for commencing a
process for developing a 5-year plan to research, develop, translate
and validate new and revised non-animal and other alternative assays
for integration of relevant and reliable methods into the Federal
agency testing programs. The 5-year plan shall be used to prioritize
areas, including tiered testing and evaluation frameworks, which have
the potential to most significantly and rapidly reduce, refine or
replace laboratory animal methods. The committee directs a transparent,
public process for developing this plan and recommends the plan be
presented to the committee by November 15, 2007. Funding for completing
the 5-year plan shall not reduce the NICEATM/ICCVAM appropriation.''
______
Prepared Statement of The Humane Society of the United States
On behalf of The Humane Society of the United States (SUS) and our
more than 10 million supporters nationwide, we appreciate the
opportunity to provide testimony on our top funding priority for the
Labor, Health and Human Services, Education and Related Agencies
Subcommittee in fiscal year 2008. We are also submitting our testimony
on behalf of The Humane Society Legislative Fund (HSLF). Thank you for
the opportunity to present testimony relevant for the fiscal year 2008
budget request.
BREEDING OF CHIMPANZEES FOR RESEARCH
The HSUS requests that no Federal funding be appropriated for
breeding of chimpanzees for research, or for research that requires
breeding of chimpanzees, for the following reasons:
--The National Center for Research Resources has a publicly-declared
moratorium (extended until December 2007) on breeding
chimpanzees which prohibits breeding of federally owned or
supported chimpanzees or NIH funding of projects that require
chimpanzee breeding (NCRR written communication, February 28,
2006).
--The United States currently has a surplus of chimpanzees available
for use in research due to overzealous breeding for HIV
research and subsequent findings that they are a poor HIV
model.\1\
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\1\ NRC (National Research Council) (1997) Chimpanzees in research:
strategies for their ethical care, management and use. National
Academies Press: Washington, D.C.
---------------------------------------------------------------------------
--The cost of maintaining chimpanzees in laboratories is exorbitant,
totaling between $4.7 and $9.3 million each year for the
current population of approximately 800 federally owned or
supported chimpanzees ($15-39 per day per chimpanzee; $500,000
per chimpanzee's 50-year lifetime). Breeding of additional
chimpanzees into laboratories will only perpetuate a number of
burdens on the government--up to 60 years per chimpanzee born
into the system.
--Expansion of the chimpanzee population in laboratories only creates
more concerns than presently exist about their quality of care.
--Use of chimpanzees in research raises strong public concerns.
BACKGROUND AND HISTORY
Beginning in 1995, the National Research Council (NRC) confirmed a
chimpanzee surplus and recommended a moratorium on breeding of
federally owned or supported chimpanzees,\1\ who now number
approximately 800 of the 1,300 total chimpanzees available for research
in the United States. According to a National Research Resources
Advisory Council September 15, 2005 meeting, the National Center for
Research Resources (NCRR) of NIH extended the moratorium until December
2007 because of high costs of chimpanzee care, lack of existing colony
information, and failure of chimpanzees as a model, such as for HIV.
Further, it has also been noted that ``a huge number'' of chimpanzees
were not being used in active research protocols and were therefore
``just sitting there.'' \2\ NCRR will be making a decision this year as
to whether the breeding moratorium should continue. There is no
justification for breeding of additional chimpanzees for research;
therefore The HSUS hopes that NCRR will continue the moratorium into
the future. Importantly, however, lack of Federal funding for breeding
will ensure that no breeding of federally owned or supported
chimpanzees for research will occur in fiscal year 2008.
---------------------------------------------------------------------------
\2\ Cohen, J. (2007) Biomedical Research: The Endangered Lab Chimp.
Science. 315:450-452.
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Furthermore, despite the moratorium on breeding, there are cases in
which the moratorium is not being obeyed, further prompting the need
for congressional action.
DEVIATIONS FROM THE MORATORIUM
Despite the NCRR breeding moratorium, which prohibits breeding of
federally owned or supported chimpanzees or NIH funding of projects
that require chimpanzee breeding (NCRR written communication, February
28, 2006), chimpanzee breeding is still being funded by NIH. For
example, the National Institute of Allergy and Infectious Diseases
maintains a contract with New Iberia Research Center in Louisiana to
provide 10 to 12 infant chimpanzees annually for research projects. The
10-year contract entitled ``Leasing of chimpanzees for the conduct of
research'' has been allotted over $22 million, with $3.9 million
awarded since its inception in September 2002.
CONCERNS REGARDING CHIMPANZEE CARE IN LABORATORIES
Inspections conducted by the U.S. Department of Agriculture
demonstrate that basic chimpanzee housing requirements are often not
being met. Inspection reports for three federally funded chimpanzee
facilities reported housing of chimpanzees in less than minimal space
requirements, inadequate environmental enhancement for primates, and/or
general disrepair of facilities. Problems at three major chimpanzee
research facilities add further argument against the breeding of even
more chimpanzees.
CHIMPANZEES HAVE OFTEN BEEN A POOR MODEL FOR HUMAN HEALTH RESEARCH
The scientific community recognizes that chimpanzees are poor
models for HIV because chimpanzees do not develop AIDS. Similarly,
though chimpanzees do not model the course of the human Hepatitis C
virus, they continue to be widely used for this research. According to
the chimpanzee genome, some of the greatest differences between
chimpanzees and humans relate to the immune system,\3\ calling into
question the validity of infectious disease research using chimpanzees.
---------------------------------------------------------------------------
\3\ The Chimpanzee Sequencing and Analysis Consortium/Mikkelsen,
TS, et al., (1 September 2005) Initial sequence of the chimpanzee
genome and comparison with the human genome, Nature 437, 69-87.
---------------------------------------------------------------------------
ETHICAL AND PUBLIC CONCERNS ABOUT CHIMPANZEE RESEARCH
Chimpanzee research raises serious ethical issues, particularly
because of their extremely close similarities to humans in terms of
intelligence and emotions. Americans are clearly concerned about these
issues: 90 percent believe it is unacceptable to confine chimpanzees
individually in government-approved cages; 71 percent believe that
chimpanzees who have been in the laboratory for over 10 years should be
sent to sanctuary for retirement (chimpanzees can live to be 60 years
old); \4\ and 54 percent believe that it is unacceptable for
chimpanzees to ``undergo research which causes them to suffer for human
benefit.'' \5\
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\4\ 2006 poll conducted by the Humane Research Council for Project
Release & Restitution for Chimpanzees in laboratories.
\5\ 2001 poll conducted by Zogby International for the Chimpanzee
Collaboratory.
---------------------------------------------------------------------------
We respectfully request the following committee bill or report
language: ``The committee directs that no funds provided in this act be
used to support the breeding of chimpanzees for research or to support
research that requires breeding of chimpanzees.''
We appreciate the opportunity to share our views for the Labor,
Health and Human Services, Education and Related Agencies
Appropriations Act for fiscal year 2008. We hope the committee will be
able to accommodate this modest request that will save the government a
substantial sum of money, benefit chimpanzees, and allay some concerns
of the public at large. Thank you for your consideration.
______
Prepared Statement of the Trust for America's Health
Trust for America's Health (TFAH), a national non-profit,
nonpartisan organization dedicated to saving lives by protecting the
health of every community and working to make disease prevention a
national priority, is pleased to provide the subcommittee with the
following testimony. In order to provide the resources to build a 21st
century public health system that gives all communities a strong
defense against today's health threats, TFAH identifies a number of
programs essential to achieving this goal.
BOLSTERING THE NATION'S ABILITY TO DETECT AND CONTROL INFECTIOUS
DISEASES SUCH AS PANDEMIC INFLUENZA
Pandemic Preparedness ($1.542 billion, $350 million over the
President's request).--In November 2005, the President requested a
total of $7.1 billion to respond to an influenza pandemic. To date,
Congress has appropriated just over $6 billion of that request. We were
pleased that the fiscal year 2008 budget proposal would honor that
commitment with an additional $1.2 billion for pandemic preparedness
activities, including making improvements in vaccine technology and
manufacturing; stockpiling antivirals, diagnostics and medical
supplies; developing contingency planning; enhancing risk
communication; and enhancing global and domestic health surveillance.
The emergency supplemental passed by the House and Senate contains
$625 million of the $870 in one-time pandemic flu funding recommended
in the President's fiscal year 2008 budget proposal, primarily for
purchasing antiviral medications and medical supplies. In addition,
there is a need for an ongoing annual investment, particularly at the
CDC, to ensure that preparedness efforts are sustained and effective.
These activities require funding beyond the life cycle of the
supplemental appropriations vehicles. TFAH supports the remaining $245
million in one-time pandemic flu funding not included in the emergency
supplemental; and $322 million for ongoing pandemic preparedness
activities in the Department of Health and Human Services, which
includes $158 million at the CDC.
Further, we support $350 million in annual recurring funding for
State and local pandemic preparedness activities. States would use this
funding to exercise response plans, make revisions and updates to
plans, and build medical surge capacity. In the midst of a pandemic, it
could be difficult to shift resources from one part of the country to
another, so every jurisdiction must be prepared. In fiscal year 2006,
Congress provided $600 million in one-time funding for State and local
pandemic preparedness, but this funding will expire at the end of
fiscal year 2007, and no such funds have been requested for fiscal year
2008.
GLOBAL DISEASE DETECTION
Global surveillance for infectious disease outbreaks is also
critical. The CDC's Global Disease Detection initiative aims to
recognize infectious disease outbreaks faster, improve the ability to
control and prevent outbreaks, and detect emerging microbial threats.
In fiscal year 2006, Global Disease Detection centers across the globe
help countries investigate numerous outbreaks, including avian
influenza, hemorrhagic fever, meningitis, cholera and unexplained
sudden death. TFAH recommends funding the Global Disease Detection
initiative at $45 million, which is an increase of $12.5 million over
the President's requested level.
UPGRADING STATE AND LOCAL BIOTERRORISM PREPAREDNESS
The terrorism events of 2001 and the subsequent anthrax and ricin
attacks illustrated the need for a responsive public health system and
demonstrated that the existing structure has enormous gaps. The Federal
Government took unprecedented first steps towards improved preparedness
by providing funding to State and local public health departments to
better respond to terrorism. These funds have allowed States and
localities to conduct needs assessments, develop terrorism response
plans and training activities, strengthen epidemiology and surveillance
capabilities, and upgrade lab capacity and communications systems. Yet
a great deal of work remains to be done.
The December 2006 TFAH Report, Ready or Not?--Protecting the
Public's Health from Diseases, Disasters and Bioterrorism, examined 10
key indicators to assess areas of both improvement and ongoing
vulnerability in our Nation's effort to protect against bioterrorism.
The report found that 5 years after the September 11th and anthrax
tragedies, emergency health preparedness is still inadequate in
America. To address these shortcomings, we recommend the following:
--State and Local Capacity ($919 million, $221 million over the
President's request).--CDC distributes grants to 50 States and
four metropolitan areas for public health infrastructure
upgrades to respond to acts of terrorism or infectious disease
outbreaks. In fiscal year 2008, the President proposes to cut
funding for this program by $125.4 million, a nearly 25 percent
cut since fiscal year 2005. This would force health departments
to cut staff dedicated to preparedness; laboratories would lose
trained personnel and the ability to purchase new technology;
and disease surveillance and response efforts would be
hindered.
--Hospital Preparedness Grants ($650 million, $236 million over the
President's request).--The primary focus of the National
Bioterrorism Hospital Preparedness Program is to improve the
capacity of the Nation's hospitals and other supporting
healthcare entities to respond to bioterrorist attacks,
infectious disease epidemics, and other large-scale emergencies
by enabling hospitals, EMS, and health centers to plan a
coordinated response. The President proposes to cut funding for
hospital preparedness grants by $60 million in fiscal year
2008.
CHRONIC DISEASES CONTINUE TO TAKE A TOLL
Chronic diseases account for 70 percent of all deaths in the United
States and untold disability and suffering. In fact, five of our top
six causes of death--heart disease, cancer, stroke, chronic obstructive
pulmonary disease, and diabetes--are chronic diseases. The treatment of
chronic diseases consumes three-quarters of the $1.7 trillion the
United States spends annually on health care.
Smoking, for example, is the single most preventable cause of death
and disease in the United States, causing 440,000 premature deaths
annually. And increasingly, obesity is a significant risk factor in
such major chronic disease killers as heart disease, stroke and
diabetes.
FIGHTING THE EMERGING OBESITY EPIDEMIC
The number of overweight and obese individuals has reached epidemic
proportions in the United States with 64.5 percent of the adult
population being diagnosed as obese (119 million). In the United
States, the percentage of young people who are overweight has tripled
in the last 20 years. Despite this troubling trend, the President's
proposed fiscal year 2008 budget provides no increases for existing
obesity-related programs.
--Division of Nutrition and Physical Activity (DNPA) ($65 million,
$23.6 million over the President's request).--CDC's grant
funding allows State health departments to develop a nutrition
and physical activity infrastructure; develop a primary
prevention plan for nutrition and physical activity to
coordinate and link partners in and out of State government;
identify and assess data sources to monitor the burden of
obesity; and evaluate the progress and impact of the State
plans and intervention projects. Currently, only 28 States
receive DNPA grants, 7 at basic implementation, and 21 at
capacity-building levels. An increase to $65 million would fund
all 50 States and provide $5 million for the National Fresh
Fruit and Vegetable Nutrition Program.
--School Health Programs ($75.8 million, $20 million over the
President's request).--CDC's grant funding assists States in
improving the health of children through a school level program
that engages families and communities and develops health
education, physical education, school meals, health services,
healthy school environments, and staff health promotion.
Currently, school health programs are funded in only 23 States.
The recommended increase of $20 million would expand the number
of States to 40.
--STEPS to a Healthier United States ($43.6 million, $17.3 million
over the President's request).--STEPS grants support
communities, cities and tribal entities to implement health
promotion programs and community initiatives. STEPS works with
health care and insurance systems to combat obesity in over 40
communities, cities, and tribal entities. The President's
budget proposes to cut funding for STEPS by $17.2 million.
--Adolescent Health Promotion Initiative ($17.3 million, equal to the
President's request).--This new initiative aims to help schools
encourage regular physical activity, healthy eating, and injury
prevention. Schools will have access to the Department of
Health and Human Services' (HHS) School Health Index, which
they can use to make self-assessments and develop action plans.
Schools can apply for one of CDC's approximately 3,600 School
Culture of Wellness Grants to help implement their action
plans.
IMMUNIZATION
Immunization through vaccination of children and adults is proven
effective as a means to prevent some of the most important infectious
diseases. Immunization should remain a high public health priority,
and, to ensure that its benefits are fully realized, the Federal
Government should increase its commitment to these life saving public
health interventions.
National Immunization Program ($802.5 million, $257.5 million over
the President's request).--This program provides for childhood and
adult operations/infrastructure grants, the purchase of childhood and
adult vaccines, and related prevention activities. Each day, 11,000
babies are born in the United States who will need up to 28
vaccinations before they are 2 years old. Even so, nearly 1 million 2-
year-olds do not receive all the recommended doses. Every dollar spent
on vaccines saves an extraordinary amount downstream: $27 with DTaP
(Diphtheria, Tetanus and Pertussis), $26 with MMR (Measles, Mumps and
Rubella), and $15 with Hepatitis B. However, the vaccine cost to fully
immunize one child has risen in the past 6 years alone from $186 to
$570.
Currently, the CDC provides grants to all 50 States, six cities and
eight current or former territories to carry out immunization
activities. TFAH recommends providing $802.5 million for the National
Immunization Program at CDC. This includes $720 million for the 317
Immunization Program ($245 million for State operations/infrastructure
grants, and $475 million for the purchase of childhood vaccines); and
$82.543 million for program operations ($4.887 million for vaccine
tracking and $77.656 million for prevention activities).
SUPPORTING OTHER PUBLIC HEALTH TOOLS
TFAH supports additional funding for disease detection and
surveillance activities which are vital to stemming an infectious
disease outbreak, tracking rises in chronic diseases, or responding to
a bioterror event.
Federal and State public health laboratory capabilities ($47
million, $20 million over the President's request).--Additional funds
are needed to upgrade facilities and equipment and to bolster the
workforce. This funding is essential if scientists are to have the
capability to conduct clinical testing for potentially dangerous
chemicals, such as ricin, cyanide, nerve agents, and pesticide exposure
or test for novel strains of influenza. Of the suggested $20 million
increase, TFAH recommends that $10 million be used to enhance State
public health laboratory biomonitoring capabilities, with $10 million
used to bolster the intramural CDC lab program.
Environment and Health Outcome Tracking ($50 million, $26 million
over the President's request).--The program links environmental and
health data in order to identify problems and effective solutions to
reduce the burden of chronic disease. Additional funds would enable the
program to fund additional States and local health departments, or
order to systematically and comprehensively track respiratory diseases,
developmental disorders, birth defects, cancers and environmental
exposures to help scientists find answers about causes and cures of
these diseases. Further, the program plans to issue a major national
report on the environment and health in 2008, and expects to make
operational its Web-based environmental tracking system and roll out a
report reflecting data from funded States within 2 years.
Mr. Chairman, thank you again for the opportunity to submit
testimony on the urgent need to enhance Federal funding for core public
health programs.
______
Prepared Statement of the United Tribes Technical College
For 38 years, United Tribes Technical College (UTTC) has been
providing postsecondary vocational education, job training and family
services to Indian students from throughout the Nation. We are governed
by the five tribes located wholly or in part in North Dakota. We are an
educational institution that consistently has excellent results,
placing Indian people in good jobs and reducing welfare rolls. The
Perkins funds constitute about half of our operating budget. We do not
have a tax base or State appropriated funds on which to rely.
The request of the United Tribes Technical College Board for the
section 117 of the Perkins Act, Tribally Controlled Postsecondary
Career and Technical Institutions Program is:
--$8.5 million or $1.1 million above the administration's request and
the fiscal year 2007 enacted level. Funding under section 117
of the Perkins Act has in recent years it has been distributed
on a formula basis.
UTTC Performance Indicators. UTTC has:
--An 87 percent retention rate,
--A placement rate of 95 percent (job placement and going on to 4-
year institutions),
--A projected return on Federal investment of 1 to 20 (2005 study
comparing the projected earnings generated over a 28-year
period of UTTC Associate of Applied Science and Bachelor degree
graduates of June 2005 with the cost of educating them.), and
--The highest level of accreditation. The North Central Association
of Colleges and Schools has accredited UTTC again in 2001 for
the longest period of time allowable--10 years or until 2011--
and with no stipulations. We are also the only tribal college
accredited to offer on-line associate degrees.
The Demand for our Services is Growing and we are Serving More
Students.--For the 2006-2007 school year we enrolled 1,018 students (an
unduplicated count). The majority of our students are from the Great
Plains States, an area that, according to the 2003 BIA Labor Force
Report, has an Indian reservation jobless rate of 76 percent. UTTC is
proud that we have an annual placement rate of 95 percent.
In addition, we have served 254 students during school year 2005-
2006 in our Theodore Jamerson Elementary school, and 350 children,
birth to 5, were served in the child developments centers for 2005-
2006.
UTTC Course Offerings and Partnerships With Other Educational
Institutions.--We offer 15 vocational/technical programs and award a
total of 24 2-year degree and 1-year certificates. We are accredited by
the North Central Association of Colleges and Schools.
Licensed Practical Nursing.--This is our program with the highest
number of students. We have an agreement with the University of North
Dakota system that allows our students to transfer their credits to
these 4-year nursing programs.
Medical Transcription and Coding Certificate Program.--Our newest
academic endeavor is our Medical Transcription and Coding Certificate
Program which is offered through the college's Exact Med Training
program and supported by Department of Labor funds.
Tribal Environmental Science.--Our Tribal Environmental Science
program is being offered through a National Science Foundation Tribal
College and Universities Program grant. The 5-year project supports
UTTC in implementing a program that leads to a 2-year Associate of
Applied Science degree in Tribal Environmental Science.
Injury Prevention.--Through our Injury Prevention Program we are
addressing the injury death rate among Indians, which is 2.8 times that
of the U.S. population We received assistance through Indian Health
Service to offer the only degree-granting Injury Prevention program in
the Nation. Injuries are the number one cause of mortality among Native
people for ages 1-44 and the third for overall death rates.
Online Education.--We are working to bridge the ``digital divide''
by providing web-based education and Interactive Video Network courses
from our North Dakota campus to American Indians residing at other
remote sites and as well as to students on our campus. This spring
semester 2007, we have 61 students registered in online courses, of
which 48 students are studying exclusively online (approximately 34
FTE) and 13 are campus-based students. These online students come from
the following States: Colorado, Georgia, Hawaii, Idaho, Kentucky,
Nebraska, North Dakota, Oklahoma, Oregon, South Dakota, West Virginia,
and Wisconsin.
Online courses provide the scheduling flexibility students need,
especially those students with young children. We offer online full
degree programs in the areas of Early Childhood Education, Injury
Prevention, Health Information Technology, Nutrition and Food Service
and Elementary Education. All totaled, 156 online course seats are
filled by students this semester. Over 50 courses are currently offered
online, including those in the Medical Transcription and Coding program
and those offered through an MOU with Owens Valley Career Development
Center.
Our newest online course is suicidology--the study of suicide, its
causes, and its prevention and of the behavior of those to threaten or
attempt suicide--and we expect that with additional outreach that there
will be a significant demand for this course. We also offer a training
program through the Environmental Protection Agency to train
environmental professionals in Indian Country. The Indian Country
Environmental Hazard Assessment Program is a training course designed
to help mitigate environmental hazards in reservation communities.
United Tribes Technical College is accredited by the Higher
Learning Commission of the North Central Association of Colleges and
Schools to provide associate degrees online. This approval is required
in order for us to offer Federal financial aid to students enrolled in
these online courses. We are the only tribal college accredited to
offer associate degrees online.
Computer Information and Technology.--The Computer Support
Technician program is at maximum student capacity because of
limitations on learning resources for computer instruction. In order to
keep up with student demand and the latest technology, we will need
more classrooms, equipment and instructors. Our program includes all of
the Microsoft Systems certifications that translate into higher income
earning potential for graduates.
Nutrition and Food Services.--UTTC will meet the challenge of
fighting diabetes in Indian Country through education. Indians and
Alaska Natives have a disproportionately high rate of type 2 diabetes,
and have a diabetes mortality rate that is three times higher than the
general U.S. population. The increase in diabetes among Indians and
Alaska Natives is most prevalent among young adults aged 25-34, with a
160 percent increase from 1990-2004. Diabetes mortality is 3.1 times
higher in the Indian/Alaska Native population than in the general U.S.
population (Source: fiscal year 2008 Indian Health Service Budget
Justification).
As a 1994 Tribal Land Grant institution, we offer a Nutrition and
Food Services Associate of Applied Science degree in an effort to
increase the number of Indians with expertise in nutrition and
dietetics. Currently, there are only a handful of Indian professionals
in the country with training in these areas. Among our offerings is a
Nutrition and Food Services degree with a strong emphasis on diabetes
education, traditional food preparation, and food safety.
We have also established the United Tribes Diabetes Education
Center to assist local tribal communities and our students and staff in
decreasing the prevalence of diabetes by providing diabetes educational
programs, materials and training. We publish and make available tribal
food guides to our on-campus community and to tribes.
Business Management/Tribal Management.--Another of our newer
programs is business and tribal management designed to help tribal
leaders be more effective administrators. We continue to refine our
curricula for this program.
Job Training and Economic Development.--UTTC is a designated
Minority Business Development Center serving Montana, South Dakota and
North Dakota. We also administer a Workforce Investment Act program and
an internship program with private employers in the region.
Economic Development Administration funding was made available to
open a ``University Center.'' The Center is used to help create
economic development opportunities in tribal communities. While most
States have such centers, this center is the first-ever tribal center.
Upcoming Endeavors.--We continue to seek a Memorandum of
Understanding with the BIA's Police Academy in New Mexico that would
allow our criminal justice program to be recognized for the purpose of
BIA and Tribal police certification, so that Tribal members from the
BIA regions in the Northern Plains, Northwest, Rocky Mountain, and
Midwest areas would not have to travel so far from their families to
receive training. Our criminal justice program is accredited and
recognized as meeting the requirements of most police departments in
our region. We also anticipate providing similar training for
correctional officers, a vital need in Indian country.
Additionally, we are interested in developing training programs
that would assist the BIA in the area of provision of trust services.
We have several technology disciplines and instructors that are capable
of providing those kinds of services with minimum of additional
training.
Department of Education Study Documents our Facility/Housing
Needs.--The 1998 Carl Perkins Vocational Education and Applied
Technology Act required the Department of Education to study the
facilities, housing and training needs of our institution. That report
was published in November 2000 (``Assessment of Training and Housing
Needs within Tribally Controlled Postsecondary Vocational Institutions,
November 2000, American Institute of Research''). The report identified
the need for $17 million for the renovation of existing housing and
instructional buildings and $30 million for the construction of housing
and instructional facilities. These figures do not take into account
the costs of inflation since the study was completed in 2000.
We continue to identify housing as our greatest need. Some families
must wait from 1 to 3 years for admittance due to lack of available
housing. Since 2005 we have assisted 311 families with off campus
housing, a very expensive proposition. In order to accommodate the
enrollment increase, UTTC partners with local renters and two county
housing authorities (Burleigh, Morton).
UTTC has worked hard to combine sources of funding for desperately
needed new facilities--within the past few years we have built a 86-bed
single-student dormitory on campus, a family student apartment complex,
and a Wellness Center. Sources of funds included the U.S. Department of
Education, the U.S. Department of Agriculture, the American Indian
College Fund, the Shakopee-Mdewakanton Sioux Tribe, among others. We
still have a critical housing shortage and more housing must be built
to accommodate those on the waiting list and to meet expected increased
enrollment. We also have housing which needs renovation to meet safety
codes.
UTTC has acquired an additional 132 acres of land. We have also
developed a master facility plan. This plan includes the development of
a new campus on which would be single-student and family housing,
classrooms, recreational facilities, offices and related
infrastructure. A new campus will address our need for expanded
facilities to accommodate our growing student population. It will also
enable us to effectively address safety code requirements, Americans
with Disabilities Act requirements, and to become more efficient in
facility management.
Thank you for your consideration of our request. We cannot survive
without the basic core vocational/technical education funds that come
through the Department of Education. They are essential to the
operation of our campus and to the welfare of Indian people throughout
the Great Plains region and beyond.