[Senate Hearing 111-]
[From the U.S. Government Publishing Office]
DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND
RELATED AGENCIES APPROPRIATIONS FOR FISCAL YEAR 2010
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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 AIDS Action
I am pleased to submit this testimony to the members of this
subcommittee on the importance of increased funding for the fiscal year
2010 HIV/AIDS portfolio. Since 1984, AIDS Action Council, through its
member organizations and the greater HIV/AIDS and public health
communities, has worked to enhance HIV prevention programs, research
protocols, and care and treatment services at the community, State and
Federal level. AIDS Action represents many AIDS service organizations
located in the Nation's HIV epicenters, local health departments,
smaller service providers, faith-based organizations, substance abuse
treatment centers, and education and advocacy organizations from all
over the country. 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 I bring your
attention to issues impacting funding for fiscal year 2010.
Nearly 30 years since it was first identified, the HIV/AIDS
epidemic in the United States is characterized by needless mortality,
inadequate access to care, persistent levels of new infection, and
stark racial inequalities. 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. Consider that
in the United States:
--Every year, 56,300 people are newly infected with HIV--one new
infection every 9\1/2\ minutes. According to the Centers for
Disease Control and Prevention (CDC) the HIV infection rate has
not fallen in 15 years and the new incidence figure represent a
40 percent increase from previous estimates
--CDC stated that the HIV incidence rate increased by 15 percent from
2006 to 2007.
--More than 1 million people are living with HIV or AIDS; an
estimated half of people living with HIV/AIDS are not in care.
--Of those people living with HIV/AIDS 21 percent are unaware of
their HIV status.
--CDC estimates in 2007, 14,561 people died from AIDS-related causes.
--African Americans represent 13 percent of the population but nearly
half of all newly reported HIV infections.
--Hispanics/Latinos represent 13 percent of the population, but
account for 18 percent of newly reported cases of HIV.
--The percentage of newly reported HIV/AIDS cases in the United
States. among women tripled from 8 percent to 27 percent
between 1985 and 2007.
--AIDS is the leading cause of death among Black women aged 25-34
--HIV is the No. 1 healthcare risk for gay men and men who have sex
with men, especially in communities of color.
--More than half of all newly diagnosed individuals are identified
with full-blown AIDS in less than 12 months of their initial
diagnosis.
--There is neither a cure nor a vaccine for HIV and current
treatments do not work for everyone.
The Federal Government's commitment to funding prevention,
research, and care and treatment for those living with HIV is critical.
We would be unable to respond to this epidemic without the Federal
Government's increased commitment to funding HIV programs at home.
However, we are not doing enough. The unsatisfactory outcomes from our
country's response to AIDS have serious human and economic costs. A
study published in 2003 found that failure to meet the Government's
then goal of reducing HIV infections by half would lead to $18 billion
in excess expenses through 2010. We need more prevention, more
treatment and care and more research if we are ever to slow and
eventually reverse the HIV epidemic.
It is AIDS Action's expectation that the Congress, through the good
work of this subcommittee, will recognize and address the true funding
needs of the programs in the HIV/AIDS portfolio. HIV is a 100 percent
preventable disease that can be lessened with a focused, concentrated
effort and increased funding. The community has come together under the
umbrella of the AIDS Budget and Appropriations Coalition with the
community funding request for the HIV/AIDS domestic portfolio for
fiscal year 2010. The numbers requested represent that community work.
These requests have been submitted to the subcommittee.
CDC estimate that approximately 13 percent of all HIV cases and
approximately 60 percent of all hepatitis C cases in the United States
are directly or indirectly related to intravenous drug use. One of the
most important ways to reduce these epidemics is through the use of
syringe exchange. More than eight Federal studies along with numerous
scientific peer-reviewed papers published more than 15 years have
conclusively established that syringe exchange programs reduce the
incidence of HIV among people who inject drugs and their sexual
partners. Such studies have all concluded that syringe exchange does
not increase drug abuse. Instead, syringe exchange programs connect
people who use drugs to healthcare services including addiction
treatment, HIV and viral hepatitis prevention services and testing,
counseling, education, and support.
The ban on Federal funding for syringe exchange is
counterproductive and limits the ability of local and State
jurisdictions to respond effectively to the twin HIV and hepatitis
epidemics. AIDS Action and the HIV community recommends that the
subcommittee remove any language prohibiting the use of Federal funds
to establish or carry out a program of distributing sterile syringes to
reduce the transmission of blood borne pathogens, including the human
immunodeficiency virus (HIV) and viral hepatitis.
According to CDC estimates contained in the agency's March 2006
HIV/AIDS Surveillance Report, 1,014,797 cumulative cases of AIDS have
been diagnosed in the United States, with a total of 565,927 deaths
since the beginning of the epidemic. As noted above, the CDC estimates
that between 1.1 and 1.2 million people are living with HIV/AIDS and
that 250,000-350,000 people are unaware of their status and could
unknowingly transmit the virus to another person. As funding has
remained essentially flat for more than 8 years, money has shifted to
new and needed HIV testing efforts and initiatives. As a result, grants
to States and local communities have significantly decreased and new
infections have increased to an estimated 56,300 per year, according to
a CDC report released in August 2008. Therefore, AIDS Action Council,
the HIV community, and the CDC in their budget justification before
Congress September 2008, estimates that the CDC HIV Prevention and
Surveillance programs will need $1.5 billion, an increase of $878
million, in fiscal year 2010 to address the true unmet needs of
preventing HIV in the United States. In the United States, HIV is
transmitted primarily through sex. In order to combat the rising rates
of transmission, we must ensure that sexuality education programs are
medically sound and effective in fostering healthy behavior over the
long-term. Abstinence is an important component of comprehensive
sexuality education and HIV prevention programs; however, when it is
advocated as the only option for young people, research has shown that
it is ineffective, unrealistic, and potentially harmful. We believe the
Federal Government should only support those sexuality education and
HIV-prevention programs that are evidence-based. For that reason we
support the elimination of all funding for the Community-Based
Abstinence Education (CBAE) programs. All such funds should be re-
directed to evidence-based prevention and educational programs. This
past World AIDS Day, President Obama affirmed that, ``My administration
will .work with Congress to enact an extensive program of prevention,
including access to comprehensive age-appropriate sex education for all
school age children.'' We request that at least $50 million be
allocated to promote comprehensive sex education in our schools and
communities nationwide.
Now in its 19th year, 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; it provides the framework for our national response to the
HIV epidemic. CARE Act programs have been critical to reducing the
impact of the domestic HIV epidemic. Yet in recent years, CARE Act
funding has not kept pace with the epidemic and has decreased through
across-the-board rescissions. It is important to remember that CARE Act
programs are designed to compliment each other. It is necessary that
all parts of the CARE Act receive substantial increased funding to
ensure the success of the total program. AIDS Action and the HIV/AIDS
community estimate that the entire Ryan White CARE Act portfolio needs
$2.816 million in fiscal year 2010, an increase of $577.8 million to
address the true needs of the hundreds of thousands of people living
with HIV who are uninsured, underinsured, or who lack financial
resource for healthcare.
Part A of The Ryan White CARE Act now includes five additional
Transitional Grant Areas (TGAs). Some of the services provided under
part A include physician visits, laboratory services, case management,
home-based and hospice care, and substance abuse and mental health
services. Under the most recent reauthorization these services are 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 part A at $766.1 million, an increase of
$103 million.
Part B of the CARE Act ensures a foundation for HIV related
healthcare services in each State and territory, including the
critically important AIDS Drug Assistance Program (ADAP). Part B base
grants (excluding ADAP) received a decrease of $28.5 million in fiscal
year 2009. AIDS Action along with the HIV/AIDS community recommends
funding for part B base grants at $514.2 million, an increase of $105.4
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 2009 National ADAP
Monitoring Project, ADAP provided medications to approximately 183,299
clients in fiscal year 2007, including 36,354 new clients. AIDS Action
along with the HIV/AIDS community recommends $1,083 million, an
increase of $268.6 million, for ADAP for fiscal year 2010. This
``community need'' number 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. The need number
represents the amount of new funding required to allow State ADAPs to
provide a minimum clinical standard formulary of HIV/AIDS medications
to ADAP clients under the current eligibility rules for each State.
Part C 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. Part C funds are
particularly needed in rural areas where the availability of HIV care
and treatment is still relatively new. Urban areas continue to require
part C funds as emerging populations as grantees struggle to meet the
needs of previously identified HIV positive populations. AIDS Action,
along with the HIV/AIDS community, requests $268.3 million, an increase
of $66.4 million, for part C.
Part D 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 $134.6 million, an increase
of $57.7 million, for Part D.
Under Part F, the AIDS Education and Training Centers (AETCs) is
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 has been added for additional
materials, training of staff, or programs. The AETCs received a modest
increase of $0.3 million in fiscal year 2009. AIDS Action and the HIV/
AIDS community request $50 million, a $15.6 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. Oral
health problems are often one of the first manifestations of HIV
disease. Unfortunately oral health is one of the first aspects of
healthcare 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 $19
million, a $5.6 million increase, for this program. Finally under part
F, rising infections and strapped care systems necessitate the research
and development of innovative models of care. The SPNS program is
designed for this purpose and must continue to receive sufficient
funding.
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 healthcare
and supportive services to historically underserved groups. HIV/AIDS in
the United States continues to disproportionately affect communities of
color. According to the CDC in 2006, the overall rate of HIV diagnosis
(the number of diagnoses per 100,000 population) in the 33 States (that
currently report HIV data) was 18.5 per 100,000. The rate for blacks
was roughly 8 times the rate for whites (67.7 per 100,000 vs 8.2 per
100,000). 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
agencies. AIDS Action and the HIV/AIDS community request a total of
$610 million for the Minority AIDS Initiative.
Research on preventing, treating, and ultimately curing HIV is
vital to the domestic and global control of the disease. It is
essential that Office of AIDS Research continue its groundbreaking
research in both basic and clinical science to develop a preventative
vaccine, microbicides, and other scientific, behavioral, and structural
HIV prevention interventions. 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. NIH's Office of AIDS Research is
critical in supporting all of these research arenas. Commitment in
research will ultimately decrease the care and treatment dollars needed
if HIV continues to spread at the current rate. AIDS Action requests
that the NIH be funded at $34 billion in fiscal year 2010 and that the
AIDS portfolio must be funded at $3.4 billion a $500 million increase.
HIV is a continuing health crisis in the United States. We must
continue to work to fully fund our domestic prevention, treatment and
care, and research efforts. 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.
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Prepared Statement of the Alzheimer's Association
Mr. Chairman and members of the subcommittee: As President and CEO
of the Alzheimer's Association, I want to take this opportunity to
thank you for the leadership role this subcommittee has played over the
years in the fight to conquer Alzheimer's disease.
Indeed, it was this subcommittee that first drew attention to
Alzheimer's disease in its fiscal year 1982 appropriations report. At
the time, an estimated 2.5 million people were thought to be suffering
with Alzheimer's disease, their families quietly bearing most of the
financial, physical, and emotional burden of care giving. Even if they
were personally affected, relatively few Americans had even heard of
Alzheimer's disease because so many went undiagnosed or were
inaccurately diagnosed; far fewer were aware of the crisis just
beginning to unfold. All this is still too true today.
Alzheimer's disease now is now estimated to afflict more than 5
million Americans. It is in a virtual tie as the Nation's sixth leading
cause of death, while significantly underreported and growing. It is
already the third most expensive disease, draining billions of dollars
from our economy every year. But the story does not end with those grim
statistics because this problem is not going to age itself away. On the
contrary, as Baby Boomers shoulder their way into the age of highest
risk, we will see 10 million members of this generation fall victim to
Alzheimer's disease.
At times called the quiet epidemic, the great unlearning or the
long dying, year by year Alzheimer's disease strips away memory,
personality and independence, leaving its victims unable to handle the
most basic functions of daily living. For those who do not succumb to
pneumonia or other complications of Alzheimer's, there is the final act
of forgetting--when the brain forgets to breathe.
But make no mistake the effects of Alzheimer's extend well beyond
the human suffering and the physical and emotional strain it puts on
families. Indeed, despite all that is challenging America today,
Alzheimer's disease represents a grave threat to our Nation's social
and economic well-being.
This year, Medicare and Medicaid will spend more than $100 billion
to finance care for those struggling with Alzheimer's disease. Over the
next 40 years, those two programs alone will spend almost $20 trillion
on the care of Alzheimer patients.
Unless we find a way to prevent or slow its progression, by the
year 2050 the annual cost of this disease to Medicare and Medicaid
programs alone will be equal to one-tenth of our entire current
domestic economy.
Alzheimer's disease is so expensive because, in addition to its
direct costs, it greatly increases the use and costs of Medicare to
treat other serious medical conditions. Ninety-five percent of Medicare
beneficiaries with Alzheimer's disease have at least one co-morbid
condition. Tasks such as medication management become extremely
difficult and time-consuming. As a result, the health and long-term
care costs of treating these individuals is more than three times that
of a Medicare beneficiary without Alzheimer's disease.
BOLD ACTION IS NEEDED NOW
Over the years this body has exercised its prerogative to channel
funds to the Nation's most pressing public health problems. Added funds
provided by this subcommittee led to cancer patients living longer,
with many beating the disease. Thanks to those investments, survival
rates have steadily improved for breast, prostate, colorectal and some
other types of cancer, so that today, the 5-year relative survival rate
is 66 percent across all cancers. According to the most recent
estimates, 10.8 million Americans with a history of cancer are alive
today. As a result of this subcommittee's strong and sustained
investment in cardiovascular disease research, death rates from heart
disease and stroke fell by 40 percent and 51 percent, respectively,
since 1975. And when challenged by the HIV/AIDS epidemic, this
subcommittee responded quickly and decisively--providing a research
investment that yielded vastly improved treatments and prevention
strategies and a two-thirds reduction in annual deaths.
Mr. Chairman, unlike cancer, cardiovascular disease and so many
other chronic conditions that have dramatically improved with
significant investments in research, there are no Alzheimer's disease
survivors. None. We cannot prevent, halt or reverse it. Every day some
of the 5 million who have it die of this fatal disease, only to be
replaced by even more who will progressively decline and die, as more
replace them. Indeed, the only way to avert this rapidly developing
social and economic catastrophe is if this subcommittee, once again,
leads the way.
Past investments in Alzheimer's research have helped bring us to a
point no one would have dreamed possible when this subcommittee first
called attention to this disease. Scientists now have a much clearer,
but still incomplete picture of the basic mechanisms of Alzheimer's;
epidemiological research is shedding light on new targets for
intervention that now must be tested in large-scale clinical trials.
And work is underway to help identify potential uses of imaging and
other surrogate markers to follow the progression of cognitive decline,
and to assess the effectiveness of drug interventions. But we still
have so much to accomplish.
Much of what we have learned came about because Congress invested
in Alzheimer research throughout the 1980s and 1990s. But even those
investments were not commensurate with the impact of the disease. The
evidence from cancer and cardiovascular disease illustrates the returns
that can be derived from additional investments in Alzheimer's research
now. As the mortality rates for cancer and heart disease decline,
Alzheimer's is still rising at a steady and rapid pace.
In fact, during the past 6 years we have seen a dramatic slowdown
in overall research investments, signaling a slowdown in advances to
come, but the effects on Alzheimer research are potentially greater as
the funding stalled at such a comparatively low level. Today, the
National Institutes of Health (NIH) devotes only $412 million a year
for research on Alzheimer's disease--far short of the $1 billion that
leading scientific minds estimate as the minimum required investment to
uncover ways to prevent, slow and more effectively treat this disease.
That $412 million is also considerably less than what is spent for
research on other major threats to society, such as cancer,
cardiovascular disease, and AIDS. All of these problems merit
significant investments, but Alzheimer's research is underfunded when
measured against the suffering inflicted by the disease or by the
potential cost savings in care that could be gained by investing in
research today--before it's too late.
What can the subcommittee do to help stop this serious threat to
America's future?
First and foremost, the Alzheimer's Association recommends that you
appropriate an additional $250 million this year and next to raise the
total NIH investment in Alzheimer's research up to $1 billion. These
added funds will be put to use in three crucial areas:
--Clinical Trials.--The funding of clinical trials and
epidemiological studies, particularly through the Alzheimer's
Disease Cooperative Study (ADCS) national research consortium
funded by the NIH, are identifying new targets for
interventions, including compounds that are already widely
available such as over-the-counter medications. Time is not on
our side. If we hope to forestall this looming crisis, large-
scale clinical trials must be undertaken soon and must be
launched simultaneously, not sequentially.
--Early Markers of Disease.--Earlier diagnosis is critical if we hope
to stop the disease before it ravages brain cells beyond
repair. Additional resources are sorely needed to fully fund
the next phase of a neuro-imaging initiative currently being
supported at the National Institute on Aging.
--Basic Science Research.--Science must find new answers and ask
better questions. While significant progress has been made,
scientists are still searching for definitive answers to
questions about the basic mechanisms of Alzheimer's disease.
Congress must maintain the pipeline of basic scientific
discovery to develop additional targets for treatment. At
current funding levels, work on promising avenues of research
is either delayed or never started. Young investigators--and
their fresh new ideas--are discouraged from entering this field
of study.
While research holds the answers, there are other steps we
recommend you take to help forestall or lessen the impact of
Alzheimer's.
EXPAND THE HEALTHY BRAIN INITIATIVE TO $5 MILLION
Four years ago, this subcommittee launched the first single-focused
effort on brain health promotion at the Centers for Disease Control and
Prevention (CDC). As a result of the investment that has been made in
the Healthy Brain Initiative, the CDC, in partnership with the
Alzheimer's Association, has developed a public health roadmap for
maintaining cognitive health, implemented community education programs
targeting African-American baby boomers, and developed modules for
enhancing the surveillance system for cognitive decline.
The impetus for this program was the mounting scientific evidence
suggesting that brain health may be maintained by preventing or
controlling cardiovascular risk factors, such as high blood pressure,
high cholesterol and diabetes, and by engaging in regular physical
activity. In light of the dramatic aging of the population, scientific
advancements in risk behaviors, and the growing awareness of the
significant health, social and economic burdens associated with
cognitive decline, the Federal investment in a public health response
must be expanded. We recommend that this program be increased to $5
million to focus on the following activities:
--Healthy Brain Engagement Initiative.--The promising approaches that
have been identified through the community education programs
need to be expanded to additional locations and new target
audiences to impact attitudes and behaviors related to
cognitive health. Particularly, we must focus on other high-
risk and underserved populations, specifically the Hispanic/
Latino population.
--Tracking Cognitive Impairment as America Ages.--In order to
accelerate the availability of data to clarify the burden of
Alzheimer's, an enhanced surveillance system for cognitive
health is required. This can be achieved through implementation
of appropriate Behavioral Risk Factor Surveillance System
(BRFSS) modules in as many States as possible. The development
and testing of BRFSS modules is currently underway and will be
available for use in 2010.
--Tools for Care Coordination in the Face of Cognitive Impairment.--
Cognitive health challenges--from mild cognitive decline to
dementia--can have profound implications on an individual's
ability to self-manage other coexisting conditions. In order to
effectively address this challenge, interventions that target
the coordination of care for those with cognitive impairment
and coexisting chronic diseases will be adapted or developed.
--Early Detection.--Early recognition of Alzheimer's, an accurate
diagnosis, and early intervention, including medication, can
significantly improve the quality of life and mental function
of people with the disease. Communications strategies that
provide information on the signs and symptoms of the disease
and options for maintaining brain health will be developed and
disseminated, targeting consumers and providers.
CONTINUE ALZHEIMER'S DISEASE DEMONSTRATION GRANTS AND THE ALZHEIMER'S
CONTACT CENTER
The Administration on Aging (AoA) operates two Alzheimer-related
programs that warrant continuation. The first is a program of matching
grants to States for the development of innovative, community-based
services for Alzheimer patients and caregivers, especially hard-to-
reach and underserved populations. For this program, we recommend an
appropriation of $11.6 million.
In 2003, this subcommittee launched the Alzheimer's Contact Center,
a nationwide call-in program that provides families in crisis with
around-the-clock support and assistance. Services include access to
professional clinicians who provide decision-making support, crisis
assistance and referrals. In 2008, the center fielded more than 106,000
calls from families. The Alzheimer's Association recommends you
appropriate $1 million to continue this valuable service.
Each of the recommendations I have outlined fall within the purview
of this subcommittee. But I would also like to call your attention to a
report issued recently, called A National Alzheimer's Strategic Plan:
The Report of the Alzheimer's Study Group.
This landmark report was the culmination of nearly 2 years of work
by an independent task force of prominent national leaders. It was co-
chaired by former Speaker of the House Newt Gingrich and former U.S.
Senator Bob Kerrey, and included other distinguished individuals such
as former Supreme Court Justice Sandra Day O'Connor and Drs. Harold
Varmus, David Satcher, and Mark McClellan. The Alzheimer's Study Group
also drew on the knowledge and expertise of more than 100 experts in
various facets of this disease.
Mr. Chairman, in a word, the Alzheimer's Study Group concluded that
to achieve a world without Alzheimer's disease we do not need to re-
invent the wheel; but we have to make it work more efficiently.
This report contains many important recommendations, including
developing the capability to prevent Alzheimer's disease in 90 percent
of individuals by 2020. But one that warrants special attention within
the context of this subcommittee's deliberations is the creation of an
outcomes-oriented, objective-driven Alzheimer's Solutions Project
Office within the Federal Government. With support from the president
and Congress, this effort would oversee a decade-long mission to
undertake a coordinated and sustained attack on Alzheimer's disease.
Mr. Chairman, thank you for your time and attention. Should you
have any questions or require additional information, please feel free
to call on me.
______
Prepared Statement of the Association of American Cancer Institutes
The Association of American Cancer Institutes (AACI), representing
95 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, and Education, and Related
Agencies subcommittee plans the fiscal year 2010 appropriations for the
National Institutes of Health (NIH) and the National Cancer Institute
(NCI).
AACI applauds recent budgetary commitments--notably, increased
funding for NIH and support from the Obama administration through the
American Recovery and Reinvestment Act of 2009--that have created a
more encouraging landscape for cancer research compared to the last 5
years. While AACI understands and appreciates the budgetary constraints
currently facing our Nation, we also believe that advances in cancer
and biomedical research must remain a very high national priority.
Therefore, we hope that high levels of support will continue in the
years ahead, to ensure that this recognition of the importance of
biomedical research is sustained.
For fiscal year 2010, AACI joined its colleagues in the biomedical
research community in supporting the request in the President's initial
budget proposal for $6 billion in funding for cancer research in fiscal
year 2010, and his commitment to double funding for cancer research
over the next 5 years.
AACI also requests that total funding to NIH be increased by 10
percent, including a 20 percent increase for NCI and a 7 percent
increase for the other Institutes and Centers within NIH. The Nation's
investment in the NIH and NCI helps lead to scientific advances that
can save lives and improve the health of Americans. Early funding
increases helped speed the pace of cancer research, and this investment
can be leveraged significantly with a renewed commitment to strong,
sustained Federal funding of medical research and, in particular,
cancer research. AACI will work to ensure that Congress approves the
maximum possible appropriations for NIH and NCI.
THE GROWING CANCER BURDEN
In 2008, there were approximately 1.44 million new cases of cancer
in the United States and approximately 565,650 deaths due to the
disease.\1\ About 150,090 new cancer cases were expected to be
diagnosed among African Americans in 2009, with about 63,360 expected
to die from the disease. In men, the death rate for all cancers
combined continued to be substantially higher among African Americans
than whites during 1975-2005. Similar trends were seen among women,
although the gap is much smaller.\2\
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\1\ Cancer Facts and Figures 2008. American Cancer Society; 2008.
(The publication of Cancer Facts & Figures 2009 has been delayed due to
the late release of the US final mortality data by the National Center
for Health Statistics.)
\2\ American Cancer Society. Cancer Facts & Figures for African
Americans 2009-2010. Atlanta: American Cancer Society, 2009.
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Looking further into the future, the need for cancer care will
expand dramatically. From 2010 to 2030, the total projected cancer
incidence will increase by approximately 45 percent, from 1.6 million
in 2010 to 2.3 million in 2030. This increase is driven by cancer
diagnosed in older adults and minorities. A 67 percent increase in
cancer incidence is anticipated for older adults, compared with an 11
percent increase for younger adults. A 99 percent increase is
anticipated for minorities, compared with a 31 percent increase for
whites. From 2010 to 2030, the percentage of all cancers diagnosed in
older adults will increase from 61 percent to 70 percent, and the
percentage of all cancers diagnosed in minorities will increase from 21
percent to 28 percent.\3\
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\3\ Smith et al., ``Future of Cancer Incidence in the United
States: Burdens Upon an Aging, Changing Nation'', J Clin Oncol 2009; 27
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The human toll of cancer is staggering, as is its financial toll;
the NCI reports that in 2006, $206.3 billion was spent on healthcare
costs for cancer alone. Additionally, NCI acknowledges that the burdens
of cancer--physical, emotional, and financial--are ``unfairly
shouldered by the poor, the elderly, and minority populations.'' The
number of cancer diagnoses will only continue to climb as our
population ages, with an estimated 18.2 million cancer survivors (those
undergoing treatment, as well as those who have completed treatment)
alive in 2020.
CANCER RESEARCH: BENEFITING ALL AMERICANS
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 at cancer
centers across the United States.
Though more than a half-million Americans will die this year from
the many diseases defined as cancer, progress is being made. Because of
continued progress made by the Nation's researchers, cancer death rates
have continued to decline; between 1991 and 2004, the death rates for
cancer in men and women declined 18.4 percent and 10.5 percent,
respectively.\4\ Similarly, death rates among African Americans for all
cancers combined have been decreasing since 1991 after increasing from
1975 to 1991. The decline was larger in men (2.5 percent per year since
1995) than in women (1.3 percent per year since 1997). Similar trends
were observed among whites from 1991-2005, with a greater reduction in
the rate among men than women.
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\4\ Cancer Statistics, 2008. CA: Cancer Journal for Clinicians
2008; 58(2): 71-96.
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Biomedical research has provided Americans with better cancer
treatments, as well as enhanced cancer screening and prevention
efforts. Some of the most exciting breakthroughs in current cancer
research are those in the field of personalized medicine. In
personalized medicine for cancer, not only is the disease itself
considered when determining treatments, but so is the individual's
unique genetic code. This combination allows physicians to better
identify those at risk for cancer, detect the disease, and treat the
cancer in a targeted fashion that minimizes side effects and refines
treatment in a way to provide the maximum benefit to the patient.
In the laboratory setting, multi-disciplinary teams of scientists
are working together to understand the significance of the human genome
in cancer. For instance, the Cancer Genetic Markers of Susceptibility
initiative is comparing the DNA of men and women with breast or
prostate cancer with that of men and women without the diseases to
better understand the diseases. The Cancer Genome Atlas is in
development as a comprehensive catalog of genetic changes that occur in
cancer. Another initiative, the Childhood Cancer Therapeutically
Applicable Research to Generate Effective Treatments Initiative, is
identifying targets that can lead to better treatments for young people
with cancer.
These projects--along with the work being performed by dedicated
physicians and researchers at cancer centers across the United States
every day--have the potential to radically change the way cancer, as a
collection of diseases, affects the people who live with it every day.
Every discovery contributes to a future without cancer as we know it
today.
THE NATION'S CANCER CENTERS
The nexus of cancer research in the United States is the Nation's
network of cancer centers that are represented by AACI. These cancer
centers conduct the highest-quality cancer research anywhere in the
world and provide exceptional patient care. The Nation's research
institutions, which house AACI's member cancer centers, receive an
estimated $3.17 billion \5\ from NCI to conduct cancer research; this
represents 66 percent of NCI's total budget. In fact, 85 percent of
NCI's budget supports research at nearly 650 universities, hospitals,
cancer centers, and other institutions in all 50 States. Because these
centers are networked nationally, opportunities for collaborations are
many--assuring wise and nonduplicative investment of scarce Federal
dollars.
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\5\ National Cancer Institute 2007 Fact Book. U.S. Department of
Health and Human Services, U.S. National Institutes of Health, 2007.
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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. Sustained Federal support will
significantly enhance the centers' ability to continue to train the
next generation of cancer specialists--both researchers and providers
of cancer care.
By providing access to a wide array of expertise and programs
specializing in prevention, diagnosis, and treatment of cancer, cancer
centers play an important role in reducing the burden of cancer in
their communities. The majority of the clinical trials of new
interventions for cancer are carried out at the Nation's network of
cancer centers.
Beyond their healthcare and research roles, cancer centers are also
reliable engines of economic activity for the Nation as a whole, and
for the communities and regions that they serve. For every $1 spent on
biomedical research, a national average of $2.21 in economic benefit
results.\6\
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\6\ In Your Own Backyard: How NIH Funding Helps Your State's
Economy, Families USA, June 2008
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ENSURING THE FUTURE OF CANCER CARE AND RESEARCH
Because of an aging population, an increasing number of cancer
survivors require ongoing monitoring and care from oncologists, and new
therapies that tend to be complex and often extend life.
Demand for oncology services is projected to increase 48 percent by
2020. However, the supply of oncologists expected to increase by only
20 percent and 54 percent of currently practicing oncologists will be
of retirement age within that timeframe. Also, alarmingly, there has
been essentially no growth over the past decade in the number of
medical residents electing to train on a path toward oncology as a
specialty.\7\
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\7\ Forecasting the Supply of and Demand for Oncologists: A Report
to the American Society of Clinical Oncology (ASCO) from the AAMC
Center for Workforce Studies. American Society of Clinical Oncology,
2007.
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Cancer physicians--while essential--are only one part of the
oncology workforce that is in danger of being stretched to the breaking
point. The Health Resources and Services Administration predicted that
by 2020, more than 1 million nursing positions will go unfilled, and a
2002 survey by the Southern Regional Board of Education projected a 12
percent shortage of nurse educators by last year.\8\
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\8\ ONS: Ready to Collaborate with Other Policymakers to Ensure
Future of Quality Cancer Care, Oncology Times, August 25, 2007; (29):
8-9.
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Without immediate action, these predicted shortages will prove
disastrous for the state of cancer care in the United States. The
discrepancy between supply and demand for oncologists will amount to a
shortage of 9.4 to 15.1 million visits, or a shortage of 2,550 to 4,080
oncologists. The Department of Health and Human Services projects that
today's 10-percent vacancy rate in registered nursing positions will
grow to 36 percent, representing more than 1 million unfilled jobs by
2020.
Greater Federal support for training oncology physicians, nurses,
and other professionals who treat cancer must be enacted to prevent a
disaster within our healthcare system when demand for oncology services
far outstrips the system's ability to provide adequate care for all.
AMERICANS SUPPORT FEDERAL FUNDING FOR RESEARCH
The research community has long understood the obstacles that are
facing cancer research. Though the nuances of R01 grants and oncology
workforce training may not be well understood by the average American,
the people of the United States believe in supporting the disparate
activities that make up America's biomedical research infrastructure.
In a 2007 Research!America poll, 91 percent of those surveyed
believed it was somewhat or very important for policymakers to create
more incentives to encourage individuals to pursue careers as nurses,
while 89 percent believed the same for encouraging careers as
physicians. Forty-seven percent of those surveyed agreed that he United
States must increase investment in NIH to ensure our future health and
economic security, and 54 percent favored annual 6.7 percent increases
in funding for NIH in 2008, 2009, and 2010. An overwhelming majority--
70 percent--agreed that the United States is losing its global
competitive edge in science, technology, and innovation.
We encourage our Members of Congress to respond to the concerns of
the American people by enhancing support for biomedical research that
will lead to improved health for everyone in the United States and
around the world.
CONCLUSION
These are exciting times in science and, particularly, in cancer
research. The AACI cancer center network is unrivaled in its pursuit of
excellence, and place the highest priority on affording all Americans
access to that care, including novel treatments and clinical trials. It
is through the power of collaborative innovation that we will
accelerate progress toward a future without cancer, and research
funding through the NIH and NCI is essential to achieving our goals.
______
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 2010. AACN represents
more than 640 schools of nursing at public and private institutions
with baccalaureate and graduate nursing programs that include more than
270,000 students and 13,000 faculty members. These institutions educate
almost half of our Nation's Registered Nurses (RNs) and all of the
nurse faculty and researchers. Many of these nursing schools sponsor
intensive research programs and training activities that are funded by
the National Institute of Nursing Research (NINR).
THE NATIONWIDE NURSING SHORTAGE
The United States is in the midst of a nursing shortage that has
expanded over the last decade. The current economic downturn has led to
a false impression that the nursing shortage is ``easing'' in some
parts of the country because hospitals are enacting hiring freezes and
nurses are choosing to delay retirement. However, this trend is only
temporary. More positions continue to open for RNs across the country,
and the shortage is projected to intensify as the baby-boomer
population ages and the need for healthcare grows. The U.S. Bureau of
Labor Statistics (BLS) recently reported that the healthcare sector of
the economy is continuing to expand, despite significant job losses in
nearly all other major industries. Hospitals, long-term care
facilities, and other ambulatory care settings added 27,000 new jobs in
February 2009, a month when 681,000 jobs were eliminated across the
country. As the largest segment of the healthcare workforce, RNs likely
will be recruited to fill many of these new positions. Moreover,
according to the latest projections from the BLS, more than 1 million
new and replacement nurses will be needed by 2016. Unless we act now,
this shortage will further jeopardize patient access to quality care.
Nursing and economic research clearly indicate that today's
shortage is far worse than those of the past. The current supply and
demand for nurses demonstrates two distinct challenges. First, due to
the present and looming demand for healthcare by American consumers,
the supply is not growing at a pace that will adequately meet long-term
needs, including the demand for primary care, which is often provided
by Advanced Practice Registered Nurses (APRNs). This is further
compounded by the number of nurses who will retire or leave the
profession in the near future, ultimately reducing the nursing
workforce. Second, the supply of nurses nationwide is stressed due to
an ongoing shortage of nurse faculty. The nurse faculty shortage
continues to inhibit nursing schools from educating the number of
nurses needed to meet the demand. According to AACN, 49,948 qualified
applicants were turned away from baccalaureate and graduate nursing
programs in 2008 primarily due to a lack of faculty. Of those potential
students, nearly 7,000 were students pursuing a master's or doctoral
degree in nursing, which is the education level required to teach.
NURSING WORKFORCE DEVELOPMENT PROGRAMS: A PROVEN SOLUTION
For nearly five decades, the Nursing Workforce Development Programs
have supported hundreds of thousands of nurses and nursing students.
The title VIII programs award grants to nursing education programs, as
well as provide direct support to nurses and nursing students through
loans, scholarships, traineeships, and programmatic grants.
The Nursing Workforce Development Programs are effective and meet
their authorized mission. In a 2009 survey by AACN, 1,501 title VIII
student recipients reported that these programs played a critical role
in funding their nursing education. An overwhelming number of
respondents (92.7 percent), reported that title VIII paid for a portion
of their tuition and, of those students, approximately 11 percent
reported their tuition was paid in full. While millions of Americans
are struggling during this economic downturn and thousands of students
need to obtain student loans for their education, Federal support is
greatly appreciated and needed. The nursing students responding to this
study expressed overwhelming gratitude for the funding they receive
through title VIII. Nursing remains an attractive and rewarding career
with more than 135,000 current vacant positions, and according to the
BLS, more than 587,000 new nursing positions will be needed by 2016.
Providing support for title VIII is the key to filling these vacant
positions and, in turn, improving healthcare quality.
Over the last 45 years, Congress has used the title VIII
authorities as a mechanism to address nursing shortages. When the need
for nurses was great, higher funding levels were appropriated. During
the nursing shortage of the 1970s, Congress provided $160.61 million to
the title VIII programs in fiscal year 1973. Adjusting for inflation to
address the 36-year difference, the fiscal year 2009 funding level of
$171.03 million in 1973 dollars would be approximately $820 million
today (see Figure 1). More recently, slow rising funding levels between
fiscal year 2006 and fiscal year 2008 for title VIII, coupled with
inflation and rising educational costs, have greatly decreased the
purchasing power of these programs, resulting in a 43 percent decrease
in the number of nurses supported by the programs (see Figure 2).
AACN is delighted that President Obama has noted the need for
increased title VIII funding in his fiscal year 2010 budget proposal.
Therefore, AACN respectfully requests the subcommittee's support for
the President's proposal of $263.4 million for title VIII Nursing
Workforce Development Programs in fiscal year 2010, an additional $92
million more than the fiscal year 2009 level. New monies would expand
nursing education, recruitment, and retention efforts to help resolve
all aspects contributing to the shortage.
NINR: SUPPORTING HEALTH PROMOTION AND DISEASE PREVENTION
As the scientific and research nucleus for nursing science, the
NINR funds research that establishes the scientific basis for health
promotion, disease prevention, and high-quality nursing care services
to individuals, families, and populations. NINR is one of the 27
Institutes and Centers at the National Institutes of Health (NIH).
Often working collaboratively with physicians and other researchers,
nurse scientists are vital in setting the national research agenda.
While medical research focuses on curing diseases, nursing research is
conducted to prevent disease. The four strategic areas of emphasis for
research at NINR are:
--Promoting health and preventing disease;
--Improving quality of life;
--Eliminating health disparities; and
--Setting directions for end-of-life research.
The science advanced at NINR is integral to the future of the
Nation's healthcare system. With a renewed national priority on
utilizing cost-effective treatment modalities and preventive
interventions, NINR has developed research programs in these areas:
Comparative Effectiveness Research.--Has been an NINR funding
priority for many years. Comparative effectiveness research
demonstrates how prevention strategies or interventions can impact
system-wide savings. At a time when healthcare consumers and reformers
are seeking quality care focused on prevention that is affordable and
accessible by all, comparative effectiveness research is a critical
area of inquiry.
Promoting Health and Preventing Disease.--Is vital considering that
more than 1.7 million Americans die each year from chronic diseases.
Nurse researchers focus on investigating wellness strategies to prevent
these chronic diseases. A healthcare system which promotes prevention
promises to be a major focus of health reform, and NINR is a leader in
funding scientific research to discover optimal prevention methods.
NINR's fiscal year 2009 funding level of $141.88 million is
approximately 0.47 percent of the overall $30.03 billion NIH budget
(see Figure 3). Spending for nursing research is a modest amount
relative to the allocations for other health science institutes and for
major disease category funding. For NINR to adequately continue and
further its mission, the Institute must receive additional funding.
Cuts in funding have impeded the Institute from supporting larger
comprehensive studies needed to advance nursing science and improve the
quality of patient care.
Therefore, AACN respectfully requests $178 million for NINR, an
additional $36.12 million more than the fiscal year 2009 level.
Considering that NINR presently allocates 7 percent of its budget to
training that helps develop the pool of nurse researchers, additional
funding would support NINR's efforts to prepare faculty researchers
needed to educate new nurses.
THE CAPACITY FOR NURSING STUDENTS AND FACULTY PROGRAM, SECTION 804 OF
THE HIGHER EDUCATION OPPORTUNITY ACT OF 2008 (PUBLIC LAW 110-315)
According to AACN (2009), the major barriers to increasing student
capacity in nursing schools are insufficient numbers of faculty,
admission seats, clinical sites, classroom space, clinical preceptors,
and budget constraints. The Capacity for Nursing Students and Faculty
Program, a recently passed section of the Higher Education Opportunity
Act of 2008, offers capitation grants (formula grants based on the
number of students enrolled/or matriculated) to nursing schools
allowing them to increase the number of students. AACN respectfully
requests $50 million for this program in fiscal year 2010.
CONCLUSION
AACN acknowledges the fiscal challenges within which the
subcommittee and the entire Congress must work. However, the title VIII
authorities provide a dedicated, long-term vision for educating the new
nursing workforce and the next cadre of nurse faculty. NINR invests in
developing the scientific basis for quality nursing care. The Capacity
for Nursing Students and Faculty Program will allow schools to increase
student capacity. To be effective these programs must receive
additional funding. AACN respectfully requests $263.4 million for title
VIII programs, $178 million for NINR, and $50 million for the Capacity
for Nursing Students and Faculty Program in fiscal year 2010.
Additional funding for these programs will assist schools of nursing to
expand their educational and research programs, educate more nurse
faculty, increase the number of practicing RNs, and ultimately improve
the patient care provided in our healthcare system.
______
Prepared Statement of the American Association of Colleges of
Osteopathic Medicine
On behalf of the American Association of Colleges of Osteopathic
Medicine (AACOM), I am submitting this testimony in support of
increased funding in fiscal year 2010 for the title VII health
professions education programs, the National Health Service Corps
(NHSC), the National Institutes of Health (NIH), and the Agency for
Healthcare Research and Quality (AHRQ). AACOM represents the
administrations, faculty, and students of the Nation's 25 colleges of
osteopathic medicine and three branch campuses that offer the doctor of
osteopathic medicine degree. Today, more than 15,500 students are
enrolled in osteopathic medical schools. Nearly 1 in 5 U.S. medical
students is training to be an osteopathic physician, a ratio that is
expected to grow to 1 in 4 by 2019.
TITLE VII
The health professions education programs, authorized under title
VII of the Public Health Service Act and administered through the
Health Resources and Services Administration (HRSA), support the
training and education of health practitioners to enhance the supply,
diversity, and distribution of the healthcare workforce, filling the
gaps in the supply of health professionals not met by traditional
market forces. Title VII and title VIII nurse education programs are
the only Federal programs designed to train clinicians in
interdisciplinary settings to meet the needs of special and underserved
populations, as well as increase minority representation in the
healthcare workforce.
According to HRSA, an additional 30,000 health practitioners are
needed to alleviate existing health professional shortages. Combined
with faculty shortages across health professions disciplines, racial
and ethnic disparities in healthcare, and a growing, aging population,
these needs strain an already fragile healthcare system. AACOM
recommends $330 million in fiscal year 2010 for the title VII programs.
Investment in these programs, including the Training in Primary Care
Medicine and Dentistry Program, the Health Careers Opportunity Program,
and the Centers of Excellence, is necessary to address the primary care
workforce shortage. Such an investment will help sustain the health
workforce expansion supported by the American Recovery and Reinvestment
Act (ARRA) and restore funding to critical programs that suffered
drastic funding reductions in fiscal year 2006 and remain well below
fiscal year 2005 levels.
AACOM is pleased that President Obama requested considerable
increases in the following title VII programs: Training in Primary Care
Medicine and Dentistry ($56.4 million requested/16.5 percent increase);
Centers of Excellence ($24.6 million requested/19.4 percent increase);
and Health Careers Opportunity Program ($22.1 million requested/15.7
percent increase).
NHSC
Approximately 50 million Americans live in communities with a
shortage of health professionals, lacking adequate access to primary
care. Through scholarships and loan repayment, HRSA's NHSC supports the
recruitment and retention of primary care clinicians to practice in
underserved communities. The NHSC is comprised of more than 4,000
clinicians, with more than half working in community health centers.
Growth in HRSA's Health Center Program must be complemented with
increases in the recruitment and retention of primary care clinicians
to ensure adequate staffing. ARRA funding for the NHSC is vital in this
regard, and additional investment will be necessary to sustain the
progress once the ARRA funding period ends. AACOM recommends $235
million in fiscal year 2010 for NHSC, the amount authorized under the
Health Care Safety Net Amendments of 2002.
AACOM notes that President Obama requested significant increases
for NHSC field placement ($46 million requested/6 percent increase) and
recruitment ($123 million requested/29.5 percent increase).
NIH
Research funded by the NIH leads to important medical discoveries
regarding the causes, treatments, and cures for common and rare
diseases as well as disease prevention. These efforts improve our
Nation's health and save lives. The NIH funding under the ARRA will
produce more high-quality research. To seize the momentum created by
the ARRA and maintain a robust research agenda, further investment will
be needed. AACOM recommends $33.35 billion in fiscal year 2010 for the
NIH.
In today's increasingly demanding and evolving medical curriculum,
there is a critical need for more research geared toward evidence-based
osteopathic medicine. AACOM believes that it is vitally important to
maintain and increase funding for biomedical and clinical research in a
variety of areas related to osteopathic principles and practice,
including osteopathic manipulative medicine and comparative
effectiveness. In this regard, AACOM encourages support for the NIH's
National Center for Complementary and Alternative Medicine (NCCAM) to
continue fulfilling this essential research role.
AACOM appreciates President Obama requesting increases for NIH ($31
billion requested/1.45 percent increase) and NCCAM ($127 million
requested/1.6 percent increase).
AHRQ
AHRQ supports research to improve healthcare quality, reduce costs,
advance patient safety, decrease medical errors, and broaden access to
essential services. AHRQ plays an important role in producing the
evidence base needed to improve our Nation's health and healthcare. The
incremental increases for AHRQ's Effective Health Care Program in
recent years, as well as the funding provided to AHRQ in the ARRA, will
help AHRQ generate more comparative effectiveness research and expand
the infrastructure needed to increase capacity to produce this
evidence. More investment is needed, however, to fulfill AHRQ's mission
and broader research agenda. AACOM recommends $405 million in fiscal
year 2010 for AHRQ. This investment will preserve AHRQ's current
programs while helping to restore its critical healthcare safety,
quality, and efficiency initiatives.
AACOM greatly appreciates the support of the subcommittee for these
funding priorities in an ever increasing competitive environment and is
grateful for the opportunity to submit its views. AACOM looks forward
to continuing to work with the subcommittee on these important matters.
______
Prepared Statement of the American Association of Colleges of Pharmacy
The American Association of Colleges of Pharmacy (AACP) and its
member colleges and schools of pharmacy appreciate the continued
support of the Senate Appropriations Subcommittee on Labor, Health and
Human Services, and Education, and Related Agencies. Our Nation's 111
accredited colleges and schools of pharmacy are engaged in a wide-range
of programs supported by grants and funding administered through the
agencies of the Department of Health and Human Services (HHS) and the
Department of Education. 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.
DEPARTMENT OF HEALTH AND HUMAN SERVICES SUPPORTED PROGRAMS AT COLLEGES
AND SCHOOLS OF PHARMACY
Agency for Healthcare Research and Quality (AHRQ)
AACP supports the Friends of AHRQ recommendation of $405 million
for AHRQ programs in fiscal year 2010.
Pharmacy faculty are strong partners with AHRQ. Academic pharmacy
researchers are working to develop a sustainable health services
research effort among faculty with AHRQ grant support. As partners in
the AHRQ Effective Healthcare programs (CERTs, DeCIDE), pharmacy
faculty researchers improve the effectiveness of healthcare services.
Some of this research will take place through the development of
practice-based research networks focused on improving the medication
use process.
--Last fall, AHRQ expanded its Centers for Education and Research on
Therapeutics (CERTs) program by awarding $41.6 million over the
next 4 years for a new coordinating center, 10 research centers
and four new centers receiving first-time funding. The
University of Illinois at Chicago College of Pharmacy joins the
13 CERTs program centers in efforts to conduct research and
provide education that advances the optimal use of
therapeutics.
http://www.aacp.org/news/academicpharmnow/Documents/
MarApr%202008%20APN.pdf
--Pharmacy faculty researchers, supported by AHRQ grant HS016097,
determined that children who are prescribed medications related
to their diagnosis of attention deficit/hyperactivity disorder
were not at increased risk for hospitalization for cardiac
events. The results of this research will be presented in a web
conference sponsored by AHRQ and APhA on May 1, 2009.
Centers for Disease Control and Prevention (CDC)
AACP supports the CDC Coalition recommendation of $8.6 billion for
CDC core programs in fiscal year 2010.
The educational outcomes of a pharmacist's education include those
related to public health. When in community-based positions,
pharmacists are frequently providers of first contact. The opportunity
to identify potential public health threats through regular interaction
with patients provides public health agencies such as the CDC with on-
the-ground epidemiologists. Pharmacists support the public health
system through the risk identification of patients seeking medications
associated with preventing and treating travel-related illnesses.
Pharmacy faculty are engaged in CDC-supported research in areas such as
immunization delivery, integration of pharmacogenetics in the pharmacy
curriculum and inclusion of pharmacists in emergency preparedness.
Information from the National Center for Health Statistics (NCHS) is
essential for faculty engaged in health services research and for the
professional education of the pharmacist.
--Grace Kuo, CDC-supported member of the faculty at the University of
California, San Diego, is engaged in research aimed at
improving the safety of medication use in primary care
settings.
--Jeanine Mount, CDC-supported member of the faculty at the
University of Wisconsin, is engaged in research to determine
how pharmacists can be better utilized in increase the
vaccination rates across our Nation.
Health Resources and Services Administration (HRSA)
AACP supports the Friends of HRSA recommendation of $8.5 billion.
HRSA is a Federal agency with a wide-range of policy and service
components. Faculty at colleges and schools of pharmacy are integral to
the success of many of these. Colleges and schools of pharmacy are the
administrative units for interprofessional and community-based linkages
programs including geriatric education centers and area health
education centers. Pharmacy faculty are supported in their research
efforts regarding rural health issues through the Office of Rural
Health Policy. Pharmacy students benefit from diversity program funding
including Scholarships for Disadvantaged Students.
OFFICE OF PHARMACY AFFAIRS (OPA)
AACP recommends a program funding of $5 million for fiscal year
2010 for OPA.
AACP member institutions are actively engaged in OPA efforts to
improve the quality of care for patients in federally qualified health
centers and entities eligible to participate in the 340B drug discount
program. The success of the HRSA Patient Safety and Clinical Pharmacy
Collaborative is a direct result of past OPA actions linking colleges
and schools of pharmacy with federally qualified health centers
(www.hrsa.gov/patientsafety). The result of these links has been the
establishment of medical homes that improve health outcomes for
underserved and disadvantaged patients through the integration of
clinical pharmacy services. The Office of Pharmacy Affairs would
benefit from a direct line-item appropriation so that public-private
partnerships aimed at improving the quality of care provided at
federally qualified health centers can be sustained and expanded.
POISON CONTROL CENTERS
Colleges and schools of pharmacy are supported by HRSA grant
funding for the operation of 9 of the 42 poison control centers
administered by HRSA.
--Jill E. Michels, faculty member from the University of South
Carolina--South Carolina College of Pharmacy (USC), and the
Palmetto Poison Center (PPC) were awarded a $310,000 grant from
HRSA. The PPC is housed at the College of Pharmacy and serves
all 46 counties in South Carolina receiving more than 37,000
calls per year for information and advice. A recent USC study
found that for every $1 spent on the Palmetto Poison Center,
more than $7 was saved in unnecessary healthcare costs,
including emergency room and physician visits, ambulance
services, and unnecessary medical treatments. http://
poison.sc.edu/about.html
BUREAU OF HEALTH PROFESSIONS (BHPR)
AACP supports the Health Professions and Nursing Education
Coalition (HPNEC) recommendation of $550 million for title VII and VIII
programs in fiscal year 2010.
AACP member institutions are active participants in BHPr programs.
Two colleges of pharmacy are current grantees in the Centers of
Excellence program (Xavier University--Louisiana and the University of
Montana) which focuses on increasing the number of underserved
individuals attending health professions institutions. Colleges and
schools of pharmacy are also part of title VII interprofessional and
community-based linkages programs including Geriatric Education Centers
and Area Health Education Centers. These programs are essential for
creating the educational approaches that align with the Institute of
Medicine's recommendations for improving quality through team-based,
patient-centered care.
OFFICE OF TELEHEALTH ADVANCEMENT
Technology is an important component for improving healthcare
quality and maintaining or increasing access to care. Colleges and
schools of pharmacy utilize technology to increase the reach of
education to aspiring and current professionals.
--Massachusetts College of Pharmacy and Health Sciences--Worcester
Campus Distance Learning Initiative--Phase II.--Grant support
for this program will allow the expansion of health profession
education programs throughout Massachusetts and New Hampshire.
http://hrsa.gov/telehealth/granteedirectory/overview_ma.htm
--North Dakota State University College of Pharmacy, Nursing, and
Allied Sciences uses grant funding to maintain access to
pharmacy services in rural, underserved areas of North Dakota.
This program helps more than 40,000 rural citizens maintain
access to pharmacy services and also supports rural hospital
pharmacies. http://hrsa.gov/telehealth/granteedirectory/
overview_nd.htm
FOOD AND DRUG ADMINISTRATION (FDA)
AACP recommends a funding level of $3 billion for FDA programs in
fiscal year 2010.
Academic pharmacy is working with the FDA to fulfill its strategic
goals and the responsibilities assigned to the agency through the Food
and Drug Administration Amendments Act. The FDA sees the colleges and
schools of pharmacy as essential partners in assuring the public has
access to a healthcare professional well versed in the science of
safety.
--Carole L. Kimberlin, a professor, and Almut G. Winterstein, an
assistant professor at the University of Florida College of
Pharmacy Department of Pharmaceutical Outcomes and Policy,
received a 1-year $184,229 award from the FDA to conduct an
evaluation of Consumer Medication Information leaflets on
selected prescription medications from community pharmacies
throughout the United States.
--Thomas C. Dowling's research, ``Evaluation of Biopharmaceutics
Classification System Class 3 Drugs for Possible Biowaivers,''
is supported by an FDA grant.
--The FDA-supported National Institute of Pharmaceutical Technology
and Education is funding research at the University of
Connecticut focused on the development of freeze-dried
products.
NATIONAL INSTITUTES OF HEALTH (NIH)
AACP supports the Ad Hoc Group for Medical Research recommendation
of $32.4 billion for fiscal year 2010.
Pharmacy faculty are supported in their research by nearly every
Institute at the NIH. The NIH-supported research at AACP member
institutions spans theresearch spectrum from the creation of new
knowledge through the translation of that new knowledge to providers
and patients. In 2008, pharmacy faculty researchers received more than
$260 million in grant support from the NIH.
--Researchers at the University of Illinois at Chicago College of
pharmacy have received a $1.7 million 5-year Federal grant to
develop a new approach to treat brain tumors. The novel
approach stabilizes the drug and provides better control of the
time and location of its activity, thereby reducing its side
effects.
--University of Nebraska Medical Center (UNMC) received $10.6 million
from the National Center for Research Resources (NCRR) to
research nanomedicine, drug delivery, therapeutics, and
diagnostics. UNMC researcher, Dr. Alexander V. Kabanov, is the
principal investigator on the $10.6 million COBRE (Centers for
Biomedical Research Excellence) grant, which will be awarded by
the NIH/NCRR over the next 5 years.
--Dr. Maria Croyle, associate professor of pharmaceutics at The
University of Texas at Austin College of Pharmacy, has received
$2.6 million from NIH to develop a vaccine against Ebola virus
infection.
--As part of NIH funding for the new NIH Roadmap Epigenomics Program,
Dr. Rihe Liu, associate professor at the University of North
Carolina at Chapel Hill Eshelman School of Pharmacy, received a
technology development grant to support the advancement of
innovative technologies that have the potential to transform
the way that epigenomics research can be performed in the
future.
--A project funded by the National Institute of General Medical
Sciences takes computer-aided drug design to the next level
with the help of a University of Michigan College of Pharmacy
professor.
--Fourteen additional universities were awarded the Clinical and
Translational Science Award in May 2008. Five colleges of
pharmacy are included in this group and will play significant
collaborative roles with the new consortium members as the NIH
provides $533 million over 5 years to help enable researchers
to provide new treatments more efficiently and effectively to
patients.
--Dr. Laurence H. Hurley, professor of pharmaceutical sciences at The
University of Arizona College of Pharmacy, is 1 of 38
scientists to receive the 2009 NIH EUREKA grant.
DEPARTMENT OF EDUCATION SUPPORTED PROGRAMS AT COLLEGES AND SCHOOLS OF
PHARMACY
AACP supports the recommendation of the Student Aid Alliance that
the:
--Perkins Loan Program Federal Capital Contribution should be
increased to the newly reauthorized level of $300 million and
loan cancellations should be increased to $125 million.
--Pell Grant maximum be increased to $5,500.
--Gaining Early Awareness and Readiness for Undergraduate Programs
(GEAR UP) should be increased to the authorized level of $400
million.
--Graduate level programs should be increased to $77 million.
AACP recommends a funding level of $140 million for the Fund for
the Improvement of Post Secondary Education (FIPSE).
The Department of Education supports the education of healthcare
professionals by:
--assuring access to education through student financial aid
programs;
--supporting educational research allows faculty to determine
improvements in educational approaches; and
--maintaining the quality of higher education through the approval of
accrediting agencies.
AACP actively supports increased funding for undergraduate student
financial assistance programs. Admission to into the pharmacy
professional degree program requires at least 2 years of undergraduate
preparation. Student financial assistance programs are essential to
assuring colleges and schools of pharmacy are accessible to qualified
students. Likewise, financial assistance programs that support graduate
education are an important component of creating the next generation of
scientists and educators that both our Nation and higher education
depend on.
______
Prepared Statement of the American Association for Cancer Research
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 recent large-
scale investment in research through the American Recovery and
Reinvestment Act (ARRA) and the fiscal year 2009 budget will support
current projects and provide for new efforts in the fight against
cancer. These new efforts promise to yield innovative and potentially
breakthrough approaches to understanding, preventing, treating, and
ultimately curing cancer. The full potential, however, will not be
fully realized in a short 1- or 2-year period. Sustained, stable
funding through regular appropriations will be necessary to allow
researchers to make the key investments that will leverage the ARRA
funds so that they both create jobs today and save lives tomorrow.
Unquestionably, the Nation's investment in cancer research is
having a remarkable impact. Cancer deaths in the United States have
declined in recent years. 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 stable and sustained Federal funding for critical
cancer research priorities.
AACR urges the United States House of Representatives to support
President Obama's vision for doubling cancer research funding over the
next 5 years and strongly support other biomedical research funding at
the National Institutes of Health (NIH). AACR supports the $6 billion
for cancer research highlighted in the President's fiscal year 2010
budget outline, which would be best allocated to the National Cancer
Institute (NCI). The AACR also supports the biomedical community's
recommendation of a 7 percent increase for the NIH, which, when
combined with President Obama's vision for cancer research, would fund
NIH at a level of $33.3 billion in fiscal year 2010.
AACR: FOSTERING A CENTURY OF RESEARCH PROGRESS
The American Association for Cancer Research has been moving cancer
research forward since its founding in 1907. Celebrating its 100th
annual meeting, the AACR and its more than 28,000 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
half a million people expected to die from their cancer in 2009. 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 avoid this cancer crisis.
BLUEPRINT FOR PROGRESS: NCI'S STRATEGIC OBJECTIVES
Basic, translational, and clinical cancer research in this country
is conducted primarily through three venues--Government, academia and
the nonprofit sector, and the pharmaceutical/biotechnology industry.
The Congress provides the appropriations for the National Institutes of
Health and the NCI through which most of the Government's research on
cancer is conducted. The NCI has developed documents and processes that
describe and guide its priorities--established with extensive community
input--for the use of these finite resources. ``The NCI Strategic Plan
for Leading the Nation'' and ``The Nation's Investment in Cancer
Research: An Annual Plan and Budget Proposal fiscal year 2010'' are the
recognized professional blueprints for what needs to be done to
accelerate progress against cancer.
AACR and many in the cancer research community concur that if the
NCI receives the increased investment of $2.1 billion as proposed for
fiscal year 2010, the Director's proposed budget will enable the NCI to
rebuild America's research infrastructure capacity and accelerate
research progress in critical priority areas.
FEDERAL INVESTMENT FOR LOCAL BENEFIT
More than 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 6,500
research grants are funded at more than 150 cancer centers and
specialized research facilities located in 49 States. More than half
the States receive more than $15 million in grants and contracts to
institutions located within their borders. This Federal investment
provides needed economic stimulus to local economies: on average, each
dollar of NIH funding generated more than twice as much in State
economic output in fiscal year 2007. Many AACR member scientists across
the Nation are engaged in this rewarding work, and many have had their
long-term research jeopardized by grant reductions caused by the flat
and declining overall funding for the NCI since 2003. The recent
increase in fiscal year 2009 appropriations and the funds from the
American Recovery and Reinvestment Act of 2009 will help to revitalize
America's research infrastructure; however, sustained and stable
funding is critical to reap the benefits of this investment. Thus, the
AACR supports the request in the President's budget proposal for $6
billion in funding for cancer research in fiscal year 2010 and his
commitment to double funding for cancer research over the next 5 years
and, thus, recommends a 20 percent increase in funding for the NCI to
enable it to continue and expand its important work.
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. The
focus of this research includes: investigating the underlying basis of
the full spectrum of genetic susceptibility to cancer; identifying the
influence of the macroenvironment (tumor level) and microenvironment
(tissue level) on cancer initiation and progression; understanding the
behavioral, environmental, genetic, and epigenetic causes of cancer and
their interactions; developing and applying emerging technologies to
expand our knowledge of risk factors and biologic mechanisms of cancer;
and elucidating the relationship between cancer and other human
diseases.
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.
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. The NCI research in this area concentrates on: identifying the
determinants of metastatic behavior; validating cancer biomarkers for
prognosis, metastasis, treatment response, and progression;
accelerating the identification and validation of potential cancer
molecular targets; minimizing the toxicities of cancer therapy; and
integrating the clinical trial infrastructure for speed and efficiency.
The completion of the Human Genome Project has opened the door to the
promise of personalized medicine.
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 historically 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.
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. Just a few of
AACR's contributions include:
--sponsoring the largest meeting of cancer researchers in the world,
with more than 14,000 scientists, where 6,000 scientific
abstracts featuring the latest basic, translational, and
clinical scientific advances are presented;
--publishing more than 3,400 original research articles each year in
six prestigious peer-reviewed scientific journals, including
cancer research, the most frequently cited cancer journal;
--sponsoring the annual International Conference on Frontiers of
Cancer Prevention Research, the largest such prevention meeting
of its kind in the world;
--supporting the work of its Chemistry in Cancer Research Working
Group;
--convening an AACR-FDA-NCI Think Tank on Clinical Biomarkers;
--hosting, with NCI, the Molecular Targets and Cancer Therapeutics
Conference;
--sponsoring and supporting a Minorities in Cancer Research Council
and a Women in Cancer Research Council;
--Conducting the scientific review and grants administration for the
more than $100 million donated to Stand Up To Cancer;
--raising and distributing more than $5 million in awards and
research grants.
STABLE, SUSTAINED INCREASES IN RESEARCH FUNDING
Remarkable progress is being made in cancer research, but much more
remains to be done. Cancer costs the Nation more than $219 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 one percent reduction in
mortality from cancer would be worth nearly $500 billion in social
value. Investments in cancer research stimulate the local economy today
have huge potential returns in the future. Thanks to successful past
investments, promising research opportunities abound and must not be
lost. To maintain our research momentum, the AACR urges the United
States House of Representatives to support a budget of $33.3 billion
for the NIH, including $6 billion for the NCI.
______
Letter From the American Association of Colleges for Teacher Education
April 30, 2009.
Hon. Tom Harkin,
Chairman, Subcommittee on Labor, Health and Human Services, and
Education, and Related Agencies, Washington, DC.
Dear Chairman Harkin: I want to extend my appreciation to you and
your colleagues in Congress for your support of Federal education
programs. Your commitment makes a significant difference for the
education of our millions of PK-12 and postsecondary students.
As you and your colleagues begin the fiscal year 2010
appropriations process, the American Association of Colleges for
Teacher Education (AACTE) urges you to increase the Federal
Government's investment in the preparation of professional educators.
While there are significant funds behind title II of the No Child Left
Behind Act in the Improving Teacher Quality State Grants, the vast
majority of these funds, and other funds in title II, go towards class
size reduction and the professional development of practicing teachers.
Equally important, though, is the initial preparation of teachers and
other school personnel. And, in this respect, the Federal Government's
investment, until very recently, has declined over the years. As this
Nation is in the midst of teacher retention and shortage crises, it is
critical that the Government responds with a plan that provides for
systemic change.
There are several programs within the Department of Education
intended to strengthen and improve educator recruitment and preparation
efforts. We are working with program authorizers in Congress and staff
within the agencies to ensure that these programs work in concert with
each other. However, one of the key factors that prevents these
programs from becoming levers for systemic change is their consistent
underfunding. The cost of preparing school personnel is significant.
The primary Federal program in this area is the Teacher Quality
Partnership (TQP) Grants (title II, Higher Education Opportunity Act).
During the reauthorization of the Higher Education Act we supported
several changes to title II of the bill that have resulted in a much
stronger TQP program. Under this program, these grants go to
partnerships of institutions of higher education, high-need local
educational agencies, and high-need K-12 schools to prepare teachers
and other school personnel to effectively serve in the schools. The
grants are particularly focused on strengthening the clinical component
of preparation programs--research has shown that preservice clinical
experiences are essential to preparing effective teachers and to
teacher retention.
Grants can be used to strengthen prebaccalaureate preparation
programs and/or to develop 1-year master's degree level teaching
residency programs. In exchange for receiving a living stipend during
the residency, teachers would commit to teaching for at least 3 years
in a shortage field in a high-need school. The residency programs are
targeted to recruiting career-changers and recent college graduates. In
these times of rising unemployment, these programs are ideal for those
who have been laid off and are seeking a stable and rewarding new
career. President Obama wrote the legislation for the teaching
residency programs when he was a Senator on the HELP Committee. During
his Presidential campaign and since his election he has stated that he
wants to prepare 30,000 new educators through the residency programs.
In order to meet that goal, and to provide sufficient support to
the partnerships that carry out TQP Grants, we ask that you fund the
TQP program at the $150 million level in fiscal year 2010. The TQP
program received $50 million in fiscal year 2009, and $100 million in
the stimulus package. This is a significant boost to the program which
was funded in fiscal year 2008 at $33 million. The $150 million in
fiscal year 2010 appropriations will maintain the current level of
funding when the stimulus funding concludes.
Below you will find AACTE's recommendations for funding additional
programs in fiscal year 2010.
--Fund Teachers for a Competitive Tomorrow at the $60 Million
Level.--This program was authorized in the America Competes
Act, and it is currently funded at $2.18 million. This program
and the TQP program are the only two Federal education program
directed targeted to higher-education-based educator
preparation programs. With the teacher shortage and retention
crisis acutely felt in the math and science teaching fields,
this program is a crucial piece of the response to ameliorate
the teacher shortage challenges. This competitive grant program
helps higher education institutions build baccalaureate and
master's degree programs that allow students to major in STEM
fields while working toward teacher certification.
--Fund the Transition to Teaching program at the $60 Million Level.--
This program, authorized in title II of the No Child Left
Behind Act at the $150 million level and currently funded at
$43.7 million, supports the development of teacher preparation
programs suited for career-changers and others who enter
teaching through nontraditional routes. Higher education
institutions and other entities have used funds from this
program to develop innovative preparation programs that
accommodate the needs of a diverse educator candidate pool
while ensuring that candidates are prepared to teach in today's
K-12 classrooms.
--Fund the Troops-to-Teachers program at the $25 Million Level.--Like
Transition to Teaching, this program aims to attract teachers
from another profession into the classroom. Troops-to-Teachers
has been very successful at recruiting retired military into
the teaching profession. By funding the program at $25 million,
this would almost double the Government's investment in the
program (currently at $14.4 million) during a time in which
there is higher military interest in entering the K-12 teaching
ranks.
--Fund the IDEA Personnel Preparation Program at the $120 Million
Level.--Currently funded at $90.65 million, this program
provides essential funds to prepare and develop special
educators. Special education teachers, much like math and
science teachers, are in high demand in the K-12 schools with
the shortage being significant. With the wide breadth and
increasing number of special need students there needs to be an
adequate supply of teachers who can work with them to ensure
student learning.
--Fund the Centers for Excellence Program at the $20 Million Level.--
This new program was authorized in title II of the Higher
Education Opportunity Act and is currently unfunded. Grants
would support the strengthening of educator preparation
programs at institutions that serve historically under-
represented populations.
--Fund the Teach to Reach Grant Program at the $15 Million Level.--
This new program was authorized in title II of the Higher
Education Opportunity Act and is currently unfunded.
Institutions of higher education would use grants to ensure
that all of their teacher candidates were prepared to teach
children with disabilities. Almost every K-12 classroom has
students with learning, intellectual, and/or physical
disabilities. It is critical that every teacher is prepared
with instructional skills that will assure that every child has
the opportunity to learn.
--Fund the Graduate Fellowships To Prepare Faculty at Colleges of
Education Program at the $15 Million Level.--This new program
was authorized in title II of the Higher Education Opportunity
Act and is currently unfunded. The current shortage of K-12
teachers in the math, science, special education, and English
language learners fields is directly correlated with the
shortage of faculty at institutions of higher education who
prepare teachers in these fields. This program would support
doctoral students who intend to become faculty who prepare
teachers in these shortage areas.
The AACTE is a national voluntary association of higher education
institutions and other organizations and is dedicated to ensuring the
highest-quality preparation and continuing professional development for
teachers and school leaders. Our overarching mission is to enhance PK-
12 student learning. Collectively, the AACTE membership prepares more
than two-thirds of the new teachers entering schools each year in the
United States.
Thank you for your consideration of the perspective of AACTE and
its membership of close to 800 private, State, and municipal colleges
and universities--large and small--located in every State, the District
of Columbia, the Virgin Islands, Puerto Rico, and Guam.
Sincerely,
Sharon P. Robinson, Ed.D.,
President and CEO.
______
Prepared Statement of the American Association for Dental Research
The American Association for Dental Research (AADR) is a nonprofit
organization with more than 4,000 individual members and 100
institutional members within the United States. The AADR's mission is
to advance research and increase knowledge for the improvement of oral
health for all Americans.
The AADR thanks the subcommittee for this opportunity to testify
about the exciting advances in oral health science. Americans are
living better and healthier lives into old age due to recent advances
in healthcare, including dental care and oral health research, thanks
to the efforts of the National Institute of Dental and Craniofacial
Research (NIDCR). NIDCR was formed in 1948 by the National Institutes
of Health (NIH). Its staff has conducted research, trained researchers,
and disseminated health information to improve the health of Americans
and make it possible for them to live longer and healthier lives.
On February 17 of this year, President Barack Obama signed into law
the $787 billion stimulus package known as the American Recovery and
Reinvestment Act (ARRA). This legislation will provide NIH with $8.2
billion to conduct additional scientific research. AADR members,
researchers across the country, would like to thank the committee for
its past support and in particular for the funds contained in the
stimulus package. The past investment in NIH has paid a dividend to
taxpayers in the form of improved oral health.
HEALTH DISPARITIES
One very challenging issue we face in this country is health
disparities. We must learn more about the causes of cultural inequality
among individual members of society if we are to conduct more effective
research.
The NIDCR's mission is to train and engage as many young
investigators as possible in oral health disparities research to
develop various methods of research to eliminate these disparities.
They hope that this will improve the oral, dental, and craniofacial
health of diverse populations.
Health disparities are the persistent gaps between the health
status of minorities and nonminorities in the United States. Despite
continued advances in healthcare and technology, racial and ethnic
minorities continue to have higher rates of disease, disabilities, and
premature death than nonminorities. African Americans, Hispanics/
Latinos, American Indians and Alaska natives, Asian Americans, Native
Hawaiians, and Pacific Islanders have higher rates of infant mortality,
cardiovascular disease, diabetes, AIDS, and cancer, and lower rates of
immunizations and cancer screening.
There is debate about what causes health disparities between ethnic
and racial groups. However, it is generally accepted that disparities
can result from three main areas:
--from the personal, socioeconomic, and environmental characteristics
of different ethnic and racial groups;
--from the barriers certain racial and ethnic groups encounter when
trying to enter into the healthcare delivery system; and
--from the quality of healthcare different ethnic and racial groups
receive.
These are all considered possible causes for disparities between
racial and ethnic groups. However, most attention on the issue has been
given to the health outcomes that result from differences in access to
medical care among groups and the quality of care that various groups
receive. Since many scientific discoveries do not reach all people,
there are disparities in the health and healthcare among various groups
in the United States. Even though data on racial and ethnic disparities
are relatively widely available, data on socioeconomic healthcare
disparities are collected less often.
The Health Disparities Research Program responds to the growing
awareness that, despite improvements in some oral health status
indicators, the burden of disease is not evenly distributed across all
segments of our society. The program supports research that explores
the multiple and complex factors that may determine oral and
craniofacial health, diseases, and conditions in disadvantaged and
underserved populations. Funds go to a wide variety of different
scientific approaches designed to reduce and eventually eliminate oral
and craniofacial diseases and conditions in disadvantaged and
underserved populations. The program supports both qualitative and
quantitative approaches.
The NIDCR will support interventional research that will have a
meaningful impact on caries, oral and pharyngeal cancer, and
periodontal disease, and that will influence clinical practice, health
policy, community and individual action, ultimately eliminating
disparities in vulnerable people. NIDCR will also fund health
disparities interventional research beyond that conducted through the
Centers for Research to Reduce Disparities in Oral Health program.
SALIVARY DIAGNOSTICS
For many oral and systemic diseases, early detection offers the
best hope for successful treatment. Oral and systemic diseases can be
difficult to diagnose, involving complex clinical evaluation and/or
blood and urine tests that are labor-intensive, expensive, and
invasive. Now, after many years of research, saliva is poised to be
used as a noninvasive diagnostic fluid for a number of oral and
systemic conditions. Saliva, a protective fluid of the oral cavity,
combats bacteria and viruses that enter the mouth and serves as a first
line of defense in oral and systemic diseases. It contains many
compounds indicating a person's overall health and disease status, and,
like blood or urine, its composition may be affected by a disease--
therefore, saliva is a mirror of the body. Since saliva is easy to
collect, it is a good alternative to using blood or urine for
diagnostic tests.
The year 2008 was exciting in the incremental development of
salivary diagnostics. A consortium of NIDCR-supported scientists
completed the first catalogue of the human salivary proteome, or the
full set of 1,166 proteins present in saliva. This will help facilitate
the future testing of saliva as a standard body fluid to detect early
signs of disease. A team of NIDCR grantees also assembled the first
panel of salivary protein biomarkers to detect oral squamous cell
carcinoma (OSCC). This is the most common form of the oral cancers.
Salivary diagnostic techniques have already been developed for and
are being used to detect HIV. Saliva could be used as a potential
monitor of disease progression in systemic disorders, including
Alzheimer's disease, cystic fibrosis, and diabetes. Specific protein
markers in human saliva are being investigated that can be identified
and quantified to provide an early, noninvasive diagnosis for even
cancers distant from the oral cavity, such as pancreatic and breast
cancer. Getting a diagnosis used to entail making a trip to the
doctor's office. The doctor's examination often required the patient
providing a blood and/or urine sample. Even though getting a diagnosis
still requires a trip to the doctor's office, scientists are now
identifying the genes and proteins that are expressed in the salivary
glands that will help define the patterns and certain conditions under
which these genes and proteins are expressed in the salivary glands.
Building on this research, saliva will become a more commonly used
diagnostic fluid.
ORAL CANCER
Oral cancer affects 38,000 Americans each year and 350,000 people
worldwide. The death rate associated with this cancer is especially
high, due to delayed diagnosis. Oral cancer is any cancerous tissue
growth located in the mouth. About two-thirds of oral cancers occur in
the mouth, and about one-third are found in the pharynx. On average,
only 60 percent of people with the disease will survive more than 5
years. However, here again, disparities play a role, and only 35
percent of black men will survive 5 years. Oral cancer occurs most in
people over the age of 40 and affects more than twice as many men as
women. Researchers are developing a Point of Care diagnostic system
(real-time) for rapid on-site detection of saliva-based tumor markers.
Early detection of oral cancer will increase survival rates, improve
the quality of life of cancer patients, and result in a significant
reduction in healthcare costs.
Oral cancer forms in tissues of the lip or mouth. In 2008,
approximately 22,900 new cases of oral cancer occurred in the United
States. Oral cancer claimed roughly 5,390 deaths that year. It
represents approximately 3 percent of all cancers. This, however,
translates to 30,000 new cases every year in the United States. More
than 34,000 Americans will be diagnosed with oral or pharyngeal cancer
this year. It will cause more than 8,000 deaths, killing roughly 1
person per hour, 24 hours per day. Of those 34,000 newly diagnosed
individuals, only half will be alive in 5 years. The death rate for
oral cancer is higher than that of cancers such as cervical cancer,
laryngeal cancer, thyroid cancer, or skin cancer. Worldwide, the
problem is much greater, with more than 400,000 new cases being found
each year.
Survival rates can be calculated by different methods for different
purposes. If oral cancer is caught when the disease has not spread
beyond the original tumor site, the 5-year relative survival rate is 82
percent. However, half of oral cancers are not diagnosed until the
cancer has spread to nearby tissues. At this stage, the 5-year relative
survival rate drops to 53 percent. Those diagnosed when the cancer has
spread further, to distant organs, have only a 28 percent 5-year
relative survival rate. It's important to detect oral cancer early,
when it can be treated more successfully. Typically, the earlier cancer
is detected and diagnosed, the more successful the treatment, thus
enhancing the survival rate.
CONCLUSION
There are many research opportunities with an immediate impact on
patient care that need to be pursued. A consistent and reliable funding
stream for NIH overall, and for NIDCR in particular, is essential for
continued improvement in the oral health of Americans. Oral cancer is
one of the most expensive cancers to treat--the average cost for
treating an advanced case is $200,000. Overcoming cancer health
disparities is one of the best opportunities we have for lessening the
burden of cancer. But the burden of cancer is too often greater for the
poor, for ethnic minorities, and for the uninsured than for the general
population.
A great amount of promising research is under way, and the
potential to improve oral health specifically, and overall health in
general, is significant. Therefore, we are requesting that NIDCR
receive a fiscal year 2010 appropriation of $442 million, not including
the ARRA funding, to help sustain and build upon the discoveries and
employment opportunities that were created using stimulus funding.
Thank you for the subcommittee's support of NIH programs in the past,
and we are grateful for this opportunity to present our views.
______
Prepared Statement of the American Academy of Family Physicians
On behalf of the American Academy of Family Physicians (AAFP), I
commend President Barack Obama for demonstrating a commitment to a
strong primary care workforce by seeking to increase training under
title VII, section 747 of the Public Health Services Act in his fiscal
year 2010 budget. As one of the largest national medical organizations,
representing family physicians, residents, and medical students, the
AAFP recommends that the Senate Appropriations Subcommittee on Labor,
Health and Human Services, and Education, and Related Agencies build on
that commitment to title VII section 747 in fiscal year 2010 and
increase funding for other key HHS programs to allow healthcare reform
to succeed and support better healthcare all.
HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA)
HRSA is charged with improving access to healthcare services for
people who are uninsured, isolated, or medically vulnerable. One of the
most critical aspects of this mission is ensuring a healthcare
workforce which is sufficient to meet the needs of patients and
communities.
HRSA--HEALTH PROFESSIONS
For 40 years, the training programs authorized by title VII of the
Public Health Services Act evolved to meet our Nation's healthcare
workforce needs. While it is increasingly clear that our Nation has a
worsening shortage of primary care physicians, many ``studies have
found a strong, sometimes dose-dependent associations between title VII
funding and increased production of primary care graduates, and
physicians who eventually practice in rural areas and federally
designated physician shortage areas.'' \1\
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\1\ Robert Graham Center. Specialty and Geographic Distribution of
Physician Workforce: What Influences Medical Student & Resident
Choices? 2009 Washington, DC.
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The sixth report of the HRSA Advisory Committee on Training in
Primary Care Medicine and Dentistry recommended an annual minimum level
of $215 million for the title VII section 747 grant program. The
subcommittee reasoned that:
Title VII funds are essential to support major primary care
training programs that train the providers who work with vulnerable
populations. It is critical that funds not only be restored to 2005
levels, but that funding be increased, as the need for healthcare of
the public, including those high-risk groups identified in this report,
increases. It is critical that funds offset the acknowledged rate of
inflation. This additional funding is also necessary to prepare current
and future primary care providers for their critical role in responding
to healthcare challenges including demographic changes in the
population, increased prevalence of chronic conditions, decreased
access to care, and a need for effective first-response strategies in
instances of acts of terrorism or natural disasters.
Healthcare reform demands that we must modernize workforce and
education policies to ensure an adequate number of primary care
physicians trained to serve in the new healthcare delivery model. The
patient centered medical home will give patients access to preventive
care and coordination of the care needed to manage chronic diseases as
well as appropriate care for acute illness. The medical home practice
model provides improved efficiency and better health because it serves
as a principal source of access and care. As a result, duplication of
tests and procedures and unnecessary emergency department visits and
hospitalizations can be avoided
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). Section 747
offers competitive grants for family medicine training programs in
medical schools and in residency programs. Section 747 is vital to
stimulate medical education, residency programs, as well as academic
and faculty development in primary care to prepare physicians to
support the patient centered medical home.
The value of title VII 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.\2\ Health Professions Grants are one important tool to
help refocus the Nation's health system on primary care.
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\2\ Starfield B, et al. The effects of specialist supply on
populations' health: assessing the evidence. Health Affairs. 15 March
2005
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Although HRSA has not released the spending plan for the American
Recovery and Reinvestment Act (ARRA) health professions training funds
for fiscal year 2009-2010, the omnibus appropriation increased section
747 by less than 1 percent more than the final fiscal year 2008 amount
to $48,425,000 for fiscal year 2009. It remains well below the $92
million provided for Primary Care Medicine and Dentistry Training in
fiscal year 2003. The Nation needs significant additional support from
section 747 because it is the only national federally funded program
that provides resources for important innovations necessary to increase
the number of physicians who will lead the primary care teams providing
care in patient-centered medical homes.
AAFP recommends a substantial increase in the fiscal year 2010
appropriation bill for the Health Professions Training Programs
authorized under title VII of the Public Health Services Act. We
respectfully request that the subcommittee provide $215 million for the
section 747, the Primary Care Medicine and Dentistry Cluster, which
will signal the commitment of Congress to reform healthcare delivery in
this Nation.
HRSA--NATIONAL HEALTH SERVICE CORPS (NHSC)
NHSC offers scholarship and loan repayment awards to primary care
physicians, nurse practitioners, dentists, mental and behavioral health
professionals, physician assistants, certified nurse-midwives, and
dental hygienists serving in underserved communities. Research has
shown that debt plays a complex yet important role in shaping career
choices for medical students. The NHSC offers financial incentives for
the recruitment and retention of family physicians to practice in
underserved communities without adequate access to primary care. The
AAFP supports the work of the NHSC toward the goal of full funding for
the training of the health workforce and zero disparities in
healthcare.
AAFP respectfully requests that the subcommittee fully fund these
important scholarship and loan repayment programs by providing the
authorized amount of $235 million for NHSC in fiscal year 2010.
HRSA--RURAL HEALTH
Americans in rural areas face more barriers to care than those in
urban and suburban areas. Rural residents also struggle with the higher
rates of illness associated with lower socioeconomic status.
Family physicians provide the majority of care for America's
underserved and rural populations.\3\ Despite efforts to meet
scarcities in rural areas, the shortage of primary care physicians
continues. 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.
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\3\ Hing E, Burt CW. Characteristics of office-based physicians
and their practices: United States, 2003-04. Series 13, No. 164.
Hyattsville, MD: National Center for Health Statistics. 2007.
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HRSA's Office of Rural Health administers a number of programs to
improve healthcare services to the quarter of our population residing
in rural communities. Rural Health Policy Development and Outreach
Grants fund innovative programs to provide healthcare in rural areas.
State rural health offices, funded through the NHSC budget, help States
implement these programs so that rural residents benefit as much as
urban patients.
AAFP encourages the subcommittee to provide adequate funding in the
fiscal year 2010 appropriation bill for the important programs
administered by HRSA's Office of Rural Health to address the many
unique health service needs of rural communities.
AGENCY FOR HEALTHCARE RESEARCH AND QUALITY (AHRQ)
The mission of AHRQ--to improve the quality, safety, efficiency,
and effectiveness of health care for all Americans--closely mirrors
AAFP's own mission. AHRQ is a small agency with a huge responsibility
for research to support clinical decisionmaking, reduce costs, advance
patient safety, decrease medical errors, and improve healthcare
quality, and access. Family physicians recognize that AHRQ has a
critical role to play in promoting healthcare safety, quality, and
efficiency initiatives.
AHRQ--COMPARATIVE EFFECTIVENSS RESEARCH
One of the hallmarks of the patient centered medical home is
evidence-based medicine. Comparative effectiveness research, which
compares the impact of different options for treating a given medical
condition, is vital to quality care. Studies comparing various
treatments (e.g., competing drugs) or differing approaches (e.g.,
surgery and drug therapy) can inform clinical decisions by analyzing
not only costs but the relative medical benefits and risks for
particular patient populations.
AAFP commends the Congress for including $1.1 billion in ARRA for
comparative effectiveness research which holds out the promise of
reducing healthcare costs while improving medical outcomes.
AAFP respectfully suggests that the subcommittee provide at least
$405 million for AHRQ in the fiscal year 2010 appropriations bill, an
increase of $32 million above the fiscal year 2009 level.
______
Prepared Statement of the American Association for Geriatric Psychiatry
The American Association for Geriatric Psychiatry (AAGP)
appreciates this opportunity to comment on issues related to fiscal
year 2010 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 aging
adults. 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.
A NATIONAL HEALTH CRISIS: 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 older than the age of 65. More than 20 percent of
those people will experience mental health problems.
The cost of treating mental disorders can be staggering. For
example, it is estimated that total costs associated with the care of
patients with Alzheimer's disease is more than $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 crippling family burden. These psychiatric
symptoms, associated with Alzheimer's disease, can increase the cost of
treating these patients by more than 20 percent. However, these costs
pale when compared to the costs of not treating mental disorders
including lost work time, co-morbid illness, and increased nursing home
utilization. It is also important to note the added burden, financial
and emotional, on family caregivers, as the Nation's informal
caregiving system is already under tremendous strain and will require
more support in the years to come.
PREPARING A WORKFORCE TO MEET THE MENTAL HEALTH NEEDS OF THE AGING
POPULATION
In 2008, the Institute of Medicine (IOM) released a study of the
readiness of the Nation's healthcare workforce to meet the needs of its
aging population. The Re-tooling for an Aging America: Building the
Health Care Workforce called for immediate investments in preparing our
healthcare system to care for older Americans and their families.
Virtually all healthcare providers need to be fully prepared to manage
the common medical and mental health problems of old age. In addition,
the number of geriatric health specialists, including mental health
providers, needs to be increased both to provide care for those older
adults with the most complex issues and to train the rest of the
workforce in the common medical and mental health problems of old age.
The small numbers of specialists in geriatric mental health, combined
with increases in life expectancy and the growing population of the
nation's elderly, foretells a crisis in healthcare that will impact
older adults and their families nationwide. Unless changes are made
now, older Americans will face long waits, decreased choice, and
suboptimal care.
In order to implement the IOM report, AAGP believes that there are
several critical issues that this subcommittee should address:
IOM Study on Geriatric Mental Health Workforce
AAGP believes that the broad scope of the 2008 IOM study, while
meeting a crucial need for information on the many issues regarding the
health workforce for older adults, precluded the in-depth consideration
of the workforce needed for treating mental illness. The study should
be followed by a complementary study focused on the specific challenges
in the geriatric mental health field. This study should follow up the
general IOM study in two specific ways: it should examine the access
and workforce barriers unique to geriatric mental healthcare services;
and, in discussing possible alternative models of geriatric service
delivery (such as medical homes, PACE programs, collaborative care
models like those demonstrated in the IMPACT and PROSPECT studies), it
should articulate the importance of integrating geriatric mental health
services as intrinsic components. ``The Retooling the Health Care
Workforce for an Aging America Act,'' S. 245/H.R. 46, contains a
provision mandating this additional study.
In discussions with AAGP, the senior staff of IOM suggested the
following language for inclusion in the Labor, Health and Human
Services, and Education, and Related Agencies appropriations bill:
The subcommittee 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 IOM to conduct a
thorough analysis of the forces that shape the mental healthcare
workforce for older adults, including education, training, modes of
practice, and reimbursement.
Title VII Geriatric Health Professions Education Programs
The Bureau of Health Professions in the HHS Health Resources and
Services Administration (HRSA) administers programs aimed to help to
assure adequate numbers of healthcare practitioners for the Nation's
geriatric population, especially in underserved areas.
The geriatric health professions program supports three important
initiatives. The Geriatric Education Center (GEC) Program, within
defined geographic areas, provides interdisciplinary training for
healthcare professionals in assessment, chronic disease syndromes, care
planning, emergency preparedness, and cultural competence unique to
older Americans. The Geriatric Training for Physicians, Dentists, and
Behavioral and Mental Health Professionals (GTPD Program) provides
fellows with exposure to older adult patients in various levels of
wellness and functioning and from a range of socioeconomic and racial/
ethnic backgrounds. The Geriatric Academic Career Awards (GACA) support
the academic career development of geriatricians in junior faculty
positions who are committed to teaching geriatrics in medical schools
across the country. GACA recipients are required to provide training in
clinical geriatrics, including the training of interdisciplinary teams
of healthcare professionals. AAGP supports increased funding for these
programs as a means to increase geriatric specialist healthcare
providers.
Specifically, AAGP supports expanding the number of GECs across the
Nation; expanding GEC grants to offer mini-fellowships in geriatrics to
faculty members of health professions schools in all disciplines;
enhancing GACA awards to support and retain clinician educators from a
variety of disciplines as they advance in their careers; and providing
full funding for the National Center for Workforce Analysis to analyze
current and projected needs for healthcare professionals and
paraprofessionals in the long-term care sector.
NATIONAL INSTITUTES OF HEALTH (NIH) AND NATIONAL INSTITUTE OF MENTAL
HEALTH (NIMH)
With the graying of the population, mental disorders of aging
represent a growing crisis that will require a greater investment in
research to understand age-related brain disorders and to develop new
approaches to prevention and treatment. Even in the years in which
funding was increased for NIH and the NIMH, these increases did not
always translate into comparable increases in funding that specifically
address problems of older adults. For instance, according to figures
provided by NIMH, NIMH total aging research amounts decreased from
$106,090,000 in 2002 to $85,164,000 in 2006 (dollars in thousands:
$106,090 in 2002; $100,055 in 2003; $97,418 in 2004; $91,686 in 2005;
and $85,164 in 2006).
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.
This trend must be immediately reversed to ensure that our next
generation of elders is able to access effective treatment for mental
illness. Federal funding of research must be broad-based and should
include basic, translational, clinical, and health services research on
mental disorders in late life.
As the NIMH utilizes the new funding from ``The American Recovery
and Reinvestment Act of 2009,'' it is necessary that a portion of those
funds be used to invest in the future evidence-based treatments for our
Nation's elders. Beginning in fiscal year 2010, annual increases of
funds targeted for geriatric mental health research at NIH should be
used to: (1) identify the causes of age-related brain and mental
disorders to prevent mental disorders before they devastate lives; (2)
speed the search for effective treatments and efficient methods of
treatment delivery; and (3) improve the quality of life for older
adults with mental disorders.
Participation of Older Adults in Clinical Trials
Federal approval for most new drugs is based on research
demonstrating safety and efficacy in young and middle-aged adults.
These studies typically exclude people who are old, who have more than
one health problem, or who take multiple medications. As the population
ages, that is the very profile of many people who seek treatment. Thus,
there is little available scientific information on the safety of drugs
approved by the Food and Drug Administration (FDA) in substantial
numbers of older adults who are likely to take those drugs. Pivotal
regulatory trials never address the special efficacy and safety
concerns that arise specifically in the care of the nation's mentally
ill elderly. This is a critical public health obligation of the
nation's health agencies. Just as the FDA has begun to require
inclusion of children in appropriate studies, the agency should work
closely with the geriatric research community, healthcare consumers,
pharmaceutical manufacturers, and other stakeholders to develop
innovative, fair mechanisms to encourage the inclusion of older adults
in clinical trials. Clinical research must also include elders from
diverse ethnic and cultural groups. In addition, AAGP urges that
Federal funds be made available each year for support of clinical
trials involving older adults.
As little emphasis has been placed on the development of new
treatments for geriatric mental disorders, AAGP would encourage the NIH
to promote the development of new medications specifically targeted at
brain-based mental disorders of the elderly. AAGP urges this
subcommittee to request a Government Accountability Office (GAO) study
on spending by NIH on conditions and illnesses related to the mental
health of older individuals. The NIH has already undertaken, in its
Blueprint for Neuroscience Research, an endeavor to enhance cooperative
activities among NIH Institutes and Centers that support research on
the nervous system. A GAO study of the work being done by these 16
Institutes in areas that predominately involve older adults could
provide crucial insights into possible new areas of cooperative
research, which in turn will lead to advances in prevention and
treatment for these devastating illnesses.
CENTER FOR MENTAL HEALTH SERVICES (CMHS)
It is critical that there be adequate funding for the mental health
initiatives under the jurisdiction of the CMHS within the Substance
Abuse and Mental Health Services Administration (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. The final SAMHSA budgets for the last 8 years have included
$5 million for evidence-based mental health outreach and treatment to
the elderly. AAGP urges an increase in funding from $5 million to $20
million for this essential program to disseminate and implement
evidence-based practices in routine clinical settings across the
States. 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.
CONCLUSION
AAGP recommends:
--An IOM study on the geriatric mental health workforce to examine
the access and workforce barriers unique to geriatric mental
healthcare services and, to articulate the importance of
integrating geriatric mental health services as intrinsic
components;
--Increased funding for the geriatric health professions education
programs under title VII of the Public Health Service Act;
--A GAO study on spending by NIH on conditions and illnesses related
to the mental health of older individuals.
--Increased funding for evidence-based geriatric mental health
outreach and treatment programs at CMHS.
______
Prepared Statement of the American Association of Immunologists
The American Association of Immunologists (AAI), a not-for-profit
professional society representing more than 6,000 of the world's
leading experts on the immune system, appreciates having this
opportunity to submit testimony regarding fiscal year 2010
appropriations for the National Institutes of Health (NIH). The vast
majority of AAI members--research scientists and physicians who work in
academia, Government, and industry--depend on NIH funding to advance
their work and the field of immunology.\1\ With approximately 83
percent of NIH's approximately $29 billion budget awarded to scientists
throughout the United States and around the world, NIH funding advances
not only immunological and biomedical research, but also regional and
national economies.\2\
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\1\ The majority of AAI members receive grants from the National
Institute of Allergy and Infectious Diseases or the National Cancer
Institute; some receive grants from the National Institute on Aging,
the National Institute of Arthritis and Musculoskeletal and Skin
Diseases, or other Institutes or Centers.
\2\ NIH funding supports ``almost 50,000 competitive grants to more
than 325,000 researchers at over 3,000 universities, medical schools,
and other research institutions in every state and around the world.''
NIH Website: http://www.nih.gov/about/NIHoverview.html (April 28, 2009)
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THE SCOPE AND IMPORTANCE OF IMMUNOLOGY
From infectious diseases including influenza, HIV/AIDS, malaria,
smallpox, and the common cold, to chronic diseases like cancer,
diabetes, rheumatoid arthritis, asthma, and lupus, the immune system
plays a central role in human and animal health.\3\ Whether protecting
the body from disease--or causing it (as in the case of autoimmune
disease or the rejection of transplanted organs) \4\--the immune system
is critical to maintaining individual human life and pivotal to
community and global public health.\5\ Prevention, treatments, and
cures depend on our understanding of a scientific field that is
relatively new: although the first vaccine was developed in 1798 (to
protect against smallpox), most of our basic understanding of the
immune system has developed in the past 30-40 years, making immunology
ripe for the many new discoveries that are unfolding every day.
Emerging areas in immunology involve understanding the immune response
to environmental threats, to pathogens that threaten to become the next
pandemic, and to manmade and natural infectious organisms that are
potential agents of bioterrorism (including plague, smallpox, and
anthrax). For all of these urgent needs, basic research on the immune
system provides a crucial foundation for the development of
diagnostics, vaccines, and therapeutics.
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\3\ Research on the immune system is also of enormous benefit to
pets and livestock.
\4\ The immune system works by recognizing and attacking ``foreign
invaders'' (e.g., 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 is also
responsible for the rejection responses observed following
transplantation of organs or bone marrow. The immune system can
malfunction, causing the body to attack itself, resulting in an
``autoimmune'' disease, such as Type 1 diabetes, multiple sclerosis, or
rheumatoid arthritis.
\5\ NIH funds research ``on `neglected infectious diseases' such as
malaria, tuberculosis, and a host of tropical diseases--diseases that
are most prevalent in low-income countries, and that are insufficiently
researched by the drug industry.'' Testimony of Ron Pollack, Executive
Director, Families USA, before the House Energy and Commerce
Subcommittee on Health, hearing on ``Treatments for an Ailing Economy:
Protecting Health Care Coverage and Investing in Biomedical Research,''
November 13, 2008, page 4.
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RECENT IMMUNOLOGICAL DISCOVERIES
Immunologists are making significant advances in the development of
treatments and vaccines against pernicious viruses such as influenza
strains and HIV. Recently, commonalities were identified among the
viruses causing seasonal flu, avian flu, and the 1918 pandemic flu,
indicating that some of the antibodies will react against all these
strains. Such antibodies could be developed for therapeutic use in the
case of a flu outbreak. In studies on HIV, immunologists have also
identified a unique small antibody fragment that is able to stop a
broad range of HIV strains from entering their target cells. This
offers hope for a therapy against HIV, which mutates too quickly to be
responsive to most traditional vaccine strategies.
An explosion of research has followed the major recent discovery of
the central role of the inflammasome in immunity. Inflammasomes are
broadly important molecular complexes within cells that sense
infections, environmental pollutants, and other ``danger'' signals and
control the activation of the pro-inflammatory, hormone-like molecules
interleukin-1 and interleukin-18. Although it may help protect against
infection, inflammasome-induced interleukin-1 has also been found to be
a key ``offender'' in many inflammatory and autoimmune diseases.
Inhibitors of these inflammatory molecules have already demonstrated
significant clinical efficacy in autoimmune diseases, gout, and
inherited periodic fever syndromes and are being investigated in other
illnesses given the potential of the inflammasome to be relevant to
almost any type of disease.
Immunologists have made important progress against the increasing
prevalence of childhood peanut allergies by developing a mouse model
that is being used to study the basis of this allergy. They have also
identified a possible treatment course that might reverse the resulting
potentially life-threatening anaphylaxis.
Immunologists are also focusing research efforts in the area of
cancer vaccines. Novel delivery strategies, to effectively present
tumor antigens or portions of the tumors themselves, have allowed the
redirection of the immune system to attack cancerous cells within the
body. Other strategies that manipulate molecules (including the
inhibitory receptor CTLA4) on immune cells have shown remarkable
clinical promise for melanoma and prostate cancer. In addition, our
understanding of how tumors evade and suppress immunity is evolving,
providing new options for therapy, such as altering the function of T-
regulatory cells, which normally suppress immunity and thereby promote
tumor growth.
Immunologists have also made significant progress in understanding
autoimmune disease by discovering that furin, a catalytic enzyme,
prevents some forms of systemic autoimmunity. Scientists have found
that mice lacking this enzyme had overactive effector T cells as well
as suppressive T cells with impaired activity, a key finding which may
lead to treatment of autoimmune disease without suppressing basic
immunity.
THE NIH BUDGET: GREAT PROMISE--AND GRAVE DANGER
AAI is very grateful to this subcommittee and the Congress for
doubling the NIH budget from fiscal year 1999 to fiscal year 2003 and
for addressing the extremely serious problem caused by post-doubling
subinflationary budget increases through passage of both The American
Recovery and Reinvestment Act of 2009 (ARRA), which provided $10.4
billion to NIH, and the fiscal year 2009 Appropriations Act, which
provided a 3.2 percent ($938 million) budget increase more than fiscal
year 2008. NIH is now in the extraordinary position of being able to
fund many worthy projects that had been denied funding, to invest in
modernizing and enhancing the Nation's research infrastructure, and to
support scientific and administrative jobs that are crucial to the
scientific enterprise. This infusion of funds, together with the
exceptional commitment to advancing scientific research articulated by
President Obama, is also giving our brightest young students the
confidence and desire to pursue careers in biomedical research, a
crucial factor in helping research advances today become cures
tomorrow.
Passage of ARRA acknowledged the multi-faceted impact of investing
in biomedical research and the NIH: improving individual and global
health, and stimulating local and national economic activity and job
creation. NIH has estimated that each NIH grant supports on average,
``6 to 7 in-part or full scientific jobs.'' \6\ Families USA, a not-
for-profit consumer advocacy organization, has reported that (1) on
average, each $1 of NIH funding going into a State generates more than
twice as much in State economic output, and (2) in fiscal year 2007,
NIH funding created and supported more than 350,000 jobs that generated
wages in excess of $18 billion, with an average wage of $52,000 (nearly
25 percent higher than the average U.S. wage).\7\
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\6\ Testimony of Raynard S. Kington, M.D., Ph.D., Acting Director,
National Institutes of Health, Witness appearing before the House
Subcommittee on Labor, Health and Human Services, and Education, and
Related Agencies Appropriations Subcommittee, March 26, 2009. Dr.
Kington was citing the NIH report: ``Estimating the Number of Senior/
Key Personnel Engaged in NIH Supported Research,'' study issued October
2008.
\7\ ``In Your Own Backyard: How NIH Funding Helps Your State's
Economy,'' Families USA, (June 2008). The report cited numerous
economic benefits of NIH funding, including: (1) The amount of new
business activity generated ranged from $8.39 billion in California to
$13 million in Wyoming; (2) In 14 States, NIH funding generated more
than $1 billion in new business activity; 3) In 10 States, each $1 of
NIH funding generated at least $2.26 in economic activity; and (4) In 6
States, more than 20,000 new jobs were created.
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While AAI--and the entire biomedical research community--is deeply
grateful for ARRA's tremendous influx of funds and support, some of the
constraints accompanying the ARRA funding (i.e., that the funds must be
obligated by the end of fiscal year 2010 and must be used for immediate
economic impact, including creating jobs) are somewhat inconsistent
with the longer view and nature of science and the strong need for
reliable, sustained funding. Although significant advances can be made
in 2 years, few projects can be completed in that time. As such, AAI
looks ahead with concern to future years, when advances poised to be
made may not come to fruition should ARRA funds end without adequate
regular appropriations to cushion the reduction. AAI's appropriations
recommendations for fiscal year 2010 (and ultimately for 2011, though
not offered here), are premised on that concern and designed to address
that future.
AAI RECOMMENDS A 7 PERCENT BUDGET INCREASE FOR FISCAL YEAR 2010
AAI urges the subcommittee to increase the NIH budget by 7 percent
in fiscal year 2010. Such an increase would help ensure that research
and jobs supported by ARRA funds are not lost, and that ongoing
research would be on track to reach its full potential even after the
ARRA funding is spent. A 7 percent budget increase would also put NIH
on the path that most scientists have long sought and urgently need: a
path of predictable, sustained funding that stabilizes ongoing research
projects and the overall research enterprise.
AAI also supports President Obama's request for an additional $1.5
billion to specifically address recent developments regarding the
emergent H1N1 (swine) influenza virus. This is an important investment
in pandemic preparedness, whether that pandemic proves to be influenza
or a pathogen not yet predicted.
OTHER KEY ISSUES
Seasonal Influenza and Pandemics.--Seasonal influenza leads to an
average of more than 200,000 hospitalizations and about 36,000 deaths
nationwide annually. An influenza pandemic could occur at any time; a
pandemic as serious as the 1918 pandemic could result in the illness of
almost 90 million Americans and the death of more than 2 million.\8\
While researchers and public health professionals must respond to
emergent threats (such as the current concern related to the H1/N1 flu
virus), AAI believes that the best preparation for a pandemic is to
focus on basic research to combat seasonal flu, including building
capacity, pursuing new production methods (cell based), and seeking
optimized flu vaccines and delivery methods.
---------------------------------------------------------------------------
\8\ A report issued by Trust for America's Health (``Pandemic Flu
and the Potential for U.S. Economic Recession'') predicted that a
severe pandemic flu outbreak could result in the second worst recession
in the United States since World War II, resulting in a projected cost
of $683 billion. (March 2007)
---------------------------------------------------------------------------
Bioterrorism.--To best protect against bioterrorism, scientists
should focus on basic research, including working to understand the
immune response, identifying new and potentially modified pathogens,
and developing tools (including new and more potent vaccines) to
protect against these pathogens.
The NIH ``Common Fund''.--The NIH Reform Act of 2006 established
within NIH a ``Common Fund'' (CF) to support trans-NIH initiatives.
Although AAI recognizes the value of interdisciplinary research, the
existence of the CF should not permit the funding of lesser quality
research. Instead, all CF applications should be subject to a
transparent and rigorous peer-review process like all other funded
research grant applications. In addition, AAI recommends that the CF
not grow faster than the overall NIH budget.
The NIH Public Access Policy (``Policy'').--AAI continues to
believe that the Policy will duplicate, at great cost to NIH and to
taxpayers, publications and services which are already provided cost-
effectively and well by the private sector. Therefore, AAI respectfully
requests that the subcommittee require that NIH publicly report on the
cost to date of implementing the Policy (both voluntary and mandatory),
and projected future costs (including all personnel, administrative,
infrastructure and enforcement costs) incurred by the various NIH
Institutes, Centers, and Offices involved.
Preserving High-quality Peer Review.--NIH's recent completion of
its ``Peer Review Self-Study'' has resulted in the adoption and
implementation of numerous changes to its internationally respected and
highly successful peer review system. While AAI applauds this effort to
address some legitimate problems with the system, AAI urges that NIH be
required to conduct timely and transparent evaluation of all pilot
projects and permanent changes, and provide ample opportunity for
public comment.
Ensuring NIH Operations and Oversight.--AAI urges the subcommittee
to ensure adequate funding for the NIH Research, Management, and
Services (RM&S) account, which supports the management, monitoring, and
oversight of all research activities. Particularly with the infusion
and rapid dissemination of ARRA funds, NIH must be able to properly
supervise and oversee its increasingly large and complex portfolio.
CONCLUSION
AAI greatly appreciates this opportunity to submit testimony and
thanks the Chairman and 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 Nurse Anesthetists
FISCAL YEAR 2010 APPROPRIATIONS REQUEST SUMMARY
[Dollars in thousands]
----------------------------------------------------------------------------------------------------------------
AANA fiscal year 2010
Fiscal year 2009 actual Fiscal year 2010 budget request
----------------------------------------------------------------------------------------------------------------
HHS /HRSA /BHPr Title VIII Advanced Awaiting grant Grant allocations not $4,000 for nurse
Education Nursing, Nurse Anesthetist allocations--in fiscal specified. anesthesia education
Education Reserve. year 2008 awards
amounted to
approximately $3,500.
Total for Advanced Education Nursing, $64.44 for Advanced $64.44 for Advanced $79.55 for Advanced
from Title VIII. Education Nursing. Education Nursing. Education Nursing
Title VIII HRSA BHPr Nursing $171,031............... $263,403............... $263,403
Education Programs.
----------------------------------------------------------------------------------------------------------------
The AANA is the professional association for more than 40,000
Certified Registered Nurse Anesthetists (CRNAs) and student nurse
anesthetists, representing more than 90 percent of the nurse
anesthetists in the United States. Today, CRNAs are directly involved
in delivering 30 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, and providing acute and chronic pain management
services. CRNAs provide anesthesia for a wide variety of surgical
cases, and in some States are the sole anesthesia providers in almost
100 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 in 2000, which found
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 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, a study published in Nursing Research indicates
that 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. (Simonson, Daniel
C et al. ``Anesthesia Staffing and Anesthetic Complications During
Cesarean Delivery: A Retrospective Analysis.'' Nursing Research, Vol.
56, No. 1, pp. 9-17. January/February 2007). In addition, a recent AANA
workforce study showed that CRNAs and anesthesiologists are substitutes
in the production of surgeries, and it is important to note that
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 anesthesia care required by our
U.S. Armed Forces through active duty and the reserves. 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. In
addition, CRNAs predominate in rural and medically underserved areas
and areas where more Medicare patients live. A recent analysis of the
nurse anesthesia workforce, indicates that in 2006, 38 percent of nurse
anesthesia graduates went to work in a Medically Underserved Area or
for a Medically Underserved Population.
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
$79.55 million for advanced education nursing from the title VIII
program. We feel that this funding request is well justified, as we are
seeing a vacancy rate of nurse anesthetists in the United States that
is impacting the public's access to healthcare. 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.
Increasing funding for advanced education nursing from $64.44
million to $79.55 million is necessary to meet the continuing demand
for nursing faculty and other advanced education nursing services
throughout the United States. The program provides for competitive
grants that help enhance advanced nursing education and practice and
traineeships for individuals in advanced nursing education programs.
This funding is critical to meet the nursing workforce needs of
Americans who require healthcare. In fact, this funding not only seeks
to increase the number of providers in rural and underserved America
but also prepares providers at the master's and doctoral levels,
increasing the number of clinicians who are eligible to serve as
faculty.
The CRNA workforce is seeing a shortage in the clinical and
educational setting. In 2007, an AANA nurse anesthesia workforce study
found a 12.6 percent vacancy rate in hospitals for CRNAs, and a 12.5
percent faculty vacancy rate. The supply of clinical providers has
increased in recent years, stimulated by increases in the number of
CRNAs trained. Between 2000-2008, the number of nurse anesthesia
educational program graduates doubled, with the Council on
Certification of Nurse Anesthetists (CCNA) reporting 1,075 graduates in
2000 and 2,158 graduates in 2008. This growth is expected to continue.
However, it is important to note that even though the number of
graduates has doubled in 8 years, the nurse anesthetist vacancy rate
remained steady at around 12 percent, which is likely due to increased
demand for anesthesia services as the population ages, growth in the
number of clinical sites requiring anesthesia services, and CRNA
retirements.
The problem is not that our 108 accredited programs of nurse
anesthesia are failing to attract qualified applicants. It is that they
have to turn them away by the hundreds. 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 Alabama, Arkansas, Iowa, Illinois,
Louisiana, Pennsylvania, Rhode Island, Tennessee, Texas, Washington,
and Wisconsin.
Recognizing the important role nurse anesthetists play in providing
quality healthcare, the AANA has been working with the 108 accredited
nurse anesthesia educational programs to increase the number of
qualified graduates. In addition, the AANA has worked with nursing and
allied health deans to develop new CRNA programs.
To truly meet the nurse anesthesia workforce challenge, the
capacity and number of CRNA schools must continue to grow. 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, more costly, 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 11 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. Moreover, they reported producing additional
CRNAs that went to serve in rural or medically underserved areas.
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
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 $263 million in fiscal year 2010 for
nursing shortage relief through title VIII. This amount is the same as
the President's request for 2010. However, AANA asks that of the $263
million, $79.55 million go to Advanced Education Nursing to help
increase clinicians in underserved communities and those eligible to
serve as faculty. The AANA appreciates the support for nurse education
funding in fiscal year 2009 and past fiscal years from this
subcommittee and from the Congress.
In the interest of patients past and present, particularly those in
rural and medically underserved parts of this country, we ask Congress
to invest 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 title VIII and
advanced education nurses will improve patient access to quality
services and strengthen the Nation's healthcare delivery system.
SAFE INJECTION PRACTICES
Last, as a leader in patient safety, the AANA has been playing a
vigorous role in the development and projects of the Safe Injection
Practices Coalition, intended to reduce and eventually eliminate the
incidence of healthcare facility acquired infections. In the interest
of promoting safe injection practice, and reducing the incidence of
healthcare facility acquired infections, we recommend the subcommittee
provide the following appropriations for fiscal year 2010:
--Centers for Disease Control and Prevention.--$9 million for
provider education and patient awareness activities; $8 million
to promote private-sector healthcare solutions to injection
safety and infection control problems; $9 million for detection
and tracking in order to enable States to investigate outbreaks
of hepatitis and other potential pathogens related to injection
safety.
--Agency for Healthcare Research and Quality (AHRQ).--$10 million in
general patient safety funds for the AHRQ's Ambulatory Patient
Safety Program.
--Department of Health and Human Services.--$1 million to expand its
current focus for reducing HAIs from hospitals to all
healthcare settings, including outpatient facilities.
______
Prepared Statement of the American Academy of Ophthalmology
EXECUTIVE SUMMARY
The American Academy of Ophthalmology (AAO) requests a fiscal year
2010 National Institutes of Health (NIH) funding increase of at least 7
percent, to a level of $32.4 billion, which represents a modest 3
percent increase plus the biomedical inflation rate, estimated at 3.8
percent in fiscal year 2009. This increase is necessary to keep pace
with inflation and rebuild the base, since NIH has lost 14 percent of
its purchasing power during the past six funding cycles. AAO commends
the congressional leadership's actions in fiscal year 2008 and 2009 to
increase NIH funding, including the $150 million in the fiscal year
2008 supplemental dedicated to investigator-initiated grants, the $10.4
billion in 2-year stimulus NIH funding within the American Recovery and
Reinvestment Act (ARRA), and the final fiscal year 2009 appropriations
inflationary increase of 3.2 percent. However, NIH needs sustained and
predictable funding to rebuild its base and support multi-year,
investigator-initiated research, which is the cornerstone of the
biomedical enterprise. Annual increases of at least 7 percent put NIH
on a pathway to budget-doubling within the next 10 years. Secure and
consistent funding for biomedical research is integral to the Nation's
economic and global competitiveness. NIH is a world-leading institution
that must be adequately funded so that its research can reduce
healthcare costs, increase productivity, and save and improve the
quality of lives.
AAO requests that Congress make vision health a top priority by
increasing National Eye Institute (NEI) funding by at least 7 percent,
to a level of $736 million, in this year that NEI celebrates its 40th
anniversary. Over the past 6 funding cycles, NEI lost 18 percent of its
purchasing power. Despite funding challenges, NEI has maintained its
impressive record of breakthroughs in basic and clinical research that
have resulted in treatments and therapies to save and restore vision
and prevent eye disease. NEI will be challenged further, as 2010 begins
the decade in which more than half of the 78 million Baby Boomers will
turn 65 and be at greatest risk for aging eye disease. 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.
Fiscal year 2010 funding at $736 million enables NEI to expand its
impressive record of basic and clinical collaborative research that has
resulted in treatments and therapies to save and restore vision.
NEI continues to be a leader in basic research--especially that
which elucidates the genetic basis of ocular disease--and in
translational research, as those gene discoveries can lead to
development of diagnostics and treatments. NEI Director Paul Sieving,
M.D., Ph.D., has reported that one-quarter of all genes identified to
date through NEI's collaboration with the National Human Genome
Research Institute (NHGRI) are associated with eye disease/visual
impairment. Recent examples include:
--In 2005, NEI reported that gene variants of Complement Factor H
(CFH), the protein product of which is engaged in the control
of the body's immune response, are associated with increased
risk of developing age-related macular degeneration (AMD), the
leading cause of vision loss. NEI-funded researchers are now
working on potential therapies, including the manufacture and
use of a protective version of the CFH protein in an
augmentation strategy similar to that of treating diabetes with
insulin. This therapy is under development and expected to
enter Phase I clinical safety trials in summer 2009.
--In March 2008, NEI-funded researchers announced that damage from
both AMD and diabetic retinopathy was prevented and even
reversed when the protein Robo4 was activated in mouse models
that simulate the two diseases. Robo4 treated and prevented the
diseases by inhibiting abnormal blood vessel growth and by
stabilizing blood vessels to prevent leakage. Since this
research into the ``Robo4 Pathway'' used animal models
associated with these diseases that are already used in drug
development, the time required to test this approach in humans
could be shortened, expediting approvals for new therapies
--In late April 2008, researchers funded by the NEI and private
funding organization Foundation Fighting Blindness reported on
their use of gene therapy to restore vision in young adults who
were virtually blind from a severe form of the
neurodegenerative disease Retinitis Pigmentosa, known as Leber
Congenital Amaurosis (LCA). Seven years earlier, the
researchers shared on Capitol Hill results of a preclinical
study of the same gene therapy, which at the time was
successfully giving vision to dogs born blind with LCA. The
subsequent human gene therapy trial validated the process of
putting genes in the body to restore vision. Although the
primary goal of the Phase I study was to ensure patient safety,
the researchers reported through both objective and subjective
testing that the patients were able to read several additional
lines on an eye chart, had better peripheral vision, and better
eyesight in dimly lit settings. In further research, the
investigators will treat LCA patients as young as 8 years old,
since they believe the most dramatic results will be seen in
young children.
--In late 2008, NEI initiated its new NEI Glaucoma Human genetics
collaBORation, known as NEIGHBOR, through which seven U.S.
research teams will lead genetic studies of the disease.
Glaucoma is called the ``stealth robber of vision'' as it often
has no symptoms until vision is lost, and anywhere from 50-75
percent of individuals with it are undiagnosed. It is also the
leading cause of preventable vision loss in African American
and Hispanic populations, which emphasizes the vital nature of
determining the genetic basis of this disease.
Fiscal year 2010 funding at $736 million enables NEI to fully fund
new initiatives that more fully characterize eye disease.
NEI has been a leader in collaborative research, the use of
networks to study diagnostics and treatments and their use in clinical
settings, and in ocular epidemiology to characterize the nature and
frequency of eye disease in diverse populations to better manage public
health. In fiscal year 2008, NEI reported on/launched the initial phase
of three important new programs to characterize eye disease requiring
adequate future funding.
--In early 2009, the NEI and the National Aeronautics and Space
Administration (NASA) reported on the use of a compact fiber
optic probe developed for the space program that has proven
valuable as the first non-invasive early detection device for
cataracts, the leading cause of vision loss worldwide. Using a
laser light technique called dynamic light scattering (DLS),
which was developed to analyze the growth of protein crystals
in a zero-gravity environment, the probe measures the amount of
light scattering by an anti-cataract protein called alpha-
crystallin. The probe senses protein damage due to oxidative
stress, a key process involved in many medical conditions
including age-related cataract and diabetes, as well as
Alzheimer's and Parkinson's disease.
--In late 2008, NEI launched a new research network, the Neuro-
Ophthalmology Research Disease Investigator Consortium, or
NORDIC. It will initially lead multi-site observational and
treatment trials, involving nearly 200 community and academic
practitioners, to address the risks, diagnosis, and treatment
of two ``rare'' diseases: idiopathic intracranial hypertension
(visual dysfunction due to increased intracranial pressure) and
thyroid eye disease (also called Graves' disease, in which
muscles of the eye enlarge and cause bulging of the eyes,
retraction of the lids, double vision, decreased vision, and
irritation). The NEI and NORDIC's Principal Investigator have
already begun coordinating with the Department of Defense's
(DOD) newly established Vision Center of Excellence (VCE) about
the applicability of NORDIC research to combat-related eye
injuries, especially those associated with Traumatic Brain
Injury (TBI).
--There is currently almost no information on the prevalence, risk
factors, and genetic determinants in Asian Americans--one of
the fastest growing racial groups in the United States. Studies
from East Asia have suggested that Asians have a spectrum of
eye diseases different from that of White Americans, African
Americans, and Hispanics. In late 2008, NEI launched the
Chinese American Eye Study to characterize the extent of eye
disease in Chinese Americans, the largest Asian subgroup in the
United States. Participants 50 years and older will be
evaluated for blindness, visual impairment, and eye disease.
These results will add to the expanding body of knowledge about
vision health disparities already characterized by NEI in the
African-American and Hispanic populations.
Vision impairment/eye disease is a major public health problem that
increases healthcare costs, reduces productivity, and diminishes
quality of life.
The NEI estimates that 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 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 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 recently as March 2008, the NEI's Survey of
Public Knowledge, Attitudes, and Practices Related to Eye
Health and Disease reported that 71 percent of respondents
indicated that a loss of their eyesight would rate as a ``10''
on a scale of 1 to 10, meaning that it would have the greatest
impact on their day-to-day life.
In 2009, the NEI will celebrate its 40th anniversary as the NIH
Institute that leads the Nation's commitment to save and restore
vision. During the next decade, more than half of the 78 million Baby
Boomers will celebrate their 65th birthday and be at greatest risk for
developing aging eye disease. As a result, sustained, adequate Federal
funding for the NEI is an especially vital investment in the health,
and vision health, of our Nation as the treatments and therapies
emerging from research can preserve and restore vision. Adequately
funding the NEI can also delay, save, and prevent health expenditures,
especially those associated with the Medicare and Medicaid programs,
and is, therefore, a cost-effective investment.
AAO urges fiscal year 2010 NIH and NEI funding at $32.4 billion and
$736 million, respectively, reflecting an at-least 7 percent increase
more than fiscal year 2009.
ABOUT AAO
The American Academy of Ophthalmology is a 501c(6) educational
membership association. AAO is the largest national membership
association of eye M.D.s with more than 27,000 members, more than
17,000 of which are in active practice in the United States. Eye M.D.s
are ophthalmologists, medical, and osteopathic doctors who provide
comprehensive eye care, including medical, surgical and optical care.
More than 90 percent of practicing U.S. eye M.D.s are AAO members.
______
Prepared Statement of the American Academy of Physician Assistants
On behalf of the more than 75,000 clinically practicing physician
assistants in the United States, the American Academy of Physician
Assistants is pleased to submit comments on fiscal year 2010
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 2010,
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.
AAPA recommends that Congress provide additional support to grow
the PA primary care workforce through healthcare reform initiatives. A
reformed healthcare system will require a much-expanded primary
healthcare workforce, both in the private and public healthcare
markets. For example, the National Association of Community Health
Centers' March 2009 report, Primary Care Access: An Essential Building
Block of Health Reform, predicts that in order to reach 30 million
patients by 2015, health centers will need at least an additional
15,585 primary care providers, just more than one-third of whom are
nonphysician primary care professionals.
The Academy believes that the recommended restoration in funding
for title VII health professions programs is well justified.
A review of PA graduates from 1990-2006 demonstrates that PAs who
have graduated from PA educational programs supported by title VII are
59 percent more likely to be from underrepresented minority populations
and 46 percent more likely to work in a rural health clinic than
graduates of programs that were not supported by title VII.
A study by the UCSF Center for California Health Workforce Studies
found a strong association between physician assistants exposed to
title VII during their PA educational preparation and those who ever
reported working in a federally qualified health center or other
community health center.
Title VII safety net programs are essential to the development and
training of primary healthcare professionals and, in turn, provide
increased access to care by promoting healthcare delivery in medically
underserved communities. Title VII funding is especially important for
PA programs as it is the only Federal funding available on a
competitive application basis to these programs.
The AAPA is very appreciative of the recent funding increases, for
the title VII Health Professions Programs, in the fiscal year 2009
omnibus appropriations bill (Public Law 111-8), which appropriated
$221.7 million, a 14.3 percent increase, more than fiscal year 2008 and
the American Recovery and Reinvestment Act (Public Law 111-5), which
invested $200 million in expanding title VII Health Professions
Programs. However, the AAPA believes that these recent investments only
begin to rectify the chronic underfunding of these programs and address
existing and looming shortages of health professionals, especially
physician assistants. According to HRSA, an additional 30,000 health
practitioners are needed to alleviate existing health professional
shortages.
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 2010 to the fiscal
year 2005 funding level.
OVERVIEW OF PHYSICIAN ASSISTANT EDUCATION
Physician assistant programs train students to practice medicine
with physician supervision. PA programs are located within schools of
medicine or health sciences, universities, teaching hospitals, and the
Armed Services. All PA educational programs are accredited by the
Accreditation Review Commission on Education for the Physician
Assistant.
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
healthcare experience. The first phase of the program consists of
intensive classroom and laboratory study. More than 400 hours in
classroom and laboratory instruction are devoted to the basic sciences,
with more than 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. On
average, students devote more than 2,000 hours, or 50-55 weeks, to
clinical education, divided between primary care medicine--family
medicine, internal medicine, pediatrics, and obstetrics and
gynecology--and various specialties, including surgery and surgical
specialties, internal medicine subspecialties, emergency medicine, and
psychiatry. 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.
After graduation from an accredited PA program, physician
assistants must pass a national certifying examination developed by the
National Commission on Certification of Physician Assistants. To
maintain certification, PAs must log 100 continuing medical education
hours every 2 years, and they must take a recertification exam every 6
years.
PHYSICIAN ASSISTANT PRACTICE
Physician assistants are licensed healthcare 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 allowed by law and are within the physician's scope of
practice and the PA's training and experience. All States, the District
of Columbia, and Guam authorize physicians to delegate prescriptive
privileges to the PAs they supervise. Nineteen percent of all PAs
practice in nonmetropolitan areas where they may be the only full-time
providers of care (State laws stipulate the conditions for remote
supervision by a physician). Approximately 41 percent of PAs work in
urban and inner city areas. Approximately 40 percent of PAs are in
primary care. Roughly 80 percent of PAs practice in outpatient
settings.
AAPA estimates that in 2008, more than 257 million patient visits
were made to PAs and approximately 332 million medications were written
by PAs.
CRITICAL ROLE OF TITLE VII PUBLIC HEALTH SERVICE ACT PROGRAMS
Title VII programs promote access to healthcare in rural and urban
underserved communities by supporting educational programs that train
health professionals in fields experiencing shortages, improve the
geographic distribution of health professionals, increase access to
care in underserved communities, and increase minority representation
in the healthcare workforce.
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. More importantly, GME was not intended to generate a supply
of providers who are willing to work in the Nation's medically
underserved communities--the purpose of title VII.
Furthermore, title VII programs seek to recruit students who are
from underserved minority and disadvantaged populations, which is a
critical step towards reducing persistent health disparities among
certain racial and ethnic U.S. populations. Studies have found that
health professionals from disadvantaged regions of the country are 3 to
5 times more likely to return to underserved areas to provide care.
It is also important to note that a December 2008 Institute of
Medicine report characterized HRSA's health professions programs as
``an undervalued asset.''
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 healthcare needs.
The PA programs' success in recruiting and retaining
underrepresented minority and disadvantaged students 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
nonclinical 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 and
methodologies so students can remain at clinical practice sites. In New
York, a PA program with a 90 percent ethnic minority student population
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 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 healthcare providers by
exposing students to underserved sites during their training, where
they frequently choose to practice following graduation. Currently, 36
percent of PAs met their first clinical employer through their clinical
rotations.
Changes in the healthcare marketplace reflect a growing reliance on
PAs as part of the healthcare team. Currently, 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.
One way to assure an adequate supply of physician assistants practicing
in underserved areas is to continue offering financial incentives to PA
programs that emphasize recruitment and placement of PAs interested in
primary care in medically underserved communities.
Despite the increased demand for PAs, funding has not
proportionately increased for title VII programs that educate and place
physician assistants 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, as Federal support has decreased.
RECOMMENDATIONS ON FISCAL YEAR 2010 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
2010. For instance, while it is critical, now more than ever, 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 the Health Resources and Services
Administration (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, CDC is
heavily dependent upon an adequate supply of healthcare providers to be
sure that disease outbreaks are reported, tracked, and contained.
The Academy respectfully requests that title VII health professions
programs receive $300 million in funding for fiscal year 2010,
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 2010 appropriations.
______
Prepared Statement of the Alliance for Aging Research
Chairman Harkin and members of the subcommittee, for more than two
decades the not-for-profit Alliance for Aging Research has advocated
for research to improve the experience of aging for all Americans. Our
efforts have included supporting Federal funding of aging research by
the National Institutes of Health (NIH), through the National Institute
on Aging (NIA) and other Institutes and Centers that work with the NIA
on cross-cutting initiatives. To this end, the Alliance appreciates the
opportunity to submit testimony highlighting the important role that
the NIH plays in facilitating aging research activities and the ever
more urgent need for increased appropriations to advance scientific
discoveries to keep individuals healthier longer.
Many challenges will arise as Americans age in increasing numbers.
There are approximately 36 million Americans aged 65 and older. That
group is expected to double in size within the next 20 years, at which
time at least 20 percent of the U.S. population will be older than 65.
Of particular concern is the dramatic growth that is anticipated among
those aged 85 and older. By 2050, 19.4 million Americans will be older
than the age of 85.
Late-in-life diseases such as type 2 diabetes, cancer, neurological
diseases, heart disease, and osteoporosis are increasingly driving the
need for healthcare services in this country. If rapid discoveries are
not made now to reduce the prevalence of age-related diseases and
conditions like these, the costs associated with caring for the oldest
and sickest Americans will place an unmanageable burden on patients,
their families, and our healthcare system. The Alliance strongly
believes that with a relatively modest investment, further advances in
the area of longevity science could yield tremendous health and
economic benefits by shortening the period during which humans suffer
from costly, debilitating diseases.
Within the NIH, the NIA leads research efforts to better understand
the nature of aging and to maintain the health and independence of
Americans as they grow older. The NIA supports a range of genetic,
biological, clinical, social, and economic research related to aging
and the diseases of the elderly. Through the Division of Aging Biology,
the NIA funds research focused on understanding and exploiting the
mechanisms underlying the aging process. Research supported by the
Division of Aging Biology program is critically important in that much
of it is centered around how changes in function considered to be
``normal aging'' become risk factors for many age-associated
infirmities. Other noteworthy NIA-supported projects focus on
increasing healthspan. These include studies to assess the beneficial
effects of reducing caloric intake in animals, as well as those to test
compounds that mimic this process in subjects with the potential to
extend the years of disease-free life. Both approaches have produced
promising results that may lead to insights into human applications. By
capitalizing on these and other successful studies to identify genes
that influence longevity, investigators hope to delay the onset of
disease and disability associated with human aging in the future.
The NIA also participates in multi-Institute collaborations on
disease-specific research aimed at preventing, diagnosing, and more
effectively treating age-related illnesses. Action to Control
Cardiovascular Disease, led by the National, Heart, Lung, and Blood
Institute in partnership with the NIA and three other NIH Institutes,
is a large clinical trial of adults with type 2 diabetes who are at
high risk for cardiovascular disease. The trial involves the aggressive
testing of interventions to reduce the burden of cardiovascular disease
in high-risk patients, many of whom are elderly. Major cardiovascular
disease events result in death for 65 percent of diabetic patients and
no effective preventative strategies currently exist for this
vulnerable population. The Alzheimer's Disease Neuroimaging Initiative
(ADNI) is a major public-private partnership led by the NIA to evaluate
imaging technologies, biological markers, and other tests to improve
knowledge surrounding the progression of Alzheimer's disease. ADNI has
produced a wealth of data that is accessible to researchers worldwide.
It is believed that ADNI findings could lead to shorter and less costly
trials for Alzheimer's therapies. As many as 5.3 million people have
Alzheimer's disease and it drains more than $148 billion from the
Nation's economy each year. Streamlined clinical trials could
accelerate the development and approval of more effective AD treatments
to the benefit of those who are yet to be diagnosed. The Diabetes
Prevention Program, which was an NIH-supported clinical trial involving
the NIA, continues to reveal information about diabetes onset,
prevention an outcomes. It was initially intended to examine the
effects of multiple interventions for adults at risk of type 2
diabetes. While it succeeded in identifying lifestyle changes that were
particularly effective in the 60 and older population, it is the
analysis of the long-term effects of these interventions on diabetes
onset that could have the most impact on the 57 million adults who are
at risk for developing the disease.
In general, the NIH is the primary funder of biomedical research in
this country. Eighty percent of all the nonprofit medical research in
the United States is funded by the NIH. But the unfortunate reality is
that shrinking budgets have impeded progress. In part the scarcity of
resources has resulted in a decline of the overall success rate for NIH
research grant applications. At its lowest point only 1 in 4 research
proposals could be funded by the NIH. The effect of this has been
reluctance on behalf of new investigators to submit truly ground-
breaking research proposals for consideration. While we recognize that
there is enormous competition for congressional appropriations each
year, a lack of sustained funding for the NIH will have a devastating
impact on the rate of basic discovery and the development of
interventions that could have the significant public health benefits
for our aging population.
Until recent actions taken by Congress and the President to provide
a short-term resource infusion through passage of the American
Reinvestment and Recovery Act, funding for the NIH had been on a
downward trajectory. In the 6 years through 2008, a series of nominal
increases and cuts has amounted to flat funding for the NIH, and as a
result it has lost as much as 17 percent of its purchasing power. Aging
in particular is a field of research that had been hampered by this
stagnant funding. To operate in this environment the NIA and other
Institutes involved in aging-related research have not been able to
fund increasing numbers of high-quality research grants each year.
The Alliance for Aging Research applauds Congress and the Obama
administration's renewed focus on the importance of medical research in
improving the overall health of the country. In order to demonstrate a
strong commitment to bolstering science, we would recommend an increase
in funding for the NIH of at least 7 percent in fiscal year 2010. This
increase would begin to restore the NIH's ability to pursue new basic,
translational, and clinical research opportunities. A $32.4 billion
budget for the NIH in fiscal year 2010 would allow the NIA specifically
to increase support of new and existing investigator initiated research
projects and better facilitate the acceleration of discoveries for a
wide range debilitating age-related diseases and conditions among our
growing population of older Americans.
Mr. Chairman, the Alliance for Aging Research thanks you for the
opportunity to outline the challenges posed by the aging population
that lie ahead as you consider the fiscal year 2010 appropriations for
the NIH and we would be happy to furnish additional information upon
request.
______
Prepared Statement of the American College of Obstetricians and
Gynecologists
The American College of Obstetricians and Gynecologists (ACOG),
representing 53,000 physicians and partners in women's healthcare, is
pleased to offer this statement to the Senate Committee on
Appropriations, Subcommittee on Labor, Health and Human Services, and
Education, and Related Agencies. We thank Chairman Harkin, and the
entire subcommittee for their leadership to continually address women's
health research at the National Institutes of Health (NIH). The Nation
has made important strides to improve women's health over the past
several years, and ACOG is grateful to this subcommittee for its
commitment to ensure that vital research continues to eliminate disease
and to ensure valuable new treatment discoveries are implemented.
The American Recovery and Reinvestment Act (ARRA) made a sizeable
down payment on healthcare programs that have been underfunded in
recent years. The $10.4 billion for the National Institutes of Health
(NIH) and the commitment to comparative effectiveness research will
help to foster innovation and convey best practices to physicians.
While ACOG is thankful for the generous funding from the stimulus
package, funds for NIH must be used within 2 years, limiting the
ability of programs to be carried out to their completion.
An increase in funds through the regular appropriations process
will help supplement programs supported by the stimulus package beyond
the 2-year mark. The President's budget provides a modest increase of
1.4 percent, not enough to sustain the 19,000 grant applications that
have been submitted in the wake of the stimulus, which will result in
lower pay lines. Therefore, we urge the subcommittee to support an
appropriation of at least $32.4 billion for NIH, a $2.1 billion
increase (7 percent) for fiscal year 2010.
WOMEN'S HEALTH RESEARCH AT THE NIH
NIH Institutes work collaboratively to conduct women's health
research. The Eunice Kennedy Shriver National Institute of Child Health
and Human Development (NICHD) conducts the majority of women's health
research, and has made critical accomplishments in preterm birth,
contraceptive research, and infertility. The National Cancer Institute
(NCI) has made monumental discoveries on gynecologic cancers, and the
National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK) works with the NICHD to discover treatments for urinary
incontinence. The Office of Research on Women's Health (ORWH) in the
NIH Office of the Director coordinates women's health research projects
and manages mentoring programs for new investigators.
Despite the NIH's critical advancements, reduced funding levels
have made it difficult for research to continue, largely due to the
lack of new investigators. The NIH advanced women's health research
during the congressional doubling between fiscal year 1998 and fiscal
year 2003, but funding increases have been so low since fiscal year
2003, the NIH budget is almost the same as it was before the doubling.
office of the director--office of research on women's health (orwh)
Coordinating and Promoting Women's Health Research Throughout NIH
Established in September 1990, the Office of Research on Women's
Health (ORWH) is a focal point for women's health research at the NIH.
The Building Interdisciplinary Research Careers in Women's Health
(BIRCWH) is operated by the ORWH, and the Women's Reproductive Health
Research (WRHR) Career Development Program at the NICHD. BIRCWH
programs are expanding women's health research through career
development, increasing diversity in the field of women's health,
promoting interdisciplinary research training and developing
independent researchers with backgrounds in high-priority women's
health research areas. These programs attract new researchers, but low
pay lines make it difficult for the NIH to maintain them.
The ORWH recently launched the NIH Women's Health Fellowships in
Intramural Women's Health Research. This intramural program is funded
through the Foundation of the NIH, which was established by Congress to
maximize the resources at the NIH and support medical research through
public-private partnerships. The fellowships are supported by donations
from Battelle and AstraZeneca.
An ob-gyn resident at Loyola University, Chicago, Illinois, is one
of the first recipients of the fellowship. She is studying the
difference in severity and prevalence of fibroids in African American
and white women. The Women's Health Fellowship helps new investigators
enhance their research skills, and mentor women to senior positions in
science.
ACOG urges Congress to increase funding for the ORWH to help
prepare the next generation of women's health researchers and 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.
NICHD
ACOG supports a $90.6 million increase (7 percent) in funds more
than fiscal year 2009 for NICHD at NIH. These funds will assist
research into the following areas:
Expanding Maternal Health Research
The Maternal Fetal Medicine Units (MFMU) Network investigates
clinical questions in maternal fetal medicine and obstetrics, with a
focus on preterm birth, and has advanced women's health research by
making several monumental discoveries including using progesterone
treatments to reduce preterm birth. The MFMU is working at 14 sites
across the United States to reduce the risks of preterm birth, cerebral
palsy, and pre-eclampsia (high blood pressure).
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, and how to reduce these risks. Prematurity rates have
increased almost 35 percent since 1981, accounting for 12.5 percent of
all births, yet the causes are unknown in 25 percent of cases. Preterm
births cost the Nation $26 billion annually, $51,600 for every infant
born prematurely. Direct healthcare costs to employers for a premature
baby average $41,610, 15 times higher than the $2,830 for a healthy,
full-term delivery.
The 2008 Surgeon General's Conference on the prevention of preterm
birth brought together experts from the public and private sectors to
discuss key research findings and to develop an agenda to mitigate the
problem of prematurity. The conference concluded by calling on the
surgeon general to make the prevention of preterm birth a national
public health priority. ACOG supports this effort and urges Congress to
recognize the importance of new research to identify the causes and
effective interventions for preterm births.
Improving 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 is unintended.
Contraceptive use saves as much as $19 billion in healthcare costs
annually. Research has found that oral contraceptives are less
effective in overweight and obese women, yet the causes are unknown. It
is critical that Congress continue to invest in contraceptive research,
ensuring that women have access to safe and effective contraceptives to
help them time and space their pregnancies. The NICHD's research on
male and female contraceptives can help reduce the number of unintended
pregnancies and abortions, and improve women's health.
National Cancer Institute (NCI)
Developing Gynecologic Cancer Research, Prevention, and
Education
--Effects of Cervical Procedure on Pregnancy.--At the Washington
University School of Medicine, St. Louis, Missouri, researchers
are studying the impact of the Loop Electrosurgical Excision
Procedure (LEEP), which is a common treatment for abnormal
cells on the cervix, on subsequent pregnancy. This study may
determine whether LEEP increases the risk of preterm birth and
other adverse pregnancy outcomes.
--Stress and Ovarian Cancer.--At the University of Texas, MD Anderson
Cancer Center, Houston, Texas, researchers are examining the
effects of chronic stress on growth and progression of ovarian
cancer along with underlying mechanisms. Based on these
results, researchers hope to gain a better understanding of the
adverse effects of chronic stress and discover new strategies
for blocking its harmful effects on cancer patients.
--Pediatric Cancer Survivor Fertility.--There are currently more than
250,000 childhood cancer survivors in the United States, and
while cancer therapies improve long-term survival, such
treatments may impair fertility potential and cause premature
ovarian failure. Research at the University of Pennsylvania--
Philadelphia, Philadelphia, will provide preliminary data for
the establishment of a long-term study of pediatric cancer
survivors and their pregnancy rates, pregnancy outcomes and the
occurrence of premature menopause.
Expanding Ovarian Cancer Research
Despite the women's health research advancements at the NCI, much
more needs to be done. According to the NCI, there will be 22,430 new
cases of ovarian cancer and 15,280 deaths from ovarian cancer in the
United States in 2007. With more ovarian cancer biomarker research, we
may reduce ovarian cancer. ACOG urges Congress to pass the Ovarian
Cancer Biomarker Act, S. 2569/H.R. 3689, which would increase funding
for research and clinical centers at the NCI for risk stratification,
early detection, and screening of ovarian cancer.
INCREASING GYNECOLOGIC CANCER EDUCATION
Public and provider education on gynecologic cancers is critical to
early detection. When women and their doctors understand the symptoms
and risk factors of gynecologic cancers they can find appropriate
medical help quickly, increasing the potential for earlier detection.
ACOG urges Congress to fully fund Johanna's Law, Public Law 109-475, at
$10 million in fiscal year 2009, which would increase provider and
public education on gynecologic cancers, saving thousands of lives.
NIDDK
Exploring Treatments for Urinary Incontinence
The Urinary Incontinence Treatment Network (UITN) at the NIDDK and
the NICHD, researches urinary incontinence treatments. The UITN
clinical trials compare the outcomes of commonly used surgical
procedures, drug therapies, and behavioral treatments for incontinence.
--The Trial of Mid-urethral Slings.--Researches the outcomes of
surgical procedures to treat stress urinary incontinence.
Although these surgical procedures are approved by the Food and
Drug Administration, researchers are investigating which are
more effective.
--The Stress Incontinence Surgical Treatment Efficacy Trial.--Studies
the long-term outcomes of commonly performed stress urinary
incontinence treatment surgeries. The Burch procedure and the
sling produce have estimated cure rates of 60 percent -90
percent, and researchers are determining which produces the
best long-term outcome.
--The Behavior Enhances Drug Reduction of Incontinence.--Studies
whether adding behavioral treatment to drug therapy makes it
possible to discontinue drug treatment, and still maintain a
reduced number of incontinence accidents.
ACOG urges Congress to increase funding for critical women's health
research at the NIDDK.
Again, we would like to thank the subcommittee for its continued
support of programs to improve women's health, and urge Congress to
increase funding for the NIH and its Institutes 7 percent more than
fiscal year 2009 levels in fiscal year 2010.
______
Prepared Statement of the American College of Physicians
Chairman Harkin and Ranking Member Cochran, thank you for allowing
the American College of Physicians (ACP) to share our views on the
Department of Health and Human Services budget for fiscal year 2010.
ACP represents 126,000 internal medicine physicians, residents, and
medical students. ACP is also the Nation's largest medical specialty
society and its second largest physician membership organization.
Today, ACP is urging the following funding levels:
--Title VII and title VIII programs, under the Public Health Service
Act, $550 million;
--National Health Service Corps (NHSC), $235 million;
--Agency for Healthcare Research and Quality (AHRQ), $405 million;
and
--National Institutes of Health (NIH), at minimum a 7 percent
increase more than the fiscal year 2009 baseline.
PRIMARY CARE WORKFORCE
We are experiencing a primary care shortage in this country, the
likes of which we have not seen. The expected demand for primary care
in the United States continues to grow exponentially while the Nation's
supply of primary care physicians dwindles and interest by U.S. medical
graduates in primary care specialties steadily declines. The reasons
behind this decline in primary care physician supply are multi-faceted
and complex. Key factors include the rapid rise in medical education
debt, decreased income potential for primary care physicians, failed
payment policies, and increased burdens associated with the practice of
primary care.
A strong primary care infrastructure is an essential part of any
high-functioning healthcare system. In this country, primary care
physicians provide 52 percent of all ambulatory care visits, 80 percent
of patient visits for hypertension, and 69 percent of visits for both
chronic obstructive pulmonary disease and diabetes, yet they comprise
only one-third of the U.S. physician workforce. Those numbers are
compelling, considering the fact that primary care is known to improve
health outcomes, increase quality, and reduce healthcare costs.
There are many regions of the country that are currently
experiencing shortages in primary care physicians. The Institute of
Medicine reports that it would take 16,261 additional primary care
physicians to meet the need in currently underserved areas alone. To
help alleviate the shortage of primary care physicians, we believe
sufficient funding should be provided for title VII and title VIII
programs, as well as NHSC.
TITLE VII AND TITLE VIII PROGRAMS
The health professions education programs, authorized under titles
VII and VIII of the Public Health Service Act and administered through
the Health Resources and Services Administration, support the training
and education of healthcare providers to enhance the supply, diversity,
and distribution of the healthcare workforce, filling the gaps in the
supply of health professionals not met by traditional market forces.
ACP was pleased that the American Recovery and Reinvestment Act (ARRA,
Public Law 111-5) provided a down payment of $200 million for title VII
and title VIII programs.
NHSC, along with the Health Professions and Nursing Education
Coalition, is recommending that these programs require at least $550
million to adequately educate and train a healthcare workforce that
meets the public's healthcare needs. This amount includes restoration
of title VII to at least the fiscal year 2005 level (close to $300
million).
Lower funding or elimination of title VII programs will have an
immediate impact on the training and recruitment of health professions
students and the educational infrastructures developed and supported by
title VII. It is important to note that these programs are unique in
that they are the only federal investment in interdisciplinary
training, which is vitally important as care is often provided in
interdisciplinary settings. These programs are also designed to enhance
minority representation in the healthcare workforce, which is essential
when it comes to providing access to care as minority providers are
more likely than others to care for underserved populations and help
reduce the shortages in these specific areas. Moreover, not only does
this funding support essential training programs, it also facilitates
the delivery of care to the underserved areas of the country through
the Area Health Education Centers and Health Education and Training
Centers.
As the Nation's healthcare delivery system undergoes rapid and
dramatic changes, an appropriate supply and distribution of health
professionals has never been more essential to the public's health. The
title VII and title VIII programs are critical to help institutions and
programs respond to these current and emerging challenges and ensure
that all Americans have access to appropriate and timely health
services.
NHSC
In conjunction with other stakeholders, ACP is recommending a
combined appropriation of $235 million for NHSC. We are pleased the
ARRA provided an additional $300 million, which will enable 4,200 more
clinicians to access the scholarship and loan repayment programs.
The NHSC scholarship and loan repayment programs provide payment
toward tuition/fees or student loans in exchange for service in an
underserved area. The programs are available for primary medical, oral,
dental, and mental and behavioral professionals. Participation in the
NHSC for 4 years or more greatly increases the likelihood that a
physician will continue to work in an underserved area after leaving
the program. Over the years, the number of clinicians in those programs
has grown from 180 to more than 4,000. In 2000, the NHSC conducted a
large study of NHSC clinicians who had completed their service
obligation up to 15 years before and found that 52 percent of those
clinicians continued to serve the underserved in their practice. The
programs under NHSC have proven to make an impact in meeting the
healthcare needs of the underserved, and with more appropriations, they
can do more.
The NHSC estimates that nearly 50 million Americans currently live
in health professions shortage areas (HPSAs)--underserved communities
which lack adequate access to primary care services--and that 27,000
primary care professionals are needed to adequately serve the people
living in HPSAs. Currently, more than 4,000 NHSC clinicians are caring
for nearly 4 million people. The outstanding need remains unmet.
Limited funding has reduced new NHSC awards from 1,570 in fiscal
year 2003 to an estimated 947 in fiscal year 2008, a nearly 40 percent
decrease. The NHSC scholarship program already receives 7 to 15
applicants for every award available. The National Advisory Council on
the NHSC has recommended that Congress double the appropriations for
the NHSC to more than double its field strength to 10,000 primary care
clinicians in underserved areas.
AHRQ
AHRQ is the leading public health service agency focused on
healthcare quality. AHRQ's research provides the evidence-based
information needed by consumers, providers, health plans, purchasers,
and policymakers to make informed healthcare decisions.
ACP is dedicated to ensuring AHRQ's vital role in improving the
quality of our Nation's health and supports a fiscal year 2010 budget
allocation of $405 million for AHRQ. This amount will allow AHRQ to
carry out its congressional mandate to improve healthcare quality and
reduce costs by identifying which treatments work best and at what
cost. ACP's request of an additional $32 million more than the fiscal
year 2009 funding level would be designated for increased research in
patient safety, health information technology, resources for research
into the causes of and solutions to raising healthcare costs, chronic
care management, and strategies to translate research into practice.
The additional $32 million will allow AHRQ to expand its
investigator-initiated research program, a critically important element
of our Nation's healthcare research effort. This funding stream
provides for many clinical innovations--innovations that improve
patient outcomes. It will also facilitate the translation of research
into clinical practice and disease management strategies, and address
the healthcare needs of vulnerable populations. Investment in AHRQ's
investigator-initiated research is an investment in America's health.
Additionally, investment in investigator-initiated research represents
a cost-effective and efficient use of our Federal health research
dollars. The relatively modest investment provided to clinical
investigators in the form of grants often result in advancements with
positive economic implications far outweighing the original investment.
ACP was pleased that the ARRA provided AHRQ with $300 million for
comparative clinical effectiveness research. This funding, along with
an additional $400 million for the Office of the Director of the NIH
and $400 million to the Secretary of Health and Human Services, will
stimulate the development of comparative effectiveness research and
provide a good foundation for the establishment of the recommended,
national comparative effectiveness entity. Furthermore, the act
prohibits the Government from using the research for making any
coverage or payment decisions or issuing clinical guidelines. The sole
purpose is to develop this research and disseminate the results to all
stakeholders.
NIH
Together, the fiscal year 2009 omnibus and the ARRA provided $38.5
billion to NIH, which will fund more than 16,000 new research grants
for live-saving research into diseases such as cancer, diabetes, and
Alzheimer's.
In his budget, the President envisions doubling our investment in
basic research. Consistent with his proposal, we respectfully urge the
subcommittee to increase funding for NIH by at least 7 percent more
than the fiscal year 2009 baseline.
CONCLUSION
Mr. Chairman and Ranking Member Cochran, thank you for the
opportunity to offer testimony on the importance of the Department of
Health and Human Services budget for fiscal year 2010.
In conclusion, ACP would like to reiterate ACP's recommended
funding levels:
--Title VII and title VIII programs, under the Public Health Service
Act, $550 million;
--NHSC, $235 million;
--AHRQ, $405 million; and
--NIH, at minimum a 7 percent increase more than the fiscal year 2009
baseline.
The United States must invest in these programs in order to achieve
a high-performance healthcare system. ACP greatly appreciates the
support of the subcommittee on these issues and looks forward to
working with Congress as you being to work on the fiscal year 2010
appropriations process.
______
Prepared Statement of the American College of Preventive Medicine
Each year, 50,000 Americans die violent deaths. Homicide and
suicide are, respectively, the third and fourth leading causes of death
for people aged 1-39 years. An average of 80 people take their own
lives every day.
Before the National Violent Death Reporting System (NVDRS) was
created, Federal and State public health and law enforcement officials
collected valuable information about violent deaths, but lacked the
ability to combine it into one comprehensive reporting system. Instead,
data was held in a variety of different systems, and policymakers
lacked the clear picture necessary to develop effective violence
prevention policies.
When it was created in 2002, NVDRS promised to capture data that is
critical to identifying patterns and developing strategies to save
lives. With a clearer picture of why violent deaths occurs, law
enforcement and public health officials can work together more
effectively to identify those at risk and provide effective preventive
services.
Currently, NVDRS funding levels only allow the program to operate
in the following 17 States: Alaska, California, Colorado, Georgia,
Kentucky, Maryland, Massachusetts, New Jersey, New Mexico, North
Carolina, Oklahoma, Oregon, Rhode Island, South Carolina, Utah,
Virginia, and Wisconsin. Nine additional States, plus the District of
Columbia were previously approved for participation in the NVDRS, but
were unable to join due to funding shortfalls: Connecticut, Illinois,
Maine, Michigan, Minnesota, New York, Ohio, and Texas. Several other
States have expressed an interest in joining once new funding becomes
available.
While NVDRS is beginning to strengthen violence and suicide
prevention efforts in the 17 participating States, many other States
have been forced to sit idle until additional funding is allocated.
With the inclusion of $7.5 million for NVDRS in fiscal year 2010, NVDRS
will be able to expand to additional States and continue its
incremental growth toward national implementation.
NVDRS PROVIDES CRITICAL DATA FOR SUICIDE PREVENTION
Although it is preventable, more than 30,000 Americans die by
suicide each year, and another 1.8 million Americans attempt it,
costing more than $3.8 billion in hospital expenses and $13 billion in
lost earnings.
In the United States today, there is no comprehensive national
system to track suicides. However, because NVDRS includes information
on all violent deaths--include deaths by suicide--information from the
system can be used to develop effective suicide prevention plans at the
community, State, and national level.
Among the ways NVDRS data is being used to inform suicide
prevention programs: NVDRS data from 13 States uncovered significant
racially and ethnically based differences in mental illness diagnoses
and treatment among those who died by suicide. Specifically, whites
were more likely to have been diagnosed with depression or bipolar
disorder, while blacks were more likely than other groups to have been
diagnosed with schizophrenia. Hispanics were less likely to have been
diagnosed with a mental illness or to have received treatment at all,
although the family reports of depression were comparable to other
racial groups. Additionally, NVDRS data from all 17 States show that
veterans accounted for 26 percent of males who died by suicide in 2004.
While veterans also accounted for 26 percent of the male U.S.
population, this finding points to the importance of veterans' services
to potentially identify and treat at-risk individuals.
With such information available for the first time, officials in
participating States are using NVDRS data in myriad ways. For example,
--With the sixth-highest rate of elder suicide in the Nation, Oregon
tailored its NVDRS data to develop an epidemiological profile
of victims and establish an elder suicide prevention plan.
NVDRS data indicated that most victims of elder suicide in
Oregon had been suffering from physical illness, and that 37
percent had visited a doctor in the 30 days prior to their
death. As a result of this NVDRS data, the State developed an
elder suicide prevention plan that calls for better integration
of primary care and mental health services, so that potential
suicide victims can be better identified and treated. The plan
also calls for training primary healthcare providers,
integrating mental healthcare into primary care, and educating
family members about the risks of suicide and warning signs of
depression.
--NVDRS data found that 1 in 4 of Virginia's suicide victims had
served in the military. Among male victims older than 65, more
than 60 percent were veterans. These findings indicate that the
State's suicide prevention and education efforts must extend to
veterans' hospitals and service providers.
--NVDRS data provides State health officials in South Carolina with
vital information that indicates behavior patterns, enables
health officials to identify individuals at risk, and to
intervene early with appropriate preventive measures. After
NVDRS data showed that more than 40 percent of suicide victims
were currently or formerly receiving mental health treatment or
tested positive for psychiatric medication, the State
established its first ever suicide prevention plan, which also
included the formation of a Suicide Prevention Task Force.
NVDRS PROVIDES CRITICAL DATA TO PROTECT CHILDREN AND ADOLESCENTS
Child abuse and other violence involving children and adolescents
remains a problem in America, and it is only through a comprehensive
understanding of its root causes that many needless deaths can be
prevented. Studies suggest that between 3.3 and 10 million children
witness some form of domestic violence annually. Additionally, 1,387
children died as a result of abuse or neglect in 2004, according to the
Federal Administration on Children, Youth, and Families, part of the
Department of Health and Human Services.
Children are most vulnerable and most dependent on their caregivers
during infancy and early childhood. Sadly, NVDRS data has shown that
young children are at the greatest risk of homicide in their primary
care environments. Combined NVDRS data from Alaska, Maryland,
Massachusetts, New Jersey, Oregon, South Carolina, and Virginia
determined that African American children 4 years old and younger are
more than four times more likely to be victims of homicide than
Caucasian children, and that homicides of children 4 and under are most
often committed by a parent or caregiver in the home. The data also
shows that household items, or ``weapons of opportunity,'' were most
commonly used, suggesting that poor stress responses may be factors in
these deaths. Knowing the demographics and methods of abusers can lead
to more effective, targeted prevention programs.
Other examples of how NVDRS data is informing programs to protect
children and adolescents from violence, include the following:
--Data from NVDRS pilot sites in Connecticut, Maine, Utah, Wisconsin,
Pennsylvania, and California found that almost 30 percent of
suicide victims age 17 and under told someone they felt
suicidal. Many teen suicides also appear to be linked to recent
events in their lives, with nearly one-third of suicides taking
place on the same day as a crisis and almost half within the
same week. This data underscores the importance of developing
community-based programs to rapidly respond to the warning
signs of suicide.
--With data generated by NVDRS, State health officials in
Massachusetts have been able to monitor suicides and homicides
more accurately among specific populations, such as foster
children and youths in custody. The NVDRS data has been used to
secure grants for violence prevention programs for these
special populations, about whom data had previously been
impossible to obtain.
NVDRS PROVIDES CRITICAL DATA TO PREVENT INTIMATE PARTNER VIOLENCE
While intimate partner violence has declined along with other
trends in crime over the past decade, thousands of Americans still fall
victim to it every year. Women are much more likely than men to be
killed by an intimate partner. Intimate partner homicides accounted for
33.5 percent of the murders of women and less than four percent of the
murders of men in 2000, according to the Bureau of Justice Statistics.
Although the program is still in its early stages, NVDRS is
providing critical information that is helping law enforcement and
health and human service officials allocate resources and develop
programs in ways that target those most at risk for intimate partner
violence, thereby preventing needless deaths. For example, NVDRS data
shows that while occurrences are rare, most murder-suicide victims are
current or former intimate partners of the suspect, and a substantial
number of victims were the suspect's children. In addition, NVDRS
indicates that women are about seven times more likely than men to be
killed by a spouse, ex-spouse, lover, or former lover, and the majority
of these incidents occurred in the women's homes
Examples of how State officials are using NVDRS data to better
understand and prevent intimate partner violence include:
--Based on an analysis of NVDRS data, the Kentucky Injury Prevention
Research Center concluded that among women killed by an
intimate partner, only 39 percent had had filed for a
restraining order or been seen by or reported to Adult
Protective Services. This finding underscored a perceived need
in the community to improve outreach linking potential victims
to local protective services.
--Working with the State's NVDRS program, the Alaska Department of
Law and Public Safety found there is a high risk for intimate
partner violence, both homicide and suicide, when one partner
is attempting to leave the relationship. Findings such as this
one are molding the State's strategy for domestic violence
prevention.
STRENGTHENING AND EXPANDING NVDRS IN FISCAL YEAR 2010
At an estimated annual cost of $20 million for full implentation,
NVDRS is a relatively low-cost program that yields high-quality
results. While State-specific information provides enormous value to
local public health and law enforcement officials, national data from
all 50 States, the U.S. territories and the District of Columbia must
be obtained to complete the picture and establish effective national
violence prevention policies and programs.
That is why the National Violence Prevention Network, a coalition
of national organizations who advocate for health and welfare, violence
and suicide prevention, and law enforcement, is calling on Congress to
provide no less than $7.5 million for NVDRS for fiscal year 2010. The
cost of not implementing the program is much greater: without national
participation in the program, thousands of American lives remain at
risk.
______
Prepared Statement of the American College of Preventive Medicine
RECOMMENDATION
The American College of Preventive Medicine (ACPM) urges the Labor,
Health and Human Services, and Education, and Related Agencies
Appropriations Subcommittee to reaffirm its support for training
preventive medicine physicians and other public health professionals by
providing $10.1 million in fiscal year 2010 for preventive medicine
residency training under the public health, dentistry, and preventive
medicine line item in title VII of the Public Health Service Act. ACPM
also supports the recommendation of the Health Professions and Nursing
Education Coalition that $550 million be appropriated in fiscal year
2010 to support all health professions and nursing education and
training programs authorized under titles VII and VIII of the Public
Health Service Act.
THE NEED FOR PREVENTIVE MEDICINE IS GROWING
In today's healthcare environment, the tools and expertise provided
by preventive medicine physicians are integral to the effective
functioning of our Nation's public health system. These tools and
skills include the ability to deliver evidence-based clinical
preventive services, expertise in population-based health sciences, and
knowledge of the social and behavioral aspects of health and disease.
These are the tools employed by preventive medicine physicians who
practice in public health agencies and in other healthcare settings
where improving the health of populations, enhancing access to quality
care, and reducing the costs of medical care are paramount. As the body
of evidence supporting the effectiveness of clinical and population-
based interventions continues to expand, so does the need for
specialists trained in preventive medicine.\1\ \2\ \3\
---------------------------------------------------------------------------
\1\ Berrino, F. Role of Prevention: Cost Effectiveness of
Prevention. Annals of Oncology 2004; 15:iv245-iv248.
\2\ Eikjemans G, Takala J. Moving Knowledge of Global Burden into
Preventive Action. American Journal of Industrial Medicine 2005;
48:395-399.
\3\ Ortegon M, Redekop W, Niesen L. Cost-Effectiveness of
Prevention and Treatment of the Diabetic Foot. Diabetes Care 2004;
27:901-907.
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Organizations across the spectrum have recognized the growing
demand for public health and preventive medicine professionals. The
Institute of Medicine released a report in 2007 calling for an
expansion of preventive medicine training programs by an ``additional
400 residents per year''.\15\ The Health Resources and Services
Administration's (HRSA) Bureau of Health Professions, using data
extracted from the Department of Labor, reports that the demand for
public health professionals will grow at twice the rate of all
occupations between 2000 and 2010.\4\ The Council on Graduate Medical
Education recommends increased funding for training physicians in
preventive medicine.\5\ In addition, the Nation's medical schools are
devoting more time and effort to population health topics.\6\ These are
just a few of the examples demonstrating the growing demand for
preventive medicine.
---------------------------------------------------------------------------
\15\ Training Physicians for Public Health Careers. Institute of
Medicine. National Academies Press, June 2007.
\4\ Biviano M. Public Health and Preventive Medicine: What the Data
Shows. Presented at the 9th Annual Preventive Medicine Residency
Program Directors Workshop, San Antonio, Texas. HRSA. 2002.
\5\ Glass JK. Physicians in the Public Health Workforce. In Update
on the Physician Workforce. Council on Graduate Medical Education.
2000.
\6\ Sabharwal R. Trends in Medical School Graduates' Perceptions of
Instruction in Population-Based Medicine. In Analysis in Brief.
American Association of Medical Colleges. Vol. 2, No. 1. January 2002.
---------------------------------------------------------------------------
In fact, preventive medicine is the only 1 of the 24 medical
specialties recognized by the American Board of Medical Specialties
that requires and provides training in both clinical medicine and
public health. Preventive medicine physicians possess critical
knowledge in population and community health issues, disease and injury
prevention, disease surveillance and outbreak investigation, and public
health research. Preventive medicine physicians are employed in
hospitals, State and local health departments, Health Maintenance
Organizations (HMOs), community and migrant health centers, industrial
sites, occupational health centers, academic centers, private practice,
the military, and Federal Government agencies.
The recent focus on emergency preparedness is also driving the
demand for these skills. Unfortunately, many experts have expressed
concerns about the preparedness level of our public heath workforce and
its ability to respond to emergencies. The nonpartisan, not-for-profit
Trust for America's Health has published annual reports assessing
America's pubic health emergency response capabilities. The most recent
report, released in December 2008, found that neither State nor Federal
Governments are adequately prepared to manage a public health
emergency. One reason for this is a significant shortfall in funding
needed to improve the Nation's public health systems.\7\ Furthermore,
the Centers for Disease Control and Prevention recently affirmed that
there are significant holes in U.S. hospital emergency planning efforts
for bioterrorism and mass casualty management.\8\ These include varying
levels of training among hospital staff for treating exposures to
chemical, biological or radiological agents; lack of memoranda of
understanding with supporting local healthcare facilities; and lack of
preparedness training for explosive incidents.
---------------------------------------------------------------------------
\7\ Hearne S, Chrissie J, Segal L, Stephens T, Earls M. Ready or
Not? Protecting the Public's Health from Diseases, Disasters, and
Bioterrorism 2008; Trust for America's Health.
www.healthyamericans.org.
\8\ Niska R, Burt C. Bioterrorism and mass casualty preparedness in
hospitals: United States, 2003. Advance data from vital and health
statistics; no 364. Hyattsville, MD: National Center for Health
Statistics. 2005.
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THE SUPPLY OF PREVENTIVE MEDICINE SPECIALISTS IS SHRINKING
According to HRSA and health workforce experts, there are personnel
shortages in many public health occupations, including among others,
preventive medicine physicians, epidemiologists, biostatisticians, and
environmental health workers.\9\
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\9\ Health Professions and Nursing Education Coalition.
Recommendation for Fiscal Year 2007. March 2006.
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Exacerbating these shortages is a shrinking supply of physicians
trained in preventive medicine:
--In 2002, only 6,893 physicians self-designated as specialists in
preventive medicine in the United States, down from 7,734 in
1970. The percentage of total U.S. physicians self-designating
as preventive medicine physicians decreased from 2.3 percent to
0.8 percent over that time period.\10\
---------------------------------------------------------------------------
\10\ American Medical Association (AMA). Physician Characteristics
and Distribution in the U.S. 2004, Table 5.2, p. 323.
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--Between 1999 and 2006, the number of residents enrolled in
preventive medicine training programs declined nearly 20
percent.\11\
---------------------------------------------------------------------------
\11\ AMA. Graduate Medical Education Database. Copyright 1994-2005,
Chicago, IL.
---------------------------------------------------------------------------
--The number of preventive medicine residency programs decreased from
90 in 1999 to 71 in 2008-2009.\12\
---------------------------------------------------------------------------
\12\ Magee JH. Analysis of Program Data for Preventive Medicine
Residencies in the United States: Report to the Bureau of Health
Resources & Services Administration. Washington, DC: American College
of Preventive Medicine, 1997.
---------------------------------------------------------------------------
ACPM is deeply concerned about the shortage of preventive medicine-
trained physicians and the ominous trend of even fewer training
opportunities. The decline in numbers is dramatic considering the
existing critical shortage of physicians trained to carry out core
public health activities. This deficiency will lead to major gaps in
the expertise needed to deliver clinical prevention and community
public health. The impact on the health of those populations served by
HRSA may be profound.
FUNDING FOR RESIDENCY TRAINING IS ERODING
Physicians training in the specialty of preventive medicine,
despite being recognized as an underdeveloped national resource and in
shortage for many years, are the only medical residents whose graduate
medical education (GME) costs are not supported by Medicare, Medicaid
or other third-party insurers. Training occurs outside hospital-based
settings and therefore is not financed by GME payments to hospitals.
Both training programs and residency graduates are rapidly declining at
a time of unprecedented national, State, and community need for
properly trained physicians in public health and disaster preparedness,
prevention-oriented practices, quality improvement and patient safety.
Both the Council on Graduate Medical Education and Institute of
Medicine have called for enhanced training support.
Currently, residency programs scramble to patch together funding
packages for their residents. Limited stipend support has made it
difficult for programs to attract and retain high-quality applicants;
faculty and tuition support has been almost nonexistent.\12\ Directors
of residency programs note that they receive many inquiries about and
applications for training in preventive medicine; however, training
slots often are not available for those highly qualified physicians who
are not directly sponsored by an outside agency (such as the Armed
Services) or who do not have specific interests in areas for which
limited stipends are available (such as research in cancer prevention).
---------------------------------------------------------------------------
\12\ Magee JH. Analysis of Program Data for Preventive Medicine
Residencies in the United States: Report to the Bureau of Health
Resources & Services Administration. Washington, DC: American College
of Preventive Medicine, 1997.
---------------------------------------------------------------------------
HRSA--as authorized in title VII of the Public Health Service Act--
is a critical funding source for several preventive medicine residency
programs. HRSA funding ($1.1 million in fiscal year 2008) currently
supports only about 20 physicians in 5 preventive medicine training
programs,\13\ yet it represents the largest Federal funding source for
public health and general preventive medicine (PH/GPM) programs.
Funding is in steady decline; in fiscal year 2002 the level was $1.9
million.
---------------------------------------------------------------------------
\13\ http://bhpr.hrsa.gov/publichealth/preventive/index.htm.
Preventive Medicine Residency Training Grants.
---------------------------------------------------------------------------
These programs directly support the mission of the HRSA health
professions programs by facilitating practice in underserved
communities and promoting training opportunities for underrepresented
minorities:
--Forty percent of HRSA-supported preventive medicine graduates
practice in medically underserved communities, a rate four
times the average for all health professionals.\4\ These
physicians are meeting a critical need in these underserved
communities.
---------------------------------------------------------------------------
\4\ Biviano M. Public Health and Preventive Medicine: What the Data
Shows. Presented at the 9th Annual Preventive Medicine Residency
Program Directors Workshop, San Antonio, Texas. HRSA. 2002.
---------------------------------------------------------------------------
--One-third of preventive medicine residents funded through HRSA
programs are under-represented minorities, which is three times
the average of minority representation among all health
professionals.\4\ Increased representation of minorities is
critical because (1) under-represented minorities tend to
practice in medically underserved areas at a higher rate than
nonminority physicians, and (2) a higher proportion of
minorities contributes to high-quality, culturally competent
care.
--Fourteen percent of all preventive medicine residents are under-
represented minorities, the largest proportion of any medical
specialty.\16\
---------------------------------------------------------------------------
\16\ Percentage of ACGME Residents/Fellows Who are Black, Native
American or Native Hawaiian by Speciality. AAMC/AMA National GME
census, October 2008.
---------------------------------------------------------------------------
THE BOTTOM LINE: A STRONG, PREPARED, PUBLIC HEALTH SYSTEM REQUIRES A
STRONG PREVENTIVE MEDICINE WORKFORCE
The growing threats of a flu pandemic, disasters, and terrorism has
thrust public health into the forefront of the Nation's consciousness.
ACPM applauds recent investments in disaster planning, information
technology, laboratory capacity, and drug and vaccine stockpiles.
However, any efforts to strengthen the public health infrastructure and
disaster response capability must include measures to strengthen the
existing training programs that help produce public health leaders.
Many of the public health leaders who guide the Nation's public
health response in the aftermath of the September 11 attacks and the
recent hurricane disasters were physicians trained in preventive
medicine. According to William L. Roper, MD, MPH, Dean of the School of
Public Health, The University of North Carolina at Chapel Hill,
``Investing in public health preparedness and response without
supporting public health and preventive medicine training programs is
like building a sophisticated fleet of fighter jets without training
the pilots to fly them.''
______
Prepared Statement of the Association for Clinical Research Training
SUMMARY OF RECOMMENDATIONS FOR FISCAL YEAR 2010
Works towards fully funding the emerging Clinical and Translational
Science Awards (CTSA) program by a providing $532 million of support.
Continued support for the NIH K-awards for the training of research
scientists. Continued emphasis on the importance of Comparative
Effectiveness Research (CER).
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).
The National Alliance of Socieities for Clinical Research Resources
(NASCRR) is comprised of the national organizations that provide
leadership in the field of clinical and translational medical research.
NASCRR coalesces around areas of common concern for the entire
community and works in support of the mission of the National Center
for Research Resources (NCRR).
Let me begin by thanking the subcommittee for showing a strong
commitment to improving public health through the recently passed
fiscal year 2009 omnibus appropriations package. The legislation
included $938 million for NIH; the first meaningful funding increase to
the agency's baseline budget in many years. ACRT applauds the
subcommittee for its role in securing this funding, and we hope that
significant funding increases for NIH and other public health programs
will continue in subsequent fiscal years.
Clinical research is an increasingly important component of medical
research. A large, well-trained workforce is required to ensure that
breakthroughs in bioscience are translated into improved treatment
options for patients. Currently, the field of clinical research is
facing the same work-force shortage and retention issues felt
throughout the medical research community. Additionally, clinical
investigators undertake comparative effectiveness research activities
and as investment in this area is increased, it stands to reason that
the present pressures on the clinical research community will be
exacerbated. Commitments to increase funding for clinical research
training activities and programs must be made to ensure that in the
future, the workforce is robust and capable of improving the public
health in an effective and expeditious manner.
THE IMPORTANCE OF FULLY FUNDING THE CTSA PROGRAM.
The CTSA program is a critical effort to modernize this Nation's
clinical and translational research infrastructure, and bring the
entire field of medical research into the 21st century. To accomplish
this task, the program has identified four important goals; improving
the way biomedical research is conducted across the country, reducing
the time it takes for laboratory discoveries to become treatments for
patients, engaging communities in clinical research efforts, and
training the next generation of clinical and translational researchers.
The CTSA program is intended to assist institutions in creating a
home for clinical and translational science. The program started with
12 academic health centers located throughout the Nation, and the NIH's
plan for the CTSAs will ultimately link 60 institutions together to
energize the discipline of clinical and translational science.
Currently, there are 38 CTSA sites.
Recent years of near-level funding for NIH have hampered NCRR's
budget and drained the pool of resources that could be committed to
supporting the growing CTSA network.
NCRR has to reduce the size of awards by about half in some
instances. NCRR does not have the funds necessary to support 60 sites.
When applying to be part of the CTSA network, institutions had to
identify the types of programs and research they would be conducting.
The proposals that were deemed meritorious were subsequently funded,
but in most cases at a reduced level.
While we applaud the funding for NCRR that was provided through the
economic stimulus package, this additional money has created a
frustrating situation for CTSA-recipients. Presently, NCRR and other
NIH Institutes, Centers, and Offices are holding competitions and
accepting proposals to allocate the stimulus funds. Many of the
research activities which are being proposed are very similar to
activities the CTSA's already outlined in their initial peer-reviewed
applications, but have been unable to undertake due to a lack of
funding. In fact, many CTSA's are simply peeling off the programs which
have been approved, but unfunded and redundantly competing for stimulus
funds. Trying to fully fund CTSA activities in this manner is overly
complicated and inefficient.
The CTSA program is currently funded at just under $475 million.
You will note from the attached professional judgment provided by NCRR
that to facilitate appropriate implementation, the program requires a
funding level of $532 million in fiscal year 2010. Additionally, this
document states that to fully implement the program and support a
network of 60 centers by 2011, a funding level of $669 million is
required.
It is our recommendation that the subcommittee work towards full
implementation of the CTSA program by providing $532 million in support
for fiscal year 2010.
THE IMPORTANCE OF CONTINUING TO SUPPORT THE K-AWARDS PROGRAM.
As the CTSA program is rolled out, it is meant to subsume the
activities of other NCRR programs, such as the K-30 Clinical Research
Curriculum Awards (CRCA). However, while flat budgets slowed
implementation of the CTSA network, the phasing out of K-30 awards
continued on unimpeded. Last year the subcommittee showed strong
leadership and urged NCRR to continue the CRCA program for those
institutions that had not yet received a CTSA. I am pleased to inform
you that the NCRR has complied with this request, and recently the
Center issued the K-30 recompetition notice. Thank you for taking an
interest in clinical research training and please continue to do so
moving forward.
K-30 awards remain an exceedingly cost-effective approach to
improving the quality of training in clinical research. This efficiency
is seen throughout the larger K-award program which has many mechanisms
that go beyond the scope of the K-30's to provide support for career
development for individual researchers. Highly trained clinical
researchers are needed in order to capitalize on the many profound
developments and discoveries in basic science and to translate them to
clinical settings at all research institutions.
While the K-30 awards are primarily funded by NCRR, these
individualized K-awards, like the K-23 Mentored Patient-Oriented
Research Career Development Awards and the K-24 Midcareer Investigator
Awards in Patient-Oriented Research are administered by many NIH
Institutes and Centers. K-23 awards support the career development of
investigators who have made a commitment to focus their research
endeavors on patient-oriented research. The purpose of K-24 awards is
to provide support to mid-career health-professional doctorates that
are typically at the Associate Professor level for protected time to
devote to patient-oriented research and to act as research mentors
primarily for clinical residents, clinical fellows and/or junior
clinical faculty.
The universe of K-awards is vast and also includes K-01 Mentored
Research Scientist Development Awards and K-08 Mentored Clinical
Scientist Development Awards, amongst others. All of these awards
mechanism fill a critical research training niche. As the role of the
clinical investigator gains prominence, it is important to begin
raising awareness of these mechanisms and to bolstering their support.
We ask the subcommittee to emphasize its interest in the K-award
programs and to urge NIH to continue to provide adequate support for K-
awards moving forward.
THE IMPORTANCE OF CONTINUING TO SUPPORT CER
The American Recovery and Reinvestment Act of 2009 contained $1.1
billion for CER activities at NIH and AHRQ. NIH has been conducting
critical CER for some time and we are pleased that Congress is
beginning to appreciate the importance of these activities.
Within the $1.1 billion allocation for CER, $400 million was
provided to NIH. CTSA program recipients should compete well for a
portion of these funds as many sites consider CER a crucial component
of clinical and translational research. Additionally, the CTSA network
is intended to be a collaborative endeavor capable of leveraging great
resources to maximize productivity. As CER gains prominence, we hope
the Subcommittee will recognize the CTSA network as an ideal home for
comparative effectiveness research activities.
CER is just one example of how the role of the clinical
investigator is becoming more critical in a modern healthcare system.
However, without bolstering clinical research training opportunities we
will not be able to properly prepare the next generation of clinical
researchers. This will slow hinder our Nation's capability to stay on
the cutting edge of medical research and slow the development of new
treatment options for patients.
We ask the subcommittee to continue to appreciate and support CER
activities at NIH and AHRQ. We also ask that concurrently the
subcommittee express its interest in expanding clinical research
training opportunities at both NIH and AHRQ.
Thank you for this opportunity to present the views and
recommendations of the clinical research training community.
ADDENDUM
National Institutes of Health--National Center for Research Resources
(NCRR)
CTSA/GCRC ESTIMATE PER CURRENT MODEL
[Dollars in millions]
----------------------------------------------------------------------------------------------------------------
Fiscal year Fiscal year Fiscal year
Cohort No. 2009 2010 2011
----------------------------------------------------------------------------------------------------------------
Fiscal year 2006 Grants \1\..................... 12 $140 $140 $116
Fiscal year 2007 Grants \1\..................... 12 120 121 121
Fiscal year 2008 Grants \1\..................... 14 107 107 107
Fiscal year 2009 Grants \1\..................... 5 36 36 36
Fiscal year 2010 Grants \1\..................... 2 .............. 14 14
Fiscal year 2011 Grants \1\..................... 15 .............. .............. 100
---------------------------------------------------------------
Total, CTSA Grants........................ 60 403 418 494
CTSA Support Contract........................... .............. 3 3 3
K30 Recompetition............................... .............. .............. 5 1
---------------------------------------------------------------
Total, CTSAs.............................. .............. 406 426 497
GCRCs........................................... .............. 69 41 3
Total, CTSAs/IGCRCs....................... .............. 475 467 500
----------------------------------------------------------------------------------------------------------------
\1\ UL1, KL2, TL1 awards.
CTSAI/GCRC ESTIMATE IF REQUESTED AMOUNT AWARDED
[Dollars in millions]
----------------------------------------------------------------------------------------------------------------
Fiscal year Fiscal year Fiscal year
Cohort No. 2009 2010 2011
----------------------------------------------------------------------------------------------------------------
Fiscal year 2006 Grants \1\..................... 12 $140 $140 $140
Fiscal year 2007 Grants \1\..................... 12 158 158 158
Fiscal year 2008 Grants \1\..................... 14 155 155 155
Fiscal year 2009 Grants \1\..................... 5 50 50 50
Fiscal year 2010 Grants \1\..................... 2 .............. 21 21
Fiscal year 2011 Grants \1\..................... 15 .............. .............. 142
---------------------------------------------------------------
Total, CTSA Grants........................ 60 503 524 \2\ 666
CTSA Support Contract........................... .............. 3 3 3
K30 Recompetition............................... .............. .............. 5 1
---------------------------------------------------------------
Total, CTSAs.............................. .............. 506 532 669
GCRCs........................................... .............. 69 41 3
---------------------------------------------------------------
Total, CTSAs/IGCRCs....................... .............. 575 573 672
----------------------------------------------------------------------------------------------------------------
\1\ UL1, KL2, TL1 awards.
\2\ It would cost $666 million to fund 60 CTSAs at the amounts requested by the institutions, which is $166
million more than the $500 million budget.
DIFFERENCE
[Dollars in millions]
----------------------------------------------------------------------------------------------------------------
Fiscal year Fiscal year Fiscal year
Cohort No. 2009 2010 2011
----------------------------------------------------------------------------------------------------------------
Fiscal year 2006 Grants \1\..................... 12 .............. .............. \2\ $24
Fiscal year 2007 Grants \1\..................... 12 38 $37 37
Fiscal year 2009 Grants \1\..................... 14 $48 48 48
Fiscal year 2009 Grants \1\..................... 5 14 14 14
Fiscal year 2010 Grants \1\..................... 2 .............. 7 7
Fiscal year 2011 Grants \1\..................... 15 .............. .............. 42
---------------------------------------------------------------
Total, CTSA Grants........................ 60 100 106 172
CTSA Support Contract........................... .............. .............. .............. ..............
K30 Recompetition............................... .............. .............. .............. ..............
---------------------------------------------------------------
Total, CTSAs.............................. .............. 100 106 172
GCRCs........................................... .............. .............. .............. ..............
---------------------------------------------------------------
Total, CTSAs/IGCDCs....................... .............. 100 106 172
----------------------------------------------------------------------------------------------------------------
\1\ UL1, KL2, TL1 awards.
\2\ It would cost an additional $100 million in fiscal year 2009, $106 million in fiscal year 2010, and $172
million in fiscal year 2011 to fund the CTSAs at the amounts requested by the institutions.
______
Prepared Statement of The American Heart Association
Despite considerable progress, heart disease, stroke, and other
forms of cardiovascular disease remain major causes of permanent
disability and our Nation's No. 1 and most costly killer, with a death
every 37 seconds. Cardiovascular disease will cost our country a
projected $475 billion in medical costs and lost productivity this
year. Heart disease, alone, is our leading cause of death and stroke is
our No. 3 killer.
In the face of these staggering statistics, heart disease and
stroke research, treatment and prevention programs remain woefully
underfunded. For example, National Institutes of Health (NIH) invests
only 4 percent of its budget on heart research and a mere 1 percent on
stroke research. This level of funding is not commensurate with
scientific opportunities, the number afflicted and the economic toll
exacted on our Nation.
Cardiovascular disease remains the No. 1 killer in every State and
many preventable and treatable risk factors continue to escalate.
Unfortunately, the Centers for Disease Control and Prevention (CDC) has
been able to provide basic implementation awards to only 14 States
through its Heart Disease and Stroke Prevention Program and only 20
States are funded for CDC's WISEWOMAN, a heart disease and stroke
screening program for low-income uninsured and underinsured females.
Moreover, where you live could affect whether you survive a
particularly deadly form of heart disease, sudden cardiac arrest. At
present, only 12 States receive funding for the Health Resources and
Services Administration's (HRSA) Rural and Community Access to
Emergency Devices Program designed to save lives from sudden cardiac
death.
The American Heart Association (AHA) appreciates Congress providing
hope to the 1 in 3 adults in the United States who live with the
consequences of cardiovascular disease, with the enactment of the
American Recovery and Reinvestment Act (ARRA) and the fiscal year 2009
Omnibus Appropriations Act. The Association commends Congress for
including $10 billion for the NIH and $1 billion for a Prevention and
Wellness Fund in the ARRA. These are wise and prudent investments that
will provide both a much needed boost to our Nation's economy and
enhance health. Yet these funds represent a one-time infusion of
resources. Stable and sustained funding is imperative to boost heart
disease and stroke prevention and treatment.
FUNDING RECOMMENDATIONS: INVESTING IN THE HEALTH OF OUR NATION
With numerous new and promising research opportunities on the
horizon and with cardiovascular disease risk factors on the rise, now
is the time to make a wise enhanced investment to prevent and treat
America's No. 1 and most costly killer. If Congress fails to capitalize
on progress against cardiovascular disease now, Americans will pay more
in the future in lost lives and higher healthcare costs. Our
recommendations listed below address these issues in a comprehensive
but fiscally responsible way follow.
FUNDING GAP FOR THE NIH
NIH research has revolutionized patient care and holds the key to
finding new ways to prevent, treat, and cure cardiovascular disease,
resulting in longer, healthier lives and reduced healthcare costs. NIH
invests resources in every State and in 90 percent of congressional
districts.
The AHA Recommends.--AHA supports the President's campaign pledge
to double the NIH budget over the next decade. We advocate for a fiscal
year 2010 appropriation of $32.4 billion for NIH, a 7 percent increase
over the fiscal year 2009 appropriation, representing the first
installment to double the NIH budget by fiscal year 2020. Stable and
sustained funding is needed to help secure a solid return on Congress'
investment that has saved millions of lives. NIH supported research
prevents and cures disease and generates economic growth, creates jobs
and preserves the U.S. role as the world leader in pharmaceuticals and
biotechnology. Each NIH grant is associated with approximately seven
jobs.
ENHANCE FUNDING FOR NIH HEART AND STROKE RESEARCH: A PROVEN AND WISE
INVESTMENT
Death rates from coronary heart disease and stroke have each fallen
by almost 30 percent since 1999. This decline is directly related to
NIH heart and stroke research, with scientists on the verge of new and
exciting discoveries that could lead to innovative treatments and even
cures for heart disease and stroke. For instance, recent NIH research
has shown that postmenopausal hormone therapy does not prevent heart
disease and stroke, has defined the genetic basis of dangerous
responses to vital blood-thinners, and funded early work of the 2007
Nobel Prize winners in Physiology or Medicine for development of gene
targeting technology.
In addition to saving lives, NIH-supported research can cut
healthcare costs. For example, the original NIH tPA drug trial resulted
in a 10-year net $6.47 billion reduction in stroke healthcare costs.
The Stroke Prevention in Atrial Fibrillation Trial 1 produced a 10-year
net saving of $1.27 billion. But, despite such concrete returns on
investments and other successes, NIH heart and stroke research
continues to be disproportionately underfunded, with NIH spending only
4 percent of its budget on heart research, and a mere 1 percent on
stroke research. NIH funding for these diseases are not commensurate
with scientific opportunities, the number afflicted, the increasing
prevalence, and the economic toll exacted on our Nation.
CARDIOVASCULAR DISEASE RESEARCH: NATIONAL HEART, LUNG, AND BLOOD
INSTITUTE (NHLBI)
Cardiovascular disease research funding fails to keep pace with
medical research inflation and cannot sufficiently support existing
studies or permit investment in promising research opportunities. The
sustained loss of purchasing power has reduced NHLBI's ability to
support investigator-initiated research and has forced cuts in
Institute programs. Cutbacks will limit the implementation of both the
NHLBI general and cardiovascular-specific strategic plans. Studies that
could be scaled back include, the translation of basic research on
human behavior into real world ways to reduce obesity and promote
cardiovascular health; research on genetic susceptibility to heart
disease in the Framingham population followed for three generations,
and additional research into the best methods for saving lives of
sudden cardiac arrest sufferers.
STROKE RESEARCH: NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND
STROKE (NINDS)
An estimated 795,000 Americans will suffer a stroke this year, and
more than 137,000 will die. Many of the 6.5 million stroke survivors
face physical and mental disabilities, emotional distress and huge
costs--a projected $69 billion in medical expenses and lost
productivity in 2009.
The NINDS-sponsored Stroke Progress Review Group has issued a long-
term, stroke research strategic plan. A variety of research initiatives
have since been undertaken, but more funding is needed to fully
implement the plan. The fiscal year 2009 estimate for NINDS stroke
research falls about 60 percent short of the plan's target and
additional funding is needed for programs such as:
--Stroke Translational Research.--Translational studies are essential
to providing cutting-edge stroke treatment, patient care and
prevention. However, due to budget shortfalls, NINDS has been
forced to scale back by 30 percent its Specialized Programs of
Translational Research in Acute Stroke from a planned 10
centers to only 7.
--Genetic Repository.--NINDS could better understand genetic risk
factors associated with stroke by helping more researchers
contribute data and findings to an NIH-funded genetic
repository and to study available samples.
--Neurological Emergencies Treatment Trials Network.--NINDS has
established a clinical research network of emergency medicine
physicians, neurologists and neurosurgeons to develop more and
improved treatments for acute neurological emergencies, such as
strokes. However, the number of trials will be limited by
available funding.
The AHA Recommends.--AHA supports an fiscal year 2010 appropriation
of $3.227 billion for the NHLBI; and $1.705 billion for the NINDS.
These represent a 7 percent increase more than fiscal year 2009--
comparable to the Association's recommended percentage increase for the
NIH.
INCREASE FUNDING FOR THE CDC
Prevention is the best way to protect the health of Americans and
reduce the economic burden of heart disease and stroke. However,
effective prevention strategies and programs are not being implemented
due to insufficient Federal resources.
For example, despite the fact that cardiovascular disease remains
the No. 1 killer in every State, CDC's Division for Heart Disease and
Stroke Prevention funds only 14 States to implement programs to reduce
risk factors for heart disease and stroke, improve emergency response
and quality care, and end treatment disparities. Another 27 States
receive funds for capacity building (planning); but, there are no funds
for actual implementation and many of these States have been stalled in
the planning phase for years--some for a decade.
This division also administers the WISEWOMAN program that screens
uninsured and underinsured low-income women ages 40 to 64 in 20 States
for heart disease and stroke risk. They receive counseling, education,
referral, and followup as needed. Since January 2000, more than 84,000
women have been screened and more than 210,000 lifestyle interventions
have been conducted. An estimated 94 percent of these women were found
to have at least one risk factor or pre-condition for heart disease,
stroke, or other forms of cardiovascular disease. This program should
be expanded to the other 30 States and to screen more eligible women in
currently funded States.
The AHA Recommends.--AHA joins with the CDC Coalition in support of
an appropriation of $8.6 billion for CDC core programs, including
increases for the Heart Disease and Stroke Prevention and WISEWOMAN
programs. Within that total, we recommend $74 million for the Heart
Disease and Stroke Prevention Program, allowing CDC to: (1) add the
nine unfunded States; (2) elevate up to 18 States with capacity
building awards to basic program implementation; (3) continue to
support the remaining funded States; (4) maintain the Paul Coverdell
National Acute Stroke Registry; (5) increase the capacity for heart
disease and stroke surveillance; and (6) provide additional support for
prevention research and program evaluation. We advocates $37 million to
expand WISEWOMAN to more States. During last year's national
competition, 10 States received approved applications but were denied
funding due to insufficient resources. And, we join with the Friends of
the NCHS in recommending $137.5 million for NCHS and one-time funding
of $15 million to modernize the vital statistics system.
RESTORE FUNDING FOR RURAL AND COMMUNITY ACCESS TO EMERGENCY DEVICES
(AED) PROGRAM
About 92 percent of cardiac arrest victims die outside of a
hospital. Receiving immediate CPR and the use of an AED can more than
double your chance of survival. Communities with comprehensive AED
programs have achieved survival rates of 40 percent or higher. The
Rural and Community AED Program provides grants to States to buy and
place AEDs and train lay rescuers and first responders to use them.
During its first year, 6,400 AEDs were purchased, and placed and 38,800
individuals were trained. Due to budget cuts, only 12 States receive
resources for this program.
The AHA Recommends.--For fiscal year 2010, AHA advocates restoring
the 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 develops scientific evidence to improve health and healthcare.
Through its Effective Health Care Program, AHRQ supports research
focused on outcomes, comparative effectiveness, and the appropriateness
of pharmaceuticals, devices and healthcare services for conditions such
as heart disease, stroke, and high blood pressure.
On another front, AHRQ's health information technology (HIT) plan
will help bring healthcare into the 21st century through more than $260
million invested in more than 200 projects and demonstrations since
2004. AHRQ and its partners identify challenges to HIT adoption and
use; develop solutions and best practices; and produce tools that help
hospitals and clinicians successfully integrate HIT. This work must
continue as a key component to health reform.
The AHA Recommends.--AHA joins with Friends of AHRQ in advocating
for a $405 million in base funding for AHRQ. It will preserve AHRQ's
current initiatives and get the agency on track to a base budget of
$500 million by 2013.
CONCLUSION
Cardiovascular disease continues to impose a deadly, disabling and
costly burden on Americans. However, a robust funding increase for NIH,
CDC and HRSA research, treatment, and prevention programs will continue
to save lives and reduce rising healthcare costs. The AHA urges
Congress to give serious consideration to our recommendations during
the fiscal year 2010 congressional appropriations process. They are a
wise investment for our Nation and the health and well-being of all
Americans now and in future generations.
______
Prepared Statement of Advocate Health Care
INTRODUCTION AND OVERVIEW
Advocate Health Care (Advocate)--the largest integrated healthcare
provider in Illinois--very much appreciates the opportunity to submit
written testimony for the record regarding Federal funding for the
title VII and title VIII programs of the Public Health Service Act.
Advocate serves 3.1 million patients annually and has a presence in
virtually every Illinois congressional district through the operation
of more than 200 sites of care. Specifically, 9 acute care hospitals, 2
children's hospitals, 4 Level I trauma centers (the State's highest
designation in trauma care), a home healthcare company, and the
region's largest medical group--in Illinois' 1st, 2nd, 3rd, 4th, 5th,
6th, 7th, 8th, 9th, 10th, 13th and 14th Congressional Districts.
Advocate also serves patients from--and employs people in the 11th and
16th Congressional Districts of Illinois. As the second largest
employer in the Chicagoland area, Advocate employs 28,000 individuals,
including 7,000 nurses. More than 5,000 physicians are also affiliated
with Advocate.
Advocate maintains a long-standing commitment to supporting the
nurses who work within the Advocate system and to increasing resources
at the State and Federal level to bolster and expand Illinois' and the
Nation's nursing workforce. High-quality, compassionate health
professionals are critical to the delivery of care in the Advocate
system. Without our 7,000 nurses--who work hard every day on behalf of
patients and their families, our standard of care could not be achieved
for the millions of people we serve throughout Illinois each year.
Advocate joins with Members of Congress, national nursing
organizations, health professional societies and coalitions, and the
general public in being deeply concerned about the current and
anticipated national shortages of nurses and other health professionals
and their potential adverse impact on patient access to quality care.
To that end, Advocate respectfully urges the House Labor, Health and
Human Services, and Education, and Related Agencies Appropriations
Subcommittee to provide $550 million in fiscal year 2010 funding for
the title VII and title VIII programs of the Public Health Service Act
to support and expand diversity within the Nation's healthcare
workforce, and ensure that the Nation has the nurses and other health
professionals it needs to provide quality care to the patients of today
and tomorrow.
THE NURSING SHORTAGE AND THE NEED FOR TITLE VIII FUNDING
According to an April 13, 2009 Wall Street Journal article, last
summer, the nation was short approximately 125,000 nurses. The nurse
faculty shortage is of serious concern, since it is widely recognized
as a principal cause of the nursing shortage. The American Association
of Colleges of Nursing reports that in 2008, nearly 50,000 qualified
applicants were not able to matriculate in nursing school, ``due
primarily to a shortage of faculty shortage and resource constraints.''
Although the recent economic downturn has prompted some nurses, who
were retired or otherwise not working, to return to the workforce, many
communities across the nation still do not have enough nurses to work
in their hospitals and nursing homes, or to provide care in home or
ambulatory settings.
The Health Resources and Services Administration (HRSA) estimates
that, due to a combination of increased demand and the anticipated
insufficient supply of registered nurses, the Nation will face a
growing shortage in the years ahead. Specifically, the Nation will be
short an estimated 275,215 nurses in 2015--a deficit that will grow to
approximately 808,416 by 2020. Within Illinois, HRSA predicts that the
State will be short an estimated 9,300 nurses in 2010 and 31,900 in
2020. Since nearly 60 percent of all nurses are employed by hospitals,
the national and State level nursing shortages will have a significant
and disproportionate impact on hospitals and hospital systems,
including Advocate.
The Title VIII Nursing Workforce Development Programs, housed at
HRSA, provide resources to support the education and training for
entry-level and advanced practice nurses. Specifically, title VIII
programs offer loans, scholarships, traineeships, and other support to
tens of thousands of individuals each year. According to the Health
Professions and Nursing Education Coalition (HPNEC), more than 50,000
nursing students and nurses received support from title VIII in fiscal
year 2008. However, it is important to note that the demand for such
financial support far exceeds current resources. In fiscal year 2008,
HRSA received 6,078 applications for the Nurse Education Loan Repayment
Program, but only had the funds to award 435 of those applications.
Also, in fiscal year 2008, HRSA received 4,894 applications for the
Nursing Scholarship Program, but only had funding to support 172
awards. As such, to ensure that the nation can educate, train, and
deploy enough nurses to the communities most in need, Advocate urges
the subcommittee to provide a significant increase to title VIII
programs in fiscal year 2010.
PHYSICIAN SHORTAGES AND THE NEED FOR TITLE VII FUNDING
The title VII health professions programs, housed within HRSA,
provide: loans, loan guarantees and repayments, and scholarships to
students; and contracts and grants to nonprofit organizations and
entities, as well as academic institutions. Program funding supports:
(1) health professional training--with a focus on increasing minority
representation in the healthcare workforce, and (2) myriad community-
based programs, which seek to increase access to care for underserved
individuals and communities in Illinois and across the nation. As the
nation currently faces shortages of primary care and specialty
physicians--shortfalls that are expected to worsen in the coming
years--these programs play a critical role in bolstering the nation's
health workforce and helping to ensure its diversity.
Advocate is proud that from fiscal year 2003 to fiscal year 2006,
Advocate Illinois Masonic Medical Center (AIMMC)--an urban, Level I
trauma center serving primarily high-risk populations in medically
underserved and ethnically diverse Chicago northside communities--
received a total of more than $600,000 in funding from HRSA for its two
residency programs--in family practice and dentistry. HRSA funding
helped support the training of 23 primary care/family practice
residents, approximately 40 percent of whom were ethnic minorities.
This Federal funding of the AIMMC residency program helped develop
dozens of physicians who chose to practice in primary care, many of
whom specifically work in underserved communities. For example,
graduates of the AIMMC family residency program have gone on to
practice in rural health clinics, Federally Qualified Health Centers,
Federal and State Health Professional Shortage Areas, the Indian Health
Service, and HIV/AIDS primary care clinics. In addition, past HRSA
funding also supported the AIMMC dental residency program, allowing the
staffing of a mobile dental van that provides care to approximately 600
individuals--primarily uninsured--who have limited access to dental
providers and care.
As you know, funding for the title VII programs was reduced by more
than 50 percent from fiscal year 2005 to fiscal year 2006, and funding
for the title VIII program was decreased by nearly 34 percent during
the same period. Due to these significant cuts--coupled with modest
increases in the subsequent years--there have not been adequate
resources to continue to fund Advocate's residency programs. The lack
of title VII and title VIII funding has had a significant impact on
our--and other hospitals'--ability to train the next generation of
physicians and dentists. Moreover, we are concerned that the Nation is
not investing adequately in health professionals who have an interest
in--and commitment to--working in underserved communities. Increased
fiscal year 2010 funding for title VII will help ensure that our nation
is making the investment necessary to have the educated, well-trained,
and diverse health professional workforce to care for a growing
population in need.
FISCAL YEAR 2010 FUNDING REQUEST AND CONCLUSION
As the Congress works to increase access to healthcare for all
Americans--a critical action we support--the number of individuals
seeking care is anticipated to grow significantly. At the exact same
time that demand for healthcare likely will rise, the Nation is facing
a significant shortage of nurses, physicians, and other health
professionals. Therefore, we urge the subcommittee to provide $550
million to the title VII and title VIII programs of the Public Health
Service Act to bolster the Nation's health workforce and ensure access
to care for all in need. We thank the subcommittee for its
consideration of our views and stand ready to be a resource to you on
health workforce and other matters.
______
Prepared Statement of The Ad Hoc Group for Medical Research
The Ad Hoc Group for Medical Research, which is a coalition of more
than 300 patient and voluntary health groups, medical and scientific
societies, academic and research organizations, and industry, thanks
and commends Congress for including the extraordinary investment in
medical research through the National Institutes of Health (NIH) that
was included as part of in the American Recovery and Reinvestment Act
(ARRA, Public Law 111-5) as well as the $938 million increase in NIH
funding in the Omnibus Appropriations Act for fiscal year 2009 (Public
Law 111-8). In particular, we are deeply grateful to the subcommittee
for its long-standing support of NIH. These are difficult times for our
Nation and for people all around the globe, but the affirmation of
science is the key to a better future is a strategic step forward.
The partnership between NIH and America's scientists, medical
schools, teaching hospitals, universities, and research institutions
continues to serve as the driving force in this Nation's search for
ever-greater understanding of the mechanisms of human health and
disease, from which arise new diagnostics and treatments, and cures,
and better ways to improve the health and quality of life for all
Americans. These advances also contribute to the Nation's economic
strength by creating skilled, high-paying jobs; new products and
industries; and improved technologies.
The recent history of the NIH budget has hindered scientific
discovery and limited the capacity of a key engine for today's
innovation-based economy. The additional funding in the ARRA and the
fiscal year 2009 omnibus are critical first steps to returning the NIH
to a course for even greater discovery. These investments give
patients, their families and researchers renewed hope for the future,
and will help ensure the success of America's medical research
enterprise and leadership.
The funding increases in the ARRA and the fiscal year 2009 omnibus
will provide an immediate infusion of funds into the Nation's proven
and highly competitive medical research enterprise to sustain the
pursuit of improved diagnostics, better prevention strategies, and new
treatments for many devastating and costly diseases as well as support
innovative research ideas, state-of-the-art scientific facilities and
instrumentation, and the scientists, technicians, laboratory personnel,
and administrators necessary to maintain the enterprise. More
importantly, these funds will reinvigorate this Nation's ability to
produce the human and intellectual capital that will continue to drive
scientific discovery, transform health, and improve the quality of life
for all Americans.
Moreover, we see this as the first step in renewing a national
commitment to sustained, predictable growth in NIH funding, which we
believe is an essential element in restoring and sustaining both
national and local economic growth and vitality as well as maintaining
this Nation's prominence as the world leader in medical research.
President Obama has committed to increase Federal support for
research, technology, and innovation so that America can lead the world
in creating new advanced jobs and products. A key element of his
strategy is to double Federal funding for basic research to ``foster
home-grown innovation, help ensure the competitiveness of U.S.
technology-based businesses, and ensure that 21st century jobs can and
will grow in America.'' If America is to succeed in the information-
based, innovation driven world-wide economy of the 21st century, we
must recommit to long-term sustained and predictable growth in medical
research funding.
As a result of this subcommittee's prior investment in NIH, we have
made critical advances in several key areas including:
--Stem Cells.--Reprogramming skin cells from a patient with
Parkinson's Disease into normal neurons that could be used to
fight this degenerative disease.
--Infectious Diseases.--Developing more effective antibodies, and
ultimately vaccines, to fight lethal flu viruses before they
become pandemic.
--Cancer.--Launching the Cancer Genome Atlas as a partnership between
the National Cancer Institute and the National Human Genome
Research Institute to discover the genetic basis for various
cancers.
In addition, as a consequence of the investment over the past two
decades in the human genome project and other areas of genetics, we are
now entering an era of personalized medicine, which has the potential
to transform healthcare through earlier diagnosis, more effective
prevention and treatment of disease, and avoidance of drug side
effects. For example, the same medication can help one patient and be
ineffective for, or toxic to, another. By applying our greater
understanding of how an individual's genetic make-up affects a response
to specific drugs, we will increasingly know which patients will likely
benefit from treatment and which will not benefit, or worse, be harmed.
Cancer chemotherapy and the use of the anticoagulant Coumadin are good
examples of how this might be applied.
However, the discovery process--while it produces tremendous
value--often takes a lengthy and unpredictable path. The talent base
and infrastructure that we are creating needs to be maintained. Large
fluctuations in funding will be disruptive to training, to careers,
long range projects and ultimately to progress. The research engine
needs a predictable, sustained investment in science to maximize our
return.
We must ensure that after the stimulus money is spent we do not
have to dismantle our newly built capacity and terminate valuable, on-
going research. In 2011 and beyond we need to be able to continue to
advance the new directions initiated with ARRA support.
The fiscal year 2009 omnibus and the ARRA provided $38.5 billion
for NIH to provide more than 16,000 new research grants for live-saving
research into diseases such as cancer, diabetes, and Alzheimer's.
Keeping up with the rising cost of medical research in the 2010
appropriations will help NIH begin to prepare for the ``post-stimulus''
era. In 2011 and beyond we need to make sure that the total funding
available to NIH does not decline and that we can resume a steady,
sustainable growth that will enable us to achieve the President's goal
of doubling our investment in basic research. Consistent with the
President's vision, we respectfully urge this subcommittee to increase
funding for NIH in fiscal year 2010 by at least 7 percent.
The ravages of disease are many, and the opportunities for progress
across all fields of medical science to address these needs are
profound. The community appreciates that this subcommittee has always
recognized that science is unpredictable and that it is difficult to
know exactly which discoveries gained through basic research will
foster the next medical advancement. There are many examples of areas
where important therapies for one disease have resulted from
investments in unrelated areas of research. Investing broadly in
biomedical research is the key to ensuring the future of America's
medical research enterprise and the health of her citizens.
Thank you again for your leadership in improving the health and
quality of life for all Americans.
______
Prepared Statement of the AIDS Institute
Dear Chairman Harkin and members of the subcommittee: 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 2010 Labor, Health and
Human Services, and Education, and Related Agencies appropriation
measure. We thank you for your 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 the Nation.
HIV/AIDS
HIV/AIDS remains one of the world's worst health pandemics in
history. Worldwide, some 33 million people are infected with this
incurable infectious disease, and 7,400 new infections occur each day.
Tragically, AIDS has already claimed the lives of more than 25 million.
In the United States 583,298 people have died of AIDS. Last year, the
CDC announced that its estimate of new infections per year is now
56,300, which is 40 percent higher than previous estimates. That
translates into a new infection every 9\1/2\ minutes. At the end of
2007, an estimated 1.1 million people in the United States were living
with HIV/AIDS.
Persons of minority races and ethnicities are disproportionately
affected by HIV/AIDS. African Americans, who make up 12 percent of the
U.S. 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 healthcare financing.
The U.S. Government has played a leading role in fighting HIV/AIDS,
both here and abroad. The vast majority of the discretionary programs
supporting HIV/AIDS efforts domestically are funded through your
subcommittee. The AIDS Institute, working in coalition with other AIDS
organizations, has developed funding request numbers for each of these
domestic AIDS programs. We ask that you do your best to adequately fund
them at the requested level.
Below are the program requests and supporting explanation:
CENTERS FOR DISEASE CONTROL AND PREVENTION--HIV PREVENTION AND
SURVEILLANCE
[In millions of dollars]
------------------------------------------------------------------------
Amount
------------------------------------------------------------------------
Fiscal year 2009........................................ 692
Fiscal year 2010 President's budget request............. 745
Fiscal year 2010 community request...................... 1,570
------------------------------------------------------------------------
As stated above, the Centers for Disease Control and Prevention
(CDC) has increased the estimate of people infected each year by 40
percent. New infections are particularly occurring in certain
populations, such as the poor, African-Americans, men who have sex with
men, Latinos, substance users, and the incarcerated. In order to
address the specific needs of these populations and the increased
number of people infected, CDC is going to need additional funding.
The CDC has developed a professional judgment budget outlining what
funding is necessary to improve HIV prevention efforts and reduce HIV
transmission in the United States. The professional judgment budget
called for an additional $877 million in funding over the next 5 years.
With the additional funding the CDC estimates that by 2020 it could
decrease the HIV transmission rate by 50 percent, reduce the number of
people who do not know their status by 50 percent, and halve the
disparities in the Black and Hispanic communities.
This additional funding would be targeted toward: (1) Increasing
HIV testing and the number of people who are reached by effective
prevention programs; (2) developing new tools to fight HIV with
scientifically proven interventions; and (3) improving systems to
monitor HIV and related risk behaviors, and to evaluate prevention
programs.
Investing in prevention today will save money tomorrow. Every case
of HIV that is prevented saves, on average, $1 million of lifetime
treatment costs for HIV. The CDC estimates that the cost of treating
the estimated 56,300 new HIV infections in 2006 will translate into
$9.5 billion in annual future medical costs.
RYAN WHITE HIV/AIDS PROGRAMS
[In millions of dollars]
------------------------------------------------------------------------
Amount
------------------------------------------------------------------------
Fiscal year 2009........................................ 2,238
President's budget request.............................. 2,292
Community request....................................... 2,816
------------------------------------------------------------------------
The centerpiece of the Government's response to caring and treating
low-income people with HIV/AIDS is the Ryan White HIV/AIDS Program.
Ryan White currently serves more than half and million low-income,
uninsured, and underinsured people each year.
In fiscal year 2009, the Program received an increase of $72
million, or just 3.3 percent. This increase does not even cover the
rate of inflation. In his fiscal year 2010 budget the President is
proposing an increase of $54 million, or just 2.2 percent. This
includes a $20 million increase, or only 2.5 percent, to the AIDS Drug
Assistance Program. The AIDS Institute urges you to provide substantial
funding increases to all parts of the Ryan White Program. Consider the
following:
--Caseload Levels are Increasing.--People are living longer due to
lifesaving medications; there are more than 56,000 new
infections each year; and increased testing programs, according
to the CDC, will identify 12,000 to 20,000 new people infected
with HIV each year. With rising unemployment, people are losing
their employer-sponsored health coverage. All of this will
necessitate the need for more Ryan White services and
medications.
--The price of healthcare, including medications, is increasing and
State and local budgets are experiencing cutbacks due to the
economic downturn. A recent survey by the National Alliance of
State and Territorial AIDS Directors found that 50 percent of
ADAP programs have experienced or will experience State funding
decreases in fiscal year 2009.
--There are significant numbers of people in the United States who
are not receiving life-saving AIDS medications. An IOM report
concluded that 233,069 people in the United States who know
their HIV status do not have continuous access to Highly Active
Antiretroviral Therapy.
Specifically, The AIDS Institute requests the following funding
levels for each part of the Program:
--Part A provides medical care and vital support services for persons
living with HIV/AIDS in the metropolitan areas most affected by
HIV/AIDS. We request an increase of $103 million, for a total
of $766.1 million.
--Part B base provides essential services including diagnostic, viral
load testing, and viral resistance monitoring and HIV care to
all 50 States, DC, Puerto Rico, and the territories. We are
requesting a $105.4 million increase, for a total of $514.2
million.
The AIDS Drug Assistance Program (ADAP) provides life-saving HIV drug
treatment to more than 140,000 people. Due to a lack of
funding, States have not been able to include all necessary
drugs on their formularies, have limited eligibility and capped
enrollment. In order to address the 8,472 new ADAP clients and
drug cost increases, we are requesting an increase of $268.6
million for a total of $1,083.6 million.
--Part C provides early medical intervention and other supportive
services to more than 248,000 people at more than 380 directly
funded clinics. We are requesting a $66.4 million increase, for
a total of $268.3 million.
--Part D provides care to more than 84,000 women, children, youth,
and families living with and affected by HIV/AIDS. This family-
centered care promotes better health, prevents mother-to-child
transmission, and brings hard-to-reach youth into care. We are
requesting a $57.7 million increase, for a total of $134.6
million.
--Part F includes the AIDS Education and Training Centers (AETCs)
program and the Dental Reimbursement program. We are requesting
a $15.6 million increase for the AETC program, for a total of
$50 million, and a $5.6 million increase for the Dental
program, for a total of $19 million.
The AIDS Institute supports increased funding for the Minority AIDS
Initiative (MAI). MAI funds services nationwide that address the
disproportionate impact that HIV has on communities of color. We are
requesting a $200.5 million increase across these programs, for a total
of $610 million.
NATIONAL INSTITUTES OF HEALTH--AIDS RESEARCH
[In billions of dollars]
------------------------------------------------------------------------
Amount
------------------------------------------------------------------------
Fiscal year 2009........................................ 3.01
President's budget request.............................. 3.06
Community request....................................... 3.5
------------------------------------------------------------------------
Through the National Institutes of Health (NIH), research is
conducted to understand HIV and its complicated mutations, discover new
drug treatments, develop a vaccine and other prevention programs such
as microbicides, and ultimately develop 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. NIH also conducts the necessary behavioral research to learn
how HIV can be prevented best in various affected communities. We ask
the subcommittee to fund critical AIDS research at the community
requested level of $3.5 billion.
COMPREHENSIVE SEX EDUCATION
The President's proposed budget eliminates appropriated funding for
abstinence-only until marriage programs and instead creates a Teen
Pregnancy Prevention Program primarily for interventions that have gone
through a rigorous evaluation to delay sexual activity, reduce teen
pregnancy, or increase contraceptive use. We fully support the zeroing-
out of Community Based Abstinence Education programs. However, we hope
these new programs will be used to fund efforts to protect teen sexual
health beyond the prevention of teen pregnancy. Messages to prevent
teen pregnancy may not speak to all youth, particularly gay youth, who
are at a high risk of HIV infection. We request that the $110 million
in discretionary funds in the President's budget for the Teen Pregnancy
Prevention Initiative be maintained and that the language be broadened
to include HIV and STD prevention.
SYRINGE EXCHANGE PROGRAMS
At least one-quarter of all reported AIDS cases in our country are
attributed to injection drug use through the sharing of needles and
syringes. Federal scientific studies have repeatedly demonstrated that
syringe exchange programs reduce the transmission of HIV and other
infectious diseases without increasing or encouraging the use of
illicit drugs, and may even help reduce drug use by creating a point of
entry for addiction treatment. Today, there are nearly 200 such
programs operating in 38 States, DC, and Puerto Rico. Despite their
proven effectiveness, there is a ban on the use of Federal funds for
these programs. We urge you to lift the Federal funding ban on syringe
exchange programs in fiscal year 2010.
VIRAL HEPATITIS
Viral Hepatitis, whether A, B, or C, is an infectious disease that
also deserves increased attention by the Federal Government. According
to the CDC, there are an estimated 800,000 to 1.4 million Americans
chronically infected with Hepatitis B, and 46,000 new infections each
year. An estimated 1.6 percent of Americans have been infected with
Hepatitis C, of whom 3.2 million are chronically infected. It is
believed that one quarter of those infected with HIV are co-infected
with Hepatitis C.
Given these numbers, we are disappointed the program is currently
funded at a level that is substantially less than what it was funded in
fiscal year 2003 and falls far short of what is needed. In the
President's budget, funding for Hepatitis Prevention at the CDC is
slated to receive a negligible increase of $51,000. Funds are needed to
establish a program to lower the incidence of Hepatitis through
education, outreach, and surveillance. We are requesting an increase of
$31.7 million for the program, for a total of $50 million.
The AIDS Institute asks that you give weight to our testimony as
you consider the fiscal year 2010 appropriation bill.
______
Prepared Statement of the American Indian Higher Education Consortium
Summary of Requests.--Summarized below are the fiscal year 2010
recommendations for the Nation's 36 Tribal Colleges and Universities
(TCUs), covering three areas within the Department of Education and one
in the Department of Health and Human Services (HHS), Administration
for Children and Families' (ACF) Head Start Program.
DEPARTMENT OF EDUCATION PROGRAMS
Higher Education Act (HEA) Programs
Strengthening Developing Institutions.--Section 316 of title III-A,
specifically supports TCUs through two separate grant programs: (a)
formula funded development grants, and (b) competitive facilities/
construction grants designed to address the critical facilities needs
at TCUs. The TCUs request that the Subcommittee appropriate $32 million
to support these two vital programs.
Pell Grants.--TCUs urge the subcommittee to fund the Pell Grant
Program at the highest possible level.
Perkins Career and Technical Education Programs
The TCUs urge the Subcommittee to appropriate $8.5 million for
section 117 of the Carl D. Perkins Career and Technical Education
Improvement Act, which supports our 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 section 116 of the act.
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 million of the
Adult Education State Grants appropriated funds to make awards to TCUs
to support their ongoing and essential 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 million and $5 million, respectively.
HHS PROGRAM
TCUs Head Start Partnership Program (DHHS-ACF)
TCUs 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 million be designated for the TCU-
Head Start Partnership program, to ensure the continuation of current
programs and the resources needed to support additional TCU-Head Start
Partnership programs.
BACKGROUND ON TCUS
TCUs are 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
essential high school completion (GED), basic remediation, job
training, college preparatory courses, and adult education programs.
TCUs 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 and elder care centers. Each TCU is
committed to improving the lives of its students through higher
education and to moving American Indians toward self-sufficiency.
TCUs provide access to higher education for American Indians and
others living in some of the Nation's most rural and economically
depressed areas. According to 2000 Decennial Census data, the annual
per capita income of the U.S. population was $21,587. In contrast, the
annual per capita income of Native Americans was $12,893 or about 40
percent less. In addition to serving their student populations, TCUs
offer a variety of much needed 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 effectively
blend 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 just 40 years ago, 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.
justifications for fiscal year 2010 appropriations requests for tcus
HEA
The Higher Education Act Amendments Act of 1998 created a separate
section (Sec. 316) within title III-A specifically for the Nation's
TCUs. Programs under titles III and V of the act support institutions
that enroll large proportions of financially disadvantaged students and
that have low per-student expenditures. Tribal colleges, which are
truly developing institutions, are providing access to quality higher
education opportunities to some of the most rural, impoverished, and
historically underserved areas of the country. A clear goal of HEA
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 to succeed in a
global, competitive workforce. The TCUs urge the subcommittee to
appropriate $32 million in fiscal year 2010 for title III-A section
316, an increase of $8.8 million more than fiscal year 2009. These
funds will afford these developing institutions the resources necessary
to continue their ongoing grant programs and address the needs of their
historically underserved students and communities.
The importance of Pell Grants to TCU 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
financial aid than students at State-funded and other mainstream
institutions. Within the TCU 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
program at the highest possible level.
CARL D. PERKINS CAREER AND TECHNICAL EDUCATION ACT
Tribally-controlled Postsecondary Vocational Institutions.--Section
117 of the Perkins Act provides 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 appropriate $8.5 million for section 117
of the act.
Native American Career and Technical Education Program.--The Native
American Career and Technical Education Program (NACTEP) under section
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 continuation of much
needed career and technical education programs being offered at TCUs.
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 in need of remedial education before embarking on their degree
programs is considerable at TCUs. There is a broad need for basic adult
educational programs and TCUs need adequate funding to support these
essential activities. TCUs respectfully request that the subcommittee
direct $5 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 that exists
on their respective reservations.
American Indian Teacher/Administrator Corps (Special Programs for
Indian Children).--American Indians are severely underrepresented 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 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 million and $5 million,
respectively, to increase the number of qualified American Indian
teachers and school administrators in Indian Country.
HHS/ACF/HEAD START
TCUs 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 awarded. 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 February 26, 2009 budget summary includes an additional $1
billion to improve and expand Head Start. The TCUs request that the
subcommittee direct the Head Start Bureau to designate $5 million, of
the more than $7.2 billion included in the President's budget, to fund
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.
CONCLUSION
TCUs are providing 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. TCUs 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 TCUs and full consideration
of our fiscal year 2010 appropriations needs and recommendations.
______
Prepared Statement of the Association of Independent Research
Institutes
The Association of Independent Research Institutes (AIRI)
respectfully submits this written testimony for the record to the
Senate Appropriations Subcommittee on Labor, Health and Human Services,
Education, and Related Agencies. AIRI appreciates the commitment that
the members of this subcommittee have made to biomedical research
through your strong support for the National Institutes of Health
(NIH), and recommends that you maintain this support for NIH in fiscal
year 2010 by providing the agency with at least a 7 percent increase
more than fiscal year 2009.
AIRI is a national organization of 90 independent, nonprofit
research institutes that perform basic and clinical research in the
biological and behavioral sciences. AIRI institutes vary in size, with
budgets ranging from a few million to hundreds of millions of dollars.
In addition, each AIRI member institution is governed by its own
independent board of directors, which allows our members to focus on
discovery based research while remaining structurally nimble and
capable of adjusting their research programs to emerging areas of
inquiry. Researchers at independent research institutes consistently
exceed the success rates of the overall NIH grantee pool, and receive
about 10 percent of NIH's peer-reviewed, competitively awarded
extramural grants. On average, AIRI member institutes receive a total
of $1.6 billion in extramural grants from NIH in any given year.
Through passage of the American Recovery and Reinvestment Act
(ARRA) and the Omnibus Appropriations Act for fiscal year 2009, the
administration and Congress have taken critical steps to jump start the
Nation's economy. Simultaneously, Congress is advancing and
accelerating the biomedical research agenda in this country by focusing
on scientific opportunities to address public health challenges. NIH
now has the ability to fund a record number of research grants, with
special emphasis on groundbreaking projects in areas that show the
greatest potential for improving health, including genetic medicine,
clinical research, and health disparities. In addition, NIH is also
funding construction projects and providing support for equipment and
instrumentation.
NIH is responding to its charge of stimulating the economy through
job creation by supporting new scientists, construction workers, and
suppliers. NIH is also supporting the next generation of biomedical
research through cross-cutting, interdisciplinary initiatives such as
those supported in the NIH Roadmap, the NIH Neuroscience Blueprint, the
Clinical and Translational Science Award program, and the Genes,
Environment and Health Initiative. Independent research institutes are
involved extensively in these initiatives and will be beneficiaries of
ARRA funds, making them an important and vital component of the overall
U.S. medical research enterprise. Therefore, independent research
institutes are positioned to help Congress achieve its goal of
improving the quality of life for all Americans.
However, the discovery process--while it produces tremendous
value--often takes a lengthy and unpredictable path. The infrastructure
that we are creating needs to be maintained. Large fluctuations in
funding will be disruptive to training, to careers, long-range projects
and ultimately to progress. The research engine needs a predictable,
sustained investment in science to maximize our return.
We must ensure that after the stimulus money is spent we do not
have to dismantle our newly built capacity and terminate valuable, on-
going research. In 2011 and beyond we need to be able to continue to
advance the new directions charted with the ARRA support.
Keeping up with the rising cost of medical research in the 2010
appropriations will help NIH begin to prepare for the ``post-stimulus''
era. In 2011 and beyond we need to make sure that the total funding
available to NIH does not decline and that we can resume a steady,
sustainable growth that will enable us to complete the President's
vision of doubling our investment in basic research, which is why we
are respectfully urging this subcommittee to increase funding for NIH
in fiscal year 2010 by at least 7 percent.
AIRI'S COMMITMENT
Pursuing New Knowledge
The United States model for conducting biomedical research, which
involves supporting scientists at universities, medical centers, and
independent research institutes, provides an effective approach to
making fundamental discoveries in the laboratory and translating them
into medical advances that save lives. AIRI member institutes are
private, stand-alone research centers that set their sights on the vast
frontiers of medical science, specifically focused on pursuing
knowledge about the biology and behavior of living systems and to apply
that knowledge to extend healthy life and reduce the burdens of illness
and disability.
Providing Efficiency and Flexibility
AIRI member institutes' smaller size and greater flexibility
provide an environment that is particularly conducive to creativity and
innovation. In addition, independent research institutes possess a
unique versatility/culture that encourages them to share expertise,
information, and equipment across their institutes and elsewhere, which
helps to minimize bureaucracy and increase efficiency when compared to
larger degree-granting academic universities.
Supporting Young Researchers
While the primary function of AIRI institutes is research, most are
strongly involved in training the next generation of biomedical
researchers and ensuring that a pipeline of promising researchers are
prepared to make significant and potentially transformative discoveries
in a variety of areas.
AIRI would like to thank the subcommittee for its important work to
ensure the health of the Nation, and we appreciate this opportunity to
present funding recommendations concerning NIH in the fiscal year 2010
appropriations bill. AIRI looks forward to working with Congress to
carry out the research that will lead to improving the health and
quality of life for all Americans.
______
Prepared Statement of the Association of Maternal and Child Health
Programs
Chairman Harkin and distinguished subcommittee members: I am
grateful for this opportunity to submit written testimony on behalf of
the Association of Maternal & Child Health Programs (AMCHP), our
members, and the millions of women and children that are served by the
title V Maternal and Child Health Services Block Grant. My name is Dr.
Phyllis Sloyer and I am the current president of AMCHP, as well a
Division Director at the Florida Department of Health. I am asking the
subcommittee to support full funding for the title V Maternal and Child
Health Services Block Grant at its authorized level of $850 million for
Federal fiscal year 2010.
To help illustrate the importance of title V MCH funding, I want to
begin by sharing the story of a girl from Iowa who was helped by title
V services.
Cora is a girl who was born 34 weeks prematurely. She was first
seen at a Child Health Specialty Clinic when she was only 3 weeks of
age. While at the clinic, she was diagnosed with, plagiocephaly also
sometimes referred to a ``flat head syndrome''. This problem occurs
when a portion of an infant's skull becomes flattened due to pressure
from outside forces and is not uncommon in premature infants. Workers
at the clinic provided the new family with vital information on the
disorder and what to expect. Cora was able to be seen by a pediatrician
via telemedicine and was able to obtain a referral to see specialists
in the treatment of plagiocephal. Cora is now 20 months old and likes
to go to the local park and ride the merry-go-round. This same clinic
that helped Cora and her family is supported by the Title V MCH Block
Grant and would not be able to remain open without the funds and
support that title V funds offer. It is a great thing that families can
come to a clinic close to their home, or be seen using health
technology and be provided a complete physical, neurological,
developmental evaluation for their kids.
This is just one example of the literally thousand of children--
children with special healthcare needs and pregnant women that are
served by title V programs in Chairman Harkin's State alone. The MCH
Block Grant supports a similar network in my home State of Florida, and
none of this could happen without the Title V MCH Block Grant funding.
Title V of the Social Security Act was created during the Great
Depression to ``improve the health of all women and children.'' The MCH
Block Grant is a celebrated example of an effective Federal and State
partnership with a common goal of improving the health of all mothers
and children, including those children with special healthcare needs.
It is also at the forefront of promoting family-centered care in all of
its work. But we are losing ground fast and we believe it is time to go
back to the roots of title V and recommit ourselves to truly improving
the health of our Nation's women and children by fully investing in the
MCH Block Grant.
Despite major advances in medicine, technology, and our healthcare
system, America still faces huge challenges to improving maternal and
child health outcomes and addressing the needs of very vulnerable
children.
Reductions in maternal and infant mortality have stalled in recent
years and rates of preterm and low-birth-weight births have increased
over the last decade. As we sit here today, the United States ranks
29th in infant mortality rates when compared to other nations. Every 18
minutes a baby in America dies before his or her first birthday. Each
day in America we lose 12 babies due to a sudden unexpected infant
death. There are places in this country where the African American
infant mortality rate is double, and in some places even triple, the
rate for whites. Preventable injuries remain the leading cause of death
for all children, we are failing to adequately screen all young
children for developmental concerns and childhood obesity has reached
epidemic proportions, threatening to reverse a century of progress in
extending life expectancy.
Sadly, there are gaps between what a family needs and actually
receives for a child with a special need. Out of pocket healthcare
costs are increasing and we are erasing gains we made in supporting
effective services for children with special needs and their families.
Currently, only 50 percent of these children receive comprehensive care
within the context of a medical home and less than 20 percent of youth
with special needs are able to find an adult healthcare provider who
can appropriately care for them.
State programs, funded through MCH Block Grant dollars, are key to
reversing this picture. Considering these and many other urgent health
needs, AMCHP asks for your leadership in fully funding the MCH Block
Grant at $850 million for fiscal year 2010.
AMCHP urges Congress to recognize the need to revitalize resources
for States and their partners to reverse the trends and continue this
critical work. We have a track record of demonstrating that we make a
positive difference and are fully accountable for the funds that we
receive. Fully funding the MCH Block Grant is an effective and
efficient way to invest in our Nation's women, children, and families.
The Office of Management and Budget found that MCH Block Grant-
funded programs deliver results and decrease the infant mortality rate,
prevent disabling conditions, increase the number of children
immunized, increase access to care for uninsured children, and improve
the overall health of mothers and children. Close coordination with
other health programs assures that funding is maximized and services
are not duplicated.
Our results are available to the public through a national Web site
known as the Title V Information System. Such a system is remarkably
rare for a Federal program and we are proud of the progress we have
made.
However, despite the increasing demand for maternal and child
health services, reductions to the MCH Block Grant threaten the ability
of programs to carry out their vital work. As States continue to face
increasing economic hardship, more women and children will seek
services through MCH Block Grant funded programs. Due to years of
reduced investment, the MCH Block Grant is at its lowest funding level
since 1993, $662 million, meaning States again are being asked to serve
additional people with less.
Now, as economic troubles increase demand for health services,
State MCH programs desperately need additional resources to:
--increase outreach and screening services to identify and link women
and children to available healthcare services;
--assure coordination of those services and assist new parents
through efforts such as expanded home visitation programs; and
--deliver essential prevention and health promotion services to make
sure that every mom has a healthy pregnancy; every child has
the opportunity for a healthy birth and strong start in life;
and every child with special healthcare needs receives ongoing
comprehensive care within a medical home.
Crucial MCH activities are also supported by title V under the
Special Projects of Regional and National Significance (SPRANS)
program, including MCH research, training, hemophilia diagnostic and
treatment centers, and MCH improvement projects that develop and
support a broad range of strategies. The SPRANS investment drives
innovation for MCH programs and is an important part of the Title V MCH
Block Grant.
Mr. Chairman and distinguished members, in closing I ask you to
imagine with me an America in which every child in the United States
has the opportunity to live until his or her first birthday; a Nation
where our Federal and State partnership has effectively moved the
needle on our most pressing maternal and child health issues. Imagine a
day when we are celebrating significant reductions or even the total
elimination of health disparities by creatively solving our most urgent
maternal and child health challenges. The MCH Block Grant aims to do
just that--using resources effectively to improve the health of all of
America's women and children.
I want to close with one more story from a parent in my State that
I think illustrates the personal impact of Title V MCH Block Grant
funds.
My daughter Ashley continues to be at risk for a detached retina
with myopia of the eye. Title V Children and Youth with Special Health
Care Needs has been instrumental in providing medically necessary
funding for the type of eyeglasses that she needs in order to be able
to see and have some quality of life as an adolescent. There are
medications that she needs to be able to control her executive
functions, her impulses and her motor coordination in order to be able
to function in school that I would not be able to afford as a parent.
As a parent it would be devastating if she could not go to school which
increases her chances of being able to transition into work and/or
higher education.
______
Prepared Statement of the American Nurses Association
The American Nurses Association (ANA) appreciates this opportunity
to comment on fiscal year 2010 appropriations for nursing education,
workforce development, and research programs. Founded in 1896, ANA is
the only full-service national association representing registered
nurses (RNs). Through our 51 constituent member associations, ANA
represents RNs across the Nation in all practice settings.
The ANA gratefully acknowledges this subcommittee's history of
support for nursing education and research. We appreciate your
continued recognition of the important role nurses play in the delivery
of quality healthcare services. This testimony will give you an update
on the status of the nursing shortage, its impact on the Nation, and
the outlook for the future.
THE NURSING SHORTAGE TODAY
The nursing shortage is far from solved. Here are a few quick
facts:
--The American Hospital Association reported that hospitals needed
116,000 more RNs to fill immediate vacancies in July 2007.
Hospitals report that this vacancy rate is hampering the
ability to provide emergency care.
--The Bureau of Labor Statistics reports that registered nursing will
have remarkable job growth in the time period spanning 2006-
2016. During this time, the healthcare system will require more
than 1 million new nurses.
--The Health Resources and Services Administration (HRSA) projects
that the supply of nurses in America will fall 26 percent (more
than 1 million nurses) below requirements by the year 2020. In
year 2020, Wisconsin's demand for full-time RNs will outstrip
the supply by 20 percent (a shortage of 10,200 RNs). New York's
shortage will reach 39 percent (54,200 RNs) and Ohio will have
a 30 percent shortage (34,000 RNs). California's demand will
outstrip its supply by 45 percent (116,600 RNs).
This growing nursing shortage is having a detrimental impact on the
entire healthcare system. Numerous studies have shown that nursing
shortages contribute to medical errors, poor patient outcomes, and
increased mortality rates. A study published in the January/February
2006 issue of Health Affairs showed that hospitals could avoid 6,700
deaths per year by increasing the amount of RN care provided to their
patients. This study, ``Nurse Staffing in Hospitals: Is There a
Business Case for Quality?'' by Jack Needleman, Peter Buerhaus, et al.
also revealed that hospitals are currently providing 4 million days
worth of inpatient care annually to treat avoidable patient
complications associated with a shortage of RN care.
Research published in the October 23, 2002, Journal of the American
Medical Association also demonstrated that more nurses at the bedside
could save thousands of patient lives each year. In reviewing more than
232,000 surgical patients at 168 hospitals, researchers from the
University of Pennsylvania concluded that a patient's overall risk of
death rose roughly 7 percent for each additional patient above four
added to a nurse's workload.
A Joint Commission on the Accreditation of Healthcare Organizations
study published in 2002 shows that the shortage of nurses contributes
to nearly a quarter of all unexpected incidents that kill or injure
hospitalized patients.
NURSING WORKFORCE DEVELOPMENT PROGRAMS
Federal support for the Nursing Workforce Development Programs
contained in title VIII of the Public Health Service Act is
unduplicated and essential. The 107th Congress recognized the
detrimental impact of the developing nursing shortage and passed the
Nurse Reinvestment Act (Public Law 107-205). This law improved the
title VIII Nursing Workforce Development programs to meet the unique
characteristics of today's shortage. This achievement holds the promise
of recruiting new nurses into the profession, promoting career
advancement within nursing, and improving patient care delivery.
However, this promise cannot be met without a significant investment.
Prior to the release of President Obama's proposed budget for fiscal
year 2010, ANA was strongly advocating Congress to increase funding for
title VIII programs by at least $44 million to a total of $215 million.
Now that President Obama is requesting $263 million for title VIII
programs, we are urging the subcommittee to support this request and
fund title VIII programs at $263 million.
Current funding levels are clearly failing to meet the need. In
fiscal year 2008, the HRSA was forced to turn away 92.8 percent of the
eligible applicants for the Nurse Education Loan Repayment Program
(NELRP), and 53 percent of the eligible applicants for the Nursing
Scholarship Program (NSP) due to a lack of adequate funding. These
programs are used to direct RNs into areas with the greatest need--
including departments of public health, community health centers, and
disproportionate share hospitals.
In 1973, Congress appropriated $160.61 million to title VIII
programs. Inflated to today's dollars, this appropriation would equal
$763.52 million, more than four times the fiscal year 2009
appropriation. Certainly, today's shortage is more dire and systemic
than that of the 1970's; it deserves an equivalent response.
Title VIII includes the following program areas:
Nursing Education Loan Repayment Program and Scholarships
(NELRP).--This line item is comprised of the NELRP and the NSP. In
fiscal year 2009, the NELRP and the NSP received $37 million.
The NELRP repays up to 85 percent of a RN's student loans in return
for full-time practice in a facility with a critical nursing shortage.
The NELRP nurse is required to work for at least 2 years in a
designated facility, during which time the NELRP repays 60 percent of
the RN's student loan balance. If the nurse applies and is accepted for
an optional third year, an additional 25 percent of the loan is repaid.
The NELRP boasts a proven track record of delivering nurses to
facilities hardest hit by the nursing shortage. HRSA has given NELRP
funding preference to RNs who work in departments of public health,
disproportionate share hospitals, skilled nursing facilities, and
federally designated health centers. However, lack of funding has
hindered the full implementation of this program. In fiscal year 2008,
92.8 percent of applicants willing to immediately begin practicing in
facilities hardest hit by the shortage were turned away from this
program due to lack of funding.
The NSP offers funds to nursing students who, upon graduation,
agree to work for at least 2 years in a healthcare facility with a
critical shortage of nurses. Preference is given to students with the
greatest financial need. Like the loan repayment program, the NSP has
been stunted by a lack of funding. In fiscal year 2008, HRSA received
3,039 applications for the nursing scholarship. Due to lack of funding,
a mere 177 scholarships were awarded. Therefore, 2,862 nursing students
(94 percent) willing to work in facilities with a critical shortage
were denied access to this program.
Nurse Faculty Loan Program.--This program establishes a loan
repayment fund within schools of nursing to increase the number of
qualified nurse faculty. Nurses may use these funds to pursue a
master's or doctoral degree. They must agree to teach at a school of
nursing in exchange for cancellation of up to 85 percent of their
educational loans, plus interest, over a 4-year period. In fiscal year
2009, this program received $11.5 million.
This program is vital given the critical shortage of nursing
faculty. America's schools of nursing can not increase their capacity
without an influx of new teaching staff. Last year, schools of nursing
were forced to turn away tens of thousands of qualified applicants due
largely to the lack of faculty. In fiscal year 2008, HRSA funded 95
faculty loans.
Nurse Education, Practice, and Retention Grants.--This section is
comprised of many programs designed to support entry-level nursing
education and to enhance nursing practice. All together, the Nurse
Education, Practice, and Retention Grants received $37.3 million in
fiscal year 2009.
The education grants are designed to expand enrollments in
baccalaureate nursing programs; develop internship and residency
programs to enhance mentoring and specialty training, and; provide new
technologies in education including distance learning.
Retention grant areas include career ladders and improved patient
care delivery systems. The career ladders program supports education
programs that assist individuals in obtaining the educational
foundation required to enter the profession, and to promote career
advancement within nursing. Enhancing patient care delivery system
grants are designed to improve the nursing work environment. These
grants help facilities to enhance collaboration and communication among
nurses and other healthcare professionals, and to promote nurse
involvement in the organizational and clinical decisionmaking processes
of a healthcare facility. These best practices for nurse administration
have been identified by the American Nurse Credentialing Center's
Magnet Recognition Program. These practices have been shown to double
nurse retention rates, increase nurse satisfaction, and improve patient
care.
Nursing Workforce Diversity.--This program provides funds to
enhance diversity in nursing education and practice. It supports
projects to increase nursing education opportunities for individuals
from disadvantaged backgrounds--including racial and ethnic minorities,
as well as individuals who are economically disadvantaged. In fiscal
year 2008, 85 applications were received for workforce diversity
grants, 51 were funded. In fiscal year 2009, these programs received
$16 million.
Advanced Nurse Education.--Advanced practice registered nurses
(APRNs) are nurses who have attained advanced expertise in the clinical
management of health conditions. Typically, an APRN holds a master's
degree with advanced didactic and clinical preparation beyond that of
the RN. Most have practice experience as RNs prior to entering graduate
school. Practice areas include, but are not limited to: anesthesiology,
family medicine, gerontology, pediatrics, psychiatry, midwifery,
neonatology, and women's and adult health. Title VIII grants have
supported the development of virtually all initial State and regional
outreach models using distance learning methodologies to provide
advanced study opportunities for nurses in rural and remote areas. In
fiscal year 2008, 7,650 advanced education nurses were supported
through these programs. In fiscal year 2009, these programs received
$64.4 million.
These grants also provide traineeships for masters and doctoral
students. Title VIII funds more than 60 percent of U.S. nurse
practitioner education programs and assists 83 percent of nurse
midwifery programs. more than 45 percent of the nurse anesthesia
graduates supported by this program go on to practice in medically
underserved communities. A study published last year in the Journal of
Rural Health showed that 80 percent of the nurse practitioners who
attended a program supported by title VIII chose to work in a medically
underserved or health profession shortage area after graduation.
Comprehensive Geriatric Education Grants.--This authority awards
grants to train and educate nurses in providing healthcare to the
elderly. Funds are used to train individuals who provide direct care
for the elderly, to develop and disseminate geriatric nursing
curriculum, to train faculty members in geriatrics, and to provide
continuing education to nurses who provide geriatric care. In fiscal
year 2009, these grants received 4.5 million.
The growing number of elderly Americans and the impending
healthcare needs of the baby boom generation make this program
critically important. In fiscal year 2006, HRSA continued 8 previously
awarded grants and awarded 11 new ones.
NATIONAL INSTITUTE OF NURSING RESEARCH (NINR)
ANA also urges the subcommittee to increase funding for the NINR,
one of the Institutes at the National Institutes of Health (NIH). The
Institute's research focus transcends disciplines to address issues of
health management, symptom management, and caregiving; health promotion
and disease prevention; end-of-life care; technology integration; and
research capacity development. This research is integral to improving
the effectiveness of nursing care. Advances in nursing care arising
from behavioral and biomedical research have shown excellent progress
in reducing healthcare costs. Research programs supported by NINR
address a number of critical public health and patient care questions.
The cross-discipline research is driven by real and immediate problems
currently facing patients and their families.
Recent NINR funded studies have shown that inadequate nurse
staffing increases risks for patients; coping skills training improves
teens' self-management of diabetes; a healthcare team helps reduce high
blood pressure among inner-city black men; a community-based program
improves self-management of arthritis among older Hispanics; home
nursing visits benefit low-income mothers and their children; and
transitional care improves outcomes for elders after leaving the
hospital. NINR is leading the NIH research on end-of-life and
palliative care. NINR is also the lowest-funded Institute at NIH. In
fiscal year 2009, NINR received $141.88 million. ANA recommends $178
million, or a 25 percent increase more than fiscal year 2009, in fiscal
year 2010 NINR funding.
CONCLUSION
While ANA appreciates the continued support of this subcommittee,
we are concerned that title VIII funding levels have not been
sufficient to address the growing nursing shortage. The nursing
shortage will continue to worsen if significant investments are not
made. Recent efforts have shown that aggressive and innovative
recruitment efforts can help avert the impending nursing shortage--if
they are adequately funded.
ANA asks you to meet today's shortage with a relatively modest
investment of $263 million in title VIII programs. Additionally, an
investment of $178 million in the NINR will help assure that nurses are
equipped with the latest information and research needed to provide the
best patient care possible.
______
Prepared Statement of the American National Red Cross
Chairman Tom Harkin, Ranking Member Thad Cochran, 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. We sincerely hope that Congress
will continue to support the CDC during this critical period in measles
control.
In 2001, CDC--along with the American Red Cross, the United Nations
Foundation, the World Health Organization (WHO), and UNICEF--became one
of the spearheading partners of the Measles Initiative, a partnership
committed to reducing measles deaths globally. The current U.N. goal is
to reduce measles deaths by 90 percent by 2010 compared to 2000
estimates. The Measles Initiative is committed to reaching this goal by
proving technical and financial support to governments and communities
worldwide.
The Measles Initiative has achieved ``spectacular'' \1\ results by
supporting the vaccination of more than 600 million children. Largely
due to the Measles Initiative, global measles mortality dropped 74
percent, from an estimated 750,000 deaths in 2000 to 197,000 in 2007.
During this same period, measles deaths in Africa fell by 89 percent,
from 395,000 to 45,000.
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\1\ The Lancet, Volume 8, page 13 (January 2008).
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 $670 million
and provided technical support in more than 60 developing countries on
vaccination campaigns, surveillance, and improving routine immunization
services. From 2000 to 2007, an estimated 3.6 million measles deaths
were averted as a result of accelerated measles control activities
(increased routine immunization coverage and mass immunization
campaigns) at a donor cost of $184/death averted, making measles
mortality reduction one of the most cost-effective public health
interventions.
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 ``integrating'' the
campaigns with other life-saving health interventions has become the
norm. 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 37 million ITNs were
distributed in vaccination campaigns in the last few years. 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.
Countries are well positioned to achieve the 2010 goal and to take
a bold step toward achievement of the 2015 Millennium Development Goal
#4 of reducing under 5 child mortality. However, achieving the 2010
goal will require:
--Accelerating activities, both campaigns and further efforts to
improve routine measles coverage, in India since it is the
greatest contributor to the global burden of measles.
--Sustaining the gains in reduced measles deaths, especially in
Africa, by strengthening immunization programs to ensure that
more than 90 percent of infants are vaccinated against measles
through routine health services before their first birthday as
well as conducting timely, high-quality follow-up campaigns.
--Securing sufficient funding for measles-control activities both
globally and nationally. The Measles Initiative faces a funding
shortfall of an estimated $100 million for 2010. Implementation
of timely follow-up campaigns is increasingly dependent upon
countries funding these activities locally. The decrease in
donor funds available at global level to support activities to
reduce measles mortality makes increased political commitment
and country ownership of the activities critical for achieving
and sustaining the goal of reducing measles mortality by 90
percent.
If these challenges are not addressed, the remarkable gains made
since 2000 will be lost and a major resurgence in measles deaths will
occur.
By controlling measles cases in other countries, U.S. children are
also being protected from the disease. Measles can cause severe
complications and death. 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. In 2008, the number of reported measles cases in
the United States more than doubled and outbreaks are currently on-
going in Virginia, Maryland, Washington, District of Columbia,
Pennsylvania, California, and Missouri. These outbreaks cause needless
suffering and accrue public health costs which in the United States are
upwards of $150,000 to respond to each case.
THE ROLE OF CDC IN GLOBAL MEASLES MORTALITY REDUCTION
Since fiscal year 2001, Congress has provided approximately $42
million annually in funding to CDC for global measles control
activities. These funds were used toward the purchase of approximately
415 million doses of measles vaccine for use in large-scale measles
vaccination campaigns in more than 60 countries in Africa and 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 the 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 7 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 2009, Congress has appropriated approximately $41.8
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 a total of $51.8 million for fiscal year
2010 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,
especially in India, thus protecting millions of children;
Your commitment has brought us unprecedented victories in reducing
measles mortality around the world. In addition, your continued support
for this initiative helps prevent children from suffering from this
preventable disease both abroad and in the United States.
Thank you for the opportunity to submit testimony.
______
Prepared Statement of the Americans for Nursing Shortage Alliance
The undersigned organizations of the ANSR Alliance greatly
appreciate the opportunity to submit written testimony on fiscal year
2010 appropriations for Title VIII--Nursing Workforce Development
Programs. The Alliance represents a diverse cross-section of health
care and other related organizations, healthcare providers, and
supporters of nursing issues that have united to address the national
nursing shortage. We stand ready to work with the 111th Congress to
advance programs and policies that will ensure that our Nation has a
sufficient and adequately prepared nursing workforce to provide quality
care to all well into the 21st century. The Alliance, therefore, urges
Congress to:
--Appropriate $263.4 million in funding in fiscal year 2010 for the
Nursing Workforce Development Programs under title VIII of the
Public Health Service Act at the Health Resources and Services
Administration (HRSA).
--Fund the Advanced Education Nursing program (section 811) at an
increased level on par with the other title VIII programs.
THE EXTENT OF THE NURSING SHORTAGE
Nursing is the largest healthcare profession in the United States.
According to the National Council of State Boards of Nursing, there
were nearly 3.4 million licensed registered nurses (RNs) in 2006.\1\
Nurses and advanced practice nurses (nurse practitioners, nurse
midwives, clinical nurse specialists, and certified registered nurse
anesthetists) work in a variety of settings, including primary care,
public health, long-term care, surgical care facilities, and hospitals.
Approximately 59 percent of RN jobs are in hospitals.\2\ A Federal
report published in 2004 estimates that by 2020 the national nurse
shortage will increase to more than 1 million full-time nurse
positions. According to these projections, which are based on the
current rate of nurses entering the profession, only 64 percent of
projected demand will be met.\3\ A study, published in March 2008, uses
different assumptions to calculate an adjusted projected demand of
500,000 full-time equivalent registered nurses by 2025.\4\ According to
the U.S. Bureau of Labor Statistics, about 233,000 additional jobs for
registered nurses will open each year through 2016, in addition to
about 2.5 million existing positions. Based on these scenarios, the
shortage presents an extremely serious challenge in the delivery of
high-quality, cost-effective services, as the Nation looks to reform
the current healthcare system. Even considering only the smaller
projection of vacancies, this shortage still results in a critical gap
in nursing service, essentially three times the 2001 nursing shortage.
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\1\ National Council of State Boards of Nursing. (2008). 2006 Nurse
Licensee Volume and NCLEX Examination Statistics. (Research Brief Vol.
31). On the Internet at: https://www.ncsbn.org/
08_2006_LicExamRB_Vol31_21208_MW(1).pdf. (Accessed February 3, 2009).
\2\ Bureau of Labor Statistics, U.S. Department of Labor.
Occupational Outlook Handbook, 2008-2009 Edition, Registered Nurses. On
the Internet at: http://www.bls.gov/oco/ocos083.htm (Accessed December
9, 2008).
\3\ Health Resources and Services Administration, (2004) What is
Behind HRSA's Projected Supply, Demand, and Shortage of Registered
Nurses? On the Internet at: http://bhpr.hrsa.gov/healthworkforce/
reports/behindrnprojections/4.htm. (Accessed December 9, 2008).
\4\ Buerhaus, P., Staiger, D., Auerbach, D. (2008). The Future of
the Nursing Workforce in the United States: Data, Trends, and
Implications. Boston, MA: Jones & Bartlett.
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BUILDING THE CAPACITY OF NURSING EDUCATION PROGRAMS
Nursing vacancies exist throughout the entire healthcare system,
including long-term care, home care, and public health. Even the
Department of Veterans Affairs, the largest sole employer of RNs in the
United States, has a nursing vacancy rate of 10 percent. In 2006, the
American Hospital Association reported that hospitals needed 116,000
more RNs to fill immediate vacancies, and that this 8.1 percent vacancy
rate affects hospitals' ability to provide patient/client care.\5\
Government estimates indicate that this situation only promises to
worsen due to an insufficient supply of individuals matriculating in
nursing schools, an aging existing workforce, and the inadequate
availability of nursing faculty to educate and train the next
generation of nurses. At the exact same time that the nursing shortage
is expected to worsen, the baby boom generation is aging and the number
of individuals with serious, life-threatening, and chronic conditions
requiring nursing care will increase. Consequently, more must be done
today by the Government to help ensure an adequate nursing workforce
for the patients/clients of today and tomorrow.
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\5\ American Hospital Association, (2007) The State of America's
Hospitals: Taking the Pulse, Findings from the 2007 AHA Survey of
Hospital Leader. On the Internet at: http://www.aha.org/aha/content/
2007/PowerPoint/StateofHospitalsChartPack2007.ppt. (Accessed December
3, 2008).
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A particular focus on securing and retaining adequate numbers of
faculty is essential to ensure that all individuals interested in--and
qualified for--nursing school can matriculate in the year they are
accepted. In the 2006-2007 academic years, 99,000 qualified
applications--or almost 40 percent of qualified applications submitted
to prelicensure RN programs--were denied due to lack of capacity.\6\
Aside from having a limited number of faculty, nursing programs
struggle to provide space for clinical laboratories and to secure a
sufficient number of clinical training sites at healthcare facilities.
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\6\ National League for Nursing, (2009) Nursing Data Review 2006-
2007: Baccalaureate, Associate Degree, and Diploma Programs. On the
Internet at: http://www.nln.org/research/slides/index.htm. (Accessed
March 20, 2009).
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ANSR supports the need for sustained attention on the efficacy and
performance of existing and proposed programs to improve nursing
practices and strengthen the nursing workforce. The support of research
and evaluation studies that test models of nursing practice and
workforce development is integral to advancing healthcare for all in
America. Investments in research and evaluation studies have a direct
effect on the caliber of nursing care. Our collective goal of improving
the quality of patient/client care, reducing costs, and efficiently
delivering appropriate healthcare to those in need is served best by
aggressive nursing research and performance and impact evaluation at
the program level.
THE IMPACT ON THE NATION'S PUBLIC HEALTH INFRASTRUCTURE
The National Center for Health Workforce Analysis reports that the
nursing shortage challenges the healthcare sector to meet current
service needs. Nurses make a difference in the lives of patients/
clients from disease prevention and management to education to
responding to emergencies. Chronic diseases, such as heart disease,
stroke, cancer, and diabetes, are the most preventable of all health
problems as well as the most costly. Nearly half of Americans suffer
from one or more chronic conditions and chronic disease accounts for 70
percent of all deaths. In addition, increased rates of obesity and
chronic disease are the primary cause of disability and diminished
quality of life.
Even though America spends more than $2 trillion annually on
healthcare--more than any other Nation in the world--tens of millions
of Americans suffer every day from preventable diseases such as type 2
diabetes, heart disease, and some forms of cancer that rob them of
their health and quality of life.\7\ In addition, major vulnerabilities
remain in our emergency preparedness to respond to natural,
technological and manmade hazards. An October 2008 report issued by
Trust for America's Health entitled ``Blueprint for a Healthier
America'' found that the health and safety of Americans depends on the
next generation of professionals in public health.\8\ Further, existing
efforts to recruit and retain the public health workforce are
insufficient. New policies and incentives must be created to make
public service careers in public health an attractive professional
path, especially for the emerging workforce and those changing careers.
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\7\ KaiserEDU.org. ``U.S. Health Care Costs: Background Brief.''
Kaiser Family Foundation. On the Internet at: http://www.kaiseredu.org/
topics_im.asp?imID=1&parentID=61&id=358 (Accessed November 24, 2008).
\8\ Trust for America's Health. (2008) Blueprint for a Healthier
America: Modernizing the Federal Public Health System to Focus on
Prevention and Preparedness. On the Internet at: http://
healthyamericans.org/report/55/blueprint-for-healthier-america
(Accessed December 3, 2008).
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An Institute of Medicine report notes that nursing shortages in
U.S. hospitals continue to disrupt hospitals operations and are
detrimental to patient/client care and safety.\9\ Hospitals and other
healthcare facilities across the country are vulnerable to mass
casualty incidents themselves and/or in emergency and disaster
preparedness situations. As in the public health sector, a mass
casualty incident occurs as a result of an event where sudden and high-
patient/client volume exceeds the facilities/sites resources. Such
events may include the more commonly realized multi-car pile-ups, train
crashes, hazardous material exposure in a building or within a
community, high-occupancy catastrophic fires, or the extraordinary
events such as pandemics, weather-related disasters, and intentional
catastrophic acts of violence.
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\9\ Institute of Medicine, Committee on the Future of Emergency
Care in the United States Health System. (2007) Hospital-Based
Emergency Care: At the Breaking Point. On the Internet at: http://
www.iom.edu/?id=48896. (Accessed December 3, 2008).
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Since 80 percent of disaster victims present at the emergency
department, nurses as first receivers are an important aspect of the
public health system as well as the healthcare system in general. The
nursing shortage has a significant adverse impact on the ability of
communities to respond to health emergencies, including natural,
technological and manmade hazards.
SUMMARY
The link between healthcare and our Nation's economic security and
global competitiveness is undeniable. Having a sufficient nursing
workforce to meet the demands of a highly diverse and aging population
is an essential component to reforming the healthcare system as well as
improving the health status of the Nation and reducing healthcare
costs. To mitigate the immediate effect of the nursing shortage and to
address all of these policy areas, ANSR requests $263.4 million in
funding for the Nursing Workforce Development Programs under title VIII
of the Public Health Service Act at HRSA in fiscal year 2010. As part
of this funding, the Advanced Education Nursing training program
(section 811) should be funded at an increased level on par with the
other title VIII programs.
UNDESIGNED ORAGNIZATIONS
Academy of Medical-Surgical Nurses; American Academy of Ambulatory
Care Nursing; American Academy of Nurse Practitioners; American Academy
of Nursing; American Association of Critical-Care Nurses; American
Association of Nurse Anesthetists; American Association of Nurse
Assessment Coordinators; American Association of Nurse Executives;
American Association of Occupational Health Nurses; American College of
Nurse Practitioners.
American Organization of Nurse Executives; American Psychiatric
Nurses Association; American Society for Pain Management Nursing;
American Society of PeriAnesthesia Nurses; American Society of Plastic
Surgical Nurses; Association for Radiologic & Imaging Nursing;
Association of Pediatric Hematology/Oncology Nurses; Association of
periOperative Registered Nurses; Association of Rehabilitation Nurses;
Association of State and Territorial Directors of Nursing.
Association of Women's Health, Obstetric & Neonatal Nurses;
Developmental Disabilities Nurses Association; Emergency Nurses
Association; Gerontological Advanced Practice Nurses Association;
Infusion Nurses Society; International Society of Nurses in Genetics,
Inc.; Legislative Coalition of Virginia Nurses; National Association of
Clinical Nurse Specialists; National Association of Neonatal Nurses;
National Association of Neonatal Nurse Practitioners.
National Association of Nurse Massage Therapists; National
Association of Nurse Practitioners in Women's Health; National
Association of Orthopaedic Nurses; National Association of Pediatric
Nurse Practitioners; National Association of Registered Nurse First
Assistants; National Black Nurses Association; National Council of
State Boards of Nursing; 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.; Nurses Organization of Veterans Affairs; Oncology Nursing
Society; Pediatric Endocrinology Nursing Society; RN First Assistants
Policy & Advocacy Coalition; Society of Gastroenterology Nurses and
Associates, Inc.; Society of Pediatric Nurses; Society of Trauma
Nurses; Wound, Ostomy and Continence Nurses Society.
______
Prepared Statement of the Americans for Nursing Shortage Relief
Alliance
The Tri-Council for Nursing, a long-standing alliance focused on
leadership and excellence in the nursing profession, is composed of the
American Association of Colleges of Nursing, the American Nurses
Association, the American Organization of Nurse Executives, and the
National League for Nursing. The collaborative leadership of these four
professional organizations impacts the breadth of nursing practice,
including nurse executives, educators, researchers, and nurses
providing direct patient care. The Tri-Council asks the subcommittee to
provide $215 million in fiscal year 2010 for the Nursing Workforce
Development Programs under title VIII of the Public Health Service Act,
administered by the Health Resources and Services Administration
(HRSA).
In light of the economic challenges facing our country today, the
Tri-Council urges the subcommittee to focus on the larger context of
building the capacity needed to meet the increasing health care demands
of our Nation's population. Such public policy will require sustained
investments aimed at refocusing the current health care system toward
promoting health, while simultaneously improving value for our dollars.
The title VIII Nursing Workforce Development Programs are proven policy
instruments that help assure an adequately prepared nursing workforce.
These programs--
--Increase access to healthcare in underserved areas through improved
composition, diversity, and retention of the nursing workforce;
--Advance quality care by strengthening nursing education and
practice; and
--Develop the identification and use of data, program performance
measures, and outcomes to make informed decisions on nursing
workforce matters.
The Tri-Council applauds the subcommittee for the emergency
supplement provided across all the health professions programs via the
American Recovery and Reinvestment Act (Public Law 111-5). We also
value the enacted fiscal year 2009 omnibus appropriations bill (Public
Law 111-8) providing $171.031 million specifically for the title VIII
Nursing Workforce Development Programs. These investments are a
critical component supporting our healthcare infrastructure.
Examining the broad context, the healthcare industry remains the
largest industrial complex in the United States. Studies of the
Nation's gross domestic product (GDP) show healthcare spending
achieving a relatively high rate of real growth, with the portion of
GDP devoted to healthcare growing from 8.8 percent in 1980 to 16.2
percent of GDP in 2007. While healthcare spending demands greater
efficiencies, it also has helped to sustain our Nation's sagging
economy.
Since 2001, healthcare is virtually the only sector that added jobs
to the economy on a net basis. In March 2009, the U.S. Bureau of Labor
Statistics (BLS) reported continued growth in the healthcare sector,
despite our economy's freefall in a down cycle with unemployment
reaching 8.1 percent in February 2009. With that month's job loss of
681,000 realized in nearly all major industries, BLS also reported the
addition of 27,000 new jobs at hospitals, long-term care facilities,
and other ambulatory care settings.
As the predominant occupation in the healthcare industry, the nurse
workforce likely is filling most of the noted job openings. Nurses are
the front line of healthcare delivery throughout the Nation, and the
BLS numbers support that description showing the nurse workforce at
well over four times the size of the medical workforce. Increased
fiscal year 2010 investments in title VIII will help counterbalance the
economic meltdown threatening nursing programs operating in
congressional districts and serving communities by supporting nursing
education--providing title VIII loans, scholarships, traineeships, and
programmatic funding.
NURSING SHORTAGE OUTPACES CAPACITY-BUILDING
The Tri-Council contends that an episodic increased funding of
title VIII will not fully fill the gap generated by an 11-year nursing
shortage felt throughout the entire U.S. health system and projected to
continue. The BLS projections estimate that RNs will have the greatest
growth rate of all U.S. occupations in the period spanning 2006-2016,
with more than 1 million new and replacement nurses needed by 2016.
Despite this projected expansion in the profession, numerous other
studies anticipate a growing national nurse workforce shortage to
intensify as the baby boomer cohort ages, the current nurse workforce
retires, and the demand for healthcare accrues.
Funding levels for the HRSA Title VIII Nursing Workforce Programs
are failing to support the numerous qualified applicants seeking
assistance from these programs. In the last 3 years, virtually flat
title VIII funding, along with inflation and increased educational and
administrative costs, has decreased purchasing power. According to HRSA
statistics, in fiscal year 2006 the title VIII programs directly or
indirectly supported 91,189 nurses and nursing students. In fiscal year
2007, the number of grantees dropped by 21 percent and in 2008 the
grantees dropped by 28 percent to support only 51,657 nurses and
nursing students.
Additionally, schools of nursing continue to suffer from a growing
shortage of faculty, a troubling infrastructure trend that exacerbates
the nurse workforce demand-supply gap. According to a study conducted
by the American Association of Colleges of Nursing (AACN) in 2008,
schools of nursing turned away 49,948 qualified applicants to
baccalaureate and graduate nursing programs. The top reasons cited for
not accepting these potential students was a lack of qualified nurse
faculty and resource constraints. Without faculty, nursing education
programs are prevented from admitting many qualified students who are
applying to their programs. (Data are Internet accessible at http://
www.aacn.nche.edu/Media/NewsReleases/ 2009/workforcedata.html.)
The AACN survey results are reinforced by the National League for
Nursing's (NLN) study of all types of prelicensure RN programs, which
prepare students to sit for the RN licensing exam (i.e., baccalaureate,
associate, and diploma degree). The NLN statistics indicate more than
1,900 unfilled full-time faculty positions existed nationwide in 2007,
affecting more than one-third (36 percent) of all schools of nursing.
Significant recruitment challenges were found with 84 percent of
nursing schools attempting to hire new faculty in 2007-2008, more than
three-quarters (79 percent) reporting recruitment as ``difficult'' and
almost 1 in 3 schools found it ``very difficult.'' The two main
difficulties cited were ``not enough qualified candidates'' (cited by
46 percent of schools), followed by inability to offer competitive
salaries--cited by 38 percent. (Data are Internet accessible at
www.nln.org/research/slides/index.htm.)
THE FUNDING REALITY
If the United States is to reverse the eroding trends in the nurse
and nurse faculty workforce, the Nation must make a significant
investment in the title VIII programs, which are charged to favor
institutions educating nurses for practice in rural and medically
underserved communities. At adequate funding levels the title VIII
programs supporting the education of registered nurses, advanced
practice registered nurses, nurse faculty, and nurse researchers have
demonstrated successful intervention strategies to solving past nursing
shortages.
A brief examination of the HRSA title VIII illustrates the robust
nature of these programs:
Section 811.--The Advanced Education Nursing (AEN) Program funds
traineeships for individuals preparing to be nurse practitioners, nurse
midwives, nurse administrators, public health nurses, and nurse
educators, among other graduate-level education nursing roles. The AEN
awards assisted nurse education programs to support 3,419 graduate
nursing students in fiscal year 2008.
Section 821.--The Nursing Workforce Diversity Program funds grants
and contracts to schools of nursing, nurse-managed health centers
(NMCs), academic health centers, State and local governments, and
nonprofit entities to increase nursing education opportunities for
individuals from disadvantaged backgrounds and under-represented
populations among RNs. This program--of proven intervention
strategies--supported 18,741 students in fiscal year 2008, seeking to
ensure a culturally diverse workforce to provide healthcare for a
culturally diverse patient population.
Section 831.--The Nurse Education, Practice and Retention Program
provides support for academic and continuing education projects
designed to strengthen the nursing workforce. Several of this program's
priorities apply to quality patient care including developing cultural
competencies among nurses and providing direct support to establishing
or expanding NMCs in noninstitutional settings to improve access to
primary healthcare in medically underserved communities. The program
also provides grants to improve retention of nurses and enhanced
patient care. In fiscal year 2008, approximately 6,000 nurses and
nursing students were supported.
Section 846.--The Nurse Loan Repayment and Scholarship Programs
(NELRP) is divided into two primary elements. The NELRP assists
individual RNs by repaying up to 85 percent of their qualified
educational loans over 3 years in return for their commitment to work
at health facilities with a critical shortage of nurses, such as
departments of public health, community health centers, and
disproportionate share hospitals. In fiscal year 2008, of the 5,875
applications reviewed by HRSA, only 435 students (7.4 percent) received
NELRP awards. Similarly, the Nurse Scholarship Program (NSP) provides
financial aid to individual nursing students in return for working a
minimum of 2 years in a healthcare facility with a critical nursing
shortage. In fiscal year 2008, NSP turned away most of the applicants
owing to a lack of adequate funding, resulting in the distribution of
only 169 student awards.
Section 846A.--The Nurse Faculty Loan Program (NFLP) supports the
establishment and operation of a loan fund within participating schools
of nursing to assist RNs to complete their education to become nursing
faculty. The NFLP grants provide a cancellation provision in which 85
percent of the loan, plus interest, may be cancelled over 4 years in
return for serving as full-time faculty in a school of nursing. NFLP
granted 729 awards in fiscal year 2008.
Section 855.--The Comprehensive Geriatric Education Grant Program
focuses on training, curriculum development, faculty development, and
continuing education for nursing personnel caring for the elderly. In
fiscal year 2008, 18 awards were made in this program.
While title VIII is the largest source of Federal funding for
nursing, the current level of investment falls short of remedying a
chronic underfunding of the Nursing Workforce Development Programs,
compared to the existing and imminent shortages these programs address.
The title VIII authorities are capable of providing flexible and
effective support to assist students, schools of nursing, and health
systems in their efforts to recruit, educate, and retain registered
nurses. Recent efforts have shown that aggressive and innovative
strategies can help avert the nurse and nurse faculty shortages. The
Tri-Council for Nursing understands the competing priorities faced by
this Congress, but we also maintain that title VIII Nursing Workforce
Development Programs must be funded at an adequate level to begin to
impact the shortage and to address the complex health needs of the
Nation. The contributions of nurses in our healthcare system are
multifaceted, and are impacted directly by the level of Federal funding
that supports nursing programs.
______
Prepared Statement of America's Promise Alliance
THE DROPOUT CRISIS: AMERICA'S NEW SILENT EPIDEMIC
Chairman Inouye, Vice Chairman Cochran, members of the
subcommittee, thank you for the opportunity to testify on the most
pressing issue facing our Nation: the high school dropout crisis.
America's low graduation rate is our most pressing issue as a Nation
and the culmination of years of failure. Everyone with a stake in the
future of our children and the Nation--schools, parents, businesses,
community, and faith-based organizations--have a role to play in the
resolution of this crisis. We all must work together in new and
unprecedented ways in support of our children.
In addition to its significant social implications, the potential
economic impact of the dropout crisis shows why this issue is our most
critical national challenge. Today, America is the only industrialized
nation in the world where children are less likely to graduate from
high school than their parents. A student drops out of high school
every 26 seconds, with 1.2 million kids falling through the cracks each
year. The national dropout crisis has resulted in 3 in 10 students
failing to graduate with their class, a percentage that doubles for
minority, urban, and low-income students.
When President Obama and Secretary Duncan say that a long-term,
sustainable economic recovery is only possible if we strengthen our
education system, they are precisely correct. The dropout crisis may
not be as visible or swift as other important issues problems facing
this Congress and our new administration, but its implications are just
as severe and lasting. The dropout crisis, persisting without
acknowledgment or resolution, has emerged as America's ``silent
epidemic.'' Although we are working diligently to raise public
awareness of this issue, it has yet to permeate the national agenda.
This makes it easier for our actions to be slow, inadequate, or even
worse, nonexistent.
Strengthening our graduation rate will take historic focus,
unprecedented collaboration, and significant resources. The required
investments in our young people are the most cost-effective investments
we can make. We must understand that our future is at stake, and we
must resolve that failure is not an option.
MAGNITUDE OF THE DROPOUT CRISIS
Between 25 to 30 percent of high school students do not graduate on
time. For young people of color, on-time graduation is a 50-50
proposition, the flip of a coin. A new report commissioned by America's
Promise Alliance and developed by the Editorial Projects in Education
Research Center found that only 53 percent of all young people in the
Nation's 50 largest cities graduate on time. Despite some progress made
by several of these cities between 1995 and 2005, the average
graduation rate of the 50 largest cities is well below the national
average of 71 percent, and an 18 percentage point urban-suburban gap
remains.\1\ While the Nation's 50 largest school districts educate 1
out of 8 high school students; they produce one-quarter of the Nation's
students who do not graduate on time.\2\
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\1\ Christopher Swanson (2009). Cities in Crisis 2009: Closing the
Graduation Gap: Educational and Economic Conditions in America's
Largest Cities. Bethesda, Maryland: Editorial Projects in Education
Research Center.
\2\ The principal school districts of America's 50 largest cities
collectively educate 1.7 million public high school students and
produce 279,000 of the 1.2 million high school students who do not
graduate on time (Ibid., p. 13).
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A significant graduation rate gap exists between urban and suburban
school districts: 18 percentage points separate the metropolitan areas
of the 50 largest cities from their suburban counterparts.\3\ Fifty-
nine percent of high school students in urban school districts graduate
on time from high school versus 77 percent of their suburban
counterparts. The urban-suburban gap is most prominent in the Northeast
and Midwest, with Baltimore, Cleveland, Columbus, and Milwaukee
experiencing the largest differentials.\4\
---------------------------------------------------------------------------
\3\ Ibid.
\4\ Ibid.
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Economic Impact
The economic significance of the Nation's low graduation rate
cannot be overstated, as countries that out-educate us today will out-
compete us tomorrow. A report from McKinsey & Company estimated the
economic impact in 2008 if the United States had closed the achievement
gap 15 years after A Nation at Risk's 1983 release. Their findings
amount to nothing less than a multibillion dollar lost opportunity and
what they term as a ``permanent national recession.'' Closing the
international achievement, racial, and income gaps would have produced
up to a 30 percent gain in GDP, or $4.2 trillion.
On an individual level, high school graduation is a determining
factor of a student's future income. High school dropouts are less
likely to be steadily employed and earn less income when they are
employed compared with those who graduate from high school. Only 37
percent of high school dropouts nationwide are steadily employed and
are more than twice as likely to live in poverty.\5\
---------------------------------------------------------------------------
\5\ Ibid.
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High school dropouts account for 13 percent of the adult
population, but earn less than 6 percent of all dollars earned in the
United States. In the 50 largest cities, the median income for high
school dropouts is $14,000, lower than the median income of $24,000 for
high school graduates and $48,000 for college graduates. The Editorial
Projects in Education Research Center estimates that earning a high
school diploma would increase one's annual income by an average of 71
percent, or $10,000.\6\
---------------------------------------------------------------------------
\6\ Ibid.
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CONTRIBUTORS TO THE CRISIS
There are two major influences in students' lives that impact their
scholastic achievement: what happens inside the school building and
what happens outside of it. A number of factors contribute to the high
school dropout crisis, ranging from the quality of standards and rigor
in our high schools to the issues impacting students before they ever
step foot into the classroom.
In 1983, A Nation at Risk recommended that schools, colleges, and
universities adopt more rigorous, measurable standards for academic
performance and higher expectations for student conduct. Today, few
disagree with the need to raise expectations of student performance. We
must offer our students challenging curricula that are aligned with the
expectations of college and the needs of our future workforce. We need
stronger, internationally benchmarked standards, so that students,
educators, and parents understand the effectiveness of the educational
system in which they are part.
Equally important, though not duly recognized, is the importance of
a student's living and learning environment in affecting how he or she
performs in the classroom. Schools cannot shoulder the responsibility
of educating our children and youth on their own. Every year, our
students spend about 1,150 waking hours in school, and nearly five
times that number (4,700 waking hours) in their families and
communities.\7\ Today's teachers have to act as mothers, fathers,
social workers, and sometimes even police officers, in addition to the
central task of educating our students.
---------------------------------------------------------------------------
\7\ David Berliner (2009). Poverty and Potential: Out-of-School
Factors and School Success. Boulder and Tempe: Education and the Public
Interest Center and Education Policy Research Unit. Retrieved May 6,
2009 from http://epicpolicy.org/publication/poverty-and-potential.
---------------------------------------------------------------------------
In its recent report, Parsing the Achievement Gap II, the
Educational Testing Service (ETS) outlined 16 factors that correlate
with student achievement; more than half of these factors are present
in a child's life before or beyond the classroom, including forced
mobility, hunger and nutrition, and summer achievement gain and
loss.\8\ Today's educators must address the confluence of many of these
factors at the same time, which are disproportionately concentrated in
the Nation's poorest schools. Less than 4 percent of white students
attend schools where 70-100 percent of the students are poor. However,
40 percent of black and Latino students attend such high-poverty
schools.
---------------------------------------------------------------------------
\8\ Paul Barton and Richard Coley (2009). Parsing the Achievement
Gap II. Princeton, New Jersey: Educational Testing Service. Note: This
report uses the term ``frequent school changes.'' I use the term
``forced mobility'' because it more accurately describes the living
circumstances of our most at-risk students that, in turn, causes
reductions in school performance. For additional information, see
Duffield and Lovell (endnote 20).
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It is important that we have a thorough understanding of the
prevalence and importance of the larger environmental factors in a
student's life that influence their academic success. Unless we address
these foundational issues, not even the best teachers with the highest
quality curriculum will be able to ensure that every student graduates
ready for college.
THE SOLUTION: A COMPREHENSIVE APPROACH
The dropout crisis calls for a holistic solution, driven by
national leadership and local action. Research demonstrates that young
people need five core resources to be successful in life. We refer to
them as the ``five promises:'' caring adults, safe places, a healthy
start, effective education, and opportunities to serve. These promises
provide a simple but powerful framework for a robust national strategy
to end the dropout crisis, and they are at the heart of the Dropout
Prevention Campaign launched by America's Promise Alliance in April
2008.
America's Promise Alliance Dropout Prevention Campaign
The campaign begins with high-level summits in all 50 States and
the 55 cities with the largest dropout rates in order to raise the
visibility of America's ``silent epidemic.'' Within 60 days of each
summit, States, and communities are required to develop action plans
that include a cross section of stakeholders: educators, the business
community, nonprofit organizations, and students. To date, 36 high-
level summits have been held in cities nationwide--bringing together
more than 14,000 mayors and Governors, business owners, child
advocates, school administrators, students, and parents to develop
workable solutions and action plans.
Already, cities and States that held summits last year have started
implementing changes based on the discussions and early results are
promising. Detroit has set a 10-year goal to graduate 80 percent of its
youth from the 35 high schools with significant dropout rates and
created the Greater Detroit Venture Fund, a $10 million effort to
assist these efforts. Louisville set a 10-year goal to cut dropout
rates in half, and Tulsa's summit resulted in an innovative career
exploration program.
Grad Nation
The Dropout Summits and the action plans they produce are a
critical first step, but communities also need tools and guidelines for
sustainably raising their graduation rates. Grad Nation is a first-of-
its-kind research-based toolkit for communities seeking to reduce their
dropout rate and better support young people through high school
graduation and beyond. Commissioned by the Alliance and authored by
Robert Balfanz, Ph.D. and Joanna Honig Fox from the Everyone Graduates
Center at Johns Hopkins University and John M. Bridgeland and Mary
McNaught of Civic Enterprises, Grad Nation brings together--in one
place--the Nation's best evidence-based practices for keeping young
people in school. Grad Nation gives communities a comprehensive set of
tools to rally collective support, develop effective action strategies,
prepare youth for advanced learning, and build strong, lasting
partnerships around ending the dropout crisis.
The Gallup Student Poll
The youth voice is often overlooked and not included in the
national dialogue on dropout prevention. In order to determine
effective solutions to the crisis, their voices must be heard.
America's Promise Alliance (APA), along with Gallup and the American
Association of School Administrators, recently launched the Gallup
Student Poll, the largest-ever survey of students in grades 5-12. The
poll measures three key metrics--hope, engagement, and well-being--that
research has shown have a meaningful impact on educational outcomes and
more importantly, can be improved through deliberate action by
educators, school administrators, community leaders.
The March 2009 polling brought in nearly 71,000 responses from
students in 18 States, 58 districts, and more than 330 schools. Half of
those surveyed (50 percent) reported that they are not hopeful, with
one-third (33 percent) indicating that they are stuck, while 17 percent
feel discouraged. Just half (52 percent) said they were treated with
respect all day. The findings from this and future Gallup Student Polls
will highlight causes of the dropout crisis from the perspective of
students themselves. The youth voice is a critical part of the ongoing
dialogue about dropout prevention, and they can help us develop
initiatives that sustainably change outcomes for our young people.
SERVICE AND ENGAGEMENT
The recently passed Edward M. Kennedy Serve America Act will boost
the efforts of our Alliance's service initiatives through the most
sweeping expansion of our country's service programs in 16 years. APA
believes service is a bedrock strategy for tackling issues such as the
high school dropout and college-readiness crises. By affirming the
power of service to address some of the biggest challenges now facing
the United States, this landmark piece of legislation will help reverse
current dropout rates in communities across the country.
The Serve America Act will update and strengthen national service
programs, including service-learning, a teaching method that combines
volunteer service and a rigorous curriculum to engage young people in
solving community problems. Research has shown that service-learning
helps students achieve academically, develop civic and career-related
skills, increase their self-confidence, and heighten their respect for
diversity. Service-learning is a key component of our objective to help
communities in this time of need and to ensure brighter futures for our
children and youth.
Many students who ultimately drop out of school say they become
disengaged during the middle-school years. The choices young people
make at this age could set them on a course for active citizenship and
engaged learning, or down a path of risky behavior and potential
failure. Not enough opportunities currently exist for these children to
engage in active learning through real-world experiences, such as
school or community-based learning and career-centric activities.
Our national action strategy, ``Ready for the Real World,'' brings
together partners from professional societies and businesses looking
for ways to connect with and prepare their future workforce. By
designing ``real-world'' experiences relevant to them, the initiative
exposes youth to service learning and career exploration, increasing
their motivation to achieve in school, college, and life.
Through America's Promise, partners provide a range of resources
and real-life experiences, such as job shadowing and mentoring
programs. Ready for the Real World established innovative after-school
and summer programs for youth, which are integrated into school
curriculums afterwards. This type experiential learning has inspired
at-risk youth to achieve academically, pursue higher goals, and
contribute positively to their communities.
______
Prepared Statement of the American Psychological Association
The American Psychological Association (APA), the largest
scientific and professional organization representing psychology in the
United States and the world's largest association of psychologists,
works to advance psychology as a science, as a profession and as a
means of promoting human welfare. APA is grateful for the opportunity
to submit written testimony on goals for the fiscal year 2010
appropriations bill. Below we enumerate recommendations for specific
programs.
Bureau of Health Professions, Graduate Psychology Education
Program.--The APA requests that the subcommittee include $7 million for
the Graduate Psychology Education Program (GPE) within the Health
Resources and Services Administration. This nationally competitive
grant program provides integrated healthcare services to underserved
communities--those individuals most in need of mental and behavioral
health support with the least access to these services, including
children, older adults, chronically ill persons, and victims of abuse
or trauma.
Since 2002, GPE grants have provided interdisciplinary training for
approximately 2,500 graduate students of psychology and other health
professions to provide integrated healthcare services to underserved
populations. There have been 70 grants in 30 States. Students
benefiting from GPE grants have worked with more than 30 different
types of health professionals. GPE funding has allowed programs to
double the number of students they are able to train: and more students
trained means more impact on underserved populations. The GPE Program
currently supports training grants at 18 academic institutions and
training sites (e.g., children's and VA hospitals) throughout the
Nation. All of the approximately 900 psychology graduate students who
benefited from GPE funds are expected to work with underserved
populations and 34-100 percent will be working in underserved areas
immediately after completing the training.
Currently authorized under the Public Health Service Act (Public
Law 105-392, section 755(b)(1)(J)) and funded under the ``Allied Health
and Other Disciplines'' account in the Labor, Health and Human
Services, and Education, and Related Agencies appropriations bill, this
program has proven effective for meeting the growing health needs of
our Nation's least served communities. This year, specific authorizing
legislation has been introduced in the U.S. Senate (S. 811) as well as
in the U.S. House of Representatives (H.R. 2066).
The GPE program specifically seeks to support our Nation's aging
and veteran populations. Twenty percent of people older than 55 suffer
from a mental disorder (2005); mental disorders affect physical health
and the ability to function (2008); and approximately 70 percent of all
primary care visits by older adults are driven by psychological
factors. In addition, older adults with chronic illnesses such as heart
disease have higher rates of depression than those medically well, and
depression lowers immunity and may compromise a person's ability to
fight infection (2008). One in five military personnel returning from
Iraq and Afghanistan report symptoms consistent with major depression,
generalized anxiety or post-traumatic stress disorder (PTSD) (2008).
According to the Pentagon the number of U.S. troops diagnosed by the
military with PTSD jumped nearly 50 percent from 2006 to 2007 as more
troops served lengthy and repeated tours in Iraq and Afghanistan
(2008). Furthermore, the U.S. Army reported in May (2008) that more
U.S. soldiers committed suicide in 2007 than at any time since the
first Gulf War.
Providing $7 million in fiscal year 2010 would allow for 30
additional GPE grants including those that focus solely on the needs of
older adults and returning military personnel and their families. There
are approximately 900 eligible universities, professional schools and
hospitals in every State nationwide.
substance abuse and mental health services administration (samhsa)
Garrett Lee Smith Memorial Act Programs--Campus Suicide Prevention
Program
APA encourages the subcommittee to increase funding for the
programs at SAMHSA authorized by the Garrett Lee Smith Memorial Act,
especially the Campus Suicide Prevention program.
The Campus Suicide Prevention program is a small, but important
program that seeks to assist college and universities raise awareness
about mental and behavioral health to prevent suicides. By providing
educational materials and outreach, the Campus Suicide Prevention
program increases awareness about the signs of and risks of mental
health problems and ensures greater success in college completion for
those at risk of school failure because of concerns like stress,
depression, eating disorders, risk behaviors, and suicidal thoughts.
There is a special need to increase funds for this program during
the difficult economic times facing our Nation. A recent APA survey
found that 18-29 year olds felt the economy added to their stress more
than other concerns, like relationships or housing, a change from past
years. The American College Counseling Association's 2008 Survey of
College Counseling Center Directors found that ``95 percent of
directors report that the recent trend toward greater number of
students with severe psychological problems continues to be true on
their campuses.'' Addressing the mental and behavioral health needs of
students in college and university settings can mean the difference
between school failure or graduation on one hand, and life and death on
the other.
Center for Mental Health Services, Minority Fellowship Program
(MFP).--While minorities are projected to comprise 40 percent of the
U.S. population by 2025, only 23 percent of recent doctorates in
psychology, social work, and nursing were awarded to minorities. The
MFP's mission is to address this need by increasing the number of
minority mental health professionals and by training mental health
professionals to become culturally competent. APA urges Congress to
fund the Minority Fellowship Program at $7.5 million for fiscal year
2010.
Emergency Mental Health and Traumatic Stress Services Branch: Child
Trauma.--SAMHSA has made tremendous efforts in this area through the
outstanding National Child Traumatic Stress Network program. APA urges
Congress to appropriate full funding for the National Child Traumatic
Stress Initiative at the originally authorized level of $50 million for
fiscal year 2010. To ensure continuity of leadership in this program,
APA recommends the subcommittee encourage SAMHSA to expand the duration
of NCTSI grant awards from 3 years to 6 years.
Center for Substance Abuse Prevention (CSAP): Substance Use and
Mental Disorders of Persons with HIV.--According to recent reports,
almost half of those with HIV/AIDS screened positive for illicit drug
use or mental disorders. Unfortunately, healthcare providers fail to
detect mental disorders and substance use problems in almost half of
patients with HIV/AIDS. Several diagnostic screening tools are
available for use by nonmental health staff. APA encourages SAMHSA and
CDC to collaborate with HRSA to train healthcare providers to screen
HIV/AIDS patients for mental health and substance use problems.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Lifespan Respite Program Family Caregivers.--Respite can provide
family caregivers with relief necessary to maintain their own health,
bolster family stability and well-being, and avoid or delay more costly
nursing home or foster care placements. Under the Lifespan Respite Care
Program, funds are available to improve access to respite for family
caregivers. APA urges Congress to fund the Lifespan Respite Care
Program at its authorized level of $71.1 million for fiscal year 2010.
CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC)
National Center for Injury Prevention and Control: Child
Maltreatment Prevention at Community Health Centers (CHCs).--APA
recommends the implementation of at least 10 demonstration projects of
evidence-based preventative parenting programs through CHCs. Technical
assistance to demonstration sites should be provided by organizations
with expertise in parent-child relationships, parenting programs,
prevention of child maltreatment, and the integration of behavioral
health in primary and community health center settings. APA recommends
evaluating the demonstration projects' implementation and outcomes,
including health and mental health outcomes.
National Center for Health Statistics (NCHS): Eating Disorders.--
Eating disorders may have serious, chronic effects on one's quality of
life and often co-occur with significant physical and mental health
problems. However, the impact of these disorders has not yet been
appropriately investigated. APA urges the subcommittee to encourage CDC
to increase support for surveillance and research efforts regarding the
incidence, morbidity, and mortality rates of eating disorders,
including anorexia nervosa, bulimia nervosa, binge eating disorder, and
eating disorders not otherwise specified across age, ethnicity and
gender subgroups.
Sexual and Gender Identity Inclusion in Health Data Collection.--
The National Health Interview Survey (NHIS) is the most comprehensive
and widely referenced Federal health statistics survey, yet currently
does not include any question concerning sexual orientation and gender
identity. APA recommends the allocation of an additional $2 million in
funding for NHIS in the NCHS budget, to enable Government agencies to
better understand and plan for the unique health needs of lesbian, gay,
bisexual, and transgender individuals.
Administration for Children and Families.--Sexualization of Girls.
Throughout U.S. culture, female children, adolescents, and adults are
frequently depicted and treated in a sexualized manner that objectifies
them. Research links sexualization with three of the most common mental
health problems of female children, adolescents, and adults: eating
disorders, depression or depressed mood, and low self-esteem. APA
encourages HHS to fund media literacy and youth empowerment programs to
prevent and counter the effects of the sexualization of female
children, adolescents, and adults.
National Institutes of Health (NIH).--APA supports the request of
the Ad Hoc Group and Coalition for Health Funding, urging an increase
of at least 7 percent for the NIH. Years of sub-inflation budgets have
stressed the NIH research enterprise, and made sharing of resources
among programs more difficult. The fiscal year 2009 increase provided
by Congress begins to ameliorate the budget difficulties, but
scientific research will benefit from a smooth, steady and predictable
rise in spending.
APA likewise supports an increase of 7 percent (to $28.61 million)
for the NIH Office of Behavioral and Social Sciences Research in the
Office of the Director. This small but important office coordinates
behavioral and social science research initiatives across Institutes
and Centers, and helps form partnerships to leverage the intellectual
and monetary resources that make good science possible.
The behavioral and social sciences are leading proponents of
cooperation and cost-sharing in cross-cutting NIH initiatives. APA
supports NIH's decision to authorize a Basic Behavioral and Social
Sciences Research ``Blueprint,'' to which several Institutes would
contribute, to strengthen NIH funding of basic research in the
behavioral and social sciences. This innovation will build creative
cooperation and cost-sharing, and help plug gaps in NIH-supported basic
research.
A key area of cooperation is in research on obesity. Given the role
of obesity as a risk factor for the development of cardiovascular
disease, diabetes, cancer, and arthritis, many of NIH's Institutes are
collaborating with investigators and other Institutes to develop new
ways to prevent and treat obesity and overweight as well as fostering
the adoption of positive health behaviors.
For example, the Eunice Kennedy Shriver National Institute of Child
Health and Human Development supports research into physical activity
and eating behaviors and that examines the impact of family and peer
support, developmental and social context, school-based interventions,
which include the use of media and literacy, motivation, and use of
various behavioral approaches to influence motivation in physical
activity, food choices, and media use.
Alcohol and tobacco use are among the leading causes of death and
disability in the United States, but NIH research funding to prevent,
understand the etiology of, and treat tobacco and alcohol addiction is
not commensurate with the public health burden of those diseases. APA
suggests that as the NIH Scientific Management Review Board (SMRB)
undertakes its review of the NIH organizational structure to optimize
the research of substance use, abuse and addiction, that it also
quantify the amount of NIH research funding dedicated to studies of
alcohol, tobacco use and illicit substance use. Further, APA recommends
that the SMRB evaluate the proportion of all substance use research
funding at NIH compared to CDC estimates of the public health burden of
disease (and costs to the criminal justice system) and consider a
reapportionment of NIH funding to Institutes based on those findings.
DEPARTMENT OF EDUCATION
Office of the Director (OD).--Culturally and Linguistically
Appropriate Education. Ethnically diverse children and American Indian/
Alaska native children are performing at far lower levels than other
students. APA urges the subcommittee to increase support for
educational systems and the strengthening of programs that meet the
unique cultural, linguistic and educational needs of ethnic minority
and AI/AN students from pre-school to graduate-level education.
Office of Safe and Drug-free Schools: Bullying Prevention.--
Bullying directly affects about one-third of American school children
in a given semester. APA urges appropriate Federal funding to support
the implementation of effective, research-based, and comprehensive
bullying prevention programs.
National Institute on Disability and Rehabilitation Research:
Disability Research.--APA recommends that NIDRR pursue mental health-
related research proposals through its investigator-initiated and other
grants programs, and sponsor studies on the impacts of socio-emotional,
behavioral, and attitudinal aspects of disability.
ELEMENTARY AND SECONDARY SCHOOL COUNSELING PROGRAM
APA requests that the subcommittee increase funds for the
Elementary and Secondary School Counseling program. Authorized by the
Elementary and Secondary Education Act's Fund for the Improvement of
Education, this program increases the range, availability, quantity,
and quality of counseling services in the elementary and secondary
schools across the country.
______
Prepared Statement of the American Public Power Association
The American Public Power Association (APPA) is the national
service organization representing the interests of more than 2,000
municipal and other State and locally owned utilities throughout the
United States (all but Hawaii). Collectively, public power utilities
deliver electricity to 1 of every 7 electricity consumers
(approximately 45 million people), serving some of the Nation's largest
cities. However, the vast majority of APPA's members serve communities
with populations of 10,000 people or less.
We appreciate the opportunity to submit this statement supporting
funding for the Low-Income Home Energy Production Assistance Program
(LIHEAP) for fiscal year 2010.
APPA has consistently supported an increase in the authorization
level for LIHEAP. The administration's fiscal year 2010 budget requests
$3.2 billion for LIHEAP. APPA supports a level of $5.1 billion for the
program.
APPA is proud of the commitment that its members have made to their
low-income customers. Many public power systems have low-income energy
assistance programs based on community resources and needs. Our members
realize the importance of having in place a well-designed, low-income
customer assistance program combined with energy efficiency and
weatherization programs in order to help consumers minimize their
energy bills and lower their requirements for assistance. While highly
successful, these local initiatives must be coupled with a strong
LIHEAP program to meet the growing needs of low-income customers. In
the last several years, volatile home-heating oil and natural gas
prices, severe winters, high utility bills as a result of dysfunctional
wholesale electricity markets and the effects of the economic downturn
have all contributed to an increased reliance on LIHEAP funds.
Also when considering LIHEAP appropriations this year, we encourage
the subcommittee to provide advanced funding for the program so that
shortfalls do not occur in the winter months during the transition from
one fiscal year to another. LIHEAP is one of the outstanding examples
of a State-operated program with minimal requirements imposed by the
Federal Government. Advanced funding for LIHEAP is critical to enabling
States to optimally administer the program.
Thank you again for this opportunity to relay our support for
increased LIHEAP funding for fiscal year 2010.
______
Prepared Statement of the Association for Psychological Science
SUMMARY OF RECOMMENDATIONS
--As a member of the Ad Hoc Group for Medical Research Funding,
Association for Psychological Science (APS) recommends $32.4
billion for the National Institutes of Health (NIH) in fiscal
year 2010.
--APS requests subcommittee support for 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 subcommittee to ensure that NIH
leadership carries out its plan to create a cross-NIH basic
behavioral research funding initiative, and coordinates with
all Institutes and Centers to provide support for basic
behavioral science research.
--APS encourages the subcommittee to support behavioral science
priorities at 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 subcommittee: My name is Dr. Amy
Pollick, and I am speaking on behalf of the APS. Thank you for the
opportunity to provide this statement on the fiscal year 2010
appropriations for the NIH. 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 21,000
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; they
look at how genes and the environment influence behavioral traits such
as aggression and anxiety; and they address the behavioral aspects of
smoking and drug and alcohol abuse.
As a member of the Ad Hoc Group for Medical Research Funding, APS
recommends $32.4 billion for NIH in fiscal year 2010, an increase of 7
percent more than the fiscal year 2009 appropriations 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 my testimony concerns the status of those areas of
research at NIH.
HEALTH AND BEHAVIOR: THE CRITICAL ROLE OF BASIC AND APPLIED
PSYCHOLOGICAL RESEARCH
Behavior is a central part of health. Many leading health
conditions--such as 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 problems:
--Chronic stress accelerates not only the size, but also the strength
of cancer tumors;
--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
greater levels of 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 extends 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.
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. Basic
behavioral research continues to fare poorly at NIH, a circumstance
that jeopardizes the success of the entire behavioral research
enterprise. Let me remind you of the current situation.
Traditionally, the National Institute of Mental Health (NIMH) was
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. But NIMH has reduced 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 happened 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 connected to their missions,
programs of research in fundamental behavioral phenomena such as
cognition, emotion, psychopathology, perception, and development, will
continue to languish.
Current NIH leadership recognizes this gap, and has asked the
Directors of the National Institute of General Medical Sciences and the
National Institute of Aging to co-lead a new initiative that supports
and expands new basic behavioral research throughout NIH. In March
2009, NIH leadership confirmed its commitment to this Basic Behavioral
Research Opportunity Network in testimony to this subcommittee, and APS
asks you to ensure that NIH follows through with the planning and
execution of this crucial step forward for basic behavioral science at
NIH and ultimately the health of all Americans.
Despite the clear central role of behavior in health, behavioral
research has not received the recognition or support needed to prevent,
or 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.
BEHAVIORAL SCIENCE AT KEY INSTITUTES
In the remainder of my testimony, I would like to highlight
examples of cutting-edge behavioral science research being supported by
individual Institutes.
National Cancer Institute (NCI).--NCI's Behavioral Research Program
continues to make excellent progress, supporting basic behavioral
research as well as translational research on the development and
dissemination of interventions in areas such as tobacco use, dietary
behavior, sun protection, and decisionmaking. Recently, NCI's
behavioral research branch has made concerted efforts to incorporate
innovative social psychological theories into cancer prevention
research. Basic social psychology provides useful and practical
approaches for understanding risky health behaviors and tailoring
interventions to reduce the incidence of cancer. For example, NCI
funded a research program to assess differential psychological and
physiological responses to exercise and the possible genetic and
biological mechanisms of those responses. As a result, we now
understand the influence of responses to cardiovascular exercise on
future exercise behavior, and the researchers are evaluating an
intervention to increase exercise behavior in sedentary participants.
It is this kind of basic behavioral research that helps us understand
how people are persuaded to adopt and maintain healthy behaviors. APS
asks Congress to support NCI's behavioral science research and training
initiatives and to encourage other Institutes to use these programs as
models.
National Institute on Aging (NIA).--NIA's Division of Behavioral
and Social Research has one of the strongest psychological science
portfolios in all of NIH, and is supporting wide-ranging and innovative
work. For example, normal aging may be accompanied by declines not only
in such cognitive functions, but also in the processes supporting
social and emotional behavior. However, we currently know little about
the changes that may occur as we age. NIA-supported research into the
brain mechanisms and cognitive processes underlying social and
emotional behaviors in healthy older adults promises to dramatically
increase our knowledge in this area. Using a combination of behavioral
and neuroimaging methods to study social and emotional processing in
normal aging, this research will lead to much greater understanding of
the nature of aging-related changes in these central human
characteristics. NIA's commitment to cutting-edge behavioral science is
further illustrated by the Institute's leadership role in NIH's new
initiative on the Science of Behavior Change. APS asks the subcommittee
to support NIA's behavioral science research efforts and to increase
NIA's budget in proportion to the overall increase at NIH in order to
continue its high-quality research to improve the health and well being
of older Americans.
National Institute on Drug Abuse (NIDA).--By supporting a
comprehensive research portfolio that stretches across behavior,
neuroscience, and genetics, NIDA is leading the Nation to a better
understanding of drug abuse which is key to both prevention and
treatment. One of the striking things about psychological science
research is that it often dispels ``common sense'' intuition. For
example, recent NIDA-supported research has shown that certain anti-
drug media campaigns that include attention-grabbing features such as
harsh content or strong graphics, have no positive effect, and that in
fact the campaigns that use fewer such dramatic features actually lead
to better processing of the public service announcement (PSA). This
kind of message-framing research will be used to develop and tailor the
most effective PSAs, such as those that focus on social risk rather
than physical damage, to curtail use of a wide variety of illicit
substances. NIDA is also encouraging brain imaging and prevention
message investigators to work together, fostering increased validation
of health communication models. APS asks the subcommittee 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.
Eunice Kennedy Shriver National Institute for Child Health and
Human Development (NICHD).--Several Institutes recognize the value and
relevance of basic behavioral research to their mission, and NICHD is
to be particularly commended for its support of behavioral research on
important topics such as mechanisms of cognition and learning,
developmental trajectories of language, and linkages among brain,
behavior, and genes. For example, studies have shown that caregiver
behavior can modify genetic influences on social behavior. Children
with a particular variation of the serotonin gene who live in families
that provide low levels of social and emotional support were found to
be at increased risk for extreme shyness and social withdrawal in
middle school years. But those children whose families provide high
levels of support, and who have that same genetic variation, didn't
show the same levels of shyness. Research supported by NICHD's
behavioral science programs continues to yield fundamental new insights
into understanding early cognitive and behavioral development that have
the potential to change how and when medical and psychological
specialists evaluate typical cognitive, social, and behavioral
development during infancy. APS asks Congress to support NICHD's
sustained behavioral science research portfolio and to encourage other
Institutes to partner with NICHD to maximize the development of
interventions in early stages of life that have invaluable benefits in
adulthood.
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 the NIH behavioral
science research enterprise. These include the National Institute of
Dental and Craniofacial Research, the National Institute of Mental
Health, the National Institute on Alcohol Abuse and Alcoholism, the
National Heart, Lung, and Blood Institute, the National Institute of
Diabetes and Digestive and Kidney Diseases, and the National Institute
on Neurological Diseases and Stroke. Behavioral science is a central
part of the mission of these institutes, and their behavioral science
programs deserve the subcommittee's strongest possible support.
This concludes my testimony. Again, thank you for the opportunity
to discuss NIH appropriations for fiscal year 2010 and specifically,
the importance of behavioral science research in addressing the
Nation's public health concerns. I would be pleased to answer any
questions or provide additional information.
______
Prepared Statement of the American Physiological Society
The American Physiological Society (APS) thanks the Chairman and
all the members of this subcommittee for their support for the National
Institutes of Health (NIH). The funds you included in the American
Recovery and Reinvestment Act of 2009 (ARRA) are providing the NIH with
a substantial influx of resources at a crucial time. Several
consecutive years of stagnant budget growth had been eroding the
scientific capacity painstakingly built up during the doubling. The
rapid distribution of ARRA funds will allow scientists to explore new
avenues of promising research through the funding of additional grants,
which is already building momentum and sparking excitement in the
research community. The stimulus funds represent a first step toward
enabling NIH to maintain and to increase employment for highly skilled
workers, purchase critical equipment and supplies, and enhance research
capacity at institutions across the country. However, consistent future
budget growth for NIH will be necessary to sustain this momentum beyond
the period of stimulus spending and prevent an abrupt halt in these new
research initiatives after the ARRA. Furthermore, absent a continued
increase in support for NIH, as many as 20,000 jobs created in the
biomedical sciences by the stimulus money could be lost. Therefore, the
APS urges you to make every effort to provide the NIH with a 7 percent
increase in fiscal year 2010.
The APS is a professional society dedicated to fostering research
and education as well as the dissemination of scientific knowledge
concerning how the organs and systems of the body work. APS was founded
in 1887 and now has nearly 10,000 member physiologists. APS members
conduct NIH-supported research at colleges, universities, medical
schools, and other public and private research institutions across the
United States. The APS offers these comments on the budget recognizing
both the enormous financial challenges facing our Nation and the great
opportunity before us to make progress against disease.
As a result of improved healthcare, Americans are living longer and
healthier lives in the 21st century than ever before. However, diseases
such as heart failure, diabetes, cancer, and emerging infectious
diseases such as the swine flu continue to inflict a heavy burden on
our population. The NIH invests heavily in basic research to explore
the mechanisms and processes of disease. This investment will result in
new tools and knowledge that can be used to design novel treatments and
prevention strategies.
The NIH selects and funds investigator-initiated research of only
the highest scientific merit through the use of the peer review system.
Among the breakthroughs in the last year:
--NIH-funded researchers discovered that people with certain genetic
variants are at increased risk for a stroke. This genetic link
provides molecular clues to how strokes develop and also moves
the field closer to personalized medicine. This work was
performed by researchers who collaborated to study large
populations of patients over a long period of time, and is an
example of research that was supported by multiple institutes
within the NIH.\1\
---------------------------------------------------------------------------
\1\ M. A. Ikram et al, New England Journal of Medicine 360, 1718-
28. (April 23, 2009).
---------------------------------------------------------------------------
--Scientists recently discovered that adults retain brown fat, a
metabolically active type of fat tissue that was previously
thought to exist only in infants and children. Because brown
fat burns calories and energy, there is hope that this
discovery could lead to new treatments for obesity and
diabetes.\2\
---------------------------------------------------------------------------
\2\ A. M. Cypress et al, New England Journal of Medicine 360, 1509-
17. (April 9, 2009).
---------------------------------------------------------------------------
--Researchers studying obesity and diet in an animal model found that
chronic consumption of high levels of fructose leads to excess
weight gain and molecular changes when paired with a high-fat,
high-calorie diet. Understanding the physiological changes
associated with the development of obesity is a first step
toward the design of interventions that could prevent the
serious health consequences associated with being
overweight.\3\
---------------------------------------------------------------------------
\3\ A. Shapiro et al, American Journal of Physiology--Regulatory,
Integrative and Comparative Physiology 295, R1370-75. (November, 2008).
---------------------------------------------------------------------------
Over the past several years, the Office of the Director has
supplemented existing research programs with new types of awards as
part of the NIH Roadmap for Medical Research. These include the New
Innovator, Pioneer and Transformative Research Award Programs. Such
programs support bold and creative researchers as they engage in high-
risk, high-reward research, thus allowing more flexibility to explore
novel ideas and challenge existing paradigms. The NIH is also using
these programs as a model for distributing funds under the ARRA. The
Research and Research Infrastructure ``Grand Opportunities'' program
will fund potentially high-impact areas of science that will benefit
from short-term funding.
The NIH is also home to the Institutional Development Award (IDeA)
Program. Established in 1993, the goal of the IDeA program is to
broaden the geographic distribution of NIH funds by serving researchers
and institutions in areas that have not historically received
significant NIH funding. IDeA builds research capacity and improves
competitiveness in those States through the development of shared
resources, infrastructure, and expertise. IDeA currently serves
institutions and investigators in 23 States and Puerto Rico.
In addition to supporting research, the NIH must also address
workforce issues to ensure that our Nation's researchers are ready to
meet the challenges they will face in the future. Recent data from the
NIH shows that the average age of NIH supported principal investigators
is now 50.8 years.\4\ This is up nearly 12 years from the average
principal investigator's age of 39.1 years in 1980. In addition, the
average age at which a researcher obtains their first major research
award from NIH has increased to 42.4 years. As the scientific workforce
continues to age, and more researchers retire, there may be an
insufficient number of young scientists who are trained to replace
them. Over the last year, the NIH has put in place policies to help new
investigators succeed in competing for their first major research
awards. However, efforts will be successful only if funds are available
to continue to support the careers of new and young investigators
beyond the period of their first grant.
---------------------------------------------------------------------------
\4\ http://grants.nih.gov/grants/new_investigators/
resources.htm#data (accessed April 29, 2009).
---------------------------------------------------------------------------
The APS joins the Federation of American Societies for Experimental
Biology (FASEB) and the Ad Hoc Group for Medical Research Funding in
urging that NIH be provided with a 7 percent increase in fiscal year
2010 to permit the agency to maintain its current wide-ranging and
important research efforts.
______
Prepared Statement of the Association of Rehabilitation Nurses
INTRODUCTION
On behalf of the Association of Rehabilitation Nurses (ARN), I
appreciate having the opportunity to submit written testimony to the
Senate Labor, Health and Human Services, and Education, and Related
Agencies Subcommittee regarding funding for nursing and rehabilitation
related programs in fiscal year 2010. ARN represents professional
nurses who work to enhance the quality of life for those affected by
physical disability and/or chronic illness. ARN understands that
Congress has many concerns and limited resources, but believes that
chronic illness and physical disability are heavy burdens on our
society that must be addressed.
REHABILITATION NURSES AND REHABILITATION NURSING
Rehabilitation nurses help individuals affected by chronic illness
and/or physical disability adapt to their disability, achieve their
greatest potential, and work toward productive, independent lives. They
take a holistic approach to meeting patients' medical, vocational,
educational, environmental, and spiritual needs. Rehabilitation nurses
begin to work with individuals and their families soon after the onset
of a disabling injury or chronic illness. They continue to provide
support in the form of patient and family education and empower these
individuals when they return home, or to work, or school. The
rehabilitation nurse often teaches patients and their caregivers how to
access systems and resources.
Rehabilitation nursing is a philosophy of care, not a work setting
or a phase of treatment. Rehabilitation nurses base their practice on
rehabilitative and restorative principles by: (1) managing complex
medical issues; (2) collaborating with other specialists; (3) providing
ongoing patient/caregiver education; (4) setting goals for maximal
independence; and (5) establishing plans of care to maintain optimal
wellness. Rehabilitation nurses practice in all settings, including
freestanding rehabilitation facilities, hospitals, long-term subacute
care facilities/skilled nursing facilities, long-term acute care
facilities, comprehensive outpatient rehabilitation facilities; and
private practice, just to name a few.
To ensure that patients receive the best quality care possible, ARN
supports Federal programs and research institutions that address the
national nursing shortage and conduct research on medical
rehabilitation and nursing and traumatic brain injury. Therefore, ARN
respectfully requests that the subcommittee provide increased funding
for the following programs:
nursing workforce and development programs at the health resources and
SERVICES ADMINISTRATION (HRSA)
ARN supports efforts to resolve the national nursing shortage,
including appropriate funding to address the shortage of qualified
nursing faculty. Rehabilitation nursing requires a high-level of
education and technical expertise, and ARN is committed to assuring and
protecting access to professional nursing care delivered by highly
educated, well-trained, and experienced registered nurses for
individuals affected by chronic illness and/or physical disability.
According to the Department of Health and Human Services, the
Federal Nursing Workforce Development program at the Health Resources
and Services Administration (HRSA), an estimated 36,750 nurses need to
be recruited, educated, and retained to meet the current demands of the
healthcare system. Efforts to recruit and educate individuals
interested in nursing have been thwarted by the shortage of nursing
faculty. In 2007, due to the nursing faculty shortage, more than 40,000
qualified applicants were not able to matriculate in nursing school.
The number of full-time nursing faculty required to ``fill the nursing
gap'' is approximately 40,000, and, currently, there are less than
20,000 full-time nursing faculty members. Further exacerbating this
issue, HRSA predicts that the nursing shortage is expected to grow to
41 percent by 2020.
ARN strongly supports the national nursing community's request of
$263 million in fiscal year 2010 funding for Federal Nursing Workforce
Development programs at HRSA.
NIDRR
NIDRR provides leadership and support for a comprehensive program
of research related to the rehabilitation of individuals with
disabilities. As one of the components of the Office of Special
Education and Rehabilitative Services at the U.S. Department of
Education, NIDRR operates along with the Rehabilitation Services
Administration and the Office of Special Education Programs.
The mission of NIDRR is to generate new knowledge and promote its
effective use to improve the abilities of people with disabilities to
perform activities of their choice in the community, and also to expand
society's capacity to provide full opportunities and accommodations for
its citizens with disabilities. NIDRR conducts comprehensive and
coordinated programs of research and related activities to maximize the
full inclusion, social integration, employment and independent living
of individuals of all ages with disabilities. NIDRR's focus includes
research in areas such as employment; health and function; technology
for access and function; independent living and community integration;
and other associated disability research areas.
ARN strongly supports the work of NIDRR and encourages Congress to
provide the maximum possible fiscal year 2010 funding level.
NATIONAL INSTITUTE OF NURSING RESEARCH (NINR)
ARN 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 and maturation of the rehabilitation
nursing specialty. The National Institute of Nursing Research (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.
ARN respectfully requests $178 million in fiscal year 2010 funding
for NINR to continue its efforts to address issues related to chronic
and acute illnesses.
TRAUMATIC BRIAN INJURY (TBI)
Approximately 1.5 million American children and adults are living
with long-term, severe disability, as a result of traumatic brain
injury (TBI). Moreover, this figure does not include the 150,000 cases
of TBI suffered by soldiers returning from wars in Iraq and
Afghanistan.
The annual national cost of providing treatment and services for
these patients is estimated to be nearly $60 million in direct care and
lost workplace productivity. Continued fiscal support of the Traumatic
Brain Injury Act will provide critical funding needed to further
develop research and improve the lives of individuals who suffer from
traumatic brain injury.
Continued funding of the TBI Act will promote sound public health
policy in brain injury prevention, research, education, treatment, and
community-based services, while informing the public of the need
support for individuals living with TBI and their families.
ARN strongly supports the current work being done by the Centers
for Disease Control and Prevention (CDC) and HRSA on TBI programs.
These programs contribute to the overall body of knowledge in
rehabilitation medicine.
ARN urges Congress to support the following fiscal year 2010
funding requests for programs within the TBI Act: $10 million for CDC's
TBI registries and surveillance, prevention and national public
education and awareness efforts; $20 million for the HRSA Federal TBI
State Grant Program; and $13.3 million for the HRSA Federal TBI
Protection and Advocacy Systems Grant Program.
CONCLUSION
ARN appreciates the opportunity to share our priorities for fiscal
year 2010 funding levels for nursing and rehabilitation programs. ARN
maintains a strong commitment to working with Members of Congress,
other nursing and rehabilitation organizations, and other stakeholders
to ensure that the rehabilitation nurses of today continue to practice
tomorrow. By providing the fiscal year 2010 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 patients requiring rehabilitation from chronic illness and/or
physical disability.
______
Prepared Statement of the Association for Research in Vision and
Ophthalmology
Association for Research in Vision and Ophthalmology (ARVO) has two
major requests:
--For Congress to fund the National Institutes of Health (NIH) in
fiscal year 2010 at $32.4 billion (a 7 percent increase more
than fiscal year 2009); and
--For Congress to make vision health a priority in the total funding
of NIH by increasing the National Eye Institute (NEI) funding
to $736 million (also a 7 percent increase).
The requested 7 percent increase represents a 3 percent increase
plus the 2009 biomedical inflation index.
ARVO commends Congress for actions taken in fiscal year 2008 and
2009 to fund NIH. This includes the $150 million fiscal year 2008
supplement for investigator-initiated grants, the $10.4 billion of NIH
funding included in the American Recovery and Reinvestment Act, and the
fiscal year 2009 inflationary increase of 3.2 percent. However, ARVO
still has concerns about long-term, sustained, and predictable funding
for vision research.
Vision disorders are the fourth most prevalent disability in the
United States and the most frequent cause of disability in children.\1\
\2\ \3\ \4\ Healthy vision contributes to injury prevention,
independence, and economic security. Over the next 30 years the elderly
population of the United States will double and if we fail to take
action, age-related eye diseases (diabetic retinopathy, glaucoma,
cataracts, and age-related macular degeneration) will quickly
overburden our healthcare system. While age-related eye diseases are
the most common visual impairments in the United States, childhood
vision loss is also of great concern because of its lifelong economic
burden.
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\1\ Federal Interagency Forum on Aging-Related Statistics. Older
Americans 2000: key indicators of well-being. Washington, DC: U.S.
Government Printing Office; 2000 Aug. 114 p.
\2\ http://www.ncbi.nlm.nih.gov/pubmed/15078664
\3\ http://www.healthypeople.gov/data/2010prog/focus28/2004fa28.htm
\4\ http://www.preventblindness.org/vpus/
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ARVO requests $32.4 billion of NIH funding for fiscal year 2010.
This represents a 7 percent increase more than fiscal year 2009.
This ensures that prior investments in training junior
investigators and clinician scientists translate to future improvements
in health and healthcare services.
If junior investigators are unable to obtain research grants from
the NIH, then the prior Government investment in their training will
not translate into future translational medical breakthroughs. These
scientists will simply transfer acquired skills to other career
options.\5\
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\5\ http://www.the-scientist.com/article/display/16526/
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With the doubling of the NIH budget (1993-2003) universities
increased their infrastructure for training life science Ph.Ds and
hired more full-time faculty.\6\ NIH funding has since remained flat,
resulting in decreased rates of grant funding. As a consequence many
academic scientists have either lost their jobs or taken part-time
positions.\7\ The current economic crisis has further amplified the
problem. In recent months, the private sector in the United States laid
off more than 80,000 scientists.\8\ We think the best solution is to
maintain sustained and predictable funding for scientists at all
stages. If the average age when scientists obtain their first source of
independent NIH funding continues to rise (currently 43 years) and
funding bodies continue to restrict many postdoctoral funding
opportunities to 2-5 years, a generation of analytical thinkers will be
forced to find more realistic career options.\9\
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\6\ http://www.sauvonslarecherche.fr/IMG/pdf/the_postdoc_crisis.pdf
\7\ http://sciencecareers.sciencemag.org/career_magazine/
previous_issues/articles/2007_07_13/caredit.a0700099
\8\ http://sciencecareers.sciencemag.org/career_magazine/
previous_issues/articles/2009_04_10/caredit.a0900048
\9\ http://www.brokenpipeline.org/brokenpipeline.pdf
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To maintain economic and global competitiveness, research and
development is essential for the United States to remain competitive in
a global market. Both corporate and Government support of research has
been declining. Innovation is crucial for maintaining global
competitiveness.\10\ Since vision problems are a global economic
concern, the prevention and treatment of ocular disease contributes to
the economic well-being of the United States and international economy.
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\10\ http://www.nsf.gov/statistics/nsb0803/start.htm#research
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NIH and NEI have been leaders in basic research that translates to
better vision therapies. The NEI Director (Paul Sieving, MD, Ph.D.) has
reported that 25 percent of all genes identified to date are associated
with eye disease. Research supported by the NEI is aimed at translating
these genetic discoveries to improved diagnosis and therapy.\11\ \12\
\13\ \14\ \15\ The NEI has worked in association with: (1) the National
Institute on Aging to better diagnose, prevent, and treat age-related
macular degeneration, diabetes, and cataract; (2) The National
Institute of Neurological Disorders and Stroke to protect and
regenerate cells that die from retinal degeneration and glaucoma; and
(3) the National Institute of Diabetes and Digestive and Kidney
Disorders on studies of diabetic retinopathy.
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\11\ http://www.v2020.org/page.asp?section=000100010002
\12\ http://www.v2020eresource.org/newsitenews.aspx?tpath=news22007
\13\ http://www.healthypeople.gov/HP2020/
\14\ http://www.nei.nih.gov/resources/strategicplans/neiplan/
frm_cross.asp
\15\ http://www.nei.nih.gov/amd/
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NEI-sponsored research has resulted in improved therapies for age-
related macular degeneration and diabetic retinopathy, a promising gene
therapy for retinitis pigmentosa, and genetic studies of glaucoma in
minority populations that have a disproportional higher incidence of
glaucoma.\16\
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\16\ http://www.eyeresearch.org/resources/NEI_factsheet.html ARVO
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--To reduce the economic burden of eye disease on the United States
healthcare system
In 2008, 3,638,186 persons in the United States were blind. And 1
in 28 individuals older than age 40 has a visual disability . . . In
2010 more than half of baby boomers will be at high risk for developing
age-related eye diseases. Adequate research funding of studies aimed at
preventing these age related diseases will reduce future healthcare
expenditures, particularly to the Medicare and Medicaid programs.\17\
\18\ \19\
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\17\ http://www.ncbi.nlm.nih.gov/sites/
entrez?cmd=Retrieve&db=pubmed&dopt=AbstractPlus&list_uids=15078664
\18\ http://www.researchamerica.org/uploads/factsheet16vision.pdf
\19\ http://www.preventblindness.org/advocacy/Action_Plan.pdf
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Treatment of eye diseases in the United States costs $68 billion/
year. Vision impaired adults are employed at 44 percent the rate of
healthy individuals and earn an average of $10,000 less per year.\20\
\21\ \22\ Vision science research leads to therapies that delay,
prevent and treat blinding ocular disease, leading to increased
productivity of our work force and savings in the cost of healthcare.
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\20\ http://www.nei.nih.gov/
\21\ http://www.eyeresearch.org/pdf/RA_Vision_08_V5.pdf
\22\ http://www.ncbi.nlm.nih.gov/sites/entrez
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SUMMARY
ARVO urges fiscal year 2010 NIH and NEI funding at $32.4 billion
and $736 million, respectively, reflecting an at least 7 percent
increase more than fiscal year 2009.
______
Prepared Statement of the American Society for Microbiology
The American Society for Microbiology (ASM) is pleased to submit
the following testimony on the fiscal year 2010 appropriation for the
Centers for Disease Control and Prevention (CDC). The ASM supports the
fiscal year 2010 funding level of $8.6 billion for CDC recommended by
the CDC Coalition and the Campaign for Public Health. Funding levels in
recent years have not adequately supported the CDC mission to protect
public health through health promotion and disease prevention. The ASM
appreciates that the administration and Congress have included science
and public health programs in the American Recovery and Reinvestment
Act of 2009. It is essential, however, to also provide increased
funding through the fiscal year 2010 appropriation and future fiscal
years, at levels that sustain CDC programs to protect public health.
There are persistent challenges for the Nation's public health
agencies at the Federal, State, and local levels. Among these are the
nationwide outbreaks of swine influenza, salmonella food poisoning, and
upsurges in vaccine preventable diseases such as measles and
meningitis.
CDC is instrumental in preventing death and illness caused by
infectious diseases, contamination of food or water, or release of
bioterror agents. The recent public health concern surrounding human
cases of swine influenza A (H1N1) virus infection illustrates the
importance of CDC's role in the investigation and response to outbreaks
of infectious diseases. CDC is working closely with officials in States
where human cases of swine influenza A (H1N1) have been identified, as
well as with health officials in other countries experiencing outbreaks
of H1N1. CDC staff are deployed in the United States and
internationally to provide guidance and technical support in response
to this emerging health threat. During a rapidly evolving situation,
CDC is working to reduce transmission and severity of the disease and
to provide information to healthcare providers, public health
officials, and the public.
CDC COMBATS INFECTIOUS DISEASES
CDC mission specific components cover a wide spectrum of disease
control and prevention activities. One of these, the Coordinating
Center for Infectious Diseases (CCID), oversees national centers
focused on immunization and respiratory diseases; zoonotic, vector-
borne and enteric diseases; HIV/AIDS, viral hepatitis, sexually
transmitted diseases and tuberculosis prevention; and healthcare
associated infections, migration, and quarantine. CCID centers use the
latest technological tools and scientific information to respond to
emergent public health challenges as rapidly and effectively as
possible.
Emerging Infectious Diseases.--Newly recognized infectious diseases
attract considerable attention from the public and the research
community, evidenced by swine influenza A (H1N1) virus infection, H5N1
avian influenza, severe acute respiratory syndrome (SARS), HIV/AIDS,
so-called ``mad cow'' disease, West Nile Virus, and methicillin-
resistant Staphylococcus aureus (MRSA) among others. The CDC must
respond to these and other emerging diseases with scientific
proficiency and round-the-clock readiness. The National Center for
Preparedness, Detection, and Control of Infectious Disease's Division
of Emerging Infections and Surveillance Services recruits partnerships
across the CDC and with both national and international organizations,
to track outbreaks and train laboratory scientists from around the
world in preventing and responding to such threats. The CDC has
repeatedly taken part in identifying previously unrecognized pathogens
like the SARS virus. It also participates in relevant field research
around the world.
Influenza Preparedness.--The CDC effort against influenza includes
programs that focus on both seasonal and potential pandemic forms of
the disease, such as human cases of swine influenza A virus infection.
Every year, between 5 and 20 percent of the U.S. population gets the
flu, more than 200,000 are hospitalized, and about 36,000 die. The CDC
works with U.S. partners in health departments, clinical laboratories,
vital statistics offices and healthcare providers to assess the annual
burden of flu. Comprehensive CDC incidence reports use data from nine
different sources, like the Nationally Notifiable Disease Surveillance
System and the Emerging Infections Program's Influenza Project. In
October 2008, the CDC contracted with the American Type Culture
Collection to implement the CDC Influenza Reagent Resource, which will
serve as a source of diagnostic material for laboratories in the event
of an emerging pandemic. The agency also awarded $24 million for 55
projects at 29 State and local health departments to develop better
pandemic preparedness models. Last fall, the Food and Drug
Administration approved a lab test co-developed by CDC that can
reliably detect flu viruses with results within four hours.
CDC extensively monitors the avian influenza virus H5N1 that has
spread throughout Asia, the Middle East, and parts of Europe.
Recognition that the relatively new virus could cause a human pandemic
has mobilized public health institutions worldwide. There have been
only 413 confirmed human cases in 15 countries (by March 30), but the
sustained 60-plus percent mortality is unprecedented for an influenza
virus. The CDC developed a measurement tool to help at-risk countries
assess their ability to respond to an avian influenza pandemic.
Moreover, it continues its laboratory and field research on H5N1 and
other flu viruses. CDC scientists reported last year that some avian
influenza A H7 virus strains have acquired new features that might
boost their potential to cause human disease.
HIV/AIDS.--In August 2008, the CDC released its first estimates of
HIV infections in the United States based on a new CDC-developed
laboratory assay called serologic testing algorithm for recent HIV
seroconversion (STARHS). The results, unfortunately, indicate that
approximately 56,300 new U.S. HIV infections occurred in 2006, about 40
percent higher than CDC's former estimate. The STARHS technology is the
basis for the first national surveillance system relying on direct
measurement of new HIV infections and provides more precise estimates
of HIV incidence. CDC continually tracks the nation's progress against
this recalcitrant disease. For example, the CDC and other health
agencies updated guidelines in March for the prevention and treatment
of opportunistic infections in HIV-infected people.
Global Infectious Diseases.--Infectious diseases are responsible
for 15 million (26 percent) of the 57 million annual deaths worldwide
and the CDC is a valuable contributor to public health campaigns
against these diseases. Examples include its vigorous distribution in
developing countries of Haemophilus influenzae type b (Hib) vaccine.
One of the leading causes of severe childhood pneumonia and meningitis,
Hib disease annually causes an estimated 3 million illnesses and
400,000 deaths worldwide in children 5 years and younger. Hib vaccines
have been widely used in industrialized countries for nearly 20 years,
but underused in the poorest countries. The CDC estimates that this
year use of Hib vaccine in these countries will exceed 80 percent,
compared to less than 20 percent in 2004.
CDC funding supports rigorous research on globally significant
diseases like malaria and tuberculosis, and underwrites incidence data
gathered from around the world. The CDC is developing a network of
Global Disease Detection Centers, along with the participating nations'
ministries of health, academic institutions, the World Health
Organization, and U.S. Departments of State and Defense. Centers
currently operational are located in China, Egypt, Guatemala, Kenya,
Thailand, and, added in 2008, Kazakhstan. They extend the reach of
three established CDC programs in emerging infections, epidemiology
training, and influenza. The Coordinating Office for Global Health
oversees more than 200 CDC staff in more than 50 countries, as first-
responders to disease outbreaks. In 2008, CDC responded to more than 90
international disease outbreaks and public health events and found 22
new pathogens.
An estimated 1.8 million airline passengers cross international
borders daily, opening multiple routes for disease transmission. The
CDC maintains a specific branch to deal with global migration and
quarantine issues, using its GeoSentinel Network Surveillance System to
collect information from 41 sentinel sites and 200 medical clinics in
75 countries around the world. CDC personnel now staff U.S. quarantine
stations at 20 ports of entry and land border crossings. The CDC also
provides U.S. travelers with health threat alerts; educational efforts
last year included recommendations to the U.S. Olympic teams traveling
to China.
Vaccination Campaigns.--CDC collects vaccine-related information to
assist Federal, State, and local health officials. The CDC also invests
considerable resources in educating the public on the importance of
vaccination as a preventive tool. At times, vaccines can also alleviate
disease rather than prevent initial infection. Last year, the CDC
recommended that people age 60 and older be vaccinated against shingles
to reduce the number of painful episodes, even in those with previous
cases. The most recent CDC survey of childhood immunization in this
country found that rates remain at or near record levels, with at least
90 percent coverage for all but one of the recommended series for young
children. Still, more measles cases were reported in 2008 than any year
since 1996 largely due to failure to vaccinate. Another CDC report
concluded that marked reductions in rotavirus-caused gastroenteritis in
U.S. infants and young children may be due to a recently introduced
rotavirus vaccine, recommended by CDC in 2006 for routine immunization
of infants. Rotavirus is the leading cause of severe gastroenteritis in
the young, typically causing 55,000-70,000 U.S. hospitalizations and
about 410,000 physician office visits annually. Every day, rotavirus
kills about 1,600 children under age 5 worldwide.
CDC CONFRONTS HEALTHCARE-ASSOCIATED INFECTIONS, ANTIMICROBIAL
RESISTANCE
Each year, healthcare-associated infections (HAI) account for an
estimated 1.7 million infections and 99,000 associated deaths in the
United States. With more than 1 billion hospital and doctor visits made
by Americans each year, there unfortunately is ample opportunity for
HAI exposure. A CDC report released in March estimates that the annual
direct hospital cost of treating HAI ranges from $28.4 billion to $45
billion, and that improving infection control could save roughly $6
billion to $32 billion, depending on the percentage of infections
preventable in healthcare settings. With 2009 healthcare costs expected
to reach $2.5 trillion, saving resources through CDC-facilitated
prevention clearly offers a sensible public health strategy.
CDC works to optimize practices for HAI prevention. For example,
CDC reports that 85 percent of all invasive infections caused by
methicillin-resistant Staphylococcus aureus (MRSA) are associated with
healthcare settings. CDC guidelines help assure best practices in
healthcare settings. Hospitals in a CDC-supported study reduced
bloodstream and MRSA infections as much as 70 percent by implementing
CDC prevention guidelines. Last September, CDC launched a public MRSA
education campaign.
Antimicrobial resistance has emerged as a daunting global
challenge, increasing the lethality of pathogens from extensively drug-
resistant tuberculosis (XDR TB) to this year's flu virus strain highly
resistant to the most commonly used prescription drug. Last year, 16
CCID surveillance systems and programs gathered incidence data on
antimicrobial resistance among bacterial, fungal, parasitic and viral
agents. CDC scientists are developing laboratory protocols and
diagnostics for a growing list of drug-resistant pathogens. One example
is a new protocol for molecular typing of methicillin-resistant S.
aureus. The CDC's Antimicrobial Resistance Team also recently validated
tests that will amend 2009 clinical and lab standards in testing
microbial resistance to mupirocin (used for staph infections) and the
carbapenem drugs used to treat enteric pathogens resistant to most
other drugs.
CDC STRENGTHENS NATIONAL DEFENSES AGAINST BIOTERRORISM, PUBLIC HEALTH
CRISES
The CDC's Terrorism, Preparedness and Emergency Response (TPER)
funds support the Coordinating Office for Terrorism Preparedness and
Emergency Response objectives. CDC provides science-based strategies
and tactical coordination during public health events and maintains
emergency response operations like the Strategic National Stockpile
(SNS) and the Emergency Operations Center (EOC). The SNS is an
invaluable national repository of antibiotics, antitoxins and other
medical supplies that can be mobilized rapidly to augment State and
local resources during a large-scale health emergency. Opened in 2003,
the DEOC is staffed with experts 24/7/365, an integral part of the
country's National Incident Management System.
The CDC's inaugural annual report on its TPER-funded activities
released in January enumerates its wide-ranging activities. Activities
include assessing current administration routes and dosage for anthrax
vaccine, inspecting 110 research entities registered to possess
microbes on the Federal select agents list, and mapping the DNA of the
vaccinia virus (similar to smallpox virus) and tularemia bacteria for
greater scientific insight into potential bioagents. TPER-funded
capabilities help CDC respond more aggressively to public health crises
of all kinds, far beyond the threat of bioterrorism. In fiscal year
2008, the EOC was activated in response to 55 domestic and 16
international events, including the floods in the Midwest, multistate
Salmonella and E.coli 0157 outbreaks, and outbreaks of cholera and
hemorrhagic fever in Africa.
The ASM concurs with the recommended level of $8.6 billion, which
will provide needed new funding for CDC's programs that are so critical
to protecting people in the United States and worldwide.
______
Prepared Statement of the American Society for Microbiology
The American Society for Microbiology (ASM) appreciates the
opportunity to submit a written statement on the fiscal year 2010
budget for the National Institutes of Health (NIH). The ASM is the
largest single life science society with more than 42,000 members, many
of whom receive funding from the NIH. We are grateful for the $10.4
billion increase in funding for the NIH in the American Recovery and
Reinvestment Act (ARRA) and the 3.2 percent increase in funding for NIH
in the fiscal year 2009 Labor, Health and Human Services, and
Education, and Related Agencies Appropriations Act. The additional ARRA
funding enables NIH to support the ARRA goals to create and save jobs
and increase purchasing power, as well as advance scientific research.
The Nation's biomedical research enterprise will be kept more robust at
a time when it is experiencing the adverse effects of the economic
downturn and years of flat funding.
As Congress considers the fiscal year 2010 appropriation for NIH,
the ASM recommends a budget of $32.4 billion, a 7 percent increase. The
recommended funding increase will help NIH keep pace with expanded
research opportunities and higher costs. It is important for NIH to
prepare for the poststimulus years, in 2011 and beyond. It is also
important to resume sustainable NIH funding, avoiding fluctuations for
research and training programs that can disrupt projects, training,
careers, and research progress. To perpetuate the benefits of ARRA
funding, it is vitally important to provide sustained growth for the
NIH in fiscal year 2010 and beyond.
More than 83 percent of the NIH budget is awarded through 50,000
competitive grants awarded to more than 325,000 researchers at more
than 3,000 universities, medical schools, and other institutions in all
50 States. About 10 percent of the NIH budget supports research in NIH
laboratories conducted by nearly 6,000 scientists. Research project
grants are highly productive in terms of medical advances to benefit
public health. NIH funding contributes to the Nation's economic
recovery by stimulating new opportunities and investments in
biotechnology and related industries, as well as expanding the skilled
workforce critical to U.S. competitiveness in science and technology.
NIH funding also impacts allied health workers, technicians, students,
trade workers, and others who receive the leveraged benefits from NIH
funding.
The following describes some of the compelling reasons for
increased and sustained support for the NIH research mission and its
proven benefit to technological innovation and public health.
NIH RESEARCH IS CRITICAL TO SCIENTIFIC PROGRESS
NIH Institutes and Centers fund research programs that address the
Nation's challenges of safeguarding public health, security, and the
economy. The National Institute of Allergy and Infectious Diseases
(NIAID), for example, focuses on research to understand, treat, and
prevent infectious, immunologic, and allergic diseases, leading to the
development of vaccines, therapies and diagnostic tools. The NIAID also
funds research on medical countermeasures against potential bioterror
agents. The National Institute of General Medical Sciences (NIGMS)
supports basic research on life processes in fields such as
computational biology, genetics, and bioinformatics. NIH resources
invested in the agency-wide Roadmap initiatives make possible projects
that hold great potential but might otherwise not be funded due to
difficulty and scope. Recently funded Roadmap projects include a
network of nine centers using high-tech screening methods for drug
discovery.
The NIH funding to individual researchers and research groups,
through competitive peer-reviewed grants, is of particular consequence
to the U.S. research enterprise. More than 120 discoveries made by NIH
and NIH-supported researchers have garnered Nobel Prizes, and NIGMS has
funded the Nobel Prize-winning work of 64 scientists. More than three-
fourths of the U.S. recipients of the Nobel Prize in Physiology or
Medicine received NIH support prior to their award. In fiscal year 2009
NIH is striving to lower the average age of first-time grant recipients
to refresh the Nation's scientific investigator pool and help
revitalize research in the United States. Our national anxiety over
waning global competitiveness and a shrinking technical workforce
argues for sustained NIH funding for both new and established
investigators.
NIH investigator-initiated grants create new opportunities for
original biomedical inquiry and expand training environments for
students in technical fields. Investigator-initiated research projects
lead to inventive solutions for medical problems. Each year, NIH also
identifies, in consultation with the extramural research community,
targeted areas within an emerging need or opportunity, and then
requests grant applications from U.S. researchers. Focused
opportunities announced last year by NIAID include studies to advance
vaccine safety and development of assays for high-throughput drug
screening. NIGMS-featured areas currently include computational models
to detect, control, and prevent emerging infectious diseases. NIGMS
also awards grants for nontraditional research through its Exceptional,
Unconventional Research Enabling Knowledge Acceleration (EUREKA)
program. NIH has placed new emphasis on supporting high-impact
transformative research that might create new disciplines,
revolutionary technologies, or otherwise radically change biomedical
research. In 2008, it initiated transformative grant funding to foster
investigator-initiated work considered high-risk but exceptionally
promising.
NIH RESEARCH YIELDS MEDICAL ADVANCES
NIH supported research consistently produces significant
discoveries with both real-world relevance and potential future use
against emerging health threats. The following are selected examples of
recently reported research that illustrate the vitality and creativity
supported by NIH funding.
Antimicrobial Resistance and Drug Discovery.--Drug resistance
spreading among microbial pathogens is complicating control of
infectious diseases and adding to rising healthcare costs. Response by
U.S. research institutions has been aggressive, including creation of a
Federal Interagency Task Force co-chaired by NIAID, the Centers for
Disease Control and Prevention, and the Food and Drug Administration.
Causes of drug resistance are many, from overuse of prescription drugs
to natural microbial mutations, and NIAID's research portfolio is
equally diverse. In fiscal year 2007, the Institute invested more than
$800 million to support basic and translational research on
antimicrobials and on drug resistance. Recent results include:
--Scientists from NIAID, California, and China studied the genetics
of the major strain of methicillin-resistant Staphylococcus
aureus (MRSA), concluding that a radical shift may be needed in
how scientists design MRSA therapeutics. MRSA causes an
estimated 94,000 cases of infection annually in the United
States, with more than 19,000 deaths.
--NIGMS-funded researchers are developing a new generation of
antibiotic compounds that do not elicit drug resistance. The
enzyme-inhibitor compounds interfere with ``quorum sensing''--a
process by which bacteria communicate with each other. Those in
the current study work against Vibrio cholerae, which causes
cholera, and E. coli 0157:H7, the food contaminant that
annually causes about 110,000 illnesses in the United States.
To circumvent antimicrobial resistance, NIH researchers and their
extramural collaborators are intensifying research strategies better
suited to rapidly changing pathogens and disease demographics. These
include state-of-the-art technologies that fuel 21st century drug
discovery. A recent example is NIGMS-funded research using mass
spectrometry technology to determine the molecular structure of a class
of natural compounds called nonribosomal peptides (NRPs), intensely
studied for their drug potential (penicillin is an NRP). A significant
advance over previous approaches, it may help reprogram nonpathogenic
E. coli into NRP minifactories.
Infectious Diseases.--Infectious diseases remain among the most
difficult global health challenges, accounting for about one-quarter of
all deaths and nearly two-thirds in sub-Saharan Africa. At NIAID and
NIGMS, multiple programs and interdisciplinary strategies target the
major causes of global death and disability, with cutting-edge tools
like genomics and nanotechnology.
Influenza.--Despite the availability of influenza drugs and
vaccines, seasonal influenza still kills more than 250,000 people
worldwide each year. Public health officials are now concerned about
reports that 98 percent of a H1N1 influenza virus strain (1 of 3
circulating in the 2008-2009 season) are resistant to oseltamivir
(Tamiflu), the leading influenza drug, compared to 11 percent
resistance among all viral strains during the 2007-2008 season. The
possibility of an influenza pandemic caused by the more lethal H5N1
avian flu virus has mobilized an international response from health
agencies and medical researchers. In January, the Department of Health
and Human Services awarded a contract to build the first U.S.
manufacturing facility for cell-based influenza vaccines, expected to
increase the Nation's current capacity to make vaccine by at least 25
percent and much less time. NIH funding contributed to this major
advance in vaccine production and to other recent advances, such as:
--NIAID-supported scientists used new monoclonal techniques to create
human influenza-fighting antibodies in the laboratory in a
matter of weeks, rather than the months previously required.
The antibodies have potential for diagnosis and treatment
regimens that can respond more quickly to newly emerging
strains of influenza.
--NIGMS-funded researchers used super-computer capabilities to
identify more than two dozen new candidate drugs to treat avian
influenza (``bird flu''), in preparation for a possible
pandemic of drug-resistant H5N1 virus strains.
--Three research teams and a computer informatics group--part of the
NIGMS-funded Models of Infectious Disease Agent Study (MIDAS)
Network--modeled pandemic influenza in the United States,
concluding mitigation is possible with prompt, coordinated use
of social-distancing measures and antiviral treatment until
vaccine is available.
HIV/AIDS.--An estimated 33 million adults and children are living
with HIV infection worldwide, and about 2 million die each year from
related causes. In the United States, where nearly 546,000 people have
died thus far from HIV/AIDS-related illnesses, there currently are an
estimated 1.1 million infected, with 21 percent unaware of their
infection. HIV/AIDS as both a domestic and global threat is a high
priority at NIH. Difficulties in developing preventative vaccines
prompted a 2008 NIH vaccine summit and subsequent re-examination of
NIH's research agenda. NIH-supported basic research is steadily adding
to our understanding of HIV/AIDS, evidenced by recent discoveries in
mechanisms of HIV protease inhibition and the NIGMS-funded success in
seeing microscopically for the first time molecules grouping in living
cells to form single HIV particles. Other recent advances include:
--A vaginal gel to prevent HIV infection in women has shown
encouraging signs of success in a clinical trial in Africa and
the United States. This is the first human clinical study to
suggest that a microbicide may prevent male-to-female sexual
HIV transmission.
--An extended course of the antiretroviral drug nevirapine helps the
breastfeeding babies of HIV-infected mothers remain HIV-
negative and live longer, according to several new studies.
About 150,000 infants worldwide acquire HIV annually through
breastfeeding.
--The incidence of childhood illness and death due to HIV infection
can be dramatically decreased by testing very young babies for
HIV and giving antiretroviral therapy (ART) immediately to
those found infected--giving ART to HIV-infected infants
beginning at an average age of 7 weeks made them four times
less likely to die in the next 48 weeks.
Tuberculosis.--One-third of the world's 6.7 billion people are
thought to be infected by Mycobacterium tuberculosis (Mtb), the microbe
that causes tuberculosis. An estimated 13.7 million have the active
form. Each year, about 1.7 million die from this age-old disease that
has adopted some disturbing modern-day features, striking as co-
infections with the HIV virus and becoming resistant to drug therapies
used to treat tuberculosis. In 2007, about 9.3 million people developed
new cases of TB; 1.37 million were also HIV positive. The rapid spread
of multidrug- and extensively drug-resistant forms (MDR TB/XDR TB) is
alarming--MDR TB currently accounts for an estimated 5 percent of all
TB cases and the frequently fatal XDR TB has been detected in 46
countries thus far. In April 2008, NIAID launched an aggressive
research agenda against drug-resistant tuberculosis. NIH-supported
research from the past year includes:
--NIAID scientists and industry collaborators found that, when the
candidate TB drug PA-854 is metabolized inside Mtb bacteria, a
lethal dose of nitric oxide gas is produced, killing the
pathogen and suggesting new ways to develop drugs capable of
killing latent TB bacteria. Currently there are no drugs
available to target latent tuberculosis infections.
--Scientists reported that two FDA-approved drugs work in tandem to
kill the tuberculosis pathogen and could help counter drug-
resistant forms. The drugs are already used to treat other
bacterial diseases, but their effectiveness against TB bacteria
had not been studied. NIAID is planning a clinical trial this
year in patients with MDR TB and XDR TB.
Malaria.--Nearly half of the world's population is at risk of
contracting malaria, a preventable and curable mosquito-borne disease
in more than 100 countries. The World Health Organization (WHO)
estimates that 300 to 500 million cases of clinical malaria worldwide
occur each year, killing 1.3 million people. Unfortunately, its impact
is intensifying with the emergence of drug-resistant parasites and
insecticide-resistant mosquitoes. In April 2008, NIAID announced its
new strategic plan to accelerate malaria control and eradication. NIH
research often involves international partners and encompasses all
aspects of malaria, including these recent examples:
--NIGMS funding supported the genetic decoding of the parasite
responsible for 40 percent of infections, Plasmodium vivax, 1
of 4 malaria parasites that routinely affect humans. The most
common species outside Africa (including the United States), P.
vivax is increasingly resistant to some antimalarial drugs.
--The NIAID-funded Malaria Research and Training Center in Mali
completed the first clinical trial of a vaccine to block the
malaria parasite from entering human blood cells.
--NIGMS-supported research described how harmless E. coli bacteria
can be harnessed to synthesize an antimalarial compound in
bulk, far less expensive than the current process.
INFECTIOUS DISEASE RESEARCH USES INTERDISCIPLINARY STRATEGIES AND NEW
TECHNOLOGIES
NIAID and NIGMS, like other NIH Institutes and Centers, support
productive basic research on literally hundreds of diseases, from
periodic foodborne E. coli or Salmonella outbreaks to isolated cases of
Ebola fever or anthrax. This enormous responsibility forces constant
adaptation to new challenges, often through greater reliance on
interdisciplinary strategies or novel research tools and technologies--
epitomized by the large-scale, genetics-based initiatives made possible
with today's powerful computing capabilities. In 2008, NIH launched a
multi-Institute epigenomics initiative to better understand the role of
the environment in regulating mammalian genes, through genome mapping,
data analysis, and technology development. NIH also agreed to share
databases from its Human Microbiome Project in support of the newly
formed International Human Microbiome Consortium. Characterizing the
human microbiome, which is the collective DNA of all the microbes
living in or on the human body, will elucidate the relationship between
microbes and humans during health and disease. Shared sample
repositories overseen by databases expedite information exchange among
scientists. Computerized screening of pathogen genomes similarly
accelerates the search for treatments, vaccines, and diagnostics.
CONCLUSION
ASM is thankful that Congress recognizes both the medical benefits
and economic impacts of biomedical research and has provided an
infusion of funding for the NIH to uncover new knowledge that will
improve public health. Investing in NIH will impact the health of
people for years to come and the biomedical community is working to
ensure wise investment of the new resources in fiscal year 2009. We are
confident that investments in the NIH will result in new discoveries
and innovations that can address many of our health and economic
challenges.
______
Prepared Statement of the American Society for Nutrition
The American Society for Nutrition (ASN) appreciates this
opportunity to submit testimony regarding fiscal year 2010
appropriations for the National Institutes of Health (NIH) and the
National Center for Health Statistics (NCHS). ASN is the professional
scientific society dedicated to bringing together the world's top
researchers, clinical nutritionists, and industry to advance our
knowledge and application of nutrition to promote human and animal
health. Our focus ranges from the most critical details of research to
very broad societal applications. ASN respectfully requests $32.4
billion for NIH, and we request $137.5 million for NCHS in fiscal year
2010.
Basic and applied research on nutrition, nutrient composition, the
relationship between nutrition and chronic disease and nutrition
monitoring are critical to the health of all Americans and the U.S.
economy. Awareness of the growing epidemic of obesity and the
contribution of chronic illness to burgeoning healthcare costs has
highlighted the need for improved information on dietary components,
dietary intake, strategies for dietary change, and nutritional
therapies. Preventable chronic diseases related to diet and physical
activity cost the economy more than $117 billion annually, and this
cost is predicted to rise to $1.7 trillion in the next 10 years. It is
for this reason that we urge you to consider these recommended funding
levels for two agencies under the Department of Health and Human
Services that have profound effects on nutrition research, nutrition
monitoring, and the health of all Americans--NIH and NCHS.
NIH
NIH is the Nation's premier sponsor of biomedical research and is
the agency responsible for conducting and supporting 90 percent (nearly
$1 billion) of federally funded basic and clinical nutrition research.
Nutrition research, which makes up about 4 percent of the NIH budget,
is truly a trans-NIH endeavor, being conducted and funded across
multiple Institutes and Centers. Some of the most promising nutrition-
related research discoveries have been made possible by NIH support.
In order to fulfill the extraordinary promise of biomedical
research, including nutrition research, ASN recommends an fiscal year
2010 funding level of $32.4 billion for the agency, which is a 7
percent increase ($2.1 billion) more than fiscal year 2009.
Over the past 50 years, NIH and its grantees have played a major
role in the explosion of knowledge that has transformed our
understanding of human health, and how to prevent and treat human
disease. Because of the unprecedented number of breakthroughs and
discoveries made possible by NIH funding, scientists are helping
Americans to live longer, healthier, and more productive lives. Many of
these discoveries are nutrition-related and have impacted the way
clinicians prevent and treat heart disease, cancer, diabetes, and age-
related macular degeneration.
During the next 25 years, the number of Americans with chronic
disease is expected to reach 46 million, and the number of Americans
older than age 65 is expected to be the largest in our Nation's
history. Sustained support for basic and clinical research is required
if we are to confront successfully the healthcare challenges associated
with an older, and potentially sicker, population.
For several years in a row the NIH budget failed to keep up with
inflation and subsequently, the percentage of dollars funding
nutrition-focused projects declined. We applaud Congress' inclusion of
funds for NIH in H.R. 1, the American Recovery and Reinvestment Act,
and also the boost provided in the fiscal year 2009 omnibus
appropriations bill. It is imperative that we continue our commitment
to biomedical research and to fulfill the hope of the American people
by making the NIH a national priority. Otherwise, we risk losing our
Nation's dominance in biomedical research.
The 7 percent increase we recommend is an important step toward
President Obama's campaign pledge to double funding for basic research
over 10 years and is necessary to maintain both the existing and future
scientific infrastructure. The discovery process--while it produces
tremendous value--often takes a lengthy and unpredictable path. Recent
experience has demonstrated how cyclical periods of rapid funding
growth followed by periods of stagnation is disruptive to training, to
careers, long-range projects and ultimately to progress. NIH needs
sustainable and predictable budget growth to achieve the full promise
of medical research to improve the health and longevity of all
Americans.
CDC NCHS
NCHS, housed within the Centers for Disease Control and Prevention
(CDC), is the Nation's principal health statistics agency. The NCHS
provides critical data on all aspects of our healthcare system, and it
is responsible for monitoring the Nation's health and nutrition status.
Nutrition and health data, largely collected through the National
Health and Nutrition Examination Survey (NHANES), is essential for
tracking the health and well-being of the American population, and it
is especially important for observing health trends in our Nation's
children. Knowing both what Americans eat and how their diets directly
affect their health provides valuable information to guide policies on
food safety, food labeling, food assistance, military rations, and
dietary guidance.
Over the past few years, flat and decreased funding levels have
threatened the collection of this important information, most notably
vital statistics and the NHANES. ASN was pleased to see that Congress
appropriated an additional $11 million to the agency--for nearly $125
million total--in fiscal year 2009. This halted what would have been
the beginning of drastic cuts to the agency's premier health surveys--
NHANES and the National Health Information Survey--that were slated to
occur should the agency not receive additional funds.
To continue support for the agency and its important mission, ASN
recommends an fiscal year 2010 funding level of $137.5 million for the
agency, which is a $12.5 million increase over fiscal year 2009.
Current funding levels for NCHS remain precarious. Before the
recent increase in funds, NCHS had lost $13 million in purchasing power
since fiscal year 2005 due to years of flat funding, coupled with
inflation and the increased costs of technology and information
security. These shortfalls forced the elimination of data collection
and quality control efforts, threatened the collection of vital
statistics, stymied the adoption of electronic systems and limited the
agency's ability to modernize surveys to reflect changes in demography,
geography, and health delivery.
Moreover, nearly 30 percent of the funding for NHANES comes from
other Federal agencies such as the NIH and the Environmental Protection
Agency. When these agencies face flat budgets or cuts, they withdraw
much-needed support for NHANES, placing this national treasure in even
greater jeopardy.
The obesity epidemic is a case in point that demonstrates the value
of the work done by NCHS. It is because of NHANES that our Nation
became aware of this growing public health problem, and as obesity
rates have increased to 31 percent of American adults (which we know
because of continued monitoring), so too have rates of heart disease,
diabetes, and certain cancers. It is only through continued support of
this program that the public health community will be able to stem the
tide against obesity. Continuous collection of this data will allow us
to determine not only if we have made progress against this public
health threat, but also if public health dollars have been targeted
appropriately. A recent report from the Institute of Medicine
recognized the importance of NHANES and called for the enhancement of
current surveillance systems to monitor relevant outcomes and trends
with respect to childhood obesity.
Providing an additional $12.5 million in fiscal year 2010 continues
the progress on the path to boost funding for the NCHS to $175 million
by 2013. Reaching this level over 5 years, through annual increases of
approximately $11-12 million, would allow the agency to reach what its
supporters call ``blue sky.'' Such an increase would ensure
uninterrupted collection of vital statistics and sustain over-sampling
of vulnerable populations.
ASN thanks your subcommittee for its support of the NIH and NCHS in
previous years.
______
Prepared Statement of the American Society of Plant Biologists
On behalf of the American Society of Plant Biologists (ASPB) we
would like to thank the subcommittee for its extraordinary support of
the National Institutes of Health (NIH) and ask that the subcommittee
members encourage increased funding for plant biology research, which
has contributed in innumerable ways to improving the lives of people
throughout the world.
ASPB is an organization of more than 5,000 professional plant
biologists, educators, graduate students, and postdoctoral scientists.
A strong voice for the global plant science community, our mission--
which is achieved through engagement in the research, education, and
public policy realms--is to promote the growth and development of plant
biology and plant biologists and to foster and communicate research in
plant biology. The Society publishes the highly cited and respected
journals Plant Physiology and The Plant Cell, and it has produced and
supported a range of materials intended to demonstrate fundamental
biological principles that can be easily and inexpensively taught in
school and university classrooms by using plants.
PLANT BIOLOGY RESEARCH AND AMERICA'S FUTURE
Plants are vital to our very existence. They harvest sunlight,
converting it to chemical energy for food and feed; they take up carbon
dioxide and produce oxygen; and they are almost always the primary
producers in the Earth's ecosystems. Plants and plant-based products
directly or indirectly provide our food, our shelter, and our clothing.
Basic plant biology research is making many fundamental
contributions in vital areas including health and nutrition, energy,
and climate change. For example, because plants are the ultimate source
of both human nutrition and nutrition for domestic animals, plant
biology has the potential to contribute greatly to reducing healthcare
costs as well as playing an integral role in drug discovery and
therapies. Although the NIH does offer some funding support to plant
biology research, with increased funding plant biologists can offer
much more to advance the missions of the NIH. In the next section, we
highlight the particular relevance of plant biology research to human
health.
PLANT BIOLOGY AND THE NIH
The mission of the NIH is to pursue ``fundamental knowledge about
the nature and behavior of living systems and the application of that
knowledge to extend healthy life and reduce the burdens of illness and
disability'' (http://www.nih.gov/about/index.html#mission). Plant
biology research is highly relevant to this mission.
Plants are often the ideal model systems to advance our
``fundamental knowledge about the nature and behavior of living
systems,'' as they provide the context of multi-cellularity, while
affording ease of genetic manipulation, a lesser regulatory burden, and
inexpensive maintenance requirements. Many basic biological components
and mechanisms are shared by both plants and animals. For example, a
molecule named cryptochrome that senses light was identified first in
plants and subsequently found to also function in humans, where it
plays a central role in regulating our biological clock. Jet lag
provides one familiar example of what happens to us when our biological
clock is disrupted, but there are also human genetic disorders that
have been linked to malfunctioning of the clock. As another example,
some fungal pathogens can infect both humans and plants.
HEALTH AND NUTRITION
Plant biology research is also central to the application of basic
knowledge to ``extend healthy life and reduce the burdens of illness
and disability.'' This connection is most obvious in the inter-related
areas of nutrition and clinical medicine. Without good nutrition, there
cannot be good health. One World Health Organization (WHO) study on
childhood nutrition in developing countries concluded that more than 50
percent of the deaths of children less than 5 years of age could be
attributed to malnutrition's effects in exacerbating illnesses such as
respiratory infections and diarrhea. In other words, those illnesses
would not have proved fatal had the children simply received proper
nutrition. Strikingly, most of these deaths were not linked to severe
malnutrition but only to mild or moderate nutritional deficiencies.
Plant biology researchers are working today to improve the nutritional
content of crop plants by, for example, increasing the availability of
nutrients and vitamins such as iron, vitamin E and vitamin A. (Up to
500,000 children in the developing world go blind every year as a
result of vitamin A deficiency).
By contrast, obesity, cardiac disease, and cancer take a striking
toll in the developed world. Among many plant biology initiatives
relevant to these concerns are research to improve the lipid
composition of plant fats and efforts to optimize concentrations of
plant compounds that are known to have anti-carcinogenic properties,
such as the glucosinolates found in broccoli and cabbage.
DRUG DISCOVERY
Plants are also fundamentally important as sources of both extant
drugs and drug discovery leads. In fact, more than 10 percent of the
drugs considered by the WHO to be ``basic and essential'' are still
exclusively obtained from flowering plants. Some historical examples
are quinine, which is derived from the bark of the cinchona tree and
was the first highly effective antimalarial drug; and the plant
alkaloid morphine, which revolutionized the treatment of pain.
These pharmaceuticals are still in use today. A more recent example
of the importance of plant-based pharmaceuticals is the anti-cancer
drug taxol. The discovery of taxol came about through collaborative
work involving scientists at the National Cancer Institute within NIH
and plant biologists at the U.S. Department of Agriculture. The plant
biologists collected a wide diversity of plant materials, which were
then evaluated for anti-carcinogenic properties. It was found that the
bark of the Pacific yew tree yielded one such compound, which was
eventually isolated and named taxol after the tree's Latin name, Taxus
brevifolia. Originally, taxol could only be obtained from the tree bark
itself, but basic research led to identification of its molecular
structure and eventually to its chemical synthesis in the laboratory.
On the basis of a growing understanding of metabolic networks,
plants will continue to be sources for the development of new medicines
to help treat cancer and other ailments. Taxol is just one example of a
plant secondary compound. Since plants produce an estimated 200,000
such compounds, they will continue to provide a fruitful source of new
drug leads, particularly if collaborations such as the one described
above can be fostered and funded. With additional research support,
plant biologists can lead the way to developing new medicines and
biomedical applications to enhance the treatment of devastating
diseases.
CONCLUSION
Despite the fact that plant biology research underlies so many
vital practical considerations for our country, the amount invested in
understanding the basic function and mechanisms of plants is small when
compared with the impacts of this information on multibillion dollar
sectors of the economy such as health, energy, and agriculture.
Clearly, the NIH does recognize that plants are a vital component
of its mission. However, because the boundaries of plant biology
research are permeable and because information about plants integrates
with many different disciplines that are highly relevant to NIH, ASPB
hopes that the subcommittee will provide additional resources through
increased funding to NIH for plant biology in order to help pioneer new
discoveries and new methods in biomedical research.
______
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 (NIH) fiscal year 2010 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 therapeutics work in humans.
ASPET members recognize the trust and support that Congress
displayed with the recent $10.4 billion provided to the NIH in the
American Recovery and Reinvestment Act (ARRA). This was a visionary
attempt by Congress to stimulate the economy by restoring their
historic support of the NIH which has lagged over the last 6 years as
appropriations have failed to adequately fund the NIH to meet
scientific opportunities and challenges to our public health. Prior to
ARRA funding, the NIH research portfolio could barely keep pace with
the inflation rate and the country's leadership in biomedical research
was in danger. Since the completion of a bipartisan plan to double the
NIH budget that ended in 2003 and prior to ARRA funding, the NIH budget
had been going backwards.
For fiscal year 2010, ASPET urges Congress to increase funding for
the NIH by 7 percent. This would be the first step toward the
President's pledge to double funding for basic research over 10 years
and importantly, would help to maintain existing and future scientific
infrastructure. Scientific discovery takes time and a 7 percent
increase in fiscal year 2010 and beyond will help NIH manage its
research portfolio effectively without necessitating disruptions in
continuity of existing grants to researchers throughout the country.
Only through sustainable and predictable funding can NIH continue to
fund the highest-quality biomedical research to help improve the health
of all Americans and continue to make significant economic impact in
many communities across the country. Failing to capitalize upon the
ARRA investments in fiscal year 2010 and beyond will mean that NIH will
have to dismantle newly built research capacity and terminate important
research projects after the ARRA funds have been spent. This would have
serious consequences for future scientific discovery. Scientific
discovery takes time and is unpredictable. As recent experience has
shown from the postdoubling experience, boom and bust cycles of rapid
funding followed by significant periods of stagnation or retraction in
the NIH budget diminish scientific process. If NIH cannot sustain its
recent investments from the ARRA, a rapid diminishment of funding will
further disrupt scientific careers among promising young and early
career scientists who see little hope of promising and rewarding
careers in biomedical research. It is critical to avoid a boom and bust
cycle for NIH funding. Thus, appropriating NIH a 7 percent increase
beginning in fiscal year 2010 will help achieve the full promise of
biomedical research.
NIH IMPROVES HUMAN HEALTH AND IS AN ECONOMIC ENGINE
A 7 percent increase in fiscal year 2010 will help to reverse what
ASPET feels is a wrong signal that has been sent to the best and
brightest of our students who will not be able to or have chosen not to
pursue a career in biomedical research. Failing to address the NIH
scientific and infrastructure needs post-ARRA in 2010 and beyond will
mean a significant reduction in research grants, jobs lost and the
resulting phasing-out of research programs. Additionally, there would
be a loss of scientific opportunities to discover new therapeutic
targets to develop, and fewer discoveries that produce spin-off
companies that employ individuals in districts around the country. A 7
percent increase would provide the Institutes with an opportunity to
fund more high-quality and innovative research, and provide the
resources and incentives that will drive more young scientists to
commit to careers supporting continuing improvements in public health.
This investment will also go directly into supporting jobs for U.S.
citizens and residents and will continue to stimulate the economy.
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. NIH studies have indicated that adopting
intensive lifestyle changes delayed onset of type 2 diabetes by 58
percent and that progesterone therapy can reduce premature births by 30
percent in women at risk.
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. Eight out of
ten 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 NIH can maintain an adequate funding stream scientific
opportunities will be delayed, lost, or forfeited to biomedical
research opportunities in other countries and the human and economic
cost will continue to impact all of us.
Scientific inquiry leads to better medicine and there remain many
challenges and opportunities that need to be addressed. Two issues
specific to ASPET highlight the need for appropriate NIH funding
levels.
--The need to increase support for training and research in
integrative/whole organ science. This will help to develop
skilled scientists trained to understand how drugs act in whole
animals, including human beings. Support for training and
research in integrative whole organ sciences has been affirmed
in the fiscal year 2002 Labor, Health and Human Services, and
Education, and 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.
--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. 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
NIH and the biomedical research enterprise face a critical moment.
For the first time in 6 years, NIH has the potential to meet many of
the more promising scientific opportunities that currently challenge
medicine. Reversing the trends of the last half decade is only part of
the solution. In order to help sustain scientific progress it is
critical that NIH receive 7 percent to continue the progress made under
the ARRA. A 7 percent increase for the NIH in fiscal year 2010 will
permit the NIH to make greater strides to prevent, diagnose and treat
disease, improving the health of our Nation and restoring the NIH to
its role as a national treasure that attracts and retains the best and
brightest to biomedical research.
______
Prepared Statement of the American Society of Tropical Medicine and
Hygiene
OVERVIEW
The American Society of Tropical Medicine and Hygiene (ASTMH)
appreciates the opportunity to submit written testimony to the Senate
Labor, Health and Human, Services, and Education, and Related Agencies
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 respectfully request that the subcommittee provide the following
allocations in the fiscal year 2010 Labor, Health and Human, Services,
and Education, and Related Agencies Appropriations bill to support a
comprehensive effort to enhance malaria control programming globally:
--$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;
--$32.19 billion to National Institutes of Health (NIH);
--$5.07 billion to the National Institute of Allergy and Infectious
Diseases (NIAID); and
--$73.5 million to the Fogarty International Center (FIC).
We very much appreciate the subcommittee's consideration of 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 global health by
preventing and controlling tropical diseases through research and
education. As such, ASTMH 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 nonprofit environments, including academia, the U.S.
military, public institutions, Federal agencies, private practice, and
industry.
ASTMH's long and distinguished history goes back to the early 20th
century. The current organization was formed in 1951 with the
amalgamation of the National Malaria Society and the ASTMH. Over the
years, the Society has counted many distinguished scientists among its
members, including Nobel Laureates. ASTMH and its members continue to
have a major impact on the tropical diseases and parasitology research
carried out around the world.
ASTMH aims to advance policies and programs that prevent and
control those tropical diseases which particularly impact the global
poor. ASTMH supports and encourages Congress to expand funding for--and
commitments to--national and international malaria control initiatives.
As part of this effort, ASTMH recently conducted an analysis of
federally funded tropical medicine and disease programs and developed
fiscal year 2010 funding requests based on this assessment.
TROPICAL MEDICINE AND TROPICAL DISEASES
The term ``tropical medicine'' refers to the wide-ranging clinical,
research, and educational efforts of physicians, 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 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 transmitted to humans by the female
Anopheles mosquito.
Malaria is an acute, often fatal disease caused by a single-celled
parasite transmitted to humans by the female Anopheles mosquito.
Malaria can cause anemia, jaundice, kidney failure, and death. Despite
being treatable and preventable, malaria is one of the leading causes
of death and disease worldwide. The World Health Organization (WHO)
estimates there were 350 to 500 million malaria cases in 2000 and at
least 1 million deaths from malaria, the vast majority of which were
among young children in Africa. WHO estimates that one-half of the
world's people are at risk for malaria, and that 109 countries are
endemic for malaria. Malaria-related illness and mortality not only
take a human toll, but also severely impact economic productivity and
growth. The WHO has estimated that malaria reduces sub-Saharan Africa's
economic growth by up to 1.3 percent per year.
Fortunately, malaria can be both prevented and treated using four
types of relatively low-cost interventions: (1) 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 adequately funding the important
contributions of CDC. CDC originally grew out of the WWII ``Malaria
Control in War Areas'' program. Since its founding, the Atlanta-based
agency has maintained a strong role in efforts to research and mitigate
malaria. Although malaria has been eliminated as an endemic threat in
the United States for more than 50 years, CDC remains on the cutting
edge of global efforts to reduce the toll of this deadly disease.
CDC efforts on malaria fall into three broad areas--prevention,
treatment, and vaccines. The agency performs a wide range of basic
research within these categories, such as--
--investigation of the biology of host-parasite relationships;
--immune response to malaria;
--host genetic factors associated with malaria; parasite genetic
diversity and drug resistance;
--HIV and malaria interaction; the efficacy of insecticide-treated
nets in preventing illness and deaths;
--malaria and pregnancy;
--public health strategies for improving access to antimalarial
treatment and delaying the appearance of antimalarial drug
resistance;
--improved transmission reduction strategies; and
--vaccine development and evaluation.
Although endemic malaria has been eradicated in the United States,
it remains one of world's leading causes of death and disease, and a
significant proportion of CDC's malaria-focused work involves working
in and with foreign countries to prevent the spread of malaria, and to
assist in the treatment of those who have contracted the disease. CDC
funding in fiscal year 2009 for global malarial activities is
$9,396,000, which includes CDC's contribution to the $6.2 billion
President's Malaria Initiative.
CDC participates in several global efforts, including:
--The President's Malaria Initiative (PMI).--The PMI is a $6.2
billion, 9-year effort led by the U.S. Agency for International
Development in conjunction with CDC and other Government
agencies to lower the incidence of malaria in 15 targeted
countries in sub-Saharan Africa by 50 percent.
--Amazon Malaria Initiative.--This program works with countries in
South America to combat the re-emergence of malaria in that
part of the world.
--West Africa Network Against Malaria During Pregnancy.--CDC works
with countries in Francophone West Africa to encourage the use
of intermittent preventive treatment with sulfadoxine-
pyrimethamine (IPTp/SP) to prevent anemia and death in pregnant
women and malaria-related low-birthweight in their newborns.
--Preventing and Controlling Malaria During Pregnancy in Sub-Saharan
Africa.--CDC works with many partners to prevent and control
malaria among pregnant women and their newborns in sub-Saharan
Africa.
--International Red Cross and the Expanded Program for
Immunizations.--CDC works with these groups to implement and
evaluate the effectiveness of distributing ITNs during
immunization campaigns and during routine vaccine visits.
CDC collaborations support treatment and prevention policy change
based on scientific findings; formulation of international
recommendations through membership on 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
the WHO; UNICEF; the Global Fund to Fight AIDS, Tuberculosis, and
Malaria; and the World Bank--all stakeholders in the Roll Back Malaria
Partnership.
NIH MALARIA PROGRAMS
As the premier biomedical research agency for the United States and
the world, 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
2009 spending on malaria research will total $111 million while malaria
vaccine efforts will receive $35 million. ASTMH urges that NIH malaria
research portfolio and budget be increased by at least 6.6 percent in
fiscal year 2010. To support a comprehensive effort to control malaria,
ASTMH respectfully requests the following funding:
--$32.9 billion to NIH;
--$5.07 billion NIAID; and
--$73.5 million to the FIC for training that supports U.S. efforts
targeting malaria and other neglected tropical diseases.
NIAID
Malaria continues to be among the most daunting global public
health challenges we face. A long-term investment is needed to achieve
the drugs, diagnostics and research capacity needed to control malaria.
NIAID, the lead Institute for malaria research, plays an important role
in developing the drugs and vaccines needed to fight malaria. ASTMH
urges the subcommittee to increase NIAID funding so that present
malaria research efforts be maintained and new areas explored such as:
--increasing fundamental understanding of the complex interactions
among malaria parasites, the mosquito vectors responsible for
their transmission and the human host;
--developing new diagnostics, drugs, vaccines, and vector management
approaches; and
--enhancing both national and international research and research
training infrastructure to meet malaria research needs.
FIC
Although biomedical research has provided major advances in the
treatment and prevention of malaria, these benefits are often slow to
reach the people who need them most. Highly effective anti-malarial
drugs exist; when patients receive these drugs promptly, their lives
can be saved. FIC plays a critical role in strengthening science and
public health research institutions in low-income countries. By
promoting applied health research in developing countries, the FIC can
speed the implementation of new health interventions for malaria, TB,
and neglected tropical diseases.
The FIC works to strengthen research capacity in countries where
populations are particularly vulnerable to threats posed by malaria and
neglected tropical diseases. FIC efforts that strengthen the research
workforce in-country--including collaborations with U.S.-supported
global health programs--help to ensure the continuous improvement of
programs, adapting them to local conditions. This maximizes the impact
of U.S. investments and is critical to fighting malaria and other
tropical diseases.
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, with an emphasis on institutional
partnerships and networking;
--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, is a partnership supported
by FIC, The Bill & Melinda Gates Foundation, the WHO, and the
World Bank to develop recommendations on effective healthcare
interventions for resource-poor settings.
ASTMH urges the subcommittee to allocate additional resources to
the FIC in fiscal year 2010 to increase these efforts, particularly as
they address the control and treatment of malaria.
CONCLUSION
Thank you for your attention to these important global health
matters. We know you face many challenges in choosing funding
priorities, and we hope you will provide the requested fiscal year 2010
resources to those 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
The American Thoracic Society (ATS) is pleased to submit our
recommendations for programs in the Labor, Health and Human Services,
and Education, and Related Agencies Appropriations Subcommittee
purview. ATS, founded in 1905, is an independently incorporated,
international education and scientific society that focuses on
respiratory and critical care medicine. With approximately 18,000
members who help prevent and fight respiratory disease around the
globe, through research, education, patient care and advocacy, ATS's
long-range goal is to decrease morbidity and mortality from respiratory
disorders and life-threatening acute illnesses.
RESPIRATORY DISEASE IN AMERICA
Respiratory disease is a serious problem in America. Respiratory
disease is the third leading cause of death, responsible for 1 of every
7 deaths. Diseases effecting the lungs 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 death rate due to chronic obstructive pulmonary disease
(COPD) has doubled within the last 30 years and is still increasing,
while the rates for the other three top causes of death (heart disease,
cancer, and stroke) have decreased by more than 50 percent. The number
of people with asthma in the United States has surged more than 150
percent since 1980 and the root causes of the disease are still not
fully known. Cystic fibrosis and pulmonary hypertension, which jointly
affect nearly 150,000 people in the United States, have no cure.
NATIONAL INSTITUTES OF HEALTH (NIH)
The ATS deeply appreciates the $10 billion in supplemental funding
provided for the NIH in the American Recovery and Reinvestment Act and
the 3.2 percent increase provided through the omnibus fiscal year 2009
appropriations legislation. This funding will allow the NIH to continue
to fund, rather than curtail, groundbreaking research into diseases
that affect millions of Americans like COPD, asthma, and tuberculosis.
It is critical that this urgently needed reinvestment in biomedical
research is reinforced through annual budget increases that include
inflationary adjustments. We ask that this subcommittee provide a 7
percent increase for NIH in fiscal year 2010 so that the institute can
respond to biomedical research opportunities and public health needs.
Despite the rising lung disease burden, lung disease research is
underfunded. In fiscal year 2008, lung disease research represented
just 20.4 percent of the National Heart Lung and Blood Institute's
(NHLBI) budget. Although COPD is the fourth leading cause of death in
the United States, research funding for the disease is a small fraction
of the money that is invested for the other three leading causes of
death. 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.
CENTERS FOR DISEASE CONTROL AND PREVENTION
In order to ensure that health promotion and chronic disease
prevention are given top priority in Federal funding, the ATS supports
a funding level for the Centers for Disease Control and Prevention
(CDC) that enables it to carry out its prevention mission, and ensure
an adequate translation of new research into effective State and local
public health programs. We also ask that the CDC budget be adjusted to
reflect increased needs in chronic disease prevention, infectious
disease control, including TB control to prevent the spread of drug-
resistant TB, and occupational safety and health research and training.
The ATS recommends a funding level of $8.6 billion for the CDC in
fiscal year 2010. There are four lung diseases that illustrate the need
for further investment in research and public health programs: COPD,
pediatric lung disease, asthma and tuberculosis.
COPD
COPD is the fourth leading cause of death in the United States and
the third leading cause of death worldwide. Yet, the disease 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. CDC estimates that 12
million patients have COPD while an additional 12 million Americans are
unaware that they have this life threatening disease.
Today, COPD is treatable but not curable. Medical treatments exist
to relieve symptoms and slow the progression of the disease.
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. According to the NHLBI, COPD costs the U.S.
economy an estimated $37 billion per year. We recommend that the
subcommittee encourage NHLBI and other NIH Institutes to devote
additional resources to finding improved treatments and a cure for
COPD. 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. To address the increasing
public health burden of COPD, the ATS encourages the CDC to create a
COPD program at the Center for Chronic Disease Prevention and Health
Promotion. We ask that the subcommittee provide an appropriation of $1
million in fiscal year 2010 for this program. We are hopeful that the
program will include development of a national COPD response plan,
expansion of data collection efforts and creation of other public
health interventions for COPD. The ATS also 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).
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
2005, lung diseases accounted for more than 19 percent of all infant
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.
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.
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 an estimated 50-70 million Americans. A recent study conduced by
CDC found that roughly 10 percent of Americans had not gotten enough
rest at any point in the previous 30 days. 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. Despite the increased
need for study in this area, research on sleep and sleep-related
disorders has been underfunded. The ATS recommends a funding level of
$2 million in fiscal year 2010 to support activities related to sleep
and sleep disorders at the CDC, including for the National Sleep
Awareness Roundtable (NSART), surveillance activities, and public
educational activities. The ATS also recommends an increase of funding
for research on sleep disorders at the Nation Center for Sleep
Disordered Research (NCSDR) at the NHLBI.
TUBERCULOSIS
Tuberculosis (TB) is the second leading global infectious disease
killer, claiming 1.7 million lives each year. It is estimated that 9-14
million Americans have latent tuberculosis. Drug-resistant TB poses a
particular challenge to domestic TB control owing to the high costs of
treatment and intensive health care resources required. Treatment costs
for multidrug-resistant (MDR) TB range from $100,000 to $300,000, which
can cause a significant strain on State public health budgets. The
global TB pandemic and spread of drug resistant TB present a persistent
public health threat to the United States.
Despite low rates, persistent challenges to TB control in the
United States remain. Specifically: (1) racial and ethnic minorities
continue to suffer from TB more than majority populations; (2) foreign-
born persons are adversely impacted; (3) sporadic outbreaks/clusters
occur, outstripping local capacity; (4) continued emergence of drug
resistance threaten our ability to control TB; and (5) there are
critical needs for new tools for rapid and reliable diagnosis, short,
safe and effective treatments, and vaccines.
In recognition of the need to strengthen domestic TB control, the
Congress passed the Comprehensive Tuberculosis Elimination Act (Public
Law 110-392) in October, 2008. This historic legislation was based on
the recommendations of the Institute of Medicine and revitalized
programs at CDC and the NIH with the goal of putting the United States
back on the path to eliminating TB. The new law authorizes an urgently
needed reinvestment into new TB diagnostic, treatment and prevention
tools. The ATS, in collaboration with Stop TB USA, recommends a funding
level of $210 million in fiscal year 2010 for CDC's Division of TB
Elimination, as authorized under the Comprehensive TB Elimination Act.
The NIH has a prominent role to play in the elimination of
tuberculosis through the development of new tools to fight the disease.
We encourage the NIH to expand efforts, as requested under the
Comprehensive TB Elimination Act, to develop new tools to reduce the
rising global TB burden, including faster diagnostics that effectively
identify TB in all populations, new drugs to shorten the treatment
regimen for TB and combat drug resistance, and an effective vaccine.
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 in fiscal year
2010, which would allow the expansion 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.
The ATS recommends that Congress provide $340.1 million in fiscal year
2010 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. Lung disease and breathing
problems are a leading killer of babies under the age of one year.
Worldwide, tuberculosis is the second leading infectious disease
killer. 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 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 testimony on fiscal
year 2010 appropriations for the Department of Health and Human
Services (HHS).
AWHONN is a nonprofit membership organization made up of 23,000
nurses who care for mothers, their newborns, and women of all ages.
AWHONN members are registered nurses, nurse practitioners, certified
nurse-midwives, and clinical nurse specialists who work in hospitals,
independent practices, universities and community clinics throughout
the United States. Our mission is to promote the health of women and
newborns.
Nurses are typically the first and most consistent point of contact
in the healthcare setting. Evidence suggests that they spend more time
with patients--up to four times on average--than any other healthcare
provider. As such, nurses have a unique perspective on the healthcare
system and the public health programs and agencies funded under HHS.
We thank the subcommittee for providing generous funding in past
years and we are truly appreciative for the public health funding
included in the American Recovery and Reinvestment Act of 2009.
Recognizing the challenges the subcommittee will face in fiscal year
2010 in reconciling various expenditures in the face of overall budget
deficits, please find our funding recommendations for fiscal year 2010
below.
HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA)
As a member of the Friends of the Health Resources and Services
Administration coalition, AWHONN recommends $8.5 billion for HRSA in
fiscal year 2010.
HRSA programs support health professions education, healthcare
services for underserved populations, programs to address the special
needs of mothers and children, and more. For several years, HRSA has
suffered from relatively level funding. In light of these difficult
economic times, support for the Nation's safety net system is
especially critical.
One of the most important aspects of HRSA's mission is to ensure a
healthcare workforce that is sufficient to meet the needs of patients
and communities.
Nursing Workforce Development Programs, title VIII of the Public Health
Service Act
Along with the Nursing Community coalition, AWHONN recommends $215
million for title VIII programs in fiscal year 2010. An adequate supply
of nurses is essential to ensuring that all Americans receive quality
healthcare. Title VIII programs help to address the Nation's ongoing
nursing and nurse faculty shortage by providing scholarships and loan
repayment programs to nursing students, recent graduates and nursing
school faculty. Title VIII also provides grants to schools of nursing
and health centers to foster greater diversity and improved retention
rates in the nursing workforce.
Maternal and Child Health (MCH) Block Grant, Title V of the Social
Security Act
AWHONN recommends $850 million for the MCH Block Grant in fiscal
year 2010. The MCH Block Grant, the only Federal program of its kind,
is devoted to improving the health of women and children. For more than
70 years, the program has provided a source of flexible funding for
States and territories to address their unique needs related to
improving the health of mothers and children. Today, this program
provides prenatal services to more than 2 million mothers--almost half
of all mothers who give birth annually--and primary and preventive care
to more than 17 million children, including almost 1 million children
with special needs. Fully funding the MCH block grant will enable
States to expand critical health services.
We recommend $30 million for newborn screening activities, which
are currently funded under the MCH block grant Special Projects of
Regional and National Significance. 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 disability,
mental retardation, serious illnesses or even death. 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.
NATIONAL INSTITUTES OF HEALTH (NIH)
AWHONN, along with others in the science advocacy community,
support increased funding for NIH in fiscal year 2010. Scientific
research done at the NIH is leading to better patient care. In fact,
federally funded research is responsible for nearly every major medical
advancement in the last 50 years. While AWHONN supports the NIH in its
entirety, several Institutes are especially important to the
advancement of nursing and the health of women and newborns.
The Eunice Kennedy Shriver National Institute of Child Health and Human
Development (NICHD)
The rate of preterm birth has increased 20 percent since 1990. The
NICHD supports critical research into the causes and treatments for
preterm birth.
AWHONN, along with the March of Dimes, recommends that Congress
provide at least a 7 percent increase for NICHD in fiscal year 2010, a
portion to be used to begin establishing transdisplinary research
centers that focus on preterm birth. NICHD needs additional resources
to expand research on the underlying causes of preterm birth taking
into account the recommendations of the experts who participated in the
Surgeon General's Conference on Preterm Birth in the summer of 2008.
National Institute of Nursing Research (NINR)
AWHONN, along with the American Nurses Association and the American
Association of Colleges of Nursing, recommends $178 million for NINR in
fiscal year 2010.
NINR supports nurse-led research that contributes to advancing
high-quality, evidence-based care across the lifespan. Research at NINR
has targeted, among other topics, health disparities, risk reduction,
chronic illnesses, and care for rural and underserved populations. NINR
promotes a uniquely important nursing perspective, as there is no
caregiver that interacts with patients more or is more trusted by
patients than nursing professionals. There is no other body that funds
important nursing research similarly in this country, and NINR research
has contributed measurably to more efficient and effective healthcare
as our Nation struggles to fill continuing staffing shortages and gaps
in healthcare services.
CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC)
The CDC is dedicated to protecting health and promoting quality of
life through the prevention and control of disease, injury, and
disability. While AWHONN supports the CDC in its entirety, several
agencies and programs are especially important to the advancing the
health of women and newborns.
Safe Motherhood/Infant Health
The Safe Motherhood/Infant Health program works to promote infant
and reproductive health. AWHONN is especially concerned with issues
associated with prematurity. Preterm birth is the leading cause of
neonatal death in the United States. In 2006, more than half a million
babies--1 in 8 babies--were born prematurely in the United States.
In 2005, AWHONN launched its Late Preterm Initiative to address the
special needs of infants born between 34 and 36 completed weeks of
gestation. While many late preterm infants may appear healthy at birth,
they are at risk for prematurity-related complications, increased
morbidity and mortality and have an increased rate of rehospitalization
in the first month of life.
Currently, the CDC is partnering with a number of universities and
organizations to support research related to preterm birth and the
reasons for disparities between racial and ethnic groups. AWHONN
recommends a $6 million increase in the preterm birth line fiscal year
2010. This funding will allow the CDC to expand epidemiological work to
evaluate the social, biological, and medical factors associated with
preterm birth as authorized in the PREEMIE Act of 2006 (Public Law 109-
450).
National Center on Health Statistics (NCHS)
NCHS is the Nation's principal health statistics agency, providing
critical data on all aspects of the U.S. healthcare system. The agency
provides data on healthcare trends, information that is essential for
public health planning. However, current funding levels are threatening
the collection of vital information, especially complete data on
maternity and infant health status.
AWHONN, along with the Friends of NCHS, recommends at least $137.5
million for NCHS in fiscal year 2010. Additionally, we urge Congress to
allocate $15 million bolus funding to support States and territories as
they implement the 2003 birth certificates and electronic systems to
collect these data.
______
Prepared Statement of the Animal Welfare Institute
The Animal Welfare Institute (AWI) respectfully requests that the
subcommittee include the following report language regarding the
funding of research involving the use of dogs and/or cats:
None of these funds shall be used for the purchase of, or research
on, dogs or cats obtained from those USDA licensed Class B dealers who
acquire dogs or cats from third parties (i.e., individuals, dealers,
breeders, and animal pounds) and resell them.
In response to the request included in last year's appropriation
bill, the National Academy of Sciences (NAS) established a committee in
the summer of 2008 to assess if there is a scientific rationale for
relying on dogs and cats obtained from United States Department of
Agriculture (USDA) licensed Class B dealers. Information on the
Committee on Scientific and Humane Issues in the Use of Random-source
Dogs and Cats for Research (ILAR-K-08-01-A) can be found at: http://
www8.nationalacademies.org/cp/projectview.aspx?key=48974. The results
of its deliberations are expected to be public later this month.
Based on our review of the data submitted to the NAS Committee, the
presentations given during those portions of the meetings that were
open to public, and our own extensive experience regarding Class B-
licensed dealers, we anticipate findings in keeping with the proposed
report language above.
According to USDA, of the nearly 95,000 total dogs and cats used in
research, 2,863 dogs and 267 cats were supplied by random source
dealers during fiscal year 2007. There are a mere 10 Class B dealers
currently licensed by USDA and selling live random source dogs and cats
for experimentation. One other dealer is presently under a 5-year
license suspension. These dealers are notorious for selling to
laboratories animals who have been acquired illegally and for their
widespread failure to comply with other minimum requirements under the
Animal Welfare Act. In fact, at this time, half of the remaining 10
dealers are under investigation by USDA for apparent violations of the
Animal Welfare Act (AWA), and USDA is pursuing seven separate
investigations regarding apparent supply violations identified during
tracebacks conducted of dealer records.
Data from USDA inspection reports reveal myriad problems with
licensed Class B dealers (we can supply copies of these inspection
reports if they are of interest): Needed veterinary care is lacking for
many random source animals. Hookworm and mange are a widespread problem
as is heartworm, particularly in the South. An Ohio dealer had a dog
with mange on his head, around the eyes, ears and neck. Another dog had
enlarged pupils and bulging eyes, and a third had dried loose dark
stool. An Indiana dealer was cited by USDA for dogs suffering from
``loose stool with some blood,'' ``loose stool with a drop of blood,''
``infected or irritated eye,'' ``mange-like lesions,'' ``ring-worm like
lesions,'' ``sore on left carpus which was red and warm to the touch,''
and an animal with ``a bite wound to the right front foot.'' At another
inspection, this dealer had two animals who were limping; one had a
large tumor on his foot. A third animal had a bite laceration on his
face. Another record notes a chronic cough in an underweight dog and a
dog with a purulent discharge from his nose. In most cases there is no
record of any veterinary care, and after being cited by USDA
inspectors, given the poor status of the animals, they are typically
killed. An Illinois dealer was cited by USDA for ``euthanizing dogs
with truck exhaust and tying sick dogs out at the corner of the
property where they would die.'' Later he shifted to use of an electric
current administered via clips.
Research institutions may reject animals delivered by a dealer
because of the poor condition of the dogs and cats, leaving them to be
hauled from location to location in search of a taker. If not, the
animal may be taken back and left to die or may simply be shot. Some at
research institutions have let USDA know of their concerns. One such
email identified a cat ``in very poor condition: cache[c]tic, severely
matted hair coat and a severe case of ear mites.'' It went on to note:
``Many of the cats that we receive are wild or are almost wild. I
do not understand where these cats come from and how they are examined
for health certificates. I thought the animals had to come from someone
who had raised and bred the animals on their property or from a
specific shelter.''
The conditions for housing, feeding, and care can be problematic as
well. An Ohio dealer was cited by USDA inspectors for contaminated
straw, wet with urine and excessive feces. Excessive flies. Water
receptacles contaminated with black and green algae--a thick layer. A
dealer in Indiana had dogs unable to avoid contact with excreta.
Another dealer's inspection report notes, ``Some 70-75 percent dogs
have water and bread and little bits of dog food floating in water.
There were some dogs that had only bread and water. Some had dog food
floating in water. Most of dogs had not eaten the watery food blend.
About 70 percent of the total dogs had nonpotable water. Water was
mixed with bread and dog food and sitting in the direct sun.''
In addition, there are widespread problems with record-keeping and
acquiring animals from illegal sources. Further, dealers commonly
network with each other; that is, animals are sold from buncher (an
unlicensed dealer) to dealer to another dealer before being sold for
research. Also, typically, the buncher is immune from prosecution until
he is caught by USDA and warned not to sell more than 25 animals in a
year without a license again. Then he drops down to selling fewer
animals so he is exempt from licensure, he sells some of the animals
using the name of someone else he knows, or he steps forward and gets
licensed for a while, makes a lot of money and then when USDA appears
to be catching up with him, he turns in his license.
One example is the case of Clayton McDowell, a buncher with hunting
dog kennels who didn't let the fact that he had no license stop him
from selling 60 dogs to a USDA licensed Class B dealer in Illinois.
According to USDA, he ``knew about USDA licensing requirements. He
stated he would quit selling dogs to B dealers. He stated there was too
much hassle with identification, record keeping.'' McDowell received a
Letter of Warning from USDA, and he addressed the matter by getting
licensed. Ultimately, he decided to quit operating as a licensed Class
B dealer, though he continued selling hunting dogs, claiming he would
only sell the dogs retail for hunting purposes.
Then there's a Kentucky dealer cited by a USDA inspector who
repeatedly failed to include essential details on the acquisition
sheets, such as the seller's address, driver's license number, and
vehicle tag number. He was found to have failed to collect this
information on 3 different dates regarding 13 animals. And a Michigan
dealer was cited for receiving stray cats from the city of Howard City.
The city has no pound, but the licensed dealer was willing to step in
and collect cats. An Illinois dealer was cited on at least three
separate occasions for his failure to maintain complete records.
A veterinarian at a research facility expressed concern in an email
to USDA that the animals it received from a dealer appeared to be
``companion animals.'' A neutered male Airedale, an intact male
Weimeriner and a male chocolate Labrador all were affectionate and
obeyed commands. Similarly, the cats received by the facility were
``some of the most obedient and affectionate cats that we ever met.''
Another common pattern is for individuals to pass the business on
to other members of the family after carefully showing them the ropes.
Sometimes a former employee of a dealer, who has also learned how to
work the system, may go off on his own and get licensed as well. Though
it's not a formal program, in essence some dealers offer an
apprenticeship.
Brothers living in Missouri ran their licensed Class B dealer
operation as a team, then one of them retired and the other's wife
joined him in running the business. USDA finally caught up with the
pair, and they were charged with a laundry list of violations,
including failure to maintain records that fully and correctly disclose
the identities and other required information of the persons from whom
dogs were acquired on 51 separate occasions, including one incident
that pertained to 43 dogs. Further, they were charged with failing to
provide complete certifications on seven separate occasions, including
one that pertained to 195 dogs. The husband died before the case was
resolved and though the wife was fined $107,250, the judge suspended
$100,000 of it. The story doesn't end here. The couple's son and
daughter-in-law, after helping mom close down her business, set up
their own Class B dealer operation.
During a House Agriculture Subcommittee hearing held back in 1996,
then Assistant Secretary of Agriculture Michael Dunn described his
frustration with random source dealers: ``Every time we develop a new
way to look for something, they develop a new way to hide it.'' An
insurmountable hurdle for USDA is that the AWA allows anyone who claims
to have bred and raised an animal to profit by selling the animal to a
random source dealer--and how can USDA be expected to disprove it? In
addition, with animals transported back and forth across the country,
how on earth is USDA supposed to keep up with the movement of animals?
USDA has spent years inspecting random source dealers four times a year
instead of once a year as is done with all other licensees and
registrants under the AWA. In the meantime, unlike any other licensees
covered under the AWA, this one group of licensees--Class B dealers
selling dogs and cats for research--have a long-standing problem
maintaining complete and accurate records.
The Animal Welfare Act was passed in 1966 to address the illegal
supply of dogs and cats to laboratories, and here we are 43 years
later, and these problems are still widespread. What has changed
significantly over this lengthy period of time is the availability of
animals from sources other than random source dealers. Given the
problems inherent in the use of licensed Class B dealers, researchers
have increasingly and successfully shifted to acquiring most of their
dogs and cats from licensed Class A breeders--and by using these
dealers instead, the researchers will receive animals who have been
raised under controlled conditions, and the health and vaccination
status and the genetic background on each individual animal will be
known. In addition, some dogs and cats are being bred for
experimentation at registered research facilities, and in some cases,
inexpensive random type animals are purchased directly from animal
pounds.
NIH has told this subcommittee that it is ``committed to ensuring
the appropriate care and use of animals in research.'' However, NIH has
left the decision of whether or not to buy dogs and cats from random
source dealers ``to the local level on the basis of scientific need.''
NIH defends the use of licensed Class B dealers, arguing that these
dealers are needed to obtain ``animals that may not be available from
other sources, such as genetically diverse, older, or larger animals.''
In fact, in the rare circumstance that a researcher asserts the need
for such animals, they can be obtained directly from pounds, as noted
previously.
The distinction between nonpurpose-bred animals from pounds versus
licensed Class B dealers must be made. By using licensed Class B
dealers (middlemen) instead of pounds, researchers are contributing to
the problem. In their search to fill researchers' demands for
``genetically diverse, older or larger animals,'' random source dealers
and their suppliers may be stealing pets from backyards and farms or
they may be acquiring them from individuals who did not breed and raise
them as required by the AWA.
All animals used in research should be obtained from lawful
sources. Taxpayer dollars, in the form of NIH extramural grants, must
not continue to fund research using dogs and cats from dealers whose
modus operandi is illegal acquisition of animals, fraudulent or
incomplete records, and other illicit activities. Proper oversight of
NIH's dispersal of extramural grants to those engaged in research using
dogs and/or cats is urgently needed.
______
Prepared Statement of Big Brothers Big Sisters of America
Big Brothers Big Sisters of America (BBBSA) supports $17 million in
fiscal year 2010 for the Department of Education's Mentoring programs,
$50 million for the Mentoring Children of Prisoners program and $50
million for the Volunteer Generation Fund.
Chairman Harkin and Ranking Member Cochran, thank you for the
opportunity to submit this testimony for the subcommittee's record.
BBBSA is the Nation's oldest and largest mentoring organization. We
have grown over the last 105 years to serve more than 250,000 at-risk
youth in communities across the Nation. Our 392 agencies are located in
all 50 States, Guam, and Puerto Rico. We match at-risk youth with a
caring adult in a one-to-one mentoring relationship. These matches make
a significant difference in the life of a child and are the foundation
for developing the full potential of boys and girls as they grow to
become competent, confident, and caring men and women. BBBSA offers an
array of programs and services that focus on promoting positive youth
development, helping each child discover his or her full potential.
With 17 million at-risk children growing up in America, the need
for a proven strategy to reverse the statistics and to support their
successful development has never been more critical. We believe that
BBBS mentoring provides a significant return on investment,
particularly compared to the consequences of social and educational
failure. According to Independent Sector, the value of volunteer work
was estimated at $20.25 per hour in 2008. Last year, our Bigs
contributed more than 13 million volunteer hours at an estimated value
of $676 million.
BBBSA original, core program model is its community-based match.
Bigs are matched with Littles referred to the program by a parent, and
typically a match will spend about 3 hours per week together.
Professional case-management staff at each local agency guide Bigs and
provide them with the support necessary to ensure a healthy and lasting
relationship with their Littles. It is through the relationship with
these committed adults that at-risk children can to begin to gain their
own sense of self-confidence and develop healthy aspirations for the
future.
Research has shown that BBBS mentoring works as a strategy to
support at-risk youth. In 1995, Public/Private Ventures released its
landmark impact study, which found that children matched with a Big
Brother or Big Sister were:
--46 percent less likely to begin using illegal drugs;
--27 percent less likely to begin using alcohol;
--52 percent less likely to skip school;
--37 percent less likely to skip a class;
--more confident of their performance in schoolwork; and
--getting along better with their families.
SCHOOL-BASED MENTORING (MENTORING FOR SUCCESS GRANTS)
Our mentoring programs have grown exponentially over the last 10
years. A major source of this growth is the expansion of BBBSA school-
based program model. Locating our service in schools has offered a
strong complement to the traditional community-based approach and has
resulted in a significant increase in volunteer recruitment. Further,
because children are referred by teachers, it connects the positive
impact of the BBBSA relationships directly with the educational
enrichment for each matched child.
The President's fiscal year 2010 budget outline for the Department
of Education has recommended that the Department's mentoring program be
eliminated. This recommendation was made in follow-up to a Federal
study examining outcomes for school-based mentoring. The findings of
the study are generating important and welcome dialogue. BBBSA
appreciates the focus on quality programs and has reached out to the
administration to offer our input in finding the most effective way to
achieve positive outcomes for children.
We believe that well-run school based mentoring programs can and do
have real impact. We have both the local and national evidence to prove
this, including a more recent evaluation by P/PV. In fact, findings
from the P/PV study led us to adopt significant changes to the way we
run our own school-based programs in order to ensure longer and
stronger matches that lead to concrete and measurable outcomes for the
young people we serve. As a learning organization, we take seriously
our responsibility to respond to research and continually improve our
service delivery.
In 2003, with support from Atlantic Philanthropies, BBBSA began a
comprehensive study of our school-based mentoring program and evaluated
impacts on randomly selected mentored youth compared to nonmentored
youth in a control group. The scope of the study paralleled the BBBS
Impact Study of Community-Based Mentoring conducted by P/PV in the
1990s and was the first nationwide, randomized study of school-based
mentoring ever undertaken.
Among the findings:
--Three factors lead to better outcomes--
--Socio-emotional match activities;
--Matches that met more often and for longer periods; and
--A strong school environment and involvement by teachers and
principals;
--School-based mentoring has positive academic outcomes during the
first year of the match, including higher grades, higher
feelings of academic competence, greater number of assignments
completed, fewer serious school infractions, and less skipping
of school;
--But largely because so many matches did not continue into the
second year, these outcomes were for the most part not
sustained in the second year;
--Training, supervision, and school support are critical in fostering
stronger and longer relationships; and
--The cost of school-based mentoring is only slightly less than
community-based mentoring.
The challenge was clear: longer matches and closer relationships
meant stronger impacts and so how were we going to create longer
matches and their corresponding increased, longer-lasting outcomes? The
recommendations, coming out of the Study, of our internal School-Based
Mentoring Task Force were:
--Start matches as early in the school year as possible;
--Ensure that volunteers provide at least one school year of
mentoring;
--Build programs in feeder schools to sustain matches and provide
youth with consistency through school transitions;
--Select supportive schools for program involvement and continually
foster these partnerships;
--Explore ways to bridge the summer gap such as taking school-based
mentoring out of the school year and increasing match contacts
and treating school-based mentoring as a year-round program
with strong match support;
--Develop indices of match length that reflect the summer break and,
in this way, are more sensitive predictors of impacts; and
--Explore more ways to provide volunteers (particularly young
volunteers) with the support and ongoing training they need to
create high-quality, effective mentoring relationships.
While BBBSA supports the administration's position of only funding
effective programs going forward, we have proposed partnering with the
Department of Education to ensure that existing grantees do not have to
prematurely close any current mentoring relationships. We understand
that the cost of honoring the last class of grants which were awarded
in fiscal year 2008 would require Congress to provide $17 million for
the program in fiscal year 2010.
AMACHI (MENTORING CHILDREN OF PRISONERS)
An estimated 2.4 million children have an incarcerated parent--and
BBBS' Amachi program addresses this critical need. The goal of Amachi
is to demonstrate that the best way to stop the vicious cycle of
substance abuse, delinquency, and incarceration among children of
incarcerated parents is to give the children what they need the most--a
supportive and stable adult who will help them discover their own
strengths, abilities, and resistance skills. Volunteers for the program
are recruited through their congregations and matched with at-risk
children and youth, spending time each week with the child to gradually
build a supportive relationship. Research has shown that children and
youth of incarcerated parents are at higher risk of child abuse,
neglect, illiteracy, drug and alcohol abuse, crime, violence, and
premature death than are their peers. A BBBS mentor in the life of an
at-risk child can dramatically reduce a child's chance of falling prey
to these risks. We respectfully request level funding for the
``Mentoring Children of Prisoners'' program in fiscal year 2010.
VOLUNTEER GENERATION FUND (CORPORATION FOR NATIONAL SERVICE)
In the wake of President-elect Obama's ``call to service'' in
January, also known as National Mentoring Month, BBBSA saw a
significant increase in volunteer applications. As the economic crisis
deepens, these Big Brothers and Big Sisters will be helping to meet the
critical demand our disadvantaged youth have for friendship, especially
during these challenging times. There is an interest among Americans to
serve the community and BBBSA is anxious to harness this hope. The
bipartisan citizen service legislation signed in to law by President
Obama on April 21 will expand opportunities for citizens to serve, will
direct this service toward the Nation's most urgent challenges, and
provides Congress the change to invest in new and innovative solutions
to our most persistent social problems. In particular, BBBSA
respectfully requests that $50 million for the Volunteer Generation
Fund in fiscal year 2010 to spur innovation in volunteer recruitment
and management.
As we all work to change how our children grow up in America, BBBSA
is your proud partner.
______
Letter From the Brain Injury Association of America
May 6, 2009.
Hon. Tom Harkin,
Chairman, Senate Appropriations Subcommittee on Labor, Health and Human
Services, and Education, and Related Agencies, Washington, DC.
Hon. Thad Cochran,
Ranking Member, Senate Appropriations Subcommittee on Labor, Health and
Human Services, and Education, and Related Agencies,
Washington, DC.
Dear Mr. Chairman Harkin and Ranking Member Cochran: Thank you for
the opportunity to submit this written testimony with regard to the
fiscal year 2010 Labor, Health and Human Services, and Education, and
Related Agencies appropriations bill. My testimony is on behalf of the
Brain Injury Association of America (BIAA), our national network of
State affiliates, and hundreds of local chapters and support groups
from across the country.
A traumatic brain injury (TBI) is a blow or a jolt to the head that
temporarily or permanently disrupts brain function--i.e., who we are
and how we think, act, and feel. In the civilian population alone every
year, more than 1.5 million people sustain brain injuries from falls,
car crashes, assaults and contact sports. Males are more likely than
females to sustain brain injuries. Children, teens, and seniors are at
greatest risk.
And now we are seeing an increasing number of servicemembers
returning from the conflicts in Iraq and Afghanistan with TBI, which
has been termed one of the signature injuries of the war. A recent
study conducted by the RAND Corporation found that 320,000 troops, or
19 percent of all service members, returning from Operations Enduring
Freedom and Iraqi Freedom may have experienced a TBI during deployment.
Many of these returning servicemembers are undiagnosed or misdiagnosed
and subsequently they and their families will look to community and
local resources for information to better understand TBI and to obtain
vital support services to facilitate successful reintegration into the
community.
For the past 12 years Congress has provided minimal funding through
the Health Resources and Services Administration (HRSA) Federal TBI
Program to assist States in developing services and systems to help
individuals with a range of service and family support needs following
their loved one's TBI. Similarly, the grants to State Protection and
Advocacy Systems to assist individuals with traumatic brain injuries in
accessing services through education, legal, and advocacy remedies are
woefully underfunded. Rehabilitation, community support, and long-term
care systems are still developing in many States, while stretched to
capacity in others. Additional numbers of individuals with TBI as the
result of war-related injuries only adds more stress to these
inadequately funded systems.
BIAA respectfully urges you to provide States with the resources
they need to address both the civilian and military populations who
look to them for much needed support in order to live and work in their
communities.
With broader regard to all of the programs authorized through the
TBI Act, BIAA specifically requests:
--$11 million for the Centers for Disease Control and Prevention
(CDC) TBI Registries and Surveillance, Prevention and National
Public Education/Awareness;
--$20 million for the HRSA Federal TBI State Grant Program; and
--$6 million for the HRSA Federal TBI Protection & Advocacy (P&A)
Systems Grant Program.
The TBI Act Amendments of 2008, authorizes the Department of Health
and Human Services, HRSA to award grants to (1) States, American Indian
Consortia, and territories to improve access to service delivery and to
(2) State P&A Systems to expand advocacy services to include
individuals with TBI. For the past 12 years the HRSA Federal TBI State
Grant Program has supported State efforts to address the needs of
persons with TBI and their families and to expand and improve services
to underserved and unserved populations including children and youth;
veterans and returning troops; and individuals with co-occurring
conditions
In fiscal year 2009, HRSA reduced the number of State grant awards
to 15, in order to increase each monetary award from $118,000 to
$250,000. This means that many States that had participated in the
program in past years have now been forced to close down their
operations, leaving many unable to access TBI care.
Increasing the program to $20 million will provide funding
necessary for each State including the District of Columbia, the
American Indian Consortium to sustain and expand State service
delivery; and to expand the use of the grant funds to pay for such
services as Information & Referral (I&R), service coordination and
other necessary services and supports identified by the State.
Similarly, the HRSA TBI P&A Program currently provides funding to
all State P&A systems for purposes of protecting the legal and human
rights of individuals with TBI. State P&As provide a wide range of
activities including training in self-advocacy, outreach, I&R, and
legal assistance to people residing in nursing homes, to returning
military seeking veterans benefits, and students who need educational
services.
Effective Protection and Advocacy services for people with a TBI
leads to reduced government expenditures and increased productivity,
independence, and community integration. However, advocates must
possess specialized skills, and their work is often time-intensive. A
$6 million appropriation would trigger a formula that would ensure that
each P&A can provide a significant PATBI program with appropriate staff
time and expertise.
Funding for the TBI Model Systems is urgently needed to ensure that
the Nation's valuable TBI research capacity is not diminished, and to
maintain and build upon the 16 TBI Model Systems research centers
around the country.
The TBI Model Systems of Care program represents an already
existing vital national network of expertise and research in the field
of TBI, and weakening this program would have resounding effects on
both military and civilian populations. The TBI Model Systems are the
only source of nonproprietary longitudinal data on what happens to
people with TBI. They are a key source of evidence-based medicine, and
serve as a ``proving ground'' for future researchers.
In order to make this program more comprehensive, Congress should
provide $13.3 million in fiscal year 2010 funding for the National
Institute on Disability and Rehabilitation Research's TBI Model Systems
of Care Program, in order to add four new centers and two collaborative
research projects. In addition, given the national importance of this
research program, the TBI Model Systems of Care program should receive
``line-item'' status within the broader NIDRR budget.
We ask that you consider favorably these requests for the HRSA
Federal TBI Program, NIDRR TBI Model Systems Program, and for CDC to
gather needed data, shepherd public awareness, education, and
prevention programs; as well as the sustain and bolster TBI Model
Systems that conduct vital research.
Sincerely,
Susan H. Connors,
President/CEO.
______
Prepared Statement of the Crohn's and Colitis Foundation of America
Mr. Chairman and members of the subcommittee, thank you for the
opportunity to submit testimony on behalf of the 1.4 million Americans
living with Crohn's disease and ulcerative colitis. My name is Gary
Sinderbrand and I have the privilege of serving as the Chairman of the
National Board of Trustees for the Crohn's and Colitis Foundation of
America (CCFA). CCFA is the Nation's oldest and largest voluntary
organization dedicated to finding a cure for Crohn's disease and
ulcerative colitis--collectively known as inflammatory bowel diseases
(IBD).
Let me say at the outset how appreciative we are for the leadership
this subcommittee has provided in advancing funding for the National
Institutes of Health (NIH). Hope for a better future for our patients
lies in biomedical research and we are grateful for the recent
investments that you have made in this critical area.
Mr. Chairman, Crohn's disease and ulcerative colitis are
devastating inflammatory disorders of the digestive tract that cause
severe abdominal pain, fever and intestinal bleeding. Complications
include arthritis, osteoporosis, anemia, liver disease and colorectal
cancer. We do not know their cause, and there is no medical cure. They
represent the major cause of morbidity from digestive diseases and
forever alter the lives of the people they afflict--particularly
children. I know, because I am the father of a child living with
Crohn's disease.
Seven years ago, during my daughter, Alexandra's sophomore year in
college, she was taken to the ER for what was initially thought to be
acute appendicitis. After a series of tests, my wife and I received a
call from the attending GI who stated coldly: Your daughter has Crohn's
disease, there is no cure and she will be on medication the rest of her
life. The news froze us in our tracks. How could our vibrant, beautiful
little girl be stricken with a disease that was incurable and has
ruined the lives of countless thousands of people?
Over the next several months, Alexandra fluctuated between good
days and bad. Bad days would bring on debilitating flares which would
rack her body with pain and fever as her system sought equilibrium. Our
hearts were filled with sorrow as we realized how we were so incapable
of protecting our child.
Her doctor was trying increasingly aggressive therapies to bring
the flares under control.
Asacol, Steroids, Mercaptipurine, Methotrexate, and finally
Remicade. Each treatment came with its own set of side effects and
risks. Every time A would call from school, my heart would jump before
I picked up the call in fear of hearing that my child was in pain as
the flares had returned. Ironically, the worst call came from one of
her friends to report that A was back in the ER and being evaluated by
a GI surgeon to determine if an emergency procedure was needed to clear
an intestinal blockage that was caused by the disease. Several hours
later, a brilliant surgeon at the University of Chicago, removed over a
foot of diseased tissue from her intestine. The surgery saved her life,
but did not cure her. We continue to live every day knowing that the
disease could flare at any time with devastating consequences.
From the point of hearing the news, I refused to accept the fact
that this disease could not be cured. As I studied all the relevant
data I could find, I reached out to the organization that seemed to be
repeatedly mentioned, The CCFA. This organization is leading the fight
in research, education and support on behalf of the 1.4 million
Americans that suffer from these illnesses.
I made a pest of myself at the national office seeking knowledge
about how the fight was being staged. The more I learned the more I
believed that we could do better. I was invited to join the national
board and 6 years later, I have the privilege of leading an
extraordinary staff of professionals and a network of volunteers across
our entire country.
We are making dramatic progress that is the result of the
scientific excellence of our funded researchers and our volunteer
scientific leadership as well as the rapid advancement of available
technology. It is now not ``if'' we will cure IBD, but ``when.''
Mr. Chairman, I will focus the remainder of my testimony on our
appropriations recommendations for fiscal year 2010.
RECOMMENDATIONS FOR FISCAL YEAR 2010
NIH
Throughout its 40-year history, CCFA has forged remarkably
successful research partnerships with the NIH, particularly the
National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK), which sponsors the majority of IBD research, and the National
Institute of Allergy and Infectious Diseases (NIAID). CCFA provides
crucial ``seed-funding'' to researchers, helping investigators gather
preliminary findings, which in turn enables them to pursue advanced IBD
research projects through the NIH. This approach led to the
identification of the first gene associated with Crohn's--a landmark
breakthrough in understanding this disease.
To further accelerate genetic research and advance understanding of
IBD, NIDDK issued a research solicitation to establish an IBD Genetics
Consortium approximately 8 years ago. This effort was informed by
recommendations from external experts. Funding for the Consortium's six
centers began in 2002, and intensive data and sample collection,
genetic analysis, and recruitment of new patients and their families
have been under way. In 2006, the Consortium published the major
discovery of a new IBD gene. Some sequence variations in this gene,
called IL23R, were found to increase susceptibility to IBD, while
another variant actually confers protection. This gene was known
previously to be involved in inflammation, and its newly discovered
association with IBD may lead to the development of better therapies
for IBD. In recognition of the success of the Consortium's large-scale
collaborative effort, NIDDK decided to continue support for the program
beyond its initial 5-year period which was slated to end in fiscal year
2007.
Renewed funding in fiscal year 2008 has enabled the Consortium to
continue its genetic studies and recruit additional patients and
relatives (as well as subjects without IBD for comparison). This
expansion will facilitate the identification of additional predisposing
genes and enable genetic analyses of certain patient subgroups, such as
those from minority populations or those who experience an early onset
form of IBD. These findings may then be used to pursue genetically
based diagnostic tests that allow for earlier diagnosis and treatment
intervention. In addition, the data can be used to identify new
molecular targets for therapeutic development that are specifically
targeted to a unique subset of patients.
Mr. Chairman, we are grateful for the leadership of Dr. Stephen
James, Director of NIDDK's Division of Digestive Diseases and
Nutrition, for pursuing this and other opportunities in IBD research
aggressively. Fortunately, the field of IBD is widely viewed within the
scientific community as one of tremendous potential. CCFA's scientific
leaders, with significant involvement from NIDDK, have developed an
ambitious research agenda entitled ``Challenges in Inflammatory Bowel
Diseases'' that seeks to address many opportunities that currently
exist. We look forward to working with NIDDK and the subcommittee to
pursue these research goals in the coming years.
For fiscal year 2010, CCFA joins with other patient and medical
organizations in recommending a 7 percent increase in funding for the
NIH. We specifically encourage the subcommittee to support the
invaluable work of the NIDDK and NIAID.
CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC)
IBD Epidemiology Program
Mr. Chairman, as I mentioned earlier CCFA estimates that 1.4
million people in the United States suffer from IBD, but there could be
many more. We do not have an exact number due to these diseases'
complexity and the difficulty in identifying them.
We are extremely grateful for your leadership in providing funding
over the past 5 years for an epidemiology program on IBD at CDC. This
program is yielding valuable information about the prevalence of IBD
and increasing our knowledge of the demographic characteristics of the
IBD patient population. If we are able to generate an accurate analysis
of the geographic makeup of the IBD patient population, it will provide
us with invaluable clues about the potential causes of IBD.
I should note that the latest phase of this project focuses on
Rhode Island. The ``Ocean State Crohn's & Colitis Area Registry'' is
identifying each new case of inflammatory bowel disease diagnosed in
the State. The result will be a unique, population-based cohort of
newly diagnosed patients to be followed prospectively over time--the
first of its kind in the United States, and one of very few such
cohorts in the world. The goals of the study include: (1) describing
the incidence rates of Crohn's disease and ulcerative colitis; (2)
describing disease outcomes; and (3) identifying factors that predict
disease outcomes. To date more than 85 newly diagnosed patients of all
ages have been enrolled into the study.
Mr. Chairman, to continue this important epidemiological work in
fiscal year 2010, CCFA recommends a funding level of $700,000, an
increase of $16,000 more than fiscal year 2009.
PEDIATRIC IBD PATIENT REGISTRY
Mr. Chairman, the unique challenges faced by children and
adolescents battling IBD are of particular concern to CCFA. In recent
years we have seen an increased prevalence of IBD among children,
particularly those diagnosed at a very early age. To combat this
alarming trend CCFA, in partnership with the North American Society for
Pediatric Gastroenterology, Hepatology and Nutrition, has instituted an
aggressive pediatric research campaign focused on the following areas:
--Growth/Bone Development.--How does inflammation cause growth
failure and bone disease in children with IBD?
--Genetics.--How can we identify early onset Crohn's disease and
ulcerative colitis?
--Quality Improvement.--Given the wide variation in care provided to
children with IBD, how can we standardize treatment and improve
patients' growth and well-being?
--Immune Response.--What alterations in the childhood immune system
put young people at risk for IBD, how does the immune system
change with treatment for IBD?
--Psychosocial Functioning.--How does diagnosis and treatment for IBD
impact depression and anxiety among young people? What
approaches work best to improve mood, coping, family function,
and quality of life.
The establishment of a national registry of pediatric IBD patients
is central to our ability to answer these important research questions.
Empowering investigators with HIPPA compliant information on young
patients from across the Nation will jump-start our effort to expand
epidemiologic, basic and clinical research on our pediatric population.
We encourage the subcommittee to support our efforts to establish a
Pediatric IBD Patient Registry with the CDC in fiscal year 2010.
Once again Mr. Chairman, thank you very much for the opportunity to
be with you today. I look forward to any questions you may have.
______
Prepared Statement of the Children's Environmental Health Network
The Children's Environmental Health Network (the Network)
appreciates this opportunity to comment on the fiscal year 2010
appropriations to the Departments of Health and Human Services and
Education for activities that protect children from environmental
hazards. The Network appreciates the wide range of priorities that you
must consider for funding. We urge you to give priority to those
programs that directly protect and promote children's environmental
health. In so doing, you will improve not only our children's health,
but also their educational outcomes and their future.
The Network is a national organization whose mission is to promote
a healthy environment and to protect the fetus and the child from
environmental health hazards. We recognize that children, in our
society, have unique moral standing. The Children's Environmental
Health Network was created to promote the incorporation of basic
pediatric facts such as these in policy and practice:
--Children's bodies and behaviors differ from adults. In general,
they are more vulnerable than adults to toxic chemicals.
--Children are growing. Pound for pound, children eat more food,
drink more water and breathe more air than adults. Thus, they
are likely to be more exposed to substances in their
environment than are adults. Children are different from adults
in how their bodies absorb, detoxify, and excrete toxicants.
--Children's systems, such as their nervous, reproductive, and immune
systems, are developing. This process of development creates
periods of vulnerability when toxic exposures may result in
irreversible damage when the same exposure to a mature system
may result in little or no damage.
--Children behave differently than adults, leading to a different
pattern of exposures to the world around them. For example,
because of their hand-to-mouth behavior, they ingest whatever
may be on their hands, toys, household items, and floors.
Children play and live in a different space than do adults. For
example, very young children spend hours close to the ground
where there may be more exposure to toxicants in dust and
carpets as well as low-lying vapors such as radon or
pesticides.
--Children have a longer life expectancy than adults; thus they have
more time to develop diseases with long latency periods that
may be triggered by early environmental exposures, such as
cancer or Parkinson's disease.
Clear, sound science underlies these principles. A solid consensus
in the scientific community supports these concepts. The world in which
today's children live has changed tremendously from that of previous
generations. There has been a phenomenal increase in the substances to
which children are exposed. According to the Environmental Protection
Agency (EPA), more than 83,000 industrial chemicals are currently
produced or imported into the United States. Traces of hundreds of
chemicals are found in all humans and animals. Every day, children are
exposed to a mix of chemicals, most of them untested for their effects
on developing systems.
We urge the subcommittee to provide the necessary resources for the
Federal programs and activities that help to protect children from
environmental hazards. The key programs in your jurisdiction are below.
CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) AND THE NATIONAL
ENVIRONMENTAL HEALTH CENTER (NEHC)
The Network strongly supports the work of the CDC and the NEHC,
especially NEHC's efforts to continue and expand its biomonitoring
program and to continue its national report card on exposure
information, using the highly respected National Health and Nutrition
Examination Survey. A vital CDC responsibility in pediatric
environmental health is to assist in filling the major information gaps
that exist about children's exposures.
The Network supports a funding level of $8.6 billion for CDC's core
programs in fiscal year 2010. The Network urges the subcommittee to
provide an additional $19.6 million for CDC's Environmental Health
Laboratory in fiscal year 2010. The Network believes it is especially
critical for the NEHC to gather and publish expanded information in the
report card on children's exposures.
PUBLIC HEALTH TRACKING
The CDC's National Environmental Public Health Tracking Program
helps to track environmental hazards and the diseases they may cause,
coordinating and integrating local, State, and Federal health agencies'
collection of critical health and environmental data. We urge the
subcommittee to provide $50 million for the tracking network in fiscal
year 2010 to expand it to additional States and support the continued
development of a sustainable, nationwide Network.
Additionally, data on children's ``real world'' exposure and
disease are critically needed. Since children spend hours every day in
school and child care, we urge you to direct the Tracking Program to
include grants for pilot methods for tracking children's health in
schools and child care settings.
GLOBAL CLIMATE CHANGE
We strongly urge the subcommittee to designate $50 million for the
CDC to help the public prepare for and adapt to the potential health
effects of global climate change in fiscal year 2010.
Global climate change presents major challenges to public health.
Children, as a vulnerable subpopulation, are among those at greatest
risk of harm. Children in communities that are already disadvantaged
will be the most harmed. Recent studies have detailed how children's
physical and social health may be harmed, ranging from respiratory
diseases and melanoma (due to atmospheric changes), to gastrointestinal
diseases (due to increased water contamination), to an increased range
for some diseases (malaria, dengue, encephalitides, Lyme disease), to
increased rates of malnutrition (due to severe drought and severe
precipitation), to the harm caused by displacement, water and food
insecurity, and forced migration (caused by drought, increased rain and
severe storms, and rising sea levels) and the resulting international
conflict and political unrest.
It is imperative that the Federal Government undertake efforts to
mitigate and adapt to climate change. Providing funding to the CDC for
preparing for the potential health effects of global climate change is
an important step.
NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES (NIEHS) AND
CHILDREN'S ENVIRONMENTAL HEALTH RESEARCH CENTERS OF EXCELLENCE
NIEHS is a vital institution in our efforts to understand how to
protect children, whether it is identifying and understanding the
impact of substances that are endocrine disruptors, or better
understanding childhood exposures that may not affect health until
decades later, or seeking answers to many other important questions.
The Children's Environmental Health Research Centers, funded by
NIEHS and the EPA, play a key role in protecting children from
environmental hazards. With budgets of $1 million per year per center
(unchanged over more than 10 years), this program generates valuable
research. A unique aspect of this program is the requirement that each
Center actively involves its local community in a collaborative
partnership, leading both to community-based participatory research
projects and to the translation of research findings into child-
protective programs and policies. Researchers have embraced this
funding mechanism because of the ability it gives them to do
interdisciplinary research and to be involved in the community--things
that are not easy to do using other grant mechanisms. The scientific
output of these centers has been outstanding. For example, four of the
Centers had findings that clearly showed that prenatal exposure to a
widely used pesticide affected developmental outcomes at birth and
early childhood. Another recent example is the finding of a biomarker
in newborns for childhood leukemia, firmly establishing the important
role of prenatal environment factors in causation of this disease.
Unfortunately, almost all of the existing 12 centers are currently
operating on no-cost extensions. We strongly support the center concept
and the network of centers. We also support current efforts by NIEHS
and the EPA to competitively renew and to expand this valuable program
by adding four formative centers. However, only five of the existing
centers are to be renewed. If centers are shuttered, we will lose
access to valuable populations such as urban children with asthma or
children in farm communities exposed to pesticides. We will lose the
ability to learn about issues like early puberty concerns, exposures in
school settings, and pre-adolescent and adolescent outcomes.
Thus, we urge the subcommittee to appropriate at least $15 million
for the NIEHS share of funding so that, in concert with the EPA
contribution, an adequate number of centers (old and new) will have
funding in fiscal year 2010.
In addition, the Network urges the subcommittee to support NIEHS by
increasing its overall budget, and that of the Superfund research
program, by 5 percent more than last year's level and directing that
included in this increase would be a $5 million increase specifically
for research on children's environmental health issues. The Superfund
research program has supported some vital children's research but
funding has been level over the last 4 years.
NATIONAL CHILDREN'S STUDY (NCS)
The NCS is examining the effects of environmental influences on the
health and development of more than 100,000 children in 105 communities
across the United States, following them from before birth until age
21. The NCS will be one of the richest research efforts ever geared
toward studying children's health and development and will form the
basis of child health guidance, interventions, and policy for
generations to come. The NCS will provide a better understanding of how
children's genes and their environments interact to affect their health
and development, thus improving the health and well-being of all
children.
Enrollment in the NCS began this January, after 8 years of planning
and development. The Network urges the subcommittee to continue its
enthusiastic support for the NCS in this and future years, including
full funding of $195 million in fiscal year 2010. The Network also asks
the subcommittee to direct the National Institute of Child Health and
Human Development to assure that protocols are in place for measuring
exposures in the child care and school settings. The Network believes
it is critically important to understand how school and child care
exposures differ from home exposures very early in the NCS.
PEDIATRIC ENVIRONMENTAL HEALTH SPECIALTY UNITS (PEHSU)
A key, but dramatically underfunded, program is the PEHSU network.
Funded by the Agency for Toxic Substances and Disease Registry and the
EPA, the PEHSUs form a network with a center in each of the U.S.
Federal regions, plus one center in Canada and one in Mexico. PEHSU
professionals provide quality medical consultation for health
professionals, parents, caregivers, and patients. Last year, the entire
program, covering the 10 U.S. centers, received less than $2 million.
These centers have done tremendous work on these small budgets. We urge
the subcommittee to provide funding for this program in fiscal year
2010 at the level of $200,000 per center (compared to the $120,000 for
each center last year).
SCHOOL ENVIRONMENTAL HEALTH
Each school day, about 54 million children and 7 million adults
spend a full week inside schools. Unfortunately, many of the Nation's
public and private school facilities are shoddy or even ``sick''
buildings whose environmental conditions harm children's health and
undermine attendance, achievement, and productivity. In 1996, GAO
reported that more than 13 million children were compelled to be in
schools that threatened their health and safety. Two Federal statutes
that would create a foundation for healthy schools are already in
place, authorizing the U.S. Department of Education and the EPA to
address school environments. Unfortunately, to date neither of these
programs have been funded.
We strongly urge the subcommittee to provide the $25 million
authorized by the Healthy and High Performance Schools Act (Public Law
107-110) to the grant program for State agencies to develop and
disseminate information and assistance on high performance school
design standards. The subcommittee should also direct the Department of
Education to conduct a National Priority Study, as required under HHPS,
on the impacts of decayed facilities on children and to report to
Congress. To date, Education has only produced a brief review of the
scientific literature.
These programs and activities are especially vital in light of the
``stimulus'' funds for school modernization or renovation. The stimulus
bill does not require consideration of environmental health or
children's health and safety. Yet, without specific consideration of
health, steps to ``green'' a school--such as increasing insulation at a
school to improve energy efficiency--can have unintended harmful side
effects, such as creating or exacerbating indoor air quality problems.
CHILD CARE ENVIRONMENTAL HEALTH
Thirteen million preschoolers--60 percent of young children--are in
child care. Millions of preschoolers--our youngest and most vulnerable
population--enter care as early as 6 weeks of age and can be in care
for more than 40 hours per week. Yet little is known about the
environmental health status of our child care centers nor how to assure
that they are protecting this important group of children. The Network
is working to correct these gaps.
We ask the subcommittee to direct the Department of Health and
Human Services Assistant Secretary for Children and Families to report
on the Administration for Children and Families activities that protect
children from environmental hazards in childcare settings, especially
in the Office of Head Start.
In conclusion, investments in programs that protect and promote
children's health will be repaid by healthier children with brighter
futures, an outcome we can all support. That is why the Network asks
you to give priority to these programs. Thank you for the opportunity
to testify on these critical issues.
______
Prepared Statement of the Cystic Fibrosis Foundation
NATIONAL INSTITUTES OF HEALTH (NIH)
On behalf of the Cystic Fibrosis Foundation (CFF), and the 30,000
people with cystic fibrosis (CF), we are pleased to submit the
following testimony regarding fiscal year 2010 appropriations for CF-
related research at NIH and other agencies.
ABOUT CF
CF is a life-threatening genetic disease for which there is no
cure. People with CF have two copies of a defective gene, known as
CFTR, which causes the body to produce abnormally thick, sticky mucus
that clogs the lungs and results in fatal lung infections. The thick
mucus in those with CF also obstructs the pancreas, making it difficult
for patients to absorb nutrients from food.
Since its founding, CFF has maintained its focus on promoting
research and improving treatments for CF. More than thirty drugs are
now in development to treat CF, some which treat the basic defect of
the disease, while others target its symptoms. Through the research
leadership of CFF, the life expectancy of individuals with CF has been
boosted from less than 6 years in 1955 to 37 years in 2007. This
improvement in the life expectancy for those with CF can be attributed
to research advances and to the teams of CF caregivers who offer
specialized care. Although life expectancy has improved dramatically,
we continue to lose young lives to this disease.
The promise for people with CF is in research. In the past 5 years,
the CFF has invested more than $660 million in its medical programs of
drug discovery, drug development, research, and care focused on life-
sustaining treatments and a cure for CF. A greater investment is
necessary, however, to accelerate the pace of discovery and development
of CF therapies. This testimony focuses on the investment required to
more rapidly and efficiently discover and develop new CF treatments
aimed at controlling or curing CF.
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), particularly the effort to double
the NIH budget between fiscal year 1999 and fiscal year 2003 as well as
the significant investment provided by the American Recovery and
Reinvestment Act (ARRA). These increases in funding brought a new era
in drug discovery that has benefited all Americans. Congress must
adequately fund the NIH so that it can capitalize on scientific
advances in order to maintain the momentum that the doubling and the
infusion of funds from ARRA generated.
The flat-funding of the NIH since 2003 has decreased purchasing
power, limiting the pursuit of critical research. CFF joins the
Coalition for Health Funding to recommend increasing the budget for all
health discretionary spending by 13 percent in fiscal year 2010, or
$7.4 billion over the fiscal year 2009 Omnibus. This increased
investment will help maintain the NIH's ability to fund essential
biomedical research today that will provide tomorrow's care and cures.
If the subcommittee is not able to recommend funding at this level,
Congress should advise the NIH to focus on contributing funds to
research partnerships that will accelerate therapeutic development to
improve peoples' lives.
STRENGTHEING OUR NATION'S RESEARCH INFRASTRUCTURE
Because CF is a disease that impacts several systems in the body,
several Institutes at the NIH share responsibility for CF research. We
urge the NIH to pay special attention to advances in treatment methods
and mechanisms for translating basic research across Institutes into
therapies that can benefit patients across Institutes. CFF has been
recognized for its own research approach that encompasses 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 30
potential therapies that are being examined to treat people with CF.
THE CLINICAL AND TRANSLATIONAL SCIENCE AWARDS (CTSA)
CTSA program was a key component of the NIH's Roadmap initiative.
The program is designed to transform how clinical and translational
research is conducted, ultimately enabling researchers to provide new
treatments more efficiently to patients. Tremendous effort brought
institutions together to rally around this program, yet current funding
levels make it difficult for the 39 programs (out of a planned 60) to
succeed.
Key to the success of the CTSAs is the development of cost-sharing
for use of infrastructure services. An example of this mechanism is the
General Clinical Research Centers (GCRC), which allowed Institutes to
reduce their research budgets by having investigators use the GCRC when
clinical care such as inpatient stays, lab tests, nursing staff, was
made available at no additional cost. Today, individual investigators
must provide funds for clinical care cost-sharing from grants funded
from other NIH Institutes. As research becomes more expensive and
private capital dries up, it becomes even more critical to ensure
support for translational research, that is, research that moves a
potential therapy from development to the market. In order to maximize
the potential of the CTSA, multiple Institutes within NIH must be able
to provide financial resources for this critical program.
Supporting Clinical Research
A significant discrepancy persists between the funding awarded to
clinical and basic laboratory investigators for first awards. The
difference is even greater for second awards and prolonged funding of
clinical investigators. The NIH must maintain support for translational
research and the investigators piloting those projects. Without this
support, the NIH stands to lose an entire generation of clinically
trained individuals committed to clinical research. The ``generation
gap'' that would be created by the loss of these clinical researchers
would affect the ability of the NIH to conduct world-class clinical
investigation and jeopardize the standing of the United States as the
world's premiere source for biomedical research.
FACILITATING CLINICAL RESEARCH AND DRUG DEVELOPMENT
CFF applauds the NIH's efforts to encourage greater efficiency in
clinical research. CFF has been a leader in creating a clinical trials
network to achieve greater efficiency in clinical investigation.
Because the CF population is so small, a more significant portion of
people with the disease must partake in clinical trials than in most
other diseases. This unique challenge prompted CFF to streamline our
clinical trials processes. Research conducted by CFF is more efficient
than ever before and we are a model for other disease groups.
The Model of the Cystic Fibrosis Therapeutics Development Network
CFF's established clinical research program, the Therapeutics
Development Network (TDN), plays a pivotal role in accelerating the
development of new treatments to improve the length and quality of life
for CF patients. Lessons learned from its centralization of data
management and analysis and data safety monitoring in the TDN will be
useful in designing clinical trial networks in other diseases. We urge
the subcommittee to direct the NIH and other agencies to allocate
additional funds for innovative therapeutics development models like
the TDN. CFF urges the subcommittee to allocate additional resources
for clinical research in order meet the demand for testing the
promising new therapies for CF and other diseases.
Alterative Models for Institutional Review Boards
We are pleased that the Department of Health and Human Services has
encouraged the exploration of alternative models of IRBs, including
central IRBs, by the CTSA. We encourage Congress to urge the Department
to demonstrate more aggressive leadership in persuading all 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. Such oversight
could help provide greater expertise to improve trial design and enable
critical research to move forward in a timelier manner without
undermining patient safety.
RESEARCH COMPENSATION FOR SUPPLEMENTAL SECURITY INCOME (SSI)
An additional impediment in our effort to accelerate the
development of new therapies is the Social Security Administration's
(SSA) current SSI rules, which count research compensation for
participation in a clinical drug study as income for determining SSI.
This policy creates an unnecessary barrier to clinical trial
participation for a significant number of people with CF, and thus
severely limits efforts to develop new therapies. We urge the
subcommittee to direct the SSA to disregard any compensation to an
individual who is participating in a clinical trial testing rare
disease treatments that has been reviewed and approved by an
institutional review board and meets the ethical standards for clinical
research for the purposes of determining that individual's eligibility
for the SSI program.
Partnership with the National Center for Research Resources (NCRR)
The CTSA program, administered by the NCRR, encourages novel
approaches to clinical and translational research, enhances the
utilization of informatics, and strengthens the training of young
investigators. CFF 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. Recently, however, the NCRR
decided to reject funding for disease-specific networks in favor of
those without a disease focus. As a result of this policy, some of the
best clinical research consortia are prohibited from competing for NCRR
grants, including but not limited to the CF TDN. We urge the NCRR to
reverse this decision.
SUPPORTING DRUG DISCOVERY
CFF's clinical research is fueled by a vigorous drug discovery
effort; early stage translational research of promising strategies to
find successful treatments for this disease. Several research projects
at the NIH will expand our knowledge about the disease, and could
eventually be the key for controlling or curing CF.
Exploring Protein Misfolding and Mistrafficking
We applaud 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 continued
exploration in this area to build upon promising discoveries. We urge
the NIH to continue to devote special attention to research in protein
misfolding and mistrafficking, an area which could yield significant
benefits for patients with CF and other diseases where misfolding is an
issue.
Opportunities In Animal Models
CFF is encouraged by the NIH's investment in a research program at
the University of Iowa to study the effects of CF in a pig model. The
program, funded through research awards from both NHLBI and CFF, bears
great promise to help make significant developments in the search for a
cure. While a company has been established to produce the animals, the
infrastructure and extensive animal husbandry required to keep the
animals alive and conduct research on them is available at few academic
institutions. We urge additional funding to create a facility that
would enable researchers from multiple institutions to conduct research
with these models.
Facilitating Scientific Data Connections
An explosion of data is emerging from ``big science'' projects such
as the Human Genome Project and the International HapMap Project. We
encourage investments by NIH into the development of systems that
permit the linkage of gene expression, protein expression and protein
interaction data from independent laboratories. While construction of
such an interface would be difficult, it would undoubtedly facilitate
generations of new ideas and open new areas of medically important
biology.
Increasing Investment in Inflammatory Response Research
CF, like diseases such as inflammatory bowel disease, chronic
bronchitis, and rheumatoid arthritis, cause an intense inflammatory
response. CFF enthusiastically supports investments by the NIH to gain
a greater understanding of inflammatory signaling and inflammatory
cascades, which would lead to improved methods of safely interfering
with the inflammatory process and contributing to the health and well
being of the U.S. population.
Supporting High Throughput Screening
The subcommittee should urge the NIH to continue to fund high
throughput screening initiatives in keeping with the NIH Roadmap
suggestions. Support for the follow-up and optimalization of compounds
identified through this type of screening can help to bridge the
development gap and bring about more drugs that can make it to
patients' bedsides.
Funding Systems Biology Platforms
In order to rapidly accelerate the identification of potential
biomarkers and understand the mechanisms of action of CFTR function,
data generated from multiple laboratories and scientific must be
integrated. To address this, CFF has partnered with a systems biology
company called GeneGo to generate a CF-focused systems biology platform
to illustrate the various effects of CFTR dysfunction in multiple cell
systems. CFF urges NIH to provide additional funding to support
research efforts aimed at leveraging systems biology platforms to
integrate multiple disciplines within the CF research community in
order to accelerate drug development and biomarker validation for CF.
Small Business Innovation Research Program at NIH
Small Business Innovation Research (SBIR) program grants allocated
by the NIH have helped many small biotechnology and pharmaceutical
companies to develop vital treatments for a variety of diseases.
Several companies developing CF treatments have used SBIR grants to
fund their development process.
The SBIR program could provide further support by directing that a
portion of all grants awarded be used for rare disease research. With
such a small portion of the population likely to purchase the drugs,
research to produce drugs to treat rare diseases is often considered
too large a financial risk to take on. It is important to note, however
that there are more than 25 million Americans with a rare disease. By
directing even small dollar grants to develop drugs for these diseases,
Congress can eliminate some of the risk that keeps biotechnology and
pharmaceutical companies from developing drugs for rare diseases.
The NIH has wisely focused on translational research as a
touchstone for ensuring the relevance of the agency to the American
public. CFF is the perfect example of this notion, having devoted our
own resources to developing treatments through drug discovery, clinical
development, and clinical care. Several of the drugs in our pipeline
show remarkable promise in clinical trials and we are increasingly
hopeful that these discoveries will bring us even closer to a cure.
Encouraged by our successes, we believe the experience of CFF in
clinical research can serve as a model of drug discovery and
development for research on other orphan diseases and we stand ready to
work with NIH and congressional leaders. On behalf of CFF, we thank the
subcommittee for its consideration.
______
Prepared Statement of the Center for Global Health Policy
The Center for Global Health Policy of the Infectious Diseases
Society of America (IDSA) is pleased to submit testimony about the
urgent need to increase funding for the Department of Health and Human
Services' programs that address two deadly global pandemics--HIV/AIDS
and tuberculosis.
IDSA represents more than 8,000 infectious diseases and HIV
physicians and scientists devoted to patient care, education, research,
prevention, and public health. Nested within the IDSA is the HIV
Medicine Association (HIVMA), representing more than 3,500 physicians,
scientists, nurse practitioners, and other health professionals working
in HIV medicine. In 2008, IDSA and HIVMA launched the Infectious
Diseases Center on Global Health Policy and Advocacy to address global
HIV/AIDS, tuberculosis, and HIV/TB co-infection. Under the leadership
of a scientific advisory committee of world-renowned scientific experts
in these areas, IDSA works to educate policymakers, U.S. Government
program implementers and the media about evidence-based policies and
programs and the value of U.S. leadership in combating these deadly and
synergistic epidemics.
GLOBAL HIV/AIDS PANDEMIC
There are 33 million people living with HIV/AIDS in the world, with
22 million of them or 67 percent living in sub-Saharan Africa. AIDS
kills 2 million people annually. U.S. leadership has been the
catalyzing force for preventing millions of infections, ensuring access
to lifesaving HIV treatment for 3 million persons in developing
countries, and providing care and support to millions of additional
people, including orphans and vulnerable children. Despite tremendous
progress, only about one-third of persons in developing countries who
are clinically eligible for antiretroviral therapy are receiving it,
and an ongoing and robust prevention campaign is essential to reduce
the more than 7,000 new HIV infections that still occur on a daily
basis.
The National Institutes of Health (NIH)-funded HIV research at the
NIH research led to the development of lifesaving antiretroviral
therapy, identified the efficacy of antiretroviral therapy during
pregnancy to prevent mother-to-child transmission, demonstrated the HIV
prevention benefits of male circumcision, and is paving the road to the
availability of an effective microbicide. The Centers for Disease
Control and Prevention (CDC) have been a critical implementing partner
in the U.S. response to the global HIV epidemic, working with health
ministries in developing countries to launch HIV prevention and
treatment programs, conducting public health evaluation research, and
supporting heavily impacted countries in their efforts to monitor and
to employ evidence based strategies in response to their particular
epidemics.
TUBERCULOSIS
Tuberculosis is the second leading global infectious disease
killer, claiming more than 1.7 million lives annually. Worldwide, one-
third of the world's population is infected with TB and nearly 9
million people develop active TB disease each year. In recent years,
highly drug-resistant forms of TB have emerged. Drug-resistant
tuberculosis is a direct result of human failure--failure to adequately
detect and treat TB and to develop the necessary tools to effectively
address this ancient and deadly scourge.
In 2006, the CDC and the World Health Organization (WHO) reported
the findings from a survey of TB reference laboratories around the
world indicating that 20 percent of M. tuberculosis isolates were
multi-drug resistant (MDR)--that is, TB strains resistant to the two
most potent drugs in the four-drug TB regimen. Four percent of these
MDR-TB strains were resistant to multiple second-line drugs and were
deemed extensively drug-resistant TB or XDR-TB. Mortality from XDR-TB
can be as high as 85 percent, and close to 100 percent in individuals
co-infected with HIV/AIDS. The increase in MDR-TB and the advent of
XDR-TB have triggered grave alarm in the scientific community about the
potential for an untreatable XDR-TB epidemic. In 2007, WHO estimated
that there were 500,000 cases of MDR-TB and only 1 percent of these
cases were treated according to WHO standards.
The global pandemic and alarming spread of drug-resistant TB
present a persistent public health threat to the United States.
Tuberculosis is an airborne infection.
Drug-resistant TB anywhere in the world easily translates into
drug-resistant TB everywhere.
DEADLY SYNERGY OF HIV/TB CO-INFECTION
The costly MDR TB epidemic in the United States in the early 1990s
emerged against a background of HIV infection in high HIV prevalence
cities like New York City and Miami. Today, HIV-TB co-infection is
ravaging sub-Saharan Africa. TB is the leading cause of death of
persons with HIV worldwide. Tuberculosis facilitates HIV disease
progression, and persons with HIV have poorer TB treatment outcomes
than their non-HIV-infected counterparts. According to the WHO, in
2007, there were at least 1.37 million cases of HIV positive TB--nearly
15 percent of the total incident cases. There were 456,000 deaths among
this group.
CDC--TUBERCULOSIS
Last year, Congress passed landmark legislation--the Comprehensive
Tuberculosis Elimination Act of 2008--Public Law 110-873. This bill
authorizes a number of actions that will shore up State TB control
programs, enhance United States capacity to deal with the serious
threat of drug-resistant tuberculosis and escalate our efforts to
develop urgently needed new ``tools'' in the form of drugs,
diagnostics, and vaccines. Realizing these goals will require
additional resources; at a minimum, it is critical that the funding
authorized for fiscal year 2010 in this important new law--$210
million--be appropriated for the CDC Division of TB Elimination. While
this represents an increase more than current funding, the scientific
community, including the National Coalition for the Elimination of
Tuberculosis, has estimated that $528 million will be needed annually
to implement strategies through the CDC that will advance the goal of
TB elimination.
Funds are desperately needed to increase the clinical trial
capacity of the Tuberculosis Trials Consortium (TBTC) to evaluate
promising new drugs for MDR TB and to support clinical trials for
vaccine candidates that hold the hope of eliminating the scourge of TB
from the face of the earth. Additional financial support is also needed
for the Tuberculosis Epidemiologic Studies Consortium (TBESC)--critical
partnerships between TB control programs and academic institutions
aimed at designing, conducting and evaluating programmatically relevant
research.
Strengthening CDC's Division of TB Elimination to conduct research
and support State TB control programs will protect our communities, and
help ensure that another devastating outbreak of drug-resistant
tuberculosis that plagued several American cities in the late 1980s
does not recur. Ultimately, modest Federal investments will prevent the
necessity to expend huge resources treating MDR-TB and XDR-TB, which
can cost $468,000 per case to treat.
CDC--GLOBAL AIDS PROGRAM (GAP)
CDC's Global AIDS Program (GAP) helps resource-poor countries
prevent HIV infection; improve treatment, care, and support for people
living with HIV; and build healthcare capacity and infrastructure. To
meet these objectives, CDC sends clinicians, epidemiologists and other
health professionals to help foreign governments and health
institutions with a range of prevention, care, and support activities.
Working closely with health ministries in developing countries, CDC
helps build sustainable public health capacity in laboratory services
and systems, including country capacity to design and implement HIV
surveillance systems and surveys.
The CDC GAP also plays an important role in helping governments
monitor and evaluate the impact of HIV prevention, care and treatment
programs. CDC GAP also works with the Office of the Global AIDS
Coordinator as the lead on HIV prevention, and also works to evaluate
the impact of US HIV prevention, treatment and care and support
funding. For example, CDC GAP is currently conducting a public health
evaluation (PHE) to assess the impact of PEPFAR funding on developing
country health systems and access to other healthcare services. A
funding level for CDC'GAP program of at least $218 million is
essential.
NIH
NIH is the world's flagship biomedical research institution,
supporting basic science research, behavioral research, drug and
diagnostic development and research training. Unfortunately in recent
years, NIH funding has eroded, and stagnant funding has resulted in
decreasing support for original research and cuts in clinical trial
networks. With only 1 in 4 approved research applications receiving
funding, the pipeline for critical discoveries is dwindling and young
scientists are being forced to turn their attention to different
professional pursuits.
IDSA is extremely pleased that the recently enacted stimulus bill
contained an infusion of billions of desperately needed dollars for the
NIH research enterprise. Congress rightfully acknowledged the role of
scientific research in stimulating the economy. It is vital, however,
that the long overdue increases in funding enjoyed by the NIH in the
economic stimulus bill are maintained and enhanced in this year's
funding bill--funding that will ultimately translate into improvements
in individual and public health, both domestically and globally.
HIV/AIDS RESEARCH
The successes of the HIV research investment is a testament to the
value of research investment. A robust and comprehensive research
portfolio was responsible for the rapid and dramatic gains in our HIV
knowledge base, gains that resulted in reductions in mortality from
AIDS of nearly 80 percent in the United States and in developing
countries where treatment has been made available. Remarkable
discoveries helped us to reduce mother-to-child HIV transmission to
nearly 1 percent in the United States and this intervention has
prevented HIV infection in hundreds of thousands of children worldwide.
A continued robust HIV research effort is essential to accelerate our
progress in developing more effective prevention strategies, and
supporting the basic research necessary to continue our work developing
a vaccine that may end the deadliest pandemic in human history.
Research to improve treatment strategies to aid prevention and to
maximize the benefits of antiretroviral therapy, especially in
underserved populations in the United States and in resource-limited
settings is a high priority.
The National Institute on Allergies and Infectious Diseases (NIAID)
is the principal funding resource for basic and clinical HIV research,
but critical HIV research is conducted through a range of NIH
Institutes under the leadership of the Office for AIDS Research (OAR).
TUBERCULOSIS RESEARCH
NIAID is also a critical player in tuberculosis research. In 2007,
NIAID developed a research strategy for drug-resistant tuberculosis,
but limited resources have slowed implementation of this strategy.
According to the NIH Research Portfolio Online Reporting Tool, RePORT,
NIH funding for tuberculosis research, including vaccine research
totaled $160 million in fiscal year 2008--a modest level for an
infectious disease that kills millions through a pathogen that is
showing increasing resistance to available medications. In fact,
funding for TB research has gone in the wrong direction since NIH spent
$211 million on TB research in fiscal year 2007. A doubling of funding
for TB research would be a reasonable response to the world disease
burden and the current scientific opportunities.
We must increase our investment in TB research as highlighted in
the enacted Comprehensive TB Elimination Act of 2008. We must have the
resources to conduct clinical trials on new therapeutics for both drug-
susceptible and drug-resistant TB, to test new diagnostics in point-of-
care settings, and to evaluate promising TB vaccine candidates. We
urgently need treatment regimens that are shorter in duration and less
toxic. Research related to pediatric tuberculosis, including drug
development, must be stepped up.
It is also imperative that research activities focused on HIV/TB
co-infection continue with enhanced funding. Tuberculosis is the
leading cause of death among persons with HIV/AIDS worldwide. TB is
more difficult to diagnose in persons with HIV and a number of
important anti-TB drugs interact with HIV antivirals. Critical
questions remain about how best to sequence HIV and TB treatment in co-
infected individuals--questions with life and death ramifications for
millions of individuals, especially those living in sub-Saharan Africa.
Tuberculosis threatens to undermine the tremendous progress that has
been made in saving the lives of persons in developing countries
through the provision of antiretroviral therapy.
GLOBAL FUND TO FIGHT AIDS, TUBERCULOSIS AND MALARIA
Historically, one-third of U.S. funding for the Global Fund has
been appropriated through the NIAID budget and IDSA strongly supports a
significant U.S. contribution to the Global Fund. U.S. support for the
Global Fund to Fight AIDS, Tuberculosis and Malaria is a crucial part
of U.S. global health diplomacy. The Global Fund is a country-led,
performance-based partnership that embraces transparency and
accountability, and fosters multilateral cooperation. The Global Fund
provides a quarter of all international financing for AIDS globally,
two-thirds for tuberculosis, and three-quarters for malaria. Through
these efforts, the Global Fund has helped save 3.5 million lives in 140
countries
In Pakistan, for example, an American-based international aid group
called Mercy Corps has, using Global Fund resources, partnered with the
private sector on a broad TB public education campaign, training
thousands of health workers, and strengthening lab capacity to test for
TB. This work has dramatically increased Pakistan's ability to detect
TB cases, and now Pakistan is counting on the Fund's strong, continued
support to ensure medication is available to people with TB. Continued
progress on TB is essential to development in Pakistan, since 80
percent of Pakistanis afflicted with tuberculosis are in the most
economically productive years of their lives, and the disease sends
many self-sustaining families into poverty.
The Global Fund projects an $8 billion need for new and continuing
programs in 2010, but only $3 billion in pledges are in place. The
Labor, Health and Human Services, and Education, and Related Agencies
budget, through NIH, has been a crucial source of funding for the U.S.
contribution to the Fund, providing $300 million in fiscal year 2009.
The Global Fund has requested that the United States triple its total
contribution for fiscal year 2010. The portion of the U.S. contribution
provided by NIH should therefore be tripled to $900 million. The
economic, strategic and moral case for this contribution to the Global
Fund is clear, and the United States must do its part to help close
this funding gap.
The IDSA and the HIVMA have many funding priorities to champion in
the Labor, Health and Human Services, and Education, and Related
Agencies appropriations bill including funds to address antimicrobial
resistance, child and adult immunizations, pandemic influenza, the Ryan
White CARE Act, and domestic HIV prevention. Thank you for the
opportunity to highlight our funding priorities for research and
programs related to global HIV and TB in the Labor, Health and Human
Services, and Education, and Related Agencies account.
______
Prepared Statement of Children and Adults with Attention-Deficit/
Hyperactivity Disorder (CHADD)
BACKGROUND
At the Centers for Disease Control and Prevention (CDC) 1999
conference titled ``Attention Deficit Hyperactivity Disorder: A Public
Health Perspective,'' more than 150 experts gathered to discuss the
public health concerns related to AD/HD and to explore areas for future
research. The conference developed a public health research agenda
which included recommendations on the establishment of: a resource for
both professionals and the public regarding what is known about the
epidemiology of AD/HD; an avenue of dissemination of educational
materials related to the diagnosis of and intervention opportunities
for AD/HD to primary care physicians, nurse practitioners, physicians
assistants, mental health providers and educators; collaborations with
other organizations to educate and promote what is known about AD/HD
interventions, appropriate standards of practice, their effectiveness,
and their safety; and a resource to the public for accurate and valid
information about AD/HD and evidence-based interventions.
Congress responded to this research agenda in fiscal year 2002 by
providing resources for the CDC to begin a partnership with CHADD \1\
to develop the National Resource Center on AD/HD (NRC)--a significant
development in recognizing the unique challenges faced by individuals
with AD/HD across the lifespan.
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\1\ Children and Adults with Attention-Deficit/Hyperactivity
Disorder (CHADD) was founded by parents in 1987 in response to the
frustration and sense of isolation experienced by parents and their
children. CHADD is the leading national nonprofit organization for
children and adults with AD/HD, providing the public and providers with
education, advocacy, and support.
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The NRC's goals include improving the health and quality of life of
individuals with AD/HD and their families; raising awareness and
facilitating access to scientifically valid information and support
services; and improving the understanding of the impact of AD/HD among
healthcare specialists, educators, employers, and individuals with AD/
HD. The NRC fulfills these goals by disseminating evidence-based
research on AD/HD through a variety of mechanisms, including:
--a Web site (www.help4adhd.org) receiving on average 129,274 visits
each month;
--a national call center, staffed by five professional health
information specialists, including one bilingual health
information specialist. The health information specialists
responded to 9,051 individual inquiries during the last year on
10,018 different topical issues from parents, adults with AD/
HD, mental health professionals, and educators;
--partnerships with minority health organizations to reach
underserved populations;
--a series of more than 25 ``What We Know'' fact sheets on AD/HD, in
both English and Spanish; and
--a comprehensive library and online bibliographic database of more
than 3,000 evidence-based journal articles and reports on AD/
HD.
The overwhelming demand for information and support on AD/HD by the
public and the professional community has created an unprecedented need
for additional resources to keep pace with the requests for information
received by the NRC and to provide outreach and resources to unserved
and underserved populations.
WHAT IS AD/HD?
A 2005 report by the CDC found that parents reported approximately
7.8 percent of school-age children (4 to 17 years) had a diagnosis of
Attention-Deficit/Hyperactivity Disorder (AD/HD).\2\ Other evidence-
based studies have documented that more than 70 percent of children
with AD/HD will continue to experience symptoms of AD/HD into
adolescence, and almost 65 percent will exhibit AD/HD characteristics
as adults.\3\ In addition, up to two-thirds of children with AD/HD will
have at least one co-occurring disability with 50 percent of these
children having a co-occurring learning disability.
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\2\ Centers for Disease Control and Prevention (2005). Mental
Health in the United States: Prevalence of Diagnosis and Medication
Treatment for Attention-Deficit/Hyperactivity Disorder. Retrieved March
25, 2005, from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5434a2.htm.
\3\ Dulcan, M., and the Work Group on Quality Issues. (1997,
October). AACAP official action: Practice parameters for the assessment
and treatment of children, adolescents, and adults with Attention-
Deficit/Hyperactivity Disorder. Journal of the American Academy of
Child and Adolescent Psychiatry, Supplement, 36(10), 85S-121S.
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Only half of all children with AD/HD receive the necessary
treatment, with lower diagnostic and treatment rates among girls,
minorities, and children in foster care. If untreated or inadequately
treated, AD/HD can have serious consequences, increasing an
individual's risk for school failure, unemployment, interpersonal
difficulties, other mental health disorders, substance and alcohol
abuse, injury, antisocial and illegal behavior, contact with law
enforcement, and shortened life expectancy.\4\ The availability of
appropriate services and access to treatment can help individuals with
AD/HD avoid negative outcomes and lead successful lives.
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\4\ Barkley, R. A. (1997). ADHD and the nature of self-control. New
York: The Guilford Press.
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FISCAL YEAR 2010 APPROPRIATIONS REQUEST
The NRC has met and continues to meet the goals of improving the
health and quality of life for individuals with AD/HD and their
families; raising awareness and facilitating access to evidence-based
information and support services; and improving the understanding of
the impact of AD/HD among healthcare specialists, educators, employers,
and individuals with AD/HD.\5\
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\5\ Cuffe, S.P., Moore, C.G., & McKeown, R. (2009). ADHD and health
services utilization in the National Health Survey. Journal of
Attention Disorders, 12(4), 330-340.; Chan, E., Zhan, C., & Homer, C.J.
(2002). Health care use and costs for children with Attention-Deficit/
Hyperactivity Disorder, Archives of Pediatrics & Adolescent Medicine,
156, 504-511.; Rowland, A.S., Umbach, D.M., Stallone, L., Naftel, J.,
Bohlig, E.M., & Sandler, D. P. (2002). Prevalence of medication
treatment for Attention Deficit--Hyperactivity Disorder among
elementary school children in Johnston County, North Carolina, American
Journal of Public Health, 92(2), 231-234.; Ray, T.G., Levine, P.,
Croen, L.A., Bokhari, F.A.S., Hu., T., & Habel, L.A. (2006). Attention-
Deficit/Hyperactivity Disorder in children, Archives of Pediatrics &
Adolescent Medicine, 160, 1063-1069.
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Both the National Institutes of Health Consensus Conference on AD/
HD (Nov. 1998) and the Centers for Disease Control and Prevention (CDC)
Conference on Public Health and AD/HD (September 1999) concluded that
AD/HD is a serious public health concern that needs to be addressed
because of the potential economic burden associated with AD/HD.
Numerous peer-reviewed journal articles have documented the significant
healthcare cost of individuals with AD/HD.
In ``AD/HD in Adults: What the Science Says,'' Barkley, Murphy &
Fisher discuss the results of the few empirical studies that have been
conducted regarding occupational functioning of clinic-referred adults
with AD/HD. ``Although opinions abound on the topic in trade books on
ADHD in adults, there is very little research on the occupational
functioning of clinic-referred adults with ADHD'' (p. 276). One study
conducted at UMASS found that adults with a diagnosis of AD/HD are more
likely to self-report and have employers report difficulties with
occupational functioning than their clinic-referred or community
counterparts. In addition, the Milwaukee study (2006) found that
individuals diagnosed as having AD/HD as children that persists until
age 27 tend to be more severely affected in occupational functioning
than clinic-referred adults or community counterparts. In addition,
another study conducted by Biederman & Faraone (2006) concluded that
individuals with AD/HD are less likely to be employed full time (34
percent of individuals with AD/HD compared to 59 percent of individuals
without AD/HD).\7\ In addition, the study found that the household
incomes of adults older than the age of 25 were significantly lower
among individuals with AD/HD when compared to individuals without AD/HD
regardless of academic achievement or personal characteristics. The
results of these three studies indicate the need for further research
into the impact of AD/HD on the occupational functioning of adults and
how best to reasonably accommodate their disability in the workplace
because more than 30 percent of requested accommodations are at no cost
to the employer but yet according to Biederman & Faraone the total cost
of work loss among men and women with AD/HD is $2.6 billion, or 53
percent of the total $13 billion cost of adult ADHD in the United
States.
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\7\ Biederman, J.,& Faraone, S.V. (2006). The effects of attention-
deficit/hyperactivity disorder on employment and household income.
MedGenMed, 8(3),12, Retrieved March 25, 2005, from http://
www.medscape.com/viewarticle/536264.
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Therefore, we are asking that the National Center on Birth Defects
and Developmental Disabilities (NCBDDD) AD/HD line item be increased
from $1.777 million to $2.377 million and that the funding for the NRC
be increased from $980,000 to $1.280 million. This is a $600,000
increase in the AD/HD line and $300,000 increase in the NRC line.
Historically, half of the increase to the AD/HD line item has been used
to fund research on AD/HD. This increase will allow the NRC to further
develop its outreach to the African-American and Hispanic-Latino
communities, restore education campaigns at nurse, educator, and
related conferences, and most importantly during this current economic
climate to initiate an employment information specialist service.
REQUESTED REPORT LANGUAGE FOR FISCAL YEAR 2010
The subcommittee continues to support the activities of the CDC's
NCBDDD and the National Resource Center (NRC) on AD/HD and has provided
$2.377 million to continue this support, including $1.28 million to
maintain and expand the activities at the NRC as it responds to the
overwhelming demand for information and support services, reaches
special populations in need, and educates health and education
professionals on the impact of AD/HD on the ability individuals with
AD/HD to lead successful, economically self-sufficient, and independent
lives integrated into their communities with the necessary
accommodations and supports.
______
Prepared Statement of the Coalition for Health Services Research
The Coalition for Health Services Research is pleased to offer this
testimony regarding the role of health services research in improving
our Nation's health. The Coalition's mission is to support research
that leads to accessible, affordable, high-quality healthcare. As the
advocacy arm of AcademyHealth, the Coalition represents the interests
of 3,500 researchers, scientists, and policy experts, as well as 150
organizations that produce and use health services research.
Healthcare in the United States has the potential to improve
people's health dramatically, but often falls short and costs too much.
Health services research is used to understand how to better finance
the costs of care, measure and improve the quality of care, and improve
coverage and access to affordable services. Indeed, health services
research is changing the face of American healthcare, uncovering
critical challenges facing our Nation's healthcare system. For example,
the 2000 Institute of Medicine (IOM) report To Err is Human found that
up to 98,000 Americans die each year from medical errors in the
hospital. Health services research also uncovered that disparities and
lack of access to care in rural and inner cities result in poorer
health outcomes. And, it found that obesity accounts for more than $92
billion in medical expenditures each year and has worse effects on
chronic conditions than smoking or problem drinking.
Health services research does not just lift the veil on problems
plaguing American healthcare; it also seeks ways to address them.
Health services research framed the debate over healthcare reform in
Massachusetts--forming the basis for that State's 2006 health reform
legislation--and continues to frame the debate on the national stage
today. It offers guidance on implementing and making the best use of
health information technology, and getting the best care at the best
value across a menu of treatment options. And there are increasing
examples that demonstrate how comparative effectiveness research--an
emerging science in the broader field of health services research--
provides the scientific basis needed to determine what treatments work
best, for whom, and in what circumstances.
Health services research can contribute greatly to better
healthcare at better value. It is a true public good, providing a basis
for improvements in our healthcare system that will benefit the general
public. Americans overwhelmingly agree. A recent opinion survey
commissioned by Research!America found that 95 percent of Americans say
it is important to support research focused on how well our healthcare
system is functioning. After all, the investment in basic research and
the development of new medicines and equipment is wasted if the health
system cannot safely and effectively deliver that care.
For the last 6 years, the Coalition has been collecting data to
track the Federal Government's expenditures for health services
research and health data. From information provided to us by these
funders--including Agency for Healthcare Research and Quality (AHRQ),
National Institutes of Health (NIH), and the Centers for Disease
Control and Prevention (CDC)--funding for this field remained
relatively constant from fiscal year 2003--2008 and did not kept pace
with inflation. In stark contrast, spending on healthcare overall has
risen faster than the rate of inflation--from $1.4 trillion in 2000 to
nearly $2.2 trillion in 2007. The total Federal investment in health
services research and data by our estimates approaches $1.7 billion in
fiscal year 2008--representing just 0.074 percent of the $2.2 trillion
we spend on healthcare annually.
The Coalition for Health Services Research greatly appreciates the
subcommittee's recent efforts to increase the Federal investment in
health services research and comparative effectiveness research through
the fiscal year 2009 Omnibus Appropriations Act and the American
Recovery and Reinvestment Act of 2009. This funding provides a new high
watermark for the field and represents the largest single funding
increase health services research has experienced. With comprehensive
health reform on the horizon, we ask that the subcommittee continue to
strengthen the capacity of the health services research field to
address the pressing challenges America faces in providing access to
high-quality, cost-effective care for all its citizens.
AHRQ
AHRQ is the lead Federal agency charged with supporting unbiased,
scientific research to improve healthcare quality, reduce costs,
advance patient safety, decrease medical errors, and broaden access to
essential services. Steady, incremental increases for AHRQ's Effective
Health Care Program in recent years, as well as the $300 million
provided to AHRQ in the American Recovery and Reinvestment Act as a
down payment on health reform will help AHRQ generate more comparative
effectiveness research and expand the infrastructure needed to increase
capacity to produce this evidence. However, funding for AHRQ's broader
health services research portfolio on health disparities, healthcare
financing and organization, and access and coverage has languished as
funding for AHRQ's base has remained relatively flat. Future
investments should bolster these other important research topics to
balance the recent investments in comparative effectiveness research.
Comparative effectiveness research alone will not solve our health
system challenges; the full spectrum of health services research on
healthcare costs, quality, and access will be needed to support broader
health reform efforts.
In fiscal year 2009, Congress provided AHRQ $13 million to reverse
a decline in the number of, and funding for, grants that support
researcher innovation and career development. AHRQ is using this
funding for investigator initiated research grants to rejuvenate the
free marketplace of ideas through the agency's new Innovations Research
Portfolio. We request that Congress provide additional funding to
sustain and expand investigator initiated grants in fiscal year 2010.
The Coalition remains concerned about AHRQ's limited investment in
training grants for young researchers, which hit new lows in fiscal
year 2009--just 40 awards totaling $5 million--down from nearly double
that amount just 2 years ago. The Coalition requests that Congress will
provide AHRQ more funding in fiscal year 2010 for training grants to
ensure the field's capacity to respond to the growing public and
private sector demand for health services research.
While targeted funding increases in recent years have moved AHRQ in
the right direction, more core funding is needed to help AHRQ fulfill
its mission. We join the Friends of AHRQ--a coalition of more than 250
health professional, research, consumer, and employer organizations
that support the agency--in recommending a fiscal year 2009 base
funding level of at least $405 million, an increase of $32 million more
than the fiscal year 2009 level. This investment will allow AHRQ to
restore its critical healthcare safety, quality, and efficiency
initiatives; strengthen the infrastructure of the research field; and
reignite innovation and discovery.
CDC
Housed within CDC, the National Center for Health Statistics (NCHS)
is the Nation's principal health statistics agency, providing critical
data on all aspects of our healthcare system. Thanks to NCHS, we know
that too many Americans are overweight and obese, cancer deaths have
decreased, average life expectancy has increased, and emergency rooms
are overcrowded. We also know how many people are uninsured, how many
children are immunized, how many Americans are living with HIV/AIDS,
and how many teens give birth.
Despite recent funding increases secured through your leadership,
NCHS continues to feel the effects of long-term underinvestment,
forcing the agency to eliminate or further postpone the collection of
such vital information to the point where key data users now question
whether NCHS itself is in good health. Years of flat funding and budget
shortfalls forced the elimination of data collection and quality
control efforts, threaten the collection of vital statistics, stymied
the adoption of electronic systems, and limited the agency's ability to
modernize surveys to reflect changes in demography, geography, and
health delivery.
The Coalition joins the Friends of NCHS--a coalition of more than
250 health professional, research, consumer, industry, and employer
organizations that support the agency--in recommending a base funding
level of $137.5 million in fiscal year 2010 to ensure uninterrupted
collection of vital statistics; restore other important data collection
and analysis initiatives; to revise, pretest, and plan data collection
activities for future calendar years, and modernize its systems to
increase efficiency, interoperability, and security. In addition, we
respectfully request that you provide NCHS $15 million in one-time
funding to support the States and territories as they implement the
2003 birth certificates and electronic systems to collect birth data in
real-time to facilitate public health monitoring and planning. Future
supplemental funding will be required to implement the 2003 death
certificates in all States and complete the automation of data
collection. The Coalition greatly appreciates that through your
leadership early versions of the American Recovery and Reinvestment Act
in the House and Senate included $40 million for this infrastructure
development; we were disappointed that it had to be eliminated from the
final package.
While significant funding has been provided to improve the public
health system's capacity to respond to a terrorist attack or a public
health crisis such as pandemic flu, insufficient funding has been
provided to support research that evaluates the effectiveness of our
preparedness interventions and seeks to improve the delivery of public
health services. For example, how cost effective are public health and
prevention programs? How can the medical care and public health
delivery systems be better linked? CDC's important Public Health
Research program and Prevention Research Centers-a network of academic
health centers that conduct public health research-have been flat
funded since fiscal year 2006 at levels of $31 million and $29 million,
respectively. The Coalition requests at least $35 million for Public
Health Research and at least $33 million for Prevention Research
Centers in fiscal year 2010. The programs seek ways to development,
translate, and disseminate research to address obesity, diabetes, and
heart disease, healthy aging and youth development, cancer risk, and
health disparities.
CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS)
Steady funding decreases for the Office of Research, Development
and Information, together with an increasingly earmarked budget, has
hindered CMS' ability to meet its statutory requirements and conduct
new research to strengthen our public insurance programs--including
Medicare, Medicaid, and SCHIP--which together provide coverage to
nearly 100 million Americans and comprise 45 percent of America's total
health expenditures. At a time when these programs pose significant
budget challenges for both the Federal and State governments, it is
critical that we adequately fund research to evaluate these programs'
efficiency and effectiveness, and seek ways to manage their projected
spending growth.
The Coalition supports increasing CMS's discretionary research and
development budget from $31 million in fiscal year 2009 to a base
fiscal year 2010 funding level of $45 million--in addition to funding
for programmatic earmarks--as a critical down payment to help CMS
recover lost resources and restore research to evaluate their programs,
analyze pay for performance and other tools to update payment
methodologies, and to further refine service delivery methods.
NIH
The NIH reported that it spent $743 million on health services
research in fiscal year 2008--roughly 2.9 percent of its entire
budget--making it the largest Federal sponsor of health services
research. For fiscal year 2010, the Coalition recommends a health
services research base funding level of at least $940 million--2.9
percent of the $32 billion the broader health community is seeking for
NIH in fiscal year 2010. We encourage NIH to increase the proportion of
their overall funding that goes to health services research from 2.9 to
5 percent to assure that discoveries from clinical trials are
effectively translated into health services. We also encourage NIH to
foster greater coordination of its health services research investment
across its Institutes.
In conclusion, the accomplishments of health services research
would not be possible without the leadership and support of this
subcommittee. As you know, the best healthcare decisions are based on
relevant data and scientific evidence. At a time when you, your
congressional colleagues, and members of the new administration are
considering major health reform including ways to get more value for
current expenditures, health services research and health data are
needed more than ever to yield better information and lead to improved
quality, accessibility, and affordability. We urge the subcommittee to
accept our fiscal year 2010 funding recommendations for the Federal
agencies funding health services research and health data.
______
Prepared Statement of the Coalition of Northeastern Governors
The Coalition of Northeastern Governors (CONEG) is pleased to
submit this testimony for the record to the Senate Subcommittee on
Labor, Health and Human Services, and Education, and Related Agencies
regarding fiscal year 2010 appropriations for the Low Income Home
Energy Assistance Program (LIHEAP).
The governors appreciate the subcommittee's continued support for
the LIHEAP program, and we thank you for providing the full authorized
amount of $5.1 billion in fiscal year 2009 LIHEAP funding. The
governors recognize the considerable fiscal challenges facing the
subcommittee this year. However, we urge you to maintain the $5.1
billion level in regular fiscal year 2010 LIHEAP block grant funding as
well as contingency funds to address unforeseen energy emergencies.
LIHEAP is a vital safety net for millions of vulnerable low-income
households--the elderly and disabled living on fixed incomes, the
working poor, and families with young children. The highest level of
LIHEAP assistance is provided to households with the lowest incomes
that pay a high proportion of their income (up to 17 percent) for home
energy. A December 2007 study by the Oak Ridge National Laboratory
found that, in recent years, the increase in the cost of home energy
has far outpaced the rate of inflation and the increase in household
income. Even with continued belt-tightening, there is just no room in
the budget of these low-income households to pay for increasing energy
bills.
The current economic crisis exerts additional pressures on these
households, making energy assistance more important now than ever
before. In 2007, even before the current recession took hold, 8.7
million residential consumers had their electricity or natural gas
service terminated for failing to pay their bills, according to a
survey by the National Association of Regulatory Utility Commissioners
(December 2008). The same survey found at the end of the 2007-2008
winter heating season, the number of electricity and natural gas
residential households with past due accounts had jumped to almost 40
million consumers, and represented nearly $8.7 billion in past due
accounts.
According to the National Energy Assistance Directors' Association,
the $5.1 billion in fiscal year 2009 LIHEAP funding makes it possible
for States to serve approximately 7.3 million households this year.
This record number represents a 25 percent increase more than last year
and reflects the increased unemployment rate and rise in home energy
costs. Yet this is only a small portion of the LIHEAP-eligible
households in today's economy.
If the $5.1 billion level of LIHEAP funding is not sustained in
fiscal year 2010, States nationwide will be forced to eliminate more
than 1.5 million families from the program in order to maintain some of
the purchasing power of the LIHEAP grant for the program's poorest
families, or to reduce benefit levels overall. States in the Northeast
already incorporate various administrative strategies that allow them
to deliver maximum program dollars to households in need. These include
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. Opportunities to further reduce LIHEAP
administrative costs are limited, since they are already among the
lowest of the human service programs.
In spite of these State efforts to stretch Federal and State LIHEAP
dollars, the need for the program is far too great. Increased,
predictable and timely Federal funding is vital for LIHEAP to assist
the Nation's vulnerable, low-income households faced with exorbitant
home energy bills. The CONEG governors urge the Subcommittee to provide
$5.1 billion in regular block grant funding for LIHEAP in fiscal year
2010 as well as contingency funds to address unforeseen energy
emergencies. This sustained level of funding will help States to
provide meaningful assistance to households in need as millions of low-
income citizen's struggle with simply unaffordable home energy bills.
LIHEAP can continue to provide a vital safety net protecting these
vulnerable households from the potentially deadly heat and cold.
______
Prepared Statement of the Council on Social Work Education
On behalf of the Council on Social Work Education (CSWE), I am
pleased to offer this written testimony to the Senate Appropriations
Subcommittee on Labor, Health and Human Services, and Education, and
Related Agencies for inclusion in the official subcommittee record. I
will focus my testimony on the importance of fostering a skilled,
sustainable and diverse social work workforce through training and
financial support programs at the Department of Health and Human
Services and the Department of Education.
CSWE is a nonprofit national association representing more than
3,000 individual members as well as 650 graduate and undergraduate
programs of professional social work education. Founded in 1952, this
partnership of educational and professional institutions, social
welfare agencies, and private citizens is recognized by the Council for
Higher Education Accreditation as the sole accrediting agency for
social work education in the United States. Social work education
focuses students on leadership and direct practice roles helping
individuals, families, groups, and communities by creating new
opportunities that empower people to be productive, contributing
members of their communities.
Vulnerable populations from all walks of life--defined here as
children and adults with physical or mental disabilities, those living
in poverty, trauma victims, aging individuals, returning veterans,
individuals under stress or facing coping challenges both temporary and
permanent, and segments of society needing assistance to adjust to
changing circumstances or overcome injustices--are faced with hurdles
which for some cannot be overcome alone. Social workers help vulnerable
populations in society be as healthy and productive as possible by
working with them to navigate societal and personal challenges. Social
workers are employed in schools, hospitals, VA facilities,
rehabilitation centers, social service locations, child welfare
organizations, assisted living centers, nursing homes, and faith-based
organizations.
TRAINING OPPORTUNITIES AND DEBT LOAD RELIEF FOR SOCIAL WORKERS
Recruitment and retention pose the most significant challenge to
the success of the social work profession. This is true across all
sectors (public and private), at all levels (from BSW to the doctoral
level), and in all fields of practice (child welfare, public health,
mental health, geriatrics, veterans, etc.).
The Nation needs a workforce that is skilled, diverse, and able to
keep pace with demand. In 2004, the Bureau of Labor Statistics (BLS)
reported that by 2012 a total of 209,000 social workers will be needed
in the fields of child, family, and school social work; medical and
public health social work; and mental health and substance abuse social
work. In 2006, the BLS estimated there would be a total of 258,000 job
openings for social workers due to growth and net replacement between
2006 and 2016 in the same fields.
While recruitment and retention can be a significant challenge for
many professions, especially those dealing with public health and the
delivery of social services, the problem is exceptionally widespread
for social work. Recruitment into the social work profession faces many
obstacles, the most prevalent being low wages.
As we look toward reforming the American healthcare system, we must
consider the needs of the workforce that will be responsible for
ensuring the health of the population. The recommendations for fiscal
year 2010 would help to ensure that we are fostering a sustainable,
skilled, and diverse workforce that will be able to keep up with the
increasing demand.
DEPARTMENT OF HEALTH AND HUMAN SERVICES (HHS)
The various agencies within the HHS provide training and fellowship
opportunities for social workers, as well as loan forgiveness programs
to help social workers stay in the field. CSWE urges the subcommittee's
support of the following HHS programs; this is not an exhaustive list:
Minority Fellowship Program, Substance Abuse and Mental Health
Services Administration (SAMHSA).--The goal of the SAMHSA Minority
Fellowship Program (MFP), which is administered through the Center for
Mental Health Services, is to achieve greater numbers of minority
doctoral students preparing for leadership roles in the mental health
and substance abuse field. According to SAMHSA, ``Minorities make up
approximately one-fourth of the population, but only about 10 percent
of mental health providers are ethnic minorities.'' CSWE has been a
grantee of this critical program for years, administering funds to
exceptional minority social work students. Together with a program at
the National Institute of Mental Health (NIMH), CSWE has supported more
than 500 minority fellows since the program's inception, with about
two-thirds of those students having gone on to receive their doctoral
degrees. For fiscal year 2010, CSWE urges the subcommittee to fund the
SAMHSA Minority Fellowship Program at $7.5 million. This program has
suffered from flat and declining budgets over the last several years.
Thankfully, due to congressional support, it has been restored year
after year, despite efforts by the Bush administration to cancel it.
President Obama's fiscal year 2010 budget request includes level
funding for the MFP at about $4 million. Funding the MFP at $7.5
million would directly encourage more social workers of minority
background to pursue doctoral degrees in mental health and substance
abuse and will turnout minority mental health professionals equipped to
provide culturally competent, accessible mental health and substance
abuse services to diverse populations.
Institutional Research Training Program in Social Work (T32),
NIMH.--NIMH within the National Institutes of Health (NIH) initiated a
training program in the 1970s that sought to increase the number of
minority doctoral students focusing their research in mental health.
Like the SAMHSA program mentioned above, CSWE has ably administered a
grant from NIMH for many years, which provides mentored training
opportunities to minority social work researchers. The social work
profession depends on culturally competent and culturally relevant
research to assess the circumstances facing vulnerable populations and
the needs of those populations to succeed in their circumstances;
evaluate the accessibility to and effectiveness of existing social
services; and determine best practices for social work educators and
practitioners for serving the community. While this program has been
successful in enhancing diversity among social workers conducting
mental health research and has allowed more underrepresented social
work researchers to be brought into the fold as NIH investigators, NIMH
recently announced its plan to cancel the program in 2010 and
transition the funds to support the traditional, nondiversity-focused
T32 training program at NIMH. CSWE is very concerned about the
implications of this decision, both on the diversity of researchers at
NIMH and what we feel could lead to an absence of social work research
at NIMH. We hope the subcommittee will encourage NIMH to take the
necessary steps to enhance diversity of the NIH/NIMH grant pool and
express to NIMH the value and importance of social work research to the
study of mental health.
Title VII Health Professions Programs, Health Resources and
Services Administration (HRSA).--The title VII health professions
programs at HRSA provide financial support for education and
development of the healthcare workforce. The emphasis of these programs
is on improving the quality, diversity, and geographic distribution of
the health professions workforce, and is currently the only Federal
program to do so. These programs provide loans, loan guarantees and
scholarships to students and grants to institutions of higher education
and nonprofit organizations to help build and maintain a robust
healthcare workforce. Social work students and practioners are eligible
for title VII funding. We thank you for recognizing the value of these
programs by providing $200 million in stimulus funding to the title VII
and title VIII (nursing) programs in the American Recovery and
Reinvestment Act of 2009 (Public Law 111-5). CSWE urges the
subcommittee to provide $330 million for the title VII health
professions programs for fiscal year 2010.
Loan Repayment Program, Indian Health Service (IHS).--The Loan
Repayment Program at IHS offers repayment of health professions
educational loans in exchange for a commitment to work at an IHS or
other Indian health program priority site for a minimum of 2 years.
Social workers are eligible to participate in this program, as defined
in section 4(n) of the Indian Health Care Improvement Act (Public Law
94-437). With appropriate funding, this program can serve as an
effective recruitment tool. However, the program has been grossly
underfunded for a number of years. For example, last year IHS denied
funding to 231 healthcare professionals already working in IHS as well
as 95 recruits, due to a lack of resources. CSWE, a member of the
Friends of Indian Health Coalition, urges the subcommittee to provide
an additional $18.5 million above fiscal year 2009 funding for the IHS
Loan Repayment Program for fiscal year 2010 in order to address the
critical recruitment needs of the agency.
DEPARTMENT OF EDUCATION
The last few years have seen the creation of a number of loan
forgiveness and training programs for which social work would benefit,
if adequately funded. CSWE urges the subcommittee to support the
following programs at the Department of Education:
Graduate Assistance in Areas of National Need (GAANN) Program.--The
GAANN program provides graduate traineeships in critical fields of
study. Currently, social work is not defined as an area of national
need for this program; however it was recognized by Congress as an area
of national need in the Higher Education Opportunity Act of 2008 as
discussed below. We are hopeful that the Department of Education will
recognize the importance of including social work in the GAANN program
in future years. Inclusion of social work would help to significantly
enhance graduate education in social work, which is critically needed
in the country's efforts to foster a sustainable health professions
workforce. CSWE supports a budget of at least $41 million for GAANN in
fiscal year 2010. However, if social work were to be added by the
Department as a new area of national need, additional resources would
need to be provided so as not to take funding away from the already
determined areas of national need.
Loan Forgiveness for Service in Areas of National Need Program.--
The Higher Education Opportunity Act of 2008 (Public Law 110-315)
created the Loan Forgiveness for Service in Areas of National Need
program. This program applies to full-time workers who are employed in
areas of national need, such as social workers working in public or
private child welfare agencies or mental health professionals with at
least a master's degree in social work. CSWE urges full funding for
this new program for fiscal year 2010.
In addition to these discretionary programs, a number of mandatory
programs were created in the College Cost Reduction Act of 2007 (Public
Law 110-84). We look forward to working with the Department of
Education as these programs are implemented. Among the programs that
include social work education are:
Income-based Repayment (IBR)Program.--IBR program will begin
operation in July 2009. This new program caps Federal student loan
payments at a reasonable percentage of income and cancels most
remaining balances of student loans after 25 years. CSWE will be
monitoring the implementation of this new program to assess the extent
to which it is assisting social workers address their debt load
reduction needs.
Income Contingent Payment for Public Sector Employment Program
(Public Service Loan Forgiveness).--The College Cost Reduction Act of
2007 revised the Income Contingent Payment for Public Sector Employment
program, which previously allowed a borrower who works in public
service to pay their loans more than 25 years after which their debt
would be forgiven. The law now states that public service workers
working for an eligible nonprofit can cancel their loans after 10 years
of service for loans taken out after October 1, 2007. Like the IBR
program, CSWE plans to monitor the implementation of this program to
assess its success in assisting social workers address high educational
debt load.
We hope the subcommittee will take these points into consideration
as you move forward in the fiscal year 2010 appropriations process.
______
Prepared Statement of Central Technical Services
SUMMARY OF RECOMMENDATIONS FOR FISCAL YEAR 2010
Continue the Commitment to Providing the National Institutes of
Health (NIH) and the National Library of Medicine (NLM) with meaningful
funding increases on an annual basis. Continue to support and defend
the NIH's public access policy, which requires that all final, peer-
reviewed manuscripts are made available through NLM's pubmed central
database within 12 months of publication. Continue to support the
medical library community's important role in NLM's outreach,
telemedicine, disaster preparedness and health information technology
(health IT) initiatives.
On behalf of the Medical Library Association (MLA) and the
Association of Academic Health Sciences Libraries (AAHSL), thank you
for the opportunity to present testimony regarding fiscal year 2010
appropriations for the NLM.
MLA is a nonprofit, educational organization with more than 4,000
health sciences information professional members worldwide. Founded in
1898, MLA provides lifelong educational opportunities, supports a
knowledge base 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. 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 legislative task
force and a Government Relations Committee.
THE IMPORTANCE OF ANNUAL FUNDING INCREASES FOR NLM
I thank the subcommittee for its leadership and hard work on the
American Recovery and Reinvestment Act of 2009 (Public Law 111-5), the
economic stimulus package. As you know, the important mission of NIH
and the important role that NLM plays in fulfilling that mission were
hampered by past-years of near level funding. The investment in NIH and
NLM provided by the stimulus package will not only create meaningful
employment opportunities, it will also revitalize NLM's programs, which
are focused on improving the public health.
We are pleased that the recently passed fiscal year 2009 omnibus
appropriations package contains funding increases for NIH and NLM that
will bolster their baseline budgets. We hope that this funding is an
indication of the subcommittee's intention to provide annual,
meaningful increases for NIH and NLM in the coming years.
I am confident that the recovery funding and the fiscal year 2009
budget increases will stimulate the economy, stimulate biomedical
research, and in the case of NLM, improve the dissemination of health
information to researchers, practitioners, and the general public.
Moving forward, it will be critical to provide NIH's baseline budget
with the funding increases necessary to allow the short-term growth
generated by the stimulus to become a long-term investment towards
improved public health through bolstered health information programs.
Building and Facility Needs
NLM has had tremendous growth in its basic functions related to the
acquisition, organization, and preservation of an ever-expanding
collection of biomedical literature. It also has been assigned a
growing set of set of responsibilities related to the collection,
management, and dissemination genomic information, clinical trials
information, and disaster preparedness and response. As a result, NLM
faces a serious shortage of space, for staff, library materials, and
information systems. 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
(physical and digital) and as new digital resources demand increasing
amounts of storage space. As a result, the space needed for computing
facilities has also grown. 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 subcommittee urged NIH to assign a high
priority to this construction project so that the information-handling
capabilities and biomedical research are not jeopardized.
The Growing Demand for NLM's Basic Services
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.
NLM's clinical trials database, ClinicalTrials.gov, which was
launched in February 2000 and lists registration information on more
than 70,000 U.S. and international trials for a wide range of diseases,
also now serves as a repository for summary results information. The
expanded system serves not only as a free, but invaluable resource for
patients and families who are interested in participating in trials of
new treatments for a wide range of diseases and conditions, but also as
an important source of information for clinicians interested in
understanding new treatments and for those involved in evidence-based
medicine and comparative effectiveness research.
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 11.4 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. 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.
DEFEND PUBLIC ACCESS
The Appropriations Committee has shown unprecedented foresight and
leadership by using the annual spending bills as the vehicle to
establish a public access policy at the NIH. The current policy
requires that all NIH-funded researchers deposit their final, peer-
reviewed manuscripts in NLM's PubMed Central database within 12 months
of publication. This policy will not only help NIH better manage its
portfolio of research, but will contribute to the development of a
biomedical informatics infrastructure that will stimulate further
discovery by enabling a much greater and tighter interlinking of
information from NLM's wide-ranging set of databases. It also
contributes to outreach initiatives by providing much-needed access to
health literature to those without direct access to medical libraries.
While the fiscal year 2009 omnibus package made this policy permanent
moving forward, challenges remain and we urge the subcommittee to
continue to defend this policy.
SUPPORT AND ENCOURAGE NLM PARTNERSHIPS WITH THE MEDICAL LIBRARY
COMMUNITY
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. One example of NLM's leadership is the
``Partners in Information Access'' program, which 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.
With help from Congress, NLM, NIH and the Friends of NLM, launched
NIH MedlinePlus Magazine in September 2006. This quarterly publication
is distributed in doctors' waiting rooms, and provides the public with
access to high-quality, easily understood health information.
Collaborating with the National Alliance for Hispanic Health, a Spanish
version is now available, NIH MedlinePlus Salud. NLM also continues to
work with medical librarians and health professionals to encourage
doctors to provide MedlinePlus ``information prescriptions'' to their
patients. This initiative also encourages genetics counselors to
prescribe the use of NLM's Genetic Home Reference Web site.
``Go Local'' is another exciting service that engages health
sciences libraries and other local and State agencies in the creation
of Web sites that link from MedlinePlus to relevant information on
local pharmacies, hospitals, doctors, nursing homes, and other health
and social services. In Iowa, for example, University of Iowa
librarians developed an Iowa Go Local site that enables users to find
local health resources by Iowa county or city. It allows Iowa citizens
to link directly from a MedlinePlus health topic, for example asthma,
to local services, such as clinics, pulmonary specialists, and support
groups in the geographic area selected. By collecting such information
in one place, Go Local also provides a platform for enhancing access to
the information needed to prepare for and respond to disasters and
emergencies.
MLA and AAHSL applaud the success of NLM's outreach initiatives,
particularly those initiatives that reach out to medical libraries and
health consumers. We ask the subcommittee to encourage NLM to continue
to coordinate its outreach activities with the medical library
community in fiscal year 2010.
EMERGENCY PREPAREDNESS AND RESPONSE
MLA and AAHSL are pleased that NLM has established a Disaster
Information Management Research Center to expand NLM's capacity to
support disaster response and management initiatives, as recommended in
the NLM Board of Regents Long Range Plan for 2006-2016. We ask the
subcommittee to show its support for this initiative, which has a major
objective of ensuring continuous access to health information and
effective use of libraries and librarians when disasters occur.
Following Hurricane Katrina, for example, NLM worked with health
sciences libraries across the country to provide 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. Presently, libraries are a
significant, but underutilized resource for community disaster planning
and management efforts, which NLM can help to deploy. With assistance
from its NNLM, NLM is working with health sciences libraries to develop
continuity of operations and backup plans and is exploring the role
that specially trained librarians--disaster information specialists--
can play in providing information services to emergency personnel
during a crisis. MLA and AAHSL see a clear role for NLM and the NNLM in
the Nation's disaster preparedness and response activities.
HEALTH IT AND BIOINFORMATICS
NLM has played a pivotal role in creating and nurturing the field
of biomedical informatics. Not only has NLM developed key biomedical
databases, but 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. 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 U.S.-wide use (e.g., SNOMED),
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 the subcommittee to continue its 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 in ONCHIT and the Agency for Healthcare Research and
Quality that build upon initiatives housed at NLM.
______
Prepared Statement of the Close Up Foundation
Mr. Chairman, my name is Timothy S. Davis, President and CEO of the
Close Up Foundation and I submit this testimony in support of our $5
million appropriations request for the Close Up Fellowship Program.
Close Up Foundation is a nonprofit, nonpartisan civic education
organization dedicated to the idea that, within a democracy, informed,
active citizens are essential to a responsive Government. Close Up's
mission is to inform, inspire, and empower students and their teachers
to exercise their rights and accept the responsibilities of citizens in
a democracy. Close Up's experiential methodology emphasizes that
democracy is not a spectator sport, and provides young people with the
knowledge and skills to participate in the democratic process. Our
students are a diverse group--coming from every State and beyond and
from all walks of life. More than 650,000 have graduated from our
experiential programs.
Three core principles of Close Up are: (1) family income should not
be a barrier to a students' participation, (2) commitment to
diversity--outreach should reach a broad cross section of young people,
and (3) enrollment should be open to all students, not just student
leaders or high academic achievers.
The Close Up Fellowship Program provides financial assistance to
economically disadvantaged students and their teachers to participate
on week-long Close Up Washington civic education programs. The
Fellowship Program, authorized in Federal law since 1972 and currently
authorized under section 1504 of the No Child Left Behind Act, has been
continuously funded by a Congressional appropriation, through a U.S.
Department of Education grant, for more than 35 years. Close Up makes
every effort to ensure the participation of students from rural, small
town, and urban areas and gives special consideration to students with
special educational needs, including students with disabilities, ethnic
minority students, and students with migrant parents. Student
fellowships recipients are selected by their schools and must qualify
according to the income eligibility guidelines.
As in most years, funding for the Close Up Fellowship Program was
not included in the President's budget submitted to Congress. Close Up
respectfully requests that Congress again include funding for this
important program through the appropriations process. I also wish to
address some of the arguments made by the administration for
eliminating the Close Up Fellowship Program.
The administration's claim that peer organizations of Close Up
provide scholarships to participants without Federal assistance is
misleading. The average family income of a Close Up Fellowship
recipient is approximately $24,000. To the extent that other nonprofit
civic education organizations claim to provide scholarships, they
usually are provided only to high academic achievers and certainly not
on the scale and volume provided by Close Up. None of these
organizations reach the numbers of economically disadvantaged students
and teachers from under-resourced schools as Close Up does. Twenty-five
percent of Close Up participants each year receive fellowship support
provided through a mix of Federal funds and contributions raised from
private sources by the Close Up Foundation.
Close Up is also concerned with the administration's statement that
our private fundraising efforts would allow our civic education program
to continue. The statement misses the point. The result of elimination
of the Close Up Fellowship Program would immediately deny participation
to deserving and diverse students who, but for the fellowship program,
would be unable to attend. In turn, this would make Close Up's student
composition dramatically less diverse. While Federal funding represents
a small portion of Close Up's revenue, it is a critical portion of our
funding that permits us to reach as many economically disadvantaged
students as we do.
Finally, the administration wrongly asserted that it had minimal
evidence that Close Up had a positive impact on the participating
students and teachers. Close Up measures impact in four principle ways:
Qualitative Data (some of our findings include):
--97 percent of teachers said the program helped their students
understand the role of a citizen in a democracy; 94 percent
of students agreed.
--94 percent of teachers said the program helped their students
understand current policy issues facing the United States;
94 percent of students agreed.
--91 percent of teachers said the program complements what they
teach in school.
--95 percent of students said the program helped them understand
that other students have views other than their own.
--78 percent of students said that the program inspired them to
become more involved in activities in civic activities when
they return home.
Qualitatively Data:
--Close Up conducts weekly focus groups with students and teachers
about their program experience and its impact on their
lives.
--Close Up assembles anecdotal information from teachers regarding
the performance of their students and their community
action projects.
College Credit:
--The University of Virginia and the University of Indiana, after a
comprehensive evaluation of the academic value of the Close
Up civic education programs, grant the opportunity for
Close Up participants to receive undergraduate credit
(students) and graduate credit (teachers), respectively.
Local Support:
--Thousands of schools organize and fundraise each year to send
their young people on a Close Up program. Approximately
18,000 students and teachers participate annually.
--Local education officials have concluded that Close Up is of such
value as to permit students and teachers to sacrifice a
week of school and absence from all of their classes to
participate.
--Many school systems contribute scarce budget dollars to help
students attend while most others provide resources for
substitute teachers.
Close Up Fellowship recipients add diversity to the student body on
Close Up programs. The fellowship program thus benefits not only the
recipient but all Close Up student program participants.
Close Up is grateful to the United States Congress for its long-
standing support of the Close Up Fellowship Program through the
appropriations process. Tens of thousands of young people have been
able to participate on Close Up Washington civic education programs as
a result of the Federal funding.
Close Up's fiscal year 2010 request is based on its desire to
significantly increase the number of economically disadvantaged young
people who participate on Close Up Washington civic education programs.
The funds, which assist the disadvantaged and provide seed money for
at-risk schools and communities to participate on these life
transforming programs, are more important now than ever. Given the
current economic climate, it will be more challenging for communities
to raise the necessary funds for participation on Close Up programs.
The Federal funding bridges that gap and Close Up feels that with
aggressive outreach into economically distressed communities we can
continue to provide these experiences to our young people.
Close Up's appropriations request reflects the increasing cost of
providing these important Washington programs. The cost of airfare,
accommodations, food and local transportation skyrocketed during the
decade that Close Up Fellowship funding remained flat at just under
$1.5 million. The increase in the appropriations amount to $1.942
million in fiscal year 2008 has helped combat a small portion of those
increased costs but still results in a sharp decrease in the number of
economically disadvantaged students that Close Up has been able to
serve. We believe that during hard economic times it is even more
imperative for the Federal Government to invest in the civic education
of young people. And, by investing in a Close Up education, the
Government also supports the suffering transportation and hospitality
economic sectors.
Senators have the opportunity to meet with Close Up groups from
their States during Close Up ``Capitol Hill Day''. They see the
excitement and pride as our students gain the confidence to express
their views on the public policy issues that most directly affect their
lives. Through workshops, seminars and the experience of being in
Washington, Close Up instills these students with the knowledge and
skills to become active citizens in our democracy.
Many of your constituents would not be able to participate in this
life altering program without the benefit of the Close Up Fellowship
Program. There is no better investment that we can make in our Nation's
future than building educated and responsible citizens, one person at a
time.
Close Up respectfully requests that the Senate Appropriations
Subcommittee on Labor, Health and Human Services, and Education, and
Related Services appropriate $5 million for the Close Up Fellowship
Program.
______
Letter From the Digestive Disease National Coalition
Washington, DC, May 22, 2009.
Hon. Tom Harkin,
Chairman, Subcommittee on Labor, Health and Human Services, and
Education, and Related Agencies, Washington, DC.
Hon. Thad Cochran,
Ranking Member, Subcommittee on Labor, Health and Human Services, and
Education, and Related Agencies, Washington, DC.
Dear Senators Harkin and Cochran: Thank you very much for your
continued leadership in advancing healthcare policy.
The Digestive Disease National Coalition (DDNC) is an advocacy
organization comprised of the major national voluntary and professional
societies concerned with digestive diseases. The DDNC focuses on
improving public policy related to digestive diseases and increasing
public awareness with respect to the many diseases of the digestive
system. The DDNC works cooperatively to improve access to and the
quality of digestive disease healthcare in order to promote the best
possible medical outcome and quality of life for current and future
patients with digestive diseases.
In this capacity, the DDNC applauds the long-range research agenda
as stated in the March 2009 publication Opportunities and Challenges in
Digestive Diseases Research: Recommendations of the National Commission
on Digestive Diseases by the National Institute of Diabetes, and
Digestive, and Kidney Diseases (NIDDK). The DDNC requests that the
subcommittee consider the following recommendations for the fiscal year
2010 Labor, Health and Human Services, and Education, and Related
Agencies appropriations bill:
--A 6.5 percent funding increase for the National Institutes of
Health, with a proportional increase for the NIDDK; and
--An increase of $75 million for the VA Medical and Prosthetic
Research Program for a total of $555 million.
Thank you for the opportunity to present the views of the digestive
disease community. Please do not hesitate to contact me if there is any
more information you would like us to provide for your consideration.
Sincerely,
Dr. Peter Banks,
President.
Linda K. Aukett,
Chair.
______
Prepared Statement of the Dystonia Medical Research Foundation
SUMMARY OF RECOMMENDATIONS FOR FISCAL YEAR 2010
Provide a funding increase of at least 7 percent for the National
Institutes of Health (NIH) and its Institutes and Centers.
Urge the National Institute on Neurological Disorders and Stroke
(NINDS), the National Institute on Deafness and Other Communication
Disorders (NIDCD), and the National Eye Institute (NEI) to expand their
research portfolios on dystonia.
Urge the NIH Office of Rare Diseases (ORD) to explore opportunities
to partner with the Dystonia Medical Research Foundation (DRMF) and
advance dystonia research.
Dystonia is a neurological movement disorder characterized by
powerful and painful involuntary muscle spasms that cause the body to
twist, repetitively jerk, and sustain postural deformities. There are
several different variations of dystonia, including; focal dystonias,
which affect specific parts of the body, and generalized dystonia,
which affect many parts of the body at the same time. Some forms of
dystonia are genetic and others are caused by injury or illness.
Dystonia does not affect a person's consciousness or intellect, but is
chronic and progressive. In North America alone, conservative estimates
indicate that between 300,000 and 500,000 individuals suffer with
dystonia. Currently, there is no known cure and treatment options
remain limited.
While the underlying mechanisms of dystonia remain a mystery and
the onset of symptoms can occur for a number of reasons, two therapies
have emerged with proven health benefits to the dystonia patient
community. Botulinum toxin injections and deep brain stimulation have
shown varying degrees of success, depending on the individual, in
alleviating a dystonia patient's symptoms. More research is needed to
fully understand how to combat and cure dystonia, and in the mean time,
maintaining patient access to life-improving therapies remains
critical.
DEEP BRAIN STIMULATIONS (DBS)
DBS is a surgical procedure that was originally developed to treat
Parkinson's disease, but is now being applied to severe cases of
dystonia. A neurostimulator, or brain pacemaker, is surgically
implanted and delivers electrical stimulation to the areas of the brain
that control movement. While the exact reasons for effectiveness are
unknown, the electrical stimulation blocks abnormal nerve signals that
cause abnormal muscle spasms and contractions.
Since DBS was approved for use by dystonia patients in 2003, it has
drastically improved the lives of many individuals. Results have ranged
from quickly regaining the ability to walk and speak, to regaining
complete control over ones body and returning to an independent life as
an able-bodied person. DBS is currently used to treat severe cases of
generalized dystonia, but its promising role in treating focal
dystonias is being explored and requires continuous support. Surgical
interventions are a crucial and active area of dystonia research and
may continue to lead to the development of promising treatment options.
BOTULINUM TOXIN INJECTIONS (BOTOX/MYOBLOC)
The introduction of botulinum toxin as a therapeutic tool in the
late 1980s revolutionized the treatment of dystonia by offering a new,
localized method to significantly relieve symptoms for many people.
Botulinum toxin, a biological product, is injected into specific
muscles where it acts to relax the muscles and reduce excessive muscle
contractions.
Botulinum toxin is derived from the bacterium Clostridium
botulinum. It is a nerve ``blocker'' that binds to the nerves that lead
to the muscle and prevents the release of acetylcholine, a
neurotransmitter that activates muscle contractions. If the message is
blocked, muscle spasms are significantly reduced or eliminated.
Injections of botulinum toxin should only be performed by a
physician who is trained to administer this treatment. The physician
needs to know the clinical features and study the involuntary movements
of the person being treated. The physician doing the treatment may
palpate (touch) the muscles carefully, trying to ascertain which
muscles are over-contracting and which muscles may be compensating. In
some instances, such as in the treatment of laryngeal dystonia, a team
approach including other specialists may be required.
For selected areas of the body, and particularly when injecting
muscles that are difficult or impossible to palpate, guidance using an
electromyograph (EMG) may be necessary. For instance, when injecting
the deep muscles of the jaw, neck, or vocal cords, an EMG-guided
injection may improve precision since these muscles cannot be readily
palpated. An EMG measures and records muscle activity and may help the
physician locate overactive muscles.
Injections into the overactive muscle are done with a small needle,
with one to three injections per muscle. Discomfort at the site of
injections is usually temporary, and a local anesthetic is sometimes
used to minimize any discomfort associated with the injection. Many
dystonia patients frequently rely on botulinum toxins injections to
maintain their improved standard of living due to the fact that the
benefits of the treatment peak in approximately 4 weeks and lasts just
3 or 4 months. Currently, FDA-approved forms of botulinum toxin include
Botox and Myobloc.
DYSTONIA AND NIH
Currently, three Institutes at NIH conduct medical research into
dystonia. They are NINDS, NIDCD, and NEI.
NINDS has released important Program Announcements in recent years
to study the causes and mechanisms of dystonia. These awards cover a
wide range of research areas, which included gene discovery, the
genetics and genomics of dystonia, the development of animal models of
primary and secondary dystonia, molecular and cellular studies
inherited forms of dystonia, epidemiology studies, and brain imaging.
DMRF often works with NINDS to support as much critical research as
possible and advance understating of dystonia.
NIDCD has funded many studies on brainstem systems and their role
in spasmodic dysphonia. Spasmodic dysphonia is a form of focal
dystonia, and involves involuntary spasms of the vocal cords causing
interruptions of speech and affecting voice quality. Our understanding
of spasmodic dysphonia has been greatly enhanced by research
initiatives at NIDCD, like the brainstem systems studies.
NEI focuses some of its resources on the study of blepharospasm.
Blepharospasm is an abnormal, involuntary blinking of the eyelids from
an unknown cause that is associated with abnormal function of the basal
ganglion. The condition can progress to the point where facial spasms
develop. Presently, NEI is conducting a study entitled, Mexiletine for
the Treatment of Focal Dystonia and a Doxilr Blepharospasm Treatment
Trial, both of which have the potential to significantly improve
treatment options for blepharospasm patients.
An emerging area of NIH that has the potential to stimulate
important, new research into dystonia is ORD housed in the Office of
the Director. ORD can facilitate research networks into certain rare
conditions by pulling together resources housed at other NIH Institutes
and Centers. Given the prevalence of dystonia, the DMRF would like to
work more closely with ORD to stimulate and support new research
opportunities.
DMRF also supports many extramural researchers studying dystonia.
Research includes: exploring improved clinical rating scales for
dystonia, elevations of sensory motor training, utilizing Botox as a
possible treatment for focal hand dystonia, characterization of
abnormalities in sensory regions of the brain, treatments for spasmodic
dysphonia, DBS (the direct electrical stimulation of specific brain
targets), noninvasive transcranial brain stimulation, anatomy imaging
of the effect of dystonia on brain activity, and exploring the link
between laryngitis and spasmodic dysphonia.
Recent years of near level-funding at NIH have negatively impacted
the mission of its Institutes and Centers. For this reason, DMRF
applauds initiatives like Senator Arlen Specter's (D-PA) successful
effort to provide NIH with $10.4 billion in stimulus funds. IFFGD urges
this subcommittee to show strong leadership in pursuing substantial
funding increase through the regular appropriations process in fiscal
year 2010.
For fiscal year 2010, DMRF recommends a funding increase of at
least 7 percent for NIH and its Institutes and Centers.
For fiscal year 2010, DMRF recommends that NINDS, NIDCD, and NEI be
urged to increase their research activities regarding dystonia and
partner with voluntary health organizations to promote dystonia
research and awareness.
For fiscal year 2010, DMRF asks the subcommittee to urge ORD to
consider ways it can partner with DMRF and support dystonia research.
DMRF
DMRF was founded more than 30 years ago and has been a membership-
driven organization since 1993. Since our inception, the goals of DMRF
have remained: to advance research for more effective treatments of
dystonia and ultimately find a cure; to promote awareness and
education; and support the needs and well being of affected individuals
and their families.
Thank you for the opportunity to present the views of the dystonia
community.
______
Prepared Statement of the Federation of American Societies for
Experimental Biology
The Federation of American Societies for Experimental Biology
(FASEB), respectfully requests a funding increase of at least 7 percent
above the fiscal year 2009 baseline level for the National Institutes
of Health (NIH) in fiscal year 2010. This funding level is an important
step toward President Obama's campaign pledge to double funding for
basic research over 10 years and is necessary to maintain both the
existing and future scientific infrastructure. We are in a crucial time
for science in the United States. After years of stagnant funding for
research, Congress has recently made significant new investments in
NIH. The scientists and researchers represented by FASEB are sincerely
grateful to Congress for your faith in the research community and your
generosity in providing the resources that are essential for progress
in science.
As a Federation of 22 professional scientific societies, FASEB
represents nearly 90,000 life scientists, making us the largest
coalition of biomedical research associations in the Nation. FASEB's
mission is to advance health and welfare by promoting progress and
education in biological and biomedical sciences, including the research
funded by NIH, through service to its member societies and
collaborative advocacy. FASEB enhances the ability of biomedical and
life scientists to improve--through their research--the health, well-
being, and productivity of all people.
We especially thank and commend Congress for including the
extraordinary investment in medical research at NIH that was included
as part of in the American Recovery and Reinvestment Act (ARRA, Public
Law 111-5) as well as the $938 million increase in NIH funding in the
Omnibus Appropriations Act for fiscal year 2009 (Public Law 111-8). In
particular, we are deeply grateful to the chairman and this
subcommittee for your long-standing leadership in support of NIH. These
are difficult times for our Nation and for people all around the globe,
but the affirmation of science is the key to a better future is a
strategic step forward.
The recent history of the NIH budget has hindered scientific
discovery and limited the capacity of a key engine for today's
innovation-based economy. The additional funding in the ARRA and the
fiscal year 2009 omnibus are critical first steps to returning the NIH
to a course for even greater discovery. These investments give
patients, their families and researchers renewed hope for the future,
and will help ensure the success of America's medical research
enterprise and leadership.
The funding increases in the ARRA and the fiscal year 2009 omnibus
will provide an immediate infusion of funds into the Nation's proven
and highly competitive medical research enterprise to sustain the
pursuit of improved diagnostics, better prevention strategies and new
treatments for many devastating and costly diseases as well as support
innovative research ideas, state-of-the-art scientific facilities and
instrumentation, and the scientists, technicians, laboratory personnel,
and administrators necessary to maintain the enterprise. These funds
will are also reinvigorating this Nation's ability to produce the human
and intellectual capital that will continue to drive scientific
discovery, transform health, and improve the quality of life for all
Americans. Moreover, we see this as the first step in renewing a
national commitment to sustained, predictable growth in NIH funding,
which we believe is an essential element in restoring and sustaining
both national and local economic growth and vitality as well as
maintaining this Nation's prominence as the world leader in medical
research.
As a result of this subcommittee's prior investment in NIH, we have
made critical advances in understanding basic science, saved and
improved the lives of millions of Americans and provided doctors with
tools to prevent and treat costly and devastating diseases including:
--Cardiovascular Disease.--New results from multiple studies provided
the strongest evidence to date that a simple blood test for
high-sensitivity C-reactive protein (hsCRP), whose
characterization was funded by NIH, is a useful marker for
cardiovascular disease. Furthermore, scientists have discovered
that a daily dose of a commonly used statin, rosuvastatin
(Crestor), reduced the risk of heart attack, stroke, and death
by nearly half (44 percent) in individuals with high levels of
hsCRP but with normal or low levels of low density lipoprotein
(LDL), the so-called ``bad cholesterol.'' These developments
show great promise in helping clinicians better identify and
treat individuals at risk for cardiovascular disease--
potentially saving millions more lives.
--Cancer.--For the first time in a decade, incidence rates for all
cancers combined are decreasing, driven largely by declines in
some of the most common types of cancer, including breast
cancer (2.2 percent decline among women) and prostate cancer
(4.4 percent decline). Death rates declined for 10 of the top
15 causes of cancer death among both men and women.
--Alzheimer's.--Researchers isolated a toxic substance that appears
to be a key to understanding Alzheimer's disease, suggesting a
possible new target for developing drug therapies to combat the
irreversible and progressive disorder. In addition, further
insights into the early stages of Alzheimer's may answer
questions not only about the disease, but also about age-
related memory impairments.
--Type 2 Diabetes.--An international team that included NIH-funded
scientists identified six new genetic variants associated with
increased risk of type 2 diabetes. By pinpointing particular
pathways involved in diabetes risk, this discovery can empower
new approaches to understanding environmental influences and to
the development of better, more precisely targeted drugs.
investment in nih is critical to taking advantage of emerging
SCIENTIFIC OPPORTUNITIES
Prior investment in NIH has begun to unlock the secrets of the
human genome and allowed scientists to gain new insight into how
disease works at the most basic levels within our bodies. Scientists
are working tirelessly to translate research results into interventions
for our most debilitating medical conditions. NIH also serves an
invaluable role in communicating research findings to patients and
their families, healthcare providers, and the general public in
critical areas such as increasing knowledge about infectious diseases,
improving cognitive health, and reducing health disparities.
THE CONSEQUENCES OF STAGNANT FUNDING FOR RESEARCH
The re-emergence of previously eradicated diseases such as mumps,
the development of new health threats, a rapidly aging population, and
significant increases in longevity lends a sense of urgency to the need
to expedite scientific discovery. Yet even as our need to prevent
disease becomes greater and the opportunities to succeed become more
numerous, our national commitment to medical research has stagnated:
--``Success rates'' dropped to an estimated 18 percent in fiscal year
2009. This means that more than 80 percent of the highly
qualified, peer-reviewed research proposals go unfunded. With
every unfunded idea, we risk missing or delaying critical
discoveries leading to therapies for our most debilitating
health conditions.
--The competition for funding is coming at a time when both the
interest in careers in the science field and the number of
newly trained researchers entering the workforce is increasing.
Doctorates in the critical fields of engineering and biological
sciences increased 10 percent and 11 percent respectively, in 1
year.\1\
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\1\ Council of Graduate Schools. 2008. Graduate Enrollment and
Degrees: 1997-2007. http://www.cgsnet.org/portals/0/pdf/N_pr_ED2007.pdf
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--The medical schools, teaching hospitals, universities, and research
institutes where NIH research takes place are among the largest
employers in their respective communities. In fiscal year 2007,
NIH grants and contracts created and supported more than
350,000 jobs that generated wages in excess of $18 billion in
the 50 States.\2\
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\2\ Families USA. 2008. In your own backyard: How NIH funding helps
your state's economy. http://www.familiesusa.org/assets/pdfs/global-
health/in-your-own-backyard.pdf
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THE IMPORTANCE OF SUSTAINED, PREDICTABLE FUNDING FOR RESEARCH
The research engine needs a predictable, sustained investment in
science to maximize our return on investment. The discovery process--
while it produces tremendous value--often takes a lengthy and
unpredictable path. Recent experience has demonstrated how cyclical
periods of rapid funding growth followed by periods of stagnation is
disruptive to training, to careers, long-range projects, and ultimately
to progress. NIH needs sustainable and predictable budget growth to
achieve the full promise of medical research to improve the health and
longevity of all Americans. We must ensure that after the stimulus
money is spent we do not have to dismantle our newly built capacity and
terminate valuable, on-going research.
The fiscal year 2009 omnibus and the ARRA provided $38.5 billion
for NIH to provide more than 16,000 new research grants for live-saving
research into diseases such as cancer, diabetes, and Alzheimer's.
Keeping up with the rising cost of medical research in the 2010
appropriations will help NIH begin to prepare for the ``post-stimulus''
era. In 2011 and beyond we need to make sure that the total funding
available to NIH does not decline and that we can resume a steady,
sustainable growth that will enable us to complete the President's
vision of doubling our investment in basic research. Consistent with
the President's proposal, we respectfully urge this subcommittee to
increase funding for NIH in fiscal year 2010 by at least 7 percent more
than the fiscal year 2009 level.
The Federal commitment to biomedical research is profoundly
transforming medical practice, preventing disease, and creating better
therapies but additional resources are needed to pursue the historic
level of scientific opportunity that is available today. We recognize
this subcommittee has the especially difficult task of providing
funding for a wide range of critical human service programs and thank
you for recognizing that prosperity and quality of life are
increasingly shaped by investments in science and technology.
______
Prepared Statement of the Friends of the Health Resources and Services
Administration
The Friends of the Health Resources and Services Administration
(HRSA) is a nonprofit and nonpartisan alliance of more than 140
national organizations, collectively representing millions of public
health and healthcare professionals, academicians, and consumers. The
coalition's principal goal is to ensure that HRSA's broad health
programs have continued support in order to reach the populations
presently underserved by the Nation's patchwork of health services.
Through its programs in every State and thousands of communities
across the country, HRSA is a national leader in providing a health
safety net for medically underserved individuals and families,
including 86.7 million Americans who were uninsured for some or all of
2007-2008; 50 million Americans who live in neighborhoods where primary
health services are scarce; more than 1 million people living with HIV/
AIDS, and 34 million vulnerable mothers and children, including
children with special health needs. 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 $8.5
billion for fiscal year 2010.
For several years, HRSA has suffered from relatively level funding,
undermining the ability of its successful programs to grow. Our request
reflects the minimum amount necessary for HRSA to adequately meet the
needs of the populations they serve in fiscal year 2010, especially
during these difficult economic times that are causing an increase in
demand for HRSA programs and funding. Much more is needed for the
agency to achieve its ultimate mission of ensuring access to culturally
competent, quality health services for all; eliminating health
disparities; and rebuilding the public health and healthcare
infrastructure.
The coalition is very appreciative of the $2.5 billion HRSA
received in the American Recovery and Reinvestment Act of 2009 for
community health centers and health professions workforce development
to prepare our health infrastructure for health system reform. This
investment recognizes the critical role HRSA plays in building the
foundation for health service delivery. However, we urge the
subcommittee to support adequately funding all of HRSA's broad health
programs and ensure that vulnerable populations transition smoothly
into a new health system and receive continued, quality health
services. By supporting, planning for and adapting to change, we can
build on the successes of the past and address the new gaps that emerge
as a result of health system reform.
Our $8.5 billion funding request is based on recommendations
provided by coalition members for the various programs they focus on.
It includes $2.602 billion for the Health Centers program, the fully
authorized level under the Health Care Safety Net Act of 2008, as part
of a long-term plan to provide care to 30 million Americans by 2015.
Thanks to the leadership of the subcommittee, more than 7,000 health
centers in every State and territory provide a healthcare home for more
than 18 million medially underserved and low-income patients, and
demand for their services continues to grow. The Health Centers program
targets populations with special needs, including migrant and seasonal
farm workers, homeless individuals and families, and those living in
public housing. Health centers provide access to high-quality, family-
oriented, culturally and linguistically competent primary care and
preventive services, including mental and behavioral health, vision,
and dental services. While recent growth in the health centers program
has been substantial, a significant need remains in underserved
communities across the country. We strongly encourage the subcommittee
to continue its support of existing health centers and efforts to
expand the reach and scope of the Health Centers program into new
communities.
Coalition members recommend $235 million for the National Health
Service Corps (NHSC), the amount authorized under the Health Care
Safety Net Amendments of 2002. Approximately 50 million Americans live
in communities with a shortage of health professionals, lacking
adequate access to primary care. The Corps supports the recruitment and
retention of primary care clinicians to practice in underserved
communities in exchange for scholarships and loan repayment. The Corps
supports more than 4,000 clinicians, with over half working in
community health centers. Growth in the Health Centers program must be
complemented with growth in the recruitment and retention of primary
care clinicians to ensure adequate staffing.
Coalition members recommend $550 million for health professions
programs under title VII and VIII of the Public Health Service Act.
These programs are an essential component of America's health safety
net and work in concert with the Health Centers Program and National
Health Service Corps to enhance the supply, distribution and diversity
of the health professions workforce. They are the only Federal programs
that support the education and training of primary care providers in
interdisciplinary settings to work in underserved communities and
increase minority representation in the health professions workforce.
Through loans, scholarships, and grants to academic institutions and
nonprofit organizations, these programs provide support for the
training of primary care physicians, nurses, dentists, optometrists,
physician assistants, nurse practitioners, public health personnel,
mental and behavioral health professionals, pharmacists, health
educators, and other allied health providers. Adequate funding will
reduce provider shortages in rural, medically underserved and federally
designated health professions shortage areas and strengthen the
pipeline of new providers that Health Centers and other safety-net
health facilities need to meet the long-term needs of underserved
communities. In addition, we recommend funds be appropriated to re-
establish the National Center for Health Workforce Analysis to conduct
and support statistical and epidemiological activities for assessing
and improving decisionmaking to enhance the supply, distribution,
diversity, and development of the current and future public health
workforce. Finally, we urge the subcommittee to provide funding for the
grant program under section 758 of the Public Health Service Act to
develop interdisciplinary training and education programs on domestic
violence and other types of violence and abuse as authorized by the
Violence Against Women and Department of Justice Reauthorization Act of
2005.
We recommend $330 million for the Children's Hospital Graduate
Medical Education (GME) Program, the amount authorized under the
Children's Hospital GME Support Reauthorization Act of 2006. This
program provides funds to freestanding children's hospitals to support
the training of pediatric and other residents in GME programs. This
program ensures that pediatric hospitals receive Federal funding
comparable to other types of hospitals. We also request a significant
investment in the Patient Navigator program that places navigators in
underserved communities to help people with cancer and/or other chronic
diseases make their way through the health systems and utilize
community services that will help them beat chronic disease for longer,
healthier lives.
We recommend $850 million for the Maternal and Child Health (MCH)
block grant, the fully authorized level under title V of the Social
Security Act. For more than 70 years, the MCH block grant has provided
a source of flexible funding for States and territories to address
their unique needs related to improving the health of mothers, infants,
children, adolescent, and children with special healthcare needs.
Today, this program provides prenatal services to more than 2 million
mothers--almost half of all mothers who give birth annually--and
primary and preventive care to more than 17 million children, including
almost 1 million children with special needs. Fully funding the MCH
block grant will enable States to expand critical health services and
cope with ever increasing medical costs.
Newborn screening is a vital public health activity used to
identify and treat genetic, metabolic, hormonal, and functional
conditions in newborns. Screening detects heritable disorders in
newborns that, if left untreated, can cause disability, mental
retardation, serious illnesses, or even death. While nearly all babies
born in the United States undergo newborn screening for genetic birth
defects, the number of these tests varies from State to State. We
recommend $30 million for the Heritable Disorders Program to support
State efforts to improve programs, to acquire innovative testing
technologies, and to increase capacity to reach and educate health
professionals and parents on newborn screening programs and follow-up
services. These activities and the funding level are authorized by the
Newborn Screening Saves Lives Act.
We recommend $16 million for the Traumatic Brain Injury (TBI)
program in order to better serve the 5.3 million Americans with a long-
term or lifelong need for help to perform daily activities as a result
of a TBI, including many of our returning war veterans. The TBI Program
provides 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. The TBI program also provides
funds to State protection and advocacy programs that work to ensure
that people with TBI get access to the supports and services they need.
We recommend $25 million for the Emergency Medical Services for
Children (EMSC) program to address significant shortcomings in
pediatric emergency care. The EMSC program is a national initiative
designed to reduce child and youth disability and death due to severe
illness and injury. EMSC grants provide funding for States and
territories to improve existing emergency medical services systems and
develop better procedures and protocols for treating children.
Additional funding is needed to maintain and improve the program's
activities, take advantage of important opportunities and address
emerging threats such as terrorism.
We recommend $2.816 billion for the Ryan White HIV/AIDS programs,
which is the estimated amount necessary to provide health services to
all eligible individuals. The Ryan White programs provide the largest
source of Federal discretionary funding to support health services for
more than 500,000 low-income, uninsured, and underinsured people living
with HIV/AIDS. Through grants to State and local governments and
community-based organizations, the Ryan White HIV/AIDS programs support
comprehensive care, drug assistance and support services for people
living with HIV/AIDS; provide training for health professionals
treating people with HIV/AIDS; provide assistance to metropolitan and
other areas most severely affected by the HIV/AIDS epidemic; and
address the disproportionate impact of HIV/AIDS on women and
minorities. A significant funding increase is needed to meet growing
medical costs and incidence of HIV, particularly among underserved
populations.
The Office of Rural Health Policy promotes better health services
for the 60 million Americans who live in rural communities. These
communities suffer from inadequate access to quality health services
and experience the higher rates of illness associated with lower
socioeconomic status. Rural Health Outreach and Network Development
Grants, and other programs are designed to support community-based
disease prevention and health promotion projects, help rural hospitals
and clinics implement new technologies and strategies, and build health
system capacity in rural and frontier areas. In addition, Rural Health
Research Centers help policymakers better understand the challenges
that rural communities face in assuring access to health services and
improving the health of their residents. Finally, the Rural and
Community Access to Emergency Devices Program provides States with
grants to train lay rescuers and first responders to use automated
external defibrillators (AEDs) and purchase and place them in public
areas where sudden cardiac arrests are likely to occur. We encourage
the subcommittee to adequately fund these important programs that
address the many unique health service needs of rural communities.
We recommend $700 million for the Family Planning programs under
title X of the Public Health Service Act. Title X programs provide
comprehensive, voluntary, and affordable family planning services to
nearly 5 million low-income women at more than 4,500 clinics
nationwide. Title X funded clinics help improve access to
contraceptives, which help women plan the number and timing of their
pregnancies, improve maternal and infant health, and help to prevent
approximately 1.94 million unintended pregnancies each year, including
nearly 400,000 teenage pregnancies. The Guttmacher Institute estimates
that unintended pregnancies prevented each year would have resulted in
810,000 abortions and without publicly funded family planning programs,
the U.S. abortion rate would be nearly two-thirds higher than the
current level. Family planning is also cost-saving and for every public
dollar invested in family planning, $3.80 is saved in costs associated
with unintended births to women who are eligible for Medicaid. Today,
almost 17 million women need publicly supported contraceptive care--a
number which continues to grow. Title X programs require a substantial
increase in investment to meet the growing demand.
The Healthcare Systems Bureau provides national leadership on the
transplantation of organs, bone marrow and cord blood. The recently
passed Budget Resolution Conference Agreement calls for increased
funding for ``the organ transplant program.'' Coalition members
recommend $35 million for the Division of Transplantation in order to
meet the Office of Management and Budget's goal of doubling the number
of transplants by 2013 and reduce the waiting list of 101,951 people in
need of a life saving organ transplant. We recommend $38 million for
the C.W. Bill Young Cell Transplantation Program, the amount authorized
by the Stem Cell Therapeutic and Research Act of 2005. This program
helps patients who need a potentially life-saving bone marrow or cord
blood transplant, including patients with diseases like leukemia,
lymphoma, sickle cell anemia, or other inherited metabolic or immune
system disorders. We also recommend the fully authorized $15 million
for the National Cord Blood Inventory, which collects and maintains
high-quality cord blood units and makes them available for
transplantation through the C.W. Bill Young Cell Transplantation
Program.
Poison Control Centers, also administered by the Healthcare Systems
Bureau, are a critical resource for people, health professionals, and
organizations. Poisoning can happen to anyone, at anytime in any place
and can lead to serious illness or even death. Each year, more than 2
million possible poisonings are reported to the nation's poison
centers. On average, poison centers handle one possible poisoning every
13 seconds. These critical centers cannot afford to lose any resources
and we encourage the subcommittee to fully fund this program.
Finally, we recommend a significant funding increase for HRSA's
program management and staffing needs. Since 2001, HRSA has experienced
a decline of almost 600 full-time equivalent employees. While HRSA has
continued to administer its many programs effectively, the agency if
facing ever growing demands as a result of the economic crisis and a
changing health system. We strongly urge the subcommittee to increase
program management funds to provide the agency with the necessary human
and other resources to ensure the programs it administers are effective
and improve the health of the American public.
We appreciate the subcommittee's hard work in advocating for HRSA's
programs in a climate of competing priorities. The members of the
Friends of HRSA thank you for considering our fiscal year 2010 request
for $8.5 billion for HRSA and are grateful for this opportunity to
present our views to the subcommittee.
We the undersigned organizations, thank you for your attention to
this matter.
Academic Pediatric Association; Advocates for
Youth; AIDS Action; AIDS Alliance for
Children, Youth and Families; AIDS
Foundation of Chicago; AIDS Project Los
Angeles; The Alan Guttmacher Institute;
Allergy and Asthma Network Mothers of
Asthmatics; Alliance for Academic Internal
Medicine; American Academy of Family
Physicians.
American Academy of Nurse Practitioners; American
Academy of Nursing; American Academy of
Ophthalmology; American Academy of
Pediatrics; American Academy of Physician
Assistants; American Association of
Colleges of Podiatric Medicine; American
Association for Dental Research; American
Association of Colleges of Nursing;
American Association of Colleges of
Osteopathic Medicine; American Association
of Colleges of Pharmacy; American
Association of Family and Consumer
Services.
American Association of Nurse Anesthetists;
American Association of Orthopedic
Surgeons; American Association on
Intellectual and Developmental
Disabilities; American Cancer Society;
American College of Nurse-Midwives;
American College of Obstetricians and
Gynecologists; American College of
Physicians; American College of
Preventative Medicine; American Counseling
Association; American Dental Association.
American Dental Education Association; American
Dental Hygienists' Association; American
Dietetic Association; American Federation
of State, County and Municipal Employees;
American Foundation for AIDS Research;
American Heart Association; American
Hospital Association; American Medical
Student Association; American Medical
Women's Association; American Nephrology
Nurses' Association.
American Nurses Association; American Occupational
Therapy Association; American Optometric
Association; American Pediatric Society;
American Physical Therapy Association;
American Podiatric Medicine Association;
American Psychiatric Association; American
Psychological Association; American Public
Health Association; American Red Cross.
American School Health Association; American
Society for Microbiology; American Society
for Reproductive Medicine; Americans for
Democratic Action; The Arc; Asian and
Pacific Islander American Health Forum;
Association for Prevention Teaching and
Research; Association of Academic Health
Centers; Association of American Medical
Colleges; Association of American
Veterinary Medical Colleges.
Association of Clinicians for the Underserved;
Association of Departments of Family
Medicine; Association of Family Medicine
Residency Directors; Association of
Maternal and Child Health Programs;
Association of Medical School Pediatric
Department Chairs; Association of Minority
Health Professions Schools; Association of
Organ Procurement Organizations;
Association of Professors of Medicine;
Association of Public Health Laboratories;
Association of Reproductive Health
Professionals.
Association of Schools of Allied Health
Professionals; Association of Schools of
Public Health; Association of State and
Territorial Directors of Nursing;
Association of State and Territorial Health
Officials; Association of University
Centers on Disabilities; Association of
Women's Health, Obstetric and Neonatal
Nurses; Avancer Health Policy; CAEAR
Coalition; Catholic Health Association of
the U.S.; Center for Health Policy Research
and Ethics, GMU.
Center for the Advancement of Health; Center for
Women Policy Studies; Center on Disability
and Health; Charles Drew University;
Children's Defense Fund; Coalition for
American Trauma Care; Coalition for Health
Funding; Coalition for Health Services
Research; Consortium of Social Science
Associations; Council of Accredited MPH
Programs.
Easter Seals; Emergency Nurses Association;
Epilepsy Foundation; Families USA; Family
Violence Prevention Fund; Health and
Medicine Counsel of Washington; HIV
Medicine Association; Human Rights
Campaign; Infectious Diseases Society of
America; Institute for Children's
Environmental Health.
Latino Council on Alcohol and Tobacco; Legal Action
Center; March of Dimes; Meharry Medical
College; Morehouse School of Medicine;
NAADAC, the Association for Addiction
Professionals; National AHEC Organization;
National Alliance of State and Territorial
AIDS Directors; National Assembly on
School-Based Health Care; National
Association of Addiction Treatment
Providers; National Association of
Community Health Centers.
National Association of Councils on Developmental
Disabilities; National Association of
County and City Health Officials; National
Association of Local Boards of Health;
National Association of People with AIDS;
National Association of Public Health
Statistics and Information Systems;
National Association of Public Hospitals
and Health Systems; National Association of
Rural Health Clinics; National Association
of Social Workers; National Associations of
Children's Hospitals; National Black Nurses
Association.
National Coalition for the Homeless; National
Council for Diversity in the Health
Professions; National Council of La Raza;
National Disability Rights Network;
National Episcopal AIDS Coalition; National
Family Planning and Reproductive Health
Association; National Health Care for the
Homeless Council; National Hemophilia
Foundation; National Hispanic Medical
Association; National League for Nursing.
National Marrow Donor Program; National Medical
Association; National Minority AIDS
Council; National Network for Youth;
National Rural Health Association; North
American Primary Care Research Group;
Oncology Nursing Society; Organizations of
Academic Family Medicine; Partnership for
Prevention; Planned Parenthood Federation
of America.
Sexuality Information and Education Council of the
United States; Society for Adolescent
Medicine; Society for Pediatric Research;
Society for Public Health Education;
Society for the Psychological Study of
Social Issues; Society of General Internal
Medicine; Society of Teachers of Family
Medicine; The AIDS Institute; Trust for
America's Health; U.S. Conference of
Mayors.
______
Letter From The Friends of the National Institute on Aging
Dear Chairman Harkin and members of the subcommittee: I am writing
to request the opportunity to testify at the fiscal year 2010 public
witness hearing on behalf of The Friends of the National Institute on
Aging regarding the important role that the National Institute on Aging
(NIA) plays among the National Institutes of Health and the need for
increased appropriations to ensure sustained, long-term growth in aging
research in the fiscal year 2010 budget and beyond.
The Friends of the NIA is a coalition of 50 academic, patient-
centered and not-for-profit organizations that conduct, fund, or
advocate for scientific endeavors to improve the health and quality of
life for Americans as we age. We support the continuation and expansion
of NIA research activities and seek to raise awareness about important
scientific progress in the area of aging research currently guided by
the Institute. I serve as Chair of the Friends of the NIA and as such,
am respectfully requesting permission to testify on behalf of the
Friends of the NIA before the subcommittee.
Our testimony highlights the relevance of the work of the NIA to
each and every American, as well as opportunities for future progress
that are dependent on Congressional action to build upon the
unprecedented $10.4 billion in the American Recovery and Reinvestment
Act for NIH research and training activities in fiscal year 2010. I
have attached a copy of our testimony for your review.
Mr. Chairman, The Friends of the NIA thanks you in advance for this
opportunity to outline the challenges and opportunities that lie ahead
as you consider the fiscal year 2010 appropriations for the NIH.
Regards,
Kimberly D. Acquaviva,
Chair.
______
Prepared Statement of the FSH Society, Inc.
Mr. Chairman, it is a great pleasure to submit this testimony to
you today.
My name is Daniel Paul Perez, of Bedford, Massachusetts, and I am
testifying today as President and CEO of the FSH Society, Inc.
(facioscapulohumeral muscular dystrophy) and as an individual who has
this common and most prevalent form of muscular dystrophy.
the need for national institute of health (nih) funding for fshd
My testimony is about the profound and devastating effects of a
disease known as facioscapulohumeral muscular dystrophy which is also
known as facioscapulohumeral muscular disease, FSH muscular dystrophy
or FSHD, and the urgent need for increased NIH funding for research on
this disorder.
According to our research, only a limited amount of work is going
on across all the Institutes at the NIH. In fact, only 3 of the 27
Institutes at the NIH are funding FSHD research, e.g., the National
Institute of Neurological Disorders and Stroke (NINDS), the National
Institute of Arthritis, Musculoskeletal and Skin Disease (NIAMS), and
the Eunice Kennedy Shriver National Institute of Child Health and Human
Development (NICHD). Currently, the level of funding from NINDS, NICHD,
and NIAMS for FSHD research is approximately $3,093,269.
Since 1994, I have submitted testimony before both House and Senate
Appropriations Committees' Subcommittee on Labor, Health and Human
Services, and Education and Related Agencies which stated that NIH and
Congress with modest investments could help bring about a significant
research and scientific opportunity which would benefit hundreds of
thousands of people worldwide.
Today, I am asking Congress to communicate to the Public Health
Service and National Institutes of Health the need for research funding
on the FSHD disorder at a level of $10,000,000 annually in fiscal year
2010.
LIVING WITH FSHD
As a man with facioscapulohumeral muscular dystrophy, I will tell
you that it is a hard way to live, and that FSHD is a strong fort--it
will last a lifetime. Unless Congress mandates that the NIH ensure that
it receives sufficient grant applications of highest quality on FSHD
and to spend an equitable ratio of NIH muscular dystrophy dollars on
FSHD, which is now conservatively $10 million.
At 47 years of age, I consider myself a lifelong survivor of the
severe trauma and tension of FSHD, and I do not say this lightly. I
have dealt with the continuing, unrelenting, and unending loss caused
by FSHD from the first second, into the first minute, hour, day, week,
over the months and through the years. Not for a moment is there a
reprieve from continual loss of my physical ability; not for a moment
is there a time for me to mourn; not for a moment is there relief from
the physical and mental pain that is a result of this disease. There is
no known treatment and no known cause for this disease.
Look at what this disease does to people. Look at me. Look at what
I see--a child with a profound hearing loss, the broken innocence of a
child, alienation at an early age, a decision not to marry, a decision
not to have biological children, disability in the prime of life,
incapacitation in middle age, the guilt of a parent, a lifetime of
physical challenge, a suicide, a premature death, anxiety caused by
uncontrollable loss, decades spent somewhere between the able and the
disabled, the loss of ambulating, the unstoppable atrophy and loss of
muscle and the humiliation endured in the process.
For men, women, and children the major consequence of inheriting
the most prevalent form of muscular dystrophy, FSHD, is a lifelong
progressive and severe loss of all skeletal muscles. FSHD is a
terrible, crippling and life shortening disease. No one is immune, it
is genetically and spontaneously (by mutation) transmitted to children
and it affects entire family constellations.
THE MOST PREVALENT FORM OF MUSCULAR DYSTROPHY IS NOW MARKEDLY
UNDERFUNDED AT NIH
It is a fact that FSHD is now published in the scientific
literature as the most prevalent muscular dystrophy in the world. The
incidence of the disease is conservatively estimated to be 1 in 14,285.
The prevalence of the disease, those living with the disease ranges to
two or three times as many as that number based on our increasing
experiences with the disease and more available and accurate genetic
diagnostic tests.
The French Government research agency INSERM (Insitut National de
la Sante et de la Recherche Medicale) is comparable to the NIH, and it
recently published prevalence data for hundreds of diseases in Europe.
Notable is the ``Orphanet Series'' reports covering topics relevant to
all rare diseases. The ``Prevalence or reported number of published
cases listed in alphabetical order of disease''. This update contains
new epidemiological data and modifications to existing data for which
new information has been made available. This new information ranks
facioscapulohumeral muscular dystrophy (FSHD) as the most prevalent
muscular dystrophy followed by Duchenne (DMD) and Becker Muscular
dystrophy (BMD) and then, in turn, myotonic dystrophy (DM). FSHD is
historically presented as the third-most prevalent muscular dystrophy
in the Muscular Dystrophy Community Assistance, Research and Education
Amendments of 2001 and 2008 (the MD-CARE Act). This new data ranks FSHD
as the first and most prevalent.
------------------------------------------------------------------------
Estimated prevalence Cases/100,000
------------------------------------------------------------------------
Facioscapulohumeral muscular dystrophy (FSHD)........... 7/100,000
Duchenne (DMD) and Becker Muscular dystrophy (BMD) types 5/100,000
Steinert myotonic dystrophy (DM)........................ 4.5/100,000
------------------------------------------------------------------------
NIH MUSCULAR DYSTROPHY FUNDING HAS TRIPLED SINCE THE INCEPTION OF THE
MD CARE ACT ($21 MILLION TO $56 MILLION)
Between fiscal year 2006 and 2007, NIH overall funding for muscular
dystrophy increased from $39,913,000 to $47,179,000, an 18 percent
increase.
Between fiscal year 2007 and 2008, NIH overall funding for muscular
dystrophy decreased as shown in the ``Estimates of Funding for Various
Research, Condition, and Disease Categories (RCDC)'' report on the new
Research Portfolio Online Reporting Tool (RePORT) from $58 million to
$56 million, a 3 percent decrease. These figures are from the new
``2007/2008 NIH Revised Method'' columns. The same RCDC RePORT system
report shows $47 million as the 2007 figure under the ``2007 NIH
Historical Method'' column, a 23 percent increase and restatement when
converting to the new system.
Figures from the RCDC RePORT and the NIH Appropriations History for
Muscular Dystrophy report historically provided by NIH/Office of the
Director (OD) Budget Office and NIH OCPL show that from the inception
of the MD CARE Act 2001, funding has nearly tripled from $21 million to
$56 million for muscular dystrophy.
NIH FSHD FUNDING HAS REMAINED LEVEL SINCE THE INCEPTION OF THE MD CARE
ACT ($3 MILLION/$56 MILLION)
Between fiscal year 2006 and 2007, NIH funding for FSHD increased
from $1,732,655 to $4,108,555. In fiscal 2007, FSHD was 8.7 percent of
the total muscular dystrophy funding ($4.109 million/$47.179 million).
Between fiscal year 2007 and 2008, NIH funding for FSHD decreased
from $4,108,555 to $3 million under the ``2007 and 2008 NIH Revised
Method.'' The ``2007 NIH Historical Method'' was restated to $3
million. In fiscal 2008 under ``NIH Revised Method,'' FSHD was 5.3
percent of the total muscular dystrophy funding ($3 million /$56
million). The previous years 2006/2007 figures are revised and restated
under ``2007 NIH Historical Method'' as ($3 million/$58 million) which
is 5.1 percent of the total muscular dystrophy funding. FSHD funding
has merely kept its ratio in the NIH funding portfolio and has not
grown in the last 7 years.
We highly commend the Director of the NIH on the ease of use and
the accuracy of the Research Portfolio Online Reporting Tool (RePORT)
report ``Estimates of Funding for Various Research, Condition, and
Disease Categories (RCDC)'' with respect to reporting projects on
facioscapulohumeral muscular dystrophy.
NATIONAL INSTITUTES OF HEALTH (NIH) APPROPRIATIONS HISTORY
[Dollars in millions]
------------------------------------------------------------------------
FSHD
FSHD research percentage of
Fiscal year dollars muscular
dystrophy
------------------------------------------------------------------------
2002.................................... $1.3 5
2003.................................... 1.5 4
2004.................................... 2.2 6
2005.................................... 2 5
2006.................................... 1.7 4
2007.................................... 3 5
2008.................................... 3 5
------------------------------------------------------------------------
The MD CARE Act 2008 mandates the NIH Director to intensify efforts
and research in the muscular dystrophies, including FSHD, across the
entire NIH. It should be very concerning that in the last 7 years
muscular dystrophy has tripled to $56 million and that FSHD has
remained at 5 percent of the NIH muscular dystrophy portfolio or $3
million. Only three of the Institutes at the NIH are funding FSHD. OD,
National Heart, Lung, and Blood Institute, National Institute of
General Medical Sciences, National Institute of Biomedical Imaging and
Bioengineering, National Institute on Deafness and Other Communication
Disorders, National Human Genome Research Institute , NEI, National
Institute on Aging, National Cancer Institute, and National Center for
Research Resources are all aware of the high impact each could have on
FSHD. FSHD is certainly still far behind when we look at the breadth of
research coverage NIH-wide.
Now, FSHD is published as the most prevalent muscular dystrophy,
and given the extraordinary interest of the scientific and clinical
communities in its unique disease mechanism, it defies gravity that it
still remains the most prevalent and one of the most underfunded
dystrophies at the NIH and in the Federal research agency system
(Centers for Disease Control and Prevention, Department of Defense, and
Food and Drug Administration). In 2008, the third most prevalent
dystrophy, Duchenne (DMD) and Becker Muscular dystrophy (BMD) type,
received $22 million from NIH. In 2008, the second most prevalent
dystrophy myotonic dystrophy (DM), received $9 million from NIH. In
2008, the most prevalent dystrophy, FSHD, received $3 million from NIH.
It is now time to flip the stack and to make sure that FSHD with its
equal burden of disease and highest prevalence gets more funding,
stimulus and that NIH program staff initiates request for applications
specifically in FSHD. It is crystal clear, if not completely black and
white, that the open mechanism program announcement and investigator
driven model are not achieving the goal mandated by the MD CARE Acts
2001/2008 and by the NIH Action Plan for the Muscular Dystrophies as
submitted to the Congress by the NIH. Efforts of excellent program
staff and leadership at NIH, excellent reviewers and study sections,
excellent and outstanding researchers working on FSHD and submitting
applications to the NIH, and extraordinary efforts of the volunteer
health agencies working in this area have not yet enabled FSHD funding
to increase at the NIH. It is time for NIH requests, contracts, and
calls for researcher proposals on FSHD to bootstrap existing FSHD
research worldwide.
I am here once again to remind you that FSHD is taking its toll on
your citizens. FSHD illustrates the disparity in funding across the
muscular dystrophies and recalcitrance in growth over 20 years despite
consistent pressure from appropriations language and Appropriations
Committee questions, and an authorization and a reauthorization from
Congress mandating research on FSHD.
OUR REQUEST TO THE NIH APPROPRIATIONS SUBCOMMITTEE
We request this year in fiscal year 2010, immediate help for those
of us coping with and dying from FSHD. We ask NIH to fund research on
FSHD at a level of $10 million in fiscal year 2010.
We implore the Appropriations Committee to request that the
Director of NIH, the chairman/chairwoman, and executive secretary of
the Federal advisory committee Muscular Dystrophy Coordinating
Committee mandated by the MD CARE Act of 2008, to increase the amount
of FSHD research and projects in its portfolios using all available
passive and pro-active mechanisms and interagency committees. Given the
knowledge base and current opportunity for breakthroughs in treating
FSHD it is inequitable that only 3 of the 12 NIH Institutes covering
muscular dystrophy have a handful of research grants for FSHD. We
request that the Director of the NIH be more proactive in facilitating
grant applications (unsolicited and solicited) from new and existing
investigators and through new and existing mechanisms, special
initiatives, training grants and workshops--to bring knowledge of FSHD
to the next level.
Thanks to your efforts and the efforts of your subcommittee, Mr.
Chairman, the Congress, the NIH and the FSH Society are all working to
promote progress in FSHD. Our successes are continuing and your support
must continue and increase.
We ask you to fund NIH research on FSHD at a level of $10 million
in fiscal year 2010.
Mr. Chairman, thank you for this opportunity to testify before your
subcommittee.
______
Prepared Statement of the Family Violence Prevention Fund
The Family Violence Prevention Fund (FVPF) works to end violence
against women and children around the world, because every person has
the right to live free of violence. The FVPF's National Health Resource
Center on Domestic Violence provides critical information to thousands
of healthcare providers, institutions, domestic violence service
providers, Government agencies, researchers, and policy makers each
year. Its public education campaigns, conducted in partnership with The
Advertising Council, have shaped public awareness and changed social
norms for 15 years.
STRENGTHENING THE HEALTHCARE SYSTEM'S RESPONSE TO DOMESTIC VIOLENCE,
DATING VIOLENCE, SEXUAL ASSAULT, AND STALKING
Through our work as the National Health Resource Center on Domestic
Violence, I know the critical role healthcare providers can play in
preventing and responding to violence against women and children,
particularly during this difficult economic time when rates of abuse in
families seem to be rising. But it is not simply a moral imperative
that we try to reduce violence and abuse in this country; it is an
economic necessity that Congress supports prevention and intervention
efforts in the healthcare system. The Centers for Disease Control and
Prevention (CDC) classifies violence and abuse as a ``substantial
public health problem in the United States,'' noting the long-term
impact of violence and abuse has huge implications for health outcomes
and costs.
Children who experience childhood trauma, including witnessing
incidents of domestic violence, are at a greater risk of having serious
adult health problems including tobacco use, substance abuse, cancer,
heart disease, depression and a higher risk for unintended pregnancy.
Twenty years of research links childhood exposure to violence with
chronic health conditions including obesity, asthma, arthritis, and
stroke. It is worth noting that victims, particularly of sexual
violence, are linked with obesity. A meta-analysis of research on the
impact of adult intimate partner violence finds that victims of
domestic violence are at increased risk for conditions such as heart
disease, stroke, hypertension, cervical cancer, chronic pain including
arthritis, neck and pain, and asthma. In addition to injuries, adult
intimate partner violence also contributes to a number of mental health
problems including depression and PTSD, risky health behaviors such as
smoking, alcohol and substance abuse, and poor reproductive health
outcomes such as unintended pregnancy, pregnancy complications,
postpartum depression, poor infant health outcomes and sexually
transmitted infections including HIV.
According to a CDC survey, women who have experienced domestic
violence are 80 percent more likely to have a stroke, 70 percent more
likely to have heart disease, 60 percent more likely to have asthma and
70 percent more likely to drink heavily than women who have not
experienced intimate partner violence.
When Congress joined together to reauthorize the Violence Against
Women Act (VAWA) of 2005 (Public Law 109-162), the law included new
provisions to educate and train healthcare providers and public health
professionals on how to safely screen and intervene in cases of
domestic and sexual violence. These provisions were added after years
of work by medical associations, health professionals, advocates and a
National Health Care Standards Campaign on Domestic Violence funded by
the U.S. Department of Health and Human Services. These collaborations
successfully developed strategies, tools, and policies to identify and
help victims in health settings.
We know that most women seek healthcare services regularly, either
for routine, emergency, perinatal, or pediatric care. As a result,
healthcare providers are in a unique position to identify and reach out
to victims of violence, long before they may seek help from a domestic
violence shelter, rape crisis center, law enforcement agency, or family
member. However, fewer than 10 percent of primary care physicians
routinely screen patients for domestic violence during regular office
visits, according to a study published by the Journal of the American
Medical Association.
Research on the most effective interventions in the healthcare
setting and prevention messages would have significant public health
benefits and cost savings to the healthcare system. While we do not
know the full cost of violence and abuse to the healthcare system,
previous studies have shown that those who experience abuse access
healthcare 2 to 2.5 times more frequently than those without that
history. Research shows that intimate partner violence alone costs a
health plan $19.3 million each year for every 100,000 women between the
ages of 18 and 64 enrolled.
Far more important is the cost of violence and abuse over time.
Even 5 years after abuse has ended, healthcare costs for women with a
history of intimate partner violence remain 20 percent higher than
those for women with no history of violence. A study by the CDC in 2003
estimated the direct medical costs of only injuries and mental health
services related to intimate partner violence at $4.1 billion alone,
this does not include any evaluation of costs associated with chronic
health issues or reproductive health issues discussed above and known
to be highly prevalent among victims of abuse. A recent report by the
Academy on Violence and Abuse estimated the actual cost to the
healthcare system of violence and abuse may be nearly 17 percent of the
total healthcare dollar or $333 billion in 2008.
But early identification and treatment of victims can financially
benefit the healthcare system. Initial and unpublished findings from
one study found that hospital-based domestic violence interventions may
reduce healthcare costs by at least 20 percent. Preventing abuse or
associated health risks and behaviors clearly could have long term
implications for decreasing chronic disease and costs. Because of the
long-term impact of abuse on a patient's health, I recommend
integrating assessment for current and lifetime physical or sexual
violence exposure and interventions into routine care. Regular, face-
to-face screening of women by skilled healthcare providers markedly
increases the identification of victims of intimate partner violence
(IPV), as well as those who are at risk for verbal, physical, and
sexual abuse. Routine inquiry of all patients, as opposed to indicator-
based assessment, increases opportunities for both identification and
effective interventions, validates IPV as a central and legitimate
healthcare issue, and enables providers to assist both victims and
their children.
When victims or children exposed to IPV are identified early,
providers may be able to break the isolation and coordinate with
domestic violence (DV) advocates to help patients understand their
options, live more safely within the relationship, or safely leave the
relationship. Expert opinion suggests that such interventions in adult
health settings may lead to reduced morbidity and mortality. Assessment
for exposure to lifetime abuse has major implications for primary
prevention and early intervention to end the cycle of violence.
Just as the healthcare system has always played an important role
in identifying and preventing other serious public health problems, I
believe it can and must play a pivotal role in domestic and sexual
violence prevention and intervention. It is clear that by funding these
innovative and life-saving health provisions established by title V in
VAWA 2005, we can help save the lives of victims of violence and
greatly reduce healthcare expenses.
In order to advance necessary and needed health goals, I urge you
to provide $13 million to the Department of Health and Human Services
to fully fund the Violence Against Women Act's Health Care Programs for
fiscal year 2010, and specifically fund the following Labor, Health and
Human Services, and Education, and Related Agencies programs
accordingly:
--Training and Education of Health Professionals Program.--$3 million
to train healthcare providers and students in health
professional schools how to identify and screen victims of
domestic and sexual violence; ensure immediate safety; document
their injuries; and refer them to appropriate services;
--Fostering Public Health Responses.--$5 million to promote public
health programs that integrate domestic and sexual violence
assessment and intervention into basic care, as well as
encourage collaborations between healthcare providers, public
health programs, and domestic and sexual violence programs; and
--Research on Effective Interventions.--$5 million to support
research and evaluation on effective interventions in the
healthcare setting to improve abused women's health and safety
and prevent initial victimization.
PROTECT NONABUSIVE PARENTS AND CHILDREN
Another area of concern is the intersection of domestic violence
and child abuse, which often occur in the same family. Approximately 45
percent of female caregivers of children reported for child
maltreatment have experienced intimate partner violence in their
lifetime and 29 percent in the past year. In a study of families
investigated for child maltreatment, 31 percent of female caregivers
reported experiencing intimate partner violence in the past year;
however child welfare workers only identified this abuse in 12 percent
of the families.
When child welfare agencies work alone in responding to child
maltreatment, they may not understand the complexity of the domestic
violence situation and ``pre-emptively'' remove the child without
offering services to the adult victim. This can have a devastating
result for both the child and the nonabusive caretaker. In addition,
the opposite approach may also be taken. Frequently, the child
protective system fails to take seriously the threat posed by an
abusive husband or partner and fails to take any action to support the
mother's efforts to keep her and her children safe and hold him
accountable for his actions.
By supporting agencies in cooperative efforts to provide services
to victims--both children and their nonabusive caretakers--it is
possible to keep families safe and united during the difficult process
of ending abuse.
THE SOLUTION: IMPROVE COOPERATION BETWEEN CHILD WELFARE AND DOMESTIC
VIOLENCE ADVOCATES
Building on what was commonly known as the ``Greenbook Project,'' a
federally funded demonstration grant program, VAWA 2005 authorized a
program to create grants for training and collaboration on the
intersection between domestic violence and child maltreatment. The
intent is to ensure that nonabusive family members receive the services
they need to keep their families safe, and community services can deal
with both problems simultaneously, allowing for a better use of our
limited resources. As the two problems often occur together, dealing
with one problem and not the other is at the peril of our children.
I urge you to fully fund Training and Collaboration on the
Intersection Between Domestic Violence and Child Maltreatment Program
at $5 million to help serve families experiencing violence.
In addition, I ask that you continue to support full funding for
the Family Violence Prevention and Services Act, the Nation's only
designated Federal funding source for domestic violence shelters and
services. As leaders committed to both the prevention of intimate
partner violence and to the health and safety of victims, I urge you to
fund these critical programs.
______
Prepared Statement of the HIV Medicine Association
The HIV Medicine Association (HIVMA) of the Infectious Diseases
Society of America (IDSA) represents more than 3,600 physicians,
scientists, and other healthcare professionals who practice on the
frontline of the HIV/AIDS pandemic. Our members provide medical care
and treatment to people with HIV/AIDS throughout the United States,
lead HIV prevention programs and conduct research to develop effective
HIV prevention and treatment options. As medical providers and
researchers dedicated to the field of HIV medicine, we work in
communities across the country and around the globe. We appreciate the
fiscal challenges that you currently face, but the state of the economy
makes it imperative that our Nation has a strong healthcare safety net,
effective programs for preventing infectious diseases like HIV and a
vibrant scientific research agenda.
The U.S. investment in HIV/AIDS programs has revolutionized HIV
care globally making HIV treatment one of the most effective medical
interventions available. A robust research agenda and rapid public
health implementation of scientific findings have transformed the HIV
epidemic reducing morbidity and mortality due to HIV disease by nearly
80 percent in the United States. The Ryan White program has played a
critical role in ensuring that many low-income people with HIV have
access to lifesaving HIV treatment. However, the impact of our
diminished investment in public health and research programs over the
last several years has taken its toll in communities across the
country. HIV clinics are cutting hours and services while new HIV cases
are increasing by at least 15 percent.
We face a critical juncture when we must either shore up our
healthcare safety net, public health infrastructure, and research
programs or risk serious regression in our fight against this deadly
disease. The funding requests in our testimony largely reflect the
consensus of the Federal AIDS Policy Partnership (FAPP) a coalition of
HIV organizations from across the country, and are estimated to be the
amounts necessary to sustain and strengthen our investment in combating
HIV disease.
CENTER FOR DISEASE CONTROL AND PREVENTION'S (CDC) NATIONAL CENTER FOR
HIV/AIDS, VIRAL HEPATITIS, STD, AND TB PREVENTION (NCHHSTP)
HIVMA strongly supports an increase of $1.27 billion in funding for
the CDC's NCHHSTP with an increase of $878 million for HIV prevention
and surveillance, an increase of $31.7 million for viral hepatitis and
$66.1 million for Tuberculosis prevention.
Every 9\1/2\ minutes a new HIV infection happens in the United
States with more than 60 percent of new cases occurring among African
Americans and Hispanic/Latinos. While new HIV cases have increased, the
CDC's HIV prevention budget has declined 19 percent compared to
inflation since 2002. A failure to invest now in HIV prevention will be
costly. The CDC estimates that the 56,300 new HIV infections each year
in the United States may result in $56 billion in medical care and lost
productivity.
We strongly support the CDC initiative to integrate HIV screening
into medical care and remain seriously concerned about the lack of
Federal resources available to State health departments, medical
institutions, community health centers, and other community-based
organizations for implementing these programs. Increased HIV screening
with linkage to care and treatments will help lower HIV incidence and
prevalence in the United States. Effective treatment reduces the virus
to very low levels in the body and greatly reduces the risk of HIV
transmission. Furthermore through education, counseling and treatment,
individuals who are aware that they have HIV are less likely to
transmit the virus. The transmission rates among people who know their
status is 1.7 percent to 2.4 percent compared to transmission rates of
8.8 percent to 10.8 percent for those who are unaware they are infected
with HIV.
Despite the known benefit of effective treatment, 21 percent of
people living with HIV in the United States are still not aware of
their status and as many as 36 percent of people newly diagnosed with
HIV progress to AIDS within 1 year of diagnosis. Identifying people
with HIV earlier through routine HIV testing and linking them to HIV
care saves lives and is more cost effective for the healthcare system.
One study found that people living with HIV disease receiving care at
the later stages of the disease expended 2.6 times more in healthcare
dollars than those receiving treatment according to the standard of
care recommended in the Federal HIV treatment guidelines.
An infusion of HIV prevention funding is critical to restore and
enhance HIV prevention cooperative agreements with State and local
health departments; to optimize core surveillance cooperative
agreements with health departments and to expand HIV testing in key
healthcare venues by funding testing infrastructure, the purchase of
approved testing devices, including rapid HIV tests and confirmatory
testing.
Finally, we also must increase support for science-based,
comprehensive sex education programs. We strongly urge Congress to
discontinue funding for unproven abstinence-only sex education programs
and shift these funds to support comprehensive, age-appropriate sex
education programs.
CDC--TUBERCULOSIS
Tuberculosis is the major cause of AIDS-related mortality
worldwide. Congress passed landmark legislation--the Comprehensive
Tuberculosis Elimination Act of 2008--Public Law 110-873 last year that
authorizes a number of actions that will shore up State TB control
programs, enhance U.S. capacity to deal with the serious threat of
drug-resistant tuberculosis and escalate our efforts to develop
urgently needed new ``tools'' in the form of drugs, diagnostics, and
vaccines. It is critical that the $210 million in funding authorized
for fiscal year 2010 in this important new law is appropriated for the
CDC Division of TB Elimination. This represents an increase of $66.1
million more than current funding levels. Funding to support the
prevention, control, and elimination of tuberculosis must increase
substantially if we are going to make headway against this deadly
disease and to address the emerging threat of highly drug resistant
tuberculosis.
CDC--VIRAL HEPATITIS
Funds are urgently needed to provide core public health services
and to track chronic cases of hepatitis. Hepatitis is a serious co-
infection for nearly one-third of our HIV patients. We strongly urge
you to boost funding for viral hepatitis at the CDC by $31 million for
a total funding of $50 million.
HIV/AIDS BUREAU OF THE HEALTH RESOURCES AND SERVICES ADMINISTRATION
We strongly urge you to increase funding for the Ryan White program
by $577 million in fiscal year 2010 with at least an increase of $68.4
million for part C for a total appropriation of $270,254,000. We also
strongly support the $4 million included in the President's budget to
support in-depth, long-term HIV training opportunities for primary care
clinicians.
Ryan White part C funds comprehensive HIV care and treatment--the
services that are directly responsible for the dramatic decreases in
AIDS-related mortality and morbidity over the last decade. While the
patient load in part C programs has been rising in number, funding for
part C has effectively decreased. Part C programs expect a continued
increase in patients due to higher diagnosis rates and declining
insurance coverage. During this economic downturn people with HIV
across the country will rely on part C comprehensive services more than
ever. An increase in funding is critical to ensure that clinics are
able to prevent staffing cuts, as well as, to ensure the public health
of our communities. Part C of the Ryan White program has been under-
funded for years, but new pressures are creating a crisis in
communities across the country. The HIV medical clinics funded through
part C have been in dire need of increased funding for years. Years of
near flat funding, combined with large increases in the patient
population, are negatively impacting the ability of part C providers to
serve their patients.
With the rapid cost increases in all aspects of healthcare
delivery, despite small funding increases, programs are still operating
at a funding deficit because they are serving more patients than ever.
In 2008, part C programs will treat an estimated 248,070--a dramatic 30
percent increase in less than 10 years. Part C clinics are laying off
staff, discontinuing critical services such as laboratory monitoring,
creating waitlists, and operating on a 4-day work week just to get by.
HIVMA strongly supports the effort led by the Ryan White Medical
Providers Coalition to double funding for Ryan White part C programs by
fiscal year 2012. These funds are urgently critical to meet the needs
of HIV patients served by part C around the country.
The $4 million proposed in the President's budget to support
longer-term training opportunities in HIV medicine or clinical HIV
fellowships for primary care practitioners is vital to drawing
clinicians into the field of HIV medicine and ensuring new HIV
clinicians have the skills and expertise to provide effective HIV care.
More that a one-quarter of a century into the HIV epidemic, we are
seeing the graying of our Nation's HIV clinical workforce, and we have
serious concerns about ensuring a new generation of HIV medical
providers to care for Americans with HIV. In a recent survey of Ryan
White part C clinics--nearly 70 percent reported difficulty recruiting
and retaining HIV clinicians. One of the top barriers identified to
retention and to recruitment was lack of a qualified workforce. We must
promptly and swiftly address this issue before its effects are felt in
increases in morbidity and mortality from HIV and the proposed $4
million for more intensive training in HIV medicine would be an
important first step.
We also respectfully urge you to include at least $1 million in
this year's Labor, Health and Human Services, and Education, and
Related Agencies appropriations bill for a study to evaluate the
capacity of the HIV medical workforce as well as potential strategies
to increase the numbers of young physicians, nurse practitioners and
physician assistants entering HIV medicine.
NATIONAL INSTITUTES OF HEALTH (NIH)--OFFICE OF AIDS RESEARCH
HIVMA strongly supports an increase of at least $3.7 billion for
all research programs at the NIH, including at least a $500 million
increase for the NIH Office of AIDS. This level of funding is vital to
sustain the pace of research that will improve the health and quality
of life for millions of Americans.
HIVMA strongly supported the infusion of NIH research dollars
included in the economic recovery bill. The desperately needed funding
came at a critical time to sustain our Nation's scientific research
capacity while stimulating the economy in communities across the
country.
Prior to the boost in NIH funding, the declining U.S. investment in
biomedical research had taken its toll in deep cuts to clinical trials
networks and significant reductions in the numbers of high-quality,
investigator-initiated grants that were approved. With only 1 in 4
research applications receiving funding, the pipeline for critical
discoveries and HIV scientists has been dwindling and our role as a
leader in biomedical research is at serious risk.
Our past investment in a comprehensive portfolio was responsible
for the dramatic gains that we made in our HIV knowledge base, gains
that resulted in reductions in mortality from AIDS of nearly 80 percent
in the United States and in other countries where treatment is
available. Gains that also helped us to reduce the mother to child HIV
transmission rate from 25 percent to nearly 1 percent in the United
States and to very low levels in other countries where treatment is
available.
A continued robust AIDS research portfolio is essential to sustain
and to accelerate our progress in offering more effective prevention
technologies; developing new and less toxic treatments; and supporting
the basic research necessary to continue our work developing a vaccine
that may end the deadliest pandemic in human history. The sheer
magnitude of the number of people affected by HIV--more than 1 million
people in the United States; more than 33 million people globally--
demands a continued investment in AIDS research if we are going to
truly eradicate this devastating disease. We believe a high priority
should be research to discover novel prevention strategies, to improve
available treatment strategies, to aid prevention and to maximize the
benefits of antiretroviral therapy, especially in the populations
disproportionately affected by HIV in the United States and in
resource-limited settings.
We also continue to support the NIH's Fogarty International Center
(FIC) and recommend an expansion of its programs and funding. The FIC
training programs play a critical role in developing self-sustaining
healthcare infrastructures in resource-limited countries. These
important programs offer invaluable training and mentoring to
indigenous physicians from the countries hardest hit by the HIV
pandemic and other deadly infectious diseases, such as malaria and
tuberculosis. Physicians trained through the FIC are able to develop
research programs that more effectively address the healthcare,
cultural and resource needs of their country's residents while also
fostering the development of ongoing, robust research and clinical
programs.
Historically, our Nation has made significant strides in responding
to the HIV 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.
We appreciate the many difficult decisions that Congress faces this
year but urge you to recognize the importance of investing in HIV
prevention, treatment, and research now to avoid the much higher cost
that individuals, communities, and broader society will incur if we
fail to sustain these programs now. We have the opportunity to 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 globe.
______
Letter From the HIV Law Project
New York, NY, May 22, 2009.
Hon. Tom Harkin,
Chairman, Subcommittee on Labor, Health, and Human Services, and
Education, and Related Agencies, Washington, DC.
Dear Chairman Harkin: We respectfully request that you eliminate
all funding for abstinence-only-until-marriage programs (in particular
the Community-Based Abstinence Education Program as well as the Title V
Abstinence Education Programs), and instead fund programs that provide
medically accurate, age-appropriate comprehensive sex education.
President Obama has recently released a budget that zeroes out
these funding streams for abstinence-only-until-marriage programs. We
applaud his leadership in stopping the flow of dollars that has funded
these ineffective and inaccurate programs for too long. Yet the
President's budget proposes to replace these programs with a new Teen
Pregnancy Prevention Initiative that falls short of the needed
comprehensive sexuality education programming, and opens the door to
again funding ineffectual abstinence-only programs with new dollars.
Moving forward, we ask that you follow President Obama's lead in
advancing public health over ideology by embracing evidence- and
science-based educational programs through the elimination of funding
for abstinence-only programs. But we believe that new funds to protect
the sexual and reproductive health of adolescents through educational
programming must be comprehensive in nature, and not limited to the
single issue of teen pregnancy prevention.
WHAT IS COMPREHENSIVE SEXUALITY EDUCATION?
Comprehensive sexuality education programs include age-appropriate,
medically accurate information on a wide range of topics related to
sexuality including relationships, decisionmaking, abstinence,
contraception, and disease prevention. They provide students with
opportunities for developing interpersonal and relationship skills as
well as learning accurate information. Comprehensive sexuality
education programs help young people exercise responsibility regarding
sexual relationships by addressing abstinence, pressures to engage in
sexual intercourse prematurely, and the use of contraception.
Comprehensive sexuality education also addresses prevention against the
triple threats of unwanted teen pregnancies, sexually transmitted
infections, and HIV in order to preserve the sexual and reproductive
health of our young people.
ABSTINENCE-ONLY PROGRAMS ARE INEFFECTIVE AND INACCURATE
Contrary to the claims of abstinence-only proponents, these
programs have had no positive impact on teen sexuality. A study
commissioned by the U.S. Department of Health and Human Services found
that youth who participated in abstinence-only programs were no more
likely than their peers to abstain from sex, and participants reported
having similar numbers of sexual partners and having initiated sex at
the same average age as their counterparts who did not participate in
the programs.\1\
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\1\ Trenholm, Christopher, Barbara Devaney, Ken Fortson, et al. for
Mathematica Policy Research. ``Impacts of Four Title V, Section 510
Abstinence Education Programs. Final Report.'' April 2007. Available at
http://www.mathematica-mpr.com/publications/PDFs/impactabstinence.pdf
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Teaching abstinence is appropriate if discussed as one among many
possible approaches to staying healthy, and avoiding unintended
pregnancy. The problem is teaching abstinence only. Abstinence-only-
until-marriage programs are prohibited from teaching about
contraceptives, except to emphasize their failure rates. Many of the
most popular federally funded, abstinence-only curricula are rife with
false and misleading information, including that condoms fail to
prevent the spread of HIV approximately 31 percent of the time in
heterosexual sex, and that HIV is spread through sweat and tears. By
their very definition, abstinence-only programs perpetuate ignorance as
well as homophobia by teaching that a mutually faithful monogamous
relationship in the context of marriage is the expected standard of
sexual activity, and that sexual activity outside of the context of
marriage is likely to have harmful psychological and physical effects.
COMPREHENSIVE SEXUALITY EDUCATION PROGRAMS ARE EFFECTIVE
A rigorous review of 48 studies evaluating the efficacy of domestic
comprehensive sexuality education programs found numerous positive
outcomes, and debunked all the myths that serve to hamper governmental
support of comprehensive sexuality education:\2\
---------------------------------------------------------------------------
\2\ Douglas Kirby, Ph.D. et al. ``Emerging Answers 2007: Research
Findings on Programs to Reduce Teen Pregnancy and Sexually Transmitted
Diseases.'' November 2007. Available at http://
www.thenationalcampaign.org/EA2007/EA2007_full.pdf
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--Comprehensive sexuality education program participants were found
to delay sexual initiation in 40 percent of the programs
reviewed, and no study found that comprehensive sexuality
education programs hasten the initiation of sex.
--Of the studies that measured the programs' impact on frequency of
sexual activity among participants, 30 percent found that
programs reduced the frequency of sexual activity, and none
found an increase in frequency.
--A decrease in the number of sexual partners was documented by 41
percent of those studies measuring for this.
--An increase in condom use among program participants was found by
41 percent of the studies.
--56 percent of the programs found that sexuality and STD/HIV
education programs significantly reduced sexual risk-taking.
Reducing risk-taking reduces the transmission of STIs and HIV,
and helps to prevent unwanted pregnancies. None of the programs
increased sexual risk-taking.
--One of the studies estimated the cost-effectiveness of a sex
education program, and found that for every $1 invested in the
comprehensive sexuality program studied, $2.65 was saved in
medical and social costs, attributable to pregnancy prevention
and prevention of the transmission of sexually transmitted
infections, including HIV.
THE PUBLIC SUPPORTS COMPREHENSIVE SEX EDUCATION
A 2004 poll by Harvard's Kennedy School of Government, the Kaiser
Family Foundation, and National Public Radio found that 77 percent of
Americans believe that giving teens information about how to obtain and
use condoms makes it more likely that teens will practice safe sex now
or in the future. Further, a mere 7 percent of Americans said sex
education should not be taught in schools.\3\
---------------------------------------------------------------------------
\3\ National Public Radio, Kaiser Family Foundation, and Kennedy
School of Government, ``Sex Education in America: General Public/
Parents Survey.'' January 2004. Available at http://www.kff.org/
newsmedia/upload/Sex-Education-in-America-Summary.pdf
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YOUTH ARE SEXUALLY ACTIVE
One of the fundamental problems with abstinence-only programs is
that they ignore the reality of teenage sexuality. According to the
Centers for Disease Control and Prevention, in 2007, 47 percent of high
school students had sex at some time. In addition, nearly 15 percent of
students had sex with four or more sexual partners.\4\ Further, that
same year 38 percent of high school students who were then sexually
active had not used a condom during last sexual intercourse. In other
words, sexually active youth are engaging in risky sexual behaviors.
---------------------------------------------------------------------------
\4\ Centers for Disease Control and Prevention. ``Youth Risk
Behavior Surveillance--United States, 2007''. June 6, 2008. Available
at: http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5704a1.htm
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negative health outcomes are prevalent among youth
--Almost half of all new STD infections are among youth aged 15 to
24.
--Approximately 14 percent of the persons diagnosed with HIV/AIDS in
2006 were young people, between the ages of 13 and 24.
--In 2002, there were approximately 757,000 pregnancies among
adolescents aged 15-19.\5\
---------------------------------------------------------------------------
\5\ Centers for Disease Control and Prevention, ``Sexual Risk
Behaviors''. Available at http://www.cdc.gov/healthyyouth/
sexualbehaviors/index.htm
---------------------------------------------------------------------------
Comprehensive sex education has great potential to influence safer
sexual behavior among youth and reduce the risk of HIV and STI
transmission, as well as prevent unwanted pregnancies. Yet many young
people still lack both the knowledge and the skills to minimize their
risk. Prevention is not possible without knowledge of risk and
appropriate risk-reduction strategies.
SCHOOLS ARE FAILING TO EDUCATE STUDENTS ABOUT SEXUAL AND REPRODUCTIVE
HEALTH
Unfortunately, recent history indicates that young people are
becoming less able to protect themselves due to their schools' failure
to provide comprehensive sexuality education. In 2006, only 38.5
percent of high schools provided students with information regarding
proper condom use,\6\ a decrease from 2000 when 55.1 percent of high
schools provided this information.\7\ Additionally, while 96 percent of
States provided funding for or offered staff development on HIV
prevention to health educators in 2000, only 84 percent did so in
2006.\8\
---------------------------------------------------------------------------
\6\ SHPPS 2006. ``HIV Prevention''. Available at: http://
www.cdc.gov/HealthyYouth/SHPPS/2006/factsheets/pdf/
FS_HIVPrevention_SHPPS2006.pdf
\7\ SHPPS 2000. ``Fact Sheet: HIV Prevention''. Available at:
http://www.cdc.gov/HealthyYouth/SHPPS/2000/factsheets/pdf/hiv.pdf
\8\ SHPPS 2006. ``HIV Prevention''.
---------------------------------------------------------------------------
In sum, young people need prevention information and skills in
order to make healthy decisions. Funding for abstinence-only
programming, which has been proven ineffective, must be eliminated and
replaced with funds for comprehensive sexuality education. We cannot
afford to continue to spend money on ineffective programs. Our young
people deserve, and it is Government's obligation to provide, programs
that give them the information they need to make responsible decisions
to maintain their own sexual and reproductive health.
Sincerely yours,
ADAP Advocacy Association; African Services
Committee; AIDS Alabama; AIDS Alliance for
Children, Youth and Families; AIDS Law
Project of Pennsylvania; Alliance of AIDS
Services--Carolina; Cascade AIDS Project;
Center for HIV Law & Policy; Center for
Women & HIV Advocacy at HIV Law Project;
CHAMP.
Christie's Place; Colorado AIDS Project; Community
Access National Network; Global Life Works;
HIVictorious, Inc.; Housing Works; Positive
Women's Network; Latino Commission on AIDS;
Lifelong AIDS Alliance; National Alliance
of State and Territorial AIDS Directors.
New York City AIDS Housing Network (NYCAHN);
Sisterlove; SMART (Sisterhood Mobilized for
AIDS/HIV Research & Treatment); The Women's
Collective; Women's HIV Collaborative of
New York; Women's Initiative to Stop HIV--
NY of the Legal Action Center; Women's
Lighthouse Project; Women Organized to
Respond to Life-Threatening Diseases
(WORLD); Young Women of Color HIV/AIDS
Coalition.
______
Prepared Statement of HONOReform
Mr. Chairman and members of the subcommittee: As president and
cofounder of Hepatitis Outbreaks National Organization for Reform
(HONOReform), I want to take this opportunity to thank you for the
leadership role this subcommittee has played on healthcare acquired
infections (HAIs). HONOReform is a nonprofit foundation that advances
the lessons learned in hepatitis outbreaks and seeks to prevent future
healthcare-associated hepatitis epidemics through education and policy
reform.
The Centers for Disease Control and Prevention (CDC) estimates
there are 1.7 million infections resulting in approximately 99,000
deaths annually in the United States, making HAIs the fourth-leading
cause of death. Beyond the human toll, there is an enormous financial
burden to our healthcare system.
We are deeply concerned with the rise in the number of disease
outbreaks related to the reuse of syringes and misuse of multidose
vials in the outpatient setting. In the January 2009 edition of the
Annals of Internal Medicine, an article by the CDC, revealed the
occurrence of 33 outbreaks of viral hepatitis in healthcare settings
over the last decade. All of these documented outbreaks occurred in
nonhospital settings and involved failure on the part of healthcare
providers to adhere to basic infection control practices, most notably
by reusing syringes and other equipment intended for single use.
I am a victim of what was the largest single source outbreak of
Hepatitis C in U.S. history, until last year's Las Vegas, Nevada
outbreak that potentially exposed more than 63,000 patients to
hepatitis C. In 2001, I contracted hepatitis C through an oncology
clinic (nonhospital setting), in Fremont, Nebraska as I was fighting to
survive breast cancer for the second time. Ninety-eight other patients
from the oncology clinic became infected with hepatitis C. The nurse
would reuse the syringe for port flushes, which would then contaminated
a 500cc saline bag. The saline bag was used for other patients, which
in turn became the source of infection for multiple cancer patients.
This improper practice was repeated on a regular basis over a 2-year
period.
I utilized my malpractice settlement to establish HONOReform in
2007 to put an end to these completely preventable outbreaks. More than
100,000 patients seeking healthcare and treatment have received letters
notifying them of potential exposure to hepatitis and HIV due to
improper injection practices in the last 10 years. In April 2009, two
outbreaks in New Jersey--a cancer clinic and hospital--and an outbreak
at a South Dakota outpatient urology clinic, conducted large patient
notifications which further illustrates that this problem requires
immediate action to protect the citizens that are accessing our
healthcare system each day.
Moreover, these hepatitis outbreaks are entirely preventable when
healthcare providers adhere to proper infection control procedures. A
2002 study by the American Association of Nurse Anesthetists (AANA)
found that 1 percent of practitioners felt it was acceptable to reuse a
syringe for multiple patients and more than 30 percent of healthcare
providers believed it was acceptable to reuse a syringe on the same
patient if the needle is changed.
Mr. Chairman, beyond the significant risk posed to the physical
health of patients, even the receipt of a notification of potential
exposure can cause significant mental anguish and lead to an even
greater danger--a loss of faith in the medical system by the public.
Victims feel that they have been personally violated and betrayed by
those to whom they entrusted their health. We, as a Nation, can not
afford to ignore the issue and hope it goes away.
Through its foundation, HONOReform has joined forces with the
Accreditation Association for Ambulatory Health Care, AANA, Association
for Professionals in Infection Control and Epidemiology, Ambulatory
Surgery Foundation, Becton, Dickinson and Company, CDC, CDC Foundation,
Nebraska Medical Association, and the Nevada State Medical Association,
to establish the One & One Campaign. The One & Only Campaign is an
effort aimed at re-educating healthcare providers that syringes and
other medical equipment must not be reused and empowering patients to
ask the right questions when seeking healthcare. If patients are
knowledgeable about injection safety, they will be empowered to speak
up in their provider's office to ask if they are getting ``One Needle,
One Syringe, and Only One Time.
In fiscal year 2009, the CDC received $2.5 million to establish a
pilot campaign in Nevada for the launch of the One & Only Campaign,
which we hope will be expanded to the national campaign with your
support for continued and expanded funding in fiscal year 2010.
Each of these requests will have a profound impact on all patients
and consumers. They are aimed at reducing the knowledge gap for
providers, empowering patients, tracking HAIs to limit the spread of
disease, and improving the quality and standards of care in our
Nation's ambulatory care facilities. By focusing on prevention, this
subcommittee can realize savings for healthcare systems and promote
increased patient safety for all Americans.
Mr. Chairman, we respectfully request that the subcommittee
continue supporting prevention efforts at CDC, HHS, and the Agency for
Healthcare Research and Quality (AHRQ) to help prevent future hepatitis
and HIV outbreaks through the following fiscal year 2010 appropriations
requests:
HONOReform requests $26 million for CDC's Division of Healthcare
Quality and Promotion to build infrastructure for complete and
consistent adherence to injection safety and infection control
guidelines in the delivery of outpatient care.
As you know, the migration of healthcare delivery from primarily
acute care hospitals to other nonhospital settings (e.g., home care,
ambulatory care, free-standing specialty care sites, long-term care,
etc.) requires that common principles of infection control practice be
applied to the spectrum of healthcare delivery settings. The CDC needs
additional resources to use the knowledge gained through these
activities to detect infections and develop new strategies to prevent
healthcare-associated transmission of blood borne pathogens. This
request includes the following elements:
--Provider Education and Awareness.--Nine million dollars to be used
to support CDC's efforts around provider education and patient
awareness activities. Currently, the CDC along with patient
advocacy organizations, foundations, provider associations and
societies and industry partners have established the Safe
Injection Practices Coalition. The requested funding would be
used to roll out a national public health campaign focused on
safe injection practices. Additionally, funds will be used to
develop and disseminate safe practice materials and develop
related tools designed for inpatient and outpatient settings.
Innovative tools will be developed in conjunction with key
partners and stakeholders for use by providers and healthcare
personnel, including training tools to be used by professional
organizations and accreditation and licensing groups to
increase adherence to recommendations
--Engineering and Innovation.--Eight million dollars would be used to
support CDC in promoting private-sector healthcare solutions to
injection safety and infection control problems by engage and
incentivizing the private sector to innovate and create fast
track engineering solutions to injection safety and infection
control problems through the development of innovative products
to reduce infection transmission for inpatient and outpatient
healthcare settings. With this funding, CDC will convene a
roundtable with industry, conduct a study on available
technology, assess opportunities for investment in research and
development, and examine incentives required for adoption of
equipment designed with engineering controls (e.g., sharps
disposal containers, self-sheathing needles, safer medical
devices, such as sharps with engineered sharps injury
protections and needless systems, etc.). CDC will also pursue
mechanisms such as grants or CRADAs with industry to accelerate
the development of products that have the potential for
eliminating the opportunity for human error from process of
administering injections.
--Detection and Tracking.--Nine million dollars would be used for
detection and tracking in order to enable States to investigate
outbreaks of hepatitis and other potential pathogens related to
injection safety. In addition, this funding would provide
support to CDC for emergency response to assist States in
responding to hepatitis outbreaks (i.e., Nevada), including
genetic sequencing tests. Funding would support efforts
including training at health departments related to safe
injection practices and recognition of errors, and to enable
rapid investigation and intervention when errors are detected.
The funding would also support the augmentation of survey
capacity in outpatient settings to strengthen State capacity to
detect infections that indicate systemic patient safety errors.
The funding will enable CDC to provide support to States by
providing training tools for surveyors, health department staff
and epidemiologists to improve methods of monitoring adherence
to correct practices and to provide tools for investigation,
response and intervention strategies. Funds will also enable
CDC to provide data analysis and feedback to States.
HONOReform requests $1 million for the Department of Health and
Human Services (HHS) to expand its current focus for reducing
healthcare acquired infections (HAIs) from hospitals to all healthcare
settings, including outpatient facilities. We are deeply concerned with
the number of HAIs occurring in office-based settings, such as
ambulatory care centers, infusion centers, and endoscopy clinics, due
to a lack of adherence to basic infection control procedures. In the
past year, more than 100,000 patients across the country have been
exposed to hepatitis and HIV from healthcare providers failing to
adhere to proper safe injection practices and infection control.
HONOReform requests $10 million in general patient safety funds for
the AHRQ's Ambulatory Patient Safety Program. While much is known about
risk and hazards in the hospital setting, the same cannot be said of
ambulatory care setting. Few safety practices have been identified, and
there is limited data on the nature of risk and hazards to patients and
the threat to quality in the ambulatory care setting. As part of the
overall AHRQ patient safety and quality improvement efforts, the
identification, assessment, and modeling of risk and hazards prior to
designing or implementing intervention strategy in ambulatory care is
critical. In light of the growing number of incidents involving syringe
reuse and hepatitis C transmission, this funding would enable AHRQ to
expand its ambulatory safety and quality program ``to identify the
inherent risks in ambulatory settings and to develop potential
solutions for protecting patients.''
Mr. Chairman, on behalf of HONOReform, I would like to express my
appreciation for this opportunity to present written testimony before
the subcommittee. The growing number of incidents involving syringe
reuse and hepatitis C transmission in non-hospital settings across the
country highlights the need for enhancing education, awareness and
public health activities related to proper infection control and safe
injection practices.
______
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 $550 million in fiscal year 2010 for the health
professions education programs authorized under titles VII and VIII of
the Public Health Service Act and administered through the Health
Resources and Services Administration (HRSA). HPNEC is an informal
alliance of more than 60 national organizations representing schools,
programs, health professionals, and students dedicated to ensuring the
healthcare workforce is trained to meet the needs of our diverse
population.
As you know, the title VII and VIII health professions and nursing
programs are essential components of the Nation's healthcare safety
net, bringing healthcare services to our underserved communities. These
programs support the training and education of healthcare providers to
enhance the supply, diversity, and distribution of the healthcare
workforce, filling the gaps in the supply of health professionals not
met by traditional market forces. Through loans, loan guarantees, and
scholarships to students, and grants and contracts to academic
institutions and nonprofit organizations, the title VII and VIII
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
healthcare workforce.
We are thankful to the subcommittee for the $200 million provided
for the health professions programs in the American Recovery and
Reinvestment Act (Public Law 111-5). We also greatly appreciate that
the recently enacted fiscal year 2009 Omnibus Appropriations bill
(Public Law 111-8) provides some increases for most title VII and VIII
programs. These investments provide a crucial springboard to begin to
wholly reverse chronic underfunding of these programs and address
existing and looming shortages of health professionals.
According to HRSA, an additional 30,000 health practitioners are
needed to alleviate existing health professional shortages. Combined
with faculty shortages across health professions disciplines, racial/
ethnic disparities in healthcare, and a growing, aging population,
these needs strain an already fragile healthcare system. Because of the
time required to train health professionals, we must make appropriate
investments today. Yet, despite some increases in recent years, many of
the health professions programs remain well below their comparable
fiscal year 2005 funding levels. HPNEC's $550 million recommendation
will help sustain the health workforce expansion supported by funding
in the recovery package. Further, this appropriation will restore
funding to critical programs that sustained drastic funding reductions
in fiscal year 2006 and remain well below fiscal year 2005 levels.
We are grateful to President Obama for highlighting the need to
strengthen the health professions workforce as a national priority.
This strategy is in line with numerous recent, highly regarded
recommendations. In a December 2008 Institute of Medicine (IOM) report,
HRSA's health professions programs were characterized as ``an
undervalued asset'' and the Department of Health and Human Services was
encouraged to support additional investments in the programs. Another
IOM report on the future workforce for older Americans from April 2008
also called for increased funding for the health professions programs.
The November 2008 issue of the peer-reviewed journal Academic Medicine
chronicles the effectiveness of the programs, and the primary care
programs in particular, while the December 2008 issue of the Mt. Sinai
Journal of Medicine highlights the impact of the diversity programs.
These most recent publications showcase the network of title VII and
VIII initiatives across the country supporting the education and
training of the full range of health providers. Together, the programs
work in concert with other programs at the Department of Health and
Human Services--including the National Health Service Corps and
Community Health Centers (CHCs)--to strengthen the health safety net
for rural and medically underserved communities.
The Health Professions Education Partnerships Act of 1998 (Public
Law 105-392) consolidated the programs into seven general categories:
--The purpose of the Minority and Disadvantaged Health Professionals
Training programs is to improve healthcare access in
underserved areas and the representation of minority and
disadvantaged healthcare 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
Careers 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.
Nurses received $15.1 million in fiscal year 2007 from SDS
grants, 32 percent of funds appropriated for SDS.
--The Primary Care Medicine and Dentistry programs, including General
Pediatrics, General Internal Medicine, Family Medicine, General
Dentistry, Pediatric Dentistry, and Physician Assistants,
provide for the education and training of primary care
physicians, dentists, and physician assistants to improve
access and quality of healthcare in underserved areas. Two-
thirds of all Americans interact with a primary care provider
every year. Approximately one- half of primary care providers
trained through these programs go on to work in underserved
areas, compared to 10 percent of those not trained through
these programs. 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 healthcare 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. AHECs, which have substantial State and
local matching funds, form networks of health-related
institutions to provide education services to students, faculty
and practitioners. 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 healthcare
providers caring for our older generations. Given America's
burgeoning aging population, there is a need for specialized
training in the diagnosis, treatment, and prevention of disease
and other health concerns of the elderly. The Quentin N.
Burdick Program for Rural Health Interdisciplinary Training
places an emphasis on long-term collaboration between academic
institutions, rural healthcare agencies, and providers to
improve the recruitment and retention of health professionals
in rural areas. This program has received no funding since
fiscal year 2006. 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. Health professions
schools use this funding to help establish or expand allied
health training programs. The need to address the critical
shortage of certain allied health professionals has been
acknowledged repeatedly. For example, this shortage has
received special attention given past bioterrorism events and
efforts to prepare for possible future attacks. 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 (i.e., older adults,
children, chronically ill, and victims of abuse and trauma,
including returning military personnel and their families),
especially in rural and urban communities.
--The Health Professions Workforce Information and Analysis program
provides grants to institutions to collect and analyze data on
the health professions workforce to advise future
decisionmaking 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, the Nation's most extensive and
comprehensive source of statistics on registered nurses.
However, the Workforce Information and Analysis program has
received no appropriation since fiscal year 2006.
--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, which
receive minimal funding through Medicare GME, 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 healthcare
system, with a special emphasis on those who serve in
underserved areas. However, the traineeships have received no
appropriation since fiscal year 2006.
--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, healthcare in underserved areas.
These programs provide the largest source of Federal funding
for nursing education, providing loans, scholarships,
traineeships, and programmatic support to 51,657 nursing
students and nurses in fiscal year 2008. Healthcare 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 50,000 and 88,000 qualified applications at all
degree levels due to an insufficient number of faculty,
clinical sites, classroom space, clinical preceptors, and
budget constraints. At the same time, the need for nursing
services and licensed, registered nurses is expected to
increase significantly over the next 20 years. 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. For example,
this funding has been instrumental in doubling nurse anesthesia
graduates in the last 8 years. However, even though the number
of graduates doubled, the vacancy rate for nurse anesthetists
has remained the same at 12 percent, due to a retiring nursing
profession and an aging population requiring more care.
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 healthcare 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 loan programs under 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 of improving the supply, diversity, and distribution of
the health professions workforce. 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 healthcare professionals but also to our
Nation's efforts to provide needed healthcare services to underserved
and minority communities. We greatly appreciate the support of the
subcommittee and look forward to working with Members of Congress and
the new administration to reinvest in the health professions programs
in fiscal year 2010 and into the future.
______
Prepared Statement of the Home Safety Council
INTRODUCTION
Chairman Harkin, Ranking Member Cochran, and members of the
subcommittee, thank you for the opportunity to submit testimony on the
fiscal year 2010 appropriations for the Centers for Disease Control and
Prevention's (CDC) National Center for Injury Prevention and Control
(NCIPC).
I am Patricia Adkins, chief operating office and director of public
policy for the Home Safety Council which is located in Washington, DC.
ABOUT THE HOME SAFETY COUNCIL (HSC)
The mission of the HSC is to help prevent and reduce the nearly
20,000 deaths and 21 million medical visits each year from such hazards
as falls, poisoning, fires and burns, choking and suffocation, and
drowning. Through national programs, partnerships and the support of
volunteers, HSC educates people of all ages to help keep them safer in
and around their homes.
Our vision for our Nation is safer homes that provide the
opportunity for all individuals to lead healthy, active, and fulfilling
lives.
INCREASED FUNDING FOR CDC'S NCIPC
CDC's NCIPC has the mission of preventing injuries and violence,
and reducing their consequences. It strives to help every American live
his or her life to its fullest potential. Funds are utilized by NCIPC
for intramural and extramural research and in assisting State and local
health agencies in implementing injury prevention programs.
HSC and a coalition of 30 like-minded nonprofit organizations are
requesting an increase of $10 million to the ``Unintentional Injury
Prevention'' account to begin to comprehensively address the large-
scale growth of older adult falls.
Ultimately, success in reducing the number and severity of older
adult falls will be reached through partnerships with Federal, State,
and local agencies along with the cooperation of many nongovernmental
organizations.
WHY INJURY PREVENTION IS A CRITICAL ELEMENT OF HEALTHCARE REFORM
In 1998, the National Academy of Sciences stated, ``Injury is
probably the most under-recognized public health threat facing the
nation today.''
Each year, injuries resulting from a wide variety of physical and
emotional causes--motor vehicle crashes, sports trauma, violence,
poisoning, fires, and falls--keep millions of children and adults from
achieving their goals and making the most of their talents and
abilities.
This is what we know:
--Nationally and in every State in the United States, injuries are
the leading cause of death in the first 44 years of a person's
life.
--In a single year, more than 50 million injuries required medical
attention, with an estimated total lifetime cost of $406
billion.
--This total lifetime cost includes $80 billion in medical care costs
and $326 billion in productivity losses, including lost wages
and benefits and the inability to perform normal household
functions.
These three statistics clearly show the consequences of injuries
and its major burden on the healthcare system.
Fortunately, injury research has proven that there are steps that
can be taken to prevent injuries and increase the likelihood for full
recovery when they do occur. By incorporating these strategies into our
communities and everyday activities, we can help to ensure that
Americans remain healthy and live their lives to the fullest potential.
PROTECTING OLDER ADULTS FROM INJURY
We all want a society where people, including our older citizens,
can live healthy and productive lives. A key component of achieving
this is helping older adults avoid injuries. There are actions we can
take to prevent injuries and premature death to our parents,
grandparents, and friends. Some of the most important include
preventing older adults from falling and being injured in fires or
motor vehicle crashes.
One of the injuries affecting the quality of life for older adults
is falls. Falls are the leading cause of fatal and nonfatal injuries
for those 65 and older. Each year, 1.8 million older adults are treated
in emergency departments. Every day, 5,000 adults 65 and older are
hospitalized due to fall-related injuries, and every 35 minutes, an
older adult dies from a fall-related injury.
We know one of the greatest financial challenges facing the U.S.
Government, its citizens, and their employers is the rising cost of
healthcare services needed by older Americans. CDC reports that $80.2
billion is spent annually for medical treatment of injuries, of which
fully $19.2 billion ($12 billion for hospitalization, $4 billion for
emergency department visits, and $3 billion for outpatient care) is for
treating older adults injured by falls. That's almost one-quarter of
all healthcare expenses for injuries each year spent on older adult
falls and the majority of these expenses are paid by CMS through
Medicare. If we cannot stem this rate of increase, it is projected that
the direct treatment costs will reach $54.9 billion annually in 2020,
at which time the cost to Medicare would be $32.4 billion.
While falls are a threat to the health and independence of older
adults and can significantly limit their ability to remain self-
sufficient, the opportunity to reduce falls among older adults has
never been better. Today there are proven interventions and strategies
that can reduce falls and in turn help older adults live better and
longer. Studies show that prescription medications have an effect on
balance. A medication review and adjustment is a simple, cost-effective
way to help prevent a fall. Additionally, older adults who actively
participate in physical exercise and receive vision exams are at a
lower risk for falling. These evidence-based interventions can help
save healthcare costs and greatly improve the lives of older adults.
The costs are small compared to the potential for savings. For every $1
invested in a comprehensive falls prevention program for an older
adult, it returns close to a $9 benefit to society.
HOW CONGRESS CAN HELP
Congress took a major step forward in preventing older adult falls
with passage of the Safety of Seniors Act of 2007 (S. 845 and Public
Law 110-202) which authorized increased research, education, and
demonstration projects. Further evidence of support included the
passage of S. Res. 674 and the introduction of H. Res. 1478 for the
first National Falls Prevention Awareness Day in September 2008. For
the good intentions of Congress to bear fruit, an appropriation of $10
million is needed for fiscal year 2010 for CDC's NCIPC.
NCIPC's funding in this area is severely inadequate to address the
scale of human suffering and the impact of falls on our healthcare
system. Additional funding would enable NCIPC to expand research,
evaluation of demonstrations, public education, professional education,
and policy analysis. At present, CDC can only allocate $2 million per
year to address a problem costing $19.2 billion a year. The benefits of
increased funding would be enormous, vastly improving the quality of
life for those 65 and older and greatly reducing healthcare costs for
falls and related disabilities.
Increased funding for older adult falls prevention efforts is
supported by a broad-based coalition of nonprofit organizations and a
growing number of State falls prevention coalitions that are dedicated
to improving the safety and health of older Americans.
CDC ACTIVITY IN FALLS PREVENTION AMONG OLDER ADULTS
If the CDC NCIPC's falls prevention budget is increased by $10
million, the next steps would be to:
--Develop additional program demonstrations to test and replicate the
most cost effective interventions to reduce the risk of falls;
--Undertake additional extramural research into the causes of falls;
and
--Develop more public education programs to raise awareness about
falls and what individuals, family members, professionals,
nonprofit organizations, and the private sector can do to
reduce them.
On behalf of HSC and our supporting organizations, thank you for
the opportunity to share our fiscal year 2010 appropriations request
for the CDC NCIPC on the very costly, but often preventable problem of
falls among older adults.
______
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 nonanimal and other
alternative test methods. We are also submitting our testimony on
behalf of The Humane Society of the United States and Doris Day Animal
League, representing more than 11 million members and supporters. Thank
you for the opportunity to present testimony relevant to the fiscal
year 2010 budget request for the National Institute of Environmental
Health Sciences (NIEHS) for 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).
Function of the ICCVAM
The ICCVAM performs a valuable 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 National Institutes of Health (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.
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 fiscal year 2010 Senate Labor, Health and Human
Services, and Education, and Related Agencies appropriations bill:
``The Committee acknowledges the publication of the NICEATM/ICCVAM
Five-Year Plan but remains concerned by the slow pace at which federal
agencies have moved to adopt regulations that would replace, reduce or
refine the use of animals in testing. The Committee therefore requests
that NICEATM/ICCVAM hold an initial workshop, based upon input received
from a workshop steering committee with representation of scientists
from academia, federal government, animal welfare organizations and
industry, on ``Challenges to Incorporating Alternative Methods into US
Federal Agency Programs.'' The Committee also requests that NICEATM/
ICCVAM convene a workshop in fiscal year 2010 to assess the difficulty
of obtaining high-quality relevant data for validating alternative
methods, which is a significant barrier to validation and acceptance.
NICEATM/ICCVAM are also urged to establish timetables for completion of
all validation reviews that are currently under way.''
National Institutes of Health Support for--``Toxicity Testing in the
21st Century: A Vision and a Strategy''
NIH has launched an ambitious collaboration with the Environmental
Protection Agency (EPA) to dramatically transform the way drugs,
consumer products, pesticides, and other chemicals are assessed for
safety. The new approach will use isolated cells, molecular targets,
and lower organisms such as roundworms, instead of laboratory animals.
According to the NIH, the research collaboration is expected ``to
generate data more relevant to humans; expand the number of chemicals
that are tested; and reduce the time, money and number of animals
involved in testing.''
The tripartite arrangement is designed to capitalize on the NIH
Chemical Genomics Center's high-speed, automated screening robots to
test compounds for toxicity; the experimental toxicology expertise of
the National Toxicology Program, which is headquartered at the NIH's
NIEHS; and the computational toxicology capabilities at the EPA's
National Center for Computational Toxicology.
The Government collaboration seeks to implement a June 2007 report
by the National Research Council (NRC) entitled Toxicity Testing in the
21st Century: A Vision and a Strategy, which calls for a sustained,
well-funded effort across the toxicology community to shift the
traditional toxicity-testing paradigm away from its heavy reliance on
animal testing and towards high-throughput systems that monitor
perturbations in toxicity pathways.
The Government project could be seen as a successor, with equally
visionary possibilities for biology, to Dr. Collins and NHGRI's highly
successful Human Genome Project. In order for the new vision to be
fully realized within a decade, what is needed is a well-funded
Government effort that would attract additional partners and resources
from interested industries and overseas governments. We urge the
subcommittee to support the efforts of the NIH to implement the NRC
report.
______
Prepared Statement of The Humane Society of the United States
On behalf of The Humane Society of the United States (HSUS) and our
11 million supporters nationwide, we appreciate the opportunity to
provide testimony on our top funding priority for the Labor, Health and
Human Services, and Education, and Related Agencies Appropriations
Subcommittee in fiscal year 2010. We are also submitting our testimony
on behalf of The Humane Society Legislative Fund (HSLF) and the Doris
Day Animal League. Thank you for the opportunity to present testimony
relevant for the fiscal year 2010 budget request.
The HSUS requests that no Federal funding be appropriated for (1)
the breeding of chimpanzees for research, or (2) the transfer of
Government-owned chimpanzees to private hands (including endowments for
their maintenance) unless for retirement to appropriate sanctuary. The
basis of our request can be found below.
BREEDING OF CHIMPANZEES FOR RESEARCH
The National Center for Research Resources (NCRR) of the National
Institutes of Health (NIH), responsible for the oversight and
maintenance of federally owned chimpanzees, has announced a permanent
end to funding the breeding of federally owned and supported
chimpanzees primarily due to the excessive costs of lifetime care of
chimpanzees in laboratory settings. We recently discovered that the
Government has provided millions of dollars in recent years for
chimpanzee breeding. Therefore, we seek to ensure that neither the NIH
nor any other Federal agency provides funding for breeding of
Government-owned chimpanzees due to the future financial implications
to the Government and taxpayers of continuing to do so, particularly
during this difficult economic time.
The cost of maintaining chimpanzees in laboratories is exorbitant,
totaling up to $8.5 million each year for the current population of
approximately 500 federally owned or supported chimpanzees
(approximately $54 per day per chimpanzee; more than $1,000,000 per
chimpanzee's 60-year lifetime). Breeding of additional chimpanzees into
laboratories will only perpetuate a number of burdens on the
Government.
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.
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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.
TRANSFER OF OWNERSHIP OF GOVERNMENT-OWNED CHIMPANZEES
If the Government-owned and supported chimpanzees leave the Federal
system and are transferred into private hands with an accompanying
federally funded endowment, their lifetime support will not be
guaranteed as required now by the CHIMP Act and their transfer to a
suitable sanctuary will be highly unlikely. These chimpanzees will
instead of warehoused and/or used for research for their entire
lifetime--with the backing of the Government through an endowment. This
will surely lead to a public outcry.
--If private industry breeds and uses chimpanzees in invasive
research with Federal endowment money, the private sector would
be unfairly, and perhaps illegally, benefiting from federally
owned ``resources'' meant for the betterment of the American
public, not for the profit of private industry.
--To date, the private sector has been less than fiscally responsible
for the lifetime care of chimpanzees who they have used for
private profit. Even in the situations where they eventually
retire their chimpanzees, private users rarely offer financial
compensation for their chimpanzees' lifetime care and on the
few occasions that they have offered some financial
compensation, it falls far short of what is actually needed.
We instead urge the Government to transfer all 500 Government-owned
chimpanzees to the national sanctuary system and appropriate a portion
of the funding currently being given to chimpanzee laboratories to the
sanctuary system. A transfer of the chimpanzees to sanctuary would: (1)
consolidate and lessen chimpanzee maintenance costs, (2) provide the
chimpanzees with better care, and (3) offer the public the humane
solution they are asking for.
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 500 of the more than 1,000 total chimpanzees available
for research in the United States. On May 22, 2007, the NCRR of NIH
announced a permanent end to the funding of chimpanzee breeding, which
applies to all federally owned and supported chimpanzees as well as
NIH-funded research. Further, it has also been noted that ``a huge
number'' of chimpanzees are not being used in active research protocols
and are therefore ``just sitting there.'' \2\ If no breeding is
allowed, it is projected that the Government will have almost no
financial responsibility for the chimpanzees it owns within 30 years
due to the age of the population--any breeding today will extend this
financial burden to 90 years.
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\2\ Cohen, J. (2007) Biomedical Research: The Endangered Lab Chimp.
Science. 315:450-452.
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There is no justification for breeding of additional chimpanzees
for research; therefore lack of Federal funding for breeding will
ensure that no breeding of federally owned or supported chimpanzees for
research will occur in fiscal year 2010.
CONCERNS REGARDING CHIMPANZEE CARE IN LABORATORIES
A 9-month undercover investigation by the HSUS at University of
Louisiana at Lafayette New Iberia Research Center (NIRC)--the largest
chimpanzee laboratory in the world--revealed some chimpanzees living in
barren, isolated, conditions and documented more than 100 alleged
violations of the Animal Welfare Act at the facility in regards to
chimpanzees. The U.S. Department of Agriculture (USDA) and NIH's Office
of Laboratory Animal Welfare (OLAW) have since launched formal
investigations into the facility and NIRC was cited for several
violations of the Animal Welfare Act during an initial site visit.
Aside from the HSUS investigation, inspections conducted by the
USDA demonstrate that basic chimpanzee housing requirements are often
not being met. Inspection reports for two other federally funded
chimpanzee facilities reported housing of chimpanzees in less than
minimal space requirements, inadequate environmental enhancement, and/
or general disrepair of facilities. These problems 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,
chimpanzees do not model the course of the human hepatitis C virus yet
they continue to be used for this research, adding to the millions of
dollars already spent without a sign of a promising vaccine. 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.
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\3\ The Chimpanzee Sequencing and Analysis Consortium/Mikes, 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 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 (as we documented during our
investigation at NIRC); 71 percent believe that chimpanzees who have
been in the laboratory for more than 10 years should be sent to
sanctuary for retirement;\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.
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We respectfully request the following bill or subcommittee report
language:
``The Committee directs that no funds provided in this Act be used
to support the breeding of chimpanzees for research, research that
requires breeding of chimpanzees, or the transfer of ownership of
federally owned chimpanzees to private entities, including endowments
for their maintenance, with the exception of a transfer to an
appropriate sanctuary that meets the national chimpanzee sanctuary
system standards.''
We appreciate the opportunity to share our views for the Labor,
Health and Human Services, and Education, and Related Agencies
Appropriations Act for fiscal year 2010. We hope the subcommittee 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 Harlem United Community AIDS Center, Inc.
FUNDING REQUEST OVERVIEW
Harlem United Community AIDS Center, Inc. (Harlem United)
appreciates the opportunity to submit written comments for the record
regarding fiscal year 2010 funding for HIV/AIDS related programs.
Harlem United was founded in 1988 as a community-based, nonprofit
organization providing comprehensive, integrated care in a healthy and
healing environment. We serve individuals and families living with HIV
and AIDS in the greater Harlem and South Bronx neighborhoods of New
York City. Touching the lives of more than 6,000 people each year
through our programs, Harlem United offers its clients an array of
evidence-based, outcomes-driven, culturally sensitive medical and
support services, including: primary healthcare and dental care; mental
health and substance use counseling; individual psychotherapy and case
management; and supportive housing.
For far too long, Federal funding for domestic HIV/AIDS programs
has been inadequate, leaving communities struggling to meet the
prevention, care, and treatment needs of people at risk for and living
with HIV/AIDS. Harlem United values working with policymakers at the
local, State, and Federal levels to advance policies and programs that
support HIV prevention, care, and treatment. We respectfully request
the subcommittee provide the following allocations in fiscal year 2010
to promote HIV prevention and HIV related research and treatment
innovations:
--$1.57 billion for HIV prevention and surveillance at the Centers
for Disease Control and Prevention (CDC) to help stem the tide
of the Nation's HIV/AIDS epidemic, particularly among
individuals and communities of color.
--At least $2.81 billion in overall funding for the Ryan White
Program, including the AIDS Drug Assistance Program, to provide
essential services for more than 530,000 uninsured and
underinsured low-income individuals and families impacted by
HIV/AIDS.
--A minimum of $610 million for the Minority AIDS Initiative, which
funds programs across 8 Federal agencies to address HIV
infection-related disparities among racial and ethnic groups.
--At least $34 billion for the National Institutes of Health (NIH),
with $3.35 billion allocated to HIV/AIDS research to help
identify and deliver new therapies.
INTRODUCTION AND OVERVIEW
Despite ongoing prevention efforts, approximately 56,300 new HIV
infections occur each year, and an estimated 21 percent of infected
individuals are unaware of their HIV status. Moreover, CDC estimates
that there are 430,000 people with HIV in the United States, who are
not currently receiving HIV-related medical care. In 2004, the
Institute of Medicine estimated that more than 50 percent of Americans
living with HIV had no reliable access to the care they needed to stay
alive. Evidence has shown that new infections have been driven in large
part by (1) people who were unaware of their status and unwittingly
transmitted the virus, and (2) individuals who were diagnosed, but who
were not treatment eligible and who were engaging in risk behaviors.\1\
Prevention programs, routine HIV testing and universal access to care
are essential to stemming the tide of the HIV/AIDS epidemic nationwide.
---------------------------------------------------------------------------
\1\ Federal guidelines do not allow for treatment until an
individual's viral load reaches 350 or lower.
---------------------------------------------------------------------------
To prevent the incidence of HIV and ensure that all people living
with HIV/AIDS have access to comprehensive and quality care that they
need and deserve, Harlem United advocates ongoing and significant
Federal funding for domestic HIV/AIDS programs.
BOLSTER CDC HIV PREVENTION AND SURVEILLANCE EFFORTS
The CDC estimates that there are more than 1.1 million people
living with HIV/AIDS in the United States and an estimated 56,300 new
infections occur each year. With these staggering statistics, it
becomes clear that a sustained Federal investment in and commitment to
HIV/AIDS initiatives are essential to advancing efforts to prevent and
treat HIV infections. However, over the past 6 years, as the number of
people living with HIV/AIDS has increased, Federal funding for HIV
prevention programs at CDC has decreased by 19.3 percent. In fiscal
year 2009, CDC HIV related prevention and surveillance programs were
flat-funded after facing a $3.5 million cut in fiscal year 2008. Harlem
United calls upon the subcommittee to provide a specific allocation of
$1.57 billion, an increase of $877 million, for HIV prevention efforts
at CDC.
The current body of knowledge and research surrounding HIV
prevention provides evidence for effective interventions, yet CDC and
State and local public health departments do not always have the
resources to implement them. With increased Federal funding, gaps in
resources and fiscal needs will be alleviated and prevention efforts
can be scaled up. Specifically, additional funding will allow CDC to
expand HIV testing efforts and prevention outreach, particularly among
high-risk populations and communities of color, where the epidemic is
disproportionately concentrated. CDC also would be able to assist State
and local health departments fund prevention programs that go beyond
just testing for HIV. Furthermore, additional funding would allow CDC
to continue to build the capacity of community-based organizations to
implement evidenced-based interventions and provide technical
assistance, Lastly, CDC would also be able to improve HIV monitoring
and surveillance activities to ensure that accurate data on the disease
is captured.
PRESERVE ACCESS TO HIV TREATMENT FOR LOW-INCOME INDIVIDUALS THROUGH THE
RYAN WHITE PROGRAM
Each year, the Ryan White Program provides care and treatment to
more than half a million low-income individuals living with HIV/AIDS.
This program is vital to those who have no medical coverage or face
coverage limits, as it steps in as the ``payer of last resort.'' While
the Ryan White Program was initially implemented as an emergency
measure, it has become an integral part of the Nation's response to
HIV, providing treatment for individuals who would otherwise not have
access to care.
The AIDS Drug Assistance Program (ADAP), a critical component of
the Ryan White Program that exists under part B, provides HIV
medications to program participants and funds for purchasing health
insurance for eligible participants and services that enhance drug
treatment therapies.
Unfortunately, growing caseloads and costs of treatment have left
current funding levels inadequate. As such, Harlem United calls upon
the subcommittee to allocate at least $2.81 billion in overall funding
for the Ryan White Program, including the AIDS Drug Assistance Program.
STRENGTHEN THE MINORITY AIDS INITIATIVE
The HIV/AIDS epidemic in the United States has hit racial and
ethnic minority communities hard. While only 12 percent of the U.S.
population is African American, this racial group accounts for 49
percent of all new AIDS cases. Hispanics account for 19 percent of new
AIDS diagnoses, yet comprise only 12 percent of the total U.S.
population. Combined, minorities represent 71 percent of new AIDS
cases, 67 percent of all people living with HIV/AIDS, and 70 percent of
deaths caused by AIDS. These grim statistics demonstrate the critical
need for the Minority AIDS Initiative (MAI).
MAI provides funding to community-based organizations and
healthcare providers to implement prevention and treatment programs
specifically tailored to racial and ethnic minority populations. The
Initiative, designed to complement other HIV efforts, strengthens the
capacity of organizations serving communities of color to implement
culturally appropriate HIV prevention programs and treatment services,
in order to reduce the incidence of HIV and improve HIV related health
outcomes among these communities.
Given the urgent need to reduce HIV/AIDS disparities among racial
and ethnic communities in the United States, Harlem United urges the
subcommittee to allocate a minimum of $610 million for the Minority
AIDS Initiative.
ENHANCE HIV TREATMENT AND THERAPEUTICS RESEARCH
Despite breakthroughs in HIV treatment and prevention research,
currently, no vaccine or cure exists for HIV/AIDS. With approximately
56,300 new HIV cases each year, it is crucial that the United States
increase its commitment to research aimed at the prevention and
treatment of this disease.
The NIH is the global leader in AIDS research. It conducts research
on drug therapies, vaccines, and evidenced-based behavior and
biomedical prevention interventions. Previous breakthroughs in NIH AIDS
research include advances in antiretroviral therapy and drug regimens
that have decreased HIV-related morbidity and mortality and reduced the
risk of mother-to-child transmission of HIV. While NIH research has
significantly contributed to HIV prevention and treatment programs that
have improved the quality-of-life for many, additional and on-going
research is needed to advance existing HIV/AIDS treatments. Therefore,
Harlem United calls upon the subcommittee to allocate at least $34
billion for NIH, with $3.35 billion allocated to HIV/AIDS research.
CONCLUSION
Harlem United maintains a strong commitment to working with Members
of Congress, other community-based organizations, and stakeholders to
curtail the HIV epidemic and ensure that individuals living with HIV/
AIDS have access to quality care and treatment. By providing the fiscal
year 2010 funding levels detailed above, we believe the subcommittee
will be taking the necessary steps towards accomplishing the goals of
HIV prevention and universal access to care, ensuring that this disease
will no longer threaten our Nation.
______
Letter From The Interstitial Cystitis Association
May 22, 2009.
Hon. Tom Harkin,
Chairman, Subcommittee on Labor, Health and Human Services, and
Education, and Related Agencies, Washington, DC.
Hon. Thad Cochran,
Ranking Member, Subcommittee on Labor, Health and Human Services, and
Education, and Related Agencies, Washington, DC.
Dear Senator Harkin and Cochran: Thank you very much for your
continued leadership in advancing healthcare policy.
Interstitial cystitis (IC) is pelvic pain, pressure, or discomfort
related to the bladder typically associated with high urinary frequency
and urgency, in the absence of infection or other pathology. IC is also
called chronic pelvic pain syndrome, painful bladder syndrome (PBS),
and bladder pain syndrome (BPS).
The Interstitial Cystitis Association (ICA) is a nonprofit
organization committed to finding more effective treatments and a cure
for interstitial cystitis. ICA promotes IC research; educates the
medical community and public; advocates for IC patients, healthcare
providers and researchers; and offers support for IC patients and their
families. In this capacity the ICA requests the following funding
considerations for the fiscal year 2010 Labor, Health and Human
Services, and Education, and Related Agencies bill:
--A 7 percent increase for the National Institutes of Health (NIH)
for fiscal year 2010. A 7 percent increase will allow NIH to
continue to expand basic biomedical research on all diseases,
and take advantage of the explosion of opportunities that exist
in reducing suffering from debilitating medical disorders.
--A 7 percent increase for the National Institute of Diabetes and
Digestive and Kidney Diseases (NIDDK). NIDDK is the key NIH
agency funding research on interstitial cystitis (IC). ICA
urges that NIDDK continue to expand the research portfolio on
IC, so millions of American women and men can benefit from
advances and breakthroughs in medical care and treatments.
NIDDK supports the Multidisciplinary Approach to Chronic Pelvic
Pain clinical trial-a critical priority of ICA.
--A 7 percent increase for the NIH Office of Research on Women's
Health. Located in the NIH Office of the Director, the NIH
Office of Women's Health supports research and program
activities that contribute to the understanding of interstitial
cystitis which primarily affects women.
--$1 million for the Centers for Disease Control and Prevention (CDC)
interstitial cystitis program. A funding level of $1 million
will allow the modest expansion of IC program activities at CDC
and continue the critical CDC/ICA cooperative agreement on
public and professional awareness on interstitial cystitis.
Thank you for the opportunity to present the views of the IC
community. Please do not hesitate to contact me if there is any more
information you would like us to provide for your consideration.
Sincerely,
Barbara Gordon,
Executive Director.
______
Prepared Statement of the Infectious Diseases Society of America
The Infectious Diseases Society of America (IDSA) appreciates this
opportunity to speak in support of Federal efforts to prevent, detect,
and respond to infectious diseases in the United States and abroad as
part of the fiscal year 2010 funding cycle. IDSA represents more than
8,500 infectious diseases physicians and scientists devoted to patient
care, prevention, public health, education, and research. Our members
care for patients of all ages with serious infections, including
meningitis, pneumonia, tuberculosis (TB), antibiotic-resistant
bacterial infections such as methicillin-resistant Staphylococcus
aureus (MRSA), 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 the 2009
H1N1 virus (swine influenza) and severe acute respiratory syndrome
(SARS).
2009 H1N1 Virus (Swine Influenza)
IDSA's leadership strongly commends the administration's efforts to
date in managing and responding to the 2009 H1N1 outbreak. Of critical
importance, experts and scientists are driving key decisions. The
leadership of the Centers for Disease Control and Prevention (CDC) and
the Department of Health and Human Services (HHS) has been strong, and
their coordination with other Federal, State, and local governments is
clear. Undeniably, the investments and subsequent preparations the
country has made since the National Strategy for Pandemic Influenza was
issued in November 2005 are paying off. As the 2009 H1N1 virus outbreak
unfolds, we are witnessing firsthand the important role a robust public
health infrastructure plays in rapidly detecting and containing disease
outbreaks. Yet, additional resources are needed to adequately respond
to the 2009 H1N1 outbreak as well as to continue to prepare our Nation
for other bioemergencies.
We thank the subcommittee for providing funding for pandemic
influenza preparedness and response activities in the recent fiscal
year 2009 supplemental bill. IDSA supports a funding level of $2.05
billion to complete the funding to implement the National Strategy for
Pandemic Influenza, as well as to develop a 2009 H1N1 virus vaccine and
replenish the Strategic National Stockpile, support grants to State and
local health departments so they may adequately prepare for and respond
to the 2009 H1N1 virus and other infectious diseases outbreaks, and
provide additional funding for global pandemic preparedness activities.
IDSA further believes that funding is needed annually to adequately
maintain State and local pandemic preparedness activities. IDSA also
strongly supports strengthening funding for ongoing pandemic influenza
preparedness activities at CDC, the Food and Drug Administration (FDA),
National Institutes of Health (NIH), and HHS' Office of the Secretary.
Congress also must fully fund the Biomedical Advanced Research and
Development Authority (BARDA) within HHS so that the United States can
begin to realize goals envisioned under the Pandemic and All-Hazards
Act enacted in 2006 to address a broad spectrum of biological threats
in addition to pandemic influenza. IDSA recommends that $1.7 billion of
multi-year appropriations be allocated to BARDA in fiscal year 2010 to
fund biological therapeutics, diagnostics, vaccines, and other
technologies. Such funding would help ensure the availability of
resources throughout the stages of development and the flexibility for
BARDA to partner effectively with industry.
CDC
A strong CDC is essential to the United States' efforts to rapidly
detect and control infectious diseases as witnessed by the current H1N1
outbreak. CDC is the primary Federal agency responsible for conducting
and supporting public health protection through health promotion,
prevention, preparedness, and research. IDSA recommends increasing
funding for CDC's core programs to $8.6 billion, to enable it to
maintain a strong public health infrastructure and protect Americans
from public health threats and emergencies.
IDSA is especially concerned about CDC's Infectious Diseases
program budget, which supports critical management and coordination
functions for infectious diseases science, program, and policy,
including related specific epidemiology and laboratory activities. IDSA
recommends an fiscal year 2010 funding level of $2.7 billion for CDC's
Infectious Diseases programs.
Within the Infectious Disease programs' proposed budget, the
agency's already severely strapped Antimicrobial Resistance budget
stands at $16.9 million. This vital program is necessary to help combat
the rising tide of drug resistance, a critical medical problem marked
most publicly by the upsurge in methicillin-resistant Staphylococcus
aureus (MRSA) and other drug-resistant bacterial infections.
Antimicrobial resistance also has serious implications for our
collective response to the 2009 H1N1 virus. Viruses are unpredictable,
and should the 2009 H1N1 virus develop resistance to oseltamivir and
zamamir, our ability to respond effectively to the influenza outbreak
will significantly diminish. For these reasons, IDSA recommends
increasing fiscal year 2010 funding for resistance programs at CDC by
$48 million, to a total of $65 million. Such funding increases will
enable CDC to more effectively gather morbidity and mortality data
related to resistance, track the development of dangerous resistant
bugs as they develop, educate physicians, patients and the public about
the need to protect the long-term effectiveness of antimicrobial drugs,
and strengthen infection control activities across the United States.
This recommended level coincides well with an internal CDC professional
judgment prepared last year which, unfortunately, was not provided to
Congress.
The Emerging Infectious Diseases (EI) budget line boosts the
agency's capacity to nimbly identify and respond to emerging
infections, such as the 2009 H1N1 virus. Much of CDC's infectious
diseases funding is highly disease-targeted, making it difficult to
fund cross-cutting or emergent needs. Unique in its flexibility, the EI
line supports dozens of research and surveillance programs that address
new and unpredictable threats. Such threats have included rabies,
rotavirus, food-borne diseases, Ebola and SARS. Inadequate funding
would severely affect CDC's laboratory capacity, research grants to
academic partners, and support for State public health departments and
public health laboratories and would reduce CDC's flexibility in
setting priorities and taking action against new infections that may
emerge throughout the year. IDSA recommends, at a minimum, that the
Other Emerging Infectious Diseases line item be increased to $160
million for fiscal year 2010.
Immunizing our population against vaccine--preventable diseases is
one of our country's greatest public health achievements. Through CDC's
Section 317 Program, which funds State and local immunizations efforts,
the United States has made significant progress toward eliminating
vaccine-preventable diseases among children. IDSA applauds the actions
by the Congress over the past year to increase funding for this program
in the American Recovery and Reinvestment Act and in the fiscal year
2009 omnibus appropriations bill. At a time when new CDC-recommended
vaccines are available and a greater commitment to immunizations for
both children and adults is necessary, we need to continue to increase
access to this critical intervention that saves lives and millions of
dollars in unnecessary medical spending. To build on this important
effort, IDSA recommends a funding level for the Section 317 Program of
$802 million in fiscal year 2010.
IDSA also supports changes which will significantly strengthen the
Section 317 Program's support for adult and adolescent immunization.
Each year, more than 46,000 adults die of vaccine-preventable diseases.
Costs related to illnesses from adult vaccine-preventable diseases are
approximately $10 billion. IDSA recommends the establishment of
distinct funding floors for adult vaccine purchase and infrastructure
in amounts sufficient to cover immunization of the majority of under-
insured and uninsured adults with all CDC-recommended vaccines.
Last year, Congress passed landmark legislation in the
Comprehensive Tuberculosis Elimination Act of 2008. This bill
authorizes a number of actions that will shore up State TB control
programs, enhance U.S. capacity to deal with the serious threat of
drug-resistant tuberculosis, and escalate our efforts to develop
urgently needed ``tools,'' such as drugs, diagnostics, and vaccines.
Realizing these goals will require additional resources. At a minimum,
it is critical that the funding authorized for fiscal year 2010 in this
important law--$210 million--be appropriated for the CDC Division of TB
Elimination. The bill also separately authorized $100 million for
development of TB diagnostics, treatments and prevention tools, which
IDSA also supports for inclusion in fiscal year 2010 appropriations.
HIV prevention and surveillance activities at CDC are critical to
reducing the number of new cases occurring annually in the United
States. Sufficient resources must be devoted to HIV prevention to
support CDC's portfolio of prevention programs, including the
initiative to identify people with HIV/AIDS earlier through routine HIV
screening. This program will lead to lifesaving care sooner and will
help to prevent further transmissions. IDSA supports funding in the
amount of $1.57 billion for these programs in fiscal year 2010. We also
support funding of $2.81 billion for the Ryan White CARE Act programs
within the Health Resources and Services Administration and urge you to
increase funding for critical part C medical care by $68.4 million, to
a total of $270.3 million for part C programs. Ryan White programs
provide a vital link in our healthcare safety net and are currently
struggling to meet the need for HIV services in communities across the
country.
NIH
NIH is the single-largest funding source for infectious diseases
research in the United States and the life-source for many academic
research centers. The NIH-funded work conducted at these centers lays
the groundwork for advancements in treatments, cures, and other medical
technologies. Between 2003 and 2009, NIH lost 13 percent of its
purchasing power due to the rate of biomedical research inflation and
stagnating annual budgets. Because of the flat budget, 3 out of 4
research proposals submitted to NIH were not funded. Peer reviewers
were forced to become more risk averse, leading to a narrowing of
scientific vision and a diminishing rate of medical advancement.
Without medical advancements, thousands of Americans will have to wait
longer for the cures they need.
IDSA is extremely pleased that the recently enacted American
Recovery and Reinvestment Act provided $10 billion in additional
funding to support NIH's research efforts in 2009 and 2010. Congress
rightfully acknowledged the role of scientific research in stimulating
the economy. It is vital, however, that this long overdue increase in
funding be sustained and become part of NIH's baseline. Making this
increase permanent ultimately will translate into long-term
improvements in human health, both domestically and globally.
NIH's Fogarty International Center is at the forefront of global
health and is a leader in extending the U.S. Federal biomedical
enterprise abroad. It taps innovative thinking from all parts of the
world and fosters important scientific partnerships. Through Fogarty,
the United States has supported research and research training programs
conducted by both U.S. and foreign investigators across a wide range of
infectious diseases and needs, including HIV/AIDS, malaria, and
tuberculosis. The Center's efforts have led to improved local health
outcomes--but so much more can be done. For this reason, IDSA strongly
supports increasing Fogarty's funding level in fiscal year 2010 to $100
million--an increase of $31.3 million. These additional resources will
enable Fogarty to increase research training initiatives, forge new
partnerships between U.S. and foreign research institutions, and
conduct much-needed implementation research to increase the
effectiveness of international programs.
IDSA also urges the National Institute of Allergies and Infectious
Diseases (NIAID) at NIH to increase its antimicrobial resistance
research funding by $100 million in fiscal year 2010, bringing overall
funding in this area to $271 million. This will allow NIAID to
strengthen clinical research and establish a clinical trials network to
study resistant infections as well as antibacterial use and
development. Well-designed, multi-center, randomized, controlled trials
would create an excellent basis of evidence from which coherent and
defensible recommendations could be developed.
FDA
Additionally, in the Agriculture Appropriations bill, IDSA supports
a strengthening of antimicrobial resistance efforts at FDA.
Specifically we support a $20 million increase in antimicrobial
resistance funding for FDA in fiscal year 2010, bringing the agency's
resistance funding to $44 million. This will allow FDA to establish and
periodically update antibiotic susceptibility breakpoints based on
testing and data collection, including through the purchase of vendor
data; fund Critical Path initiatives for antibiotics; more aggressively
review the safety of antibiotic use in food animals; and quicken its
pace in developing critical guidance for industry on antibiotic
clinical trial designs.
Today's investment in infectious diseases research, prevention, and
treatments will pay significant dividends in the future by dramatically
reducing healthcare costs and improving the quality of life of millions
of Americans and others. It also will continue to enable Federal
agencies to respond effectively and efficiently to the 2009 H1N1 virus
and other potentially devastating outbreaks.
______
Prepared Statement of the International Foundation for Functional
Gastrointestinal Disorders
SUMMARY OF RECOMMENDATIONS FOR FISCAL YEAR 2010
Provide a funding increase of at least 7 percent for the National
Institutes of Health (NIH) and its Institutes and Centers.
Urge the National Institute of Diabetes and Digestive and Kidney
Diseases (NIDDK) to prioritize and implement the recently released
research recommendations of the National Commission on Digestive
Diseases.
Urge NIH And NIDDK to expand the research portfolio on functional
gastrointestinal and motility disorders, such as Irritable Bowel
Syndrome (IBS).
Thank you for the opportunity to present this written statement
regarding the importance of functional gastrointestinal and motility
disorders research.
Since our establishment in 1991, the International Foundation for
Functional Gastrointestinal Disorders (IFFGD) has been dedicated to
increasing awareness of functional gastrointestinal and motility
disorders among the public, health professionals, and researchers. We
also work to bolster digestive disease research and generate new
treatment option for patients. For example, IFFGD worked with the
NIDDK, the National Institute of Child Health and Human Development
(NICHD), and the Office of Medical Applications of Research (OMAR) to
facilitate an NIH State-of-the-Science Conference on the Prevention of
Fecal and Urinary Incontinence in Adults, which was held in December of
2007. Furthermore, I served on the National Commission on Digestive
Diseases (NCDD) which recently released a long-range road map for
digestive disease research, entitled Opportunities and Challenges in
Digestive Diseases Research: Recommendations of the National Commission
on Digestive Diseases
The majority of diseases and disorders we address have no cure and
treatment options are often limited. We have yet to completely
understand the mechanisms 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
medical and indirect costs associated with these diseases are enormous;
estimates range from $25 billion-$30 billion annually. Economic costs
spill over into the workplace, and are reflected in work absenteeism
and lost productivity. Furthermore, the human toll is not only on the
individual but also on the family. In essence, these diseases account
for lost opportunities for the individual and society.
IBS
IBS strikes people from all walks of life. It affects 30 million 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 diarrhea and/or constipation. Although
the cause of IBS is unknown, we do know that this disease needs a
multidisciplinary approach in research and treatment.
IBS can be emotionally and physically debilitating. Due to
persistent pain and bowel unpredictability, individuals who suffer from
this disorder may distance themselves from social events, work, and
even may fear leaving their home.
Numerous research recommendations regarding IBS were included as
components of the NCDD's Long-Range Research Plan for Digestive
Diseases. For fiscal year 2010, IFFGD urges Congress to review the
NCDD's Report, and provide NIH and NIDDK with the resources necessary
to adequately implement the plan's recommendations.
FECAL INCONTINENCE
At least 12 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, IFFGD sponsored a consensus conference entitled,
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 including more comprehensive identification of quality
of life issues; improved diagnostic tests for affecting management
strategies and treatment outcomes; development of new drug treatment
compounds; development of strategies for primary prevention of fecal
incontinence associated with childbirth; and attention to the process
of stigmatization as it applies to the experience of individuals with
fecal incontinence.
In December 2007, IFFGD collaborated with NIDDK, NICHD, and OMAR on
the NIH State-of-the-Science Conference on the Prevention of Fecal and
Urinary Incontinence in Adults. The goal of this conference was 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.
For fiscal year 2010, IFFGD urges Congress to review the Conference's
Report and provide NIH with the resources necessary to effectively
implement the report's recommendations.
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. Sometimes there are no apparent symptoms, and the presence of
GERD is revealed when complications become evident. One uncommon but
serious 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. Nonetheless, treatment response
varies from person to person, is not always effective, and long-term
medication use and surgery expose individuals to risks of side-effects
or complications.
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 delayed gastric emptying, 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 symptom severity.
CYCLIC VOMITING SYNDROME
Cyclic vomiting syndrome (CVS) is a disorder with recurrent
episodes of severe nausea and vomiting interspersed with symptom-free
periods. The periods of intense, persistent nausea, vomiting, and other
symptoms (abdominal pain, prostration, and lethargy) lasts hours to
days. Previously thought to occur primarily in pediatric populations,
it is increasingly understood that this crippling syndrome can occur in
a variety of age groups including adults. Patients with these symptoms
often go for years without correct diagnosis. The condition leads to
significant time lost from school and from work, as well as substantial
medical morbidity. The cause of CVS is not known. Better understanding,
through research, of mechanisms that underlie upper gastrointestinal
function and motility involved in sensations of nausea, vomiting and
abdominal pain is needed to help identify at risk individuals and
develop more effective treatment strategies.
SUPPORT FOR CRITICAL RESEARCH
IFFGD urges Congress to provide the necessary funding for the
expansion of the research activities at NIDDK and the Office of
Research on Women's Health (ORWH) regarding functional gastrointestinal
disorders and motility disorders. Additional funding will allow
necessary growth of the research portfolios on functional
gastrointestinal disorders and motility disorders at NIDDK and ORWH,
and also facilitate implementation of the NCDD's research
recommendations.
Recent years of near level-funding at NIH have negatively impacted
the mission of its Institutes and Centers. For this reason, IFFGD
applauds initiatives like Senator Arlen Specter's (R-PA) successful
effort to provide NIH with $10.4 billion in stimulus funds. IFFGD urges
this subcommittee to show strong leadership in pursuing substantial
funding increase through the regular appropriations process in fiscal
year 2010.
For fiscal year 2010, IFFGD recommends a funding increase of at
least 7 percent for NIH and its Institutes and Centers.
______
Prepared Statement of the International Myeloma Foundation
The International Myeloma Foundation (IMF) appreciates the
opportunity to submit written comments for the record regarding fiscal
year 2010 funding for myeloma cancer programs. The IMF is the oldest
and largest myeloma foundation dedicated to improving the quality of
life of myeloma patients while working toward prevention and a cure.
To ensure that myeloma patients have access to the comprehensive,
quality care they need and deserve, the IMF advocates on-going and
significant Federal funding for myeloma research and its application.
The IMF stands ready to work with policymakers to advance policies and
programs that work toward prevention and a cure for myeloma and for all
other forms of cancer.
MYELOMA BACKGROUND
Myeloma is a cancer in the bone marrow affecting production of red
cells, white cells, and stem cells. It is also called ``multiple
myeloma,'' because multiple areas of bone marrow may be involved.
Myeloma is the second most common blood cancer after lymphomas,
affecting an estimated 750,000 people worldwide and its prevalence
appears to be is increasing significantly.
No one knows the exact causes of myeloma. Doctors can seldom
explain why one person develops this disease and another does not.
Research has shown that people with certain risk factors such as age
and race are more likely than others to develop myeloma. Growing older
increases the chance of developing multiple myeloma as most people with
myeloma are diagnosed after age 65. However, in recent years the
diagnosis of myeloma in people 40 years of age and younger appears to
have become more common as our ability to detect and diagnose this
disease has improved. The risk of myeloma is highest among African
Americans and lowest among Asian Americans.
Scientists are studying other possible risk factors for myeloma.
Toxic chemicals (for example, agricultural chemicals and Agent Orange
used in Vietnam), radiation (including atomic radiation), and several
viruses (including HIV, hepatitis, herpes virus 8, and others) are
associated with an increased risk of myeloma and related diseases.
According to the American Cancer Society, 19,920 Americans were
expected to be diagnosed with myeloma and 10,690 would lose their
battle with this disease in 2008. Even while they live with the
disease, myeloma patients can suffer debilitating fractures and other
bone disorders, severe side effects of their treatment, and other
problems that profoundly affect their quality of life, and
significantly impact the cost of their healthcare. Despite these grim
statistics, significant gains in the battle against myeloma have been
made through our Nation's investment in cancer research and its
application. Research holds the key to improved myeloma prevention,
early detection, diagnosis, and treatment, but such breakthroughs are
meaningless unless we can deliver them to all Americans in need.
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). The IMF
advocates $33.3 billion for NIH in fiscal year 2010. 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. Myeloma
research is producing extraordinary breakthroughs--leading to new
therapies that translate into longer survival and improved quality of
life for myeloma patients. Although myeloma was once considered a death
sentence with limited options for treatment, myeloma is an example of
the progress that can be made and the work that still lies ahead in the
war on cancer. Many myeloma patients are living proof of what
innovative drug development and clinical research can achieve--
sequential remissions, long-term survival and good quality of life. But
these achievements are not a substitute for a cure and therefore the
IMF calls upon Congress to allocate $6 billion to the National Cancer
Institute in fiscal year 2010 to continue our battle against myeloma
and its sequelae.
BOOST OUR NATION'S INVESTMENT IN MYELOMA PREVENTION, EARLY DETECTION,
AND AWARENESS
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, the IMF joins with our partners in the cancer community--
including One Voice Against Cancer--in calling on Congress to provide
additional resources for the CDC to support and expand much-needed and
proven efforts in such areas as cancer prevention, early detection, and
risk reduction. Specifically, the IMF advocates the appropriation of
$471 million in fiscal year 2010 for CDC's cancer prevention and
control initiatives.
Within that allocation, the IMF specifically advocates $6 million
for the Geraldine Ferraro Blood Cancer Program. Authorized under the
Hematological Cancer Research Investment and Education Act of 2002,
this program was created to provide public and patient education about
blood cancers, including myeloma.
With grants from the Geraldine Ferraro Blood Cancer Program, the
IMF has successfully promoted awareness of myeloma, particularly in the
African-American community and other underserved communities. IMF
accomplishments include the production and distribution of more than
4,500 copies of an informative video which addresses the importance of
myeloma awareness and education in the African-American community to
churches, community centers, inner-city hospitals, and Urban League
offices around the country, increased African-American attendance at
IMF Patient and Family Seminars (these seminars provide invaluable
treatment information to newly diagnosed myeloma patients), increased
calls by African-American myeloma patients, family members, and
caregivers to the IMF myeloma hotline, and the establishment of
additional support groups in inner city locations in the United States
to assist underserved areas with myeloma education and awareness
campaigns. Furthermore, the more than 90 IMF-affiliated patient support
groups in the United States also made this effort their main goal
during ``Myeloma Awareness Week'' in October 2005.
An allocation of $6 million in fiscal year 2010 will allow this
important program to continue to provide patients--including those
populations at highest risk of developing myeloma--with educational,
disease management and survivorship resources to enhance treatment and
prognosis.
\
CONCLUSION
The IMF stands ready to work with policymakers to advance policies
and support programs that work toward prevention and a cure for
myeloma. Thank you for this opportunity to discuss the fiscal year 2010
funding levels necessary to ensure that our Nation continues to make
gains in the fight against myeloma.
______
Prepared Statement of the Jeffrey Modell Foundation
Thank you for the opportunity to present to you our testimony
concerning the activities of the Jeffrey Modell Foundation (JMF)
dedicated to Primary Immunodeficiency (PI). As you know, most of our
programs are conducted in partnership with various governmental
agencies under the jurisdiction of this subcommittee. We very much
appreciate the support, generosity, and kindness of spirit that we have
received from the members and staff of this subcommittee and look
forward to continuing to work together closely in the future.
As a baseline, Mr. Chairman, please let me make clear the following
four fundamental points:
--JMF programs always include our own investment of funds and
resources, thereby assuring accountability.
--JMF programs improve patients' quality of life issues through
prevention and earliest possible diagnosis.
--JMF programs, therefore, lower healthcare costs.
--JMF programs save lives as demonstrated in the 2008 Wisconsin
newborn screening program.
All of the data concerning the impact of the education and
awareness program that this subcommittee has long supported has been
published in a leading scientific journal, ``Immunologic Research'',
Humana Press, January 13, 2009 and is entitled, ``From Genotype to
Phenotype. Further Studies Measuring the Impact of a Physician
Education and Public Awareness Campaign on Early Diagnosis and
Management of Primary Immunodeficiencies''.
PHYSICIAN EDUCATION AND PUBLIC AWARENESS CAMPAIGN ON PRIMARY
IMMUNODEFICIENCIES
Five years ago, Mr. Chairman, this subcommittee set us on a path to
work with the Centers for Disease Control and Prevention (CDC) to
create a physician education and public awareness program. Today, that
program has far exceeded even our most optimistic dreams.
JMF has now generated more than $100 million in donated media from
television, radio, print, Web site, airport, and mall dioramas. This
translates to more than $18 million annually and represents $7 donated
to support this campaign for every $1 of Government support
appropriated by this subcommittee. But all that visibility would be
meaningless if there were not real impact on the health of these
patients. And, there are.
The number of patients referred, tested, diagnosed, and treated has
more than doubled every year for the past 5 years in which the campaign
has been conducted.
The Jeffrey Modell Centers Network of Research, Diagnostic and
Referral Centers now include 304 physicians, from 138 academic teaching
hospitals and medical schools. Twenty-three of the 30 ``Best Pediatric
Hospitals'' in the United States are designated Jeffrey Modell Centers.
The physician-experts at these centers have provided JMF with data on
more then 30,000 patients. And we can now pinpoint the specific
disease, where the patient is treated, who is treating the patient, and
how the patient is treated. This data can make an enormous contribution
to registries not only in the United States, but on a global platform.
After diagnosis and treatment, physicians reported annual decreases
of more than 70 percent in the number of severe infections, physician,
hospital, and emergency room visits, pneumonias, school/work days
missed, days in hospital, acute infections, and days with chronic
infections.
The consequences of these changes in patient outcomes were assigned
economic values. JMF's published study drew from the hospital
accounting reports at the Centers for Medicare and Medicaid services.
The specific hospital charges and length of stay data was obtained from
the Hospital Cost and Utilization Project, Nationwide In-patient
Sample, under the auspices of the Agency for Healthcare Research and
Quality.
The study showed that each undiagnosed patient costs the healthcare
system $102,736 annually in emergency room visits, hospitalizations,
and medical treatment for severe complications. It costs $22,696
annually to treat patients after they have been diagnosed-a savings of
more than $80,000 per patient per year.
The National Institutes of Helath (NIH) states that ``while
individual primary immunodeficiency diseases are somewhat rare,
affecting 500,000 Americans, this group of diseases may affect 1-2
percent of the U.S. population or 3 million-6 million Americans.''
Using the most conservative estimate, the minimum cost to the U.S.
healthcare system for undiagnosed PI patients is more than $40 billion
annually. Ensuring that these patients are properly diagnosed makes
enormous economic sense, not to mention their improved quality of life.
RESEARCH COLLABORATION WITH NIH
JMF established a $12 million research partnership with four of the
U.S. National Institutes of Health. The RO1 research grants solicit
investigations on Primary Immunodeficiency (PI) diseases. JMF also
established the Robert A. Good/Jeffrey Modell International Fellowship
Program, funding the brightest young investigators from around the
world, focused on PI and stem cell transplantation. JMF awarded 4
Fellowships in 2008 under this program.
Finally, in 2008, JMF established Endowed Chairs in Pediatric
Immunology Research at Children's Hospital Boston, Children's Hospital
Seattle, as well as the Jeffrey Modell Endowed Fellowship in Immunology
Research at the University of Washington.
NEWBORN SCREENING FOR PRIMARY IMMUNODEFICIENCIES
JMF and the State of Wisconsin launched the first newborn screening
program for Severe Combined Immune Deficiency. Since January 2008,
every baby born in the State of Wisconsin has been screened. The T Cell
Receptor Excision Circles assay was utilized and the screening test
identified a patient with a combined immunodeficiency disease. The baby
received a life-saving bone marrow transplant. The screening protocol
has picked up several other newborns with life threatening disorders
including Complete Di George Syndrome, T-Cell lymphopenia, and a
disorder where white blood cells are unable to migrate to sites of
infection. We anticipate that Massachusetts, Illinois, Connecticut,
Texas, and New York will move forward with pilot programs in 2009.
At this date, the cost to screen for these life threatening
diseases is $5 per child. It is anticipated that this cost will
decrease. There are approximately 4 million newborns per year in the
United States. Thus, the outside cost to screen every newborn in the
United States is estimated to be less than $20 million.
SPIRIT--SOFTWARE FOR PRIMARY IMMUNODEFICIENCY RECOGNITION INTERVENTION
AND TRACKING
JMF brought its 2008 data to the annual meeting of the Managed Care
Network (MCN). Senior executives and medical directors of private and
Medicare/Medicaid health plans nationwide, as well as the leadership of
pharmacy groups representing more than 150 million covered lives,
attended the 2-day meeting. JMF was asked to develop an early warning
system software program matching the ICD-9 codes to the 10 Warning
Signs and Physician Algorithm. This software, known as SPIRIT, is now
in development and will be piloted with National managed care carriers
during 2009. The software protocol is being developed by JMF and its
Medical Advisory Board, and the technology will be produced by Xcenda,
a division of AmeriSource Bergen Corporation. Besides the listing of
the ICD-9 codes, the program assigns relative weights for each code,
identifies each code as a chronic or acute condition, and provides
specific exclusion criteria.
SUMMARY
Mr. Chairman, I hope you will agree that the many programs run by
the Jeffrey Modell Foundation are a ``perfect fit'' with the announced
approach to reforming healthcare articulated by the President and
currently being addressed by this Congress. Specifically we have
focused our attention on:
--Prevention through physician education and public awareness;
--Quality of care through the JMF Network of specialized centers;
--Control of healthcare costs through early diagnosis and Newborn
Screening; and
--Use of technology to streamline records and generate electronic
data though new software developed by JMF for third-party
payers.
For fiscal year 2010, we bring you what we consider to be a very
modest agenda:
--We ask for no new appropriations or programs from the subcommittee.
--We ask for continuation of the successful programs that we are now
operating.
--We ask for Government encouragement and support for these programs.
In exchange, we can assure you that we will continue to contribute
our own funds to every program with which we are involved. We will
continue to operate these programs by fully exercising good management
and ever-cognizant of our responsibilities to this subcommittee and to
the taxpayers who have supplied the funds that you pass on to us.
Mr. Chairman, we are at a critical time in our Nation's healthcare
history. JMF is proud of the contributions we have made to the
healthcare system and look forward to continuing to work with you and
with all members of Congress to continue to serve the American people.
______
Prepared Statement of the Mentor Consulting Group
``It must not for a moment be forgotten that the core of any
social plan must be the child.''
President Franklin
Roosevelt
U.S. Committee on
Economic Security,
Report to the
President, 1935
Senator Harkin and distinguished members of the subcommittee:
Mentor Consulting Group (MCG) is pleased to submit testimony for the
outside witness record to ask the subcommittee to direct its attention
to the President's fiscal year 2010 proposed budget recommendation
calling for the elimination of the U.S. Department of Education's (ED)
mentoring program. MCG is seeking your help in restoring the funding
for this important and much needed program to enable agencies from
Storm Lake, Iowa, to McAllen, Texas, from Rhinelander, Wisconsin to
Starkville, Mississippi, to continue supporting match relationships for
a third year.
It is our understanding that the cost of restoring the third year
of funding for 2008 mentoring program grantees is estimated at $17
million.
Mentoring is fundamentally predicated on creating healthy and
meaningful relationships for youngsters who are in jeopardized
circumstances with respect to their potential for achieving long-term
educational and socio-emotional success. Research demonstrates that
youth who successfully transition from risk-filled backgrounds to
responsible adulthood are consistently distinguished by the presence of
a caring adult in their lives. Prematurely ending matches, such as
those that have been recently established through the mentoring program
grants, can be potentially harmful to mentees. MCG strongly urges the
subcommittee to prevent this possibility from turning into a tragic
reality for thousands of vulnerable children.
The ED mentoring program, authorized under the No Child Left Behind
Act (NCLB) of 2002, section 4130, is a competitive Federal grant
program managed by the Office of Safe and Drug Free Schools (OSDFS). It
addresses the lack of supportive adults at critical turning points in
the lives of youngsters in grades 4-8. The funding supports mentoring
programs operating in local education agencies (LEAs); nonprofit
community- and faith-based organizations; and partnerships between LEAs
and local nonprofits. Funded programs are designed to:
--improve interpersonal relationships with peers, teachers, family
members, and other adults;
--increase personal responsibility and community involvement;
--discourage the use of drugs and alcohol;
--discourage the use of weapons;
--reduce delinquency;
--improve academic achievement; and,
--reduce school dropout.
Since 2004, MCG has worked on-site with 57 ED mentoring program
grantees serving in the capacity of overall technical assistance
provider, e.g., mentor/mentee training, mentor recruitment, marketing,
sustainability planning, and/or as the external evaluator. Our client
sample is rich with diversity both with respect to the size and scope
of their grants, e.g., we work with the agency receiving the smallest
of the 2008 awards, as well as their experience in operating a formal
mentoring program. Another of our clients, also a 2008 grantee, is
among the 30 largest school districts in Texas and is working with 17
partnering school campuses. This grantee exceeded their 1 to 1 match
goal of 150 matches before the end of the first year of the grant. The
potential impact on 150 youngsters, in this one community alone, should
this program be eliminated, is unimaginable.
A key ``lesson learned'' based on our experience with all of these
clients is that the complexities of operating a mentoring program
cannot be overstated. Building safe and secure relationships between
youngsters and caring adults requires the attention and involvement of
trained, committed, and competent staff who understand the quality
assurance standards of the mentoring field.
Beyond the potential benefits for the youth, the ED mentoring
program has enabled grantees to forge strategic community partnerships
between concerned citizens and multiple youth serving organizations to
maximize the use of community resources. Also negatively affected by
this proposed termination of funds is those staff hired to work with
the ED mentoring program who have worked diligently over the past 13
months to introduce and promote these programs in their community and
to build these vital new mentor/mentee relationships. Premature
termination of this grant program would, of course, force layoffs in
110 communities across the country. By contrast, the economic stimulus
package is working hard to counter just such layoffs.
Research over the past decade has demonstrated that mentoring is a
viable intervention strategy that holds considerable promise. Studies
of structured mentoring programs, including those that have received
Federal funding, suggest that the programs are likely to be more
successful when they include a strong infrastructure and facilitate
caring relationships. Infrastructure refers to a number of activities
including identifying the youth population to be served and the
activities to be undertaken, screening and training mentors, supporting
and supervising mentoring relationships, collecting data on youth
outcomes, and creating strategies for long-term sustainability. (Ref.
Jean Balwin Grossman, ed., Contemporary Issues in Mentoring, Public/
Private Ventures, p.6). The ED mentoring program is providing much
needed funding to ensure the integrity of the requisite infrastructure
and facilitation of caring relationships in programs that would
otherwise be severely marginalized.
Another signal research finding is that mentoring relationships are
likely to promote positive outcomes for youth and avoid harm when they
are close, consistent, and enduring. (Ref. Rhodes and DuBois,
``Understanding and Facilitating the Youth Mentoring Movement,'' p. 9).
Closeness is the bond that is created between the youth and mentor. The
characteristics of the volunteer mentors (no mentors in ED mentoring
program matches are able to be remunerated) have also proven to be
important in shaping the relationships and strengthening the bond. For
example, individuals with prior experience in helping roles or
occupations, an ability to understand and respect cultural differences,
and an overall sense of commitment to mentoring all appear to
contribute positively to the relationship and overall match quality.
Further, it appears that relationships may be especially beneficial
when they remain part of the youth's life for multiple years (Klaw,
Fitzgerald & Rhodes, 2003: McLearn et al., 1998) and have the
opportunity to facilitate adaptation throughout significant portions of
their development (DuBois & Silverthorn, 2005b; Werner, 1995). These
findings are of particular importance to the 4th through 8th grade
population served by the ED mentoring program.
The ED mentoring program garnered national attention recently
following publication of the Impact Evaluation of the U.S. Department
of Education's Student Mentoring Program report prepared by Abt
Associates for the Institute of Education Sciences (March 2009). ED
contracted with Abt in 2005 to conduct the study which used an
experimental design in which students were randomly assigned to a
treatment or control group. The study involved 32 ED Mentoring Program
grantee sites that were funded beginning in 2004 or 2005. Grantees
selected for participation in the Impact Study were required to meet
three criteria:
--Be operational so that it could recruit and match students to
mentors in the fall of 2005 for the first group of grantees and
fall 2006 for the second group;
--Able to oversubscribe or identify excess demand supporting
experimental study needs for an unserved control group (i.e.,
able to provide tangible evidence of a pool of 4th through 8th
grade students referred to the mentoring program) of adequate
size to support study requirements; and
--Willing and able to cooperate with the data collection and
logistical needs of the national evaluation, including random
assignment.
While the findings of the impact evaluation study are indeed mixed,
MCG is encouraged that this study has captured several of the inherent
challenges that often confront early cohorts of federally funded
mentoring initiatives. This study contributes to the growing body of
research evidence, however, the field warrants additional comparative
evaluation studies that look at different program models. Each and
every cohort of a federally funded initiative should be evaluated and
this study helps to make that very point. More recently funded ED
mentoring program grantees, including those in 2008, have had the
benefit of an expanded comprehensive technical assistance package that
includes conference trainings, webinars, resource materials (available
online), and site visits designed to help program coordinators with all
aspects of program implementation, data tracking, and operation. In
addition, grantees are now trained on specific aspects of program
sustainability.
In closing, we would like to share with you a comment from a mentee
who met with us during a recent site visit. When asked what having a
mentor meant to him, Isaiah, a fourth grade student replied, ``Having a
mentor has been the best thing that has happened to me in my whole
life.''
MCG fully acknowledges and appreciates the widespread economic and
social challenges facing our country at this time. However,
reinstatement of the ED mentoring program funding in the 2010 budget is
a clarion call for moral policymaking.
That call is befitting of your role as members of this august body
and will ensure that youngsters like Isaiah will one day achieve their
full potential and enjoy their opportunity to sit as a distinguished
member of Congress.
Thank you for the opportunity to submit this testimony.
______
Prepared Statement of the Montgomery County Stroke Association
I am Flora Ingenhousz, a psychotherapist in private practice in
Silver Spring, Maryland. I have always been in excellent health and
live an active, healthy lifestyle. Doctors always commented on my low
blood pressure and my excellent cholesterol numbers. But I suffered a
stroke 3 years ago. It was a shock to me and my family, friends, and
clients.
One morning 3 years ago, when doing a load of laundry, I had no
idea how to set the dials, despite the fact that I had used them weekly
for the last 10 years. I stood there for what seemed an eternity before
I figured out how to set the dials.
Next, I went to do yoga. In one of the poses, I noticed my right
arm was hanging limp. When my husband asked me a question, my answer
was just the opposite of what I wanted to say. I caught my error and
tried again, but it soon became clear that something was wrong. My
symptoms kept getting worse.
When we walked into the emergency room (ER), my right leg was weak,
and I could not sign my name at the desk. Twelve hours later, I could
not move my right side, and my speech was reduced to ``yes'' and
``no''. Not a good thing for a psychotherapist, where language is a
primary tool.
In the emergency room, a CT scan showed a hemorrhagic or bleeding
stroke where an artery burst, destroying millions of brain cells within
minutes, affecting my speech and my ability to perform activities like
dressing in the correct order. Also, my right arm and leg were
extremely weak. However, I could understand everything, and I was never
completely paralyzed. But, I was scared.
I was in intensive care for 4 days of observation and lots of
testing, but the tests provided no answers. Two days after my stroke,
while still in intensive care, I started occupational, physical, and
speech therapy. It was extremely challenging to feed myself with my
right hand, requiring all my concentration. After a meal or brushing my
teeth, I was exhausted. Speaking was the hardest of all. My brain
seemed devoid of words.
After being stabilized, I was transferred to the National
Rehabilitation Hospital. For a week, I endured speech, physical,
occupational and recreational therapies.
Speech therapy was the hardest, but also the most important given
my profession. Several times, the speech therapist challenged me to the
brink of tears.
After a week at the Rehabilitation Hospital, I went home and to
outpatient therapies. Speech therapy lasted the longest. After being
discharged from speech therapy, I still had deficits in my
organizational skills and abstract thinking.
As I struggled with starting to see my clients again, I slid into a
deep depression. I was not confident that I could continue to practice.
For months, I saw no point in living. Recovery from my poststroke
depression was harder than the recovery of my arms and legs and even
speech.
Being a psychotherapist, I know how to treat depression, so I went
to a psychiatrist who prescribed anti-depressant medication and, I also
found a psychotherapist.
After months on anti-depressants and excellent psychotherapy, my
depression began to lift. I continue on the drugs and to see my
psychotherapist. Emotionally, the aftermath of my stroke cut deep.
I am fortunate that 3 years poststroke, I am back to my practice
full time. I lead support groups for stroke survivors and caregivers
through the Montgomery County Stroke Association and served on its
Board. I now lecture on stroke, stroke prevention and stroke recovery.
I founded ``hope for stroke''--individual and family counseling for
stroke survivors and caregivers. And I have developed, together with a
colleague, a seminar for professionals in the stroke field on the role
of mental health providers in stroke recovery. In addition, I have
participated in a National Institutes of Health (NIH) study about
stroke recovery.
Once again, I am in excellent health and have resumed my active
lifestyle. I thank my brain for having the capacity to work around the
dead cells. But most of all, I thank my therapists for my recovery.
Their ability to zero in so effectively would not have been possible
without NIH research.
Because stroke is a leading cause of death and disability and major
cost to society, I urge you to provide stroke research with a
significant funding increase. I am concerned that NIH continues to
invest only 1 percent of its budget in stroke research.
Thank you.
______
Prepared Statement of MENTOR
Chairman Harkin and Ranking Member Cochran, we thank you for the
opportunity on behalf of MENTOR to submit written testimony in support
of resources for youth mentoring.
Primarily, this includes $100 million in Federal funding for youth
mentoring--$50 million for the Department of Health and Human Services'
Mentoring for Children of Prisoners program and $50 million for the
Department of Education's Mentoring Programs grants. MENTOR has
appreciated the support of the subcommittee in previous years, in
funding these programs at these levels since fiscal year 2004.
Mentoring has been recognized as an important form of service by
the Obama administration and the 111th Congress, given its inclusion in
several portions of the recently signed Edward M. Kennedy Serve America
Act. The act, in its wide-ranging call to significantly increase
service opportunities, will also augment the pool of volunteers who can
become mentors to young people.
We would like to appeal that the Serve America Act be fully funded
in fiscal year 2010 to ensure that this historical boost in national
and community service is allowed to occur. We also are recommending
that Congress continue to provide $50 million each for the U.S.
Department of Education Mentoring Programs grants and the U.S.
Department of Health and Human Services' Mentoring for Children of
Prisoners program.
Background on MENTOR and Youth Mentoring.--MENTOR is the Nation's
leading advocate and resource for mentoring, delivering the research,
policy recommendations, advocacy, and practical performance tools that
facilitate the expansion of mentoring initiatives. We believe that,
with the help and guidance of an adult mentor, each child can unlock
his or her potential.
For nearly two decades, MENTOR has worked to expand the world of
quality mentoring. In cooperation with a national network of Mentoring
Partnerships and with more than 4,100 mentoring programs nationwide,
MENTOR helps connect young Americans who want and need caring adults in
their lives with the power of mentoring.
We build the infrastructure that enables mentoring programs to
flourish, and we leverage resources and provide tools that local
mentoring programs need to operate high-quality mentoring. We also
assist mentoring programs nationwide in building greater awareness of
the need for mentors, and raising the profile of mentoring among
corporate leaders, foundation executives, policymakers and researchers.
Three million young people are currently benefiting from the
guidance of caring adult mentors under our system. And through the
combined efforts of the mentoring field, we seek to close the mentoring
gap so that the 15 million children who currently need mentors also can
benefit from caring mentors.
It is on behalf of these 4,100 mentoring programs, the national
network of mentoring partnerships and 15 million children who need
mentors all across our country that we submit this testimony today.
Benefits of Mentoring.--Youth mentoring is a simple, yet powerful
concept: an adult provides guidance, support and encouragement to help
a young person achieve success in life. Mentors serve as role models,
advocates, friends and advisors.
Mentoring today offers many options--the traditional one-to-one
format, team and group mentoring, peer mentoring, and even online
mentoring. And mentoring programs are run by nonprofit community-based
organizations, schools, faith-based organizations, local government
agencies, workplaces, and more.
Numerous program evaluations have demonstrated that high-quality
mentoring relationships can lead to a range of positive outcomes. A
meta-analysis of 55 mentoring program evaluations found benefits of
participation in the areas of emotional/psychological well-being,
involvement in problem/high-risk behavior and academic outcomes.
Looking at a broader range of outcomes, conducted a meta-analysis of 40
youth mentoring evaluations, and found that youth in mentoring
relationships fared significantly better than nonmentored youth.
Likewise, a recent, large randomized evaluation of Big Brothers Big
Sisters of America's newer, school-based mentoring revealed
improvements in mentored youth's academic performance, perceived
scholastic efficacy, school misconduct, and attendance relative to a
control group of nonmentored youth. In short, mentoring is an effective
strategy that addresses both the academic and nonacademic needs of
struggling young people. It can help ensure that students come to
school and are ready and able to learn.
HIGH-QUALITY MENTORING GENERATES THE STRONGEST IMPACT
Like any youth-development strategy, mentoring works best when
measures are taken to ensure quality and effectiveness. Money,
personnel and resources are required to initiate and support quality
mentoring relationships. The average per-child expenditure for a
mentoring match that adheres to The Elements of Effective Mentoring
PracticeTM--the mentoring industry standard--is between
$1,000 and $1,500 per year, depending on the program model.
Successful mentoring programs must have well-trained staff familiar
with the needs of the community. One-third of mentoring programs
indicate that hiring and retaining quality staff can be a challenge due
to low salaries. A recruitment campaign must be conducted to attract
volunteers, as many programs have young people on their waiting lists
for mentors.
Program staff must interview each potential volunteer, check
references, and perform criminal background checks. Thorough background
checks alone can cost as much as $50-$90 per volunteer. Once the
screening process is complete, each mentor must receive first-rate
training before being matched with a mentee. The work of the mentoring
program does not end with the first meeting of the mentor and young
person--both require ongoing support, monitoring, and guidance.
All of these elements are critical because research clearly links
program quality with positive outcomes. According to Dr. Jean Rhodes,
professor of psychology at University of Massachusetts at Boston,
careful screening, training and ongoing support are essential to the
longevity of mentoring relationships and to the ultimate success of
mentoring relationships.
Rhodes also found that the longer a mentoring relationship lasts,
the greater the positive, long-lasting effect it has on a young person.
Other researchers in the field have substantiated her findings. In
essence, when properly prepared and supported, a mentor is more likely
to connect with the young person and to stick with the relationship
when times get hard.
Need for Federal Dollars.--The mentoring field needs continued
access to Federal funds if we are to be able to serve more children,
and serve them well. Once again, America has a wide mentoring gap of
nearly 15 million young people. The demand for mentoring far exceeds
the current capacity of local mentoring programs and the number of
adults who volunteer as mentors, and thousands of children sit on
waiting lists for mentors. As noted above, it takes financial resources
to be able to adhere to mentoring best practices and provide quality
mentoring experiences to young people.
Since fiscal year 2004, Congress has devoted approximately $100
million annually for youth mentoring, split evenly between two critical
grant programs:
--Department of Education, Mentoring Programs Grants.--These grants
go to local mentoring organizations to establish or expand
their mentoring program. It can support recruiting, screening,
and training of mentors, as well as hiring and professional
development of mentoring coordinators and support staff.
Community-based organizations, faith-based organizations, and
schools are eligible to apply for funding.
--Department of Health and Human Services, Mentoring for Children of
Prisoners.--This program provides funding to organizations that
match mentors with young people whose parents are incarcerated.
It also is open to community-based and faith-based
organizations.
Both of these programs provide much-needed Federal dollars to help
mentoring programs get established or to expand to serve more children.
Both programs are competitive grant programs, with all funding being
awarded to local organizations. The request for proposals for both
programs require applicants to detail how they will be able to carry
out key mentoring best practices. Since 2004, coinciding with this
significant increase in Federal support, we have seen the number of
young people in mentoring relationships grow from 2.5 million to the
current level of 3 million. Clearly, this funding is having an impact
on the mentoring gap.
President Obama stated in remarks about his fiscal year 2010 budget
February 26, 2009, ``Education Secretary Duncan is set to save tens of
millions of dollars more by cutting an ineffective mentoring program
for students, a program whose mission is being carried out by 100 other
programs in 13 other agencies.'' Once again, we are not certain that
this means the total elimination of school-based mentoring programs in
the Department of Education, but even in the absence of a detailed
budget justification, we feel that comment is warranted.
We understand that this decision may rest in large part on a recent
evaluation that showed that school-based mentoring, as practiced by
many programs around the country, failed to increase grades or test
scores. However, just 2 years ago, another rigorous evaluation of
school-based mentoring found that teachers reported the quality of the
mentored students' school work improved.
To understand these apparently contradictory findings, it is
important to note that the earlier evaluation answered the question,
``What effect does a well-run, school-based mentoring program have?''
The more recent evaluation answered the question, ``What effect does
the average school-based mentoring program have?'' Findings from both
studies reveal that strong programs can improve academic performance,
while programs that do not incorporate best practices cannot.
Interestingly, both types of programs have increased attendance.
School-based mentoring was never designed to be a program that
primarily improved academic achievement. Mentoring aims more broadly to
keep children on a constructive, responsible path (such as encouraging
behaviors like coming to school and following the rules). Mentors are
not supposed to be teachers, but friends and role models. Even so, the
earlier evaluation did show that well-run programs improved academic
performance and behavior by the end of the school year.
Mentoring addresses a particular challenge facing our Nation today:
the high rate at which young people drop out of high school. Nearly
one-third of all high school students drop out before receiving their
diploma, a rate which approaches 50 percent for minority students.
Research on the dropout rate shows that young people can fail to
graduate for a wide variety of reasons, including: lack of connection
to the school environment, lack of motivation or inspiration, chronic
absenteeism, lack of parental involvement, personal reasons such as
teen pregnancy, and failing in school.
We know that young people who drop out will face a future of
unemployment, Government assistance, and even criminal involvement. We
need to help these young people before they reach the point of dropping
out of high school. Fortunately, youth mentoring can play in important
role in addressing the issues young people face within the learning
environment. Research demonstrates that many of the impacts of
mentoring can directly address the underlying causes of our Nation's
dropout crisis. Specific impacts of mentoring include:
--Mentored youth feel greater competence in completing their
schoolwork, which is linked to higher levels of classroom
engagement and higher grades.
--School-based mentoring enhances connectedness to schools, peers and
society, and mentored youth have more positive attitudes toward
school and teachers;
--Evaluations of mentoring programs indicated that both one-to-one
mentoring and group mentoring result in better school
attendance for mentored youth;
--Mentored youth experience improvements in parental relationships
and their own sense of self-worth; and
--Mentored youth are significantly less likely to participate in
high-risk behaviors, including substance abuse, carrying a
weapon, unsafe sex, and violent behaviors.
Mentoring is an important tool to help address dropout risk factors
and help ensure that young people are supported in their effort to
graduate from high school and make a successful transition to
adulthood.
These are tough economic times that warrant tough decisions.
However, rather than eliminating or cutting funding for school-based
mentoring, Congress and the administration could restrict the funding
to programs that truly incorporate best practices--the kind of programs
that have been shown to produce results. MENTOR recommends that the
request for proposals issued for the program be revisited to ensure
that it focuses on the key functions mentoring programs must perform
and their adherence to The Elements of Effective Mentoring Practice--
research-based industry standards now in their third edition. These
standards work to ensure that programs do their utmost to ensure that
mentoring does, in fact, work for America's young people by providing
the best mentoring experience possible. Within the Elements, Program
Design and Planning includes comprehensive guidelines to launch an
effective new mentoring initiative. Program Management and Program
Operations contain guidelines for managing and implementing the many
elements of a new program or fine-tuning certain elements for an
established program. Program Evaluation provides guidance for analyzing
a program to ensure it is safe, effective and able to meet its goals.
It is important to ensure that funding is going to high-quality
programs with real potential to make a difference, rather than
dismantle a strong infrastructure for service that is now in place in
thousands of American schools.
Thus, MENTOR recommends that $50 million once again be provided to
the Department of Education's Mentoring Programs grants in fiscal year
2010. Some of this funding is needed to simply support commitments
already made to existing grantees. All grants awarded under this
program are 3-year projects and require continued appropriations. We
also expect new grants to be made out of fiscal year 2009 funding,
approved at $48.5 million. Those organizations that see their funding
terminate early would likely have to downsize or even close. This would
likely result in the premature end to hundreds--if not thousands--of
mentoring relationships. Research shows that when mentoring
relationships terminate unexpectedly, it can have a detrimental impact
on the child.
Besides the immediate 1-year impact, the elimination of this
program will mean the end of the only authorized Federal program
specifically focused on providing mentors for young people at risk of
failing academically--this is not a function that is duplicated in many
programs more than 13 different agencies as the President mentioned in
February. In the 7 years the program has been in existence, more than
600 grants have been awarded to local mentoring programs in every
State, including rural, suburban, and urban settings. These grants have
totaled nearly $300 million. At the average per-child mentoring cost of
$1,500 per year, this means that approximately 200,000 young people are
benefiting from a mentoring relationship that otherwise likely would
not have been possible.
To conclude this portion of my testimony, we respectfully request
that Congress provide $50 million each for the Department of Education
Mentoring Programs grants and the Department of Health and Human
Services Mentoring Children of Prisoners program.
The Call to Fund Service.--MENTOR joined the strong ranks of
community organizations delighted when the Edward M. Kennedy Serve
America Act became law last week. With significant, bi-partisan
support, this legislation provides for the largest expansion of
national and community service since the 1930s and expands major
initiatives, such as AmeriCorps and the Retired Senior Volunteer
Program, which emerged during the course of the past 20 years. The
legislation also includes key new provisions that recognize mentoring
as an important form of national and community service and support its
growth.
As enacted, the Serve America Act provides many more opportunities
to support quality mentoring. For example, mentoring is an eligible
activity for those engaged in the newly expanded AmeriCorps, Volunteers
In Service To America (VISTA) and Retired and Senior Volunteer
Programs, as well as the newly created Education Corps and Veterans'
Corps. In addition, mentoring partnerships, which support the expansion
of quality mentoring in many States throughout the country, are now
eligible for funding through the National Service Trust Program and
Volunteer Generation Fund.
Now that it is authorized, it is doubly important that the act's
provisions be funded properly in fiscal year 2010 and beyond. mentoring
programs and our national network of Mentoring Partnerships already
rely on the tremendous contributions that AmeriCorps and VISTA
volunteers make, as mentors to youth in need and staff support at those
organizations. The boost in service represented by the Serve America
Act would allow programs and Partnerships to make an even more
meaningful impact in our communities and help us close the gap of 15
million young people who want and need high-quality mentoring
relationships.
CONCLUSION
On behalf of the thousands of mentoring programs and millions of
mentored children across the country, we commend you for your past
support of mentoring and national and community service funding. We
strongly encourage you to continue this wise investment in our young
people and in our country. Thank you for your consideration.
______
Letter Submitted by Maui Family Support Services
Wailuku, HI, May 12, 2009.
Hon. Tom Harkin,
Chairman, Subcommittee on Labor, Health and Human Services, and
Education, and Related Agencies, Washington, DC.
I write to express support for increased funding for the Child
Abuse Prevention and Treatment Act (CAPTA) programs. We propose to
increase CAPTA basic State grant funding to $84 million, community-
based prevention grants funding to $80 million, and research and
demonstration grants funding to $37 million in fiscal year 2010.
CAPTA's title II authorizes grants to States to help develop
community-based prevention services to support families, including
parenting education classes, home visiting services, respite care, as
well as family resource centers to connect families and children to the
services they need. While 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. Community prevention services to at-risk families are far
less costly than the damage inflicted on children from abuse and
neglect. Increasing for CAPTA prevention grants to $80 million would
help communities support proven, cost-effective approaches to
preventing child abuse and neglect.
It is extremely important that we give the highest priority to the
children of this Nation for they are the most vulnerable population
that needs protection and support to grow into a well-balanced,
healthy, and productive citizenry.
Thank you for your time and consideration.
Ave Diaz,
Healthy Start Home Visiting Supervisor.
______
Prepared Statement of the National Association of Anorexia Nervosa and
Associated Disorders
Founded in 1976, the National Association of Anorexia Nervosa and
Associated Disorders (ANAD) is our Nation's first nonprofit
organization dedicated to education, early detection, and prevention of
anorexia nervosa, bulimia nervosa, binge eating disorder, obesity, and
related eating disorders.
Eating disorders are severe mental illnesses which often have
significant physical health consequences for their victims, including
malnutrition, obesity, and diabetes, as well as death due to cardiac
arrest, organ failure, blood imbalances, and suicide. Anorexia nervosa
has the highest mortality rate of any mental illness. An estimated 6
percent of those who have the disease die as a result. These disorders
also frequently lead to or co-occur with other serious illnesses such
as severe depression, alcoholism, and drug abuse.
Eating disorders are at epidemic levels in America. An estimated 7
million women and 1 million men have eating disorders. These illnesses
affect all segments of society--the young and old, the rich and poor,
and all races and ethnicities, including African Americans, Asian
Americans, Latino Americans, and Native Americans. But this is an
epidemic that can be averted with education and prevention programs,
and cured with early diagnosis and appropriate treatment.
Data from an ANAD survey of 18 middle and high schools in 15 States
indicates that eating disorders are almost as prevalent as alcohol or
drug problems among female middle school and high school students. The
survey also indicates that our schools are spending far less time on
eating disorder prevention than on alcohol or drug prevention programs.
Seventeen percent of the schools surveyed spent 1 hour per year on
eating disorder education. Eleven percent of the schools surveyed had
no eating disorder prevention program of any kind.
The failure to fund eating disorder education and prevention in
schools is especially troubling in light of the fact that eating
disorders are often accompanied by or lead to alcoholism or drug
addiction, as well as diabetes, severe depression, and suicide.
Tens of millions of dollars are spent each year at the local,
State, and Federal levels to ensure that our children are properly
educated to the dangers of alcohol and drugs. The value of such
programs has been proven and accepted in schools throughout the
country. With eating disorders almost as prevalent as alcohol and drug
abuse in our schools, it is imperative that we provide more support for
eating disorder prevention efforts in our middle schools and high
schools. Millions of our youth can benefit from proven, low-cost
educational and preventive measures that help faculty and students to
understand and avoid the dangers of eating disorders.
Eating disorder research into the underlying causes and risk
factors associated with eating disorders is just as important as
education and prevention. As we continue to learn more about underlying
causes, risk factors and predictors through medical research, it will
undoubtedly improve the efficacy of our education and prevention
efforts.
Based on the foregoing, ANAD respectfully makes this request of the
subcommittee with regard to funding priorities for fiscal year 2010.
Millions of our youth can benefit from proven, low-cost services that
assist students to understand and avoid the dangers of eating
disorders. Programs, such as those provided by ANAD's Eating Disorders
and Obesity Education/Prevention Program for Middle and High Schools,
promote the elements of a healthy lifestyle: self-acceptance, a good
diet, adequate exercise and sufficient sleep.
Given the troubling lack of education and prevention in our
schools, ANAD respectfully requests $4 million or $75.00 per school be
allocated to place these life-enhancing programs in every middle and
high school in the United States. This $4 million in funds is above and
beyond the current request in the administration's proposed budget, for
the Department of Education's Safe and Drug-Free Schools programs to
provide grants for eating disorder prevention and education programs in
our Nation's middle schools and high schools.
Eating disorders cause serious physical problems that can last a
lifetime. They rob people of their ability to function as productive
members of society because, if not properly treated, victims of these
illnesses find themselves requiring more and more costly medical
services throughout their lives. With early education and detection,
eating disorders are treatable and at a much lower economic and
personal cost to society.
SUMMARY OF ANAD EATING DISORDERS STUDY
Data from a 2005 ANAD study shows that eating disorders are almost
as prevalent as alcohol or drug problems in middle and high school
female students. The study also shows that far less time is spent on
eating disorder prevention than on alcohol or drug prevention programs.
This is especially significant since eating disorders are often
accompanied by or lead to severe depression, suicidal tendencies, self-
mutilation, or diabetes. Many victims become alcohol or drug addicted.
Eating disorders cause great suffering for victims and families and
are expensive to treat. Anorexia nervosa has the highest mortality rate
of any mental illness. An estimated 6 percent of all anorexics die from
an eating disorder or from complications from their disorder. However,
these very dangerous illnesses can be cured and prevented.
Eight middle schools and 10 high schools from 15 States were
surveyed for this study.
Incidence of Alcoholism, Drugs, and Eating Disorders in Schools
Nine point eight percent of girls have problems with alcohol; 8
percent of girls have problems with drugs; and 7.8 percent of girls
have problems with eating disorders.
Time Devoted to Education/Prevention
Time devoted to Alcohol Education/prevention--12.3 percent; time
devoted to Drugs Education/Prevention--13.8 percent; and time devoted
to Eating Disorders Education/prevention--6.2 percent.
Three schools reported 1 hour per year was spent on eating
disorders education and two schools reported that they did not have any
program.
______
Prepared Statement of the National Association of County and City
Health Officials
The National Association of County and City Health Officials
(NACCHO) represents the Nation's approximately 2,860 local health
departments (LHDs). These governmental agencies work every day in their
communities to prevent disease, promote wellness, and protect health.
They organize community partnerships and facilitate community
conversations to create the conditions in which people can be healthy.
The work of local health departments and NACCHO improves economic well-
being, educational success, and nationwide competitiveness community by
community.
The current H1N1 influenza cases in the United States could signal
the onset of the next pandemic. State and local public health agencies
are actively engaged in outbreak investigation, control and response
activities to control the virus' spread and minimize illness and death.
NACCHO appreciates the past support of the subcommittee for public
health emergency preparedness and urges the subcommittee to provide the
necessary resources so that State and local health departments are able
to respond to all hazards, including a possible resurgence of pandemic
influenza in the fall.
LHDs have a unique and distinctive role and set of responsibilities
in the larger health system and within every community. The Nation
depends upon the capacity of local health departments to play this role
well. A LHD is the only local governmental entity that works from a
population-wide perspective. LHDs have statutory powers which enable
their role and enshrine a duty to serve every person and household in
their jurisdiction.
Funding to local health departments continues to be inadequate and
many people in the United States suffer from conditions whose causes
are preventable, whose costs for treatment are unsustainable into the
future, and whose treatment is of erratic quality, effectiveness and
efficiency. One clear, measured result is that the United States is not
the healthiest Nation in the world despite higher per capita
expenditures than any other Nation.
The Nation's current recession further diminishes the ability of
local health departments to measure population-wide illness and death,
organize efforts to prevent disease and prolong quality of life, and to
serve the public through organized programs not offered elsewhere.
Repeated rounds of budget cuts and layoffs in LHDs continue to erode
capacity. Reductions in local and State tax bases further undermine
these sources of support. A NACCHO survey found that in 2008, at least
7,000 LHD jobs were lost in 46 States across the country. Far more are
expected this year and many LHDs are currently reporting budget cuts in
the 20 to 40 percent range.
Protections people take for granted--from enforcement of rules
requiring safe food in restaurants and schools to early identification
of disease outbreaks to the expectation that their LHD will examine,
discover, and take action--are disappearing. In economic hard times,
people are more dependent than ever on their local health departments.
Programs offered by LHDs serve as a safety net for people in
communities where the numbers of unemployed, uninsured, and
underinsured are growing daily, compounding the numbers of formerly
working adults who need care.
NACCHO's recommendations focus on the Centers for Disease Control
and Prevention (CDC) and the Health Services and Resources
Administration (HRSA). Consistent funding with growth over time is
needed. NACCHO recommends an overall funding level for CDC of $8.6
billion not including funding for Vaccines for Children.
CHRONIC DISEASE PREVENTION AND HEALTH PROMOTION
Preventive Health and Health Services Block Grant
NACCHO recommends: Not less than fiscal year 2005 funding of $131
million. Local public health departments receive approximately 40
percent of the Preventive Health and Health Services block grant (PHHS)
nationally. The proportion received by local health departments varies
among states from less than five percent to almost 100 percent.
Increasing the availability of flexible funds is particularly important
as the gaps in public health protections grow.
PHHS funds enable States to address critical unmet public health
needs. Improving chronic disease prevention through screening programs
and programs that promote healthy nutrition and physical activity are
prime examples of activities to which many jurisdictions devote PHHS
funds. Population-based strategies which create the conditions in which
people are more likely to be healthy are also supported with these
funds. Flexible PHHS funds allow local priorities and unexpected
problems to be addressed. West Nile virus, a fully preventable disease
spread to humans by mosquitoes, is one good example. Finally, PHHS
funds provide leverage for additional support from non-Federal sources.
NACCHO also recommends that the subcommittee include language with
the appropriations bill which would require concurrence of LHDs with
State public health officials in the uses for and distribution of these
funds. Such language has been instrumental in the effective use of
preparedness funds, assuring that a reasonable proportion of funds help
local communities.
EMERGENCY PREPAREDNESS
Public Health Emergency Preparedness Cooperative Agreement
NACCHO recommends not less than fiscal year 2005 funding of $919
million. Federal funding for improving State and local public health
emergency preparedness has stalled for the past several years and is
substantially down from $919 million in fiscal year 2005 to $746
million in the fiscal year 2009 omnibus appropriations bill. Local
health departments successfully responded to the outbreak of H1N1
influenza this spring, but a sustained epidemic would further tax
resources and stretch the capacity of local health professionals to
respond adequately to the influenza outbreak as well as other
responsibilities in the areas of infectious and chronic disease.
Last year more than 25 percent of LHDs reduced their preparedness
activities, delayed completion of plans, and/or delayed acquisition of
equipment and supplies as a result. Constant readiness for both new and
emerging threats requires staff, plans, training and practice, all of
which require financial support. The benefits to safety and well-being
of local communities are clear when LHDs are prepared and work
effectively with their communities to be prepared for all hazards.
Reduction in Federal financial support has reduced readiness and the
capacity to respond to emergencies.
ADVANCED PRACTICE CENTERS
NACCHO recommends level funding of $5.3 million plus inflation
adjustment. NACCHO appreciates the past support of the subcommittee for
the Advanced Practice Centers program. The Advanced Practice Center
(APC) program funded through CDC provides funds to seven local health
departments to develop innovative field-tested tools and models to help
other LHDs meet emergency preparedness goals. The APCs are located in
Santa Clara County, California; Cambridge, Massachusetts; Montgomery
County, Maryland; Twin Cities Metro, Minnesota; Western New York Public
Health Alliance; Tarrant County, Texas and Public Health--Seattle and
King County, Washington. The 70 unique preparedness tools produced to
date by the APCs have become essential instruments that LHDs nationwide
routinely employ to assess their vulnerability, strengthen their
response capacity, and enhance the resilience of their communities and
workforce. The APC network provides a national learning laboratory that
creates tools, resources, and technical guidance that can be used for
all LHDs and that align with public health preparedness priority areas.
PUBLIC HEALTH WORKFORCE
NACCHO recommends $10 million new funding. The shortages in the
public health workforce have been well-documented, particularly in
public health nursing, epidemiology, laboratory science, and
environmental health. The Nation's wellness depends on a continuing
supply of people for this workforce. Additional funding and leadership
is required to support a program of training, continuing education, and
education for the full range of public health professions and community
workers. Section 765 of the Public Health Service Act authorizes grants
that would allow State and local health departments to provide training
and trainee support. Funds have never been appropriated for this
purpose.
EMERGENCY PREPAREDNESS WORKFORCE
NACCHO recommends $10 million new funding. Workforce shortages also
exist in the area of public health preparedness. In 2006, the Pandemic
and All-Hazards Preparedness Act created two new programs within the
National Health Service Corps (NHSC) in the Health Resources and
Services Administration, yet no funding was appropriated for these
programs. Funding would allow expansion of the NHSC on a trial basis to
include loan repayment for individuals who complete their service in a
State, local, or tribal health department that serves health
professional shortage areas or areas at risk of a public health
emergency. The second program establishes grants to States to create
loan repayment programs. These programs are essential to ensure a
workforce trained to carry out specialized tasks in preparedness.
______
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 include
local faith-based and community-based nonprofit organizations and
public sector agencies that provide homeless people with housing and
services such as substance abuse treatment, job training, and physical
health and mental healthcare. The Alliance represents a united effort
to address the root causes of homelessness and challenge society's
acceptance of homelessness as an inevitable byproduct of American life.
SUMMARY OF APPROPRIATIONS GOALS
Moving Forward To End Homelessness.--Communities are using Federal,
State, and local funds to help homeless persons maintain housing.
Especially during the current economic recession, it is important that
this progress not be undermined. To this end, the Alliance recommends
the following:
--Allocate $120 million for services for people experiencing
homelessness within the Programs of Regional and National
Significance accounts of both Substance Abuse and Mental Health
Services Administration's (SAMHSA) Center for Mental Health
Services and Center for Substance Abuse Treatment.
--Increase funding for the Projects for Assistance in Transition from
Homelessness (PATH) program to $75 million.
--Increase funding for the Runaway and Homeless Youth Act (RHYA)
Programs to $165 million.
--Provide $2.602 billion in the Community Health Center program
within the Health Resource Services Administration (HRSA). This
would result in $226.3 million for the Health Care for the
Homeless (HCH) program, a $36 million increase from fiscal year
2009.
--Fund Education for Homeless Children and Youth (EHCY) services at
$210 million.
--Increase funding for the Homeless Veterans Reintegration Program to
$50 million, its authorized level.
Connecting Homeless Families, Individuals, and Youth to Mainstream
Services
People experiencing homelessness also depend on mainstream
programs. The Alliance recommends the following to meet this goal:
--Fund the Social Services Block Grant (SSBG) program at $2.3
billion.
--Fund the Community Services Block Grant (CSBG) program at $725
million.
--Appropriate $60 million in education and training vouchers for
youth exiting foster care under the Safe and Stable Families
Program.
--Fund the Community Mental Health Services Performance Partnership
Block Grant at $486.9, a $66.1 million increase.
--Fund the Substance Abuse Prevention and Treatment Block Grant at
$1.929 billion, a $150 million increase more than fiscal year
2009.
BACKGROUND
Our 2009 report, Homelessness Counts: Changes in Homelessness from
2005 to 2007, estimates that 671,859 people are homeless on any given
night. This includes 248,511 persons in families and 423,348
individuals. Eighteen percent of all homeless people are defined as
chronically homeless; these are people who have a disability and who
have been homeless repeatedly or continuously for 12 months. These
numbers are based on homeless counts performed in 2007, prior to the
current economic recession. Compared to 2005, there were decreases
across the country resulting in a 10 percent overall decline in
homelessness. Anecdotal evidence suggests there could be increases in
homelessness as communities report the results of their 2009 counts. To
help stave off drastic increases in homelessness, we need Congress to
invest in what we know works. Successful interventions for all homeless
populations couple housing with an appropriate level of services for
the family or individual. We call on Congress to adequately fund
programs that assist States and local entities in developing permanent
housing and the necessary social services to end homelessness for all
Americans.
DETAILED PROGRAM DESCRIPTIONS
Goal No. 1--Moving Forward To End Homelessness
Support Services for Permanent Supportive Housing Projects
The Alliance recommends allocating $120 million for services in
permanent supportive housing within SAMHSA's Center for Mental Health
Services and Center for Substance Abuse Treatment. Years of reliable
data and research demonstrate that the most successful intervention to
solve chronic homelessness is linking housing to appropriate support
services. Current SAMHSA investments in homeless programs are highly
effective and cost-efficient.
PATH
The Alliance recommends that Congress increase PATH funding to $75
million and adjust the funding formula to increase allocations for
small States and territories.
PATH provides outreach to eligible consumers and ensures that those
consumers are connected with mainstream services, such as Supplemental
Security Income, 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.
RHYA PROGRAMS
The Alliance recommends funding the RHYA programs at $165 million.
RHYA programs support cost effective, community- and faith-based
organizations that protect youth from the harms of life on the streets.
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. For example,
only one-tenth of the youth who connect with a RHYA program are able to
receive services. It is essential that Congress increase this program.
COMMUNITY HEALTH CENTERS AND HCH PROGRAMS
The Alliance recommends $2.602 billion in the Community Health
Center program within HRSA. This would result in $226.4 million for the
HCH program, a $36 million increase more than fiscal year 2009. Persons
living on the street suffer from health problems resulting from or
exacerbated by 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. Healthcare 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
HCH projects.
EDUCATION FOR HOMELESS CHILDREN AND YOUTH (EHCY)
The Alliance recommends funding EHCY at $210 million. The most
important potential source of stability for homeless children is
school. The mission of the EHCY program is to ensure that these
children can continue to attend school and thrive. EHCY, 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, which is 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 is 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 No. 2--Connecting Homeless Families, Individuals and Youth to
Mainstream Services
social services block grant (ssbg)
The Alliance recommends that Congress increase SSBG funding to $2.3
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 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 rejects cuts and fund CSBG at
$725 million. Funding cuts for 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 the
Department of Housing and Urban Development. Community Action Agencies
(CAAs), which are the primary local recipients of CSBG funding, 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 2006 Community Services Block Grant Information
Systems report published by the U.S. Department of Health and Human
Services, CAAs reported expending approximately $42 million on housing-
related services. In addition, approximately $50 million was spent
nationwide on youth services, some of which related to housing. States
reported that 180,000 clients served with CSBG funds were homeless.
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 future homelessness.
COMMUNITY MENTAL HEALTH PERFORMANCE PARTNERSHIP BLOCK GRANT
The Alliance recommends that Congress appropriate $486.9 million
for the Community Mental Health Performance Partnership Block Grant.
The Mental Health Block Grant provides flexible funding to states to
provide mental health services. Ending homelessness requires Federal,
State, and local partnerships. Additional mental health funds will give
States the resources to improve their mental health system and serve
all people with mental health disorders better, including homeless
populations. For example, block grant funds can be used to pay for
services linked to housing for homeless people, thereby meeting the
match requirements for projects funded through Shelter Plus Care or the
Supportive Housing Program.
SUBSTANCE ABUSE PREVENTION AND TREATMENT (SAPT) BLOCK GRANT
The Alliance recommends that Congress appropriate $1.929 billion
for the SAPT Block Grant. The SAPT Block Grant is the primary source of
Federal funding for substance abuse treatment and prevention for many
low-income individuals, including those experiencing homelessness.
Studies have shown that half of all people experiencing homelessness
have a diagnosable substance use disorder. States need more resources
to implement proven treatment strategies and work with housing
providers to keep homeless populations, especially chronically homeless
populations, stably housed.
CONCLUSION
Homelessness is not inevitable. As communities implement plans to
end homelessness, they are struggling to find funding for the services
that homeless and formerly homeless clients need to maintain housing.
The Federal investments in mental health services, substance abuse
treatment, employment training, youth housing, veterans' services, 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
National Alliance for Eye and Vision Research (NAEVR) requests a
fiscal year 2010 National Institute of Health (NIH) funding increase of
at least 7 percent, to a level of $32.4 billion, which represents a
modest 3 percent increase plus the biomedical inflation rate, estimated
at 3.8 percent in fiscal year 2009. This increase is necessary to keep
pace with inflation and rebuild the base, since NIH has lost 14 percent
of its purchasing power during the past 6 funding cycles.
NAEVR commends the congressional leadership's actions in fiscal
year 2008 and 2009 to increase NIH funding, including the $150 million
in the fiscal year 2008 supplemental dedicated to investigator-
initiated grants, the $10.4 billion in 2-year stimulative NIH funding
within the American Recovery and Reinvestment Act (ARRA), and the final
fiscal year 2009 appropriations inflationary increase of 3.2 percent.
However, NIH needs sustained and predictable funding to rebuild its
base and support multi-year, investigator-initiated research, which is
the cornerstone of the biomedical enterprise. Annual increases of at
least 7 percent put NIH on a pathway to budget-doubling within the next
10 years. Secure and consistent funding for biomedical research is
integral to the Nation's economic and global competitiveness. NIH is a
world-leading institution that must be adequately funded so that its
research can reduce healthcare costs, increase productivity, and save
and improve the quality of lives.
NAEVR requests that Congress make vision health a top priority by
increasing National Eye Institute (NEI) funding by at least 7 percent,
to a level of $736 million, in this year that NEI celebrates its 40th
anniversary. Over the past 6 funding cycles, NEI lost 18 percent of its
purchasing power. Despite funding challenges, NEI has maintained its
impressive record of breakthroughs in basic and clinical research that
have resulted in treatments and therapies to save and restore vision
and prevent eye disease. NEI will be challenged further, as 2010 begins
the decade in which more than half of the 78 million baby boomers will
turn 65 and be at greatest risk for developing aging eye disease.
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.
Fiscal year 2010 funding at $736 million enables NEI to expand its
impressive record of basic and clinical collaborative research that has
resulted in treatments and therapies to save and restore vision.
NEI continues to be a leader in basic research--especially that
which elucidates the genetic basis of ocular disease--and in
translational research, as those gene discoveries can lead to
development of diagnostics and treatments. NEI Director Paul Sieving,
M.D., Ph.D., has reported that one-quarter of all genes identified to
date through NEI's collaboration with the National Human Genome
Research Institute (NHGRI) are associated with eye disease/visual
impairment. Recent examples include:
--In 2005, NEI reported that gene variants of Complement Factor H
(CFH), the protein product of which is engaged in the control
of the body's immune response, are associated with increased
risk of developing age-related macular degeneration (AMD), the
leading cause of vision loss. NEI-funded researchers are now
working on potential therapies, including the manufacture and
use of a protective version of the CFH protein in an
augmentation strategy similar to that of treating diabetes with
insulin. This therapy is under development and expected to
enter phase I clinical safety trials in summer 2009.
--In March 2008, NEI-funded researchers announced that damage from
both AMD and diabetic retinopathy was prevented and even
reversed when the protein Robo4 was activated in mouse models
that simulate the two diseases. Robo4 treated and prevented the
diseases by inhibiting abnormal blood vessel growth and by
stabilizing blood vessels to prevent leakage. Since this
research into the ``Robo4 Pathway'' used animal models
associated with these diseases that are already used in drug
development, the time required to test this approach in humans
could be shortened, expediting approvals for new therapies
--In late April 2008, researchers funded by the NEI and private
funding organization Foundation Fighting Blindness reported on
their use of gene therapy to restore vision in young adults who
were virtually blind from a severe form of the
neurodegenerative disease Retinitis Pigmentosa, known as Leber
Congenital Amaurosis (LCA). Seven years earlier, the
researchers shared on Capitol Hill results of a preclinical
study of the same gene therapy, which at the time was
successfully giving vision to dogs born blind with LCA. The
subsequent human gene therapy trial validated the process of
putting genes in the body to restore vision. Although the
primary goal of the phase I study was to ensure patient safety,
the researchers reported through both objective and subjective
testing that the patients were able to read several lines on an
eye chart, had better peripheral vision, and better eyesight in
dimly lit settings. In further research, the investigators will
treat LCA patients as young as 8 years old, since they believe
the most dramatic results will be seen in young children.
--In late 2008, NEI initiated its new NEI Glaucoma Human genetics
collaBORation, known as NEIGHBOR, through which seven U.S.
research teams will lead genetic studies of the disease.
Glaucoma is called the ``stealth robber of vision'' as it often
has no symptoms until vision is lost, and anywhere from 50-75
percent of individuals with it are undiagnosed. It is also the
leading cause of preventable vision loss in African-American
and Hispanic populations, which emphasizes the vital nature of
determining the genetic basis of this disease.
FISCAL YEAR 2010 FUNDING AT $736 MILLION ENABLES NEI TO FULLY FUND NEW
INITIATIVES THAT MORE FULLY CHARACTERIZE EYE DISEASE
NEI has been a leader in collaborative research, the use of
networks to study diagnostics and treatments and their use in clinical
settings, and in ocular epidemiology to characterize the nature and
frequency of eye disease in diverse populations to better manage pubic
health. In fiscal year 2008, NEI reported on/launched the initial phase
of three important new programs to characterize eye disease requiring
adequate future funding.
--In early 2009, the NEI and the National Aeronautics and Space
Administration (NASA) reported on the use of a compact fiber
optic probe developed for the space program that has proven
valuable as the first noninvasive early detection device for
cataracts, the leading cause of vision loss worldwide. Using a
laser light technique called dynamic light scattering (DLS),
which was developed to analyze the growth of protein crystals
in a zero-gravity environment, the probe measures the amount of
light scattering by an anti-cataract protein called alpha-
crystallin. The probe senses protein damage due to oxidative
stress, a key process involved in many medical conditions
including age-related cataract and diabetes, as well as
Alzheimer's and Parkinson's disease.
--In late 2008, NEI launched a new research network, the Neuro-
Ophthalmology Research Disease Investigator Consortium, or
NORDIC. It will initially lead multi-site observational and
treatment trials, involving nearly 200 community and academic
practitioners, to address the risks, diagnosis, and treatment
of two ``rare'' diseases: idiopathic intracranial hypertension
(visual dysfunction due to increased intracranial pressure) and
thyroid eye disease (also called Graves' disease, in which
muscles of the eye enlarge and cause bulging of the eyes,
retraction of the lids, double vision, decreased vision, and
irritation). The NEI and NORDIC's principal investigator have
already begun coordinating with the Department of Defense's
(DOD) newly established Vision Center of Excellence (VCE) about
the applicability of NORDIC research to combat-related eye
injuries, especially those associated with Traumatic Brain
Injury (TBI).
--There is currently almost no information on the prevalence, risk
factors, and genetic determinants in Asian Americans--one of
the fastest growing racial groups in the United States. Studies
from East Asia have suggested that Asians have a spectrum of
eye diseases different from that of White Americans, African
Americans, and Hispanics. In late 2008, NEI launched the
Chinese American Eye Study to characterize the extent of eye
disease in Chinese Americans, the largest Asian sub-group in
the United States. Participants 50 years and older will be
evaluated for blindness, visual impairment, and eye disease.
These results will add to the expanding body of knowledge about
vision health disparities already characterized by NEI in the
African-American and Hispanic populations.
VISION IMPAIRMENT/EYE DISEASE IS A MAJOR PUBLIC HEALTH PROBLEM THAT
INCREASES HEALTHCARE COSTS, REDUCES PRODUCTIVITY, AND DIMINISHES
QUALITY OF LIFE
The NEI estimates that 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 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 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 recently as March 2008, the NEI's Survey of Public
Knowledge, Attitudes, and Practices Related to Eye Health and Disease
reported that 71 percent of respondents indicated that a loss of their
eyesight would rate as a ``10'' on a scale of 1 to 10, meaning that it
would have the greatest impact on their day-to-day life.
In 2009, the NEI will celebrate its 40th anniversary as the NIH
Institute that leads the Nation's commitment to save and restore
vision. During the next decade, more than half of the 78 million baby
boomers will celebrate their 65th birthday and be at greatest risk for
developing aging eye disease. As a result, sustained, adequate Federal
funding for the NEI is an especially vital investment in the health,
and vision health, of our Nation as the treatments and therapies
emerging from research can preserve and restore vision. Adequately
funding the NEI can also delay, save, and prevent health expenditures,
especially those associated with the Medicare and Medicaid programs,
and is, therefore, a cost-effective investment.
NAEVR urges fiscal year 2010 NIH and NEI funding at $32.4 billion
and $736 million, respectively, reflecting an at least 7 percent
increase more than fiscal year 2009.
______
Prepared Statement of the National Association of State Alcohol and
Drug Abuse Directors
Chairman Harkin, Ranking Member Cochran, members of the
subcommittee, on behalf of the National Association of State Alcohol
and Drug Abuse Directors (NASADAD), and our component organizations,
the National Prevention Network, and the National Treatment Network,
thank you for your leadership on issues related to addiction. I am Flo
Stein, NASADAD President and member from North Carolina. I am pleased
to present testimony regarding fiscal year 2010 funding priorities.
Scope of the Problem.--According to the Substance Abuse and Mental
Health Services Administration's (SAMHSA) National Survey on Drug Use
and Health (NSDUH), approximately 23.2 million Americans aged 12 or
older needed services for an alcohol or illicit drug problem in 2007.
During the same year, approximately 2.4 million received treatment for
such a problem at a specialty facility. As a result, approximately 20.8
million people needed but did not receive services in 2007 in a
specialty facility.
Substance Abuse Spending Represents a Tiny Fraction of all Health
Expenditures.--Substance abuse expenditures represented 1.3 percent of
all healthcare expenditures in 2003 ($21 billion for substance abuse
compared to $1,614 billion for all health expenditures). Using
inflation adjusted terms, the growth rate for all health spending from
1993 to 2003 was 4.6 percent, while the growth rate for substance abuse
spending during this same time period was 1.4 percent.
Yet Addiction is Associated With Many Other Diseases.--In a 2004
study appearing in the Journal of the American Medical Association
(JAMA), researchers examined ``actual causes of death'' defined by the
Centers for Disease Control and Prevention (CDC) as factors that
contribute to leading killers such as heart disease, cancer and stroke.
The study identified nine leading ``actual causes of death.'' Tobacco,
alcohol and illicit drugs--killing 530,000 Americans in 2000--were 3 of
the top 9. The others were diet/weight; microbial agents; toxic agents;
motor vehicles; firearms and sexual behaviors.
Unaddressed Substance Abuse Problems are Costly.--As noted in
SAMHSA's National Expenditures for Mental Health Services and Substance
Abuse Treatment, 1993-2003 (2007), when substance abuse spending was
$15.5 billion in 1998, the total economic costs of alcohol abuse were
approximately $184.6 billion and the total economic costs for drug
abuse were $143.4 billion (Harwood, 2000). These costs were linked not
only to medical consequences of alcohol/drug use, but also crime, lost
earnings, motor vehicle crashes, and more.
Financial Investments in Addiction Services Save Taxpayer
Dollars.--The National Institute on Drug Abuse (NIDA) notes that for
every $1 spent on addiction treatment programs, there is an estimated
$4 to $7 reduction in the cost of drug-related crimes. With some
outpatient programs, total savings can exceed costs by a ratio of 12:1
(NIDA InfoFacts, 2006).
Maintain SAMHSA as Strong Agency.--NASADAD supports action to
ensure that SAMHSA remains a unique, strong and vibrant agency. SAMHSA
has demonstrated excellent leadership and collaboration--promoting
innovative strategies to improve our service delivery system. NASADAD
thanks Dr. Eric Broderick, Acting Administrator of SAMHSA, for his
work. SAMHSA is to be commended and should be considered a vital voice
in discussions related to health reform.
Top Priority for Fiscal Year 2010--Increase Funding for Substance
Abuse Prevention and Treatment (SAPT) Block Grant.--NASADAD recommends
$1,928.6 million for the SAPT Block Grant in fiscal year 2010--an
increase of $150 million more than fiscal year 2009 and more than the
President's request. Since 2007, as the economy and State budgets
struggled, unemployment grew by 5.5 million. This is critical news for
the SAPT Block Grant given that the NSDUH found unemployed persons need
services at almost twice the rate as those with jobs. An increase in
SAPT Block Grant funds would help our public treatment system to better
serve this increased need on the part of the low-income and uninsured
population.
Background.--The SAPT Block Grant, a program distributed by formula
to all States and territories, serves our Nation's most vulnerable,
low-income populations: those with HIV/AIDS, pregnant and parenting
women, youth, and others. This vital program helps States and
communities address their own unique needs--whether the problem is
alcohol, methamphetamine, and prescription drug abuse or persons using
multiples substances. The SAPT Block Grant represents approximately 40
percent of treatment expenditures by State substance abuse agencies
across the country.
SAPT Block Grant Funded Services Achieve Results.--The SAPT Block
Grant is an effective and efficient program that emphasizes
accountability through the reporting of outcomes data. In particular,
States have worked diligently with SAMHSA to implement the National
Outcome Measures (NOMs) initiative. The SAMHSA/State partnership on
NOMs promotes continuous quality improvement through a more systematic
approach to data management and reporting. States now measure the
impact of services on the use of alcohol and other drug use;
employment; having stable housing; involvement with criminal activity;
and efforts to live productively in the community. As noted by SAMHSA
in 2008, SAPT Block Grant funded programs had positive results, where
``. . . at discharge, clients have demonstrated high abstinence rates
from both illegal drug (68.3 percent) and alcohol (73.7 percent) use.''
In my own State of North Carolina, our Division of Mental Health,
Developmental Disabilities and Substance Abuse Services reported 21,102
to treatment admissions in State fiscal year 2006/2007. In State fiscal
year 2006/2007, North Carolina showed the following client outcomes at
discharge: 82 percent were abstinent from alcohol use; 74 percent were
abstinent from drug use; and 77 percent were involved in social support
groups.
Important Prevention Funding Within SAPT Block Grant.--Twenty
percent of the SAPT Block Grant is dedicated to funding much needed
substance abuse prevention programming. In many States set-aside
funding represents a large source of prevention funds for the agency.
Overall, SAPT Block Grant funding represents 64 percent of State
substance abuse agency prevention funding. In 21 States, the set-aside
represents 75 percent or more of the agency's prevention budget.
The prevention set-aside has also helped produce demonstrable
results. The Monitoring the Future (MTF) Survey found a 25 percent
decline in any illicit drug use in the past month by 8th, 10th, and
12th graders combined between 2001 and 2008. As a result, there were
840,000 fewer teens using drugs in 2008 compared to 2001. A strong
commitment to the SAPT Block Grant will ensure a strong commitment to
much needed prevention services for our youth.
Recent History of SAPT Block Grant Funding.--NASADAD is thankful
for the increase of $19.9 million for the SAPT Block Grant in fiscal
year 2009. However, the program has suffered over the past few years:
from fiscal year 2004 to fiscal year 2008, funding was cut by more than
$20 million. In fact, it is estimated that the 2010 SAPT Block Grant
appropriation would have to be increased by $403.7 million above the
2009 appropriation to maintain services at 2004 levels using the CPI-U
as the proxy (Data courtesy of the New York State Office of Alcoholism
and Substance Abuse Services (OASAS)]). As a result, NASADAD and others
view an increase of $150 million as a down payment to make up for lost
ground.
Center for Substance Abuse Treatment (CSAT).--NASADAD recommends
$489.3 million in fiscal year 2010--an increase of $75 million compared
to fiscal year 2009 and an increase of $29.3 million compared to the
President's request. NASADAD acknowledges Dr. H. Westley Clark,
Director of CSAT, for his excellent leadership.
NASADAD is thankful for the President's proposed $45.7 million
increase for CSAT in fiscal year 2010. NASADAD is also thankful for an
increase of $14.5 million for CSAT in fiscal year 2009. This increase
reversed the previous administration's proposal to cut CSAT by $63
million. The fiscal year 2009 omnibus bill restored all or a portion of
a number of NASADAD priority programs that were set to be eliminated.
Center for Substance Abuse Prevention (CSAP).--NASADAD recommends
$276.3 million--an increase of $75 million compared to fiscal year 2009
and an increase of $77.7 million compared to the President's fiscal
year 2010 request. NASADAD applauds the work of Fran Harding, Director
of CSAP, for her work and dedication.
NASADAD appreciates the $6.8 million increase for CSAP in fiscal
year 2009. Approving the fiscal year 2009 omnibus package restored
funding for CSAP programs which were slated to be eliminated or reduced
by the previous administration.
Safe and Drug Free Schools and Communities--State Grants.--NASADAD
is extremely concerned with the President's proposal to eliminate or
zero out the Safe and Drug Free Schools and Communities (SDFSC)--State
Grants portion in fiscal year 2010.
NASADAD believes that the SDFSC State Grants program is an
effective initiative that represents a core component of each State's
substance abuse prevention system. The efficiency of the program can in
part be attributed to principles of effectiveness that each grantee
follows. These principles include (1) an assessment of the problem; (2)
development of measurable goals and objectives; (3) implementation of
effective programs and (4) assessment of program outcomes.
We believe the program also benefits from close collaboration with
NASADAD members. In particular, certain Governors choose NASADAD
members as the designee to manage these important funds. This
designation allows for a more comprehensive and coordinated approach to
planning and implementing an effective State-wide system of care.
NASADAD recommends $346.5 million, representing a $51.8 million
increase more than fiscal year 2009 and representing a $346.5 million
increase more than the President's fiscal year 2010 request for the
program.
National Institute on Drug Abuse (NIDA).--NASADAD recommends
$1,105.1 million for NIDA, representing a $59.3 million increase
compared to the President's fiscal year 2010 request and a $72.3
million increase compared to fiscal year 2009. NASADAD wishes to thank
Dr. Nora Volkow, Director of NIDA, for her collaboration with State
substance abuse agencies through its ``Blending Initiative.'' This work
improves the translation of research into everyday practice.
National Institute on Alcohol Abuse and Alcoholism (NIAAA).--
NASADAD recommends $481.7 million for NIAAA, which represents a $26.6
million increase compared to the President's fiscal year 2010 request
and a $31.5 million increase compared to fiscal year 2009.
______
Prepared Statement of the National Association for State Community
Services Programs
The National Association for State Community Services Programs
(NASCSP), the national association representing State administrators of
the Department of Health and Human Services' Community Services Block
Grant (CSBG) and State directors of the Department of Energy's Low-
Income Weatherization Assistance Program, would like to thank Congress
for its continued support of the CSBG and requests an appropriation of
$800 million for fiscal year 2010. We are requesting $800 million in
CSBG funding for fiscal year 2010 to ensure the CSBG Network has
adequate resources to sustain its expanded efforts to address the long-
term needs of those families affected by the current economic recession
and those transitioning from welfare to work. In addition, increased
funding would enable the network to continue and strengthen its efforts
to assist low-income workers in remaining at work through supportive
services such as transportation and child care. The across the board
cuts to the CSBG funding in past years have severely decreased the
ability of the CSBG Network to provide and enhance essential services
to low-income Americans. It is essential that the CSBG funding be
increased for fiscal year 2010.
BACKGROUND
The States believe the CSBG is a unique block grant that has
successfully transferred decisionmaking to the local level. Federally
funded with oversight at the State level, the CSBG has maintained a
local network of nearly 1,100 agencies which operate in 99 percent of
counties in the Nation. This network serves nearly 16.2 million low-
income individuals, members of more than 6.4 million low-income
families, CSBG eligible entities, largely local Community Action
Agencies (CAAs), provide States with a stable and guaranteed network of
designated entities which are mandated to change the conditions that
perpetuate poverty for individuals, families, and communities. There is
no other program in the United States mandated by Federal statute to
respond to poverty. To fulfill that mandate, CAAs provide services
based on the characteristics of poverty in their communities. For one
community, this might mean providing job placement and retention
services; for another, developing affordable housing. In rural areas,
it might mean providing access to health services or developing a rural
transportation system.
Since its inception, the CSBG has shown how partnerships between
States and local agencies benefit citizens in each State. We believe it
should be viewed as a model of how the Federal Government can best
promote self-sufficiency for low-income persons in a flexible,
decentralized, nonbureaucratic, and accountable way.
Long before the creation of the Temporary Assistance for Needy
Families (TANF) block grant, the CSBG set the standard for private-
public partnerships that work to revitalize local communities and
address the needs of low-income residents. Family oriented, while
promoting economic development and individual self-sufficiency, the
CSBG relies on an existing and experienced community-based service
delivery system of CAAs and other nonprofit organizations to produce
results for its clients.
WHAT DO LOCAL CSBG AGENCIES DO?
One thing that is common to all CAAs is the goal of self-
sufficiency for all of their clients. But, since CAAs operate in rural
areas as well as in urban areas, it is difficult to describe a typical
CAA. Most CAAs will provide some, if not all, of the services listed
below:
--a variety of crisis and emergency safety net services;
--employment and training programs;
--transportation and child care for low-income workers;
--individual development accounts;
--micro business development help for low-income entrepreneurs;
--local community and economic development projects;
--housing, transitional housing, and weatherization services;
--Head Start;
--energy assistance programs;
--nutrition programs;
--family development programs; and
--senior services.
CSBG is the core funding which holds together a local delivery
system able to respond effectively and efficiently, without a lot of
red tape, to the needs of individual low-income households as well as
to broader community needs. In addition, CSBG funds many of these
services directly. Without the CSBG, local agencies would not have the
capacity to work in their communities developing local funding, private
donations and volunteer services and running programs of far greater
size and value than the actual CSBG dollars they receive.
CAAs manage a host of other Federal, State, and local programs
which makes it possible to provide a one-stop location for persons
whose problems are usually multi-faceted. More than half (52 percent)
of the CAAs manage the Head Start program in their community. Using
their unique position in the community, CAAs recruit additional
volunteers, bring in local school district personnel, tap into faith-
based organizations for additional help, coordinate child care and
bring needed healthcare services to Head Start centers. In many States
they also manage the Low Income Home Energy Assistance Program
(LIHEAP), raising additional funds from utilities for this vital
program. CAAs may also administer the Weatherization Assistance Program
and are able to mobilize funds for additional work on residences not
directly related to energy savings that, for example, may keep a low-
income elderly couple in their home. CAAs also coordinate their
programs with the Community Development Block Grant program to stretch
Federal dollars and provide a greater return for tax dollars invested.
They also administer the Women, Infants and Children nutrition program,
as well as job training programs, substance abuse programs,
transportation programs, domestic violence and homeless shelters, and
food pantries.
For every CSBG dollar they receive, CAAs leverage $5.59 in non-
Federal resources (State, local, and private) to coordinate efforts
that improve the self-sufficiency of low-income persons and lead to the
development of thriving communities.
WHO DOES THE CSBG SERVE?
National data compiled by NASCSP show that the CSBG serves a broad
spectrum of low-income persons, particularly those who are not being
reached by other programs and are not being served by welfare programs.
Based on the most recently reported data, from fiscal year 2007 CSBG
serves:
--More than 3 million families with incomes at or below the poverty
level; of these customer families, 1.4 million are severely
poor as they have incomes at or below 50 percent of the poverty
guideline.
--More than 1.3 million families headed by single mothers.
--More than 1.7 million ``working poor'' families relying on wages or
unemployment benefits as income.
--More than 384,000 TANF participant families, 23 percent of all TANF
families nationwide.
--About 4 million children.
--Almost 2.7 million people without health insurance.
--More than 1.7 million adults who had not completed high school.
MAJOR CHARACTERISTICS OF THE CSBG NETWORK
Due to the unique structure of the CSBG, the CSBG Network has
earned a reputation for its:
Emergency Response.--CAAs are utilized by Federal and State
emergency personnel as a frontline resource to deal with emergency
situations such as floods, hurricanes, and economic downturns. They are
also relied on by citizens in their community to deal with individual
family hardships, such as house fires or other emergencies. In fact,
during and after Hurricanes Katrina and Rita, the State CSBG offices
and local CAAs quickly mobilized to provide immediate and long-term
assistance to evacuees.
Leveraging Capacity.--In fiscal year 2007, every CSBG dollar
leveraged $18.40 from all other sources. Of those leveraged funds,
$5.59 came from non-Federal resources (State, local, and private) to
coordinate efforts that improve the self-sufficiency of low-income
persons and lead to the development of thriving communities.
Volunteer Mobilization.--CAAs mobilize volunteers in large numbers.
In fiscal year 2006, the most recent year for which data are available,
the CAAs elicited more than 46 million hours of volunteer efforts, the
equivalent of almost 21,857 full-time employees. Using just the minimum
wage, these volunteer hours are valued at nearly $266 million.
Adaptability.--CAAs provide a flexible local presence that
governors have mobilized to deal with emerging poverty issues.
Moreover, the CSBG Network has also earned a reputation for its:
Accountability.--The Federal Office of Community Services, State
CSBG offices, and CAAs have worked closely to develop a results-
oriented management and accountability (ROMA) system. Through this
system, individual agencies determine local priorities within six
common national goals for CSBG and report on the outcomes that they
achieved in their communities.
Local Direction and Oversight.--Tri-partite boards of directors
guide CAAs. These boards consist of one-third elected officials, one-
third representatives from the private sector, and not less than one-
third of the members are representative of the low-income persons in
the neighborhoods served by the CAA. The boards are responsible for
establishing policy and approving business plans of the local agencies.
Since these boards represent a cross-section of the local community,
they guarantee that CAAs will be responsive to the needs of their
community.
The statutory goal of the CSBG is to ameliorate the effects of
poverty. The primary goal of every CAA is self-sufficiency for its
clients. Helping families become self-sufficient is a long-term process
that requires multiple resources. This is why the partnership of
Federal, State, local, and private enterprise has been so vital to the
successes of the CAAs.
EXAMPLES OF CSBG AT WORK
Since 1994, CSBG has implemented a Results-Oriented Management and
Accountability (ROMA) system. Through ROMA, the effectiveness of
programs is captured through the use of goals and outcomes measures.
Below you will find several of the network's nationally aggregated
outcomes achieved by individuals, families and communities as a result
of their participation in innovative CSBG programs during fiscal year
2007:
--Increased Economic Asset Enhancement and Utilization.--694,000 low-
income households achieved an increase in financial assets or
financial skills as a result of Community Action assistance.
--Procured Supports To Reduce or Eliminate Barriers to Employment.--
1.3 million low-income participants obtained supports which
reduced or eliminated barriers to initial or continuous
employment through assistance from Community Action.
--Gained Employment.--193,000 low-income participants in Community
Action employment initiatives got a job, obtained an increase
in employment income, or achieved ``living wage'' employment
and benefits.
--Improved Child and Family Development.--2.9 million Infants,
children, youth, parents, and other adults participated in
developmental or enrichment programs facilitated by Community
Action and achieved program goals.
--Secured Independent Living for Low-Income Vulnerable Populations.--
2 million low-income vulnerable individuals received services
from Community Action and maintained an independent living
situation as a result.
At the end of the day, the CSBG Network represents our abiding
national commitment to care for the less fortunate and in recognition
that we are stronger when we do so. The CSBG and CSBG Network, in
addition to other nonprofit faith-based and community-based
organizations, are a critical complement to the public sector's efforts
towards helping to lift low-income Americans and their communities out
of poverty and into self-sufficiency.
In fiscal year 2007, the CSBG Network assisted approximately 20
percent of the persons in poverty that year and almost 15 million low-
income individuals who are members of more than 6.4 million low-income
families. Renewed funding for the CSBG Network is one of the best ways
to ensure that America has an experienced, guaranteed and trusted
network to assist its working and vulnerable families in achieving and
maintaining self-sufficiency. As such, NASCSP requests $800 million in
CSBG funding for fiscal year 2010.
______
Prepared Statement of the National Association of State Directors of
Career Technical Education Consortium
DEPARTMENT OF EDUCATION BUDGET
In his budget submission to Congress, President Obama has requested
flat funding for programs funded under the Carl D. Perkins Career
Technical Education (CTE) Act. If this level of funding holds, this
will be the third year in a row these programs will have received flat
funding. These programs are worthy of stronger support because of the
valuable contributions they make to serving adults and high school
students in their journey for education and training and eventual entry
into the workforce. Perkins CTE programs:
--Provide education that is relevant to students;
--Are actively reforming high school curriculum;
--Provide coordination between high schools and community colleges;
and
--Prepare workers for jobs that are in demand.
We respectfully request that the subcommittee include $1.4 billion
in support of Perkins programs. The last substantial funding increase
for Perkins occurred in fiscal year 2002. Since that time funding has
decreased by $42 million. When factoring in inflation this is the
equivalent of a reduction of $254 million.
Perkins includes a ``hold harmless'' provision that protects small
States from significant losses when there are reductions in Tech Prep
(title II of Perkins) funding. However, this provision only applies as
long as the total funding for Tech Prep does not fall below 1998
levels. Unfortunately, during the fiscal year 2008 appropriations
cycle, Tech Prep funding fell below this level and in turn, the hold
harmless provision put in place to protect small States was de-
activated. While most States have taken a loss of Tech Prep funds, the
small States have felt this cut in funding disproportionately. These
States have seen their Tech Prep funds reduced between 7 and 56 percent
below their fiscal year 2007 levels, costing some States hundreds of
thousands of dollars over the last 2 years. Below is a chart that
details the States and the approximate amount of funds they have lost
over the last 2 years. The funding figures are approximated because
only tentative fiscal year 2009 allocation numbers are available.
------------------------------------------------------------------------
State Amount
------------------------------------------------------------------------
Alaska.................................................. $221,390
Delaware................................................ 426,666
District of Columbia.................................... 349,264
Hawaii.................................................. 224,508
Montana................................................. 144,226
Nevada.................................................. 279,600
New Hampshire........................................... 295,212
North Dakota............................................ 50,758
Rhode Island............................................ 370,442
South Dakota............................................ 92,616
Vermont................................................. 209,334
Wyoming................................................. 86,416
------------------------------------------------------------------------
Tech Prep funding for the last 2 years was less than $100,000 below
the fiscal year 1998 hold harmless level of $103 million. If funding
for Tech Prep is raised ever so slightly to $103 million these States
will not be so negatively impacted.
Why Career Technical Education?
Career technical education (CTE) provides students and adults with
the academic and technical skills, knowledge and training necessary to
succeed in future careers and develop skills they will use throughout
their careers. CTE programs have been organized into 16 career
clusters, or similar occupational groupings, that identify the
knowledge and skills students need as they follow a pathway to their
goals. These clusters are: Agriculture, Food, and Natural Resources;
Architecture and Construction; Arts, A/V Technology and Communications;
Business Management and Administration; Education and Training;
Finance; Government and Public Administration; Health Science;
Hospitality and Tourism; Human Services; Information Technology; Law,
Public Safety, Corrections, and Security; Manufacturing; Marketing;
Science, Technology, Engineering and Mathematics; and Transportation,
Distribution and Logistics.
CTE prepares students for the world of work by introducing them to
workplace competencies, and makes academic content accessible to
students by providing it in a hands-on context.
CTE programs can be found in comprehensive high schools with career
technical education programs, as well as high schools solely devoted to
career technical education. Community colleges, technical institutes,
and skill centers also offer career technical education at the
postsecondary level. Nationally, about 60 percent of Perkins funds are
allocated for secondary school purposes and 40 percent for
postsecondary programs.
Programs of Study
The Carl D. Perkins Career and Technical Education Act of 2006
(Public Law 109-270), which funds CTE programs, requires States to
develop programs of study to guide students when choosing courses.
These programs of study include career and technical areas that:
--Incorporate both secondary and postsecondary education elements;
--Include rigorous content, challenging academic standards, and
relevant career and technical content in a coordinated,
nonduplicative series of courses that align secondary and
postsecondary education;
--May allow high school students to participate in dual or concurrent
enrollment programs or otherwise acquire postsecondary credit;
and
--Result in an industry-recognized credential or certificate, or
associate or baccalaureate degree.
Tech Prep
Tech Prep is a program in the Perkins Act that links a minimum of 2
years of secondary school and 2 years of post-secondary school or an
apprenticeship program, resulting in an associate degree or
certificate. Tech Prep allows students to begin a sequence of classes
in a career pathway while still in high school. Students enroll in both
academic and career and technical classes in the career field of their
choosing in order to develop the technical skills necessary for future
employment.
The Benefits of CTE
Academic
--Students enrolled in CTE programs are held to the same rigorous
academic standards as all students;
--CTE provides a strong foundation for those pursuing a traditional
4-year degree; and
--CTE students are more interested and motivated in their coursework
because of its connection to the real world, and have lower
dropout rates than traditional students.
Economic
--Many sectors of the economy that require skilled workers report a
shortage of qualified applicants to fill these positions. CTE
programs prepare individuals for skilled professions that are
essential to our Nation's economic recovery.
--CTE programs prepare students, adults, and displaced workers for
entry into high-skill, high-wage, and high-demand careers in
every industry sector.
The Federal role in ``vocational'' education began as a way to
prepare students for the newly industrialized economy. Over the years,
the program has evolved to match the needs of the changing economy,
focusing on postsecondary as well as secondary education while giving
students skills they can use throughout their careers.
In 2006, the language ``vocational and technical'' was updated to
``career and technical'' education. This transition was more than just
a name change. It represented a fundamental shift in philosophy from
CTE being for those who were not going to college to a system that
prepares students for both employment and postsecondary education. The
integration of academic and technical education programs was
strengthened, further emphasizing the goal of ensuring that students
who participate in CTE are taught the same rigorous content aligned
with challenging academic standards as all other students. With all
school programs now adhering to the same academic standards, the
separate ``track'' system that has stigmatized CTE is disappearing. The
chart that follows summarizes these changes.
------------------------------------------------------------------------
New career and technical
Traditional vocational education education
------------------------------------------------------------------------
For specific students For all students
------------------------------------------------------------------------
Limited program areas offered 16 Career Clusters and 79
pathways offered
Separate ``track'' with a focus on Integrated with academics in
technical education a rigorous and relevant
curriculum
------------------------------------------------------------------------
High school focused High school and
postsecondary partnerships
providing pathways to
employment and/or
associate, bachelor's, and
advanced degrees
------------------------------------------------------------------------
Students trained with focus on specific Progression of foundational,
occupational skill set pathway, occupational, and
21st century skills
------------------------------------------------------------------------
Career technical education programs have changed with the times and
are a fundamental piece of the education and training available to
Americans so that they can get the skills they need in today's economy.
Today, there are more than 15 million students and displaced workers
enrolled in CTE programs all across America. An increase in funding
would enable CTE programs to produce more skilled workers to fill the
jobs that are crucial to America's economy. Funds for these programs
will help high schools that are reeling from State and local budget
reductions and help community colleges accommodate their increasing
enrollments. We hope that you can provide $1.4 billion for Perkins CTE
supported programs in the fiscal year 2010 budget.
______
Prepared Statement of the National Alliance of State and Territorial
AIDS Directors
The National Alliance of State and Territorial AIDS Directors
(NASTAD) represents the Nation's chief State health agency staff who
have programmatic responsibility for administering HIV/AIDS and viral
hepatitis healthcare, prevention, education, and supportive service
programs funded by State and Federal Governments.
As you craft the fiscal year 2010 Labor, Health and Human Services,
and Education, an Related Agencies appropriations legislation, we urge
you to consider the following critical funding needs of HIV/AIDS, viral
hepatitis, and sexually transmitted diseases (STD) programs:
--$1.6 billion for the Ryan White Part B Program, including $514
million for the Part B Base and $1.1 billion for the AIDS Drug
Assistance Program (ADAP);
--$1.6 billion for the Centers for Disease Control and Prevention's
(CDC) HIV/AIDS Prevention Program, including an additional $249
million for State and local health department prevention
cooperative agreements to include an additional $49 million for
State and local HIV/AIDS surveillance systems, and the
expansion of the domestic HIV/AIDS Testing Initiative to
additional populations and jurisdictions;
--$50 million for CDC's Viral Hepatitis Prevention Program, including
a doubling of resources for the Adult Viral Hepatitis
Prevention Coordinator Program to $10 million.
--$16 million for hepatitis B vaccination for high-risk adults
through the Section 317 Vaccine Program;
--$451 million for CDC's STD Prevention Program for prevention,
treatment and surveillance cooperative agreements with State
and local health departments; and
--$610 million for the Minority AIDS Initiative to enhance capacity
in communities of color.
HIV/AIDS Care and Treatment Programs
The Health Resources and Services Administration administers the
$2.2 billion Ryan White Program that providing health and support
services to more than 500,000 HIV-positive individuals. NASTAD
respectfully requests a minimum increase of $362 million in fiscal year
2010 for State Ryan White Part B grants, including an increase of at
least $113 million for the Part B Base and at least $269 million for
ADAPs. With these funds all States and territories provide care,
treatment, and support services to persons living with HIV/AIDS. People
living with HIV need access to trained HIV clinicians, life-saving and
life-extending therapies, and a full range of support services to live
as healthy a life as possible and to ensure adherence to complicated
treatment regimens. All States are reporting to NASTAD that they are
seeing a significant increase in the number of individuals seeking Part
B Base and ADAP services--for some States it's a doubling of new
clients per month from the previous year. This is due to a number of
factors including, increased testing efforts and unemployment.
Ryan White Part B Base programs include ambulatory medical
services, case management, laboratory services, and an array of support
services. As of October 10, 2008, four States report that 266
individuals are on either a medical or support service waiting list for
services that include housing, mental health counseling, specialty
medical care, and transportation. Five States report that funding is
insufficient to ensure that all eligible patients attend medical
appointments every 3 months, which is the standard of care. Eight part
B programs are also considering cost containment measures for their
part B services in light of high demand and reduced funding.
State ADAPs provide medications to low-income individuals with HIV
disease who have limited or no coverage from private insurance or
Medicaid. While only three States currently have a waiting list with 53
individuals, the present fiscal condition of State ADAPs remain
fragile. In fiscal year 2008, State ADAPs were relatively stable due to
increased State contributions, increased rebates from drug companies,
$39.7 million in ADAP Supplemental grants, transfers of Part B Base
funding into ADAP, and program savings from the Medicare Part D
Prescription Drug Benefit. The continuing increase in clients and the
cuts in State contributions to ADAP (one State has cut their ADAP
contribution by $70 million) render the fiscal future of ADAPs
uncertain. On average, State spending accounts for 21 percent of the
total ADAP budget. Additionally, CDC estimates that their on-going
Domestic HIV/AIDS Testing Initiative will find 20,000 new infections
over the next year.
While we are very supportive of the funding increases in recent
years for the community health center (CHC) program, we want to be
clear that this hasn't necessarily translated into more care for person
living with HIV/AIDS. CHCs focus on primary care with most of the HIV/
AIDS care being provided in centers with Ryan White Part C grants.
HIV/AIDS Prevention and Surveillance Programs
At the request of Congress, the CDC developed a Professional
Judgment Budget detailing the needed resources to significantly reduce
the number of Americans becoming infected with HIV each year. CDC
identified the need for a funding increase of $878 million for total
funding of $1.6 billion for CDC's HIV prevention program in fiscal year
2010. As Congress strives to reach the $1.6 billion overall investment
in HIV prevention, NASTAD respectfully requests an initial increase of
$249 million in State and local health department HIV prevention and
surveillance cooperative agreements. This would include an additional
$49 million for State and local HIV/AIDS surveillance systems and the
expansion of the Domestic HIV/AIDS Testing Initiative to additional
populations and jurisdictions.
An estimated 56,300 new infections occur every year while State and
local HIV prevention cooperative agreements have been cut by $21
million between fiscal year 2003 and fiscal year 2008. CDC's 2007
surveillance reports showed a 15 percent increase in HIV diagnoses in
the 34 States included in the national database while CDC's HIV
prevention funding was cut in fiscal year 2008 and flat-funded in
fiscal year 2009. Additionally, core HIV/AIDS surveillance funding has
eroded over the last decade, while the importance of this data has
become paramount for targeting prevention efforts and directing Ryan
White resources.
The Nation's prevention efforts must match our commitment to the
care and treatment of infected individuals. State and local public
health departments know what to do to prevent new infections, they just
need the resources. First and foremost we must address the devastating
impact on racial and ethnic minority communities. We must expand
outreach and HIV testing efforts targeting high-risk populations
including gay and bisexual men of all races, racial, and ethnic
minority communities, substance users, women, and youth. But, testing
alone can never end the epidemic. All tools in the prevention arsenal
must be supported. Additional resources must be directed to build
capacity and provide technical assistance to enable community-based
organizations and healthcare providers to implement evidence-based
behavior change interventions, ensure fiscal responsibility and refer
partners of HIV-positive individuals to counseling and testing
services.
The Domestic HIV/AIDS Testing Initiative is an important step to
increasing knowledge of serostatus, particularly among African
Americans. Currently 25 jurisdictions (20 States and five cities)
receive $36 million for the Expanded Testing Initiative (ETI),
including rapid testing, in clinical settings such as emergency rooms,
community health centers, correctional health facilities, and STD and
tuberculosis clinics. Both CDC and NASTAD conducted assessments of year
1 including progress and challenges faced. Following significant scale-
up efforts in all jurisdictions, 21 of the funded jurisdictions
conducted 446,503 tests in year 1 of the ETI. Nearly 4,000 new HIV
infections were identified, 80 percent of which were in clinical
settings. During the first year, 86 percent of testing occurred in
clinical settings. Of the total number of tests conducted in the first
year, 64 percent were administered to African Americans. Seventy
percent of the newly identified infections were among African
Americans.
We are requesting that CDC receive sufficient resources to expand
the number of jurisdictions participating in the initiative--all
jurisdictions have a need for increased resources for testing if we are
to truly commit to providing access to testing for all individuals who
do not yet know their HIV status. Additional funding would also allow
the targeting of additional populations such as gay and bisexual men of
all races and Latinos. Another key component of the initiative to
expand is identification, notification and counseling of partners of
persons living with HIV/AIDS. Partner services are time and resource
intensive but maximize prevention efforts.
With 21 percent of HIV-infected persons unaware that they have HIV,
increased funding for testing and partner services will avert millions
in unnecessary healthcare costs.
We urge the subcommittee to not include language banning use of
Federal funds for syringe exchange programs in the fiscal year 2010
Labor, Health and Human Services, and Education, an Related Agencies
appropriations bill. Abundant research, endorsed by the findings of
eight federally commissioned reviews, has conclusively demonstrated
that syringe exchange is effective in reducing the transmission of HIV
without increasing drug use. In communities that fund and support
access to sterile injection equipment using State and local funds,
transmission of HIV and hepatitis in persons who inject drugs has
declined as a proportion of all cases by mode of transmission.
Unfortunately, State and locally funded syringe exchange are only
reaching a small portion of persons who inject drugs. It's time for the
Federal Government to use every tool at its disposal to arrest the
further spread of HIV and hepatitis C.
We also urge you to eliminate funds for the three separate Federal
abstinence-only-until-marriage programs. Instead, we request that you
create a dedicated Federal funding stream of at least $50 million in
your 2010 budget to fund medically accurate, comprehensive sex
education programs that teach young people about both abstinence and
contraception.
Lastly, we thank you and ask that you continue to limit the funding
for the duplicative Early Diagnosis Grant Program in Section 209 of the
Ryan White Treatment Modernization Act of 2006. This program is a carve
out of limited HIV testing resources when there is already $10 million
dedicated to perinatal prevention.
Viral Hepatitis Prevention Programs
NASTAD respectfully requests an increase of $36.4 million for a
total of $50 million in fiscal year 2010 for the CDC's Division of
Viral Hepatitis (DVH) to enable State and local health departments to
provide basic core public health services. DVH currently receives $18.3
million to address chronic viral hepatitis B and C impacting 6.2
million Americans. This is $7 million less than its peak funding of $25
million in fiscal year 2001. Currently CDC addresses viral hepatitis on
outbreak at a time, which is neither cost-effective nor real
prevention.
Of the DVH funding, $5.2 million is used to fund the Adult Viral
Hepatitis Coordinator Program with an average award to States of
$90,000. Doubling this program to $10 million would allow States to
implement a hepatitis prevention strategy. The coordinator position
receives precious little above personnel costs, leaving little to no
money for the provision of public health services including public
education, hepatitis counseling, testing, and hepatitis A and B
vaccine. In addition, there are no funds for surveillance of chronic
viral hepatitis, which would allow States to better target their
limited resources. Given the recent hepatitis public health crises in
Nevada and New York, the Government has a choice--invest in prevention
now or wait until public systems are overwhelmed by a lack of
infrastructure to address future outbreaks.
The greatest remaining challenge for hepatitis A and B prevention
is the vaccination of high-risk adults. High-risk adults account for
more than 75 percent of all new cases of hepatitis B infection each
year and annually result in an estimated $658 million in medical costs
and lost wages. In fiscal year 2007, CDC allowed States to use $20
million of 317 Vaccine funds to vaccinate high-risk adults for
hepatitis B and $16 million in fiscal year 2008. By targeting high-risk
adults, including those with hepatitis C, for vaccination, the gap
between children and adults who have not benefited from routine
childhood immunization programs can be bridged. NASTAD requests a
continuation of the $16 million in section 317 Vaccine funds in fiscal
year 2010 for hepatitis B vaccination for high-risk adults with the
request that in the future DVH receives dedicated funding for hepatitis
A and B vaccine for high-risk adults and funding to support the
infrastructure necessary for vaccine delivery.
STD Prevention Programs
NASTAD supports an increase of $299 million for a total of $451
million in fiscal year 2010 for STD prevention, treatment and
surveillance activities undertaken by State and local health
departments. STD prevention programs at CDC have been cut by $6 million
since fiscal year 2004 while the number of persons infected continues
to climb. The United States has the unwanted distinction of having the
highest rates of STDs of all industrial nations with 1 in 4 adolescent
girls in the United States, or more than 3 million, having an STD. The
rates of syphilis infection have increased for the seventh year in a
row. In 1 year, our Nation spends more than $8 billion to treat the
symptoms and consequences of STDS. Additional Federal resources are
needed to reverse these alarming trends and reduce the Nation's health
spending.
Minority AIDS Initiative
NASTAD also supports a $200 million increase for a total of $610
million for the Minority AIDS Initiative (MAI) in fiscal year 2010. The
MAI provides targeted resources to four agencies and the Office of the
Secretary to address the HIV/AIDS epidemic in hard-hit communities of
color. The data from CDC on the disproportionate impact on African
Americans and Latinos continues to be alarming. Support for the MAI
along with the traditional funding streams that serve these populations
is essential.
As you craft the fiscal year 2010 Labor, Health and Human Services,
and Education, an Related Agencies appropriations bill, we ask that you
consider all of these critical funding needs. National Alliance of
State and Territorial AIDS Directors thanks the Chairman, Ranking
Member and members of the subcommittee, for their thoughtful
consideration of our recommendations. Our response to the HIV, viral
hepatitis, and STD epidemics in the United States defines us as a
society, as public health agencies, and as individuals living in this
country. There is no time to waste in our Nation's fight against these
infectious and often chronic diseases.
______
Prepared Statement of the National Congress of American Indians
On behalf of the tribal nations of the National Congress of
American Indians (NCAI), we are pleased to present our recommendations
for fiscal year 2010 funding of Indian programs in the Departments of
Labor, Health and Human Services, and Education, and Related Agencies.
President Obama released a broad budget plan for fiscal year 2010 and
from what NCAI has reviewed of the blueprint so far, the new
administration plans to ensure America's promise extends to the entire
Nation, including throughout Indian country.
After tribes witnessed years of declining resources for critical
Indian programs in the Federal budget, the attention the
administration's fiscal year 2010 proposed budget has given to tribal
priorities is a welcome change. The chairman of this subcommittee has
heard often of the social and economic challenges facing Indian
country. This subcommittee has also heard that the recent resurgence of
tribal self-determination has resulted in measurable improvements in
the poverty, income, and unemployment among Indian people.
Indian tribes are rebuilding our Nations in ways that honor our
ancestors and cultures as well as meeting the demands and opportunities
of living in the modern world. An analysis of socioeconomic change
between 1990 and 2000 showed that Indian country economies grew at a
faster pace than the economy as a whole. Although Indian tribes have
made great strides in addressing the long-accumulated economic deficits
in our communities, much work remains to be done. Tribes also have a
critical role to play in the recovery as the Nation pulls out of the
current destructive recession. As the President and Congress aim to
invest in people to strengthen the middle class and the drivers of
economic growth, NCAI looks forward to tribal self-determination
playing a part in the solution. To ensure tribes continue to make
progress, sustained investment in tribal governments and programs that
support self-determination will be critical in fiscal year 2010. With
the new administration and the fiscal year 2010 budget request, there
is renewed hope in Indian country.
The President's fiscal year 2010 budget priorities appear to align
with many of Indian country's priorities: education, healthcare,
infrastructure, and clean energy. Below are some budget recommendations
for the Labor, Health and Human Services, and Education, and Related
Agencies appropriations bill.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Tragically, over the last year, nearly 3,000 American Indians and
Alaska natives died of cardiovascular disease, more than 16,500 were
diagnosed with a sexually transmitted disease, 5,000 were diagnosed
with diabetes for the first time, more than 22,000 are now living with
cancer (45 percent of which were diagnosed in the late-stages), and 400
took their own life.
These people are our tribal leaders; our daughters and sons; our
mothers and fathers; and, our brothers and sisters. For more than 100
years, Native people have experienced inferior health outcomes. Our
life expectancy is still 5 years less than that of other Americans.
Adequate funding is needed to end this lasting injustice and uphold the
Federal trust responsibility of the United States and the Federal
Government.
Provide $1 billion overall for Head Start funding. Provide $10
million for Esther Martinez language programs under the Administration
for Native Americans. Fifteen million dollars to fund SAMHSA Behavioral
Health Services Grants for American Indian and Alaska Natives. Increase
Circles of Care, SAMHSA by $5 million
ADMINISTRATION FOR CHILDREN AND FAMILIES
Head Start.--Over the past 40 years, Head Start has played a major
role in the education of Indian children and in the well-being of many
tribal communities. However, because of inadequate funding, only about
16 percent of the age-eligible Indian child population is enrolled in
Indian Head Start. The comprehensive nature of this program integrates
education, health, and family services. Since it closely mirrors a
traditional Indian educational model, it is one of the most successful
Federal programs operating in Indian country. Despite these successes,
Head Start funding has declined by 14 percent over the last 6 years,
after factoring in inflation. Head Start should be funded at a rate
substantially greater than inflation to make up for prior year cuts and
also to trigger special Indian expansion funds that Congress provided
when the Head Start Act was reauthorized in 2007.
--$1 billion--Head Start funding (overall)
ADMINISTRATION FOR NATIVE AMERICANS
Native Languages.--Throughout Indian country, tribes are combating
the loss of traditional languages by advocating for and instituting
language programs within their communities. These language programs
serve Native communities by preventing the loss of tribal traditions
and cultures. The tribal students in these language immersion programs
perform substantially better academically, including on national tests,
than Native students who have been enrolled in such programs.
--$10 million--Esther Martinez language programs under the
Administration for Native Americans
SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION (SAMHSA)
American Indian and Alaska Native Grant Program.--This grant
program within SAMHSA has been authorized to award grants to Indian
health programs to provide the following services: prevention or
treatment of drug use or alcohol abuse, mental health promotion, or
treatment services for mental illness. To date, these funds have never
been appropriated.
--$15 million to fund SAMHSA Behavioral Health Services Grants for
American Indian and Alaska natives.
Circles of Care.--Increase funding to $10 million a year for the
Circles of Care children's mental health grant program under Programs
of National and Regional Significance under SAMHSA. This grant program
has historically been funded at about $5 million a year, which provides
for approximately seven tribal grants during each 3-year grant cycle.
The program has been very successful and has spawned several new tribal
children's mental health programs in Indian country that as a result
have been self-sustaining.
--Increase of $5 million
DEPARTMENT OF EDUCATION
The administration intends to make investments in education so all
Americans can have the chance to receive a world-class education from
cradle to career. The 2007 National Indian Education Study indicated
that in reading and math, American Indian and Alaska native students
scored significantly lower than their peers in both fourth and eighth
grades. To ensure that Native students--from pre-school to college--
meet the same challenging academic standards as other populations and
experience the benefits of a quality and supportive education, it is
imperative that the Federal Government uphold its responsibility for
the education of Indian people.
Provide $195.5 million for title VII funding under the No Child
Left Behind Act. Increase Impact Aid funding 10 percent to adjust for
inflation and population growth ($1,365 million). Provide $32 million
for title III, Higher Education Act (HEA). Provide $62 million (one-
time) forward funding for Tribal Colleges and Universities (TCUs).
Provide $10 million for tribal education departments.
Title VII Funding.--This funding provides critical support for
culturally based education approaches for American Indian and Alaska
native students and addresses the unique educational and cultural needs
of Native students. It is well-documented that Native students are more
likely to thrive in environments that support their cultural identities
while introducing different ideas. Title VII has produced many success
stories within our communities, but increased funding is critical in
this area to bridge the achievement gap for Native students.
--$195.5 million
Impact Aid Funding.--Impact Aid provides resources to public
schools whose tax bases are reduced because of Federal activities,
including the presence of an Indian Reservation. Impact Aid affects
Native children living on or near tribal lands and children of military
families living on or near bases. Approximately 95 percent of American
Indian and Alaska Native youth are educated in public schools. Impact
Aid funding must be adjusted based on population increases and
inflation.
--Increase impact aid funding 10 percent to adjust for inflation and
population growth ($1,365 million)
TCUs.--Titles III and V of the HEA, known as Aid for Institutional
Development programs, support institutions with a large proportion of
financially disadvantaged students and low cost-per-student
expenditures. TCUs fit this definition. The Nation's 36 TCUs serve some
of the most impoverished areas in the Nation, yet they are the
country's most poorly funded postsecondary institutions. Congress
recognized the TCUs as young and struggling institutions and authorized
a separate section of title III (part A, section 316) specifically to
address their needs. Additionally, a separate section (section 317) was
created to address similar needs of Alaska native and Native Hawaiian
institutions. Section 316 is divided into two competitive grants
programs: Formula funded basic development grants and competitive
single-year facilities construction grants. Under the Tribal College
Act, securing the one-time payment to transition institutional
operating grants to a forward funded program would finally end the
cycle of delayed payments, short-term loans, and layoffs that currently
plague TCUs each year; and, further for the first time, it would
provide these institutions the resources they need at the start of each
academic year.
--$32 million--Title III, HEA
--$62 million (one-time) forward funding for TCUs
Tribal Education Departments.--More than 100 Indian tribes have
started Tribal Education Departments (TED). TEDs develop and administer
policies, gather and report data and perform critical research to help
tribal students from early childhood through higher and adult
education. TEDs serve thousands of tribal students nationwide in BIA,
tribal, and public schools. They also cultivate leadership skills and
train a potential workforce. Funding for TEDs has been authorized by
Congress but never appropriated in either the BIA budget or that of the
Department of Education. Both of these authorizations are retained in
the No Child Left Behind Act of 2001. Tribes must have access to
funding in order to close the achievement gaps so that tribal students
will be better equipped to perform well in school. We recommend that $5
million of the funding be directed from the Department of the Interior
and $5 million of the funding be directed from the Department of
Education.
--$10 million--Tribal education departments
conclusion
NCAI realizes Congress must make difficult budget choices this
year. As elected officials, tribal leaders certainly understand the
competing priorities that you must weigh over the coming months.
However, the Federal Government's constitutional and treaty
responsibility to address the serious needs facing Indian country are
unique. These responsibilities remain unchanged, whatever the economic
climate and competing priorities may be. We at NCAI urge you to make a
strong, across-the-board commitment to meeting the Federal trust
obligation by fully funding those programs that are vital to the
creation of vibrant Indian nations. Such a commitment, coupled with
continued efforts to strengthen tribal governments and to clarify the
Government-to-government relationship, truly will make a difference in
helping us to create stable, diversified, and healthy economies in
Indian country.
______
Prepared Statement of the National Consumer Law Center \1\
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\1\ Prepared by Olivia Wein, Staff Attorney, National Consumer Law
Center (202-452-6252, [email protected]).
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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. LIHEAP is an important safety net program for low-
income, unemployed, and underemployed families struggling in this
economy. In fiscal year 2009, the program is expected to assist 7.3
million low-income households afford their energy bills. Residential
consumers continue to pay much higher heating bills than in the past,
and depending on the region of the country and the heating fuel, the
increase in expenditures for heating fuel have been substantial over
time. 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 2010 and that advance funding of $5.1 billion be provided
for the program in fiscal year 2011.
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\2\ 42 U.S.C. Sec. Sec. 8621 et seq.
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HOME ENERGY BILLS REMAIN HIGH AT A TIME WHEN UNEMPLOYMENT AND
UNDEREMPLOYMENT IS GROWING
Residential heating expenditures remain at high levels. Average
residential heating expenditures this winter are expected to be about
38 percent higher for heating oil, 16 percent higher for natural gas,
42 percent higher for propane, and 24 percent higher for electricity
when compared to the 5-year average for 2002-2007.\3\ The steady, high
energy bills are hitting low-income households struggling in this
economic downturn. According to the Bureau of Labor Statistics, in
March 2009, the number of unemployed workers was 13.2 million, with
half the increase in the number of unemployed occurring within the past
4 months.\4\ According the Economic Policy Institute, the number of
involuntary part-time workers nearly doubled to more than 8 million in
the past year, largely due to full-time workers accepting reduced
hours.\5\ The hardship low-income households face is also apparent in
the data below on the number of households falling behind.
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\3\ Derived from data in the Energy Information Agency, Short-Term
Energy Outlook (Feb. 2009), Table WF01.
\4\ US, DOL, Bureau of Labor Statistics, The Employment Situation:
March 2009 (rel. April 3, 2009).
\5\ See Ross Eisenbrey and Kathryn Edwards, Downtime: Workers
forced to settle for fewer hours, Economic Policy Institute (Jan. 14,
2009).
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STATES' DATA ON ELECTRIC AND NATURAL GAS DISCONNECTIONS AND ARREARAGES
SHOW THAT MORE HOUSEHOLDS ARE FALLING BEHIND
The steady and dramatic rise in residential energy costs has
resulted in increases in electric and natural gas arrearages and
disconnections. For example, in Rhode Island in 2008 there were 8
percent more service disconnections for nonpayment than in any other
year on record, and 21 percent of those accounts were not restored.\6\
A recent national survey by the National Association of Regulatory
Utility Commissioners found that almost 40 million electricity and
natural gas residential consumers held nearly $8.7 billion in past-due
accounts at the end of the 2007-2008 Winter heating season. The survey
also concluded that in calendar year 2007, 8.7 million residential
consumers had their electricity or natural gas service terminated for
failing to pay their bills, with 3.6 million who remained disconnected
as of this past May 2008.\7\
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\6\ Analysis of John Howat, senior policy analyst at National
Consumer Law Center (April 2009).
\7\ Sandra Sloane, Mitchell Miller, Beverly Barker, Lisa Colosimo,
``2008 Individual State Report by NARUC Consumer Affairs Subcommittee
on Collections Data Gathering.'' (Approved on Nov. 17, 2008 by the
NARUC Consumers Affairs Committee).
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Although there are winter utility shut-off moratoria in place in
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. Low-income families are
falling further behind as we endure year after year of rising home
energy prices. We expect the number of disconnections to grow and the
gap between disconnections and reconnections to also grow, especially
in light of the economic challenges faced by the unemployed and
underemployed workers.
Iowa.--Iowa has experienced a steady increase in enrollment for the
regular LIHEAP program from fiscal year 2007 to fiscal year 2009 with
86,000 households in 2007; 87,000 in 2008 and projects 95,700 in fiscal
year 2009.\8\ As a testament to the difference LIHEAP can make for low-
income households, in February 2009, the number of Iowa low-income
households with past-due energy accounts and the total amount of the
low-income arrears were lower than for the past 3 years at this point
in time (e.g., February 2006, February 2007, and February 2008).
Comparatively, when looking at the arrearage data for February over
time for the total residential gas and electric accounts in arrears and
the amount of those arrears, those numbers are at historic highs.\9\
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\8\ NEADA press releases from April 25, 2008 and January 12, 2009.
\9\ Based on data provided by the Iowa Bureau of Energy Assistance.
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Ohio.--Ohio has experienced a steady and dramatic demand for low-
income energy assistance. The number of households entering into the
State's low-income energy affordability program, the Percentage of
Income Payment Program (PIPP), increased 9 percent from January 2008 to
January 2009. The increase is an even more dramatic 86 percent between
January 2003 and January 2009. The total dollar amount owed (arrearage)
by low-income PIPP customers increased 11 percent from January 2008 to
January 2009 and 52 percent when comparing PIPP customer arrears from
January 2003 to January 2009.\10\ Ohio has experienced a steady
increase in enrollment for the regular LIHEAP program (HEAP) from
fiscal year 2007 to fiscal year 2009 with 360,000 households in 2007;
370,000 in 2008 and projects 400,000 in fiscal year 2009.\11\
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\10\ Public Utilities Commission of Ohio.
\11\ NEADA press releases from April 25, 2008 and January 12, 2009.
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Pennsylvania.--Pennsylvania has also experienced a steady increase
in enrollment for the regular LIHEAP program from fiscal year 2007 to
fiscal year 2009 with 367,000 households in 2007; 398,000 in 2008 and
projects 490,000 in fiscal year 2009.\12\ 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 17,745 households entered the current heating season without heat-
related utility service--this number includes about 3,373 households
who are heating with potentially unsafe heating sources such as
kerosene or electric space heaters and kitchen ovens. In mid-December
2008, an additional 13,595 residences where electric service was
previously terminated were vacant and more than 6,442 residences where
natural gas service was terminated were vacant. In 2008, the number of
terminations increased 73 percent compared with terminations in 2004.
As of December 2008, 18.3 percent of residential electric customers and
16.9 percent of natural gas customers were overdue on their energy
bills. These 2008 overdue utility bills have increased 9.57 percent
more than 2007. In addition, in recognition of the increases in media
reports of deaths of terminated customers the PA PUC implemented a new
reporting requirement. Utilities in Pennsylvania are now required to
file reports regarding any incidents involving death at locations where
residential utility service has been terminated.\13\ The economic
downturn is putting additional pressures on local human service
agencies as well. A report on the effect of economy on Pittsburgh,
Pennsylvania shows a 73.3 percent increase in ``first time'' applicants
for a range of basic needs assistance, including energy assistance.\14\
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\12\ NEADA press releases from April 25, 2008 and January 12, 2009.
\13\ Pennsylvania Public Utility Commission Bureau of Consumer
Services.
\14\ Vivien Luk and Stacy Kehoe, Understanding the Impact of the
Economic Downturn on Pittsburgh Residents and Human Service Agencies,
the Forbes Funds (November 2008).
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States are Predicting Record LIHEAP Participation.--NEADA reports
that for fiscal year 2009, 15 States have projected increases in
participation of at least 21 percent, with Texas estimating a 201
percent increase; Florida 200 percent; California 162 percent;
Tennessee 60 percent; Arkansas 50 percent; Arizona 35 percent; Alaska
34 percent; New Mexico 26 percent; Oregon 26 percent; Alabama 25
percent; Massachusetts 25 percent; New Hampshire 25 percent;
Pennsylvania 23 percent; Connecticut 23 percent; and Delaware 21
percent.\15\ In Arkansas, many of the community action agencies are
estimating that about 40 percent of the people contacting them for
services over the past 8 to 10 months are new applicants;
overwhelmingly, these new applicants are seeking utility
assistance.\16\ Thus there is great need for a fully funded LIHEAP
program in the States.
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\15\ NEADA press release, Applications for Low Income Energy
Assistance Reach Record Levels: States Call on Congress to Increase
Funding for LIHEAP (January 12, 2009).
\16\ Estimates provided by Arkansas Community Action Agencies
Association, Inc.
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LIHEAP IS A CRITICAL SAFETY NET PROGRAM FOR THE ELDERLY, THE DISABLED
AND HOUSEHOLDS WITH YOUNG CHILDREN
LIHEAP is Vital to Poor Seniors.--Poor seniors are cutting back on
energy usage because it is not affordable. In general, elder households
use less total household energy than nonelderly households, which is
attributable primarily to the smaller dwelling units. However, poor
elderly households use markedly less energy than nonpoor elderly
households. Even worse, poor elderly households, on average, consume 12
percent more energy per square foot of living space (this measurement
is also referred to as energy intensity) than non-poor elderly
households. This disparity is attributable to the poorly weatherized
living spaces and the use of old, inefficient heating equipment and
appliances.\17\ LIHEAP is critical for helping low-income seniors
maintain safe temperatures in their homes.
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\17\ NCLC analysis of U.S. Energy Information Administration, 2001
Residential Energy Consumption Survey data on elderly energy
consumption and expenditures.
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Dire Choices and Dire Consequences.--Recent national studies have
documented the dire choices low-income households face 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.\18\ The U.S. Department of Agriculture has
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.\19\ 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.\20\ Clearly, families are going without food during the winter to
pay their heating bills, and their children fail to thrive and grow.
The loss of essential utility services can be devastating, especially
for poor families that can find themselves facing eviction. A 2007
Colorado study found that the second leading cause of homelessness for
families with children is the inability to pay for home energy.\21\
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\18\ See e.g., National Energy Assistance Directors' Association,
2008 National Energy Assistance Survey, Tables in section IV, G and H
(April 2009) (To pay their energy bills 32 percent of LIHEAP recipients
went without food, 42 percent went without medical or dental care, 38
percent did not fill or took less than the full dose of a prescribed
medicine, 15 percent got a payday loan). Available at http://
www.neada.org/communications/press/2009-04-28.htm.
\19\ 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.
\20\ 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) and the Testimony of Dr. Frank
Before the Senate Committee on Health, Education, Labor and Pensions
Subcommittee on Children and Families (March 5, 2008).
\21\ Colorado Interagency Council on Homelessness, Colorado
Statewide Homeless Count Summer, 2006, research conducted by University
of Colorado at Denver and Health Sciences Center (Feb. 2007).
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When people are unable to afford paying their home energy bills,
dangerous and even fatal results occur. In the winter, families resort
to using unsafe heating sources, such as space heaters,\22\ ovens and
burners, all of which are fire hazards. In 2006, 73 percent of home
heating fire deaths, 43 percent of home heating fire injuries and 51
percent of property damage from home heating fires involved stationary
or portable space heaters. In the summer, the inability to keep the
home cool can be lethal, especially to seniors. According to the CDC,
older adults, young children and person with chronic medical conditions
are particularly susceptible to heat-related illness and are at a high
risk of heat-related death. The CDC reports that 3,442 deaths resulted
from exposure to extreme heat during 1999-2003.\23\ The CDC also notes
that air-conditioning is the number one protective factor against heat-
related illness and death.\24\ LIHEAP assistance helps these vulnerable
seniors, young children and medically vulnerable persons keep their
homes at safe temperatures during the winter and summer and also funds
low-income weatherization work to make homes more energy efficient.
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\22\ John R. Hall, Jr., Home Fires Involving Heating Equipment:
Space Heaters (In 2006 there were an estimated 64,100 home fires
involving space heaters resulting in 540 deaths, 1,400 injuries and
$943 million in property damage) National Fire Protection Association
(Jan. 2009).
\23\ CDC, ``Heat-Related Deaths--United States, 1999-2003'' MMWR
Weekly, July 28, 2006.
\24\ CDC, ``Extreme Heat: A Prevention Guide to Promote Your
Personal Health and Safety'' available at http://emergency.cdc.gov/
disasters/extremeheat/heat_guide.asp.
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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 2010 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 during this economic
downturn. In addition, fiscal year 2011 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 Coalition of STD Directors
The National Coalition of STD Directors (NSCD) is a nonprofit,
nonpartisan association of public health sexually transmitted (STD)
program directors in the 65 Centers for Disease Control and Prevention
(CDC) directly funded project areas, which includes all 50 States, 7
cities, and 8 U.S. territories. As the only national organization with
a constituency that provides frontline STD services, NCSD is the
leading national voice for strengthening STD prevention, research and
treatment. These efforts include advocating for effective policies,
strategies, and sufficient resources, as well as increasing awareness
of the medical and social impact of STDs.
We appreciate this opportunity to provide the subcommittee with
information about the health crisis caused by the persistent and
staggeringly high rates of STDs in the United States and about the
programs of the CDC that combat these diseases.
The United States has the highest STD rates in the industrialized
world, with more than 19 million people contracting an STD annually. In
1 year, our Nation spends more than $8.4 billion to treat the symptoms
and consequences of STDs. The indirect costs are higher, including lost
wages and productivity, as well as human costs such as anxiety, shame,
anger, depression and the challenges of living with infertility or
cancer. The health consequences of STDs include: chronic pain,
infertility, pregnancy complications, pelvic inflammatory disease,
cervical cancer, birth defects, and increased vulnerability to HIV, the
virus that causes AIDS. Persons with a pre-existing STD have a three-
to fivefold increased risk of acquiring HIV through sexual contact. In
addition, studies have shown that HIV-infected persons who are also
infected with other STDs are more likely to transmit HIV. Comprehensive
STD treatment can reduce the likelihood of HIV transmission.
STDs have a disproportionate impact on young people--women, men who
have sex with men (MSM), and racial and ethnic minorities. Of the
approximately 19 million new STD infections each year, nearly half are
among young people ages 15 to 24. Chlamydia, which leads to
infertility, is the most frequently reported disease in the United
States. Nearly 1 million women will have a severe case of pelvic
inflammatory disease due to STDs. The transmission of STDs to babies--
prenatally, during birth, or after--can cause serious life-long
complications including physical disabilities, developmental
disabilities, and death. MSM have historically experienced high rates
of all STDs, including HIV/AIDS. In 2007, 65 percent of all primary and
secondary syphilis cases were among MSM. The syphilis rate among males
is now six times the rate among females, a dramatic disparity that did
not exist a decade ago, when rates were nearly equivalent between the
sexes. This trend suggests that the increase in cases among men have
been primarily among men who have sex with men. Persons of color,
particularly African-Americans, American Indians/Alaska natives, and
Hispanics are also at higher risk of contracting STDs. In 2007, the
rate of chlamydia among African Americans was eight times that of
whites, for American Indian/Alaska natives it was five times higher
than whites, and for Hispanics it was three times higher than whites.
African American women experience syphilis rates 14 times higher than
white women. Socioeconomic, cultural and linguistic barriers to quality
healthcare and STD prevention and treatment services have likely
contributed to a higher prevalence and incidence of STDs among racial
and ethnic minorities.
While rates of STDs in this country have continued to skyrocket,
Federal funding for CDC's Division of STD Prevention has steadily
declined since fiscal year 2003. For every $1 spent on STD prevention,
$43 is spent each year on STD-related costs. In addition, for every $1
spent on research, $92 is spent each year on STD-related costs.
NSCD requests an fiscal year 2010 funding level of $451.3 million,
an increase of $299 million, for the STD prevention, treatment, and
surveillance programs of the CDC. These funds will significantly
enhance the CDC's ability to reduce STD rates across the country.
Public Health Infrastructure (+$40 Million)
Federal funding for CDC's Division of STD Prevention has been
relatively flat for the past 15 years. The combined effect of this,
along with steadily increasing rates of STDs and more recently, drastic
State and local budget cuts due to the economic crisis, STD programs
are in crisis mode and stretched thinner than ever. STD programs have
had to cut staff, dramatically cut clinical services or close clinic
doors altogether, and eliminate critical services such as free condom
distribution programs. The public health infrastructure must be rebuilt
and modernized. Investments in training, information and surveillance
systems, public health laboratories, and better diagnostic technologies
would increase efficiency, ensure program effectiveness, and protect
the health of future generations.
Public Health Workforce (+$24 Million)
A critical piece of rebuilding the public health infrastructure is
scaling up the public health workforce. One-quarter of the current
public health workforce will be eligible to retire by 2012. We must
invest now in training and retraining the next generation of public
health professionals. This is particularly critical for STD programs.
The underpinning of all STD programs is the Disease Intervention
Specialist (DIS), who provide partner services to individuals infected
with STDs, their partners, and to other persons who are at increased
risk for STD infection. DIS are specially trained public health workers
who are responsible for locating, counseling, and coordinating the
testing of individuals exposed to an STD. DIS complete an intensive CDC
training course, which provides a strong foundation in field
investigation techniques, both on the ground and on the Internet. In
some States, DIS also assist in the HIV Partner Services program, by
assisting newly HIV-infected individuals with informing their partners
of their status and encouraging those partners to seek HIV counseling,
testing, and related prevention services. DIS also provide surge
capacity during an emergency response, such as the current swine flu
epidemic. The versatile expertise of DIS make them indispensable during
a public health crisis, and also highlights the need for increased
resources to support the training and hiring of new DIS. The current
economic crisis has forced many States to freeze the hiring of new DIS
and even lay off DIS, in spite of increasing STD cases.
Expand Chlamydia Screening and Infertility Prevention (+$100 Million)
Chlamydia is the most commonly reported disease in the United
States, as well as the primary cause of infertility. The Infertility
Prevention Project (IPP), a collaborative effort between CDC and Office
of Population Affairs within the Department of Health and Human
Services, has been working to reduce STD-related infertility for 15
years. IPP provides funding to screen low-income women for chlamydia
and gonorrhea in STD and family planning clinics. This project is a
major success story in STD prevention, having been highly successful in
reducing new cases of chlamydia and gonorrhea in areas where it has
been implemented. However, additional resources are needed to bring
this project to scale and reach a greater number of at-risk women.
Chlamydia screening has also been shown to be extremely cost effective.
Among 21 evidence-based clinical services recommended by the U.S.
Preventive Service Task Force, chlamydia screening for young women
ranked among the top 5 as having the most health benefits and best
value for the dollar.
Additional Federal resources would help support increased chlamydia
screening in the public sector, expand school-based and correctional-
based screening, as well as initiate a series of demonstration projects
in the private sector aimed at increasing private sector screening
rates.
Gonorrhea Control and Health Disparities Reduction (+$78 Million)
Gonorrhea is the second most commonly reported infectious disease
in the United States. African Americans are the most heavily impacted
by this disease, with overall rates 19 times greater than that of
whites in 2007. African-American men aged 15 to 19 years old experience
gonorrhea rates 39 times higher than white men in the same age group.
An increasing issue of concern in the treatment of gonorrhea is
antimicrobial drug resistance. In 2006, 13.8 percent of all gonorrhea
cases demonstrated resistance, while 39 percent of the cases
specifically among MSM demonstrated resistance. In 2007, CDC revised
its gonorrhea treatment guidelines to include only a single class of
antibiotics.
Additional Federal resources would be used to monitor antimicrobial
resistant gonorrhea and test alternate or new drug regimens, initiate
culturally competent social marketing campaigns, increase screening and
partner services in hyperendemic areas, and develop demonstration
research projects to determine the effectiveness and cost-effectiveness
of gonorrhea prevention and control interventions.
Syphilis Elimination (+$50 Million)
The rates of primary and secondary syphilis, the most infectious
stages of the disease, decreased throughout the 1990s, and in 2000
reached an all-time low. However, since 2000 as STD funding has
declined, the syphilis rate in the United States has increased by 76
percent. Since 1999, the Syphilis Elimination Effort (SEE), a
collaboration between CDC and State, local, and nongovernmental
partners, has worked to eliminate syphilis from all areas of the
country and reduce long-standing health disparities. These strategies
include: expanded surveillance and outbreak response activities, rapid
screening and treatment in and out of medical settings, expanded
laboratory services, strengthened community involvement and agency
partnerships, and enhanced health promotion. These efforts have been
shown to be successful, but must be funded adequately. A 2008 study
suggested that SEE funding in a given year was associated with
subsequent declines (over the following 2 years) in syphilis rates in a
given State. The greater a State's per capita syphilis elimination
funding in a given year, the greater the decline in syphilis rates in
subsequent years. While the activities of SEE have proven themselves to
be effective, they must be adequately and consistently funded to
ultimately eliminate this disease in the United States.
Additional Federal resources for SEE would be prioritized for
increased screening, particularly among HIV positive persons and
pregnant women, the development and evaluation of rapid diagnostic
tests, implementation of social marketing campaigns targeted towards
MSM and minority populations, and expanded screening in correctional
facilities.
Build a Response to Viral STDs (Herpes, HPV, Hepatitis B)
More than 45 million Americans, almost 26 percent of the U.S.
population, are infected with herpes simplex virus (HSV), a treatable
but incurable viral STD. Improved treatment of HSV is fundamental to
reducing the rates of transmission. Individuals with herpes are more
susceptible to acquiring HIV. An estimated 20 million Americans are
infected with human papillomavirus (HPV), the cause of about 90 percent
of all cervical cancer cases. CDC would utilize additional funds to
monitor the HPV vaccine introduction and behavioral impact of HPV
vaccine through demonstration projects and an expansion of an existing,
multi-level, multi-year behavioral research project. The most common
source of hepatitis B virus (HBV) infection among adults is sexual
contact. Funding is needed to expand prevention efforts on HPV and HBV
and to deliver education on the availability of preventive vaccines.
______
Prepared Statement of the National Down Syndrome Society
Mr. Chairman and members of the subcommittee: As Chairperson of the
National Down Syndrome Society, I want to take this opportunity to
thank you for the leadership role this subcommittee has played over the
years in supporting and creating awareness on Down syndrome. I am
pleased to offer the following written testimony regarding
appropriation requests for Down syndrome in fiscal year 2010.
There are more than 400,000 people living with Down syndrome in the
United States, and about 5,000 babies, or 1 in 800, that are born each
year. Down syndrome occurs in people of all races and economic levels,
and it is the most frequently occurring chromosomal condition. The
incidence of births of children with Down syndrome increases with the
age of the mother. But due to higher fertility rates in younger women,
80 percent of children with Down syndrome are born to women under 35
years of age.
Advancements in the treatment of health problems have allowed
people with Down syndrome to enjoy fuller and more active lives, and
become more integrated into the economic and social structures of our
communities. Unfortunately, while progress has also been made in public
policies that enhance the lives of individuals with Down syndrome,
barriers still exist, making it difficult for people to access adequate
healthcare, housing, employment, and education.
We have been working with Congress for decades to address these
challenges and advance public policies that promote the acceptance and
inclusion of individuals with Down syndrome, and help them to achieve
their full potential in all aspects of their lives.
Mr. Chairman, we understand the challenges the subcommittee faces
in prioritizing requests, we believe that funding the requirements of
the Prenatally and Postnatally Diagnosed Conditions Awareness Act of
2007 (Public Law 110-374) is imperative given the significant impact
Down syndrome has on families and communities across the country and
the great potential for improvements in quality of life. On behalf of
the National Down Syndrome Society, we recommend that you appropriate
$5 million in the fiscal year 2010 to implement the requirements of the
Prenatally and Postnatally Diagnosed Conditions Awareness Act of 2007.
As you know, last year, Congress passed the Prenatally and
Postnatally Diagnosed Conditions Awareness Act of 2007. This new law
seeks to ensure that pregnant women receiving a positive prenatal
diagnosis of Down syndrome and parents receiving a postnatal diagnosis
will receive up-to-date, scientific information about life expectancy,
clinical course, intellectual and functional development, and prenatal
and postnatal treatment options. It offers referrals to support
services such as hotlines, Web sites, informational clearinghouses,
adoption registries, parent support networks, and Down syndrome and
other prenatally diagnosed conditions programs. The goal is to create a
sensitive and coherent process for delivering information about the
diagnosis across the variety of medical professions and technicians, to
avoid any conflicting, inaccurate, or incomplete information. Also, the
legislation would promote the rapid establishments of links to
community supports and services for parents who choose to take their
baby with Down syndrome home or for those who choose to have their
child adopted.
It is estimated that more than 1,000 prenatal tests are available
or in development. Included among them are tests for conditions that
are not life-threatening, could be helped by surgery or medical care,
or don't appear until adulthood. The prognoses for people with some
prenatally diagnosable disabilities have been improving markedly in
recent years, leaving medical professionals scrambling to keep up with
changing data. By including $5 million in the fiscal year 2010 Labor,
Health and Human Services, and Education, and Related Agencies
appropriations bill, the Department of Health and Human Services (HHS)
will be able to fund its responsibilities to:
--Collect and distribute information relating to Down syndrome and
other prenatally or postnatally diagnosed conditions;
--Coordinate the provision of supportive services for patients
receiving a positive diagnosis of a prenatally or postnatally
diagnosed condition; and
--Oversee the new requirements for healthcare providers established
by the law. The funding is also needed to carry out the
requirement that the CDC assist State and local health
departments to integrate testing results into surveillance
systems.
Mr. Chairman, thank you for your time and attention. Given the
considerable impact this condition has on families and communities
across the country, the promise of further assistance and improving
research outcomes for individuals with Down syndrome is crucial. We are
thrilled beyond measure that Congress enacted this legislation and hope
that funding this request will help to shift the way the Nation regards
individuals with disabilities. Through providing accurate, updated
information about diagnosable conditions like Down syndrome to pregnant
women, the expectation is that individuals and families will make
better, more-informed decisions. But the bigger impact will be better
understanding on the part of the American people about the nature of
disability and the value of these citizens to their families, their
communities and to our country. Should you have any questions or
require additional information, please feel free to call on me.
______
Prepared Statement of the NephCure Foundation
ONE FAMILY'S STORY
Chairman Cochran and members of the subcommittee thank you for the
opportunity to provide written testimony today, I am Dee Ryan and my
husband is Lieutenant Colonel John Kevin Ryan, an Iraq war veteran. I
would like to tell you about my 6-year-old daughter Jenna's nephrotic
syndrome (NS), a medical problem caused by rare diseases of the kidney
filter. When affected, these filters leak protein from the blood into
the urine and often cause kidney failure requiring dialysis or kidney
transplantation. We have been told by our physician that Jenna has 1 of
2 filter diseases called Minimal Change Disease or Focal and Segmental
Glomerulosclerosis (FSGS). According to a Harvard University report
there are presently 73,000 people in the United States who have lost
their kidneys as a result of FSGS. Unfortunately, the causes of FSGS
and other filter diseases are very poorly understood.
In October 2007 my daughter began to experience general swelling of
her body and intermittent abdominal pain, fatigue, and general malaise.
Jenna began to develop a cough and her stomach became dramatically
distended. We rushed Jenna to the emergency room where her breathing
became more and more labored and her pulse raced. She had symptoms of
pulmonary edema, tachycardia, hypertension, and pneumonia. Her lab
results showed a large amount of protein in the urine and a low
concentration of the blood protein albumin, consistent with the
diagnosis of FSGS. Jenna's condition did not begin to stabilize for
several frightening days.
Following her release from the hospital we had to place Jenna on a
strict diet which limited her consumption of sodium to no more than
1,000 mg per day. Additionally, Jenna was placed on a steroid regimen
for the next 3 months. We were instructed to monitor her urine protein
levels and to watch for swelling and signs of infection, in order to
avoid common complications such as overwhelming infection or blood
clots. Because of her disease and its treatment, which requires strong
suppression of the immune system, Jenna did have a serious bacterial
infection several months after she began treatment.
We are frightened by her doctor's warnings that NS and its
treatment are associated with growth retardation and other medical
complications including heart disease. As a result of NS, Jenna has
developed hypercholesterolemia and we worry about the effects the
steroids may have on her bones and development. This is a lot for a
little girl in kindergarten to endure.
Jenna's prognosis is currently unknown because NS can reoccur. Even
more concerning to us is that Jenna may eventually lose her kidneys
entirely and need dialysis or a kidney transplant. While kidney
transplantation might sound like a cure, in the case of FSGS, the
disease commonly reappears after transplantation. And even with a
transplant, end stage renal disease caused by FSGS dramatically
shortens one's life span.
The NephCure Foundation (NCF) has been very helpful to my family.
They have provided us with educational information about NS, Minimal
Change Disease, and FSGS and the organization works to provide grant
funding to scientists for research into the cause and cure of NS.
Mr. Chairman, because the causes of NS are poorly understood, and
because we have a great deal to learn in order to be able to
effectively treat NS, I am asking you to please significantly increase
funding for the National Institutes of Health. Also, please support the
establishment of a collaborative research network that would allow
scientists to create a patient registry and biobank for NS/FSGS, and
that would allow coordinated studies of these deadly diseases for the
first time. Finally, please urge the National Institute of Diabetes and
Digestive and Kidney Disease (NIDDK) to continue to focus on FSGS/NS
research in general, consistent with the recent program announcement
entitled Grants for Basic Research in Glomerular Disease (R01) (PA-07-
367).
Mr. Chairman, on behalf of the thousands of people suffering from
NS and FSGS and NCF, thank you for this opportunity to submit this
testimony to the subcommittee and for your consideration of my request;
Thank you.
MORE RESEARCH IS NEEDED
We are no closer to finding the cause or the cure of FSGS.
Scientists tell us that much more research needs to be done on the
basic science behind the disease.
NCF, the University of Michigan, and other important university
research health centers have come together to support the establishment
of the Nephrotic Syndrome Rare Disease Clinical Research Network. This
network is a new collaboration between research institutions and NCF
supporting research on NS and FSGS. This initiative has tremendous
potential to make significant advancements in NS and FSGS research by
pooling efforts and resources. The addition of Federal resources to
this important initiative is crucial to ensuring the best possible
outcomes for the Nephrotic Syndrome Rare Disease Clinical Research
Network occur.
NCF is also grateful to the NIDDK for issuing of a program
announcement (PA) that serves to initiate grant proposals on glomerular
disease The PA, issued in March of 2006, is glomerular-disease
specific. The announcement will utilize the R01 mechanism to award
researchers funding.
We ask the subcommittee to encourage the ORD to support the
Nephrotic Syndrome Rare Disease Clinical Research Network to expand
FSGS research. We also ask the NIDDK to continue to issue glomerular
disease program announcements.
TOO LITTLE EDUCATION ABOUT A GROWING PROBLEM
When glomerular disease strikes, the resulting NS 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.
We 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 subcommittee 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 NCF's work. These
efforts should be targeted towards both physicians and patients.
GLOMERULAR DISEASE STRIKES MINORITY POPULATIONS
Nephrologists tell us 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.
I ask that the NIH pay special attention to why this disease
affects African Americans 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 Panamanian
descent. Frankie has FSGS 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 subcommittee to join with us in urging the NIDDK and
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.
PATIENT REGISTRY AND BIOBANK
Experts currently believe glomerular disease is increasing in
frequency and it is often misdiagnosed or undetected and, as a result,
is often unreported. Since many cases of glomerular disease are
unreported, it is difficult to ascertain different aspects of the
disease and to form more comprehensive data sets on the patient
population. While databases and registries have helped defeat other
diseases, one does not exist for FSGS.
The development of a biobank would be beneficial in understanding
the genetic components of glomerular disease and their corresponding
interactions with environmental factors.
We ask the subcommittee to support the funding of the first-ever
national database/registry for FSGS within NIDDK. Experts say that the
incidence of FSGS is increasing and that the disease is often
misdiagnosed, undetected, or unrecorded. We also ask the subcommittee
support the development of a biobank as a further means of
understanding the causes of FSGS, both genetic and environmental.
______
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 (NFCB), I speak on behalf of 250 community
radio stations and related individuals and 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
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 independent, local 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 $542 million in funding for CPB for fiscal year 2012;
--Supports a $307 million supplemental appropriation in fiscal year
2010 to ensure that public broadcasting is not lost to any
parts of the country because of the economic crisis;
--Requests $40 million in fiscal year 2010 for conversion of public
radio and television to digital broadcasting;
--Requests $27 million in fiscal year 2010 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;
--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 the appropriation of $542 million in
Federal funding for the Corporation for Public Broadcasting in fiscal
year 2012. Federal support distributed through CPB is an essential
resource for rural stations and for those 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. For example, these stations
offer programming in languages other than English or Spanish, they can
offer emergency information targeted for a particular geographic area,
and can offer in-depth programming on public health issues.
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. Federal
funding allows an alternative to exist in these larger markets. And
with large newspaper shedding journalists, local community radio may be
one of the only outlets able to pick up the slack in coverage of local
political matters.
For more than 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
nongovernmental support to augment the Federal funds. Most important,
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 past 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 support these new technologies we can better serve the
American people, but want to ensure that smaller stations with more
limited resources are not left behind in 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, particularly rural and minority stations, utilize new
technology.
NFCB commends CPB for the leadership it has shown in supporting and
fostering programming services to Latino stations and Native American
stations. For example, Satelite Radio Bilingue provides 24 hours of
programming to stations across the United States and Puerto Rico
addressing issues of particular interest to the Latino population in
Spanish and English. At the same time, Native Voice One (NV1) is
distributing politically and culturally relevant programming to Native
American stations. There are now more than 33 stations in the United
States controlled by and serving Native Americans.
Five years ago, CPB funded the establishment of the Center for
Native American Public Radio (CNAPR). After 4 years in operation, CNAPR
has assisted with the renewal of licenses and expansion of the
interconnection system to all Native stations and has advanced the
opportunity for native nations to own 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 (NPM) 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. The funding of
the Intertribal Native Radio Summit by CPB in 2001 helped to gather
these isolated stations together into a system of stations that can
support one another. 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.'' NPM promises
to leverage additional new funding to ensure that these stations
continue providing 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. This year, CPB has provided funding to the Latino
Public Radio Consortium to develop a strategic plan and business model
to expand the service of public radio to the Latino population. The
Latino population is growing in this country and requires news services
geared toward them in order to fully participate in civic life.
Hispanics were 12.5 percent of the population in 2000, by 2007 they
were 15 percent, and the number is only growing.\1\
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\1\ Pew Hispanic Center, Statistical Portrait of Hispanics in the
United States, 2007.
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CPB plays an extremely important role in the public and Community
radio system: They convene 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 audiences, 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 media consolidation and new distribution
technologies.
Community radio supports a $307 million supplemental appropriation
in fiscal year 2010 to ensure that public broadcasting is not lost to
any parts of the country because of the economic crisis. Public
Broadcasting is requesting a one-time investment of Federal resources
to help stations maintain local service and assist their communities
cope with the economic crisis and to assure continuity of public
broadcasting service to the American people. Financial contributions
from corporations, foundations, institutions are down dramatically and
listeners contributions, the main source of funding for Community radio
are beginning to be impacted by the growing unemployment. Community
stations are critical sources of local information and it is essential
that they be able to continue to provide their unique local service.
Community radio supports $40 million in fiscal year 2010 for the
conversion to digital broadcasting by public radio and television.
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 that will allow multicasting. CPB has provided funding for
more than 650 radio transmitters to convert to digital. Of those, 160
are multicasting two or more streams of programming. The development of
second and third audio channels will potentially double or triple the
service that public radio can provide listeners, particularly in un-
served and underserved communities. However, this initial funding still
leaves nearly 200 radio transmitters that must ultimately convert to
digital or become obsolete.
Community radio strongly supports $27 million in fiscal year 2009
for the public radio interconnection system. Public radio pioneered the
use of satellite technology to distribute programming. The Public Radio
Satellite System's recently launched ContentDepot continues this
tradition of cutting edge technology. Satellite capacity supporting it
must be renewed and upgrades are necessary at the station and network
operations levels. Interconnection is vital to the delivery of the
high-quality programming that public broadcasting provides to the
American people. This is the last year of a 3-year request for $80
million to the complete the project.
We are in a period of tremendous change. ``Radio is well on its way
to becoming something altogether new--a medium called audio.'' \2\ The
digital movement is transforming the way we do things; new distribution
avenues like digital satellite broadcasting and the Internet are
changing how we define our business; 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 local voices in
their communities an avenue of expression, and many new community
stations will be going on the air within the next few years. Community
radio is providing essential local emergency information, programming
about the local impact of major global events taking place, and
culturally relevant information and entertainment in native languages,
as well as helping to preserve cultures that are in danger of dying
out. During the natural disasters of recent years, radio proved once
again that it is the most dependable and available medium for getting
emergency information to the public.
---------------------------------------------------------------------------
\2\ The State of the News Media, Pew Project for Excellence in
Journalism, 2008.
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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 smaller stations to participate alongside larger stations
that have more resources as we move into a new era of communications.
______
Prepared Statement of the National Fragile X Foundation
Mr. Chairman and members of the subcommittee: As President of the
Board of Directors for the National Fragile X Foundation, I want to
take this opportunity to thank you for the leadership role this
subcommittee has played over the years in the fight for Fragile X-
associated Disorders. I am pleased to offer the following written
testimony regarding appropriation requests in fiscal year 2010.
Fragile X-associated Disorders are genetic disorders that cause
behavioral, developmental, and language disabilities across a person's
lifespan. It is linked to a mutation on the X chromosome, and is the
most commonly inherited form of intellectual disabilities. Fragile X is
also linked to reproductive problems in women including early menopause
Fragile X-associated primary ovarian insufficiency (FXPOI) and, a
Parkinson's-like condition in older male carriers Fragile X-associated
tremor/ataxia syndrome (FXTAS). More than 100,000 Americans have
Fragile X Syndrome and more than 1 million Americans carry a Fragile X
mutation and either have, or are at risk for developing a Fragile X-
associated disorder.
These appropriations requests are significant in order to continue
to build the infrastructure needed and assure continued progress toward
targeted treatments for Fragile X-associated Disorders. The National
Fragile X Foundation has invested significantly in the creation of the
Fragile X Clinical & Research Consortium, a network of 20 clinics
across the country who collaborate to align data collection efforts,
participate in clinical trials of new pharmacological agents, share
research findings and develop consistent best practices and standards
of care for the treatment of Fragile X-associated Disorders.
In addition, these appropriations requests would assist in building
upon important work already initiated by the Federal Government. We
have been successful at building programs at the Centers for Disease
Control and Prevention (CDC), National Institutes of Health (NIH), and
Health Resources and Services Administration (HRSA). The CDC has
recognized the value of this important collaboration, and has provided
resources to ensure the continued growth and evolution of the Fragile X
Clinical & Research Consortium. Previously, the CDC had secured nearly
$4.5 million in funding since fiscal year 2005 for the CDC Fragile X
National Public Health Initiative. The program is currently funded at
just more than $1.8 million annually. Furthermore, the CDC has worked
with Congress to define the highest impact public health priorities for
the Fragile X community. These efforts led to:
--Development of a newborn screening test for fragile X syndrome;
--Single gene resource network for fragile X syndrome;
--Fragile X syndrome cascade testing and genetic counseling
protocols;
--Fragile X Family Needs Assessment; and
--Support for the Fragile X Clinical & Research Consortium.
Moreover, public efforts, including three National Institute of
Child Health and Human Development (NICHD)-funded Fragile X Research
Centers, has proven critically important in the development of
effective treatments. The development of key therapeutics for Fragile X
will likely be effective for a much larger population living with
related autism spectrum disorders. We recognize that in order to
translate basic science findings into viable treatments for Fragile X,
additional coordination and resources are required at the NIH.
The Fragile X community has been working to promote the work of NIH
to ensure improved coordination among the various Institutes to ensure
the most effective use of Federal research dollars devoted to Fragile
X-associated Disorders (i.e., Fragile X Syndrome, Fragile X-associated
Tremor/Ataxia Syndrome, and Fragile X-associated Primary Ovarian
Insufficiency). Congress has advocated for greater resources at NIH
leading to an increase in NIH Fragile X-associated Disorders efforts
from approximately $12 million annually in 2001 to approximately $27
million in fiscal year 2009. With this increase, NIH recently awarded
the largest Fragile X Federal research grant in history, a 5-year,
$21.8 million grant to a team of researchers at the UC Davis School of
Medicine and M.I.N.D. Institute.
As you know, the fiscal year 2008 Departments of Labor, Health and
Human Services, and Education, and Related Agencies Appropriations Act
included language directing the NIH, under the leadership of the NICHD
(Senate Report 110-107) to coordinate, intensify, and expedite research
efforts related to Fragile X-associated Disorders. The law specifically
directed the NIH to convene a scientific session in 2008 to develop
pathways to new opportunities for collaborative, directed research
across Institutes, and to produce a blueprint of coordinated research
strategies and public-private partnership opportunities for Fragile X.
The NICHD was directed to lead this initiative and was urged to
collaborate with the three existing federally funded Centers of
Excellence as well as the Fragile X Clinical & Research Consortium.
In response to this directive, NICHD leadership convened a 2-day
scientific session and created a rigorous working group infrastructure
consisting of the world's leading researchers and NIH staff to ensure
timely development of the NIH Research Blueprint on Fragile-X
associated disorders. The leadership team at NICHD and three working
groups prepared a comprehensive blueprint that will provide a clear
direction for future research activities for Fragile-X associated
disorders. The final draft of this report was completed in late 2008,
and will be published by NIH this week.
Mr. Chairman, we respectfully request Congress to continue its
support of these ongoing initiatives, and to support increased
prioritization of Fragile X-associated Disorders at the CDC and NIH in
order to accelerate the critical work being accomplished through the
Fragile X Clinical & Research Consortium.
The National Fragile X Foundation recommends that you appropriate
the following fiscal year 2010 requests:
--A $2 million increase in funding from fiscal year 2009 levels, for
the National Fragile X Public Health Initiative and other CDC
initiatives to:
--Focus efforts on identifying ongoing needs, effective treatments,
and positive outcomes for families by increasing
epidemiological research, surveillance, screening efforts,
and the introduction of early interventions and supports
for individuals living with Fragile X-associated Disorders.
--Focus on the continued growth and development of initiatives that
support health promotion activities and foster rapid, high-
impact translational research practice for the successful
treatment Fragile X-associated Disorders, including ongoing
collaborative activities with the Fragile X Clinical &
Research Consortium.
--Report language and increased resources for Fragile X at the NIH
to:
--Support continued implementation of the recommendations outlined
in the NIH Fragile X-associated Disorders Research
Blueprint as well as increased NIH support for the Fragile
X Clinical & Research Consortium.
--Enhance its efforts across its Institutes to translate basic
science findings into viable treatments for Fragile X, and
encourage clinical drug trials for this orphan indication.
--Maximize Fragile X resources by ensuring that appropriate
resources and direction is provided to implement the
objectives outlined in the Fragile X Research Blueprint.
--Strengthen and broaden research on Fragile X- associated
disorders (i.e., FXTAS and FXPOI).
Furthermore, as part of our overall to increase support and
prioritization of Fragile X-associated Disorders at the Federal level,
the Fragile X community is also working with the Defense Subcommittee
on Appropriations to include Fragile X-associated Disorders among the
list of eligible healthcare conditions for targeted biomedical research
funding through the U.S. Department of Defense. The success from all of
these intense public and private research efforts, including the NIH
and CDC, has brought discoveries to bear for Fragile X-associated
Disorders. However, we feel continued expansion of Federal efforts and
resources at each of these agencies will be instrumental to conduct
promising research on Fragile X-associated Disorders.
Mr. Chairman, thank you for your time and attention. We, at the
National Fragile X Foundation, believe that continued awareness and
support for enhancing Fragile X research and translational activities
is imperative. Given the significant impact this condition has on
families and communities across the country, the promise of a
breakthrough for the treatment and cure of this disease is urgent.
Should you have any questions or require additional information, please
feel free to call on me.
______
Prepared Statement of the National Health Care for the Homeless Council
The National Health Care for the Homeless Council respectfully asks
the Senate Committee on Appropriations to strengthen and expand the
Nation's health centers by appropriating $2.9 billion for the
Consolidated Health Centers Program in fiscal year 2010.
The National Health Care for the Homeless Council is a membership
organization engaged in education and advocacy to improve healthcare
for homeless persons and all Americans. We represent 111 organizational
members, including 100 Health Care for the Homeless (HCH) projects, and
more than 700 individuals who provide care to people experiencing
homelessness throughout the country.
Homelessness and Health.--Poverty, lack of affordable housing, and
the lack of comprehensive health insurance are among the underlying
structural causes of homelessness. For those struggling to pay for
housing and other basic needs, the onset of a serious illness or
disability easily can result in homelessness following the depletion of
financial resources. The experience of homelessness causes poor health,
and poor health is exacerbated by restricted access to appropriate
healthcare--which only prolongs homelessness. Additional barriers to
healthcare access include lack of transportation, inflexible clinic
hours, complex requirements to qualify for public health insurance, and
mandatory unaffordable co-payments for various services.
Mainstream healthcare safety net providers often fail to meet the
needs of homeless people. In the absence of universal healthcare, the
Federal Government supports a separate healthcare system for low-income
and uninsured people. Community Health Centers and publicly funded
mental health and addictions programs form the core of this healthcare
safety net. Unfortunately, limited resources, lack of experience with
this population, and insufficient linkages to a full range of health
and supportive services seriously restrict the ability of mainstream
providers to meet the unique needs of people experiencing homelessness.
The Federal Health Care for the Homeless Program--administered by
the Health Resources and Services Administration (HRSA)--currently
supports 205 HCH projects in all 50 States, the District of Columbia,
and Puerto Rico. Congress established HCH in 1987 to provide targeted
services for people experiencing homelessness, including primary and
behavioral healthcare along with social services, as well as intensive
outreach and case management to link clients with appropriate
resources. Approximately 70 percent of those served by HCH projects
lack comprehensive health insurance. The HCH program has been
reauthorized three times, most recently in 2008 with passage of the
Health Care Safety Net Act. HCH projects served 742,588 in 2007--a
sizable number, but far below the 3.5 million Americans who annually
experience homelessness. Authorizing language designates 8.7 percent of
the total Health Center appropriation to support the HCH program.
Community Health Centers.--Over the past several years, the
expansion of community health centers has received bipartisan support
from Members of Congress. Federally-Qualified Health Centers (FQHCs)
consistently have proven their effectiveness in delivering
comprehensive medical care to underserved populations. Though health
centers currently serve more than 16 million people annually, at least
56 million Americans--both insured and uninsured--face inadequate
access to primary care due to a shortage of physicians and other
providers. Without sufficient access to care, the health problems of
the insured and underinsured are exacerbated, resulting in costly
treatment, medical complications, and even premature death.
Within the current economic context, a massive unmet need remains
for health center resources despite years of incremental expansion
through the Health Center Growth Initiative. The deteriorating economy
leaves more Americans unemployed, at risk of homelessness, and in need
of health services. According to the Department of Labor, unemployment
jumped to 8.5 percent in March 2009, the highest in 14 years. With
continued increases in unemployment, more Americans are expected to
lose health coverage, thus placing additional burden upon community
health centers.
Fiscal Year 2010 Appropriations.--In recognition of the growing
need for primary healthcare services, the Senate Committee on
Appropriations along with other Members of Congress has been supportive
of strengthening and expanding community health centers. In the current
year, Congress appropriated $2.2 billion--$125 million above the fiscal
year 2008 appropriation. This included $56 million in base grant
adjustments and provided a total of $191 million (8.7 percent) for the
HCH program.
To continue strengthening the Nation's health center
infrastructure, we encourage the Senate Committee on Appropriations
Subcommittee on Labor, Health and Human Services, and Education, and
Related Agencies to appropriate $2.9 billion for the Community Health
Center program (including $252 million for the HCH program) in fiscal
year 2010. The National Council's request is consistent with planned
increases outlined in the Access for All America Act (S. 486). This
important legislation, introduced by Senator Bernie Sanders, would
quadruple the amount of funding for community health centers over the
next 5 years.
The National Council applauds Congress for its strong support of
community health centers. We thank Chairman Harkin and the Senate
Committee on Appropriations Subcommittee on Labor, Health and Human
Service, and Education, and Related Agencies for your consideration of
this testimony.
______
Prepared Statement of the National Marfan Foundation
Mr. Chairman, thank you for the opportunity to submit testimony
regarding the fiscal year 2010 budget for the National Heart, Lung and
Blood Institute (NHLBI), the National Institute of Arthritis,
Musculoskeletal and Skin Diseases (NIAMS), and the Centers for Disease
Control and Prevention (CDC). The National Marfan Foundation is
grateful to you and the subcommittee for your strong support of the
National Institutes of Health and CDC, particularly as it relates to
life-threatening genetic disorders such as Marfan syndrome. Thanks in
part to your leadership we are at a time of unprecedented hope for our
patients.
It is estimated that 200,000 people in the United States are
affected by Marfan syndrome or a related condition. Marfan syndrome is
a genetic disorder of the connective tissue that can affect many areas
of the body, including the heart, eyes, skeleton, lungs, and blood
vessels. It is progressive condition and can cause deterioration in
each of these body systems. The most serious and life-threatening
aspect of the syndrome is a weakening of the aorta. The aorta is the
largest artery carrying oxygenated blood 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.
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 more
than 95 percent. 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 might be effective in preventing this
frequent and devastating event.
NHLBI
Pediatric Heart Network Clinical Trial
NMF applauds NHLBI for its leadership in advancing a landmark
clinical trail on Marfan syndrome. Under the direction of Dr. Lynn
Mahoney and Dr. Gail Pearson, the Institute's Pediatric Heart Network
has spearheaded a multicenter study focused on the potential benefits
of a commonly prescribed blood pressure medication (losartan) on aortic
growth in Marfan syndrome patients.
NHLBI Director Dr. Elizabeth Nabel describes this promising
research well:
``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. Then 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 and the results 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,
has undertaken 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 NMF is proud to
have supported Dr. Dietz's cutting-edge research for many years.
NMF is also proud to actively support the losartan clinical trial
in partnership with the Pediatric Heart Network. Throughout the life of
the trial we will provide support for patient travel costs, coverage of
select echocardiogram examinations, and funding for ancillary studies.
These ancillary studies will explore the impact that losartan has on
other manifestations of Marfan syndrome.
NHLBI ``Working Group on Research in Marfan Syndrome and Related
Conditions''
In April 2007, NHLBI convened a ``Working Group on Research in
Marfan Syndrome and Related Conditions.'' Chaired by Dr. Dietz, this
panel was comprised of experts in all aspects of basic and clinical
science related to the disorder. The panel was charged with identifying
key recommendations for advancing the field of research in the coming
decade. The recommendations of the Working Group are as follows:
``Scientific opportunities to advance this field are conferred by
technological advances in gene discovery, the ability to dissect
cellular processes at the molecular level and imaging, and the
establishment of multi-disciplinary teams. The barriers to progress are
addressed through the following recommendations, which are also
consistent with Goals and Challenges in the NHLBI Strategic Plan.
--Existing registries should be expanded or new registries developed
to define the presentation, natural history, and clinical
history of aneurysm syndromes.
--Biological and aortic tissue sample collection should be
incorporated into every clinical research program on Marfan
syndrome and related disorders and funds should be provided to
ensure that this occurs. Such resources, once established,
should be widely shared among investigators.
--An Aortic Aneurysm Clinical Trials Network (ACTnet) should be
developed to test both surgical and medical therapies in
patients with thoracic aortic aneurysms. Partnership in this
effort should be sought with industry, academic organizations,
foundations, and other governmental entities.
--The identification of novel therapeutic targets and biomarkers
should be facilitated by the development of genetically defined
animal models and the expanded use of genomic, proteomic, and
functional analyses. There is a specific need to understand
cellular pathways that are altered leading to aneurysms and
dissections, and to develop robust in vivo reporter assays to
monitor TGFb and other cellular signaling cascades.
--The developmental underpinnings of apparently acquired phenotypes
should be explored. This effort will be facilitated by the
dedicated analysis of both prenatal and early postnatal tissues
in genetically defined animal models and through the expanded
availability to researchers of surgical specimens from affected
children and young adults.''
We look forward to working closely with NHLBI to pursue these
important research goals and ask the subcommittee to support the
recommendations of the Working Group. Mr. Chairman, for fiscal year
2010 NMF joins with other professional and patient organizations in
recommending a 7 percent for NHLBI.
NIAMS
NMF is proud of its longstanding partnership with NIAMS. 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 related 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. We would welcome an
opportunity to partner with NIAMS in support of this research moving
forward.
For fiscal year 2010, NMF recommends a 7 percent increase for
NIAMS.
CDC
Mr. Chairman, we are grateful for the subcommittee's encouragement
in recent years of collaboration between 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.
Despite our ongoing efforts to raise awareness among the general
public and healthcare providers, we know of too many families who have
lost a loved one because of a missed diagnosis.
We are very appreciative of CDC's support of our 25th annual
patient conference taking place in Rochester, Minnesota August 6-9,
2009. We have also discussed other potential collaborations with the
National Center on Birth Defects and Development Disabilities focused
on education and early diagnosis. We ask the subcommittee to continue
to encourage CDC to work with us to initiate these activities in fiscal
year 2010.
For fiscal year 2010, NMF joins with the CDC Coalition in
recommending an appropriation of $8.6 billion for core CDC programs.
______
Prepared Statement of the National Network to End Domestic Violence
Chairman Harkin, Ranking Member Cochran, and members of the
subcommittee, thank you for the opportunity to submit written testimony
to the Labor, Health and Human Services, and Education, an Related
Agencies (LHHS) Appropriations Subcommittee. We are grateful to the
subcommittee for your continued leadership and your investment in
lifesaving programs that prevent and end domestic violence.
The National Network to End Domestic Violence (NNEDV) is a
membership and advocacy organization representing the 56 State and U.S.
territory domestic violence coalitions. NNEDV provides a national voice
for the coalitions, their more than 2,000 local domestic violence
member programs, and the millions of domestic violence survivors who
turn to them for services. In their work with victims and their
families, our members see the impact that abuse and violence have on
the lives of children who are vulnerable both as witnesses to violence
and as victims themselves.
Over the last 25 years, millions of victims have found refuge and
safety through domestic violence programs funded by the Family Violence
Prevention and Services Act (FVPSA). The success of this LHHS-funded
program, however, is threatened by budget stagnation and an increasing
demand for services. Small budget increases, while appreciated, simply
cannot meet the desperate needs of victims. Now, more than ever, we
need to increase our country's investment in this vital, cost-effective
program. Increases to FVPSA funding will help bridge the unconscionable
gap created by an increased demand and inadequate funding. On behalf of
the millions of victims and families that our member programs serve
each year, we urge you to fully fund the FVPSA/Battered Women's Shelter
Services program (FVPSA) at $175 million, the National Domestic
Violence Hotline at $3.5 million, and the Community Initiatives to
Prevent Abuse (DELTA) program at $6 million in the fiscal year 2010
congressional budget.
DOMESTIC VIOLENCE
Domestic violence is pervasive and life-threatening. According to
the 2005 Bureau of Justice Statistics' Family Violence Statistics, of
the total victims of violence between 1998 and 2002, 11 percent were
victims of family violence.\1\ One in four women has been beaten or
raped by a husband, boyfriend, or partner in her lifetime.\2\ In 2005
alone, 1,181 women were murdered by an intimate partner in the United
States \3\ and approximately one-third of all female murder victims are
killed by an intimate partner.\4\
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\1\ U.S. Department of Justice, Bureau of Justice Statistics,
Family Violence Statistics: Including Statistics on Strangers and
Acquaintances, June 2005.
\2\ Tjaden, Patricia & Thoennes, Nancy. National Institute of
Justice and the Centers of Disease Control and Prevention, ``Extent,
Nature and Consequences of Intimate Partner Violence: Findings from the
National Violence Against Women Survey,'' 2000. The Centers for Disease
Control (CDC) (2008). Adverse Health Conditions and Health Risk
Behaviors Associated with Intimate Partner Violence, United States,
2005.
\3\ Bureau of Justice Statistics, Homicide Trends in the U.S. from
1976-2005. US Department of Justice. (2008).
\4\ Bureau of Justice Statistics, Homicide Trends from 1976-1999.
U.S. Department of Justice. (2001)
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The cycle of intergenerational violence is perpetuated as children
witness violence. It is estimated that a staggering 15.5 million
children are exposed to domestic violence every year.\5\ Children who
are exposed to domestic violence are more likely to exhibit behavioral
and physical health problems including depression, anxiety, and
violence towards peers.\6\ They are also more likely to attempt
suicide, abuse drugs and alcohol, run away from home, engage in teenage
prostitution, and perpetrate sexual assault.\7\ One study found that
men exposed to physical abuse, sexual abuse, and adult domestic
violence as children were almost four times more likely than other men
to have perpetrated domestic violence as adults.\8\
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\5\ McDonald, R., et al. (2006). ``Estimating the Number of
American Children Living in Partner-Violence Families.'' Journal of
Family Psychology, 30(1), 137-142.
\6\ Jaffe, P. and Sudermann, M., ``Child Witness of Women Abuse:
Research and Community Responses,'' in Stith, S. and Straus, M.,
Understanding Partner Violence: Prevalence, Causes, Consequences, and
Solutions. Families in Focus Services, Vol. II. Minneapolis, MN:
National Council on Family Relations, 1995.
\7\ Wolfe, D.A., Wekerle, C., Reitzel, D. and Gough, R.,
``Strategies to Address Violence in the Lives of High Risk Youth.'' In
Peled, E., Jaffe, P.G. and Edleson, J.L. (eds.), Ending the Cycle of
Violence: Community Responses to Children of Battered Women. New York:
Sage Publications. 1995.
\8\ Greendfeld, L. A. (1997). Sex Offences and Offenders: An
Analysis of Date on Rape and Sexual Assault. Washington, DC. Bureau of
Justice Statistics, U.S. Department of Justice.
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Domestic violence is not just a crime; it is a public health crisis
that leads to chronic health conditions, disabilities, lost work time,
frequent trips to the emergency room and, all too often, serious injury
or death.
In addition to the terrible cost domestic and sexual violence have
on the lives of individual victims and their families, these crimes
cost taxpayers and communities. In fact, the cost of intimate partner
violence exceeds $5.8 billion each year, $4.1 billion of which is for
direct medical and mental healthcare services.\9\ Research shows that
for every 100,000 women between 18 and 64 enrolled, intimate partner
violence costs a health insurance plan $19.3 million each year.\10\
Domestic violence costs U.S. employers an estimated $3 to $13 billion
annually.\11\
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\9\ National Center for Injury Prevention and Control. Costs of
Intimate Partner Violence Against Women in the United States. Atlanta
(GA): Centers for Disease Control and Prevention; 2003.
\10\ Ibid.
\11\ Bureau of National Affairs Special Rep. No. 32, Violence and
Stress: The Work/Family Connection 2 (1990); Joan Zorza, Women
Battering: High Costs and the State of the Law, Clearinghouse Rev.,
Vol. 28, No. 4,383,385; Supra note 10.
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THE FAMILY VIOLENCE PREVENTION AND SERVICES ACT (FVPSA)
Despite this grim reality, we know that when immediate, essential
services are available victims can escape from life-threatening
violence and begin to rebuild their shattered lives.
FVPSA has significantly enhanced community-based domestic violence
intervention and prevention efforts since it was first authorized by
Congress in 1984. Administered by the Department of Health and Human
Services Administration on Children and Families through a State
formula grant, FVPSA provides funding to States, territories and tribes
to support domestic violence services in their communities using a
population-based formula. These essential services that are at the core
of ending domestic violence: emergency shelters, hotlines, counseling
and advocacy, primary and secondary prevention--immediate crisis
response and the comprehensive support to help victims put their lives
back together. FVPSA also authorizes the Community Initiatives to
Prevent Abuse program (frequently referred to as Domestic Violence
Prevention Enhancement and Leadership Through Alliances (DELTA) Grants)
and the National Domestic Violence Hotline. Working together, these
FVPSA programs have made significant progress toward ending domestic
violence and keeping families and communities safe. Since its passage
in 1984, FVPSA remains the only Federal funding directly for shelter
programs.
There are approximately 2,000 FVPSA-funded community-based domestic
violence programs for victims and their children, providing emergency
shelter to approximately 300,000 victims and offering services such as
counseling, crisis lines, safety planning, legal assistance, and
preventative education to millions of adults and children annually.\12\
In just 1 day in 2008, 60,799 victims were served by 1,553 domestic
violence programs. Of the 20,307 victims in emergency shelter that day,
nearly 50 percent were children.\13\ Programs answered 21,683 hotline
calls and trained 30,210 community members.
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\12\ National Coalition Against Domestic Violence, Detailed Shelter
Surveys (2001).
\13\ Domestic Violence Counts 08: A 24-hour census of domestic
violence shelters and services across the United States. The National
Network to End Domestic Violence. (Jan. 2009).
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These effective programs save and help rebuild lives. A recently
released multi-State study shows conclusively that the Nation's
domestic violence shelters are addressing both urgent and long-term
needs of victims of violence, and are helping victims protect
themselves and their children.\14\ Research shows that shelter programs
are among the most effective resources for victims with abusive
partners \15\ and that staying at a shelter or working with a domestic
violence advocate significantly reduced the likelihood that a victim
would be abused again and improved the victim's quality of life.\16\
The impact of being and feeling safe cannot be underestimated--when
asked what he liked best about staying in the shelter, a 10-year-old
boy in Maryland replied, ``I can sleep at night.''
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\14\ Lyon, E., Lane S. (2009). Meeting Survivors' Needs: A Multi-
State Study of Domestic Violence Shelter Experiences. National Resource
Center on Domestic Violence and UConn School of Social Work. Found at
http://www.vawnet.org.
\15\ See: Bennett, L., Riger, S., Schewe, P., Howard, A., & Wasco,
S. (2004). Effectiveness of hotline, advocacy, counseling and shelter
services for victims of domestic violence: A statewide evaluation.
Journal of Interpersonal Violence, 19(7), 815-829; Bowker, L. H., &
Maurer, L. (1985). The importance of sheltering in the lives of
battered women. Response to the Victimization of Women and Children, 8,
2-8; Gordon, J. S. (1996). ``Community services for abused women: A
review of perceived usefulness and efficacy.'' Journal of Family
Violence 11(4): 315-329; Sedlak, A. J. (1988). Prevention of wife
abuse. In V. B. Van Hasselt, R. L. Morrison, A. S. Bellack, & M. Hersen
(Eds.), Handbook of Family Violence (pp. 319-358). NY: Plenum Press;
Straus, M. A., Gelles, R. J., & Steinmetz, S. K. (1980). Behind closed
doors: Violence in the American family. NY: Anchor Press; Tutty, L. M.,
Weaver, G., & Rothery, M. (1999). Residents' views of the efficacy of
shelter services for assaulted women. Violence Against Women, 5(8),
898-925.
\16\ See: Berk, R. A., Newton, P. J., & Berk, S. F. (1986). What a
difference a day makes: An empirical study of the impact of shelters
for battered women. Journal of Marriage and the Family, 48, 481-490;
Bybee, D.I., & Sullivan, C.M. (2002). The process through which a
strengths-based intervention resulted in positive change for battered
women over time. American Journal of Community Psychology, 30(1), 103-
132; Constantino, R., Kim, Y., & Crane, P.A. (2005). Effects of a
social support intervention on health outcomes in residents of a
domestic violence shelter: A pilot study. Issues in Mental Health
Nursing, 26, 575-590; Goodkind, J., Sullivan, C.M., & Bybee, D.I.
(2004). A contextual analysis of battered women's safety planning.
Violence Against Women, 10(5), 514-533; Sullivan, C.M. (2000). A model
for effectively advocating for women with abusive partners. In J.P.
Vincent & E.N. Jouriles (Eds.), Domestic violence: Guidelines for
research-informed practice (pp. 126-143). London: Jessica Kingsley
Publishers; Sullivan, C.M., & Bybee, D.I. (1999). Reducing violence
using community-based advocacy for women with abusive partners. Journal
of Consulting and Clinical Psychology, 67(1), 43-53.
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Once FVPSA appropriations reach $130 million, a portion will be set
aside solely for children's services. Battered women's shelters and
domestic violence programs provide safety and support for children, but
struggle to meet the demand for children's services. They see the needs
of children who are recovering from the trauma of witnessing or
experiencing abuse and they are eager to implement new and expanded
children's programming.
The Community Initiatives to Prevent Abuse/DELTA Grants program
supports community-based primary prevention that address the underlying
causes of domestic violence in order to stop abuse before it starts.
DELTA is administered by the Centers for Disease Control and
Prevention, National Center for Injury Prevention and Control, and it
is one of the few funding sources for primary prevention work. DELTA
programs use innovative strategies including peer education programs
for men about family and relationships, community change initiatives
focused on engaging men in prevention efforts, school-based education
to prevent youth bullying that often carries into adulthood, and youth-
led initiatives to prevent dating violence and promote healthy
relationships.
FVPSA also includes the National Domestic Violence Hotline, a 24-
hour, confidential, toll-free hotline, located in Texas. Since opening
in 1996, the National Domestic Violence Hotline has received more than
2 million calls from individuals in need of support and assistance.
Highly trained hotline advocates provide support, information,
referrals, safety planning, and crisis intervention to hundreds of
thousands of domestic violence victims and perpetrators. More than 60
percent of callers report that their call to the hotline is the first
time they open up about the abusive relationship.
THE FUNDING GAP
Due to the overwhelming success of Violence Against Women Act
(VAWA) and FVPSA funded programs, more and more victims are coming
forward for help each year. This rising demand for services, without a
concurrent increase in funding, means that many desperate victims are
turned away from life-saving services. In just 1 day last year, nearly
9,000 requests for services went unmet across the country due to a lack
of resources, including 3,286 requests for emergency shelter.\17\
Additionally, the National Domestic Violence Hotline was unable to
answer 42,500 calls (17 percent of the total) because they lacked the
resources to answer the calls.
---------------------------------------------------------------------------
\17\ Domestic Violence Counts 08: A 24-Hour census of domestic
violence shelters and services across the United States. The National
Network to End Domestic Violence. (Jan. 2009).
---------------------------------------------------------------------------
The economic crisis further exacerbates the gap created by the
increasing demand for services and the lack of adequate resources.
While economic hard times do not cause violence, the economic stresses
can increase the frequency and level of violence in a home. With fewer
personal, family, and community resources upon which to rely, more
victims turn to domestic violence programs for help. A survey of
domestic violence shelters across the country revealed that 3 out of 4
domestic violence shelters have seen an increase in women seeking
assistance from abuse since September 2008, a major turning point in
the U.S. economy. Just as more victims are seeking services, programs
are facing cutbacks from State and country funding sources, as well as
philanthropic dollars. Many programs have been forced to lay off staff
and cuts services--a number of programs have even been forced to close
their doors permanently.
Laurie Schipper, Executive Director of the Iowa Coalition Against
Domestic Violence explains the stark consequences of this reality, ``If
women have nowhere to go, especially in rural areas, women and kids are
going to die. It's difficult to overstate the gravity of this.'' \18\
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\18\ Alex, Tom. Wife flees, alleging decades of abuse.
DesMoinesRegister.com, April 18, 2009. Available at: http://
www.desmoinesregister.com/apps/pbcs.dll/article?AID=/20090418/NEWS01/
904180322.
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FVPSA REAUTHORIZATION
Due to a busy congressional calendar, FVPSA expired in 2008 and has
yet to be reauthorized. The Senate HELP Committee is currently working
to reauthorize FVPSA, along with the Child Abuse Prevention and
Treatment Act. Advocates remain concerned, however, that while FVPSA
remains expired programs will be further jeopardized. We call on the
Senate LHHS Appropriations Subcommittee to include report language in
the final appropriations bill that acknowledges the vital work of FVPSA
and directs the funding to be spent in a way consistent with its
authorization.
NNEDV chairs a national coalition of FVPSA stakeholders who have
delineated clear priorities for the FVPSA reauthorization.
Collectively, we want to see FVPSA continue its success while expanding
to reach the needs of victims who have historically been underserved.
These needed improvements will require commitment and investment from
the Appropriations Committee.
INVESTING IN SERVICES SAVES LIVES
In the fiscal year 2008 congressional budget, FVPSA funding was cut
by $2.1 million, bringing FVPSA funding to $122.6, which is $52.5
million below the authorized level of $175 million. We applaud the
subcommittee's commitment to these programs, evidenced in the modest
funding increases allocated in fiscal year 2009. FVPSA was funded at
$127.7 million (a $5 million increase from fiscal year 2008), the
National Domestic Violence Hotline was funded at $3.2 million (a $0.2
million increase from fiscal year 2008), and DELTA was funded at $5.5
million (a $0.5 million increase from fiscal year 2008). While these
increases will pay dividends over time by preventing other costly
social ills, in order to meet the ever-growing demand for services, it
is essential that Congress continue to provide steady increases.
The President's fiscal year 2010 budget proposal requests level
funding for all three programs. Yet we know that level funding simply
will not bridge the gap in funding. Congress should invest in FVPSA not
only to meet the needs of victims in life-threatening situations but
also to prevent future social ills.
Fully funding FVPSA at $175 million, the hotline at $3.5 million
and DELTA at $5.5 million will allow communities across the country to
continue to provide critically needed direct services to victims of
domestic violence and their children, which will help to prevent
homicides and break the cycle of violence.
Without effective intervention, domestic violence will repeat
itself and continue to impact successive generations. FVPSA is a
critical component in breaking the cycle of violence affecting our
children, families and communities. FVPSA funding, has begun to make
our country a safer place for families, victims and communities. Now,
however, this phenomenal progress is in jeopardy. We have seen a
reduction in homicides and the incidence of these heinous crimes. Yet
these tough economic times, combined with funding cuts forcing shelters
to close, real victims face life-threatening situations with no
support. Every day shelters and service providers must turn away
families in danger due to lack of resources. While a tough economy may
tempt lawmakers to cut or maintain existing funding levels, we cannot
allow this unmet need to continue.
By prioritizing these vital, cost-effective funding streams,
Congress will help to break the cycle of domestic violence in our
country.
______
Prepared Statement of the National Psoriasis Foundation
The National Psoriasis Foundation (NPF) appreciates the opportunity
to submit written testimony for the record regarding Federal funding
for psoriasis and psoriatic arthritis research for fiscal year 2010.
NPF serves as the Nation's largest patient-driven, nonprofit, voluntary
association committed to finding a cure for psoriasis and psoriatic
arthritis, which affects as many as 7.5 million Americans, and
eliminating their devastating effects. Psoriasis is among the most
prevalent autoimmune diseases.
As part of our mission, we educate health professionals, the public
and policymakers to increase public awareness and understanding of the
challenges faced by people with psoriasis and psoriatic arthritis.
Moreover, NPF maintains a strong commitment to securing public policies
and programs that support its focus of education, advocacy, and
research toward better treatments and a cure. NPF specifically seeks to
advance public and private efforts to improve treatment of these
diseases, identify a cure and ensure that all people with psoriasis and
psoriatic arthritis have access to the medical care and treatment
options they need to live the highest quality of life possible.
NPF stands ready to partner with policymakers at the local, State,
and Federal levels to advance policies and programs that will reduce
and prevent suffering from psoriasis and psoriatic arthritis.
Specifically, NPF advocates that in fiscal year 2010 the National
Institutes of Health (NIH) receive an additional $2.1 billion for a
total allocation of $32.5 billion to support new investigator-initiated
research grants for genetic, clinical, and basic research related to
the understanding of the cellular and molecular mechanisms of psoriasis
and psoriatic arthritis, as well as studies to explore the nascent
understanding of co-morbidities, such as obesity, depression and heart
disease that may be associated with inflammation in the skin and
joints. In addition, we urge that Congress provide $1.5 million in
fiscal year 2010 to the Centers for Disease Control and Prevention
(CDC) to support such data collection to increase understanding of the
comorbidities associated with psoriasis, examine the relationship of
psoriasis to other public health concerns, such as the high rate of
smoking and obesity among those with the disease, and gain insight into
the long-term impact and treatment of these two conditions.
THE IMPACT OF PSORIASIS AND PSORIATIC ARTHRITIS
According to the NIH, as many as 7.5 million Americans have
psoriasis--an immune-mediated, genetic, chronic, inflammatory, painful,
disfiguring, and life-altering disease that requires life-long
sophisticated medical intervention and care, and imposes serious
adverse effects on the individuals and families affected. On average,
17,000 people with psoriasis live in each Congressional District.
Psoriasis typically first strikes between the ages of 15 and 25,
but can occur at any time. It lasts a lifetime. Unfortunately,
psoriasis often is overlooked or dismissed, because it typically does
not cause death. It is commonly and incorrectly considered by insurers,
employers, policymakers, and the public as a mere annoyance--a
superficial problem, mistakenly thought to be contagious and/or due to
poor hygiene. Yet, together psoriasis and psoriatic arthritis impose
significant economic costs on individuals and society. Total direct and
indirect healthcare costs of psoriasis are calculated at more than
$11,250,000,000 annually with work loss accounting for 40 percent of
the cost burden.
There is mounting evidence that people with psoriasis are at
elevated risk for myriad other serious, chronic, and life-threatening
conditions. Although data are still emerging on the relationship of
psoriasis to other diseases and their ensuing costs to the medical
system, it is clear that psoriasis goes hand-in-hand with co-
morbidities, such as Crohn's disease, diabetes, metabolic syndrome,
obesity, hypertension, heart attack, cardiovascular disease, liver
disease, and psoriatic arthritis--which occurs in up to 30 percent of
people with psoriasis. Other recent studies have found that people with
severe psoriasis have a 50 percent higher mortality risk and that these
patients die 3 to 6 years younger than those who do not have psoriasis.
Of serious concern is that studies have shown that psoriasis causes as
much disability as other major chronic diseases, and individuals with
psoriasis are twice as likely to have thoughts of suicide, as people
without psoriasis or with other chronic conditions.
Despite some recent breakthroughs, many people with psoriasis and
psoriatic arthritis remain in need of improved quality of life and
effective, safe, and affordable therapies, which could be delivered
through an increased Federal commitment to genetic, clinical, and basic
research. Research holds the key to improved treatment of these
diseases, better diagnosis of psoriatic arthritis and eventually a cure
for both conditions.
FEDERAL PSORIASIS AND PSORIATIC ARTHRITIS RESEARCH
Although overall NIH funding levels improved for psoriasis research
in fiscal year 2007, 3 out of 5 NIH agencies decreased psoriasis
funding that same year. NPF is concerned that at the historical and
current rate of psoriasis funding, NIH funding is not keeping pace with
research needs, nor is the investment commensurate with the impact of
the disease. Within the NIH, the National Institute of Arthritis and
Musculoskeletal and Skin Diseases (NIAMS), the National Center for
Research Resources, the National Human Genome Research Institute, and
the National Institute of Allergy and Infectious Diseases are the
principal Federal Government agencies that currently support psoriasis
research. Additionally, research activities that relate to psoriasis or
psoriatic arthritis also have been undertaken at the National Cancer
Institute. An analysis of longitudinal Federal funding data shows that,
on average over the past decade, NIAMS has spent less than $1 per
person with psoriasis per year.
Adequate investment in psoriasis and psoriatic arthritis in fiscal
year 2010 and beyond is imperative, because a rare opportunity for
breakthroughs in both conditions is presenting itself at this time. A
convergence of findings reached through various types of studies has
stimulated new ideas about the mechanisms involved in psoriasis.
It has taken nearly 30 years to understand that psoriasis is not
solely a disease of the skin, but also of the immune system. Finally,
scientists are identifying the genes immune cells involved in
psoriasis--findings that will help improve understanding of which cells
or molecular processes should be targeted in psoriasis drug
development. With these important advances, we are poised and
positioned, as never before, to identify and develop a permanent method
of control for psoriasis and, eventually, a cure. Greater funding of
genetics, immunology and clinical research focused on understanding the
mechanisms of psoriasis and psoriatic arthritis is needed. Key areas
for additional support and exploration include:
--Studying the genetic susceptibility of psoriasis;
--Developing animal models of psoriasis;
--Identifying the environmental and lifestyle triggers for psoriasis;
--Studying a number of important epidemiologic issues, such as the
risk of heart attack, diabetes, increased mortality, and
lymphoma in psoriasis patients;
--Identifying and examining immune cells and inflammatory processes
involved in psoriasis;
-- Examining the relationship between psoriasis and mental illnesses,
such as depression and suicidal ideation; and
--Elucidating psoriatic arthritis specific genes and other
biomarkers.
the role of cdc in psoriasis and psoriatic arthritis research
NPF is concerned that there have been very few efforts to collect
epidemiological and other related data on individuals with psoriasis
and psoriatic arthritis. Researchers and clinicians continue to be
limited in their longitudinal understanding of these conditions and
their effects on individual patients. There are many mysteries related
to psoriasis and psoriatic arthritis. For example, we know of people
who never had any evidence of disease who, after falling ill with the
flu or spiking a fear, wake the next day to be covered in psoriasis
plaques. Why? A treatment could work well for an individual for years
and then suddenly become ineffective. Why?
Researchers agree that collecting data through a patient registry
would help increase the understanding of: the other chronic conditions
that co-occur with psoriasis; how factors like age or gender impact the
course and burden of psoriasis; and how certain environmental exposures
might contribute to the occurrence and severity of psoriasis and
psoriatic arthritis. In turn, this information would help improve
treatments and advance efforts toward a cure. CDC psoriasis and
psoriatic arthritis data collection efforts would help answer myriad
questions about these autoimmune conditions, contribute to improved
disease treatment and management, and further the Nation's efforts to
find a cure.
For 3 years, your subcommittee has encouraged CDC to undertake data
collection, and we very much appreciate your recognition of this much-
needed effort. We have met with CDC staff to offer our assistance and
expertise, however, it is clear the agency must receive specific,
dedicated funding so it has the resources necessary to develop a
registry. To that end, NPF respectfully requests that the subcommittee
allocate $1.5 million in fiscal year 2010 for the National Center for
Chronic Disease Prevention and Health Promotion (NCCDPHP) within the
CDC to examine and develop options and recommendations for the creation
of a National Psoriasis and Psoriatic Arthritis Patient Registry. A
national patient registry that collects longitudinal patient data will
help researchers to learn about key attributes, such as response to
treatment, substantiating the waxing and waning of psoriasis,
understanding associated manifestations like nail disease and
arthritis, and the relationship of psoriasis to other public health
concerns.
FUNDING REQUEST SUMMARY
NPF recognizes that Congress and the Nation face unprecedented
fiscal challenges. However, we also believe that greater fiscal year
2010 investment in biomedical and epidemiologic research at NIH and CDC
will prove simulative to the economy and bear fruit with regard to the
development of new, safe, effective, and long-lasting treatments and--
ultimately--a cure for psoriasis and psoriatic arthritis. We thank the
subcommittee in advance for providing the following allocations:
--$32.4 billion to NIH and its Institutes and Centers that play an
integral role in psoriasis and psoriatic arthritis research and
urge them to initiate and/or expand psoriasis and psoriatic
arthritis research and;
--$1.5 million to the NCCDPHP within the CDC to collect data on
psoriasis and psoriatic arthritis and begin to establish a
patient registry to improve the knowledge base of the
longitudinal impact of these diseases on the individuals they
affect.
CONCLUSION
On behalf of NPF's Board of Trustees and the as many as 7.5 million
individual with psoriasis and psoriatic arthritis who we represent,
thank you for this opportunity to submit written testimony regarding
the fiscal year 2010 funding levels necessary to ensure that our Nation
adequately addresses psoriasis and psoriatic arthritis and to make
gains in improving therapies and eventually attaining a cure. We
believe that additional research undertaken at the NIH coupled with
epidemiologic efforts at the CDC together will help advance the
Nation's efforts to improve treatments and identify a cure for
psoriasis and psoriatic arthritis. Please feel free to contact us at
any time; we are happy to be a resource to subcommittee members and
your staff. We very much appreciate the subcommittee's attention to--
and consideration of--our requests.
______
Prepared Statement of National Public Radio
Thank you Chairman Inouye and Senator Cochran for the opportunity
to offer testimony on behalf of National Public Radio (NPR), our more
than 850 public radio station partners, and for other producers and
distributors of public radio programming including American Public
Media, Public Radio International, the Public Radio Exchange, and many,
many stations, both large and small, that create and distribute content
through the Public Radio Satellite System (PRSS).
The state of public radio today is both sobering and heartening.
While the economic crisis has undermined the financial stability of the
public radio system, the audience is tuning at record levels. But
without your help, we will not be able to continue to achieve our
public service mission, and your expectations.
AN ADDITIONAL INVESTMENT IN STATIONS
Public broadcasting is requesting $307 million--$96 million for
public radio stations and $211 million for public television stations--
in additional emergency investment funding for the fiscal year 2010
budget of the Corporation for Public Broadcasting (CPB). This action is
necessary to offset the tide of losses at public broadcasting stations.
This one-time investment of Federal resources will help protect
thousands of station jobs now at risk, and assure continuity in
services used daily by tens of millions of Americans. These funds are
in addition to the $420 million that Congress approved 2 years ago as
part of the advance funding process.
The funds we are requesting only partially close the expected 2-
year revenue shortfall of almost $170 million at the public radio
station level, plus an additional $55 million in loses at NPR. The
remainder will come about as a result of significant cost cutting at
the local and national levels. Every week brings another announcement
of a service reduction or employment layoff at public broadcasting
stations. In fact, a survey last month of locally licensed and operated
public radio stations projected more than a 46 percent reduction in
financial support from local and State government agencies, a 23
percent decline in foundation and philanthropic contributions and a 23
percent drop in underwriting from local businesses.
Public broadcasting's contribution to America's democracy is more
important today than at anytime during our four decades of public
service. More than 33 million people each week are tuning into public
radio programming and listening to member stations. Our audience has
grown 66 percent in the past 10 years, bucking a precipitous decline in
other media and stands in sharp contrast with the general overall
decline in radio listening. Consider that public radio programming
today reaches more people than the circulation of USA Today, the Wall
Street Journal, the New York Times, Los Angeles Times, the Washington
Post and the next top 45 newspapers combined.
Stations in every State have become living embodiments of
journalistic excellence, providing news, information and cultural
programming that have become increasingly rare in other media. Public
radio programming is rooted in the fundamentals of accuracy,
transparency, independence, balance, and fairness and serves as
cornerstone of understanding for millions of Americans seeking
information, context and insight.
PUBLIC FUNDS FOR PUBLIC MEDIA
CPB is the primary public funding mechanism for public radio,
accounting for roughly 12 percent of an average public radio station's
annual budget. These funds help public broadcasting stations produce,
purchase and distribute programming that sparks imagination and kindles
thought about our world. Several stations specifically serve rural and
minority communities including numerous African-American, Native
American, Latino, and multicultural licensees. In many cases, they are
the sole local broadcasting service available. These critical Federal
funds allow all stations to continue serving the needs of public
radio's 33 million weekly listeners, irrespective of their communities'
location or financial status.
CPB's general appropriation is allocated according to a
congressionally set formula that ensures the funds go directly to the
people and organizations that create and deliver highly valued programs
and services. The public broadcasting community is urging Congress to
appropriate $542 million in 2-year advanced funding for fiscal year
2012 for CPB.
THE PUBLIC RADIO SATELLITE SYSTEM
As the public broadcasting community grapples with the financial
crisis, we also remain committed to ensuring that the Nation's public
radio infrastructure continues to be robust and viable. This commitment
requires a periodic investment by Congress in PRSS. This year, CPB is
requesting $27 million as the third and final installment of a 3-year
request to renew and replenish the PRSS.
This system, originally built in 1979 with funds provided by this
Committee, distributes 400,000 hours of programming, or 7\1/2\ billion
listener hours each year. Every minute of every hour of public radio
programming--from NPR's Morning Edition, and All Things Considered, to
American Public Media's Marketplace and A Prairie Home Companion, to
Public Radio International's This American Life and Capitol News
Connection--is distributed by the PRSS. Quite simply, without the PRSS,
there would be no public radio in the United States.
An important mission of the PRSS is to facilitate the cost-
effective and efficient distribution of news, information, cultural,
and educational programming to this country's increasingly diverse
population. As part of that mission, the PRSS provides satellite
transmission services to distribute programming that targets unserved
or underserved audiences from sources who meet certain criteria
established by the NPR Board, including demonstrated financial need.
PRSS is the indispensable distribution backbone for everything heard on
public radio. On behalf of all in public radio, I ask for your support
of this critically important funding request.
DIGITAL TRANSITION FUNDING
Change is rapidly occurring in over the air radio broadcasting, the
last enclave of the old analogue world. As of today, more than 650
public radio stations had either completed or have nearly completed
conversion to a digital signal, which improves the overall listener
experience by enhancing audio quality; eliminating reception
interference; and utilizing multiple audio programming channels, or
multicasting. To continue supporting this necessary change in our basic
broadcast technology, CPB is requesting $40 million as part of its
fiscal year 2010 budget.
Digital broadcasting technology has enabled public radio stations
to increase local services to their communities. More than 160 stations
are multicasting--doubling and tripling their programming to broaden
and expand the base of listeners. Many stations have created Spanish
language channels to provide news, including through BBC Mundo.
Stations serving Native American communities are providing tribal
programming over the air and online. Local community events such as
concerts, town hall meetings, committee hearings, legislative floor
sessions, and other government programming are broadcast live using HD
radio technology. Listeners with HD radio receivers may view a variety
of useful messages that scroll across radio display screens, including
artist name and song title, emergency alerts, live weather and real-
time traffic updates, local news, school closings, and movie listings.
Digital technology using the Internet and mobile platforms expands
public radio programming and community services. Expansion and
improvement of public radio Web sites and our digital connections with
audiences remain a major priority. Public radio stations and public
radio program producers are all expanding to new platforms, and in so
doing bring broader, deeper and more varied content to our audiences.
The impact is already being felt. News coverage of the U.S.
Presidential election resulted in record level traffic to public radio
station Web sites and NPR.org in terms of both visitors and page views.
Ten million visitors went each month to NPR.org during October and
November 2008 to view 115 million pages during the same time period.
And just this past week, public radios web sites became an essential
platform for updated information on Swine flu.
Other Internet and mobile platform program distribution efforts
using iPhone applications, for example, have gained wide acceptance
among public radio listeners and brought a new generation of consumers
to our coverage. Local public radio station and NPR podcasts have
become very popular, with some 14 million downloads occurring each
month. Podcasts offered by stations are expanding programming in areas
such as science, poetry, music, arts, history, politics, international
affairs, and health. The audience may also now download interactive
media such as photo slide shows, video, Web streams and audio of local
news, music, and programming on their local station Web site.
Audiences are visiting station Web sites with greater frequency for
local news and community events. Online community calendars posted on
station Web sites allow local organizations of all sizes and areas to
list public events and reach a wide audience. Listeners viewing station
Web sites are connecting with local nonprofit organizations to obtain
information about special cultural activities, festivals, public health
fairs, musical events, educational seminars, lectures, classes, and
workshops. Station Web sites also increasingly have online music play
lists allowing the audience to find information on music played at
their local station. Web-based social-networking features are used to
foster online communities to give listeners the opportunity to connect
over common interests and passions by engaging in dialogue and sharing
viewpoints about their lives.
We are confident in our ability to meet the needs of our audience
and our ability to emerge from the current economic crisis more
prepared and better structured. But we cannot do either without your
help. We ask for your approval of CPB's funding requests, including the
additional, emergency, one-time investment to stations of $307 million
in fiscal year 2010.
______
Prepared Statement of National Primate Research Centers
The Directors of the eight National Primate Research Centers
(NPRCs) respectfully submit this written testimony for the record to
the Senate Appropriations Subcommittee on Labor, Health and Human
Services, and Education, and Related Agencies. The NPRCs appreciate the
commitment that the members of this subcommittee have made to
biomedical research through your strong support for the National
Institutes of Health (NIH), and recommends that you maintain this
support for NIH in fiscal year 2010 by providing the agency with at
least a 7 percent increase more than fiscal year 2009. The NPRCs also
respectfully request that the subcommittee encourage the National
Center for Research Resources (NCRR), the sponsoring institute of the
NPRCs within NIH, to carry out the NPRCs 5-year Federal advancement
initiative, which as explained in this testimony, would help to ensure
that the NPRCs continue to serve effectively in their role as a vital
national resource.
Through passage of the American Recovery and Reinvestment Act
(ARRA) and the Omnibus Appropriations Act for Fiscal Year 2009, the
administration and Congress have taken critical steps to jump start the
Nation's economy. Simultaneously, Congress is advancing and
accelerating the biomedical research agenda in this country by focusing
on scientific opportunities to address public health challenges. The
success of the U.S. Government's efforts, however, is contingent upon
the quality of research resources that enable and enhance scientific
research ranging from the most basic and fundamental to the most highly
applied.
Biomedical researchers have relied on one such resource--NPRCs--for
nearly 50 years for research models and expertise with nonhuman
primates. The NPRCs are highly specialized facilities that foster the
development of nonhuman primate animal models and provide expertise in
all aspects of nonhuman primate biology. NPRC facilities and resources
are currently used by more than 2,000 NIH-funded investigators around
the country. NCRR provides the NPRCs with an annual base grant (funded
through NCRR's P51 program) which supports the operational costs of the
NPRCs. In fiscal year 2009, the 8 NPRCs received $79.235 million from
NCRR's P51 program.
The NPRCs also serve an essential role in translating basic
research toward a clinical outcome. Specifically, the nonhuman primate
models that are housed at the NPRCs often provide the critical link
between research with small laboratory animals and studies involving
humans. As a result, the network of the eight NPRCs is taking a
leadership role to encourage collaboration among researchers and
healthcare providers across disciplines and institutions, with the goal
of advancing biomedical knowledge and improving human health.
The NPRCs face several serious barriers to successfully supporting
and advancing nonhuman primate research; specifically, the lack of
adequate infrastructure to breed and house animals for research, the
limited number of primates available, and the shortage of properly
trained staff to handle nonhuman primates and provide sophisticated
care. The need to address these problems has become even more critical
due to the additional nonhuman-primate-related grants that will be
funded as a result of ARRA, the new demands to increase research in
nonhuman primate challenge models for AIDS, and the need for nonhuman
primates to enhance our emerging infectious disease and biodefense
response capabilities.
NCRR has published on the need for increased primate resources in
its 2009-2013 Strategic Plan. The plan specifically States that
nonhuman animal models are indispensable for finding ways to treat and
prevent cancer, HIV/AIDS, Alzheimer's disease, and Parkinson's disease,
as well as to develop effective biodefense strategies. The NPRCs have
been leading the development of new IT approaches, including the
Biomedical Informatics Research Network (BIRN) for linking brain
imaging, behavior, and molecular informatics in nonhuman primate
preclinical and translational models research.
In an effort to address many of the concerns within the scientific
community, ranging from the lack of infrastructure improvements to the
shortage of relevant nonhuman primates to the need for quality, trained
personnel, the NPRCs have developed a 5-year Federal advancement
initiative which addresses the necessary program capacity expansions
and required upgrades. This initiative will help to ensure that the
NPRCs will continue to serve effectively in their role as a vital
national resource. As part of the 5-year plan development process, the
NPRCs calculated the increases in NIH funding dedicated specifically to
the National Primate Research Centers Program (NCRR's P51 program)
necessary to achieve their goals. Below is an outline of the plan:
--Primate Infrastructure Investment.--Request for an additional $90
million over 5 years to improve the quality and capacity of
primate housing and breeding facilities and ensure availability
of related state-of-the-art diagnostic and clinical support
equipment at the NPRCs.
While NIH has been responsive in their actions during the past few
years to provide funding to the NPRCs for infrastructure improvements,
the difficulty the National Primate Research Centers Program has in
meeting even current demands, let alone future increases is inexorably
linked to the ability to house these animals in the unique living
environments that they require and to provide specialized facilities
equipped with state-of-the-art diagnostic and clinical support
equipment to conduct research. The NPRCs plan to focus on the following
goals in their effort to comprehensively improve primate
infrastructure:
--Bring older primate housing facilities and related equipment up to
present-day standards.
--Construct additional primate housing facilities and acquire related
equipment to accommodate the projected increase in breeding
colonies.
--Primate Model Investment.--Request for an additional $75 million
over 5 years to enhance the availability of primates for
research.
NCRR's Expert Panels have repeatedly stated that the NPRCs do not
have the capacity to satisfy the needs of outside investigators, and
have recommended that the NPRCs program must be responsive to national
needs for nonhuman primates. Currently, outside investigators who are
already funded for their studies must sometimes wait a year or more to
begin their research because of the high demand for the limited number
of primates. In addition, there are ongoing difficulties associated
with acquiring certain types of primates from their natural places of
origin. Accordingly, increasing domestic breeding capabilities and
developing bridging programs to effectively use other types of primates
are critical to the success of the NPRCs program.
--Primate Care and Research Personnel Investment.--Request for an
additional $35 million over 5 years to train NPRC personnel in
primate care and management.
Numerous scientific reports have highlighted the vital need for
experts who are well-trained in laboratory animal medicine and in
research methodology. Since nonhuman primates represent the most
sophisticated and relevant animal models, there is a heightened
responsibility to properly care for and manage these animals. Each NPRC
requires a primate management team comprised of behaviorists,
veterinarians, and primate research specialists. As the number of
primates at the NPRCs grows, the primate management teams must expand
proportionally.
Total anticipated cost of the National Primate Research Centers
Program 5-year Federal Advancement Initiative--$200 million more than
the current funding that is dedicated specifically to the National
Primate Research Centers Program during the 5-year period of fiscal
years 2010-2015.
Thank you for the opportunity to submit this written testimony and
for your attention to the critical need for primate research and
enhancement of the NPRCs P51 base grant, as well as our recommendations
concerning funding for NIH in the fiscal year 2010 Labor, Health and
Human Services, and Education, and Related Agencies Appropriations
bill.
______
Prepared Statement of the National Sleep Foundation
SUMMARY OF FISCAL YEAR 2010 RECOMMENDATIONS
--Provide $5 million in funding for sleep activities within the
Community Health Promotion account within the Chronic Disease
Program at the Centers for Disease Control and Prevention
(CDC). Expanded funding for sleep and sleep disorder-related
activities would allow the CDC to create targeted public
educational initiatives for schools and workplaces; training
materials for current and future health professionals; build
and test public health interventions; expand surveillance and
epidemiological activities; and create fellowship and research
opportunities.
--Encourage the National Institutes of Health (NIH) to conduct multi-
center clinical trials to evaluate whether healthcare costs and
the incidence of stroke, cardiovascular disease and diabetes
can be reduced by treating sleep disorders such as obstructive
sleep apnea as part of usual care practices.
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. Frankie Roman, Chair of the NSF's Government
Affairs Committee and a sleep specialist at Ohio Sleep Disorder
Centers, in Akron, Ohio. NSF is an independent, nonprofit 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 medicine
and other healthcare professionals, researchers, patients and drowsy
driving advocates throughout the country as well as collaborate with
many Government, public and professional organizations with the goal of
preventing 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. Annual
surveys conducted by NSF 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 has been identified as the cause of a
growing number of on-the-job accidents, automobile crashes and multi-
model transportation tragedies.
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 previous 5 years. According to NSF's 2009
Sleep in America poll, 54 percent of people report that they have
driven drowsy at least once in the past year, with 28 percent reporting
that they do so at least once a month or more. A large number of
academic studies and Government reports have linked lost productivity,
poor school performance, and major public health problems to chronic
sleep loss and sleep disorders.
The 2006 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 such as alcohol
and drug abuse--all of which represent long-term targets of the
Department of Health and Human Services (HHS) and other public health
agencies. 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 Federal reports have clearly detailed the
importance of sleep to health, safety, productivity and well-being, yet
studies continue to show that millions of Americans remain at risk for
serious health and safety consequences of untreated sleep disorders and
inadequate sleep, due to a lack of awareness, community interventions,
and inadequate screening. Unfortunately, despite recommendations in
numerous Federal reports, there is a lack of epidemiological data,
large clinical trials and no on-going national educational programs
regarding sleep issues aimed at the general public, healthcare
professionals, underserved communities or major 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. Sleep must be elevated to the top of the national
health agenda in order to adequately address other national public
health problems mentioned above. We need your help to make this happen.
First, one of the most devastating sleep disorders is obstructive
sleep apnea (OSA), a sleep-related breathing disorder which affects at
least 5 percent of adult Americans and is closely related to some of
America's most pressing health problems, such as obesity, hypertension,
heart failure, and diabetes. NSF and its partners, including the
National Center on Sleep Disorders Research at the National Institutes
of Health, have been working diligently to create better patient and
primary care physician awareness of sleep apnea. However, despite
considerable progress, sleep apnea remains woefully underdiagnosed and
undertreated primarily due to a lack of understanding in the primary
care community, good epidemiological data, and randomized evidence
regarding long-term treatment. Therefore, we recommend that the NIH be
encouraged to conduct multi-center clinical trials to evaluate whether
treatment of OSA can reduce healthcare costs and the incidence of
stroke, cardiovascular disease and diabetes.
Second, our biggest challenge is bridging the gap between the
established sleep science best practices and the level of knowledge
about sleep held by healthcare 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 clinical training initiatives.
Consequently, the NSF has spearheaded important initiatives to raise
awareness of the importance of sleep to the health, safety, and well-
being of the Nation. One of our most important partnerships in these
efforts is with the Centers for Disease Control and Prevention (CDC).
For the last 5 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 NSF and more than 20 voluntary organizations
and Federal agencies to form the National Sleep Awareness Roundtable
(NSART), which was officially launched in March of 2007. Congress also
provided specific funding for these efforts for the past 2 years.
In fiscal year 2008, Congress provided $818,000 for activities
related to sleep and sleep disorders, including CDC's participation in
NSART and incorporating sleep-related questions into established CDC
surveillance systems. With this funding, CDC included one core sleep
question in its national data collection efforts in 2008 and has
provided grants to eight States to include an optional sleep module in
their data collection efforts through the Behavioral Risk Factor
Surveillance System (BRFSS), which will occur in the summer of 2009.
CDC also included one question in the Youth Risk Behavior Surveillance
System (YRBSS). Of note, the YRBSS has already revealed that only one-
third of high school students get 8 or more hours of sleep on an
average school night, far below the recommended 9.25 hours. This new
data will provide important information on the prevalence of sleep
disorders and enable researchers to better address the complex
interrelationship between sleep loss and comorbid conditions such as
obesity, diabetes, depression, hypertension, and drug and alcohol
abuse.
Additionally, CDC and NSART participated in NSF's national public
awareness initiatives including National Sleep Awareness Week and
Drowsy Driving Prevention Week. CDC also launched its own Sleep and
Sleep Disorders Web site, created a fellowship position to analyze
sleep and chronic disease data, held a Sleep and Public Health Workshop
at the CDC campus, and released a number of multi-media health
marketing materials to promote better sleep.
In fiscal year 2009, Congress provided $900,000 to the CDC for
sleep activities. CDC plans to expand the number of States it is able
to fund for BRFSS data collection and provide support for national
public and professional awareness initiatives as well as activities of
the National Sleep Awareness Roundtable.
NSF and NSART have actively been involved in conducting outreach to
public health officials and are currently working to develop a national
action plan. This document will address ways to organize and implement
effective public and professional awareness and education initiatives
primarily aimed at the diagnosis and treatment of obstructive sleep
apnea and the promotion of sleep as a healthy behavior. 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 initiatives.
Although the CDC has taken initial steps to begin to consider how
sleep affects public health issues, the agency needs additional
resources to take appropriate actions, as recommended by the IOM and
other governmental reports.
Expanded funding for sleep and sleep disorder-related activities
would allow the CDC to create much needed educational programs for
schools and occupational settings and training materials for current
and future health professionals; build and test public health
interventions; expand surveillance and epidemiological activities; and
create further fellowships and research opportunities. The following
are detailed scenarios for various funding levels.
--$2 million:
--Expand Surveillance on BRFSS.--CDC could double the number of
grants it provides to States to use the optional sleep
module and include more core questions in the nationwide
data collection through the Behavioral Risk Factor
Surveillance System. CDC would also expand its
participation in and funding of national public and
professional initiatives as well as the goals and
activities of the National Sleep Awareness Roundtable.
--$5 million--All activities detailed in the $2 million scenario,
plus:
--Public Education.--CDC could support the development of a
national sleep health communications campaign that use
targeted approaches for delivering sleep-related messages,
especially in public schools and workplaces. Currently, no
such programs exist.
--Training Materials.--Tools and programs could be developed for
current and future health professionals, including school
nurses, to promote sleep as a healthy behavior and increase
the diagnosis and treatment of sleep disorders. Today, most
health care professionals receive no such training, which
increases the Nation's health burden.
NSF and members of the National Sleep Awareness Roundtable believe
that an ongoing partnership with CDC is critical to address the
enormous public health impact of sleep and sleep disorders. We hope
that the Committee will provide funding of $5,000,000 to the CDC to
execute programs as outlined here.
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 subcommittee: I am pleased to
present the fiscal year 2010 budget request for NTID, 1 of 8 colleges
of Rochester Institute of Technology (RIT), in Rochester, New York.
Created by Congress, we provide university technical education, serving
a total of 1,450 students, including 1,284 deaf and hard-of-hearing
students from across the Nation and 166 hearing students. NTID students
live, study, and socialize with more than 15,000 hearing students on
the RIT campus.
NTID has fulfilled our mission with distinction for 41 years.
BUDGET REQUEST
This request details the importance of obtaining our full fiscal
year 2010 request of $71,352,000. We ask for $65,952,000 for continuing
operations and $5,400,000 for construction to replace aging mechanical
systems as detailed below. The NTID and President's requests are:
[In millions of dollars]
----------------------------------------------------------------------------------------------------------------
Operations Construction Total
----------------------------------------------------------------------------------------------------------------
NTID request.................................................... 65,952 5,400 71,352
President's request \1\......................................... 63,037 5,400 68,437
-----------------------------------------------
Difference................................................ 2,915 .............. 2,915
----------------------------------------------------------------------------------------------------------------
\1\ These numbers are our understanding of what the President will submit to Congress.
We respectfully request your support of our full appropriation
request. We do not request new operations funding for additional
academic programs or headcount; instead, we commit to fund increases,
if any, through reallocating resources. This commitment continues our
history of funding changes through internal reallocation. From fiscal
year 2003 through fiscal year 2007 we documented $6,200,000 in budget
reductions, including the elimination of 49 headcounts, and increasing
our revenues. These difficult savings allowed us to improve our
programs and services while limiting our request for Federal support.
As one example, we dramatically increased the number of captionists
employed to deliver in-classroom speech-to-text real-time access
services to students, without additional funding.
We are proud of those cost savings and reallocations
accomplishments.
Our fiscal year 2010 operations request represents costs driven by
personnel and health benefits, as well as payment for services provided
by RIT that are subject to the same inflationary pressures. The
significant enrollment increases detailed below add proportionally to
anticipated costs. We do not ask for funds to address program
modifications; we will reallocate to meet those needs.
ENROLLMENT
As we prepare to enter fiscal year 2010, we do so having attracted,
in fiscal year 2009, the largest enrollment in our 41-year history.
Truly a national program, NTID enrolls students from all 50 States.
Current enrollment of 1,450; in the last 2 years our enrollment has
increased by 200 students, an increase of 16 percent. For fiscal year
2010, NTID anticipates maintaining or slightly increasing enrollment.
Our 5-year enrollment history follows.
NTID ENROLLMENTS: FIVE-YEAR HISTORY
--------------------------------------------------------------------------------------------------------------------------------------------------------
Deaf/Hard-of-Hearing students Hearing students
--------------------------------------- ----------------------------------------
Fiscal year Subtotal Interpreting Grand total
Undergrad Grad RIT MSSE program MSSE Subtotal
--------------------------------------------------------------------------------------------------------------------------------------------------------
2005........................................... 1,055 42 49 1,146 100 35 135 1,281
2006........................................... 1,013 53 38 1,104 116 36 152 1,256
2007........................................... 1,017 47 31 1,095 130 25 155 1,250
2008........................................... 1,103 51 31 1,185 130 28 158 1,353
2009........................................... 1,212 48 24 1,284 135 31 166 1,450
--------------------------------------------------------------------------------------------------------------------------------------------------------
STUDENT ACCOMPLISHMENTS
For our graduates, 95 percent have been placed in jobs commensurate
with the level of their education (using the Bureau of Labor Statistics
methodology). Of our fiscal year 2007 graduates (the most recent class
for which numbers are available), 63 percent were employed in business
and industry, 29 percent in education/nonprofits, and 8 percent in
Government.
Graduation from NTID has a significant, positive effect on earnings
over a lifetime, and results in a noteworthy reduction in dependence on
welfare programs. In fiscal year 2007, NTID, the Social Security
Administration, and Cornell University examined approximately 13,000
deaf and hard-of-hearing individuals who applied and attended NTID over
our entire history. We learned NTID graduation has significant economic
benefits. By age 50, deaf and hard-of-hearing baccalaureate graduates
earned on average $6,021 more per year than those with associate
degrees, who in turn earned $3,996 more per year on average than those
who withdraw. Students who withdraw earned $4,329 more than those who
were not admitted. Students who withdrew experienced twice the rate of
unemployment as graduates.
The same studies showed 78 percent of these individuals were
receiving Supplemental Security Income (SSI) benefits at age 19, but
when they were 50 years old, only 1 percent of graduates drew these
benefits, while on average 19 percent of individuals who withdrew or
were rejected for admission continued to participate in the SSI
program. Graduates also accessed Social Security Disability Insurance
(SSDI), an unemployment benefit, at far lesser rates than students who
withdrew; by age 50, 34 percent of nongraduates were receiving SSDI,
while only 22 percent of baccalaureate graduates were receiving them
and only 27 percent of associate graduates were receiving them.
Considering the reduced dependency on these Federal income support
programs, the Federal investment in NTID returns significant societal
dividends.
NTID clearly makes a significant, positive difference in earnings,
and in lives.
NEW ``MILITARY VETERANS WITH HEARING LOSS'' PROGRAM
In fiscal year 2010, NTID will establish the ``Military Veterans
with Hearing Loss'' program to enroll veterans who have suffered
significant hearing loss as a result of their military service.
Recently returned veterans with hearing loss can earn bachelor or
graduate-level degrees at RIT with access services--such as real-time
captioning and notetaking in the classroom--from NTID. Our faculty and
staff are experienced in helping those with sudden hearing loss, and we
provide comprehensive services for those with hearing aids or cochlear
implants.
The access services provided at NTID are unparalleled. More than 50
classroom captionists provide real-time captioning to students. More
than 120 sign language interpreters support students who benefit from
interpreting.
As many as 10 veterans could be admitted each year, growing to 50
veterans over time. (RIT also recently announced it will become a
``Yellow Ribbon'' institution.)
CONSTRUCTION
For the past 3 years, NTID has informed Congress of on-going
planning to replace the deteriorating 25 boilers and 23 chillers in
individual buildings throughout the RIT campus. Existing heating,
ventilation and air conditioning systems remain from the original
campus construction more than 40 years ago. Although prudent in
providing on-going maintenance, RIT/NTID reached a point where normal
maintenance was no longer feasible and the decision was reached to
replace the existing system with five new boilers and seven new
chillers.
All of the buildings and spaces devoted to NTID programs across the
RIT campus are connected to this system. An analysis determined the
square footage used by NTID in each building serviced by the new
system, and the resulting proportion of the total expenses was
allocated to NTID. That analysis showed that NTID buildings and other
spaces utilized 15 percent of the total square footage. With a total
project cost of $36,000,000, NTID is responsible for $5,400,000 (15
percent) of the total cost, which we request for fiscal year 2010.
In addition to discussions with Congress, this request has been
discussed repeatedly over several years with the U.S. Department of
Education (ED); presentations and facilities tours were provided during
oversight visits to NTID. We understand that the President supports
this request, and we ask that Congress also support this construction
cost.
NTID BACKGROUND
Academic Programs
NTID offers high-quality, career-focused, associate degree programs
preparing students for specific well-paying technical careers. A
cooperative education component ties closely to high-demand employment
opportunities. Expanding transfer associate degree programs 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 seamless transition to baccalaureate
studies in other colleges of NTID where we support students in
baccalaureate programs with access services and tutoring. One of NTID's
greatest strengths is our outstanding track record of assisting high-
potential students gain admission to and graduate from the other
colleges of RIT at rates that are better than their hearing peers.
Research
Our research program is guided and organized according to these
general research areas: language and literacy, teaching and learning,
sociocultural influences, career development, technology integration,
and institutional research. All benefit the deaf and hard-of-hearing
population.
Outreach
Extended outreach activities to junior/senior high school students,
expand their horizons regarding a college education. We also serve
other universities and postcollege adults.
Student Life
Our activities foster student leadership and community service, and
provide opportunities to explore other educational interests.
SUMMARY
It is extremely important that our funding be provided at the full
level requested as we continue our mission to prepare deaf and hard-of-
hearing people to enter the workplace and society.
Our alumni have demonstrated that they can achieve independence,
contribute to society, earn a living, and live a satisfying life as a
result of NTID. Research 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 than those who withdraw or who apply
but do not attend NTID.
We are hopeful that the members of the subcommittee will agree that
NTID, with its long history of successful stewardship of Federal funds
and outstanding educational record of service with deaf and hard-of-
hearing people, remains deserving of your support and confidence.
______
Letter From the National Union of Labor Investigators
Dear Sir or Madam: Before the budget for the Department of Labor,
Office of Labor-Management Standards (OLMS) is approved, please
consider the 43 employees who were recently deemed ``unaffordable''
because of budget shortfalls, and please consider the OLMS's re-
organization in 2008, a reorganization that now seems morally
reprehensible. ``Fiscal Year 2010 Budget Shortfalls and Solutions'' was
presented to OLMS employees on May 8, 2009, and during that
presentation Deputy Assistant Secretary Andrew Auerbach said that OLMS
hired just about as many investigators as it could afford because OLMS
had been criticized for leaving itself understaffed.
The presentation went on to point out that approximately $4.5
million cut from the OLMS budget would return OLMS to its 2003 staffing
level, and that OLMS's mission would not be compromised because
workload and productivity have remained (relatively) constant since
2003. The presentation reported 260 full-time employees in fiscal year
2003, and 303 full-time employees in fiscal year 2009. The result, we
were told, is that 43 OLMS employees are no longer affordable.
The tone taken during the presentation was that the result was
unavoidable. However, OLMS's reorganization in 2008 moved all managers
to a higher pay grade, and given the current budget shortfalls, and the
speed with which the reorganization took place, it seems less like a
move intended to improve OLMS's effectiveness, and more like a case of
traders with inside information dumping stocks just before the company
that issued them goes bankrupt. Managers at every level, and in every
office, warned their investigators of potential budget cuts and of the
affect they might have on OLMS, and yet management went forward with a
reorganization that exacerbated OLMS's budget crisis.
It seems that if an unaltered work load and unaffected productivity
has been used to defend OLMS's $4.5 million budget cut, the same logic
should be applied to the reorganization. If their job responsibilities
have not changed since 2003, why were OLMS managers given a raise in
pay and grade, and why haven't managers been returned to their 2003 GS
levels in order to address the budget shortfall? If all OLMS management
positions were returned to their 2003 pay grade, would (all) 43
employees have become unaffordable?
I appreciate your consideration of this matter.
Sincerely,
Bennett Allen.
______
Letter From the National Union of Labor Investigators
May 11, 2009.
Hon. Tom Harkin,
Chairman, Subcommittee on Labor, Health and Human Services, and
Education, and Related Agencies,
Washington, DC.
Dear Subcommittee on Labor, Health and Human Services, and
Education, and Related Agencies Members: The new budget is out and our
agency, Office of Labor Management Standards (OLMS), within the
Department of Labor suffered a severe reduction in our budget. On May
8, 2009, all employees of OLMS were notified that 43 positions were
deemed unaffordable by the Employment Standards Administration (ESA),
which OLMS falls under. As of the same date, 20 employees were
involuntarily transferred to other agencies. They have 5 days to agree
to this or lose their job. Though it was repeated this was not a
Reduction in Force (RIF), this is essentially what has occurred.
Additionally, the remaining 23 employees/positions have not been
identified. OLMS is represented by an independent union, created in
1971, the National Union of Labor Investigators (NULI). Despite an
official union request seeking documents regarding the reorganization,
nothing has been provided to NULI that represents all bargaining unit
employees. Anxiety runs high as OLMS employees cannot know whether they
are one of the designated 23 employees, and whether they should
immediately look for work.
NULI cannot possibly negotiate the impact of a plan that they do
not have and cannot obtain. OLMS has essentially ignored the collective
bargaining agreement negotiated by OLMS and NULI; and the right of NULI
as the sole and exclusive bargaining representative for all unit
employees. Regardless of the political powers, reasonable notice is
still warranted. Rights of working people should be respected.
In 1959, the Labor Management Reporting and Disclosure Act was
enacted to correct the abuses which had crept into labor and management
which was revealed during the investigations of the McClellan
Committee. The Secretary of Labor administers and enforces the act.
Shortly after the election of President Obama, the AFL-CIO wrote a
proposal entitled AFL-CIO 2008 Transition Project Recommendations for
the Obama Administration: Regulations of Union Finances and Elections
Under the Labor Management and Disclosure Act that was provided to the
Obama-Biden Transition team. Their recommendations asked for immediate
revocation of revisions made to union financial disclosures. This was
essentially enacted. They recommended a scaling back of OLMS'
enforcement efforts. This, too, was enacted.
Additionally, the transition team evaluating the OLMS was headed by
Deborah Greenfield, former AFL-CIO Associate General Counsel. Her first
stop in that position was to OLMS. Ms. Greenfield was one of the
attorney's suing OLMS on behalf of the AFL-CIO. According to a recent
Washington Times article, Ms. Greenfield currently is in charge of the
Department's Executive Secretariat's office, which handles much of the
correspondence for Secretary Solis. This appears to be in violation of
President Obama's pledge to the American public when he said:
``No political appointees in an Obama-Biden administration will be
permitted to work on regulations or contracts directly and
substantially related to their prior employer for two years.''
OLMS is not a partisan issue; it is about protecting the money and
the democratic rights of American workers who engage in legitimate
union activity. We are the only agency, created by Congress, to oversee
and protect the rights of union workers. Allowing the budget to pass as
is, allows for the rights of American workers to be trampled on.
The rationale and the statistics provided to justify the decrease
in funding and reduction in staff are gravely misconstrued and
misleading. The Secretary of Labor has now directed OLMS to reduce the
number of staff back to the levels when union officers and employees
rest assured that the Government could not closely monitor or oversee
their actions. As a society we are aware that when the Government
cannot monitor, oversee, or enforce Federal law, those affected by
those laws are left susceptible to violations of the law. What does
this mean? It simply means that hard-working Americans who are union
members may be subjected to an increase of theft: theft of their hard-
working union dues and theft of their right to democracy in their
union.
I understand that our economy is currently struggling and we all
need to make sacrifices. Every other agency within the Department of
Labor has seen an increase in funding, except ours. While I greatly
applaud the Secretary's efforts to bring back enforcement in areas that
have been sorely underfunded in recent years, it seems somewhat
antithetical that the one area that protects a large portion of the
America's workers are scaled back. Let's not hurt the American workers
more by allowing their hard earned money to be misused or having their
democratic rights within the union reduced.
I write to you not only as an employee but as a union member as
well. I urge the Subcommittee on Labor, Health and Human Services, and
Education, and Related Agencies to ask for a full inquiry and
accounting into the reasoning behind the reductions of the OLMS budget
and who will truly benefit from the lack of enforcement. I also ask
that prior to approving the budget to please educate yourself on the
true role and purpose of OLMS.
Union rights are human rights. Whether you are for or against labor
unions, they are an essential component for any true democracy. Cutting
funding will only make unions weaker by reducing the rank and file's
faith in their union leadership.
Thank you for you time and consideration.
Sincerely,
Elizabeth Messenger.
______
Prepared Statement of the National Wildlife Federation
Mr. Chairman, members of the subcommittee, on behalf of the
National Wildlife Federation (NWF), our Nation's largest conservation
advocacy and education organization, and our more than 4 million
members and supporters, I thank you for the opportunity to provide
funding recommendations for the Department of Education, Department of
Labor (DOL), and the Corporation for National and Community Service
(CNCS).
We believe that the overall Federal investment in environmental
education and sustainability education programs nationwide--pennies per
capita--is woefully inadequate. While NWF supports numerous programs
under the jurisdiction of this subcommittee, the purpose of this
testimony is to recommend levels of funding for specific sustainability
education, green jobs education and training, and national service
programs that we believe are vital to NWF's mission to inspire
Americans to protect wildlife for our children's future. NWF also
supports climate change education and environmental education programs
across the Federal agencies at the U.S. Forest Service, Environmental
Protection Agency, National Science Foundation, National Space and
Atmospheric Administration, National Oceanic and Atmospheric
Administration, and U.S. Department of the Interior.
SUMMARY OF RECOMMENDATIONS
----------------------------------------------------------------------------------------------------------------
Fiscal year 2010
Agency Program recommendation Fiscal year 2009 level
----------------------------------------------------------------------------------------------------------------
Education............................ University $50 million............ Not authorized in
Sustainability Program. fiscal year 2009
Education............................ Healthy High $25 million............ None
Performance Schools.
Labor................................ Green Jobs Act......... $125 million........... Funded at $500 million
total in ARRA
Labor................................ Community Based Jobs $250 million--green $125 million
Training Grants. prior- ity.
CNCS................................. Clean Energy Service $100 million........... Not authorized in
Corps. fiscal year 2009
----------------------------------------------------------------------------------------------------------------
THE NEED FOR ENVIRONMENTAL EDUCATION AND SUSTAINABILITY EDUCATION
As our Nation moves towards a clean energy economy and creates new
``green jobs,'' we must ensure that our education and training
infrastructure keeps pace. Congress and President Obama have stated
their desire to cap global warming pollution this year, a priority that
NWF strongly supports. To be successful as a Nation under a new cap and
trade system, we must have an environmentally literate citizenry that
has the knowledge and skills to find new and innovative solutions to
protect our planet. While public awareness and concern about global
warming continues to rise, the vast majority of the public does not
understand how climate change works, how it impacts their lives and
careers, and how their decisions and actions contribute to it. Consider
the following examples:
--Survey research shows that most Americans do not know what the
carbon cycle is or understand what actually causes global
warming. They do not know how most electricity is generated or
the importance of healthy forests and oceans in generating
oxygen and absorbing carbon dioxide.
--Less than half of the population recognizes that the cars and
appliances they use contribute to global warming, and 8 out of
10 parents admit that they know ``little'' to ``nothing'' about
the specific causes of climate change.
--The average high school student fails a quiz on the causes and
consequences of climate change (nearly 82 percent of
participants affirmed, incorrectly, that ``scientists believe
radiation from nuclear power plants cause global temperatures
to rise'').
Educating Americans about climate change is a huge opportunity for
our Nation to prepare today's leaders, and the leaders of tomorrow, to
implement the solutions created by a cap and trade system. Addressing
global warming will generate millions of good new jobs and put the
United States at the exciting forefront of a new clean energy economy.
The successful transition to this new green economy hinges on education
and training. This testimony focuses on key programs that educate and
train Americans at institutions of higher education, through
conservation corps programs that educate and train at-risk youth for
careers in clean energy, and through green workforce education and
training programs through the Department of Labor.
DEPARTMENT OF EDUCATION
University Sustainability Program (USP)
The National Wildlife Federation supports funding the newly
authorized USP at $50 million in fiscal year 2010. Interest in
sustainability is exploding on college campuses across the Nation, and
institutions are making remarkable changes to try to reduce campus
carbon footprints and energy use. However, despite increasing interest
and demand from students, sustainability education programs on college
campuses are on the decline according to a comprehensive study released
in August 2008 by NWF and Princeton Survey Research Associates
International, called the ``Campus Environment 2008: A National Report
Card on Sustainability in Higher Education.'' Environmental curriculum
requirements are slipping and today's students may be less
environmentally literate when they graduate than their predecessors.
Congress authorized a new USP at the Department of Education as
part U of the recently enacted Higher Education Opportunity Act of 2008
(H.R. 4137). This program has the potential for high-impact, high-
visibility, broad support within higher education, and is responsive to
an important national trend in higher education. Sustainability on
college campuses is critical, from education in the classroom to
facility operations. Higher education produces almost all of the
Nation's leaders in all sectors and endeavors, and many college
campuses are virtually small cities in their size, environmental
impact, and financial influence. Campuses use vast amounts of energy to
heat, cool, and light their facilities. In all, the Nation's 4,100
campuses educate or employ around 20 million individuals and generate
more than 3 percent of the Nation's GDP. The economic clout of these
schools is further multiplied by the hundreds of thousands of business
suppliers, property owners, and other commercial and nonprofit entities
involved with higher education. Funding for the newly authorized USP is
critical to help provide difficult-to-get seed funding to launch
sustainability education programs and to help support mainstream higher
education associations in including sustainability in their work with
their member institutions.
HEALTHY HIGH PERFORMANCE SCHOOLS PROGRAM
The National Wildlife Federation supports funding the Healthy High
Performance Schools Program at $25 million in fiscal year 2010. The
Healthy High Performance Schools Program seeks to facilitate the
design, construction and operation of high performance schools:
environments that are not only energy and resource efficient, but also
healthy, comfortable, well lit, and containing the amenities for a
quality education. This grant program is critical at a time when energy
costs for America's elementary and secondary schools are skyrocketing.
The No Child Left Behind Act (Public Law 107-110, title 5, part D,
subtitle 18) authorized grants to State education agencies to advance
the development of ``healthy, high performance'' school buildings.
States may use the funds to provide information, technical assistance,
monitor, evaluate, and provide funding to local education agencies for
healthy, high-performance school buildings. In turn, local agencies may
use the funding to obtain technical assistance, develop plans that
address reducing energy and meet health and safety codes, and conduct
energy audits. Funds may not be used for construction, maintenance,
repair or renovation of buildings. Research clearly shows that
improving specific factors such as school indoor environmental quality
improves attendance, academic performance, and productivity. This
program has yet to be funded by Congress.
NWF also supports a priority for funding green Career and Technical
Education programs and initiatives at the Department of Education.
While not yet authorized, NWF strongly supports authorization of
and full funding at $100 million per year for the No Child Left Inside
(NCLI) Act of 2009, which has the support of more than 1,300 national,
State, and local organizations representing more than 45 million
Americans. The central new policy in this legislation is the incentive
for States to create or update a State Environmental Literacy Plan.
Environmental Literacy Plans can be developed to meet the needs of each
State and systemically advance environmental education through the K-12
education system. These State plans support teacher training and
professional development and support capacity building for
environmental education. The House passed a modified version of the
bill in the 110th Congress by a bipartisan vote of 293-109.
DEPARTMENT OF LABOR
NWF supports a priority for green jobs education and training at
the Department of Labor though the Workforce Investment Act Adult and
Youth funding streams, the Energy Efficiency and Renewable Energy
Worker Training Program, and the Community-Based Job Training program.
Energy Efficiency and Renewable Energy Worker Training Program
NWF supports funding the Energy Efficiency and Renewable Energy
Worker Training Program at $125 million in fiscal year 2010. NWF
greatly appreciates this subcommittee's first-time investment in Green
Jobs Education and Training in the recent American Recovery and
Reinvestment Act (ARRA). This unprecedented investment will help
jumpstart the education and training needed to prepare Americans for
the clean energy economy. We hope that the subcommittee will fund The
Green Jobs Act (GJA), title X of the Energy Independence and Security
Act, which authorizes $125 million per year in grants for an Energy
Efficiency and Renewable Energy Worker Training Program. NWF is seeking
$125 million in this fiscal year 2010 bill, recognizing that the
subcommittee will assess how the investment through ARRA is spent
before making new funding available. NWF believes it is important to
make annual investments in this program through the regular
appropriations process, in addition to necessary infusions of funding
through stimulus and supplemental bills. This program identifies needed
skills, develops training programs, and trains workers for jobs in a
range of green industries, but has a special focus on creating ``green
pathways out of poverty.'' The program is administered by the
Department of Labor in consultation with the Department of Energy. ARRA
responds to already existing skill shortages. The National Renewable
Energy Lab has identified a shortage of skills and training as a
leading barrier to renewable energy and energy efficiency growth. This
labor shortage is only likely to get more severe as baby-boomers
skilled in current energy technologies retire; in the power sector, for
example, nearly one-quarter of the current workforce will be eligible
for retirement in the next 5 to 7 years.
Community-Based Job Training Grants Program
NWF supports funding the Community-Based Job Training Grants
Program at $250 million in fiscal year 2010. NWF believes that
community colleges are critical partners in training and educating the
next generation of Americans for green jobs. NWF supports a priority
within this program for green jobs education and training grants. The
Community-Based Job Training Grants program supports partnerships of
community colleges, business, and workforce investment boards seeking
to train workers for high-demand occupations. These competitive grants
help ensure that efforts funded through the program are well
coordinated with other local and regional workforce development
efforts. Community-Based Job Training Grants support workforce training
for high-growth industries through the Nation's community and technical
colleges. Their primary purpose is to build community colleges'
capacity to equip workers with the skills required to succeed in local
industries.
CORPORATION FOR NATIONAL AND COMMUNITY SERVICE
Clean Energy Service Corps
NWF supports funding the Clean Energy Service Corps at $100 million
in fiscal year 2010. The Clean Energy Service Corps, building on the
legacy of the depression-era Civilian Conservation Corps and modeled
after today's Service and Conservation Corps, will address the Nation's
energy and environmental needs while providing work and service
opportunities, especially for disadvantaged youth ages 16-25. In a
manner similar to the Civilian Conservation Corps of the 1930s,
disconnected young people may be mobilized through this program to
retrofit, weatherize, and otherwise improve the energy efficiency of
residential and public facilities that account for more than 40 percent
of carbon emissions. Specific projects that are authorized include
weatherizing and retrofitting housing units for low-income households,
cleaning and improving rivers, and working with schools and youth
programs to educate students and youth about ways to reduce home energy
use and improve the environment.
CONCLUSION
Providing Federal support for environmental education,
sustainability education, green jobs education and training, and green
national service programs is critical for securing our new clean energy
future and preparing the next generation for the challenges and
opportunities ahead.
______
Prepared Statement of the Ovarian Cancer National Alliance
On behalf of the Ovarian Cancer National Alliance (the Alliance),
thank you for this opportunity to submit comments for the record
regarding the Alliance's fiscal year 2010 funding recommendations. We
believe these recommendations are critical to ensure advances to help
reduce and prevent suffering from ovarian cancer. For 12 years, the
Alliance has worked to increase awareness of ovarian cancer and
advocated for additional Federal resources to support research that
would lead to more effective diagnostics and treatments.
As an umbrella organization with 45 State and local organizations,
the Alliance unites the efforts of survivors, grassroots activists,
women's health advocates, and healthcare professionals to bring
national attention to ovarian cancer. Our sole mission is to conquer
ovarian cancer.
According to the American Cancer Society, in 2008, more than 22,000
American women were diagnosed with ovarian cancer and approximately
15,000 lost their lives to this terrible disease. Ovarian cancer is the
fifth leading cause of cancer death in women. Currently, more than half
of the women diagnosed with ovarian cancer will die within 5 years.
While ovarian cancer has early symptoms, there is no early detection
test. Most women are diagnosed in stage III or stage IV, when survival
rates are low. If diagnosed early, more than 90 percent of women will
survive for 5 years, but when diagnosed later, less than 30 percent
will.
In addition, only a few treatments have been approved by the Food
and Drug Administration for ovarian cancer treatment. These are
platinum-based therapies and women needing further rounds of treatment
are frequently resistant to them. More than 70 percent of ovarian
cancer patients will have a recurrence at some point, underlying the
need for treatments to which patients do not grow resistant.
For all of these problems, we urgently call on Congress to
appropriate funds to find solutions.
As part of this effort, the Alliance advocates for continued
Federal investment in the Centers for Disease Control and Prevention's
(CDC) Ovarian Cancer Control Initiative. The Alliance respectfully
requests that Congress provide $10 million for the program in fiscal
year 2010.
The Alliance also fully supports Congress in taking action on
ovarian cancer through its recent passage of Johanna's Law: The
Gynecologic Cancer Education and Awareness Act (Public Law 109-475).
The Alliance respectfully requests that Congress provide $10 million to
implement Johanna's Law in fiscal year 2010.
Further, the Alliance urges Congress to continue funding the
Specialized Programs of Research Excellence (SPOREs), including the
four ovarian cancer sites. These programs are administered through the
National Cancer Institute (NCI) of the National Institutes of Health
(NIH). The Alliance respectfully requests that Congress provide $6
billion to NCI for fiscal year 2010.
CDC
The Ovarian Cancer Control Initiative
As the statistics indicate, late detection and, therefore, poor
survival are among the most urgent challenges we face in the ovarian
cancer field. The CDC's cancer program, with its strong capacity in
epidemiology and excellent track record in public and professional
education, is well-positioned to address these problems. As the
Nation's leading prevention agency, the CDC plays an important role in
translating and delivering at the community level what is learned from
research, especially ensuring that those populations disproportionately
affected by cancer receive the benefits of our Nation's investment in
medical research.
Prompted by efforts from leaders of the Alliance and championed by
Representative Rosa DeLauro--with bipartisan, bicameral support--
Congress established the Ovarian Cancer Control Initiative at the CDC
in November 1999. Congress' directive to the agency was to develop an
appropriate public health response to ovarian cancer and conduct
several public health activities targeted toward reducing ovarian
cancer morbidity and mortality.
Through the OCCI, the National Comprehensive Cancer Control Program
is helping States address issues related to ovarian cancer. The program
currently funds efforts in California, Florida, Michigan, New York,
Pennsylvania, Texas, and West Virginia. These projects are working to
develop ovarian cancer health messages for the general public and for
healthcare providers.
JOHANNA'S LAW: THE GYNECOLOGIC CANCER EDUCATION AND AWARENESS ACT
It is critical for women and their healthcare providers to be aware
of the signs, symptoms and risk factors of ovarian and other
gynecologic cancers. Often, women and providers mistakenly confuse
ovarian cancer signs and symptoms with those of gastrointestinal
disorders or early menopause. While symptoms may seem vague--bloating,
pelvic or abdominal pain, increased abdominal size and bloating and
difficulty, eating or feeling full quickly, or urinary symptoms
(urgency or frequency)--they can be deadly without proper medical
intervention.
In recognition of the need for awareness and education, Congress
unanimously passed Johanna's Law in 2006, enacted in early 2007. This
law provides for an education and awareness campaign that will increase
providers' and women's awareness of all gynecologic cancers including
ovarian. Together, Johanna's Law and the Ovarian Cancer Control
Initiative will help increase awareness and understanding of ovarian
cancer and work to reduce ovarian cancer morbidity and mortality.
Already, with only a small amount of seed money, the CDC has
launched the Inside Knowledge: Get the Facts About Gynecologic Cancer
campaign to raise awareness of the five main types of gynecologic
cancer: ovarian, cervical, uterine, vaginal, and vulvar. Many fact
sheets, including the ovarian cancer fact sheet, are already available
on the CDC's Web site for download. The CDC plans to develop broadcast
advertisements, posters--such as dioramas for bus stops--and other
print materials, a comprehensive brochure on gynecologic cancers, and
materials aimed at healthcare providers.
NCI
SPOREs at NIH
The Specialized Programs of Research Excellence were created by the
NCI in 1992 to support translational, organ site-focused cancer
research. The ovarian cancer SPOREs began in 1999. There are four
currently funded Ovarian Cancer SPOREs located at the MD Anderson
Cancer Center, the Fred Hutchinson Cancer Research Center, the Fox
Chase Cancer Center and the Dana Farber/Harvard Cancer Center.
These SPORE programs have made outstanding strides in understanding
ovarian cancer, as illustrated by their more than 300 publications as
well as other notable achievements, including the development of an
infrastructure between Ovarian SPORE institutions to facilitate
collaborative studies on understanding, early detection, and treatment
of ovarian cancer.
Clinical Trials
NCI supports clinical research--the only way to test the safety and
efficacy of potential new treatments for ovarian cancer. Two recent
studies from NCI clinical trials show the impact of intraperitoneal
chemotherapy in treating ovarian cancer (when chemotherapy is
introduced directly into the woman's abdominal cavity, rather than her
bloodstream) and the importance of ultrasound expertise in properly
diagnosing the disease.
NCI supports the Gynecology Oncology Group (GOG), a more than 50-
member collaborative focusing on cancers of the female reproductive
system. In 2007 alone, GOG published 23 articles about ovarian cancer.
SUMMARY
The Alliance maintains a long-standing commitment to work with
Congress, the administration, and other policy makers and stakeholders
to improve the survival rate for women with ovarian cancer through
education, public policy, research, and communication. Please know we
appreciate and understand that our Nation faces many challenges and
Congress has limited resources to allocate; however, we are concerned
that without increased funding to bolster and expand ovarian cancer
education, awareness and research efforts, the Nation will continue to
see growing numbers of women losing their battle with this terrible
disease.
On behalf of the entire ovarian cancer community--patients, family
members, clinicians, and researchers--we thank you for your leadership
and support of Federal programs that seek to reduce and prevent
suffering from ovarian cancer. Thank you in advance for your support of
$10 million in fiscal year 2010 funding for the CDC's Ovarian Cancer
Control Initiative and $10 million in fiscal year 2010 funding for
Johanna's Law as well as your continued support of the SPORES program,
an appropriation of $6 billion to NCI.
______
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 2010
funding for cancer and nursing-related programs. ONS, the largest
professional oncology group in the United States, composed of more than
37,000 nurses and other health professionals, exists to promote
excellence in oncology nursing and the provision of quality care to
those individuals affected by cancer. As part of its mission, ONS
honors and maintains nursing's historical and essential commitment to
advocacy for the public good.
In 2009, an estimated 1.44 million Americans will be diagnosed with
cancer, and more than 565,650 will lose their battle with this terrible
disease; at the same time the national nursing shortage is expected to
worsen. Overall, age is the number one risk factor for developing
cancer. Approximately 77 percent of all cancers are diagnosed at age 55
and older.\1\ 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. These
vacancies in all care settings create significant barriers to ensuring
access to quality care.
---------------------------------------------------------------------------
\1\ American Cancer Society. Cancer Facts and Figures 2008. http://
www.cancer.org/downloads/STT/2008CAFFfinalsecured.pdf.
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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. ONS
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 2010 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 treatment education and 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.
As the overall number of nurses is expected to 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
healthcare, 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.\2\ 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.
---------------------------------------------------------------------------
\2\ Needleman J., Buerhaus P., Mattke S., Stewart M., Zelevinsky K.
``Nurse-Staffing Levels and the Quality of Care in Hospitals.'' New
England Journal of Medicine 346:, (May 30, 2002): 1715-1722.
---------------------------------------------------------------------------
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 joins with President Obama and others in the nursing
community in advocating $263 million as the fiscal year 2010 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 2008 HRSA received 6,078 applications for the Nurse
Education Loan Repayment Program, but only had the funds to award 435
of those applications.\3\ Also, in fiscal year 2008 HRSA received 4,894
applications for the Nursing Scholarship Program, but only had funding
to support 172 awards.\4\
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\3\ U.S. Health Resources and Services Administration: Nurse
Education Loan Repayment Program: http://bhpr.hrsa.gov/nursing/
loanrepay.htm. Accessed April 22, 2009.
\4\ U.S. Health Resources and Services Administration: Nursing
Scholarship Program Statistics: http://bhpr.hrsa.gov/nursing/
scholarship/. Accessed April 22, 2009.
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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 ONS, our nursing community partners, 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 50,000 qualified applicants from baccalaureate and
graduate nursing programs in 2008, due to insufficient number of
faculty and inadequate resources.\5\ Of those potential students,
nearly 7,000 were students pursuing a master's or doctoral degree in
nursing, which is the education level required to teach. Within the
next decade, it is expected that half of all nurse faculty will reach
retirement age.\6\ Given the expected wave of retirement among faculty,
the nurse faculty shortage is only expected to worsen as there are
insufficient numbers of candidates in the pipeline to take their
places. The number of full-time nursing faculty required to ``fill the
nursing gap'' is approximately 40,000, and, currently, there are less
than 20,000 full-time nursing faculty in the system.
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\5\ American Association of Colleges of Nursing ,``2006-2007
Enrollment and Graduations in Baccalaureate and Graduate Programs in
Nursing.'' http://www.aacn.nche.edu/IDS/datarep.htm, March 2007.
\6\ Preliminary Results: ``National Survey of Nurse Educators:
Compensation, Workload, and Teaching Practices.'' National League of
Nursing/Carnegie Foundation. (February 7, 2007) http://www.nln.org/
newsreleases/pres_budget2007.htm.
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With additional funding in fiscal year 2010, the HRSA Workforce
Development Programs will have much-needed resources to address the
multiple factors contributing to the nationwide nursing shortage,
including the shortage of faculty. 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 $263
million in fiscal year 2010 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. 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 10 percent
increase ($33.349 billion) for NIH in fiscal year 2010. This level of
investment will allow NIH to sustain and build on its research
progress, while avoiding the severe disruption to advancement that
could result from a minimal increase. Cancer research is producing
amazing breakthroughs--leading to new therapies that translate into
longer survival and improved quality of life for cancer patients. In
recent years, 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 $5.957 billion to the
National Cancer Institute, as well as $227 million to the National
Center for Minority Health and Health Disparities in fiscal year 2010
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
healthcare 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 and NCCR in
advocating a fiscal year 2010 allocation of $178 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. 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 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 2010 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; and
--$6 million for the Geraldine Ferraro Blood Cancer Program.
CONCLUSION
ONS maintains a strong commitment to working with Members of
Congress, other nursing and oncology 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 2010 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 the Population Association of America/Association
of Population Centers
Introduction
Thank you, Mr. Chairman Harkin, Mr. Ranking Member Cochran, and
other distinguished members of the subcommittee, for this opportunity
to express support for the National Institutes of Health (NIH), the
National Center for Health Statistics (NCHS), and Bureau of Labor
Statistics (BLS).
Background on the Population Association of America (PAA)/Association
of Population Centers (APC) and Demographic Research
The Population Association of America (PAA) is a scientific
organization comprised of more than 3,000 population research
professionals, including demographers, sociologists, statisticians, and
economists. The Association of Population Centers (APC) is a similar
organization comprised of 40 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. Population research
centers are located at public and private research institutions,
including, for example, the University of Wisconsin--Madison, RAND
Corporation, State University New York Albany, Brown University, Ohio
State University, University of North Carolina--Chapel Hill, and
Pennsylvania State University.
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 extramural
population research programs primarily through the National Institute
on Aging (NIA) and the Eunice Kennedy Shriver National Institute of
Child Health and Human Development (NICHD).
NIA
According to the Census Bureau, by 2029, all of the baby boomers
(those born between 1946 and 1964) will be age 65 years and older. 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. 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 Division of Behavioral
and Social Research (BSR) 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 and Roybal
Centers for Applied Gerontology Programs, the NIA BSR program also
supports several large, accessible data surveys. One of these surveys,
the Health and Retirement Study (HRS), has become one of the seminal
sources of information to assess the health and socioeconomic status of
older people in the United States. Since 1992, the HRS has tracked
27,000 people, providing 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. 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 HRS data indicating an increase in
pre-retirees self-reported rates of disability. In 2009 and 2010, HRS
is seeking to increase its minority sample size and collect unique,
enhanced data on the effects of the current economic downturn on older
people.
With additional support in fiscal year 2010, the NIA BSR program
could fully fund its existing centers programs and support its ongoing
surveys without resorting to cost cutting measures, such as cutting
sample size. Currently, the Demography of Aging and Roybal Centers
programs are recompeting their 5-year awards. Additional funding may
give the Institute resources it needs to award more center grants. NIA
could also use additional resources to improve its funding payline and
sustain training and research opportunities for new investigators.
NICHD
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, New Immigrant Study, and National Longitudinal Study of
Adolescent Health.
NIH-funded demographic research has consistently provided critical
scientific knowledge on issues of greatest consequence for American
families: work-family conflicts, marriage and childbearing, 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.
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.
Policymakers and community programs can use these findings to support
unstable families and improve the health and well-being of children.
One of the most important programs the NICHD DBSB supports is the
Population Research Infrastructure Program (PRIP). Through PRIP,
research is conducted at private and public research institutions
nationwide. The primary goal of PRIP is ``to facilitate
interdisciplinary collaboration and innovation in population research,
while providing essential and cost-effective resources in support of
the development, conduct, and translation of population research.''
Population research centers supported by PRIP are focal points for the
demographic research field where innovative research and training
activities occur and resources, including large-scale databases, are
developed and maintained for widespread use.
With additional support in fiscal year 2010, 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
been as low as the 10th percentile prior to the recent infusion of ARRA
funds. Additional support could be used to support and stabilize
essential training and career development programs necessary to prepare
the next generation of researchers and to support and expand proven
programs, such as PRIP.
NCHS
Located within the Centers for Disease Control (CDC), 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 (NHANES), National Health Interview Survey
(HIS), 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.
Despite a funding increase last year, NCHS continues to feel the
effects of long-term funding shortfalls, compelling the agency to
undermine, eliminate, or further postpone the collection of vital
health data. For example, in 2009, sample sizes in HIS and NHANES have
been cut, while other surveys, most notably the National Hospital
Discharge Survey, are not being fielded. In addition, in 2009, NCHS has
proposed purchasing only ``core items'' of vital birth and death
statistics from the States (starting in 2010), effectively eliminating
three-fourths of data routinely used to monitor maternal and infant
health and contributing causes of death.
The administration recommends NCHS receive $138 million in fiscal
year 2010. PAA and APC, as members of The Friends of NCHS, support the
administration's request, but also hope Congress will give the agency
an additional $15 million in fiscal year 2010. The additional $15
million should be designated specifically for supporting the States so
they can modernize their vital statistics systems and make all
collections electronic according to the 2003 birth and death
certificates. If NCHS receives this funding, they can abandon their
proposal to collect core vs. enhanced vital statistics data as well and
focus on improving the current system. The underlying fiscal year 2010
budget request should be targeted at precluding further cuts in key
surveys and collecting the full panel of vital statistics data.
If Congress fails to, at a minimum, provide the administration's
fiscal year 2010 request, NCHS will be forced to eliminate over-
sampling of minority populations in NHANES, which will compromise our
understanding of health disparities at a time when our society is
becoming increasingly diverse. Further, we will lose insurance coverage
information on who's covered and who's not (particularly within
minority populations), how people are covered and why they're not--at a
time when Congress and the administration are debating healthcare
reform. Finally, we will lose vital statistics, adversely affecting the
amount of data researchers and health practitioners alike need to be
effective in identifying trends and developing interventions.
BLS
During these turbulent economic times, data produced by BLS are
particularly relevant and valued. PAA and APC members have relied
historically on objective, accurate data from the BLS. In recent years,
our organizations have become increasingly concerned about the state of
the agency's funding.
We are pleased the administration has requested BLS receive a total
of $611,623,000 in fiscal year 2010, an increase of $14,441,000 more
than the 2009 enacted level. According to the agency, this funding
level would enable BLS to meet its highest-priority goals and
objectives in 2010. Ideally, the agency will receive enough funding not
only in 2010, but also in future years to invest in research and assure
continuous improvement of its measures, including the Consumer Price
Index. We also hope BLS receives sufficient funds to maintain, or
increase, the sample sizes of key surveys, such as the Current
Population Survey. It is imperative sample sizes be increased to ensure
surveys are accurate and providing adequate detail. We also hope fiscal
year 2010 marks the beginning of a steady, predicable growth trend in
the BLS budget.
Summary of Fiscal Year 2010 Recommendations
Despite the generous, short-term funding the NIH received from the
American Recovery and Reinvestment Act (ARRA), the agency faces
``falling off the cliff'' in 2011 when ARRA funds expire. Thus, PAA and
APC, as members of the Ad Hoc Group for Medical Research Funding, are
asking Congress to provide NIH with and appropriation of $32.4 billion
in fiscal year 2010, an increase of 7 percent more than the fiscal year
2009 appropriation. This funding level would put NIH on a stable
course, ensuring the agency receives an inflationary increase plus
enough money to support the best research projects, including new and
innovative projects, and stabilize research training programs in fiscal
year 2010.
As part of the NIH request, we also urge the subcommittee to
appropriate $194.4 million for the National Children's Study (NCS) in
fiscal year 2010 through the NIH Office of the Director, as proposed by
the President's budget. This funding will allow for the completion of
the pilot phase of the NCS.
PAA and APC, as members of the Friends of NCHS, ask that NCHS
receive $138 million in fiscal year 2010, with an additional $15
million set aside for vital statistics infrastructure development. This
funding is needed to maintain and improve the Nation's vital statistics
system and to sustain and update the agency's major health survey
operations.
Finally, we ask you to support the administration's request, $611.6
million, for the BLS, in fiscal year 2010.
Thank you for considering our requests and for supporting Federal
programs that benefit the field of demographic research.
______
Prepared Statement of the Program for Appropriate Technology in Health
OVERVIEW
Program for Appropriate Technology in Health (PATH) appreciates the
opportunity to submit written testimony to the Senate Labor, Health and
Human Services, Education, and Related Agencies Appropriations
Subcommittee. PATH is a U.S.-based, international nonprofit
organization that creates sustainable, culturally relevant solutions
that enable communities worldwide to break longstanding cycles of poor
health. By collaborating with diverse public- and private-sector
partners, we help provide appropriate health technologies and vital
strategies that change the way people think and act. Our work improves
global health and well-being.
The broad, ongoing, and successful struggle to improve global
health relies on the availability of health interventions and
technologies designed to prevent, diagnose, and treat disease. Although
some effective interventions already exist, many more will be necessary
if existing gains against infectious disease and other global health
burdens are to be maintained and expanded. The drugs currently
available for use against diseases that disproportionately impact the
developing world are often too expensive for use in the developing
world, and are also subject to disease resistance. Vaccines for many of
these infectious diseases do not yet exist and diagnostic equipment,
vaccine delivery devices, microbicides, contraceptives, and other
health technologies appropriate for the developing world are in many
cases not available or affordable. Achieving sustainable progress in
the struggle to improve global health will require developing new
health technologies, and creating or strengthening infrastructures that
facilitate their availability to those who need them most.
Several programs funded in the Labor, Health and Human Services,
and Education appropriations bill make a particularly critical
contribution to point-of-care diagnostics, a research area that is key
to improving health in the developing world. In low-resource settings,
where many diagnostic tests are difficult to perform and laboratories
are often inaccessible, there is a great opportunity to make
significant improvements to global health through the development and
use of appropriate point-of-care diagnostics. In poor countries,
healthcare facilities can be far away, serving widely dispersed
populations. Specialized equipment, personnel, and safe waste disposal
systems are often not available. Without diagnostic testing, healthcare
professionals have to rely on just evaluating symptoms to diagnose and
treat illness--an imperfect method given the similarity of symptoms
between many diseases. This lack of clarity puts individuals,
communities, and the world in danger. Incorrect diagnoses can harm
people and even cost lives. And from a global perspective,
ineffectively treated disease can become a starting point for epidemic
or pandemic outbreaks.
Fortunately, there is an array of promising new tests in the
pipeline--inexpensive, portable, easy-to-use diagnostics that are
practical at even small, local health centers, and which can deliver
results the same day. Some are new takes on established technologies
like the home pregnancy test. Others are exciting scientific advances.
Effective diagnosis at, or near, the point of care enables better
application of available treatment, avoids overuse of antibiotics that
can promote resistant strains of pathogens, and allows healthcare
workers to track outbreaks and mobilize resources quickly.
The National Institutes of Health (NIH) and the Centers for Disease
Control and Prevention (CDC) continue to make significant contributions
to the development of new health technologies. Generally speaking, NIH
carries out the critical basic and preclinical research that provides
the foundation for new product discovery and development, supports and
conducts clinical trials of promising products, and develops the in-
country research capacity of developing world partners. CDC monitors
and tracks infectious diseases worldwide, provides those involved in
the control and prevention of these diseases with the critical
intelligence they need to implement their programs effectively,
supports researchers in their work by helping to direct their efforts
towards the areas with the greatest potential for benefit, and warns
researchers when new trends or disease strains emerge.
Point-of-care diagnostics are one of the most critical global
health technologies whose development of testing is supported by NIH
and CDC. One example of this support is the ongoing and successful
partnership between the NIH's National Institute of Biomedical Imaging
and Bioengineering (NIBIB) and PATH. Working together with an
investment from NIH/NIBIB, PATH formed the Center for Point-of-Care
Diagnostics for Global Health (GHDx Center), a diagnostics research,
development, testing, needs assessment and training program that works
to improve the availability, accessibility, and affordability of
essential point-of-care diagnostic tests for use in low-resource
settings around the world. The GHDx Center, managed by PATH in
collaboration with its partners at the University of Washington, is on
the cutting edge of developing new diagnostic tools that can be used in
developing countries to quickly and accurately diagnose diseases that
disproportionately impact the developing world, but which until now
have been difficult to accurately diagnose without laboratory
facilities or extensively trained medical workers.
The GHDx Center focuses its work on four main areas that encompass
the breadth of the health technology product development cycle. The
GHDx Center performs and supports clinical needs assessments that help
diagnostics developers target the most pressing global health
challenges and increase the likelihood of product success. It supports
exploratory technology projects that could have a significant positive
impact on public health outcomes. It conducts laboratory and field-
based clinical testing of prototype point-of-care diagnostics. Finally,
the GHDx Center--in a program led by the University of Washington
Department of Global Health and Department of Medicine (Division of
Infectious Diseases)--trains individuals with varied experience and
backgrounds from the fields of assay and device development, clinical
laboratories, and disease specialties, with the objective of creating a
networked group of researchers trained in state-of-the-art technology
that address the challenges for global health in low-resource settings.
This extraordinarily promising new program would not have been
possible without NIH support, and PATH thanks the subcommittee for its
wise investments in NIH. Without robust funding for NIH and CDC, much
of the cutting-edge research and development being performed on point-
of-care diagnostics for the developing world would not be taking place.
While many commercial and nonprofit groups are working on diagnostic
technologies, they are not necessarily doing so with an eye toward the
developing world. For example, their efforts often target diseases that
mainly concern wealthier countries, or they assume that sophisticated
laboratories and trained personnel will be available to complement and
operate their diagnostics. In contrast, diagnostic technologies for
malaria, enteric diseases, hepatitis b, and other conditions whose
heaviest burden falls on the developing world, or which can be used in
resource--poor conditions where laboratory equipment are scarce, do not
have a significant commercial market that incentivizes research and
development. Without investment by the U.S. Government, efforts to
develop these diagnostic technologies--and by doing so improve care and
reduce the development of drug resistance--would be hindered
significantly. Expanding funds for these agencies would provide a
powerful boost to point-of-care diagnostic development and
availability.
Another area where agencies funded by this subcommittee are making
a significant contribution to global health is in the ongoing effort to
develop and test malaria vaccines. Malaria is a devastating parasitic
disease transmitted through the bite of infected Anopheles mosquitoes.
More than one-third of the world's population is at risk of malaria,
with approximately 250 million cases and 1 million deaths per year, the
vast majority of which occur among African children under the age of 5.
A malaria vaccine is desperately needed to confront this deadly disease
and its impact in the developing world. While consistent use of
effective insecticides, insecticide-treated nets, and malaria medicines
saves lives, eradicating or even significantly reducing the impact of
malaria will require additional interventions, including vaccines.
Immunization is one of the most effective health interventions
available. Just as it was necessary to use vaccines to control polio
and measles in the United States, vaccines are needed as part of an
effective control strategy for malaria.
Several Federal agencies are involved in the research and
development of malaria interventions such as vaccines, as is the PATH
Malaria Vaccine Initiative (MVI). Indeed, many promising vaccine
concepts would never have emerged from the laboratory without the
research performed by Government scientists. Government-sponsored
research is also critical to eliminating from consideration less
promising approaches. Unfortunately, funding for this critical research
at NIH and CDC has been relatively flat for several years. By
increasing investments in NIH and CDC, Congress can help advance the
day when a highly effective malaria vaccine is available, thereby
saving many lives.
Continued progress in our Nation's effort to improve global health
requires the development of new tools and technologies. Point-of-care
diagnostics and, eventually, malaria vaccines, are important components
of the portfolio of needed tools and technologies, and the development
of those tools and technologies is heavily reliant on Federal support.
For this reason, we respectfully request that the subcommittee expand
funding for research and development at NIH and CDC. We very much
appreciate the subcommittee's consideration of our views, and we stand
ready to work with subcommittee members and staff on these and other
important tropical disease matters.
______
Prepared Statement of Prevent Blindness America
FUNDING REQUEST OVERVIEW
Prevent Blindness America (PBA) appreciates the opportunity to
submit written testimony for the record regarding fiscal year 2010
funding for vision-related programs. As the Nation's leading nonprofit,
voluntary organization dedicated to preventing blindness and preserving
sight, PBA maintains a long-standing commitment to working with
policymakers at all levels of government, organizations, and
individuals in the eye care and vision loss community, and other
interested stakeholders to develop, advance, and implement policies and
programs that prevent blindness and preserve sight. PBA respectfully
requests that the subcommittee provide the following allocations in
fiscal year 2010 to help promote eye health and prevent eye disease and
vision loss:
--$4.5 million for the Vision Health Initiative at the Centers for
Disease Control and Prevention (CDC);
--$32.4 billion for the National Institutes of Health (NIH) to
support biomedical research; and
--$736 million for the National Eye Institute (NEI).
INTRODUCTION AND OVERVIEW
Vision-related conditions affect people across the lifespan from
childhood through elder years. Good vision is an integral component to
health and well-being, affects virtually all activities of daily
living, and impacts individuals physically, emotionally, socially, and
financially. Loss of vision can have a devastating impact on
individuals and their families. An estimated 80 million Americans have
a potentially blinding eye disease, 3 million have low vision, more
than 1 million are legally blind, and 200,000 are more severely
visually blind. Vision impairment in children is a common condition
that affects 5 to 10 percent of preschool age children. Vision
disorders (including amblyopia (``lazy eye''), strabismus (``cross
eye''), and refractive error are the leading cause of impaired health
in childhood.
Of serious concern is that the NEI reports ``the number of
Americans with age-related eye disease and the vision impairment that
results is expected to double within the next three decades.'' \1\
Among Americans age 40 and older, the four most common eye diseases
causing vision impairment and blindness are age-related macular
degeneration (AMD), cataract, diabetic retinopathy, and glaucoma.\2\
Refractive errors are the most frequent vision problem in the United
States--an estimated 150 million Americans use corrective eyewear to
compensate for their refractive error.\3\ Uncorrected or undercorrected
refractive error can result in significant vision impairment.\4\
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\1\ ``Vision Problems in the U.S.: Prevalence of Adult Vision
Impairment and Age-Related Eye Disease in America,'' Prevent Blindness
America and the National Eye Institute, 2008.
\2\ Ibid.
\3\ Ibid.
\4\ Ibid.
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While half of all blindness can be prevented through education,
early detection, and treatment, it is estimated that the number of
blind and visually impaired people will double by 2030, if nothing is
done to curb vision problems. To curtail the increasing incidence of
vision loss in America, PBA advocates sustained and significant Federal
funding for vision research and application, as well as resources for
programs that help promote eye health and prevent eye disease, vision
loss, and blindness. We thank the subcommittee for its consideration of
our specific fiscal year 2010 funding requests, which are detailed
below.
CDC'S VISION HEALTH INITIATIVE: HELPING TO SAVE SIGHT AND SAVE MONEY
The financial costs of vision impairment to our country's fiscal
health are staggering. PBA estimates that the annual costs of adult
vision problems in the United States are approximately $51.4
billion.\5\ The annual cost of untreated amblyopia--reduced vision in
an eye that has not received adequate use during early childhood--is
approximately $7.4 billion in lost productivity.\6\ NEI estimates that
in 2003 the total direct and indirect costs of visual disorders and
disabilities in the United States were approximately $68 billion, and
with each passing year these costs continue to escalate.\7\ Vision care
services consistently have been found to help prevent blindness, reduce
vision loss, improve quality of life and well-being, increase
productivity, and reduce costs and burdens on the Nation's healthcare
system. Therefore, the Nation must increase access to--and awareness of
the importance of--vision screenings and linkage to appropriate care
for at-risk and underserved populations, as is provided by the CDC's
Vision Health Initiative.
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\5\ ``The Economic Impact of Vision Problems,'' Prevent Blindness
America, 2007.
\6\ ``Our Vision for Children's Vision: A National Call to Action
for the Advancement of Children's Vision and Eye Health, Prevent
Blindness America,''Prevent Blindness America, 2008.
\7\ Ellwein Leon. Updating the Hu 1981 Estimates of the Economic
Costs of Visual Disorders and Disabilities.
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The CDC reports that ``vision disability is one of the top 10
disabilities among adults 18 years and older and the single most
prevalent disabling condition among children.'' \8\ Effective public
health initiatives can dramatically decrease the number of Americans
who have vision loss or low vision. Initially funded by Congress in
fiscal year 2003, the CDC's Vision Health Initiative program has worked
in a cost-effective way to identify, screen, and link to appropriate
care individuals at risk for vision loss. This public-private
partnership combines the resources of the CDC, chronic disease
directors, State and local Agencies on Aging, and nonprofit
organizations such as PBA. Highlights of the significant work of the
CDC's Vision Health Initiative include:
---------------------------------------------------------------------------
\8\ ``Improving the Nation's Vision Health: A Coordinated Public
Health Approach,'' Centers for Disease Control, 2006.
---------------------------------------------------------------------------
--Support for the eye evaluation component of the National Health and
Nutrition Examination Survey (NHANES) that provides current,
nationally representative data and help assess progress for
vision objectives contained within Healthy People 2010 and the
future efforts for Healthy People 2020.
--Development of the first optional Behavioral Risk Factor
Surveillance System (BRFSS) vision module and introducing it
into State use in 2005 to gather information about access to
eye care and prevalence of eye disease and eye injury. Five
States implemented the module in 2005, and 11 States began
using the module in 2006.
--Utilization of applied public health research to address the
economic costs of vision disorders and develop cost-
effectiveness models for eye diseases among various
populations. Estimating the true economic burden is essential
for informing policymakers and for obtaining necessary
resources to develop and implement effective interventions.
--Providing data analyses and a systematic review of interventions to
promote screening for diabetic retinopathy and reviewing access
to and utilization of vision care in the United States.
--Developing best practices for the integration of vision care
services with community health centers, as well as methods for
linking clients to appropriate and needed care.
--Aiding in the translation of science into programs, services, and
policies and in coordinating service activities with partners
in the public, private, and voluntary sectors.
In fiscal year 2009, PBA requested $4.5 million to sustain and
expand the Vision Health Initiative. In the final fiscal year 2009
Omnibus Appropriations Act, Congress allocated $3.222 million. PBA
understands the budgetary challenges facing Congress and the Nation
and, as such, appreciates this much-needed funding. However, with the
demographics of eye disease, we strongly feel that a greater investment
in the Vision Health Initiative must be made, so we can mount an
adequate effort to address the growing public health threat of
preventable vision loss among older Americans, low-income, and
underserved populations.
To that end, PBA again respectfully requests the subcommittee
provide a $4.5 million allocation for the Vision Health Initiative.
Increased fiscal year 2010 funding for this important program will
support additional vision screenings, increased public awareness
efforts regarding risk of vision loss, develop best practices for
linkage to care, and the expansion of eye disease surveillance and
evaluation systems, which will help ensure our Nation has much-needed
epidemiological data regarding overall burden and high-risk
populations, so we can best formulate and assess strategies to prevent
and reduce the economic and social costs associated with vision loss
and eye diseases.
ADVANCE AND EXPAND VISION RESEARCH OPPORTUNITIES
Our Nation has benefited from past Federal investment in biomedical
research at the NIH. Unfortunately, due to flat funding over the past
six appropriations cycles, NIH has lost 14 percent of its purchasing
power. While we commend Congress for the $10.4 billion in funding
provided in the American Recovery and Reinvestment Act, PBA joins the
broader vision community in advocating a 7 percent increase ($32.4
billion) for NIH in fiscal year 2010. This level of investment will
allow NIH to sustain and expand its research progress and avoid the
potential disruption of vital research that could result from a minimal
increase.
PBA also calls upon the subcommittee to provide a specific
allocation of $736 million for the NEI to bolster its efforts to
identify the underlying causes of eye disease and vision loss, improve
early detection and diagnosis of eye disease and vision loss, and
advance prevention and treatment efforts. Celebrating 40 years of
service this year, NEI is a leading Institute in translating basic
research into clinical practice. Just as NIH has seen a decline in
purchasing power, so too has the NEI, an overall decrease of 18 percent
in the last 6 appropriations cycles. In fiscal year 2009, NEI's funding
level of $688 million reflected just 1 percent of the estimated $68
billion annual costs of eye disease and vision impairment. Despite
significant funding challenges, NEI has maintained its impressive
record of breakthroughs in basic and clinical research that have
resulted in treatments and therapies to save and restore vision and
prevent eye disease. However, NEI will be challenged further, as 2010
begins the decade in which more than half of the 78 million Baby
Boomers will turn 65 and be at greatest risk for developing aging eye
disease. Adequate funding to NEI is a cost-effective investment in our
Nation's health, as it can delay, save, and prevent eye disease-related
expenditures, especially to the Medicare and Medicaid programs.
INVESTING IN THE VISION OF OUR NATION'S MOST VALUABLE RESOURCE--
CHILDREN
While the risk of eye disease increases after the age of 40, eye
and vision problems in children are of equal concern, due to the fact
that, if left untreated, they can lead to permanent and irreversible
visual loss and/or cause problems socially, academically, and
developmentally. Although more than 12.1 million school-age children
have some form of a vision problem, only one-third of all children
receive eye care services before the age of 6.\9\ Approximately 80
percent of what a child learns is done so visually.\10\ As such, good
vision is essential for educational progress, proper physical
development and athletic performance, and healthy self-esteem in
growing children. Yet, according to a CDC report, only 1 in 3 children
in America has received eye care services before the age of 6.
---------------------------------------------------------------------------
\9\ ``Our Vision for Children's Vision: A National Call to Action
for the Advancement of Children's Vision and Eye Health, Prevent
Blindness America,'' Prevent Blindness America, 2008.
\10\ Ottar WL, Scott WK, Holgado SI. Photoscreening for amblyogenic
factors. J Pediatr Ophthalmol Strabismus. 1995; 32:289-295.
---------------------------------------------------------------------------
Vision screening is an appropriate and essential element of a
strong public health approach to children's vision care; the sooner
vision problems are identified, the faster they can be addressed. As
you know, the Maternal and Child Health Bureau (MCHB) oversees the
Maternal and Child Health Services State title V (Title V) Block Grant
program. As a condition of funding under title V, States are required
to report on certain measures to the MCHB. PBA urges the subcommittee
to support the development and implementation of a nationwide title V
core performance measure related to vision screening. A core
performance measure regarding vision screening will help ensure that
more children receive comprehensive eye examinations at a young age and
provide specific information to MCHB and other public health officials
regarding the progress of the programs and identify areas where
improvement can be made to provide better vision care to children
served by the title V program. Specifically, we hope the subcommittee
will include language in the report accompanying the fiscal year 2010
Labor, Health and Human Services, and Education, an Related Agencies
appropriations measure that expresses support for MCHB's work in this
area.
We are pleased that the Head Start program currently requires
children to be screened for vision problems. Unfortunately, there are
no procedures for training, tracking, or even conducting the screening.
As such, without a national uniform standard, many Head Start enrollees
are falling through the cracks and vision problems are not being
identified in this already often underserved and at-risk population.
PBA stands ready to work with Head Start, the Congress, and other
stakeholders to ensure that all Head Start enrollees receive vision
screening services and other related resources available to them in
their community. PBA respectfully requests that the subcommittee
include language in the report accompanying the fiscal year 2010 Labor,
Health and Human Services, and Education, an Related Agencies
appropriations measure that encourages collaborations and initiatives
within the Head Start program to ensure that such screenings are
delivered and provided in a manner that promotes consistency and
quality in protocol and administration.
CONCLUSION
On behalf of PBA, our board of directors, and the millions of
people at risk for vision loss and eye disease, we thank you for the
opportunity to submit written testimony regarding fiscal year 2010
funding for the CDC's Vision Health Initiative, NIH, and NEI. Please
know that PBA stands ready to work with the subcommittee and other
Members of Congress to advance policies that will prevent blindness and
preserve sight.
______
Prepared Statement of the Pancreatic Cancer Action Network
Mr. Chairman and members of the subcommittee: You may recall that
last year you received testimony from Dr. Randy Pausch, a computer
science professor at Carnegie Mellon University, author of the widely
acclaimed ``Last Lecture'', which was released on YouTube and later as
a book, and at that time, a pancreatic cancer survivor.
Last year, Randy in his frank and humorous manner, told you that it
was unlikely that he would survive until Father's Day and that his
widow, Jai, and three beautiful children, Dillon, Logan, and Chloe
would have to mark that holiday without him.
Approximately 76 percent of pancreatic cancer patients die within
the first year of diagnosis. Randy used to call himself a ``Pancreatic
Cancer Rock Star'' given that he had already survived 18 months when he
provided his testimony to you. While I am very happy to report that
Randy did indeed survive long enough to spend Father's Day with his
family, he unfortunately passed soon after on July 25, 2008. With his
passing, we lost a dear friend to the pancreatic cancer community, and
as I'm sure you would all attest to, a phenomenal pancreatic cancer
advocate.
Much has changed in the last year, including some of the
statistics. According to the American Cancer Society's recently
released Cancer Facts & Figures 2009, the projected incidence for
pancreatic cancer rose 12 percent in the last year. Pancreatic cancer
is now the 10th most commonly diagnosed cancer in both men and women.
Unfortunately, the survival rate has not changed. Pancreatic cancer
is still one of the most deadly cancers and is still the fourth-leading
cause of cancer-related death. It is still true that 95 percent of all
pancreatic cancer patients die within 5 years of diagnosis, a fact that
has changed little in the last 30 years. The new statistics show that
75 percent of these patients die within the first year of diagnosis.
There are still no early detection or treatment tools for this disease.
And while pancreatic cancer funding did increase last year, it is also
still true that pancreatic cancer research is not funded at a level
that will likely change this picture any time soon.
The news gets worse as we look to the future. According to an
article recently released in the Journal of Clinical Oncology,\1\ a 55
percent increase in pancreatic cancer incidence is expected by 2030.
This would be among the top five most significant increases across all
forms of cancer. According to the authors, ``Alarmingly, certain cancer
sites with particularly high mortality rates, such as liver, stomach,
pancreas, and lung, will be among those with the greatest relative
increase in incidence. Therefore, unless substantial improvements in
cancer therapy and/or prevention strategies emerge, the number of
cancer deaths may also grow dramatically over the next 20 years.'' We
simply cannot afford to keep the status quo in terms of funding levels
or scientific approaches for pancreatic cancer in the face of these
statistics. We must make finding early detection tools and effective
treatments for pancreatic cancer and the other highest mortality
cancers an immediate priority.
---------------------------------------------------------------------------
\1\ Benjamin D. Smith, Grace L. Smith, Arti Hurria, Gabriel N.
Hortobagyi, and Thomas A. Buchholz, ``Future of Cancer Incidence in the
United States: Burdens Upon an Aging, Changing Nation,'' Journal of
Clinical Oncology 27 (April 2009), 4.
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Admittedly, part of the problem has been the recent flat or
declining biomedical research budgets. Adjusting for inflation, the
National Cancer Institute's (NCI) budget has decreased by nearly $639
million (13.9 percent) since fiscal year 2003. However, it is also
clear that NCI is not making pancreatic cancer a research priority. In
fact, the NCI currently allocates just $87 million for pancreatic
cancer research, a mere 2 percent of its total budget. A percentage
that is also unchanged from last year.
We, like many in the cancer and biomedical research communities,
worked hard to secure funding increases for the National Institute of
Health (NIH) in the fiscal year 2009 Omnibus Appropriations bill and in
the American Recovery and Reinvestment Act and we are grateful to you
for granting the community's requests and providing increases through
these bills. The Pancreatic Cancer Action Network took part in these
efforts because we believed that increasing funding through these bills
would lead to increased funding for pancreatic cancer research.
Unfortunately, it does not appear that this hope is turning into a
reality.
As the National Institute of Health (NIH) was preparing the
Challenge Grants, we were excited about the potential that these grants
might bring to the most deadly diseases such as pancreatic cancer.
Unfortunately, once we had an opportunity to review the Requests for
Applications (RFAs), we realized that few if any of the grants were
actually applicable to pancreatic cancer.
We have also been looking forward to learning more about how NCI
plans to use their remaining portion of the stimulus funds. Our hope is
that Dr. Niederhuber will dedicate some portion of the funds for the
cancers with the highest mortality, defined as those cancers with 5-
year survival rates of 50 percent or less. Currently, just 8 cancers
(ovarian, brain, myeloma, stomach, esophageal, lung, liver, and
pancreatic) account for 50 percent of all cancer deaths. For some of
these, such as pancreatic and lung cancer, there has been little
movement in survival rates in the last 30 years.
As you may know, NIH Director, Dr. Raynard Kington recently asked
Dr. Niederhuber and Dr. Steve Katz, Director of National Institute of
Arthritis and Musculoskeletal and Skin Diseases to co-chair a task
force to develop an NIH-wide cancer research plan in response to the
President's call to double cancer research funding in 8 years. Ideally,
this plan would include some defined focus on steps that should be
taken to reduce mortality for the deadliest cancers. Unfortunately,
while we have not yet seen the actual plan, based on the NCI's
statement about it on April 20, 2009 \2\ and based on conversations we
have had with Dr. Niederhuber earlier this week, we are concerned that
again, our hopes may not turn into a reality.
---------------------------------------------------------------------------
\2\ National Cancer Institute, National Cancer Institute's Plan to
Accelerate Cancer Research Announced, http://www.cancer.gov/newscenter/
pressreleases/AccelerateResearch (April 22, 2009).
---------------------------------------------------------------------------
The mission of the Pancreatic Cancer Action Network is based on
hope and on action, so it is in the spirit of both that I am today
submitting testimony. I am not only asking that you significantly
increase funding for the NCI, but that you also take steps to ensure
that NCI places special emphasis on the most deadly cancers, including
pancreatic cancer.
While I realize that Congress is reluctant to direct how NCI
allocates research dollars, I would argue that something is wrong when
one of the deadliest types of cancer receives so little attention. In
fact, pancreatic cancer research receives the least amount of NCI
funding of any of the top cancer killers.
One of our most significant issues in addition to the overall
funding level, is that there are relatively few researchers studying
pancreatic cancer--including both young investigators and more
experienced investigators. While the NCI's commitment to young
investigators has increased from 2007 when it awarded zero Career
Development Awards (K awards) or Research Training Awards (F and T
awards), it still has a long way to go. For example, last year, NCI
made nearly 180 awards to young breast cancer researchers and more than
70 K, T, or F awards to young researchers in fields of each of the
other top 5 cancer killers (lung, colon, and prostate); only 32 were
awarded to young pancreatic cancer researchers. We can and must do
better.
The story is much the same for experienced investigators. In 2008,
only 32 pancreatic cancer projects were funded at $500,000 or above,
and only 11 projects received at least $1 million. In contrast, the
number of projects funded at $500,000 or above was 109 for lung, 114
for colon, 237 for breast, and 105 for prostate.
Further, though the pool of researchers that the NCI has funded to
conduct pancreatic cancer has expanded, it is still a very small pool,
especially when compared to the numbers of researchers funded in the
other leading cancer fields. In fact, by way of comparison, in 2008 the
NCI funded close to 1,600 different investigators in breast cancer
research, of whom 231 received multiple awards. As many as 91 of these
researchers received an aggregate of $1 million in funding for their
research. By comparison, NCI funded 327 different investigators in
pancreatic cancer research last year, of whom 41 received multiple
awards and just 13 received an aggregate of $1 million for their
research.
Given that the current 5-year survival rate for breast cancer is
nearly 90 percent, it is clear that a similar pipeline of committed and
federally funded scientists is needed in pancreatic cancer to help
speed advances and medical breakthroughs if we are to hope to finally
increase survival beyond 5 percent.
The fact is that the number of new pancreatic cancer cases and
deaths are increasing--not decreasing. The projected number of new
pancreatic cancer cases is expected to reach 70,000 by 2040. As stated
above, while overall cancer death rates have significantly declined,
the 5-year survival rates for pancreatic cancer have remained largely
unchanged in the last 30 years. If we do not take steps to address this
issue now, 95 percent of these patients will continue to hear their
diagnosis expressed as a death sentence.
Sadly, it is also a fact that for too long, the broader scientific
research community has faced the challenge of doing more with less.
While they have achieved some important successes, the funding crisis
has fostered an environment of focusing on ``safe bets.'' Compared to
most other cancers, we know relatively little about pancreatic cancer.
More research is needed in the basic biology of the disease to
understand how it starts and why it spreads so rapidly. Therefore,
pancreatic cancer research does not fall into a ``safe bet'' category.
It falls into the category of high risk/high reward.
The time has come to not only fund new progress and give our
researchers the opportunity to do more with more, but to also find new
ways to encourage the research community to tackle the hardest and most
complex problems. As Randy mentioned in his testimony last year, it is
by solving the hardest problems that we will likely see the greatest
rewards for the entire field. On behalf of the tens of thousands of
pancreatic cancer patients who die without a chance, including Dr.
Randy Pausch, I am asking that you not only inject significant new
funding into the cancer research community, but that you also issue a
challenge to the NCI to focus on the hardest problems by placing
special emphasis on finding answers for the most deadly cancers,
including pancreatic. Doing so will not only fuel progress, but will
also generate jobs and stem the current trend of losing American-
trained researchers to other countries more willing to invest in
scientific research.
We therefore join with our partners in the One Voice Against Cancer
coalition to ask that you provide $5.96 billion in funding for the NCI
in fiscal year 2010--an increase of $993 million (20 percent) more than
fiscal year 2009. We recognize that this is a significant request.
However, the reality is that this is the minimum amount needed to make
true progress on all forms of cancer, including pancreatic and the
other cancers for which we have yet to see significant improvement in
survival.
We also respectfully request that you work with us to ensure that
NCI creates a strategic plan for the highest mortality cancers, defined
as those with 5 survival rates below 50 percent, and that the NIH-wide
cancer research plan that is currently under development also includes
these cancers as a specific area of focus.
______
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 would like to extend my sincere thanks to the subcommittee for
your past support of pulmonary hypertension (PH) programs at the
National Institutes of Health (NIH), Centers for Disease Control and
Prevention (CDC), and Health Resources and Services Administration
(HRSA). These initiatives have opened many new avenues of promising
research, helped educate hundreds of physicians in how to properly
diagnose PH, and raised awareness about the importance of organ
donation and transplantation within the PH community.
In addition, I want to commend the subcommittee for actively
addressing the current backlog in Social Security Disability
applications at the Social Security Administration. Many PH patients
end up applying for disability coverage, and streamlining the benefits
process would go a long way toward improving the quality of life for
our most in-need families.
I am honored today to represent the hundreds of thousands of
Americans who are fighting a courageous battle against a devastating
disease. 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 with some managing the disorder for 20 years or longer.
Nineteen years ago, when three PH patients found each other, with
the help of the National Organization for Rare Diseases, and founded
the PHA, 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.
I am pleased to report that we are making good progress in our
fight against this deadly disease. Six new therapies for the treatment
of PH have been approved by the FDA in the past 10 years.
Today, PHA includes:
--More than 10,000 patients, family members, and medical
professionals as members and an additional 34,000 supporters
and friends.
--A network of more than 200 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 (NHLBI) and the
American Thoracic Society, have committed more than $7.5
million toward PH research as of December 2008.
--Numerous electronic and print publications, including the first
medical journal devoted to PH--published quarterly and
distributed to all cardiologists, pulmonologists, and
rheumatologists in the United States.
A Web site dedicated to providing educational and support resources
to patients, medical professionals, and the public. Thanks to support
from CDC, PHA's online resources now include the PHA Online University
which provides PH-specific continuing education opportunities to
medical professionals.
THE PH COMMUNITY
Mr. Chairman, I am privileged to serve as the president of the PHA
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.
Carl Hicks is a former Army Ranger and a retired Colonel who lead
the first battalion into Iraq during the first Iraq war. Every member
of his family was touched by pulmonary hypertension after the diagnosis
of his daughter Meghan in 1994. I share their story here, in Carl's own
words:
``We're sorry Colonel Hicks, your daughter Meaghan has contracted
primary pulmonary hypertension. She likely has less than a year to live
and there is nothing we can do for her. Those words were spoken in the
spring of 1994 at Walter Reed Army Medical Center. They marked the
start down the trail of tears for a young military family that, only
hours before, had been in Germany. My family's journey down this trail
hasn't ended yet, even though Meaghan's fight came to an end with her
death on January 30th, 2009. She was 27.
Pulmonary hypertension struck our family, as it so often does,
without warning. One day, we had a beautiful, healthy, energetic 12-
year old gymnast, the next, a child with a death sentence being robbed
of every breath by this heinous disease. The toll of this fight was
far-reaching. Over the years, every decision of any consequence in the
family was considered first with regards to its impact on Meaghan and
her struggle for breath.
The investment made by our country in my career was lost, as I left
the service to stay nearer my family. The costs for Meaghan's medical
care, spread over the nearly 14 years of our fight, ran well into the 7
figures. Meghan even underwent a heart and dual-lung transplant These
challenges, though, were nothing compared to the psychological toll of
losing Meaghan who had fought so hard for something we all take for
granted, a breath of air.''
Over the past decade, treatment options, and the survival rate, for
PH patients have improved significantly. As Meaghan's story
illustrates, however, courageous patients of every age lose their
battle with PH each day. There is still a long way to go on the road to
a cure and biomedical research holds the promise of a better tomorrow.
Thanks to congressional action, and to advances in medical research
largely supported by the NHLBI and other Government agencies, PH
patients have an increased chance of living with their PH for many
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 2010 APPROPRIATIONS RECOMMENDATIONS
NHLBI
Recently, the World Health Organization's Fourth World Symposium on
Pulmonary Hypertension brought together PH experts from around the
world. 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. Fifteen 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 six 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 NIH, particularly the NHLBI, with a 7 percent increase in
funding in fiscal year 2010.
CDC
PHA applauds the subcommittee for its leadership over the years in
encouraging CDC 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.
Mr. Chairman, we are grateful to the Congress for providing
$238,000 in support of a pulmonary hypertension awareness program in
fiscal year 2009. By educating physicians and patients about pulmonary
hypertension, this funding will save lives. We encourage the
subcommittee to continue its support for PH awareness activities
through the CDC in fiscal year 2010.
``Gift of Life'' Donation Initiative at HRSA
Mr. Chairman, PHA applauds the success of HRSA'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 2010, PHA recommends an appropriation of $30 million for
this important program.
______
Prepared Statement of the Religious Coalition for Reproductive Choice
Mr. Chairman and members of the subcommittee: The Religious
Coalition for Reproductive Choice (RCRC) appreciates this opportunity
to submit testimony. We strongly support President Obama's proposal to
eliminate the dedicated funding streams for abstinence-only programs
and to support proven teen pregnancy prevention programs.
RCRC is an interfaith alliance of national mainstream religious
organizations dedicated to ensuring access to reproductive healthcare
and achieving reproductive justice. For more than 35 years, RCRC has
brought together 40 national religious and religiously affiliated
organizations from 15 denominations and traditions. Our membership
includes the Episcopal Church, the Presbyterian Church (USA), the
United Church of Christ, the United Methodist Church (General Board of
Church and Society and Women's Division, General Board of Global
Ministries), the Unitarian Universalist Association of Congregations;
and Reform, Reconstructionist and Conservative Judaism.
As faith communities, we are committed to sex education in our
public schools that empowers and protects young people, honors diverse
values, and promotes the highest ethical standards. Religious Americans
overwhelmingly favor responsible sex education that is complete, age
appropriate and includes accurate information about abstinence and
contraception.
Abstinence-only-until-marriage programs cannot offer this and
moreover they are ineffective. These programs often are dishonest and
scientifically inaccurate. There is no justification for endangering
the health and well-being of the young people of our Nation for the
sake of a very parochial moral vision.
In fact, while there certainly is great value in adolescents
postponing sex until they are mature, Federal policies that withhold
important life saving information about STDs or HIV/AIDS or other
aspects of reproductive health raise serious moral and ethical
questions. Young people have a basic human right to complete and
accurate HIV/AIDS and sexual health information. Without it they will
be unable to realize the highest attainable standard of health and for
some, their futures will be compromised with disease or unintended
pregnancy.
support of religious communities for comprehensive sexuality education
Major faith traditions representing millions of Americans support
comprehensive sex education. In keeping with our Nation's
constitutional guarantee of freedom of religion, they oppose civil laws
that would impose specific religious views about sexuality education on
all Americans.
These faith communities take seriously their duty to instill a set
of religious and moral values that will help guide young people to
responsible life choices. They believe that it is the role of
Government to ensure that the Nation's youth receive the facts--
unblemished by ideology--that will protect them from disease and
unintended pregnancy.
RCRC has compiled excerpts of official statements of religious
denominations and traditions on the importance of sexuality education.
We have attached a copy of the complete document, Religious Communities
and Sexuality Education: In the Home, In the Congregation, In the
Schools, for your review. But to give you a brief taste of these
statements, please consider the following:
United Methodist Church
--``Children, youth and adults need opportunities to discuss
sexuality and learn from quality sex education materials in
families, churches and schools.''
United Synagogue of Conservative Judaism
--``. . . supports comprehensive sex education . . . calls upon the
U.S. Congress to cease funding of abstinence only education.''
Presbyterian Church (U.S.A.)
--``. . . supports . . . comprehensive school health education that
includes age and developmentally appropriate sexuality
education in all grades . . .''
Muslim Women's League
--``Sex education can be taught in a way that informs young people
about sexuality in scientific and moral terms.''
Episcopal Church
--``. . . we encourage the members of this Church to give strong
support to responsible local public and private school programs
of education in human sexuality.''
NEED FOR ATTENTION TO DISEASE PREVENTION
Although the President's budget does not link the issues of teen
pregnancy prevention and disease prevention, we know that the most
effective programs are comprehensive and do connect the two. According
to the American Social Health Association, each year 9 million new
cases of STDs occur among young people aged 15-24. Sexually active
youth have the highest STD rates of any age group in the country. Young
people are at greatest risk for STDs because, as a group, they are more
likely to have unprotected sex.
The health consequences of STDs include chronic pain, infertility,
cervical cancer and increased vulnerability to HIV, the virus that
causes AIDS. The transmission of STDs to babies--prenatally, during
birth or after--can cause serious life-long complications and even
death.
We urge the Appropriations Committee to include language that
expands the requirement for funded programs to include disease
prevention.
How did you learn about sex?
This past year, RCRC put out a request to ``tell us your story: how
did you learn about sex?'' We received well more than 400 responses
from individuals around the country age 17 through 94. These replies
offer thoughtful reflections and often intimate, sometimes painful,
glimpses into personal lives.
Among other things, we found that what you learn--or don't learn--
as a young person can have life-long repercussions. And abstinence-only
programs, by their design, leave out important health information.
``If I had known what sex was, I would have understood what was
happening to me when I was molested by a male relative beginning at age
8.''----Deborah, 45
``I wish I'd learned what intercourse was and how easy it is to get
pregnant.''----Anonymous, 79
``I wish I'd learned about STDs and the way in which they can be
transmitted. I was under the impression that oral sex was safe, since
you couldn't get pregnant from it.''----Miranda, 26
``The good girl/bad girl images prevalent when I was young only
served to instill a great deal of fear in me, which negatively impacted
on my marriage for years.''----Anonymous, 57
COMMUNITIES OF COLOR
According to former Surgeon General Joycelyn Elders, the black
community's ``problem with sexuality has contributed more to the
poverty in the black community than anything else in our society. A
pregnant teenager who does not finish high school or marry has an 80
percent likelihood of being poor.'' She challenged Congress to ``stop
legislating morals and start teaching responsibility.'' Abstinence-only
education has been proved through studies and in harsh reality to be a
horrible failure. A low-income woman is four times as likely to have an
unintended pregnancy, five times as likely to have an unintended birth
and more than four times as likely to have an abortion as her higher-
income counterpart. It is the poor and communities of color who suffer
from illogical and ineffective public policy. The denominations and
people of faith that comprise RCRC agree with Dr. Elders that ``If I
could make any changes at all to the current health care system, you
know I would start with education, education, education. You can't
educate people that are not healthy. But you certainly can't keep them
healthy if they're not educated.''
RCRC addresses these issues through our National Black Church
Initiative, a program begun in 1997 to ``break the silence'' about sex
and sexuality in the African American community. The initiative assists
Black clergy and laity in addressing teenage pregnancy, sexuality
education and reproductive health within the context of African
American religion and culture. We have worked in more than 700 churches
providing our ``Keeping It Real!'' faith based sexuality education
curriculum to more than 7,000 young men and women. We have a similar
faith based initiative, La Iniciativa Latina (LIL), which provides
model programs on sexuality and reproductive health for Latino youth,
adults and clergy in the context of Latino values, religion and
culture.
But the answer to the Nation's high rate of unintended pregnancy
and pandemic of sexually transmitted diseases does not rest with
churches and nonprofit organizations alone. Public schools must be part
of the solution. We are morally compelled to empower our young people
with the knowledge to make responsible decisions. As Dr. Elders so
succinctly stated, ``Vows of abstinence break more easily than latex
condoms.'' According to the CDC's National Center for Health
Statistics, in 2002, the pregnancy rates for black and Hispanic
teenagers were each more than two and one-half times the rate for white
teenagers. This is the reality.
One of the most compelling arguments for comprehensive sexuality
education was made by a member of our youth program, a proud
Pentecostal Christian from rural Mississippi. In a meeting with her
Member of Congress, she explained that there was no sex education in
her high school and a lot of girls in her class got ``knocked up.''
They did not graduate from high school. They did not marry. Their
futures were compromised. But the impact of these unintended
pregnancies goes well beyond the lives of these young women and their
children. They contribute to the economic depression of their
communities.
CONCLUSION
Let's be real and make a real difference. We know that 95 percent
of Americans will have sex before they marry; therefore programs need
to teach about abstinence and also about contraception, relationships
and disease prevention. We must empower youth with the knowledge to
make responsible decisions.
We believe that being of faith means being engaged in the world.
And like it or not, the facts are clear: more than 80 percent of the
750,000 teen pregnancies each year are unintended and 25 percent of
American teens contract an STD. We want our young people to be safe.
For that to happen, they must be informed by comprehensive sex
education. Offering them anything less is irresponsible and dangerous.
______
Prepared Statement of the Railroad Retirement Board
Mr. Chairman and members of the committee: We are pleased to
present the following information to support the Railroad Retirement
Board's (RRB) fiscal year 2010 budget request.
The RRB administers comprehensive retirement/survivor and
unemployment/sickness insurance benefit programs for railroad workers
and their families under the Railroad Retirement and Railroad
Unemployment Insurance Acts. The RRB also has administrative
responsibilities under the Social Security Act for certain benefit
payments and Medicare coverage for railroad workers. During fiscal year
2008, the RRB paid $10.1 billion in retirement/survivor benefits and
vested dual benefits to about 598,000 beneficiaries. We also paid $80
million in net unemployment/sickness insurance benefits to about 30,000
claimants.
PROPOSED FUNDING FOR AGENCY ADMINISTRATION
The President's proposed budget would provide $109,073,000 for
agency operations, which would enable us to maintain a staffing level
of 920 full-time equivalent staff years in 2010. The proposed budget
would also provide about $1,651,000 for information technology (IT)
investments. This includes $615,000 for costs related to information
security and privacy, and for continuity of operations in the event of
an emergency. The remaining IT funds will be used for E-Government
initiatives, systems modernization, infrastructure needs and system
support.
AGENCY STAFFING
The RRB's dedicated, experienced employees have been the foundation
for our tradition of excellence in customer service and satisfaction.
And, we have an ongoing need and responsibility to effectively manage
our human capital resources. This is particularly important given the
number of RRB employees who are eligible for retirement and those who
soon will be. We are developing a long-range approach to workforce
planning that will position the agency for continued success in
administering our programs. This includes a detailed analysis of the
demographic features of the RRB workforce and the skills needed to
fulfill our mission. It will also establish a procedural framework for
recruiting, training, and developing talented employees.
Like many agencies, the RRB has an aging workforce. About 30
percent of our workforce is currently eligible to retire, and more than
50 percent will be eligible by fiscal year 2012. In response to this
trend, we have placed added emphasis on filling entry-level positions,
focusing on front-line service employees and claims examiners to the
extent possible. In anticipation of an increase in the agency attrition
rate as more employees become eligible to retire, these new employees
will be key to effectively administering the RRB's programs and
continuing to provide excellent service over the long term.
SERVICE IMPROVEMENTS
In fiscal year 2009, we have implemented nationwide, toll-free
telephone service, which enables us to dynamically route phone calls
among our offices based on logical business rules and customer needs.
In addition to providing our customers with faster response times, the
toll-free service allows agency management to more effectively balance
and share workloads among offices. We plan to continue expanding the
functionality and services offered through the toll-free number (1-877-
772-5772 or 1-877-RRB-5RRB). Enhancements will focus on new self-
service options available through the toll-free system.
The RRB's long-term information technology strategy also calls for
expanded use of the Internet to provide services to our customers. We
plan to use contractor services to augment agency staff to expand the
electronic services available to the railroad public via the RRB's
website. As part of this strategy, we are continuing to work on the
Employer Reporting System to increase the amount of information related
to railroad compensation, employment and service that employers can
transmit to the RRB through the Internet. In fiscal year 2010, we plan
to expand services to provide additional notifications to rail
employers and enable employers to correct data through the system.
SYSTEMS MODERNIZATION
Over the last few years, we have undertaken a series of strategic
measures to improve computer processes and better position the RRB for
the future. First, the agency moved to a relational database
environment, and then optimized the data that reside in the legacy
databases. Our next steps involve modernizing the agency's computer
processes.
Many of the RRB's existing systems are old, complex, and require a
large investment in maintenance. As projected staff attrition occurs,
we will be losing both experienced technical staff and some of the
business subject-matter experts who now support our legacy systems. The
modernization process will enable us to maintain the capability of our
business function in the face of expected staff turnover, and to
upgrade our systems based on the improvements that we have already
completed. Through these initiatives, we will eliminate or reduce
unnecessary or redundant activities, improve the accuracy and security
of our systems and their transactions, make the systems more user-
friendly for agency employees and our customers, improve the
interoperability and flexibility of systems, and improve the RRB's
ability to collaborate with agency partners. These improvements will
ultimately decrease the time and cost to develop and operate RRB
systems and allow an increased focus on new initiatives.
We plan to begin this process in fiscal year 2009, with selection
of the agency's first system to modernize and development of a project
plan. The selected system will serve as a pilot for further
modernization. In fiscal year 2010, we will use contractor services to
evaluate the pilot project's business requirements, identify possible
solutions, analyze them, and recommend one for implementation.
The President's proposed budget includes $64 million to fund the
continuing phase-out of vested dual benefits, plus a 2 percent
contingency reserve, $1,280,000, which ``shall be available
proportional to the amount by which the product of recipients and the
average benefit received exceeds the amount available for payment of
vested dual benefits.''
In addition to the requests noted above, the President's proposed
budget includes $150,000 for interest related to uncashed railroad
retirement checks.
FINANCIAL STATUS OF THE TRUST FUNDS
Railroad Retirement Accounts.--The RRB continues to coordinate its
activities with the National Railroad Retirement Investment Trust
(Trust), which was established by the Railroad Retirement and
Survivors' Improvement Act of 2001 (RRSIA) to manage and invest
railroad retirement assets. Pursuant to the RRSIA, the RRB has
transferred a total of $21.276 billion to the Trust. All of these
transfers were made in fiscal years 2002 through 2004. The Trust has
invested the transferred funds, and the results of these investments
are reported to the RRB and posted periodically on the RRB's website.
The market value of Trust-managed assets on September 30, 2008, was
approximately $25.3 billion. Trust-managed assets have declined as a
result of the general economic downturn in 2008 and the early part of
2009. The Trust reported that Trust-managed assets amounted to $19.1
billion as of March 31, 2009. The Trust has transferred to the RRB for
payment of railroad retirement benefits approximately $7.3 billion
since the inception of the Trust.
In June 2008, we released the annual report on the railroad
retirement system required by section 22 of the Railroad Retirement Act
of 1974, and section 502 of the Railroad Retirement Solvency Act of
1983. The report, which reflects changes in benefit and financing
provisions under the RRSIA, addressed the 25-year period 2008-2032 and
contained generally favorable information concerning railroad
retirement financing. The report included projections of the status of
the retirement trust funds under three employment assumptions. These
indicated that, barring a sudden, unanticipated, large decrease in
railroad employment or substantial investment losses, the railroad
retirement system would experience no cash flow problems throughout the
projection period. Our next report, which will be released in June
2009, will include updated projections reflecting the economic events
of the past year.
Railroad Unemployment Insurance Account.--The equity balance of the
Railroad Unemployment Insurance Account at the end of fiscal year 2008
was $99.9 million, a decrease of $0.8 million from the previous year.
The RRB's latest annual report on the financial status of the railroad
unemployment insurance system was issued in June 2008. The report
indicated that even as maximum daily benefit rates rise 47 percent
(from $59 to $87) from 2007 to 2018, experience-based contribution
rates maintain solvency. The report did not recommend any financing
changes. We will update this analysis in our next annual report on the
system, which will be released in June 2009.
In conclusion, we want to stress the RRB's continuing commitment to
improving our operations and providing quality service to our
beneficiaries. Thank you for your consideration of our budget request.
We will be happy to provide further information in response to any
questions you may have.
______
Prepared Statement of the Railroad Retirement Board
Mr. Chairman and members of the subcommittee: My name is Martin J.
Dickman and I am the Inspector General for the Railroad Retirement
Board (RRB). I would like to thank you, Mr. Chairman, and the members
of the subcommittee for your continued support of the Office of
Inspector General (OIG).
BUDGET REQUEST AND BACKGROUND INFORMATION
I wish to describe our fiscal year 2010 appropriations request and
our planned activities. The OIG respectfully requests funding in the
amount of $8,186,000 to ensure the continuation of its independent
oversight of the RRB.
The RRB's central mission is to pay accurate and timely benefits.
During fiscal year 2008, the RRB paid approximately $10.1 billion in
retirement and survivor benefits to 598,000 beneficiaries. The RRB also
paid $80 million in net unemployment and sickness insurance benefits to
almost 30,000 claimants during the benefit year ending June 30, 2008.
The RRB contracts with a separate Medicare Part B carrier, Palmetto
GBA, to process Railroad Medicare Part B claims. As of September 30,
2008, there were 469,442 Railroad Medicare Part B beneficiaries and
during fiscal year 2008 Palmetto GBA paid more than $844 million in
medical insurance benefits on their behalf.
During fiscal year 2010, the OIG will focus on areas affecting
program performance; the efficiency and effectiveness of agency
operations; and areas of potential fraud, waste, and abuse.
OFFICE OF AUDIT (OA)
The mission of the OA is to (1) promote economy, efficiency, and
effectiveness in the administration of RRB programs, and (2) detect and
prevent fraud and abuse in such programs. To accomplish its mission OA
conducts financial, performance and compliance audits and evaluations
of RRB programs. In addition, OA develops the OIG's response to audit-
related requirements and requests for information.
During fiscal year 2010, OA will focus on areas affecting program
performance, the efficiency and effectiveness of agency operations and
areas of potential fraud, waste, and abuse. OA will continue its
emphasis on long-term systemic problems and solutions, and will address
major issues that affect the RRB's service to rail beneficiaries and
their families. OA has identified four broad areas of potential audit
coverage:
--Financial accountability;
--Railroad Retirement Act & Railroad Unemployment Insurance Act
Benefit Program Operations;
--Railroad Medicare program operations; and
--Security, privacy, and information management.
During fiscal year 2010, OA must accomplish the following mandated
activities with its own staff:
--Audit of the RRB's financial statements pursuant to the
requirements of the Accountability of Tax Dollars Act of 2002;
and
--Evaluation of information security pursuant to the Federal
Information Security Management Act (FISMA).
During fiscal year 2010, OA will complete the audit of the RRB's
fiscal year 2009 financial statements and begin its audit of the
agency's fiscal year 2010 financial statements. OA contracts with a
consulting actuary for technical assistance in auditing the RRB's
``Statement of Social Insurance'' which became basic financial
information effective for fiscal year 2006.
In addition to performing the annual evaluation of information
security, OA also conducts audits of individual computer application
systems which are required to support the annual FISMA evaluation. Our
work in this area is targeted toward the identification and elimination
of security deficiencies and system vulnerabilities, including controls
over sensitive personally identifiable information.
OA undertakes additional projects with the objective of allocating
available audit resources to areas in which they will have the greatest
value. In making that determination, OA considers staff availability,
current trends in management, congressional and Presidential concerns.
OFFICE OF INVESTIGATIONS (OI)
The OI focuses its efforts on identifying, investigating and
presenting benefit fraud cases for prosecution. OI conducts
investigations, throughout the United States, relating to the
fraudulent receipt of RRB disability, unemployment, sickness,
retirement/survivor, and Railroad Medicare benefits. OI investigates
railroad employers and unions when there is an indication that they
have submitted false reports to the RRB. OI also investigates
allegations regarding agency employee misconduct and threats against
RRB employees. Investigative efforts can result in criminal
convictions, administrative sanctions, civil penalties and/or the
recovery of program benefit funds.
OI initiates cases based on information from a variety of sources.
The agency conducts computer matching of employment and earnings
information reported to State governments with RRB benefits paid.
Referrals are made to OI if a match is found. OI also receives
allegations of fraud through the OIG Hotline, contacts with State,
local and Federal agencies, and information developed through audits
conducted by the OIG's OA.
OI's investigative results from October 1, 2008 through March 31,
2009 are:
----------------------------------------------------------------------------------------------------------------
Civil judgments Indictments/information Convictions Recoveries/collections
----------------------------------------------------------------------------------------------------------------
12.......................... 16 29 $5,125,573
----------------------------------------------------------------------------------------------------------------
OI anticipates an ongoing caseload of approximately 450
investigations in fiscal year 2010. At present, OI has cases open in 47
States, the District of Columbia, and Canada with estimated fraud
losses totaling almost $16 million.
OI will continue to concentrate its resources on cases with the
highest fraud losses. Typically, these cases are related to the RRB's
disability program. Disability fraud cases currently constitute
approximately 50 percent of OI's total caseload. These cases involve
more complicated schemes and result in the recovery of substantial
funds for the agency's trust funds. They also require considerable time
and resources such as travel by special agents to conduct sophisticated
investigative techniques such as surveillance and witness interviews.
These fraud investigations are extremely document-intensive and involve
complicated financial analysis.
Since March 2008, OI has added Railroad Medicare fraud
investigations to its caseload and has identified 35 cases which
involve losses to the Railroad Medicare program. Similar to the
disability fraud matters, Medicare fraud cases are extremely complex in
nature and often involve extensive document/data reviews that demand
significant resources.
OI will continue to investigate fraud violations of railroad
employees collecting unemployment or sickness insurance benefits while
working and receiving wages from an employer. OI will also investigate
retirement fraud and will continue to use the Department of Justice's
Affirmative Civil Enforcement Program to recover trust fund monies from
cases that do not meet U.S. Attorney's guidelines for criminal
prosecution.
OI will also investigate complaints involving administrative
irregularities and any alleged misconduct by agency employees.
In fiscal year 2010, OI will continue to coordinate its efforts
with agency program managers to address vulnerabilities in benefit
programs that allow fraudulent activity to occur and will recommend
changes to ensure program integrity. OI plans to continue proactive
projects to identify fraud matters that are not detected through the
agency's program policing mechanisms.
REQUESTED CHANGE IN OPERATIONAL AUTHORITY
Oversight of the National Railroad Retirement Investment Trust
The National Railroad Retirement Investment Trust (NRRIT) was
established by the Railroad Retirement and Survivors' Improvement Act
of 2001 (RRSIA) to manage and invest Railroad Retirement assets. As of
February 28, 2009, the RRB's investments in the NRRIT were valued at
approximately $18.3 billion. Although the Trust is a tax-exempt entity
independent of the Federal Government, RRSIA requires the Trust to
report to the RRB. This office has previously reported its concerns
about the RRB's passive relationship with the NRRIT and has identified
the RRB's oversight in this area as a critical issue. However, the
RRSIA does not provide the OIG with oversight authority to conduct
audits and investigations of the NRRIT. This office believes that
independent oversight of the Trust's operations is necessary to ensure
that sufficient reporting mechanisms are in place and to ensure that
the Trustees are fulfilling their fiduciary responsibilities. The OIG
respectfully requests oversight and enforcement authority to conduct
audits and investigations of the NRRIT.
SUMMARY
In fiscal year 2010, the OIG will continue to focus its resources
on the review and improvement of RRB operations and will conduct
activities to ensure the integrity of the agency trust funds. This
office will continue to work with agency officials to ensure the agency
is providing quality service to railroad workers and their families.
The OIG will also aggressively pursue all individuals who engage in
activities to fraudulently receive RRB funds. The OIG will continue to
keep the subcommittee and other members of Congress informed of any
agency operational problems or deficiencies. The OIG sincerely
appreciates it cooperative relationship with the agency and the ongoing
assistance extended to its staff during the performance of their audits
and investigations. Thank you for your consideration.
______
Prepared Statement of the Ryan White Medical Providers Coalition
Dear Chairman and Ranking Member: I am Dr. Kathleen Clanon, an HIV
physician and director of the Tri-City Health Center's HIVACCESS
program in Oakland, California. I am submitting public testimony on
behalf of the Ryan White Medical Providers Coalition (RWMPC). I
appreciate the opportunity to discuss the important HIV/AIDS care
conducted at Ryan White Part C funded programs around the country and
to request a dramatic increase in funds. Specifically, we recommend a
$68.4 million increase for part C for fiscal year 2010 resulting in a
total appropriation of $270,254,000.
Our coalition was formed in 2006 to be a voice for medical
providers across the Nation delivering quality care to their patients
through part C of the Ryan White program. We represent every kind of
program from small and rural to large urban sites in every region in
the country. Our membership has rapidly increased as word spread that
an advocacy group was forming to speak on behalf of the needs of part C
programs.
Ryan White Part C funds comprehensive HIV care and treatment--the
services that are directly responsible for the dramatic decreases in
AIDS-related mortality and morbidity over the last decade. We speak for
those who often cannot speak for themselves and we advocate for a full
range of primary care services for this unique population. Sufficient
funding for part C is essential for the work that we do in service of
those living with HIV/AIDS.
While the patient load in our programs is rising in number, funding
for part C has effectively decreased. At the same time, we expect a
continued increase in patients due to higher diagnosis rates and
declining insurance coverage. The Centers for Disease Control and
Prevention (CDC) reports that the number of HIV/AIDS cases increased by
15 percent from 2004 to 2007 in 34 States.\1\ Our patients struggle in
times of plenty; during this economic downturn they will rely on our
comprehensive services more than ever. An increase in funding is
critical to ensure that we are able to sustain and improve our current
staffing levels, which is important to ensure access to healthcare for
our patients, as well as, to provide security to our community. Part C
of the Ryan White program has been under-funded for years, but new
pressures are creating a crisis in our community. The HIV medical
clinics funded through part C have been in dire of increased funding
for years. An infusion of new funding would offer much needed
assistance. Years of near flat funding, combined with large increases
in the patient population, are negatively impacting the ability of part
C providers to serve their patients.
---------------------------------------------------------------------------
\1\ Centers for Disease Control and Prevention. HIV/AIDS
Surveillance Report, 2007. Vol. 19. U.S. Department of Health and Human
Services, Centers for Disease Control and Prevention; 2009:5
www.cdc.gov/hiv/topics/surveillance/resources/reports.
---------------------------------------------------------------------------
With the rapid cost increases in all aspects of healthcare
delivery, despite small funding increases programs are still operating
at a funding deficit because we are serving more patients than ever. In
2008, part C programs will treat an estimated 248,070--a dramatic 30
percent increase in less than 10 years. Our clinics are laying off
staff, discontinuing critical services such as laboratory monitoring,
creating waitlists, and operating on a 4-day work week just to get by.
All of this at a time when the new data reporting requirements
resulting from the 2006 reauthorization of Ryan White are requiring
even more staff and administrative time than the 10 percent allocation
permitted.
Frankly, we can do better than this and the HIV/AIDS population
served through part C deserves more support. I have included the
following graph in my testimony to demonstrate the growing disparity
between funding for part C and our patient population. I call the gap
between funding and patients the ``Triangle of Misery'' because it
represents the thousands of patients who deserve more than we can offer
them and the part C programs around the Nation who are struggling to
serve them with rapidly shrinking resources.
The purpose of my testimony is to urge you to respond to this
crisis and ask that you commit to doubling funding for Ryan White Part
C programs by fiscal year 2012. Through a careful process that
determined the actual cost of our care for our patients, the Ryan White
Medical Providers Coalition worked collaboratively with the CAEAR
Coalition and the American Academy of HIV Medicine to calculate the
funding demands for Ryan White Part C. We unanimously agreed that a
Federal appropriation of $407,300,078 is needed for part C.
These are challenging fiscal times, and we recognize the multiple
fiscal constraints you face as you determine how to allocate limited
Federal dollars. That is why we are not asking for $407.3 million for
Ryan White Part C for fiscal year 2010. Rather, we join with our
partners in asking you to commit to doubling our funding by fiscal year
2012. Such an agreement would result in an increase of $68.4 million
for part C for each year: fiscal years 2010, 2011, and 2012. We believe
this is a reasonable approach to meeting the needs of HIV/AIDS patients
served by part C around the country.
It is important for you to understand how we developed our request
number. It is based on the following calculations:
--We assumed that 1,381,418 will be the number of people living with
HIV/AIDS in 2012 based on the Centers for Disease Control and
Prevention, New Estimates of HIV Prevalence, 2006. The estimate
equals the CDC's 2006 estimated cases multiplied by their
annual estimated prevalence increases for the years 2007-2012.
--Using data from the HRSA HIV/AIDS Bureau we estimated that 248,070
uninsured people living with HIV/AIDS were served by part C
programs in 2008.
--Using data from a report by Julie Gerberding, MD, MPH and Elizabeth
Duke, Ph.D. to the Honorable Henry Waxman (http://
oversight.house.gov/story.asp?ID1675) we estimated that 168,688
PLWHA who were underinsured were served by part C programs in
2008.
--We estimate the cost of care per patient at $3,501 per year.
(Gilman, BH, Green, JC. Understanding the variation in costs
among HIV primary care providers. AIDS Care. 2008:20;1050-6.)
--We calculated the cost of providing care to uninsured part C
patients to be $277,916,382 per year (79,382 patients $3,501
cost of care).
--We calculated the costs of providing care to underinsured part C
patients to be $129,383,696 per year (168,688 patients $767
cost of care). The cost of care for underinsured patients is a
conservative estimate based on Institute of Medicine figures.
--The total cost of care for all part C patients will be $407,300,078
in fiscal year 2012.
Our data demonstrate the undeniable. Our patient load is increasing
as is the cost of their care. A substantial Federal investment is
necessary to support part C sites around the country in their efforts
to provide the comprehensive care that we know HIV/AIDS patients
deserve and from which both they and our communities benefit.
I thank you for your attention to our request and urge you to
commit to doubling the funding for Ryan White Part C in 3 years. We
request a $68.4 million increase for part C for fiscal year 2010
resulting in a total appropriation of $270,254,000. By working
together, we are hopeful that in fiscal year 2012 the full
appropriation for Ryan White Part C will be $407,300,078.
______
Prepared Statement of the Spina Bifida Association and Spina Bifida
Foundation
FUNDING REQUEST OVERVIEW
The Spina Bifida Association (SBA) and the Spina Bifida Foundation
(SBF) respectfully request that the subcommittee provide the following
allocations in fiscal year 2010 to help improve quality-of-life for
people with Spina Bifida:
--$7 million for 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.
--$4.818 million for the CDC's national folic acid education and
promotion efforts to support the prevention of Spina Bifida and
other neural tube defects.
--$25.623 million to strengthen the CDC's National Birth Defects
Prevention Network.
--$77.059 million for the CDC's National Center on Birth Defects and
Developmental Disabilities.
--$405 million for the Agency for Healthcare Research and Quality
(AHRQ).
--$33.349 billion for the National Institutes of Health (NIH) to
support biomedical research.
BACKGROUND ON SPINA BIFIDA
On behalf of the more than 185,000 \1\ individuals and their
families who are affected by Spina Bifida--the Nation's most common,
permanently disabling birth defect--SBA and SBF appreciate the
opportunity to submit written testimony for the record regarding fiscal
year 2010 funding for the National Spina Bifida Program and other
related Spina Bifida initiatives. SBA is a national voluntary health
agency working on behalf of people with Spina Bifida and their families
through education, advocacy, research and service. The Spina Bifida
Foundation assists SBA in its fundraising and advocacy efforts. SBA and
SBF stand ready to work with Members of Congress and other stakeholders
to ensure our Nation mounts and sustains a comprehensive effort to
reduce and prevent suffering from Spina Bifida.
---------------------------------------------------------------------------
\1\ At the First World Congress on Spina Bifida Research and Care
in March 2009 representatives from the CDC reported on new data
indicating that there are an estimated 185,000 individuals living with
Spina Bifida in the United States.
---------------------------------------------------------------------------
Spina Bifida, a neural tube defect, occurs when the spinal cord
fails to close properly within the first few weeks of pregnancy and
most often before the mother knows that she is pregnant. Over the
course of the pregnancy--as the fetus grows--the spinal cord is exposed
to the amniotic fluid, which increasingly becomes toxic. It is believed
that the exposure of the spinal cord to the toxic amniotic fluid erodes
the spine and results in Spina Bifida. There are varying forms of Spina
Bifida occurring from mild--with little or no noticeable disability--to
severe--with limited movement and function. In addition, within each
different form of Spina Bifida the effects can vary widely.
Unfortunately, the most severe form of Spina Bifida occurs in 96
percent of children born with this birth defect.
The result of this neural tube defect is that most people with it
suffer from a host of physical, psychological, and educational
challenges--including paralysis, developmental delay, numerous
surgeries, and living with a shunt in their skulls, which seeks to
ameliorate their condition by helping to relieve cranial pressure
associated with spinal fluid that does not flow properly. As we have
testified previously, the good news is that after decades of poor
prognoses and short life expectancy, children with Spina Bifida are now
living into adulthood and increasingly into their advanced years. These
gains in longevity, principally, are due to breakthroughs in research,
combined with improvements generally in healthcare and treatment.
However, with this extended life expectancy, our Nation and people with
Spina Bifida now face new challenges--education, job training,
independent living, healthcare for secondary conditions, and aging
concerns, among others. Individuals and families affected by Spina
Bifida face many challenges--physical, emotional, and financial.
Fortunately, with the creation of the National Spina Bifida Program in
2003, individuals and families affected by Spina Bifida now have a
national resource that provides them with the support, information, and
assistance they need and deserve.
As is discussed below, the daily consumption of 400 micrograms of
folic acid by women of childbearing age prior to becoming pregnant and
throughout the first trimester of pregnancy can help reduce the
incidence of Spina Bifida, by up to 70 percent. However, 1,500 babies
are still born each year with Spina Bifida, and, as such, with the
aging of the Spina Bifida population and a steady number of affected
births annually, the Nation must take additional steps to ensure that
all individuals living with this complex birth defect can live full,
healthy, and productive lives.
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. The emotional,
financial, and physical toll and costs of Spina Bifida on the
individuals and families affected are extraordinary. Efforts to reduce
and prevent suffering from Spina Bifida will help to not only save
money, but will also save--and improve--lives.
IMPROVING QUALITY-OF-LIFE THROUGH THE NATIONAL SPINA BIFIDA PROGRAM
SBA has worked with Members of Congress to help improve our
Nation's efforts to prevent Spina Bifida and diminish suffering--and
enhance quality-of-life--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 CDC's National
Spina Bifida Program 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
individuals 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 allergies, 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 185,000 individuals living with Spina Bifida with the goal being
living well with Spina Bifida.
One way to enhance the knowledge base of Spina Bifida, improve
quality of care, and save precious resources is to establish a patient
registry for Spina Bifida. Plans are underway to create the National
Spina Bifida Patient Registry. This registry is intended to determine
the best clinical practices and the most cost-effective treatment for
Spina Bifida, as well as, support the creation of quality measures to
improve overall care. It is only through clinical research towards
improved care that we can truly save lives, while also realizing a
significant cost savings.
In fiscal year 2009, SBA requested $7 million be allocated to
support and expand the National Spina Bifida Program. In the final
fiscal year 2009 Omnibus Appropriations Act, Congress provided $5.468
million for this program, following 3 years of essentially flat
funding. SBA understands that the Congress and the Nation face
unprecedented budgetary challenges and, as such, appreciates this
modest increase. 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
respectfully urges the subcommittee to Congress allocate $7 million in
fiscal year 2010 to the program so it can continue and expand its
current scope of work; further develop the National Spina Bifida
Patient Registry; and sustain the National Spina Bifida 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--and the costs of--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 of child-bearing age 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 an estimated
1,500 births. As mentioned above, the daily consumption of 400
micrograms of folic acid prior to becoming pregnant and throughout the
first trimester of pregnancy can help reduce the incidence of Spina
Bifida, by up to 70 percent. There are few public health challenges
that our Nation can tackle and conquer by nearly three-fourths in such
a straightforward fashion. However, we must still be concerned with
addressing the 30 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 a
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 still too many
women of childbearing age consume inadequate daily amounts of folic
acid prior to becoming pregnant, and too many pregnancies are still
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 is the managing agent for the National Council on Folic Acid, a
multi-sector partnership reaching more than 100 million people a year
with the folic acid message. The goal is to increase awareness of the
benefits of folic acid, particularly 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 2010, CDC's folic acid
awareness 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 targeted 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 2010 allocation for the
National Spina Bifida Program, SBA urges the subcommittee to provide
$4.818 million for the CDC's national folic acid education and
promotion efforts to support the prevention of Spina Bifida and other
neural tube defects; $25.623 million to strengthen the CDC's National
Birth Defects Prevention Network; and a total of $77.059 million for
the National Center on Birth Defects and Developmental Disabilities.
IMPROVING HEALTHCARE FOR INDIVIDUALS WITH SPINA BIFIDA
As you know, AHRQ's mission is to improve the outcomes and quality
of healthcare, reduce healthcare costs, improve patient safety,
decrease medical errors, and broaden access to essential health
services. AHRQ's work is vital to the evaluation of new treatments,
which helps ensure that individuals living with Spina Bifida continue
to receive state-of-the-art care and interventions. To that end, we
request a $405 million fiscal year 2010 allocation for AHRQ, so it can
continue to provide guidance and support to the National Spina Bifida
Patient Registry.
SUSTAIN AND SEIZE SPINA BIFIDA RESEARCH OPPORTUNITIES
Our Nation has benefited immensely from our past Federal investment
in biomedical research at the NIH. SBA joins with other in the public
health and research community in advocating that NIH receive $33.349
billion in fiscal year 2010. 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 respectfully requests that the subcommittee include language in the
report accompanying the fiscal year 2010 Labor, Health and Human
Services, and Education, and related Agencies appropriations measure:
--Urging the National Institute of Child Health and Human Development
to continue to support--and expand--a more comprehensive Spina
Bifida research portfolio that focuses on addressing the myriad
secondary effects and conditions associated with Spina Bifida;
--Commending the National Institute of Diabetes and Digestive and
Kidney Diseases 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
--Encouraging the National Institute of Neurological Diseases and
Stroke to continue and expand its research related to the
treatment and management of hydrocephalus.
CONCLUSION
Please know that SBA and SBF stand ready to work with the
subcommittee and other Members of Congress to advance policies and
programs that will reduce and prevent suffering from Spina Bifida.
Again, we thank you for the opportunity to present our views regarding
fiscal year 2010 funding for programs that will improve the quality-of-
life for the 185,000 Americans and their families living with Spina
Bifida.
______
Prepared Statement of the Scleroderma Foundation
Mr. Chairman, I am Cynthia Cervantes, I am 12 and in the ninth
grade. I live in southern California and in October 2006 I was
diagnosed with scleroderma. Scleroderma means ``hard skin'' which is
literally what scleroderma does and, in my case, also causes my
internal organs to stiffen and contract. This is called diffuse
scleroderma. It is a relatively rare disorder effecting only about
300,000 Americans.
About 2 years ago I began to experience sudden episodes of
weakness, my body would ache and my vision was worsening, some days it
was so bad I could barely get myself out of bed. I was taken to see a
doctor after my feet became so swollen that calcium began to ooze out.
It took the doctors (period of time) to figure out exactly what was
wrong with me, because of how rare scleroderma is.
There is no known cause for scleroderma, which affects three times
as many women as men. Generally, women are diagnosed between the ages
of 25 and 45, but some kids, like me, are affected earlier in life.
There is no cure for scleroderma, but it is often treated with skin
softening agents, anti-inflammatory medication, and exposure to heat.
Sometimes a feeding tube must be used with a scleroderma patient
because their internal organs contract to a point where they have
extreme difficulty digesting food.
The Scleroderma Foundation has been very helpful to me and my
family. They have provided us with materials to educate my teachers and
others about my disease. Also, the support groups the foundation helps
organize are very helpful because they help show me that I can live a
normal, healthy life, and how to approach those who are curious about
why I wear gloves, even in hot weather. It really means a lot to me to
be able to interact with other people in the same situation as me
because it helps me feel less alone.
Mr. Chairman, because the causes of scleroderma are currently
unknown and the disease is so rare, and we have a great deal to learn
about it in order to be able to effectively treat it. I would like to
ask you to please significantly increase funding for the National
Institute of Health (NIH) so treatments can be found for other people
like me who suffer from scleroderma. It would also be helpful to start
a program at the Centers for Disease Control and Prevention to educate
the public and physicians about scleroderma.
OVERVIEW OF THE SCLERODERMA FOUNDATION AND SCLERODERMA
Scleroderma Foundation
The Scleroderma Foundation is a nonprofit organization based in
Danvers, Massachusetts with a three-fold mission of support, education,
and research. The Foundation has 21 chapters nationwide and more than
175 support groups.
The Scleroderma Foundation was established on January 1, 1998
through a merger between two organizations, one on the west coast and
one on the east coast, which can trace their beginnings back to the
early 1970s. The Foundation's mission is to provide support for people
living with scleroderma and their families through programs such as
peer counseling, doctor referrals, and educational information, along
with a toll-free telephone helpline for patients and a quarterly
magazine, The Scleroderma Voice.
The Foundation also provides education about the disease to
patients, families, the medical community, and the general public
through a variety of awareness programs at both the local and national
levels. More than $1 million in peer-reviewed research grants are
awarded annually to institutes and universities to stimulate progress
in the search for a cause and cure for scleroderma. Building awareness
of the disease to patients, families, the medical community, and the
general public to not only generate more funding for medical research,
but foster a greater understanding of the complications faced by people
living with the disease is a further major focus.
Among the many programs arranged by the Foundation is the Annual
Patient Education Conference held each summer. The conference brings
together an average of 500 attendees and experts for a wide range of
workshops on such topics as the latest research initiatives, coping and
disease management skills, caregiver support, and exercise programs.
Scleroderma Overview
Scleroderma is an autoimmune disease which means that it is a
condition in which the body's immune system attacks its own tissues. In
autoimmune disorders, this ability to distinguish foreign from self is
compromised. As immune cells attack the body's own tissue, inflammation
and damage result. Scleroderma (the name means ``hard skin'') can vary
a great deal in terms of severity. For some, it is a mild condition;
for others it can be life threatening. Although there are medications
to slow down disease progression and help with symptoms, there is as
yet no cure for scleroderma.
Who Gets Scleroderma?
There are many clues that define susceptibility to develop
scleroderma. A genetic basis for the disease has been suggested by the
fact that it is more common among patients whose family members have
other autoimmune diseases (such as lupus). In rare cases, scleroderma
runs in families, although for the vast majority of patients there is
no other family member affected. Some Native Americans and African
Americans get worse scleroderma disease than Caucasians.
Women are more likely to get scleroderma. Environmental factors may
trigger the disease in the susceptible host. Localized scleroderma is
more common in children, whereas scleroderma is more common in adults.
However, both can occur at any age.
There are an estimated 300,000 people in the United States who have
scleroderma, about one-third of whom have the systemic form of
scleroderma. Diagnosis is difficult and there may be many misdiagnosed
or undiagnosed cases as well.
Scleroderma can develop and is found in every age group from
infants to the elderly, but its onset is most frequent between the ages
of 25 to 55. There are many exceptions to the rules in scleroderma,
perhaps more so than in other diseases. Each case is different.
Causes of Scleroderma
The cause is unknown. However, we do understand a great deal about
the biological processes involved. In localized scleroderma, the
underlying problem is the overproduction of collagen (scar tissue) in
the involved areas of skin. In systemic sclerosis, there are three
processes at work: blood vessel abnormalities, fibrosis (which is
overproduction of collagen) and immune system dysfunction, or
autoimmunity.
RESEARCH
Research suggests that the susceptible host for scleroderma is
someone with a genetic predisposition to injury from some external
agent, such as a viral or bacterial infection or a substance in the
diet or environment. In localized scleroderma, the resulting damage is
confined to the skin. In systemic sclerosis, the process causes injury
to blood vessels, or indirectly perturbs the blood vessels by
activating the immune system.
Research continues to assemble the pieces of the scleroderma puzzle
to identify the susceptibility genes, to find the external trigger and
cellular proteins driving fibrosis, and to interrupt the networks that
perpetuate the disease.
TYPES OF SCLERODERMA
There are two main forms of scleroderma: systemic (systemic
sclerosis, SSc) that usually affects the internal organs or internal
systems of the body as well as the skin, and localized that affects a
local area of skin either in patches (morphea) or in a line down an arm
or leg (linear scleroderma), or as a line down the forehead
(scleroderma en coup de sabre). It is very unusual for localized
scleroderma to develop into the systemic form.
Systemic Sclerosis
There are two major types of systemic sclerosis (SSc)--limited
cutaneous SSc and diffuse cutaneous SSc. In limited SSc, skin
thickening only involves the hands and forearms, lower legs, and feet.
In diffuse cutaneous disease, the hands, forearms, the upper arms,
thighs, or trunk are affected.
The face can be affected in both forms. The importance of making
the distinction between limited and diffuse disease is that the extent
of skin involvement tends to reflect the degree of internal organ
involvement.
Several clinical features occur in both limited and diffuse
cutaneous SSc. Raynaud's phenomenon occurs in both. Raynaud's
phenomenon is a condition in which the fingers turn pale or blue upon
cold exposure, and then become ruddy or red upon warming up. These
episodes are caused by a spasm of the small blood vessels in the
fingers. As time goes on, these small blood vessels become damaged to
the point that they are totally blocked. This can lead to ulcerations
of the fingertips.
People with the diffuse form of SSc are at risk of developing
pulmonary fibrosis (scar tissue in the lungs that interferes with
breathing, also called interstitial lung disease), kidney disease, and
bowel disease.
The risk of extensive gut involvement, with slowing of the movement
or motility of the stomach and bowel, is higher in those with diffuse
rather than limited SSc. Symptoms include feeling bloated after eating,
diarrhea, or alternating diarrhea and constipation.
Calcinosis refers to the presence of calcium deposits in, or just
under, the skin. This takes the form of firm nodules or lumps that tend
to occur on the fingers or forearms, but can occur anywhere on the
body. These calcium deposits can sometimes break out to the skin
surface and drain whitish material (described as having the consistency
of toothpaste).
Pulmonary Hypertension (PH) is high blood pressure in the blood
vessels of the lungs. It is totally independent of the usual blood
pressure that is taken in the arm. This tends to develop in patients
with limited SSc after several years of disease. The most common
symptom is shortness of breath on exertion. However, several tests need
to be done to determine if PH is the real culprit. There are now many
medications to treat PH.
Localized Scleroderma
Morphea
Morphea consists of patches of thickened skin that can vary from
one-half inch to 6 inches or more in diameter. The patches can be
lighter or darker than the surrounding skin and thus tend to stand out.
Morphea, as well as the other forms of localized scleroderma, does not
affect internal organs.
Linear scleroderma
Linear scleroderma consists of a line of thickened skin down an arm
or leg on one side. The fatty layer under the skin can be lost, so the
affected limb is thinner than the other one. In growing children, the
affected arm or leg can be shorter than the other.
Scleroderma en coup de sabre
Scleroderma en coup de sabre is a form of linear scleroderma in
which the line of skin thickening occurs on the forehead or elsewhere
on the face. In growing children, both linear scleroderma and en coup
de sabre can result in distortion of the growing limb or lack of
symmetry of both sides of the face.
fiscal year 2010 appropriations recommendations
A 7 percent overall increase for NIH.
A 7 percent increase for the National Institute of Arthritis and
Musculoskeletal and Skin Diseases (NIAMS) at the NIH.
A subcommittee recommendation encouraging NIAMS to support a State
of the Science Conference on Scleroderma in fiscal year 2010.
Subcommittee recommendation encouraging the Centers for Disease
Control and Prevention to partner with the Scleroderma Foundation to
promoting increased awareness of scleroderma among the general public
and healthcare providers.
______
Prepared Statement of the Society for Healthcare Epidemiology of
America
Society for Healthcare Epidemiology of America (SHEA) was founded
in 1980 to advance the application of the science of healthcare
epidemiology. SHEA works to achieve the highest quality of patient care
and healthcare personnel safety in all health care settings by applying
epidemiologic principles and prevention strategies to a wide range of
quality-of-care issues. SHEA is a growing organization, strengthened by
its membership in all branches of medicine, public health, and
healthcare epidemiology.
SHEA and its members are committed to implementing evidence-based
strategies to prevent healthcare-associated infections (HAIs). SHEA
members have scientific expertise in evaluating potential strategies
for eliminating preventable HAIs. We collaborate with a wide range of
infection prevention and infectious disease societies, specialty
medical societies in other fields, quality improvement organizations,
and patient safety organizations in order to identify and disseminate
evidence-based practices.
Our principal partners in the private sector are sister societies
such as the Infectious Diseases Society of America and the Association
of Professionals in Infection Control and Epidemiology. The Centers for
Disease Control and Prevention (CDC), its Division of Healthcare
Quality Promotion (DHQP) and the Federal Healthcare Infection Practices
Advisory Committee (HICPAC), and the Council of State and Territorial
Epidemiologists have been invaluable Federal partners in the
development of guidelines for the prevention and control of HAIs and in
their support of translational research designed to bring evidence-
based practices to patient care. Further, collaboration between experts
in the field (epidemiologists and infection preventionists), CDC and
the Agency for Healthcare Research and Quality (AHRQ) plays a critical
role in defining and prioritizing the research agenda. More recently,
SHEA has aligned with the Joint Commission and the American Hospital
Association to produce and promote the implementation of evidence-based
recommendations in the Compendium of Strategies to Prevent Healthcare-
Associated Infections in Acute Care Hospitals (http://www.shea-
online.org/about/compendium.cfm). The organization also contributes
expert scientific advice to quality improvement organizations such as
the Institute for Healthcare Improvement (IHI), the National Quality
Forum, and State-based task forces focused on infection prevention and
public reporting issues.
The current swine flu emergency and the Obama administration's
request for an additional $1.5 billion to address the situation
highlights the need for ongoing congressional support of a national
prevention strategy and dedicated funding stream for core public health
programs. It is our hope that health reform can serve as an opportunity
to strengthen our public health infrastructure and reorient our health
system towards prevention and preparedness.
SHEA applauds the Congress for its support of HAI prevention and
reduction activities through the American Recovery and Reinvestment Act
(ARRA) and the fiscal year 2009 Omnibus Appropriations bill. The
Society is collaborating with the Department of Health and Human
Services (HHS) and the CDC to translate agency goals and objectives for
these funds into actions at the bedside that can achieve meaningful
reductions in preventable HAIs. However, SHEA believes that this level
of funding is substantially insufficient to address a problem estimated
by CDC to be one of the top 10 causes of death in the Nation and one
that poses a significant economic burden on the Nation's healthcare
system.
SHEA supports the conclusions of last year's GAO report on
coordination among HHS agencies related to HAI prevention. We believe
that coordinated action among CDC, the Centers for Medicare and
Medicaid Services (CMS) and AHRQ is critical. CDC and its DHQP should
function as the lead agency in surveillance and prevention activities
related to HAIs at the Federal level because of its historic and
successful role in this area. CDC has had an enviable track record of
prevention and its development and management of the foremost
surveillance system of its kind, the National Healthcare Safety Network
(NHSN) has created a national resource that many States have now
mandated as their public reporting tool. Furthermore, guidelines
developed by the HICPAC are widely regarded as the standards for the
field. Coordinated activity among the agencies can lead to better
informed public policy and payment reform.
Clearly, the CDC plays a critical role in public health protection
through its health promotion, prevention, preparedness, and research
activities. As you consider fiscal year 2010 funding levels for the
CDC, SHEA urges your support of at least $8.6 billion for CDC's ``core
programs'' (not including the mandatory funding provided for the
Vaccines for Children Program) to ensure that the agency is able to
carry out its prevention mission and to assure an adequate translation
of new research into effective State and local programs. In addition to
maintaining a strong public health infrastructure and protecting
Americans from public health threats and emergencies, SHEA strongly
believes that CDC programs play a vital role in reducing healthcare
costs and improving the public's health.
Within this total, SHEA recommends a fiscal year 2010 funding level
of $2.4 billion for CDC's Infectious Diseases program budget which
supports vital management and coordination functions for infectious
disease science, program, and policy, including infectious disease
specific epidemiology and laboratory activities. In particular, SHEA
believes that protecting and improving resources for implementation of
programs that standardize measurement of appropriate HAI outcomes and
performance measures should be a priority. Our most valuable resource
in this regard is NHSN, a voluntary, secure, Internet-based
surveillance system that integrates and expands patient and healthcare
personnel safety surveillance systems. Many States consider NHSN to be
the best option for implementing standardized reporting of HAI data.
NHSN has now been adopted by 19 States and more than 2,100 U.S.
hospitals for the surveillance and reporting of HAIs. It is an
enormously important national resource and effective funding and
support is essential to expand its implementation. Further, recognizing
that multiple States mandate the use of NHSN for State public
reporting, immediate efforts should be made to enable interfaces
between electronic health records and NHSN. In this way, additional
burdens are not placed upon healthcare entities from either an
infection prevention and control or information technology perspective
as the desirability for national database integration proceeds.
As already noted, SHEA believes that additional Federal dollars
should be appropriated for HAI prevention and reduction to build upon
the investment already made through the ARRA and fiscal year 2009
omnibus appropriations bill. It is SHEA's perspective that additional
funding in this area will have the greatest impact when prioritized in
the following ways:
--SHEA strongly encourages an emphasis on implementation of evidence-
based practices, as supported by guidelines (CDC-HICPAC) and
evidence-based recommendations (Compendium of Strategies to
Prevent Healthcare-Associated Infections in Acute Care
Hospitals). Protecting the health of our patients and
preventing HAIs in the settings where healthcare is delivered
in the United States will require a multi-faceted approach that
includes identification and widespread adoption of evidence-
based best practices. Where evidence does not exist, uniformity
in practice should be adopted and studied to determine
effectiveness. Failed practices should be discarded and
successes widely disseminated. Prevention and control of HAIs
also will require better tools in the form of new and novel
antimicrobial agents, better knowledge of strategies to effect
implementation and adherence to proven prevention methods, and
accountability for performance.
--SHEA supports investment in training and education programs for
both hospital-wide personnel, local public health personnel and
patients/families in evidence-based prevention practices and
development of educational materials /tools for patients and
families with respect to HAI and multiple drug resistant
organisms (MDRO).
--SHEA supports a broad context for use of dollars for HAIs rather
than pathogen-specific targets or mandates (e.g., on MRSA or C.
difficile). Ideally, funding should be tied to locally
identified priorities emphasizing that implementation of best
practice bundles for catheter-associated bloodstream infections
(CLA-BSI), ventilator-associated pneumonia and catheter-
associated urinary tract infection (CA-UTI) will have a greater
impact on prevention of HAIs, including those due to MDRO, than
pathogen-specific practices. This approach recognizes the
influence of local conditions on the control of healthcare-
associated infections, and allows rapid modification of
strategies as new knowledge is gained. As an example, SHEA and
CMS emphasize that a risk assessment must be the first step in
any epidemiologic study or infection prevention and control
program in order to target preventive efforts effectively. We
are pleased that the Joint Commission supports this critical
step by developing it into a basic infection prevention
standard. SHEA believes that this strategy allows healthcare
facilities to use local information to develop and implement
optimal and individualized prevention plans designed to reduce
healthcare-associated infections that are identified as local
problems. Goals should be written in such a way to allow
hospitals the flexibility to identify and target their own
safety threats within the domains that are considered critical,
and healthcare facilities should be expected to be able to
justify their infection prevention program based on local risk
assessments.
--SHEA supports investment in hospital infrastructure and qualified
personnel for infection prevention and control including
epidemiologists, infection prevention and control
professionals, NHSN implementation, and adequate microbiology/
lab diagnostic capability as dictated by locally derived needs
assessment and priority.
--SHEA believes that funds made available through CDC and AHRQ should
be used, in part, for translational research projects that can
allow more rapid integration of science into practice. As an
example, this could involve use of funds to support positions
through which large collaboratives could be supported in States
not currently part of AHRQ or HRET projects (for example PHRI
and Keystone, which have achieved successful reductions in
device-associated infections). Experts in the field
(Epidemiologists and Infection Preventionists), in
collaboration with CDC and the AHRQ, should be engaged in order
to further define and prioritize the research agenda. As we
strive to eliminate all preventable HAIs, we need to identify
the gaps in our understanding of what is actually preventable.
This distinction is critical to help guide subsequent research
priorities and to help set realistic expectations. SHEA
believes in the importance of conducting basic, epidemiological
and translational studies (to fill basic and clinical science
gaps). While health services research (i.e., successful
implementation of strategies already known or suspected to be
beneficial) may provide some immediate short-term benefit, to
achieve further success, a substantial investment in basic
science, translational medicine, and epidemiology is needed to
permit effective and precise, interventions that prevent HAIs.
--SHEA strongly favors local decision-making about priorities for use
of funds; however, State efforts should be aligned with CDC
priorities and should be carried out through collaboration with
key stakeholders such as State hospital associations and local
experts. CDC should lead the effort to measure and report on
the success of State prevention efforts to HHS.
With respect to the National Institutes of Health (NIH), SHEA is
very pleased that the ARRA infused the Institutes with billions of
dollars for research projects that will enable growth and investment in
biomedical research and development, public health and healthcare
delivery. The NIH is the single-largest funding source for infectious
diseases research in the United States and the life-source for many
academic research centers. The NIH-funded work conducted at these
centers lays the ground work for advancements in treatments, cures, and
medical technologies. We applaud Congress for acknowledging the impact
of scientific research in stimulating the economy.
SHEA believes that any national effort designed to address the
problem of HAIs should begin with the following principles: scrutiny of
the science base; development of an aggressive, prioritized research
agenda; the conduct of studies that address the identified questions;
creation and deployment of guidelines based on the outcomes of these
studies, followed by studies that assess the efficacy of the
intervention.
In order to determine the preventability of infections, we first
need to understand how and why these infections occur. A comprehensive
national research agenda on HAIs must include at least three major
categories of research: pathogenesis, epidemiology, and infection
prevention strategies. A fourth area of, perhaps, even greater
importance is the development and use of improved approaches to the
design of healthcare epidemiology studies. Carefully designed
multicenter prospective clinical trials are needed to establish the
effectiveness of prevention and control strategies.
Unfortunately, support for basic, translational, and
epidemiological research on HAIs has not been a priority of major
funding bodies. Despite the fact that HAIs are among the top 10 annual
causes of death in the United States, scientists studying these
infections have received relatively less funding than colleagues in
many other disciplines. In 2008, NIH estimated that it spent more than
$2.9 billion dollars on funding for HIV/AIDS research, about $2 billion
on cardiovascular disease research, about $664 million on obesity
research and, by comparison, National Institute of Allergy and
Infectious Diseases provided $18 million for MRSA research. SHEA
believes that as the magnitude of the HAI problem becomes part of the
dialogue on healthcare reform, it is imperative that the Congress and
funding organizations put significant resources behind this momentum.
The limited availability of Federal funding to study HAIs has the
effect of steering young investigators interested in pursuing research
on HAIs toward other, better-funded fields. While industry funding is
available, the potential conflicts of interest, particularly in the
area of infection-prevention technologies, make this option seriously
problematic. These challenges are limiting professional interest in the
field and hampering the clinical research enterprise at a time when it
should be expanding.
Our discipline is faced with the need to bundle, implement, and
adhere to interventions we believe to be successful while
simultaneously conducting basic, epidemiological, pathogenetic, and
translational studies that are needed to move our discipline to the
next level of evidence-based patient safety. The current convergence of
scientific, public, and legislative interest in reducing rates of HAIs
can provide the necessary momentum to address and answer important
questions in HAI research. SHEA strongly urges you to enhance NIH
funding for fiscal year 2010 to ensure adequate support for the
research foundation that holds the key to addressing the multifaceted
challenges presented by HAIs.
SHEA thanks for the subcommittee for this opportunity to share our
priorities with respect to fiscal year 2010 funding for HHS, CDC, and
the NIH. SHEA is pleased to serve as a resource to the subcommittee
going forward on issues related to healthcare epidemiology.
______
Prepared Statement of the Society for Maternal-Fetal Medicine
Mr. Chairman and members of the subcommittee: The Society for
Maternal-Fetal Medicine (SMFM) is pleased to have the opportunity to
submit testimony in support of the fiscal year 2010 budget for the
National Institute of Child Health and Human Development (NICHD).
Established in 1977, SMFM is dedicated to improving maternal and
child outcomes; and raising the standards of prevention, diagnosis, and
treatment of maternal and fetal disease.
ISSUE
Preterm birth is a major public health priority and a major
research priority for NICHD.
--Nearly 500,000 babies born in the United States (1 of every 8
births) are preterm and the number continues to rise.
--The annual cost due to preterm birth in the United States is
estimated to be $26 billion.
--These infants are at high risk for a variety of disorders including
mental retardation, cerebral palsy and vision impairment.
--They are also at high risk for long-term health issues including
heart attack, stroke, and diabetes.
NICHD has been given the mandate of supporting almost all research
into maternal, child, and fetal health problems. In 1986, the NICHD
established the Maternal Fetal Medicine Units Network to achieve a
greater understanding and pursue development of effective treatments
for the prevention of preterm births, intrauterine fetal growth
disorders, and medical complications during pregnancy. The Network
currently funds 14 university-based clinical centers and one data
coordinating center, located around the country. Each site is funded
for 5 years and is renewed by open competition. The advantages of doing
clinical trials within the Network include: having large populations
with which to conduct studies (there are approximately 120,000 births
per year within the Network); provides diverse populations across an
array of ethnic and socioeconomic backgrounds--as a result, the study
outcomes are more likely to prove effective in real-world clinical
practice.
The Network has made a number of landmark contributions to
obstetric practice. In particular, NICHD-supported research identified
progesterone as a medication that can reduce premature deliveries
significantly, and now patients are benefiting from this treatment.
Another major advance is the use of magnesium sulfate--a common
treatment to delay labor--to reduce the risk of cerebral palsy in
preterm infants.
Building on information gathered in previous Network studies, the
Network is currently addressing whether progesterone will also prevent
preterm birth in first pregnancies found to have a short cervix. We
have learned that:
--one of the largest segments of women at risk for preterm births are
those having their first child.
--when an ultrasound exam shows a short cervix (the opening of a
woman's uterus), the risk of preterm birth is much higher.
--progesterone injections reduce the risk for those women with a
prior preterm birth.
If benefit can be shown, progesterone will then be an intervention
for prematurity prevention to apply to the largest segment of pregnant
women at risk for preterm birth.
While we are making progress, there are still many areas about
maternal health, pregnancy, fetal well-being, labor, and delivery and
the developing child that NICHD investigators must understand better.
For example:
--Steroids for the prevention of respiratory distress syndrome (RDS)
and neonatal complications in the late preterm infant (34-37
weeks).
--Evaluation of the STAN monitor as an adjunct to intrapartum fetal
monitoring to improve outcome of labor.
However these areas are not being pursued due to a projected
limited budget.
We urge the subcommittee, as you move forward with your
deliberations on the fiscal year 2010 budget, to provide greater
resources to National Institutes of Health and in particular to the
NICHD. Without a substantial increase and sustained investment in the
critical medical research being conducted by the NICHD, therapies and
preventive strategies that have a significant impact on the health of
mothers and their babies will be delayed.
RECOMMENDATION
SMFM recommends that Congress provide at least a 7 percent increase
more than the fiscal year 2009 budget for NICHD in fiscal year 2010.
Within the funds appropriated to the NICHD, SMFM urges Congress to
instruct NICHD to adequately fund the Maternal Fetal Medicine Units
Network.
Thank you for the opportunity to submit our concerns to the
subcommittee.
______
Prepared Statement of the Society of Teachers of Family Medicine
Mr. Chairman, the Society of Teachers of Family Medicine, the
Association of Departments of Family Medicine, the Association of
Family Medicine Residency Directors, and the North American Primary
Care Research Group thank you for the opportunity to provide this
testimony in support of funding for family medicine training in health
professions training, the Agency for Healthcare Research and Quality
(AHRQ) and the National Institutes of Health (NIH).
healthcare reform requires a robust primary care workforce
Healthcare reform without measures to address the need for more
primary care physicians will never be comprehensive or effective; it
will not be able to help the most vulnerable populations, and it will
not address the significant cost and quality issues currently so
problematic in the United States. Increased access for patients in
terms of insurance coverage is critical, but not sufficient to resolve
the growing shortage of primary care physicians. In fact increased
coverage, without increased numbers of primary care physicians, is a
recipe for disaster.
Solving the problem of the primary care crisis requires a multi-
faceted solution. One key element is to increase the value of primary
care, both in terms of payment rates and loan forgiveness, and through
other avenues to make primary care an attractive specialty choice for
medical students. A second is to change the incentives and rules
surrounding training under the Medicare graduate medical education
system. A third is to increase funding of programs that are effective
in producing more primary care physicians, such as the primary care
medicine and dentistry cluster of the health professions training
programs. And the fourth is to support research regarding the clinical
needs of most people seeking care, relating to the most common acute,
chronic, and comorbid conditions routinely cared for by primary care
physicians.
It is the latter two building blocks: funding for primary care
physician training programs and funding for primary care research that
come under this subcommittee's jurisdiction and that this testimony
addresses
Health Professions: Primary Care Medicine and Dentistry (title VII,
section 747)
We recommend that Congress build on the investment in primary care
medicine training made in the American Recovery and Reinvestment Act
(ARRA) by providing an appropriation of $215 million for primary care
medicine and dentistry health professions training grants. The fiscal
year 2009 omnibus appropriations bill only provided $500,000 more for
these programs than in fiscal year 2008. This funding level ($48.4
million) is less than half of the funding these programs received in
fiscal year 2003. We appreciate your efforts in that the House had
proposed to double that account in the ARRA. We applaud the $300
million included for the National Health Service Corps, but we do not
know how the remaining $200 million in workforce funds will be
distributed between the many other workforce programs included in the
ARRA.
KEY ADVISORY COMMITTEES KNOW THESE PROGRAMS ARE EFFECTIVE
The Institute of Medicine (IOM) calls the title VII program an
``undervalued asset.'' Title VII, section 747, administered by HRSA, is
the only program aimed directly at training primary care physicians. On
December 12, 2008, the Institute of Medicine released ``HHS in the 21st
Century: Charting a New Course for a Healthier America,'' which points
to the drastic decline in title VII funding. Within that report, the
IOM terms title VII an ``undervalued asset.
The HRSA Advisory Committee on Training in Primary Care Medicine
and Dentistry \1\ recommends an annual minimum level of $215 million
for the title VII, section 747 grant program. The Committee reasoned
that:
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\1\ The Role of Title VII, Section 747 in Preparing Primary Care
Practitioners to Care for the Underserved and Other High-Risk Groups
and Vulnerable Populations. Sixth Annual Report to the Secretary of the
U.S. Department of Health and Human Services and to Congress.
Title VII funds are essential to support major primary care
training programs that train the providers who work with vulnerable
populations . . . additional funding is also necessary to prepare
current and future primary care providers for their critical role in
responding to healthcare challenges including demographic changes in
the population, increased prevalence of chronic conditions, decreased
access to care, and a need for effective first-response strategies in
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instances of acts of terrorism or natural disasters.
The Congressional Research Service also found that reduced funding
for the primary care medicine and dentistry cluster had a deleterious
impact on the effectiveness of these programs--at a time when more,
rather than less primary care is needed. For example, ``In fiscal year
2006, the program supported a total of 17,870 individuals in clinical
training in underserved areas, a decrease from the support of 31,153
individuals in fiscal year 2005.'' \2\ This is a decrease of almost 43
percent, in only 1 year.
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\2\ CRS Report to Congress. February 7, 2008 Title VII Health
Professions Education and Training: Issues in Reauthorization (Order
Code RL32546).
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A study in the Annals of Family Medicine (September/October 2008)
shows that medical schools that receive primary care training dollars
produce more physicians who work in Community Health Centers (CHCs) and
serve in the National Health Service Corps compared to schools without
title VII primary care funding. In spite of an effort to double the
capacity of CHCs between 2002 and 2006, CHCs have found it difficult to
recruit a sufficient number of primary care physicians and have
hundreds of vacant positions.
PROGRAMS ARE ECONOMIC DRIVERS OF COST-SAVINGS AND HIGHER QUALITY
A Health Affairs (April 2004) article found a lower quality of care
in States with higher levels of Medicare spending. The authors from the
Dartmouth Center for the Evaluative Clinical Sciences found that States
with more specialists and fewer primary care physicians had
significantly higher costs and lower quality. A small increase in the
number of primary care physicians in a State was associated with a
large boost in that State's quality ranking. Indeed, States at the 75th
percentile in number of primary care physicians per capita recorded
Medicare costs $1,600 less per Medicare beneficiary per year and
higher-quality indicators than States at the 25th percentile. If all
States were to move to this level of primary care services, higher-
quality care could be delivered at a savings of $60 billion or more per
year for Medicare patients alone. Increased funding for title VII,
section 747 could train more family doctors to be available to provide
this much needed high-quality, lower-cost care.
The Government Accountability Office (GAO) and the Medicare Payment
Advisory Commission have noted research indicating that access to
primary care is associated with better health outcomes and lower
healthcare costs. The GAO states ``Ample research in recent years
concludes that the nation's over reliance on specialty care services at
the expense of primary care leads to a healthcare system that is less
efficient. At the same time, research shows that preventive care, care
coordination for the chronically ill, and continuity of care--all
hallmarks of primary care medicine--can achieve improved outcomes and
cost savings.'' \3\
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\3\ Testimony before the Committee on Health, Education, Labor, and
Pensions, U.S. Senate. Primary Care Professionals: Recent Supply
Trends, Projections and Valuation of Services. Statement of A. Bruce
Steinwald, Director Health Care, United States Accountability Office.
February 12, 2008 GAO-08-472T.
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According to a report prepared by the National Association of
Community Health Centers, The Robert Graham Center, and Capitol
Link,\4\ ``There is a growing consensus among the Nation's political
and industry leaders that the U.S. health care crisis has shifted from
the realm of the poor and disenfranchised, to the doorstep of middle-
class America.'' Additionally, they cite the following:
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\4\ Access Granted: The Primary Care Payoff, August 2007, National
Association of Community Health Centers, The Robert Graham Center,
Capitol Link (pgs 1-2).
``If every American made use of primary care, the healthcare system
would see $67 billion in savings annually. This reflects not only those
who do not have access to primary care, but also those who rely
extensively on costly specialists for most of their care, leading to
inefficiencies in the system. More specifically, the expansion of
Medical homes can even more dramatically facilitate effective use of
health care, improve health outcomes, minimize health disparities, and
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lower overall costs of care.''
Another study by the Robert Graham Center,\5\ found that the
economic impact of one family physician to his or her community was
just more than $900,000 annually. Family physicians are the specialty
most widely distributed throughout the United States. Using the data
from their study on the economic impact of family physicians in their
communities, they estimate that family physicians generate a nationwide
economic impact of more than $46 billion per year. This is a
conservative estimate, and does not include a number of intangible and
other tangible economic benefits of family physicians, such as their
contribution to the generation of income for other local healthcare
organizations such as hospitals and nursing homes. In addition, while
most medical specialties tend to cluster in urban areas and near
academic health centers, family physicians are the specialists that are
most likely to work in the poorest rural and urban areas. These
underdeveloped geographies are also the ones most likely to be
medically underserved.
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\5\ The Family Physician as Economic Stimulus, http://www.graham-
center.org/online/graham/home/tools-resources/directors-corner/dc-
economic-stimulus.html.
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Multiple studies from the Johns Hopkins Bloomberg School of Public
Health have demonstrated that disparities in healthcare outcomes due to
income inequality and socioeconomic status are reduced when there is an
adequate supply of primary care.
AHRQ and NIH--Health Care Reform Requires New Areas of Endeavor
Research related to the most common acute, chronic, and comorbid
conditions that primary care clinicians care for on a daily basis is
currently lacking. Primary care physicians are in the best position to
design and implement research of the common clinical questions
confronted in practice. Funding should be increased both for the
training of primary care researchers and for this type of clinical
research. Such training is necessary to impart critical research skills
to the primary care workforce and to contribute to the body of
knowledge necessary to put primary care on similar footing with other
specialties that have established research infrastructures. We are
pleased with the infusion of funding through the ARRA for comparative
effectiveness research, but there is a need to provide new funding
directly toward specific clinical and translational endeavors.
AHRQ
AHRQ supports research to improve healthcare quality, reduce costs,
advance patient safety, decrease medical errors, and broaden access to
essential services. While targeted funding increases in recent years
have moved AHRQ in the right direction, more core funding is needed to
help AHRQ fulfill its mission. We support the request of the Friends of
AHRQ which recommends an fiscal year 2010 base funding level of $405
million, an increase of $32 million over the fiscal year 2009 level.
This increase will preserve AHRQ's current initiatives and get the
agency on track to a base budget of $500 million by 2013.
IOM's report, Crossing the Quality Chasm: A New Health System for
the 21st Century (2001) recommended a much larger investment in AHRQ.
It recommended $1 billion a year for AHRQ to ``develop strategies,
goals, and action plans for achieving substantial improvements in
quality in the next 5 years.'' AHRQ is critical to retooling the
American healthcare system.
One of the hallmarks of the Patient-Centered Medical Home is
evidence-based medicine. Comparative effectiveness clinical research,
compares the impact of different options for treating a given medical
condition, and is vital to improving the quality of healthcare. Studies
comparing various treatments (e.g., competing drugs) or differing
approaches (e.g., surgery vs. drug therapy) can inform clinical
decisions by analyzing not only costs, but the relative medical
benefits and risks for particular patient populations.
NIH
Historically, the NIH has placed little emphasis on the research
questions asked by primary care physicians and in primary care
settings. We have been 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 that would make NIH
more relevant to where most people receive care. We support an increase
in NIH funding. In addition, we would like to see some report language
that would help NIH ensure that the promise of ``bench to bedside''
research truly becomes ``bench to bedside to community''--and community
to bedside to bench.
We support the inclusion of the following language in the report to
accompany the Labor, Health and Human Services, and Education, and
Related Agencies appropriations bills for fiscal year 2010:
``Translational Research has been identified by the former Director
of the National Institutes of Health (NIH) as a road map initiative.
The committee supports this effort and encourages NIH to integrate such
research as a permanent component of the research portfolio of each
institute and center. The committee urges NIH to work with the primary
care community to determine how best to facilitate progress in
translating existing research findings and to disseminate and integrate
research findings into community practice. Translational research
should also include the discovery and application of knowledge within
the practice setting using such laboratories as practice-based research
networks. This research spans biological systems, patients, and
communities, and arises from questions of importance to patients and
their physicians, particularly those practicing primary care. The
committee requests that the Director of NIH include a progress update
in next year's Budget Justification.''
CONCLUSION
As the United States moves toward major healthcare reform, we urge
the subcommittee to support programs needed to ensure the proper supply
of primary care physicians and the type of research that will work
together to improve healthcare outcomes, enhance equity in care, and
lower healthcare costs. We support increases in these three important
programs: health professions primary care medicine and dentistry
training, AHRQ, and NIH.
______
Prepared Statement of the State and Territorial Injury Prevention
Directors Association
Thank you for the opportunity to offer written testimony to the
Senate Appropriations Subcommittee on Labor, Health and Human Services,
and Education and Related Agencies regarding the critical need for
investments in State and territorial injury and violence prevention
programs. It is well-recognized that injury and violence are a
significant public health problem in terms of risk and costs to
society. Injuries are the leading cause of death among persons 1-44
years of age, and a major cause of death, disability, and
hospitalization for all age group. There are more than 170,000 injury-
related deaths each year in the United States and approximately 30
million people seek emergency treatment as a result of injuries and
violence annually.\1\ Injury is the most common cause of premature
deaths before age 65, accounting for 30 percent of years of potential
life lost. In 2004, 1 in 14 deaths was caused by an injury, including 3
out of 4 deaths for adolescents and young adults.\2\
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\1\ National Center for Health Statistics. (2005). Deaths, Leading
Causes. Center for Disease Control and Prevention. Retrieved December
2, 2008 from http://www.cdc.gov/nchs/FASTATS/lcod.htm.
\2\ Injury in the United States: 2007 Chartbook.. U.S. Department
of Health and Human Services, Centers for Disease Control and
Prevention, National Center for Health Statistics. March 2008.
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In 2000 alone, Americans suffered injuries resulting in more than
$117 billion in medical costs and an estimated $289 billion in
productivity losses, approximately 10 percent of total U.S. medical
expenditures.\3\ Long-term disabilities from brain, spinal cord, and
burn injuries, and fall-related hip fractures, frequently result in
high costs for continued, long-term care. Additionally injuries,
especially fractures, for persons age 65 and older make up a
substantial proportion of Medicare expenditures. As the U.S. population
continues to age, this problem will be an even more significant burden
on the Medicare system.
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\3\ Zaloshnja, E., Miller, T. R., Lawrence, B. A., & Romano, E.
(2005). The costs of unintentional home injuries. Am J Prev Med, 28:
88-94.
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Despite the enormous toll of injury and violence, dedicated and
ongoing Federal or State funding to respond to these problems does not
exist as it does for other major public health priorities. State
governments have a responsibility to protect the public's health and
safety. A comprehensive injury and violence prevention program at the
State health department provides focus and direction, coordinates and
finds common ground among the many prevention partners, and makes the
best use of limited injury and violence prevention resources. State
public health injury and violence prevention programs apply the public
health approach to help understand, predict and prevent injuries and
use a population-based approach to extend the benefits of prevention
beyond individuals.
State and Territorial Injury Prevention Directors Association
(STIPDA) believes that all State and territorial health departments in
the United States must have a comprehensive injury surveillance and
prevention programs. These programs must be adequately staffed and
funded commensurate with the magnitude of the burden of injury and
violence in each State. They must have programs and expertise to
address the leading causes of unintentional and violent injuries; and
have disaster and terrorism epidemiology and injury mitigation
programs. State public health departments bring significant leadership
to reduce injuries and injury-related healthcare costs by:
--Informing the development of public policies through data and
evaluation.
--Designing, implementing, and evaluating injury and violence
prevention programs in cooperation with other agencies and
organizations.
--Collaborating with partners in healthcare and the community.
--Collecting and analyzing injury and violence data from a variety of
sources to identify high-risk groups and geographic locations.
--Providing technical support and training to injury prevention
partners.
State injury and violence prevention programs use surveillance data
to determine how injuries occur, who is most at risk, and what other
factors contribute to whether or not an individual will be injured and
to what degree. State programs have come a long way in understanding of
how to prevent injuries and look beyond just the personal behaviors
that lead to an injury. They also investigate the products that people
use, the physical and social environment, and how organizational and
governmental policies affect the safety of our environments.
State programs have also contributed to the dissemination of
effective practices through partnerships with injury control research
centers, local health departments, local coalitions and other
organizations. To ensure the widespread adoption of these
interventions, State programs provide training and technical assistance
to local injury prevention efforts every day and often financial and
in-kind support, as well as implement interventions.
The following are some examples of how State public health
departments have contributed to the declines we have seen in deaths due
to injuries in this country:
--Washington State's Injury and Violence Prevention Program has seen
a decline in youth suicide while the U.S. rates have remained
static. Washington found that on average 2 young people were
dying of suicide per week with another 16 attempts that
required hospitalization. The program estimated that a 50
percent reduction in youth suicidal behavior would result in
$12 million in healthcare savings alone. The program
implemented a comprehensive prevention program including
gatekeeper training, public awareness and strengthening
community safety nets for youth.
--The Georgia State Injury and Violence Prevention Program have been
able to document at least 56 lives potentially saved through a
unique partnership with Emergency Medical Services since 2006
through a child safety seat education and distribution program
for low-income families in 109 of 169 counties throughout the
State.
--The New York Injury and Violence Prevention Program was able to
document reductions in bicycle-related injuries and traumatic
brain injuries following the implementation of a statewide
comprehensive bicycle helmet program that culminated in a
bicycle helmet law passing easily through the State
legislature.
--The Oklahoma Injury Prevention Service was able to identify a high-
risk area in Oklahoma City for house-related fire injuries. In
response, they conducted a smoke alarm distribution program.
After the program, Oklahoma saw an 81 percent decline in
residential fire injury-related deaths in the target population
while rates declined only 7 percent in the rest of Oklahoma
during the same time period.
--After finding that its drowning rate was ten times the national
average, Alaska's Department of Health and Human Services
formed a unique partnership with the U.S. Coast Guard, State
Office of Boating Safety, Alaska Safe Kids to develop the
``Kids Don't Float'' program. Following extensive analysis of
the problem, the coalition found that 90 percent of fatality
victims were not wearing a life jacket (personal flotation
device), more than half occurred in lakes and rivers, and that
children younger than 18 make up a significant proportion of
the victims. The program consists of adult and youth education
(including peer-to-peer education for teens) and a life jacket
loaner program. At least 5 documented lives have been saved
through this program that is now implemented in 200 locations
throughout the State.
--California's Epidemiology and Prevention for Injury Control Branch-
funded and -evaluated a statewide social marketing campaign
designed to engage high school age males as allies in
preventing sexual violence through a message ``My Strength is
Not for Hurting.'' Through media efforts and ``Men of Strength
(MOST)'' clubs in six pilot sites, California found that
campaign appear promising, particularly when it involves MOST
clubs, for favorably influencing high-school age males towards
more respectful attitudes and affecting a healthier social
climate in high schools.
When evidence-based injury prevention strategies are implemented,
the estimated return on investment is substantial. For instance, home
visitation programs have been demonstrated to be particularly effective
in reducing child abuse and injury, and provide a cost savings of
nearly $2.88 to $5.70 per $1 spent. Other proven cost-effective injury
prevention strategies include:
------------------------------------------------------------------------
Total benefits
Intervention Cost per unit to society \1\
------------------------------------------------------------------------
Booster seat...................... $31/seat $2,200
Child bicycle helmet.............. $11/helmet $570
Motorcycle helmets................ $240/helmet $4,300
Sobriety checkpoints.............. $9,600/checkpoint $73,000
Midnight curfew and provisional $74/driver $600
licensing for teen drivers.......
Smoke alarm purchases............. $33/smoke alarm $940
Fall prevention for high-risk $1,250/person $10,800
elderly..........................
Youth suicide prevention, native $175/youth $6,700
american.........................
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\1\ The total benefit to society is defined as the amount injury
prevention interventions saved by preventing injuries, including
medical costs, other resource costs (police, fire services, property
damages, etc.), work loss, and quality of life costs. These benefits
are calculated in 2004 dollars.
Currently, the National Center for Injury Prevention and Control
(NCIPC)provides very minimal funding to 30 States through the Public
Health Injury Surveillance and Prevention Program (PHISPP). According
to STIPDA's 2007 State of the States survey, States with PHISPP funding
were more likely to have a centralized program, a full-time director,
and greater access to key injury data sets. They were also more likely
to provide support to local injury efforts and provide surveillance
data and technical assistance to inform public policy related to injury
and violence. States with PHISPP funding are well-positioned to
leverage additional resources, implement interventions for major injury
issues, evaluate interventions, gain political support for specific
injury topics, and raise awareness of injury trends.
We are asking the Senate to provide an additional $10 million to
the NCIPC at the Centers for Disease Control and Prevention to
supplement current investments for State injury and violence prevention
programs. This funding would allow for:
--Expansion and stabilization of resources for State injury and
violence prevention programs;
--Strengthening the ability of States to improve the collection and
analysis of injury data, build coalitions and establish
partnerships to promote programs and policies; and
--Disseminating proven injury and violence prevention strategies,
with a focus on persons at highest risk.
Preventable injuries exact a heavy burden on Americans through
premature deaths and disabilities, pain and suffering, healthcare
costs, rehabilitation costs, disruption of quality of life for families
and disruption of productive for employers. Strengthening the
investments made to public health injury and violence prevention
programs is a critical step to keep Americans safe and productive for
the 21st century.
ABOUT STIPDA
Formed in 1992, STIPDA, is the only organization that represents
public health injury prevention professionals in the United States.
STIPDA has a membership of more than 300 professionals committed to
strengthening the ability of State, territorial, and local health
departments to reduce death and disability associated with injuries and
violence. STIPDA engages in activities to increase awareness of injury,
including violence, as a public health problem and works to enhance the
capacity of public health agencies to conduct injuries and violence
prevention.
______
Prepared Statement of the Society for Women's Health Research and the
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, and in particular women's health research.
The Society for Women's Health Research is the Nation's only
nonprofit organization whose mission is to improve the health of all
women through advocacy, research, and education. 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 exclusively,
disproportionately, or differently than men. The Society advocates
increased funding for research on women's health; encourages the study
of sex differences that may affect the prevention, diagnosis and
treatment of disease; promotes the inclusion of women in medical
research studies; and informs women, providers, policy makers and media
about contemporary women's health issues. 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
are absolutely essential if we are to meet the health needs of the
population and advance the Nation's research capability.
NATIONAL INSTITUTES OF HEALTH (NIH)
Congressional investment and support for NIH continues to make the
United States the world leader in biomedical 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 were made through the doubling of the NIH budget from
$13.7 billion in 1998 to $27 billion in 2003, though the momentum
driving new research in recent years was eroded under budgetary
constraints. The 111th Congress saw the importance of increasing funds
to NIH in the fiscal year 2009 omnibus bill providing the NIH with
$30.317 billion, $937.5 million over fiscal year 2008, (a 3.2 percent
increase.) Thankfully, Congress also sought fit to include the NIH in
the American Recovery and Reinvestment Act of 2009 (Public Law 111-5)
(ARRA) providing it with an infusion of short-term funding of $10.4
billion. This funding will have and is having an enormous impact on
research and research facilities throughout the United States, creating
new jobs, new innovations and improved technologies.
Without a robust budget, NIH has shown that it is forced to reduce
the number of grants it is able to fund. The number of new grants
funded by NIH has dropped 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 are forced to consider other careers, 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 findings from the laboratory to
the patients who depend on these advances for improved health and
welfare, the Society proposes a 10 percent increase more than fiscal
year 2009, and establishing a goal of reaching an annual appropriation
of $40 billion in the next 3 years. In addition, we request that
Congress strongly encourage the NIH to utilize ARRA funding as well as
appropriated dollars to assure that women's health research receives
resources sufficient to meet the health needs of all women. Further,
the Society recommends that NIH support the advances being discovered
in sex-based biology research.
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, heart disease, immune dysfunction, mental health disorders,
and many other illnesses. It is imperative that research addressing
these important differences between males and females be supported and
encouraged. Congress clearly recognizes these important sex differences
and NIH should as well.
OFFICE OF RESEARCH ON WOMEN'S HEALTH (ORWH)
The NIH 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 and sex and gender research; 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 is currently
implementing recommendations from the NIH working Group on Women in
Biomedical Careers to maximize the potential of women biomedical
scientists and engineers in both the NIH and extramural community.
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. 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 program has released four RFAs (1999,
2001, 2004, and 2006). Since 2000, 335 scholars have been trained (76
percent women) in the 24 centers resulting in more than 1,300
publications, 750 abstracts, 200 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 but is also supported
by many NIH Institutes and Centers.
The SCOR program was developed by ORWH in 2002. SCORs are designed
to increase the transfer of basic research findings into clinical
practice by housing laboratory and clinical studies under one roof. The
eleven SCOR programs are conducting interdisciplinary research focused
on major medical problems affecting women and comparing gender
differences to health and disease. Each SCOR works hard to transfer
their basic research findings into the clinical practice setting. In
2007, seven SCORS competed successfully for renewal and four new SCORS
were added. In 2008, the 11 SCORs report publishing 113 journal
articles, 144 abstracts, and 30 other publications. Each program costs
approximately $1 million per year and results in research that would
not have taken place without this program.
Advancing Novel Science in Women's Health Research (ANSWHR) was
created by ORWH in 2007 and funding starting in July 2008 to promote
innovative new concepts and interdisciplinary research in women's
health research and sex/gender differences. This program has had broad
appeal and is evolving into an important scientific tool for both
early-stage investigators and veteran researchers to test nascent
scientific concepts relevant to women's health research and the study
of sex and gender differences. Researchers can apply for support to
promote innovative, interdisciplinary research to answer unresolved
questions and expand the knowledge base in a host of areas relevant to
women's health research. In fiscal year 2009, 13 ICs have one or more
applications that have been scientifically reviewed and are considered
competitive for funding. These applications, and the fiscal year 2008
awards, represent a wide range of scientific areas as well as junior
investigators and experienced researchers. ANSWHR serves as a way for
interested researchers to compete for funding that is expanding the
scientific basis for women's health research and the study of sex and
gender differences.
ORWH also has the Research Enhancement Awards Program (REAP) to
support meritorious research on women's health that just missed the IC
pay line and a Partnership with the National Library of medicine to
identify overarching themes, specific health topics, and research
initiatives into women's health.
ORWH, through successful collaboration with the NIH ICs provides
research funding for: breast cancer pharmacogenomics, HPV vaccines,
uterine leiomyoma, vulvodynia, irritable bowel syndrome, stroke,
substance abuse, eating disorders including obesity, menopause,
microbicides, chronic pain syndromes, autoimmune disorders, muscular
skeletal disorders, and health disparities among many other issues.
Despite all of ORWH's advancements of women's health research and
its innovative programs to advance women scientists, the office has
seen its budget flat lined at $40.9 million for fiscal year 2008 and
2009 after having also received a cut of $249,000 in fiscal year 2006
and no additional funding in fiscal year 2007. Flat funding is the same
as receiving a decrease in budget and must not continue to happen. In
order for ORWH's programs and research grants to thrive Congress must
direct that NIH to continue its support of ORWH and provide it with $2
million budget increase.
DEPARTMENT OF HEALTH AND HUMAN SERVICES (HHS)
Under the HHS several agencies have Federal offices on women's
health, in addition to ORWH described above. Agencies with offices,
advisors, or coordinators for women's health or women's health research
are HHS, the Food and Drug Administration, the Centers for Disease
Control and Prevention, the Agency for Healthcare Quality and Research
(AHQR), 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. It
is imperative that these offices are 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
Federal women's health offices and recommends that they are
appropriately funded to ensure 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, healthcare 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. OWH has a central role in communicating the appropriate
messages to patients and healthcare providers, helping to move forward
recent research discoveries. Without OWH's actions the task of
translating research into practice would and will be only more
difficult and delayed.
Over the years OWH has been active in various efforts such as:
joining with NIH to launch the ``The Heart Truth'' campaign, a
prevention and awareness campaign concerning heart disease and women;
leading a series of Women's Heart Health Fairs nationwide; partnering
with the Lupus Foundation of America and the Advertising Council to
launch a new lupus public awareness campaign targeted toward young
minority women of childbearing age who are at most risk for developing
the disease to identify early warning signs.
OWH created a new training program ``Body Works'' for parents and
caregivers designed to improve family eating and activity habits and is
available in both English and Spanish. They collaborated with other
organizations to lead a conference on ``Charting New Frontiers in Rural
Women's Health,'' as well as hosting the third Minority Women's Health
Summit to address the unique health issues many women of color
experience. In addition, OWH has continued its efforts to improve the
health of young women by providing information on their Web site to
address eating disorders and HIV/AIDS prevention for adolescent girls,
in conjunction with conducting their HIV/AIDS National Awareness Day.
Further, OWH is leading efforts to improve breastfeeding information
available to women of all cultures by offering multilingual Web sites
and help-lines.
This year marks the 10th anniversary of the launch of the
womenshealth.gov Web site and care center and National Women's Health
Week. As part of the annual celebration, OWH is sponsoring many events
with communities, businesses and other governmental and health
organizations to educate women on how they can improve their physical
and mental health. Further, this year OWH is celebrating the
publication of ``The Healthy Women'' a book with wonderful health
information and tips for women of all ages.
It is only through continued and increased funding that the OWH
will be able to achieve its goals. While the budget for fiscal year
2008 increased the OWH budget by $2 million to a total of $30 million,
its budget was flat lined for fiscal year 2009. This is, in essence, a
decrease due to inflation. Considering the amount and impact of women's
health programs from OWH, we urge Congress to provide an increase of $2
million for the HHS OWH for fiscal year 2010.
AHQR
AHQR is the lead public health service agency focused on healthcare
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 healthcare. This important information provided by AHRQ is
brought to the attention of policymakers, healthcare providers, and
consumers all of whom make a difference in the quality of healthcare
women receive. 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, which 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, its
budget has been dismally funded for years though targeted funding
increases in recent years for dedicated projects are moving AHRQ in the
right direction. However, more core funding is needed to help AHRQ
fulfill its mission. AHRQ's budget for fiscal year 2009 was $372
million. This must change for fiscal year 2010. The Society recognizes
that AHRQ received a dramatic boost under ARRA of $400 million of
dedicated stimulus funding for the comparative effectiveness project
this amount does not add to AHRQ's base numbers. This Agency has been
operating under a major shortfall for years. Decreased funding
seriously jeopardizes the research and quality improvement programs
that Congress mandates from AHRQ.
We recommend Congress fund AHRQ at $405 million for fiscal year
2010, an increase of $32 million more than the fiscal year 2009 level.
This will ensure that adequate resources are available for high-
priority research, including women's healthcare, sex and gender-based
analyses, Medicare, and health disparities.
In conclusion, Mr. Chairman, we thank you and this subcommittee 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 Trust for America's Health
My name is Jeff Levi, and I am Executive Director of Trust for
America's Health (TFAH), a nonprofit, nonpartisan organization
dedicated to saving lives by protecting the health of every community
and working to make disease prevention a national priority. I am
grateful for the opportunity to submit testimony to the subcommittee
about public health appropriations.
Americans deserve a well-financed, modern, and accountable public
health system. Funding for public health and disease prevention is a
down payment toward reducing healthcare costs over the long term. As
you craft the fiscal year 2010 Labor, Health and Human Services, and
Education, and Related Agencies appropriations bill, I hope that you
will include robust funding for prevention and preparedness programs at
the Centers for Disease Control and Prevention (CDC) and the Office of
the Assistant Secretary for Preparedness and Response (ASPR) in order
to promote health and help protect Americans from natural and manmade
threats and disasters.
CASE FOR SUPPORT
There is increasing evidence that community level interventions,
the kind of programs that CDC funding supports, make a difference in
health outcomes and costs. In 2008, TFAH released a report, Prevention
for a Healthier America: Investments in Disease Prevention Yield
Significant Savings, Stronger Communities, which examines how much the
country could save by strategically investing in community-based
disease prevention programs. The report concludes that an investment of
$10 per person per year in proven community-based programs to increase
physical activity, improve nutrition, and prevent smoking and other
tobacco use could save the country more than $16 billion annually
within 5 years. This is a return of $5.60 for every $1 spent. The
findings are based on a model developed by researchers at the Urban
Institute and a review of evidence-based studies conducted by the New
York Academy of Medicine. The evidence shows that implementing these
programs in communities reduces rates of type 2 diabetes and high blood
pressure by 5 percent within 2 years; reduces heart disease, kidney
disease, and stroke by 5 percent within 5 years; and reduces some forms
of cancer, arthritis, and chronic obstructive pulmonary disease by 2.5
percent within 10 to 20 years, which, can save money through reduced
health care costs to Medicare, Medicaid and private payers.
CHRONIC DISEASES
Chronic diseases, most of which are preventable, account for 70
percent of deaths in the United States and approximately 75 percent of
healthcare spending. CDC's Division of Nutrition, Physical Activity,
and Obesity (DNPAO) provides funding to States to create, implement,
and monitor a nutrition, physical activity, and obesity State plan. In
the previous grant cycle, 28 grantees were supported, but CDC is only
able to award funds to 25 States in fiscal year 2009. The Division of
Adolescent and School Health's (DASH) Coordinated School Health Program
assists States in improving the health of children through a program
that engages families and communities and develops healthy school
environments. The President's fiscal year 2010 budget proposes to
increase funding for DASH by $5 million to fund 10 additional State
educational agencies to assist them in meeting the needs of their K-12
children. TFAH strongly supports this request. In the coming years, we
will ultimately need chronic disease prevention and promotion programs
in all 50 States. That will require $90 million for DNPAO to fund all
approved States at the level at which they applied for funds and at
least an additional $20 million for DASH's School Health program to
fund all States that have been approved.
Another important anti-obesity program is the Healthy Communities
Program. Healthy Communities grants support communities, cities,
States, and tribal entities to implement health promotion programs and
community initiatives. TFAH supports at least $30 million for the
Healthy Communities Program. Yet, funding for this program has
decreased dramatically over recent years, from $43 million in fiscal
year 2007 to $22.7 million in the fiscal year 2009 omnibus
appropriations bill. We support restoration of Healthy Communities
funding because action at the local level is essential if we are to
begin to mitigate the obesity epidemic.
PREPARING FOR PUBLIC HEALTH EMERGENCIES
In December of last year, TFAH released its annual ``Ready or Not''
report on the Nation's preparedness for a catastrophic event.
Unfortunately, there are many areas where the United States remains
underprepared. Funding for the Public Health Emergency Preparedness
Cooperative Agreements to States and localities--where public health
actually happens--has been cut in recent years. With these funds, local
health departments have enhanced their disease surveillance systems and
trained their staff in emergency response, including the recent H1N1
outbreak. More than 90 percent of local health departments have
developed mass vaccination and prophylaxis planning, conducted all-
hazards preparedness training, and implemented new or improved
communication systems. All States have established the infrastructure
necessary to evaluate urgent disease reports and to activate emergency
response operations 24 hours a day. Yet despite this progress,
challenges remain. In its 2008 progress report, CDC noted that 31 State
public laboratories reported difficulty recruiting qualified laboratory
scientists, and no State public health laboratory can rapidly identify
priority radioactive materials in clinical samples. To continue our
commitment to emergency preparedness, sustainable funding is necessary.
TFAH recommends $1 billion for upgrading State and local capacity, an
increase of $253 million more than the fiscal year 2009 level. We also
recommend $596 million for ASPR's Hospital Preparedness Program, an
increase of $208 million over the fiscal year 2009 level, to improve
the capacity of our 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. To begin to build toward these
funding levels, TFAH is very supportive and appreciative of the $14.5
million increase included in the President's budget proposal for
upgrading state and local capacity, as well as for the $32 million
increase for the Hospital Preparedness Program.
Another important program for our Nation's preparedness is the
Biomedical Advanced Research and Development Authority (BARDA). BARDA
was established in 2006 to help jumpstart innovation in vaccines,
diagnostics, and therapeutics to combat health threats; yet limited
funds have prevented BARDA from fulfilling its mission. BARDA provides
incentives and guidance for research and development of products to
counter bioterrorism and pandemic flu and manages Project BioShield,
which includes the procurement and advanced development of medical
countermeasures for chemical, biological, radiological, and nuclear
agents. The fiscal year 2009 omnibus appropriations bill provided $275
million for BARDA, an increase of approximately $173 million more than
fiscal year 2008 levels. TFAH applauds Congress' commitment to BARDA,
as well as the President's proposed $30 million increase, but notes
that a significant increase in funding would be necessary to support
the successful development of medical countermeasures. TFAH requests
$500 million for BARDA in fiscal year 2010, with 2 years of fiscal
availability, noting that over the next few years, higher funding
levels must be allocated and sustained.
BOLSTERING THE NATION'S ABILITY TO DETECT AND CONTROL INFECTIOUS
DISEASES SUCH AS PANDEMIC INFLUENZA
In fiscal year 2006, Congress appropriated $5.6 billion to the
Department of Health and Human Services (HHS) for emergency and agency
funding for pandemic preparedness. The funding has been used for
stockpiling enough antiviral drugs for the treatment of more than 50
million Americans, licensing a prepandemic influenza vaccine,
developing rapid diagnostics and completing the sequencing of the
entire genetic blueprints of 2,250 human and avian influenza viruses.
The recent H1N1 influenza outbreak clearly demonstrates the importance
of this investment.
TFAH was pleased that the fiscal year 2009 omnibus provided $507
million in no-year funding to be used to build vaccine production
capacity, maintain a ready supply of eggs for the production of
vaccine, and enable HHS to purchase medical countermeasures for its
critical employees and contractors, as well as the Indian Health
Service population. We are also appreciative that the House and Senate
versions of the supplemental appropriations legislation include
significant funding to address the H1N1 outbreak. In light of the
challenges that could be posed if H1N1 resurfaces this fall, TFAH urges
you to include $350 million for State and local preparedness
activities, as proposed by the House, in the final version of the
supplemental and to continue support for State and local preparedness
through the annual appropriations process. Additionally, TFAH is
hopeful that Congress will create a contingency fund to cover the
production costs for a potential H1N1 vaccine, should health officials
determine that mass production is necessary.
In fiscal year 2010, we urge Congress to fully fund the President's
request for pandemic preparedness activities, including $354 million to
the Public Health and Social Services Emergency Fund for vaccine,
antivirals, ventilators, and countermeasures and personal protective
equipment for HHS clinical and patient populations, and $230 million
for agency budgets.
ENVIRONMENTAL HEALTH
An additional area of interest for TFAH is the connection between
our environment and our health. CDC's Environmental Health Laboratory
performs biomonitoring measurements--the direct measurement of people's
exposure to toxic substances in the environment. By analyzing blood,
urine, and tissues, scientists can measure actual levels of chemicals
in people's bodies, and determine which population groups are at high
risk for exposure and adverse health effects, assess public health
interventions, and monitor exposure trends over time. In fiscal year
2009, the Environmental Health Laboratory was funded at $42.7 million.
Additional funds are needed to upgrade facilities and equipment and to
bolster the workforce. Of the suggested $19.6 million increase, $10
million would be used extramurally to support State public health
laboratory biomonitoring capabilities. An additional $7.6 million would
be used for intramural activities, including increasing the number of
chemicals CDC measures, providing training and quality assurance for
State laboratories; and increasing the number of studies used to assess
health effects associated with exposure to environmental chemicals.
Additionally, $2 million would support the National Report on
Biochemical Indicators of Diet and Nutrition in the U.S. Population.
TFAH is also concerned about the potential health effects of
climate change, including injuries and fatalities related to severe
weather events and heat waves; infectious diseases; allergic symptoms;
respiratory and cardiovascular disease; and nutritional and water
shortages. TFAH was appreciative of the $7.5 million included in the
omnibus for a Climate Change Program at CDC. To expand this program,
for fiscal year 2010, TFAH recommends $17,500,000 to enable CDC to
bolster its climate change staff, conduct climate change research and
begin to work with State and local health departments on capacity
building for climate change and health preparedness. Ultimately, $50
million is needed to develop a credible and effective Climate Change
Program.
Another important program, the National Environmental Health
Tracking Network, enhances our understanding of the relationship
between environmental exposures and the incidence and distribution of
disease. Health tracking, through the integration of environmental and
health outcome data, enables public health officials to better target
preventive services so that health care providers can offer better
care, and the public will be able to develop a clear understanding of
what is occurring in their communities and how overall health can be
improved. Since 2002, Congress has provided funding for pilot programs
in some States and cities. The National Network is launching in 2009.
With that in mind, TFAH recommends providing $50 million for CDC's
Environmental and Health Outcome Tracking Network, an increase of $19
million more than the fiscal year 2009 level, to expand it to
additional States and support the continued development of a
sustainable Network.
Finally, TFAH supports the expansion of CDC's Global Disease
Detection (GDD) Program. Despite remarkable breakthroughs in medical
research and advancements in immunization and treatments, infectious
diseases are undergoing a global resurgence that threatens health.
Worldwide, infectious diseases are the leading killer of children and
adolescents and are one of the leading causes of death for adults. It
is estimated that newly emerging and re-emerging infectious diseases
will continue to kill at least 170,000 Americans annually. CDC's GDD
Program helps recognize infectious disease outbreaks, improve the
ability to control and prevent outbreaks, and detect emerging microbial
threats. To address the magnitude and urgency of emerging and resurging
diseases, TFAH recommends $56 million for the GDD Program, an increase
of $22 million over the fiscal year 2009 level. Funding will increase
the number of GDD centers across the globe and bring some existing
centers to full capacity.
Mr. Chairman, thank you again for the opportunity to submit
testimony on the urgent need to enhance Federal funding for public
health programs which can save countless lives and protect our
communities and our Nation.
______
Prepared Statement of the TB Coalition
TUBERCULOSIS
The TB Coalition is a network of public health, research,
professional, and advocacy organizations working to support policies to
eliminate tuberculosis (TB) in the United States and around the world.
The TB Coalition is pleased to submit our recommendations for programs
in the Labor, Health and Human Services, and Education, and Related
Agencies Subcommittee purview. The TB Coalition, in collaboration with
Stop TB USA, recommends a funding level of $210 million in fiscal year
2010 for CDC's Division of TB Elimination, as authorized under the
Comprehensive TB Elimination Act.
TUBERCULOSIS
Tuberculosis (TB) is an airborne infection caused by a bacterium,
Mycobacterium tuberculosis. TB primarily affects the lungs but can also
affect other parts of the body, such as the brain, kidneys or spine. TB
is the second leading global infectious disease killer, claiming 1.8
million lives each year. Currently, about a one-third of the world's
population is infected with the TB bacterium. It is estimated that 9-14
million Americans have latent TB. Tuberculosis is the leading cause of
death for people with HIV/AIDS in the developing world. According to a
2009 World Health Organization (WHO) report on global TB control, about
5 percent of all new TB cases are drug resistant. The global TB
pandemic and spread of drug resistant TB present a persistent public
health threat to the United States.
The major factors that have caused the spread of drug resistant
TB--including multi-drug resistant TB (MDR) and extensively drug
resistant (XDR) TB--are inadequate attention to and funding for basic
TB control measures in high TB burden; resource-limited settings, which
also have high HIV prevalence; as well as the lack of investment in new
drugs, diagnostics and vaccines for TB. While most TB prevalent today
is a preventable and curable disease when international prevention and
treatment guidelines are used, many parts of the world--such as Africa
and Eastern Europe--are struggling to implement them, giving rise to
more drug resistant TB and increasingly, XDR-TB.
XDR-TB AS A GLOBAL HEALTH CRISIS
XDR-TB has been identified in all regions of the world, including
the United States. The strain is resistant to two main first-line drugs
and to at least 2 of the 6 classes of second-line drugs. Because it is
resistant to many of the drugs used to treat TB, XDR-TB treatment is
severely limited and the strain has an extremely high-fatality rate. In
an outbreak in the Kwazulu-Natal province of South Africa from late
2005 through early 2006, XDR TB killed 52 out of 53 infected HIV-
infected patients within just 3 weeks of diagnosis. According to the
CDC, there have been 83 cases of XDR-TB in the United States between
1998 and 2008. While the treatment success rate for XDR-TB in the
United States is about 64 percent, the extremely high costs of treating
XDR-TB, coupled with high fatality rates associated with the strain
make XDR-TB a significant public health concern for the United States.
NEW TB TOOLS NEEDED
Although drugs, diagnostics, and vaccines for TB exist, these
technologies are antiquated and are increasingly inadequate for
controlling the global epidemic. The most commonly used TB diagnostic
in the world, sputum microscopy, is more than 100 years old and lacks
sensitivity to detect TB in most HIV/AIDS patients and in children.
Skin tests used in the United States are more effective at detecting
TB, but take up to 3 days to complete. Current diagnostic tests to
detect drug resistance take at least 1 month to complete. Faster drug
susceptibility tests must be developed to stop the spread of drug
resistant TB. The TB vaccine, BCG, provides some protection to
children, but it has little or no efficacy in preventing pulmonary TB
in adults.
There is an urgent need for new anti-TB treatments, and
particularly for a shorter drug regimen. Currently, the drug regime for
TB treatment is 6-9 months. A shorter drug regimen with new classes of
drugs active against susceptible and drug-resistant strains would
increase compliance, prevent development of more extensive drug
resistance, and save program costs by reducing the time required to
directly observe therapy for patients. There is also a critical need
for drugs that can safely be taken concurrently with antiretroviral
therapy for HIV. The good news is that new drugs in development hold
the promise of shortening treatment from 6-9 months to 2-4 months.
TB IN THE UNITED STATES
Although the numbers of TB cases in the United States continue to
decline, with 12,898 new cases reported in 2008, progress towards TB
elimination has slowed. The average annual percentage decline in the TB
rate slowed from 7.3 percent per year during 1993-2000 to 3.8 percent
during 2000-2008. Foreign-born and ethnic minorities bear a
disproportionate burden of U.S. TB cases. The proportion of TB cases in
foreign-born people has increased steadily in the last decade, from 27
percent of all cases in 1992 to 58 percent of all cases in 2008. Border
States and States with high immigration levels such as California,
Texas, and New York are among the highest-burdened TB States. U.S.-born
blacks make up almost half (45percent) of all TB cases among U.S.-born
persons.
In the 1970s and early 1980s, the United States began significantly
reducing the TB control infrastructure. Consequently, the trend towards
TB elimination was reversed and the Nation experienced an unprecedented
resurgence of TB, including many MDR-TB cases. There was a 20 percent
increase in cases reported between 1985 and 1992. In just one city, New
York City, the cost to regain control of TB was more than $1 billion.
The 2000 Institute of Medicine (IOM) report, Ending Neglect: the
Elimination of Tuberculosis in the United States, found that the
resurgence of TB in the United States between 1985 and 1992 was due in
large part to funding reductions and concluded that with proper
funding, organization of prevention and control activities, and
research and development of new tools, TB could be eliminated as a
public health problem in the United States.
Drug-resistant TB poses a particular challenge to domestic TB
control, owing to the high costs of treatment and intensive healthcare
resources required. Treatment costs for multidrug-resistant (MDR) TB
range from $100,000 to $300,000, which can cause a significant strain
on State public health budgets. Inpatient care has been estimated for
California XDR TB patients from 1993-2006 at an average of
approximately $600,000 per patient.
STRONG STATE AND LOCAL TB CONTROL PROGRAMS
The best defense against the development of drug-resistant
tuberculosis is a strong network of State and local public health
programs and laboratories. State, local, and territorial health
departments provide important TB control services such as directly
observed therapy (DOT, a proven method to improve adherence and thus
prevent drug resistance), laboratory support, surveillance, contact
tracing, and patient counseling. CDC provides about $100 million
annually in support to State, local and territorial health departments
to prevent and control TB.
According to the National Tuberculosis Controller's Association,
for every confirmed case of TB, State and local health department must
identify and test an estimated 14 persons who may have been exposed.
Yet after almost a decade of stagnant funding, many State TB programs
have been left seriously under-resourced at a time when TB cases are
growing more complex to diagnose and treat. The higher percentage of
foreign-born TB patients adds to the need for specially trained TB
professionals. According to a recent assessment by CDC's Division of TB
Elimination, more than 1,077 jobs have been lost in State TB control
programs over the last 3 years--ranging from doctors and nurses to lab
personnel and outreach workers.
Despite low rates, persistent challenges to TB control in the
United States remain. Specifically: (1) racial and ethnic minorities
continue to suffer from TB more than majority populations; (2) foreign-
born persons are adversely impacted; (3) sporadic outbreaks/clusters
occur, outstripping local capacity; (4) continued emergence of drug
resistance threaten our ability to control TB; and (5) there are
critical needs for new tools for rapid and reliable diagnosis, short,
safe, and effective treatments, and vaccines.
CONGRESSIONAL RESPONSE TO TB
In recognition of the need to strengthen domestic TB control, the
Congress passed the Comprehensive Tuberculosis Elimination Act (CTEA)
(Public Law 110-392) in October 2008. This historic legislation was
based on the recommendations of the Institute of Medicine and
revitalized programs at CDC and the NIH with the goal of putting the
United States back on the path to eliminating TB. The new law
authorizes an urgently needed reinvestment into new TB diagnostic
treatment and prevention tools. The TB Coalition, in collaboration with
Stop TB USA, recommends a funding level of $210 million in fiscal year
2010 for CDC's Division of TB Elimination, as authorized under the
CTEA. The CTEA, as introduced, included a separate authorization of
$100 million through CDC's TB elimination program for the development
of urgently needed new TB diagnostic, treatment and prevention tools to
ease the global TB pandemic. We hope that this unique area of need will
also be considered in the final fiscal year 2010 funding levels.
NATIONAL INSTITUTES OF HEALTH (NIH)
The NIH has a prominent role to play in the elimination of
tuberculosis through the development of new tools to fight the disease.
However, the Coalition is concerned that the NIH has reduced funding
for TB research from $211 million in 2007 to $160 million in 2008. We
encourage the NIH to expand efforts, as requested under the
Comprehensive TB Elimination Act, to develop new tools to reduce the
rising global TB burden, including faster diagnostics that effectively
identify TB in all populations, new drugs to shorten the treatment
regimen for TB and combat drug resistance, and an effective vaccine.
CONCLUSION
The global TB epidemic endangers TB control efforts in the U.S. TB
case rates in the United States reflect the global situation. The best
way to prevent the future development of drug-resistant strains of
tuberculosis is through establishing and supporting effective global
and domestic tuberculosis control programs and research programs
through the CDC, NIH, and U.S. Agency for International Development
(USAID). The TB Coalition appreciates this opportunity to provide
testimony.
______
Prepared Statement of the Tri-Council for Nursing
The Tri-Council for Nursing, a long-standing alliance focused on
leadership and excellence in the nursing profession, is composed of the
American Association of Colleges of Nursing (AACN), the American Nurses
Association, the American Organization of Nurse Executives, and the
National League for Nursing (NLN). The collaborative leadership of
these four professional organizations impacts the breadth of nursing
practice, including nurse executives, educators, researchers, and
nurses providing direct patient care. The Tri-Council asks the
subcommittee to provide $263.4 million in fiscal year 2010 for the
Nursing Workforce Development Programs under title VIII of the Public
Health Service Act, administered by the Health Resources and Services
Administration (HRSA).
In light of the economic challenges facing our country today, the
Tri-Council urges the subcommittee to focus on the larger context of
building the capacity needed to meet the increasing healthcare demands
of our Nation's population. Such public policy will require sustained
investments aimed at refocusing the current healthcare system toward
promoting health, while simultaneously improving value for our dollars.
The title VIII Nursing Workforce Development Programs are proven policy
instruments that help assure an adequately prepared nursing workforce.
These programs--
--Increase access to healthcare in underserved areas through improved
composition, diversity, and retention of the nursing workforce;
--Advance quality care by strengthening nursing education and
practice; and
--Develop the identification and use of data, program performance
measures, and outcomes to make informed decisions on nursing
workforce matters.
The Tri-Council applauds the subcommittee for the emergency
supplement provided across all the health professions programs via the
American Recovery and Reinvestment Act (Public Law 111-5). We also
value the enacted fiscal year 2009 Omnibus Appropriations bill (Public
Law 111-8) providing $171.031 million specifically for the title VIII
Nursing Workforce Development Programs. These investments are a
critical component supporting our healthcare infrastructure.
Examining the broad context, the healthcare industry remains the
largest industrial complex in the United States. Studies of the
Nation's gross domestic product (GDP) show healthcare spending
achieving a relatively high rate of real growth, with the portion of
GDP devoted to healthcare growing from 8.8 percent in 1980 to 16.2
percent of GDP in 2007. While healthcare spending demands greater
efficiencies, it also has helped to sustain our Nation's sagging
economy.
Since 2001, healthcare is virtually the only sector that added jobs
to the economy on a net basis. In March 2009, the U.S. Bureau of Labor
Statistics (BLS) reported continued growth in the healthcare sector,
despite our economy's freefall in a down cycle with unemployment
reaching 8.1 percent in February 2009. With that month's job loss of
681,000 realized in nearly all major industries, BLS also reported the
addition of 27,000 new jobs at hospitals, long-term care facilities,
and other ambulatory care settings.
As the predominant occupation in the healthcare industry, the nurse
workforce likely is filling most of the noted job openings. Nurses are
the front line of healthcare delivery throughout the Nation, and the
BLS numbers support that description showing the nurse workforce at
well more than four times the size of the medical workforce. Increased
fiscal year 2010 investments in title VIII will help counterbalance the
economic meltdown threatening nursing programs operating in
congressional districts and serving communities by supporting nursing
education--providing title VIII loans, scholarships, traineeships, and
programmatic funding.
NURSING SHORTAGE OUTPACES CAPACITY BUILDING
The Tri-Council contends that an episodic increased funding of
title VIII will not fully fill the gap generated by an 11-year nursing
shortage felt throughout the entire U.S. health system and projected to
continue. The BLS projections estimate that RNs will have the greatest
growth rate of all U.S. occupations in the period spanning 2006-2016,
with more than 1 million new and replacement nurses needed by 2016.
Despite this projected expansion in the profession, numerous other
studies anticipate a growing national nurse workforce shortage to
intensify as the baby boomer cohort ages, the current nurse workforce
retires, and the demand for healthcare accrues.
Funding levels for the HRSA title VIII Nursing Workforce Programs
are failing to support the numerous qualified applicants seeking
assistance from these programs. In the last 3 years, virtually flat
title VIII funding, along with inflation and increased educational and
administrative costs, has decreased purchasing power. According to HRSA
statistics, in fiscal year 2006 the title VIII programs directly or
indirectly supported 91,189 nurses and nursing students. In fiscal year
2007, the number of grantees dropped by 21 percent and in 2008 the
grantees dropped by 28 percent to support only 51,657 nurses and
nursing students.
Additionally, schools of nursing continue to suffer from a growing
shortage of faculty, a troubling infrastructure trend that exacerbates
the nurse workforce demand-supply gap. According to a study conducted
by the AACN in 2008, schools of nursing turned away 49,948 qualified
applicants to baccalaureate and graduate nursing programs. The top
reasons cited for not accepting these potential students was a lack of
qualified nurse faculty and resource constraints. Without faculty,
nursing education programs are prevented from admitting many qualified
students who are applying to their programs. (Data are Internet
accessible at http://www.aacn.nche.edu/Media/NewsReleases/2009/
workforcedata.html.)
The AACN survey results are reinforced by the NLN study of all
types of prelicensure RN programs, which prepare students to sit for
the RN licensing exam (i.e., baccalaureate, associate, and diploma
degree). The NLN statistics indicate more than 1,900 unfilled full-time
faculty positions existed nationwide in 2007, affecting more than one-
third (36 percent) of all schools of nursing. Significant recruitment
challenges were found with 84 percent of nursing schools at-tempting to
hire new faculty in 2007-2008, more than three-quarters (79 percent)
reporting recruitment as ``difficult'' and almost 1 in 3 schools found
it ``very difficult.'' The two main difficulties cited were ``not
enough qualified candidates'' (cited by 46 percent of schools),
followed by inability to offer competitive salaries--cited by 38
percent. (Data are Internet accessible at www.nln.org/research/slides/
index.htm.)
THE FUNDING REALITY
If the United States is to reverse the eroding trends in the nurse
and nurse faculty workforce, the Nation must make a significant
investment in the title VIII programs, which are charged to favor
institutions educating nurses for practice in rural and medically
underserved communities. At adequate funding levels the title VIII
programs supporting the education of registered nurses, advanced
practice registered nurses, nurse faculty, and nurse researchers have
demonstrated successful intervention strategies to solving past nursing
shortages.
A brief examination of the HRSA title VIII illustrates the robust
nature of these programs:
Section 811.--The Advanced Education Nursing (AEN) Program funds
traineeships for individuals preparing to be nurse practitioners, nurse
midwives, nurse administrators, public health nurses, and nurse
educators, among other graduate-level education nursing roles. The AEN
awards assisted nurse education programs to support 3,419 graduate
nursing students in fiscal year 2008.
Section 821.--The Nursing Workforce Diversity Program funds grants
and contracts to schools of nursing, nurse-managed health centers
(NMCs), academic health centers, State and local governments, and
nonprofit entities to increase nursing education opportunities for
individuals from disadvantaged backgrounds and under-represented
populations among RNs. This program--of proven intervention
strategies--supported 18,741 students in fiscal year 2008, seeking to
ensure a culturally diverse workforce to provide healthcare for a
culturally diverse patient population.
Section 831.--The Nurse Education, Practice and Retention Program
provides support for academic and continuing education projects
designed to strengthen the nursing workforce. Several of this program's
priorities apply to quality patient care including developing cultural
competencies among nurses and providing direct support to establishing
or expanding NMCs in noninstitutional settings to improve access to
primary healthcare in medically underserved communities. The program
also provides grants to improve retention of nurses and enhanced
patient care. In fiscal year 2008, approximately 6,000 nurses and
nursing students were supported.
Section 846.--The Nurse Loan Repayment and Scholarship Programs is
divided into two primary elements. The Nursing Education Loan Repayment
Program (NELRP) assists individual RNs by re-paying up to 85 percent of
their qualified educational loans over 3 years in return for their
commitment to work at health facilities with a critical shortage of
nurses, such as departments of public health, community health centers,
and disproportionate share hospitals. In fiscal year 2008, of the 5,875
applications reviewed by HRSA, only 435 students (7.4 percent) received
NELRP awards. Similarly, the Nurse Scholarship Program (NSP) provides
financial aid to individual nursing students in return for working a
minimum of 2 years in a healthcare facility with a critical nursing
shortage. In fiscal year 2008, NSP turned away most of the applicants
owing to a lack of adequate funding, resulting in the distribution of
only 169 student awards.
Section 846A.--The Nurse Faculty Loan Program (NFLP) supports the
establishment and operation of a loan fund within participating schools
of nursing to assist RNs to complete their education to become nursing
faculty. The NFLP grants provide a cancellation provision in which 85
percent of the loan, plus interest, may be cancelled over 4 years in
return for serving as full-time faculty in a school of nursing. NFLP
granted 729 awards in fiscal year 2008.
Section 855.--The Comprehensive Geriatric Education Grant Program
focuses on training, curriculum development, faculty development, and
continuing education for nursing personnel caring for the elderly. In
fiscal year 2008, 18 awards were made in this program.
While title VIII is the largest source of Federal funding for
nursing, the current level of investment falls short of remedying a
chronic underfunding of the Nursing Workforce Development Programs,
compared to the existing and imminent shortages these programs address.
The title VIII authorities are capable of providing flexible and
effective support to assist students, schools of nursing, and health
systems in their efforts to recruit, educate, and retain registered
nurses. Recent efforts have shown that aggressive and innovative
strategies can help avert the nurse and nurse faculty shortages. The
Tri-Council for Nursing understands the competing priorities faced by
this Congress, but we also maintain that title VIII Nursing Workforce
Development Programs must be funded at an adequate level to begin to
impact the shortage and to address the complex health needs of the
Nation. The contributions of nurses in our healthcare system are
multifaceted, and are impacted directly by the level of Federal funding
that supports nursing programs.
______
Prepared Statement of The Endocrine Society
The Endocrine Society is pleased to submit the following testimony
regarding fiscal year 2010 Federal appropriations for biomedical
research, with an emphasis on appropriations for the National
Institutes of Health (NIH). The Endocrine Society is the world's
largest and most active professional organization of endocrinologists
representing more than 14,000 members worldwide. Our organization is
dedicated to promoting excellence in research, education, and clinical
practice in the field of endocrinology. The Society's membership
includes thousands of researchers who depend on Federal support for
their careers and their scientific advances.
Since the doubling of its budget, the NIH has received annual
funding increases below the rate of biomedical inflation. Fiscal year
2009 appropriations resulted in the first real-dollar increase in NIH
funding since fiscal year 2003. This decline in useable dollars has
resulted in a significant decrease in the number of R01 grants funded.
In 2003, the number of new and continuing R01s was 7,211; the number of
grants awarded in 2008 dropped to 5,886. As a result of the decreasing
number of grants awarded, the success rate for new R01 grants dropped
from 25.5 percent in 1999 to a low of 16.3 percent in 2006 (the 2008
success rate was 19 percent). Not only does the decline in grants
affect the number of scientists who are able to continue their research
and discover new treatments and cures, it also has a significant impact
on the U.S. economy.
In fiscal year 2007, every $1 million that the public invested in
NIH research generated $2.21 million in new business activity across
the Nation. At a recent House Energy and Commerce Committee hearing,
Dr. Raynard Kington, Acting Director of the NIH, stated that each NIH
grant supports seven jobs on average. Since grants are dispersed to all
50 States and 90 percent of Congressional Districts, increasing funding
for science will have a significant positive impact on job growth. And
unlike many other proposals to stimulate the economy, funding NIH
grants can have an immediate impact on the economy because these grants
can be funded in a matter of weeks, stimulating local economies through
salaries and purchase of equipment, laboratory supplies, and vendor
services.
Members of Congress and President Obama recognized the positive
impact that funding NIH research can have on the economy and allocated
more than $10 billion to the NIH in the American Recovery and
Reinvestment Act of 2009. These funds will go a long way towards
increasing the success rate of new R01 applications, keeping scientists
employed, and creating new jobs. The Endocrine Society thanks Congress
for the support of biomedical research funding in the ARRA.
However, the Federal Government needs to make a long-term,
sustainable commitment to biomedical research funding. The money
allocated to the NIH in the ARRA is a one-time infusion of money, and
it is unclear how much NIH's budget will be when the stimulus funds run
out at the end of fiscal year 2010. These funds will create thousands
of new jobs, most of which will end when fiscal year 2011 begins if
Congress does not bring NIH's budget closer to $40 billion than to $30
billion. The loss of these jobs could have a drastic effect on our
economy and counteract the benefits realized during fiscal year 2009
and 2010 as a result of the stimulus funding.
While the Nation is struggling with a failing economy, health
reform is also on the top of the minds of Members of Congress and the
American people. With the aging of the Baby Boomer generation, the
incidence of costly, chronic conditions will significantly increase,
and a large portion of the projected increase in healthcare costs will
be as a result of escalating costs associated with diabetes, obesity,
hypertension, Alzheimer's disease, muscular dystrophy, cystic fibrosis,
and stroke. In order to prevent and treat these diseases, and save the
country billions in healthcare costs, significant investment in
biomedical research will be needed. For instance, treatments that delay
or prevent diabetic retinopathy save the country $1.6 billion a year,
and new treatments that delay the onset and progression of Alzheimer's
disease by 5 years can save $50 billion a year in healthcare costs.
The Endocrine Society remains deeply concerned about the future of
biomedical research in the United States without sustained support from
the Federal Government. The Society strongly supports the continued
increase in Federal funding for biomedical research in order to provide
the additional resources needed to enable American scientists to
address the burgeoning scientific opportunities and new health
challenges that continue to confront us. The Endocrine Society supports
President Obama's campaign pledge to double the NIH budget over 10
years. We therefore recommend that NIH receive an increase of at least
7 percent in fiscal year 2010 to prepare for the poststimulus era and
ensure the steady, sustainable growth necessary to complete the
President's vision of doubling the investment in basic and clinical
research.
______
Prepared Statement of The Mended Hearts, Incorporated
I am Robert A. Scott, National Advocacy Chairman for The Mended
Hearts, Incorporated, a heart disease support group with more than 300
chapters across the United States and Canada. In 2008, accredited
Mended Hearts volunteers visited about 3,000 heart patients in more
than 400 hospitals throughout the United States.
As a walking testimony of the benefits of the National Institutes
of Health (NIH)-supported heart research, I would like to share my
story. In 1998, at age 48, I suffered my first heart attack while
playing volleyball. While at Woonsocket, Rhode Island's Landmark
Medical Center, doctors diagnosed me as suffering a so-called silent
heart attack. I learned that as many as 4 million Americans experience
this type of episode--a heart attack with no warning.
After being stabilized, I was transferred to Roger Williams
Hospital, in Providence, Rhode Island for a heart catheterization--the
gold standard for diagnosis of heart problems. The procedure showed
that I had a blockage in my artery that required a stent to open it.
Also, it showed that the lower chamber of my heart was damaged,
resulting in congestive heart failure that could be controlled with
medicine. A stent was inserted in my artery in Rhode Island Hospital.
In 1999, I received another heart catheterization in Miriam
Hospital because of the damage to my heart from the silent heart
attack. However, this time, I was told that my artery could not be
repaired with a stent and that I needed heart bypass surgery the next
morning. Calling me a high-risk patient because of my age and my
weakened heart, my surgeon encouraged me to find a doctor in Boston
because my heart might not start again. However, he assured me that if
this happens they had a device that could keep me alive for only 7
hours. Thank goodness, he told me that in Boston they had another
device that could keep me alive for 7 months while they located a
replacement heart. In less then 10 hours, I went from the possibility
of needing another stent, heart bypass surgery, and a heart transplant.
My journey with heart disease continued.
My next stop was to visit my local cardiologist in Woonsocket who
estimated my survival rate at 20 percent, but he thought I would
survive the heart bypass surgery. Thankfully, he was right and I
survived heart bypass surgery.
But my journey didn't end there. My congestive heart failure was
causing my heart to beat irregularly, so an implantable defibrillator
was inserted to control the problem in 2002. However, this device had
to be replaced nearly 4 years later. My story continues in 2007 where I
started experiencing daily chest pain and shortness of breath. Yet
another heart catheterization showed that I needed an additional stent,
but this time in Miriam Hospital. After the procedure, the doctor told
me the original heart bypass surgery was no longer effective. Although
I was scared, my doctors comforted me by explaining that a new medical
innovation could save my life-a drug eluting stent. They explained that
it could open up the original blockage from my silent heart attack. My
doctor explained that if these state-of-the art stents had been
available in 1998, I would not have had to have heart bypass surgery.
Today, heart attack, stroke, and other cardiovascular diseases
remain our Nation's most costly and No. 1 killer and a major cause of
disability. Thanks to medical research supported by the NIH, I am alive
today. I am concerned that NIH continues to invest only 4 percent of
its budget on heart research and a mere 1 percent on stroke research
when there are so many people in our country just like I am. Enhanced
NIH funding dedicated to heart and stroke research will bring us closer
to a cure for these often deadly and disabling diseases.
______
Prepared Statement of the United Tribes Technical College
For 40 years, United Tribes Technical College (UTTC) has provided
postsecondary career and technical education, job training, and family
services to some of the most impoverished Indian students from
throughout the Nation. We are governed by the five tribes located
wholly or in part in North Dakota. We have consistently had excellent
results, placing Indian people in good jobs and reducing welfare rolls.
The Perkins funds constitute about half of our operating budget and
provide for our core instructional programs for many of our Associate
of Applied Science degrees. We do not have a tax base or State-
appropriated funds on which to rely.
The request of the UTTC Board is for the following authorized
programs:
--$8.5 million or $727,000 above the fiscal year 2009 enacted level
for section 117 of the Carl Perkins Act. These funds are shared
via a formula by UTTC and Navajo Technical College.
--Provision of additional funding for title III and title III-A of
the Higher Education Act (HEA) that provide construction funds
for facilities at institutions of higher education (title III)
and at tribally controlled colleges (title III-A). For example,
UTTC needs an additional $10.9 million to complete the
construction of a new science and technology building towards
which UTTC already has obtained $3 million.
The students who attend UTTC are from Indian reservations from
throughout the Nation, with a significant portion of them being from
the Great Plains area. Our students come from impoverished backgrounds
or broken families. They may be overcoming extremely difficult personal
circumstances as single parents. They often lack the resources, both
culturally and financially, to go to other mainstream institutions.
Through a variety of sources, including funds from section 117 of the
Carl Perkins Act, UTTC provides a set of family and culturally based
campus services, including: an elementary school for the children of
students, housing, day care, a health clinic, a wellness center,
several on-campus job programs, student government, counseling,
services relating to drug and alcohol abuse and job placement programs.
The Carl Perkins funds we receive are essential to our students'
success.
Perkins Authorization.--Section 117 of the Carl D. Perkins Career
and Technical Education Act (20 U.S.C. section 2327) is the source of
authorization of Perkins funding for UTTC. Section 117 is entitled
``Tribally Controlled Postsecondary Career and Technical
Institutions.'' First authorized in 1991, Congress has continued this
authorization in the subsequent reauthorizations of the Perkins Act.
Funding under this act has in recent years been distributed on a
formula basis to UTTC and to Navajo Technical College.
Despite the explicit congressional authorization for Carl Perkins
funding for section 117, and despite the administration's requests for
funding for section 117 in all previous years, the Bush administration
requested nothing for this program for fiscal year 2009. We are pleased
that Congress recognized the value of UTTC's programs, and instead gave
a priority to UTTC and Navajo Technical College by appropriating a
$227,000 increase for section 117 Perkins in the recently enacted
Omnibus appropriations bill for fiscal year 2009. However, in the
process our section 117 program was listed as an earmark, despite the
authorization for the appropriated amount. As a continuing, authorized
Native American serving program, we should not be considered an
earmark.
UTTC Performance Indicators.--UTTC has:
--An 80 percent retention rate.
--A placement rate of 94 percent (job placement and going on to 4-
year institutions).
--A projected return on Federal investment of 20 to 1 (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).
--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 1 of only 2 tribal
colleges accredited to offer accredited on-line (Internet-
based) associate degrees.
--More than 20 percent of our graduates go on to 4-year or advanced
degree institutions.
We also note the January 13, 2009, report of the Department of
Education's Office of Vocational and Adult Education on its recent site
visit to UTTC (October 7-9, 2008). While some suggestions for
improvements were made, the Department commended UTTC in many areas:
for efforts to improve student retention; the commitment to data-driven
decisionmaking, including the implementation of the Jenzabar system
throughout the institution; the breadth of course offerings;
collaboration with 4-year institutions; expansion of online degree
programs; unqualified opinions on both financial statements and
compliance in all major programs; being qualified as a low-risk
grantee; having no reportable conditions and no known questioned costs;
clean audits; and use of the proposed measurement definitions in
establishing institutional performance goals.
The demand for our services is growing and we are serving more
students. For the 2008-2009 year we enrolled 1,023 students (an
unduplicated count), nearly four times the number served just 6 years
ago. Most of our students are from the Great Plains, where the Indian
reservations have a jobless rate of 76 percent (Source: 2003 BIA Labor
Force Report), along with increasing populations. These statistics
dramatically demonstrate the need for our services at increased levels
for at least the next 10 years.
In addition, we are serving 141 students during school year 2008-
2009 in our Theodore Jamerson Elementary school and 202 children, birth
to 5, are being served in our child development centers.
UTTC course offerings and partnerships with other educational
institutions. We offer 17 accredited vocational/technical programs that
lead to 17, 2-year degrees (Associate of Applied Science (AAS)) and 11,
1-year certificates, as well as a 4-year degree in elementary education
in cooperation with Sinte Gleska University in South Dakota.
Licensed Practical Nursing.--This program has one of the highest
enrollments at UTTC and results in the greatest demand for our
graduates. Our students have the ability to transfer their UTTC credits
to the North Dakota higher educational system to pursue a 4-year
nursing degree.
Medical Transcription and Coding Certificate Program.--This program
provides training in transcribing medical records into properly coded
digital documents. It is offered through the college's Exact Med
Training program and is supported by Department of Labor funds.
Tribal Environmental Science.--Our Tribal Environmental Science
program is supported by a National Science Foundation Tribal College
and Universities Program grant. This 5-year project allows students to
obtain a 2-year AAS degree in Tribal Environmental Science.
Community Health/Injury Prevention/Public Health.--Through our
Community Health/Injury Prevention Program we are addressing the injury
death rate among Indians, which is 2.8 times that of the U.S.
population, the leading cause of death among Native Americans ages 1-
44, and the third leading cause of death overall. This program has in
the past been supported by the Indian Health Service, and is the only
degree-granting Injury Prevention program in the Nation. Given the
overwhelming health needs of Native Americans, we continue to seek new
resources to increase training opportunities for public health
professionals.
Online Education.--Our online education courses provide increased
opportunities for education by providing web-based courses to American
Indians at remote sites as well as to students on our campus. These
courses provide needed scheduling flexibility, especially for students
with young children. They allow students to access quality, tribally
focused education without leaving home or present employment. However,
we also note the lack of on-line opportunities for Native Americans in
both urban and rural settings, and encourage the Congress to devote
more resources in this area.
We offer online fully accredited degree programs in the areas of
Early Childhood Education, Community Health/Injury Prevention, Health
Information Technology, Nutrition and Food Service and Elementary
Education. More than 80 courses are currently offered online, including
those in the Medical Transcription and Coding program. We presently
have 50 online students in various courses and 137 online students in
the Medical Transcription program.
We also provide an online Indian Country Environmental Hazard
Assessment program, offered through the Environmental Protection
Agency. This is a training course designed to help tribes understand
how to mitigate environmental hazards in reservation communities.
Computer Information Technology.--This program is at maximum
student capacity because of limitations on resources for computer
instruction. In order to keep up with student demand and the latest
technology, we need more classrooms, equipment and instructors. We
provide all of the Microsoft Systems certifications that translate into
higher income earning potential for graduates.
Nutrition and Food Services.--UTTC helps meet the challenge of
fighting diabetes and other health problems in Indian Country, such as
cancer, through education and research. 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. (Source: Fiscal Year 2009 Indian Health
Service Budget Justification). Our research about native foods is
helping us learn how to reduce the high levels of diseases in our
communities.
As a 1994 Tribal Land Grant institution, we offer a Nutrition and
Food Services AAS degree in order to increase the number of Indians
with expertise in nutrition and dietetics. Currently, there are very
few Indian professionals in the country with training in these areas.
Our degree places a strong emphasis on diabetes education, traditional
food preparation, and food safety. We have also established the United
Tribes Diabetes Education Center that assists local tribal communities,
our students and staff to decrease the prevalence of diabetes by
providing educational programs, training and materials. We publish and
make available tribal food guides to our on-campus community and to
tribes.
Business Management/Tribal Management.--Another critical program
for Indian country is business and tribal management. This program is
designed to help tribal leaders be more effective administrators and
entrepreneurs. As with all our programs, curriculum is constantly being
updated.
Job Training and Economic Development.--UTTC continues to provide
economic development opportunities for many tribes. We are a designated
Minority Business Development Center serving South and North Dakota. We
administer a Workforce Investment Act program and an internship program
with private employers in the region.
South Campus Development.--The bulk of our current educational
training and student housing is provided in 100-year-old buildings,
part of a former military base used by UTTC since its founding in 1969
and donated to us by the United States in 1973. They are expensive to
maintain, do not meet modern construction and electrical code
requirements, are mostly not ADA compliant, and cannot be retrofitted
to be energy efficient.
As a result, UTTC has developed plans for serving more students in
new facilities that will provide training and services to meet future
needs. We are now developing land purchased with a donation that will
become our south campus. Infrastructure for one-fourth of the new
campus has been completed, and we have now obtained partial funds for a
new, and badly needed, science, math, and technology building. We need
an additional $10.9 million to help complete this building. Our vision
for the south campus is to serve up to 5,000 students. We expect that
funding for the project will come from Federal, State, tribal, and
private sources. Without additional funding for titles III and III-A of
the HEA, that provide construction funds for campuses such as ours,
many students will be denied the opportunity for higher education.
Our Department of Education funds are essential to the operation of
our campus. Our programs at UTTC continue to be critical and relevant
to the welfare of Indian people throughout the Great Plains region and
beyond. Thank you for your consideration of our request.