[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 2011
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U.S. Senate,
Subcommittee of the Committee on Appropriations,
Washington, DC.
NONDEPARTMENTAL WITNESSES
[Clerk's note.--The subcommittee was unable to hold
hearings on nondepartmental witnesses. The statements and
letters of those submitting written testimony are as follows:]
Prepared Statement of the 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
by the United States Senate's Subcommittee on Labor, Health and Human
Services, and Education, and Related Agencies.
AACI applauds recent budgetary commitments--notably, increased
funding for the National Institutes of Health (NIH) and support from
the Obama administration through the American Recovery and Reinvestment
Act of 2009 (ARRA)--that have created a more encouraging landscape for
cancer research compared to recent years. We hope that this support
will continue in the years ahead, to ensure that this recognition of
the importance of biomedical research is sustained.
AACI congratulates the administration and Congress on their
commitment to ensuring quality care for cancer patients, as well as for
providing researchers with the tools that they need to develop better
cancer treatments and, ultimately, to cure this disease.
President Obama has released his fiscal year 2011 budget which
includes a $1 billion increase to NIH budget for an expansion of
support for biomedical research. This funding boost would make the NIH
budget $32.1 billion, representing a 3.2 percent increase. The National
Cancer Institute (NCI) would receive an additional $161 million, or
3.16 percent more, for a total of $5.26 billion.
AACI has joined its colleagues in the biomedical research community
in supporting the proposed increase for NIH and in calling on Congress
to further strengthen the impact of the President's request by
increasing funding to $35 billion.
With the extra NIH and NCI funding, the cancer community will be
better equipped to leverage ARRA financial support. ARRA dollars have
helped to sustain the momentum achieved in reducing death rates from
cancer, and they are proving to be an effective means of stimulating
local economies and creating or maintaining jobs throughout the
country.
For example, The Ohio State University Comprehensive Cancer Center
and the Winthrop P. Rockefeller Cancer Institute at the University of
Arkansas for Medical Sciences are moving forward with major
construction projects supported by ARRA funding. Another AACI member,
the University of New Mexico Cancer Center, is buying equipment and
hiring more staff with ARRA money, while a researcher at Tennessee's
Vanderbilt-Ingram Cancer Center is studying imaging techniques in
colorectal cancer with help from ARRA grants (Association of American
Cancer Institutes, AACI Update, February 2010).
Maintaining the flow of sufficient, dependable funding streams for
NCI will help to continue the work that started under the stimulus
plan. It will also serve as recognition that $70 million worth of great
ideas--the approximate amount of ARRA funding for NCI to date--might
not have been explored if it were not for the administration's
unprecedented infusion of funds for cancer research. And much untapped
scientific potential remains.
Cancer Research: Benefiting all Americans
Cancer's financial and personal impact on America is substantial
and growing--1 in 2 men and 1 in 3 women will face cancer in their
lifetimes, and cancer cost our Nation more than $228 billion in 2008
(Centers for Disease Control and Preventions, Addressing The Cancer
Burden: At A Glance 2010). This year, cancer will become the world's
number one killer. Investing in cancer research is a prudent step--both
for the health of our Nation and for our Nation's economic well-being.
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.
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.
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.
Clinical Trials
Clinical trials are the cornerstone of cancer research, and it is
commonly held that ``yesterday's clinical trials are today's standard
therapies''. Without clinical trials we cannot discover new cancer
drugs and better treatments, and without volunteers we cannot conduct
trials.
With no more than 5 percent of adult cancer patients participating
in clinical trials, attracting volunteers to trials has been a long-
standing struggle for cancer researchers. And yet, thanks in large part
to advances realized through clinical trials, two-thirds of cancer
patients now survive at least 5 years after diagnosis, compared with
only half a generation ago.
Unfortunately, running a clinical trial from start to finish can be
prohibitively complicated and expensive. While the Nation's cancer
centers represented by AACI work to untangle red tape and other factors
that can derail trials, a serious obstacle stands largely beyond their
control--the cost to patients of participating in trials.
Section 2709 of the Patient Protection and Affordable Care Act of
2010 requires health insurance plans, including those offered through
the Federal Employee Health Benefit Program, to provide coverage for
routine costs associated with participation in clinical trials.
Commercial health insurers often refuse to pay for routine care
costs associated with a clinical trial, arguing that the trial is
``investigational'' and thus optional or unnecessary. Consequently,
patients experience financial difficulties that limit their
participation in trials. That, in turn, has a negative impact on
research and patients' ability to receive promising treatments that are
available through trials. It slows the development of new cancer
therapies.
Routine costs associated with clinical trials include physician
visits, blood work, hospital stays and x-rays. These costs would
usually be reimbursed by the insurer if the patient was not
participating in a clinical trial. The investigational portion of the
trial (usually a new drug or device) is not charged to the patient or
the insurer.
Since 1994, 27 States and the District of Columbia have passed laws
requiring insurance coverage for routine patient care costs when
patients participate in clinical trials, and another 5 States have
established cooperative agreements with insurers to do so. However,
beyond the patchwork nature of such coverage, some of these laws do not
necessarily require insurers to cover all cancer patients, such as
those in phase I or II clinical trials, or those with employer self-
insured plans, in which a large company self-insures its employees.
With the new Federal policy, all cancer patients can now afford to
enroll in a potentially life-saving clinical trial.
The Nation's Cancer Centers
The nexus of cancer research in the United States is the Nation's
network of cancer centers 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 $3.15
billion from NCI to conduct cancer research; this represents 65 percent
of NCI's total budget (U.S. Department of Health and Human Services,
National Institutes of Health, National Cancer Institute 2008 Fact
Book). In fact, 84 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.
Collaboration between the cancer centers' and NCI is also
essential, and extramural input in shaping NCI's programmatic
priorities is vital for effecting cancer research breakthroughs.
Furthermore, AACI endorses the call for greater collaboration expressed
in recent testimony by Robert S. DiPaola, MD, Director of the Cancer
Institute of New Jersey, delivered before the Health Subcommittee of
the House Energy and Commerce Committee. The association is in strong
agreement with Dr. DiPaola that ``culture of collaboration'' needs to
be nurtured among NCI-designated cancer centers, as well as between
such centers and the pharmaceutical and biotechnology companies that
develop drug treatment for cancer and related illnesses.
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 depends 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.
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 (American Society of Clinical Oncology, 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,
2007).
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. (American Cancer Society, Cancer Facts and Figures 2008).
Cancer physicians--while essential--are only one part of the
oncology workforce that is in danger of being stretched to the breaking
point. For example, the Health Resources and Services Administration
has predicted that by 2020, more than 1 million nursing positions will
go unfilled. 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 where demand for oncology services far outstrips the system's
ability to provide adequate care for all.
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 places the highest priority on affording all Americans
access to superior cancer 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.
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Prepared Statement of the American Association of Colleges of Nursing
The American Association of Colleges of Nursing (AACN) respectfully
submits this testimony highlighting funding priorities for nursing
education and research programs in fiscal year 2011. AACN represents
nearly 650 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
Advanced Practice Registered Nurses (APRNs), nurse faculty, and
researchers.
The Nationwide Nursing Shortage
The United States is in the midst of a nursing shortage that has
impacted the quality care in our Nation's healthcare system for 12
years. 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 due to factors such as an
aging population, increased complexity of care, and a significant
population with chronic diseases. Moreover, the new healthcare reform
law will increase access to care, which will require a surge in the
number healthcare providers. RNs and APRNs will be in high demand. This
comes at a time when the U.S. Bureau of Labor Statistics (BLS),
currently reports that nursing is the Nation's top profession in terms
of projected job growth with more than 581,000 new positions being
created through 2018 (a 22 percent increase in the workforce). 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 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 capacity barriers in schools of nursing. According to
AACN, 54,991 qualified applicants were turned away from baccalaureate
and graduate nursing programs in 2009 primarily due to insufficient
number of faculty, clinical sites, classroom space, clinical
preceptors, and budget constraints. Federal support for nursing
education is critical at this juncture in American history. National
reform goals cannot be met without an adequate number of nurses to
provide the cost-effective and quality care associated with the nursing
discipline.
Nursing Workforce Development Programs: A Proven Solution
For nearly five decades, the title VIII Nursing Workforce
Development Programs (42 U.S.C. 296 et seq.) 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. AACN's 2009-2010 title VIII Student Recipient
Survey included responses from 1,420 students who noted that these
programs played a critical role in funding their nursing education,
which will ultimately help them to achieve future career goals. The
students responding to the title VIII survey have career aspirations
that meet the direct needs of the healthcare system and the profession.
A high percentage of the students surveyed (48.9 percent) reported that
their career goal is to become a nurse practitioner. Given the demand
for primary care providers, the title VIII funds are helping to support
the next generation of these essential practitioners. Moreover, the
nurse faculty shortage continues to inhibit the ability of nursing
schools to increase student capacity and address the shortage. Of the
students who responded to the survey, 40.6 percent stated their
ultimate career goal was to become nurse faculty. Providing support for
title VIII is the key to help schools expand student capacity, fill
vacant nursing positions, and, in turn, improve healthcare quality.
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. The student
recipients reported that more funding was needed for these programs to
help offset the considerable cost of nursing education. Fifty-two
percent of the students responded that the title VIII funding paid for
25 percent or less of their total student loans. Of those students, 26
percent stated that the funding paid for less than 5 percent of their
total nursing student loans.
Over the last 45 years, Congress has used the title VIII
authorities as a mechanism to address past nursing shortages. When the
need for nurses was great, higher funding levels were appropriated. For
example, during the nursing shortage in the 1970s, Congress provided
$160.61 million to the title VIII programs in 1973. Adjusting for
inflation to address the 37-year difference, $160.61 million (fiscal
year 1973 funding level) in 2010 dollars would be approximately $784
million. At a time when nursing economists project the current shortage
to be twice as large as any nursing shortage experienced in this
country since the mid-1960s, more must be invested in title VIII to
decrease the magnitude of the RN demand.
AACN respectfully requests $267.3 million (a 10 percent increase)
for the Nursing Workforce Development programs authorized under title
VIII of the Public Health Service in fiscal year 2011. Last year, your
subcommittee provided a significant funding boost for title VIII that
helped support the Loan Repayment and Scholarship program and Nurse
Faculty Loan program. These increases will help bolster the pipeline of
nurses and nurse faculty, which are so critical to reversing the
nursing shortage. It is extremely important to maintain last year's
funding level for these crucial programs in fiscal year 2011. AACN
believes the 10 percent requested increase should be directed to the
four title VIII programs that have not kept pace with inflation since
fiscal year 2005. These programs include the Advanced Education
Nursing, Nursing Workforce Diversity, Nurse Education, Practice, and
Retention, and Comprehensive Geriatric Education programs, which help
expand nursing school capacity and increase patient access to care. The
10 percent increase awarded to these programs in proportion to their
fiscal year 2010 funding level would be a wise investment of Federal
resources.
Nursing Research: Supporting Health Promotion and Disease Prevention
The National Institute of Nursing Research (NINR) is 1 of the 27
Institutes and Centers at the National Institutes of Health (NIH). As
the nucleus for nursing science, NINR funds research that establishes
the scientific basis for health promotion, disease prevention, and
high-quality nursing care services to individuals, families, and
populations. 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.--Presently, 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 that
promotes prevention is a major focus of the new health reform
law, and NINR is a leader in funding scientific research to
discover optimal prevention methods.
--Eliminating Health Disparities.--Race, gender, socioeconomic
status, ethnic origin, geography, and culture impact the
healthcare of individuals and communities. NINR is committed to
funding research that investigates culturally appropriate
interventions and care strategies focused on at-risk
populations.
--Improving Quality of Life.--Disease prevention is a critical goal
of clinical research. NINR is committed to funding research
that assists individuals with managing their own health
conditions, decreases adverse symptoms, and reduces the burden
on caregivers.
--Setting Directions for End-of-Life Research.--Palliative care and
respect for those at the end of their life is a critical part
of treatment for serious and life-threatening illness. This
care is provided alongside disease treatment to ease suffering
and improve the quality-of-life for the patient. NINR seeks,
through scientific research, to improve the understanding of
the processes underlying palliative care efforts and develop
effective strategies to optimize care across all patient
populations.
Research conducted at NINR improves quality of care to benefit
health both globally and nationally. With increased appropriations for
NINR, more comprehensive, complex, and longitudinal studies could be
funded in the areas provided below as well as meet the current goals,
projects, and priorities of the Institute.
--Expand the scope of science in symptom management;
--Global health;
--Increase funding for scientist-initiated research applications;
--Expand the translation, dissemination, and outreach of NINR
generated research to bridge the gap between scientific
evidence and clinical practice;
--Evaluate the impact of nursing science on the health of the Nation;
and
--Support future nurse researchers.
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.
NINR's fiscal year 2010 funding level of $145.66 million is
approximately 0.47 percent of the overall $31.247 billion NIH budget
(see Figure 1). 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, NINR must receive additional funding. Cuts in
funding have impeded NINR from supporting larger comprehensive studies
needed to advance nursing science and improve the quality of patient
care.
Therefore, AACN respectfully requests $160 million for the National
Institute of Nursing Research, an additional $14.34 million over the
fiscal year 2010 level.
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 (2010), 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 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 2011.
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. The National
Institute of Nursing Research 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 $267.3 million for title VIII programs, $160
million for NINR, and $50 million for the Capacity for Nursing Students
and Faculty Program in fiscal year 2011. 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.
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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 pleased to submit this testimony in support of
increased funding in fiscal year 2011 for programs at the Health
Resources Services Administration (HRSA), 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 26 colleges of osteopathic medicine and three branch
campuses that offer the doctor of osteopathic medicine degree. Today,
more than 18,000 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 HRSA,
support the training and education of health practitioners to enhance
the supply, diversity, and distribution of the healthcare workforce,
acting as an essential part of the healthcare safety net and 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,
the anticipated demand for access to care once 32 million more
Americans have health insurance as a result of healthcare reform will
strain an already fragile healthcare system. While AACOM appreciates
the investments that this subcommittee has made in these programs, it
recommends increasing funding to $330 million in fiscal year 2011 for
the title VII programs. Investment in these programs, including the
Training in Primary Care Medicine Program, the Health Careers
Opportunity Program, and the Centers of Excellence, is necessary to
address the primary care workforce shortage. Strengthening the
workforce has been recognized as a national priority, and the
investment in these programs recommended by AACOM will help sustain the
health workforce expansion supported by the American Recovery and
Reinvestment Act (ARRA) and necessitated by the demand for a well
trained, diverse workforce that this country will experience as a
result of healthcare reform.
National Health Service Corps (NHSC)
AACOM applauds Congress for increasing the authorization to $414
million in fiscal year 2011 for the NHSC through direct appropriations
and including the authorized Community Health Center Fund (CHC Fund),
which also covers the NHSC, in the Patient Protection and Affordable
Care Act. Approximately 50 million Americans live in communities with a
shortage of health professionals, lacking adequate access to primary
care. Through scholarships and loan repayment, NHSC supports the
recruitment and retention of primary care clinicians to practice in
underserved communities. At a field strength of 4,760 in fiscal year
2009, the NHSC still fell more than 24,000 practitioners short of
fulfilling the need for primary care, dental, and mental health
practitioners in federally designated Health Professions Shortage Areas
(HPSAs), as estimated by HRSA. Growth in HRSA's Community Health Center
Program must be complemented with increases in the recruitment and
retention of primary care clinicians to ensure adequate staffing, which
the NHSC provides. ARRA funding for the NHSC has been vital in this
regard, and additional investment will be necessary to sustain the
progress as the ARRA funding period ends. AACOM supports the
President's budget request of $169 million for the NHSC program in
fiscal year 2011, which would be sufficient to trigger the release of
dollars from the CHC Fund. AACOM further recommends that the
subcommittee include report language directing the Secretary to provide
enhanced funding for the NHSC, as required under the Patient Protection
and Affordable Care Act.
Medical School Development
The President's fiscal year 2011 budget request included $100
million for the development of new medical schools in HPSAs. The grant
program would be administered by HRSA. The budget projected that these
funds would support approximately 20 grants for new academic health
centers to provide training and research in community-oriented
settings. The goal is to increase clinical training in HPSAs as well as
to increase the number of new providers who go on to practice in these
underserved areas. AACOM supports the appropriation of these funds at a
time when it is critical to support the training of new medical
students in order to ensure that Americans have access to care.
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. To maintain a robust research agenda,
further investment will be needed. AACOM recommends $35 billion in
fiscal year 2011 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 to continue
fulfilling this essential research role.
AHRQ
The 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 Patient Centered Health Research
Program in recent years, as well as the funding provided to AHRQ in the
ARRA, will help AHRQ generate more of this 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, especially research in patient safety and
prevention and care management research. AACOM recommends $611 million
in fiscal year 2011 for AHRQ, as requested by the President. 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.
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Prepared Statement of the American Association of Colleges of Pharmacy
AACP and its member colleges and schools of pharmacy appreciate the
continued support of the U.S. Senate Appropriations Subcommittee on
Labor, Health and Human Services, and Education, and Related Agencies.
Our Nation's 116 accredited colleges and schools of pharmacy are
engaged in a wide-range of programs supported by grants and funding
administered through the U.S. Department of Education and agencies of
the Department of Health and Human Services (HHS). We also understand
the difficult task you face annually in your deliberations to do the
most good for the nation and remain fiscally responsible to the same.
AACP respectfully offers the following recommendations for your
consideration as you undertake your deliberations.
u.s. 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 $5,710.
--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 $126 million.
AACP recommends a funding level of $160 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.
u.s. 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 $611 million
for AHRQ programs in fiscal year 2011.
Pharmacy facultyare strong partners with the Agency for Healthcare
Research and Quality (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.
Researchers, including faculty at the University of Illinois,
Chicago School of Pharmacy, supported through an AHRQ DEcIDE Network
contract determined that a specific drug triad regularly prescribed to
patients suffering from chronic obstructive pulmonary disease reduced
the risk of death. Researchers determined that other drug combinations
increased the risk of death. This research was published in the
Archives of Internal Medicine allowing for ready translation of this
life-saving knowledge into practice. AHRQ Contract Number 290-05-0038
Pharmacy faculty researchers at the University of Iowa, supported
by AHRQ grant HS018353-01, will seek to improve the quality of
medication therapy management programs (MTM) which is a mandated
service of the Medicare Part D benefit. This research will provide
additional guidance to CMS, PDPs, and other payers and organizations
interested in improving the quality of care provided to patients in
regard to their medications.
Centers for Disease Control and Prevention (CDC)
AACP supports the CDC Coalition recommendation of $8.8 billion for
CDC core programs in fiscal year 2011.
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.
Researchers at the University of Mississippi School of Pharmacy
will be supported in their work to develop and test new malaria drugs
by CDC grant 3U01CI000211-05S1.
Health Resources and Services Administration (HRSA)
AACP supports the Friends of HRSA recommendation of $8.5 billion
for fiscal year 2011.
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
AACP recommends a program funding of $5 million for fiscal year
2011 for the Office of Pharmacy Affairs.
AACP member institutions are actively engaged in Office of Pharmacy
Affairs (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 federal 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. The PPC provides services free-of-charge to the public and
health professionals 24 hours-a-day, 365 days-a-year. A recent USC
study found that for every $1 spent on the Palmetto Poison Center, more
than $7 were 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 $600 million for title VII and VIII
programs in fiscal year 2011.
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, University of
Montana). This program 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 necessary for the Institute of
Medicine's recommendations of improving quality through team-based,
patient-centered care.
______
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 continuing
investment in research through the American Recovery and Reinvestment
Act of 2009 (ARRA) and the fiscal year 2010 budget will support current
projects and provide for new efforts in the fight against cancer. These
new efforts are now underway and 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 uncover the discoveries today that will lead to
more lives saved 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 is occurring 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 strongly
support biomedical research funding at the National Institutes of
Health (NIH), including carrying out President Obama's vision for
doubling cancer research funding in order to find a cure for cancer in
our time. Therefore, the AACR supports the biomedical community's
recommendation of sustaining the current funding for NIH, which would
amount to $35.2 billion in fiscal year 2011.
AACR: Fostering a Century of Research Progress
AACR has been moving cancer research forward since its founding in
1907. Celebrating its 101st annual meeting in Washington, DC, this
April, the AACR and its more than 30,000 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 last century, 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 rare 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 2010. 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 is
essential to avoid this cancer crisis.
Blueprint for Progress: National Cancer Institute (NCI) Strategic
Objectives
Basic, translational, and clinical cancer research in this country
are conducted primarily through three venues--government, academia, and
the nonprofit sector--and the pharmaceutical/biotechnology industry.
The Congress provides the appropriations for 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 2011'' 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 $1.2 billion as proposed for
fiscal year 2011, the NCI will have the capability to rebuild America's
research infrastructure capacity and accelerate research progress in
critical priority areas:
--understanding the causes and mechanisms of cancer;
--accelerating progress in cancer prevention;
--improving early detection and diagnosis;
--developing effective and efficient treatments;
--understanding the factors that influence cancer outcomes;
--improving the quality of cancer care;
--improving the quality of life for cancer patients, survivors, and
their families; and overcoming cancer health disparities.
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. In more than half
the States, grants and contracts to institutions exceed $15 million.
This Federal investment also provides needed economic stimulus to local
economies. For example, on average, each $1 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 2010
appropriations and the ARRA funding 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 sustaining the current investment in the NCI with a budget of
$5.8 billion.
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.
Accelerating Progress in Cancer Prevention
Preventing cancer is far more cost-effective and desirable than
treating it. NCI's strategic plan supports research in: understanding
and modifying behaviors that increase risk; reducing the influence of
genetic and environmental risk factors; and interrupting the initiation
of cancer through early medical intervention. A critical component of
this multifaceted approach is ensuring that evidence-based advances
that have been shown to inform and motivate people toward healthy
behaviors are widely disseminated and accessible.
The NCI uses multidisciplinary teams and a systems biology approach
to identify early events and determine how to modify them. More than
half of all cancers are related to modifiable behavioral factors,
including tobacco use, diet, physical inactivity, sun exposure, and
failure to get cancer screenings. The NCI supports research to
understand how people perceive risk, make health-related decisions, and
maintain healthy behavior. Prevention is the keystone to success in the
battle against cancer.
Developing Effective and Efficient Treatments
The future of cancer care is all about developing individualized
therapies tailored to the specific characteristics of a patient's
cancer. The NCI's 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 and breakthroughs resulting
from The Cancer Genome Atlas project are leading the way toward an era
of personalized medicine.
Overcoming Cancer Health Disparities
Some minority and underserved population groups suffer
disproportionately from cancer. Solving this issue will contribute
significantly to reducing the cancer burden. The NCI's investments in
this area include: studying the factors that cause cancer health
disparities; working with underserved communities to develop targeted
interventions; developing the knowledge base for integrating cancer
services to the underserved; collaborating to implement culturally
appropriate information dissemination approaches to underserved
populations; and examining the role of health policy in eliminating
cancer health disparities. One size does not fit all in cancer research
special populations require special treatment to achieve success.
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 support 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 the AACR Chemistry in Cancer Research
Working Group;
--convening and supporting the AACR-FDA-NCI Cancer Biomarkers
Collaborative;
--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; and
--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 $228 billion in
direct medical costs and lost productivity due to illness and premature
death. Respected University of Chicago economists Kevin Murphy and
Robert Topel have estimated that even a modest 1 percent reduction in
mortality from cancer would be worth nearly $500 billion in social
value. In addition, investments in cancer research stimulate the local
economy today and promise 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, AACR urges the
United States House of Representatives to support a budget of $35.2
billion for the NIH, including $5.8 billion for NCI.
______
Prepared Statement of the American Association for Dental Research
Introduction
Mr. Chairman and members of the subcommittee, I am David Wong,
Director of the Dental Research Institute at the University of
California, Los Angeles (UCLA) School of Dentistry. My testimony is on
behalf of the American Association for Dental Research (AADR).
I thank the subcommittee for this opportunity to testify about the
exciting advances in oral health science. Research funded by the
National Institutes of Health (NIH) has returned significant dividends
in terms of 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). Since 1948, NIDCR has
conducted research, trained researchers, and disseminated health
information in order to improve the health of Americans and make it
possible for them to live longer and healthier lives.
What Is the American Association for Dental Research?
The AADR, headquartered in Alexandria, Virginia, is a nonprofit
organization with more than 4,000 individual members and 100
institutional members within the United States. Its mission is: (1) to
advance research and increase knowledge for the improvement of oral
health; (2) to support and represent the oral health research
community; and (3) to facilitate the communication and application of
research findings. AADR is the largest Division of the International
Association for Dental Research.
Why Oral Health Is Important
Oral health is an essential component of health throughout life.
Poor oral health and untreated oral diseases and conditions can have a
significant impact on quality of life. They can affect the most
significant human needs including the ability to eat and drink,
swallow, maintain proper nutrition, smile, and communicate.
Over the past 50 years, there has been a dramatic improvement in
oral health. Still, oral diseases remain a major concern. Oral health
and general health are inseparable. Diseases and conditions of the
mouth have a direct impact on the health of the entire body.
Good oral health can help improve birth outcomes, keep children
from developing painful cavities and prevent seniors, and those with
chronic health conditions, from developing life-threatening
complications. In recent years, new scientific reports have linked poor
oral health to poor general health. Dental decay (cavities) is one of
the most common chronic illnesses among children. Although most dental
diseases are preventable, many children unnecessarily suffer from
dental disease because of inadequate home care and lack of access to
dental services. An estimated 51 million school hours per year are lost
in the United States because of dental-related illness. Poor oral
health has been related to decreased school performance, poor social
relationships, and less success later in life.
Employed adults in the United States lose more than 164 million
hours of work each year as a result of oral health problems or dental
visits. About 30 percent of adults 65 years old and older have lost all
of their natural teeth. Older Americans with the poorest oral health
are those who are economically disadvantaged, lack insurance, and are
members of racial and ethnic minorities.
As the Nation ages, oral health issues related to gum disease and
the impact of medical treatments and medicines will increase.
Maintaining good oral health throughout a person's life is important.
Research Accomplishments
Oral and Systemic Health.--The oral cavity plays an important role
in the overall health of the body. Some say the mouth is the body's
mirror. And while associations between oral and systemic health can be
made, specific cause-and-effect relationships remain elusive. It has
been reported that 3 out of every 4 Americans have signs of mild
periodontal disease. Almost 30 percent show signs of the more severe
disease, chronic periodontitis. We now have reason to believe that the
health of your teeth and gums may have a significant effect on the
overall health of your body. Recent scientific literature suggests a
strong relationship between oral disease and other systemic diseases
and medical conditions.
According to numerous studies, there are three ways oral disease
may affect your overall health. First, bacteria from your gums enter
the saliva. From the saliva it may adhere to water droplets within the
air you inhale each time you breathe. These bacteria laden water
droplets may be aspirated into the lungs, potentially causing pulmonary
infection and pneumonia. This can be a serious problem for the elderly
or those who may suffer from generalized weakened immunity, associated
with chronic obstructive pulmonary disease (COPD). Inflammatory
mediators found in inflamed gums called ``cytokines'' can also enter
your saliva.
Secondly, bacteria associated with periodontal disease can enter
the body's circulatory system through the gums (periodontium) around
teeth and travel to all parts of the body. As the oral bacteria
travels, it may cause secondary infections or it may contribute to the
disease process in other tissues and organ systems.
Finally, inflammation associated with periodontal disease may
stimulate a second systemic inflammatory response within the body and
contribute to or complicate other disease entities that may have an
inflammatory origin such as, cardiovascular disease, diabetes, and
kidney disease.
The goal of many studies being conducted at dental schools and
research centers throughout the world is to understand just how oral
bacteria affect overall health. As these studies are published,
healthcare professionals will begin to better understand the underlying
biological mechanisms that are responsible for this oral systemic
connection.
Health Disparities.--Despite remarkable improvements in the oral
health of many, not everyone in the nation has benefited equally. Oral,
dental, and craniofacial conditions remain among the most common health
problems for low-income, racial/ethnic minority, disadvantaged,
disabled, and institutionalized individuals across the life span.
Dental caries, periodontal diseases, and oral and pharyngeal cancer are
of particular concern.
The NIDCR Health Disparities Research Program supports studies
that:
--Provide a better understanding of the basis of health disparities
and inequalities;
--Develop and test interventions tailored and targeted to underserved
populations; and
--Explore approaches to the dissemination and implementation of
effective findings to assure rapid translation into practice,
policy and action in communities.
The NIDCR supports:
--Research that seeks to understand a broadened array of determinants
of disparities/inequalities in oral health status and care at
multiple levels;
--Interventional research designed to have a meaningful impact on
oral health status and quality of life that will influence
action in healthcare, public policy, or diseases/disability
prevention in communities;
--Cost analyses of interventions as well as comparative effectiveness
studies;
--Behavioral and social science intervention research that is
grounded in theory and considers mechanisms of action;
--Research that utilizes new technologies and approaches that are
practical, culturally appropriate and sustainable for
individuals, caregivers, and workers.
--Novel interventions as well as those that have previously been
untested with vulnerable populations.
Researchers from many backgrounds and disciplines contribute to
health disparities/inequalities research. Some of the disciplines of
researchers on health disparities/inequalities research teams are
genetics, dentistry and dental hygiene, and medicine and nursing. Teams
that conceptualize, plan and conduct this type of research include
community members of the disadvantaged and vulnerable population
subgroups as partners in the research enterprise.
Salivary Diagnostics.--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 years of research, saliva is poised to be used as a noninvasive
diagnostic fluid for a number of oral and systemic conditions. Salivary
diagnostics has come of age. In just a little more than 6 years,
research supported by the NIDCR has sprung to the forefront of basic,
translational, and clinical research.
Saliva not only combats bacteria and viruses that enter the mouth,
but it also 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 altered in the presence of a disease. Saliva is very easy to
collect, providing a major advantage over the use of blood or urine for
diagnostic tests. Saliva has the same biomarkers found in blood and
urine.
Oral cancer affects 38,000 Americans each year. The death rate
associated with this cancer is especially high due to delayed
diagnosis. Saliva is not only more accurate than blood for oral cancer
detection, but saliva diagnostics will likely outperform other biomedia
for other disease diagnostics as well. The risk of oral cancer,
prostate cancer, breast cancer, and a host of other health conditions
can be determined and often prevented when acting on information
provided from a saliva hormonal assay. Saliva tests could prove to be a
potentially life-saving alternative to detect diseases where early
diagnosis is critical, such as certain cancers. For most cancers,
successful treatment depends on early detection and successful
prevention depends on the accurate evaluation of risk. Early detection
of oral cancer will increase survival rate, improve the quality of life
of cancer patients, and will result in a significant reduction in
healthcare costs.
Conclusion
As you can see, Mr. Chairman, 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 NIDCR in
particular, is essential for continued improvement in the oral health
of Americans.
In order to sustain momentum in the field of oral and systemic
health, health disparities, and salivary diagnostics, it is requested
that NIH receive a fiscal year 2011 appropriation of $35 billion, of
which NIDCR should receive an fiscal year 2011 appropriation of $481
million.
Thank you for the opportunity to testify.
______
Prepared Statement of the American Academy of Family Physicians
As one of the largest national medical organizations, representing
94,700 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 continue its
commitment to title VII in fiscal year 2011 and increase funding for
other key Health Resources and Services Administration programs to
allow health reform to succeed. We also recommend increased funding for
the Agency for Healthcare Research and Quality to provide better
healthcare all.
health resourses and services administration
The Patient Protection and Affordable Care Act (Public Law 111-148)
holds the promise of health security for Americans and moves us toward
genuine health system reform, but it will require the support of this
subcommittee to invest in the necessary primary care physician
workforce. Primary care physicians will serve as a strong foundation
for a more efficient and effective healthcare system. We are pleased
that the health reform law reauthorizes the title VII health
professions programs including the grants for the education and
training of primary care physicians under title VII, section 747.
Workforce Shortages
Successful implementation of health reform requires an investment
to strengthen our Nation's primary care workforce. The current national
primary care physician workforce of just more than 200,000 is estimated
to be 8,000-10,000 lower than projected demand based on adjusted
average population utilization patterns, according to the Robert Graham
Center for Policy Studies in Family Medicine and Primary Care. However,
distribution is not equitable leaving many areas with physician
shortages, especially in rural and underserved communities with
measurable social deprivation.
In the coming years, medical services utilization is likely to rise
given the increasing and aging population as well as the insured status
of more of the populace. Those demographic trends will cause primary
care physician shortages to worsen. By 2025, the current downturn in
primary care physician production is expected to yield a workforce 28.5
percent below need based on current practice models or 50 percent below
the level needed to provide all Americans with a patient-centered
medical home.
The recently enacted health reform legislation includes a number of
provisions to increase the primary care workforce. It amends and
expands many of the existing health workforce programs authorized under
title VII (health professions) and makes a number of changes to
Medicare graduate medical education (GME) payments to teaching
hospitals, in part to encourage the training of more primary care
physicians. The new law also establishes a national commission to study
projected health workforce needs and make appropriate recommendations.
Increasing the level of Federal funding for primary care training would
reinvigorate medical education, residency programs, as well as academic
and faculty development in primary care to prepare physicians to
support the patient centered medical home.
This subcommittee has demonstrated its commitment to a strong
primary care workforce by doubling the appropriation for training under
title VII section 747 of the Public Health Services Act in the American
Recovery and Reinvestment Act of 2009 (Public Law 111-5).
The AAFP urges the subcommittee to provide a fiscal year 2011
appropriation of $170 million for the title VII section 747 Primary
Care Training and Enhancement and the Integrative Academic
Administrative Units programs as authorized by the Patient Protection
and Affordable Care Act. We also recommend an appropriation of at least
$600 million for all of the Health Professions Training Programs
authorized under title VII of the Public Health Services Act.
Rural Health Needs
Physician shortages are harder for Americans in rural areas who
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.
We were pleased that title VII, section 749B, the ``Rural Physician
Training Grants'' program, was enacted to help medical schools to
recruit students most likely to practice medicine in underserved rural
communities, provide rural-focused training and experience, and
increase the number of recent medical school graduates who practice in
underserved rural communities.
Family physicians provide the majority of care for America's
underserved and rural populations.\1\ 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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\1\ 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.
The AAFP requests that the Committee provide $4 million in fiscal
year 2011 for title VII section 749B Rural Physician Training Grants.
The AAFP also encourages the subcommittee to provide $176 million for
the programs administered by HRSA's Office of Rural Health to address
the many unique health service needs of rural communities.
Teaching Health Centers
The AAFP supported the authorization in the health reform
legislation of the innovative Teaching Health Centers program under
title VII section 749A to increase primary care physician training
capacity. Federal financing of graduate medical education has led to
training which occurs mainly in hospital inpatient settings in spite of
the fact that most patient care is delivered outside of hospitals in
ambulatory settings across the Nation. As a result, we have been
training physicians using experiences which poorly prepare them to
practice primary care in the community outside the hospital.
The Teaching Health Center program will train primary care
residents in nonhospital settings where most primary care is delivered.
A Teaching Health Center can be any community based ambulatory care
setting that operates a primary care residency program including
Federally Qualified Health Centers or Federally Qualified Health
Centers Look Alikes, Rural Health Clinics, Community Mental Health
Centers, a Health Center operated by the Indian Health Service, or a
center receiving title X grants.
We were pleased that the Patient Protection and Affordable Care Act
authorized a mandatory appropriations trust fund of $230 million over 5
years to fund the operations of Teaching Health Centers. However, if
this program is to be effective, there must be funds for the planning
grants to establish newly accredited or expanded primary care residency
programs.
The AAFP recommends that the subcommittee appropriate the full
authorized amount for the new title VII Teaching Health Centers
development grants of $50 million for fiscal year 2011.
National Health Service Corps
The National Health Services Corps (NHSC) has long served to
provide access to healthcare to underserved Americans and offer
incentives for practitioners to enter primary care. NHSC also provides
important student debt relief for new physicians.
Student debt was found to be a significant barrier to the
production of primary care physicians by a report published in March
2009, by the Graham Center with the support of the Macy Foundation.\2\
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. We recognize that this subcommittee provided an increase
for the NHSC in the American Recovery and Reinvestment Act, and we
commend Congress for increasing the authorization level for the NHSC in
the new health reform law.
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\2\ The Robert Graham Center. Specialty and Geographic Distribution
of the Physician Workforce: What Influences Medical Student & Resident
Choices? March 2, 2009.
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The AAFP recommends that the National Health Service Corps receive
$414.1 million in fiscal year 2011 as authorized in the Patient
Protection and Affordable Care Act which makes $290 million of that
amount available from a fund created in section 10503.
Workforce Commission
The AAFP has called for a commission on national health workforce
issues which represents the multiple stakeholders and reports to
Congress and the Executive Branch as appropriate. We were pleased that
the health reform bill established a National Health Care Workforce
Commission to provide ``analysis of, and recommendations for,
eliminating the barriers to entering and staying in primary care,
including provider compensation.'' We also recognize the importance of
the National Center for Health Care Workforce Analysis as well as State
and Regional Centers for such analysis. The legislation authorized such
sums as necessary to establish the Commission as well as $8 million in
planning grants and $150 million for implementation grants. The
National Center was authorized at $7.5 million annually and the State
and Regional Centers were authorized at $4.5 million annually.
The AAFP recommends that the subcommittee fully fund the National
Health Care Workforce Commission, the National and State and Regional
Centers for Health Care Workforce Analysis in fiscal year 2011.
agency for heatlhcare research and quality
To assure the success of health reform, we must also focus on
paying for quality rather than quantity. The mission of the Agency for
Healthcare Research and Quality (AHRQ)--to improve the quality, safety,
efficiency, and effectiveness of healthcare for all Americans--closely
mirrors the 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 patient-centered, comparative
effectiveness research.
Primary Care Extension Program
The AAFP commends the Congress for authorizing in the Patient
Protection and Affordable Care Act a Primary Care Extension Program to
be administered by AHRQ to provide support and assistance to primary
care providers about evidence-based therapies and techniques so that
providers can incorporate them into their practice. Family physicians
Kevin Grumbach, MD and James W. Mold, MD, MPH recognized that small
primary care practices need a similar kind of support offered by the
Federal Government to farms by the Cooperative Extension Service to
implement innovation and best practices.\3\
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\3\ Grumbach K, Mold JW. A Health Care Cooperative Extension
Services: Transforming Primary Care and Community Health. JAMA, June
24, 2009--Vol. 301, No. 24.
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The AAFP requests that the subcommittee provide $731 million for
AHRQ in fiscal year 2011 to provide for the funding requested by the
President's budget request of $611 million as well as the important new
Primary Care Extension program authorized by the health reform law at
$120 million.
______
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 2011 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
The aging of the baby boomer generation will result in an increase
in the proportion of persons older than 65 from 12.7 percent currently
to 20 percent in 2030, with the fastest growing segment of the
population consisting of age 85 and older. During the same period, the
number of older adults with major psychiatric illnesses will more than
double, from an estimated 7 million to 15 million individuals, meeting
or exceeding the number of consumers in discrete, younger age groups.
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 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. AAGP
is deeply grateful to this subcommittee and its House counterpart for
providing, in the appropriations bill for fiscal year 2010, funding for
a follow-up study of the current and projected mental and behavioral
healthcare needs of the American people, particularly for aging and
growing ethnic populations. This study, first proposed by Senator Kohl
in the Retooling the Health Care Workforce for an Aging America Act (S.
245), will complement the 2008 IOM study in providing in-depth
consideration of the mental health needs of geriatric and ethnic
minority populations that were precluded by the broad scope of the
earlier one.
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.
Already, there are programs administered by the Bureau of Health
Professions in the HHS Health Resources and Services Administration
administers that are aimed to help to assure adequate numbers of
healthcare practitioners for the Nation's geriatric population,
especially in underserved areas. The breadth of these programs has been
strengthened by provisions from S. 245 included in the recently enacted
Patient Protection and Affordable Care Act (PPACA).
The geriatric health professions program supports these important
initiatives:
--The Geriatric Education Center (GEC) program provides
interdisciplinary training for healthcare professionals in
assessment, chronic disease syndromes, care planning, emergency
preparedness, and cultural competence unique to older
Americans. PPACA authorizes $10.8 million in supplemental
grants for the GEC Program to support training in geriatrics,
chronic care management, and long-term care for faculty in a
broad array of health professions schools, as well as direct
care workers and family caregivers. GECs receiving these grants
are required to develop and include material on depression and
other mental disorders common among older adults, medication
safety issues for older adults, and management of the
psychological and behavioral aspects of dementia in all
appropriate training courses.
--The Geriatric Training for Physicians, Dentists, and Behavioral and
Mental Health Professionals 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 geriatric specialists in junior faculty
positions who are committed to teaching geriatrics in
professional schools. PPACA expands the disciplines eligible
for the awards. GACA recipients are required to provide
training in clinical geriatrics, including the training of
interdisciplinary teams of healthcare professionals.
--PPACA authorized a new Geriatric Career Incentive Awards Program in
title VIII of the Public Health Service Act for grants to
foster great interest among a variety of health professionals
in entering the field of geriatrics, long-term care, and
chronic care management. This program was authorized for $10
million over 3 years.
--A new program, authorized by PPACA at $10 million for 3 years, will
provide advanced training opportunities for direct care workers
in the field of geriatrics, long-term care or chronic care
management.
AAGP strongly supports increased funding for the existing programs,
particularly as the disciplines included have been expanded, and
funding to fully authorized levels for the new programs.
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,
$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.
AAGP believes that it is critical that NIH begin to invest
increased funding in future evidence-based treatments for our Nation's
elders. 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.
Study on NIH Funding for Mental Disorders among Older
Adults
As little emphasis has been placed on the development of new
treatments for geriatric mental disorders, AAGP encourages 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 Accountablity Office (GAO) study
on spending by NIH on conditions and illnesses related to the mental
health of older individuals. 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
It is critical that there be adequate funding for the mental health
initiatives under the jurisdiction of the Center for Mental Health
Services (CMHS) within the Substance Abuse and Mental Health Services
Administration (SAMHSA). While research is of critical importance to a
better future, today's patients must also receive appropriate treatment
for their mental health problems.
Evidence-based Mental Health Outreach and Treatment for the
Elderly
For the last 8 years $5 million has been allocated for evidence-
based mental health outreach and treatment to the elderly. AAGP urges
an increase in funding from $5 million to $10 million for this
essential program to disseminate and implement evidence-based practices
in routine clinical settings across the States.
Centers of Excellence for Depressive and Bipolar Disorders
PPACA also included authorization for a new national network of
centers of excellence for depressive and bipolar disorders, which will
enhance the coordination and integration of physical, mental and social
care that are critical to the identification and treatment of
depression and other mental disorders across the lifespan. The work of
these centers will help to disseminate and implement evidence-based
practices in clinical settings throughout the country. AAGP strongly
supports funding for the centers authorized by this legislation.
Conclusion
AAGP recommends:
--Increased funding for the geriatric health professions education
programs under title VII of the Public Health Service Act and
full funding for new programs authorized by the PPACA;
--Funding to support clinical trials involving older adults;
--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;
--Funding for Centers of Excellence for Depressive and Bipolar
Disorders.
______
Prepared Statement of the American Association of Immunologists
The American Association of Immunologists (AAI), a not-for-profit
professional association representing more than 6,500 of the world's
leading experts on the immune system, appreciates having this
opportunity to submit testimony regarding fiscal year 2011
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.\1\ With more than 80 percent of the $30.5 billion budget
awarded to scientists in communities throughout the United States and
around the world, NIH funding advances not only immunological and
biomedical research, but also regional and national economies by
creating and supporting skilled jobs that are focused on improving
human health.\2\
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\1\ AAI members receive grants from the National Institute of
Allergy and Infectious Diseases (NIAID), the National Cancer Institute;
the National Institute on Aging, and the National Institute of
Arthritis and Musculoskeletal and Skin Diseases, but may also receive
grants from other NIH Institutes and 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.''
See http://www.nih.gov/about/budget.htm (2/8/10).
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The Immune System's Wide Reach
Influenza, HIV/AIDS, malaria, tuberculosis, salmonella, the common
cold, and more--all are infectious diseases that challenge and
sometimes overcome the defenses mounted by the immune system. Chronic
diseases like cancer, diabetes, multiple sclerosis, rheumatoid
arthritis, asthma, inflammatory bowel disease, and lupus, are either
caused by--or due in large part to--an overactive or underactive immune
response.\3\ Scientists' discovery of ways to prevent, diagnose, and
treat these diseases depends on increased knowledge in the field of
immunology.\4\ Important new challenges require understanding the
immune response to: (1) pathogens that threaten to become the next
pandemic,\5\ (2) man-made and natural infectious organisms that are
potential agents of bioterrorism (including plague, smallpox, and
anthrax),\6\ and (3) environmental threats. The immune system,
therefore, plays a crucial role in preserving human and animal health
\7\ and increasingly--in our fast-paced, interconnected world--ensuring
both community and global health.
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\3\ The immune system works by recognizing and attacking 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 destroying the virus,
bacterium, or tumor cell--or partially, resulting in a less serious
illness. It is also responsible for the rejection response following
transplantation of organs or bone marrow. The immune system can also
malfunction, causing the body to attack itself, resulting in an
``autoimmune'' disease, such as Type 1 diabetes, multiple sclerosis,
lupus or rheumatoid arthritis.
\4\ Although the first vaccine (against smallpox) was developed in
1798, most of our basic understanding of the immune system has
developed in the last 30-40 years, making immunology ripe for new
discoveries.
\5\ While researchers and public health professionals must respond
to emergent threats, 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, and
seeking optimized flu vaccines and delivery methods.
\6\ 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.
\7\ Research on the immune system leads to new vaccines/treatments
for pets and livestock, and improves our understanding of animal to
human transmission [as, for example, with H1N1 influenza (``swine
flu'')].
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Recent Advances in Immunological Research
Knowledge of the intricacies of the immune system has led to
unprecedented medical advances such as successful organ
transplantation, new vaccines, and better treatments. Recent
immunological advances may further yield profound improvements for
people afflicted with debilitating diseases. One such advance involves
lupus, a serious chronic autoimmune disease affecting some 1.5 million
Americans.\8\ Exciting recent results from the largest clinical trials
yet performed have opened the door for the first new drug for effective
lupus treatment in 50 years. These trials show that a new type of
therapeutic that inactivates the natural molecule ``BLyS'' results in
substantial disease reduction in lupus patients. Both the discovery of
BLyS and the development of novel effective treatments are a product of
decades of basic immunology research by scientists supported by NIH and
other nonprofit organizations.
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\8\ See http://www.lupusresearch.org/about/press-room/press-
releases/new-study-findings-represent.html.
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An advance with international importance was the successful
response of the biomedical research community to the 2009 swine flu/
H1N1 influenza outbreak. Researchers working against time were able to
develop an effective vaccine within 4 months after the first U.S. case
was diagnosed on April 13, 2009 \9\. This success depended on years of
comprehensive basic research on the immune and viral systems, including
the ability to identify the molecular DNA sequence of the virus
necessary to produce a vaccine. This provided an excellent ``test run''
for a future pandemic of even more significant public health
concern,\10\ and demonstrated a successful collaboration among basic
and translational scientists, clinical practitioners, and
pharmacological companies against an infectious disease pandemic.
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\9\ See http://www3.niaid.nih.gov/about/directors/pdf/
110409NIAIDStatementLHHSH1N1.pdf. On 7/22/09, NIAID reported the launch
of clinical trials on two candidate H1N1 vaccines in adults (see http:/
/www.nih.gov/news/health/jul2009/niaid-22.htm). On 8/18, NIAID
announced it would begin trials in children (see http://
www3.niaid.nih.gov/news/newsreleases/2009/H1N1pedvax.htm). The Food and
Drug Administration approved a vaccine on 9/15; it was made publicly
available on 10/5 (see http://www3.niaid.nih.gov/about/directors/pdf/
110409NIAIDStatementLHHSH1N1.pdf).
\10\ A pandemic can be mild or serious. Seasonal influenza, which
may or may not lead to a pandemic, results in 200,000 hospitalizations
and 36,000 deaths nationwide in an average year. A serious influenza
pandemic could result in the hospitalization of nearly 10 million
Americans and the death of almost 2 million, at a projected cost of
over $680 billion. (See ``Pandemic Influenza: Warning, Children At-
Risk,'' Trust for America's Health, 10/07, at http://
healthyamericans.org/reports/fluchildren/KidsPandemicFlu.pdf).
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Another advance involves the successful use of new and improved
technologies to identify all the human genes stimulated by a vaccine,
in this case, the Yellow Fever vaccine.\11\ This was the first time
scientists could determine how different individuals immunized with the
same vaccine responded on a molecular level; this approach will
significantly enhance our ability to determine how effective vaccines
stimulate protective responses and may lead the way to customize
vaccines to be more effective for the individual.
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\11\ Published in Nature Immunology, Jan. 10, 2009, pp. 116-25,
from the laboratory of B. Pulendran.
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The NIH Budget: Building on a Strong Start
AAI greatly appreciates the strong support of this subcommittee for
medical research, from doubling the NIH budget (fiscal year 1999 to
fiscal year 2003), to passing the fiscal year 2009 and 2010
Appropriations Acts, to including in the ``American Recovery and
Reinvestment Act of 2009'' (ARRA) a $10.4 billion supplemental
appropriation for NIH. ARRA underscored both the President's and
Congress's realization that investing in biomedical research would not
only improve individual and global health, but also stimulate economic
activity and job creation: NIH has estimated that each NIH grant
supports, on average, ``6 to 7 in-part or full scientific jobs,'' \12\
while Families USA, a nonprofit consumer organization, has found that,
on average, each $1 of NIH funding going into a State generates more
than twice as much in State economic output.\13\
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\12\ Testimony of Raynard S. Kington, M.D, Ph.D., Acting Director,
National Institutes of Health, Witness appearing before the House
Subcommittee on Labor-HHS-Education Appropriations, March 26, 2009.
\13\ ``In Your Own Backyard: How NIH Funding Helps Your State's
Economy,'' Families USA (June 2008).
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As a result of this generous infusion of funds, NIH has also been
able to fund many excellent, innovative projects with great promise for
advancing human health, and to invest in modernizing the Nation's
research infrastructure. And while AAI--and the biomedical research
community--are deeply grateful for these funds, AAI is concerned that
imminent advances may not come to fruition if the fiscal year 2011
appropriations level fails to acknowledge the crucial role that ARRA
funding now plays within the NIH budget. The AAI funding recommendation
for fiscal year 2011 is premised on that concern and designed to
address that future.
AAI Recommendation for NIH Funding for Fiscal Year 2011: Achieving the
President's Vision
Although President Obama's proposed fiscal year 2011 budget of
$32.2 billion, a 3.2 percent increase over the regular fiscal year 2010
appropriations level, is a good next step toward achieving the
President's vision that ``investments in research will improve and save
countless lives for generations to come . . .,'' \14\ it will not
ensure that important ongoing research currently funded by combined
regular and supplemental (ARRA) appropriations is not interrupted,
suspended or delayed. AAI urges the subcommittee to provide NIH with a
fiscal year 2011 budget of $37 billion to preserve ongoing research and
to enable NIH to grow modestly from its 2009 and 2010 program levels of
$35 billion.\15\ Such a budget would also provide NIH with
predictable, sustained funding that stabilizes ongoing research
projects and the overall research enterprise, inspiring many of our
brightest young students to pursue careers in biomedical research.\16\
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\14\ See http://www.whitehouse.gov/blog/09/09/30/
An_Historic_Commitment_to_Research.
\15\ After adding an increase for the projected rate of biomedical
research inflation (3.2 percent), and (2) a modest increase for growth
(2.5 percent), the total increase requested above the fiscal year 2010
program level is 5.71 percent.
\16\ Presidential candidate Barack Obama acknowledged that
``Sustained and predictable increases in research funding will allow
the United States to . . . provide greater support for . . . young
scientists at the beginning of their careers.'' (See http://
www.sciencedebate2008.com/www/index.php?id=42) (8/30/08).
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NIH Research Priorities for Fiscal Year 2011
AAI is concerned that the President's proposed budget focuses
primarily on large-scale, trans-NIH initiatives, at the expense of
investigator-initiated research, a proven route to medical advancement.
In fact, the fiscal year 2011 budget decreases the number of competing
Research Project Grants by 199. AAI urges that the budget support the
NIH Director's stated commitment to individual investigator-initiated
research. In addition, AAI supports the proposed 6 percent increase for
the Ruth Kirschstein National Research Service Awards, a long-needed
training stipend increase for the young scientists who are the next
generation of research leaders. AAI also supports the President's
request for $300 million for the Global Fund to Fight AIDS,
Tuberculosis, and Malaria--infectious diseases which devastate people
and communities worldwide.
Preserving High-quality Peer Review
Peer review is at the heart of the many decades of successful
biomedical research in the United States; the NIH peer review system is
internationally respected and highly successful. NIH is currently
implementing dramatic changes intended to improve its system. Although
AAI supports NIH's effort to address legitimate problems, AAI is
concerned that some of the changes have harmed the peer review system,
its reviewers, and its applicants, and believes that independent
oversight and evaluation is urgently needed.
The NIH Common Fund
AAI is concerned that the proposed increase of $17.5 million for
the NIH Common Fund (CF), which supports trans-NIH initiatives, may
over-emphasize large-scale, multi-disciplinary initiatives, as compared
with entrepreneurial investigator-initiated approaches. Although AAI
recognizes the value of interdisciplinary research, the CF should not
permit the funding less well regarded 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 so that individual researchers, who drive American
scientific advancement, are not marginalized.
NIH Operations and Oversight
AAI strongly supports the President's request for $1.525 billion
for the NIH Research, Management, and Services account, which supports
the management, monitoring, and oversight of all research activities.
NIH must have adequate resources to supervise and oversee its
increasingly large and complex portfolio.
The NIH Public Access Policy
AAI requests that the subcommittee require NIH to publicly report
on the cost of the NIH Public Access Policy (Policy), including the
cost of implementing the voluntary Policy (May 2, 2005-January 11,
2008); the mandatory Policy (fiscal year 2009 and fiscal year 2010);
and the Policy in fiscal year 2011 (projected cost). AAI believes that
the Policy duplicates publications and services which are already
provided cost-effectively and well by the private sector. The private
sector, including not-for-profit scientific societies, already
publishes--and makes publicly available--thousands of scientific
journals (and millions of articles) that report cutting-edge research
funded by NIH and other entities. AAI urges that, rather than
supporting a Government bureaucracy that competes with private
publishers, NIH should partner with publishers to enhance public access
while addressing publishers' key concerns, including respecting
copyright law and ensuring journals' continued ability to provide
quality, independent peer review of NIH-funded research.
Conclusion
AAI thanks the subcommittee for its strong support for biomedical
research, the NIH, and the biomedical researchers who devote their
lives to scientific discovery and the prevention, treatment, and cure
of disease.
______
Prepared Statement of the Association of American Medical Colleges
The Association of American Medical Colleges (AAMC) is a not-for-
profit association representing all 131 accredited U.S. medical
schools; nearly 400 major teaching hospitals and health systems; and
nearly 90 academic and scientific societies. Through these institutions
and organizations, the AAMC represents 128,000 faculty members, 75,000
medical students, and 110,000 resident physicians. The association
appreciates the opportunity to address four programs that play critical
roles in assisting medical schools and teaching hospitals to fulfill
their missions of education, research, and patient care: the National
Institutes of Health (NIH); the Agency for Healthcare Research and
Quality (AHRQ); health professions education funding through the Health
Resources and Services Administration (HRSA)'s Bureau of Health
Professions; and the National Health Service Corps (NHSC). The AAMC
thanks the Subcommittee for its steadfast support of these programs.
National Institutes of Health (NIH).--The AAMC believes that the
NIH is one of the Nation's greatest achievements. The Federal
Government's unwavering support for medical research through the NIH
has created a scientific enterprise that is the envy of the world and
has contributed greatly to improving the health and well-being of all
Americans--indeed of all humankind.
The AAMC supports the Obama administration's proposal to increase
funding for NIH to $32 billion in fiscal year 2011. Boosting NIH's
funding to a level that keeps pace with biomedical inflation recognizes
the need for continued, predictable growth in the Nation's medical
research effort. At a time when the Nation faces extraordinary fiscal
challenges, the President's commitment to medical research is a wise
investment that will yield long-term benefits for our Nation's health.
The partnership between NIH and America's medical schools and teaching
hospitals continues to serve as the engine for this Nation's search for
an ever-greater understanding of the mechanisms underlying human health
and disease. The foundation of scientific knowledge that continues to
be built through NIH-funded research drives medical innovation that
improves health and quality of life through new and better diagnostics,
improved prevention strategies, and more effective treatments.
For example, a new ability to comprehend the genetic mechanisms
responsible for disease is already providing insights into diagnostics
and identifying a new array of drug targets. We are entering an era of
personalized medicine, where prevention, diagnosis, and treatment of
disease can be individualized, instead of using the standardized
approach that all too often wastes healthcare resources and potentially
subjects patients to unnecessary and ineffective medical treatments and
diagnostic procedures.
Peer-reviewed, investigator-initiated basic research is the heart
of NIH research. These inquiries into the fundamental cellular,
molecular, and genetic events of life are essential if we are to make
real progress toward understanding and conquering disease. Additional
funding is needed to sustain and enhance basic research activities,
including increasing support for current researchers and promoting
opportunities for new investigators and in those areas of biomedical
science that have historically been underfunded.
The application of the results of basic research to the detection,
diagnosis, treatment, and prevention of disease is the ultimate goal of
medical research. Clinical research not only is the pathway for
applying basic research findings, but it often provides important
insights and leads to further basic research opportunities. The AAMC
supports additional funding for the continued expansion of clinical
research and clinical research training opportunities, including
rigorous, targeted postdoctoral training; developmental support for new
and junior investigators; and career support for established clinical
investigators, especially to enable them to mentor new investigators.
Anecdotal evidence suggests that changes in healthcare delivery
systems and other financial factors pose a serious threat to the
research infrastructure of America's medical schools and teaching
hospitals, particularly for clinical research. The AAMC supports
efforts to enhance the research infrastructure, including resources for
clinical and translational research; instrumentation and emerging
technologies; and animal and other research models.
The AAMC supports efforts to reinvigorate research training,
including developing expanded medical research opportunities for
minority and disadvantaged students. For example, the volume of data
being generated by genomics research, as well as the increasing power
and sophistication of computing assets on the researcher's lab bench,
have created an urgent need, both in academic and industrial settings,
for talented individuals well-trained in biology, computational
technologies, bioinformatics, and mathematics to realize the promise
offered by modern interdisciplinary research.
The AAMC is heartened by the administration's proposals to provide
a 6 percent stipend increase for predoctoral and postdoctoral research
trainees supported by NIH's Ruth L. Kirschstein National Research
Service Awards program. These stipend increases are necessary if
medical research is to remain an attractive career option for the
brightest U.S. students. Attracting the most talented students and
postdoctoral fellows is essential if the United States is to retain its
position of world leadership in biomedical and behavioral research.
As President Obama noted in his State of the Union address, ``We
need to encourage American innovation.'' Research conducted and
supported by NIH has played a major role in the development of the
biotechnology, pharmaceutical, and medical device industries and
continues to provide the basis for their continued success. Sustaining
this Nation's investment in medical research will continue to
strengthen our Nation's economic health by creating skilled and high-
paying jobs, new products and industries, and improved technologies.
Agency for Healthcare Research and Quality.--Complementing the
medical research supported by NIH, AHRQ sponsors health services
research designed to improve the quality of healthcare, decrease
healthcare costs, and provide access to essential healthcare services
by translating research into measurable improvements in the healthcare
system. The AAMC firmly believes in the value of health services
research as the Nation continues to strive to provide high-quality,
efficient, and cost-effective healthcare to all of its citizens. The
AAMC supports the President's request for AHRQ, which calls for $611
million for the agency in fiscal year 2011.
As the lead Federal agency to improve healthcare quality, AHRQ's
overall mission is to support research and disseminate information that
improves the delivery of healthcare by identifying evidence-based
medical practices and procedures. The funding increase proposed in the
President's budget will allow AHRQ to continue to support patient-
centered health research and other valuable research initiatives,
including strategies for translating the knowledge gained from patient-
centered research into clinical practice, healthcare delivery, and
provider and patient behaviors. These research findings will better
guide and enhance consumer and clinical decisionmaking, provide
improved healthcare services, and promote efficiency in the
organization of public and private systems of healthcare delivery.
While we support a strong investment in patient-centered health
research, we also encourage the subcommittee to maintain balance across
AHRQ's portfolio to allow the agency to support the full spectrum of
activities aligned with its mission. For example, the President's
budget does not continue funding for the Centers for Education and
Research in Therapeutics (CERTs) grants, and instead, funds six new
CERTs in the Patient-Centered Health Research portfolio and one new
pediatric patient safety CERT. The AAMC believes AHRQ is perfectly
positioned to take the lead on improving the quality of healthcare
through the reduction of medical errors, and strongly supports the
CERTs program; we encourage the subcommittee not to limit or narrow its
scope. The request also decreases other initiatives within the agency's
``Crosscutting Activities'' portfolio, including a proposed decrease
for investigator-initiated research that would preclude AHRQ from
offering any new grants in this area.
Additionally, in recent years, much of the funding for AHRQ has
been derived from interagency transfers, rather than direct
appropriations. The AAMC urges the subcommittee to provide the majority
of the agency's funding through direct appropriations.
Health Professions Funding.--The AAMC thanks the Subcommittee for
the increased support in recent years for the health professions and
nursing education programs under titles VII and VIII of the Public
Health Service Act. These programs work to improve the diversity,
distribution, and supply of the health professions workforce, with an
emphasis on primary care and interdisciplinary training.
The AAMC is pleased that the Patient Protection and Affordable Care
Act (Public Law 111-148) updated and restructured the existing title
VII and VIII programs to improve their efficiency, effectiveness, and
accountability, and reauthorized them at funding levels that reflect
the health workforce needs of the Nation. To enable the programs to
perform most optimally and help achieve the goals of the legislation,
the AAMC joins the Health Professions and Nursing Education Coalition
(HPNEC) in support of an fiscal year 2011 appropriation of at least
$600 million for the existing title VII and title VIII programs. This
funding level will allow the programs to continue educating and
training health professionals that are prepared to respond to the
increased demand for healthcare services, improving access and quality
of care across the country.
In addition to the existing health professions programs, the
legislation authorizes several new programs and initiatives under
titles VII and VIII designed to mitigate health workforce challenges
and expand the scope of the programs to additional fields. These new
programs recognize the breadth of shortages across healthcare
disciplines and aim to alleviate these existing and looming workforce
shortages. The AAMC encourages the subcommittee to support these new
programs with an investment that supplements the support for the core
of title VII and VIII programs that have demonstrated their
effectiveness.
During their 40-year existence, the title VII and VIII programs
have created a network of initiatives across the country that supports
the training of many disciplines of health providers. These are the
only Federal programs designed to create infrastructures at health
professions schools and in their communities that facilitate customized
training designed to bring the latest emerging national priorities to
the populations at large and meet the healthcare needs of special,
underserved populations. The AAMC urges the subcommittee to continue
its commitment to the title VII and VIII health professions programs.
National Health Service Corps.--The AAMC lauds the ambition of the
Patient Protection and Affordable Care Act to provide up to $414
million for the NHSC in fiscal year 2011 through discretionary
appropriations and the HHS Secretary's new Community Health Center
(CHC) Fund.
The NHSC is widely recognized--both in Washington and in the
underserved areas it helps--as a success on many fronts. It improves
access to healthcare for the growing numbers of underserved Americans,
provides incentives for practitioners to enter primary care, reduces
the financial burden that the cost of health professions education
places on new practitioners, and helps ensure access to health
professions education for students from all backgrounds. Over its 39-
year history, the NHSC has offered recruitment incentives, in the form
of scholarship and loan repayment support, to more than 29,000 health
professionals committed to serving the underserved.
In spite of the NHSC's success, demand for health professionals
across the country remains high. At a field strength of 4,760 in fiscal
year 2009, the NHSC fell more than 24,000 practitioners short of
fulfilling the need for primary care, dental, and mental health
practitioners in Health Professions Shortage Areas (HPSAs), as
estimated by HRSA. While the ``American Recovery and Reinvestment Act
of 2009'' (Public Law 111-5) provided a temporary boost in annual
awards, this increase must be sustained to help address the health
professionals workforce shortage and growing maldistribution.
The AAMC supports the President's fiscal year 2011 budget request
($169 million), which will ensure that the NHSC has access to
additional dedicated funding through the HHS Secretary's CHC Fund. The
AAMC further recommends that the subcommittee include report language
directing the Secretary to provide enhanced funding for the NHSC over
the fiscal year 2008 level, as directed under healthcare reform.
______
Prepared Statement of the American Association of Nurse Anesthetists
fiscal year 2011 appropriations request summary
----------------------------------------------------------------------------------------------------------------
AANA fiscal year 2011
Fiscal year 2010 actual Fiscal year 2011 budget request
----------------------------------------------------------------------------------------------------------------
HHS/HRSA/BHPr Title VIII Advanced Awaiting grant Grant allocations not $4 million for nurse
Education Nursing, Nurse Anesthetist allocations--in fiscal specified. anesthesia education
Education Reserve. year 2009 awards
amounted to
approximately $3.5
million.
Total for Advanced Education Nursing, $64.44 million for $64.44 million for $76.514 million for
from Title VIII. Advanced Education Advanced Education Advanced Education
Nursing. Nursing. Nursing
Title VIII HRSA BHPr Nursing $243,872,000........... $243,872,000........... $267,300,000
Education Programs
CDC/Division of Healthcare Quality $26 million
and Promotion.
HHS/Office of the Secretary.......... $1 million
----------------------------------------------------------------------------------------------------------------
The American Association of Nurse Anesthetists (AANA) is the
professional association for the 44,000 Certified Registered Nurse
Anesthetists (CRNAs) and student nurse anesthetists practicing today,
representing over 90 percent of the nurse anesthetists in the United
States. Today, CRNAs deliver approximately 32 million anesthetics to
patients each year in the U.S. 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 in the 1980s. (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 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. Through continual improvements in research,
education, and practice, nurse anesthetists are vigilant in our 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. 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 where
more Medicare patients live.
importance of title viii nurse anesthesia education funding
The nurse anesthesia profession's chief request of the subcommittee
is for $4 million to be reserved for nurse anesthesia education and
$76.514 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 $76.514 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, particularly as we see more patients
enter the system with the successful passage of health reform. More
APRNs will be needed to fill the gap to ensure access to care. In
addition, this funding provides a two-fold benefit for the nurse
workforce. It 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.
There continues to be high demand for CRNA workforce in clinical
and educational settings. 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 2000-2009, 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 2,239 graduates in 2009. This growth is leveling off somewhat,
but is expected to continue. However, 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 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, 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. Third, 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 The Nursing Community and the Americans for Nursing
Shortage Relief (ANSR) Alliance in support of the Subcommittee
providing a total of $267.3 million in fiscal year 2011 for nursing
shortage relief through title VIII. This amount is a modest 10 percent
increase over fiscal year 2010 levels and necessary in a time of
expanded access through health reform. As more patients enter the
system, it's imperative there are enough nurses to care for them. AANA
asks that of the $267.3 million, $76.514 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 2010
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
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 2011:
--$26 million for the Centers for Disease Control and Prevention's
(CDC) Division of Healthcare Quality and Promotion to address
outbreaks and promote innovative ways to adhere to injection
safety and infection control guidelines. $5 million would be
used to support the CDC's efforts around provider education and
patient awareness activities; and
--$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 outpatient settings with
the development of an action plan to reduce HAIs in outpatient
settings with a specific focus on injection safety.
______
Prepared Statement of the American Academy of Nurse Practitioners
The American Academy of Nurse Practitioners is the full service
organization representing more than 135,000 nurse practitioners
throughout the United States. This testimony speaks to the need for
continued and increased Federal funding for nurse practitioner
educational programs and traineeships for the coming fiscal year.
As the subcommittee knows, nurse practitioners are highly qualified
healthcare providers who have demonstrated their ability and interest
in providing primary care to individuals and families in both rural and
urban settings, regardless of age, occupation or income. The quality of
their care has been well documented over the years. With their advanced
preparation, they are able to manage the medical and health problems
seen in the primary care and acute care settings in which they work.
Nurse practitioners constitute an effective body of primary care
providers that may be utilized at a cost savings in both fee for
service and managed care arenas in this country. Savings to the Federal
government of greater than $100,000,000 per year in the Medicare
program alone are estimated when full utilization of nurse
practitioners is implemented. Likewise, managed care data has
demonstrated cost savings among patients seen by nurse practitioners
when compared to similar patients being cared for by physicians.
Other cost savings that can be realized by the Government when
nurse practitioners are appropriately utilized, include savings due to
reductions in emergency room visits and hospitalizations and savings
associated with the treatment of illness in its early stages. Studies
in both fee for service and managed care have been conducted that
demonstrate cost savings in diagnostic testing, prescribing, and
hospitalizations and emergency room use when these two groups of
providers are utilized to provide primary care to populations of all
ages.
Nurse practitioner specialties include family, adult, pediatric,
women's health, and gerontology. Their services include obtaining
medical histories, performing physical examinations, ordering,
performing, supervising and interpreting diagnostic tests, diagnosing
and treating acute episodic and chronic illnesses including the
prescription of medications and other nonpharmacologic treatments, and
appropriate referral to other sources of care. In addition, they are
skilled in the areas of health promotion and disease prevention which
include health education, screening and counseling for patients of all
ages.
Nurse practitioners provide care in both rural and urban settings,
in community health centers, public health clinics, hospitals and
hospital outpatient clinics, Indian Health Service and National Health
Service Corps sites as well as other freestanding primary care
settings. According to data collected by the American Academy of Nurse
Practitioners, more than 70 percent of nurse practitioners provide
primary care and more than 50 percent of their patients have family
incomes in the poverty range.
In order to guarantee the proper preparation of nurse
practitioners, assistance in the development of high-quality programs
continues to be needed across the country. The funding for such
programs has always been limited, and should always be more. The value
and worth of such funding continues to be undisputable.
The sums of money described here are but a drop in the bucket
compared to investments made by the Federal Government to underwrite
the cost of preparing other medical professionals. Yet in the face of
significant nursing shortages, the existence of more than 40,000,000
people with no health insurance and the continued lack of primary care
providers in this country increases in this funding are obviously
needed. Without these increases, additional barriers to the effective
utilization of the most cost-effective primary care providers in our
healthcare system are created.
Likewise, traineeship monies are being utilized by students in all
50 States and the District of Columbia. These monies are of particular
importance in the recruitment of nurse practitioners. Current funds
fall far short of the mark for assisting in the preparation of these
important, cost-effective healthcare providers in the system. These
appropriations help to reduce barriers for many students desiring to
become nurse practitioners. Surveys of nurse practitioners have shown
this investment to be a good one in terms of assisting students who
otherwise might not be able to return to school, and in terms of adding
providers who care for the rural and urban underserved in this country.
The recommended increase of 10 percent to the current funding
levels in the advanced practice line of title VIII will only begin to
make a dent in meeting the unmet healthcare needs of today's
populations. In light of the current and future needs for primary care
providers, it is obvious that increasing appropriations for nurse
practitioner education, traineeships and program exploration will be a
wise investment.
We thank the members of the Appropriations Committee for their
efforts in behalf of nurse practitioners and the patients they serve.
We know you recognize the value of our services and the need for
utilizing us in the provisions of quality, cost-effective healthcare.
It is obvious that we can be part of the solution to the current
shortage of healthcare providers in this country and we are asking for
your help to facilitate the process. If there is anything we can do to
provide further information or assistance regarding this issue, please
feel free to call on us.
______
Prepared Statement of the American Academy of Ophthalmology
executive summary
The American Academy of Ophthalmology requests fiscal year 2011 NIH
funding at $35 billion, which reflects a $3 billion increase more than
President Obama's proposed funding level of $32 billion. Funding at $35
billion, which reflects NIH's net funding levels in both fiscal year
2009 and fiscal year 2010, ensures it can maintain the number of multi-
year investigator-initiated research grants, the cornerstone of our
Nation's biomedical research enterprise.
The vision community commends Congress for $10.4 billion in NIH
funding in the American Recovery and Reinvestment Act (ARRA), as well
as fiscal year 2009 and fiscal year 2010 funding increases that enabled
NIH to keep pace with biomedical inflation after 6 previous years of
flat funding that resulted in a 14 percent loss of purchasing power.
Fiscal year 2011 NIH funding at $35 billion enables it to meet the
expanded capacity for research--as demonstrated by the significant
number of high-quality grant applications submitted in response to ARRA
opportunities--and to adequately address unmet need, especially for
programs of special promise that could reap substantial downstream
benefits, as identified by NIH Director Francis Collins, M.D., Ph.D. in
his top five priorities. As President Obama has stated repeatedly,
including at a visit to the NIH in September 2009, biomedical research
has the potential to reduce healthcare costs, increase productivity,
and ensure the global competitiveness of the United States.
The Academy requests that Congress improve upon the President's
proposed 2.5 percent NEI increase--the second smallest increase of all
Institutes and Centers--especially if it does not increase overall NIH
funding above the President's request.
In 2009, Congress spoke volumes in passing S. Res. 209 and H. Res.
366, which acknowledged NEI's 40th anniversary and designated 2010-2020
as The Decade of Vision, in which the majority of 78 million baby
boomers will turn 65 years of age and face greatest risk of aging eye
disease. This is not the time for a less-than-inflationary increase
that nets a loss in NEI's purchasing power, which eroded by 18 percent
in the fiscal year 2003-2008 timeframe. NEI-funded research is
resulting in treatments that save vision and restore sight, which can
reduce healthcare costs, maintain productivity, ensure independence,
and enhance quality of life.
Fiscal year 2011 NIH funding at $35 billion enables the NEI to
build upon the impressive record of basic and clinical collaborative
research that meets NIH's top five priorities and was funded through
fiscal year 2009-2010 ARRA and increased ``regular'' appropriations.
NEI's research addresses the pre-emption, prediction, and
prevention of eye disease through basic, translational, epidemiological
and comparative effectiveness research which also address the top five
NIH priorities, as identified by Dr. Collins: genomics, translational
research, comparative effectiveness, global health, and empowering the
biomedical enterprise. NEI continues to be a leader within the NIH in
elucidating the genetic basis of ocular disease--NEI Director Paul
Sieving, M.D., Ph.D., has reported that one-quarter of all genes
identified to date through collaborative efforts with the National
Human Genome Research Institute (NHGRI) are associated with eye disease
or visual impairment.
NEI received $175 million of the $10.4 billion in NIH ARRA funding.
As a result, NEI's total funding levels in the fiscal year 2009-2010
timeframe were $776 million and $794.5 million, respectively. In fiscal
year 2009, NEI made 333 ARRA-related awards, the majority of which
reflect investigator-initiated research that funds new science or
accelerates ongoing research, including 10 Challenge Grants. Several
examples of research and the reasons why it is important, include:
--Biomarker for Neovascular Age-related Macular Degeneration (AMD).--
Researchers will use a recently discovered biomarker for
choroidal neovascularization (CNV)--the growth of abnormal
blood vessels into the retina and responsible for 90 percent of
vision loss associated with AMD--to develop an early detection
method to minimize vision loss. Why is this important? AMD is
the leading cause of vision loss in the United States,
especially in the elderly.
--Cellular Approach to Treating Diabetic Retinopathy (DR).--
Researchers propose to develop a clinical treatment for
diabetic retinopathy--in which diabetes damages small blood
vessels in the retina, causing them to leak--that uses stem
cells from the patient's own blood that have been activated
outside of the body and then returned to repair damaged vessels
in the eye. Why is this important? DR is the leading cause of
vision loss in younger Americans and its incidence is
disproportionately higher in African Americans, Latinos, and
Native Americans.
--Small Heat Shock Proteins as Therapeutic Agents in the Eye.--
Researchers propose to develop new drugs to prevent or reverse
blinding eye diseases, such as cataract (clouding of the lens),
that are associated with the aggregation of proteins. Research
will focus on the use of small ``heat shock'' proteins that
facilitate the slow release and prolonged delivery of targeted
macromolecules to degenerating cells of the eye. Why is this
important? Delivering effective, long-lasting therapies through
a minimally invasive route into the eye is a major challenge.
--Identification of Genes and Proteins That Control Myopia
Development.--Researchers propose to identify targets that will
facilitate development of interventions to slow or prevent
myopia (nearsightedness) development in children. Identifying
an appropriate myopia prevention target can reduce the risk of
blindness and reduce annual life-long eye care costs. Why is
this important? More than 25 percent of the U.S. population has
myopia, costing $14 billion annually, from adolescence to
adulthood.
--Comparison of Interventions for Retinopathy of Prematurity (ROP).--
In animal studies, researchers will simulate Retinopathy of
Prematurity--a blinding eye disease that affects premature
infants--and study novel treatments that involve modulating the
metabolism of the retina's rod photoreceptors. Why is this
important? ROP affects 15,000 children a year, about 400-600 of
whom progress to blindness, at an estimated lifetime cost for
support and unpaid taxes of $1 million each.
--The NEI Glaucoma Human Genetics CollaBORation, NEIGHBOR.--This
research network, in which seven U.S. teams will lead genetic
studies of glaucoma, may lead to more effective diagnosis and
treatment. Researchers were primarily funded through ARRA
supplements. Why is this important: Glaucoma, a complex
neurodegenerative disease that is the second leading cause of
preventable blindness in the United States, often has no
symptoms until vision is lost.
--Comparative Effectiveness of Interventions for Primary Open Angle
Glaucoma (POAG).--Researchers will evaluate existing data on
the effectiveness of various treatment options for primary open
angle glaucoma--many emerging from past NEI research. Why is
this important? POAG is the most common form of the disease,
which disproportionately affects African Americans and Latinos.
In addition to ARRA funding, the ``regular'' appropriations
increases in fiscal year 2009-2010 enabled NEI to continue to fund key
research networks, such as:
--The African Descent and Glaucoma Evaluation Study (ADAGES), is
designed to identify factors accounting for differences in
glaucoma onset and the rate of progression between individuals
of African and European descent.
--The Diabetic Research Clinical Research Network's (DRCR) initiation
of new trials comparing the safety and efficacy of drug
therapies as an alternative to laser treatment for diabetic
macular edema and proliferative diabetic retinopathy.
--The Neuro-Ophthalmology Research Disease Investigator Consortium
(NORDIC), which will lead multi-site observational and
treatment trials involving nearly 200 community and academic
practitioners, to address the risks, diagnosis and treatment of
visual dysfunction due to increased intracranial pressure and
thyroid eye disease.
The unprecedented level of fiscal year 2009-2010 vision research
funding is moving our Nation that much closer to the prevention of
blindness and restoration of vision. With an overall NIH funding level
of $35 billion, which translates to an NEI funding level of $794.5
million, the vision community can accelerate these efforts, thereby
reducing healthcare costs, maintaining productivity, ensuring
independence and enhancing quality of life.
If Congress does not increase fiscal year 2011 NIH funding above
the President's request, it is even more vital to improve upon the
proposed 2.5 percent increase for NEI.
The NIH budget proposed by the administration and developed by
Congress during the very first year of the Congressionally-designated
Decade of Vision should not contain a less-than-inflationary increase
for NEI due to the enormous challenges it faces in terms of the aging
population, the disproportionate incidence of eye disease in fast-
growing minority populations and the visual impact of chronic disease
(e.g., diabetes). If Congress is unable to fund NIH at $35 billion in
fiscal year 2011 (NEI level of $794.5 million) and adopts the
President's proposal, the 2.5 percent increase in funding must be
increased to at least an inflationary level of 3.2 percent to prevent
any further erosion in NEI's purchasing power. NEI funding is an
especially vital investment in the overall health, as well as the
vision health, of our Nation. It can ultimately delay, save and prevent
health expenditures, especially those associated with the Medicare and
Medicaid programs, and is therefore a cost-effective investment.
Vision loss is a major public health problem: increasing healthcare
costs, reducing productivity, diminishing life quality.
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 due to its disproportionate incidence in minority
populations and as a co-morbid condition of chronic disease such as
diabetes.
Although 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 combined impacts 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.
about the american academy of ophthalmology
The American Academy of Ophthalmology is a 501c(6) educational
membership association. The Academy is the largest national membership
association of eye M.D.s with more than 27,000 members, over 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 Academy members.
______
Prepared Statement of the American Academy of Physician Assistants
On behalf of the nearly 80,000 clinically practicing physician
assistants in the United States, the American Academy of Physician
Assistants is pleased to submit comments on fiscal year 2011
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 $330 million for title VII programs in fiscal year 2011,
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 over 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 1990-2009 demonstrates that PAs who
have graduated from PA educational programs supported by title VII are
67 percent more likely to be from underrepresented minority populations
and 47 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 39 percent between 2008 and 2018. 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 2011 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 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 $330 million in funding for fiscal year 2011,
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 2011 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.
The Alliance for Aging Research supports the continuation and
expansion of NIH research activities which affect tens of millions of
older Americans. The NIA leads national research efforts within the NIH
to better understand the aging process and ways to better maintain the
health and independence of Americans as they age. Research on healthy
aging has never been more critical for so many Americans as the first
of the baby boomers will turn 65 in 2011. Presently, there are about 36
million Americans age 65 and older and this group is expected to double
in size within the next 25 years. By 2050, an estimated 19.4 million
Americans will be over the age of 85. Healthcare spending in the United
States is growing, and by 2018 national healthcare spending is
projected to be about $4.4 trillion and account for 20.3 percent of
GDP, according to Centers for Medicare and Medicaid Services.
Many diseases of aging are expected to become more widespread as
the number of older Americans increases. The number of Americans age 65
and older with Alzheimer's disease is projected to more than double by
2030. A recent report in the Journal of Clinical Oncology projected
cancer incidence will increase by about 45 percent from 2010-2030,
accounted for largely by cancer diagnoses in older Americans and
minorities, and by 2030, people aged 65 and older will represent 70
percent of all cancer diagnoses in the United States. Currently, the
average 75-year old has three chronic health conditions and takes five
prescription medications. Six diseases--heart disease, stroke, cancer,
diabetes, Alzheimer's and Parkinson's diseases--cost the United States
more than $1 trillion each year. The rising tide of chronic diseases of
aging threatens to deluge the U.S. healthcare system in the coming
years.
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. According to a 2005 AHRQ
report, up to $2.5 billion per year could be saved by preventing
diabetes-related hospitalizations with appropriate primary care, and
much of the savings would come from Medicare and Medicaid. Osteoporosis
is estimated to cost the United States $25.3 billion per year by 2025
unless discoveries are made to better treat and prevent the disease.
According to an Alzheimer's Association report from 2004, research
breakthroughs that slow the onset and progression of Alzheimer's
disease could yield annual Medicare savings of $51 billion by 2015 and
$126 billion by 2025. Research which leads to a better understanding of
the aging process and human vulnerability to age-related diseases could
help Americans live longer, more productive lives, and help reduce the
need for care to manage costly chronic diseases.
In fiscal year 2009, the NIA, which supports a range of genetic,
biological, clinical, social and economic research related to aging and
the diseases of the elderly, oversaw approximately 1,900 research
projects. Through the Division of Aging Biology (DAB), the NIA funds
research focused on understanding and exploiting the mechanisms
underlying the aging process. Research supported by the DAB 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. Some studies supported by the DAB
assess the beneficial effects of reducing caloric intake in animals.
Intramural and extramural research is ongoing 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 has supported grants in recent years to examine public
health concerns caused by the rising obesity epidemic. In particular,
NIA's Division of Behavioral and Social Science Research funded
projects to investigate the role social networks play in influencing an
individual's food choices, acceptability of being overweight, and how
those networks might be modifiable to slow the spread of obesity; as
well as those to explore how the rapid increase in obesity will
negatively affect U.S. gains in life expectancy. Investigators
supported by the Division of Geriatrics and Clinical Gerontology have
focused heavily on the central role exercise plays in improving the
health of older adults, reducing health risks associated with diabetes
and cardiovascular disease, and lowering the risk of death by
increasing a individual's fitness level. Results from studies such as
these will not only yield important information for use in the care of
the elderly, but also for promoting healthier behavior by the larger
U.S. population.
The NIA also participates in collaborations on disease-specific
research aimed at preventing, diagnosing, and more effectively treating
age-related illnesses. 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
clinical trials for Alzheimer's therapies. 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 (DPP), a large nationwide clinical
study of adults at high risk for diabetes, funded in part by the NIA,
showed that lifestyle intervention (intensive training on diet,
physical activity and behavior changes with the goal of weight loss)
reduced the development of diabetes by 58 percent over several years.
The risk reduction was even greater, 71 percent, among adults aged 60
years or older. Taking an oral diabetes drug reduced the development of
diabetes among participants by 31 percent, but was less effective in
adults older than age 45 compared to younger adults. This landmark
research study identified effective interventions for adults with pre-
diabetes and showed the development of diabetes was not necessarily
inevitable but could be slowed or prevented in this group by losing a
modest amount of weight through diet and exercise. More recent studies,
both completed and ongoing, have further examined DPP data and continue
to build on the findings from the diverse group of study participants.
The Diabetes Prevention Program Outcomes Study is examining the long
term risk reduction effects of the DPP intervention and the clinical
course of new-onset diabetes and complications in participants, with
attention to differences among minority populations and gender groups.
Shedding light on differences between these groups could have wide-
reaching implications for millions of Americans at risk for diabetes
and may assist in the creation of more effective interventions.
Eighty percent of all the nonprofit medical research in the United
States is funded by the NIH. However, the unfortunate reality is that
shrinking budgets have impeded progress. Aging is a field of research
whose progress has been hampered by stagnant funding. In part the
scarcity of resources has resulted in a decline of the overall success
rate for NIH research grant applications. The effect of this has been
reluctance on behalf of new investigators to submit truly ground-
breaking research proposals for consideration. 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. At its lowest point only one in four
research proposals could be funded by the NIH. In recognition of this
downward trend, last February President Obama signed into law the
American Recovery and Reinvestment Act of 2009 (ARRA), which
appropriated $10.4 billion in funding to the NIH to be used
expeditiously in fiscal year 2009 and fiscal year 2010. That March, the
NIH budget for fiscal year 2009 was increased 3.2 percent more than
fiscal year 2008 to $30.3 billion. This was a much needed boost across
the NIH Institutes for critical medical research to benefit Americans,
including just more than 170 research grants funded by the NIA in
ARRA's first year.
Promising areas of research targeted by the NIA to receive ARRA
funds include those to identify additional risk factor genes associated
with Alzheimer's disease, discovering improved diagnostic tools,
possible biomarkers, and therapies. ADNI will receive the most
significant amount of stimulus funding to further groundbreaking
research that will enable experts to track changes in living brains as
older adults as they transition from normal cognitive aging to the
early stages of Alzheimer's disease. The overall impact of this
investment will be to increase knowledge of the sequence and timing of
events leading up to disease onset and to develop better methods of
early detection and monitoring of the disease. Another grant awarded
funding through ARRA will develop new technologies, called biosensors,
to follow protein folding in cells. Proper protein folding
(proteostasis) is important to health. Researchers believe that protein
folding is affected by age. If proteins are formed incorrectly, or they
misfold normal cell function is disrupted. These problems are thought
to cause disease. The biosensors created with ARRA funds will help
monitor aging and age-related disease by focusing on patterns of
protein folding. ARRA funds have also been awarded to investigators who
will study the effects of rapamaycin, a compound that mimics caloric
restriction, on models of human diseases in mice. Models of Alzheimer's
disease, atherosclerosis, cardiovascular disease, Parkinson's disease,
kidney disease and cancer will be utilized in this project. The
investigators will ultimately seek to determine if the quality of life
for the mice has improved and if the age-related diseases have been
slowed or reduced over a 2-year period.
The ARRA funding begins to make up for flat budgets and unfunded
research proposals that have occurred in recent years. However,
research at the NIH cannot be sustained and will not flourish in the
long term without a steady increase in appropriations which, at
minimum, keeps pace with inflation. A slowdown in NIH funding will have
a devastating impact on the rate of basic discovery, innovation and the
development of interventions which could have major health benefits for
the burgeoning population of older Americans. The Alliance for Aging
Research supports funding the NIH at $35 billion in fiscal year 2011
with a minimum of $1.14 billion in funding for the NIA specifically.
This level of support would allow the NIH and the NIA to adequately
fund new and existing research projects, accelerating progress toward
findings which could prevent, treat, slow the progression or even
possibly cure conditions related to aging. With the silver tsunami on
the near horizon, an increased investment in NIA's research activities
has never been more necessary or had such potential to impact so many
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 2011 appropriations for
the NIH and we would be happy to furnish additional information upon
request.
______
Prepared Statement of the American Brain Coalition
Introduction
The National Institutes of Health (NIH) is the world's leader in
medical discoveries that improve people's health and save lives. NIH-
funded scientists at universities and research centers throughout the
Nation investigate ways to prevent, treat, and even cure the complex
diseases of the brain. Because there is much work still to be done, the
American Brain Coalition (ABC) writes to ask for the Senate
Appropriations Committee's continued support for increased biomedical
research funding at NIH.
ABC
ABC is a nonprofit organization that seeks to reduce the burden of
brain disorders and advance the understanding of the functions of the
brain. The ABC, made up of more than 50 member organizations, brings
together afflicted patients, the families of those that suffer, the
caregivers, and the professionals that research and treat diseases of
the brain.
The brain is the center of human existence, and the most complex
living structure known. As such, there are thousands of brain diseases
from Rett Syndrome and autism to mental illness and Parkinson's
disease. ABC, unlike any other organization, brings together people
affected by all diseases of the brain.
The ABC is working to raise public awareness and support for
diseases of the brain. Fifty million Americans--our relatives, friends,
neighbors, and your constituents--are affected by diseases of the
brain. This number does not include the millions more family members
whose lives are affected as they care for those who suffer. Our goal is
to be a united voice for these patients, and to work with Congress and
the administration to alleviate the burden of brain disease. A large
part of that goal involves support for NIH research.
Thank You for Your Support
ABC would like to thank the members of this subcommittee and the
Senate for its support for the $10 billion provided to NIH in the 2009
economic stimulus package. This funding provided the opportunity for a
substantial number of 2-year research grants and infrastructure
projects in every State of the Nation to move forward and enhance our
understanding of an array of physical and mental health concerns.
Progress in the fields of addiction, alcoholism, Parkinson's
disease, and stroke has already been made by scientists funded through
ARRA funding. One such investigator is studying how to improve motor
function following stroke. Another investigator is using specially
designed video games to understand the cognitive effects of autism, in
order to develop behavioral or drug treatments. Please visit http://
bit.ly/a0g8aA to learn more about the progress made.
More than 1,900 new investigators received ARRA grant funding.
Scientists were inspired to do more research and patients suffering
from debilitating neurological and psychiatric disorders were given
hope, thanks to your generous support of ARRA.
Congressional Support Accelerates Discovery
In the late 1990s, Congress made a commitment to double the budget
of the NIH over the course of 5 years. The primary goal for the added
funds was to discover better treatments and cures for human disease.
Congress delivered on its promise, and scientists have amassed a wealth
of medical knowledge. Today, researchers have a greater understanding
of how the brain and nervous system function due to NIH-funded
research.
Many recent scientific discoveries, including those in neurology,
psychiatry, and behavioral research have begun to show their potential.
Insights into the biology of schizophrenia, epilepsy, Alzheimer's, and
other disorders have led to the development of enhanced diagnostic
techniques, better prevention methods, and more effective treatments.
Simply put: the result of congressional support for research leads to
improved patient care.
Today's Research: Hope for the Future
Today's research is the foundation for future breakthroughs. The
Federal Government's investment in research must be sustained in order
to translate today's scientific findings into further bedside
treatments, and the ABC supports NIH in its entirety. Recent
discoveries, such as those listed below, are a direct result of robust
funding for the NIH.
--The development of drugs that reduce the severity of symptoms for
those suffering with multiple sclerosis and Parkinson's
disease.
--The identification of stroke treatment and prevention methods.
--The discovery of a new class of anti-depressants that produce fewer
side effects than their predecessors.
--The creation of new drugs to help prevent epileptic seizures.
--The expansion of treatments for the psychotic symptoms of
schizophrenia.
My own field of research concerns schizophrenia, a devastating
brain disorder that affects 1 percent of the population but is the
seventh most costly medical illness to our society because of its life-
long disability. Basic brain research funded by the National Institute
of Mental Health has transformed our understanding of the disorder and
illuminated new targets for therapeutic intervention that affect
symptoms untouched by existing drugs.
Research Improves Health and Fuels the Economy
Diseases of the nervous system pose a significant public health and
economic challenge, affecting nearly 1 in 3 Americans at some point in
life. Improved health outcomes and positive economic data support the
assertion that biomedical research is needed to improve public health
today and save money tomorrow.
Not only does research save lives and fuel today's economy, it is
also a wise investment in the future. For example, 5 million Americans
suffer from Alzheimer's disease today, and the cost of caring for these
people is staggering. Medicare expenditures are $91 billion each year,
and the cost to American businesses exceeds $60 billion annually,
including lost productivity of employees who are caregivers. As the
baby boom generation ages and the cost of medical services increases,
these figures will only grow. Treatments that could delay the onset and
progression of the disease by even 5 years could save $50 billion in
healthcare costs each year. Research funded by the NIH is critical for
the development of such treatments. The cost of investing in NIH today
is minor compared to both current and future healthcare costs.
Additionally, it is estimated that each billion of dollars of NIH
funding generates 15,000 to 20,000 well-paying jobs that can't be sent
offshore. Science funding also generates more than twice as much in
State and local economic output. A strong Federal investment in
research can assist your State in maintaining a biomedical research
foundation that attracts companies and investors. For instance, in
fiscal year 2007, NIH dollars generated more than $50 billion in new
State business.
Strong science funding can bolster the economy today and improve
our Nation's long term health and competitiveness tomorrow. Robust
research and development investment remains the key to America's long-
term global competitiveness. NIH funding serves as the basis for future
innovation and industries such as pharmaceutical, medical device, and
biotechnology.
Fiscal Year 2011 Recommendation
ABC supports $35 billion for the National Institutes of Health in
fiscal year 2011. This represents the new functional capacity funded by
the annual appropriations process and the American Recovery and
Reinvestment Act. In addition, it will help the NIH to achieve its
broad research goals and provide hope for the millions of Americans
affected with neurological and psychiatric disorders, while
strengthening the economy and creating jobs throughout the country.
There is still much work to be done to uncover the mysteries of the
brain. Fiscal year 2011 provides Congress with the opportunity to renew
its past commitment to health funding as a national priority.
______
Prepared Statement of the American College of Cardiology
The American College of Cardiology (ACC) appreciates the
opportunity to provide the subcommittee with recommendations for fiscal
year 2011 funding for cardiovascular research and prevention. The ACC
is a more than 38,000 member, non-profit professional medical society
and teaching institution whose mission is to advocate for quality
cardiovascular care--through education, research promotion, development
and application of standards and guidelines--and to influence
healthcare policy.
Heart disease is America's number one killer and a major cause of
permanent disability. Nearly 1 in 3 adults in the United States suffers
from heart disease. Heart disease and stroke will cost the United
States an estimated $503.2 billion in 2010, including healthcare costs
and lost productivity.
The death rates attributable to cardiovascular disease actually
have declined due to advances in science through diagnostic tests, drug
and device therapies, surgical innovations, enhanced emphasis on
prevention, and innovative public education programs. Federal research
provided for many of these advances that improve understanding of the
prevention and treatment of cardiovascular disease, leading to better
outcomes and increased quality of life for patients.
acc funding recommendations for fiscal year 2011
As the subcommittee considers its appropriations for programs
within the Department of Health and Human Services, the ACC urges
support of the following recommendations.
National Institutes of Health (NIH)
The ACC supports an appropriation of $35.2 billion for the National
Institutes of Health (NIH). This funding level will allow the NIH to
build on momentum achieved from investments from the American Recovery
and Reinvestment Act (ARRA). The NIH currently invests only 4 percent
of its budget on heart research; the ACC urges NIH to invest a higher
percentage of its budget to heart research.
National Heart, Lung, and Blood Institute (NHLBI)
The ACC supports an appropriation of $3.514 billion for the
National Heart, Lung, and Blood Institute (NHLBI). The NHLBI does
critical research into the causes, diagnosis, and treatment of heart
disease.
Agency for Healthcare Research and Quality (AHRQ)
The ACC supports the President's budget request of $611 million for
the Agency for Healthcare Research and Quality (AHRQ). The ACC supports
the recent increases in funding for AHRQ's comparative effectiveness
research program, and also believes AHRQ's health services research
related to healthcare costs, quality, and access are critically
important.
CDC Heart Disease and Stroke Prevention
The ACC supports an appropriation of $76.221 million for the
Centers for Disease Control and Prevention (CDC) Division for Heart
Disease and Stroke Prevention. These public education efforts are
helping to reduce blood pressure and cholesterol, educate about heart
disease and stroke signs and symptoms, enhance emergency response and
quality care, and end treatment disparities.
The ACC also supports an appropriation of $37.087 million for CDC's
WISEWOMAN program. This program screens uninsured and under-insured
low-income women ages 40 to 64 for heart disease and stroke risk and
those with abnormal results receive counseling, education, referral and
follow up.
HRSA Rural and Community AED Program
The ACC supports an appropriation of $8.927 million for the Health
Resources and Services Administration (HRSA) Rural and Community Access
to Emergency Devices Program, which would restore it to its fiscal year
2005 level when 47 States received resources from the initiative. This
program provides competitively awarded grants to States to purchase
automated external defibrillators (AEDs), train lay rescuers and first
responders in their use, and place them in public areas where sudden
cardiac arrests are likely to occur. In 2009 only ten states received
funding for this initiative.
NHLBI and CDC: Congenital Heart Disease Research and Surveillance
The ACC is pleased that the recently enacted ``Patient Protection
and Affordable Care Act'' includes provisions to enhance and expand the
infrastructure to track the epidemiology of congenital heart disease
(CHD) and to conduct and support research on it. The ACC as well as the
Adult Congenital Heart Association, Mended Little Hearts and Children's
Heart Foundation, stand ready to work with the subcommittee to advance
these policies.
Congenital heart defects are the most common birth defect in the
United States and are a leading cause of child mortality. The success
of childhood cardiac intervention has created a new chronic disease--
CHD. Those who receive successful intervention will need life-long
special cardiac care and face high rates of heart failure, rhythm
disorders, stroke and sudden cardiac death. Thanks to the increase in
survival, the CHD population is rising by 5 percent a year; there are
about 800,000 children and 1 million adults in the United States now
living with CHD.
Despite the prevalence and seriousness of the disease, data
collection and research are limited. Federal funding support for CHD
surveillance through CDC and research through NHLBI is necessary to
help prevent premature death and disability in this rapidly growing and
severely underserved population.
cardiovascular disease research gaps
As the healthcare system evolves towards better integration of
health information technology (HIT), clinical decision support tools,
and performance measurement, the need for meaningful clinical practice
guidelines is essential. The American College of Cardiology Foundation
(ACCF) and the American Heart Association (AHA) have a long history in
the development of clinical practice guidelines, and have close to 20
guidelines on a range of cardiovascular topics. The guidelines are
developed through a rigorous, evidence-based methodology, including
multiple layers of review and expert interpretation of the evidence on
an ongoing, regular basis.
Many clinical research questions remain unanswered or understudied,
however. The ACC has identified knowledge gaps for cardiovascular
disease that if addressed, have potential to positively impact patient
outcomes, costs, and the efficiency of care delivery. A Federal
investment through the NHLBI and AHRQ to answer the following questions
will help to better narrow the target population who can benefit from
treatment and therefore increase the efficacy and efficiency of
patient-centered care delivery.
--What is the effect of common cardiovascular therapies on elderly
populations whose metabolism and kidney function are lower and
may not respond to medications in the same way as the younger
patients typically included in clinical trials?
--What is the effect of common cardiovascular therapies on patients
with multiple other diseases/conditions?
--What is the effect of common cardiovascular therapies on women?
What are signs and risk factors for cardiovascular disease in
women?
--What are the best approaches to increasing patient compliance with
existing therapies?
--What screening and risk models (existing or new) could further
define who will benefit from various therapies?
--What are the optimal management strategies for anticoagulation and
antiplatelet agents in heart attack patients, patients with
stents, and atrial fibrillation patients to maximize benefit
and reduce bleeding risks?
--What are the best approaches to managing complex but understudied
cardiovascular topics such as congenital heart disease,
valvular heart disease, and hypertrophic cardiomyopathy? These
topics have become areas of higher research interest as
techniques have developed to extend the lives of patients with
these disorders.
--What are the risks and benefits of common off-label uses of widely
used therapies and procedures?
--What are the risks and benefits of various cardiovascular screening
protocols, such as those for imaging methods used to correctly
identify patients who will benefit from surgical, endovascular,
and/or medical interventions?
--What are the best catheter-based techniques to increase treatment
success and reduce complications for both coronary and cardiac
rhythm procedures?
--What are the effects of nutrition, environment and genetics on the
occurrence of congenital heart defects?
The above list of topics is not exhaustive but gives an overview of
some of the themes of the evidence gaps that exist across the ACCF/AHA
guidelines. In addition to specific clinical research topics, the ACCF
recommends funding to help address structural issues that could help
identify, prioritize, and interpret research findings over the long
term.
--The NIH and or AHRQ should fund more trials of direct comparison of
clinical effectiveness between pharmacological and other
therapies. Without these important trials, the current emphasis
on promoting comparative effectiveness will be founded upon
efficacy trials and not effectiveness.
--The NHLBI should work with the clinical cardiology community to
proactively design clinical trials to address unanswered
clinical questions and identify methods that allow for greater
comparability among studies. NHLBI should work with ACCF and
the AHA to develop an evidence model that would drive future
research initiatives based on current evidence gaps in the
guidelines; and
--NIH should fund the development of a robust informatics
infrastructure across Institutes to process research evidence.
Studies should be designed such that their results could be
``fed'' into a computer model that would provide additional
insights for developers of clinical recommendations.
--NIH and or AHRQ should fund studies of patient preference and
values.
arra in action: collaborating to improve cardiovascular care
In September 2009, the ACC was pleased to be awarded two Federal
grants under ARRA. The ACC has applied for three others, in addition to
serving as a subcontractor on several other grant applications.
Grand Opportunity Grants
Comparative Effectiveness of PCI versus CABG Grant
The NHLBI awarded a Grand Opportunity grant to the ACC in
partnership with the Society of Thoracic Surgeons (STS) to study the
comparative effectiveness of the two forms of coronary
revascularization; percutaneous coronary intervention (PCI) and
coronary artery bypass graft (CABG) surgery (Award Number 1RC2HL10148).
Now entering the second half of this 2 year award period, the study is
comparing these two cardiac procedures using existing databases from
the ACC and STS, as well as the Centers for Medicare and Medicaid
Services 100 percent denominator file data. By linking these three
databases, the study will help physicians make better decisions and
improve healthcare for patients with coronary artery disease.
National Cardiovascular Research Infrastructure (NCRI)
Grant
The NHLBI also awarded a Grand Opportunity grant (Award Number
1RC2HL101512-01) to Duke Clinical Research Institute (DCRI), with the
ACC serving as a subcontractor, to develop a clinical investigator
network based upon the data collection activities of ACC's National
Cardiovascular Data Registries (NCDRr). These registries have
previously been used to quantify outcomes and identify gaps in the
delivery of quality cardiovascular patient care in the United States.
The current grant will extend these existing systems by establishing a
National Cardiovascular Research Infrastructure (NCRI) that will unify
sites with a centralized clinical research network. NCRI will
facilitate interoperable clinical research by enhancing site
recruitment, training, performance, and accountability and will create
a sustained improvement in the efficiency and quality of the
interaction between the clinical research subject, the clinician
investigator, the expert guidelines committee, and policymakers.
Prospect Grants #RFA-HS-10-005: Building New Clinical Information for
Comparative Effectiveness Research
Valvular Heart Disease Registry Grant Application
In February 2010, ACC and STS again joined forces to submit a grant
application entitled ``ACCF-STS Database Development and Collaboration
on the Comparative Effectiveness of Valvular Heart Disease.'' This
application was in response to the above announcement from AHRQ. The
DCRI Data Coordinating and Analysis Center collaborated on the
development of this grant and, if awarded, would provide the clinical
outcomes and analysis for the project. The purpose of this grant would
be for ACCF and STS to take advantage of their existing registries to
create and maintain a sustainable disease-based, multi-center registry
for valvular heart disease (VHD), a robust, efficient system of
longitudinal follow-up for registry patients, and to perform a direct
comparison of initial clinical outcomes following different management
strategies of patients with severe aortic stenosis.
Infrastructure Development for the Comparative
Effectiveness of Atrial Fibrillation
In partnership with the Heart Rhythm Society (HRS), ACC submitted a
grant to AHRQ proposing to develop the electronic database
infrastructure necessary to collect prospective data of patients with
atrial fibrillation through use of ACC's NCDR. Once developed, new
evidence comparing various interventions will be available by using
this new NCDR registry database to better understand the procedures and
improve healthcare for patients with atrial fibrillation, one of the
most common arrhythmias in clinical practice. Such data will contain
process, risk-adjusted outcomes, utilization, provider characteristics,
and cost data spanning several years that has a potentially great
benefit to society. Specifically, this study will permit comparative
effectiveness research of the management of patients with atrial
fibrillation, including comparisons across race, gender, and age. These
comparisons will be more comprehensive than any currently available,
and will be of inestimable benefit in provider decisionmaking and
patient care in a variety of clinical situations.
Enhanced Registries for Quality Improvement and Comparative
Effectiveness (AHRQ #RFA-HS-10-020)
Integrating Local EHR Data into the ACC NCDR Registry to
Improve Care (LEAN) Grant Application
The aim of this grant application is to develop an informatics
solution that captures and delivers real-time clinical patient
information to multiple care settings. ACC is collaborating with Yale
University School of Medicine, Christiana Care Center for Outcomes
Research, Sisters of Mercy Health System, Saint Luke's Hospital of
Kansas City-Mid America Heart Institute, and Duke University Medical
Center on this important endeavor. The formation of the proposed
infrastructure will not only drive quality improvement, but also
facilitate comparative effectiveness research. This project aligns
particularly well with the goals and purposes expressed nearly 2 years
ago by the ACCF and the NCDR with the launch of the IC\3\ Registry
(renamed the PINNACLE RegistryTM in the fall of 2009).
PINNACLE was designed to improve the quality of outpatient
cardiovascular care by reducing inappropriate variations in care, by
eliminating gaps in care, and by improving care coordination for
patients with cardiovascular disease. Realization of these objectives
will rely on the existence of a strong, unified data collection
infrastructure that will allow for retrieval across both inpatient and
outpatient care settings, as well as provide quality improvement
feedback.
______
Prepared Statement of the Adult Congenial Heart Association
The Adult Congenial Heart Association (ACHA) is pleased that the
recently enacted ``Patient Protection and Affordable Care Act''
includes provisions to enhance and expand the infrastructure to track
the epidemiology of congenital heart disease (CHD) and to conduct and
support research on causation, including genetic causes; long-term
outcomes in individuals with congenital heart disease; diagnosis,
treatment, and prevention; studies using longitudinal data and
retrospective analysis to identify effective treatments and outcomes;
and identifying barriers to life-long care for individuals with
congenital heart disease. The Adult Congenital Heart Association, along
with coalition partners Mended Little Hearts and Children's Heart
Foundation, stand ready to work with the subcommittee and Members of
Congress to advance these policies.
CHD are the most common birth defect in the United States and are a
leading cause of child mortality. The success of childhood cardiac
intervention has created a new chronic disease--CHD. Those who receive
successful intervention will need life-long special cardiac care and
face high rates of heart failure, rhythm disorders, stroke, and sudden
cardiac death. Thanks to the increase in survival, the CHD population
is rising by 5 percent a year. There are about 800,000 children and 1
million adults in the United States now living with CHD.
Despite the prevalence and seriousness of the disease, data
collection and research are limited. In 2004, the National Heart, Lung
and Blood Institute (NHLBI) convened a working group on congenital
heart disease, which recommended developing a research network to
conduct clinical research and establishing a national database of
patients.
Federal funding support for CHD surveillance through CDC and
research through NHLBI will help prevent premature death and disability
in this rapidly growing and severely underserved population.
______
Prepared Statement of the American Congress of Obstetricians and
Gynecologists
The American Congress of Obstetricians and Gynecologists,
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 Department of Health and Human Services. Today,
the United States lags behind other nations in healthy births, yet
remains high in birth costs. ACOG's Making Obstetrics and Maternity
Safer (MOMS) Initiative seeks to improve maternal outcomes through more
research and better data, and we urge you to make this a top priority
in fiscal year 2011.
Research is critically needed to understand why our maternal and
infant mortality rate remains comparatively high. Having better data
collection methods and comprehensive maternal mortality reviews has
shown maternal mortality rates in some States, such as California, to
be higher than previously thought. States without these resources are
likely underreporting maternal and infant deaths and complications from
childbirth. Without accurate data, the full range of causes of these
deaths remains unknown. Effective research based on comprehensive data
is a key MOMS element to developing and implementing evidence-based
interventions.
Unfortunately, the MOMS Initiative is threatened by the sizeable
cliff in research funding that will be created in fiscal year 2011 once
the stimulus package ends this year. Building funding levels from the
stimulus into the base for fiscal year 2011 appropriations will ensure
the continuation of current research important to the MOMS Initiative,
and ensure that future research necessary to improving maternal
outcomes does not go unfunded.
The President's budget for fiscal year 2011 takes a positive first
step towards this goal, including a $1 billion increase for NIH, and
ACOG requests the subcommittee build on these increases to maintain the
momentum created by the stimulus. The NIH and many other HHS agencies
are vital to carrying out the goals of the MOMS Initiative. Therefore,
ACOG asks for a 13.5 percent increase for NIH to $35.2 billion, a 22.3
percent increase for HRSA to $9.15 billion, a 35.9 percent increase for
CDC to $8.8 billion, and a 53.9 percent increase for AHRQ to $611
million.
Research and programs in the following areas are vital to the MOMS
Initiative:
Maternal/Child Health Research at the NIH
The Eunice Kennedy Shriver National Institute of Child Health and
Human Development (NICHD) conducts the majority of women's health
research. Despite the NIH's critical advancements, reduced funding
levels have made it difficult for research to continue.
ACOG supports a 12.5 percent increase in funds over fiscal year
2010 to $1.495 billion for the NICHD. These funds will assist the
following research areas critical to the MOMS Initiative:
Reducing the Prevalence of Premature Births
There is a known link between pre-term birth and infant mortality,
and women of color are at increased risk for delivering pre-term. 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.
ACOG supports the Surgeon General's effort to make the prevention
of pre-term birth a national public health priority, and urges Congress
to allocate $1 million to NICHD to create a Trans-disciplinary Research
Center on Prematurity to help streamline efforts to reduce pre-term
births.
Obesity Research, Treatment, and Prevention
Obese pregnant women are at higher risk for poor maternal and
neonatal outcomes. Additional research and interventions are needed to
address the increased risk for poor outcomes in obese women receiving
infertility treatment, the increased incidence of birth defects and
stillbirths in obese pregnant women, ways to optimize outcomes in obese
women who become pregnant after bariatric surgery, and the increased
future risk of childhood obesity in their offspring.
ACOG is grateful to the NIH for making obesity a priority and
initiating trans-disciplinary approaches to combat obesity. We also
applaud First Lady Michelle Obama for naming childhood obesity a top
priority. ACOG urges the NIH and the NICHD to make obesity in pregnant
women a high priority, to improve the health of mother and child.
Maternal/Child Health Programs at CDC
CDC funds programs that are critical to providing resources to
mothers and children in need. Where NIH conducts research to identify
causes of pre-term birth, CDC funds programs that provide resources to
mothers to help prevent pre-term birth, and help identify factors
contributing to pre-term birth and poor maternal outcomes.
ACOG supports a 35.9 percent increase in funds over fiscal year
2010 to $8.8 billion to increase CDC's ability to bring prevention,
treatment and interventions to more women and children in need, and to
help enact some of the important provisions within healthcare reform.
This funding will help the following programs important to the MOMS
Initiative:
Maternal Mortality Reviews, Division of Reproductive Health
National data on maternal mortality is inconsistent and incomplete
due to the lack of standardized reporting definitions and mechanisms.
To capture the accurate number of maternal deaths and plan effective
interventions, maternal mortality should be addressed through multiple,
complementary strategies. ACOG recommends that CDC fund States in
implementing maternal mortality reviews that would allow them to
conduct regular reviews of all deaths within the State to identify
causes, factors in the communities, and strategies to address the
issues. Combined with adoption of the recommended birth and death
certificates in all States and territories, CDC could then collect
uniform data to calculate an accurate national maternal mortality rate.
Results of maternal mortality reviews will inform research needed to
identify evidence based interventions addressing causes and factors of
maternal mortality and morbidity.
ACOG urges Congress to provide $2.375 million to the Division of
Reproductive Health to assist States in setting up maternal mortality
reviews.
Electronic Birth Records and Death Records, National Center
for Health Statistics (NCHS), National Vital
Statistics System (NVSS)
NCHS is the Nation's principal health statistics agency; it
collects, analyzes and reports on data critical to all aspects of our
healthcare system. NCHS collects State data needed to monitor maternal
and infant health, such as use of prenatal care, and smoking during
pregnancy. This data allows investigators to monitor maternal and child
health objectives, and develop efficient prevention and treatment
strategies.
Uniform consistent data from birth and death records is critical to
conducting research and directing public programs to combat maternal
and infant death. Only 75 percent of States and territories use the
2003 recommended birth certificates and 65 percent have adopted the
2003 recommended death certificate. Within the increased funding
provided to NCHS in the President's budget, $8 million was included
specifically for the National Vital Statistics System (NVSS) to support
States and territories in implementing the 2003 birth certificate and
modernizing their infrastructure to collect these data electronically
to expand the scope and quality of data collected on a national basis.
The President's budget provides NVSS $3 million to phase in the 2003
death certificate and electronic death records in States and
territories.
ACOG urges Congress to allocate $11 million for States to modernize
their birth and death records systems to the 2003 recommended
guidelines, consistent with the President's budget.
Safe Motherhood/Infant Health
Two to three women a day die from delivery complications. The Safe
Motherhood Program supports CDC's work with State health departments
and other groups to identify and gather information on pregnancy-
related deaths; collect and provide information about women's health
and health behaviors before, during, and immediately after pregnancy;
and expand the acceptance and use of findings and guidelines on
preconception care into everyday practice and healthcare policy.
Safe Motherhood also tracks infant morbidity and mortality
associated with pre-term birth. ACOG is concerned with recent trends
particularly among rates of late pre-term births. Increased funding is
needed for CDC to improve national data systems to track pre-term birth
rates and expand epidemiological research that focuses especially on
the causes and prevention of preterm birth and births at 37-38 weeks
gestation.
ACOG urges Congress to include a 23.7 percent increase in funds to
$55.4 million for Safe Motherhood, consistent with the President's
budget.
Maternal/Child Health Programs at HRSA
HRSA delivers critical resources to communities to improve the
health of mothers and children. ACOG urges a 22.3 percent increase in
funds over fiscal year 2010 to $611 million to increase the scope of
HRSA programs, ultimately bringing more resources to more mothers and
children. This funding will help expand the following programs
important to the MOMS Initiative:
Fetal Infant Mortality Reviews, Healthy Start Program
After decades of decline, the U.S. infant mortality rate is again
on the rise and is particularly severe among minority and low-income
women. The infant mortality rate among African American women has been
increasing since 2001 and reached 14.2 deaths per 1,000 births in 2004.
There also has been a startling rise in infant mortality in the South.
Mississippi, for example, had an infant mortality rate of 11.4 in 2005
compared to 9.6 the previous year.
The Healthy Start Program through HRSA promotes community-based
programs that focus on infant mortality and racial disparities in
perinatal outcomes. These programs are encouraged to use the Fetal and
Infant Mortality Review (FIMR) which brings together ob-gyn experts and
local health departments to help solve problems related to infant
mortality. Today more than 220 local programs in 42 States find FIMR a
powerful tool to help solve infant mortality.
ACOG urges Congress to include $.5 million for Healthy Start
Programs to include FIMR.
Maternal Child Health Block Grant (MCH)
The MCH is the only Federal program that exclusively focuses on
improving the health of mothers and children. State and territorial
health agencies and their partners use MCH Block Grant funds to reduce
infant mortality, deliver services to children and youth with special
healthcare needs, support comprehensive prenatal and postnatal care,
screen newborns for genetic and hereditary health conditions, deliver
childhood immunizations, and prevent childhood injuries.
ACOG urges Congress to increase funding for MCH $730 million, a
10.3 percent increase over fiscal year 2010.
Comparative Effectiveness Research on Maternal Disparities at AHRQ
There are glaring disparities in maternal outcomes among different
ethnic and racial groups, particularly related to pre-term birth and
maternal and infant mortality rates among African American women. For
that reason, disparities research is a major tenant of ACOG's MOMS
Initiative. Comparative effectiveness research has the capacity to
greatly improve pre-term birth rates and maternal and infant mortality
rates by testing the efficacy of prevention and treatment interventions
on different populations. As more comparative effectiveness research
gets funded from the stimulus and healthcare reform bills, ACOG urges
Congress to make disparities research into maternal outcomes a top
priority.
ACOG supports a 53.9 percent increase in funds for AHRQ to $611
million, consistent with the President's budget.
Again, we would like to thank the subcommittee for its continued
support of programs to improve women's health, and we urge you to
consider our MOMS Initiative in fiscal year 2011.
______
Prepared Statement of the American College of Physicians
Chairman Harkin and Ranking Member Cochran, thank you for allowing
me to share the American College of Physicians' (ACP) views on the
Department of Health and Human Services (HHS) budget for fiscal year
2011.
I am Joseph W. Stubbs, MD, FACP, President of the ACP. I have also
had the privilege of serving adult patients for the past 27 years as a
full-time internist and geriatrician in a nine-person primary care
group practice in Albany, Georgia. Every day, I see where the rubber of
health policy meets the road of real patient lives. In my practice, we
have more than 50 employees, and I have seen the ratio of physician to
staff grow from 1:3 to 1:6 in the last 10 years. Healthcare in the
United States is facing an unprecedented challenge of affordability and
sustainability. I am pleased to be able to represent ACP.
ACP represents 129,000 internal medicine physicians, residents, and
medical students. ACP is also the Nation's largest medical specialty
society and its second largest physician membership organization.
ACP is pleased to urge full funding for the following proven
programs that currently receive appropriations from the subcommittee:
--Title VII, section 747, Primary Care Training and Enhancement, at
no less than $125 million;
--National Health Service Corps, $414,095,394, in addition to the
$290 million in enhanced funding through the Community Health
Fund; and
--Agency for Healthcare Research and Quality, $611 million.
In addition to fully funding the existing programs noted above, ACP
is pleased to support the following new programs, as created in the
Patient Protection and Affordable Care Act (PPACA), with the
stipulation that they should be fully funded:
--Title VII, section 747A, Teaching Health Centers, $50 million;
--Primary Care Training Extension Program, $120 million;
--National Health Care Workforce Commission;
--State healthcare workforce development grants; and
--State demonstration programs to evaluate alternatives to current
medical tort litigation, $50 million.
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 adult primary care specialties steadily declines. With
passage of the PPACA, we expect the demand for primary care services to
increase with the addition of 32 million Americans receiving access to
health insurance, once the law is fully implemented.
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 that more than 100 studies show primary care is
associated with better outcomes and lower costs of care (http://
www.acponline.org/advocacy/where_we_stand/policy/primary_shortage.pdf).
Many regions of the country 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. A 2008 study published in Health
Affairs projects a shortage of 35,000 to 40,000 or more primary care
physicians for adults by 2025 (Colwill JM, Cultice JM, Kruse RL. Will
generalist physician supply meet demands of an increasing and aging
population? Health Affairs (Millwood). 2008 May-Jun;27(3):w232-41. Epub
2008 Apr 29). With an aging and growing population, family physicians'
and general internists' workloads are expected to increase by 29
percent between 2005 and 2025. To help alleviate the shortage of
primary care physicians, we believe sufficient funding should be
provided for title VII programs and the National Health Service Corps.
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 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, and are critical to help institutions and programs
respond to the current and emerging challenges of ensuring all
Americans have access to appropriate and timely health services.
Within the title VII program, while we applaud the President's
request for $54 million for the section 747, Training in Primary Care
Medicine and Dentistry, with passage of the PPACA and the
reauthorization of the section 747, Primary Care Training and
Enhancement, we urge the subcommittee to fund the program at $177.6
million, which is double the amount of funding the program received in
fiscal year 2005, the high watermark for this program. We urge the
subcommittee to not designate a percentage of the funding to a specific
primary care disciple, as has been done in previous years. The
reauthorization of the section 747 program calls for capacity building
in the fields of general internal medicine, general pediatrics, and
family medicine, as well as eliminates the rateable reduction language
which has diverted over two-thirds of the funding in this program to
one primary care discipline. The section 747 program is the only source
of Federal training dollars available for general internal medicine,
general pediatrics, and family medicine. For example, general
internists, who have long been at the frontline of patient care, have
benefited from title VII training models that promoted
interdisciplinary training that helped prepare them to work with other
health professionals, such as physician assistants, patient educators
and psychologists.
ACP strongly supports the creation of the title VII, section 749A,
Teaching Health Centers Development Grants, as established in the
PPACA, which would provide grants and Graduate Medical Education
funding for Teaching Health Centers to train primary care physicians in
community based settings. Developing residency programs within
community-based ambulatory primary care settings, with the appropriate
infrastructure investment, will help strengthen the primary care
workforce. Residents in primary care training programs need increased
exposure to the ambulatory care setting, a practice environment that
demonstrates that satisfaction can be gained from providing ongoing,
continuous care to patients. The evidence suggests that residents who
spend increased time in outpatient settings opposed to the hospital
deliver a higher quality of care and maintained a higher degree of
satisfaction from their work. ACP strongly urges the subcommittee to
fully fund this program at its fiscal year 2011 authorized level of $50
million.
ACP recommends an appropriation of $414,095,394 for the National
Health Service Corps (NHSC), the amount authorized for fiscal year 2011
under the PPACA. This is in addition to the $290 million in enhanced
funding the HHS Secretary has been given the authority to provide to
the NHSC through the Community Health Care Fund in fiscal year 2011, as
authorized under the PPACA. The increase in funds must be sustained to
help address the health professionals' workforce shortage and growing
maldistribution.
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. 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.
At a field strength of 4,760 in fiscal year 2009, the NHSC fell
more than 24,000 practitioners short of fulfilling the need for primary
care, dental, and mental health practitioners in Health Professions
Shortage Areas (HPSA), as estimated by HRSA. The NHSC estimates that
nearly 50 million Americans currently live in a HPSA and that 27,000
primary care professionals are needed to adequately serve the people
living in a HPSA. 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. 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 Primary Care Extension Program, a new program created by the
PPACA under title III of the Public Health Service Act, would help to
educate and provide technical assistance to primary care providers
including general internists currently in practice, about evidence-
based therapies, preventive medicine, health promotion, chronic disease
management, and mental health. This much-needed assistance will
strengthen primary care practices caring for newly insured individuals
and an aging population with multiple chronic conditions. ACP
encourages the subcommittee to fund this program at its fiscal year
2011 authorized level of $120 million.
We encourage the subcommittee to fully fund the necessary amounts
for the National Health Care Workforce Commission, as created by the
passage of the PPACA. The Commission is authorized to review current
and projected healthcare workforce supply and demand and make
recommendations to Congress and the administration regarding national
healthcare workforce priorities, goals, and polices. ACP believes the
Nation needs sound research methodologies embedded in its workforce
policy to determine the Nation's current and future needs for the
appropriate number of physicians by specialty and geographic areas; the
work of the Commission is imperative to ensure Congress is creating the
best policies for our Nation's needs.
The PPACA also establishes a competitive healthcare workforce
development grant program for the purpose of enabling State
partnerships to complete comprehensive planning and to carry out
activities leading to coherent and comprehensive healthcare workforce
development strategies at the State and local levels. We urge the
subcommittee to fully fund the necessary amounts as needed, for both
planning and implementation grants, given that our States are an
essential link in sustaining our Nation's health.
The Agency for Healthcare Research and Quality (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 endorses
the President's fiscal year 2011 budget request of $611 million. This
amount will allow AHRQ to continue its critical healthcare safety,
quality, and efficiency initiatives; strengthen the infrastructure of
the research field; re-ignite innovation and discovery; develop the
next generation of scientific pioneers; and ultimately, help transform
health and healthcare.
ACP is supportive of ARHQ's investigator-initiated research
program, a critically important element of our Nation's healthcare
research effort. The funding stream provides for many clinical
innovations, innovations that improve patient outcomes, facilitates the
translation of research into clinical practice and disease management
strategies, and addresses 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.
The PPACA allows the HHS Secretary to establish State demonstration
programs to evaluate alternatives to current medical tort litigation,
such as certificate of merit programs, which require a finding that a
suit has merit before it can proceed to trial, and health courts, which
would have cases heard by a panel of medical experts rather than a lay
jury. ACP believes that reform of medical liability system is
essential, and this program is a step in that direction. ACP strongly
urges the subcommittee to fully fund the program at its authorized
level of $50 million immediately, allowing States the opportunity to
build upon the work already being done under the October 2009 Funding
Opportunity Announcement released by AHRQ, entitled ``Medical Liability
Reform and Patient Safety Planning Grants.''
conclusion
Mr. Chairman and Ranking Member Cochran, I appreciate the
opportunity to offer testimony on the importance of HHS budget for
fiscal year 2011.
ACP is keenly aware of the fiscal pressures facing the subcommittee
today, but strongly believes the United States must invest in these
programs in order to achieve a high performance healthcare system and
build capacity in our public health system. ACP greatly appreciates the
support of the subcommittee on these issues and looks forward to
working with Congress as you begin to work on the fiscal year 2011
appropriations process.
______
Prepared Statement of the American College of Preventive Medicine
Recommendation
The American College of Preventive Medicine (ACPM) urges the Labor,
Health and Human Services, Education, and Related Agencies
Appropriations Subcommittee to reaffirm its support for training
preventive medicine physicians and other public health professionals by
providing $5 million in fiscal year 2011 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 $600 million be appropriated in fiscal year
2011 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''. 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 professionals.
---------------------------------------------------------------------------
\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.
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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 public 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\
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\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.
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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. Yet, the skills needed to effectively prepare for and
respond to bioterrorism and other public health threats--epidemiologic
surveillance, disease prevention and containment, understanding and
management of the health systems--are at the heart of preventive
medicine training and public health practice. Preventive medicine
training produces the public health leaders needed to effectively
respond to today's threats to the public's health. A recent article on
public health leadership trends showed that health department directors
who were not physicians had difficulty handling serious outbreaks and
other medical emergencies.\9\
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\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.
\9\ Kahn, LH. A Prescription for Change: The Need for Qualified
Physician Leadership in Public Health. Health Affairs 2003; 22:241-8.
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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.\10\
---------------------------------------------------------------------------
\10\ 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.\11\
---------------------------------------------------------------------------
\11\ 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.\12\
---------------------------------------------------------------------------
\12\ 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\
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.\13\ 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 or who do not have
specific interests in areas for which limited stipends are available
(such as research in cancer prevention).
---------------------------------------------------------------------------
\13\ 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.
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The Health Resources and Services Administration (HRSA)--as
authorized in title VII of the Public Health Service Act--is a critical
funding source for several preventive medicine residency programs, as
it represents the largest Federal funding source for these programs.
HRSA funding ($2.3 million in 2010) currently supports only physicians
in preventive medicine training programs. An increase of $2.7 million
will allow HRSA to support up to 25 new preventive medicine residents.
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.
--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.
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 guided 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
(ACRT)
The Association for Clinical Research Training (ACRT), the
Association for Patient-Oriented Research (APOR), the Clinical Research
Forum (CR Forum), and the Society for Clinical and Translational
Science (SCTS) represent a coalition of professional organizations
dedicated to improving the health of the public through increased
clinical and translational research, and clinical research training.
United by the shared priorities of the clinical and translational
research community, ACRT, APOR, CR Forum, and SCTS advocate for
increased clinical and translational research at the National
Institutes of Health (NIH), the Agency for Healthcare Research and
Quality (AHRQ), and other Federal science agencies.
On behalf of ACRT, APOR, CR Forum, and SCTS, I would like to thank
the Subcommittee for their continued support of clinical and
translational research, and clinical research training. The creation of
the Patient-Centered Outcomes Research Institute in recent healthcare
reform legislation will provide a much-needed and greatly appreciated
boost to comparative effectiveness research (CER) at the Federal level.
As outlined by NIH Director Dr. Francis Collins in his five priorities
for NIH, the translation of basic science to clinical treatment is an
integral component of modern biomedical research, and a necessity to
developing the treatments and cures of tomorrow.
Today, I would like to address a number of issues that cut to the
heart of the clinical and translational research community's
priorities, including the Clinical and Translational Science Awards
program (CTSA) at NIH, career development for clinical researchers, and
support for CER at the Federal level.
As our Nation's investment in biomedical research expands to
provide more accurate and efficient treatments for patients, we must
continue to focus on the translation of basic science to clinical
research. The CTSA program at NIH is quickly becoming an invaluable
resource in this area, but full funding is needed if we are to truly
take advantage of the CTSA infrastructure.
Fully Funding and Support for the CTSA Program at NIH
With its establishment in 2006, the CTSA program at NIH began to
address the need for increased focus on translational research, or
research that bridges the gap between basic science discoveries and the
bedside. Originally envisioned as a consortium of 60 academic
institutions, the CTSA program currently funds 46 academic medical
research institutions nationwide, and is set to expand to the full 60
by 2012. The CTSAs have an explicit goal of improving healthcare in the
United States by transforming the biomedical research enterprise to
become more effectively translational. Specifically, the CTSA program
hopes to (1) improve the way biomedical research is conducted across
the country; (2) reduce the time it takes for laboratory discoveries to
become treatments for patients; (3) engage communities in clinical
research efforts; (4) increase training and development in the next
generation of clinical and translational researchers; and (5)
accelerate T1 translational science.
Although the promise of the CTSA program is recognized both
nationally and internationally, it has suffered from a lack of proper
funding along with NIH, and the National Center for Research Resources
(NCRR). In 2006, 16 initial CTSAs were funded, followed by an
additional 12 in 2007 and 14 in 2008. Level-funding at NIH curtailed
the growth of the CTSAs, preventing recipient institutions from fully
implementing their programs and causing them to drastically alter their
budgets after research had already begun. If budgets continue to
decline, the CTSAs risk jeopardizing not only new research but also the
research begun by first, second, and third generation CTSAs.
Professional judgment determined full funding to be at a level of $700
million.
We recognize the difficult economic situation our country is
currently experiencing, and greatly appreciate the commitment to
healthcare Congress has demonstrated through stimulus funding, the
fiscal year 2010 appropriations process, and most recently through
healthcare reform. The CTSAs are currently funding 46 academic research
institutions nationwide at a level of $474 million, with the goal of
full implementation by 2012. In order to reach full implementation of
60 CTSAs by 2012, and to realize the promise of the CTSAs in
transforming biomedical research to improve its impact on health, it is
imperative that the CTSA program receive funding at the level of $700
million in fiscal year 2011. Without full funding, more CTSAs will be
expected to operate with fewer resources, curtailing their
transformative promise.
A major part of the CTSA program's promise lies in its synergy with
all of NIH's Institutes and Centers (ICs), and the acceleration and
facilitation of the ICs' impact. The translation of laboratory research
to clinical treatment directly benefits patients suffering from complex
diseases and all fields of medicine. The CTSA program has created
improved translational research capacity and processes from which all
NIH's ICs stand to benefit. The development of a formal NIH-wide plan
to link all ICs to the CTSA program would efficiently capitalize on NIH
and NCRR's investment in clinical and translational science.
It is our recommendation that the subcommittee support full
implementation of the CTSA program by providing $700 million in fiscal
year 2011, and we ask that the subcommittee support the development of
a formal NIH-wide plan to integrate the CTSAs to all of NIH's
Institutes and Centers.
Continuing Support for Research Training and Career Development
Programs Through the K Awards
The future of our Nation's biomedical research enterprise relies
heavily on the maintenance and continued recruitment of promising young
investigators. Clinical investigators have long been referred to as an
``endangered species'', as financial barriers push medical students
away from research. This trend must be arrested if we are to continue
our pursuits of better treatments and cures for patients.
The K Awards at NIH and AHRQ provide much-needed support for the
career development of young investigators. As clinical and
translational medicine takes on increasing importance, there is a great
need to grow these programs, not reduce them. Career development grants
are crucial to the recruitment of promising young investigators, as
well as to the continuing education of established investigators.
Reduced commitment to the K-12, K-23, K-24, and K-30 awards would have
a devastating impact on our pool of highly trained clinical
researchers. Even with the full implementation of the CTSA program, it
will be critical for institutions without CTSAs to retain their K-30
Clinical Research Curriculum Awards, as the K-30s remain a highly cost-
effective method of ensuring quality clinical research training. ACRT,
APOR, CRF, and SCTS strongly support the ongoing commitment to clinical
research training through K Awards at NIH and AHRQ.
We ask the subcommittee to continue their support for clinical
research training and career development through the K Awards at NIH
and AHRQ, in order to promote and encourage investigators working to
transform biomedical science.
Continuing Support for CER
Comparative effectiveness research or ``CER'' emerged at the
forefront of the healthcare reform debate, capturing the interest of
lawmakers and the American people. CER is the evaluation of the impact
of different options that are available for treating a given medical
condition for a particular set of patients. This broad definition can
include medications, behavioral therapies, and medical devices among
other interventions, and is an important facet of evidence-based
medicine. On behalf of ACRT, APOR, CR Forum, and SCTS, I would like to
thank the Senate for the creation of the Patient-Centered Outcomes
Research Institute in the Patient Protection and Affordable Care Act,
as well as the $1.1 billion included for CER at NIH and AHRQ in the
American Recovery and Reinvestment Act (ARRA). Both AHRQ and NIH have
long histories of supporting CER, and the standards for research
instituted by agencies like NIH and AHRQ serve as models for best
practices worldwide. Not only are these agencies experienced in CER,
they are universally recognized as impartial and honest brokers of
information.
We are pleased that Congress recognizes the importance of these
activities and believe that the peer review processes and
infrastructure in place at NIH and AHRQ ensure the highest quality CER.
We believe that collaboration between the Patient-Centered Outcomes
Research Institute, NIH, and AHRQ will motivate all Federal CER
efforts. In addition to support for the CTSA program at NIH, we
encourage the Subcommittee to provide continued support for Patient-
Centered Health Research at AHRQ.
Thank you for the opportunity to present the views and
recommendations of the clinical research training community. On behalf
of ACRT, APOR, CR Forum, and SCTS, I would be happy to be of assistance
as the appropriations process moves forward.
______
Prepared Statement of the American College of Sports Medicine
On behalf of the American College of Sports Medicine (ACSM), I am
pleased to offer this written testimony to the Senate Appropriations
Subcommittee on Labor, Health and Human Services, Education, and
Related Agencies for inclusion in the official Committee record. I will
focus my comments on the importance of programs within the Department
of Health and Human Services (HHS), the Department of Education, and
programs recently authorized in the Patient Protection and Affordable
Care Act (Public Law 111-148) that serve as a means to educate about or
provide services that enhance healthy lifestyles for all Americans.
Within these programs, ACSM is strongly supportive of the inclusion of
provisions that enhance access to information about physical activity
and exercise as a mechanism for improving health and reducing chronic
diseases or health disparities.
ACSM is a 35,000-member organization that applies knowledge,
training, and dedication in sports medicine and exercise science to
promote healthier lifestyles for people around the globe. ACSM members
are dedicated to improving public health through a spectrum that ranges
from basic research to translating that research into effective
practice. ACSM members include leading scientists, physicians,
educators, public health experts, clinical exercise physiologists,
health and fitness professionals, physical therapists, and more.
The Nation's focus on physical activity and exercise as a means to
improve health and prevent disease has recently been garnering
increased attention. However, expanded and sustained Federal support is
necessary to fully leverage the health benefits that have been shown to
result from physical activity and exercise. Additional funding is
needed to expand basic and translational research to ensure that the
most up-to-date and effective guidance is disseminated and that
programs are developed with the goals of keeping Americans strong and
healthy and reducing the levels of chronic diseases such as heart
disease, diabetes, obesity, stroke, osteoporosis, and depression.
In particular, scientific and medical research conducted at the
National Institutes of Health (NIH) will be instrumental in building on
current efforts to improve the Nation's health and reduce diseases and
health disparities. ACSM appreciates the subcommittee's past support
for NIH and encourages the subcommittee to maintain its commitment by
allocating a total discretionary budget of $32.239 billion, which is
equal to the President's fiscal year 2011 budget request for NIH. ACSM
also encourages the subcommittee to direct a portion of this increased
funding toward institutes and programs that focus on prevention and
wellness. The combination would allow NIH to fund a record number of
research grants, including those that will help us to understand what
is needed to ensure Americans live healthier lifestyles.
In addition, summarized below are recommendations for fiscal year
2011 funding for programs within HHS, the Department of Education, and
new programs recently authorized through the Patient Protection and
Affordable Care Act (Public Law 111-148) to help ensure that the
necessary mechanisms are provided to improve health, eliminate
disparities, and reduce diseases among all Americans.
department of health and human services
The agencies within HHS include programs that support ACSM's goals.
ACSM urges the subcommittee's support for the following HHS programs:
Community Health Centers.--ACSM appreciates the subcommittee's
support for the Health Centers program within the Health Resources and
Services Administration (HRSA). The Health Centers program provides
access to comprehensive primary healthcare, including supportive
services such as transportation and education for individuals and
families in high-need communities. ACSM urges the Committee to
appropriate at least the President's fiscal year 2011 request of $2.5
billion for the program, an increase of $290 million above the fiscal
year 2010 enacted level and to direct a portion of this funding to
allow new and existing centers to expand to include services and
information that highlight the health benefits of physical activity and
exercise.
Centers for Disease Control and Prevention.--ACSM supports the
increases proposed in the President's fiscal year 2011 budget request
for programs within the Centers for Disease Control and Prevention
(CDC), including: Chronic Disease Prevention, Health Promotion and
Genomics, a total of $937 million; Public Health Research, a total of
$31 million; and Preventive Health and Health Services Block Grant, a
total of $102 million. ACSM urges the Committee to direct a portion of
the funding within these programs to physical activity and exercise
programs and research.
patient protection and affordable care act
ACSM urges the subcommittee to fund the following programs
authorized in the Patient Protection and Affordable Care Act (Public
Law 111-148), which deal with prevention of chronic disease and
improving public health:
Prevention and Public Health Fund.--This fund would be administered
by the Secretary of HHS and would increase funding for programs
authorized by the Public Health Service Act for prevention, wellness,
and public health activities. ACSM urges the Committee to use its
authority to transfer money from the fund to existing or new programs
authorized by the Public Health Service Act that have a particular
focus on physical activity and exercise, including the Community
Transformation grant program.
U.S. Preventive Services Task Force/Community Preventive Services
Task Force.--These task forces will coordinate with the Advisory
Committee on Immunization Practices, and will comprise experts to
review scientific evidence related to effectiveness, appropriateness,
and cost-effectiveness of clinical preventive services for the purpose
of developing recommendations to be widely distributed to and utilized
by the public. ACSM urges the Committee to appropriate the necessary
funding to establish these task forces, in order to help ensure that
the best practices in health and wellness, including physical activity
and exercise guidelines and recommendations, are being promoted.
Education and Outreach Campaign.--This campaign would be developed
by a public-private partnership with the aim of raising public
awareness of health improvement across the life span. ACSM urges the
Committee to appropriate funding to allow for successful development
and implementation of the campaign.
department of education
ACSM urges the subcommittee to support the following program at the
Department of Education:
Carol M. White Physical Education Program/Successful, Safe, and
Healthy Students.--ACSM supports programming within the Department of
Education that focuses on developing healthy lifestyles for students
and the Nation's youth population. In the President's fiscal year 2011
budget request, the Carol M. White Physical Education Program was
proposed for consolidation into an overarching Successful, Safe, and
Healthy Students program, of which one goal is improving students'
physical health and well-being through the use of, or access to,
comprehensive services that improve student physical activity and
fitness. ACSM urges the Committee to provide increased funding for the
Carole M. White Physical Education Program or direct a significant
portion of the funding provided to the Successful, Safe, and Healthy
Students program to focus on physical activity, exercise, and the
development of healthy lifestyles for youth.
I appreciated the opportunity to submit these recommendations and
hope the Committee will consider them while developing appropriations
for fiscal year 2011.
______
Prepared Statement of the American Diabetes Association
Thank you for the opportunity to provide this testimony to the
Senate Labor, Health and Human Services, and Education, and Related
Agencies Subcommittee. I am pleased to have the opportunity to submit
testimony on behalf of the American Diabetes Association. As someone
who has lived with diabetes for more than 30 years, I am proud to be a
representative of the 81 million American adults and children living
with diabetes or pre-diabetes.
Every minute, three more people are diagnosed with the disease.
While nearly 24 million Americans have diabetes today, that number is
expected to grow to 44 million in the next 25 years if present trends
continue. Every 24 hours, 230 people with diabetes will undergo an
amputation, 120 people will enter end-stage kidney disease programs,
and 55 people will go blind from diabetes. Each and every day diabetes
will cost our country over a half a billion dollars, yet, it is but a
fraction of the costs that lie ahead unless we take action immediately
to stop the march of this epidemic.
Thanks to you and your colleagues, Congress has consistently funded
vital Department of Health and Human Services programs to help reduce
the overwhelming costs of diabetes. However, if we are to cure and
prevent diabetes, there is much more to accomplish. Therefore, the
Association urges the Senate Labor, Health and Human Services, and
Education, and Related Agencies Subcommittee to invest in research and
prevention proportionate to the magnitude of the burden diabetes has on
our country and, by doing so, to change the future of diabetes in
America.
As the Nation's leading nonprofit health organization providing
diabetes research, information and advocacy, the Association believes
Federal funding for diabetes prevention and research is critical, not
only for the 24 million American adults and children (nearly 8 percent
of the population) who currently have diabetes, but for the 57 million
more with pre-diabetes. Of the 24 million, 6 million are unaware they
have diabetes. Together, this means 25 percent of the U.S. population
either has, or is at risk for developing, this serious disease. Federal
funding for diabetes prevention and research efforts is critical to
reversing this epidemic.
Diabetes is a chronic condition that impairs the body's ability to
use food for energy. The hormone insulin, which is made in the
pancreas, helps the body change food into energy. In people with
diabetes, either the pancreas does not create insulin, which is type 1
diabetes, or the body does not create enough insulin and/or cells are
resistant to insulin, which is type 2 diabetes. If left untreated,
diabetes results in too much glucose in the blood stream. The majority
of diabetes cases, 90 to 95 percent, are type 2, while type 1 diabetes
accounts for 5 to 10 percent of diagnosed cases. The complications of
diabetes are widespread and serious. In those with pre-diabetes, blood
glucose levels are higher than normal and taking action to reduce their
risk of developing diabetes is essential.
The Centers for Disease Control and Prevention (CDC) has identified
diabetes as a disabling, deadly epidemic that is on the rise. Between
1990 and 2001, the prevalence of diabetes increased by 60 percent.
According to the CDC, 1 in 3 children born in the year 2000 is likely
to develop the disease in their lifetime if current trends continue.
This number is even greater among minority populations, where nearly 1
in 2 children will develop diabetes.
Additionally, type 2 diabetes, traditionally seen in older
patients, is beginning to reach a younger population, due in part to
the surge in childhood obesity. Approximately 1 in every 500 children
and adolescents has Type 1 diabetes, and an alarming 2 million
adolescents (or 1 in 6 overweight adolescents) aged 12-19 have pre-
diabetes. The impact diabetes has on individuals and the healthcare
system is enormous and continues to grow at a shocking rate. Diabetes
is a leading cause of kidney disease, adult-onset blindness and lower
limb amputations as well as a significant cause of heart disease and
stroke. Since 1987, the death rate due to diabetes has increased by 45
percent. In that same period, death rates for heart disease, stroke,
and cancer have dropped.
In addition to the physical toll, diabetes also attacks our
pocketbooks. A recent study by the Lewin Group found when factoring in
the additional costs of undiagnosed diabetes, pre-diabetes, and
gestational diabetes, the total cost of diabetes and related conditions
in the United States in 2007 was $218 billion ($18 billion for
undiagnosed diabetes; $25 billion for pre-diabetes; $623 million for
gestational diabetes). That year, medical expenditures due to diabetes
totaled $116 billion, including $27 billion for diabetes care, $58
billion for chronic diabetes-related complications, and $31 billion for
excess general medical costs. Indirect costs resulting from increased
absenteeism, reduced productivity, disease-related unemployment
disability and loss of productive capacity due to early mortality
totaled $58 billion. This is an increase of 32 percent since 2002.
Thus, in just 5 years, the cost of diabetes increased by $42 billion,
or $8 billion per year. In fact, approximately 1 out of every 5
healthcare dollars is spent caring for someone with diagnosed diabetes,
while 1 in 10 healthcare dollars is attributed to diabetes.
Additionally, one-third of Medicare expenses are associated with
treating diabetes and its complications.
Despite these numbers, there is hope. A greater Federal investment
in diabetes research at the National Institute of Diabetes and
Digestive and Kidney Diseases (NIDDK) at the National Institutes of
Health (NIH), and prevention, surveillance, control, and research work
currently being done at the Division of Diabetes Translation (DDT) at
the CDC is crucial for finding a cure and improving the lives of those
living with, or at risk for, diabetes. Additionally, the National
Diabetes Prevention Program (NDPP), a new program authorized through
the Patient Protection and Affordable Care Act (Public Law 111-148,
section 399V-3), is poised to cut dramatically the number of new
diabetes cases in high-risk individuals. In this vein, for fiscal year
2011, the American Diabetes Association is requesting:
--$2.209 billion for the NIDDK, an increase of $252 million over the
fiscal year 2010 level. This additional funding will act to
offset years of flat funding and inflation that caused cutbacks
to promising research. It will also demonstrate Congress's
commitment to science and research.
--$86 million for the CDC's DDT, which represents a total increase of
$20 million for the DDT's critical prevention, surveillance and
control programs. Expanded investment in the DDT will produce
much larger savings in reduced acute, chronic, and emergency
care spending.
Additionally, we are also requesting your support of $80 million
for the implementation of the NDPP through the Prevention and Public
Health Fund created in Public Law 111-148.
NIH's National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK)
One of the 27 Institutes housed at the NIH, NIDDK is poised to make
major discoveries that could prevent diabetes, better treat its
complications, and--ultimately--find a cure. Researchers at the NIH are
working on a variety of projects that represent hope for the millions
of individuals with both type 1 and type 2 diabetes. The list of
advances in treatment and prevention is long, but it is important to
understand much more can be achieved for people with diabetes with an
increased investment in scientific research at the NIDDK.
Researchers have already learned a great deal about the biology of
diabetes, and they now understand much more about the loss of islet
cell function, which can affect the body's ability to regulate blood
glucose levels. These discoveries have led directly to islet cell
transplants and ongoing work to extend the life of transplanted cells.
Thanks to research at the NIDDK, people with diabetes now manage their
disease with a variety of insulin formulations and regimens far
superior to those used in decades past. The result is the ability to
live healthier lives with diabetes. Because of these advances, my
hemoglobin A1C, which provides a snapshot of an individual's blood
glucose, went from 12.9 percent to 5.9 percent. This is a dramatic
development for me and proof of the importance of NIDDK's work.
Recent discoveries at the NIDDK include the ability to predict type
1 diabetes risk, new drug therapies for type 2 diabetes, and the
discovery of genetic markers that explain the increased burden of
kidney disease among African Americans. The NIDDK funded the Diabetes
Prevention Program, a multicenter clinical research trial that found
modest weight loss through dietary changes and increased physical
activity could prevent or delay the onset of type 2 diabetes by 58
percent.
While great strides have been made in diabetes research, there are
many unanswered questions about the disease that merit further study.
Towards that end, the NIDDK, in its role as the convener of the
Diabetes Mellitus Coordinating Committee, a panel of key HHS agencies,
including the Food and Drug Administration and the CDC, and other
Federal partners such as the Department of Veterans Affairs, has
developed a Diabetes Research Strategic Plan, to be finalized later
this year, which outlines diabetes research needs.
The plan identifies a number of areas for additional research.
These include study into the intersection of genetic and environmental
risk factors for diabetes in people of color in order to reduce the
prevalence of the disease and its complications; identification of the
key genetic factors that predispose or protect individuals against
diabetes complications; and, study of the natural history of type 1
diabetes in order to foster the design of preventive therapy.
Additional fiscal year 2011 funding would allow the NIDDK to support
additional research in order to build upon past successes, improve
prevention and treatment, and close in on a cure.
CDC's Division of Diabetes Translation (DDT)
The CDC's DDT works to eliminate the preventable burden of diabetes
through proven educational programs, best practice guidelines and
applied research. Funds appropriated to the DDT focus on developing and
maintaining State-based Diabetes Prevention and Control Programs
(DPCPs); supporting the National Diabetes Education Program (NDEP);
defining the diabetes burden through the use of public health
surveillance; and translating research findings into clinical and
public health practice. Our request of an additional $20 million will
allow these critical programs at the DDT to reach more at risk
Americans and help to prevent or delay this destructive disease.
The DDT's most important efforts are based within the DPCPs in all
50 States, the District of Columbia, and 8 other territories and are
cornerstones of the Division's work. DPCPs work to not only reduce the
incredible burden of diabetes, but to make certain the people they
serve are fully aware of the disease and those with or at risk of
developing diabetes are receiving the highest quality of care possible.
Because they are community based, DPCPs are highly adaptable and
capable of reaching those at greatest risk in a given area. DPCPs
provide a vital infrastructure to coordinate diabetes prevention and
control efforts, however, a severe lack of funding leaves DPCPs unable
to reach all of those who could benefit from their work.
The Division also recognizes the role that education and awareness
plays in the fight against diabetes. With this in mind, the DDT
implements the NDEP in coordination with the NIDDK. The NDEP develops
and disseminates information on the prevention and control of diabetes
that serve as the guiding principles to improve the treatment and
outcomes for people with diabetes and to prevent or delay the onset of
diabetes. Another vital component of the DDT's efforts is the National
Diabetes Surveillance System, which provides comprehensive diabetes
data at the national, State, and local levels so analysts may better
track the epidemic, and ensure the most effective use of taxpayer
dollars.
The DDT also identifies important research findings, including the
results of clinical trials and scientific studies, in order to pinpoint
the public health implications of the research. These findings are
applied in healthcare systems and within local communities. Areas of
translational research include access to quality care for diabetes;
cost-effectiveness of diabetes prevention and control activities;
effectiveness of health practices to address risk factors for diabetes;
and demonstration of primary prevention of type 2 diabetes. One example
of a highly successful translational effort by the DDT is the Diabetes
Prevention Program Initiative (DPPI), a structured lifestyle
intervention modeled after the NIDDK's Diabetes Prevention Program
(DPP) clinical research study. The DPPI is proving group lifestyle
intervention can lower diabetes risk while being delivered in a cost
effective way in a community setting, thus increasing the likelihood of
improved outcomes for individuals at risk of developing the disease.
While the DDT has played an invaluable and instrumental role in
fighting the diabetes epidemic, the reach of the Division could be
significantly broader with additional fiscal year 2011 funding. With an
additional $20 million, the DDT will be able to expand the reach of
DPCPs in every State and territory. Given the dramatic decreases in
funding for State and local health departments, supporting the work of
the DPCPs to provide prevention and control guidelines and technical
assistance to health officials in local communities is more critical
than ever to ensure access to affordable and high-quality diabetes care
and services.
Increased funding for the DDT will also allow the Division to build
upon its work in reducing health disparities through vital programs
such as the Native Diabetes Wellness Program, furthering the
development of effective health promotion activities and messages
tailored to American Indian/Native Alaskan communities. Additional
resources will enable the DDT to expand its translational research
studies that will lead to improved public health interventions. An
excellent example of this work is the Search for Diabetes in Youth
study; a collaboration between the DDT and the NIDDK designed to
further clarify the impact of type 2 diabetes in youth so prevention
activities aimed at young people can be improved.
The National Diabetes Prevention Program (NDPP)
Further studies of the DPP have shown this groundbreaking
intervention can be replicated in community settings for a cost of less
than $300 per participant. With this in mind, the NDPP was authorized
by the Patient Protection and Affordable Care Act of 2010 (Public Law
111-148). This new program will provide funding to the CDC to expand
such evidence-based programs across the country. The Association
acknowledges your leadership in the implementation of Public Law 111-
148, specifically the Prevention and Public Health Fund (section 4002),
which provided $15 billion in mandatory funding over the next 10 years
for public health, wellness and prevention programs. We respectfully
ask the subcommittee to support $80 million from the Fund for the NDPP.
The NDPP meets the goals of the Fund, which seeks to make a
national investment in prevention and public health programs, both to
improve the health of Americans and to rein in healthcare costs. The
Urban Institute reported our country could save as much as $190 billion
over 10 years by bringing the NDPP to scale. Implementation of the NDPP
would allow the CDC to expand the reach of evidence-based community
programs to identify, refer and provide those at high risk for diabetes
with cost-effective interventions.
conclusion
As you consider the fiscal year 2011 appropriation for the NIDDK
and the DDT, we ask that you consider diabetes is an epidemic growing
at an astonishing rate. If left unaddressed diabetes will overwhelm the
healthcare system with tragic consequences. To change this future we
need to increase our commitment to research and prevention in a way
that reflects the burden diabetes poses both for us and for our
children.
Increasing NIDDK funding to $2.209 billion for next year opens the
door to research opportunities that will both improve patient outcomes
and reduce the economic cost of diabetes. Through the CDC's important
programs at the DDT, we have the chance to drastically reduce the
number of people with diabetes. Given the astounding costs of diabetes,
the request of $86 million for DDT is a modest investment in our
future. Further, $80 million from the Prevention and Public Health Fund
for the implementation of the NDPP will not only improve the health of
millions of Americans who are at high risk for diabetes, but it will
also save healthcare costs in the long term.
Our fight against diabetes must be significantly expanded. Your
continued leadership in combating this growing epidemic is essential in
stemming the epidemic. Thank you for your commitment to the diabetes
community and for the opportunity to submit this testimony. The
Association is prepared to answer any questions you might have on these
important issues.
______
Prepared Statement of the American Dental Education Association
The American Dental Education Association (ADEA) is pleased to
offer its recommendations for fiscal year 2011 appropriations for
dental education and research.
The ADEA represents all 60 dental schools in the United States, in
addition to more than 700 dental residency training programs and nearly
600 allied dental programs, as well as more than 12,000 faculty who
educate and train the nearly 50,000 students and residents attending
these institutions. It is at these academic dental institutions that
future practitioners and researchers gain their knowledge, where the
majority of dental research is conducted, and where significant dental
care is provided. ADEA member institutions serve as dental homes for a
broad array of racially and ethnically diverse patients, many who are
uninsured, underinsured, or reliant on public programs such as Medicaid
and the Children's Health Insurance Program for their healthcare.
ADEA's requests build upon funding from the American Economic
Recovery and Reinvestment Act (ARRA) and the Labor, Health and Human
Services, and Education, and Related Agencies fiscal year 2010
appropriations. The Department of Health and Human Services has several
oral health programs that address the various aspects needed to improve
oral healthcare in America. These programs build and sustain State oral
health departments, fund proven public health programs to prevent oral
disease, target research to eradicate dental disease, and work to
develop an adequate workforce of dentists with advanced training to
serve children, the aged and those suffering from specific diseases
like AIDS.
Our budget recommendations include the following:
--Dental Education.--The Title VII Health Professions Education and
Training Programs and Diversity and Student Aid Programs,
administered by the Health Resources and Services
Administration (HRSA);
--Oral Health Research.--The National Institutes of Health (NIH) and
the National Institute of Dental and Craniofacial Research
(NIDCR); and
--Access to Care.--The Ryan White CARE Act HIV/AIDS Dental
Reimbursement Program and the Community-Based Dental
Partnerships Program; the Dental Health Improvement Act; the
Oral Health Program at the Centers for Disease Control and
Prevention (CDC); and the National Health Service Corps (NHSC).
Specifically, the ADEA respectfully urges the subcommittee to
provide $30 million for section 5303 of (Public Law 111-148) for the
continuation and enhancement of dental training programs. The following
programs help to address the Nation's oral healthcare needs:
dental education
$16 Million for General Dentistry and Pediatric Dentistry Residency
Training in the Title VII Health Professions Programs
The Title VII General and Pediatric Dentistry Programs are critical
to building the primary care dental workforce. Support for these
programs is essential to expanding existing or establishing new general
dentistry and pediatric dentistry residency programs, which have shown
to be effective in increasing access to dental care for vulnerable
populations, including patients with developmental disabilities,
children, and geriatric patients. These primary care dental residency
programs generally include outpatient and inpatient care and afford
residents an excellent opportunity to learn and practice in all phases
of primary care dentistry, including trauma and emergency care, and
comprehensive ambulatory dental care for adults and children.
$118 Million for Diversity and Student Aid
$33 Million for Centers of Excellence
$49 Million for Scholarships for Disadvantaged Students
$35 Million for Health Careers Opportunity Program
$1.3 Million for Faculty Loan Repayment Program
The Title VII Diversity and Student Aid programs play a critical
role in helping to diversify the health profession's student body and
thereby the healthcare workforce. Blacks, Hispanics, and American
Indians currently represent more than 25 percent of the U.S.
population. By the year 2050, nearly 1 in 5 Americans (19 percent) will
be an immigrant, compared with 1 in 8 (12 percent) in 2005. Despite
these population trends, minorities are underrepresented in the U.S.
healthcare workforce. This is no less true of dentistry, where they
comprise less than 5 percent of dentists and about 9 percent of dental
faculty. For the last several years, these programs have not enjoyed an
adequate level of funding to sustain the progress that is necessary to
meet the challenges of an increasingly diverse U.S. population.
oral health research
$35 Billion for the NIH, Including $463 Million for the NIDCR
Discoveries stemming from dental research have reduced the burden
of oral diseases, led to better oral health for tens of millions of
Americans, and uncovered important associations between oral and
systemic health. Dental researchers are poised to make new
breakthroughs that can result in dramatic progress in medicine and
health, such as repairing natural form and function to faces destroyed
by disease, accident, or war injuries; diagnosing systemic disease from
saliva instead of blood samples; and deciphering the complex
interactions and causes of oral health disparities involving social,
economic, cultural, environmental, racial, ethnic, and biological
factors. Dental research is the underpinning of the profession of
dentistry. With grants from NIDCR, dental researchers in academic
dental institutions have built a base of scientific and clinical
knowledge that has been used to enhance the quality of the Nation's
oral health and overall health.
Dental scientists also are putting science to work for the benefit
of the healthcare system through translational research, comparative
effectiveness research, health information technology, health research
economics, and further research on health disparities. NIDCR continues
to make disparities a priority by renewing five disparities centers for
2008-2015: Boston University Henry M. Goldman School of Dental
Medicine, the University of California San Francisco School of
Dentistry, the University of Colorado Denver School of Dental Medicine,
the University of Florida College of Dentistry, and the University of
Washington School of Dentistry.
The latest NHANES data that provided a full dental examination,
1999-2004, show that dental caries in young children has actually
increased, particularly in those populations covered by SCHIP and
Medicaid. The June 2009 IOM Study on Comparative Effectiveness Research
(CER) included two oral health topics in the top 100 national
priorities for CER.
NIDCR funded four ARRA Challenge Grants on CER. Investments in
dental research will produce inventions that make corporations more
competitive in the global economy and benefit everyone with new
businesses and jobs. Investments in dental research will produce
inventions that make corporations more competitive in the global
economy and benefit everyone with new businesses and jobs. It is
important to note that NIH disproportionately creates higher-paying
employment opportunities that require a higher level of technical
sophistication in construction, staffing, and supporting laboratories.
The average wage associated with jobs created through NIH grants and
contracts was $52,000 in 2007.
access to dental care
$19 Million for the Dental Reimbursement Program and the Community-
Based Dental Partnerships Program, part F of the Ryan White
HIV/AIDS Treatment and Modernization Act
Patients with compromised immune systems are more prone to oral
infections like periodontal disease and tooth decay. By providing
reimbursement to dental schools and schools of dental hygiene, the
Dental Reimbursement Program provides access to quality dental care for
people living with HIV/AIDS while simultaneously providing educational
and training opportunities to dental residents, dental students, and
dental hygiene students who deliver the care. The Dental Reimbursement
Program is a cost-effective Federal/institutional partnership that
provides partial reimbursement to academic dental institutions for
costs incurred in providing dental care to people living with HIV/AIDS.
Particularly important to this program is the fact that Congress
designated dental care as a ``core medical service'' when it
reauthorized the Ryan White program in 2006.
The Community-Based Dental Partnership Program fosters partnerships
between dental schools and communities lacking academic dental
institutions to ensure access to dental care for HIV/AIDS patients
living in those areas.
$20 Million for the Dental Health Improvement Act (DHIA)
This program supports the development of innovative dental
workforce programs specific to States' dental workforce needs and
increases access to dental care for underserved populations. In fiscal
year 2006, Congress provided first-time DHIA funding of $2 million to
assist States in developing innovative dental workforce programs. The
inaugural grant cycle, held in fiscal year 2006, yielded 36
applications from States. Eighteen States were awarded grants ranging
from $67,865 to $124,080. Grants are being used to support a variety of
initiatives including, but not limited to, loan repayment programs to
recruit culturally and linguistically competent dentists to work in
underserved areas with underserved populations including the
developmentally disabled; rotating residents and students in rural
areas; recruiting dental school faculty; training pediatricians and
family medicine physicians to provide oral health services (screening
exams, risk assessments, fluoride varnish application, parental
counseling, and referral of high-risk patients to dentists); and
supporting teledentistry.
$33 Million for the Oral Health Programs at the Centers for Disease
Control and Prevention (CDC)
The CDC Oral Health Program expands the coverage of effective
prevention programs. The program increases the basic capacity of State
oral health programs to accurately assess the needs of the State,
organize and evaluate prevention programs, develop coalitions, address
oral health in State health plans, and effectively allocate resources
to the programs. CDC's funding and technical assistance to States is
essential to help oral health programs build capacity. Increasing the
funding will help to ensure that all States that apply may be awarded
an oral health grant.
$414 Million for the NHSC
The NHSC scholarship and loan repayment program provides awards to
healthcare professionals, including dentists and dental hygienists who
agree to work in underserved communities for a minimum of 2 years.
Participants must work in a Health Professional Shortage Area (HPSA),
and dentists and dental hygienists work in Dental Health Professional
Shortage Areas (Dental HPSAs). According to the HRSA there are 4,230
Dental HPSAs with 49 million people living in them. It would take 9,642
practitioners to meet their need for dental providers (a population to
practitioner ratio of 3,000:1). The dedicated clinicians of the NHSC
provide quality care to millions of people who would otherwise lack
adequate access to health services.
The ADEA is grateful to the subcommittee for considering our fiscal
year 2011 budget requests for Federal agencies and programs that
sustain and enhance dental education, oral health research, and access
to care. A continuing Federal commitment is needed to help meet the
challenges oral diseases pose to the Nation's most vulnerable citizens,
including children. Also critical is the development of a partnership
between the Federal Government and dental education programs to
implement a national oral health plan that guarantees access to dental
care for everyone, ensures continued dental health research, and
eliminates disparities and workforce shortages.
______
Prepared Statement of the Arthritis Foundation
The Arthritis Foundation greatly appreciates the opportunity to
submit testimony in support of increased funding for arthritis
prevention at the Centers for Disease Control and Prevention (CDC);
additional investment in arthritis research at the National Institutes
of Health (NIH); and funding for the Health Resources and Services
Administration (HRSA) to commence a loan repayment program for
pediatric specialists.
Arthritis is a term used to describe more than 100 different
conditions that affect joints as well as other parts of the body.
Arthritis is one of the most prevalent chronic health problems and the
most common cause of disability in the United States. Forty-six million
people (1 in 5 adults) and almost 300,000 children live with the pain
of arthritis every day. The medical and societal impact of arthritis in
the United States is staggering at $128 billion, including $81 billion
in direct costs for physician visits and surgical interventions and $47
billion in indirect costs for missed work days. Counter to public
perception, two-thirds of the people with doctor-diagnosed arthritis
are under the age of 65.
By the year 2030, an estimated 67 million or 25 percent of the
projected adult population will have arthritis. Furthermore, arthritis
limits the ability of people to effectively manage other chronic
diseases. More than 57 percent of adults with heart disease and more
than 52 percent of adults with diabetes also have arthritis. The
Arthritis Foundation strongly believes that in order to prevent or
delay arthritis from disabling people and diminishing their quality of
life that a significant investment in prevention and intervention
strategies is essential. Research shows that the pain and disability of
arthritis can be decreased through early diagnosis and appropriate
management, including evidence based self-management activities such as
weight control and physical activity. The Arthritis Foundation's Self-
Help Program, a group education program, has been proven to reduce
arthritis pain by 20 percent and physician visits by 40 percent. These
interventions are recognized by the CDC to reduce the pain of arthritis
and importantly reduce healthcare expenditures through a reduction in
physician visits.
CDC
During the past year, the CDC has partnered with the Arthritis
Foundation and more than 50 organizations to create a National Public
Health Agenda for Osteoarthritis. The Agenda states the need to
increase availability of evidence-based intervention strategies;
increase public health attention for prevention and disease management;
and increase research to better understand disease risk factors and
other effective disease management strategies.
With CDC funding, 12 State health departments in partnership with
other State organizations have successfully increased public awareness
of the burden of arthritis and increased the availability of four main
interventions. First, self-management education (as described above) is
proven to improve the quality of life and healthcare for people with
arthritis and should be expanded to people with symptomatic arthritis.
Second, physical activity is the best medicine to fight arthritis pain.
The promotion of low-impact aerobic physical activity and muscle
strengthening exercises for weight loss and to provide joint support is
key. Losing just 1 pound of weight reduces 4 pounds of pressure off
each knee. Third, preventing joint injuries through existing policies
and interventions which have been shown to reduce arthritis-related
joint injuries. Finally, promoting weight management and healthy
nutrition will facilitate the prevention and treatment of arthritis.
Now, is the time to make a significant investment to sustain and
improve the reach of these proven interventions.
Currently, the CDC's arthritis program receives $13 million in
annual funding and about half of that amount is distributed via
competitive grant to 12 States. An additional investment of $10 million
would fund 12-14 new States and enable evidence-based prevention
programs to reach many more Americans through innovative delivery
approaches. The Arthritis Foundation strongly recommends that Congress
invest an additional $10 million (total of $23 million) in the CDC's
arthritis program in fiscal year 2011 to expand proven prevention and
treatment strategies and fund up to 14 new States.
NIH/National Institute of Arthritis and Musculoskeletal and Skin
Diseases (NIAMS)
While new treatment options are available which greatly improve the
quality of life for people living with arthritis, the ultimate goal is
to find a cure. The Arthritis Foundation firmly believes research holds
the key to tomorrow's advances and provides hope for a future free from
arthritis pain. As the largest nonprofit contributor to arthritis
research, the Arthritis Foundation fills a vital role in the big
picture of arthritis research. Our research program complements
Government and industry-based arthritis research by focusing on
training new investigators and pursuing innovative strategies for
preventing, controlling, and curing arthritis. By supporting
researchers in the early stages of their careers, the Arthritis
Foundation makes important initial discoveries possible that lead to
ultimate breakthrough results.
The mission of NIAMS is to support research into the causes,
treatment, and prevention of arthritis and musculoskeletal and skin
diseases, the training of basic and clinical scientists to carry out
this research, and the dissemination of information on research
progress in these diseases. Research opportunities at NIAMS are being
curtailed due to the stagnating and in some cases declining numbers of
new grants being awarded for specific diseases. The training of new
investigators has unnecessarily slowed down and contributed to a crisis
in the research community where new investigators have begun to leave
biomedical research careers in pursuit of other more successful
endeavors.
The Arthritis Foundation is dedicated to finding a cure for
arthritis. However, the investment in NIH research is absolutely
crucial to realize this dream. With continued and increased investment
in research, the Arthritis Foundation believes a cure is on the
horizon. To support research that will lead to improved treatments and
a potential cure for arthritis, the Arthritis Foundation urges Congress
to provide $603.8 million, a 12 percent increase, for the NIH/NIAMS.
HRSA
Juvenile arthritis is the leading cause of acquired disability in
children and is the sixth most common childhood disease. Sustaining the
field of pediatric rheumatology is essential to the care of the almost
300,000 children under the age of 18 living with a form of juvenile
arthritis. Children who are diagnosed with juvenile arthritis will live
with this chronic and potentially disabling disease for their entire
life. Therefore, it is imperative that children are diagnosed quickly
and start treatment before significant irreversible joint damage is
done. However, it is a challenge to first find a pediatric
rheumatologist, as nine States do not have a single one, and then to
have a timely appointment as many States have only one or two to see
thousands of patients. Pediatric rheumatology is one of the smallest
pediatric subspecialties with less than 200 pediatric rheumatologists
actively practicing in the United States. A report to Congress in 2007
stated there was a 75 percent shortage of pediatric rheumatologists and
recommended loan repayment program to help address the workforce issue.
The recent passage of the Patient Protection and Affordable Care
Act authorizes HRSA to commence a loan repayment program for pediatric
specialists and authorizes Congress to appropriate $30 million for this
program. A percentage of this funding should be allocated for pediatric
rheumatology. The Arthritis Foundation strongly recommends funding this
program immediately at the $30 million level to help increase the
pediatric rheumatology workforce.
The Arthritis Foundation appreciates the opportunity to submit our
recommendations to Congress on behalf of the 46 million people with
arthritis. The mission of the Arthritis Foundation is the prevention,
control, and cure of arthritis. The Arthritis Foundation urges Congress
to focus Federal investment through a $23 million appropriation for
arthritis prevention at CDC; a $30 million appropriation to help
control juvenile arthritis; and a 12 percent increase toward a cure in
arthritis research at the NIH. Each part of the equation-prevention,
control, and cure-are an essential part to a future world free of
arthritis pain and disability.
______
Prepared Statement of the American Heart Association
Over the past 50 years, significant progress has been made in the
battle against cardiovascular disease (CVD) and stroke. The improved
diagnosis and treatment has been remarkable--as has the survival rate.
According to the National Institutes of Health (NIH), 1.6 million lives
have been saved since the 1960s that otherwise would have been lost to
CVD. Americans can expect to live on average 4 years longer due to the
reduction in heart-related deaths.
However, one startling fact remains. Heart disease and stroke are
still respectively the No. 1 and No. 3 killers of men and women in the
United States. Nearly 2,300 Americans die of CVD each day--one death
every 38 seconds. CVD is a leading cause of disability and will cost
our Nation an estimated $503 billion in medical expenses and lost
productivity this year.
An estimated 81 million American adults now suffer from heart
disease, stroke, and other forms of CVD. Risk factors such as obesity
and diabetes are increasing. At the age of 40, lifetime risk for CVD is
2 in 3 for men and more than 1 in 2 for women.
In the face of these staggering statistics, heart disease and
stroke research, treatment and prevention programs remain woefully
underfunded and overall funding for the NIH is too volatile to have the
continuity of effort needed for the major breakthroughs that will
redefine diseases, spur prevention and promote best care.
CVD is the No. 1 killer in each State and many preventable and
treatable risk factors continue to rise. Yet, the Centers for Disease
Control and Prevention (CDC) invests on average only 16 cents per-
person a year on heart disease and stroke prevention. Specifically, CDC
still provides basic implementation awards to only 14 States for its
Heart Disease and Stroke Prevention Program and only 20 States are
funded for WISEWOMAN--a heart disease and stroke screening and
prevention program proven to be effective in reaching uninsured and
under-insured low-income women ages 40 to 64 with a high prevalence of
risk factors for these diseases.
Where you live could also affect if you survive a very deadly form
of heart disease--sudden cardiac arrest (SCA). Only 10 States received
funding in fiscal year 2009 for 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 applauds the Administration and
Congress for providing hope to the 1 in 3 adults in the United States
who live with the consequences of CVD through the enactment of the
American Recovery and Reinvestment Act (ARRA).
The $10 billion in funding for NIH and the $650 million for
Communities Putting Prevention to Work Program are wise and prudent
investments that have provided a much needed boost to improve our
Nation's physical and fiscal health. Yet, these funds denote a one-time
infusion of resources. Stable and sustained funding is imperative in
fiscal year 2011 to advance heart disease and stroke research,
prevention and treatment.
funding recommendations: investing in the health of our nation
Heart disease and stroke risk factors continue to rise, yet
promising research opportunities to stem this tide go unfunded.
Americans still die from CVD, while proven prevention programs and
techniques beg for implementation. Clearly, now is the time to
capitalize on the momentum achieved under ARRA to enhance research,
prevention and treatment of America's No. 1 and most costly killer. If
Congress fails to build on this progress, Americans will pay more in
the future in lives lost and higher healthcare costs. Our
recommendations below address these issues in a comprehensive and
fiscally responsible manner.
Capitalize on ARRA Investment for the National Institutes of Health
(NIH)
NIH research has revolutionized patient care and holds the key to
finding new ways to prevent, treat and even cure CVD, resulting in
longer, healthier lives and reduced healthcare costs. NIH invests
resources in every State and in 90 percent of congressional districts.
Each NIH grant generates on average 7 jobs.
The American Heart Association Advocates.--We advocate for a fiscal
year 2011 appropriation of $35.2 billion for NIH--a $4.2 billion
increase more than fiscal year 2010, to capitalize on the momentum
achieved under the ARRA investment to save lives, advance better
health, spur our economy and spark innovation. NIH-supported research
prevents and cures disease, generates economic growth and preserves the
U.S. role as the world leader in pharmaceuticals and biotechnology.
Enhance Funding for NIH Heart and Stroke Research: A Proven and Wise
Investment
Death rates for coronary heart disease fell 36 percent and nearly
34 percent for stroke from 1996-2006. These declines are directly
related to NIH heart and stroke research, with scientists on the verge
of exciting discoveries that could lead to new treatments and even
cures. Landmark NIH research has shown that surgery and stenting are
both safe and effective in preventing stroke. It has demonstrated that
over-zealous blood pressure lowering and combination lipid drugs do not
cut cardiovascular disease in adult diabetics more so than standard
evidence-based care; nor does postmenopausal hormone therapy avert
heart disease or stroke. And it has defined the genetic basis of risky
responses to vital blood-thinners.
In addition to saving lives, NIH-funded 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
savings of $1.27 billion. But, in the face of such solid returns on
investments and other successes, NIH still invests a meager 4 percent
of its budget on heart research, and a mere 1 percent on stroke
research.
Cardiovascular Disease Research: National Heart, Lung, and Blood
Institute (NHLBI)
Despite progress and promising research opportunities, there is no
cure yet for CVD. As our population ages, the demand will increase for
more and better ways to allow Americans to live healthy and productive
lives despite CVD. Stable and sustained funding is needed to allow
NHLBI to build on ARRA investments that provided grants to use genetics
to identify and treat those at greatest risk from heart disease; hasten
drug development to treat high cholesterol and high blood pressure; and
create tailored strategies to treat, slow or prevent heart failure.
Other important studies include an analysis of whether maintaining a
lower blood pressure than currently recommended further reduces risk of
heart disease, stroke, and cognitive decline. This information is
critically important to ideally manage the burden of heart disease and
stroke. Continued needed funding will allow for aggressive
implementation of other initiatives in both the NHLBI general and
cardiovascular strategic plans.
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 6.4 million survivors face
severe physical and mental disabilities, emotional distress and huge
costs--a projected $74 billion in medical expenses and lost
productivity in 2010.
Stable and sustained funding is required for NINDS to capitalize on
ARRA investments to prevent stroke, protect the brain from damage and
enhance rehabilitation. This includes: (1) initiatives to determine
whether MRI brain imaging can assist in selecting stroke victims who
could benefit from the clot busting drug tPA beyond the 3-hour
treatment window; (2) assessing chemical compounds that might shield
brain cells during a stroke; and (3) advance stroke rehabilitation by
studying whether the brain can be helped to ``rewire'' itself.
Continued needed funding will also allow for assertive
implementation of the NINDS Stroke Progress Review Group Report--a
long-term, stroke research strategic plan. A variety of research
initiatives have been undertaken, but more resources are needed to
fully implement the plan. The fiscal year 2010 estimate for NINDS
stroke research is less than half of the expected need.
The American Heart Association Advocates: AHA supports an fiscal
year 2011 appropriation of $3.514 billion for the NHLBI; and $1.857
billion for the NINDS. These funding levels represent comparable
increases to the Association's overall recommended percentage increase
for the NIH.
Increase Funding for the Centers for Disease Control and Prevention
(CDC)
Prevention is the best way to protect the health of all 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. Currently, CDC invests on
average only 16 cents per-person each year on heart disease and stroke
prevention.
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 still funds only 14 States to implement programs in
healthcare, worksite and community settings to: (1) reduce high blood
pressure and elevated cholesterol; (2) improve emergency response and
quality care; and (3) end treatment disparities. Another 27 States
receive funds for capacity building (planning). However, 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. Nine States
receive no prevention resources at all.
This CDC division also administers the WISEWOMAN program that
screens uninsured and under-insured low-income women ages 40 to 64 in
20 States for heart disease and stroke risk. They receive counseling,
education, referral and follow-up as needed. From 2000 to mid-2008,
WISEWOMAN reached more than 84,000 low-income women, provided more than
210,000 lifestyle interventions, and identified 7,647 new cases of high
blood pressure, 7,928 new cases of high cholesterol, and 1,140 new
cases of diabetes. Among those participants who were re-screened 1 year
later, average blood pressure and cholesterol levels had decreased
considerably.
The American Heart Association Advocates: AHA joins with the CDC
Coalition in support of an appropriation of $8.8 billion for CDC core
programs, including increases for the Heart Disease and Stroke
Prevention Program and WISEWOMAN. Within the total for CDC, AHA
recommends $76.221 million for the Heart Disease and Stroke Prevention
Program, allowing CDC to: (1) add the nine unfunded States; (2) elevate
more States 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 National, State
and local heart disease and stroke surveillance; and (6) provide
additional assistance for prevention research and program evaluation.
AHA also advocates $37 million to expand WISEWOMAN to additional States
and screen more eligible women in funded States. And, we join the
Friends of the NCHS in recommending $162 million for the National
Center for Health Statistics.
Restore Funding for Rural and Community Access to Emergency Devices
(AED) Program
About 92 percent of SCA victims die outside of a hospital. However,
prompt CPR and defibrillation, with an automated external defibrillator
(AED), can more than double their chances of survival. Communities with
comprehensive AED programs have achieved survival rates of about 40
percent. HRSA's Rural and Community AED Program provides grants to
States to buy AEDs, train lay rescuers and first responders in their
use and place AEDs where SCA is likely to occur. During year one, 6,400
AEDs were bought, and placed and 38,800 people were trained. Due to
budget cuts, only 10 States received funds for this life-saving program
in fiscal year 2009.
The American Heart Association Advocates: For fiscal year 2011, AHA
advocates restoring HRSA's Rural and Community AED Program to its
fiscal year 2005 level of $8.927 million.
Increase Funding for the Agency for Healthcare Research and Quality
(AHRQ)
AHRQ develops scientific evidence to improve health and healthcare.
Through its Effective Health Care Program, AHRQ supports research on
outcomes, comparative effectiveness and appropriateness of
pharmaceuticals, devices and healthcare services for diseases, such as
heart disease, stroke, and high blood pressure. Also, AHRQ's health
information technology (HIT) plan is helping bring healthcare into the
21st century through more than $300 million invested in over 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 is a key component to healthcare
reform.
The American Heart Association Advocates.--AHA joins Friends of
AHRQ in advocating for $611 million for AHRQ to preserve its vital
initiatives, boost the research infrastructure, reignite innovation,
nurture the next generation of scientists and help reinvent health and
healthcare.
Cardiovascular disease continues to inflict a deadly, disabling and
costly toll on Americans. But, our recommended funding increases for
NIH, CDC, and HRSA outlined above will save lives and cut rising
healthcare costs. The American Heart Association urges Congress to
seriously consider our recommendations during the fiscal year 2011
appropriations process. They represent a wise investment for our Nation
and the health and well-being of this and future generations.
______
Prepared Statement of the American Indian Higher Education Consortium
department of education programs
Higher Education Act Programs
Strengthening Developing Institutions.--Section 316 of Higher
Education Act (HEA) 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 $36 million to support these two vital
programs.
TRIO Programs.--Retention and support services are vital to
achieving the administration's goal of having the highest percentage of
college graduates globally by 2020. The President's fiscal year 2011
budget request includes level funding for TRIO programs, which if
ultimately enacted, will result in a decrease in the current level of
program services. In addition to increasing Pell Grants, it is
imperative that Congress bolster TRIO programs such as Student Support
Services and Upward Bound so that low-income students are given the
support necessary to persist in and, ultimately, complete their
postsecondary courses of study. The TCUs support an increase in fiscal
year 2011 TRIO programs and technical assistance funding.
Pell Grants.--TCUs urge the subcommittee to fund the Pell Grant
program at the highest possible level.
Perkins Career and Technical Education Programs
Section 117 of the Carl D. Perkins Vocational and Technical
Education Act provides funding for the operating budgets for the
Nation's two tribally controlled vocational institutions: United Tribes
Technical College in Bismarck, North Dakota, and Navajo Technical
College in Crownpoint, New Mexico. AIHEC requests $10 million for the
two tribal colleges that are funded under this section. 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 funding 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.
department of health and human services program
Tribal Colleges and Universities 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 a minimum of $5 million be designated
for the TCU-Head Start Partnership program, to ensure the continuation
of current programs and the resources needed to expand participation to
include 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, 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 more than 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 2011 appropriations requests for tcus
Higher Education Act
The Higher Education Act Amendments 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 the 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 $36 million in fiscal year 2011 for HEA title III-A section
316, an increase of $5.8 million more than fiscal year 2010, and to
direct the Department to reserve a portion of the funds, as authorized,
to award several competitive construction grants. 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, as well as their
substandard facilities and infrastructure issues.
Retention and support services are vital to achieving the
administration's goal of having the highest percentage of college
graduates globally by 2020. The TRIO-Student Support Services program
was created out of recognition that college access was not enough to
ensure advancement and that multiple factors worked to prevent the
successful completion of higher education for many low-income and
first-generation students and students with disabilities. Therefore, in
addition to increasing Pell Grants, it is critical that Congress also
bolster student assistance programs such as Student Support Services so
that low-income students have the support necessary to allow them to
persist in and, ultimately, complete their postsecondary courses of
study.
The importance of Pell Grants to TCU students cannot be overstated.
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. 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 Career and Technical
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 $10 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 State and local education agencies,
Indian tribes, agencies, and TCUs. 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 funds appropriated for the Adult Education State Grants
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.
department of health and human services/administration for children and
families/head start
Tribal Colleges and Universities (TCU) Head Start Partnership
Program.--The TCU-Head Start Partnership has made a lasting investment
in our Indian communities by creating and enhancing associate degree
programs in Early Childhood Development and related fields. Graduates
of these programs help meet the degree mandate for all Head Start
program teachers. More importantly, this program has afforded American
Indian children Head Start programs of the highest quality. A clear
impediment to the ongoing success of this partnership program is the
erratic availability of discretionary funds made available for the TCU-
Head Start Partnership. In fiscal year 1999, the first year of the
program, some colleges were awarded 3-year grants, others 5-year
grants. In fiscal year 2002, no new grants were 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 TCUs request that the subcommittee direct the
Head Start Bureau to designate a minimum of $5 million, of the more
than $8.2 billion included in the President's fiscal year 2011 budget
request for programs under the Head Start Act, for the TCU-Head Start
Partnership program, to ensure that this critical program can be
expanded so that all TCUs have the opportunity to participate in the
TCU-Head Start Partnership program to benefit their respective tribal
communities.
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 2011 appropriations needs and recommendations.
______
Prepared Statement of the American Institute for Medical and Biological
Engineering
Mr. Chairman and members of the subcommittee: The American
Institute for Medical and Biological Engineering (AIMBE) appreciates
the opportunity to submit testimony to advocate for funding for
research within the National Institutes of Health (NIH) broadly, and
specifically research funding within the National Institute for
Biomedical Imaging and Bioengineering (NIBIB). NIH and NIBIB provide
avenues for research funding that are vital to the Nation's efforts to
support medical and biological engineering (MBE) innovation. AIMBE
represents 50,000 individuals and organizations throughout the United
States, including major healthcare companies, academic research
institutions and the top 2 percent of engineers, scientists and
clinicians whose discoveries and innovations have touched the health of
many Americans. While today's testimony focuses on the impact MBE has
on improving the health and well being of Americans, it is important to
note that MBE can also have a positive impact on many of the other
important issues facing us today; ranging from improvements to the
environment by finding green-energy solutions, to solving problems
relating to hunger, disease prevention, diagnosis and treatment of
disease; to economic growth spurred by the innovation of new health
products.
AIM BE was founded in 1991 to establish a clear and comprehensive
identity for the field of medical and biological engineering--which
applies principles of engineering science and practice to imagine,
create, and perfect the medical and biological technologies that are
used to improve the health and quality of life of Americans and people
across the world. AIMBE's vision is to ensure MBE innovations continue
to develop for the benefit of humanity.
AIMBE applauds the past support of this subcommittee to provide
funding to NIH, and is particularly pleased to see the strong
investment in NIH provided by the American Recovery and Reinvestment
Act. However, we believe more stable, adequate and reliable funding is
necessary to ultimately ensure America remains competitive and
continues to develop innovations that improve human health. We
therefore support NIBIB at the level of $332.4 million for fiscal year
2011. This increase in funding will support important work which is
highly translatable or applicable research into products that are life-
saving, and life enhancing. NIBIB is the only Institute at the NIH with
the specific purpose of supporting and conducting biomedical
engineering research, which impacts all sectors of health across many
disease states. Research conducted within NIBIB is on the cutting edge
of biomedical engineering research and has the potential to save lives
and reduce healthcare costs.
While each Institute within the NIH plays a vital role researching
and identifying disease prevention and treatment positively impacting
patient outcomes; the NIBIB plays a unique role and has not benefited
from large-scale NIH funding increases, such as the doubling of the
budget in 2004. First appropriated with its own funding in 2004 (fiscal
year 2003 and fiscal year 2004 were funded through transfers from other
Institutes within NIH), the mission of NIBIB is to improve health by
leading the development and accelerating the application of biomedical
technologies. The NIBIB is committed to integrating the physical and
engineering sciences with the life sciences to advance basic research
and medical care. This is achieved through research and development of
new biomedical imaging and bioengineering techniques and devices to
fundamentally improve the detection, treatment, and prevention of
disease; enhancing existing imaging and bioengineering modalities;
supporting related research in the physical and mathematical sciences;
encouraging research and development in multidisciplinary areas;
supporting studies to assess the effectiveness and outcomes of new
biologics, materials, processes, devices, and procedures; developing
nonimaging technologies for early disease detection and assessment of
health status; and developing advanced imaging and engineering
techniques for conducting biomedical research at multiple scales
through modeling and simulation. Finally, the NIBIB plays an important
role in providing engineering research resources to the entirety of the
NIH. As the only engineering research arm within the NIH, NIBIB is
often relied upon to partner with other institutes at the NIH to
provide engineering expertise. The Laboratory of Molecular Imaging and
Nanomedicine, and Laboratory of Bioengineering and Physical Science are
two examples of NIBIB's role as a partner for researchers working at
other Institutes at the NIH.
We strongly recommend that early-stage, proof-of-concept projects
for translational research be funded at an enhanced level, ideally 0.5
percent of all external research budgets, at all Institutes. This is
critical to maintaining the U.S. lead in innovation by moving new
discoveries and novel systems to the stage where third-party private
funding can take them through development to the marketplace where they
help patients and health of Americans. Publicly held companies cannot
invest in this stage of work due to stockholder pressures, so that the
Federal Government is critical to ensuring the viability of this
innovation pipeline.
NIBIB as a Stimulus for Innovation/Cost Effectiveness
The fiscal year 2010 NIBIB Budget submission is $316.6 million, a
2.7 percent increase from the fiscal year 2009 appropriation, and is 37
percent lower than the original 5-year congressional authorization for
NIBIB funding of $504 million. As the economy worsens, private industry
and private investors are less likely to invest in high-risk research,
potentially slowing the pace of innovation. By funding bioengineering
research, NIBIB fills a void by providing funding for high-risk, high-
reward research that leads to the development of new technologies.
Often times, private investors in biomedical innovation are unwilling
to invest in this type of research, because of the risks involved.
However, NIBIB can be a mechanism to bring new technologies to market
and fills the void left by a lack of private capital.
The NIBIB's Quantum Grants program, for example, challenges the
research community to propose projects that have a highly focused,
collaborative, and interdisciplinary approach to solve a major medical
problem or to resolve a highly prevalent technology-based medical
challenge. The program consists of a 3-year exploratory phase to assess
feasibility and identify best approaches, followed by a second phase of
5 to 7 years. Major advances in medicine leading to quantifiable
improvements in public health require the kind of funding commitment
and intellectual focus found in the Quantum Grants program at NIBIB,
because early stage investors are reluctant to invest in high-risk
research. That said, the Quantum Grants offer a place for Government to
invest in translational research, potentially solving huge medical
problems facing Americans today.
The five currently funded Quantum Grants focus on: stem cell
therapies for patients suffering from the effects of diabetes and
stroke; the utilization of nanoparticles to help visualize brain tumors
so that surgeons can easily see and remove the cancerous mass in the
patient's brain; the development of an implantable artificial kidney
offering an improved quality of life for patients currently undergoing
dialysis treatment; and a microchip to capture circulating tumor cells
for clinicians to diagnose cancer earlier than ever before, giving
patients a greater hope for recovery thanks to earlier detection and
treatment. All these projects, in their early stages of funding, have
demonstrated promise for improving patient outcomes in the laboratory
setting.
An increase of funding to NIBIB and the Quantum Grants program may
offer opportunities to expedite research beyond laboratory study and
move to clinical trial. For example, if this research is developed and
put on the market, the cost reduction to a person with kidney disease
would radically decrease because it would eliminate the need for
dialysis, which is a costly and resource heavy procedure typically done
in an out-patient hospital setting.
The Fundamental Role of Engineering Research
Advances in the process of engineering research, in a variety of
fields, are a part of technological innovation. Medical and biological
engineering draws from research specialties across disciplines
(including mechanical, electrical, material, medical and biological
engineering, and clinicians), bringing together teams to create unique
solutions to the most pressing health problems. Engineering is the
practical application of science and math to solve problems. For
example, the insulin pump, which is the primary device used by patients
with diabetes who requires continuous insulin infusion therapy, is the
result of multi-disciplinary effort by engineers to develop a more
efficient way to manage diabetes. The science to develop and perfect an
insulin pump existed well before the creation of the medical device;
however it took biomedical engineers to apply the basic science toward
product development.
The first insulin pump to be manufactured was released in the late
1970s. It was known as the ``big blue brick'' because of its size and
appearance. It sparked interest among healthcare professionals who saw
it as a device that would render syringes obsolete for people who have
daily insulin injection needs. While the technology was promising, the
first commercial pump lacked the controls and interface to make it a
safe alternative to manual injections. Dosage was inaccurate thus
making the device more of a danger than a solution.
It was only in the beginning of the 1990's that biomedical
engineers began to develop more user-friendly models that could be used
by diabetics. Advances in biomedical engineering research focused on
reducing device size, increasing energy efficiency (and thus improving
battery life), and improving reliability were of great benefit to
insulin pump manufacturers who were able to make their models smaller,
more affordable, and easier for patients to use. Insulin pumps enable
many diabetic patients to live productive lives due to fewer absences
from work and reduced hospitalizations.
A similar advancement in the treatment of atherolosclerosis through
MBE is the use of angioplasty with an arterial stent which releases
drugs directly to the coronary artery (referred to as a drug eluting
stent). This advancement has replaced more then 500,000 bypass
surgeries a year, at an annual cost savings of $4 billion, and an
immeasurable improvement in the quality of life of patients receiving
this treatment.
Engineering research in human physiology, specifically in range of
motion and function, has increased the function for artificial limbs.
The decreasing mortality and increasing number of disabled war veterans
highlights the need for more highly functional prosthetics. Engineering
research and development processes have taken the strapped wooden leg
to a realistic synergic leg and foot transtibial prosthetic that
employs advanced biomechanics and microelectronic controls to allow a
fuller range of motion, including running. Basic engineering research
in polymers and materials science has changed the look and feel of
prosthetic limbs so they are no longer easily discernable, reducing the
stigma, and making them more durable, lessening the cost of maintenance
and replacement. Researchers in Baltimore, Cleveland and Chicago are
developing the next generation of prosthetic limbs, utilizing cutting
edge biomedical engineering research to develop prosthesis that are
more sensitive, more responsive, and more lifelike then anything
developed in the past. These new ``bionic limbs'' are giving patients
pieces of their body back, pieces taken from them through traumatic
injury or disease. Increases in funding to NIBIB, who uniquely partners
with other Federal agencies such as the Department of Veterans Affairs
and Department of Defense, may lead to biomedical engineering
innovations to improve the quality of life of warfighters injured on
the battlefield as well as civilians.
The engineering research process has played a large part in
extending and deploying innovative imaging technologies such as
magnetic resonance imaging (MRI) and ultra-fast computerized tomography
(CT scan). These technologies facilitate early detection of disease and
dysfunction, allowing for earlier treatment and slowing the progression
of disease. When prescribed correctly these technologies can reduce the
costs of healthcare by diagnosing diseases earlier, allowing for
earlier clinical intervention and reduced hospitalizations with faster
recovery times.
The Nation deserves to obtain a strong return on its investment in
the basic medical research funded by NIH. Additional engineering
research, including translation of basic research into new devices and
more efficient medical procedures, is a critical part of ensuring that
return. This combination of basic scientific studies and engineering
research, will in turn, lead to many technological innovations which
will improve the quality of life and well being of Americans. Industry
will supply developmental engineering research; however, they usually
do not support the fundamental level of engineering research done at
NIH and NIBIB due to the high risks to their returning investments. The
government needs to continue to fund the vital research at NIH and
NIBIB to continue to be a leader in healthcare innovation, and for the
creation of jobs in the healthcare segment of our national economy.
AIMBE looks forward to the opportunity to continue this dialogue
with all of you individually. Thank you again for your time, and
consideration on this important matter.
______
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,
and 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 2011 by providing the agency with a total discretionary budget of
at least $32.239 billion as requested by President Obama. This would be
a 3.2 percent increase more than the fiscal year 2010 enacted level.
AIRI is a national organization of 91 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 recent year appropriations bills, Congress has taken
important steps to jump start the Nation's economy through investments
in science. 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, which is critically needed to update aging research
facilities. We urge NIH to continue its commitment to facility,
equipment, and infrastructure support. The infrastructure that we are
creating needs to be maintained. Large fluctuations in funding will be
disruptive to training, to careers, to long range projects and
ultimately to progress. The research engine needs a predictable,
sustained investment in science to maximize our return.
NIH is responding to its charge of stimulating the economy through
job creation by supporting new scientists. ARRA investments allowed us
to see firsthand how research is impacting the economy. We cannot stop
the momentum created by these historic investments. We need to be able
to continue to advance the new directions charted with the ARRA support
in 2011 and beyond.
Keeping up with the rising cost of medical research in the fiscal
year 2011 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 2011 by at least 3.2 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.
--High Throughput Technologies.--AIRI Institutes have embraced
technologies and research centers to collaborate on biological
research for all diseases. Using advanced technology platforms
or ``cores,'' AIRI institutes use genomics, imaging, and other
broad-based technologies for drug discovery.
--Translational Research.--Translational sciences bridges the divide
between basic biomedical research and implementation in a
clinical setting. Currently, more than 15 AIRI member
institutes are affiliated with and collaborate with the
Clinical and Translational Science Awards (CTSA) Program. Many
AIRI institutes also support research on human embryonic stem
cells (hESC) with the hope of discovering new and innovative
disease interventions.
--Using Science to Enable Health Care Reform.--As basic biomedical
research institutes, AIRI members collaborate with other
research partners on patient-centered outcomes research. AIRI
members act as the basic research arm for disease treatment
(for example, by supporting genetic testing), while other
project collaborators study other aspects of disease
intervention in an effort to learn the best practices for
preventing and treating disease.
--Global Health.--AIRI member institutes focus on a wide range of
diseases, many of which have a global affect on human health.
Besides supporting research for the treatments, vaccines, and
cures of the world's deadliest diseases, a number of AIRI
institutes partner with research institutions in the developing
world to support international disease research, such as
collaborations on HIV/AIDS, Tuberculosis, and Malaria.
--Reinvigorating the Biomedical Research Community.--AIRI supports
policies that promote the United States' ability to maintain a
competitive edge in biomedical science. The biomedical research
community is dependent upon a knowledgeable, skilled, and
diverse workforce to address current and future critical health
research questions. The cultivation and preservation of this
workforce is dependent upon the ability to recruit scientists
and students globally as well as training programs in basic and
clinical biomedical research. Initiatives focusing on career
development and recruiting a diverse scientific workforce are
important to innovation in biomedical research for the benefit
of public health.
Providing Efficiency and Flexibility.--AIRI member institutes'
small size and valuable 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 2011
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 American Lung Association
summary of programs
Centers for Disease Control and Prevention (CDC)
Increased overall CDC funding--$8.8 billion
--Funding CDC COPD Program--$3 million
--Funding Healthy Communities--$52.8 million
--Office on Smoking and Health--$280 million
--Asthma programs--$70 million
--Environment and Health Outcome Tracking--$50 million
--Tuberculosis programs--$220.5 million
--CDC Influenza preparedness--$159.1 million
--NIOSH--$364.3 million
National Institutes of Health (NIH)
Increased overall NIH funding--$35 billion
--National Heart, Lung and Blood Institute--$3.514 billion
--National Cancer Institute--$5.725 billion
--National Institute of Allergy and Infectious Diseases--$5.395
billion
--National Institute of Environmental Health Sciences--$779.4 million
--National Institute of Nursing Research--$163 million
--National Center on Minority Health & Health Disparities--$236.9
million
--Fogarty International Center--$78.4 million
The American Lung Association is pleased to present our
recommendations to the Labor, Health and Human Services, and Education,
and Related Agencies Appropriations Subcommittee. The public health and
research programs funded by this subcommittee will prevent lung disease
and improve and extend the lives of millions of Americans who suffer
from lung disease.
The American Lung Association is the oldest voluntary health
organization in the United States, with national offices and local
associations around the country. Founded in 1904 to fight tuberculosis,
the American Lung Association today fights lung disease in all its
forms through research, advocacy and education.
a sustained and sustainable investment
We thank the chairman and the subcommittee for your leadership in
healthcare reform and the priority paid to prevention and wellness. The
investments this committee makes can and will pay near-term and long-
term dividends for the health of the American people.
Specifically, we want to highlight the need for the American
Recovery and Reinvestment (ARRA) funds to be incorporated into base
funding levels in order to sustain these critical investments,
particularly for the Center for Disease Control and Prevention's public
health programs. These investments in prevention and wellness are
crucial to ensuring a healthier population and a reduction in
healthcare costs. Chronic disease is a huge driver of cost and human
suffering and incorporating the ARRA funds into the baseline will allow
sustained investments in proven interventions like smoking cessation.
The United States must also maintain its renewed commitment to
medical research. While our focus is on lung disease research, we
strongly support increasing the investment in research across the
entire National Institutes of Health.
lung disease
Each year, almost 400,000 Americans die of lung disease. It is
responsible for 1 in every 6 deaths. More than 35 million Americans
suffer from a chronic lung disease. Each year lung disease costs the
economy an estimated $173 billion. Lung diseases include: lung cancer,
asthma, chronic obstructive pulmonary disease (COPD), tuberculosis,
pneumonia, influenza, sleep disordered breathing, pediatric lung
disorders, occupational lung disease and sarcoidosis.
improving public health
The American Lung Association strongly supports investments in the
public health infrastructure. In order for the CDC to carry out its
prevention mission, and to assure an adequate translation of new
research into effective State and local programs to improve the health
of all Americans, we strongly support increasing the overall CDC
funding to $8.8 billion.
We strongly encourage improved disease surveillance and health
tracking to better understand diseases like asthma. We support an
appropriations level of $50 million for the Environment and Health
Outcome Tracking Network to allow Federal, State, and local agencies to
track potential relationships between hazards in the environment and
chronic disease rates.
We strongly support investments in communities to bring together
key stakeholders to identify and improve policies and environmental
factors influencing health in order to reduce the burden of chronic
diseases. These programs lead to a wide range of improved health
outcomes including reduced tobacco use. We strongly recommend at least
$52.8 million in funding for the Healthy Communities program to expand
its reach to more communities.
chronic obstructive pulmonary disease
Chronic Obstructive Pulmonary Disease, or COPD, is the fourth
leading cause of death both in the United States and worldwide. Yet, it
remains relatively unknown to most Americans. COPD refers to a group of
largely preventable diseases, including emphysema and chronic
bronchitis that gradually limit the flow of air in the body. It has
been estimated that 12.1 million patients have been diagnosed with some
form of COPD and as many as 24 million adults may suffer from its
consequences. In 2006, 120,970 people in the United States died of
COPD. The annual cost to the nation for COPD in 2010 is projected to be
$49.9 billion. Medicare expenses for COPD beneficiaries were nearly 2.5
times that of the expenditures for all other patients.
Despite the enormity of this problem, COPD receives far too little
attention at CDC or in health departments across the Nation. The
American Lung Association strongly supports the establishment of a
national COPD program within CDC's National Center for Chronic Disease
Prevention and Health Promotion with a specific line item of $3 million
for fiscal year 2011 to create a comprehensive national action plan for
combating COPD. Creating this plan will address the public health role
in prevention, treatment and management of this disease.
Today, COPD is treatable but not curable. Despite promising
research leads, the American Lung Association believes that research
resources committed to COPD are not commensurate with the impact COPD
has on the United States and the world. The American Lung Association
strongly recommends that the NIH and other Federal research programs
commit additional resources to COPD research programs. We strongly
support funding the National Heart, Lung and Blood Institute and its
lifesaving lung disease research program at $3.514 billion.
tobacco use
Tobacco use is the leading preventable cause of death in the United
States, killing more than 443,000 people every year. Smoking is
responsible for 1 in 5 U.S. deaths. The direct healthcare and lost
productivity costs of tobacco-caused disease and disability are also
staggering, an estimated $193 billion each year.
Given the magnitude of the tobacco-caused disease burden and how
much of it can be prevented; the CDC Office on Smoking and Health
should be much larger and better funded. This neglect cannot continue
if the nation wants to prevent disease and promote wellness. Public
health interventions have been scientifically proven to reduce tobacco
use.
In light of new funds available from the Patient Protection and
Affordable Care Act and the subcommittee's fiscal year 2010 request to
OSH for a 5-year plan to significantly reduce tobacco use in the United
States, the American Lung Association urges that a minimum of $280
million be appropriated to CDC's Office on Smoking and Health for
fiscal year 2011.
lung cancer
An estimated 364,996 Americans are living with lung cancer. During
2009, an estimated 219,440 new cases of lung cancer were diagnosed, and
158,664 Americans died from lung cancer in 2006. Survival rates for
lung cancer tend to be much lower than those of most other cancers and
significant health disparities exist in the incidence and treatment of
this disease.
Lung cancer receives far too little attention and focus. Given the
magnitude of lung cancer and the enormity of the death toll, the
American Lung Association strongly recommends that the NIH and other
Federal research programs commit additional resources to lung cancer.
We support a funding level of $5.725 billion for National Cancer
Institute and urge more attention and focus on lung cancer.
asthma
Asthma is a chronic lung disease in which the bronchial tubes
become swollen and narrowed, preventing air from getting into or out of
the lung. Approximately 23.3 million Americans currently have asthma,
of which 12.7 million had an asthma attack in 2008. Asthma is expensive
and incurs an estimated annual economic cost of $20.7 billion to our
Nation. Asthma is the third leading cause of hospitalization among
children under the age of 15. It is also one of the leading causes of
school absences. The Federal response to asthma has three components:
research, programs and planning.
We recommend that the National Heart, Lung and Blood Institute
receive $3.514 billion and the National Institute of Allergy and
Infectious Diseases be appropriated $5.395 billion, and that both
agencies continue their investments in asthma research in pursuit of
treatments and cures.
The American Lung Association also recommends that CDC be provided
$70 million in fiscal year 2011 to expand its asthma programs.
influenza
Influenza is a highly contagious viral infection and one of the
most severe illnesses of the winter season. It is responsible for an
average of 226,000 hospitalizations and 36,000 deaths each year.
Further, the emerging threat of a pandemic influenza is looming as the
recently emerging strain of H1N1 reminded us. The American Lung
Association supports funding the Federal CDC Influenza efforts at $156
million. We also support investments in influenza totaling $45 million
for the Food and Drug Administration (FDA), $35 billion for the
National Institutes of Health (NIH), and $66 million for the Office of
the Secretary, as proposed in the President's budget.
tuberculosis
Tuberculosis primarily affects the lungs but can also affect other
parts of the body. There are an estimated 10 million to 15 million
Americans who carry latent TB infection. Each has the potential to
develop active TB in the future. In 2008, there were 12,904 cases of
active TB reported in the United States. While declining overall TB
rates are good news, the emergence and spread of multi-drug resistant
TB pose a significant threat to the public health of our Nation.
Continued support is needed if the United States. is going to continue
progress toward the elimination of TB. We request that Congress
increase funding for tuberculosis programs at CDC to $220.5 million.
conclusion
Mr. Chairman, lung disease is a continuing, growing problem in the
United States. It is America's number three killer, responsible for 1
in 6 deaths. Progress against lung disease is not keeping pace with
other major causes of death and more must be done. The level of support
this subcommittee approves for lung disease programs should reflect the
urgency illustrated by these numbers.
______
Prepared Statement of the American Liver Foundation
Mr. Chairman and members of the subcommittee, thank you for giving
the American Liver Foundation the opportunity to provide testimony as
the subcommittee begins to consider funding priorities for fiscal year
2011. My name is Dr. Allan Wolkoff and I am the Chairman of the Board
of Directors of the American Liver Foundation (ALF), a national
voluntary health organization dedicated to the prevention, treatment
and cure of hepatitis and other liver diseases through research,
education and advocacy. I am also a Professor of Medicine and Chief of
the Division of Hepatology at the Albert Einstein College of Medicine.
ALF has a nationwide network of divisions and provides information
to 300,000 patients and families. More than 70,000 physicians,
including primary care practitioners and liver specialists and
scientists also receive information from ALF. The ALF Board of
Directors is composed of scientists, clinicians, patients and others
who are directly affected by liver diseases. Every year ALF handles
more than 100,000 requests for information, helping patients and their
families understand their illnesses, informing them about available
services, and showing them that there are knowledgeable and concerned
individuals to assist them in every possible way.
Mr. Chairman, ALF joins the Ad Hoc Group for Medical Research
Funding, a coalition of some 300 patient and voluntary health groups,
medical and scientific societies, academic research organizations and
industry, in recommending $35 billion in funding for the National
Institutes of Health in fiscal year 2011. While the ALF recognizes the
demands on our Nation's resources, we believe the ever-increasing
health threats and expanding scientific opportunities continue to
justify increased funding levels for the National Institutes of Health
(NIH). To ensure that NIH's momentum is not further eroded, and to
ensure the fight against diseases and disabilities that affect millions
of Americans can continue, ALF supports $35 billion for the NIH in
fiscal year 2011 and a minimum increase of 12 percent ($235 million)
for the National Institute for Diabetes and Digestive and Kidney
Diseases and for liver disease research across all NIH Institutes.
In addition to the NIH, there are a number of programs within the
jurisdiction of the subcommittee that are important to ALF including
the Centers for Disease Control's Division of Viral Hepatitis and the
Health Resources Services Administration. Mr. Chairman, our specific
recommendations for these and other areas of interest are summarized in
a table at the end of this statement.
recognizing the leadership of the subcommittee
Mr. Chairman, ALF appreciates your leadership and the leadership of
this Subcommittee in supporting NIH in a time of fiscal austerity. Your
leadership in supporting CDC and HRSA are also greatly recognized and
appreciated. These programs are important to our shared goals of
improving the public health response to the threats of hepatitis and
liver disease and to increasing the rate of organ donation. We applaud
the subcommittee's leadership in making progress in these important
areas and to allocating increased funding to these programs during
periods of fiscal austerity.
a national strategy for prevention and control of hepatitis b and c.
The ALF is very pleased that the Office of the Secretary has
convened and established an inter-departmental task-force to address
the public health challenge of viral hepatitis. This is an important
step for the Department to take to develop a comprehensive response to
the challenge of hepatitis. In January 2010, the Institute of Medicine
released a groundbreaking report titled ``Hepatitis and Liver Cancer: A
National Strategy for Prevention and Control of Hepatitis B and C''
documenting the problem and highlighting a course of action to address
it. ALF urges its review and consideration by the Task Force. ALF also
urges the Committee to request an update from the Task Force of their
recommendations and actions and further urges the Committee to review
and address the chronic underfunding of viral hepatitis prevention
programs within the Department, including the National Institutes of
Health and the CDC's Division of Viral Hepatitis.
the national institutes of health and the liver disease research action
plan
We depend upon the NIH to fund research that will lead to new and
more effective interventions to treat people with liver diseases. The
American Liver Foundation joins with the Ad Hoc Group for Biomedical
Research and requests a funding level of $35 billion for the NIH in
fiscal year 2011.
We thank the subcommittee for their continued investment in NIH in
fiscal year 2010. Sustaining progress in medical research is essential
to the twin national priorities of smarter healthcare and economic
revitalization. With additional investment, the nation can seize the
unique opportunity to build on the tremendous momentum emerging from
the strategic investment in NIH made through the 2009 American Recovery
and Reinvestment Act (ARRA). NIH invested those funds in a range of
potentially revolutionary new avenues of research that will lead to new
early screenings and new treatments for disease.
In fiscal year 2009, NIH spent approximately $651 million on liver
disease research overall (ARRA and non-ARRA funds), and estimates that
in fiscal year 2010 $635 million will be spent. This includes research
for viral hepatitis, liver cancer, and a host of other liver diseases.
An additional $235 million (12 percent increase) for the National
Institute of Diabetes and Digestive and Kidney Diseases, the Institute
with lead on liver disease research, could make transformational
advances in research leading to better treatments for people with liver
disease. The ALF recommends that in fiscal year 2011 the National
Institute of Diabetes and Digestive and Kidney Diseases be funded at
$2,192,247,000 and that overall NIH funding total $35 billion.
Mr. Chairman, in December of 2004, the NIDDK released the Liver
Disease Research Action Plan outlining major research goals for the
various aspects of liver disease. Working with the leading scientific
experts in the field, the plan is organized into 16 chapters and
identifies numerous areas of research important to virtually every
aspect of liver disease, including: improving the success rate of
therapy of hepatitis C; developing noninvasive ways to measure liver
fibrosis; developing sensitive and specific means of screening
individuals at high risk for early hepatocellular carcinoma; developing
standardized and objective diagnostic criteria for major liver diseases
and their grading and staging; and decreasing the mortality rate from
liver disease. Each year, the plan is reviewed and updated. The ALF
urges the Committee to provide adequate funding and policy guidance to
NIH to urge continued implementation of the plan.
cdc's division of viral hepatitis
The Division of Viral Hepatitis (DVH) is included in the National
Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention at the
CDC, and is responsible for the prevention and control of viral
hepatitis, a disease which impacts more than 6 million Americans and
often leads to liver cancer and liver failure. The DVH provides the
scientific and programmatic foundation for the prevention, control and
elimination of hepatitis virus infections in the United States and also
assists the international public health community in these activities.
DVH works with State and local health departments to provide the
guidance and technical expertise needed to integrate hepatitis
prevention services such as hepatitis A and B vaccine, hepatitis B and
C counseling, and testing and referral to existing public health
programs serving individuals at high risk.
DVH is currently funded at $19.3 million, $6 million less than its
funding level in fiscal year 2003, which does not allow for the
provision of core prevention services. The ALF joins the hepatitis
community and urges a fiscal year 2011 funding level for the Division
of Viral Hepatitis of $50 million.
increasing the supply of organs for donation
As the subcommittee knows, even with advances in the use of living
liver donors, the increase in the demand for livers needed for
transplantation will continue to exceed the number available. The need
to increase the rate of organ donation is critical. On April 9, 2010
there were 106,917 men, women and children on the national
transplantation waiting list. Last year an average of 80 patients were
transplanted each day; however a daily average of 18 patients died
because the organ they needed did not become available in time to save
them. The shortage of organs for donation can be positively impacted by
healthcare professionals, particularly physicians, nurse, and physician
assistants that are frequently the first to identify and refer a
potential donor. These professionals also have an established
relationship with the family members that weigh the option to donate
their loved one's organs. In order to improve the knowledge and skills
of the several key health professions, ALF requests funding to develop
curriculum and continuing medical education programs for targeted
health professions. To launch a new five year effort to improve the
competency of health professionals to help meet the goal of increasing
the number or organs available for transplantation $450,000 is
requested for the United Network for Organ Sharing (UNOS) to be made
available from within the Division of Health Professions set aside
authority for technical assistance.
summary and conclusion
Mr. Chairman, again we wish to thank the subcommittee for its past
leadership. Significant progress has been made in developing better
treatments and cures for the diseases that affects mankind due to your
leadership and the leadership of your colleagues on this subcommittee.
Significant progress has also similarly been made in the fight against
liver disease. For fiscal year 2011 we recommend a 12 percent, increase
for NIH above the level of the fiscal year 2010 funding levels, with
the level of liver disease research also increased by at least 12
percent. We also urge a $50 million for the CDC's Division of Viral
Hepatitis to strengthen the public health response to hepatitis and
liver disease and a $2 million increase to HRSA's Division of
Transplantation, as well as $450,000 for the Division of Health
Professions to increase the rate of organ donation. Mr. Chairman, if
this country is to maintain its leadership role in health maintenance,
disease prevention, and the curing of diseases, adequate funding for
NIH, CDC and HRSA is paramount. The ALF appreciates the opportunity to
provide testimony to you on behalf of our constituents and yours.
alf recommendations for fiscal year 2010 funding
NIH and the Liver Disease Research Action Plan: $35 billion for NIH
overall and 12 percent increase for the National Institute of Diabetes
and Digestive and Kidney Diseases; and +$25 million to implement the
Liver Research Action Plan.
CDC: National Hepatitis C Prevention Strategy, Public Health
Information, HAV & HBV Vaccinations: Fund the CDC's Division of Viral
Hepatitis at $50 million to strengthen the public health response to
chronic viral hepatitis.
HRSA: Expanding the supply or organs: +$450,000 for an organ
donation curriculum development initiative at HRSA's Division of Health
Professions.
______
Letter From the American Mosquito Control Association
April 12, 2010.
Hon. Tom Harkin,
Chairman, Labor, Health and Human Services, Education, and Related
Agencies Subcommittee, Washington, DC.
Dear Chairman Harkin: On behalf of the American Mosquito Control
Association, I am writing to ask your assistance in maintaining $26.7
million in funding for controlling vector-borne diseases including West
Nile Virus (WNV) under the fiscal year 2011 Labor, Health and Human
Services, and Education, and Related Agencies appropriations bill.
The American Mosquito Control Association represents an
international association of individuals and organizations interested
in mosquito and other vector control. Our mission is to provide
leadership, information, and education leading to the enhancement of
public health and quality of life through the suppression of mosquitoes
and other vectors.
Since 1999, there have been more than 29,000 documented cases of
WNV in the United States.
Almost 12,000 of those cases have involved West Nile Neuroinvasive
Disease, the most severe form. It is estimated that 1.65 million people
in the United States have been infected with and 1,122 people have died
from WNV since 1999. It is believed that WNV will continue to
intermittently produce local or regional epidemics resulting in
thousands of human cases.
Since 2000, appropriated funds have been provided to the Centers
for Disease Control and Prevention for distribution to States to assist
them in developing and sustaining public health infrastructure to
reduce risk of WNV. These funds are used for surveillance and
monitoring of mosquito populations and the presence of WNV, for virus
testing, and for applied research. Many State public health agencies
and State, county, or municipal mosquito control programs depend upon
these funds to contend with WNV, and have also utilized this support to
develop capacity to deal with exotic diseases transmitted by insects
that may be introduced into the country.
However, the President's budget recommendation for fiscal year 2011
eliminates all of the current $26.7 million of this funding. Given the
virulence of WNV, coupled with the fiscal strain already put on States
due to various economic factors, we respectfully request that the
Labor, Health and Human Services, and Education, and Related Agencies
Appropriations Subcommittee resist elimination of any of this funding
for fiscal year 2011. Any savings provided by eliminating this
essential funding will be insignificant compared to the losses suffered
if the mosquito vector populations that spread WNV are not adequately
suppressed.
Thank you for your consideration of this urgent public health
matter.
Sincerely,
David Brown,
Chairman.
______
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 and 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 an increase in funding for the Title V Maternal
and Child Health Services Block Grant to $730 million for Federal
fiscal year 2011.
To help illustrate the importance of Title V MCH Block Grant
funding, I want to begin by sharing the story of a girl from Iowa who
was helped by title V-supported 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--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 thousands of children,
children with special healthcare needs and pregnant women that are
served by Title V MCH Block Grant programs in Chairman Harkin's State
alone. The Title V MCH Block Grant supports a similar network in my
home State of Florida, and none of this could happen without Title V
MCH Block Grant funding.
Health reform was a great step forward in advancing the health of
women and children but America still faces huge challenges in 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. Today the United States ranks 30th in infant
mortality rates and 41st in maternal mortality 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, the United States still fails
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.
Health reform will increase coverage and work to improve access to
healthcare and services for millions of Americans and Title V MCH Block
Grant programs have the expertise to assure that women's and children's
specific needs are addressed as programs are implemented. MCH is
uniquely positioned to support and strengthen health reform by:
--Ensuring that improvements in health, not just healthcare, are
realized through health reform. Coverage and access to medical
care have only a limited impact on overall population health.
Within the maternal and child health community, many States are
seeing that early access to quality prenatal care services is
no longer adequate to assure healthy birth outcomes for high-
risk women. Despite expanded access to healthcare for pregnant
women, the infant mortality rate in America has not improved
significantly in the past decade. Programs funded by the Title
V MCH Block Grant can help assure statewide implementation of
primary prevention strategies including public information and
education efforts targeted to populations at risk. Title V MCH
Block Grant can help guide implementation of systems of
comprehensive secondary prevention services (including newborn
screening and counseling; regionalized systems of perinatal and
neo-natal high-risk services; high-risk tracking and follow-up
services; early intervention services; and infectious disease
control).
--Offering leadership and support for outreach, enrollment, and
access to family-centered care. All children will now have
health insurance coverage and Title V MCH Block Grant programs
can help reach out to those children and their families to help
them access the healthcare system. Since the 1990's Title V MCH
leaders have been instrumental in supporting the Bright Futures
initiative that sets a standard of care for kids and children
with special healthcare needs. In health reform, co-pays for
these preventive care and screening guidelines were eliminated,
showing that Congress recognizes the importance of this
national health promotion and Maternal and child health
programs at the State level will support and promote The Bright
Futures guidelines by offering training to children's health
professionals. Many already insured individuals report they do
not have a usual source of care. Only 50 percent of Children
with Special Health Care Needs report that they 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. Those with special needs often need additional
services and care coordination not typically covered by health
insurance.
--Assessing the health status of women and children by conducting
data collection, surveillance, and monitoring activities
related to MCH population health measurement and outcomes.
Title V MCH Block Grant programs regularly collect and report
on public health measures, vital statistics, and personal
health services data and use this information to inform state
and local program planning.
Without increased funding, Title V MCH Block Grant Programs will be
overwhelmed by this work if they are not provided the resources they
need. AMCHP asks for your leadership in providing States the funding
they need by increasing the Title V MCH Block Grant to $730 million for
fiscal year 2011. We have a track record of demonstrating that we make
a positive difference and are fully accountable for the funds that we
receive. Increasing the funding to the Title V 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 Title V 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 website
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 Title V 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 Title V MCH Block Grant funded programs. Due to years
of reduced investment, the Title V MCH Block Grant is at its lowest
funding level since 1993, $662 million, meaning States again are being
asked to continue to serve additional people with less.
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 Title V MCH Block Grant aims
to do just that--using resources effectively to improve the health of
all of America's women and children. Investing in the Title V MCH Block
Grant is a cost-effective investment in our Nation's future, and we
again appreciate your leadership to fund it at to $730 million for
Federal fiscal year 2011. Thank you.
______
Prepared Statement of the Association of Minority Health Professions
Schools
Mr. Chairman and members of the subcommittee, thank you for the
opportunity to present my views before you today. I am Dr. Leo Rouse,
Chairman of the Association of Minority Health Professions Schools
(AMHPS) and the dean of the college of dentistry at Howard University.
AMHPS, established in 1976, is a consortium of our Nation's 12
historically black medical, dental, pharmacy, and veterinary schools.
The members are two dental schools at Howard University and Meharry
Medical College; four schools of medicine at The Charles Drew
University, Howard University, Meharry Medical College, and Morehouse
School of Medicine; five schools of pharmacy at Florida A&M University,
Hampton University, Howard University, Texas Southern University, and
Xavier University; and one school of veterinary medicine at Tuskegee
University. In all of these roles, I have seen firsthand the importance
of minority health professions institutions and the Title VII Health
Professions Training programs.
Mr. Chairman, time and time again, you have encouraged your
colleagues and the rest of us to take a look at our Nation and evaluate
our needs over the next 10 years. I want to say that minority health
professional institutions and the Title VII Health Professionals
Training programs address a critical national need. Persistent and
severe staffing shortages exist in a number of the health professions,
and chronic shortages exist for all of the health professions in our
Nation's most medically underserved communities. Furthermore, even
after the landmark passage of health reform, it is important to note
that our Nation's health professions workforce does not accurately
reflect the racial composition of our population. For example while
blacks represent approximately 15 percent of the U.S. population, only
2-3 percent of the Nation's health professions workforce is black. Mr.
Chairman, I would like to share with you how your subcommittee can help
AMHPS continue our efforts to help provide quality health professionals
and close our Nation's health disparity gap.
There is a well-established link between health disparities and a
lack of access to competent healthcare in medically underserved areas.
As a result, it is imperative that the Federal Government continue its
commitment to minority health profession institutions and minority
health professional training programs to continue to produce healthcare
professionals committed to addressing this unmet need.
An October 2006 study by the Health Resources and Services
Administration (HRSA), entitled ``The Rationale for Diversity in the
Health Professions: A Review of the Evidence'' found that minority
health professionals serve minority and other medically underserved
populations at higher rates than nonminority professionals. The report
also showed that; minority populations tend to receive better care from
practitioners who represent their own race or ethnicity, and non-
English speaking patients experience better care, greater
comprehension, and greater likelihood of keeping follow-up appointments
when they see a practitioner who speaks their language. Studies have
also demonstrated that when minorities are trained in minority health
profession institutions, they are significantly more likely to: (1)
serve in rural and urban medically underserved areas; (2) provide care
for minorities; and (3) treat low-income patients.
As you are aware, Title VII Health Professions Training programs
are focused on improving the quality, geographic distribution and
diversity of the healthcare workforce in order to continue eliminating
disparities in our Nation's healthcare system. These programs provide
training for students to practice in underserved areas, cultivate
interactions with faculty role models who serve in underserved areas,
and provide placement and recruitment services to encourage students to
work in these areas. Health professionals who spend part of their
training providing care for the underserved are up to 10 times more
likely to practice in underserved areas after graduation or program
completion.
In fiscal year 2011, funding for the Title VII Health Professions
Training programs must be restored to the fiscal year 2005 level of at
least $300 million, with two programs--the Minority Centers of
Excellence (COEs) and Health Careers Opportunity Program (HCOPs)--in
particular need of further funding restoration. In addition, the
National Institutes of Health (NIH)'s National Institute on Minority
Health and Health Disparities (NIMHD), as well as the Department of
Health and Human Services (HHS)'s Office of Minority Health (OMH), are
both in need of a funding increase.
Minority Centers of Excellence (COE).--COEs focus on improving
student recruitment and performance, improving curricula in cultural
competence, facilitating research on minority health issues and
training students to provide health services to minority individuals.
COEs were first established in recognition of the contribution made by
four historically black health professions institutions to the training
of minorities in the health professions. Congress later went on to
authorize the establishment of ``Hispanic'', ``Native American'' and
``Other'' Historically black COEs. For fiscal year 2011, I recommend a
funding level of $33.6 million for COEs.
Health Careers Opportunity Program (HCOP).--HCOPs provide grants
for minority and nonminority health profession institutions to support
pipeline, preparatory, and recruiting activities that encourage
minority and economically disadvantaged students to pursue careers in
the health professions. Many HCOPs partner with colleges, high schools,
and even elementary schools in order to identify and nurture promising
students who demonstrate that they have the talent and potential to
become a health professional. For fiscal year 2011, I recommend a
funding level of $35.6 million for HCOPs.
National Institutes of Health (NIH): Extramural Facilities Construction
Mr. Chairman, if we are to take full advantage of the recent
funding increases for biomedical research that Congress has provided to
NIH over the past decade, it is critical that our Nation's research
infrastructure remain strong. The current authorization level for the
Extramural Facility Construction program at the National Center for
Research Resources is $250 million. The law also includes a 25 percent
set-aside for ``Institutions of Emerging Excellence'' (many of which
are minority institutions) for funding up to $50 million. Finally, the
law allows the NCRR Director to waive the matching requirement for
institutions participating in the program. We strongly support all of
these provisions of the authorizing legislation because they are
necessary for our minority health professions training schools. In
fiscal year 2011, please provide a funding appropriation of $50 million
for extramural facilities.
Research Centers in Minority Institutions.--The Research Centers at
Minority Institutions program (RCMI) at the National Center for
Research Resources has a long and distinguished record of helping our
institutions develop the research infrastructure necessary to be
leaders in the area of health disparities research. Although NIH has
received unprecedented budget increases in recent years, funding for
the RCMI program has not increased by the same rate. Therefore, the
funding for this important program grow at the same rate as NIH overall
in fiscal year 2011.
Strengthening Historically Black Graduate Institutions--Department
of Education.--The Department of Education's Strengthening Historically
Black Graduate Institutions program (title III, part B, section 326) is
extremely important to AMHPS. The funding from this program is used to
enhance educational capabilities, establish and strengthen program
development offices, initiate endowment campaigns, and support numerous
other institutional development activities. In fiscal year 2011, an
appropriation of $75 million is suggested to continue the vital support
that this program provides to historically black graduate institutions.
National Center on Minority Health and Health Disparities
(NCMHD).--NCMHD is charged with addressing the longstanding health
status gap between minority and nonminority populations. The NCMHD
helps health professional institutions to narrow the health status gap
by improving research capabilities through the continued development of
faculty, labs, and other learning resources. The NCMHD also supports
biomedical research focused on eliminating health disparities and
develops a comprehensive plan for research on minority health at the
NIH. Furthermore, the NCMHD provides financial support to health
professions institutions that have a history and mission of serving
minority and medically underserved communities through the Minority
Centers of Excellence program. For fiscal year 2011, I recommend a
funding level of $500 million for the NCMHD.
Department of Health and Human Services' Office of Minority Health
(OMH).--Specific programs at OMH include: assisting medically
underserved communities with the greatest need in solving health
disparities and attracting and retaining health professionals;
assisting minority institutions in acquiring real property to expand
their campuses and increase their capacity to train minorities for
medical careers; supporting conferences for high school and
undergraduate students to interest them in health careers, and
supporting cooperative agreements with minority institutions for the
purpose of strengthening their capacity to train more minorities in the
health professions.
The OMH has the potential to play a critical role in addressing
health disparities. For fiscal year 2011, I recommend a funding level
of $75 million for the OMH.
Mr. Chairman, please allow me to express my appreciation to you and
the members of this subcommittee. With your continued help and support,
AMHPS's member institutions and the Title VII Health Professions
Training programs can help this country to overcome health disparities.
Congress must be careful not to eliminate, paralyze or stifle the
institutions and programs that have been proven to work. The
Association seeks to close the ever widening health disparity gap. If
this subcommittee will give us the tools, we will continue to work
towards the goal of eliminating that disparity everyday.
Thank you, Mr. Chairman, and I welcome every opportunity to answer
questions for your records.
______
Prepared Statement of the American Nurses Association
The American Nurses Association (ANA) appreciates this opportunity
to comment on fiscal year 2011 appropriations for nursing education,
workforce development, and research programs. Founded in 1896, ANA is
the only full-service professional association representing the
interests of the Nation's 3.1 million registered nurses (RNs) through
its constituent member nurses associations, its organizational
affiliates, and its workforce advocacy affiliate, the Center for
American Nurses. The ANA advances the nursing profession by fostering
high standards of nursing practice, promoting the rights of nurses in
the workplace, projecting a positive and realistic view of nursing, and
by lobbying the Congress and regulatory agencies on healthcare issues
affecting nurses and the public.
The ANA gratefully acknowledges this subcommittee's history of
support for nursing education and research. We also appreciate your
continued recognition of the important role nurses play in the delivery
of quality healthcare services. This testimony will provide 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 Bureau of Labor Statistics reports that registered nursing will
have remarkable job growth in the time period spanning 2006-
2016. During this time decade, 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.
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.
ANA strongly urges Congress to increase funding for title VIII programs
by at least $23 million (10 percent increase) to a total of $267.3
million in fiscal year 2011.
Current funding levels are clearly failing to meet the need. In
fiscal year 2008 (most recent year statistics are available), 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 three times the fiscal year 2010
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:
NELRP and Scholarships.--This line item is comprised of the NELRP
and the NSP. In fiscal year 2010, the NELRP s received $93.8 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 NELRP, the NSP has been stunted by a
lack of funding. In fiscal year 2008, HRSA received 3,039 applications
for the NSP. 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
2010, this program received $25 million.
This program is vital given the critical shortage of nursing
faculty. America's schools of nursing cannot 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. 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. All together, the Nurse Education, Practice, and
Retention Grants supported 42,761 nurses and nursing students in fiscal
year 2008. The program received $39.8 million in fiscal year 2010.
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 2010, 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, 5,649 advanced education nurses were supported
through these programs. In fiscal year 2010, these programs received
$64.4 million.
These grants also provide traineeships for master's 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 2008, 6,514 nurses and nursing students were supported through
these programs. In fiscal year 2010, 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.
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. In preparation for
the implementation of healthcare reform initiatives, which ANA
supported, we believe there will be an even greater need for nurses and
adequate funding for these programs is even more essential. ANA asks
you to meet today's shortage with a relatively modest investment of
$267.3 million in title VIII programs. Thank you.
______
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, and UNICEF--founded 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 700 million children. Largely
due to the Measles Initiative, global measles mortality dropped 78
percent, from an estimated 733,000 deaths in 2000 to 164,000 in 2008.
During this same period, measles deaths in Africa fell by 92 percent,
from 371,000 to 28,000.
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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 $720 million
and provided technical support in more than 60 developing countries on
vaccination campaigns, surveillance and improving routine immunization
services. From 2000 to 2008, an estimated 4.3 million measles deaths
were averted as a result of these accelerated measles control
activities 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 opportunity 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 (reduces
malnutrition), 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 40 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.
By the end of 2008 all WHO regions, with the exception of one
(South East Asia), achieved the 2010 goal 2 years ahead of target. The
extraordinary reduction in global measles deaths contributed an
estimated 25 percent of the progress to date toward Millennium
Development Goal #4 (reducing under 5 child mortality). However, at the
height of global achievements in measles control, a sharp decline in
commitments threatens to erase the gains of the last decade and a
global measles resurgence is likely. If mass immunization campaigns are
not continued, an estimated 1.7 million measles-related deaths could
occur between 2010-13, with more than half a million deaths in 2013
alone.
To achieve the 2010 goal and avoid a resurgence of measles the
following actions are required:
--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 mass immunization
campaigns.
--Securing sufficient funding for measles-control activities both
globally and nationally. The Measles Initiative faces a funding
shortfall of an estimated $47 million for 2011. Implementation
of timely measles campaigns is increasingly dependent upon
countries funding these activities locally. The decrease in
donor funds available at global level to support measles
elimination activities 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 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, several measles outbreaks in the United
States, all linked to importation of the virus from overseas, led to
the largest number of U.S. measles cases since 1996. These cases
resulted in dozens of hospitalizations and the costs of response to the
outbreaks were substantial, both in terms of the costs to public health
departments and in terms of productivity losses among people with
measles, parents of sick children, and people exposed to measles cases.
The Role of CDC in Global Measles Mortality Reduction
Since fiscal year 2001, Congress has provided approximately $43.6
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 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 8 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 2010, Congress has appropriated approximately $51.9
million to fund CDC for global measles control activities. The American
Red Cross and the United Nations Foundation thank Congress for the
increase in financial support from past years. We respectfully request
level funding for fiscal year 2011 for CDC's measles control activities
to prevent a global resurgence of measles and a loss of progress toward
Millennium Development Goal #4.
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 Americans for Nursing Shortage Relief
The undersigned organizations of the ANSR Alliance greatly
appreciate the opportunity to submit written testimony regarding fiscal
year 2011 appropriations for Title VIII--Nursing Workforce Development
Programs. We represent a diverse cross-section of healthcare and other
related organizations, healthcare providers, and supporters of nursing
issues that have united to address the national nursing shortage. ANSR
stands ready to work with the Congress to advance programs and policy
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 $267.3 million in funding in fiscal year 2011 for the
Nursing Workforce Development Programs under title VIII of the
Public Health Service Act at the Health Resources and Services
Administration (HRSA).
--Direct the requested increase at the title VIII programs that have
not kept pace with inflation since fiscal year 2005: Advanced
Education Nursing, Nursing Workforce Diversity, Nurse
Education, Practice and Retention, and Comprehensive Geriatric
Education. These programs, which help expand nursing school
capacity and increase patient access to care, would greatly
benefit from the 10 percent increase awarded in proportion to
their fiscal year 2010 funding levels.
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 3.733 million licensed RNs in 2008.\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. In 2008, 60 percent of
RN jobs were in hospitals.\2\ About 8 percent of RN jobs were in
physician offices, 5 percent in home healthcare services, 5 percent in
nursing care facilities, and 3 percent in employment services. The
remainder worked mostly in government agencies, social assistance
agencies, and education services. A Federal report published in 2004
estimates that by 2020 the national nurse shortage will increase to
more than one 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,
employment of registered nurses is expected to grow by 22 percent from
2008 to 2018, much faster than the average for all occupations and,
because the occupation is very large, 581,500 new jobs will result.
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, (2010). 2008 Nurse
Licensee Volume and NCLEX Examination Statistics. (Research Brief Vol.
42). On the Internet at: https://www.ncsbn.org/
10_2008NCLEXExamStats_Vol42_web_links.pdf (Accessed March 15, 2010).
\2\ Bureau of Labor Statistics, U.S. Department of Labor.
Occupational Outlook Handbook, 2010-11 Edition, Registered Nurses. On
the Internet at: http://www.bls.gov/oco/ocos083.htm (Accessed February
26, 2010).
\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 February 26, 2010).
\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
now 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. The National League for Nursing found that in the 2007-2008
academic year, 119,000 qualified applications--or 39 percent of all
qualified applications submitted to nursing education programs--were
denied due to lack of capacity. Baccalaureate degree programs turned
away 24 percent of its applications, while associate degree programs
turned away 42 percent.\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, (2010). Nursing Data Review 2007-
2008: Baccalaureate, Associate Degree, and Diploma Programs. On the
Internet at: http://www.nln.org/research/slides/index.htm. (Accessed
February 26, 2010).
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The Alliance 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: (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 because 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. 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.
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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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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 $267.3 million in
funding for the Nursing Workforce Development Programs under Title VIII
of the Public Health Service Act at HRSA in fiscal year 2011. The
requested increase should be directed at the Title VIII programs that
have not kept pace with inflation since fiscal year 2005: Advanced
Education Nursing, Nursing Workforce Diversity, Nurse Education,
Practice and Retention, and Comprehensive Geriatric Education. These
programs, which help expand nursing school capacity and increase
patient access to care, would greatly benefit from the 10 percent
increase awarded in proportion to their fiscal year 2010 funding
levels.
undersigned organizations
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
Citizen Advocacy Center
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 Hispanic Nurses
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 Council of Women's Organizations
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
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
Women's Research & Education Institute
Wound, Ostomy and Continence Nurses Society
______
Prepared Statement of the Association of Organ Procurement
Organizations
The Association of Organ Procurement Organizations (AOPO) supports
additional funding for the Division of Transplantation. AOPO is the
nonprofit, national organization that represents the Nation's 58
federally designated organ donation agencies through advocacy, support,
and program development that will maximize the availability of organs
and tissues. AOPO seeks to enhance the quality, effectiveness, and
integrity of the donation process. The Division of Transplantation's
mission is to provide oversight and guidance to the donation and
transplantation regulations and processes in the United States, and, in
that role, it enhances the efforts of AOPO and other organizations
working to increase the number of lives saved through transplantation,
research, education and therapy.
The timeliness of this funding request is particularly urgent.
Organ donation saves lives. Since transplantation is standard therapy
for end-stage organ failure, donation is a vital component of end-of-
life care in the United States. There are almost 107,000 people waiting
for a transplant in the United States, 18 of whom will die today while
waiting for the gift of life. That equates to approximately one person
dying every 90 minutes, an entirely preventable public health crisis.
In 2005, the Office of Management and Budget (OMB) set a Federal
goal to increase the number of organs donated annually by deceased
individuals in the United States to 35,000 by 2012. In 2009, more than
24,000 organs were donated. As one of the catalysts in the donation
process, organ procurement organizations (OPOs) must coordinate with
all stakeholders to reach this Federal goal. OPOs provide community
education and programs to medical professionals to help them
participate and support the donation process in every hospital in the
United States. The hospital turns to the OPO for support and expertise
when a donation situation presents itself. By law, OPOs must meet
strict Federal performance standards and operate within a regulated
system under the Department of Health and Human Services.
Increasing organ availability in the United States can be achieved
through several simultaneous strategies: enrolling all willing donors
in donor registries; improving how donation from deceased donors is
handled in U.S. hospitals; and by encouraging and protecting those who
wish to donate organs while they are still alive.
Organ donation from deceased donors remains the most important
source of increasing organ availability. Today, donation occurs in
approximately 68 percent of eligible cases. This is up from 50 percent
in 2003. OPOs now recover more than 3 organs per deceased individual.
More increases can be achieved if the government and organ donation and
transplantation professionals act on the changing nature of the organ
donor pool. The increases in the incidence of obesity, diabetes and
hypertension that affect the general public affect organ donors as
well. It takes more resources to evaluate medically complex donation
cases and it takes longer for recipients to recover from
transplantation when these organs are received. Outdated Federal
regulations fail to account for this new donation and transplantation
reality, and do not go far enough to safeguard the potential supply of
organs and tissues from possible unintended consequences. Performance
outcome measures for transplant hospitals and OPOs must be risk-
adjusted to account for the use of these donors with potentially
compromising medical conditions. OPOs are already reimbursed on a cost-
basis. Any reduction in payment would cause recovery costs to fall
below the actual costs of procuring organs. Increased funding is
critical to ensure that organ and tissue recovery does not decrease as
a result of inadvertent consequences. New healthcare reform measures
should not affect reimbursement policies by penalizing hospitals for
potentially longer inpatient stays to manage transplant recipients with
challenged donor organs because transplanting these organs is the
optimal outcome for these patients.
Current OPO success measures are based on organs transplanted per
donor and categorized by the type of donor. Preliminary work shows
promise with a more objective and replicable evaluation system for
OPOs. With additional funding, new tools can be developed that
strengthen performance-based metrics and expand organ donation
potential. To accomplish these goals, it is necessary for HHS officials
and representatives of HRSA and CMS to partner with the donation and
transplantation community to create a regulatory and reimbursement
environment that fosters achievement of national performance goals.
The President's fiscal year 2011 budget allocates $4 million for
Breakthrough Collaboratives on Organ Donation and Transplantation,
initiatives that encourage teams of organ procurement, transplantation
and critical care professionals to improve the organ donation and
transplantation process in their local areas. OPOs must have the
ability to identify, recruit, train, and financially support the
involvement of critical care professionals (e.g., physicians, nurses,
respiratory therapists) in local, regional, and national efforts to
optimize donor organ function prior to donation. Best practices are
shared for replication on a local level. More funding can and should be
provided to ensure that healthcare professionals are properly trained
to partner with OPO professionals to lead the donation process in their
hospitals. We recommend that funding for the Collaboratives be
increased from $4 million to $6 million to strengthen this national
learning program.
The extra $2 million appropriated to the Division of
Transplantation in fiscal year 2010 was allocated to the OPTN (Organ
Procurement and Transplantation Network) to develop strategies to
increase living donation and establish a greater number of paired
kidney programs. Although living donation is one way to increase the
supply of scarce resources, and the $2 million will make a positive
impact, our country currently lacks the infrastructure to take full
advantage of this donation option. Barriers to living donation remain.
For example, there is no national living donor registry. Even more
concerning, insurance companies can include living donation as a
preexisting condition. Legislation to include prohibiting living organ
donation as a preexisting condition for health insurance exclusions was
introduced more than a year ago in both the House (H.R. 1558) and
Senate (S. 623). Last June, a bill was introduced that would amend the
Family and Medical Leave Act of 1993 to allow non-Federal employees up
to 12 weeks of unpaid, job-protected leave in a 12-month period to
provide living donation. Other methods to encourage living donation,
such as the Living Organ Donor Tax Credit Act of 2009 (H.R. 218), have
been proposed to allow incentives to encourage organ donation. Though
this bill is stalled, it would allow a nonrefundable tax credit of up
to $5,000 for unreimbursed costs and lost wages related to living
donation. No action has been taken on any of these bills. Until this is
done, it could be unwise to encourage more organ donation from living
individuals.
OPOs and other agencies, such as Donate Life America, have tried to
counterbalance the rising waiting list numbers by increasing the number
of Americans who are registered organ and tissue donors. At the end of
2009, donor registrants in state registries topped 86.3 million. Donate
Life America has just released a survey in early 2010 showing that 57
percent of U.S. adults support organ donation, a 7 percent increase
from a 2009 survey. While 57 percent of Americans would sign up, only
37.1 percent have actually done so, indicating many do not know how to
do so.
Representative Clay from Missouri proposed a bill (H.R. 3071) which
authorized successful grants for the development, enhancement,
expansion, and evaluation of State organ and tissue donor registries to
aid in this effort to expand the donor pool. In addition, AOPO has
worked with States to strengthen donor designation laws through efforts
such as a nationwide effort to pass the revised Uniform Anatomical Gift
Act (UAGA) in every State, and through a proposed resolution to the
National Association of Attorneys General (NAAG). Donor registries have
proven successful, but to close this gap, funding for public and
professional education programs focused on increasing donor
registrations should be extended from $3.749 million to $6.2 million.
Almost 107,000 people in the United States are waiting for
lifesaving organ transplants, and every 11 minutes another name is
added to the transplant waiting list. A million more suffer from
conditions that could be successfully treated with donated corneas or
tissue. The current system is not keeping pace with the critical
shortage of vital organs in this country. Through additional funding
for research, training and outreach, many more lives will be saved and
improved.
The Division of Transplantation represents less than 0.35 percent
of HRSA's discretionary budget authority, but adequate funding to help
reach the HRSA national performance goals could amount to millions of
dollars in savings to the Medicare program as a result of patients
being freed from the requirement of long-term dialysis. These are the
additional increases to the fiscal year 2011 budget supported by AOPO:
--Additional funding for the Division of Transplantation should be
granted. In order to reach Federal goals, the pool of potential
donors must be widened. OPOs are looking at numerous ways to
increase organ donation. Some programs are taking advantage of
extended criteria donors, while others are mastering other
donation options such as donation after cardiac determination
of death. In order to fully and safely explore these and other
avenues to increase donation, funding for these and other
programs must be specified. OPOs operate under strict
governmental guidelines, which limit the amount of research and
development OPOs can perform.
--Studies about the effect of potential healthcare reform measures
should be conducted to guarantee organ recovery is not
negatively impacted. We recommend that the $500,000 to conduct
a study to define organ donor potential in the United States be
increased to $2 million.
--HRSA has not altered the types of organ donation grants in several
years. We recommend that funding for new grant projects to
increase organ donation be given $10.2 million, up from $7.2
million requested.
______
Prepared Statement of the American Psychological Association
The American Psychological Association (APA), in Washington, DC, is
the largest scientific and professional organization representing
psychology in the United States, including more than 150,000
researchers, educators, clinicians, consultants, and students. APA
works to advance psychology as a science, as a profession and as a
means of promoting health, education and human welfare. Below are APA's
recommendations for the funding of programs in the Departments of
Health and Human Services, and Education for fiscal year 2011.
APA supports the recommendations of the Ad Hoc Group for Medical
Research Funding of $35 billion for the National Institutes of Health,
and of the Coalition for Health Funding which supports an increase of
$9.3 billion for all the agencies of the U.S. Public Health Service.
The public health system requires additional support after years of
underinvestment. We are concerned that our already fragile public
health infrastructure lacks the capacity to support mounting health
needs under the weight of an ongoing recession, an aging population, a
health workforce shortage, and persisting declines in health status.
department of health and human services
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 & Services Administration. This nationally competitive grant
program provides integrated healthcare services to underserved rural
and urban communities and individuals most in need of mental and
behavioral health support with the least access to these services
(e.g., children, older adults, chronically ill persons, victims of
abuse or trauma, including veterans). To date there have been 70 grants
in 30 States to universities and hospitals throughout the Nation. All
psychology graduate students who benefited from GPE funds are expected
to work with underserved populations and 34-100 percent will work in
underserved areas immediately after completing the training.
Currently it is 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.
Explicit authorizing legislation was introduced in the First Session of
the 111th Congress in the U.S. Senate (S. 811), as well as in the U.S.
House of Representatives (H.R. 2066). The GPE Program has been included
in the President's Budget for the past 2 years.
Established in 2002, GPE grants have supported the
interdisciplinary training of more than 2,500 graduate students of
psychology and other health professions to provide integrated
healthcare services to underserved populations. The fiscal year 2011
GPE funding request will focus especially on providing services to
older adults, returning veterans, and the unemployed. The GPE funding
request will also be used to create training opportunities at our
Nation's Federal Qualified Health Centers, which play a critical role
in meeting the health and mental/behavioral healthcare needs of
underserved communities all across the country.
The GPE Program specifically seeks to address the needs of older
adults. Approximately 20 percent of older adults have a mental health
condition, such as depression, anxiety, alcohol, or substance abuse. In
addition, studies show that substance abuse combined with depression
makes older adults especially vulnerable to suicide (Retooling for an
Aging America, IOM, 2008). Moreover, older adults with chronic
illnesses such as heart disease have higher rates of depression than
those who are physically healthy (APA, 2008). Rural areas have a
greater percentage of older adults than urban areas, and older adults
in rural communities have a higher incidence of chronic illnesses such
as heart disease, diabetes, high blood pressure, and obesity than those
in urban communities (Alliance for Health Reform, RWJ Foundation,
January 2010).
Because of their extensive education and training, psychologists
are uniquely qualified to address the needs of unemployed persons
(e.g., assessing skills and interests for retraining; determining the
emotional status of the individual; treating mental and behavioral
health issues; and providing guidance for job searches, interviewing
strategies and techniques). The issue of joblessness and unemployment
is a serious problem for many families, including those of returning
veterans. Job loss due to multiple deployments has become a serious
issue for this population, especially in the current economy.
Center for Mental Health Services, Minority Fellowship Program.--
MFP's mission is to increase the number of minority mental health
professionals and by training mental health professionals to become
culturally competent. APA urges Congress to fund Minority Fellowship
Program at $7.5 million for fiscal year 2011. APA does not recommend
that SAMHSA include additional organizations in the program if it would
mean reductions in funding for current grantees.
Center for Substance Abuse Prevention, Substance Use and Mental
Disorders of Persons with HIV.--HIV-positive individuals who have co-
occurring mental health and substance use disorders rarely receive
``integrated'' care with a treatment plan for all three disorders. APA
recommends that Congress urge HRSA and SAMHSA to collaborate to expand
the availability of the integrated care model. An integrated approach
to HIV/AIDS care, mental health support and substance abuse treatment
can improve patient adherence and lead to more favorable health
outcomes for people living with HIV/AIDS.
Emergency Mental Health and Traumatic Stress Services Branch, Child
Trauma.--APA urges full funding for the National Child Traumatic Stress
Initiative at the authorized level of $50 million for fiscal year 2011.
Also, APA recommends the Committee to encourage SAMHSA to expand the
duration of NCTSI grant awards from 3 years to 6 years.
Centers for Disease Control and Prevention, National Center for
Health Statistics, Sexual and Gender Identity Inclusion in Health Data
Collection.--APA recommends the allocation of an additional $2 million
in funding for NHIS in the NCHS budget, to cover the cost of adding a
sexual orientation/gender identity question to the survey. This would
enable government agencies to better understand and plan for the unique
health needs of lesbian, gay, bisexual, and transgender individuals.
CDC, National Center for Injury Prevention and Control, Youth
Violence Prevention.--APA supports CDC's efforts to foster innovation
in evidence-based youth violence prevention strategies through its
Striving to Reduce Youth Violence Everywhere program. Recent, high-
profile incidents have highlighted youth violence as a significant
public health concern and homicide as the second leading cause of death
among individuals age 10-24.
Community Health Centers (CHCs), Child Maltreatment Prevention.--
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. APA also supports education, recruitment, and training of
mental health and primary care providers to implement culturally
informed preventative programs that enhance parenting practices and
screenings at the centers.
Administration for Children and Families, Healthy Media for
Youth.--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.
Strengthening Families.--APA encourages ACF to continue its support
of research programs that aim to strengthen families with economic
hardship using empirically supported skills-based approaches. These
projects aim to teach proven family strengthening skills and principles
such as relationship education, stress management, and child-centered
parenting to promote healthy inter-parental relationships that lead to
healthy, well-functioning children.
National Institutes of Health (NIH), behavioral research.--
Understanding the complex influences of behavior on health is a
critical part of NIH's mission. There is strong evidence that half of
all deaths in the United States can be attributed to behavioral factors
such as smoking, poor diet, substance abuse, and physical inactivity.
In addition, behavioral and social factors contribute to the staggering
costs of preventable morbidity and mortality. NIH-supported behavioral
and social sciences research ranges from basic research on memory,
learning and perception, to prevention research, to clinical trials and
comparative effectiveness research.
NIH, Office of Behavioral and Social Sciences Research.--OBSSR was
authorized by Congress in the NIH Revitalization Act of 1993 and
established in 1995. For fiscal year 2011, APA supports a budget of
$41.32 million for OBSSR to fulfill its coordinating role, commensurate
with the administration's request of $38.2 million for the Office and
the scientific community's request for the NIH as a whole.
NIH, Office of Behavioral and Social Sciences Research, Basic
Behavioral and Social Sciences Research.--APA is pleased that NIH has
established a initiative to increase and coordinate trans-NIH support
for basic behavioral and social sciences research. Coordinated by OBSSR
with leadership and contributions from multiple NIH institutes, the
Opportunity Network for Basic Behavioral and Social Sciences Research
(OppNet), will fund basic research to help fill gaps in knowledge about
fundamental mechanisms and patterns of behavioral and social
functioning, relevant to health and well-being, as they interact with
each other, with biology and the environment.
NIH, National Institute on Minority Health and Health Disparities,
Health Disparities.--The recent healthcare reform legislation elevated
the National Center on Minority Health and Health Disparities within
NIH, giving it greater authority to address the health disparities that
exist in minority communities. APA recommends that Congress provide
sufficient funding for NIMHD to carry out its mandated functions, and
urges Congress to support NIMHD in its enhanced role to address
priority health conditions of minority populations.
NIH, Behavioral Research Highlights.--The following areas of NIH-
supported research are good examples of the breadth and vitality of the
behavioral research portfolio at NIH:
NIH Roadmap, Science of Behavior Change.--By focusing basic
research on the initiation, personalization, and maintenance of
behavior change, and by integrating work across disciplines, this
Roadmap effort and subsequent trans-NIH activity could lead to an
improved understanding of the underlying principles of behavior change,
and drive a transformative increase in the efficacy, effectiveness, and
(cost) efficiency of many behavioral interventions.
NIMH, Children's Mental Health.--Early diagnosis, prevention and
treatment is critical for the millions of families affected by autism,
attention deficit hyperactivity disorder, anxiety disorders,
depression, bipolar disorder, and eating disorders. NIMH is supporting
important clinical trials to demonstrate the evidence base for
effective pharmacological and behavioral interventions treatments for
child and adolescent populations with these disorders.
NIDA, Tobacco Addiction.--While significant declines in smoking
have been achieved in recent decades, too many Americans, particularly
youth, remain addicted to tobacco products. NIDA-supported researchers
are identifying genetic and environmental factors that contribute to
nicotine dependence and affect the efficacy of smoking cessation
treatments.
department of education
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, including sponsoring studies that will demonstrate the
impact of socio-emotional, behavioral and attitudinal aspects of
disability. APA encourages initiatives that support a broad field of
NIDRR research, including Health and Functioning, Community Integration
and Employment which will address societal barriers, such as
stigmatization and discrimination, and their impact on people with
physical, mental and neurological disabilities.
______
Prepared Statement of the Association for Professionals in Infection
Control and Epidemiology
The Association for Professionals in Infection Control and
Epidemiology (APIC) thanks you for this opportunity to submit testimony
and greatly appreciates this subcommittee's leadership in providing the
necessary funding for the Federal Government to have a leadership role
in the effort to eliminate healthcare-associated infections (HAIs).
APIC's mission is to improve health and patient safety by reducing
the risk of healthcare-associated infections and related adverse
outcomes. The organization's more than 13,000 members, known as
infection preventionists, direct infection prevention programs that
save lives and improve the bottom line for hospitals and other
healthcare facilities throughout the United States and around the
globe. Our association strives to promote a culture within healthcare
institutions where all members of the healthcare team fully embrace the
elimination of HAIs. We advance these efforts through education,
research, collaboration, practice guidance, public policy, and
credentialing.
HAIs are among the leading causes of preventable death in the
United States, accounting for an estimated 1.7 million infections and
99,000 associated deaths in 2002. In addition to the substantial human
suffering caused by HAIs, these infections contribute $28 billion to
$33 billion in excess healthcare costs each year.
We are greatly appreciative of funding provided in the fiscal year
2010 Consolidated Appropriations Act to resource HAI reduction efforts.
In particular, we support the $5 million appropriation for the HHS
Office of the Secretary to coordinate and integrate HAI-related
activities across the Department, $136 million for the Centers for
Disease Control and Prevention's (CDC) emerging infectious diseases
portfolio for expanded surveillance, public health research and
prevention activities, $15 million to expand the CDC National
Healthcare Safety Network (NHSN) and finally, $34 million for the
Agency for Healthcare Research and Quality's (AHRQ) MRSA Collaborative
Research Initiative and for implementing evidence-based HAI prevention
training nationwide.
In fiscal year 2011, we ask that you support the CDC Coalition's
$8.8 billion for CDC's ``core programs.'' CDC serves as the command
center for our Nation's public health defense system against emerging
and reemerging infectious diseases. From pandemic flu preparedness and
prevention activities to West Nile virus to smallpox to SARS, the
Centers for Disease Control and Prevention is the Nation's--and the
world's--expert resource and response center, coordinating
communications and action and serving as the laboratory reference
center. APIC members rely on CDC for accurate information and direction
in a crisis or outbreak. We ask that you provide $2.3 billion for the
CDC's Infectious Diseases programs.
Because our members are on the front line in healthcare facilities,
bringing their expertise in infection prevention to the patient's
bedside, there are so many areas within the CDC budget that we could
highlight. Allow us to outline some of the areas of greatest concern to
our membership. We support the administration's fiscal year 2011
request for $27 million to expand NHSN to approximately 2,500 new
hospitals. Currently, 21 States require hospitals to report HAIs using
NHSN. However, CDC supports more than 2,300 participating hospitals in
NHSN in all 50 States. This surveillance system plays an important role
in improving patient safety at the local and Federal levels. NHSN's
data analysis function helps our members analyze facility-specific data
and compare rates to national aggregate metrics. It also allows CDC to
estimate and characterize the current burden of HAIs in the United
States. Every step taken to create interoperable data systems in which
our members can input HAI data and have it go directly to NHSN is a
step toward freeing our members to do more hands-on infection
prevention activities.
We also appreciate the administration's proposal of $155.9 million
for emerging infectious diseases in fiscal year 2011 and ask that you
increase funding for this purpose to $200 million to allow CDC to work
with partners at the State and local level to detect and respond to
this important public health threat.
In addition, we support the $10 million budget request for the new
Health Prevention Corps. We appreciate the importance of targeting
disciplines with existing shortages with a workforce program designed
to recruit talented new individuals for State and local health
departments.
APIC is concerned, that the administration's proposed budget would
cut the Antimicrobial Resistance budget by $8.6 million, just more than
50 percent. We agree with the agency's congressional justification that
this is ``one of the world's most pressing public health problems'' and
ask that you increase funding for CDC antimicrobial resistance
activities in fiscal year 2011 to $40 million.
In addition, we support the $34 million in the administration's
fiscal year 2011 budget to build upon AHRQ efforts--now in all 50
States, the District of Columbia and Puerto Rico--to reduce bloodstream
infections in intensive care units (ICUs) through implementation of a
safety compliance checklist and providing staff with evidence-based
practices. We support these efforts and AHRQ's plans to reach out to
the CDC to identify and design projects to reduce the incidence of HAIs
in other infection sites using evidence-based practices.
Further, APIC supports the administration's request to build upon
American Recovery and Reinvestment Act (ARRA) efforts by supporting use
of the HAI survey tool developed jointly by CDC and the Centers for
Medicare and Medicaid Services (CMS) with ARRA funds. The
administration's fiscal year 2011 request under Survey and
Certification would increase survey frequencies at ambulatory surgery
centers (ASCs) to every 4 years. Due to the increasing number of
surgeries performed in outpatient settings, and the need to ensure that
basic infection prevention practices are followed, APIC supports
efforts to increase the use of this survey tool.
Finally, we support the administration's $5 million request for HAI
activities to support continued efforts of the HHS Action Plan to
Prevent Healthcare-Associated Infections (HAI Action Plan). This
funding will allow HHS to continue current efforts and expand upon a
national media campaign, utilize social media tools, develop a single
comprehensive Web site for HAI information, and evaluate the media
campaign and original Action Plan and assess whether it is achieving
its intended goals.
We believe the development of the HAI Action Plan and the funding
to support these activities has been an essential tool in the effort to
build support for a coordinated Federal message on preventing
infections. Additionally, we feel very strongly that the CDC has the
necessary expertise to define appropriate metrics through which the HAI
Action Plan can best measure its efforts.
APIC strongly believes that to move toward our goal of HAI
elimination, there needs to be a concerted effort to fund research into
the knowledge gaps outlined in the HAI Action Plan, with an eye toward
the science of implementation.
This subcommittee has taken essential steps in using stimulus funds
to build the necessary infrastructure within States to address HAI
reduction. Your leadership has also put resources into improving
surveillance efforts and scaling-up proven HAI prevention approaches.
However, while resources have encouraged States to plan for HAI
prevention efforts, APIC's 2009 Economic Survey of our membership
indicates that infection prevention budgets within healthcare
facilities have been hard hit, particularly in the area of education.
Three-quarters of our members who reported that their budgets were
cut in our recent survey have experienced decreases for the education
that trains healthcare workers in preventing HAI transmission. Half saw
reductions in overall budgets for infection prevention, including money
for technology, staff, education, products equipment and updated
resources. Nearly 40 percent had layoffs or reduced hours. While we
fully support your effort to put infrastructure in place in States to
promote HAI reduction efforts and believe that was a very wise use of
one-time stimulus funding, we need to make clear that our membership
would be hard-pressed to scale up HAI reduction efforts while their
budgets are facing these kinds of decreases.
We thank you for the opportunity to submit testimony and greatly
appreciate this subcommittee's leadership in providing the necessary
funding for the Federal government to have a leadership role in the
effort to eliminate HAIs.
______
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 2011.
APPA has consistently supported an increase in the authorization
level for LIHEAP. The administration's fiscal year 2011 budget requests
$3.3 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 2011.
______
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). Research carried out by the NIH contributes
to our understanding of health and disease, which allows all Americans
to look forward to a healthier future. In this testimony, APS
recommends that the NIH be funded at $37 billion in fiscal year 2011.
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.
Momentum From the American Recovery and Reinvestment Act (ARRA) Should
be Maintained at NIH
The inclusion of $10.4 billion for biomedical research in ARRA has
provided the NIH with an unprecedented opportunity to move science
forward. To date, the ARRA investment has funded more than 14,000
scientific projects in all 50 States.\1\
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\1\ http://report.nih.gov/recovery/arragrants.cfm
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Last year the NIH moved quickly to take advantage of the
opportunities provided by ARRA to address important areas of scientific
need. ARRA funds are already being used to support new science in high-
priority areas such as biomarker discovery, regenerative medicine, stem
cell research and translational science through the Challenge Grant
program. ARRA funds are also being used to support highly meritorious
research proposals that had gone unfunded due to years of slow growth
in the NIH budget. In recent years, only 1 out of every 5 proposals
submitted to the NIH received funding, leaving many important research
questions unexplored. The ARRA funds have allowed NIH to direct funds
to some of the most interesting and important projects that were
unfunded for budgetary reasons. ARRA funds will also reach the next
generation of scientists through hands-on summer research experiences
for approximately 5,000 undergraduates and science educators.
As a result of the ARRA investment, the NIH estimates that 50,000
jobs nationwide will be created or retained.\2\ The widespread
distribution of NIH ARRA funds has already had a direct economic impact
on the research community by funding labs and projects that would
otherwise have gone unfunded. However, State and local economies also
stand to benefit substantially from the stimulus funds being spent by
NIH researchers. A report by Families USA showed that on average in the
year 2007, every $1 of NIH funding generated twice as much in State
economic output.\3\
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\2\ http://report.nih.gov/PDF/
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\3\ http://www.familiesusa.org/assets/pdfs/global-health/in-your-
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In order to capitalize and build on the functional capacity created
through the ARRA investment, we urge Congress to make every effort to
fund the NIH at a level of $37 billion in fiscal year 2011. Funding at
this level takes into account the additional ARRA funds that have been
added to the NIH budget, and allows for growth at the rate of the
biomedical research and development price index (BRDPI). This will
maintain the momentum created by ARRA and start the NIH on a new path
of consistent and sustainable growth in future budget cycles.
NIH Funds Outstanding Science
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 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 results in new tools and
knowledge that can be used to design novel treatments and prevention
strategies. A key example comes from the recent outbreak of H1N1 flu.
From the time that the first cases of the disease emerged, it took
approximately 6 months to develop a vaccine, identify those most at
risk and begin to understand how and why the H1N1 flu strain differs
from those seen in an average year. The ability to rapidly respond to
this and other threats to human health is directly dependent upon
maintaining a robust scientific enterprise.
Last year the Nobel Prize in Physiology or Medicine was awarded to
three longtime NIH grantees. Drs. Jack Szostak, Elizabeth Blackburn and
Carol Greider shared the 2009 prize for their discovery of how the tips
of chromosomes are protected from degradation during cell division.
Since the discovery of this fundamental cellular mechanism, researchers
have been able to apply this knowledge to better understand how cells
age and why they sometimes become cancerous. Collectively NIH has
supported their research for more than 30 years.\4\ Three other NIH
grantees won the Nobel Prize in Chemistry in 2009. Drs. Venkatraman
Ramakrishnan, Thomas A. Steitz and Ada E. Yonath identified the
structure of the ribosome, the molecular machinery that makes proteins
in cells. NIH has supported these researchers in their work for nearly
four decades.\5\
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NIH Nurtures the Biomedical Research Enterprise
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. The administration's
fiscal year 2011 budget proposal includes funding for a 6 percent
increase in stipend levels for National Research Service Awards. The
APS applauds this proposed increase and calls on Congress to make every
effort to fully fund the request.
New investigators entering the scientific workforce have frequently
encountered long training periods before gaining independence and
funding for their own research labs. In fiscal year 2007, the average
age of new investigators receiving their first awards from NIH rose to
42 years. To address this problem and foster the next generation of
scientists, the NIH has committed to funding new investigators at
approximately the same rate as established investigators.\6\ This will
allow investigators to become independent and able to explore
innovative ideas at an earlier stage of their careers. 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.
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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.
The APS joins the Federation of American Societies for Experimental
Biology in urging that NIH be provided with $37 billion in fiscal year
2011 so that researchers can build on the momentum and capacity created
through the ARRA investment.
______
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 $35 billion for
the National Institutes of Health (NIH) in fiscal year 2011.
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 sustains
its cross-NIH basic behavioral research funding initiative, the Basic
Behavioral and Social Science Opportunity Network (OppNet), 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 2011
appropriations for 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 22,000
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
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 $35 billion for NIH in fiscal year 2011, an increase of 12.6
percent more than the fiscal year 2010 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.
NIH's New Commitment to Basic Behavioral Science Research Should Be
Made Permanent
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. Thanks
in large part to the leadership of this Committee and your counterparts
in the House, NIH has launched a new initiative that supports and
expands new basic behavioral research throughout NIH. In November 2009,
NIH leadership launched the Basic Behavioral and Social Science
Opportunity Network (OppNet), and has already released several funding
opportunities. OppNet is currently organizing its strategic plan to
prioritize research areas it will fund over the next 4 years. This plan
should include, at the very least, the following areas of research that
will be critical to its success and more importantly, critical for the
NIH to best take advantage of what this field has to offer:
--identifying the dimensions of the environment that create,
moderate, and reverse risks for mental and physical health
disorders;
--a rigorous understanding of emotions, their regulation, and
functions;
--development of multiple methods of behavioral measurement;
--the role of emotions and environmental factors in behavior change;
--animal models of behavior that enrich our understanding of human
processes;
--interpersonal interactions across the lifespan and across social,
economic, and cultural contexts; and
--individual processes underlying personality, self, and identity.
While we are greatly encouraged by the launch of OppNet, it is
slated to end in 2014. That, combined with the lack of a permanent
organizational structure for basic behavioral research at NIH, creates
enormous uncertainty for an enterprise that by nature inherently
requires a longer-term, stable commitment.
APS respectfully asks the subcommittee to:
--ensure that NIH adequately supports and sustains a strong,
permanent program of basic behavioral science research and
training as a critical element in improving the health and
welfare of all Americans; and
--ensure that behavioral research is a priority at NIH both by
providing maximum funding for those institutes where behavioral
science is a core activity and encouraging NIH to advance a
model of health that includes behavior in its scientific
priorities.
Psychological Clinical Science Training and Public Health
One in 4 adults and 1 in 5 children in the United States have a
diagnosable mental disorder that impairs normal functioning, and mental
illness accounts for more than 15 percent of the burden of disease in
major nations; the economic burden associated with mental illness
exceeds that of all forms of cancer combined. The costs associated with
mental illness are staggering; $69 billion was spent on mental health
services in the United States alone in 1996. This is more than 7
percent of our total health spending. For these reasons, it is critical
that our understanding of, diagnosis, treatment, and prevention of
mental illness reflects the very best and most modern science possible.
Unfortunately, the vast majority of clinical psychologists are
currently being trained outside of the major research universities and
hospitals. Even in the best of these training programs, students
receive little or no direct contact with cutting-edge research. In many
of these programs there is even an anti-science bias; students in these
programs are being trained to diagnose and treat mental illness using
methods that have no scientific support or, even worse, that have been
shown to be of little or no value. To combat this problem, a group of
the top 50 clinical psychology programs in the United States formed the
Academy for Psychological Clinical Science, an organization committed
to reaffirming the critical importance of science in clinical
psychology training. The Academy recently established an independent
accreditation system to insure that clinical psychology training
programs meet the highest scientific standards, which will be critical
for re-establishing the scientific foundation of clinical psychology.
Individuals with mental illness and their families will know that
practitioners who graduate from these programs will be delivering
treatments that incorporate state-of-the-art scientific advances and
that have passed the most critical scientific tests of their efficacy.
Those communities and organizations wishing to provide state-of-the-
art, scientifically based mental health services will know where to
seek consultation and find the very best personnel. And finally, this
new accreditation system will increase the supply of highly skilled
scientists who will continue to fight the good fight again the ravages
of mental illness.
The National Institute of Mental Health's (NIMH) mission includes
the assurance that that the science-based interventions its researchers
generate can be used by patients, families, healthcare providers, and
the wider community involved in mental healthcare. Most of the
institutions that will be accredited under the new system (called the
Psychological Clinical Science Accreditation System) include NIMH-
funded researchers, and NIMH has already begun to support the new
system in the spirit of advancing scientifically-sound treatments that
its research helped develop. APS asks the Committee to support the new
accreditation system for psychological clinical science training
programs in order to reduce the burden of mental illness on
individuals, families, communities, and society, through the use of
empirically validated treatments by qualified practitioners.
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 is at the forefront of
supporting behavioral science in the spirit of advancing the Nation's
effort to prevent cancer. The Behavioral Research Program continues to
invest in research on the development and dissemination of
interventions in areas such as tobacco use, dietary behavior, sun
protection, and decisionmaking. For example, knowledge about basic
psychological mechanisms can be brought to bear on warnings about risky
behavior, with a particular focus on tobacco use. The recently enacted
FDA regulation of tobacco products is a landmark opportunity for
tobacco control, and it presents a complimentary invitation for
psychological science to revolutionize the study of warning labels and
risky behavior. Specifically, recent research on graphic warning labels
for cigarettes indicates that specific types of images can improve
understanding of the consequences of smoking, and encourage motivations
to quit smoking. APS asks the subcommittee to support NCI's behavioral
science research and training initiatives and to encourage other
Institutes to use them 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, older individuals face important and often complex
decisions about retirement and other financial matters, and the normal
aging process alters many of the psychological capacities and neural
systems that come into play when making these decisions. Researchers
are now looking at how healthy aging influences the psychological and
neural bases of economic choice, and hope to speed along the
development of interventions that remediate problems with
decisionmaking in the elderly, resulting in public health benefits.
NIA's commitment to cutting-edge behavioral science is further
illustrated by the Institute's leadership role in NIH's new Common Fund
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 Americans across the lifespan.
Eunice Kennedy Shriver National Institute for Child Health and
Human Development (NICHD).--NICHD is to be commended for supporting a
broad spectrum of behavioral research, particularly as it relates to
real-world problems. Let me give you one example, centering on the
effects of socioeconomic adversity on children's brain development.
Researchers are beginning to clarify the relationship among
socioeconomic status (SES), early life experience, and learning in
adolescents. We know that learning ability is positively correlated
with SES, and recent research suggests that the effects of childhood
experience on the development of certain parts of the brain may
partially explain this. Researchers at the University of Pennsylvania
are now learning about the nature and causes of the SES disparity in
learning ability by examining its scope across different types of
learning and different neural systems, and assessing its relation to
early experience, including stress and parental nurturing. Thus, we are
closer to understanding the crucial role played by learning in the
academic, occupational, and personal lives of all Americans, and the
prospect of preserving and fostering the learning ability in at-risk
youth though the application of insights from the cognitive
neuroscience of memory, stress, and early experience. APS asks the
subcommittee 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.
National Institute on Deafness and Other Communication Disorders
(NIDCD).--NIDCD supports a vibrant and important portfolio of
behavioral science research on voice, speech, and language. This
research expands our understanding of the role of each hemisphere of
the brain in communication and language, of early specialization of the
brain, and of the recovery process following brain damage. Scientists
are now exploring the genetic bases of child language disorders, as
well as characterizing the linguistic and cognitive deficits in
children and adults with language disorders. This and similar research
programs are important because they offer valuable insight into the
basis of the disorder and the associated academic problems encountered
by many children with SLI. They are also likely to improve the
classification, diagnosis, and treatment of other language, reading,
and speech disorders. APS asks the subcommittee to support NIDCD's
behavioral science research program and to increase NIDCD's budget in
proportion to the overall increase at NIH in order to continue making
significant advances in our understanding of and treatments for
communication disorders in Americans of all ages.
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
Mental Health, the National Institute on Alcohol Abuse and Alcoholism,
and the National Institute on Drug Abuse. 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 2011 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 Physical Therapy Association
Chairman Harkin and Members of the Senate Subcommittee on Labor,
Health and Human Services, and Education, and Related Agencies: On
behalf of more than 74,000 physical therapists, physical therapist
assistants, and students of physical therapy, the American Physical
Therapy Association (APTA) thanks you for the opportunity to submit
official testimony regarding recommendations for the fiscal year 2011
appropriations. APTA's mission is to improve the health and quality of
life of individuals in society by advancing physical therapist
practice, education, and research. Physical therapists across the
country utilize a wide variety of Federally funded resources to work
collaboratively toward the advancement of these goals. APTA's
recommendations for Federal funding as outlined in this document
reflect the commitment toward these priorities for the good of society
and the rehabilitation community.
department of health and human services
National Institutes of Health (NIH)
Rehabilitation research was funded at $404 million within NIH's
approximately $30.5 billion budget in fiscal year 2009. This represents
roughly 1 percent of NIH funds for an area of biomedical research that
impacts a growing percentage of our Nation's seniors, persons with
disabilities, young persons with chronic disease or traumatic injuries,
and children with development disabilities. The Institute of Medicine
estimates that 1 in 7 individuals have an impairment or limitation that
significantly limits their ability to perform activities of daily
living. Investment in and recognition of rehabilitation within NIH is a
necessary step toward continuing to meet the needs of these individuals
in our population. Through the American Recovery and Reinvestment Act
(ARRA), rehabilitation research has been able to take advantage of an
extra infusion of approximately $75 million in fiscal year 2009.
However, APTA believes that rehabilitation research at NIH has been
underfunded for many years. The funds currently utilized are well-
invested for the impact that rehabilitation interventions will have on
the quality of lives of individuals. Continued investment and greater
recognition and coordination of rehabilitation research among
Institutes and across Federal Departments will enhance the returns the
Federal Government receives when investing in this area. Taking this
into consideration, APTA advocates for $35.2 billion (a $4.2 billion
increase more than fiscal year 2010) for NIH to capitalize on the
momentum achieved under the ARRA investment to improve health, spur
economic growth and innovation, and advance science.
Specifically, the physical therapy and rehabilitation science
community recommends that Congress allocate crucial funding
enhancements in the following Institutes:
--$1.5 billion (a 12.5 percent increase more than fiscal year 2010)
for the Eunice Kennedy Shriver National Institute of Child
Health and Human Development which houses the National Center
for Medical Rehabilitation Research (NCMRR), the only entity
within NIH explicitly focused on the advancement of
rehabilitation science. NCMRR fosters the development of
scientific knowledge needed to enhance the health,
productivity, independence, and quality-of-life of people with
disabilities. A primary goal of the Center-supported research
is to bring the health-related problems of people with
disabilities to the attention of the best scientists in order
to capitalize upon the myriad advances occurring in the
biological, behavioral, and engineering sciences.
--$1.857 billion ($221 million increase more than fiscal year 2010)
for the National Institute of Neurological Disorders and
Stroke. This funding level is required to enhance existing
initiatives and invest in new and promising research to prevent
stroke and advance rehabilitation in stroke treatment. Despite
being a major cause of disability and the number three cause of
death in the United States, NIH invests only 1 percent of its
budget on stroke research. However, APTA recognizes the
advancements that NIH-funded research has achieved in the
specific area of stroke rehabilitation. APTA commends this area
of leadership at NIH and encourages a continued focus on
rehabilitation interventions and physical therapy to maximize
an individual's function and quality of life after a stroke.
--$500 million in arthritis and musculoskeletal research within the
National Institute of Arthritis and Musculoskeletal and Skin
Diseases
Centers for Disease Control and Prevention (CDC)
APTA was disappointed to see the cuts that have been proposed for
CDC through the administration's fiscal year 2011 budget proposal. The
potential contributions of CDC to the lives of countless individuals
are limited only by the resources available for carrying out its vital
mission. Our Nation and the world will continue to benefit from further
improvement in public health and investment in scientific advancement
and prevention. APTA recommends Congress provide at least $8.8 billion
for CDC's fiscal year 2010 ``core programs'' in the fiscal year 2011
Labor, Health and Human Services, and Education, and Related Agencies
appropriations bill. This request reflects the support CDC will need to
fulfill its core missions for fiscal year 2011. APTA strongly believes
that the activities and programs supported by CDC are essential in
protecting the health of the American people.
Physical therapists play an integral role in the prevention,
education, and assessment of the risk for falls. The CDC is currently
only allocating $2 million per year to address the increasing
prevalence of falls, a problem costing more than $19.2 billion a year.
Among older adults, falls are the leading cause of injury deaths. This
is why APTA respectfully requests that $20.7 million be provided in
funding for the ``Unintentional Injury Prevention'' account to allow
CDC's National Center for Injury Prevention and Control to
comprehensively address the large-scale growth of older adult falls.
Currently, CDC's program on arthritis receives $13 million in
annual funding, and about half of which is distributed via competitive
grants to 12 States to deliver and promote proven arthritis
intervention strategies. Physical therapy interventions are designed to
restore, maintain, and promote maximal physical function for people
with arthritis. An additional investment of $10 million, beginning in
fiscal year 2011, would fund up to 14 new States and bring evidence-
based prevention programs to many more Americans through innovative
delivery approaches.
Traumatic Brain Injury (TBI) is a leading cause of death and
disability among young Americans and continues to be the signature
injury of the conflicts in Iraq and Afghanistan. CDC estimates that at
least 5.3 million Americans, approximately 2 percent of the U.S.
population, currently require lifelong assistance to perform activities
of daily living as a result of TBI. High-quality, evidence-based
rehabilitation for TBI is typically a long and intensive process. From
the battlefield to the football field, American adults and youth
continue to sustain TBIs at an alarming rate and funding is desperately
needed for better diagnostics and evaluation, treatment guidelines,
improved quality of care, education and awareness, referral services,
State program services, and protection and advocacy for those less able
to advocate for themselves. APTA recommends at least $10 million in
fiscal year 2011 for CDC's TBI Registries and Surveillance, Brain
Injury Acute Care Guidelines, Prevention, and National Public
Education/Awareness programs.
APTA would like to see $76 million ($20 million increase more than
fiscal year 2010) for CDC's Heart Disease and Stroke Prevention Program
in fiscal year 2011. CDC spends on average only 16 cents a person each
year on heart disease and stroke prevention, despite the fact that
heart disease, stroke, and other forms of cardiovascular disease remain
our Nation's number one and most costly killer. A $20 million increase
in funding will allow CDC to support the 9 States that receive no
funding for the competitively awarded Heart Disease and Stroke
Prevention Program, elevate more States to basic program
implementation, and support the other funded States.
CDC's Well-Integrated Screening and Evaluation for Women Across the
Nation (WISEWOMAN) programs screens uninsured and under-insured low-
income women ages 40 to 64 for heart disease and stroke risk and those
with abnormal results receive counseling, education, referral and
follow up. WISEWOMAN reached more than 84,000 women and provided more
than 210,000 lifestyle intervention sessions from 2000 to mid-2008,
while also identifying 7,647 new cases of high blood pressure, 7,928
new cases of high cholesterol, and 1,140 new cases of diabetes. Among
those WISEWOMAN participants who were re-screened 1 year later, average
blood pressure and cholesterol levels had decreased considerably. APTA
recommends $37 million ($16.3 million increase more than fiscal year
2010) for CDC's WISEWOMAN Program in fiscal year 2011.
Health Resources and Services Administration (HRSA)
Through the successful passage of healthcare reform legislation, it
becomes more important now than ever that America is able to supply an
adequate and well-trained healthcare workforce to meet the demands of
an expanded market of U.S. citizens that have health insurance
coverage. APTA urges you to provide at least $9.15 billion for HRSA in
fiscal year 2011. This amount reflects the minimum amount necessary for
the agency to adequately meet the needs of the populations they serve.
The relatively level funding HRSA has received over the past several
years has undermined the ability of its successful programs to grow and
be expanded to represent professions that shape the entire healthcare
team, such as physical therapy. Any shortage areas of physical
therapists and rehabilitation professionals may become more accentuated
as the percentage of the U.S. population that has health coverage
increases and demand rises. It is beneficial to undertake efforts to
strengthen the healthcare workforce and delivery across the whole
spectrum of an individual's care--from onset through rehabilitation.
More resources are needed for HRSA to achieve its ultimate mission of
ensuring access to culturally competent, quality health services;
eliminating health disparities; and rebuilding the public health and
healthcare infrastructure.
In conjunction with the importance of funding TBI efforts within
CDC, APTA also recommends $8 million for the HRSA Federal TBI State
Grant Program and $4 million for the HRSA Federal TBI Protection &
Advocacy (P&A) Systems Grant Program
department of education
In 2008, as part of the reauthorization of the Higher Education Act
(Public Law 110-315), the Loan Forgiveness for Service in Areas of
National Need (LFSANN) program was created. This program would provide
a modest amount of loan forgiveness for a variety of education and
healthcare professional groups, including physical therapists, upon a
commitment to serve in targeted populations that were identified as
areas of crucial importance and national need. However, the program has
not been implemented because it has not received any funding. APTA
commends the recent efforts of Congress to reform the higher education
loan industry. The lowering of the limit on the income-based repayment
plan for consolidated Federal Direct Loans will assist the burdensome
payments for all higher education loan borrowers. However, this program
still fails to meet the most important impact of LFSANN--channeling
providers and professionals into areas where there are demonstrated
shortages and high need, such as physical therapy care for veterans and
children and adolescents. APTA strongly urges Congress to take action
and provide $10 million in initial funding for this vital LFSANN
program that will impact the healthcare and education services of those
most in need.
National Institute for Disability and Rehabilitation Research (NIDRR)
NIDRR has been one of the longest standing agencies to focus on
federally funded medical rehabilitation research. Rehabilitation
research makes a difference in the lives of individuals with
impairments, functional limitations, and disability. Advancements in
rehabilitation research have led to greater quality of life for
individuals who have spinal cord injuries, loss of limb, stroke and
other orthopedic, neurological, and cardiopulmonary disorders.
Investment in NIDRR is a necessary step toward continuing to meet the
needs of individuals in our population who have chronic disease,
developmental disabilities or traumatic injuries. Therefore, APTA
recommends at least $20 million per year for NIDRR to support research
and development, capacity building, and knowledge translation in
health, rehabilitation, and function.
APTA also requests $11 million for NIDRR's TBI Model Systems
administered by the Department of Education. 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 brain
injury. They are a key source of evidence-based medicine and
rehabilitation care for this crucial and growing population.
Interagency Committee on Disability Research (ICDR)
APTA would like to see $1.5 million appropriated for the ICDR to
support a research agenda-setting summit. The disability and
rehabilitation research community feels that such a meeting would
ultimately be beneficial to work cooperatively on strategies to
leverage the Federal investments in disability and rehabilitation
research across all respective agencies and facilitate the conducting
of meaningful collaborative projects and initiatives, including
capacity building and knowledge translation.
conclusion
APTA looks forward to working with the subcommittee and the various
agencies outlined above to advance the resources available for the
rehabilitation needs of society.
______
Prepared Statement of the Association of Public Television Stations and
Public Broadcasting Service
On behalf of America's 361 public television stations, we
appreciate the opportunity to submit testimony for the record on the
importance of Federal funding for local public television stations.
Corporation for Public Broadcasting--Fiscal Year 2013 Request: $604
Million, Advance Funded
More than 40 years after the inception of public television, local
stations continue to serve as the treasured cultural institutions
envisioned by their founders, reaching America's local communities with
unsurpassed programming and services. Furthermore, the power of digital
technology has enabled stations to greatly expand their delivery
platforms to reach Americans where they are increasingly consuming
media--online and on-demand--in addition to on-air.
However, at the same time that stations are expanding their
services and the impact they have in their communities, stations are
also facing unprecedented revenue declines--presenting them with the
greatest financial challenge in their 40-year history. Every revenue
source upon which our operations depend is under siege. State funding
support is in a wholesale free-fall. Financial contributions from
foundations and underwriters, at the local and national levels, have
declined. Individual contributions, the bed-rock of every public
station's annual operating budget, are dropping, reflecting the effects
of rising unemployment and declining personal discretionary income. As
such, increased Federal support for public broadcasting is perhaps more
important now than ever before.
Funds appropriated to CPB reach local stations in the form of
Community Service Grants (CSGs). CSGs, while accounting for
approximately 15 percent of the average station's overall budget, serve
as the backbone of support for stations. Stations are also able to
leverage those CSGs to raise additional funds from State legislatures,
private foundations and their viewers.
Funding through CPB is absolutely essential to public television
stations. A 2007 GAO report concluded that Federal funding, such as
CSGs, is an irreplaceable source of revenue, and that ``substantial
growth of non-Federal funding appears unlikely.'' It also found that
``cuts in Federal funding could lead to a reduction in staff, local
programming or services.''
Federal support for CPB and local public television stations has
resulted in a nationwide system of locally owned and controlled,
trusted, community-driven and community responsive media entities. For
the seventh consecutive year, a 2010 Roper poll rated public television
the most trusted institution among nationally known organizations. And
in a recent report, the American Academy of Pediatrics recommended that
Congress increase funding for public television, characterizing it as
``the sole source for high quality, educational, noncommercial
programming for children.''
In addition, the advent of digital technology has created enormous
potential for stations, allowing them to bring content to Americans in
new, innovative ways while retaining our public service mission. Public
television stations are now utilizing a wide array of digital tools to
expand their current roles as educators, local conveners and vital
sources of trusted information at a time when their communities need
them most.
For example, in an effort to address the decline of local
journalism, CPB has just announced a significant investment in
partnership with 28 local public television and radio stations to form
seven regional journalism centers. The Centers will form teams of
multimedia journalists, who will focus on issues of particular
relevance to each region; their in-depth reports will be presented
regionally and nationally via digital platforms, community engagement
programs and radio and television broadcasts. For example, in the
Plains, the project will focus on agribusiness including farming
practices, food and fuel production. In the Upper-Midwest, the
collaboration will focus on the changing economy of the region. In the
Southwest, a bilingual reporting team will focus on cultural shifts
that are transforming the southwest, including Latino, Native American,
and border issues.
In order for our stations to continue playing this vital role in
their communities, APTS and PBS respectfully request $604 million for
CPB, advance funded for fiscal year 2013. Advance funding is essential
to the mission of public broadcasting. The longstanding practice
ensures that stations are able to insulate programming decisions from
political influence, leverage the promise of Federal dollars to raise
State, local and private funds, and have the critical lead-in time
needed to plan and produce programs.
Digital Funding--Fiscal Year 2010 Request: $59.5 million
Public television stations have been at the forefront of the
digital transition, embracing the technology early and recognizing its
benefits to their viewers. Fortunately, Congress wisely recognized that
the Federal mandated transition to digital broadcast would place a
hardship on public television's limited resources. Since 2001, Congress
has provided public television stations with funds to ensure that they
have the ability to continue to meet their public service mission and
deliver the highest-quality educational, cultural and public affairs
programming post-transition.
Although the Federal mandated portion of the transition is
complete, what remains to be finished is the ability of stations to
fully replicate in digital their analog services. As stations have
completed the transition of their main transmitters, they will continue
to convert their master controls, digital storage equipment and other
necessary studio equipment--necessary to produce and distribute local
educational programming. This program is also critical to providing
funds that can be invested in interactive public media that maximizes
investments in digital infrastructure--including such content
investments as the American Archive.
Unlike most commercial broadcasters, public television has used
this new public digital spectrum to maximize programming choices by
offering an array of new channel options, including the national
offerings of V-me (the first 24-hour, Spanish-language, educational
channel), World, and Create.
More importantly, stations have also used these multicast
capabilities to expand their local offerings with digital channels
dedicated to community or State-focused programming. Some stations have
even utilized this technology to provide gavel-to-gavel coverage of
their state legislatures. In addition, digital broadcasting has enabled
stations to double the amount of noncommercial, children's educational
programming offered to the American public.
APTS and PBS respectfully request $59.5 million in CPB Digital
funding for fiscal year 2011 to enable stations to fully leverage this
groundbreaking technology.
Ready To Learn and Ready to Teach (U.S. Department of Education)
The President's budget proposed for the consolidation of both the
Ready To Learn and Ready To Teach programs into larger grant programs.
APTS and PBS are concerned that the consolidation of these programs
could lead to, at worst, the elimination of these critical programs
that Congress has seen fit to invest more than $216 million since
fiscal year 2005. At best, under the proposed budget, these programs
would cease to exist in their current structure, removing the
mechanisms that have provided for the tremendous efficient and
effective nature in which these programs successfully operate.
Consolidation or elimination of these programs would severely
affect the ability of local stations to respond to their communities'
educational needs, removing the needed resources provided by these
programs for children, parents and teachers. For example, our stations
that participate in Ready To Learn or Ready To Teach activities in
places such as Iowa (Iowa Public Television), Wisconsin (Wisconsin
ECB), Washington (KCTS 9), Louisiana (Louisiana Public Broadcasting),
Illinois (WSIU, WEIU), Arkansas (AETN), Pennsylvania (WPSU, WQLN, WITF,
WVIA), Mississippi (Mississippi Public Broadcasting), New Hampshire
(New Hampshire Public Television), Texas (KLRN, KLRU, KAVC, KAMU, KEDT,
KMBH, KUHT, KNCT, KTXT, KOCV, KWBU), Alabama (Alabama Public
Television) and Tennessee (WLJT, WNPT) would be severely impacted by
the proposed consolidation.
We urge that the subcommittee maintain the Ready To Learn and Ready
To Teach programs as stable line-items in the fiscal year 2011 budget
and resist the calls for consolidation. Additionally, we encourage the
subcommittee to express their support for Ready To Learn and Ready To
Teach as stable, Federal funded programs as Congress considers the
reauthorization of the Elementary and Secondary Education Act which
contains the authorizing language for both of these programs.
Ready To Learn--Fiscal Year 2011 Request: $32 million
With a specific target of at-risk children, Ready To Learn is
improving the reading skills of all of America's children through fully
researched, engaging educational television and on-line content, with a
particular focus on more than 150,000 low-income households in 23
States and the District of Columbia. Ready To Learn content, based on
the findings of the National Reading Panel of 2000, is on-air-reaching
99 percent of the country's television households through Public
Television stations--as well as on-line, and on the ground in
classrooms and communities.
In addition to successful on the ground partnerships with local
stations, national nonprofit organizations and State education leaders,
including the Council of Chief State School Officers, Ready To Learn's
signature component is its research-based and teacher-tested television
programs that teach key reading skills, including: ``SUPER WHY!'',
``WordWorld'', ``Martha Speaks'', ``Sesame Street'', ``Between The
Lions'', and ``The Electric Company'' produced by the best educational
children's content producers.
Recent evaluations of one such program, ``SUPER WHY!'', tell a
story of enormous success.
The evaluation found that preschool children who watched the
program performed significantly better on most of the standardized
measures of early reading achievement when compared with those
preschool children who watched an alternate program. In fact, pre-test
to post-test gains averaged 28.7 percent for ``SUPER WHY!'' viewers
compared with an average gain of 13.2 percent for alternate program
viewers. Specifically, preschool children demonstrated significant
growth in targeted early literacy skills featured in ``SUPER WHY!'',
including alphabet knowledge, phonological and phonemic awareness,
symbolic and linguistic awareness, and comprehension.
In addition, ``SUPER WHY!'s'' 2008 5-day Summer Reading Camps--33
camps in 19 communities with 454 low-income Pre-K children--produced
measurable results in raising children's reading skills through their
interaction with strategically executed instructional materials
designed to boost letter knowledge, decoding, encoding, and reading
ability. During these camps, preschoolers showed an 84 percent gain in
phonics skills and a 139 percent gain in word recognition skills.
A separate study conducted by the University of Michigan, found
that low income children who were exposed to Ready to Learn content
used in formal curriculum preformed at nearly the same level as their
higher income peers--effectively erasing the achievement gap.
With additional funding, Ready To Learn can continue to meet the
needs of those most lacking reading skills by extending the program's
community engagement and partnership-driven work to additional high-
need communities nationwide and by increasing capacity and reach
through the innovative use of digital media.
APTS and PBS respectfully request $32 million for Ready To Learn in
fiscal year 2011.
Ready To Teach--Fiscal Year 2011 Request: $17 million
Ready To Teach was first introduced in Congress in 1994 as a
demonstration project to show how distance learning technology coupled
with public broadcasting's rich educational content could help teachers
enhance their proficiency in specific curriculum areas.
Later authorized under the No Child Left Behind Act, Ready To Teach
currently funds the development of digital educational services aimed
at enhancing teacher performance. Through four Ready To Teach
services--PBS TeacherLine, e-Learning for Educators, VITAL and HELP--
PBS, Alabama Public Television, Thirteen/WNET and Rocky Mountain PBS
(RMPBS), have provided online professional development targeted toward
Pre-K-12 educators, video clips aligned to math and reading State
standards, and an English-Language Learner program for math
instruction.
Together, Ready To Teach programs have served nearly 500,000
educators since 2001, and represent an enormously successful
utilization of innovative, digital technology for the benefit of
teachers and their students in the 21st century classroom.
APTS and PBS respectfully request $17 million in fiscal year 2011
in order to build the library of professional development courses,
resources and support materials for teachers through the public
broadcasting infrastructure, and increase the number of local stations
able to participate in Ready To Teach, thereby increasing the efforts
to prepare highly qualified teachers.
______
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 Appropriations Subcommittee regarding funding for nursing- and
rehabilitation-related programs in fiscal year 2011. ARN represents
5,700 Registered Nurses (RNs) with 10,000 nurses certified in the
specialty 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 illnesses and physical disabilities 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 condition, achieve their
greatest potential, and work toward productive, independent lives. They
take a holistic approach to meeting patients' nursing and 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 and care, including 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 maximum
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 practices, 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 focused on nursing and
medical rehabilitation, e.g., 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 (RNs) for
individuals affected by chronic illness and/or physical disability.
According to the Department of Health and Human Services, an
estimated 36,750 nurses need to be recruited, educated, and retained
through the Federal Nursing Workforce Development program at HRSA 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 July 2008, the American Health Care
Association reported that more than 19,400 RN vacancies exist in long-
term care settings. These vacancies, coupled with an additional 116,000
open positions in hospitals reported by the American Hospital
Association in July 2007, bring the total RN vacancies in the United
States to more than 135,000. The demand for nurses will continue to
grow as the baby-boomer population ages, nurses retire, and the need
for healthcare intensifies. According to the U.S. Bureau of Labor
Statistics (BLS), nursing is the Nation's top profession in terms of
projected job growth, with more than 587,000 new nursing positions
being created through 2016. Furthermore, BLS analysts project that more
than 1 million new and replacement nurses will be needed by 2016.
ARN strongly supports the national nursing community's request of
$267.3 million in fiscal year 2011 funding for Federal Nursing
Workforce Development programs at HRSA.
National Institute on Disability and Rehabilitation Research (NIDRR)
The National Institute on Disability and Rehabilitation Research
(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 2011 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 healthcare 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 $160 million in fiscal year 2011 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 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 needed 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 2011
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; $8 million for the HRSA Federal TBI
State Grant Program; and $4 million for the HRSA Federal TBI Protection
and Advocacy Systems Grant Program.
Conclusion
ARN appreciates the opportunity to share our priorities for fiscal
year 2011 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 2011 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 &
Ophthalmology
The Association for Research in Vision & Ophthalmology (ARVO) has
two major requests:
--For Congress to fund the National Institutes of Health (NIH) in
fiscal year 2011 at $35 billion; and
--For Congress to make vision health a priority in the total funding
of NIH by increasing National Eye Institute (NEI) funding more
than the President's proposed 2.5 percent increase for NEI.
The requested increase in the total NIH budget is a $3 billion
increase more than President Obama's proposed funding level of $32
billion. We are also concerned that NEI funding has been less than the
increase for NIH funding for all funding cycles since 2001. NEI has
lost 20.1 percent loss in purchasing power \1\ over the last 10 years,
while NIH has lost 17.2 percent loss in purchasing power \1\ over the
last 10 years.
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\1\ Calculations were based solely upon annual biomedical research
and development price index and annual appropriated amounts.
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ARVO commends Congress for actions taken in fiscal year 2009 and
fiscal year 2010 to fund NIH. This includes the $10.4 billion for NIH
funding in the American Recovery and Reinvestment Act (ARRA). We also
applaud the fact that the 2011 NIH budget draft, requesting a 3.2
percent increase for NIH, keeps pace with inflation for the first time
in 10 years. However, ARVO still has concerns about long-term,
sustained and predictable funding for vision research at the NEI, which
has lost approximately 3 percent more purchasing power \1\ than NIH in
the past decade, which is not in proportion to the fact that vision
disorders are the fourth most prevalent disability in the United States
and the most frequent cause of disability in
children.\2\-\5\
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\2\ 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.
\3\ http://www.ncbi.nlm.nih.gov/pubmed/15078664
\4\ http://www.healthypeople.gov/data/2010prog/focus28/2004fa28.htm
\5\ http://www.preventblindness.org/vpus/
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ARVO also commends Congress for passing S. Res. 209 and H. Res.
366, which acknowledged NEI's 40th anniversary as a free-standing
institute and designated 2010-2020 as the Decade of Vision, in which
the majority of 78 million baby boomers will turn age 65 and face great
risk of developing aging eye diseases. In a 2007 report, age-related
eye diseases were estimated to cost $51.4 million.\6\ Costs to
healthcare also add up when more individuals with vision impairment
live in nursing homes than would be the case if they had normal
vision.\7\ NEI-funded research results in treatments and therapies that
save vision, restore sight, reduce healthcare costs, maintain
productivity, ensure financial independence, and enhance quality of
life.
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\6\ http://www.preventblindness.org/research/
Impact_of_Vision_Problems.pdf
\7\ Archives of Ophthalmology. Vol. 124, No. 12:1754.
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ARVO requests $35 billion in NIH funding for fiscal year 2011,
especially to ensure that NEI can build upon the impressive record of
basic and clinical collaborative research that meets NIH's top five
priorities and has been funded through fiscal year 2009-2010 ARRA and
regular appropriations.
NEI research addresses the top five NIH priorities, as identified
by Dr. Collins: genomics, translational research, comparative
effectiveness, global health, and empowering the biomedical
enterprise.\8\ Such research also addresses the pre-emption,
prediction, personalization (ex. gene therapy), and prevention of eye
disease through basic, translational, epidemiological, and comparative
effectiveness research. NEI continues to be a leader within NIH for
elucidating the genetic basis of eye disease. NEI Director, Paul
Sieving, MD, Ph.D. has reported that one-quarter of all genes
identified to date through collaborative efforts with the National
Human Genome Research Institute (NHGRI) are associated with eye
disease/visual impairment.
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\8\ Science. Vol. 327:36.
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NEI received $175 million of the $10.4 billion in NIH ARRA funding.
As a result, NEI's total funding levels in the fiscal year 2009-2010
timeframe were $776 million and $794.5 million, respectively. In fiscal
year 2009, NEI made 333 ARRA-related awards, the majority of which
reflect investigator-initiated research that funds new science or
accelerates ongoing research, including ten Challenge Grants. Several
examples of research, and the reasons why it is important, include:
--Biomarker for Neovascular Age-related Macular Degeneration (AMD).--
Researchers are utilizing a recently discovered biomarker to
develop an early detection method to minimize vision loss. This
marker identifies a risk factor (for abnormal growth of blood
vessels into the retina), which causes 90 percent of the vision
loss associated with AMD. Importance: 1.75 million people were
living with AMD in 2000, and the number is estimated to reach 3
million by 2020.\9\ Without accounting for healthcare
inflation, the most recent estimated of cost for AMD \10\
treatment times 3 million is ($2.5-4.8 billion) over 5 years.
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\9\ Archives of Ophthalmology. Vol. 122, No. 4:564.
\10\ Ophthalmology. Vol. 115, No. 1:18.
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--Cellular Approach to Treating Diabetic Retinopathy (DR).--
Researchers are developing a clinical treatment for diabetic
retinopathy by using specially treated stem cells from the
patient's own blood to repair damaged vessels in the eye.
Importance: DR is increasing in younger Americans and the aging
population. In a 2004 paper, the reported prevalence was 4.1
million Americans.\11\
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\11\ Archives of Ophthalmology. Vol. 122, No. 4:552.
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--Small Heat Shock Proteins as Therapeutic Agents in the Eye.--
Researchers propose to develop new drugs to prevent or reverse
blinding eye diseases, such as cataract (clouding of the lens),
that are associated with the aggregation of proteins. Research
will focus on the use of small ``heat shock'' proteins that
facilitate the slow release and prolonged delivery of targeted
macromolecules to degenerating cells of the eye. Importance:
Delivering effective, long-lasting therapies through a
minimally invasive route into the eye may help to reduce
cataracts, the leading cause of low vision among all
Americans.\12\
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\12\ http://www.nei.nih.gov/news/pressreleases/041204.asp
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--Identification of Genes and Proteins that Control Myopia
Development.--Researchers propose to identify targets that will
facilitate development of interventions to slow or prevent
myopia (nearsightedness) development in children. Identifying
an appropriate myopia prevention target can reduce the risk of
blindness and reduce annual life-long eye care costs.
Importance: More than 25 percent of the U.S. population has
myopia, costing $14 billion annually, from adolescence to
adulthood (data from NEI-supported study on myopia).\14\
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\14\ Archives of Ophthalmology. Vol. 101:405-407
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--Comparison of Interventions for Retinopathy of Prematurity (ROP).--
In animal studies, researchers will simulate Retinopathy of
Prematurity--a blinding eye disease that affects premature
infants--and then study novel treatments that involve
modulating the metabolism of the retina's rod photoreceptors.
Importance: ROP affects 15,000 children a year, about 400-600
of whom progress to blindness, at an estimated lifetime cost
for support and unpaid taxes of $1 million
each.\15\-\16\
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\15\ http://www.nei.nih.gov/news/pressreleases/041210b.asp
\16\ http://www.actionfund.org/actionfund/
Blindness_in_America.asp?SnID=2
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--The NEI Glaucoma Human genetics collaBORation, NEIGHBOR.--This
research network, in which seven U.S. teams will lead genetic
studies of the disease, may lead to more effective diagnosis
and treatment. Researchers were primarily funded through ARRA
supplements. Importance: Glaucoma, a complex neurodegenerative
disease that is the second leading cause of preventable
blindness in the United States, often has no symptoms until
vision is lost.\17\
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\17\ http://www.glaucoma.org/learn/glaucoma_awaren.php
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--Comparative Effectiveness of Interventions for Primary Open Angle
Glaucoma (POAG).--Researchers will evaluate existing data on
the effectiveness of various treatment options for primary open
angle glaucoma--many emerging from past NEI research.
Importance: POAG is the most common form of the disease, which
disproportionately affects African Americans and Latinos. It is
estimated that 3.36 million individuals will have glaucoma by
2020.\18\ This number times the average cost of treatment,\19\
not accounting for inflation, is ($2.1-8.4 billion/year).
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\18\ Archives of Ophthalmology. Vol. 122, No. 4:532.
\19\ Archives of Ophthalmology. Vol. 124, No. 1:12.
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In addition to ARRA funding, the ``regular'' appropriations
increases in fiscal year 2009-2010 enabled the NEI to continue to fund
key research networks, such as the following:
--The African Descent and Glaucoma Evaluation Study (ADAGES), which
is designed to identify factors accounting for differences in
glaucoma onset and rate of progression between individuals of
African and European descent. Importance: African Americans are
more than three times as likely to develop visual impairment
from glaucoma, compared to other ethnic groups.\20\
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\20\ http://www.nei.nih.gov/nehep/programs/glaucoma/goals.asp#data
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--The Diabetic Research Clinical Research Network's (DRCR) initiation
of new trials comparing the safety and efficacy of drug
therapies as an alternative to laser treatment for diabetic
macular edema and proliferative diabetic retinopathy.
Importance: In 2007, an estimated 23.6 million Americans were
living with diabetes, and almost 1.6 million new cases were
diagnosed per year. One out of 12 individuals with diabetes has
diabetic retinopathy.\21\
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\21\ http://www.nei.nih.gov/strategicplanning/
disparities_strategic_plan.asp#retinopathy
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--The Neuro-Ophthalmology Research Disease Investigator Consortium
(NORDIC), which will lead multi-site observational and
treatment trials, involving nearly 200 community and academic
practitioners, to address the risks, diagnosis, and treatment
of visual dysfunction due to increased intracranial pressure
and thyroid eye disease.
--Importance: A broad spectrum of neuro-ophthalmic disorders
collectively affects millions of people. Many are associated
with other neurological disease processes and have not been
adequately investigated because they are rare. NORDIC will
address unanswered questions about risks, diagnosis, and
treatment that could not be studied without a clinical research
organization.\22\
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\22\ http://www.nyee.edu/pdf/m_kupersmith.pdf
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The unprecedented level of fiscal year 2009-2010 vision research
funding is moving our Nation that much closer to the prevention of
blindness and restoration of vision. With an overall NIH funding level
of $35 billion, which translates to an NEI funding level of $794.5
million, the vision community can accelerate these efforts, thereby
reducing healthcare costs, maintaining productivity, ensuring
independence, and enhancing quality of life.
Summary
ARVO urges fiscal year 2011 NIH and NEI funding at $35 billion and
$794.5 million, respectively.
______
Prepared Statement of the American Society of Clinical Oncology
The American Society of Clinical Oncology (ASCO), the world's
leading professional organization representing more than 28,000
physicians and other professionals who treat people with cancer,
appreciates this opportunity to express our views on funding for the
National Institutes of Health (NIH) for fiscal year 2011. ASCO's
members set the standard for cancer patient care worldwide and lead the
way in carrying out clinical research aimed at improving the screening,
prevention, diagnosis, and treatment of cancer. ASCO's efforts are also
directed toward advocating for policies that provide access to high-
quality care for all patients with cancer and supporting the clinical
and translational research in the area of oncology that is critical to
improving the lives of our citizens.
ASCO thanks the subcommittee for its continued investment in cancer
research through the annual appropriations process, as well as through
the American Recovery and Reinvestment Act (ARRA). The years of
investment in cancer research are paying off in the most important
ways--deaths rates are decreasing, survival rates are increasing, and
treatments have fewer side-effects. Researchers are discovering that
not only is cancer made up of hundreds of diseases, but these diseases
have numerous subtypes that can be treated with targeted therapies.
This translates to progress in treatments, as well as the need for
exponentially more research.
Without sustained and predictable increases in funding for NIH and
the National Cancer Institute (NCI), the progress that has been made
will be significantly delayed. On behalf of the cancer community, we
wish to highlight that we are very grateful for the support of the
administration and Congress, which resulted in NIH receiving an
inflationary increase in fiscal year 2010. However, between 2004 and
2008, NIH actually lost more than 13 percent of the purchasing power it
had in 2003, the final year of the NIH budget doubling period.
In addition to providing important economic stimulus to local
communities throughout the United States provided through funding for
research, the ARRA funding for research helped restore this significant
decline in NIH purchasing power. With the ARRA funding, Congress
temporarily reinstated the impact and spirit of doubling the NIH
budget. Progress in fighting cancer would be faster, more efficient,
and more sustainable if funding were equally steady and sustainable.
appropriations for fiscal year 2011 for nih
ASCO is joining with the biomedical research community in
respectfully requesting the subcommittee appropriate $35 billion to NIH
for fiscal year 2011. This request would maintain the total funding
levels from fiscal year 2010 (including an annualized portion of the
ARRA funds for research, which is 50 percent of the total ARRA funds
for research), and allow us to sustain the pace of research made
possible with ARRA. By adding an annualized portion of the research
dollars provided by ARRA to the base budget of NIH, important
advancements will continue to be made.
Research is a long-term process and allowing the important work
begun with ARRA funds will ensure faster progress in cancer research.
Progress that has meaning and important positive impacts in patients'
lives will continue to be made--it is a question of how quickly
progress will be made going forward and whether researchers in the
United States will continue to play a leadership role in pursuing these
advancements.
ASCO is also respectfully requesting that the subcommittee dedicate
itself to a sustained, multi-year commitment to research funding.
Meaningful progress cannot be made if NIH funding does not keep pace
with the annual increase in the cost of conducting biomedical research.
Unpredictable increases and decreases in NIH funding not only make it
difficult for NIH to make commitments to multi-year projects, but also
serve to discourage the best and brightest researchers to pursue
careers in medical research. Sustained and predictable funding is key
to a prosperous and vigorous biomedical research enterprise.
benefits of arra
ARRA has given biomedical research a much needed boost in funding,
but those funds are set to expire on September 30, 2010. ARRA has made
it possible to enhance important research projects at NIH and the NCI,
such as accelerating the identification of genomic alterations in tumor
types in The Cancer Genome Atlas. This project is mapping cancer genes
and will lead to increased understanding of how to target new
treatments to halt the development and spread of cancer. Other uses of
ARRA funds at NCI include the Accelerating Clinical Trials of Novel
Oncologic PathWays (ACTNOW), the Cancer Human Biobank, and grants to
Cancer Centers all across the country to promote personalized cancer
care and drug development. These efforts are the beginning of a long-
term process to translate discoveries into new treatments for cancer
patients. Preservation of ARRA funds in the base NIH budget is
necessary to translate these important discoveries into meaningful
improvements in care for cancer patients.
Funding cancer research also benefits local communities. According
to a Families USA report, for every $1 in grants given by NIH, the
economic benefit to the local community is, on average nationally,
$2.21 in economic stimulus by way of new business activity, jobs and
wages.
clinical trials and translational research
In the area of oncology, clinical trials play a significant role in
the day-to-day treatment options that should be available to patients,
in large part because clinical trials often provide the best hope for
successful treatment for cancer patients. NIH and NCI are leading the
way by funding some very important data-driven translational research
and clinical trials, bringing new, innovative therapies from research
laboratories into clinics and hospitals to offer our patients targeted,
personalized care. Clinical trials are absolutely critical to identify
better, more cost effective care and longer lives for cancer patients.
Translational research and clinical trials have changed the standard of
care in many cancers.
Clinical trials funded by NIH and NCI examine important questions
that are not being investigated elsewhere, generate practice-changing
science, and often recruit difficult to reach subpopulations.
Unfortunately, these trials are at risk, due to concerns about
inadequate funding, the pace of the trials and accrual rates. Clinical
trials are increasingly being conducted overseas, due to the costs and
regulatory complexities of conducting trials in the United States. This
denies your constituents the opportunity to participate, either as a
physician conducting research or as a patient enrolling, in a clinical
trial. Congress must demonstrate a continued commitment to ensure
biomedical research is federally funded. NIH research advances have
transformed the way cancer is prevented, detected and treated, and
cancer has become a much more survivable disease as a result.
Federal funding has led to advances in screening that significantly
contributed to the decline in cancer death rates. Federally funded
clinical trials have also contributed directly to most patients having
meaningful access to recommended chemotherapy regimens within their
communities, often with far fewer side effects than in the past. Today,
as a direct result of the investment in biomedical research (i.e.,
clinical trials and translational research), we are implementing
changes that are improving cancer care for our patients.
Because of these advances and the incredible scientific
opportunities facing us, ASCO urges the NIH and NCI to focus more of
its resources in the area of clinical trials and translational
research. Specifically, ASCO would also like to see an increase in the
NCI per-case reimbursement for physicians who enroll patients on
federally funded clinical trials. Studies conducted by ASCO and C-
Change indicate that the current payment rate accounts for only half of
the actual extra costs imposed on healthcare providers to enroll and
participate within NCI-funded clinical trials. An ASCO survey of
clinical trial sites in August 2009 revealed that a significant portion
of sites are considering limits to their participation in federally
funded research--in large part due to the inadequate funding provided.
The funding NCI provides to sites that participate in their trials
should be increased to account for actual research costs and keep pace
with the growing costs of collecting and maintaining data and hiring
skilled staff to oversee the research.
ASCO again thanks the subcommittee for its continued dedication to
Americans facing cancer through support of the important work
accomplished under the guidance of NIH and NCI. We look forward to
working with all members of the subcommittee to advance cancer
research.
______
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 2011 appropriation for the
National Institutes of Health (NIH). The ASM is the largest single life
science organization in the world with more than 40,000 members.
The ASM is grateful for the support of Congress for the NIH, which
is the single largest source of funding for biomedical research, with
an annual budget of more than $31 billion. NIH supports extraordinary
biomedical research successes, which are also critical to national
security and a catalyst for the Nation's industrial, business, and
education enterprises. To ensure continued biomedical research progress
and to keep pace with the cost of conducting research, we recommend
that Congress provide at least an 8 percent increase for NIH, and a
higher level of funding, if possible.
NIH Funding: The Need for Increased Funding for Biomedical Research
In 2009, healthcare costs in the United States reached $2.5
trillion, nearly 17 percent of the gross national product and more than
any other nation, yet key health outcomes need improvement. Biomedical
research offers innovative individual and population based medical
interventions that will improve health and productivity. In fiscal year
2011 the NIH will support emerging technology dependent areas like
computational biology and DNA sequencing, as well as basic research and
trans-NIH, multidisciplinary programs, including: (1) genomics and
other high-throughput technologies; (2) translational medicine to
expedite the path from basic research to clinical treatments and
preventives; (3) greater focus on global health; (4) use of science in
support of healthcare reform; and (5) revitalization of medical
research, including training new scientists.
In fiscal year 2011, NIH will support research by its own 6,000
scientists and by nearly 325,000 other researchers at more than 3,100
institutions, including medical schools, universities, and hospitals.
About 83 percent of the fiscal year 2011 appropriation will fund
extramural research, stimulating medical innovations, local economies,
and the technical workforce needed to sustain the Nation's high-tech
competitiveness. The Department of Health and Human Services funds 85
percent of the country's life sciences research, primarily through the
37,000 research project grants NIH will award in fiscal year 2011.
Each dollar of NIH funding results in another $2 in business
activity and other financial benefits. Last year, analysts found that
20 percent of every NIH stimulus dollar spent under the 2009 American
Recovery and Reinvestment Act (ARRA) purchased commercial products like
software, instruments, and reagents, boosting technology-based
industries and services. ARRA has enabled NIH to invest $10.4 billion
over 2 years in NIH programs, distributed to researchers across the
Nation through roughly 14,000 grants to date. ARRA stimulus funds to
NIH ultimately will create or retain 50,000 jobs. ARRA funding clearly
has stimulated NIH research, which until recently suffered years of
stagnant or declining resources.
With stimulus funds, NIH was able to support about 20 percent of
grant applicants; but in fiscal year 2011, that figure likely will drop
by half, to an historically low funding rate that will impinge medical
innovation in the United States. NIH received more than 20,000
proposals last year for new Challenge grants, which specifically
support high-risk, high-return projects, but only 229 could be funded.
Increased funding for NIH in fiscal year 2011 is essential to ensure
that scientists can pursue research opportunities that will lessen the
human burdens of disease and disability.
NIH Funding: Foundation for Advances in Medicine
Last September, NIH and the U.S. Army concluded their joint
clinical trial in Thailand of a new AIDS vaccine, the first vaccine
candidate to elicit a protective effect in humans against HIV
infection. In 2009, NIH achieved advances in the global offensive
against H1N1 influenza, most notably rapid development and
implementation of clinical trials for various H1N1 vaccines. The three
winners of the 2009 Nobel Prize in physiology or medicine had received
more than $31 million in NIH research grants, while the three Nobel
winners in chemistry received more than $17 million. Their respective
studies on cellular aging and on the structure and function of
ribosomes have transformed medical science and will continue to do so
into the future.
Worldwide, communicable diseases are responsible for 51 percent of
the calculated ``years of life lost'' each year, according to the World
Health Organization (WHO). Even in wealthy nations like the United
States, preventable infectious diseases persist as leading causes of
morbidity and mortality. The National Institute of Allergy and
Infectious Diseases (NIAID) sponsors a range of research activity from
diseases like malaria and HIV/AIDS, to immune system disorders,
biodefense, and the antibiotic resistance among pathogenic microbes to
drug treatments. NIAID focuses on nearly 300 pathogens that include
bacteria, viruses, parasites, fungi and prions. New therapies,
vaccines, diagnostics, and other products nurtured by NIAID have
benefited every American and contributed in some way to global health.
Influenza.--Approximately 86 million Americans have received 97
million doses of 2009 H1N1 influenza vaccine largely developed and
tested with the support of NIAID. Although the H1N1 pandemic has
fortunately proved to be more moderate than originally feared, it still
has produced an estimated 59 million U.S. cases since April 2009;
265,000 hospitalizations; and 12,000 deaths. Stopping H1N1 requires
thorough understanding of the viral pathogen's unique features. Ninety
percent of seasonal flu deaths occur in those older 65, whereas 87
percent of reported H1N1 deaths were patients under 65. In the past
year, NIAID funded numerous H1N1 studies, including microscopic exams
of respiratory tissue from fatal cases; lab experiments suggesting that
H1N1 may outcompete seasonal flu virus strains and may be more
communicable; a series of vaccine trials in different human
subpopulations; and alternative vaccine production strategies,
including tissue culture based vaccines and an early clinical trial of
a candidate DNA vaccine, an experimental class of vaccine where a
pathogen's genetic material is injected directly into the body.
HIV/AIDS.--In fiscal year 2011, The NIH will spend nearly $3.2
billion for research on HIV/AIDS, which remains one of the most
intractable health challenges faced by the world. An estimated 33
million people are living with HIV worldwide, and another 2 million
have died. Each year, there are 56,300 new HIV infections in the United
States; of the estimated 1.1 million Americans living with HIV, 21
percent are unaware of their infection. The NIAID's Vaccine Research
Center investigates multiple approaches to new vaccine development,
like how neutralizing antibodies develop during natural HIV infection,
which could point to an effective vaccine. NIAID also supports other
prevention strategies, such as using antiretroviral drugs to stop
mother to child HIV transmission (an estimated 430,000 children became
infected in 2008, mostly through birth or breastfeeding from an HIV
infected mother). In 2009, NIAID outlined its ``test and treat''
prevention agenda, based on a WHO mathematical model predicting that
universal, voluntary, annual HIV testing and immediate treatment for
those who test positive could radically reduce HIV incidence within a
decade, and potentially end the pandemic within 50 years.
Global Health Infectious.--Diseases can quickly spread through the
world's populations and across national borders. Global health research
at NIAID informs science based public health policies worldwide, and
the institute participates in several global partnerships with entities
like WHO and UNICEF. It also has interagency agreements with USAID,
CDC, NASA, and the State Department to combat diseases that migrate
from country to country. With its scientific expertise in major global
diseases, NIAID will be a vital contributor to the Administration's new
Global Health Initiative (GHI) designed to reform and coordinate U.S.
support for international health. NIAID has established programs tied
to four of the six GHI focus areas, that is, HIV/AIDS, tuberculosis,
malaria, and neglected tropical diseases (also, health systems and
health workforce; maternal, newborn, and child health).
Malaria.--This disease threatens an estimated 3.3 billion people,
nearly half of the world's population. Each year, this age-old disease
causes about 250 million clinical cases and nearly 1 million deaths,
most of those deaths in and children under 5 years and pregnant women.
At least four species of the causative Plasmodium protozoa are
transmitted through bites from dozens of Anopheles mosquito species,
all of which can develop resistance to known pesticides and
antimalarial drugs and a fifth human malaria parasite was recently
discovered in Asia. The complex parasite vector human host cycle ranks
malaria among medicine's grand challenges. NIAID funds basic and
applied research to develop tools and strategies for the treatment,
prevention, and control of this disease.
One-third of the world's population is infected with the pathogen
Mycobacterium tuberculosis. There are 9.4 million new tuberculosis
cases annually and 1.8 million deaths, making TB the leading cause of
global mortality after HIV/AIDS. Public health efforts against TB are
often outmoded, the mostly commonly used diagnostics were developed a
century ago, there have been no new drugs introduced for decades, and
the last new vaccine was produced 40 years ago. Therapy is difficult at
best, and the emergence of drug-resistant strains has greatly
complicated treatment. TB cases classified as ``extensively drug
resistant'' (XDR) now occur in nearly 60 nations, with mortality rates
exceeding 95 percent in some areas. NIAID funding supports research to
discover updated diagnostics, therapeutics, and vaccines.
The so called ``neglected tropical diseases'' (NTDs) like
leishmaniasis, sleeping sickness, and Chagas disease cumulatively
infect more than 1 billion people and kill 534,000 per year. WHO
categorizes 14 diseases as NTDs important to global health, serious
illnesses that most often affect impoverished countries. Many are often
fatal, usually ignored by control and treatment programs, and
associated with poor surveillance tools and systems. NIAID conducts
research on selected NTDs.
NIH Funding: Defense Against Emerging Infectious Diseases
The proposed fiscal year 2011 budget increases funding for NIAID's
activities emerging infectious diseases. These diseases might migrate
or evolve naturally, perhaps developing resistance to standard drug
treatments, or their pathogens might be deliberately dispersed as
agents of bioterrorism. NIAID funding has created countermeasures
against anthrax, botulinum toxin, and smallpox.
In recent years, alarmed public health officials have devoted
increasing resources toward mitigating the social and economic impacts
of antimicrobial resistance. NIAID supports multiple projects devoted
to the biological aspects of this problematic phenomenon. Drug
resistant pathogens of greatest concern include methicillin resistant
Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE),
and the microbial causes of malaria, HIV/AIDS, influenza, tuberculosis,
streptococcal pneumonia, and various foodborne illnesses. Many
resistant infections develop in healthcare settings. Each year, about 2
million people develop infections in U.S. hospitals, with 90,000
deaths. About 70 percent of those infections are linked to pathogens
resistant to at least one drug. Data now indicate that the problem
outside healthcare settings is greater than originally believed. In
fiscal year 2011, NIAID will fund a new initiative, Development of
Therapeutic Products for Biodefense, with particular emphasis on broad
spectrum products or those addressing the growing dilemma of
antimicrobial resistance.
NIH Funding: Moving Forward in Biomedical Research
Discoveries through NIAID and NIGMS programs have fostered
breakthrough tools and methods vital to sectors of the US medical
enterprise, like biotechnology. Research strategies at NIH must take
advantage of cutting edge technologies and modern scientific
disciplines like genomics and bioinformatics. NIAID research
partnerships will develop next-generation biodefense diagnostics, like
those using nanotechnology-based microfluidic platforms, in vivo
imaging methods, or other emerging technologies.
By supporting high-risk, high-return projects, NIGMS lays the
foundation for future advances in disease diagnosis, treatment, and
prevention. It promotes large-scale initiatives to solve complex
problems through collaborative research. An example is the NIGMS
pharmacogenetics research program, which integrates laboratory science
and databases linking genes, medicines, and diseases. In December,
NIGMS announced five new projects in its pharmacogenomics collaboration
with Japan's Center of Genomic Medicine; one will examine why
antiretrovirals used to treat HIV are not effective in some people.
NIH funding also invests in the future by building the workforce
needed to sustain innovation. Each year, NIH also provides grants for
STEM education across the United States, and supports pre- and
postdoctoral scientists at the NIH campus or with fellowships
elsewhere. NIGMS alone supports approximately 50 percent of Ph.D.
training positions at NIH.
NIH plays a key role in accelerating transformation of basic
science into clinical tools that save lives. The ASM recommends that
Congress approve at least an 8 percent increase for the National
Institutes of Health.
______
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 2011 appropriation for the
Centers for Disease Control and Prevention (CDC). The ASM is the
largest single life science organization in the world with more than
40,000 members.
The ASM is very concerned that the proposed CDC budget of $6.6
billion for fiscal year 2011 is 2 percent below the fiscal year 2010
appropriation. The administration's proposed budget is inconsistent
with the need to adequately fund the agency acknowledged to be the
principal Federal driver in meeting our Nation's goals for enhanced
prevention and wellness. Focusing only on the infectious disease
component of the CDC budget, the ASM notes that the administration has
proposed a $19.6 million increase in this area. However, such a modest
increase does not adequately address the growing complexity and
challenges of emerging infectious diseases. These challenges have been
abundantly evident over the past year with the H1N1 influenza pandemic.
Furthermore, the proposed budget substantially decreases two priority
program areas: the CDC's vector-borne diseases program (by $26.7
million, which will essentially eliminate the program), and the CDC's
antimicrobial resistance program (by $6.8 million). In the fiscal year
2011 budget, both programs are to be supported out of emerging
infectious disease funds. Therefore, the proposed increase of $19.6
million for emerging infectious diseases is insufficient to offset the
$34 million in proposed reductions for vector-borne diseases and
antimicrobial resistance, resulting in a net decrease of $15 million
for emerging infectious diseases.
Eliminating funding for the vector-borne diseases program will
impair CDC's collaborations with State and local partners consisting of
vector-borne disease surveillance, outbreak response, the development
of new diagnostics, diagnostic training and proficiency testing, as
well as applied research and prevention efforts to address arboviral
diseases. In the proposed budget, it is unclear what, if any, support
will be available in fiscal year 2011 for prevention and control of
vector-borne pathogens. This funding reduction will essentially destroy
the infrastructure developed in the past decade in response to the
importation of West Nile virus in 1999 and its subsequent spread across
the United States, and will leave the country vulnerable to similar
importation of other vector-borne diseases. In view of the net
reduction for infectious diseases of approximately $15 million, the ASM
recommends that Congress increase the budget for emerging infectious
diseases and for CDC by at least 8 to 10 percent, to restore and
strengthen funding for infectious disease prevention and control and
other priority public health programs.
Vector-borne Diseases.--The administration's proposed elimination
of funding (-$26.7 million) for vector-borne diseases, including West
Nile Virus, in its fiscal year 2011 budget will have serious
repercussions. Many emerging or re-emerging infectious diseases are
tied to pathogens transmitted from animals to humans, often through
insect vectors. CDC programs protect public health through ``one
health'' strategies, based on the understanding that human health is
intertwined with the health of animals and the environment. The vector-
borne program not only supports the West Nile virus activities, but
also supports work on agents like plague, tularemia, Lyme disease,
dengue fever, and Japanese encephalitis. Lyme disease is by far the
most common tickborne infection in the United States and exacts an
enormous toll in healthcare costs and lost productivity. The U.S.
mainland is constantly threatened by the potential for establishment of
dengue virus, as occurred last year in the Florida Keys. Emerging
public health risks like chikungunya virus in South Asia and the Indian
Ocean are an ongoing concern similar to West Nile. To appropriately
address vector-borne infections requires a vibrant infrastructure for
detection, diagnosis, response and prevention at the national, State,
and local level. The proposed budget cuts will substantially dismantle
the system developed in response to West Nile virus, causing much of
the $200 million investment over the last decade to disappear. ASM
urges the Administration to restore the vector borne disease funding.
Antimicrobial Resistant Infections.--The administration's proposed
budget reduces the antimicrobial resistance program by $6.8 million.
The ASM disagrees with the proposed fiscal year 2011 decreases for
crucial CDC efforts at a time when drug-resistant pathogens continue to
emerge in both the community and healthcare setting. The decrease will,
among other negative outcomes, substantially cut funding to States for
surveillance and control programs. As a partner in the Federal
Interagency Action Plan to Combat Antimicrobial Resistance, CDC has
been instrumental in tracking the grim increase in microbial pathogens
resistant to antimicrobial drugs, like methicillin-resistant
Staphylococcus aureus (MRSA). Invasive MRSA infections attack about
94,000 Americans annually, contributing to 19,000 deaths. MRSA is an
increasing problem in community settings where different control
strategies are necessary than in the hospital environment. A similar
trend is being seen with Clostridium difficile, an organism once
largely confined to hospital and nursing home settings but now
associated with increasing severity in the community. Microbial drug
resistance is driven by various factors, from pathogens' natural
evolution to the growing use of antimicrobials in human and animal
healthcare. One estimate suggests that between 5 and 10 percent of all
hospitalized U.S. patients acquire a drug-resistant infection, adding
$5 billion in annual healthcare costs. CDC either leads or collaborates
in multiple projects against antimicrobial resistance, like the World
Health Organization (WHO) effort to reduce the global spread of
cephalosporin-resistant gonorrhea. Reduced funding would seriously
impact the ability to mount and sustain programs to confront the
problem of antimicrobial resistant pathogens.
CDC Funding: The Need for Increased Resources
While life expectancy has steadily increased, influenza, pneumonia,
and septicemia caused by microbial pathogens remain among the top 10
causes of death. The sudden emergence of pandemic H1N1 in the spring of
2009 in Mexico, California, and Texas highlights the profound impact
infectious diseases can have on our well being and economy. In addition
to such emergent threats, other infectious diseases are on the rise.
Reported cases of sexually transmitted Chlamydia infections have more
than tripled since 1990, making it the most commonly reported
infectious disease in the United States. Each year, children are absent
38 million school days due to influenza. About 43,000 Americans still
develop acute hepatitis B annually, despite effective vaccines. The
estimated annual cost to U.S. hospitals of treating healthcare
associated infections ranges from $28.4 billion to $45 billion.
Foodborne illnesses continue to produce tens of millions of infections
annually. And each year, Americans visit physician offices, hospital
outpatient units or emergency rooms for infectious and parasitic
diseases an estimated 30 million times.
The CDC Office of Infectious Diseases (OID) has three programs to
prevent numerous microbial diseases: the National Center for
Immunization and Respiratory Diseases, the National Center for Emerging
and Zoonotic Infectious Diseases and the National Center for HIV/AIDS,
Viral Hepatitis, STD and TB Prevention. The CDC's Center for Global
Health and other agency offices add expertise to the fight against
disease pathogens here and abroad. In the past year, CDC personnel have
contributed to the fight against H1N1 influenza and identified or
confirmed the causes of disease outbreaks nationwide. They monitor
drug-resistant tuberculosis and other communicable diseases at U.S.
ports of entry, and collaborate with local, State, Federal, and
international partners to protect and promote good health in countries
such as Haiti in response to the recent catastrophic earthquake.
Monitoring Disease, Protecting Public Health
HIV/AIDS.--CDC estimates that about 1.1 million persons in the
United States are living with HIV or AIDS; an estimated 21 percent do
not know that they are infected. With life saving antiretroviral
treatments now available, earlier diagnosis is the goal of recent CDC
guidances on opt-out testing in correctional institutions and other
settings and for routine screening in all healthcare settings for those
aged 13-64 years and pregnant women, and retesting at least annually
for all at high risk. In November, CDC reported that HIV incidence
among intravenous drug users had declined by nearly 80 percent since
the late 1980s, a positive public health outcome, yet late diagnosis of
new infections persists. The fiscal year 2011 budget increases funds
for a National HIV/AIDS Strategy under development, to include renewed
efforts toward HIV risk reduction.
Hepatitis.--Two percent of the U.S. population or an estimated 5.3
million are living with chronic hepatitis B (HBV) or hepatitis C (HCV),
most unaware of their infection unless they later develop liver disease
or cancer. Last year, a CDC study concluded that in the previous
decade, failures by healthcare workers to follow basic infection
control practices had placed more than 60,000 U.S. patients at risk for
HBV or HCV infection. In January, the Institute of Medicine called for
a new, improved national strategy to prevent and control these
infections. Each year an estimated 25,000 persons become infected with
hepatitis A (HAV), even though rates of acute symptomatic cases have
declined by 92 percent since a vaccine first became available in 1995.
CDC now recommends HAV vaccine for all children at age one, since
children are a major source of infection for adults who can develop
more serious symptoms. CDC reported last year that vaccination among
U.S. children increased from about 26 percent in 2006 to more than 47
percent in 2007, but this means that still over half of our children
are needlessly at risk of a fully preventable disease like hepatitis A.
They also serve as a source of infection to vulnerable adults.
Tuberculosis.--In a new CDC report, preliminary statistics from the
agency's National TB Surveillance System reveals that 2009 saw the
largest single year decrease in U.S. cases since data collection began
in 1953. The 11,540 cases reported last year were roughly 11 percent
fewer than the previous year, with declines in both U.S.- and foreign-
born persons, although the TB rate among foreign born was still nearly
11 times higher. Possible explanations for the unprecedented drop,
which CDC is investigating, include failure to recognize, diagnose, or
report the disease due to weakening infrastructure or diversion of
public health resources to the H1N1 response. This would represent a
serious setback to TB disease control and elimination efforts in the
United States. The emergence of tuberculosis bacteria resistant to
available antimicrobial drugs has alarmed health organizations
worldwide. CDC scientists identified genetic mutations associated with
drug resistance in tuberculosis bacteria, which are now included in CDC
laboratory testing available to State public health laboratories.
Foodborne/Waterborne Illness.--A recent study estimates that the
total economic impact of foodborne illness in the United States reaches
$152 billion annually. Last April, CDC reported that progress in
foodborne illness prevention had reached a plateau, with the incidence
of the most common foodborne illnesses stagnating over the previous 3
years after several years of decline in the late 1990s and early 2000s.
Of particular concern is the incidence of Salmonella infections, which
persists at 14-16 cases per 100,000 Americans and periodically causes
disease outbreaks. CDC reports the following foodborne illnesses: (1)
of the 1,270 outbreaks in 2006, 621 had a confirmed single cause, most
often norovirus (54 percent), followed by Salmonella (18 percent); and
(2) foods tied to the largest number of outbreak cases were poultry (21
percent), leafy vegetables (17 percent) and fruits-nuts (16 percent).
The ASM commends the appreciable increases in fiscal year 2011 funding
for food safety activities that will boost CDC capabilities, such as
expanded outbreak surveillance and standardized investigations at the
State and local level. The proposed fiscal year 2011 budget
specifically supports CDC water quality programs, including expansion
of its Safe Water System and Water Safety Plan to additional countries
to reduce waterborne diseases like cholera, giardiasis and
cryptosporidioisis.
Preventing Disease, Protecting Public Health
Over the past year, considerable CDC resources focused on
preventing H1N1 influenza. Americans have received 97 million doses of
H1N1 vaccine via CDC distribution systems. Although the pandemic has
been less severe than originally feared, it has still resulted in an
estimated 55 million U.S. cases since April 2009, 246,000
hospitalizations and 11,000 deaths, many in infants, children, and
young adults. CDC testing determined that many Americans who died from
H1N1 had co-infections with the common pneumonia bacterium,
Streptococcus pneumoniae, which likely contributed to their death.
Unfortunately, vaccine preventable pneumococcal infections still kill
an estimated 40,000 Americans each year. CDC officials are currently
assessing the lessons learned during the 2009-2010 influenza season.
In February, CDC recommended universal use in children of an
updated pneumococcal vaccine just approved by the Food and Drug
Administration, which should greatly reduce S. pneumoniae infections
and stop a leading cause of bacteremia, meningitis and pneumonia.
Pneumonia kills nearly 2 million children each year, most in
impoverished nations.
Improving Preparedness and Response
Being prepared for the unexpected is one of CDC's primary
responsibilities in protecting our health and well-being. During an
emergency, CDC can quickly convene expert teams and deploy both
personnel and medical supplies anywhere in the world. CDC leads Federal
efforts to detect and contain biothreats and to ensure availability of
medical countermeasures. It operates the Strategic National Stockpile,
a repository of countermeasures for rapid deployment, as well as its
quarantine stations at the Nation's borders. It distributes grants to
State and local health departments to build capacity against public
health emergencies and acts of terrorism. The ASM supports the proposed
additional fiscal year 2011 funds to improve CDC's overall preparedness
and response efforts, including the Laboratory Response Network and
Select Agent Program.
In light of the significant role played by the CDC as the Nation's
first line of defense against a host of infectious disease threats and
its leadership in national efforts to promote wellness and prevention,
these efforts should not be handicapped by a funding reduction as
proposed in the 2011 budget. The ASM supports an 8 to 10 percent
increase in infectious disease activities to assure critical programs
are not reduced or eliminated and that opportunities to prevent and
control infectious diseases are not curtailed. ASM appreciates the
opportunity to comment on the fiscal year 2011 budget for the CDC.
______
Prepared Statement of the American Society of Mechanical Engineers
The NIH Task Force (``Task Force'') of the Inter Sector Committee
on Federal Research and Development (ISCFRD) of ASME is pleased to
provide comments on the bioengineering-related programs contained
within the National Institutes of Health (NIH) fiscal year 2011 budget
request. The Task Force is focused on the application of mechanical
engineering knowledge, skills, and principles for the conception,
design, development, analysis, and operation of biomechanical systems.
The Importance of Bioengineering
Bioengineering is an interdisciplinary field that applies physical,
chemical, and mathematical sciences, and engineering principles to the
study of biology, medicine, behavior, and health. It advances knowledge
from the molecular to the organ levels, and develops new and novel
biologics, materials processes, implants, devices, and informatics
approaches for the prevention, diagnosis, and treatment of disease, for
patient rehabilitation, and for improving health. Bioengineers have
employed mechanical engineering principles in the development of many
life-saving and life-improving technologies, such as the artificial
heart, prosthetic joints, diagnostics, and numerous rehabilitation
technologies.
Background
The NIH is the world's largest organization dedicated to improving
health through medical science. During the last 50 years, NIH has
played a leading role in the major breakthroughs that have increased
average life expectancy by 15 to 20 years.
The NIH is comprised of different Institutes and Centers that
support a wide spectrum of research activities including basic
research, disease and treatment-related studies, and epidemiological
analyses. The mission of individual Institutes and Centers varies from
either study of a particular organ (e.g., heart, kidney, eye), a given
disease (e.g., cancer, infectious diseases, mental illness), a stage of
life (e.g., childhood, old age), or finally it may encompass
crosscutting needs (e.g., sequencing of the human genome and the
National Institute of Biomedical Imaging and Bioengineering (NIBIB).
The total fiscal year 2011 NIH budget request is $32.2 billion, or
3.2 percent above the $31.2 billion fiscal year 2010 appropriated
amount. The Task Force recognizes that this proposed increase is
significant given the administration's commitment to reducing the
Federal deficit. However, the Task Force notes that the
administration's 3.2 percent increase to the overall NIH budget is less
than the up to 3.8 percent projected increase in research costs due to
inflation--as predicted by the Biomedical Research and Development
Price Index (BRDPI)--and as a consequence actually results in an
effective decrease in funding for the NIH compared to fiscal year 2010.
The Task Force therefore recommends out-year budget increases well
beyond BRDPI inflation rates to compensate for this flat level of
funding.
The Task Force further notes that NIH received $10.4 billion as
part of the American Recovery and Reinvestment Act (ARRA) of 2009
(Public Law 111-5), an important influx for several key divisions of
NIH over the fiscal year 2009 and fiscal year 2010 funding cycles,
particularly the NIBIB, which received $78 million--less than 1 percent
of the $10.4 billion ARRA budget assigned to the NIH for the fiscal
year 2009 and fiscal year 2010 funding cycles. NIBIB has already
exhausted approximately 95 percent of this budget, leaving little ARRA
funding to leverage through the fiscal year 2010 budget cycle and
underscore the need for more robust investment in bioengineering at
NIBIB. While this one-time influx of funding for health research and
infrastructure was justified, the Task Force notes that the unstable
nature of such funding inhibits the potential impact on the economy and
should not be viewed as a viable substitute for steady and consistent
support from Congress for these critical national research priorities.
Overall research and development activities are expected to account
for 97.4 percent of the total fiscal year 2011 NIH budget, or $31.4
billion. With this, the administration estimates 9,052 research project
grants (RPGs) will be supported, 199 less than fiscal year 2010,
essentially flat year-on-year. Of the administration's priority
programs this year, the Task Force commends the recommended $382
million in support for the National Nanotechnology Initiative, a 6
percent or $22 million increase over fiscal year 2010.
NIBIB Research Funding
The administration's fiscal year 2011 budget requests $325.93
million for the NIBIB, an increase of $9.47 million or 3 percent from
the fiscal year 2010 appropriated amount. This increase is less than
the 3.8 percent projected increase in research costs due to inflation
(predicted by the BRDPI index) and, as a consequence, actually results
in an effective decrease in funding for NIBIB compared to fiscal year
2010. The mission of the NIBIB is to seek to improve human health by
leading the development and application of emerging and breakthrough
technologies based on a merging of the biological, physical, and
engineering sciences.
The budget for NIBIB Research Grants would increase by $6.1 million
to $268.8 million, a 2.4 percent increase from fiscal year 2010.
Funding for intramural research would increase 3.6 percent to $11.5
million from $11 million in fiscal year 2010. NIBIB's Research
Management and Support request is $17.7 million, a 5.4 percent increase
or $0.84 million over fiscal year 2010.
NIBIB funds the Applied Science and Technology (AST) program, which
supports the development and application of innovative technologies,
methods, products, and devices for research and clinical application
that transform the practice of medicine. The fiscal year 2011 request
for AST is $176.8 million, a $5.2 million increase or 3 percent from
fiscal year 2010.
Additionally, NIBIB funds the Discover Science and Technology (DST)
program, which is focused on the discovery of innovative biomedical
engineering and imaging principles for the benefit of public health.
The fiscal year 2011 request for DST is $95.1 million, a $2.2 million
or 2.4 percent increase from fiscal year 2010.
The Technological Competitiveness-Bridging the Sciences program,
which funds interdisciplinary approaches to research, would receive
$24.9 million in fiscal year 2011, a $0.9 million increase or 3.6
percent over the fiscal year 2010 enacted level.
Task Force Recommendations
The Task Force is concerned that the United States faces rapidly
growing challenges from our counterparts in the European Union and Asia
with regards to bioengineering advancements. While total health-related
U.S. research and development investments have expanded significantly
over the last decade, investment in bioengineering at NIBIB have
remained relatively flat over the last several years. In fact, the
fiscal year 2011 budget actually represents a small reduction in
funding when the fiscal year 2003 NIBIB appropriation of $280 million
is adjusted for inflation ($329 million in 2010 dollars).
The Task Force wishes to emphasize that, in many instances,
bioengineering-based solutions to healthcare problems can result in
improved health outcomes and reductions in healthcare costs--a
fundamental tenet of the President's National Innovation Strategy. For
example, coronary stent implantation procedures cost approximately
$20,000, compared to bypass graft surgery at double the cost. Stenting
involves materials science (metals and polymers), mechanical design,
computational mechanical modeling, imaging technologies, etc. that
bioengineers work to develop. Not only is the procedure less costly,
but the patient can return to normal function within a few days rather
than months to recover from bypass surgery, greatly reducing other
costs to the economy. Therefore, we strongly urge Congress to consider
increased funding for bioengineering within the NIBIB and across NIH,
and work to strengthen these investments in the long run to reduce U.S.
healthcare costs and support continued U.S. leadership in
bioengineering.
The NIBIB must obtain sustained funding increases, both to
accelerate medical advancements as our Nation's population ages, and to
mirror the growth taking place in the bioengineering field. The Task
Force believes that the administration's budget request for fiscal year
2010 is not aligned with the challenges posed by this objective; a 3
percent budget increase will not keep up with current inflationary
increases for biomedical research, eroding the United States' ability
to lay the groundwork for the medical advancements of tomorrow.
While the Task Force supports Federal proposals that seek to double
Federal research and development in the physical sciences over the next
decade, we believe that strong Federal support for bioengineering and
the life sciences is especially essential to the health and
competitiveness of the United States. The supplemental funding that NIH
received as part of ARRA and the budget request by the administration
does not completely erase the past several years of disappointing
budgets. Congress and the administration should work to develop a
specific plan, beyond President Obama's call for ``innovations in
healthcare technology'' in his ``Strategy for American Innovation'', to
focus on specific and attainable medical and biomedical research
priorities which will reduce the costs of healthcare and improve
healthcare outcomes. Further, Congress and the administration should
include in this strategy new mechanisms for partnerships between NSF
and the NIH to promote bioengineering research and education. The Task
Force feels these initiatives are necessary to build capacity in the
U.S. bioengineering workforce and improve the competitiveness of the
U.S. bioengineering research community.
______
Prepared Statement of the American Society for Nutrition
The American Society for Nutrition (ASN) appreciates this
opportunity to submit testimony regarding fiscal year 2011
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 $37 billion
for NIH, and we request $162 million for NCHS in fiscal year 2011.
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--the NIH and the NCHS .
NIH
NIH is the Nation's premier sponsor of biomedical research and is
the agency responsible for conducting and supporting 90 percent (more
than $1.4 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
2011 funding level of $37 billion for the agency.
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. Thanks to Congress' inclusion of
nearly $10 billion for NIH in H.R. 1, the American Recovery and
Reinvestment Act, the scientific enterprise has been revitalized and
additional biomedical research projects have been supported. ASN was
pleased to see that more than 2 years. These projects also are, in
addition to generating new findings to improve human health and
nutrition, providing jobs and generating commercial activity throughout
the broader community. 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 research engine needs predictable, sustained investment in
science to maximize our return on investment. Recent experience has
demonstrated how cyclical periods of rapid funding growth followed by
periods of stagnation is disruptive to the discovery process, can lead
to fewer students choosing careers in research, impedes long-range
projects and ultimately slows 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 National Center for Health Statistics
The National Center for Health Statistics (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.
Not surprisingly, NHANES serves as a gold standard for nutrition and
health data collection around the world.
For several years, flat and decreased funding levels threatened the
collection of this important information, most notably vital statistics
from the NHANES. Beginning in fiscal year 2009, Congress made a renewed
commitment to this agency by appropriating an additional $11 million to
the agency--for nearly $125 million total--in fiscal year 2009 and a
$14 million boost in fiscal year 2010. Actions in fiscal year 2009
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. Last year's continued support enabled the
agency to rebuild after years of underinvestment. ASN appreciates very
much the leadership this subcommittee has shown in securing steady and
sustained funding increases for NCHS over the past 3 fiscal years.
To continue support for the agency and its important mission, ASN
supports the President's fiscal year 2011 budget request of $162
million for the agency.
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.\1\
---------------------------------------------------------------------------
\1\ Institute of Medicine. Progress in Preventing Childhood Obesity
Washington, DC: National Academies Press, 2006.
---------------------------------------------------------------------------
Now that healthcare reform has been signed into law, collecting
health statistics is of even greater importance. Providing an
additional $23 million in fiscal year 2011 continues the progress on a
path that can mitigate previous years of flat-funding and ensure we
have a 21st century health statistics system in the United States.
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.
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 discovery of new drugs and therapies.
Although NIH does offer some funding support to plant biology research,
with increased funding plant biologists can offer much more to advance
the missions of NIH. In the next section, we highlight the particular
relevance of plant biology research to human health.
Plant Biology and 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.'' 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, and the
molecular mechanisms employed by both the pathogen and its targeted
host can be very similar.
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. Indeed, one World Health Organization 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 common illnesses
such as respiratory infections and diarrhea. 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, and the
lycopenes found in tomato. Ongoing development of crop varieties with
tailored nutraceutical content is an important contribution that plant
biologists are making toward realizing the goal of personalized
medicine, especially personalized preventative medicine.
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 World Health Organization 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 anti-malarial 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
isolated and named taxol after the tree's Latin name, Taxus brevifolia.
Originally, taxol could only be obtained from the tree bark itself, but
additional research led to the elucidation 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 of Tropical Medicine and
Hygiene
The American Society of Tropical Medicine and Hygiene (ASTMH)--the
principal professional membership organization representing, educating,
and supporting scientists, physicians, clinicians, researchers,
epidemiologists, and other health professionals dedicated to the
prevention and control of tropical diseases--appreciates the
opportunity to submit written testimony to the Senate Labor, Health and
Human Services, and Education, and Related Agencies Appropriations
Subcommittee. We respectfully request that the subcommittee provide the
following allocations in the fiscal year 2011 Labor, Health and Human
Services, and Education, and Related Agencies appropriations bill to
support a comprehensive effort to promote malaria, neglected tropical
disease (NTD), and diarrheal disease control programming globally:
--$35 billion to the National Institutes of Health (NIH);
--$5.04 billion to the National Institute of Allergy and Infectious
Diseases (NIAID);
--$78.5 million to the Fogarty International Center (FIC);
--$18 million to the Centers for Disease Control and Prevention (CDC)
for malaria research, control, and program evaluation efforts
with a $6 million set-aside for program monitoring and
evaluation; and
--Direct funding to the CDC for ongoing efforts on NTDs and diarrheal
disease.
ASTMH Background
The 3,700 members of ASTMH work in a myriad of public, private, and
nonprofit environments. The largest proportion of our membership (34
percent) work in academia at the Nation's leading research
universities. Fifteen percent of ASTMH members are employed by the U.S.
military, and 11 percent are employed in public institutions and
Federal agencies. Nine percent of ASTMH members are in private
practice, with another 4 percent working in industry (e.g.,
pharmaceutical companies). The balance of the ASTMH membership works in
numerous other capacities and for various other entities seeking to
reduce and prevent tropical disease.
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 vector borne 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.
ASTMH aims to advance policies and programs that prevent and
control those tropical diseases which particularly impact the global
poor. The United States has a long history of leading the fight against
tropical diseases which cause human suffering and pose a great
financial burden that can negatively impact a country's economic and
political stability. The benefits of U.S. investment in tropical
diseases are not only humanitarian, they are diplomatic as well. ASTMH
members and others work to reduce the impact of tropical diseases and
to directly and positively impact populations that are otherwise
generally ignored, but on whom many countries' futures depend. Tropical
diseases, many of them neglected for decades, impact U.S. citizens
working or traveling overseas as well as our military personnel.
Furthermore, some of the agents responsible for these diseases can be
introduced and become established in the United States (as was the case
with West Nile virus), or might even be weaponized.
Malaria
Malaria remains a global emergency affecting mostly poor women and
children; it is an acute, sometimes fatal disease caused by the single-
celled Plasmodium parasite transmitted to humans by Anopheles
mosquitoes. 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. Approximately every 30
seconds, a child dies of malaria--a total of about 800,000 under the
age of 5 every year. (During the time it took to read this message, 10
children have died.)
The World Health Organization (WHO) estimates that one-half of the
world's people are at risk for malaria and that there are 108 malaria-
endemic countries. Malaria-related illness and mortality not only take
a human toll, they 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) the indoor residual
spraying (IRS) of insecticide on the walls of homes; (2) long-lasting
insecticide-treated nets (LLIN); (3) Artemisinin-based combination
therapies (ACTs); and (4) intermittent preventive therapy (IPT) for
pregnant women in areas with high transmission. However, limited
resources preclude the provision of these interventions and treatments
to all individuals and communities in need. Thus, ASTMH calls upon
Congress to fund a comprehensive approach to malaria control, including
public health infrastructure improvements, mosquito abatement
initiatives, and increased availability of existing anti-malarial
drugs, development of new anti-malarial drugs and better diagnostics,
and research to identify an effective malaria vaccine.
Neglected Tropical Diseases, Diarrheal Disease and Arboviruses
According to WHO, more than 1 billion people--one-sixth of the
world's population--suffer from one or more NTDs, including arboviruses
such as yellow fever and Dengue fever. The pediatric death toll due to
diarrheal illnesses exceeds that of AIDS, tuberculosis, and malaria
combined. In poor countries, diarrheal disease is second only to
pneumonia in causing the deaths of children under 5 years old. Every
week, 31,000 children in low-income countries die from diarrheal
diseases. Diarrheal and NTDs, including arboviruses, are a symptom of
poverty and disadvantage. Most of those affected are the poor
populations in rural areas, urban slums or conflict zones.
Traditionally, these diseases have been neglected by the world.
Requested Activities and Funding Levels
NIAID.--Malaria continues to be among the most daunting global
public health challenges we face and one-sixth of the world's
population suffers from one or more NTDs. A long-term investment is
needed to achieve the drugs, diagnostics and research capacity needed
to control malaria and neglected tropical disease. NIAID, the lead
institute for malaria research, plays an important role in developing
the drugs and vaccines needed to fight malaria.
Malaria.--NIH estimates spending approximately $152 million overall
with for malaria research and $36 million for research related
specifically to creating a malaria vaccine in fiscal year 2011. NIAID,
the lead Institute for this research, has developed an Implementation
Plan for Global Research on Malaria, which is focused on five research
areas: vaccine development, drug development, diagnostics, vector
control, and infrastructure and research capability strengthening.
NTDs.--The NIH, through NIAID conducts research to better
understand NTDs, which includes conducting its own basic and clinical
studies as well as extramural research. These efforts include:
--Research at the NIAID Laboratory of Parasitic Diseases to uncover
how NTD-causing pathogens interact with humans, animals, and
the organisms that spread them from host to host. The lab
conducts patient-centered research at the NIH Clinical Center
in Bethesda, MD, as well as field studies in India, Latin
America, and Africa.
--Actively supporting the discovery and development of drugs for NTDs
including a low-cost treatment for visceral leishmaniasis and
identifying new drugs for sleeping sickness and Chagas disease.
--The Vector Biology Research Program at NIAID supports research on
several vectors that transmit agents of NTDs. Many of these
projects have field components in disease-endemic areas of the
world.
--NIAID also has research repositories that provide researchers with
parasite species, standard study protocols, and training.
ASTMH encourages NIH to continue and expand its investment in
malaria, NTD, diarrheal disease, and arbovirus research and to
coordinate that work with other Government agencies to maximize
resources and ensure development of basic discoveries into useable
solutions. NIAID is at the forefront of these efforts and continued
funding is crucial to developing the next generation of drugs,
vaccines, and other interventions.
FIC.--Although biomedical research has provided major advances in
the treatment and prevention of malaria, neglected tropical diseases
and other infectious diseases, 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. For example, for
nearly a decade FIC has funded a program that has produced a
substantial number of researchers with the expertise to address the
research and clinical challenges associated with diarrheal diseases in
Latin America. This strong international collaboration is fostering new
discoveries on the long-term effects of and treatments for diarrheal
diseases. By promoting applied health research in developing countries,
the FIC can speed the implementation of new health interventions for
malaria and NTDs.
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 many 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, 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 2011 to increase these efforts, particularly as
they address the control and treatment of malaria, NTDs, and diarrheal
disease.
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.
The CDC is crucial partner in the President's Malaria Initiative
(PMI), a $6.2 billion, 9-year effort led by the U.S. Agency for
International Development (USAID) 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.
CDC efforts on malaria fall into three broad areas--prevention,
treatment, and monitoring/evaluation. The agency performs a wide range
of basic research within these categories, such as:
--Providing technical assistance to malaria-endemic, non-PMI
countries;
--Conducting research on LLINs, IRS, malaria in pregnancy, and case
management including diagnosis, treatment and antimalarial drug
resistance to inform new strategies and prevention approaches;
--Assessing new monitoring, evaluation and surveillance strategies;
--Conducting additional research on malaria vaccines, including field
evaluations; and
--Developing novel public health strategies for improving access to
antimalarial treatment and delaying the appearance of
antimalarial drug resistance.
CDC NTD Programs.--CDC has had a long history of working on NTDs
and has provided much of the science that underlies those global
policies and programs in existence today. ASTMH encourages the
Subcommittee to provide direct funding to the CDC to continue its work
on NTDs, diarrheal diseases, and arboviruses, such as Japanese
encephalitis and Dengue. This work is important to any global health
initiative as individuals are often infected with multiple NTDs
simultaneously. It is essential that CDC be encouraged to continue its
monitoring, evaluation and technical assistance in these areas as an
underpinning of efforts to control and eliminate these diseases.
Currently the CDC receives zero dollars directly for NTD work; however
this should be changed to allow for more comprehensive work to be done
on NTDs directly at the CDC.
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 2011
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
SUMMARY: FUNDING RECOMMENDATIONS
[In millions of dollars]
------------------------------------------------------------------------
Amount
------------------------------------------------------------------------
National Institutes of Health.......................... 35,000
National Heart, Lung & Blood Institute............. 3,514
National Institute of Allergy and Infectious 5,395
Disease...........................................
National Institute of Environmental Health Sciences 779.4
Fogarty International Center....................... 78.4
National Institute of Nursing Research............. 163
Centers for Disease Control and Prevention............. 8,800
National Institute for Occupational Safety and 364.3
Health............................................
Asthma Programs.................................... 70
Division of Tuberculosis Elimination............... 220.5
Chronic Disease Prevention and Health Promotion: 3
COPD..............................................
Office on Smoking and Health....................... 280
National Sleep Awareness Roundtable................ 1
------------------------------------------------------------------------
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. Founded in 1905, the ATS is an international education and
scientific society that focuses on respiratory and critical care
medicine. The ATS's 18,000 members help prevent and fight respiratory
disease through research, education, patient care, and advocacy.
lung disease in america
Diseases of breathing constitute the third-leading cause of death
in the United States, responsible for 1 of every 7 deaths. Diseases
affecting the respiratory (breathing) system include chronic
obstructive pulmonary disease (COPD), lung cancer, tuberculosis (TB),
influenza, sleep-disordered breathing, pediatric lung disorders,
occupational lung disease, sarcoidosis, asthma, and critical illness.
The death rate due to 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.
In recognition of the rising global burden of lung disease and the
need for increased awareness and action to promote lung health, the
ATS, in conjunction with the Federation of International Respiratory
Societies, has declared 2010 to be the Year of the Lung. Throughout
2010, the ATS will be sponsoring a series of congressional briefings
and other events to raise lung disease awareness.
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.
This funding has sustained NIH support for groundbreaking research into
diseases like COPD and asthma that affect millions of Americans. It is
critical that this reinvestment in biomedical research is reinforced
through annual budget increases that permit the NIH to respond to
public health needs. We ask the subcommittee to provide $35 billion in
funding for the NIH in fiscal year 2011.
Despite the rising lung disease burden, lung disease research is
underfunded. In fiscal year 2009, 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 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.
Centers for Disease Control and Prevention (CDC)
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 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 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 $8.8
billion for the CDC in fiscal year 2011.
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 limitation in breathing due mainly to emphysema and chronic
bronchitis. CDC estimates that 12 million patients have COPD; an
additional 12 million Americans are unaware that they have this life
threatening disease.
The ATS feels that resources committed to COPD for research and
education are not commensurate with the impact the disease has on
Americans. 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 COPD Education and Prevention Program.
CDC also has a role to play in this work. To address the increasing
public health burden of COPD, we encourage the creation of a CDC COPD
program at the Center for Chronic Disease Prevention and Health
Promotion, and request an appropriation of $3 million in fiscal year
2011 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, and that the CDC be encouraged to add COPD-based questions to
future CDC health surveys, including the National Health and Nutrition
Evaluation Survey, the National Health Information Survey, and the
Behavioral Risk Factor Surveillance Survey.
tobacco control
Cigarette smoking is the leading preventable cause of death in the
United States, responsible for 1 in 5 deaths annually. The ATS
congratulates the President and the Congress for enactment of the
Family Smoking and Tobacco Prevention Act. The CDC's Office of Smoking
and Health coordinates public health efforts to reduce tobacco use. In
order to significantly reduce tobacco use within 5 years, as
recommended by the subcommittee in fiscal year 2010, the ATS recommends
$280 million in funding for the Office of Smoking and Health in fiscal
year 2011.
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. In 2006, about 1 in 5 deaths in children under 1
year of age was due to a lung disease. 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, including 7
million children. 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. The
ATS recommends an fiscal year 2011 funding level of $70 million for the
CDC's asthma program.
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-disordered breathing and sleep-related
illnesses affect an estimated 50-70 million Americans. The public
health impact of sleep illnesses and sleep disordered breathing is
still being determined, but is known to include increased mortality,
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 $1 million in fiscal year 2011 to
support activities related to sleep and sleep disorders at the CDC,
including for the National Sleep Awareness Roundtable, 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 at the NHLBI.
tuberculosis (tb)
TB is the second-leading global infectious disease killer, claiming
1.8 million lives each year. It is estimated that 9-14 million
Americans have latent TB. 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 TB range from $100,000 to $300,000. The global TB
pandemic and spread of drug resistant TB present a persistent public
health threat to the United States.
Despite declining 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 occur,
outstripping local capacity; (4) continued emergence of drug
resistance; and (5) there are critical needs for new diagnostics,
treatment, and prevention tools.
In 2008, Congress passed the Comprehensive Tuberculosis Elimination
Act (CTEA, Public Law 110-392). This historic legislation 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 also authorizes an
urgently needed reinvestment into new TB diagnostic, treatment and
prevention tools. The ATS, recommends a funding level of $220.5 million
in fiscal year 2011 for CDC's Division of TB Elimination, as authorized
under the CTEA, and encourages the NIH to expand efforts, as requested
under the CTEA, to develop new tools to reduce the rising global TB
burden.
critical care
The burden associated with provision of care to critically ill
patients is enormous, and is anticipated to increase significantly as
the population ages. Investigation into diagnosis, treatment, and
outcomes in critically ill patients should be a high priority, and the
NIH should be encouraged and funded to coordinate investigation related
to critical illness in order to meet this growing national imperative.
fogarty international center
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
professionals in TB treatment and research. These training grants
should be expanded and offered to all institutions. The ATS recommends
Congress provide $78.4 million for FIC in fiscal year 2011, to allow
expansion of 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 $364.3 million in fiscal year
2011 for NIOSH to expand or establish the following activities: the
National Occupational Research Agenda; 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. 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 Animal Welfare Institute
As part of the fiscal year 2010 appropriations bill for the
National Institutes of Health (NIH), both the Senate and the House of
Representatives included language in their reports directing NIH to
take steps to end the use of Class B dealers by its grant recipients.
Grantees affected by this language are small in number. According to
USDA, for the period November 2007-November 2008, 2,863 dogs and 276
cats came from Class B dealers. This constitutes just 3 percent of the
almost 95,000 total dogs and cats used in fiscal year 2007 for all
research purposes, which include not only NIH-sponsored research, but
also non-NIH-related research, testing and teaching.
Both chambers were responding to a report from the National Academy
of Sciences (NAS) (``Scientific and Humane Issues in the Use of Random
Source Dogs and Cats in Research''), undertaken at the request of
Congress, that ``critically examine[d] the general desirability and
necessity of using random source dogs and cats in NIH-funded research,
and the specific necessity of using Class B dealers as a source of such
animals for NIH-funded research.'' (p. 2) While the Committee
``concluded that under some circumstances, dogs and cats with qualities
of random source animals may be desirable and necessary for NIH-funded
research,'' it also ``determined Class B dealers are not necessary as
providers of random source animals for NIH-related research'' (p. 5)
and that adequate numbers of such animals are available from other
sources. Acknowledging this finding, the Senate Appropriations
Committee said, in part, that it ``expects the NIH to phase out, as
quickly as possible, the use of any of its funds 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 . . . and resell
them. Specifically, the NIH should not award any new grants or
contracts that involve such animals and should immediately begin
supporting alternative sources of random source animals from non-class
B dealers.''
NIH has been dragging its feet in addressing the problem of Class B
dealers for a decade, since Congress first expressed its concern over
the matter. Based on statements NIH representatives have made with
respect to the NAS report and the appropriations report language, we
expect them to continue dragging their feet. We respectfully request
that the subcommittee follow up the strong, sound position it laid out
in the report language with statutory language prohibiting NIH from
awarding or renewing any grants or contracts that involve the use of
dogs or cats acquired from class B dealers, and that, moreover, NIH
immediately begin supporting alternative sources of random-source dogs
and cats from non-Class B dealers.
It should be clarified that the NAS report addressed extramural
research funded by NIH, not NIH's internal research endeavors. The
irony is, NIH ceased using Class B dealers in its own intramural
research over 20 years ago, recognizing the problems--both ethical and
scientific--caused by acquiring dogs from sources that treat the
animals inhumanely; fail to provide proper veterinary care and the
basic necessities such as clean water, food, and shelter; acquire
animals through fraud and deception; and are constantly under
investigation for violations of the Animal Welfare Act (AWA). In fact,
in a recent article in Science (David Grimm, ``Dog Dealers' Days May Be
Numbered,'' Vol. 327, 26 February 2010, p. 1076-1077), Dr. Robert
Whitney, former director of NIH's National Center for Research
Resources (1972-1992) and Deputy Surgeon General of the U.S. Public
Health Service (1992), is quoted as saying, ``By using these animals,
we risk losing our credibility with the public. It's an Achilles' heel
for research.'' Even so, NIH steadfastly refuses to hold its extramural
grant recipients to the same high standard it requires of its
intramural researchers.
Of the 10 remaining licensed Class B dealers who sell live random
source dogs and cats for experimentation, one is presently under a 5-
year license suspension, and 6 are under investigation for AWA
violations. And welfare problems with licensed Class B dealers are
myriad. Needed veterinary care is lacking for many random source
animals. Heartworm is a widespread problem, particularly in the South.
Hookworm and mange are as well. Inspectors have observed animals at
dealer premises with mange, ``loose stool with some blood,'' ``ring-
worm like lesions,'' infected eyes, bite wounds, lameness, tumors,
chronic cough, and animals who are severely underweight and others with
a ``purulent discharge from the nose.'' In most cases, there is no
record of any veterinary care.
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 to see if there will be a taker. If
not, the animal may be taken back and left to die or simply 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 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 non-potable water. Water was mixed with bread and dog food and
sitting in the direct sun.''
The NAS report took note of these failures to provide for the
animals' basic welfare: ``In addition, the Committee determined that
the husbandry standards and humane treatment of animals was
unacceptably variable among existing Class B dealers, and not
commensurate with NIH standards of research animal care and quality.''
(p. 86; emphasis added.) The report also observed that ``random source
dogs and cats used for research probably endure greater degrees of
stress and distress compared to purpose-bred animals. This conclusion
has implications not only for the welfare of random source animals but
also for their overall reliability as research models.'' (p. 59)
USDA is also pursuing separate investigations regarding apparent
supply violations identified during tracebacks conducted of dealer
records necessitated by ongoing questions about the illegality of the
sources of animals. Unlike any other licensees covered under the AWA,
this one group--Class B dealers selling dogs and cats for research--has
a long-standing problem maintaining complete and accurate records. 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?
Complicating matters further is the fact that dealers commonly
network with each other; that is, animals are sold from buncher (an
unlicensed dealer who literally bunches together animals from various
sources) to dealer to another dealer, often across multiple State
lines, before being sold for research. With animals changing hands and
being shipped across the country, how is USDA supposed to keep up with
the movement of animals and verify their source?
Another shell game dealers like to play is passing the business on
to other members of the family after 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. Brothers Danny
and Johnny Schachtele of Missouri ran their licensed Class B dealer
operation as a team beginning in 1987. Later Johnny left the business
and Danny's wife, Mildred, replaced him. Over the ensuing years, the
husband-wife team were cited by USDA for a host of violations of the
AWA, 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. But 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. Becky and Tony
Schachtele have been cited repeatedly by USDA for apparent violations
including inadequate veterinary care, faulty recordkeeping, inadequate
cleaning and sanitization and problems with housing and primary
enclosures. Among multiple dogs in need of veterinary care, the USDA
inspector noted one dog ``standing with its head down and rocking in an
abnormal manner from front to back and side to side . . . dull eyes . .
. never lifted its head . . . was very thin with very prominent, easily
visible bony structures . . . the dogs abdomen was extremely tucked and
its hair coat was dull.'' At one inspection alone, 48 records had
incomplete addresses for the persons who sold the animals; 31 animal
certification forms were incomplete; and 44 forms had inconsistent and
therefore inaccurate information regarding the animals and when they
were acquired and sold. Though under investigation, the Schachteles are
still selling dogs and cats for research.
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.'' To
address these numerous and ongoing violations, USDA has to inspect
random source dealers four times a year instead of once a year as is
done with all other licensees and registrants under the AWA. It spends
approximately $300,000 per year trying to regulate this small number of
dealers, and even with that, the department acknowledged in its NAS
testimony that it cannot guarantee that stolen pets are not being sold
into research.
The effect on the animals of such inhumane treatment, and the costs
of enforcement, are not included in the calculation when NIH cites the
cheaper cost of random source dogs and cats acquired from Class B
dealers. But the NAS report does take this into account: ``. . .
[O]ftentimes dogs and cats from Class B dealers are not free from
disease. In addition to being a potential threat to other animals and
people in the research facility, they may need to undergo prolonged
quarantine, socialization, treatment, or be removed from the study all
together [sic]. These hidden costs may substantially increase the
actual final cost by hundreds of dollars per animals. Additionally, the
price of USDA/APHIS oversight of Class B dealers . . . represents a
substantial cost to the U.S. government and ultimately the American
public that is not incurred by NIH, the research institution, nor the
research investigator.'' (p.75)
The AWA was passed in 1966 to address the illegal supply of dogs
and cats to laboratories, and now, over four decades later, these
problems are still widespread. What has changed significantly over this
lengthy period of time is the availability of animals from suppliers
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, with the health and vaccination status and the genetic
background on each individual animal 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 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.'' The
National Academies report clearly states that ``it is not necessary to
acquire them [random source dogs and cats] through Class B dealers,''
(``Report In Brief''), and that adequate numbers are available through
alternative sources.
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 involves illegal acquisition of animals, fraudulent or
incomplete records and other illicit activities, and failure to abide
by the minimum care requirements of the AWA.
Thank you very much for your consideration of our request for
statutory language to address this issue and put an end to wasting
taxpayer money on propping up this corrupt system.
______
Prepared Statement of the Building and Construction Trades Department
AFL-CIO
My name is Erich (Pete) Stafford and I am the Director of Safety
and Health for the Building and Construction Trades Dept (BCTD) AFL-
CIO. The BCTD is composed of 13 international unions representing some
3 million members employed in the building and construction industry.
The purpose of this testimony is to request your support for
increased funding for the National Institute for Occupational Safety
and Health (NIOSH), and its construction research program.
Despite improvements in workplace safety and health, nearly 15
American workers die each day from injuries sustained at work, and 134
die from work-related diseases. Of those killed every day, nearly 4
work in the construction industry.
Indeed, construction has the dubious distinction of being the
single most hazardous industry in the United States accounting for some
1,200 construction workers killed on the job each year. (see attached
chart). Another 150,000 suffer serious injuries requiring time off from
work. Moreover, due to exposures to an array of toxic and hazardous
substances, construction workers have unacceptably high levels of
occupational disease including cancers, silicosis, asbestosis, and
other heart, lung and neurological diseases.
While construction workers make up only 8 percent of the U.S.
workforce, they account for more than 22 percent of all work-related
deaths. The number of construction workers killed on the job is 10
times the number of firefighters and law enforcement officers killed in
the line of duty each year, and 20 times the number of job-related
deaths to miners.
In addition to the human tragedy, the economic costs are
staggering. The total cost of fatal and nonfatal injuries and disease
in the construction industry has been estimated at nearly $13 billion
annually. And, that does not count the costs of workers' compensation,
which, at $30 billion a year, are twice that of manufacturing and three
times that for all industries.
NIOSH, is the only Federal agency responsible for conducting
research and making recommendations for the prevention of work-related
injury and illness. Yet it is one of the most under funded health
research agencies in the Federal Government, and is hamstrung by being
buried in the bowels of the Centers for Disease Control and Prevention
bureaucracy where it remains an orphan.
Except for a special $80 million increase for the World Trade
Center (WTC) health program and some $7 million for nanotechnology
research, the President's fiscal year 2011 NIOSH budget request remains
at last year's level. While we support both the WTC and nanotechnology
programs, we think it's high time for the Congress to review the entire
NIOSH program with an eye towards dramatically improving both its
structural place within the Department of HHS and its funding.
With respect to funding, especially funding for the NIOSH National
Occupational Research Agenda (NORA) program, we recommend a $25 million
increase more than the President's static $124.5 million NORA request.
This would permit a modest expansion of NIOSH/NORA research activities
beyond nanotechnology.
We are particularly concerned with NORA funding for the
``construction initiative'' that seeks to (1) identify safety and
health problem areas and obstacles to prevention and (2) translate that
research into practice via partnerships and field studies across a
variety of construction trades.
A recent National Academy of Sciences' Institute of Medicine review
of the NIOSH construction program, recommended:
--Increased funding for the program.
--Strengthening NIOSH's internal management of the program.
--Retaining ``The National Construction Center'' as the main focus
for ``research to practice'' (R2P) activities.
According to the National Academy: ``Total annual funding for the
Construction Research Program between fiscal year 1997 and fiscal year
2007 has averaged about $17.8 million, ranging from a high of $20.3
million in fiscal year 1997 to a low of $13.8 million in fiscal year
2007. . . . When adjusted for inflation and changes in technologies,
the funding level for the program has declined in terms of real
purchasing power . . .''
Moreover, the study committee concluded ``. . . that in spite of
budget constraints, the Construction Research Program has made an
impact on one of the most dangerous and largest of U.S. industries. The
committee finds the funding level inadequate and recommends that high-
level attention be given to determining how to provide program
resources that are commensurate with a more robust pursuit of the
program's goals . . .''
Given the research agenda outlined and recommended by the NAS
Review Committee, we believe that the construction program should be
placed on a sounder financial footing and recommend that it receive
additional funds from the $25 million NIOSH/NORA budget increase we
have requested.
To address the many construction safety and problems in our
industry, the BCTD research arm--The Center for Construction Research
and Training (CPWR)--has, for many years, been working with NIOSH
through the NORA construction research initiative. The CPWR was
recently awarded another 5-year extension of its NIOSH contract to
serve as the ``National Construction Center'' to coordinate the
``Research to Practice'' program. Unfortunately, funding for the
``National Construction Center'' has remained flat for the past 15
years at about $5 million annually.
We strongly believe that the best way to address what has become a
safety and health crisis in our industry is through targeted and
applied research to better understand the causes of construction-
related incidents and illness and find ways implement solutions on U.S.
construction sites. While there is certainly an additional need for
better standards and enforcement by the Department of Labor, NIOSH
construction research is the critical first step towards a safer and
healthier construction workforce.
In addition to fostering more investigator-initiated extramural
research into risks from emerging technologies such as nano-particles
and strengthening NIOSH administration, a modest increase in funding
would expand the transfer of research-to-practice functions of the
National Construction Center with special emphasis on:
--Social marketing outreach to small-to-medium sized (less than 50
employees) workplaces
--Special worker populations including immigrant, minority, young and
older workers.
--Opportunities to combine safety and health with more energy-
efficient construction practices and investigate emerging
hazards in green construction.
As you consider the fiscal year 2011 Labor, Health and Human
Services, and Education, and Related Agencies appropriation bill, we
urge you to take some time to consider the safety and health of our
building and construction workforce. The current situation is simply
unacceptable and, in light of demands for increased public spending for
construction projects to stimulate the economy, the safety and health
pressures on our workers will only become more intense.
Thank you.
FACILITIES IN THE U.S. CONSTRUCTION INDUSTRY
----------------------------------------------------------------------------------------------------------------
2003 2004 2005 2006 2007
----------------------------------------------------------------------------------------------------------------
Construction.................... 1,171 1,278 1,243 1,297 1,239
Transportation.................. >800 >800+ >800 <900 <900
Manufacturing................... >400 >400 <400 >400 400
Agriculture..................... >700 >600 >700 >600 600
Mining.......................... >100+ >100 >100 200 <200
----------------------------------------------------------------------------------------------------------------
Source: Center for Construction Research and Training.
safety and health facts \1\
---------------------------------------------------------------------------
\1\ Source: Center for Construction Research and Training.
---------------------------------------------------------------------------
The construction industry employs only 8 percent of the workforce
but it suffers 22 percent of all work-related deaths.
Low-skilled, low-paid laborers suffer the most fatalities.
Construction establishments with less than 20 workers account for
55 percent of all fatalities.
Lung cancer deaths are 50 percent higher among construction workers
than the U.S. population, adjusted for smoking.
Construction workers are twice as likely to have chronic
obstructive lung diseases.
Construction workers are five times as likely to have a cancer of
the lung lining, mesothelioma, and 33 times as likely to have
asbestosis, an incurable and fatal lung disease.
30-40 percent of construction workers suffer musculoskeletal
disorders and chronic pain.
50 percent of construction workers have noise-induced hearing loss.
Construction workers account for 17 percent of workers with
elevated blood lead levels.
Welding fumes account for 75 percent of boilermakers, 15 percent of
ironworkers and 7 percent of pipefitters exceed the accepted 8-hour
level for manganese exposure; a known neurotoxin.
______
Letter From the Brain Injury Association of America
April 7, 2010.
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 Chairman Harkin and Ranking Member Cochran: Thank you for the
opportunity to submit this written testimony with regard to the fiscal
year 2011 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.
Recently, we are seeing an increasing number of service members
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 traumatic brain injury
during deployment. Many of these returning service members 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 13 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 brain injury. 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:
--$10 million (+$4 million) for the Centers for Disease Control and
Prevention TBI Registries and Surveillance, Brain Injury Acute
Care Guidelines, Prevention and National Public Education/
Awareness
--$8 million (+$1 million) for the Health Resources and Services
Administration (HRSA) Federal TBI State Grant Program
--$4 million (+$1 million) for the HRSA Federal TBI Protection &
Advocacy (P&A) Systems Grant Program
CDC--National Injury Center.--The Centers for Disease Control and
Prevention's National Injury Center is responsible for assessing the
incidence and prevalence of TBI in the United States. The CDC estimates
that 1.4 million TBIs occur each year and 3.4 million Americans live
with a life-long disability as a result of TBI. In addition, the TBI
Act as amended in 2008 requires the CDC to coordinate with the
Departments of Defense and Veterans Affairs to include the number of
TBIs occurring in the military. This coordination will likely increase
CDC's estimate of the number of Americans sustaining TBI and living
with the consequences.
CDC also funds States for TBI registries, creates and disseminates
public and professional educational materials, for families, caregivers
and medical personnel, and has recently collaborated with the National
Football League and National Hockey League to improve awareness of the
incidence of concussion in sports. CDC plays a leading role in helping
standardize evidence based guidelines for the management of TBI and $3
million of this request would go to fund CDC's work in this area as
well as support a pilot project to improve hospital compliance with
existing guidelines.
HRSA TBI State Grant Program.--The TBI Act authorizes the HHS,
Health Resources and Service Administration (HRSA) to award grants to
(1) States, American Indian Consortia and territories to improve access
to service delivery and to (2) State Protection and Advocacy (P&A)
Systems to expand advocacy services to include individuals with
traumatic brain injury. For the past 13 years the HRSA Federal TBI
State Grant Program has supported State efforts to address the needs of
persons with brain injury 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 brain injury care.
Increasing the program to $8 million will provide funding necessary
to sustain the grants for the 15 States currently receiving funding
along with the three additional States added this year and to ensure
funding for four additional States. Steady increases over 5 years for
this program will provide for each State including the District of
Columbia and the American Indian Consortium and territories 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.
HRSA TBI P&A Program.--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, information, and referral 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
traumatic brain injury is needed to help reduce government expenditures
and increase productivity, independence and community integration.
However, advocates must possess specialized skills, and their work is
often time-intensive. A $4 million appropriation would ensure that each
P&A can move towards providing a significant PATBI program with
appropriate staff time and expertise.
National Institute on Disability and Rehabilitation Research
(NIDRR) TBI Model Systems of Care.--Funding for the TBI Model Systems
in the Department of Education 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 brain injury. 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 $11 million (+$1.5 million) in fiscal year 2011 for NIDRR's TBI
Model Systems of Care program, in order to add one new Collaborative
Research Project. In addition, given the national importance of this
research program, the TBI Model Systems of Care should receive ``line-
item'' status within the broader NIDRR budget.
We ask that you consider favorably these requests for the CDC, the
HRSA Federal TBI Program, and the NIDRR TBI Model Systems Program to
further data collection, increase public awareness, improve medical
care, assist States in coordinating services, protect the rights of
persons with TBI, and bolster vital research.
Sincerely,
Susan H. Connors,
President/CEO,
Brain Injury Association of America.
______
Prepared Statement of the CAEAR Coalition
On behalf of the tens of thousands of individuals living with HIV/
AIDS to whom the members of the Communities Advocating Emergency AIDS
Relief (CAEAR) Coalition provide care, I want to thank Chairman Tom
Harkin and Ranking Member Thad Cochran for affording CAEAR Coalition
the opportunity to submit this written testimony for the record
regarding increased funding for the Ryan White HIV/AIDS Program.
CAEAR Coalition is a national membership organization which
advocates for Federal appropriations, legislation, policy and
regulations to meet the care, treatment, support service, and
prevention needs of people living with HIV/AIDS and the organizations
that serve them. CAEAR Coalition's proactive national leadership is
focused on the Ryan White Program as a central part of the Nation's
response to HIV/AIDS. CAEAR Coalition's members include Ryan White
Program part A, part B, and part C consumers, grantees, and providers.
A Wise Investment in a Program That Works
The Ryan White Program works. Those on the epidemic's frontlines
know this to be true, and that faith received a ringing endorsement
from the White House Office of Management and Budget (OMB). In its 2007
Program Assessment Rating Tool (PART), OMB gave the Ryan White Program
its highest possible rating of ``effective''--a distinction shared by
only 18 percent of all programs rated. According to OMB, effective
programs ``set ambitious goals, achieve results, are well-managed and
improve efficiency.'' Even more impressively, OMB's assessment of the
Ryan White Program found it to be in the top 1 percent of all Federal
programs in the area of ``Program Results and Accountability.'' Out of
the 1,016 Federal programs rated--98 percent of all Federal programs--
the Ryan White Program was one of seven that received a score of 100
percent in ``Program Results and Accountability.''
The reauthorization of the Ryan White Program signed in October
2009 was a tremendous victory for people living with HIV/AIDS and those
who care for them. We are grateful for congressional efforts to ensure
that this vital program continued uninterrupted when it expired in
September. As you are aware, the Ryan White Program serves as the
indispensable safety net for thousands of low-income, uninsured, or
underinsured people living with HIV/AIDS.
--Part A provides much-needed funding to the 56 major metropolitan
areas hardest hit by the HIV/AIDS epidemic with severe needs
for additional resources to serve those living in their
communities.
--Part B assists States and territories in improving the quality,
availability, and organization of healthcare and support
services for individuals and families with HIV disease.
--The AIDS Drug Assistance Program (ADAP) in part B provides urgently
needed medications to people living with HIV/AIDS in all 50
States and the territories.
--Part C provides grants to 357 faith- and community-based primary
care health clinics and public health providers in 49 States,
Puerto Rico and the District of Columbia. These clinics play a
central role in the delivery of HIV-related medical services to
underserved communities, people of color, and rural areas.
--Part F AETC supports training for healthcare providers to identify,
counsel, diagnose, treat, and manage individuals with HIV
infection and to help prevent high-risk behaviors that lead to
infection. It has 130 program sites in all 50 States.
We thank you in advance for your consideration of our comments and
our request for:
--$905 million for part A to support grants to the cities hardest hit
by HIV/AIDS so they can provide quality care to people with
HIV/AIDS (an increase of $225.9 million);
--$474.7 million for part B base to provide additional needed
resources to the States in their efforts to address the HIV/
AIDS epidemic (an increase of $55.9 million).
--$1,205.1 million in funding for the ADAP line item in part B so
uninsured and underinsured people with HIV/AIDS can access the
prescribed medications they need to survive (an increase of
$307.1 million).
--$337.8 million for part C to support grants to community-based
organizations, agencies, and clinics that provide quality care
to people living with HIV/AIDS (an increase of $131 million).
--$50 million to fund the 11 regional centers funded under by part F
AETC to offer specialized clinical education and consultation
on HIV/AIDS transmission, treatment, and prevention to
frontline healthcare providers (an increase of $15.9 million).
The increases CAEAR Coalition seeks in the current funding for part
A, part B base and ADAP, part C, and part F AETC reflect the reality
that the HIV/AIDS epidemic and the healthcare and social service needs
of people with HIV/AIDS require significantly more Federal resources
than those provided in recent years. There continues to be an ever-
growing gap between the number of people living with AIDS in the United
States in need of care and the resources available to serve them. For
example, between 2001 and 2007 the number of people living with AIDS
grew 33 percent and yet funding for medical care and support services
in the Nation's hardest hit communities grew less than 12 percent
between 2001 and 2010. Similarly, funding for part C-funded, community-
based primary care clinics, which provided medical care for people
living with HIV/AIDS in rural and urban communities nationwide, grew by
only 11 percent between 2001 and 2010 as the number of people they care
for grew by 52 percent.
Growing Needs, Diminishing Resources
In 2008, CDC yet again revised upward its estimate of persons
living with HIV/AIDS in the United States to 1,106,400 (as of 2006).
Approximately one-half of those people have yet to access HIV-related
medical care and there is a projected influx of newly diagnosed
individuals into care as a result of CDC initiatives to promote routine
HIV testing. CDC also estimates that in 2006, more than 56,000 people
were newly infected with HIV. Ryan White Program part A, part B base
and ADAP, part C, and part F AETCs must receive adequate increases to
meet the healthcare and supportive services needs of individuals
already in care and those newly identified HIV patients entering care-
many of whom will require comprehensive medical treatment and
supportive services at the time of diagnosis.
Additional increases are desperately needed to address the growing
demand for services, offset the rising cost of care, and help the many
jurisdictions forced year after year to make service reductions and
eliminations to rebuild their programs.
State budget cuts have created an immediate ADAP funding crisis.
Many State ADAPs are on the brink of the worst funding shortfall in
many years and there is a record number of people in need of ADAP
services due to the economic downturn. As of March 2010, there are 662
people on ADAP waiting lists in 10 States. Additionally, ADAP waiting
lists and other cost-containment measures, including limited
formularies, reducing eligibility, or removing already enrolled people
from the program, are clear evidence that the need for HIV-related
medications continues to outstrip availability. ADAPs are forced to
make difficult trade-offs between serving a greater number of people
living with HIV/AIDS with fewer services or serving fewer people with
more services. Additional resources are needed to reduce and prevent
further use of cost-containment measures to limit access to ADAPs and
to allow all State ADAPs to provide a full range of HIV antiretrovirals
and treatment for opportunistic infections.
The number of clients entering the 357 part C community health
centers and outpatient clinics has consistently increased over the last
5 years. More than 248,000 persons living with HIV and AIDS receive
medical care in part C-funded community health centers and clinics each
year. These community- and faith-based HIV/AIDS providers are
staggering under the burden of treatment and care after years of
funding cuts prior to the modest increase in recent years. The CDC has
implemented a number of initiatives designed to promote routine HIV
testing to identify people living with HIV. Their success continues to
generate new clients seeking care at part C-funded health centers and
clinics with no commensurate increase in the funds necessary to provide
access to comprehensive, compassionate treatment and care.
Increasing Testing Requires Increasing Access to Care
The fiscal year 2011 appropriation presents a crucial initial
opportunity to restore the Ryan White Program to the levels of funding
demanded by the epidemic as the Centers for Disease Control and
Prevention (CDC) continue their increased efforts to expand HIV testing
to help people living with HIV learn their status. With the continued
influx of newly diagnosed individuals into care and the additional
56,000 estimated new cases of HIV every year, the Ryan White program
must receive adequate increases to meet the healthcare and supportive
services needs of individuals already in care and those newly
identified HIV patients.
CAEAR Coalition supports efforts to help identify those individuals
infected with HIV but unaware of their status. However, CAEAR Coalition
is concerned that without the simultaneous allocation of additional
resources for treatment, these CDC initiatives have resulted in a
significant increase in the demand for HIV/AIDS services without the
capacity in place to provide that care.
Increased demand for services has placed a severe strain on the
HIV/AIDS safety net and forced community-based providers to stretch
already scarce resources even further to address growing needs. This
additional pressure on an already overburdened system will leave many
of the 200,000+ HIV-infected individuals who do not know their HIV
status without access to the care they need. CAEAR Coalition urges
Congress and the administration to provide a commensurate increase for
treatment programs to meet the demand that has resulted from the CDC
testing initiative.
Sufficient Funding for Ryan White Programs Saves Money and Saves Lives
Increased funding for Ryan White Programs will reap a significant
health return for minimal investment. Data show that part A and part C
programs have reduced HIV-related hospital admissions by 30 percent
nationally and by up to 75 percent in some locations. The programs
supported by the Ryan White HIV/AIDS Program also have been critical in
reducing AIDS mortality by 70 percent. Taken together, the Ryan White
Program works--resulting in both economic and social savings by helping
keep people healthy and productive.
CAEAR Coalition is eager to work with Congress to meet the
challenges posed by the HIV/AIDS epidemic. Congress and the
Administration must do more to address the grim reality that the
domestic epidemic is not static; it is continuing to grow at a
significant rate and more Federal resources are needed to prevent it
from becoming a public health catastrophe similar to what we are
witnessing in the developing world. Already, some communities in the
United States have infection and death rates similar to those in
Africa. We must make a commensurate domestic investment to care for
people in our own communities. CAEAR Coalition looks forward to working
with the subcommittee and the Congress to help meet the needs of
Americans living with HIV/AIDS as the appropriations process moves
forward.
Given the Ryan White Program's stellar history of accomplishments,
the vast need for more resources to address unmet need, and such strong
praise from the Federal Government's most stringent and assiduous
assessors, we hope the subcommittee will act to provide these
relatively modest funding increases.
______
Prepared Statement of the Council of Academic Family Medicine
On behalf of the Council of Academic Family Medicine (CAFM), we are
pleased to submit testimony on behalf of several programs under the
jurisdiction of the Health Resources and Services Administration (HRSA)
and the Agency for Healthcare Research and Quality (AHRQ).
We are very pleased to have supported the Patient Protection and
Affordable Care Act (PPACA) and to see it enacted into law. We
appreciate Congress's efforts to extend healthcare coverage to all and
are pleased that the law contains significant efforts to support and
sustain programs that will help produce a workforce needed to take care
of the Nation. As the law acknowledges, there is much that must be done
to support primary care production and nourish the development of a
high-quality, highly effective primary care workforce to serve as a
foundation for our healthcare system.
Health Care Reform Requires a Robust Primary Care Workforce
The PPACA contains many measures to address the need for more
primary care physicians. As you know, 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. The implementation of the 2006 Massachusetts
healthcare reform law demonstrated that universal coverage will
overwhelm a healthcare system with too few primary care physicians,
especially, family physicians. Addressing the shortage of primary care
physicians requires a long-term commitment to train an appropriate
number of these essential healthcare providers. We must increase our
investment in effective programs that encourage medical students to
enter primary care specialties.
Toward that end, there are several programs and agencies whose
domain is critically important to producing more primary care
physicians and providing them with the tools to support high quality
care. It is those programs and agencies that come under this
subcommittee's jurisdiction and that this testimony addresses.
Primary Care Training and Enhancement
Section 747 of the Public Health Service Act has a long history of
providing necessary funding for the training of primary care
physicians. In each reauthorization Congress has modified the program
to obtain certain key goals. The current authorization gives direction
to HRSA to recognize and prioritize training that will support
development of expertise in new competencies, including those relevant
to providing care through patient-centered medical homes, development
of infrastructure within primary care departments for the improvement
of clinical care and research critical to primary care delivery, as
well as innovations in team management of chronic disease, integrated
models of care, and transitioning between healthcare settings. One new
area of endeavor is the integration of academic administrative units
within a school of medicine to promote team based care and true primary
care production. This provision has a separate, additional
authorization of $750,000.
The Advisory Committee on Training in Primary Care Medicine and
Dentistry recommends $235 million for these programs (including
dentistry which has subsequently been dropped from this cluster). Other
key advisory bodies such as the Institute of Medicine (IOM) and the
Congressional Research Service (CRS) call for increased funding. The
IOM (December 2008) pointed to the drastic decline in title VII funding
and described these health professions workforce training programs as
``an undervalued asset.'' The Congressional Research Service found that
reduced funding to the primary care cluster has had a negative impact
on the effectiveness of the programs during a time when more primary
care is needed (February 2008).
According to the Robert Graham Center, (Title VII's decline:
Shrinking investment in the primary care training pipeline, October
2009), ``the number of graduating U.S. allopathic medical students
choosing primary care declined steadily over the past decade, and the
proportion of minorities within this workforce remains low.''
Unfortunately, this decline coincides with a decline in funding of
primary care training funding--funding that we know is associated with
increased primary care physician production and practice in underserved
areas.
The report goes on to say that ``the nation needs renewed or
enhanced investment in programs like Title VII that support the
production of primary care physicians and their placement in
underserved areas.'' This situation is only exacerbated by the
wonderful explosion of people who will gain insurance coverage under
the new healthcare reform law. Given the tremendous need, we urge the
Committee to provide a fiscal year 2011 appropriation of $170 million
for the title VII, section 747 Primary Care Training and Enhancement,
including the Integrative Academic Administrative Units program, as
authorized by the Patient Protection and Affordable Care Act. We also
recommend an appropriation of at least $600 million for all of the
Health Professions Training Programs authorized under title VII of the
Public Health Services Act.
Rural Physician Training Grants
We were pleased that the PPACA included a new program as part of
title VII of the Public Health Service Act, section 749B, entitled the
``Rural Physician Training Grants'' program. It is intended to increase
the supply of rural physicians by authorizing grants to medical schools
which establish or expand rural training. The program would provide
grants to produce rural physicians of all specialties. It would help
medical schools recruit students most likely to practice medicine in
underserved rural communities, provide rural-focused training and
experience, and increase the number of medical graduates who practice
in underserved rural communities.
According to a July 2007 report of the Robert Graham Center
(Medical school expansion: An immediate opportunity to meet rural
healthcare needs), data show that although 21 percent of the U.S.
population lives in rural areas, only 10 percent of physicians practice
there. The Graham Center study describes the educational pipeline to
rural medical practice as ``long and complex.'' There are multiple
tactics needed to reverse this situation, and this grant program
includes several of them. Strategies to increase the number of
physicians practicing in rural areas include ``increasing the number of
rural-background students in medical school, selecting the ``right''
students and giving them the ``right'' content and experiences to train
them for rural practice.'' This is exactly what this grant program is
designed to do.
We request the subcommittee provide the fully authorized amount of
$4 million in fiscal year 2011 for title VII, section 749B Rural
Physician Training Grants.
Teaching Health Centers Development Grants
One of the more creative programs to come out of the healthcare
reform bill as it relates to workforce is the establishment of Teaching
Health Centers (THCs). These are community health centers or other
similar venues that sponsor residency programs and provide residents
with their ambulatory training experiences in the health center. This
training in the community, rather than solely at the hospital bedside
is one of the hallmarks of family medicine training. In fact, numerous
family medicine residency programs currently align with health centers
to provide residents with their ambulatory continuity training in these
settings. However, payment issues have always caused a tension and
struggle between the hospital, which currently receives reimbursement
for residents it sponsors when they train in the hospital, and programs
that require training in nonhospital settings. This program is designed
to provide residency programs and community health centers grant
funding to plan for a transition in sponsorship, or the establishment
of new programs.
It allows the Secretary to award grants to THCs (community based
ambulatory patient care centers that operate a primary care residency
program; listed as FQHC, rural health clinic, community mental health
center, health center operated by Indian Health Service, or a center
receiving title X grants) to establish new accredited or expanded
primary care residency programs. We were pleased that the Patient
Protection and Affordable Care Act authorized a mandatory
appropriations trust fund of $230 million over 5 years to fund the
operations of Teaching Health Centers. However, if this program is to
be effective, there must be funds for the planning grants to establish
newly accredited or expanded primary care residency programs.
We recommend the subcommittee appropriate the full authorized
amount for the new title VII Teaching Health Centers development grants
of $50 million for fiscal year 2011.
AHRQ
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. 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.
The Institute of Medicine'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.
We support the President's budget request for AHRQ in fiscal year
2011 of $611 million. With the inclusion of new programs authorized
under the PPACA, we support a total appropriations level of $731
million for the Agency.
Primary Care Extension Program
One of the most exciting new programs to be included in the new
healthcare reform law is one that utilizes the experience of the United
States Agriculture Extension Service as its model. This new program,
under title III of the Public Health Service Act, is designed to
support and assist primary care providers with the adoption and
incorporation of techniques to improve community health. As the authors
of an article describing this new concept (JAMA, June 24, 2009) have
stated, ``To successfully redesign practices requires knowledge
transfer, performance feedback, facilitation, and HIT support provided
by individuals with whom practices have established relationships over
time. The farming community learned these principles a century ago.
Primary care practices are like small farms of that era, which were
geographically dispersed, poorly resourced for change, and inefficient
in adopting new techniques or technology but vital to the Nation's
well-being.''
Congress agreed with the authors that ``practicing physicians need
something similar to the agricultural extension agent who was so
transformative for farming,'' and authorized this program at $120
million for fiscal year 2011 and 2012.
We support the President's budget request for AHRQ in fiscal year
2011 of $611 million. In addition, since the $611 million does not
include this newly passed provision, we request the subcommittee
provide AHRQ with an additional $120 million for the Primary Care
Extension program authorized by the health reform law, bringing the
total request to $731 million.
Workforce Commission
We have recognized the need, and called for a national commission
on health workforce issues for many years. We are pleased that the
PPACA established a National Health Care Workforce Commission to
provide ``analysis of, and recommendations for, eliminating the
barriers to entering and staying in primary care, including provider
compensation.'' We also recognize the importance of the National Center
for Health Care Workforce Analysis as well as State and Regional
Centers for such analysis. PPACA authorizes such sums as necessary to
establish the Commission as well as $8 million in planning grants and
$150 million for implementation grants. The National Center was
authorized at $7.5 million annually and the State and Regional Centers
were authorized at $4.5 million annually.
We recommend the Committee fully fund the National Health Care
Workforce Commission, the National and State and Regional Centers for
Health Care Workforce Analysis in fiscal year 2011.
We appreciate the work of the Committee in making difficult choices
when funding many critical programs. We caution the committee not to
ruin the positive impact of healthcare reform by not supporting the
complementary programs that are so necessary to its success.
______
Prepared Statement of the Coalition for the Advancement of Health
Through Behavioral and Social Science Research
Mr. Chairman and members of the subcommittee, the Coalition for the
Advancement of Health Through Behavioral and Social Science Research
(CAHT-BSSR) appreciates and welcomes the opportunity to comment on the
fiscal year 2011 appropriations for the National Institutes of Health
(NIH). CAHT-BSSR includes 13 professional organizations, scientific
societies, coalitions, and research institutions concerned with the
promotion of and funding for research in the social and behavioral
sciences. Collectively, we represent more than 120 professional
associations, scientific societies, universities, and research
institutions.
CAHT-BSSR would like to thank the subcommittee and the Congress for
its continued support of the NIH. Strong sustained funding is essential
to national priorities of better health and economic revitalization.
Providing adequate resources in fiscal year 2011 that allows the NIH to
keep up with the rising costs of biomedical, behavioral, and social
sciences research will help NIH begin to prepare for the era beyond
recovery. It is essential that funding in fiscal year 2011 and beyond
allow the agency to resume steady, sustainable growth and allow for
fulfilling the President's vision of doubling our investment in basic
research. Accordingly, CAHT-BSSR joins the Ad Hoc Group for Medical
Research in its request for $35 billion in funding for NIH in fiscal
year 2011. This level of funding will sustain America's enhanced
medical research capacity. It also represents the new functional
capacity funded by annual appropriations and the historic American
Recovery and Reinvestment Act (ARRA).
NIH Behavioral and Social Sciences Research.--NIH supports
behavioral and social science research throughout most of its 27
institutes and centers. The behavioral and social sciences regularly
make important contributions to the well-being of this Nation. Due in
large part to the behavioral and social science research sponsored by
the NIH, we are now aware of the enormous contribution behavior makes
to our health. At a time when genetic control over diseases is
tantalizingly close but not yet possible, knowledge of the behavioral
influences on health is a crucial component in the Nation's battles
against the leading causes of morbidity and mortality: obesity, heart
disease, cancer, AIDS, diabetes, age-related illnesses, accidents,
substance use and abuse, and mental illness.
As a result of the strong congressional commitment to the NIH in
years past, our knowledge of the social and behavioral factors
surrounding chronic disease health outcomes is steadily increasing. The
NIH's behavioral and social science portfolio has emphasized the
development of effective and sustainable interventions and prevention
programs targeting those very illnesses that are the greatest threats
to our health, but the work is just beginning.
The grandest challenge we face is understanding the brain,
behavior, and society--from global warming to responding to short term
pleasures; from self destructive behavior, such as addiction, to life
style factors that determine the quality of life, infant mortality rate
and longevity. Nearly 125 million Americans are living with one or more
chronic conditions, like heart disease, cancer, diabetes, kidney
disease, arthritis, asthma, mental illness and Alzheimer's disease.
Significant factors driving the increase in healthcare spending in the
United States are the aging of the U.S. population, and the rapid rise
in chronic diseases, many caused or exacerbated by behavioral factors:
for example, obesity, caused by sedentary behavior and poor diet;
addictions and resulting health problems caused by tobacco and other
drug use. Behavioral and social sciences research supported by NIH is
increasing our knowledge about the factors that underlie positive and
harmful behaviors, and the context in which those behaviors occur.
CAHT-BSSR applauds the NIH's recognition that the ``scientific
challenges in developing an integrated science of behavior change are
daunting.'' We especially commend the new basic behavioral and social
science research trans-NIH initiative, Opportunity Network for Basic
Behavioral and Social Sciences Research (OppNet), being undertaken by
the NIH to examine the important scientific opportunities that cut
across the structure of NIH and designed to look for strategic
opportunities to build areas of research where there are gaps and that
have the potential to affect the missions of multiple institutes and
centers. Research results could lead to new approaches for reducing
risky behaviors and improving health.
Likewise, we commend the designation of the ``Science of Behavior
Change'' Roadmap Initiative included in the third cohort of research
areas for the Common Fund. We agree with the goals of this Roadmap
Pilot to ``establish the groundwork for a unified science of behavior
change that capitalizes on both the emerging basic science and the
progress already made in the design of behavioral interventions in
specific disease areas. By focusing basic research on the initiation,
personalization, and maintenance of behavior change, and by integrating
work across disciplines, this Roadmap effort and subsequent trans-NIH
activity could lead to an improved understanding of the underlying
principles of behavior change. This should drive a transformative
increase in the efficacy, effectiveness, and (cost) efficiency of many
behavioral interventions.''
With the recent passage of healthcare reform legislation, there has
been the accompanying and appropriate attention to the issue of
personalized healthcare. CAHT-BSSR believes that personalization needs
to reflect genes, behaviors, and environments. And as the agency has
acknowledged with its recent support of the Science of Behavior Change
initiative, assessing behavior is critical to helping individuals see
how they can improve their health. It is also critical to helping
healthcare systems see where it needs to put resources for behavior
change. Fortunately, the NIH acknowledges the need to focus less on
finding the ``magic answer'' and, at the same time, recognizes that
healthcare is different from region to region across the country. Full
personalization needs to consider the environmental, community, and
neighborhood circumstances that govern how individuals' genes and
behavior will influence their health. For personalized healthcare to be
realized, we need a sophisticated understanding of the interplay
between genetics and the environment, broadly defined.
CAHT-BSSR applauds the NIH's recognition of a unique and compelling
need to promote diversity in health-related research. The agency
expects these efforts to lead to: the recruitment of the most talented
researchers from all groups; an improvement in the quality of the
educational and training environment; a balanced perspective in the
determination of research priorities; an improved ability to recruit
subjects from diverse backgrounds into clinical research; and an
improved capacity to address and eliminate health disparities. Numerous
studies provide evidence that the biomedical and educational enterprise
will directly benefit from broader inclusion.
NIH recognizes that developing a more diverse and academically
prepared workforce of individuals in S.T.E.M. disciplines will benefit
all aspects of scientific and medical research and care. CAHT-BSSR
applauds the agency its recognition that to remain competitive in the
21st century global economy, the Nation must foster new opportunities,
approaches, and technologies in math and science education. This
recognition extends to the need for a coordinated effort to bolster
science, technology, engineering, and math (S.T.E.M.) education
nationwide, starting at the earliest stages in education. We applaud
the agency for its use of ARRA funds to support research designed to
strengthen and enhance efforts to attract young people to biomedical
and behavioral science careers and to improve science literacy in
adults and children.
CAHT-BSSR also commends the NIH for commissioning the Institute of
Medicine (IOM) study of LGBT (lesbian, gay, bisexual, and transgender)
health issues, research gaps and opportunities. LGBT populations are
among those for whom little or no national-level health data exist
resulting in significant gaps in knowledge and research on LGBT health.
At the same time, multidisciplinary research has begun to identify
important sexual orientation and gender identity-related health
concerns and disparities. The IOM study is a step in the right
direction to begin to address many of the research challenges this
issue presents, including methodological limitations. The study could
examine the best methodological practices for investigating health
concerns in LGBT communities. It also provides the opportunity for the
development of a strategic plan for the NIH to investigate and address
the health concerns of LGBT people. At the very least, the IOM study
could examine the current state of knowledge on LGBT health, including
general health concerns and health disparities.
nih office of behavioral and social sciences research
The NIH Office of Behavioral and Social Sciences Research (OBSSR),
authorized by Congress in the NIH Revitalization Act of 1993 and
established in 1995, serves as a convening and coordinating role among
the institutes and centers at NIH. In this capacity, OBSSR develops,
coordinates, and facilitates social and behavioral science research
agenda at NIH; advises the NIH director and directors of the 27
Institutes and Centers; informs NIH and the scientific and lay publics
of social and behavioral science research findings and methods; and
trains scientists in the social and behavioral sciences. For fiscal
year 2011, CAHT-BSSR supports a budget of $41.32 million for OBSSR
commensurate with the administration's request of $38.2 million for the
Office and the scientific community's request for the NIH as a whole.
To achieve its vision of bringing together the biomedical,
behavioral, and social sciences research communities to work towards
solving the most pressing health challenges faced by society, OBSSR is
expanding its efforts to promote and support social and behavioral
science research in four areas: (1) problem-based research; (2) basic
science; (3) systems-thinking approaches to population health; and (4)
interdisciplinary team science. Given the NIH's focus on gene and
environment interaction, new leading edge research examining how social
and behavioral factors change or alter the actions of genes to
influence health and disease is needed.
OBSSR focuses on cross-cutting behavioral and social research
issues (e.g., ``Long-term Maintenance of Behavior Change'') using its
modest budget to seed cross-institute research initiatives. OBSSR has
spurred cutting edge research in areas such as measures of community
health, including new community-based participatory programs supporting
intervention research methods to disease prevention and health
promotion in medically underserved areas; socioeconomic status; health
literacy; and new methodology development.
In fiscal year 2011, OBSSR, in addition to continuing to support
cross-cutting behavioral and social science research issues intends to
address the issue of health literacy. Low health literacy is a wide
spread problem, affecting more than 90 million adults in the United
States, where 43 percent of adults demonstrate only the most basic or
below-basic levels of prose literacy. Low health literacy results in
patients' inadequate engagement in decisions regarding their healthcare
and can hinder their ability to realize the benefits of healthcare
advances. Research has linked low or limited health literacy with such
adverse outcomes as poorer self-management of chronic diseases, fewer
healthy behaviors, higher rates of hospitalizations, and overall poorer
health outcomes. These situations hamper the effectiveness of health
professionals' efforts to prevent, diagnose and treat medical
conditions, and limit many healthcare consumers' abilities to make
important healthcare decisions.
CAHT-BSSR would be pleased to provide any additional information on
these issues. Below is a list of coalition member societies. Again, we
thank the subcommittee for its generous support of the National
Institutes of Health and for the opportunity to present our views.
CAHT-BSSR
American Educational Research Association
American Psychological Association
American Sociological Association
Association of Population Centers
Center for the Advancement of Health
Consortium of Social Science Associations
Council on Social Work Education
Federation of Associations in Behavioral & Brain Sciences
National Association of Social Workers
Population Association of America
Society for Behavioral Medicine
Society for Research in Child Development
The Alan Guttmacher Institute (AGI)
______
Prepared Statement of the Center for American Progress Action Fund
The Center for American Progress Action Fund commends the Senate
Appropriations Committee and the House Labor, Health and Human
Services, Education Appropriations Subcommittee for reporting out
strong fiscal year 2011 Labor, Health and Human Services, Education
Appropriations bills. Both pieces of legislation make investments in
the innovative education reform programs needed to make our schools
better.
These education reform programs, proposed by the Obama
administration and funded through the two Labor-HHS bills, constitute
the right mix of formula-based funding and innovation promotion
necessary to improve our schools. Some may question the soundness of
investing in innovative reforms at a period when our country is still
working to recover from the recession. The reality, however, is that
the need for innovation has never been greater. School achievement has
remained essentially flat for more than 30 years, and without
significant changes in the way we fund and operate schools we will
almost certainly not see any significant gains in the future.
We wanted to share our recommendations for the educational
priorities outlined below as the House and Senate prepare to reconcile
the two bills before final passage in either a standalone bill or
within an omnibus spending bill.
Race to the Top
Race to the Top, a competitive grant program, has been a part of
the Federal education agenda for only a short period. But it has
already yielded some of the most significant reforms ever seen in
education by tying Federal dollars to systemic education reform.
Twenty-eight States changed their policies in 2009 and 2010 to improve
their chances of winning a piece of the pie. We urge you to include the
House funding level of $800 million, which will allow us to continue
building on these early successes.
Race to the Top was originally enacted through the American
Recovery and Reinvestment Act, or ARRA, and has not been authorized.
CAP Action urges the committee to use its authority to fund this
promising program.
Investing in Innovation Fund
The House bill includes $400 million for the Investing in
Innovation, or i3 fund, which is nearly the full amount of the
President's request. This program was also enacted through ARRA and has
not been authorized. But we again urge you to use your authority to
include this funding level in the final bill. The i3 fund awards grants
to districts as well as nonprofit organizations partnering with schools
and districts to scale up evidence-based practices and programs.
There already has been promising growth in nonprofit educational
entrepreneurs such as the New Teacher Project and College Summit, but
these have been established in the absence of significant Federal
investment. They rely instead on philanthropy, the private sector, and
local school district contracts. While their achievements have been
dramatic, limited funding and other policy barriers challenge efforts
to take their practices to scale.
Teacher Incentive Fund
The Teacher Incentive Fund is a 4-year-old appropriations line item
that supports competitive grants to States and school districts to
implement pay-for-performance programs in high-needs schools. TIF funds
may also support pay for teaching in subject shortage areas such as
mathematics and science as well as career ladders for teachers that
offer them additional pay for increased responsibilities.
Critics argue that ``merit pay'' is a failed policy that has been
around since the early 1900s. But the truth is that past merit pay
programs were destined to fail. They were based on subjective measures
of teacher performance and weren't part of a comprehensive plan to
improve teachers' instructional practice. The kinds of programs TIF now
supports are generally comprehensive programs that include professional
development, high-quality evaluation, and performance-based
compensation. And the Department of Education's new guidance for TIF
has an even greater focus on comprehensive approaches.
Title I School Improvement Grants
Our education system desperately needs resources to turn around the
Nation's lowest-performing schools. School improvement grants support
targeted reforms at the lowest-achieving 5 percent of Title I schools
in each State. The SIG program also funds efforts to decrease the
number of ``drop-out'' factories, or high schools that continually
graduate 60 percent or less of students.
Through the use of SIG funds we are finally seeing the type of
dramatic interventions needed to end the cycle of underperformance at
these schools. We are also encouraged by the recommendation made by the
Senate Appropriations Committee Report (111-243) that SIG funds be used
to support strategies meeting more rigorous evidentiary standards (see
discussion below).
Unfortunately, too few dollars reach the schools with the greatest
need, particularly high schools. While the funding level in the House
bill remains embargoed, CAP Action urges the committee to move forward
with the Senate funding level of $625 million in school improvement
grants and help ensure that a more significant proportion of these
dollars reach middle and high schools.
21st Century Learning Centers Program
The Senate Labor-HHS bill includes $1.266 billion--a $100 million
increase--in funding for the 21st Century Community Learning Centers
program, or CCLC, which has traditionally funded afterschool programs,
to support expanded learning time and community schools. CAP Action
urges you to include this level of funding in the final legislation as
well as the report language that provides new flexibility to use funds
to expand school time.
Expanded learning time schools formally incorporate traditional
out-of-school activities-including enrichment activities such as the
arts and service opportunities-into the official school calendar so
that all students have access, including those living in high poverty.
Expanded learning time can close not only academic achievement gaps but
enrichment gaps as well.
Community schools are fully equipped to tackle ``out-of-school''
barriers by opening up social and health resources to students and
their families. Community schools that seamlessly integrate academic
and nonacademic services help educators navigate the effects of
poverty, ill health, and language barriers so students are ready to
learn every day.
CCLC dollars are currently limited to activities during nonschool
hours, which prohibits the expansion of expanded learning time and
community schools. CAP Action thus calls on the committee to lift this
prohibition and provide States, districts, and schools with the
flexibility to choose to dedicate these dollars to the models that best
suit their students' needs.
Charter Schools Program
The Charter Schools Program provides grants to States to support
the planning and development of new charter schools. This funding is
critical because charter schools usually receive less public funding
than traditional public schools. In fact, a recent study finds that
charter schools receive 19.2 percent less funding per pupil on average.
The existence of charter schools has spurred the development of
some of the most promising school models for educating disadvantaged
students. School models like KIPP, Yes Prep, and Achievement First have
achieved unprecedented outcomes for students in poverty and have even
outperformed schools with higher-income students. A recent Mathematica
study of KIPP middle schools found that the schools had a positive
impact on students' math and reading achievement 4 years after students
entered the schools.
High-achieving charter schools like these would not exist without
adequate financial support. We understand that the House bill includes
$266 million in funding for the Charter School Program, and we urge you
to include this in the final legislation.
Promise Neighborhoods
Promise Neighborhoods are focused on improving educational outcomes
for children living in our most distressed communities and represent an
unprecedented shift in how localities address child poverty and
academic opportunity. Each Promise Neighborhood will provide ``cradle-
to-career'' services to support students who attend schools in a
designated geographic area. Schools, city governments, colleges and
universities, nonprofits, health providers, and other organizations in
each Promise Neighborhood will collaborate to finally break down the
silos that may have prevented past efforts to help low-income students
achieve.
The Department of Education recently awarded 21 planning grants to
communities across the country to create Promise Neighborhoods. The
important work funded by these planning grants will be wasted without
sufficient funding in the fiscal year 2011 budget to scale up these
initiatives. We hope you will provide at least $60 million for Promise
Neighborhoods--as was included in the House bill--and encourage you to
provide more if possible to bring the funding level closer to the
Administration's original request of $210 million.
Evidence-based intervention
The Senate Appropriations Committee Report (111-243) calls for a
refinement of the criteria relating to interventions appropriate for
persistently failing schools. We strongly support this language, which
encourages the Department of Education to urge States and districts to
use their Title I School Improvement Grants only for interventions that
meet two standards of evidence specified by the Investing in Innovation
(i3) grant program. Specifically, Congress should stipulate that the
Department of Education foster the use of intervention strategies
meeting the evidence standards required of ``validation'' grants or
``scale-up'' grants under i3.
This approach honors the idea that educators should strive
generally to expose children to research-based practices. And it
creates a logical connection between the department's support for
research and development on the one hand and its support for sound
practice on the other.
A challenging economy requires responsible Federal spending. CAP
Action believes the fiscal year 2011 education appropriations budget
should target investment to support the necessary innovative reforms to
strengthen our schools for the 21st century. The House LHHS
subcommittee and the Senate Appropriations Committee both produced
strong bills. Together they will help to provide all of America's young
people with a high-quality education that prepares them for college and
a career. Thank you for your consideration.
______
Prepared Statement of the Center for Civic Education
I appreciate the opportunity to present this testimony requesting
continued support of $35 million (the same amount as fiscal year 2010)
for the civic education program (Elementary and Secondary Education
Act, Sections 2341-2346) that the U.S. Department of Education (ED) cut
from its fiscal year 2011 budget request to Congress. I am Charles N.
Quigley, executive director of the Center for Civic Education (Center),
the principal organization supported under the Education for Democracy
Act.
Other worthy organizations supported under the Act include the
Center on Congress at Indiana University (COC), the National Conference
of State Legislatures (NCSL), the Council for Economic Education, and a
domestic network of public- and private-sector organizations in every
State and Congressional District in the Nation. Together with the
Center, these organizations provide effective programs in civic and
economic education to millions of students annually at precollegiate
levels in the United States and in more than 80 emerging and advanced
democracies throughout the world.
The justification for the elimination of funding for the civic
education program, namely, that such activities would be continued
through a consolidated competitive program of relatively small grants,
is not supported by the facts. Furthermore, it overlooks the valuable
national infrastructure of programming--supported by Congress through
many years of directed funding--that would be lost without this
sustained investment. The national program funded under the Education
for Democracy Act is implemented with the assistance of an extensive
network of State and congressional district coordinators that provides
equal support to schools in every congressional district in the form of
free curricular materials, assistance in professional development, and
other technical assistance. This equal support for schools in each
congressional district would not be available under the proposed
consolidation plan.
the education for democracy act
The Education for Democracy Act (EDA) supports highly successful
national and international projects authorized and approved by the U.S.
Congress and funded by the U.S. Department of Education. Since 1987,
directed funding from the EDA has ensured that more than 30 million
students across the Nation have been taught the principles of American
constitutional democracy through the We the People: The Citizen and the
Constitution program and related programs. In addition, millions of
students in emerging democracies throughout the world have benefited
from the civic and economic education exchange programs supported by
the EDA. The proposed elimination of this directed funding in favor of
competitive grants to numerous smaller initiatives would ensure the
destruction of this proven, exemplary domestic civic education program
representing 22 years of federally funded investment.
Congress has long recognized that directed funding is essential for
certain large-scale projects of national significance. The improvement
of civic education in the United States and the establishment of
effective civic and economic education programs in emerging democracies
require a large-scale, long-term program involving the establishment of
extensive national implementation networks supported by highly skilled,
experienced, and dedicated staff. It would be grossly inefficient and
extremely difficult to achieve the goals of such programs through a
number of relatively small and uncoordinated grants with 2- to 5-year
timelines.
The civic education programs (We the People and related programs),
authorized by the EDA, are: cost effective; validated by independent
research; effective in raising student academic achievement in schools
throughout the country; implemented nationwide in every congressional
district; administered locally by dedicated volunteers; supported by
professional development for teachers; providers of free, high-quality
curricular materials for students and teachers; and supported by
Congress and numerous national, State, and local public- and private-
sector groups.
Furthermore, the Cooperative Education Exchange Program's
international civics programs promote U.S. foreign policy objectives in
more than 80 countries, encourage respect for human rights, and promote
commitment to democratic values and principles in emerging democracies.
benefits of the domestic programs
Cost-effective civic education in every congressional district.
Over 22 years, the EDA has ensured the civic education of more than 30
million students nationwide. On average, in each congressional district
the existing program annually supports a total of 5,700 students; in
190 classes at the elementary, middle, and high school levels; and at a
cost of $7.20 per student--far less than the retail cost of one history
or civics textbook.
Note: The program currently reaches approximately 2.5 million
students each year. It is highly unlikely that a competitive,
relatively small grant program would reach as many students in every
congressional district of the Nation as cost effectively as the We the
People Programs.
Proven Impact on Student Outcomes.--The We the People Programs are
independently proven to be effective. Evaluations by the Educational
Testing Service, Stanford University, RMC Research Corporation, and
others have shown that the We the People Programs have had a
statistically significant positive effect on student knowledge, skills,
dispositions, and behaviors (see www.civiced.org/research).
Note: To place the funding for these programs in a competitive
grant program would be to discard proven programs developed and
implemented with Federal dollars in favor of numerous smaller programs
that lack any independent evidence of proven effectiveness.
National Network.--The We the People Programs have grassroots
community support in every congressional district. They are implemented
by a national civic education network of 120 public- and private-sector
organizations in all 50 States and the District of Columbia and 123
representatives of local education agencies or civic-minded community
groups at the congressional district level.
Note: In every State, the We the People Programs are supported by
an extensive network of civic educators and community volunteers who
administer the programs and raise funds to support local program
activities. This network would cease to exist if its funding were to be
placed in a competitive grant program.
Effective Use of Federal Dollars.--Approximately 70 percent of the
funding for the program is distributed equitably to every congressional
district. The funds provide free curricular materials for elementary,
middle, and high schools; professional-development programs for
teachers; and funding at the State and congressional district levels
for the implementation of curricular programs in civic education.
Note: A competitive program of relatively small grants would not
result in such an effective and equitable distribution of resources.
Instead, many congressional districts would receive little or no
assistance in implementing civic education programs.
In addition, funding relatively large nationwide programs--such as
the We the People Programs--compared to funding numerous smaller
programs is more likely to be cost effective in controlling
administrative costs and providing more funding for programmatic costs.
As noted above, approximately 70 percent of the funds the Center
received for its USED-supported programs were spent for programmatic
costs throughout the United States. The remaining 30 percent consists
of staff and benefits (approximately 20 percent) and general
administrative costs (approximately 10 percent). Of the staff costs,
some are for general administration, but a considerable amount is for
technical assistance to State and local programs for such purposes as
professional development and evaluation.
Curriculum Backed by Professional Development of Teachers.--The
Center sponsors professional development activities throughout the
Nation with the assistance of a national network of directors, mentor
teachers, and scholars. These activities range in length from less than
1 day to 7 days. Participants explore content, teaching methods, and
assessment strategies. Free materials are provided for participants.
Innovative Content and Methods.--The We the People program is the
first curriculum based entirely on constitutional principles and
history. Students take part in a competition on constitutional topics
that takes the form of simulated congressional hearings. This is an
educational innovation that works. There is no other civic education
competition in the world comparable to the We the People program.
Note: Elimination of directed EDA funding for We the People would
mean the elimination of district, State, and national simulated
congressional hearings, during which students compete in a test of
knowledge and understanding of contemporary and historical issues
surrounding the Constitution. These hearings have inspired students to
choose lives of active citizenship, public service, and civic
engagement.
Adherence to Authorizing Language.--Congress recognized the
national need for programs that develop a reasoned commitment to
American constitutional democracy and the ability of young people to
participate competently and responsibly in the political life of the
Nation. The programs supported under the EDA have demonstrated their
efficacy in promoting such goals.
Note: To eliminate support for these proven, effective programs and
place their funding into a competitive grant program would be to
withdraw the long-term investment of the Federal Government in programs
proven to yield high returns. Federal funding would instead be spent on
unproven programs with unpredictable outcomes.
benefits of the international programs
Promoting U.S. Foreign Policy Objectives Abroad.--The Cooperative
Education Exchange Program's civics and economics programs help to
institutionalize democratic ideals in more than 80 emerging and
established democracies worldwide. These highly successful programs,
helping to meet the U.S. foreign policy objectives of promoting
democracy, human rights, and an understanding of the principles of
market economies and their relationship to democracy are not mentioned
in the ED alternative, thereby ignoring the intent of Congress to
support these critical programs.
International Network for Democracy Promotion.--The Civitas
International Exchange Program created a network of international
public- and private-sector organizations and colleagues and their
American counterparts in 30 States. The members of this network work in
unison to translate and adapt civics textbooks to help educational
systems in emerging democracies teach democratic principles and values.
Without the support of the EDA, the network would be eliminated and
highly effective programs in these emerging democracies would be
deprived of the support needed for their institutionalization. It is
estimated that these programs reach 1.5 million students each year at a
cost of $3 per student.
conclusion
The Education for Democracy Act programs have been highly
scrutinized by Congress since their inception in 1987 and have
undergone multiple authorizations in the law and annual approval in the
appropriations process. They have survived multiple sessions of
Congress and several administrations, including initiatives to downsize
and reinvent Government. Recent ``Dear Colleague'' letters in support
of the EDA routinely received the support of more than 100 members of
the House and nearly half of the Senate. There are compelling reasons
for this support that ultimately reflect a simple truth--the programs
have a proven track record of success in furthering support for
democracy; fostering competent and responsible participation by
students in the political life of their communities, States, and
nations; raising student academic achievement; improving teacher
quality; and providing schools with free, exemplary curricular programs
and technical assistance.
support for a competitive civic education grant program
The Center supports the establishment in ED of a competitive grant
program in civics and government in addition to continued support for
the current programs. There are many other public- and private-sector
agencies working in the field of civic education worthy of support. A
large percentage of these groups are colleagues and participants in the
Center's domestic networks. A new, competitive grant program could
result in the development and promulgation of new ideas and programs to
enhance the field. Such support from both the public and private
sectors, in fact, gave the Center its start in 1965. The Center is
working with representatives of other organizations in the field to
support the inclusion of a competitive grant program in the
reauthorization of the Elementary and Secondary Education Act.
______
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 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.
Let me express at the outset how appreciative we are for the
leadership this subcommittee has provided in advancing funding for the
National Institutes of Health. 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.
Mr. Chairman, I will focus the remainder of my testimony on our
appropriations recommendations for fiscal year 2011.
recommendations for fiscal year 2011
Centers for Disease Control and Prevention
Inflammatory Bowel Disease Epidemiology Program
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. Mr. Chairman, we are extremely grateful
for your leadership in providing funding over the past 5 years for an
epidemiology program focused on IBD at the Centers for Disease Control
and Prevention. This program is the only one of its kind in our long
fight against IBD and its accomplishments have been applauded by the
CDC. Unfortunately, the President's fiscal year 2011 budget proposal
recommends that this highly successful program be eliminated. CCFA
strongly disagrees with the administration's position and urges the
subcommittee to provide full funding for this important research in
fiscal year 2011.
CCFA has been a proud partner with CDC in conducting the research
funded under the epidemiology program. For the first 2 years of the
project the Foundation worked collaboratively with Kaiser Permanente in
California to better understand the incidence and prevalence of IBD,
the natural history of the disease, and why patients respond
differently to the same therapy. This research has resulted in 11
publications to date and another 11 papers to be submitted to high-
quality peer-reviewed journals. Topics include but are not limited to
the following:
--Incidence and Prevalence of IBD;
--Patterns of Care and Outcomes in IBD;
--Qualitative study of provider opinions;
--Utilization of biologics (Infliximab);
--Disparities in Mortality;
--Myelosuppression during Thiopurine Therapy for Inflammatory Bowel
Disease: Implications for Monitoring Recommendations;
--Severity and Flare Algorithms;
--Disparities in Surveillance for Colorectal Cancer;
--Pediatric Epidemiology.
In 2007, our focus shifted to the establishment of the ``Ocean
State Crohn's & Colitis Area Registry'' or OSCCAR. Under the leadership
of Dr. Bruce Sands, this study is being conducted jointly by
investigators at the Massachusetts General Hospital and Rhode Island
Hospital/Brown University. The State of Rhode Island is an excellent
location to conduct a population-based IBD study because (1) it is a
small state geographically; (2) it has a diverse ethnic and
socioeconomic population that does not tend to migrate out of State:
and (3) a small number of gastroenterologists treat essentially all IBD
patients within the State. Since 2007, Dr. Sands has been able to
recruit virtually all GI physicians in Rhode Island to refer patients
into the study. To date, almost 200 patients have been recruited. All
of this progress will be lost if the program is eliminated in 2011.
The goals of the OSCCAR study moving forward are to: (1) describe
the age and sex adjusted incidence rate of Crohn's disease and
ulcerative colitis; (2) describe variations in presenting symptoms
among children, men and women with newly diagnosed disease; (3)
identify factors that predict resistance to steroids, including
clinical characteristics and blood test markers that could be useful to
treating physicians; (4) identify predictors of the need for surgery;
and (5) describe factors that predict either impaired quality of life
or a benign course of disease.
Mr. Chairman, to ensure that this important epidemiological work
moves forward in fiscal year 2011, CCFA recommends an appropriation of
$686,000 (level funded from fiscal year 2010).
pediatric inflammatory bowel disease 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 2011.
national institutes of health
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.
Mr. Chairman, NIDDK-sponsored research on IBD has been a remarkable
success story. In 2008, a consortium of researchers from the United
States, Canada, and Europe identified 21 new genes for Crohn's disease.
This discovery, funded in part by the NIDDK, brings the total number of
known genes associated with Crohn's disease to more than 30 and
provides new avenues for the development of promising treatments. We
are grateful for the leadership of Dr. Stephen James, Director of
NIDDK's Division of Digestive Diseases and Nutrition, for aggressively
pursuing this and other promising areas of research.
CCFA's scientific leaders, with significant involvement from NIDDK,
have developed an ambitious research agenda entitled ``Challenges in
Inflammatory Bowel Diseases.'' In addition, CCFA-affiliated
investigators played a leading role in developing the recommendations
on IBD in the new NIH National Commission on Digestive Diseases
strategic plan. We look forward to working with the NIDDK to advance
the cutting-edge science called for in these two roadmaps.
Mr. Chairman, I also wanted to thank you and your colleagues for
the unprecedented support you provided to the NIH as part of the
American Recovery and Reinvestment Act. IBD research has benefited
substantially from that investment with more than 15 IBD-specific
projects receiving ARRA funding. This portfolio includes grants focused
on; pediatric IBD, clinical diagnostics, basic research on the
mechanisms of chronic inflammation and the role of the intestinal
barrier in IBD, genetics, and new therapeutic approaches. This research
has the potential to dramatically improve the quality of life for our
patients and we thank you for making this possible.
For fiscal year 2011, CCFA joins with other voluntary patient and
medical organizations in recommending an appropriation of $35 billion
for the NIH. Once again Mr. Chairman, thank you very much for the
opportunity to submit our views for your consideration.
______
Prepared Statement of the Charles R. Drew University of Medicine and
Science
Mr. Chairman and members of the subcommittee, thank you for the
opportunity to present you with testimony. The Charles Drew University
is distinctive in being the only dually designated Historically Black
Graduate Institution and Hispanic Serving Institution in the Nation. We
would like to thank you, Mr. Chairman, for the support that this
subcommittee has given to our University to produce minority health
professionals to eliminate health disparities as well as do
groundbreaking research to save lives.
The Charles Drew University is located in the Watts-Willowbrook
area of South Los Angeles. Its mission is to prepare predominantly
minority doctors and other health professionals to care for underserved
communities with compassion and excellence through education, clinical
care, outreach, pipeline programs, and advanced research that makes a
rapid difference in clinical practice. The Charles Drew University has
established a national reputation for translational research that
addresses the health disparities and social issues that strike hardest
and deepest among urban and minority populations.
Health Resources and Services Administration (HRSA)
Title VII Health Professions Training Programs.--The health
professions training programs administered by the HRSA are the only
Federal initiatives designed to address the longstanding under
representation of minorities in health careers. HRSA's own report,
``The Rationale for Diversity in the Health Professions: A Review of
the Evidence,'' found that minority health professionals
disproportionately serve minority and other medically underserved
populations, minority populations tend to receive better care from
practitioners of their own race or ethnicity, and non-English speaking
patients experience better care, greater comprehension, and greater
likelihood of keeping follow-up appointments when they see a
practitioner who speaks their language. Studies have also demonstrated
that when minorities are trained in minority health professions
institutions, they are significantly more likely to: (1) serve in
medically underserved areas; (2) provide care for minorities; and (3)
treat low-income patients.
Minority Centers of Excellence (COE).--The purpose of the COE
program is to assist schools, like Charles Drew University, that train
minority health professionals, by supporting programs of excellence.
The COE program focuses on improving student recruitment and
performance; improving curricula and cultural competence of graduates;
facilitating faculty and student research on minority health issues;
and training students to provide health services to minority
individuals by providing clinical teaching at community-based health
facilities. For fiscal year 2011, the funding level for COE should be
$33.6 million.
Health Careers Opportunity Program (HCOP).--Grants made to health
professions schools and educational entities under HCOP enhance the
ability of individuals from disadvantaged backgrounds to improve their
competitiveness to enter and graduate from health professions schools.
HCOP funds activities that are designed to develop a more competitive
applicant pool through partnerships with institutions of higher
education, school districts, and other community based entities. HCOP
also provides for mentoring, counseling, primary care exposure
activities, and information regarding careers in a primary care
discipline. Sources of financial aid are provided to students as well
as assistance in entering into health professions schools. For fiscal
year 2011, the HCOP funding level of $35.6 million is suggested.
National Institutes of Health's (NIH) Contribution to Fighting Health
Disparities
National Institute on Minority Health and Health Disparities
(NIMHD) .--The NIMHD is charged with addressing the longstanding health
status gap between under-represented minority and nonminority
populations. The NIMHD helps health professional institutions to narrow
the health status gap by improving research capabilities through the
continued development of faculty, labs, telemedicine technology and
other learning resources. The NIMHD also supports biomedical research
focused on eliminating health disparities and developed a comprehensive
plan for research on minority health at NIH. Furthermore, the NIMHD
provides financial support to health professions institutions that have
a history and mission of serving minority and medically underserved
communities through the COE program and HCOP. For fiscal year 2011,
$500 million is recommended for NIMHD to support these critical
activities.
Research Centers At Minority Institutions (RCMI)
RCMI at the National Center for Research Resources (NCRR) has a
long and distinguished record of helping institutions like The Charles
Drew University develop the research infrastructure necessary to be
leaders in the area of translational research focused on reducing
health disparities research. Although NIH has received some budget
increases over the last 5 years, funding for the RCMI program has not
increased by the same rate. Therefore, the funding for this important
program grow at the same rate as NIH overall in fiscal year 2011.
Extramural Facilities Construction
Mr. Chairman, one issue that sets The Charles Drew University and
many minority-dedicated institutions apart from the major universities
of this country is the facilities where research takes place. The need
for research infrastructure at our Nation's minority serving
institutions must also remain strong to maximize efforts to reduce
health disparities. The current authorization level for the Extramural
Facility Construction program at the NCRR is $250 million. The law also
includes a 25 percent set-aside for ``Institutions of Emerging
Excellence'' (many of which are minority institutions) for funding up
to $50 million. In fiscal year 2011, we respectfully request.
Department of Health and Human Services' Office of Minority Health
(OMH)
Specific programs at OMH include assisting medically underserved
communities, supporting conferences for high school and undergraduate
students to interest them in health careers, and supporting cooperative
agreements with minority institutions for the purpose of strengthening
their capacity to train more minorities in the health professions. For
fiscal year 2011, I recommend a funding level of $75 million for OMH to
support these critical activities.
Strengthening Historically Black Graduate Institutions--Department of
Education
The Department of Education's Strengthening Historically Black
Graduate Institutions program (title III, part B, section 326) is
extremely important to MMC and other minority serving health
professions institutions. The funding from this program is used to
enhance educational capabilities, establish and strengthen program
development offices, initiate endowment campaigns, and support numerous
other institutional development activities. In fiscal year 2011, an
appropriation of $75 million is suggested to continue the vital support
that this program provides to historically black graduate institutions.
Conclusion
Despite all the knowledge that exists about racial/ethnic, socio-
cultural and gender-based disparities in health outcomes, the gap
continues to widen. Not only are minority and underserved communities
burdened by higher disease rates, they are less likely to have access
to quality care upon diagnosis. As you are aware, in many minority and
underserved communities preventative care and research are inaccessible
either due to distance or lack of facilities and expertise. As noted
earlier, in just one underserved area, South Los Angeles, the number
and distribution of beds, doctors, nurses and other health
professionals are as parlous as they were at the time of the Watts
Rebellion, after which the McCone Commission attributed the so-named
``Los Angeles Riots'' to poor services--particularly access to
affordable, quality healthcare. The Charles Drew University has proven
that it can produce excellent health professionals who ``get'' the
mission--years after graduation they remain committed to serving people
in the most need. But, the university needs investment and committed
increased support from Federal, State, and local governments and is
actively seeking foundation, philanthropic, and corporate support.
Even though institutions like The Charles Drew University are
ideally situated (by location, population, community linkages, and
mission) to study conditions in which health disparities have been well
documented, research is limited by the paucity of appropriate research
facilities. With your help, the Life Sciences Research Facility will
translate insight gained through research into greater understanding of
disparities and improved clinical outcomes. Additionally, programs like
Title VII Health Professions Training programs will help strengthen and
staff facilities like our Life Sciences Research Facility.
We look forward to working with you to lessen the huge negative
impact of health disparities on our Nation's increasingly diverse
populations, the economy and the whole American community.
Mr. Chairman, thank you again for the opportunity to present
testimony on behalf of The Charles Drew University. It is indeed an
honor.
______
Prepared Statement of the Children's Environmental Health Network
The Children's Environmental Health Network (CEHN) appreciates the
opportunity to support fiscal year 2011 appropriations for activities
that protect children from environmental hazards. CEHN appreciates the
wide range of needs that you must consider for funding. We urge you to
give priority to those programs that 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.
CEHN was created to promote a healthy environment and to protect
the fetus and the child from environmental health hazards. Every day,
children are exposed to a mix of chemicals, most of them untested for
their effects on developing systems. In general, children have unique
vulnerabilities and susceptibilities to toxic chemicals. In some cases,
an exposure which may cause little or no harm to an adult may lead to
irreparable damage to a child. Thus it is vital that the Federal
programs and activities that protect children from environmental
hazards receive adequate resources.
Global Climate Change and Public Health.--We strongly urge the
subcommittee to designate $50 million for the Department of Health and
Human Services (HHS) to help the public prepare for and adapt to the
potential health effects of global climate change in fiscal year 2011.
Global climate change presents major challenges to public health.
Children will be the first and worst hit by climate change. Young
children are almost 85 percent of the estimated 150,000+ climate
change-related deaths/year that are already occurring in low-income
nations, according to the World Health Organization. Children in
communities that are already disadvantaged will be the most harmed.
Recent studies have detailed the multiple ways in which climate change
may harm children. It is imperative that the Federal Government
undertake efforts to mitigate and adapt to climate change.
Centers for Disease Control and Prevention (CDC) and the National
Center for Environmental Health (NCEH).--As the Nation's leader in
health promotion and disease prevention the CDC should receive top
priority in Federal funding. CEHN is grateful for your support in the
past and urges you to support a funding level of $8.8 billion for CDC's
core programs in fiscal year 2011.
CEHN is supportive of all NCEH programs and especially its efforts
to continue and expand its biomonitoring program and to continue its
national report card on exposure information. A vital CDC
responsibility in pediatric environmental health is to assist in
filling the major information gaps that exist about children's
exposures. CEHN believes it is especially critical for the NCEH to
gather and publish expanded information in the report card on
children's exposures.
CEHN strongly supports increased funding for CDC's Environmental
Health Laboratory, which allows us to measure with great precision the
actual levels of more than 450 chemicals and nutritional indicators in
people's bodies. This information helps public health officials to
determine which population groups are at high risk for exposure and
adverse health effects, assess public health interventions, and monitor
exposure trends over time.
Among its many recent accomplishments, CDC has funded three States
for State biomonitoring activities. We enthusiastically support these
State biomonitoring efforts, but were disappointed that another 21
quality State proposals were turned down due to lack of funding.
Unfortunately, the President's fiscal year 2011 budget would cut
this program by $1.3 million. CEHN supports a $19.6 million increase
for the Environmental Health Laboratory in fiscal year 2011: $10
million to fund 7-10 grantees to conduct biomonitoring; $7.6 million
for intramural activities such as increasing the number of chemicals
CDC measures and improving quality assurance at the State laboratories
awarded biomonitoring funds; and $2 million for the National Report on
Biochemical Indicators of Diet and Nutrition in the U.S. Population.
National Environmental Public Health Tracking Program.--The CDC's
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. The Web-based National Environmental Public Health
Tracking Network launched this past summer. CEHN strongly supports this
program.
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.
To date, 24 grantees have received funds from the CDC for health
tracking networks. Health officials in all States need integrated
health and environmental data. We urge the subcommittee to provide $50
million for the Health Tracking Program in fiscal year 2011.
National Institute of Environmental Health Sciences (NIEHS).--The
NIEHS is the leading Institute conducting research to understand how
the environment influences the development and progression of human
disease. Thus it 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 understanding
childhood exposures that may not affect health until decades later.
NIEHS's National Toxicology Program is the leading Federal program
studying the toxicity of environmental agents in our environment; a
major focus of this program is endocrine disrupting chemicals. NIEHS is
studying the health effects of global climate change. The Institute has
taken the lead among Federal agencies to develop a comprehensive
research plan to respond to the significant consequences that climate
change is expected to have on human health. CEHN asks you to provide
$779.4 million for NIEHS in fiscal year 2011.
Children's Environmental Health Research Centers of Excellence.--
The Children's Environmental Health Research Centers, jointly funded by
the Environmental Protection Agency (EPA) and NIEHS, play a key role in
providing the scientific basis for protecting children from
environmental hazards. With their modest budgets (unchanged over more
than 10 years), these centers generate valuable research. A unique
aspect of these centers 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.
The scientific output of these centers has been outstanding. The
Congress recognized this last year, when it supported increased
funding, resulting in the upcoming addition of a child care component
and additional research. These goals call for a continued effort, yet
the administration's fiscal year 2011 budget proposal did not continue
this funding. We strongly urge that the subcommittee reinstate these
funds and direct NIEHS to sustain this effort.
Unfortunately, almost all of the existing 12 centers are currently
operating on no-cost extensions and only 5 of the existing centers are
to be renewed. If centers are shuttered, we will lose access to
valuable populations such as children with asthma or children growing
up with pesticide exposure in farm communities. We will lose the
ability to learn about issues like early puberty concerns, exposures in
school settings, and pre-adolescent and adolescent outcomes.
National Children's Study (NCS).--NCS is examining the effects of
environmental influences on the health and development of more than
100,000 children across the United States, following them from before
birth until age 21. This landmark study--involving a consortium of
agencies--will form the basis of child health guidance, interventions,
and policy for generations to come. This study may be the only means
that we will have to understand the links between exposures and the
health and development of children and to identify the antecedents for
a healthy adulthood.
We urge the subcommittee to assure stable support for this study,
recognizing that the necessary components of the study are resource
intensive. It is vital, however, that this study proceed and also
guarantee that scientists, clinicians, and policy makers will have a
complete archive of the study's exposure measurements.
A study of this scope calls for the participation of multiple
agencies. We urge the subcommittee to assure that the NCS remains a
collaborative study that retains on its original environmental focus,
responsive to its mission and to the lead agencies, in and out of the
National Institutes of Health.
CEHN also asks the subcommittee to direct that protocols are in
place for measuring exposures in child care and school settings. 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 (PEHSUs).--Funded by
the ATSDR and the EPA, the PEHSUs form a valuable resource network,
with a center in each of the U.S. Federal regions. PEHSU professionals
provide medical consultation to healthcare professionals on a wide
range of environmental health issues. PEHSUs also provide information
and resources to school, child care, health and medical, and community
groups. PEHSUs assist policymakers by providing data and background on
local or regional environmental health issues and implications for
specific populations or areas. These centers, all based in
universities, have done tremendous work on very limited budgets. We
urge the subcommittee to fully fund ATSDR's portion of this program's
fiscal year 2011 budget of $1.8 million.
Environmental Health in Schools.--Each school day, about 20 percent
of the total U.S. population spend a full week inside schools.
Unfortunately, many of our school facilities are shoddy or ``sick''
buildings whose environmental conditions harm children's health and
undermine attendance, achievement, and productivity.
No agency is authorized to intervene to protect children from
environmental hazards in schools. Thus, every day we require our
children to spend hours in an environment where they and their parents
have no options, alternatives or recourse if the environment is not
healthy. Thus, CEHN urges the subcommittee to provide full funding for
the aspects of the Clean, Green and Healthy Schools Initiative in its
jurisdiction. Agencies need adequate resources to assure their
participation in the vital cross-agency work of this initiative.
A formal partnership between HHS, the Department of Education, and
EPA to coordinate their pediatric environmental health efforts would
leverage resources and be beneficial for children's health and
research. Providing resources for the newly re-vitalized Interagency
Task Force on Children's Environmental Health would support such a
partnership.
Environmental Health in Child Care Settings.--60 percent of
preschoolers--13 million children--are in child care. This youngest and
most vulnerable population can enter care as early as 6 weeks of age
and be in care for more than 40 hours per week. Yet little is known
about the environmental health status of these centers. CEHN is working
to correct these gaps.
We urge the subcommittee to bring the child care environment into
the Clean, Green and Healthy Schools Initiative by providing additional
resources and direction focused on this important environment.
We ask the subcommittee to direct the HHS Assistant Secretary for
Children and Families to report on the Administration for Children and
Families activities that protect children from environmental hazards in
child care 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 CEHN 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
On behalf of the Cystic Fibrosis Foundation and the 30,000 people
with cystic fibrosis (CF), we are pleased to submit the following
testimony regarding fiscal year 2010 appropriations for cystic
fibrosis-related research at the National Institutes of Health (NIH)
and other agencies.
about cf
CF is a life-threatening genetic disease for which there is no
cure. The bodies of people with CF produce abnormally thick, sticky
mucus that clogs the lungs, results in fatal lung infections and
obstructs the pancreas, making it difficult for patients to absorb
nutrients from food. Since its founding, the Cystic Fibrosis Foundation
has maintained its focus on promoting research and improving treatments
for CF. More than thirty drugs are now in development to treat CF; some
treat the basic defect of the disease, while others target its
symptoms. Through the research leadership of the Cystic Fibrosis
Foundation, the life expectancy of individuals with CF has been boosted
from less than 6 years in 1955 to 37 years today. Although life
expectancy has improved dramatically, we continue to lose young lives
to this disease. In the past 5 years, the Cystic Fibrosis Foundation
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
rapidly and efficiently discover and develop new CF treatments aimed at
controlling and 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 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) in 2009.
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 generated by the doubling of funds and the infusion from ARRA.
The flat-funding of the NIH since 2003 has decreased purchasing
power, limiting the pursuit of critical research. The Cystic Fibrosis
Foundation joins the Coalition for Health Funding to recommend all
health discretionary spending be increased $67.1 billion in fiscal year
2011, or $9.3 billion more than the fiscal year 2010 levels. This
increased investment will help maintain the NIH's ability to fund
essential biomedical research today that will provide the care and
cures of tomorrow. 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 people's lives.
strengthening clinical research and drug development
The Cystic Fibrosis Foundation has been recognized for its unique
research approach which encompasses everything from basic research
through phase III clinical trials, and has created the infrastructure
required to accelerate the development of new CF therapies. As a
result, we now have a pipeline of more than thirty potential therapies
which are being examined to treat people with CF. As a prime example,
in February 2010, Caystonr a new much-needed antibiotic that combats
recurrent lung infections, arrived in the hands of people with CF. This
new treatment is a direct result of the Foundation's innovative
research agenda, advancing from bench to bedside through the
Foundation's research program which speeds the creation of new CF
therapies. Our successes, and specifically our Therapeutics Development
Network discussed below, can serve as a map for the development of new
treatments for other diseases.
The Foundation is a leader in creating a clinical trials network to
achieve greater efficiency in clinical investigation. Because the CF
population is small, a higher proportion of people with the disease
must partake in clinical trials than in most other diseases. This
unique challenge prompted the Foundation to streamline our clinical
trials processes. As a result, research conducted by the Foundation is
more efficient than ever before and we are a model for other disease
groups. We applaud the efforts by the Nation's health agencies to
encourage greater efficiency in clinical research and we are hopeful
that the subcommittee will direct the national health agencies to pay
special attention to advances in treatment methods and mechanisms for
translating basic research across Institutes into therapies that can
benefit patients.
Development of Rare Disease Research Networks
The subcommittee should direct the NIH and other agencies to
allocate additional funds for innovative therapeutics development
models including the Therapeutics for Rare and Neglected Diseases
(TRND) and Cures Acceleration Network (CAN) programs as well as for
clinical research to meet the demand for testing promising new
therapies for CF and other diseases. Support should also be directed
toward the continuation of other rare disease research networks, such
as the NIH's pediatric liver disease consortium.
The CF Foundation'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 the TDN's
centralization of data management and analysis and data safety
monitoring in the TDN will be useful in designing clinical trial
networks for other diseases. Dr. Francis Collins, Director of the NIH,
has specifically cited the TDN as an exemplar for TRND. Coupled with
the newly established CAN, the time between discovery and development
of drugs and therapies can be accelerated if these programs are fully
funded.
Providing for the U.S. Food and Drug Administration (FDA)
We urge the subcommittee to increase funding for the FDA to ensure
that the Agency has the necessary resources and funding to effectively
evaluate new and emerging treatments. In order to be effective, the FDA
needs not only an adequate number of reviewers of new treatments, but
also those with the appropriate skills and expertise, particularly for
rare diseases like CF. Additional support for the FDA through increased
funding not only assures that the Nation has a safe and effective
supply of drugs and devices, but also that the agency can give the
necessary attention to reviewing treatments that treat small
populations but serve specific unmet medical needs, such as Caystonr.
The CF Foundation applauds the appointment of Dr. Anne Pariser as
the new Associate Director for Rare Diseases in the FDA's Center for
Drug Evaluation and Research's Office of New Drugs. We are pleased to
see this new position held by such a capable and competent
administrator. Similarly, we applaud the regulatory science initiative
formed by the NIH and the FDA with the goal of accelerating the
development and use of new approaches to evaluate drug safety,
efficacy, and quality and urge the subcommittee to strongly support
this type of collaboration. Support for coordination between new
programs like TRND and CAN throughout the national health agencies
leverages the Federal investment in new research, facilitating swifter
development and delivery of new medical treatments.
Supporting Translational Research and Investigators
A significant discrepancy persists between the first award funding
granted to clinical laboratory investigators and that granted to basic
laboratory investigators. 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.
The Clinical and Translational Science Awards (CTSA)
We urge the NIH to enhance the Clinical and Translational Science
Awards (CTSA), a program designed to transform the way in which
clinical and translational research is conducted. Such an increased
emphasis on clinical translation can enable researchers to provide new
treatments more efficiently to patients. For example, at Seattle
Children's Hospital, a CTSA program has been instrumental in
identifying best practices for efficient clinical trial participation
and improving clinical outcomes in care for CF. Tremendous effort has
brought institutions together to rally around this program and similar
programs at other institutions, yet current funding levels make it
difficult for the full complement of programs to be funded.
Additionally, key to the success of the CTSAs is the development of
cost-sharing mechanisms like the General Clinical Research Centers
(GCRC), which allowed institutes to reduce their research budgets by
having investigators use the GCRC when clinical care was made available
at no additional cost. In order to maximize the potential of the CTSA,
multiple institutes within the NIH must be able to provide financial
resources for critical programs such as this.
Alterative Models for Institutional Review Boards (IRB)
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
An additional impediment in our effort to accelerate the
development of new therapies is the Social Security Administration's
current Supplemental Security Income (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. S. 1674, the
Improving Access to Clinical Trials Act of 2009, would allow the Social
Security Administration to disregard any income received from
compensation for clinical trials when determining eligibility for
programs like SSI. Support from the subcommittee on resolving this
disincentive toward clinical research is appreciated.
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. 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
The Cystic Fibrosis Foundation'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.
Opportunities in Animal Models
The Cystic Fibrosis Foundation 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 the Cystic Fibrosis Foundation, 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, causes an intense inflammatory
response. The Cystic Fibrosis Foundation enthusiastically supports
investments by the NIH to gain a greater understanding of neutrophil-
driven inflammatory responses, 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 Common Fund
priorities. 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 centers must
be integrated. To address this, the Cystic Fibrosis Foundation 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. The CF Foundation 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. 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. 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. The CF Foundation 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 the CF Foundation 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 the Cystic Fibrosis Foundation, we thank the subcommittee
for its consideration.
______
Prepared Statement of Children and Adults with Attention-Deficit/
Hyperactivity Disorder
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 130,000 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 9,364 individual inquiries during the last year on
17,115 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 4,100 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 2011 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.
Both the National Institutes of Health Consensus Conference on AD/
HD (Nov. 1998) and the Centers for Disease Control and Prevention
Conference on Public Health and AD/HD (Sept. 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.\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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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.\6\ ``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 over 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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\6\ Barkley, R.A., Murphy, K.R., & Fischer, M. (2008). ADHD in
Adults: What the Science Says. New York: The Guilford Press.
\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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Last year, the AD/HD line item was funded at $1.751 million. We are
requesting a $400,000 increase in the AD/HD line item, which will
result in a $200,000 increase in the NRC. Historically, half of the
increase to the AD/HD line item has been used to fund research on AD/
HD. The $200,000 increase to the NRC will allow the NRC to further
develop its outreach to the African-American and Hispanic-Latino
communities, and most importantly during this current economic climate
to initiate an employment information specialist service.
Requested Report Language for Fiscal Year 2011
The subcommittee continues to support the activities of the CDC's
NCBDDD and the National Resource Center (NRC) on AD/HD and has provided
$2,151,000 to continue this support, including $1,075,500 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 most importantly during this current economic
climate, provides support for a health information specialist focused
on employment to assist 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 (CHSR) 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 3,800 researchers, scientists, and policy experts and 150
organizations that produce and use health services research.
Healthcare in the United States has the potential to dramatically
improve people's health, but often falls short and costs too much.
Health services research is used to understand how better to finance
the costs of care, measure and improve the quality of care, and improve
coverage and access to affordable services. It provides patients,
providers, payers, and policymakers with the tools needed to make
healthcare:
--Affordable by decreasing cost growth to sustainable levels.
--Efficient by decreasing waste and overpayment and monitoring the
cost-effectiveness of care.
--Safe by decreasing preventable medical errors, monitoring public
health, and improving preparedness.
--Effective by evaluating programs and outcomes and promoting
evidence-based innovations.
--Equitable by eliminating disparities in health and healthcare.
--Accessible, by connecting people with the healthcare they need when
they need it.
--Patient-centered by increasing patient engagement in and
satisfaction with the care received.
Indeed, health services research has been changing the face of U.S.
healthcare, uncovering critical challenges confronting 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
found that disparities and lack of access to care in rural and inner
cities result in poorer health outcomes. And it demonstrated 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.
But health services research does not just lift the veil on the
problems plaguing U.S. healthcare; it also seeks ways to address them.
Health services research offers guidance on implementing and making the
best use of health information technology and getting the best care at
the best value. Health services research framed the debate over
healthcare reform in Massachusetts--forming the basis for that State's
2006 health reform legislation--and was instrumental in shaping
comprehensive national health reform through The Patient Protection and
Affordable Care Act. As health reform is implemented over the next few
years, health services research will be needed more than ever to
monitor and evaluate the new law's impact on the healthcare system and
the health status of Americans. Do Americans have better access to
healthcare? Are the measures projected to bend the healthcare cost
curve downward having the desired effect? Are patients more engaged in
healthcare decisionmaking? Is care better coordinated across providers?
Health services research will provide the answers to these and other
important questions.
For the last 7 years, the Coalition has collected data to track the
Federal Government's expenditures for health services research and
health data. Information provided to us by the principal funders of
health services research and data--including the Agency for Healthcare
Research and Quality (AHRQ), the National Institutes of Health (NIH),
the Centers for Disease Control and Prevention (CDC), and the Centers
for Medicare and Medicaid Services (CMS)--indicates that the field of
health services research and data has operated with diminished
purchasing power for years. Up until 2008, overall spending on
healthcare continued to rise faster than the rate of inflation--from
$1.4 trillion in 2000 to nearly $2.3 trillion in 2008. Despite the
recent increase in Federal funding for health services research and
data--$1.8 billion in fiscal year 2009--the total Federal investment
still accounted for only 0.078 percent of the $2.3 trillion we spend on
healthcare annually.
The CHSR greatly appreciates the subcommittee's recent efforts to
increase the Federal investment in health services research and
comparative effectiveness research through the fiscal year 2010 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-ever single funding increase in health services
research. With comprehensive health reform now a reality, we ask the
subcommittee to continue strengthening 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. Recent years' steady, incremental increases for
AHRQ's Effective Health Care Program, as well as the $300 million
provided to AHRQ in the American Recovery and Reinvestment Act, have
helped 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 has languished as funding for AHRQ's base has remained
relatively flat. To balance the recent investments in AHRQ's
comparative effectiveness research, we recommend that:
--AHRQ's broader health services research portfolio should not be
sacrificed for the sole benefit of comparative effectiveness
research. The entirety of the President's requested budget
increase will support ``patient-centered health research''
(i.e., comparative effectiveness research) while funding for
programs in AHRQ's broader research portfolio are cut or flat-
funded to support a more robust comparative effectiveness
research portfolio. The full spectrum of health services
research on healthcare cost, quality, and access is essential
to ensure that research on ``what works'' is implemented in
ways that support broader health reform efforts.
--Congress should continue to place priority on investigator-
initiated research and should target funding for innovative,
competitive grants in fiscal year 2011. The President's
proposed budget does not fund new investigator-initiated
research grants at AHRQ in fiscal year 2011. The Coalition is
grateful to the subcommittee for its leadership in recognizing
the value of investigator-initiated research at AHRQ. The
Coalition requests that you continue this investment in fiscal
year 2011 and sustain the momentum for competition and
innovation you have cultivated over several years.
--Congress should target more funding for pre- and postdoctoral
training grants to increase capacity to respond to growing
public and private sector demand for health services research.
At the direction of Congress, AHRQ doubled its investment in
training grants for the next generation of researchers in the
last year. Still, training grants for new researchers fall far
short of what is needed across all disciplines to meet growing
public and private sector demand for health services research.
As the lead agency for health services research, AHRQ requires
more funding to develop the next generation of health services
researchers--both physician and nonphysician researchers.
While targeted funding increases in recent years have moved AHRQ in
the right direction, more core funding is needed to help AHRQ fulfill
all aspects of 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 supporting the President's
requested funding level of $611 million.
Centers for Disease Control and Prevention (CDC)
Housed within the 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. With the
subcommittee's leadership in securing steady and sustained funding
increases for NCHS over the last 3 fiscal years, NCHS is rebuilding
after years of underinvestment that 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. We join the Friends of
NCHS--a coalition of more than 250 health professional, research,
consumer, industry, and employer organizations that support the
agency--in endorsing the President's fiscal year 2011 request of $162
million, a funding level that will build on your previous investments
and put the agency on track to become a fully functioning, 21st
century, national statistical agency.
The Patient Protection and Affordable Care Act recognizes the need
for linking the medical care and public health delivery systems by
authorizing a new CDC research program to study the delivery of public
health services. If funded in fiscal year 2011, this program will
support the examination of evidence-based practices relating to
prevention; analyze the translation of interventions from academic to
real-world settings; and identify effective strategies for organizing,
financing, or delivering public health services in real-world community
settings by, for example, comparing State and local health department
structures and systems in terms of effectiveness and costs. The
Coalition urges you to appropriate $50 million for this important
program in fiscal year 2011, enabling us to study ways to improve the
efficiency and effectiveness of public health service delivery.
In addition, the Coalition urges you to provide the CDC's important
Public Health Research portfolio and Prevention Research Centers--a
network of academic health centers that conduct public health
research--with at least $35 million for Public Health Research and at
least $35 million for Prevention Research Centers in fiscal year 2011.
These programs--which seek ways to develop, translate, and disseminate
research to address obesity, diabetes, and heart disease; healthy aging
and youth development; cancer risk; and health disparities--have been
virtually flat-funded since fiscal year 2006. At a time when chronic
diseases persist as the primary drivers of escalating healthcare costs,
greater investment in public health research is needed to identify
evidence-based solutions to curbing the prevalence of these diseases.
Centers for Medicare and Medicaid Services (CMS)
Steady funding decreases for the Office of Research, Development
and Information, together with an increasingly earmarked budget, have
hindered CMS's ability to meet its statutory requirements and conduct
new research to strengthen public insurance programs--including
Medicare, Medicaid, and the Children's Health Insurance Program--which
together cover nearly 100 million Americans and comprise 45 percent of
America's total health expenditures. As these Federal entitlement
programs continue to pose significant budget challenges for both
Federal and State governments, it is critical that we adequately fund
research to evaluate the programs' efficiency and effectiveness and
seek ways to manage their projected spending growth.
The Coalition supports an increase in CMS's discretionary research
and development budget from $36 in fiscal year 2010 to a base fiscal
year 2011 funding level of $47 million, consistent with the President's
request. This funding is a critical down payment to help CMS recover
lost resources and restore research to evaluate its programs, analyze
pay for performance and other tools for updating payment methodologies,
and further refine service delivery methods.
In addition, the Coalition supports the President's fiscal year
2011 request of $110 million for a new data improvement initiative at
CMS. This investment would enhance the quality and timeliness of data,
support health reform initiatives such as value-based purchasing and
comparative effectiveness research, improve payment accuracy, and
enhance systems security. The Coalition supports the President's
efforts to improve data quality, timeliness, and access and encourages
Congress to appropriate funding so that the research community will be
able to access CMS's valuable data to enhance these Federal programs
and ultimately reduce mandatory spending.
NIH
NIH reported that it spent $1.1 billion on health services research
in fiscal year 2009--roughly 3.6 percent of its entire budget--making
it the largest Federal sponsor of health services research. For fiscal
year 2011, the Coalition recommends a health services research base
funding level of at least $1.27 billion--3.6 percent of the $35 billion
sought by the broader health community for NIH. The Coalition believes
that NIH should increase the proportion of its overall funding that
goes to health services research from 3.6 to 5 percent to ensure 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. With important health reforms
now undergoing implementation, health services research will continue
to yield valuable scientific evidence in support of improved quality,
accessibility, and affordability of healthcare. We urge the
subcommittee to accept our fiscal year 2011 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 2011 appropriations for the Low-Income Home
Energy Assistance Program (LIHEAP).
The Governors appreciate the subcommittee's continued support for
LIHEAP, and we thank you for providing $5.1 billion in fiscal year 2010
funding for the program. The Governors recognize the considerable
fiscal challenges facing the subcommittee this year. However, as the
number of households seeking heating and cooling assistance continues
to increase nationwide, we urge you to provide fiscal year 2011 funding
for the core LIHEAP block grant program at least at the most recent
authorized level of $5.1 billion, as well as provide sufficient
contingency funds to address unforeseen energy emergencies. Providing
this funding level through the block grant program provides the
certainty that States need to implement an effective program.
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 newly unemployed, and families with young children.
Under this targeted program, the majority of households receiving
assistance have incomes of less than $8,000 a year. These households
have the highest energy burden, spending more than 16 percent of their
income on home energy compared to 3 percent for non-low-income
households.
This disproportionate energy burden experienced by vulnerable low-
income families continues. In recent years, the increase in the cost of
home energy has far outpaced both the rate of inflation and the
increase in household income.\1\ The share of income that elderly
households spend on housing costs and out-of-pocket healthcare
expenditures has increased substantially in the last two decades.\2\
LIHEAP is an effective tool for helping these households better manage
the financial pressures of unaffordable home energy costs, through
assistance in paying bills as well as making their homes and heating
systems safer and more efficient.
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\1\ Short and Long-Term Perspectives: The Impact on Low-Income
Consumers of Forecasted Energy Price Increases in 2008 and a Cap-and-
Trade Carbon Policy in 2030, Oak Ridge National Laboratory, December
2007.
\2\ Recipiency Targeting Analysis for Elderly and Young Child
Households, prepared for the Office of Community Services' Division of
Energy Assistance by APPRISE Incorporated, December 2008.
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While some national economic reports are hopeful, the current
situation remains challenging for these low-income households as the
costs of essential household expenses including home energy and food
remain high. This is particularly true in the Northeast where a greater
percentage of households use delivered heating fuels, such as home
heating oil, propane and kerosene, than in any other region of the
country. These households are more vulnerable to price volatility,
making it more difficult for families to manage their household
budgets. Households using deliverable fuels tend to have an extremely
high energy burden, with historically higher energy bills than those
using other heating sources. The average annual heating bill for all
LIHEAP recipients was $717 in 2007. However, the average annual heating
bill for households using home heating oil was $1,686, and the average
heating bill for propane users was $1,052.\3\ This pattern continues.
Even as the price of some home energy prices stabilize, the Energy
Information Administration finds that home heating oil prices have
increased 20 percent more than last year.\4\ In addition, households
that rely upon delivered fuels do not have the benefit of a program
comparable to a utility service shut-off moratorium. If a household
cannot afford to purchase the home heating fuel, the delivery truck
simply does not come.
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\3\ LIHEAP Home Energy Notebook for Fiscal Year 2007, U.S.
Department of Health and Human Services, Administration for Children
and Families, Office of Community Services, Division of Energy
Assistance, June 2009.
\4\ Short-Term Energy Outlook, Energy Information Administration,
March 2010.
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The number of households receiving LIHEAP assistance continues to
reach record levels. According to the National Energy Assistance
Directors' Association (NEADA), 8.3 million households received heating
assistance in 2009, compared to 6.1 million in 2008. States expect that
number to grow to more than 9.5 million in 2010. Many of these
applicants have never requested help before, but are facing
extraordinary economic hardship due to increased unemployment and
layoffs. Yet, this is only a small portion of the eligible households.
As spring approaches and utility shut-off moratoria end, too many
families are in danger of having their utility service terminated for
nonpayment. According to NEADA, approximately 4.3 million households
were shut off from power in fiscal year 2009 up from 4.1 million in
2008. In fiscal year 2009 approximately 12.5 million households were at
least 30 days behind in their utility bills. The effects on these
vulnerable households can be deadly. Numerous studies have found that
the elderly and very young children are at risk for serious health
consequences from prolonged exposure to home temperatures that are
either too cold in the winter or too hot in the summer.
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
at least $5.1 billion in regular block grant funding for LIHEAP in
fiscal year 2011 as well as sufficient 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 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 Corporation for Public Broadcasting
Chairman Harkin, Ranking Member Cochran, and members of the
subcommittee, thank you for allowing me to submit testimony on behalf
of our Nation's public media system.
As you know, the Corporation for Public Broadcasting (CPB), a
private, nonprofit corporation created by the Public Broadcasting Act
of 1967, is the steward of the Federal Government's investment in
public broadcasting. We support the operations of more than 1,100
locally owned and operated public television and radio stations
nationwide. Throughout the United States, public broadcasting, or what
should more accurately be called ``public media,'' engages citizens on-
air, on-line, and on the ground with information they can use to
improve their lives and strengthen their local communities. As
commercial media becomes increasingly consolidated, a key strength of
public media remains its design: a decentralized set of stations, each
with deep local roots and maintaining individual service strategies
tailored to the unique needs of its local community.
Public broadcasting was born in an earlier moment of profound
change and transition. In the 1950s and 1960s a new media technology
was diffusing quickly: the television. Around it grew a movement to use
the new medium, as well as existing radio technology, for educational
purposes, and public broadcasting was born. Today, nearly a half-
century after the signing of the Public Broadcasting Act, we are making
a similar transition from public broadcasting to the ``Public Media
2.0'' the President called for during his campaign. As we leverage our
legacy to become a leader in the new and ever-changing media landscape,
public media has focused its efforts through a strategic framework
comprising the ``Three Ds'': Digital, Diversity, and Dialogue.
Innovation on Digital Platforms
As an outgrowth of its dedication to universal service, public
media is embracing a range of digital delivery methods to reach all
Americans, wherever and whenever they seek information. Because of its
reach, its availability for free, and its unmatched efficiency in
point-to-multipoint communications, over-the-air service remains an
essential part of the public media portfolio. At the same time, public
broadcasters are evolving into true multi-platform media entities by
creating content and services, some related to and some entirely
independent from broadcast content, that capitalize on the power of
broadband and other digital technologies. For example:
--KQED's (San Francisco) QUEST is a new multimedia series about the
people behind Bay Area science and environmental issues which
utilizes all of KQED's media platforms, educational resources
and extraordinary partnerships, and includes a half-hour weekly
HD television program, weekly radio segments, an innovative Web
site and education guides.
--Public Broadcasting Atlanta is developing Lens on Atlanta, an on-
line portal that invites citizens to create and participate in
blogs, wikis, forums, petitions, and surveys, and engages
institutions and Government entities around Atlanta to listen
and participate.
--Many public radio stations have expanded the reach of their
cultural programming by investing in and creating substantial
Internet music services with significant audiences. Examples
include WAMU's Bluegrass Country, WKSU's Folk Alley, WXPN's
Xponential, and KCRW's Eclectic24.
In addition to these local station efforts, public broadcasting's
national organizations have been moving for some time to leverage the
power of digital media. For example:
--CPB is funding the creation of Local Journalism Centers, combining
our and participating stations' resources for a ground-breaking
approach to news gathering and distribution. The seven centers
will form teams of multimedia journalists, who will focus on
issues of particular relevance to each region, and their in-
depth reports will be presented regionally and nationally via
digital platforms, community engagement programs and
broadcasts.
--In October 2009, NPR initiated Argo, a new multi-media journalism
project, funded by CPB and the Knight Foundation. The 2-year
project is designed to strengthen public media's local
journalism, build a significant online audience, and develop a
common publishing platform that will better support public
media's online needs. NPR is working with a dozen selected
public television and radio stations to launch Web sites for
each station that go in-depth on selected topics or
``verticals.''
--In September 2008, PBS launched its PBS KIDS GO! video player,
featuring hundreds of video clips and dozens of full-length
episodes. Since launch, the site is averaging 1.3 million
streams per week, and 9 million unique visitors a month. In
December 2009 alone, children watched more than 87.5 million
streams across the PBS KIDS family of Web sites, its highest
total ever, putting it on track to be one of the most popular
video sites in the world.
--CPB is funding the development of the American Archive, which
ultimately will restore, digitize, and preserve public
broadcasting's deteriorating collections of local television
and radio content. We expect to have 40,000 hours of local and
national television and radio content available to the American
public with in 18 months.
Content That Reflects the Nation's Diversity
Equally central to public media's universal service mission is
providing individuals of every ethnicity and economic and social
background, particularly those that are underserved by commercial
media, relevant and engaging content. The ability to transmit multiple
streams of digital programming over the air, combined with the nearly
boundless capabilities of broadband, enable local and national public
media entities to deliver content that truly reflects America's
diversity. CPB is constantly expanding its relationships with diversity
partners to both broaden its reach and to allow greater opportunities,
on a variety of platforms, for underrepresented groups. Among these
efforts:
--CPB provides ongoing support to, among others: the National
Minority Consortia, which provides seed money to producers of
multicultural content; the Independent Television Service,
which champions independently produced programming targeting
underserved audiences; Koahnic Broadcast Corporation, the
leader in bringing Native voices to Alaska and the nation
through the only urban Native public radio station and its
national production and distribution center (Native Voice One)
in Albuquerque; and Radio Bilingue, the only national
distributor of Spanish-language public radio programming, which
is now developing a transmedia service in Los Angeles targeting
a young, English-speaking, and highly diverse audience. We also
funded the creation of Native Public Media in 2004 to build and
advance Native access to, ownership of, and participation in
media, especially radio.
--In fiscal year 2010, we are creating within our multi-year PBS
National Program Service agreement (which supports primetime
and children's programming) a Diversity and Innovation Fund,
which will support major content development projects that
examine topics of interest to diverse audiences or that employ
new, lower-cost production models.
--CPB funds the National Black Programming Consortium's annual New
Media Institute, a unique professional development program
designed to introduce producers to the latest in digital media
production, marketing, and distribution. The program includes a
collaboration website where journalists can showcase their
work, find and share public domain stock, share best practices,
and brainstorm together on innovative future citizen media
projects.
--Through projects such as the Public Radio Talent Quest, CPB has
identified a new generation of public broadcasting talent--
Public Media 2.0 producers--who appeal to new audiences and
produce multimedia content for a variety of platforms. For
example, Glynn Washington, a winner of the Talent Quest,
produces a new multimedia series, Snap Judgment, that combines
his unique brand of storytelling with innovative technology to
explore the decisions people make in moments of crisis.
Services That Foster Dialogue Between Public Media and the American
People
Public media's localism remains more relevant than ever as
commercial media are increasingly owned and operated by entities
outside of their local communities--but the nature of our service to
local communities is shifting in the digital age. Critical to public
media's future will be its ability to collaborate and serve as an
active resource and trusted partner to more diverse communities, in new
ways. Public media entities are quickly adapting to the new paradigm.
For example, as part of a comprehensive local/national response to the
Nation's economic woes, CPB is supporting a number of in-depth
community engagement projects, including:
--Facing the Mortgage Crisis.--Fifty-seven stations are participating
in this multi-million dollar national project designed to help
the country's hardest-hit regions cope with an avalanche of
mortgage foreclosures. Based on an extremely successful model
developed by KETC-TV in St. Louis, stations are working with
key community partners, such as United Way's 2-1-1 call
centers, to create content on-air and online that helps
families to avoid or mitigate home foreclosures.
--Engaging Communities on the Economy.--CPB is supporting the work of
37 stations working with partners to address other pressing
economic issues, such as joblessness, hunger, loss of health
insurance and family stress. These projects serve diverse
audiences, from seniors to recent immigrants to teenagers.
CPB's Requests for Appropriations
Public media stations continue to evolve, both operationally and
more importantly in the myriad ways they serve their communities.
Stations are committed to reaching viewers and listeners on whatever
platform they use--from smart phones to iPads to radios to TV sets. But
new opportunities come with a cost. While stations can and will
continue to adapt and thrive in the digital age, without sufficient
support they cannot live up to the potential of the new technologies.
As the Federal Communications Commission's recently-issued National
Broadband Plan noted, ``Today, public media is at a crossroads . . .
[it] must continue expanding beyond its original broadcast-based
mission to form the core of a broader new public media network that
better serves the new multi-platform information needs of America. To
achieve these important expansions, public media will require
additional funding.''
CPB Base Appropriation (Fiscal Year 2013).--CPB requests a $604
million advance appropriation for fiscal year 2013. Stations have been
faced with flat CPB funding for the better part of the past decade, and
the impact of this lack of an even inflationary increase (until fiscal
year 2010) has been magnified by the economic conditions of the last
few years. As public media seeks to make the transition to a truly
digital enterprise, the Federal share of station funding has never been
more critical. CPB distributes its advance appropriation in accordance
with a statutory formula, under which almost 72 percent of funds go
directly to local public television and radio stations, as well as
discretionary support for the creation of programming for radio,
television and new media and on projects that benefit the entire public
broadcasting community. Added together, these efforts account for 95
percent of the funds appropriated to CPB; we are limited by law to an
administrative budget of 5 percent. The Federal appropriation accounts
for under 15 percent of the entire cost of public broadcasting, but it
is a vital core that leverages support from State and local
governments, universities, businesses, foundations, and especially
viewers and listeners of local public television and radio stations.
CPB Digital (Fiscal Year 2011).--CPB requests $59.5 million in
digital funding for fiscal year 2011. With this funding, CPB will
continue its mission to fund stations' efforts to adapt to audience
demands for educational, cultural and news and information content,
regardless of platform. As the Administration noted in its fiscal year
2011 budget request, while CPB Digital will continue to fund station
``equipment'' such as digital transmitters and translators, ``the
majority of this funding will be utilized to fund projects to enhance
multi-platform content creation, delivery and storage, such as the
American Archive, which by converting content to digital format, will
ensure that the vast archives of public broadcasting content will not
be lost due to physical media deterioration.'' Though needs remain, as
local stations' conversion to digital broadcasting ramps down, CPB
Digital funding for broadcast equipment will continue to diminish, and
the Department of Commerce's Public Telecommunications Facilities
Program (PTFP) can resume its role as the primary Federal source for
local station equipment funding.
Ready To Learn (Fiscal Year 2011).--CPB is requesting $32 million
in fiscal year 2011 for Ready To Learn (RTL), a Department of Education
program with a nearly 20-year proven record of using the power and
reach of public television's children's programming to raise the
reading levels of children ages 2-8 who live in high-poverty
environments. Today, Ready To Learn is a partnership between CPB, PBS,
WGBH (Boston), WTTW (Chicago), Sesame Workshop, leading researchers and
public television stations nationwide. We strongly disagree with the
administration's proposed consolidation of RTL into an umbrella
literacy program and instead believe that the difference this program
has made on children's lives makes continued dedicated Federal support
imperative. An appropriation of $32 million in fiscal year 2011 will
enable RTL content and accompanying materials to be created and tested
on a faster timeline, and will enable more communities to become
involved in existing station-based outreach activities.
Mr. Chairman and Ranking Member, thank you again for allowing CPB
to submit this testimony. For nearly a half-century, public
broadcasting has provided a safe place for millions of children to
learn and unparalleled access to news and information; given voice to
diverse points of view; and convened community dialogues. As the times
have changed, so too have the technologies available to provide service
to communities across our country. The challenge before us is how best
to incorporate new capabilities into the public interest and service
for all of our diverse citizenry, especially during these challenging
economic times. With your continued support, we are ready to meet this
challenge.
______
Prepared Statement of the Corporation for Supportive Housing
The Corporation for Supportive Housing (CSH) is a nonpartisan,
nonprofit organization that helps communities build permanent
supportive housing (PSH). We have offices in 12 States (California,
Arizona, Texas, Illinois, Indiana, Ohio, Minnesota, Michigan, New
Jersey, New York, Connecticut, and Rhode Island) and the District of
Columbia and have a presence in several others. We work with
communities and States to reorient systems and align resources to
create permanent supportive housing and end and prevent chronic
homelessness. Although many people experiencing homelessness may only
need rental or income supports to become and stay housed, a significant
and intractable subset of people experiencing homelessness need (in
addition to rental assistance or affordable housing) intensive (wrap-
around) supportive services such as substance use treatment, mental
health services, healthcare to manage chronic diseases, and case
management services.
Most PSH providers receive at least a portion of the funds
necessary to build or secure housing from the Department of Housing and
Urban Development (HUD). Unfortunately, the Department of Health and
Human Services has not made an equivalent commitment to funding the
services component of PSH. As a result, PSH providers have few places
to turn to for the funding needed to provide the wrap-around supportive
services needed to keep chronically homeless individuals housed.
Organizations and local government agencies patch together a
combination of State, local, foundation and privately raised funds to
pay for the vital social services chronically homeless populations must
have to stay housed. These funds are often limited in amount and short-
term in nature. In order to build the PSH units needed to end chronic
homelessness, the Department of Health and Human Services must increase
its investment in local permanent supportive housing projects. To this
end, CSH recommends the following:
--Allocate $120 million for services for people experiencing
homelessness within the Programs of Regional and National
Significance (PRNS) accounts of both SAMHSA's Center for Mental
Health Services and Center for Substance Abuse Treatment. This
includes the President's proposal for $15.8 million to fund a
joint HHS/HUD homeless program.
--Increase funding for the Projects for Assistance in Transition from
Homelessness (PATH) program to $75 million.
--Provide $3.28 billion for the Community Health Center program, this
would result in $278 million for the Health Care for the
Homeless program.
--Fund the Mental Health Services Block Grant (change name) at $521
million, a $121 million increase.
--Fund the Substance Abuse Prevention and Treatment Block Grant at
$2.008 billion a $289 million increase over fiscal year 2009.
Background
While HUD has made significant housing investments, there is a need
for HHS to increase its role in providing services resources for
organizations to create permanent supportive housing. A majority of
chronically homeless individuals live with and face continuing barriers
to permanent housing due to serious mental illness, substance use
disorders or chronic health conditions and to retain housing must have
access services that require HHS expertise.
We know permanent supportive housing works. Over 80 percent of
permanent supportive housing residents remain housed after the first
year. Other studies have shown decreased mortality rates, reduced use
of alcohol and other drugs, lower HIV viral loads, and improved health
among chronically homeless people due to placement into supportive
housing. In addition, work CSH has done targeting frequent users of
health, jails or prisons illustrates the cost effectiveness of PSH. In
California, we implemented the Frequent Users of Health Services
Initiative (FUHSI). Through this study, we found that by placing
clients into PSH we reduced their emergency room costs by 59 percent,
reduced their inpatient days by an average of 62 percent and reduced
average inpatient charges by 69 percent.
Our project targeting frequent users of jails and prisons has shown
similar results. The Frequent Users of Services Enhancement (FUSE)
Initiative is a joint project between the New York City Departments of
Corrections and Homeless Services with assistance from the Department
of Health and Mental Hygiene and the New York City Housing Authority.
By assisting ex-offenders and providing permanent supportive housing to
those who need it, NYC was able to help clients reduce jail stays by 53
percent and reduce shelter stays by 92 percent. For the 100 people
served, the FUSE initiative was able to offset nearly $3,000 in both
jail and shelter costs per client, not to mention reducing costly
emergency health services utilization.
In addition, there are several other subpopulations of those
experiencing homelessness that would benefit from increased social
services oriented funding. On a small scale, SAMHSA programs have
targeted youth, veterans and families to ensure that all people
experiencing homelessness who could benefit from mental health and
substance use treatment can receive specialized support. However,
without increased funding, communities will not be able to fully
implement the permanent supportive housing model and continue to end
homelessness in America.
Detailed Program Descriptions
SAMHSA Support Services for Permanent Supportive Housing
Projects
CSH 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. The
Administration obviously recognizes this and included a new initiative
the Homeless and Services for Homeless Persons Demonstration. This
joint HUD/HHS partnership is an important first step to integrating
housing and services resources to ease organizations' ability to access
Federal funding. It also shows an understanding that housing and
services is what is needed to end homelessness. This program is
estimated to cost $15.8 million. CSH asks that this initiative be fully
funded in the appropriations process and that Congress include
additional funds to ensure that current grantees can continue their
work and new grants can be awarded. We look forward to working with
Congress and the Administration to implement this initiative and ensure
that it is properly evaluated.
Projects for Assistance in Transition from Homelessness
(PATH)
CSH 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 (SSI), Medicaid, and welfare programs.
PATH supported programs served over 135,007 people through outreach
in fiscal year 2008. Of those for whom a diagnosis was reported,
approximately 35 percent had schizophrenia and other psychotic
disorders, and 47 percent had affective disorders such as depression.
Also, 60 percent had co-occurring substance use disorders.
One issue that needs consideration, 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.
Community Health Centers and Health Care for the Homeless
(HCH) Programs
CSH recommends $3.28 billion in the Community Health Center program
within Health Resource Services Administration. This would result in
$278 million for the HCH program.
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.\1\ 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.
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\1\ Harris, Shirley N, Carol T. Mowbray and Andrea Solarz. Physical
Health, Mental Health and Substance Abuse Problems of Shelter Users.
Health and Social Work, Vol. 19, 1994.
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Mental Health Services Block Grant
CSH 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
CSH joins our partners in recommending 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 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 that
is funded through a grant from the Department of Education, Office of
Innovation and Improvement.
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.
Close Up fulfills its mission with exciting, hands-on programs for
students and their teachers in Washington. Close Up uses the city as a
living classroom, giving students unique access to the people,
processes and places that make up our Nation's capital. 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 for 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 under Section 1504 of the No Child Left Behind Act, has been
annually funded through a U.S. Department of Education grant for more
than 35 years. The program provides financial assistance to
economically disadvantaged high school and middle schools students and
their teachers. 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 fellowship recipients are selected by their
schools and must qualify according to the income eligibility guidelines
established by Close Up.
Close Up Fellowship Program recipients participate in Close Up
Washington civic education programs with all other Close Up
participants. Student fellowship recipients participate in the
Washington High School Program, the Washington Middle School, and the
Program for New Americans. There is no special programming for
Fellowship recipients nor are they identified or singled out in any
manner. 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 provides a Federal fellowship to a select group of
teachers who work with economically disadvantaged students on a Close
Up program. Close Up teachers participate in the Close Up Program for
Educators, a program which ``trains the trainers''. Teachers take ideas
and methodologies for teaching and engaging young people in civic
activities and put them to use in their schools and communities.
The teacher is the essential link to reaching students of diverse
backgrounds. Close Up believes that any effort to improve and promote
civic involvement among young people must begin with inspired and well-
prepared teachers. It is from this inspired corps of teachers that a
multiplier effect in civic learning and engagement is produced.
Teachers who participate in the teacher program leave inspired and
informed and convey a similar attitude to their students. In a survey
of teachers who participated on the Close Up Program for Educators in
spring 2009, 95 percent of the teachers who responded indicated that
they returned to their schools feeling ``inspired and reinvigorated''
after completing the Close Up program.
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 2011 request is based 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
economic climate it has become even 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 civic education programs also helps to fill a gaping hole
in the civic education of our Nation's youth. In a recent survey of
high school teachers, 83 percent reported that emphasis on standardized
tests has made it difficult to teach practical citizenship skills in
the classrooms. As the teaching of social studies and civics has given
way to STEM subjects, programs like Close Up become an even more
important as a supplement to classroom teaching.
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 the Close Up Fellowship funding remained flat at 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 greatly supports economic sectors such as
transportation and hospitality which are suffering in the downturn.
Senators have the opportunity to meet with Close Up groups from
their States during Close Up ``Capitol Hill Day''. You see the
excitement and pride as our students gain confidence to express their
views on the public policy issues that most directly affect their
lives. Through their workshops, seminars, and 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 in 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.
______
Prepared Statement of the Dystonia Medical Research Foundation
Dystonia is a neurological movement disorder characterized by
involuntary muscle spasms that cause the body to twist, repetitively
jerk, and sustain postural deformities. Dystonia can affect movement in
several different ways; focal dystonias affect specific parts of the
body, while generalized dystonia affects multiple parts of the body at
the same time. Some forms of dystonia are genetic, but can also be
caused by injury or illness. Although dystonia is a chronic and
progressive disease, it does not impact cognition, intelligence, or
shorten a person's life span. Conservative estimates indicate that
between 300,000 and 500,000 individuals suffer from some form of
dystonia in North America alone. Dystonia does not discriminate,
affecting all demographic groups. There is no known cure for dystonia
and treatment options remain limited.
Although little is known regarding the causes and onset of
dystonia, two therapies have been developed and proved particularly
useful to control patients' symptoms. Botulinum toxin (Botox/Myobloc)
injections and deep brain stimulation have shown varying degrees of
success alleviating dystonia symptoms. More research is needed to fully
understand the onset and progression of the disease, in order to better
treat patients. Until a cure is discovered, the development of
management therapies remains vital.
Deep Brain Stimulation (DBS)
Deep brain stimulation (DBS) is a surgical procedure 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 to deliver electrical stimulation to the areas
that control movement. While the exact reasons for effectiveness are
unknown, the electrical stimulation blocks abnormal nerve signals that
cause debilitating muscle spasms and contractions.
DBS was approved for use by dystonia patients in 2003 and has since
drastically improved the lives of many individuals. Results have ranged
from quickly regaining the ability to walk and speak, to regaining
complete control over one's body and returning to an independent life
as an able-bodied person. DBS is currently used to treat severe cases
of generalized dystonia, but with increased research may also be a
promising treatment for those suffering from focal dystonias. Surgical
interventions are a crucial and active area of dystonia research, and
must be pursued in the development of new 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 biologic, 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,
providing considerable relief from the patient's symptoms.
Injections of botulinum toxin should only be performed by a
physician who is trained to administer this treatment. The physician
administering treatment may palpate 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.
DMRF supports the recent ``follow-on'' biologics or biosimilars
provisions included in the Patient Protection and Affordable Care Act.
This creates a regulatory pathway for biosimilars at the Food and Drug
Administration (FDA). This will help remove significant cost barriers
to treatment for dystonia patients and maintain strong patient
protections, while providing incentive for the development of new
biologic treatments.
Dystonia and the National Institutes of Health (NIH)
Currently, dystonia research at NIH is conducted through the
National Institutes on Neurological Disorders and Stroke (NINDS), the
National Institute on Deafness and Other Communication Disorders
(NIDCD), the National Eye Institute (NEI), and the Office of the
Director.
National Institute on Neurological Disorders and Stroke (NINDS)
The majority of dystonia research at NIH is conducted through
NINDS. NINDS has utilized a number of funding mechanisms in recent
years to study the causes and mechanisms of dystonia. These grants
cover a wide range of research 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 works to
support NINDS in conducting critical research and advancing
understating of dystonia.
National Institute on Deafness and Other Communication Disorders
(NIDCD)
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. DMRF
encourages partnerships between NINDS and NIDCD to further dystonia
research.
National Eye Institute (NEI)
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. While myectomy surgery, botulinum toxin injections, and oral
medication can help manage some of the symptoms of blepharospasm,
further study by NEI is needed to develop more predictable treatment
options.
Rare Diseases Clinical Research Network (RDCRN)
The second phase of the RDCRN at NIH provided funding for an
additional 19 grants aimed at studying the natural history,
epidemiology, diagnosis, and treatment of rare diseases. This includes
the Dystonia Coalition, which will facilitate collaboration between
researchers, patients, and patient advocacy groups to advance the pace
of clinical research on cervical dystonia, blepharospasm, spasmodic
dysphonia, craniofacial dystonia, and limb dystonia. Working primarily
through NINDS and the Office of Rare Disease Research in the Office of
the Director, the RDCRN holds great hope for advancing understanding
and treatment of primary focal dystonias.
After years of near-level funding for NIH, the $10.4 billion
provided in the American Recovery and Reinvestment Act (ARRA) helped
reinvigorate biomedical research efforts. However, as those funds come
to an end, DMRF joins the greater biomedical research community in its
concern that research funding will ``fall off the cliff.'' In order to
prevent the loss of research spearheaded under ARRA, continued support
for initiatives like the Cures Acceleration Network (CAN) included in
the recent healthcare reform legislation are vital as we push for rapid
translation of basic science into clinical treatments.
For fiscal year 2011, DMRF recommends a funding increase of at
least 12 percent for NIH and its Institutes and Centers.
For fiscal year 2011, DMRF recommends that the NIH expand dystonia
research through the National Institute on Neurological Disorders and
Stroke, the National Institute on Deafness and Other Communication
Disorders, the National Eye Institute, and the National Institute on
Child Health and Human Development.
For fiscal year 2011, DMRF recommends continued partnerships on
dystonia research between the Office of Rare Disease Research, the Rare
Diseases Clinical Research Network, and the dystonia patient community.
For fiscal year 2011, DMRF recommends appropriating $500 million
for the Cures Acceleration Network, as authorized in the Patient
Protection and Affordable Care Act.
The Dystonia Medical Research Foundation (DMRF)
The Dystonia Medical Research Foundation was founded over 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, we look forward to providing any additional information.
______
Prepared Statement of The Elder Justice Coalition
As your subcommittee considers the fiscal year 2011 Labor, Health
and Human Services, and Education, and Related Agencies appropriations
bills, the nonpartisan, 622-member Elder Justice Coalition, urges you
to provide first year funding for the Elder Justice Act that was
included in the final healthcare reform bill signed by President Obama.
By doing so, the nation will have substantially improved our ability to
better combat elder abuse, neglect and exploitation as well as to
protect the health of older adults.
The Elder Justice Act has authorized funding of approximately $777
million over 4 years. We strongly recommend that an appropriation of
$195 million for fiscal year 2011 be included in the Labor, Health and
Human Services, and Education, and Related Agencies appropriations
bill.
Its most direct and immediate impact would provide urgently needed
support for State and local governments for adult protective services
(APS), the front line of fighting elder abuse. Of the APS agencies in
30 States responding to a recent national survey of APS programs, 60
percent reported their budgets had been cut an average of 14 percent,
while two-thirds reported an average increase of 24 percent in reports
of abuse. In the Elder Justice Act, $100 million is authorized for APS
programs for fiscal year 2011.
Funding for the Elder Justice Act would also provide much needed
support for long-term care ombudsmen at the State and local levels who
respond to complaints of abuse and neglect in the Nation's long-term
care facilities. The number of very complex cases being referred to
long-term care ombudsman has been steadily increasing. As well, there
continues to be a very disturbing increase in the frequency and
severity of regulatory agency citations for egregious violations by
long-term care providers. Ombudsmen are needed now more than ever in
nursing homes, board and care facilities, and in assisted living
communities.
Elder abuse is a very serious health issue. According to research
funded by the National Institute of Justice, almost 11 percent of
people ages 60 and older, or 5.7 million, suffered from some form of
abuse within the past year alone. Other studies have shown that elder
victims of abuse, neglect and exploitation have three times the risk of
dying prematurely.
The Elder Justice Act promotes the safety and well-being of older
adults and their families. We urge you to fully fund the Elder Justice
Act for fiscal year 2011.
______
Prepared Statement of the Eldercare Workforce Alliance
Mr. Chairman and members of the subcommittee: We are writing on
behalf of the Eldercare Workforce Alliance (EWA),\1\ which is comprised
of 28 national organizations united to address the immediate and future
workforce crisis in caring for an aging America. As the Subcommittee
begins consideration of funding for programs in fiscal year 2011, the
Alliance asks that you consider $68,723,162 in funding for the
geriatrics health professions and direct-care worker training programs
that are authorized under titles VII and VIII of the Public Health
Service Act as follows:
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\1\ The positions of the Eldercare Workforce reflect a consensus of
75 percent of its members. This testimony reflects the consensus of the
Alliance and does not necessarily represent the position of individual
Alliance member organizations.
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--$49,697,421 million for Title VII Geriatrics Health Professions
Programs;
--$3,333,333 million for direct care workforce training; and
--$15,692,408 million for Title VIII Comprehensive Geriatric
Education Programs.
These programs are integral to ensuring that America's healthcare
workforce is prepared to care for our rapidly expanding population of
older adults.
The first of the baby boomers will begin to turn 65 in 2011. Within
20 years, 1 in 5 Americans will be older than 65 and 20 percent of
those Americans will have one or more chronic conditions. Yet there is
a growing shortage of clinicians with special training in geriatrics
and an even greater shortage of the geriatrics faculty needed to train
the entire workforce.
In 2008, the Institute of Medicine issued a ground-breaking report,
Retooling for an Aging America: Building the Health Care Workforce that
spotlighted these shortages and their impact on care. The report called
for an expansion of geriatrics faculty development awards to include
other disciplines of the interdisciplinary team, increased training for
the direct-care workforce, and other efforts to create a healthcare
workforce that is competent to care for older adults. The Eldercare
Workforce Alliance was established to ensure that the IOM
recommendations are heard.
The enactment of the Patient Protection and Affordable Care Act
(PPACA) was a historic moment for healthcare in this country. The Act
makes important strides toward addressing the severe and growing
shortages of healthcare providers with the skills and training to meet
the unique healthcare needs of our Nation's growing aging population.
The Act includes provisions championed by Senator Kohl (D-WI) and
Representative Schakowsky (D-IL) from their legislation, the Retooling
for an Aging America Act (S. 245 and H.R. 468). These provisions
implement key recommendations of the IOM report to enhance existing and
establish new geriatrics programs in an effort to build the capacity of
the healthcare workforce needed to care for older adults.
While we very much appreciate the funding for the Title VII
Geriatrics Health Professions programs that President Obama included in
his fiscal year 2011 budget, the current request does not reflect the
full amount of funding needed to advance the geriatrics workforce
priorities established under the PPACA.
We urge you to fund the geriatrics training programs adequately in
fiscal year 2011 so that we can immediately begin to realize the
healthcare workforce goals set forth in health reform. Specifically, we
request $68,723,162 in funding for the following programs under titles
VII and VIII of the Public Health Service Act:
Title VII Geriatrics Health Professions--Appropriations Request:
$49,697,421
The Title VII Geriatrics Health Professions Programs, administered
by the Health Resources and Services Administration (HRSA), are a
highly effective investment in ensuring that older adults receive high
quality healthcare now and in the future. These programs--the Geriatric
Academic Career Awards (GACAs), the Geriatric Education Center (GEC)
program, and geriatric faculty fellowships--are the only Federal
programs that: (1) seek to increase the number of faculty with
geriatrics expertise in a variety of disciplines; and (2) offer
critically important training to the entire healthcare workforce
focused on improving the quality of care we offer to America's elders.
Together, they improve the diversity of the healthcare workforce and
recruit and retain healthcare professionals in medically underserved
areas. Furthermore, title VII funding for geriatrics training address
the crisis created by the severe and growing shortage of geriatrics
health professionals in the United States.
--Geriatric Academic Career Awards (GACA).--Under health reform,
eligibility for these awards has been expanded to include a
number of new disciplines in addition to physicians.
Disciplines now eligible for the Award include faculty from
dentistry, nursing, pharmacy, psychology, social work, and
other allied disciplines as determined by the Secretary. HRSA
is moving immediately to implement the expansion of the
program, which will undoubtedly increase the demand for these
awards. EWA advocated for this expansion and we now want to
ensure that there is adequate funding to meet the increased
demand given the greater number of disciplines that will be
participating. This program currently funds 77 GAC Awardees and
we are requesting fiscal year 2011 funding for 250 awards.
--Geriatric Education Centers (GEC).--Under health reform, Congress
has approved a supplemental grant award program that will train
additional faculty through a mini-fellowship program and
requires that those faculty provide training to family
caregivers and direct care workers. Our funding request
includes support for the core work of 48 GECs and for the 24
GECs that would be funded to undertake this work though the
supplemental grants program.
--Geriatric Training Program for Physicians, Dentists, and Behavioral
and Mental Health Professions.--This program supports training
additional faculty in medicine, dentistry, and behavioral and
mental health so that they have the expertise, skills and
knowledge to teach geriatrics and gerontology to the next
generation of health professionals in their disciplines. Our
funding request includes support for 10 institutions to
continue this important faculty development program.
--Geriatric Career Incentive Awards Program.--Under health reform,
Congress has authorized grants to foster greater interest among
a variety of health professionals in entering the field of
geriatrics, long-term care, and chronic care management. Our
funding request includes support for implementation of this new
program.
Title VII Direct-Care Worker Training Program--Appropriations Request:
$3,333,333
Direct-care workers help older people carry out the basic
activities of daily living and are critical to ensuring an adequate
geriatrics workforce. Experts estimate that the United States will need
to fill one million new direct care positions within this decade.
--Training Opportunities for Direct Care Workers.--Under health
reform, Congress has approved a program, administered by HHS,
that will offer advanced training opportunities for direct care
workers. These opportunities are critical to the overall
success of healthcare reform. Our funding request includes
support for the Department of Labor to establish this unique
grants-program and support community colleges as they look to
increase the geriatrics knowledge and expertise of this
workforce.
Title VIII Geriatrics Nursing Workforce Development Programs--
Appropriations Request: $15,692,408
These programs, administered by the Health Resources and Service
Administration are the primary source of Federal funding for advanced
education nursing, workforce diversity, nursing faculty loan programs,
nurse education, practice and retention, comprehensive geriatric
education, loan repayment, and scholarship. In 2008, more than 51,657
nurses and nursing students were supported through these programs.
--Comprehensive Geriatric Education Program.--This program supports
additional training for nurses who care for the elderly;
development and dissemination of curricula relating to
geriatric care; and training of faculty in geriatrics. It also
provides continuing education for nurses practicing in
geriatrics. Our funding request includes ongoing support for
this critical program.
--Traineeships for Advanced Practice Nurses.--Under health reform,
the Comprehensive Geriatric Education Program is being expanded
to include advanced practice nurses who are pursuing long-term
care, geropsychiatric nursing or other nursing areas that
specialize in care of elderly. Our funding request includes
funds that would offer 200 traineeships to nurses under this
newly implemented program.
Without additional funds in these programs, we will fail to ensure
that America's healthcare workforce will be prepared to care for older
Americans. We understand that the Committee faces difficult budget
decisions. However, we strongly believe that by investing in these
programs, which create geriatrics faculty and offer the training that
is needed to ensure a competent workforce, we will be delivering better
care to America's seniors. Healthcare dollars will be saved from better
healthcare coordination and health outcomes, and the workforce will
grow as more people are trained, recruited, and retained in the field
of geriatrics.
On behalf of all the members of the Eldercare Workforce Alliance,
we commend you on your past support for geriatric workforce programs
and ask that you join us in expanding the geriatrics workforce at this
critical time--for all older Americans deserve quality of care, now and
in the future.
Thank you for your consideration.
______
Prepared Statement of the Federation of Associations in Behavioral and
Brain Sciences
Thank you for the opportunity to provide testimony in support of
NIH-funded research. The Federation of Associations in Behavioral and
Brain Sciences (FABBS) represents 22 scientific societies with an
interest in promoting human potential and well-being by advancing the
sciences of mind, brain, and behavior. Research covering the spectrum
from genes and molecules, to the brain and mind, and to behavior,
social relationships, culture and the environment are necessary to
provide a full understanding of health and disease.
NIH is supporting research that will lead to ground-breaking
discoveries that will improve health and save lives. An essential part
of the overall research portfolio is research on the mind, brain, and
behavior. Basic and applied research that examines how the mind
functions, its relation to behavior and society, and its underlying
biology are critically important in understanding, preventing, and
treating disease.
Important transformations are occurring in science. Scientists
often work at different levels of analysis by examining, for example,
the impact of genes on health or alternatively, the influence of
culture on health. Both are necessary to address central questions
about health and illness. Increasingly, however, scientists are also
exploring the margins and bringing to bear multiple disciplines, tools,
technologies, and approaches to inform their work. All are necessary if
we are to truly understand the human condition and, in turn, enhance
human health, potential, and productivity.
The Role of Emotions, Cognitions, and Environment in Health and Illness
NIH is supporting the best research both within and across
disciplines to better understand the contributors to illness and
disease. In one program of research, investigators are attempting to
understand the mechanisms--neural, hormonal, cellular, genetic--by
which loneliness gets under the skin to affect health, and importantly,
how the mind can modulate these health outcomes. Humans are social
beings and spend about 80 percent of their time, on average, with other
people. Much research has shown that people who are socially isolated,
or perceive that they are socially isolated, have poorer health
outcomes. Specifically, loneliness has been associated with increased
duration and extent of illnesses ranging from the common cold to
depression to heart disease. The affected factors contributing to these
effects include diminished immune system responses, elevated blood
pressure, and even changes in gene expression. This new field of social
neuroscience is illuminating how the social environment affects
cognition, emotion, personality processes, brain, biology, and health.
Research in this area suggests that the risks associated with
developing heart disease that are posed by social isolation may be as
high as those posed by high cholesterol, high blood pressure, and even
smoking. Research has also shown that perceptions of being alone may be
more harmful to health than actually being alone. By understanding the
mechanisms by which social networks, mental processes, and biology are
linked, efforts can be made to translate this work more readily into
clinical contexts.
NIH is also supporting highly innovative research to better
understand emotions, since emotional states are central to mental and
physical health. With funding from the NIH Director's Pioneer Award,
one investigator is examining the complex mental and physical processes
in emotions. What is the physiological state giving rise to an emotion,
and how does the mind make meaning of the physical state? How does the
mind control emotions, and what role does context play in emotions?
Simply put, emotions may not be simple reflexes that turn on parts of
the brain, but are likely much more complex. Emotional disturbances
exact a huge toll on patients, and this research has the potential to
transform our understanding of a broad area of science.
Complex medical problems require approaches that draw upon a range
of scientific areas to address health challenges. These research
programs illustrate some of the exciting new work in the mind, brain,
and behavioral sciences funded by NIH.
The Importance of Fundamental Research at NIH
NIH investments in basic research are a critical part of the
overall research portfolio at NIH. A basic understanding of how cells
and genes function is a necessary building block. The same is true for
fundamental research in the mind, brain, behavior sciences. As Dr.
Collins has noted, NIH's mission is ``science in pursuit of fundamental
knowledge about the nature and behavior of living systems and the
application of that knowledge to extend healthy life and to reduce the
burdens of illness and disability.''
We commend NIH for its leadership in developing research
initiatives that will build a base of knowledge to inform many public
health challenges facing this country--from cancer, heart disease, and
HIV to diabetes and childhood obesity. One such initiative, called
OPPNET for Opportunity Network, was launched in November 2009 by NIH
Director Francis Collins M.D., Ph.D. The new trans-NIH initiative will
provide funding for emerging areas in the behavioral and social
sciences, similar to the research described above. OPPNET will build
upon existing NIH investments to create a body of knowledge about the
nature of behavior, the underlying mental and physical processes, and
how social factors influence it. As with basic research on genes and
molecules, this research is a necessary building block upon which many
other advances in science will be possible.
Initiating health-promoting behaviors and maintaining positive
changes remain a central question in health research. Behavior has a
pervasive impact on health, and despite advances in the science,
significant and sustained behavior change remains elusive. Given its
importance, NIH is investing in a new cross-NIH and cross-disciplinary
research agenda on the basic science of behavior change. The goal is to
``radically move this science forward.'' Key themes identified by
scientists for a new research agenda include integrating the science at
multiple levels (i.e., brain, person, and environment) such that
behavior changes can be seen at a population level. Also, there is a
need to better understand the basic mechanisms of behavior change,
examine key opportunities for changing behavior at various points in
the lifespan, and to target multiple behaviors at once since unhealthy
behaviors can have common underlying processes. The Science of Behavior
Change is one of seven new NIH Common Fund initiatives, one in which
NIH is pushing science to cross traditional disciplinary and topical
boundaries. These basic science initiatives are supported by multiple
Institutes across NIH.
Using its modest budget, the Office of Behavioral and Social
Sciences Research (OBSSR), created by Congress in 1993, continues to
play a key role in coordinating and facilitating initiatives across the
Institutes. In addition, OBSSR identifies new and promising
opportunities for the behavioral and social sciences to help advance
NIH's mission. Projects underway or in the pipeline include improving
our knowledge of the interplay among behavior, environmental factors
(particularly social environment), and genomic/epigenetic factors in
health illness; applying complex systems modeling to understanding and
ameliorating health disparities; promoting initiatives in health
literacy and community-based participatory research in medically
underserved populations; and identifying prevention strategies for
healthcare that are both grounded in science and cost-effective.
Translating Basic Behavioral and Social Science Discoveries
NIH's investments in basic research will lead to discoveries that
can be translated for use in clinical settings. Indeed, NIH is
increasingly turning its attention to this process. As NIH Director,
Dr. Collins has made this 1 of his 5 priorities. Likewise, behavioral
and social scientists at NIH are examining the opportunities and
challenges for translating promising findings from these sciences for
use in community and clinical care settings. For example, efforts to
translate basic behavioral and social science research findings into
behavioral interventions to reduce obesity will inform a critical
public health challenge facing this country. Translational research
will improve our ability to convert basic science discoveries into
meaningful community and clinical interventions.
Building Research Capacity in All Sciences
The sciences of mind, brain, and behavior are critical to the
health and well-being of our Nation's citizens and, in turn, the
Nation's prosperity. The development and progression of many illnesses
and health problems such as heart disease, diabetes, and obesity depend
on behavior. In addition, advancing knowledge in the behavioral and
social sciences is increasingly requiring technical expertise. For
example, to understand the workings of the mind, scientists must be
able to utilize fMRI, MEG, and EEG tools. Investing in research and
training in the behavioral and social sciences, as well as research and
training that involve behavioral and social scientists and cross
disciplinary boundaries, will address current needs and help prepare
the next generation of researchers. The Nation must build capacity in
all sciences and at all educational levels to address health needs and
remain competitive.
Fiscal Year 2011 Funding Request for NIH
This is an incredible time for science. Investments by Congress in
2009 and a commitment by the administration to science are allowing
mid-career and senior scientists to remain at work on complex health
problems facing our society, while also attracting a new generation of
scientists to become engaged and excited about careers in science. In
addition, new discoveries within scientific disciplines and across
disciplinary boundaries, are keeping the U.S. competitive. These
investments are making a difference back home, both in dollars that
support research positions at local universities and in the innovations
that improve health throughout our communities.
Investments in science will continue to spur economic growth now
and well into the future. We urge this subcommittee to support $35
billion for the National Institutes of Health in the fiscal year 2011
appropriation.
______
Prepared Statement of the Federation of American Societies for
Experimental Biology
On behalf of the Federation of American Societies for Experimental
Biology (FASEB), I respectfully request an appropriation of $37 billion
for the National Institutes of Health (NIH) in fiscal year 2011.
Sustained and predictable public support for biomedical research is
needed to accelerate the pace of discovery, improve the health of our
Nation's citizens, and contribute to the economic revitalization of our
country.
As a Federation of 23 scientific societies, FASEB represents more
than 90,000 life scientists and engineers, making us the largest
coalition of biomedical research associations in the United States.
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 scientists and
engineers to improve--through their research--the health, well-being,
and productivity of all people.
Due to the prior Federal investment in NIH, researchers have made
critical advances that have saved and improved the lives of millions of
Americans and provided doctors with cutting-edge tools to prevent and
treat costly and devastating diseases including:
--Type 2 Diabetes.--In the United States, about 11 percent of
adults--24 million people--have diabetes, and up to 95 percent
of them have type 2 diabetes. An additional 57 million
overweight adults have glucose levels that are higher than
normal but not yet in the diabetic range, a condition that
substantially raises the risk of a heart attack or stroke and
of developing type 2 diabetes in the next 10 years. Researchers
have recently demonstrated, based on a decade of data
collection, that intensive lifestyle changes aimed at modest
weight loss reduced the rate of developing type 2 diabetes by
34 percent in people at high risk for the disease. Intensive
lifestyle changes consisted of lowering fat and calories in the
diet and increasing regular physical activity to 150 minutes
per week. Participants received training in diet, exercise
(most chose walking), and behavior modification skills.
--Melanoma.--Drawing on the power of DNA sequencing, NIH researchers
identified a new group of genetic mutations involved in the
deadliest form of skin cancer, melanoma. This discovery is
particularly encouraging because some of the mutations, which
were found in nearly one-fifth of melanoma cases, reside in a
gene already targeted by a drug approved for certain types of
breast cancer. In the United States and many other nations,
melanoma is becoming increasingly more common. A major cause of
melanoma is thought to be sun exposure; the ultraviolet
radiation in sunlight can damage DNA and lead to cancer-causing
genetic changes within skin cells.
--Seasonal and Pandemic Flu.--Scientists have identified a small
family of lab-made proteins that neutralize a broad range of
influenza A viruses, including the H1N1 flu viruses, the 1918
pandemic influenza virus, and H5N1 avian virus. These human
monoclonal antibodies, identical to infection-fighting proteins
derived from the same cell lineage, also were found to protect
mice from illness caused by H5N1 and other influenza A viruses.
Because large quantities of monoclonal antibodies can be made
relatively quickly, these influenza-specific monoclonal
antibodies potentially could be used in combination with
antiviral drugs to prevent or treat the flu during an influenza
outbreak or pandemic.
--Stroke.--Scientists have identified a previously unknown connection
between two genetic variants and an increased risk of stroke,
providing strong evidence for the existence of specific genes
that help explain the genetic component of stroke.
--Heart Disease.--There has been a 63 percent reduction in deaths
from heart disease, and more than 1 million lives are saved
each year by therapies developed to prevent heart attack and
stroke.
--Cancer.--Since 2002, the number of deaths from cancer has decreased
steadily. In the past 30 years, survival rates for childhood
cancers have increased from less than 50 percent to more than
80 percent.
--HIV/AIDS.--This disease has been transformed from an acute, fatal
illness to a chronic condition; the prophylactic use of anti-
virals prevented almost 350,000 deaths worldwide in 2005. In
the United States, deaths from AIDS dropped nearly 70 percent
between 1995 and 2000. Life expectancy for those infected with
HIV has increased by 10 years.
The completion of the Human Genome Project and the resulting
reductions in genome sequencing costs are another example of how the
prior investment in research has both dramatically increased the pace
of discovery and harnessed the power of technology. Genome sequencing
brings us to the threshold of personalized medicine, where knowledge of
our own individual genetic makeup can be used to target cures and
identify the most effective therapies for individuals. Researchers are
at the beginning of a whole new era of pharmacogenomics that will
identify methods to tailor treatments and scientifically match
therapies to individual circumstances in ways that were inconceivable a
few years ago.
Knowledge of an individual's genetic make-up has already been
effective in determining which drugs work best with certain cases of
AIDS, breast cancer, acute lymphoblastic leukemia, and colon cancer.
The number of new research proposals is expected to expand dramatically
as researchers exploit this exciting line of inquiry, yet continued
progress toward that goal depends on sustained and predictable funding
support for the NIH.
Sustainable Budget Growth Will Maximize the Return on Investment
Additional funding is needed to fully develop the knowledge we have
gathered to date and to apply that knowledge in clinical settings. The
research engine needs a predictable, sustained investment in science to
maximize our return on investment. The discovery process--while
producing 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 are disruptive to
training, careers, long-range projects, and ultimately to scientific
progress. 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, continuous growth that will enable us to complete President
Obama's vision of doubling our investment in basic research.
The most painful consequence of failing to continue the robust
investment in research will be the delay in relief to those suffering
from the burdens of disease. Long-term plans for Federal investment in
science facilitate coordination and planning, encourage investments by
the private sector, attract new talent, reduce the startup costs of
projects, and eliminate the possibility of waste that could result from
abrupt termination of valuable scientific investigations.
Prosperity and Quality of Life Are Shaped By Investments in Science
As a Nation, we currently find ourselves confronting a number of
unprecedented social and economic challenges, and once again our
leaders have turned to research in the quest for solutions to these
vexing problems. Funds from the American Recovery and Reinvestment Act
(ARRA) have inspired the creative energies of research teams across the
Nation. These new resources, coming after many years during which our
capacity for research was eroded by flat budgets, are a lifeline for
new ideas, research personnel, and progress.
ARRA funding was only appropriated for a 2-year period, and we face
a major shortfall when these funds have been spent. Returning to pre-
ARRA funding levels presents a frightening prospect for those whose
hopes for a brighter future rest with medical research. It will also be
a setback for the scientists who have contributed so much of their time
and talent to this quest. It is critical that we invest now to sustain
the excitement in research, maximize the return on our prior
investments, and continue the innovative pipeline of medical and
technological advancements that Federal science agencies have always
fostered.
Despite the fragile economy, now is not the time to pull back from
our historic commitment to investigation and discovery. Our leadership
in science and engineering has made us the envy of the world. However,
we must nurture our research investment to benefit from the knowledge
that we have gained and ensure that continued progress is not
curtailed. President Obama has recognized the importance of continuing
support for the NIH in his proposed budget for fiscal year 2011.
A half-century of public investment in NIH has dramatically
advanced the health and improved the lives of Americans and of people
around the globe. Unfortunately, millions of Americans and their
families still suffer from the ravages of disease and cannot wait for
new treatments, therapies, and prevention strategies. Sustained and
predictable public support for biomedical research is needed now more
than ever. We recognize that this subcommittee has the especially
difficult task of providing funding for a wide range of critical human
service programs and thank you for your prior support of the research
enterprise. Nonetheless, additional resources are needed to pursue the
unprecedented level of scientific opportunities available today and
uphold the Nation's role as a leader in medical research. Therefore,
FASEB recommends an appropriation of $37 billion for NIH fiscal year
2011.
______
Prepared Statement of the Friends of NIAAA
Mr. Chairman and members of the subcommittee: The Friends of the
National Institute on Alcohol Abuse and Alcoholism, a coalition of
scientific and professional societies, patient groups, and other
organizations committed to preventing and treating alcohol use
disorders as well as understanding the causes and public health
consequences of alcoholism and alcohol use disorders, is pleased to
provide testimony in support of the NIAAA's extraordinary work. The
coalition does not receive any Federal funds.
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) is
the lead agency for U.S. research on alcohol abuse, alcoholism, and
other health and developmental effects of alcohol use. Its mission is
to support research, and then translate and disseminate research
findings to reduce alcohol-related problems. NIAAA funds 90 percent of
all alcohol research in the United States. From fetal alcohol syndrome
to alcohol dependence, and from liver cirrhosis to alcohol poisoning,
the consequences of alcohol misuse are widespread and costly, and
affect individuals of every age, ethnic background, and socioeconomic
status. Drinking too early, too fast, too much, and/or too often can
lead to acute and chronic consequences for the drinker as well as
outcomes affecting the health and well-being of others and society-at-
large.
Approximately 18 million Americans meet the criteria for a
diagnosis of alcohol dependence (alcoholism) or alcohol use disorders
(AUD), and 40 percent of Americans have direct family experience with
alcohol use disorders or dependence. Annually, 80,000 deaths are
attributable to alcohol, as are approximately one-third of all fatal
car crashes, one-half of all homicides, one-third of all suicides, and
one-third of all hospital admissions. In fact, excessive alcohol
consumption is the third leading preventable cause of death in the
United States. AUDs cost the Nation $235 billion annually, nearly 80
percent more than the costs related to all other addictive drugs.
Because of the critical importance of alcohol research for the
health and economy of our Nation, we write to you today to request your
support for a modest 2.7 percent increase for NIAAA in the fiscal 2011
Labor, Health and Human Services, and Education, and Related Agencies
appropriations bill. That would bring total funding for NIAAA in fiscal
year 2011 to $474,649,000. This work deserves continuing, strong
support from Congress. The following is a list of key new NIAAA
initiatives that could be pursued with additional investment, and a
short summary of significant NIAAA accomplishments and successes.
NIAAA initiatives for fiscal year 2011:
--NIAAA will continue to support research on the mechanisms by which
alcohol causes damage to, as well as pharmacologic agents that
lessen alcohol's adverse effects on, the developing embryo and
fetus. Resources will also be directed towards the development
of biomarkers, which could be used to detect alcohol exposure
in pregnant women.
--New initiatives in fiscal year 2011 will support several broad
National Institutes of Health themes, including applying
genomics and other high throughput technologies to understand
fundamental biology, and to uncover the causes of specific
diseases, translating science into new and better treatments
and putting science to work for the benefit of healthcare
reform.
--NIAAA will support the continuing development of a screening guide
for use with children and adolescents to assess for risk of
alcohol use and alcohol use disorders. In addition, NIAAA is
planning a new research initiative on pharmacotherapy for
adolescents and young adults with severe alcohol use disorders
and major co morbidities, as well as behavioral interventions
that target young individuals along the continuum of alcohol-
related behaviors.
--In fiscal year 2011, NIAAA will continue to promote and disseminate
its Web-based booklet Rethinking Drinking. NIAAA is planning a
new initiative exploring the effects of community interventions
on alcohol related outcomes in young adults. Research has
demonstrated that comprehensive community interventions that
typically involve multiple levels of city government,
environmental policy change and community involvement, among
other factors, may reduce alcohol-related problems among
adolescents and young adults, including college students.
--NIAAA is planning a new initiative on developing effective
pharmacological and behavioral treatments for individuals who
have alcohol use disorders and co-existing other drug,
psychiatric, and/or physical disorders. NIAAA will also support
studies aimed at risk reduction, early identification and
diagnosis of harmful alcohol use and personalized treatment.
Additional funds will be committed for research on the
underlying mechanisms of alcohol-induced liver injury and the
identification of biomarkers of alcohol-induced tissue injury.
These studies are expected to reveal new therapeutic targets,
inform strategies for preventing tissue injury, facilitate
early diagnosis, and improve the prognosis for alcohol-related
liver disease.
A Partial List of Important NIAAA Innovations
Advancing the Understanding of the Mechanisms and
Consequences of Prenatal Alcohol Exposure
The Friends of NIAAA commends the Institute for its research to
enhance our ability for early identification of and interventions with
prenatal alcohol affected children; exploring nutritional and
pharmacological agents that could lessen alcohol's adverse effects on
the developing embryo/fetus; and research on how alcohol disrupts
normal embryonic and fetal development. Research has shown that the
severity of alcohol-related effects on the developing fetus is affected
by the timing and level of maternal alcohol consumption, maternal
nutritional status, and maternal hormones. One of the key challenges
facing clinicians is the ability to recognize women who are drinking in
pregnancy and the infant who has been exposed prenatally to alcohol
during pregnancy. Recently there have been advances in methodologies
for the measurement of nonoxidative metabolites of alcohol providing
new opportunities for monitoring alcohol exposure.
Understanding the Effects of Alcohol use on the Developing Body and
Brain, and the Interplay of Development, Genes and Environment
on Adolescent Alcohol use
As adolescence (ages 0-17) is the time of life during which
drinking, binge drinking (drinking five or more drinks on one
occasion), and heavy drinking (binge drinking five or more times in the
past 30 days) all ramp up dramatically, the Friends of NIAAA is pleased
that the Institute is vigorously focused on these concerns. Given that
alcohol use is pervasive among adolescents and the association between
early initiation and future alcohol problems, NIAAA is developing
empirically based guidelines and recommendations for screening children
and adolescents to identify risk for alcohol use especially for younger
children; alcohol use, and alcohol use disorders. NIAAA is also
supporting studies to integrate intervention for underage alcohol use
into primary healthcare. Research has shown that during adolescence,
the brain undergoes significant growth and remodeling. This finding,
coupled with the results of multiple studies showing a strong
association between early initiation of alcohol use and future alcohol
dependence, raises concerns about alcohol's effects on the developing
adolescent brain.
Specifically, the issues are whether persistent changes in neural
and behavioral function result from adolescent alcohol use, and whether
processes that confer adaptability of the adolescent brain to its
environment also make it more vulnerable to alcohol-induced changes in
structure and/or function, especially in terms of setting it up for
future dependence. Complementing NIAAA's ongoing pilot studies with
humans to determine if alcohol can disrupt, co-opt and/or alter normal
developmental processes in the brain, NIAAA is also planning an
initiative to study persistent alcohol-induced changes in the brain in
animal models.
Pioneering Risk Assessment, Universal and Selective Prevention, and
Early Intervention and Treatment for Young Adults
Given the pervasiveness of high-risk drinking and early alcohol
dependence occurring among young adults, efforts to alter drinking
trajectories at this stage have life-changing potential and can
significantly reduce the burden of illness resulting from alcohol-
related problems. Recent research has demonstrated that college-aged
individuals respond well to Web-based screening and self-change
programs, resulting in reductions in adverse alcohol-related
consequences. Making alcohol screening and brief intervention a routine
procedure in primary care and other settings is a high-priority of
NIAAA.
Exploring Pharmacologic Interventions for Alcohol-use Disorders
In addition to its role in alcohol dependence, excessive alcohol
consumption can have toxic effects on virtually every organ system in
the body resulting in liver and heart disease, pancreatitis, fetal
abnormalities, brain damage, and an increased risk for esophageal and
liver cancer. Liver disease in particular claims 37,000 lives annually,
about 40 percent of which are due to excessive alcohol use. Currently
the only treatment for liver cirrhosis--the end stage of alcoholic
liver disease--is liver transplantation which is impacted by limited
availability of matching organs, high medical costs, and increased risk
for future health complications. Intervening early in the disease
process continues to be an important priority of NIAAA, and research is
moving us closer to developing medications that can slow or even
reverse disease progression and/or mitigate health consequences. For
example, preliminary research has shown that administration of the
dietary supplement S-adenosylmethionine (SAMe) may reverse disease
symptoms in individuals with early stage liver disease and pre-empt
cirrhosis. A phase 2 clinical trial testing the effects of this
compound is currently underway. NIAAA and NIDDK are co-funding a
project focused on developing small molecules to reverse alcoholic
liver fibrosis, as well as liver damage resulting from obesity and
metabolic syndromes. Animal studies evaluating prenatal and early
postnatal supplementation with the nutrient choline, a molecule
important to the structure and function of cell membranes, have shown
reduced severity of certain behavioral and physical effects of prenatal
alcohol exposure. For alcohol dependence, NIAAA is moving medications
that promote abstinence and/or reduction in heavy drinking through the
medications development pipeline via its early phase 2 clinical trials
program. These include trials for quetiapine, a mood stabilizing drug,
completed in late fiscal year 2009 and for levetiracetam, an
antiepileptic medication, initiated in late fiscal year 2009.
Improving the Identification of Mechanisms by Which Alcohol and its
Metabolites Cause Tissue and Organ Pathologies, and the
Development of Treatment Strategies for Alcohol Dependence
Tailored to Specific Populations and for Individuals With Co-
Existing Psychiatric and Medical Disorders
Over the past four decades, numerous scientific advances have been
made in identifying the pathologic effects of alcohol and its metabolic
products on the brain, liver, heart, pancreas, and immune and endocrine
systems. Recently, NIAAA has taken a systems biology approach,
investigating how perturbation of one organ system by alcohol
influences other organ systems, leading to a cascade of effects
throughout the body. Alcohol consumption sets in motion a number of
signaling processes which operate directly and indirectly on multiple
systems in the body. For example, one mechanism by which alcohol
negatively impacts the liver and brain is through signaling molecules
released from the gut. The gut normally contains bacteria whose outer
membranes consist primarily of large amounts of molecules known as
lipopolyscaccharides (LPS). Alcohol increases gut ``leakiness''
allowing LPS to travel throughout the body, resulting in inflammation
in both the brain and liver. Liver inflammation then triggers the
release of cytokines, signaling molecules that promote further
inflammation in the brain. Gut ``leakiness'' may also be the mechanism
by which alcohol disrupts immune function. Another target of alcohol
may be the hypothalamic pituitary adrenal axis (HPA axis), a major part
of the neuroendocrine system that regulates reactions to stress and
many body processes, including digestion, the immune system, mood and
emotions, sexuality, and energy storage and expenditure. Considering
the human body as a complex network in which perturbations of one organ
system alters interactions with other organ systems thereby affecting
the functions of each, will enable the development of treatments that
address the source(s) of alcohol-induced tissue and organ damage.
The Friends of NIAAA commends the National Institute on Alcohol
Abuse and Alcoholism for making significant progress in these and many
other vital areas of research that are essential to the health and
well-being our Nation.
Thank you, Mr. Chairman, and the subcommittee, for your support for
the National Institute on Alcohol Abuse and Alcoholism.
______
Prepared Statement of the Friends of NICHD
The Friends of the National Institute of Child Health and Human
Development (NICHD) is a coalition of more than 100 organizations,
representing scientists, physicians, healthcare providers, patients,
and parents, concerned with the health and welfare of women, children,
families, and people with disabilities. We are pleased to submit
testimony to support the extraordinary work of the Eunice Kennedy
Shriver National Institute of Child Health and Human Development.
We would like to thank Chairman Harkin, Ranking Member Cochran, and
the Congress for its continued support of the National Institutes of
Health (NIH) and interest in building on the investments made in
predictable and sustained, long-term growth in NIH funding in the
fiscal year 2011 budget and beyond. To ensure that progress in basic,
translational and clinical research is sustained, the Coalition joins
the Ad Hoc Group for Medical Research in supporting a fiscal year 2011
appropriation of at least $35 billion, an increase of $2.6 billion for
NIH.
The Coalition has a particular interest in the important research
conducted and supported by the NICHD. Since its establishment in 1963,
the NICHD has made great strides in meeting the objectives of its broad
biomedical and behavioral research mission. The NICHD mission and
portfolio includes a focus on women's health and human development,
including research on child development, before and after birth;
maternal, child, and family health; learning and language development;
reproductive biology and population issues; and medical rehabilitation.
Although the NICHD has made significant contributions to the well-
being of children, women, and families, much remains to be done. With
sufficient resources, the NICHD could build upon the promising
initiatives described in this testimony and produce new insights into
human development and solutions to health and developmental problems
for the world and for the Nation--including the families living in your
districts. For fiscal year 2011, the Friends of NICHD support an
appropriation of at least $1.495 billion for NICHD.
New Discoveries
Adding to its strong record of progress over the past 45 years,
recent advances by the NICHD have contributed to the health and well-
being of our Nation and world. Several highlights are:
Tracking Brain and Behavioral Development.--The NICHD is one of the
leading Institutes in the NIH Magnetic Resonance Imaging (MRI) Study of
Normal Brain Development. The study tracks brain and behavioral
development in 500 healthy children from diverse backgrounds birth to
age 18. The latest findings show that children appear to have reached
adult levels of performance on basic cognitive and motor skills by age
11 or 12. Long-term, the goal is to link these behavioral data to MRI
scans of the children's brains. Together, the two data sets will allow
researchers to view how the brain grows and reorganizes itself, and to
explore the structural changes. The database will also serve as a
reference to better understand what goes wrong in children with genetic
disorders, language and learning difficulties, prenatal exposure to
alcohol or drugs or other brain injury.
Preterm Birth Risk Factors.--Researchers funded by the NICHD
identified DNA variants in mothers and fetuses that appear to increase
the risk for preterm labor and delivery. The current findings add to
the evidence that individual genetic variation may account for why
preterm labor occurs in some pregnancies and not in others. The
findings may one day lead to new strategies to identify those at risk
for preterm birth, and to ways to reduce the occurrence of preterm
birth among those at risk.
Treating Mild Gestational Diabetes Reduces Birth Complications.--
NICHD funded researchers found the first conclusive evidence that
treating pregnant women who have even the mildest form of gestational
diabetes can reduce the risk of common birth complications among
infants, as well as blood pressure disorders among mothers.
Specifically, women treated for mild gestational diabetes had smaller,
leaner babies less likely to be overweight and less likely to
experience shoulder dystocia, an emergency condition in which the
baby's shoulder becomes lodged inside the mother's body during birth.
Treated mothers were also less likely to undergo cesarean delivery, to
develop high blood pressure during pregnancy, or to develop pre-
eclampsia, a life-threatening complication of pregnancy that can lead
to maternal seizures and death.
Future Research Opportunities
Although the studies mentioned above have unquestionably made
significant contributions to the well-being of our children and
families, there is still much to discover about ways to improve health,
learning, and quality of life. Progress in the following research areas
can only be achieved with adequate Federal investments.
Severe, Early Adverse Pregnancy Outcomes.--Women with severe, early
adverse pregnancy outcome, such as multiple losses, demises, and severe
preeclampsia, are at increased risk for long-term chronic health
problems, including hypertension, stroke, diabetes, and obesity.
Studies have shown that women who have had preeclampsia are more likely
to develop chronic hypertension, to die from cardiovascular disease and
to require cardiac surgery later in life. In addition, approximately 50
percent of women with gestational diabetes will develop diabetes later
in life. Pregnancy can be considered as a window to future health and
the immediate postpregnancy period provides a unique opportunity for
prevention of chronic diseases later in life. Studies to identify women
at risk for long-term morbidity, and to develop strategies to prevent
long-term adverse outcomes in these women are urgently needed.
Preterm Birth.--Preterm birth is a serious and growing public
health problem that affects more than 500,000 babies each year. It is
the leading cause of neonatal death and about half of all premature
births have no known cause. A key strategy recommended by the Institute
of Medicine and experts convened for the Surgeon General's Conference
on the Prevention of Preterm Birth is to create integrated
transdisciplinary research centers to build the knowledge base needed
for development of effective interventions to prevent prematurity.
These new centers would serve as a national resource for investigators
to design new research approaches and strategies to address the serious
and growing problem of preterm birth.
National Children's Study.--The National Children's Study is the
largest and most comprehensive study of children's health and
development ever planned in the United States. Currently, the
``vanguard centers'' are recruiting pregnant women and more than 150
children have been born into the study. When fully implemented, this
study will follow a representative sample of 100,000 children from
across the United States from before birth until age 21. The data
generated will inform the work of scientists in universities and
research organizations, helping them identify precursors to disease and
to develop new strategies for prevention and treatment. Identifying the
root causes of many childhood diseases and conditions, including
preterm birth, asthma, obesity, heart disease, injury and diabetes,
will reduce healthcare costs and improve the health of children. The
Friends of NICHD thank the subcommittee for funding the NCS through the
NIH Office of the Director in fiscal year 2010, and urge the
subcommittee to provide $194.4 million for the study in fiscal year
2011.
Newborn Screening Translational Research Network.--The network is
designed to improve newborn screening, the care of patients with
disorders identified through screening, and deepen understanding of
conditions for which screening should be made available. By
contributing to our understanding of patients with genetic diseases,
this network will accelerate research in diseases related to newborn
screening and greatly improve the process by which public health
decisions are made about the expansion of newborn screening.
Unraveling Genetic Basis of Autism.--NICHD is capitalizing on
advances in genetics research by participating in the Autism Genome
Project (AGP), a public-private collaboration involving more than 120
scientists and 50 institutions in 19 countries. The first study to
emerge from AGP implicated components of the brain's glutamate chemical
messenger system and a previously overlooked site on chromosome 11.
Based on 1,168 families with at least 2 affected members, the genome
scan also adds to evidence that tiny, rare variations in genes may
heighten risk for autism spectrum disorders. The spectrum of disorders
collectively known as autism affects as many as one in 150 Americans
resulting in impaired thinking processes, emotional and social
abilities, and motor control. So far, the only known cause of autism
for which there is a verifiable blood test is Fragile X; further
research on this disorder would provide understanding of the function
of this gene (FMR1) as well as others that cause autism. With NIH
support, the AGP is pursuing studies to identify specific genes and
gene variants that contribute to vulnerability to autism. These include
explorations of interactions of genes with other genes and with
environmental factors, and laboratory research aimed at understanding
how candidate susceptibility genes might work in the brain to produce
the disorders.
Education and School Readiness Research.--NICHD continues to build
its portfolio of research on how children acquire the emotional, social
and academic skills necessary to succeed in school and beyond; however
more work is needed in four particular areas: (1) Neurological
processing disorders--how they impact learning and literacy,
particularly in reading comprehension for grades 4-8, so that early
intervention may improve learning and academic outcomes for young
adults; (2) learning delays and language development--how to
distinguish if they are caused by language barriers versus possible
learning disabilities in school-age children; (3) math disabilities--
where they reside in the brain, how they impact learning over time and
what we can do to remediate and intervene with those who have them; and
(4) school readiness--how to develop better measures of the social and
emotional bases which will inform our early education programs. The
combination of study in these four areas will help inform the Nation's
education and innovation agenda to support and grow a competitive
workforce.
Family Research.--As the family is the primary context for child
development, the NICHD has played a significant role in examining the
dramatic changes in family structure in the United States over the last
40 years. Scientists are currently focused on developing new study
designs to better understand the family processes that transcend the
traditional home environment, including the role of absent fathers, the
contributions of grandparents and others outside the immediate family.
Recognizing that so many parents are also in the workforce, NICHD is
moving forward on its Work, Family, Health and Well-Being Initiative.
The long-range goals of the initiative are to identify workplace
interventions that can improve health by improving the ability of the
worker to successfully meet both work and family demands.
Intellectual and Developmental Disabilities.--Ongoing support of
the research in mental retardation and developmental disabilities being
undertaken at the Eunice Kennedy Shriver Intellectual and Developmental
Disabilities Research Centers (IDDRC) is essential. Many disorders are
being studied by the IDDRC such as Down syndrome, Fragile X syndrome,
Rett syndrome, and autism. Genetic and biomedical advances over the
past few years hold the promise for understanding the threats to
healthy and full development and ultimately to the prevention and
amelioration of the impact of many disabilities.
Obesity.--NICHD is integrally involved in research into the origins
of obesity in childhood. Next to tobacco use, diet and exercise
represent the areas in which prevention efforts will have the greatest
impact in reducing the socioeconomic and societal burdens of the
obesity epidemic. More developmental research needs to be focused on
understanding the interplay among behavioral, social and physical
environment, and biological factors that lead to obesity so that
effective and appropriate interventions can be developed earlier in the
life cycle.
Rehabilitation Research.--The NICHD houses the National Center for
Medical Rehabilitation Research (NCMRR). This Center fosters the
development of scientific knowledge needed to enhance the health,
productivity, independence, and quality-of-life of people with
disabilities. A primary goal of Center-supported research is to bring
the health related problems of people with disabilities to the
attention of the best scientists in order to capitalize upon the myriad
advances occurring in the biological, behavioral, and engineering
sciences.
SIDS.--Though the NICHD has made remarkable progress in reducing
the rate of SIDS, SIDS remains the leading cause of death in infants
from 1 month of age to 1 year. More research and public education is
needed to address the large number of babies dying of asphyxiation and
suffocation in unsafe adult bed-sharing situations. Additional support
is also needed to expand the work of NICHD's Stillbirth Collaborative
Research Network, where for the first time we are finding answers that
may ultimately lead to prevention of many of these 26,000 devastating
losses, many of which are late term and yet unexplained.
Conclusion
The potential contributions of the Institute to the lives of
countless individuals are limited only by the resources available for
carrying out its vital mission. This is why the Friends of NICHD ask
you to provide an appropriation of $1.495 billion to the Institute. Our
Nation and the world will continue to benefit from your promise to
improving health and scientific advancement long after the doubling
effort is over.
We thank you, Mr. Chairman, and the subcommittee, for your support
of the Eunice Kennedy Shriver National Institute of Child Health and
Human Development, and thank you for the opportunity to share these
comments.
______
Prepared Statement of The Friends of the National Institute on Aging
Chairman Harkin and members of the subcommittee, thank you for the
opportunity to provide testimony regarding the crucial role of the
National Institute on Aging (NIA) within the National Institutes of
Health (NIH) and the need for increased appropriations in the fiscal
year 2011 budget to ensure sustained, long-term growth in aging
research.
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. As a coalition, 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 NIA.
My testimony today demonstrates 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 (ARRA) for NIH research and training activities in fiscal year
2011.
The Relevance of the Work of the NIA
NIH is the primary funder of biomedical research in this country
and as such, NIA leads the Federal effort to advance biomedical and
behavioral research in aging. NIA leads the national scientific effort
to understand the nature of aging in order to promote the health and
well-being of older adults. NIA's mission is three-fold: (1) Support
and conduct genetic, biological, clinical, behavioral, social, and
economic research related to the aging process, diseases and conditions
associated with aging, and other special problems and needs of older
Americans; (2) Foster the development of research- and clinician-
scientists for research on aging; and (3) Communicate information about
aging and advances in research on aging with the scientific community,
healthcare providers, and the public. The NIA carries out this mission
by supporting both extramural research at universities and medical
centers across the United States and vibrant intramural research at the
NIA's laboratories in Baltimore and Bethesda, Maryland. The work of the
NIA focuses not only on diseases and conditions of aging but also on
the processes underlying the aging process itself and as such, the
research conducted by NIA-funded scientists has relevance for each and
every person in America, regardless of age.
Forward Momentum: ARRA Funding and the NIA
The bolus of funding provided by ARRA has made it possible for NIA-
funded researchers to make progress towards key research questions
related to health and aging. As a result of ARRA funding, NIA-funded
scientists have been able to intensify their research efforts in areas
of critical importance to aging and health, including but not limited
to the following:
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Understanding how Alzheimer's Disease Investigating the ways in
develops and progresses. which Alzheimer's Disease
(AD) and vascular disease
may adversely affect one
other in the hopes of
identifying strategies for
preventing dementia.\1\
Examining the ways that
energy metabolism
influences brain aging by
looking for correlations
among brain imaging
patterns, dementia, and
metabolic measures in aging
and in people with AD.\2\
Identifying genetic and other risk factors Using genome-wide
for Alzheimer's Disease. association studies to
compare the genomes of
individuals with and
without AD to identify
potential genetic risk.\3\
Seeking new ways of screening for and Identifying best practices
detecting Alzheimer's Disease. for cerebrospinal fluid
sample collection and
attempting to identify AD
biomarkers in cerebrospinal
fluid before the onset of
symptoms.\4\
Comparing the effectiveness
of brain imaging and blood
biomarkers to diagnose
AD.\5\
Discovering possible prevention and Elucidating the long-term
treatment strategies for Alzheimer's effect of naproxen and
Disease. other NSAIDS on cognitive
health by following
participants in the
Alzheimer's Disease Anti-
inflammatory Prevention
Trial (ADAPT) to.\6\
Determining whether
compounds that manipulate
the histone code may have
therapeutic value for AD
and other neurological
disorders.\7\
Enhancing neuroimaging methods and tools.. Developing software to
simplify the analysis of
complex brain-image data
relating to the structure
and function of the human
brain.\8\
Developing a ``network
diagram'' that links
genetic information with
underlying brain circuitry
in the neural systems
controlling behavior and
emotion to improve our
understanding of the
connectivity of circuits
that are disturbed in
neurologic conditions,
including mental illness,
autism, Parkinson's
disease, Alzheimer's
disease, and addiction.\9\
Preventing neuroinflammation.............. Developing a safe and
effective vaccine for the
treatment of AD that will
not cause an inflammatory
response in the brain.\10\
Understanding the impact of economic Examining trends in
concerns on older adults. demography, economics,
health, and health care of
the elderly by evaluating
the effects of medical
technology on costs and
examining changes in
survival, health, and well-
being among older people
over time.\11\
Examining the financial
circumstances of older
Americans, including work
and retirement behavior,
health and functional
ability, and policies that
influence individual well-
being.\12\
Improving the quality of patient care..... Evaluating the effectiveness
of feeding tubes in the
hospital setting to reduce
weight loss among older
adults with dementia.\13\
Describing risk factors and
long-term consequences of
adverse medical events or
medical injuries among
older adults.\14\
Preparing the next generation of Recruiting and training
researchers. doctoral-level students in
health services research to
prepare them for careers as
independent scientists.\15\
Recruiting new faculty
members to enhance the
capacity for
transdisciplinary research
on aging that examines how
social context and the
healthcare system interact
to impact health outcomes
for older adults.\15\
------------------------------------------------------------------------
\1\ 1 F32 AG031620-01A2--Nozomi Nishimura (NY).
\2\ 3 K23 NS058252-04S1--Jeffrey Burns (KS).
\3\ 2 R01 AG016208-10A2--Alison Goate (MO); 1 RC2AG036528-01--Gerard
Schellenberger (PA); 1 RC2 AG036650-01--Denis A. Evans, Jill R.
Murrell, and Philip De Jager (IL).
\4\ 1 RC2 NS069502-01--Howard Schulman (NC); 1 RC1 AG035654-01--David
Holtzman (MO).
\5\ 1 RC1 AG036208-01--Orly Lazarov (IL).
\6\ 2 U01 AG015477-06A2--John Breitner (WA).
\7\ 1 RC1 AG035711-01--Li-Huei Tsai (MA).
\8\ 2 R01 AG013743-13A1--Edward Herskovits. (PA).
\9\ 1 RC1 NS069152-01--Julie R. Korenberg (contact), Tolga Tasdizen
(UT).
\10\ 3 R01 AG20159-08S1--Cynthia Lemere (MA).
\11\ 3 P30 AG017253-10S1--Alan Garber (CA).
\12\ 3 P30 AG012810-16S1 and 16S2--David A. Wise (MA).
\13\ 1 RC1 AG036418-01--Joan Teno (RI).
\14\ 1 R21 AG031983-01A1--Mary Carter (WV).
\15\ 2 T32 AG023482-06--Vincent Mor (RI).
\16\ 1 P30 AG036459-01--David Meltzer (IL).
With a sustained investment in the NIH funding base, these and
other NIA-funded projects will yield breakthroughs in the screening,
prevention and treatment of a host of age-associated diseases and
conditions. With the fiscal year 2011 budget, Congress has the
opportunity to increase the forward momentum of NIA-funded scientists
towards achieving these much-needed breakthroughs.
The Challenges and Opportunities Ahead
A key challenge is maintaining the positive momentum set into
motion by Congress through ARRA. Between fiscal year 2003 and fiscal
year 2009, scientists saw a series of nominal increases and cuts that
amounted to flat funding for NIH and a 12.9 percent reduction in
constant dollars for the NIA. Six years of flat funding for the NIH
took a toll on scientific progress in America--projects were sidelined,
promising grants went unfunded, and countless life-saving discoveries
went undiscovered. With the infusion of funding from ARRA NIH
researchers are regaining some of the ground lost during that time
period. NIA is poised to accelerate the scientific discoveries that we
as a nation are counting on America's leading researchers to achieve.
With millions of Americans facing the loss of their functional
abilities, their independence, and their lives to diseases like
Alzheimer's Disease, Parkinson's Disease, Amyotrophic Lateral
Sclerosis, and Frontotemporal Dementia, there is a pressing need for a
robust and sustained investment in the work of NIH and by extension,
NIA. In every community in America, healthcare providers depend upon
NIA-funded discoveries to help their patients and caregivers lead
healthier and more independent lives. In those same communities across
America, parents are hoping NIA-funded discoveries will help their
children have a brighter future, free from the diseases and conditions
of aging that plague our Nation today.
We do not yet have the knowledge needed to predict, pre-empt, and
prevent the broad spectrum of diseases and conditions associated with
aging. We do not yet have the knowledge needed about disease processes
to understand how best to prevent, diagnose, and treat diseases and
conditions of aging, nor do we have the knowledge needed about the
complex relationships between biology, genetics, and behavioral and
social factors related to aging. We do not yet have a sufficient pool
of new investigators entering the field of aging research. Bold,
visionary, and sustainable investments in the NIA will make it possible
to achieve measurable gains in these areas sooner rather than later.
The member groups of the Friends of the National Institute of Aging
respectfully urge this subcommittee to provide sustained support for
biomedical and behavioral research by increasing NIA funding by a
minimum of 7 percent in fiscal year 2011 to correspond with the overall
funding increase to NIH. NIA and the health-enhancing and life-saving
biomedical, behavioral and social research it supports require bold,
visionary, and sustainable funding to succeed in transforming the
health of our Nation. Americans depend upon the NIA to facilitate the
acceleration of discoveries to prevent, treat, and potentially cure a
wide range of debilitating age-related diseases and conditions. NIA-
supported scientists are poised to make breakthroughs in the prevention
and treatment of a host of age-associated diseases and conditions, but
in order to achieve these powerful results, meaningful investments in
aging research must be made now.
While the Friends of the NIA recognizes that there is enormous
competition for congressional appropriations, we believe that an
increase in funding for the NIH will yield unprecedented returns in
terms of accelerating the rate of basic discovery and stimulating the
rapid development of interventions with the potential to offer
significant public health benefits for our aging population.
Mr. Chairman, the Friends of the NIA thanks you for this
opportunity to outline the challenges and opportunities that lie ahead
as you consider the fiscal year 2011 appropriations for the NIH. We
would be happy to furnish additional information upon request.
______
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 & CEO of the FSH Society, Inc.
(facioscapulohumeral muscular dystrophy) and as an individual who has
this common and most prevalent form of muscular dystrophy. 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 (FSHD) and
the urgent need for increased National institutes of Health (NIH)
funding for research on this disorder. 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.
FSHD is The Most Prevalent Form of Muscular Dystrophy
It is a fact that FSHD is published in the scientific literature as
the most prevalent muscular dystrophy in the world. The incidence of
FSHD is conservatively estimated to be 1 in 14,000. The prevalence of
the disease, those living with the disease, ranges to 2 or 3 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 U.S.
National Institutes of Health (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'' November 2008--Issue 10 report can
be found at Internet Web site (http://www.orpha.net/orphacom/cahiers/
docs/GB/Prevalence_of_rare_diseases_by_alphabetical_list.pdf). This
publication 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 form of
muscular dystrophy.
------------------------------------------------------------------------
(Cases/
Estimated prevalence 100,000)
------------------------------------------------------------------------
Facioscapulohumeral muscular dystrophy (FSHD)........... 7/100,000
Duchenne (DMD) and Becker Muscular dystrophy (BMD)...... 5/100,000
Steinert myotonic dystrophy (DM)........................ 4.5/100,000
------------------------------------------------------------------------
NIH Muscular Dystrophy Funding Has Quadrupled Since Inception of the MD
CARE Act
Figures from the online RCDC RePORT and the NIH Appropriations
History for Muscular Dystrophy report historically provided by NIH/OD
Budget Office & NIH OCPL show that from the inception of the MD CARE
Act 2001, funding has nearly quadrupled from $21 million to $83 million
in fiscal year 2009 for muscular dystrophy.
NIH Funding of FSHD has Remained Level Since the Inception of the MD
CARE Act
In fiscal year 2009, FSHD was 6.02 percent of the total muscular
dystrophy funding ($5 million/$83 million). The previous year FSHD was
5.3 percent of the total muscular dystrophy funding ($3 million/$56
million). FSHD funding has simply kept its ratio in the NIH funding
portfolio and has not grown in the last 8 years.
NIH FSHD FUNDING ANMD APPROPRIATIONS
[Dollars in millions]
------------------------------------------------------------------------
FSHD
Fiscal year FSHD research percentage of
MD
------------------------------------------------------------------------
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
2009.................................... 5 6
------------------------------------------------------------------------
Sources: NIH/OD Budget Office, NIH OCPL, and NIH RCDC RePORT.
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.
FSHD: The Most Prevalent Form of Muscular Dystrophy is Drastically
Underfunded at NIH
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 credibility that
it still remains the most prevalent and one of the most underfunded
dystrophies at the NIH and in the Federal research agency system (CDC,
DOD, and FDA).
In 2009, the most prevalent muscular dystrophy, FSHD, received $5
million from NIH. In 2009, the second most prevalent dystrophy,
Duchenne (DMD) and Becker Muscular dystrophy (BMD) type, received $33
million from NIH. In 2009, the third most prevalent dystrophy myotonic
dystrophy (DM), received $13 million from NIH.
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 8
years muscular dystrophy has quadrupled to $83 million and that FSHD
has remained on average at 5 percent of the NIH muscular dystrophy
portfolio. FSHD is certainly still far behind when we look at the
breadth of research coverage NIH-wide.
It is now time to examine why FSHD receives such a disproportional
and inverse level of funding despite its equal burden of disease and
highest prevalence. It is crystal clear, if not completely black and
white, that we are not achieving the goals of parity in funding as
expected by the mandates set forth in the MD CARE Acts 2001/2008 and by
the NIH Action Plan for the Muscular Dystrophies as submitted to the
Congress by the NIH.
We would like to commend the program staff at the NIH for the
excellent progress made in FSHD and the extraordinary progress made in
increasing muscular dystrophy funding. We are very pleased with the
efforts of NIH staff and Muscular Dystrophy Coordinating Committee
(MDCC) on behalf of the community of patients and their families with
muscle disease and the research community pursuing solutions for all of
us. We recognize in particular the efforts and hard work of the
following NIH staff: Story Landis, Ph.D., Executive Secretary, MDCC and
Director, National Institute of Neurological Disorders and Stroke
(NINDS); John D. Porter, Ph.D., Executive Secretary, MDCC and Program
Director, Neuromuscular Disease, Neurogenetics Cluster and the
Technology Development Program, NINDS; Stephen I. Katz, M.D., Ph.D.,
Director, National Institute of Arthritis and Musculoskeletal and Skin
Disease (NIAMS); Glen H. Nuckolls, Ph.D., Extramural Programs,
Musculoskeletal Diseases Branch, NIAMS; James W. Hanson, M.D., Director
of the Center for Developmental Biology and Perinatal Medicine, Eunice
Kennedy Shriver National Institute of Child Health and Human
Development (NICHD); and, Ljubisa Vitkovic, M.D., Ph.D., Mental
Retardation and Developmental Disabilities Branch, DHHS NIH NICHD.
Efforts of excellent program staff and leadership at NIH, excellent
reviewers and study sections, excellent and outstanding researchers
both 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 requests, contracts ands 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 in more than 20 years
despite consistent pressure from appropriations language and
Appropriations Committee questions, and an authorization from Congress
mandating research on FSHD.
The pace of discovery and numbers of leading experts in the field
of biological science and clinical medicine working on FSHD are very
rapidly expanding. Many leading experts are now turning to work on FSHD
not only because it is one of the most complicated and challenging
problems seen in science, but because it represents the potential for
great discoveries, insights into stem cells and transcriptional
processes and new ways of treating human disease.
Areas of Scientific Opportunity in FSHD That Need NIH Funding
The majority of the international FSHD clinical and research
community recently came together at the DHHS NIH NICHD Boston
Biomedical Research Institute Senator Paul D. Wellstone MD CRC for
FSHD. Almost 90 scientists working on FSHD globally met at the 2009 FSH
Society FSHD International Research Consortium, held on Monday,
November 9, 2009, and Tuesday, November 10, 2009. The summary and
recommendations of the group state the following:
During the past two decades, the FSHD research has made steady
progress to unravel the molecular basis of this common muscle disease.
The main line of research has focused on the extremely complex
(epi)genetic enigma. This complexity has fascinated experts involved in
related research. At the present moment the FSHD research field is
covering a variety of multidisciplinary and complementary approaches.
Although the exact details of the molecular genetic basis of FSHD are
still not in place, the general picture is coming into focus. Within 1-
2 years, evidence-based intervention strategies are on the drawing-
board and trials are planned. To be prepared for this new FSHD era, we
need to accelerate the efforts in the following areas--
Patients and Clinical Trials Readiness
There is a need for well-characterized registries with uniform data
collection. NIH U54 Wellstone MD CRC, NIH registries, and patient
organizations are key to this process. These groups and registry and
patient organizations are instrumental for:
--Work on natural history--identification of phenotype modifiers
(genetic and environmental)
--Identification of the FSHD2 gene (contraction-independent FSHD)
--Bio-banking (cell lines etc.)
--Development of tools and assays to measure clinical trials
endpoints
Epigenetics/Genetics
This line of work will be instrumental to pinpoint the real
identity of FSHD1A (chromosome-4-linked cases) and FSHD1B
(nonchromosome-4-linked cases). This information will form the basis
for evidence-based intervention.
--Modifying genes for FSHD1 (large inter-individual variation in
symptoms)
--Identify the FSHD2 gene (common molecular pathway with FSHD1)
--Further work on the chromatin structure/function relationship
Biomarkers for Clinical Therapy
There is obvious need for monitoring intervention.
--Systems biology approaches
--transcriptomics, proteomics, metabolomics, etc.
--In situ (RNA, protein) to detect cellular heterogeneity
--Non-invasive monitoring (MRI etc.)
Model Systems
Urgent need for more specific model systems for mechanistic,
intervention work and advancement to clinical trials.
--Cellular models
--Biopsies--for well characterized FSHD cell lines
--Mosaics--isogenic and clonal lines
--Induced pleuropotent stem cells (iPS)
--Animal
--Mouse--inducible/humanized mouse etc.
--Other species
Molecular, Cellular, and Genomic
Myogenesis in normal and FSHD muscle (myoblasts/myotubes)
Cell cycling
Dynamics of muscle satellite cells
RNA iso-forms and alternative splicing (FRG1, DUX4, others)
--Genome wide (normal versus FSHD)
Chromatin structure at 4q35
Downstream gene targets
our request to the nih appropriations subcommittee
We request this year in fiscal year 2011, immediate help for those
of us coping with and dying from FSHD. We ask NIH to fund research on
facioscapulohumeral muscular dystrophy (FSHD) at a level of $25 million
in fiscal year 2011.
We implore the Appropriations Committee to request that the
Director of NIH, the Chair, and Executive Secretary of the Federal
advisory committee Muscular Dystrophy Coordinating Committee mandated
by the MD CARE Act 2008, to increase the amount of FSHD research and
projects in its portfolios using all available passive and pro-active
mechanisms and interagency committees.
We ask that Congress ask NIH to consider increasing the scope and
scale of the existing DHHS U.S. NIH Senator Paul D. Wellstone Muscular
Dystrophy Cooperative Research Centers (U54) to double or triple their
size--they are financially under-powered as compared to their
potential. These centers have provided an excellent catalyst for
progress in funding and a greater seriousness in the endeavor of
treating muscular dystrophy. We ask Congress to request of NIH the
development of mechanisms to help expand work from the center of the
NIH Wellstone Centers outward to address needs and priorities of the
scientific communities.
Given the knowledge base and current opportunity for breakthroughs
in treating FSHD it is inequitable that only 4 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 facioscapulohumeral muscular dystrophy. Our
successes are continuing and your support must continue and increase.
Mr. Chairman, thank you for this opportunity to testify before your
subcommittee.
______
Prepared Statement of Family Voices, Inc.
I am grateful for this opportunity to submit written testimony on
behalf of Family Voices, Inc., an organization of families whose
children have special healthcare needs and/or disabilities. Family
Voices aims to achieve family-centered care for all children and youth
with special healthcare needs and/or disabilities. Through our national
network, we provide families tools to make informed decisions, advocate
for improved public and private policies, build partnerships among
professionals and families, and serve as a trusted resource on
healthcare.
Family Voices respectfully asks the subcommittee to provide $10
million in funding for Family-to-Family Information Centers (F2F HICs)
for Federal fiscal year 2011. In addition, we request that funding for
the title V Maternal and Child Health Services Block Grant be increased
to $730 million for Federal fiscal year 2011.
family-to-family health information centers
F2F HICs are statewide, family-led information and referral centers
that provide families with information about how to obtain and finance
healthcare for their children/youth with special healthcare needs
(CYSHCN), including disabilities and chronic medical conditions like
cerebral palsy, epilepsy, or asthma. The Deficit Reduction Act of 2005
mandated that Federal grants be provided ($3 million in fiscal year
2007, $4 million in fiscal year 2008, and $5 million in fiscal year
2009) to create a F2F HIC in every State and the District of Columbia
by fiscal year 2009. The Patient Protection and Affordable Care Act
provided $5 million in each of fiscal years 2010-2012 to maintain these
F2F HICs at their current levels of funding.
The needs of CYSHCN are chronic and complex and, thus, securing and
paying for their care is often a struggle. F2F HICs provide life-
altering information to families in crisis; simply enrolling in
Medicaid for a newborn in need of expensive critical care can be an
arduous task. Most of the staff at F2F HICs are members of families
whose children have special healthcare needs. This unique perspective
allows them to provide advice, offer a multitude of resources, and tap
into a network of other families and professionals for support and
information. In addition, they help healthcare providers to understand
the various public programs available for their patients, and assist in
dealing with private insurers. In fact, about one-third of requests to
F2F HICs are from healthcare professionals. The centers also aim to
ensure that each child has a ``medical home,'' and that partnerships
are built between healthcare professionals and the families of CYSHCN,
thereby improving the quality of care.
At the present level of funding--$5 million total--each site
receives only $95,700 per year. Although hundreds of thousands of
families are being served by F2F HICs, the level of funding is not
sufficient to serve all of the families and providers who need
assistance in each State. As discussed in more detail below, an
increase to $10 million is needed to assist more families of CYSHCN and
healthcare providers who need these services; to expand training and
technical assistance to grantees; and to make these valuable services
available to additional regions and populations. Moreover, the
healthcare system navigation function provided by F2F HICs will be of
increased importance now that healthcare reform has been enacted.
There is a great need for Family-to-Family Health Information
Centers (F2F HICs).
An estimated 22 percent of U.S. household with children have at
least one child with special healthcare needs--that is more than 10
million children--and that number appears to be growing. Among these
families, 38 percent do not have adequate insurance to pay for services
their children need; 20 percent of these families pay $1,000 or more
per year in out-of-pocket expenses. These problems are exacerbated
among families of ethnic, racial, and cultural minorities because their
access to coverage and care is significantly more limited.
It is very difficult for families to figure out how to finance
their children's care, given the great expense and complexity of
potential funding sources--private insurance, Medicaid, SCHIP, State
Maternal and Child Health programs, the school system--each with
different eligibility and coverage criteria. It can also be difficult
to find sources of care, given the shortage and maldistribution of
pediatric subspecialists.
Additional funding is needed to sustain the current scope of work,
and to expand F2F HICs to territories and tribal organizations.
Currently, F2F HICs are being funded at $5 million. This money
funds 51 existing centers, one in each State and one in the District of
Columbia, at approximately $95,700 a year--barely enough to cover one
staff member or two part-time employees, and not enough to serve all
the families who need assistance. All States could use more funding to
reach more families. States with large populations in particular need
larger grants in order to serve the families within their States.
In addition, the number of centers should be expanded to serve
territories and Native American populations, which have their own
unique healthcare systems. It is anticipated that over the next several
years, 10 new grantees could be established in order to meet the needs
of these distinct populations. These new grantees would require
operating funds, and would necessitate additional costs for oversight
and technical assistance.
Additional funding is needed to provide technical assistance to
grantees.
There are currently no designated dollars to provide structured
technical assistance to funded F2Fs. A very small amount of the funds
remaining after State distributions ($21,000 in the past year) has been
used to assist in planning and coordinating a technical assistance
meeting. Substantial technical assistance for developing, assisting and
coordinating F2F programs, provided through a national, experienced,
family-run organization, in coordination with regional family-run
organizations, is needed to grow the capacity and ensure the quality of
the F2Fs to best meet the needs of families of CYSHCN navigating
complex healthcare systems.
Healthcare reform will further necessitate the services of F2F
HICs.
Healthcare reform will require the services of the F2F HICs more
than ever, as families whose children have special healthcare needs
attempt to maneuver a new and complex system of insurance and care. The
F2Fs HICs are expert in the unique needs of this sizeable population.
Family-to-Family Health Information Centers within each State will be
the best-positioned organizations to serve as navigators for families
of CYSHCN--a role that has been identified in healthcare reform bills
as necessary to ensure that the goals of the reform are met and
maximized.
F2F HICs receive less funding than a comparable educational
assistance program--Parent Training and Information Centers.
Over 25 years ago, the Federal Government recognized the
complexities faced by families whose children need or might need
special education services, and created a nationwide system of support
and technical assistance for these families--Parent Training and
Information Centers (PTIs).
Families with children who have special healthcare needs face equal
and additional challenges when faced with maneuvering the healthcare
system--a system much more complex than the special education system,
which is governed by one law (IDEA), whereas the healthcare system
consists of a myriad of private and public insurance programs,
benefits, waivers, limitations, networks, and cost-sharing.
In fiscal year 2009, the PTIs were funded at $27 million, versus
the $5 million in funding for the F2F HICs, despite the fact that they
serve a very similar population.
The F2F HIC program has demonstrated its effectiveness and value.
Although they operate on shoe-string budgets, F2F HICs are able to
help many families: from July 2008 to May 2009, the 41 F2F HICs then in
existence trained and assisted more than 665,000 families of CYSHCN by
helping them to navigate community services, partner with health
professionals, find financing for care, and access a medical home. In
addition, F2F HICs trained and assisted over 320,000 healthcare
professionals in helping families with CYSHCN. On average, each F2F HIC
collaborated with 14 State-level programs and 10 community-based
organizations.
The value and potential of F2F HICs has been established by outside
evaluators:
``Family-to-Family Centers nationwide provide important information
and assistance to families of CYSHN as well as the professionals who
care for them, often with very limited staff and resources.''--Thomson
Medstat, June 2006
``By helping families to provide a consumer perspective on program
and policy issues, F2F HICs are helping States to develop more
effective ways to assist families with CYSHCN. Ultimately, the F2F HICs
goal is to improve health and functional outcomes for families with
CYSHCN. To the extent families understand what is available for their
children and use services effectively, outcomes for their children will
improve. These benefits go well beyond the children and families.
Children whose outpatient needs are met and whose parents are able to
meet their daily care needs are less likely to require hospital or
emergency room care. Children who obtain home and community long-term
care services are less likely to need costly institutional care.
Congress has recognized the value of F2F HICs by authorizing funds to
establish one in every State. These highly effective organizations
require a stable source of funding to sustain outreach and referral
services, information development and dissemination, and education and
training initiatives.''--Research Triangle Institute, April 2006.
Perhaps more compelling are the stories of families who have been
assisted by F2F HICs. An example is provided from Louisiana, where the
F2F HIC assisted a family who had two children with severe
disabilities. Both children had private health insurance and Medicaid
for secondary coverage. The private health insurance company began
requiring their enrollees to use an out-of-State mail-order pharmacy
for their regularly renewed medications. This meant that the family was
no longer able to use Louisiana Medicaid as a secondary insurer because
the out-of-State pharmacy was not a Louisiana Medicaid provider. The
family was faced with over $500 per month in additional costs because
they could not access their Medicaid coverage. The Louisiana F2F HIC
worked with the State Medicaid Director so that this family could
submit the balance of the costs and receive their sorely needed
benefits.
For the above reasons, we respectfully request that a $10 million
appropriation be provided for F2F HICs for fiscal year 2011.
title v maternal and child health block grant
As you know, one of the missions of the title V Maternal and Child
Health Block Grant is to serve children with special healthcare needs.
State MCH programs for CYSHCN help to build an infrastructure to ensure
the provision of family-centered, community-based coordinated care for
children with chronic conditions and disabilities. They have strong
connections to pediatric specialists and the best available data on the
needs of these children and their families. Due to years of reduced
investment, however, the MCH Block Grant is at its lowest funding level
since 1993, $662 million. The program--and the populations it serves--
deserves increased funding to fulfill its valuable missions. Therefore,
Family Voices respectfully requests that the Congress provide $730
million for the Title V Maternal and Child Health Block Grant program
for fiscal year 2011.
______
Prepared Statement of Goodwill Industries International
Mr. Chairman, Ranking Member, and members of the subcommittee, on
behalf of Goodwill Industries International (GII), I appreciate this
opportunity to submit written testimony on Goodwill's priorities for
funding programs administered by the U.S. Departments of Labor, Health
and Human Services, and Education.
GII represents 159 local and autonomous Goodwill Industries
agencies in the United States that help people with barriers to
employment to participate in the workforce. One of Goodwill Industries'
greatest strengths continues to be its entrepreneurial approach to
sustaining its mission. In 2008, the Goodwill Industries network raised
nearly $3.7 billion through its retail, contracts, and mission services
operations. Nearly 83 percent of the funds Goodwill Industries raised
in 2009 was used to supplement government investments, resulting in
nearly than 2 million different people served by local Goodwill
agencies, including more than 155,000 job placements. In addition to
our efforts to help people find jobs and advance in careers, Goodwill
understands that many people need additional supportive services--child
care, reliable transportation, stable housing, counseling, and
assistance in adjusting to the workplace, assistive technology--to
ensure their success.
Especially during such trying economic times, Goodwill Industries
understands the difficult challenge that appropriators face as they
struggle to stretch limited resources to support an ever-increasing
list of national priorities. As the Nation struggles to recover from
the worst recession since the Great Depression and unemployment
stubbornly hovers near 10 percent, Goodwill Industries' remains
committed to partnering with stakeholders at the Federal, State, and
local levels by contributing the resources and expertise of local
Goodwill agencies in support of public efforts and investments.
While our agencies care about a range of Federal funding streams,
GII believes that Federal investment in the Workforce Investment Act,
Vocational Rehabilitation, the Senior Community Service Employment
Program (SCSEP), Green Jobs, and TANF will help the Goodwill network to
do more for the people in communities across the country who are
struggling to overcome employment barriers. Furthermore, Goodwill
supports the administration's proposal to increase funding to
strengthen enforcement of wage and hour standards. Goodwill urges
Congress to provide adequate funding in fiscal year 2011 for these
critical programs.
Workforce Investment Act
Funding for the Workforce Investment Act's adult, dislocated
worker, and youth formulas is one of Goodwill's top funding priorities
for fiscal year 2011. Goodwill agencies and their community partners
are on the front lines of this recovery effort assisting people with
employment barriers, including individuals with disabilities, older
workers, and welfare recipients who are struggling to find and keep
jobs at a time when unemployment is at its highest rate experienced in
a generation.
Of the nearly 2 million people served by local Goodwill agencies in
the United States in 2009, nearly 160,000 people were referred to local
Goodwill agencies for employment services through the Workforce
Investment Act (WIA) and State Vocational Rehabilitation agencies. Many
local Goodwill agencies are one-stop lead operators, or operators in
association with other service providers, and are active on State and
local workforce boards.
As members of this Subcommittee know, the administration's fiscal
year 2011 budget proposes to launch a Workforce Innovation Fund to
``support and test promising approaches to training, and breaking down
program silos, building evidence about effective practices, and
investing in what works.'' Goodwill believes that this idea is
promising, is very interested in the details, and is encouraged by the
Administration's efforts to increase interagency collaborations and
leverage resources provided by community-based organizations.
Goodwill strongly believes, however, that the proposed Workforce
Innovation Funds should be paid for with funds in addition to, rather
than at the expense of, existing WIA formula funds--in fiscal year 2011
and beyond. We understand that this subcommittee's funding allocation
will be extremely tight as a result of the President's call for a
discretionary budget freeze. However, it should be noted that the
President's budget request for WIA programs is 7 percent less in actual
dollars than in fiscal year 2002, a time when the unemployment rate was
less than half of what jobseekers are experiencing today.
Goodwill believes that the workforce system is vastly underfunded
and that the preservation of WIA's formula funding streams should be a
high priority. Therefore, Goodwill urges Congress to sustain WIA's
adult, dislocated worker, and youth funding streams at current funding
levels at a minimum before dedicating funding to the administration's
proposed WIA Innovation Fund.
VR Funding
Goodwill Industries has a long history of helping people with
disabilities to participate in the workforce despite the challenges
their disabilities present. Years of inadequate funding for Vocational
Rehabilitation have left the system stretched much too thin to serve
all who are eligible for assistance. As a result, more than half of the
80 State VR agencies have Orders of Selection, a provision within the
Rehabilitation Act that requires State VR agencies, when faced with a
shortage of funds to meet the demand for services, to prioritize the
provision of services to eligible people based on the severity of
people's disabilities. In addition, reduced funding for WIA has placed
an additional strain on mandatory partner programs, including VR, which
are being asked to contribute more funding to pay for infrastructure
and other costs associated with the operation of one-stop centers.
Goodwill Industries supports the President's intent to increase
multi-system collaboration and support for youth with disabilities who
are transitioning from education to the workforce. However, Goodwill is
concerned that the President's fiscal year 2011 budget proposal would
consolidate VR programs in order to achieve these goals. First, the
President proposes to eliminate VR's supported employment State grant
program to create a supported employment program for youth who are
transitioning from education to the workforce. For more than two
decades, Goodwill has offered supported employment as a part of its
service array. According to GII's Annual Statistical Report,
participation in local Goodwill agencies' supported employment programs
has grown dramatically in recent years from providing 270,000 coaching
sessions in 2007 to 630,000 sessions in 2009.
Furthermore, the administration's budget proposes to eliminate
funding for VR's Projects With Industry and the migrant and seasonal
farmworker program. The administration asserts that services provided
by these programs will continue under the VR State grants funds and
would eliminate duplication. The resulting savings would be used to
help pay for increased collaboration between the Department of
Education, the Department of Labor and other agency heads. As noted
earlier, Goodwill is intrigued by the administration's proposal to
stimulate system collaboration by creating a Workforce Innovation Fund;
however, Goodwill opposes paying for the Workforce Innovation Fund by
eliminating or reducing funding for critical programs for people with
barriers to employment. Therefore, Goodwill urges you to preserve
funding for VR.
Senior Community Service Employment Program (SCSEP)
According to the Bureau of Labor Statistics, the unemployment rate
for older workers older 65 years old is at the highest levels since the
Department started keeping records in 1948. The Senior Community
Service Employment Program (SCESP) helps provide low-income older
workers with community services employment and private sector job
placements. Goodwill is one of the newest SCSEP grantees. In 2009,
SCSEP participants contributed nearly 1.2 million community service
hours and our private sector placements averaged a starting wage of
$8.67 per hour. In addition, as a result of the Recovery Act, which
allowed Goodwill to start enrolling more participants in April 2009,
SCSEP participants provided and additional 140,000 community service
hours and our private sector placements started at $8.31 per hour.
Goodwill recognizes and very much appreciates the monumental
investment that the Congress has placed on helping older workers to
survive the economic crisis. Congress has demonstrated its commitment
to older workers by providing an additional $120 million for SCSEP in
the Recovery Act, and a $250 million increase in fiscal year 2010.
These funds have allowed local Goodwill agencies to better address our
waiting list of participants and help many more older workers with
part-time employment.
Goodwill is concerned that the President's budget seeks to cut this
program by 27 percent, as these older workers have multiple barriers to
employment and will be among the last rehired as the economy improves.
Goodwill urges the subcommittee to reject the administration's proposed
cuts to SCSEP. At a minimum Congress should sustain funding for SCSEP
at its fiscal year 2010 level, $825 million, so that the program can
continue to better meet the needs of the increasing number of low-
income older workers.
Green Jobs
Goodwill believes that the green jobs sector has great potential
for increasing employment opportunities in high-growth fields for
people with employment barriers and many Goodwill agencies are helping
workers learn skills that will help them secure jobs in energy
efficiency and alternative energy industries. We greatly appreciated
the subcommittee's inclusion of $500 million for sectoral initiatives
focused on green-related industries in the Recovery Act, and are
thrilled that Goodwill Industries International and four local Goodwill
agencies have been selected by DOL to provide training and placement in
the renewable energy and energy efficiency sectors. Goodwill urges you
to appropriate $85 million for green jobs as requested by the
administration.
Enforcement of Wage and Hour Standards
Goodwill favors increased enforcement of the Fair Labor Standards
Act, specifically section 14(c) which allows for the use of a special
minimum wage certificate to employee individuals with disabilities that
directly impair their productivity. As such, Goodwill supports the
President's budget proposal of $244.2 million and 1,672 full-time
employees for the Wage and Hour Division to support targeted
investigations focusing on industries where misclassification is
common.
Goodwill thanks you for considering these requests, and looks
forward to working with you to help government meet the serious
challenges our Nation faces.
______
Prepared Statement of the Hepatitis Appropriation Partnership
The Hepatitis Appropriations Partnership (HAP) is a coalition that
represents hepatitis community-based organizations, public health
officials, health providers, national hepatitis and HIV organizations,
and diagnostic, pharmaceutical and biotechnology companies. We work
with policy makers and public health officials to increase Federal
leadership and support for viral hepatitis prevention, testing,
education, research, medical management, and treatment.
As you craft the fiscal year 2011 Labor, Health and Human Services,
and Education, and Related Agencies Appropriations legislation, we urge
you to consider the following critical funding needs of viral hepatitis
programs:
Specific funding needs:
--We are requesting an increase of $30.7 million for a total of $50
million for the Centers for Disease Control and Prevention
(CDC) Division of Viral Hepatitis (DVH);
--At least $20 million for an adult hepatitis B vaccination
initiative through the CDC section 317 Vaccine Program;
--$10 million for the Substance Abuse and Mental Health Services
Administration (SAMHSA) to fund a project within the Programs
of Regional and National Significance (PRNS) to reach persons
who use drugs with viral hepatitis prevention services;
General funding needs:
--Increase funding for Community Health Centers to increase their
capacity to serve people with chronic viral hepatitis;
--Increase funding for the Ryan White Program to adequately cover
persons co-infected with viral hepatitis through additional
case management, provider education, and coverage of viral
hepatitis drug therapies;
--Increase funding for the National Institutes of Health to support
their Action Plan for Liver Disease Research
specific funding needs
Division of Viral Hepatitis
--Fiscal year 2011 request: $30.7 million
The recently released Institute of Medicine (IOM) report, Hepatitis
and Liver Cancer: A National Strategy for Prevention and Control of
Hepatitis B and C found that the public health response needs to be
significantly ramped up. The IOM report attributes low public and
provider awareness to the lack of public resources. Seventeen of the 22
recommendations in the report are specific to CDC DVH and State health
departments. In order to implement these recommendations to improve the
Federal response, resources must be increased to health departments
which are the backbone of the Nation's public health system and
coordinate the response to these epidemics.
President Obama's budget proposal includes a $1.8 million increase
for the DVH at CDC, which is woefully insufficient to address
infectious diseases of this magnitude. While operating on the smallest
Division budget for the prevention of infectious diseases within CDC,
DVH will never be able to sufficiently prevent and manage these
epidemics under its current fiscal constraints. States and cities
receive an average funding award from DVH of $90,000. This is only
enough for a single staff position and is not sufficient for the
provision of core prevention services. These services are essential to
preventing new infections, increasing the number of people who know
they are infected, and following up to help those identified to remain
healthy and productive. We believe this increase is an important first
step to making hepatitis prevention services more widely available. The
expanded services should include hepatitis B and C education,
counseling, testing, and referral in addition to delivering hepatitis A
and B vaccine, and establishing a surveillance system of chronic
hepatitis B and C.
Section 317 Vaccine Program
--Fiscal year 2011 request: $20 million
CDC identified funds through program cost savings in the section
317 Vaccine Program, allocating $20 million in fiscal year 2008 and $16
million in fiscal year 2009 for purchase of the hepatitis B vaccine for
high-risk adults. We commend CDC for prioritizing high-risk adults with
this initiative, but relying on the availability of these cost savings
is not enough. Additionally, this initiative does not support any
infrastructure or personnel and health departments need additional
funding to support the delivery of this vaccine. We request a
continuation of $20 million in fiscal year 2011 for an adult hepatitis
B vaccination initiative through the CDC's section 317 Vaccine Program.
Substance Abuse and Mental Health Services Administration
--Fiscal year 2011 Request: $10 million
Persons who use drugs are disproportionately impacted by hepatitis
B and C. The Substance Abuse and Mental Health Services Administration
(SAMHSA) Center for Substance Abuse Prevention (CSAP) and Center for
Substance Abuse Treatment are uniquely positioned to reach populations
at risk for hepatitis B and C. The existing infrastructure of substance
abuse prevention and treatment programs in the United States provides
an important opportunity to reach Americans at risk or living with
viral hepatitis. We urge you to provide $10 million to SAMHSA to fund a
project within the Programs of Regional and National Significance
(PRNS) to reach persons who use drugs with viral hepatitis prevention
services.
general funding needs
Medical Management and Treatment
Access to available treatments and support services are critical to
combat viral hepatitis mortality. While we are supportive of the
President's efforts to modernize and expand access to healthcare, we
also support increased funding for existing safety net programs. Low-
income patients who are uninsured or underinsured can and do seek
services at Community Health Centers (CHCs). With the growing
importance of CHCs as a safety net in providing frontline support for
these individuals, we support increasing resources for CHCs to increase
their capacity to serve people with chronic viral hepatitis.
Many low-income individuals co-infected with viral hepatitis and
HIV can obtain services through the Ryan White Program, however only
half of the State AIDS Drug Assistance Programs (ADAPs) are able to
provide viral hepatitis treatments to co-infected clients. We urge you
to increase Ryan White funding so States can provide adequate coverage
for co-infected clients. Increased resources are also needed to improve
provider education on viral hepatitis medical management and treatment,
to cover additional case management for patients undergoing treatment
and to allow more States to add viral hepatitis therapies and viral
load tests to their ADAP formularies. While Ryan White providers offer
lifesaving care to co-infected clients, they also have the expertise
and infrastructure to provide limited services to viral hepatitis mono-
infected clients.
Research
Finally, research is needed to increase understanding of the
pathogenesis of hepatitis B and C. Further research to improve
hepatitis B and C treatments that are currently difficult to tolerate
and have low ``cure'' rates are also needed. The development of
clinical strategies to slow the progression of liver disease among
persons living with chronic infection, especially to those who may not
respond to current treatment must be addressed. With effective vaccines
against hepatitis A and B, it is important to continue to work towards
the development of a vaccine against hepatitis C infection. The Liver
Disease Branch, located within the National Institute of Diabetes and
Digestive and Kidney Diseases (NIDDK) at the National Institutes of
Health (NIH), has developed an Action Plan for Liver Disease Research.
We request full funding for NIH to support the recommendations and
action steps outlined in this Action Plan for Liver Disease Research.
It is absolutely essential and urgent that we act aggressively to
address the threat of viral hepatitis in the United States. In 2007
alone, the CDC estimated that 43,000 Americans were newly infected with
hepatitis B and 17,000 with hepatitis C. Unfortunately, it is believed
that these estimates of hepatitis B and C infections are just the tip
of the iceberg. Most people living with hepatitis B and over three-
fourths of people living with hepatitis C do not know that they are
infected. It is estimated that the baby boomer population currently
accounts for 2 out of every 3 cases of chronic hepatitis C. It is also
estimated that this epidemic will increase costs by billions of dollars
to our private insurers and public systems of health such as Medicare
and Medicaid, and account for billions lost due to decreased
productivity from the millions of American workers suffering from
chronic hepatitis B and C.
As you continue to draft the fiscal year 2011 Labor, Health and
Human Services, and Education, and Related Agencies Appropriations
bill, we ask that you consider a generous increase for viral hepatitis
prevention to counter several years of flat or inadequate growth in
funding. A strong public health response is needed to meet the
challenges of these costly infectious diseases. The viral hepatitis
community welcomes the opportunity to work with you and your staff on
this important issue.
______
Prepared Statement of the Hepatitis B Foundation
Mr. Chairman, my name is Dr. Timothy Block, and I am the President
and Co-Founder of the Hepatitis B Foundation (HBF) and its research
institute, the Institute for Hepatitis and Virus Research. I also serve
as the president of the Pennsylvania Biotechnology Center and am a
professor at Drexel University College of Medicine. My wife Joan, and
I, and another couple, Paul and Janine Witte, from Pennsylvania started
HBF almost 20 years ago to find a cure for this serious chronic liver
disease and provide information and support to those affected.
Thank you for giving HBF the opportunity to provide testimony to
the subcommittee as you begin to consider funding priorities for fiscal
year 2011. We are grateful to the members of this subcommittee for
their interest and strong leadership for efforts to control and find
cures for hepatitis B.
Today, the HBF is the only national nonprofit organization solely
dedicated to finding a cure and improving the lives of those affected
by hepatitis B worldwide through research, education, and patient
advocacy. Our scientists focus on drug discovery for hepatitis B and
liver cancer, and early detection markers for liver cancer. HBF staff
manages a comprehensive Web site which receives almost 1 million
visitors each year, a national patient conference and outreach
services. HBF public health professionals conduct research initiatives
to advance our mission.
The hepatitis B virus (HBV) is the world's major cause of liver
cancer--and while other cancers are declining, liver cancer is the
fastest growing in incidence in the United States. Without
intervention, as many as 100 million worldwide will die from a HBV-
related liver disease, most notably liver cancer. In the United States,
up to 2 million Americans have been chronically infected and more than
5,000 people die each year from complications due to HBV.
HBV is 100 times more infectious than the HIV/AIDS virus. Yet,
hepatitis B can be prevented with a safe and effective vaccine.
Unfortunately, for those who are chronically infected with HBV, the
vaccine is too late. There are, however, promising new treatments for
HBV. We are getting close to solutions but lack of sustained support
for public health measures and scientific research is threatening
progress. The growing incidence of liver cancer, while most other
cancer rates are on the decline, represents examples of serious
shortcomings in our system. In the United States, 20,000 babies are
born to mothers infected with HBV each year, and as many as 1,200
newborns will be chronically infected with HBV. More needs to be done
to prevent new infections.
institute of medicine (iom) report
In January of this year, the Institute of Medicine (IOM) issued a
report titled Hepatitis and Liver Cancer: A National Strategy for
Prevention and Control of Hepatitis B and C. This report outlined a
national strategy for prevention and control of hepatitis B and C. The
report concludes that the current approach to the prevention and
control of viral hepatitis is not working and unless further action is
taken thousands more Americans will die each year from liver cancer, or
liver disease associated with these preventable diseases. In response
to this monumental report, the Department of Health and Human Services
Office of the Secretary has convened an inter-departmental task-force
to address the public health challenge of viral hepatitis. HBF is very
supportive of the Task Force and is hopeful that their recommendations
will result in actions to address the chronic underfunding of viral
hepatitis prevention programs within the Department.
Mr. Chairman, as you know the two Federal agencies that are
critical to the effort to help people concerned with hepatitis B are:
the Centers for Disease Control and Prevention (CDC), and the National
Institutes of Health CDC (NIH).
cdc
CDC's Division of Viral Hepatitis (DVH), the centerpiece of the
Federal response to controlling, reducing, and preventing the suffering
and deaths resulting from viral hepatitis, is chronically underfunded.
DVH is included in the National Center for HIV/AIDS, Viral Hepatitis,
STD, and TB Prevention at the CDC, and is responsible for the
prevention and control of viral hepatitis. DVH is currently funded at
$19.3 million, $6 million less than its funding level in fiscal year
2003, which does not allow for the provision of core prevention
services. The HBF joins the hepatitis community and urges a fiscal year
2011 funding level for DVH of $50 million.
The responsibility for addressing the problem of hepatitis should
not lie solely with the DVH . In view of the preventable nature of
these diseases, HBF feels that the National Center for Chronic Disease
Prevention should also include a targeted effort focused on the
prevention of chronic viral hepatitis which adversely impacts 5 million
Americans. We urge that the subcommittee include $2 million in the
National Center for Chronic Disease Prevention to initiate a focused
program on chronic viral hepatitis.
Furthermore, there are 400 million people chronically infected with
hepatitis B worldwide, with more than 120 million of these individuals
in China. While hepatitis B transmission requires direct exposure to
infected blood, worldwide misinformation about the disease has fueled
inappropriate discrimination against individuals with this vaccine-
preventable bloodborne and treatable disease. HBF urges the
subcommittee to instruct the CDC to initiate global programs to
increase the rate of vaccination, reduce mother-child transmission, and
promote educational programs to prevent the disease and to reduce
discrimination targeted against individuals with the disease.
nih
We depend upon the NIH to fund research that will lead to new and
more effective interventions to treat people with hepatitis B and liver
cancer. HBF joins with the Ad Hoc Group for Biomedical Research and
requests a funding level of $35 billion for NIH in fiscal year 2011.
We thank the subcommittee for their continued investment in NIH in
fiscal year 2010. Sustaining progress in medical research is essential
to the twin national priorities of smarter healthcare and economic
revitalization. With additional investment, the Nation can seize the
unique opportunity to build on the tremendous momentum emerging from
the strategic investment in NIH made through the 2009 American Recovery
and Reinvestment Act (ARRA). NIH invested those funds in a range of
potentially revolutionary new avenues of research that will lead to new
early screenings and new treatments for disease.
In fiscal year 2009, NIH spent approximately $57 million on
hepatitis B funding overall (ARRA and non-ARRA funds), and estimates
that in fiscal year 2010 $54 million will be spent. An additional $40
million per year could make transformational advances in research
leading to better treatments for HBV. The HBF recommends that an
additional $40 million be allocated for HBV research in fiscal year
2010 and that overall NIH funding total $35 billion.
The current leadership of the NIH has performed admirably with the
limited resources they are provided; however, more is needed. While a
number of cancers have achieved 5-year survival rates of over 80
percent and the average 5-year survival rate for all cancers has
increased from 50 percent in 1971 to 66 percent, significant challenges
still remain for other types of cancers, particularly the most deadly
forms of cancer. In fact, nearly half of the 562,340 cancer deaths in
2009 were caused by eight forms of cancer with 5-year relative survival
rates of less than 50 percent: ovary (45.5 percent), brain (35.0
percent), myeloma (34.9 percent), stomach (24.7 percent), esophagus
(15.8 percent), lung (15.2 percent), liver (11.7 percent), and pancreas
(5.1 percent). It is no coincidence that cancers with significantly
better 5-year survival rates, such as breast, prostate, colon,
testicular, and chronic myelogenous leukemia, also have early detection
tools, and in many cases, several effective treatment options thanks to
research programs championed and supported by Congress. By contrast,
research into the cancers with the lowest 5-year survival rates has
been relatively underfunded, and as a result, these cancers have no
early detection or treatment tools.
HBF requests that the establishment of a targeted cancers program
at the National Cancer Institute (NCI) for the high-mortality cancers.
It should include a strategic plan for progress, an annual report from
NCI to Congress, and a new grant program specifically focused on the
deadly cancers. Additionally, HBF urges a stronger focus on liver
cancer and urges the funding of a series of Specialized Programs of
Research Excellence (SPOREs) focused on liver cancer. While SPOREs
currently exist for every other major cancer, none currently exist that
are focused on liver cancer.
summary and conclusion
While the HBF recognizes the demands on our Nation's resources, we
believe the ever-increasing health threats and expanding scientific
opportunities continue to justify higher funding levels for the CDC's
DVH and NIH.
Significant progress has been made in developing better treatments
and cures for the diseases that affect humankind due to your leadership
and the leadership of your colleagues on this subcommittee. Significant
progress has also similarly been made in the fight against hepatitis B.
In conclusion, we specifically request the following for fiscal
year 2011:
--Fund the CDC's DVH at $50 million;
--$2 million in the National Center for Chronic Disease Prevention to
initiate a focused program on chronic viral hepatitis;
--Initiate global programs at the CDC to increase the rate of
vaccination, reduce mother-child transmission and promote
educational programs to prevent the disease and to reduce
discrimination targeted against individuals with the disease;
--Provide $35 billion for NIH, including a $40 million increase per
year for hepatitis B research;
--Establish a targeted cancers program at the NCI; and
--Fund a series of Specialized Programs of Research Excellence
(SPOREs) focused on liver cancer at the NCI.
HBF appreciates the opportunity to provide testimony to you on
behalf of our constituents and yours.
Thank you.
______
Letter From the HIV Health and Human Services Planning Council of New
York
April 16, 2010.
Hon. Tom Harkin,
Subcommittee on Labor, Health and Human Services, and Education, and
Related Agencies, Washington, DC.
Dear Senator Harkin: On behalf of the HIV Health and Human Services
Planning Council of New York City, I write to urge you to increase
funding for Ryan White Programs by $810.5 million more than the fiscal
year 2010 appropriated levels in the fiscal year 2011 Labor, Health and
Human Services, and Education, and Related Agencies; Transportation and
Housing and Urban Development, and Related Agencies; and Financial
Services and General Government appropriations bills.
The HIV Health and Human Services Planning Council of New York is
comprised of people living with HIV/AIDS, advocates, physicians, and
service providers and prioritizes the allocation of Ryan White funds
for treatment and care services for PLWHAs. Council Members are well
versed in the challenges confronting people living with this illness
and know that Ryan White HIV/AIDS Programs provide life-extending
medical care, mental health and drug treatment, and support services to
approximately 577,000 low-income, uninsured and underinsured
individuals and families affected by HIV/AIDS each year. Your proposed
fiscal year 2011 budget requests $2.33 billion for the Ryan White
Program, but Planning Council members believe that more funding is
needed in order to maintain a comprehensive system of care.
Specifically, Planning Council members recommend the following
increases:
--Part A.--An increase of $225.9 million for grants to eligible
metropolitan areas and transitional grant areas;
--Part B.--An increase of $55.9 million for care grants to State,
territories, and emerging communities;
--Part B AIDS Drug Assistance Program.--An increase of $370.1 million
to provide life-saving medications to more than 166,000
individuals already enrolled in the program and the hundreds
that are currently on waiting lists in 11 States;
--Part C.--An increase of $131 million for early intervention
services and capacity development grants;
--Part D.--An increase of $7 million for women, infants, youth, and
their families;
--Part F/Dental.--An increase of $5.4 million for Dental School
Reimbursement Programs and the Community-Based Dental
Partnership Program; and
--Part F/AETC.--An increase of $15.2 million for AIDS Education and
Training Centers.
My fellow Planning Council members join me in thanking you for your
support and commitment to improving the lives of people living with
HIV/AIDS and strongly encourage you to increase the amount of money to
support treatment and care services.
Sincerely yours,
Charles W. Shorter, MSW,
Community Co-Chair.
______
Prepared Statement of the HIV Medicine Association
The HIV Medicine Association (HIVMA) of the Infectious Diseases
Society of America represents more than 3,700 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. We work in communities across the country and around
the globe as medical providers and researchers dedicated to the field
of HIV medicine. We appreciate the fiscal challenges that Congress
currently faces, but the state of the economy makes it imperative that
our Nation have 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 the number of
their new HIV patients continues to increase dramatically in some
areas.
Implementation of healthcare reform and the administration's plans
for a National HIV/AIDS Strategy offer promise for making significant
progress in reducing the impact of the domestic HIV epidemic. However,
their success will depend on adequate investments in shoring up the
frayed healthcare safety net, prevention and public health and research
programs. The funding requests in our testimony largely reflect the
consensus of the Federal AIDS Policy Partnership, 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 $1.13 billion in funding for
the CDC's NCHHSTP with an increase of $878 million for HIV prevention
and surveillance, an increase of $30.7 million for viral hepatitis and
$76.3 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. 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.
An infusion of HIV prevention funding is critical to restore and
enhance HIV prevention programs by increasing support for cooperative
agreements with State and local health departments; optimizing core
surveillance cooperative agreements with health departments and
expanding HIV testing in key healthcare and nonhealthcare venues by
funding testing infrastructure and the purchase of approved testing
devices, including rapid HIV tests and confirmatory testing and
supporting linkage to care. 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.
While we appreciate that the President proposed a $31 million
increase for HIV prevention at the CDC, a much more robust investment
is needed to significantly reduce the number of new HIV occurring
annually in the United States. We strongly support the CDC initiative
to integrate HIV screening into medical care as an important component
of the prevention portfolio. 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 there is a growing body of evidence suggesting that
treatment can reduce risk of HIV transmission. Furthermore through
education, counseling and treatment, individuals who are aware that
they have HIV are more likely to adopt behaviors to prevent
transmission of 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. A significant investment of Federal resources is
necessary to support State health departments, medical institutions,
community health centers and other community based organizations with
implementing these programs and for their full potential to be
realized--particularly in light of steep State budget cuts.
Identifying people with HIV earlier through routine HIV testing and
linking them to HIV care saves lives and also 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.
Finally, we also must increase support for science-based,
comprehensive sex education programs. We are pleased that Congress took
important steps in the fiscal year 2010 appropriations process to
discontinue funding for unproven abstinence-only sex education programs
and shift those funds to support comprehensive, age-appropriate sex
education programs. We also support shifting administration of those
funds to the Department of Health and Human Services' Office of
Adolescent Health. However, we are concerned that by focusing the
funding on teenage pregnancy prevention alone, and not including the
equally important health issues of STIs and HIV, both the
administration and Congress missed an opportunity to provide true,
comprehensive sex education that promotes healthy behaviors and
relationships for all young people, including lesbian, gay, bisexual,
and transgender youth. We urge the subcommittee to adopt report
language that broadens the scope of the new teen pregnancy prevention
program to include an explicit focus on prevention of STDs including
HIV.
CDC--Tuberculosis
Tuberculosis is the major cause of AIDS-related mortality
worldwide. Two years ago, 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. Unfortunately,
the Administration has proposed a cut of $1.2 million for domestic TB
control. At a minimum, it is critical that the authorized funding level
of $220.5 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
HIVMA also supports for inclusion in fiscal year 2011 appropriations.
Two years ago, Congress passed landmark legislation--the
Comprehensive Tuberculosis Elimination Act of 2008--Public Law 110-873
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 $220.5 million in funding authorized
for fiscal year 2011 in this important law is appropriated for the CDC
Division of TB Elimination. This represents an increase of $76.3
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 $811 million in fiscal year 2011 with at least an increase of $131
million for part C for a total Ryan White appropriation of $3.1
billion. Ryan White Part C funds comprehensive HIV care and treatment--
the medical services that are directly responsible for the dramatic
decreases in AIDS-related mortality and morbidity over the last decade.
While the patient caseload in part C programs has been rising, funding
for part C has effectively decreased due to flat funding and funding
cuts at the clinic level. Part C programs expect a continued increase
in patients due to higher diagnosis rates and economic-related declines
in insurance coverage. During this economic downturn people with HIV
across the country are relying on part C comprehensive services more
than ever. The HIV medical clinics funded through part C have been in
dire need of increased funding for years, but new pressures are
creating a crisis in communities across the country. An increase in
funding is critical to prevent additional staffing and service cuts and
ensure the public health of our communities.
Minimal annual increases in Ryan White Part C allocations have
lagged behind rapid cost increases in all aspects of healthcare
delivery programs, leaving part C programs operating at a deficit while
struggling to meet growing patient need. Part C programs provide
comprehensive primary care to more than 240,000 HIV patients--which
represents an increase of more than 30 percent in less than 10 years.
Part C clinics are laying off staff, curtailing critical services such
as laboratory monitoring, creating waitlists, and operating on a 4-day
work week just to get by. For fiscal year 2011, HIVMA joins the Ryan
White Medical Provider Coalition, The CAEAR Coalition, and the American
Academy of HIV Medicine to request a $131 million funding increase for
Part C programs. These funds are urgently needed to provide HIV care
and treatment to Part C patients nationwide. 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 critical to meet the needs of HIV patients served by Part C
programs around the country.
Agency for Health Care Quality and Research (AHRQ)
HIVMA strongly urges full funding of $1.95 million for the HIV
Research Network (HIVRN), which represents the only significant HIV
work being done at AHRQ. The HIVRN is a consortium of 18 HIV primary
care sites co-funded by AHRQ and HRSA to evaluate healthcare
utilization and clinical outcomes in HIV infected children, adolescents
and adults in the United States. The Network analyzes and disseminates
information on the delivery and outcomes of healthcare services to
people with HIV infection. These data help to improve delivery and
outcomes of HIV care in the United States and to identify and address
disparities in HIV care that exist by race, gender, and HIV risk
factor. The HIVRN is a unique source of information on the cost and
cost-effectiveness of HIV care in the United States at a time when data
on comparative cost and effectiveness of healthcare is particularly
needed to inform health systems reform and the development and
implementation of a National HIV/AIDS Strategy. The HHS budget retained
the HRSA share of HIVRN funding ($.4 million), but inexplicably zeroed
out the AHRQ funding for the program, without any policy rationale for
eliminating it.
National Institutes of Health (NIH)--Office of AIDS Research
HIVMA strongly supports an increase of at least $4 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.
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 support these programs. We must seize 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.
______
Prepared Statement of the Hepatitis Outbreaks National Organization for
Reform (HONOReform)
Mr. Chairman and members of the subcommittee: As President and Co-
Founder 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 2008 when an outbreak that
potentially exposed more than 63,000 patients to hepatitis C occurred
in Las Vegas, Nevada. 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, cannot
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, which is
currently being piloted in New York and Nevada, 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.''
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, and HHS to help prevent
future hepatitis and HIV outbreaks through the following two fiscal
year 2011 appropriations requests:
Supporting CDC's Division of Healthcare Quality and Promotion
HONOReform requests $26 million for CDC Division of Healthcare
Quality and Promotion to address outbreaks and promote innovative ways
to adhere to injection safety and infection control guidelines.
The CDC provides national leadership in surveillance, outbreak
investigations, laboratory research, and prevention of healthcare-
associated infections. The transition of healthcare delivery from
primarily acute care hospitals to other healthcare settings (e.g., home
care, ambulatory care, free-standing specialty care sites, long-term
care) requires that common principles of infection control practice be
applied to the spectrum of healthcare delivery settings. In light of
the recent healthcare-associated transmissions of HCV in Denver,
Colorado, Las Vegas, Nebraska, North Carolina, New York City, Long
Island, and Grand Rapids, Michigan, 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.
Provider Education and Awareness ($5 million)
Funds to develop safe practice tools for additional inpatient and
outpatient healthcare settings in conjunction with key partners and
stakeholders. This will include training tools to be used by
professional organizations and accreditation and licensing groups to
increase adherence to recommendations. Funds will assist in
dissemination and use of tools to aid in implementing State HAI Action
Plans. Funds to expand the One & Only injection safety education and
awareness campaign, provide educational materials to all 50 States
through State health departments' HAI coordinators implement a national
media launch to promote awareness of the One & Only Campaign in
collaboration with the Safe Injection Practices Coalition and State
health departments; and evaluate the impact of the Campaign. Funds to
expand implementation of CMS surveys of injection safety practices in
ambulatory surgical centers to all outpatient settings.
Engineering and Innovation ($7 Million)
Funds to support the CDC in promoting private-sector and academic
healthcare solutions to injection safety and infection control
problems. This funding will enable the CDC to engage with industry and
academia through extramural grant mechanisms to:
--Examine current technologies and practices that eliminate the risk
of human error through unsafe injection practices;
--Identify and develop fast tracked safety engineered-solutions for
next generation products; and
--Demonstrate effectiveness of new technology to support inclusion in
Federal guidelines.
Detection, Tracking, and Response ($14 million)
Funds to expand augmentation of CMS survey capacity in outpatient
settings to strengthen State capacity to detect infections that
indicate errors in injection practices. These funds will enable the
CDC, in collaboration with CMS, to expand surveillance in 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 to assist State and local health
departments implement State HAI Action Plans, including detection and
tracking in order to investigate outbreaks of healthcare-associated
infections and other adverse events related to injection safety.
Funds to enable the CDC to provide assistance and respond to
outbreaks resulting from the re-use of syringes as requested by health
departments and health systems. Funds to the CDC to develop CDC
Toolkits of best practices for patient notifications and
postnotification support and best practices for investigations and
detecting clusters of outbreaks, to be used by State and local health
departments and healthcare systems.
Encouraging HHS To Focus on HAIs in the Outpatient Setting
HONOReform requests $1 million for the Department of Health and
Human Services (HHS) to expand its current focus for reducing HAIs from
hospitals to outpatient settings with the development of an action plan
to reduce HAIs in outpatient settings with a specific focus on
injection safety. HONOReform is 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 2 years, more than 150,000
patients in the United States have received ominous letters from public
health officials warning of possible exposure to deadly diseases like
hepatitis and HIV because their providers failed to follow fundamental
safety measures.
The increased frequency of such outbreaks was highlighted in the
February 2010 article, ``U.S. Outbreak Investigations Highlight the
Need for Safe Injection Practices and Basic Infection Control'',
published in Clinics in Liver Disease. The article attributed these
outbreaks to lapses in basic infection control (i.e., syringe reuse and
misuse of single dose and multidose vials).
HAIs in the Outpatient Setting ($1 million)
Funds to expand HHS' current focus for reducing healthcare-
associated infections (HAIs) from hospitals to outpatient settings with
the development and implementation of an action plan to reduce HAIs in
unlicensed outpatient settings and Health Resources and Services
Administration Community Care Centers including a specific focus on
injection safety. Funds to increase education, certifications, and
continuing education of medical, nursing, and allied health
professionals, including State-based certification, related to
injection safety.
______
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 $600 million in fiscal year 2011 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 increases provided for
many title VII and title VIII programs in the fiscal year 2010 Omnibus
Appropriations bill (Public Law 111-117). These investments are crucial
to addressing the existing and looming shortages of healthcare
professionals in this country and are key to ensuring the Nation's
healthcare professionals are able to care for the medically
underserved. The Patient Protection and Affordable Care Act (Public Law
111-148) updated and restructured the existing title VII and title VIII
programs to improve their efficiency, effectiveness, and
accountability, and reauthorized them at funding levels reflective of
the health workforce needs of the Nation. In addition to reauthorizing
the existing health professions programs, the legislation authorizes
several new programs and initiatives under titles VII and VIII designed
to mitigate health workforce challenges and expand the scope of the
programs to additional fields. HPNEC encourages an investment in these
new programs that supplements the support for the core title VII and
title VIII programs. These investments will be critical to ensuring
that the healthcare workforce can accomplish the goals of healthcare
reform.
We are grateful to President Obama for highlighting the need to
strengthen the health professions workforce as a national priority;
however, significant strides must still be made to ensure that all
Americans have access to the health professionals they need. According
to HRSA, an additional 31,000 health practitioners are needed to
alleviate existing 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 to ensure that the title VII and title VIII programs
are able to continue strengthening the country's safety net for the
healthcare needs of the medically underserved.
The existing title VII and title VIII programs can be considered in
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 make funds available to
eligible students from disadvantaged backgrounds who are
enrolled as full-time health professions students.
--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, while
the Dental Public Health Residency programs are vital to the
Nation's dental public health infrastructure. 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. And finally, the primary care cluster enhances
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 older adults. 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 National Sample Survey of
Registered Nurses, the Nation's most extensive and
comprehensive source of statistics on registered nurses.
--The Public Health Workforce Development programs are designed to
increase the number of individuals trained in public health, to
identify the causes of health problems, and respond to such
issues as managed care, new disease strains, food supply, and
bioterrorism. The Public Health Traineeships and Public Health
Training Centers seek to alleviate the critical shortage of
public health professionals by providing up-to-date training
for current and future public health workers, particularly in
underserved areas. Preventive Medicine Residencies, 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 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 77,395 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 tens of thousands of 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. 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 students from disadvantaged backgrounds 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
financially 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 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. While HPNEC members are keenly aware
of the fiscal pressures facing the subcommittee, we respectfully urge
support for funding of at least $600 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 also encourage an investment in the new
programs and responsibilities authorized in the Patient Protection and
Affordable Care Act to supplement the investment in the existing core
programs. We greatly appreciate the support of the subcommittee and
look forward to working with Members of Congress to reinvest in the
health professions programs in fiscal year 2011 and into the future.
______
Prepared Statement of the Home Safety Council
introduction
Chairman Harkin, Vice Chairman Cochran, and members of the
subcommittee, thank you for the opportunity to submit testimony on the
fiscal year 2011 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 officer and director of
public policy for the Home Safety Council (HSC) which is located in
Washington, DC.
about the home safety council
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 $20 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 health care 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.
--Nearly 30 million people are treated for injuries in U.S. emergency
departments each year. This is an average of 55 people each
minute.
--In a single year, injury and violence will cost the United States
$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 two Senate Resolutions in 2008 and 2009 recognizing National
Falls Prevention Awareness Day each September. For the good intentions
of Congress to bear fruit, an appropriation of $20 million is needed
for fiscal year 2011 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 $20
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, thank you for the opportunity to share our fiscal
year 2011 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 of the United States
On behalf of The Humane Society of the United States (HSUS) and the
Humane Society Legislative Fund, and our joint membership of more than
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 2011.
breeding of chimpanzees for research
The HSUS requests that no Federal funding be appropriated for the
breeding of chimpanzees for research. The basis of our request can be
found below.
--The National Center for Research Resources (NCRR) of the National
Institutes of Health (NIH), responsible for the oversight and
maintenance of federally owned chimpanzees, placed a moratorium
on funding the breeding of federally owned and supported
chimpanzees in 1995, primarily due to the excessive costs of
lifetime care of chimpanzees in laboratory settings. NCRR made
this moratorium permanent in 2007. As a result, no federally
owned chimpanzees should have given birth or sired infants
since 1995 and no federally owned chimpanzees should have a
date of birth later than 1995. We have discovered, however,
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.
--According to records obtained from the New Iberia Research Center
(NIRC), 42 federally owned females and 9 federally owned males
have been used for breeding since the 1995 moratorium was put
into place. Furthermore, at least 29 infants were born to a
federally owned mother and/or federally owned father since 1995
and 27 federally owned chimpanzees have a date of birth after
1995.
--There is evidence that chimpanzees being bred by the NIRC--through
their contract with the National Institute of Allergy and
Infectious Diseases (NIAID)--are owned or supported by NCRR,
and as a result, in violation of NCRR's breeding moratorium.
--The cost of maintaining chimpanzees in laboratories is exorbitant,
totaling up to $28 million each year for the current population
of approximately 800 federally owned or supported chimpanzees
(up to $67 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\
---------------------------------------------------------------------------
\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.
Background and History
Beginning in 1995, the National Research Council (NRC) confirmed a
chimpanzee surplus and recommended a moratorium on breeding of
federally owned or supported chimpanzees \1\, who now number
approximately 800 of the 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. 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 60 years.
---------------------------------------------------------------------------
\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 2011.
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 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 standards are often not being
met. Inspection reports for other federally funded chimpanzee
facilities have reported violations of the Animal Welfare Act in recent
years, including the death of a chimpanzee during improper transport,
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/Mikkelsen,
TS, et al.,(1 September 2005) Initial sequence of the chimpanzee genome
and comparison with the human genome, Nature 437, 69-87.
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Ethical 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 committee report
language:
``The Committee directs that no funds provided in this Act be used
to support the breeding of chimpanzees for research.''
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 2011. 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.
high throughput screening, toxicity pathway profiling, and biological
interpretation of findings
NIH--Office of the Director
In 2007, the National Research Council published its report titled
``Toxicity Testing in the 21st Century: A Vision and a Strategy.'' This
report catalyzed collaborative efforts across the research community to
focus on developing new, advanced molecular screening methods for use
in assessing potential adverse health effects of environmental agents.
It is widely recognized that the rapid emergence of omics technologies
and other advanced technologies offers great promise to transform
toxicology from a discipline largely based on observational outcomes
from animal tests as the basis for safety determinations to a
discipline that uses knowledge of biological pathways and molecular
modes of action to predict hazards and potential risks.
In 2008, NIH, NIEHS, and EPA signed a memorandum of understanding
\6\ to collaborate with each other to identify and/or develop high
throughput screening assays that investigate ``toxicity pathways'' that
contribute to a variety of adverse health outcomes (e.g., from acute
oral toxicity to long-term effects like cancer). In addition, the MOU
recognized the necessity for these Federal research organizations to
work with ``acknowledged experts in different disciplines in the
international scientific community.'' Much progress has been made, but
there is still a significant amount of research, development and
translational science needed to bring this vision forward to where it
can be used with confidence for safety determinations by regulatory
programs in the Government and product stewardship programs in the
private sector. In particular, there is a growing need to support
research to develop the key science-based interpretation tools which
will accelerate using 21st century approaches for predictive risk
analysis. We believe the Office of the Director at NIH can play a
leadership role for the entire U.S. Government by funding both
extramural and intramural research.
---------------------------------------------------------------------------
\6\ http://www.genome.gov/pages/newsroom/currentnewsreleases/
ntpncgcepamou121307finalv2.pdf.
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We respectfully request the following committee report language:
``The Committee supports the implementation of the National
Research Council's report `Toxicity Testing in the 21st Century: A
Vision and a Strategy' to create a new paradigm for risk assessment
based on use of advanced molecular biological methods in lieu of animal
toxicity tests and urges the National Institutes of Health to play a
leading role by funding relevant intramural and extramural research
projects. Current activities at the NIH Chemical Genomics Center,
National Institute of Environmental Health Sciences and the
Environmental Protection Agency show considerable potential and the NIH
Director should explore opportunities to augment this effort by
identifying possible additional resources that could be directed to key
extramural research projects.''
______
Prepared Statement of the Harlem United Community AIDS Center, Inc.
Harlem United Overview
Harlem United Community AIDS Center, Inc. (Harlem United) is a
community-based, nonprofit organization providing comprehensive,
integrated care to individuals and families living with HIV/AIDS in
Upper Manhattan area of New York City and its nearby boroughs.
Harlem United provides a full range of medical, social, and
supportive services to people living with HIV/AIDS whose diagnoses are
often complicated by addiction, mental illness, and homelessness.
Harlem United utilizes a comprehensive model of care that includes HIV
testing; treatment and education; primary medical care; substance use
counseling; mental health services; and an array of expressive
therapies. Each year we touch the lives of more than 6,000 people
through our services and myriad locations, including two AIDS Adult Day
Health Care centers. At these centers, patients receive medication
management, healthcare monitoring, case management, substance abuse
services, nutritional services, and health education. We are proud that
we deliver evidence-based, outcome-driven, comprehensive, medically
endorsed care in a cost-effective and supportive setting.
Harlem United is very concerned about increasing HIV incidence
among men who have sex with men (MSM) of all races and ethnicities.
Harlem United's Black Men's Initiative endeavors to reduce rates of HIV
infection and transmission of sexually transmitted infections (STIs)
among young Black and Latino MSM in New York City. Our Education and
Training Department works with populations and individuals at increased
risk for HIV infection, such as MSM, to increase knowledge and skills
to prevent HIV transmission and improve HIV-related health outcomes.
Our programs include evidence-based HIV prevention interventions,
comprehensive risk-reduction counseling, confidential HIV rapid testing
and STI screenings, primary care, mental health, and supportive housing
services many of which specialize in mobilizing effective responses for
Black and Latino MSM.
HIV/AIDS and MSM
MSM account for nearly half of the more than 1 million people
living with HIV in the United States and half of all new HIV infections
in the United States each year. While the Centers for Disease Control
and Prevention (CDC) estimates that MSM account for just 4 percent of
the U.S. male population aged 13 and older, the rate of new HIV
diagnoses among MSM in the United States is more than 44 times that of
other men and more than 40 times HIV diagnoses among women. MSM is the
only risk group in the United States in which new HIV infections are
increasing.\1\
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\1\ ``CDC Fact Sheet: HIV and AIDS among Gay and Bisexual Men,''
Centers for Disease Control and Prevention (March 2010). Available at
http://www.cdc.gov/nchhstp/newsroom/docs/FastFacts-MSM-
FINAL508COMP.pdf.
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As the CDC's fiscal year 2011 Congressional Justification noted,
MSM of all races/ethnicities are at increased risk, but substantial
racial/ethnic disparities do exist among MSM, with Black and Hispanic
MSM bearing the greatest burden of the disease. The most alarming HIV
infection increases are occurring among MSM ages 13-29 and 45 and
older.\2\ Despite having lower infection rates than older MSM, younger
MSM are more likely to have an undiagnosed HIV infection. HIV infection
among MSM is facilitated by a number of factors including STIs,
substance use, and community fatigue with HIV prevention messages. CDC
should work with community leaders to inform methodology for
communicating about HIV burden in MSM communities that encourages,
rather than discourages, greater adoption of effective HIV prevention
strategies.
---------------------------------------------------------------------------
\2\ ``Fiscal Year 2011 Centers for Disease Control and Prevention
Justification of Estimates for Appropriations Committees,'' Department
of Health and Human Services, 74. Available at http://cdc.gov/fmo/
topic/Budget%20Information/appropriations_budget_form_pdf/
FY2011_CDC_CJ_Final.pdf.
---------------------------------------------------------------------------
According to the CDC, recent increases in syphilis have largely
been seen among MSM and syphilis is associated with a two-to-five fold
increased risk of HIV. Higher rates of gonorrhea, which also
facilitates HIV acquisition and transmission, have been documented
among MSM who are HIV-infected. Thus, more needs to be done to address
STIs and HIV for MSM given their elevated risk for infection. CDC data
published in 2005 suggest that as few as 1 in 5 MSM received individual
or group-level HIV prevention interventions in the prior year.\3\
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\3\ ``Fiscal Year 2011 Centers for Disease Control and Prevention
Justification of Estimates for Appropriations Committees,'' 74.
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CDC Program for MSM
In the fiscal year 2011 budget, the President has requested $27
million for CDC to undertake targeted HIV and STI prevention efforts
for MSM. We understand this initiative will build on an effort begun in
2008, when the CDC provided $4 million in supplemental funding to 51
health departments to re-assess and strengthen their plans to address
HIV among MSM in their jurisdictions. Harlem United is pleased that the
CDC will expand this focused initiative to prevent HIV through holistic
and integrated approaches to protect the health of gay, bisexual, and
other MSM. We applaud this multiyear effort to prevent new HIV
infections, reduce the acquisition of STIs, and address substance
abuse. Harlem United hopes that additional resources will be directed
to this effort as they are identified.
Studies show that the majority of individuals who are aware of
their HIV-positive diagnosis proactively make changes to their behavior
to prevent further spread of HIV. Increased access to routine HIV
testing, irrespective of risk, is a key policy priority for Harlem
United; as such, we hope that the expanded MSM effort will complement
the 2010 HIV Expanded Testing Initiative focused on MSM.
We anticipate that the additional resources requested for fiscal
year 2011 by the President will expand HIV testing and prevention
services to more MSM who need them, improve monitoring for co-
infections among MSM and HIV-infected persons, and support the
development and refinement of intervention services specifically for
MSM. Based upon the racial and ethnic burden of HIV/AIDS among Hispanic
and Black MSM and Harlem United's strong commitment to serve this
population, we are pleased that the CDC efforts will be focused on
these populations.
Social determinants are an essential component to determining HIV
vulnerability among MSM. Effective HIV prevention strategies must be
mobilized simultaneously on an individual and community-level to
successfully reduce HIV vulnerability and infections. We encourage CDC
to utilize these new resources to promulgate a full continuum of HIV
prevention interventions which provide MSM with an array of strategies
that will best enable them to protect their sexual in the various ways
they might experience HIV-risk in their lives. Harlem United maintains
that HIV prevention among MSM should include the following initiatives:
--Increase capacity among existing community-based organizations
whose primary focus is HIV prevention among MSM, particularly
MSM of color, or have programs which focus primarily on HIV
prevention among MSM;
--Targeted social and sexual network based HIV testing approaches,
inclusive of Internet-based outreach;
--Peer-driven linkage to care initiatives that strive to connect
newly diagnosed and lost-to-care HIV-positive MSM to high-
quality and affordable healthcare; and
--Culturally competent social marketing campaigns which reach beyond
HIV testing and condom use to educate MSM communities about
strategies to protect themselves from HIV reflective of
existing community risk behaviors.
Finally, given the alarming disparity of HIV and syphilis incidence
among MSM, we also urge the CDC to assemble an MSM advisory group that
would provide guidance to decisionmaking officials in the Division of
HIV/AIDS Prevention on barriers to implementation and best practices to
be replicated. Further, this advisory group would work with CDC to
integrate HIV and STI prevention and screening programs in clinical and
community-based settings.
We urge Congress to fulfill the President's request of $27 million
for the CDC's MSM HIV and STI program and ensure that available
resources reach communities and populations who need them most.
Conclusion
We very much appreciate the opportunity to provide written
testimony in support of our Nation's efforts to prevent HIV/AIDS among
gay, bisexual, and other MSM at the CDC. While President Obama's budget
certainly reflects his commitment to the domestic fight against HIV/
AIDS, any increase in funding Congress provides to the CDC program
aimed at preventing HIV/AIDS and STIs among MSM would be greatly
appreciated and would help us further our efforts to reverse the ever
growing HIV epidemic in Harlem, other New York neighborhoods, and
across the Nation.
Harlem United is a member of the Federal AIDS Policy Partnership
and joins in the coalition's funding requests with respect to domestic
HIV/AIDS prevention funding and its call for increased funding for the
Ryan White Care Act programs.
Harlem United stands ready to be a resource for the subcommittee
and its staff with respect to HIV/AIDS prevention, the care and
treatment of individuals living with HIV/AIDS, and the provision of
supportive services for individuals living with HIV/AIDS and the
homeless.
______
Prepared Statement of the International Foundation for Functional
Gastrointestinal Disorders
Thank you for the opportunity to present the views of the
International Foundation for Functional Gastrointestinal Disorders
(IFFGD) regarding the importance of functional gastrointestinal (GI)
and motility disorders research.
Established in 1991, the IFFGD is a patient-driven nonprofit
organization dedicated to assisting individuals affected by functional
GI disorders, and providing education and support for patients,
healthcare providers, and the public at large. The IFFGD also works to
advance critical research on functional GI and motility disorders, in
order to provide patients with better treatment options, and to
eventually find a cure. The IFFGD has worked closely with NIH on a
number of priorities, including the NIH State-of-the-Science Conference
on the Prevention of Fecal and Urinary Incontinence in Adults through
NIDDK, the National Institute of Child Health and Human Development
(NICHD), and the Office of Medical Applications of Research (OMAR). I
have served on the National Commission on Digestive Diseases (NCDD),
which released a long-range road map for digestive disease research in
2009, entitled Opportunities and Challenges in Digestive Diseases
Research: Recommendations of the National Commission on Digestive
Diseases.
The need for increased research, more effective and efficient
treatments, and the hope for discovering a cure for functional GI and
motility disorders are close to my heart. My own personal experiences
as someone suffering from functional GI and motility disorders
motivated me to establish the IFFGD 19 years ago. I was shocked to
discover that despite the high prevalence of these conditions among all
demographic groups worldwide, such an appalling lack of dedicated
research existed. This lack of research translates into a dearth of
diagnostic tools, treatments, and patient supports. Even more shocking
is the lack of awareness among both the medical community and the
general public, leading to significant delays in diagnosis, frequent
misdiagnosis, and inappropriate treatments including unnecessary
medication and surgery. It is unacceptable for patients to suffer
unnecessarily from the severe, painful, life-altering symptoms of
functional GI and motility disorders due to a lack of awareness and
education.
The majority of functional GI disorders have no cure and treatment
options are limited. Although progress has been made, the medical
community still does not completely understand the mechanisms of the
underlying conditions. Without a known cause or cure, patients
suffering from functional GI disorders face a lifetime of chronic
disease management, learning to adapt to intolerable, disruptive
symptoms. The medical and indirect costs associated with these diseases
are enormous; estimates range from $25--$30 billion annually. Economic
costs spill over into the workplace, and are reflected in work
absenteeism and lost productivity. Furthermore, the emotional toll of
these conditions affects not only the individual but also the family.
Functional GI disorders do not discriminate, effecting all ages, races
and ethnicities, and genders. These diseases account for significant
lost opportunities for the individual as well as for society.
Irritable Bowel Syndrome (IBS)
IBS, one of the most common functional GI disorder, strikes all
demographic groups. It affects 30 to 45 million Americans,
conservatively at least one out of every 10 people. Between 9 to 23
percent of the worldwide population suffers from IBS, resulting in
significant human suffering and disability. IBS is a chronic disease is
characterized by a group of symptoms that may vary from person to
person, but typically include abdominal pain and discomfort associated
with a change in bowel pattern, such as diarrhea and/or constipation.
As a ``functional disorder'', IBS affects the way the muscles and
nerves work, but the bowel does not appear to be damaged on medical
tests. Without a definitive diagnostic test, many cases of IBS go
undiagnosed or misdiagnosed for years. It is not uncommon for IBS
suffers to have unnecessary surgery, medication, and medical devices
before receiving a proper diagnosis. Even after IBS is identified,
treatment options are sorely lacking, and vary widely from patient to
patient. What is known is that IBS requires a multidisciplinary
approach to 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. Stigma surrounding bowel habits may
act as barrier to treatment, as patients are not comfortable discussing
their symptoms with doctors. Because IBS symptoms are relatively common
and not life-threatening, many people dismiss their symptoms or attempt
to self-medicate using over-the-counter medications. In order to
overcome these barriers to treatment, ensure more timely and accurate
diagnosis, and reduce costly unnecessary procedures, educational
outreach to physicians and the general public remain key.
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 of 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 of 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 fund the NIH at level of $35 billion for
fiscal year 2011, an increase of 12 percent over fiscal year 2010. This
funding level will help preserve the initial investment in healthcare
innovation established by the American Recovery and Reinvestment Act of
2009. Strengthening and preserving our Nation's biomedical research
enterprise fosters economic growth, and supports innovations that
enhance the health and well-being of the American people.
Concurrent with overall NIH funding, the IFFGD supports growth of
research activities on functional GI and motility disorders,
particularly through NIDDK and the Office of Research on Women's Health
(ORWH). Increased support for NIDDK and ORWH will facilitate necessary
expansion of the research portfolio on functional GI and motility
disorders necessary to grow the medical knowledge base and improve
treatment. Such support would also expedite the implementation of
recommendations from the National Commission on Digestive Diseases.
Following years of near level-funding at NIH, research
opportunities have been negatively impacted across all NIH Institutes
and Centers, including NIDDK. With the expiration of funding from the
American Recovery and Reinvestment Act of 2009, medical researchers run
the risk of ``falling off a cliff'', stalling, if not losing promising
research from that 2 year period. For this reason, the IFFGD encouraged
support for initiatives such as the Cures Acceleration Network (CAN),
authorized in the Patient Protection and Affordable Coverage Act. The
IFFGD urges the Subcommittee to show strong leadership in pursuing a
substantial funding increase for CAN through the fiscal year 2011
appropriations process.
Thank you for the opportunity to present the views of the
functional GI disorders community.
______
Letter From the Industrial Minerals Association--North America
April 12, 2010.
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 Chairman Harkin and Ranking Member Cochran: I write to request
additional appropriations for the Department of Labor's Mine Safety and
Health Administration (MSHA). Specifically the Industrial Minerals
Association--North America (IMA-NA) requests a one-time appropriation
of $3.6 million to improve MSHA's communication capabilities,
specifically videoconferencing capabilities, and $1.7 million annually
thereafter to maintain and operate these enhanced communications
capabilities. This funding level is adequate to establish enhanced
communications capabilities at 20 sites nationally and capable of
reaching directly fully 80 percent of MSHA's approximately 2,500
employees.
It generally is recognized that mine inspectors need to stay
abreast of the latest developments in mine safety, be informed of
changes in regulatory standards and interpretations, be able to learn
from mine incidents from various parts of the country, and feel a sense
of connectedness with their headquarters in Arlington, Virginia. In
light of recent tragic events in West Virginia, these constituent
components of MSHA's mission take on added poignancy. To accomplish
these important tasks, MSHA needs a state-of-the-art communications
system. MSHA should be able to instantly and effectively communicate
with, train, and retrain its inspectors over distance.
You may be aware that the Department of Labor's Office of Inspector
General recently released an audit report regarding ``Journeyman Mine
Inspectors Do Not Receive Mandated Periodic Retraining.'' Report Number
05-10-001-06-001 (http://www.oig.dol.gov/public/reports/oa/2010/05-10-
001-06-001.pdf). The additional appropriations requested for enhanced
communications capabilities could go a long way toward addressing
issues raised in this report.
The communications systems relied upon by MSHA are antiquated and
ineffective. MSHA is relying on dated communications and IT
infrastructure that is decades behind the capabilities of those they
regulate. They also are substandard when compared to those of the
National Institute for Occupational Safety and Health, the mine safety
and health research agency that supports MSHA's mission. This is not
acceptable.
Similarly, MSHA's ability to perform meaningful stakeholder
education and outreach demands state-of-the-art communications systems.
Adequately trained inspectors and consistency of enforcement are
necessary components of MSHA's mission and the lack of appropriate
information technology infrastructure frustrates their full
implementation. Less than full implementation frustrates stakeholders.
For instance, the enhanced communications capability requested could
allow a mine operator at a locally convenient site to consult with MSHA
officials at a distant site. Similarly, the enhanced communications
capabilities could be used broadly, permitting MSHA to educate
stakeholders and perform industry outreach by district, regionally and
nationally, benefiting mine operators and miners alike.
IMA-NA respectfully requests your support for additional funding to
improve MSHA's communication capabilities, specifically
videoconferencing capabilities.
The IMA-NA is a trade association organized to advance the
interests of North American companies that mine or process industrial
minerals. These minerals are used as feedstocks for the manufacturing
and agricultural industries and are used to produce essential products.
Industrial minerals are critical to the manufacture of glass, ceramics,
paper, plastics, rubber, insulation, pharmaceuticals, and cosmetics.
They also are used to make foundry cores and molds used for metal
castings, and in paints, filtration, metallurgical applications,
refractory products and specialty fillers. The IMA-NA membership
includes producers of ball clay, barite, bentonite, borates, calcium
carbonate, diatomite, feldspar, industrial sand, magnesia, mica, soda
ash (trona), talc, wollastonite and other minerals. IMA-NA's membership
also includes many of the suppliers to the industrial minerals
industry, including equipment manufacturers, railroads and trucking
companies, and consultants. Finally, the following hyperlink will
direct you to our Web site, which provides additional information on
this important mining sector (http://www.ima-na.org).
Thank you for your timely consideration of this request.
Sincerely,
Mark G. Ellis,
President.
______
Prepared Statement of the Interstate Mining Compact Commission
We are writing in support of the fiscal year 2011 budget request
for the Mine Safety and Health Administration (MSHA), which is part of
the U.S. Department of Labor. In particular, we urge the subcommittee
to support a full appropriation for grants to States for safety and
health training of our Nation's miners pursuant to section 503(a) of
the Mine Safety and Health Act of 1977. MSHA's budget request for state
grants is $8.941 million. This is the same amount that has been
appropriated for State training grants by Congress over the past 2
fiscal years and, as such, does not fully consider inflationary and
programmatic increases being experienced by the States. We therefore
urge the subcommittee to restore funding to the statutorily authorized
level of $10 million for State grants so that States are able to meet
the training needs of miners and to fully and effectively carry out
State responsibilities under section 503(a) of the act.
The Interstate Mining Compact Commission (IMCC) is a multi-state
governmental organization that represents the natural resource,
environmental protection, and mine safety and health interests of its
24 member States. The States are represented by their Governors who
serve as commissioners.
IMCC's member States are concerned that without full funding of the
State grants program, the federally required training for miners
employed throughout the United States will suffer. States are
struggling to maintain efficient and effective miner training and
certification programs in spite of increased numbers of trainees and
the incremental costs associated therewith. State grants have flattened
out over the past several years and are not keeping place with
inflationary impacts or increased demands for training. The situation
is of particular concern given the enhanced, additional training
requirements growing out of the recently enacted MINER Act and MSHA's
implementing regulations.
As you consider our request to increase MSHA's budget for State
training grants, please keep in mind that the States play a
particularly critical role in providing special assistance to small
mine operators (those coal mine operators who employ 50 or fewer miners
or 20 or fewer miners in the metal/nonmetal area) in meeting their
required training needs.
We appreciate the opportunity to submit our views on the MSHA
budget request as part of the overall Department of Labor budget.
Please feel free to contact us for additional information or to answer
any questions you may have.
______
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 2011 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 and its
prevalence appears to be is increasing significantly. At any one time
there are over 100,000 myeloma patients undergoing treatment for their
disease in the United States. In 2009, 20,580 Americans were diagnosed
with myeloma and 10,580 lost their battle with this disease.
Although the incidence of many cancers is decreasing, myeloma cases
are increasing in incidence. Once almost exclusively a disease of the
elderly, myeloma is now being found in increasing numbers in people
under the age of 65, and it is not uncommon for patients to be
diagnosed in their 30s. IMF-funded research suggests that much of this
increase is being caused by environmental toxins. To give just one
example supporting this hypothesis, relatively recent published reports
in the peer-reviewed literature have identified a disproportionate
incidence of myeloma among clean-up and rescue workers at the 9/11
World Trade Center site.
In recent years significant gains have been made, extending myeloma
patients' lives and improving their quality of life. Furthermore,
progress begun in myeloma is already helping patients with other blood
cancers and even solid tumors. Now it's important to maintain that
momentum.
--There is no cure for myeloma
--Remissions are not permanent
--Additional treatment options are essential
At the same time, even while they live with the disease, myeloma
patients can suffer debilitating fractures and other bone disorders,
severe side effects of certain treatments, and other problems that
profoundly affect their quality of life, and significantly impact the
cost of their healthcare.
Sustain and Seize Cancer Research Opportunities
Myeloma research is producing extraordinary breakthroughs--leading
to new therapies that translate into longer survival and improved
quality of life for myeloma patients and potentially those with other
forms of cancer as well. Myeloma was once considered a death sentence
with limited options for treatment, but today 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.
Our Nation has benefited immensely from past Federal investment in
biomedical research at the National Institutes of Health (NIH) and the
IMF advocates $33.349 billion for NIH in fiscal year 2011.
A study in the Journal of Clinical Oncology projects that the
number of new cancer cases diagnosed each year will jump 45 percent in
the next 20 years. In multiple myeloma an even greater increase (57
percent) is projected, and we are already seeing increasing diagnoses
in patients under age 65 including patients in their 30s, in what was
once a rare disease of the elderly.
While a number of cancers have achieved 5-year survival rates of
over 80 percent since passage of the National Cancer Act of 1971,
significant challenges still remain for other cancers. In fact, more
than half of the 562,340 cancer deaths in 2009 were caused by just
eight forms of cancer with 5-year survival rates of 45 percent or
less--of which myeloma is one. Yet, myeloma and these other cancers
have historically also received the least amount of Federal funding. As
we have seen mortality rates of diseases such as breast cancer,
prostate cancer, AIDS, and childhood leukemia greatly reduced through
targeted, comprehensive, and well-funded programs that have led to
earlier detection and superior forms of treatment, so too must we shine
a brighter light on myeloma and the other seven deadly cancers to
achieve this same goal for them. The IMF urges Congress to allocate
$5.957 billion to the National Cancer Institute (NCI) in fiscal year
2011 to continue our battle against myeloma.
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 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 2011 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 2011
funding levels necessary to ensure that our Nation continues to make
gains in the fight against myeloma.
______
Prepared Statement of the Jeffrey Modell Foundation
Mr. Chairman and members of the subcommittee: Thank you for the
opportunity to present this testimony to the subcommittee. My husband
Fred and I created the Jeffrey Modell Foundation in 1987 in memory of
our son, Jeffrey, who died at the age of 15 as a result of a life long
battle against one of the estimated 160 primary immunodeficiency (PI)
diseases.
The Jeffrey Modell Foundation is an international organization with
its headquarters in New York City. In the 24 years since we established
it, the Foundation has grown into the premier advocacy and service
organization on behalf of people afflicted with PI diseases. As a
demonstration of the extent to which the JMF leads in the field, please
consider the following:
--The Foundation has created Jeffrey Modell Research and Diagnostic
Centers at 72 academic and teaching hospitals from coast to
coast in the United States and throughout the world. They are
located on every continent. In addition, we are affiliated with
more than 415 referring physicians at 171 academic medical
centers in 59 countries and 169 cities, again located on every
continent throughout the world.
--The Foundation conducts a National Physician Education and Public
Awareness Campaign, currently funded with approximately $3.1
million appropriated by this subcommittee to the Centers for
Disease Control and Prevention (CDC) and awarded by competitive
contract to the Foundation. To date, the Foundation has
leveraged the Federal money to generate in excess of $125
million in donated media with hundreds of thousands of
placements on television, radio, print, and other public media,
as well as a 30-minute program produced for PBS. The Campaign
has also included physician symposia, conducted for CME credits
in locations throughout the country. It has also included
mailings to physicians in a variety of specialist and primary
care fields, including pediatrics and several pediatric
specialties, family practice, and internal medicine, as well as
school nurses, clinical and registered nurses and daycare
centers.
--In addition, the Jeffrey Modell Foundation has been the leader in
advancing newborn screening for some of the most severe forms
of PI. Working with the CDC, National Institutes of Health
(NIH), UCSF and private industry, we helped fund the
development of a newborn screening test that was pilot tested
in Wisconsin. The results were so successful that Wisconsin and
Massachusetts have now implemented population-based screening
of every baby born in their States. Then, in January of this
year, we were successful in having the Secretary's Advisory
Committee for Children with Heritable Disorders add this test
to the core panel of 29 newborn screening tests recommended for
the States to utilize. It is the first test to be added since
the core panel was created in 2005. The test is already saving
lives and we know that as more states adopt it, many more will
be saved.
First and foremost, Mr. Chairman, we want to thank you and all the
members of this subcommittee on both a personal and a professional
level. Personal because whenever we come to Washington, whether it is
to testify here before the subcommittee or to meet with the members of
the subcommittee individually in their offices, every Member of
Congress and every member of your staffs are unfailingly polite,
courteous, interested, and caring. The warm and understanding response
that we receive makes this a labor of love for us.
And, professional because over the 12 years that we have been
coming to Washington, we have been given the opportunity to build a
partnership with the Congress, CDC, NIH, as well as with our own
supporters in the private sector, including industry and other
concerned donors. We believe that we have maximized the benefits for
patients from the support that this subcommittee has afforded us. I
would like to take a few minutes to discuss where we are, where we are
going with your continued support, and some changes that are need in
the President's budget request to help us help patients.
PI Education and Awareness Program
This subcommittee is currently providing CDC with $3.1 million for
physician education and public awareness of immunodeficiencies for
fiscal year 2010. This is part of an overall budget of $12.3 million
for the Office of Public Health Genomics, which uses the remaining $9.2
million for its operations.
Since the Campaign's inception, it has generated more than $125
million in donated media, including television and radio spots,
magazine ads, billboards, airport signs, and other print media. It has
also enabled us to generate additional funding from the private
sector--both individuals and the pharmaceutical industry. To this
point, every $1 of Federal funds provided by the subcommittee to this
program has been leveraged into more than $10 for this education and
awareness program.
Most importantly, Mr. Chairman, I am delighted to report to you
that the program that this subcommittee has funded is having exactly
the impact that all of us hoped it would when it was created. Allow me
to give you some specifics.
Surveying the physicians at the Jeffrey Modell Centers Referral
Network we have learned that the number of patients referred, diagnosed
and treated has doubled every year since the program's inception. The
negative health outcomes of undiagnosed cases--infections, hospital and
physician visits, and similar costs--decrease an average of 70 percent
for diagnosed patients.
But, it is fair of this subcommittee to ask ``so what?'' What
difference does it make to the health of these patients if they are now
in treatment? What is the real impact in a real world sense on the
patients that are found?
The economic impact of PI diagnosis has been carefully assessed
comparing the costs of treatment before diagnosis and after. In round
numbers what we learned was that the average annual cost of healthcare
for an undiagnosed patient is $103,000 per year. The same costs for the
same patients in the year after diagnosis are $23,000. The gross annual
savings to the healthcare system is $80,000 per patient.
Mr. Chairman, this program is working and we are delighted. But
this is where the problem comes along. The President's budget for
fiscal year 2011 reduces funding for the Office of Public Health
Genomics from $12.3 million to $11.7 million. Further it eliminates the
line item created by this subcommittee to fund the education and
awareness program. While CDC has indicated its support for continuing
the program, the only guarantee that will happen is if you act.
For this reason, we are asking that you take three modest steps as
you are assembling the Chairman's mark for the bill:
--First, restore the total line item for the Office of Public Health
Genomics to its fiscal year 2010 level of $12,308,000.
--Second, break that money out into two separate lines, as its now--
$9,201,000 for the Office and $3,107,000 for PI Education and
Awareness.
--Third, so that there is no misunderstanding, include a paragraph of
Committee Report language that says:
``The subcommittee believes that the education and awareness
program for primary immunodeficiencies has been a model of public-
private cooperation and therefore has restored the current structure
for the Office of Public Health Genomics budget. The program's success
in leveraging public money for private investment has resulted in a
huge return on the Federal dollar, led to reduced health disparities,
and will save lives as the program directs greater attention to newborn
screening.''
Newborn Screening Program
As described above, early diagnosis is critical to the health of
patients and to saving the healthcare system money. And, there are few
better examples of early diagnosis than newborn screening. The JMF has
worked long and hard to support the development of a newborn screening
program for some of the most severe and deadly forms of PI.
Early detection of these diseases through newborn screening is
critical because bone marrow transplants cure more than 98 percent of
infants who have the procedure before developing any serious
infections. The treatment costs less than $10,000. However, if an
infant receives a transplant after developing severe infections, the
success rate is only between 60 and 70 percent; the costs associated
with the treatment of these infants can be as high as $1 million during
their lifetime.
As described above, the Secretary's Advisory Committee on Children
with Heritable Disorders has recommended to the Secretary that this
test be added to the core panel that forms the basis of newborn
screening in States throughout the Nation. It is the first time the
list has ever been amended since it was created 5 years ago. The
Jeffrey Modell Foundation is proud to have played a role in this
advancement for babies and we are urging the Secretary to accept the
recommendation promptly.
Once she has done so, newborn screening officials in numerous
States have advised us that they will move forward with including this
test in their States. At that time, the Foundation is committed to
moving forward with the production of educational materials for State
labs and families that will provide the information they need to
consider the results of the test their baby is having. The funds for
the education and awareness program are critical for making the most of
this important improvement in public health.
Conclusion
With the support the Jeffrey Modell Foundation has received from
this subcommittee over the years, we have been able to increase the
public's awareness of PI and most importantly improve and save lives.
We are grateful for your past and continued support. While we
understand that the subcommittee must make difficult decisions in this
fiscal environment, please remember that the Foundation has
successfully leveraged Federal dollars to expand the reach of all of
our activities. Frankly, the collaboration between the Federal
government and the Jeffrey Modell Foundation has been a model for
successful public-private collaborations. The impact of every Federal
dollar spent on the education and awareness campaign and on newborn
screening has been exponentially increased by our commitment to bring
the Foundation's resources to bear.
We ask again that you restore the funding to fiscal year 2010
levels; break out PI Education and Awareness into a separate line item;
and include the report language provided to assure that this program
maximizes its impact.
Mr. Chairman, again, we are delighted to have the opportunity to
present to the subcommittee and stand ready to work with you.
______
Prepared Statement of Knowledge Alliance
On behalf of Knowledge Alliance, we are pleased to submit this
testimony to the subcommittee regarding our recommendations for the
fiscal year 2011 Labor, Health and Human Services, and Education, and
Related Agencies appropriations bill as they relate to the U.S.
Department of Education.
Knowledge Alliance is a nonprofit, nonpartisan trade association
dedicated to expanding the use of research-based knowledge in policy
and practice in K-12 education. We are a strong and dynamic community
of highly successful education organizations and agencies, all of which
are constantly looking for new and better ways to support high-quality
education research, development, dissemination, technical assistance,
and evaluation at the Federal, regional, State, tribal, and local
levels.
Much of our collective work is focused on advancing the effective
use of research-based knowledge as catalyst for innovation and
transformation in K-12 education and as a central organizing concept
for education reform moving forward. We firmly believe that the
effective creation, translation, and application of research-based
knowledge can significantly accelerate and bring to scale nationwide
efforts to improve academic performance and close achievement gaps for
all students. Effective knowledge use also helps advance the national
initiatives to transform education into an evidence-based field and
enhance the implementation of the American Recovery and Reinvestment
Act (ARRA), the Elementary and Secondary Education Act (ESEA) and the
Education Sciences Reform Act.
critical challenges
We believe that now is the time to intensify the focus on creating,
translating, and applying research-based knowledge into useful tools
that will improve classroom policies and practices in all schools for
the following critical reasons:
Seriously Deficient Investments in Education R&D.--ESEA requires
educators to use instructional practices and innovations supported by
research, but the Department of Education spends less than 1 percent of
its budget on research, development and statistics, the smallest of any
Cabinet-level agency.
[in billions of dollars]
------------------------------------------------------------------------
Fiscal year
2009 research
Federal department/agency and
development
request
------------------------------------------------------------------------
Defense................................................. $80.7
Health and Human Services............................... 29.9
NASA.................................................... 10.7
Energy.................................................. 10.6
National Science Foundation............................. 5.2
Agriculture............................................. 2
Commerce................................................ 1.2
Homeland Security....................................... 1.1
Transportation.......................................... 901
Veterans Affairs........................................ 884
Interior................................................ 617
Environmental Protection Agency......................... 550
Education............................................... 324
------------------------------------------------------------------------
Source: American Association for the Advancement of Science.
This low level of investment means that education is ill equipped
to rapidly develop, deliver, and scale innovations as is done in other
sectors through R&D. The bottom line is that schools and students will
suffer without an increased investment in developing and testing
research-based practices.
Rapidly Expanding Capacity Crisis.--According to a recent Center on
Education Policy report, about one-third of U.S. public schools did not
make AYP in school year 2008-2009. In nine States and the District of
Columbia, at least half the public schools did not make AYP in 2008-
2009. In a majority of the States (35 including D.C.), at least one-
fourth of the schools did not make AYP. States and districts currently
lack the sufficient funds, staff, and expertise to address the growing
demand to support low-performing schools. This capacity crisis only
exacerbates the complex challenges of transforming low-performing
schools and preparing all schools for the next generation of learning.
Urgent Need for Solutions.--Federal education policy has evolved in
phases over the past 15 years. The focus on standards and assessments
in the late 1980s and early 1990s spawned major attention on the
alignment of standards, curriculum, and assessments in the 1990s, which
played a role in the current emphasis on accountability. The next
logical step in this standards-based continuum is a more comprehensive
and vigorous focus on solutions to bring about real school improvement
by providing significant new resources and expertise targeted to
turning around low-performing schools and to building a knowledge-based
capacity and infrastructure for sustained improvement.
recommendations
Our appropriations proposal for fiscal year 2011 calls for greater
Federal investments in research-based programs to help States and
districts respond to the rapidly increasing needs We urge a stronger
and more comprehensive Federal effort to respond both to the greater
demand for knowledge-based solutions and to the underfunded supply of
well-tested practices and programs. Specifically, we propose the
following:
top priority: a knowledge, innovation, and improvement package
We urge you to consider six essential and interrelated programs as
a knowledge-innovation-improvement package:
Comprehensive Centers
Recommendation: $67.3 million ($10 million increase more than
President's request for fiscal year 2011).
Our proposed recommendation includes an increase of $500,000, or 20
percent, of additional funding for each Comprehensive Center which
would enable the 16 regional centers to expand their capacity building
work with SEAs in such areas as resource allocation, data use, teacher
effectiveness and school improvement. In addition, the proposed
increase would support the five content centers school improvement
efforts in providing in-depth, specialized support in five key areas
focusing on assessment and accountability, instruction, teacher
quality, innovation and improvement and high schools. The increase
would also enable the Centers to help States sustain their one-time
ARRA school improvement efforts.
Regional Educational Laboratories
Recommendation: $80.6 million ($10 million increase more than
President's request for fiscal year 2011).
The Regional Educational Laboratory Program is composed of a
network of 10 laboratories that serve the education reform and school
improvement needs of designated regions through rigorous research
studies and rapid response reports. Our proposed increase would expand
a special triage ``urgent response'' system to address the most
pressing, immediate educational reform issues in each region. This
request, if fulfilled, would enable the labs to further support the
crucial initiatives that are being implemented via the ARRA.
Research, Development, and Dissemination
Recommendation: $261 million (same as the President's request for
fiscal year 2011).
Our recommendation would allow IES to continue to fund more high-
quality applications under existing programs of research, development,
and dissemination in areas where the knowledge of learning and
instruction is inadequate. This recommendation would also enable IES to
invest in new grants to support evaluations at the State and district
level to evaluate whether reforms undertaken with funds awarded under
ARRA are producing the desired improvements on student achievement and
other critical outcomes. Finally, the recommended boost of $175 million
would create a sustainable venture fund for investing in what works in
education reform, as conceived in ARRA.
School Turnaround Grants
Recommendation: $900 million (same as the President's request for
fiscal year 2011).
The $354.4 million increase requested for the School Turnaround
Grants (currently School Improvement Grants) program would help build
State and local capacity to identify and implement effective
interventions to turn around their lowest-performing schools. The
proposed increase would create a sustainable base for long-term school
improvement efforts.
Investing in Innovation Fund
Recommendation: $500 million (same as the President's request for
fiscal year 2011).
The request would support a newly authorized ESEA program, modeled
after the i3 program authorized by the ARRA. The proposed request would
also provide a substantial Federal investment for scaling and
sustaining evidence based innovations. The request is a bold step in
the right direction in building from and on a knowledge base for
reform.
Race to the Top
Recommendation: $1.35 billion (same as the President's request for
fiscal year 2011).
The request would support a newly authorized ESEA program, modeled
after the Race to the Top program authorized by the ARRA. The program
would create incentives for State and local reforms and innovations
designed to support comprehensive reforms that lead to significant
improvements in student achievement and close the achievement gaps. The
program would also encourage the broad identification, dissemination,
adoption, and the use of effective policies and practices.
important support: programs contributing to innovation and improvement
We recommend continued support for the following programs which
will play an increasingly significant role in State and local efforts
to respond to the escalating demand for school improvement and
solutions.
--21st Century Community Learning Centers Recommendation: $1.16
billion (same as the President's request)
--Education for Homeless Children and Youth Recommendation: $65.4
million (same as the President's request)
--English Language Acquisition Recommendation: $800 million (same as
the President's request)
--Even Start Recommendation: $66.4 million (same as fiscal year 2010)
--High School Graduation Initiative Recommendation: $100 million ($50
million increase more than fiscal year 2010)
--Improving Teacher Quality State Grants Recommendation: $2.94
billion (same as fiscal year 2010)
--Math Science Partnerships (ED) Recommendation: $180.5 million ($1.5
million increase more than fiscal year 2010)
--National Center for Education Statistics Recommendation: $117
million (same as the President's request)
--Parental Information and Resource Centers Recommendation: $39.4
million (same as fiscal year 2010)
--Smaller Learning Communities Recommendation: $88 million (same as
fiscal year 2010)
--Special Education Research and Evaluation programs Recommendation:
$82 million (same as the President's request)
--Statewide Data Systems Recommendation: $100 million (same as the
President's request)
--Striving Readers Recommendation: $370 million ($120 million
increase more than fiscal year 2010)
--Technology State Grants Recommendation: $100 million (same as
fiscal year 2010)
In total, we believe it has never been more important to expand the
Federal supported knowledge-innovation-improvement infrastructure and
to deliver research-based solutions to schools with the greatest needs
to improve. Congress is uniquely positioned to turn the page on past
efforts and to lead us into a new era of innovation and transformation
of our public school system.
Indeed now is the time to unleash America's ingenuity to solve our
most pressing education problems, deliver break-the-mold solutions to
our schools, and guide a new knowledge and innovation revolution in
teaching and learning.
Thank you for your consideration.
______
Prepared Statement of the Lions Clubs International Foundation
I would like to begin by thanking Chairman Tom Harkin, Ranking
Member Thad Cochran and members for the opportunity to provide this
testimony on spending priorities before the Labor, Health and Human
Services, and Education, and Related Agencies Subcommittee. I would
also like to congratulate you, Mr. Chairman, and your colleagues, for
examining the way service organizations can collaborate with the
Federal Government in meeting pressing community needs for improved
health and education services.
Lions Clubs International represents the largest and most effective
NGO service organization presence in the world. Awarded and recognized
as the #1 NGO organization for partnership globally by The Financial
Times 2007, Lions Clubs International also holds the highest four star
(highest) rating from the CharityNavigator.com (an independent review
organization). Lions and its official charity arm, Lions Clubs
International Foundation (LCIF), have been world leaders in serving the
vision, hearing, youth development, and disability needs of millions of
people in America and around the world, and we work closely with other
NGOs such as Special Olympics International to accomplish our common
service goals. Since LCIF was founded in 1968, it has awarded more than
9,000 grants, totaling more than $640 million for service projects
ranging from affordable hearing aids to diabetes-prevention.
Our current 1.3 million-member global membership, representing over
200 countries, serves communities through the following ways: protect
and preserve sight; provide disaster relief; combat disability; promote
health; and serve youth. The 14,000 individual Lions Clubs representing
400,000 individual citizens in North America are constantly expanding
to add new programs its volunteers are working to bring health services
to as many communities as possible.
Some of our major collaborative partners include: Habitat for
Humanity, Special Olympics, the U.S. National Eye Institute, CADCA
(Community Anti-Drug Coalition of America), Service Nation and many
others.
Today, we face many complex challenges in the health and education
sector, from preventable diseases that cause blindness in children to
bullying, violence, and drug use among school-aged children. I will
offer a brief summary of my remarks through an overview of where Lions
Clubs International is involved in programs under the general
jurisdiction of the Labor, Health and Human Services, and Education,
and Related Agencies Subcommittee, and where we recommend areas where
Federal partnerships should be maintained and strengthened.
health and human services
Domestic Sight Services.--Through our network of foundations and
programs across America, Lions remains the single largest provider of
charitable vision care, eyeglasses and hearing care services to needy
and indigent people. Some of our major sight initiatives include:
--The Sight for Kids Program in collaboration with Johnson and
Johnson. The program has provided 6 million vision screenings
and eye-health education programs for children.
--Core 4 Preschool Vision Screening program enables Lions to conduct
screenings for children in preschools. The program strives to
deliver early detection and treatment for the most common
vision disorders that can lead to amblyopia or ``lazy eye.''
LCIF has also provided grants and services to those affected by
eye conditions that cannot be improved medically.
--Last August Lions Clubs sponsored ``United We Serve Health Week''
Signature Events around the country. These Health Week efforts,
in conjunction with the White House, were effective in bringing
awareness to vision health issues.
Vision Health Recommendations
Last year, the U.S. House overwhelmingly passed H.R. 577, the
Vision Care for Kids Act, a bill that provides for comprehensive eye
examinations to eligible children who have been screened, and to
provide treatment or services to these children. We strongly support
efforts to pass the Senate companion bill, Senator Kit Bond's S. 259.
Our network of clubs, foundations and institutions continue to
supplement public health efforts in this area through free vision
screenings, fittings for eyeglasses, free prescription eyeglasses, and
health education programs. The Lions eye-screening program for our
youngest and most vulnerable citizens has potential to expand output
with the securing of significant support from policymakers in States
and districts with strong Lions Club participation. This is
particularly relevant in providing mobile eye screening programs for
glaucoma and amblyopia treatment and follow up services in areas that
are economically disadvantaged and include high-risk urban and rural
populations.
There is recent congressional support for the continuation and
expansion of collaborative efforts between the Office of Head Start and
stakeholders to ensure that all Head Start enrollees receive vision
screening services and other resources available to them in their
community. This is an effective means of ensuring that congressionally
directed funding serve the communities where mobile screening units and
preschool testing is most needed in a cost-effective manner. Again, for
many localities in need of screening services, there is ample
opportunity to expand comprehensive vision screening services so that
no children are ``left to fall through the cracks.''
Special Olympics ``Healthy Athletes'' Program
Lions Clubs International is a central part of a global team of
healthcare volunteers who participate in the Special Olympics Healthy
Athletes program. The Opening Eyes program is a vision and eye health
screening program that has provided some 100,000 visions screenings for
Special Olympic Athletes. More than 40,000 Special Olympic athletes
have received free prescription eyeglasses to date.
Lions supports further congressional funding for ``Healthy
Athletes'' and its crucial mission to: improve access and healthcare
for Special Olympics athletes; make referrals to local health
practitioners when appropriate; train healthcare professionals and
students about the needs and care of people with intellectual
disabilities; collect, analyze and disseminate data on the health
status and needs of people with intellectual disabilities; and advocate
for improved health policies and programs for people with intellectual
disabilities.
Lions Affordable Hearing Aid Project (AHAP)
Lions Clubs International is committed to fighting hearing loss as
well as blindness. By listening to community health organizations
across the country, Lions Clubs International and their volunteer
members became aware of the lack of quality and affordable hearing
care, especially for people with incomes below or at 200 percent of the
poverty level. Many people have been unable to access other personal
and family resources to purchase hearing aids, and have been denied
State and Federal assistance. Lions Clubs 14 centers have been working
to expand output in this area as demand continues to rise with a
network of mobile health units and community based programs that screen
more than 2 million people each year and provide hearing aids to 14,000
low income patients.
The statistics are unacceptable: 31 million persons in the United
States experience some form of hearing loss, yet only 7.3 million opt
to use hearing aids. According to audiology researchers, the market
penetration for hearing aids is about 23.6 percent. For every four
patients that enter a practice needing hearing aids, only one will
purchase them. The median price tag is $1,900 (2005) for a digital
hearing aid and prices go as high as $4,000. State Foundations, public
health departments, and aging departments are in need of assistance in
this area.
With the recent 25-30 percent increase in people seeking assistance
for hearing aids, there is an immediate public imperative to address
the problem. Federal dollars are stretched, but Federal support in this
area would have significant public health dividends in difficult
economic times.
``lions quest''/education programs
Lions Clubs International's youth development initiatives, known
collectively as ``Lions Quest,'' have been a prominent part of school-
based K-12 programs since 1984. Fulfilling its mission to teach
responsible decisionmaking, effective communications and drug
prevention, Lions Quest has been involved in training more than 350,000
educators and other adults to provide services for more than 11 million
youth in programs covering 43 States. LCIF currently invests more than
$2 million annually in supporting life skills training and service
learning, and that funding is matched by local Lions, schools, and
other partners.
Lions Quest curricula incorporate parent and community involvement
in the development of health and responsible young people in the areas
of: life skills development (social and emotional learning), character
education, drug prevention, service learning, and bullying prevention.
There is even a physical fitness component to this program that can
assist Federal goals of reducing obesity in school-aged children.
These Lions Quest programs provide strong evidence of decreased
drug use, improved responsibility for students own behavior, as well as
stronger decisionmaking skills and test scores in math and reading. In
August 2002, Lions Quest received the highest ``Select'' ranking from
the University of Illinois at Chicago-based Collaborative for Academic,
Social and Emotional Learning (CASEL) for meeting standards in life
skills education, evidence of effectiveness and exemplary professional
development.
Lions Quest has extensive experience with Federal programs. Lions
Quest Skills for Adolescence received a ``Promising Program'' rating
from the U.S. Department of Education Safe and Drug Free Schools and a
``Model'' rating from the U.S. Department of Health and Human Services
Substance Abuse and Mental Health Services Administration (SAMHSA).
Lions Quest also has extensive experience of partnering with State
service commissions to reach more schools and engage more young people
in service learning. Successful partnerships have been active in
Michigan, New York, Oklahoma, Tennessee, and West Virginia with
progress being made in Texas and Ohio.
Service Learning Initiatives
Lions Quest has also pursued Learn and Serve Grant funding to
support implementation of Lions Quest programming in several States. We
strongly support Congressional efforts to fund the Edward M. Kennedy
Serve America Act that was signed into law 1 year ago. The Serve
America Act authorizes the Corporation for National and Community
Service to expand existing programs and add several new programs and
initiatives to provide service learning school-based programs for
students as well as Innovative and Community-Based Service-Learning
Programs and Research. Another program of value that was authorized by
the Edward M. Kennedy Act is the Social Innovation Fund that provides
growth capital and other support so that the most effective programs
can be identified.
Social and Emotional Learning (SEL) Programs
In addition, Lions Clubs recommends Congressional support for
social and emotional learning (SEL) programs that stimulate growth
among schools nationwide through distribution of materials and teacher
training, and to create opportunities for youth to participate in
activities that increase their social and emotional skills. Not only do
SEL curricula contribute to the social and emotional development of
youth, but they also provide invaluable support to students' school
success, health, well-being, peer and family relationships, and
citizenship. While still conducting scientific research and reviewing
the best available science evidence, over time Lions Clubs and its SEL
partners have increasingly worked to provide SEL practitioners,
trainers and school administrators with the guidelines, tools,
informational resources, policies, training, and support they need to
improve and expand SEL programming.
Overall, SEL training programs and curricula have outstanding
benefits for school-aged children:
--SEL prevents a variety of problems such as alcohol and drug use,
violence, truancy, and bullying. SEL programs for urban youth
emphasize the importance of cooperation and teamwork.
--Positive outcomes increase in students who are involved in social
and emotional learning programming by an average of 11
percentile points over other students.
--With greater social and emotional desire to learn and commit to
schoolwork, participants benefit from improved attendance,
graduation rates, grades, and test scores. Students become
caring, concerned members of their communities.
conclusion
Lions Clubs remains committed to domestic activities such as major
sight initiatives and positive youth development and youth service
programs. Today we face great health and educational challenges, and
Lions Clubs International understands the importance not only of
community service but of instilling those values among members of our
next generation. The success of nonprofit entities such as Lions Clubs
show what the service sector can do for economic and social development
of communities that are especially hard hit by the recession, and we
are committed to forming more effective alliances and partnerships to
increase our domestic impact. We look forward to working with you and
your colleagues on taking up these important challenges.
______
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. It was a shock to me and my family, friends, and clients.
One morning 4 years ago, when doing a load of laundry, I had no
idea how to set the dials, despite the fact that I had used these dials
weekly for the last 10 years. I stood there for what seemed an eternity
before I figured out how to set them.
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 ER, 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 post-stroke
depression was harder than the recovery of my arms and legs and even
speech.
Being a psycho-therapist, 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 4 years post-stroke, I am back to full-time
practice. I lead support groups for stroke survivors and caregivers
through the Montgomery County Stroke Association and serve on its
Board. I also lecture on stroke, stroke prevention, and stroke
recovery. I founded ``Hope after Stroke''--individual and family
counseling for stroke survivors and caregivers. In addition, I have
participated in NIH studies about stroke recovery.
Once again, I am in excellent health and have resumed my active
life style. 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/National Mentoring Partnership
Chairman Harkin and Ranking Member Cochran, I thank you for the
opportunity on behalf of MENTOR/National Mentoring Partnership to
submit written testimony in support of resources for youth being
mentored or in need of a caring, screened, and trained mentor.
Specifically, we ask your continued support for the:
--Mentoring Children of Prisoners program, and
--Serve America Act programs that support youth mentoring.
First, we thank you for previous support of the U.S. Department of
Health and Human Services' (HHS) Mentoring Children of Prisoners
program and request that you include level funding for the program in
fiscal year 2011. MENTOR has appreciated the support of the
subcommittee in previous years, in funding this competitive grant
program at roughly $50 million since fiscal year 2004. We applaud
President Obama for including level funding in his fiscal year 2011
budget for this program at $49.3 million.
This authorized program provides competitive grants to local
mentoring organizations to help them match children of incarcerated
parents with caring adult mentors. As noted by the Administration for
Children and Families, Faith-Based and Community Initiative,\1\ more
than 2 million children and youth in the United States have at least
one parent in a Federal or State correctional facility. Furthermore,
the Initiative writes:
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\1\ http://www.acf.hhs.gov/programs/fbci/progs/fbci_mcp.html
``In addition to experiencing disruption in the relationship with
their parent, these young people often struggle with the economic,
social, and emotional burdens of the incarceration. Data indicate that
mentoring programs can help young people, including those with
incarcerated parents, by reducing their first-time drug and alcohol
use, improving their relationships and academic performance, and
reducing the likelihood that they will initiate violence. In addition,
mentoring programs can provide these children with opportunities to
develop a trusting relationship with a supportive adult and a stable
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environment that can promote healthy values and strong families.''
In addition, since 2007, MENTOR/National Mentoring Partnership has
served as the administrator of the Mentoring Children of Prisoners:
Caregiver's Choice voucher demonstration project (Federal Grant
#90CV0457). Caregiver's Choice allows caregivers and parents the
opportunity to directly connect their children with quality mentoring
programs. Programs that meet quality standards created by experts--in
mentoring and working with families of the incarcerated--have been
selected to take part. This 3-year demonstration project has
consistently met its goals.
We ask for your continued support to ensure that HHS honors all
mentoring relationships established between eligible children and
enrolled programs under the Mentoring Children of Prisoners program.
Second, the mentoring field as a stream of service was provided a
boost through the passage and enactment of the Edward M. Kennedy Serve
America Act. We support President Obama's fiscal year 2011 budget
request for Serve America Act Programs under the Corporation for
National and Community Service. This includes $914.3 million for
AmeriCorps, $60 million for the Social Innovation Fund, $10 million for
the Volunteer Generation Fund, $40.2 million for Learn and Serve
America, and $221 million for Senior Corps.
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 (RSVP), 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 2011 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. Indeed, in its fiscal year 2011 budget justification,\2\
the Corporation notes mentoring several times in its fiscal year 2009
performance outcomes, such as in an increase to 65,696 children of
prisoners mentored through VISTA--well above its target of 50,000 for
fiscal year 2009. 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.
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\2\ http://www.nationalservice.gov/pdf/
2011_budget_justification.pdf
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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 4,700 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 4,700 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 (DuBois et al., 2002)
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, Eby, Allen, Evans, Ng
and DuBois (2008) 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 BBBSA's newer, school-based mentoring
(Herrera, Grossman, Kauh, Feldman, and McMaken, 2007) 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.
Mentoring's Impact on the Drop Out Rate.--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.\3\ \4\
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\3\ Bridgeland, John M. et al. (2006). The Silent Epidemic:
Perspectives of High School Dropouts. Civic Enterprises in Association
with Peter D. Hart Research Associates for the Bill & Melinda Gates
Foundation.
\4\ Harmacek, Marilyn, ed. (2002). Youth Out of School: Linking
Absences to Delinquency. 2nd Edition. Colorado: The Colorado Foundation
for Families and Children.
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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,\5\ which is linked to higher levels of classroom
engagement and higher grades.\6\
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\5\ Linnehan, F. (2005) ``The relation of a work-based mentoring
program to the academic performance and behavior of African American
students,'' Journal of Vocational Behavior, 59(3).
\6\ Utman, C. H. (1997). Performance effects of motivational state:
A meta-analysis. Personality and Social Psychology Review, 1, 170-182.
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--School-based mentoring enhances connectedness to schools, peers and
society,\7\ and mentored youth have more positive attitudes
toward school and teachers.\8\
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\7\ Karcher, M.J. (2005). ``The effects of school-based mentoring
and high school mentors' attendance on their younger mentees' self-
esteem, social skills and connectedness.'' Psychology in the Schools.
\8\ Jekielek, Susan M. et al. (2002). Mentoring: A Promising
Strategy for Youth Development. ChildTrends Research Brief, Washington,
DC.
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--Evaluations of mentoring programs indicated that both one-to-one
mentoring and group mentoring result in better school
attendance for mentored youth.\9\
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\9\ Sipe, Cynthia L. (1999). Mentoring Adolescents: What have we
learned? Contemporary Issues in Mentoring, Grossman, Jean Baldwin (ed),
Public/Private Ventures.
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--Mentored youth experience improvements in parental relationships
and their own sense of self-worth.\10\
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\10\ Jekielek, Susan M., et al. (2002). Mentoring Programs and
Youth Development: A Synthesis. ChildTrends, Washington, DC.
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--Mentored youth are significantly less likely to participate in
high-risk behaviors, including substance abuse, carrying a
weapon, unsafe sex, and violent behaviors.\11\
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\11\ Beier, Rosenfeld, Spitalny, Zansky, and Bontemmpo. (2000).
``The potential role of an adult mentor in influencing high-risk
behaviors in adolescents.'' Archives of Pediatric Medicine 15.
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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.
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.\12\ 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.
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\12\ Dubois, D.L. (2000) ``Effectiveness of Mentoring Programs for
Youth: A Meta-analytic Review,'' American Journal of Community
Psychology, 30(2). and Public/Private Ventures (2000). Mentoring
School-Age Children: Relationship Development in Community-Based and
School-Based Programs.
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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.
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.
______
Prepared Statement of Mended Hearts, Incorporated
I am Robert A. Scott, National Advocacy Chairman for Mended Hearts,
Inc., a national heart disease support group with more than 275
chapters across the United States and Canada. In 2009, accredited
Mended Hearts volunteers visited 187,183 patients and families and are
serving 430 hospitals throughout the United States.
As I am a walking testimony of the benefits of National Institutes
of Health (NIH) supported heart research, I would like to share my
story with you. 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 may
experience this type of episode--a heart attack with no warning just
like I had.
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 in Providence, Rhode Island 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 make
it. 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 I received an implantable
defibrillator to control the problem in 2002. However, this device had
to replaced in Rhode Island 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. 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. My doctor explained that it could open up the original
blockage from my silent heart attack. He added that if these state-of-
the art stents had been available in 1998, I would not have had to have
the heart bypass surgery.
Despite previous treatments, I once again was faced with
cardiovascular disease in February 2009. This time it was a stroke
warning sign. While driving, I suddenly felt dizzy, so pulled my car
over to stop. The next thing I knew, I had passed out for a very short
time and felt numb on the right side of my face. This scared me enough
that I drove myself to the hospital which just happened to be on the
same street where I stopped my car. Upon arrival, I was a little
confused and was later admitted into the hospital. The next day, my
cardiologist told me I had a transient ischemic attack (TIA). My doctor
said there was no need for a stress test and because of my heart
condition I should have another cardiac catheterization. The
catheterization showed that one of my arteries had minor blockage, so
the doctor placed another stent in my artery. To date, I have not
experienced another TIA.
Today, heart attack, stroke, and other cardiovascular disease
remain our Nation's most costly and number 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 me. 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 Medical Library Association
summary of recommendations for fiscal year 2011
Continue the commitment to the National Institutes of Health (NIH)
and the National Library of Medicine (NLM) by increasing funding levels
12 percent to $35 billion for NIH and $402 million for NLM.
Continue to support the NIH 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 and
support the establishment of similar policies in other Federal
agencies.
Continue to support the medical library community's important role
in NLM's outreach, telemedicine, disaster preparedness, and health
information technology (health IT) initiatives and the implementation
of healthcare reform.
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 (AAMC). AAHSL's goals are to
promote excellence in academic health sciences libraries and to ensure
that the next generation of health professionals is trained in
information-seeking skills that enhance the quality of healthcare
delivery.
Together, MLA and AAHSL address health information issues and
legislative matters of importance through a joint legislative task
force and a Government Relations Committee.
the importance of funding increases for nlm
We are pleased that the fiscal year 2010 appropriations package
contained funding increases for NIH and NLM and bolstered their
baseline budgets. We encourage the subcommittee to continue to provide
meaningful annual increases for NIH and NLM in the coming years, and
recommend a 12 percent increase for fiscal year 2011.
Recovery funding and the fiscal year 2010 budget increases
stimulated the economy and biomedical research. In the case of NLM,
Recovery Act funding allowed timely and much-needed increases in
support for leading edge research and training in biomedical
informatics--the kinds of programs that will influence future
developments in health information technology. In fiscal year 2011 and
beyond, it will be critical to augment NLM's baseline budget to
accommodate expansion of its information resources, services, and
programs, which must collect, organize, and make accessible rapidly
expanding volumes of biomedical knowledge, including the influx of data
from high-throughput genome sequencing systems and genome-wide
association studies. Increased funding will also position NLM to
strengthen its contributions to successful implementation of recent
congressional priorities related to healthcare reform, health
information technology, drug safety through its efforts to: enhance
access to the results of comparative effectiveness research, maintain
and disseminate health information technology standards, and to expand
its clinical trial registry and results database in response to
legislative requirements.
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 online integrated services, such as
GenBank and PubMed that are helping to revolutionize medicine and
advance science to the next important era which includes individualized
medicine based on an individual's unique genetic differences. PubMed,
with more than 20 million citations to the biomedical literature, is
the world's most heavily used source of information about published
results of biomedical research, and GenBank, with its international
partners, has become the definitive source of gene sequence
information.
These collections stand at more than 11.4 million items--books,
journals, technical reports, manuscripts, microfilms, photographs, and
images. 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 come to
expect.
support and extend public access
The Appropriations Committee has shown unprecedented foresight and
leadership by using the annual spending bills as the vehicle to
establish a mandatory public access policy at the NIH. This highly
beneficial policy, which requires all NIH-funded researchers to deposit
their final, peer-reviewed manuscripts in NLM's PubMed Central database
within 12 months of publication, is improving access to timely and
relevant scientific information, stimulating discovery, informing
clinical care, and improving public health literacy. We ask the
Committee to remain a strong voice in support of the NIH policy, and to
support the extension of public access policies to other Federal
science and education agencies. MLA and AAHSL strongly support the
expansion of public access policies to other agencies, because it would
bring the benefits of public access to other fields of research and
because research in other fields is increasingly relevant to
biomedicine.
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 and to
train them in the most effective use of these services. 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.
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 2011.
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. Presently,
libraries are a significant, but underutilized resource for community
disaster planning and management efforts, which NLM can help to deploy.
NLM has the ability to work 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 NLM.
health it and bioinformatics
NLM has played a pivotal role in creating and nurturing the field
of medical informatics, which is the intersection of information
science, computer science, and healthcare. Health informatics tools
include computers, clinical guidelines, formal medical terminologies,
and information and communication systems. For nearly 35 years, NLM has
supported informatics research. The importance of NLM's work in health
IT continues to grow as the Nation moves toward more interoperable
health IT systems. 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 their strong
support of NLM's medical informatics and genomic science initiatives,
at a point when the linking of clinical and genetic data holds
increasing promise for enhancing the diagnosis and treatment of
disease. MLA and AAHSL also supporting health information technology
initiatives in ONCHIT and the Agency for Healthcare Research and
Quality that build upon initiatives housed at NLM.
building and facility needs
The tremendous growth in NLM's basic functions related to the
acquisition, organization and preservation of an ever-expanding
collection of biomedical literature, combined with its growing
contributions to healthcare reform, health information technology, drug
safety, and exploitation of genomic information is straining the
Library's physical resources. NLM now houses 1,100 staff in a facility
built to accommodate only 650. This increase in the volume of
biomedical information and in the number of personnel has led to a
serious space shortage. 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.
MLA and AAHSL encourage the subcommittee to continue its strong
support of NLM's goals in order to strengthen the Library's ability to
provide support for implementation of healthcare reform. At a time when
medical and health science libraries across the nation face growing
financial and space constraints, ensuring that NLM continues to serve
as the archive of last resort for biomedical collections is critical to
the medical library community and the public we serve.
Thank you for the opportunity to present the views of the medical
library community.
______
Prepared Statement of Meharry Medical College
Mr. Chairman and members of the subcommittee, thank you for the
opportunity to present my views before you today. I am Dr. Wayne J.
Riley, President and CEO of Meharry Medical College in Nashville,
Tennessee. I have previously served as vice-president and vice dean for
health affairs and governmental relations and associate professor of
medicine at Baylor College of Medicine in Houston, Texas and as
assistant chief of medicine and a practicing general internist at
Houston's Ben Taub General Hospital. In all of these roles, I have seen
firsthand the importance of minority health professions institutions
and the title VII Health Professions Training programs.
Mr. Chairman, time and time again, you have encouraged your
colleagues and the rest of us to take a look at our Nation and evaluate
our needs over the next 10 years. I took you seriously and came here
prepared to offer my best judgments. First, I want to say that it is
clear that health disparities among various populations and across
economic status are rampant and overwhelming. Over the next 10 years,
we will need to be able to deliver more culturally relevant and
culturally competent healthcare services. Bringing healthcare delivery
up to this higher standard can serve as our Nation's own preventive
healthcare agenda keeping us well positioned for the future.
Minority health professional institutions and the title VII Health
Professions Training programs address this critical national need.
Persistent and severe staffing shortages exist in a number of the
health professions, and chronic shortages exist for all of the health
professions in our Nation's most medically underserved communities. Our
Nation's health professions workforce does not accurately reflect the
racial composition of our population. For example, African Americans
represent approximately 15 percent of the U.S. population while only 2-
3 percent of the Nation's healthcare workforce is African American.
There is a well-established link between health disparities and a
lack of access to competent healthcare in medically underserved areas.
As a result, it is imperative that the Federal Government continue its
commitment to minority health profession institutions and minority
health professional training programs to continue to produce healthcare
professionals committed to addressing this unmet need.
An October 2006 study by the Health Resources and Services
Administration (HRSA), entitled ``The Rationale for Diversity in the
Health Professions: A Review of the Evidence'' found that minority
health professionals serve minority and other medically underserved
populations at higher rates than nonminority professionals. The report
also showed that; minority populations tend to receive better care from
practitioners who represent their own race or ethnicity, and non-
English speaking patients experience better care, greater
comprehension, and greater likelihood of keeping follow-up appointments
when they see a practitioner who speaks their language. Studies have
also demonstrated that when minorities are trained in minority health
profession institutions, they are significantly more likely to: (1)
serve in rural and urban medically underserved areas; (2) provide care
for minorities; and (3) treat low-income patients.
As you are aware, title VII Health Professions Training programs
are focused on improving the quality, geographic distribution and
diversity of the healthcare workforce in order to continue eliminating
disparities in our Nation's healthcare system. These programs provide
training for students to practice in underserved areas, cultivate
interactions with faculty role models who serve in underserved areas,
and provide placement and recruitment services to encourage students to
work in these areas. Health professionals who spend part of their
training providing care for the underserved are up to 10 times more
likely to practice in underserved areas after graduation or program
completion.
Institutions that cultivate minority health professionals have been
particularly hard-hit as a result of the cuts to the title VII Health
Profession Training programs in fiscal year 2006 and fiscal year 2007
Funding Resolution passed earlier this Congress. Given their historic
mission to provide academic opportunities for minority and financially
disadvantaged students, and healthcare to minority and financially
disadvantaged patients, minority health professions institutions
operate on narrow margins. The cuts to the title VII Health Professions
Training programs amount to a loss of core funding at these
institutions and have been financially devastating.
Mr. Chairman, I feel like I can speak authoritatively on this issue
because I received my medical degree from Morehouse School of Medicine,
a historically black medical school in Atlanta. I give credit to my
career in academia, and my being here today, to title VII Health
Profession Training programs' Faculty Loan Repayment Program. Without
that program, I would not be the president of my father's alma mater,
Meharry Medical College, another historically black medical school
dedicated to eliminating healthcare disparities through education,
research and culturally relevant patient care.
Minority Centers of Excellence (COE).--COEs focus on improving
student recruitment and performance, improving curricula in cultural
competence, facilitating research on minority health issues and
training students to provide health services to minority individuals.
COEs were first established in recognition of the contribution made by
four historically black health professions institutions (the Medical
and Dental Institutions at Meharry Medical College; The College of
Pharmacy at Xavier University; and the School of Veterinary Medicine at
Tuskegee University) to the training of minorities in the health
professions. Congress later went on to authorize the establishment of
``Hispanic'', ``Native American'' and ``Other'' Historically black
COEs. For fiscal year 2011, I recommend a funding level of $33.6
million for COEs.
Health Careers Opportunity Program (HCOP).--HCOPs provide grants
for minority and nonminority health profession institutions to support
pipeline, preparatory, and recruiting activities that encourage
minority and economically disadvantaged students to pursue careers in
the health professions. Many HCOPs partner with colleges, high schools,
and even elementary schools in order to identify and nurture promising
students who demonstrate that they have the talent and potential to
become a health professional. Over the last three decades, HCOPs have
trained approximately 30,000 health professionals including 20,000
doctors, 5,000 dentists and 3,000 public health workers. For fiscal
year 2011, I recommend a funding level of $35.6 million for HCOPs.
National Institutes of Health (NIH): Extramural Facilities
Construction.--Mr. Chairman, if we are to take full advantage of the
recent funding increases for biomedical research that Congress has
provided to NIH over the past decade, it is critical that our Nation's
research infrastructure remain strong. The current authorization level
for the Extramural Facility Construction program at the National Center
for Research Resources is $250 million. The law also includes a 25
percent set-aside for ``Institutions of Emerging Excellence'' (many of
which are minority institutions) for funding up to $50 million.
Finally, the law allows the NCRR Director to waive the matching
requirement for institutions participating in the program. We strongly
support all of these provisions of the authorizing legislation because
they are necessary for our minority health professions training
schools. In fiscal year 2011, please fund this program at least at $50
million.
Research Centers in Minority Institutions (RCMI).--The RCMI program
at the National Center for Research Resources has a long and
distinguished record of helping our institutions develop the research
infrastructure necessary to be leaders in the area of health
disparities research. Although NIH has received unprecedented budget
increases in recent years, funding for the RCMI program has not
increased by the same rate. Therefore, the funding for this important
program grow at the same rate as NIH overall in fiscal year 2011.
Strengthening Historically Black Graduate Institutions--Department
of Education.--The Department of Education's Strengthening Historically
Black Graduate Institutions program (title III, part B, section 326) is
extremely important to MMC and other minority serving health
professions institutions. The funding from this program is used to
enhance educational capabilities, establish and strengthen program
development offices, initiate endowment campaigns, and support numerous
other institutional development activities. In fiscal year 2011, an
appropriation of $75 million is suggested to continue the vital support
that this program provides to historically black graduate institutions.
National Institute on Minority Health and Health Disparities
(NIMHD).--NIMHD is charged with addressing the longstanding health
status gap between minority and nonminority populations. The NIMHD
helps health professional institutions to narrow the health status gap
by improving research capabilities through the continued development of
faculty, labs, and other learning resources. The NIMHD also supports
biomedical research focused on eliminating health disparities and
develops a comprehensive plan for research on minority health at the
NIH. Furthermore, the NIMHD provides financial support to health
professions institutions that have a history and mission of serving
minority and medically underserved communities. For fiscal year 2011, I
recommend a funding level of $500 million for the NIMHD.
Department of Health and Human Services' Office of Minority Health
(OMH ).--Specific programs at OMH include:
--Assisting medically underserved communities with the greatest need
in solving health disparities and attracting and retaining
health professionals;
--Assisting minority institutions in acquiring real property to
expand their campuses and increase their capacity to train
minorities for medical careers;
--Supporting conferences for high school and undergraduate students
to interest them in health careers; and
--Supporting cooperative agreements with minority institutions for
the purpose of strengthening their capacity to train more
minorities in the health professions.
The OMH has the potential to play a critical role in addressing
health disparities. For fiscal year 2011, I recommend a funding level
of $75 million for the OMH.
Mr. Chairman, please allow me to express my appreciation to you and
the members of this subcommittee. With your continued help and support,
Meharry Medical College along with other minority health professions
institutions and the title VII Health Professions Training programs can
help this country to overcome health and healthcare disparities.
Congress must be careful not to eliminate, paralyze or stifle the
institutions and programs that have been proven to work. Meharry and
other minority health professions schools seek to close the ever
widening health disparity gap. If this subcommittee will give us the
tools, we will continue to work towards the goal of eliminating that
disparity as we have done for 1876.
Thank you, Mr. Chairman, for this opportunity.
______
Prepared Statement of the March of Dimes Foundation
The 3 million volunteers and 1,400 staff members of the March of
Dimes Foundation appreciate the opportunity to submit the Foundation's
Federal funding recommendations for fiscal year 2011. The March of
Dimes is a national voluntary health agency founded in 1938 by
President Franklin D. Roosevelt to support research and services
related to polio. Today, the Foundation works to improve the health of
women, infants and children by preventing birth defects, premature
birth and infant mortality through research, community services,
education, and advocacy. The March of Dimes is a unique partnership of
scientists, clinicians, parents, members of the business community, and
other volunteers affiliated with 51 chapters and 213 divisions in every
State, the District of Columbia and Puerto Rico. Additionally, in 1998,
March of Dimes established its Global Programs to extend its mission
overseas through partnerships with countries to deliver interventions
directed at reducing birth defects and preterm birth. The March of
Dimes recommends the following funding levels for programs and
initiatives that are essential investments in the future of health of
the Nation's children.
preterm birth
According to a 2009 report from the National Center for Health
Statistics (NCHS), the primary reason for the higher infant mortality
rate in the United States compared to European nations is the greater
percentage of preterm births--12.4 percent in the United States
compared to 6.3 percent in Sweden. This suggests that preterm birth
prevention is central to lowering the U.S. infant mortality rate.
Moreover, the Institute of Medicine estimated that preterm birth cost
the United States more than $26 billion in 2005, with costs continuing
to climb each year.
In June 2008, the U.S. Surgeon General sponsored a conference to
develop a research agenda to address the costly and serious problem of
preterm birth. More than 200 of the country's foremost researchers,
representing a diversity of backgrounds and expertise, met for 2 days
and created an action plan of needed steps. Within these steps, there
are several cross-cutting themes including recommendations to enhance
biomedical and epidemiological research and to strengthen our Nation's
vital statistics program. The March of Dimes funding requests
enumerated below are based on the recommendations of the Surgeon
General's Conference.
National Institutes of Health--Office of the Director
The March of Dimes commends members of the Committee for supporting
the National Children's Study (NCS) by including $193.8 million in the
fiscal year 2010 Consolidated Appropriations Act. For fiscal year 2011,
the Foundation supports the President's funding recommendation and
urges the subcommittee to maintain its commitment to this vital study
by providing $194.4 million. Currently in the pilot phase, the NCS is
tracking the more than 150 children born to study participants. The
data from this important effort will inform the work of scientists in
universities and research organizations across the Nation and around
the world, helping them identify precursors to disease and to develop
new strategies for prevention and treatment. The first data generated
by the NCS will provide information concerning disorders of birth and
infancy including preterm birth and its health consequences. The
Foundation remains committed to supporting a well-designed NCS that
promotes research of the very highest quality.
Eunice Kennedy Shriver National Institute of Child Health and Human
Development (NICHD)
The March of Dimes recommends a funding increase of at least 12.5
percent for NICHD in fiscal year 2011. This increase in funding will
enable NICHD to maintain the momentum and investments made with support
provided through the Recovery Act. It will also enable the Institute to
expand its support for preterm birth-related research and to initiate
establishment of a network of integrated transdisciplinary research
centers as recommended by the Institute of Medicine and the experts who
participated in the Surgeon General's Conference. The causes of preterm
birth are multi-factorial and necessitate a collaborative approach
integrating many disciplines. These new centers would serve as a
national resource for investigators to design and to share new research
approaches and strategies to comprehensively address the problems of
preterm birth.
Centers for Disease Control and Prevention (CDC)--Preterm Birth
The National Center for Chronic Disease Prevention and Health
Promotion, Division of Reproductive Health works to promote optimal
reproductive and infant health. In 2009, CDC created a robust research
agenda to prevent preterm birth by improving National and State data to
track preterm births; developing, implementing, and evaluating methods
for prevention; understanding the problem of late preterm birth; and
conducting etiologic and epidemiologic studies of early preterm birth.
For fiscal year 2011, the March of Dimes recommends a $6 million
increase in the preterm birth line to strengthen national data systems
and to expand research on very early as well as late preterm births as
authorized by the PREEMIE Act (Public Law 109-450).
Centers for Disease Control and Prevention--National Center for Health
Statistics
The National Center for Health Statistics (NCHS) national vital
statistics program collects birth data that is used to monitor the
Nation's health status, set priorities and evaluate health programs. It
is imperative that data collected by NCHS is comprehensive and timely.
Currently, only 75 percent of States and territories use the 2003 birth
certificate format and only 65 percent have adopted the 2003 death
certificate. Consistent with the President's budget request, the
Foundation recommends allocating $11 million specifically to the
National Vital Statistics System to help support modernization of the
State and territorial vital statistics infrastructure without
undermining the scope and quality of data collected nationally.
Health Resources and Services Administration--Healthy Start
The Healthy Start Initiative is a collection of community-based
projects focused on reducing infant mortality, low birthweight and
racial disparities in perinatal outcomes. Communities with Healthy
Start programs have seen significant improvements in health outcomes;
therefore the March of Dimes recommends a funding level for these
projects of $120 million in fiscal year 2011.
birth defects
An estimated 120,000 infants in the United States are born with
birth defects each year. Genetic or environmental factors, or a
combination, can cause a birth defect; however, the causes of 70
percent of birth defects remain unknown. Investing additional Federal
resources in research to unveil the causes and prevent, or reduce, the
incidence of birth defects is sorely needed.
CDC National Center on Birth Defects and Developmental Disabilities
(NCBDDD)
The NCBDDD conducts programs to protect and improve the health of
children by preventing birth defects and developmental disabilities and
by promoting optimal development and wellness among children with
disabilities. For fiscal year 2011, the March of Dimes requests an
overall funding level of $163 million, a $20 million increase over
fiscal year 2010, for NCBDDD. Within that increase, we encourage the
committee to allocate $5 million for support of birth defects research
and surveillance and an additional $2 million for folic acid education.
This is a sound public health investment that will promote wellness and
prevention, reduce health disparities, support the creation of new
educational materials for consumers and their families and will enable
CDC to better facilitate transition to adulthood for children with
disabilities.
Sustaining the investment in the National Birth Defects Prevention
Study--the largest case-controlled study of birth defects ever
conducted--is needed to support genetic analysis of the samples already
obtained. In 2009, CDC educated healthcare providers through the
dissemination of more than 10 reports which resulted from this Study.
Among the topics were the risk factors for birth defects such as
maternal smoking, obesity and antidepressant use during pregnancy.
NCBDDD also supports State-based birth defects tracking systems and
programs to prevent and treat affected children. Surveillance forms the
backbone of a vital, functional and responsive public health network.
Due to current the current fiscal crises being faced by many States,
funding for some of these systems is in jeopardy. Increased investment
from the Federal Government is necessary to ensure continued investment
in birth defects surveillance programs.
Finally, NCBDDD is conducting a national education campaign aimed
at increasing the number of women consuming appropriate amounts of
folic acid. CDC estimates that up to 70 percent of neural tube defects
could be prevented if all women of childbearing age consume 400
micrograms of folic acid daily. To achieve the full prevention
potential of folic acid, CDC's national public and health professions
education campaign must be expanded.
newborn screening
Newborn screening is a vital public health activity used to
identify and treat genetic, metabolic, hormonal and functional
disorders in newborns. Screening detects conditions in newborns that,
if left untreated, can cause disability, mental retardation, serious
illness or even death. Across the Nation, State and local governments
are experiencing significant budget shortfalls; due to this fiscal
pressure, newborn screening programs are threatened by funding cuts.
While the ramifications--such as discontinuing screening for certain
conditions or postponing the purchase of necessary technology--can vary
by State, any funding cut in this essential program puts infants at
risk for permanent disability or even death. An additional $5 million
for HRSA's heritable disorders program, as authorized by the Newborn
Screening Saves Lives Act (Public Law 110-204), is necessary to
increase support for State efforts to upgrade existing programs, to
acquire state-of-the-art technology and to increase capacity to reach
and educate health professionals and parents on newborn screening
programs and follow-up services.
closing
Thank you for the opportunity to testify on the federally supported
programs of highest priority to the March of Dimes. The Foundation's
volunteers and staff in every State, the District of Columbia and
Puerto Rico look forward to working with Members of the Subcommittee to
secure the resources needed to improve the health of the Nation's
mothers, infants and children.
MARCH OF DIMES FISCAL YEAR 2011 FEDERAL FUNDING PRIORITIES
[In millions if dollars]
------------------------------------------------------------------------
Fiscal year March of Dimes
Program 2010 funding rec
------------------------------------------------------------------------
National Institutes of Health (Total)... 31,089 35,000
National Children's Study............... 193.8 194.4
Common Fund............................. 544 612
National Institute of Child Health 1,329 1,495
and Human Development..............
National Human Genome Research 516 581
Institute..........................
National Center on Minority Health 212 239
and Disparities....................
Centers for Disease Control and 6,475 8,800
Prevention (Total).....................
Birth Defects Research & Surveillance... 21.342 26.342
Folic Acid Campaign..................... 3.1 5.1
Immunization........................ 562 865.6
Polio Eradication................... 102 102
Preterm Birth....................... 2 8
National Center for Health Statistics... 139 162
Health Resources and Services 7,483 9,150
Administration (Total).................
Maternal and Child Health Block 662 730
Grant..............................
Newborn Screening............... 10 15
Newborn Hearing Screening........... 19 19
Consolidated (Community) Health 2,146 2,560
Centers............................
Healthy Start....................... 105 120
Agency for Healthcare Research and 397 611
Quality................................
------------------------------------------------------------------------
______
Prepared Statement of the Morehouse School of Medicine
Mr. Chairman and members of the subcommittee, thank you for the
opportunity to present my views before you today. I am Dr. John E.
Maupin, president of Morehouse School of Medicine (MSM) in Atlanta,
Georgia. I have previously served as president of Meharry Medical
College, executive vice-president at MSM, as director of a community
health center in Atlanta, and deputy director of health in Baltimore,
Maryland. In all of these roles, I have seen firsthand the importance
of minority health professions institutions and the Title VII Health
Professions Training programs.
I want to say that minority health professional institutions and
the Title VII Health Professionals Training programs address a critical
national need. Persistent and sever staffing shortages exist in a
number of the health professions, and chronic shortages exist for all
of the health professions in our Nation's most medically underserved
communities. Furthermore, our Nation's health professions workforce
does not accurately reflect the racial composition of our population.
For example while blacks represent approximately 15 percent of the U.S.
population, only 2-3 percent of the Nation's health professions
workforce is black. Morehouse is a private school with a very public
mission of educating students from traditionally underserved
communities so that they will care for the underserved. Mr. Chairman, I
would like to share with you how your subcommittee can help us continue
our efforts to help provide quality health professionals and close our
Nation's health disparity gap.
There is a well-established link between health disparities and a
lack of access to competent healthcare in medically underserved areas.
As a result, it is imperative that the Federal Government continue its
commitment to minority health profession institutions and minority
health professional training programs to continue to produce healthcare
professionals committed to addressing this unmet need.
An October 2006 study by the Health Resources and Services
Administration, entitled ``The Rationale for Diversity in the Health
Professions: A Review of the Evidence'' found that minority health
professionals serve minority and other medically underserved
populations at higher rates than nonminority professionals. The report
also showed that; minority populations tend to receive better care from
practitioners who represent their own race or ethnicity, and non-
English speaking patients experience better care, greater
comprehension, and greater likelihood of keeping follow-up appointments
when they see a practitioner who speaks their language. Studies have
also demonstrated that when minorities are trained in minority health
profession institutions, they are significantly more likely to: (1)
serve in rural and urban medically underserved areas; (2) provide care
for minorities; and (3) treat low-income patients.
As you are aware, Title VII Health Professions Training programs
are focused on improving the quality, geographic distribution, and
diversity of the healthcare workforce in order to continue eliminating
disparities in our Nation's healthcare system. These programs provide
training for students to practice in underserved areas, cultivate
interactions with faculty role models who serve in underserved areas,
and provide placement and recruitment services to encourage students to
work in these areas. Health professionals who spend part of their
training providing care for the underserved are up to 10 times more
likely to practice in underserved areas after graduation or program
completion.
Given the historic mission, of institutions like MSM, to provide
academic opportunities for minority and financially disadvantaged
students, and healthcare to minority and financially disadvantaged
patients, minority health professions institutions operate on narrow
margins. The slow reinvestment in the Title VII Health Professions
Training programs amounts to a loss of core funding at these
institutions and have been financially devastating.
Mr. Chairman, I feel like I can speak authoritatively on this issue
because I received my dental degree from Meharry Medical College, a
historically black medical and dental school in Nashville, Tennessee. I
have seen first hand what title VII funds have done to minority serving
institutions like Morehouse and Meharry. I compare my days as a student
to my days as president, without that title VII, our institutions would
not be here today. However, Mr. Chairman, since those funds have been
slowly replenished, we are standing at a cross roads. This subcommittee
has the power to decide if our institutions will go forward and thrive,
or if we will continue to try to just survive. We want to work with you
to eliminate health disparities and produce world class professionals,
but we need your assistance.
Minority Centers of Excellence (COE).--COEs focus on improving
student recruitment and performance, improving curricula in cultural
competence, facilitating research on minority health issues, and
training students to provide health services to minority individuals.
COEs were first established in recognition of the contribution made by
four historically black health professions institutions (the Medical
and Dental Institutions at Meharry Medical College; The College of
Pharmacy at Xavier University; and the School of Veterinary Medicine at
Tuskegee University) to the training of minorities in the health
professions. Congress later went on to authorize the establishment of
``Hispanic'', ``Native American'' and ``Other'' Historically black
COEs. For fiscal year 2011, I recommend a funding level of $33.6
million for COEs.
Health Careers Opportunity Program (HCOP).--HCOPs provide grants
for minority and nonminority health profession institutions to support
pipeline, preparatory, and recruiting activities that encourage
minority and economically disadvantaged students to pursue careers in
the health professions. Many HCOPs partner with colleges, high schools,
and even elementary schools in order to identify and nurture promising
students who demonstrate that they have the talent and potential to
become a health professional. Over the last three decades, HCOPs have
trained approximately 30,000 health professionals including 20,000
doctors, 5,000 dentists and 3,000 public health workers. For fiscal
year 2009, I recommend a funding level of $35.6 million for HCOPs.
National Institutes of Health (NIH): Extramural Facilities Construction
Mr. Chairman, if we are to take full advantage of the recent
funding increases for biomedical research that Congress has provided to
NIH over the past decade, it is critical that our Nation's research
infrastructure remain strong. The current authorization level for the
Extramural Facility Construction program at the National Center for
Research Resources is $250 million. The law also includes a 25 percent
set-aside for ``Institutions of Emerging Excellence'' (many of which
are minority institutions) for funding up to $50 million. Finally, the
law allows the NCRR Director to waive the matching requirement for
institutions participating in the program. We strongly support all of
these provisions of the authorizing legislation because they are
necessary for our minority health professions training schools.
There was 2-year funding in the stimulus bill for extramural
facilities, but we need a sustained effort to help with our research
and infrastructure enterprises. I ask that the fiscal year 2011 L-HHS
bill include at least $50 million for this program.
Research Centers in Minority Institutions (RCMI).--The RCMI program
at the National Center for Research Resources has a long and
distinguished record of helping our institutions develop the research
infrastructure necessary to be leaders in the area of health
disparities research. Although NIH has received unprecedented budget
increases in recent years, funding for the RCMI program has not
increased by the same rate. Therefore, the funding for this important
program grow at the same rate as NIH overall in fiscal year 2011.
Strengthening Historically Black Graduate Institutions--Department
of Education.--The Department of Education's Strengthening Historically
Black Graduate Institutions program (title III, part B, section 326) is
extremely important to MMC and other minority serving health
professions institutions. The funding from this program is used to
enhance educational capabilities, establish and strengthen program
development offices, initiate endowment campaigns, and support numerous
other institutional development activities. In fiscal year 2011, an
appropriation of $75 million is suggested to continue the vital support
that this program provides to historically black graduate institutions.
National Institute on Minority Health and Health Disparities
(NIMHD).--The NIMHD is charged with addressing the longstanding health
status gap between minority and nonminority populations. The NIMHD
helps health professional institutions to narrow the health status gap
by improving research capabilities through the continued development of
faculty, labs, and other learning resources. The NIMHD also supports
biomedical research focused on eliminating health disparities and
develops a comprehensive plan for research on minority health at the
NIH. Furthermore, the NIMHD provides financial support to health
professions institutions that have a history and mission of serving
minority and medically underserved communities through the Minority
Centers of Excellence program. For fiscal year 2011, I recommend a
funding level of $500 million for the NCMHD.
Department of Health and Human Services' Office of Minority Health
(OMH).--Specific programs at OMH include: (1) Assisting medically
underserved communities with the greatest need in solving health
disparities and attracting and retaining health professionals; (2)
Assisting minority institutions in acquiring real property to expand
their campuses and increase their capacity to train minorities for
medical careers; (3) Supporting conferences for high school and
undergraduate students to interest them in health careers; and (4)
Supporting cooperative agreements with minority institutions for the
purpose of strengthening their capacity to train more minorities in the
health professions.
The OMH has the potential to play a critical role in addressing
health disparities, and with the proper funding this role can be
enhanced. For fiscal year 2011, I recommend a funding level of $75
million for the OMH.
Mr. Chairman, please allow me to express my appreciation to you and
the members of this subcommittee. With your continued help and support,
MSM along with other minority health professions institutions and the
Title VII Health Professions Training programs can help this country to
overcome health and healthcare disparities. Congress must be careful
not to eliminate, paralyze, or stifle the institutions and programs
that have been proven to work. MSM and other minority health
professions schools seek to close the ever widening health disparity
gap. If this subcommittee will give us the tools, we will continue to
work towards the goal of eliminating that disparity as we have since
our founding day.
Thank you, Mr. Chairman, and I welcome every opportunity to answer
questions for your records.
______
Prepared Statement of the North American Brain Tumor Coalition
National Institutes of Health (NIH)
It is my pleasure as Chair of the North American Brain Tumor
Coalition to submit this statement in favor of a strong Federal
investment in biomedical research, an investment that is critically
important to improving the treatments for brain tumors. For individuals
with brain tumors, the possibility of surviving their diagnosis with a
good quality of life depends on research and development of new
treatments. Our recommendations to the subcommittee are intended to
advance that research.
The North American Brain Tumor Coalition and Its Members
The North American Brain Tumor Coalition is a network of nine brain
tumor organizations. Our members are the Brain Tumor Awareness
Organization; Brain Tumour Foundation of Canada; Children's Brain Tumor
Foundation; Florida Brain Tumor Association; Michael Quinlan Brain
Tumor Foundation; National Brain Tumor Society; Preuss Foundation;
Southeastern Brain Tumor Foundation; and Voices Against Brain Cancer.
Many of the members of the Coalition raise private funds to support
brain tumor research, while also undertaking patient and family support
initiatives. Almost all of our members disseminate educational
materials about brain tumors, and many also have forums for
collaboration and cooperation among brain tumor researchers. The
diversity of our organizations reflects the serious and far-reaching
impact of brain tumors on patients and their families. We are pleased
to have a Canadian organization in the Coalition, an important sign of
international collaboration among brain tumor organizations. The fact
that the Coalition includes organizations outside the United States is
also a recognition of the fact that brain tumors respect no borders.
The North American Brain Tumor Coalition brings these diverse
organizations together to focus on advocacy on behalf of those with
brain tumors. We are dedicated to improving the prognosis and quality
of life for brain tumor patients. In order to achieve these goals,
there must be an increased investment in research to understand the
causes of brain tumors, improve brain tumor treatments, and strengthen
neuro-rehabilitation services for those treated for brain tumors.
Brain Tumors and Their Impact
Brain tumors are not a single disease; there are approximately 126
types of primary brain tumors. The diversity of brain tumors
contributes to the complexity of research in this field. Many of the
126 tumors classified as ``brain tumors'' are not in the brain but
instead arise from structures that are associated with the brain. These
include tumors of the membranes covering the brain (referred to as
meningiomas) or adjacent cranial and paraspinal nerves (schwannomas).
Brain tumors may be benign (most meningiomas are benign) to highly
aggressive (glioblastomas). Both children and adults are diagnosed with
brain tumors.
It is estimated that there will be more than 62,000 cases of
primary malignant and nonmalignant brain and central nervous system
tumors in the United States in 2010.\1\ There will be approximately
10,000 primary brain tumors in Canada in 2010. In 2010, it is estimated
that 4,030 new primary brain tumors (malignant and nonmalignant) will
be diagnosed in children in the United States in 2010. Of the 4,030 new
cases, an estimated 2,880 will be in children under the age of 15.\1\
---------------------------------------------------------------------------
\1\ Central Brain Tumor Registry, 2004-2006.
---------------------------------------------------------------------------
Approximately 612,000 Americans are living with a primary brain
tumor.\2\
---------------------------------------------------------------------------
\2\ Porter KR, McCarthy BJ, Freels S, et al., Prevalence estimates
for primary brain tumors in the US by age, gender, behavior, and
histology. Neuro-Oncology, In press.
---------------------------------------------------------------------------
The American Cancer Society estimates that almost 12,920 deaths in
2009 will be attributed to primary malignant brain tumors.\3\ This
total does not include those who will die from primary nonmalignant
brain tumors.
---------------------------------------------------------------------------
\3\ American Cancer Society, Cancer Facts & Figures 2009, Atlanta,
2009.
---------------------------------------------------------------------------
Many tens of thousands--140,000 or more--are diagnosed with
metastatic brain tumors each year. Many tumor types can spread to the
brain, but the most common are lung cancer, breast cancer, melanoma,
kidney cancer, bladder cancer, and testicular cancer. It is estimated
that metastatic brain tumors occur in 10 to 30 percent of adult
cancers, and in one-fourth of all cancers that metastasize.\4\
---------------------------------------------------------------------------
\4\ Medline Plus, National Library of Medicine, accessed on April
7, 2010.
---------------------------------------------------------------------------
These statistics about incidence, prevalence, and mortality are
important, but they do not fully convey the burden of brain tumors. For
many brain tumor patients, treatments are inadequate. Those who receive
treatments that do extend their lives may nonetheless experience
serious side-effects from their brain tumors and treatment, side-
effects that require intervention. In addition, a diagnosis with a
brain tumor does not only affect the patient; it also has a profound
effect on the patient's family and friends.
A study published in the Annals of Internal Medicine on April 6,
2010, describes the impact of a cancer diagnosis on children. The study
notes that there have been significant improvements in treatments for
some pediatric cancers. However, cancer treatments often cause serious
health problems, including but not limited to second cancers and heart
conditions. The researchers used computer models to estimate what
happens to childhood cancer survivors and determined that survivors of
brain cancer died about 18 years earlier than the general population.
This study underscores the problems confronted by brain tumor patients
who ``survive'' their diagnosis.
The Challenges of Brain Tumor Treatment and Research
In a report dated 2000, the Brain Tumor Progress Review Group,
convened by the National Cancer Institute (NCI) and National Institute
of Neurological Disorders and Stroke (NINDS), stated that the
difficulty in treating brain tumors relates to the unique biology of
the brain, including the fact the brain is enclosed in a bony canal
that allows little room for tumor growth, brain tumors invade normal
tissue and make surgical removal impossible, brain tumors are protected
by the blood-brain barrier, the brain is rich in expressed genes and
therefore is a fertile field for growth of brain tumors, and brain
tumors appear to be less susceptible to attack by the immune system
than tumors in other organs.
The complexity and diversity of brain tumors make the work of brain
tumor researchers very difficult. For this reason, an aggressive and
balanced approach to brain tumor research is necessary. The research
effort must be strongly supported by NIH, as described below.
NABTC Recommendations for NIH Funding
The North American Brain Tumor Coalition supports the
recommendations of many other biomedical research and patient advocacy
organizations that NIH funding be increased to $35 billion in fiscal
year 2011. This amount is necessary to sustain the commitment of the
American Recovery and Reinvestment Act and prevent disruptions in the
work of outstanding scientists committed to a wide range of research
topics. The Coalition understands that this is a very aggressive
recommendation in the current economic and budget climate, but this
ambitious level of funding is necessary if additional advances in basic
and applied science are to be achieved.
A recent accomplishment in brain tumor research underscores the
need for additional resources and a sustained Federal commitment in
order to realize improvements in the quality of treatments for many
diseases and quality of life for those who are diagnosed with those
diseases. The Cancer Genome Atlas (TCGA) at NCI announced in January
2010 that researchers in TCGA Research Network had determined that
glioblastoma multiforme (GBM) is not a single disease but four distinct
molecular subtypes. In announcing the research findings, TCGA said that
the research might lead to a more personalized approach to GBM, one of
the deadliest of all brain tumors.
The North American Brain Tumor Coalition applauds the important
research finding of TCGA but also notes that the finding points to the
need for additional research, including:
--Work to understand the molecular classification of other brain
tumors, in addition to GBM;
--Research to translate basic research findings into treatment
approaches;
--Identification of agents that might be evaluated in brain tumors,
including those that are newly subject to a molecular
classification scheme; and
--Clinical testing of possible new agents for brain tumor treatment.
In short, the findings of TCGA point the way to a new approach to
brain tumor treatment, but we have only taken the first step in a long
journey to effective, personalized brain tumor treatments.
This translates to the need for a balanced research program that
includes the following elements:
--Support for investigator-initiated research so that new and
promising ideas from the Nation's leading brain tumor
researchers can be tested;
--Funding for The Cancer Genome Atlas and other efforts that are
advancing the molecular classification of disease;
--Resources for translational programs to translate basic findings
into new treatments; for brain tumor research, this means the
continuation of the Specialized Programs of Research Excellence
(SPOREs) and the adult and pediatric brain tumor consortia;
--Support for clinical trials through the brain tumor consortia,
cooperative groups, and cancer centers; and
--Aggressive and creative support for research on the late and long-
term effects of brain tumor treatment, including research on
interventions for these side effects.
We recommend that medulloblastoma be added to the list of cancers
identified for further study through The Cancer Genome Atlas. We also
encourage innovative strategies for data sharing in the SPORE program,
including across SPORE sites. Research foundations and patient advocacy
organizations are pioneering creative means for sharing clinical and
research data, and we encourage NCI to consider some of these models
for their applicability to SPORE sites and other research settings.
NABTC Recommends Strategies for Encouraging Collaboration
Brain tumor treatment is complex and multi-disciplinary, and
research on these tumors must also have these characteristics. NCI and
NINDS have established and supported a collaborative venture, the
Neuro-Oncology Program, which takes a collaborative and cooperative
approach to brain tumor research.
This cooperative research approach is absolutely critical for brain
tumors, but it will yield benefits for many other diseases as well. The
Coalition applauds the leadership of the NIH Director in encouraging
collaborative ventures that yield communication and collaboration among
Institutes. We also recommend that more funding mechanisms be created
to facilitate this sort of cooperation among academic research
institutions seeking NIH funding.
Urgency in the Brain Tumor Research Program
It is necessary to keep a long view in biomedical research,
sustaining funding levels and preventing disruptions in research.
However, it is also important to have a sense of urgency about the pace
of research. The 5-year relative survival rate for primary malignant
brain tumors is 33.6 percent for males and 37 percent for females. For
these individuals, time is precious and the research effort--literally
their lifeline--must be accelerated as much as possible.
______
Prepared Statement of the National Association of County and City
Health Officials
summary
The National Association of County and City Health Officials
(NACCHO) represents the Nation's 2,800 local health departments (LHDs).
These governmental agencies work every day in their communities to
prevent disease, promote wellness, and protect the health of the entire
community. 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 LHDs to play this
role well.
The Nation's current recession further diminishes the ability of
LHDs to measure population-wide illness, organize efforts to prevent
disease and prolong quality of life and to serve the public through
programs not offered elsewhere. Repeated rounds of budget cuts and
layoffs in LHDs continue to erode capacity. A series of NACCHO surveys
found that in 2008-2009, 23,000 jobs have been lost in LHDs, which
represents a 15 percent cut in the local public health workforce.
LHDs continue to respond to increased challenges; including H1N1
influenza, an increasing incidence of chronic disease and outbreaks of
foodborne illness during a time of growing budget challenges. To help
maintain the stability of LHDs, the Federal government should increase
its investment in the following programs in fiscal year 2011
appropriations: Public Health Emergency Preparedness, Advanced Practice
Centers, Preventive Health and Health Services Block Grant, Healthy
Communities and the Health Prevention Corps. Programs authorized by the
health reform law should also be funded to the extent possible in
fiscal year 2011 appropriations.
Public Health Emergency Preparedness
NACCHO Request.--$1.152 billion (including pandemic influenza
preparedness).
President's Budget Fiscal Year 2011.--$758 million (Public Health
Emergency Preparedness).
Emergency Supplemental Funds for H1N1 Influenza.--$1.3 billion.
Fiscal Year 2010 Funding.--$761 million (Public Health Emergency
Preparedness).
The safety and well-being of America's communities is dependent on
the capacity of their health departments to respond in any emergency
that threatens human health, whether it is an act of bioterrorism, an
influenza pandemic such as occurred in 2009-2010, or a natural
disaster. The Centers for Disease Control and Prevention (CDC) has
explicitly adopted an ``all-hazards'' approach to preparedness,
recognizing that the capabilities necessary to respond to differing
public health threats have many common elements.
NACCHO requests $1.152 billion in funding for fiscal year 2011,
which reflects continued funding for local and State preparedness
activities under the Pandemic and All-Hazards Preparedness Act along
with additional support necessary to sustain the capabilities that were
put into place in 2009 to respond to the H1N1 flu epidemic, made
possible through $1.3 billion in Federal emergency supplemental
funding.
With recent progress in nationwide preparedness and ongoing
challenges, including the next flu season, now is not the time to
reduce Federal funding that helps health departments continue their
progress and address new, emerging threats. Especially when LHDs are
under great stress from the loss of 15 percent of their workforce over
the last 2 years, the Nation cannot afford to lose the gains made by
recent Federal investment in public health. A loss of readiness is
inevitable if the level of Federal investment is reduced.
The enhanced capabilities enabled by pandemic influenza
supplemental funding in 2009 will improve the response to other
potential epidemics of infectious disease. At the same time, continuous
training and exercising of all health department staff so that they are
all ready for the next emergency must continue. Incorporating pandemic
influenza preparedness into the context of all-hazards preparedness is
the most efficient use of limited resources and will fully enable
maintenance of the current level of preparedness and flexibility to
alter priorities as needed when other public health threats emerge.
Advanced Practice Centers
NACCHO Request.--$5.4 million.
President's Budget.--$5.3 million.
Fiscal Year 2010 Funding.--$5.3 million.
The mission of the Advanced Practice Center (APC) program is to
promote innovative and practical solutions that enhance the
capabilities of all LHDs to prepare for, respond to, and recover from
public health emergencies. With locations in eight different geographic
areas of the United States, the APC program supports and strengthens
LHDs by developing and disseminating resources focused on helping them
address gaps in local-level preparedness and improve responsiveness to
address myriad health hazards. An increase in funding to $5.4 million
would allow the tools produced through this program to reach more LHDs.
Preventive Health and Health Services Block Grant
NACCHO Request.--$131 million.
President's Budget Fiscal Year 2011.--$102 million.
Fiscal Year 2010 Funding.--$102 million.
LHDs are leaders in efforts to stop preventable health threats from
occurring. Obesity, heart attack, and accidental injury are all
examples of preventable health problems LHDs work on every day. The
Preventive Health and Health Services (PHHS) block grant program is a
longstanding source of funding for these efforts.
The increasing prevalence of costly and preventable chronic health
conditions represents a threat to America's health and economy.
According to the CDC, the medical care costs of people with chronic
diseases account for more than 75 percent of the Nation's healthcare
costs. The emerging epidemic of overweight and obesity is associated
with $117 billion in annual direct medical expenses and indirect costs,
including lost productivity, which impairs our economic competitiveness
during a period of severe economic decline. Increased funding of $131
million in fiscal year 2011 for the Preventive Health and Health
Services Block Grant would allow local and State health departments to
increase their efforts to focus on community priorities aimed at
reversing the increase in preventable disease rates.
Healthy Communities
NACCHO Request.--$30 million.
President's Budget Fiscal Year 2011.--$22.4 million.
Fiscal Year 2010 Funding.--$22.8 million.
The Healthy Communities program is dedicated to supporting local
communities in implementing evidence-based interventions and policy,
systems, and environmental changes necessary to help communities
prevent chronic diseases and their risk factors.
To reverse unfavorable trends in the prevalence and health
consequences of chronic diseases, communities work in collaboration
with LHD leadership to address such issues as affordable and accessible
healthy food options, safe places for physical activity, and the need
for targeted strategies that address and reduce health disparities.
Changes in the local environment facilitate healthy choices and go hand
in hand with education about how to be healthier.
The Healthy Communities program mobilizes community leadership and
resources to transform the local environments where people live, work
and play to stem the growth of chronic disease. CDC anticipates the
cumulative impact of the Healthy Communities program to reach more than
300 communities by fiscal year 2011. With increased funding of $30
million in fiscal year 2011, more communities can be reached with this
innovative program.
Health Prevention Corps
NACCHO Request: $10 million.
President's Budget.--$10 million.
According to the President's budget, the Health Prevention Corps
program will ``recruit new talent into service for State and LHDs and
provide the building blocks for creating a stronger, interdisciplinary
workforce.'' These funds are meant to create a foundation for the
program by establishing a management plan for staffing and program
administration, convening stakeholders to establish the program
framework, and developing a curriculum for Corps members. A shortage of
public health professionals is a constant challenge for LHDs and this
program will help to build a supply of new personnel offering their
talents and skills to local communities.
programs associated with health reform
The Patient Protection and Affordable Care Act authorized a number
of new programs that will be beneficial to public health and LHDs. The
health reform law provides an opportunity to focus on maintaining and
creating health through support of community prevention programs. The
law also includes programs that will help to strengthen the public
health workforce which was challenged by shortages even prior to
layoffs and attrition caused by recent budget cuts. Programs such as
Public Health Loan Repayment and Mid-Career Training grants,
Epidemiological and Laboratory Capacity Grants, Community
Transformation Grants, Healthy Living, Aging Well and the Diabetes
Prevention Program would fill tremendous needs at the local level and
should be funded to the extent possible in the fiscal year 2011
appropriations process.
______
Prepared Statement of the National Association of Children's Hospitals
On behalf of the National Association of Children's Hospitals
(N.A.C.H.) and the Nation's free-standing children's hospitals, I
respectfully request that the Labor, Health and Human Services, and
Education, and Related Agencies Appropriations Subcommittee provide the
fully authorized funding level of $330 million for the Children's
Hospitals Graduate Medical Education (CHGME) program in fiscal year
2011.
With the subcommittee's leadership, Congress has worked to provide
equitable funding for the Nation's independent children's teaching
hospitals through the CHGME program. An appropriation of $330 million
would meet the program's authorization level and ensure that children's
hospitals will receive equitable funding compared to the Federal
support that other teaching hospitals receive through Medicare.
In 2006, Congress reauthorized the CHGME program with nearly
unanimous bipartisan support. Since then the Labor, Health and Human
Services, and Education, and Related Agencies Appropriations
Subcommittee has provided strong, consistent funding for CHGME. In
fiscal year 2010, Congress appropriated the highest amount the program
has ever received at $317.5 million. President Obama recognized the
importance of CHGME in his fiscal year 2011 budget request and
maintained funding at $317.5--$7.5 million above his request for fiscal
year 2010.
CHGME is a targeted, fiscally responsible, slow-growth program that
is integral to ensuring a stable future for children's hospitals and
the pediatric workforce. Congress created CHGME in 1999 because it
recognized the importance of a well-trained pediatric workforce and
understood the disparity in Federal graduate medical education (GME)
support that existed between adult teaching hospitals and independent
children's teaching hospitals. At that time, independent children's
teaching hospitals were effectively left out of Federal GME support
provided through Medicare because they treat children and not the
elderly. In fact, children's hospitals were at a serious financial
disadvantage, receiving less than 0.5 percent of the Federal GME
support of other teaching hospitals. Medicaid GME payments, which are
left to the discretion of States to provide and are well below the
costs related to training, did not fill the gap.
Congress also understood when it created CHGME that the disparity
in GME support under Medicare jeopardized an already precarious
pipeline of pediatric specialists. As a result of congressional
foresight and commitment to this program, CHGME has played a critical
role in addressing the Nation's serious shortage of pediatric
specialists.
Independent children's teaching hospitals, which represent less
than 1 percent of all hospitals, train 35 of all general pediatric
residents, half of all pediatric specialty fellows, the great majority
of pediatric researchers, and many other physicians who require
pediatric training. In addition, they provide half of all hospital care
to seriously ill children and serve as the Nation's premier pediatric
research centers.
CHGME funding now provides children's hospitals with about 80
percent of the GME support that Medicare provides to adult teaching
hospitals. The funding has enabled children's hospitals to expand
pediatric training programs, improve the quality and depth of their
training, and prevent a net decline in the number of pediatric
residents. Since the program's inception, children's hospitals have
more than doubled the number of total pediatric specialty residents in
response to local, regional, and national needs and children's
hospitals have increased the number of new training programs by
approximately 50 percent. These gains were achieved despite the cap on
CHGME funds and caps on the number of full-time equivalent residents
that could be counted for purposes of CHGME payment in accordance with
Medicare rules.
Unfortunately, shortages in the pediatric workforce still remain,
particularly in pediatric specialty care. The National Association of
Children's Hospitals and Related Institutions' (NACHRI) 2009 Pediatric
Subspecialty Survey found a strong connection between pediatric
specialty shortages, long-term vacancies and children's access to
timely and appropriate healthcare. According to the survey, national
shortages contribute to vacancies in children's hospitals that commonly
last 12 months or longer for a number of pediatric specialties,
including pediatric neurology, developmental-behavioral pediatrics,
pediatric endocrinology, pediatric pulmonology, and pediatric
gastroenterology.
Sick children bear the brunt of the shortages of pediatric
specialists. Wait times for scheduling appointments with pediatric
specialists often exceeds the prevailing national benchmark of 2 weeks.
In fact, at least half of children's hospital survey respondents
reported wait times far longer than 2 weeks. For example:
--68 percent of children's hospitals experience difficulty scheduling
endocrinology visits; the average wait time is more than 10
weeks;
--61 percent report difficulty scheduling neurology visits; the
average wait time is 9 weeks; and
--50 percent report difficulty scheduling developmental pediatrics
visits; the average wait time is more than 13 weeks. This
exceptionally long wait time is of particular concern given the
rise in autism-related disorders among the Nation's children.
A January 2010 Wall Street Journal article, ``For Severely Ill
Children, a Dearth of Doctors,'' put a human face on the NACHRI survey
findings and described the impact of these shortages on a young patient
and his family. ``Three-year old Kenneth Jones, for example, was born
in Alaska with a rare gastrointestinal disorder that made him unable to
absorb protein. He had to travel 3 hours to see one pediatric GI
specialist in the state-a doctor who left a year later. The family
moved to Oregon for work-related reasons and found a clinic that could
provide complete care for the disorder--in Ohio, at a Cincinnati
Children's Hospital clinic where they had to wait 7 months for
Kenneth's first appointment. `There are so few pediatric GIs out there
and so many children that need to be seen that you just have to wait in
line,' says Kenneth's mother, Lauren Jones. `That's the hardest thing
to endure for a parent with a sick child who needs help right away.' ''
CHGME has allowed children's hospitals to begin to address the
large gap that exists between families' need for pediatric specialty
care and the supply. In fact, free-standing children's hospitals that
receive CHGME funding have accounted for 65 percent of the growth in
pediatric specialty programs.
By strengthening children's hospitals' training programs and the
Nation's pediatric workforce, CHGME benefits all children, not just
those treated at independent children's teaching hospitals. CHGME funds
indirectly strengthen children's hospitals' roles as pediatric centers
for excellence, the safety net for low-income children, and the leading
centers of pediatric research. Children's hospitals are at the center
of scientific discovery as a result of their strong academic programs
supported by CHGME and advanced life-saving clinical research.
Children's teaching hospitals' scientific discoveries have helped
children survive diseases that were once fatal, such as polio and
cancer. Furthermore, as a result of scientific research breakthroughs
at children's teaching hospitals, children now can grow and thrive with
disabilities and chronic health conditions, such as congenital heart
disease, cystic fibrosis, cerebral palsy, juvenile diabetes, and spina
bifida, and become economically self-supporting adults and valuable
members of their communities.
CHGME is a sound investment. With full funding, CHGME will help to
ensure a stable future for the Nation's children's hospitals and the
pediatric workforce. With that support, children's hospitals will
continue to be centers for excellence and be able to provide the
highest-quality healthcare to all children.
Once again, thank you for your past support for this critical
program. On behalf of N.A.C.H., its member hospitals, and the children
and families they serve, I respectfully ask you to provide $330 million
for CHGME in fiscal year 2011 to support the continued progress that
has been made in CHGME. As the Nation embarks on the implementation of
the landmark health reform legislation, it is imperative that we have a
strong pediatric workforce with a sufficient pool of specialists to
meet the unique healthcare needs of all children.
______
Prepared Statement of the National Association of Community Health
Centers
introduction
Chairman Harkin, Ranking Member Cochran, and members of the
subcommittee: My name is Dan Hawkins, and I am the Senior Vice
President of the National Association of Community Health Centers
(CHC). On behalf of CHCs and the more than 20 million patients served
nationwide, as well as the volunteer board members, staff, and
countless members of the health center movement, I want to thank you
for this subcommittee's unyielding support for health centers and your
dedication to the health center mission of providing affordable,
accessible primary healthcare to all Americans.
As you know, Congress recently passed the Patient Protection and
Affordable Care Act (Affordable Care Act)--a law that is historic by
any measure. The law endeavors to ensure that for the first time, all
Americans will have access to quality healthcare. From the community
health center perspective, we are incredibly humbled at the charge the
new law gives to health centers: to become the healthcare home for
millions of newly insured patients, even as we maintain our high
standards of openness to all and a focus on achieving quality that is
second to none.
Health centers were started 45 years ago because their founders
knew that an urgent intervention was needed to deal with the crisis of
access in America. Today, health centers have been called upon again,
this time to expand our proven system of care rapidly to ensure that as
our nation extends coverage to millions of Americans, the promise of
coverage truly equals care. With your continued support, health centers
stand ready to deliver and to reach the goals that Congress has set
out: providing care to 40 million Americans by 2015.
About CHCs
Today, health centers serve more than 20 million patients in nearly
8,000 communities. Health centers serve as the family doctor and
healthcare home for 1 in 8 uninsured individuals, and 1 in every 5 low-
income children.
Federal law requires that every health center be governed by a
patient-majority board, which means care is truly patient-centered and
patient-driven. Health centers must be located in a designated
Medically Underserved Area, and must provide comprehensive primary care
services to anyone who comes in the door, regardless of ability to pay.
As health leaders as well as providers in their communities, health
centers believe that they have an obligation to work to prevent disease
and improve the lives and health of their patients and their
communities. For this reason, health centers have been pioneers in
improving healthcare quality, particularly in the area of chronic
disease management. Through the Health Resources and Services
Administration's Health Disparities Collaboratives, the majority of
health centers have worked to improve their delivery systems and to
more effectively educate patients on the self-management of their
conditions such as cancer, diabetes, asthma, and cardiovascular
disease. Health centers participating in the Collaboratives almost
unanimously report that health outcomes for their patients have
dramatically improved. Published studies have documented these
outcomes, including one study on the Diabetes Collaboratives where
evidence showed that over a lifetime, the incidence of blindness,
kidney failure, and coronary artery disease was reduced.\1\
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\1\ Huang, E, Zhang, Q, Brown, S. E.S., Drum, M, Meltzer, D, Chin,
M. (2007). The Cost-Effectiveness of Improving Diabetes Care in U.S.
federal Qualified Community Health Centers. Health Services Research,
42, (6p1), 2174-2193.
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Health centers not only improve health and save lives, they also
cost significantly less, saving the health system overall. In South
Carolina, a study showed that diabetic patients enrolled in the State
employees' health plan treated in non-CHC settings were four times more
costly than those in the same plan who were treated in a community
health center. The health center patients also had lower rates of
emergency room use and hospitalization.\2\ In fact, literally dozens of
studies done over the past 25 years, have concluded that health center
patients are significantly less likely to use hospital emergency rooms
or to be hospitalized for ambulatory care-sensitive conditions, and are
therefore less expensive to treat than patients treated elsewhere.\3\ A
recent national study done in collaboration with the Robert Graham
Center found that people who use health centers as their usual source
of care have 41 percent lower total healthcare expenditures than people
who get most of their care elsewhere.\4\ As a result, health centers
saved the healthcare system $18 billion last year alone.
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\2\ Proser M. ``Deserving the Spotlight: Health Centers Provide
High-Quality and Cost-Effective Care.'' October-December 2005 Journal
of Ambulatory Care Management 28(4):321-330.
\3\ Rust G., et al. ``Presence of a Community Health Center and
Uninsured Emergency Department Visit Rates in Rural Counties.'' Journal
of Rural Health, Winter 2009 25(1):8-16; Dobson D, et al. ``The
Economic and Clinical Impact of Community Health Centers in Washington
State: Analyses of the Contributions to Public Health and Economic
Implications and Benefits for the State and Counties.'' Dec 2008
Community Health Network of Washington and Washington Association of
Community and Migrant Health Centers; McRae T. and Stampfly R. ``An
Evaluation of the Cost Effectiveness of Federal Qualified Health
Centers (FQHCs) Operating in Michigan.'' October 2006 Institute for
Health Care Studies at Michigan State University. www.mpca.net. Falik
M, Needleman J, Herbert R, et al. ``Comparative Effectiveness of Health
Centers as Regular Source of Care.'' January-March 2006 Journal of
Ambulatory Care Management 29(1):24-35; Proser M. ``Deserving the
Spotlight: Health Centers Provide High-Quality and Cost-Effective
Care.'' October-December 2005 Journal of Ambulatory Care Management
28(4):321-330; Politzer RM, et al. ``The Future Role of Health Centers
in Improving National Health.'' 2003 Journal of Public Health Policy
24(3/4):296-306; see also, e.g., Politzer RM, et al. ``Inequality in
America: The Contribution of Health Centers in Reducing and Eliminating
Disparities in Access to Care.'' 2001 Medical Care Research and Review
58(2):234-248; Falik M, et al. ``Ambulatory Care Sensitive
Hospitalizations and Emergency Visits: Experiences of Medicaid Patients
Using Federal Qualified Health Centers.'' 2001 Medical Care 39(6):551-
56; Starfield, Barbara, et al, ``Costs vs. Quality in Different Types
of Primary Care Settings,'' Journal of the American Medical Association
272,24 (December 28, 1994): 1903-1908; Stuart, Mary E., et al,
``Improving Medicaid Pediatric Care,'' Journal of Public Health
Management Practice 1(2) (Spring, 1995): 31-38; Utilization and Costs
to Medicaid of AFDC Recipients in New York Served and Not Served by
Community Health Centers, Center for Health Policy Studies (1994);
Stuart, Mary E., and Steinwachs, Donald M., (Johns Hopkins Univ. School
of Public Health and Hygiene), ``Patient-Mix Differences Among
Ambulatory Providers and Their Effects on Utilization and Payments for
Maryland Medicaid Users,'' Medical Care 34,12 (December 1993): 1119-
1137; Health Services Utilization and Costs to Medicaid of AFDC
Recipients in California Served and Not Served by Community Health
Centers, Center for Health Policy Studies/SysteMetrics (1993).
\4\ NACHC and the Robert Graham Center. Access Granted: The Primary
Care Payoff. August 2007. www.nachc.com/access-reports.cfm.
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Funding Background
Over the last decade, this subcommittee has been at the forefront
of expanding access to primary care in America and changing the way
primary care is delivered through its expansion of the Health Centers
Program. This expansion effort brought access to care to millions who
were previously medically disenfranchised. Since 2001, this
subcommittee has nearly doubled the investment in the Health Centers
program. In that time, more than 3,500 new health center sites have
been created, and more than 10 million new patients have gained access
to care in a health center. It is your commitment that has proven what
we in the health centers movement knew to be true: that our patient-
centered, community-based health center model of care is the best way
for Americans to receive primary care.
Impact of Health Reform
The passage of comprehensive health reform builds on this
subcommittee's efforts by envisioning yet another expansion of the
Health Centers Program over the next 5 years. The law creates a
Community Health Center Fund containing $11 billion in new funding for
health centers over the next 5 years. We believe this funding will
allow health centers to grow to serve 40 million Americans by the end
of fiscal year 2015. This investment will ensure that as more Americans
become insured, they will actually have a healthcare home in their
community in which to access care.
Fiscal Year 2011 Request
The CHC Fund has the potential to fundamentally and positively
change the way primary care is delivered in this country. However, in
order for the CHC Fund to have its intended impact, it is critical that
the discretionary funding level of the Health Centers Program at least
meet the fiscal year 2010 level of $2.19 billion. Keeping the
discretionary funding base at least at the fiscal year 2010 level will
allow the CHC Fund to be fully utilized for new health centers,
expanded medical, oral, behavioral, and pharmacy services at existing
health centers, and allow the continuation of desperately needed ARRA
Increased Demand for Services funding to health centers who have
already expanded care to almost 2 million new patients over the last
year.
Conclusion
At this historic moment for the health centers movement, I am
deeply proud to be speaking for CHCs nationwide. I have personally seen
the power of health centers to lift the health and the lives of
individuals and families in our most underserved communities. Thanks to
your longstanding support, health centers have revolutionized primary
care community by community and we are ready to do even more. In light
of the passage of health reform, health centers stand ready to live up
to the incredible trust that has been placed in us. With your support,
we look forward to ensuring that the Government's investment in reform
translates into improved health and wellness for the Nation for years
to come.
______
Prepared Statement of the National Alliance for Eye and Vision Research
executive summary
National Alliance for Eye and Vision Research (NAEVR) requests
fiscal year 2011 National Institutes of Health (NIH) funding at $35
billion, which reflects a $3 billion increase more than President
Obama's proposed funding level of $32 billion. Funding at $35 billion,
which reflects NIH's net funding levels in both fiscal year 2009 and
fiscal year 2010, ensures it can maintain the number of multi-year
investigator-initiated research grants, the cornerstone of our Nation's
biomedical research enterprise.
The vision community commends Congress for $10.4 billion in NIH
funding in the American Recovery and Reinvestment Act (ARRA), as well
as fiscal year 2009 and fiscal year 2010 funding increases that enabled
NIH to keep pace with biomedical inflation after 6 previous years of
flat funding that resulted in a 14 percent loss of purchasing power.
Fiscal year 2011 NIH funding at $35 billion enables it to meet the
expanded capacity for research--as demonstrated by the significant
number of high-quality grant applications submitted in response to ARRA
opportunities--and to adequately address unmet need, especially for
programs of special promise that could reap substantial downstream
benefits, as identified by NIH Director Francis Collins, M.D., Ph.D. in
his top five priorities. As President Obama has stated repeatedly,
including at a visit to the NIH in September 2009, biomedical research
has the potential to reduce healthcare costs, increase productivity,
and ensure the global competitiveness of the United States.
NAEVR requests that Congress improve upon the President's proposed
2.5 percent National Eye Instutute (NEI) increase--the second smallest
increase of all Institutes and Centers--especially if it does not
increase overall NIH funding above the President's request.
In 2009, Congress spoke volumes in passing S. Res. 209 and H. Res.
366, which acknowledged NEI's 40th anniversary and designated 2010-2020
as The Decade of Vision, in which the majority of 78 million Baby
Boomers will turn 65 years of age and face greatest risk of aging eye
disease. This is not the time for a less-than-inflationary increase
that nets a loss in the NEI's purchasing power, which eroded by 18
percent in the fiscal year 2003-2008 timeframe. NEI-funded research is
resulting in treatments and therapies that save vision and restore
sight, which can reduce healthcare costs, maintain productivity, ensure
independence, and enhance quality of life.
fiscal year 2011 nih funding at $35 billion enables the nei to build
upon the impressive record of basic and clinical collaborative research
that meets nih's top five priorities and was funded through fiscal year
2009-2010 arra and increased ``regular'' appropriations
NEI's research addresses the pre-emption, prediction, and
prevention of eye disease through basic, translational,
epidemiological, and comparative effectiveness research which also
address the top five NIH priorities, as identified by Dr. Collins:
genomics, translational research; comparative effectiveness; global
health, and empowering the biomedical enterprise. NEI continues to be a
leader within the NIH in elucidating the genetic basis of ocular
disease--NEI Director Paul Sieving, M.D., Ph.D., has reported that one-
quarter of all genes identified to date through collaborative efforts
with the National Human Genome Research Institute (NHGRI) are
associated with eye disease/visual impairment.
NEI received $175 million of the $10.4 billion in NIH ARRA funding.
As a result, NEI's total funding levels in the fiscal year 2009-2010
timeframe were $776 million and $794.5 million, respectively. In fiscal
year 2009, NEI made 333 ARRA-related awards, the majority of which
reflect investigator-initiated research that funds new science or
accelerates ongoing research, including ten Challenge Grants. Several
examples of research, and the reasons why it is important, include:
--Biomarker for Neovascular Age-related Macular Degeneration (AMD).--
Researchers will use a recently discovered biomarker for
choroidal neovascularization--the growth of abnormal blood
vessels into the retina and responsible for 90 percent of
vision loss associated with AMD--to develop an early detection
method to minimize vision loss. Why important? AMD is the
leading cause of vision loss in the United States, especially
in the elderly.
--Cellular Approach to Treating Diabetic Retinopathy (DR).--
Researchers propose to develop a clinical treatment for
diabetic retinopathy--in which diabetes damages small blood
vessels in the retina, causing them to leak--that uses stem
cells from the patient's own blood that have been activated
outside of the body and then returned to repair damaged vessels
in the eye. Why important? DR is the leading cause of vision
loss in younger Americans, and its incidence is
disproportionately higher in African Americans, Latinos, and
Native Americans.
--Small Heat Shock Proteins as Therapeutic Agents in the Eye.--
Researchers propose to develop new drugs to prevent or reverse
blinding eye diseases, such as cataract (clouding of the lens),
that are associated with the aggregation of proteins. Research
will focus on the use of small ``heat shock'' proteins that
facilitate the slow release and prolonged delivery of targeted
macromolecules to degenerating cells of the eye. Why important?
Delivering effective, long-lasting therapies through a
minimally invasive route into the eye is a major challenge.
--Identification of Genes and Proteins That Control Myopia
Development.--Researchers propose to identify targets that will
facilitate development of interventions to slow or prevent
myopia (nearsightedness) development in children. Identifying
an appropriate myopia prevention target can reduce the risk of
blindness and reduce annual life-long eye care costs. Why
important? More than 25 percent of the U.S. population has
myopia, costing $14 billion annually, from adolescence to
adulthood.
--Comparison of Interventions for Retinopathy of Prematurity (ROP).--
In animal studies, researchers will simulate Retinopathy of
Prematurity--a blinding eye disease that affects premature
infants--and then study novel treatments that involve
modulating the metabolism of the retina's rod photoreceptors.
Why important? ROP affects 15,000 children a year, about 400-
600 of whom progress to blindness, at an estimated lifetime
cost for support and unpaid taxes of $1 million each.
--The NEI Glaucoma Human genetics collaBORation, NEIGHBOR.--This
research network, in which seven U.S. teams will lead genetic
studies of the disease, may lead to more effective diagnosis
and treatment. Researchers were primarily funded through ARRA
supplements. Why important: Glaucoma, a complex
neurodegenerative disease that is the second leading cause of
preventable blindness in the United States, often has no
symptoms until vision is lost.
--Comparative Effectiveness of Interventions for Primary Open Angle
Glaucoma (POAG).--Researchers will evaluate existing data on
the effectiveness of various treatment options for primary open
angle glaucoma--many emerging from past NEI research. Why
important? POAG is the most common form of the disease, which
disproportionately affects African Americans and Latinos.
In addition to ARRA funding, the ``regular'' appropriations
increases in fiscal year 2009-2010 enabled the NEI to continue to fund
key research networks, such as the following:
--The African Descent and Glaucoma Evaluation Study (ADAGES), which
is designed to identify factors accounting for differences in
glaucoma onset and rate of progression between individuals of
African and European descent.
--The Diabetic Research Clinical Research Network's initiation of new
trials comparing the safety and efficacy of drug therapies as
an alternative to laser treatment for diabetic macular edema
and proliferative diabetic retinopathy.
--The Neuro-Ophthalmology Research Disease Investigator Consortium
(NORDIC), which will lead multi-site observational and
treatment trials, involving nearly 200 community and academic
practitioners, to address the risks, diagnosis, and treatment
of visual dysfunction due to increased intracranial pressure
and thyroid eye disease.
The unprecedented level of fiscal year 2009-2010 vision research
funding is moving our Nation that much closer to the prevention of
blindness and restoration of vision. With an overall NIH funding level
of $35 billion, which translates to an NEI funding level of $794.5
million, the vision community can accelerate these efforts, thereby
reducing healthcare costs, maintaining productivity, ensuring
independence, and enhancing quality of life.
if congress does not increase fiscal year 2011 nih funding above the
president's request, it is even more vital to improve upon the proposed
2.5 percent increase for nei
The NIH budget proposed by the administration and developed by
Congress during the very first year of the Congressionally-designated
Decade of Vision should not contain a less-than-inflationary increase
for the NEI due to the enormous challenges it faces in terms of the
aging population, the disproportionate incidence of eye disease in
fast-growing minority populations, and the visual impact of chronic
disease (e.g., diabetes). If Congress is unable to fund NIH at $35
billion in fiscal year 2011 (NEI level of $794.5 million) and adopts
the President's proposal, the 2.5 percent increase in funding must be
increased to at least an inflationary level of 3.2 percent to prevent
any further erosion in NEI's purchasing power. NEI funding is an
especially vital investment in the overall health, as well as the
vision health, of our Nation. It can ultimately delay, save, and
prevent health expenditures, especially those associated with the
Medicare and Medicaid programs, and is, therefore, a cost-effective
investment.
vision loss is a major public health problem: increasing healthcare
costs, reducing productivity, diminishing life quality
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.
about naevr
The National Alliance for Eye and Vision Research (NAEVR) is a
501(c)4 nonprofit advocacy coalition comprised of 55 professional,
consumer, and industry organizations involved in eye and vision
research. Visit NAEVR's Web site at www.eyeresearch.org.
______
Prepared Statement of the National Association of Local Boards of
Health
We strongly urge you to consider funding in the area of Public
Health Systems and Services Research (PHSSR). This is an emerging field
that is experiencing rapid growth. Research in this area is in its
infancy with tremendous potential to grow as a field of study, while at
the same time is of great benefit to the public. The National
Association of Local Boards of Health (NALBOH) has both contributed to
and benefited from research in PHSSR along with forming collaborative
partnerships with organizations having similar interests, thereby
complimenting and building on the work of others such as the National
Association of County and City Health Officials (NACCHO) and the
Association of State and Territorial Health Officials (ASTHO).
Specifically, one of these collaborative efforts has been the data
harmonization project. Through this project, a large, collective
database is being formed that researchers, boards of health, health
departments and the public can use when developing educational
materials and resources, fostering partnerships, and making more
streamlined efforts to advance public health at the local level.
Members of local boards of health are leaders on which their
communities, cities, and counties rely; therefore it is critical to
ensure that board members have adequate training and resources
available to them so they can fulfill the duties of their positions,
making evidence-based decisions.
One way that we can assess the needs of boards is through the
NALBOH profile survey. A web-based survey will be conducted in 2010
extending a mail survey that was conducted in 2008. This survey
provides a voice for the more than 3,200 local boards of health
encompassing more than 20,000 members nationwide. The information
gathered through this survey and similar projects conducted by NALBOH
and its collaborators demonstrates areas in which local boards of
health need training, provides a description of the duties and
responsibilities of these boards, and supplies a description of the
member demographic composition of these boards.
Additionally, NALBOH has on-going Public Health Systems and
Services Research projects. One project is conducting a survey of state
boards of health to provide a description of these boards and their
duties. This survey will help to fill a void of such data. Other
projects include assessing the processes by which board of health
members are appointed. A more thorough understanding of this process
will allow NALBOH and its partners to assist in ensuring that the best
interests of the public are served as board of health members are
appointed. Governance legal authority of local boards of health is
being explored to determine whether local board of health members
understand their statutory authority, how they perceive this authority,
and how this is related to their board's effectiveness.
We urge you to provide financial support for these valuable
programs.
______
Prepared Statement of the National Alliance on Mental Illness
Chairman Harkin and members of the subcommittee, I am Mike
Fitzpatrick, Executive Director of the National Alliance on Mental
Illness (NAMI). I am pleased today to offer NAMI's views on the
subcommittee's upcoming fiscal year 2011 bill. NAMI is the Nation's
largest grassroots advocacy organization representing persons living
with serious mental illnesses and their families. Through our 1,100
affiliates in all 50 States, we support education, outreach, advocacy
and research on behalf of persons with serious mental illnesses such as
schizophrenia, manic depressive illness, major depression, severe
anxiety disorders, and major mental illnesses affecting children.
The cost of mental illness to our Nation is enormous. It is
estimated that the direct and indirect cost of untreated mental illness
to our Nation exceeds $80 billion annually. However, these direct and
indirect costs do not measure the substantial and growing burden that
is imposed on ``default'' systems that are too often responsible for
serving children and adults with mental illness who lack access to
treatment. These costs fall most heavily on the criminal justice and
corrections systems, emergency rooms, schools, families, and homeless
shelters. Moreover, these costs are not only financial, but also human
in terms of lost productivity, lives lost to suicide and broken
families. Investment in mental illness research and services are--in
NAMI's view--the highest priority for our Nation and this subcommittee.
National Institute of Mental Health (NIMH) Research Funding
NIMH is the principal Federal agency charged with funding
biomedical research on serious mental illnesses. To inspire and support
research that will continue to make a difference for people living with
mental illnesses, and ultimately, promote recovery, NIMH developed a
strategic plan in 2009 to guide future research efforts. The
overarching objectives of the strategic plan are to: (1) promote
discovery in the brain and behavioral sciences to fuel research on the
causes of mental disorders; (2) chart mental illness trajectories to
determine when, where and how to intervene; (3) develop new and better
interventions that incorporate the diverse needs and circumstances of
people with mental illnesses; and (4) strengthen the public health
impact of NIMH-supported research.
Translating Research Advances into New Treatments
It is critical for us to move beyond the current universe of
palliative treatments for serious mental illness. Even with optimal
care, some children and adults living with serious mental illness will
not be able to achieve recovery (as defined as permanent remission). As
NIMH Director Dr. Tom Insel has noted, consumers and families need
rapid, effective treatments that target the core pathophysiology of
serious mental illnesses and the tools for early detection. Mental
illness research can develop new diagnostic markers and treatments, but
this will require defining the pathophysiology of these illnesses. NIMH
now has the research tools necessary. Now is the time to set an
ambitious goal of finding cures to these extremely disabling illnesses.
However, NIMH must have the resources it needs to support this critical
research agenda.
American Recovery and Reinvestment Act (ARRA) Investments
NAMI would like to draw the subcommittee's attention to two
specific critical investments NIMH is making as part of the ARRA and
collaborations with the Department of Defense. The first is the
Recovery After an Initial Schizophrenia Episode (RAISE) study which is
being financed (in part) with $368 million in ARRA funds. RAISE is the
first ever large-scale trial exploring early and aggressive treatment
integrating a variety of different therapies to reduce the symptoms and
prevent the gradual deterioration of functioning that is characteristic
in schizophrenia. The second is Study to Assess Risk and Resilience in
Service Members (STARRS)--a joint Army-NIMH study of suicide and mental
health among military personnel. Army STARRS will identify--as rapidly
as possible--modifiable risk and protective factors related to mental
health and suicide. It also will support the Army's ongoing efforts to
prevent suicide and improve soldiers' overall well being.
Continuing the Federal Investment in Mental Illness Research
The President is proposing $1.541 billion for basic scientific and
clinical research at the NIMH. This is a $51 million increase above the
current fiscal year 2010 level of $1.489 billion. While this is below
the expected increase in biomedical research inflation, it is a
tremendous accomplishment and endorsement of the importance of
investment in medical research in a budget that proposes an overall
freeze in domestic discretionary spending.
For fiscal year 2011, NAMI supports the recommendations of the Ad
Hoc Group on Medical Research for an overall NIH funding level of $36
billion (a 12 percent increase more than fiscal year 2010). For NIMH,
NAMI recommends a similar 12 percent increase, up to $1.683 billion--
$143 million above the President's request and $193.6 million above the
fiscal year 2010 appropriation.
Funding for Programs at SAMHSA's Center for Mental Health Services
(CMHS)
Mr. Chairman, as our Nation continues to struggle through this
current economic downturn and States struggle with diminished revenues,
we are experiencing unprecedented strain in mental health service
budgets. Since 2009, we have seen a combined total of nearly $1.8
billion cut from State mental health authority (SMHA) budgets. In a
number of States the spending reduction for mental health exceeds 20
percent of the entire SMHA budget. A few examples of the scale of these
cuts to State mental health budgets include:
--Ohio.--Combined State mental health authority cuts from 2009
through 2011 of 36.2 percent across the board or a $191.3
million reduction.
--Rhode Island.--A total percentage cut of 34 percent from 2007 to
2009 (from a statewide budget of $82.1 million to $54.5
million)--as a result the State is experiencing a 65 percent
increase in the number of children with Serious Emotional
Disturbance boarding in public emergency rooms.
--Illinois.--Since 2009, 10,000 low-income children and adults have
lost access to community-based mental healthcare.
--Kansas.--New admissions to the State's public psychiatric hospitals
have been frozen for the remainder of 2010 and nine of the
State's 27 Community Mental Health Centers are in operating
deficits and in jeopardy of being closed (most of these
agencies serve rural health professional shortage areas).
--Mississippi.--The Governor has proposed an $18 million cut this
year that would result in the closing of six crisis centers and
four Department of Mental Health facilities including two
inpatient psychiatric hospitals.
When investments in treatment, support and recovery are slashed to
this extreme degree, the costs to society and to Government do not go
away. Instead, the costs just get passed along far more expensively in
terms of public spending and far less successfully in terms public
health:
--Half of all lifetime mental illnesses begin by age 14 and without
access to early diagnosis and treatment, we end up paying much
more for special education, private placements, substance abuse
and juvenile detention.
--Without access to community-based treatment and support, we end up
paying much more for secondary medical symptoms, homelessness,
addiction, broken families, extended hospital emergency
admissions, nursing home beds, jails, and prisons.
--Without access to mental healthcare, our national and State
economies lose billions of dollars every year in unemployment,
under-employment and lost productivity.
--Without access to treatment and recovery, people with serious
mental illnesses are destined to die 25 years sooner than the
general population.
At NAMI we refer to this as ``spending money in all the wrong
places'' as the burden of untreated mental illness is shifted and
hidden but no less at taxpayers expense.
It is imperative that programs at the Center for Mental Health
Services (CMHS) at SAMHSA help States respond to the individual crises
they are facing in trying to manage such deep reductions to community
mental health budgets in a time of rising demand--both respect to the
needs of the existing population of people living with serious mental
illness and new populations at risk of anxiety, depression and
psychosis.
In particular, this subcommittee must expand investment in the
Mental Health Block Grant (MHBG) for fiscal year 2011. Funding for the
MHBG has been frozen at its current level of $420 million since fiscal
year 2000. NAMI urges the subcommittee to respond to this crisis at the
State level by increasing funding for the Mental Health Block Grant by
$100 million to $520 million in fiscal year 2011.
NAMI would also recommend the following priorities for CMHS for
fiscal year 2011:
--Support the President's proposal to increase the PATH Homeless
Formula Grant program to $70 million (a proposed $5 million
increase above fiscal year 2010),
--Support the President's proposal for a $5 million increase for the
Children's Mental Health program, boosting funding up to $126
million, and
--Support the President's proposal for a $6 million increase for
suicide prevention activities at CMHS (up to $54.2 million),
including funding for the Garrett Lee Smith Memorial Act.
Addressing Chronic Homelessness and Mental Illness
SAMHSA's homeless programs fill a gap created by a preference for
funding housing capital needs over the critically important services
that are necessary for programs to be effective. In the recent
competition conducted by SAMHSA the agency received more than 500
qualified applications, of which the agency was only able to fund 68.
The interest and capacity of providers to put these Federal dollars to
work and end homelessness for thousands of homeless individuals should
demonstrate to Congress a clear mandate to significantly increase
funding for SAMHSA's homeless programs.
The current fiscal year 2010 funding level of SAMHSA homeless
programs is $75 million. This is divided between two accounts: $32.25
million within the Center for Mental Health Services (CMHS) and $42.75
within the Center for Substance Abuse Treatment (CSAT). The President's
budget proposes an increase of $12.1 million, $7.446 million for CMHS
and $4.610 million for CSAT.
The President's 2011 budget proposal includes a new Homeless
Initiative Program. This is a HUD/HHS partnership creating two
demonstration programs, including one that couples Housing Choice
Vouchers with services funding by Medicaid and SAMHSA. The Medicaid
funds are mandatory spending and do not require an appropriations
amount. However, the SAMHSA contribution must be appropriated and the
President proposes $15.8 million. This funding includes the $12.1
million proposed SAMHSA homeless services increase and an additional
$3.7 million from existing CSAT resources.
NAMI applauds the administration's recognition that the Federal
Government can do a better job helping communities couple housing and
services funding. This is a good first step. However, we are concerned
that the chronically homeless demonstration would take $3.7 million
from existing resources and only States with existing 1115 Medicaid
waivers can apply. NAMI urges this subcommittee to ensure that an
optimal number of States and public housing authorities, who administer
Housing Choice Vouchers, can use the Medicaid and SAMHSA funding
available for this program to more effectively target chronically
homeless individuals living with mental illness.
Overall, NAMI urges this subcommittee to provide $120 million in
SAMHSA homeless programs for essential mental health and substance use
treatment services linked to permanent supportive housing for
chronically homeless individuals and families. This request would
increase funding by $45 million more than the fiscal year 2010 funding
level. NAMI also supports the President's recommendation for $15.8
million for SAMHSA's portion of the administration's Homeless
Initiative Program for fiscal year 2011.
Continue Progress on Addressing the Social Security Disability Claims
and Appeals Backlog
Mr. Chairman, people with mental illness and other severe
disabilities have been bearing the brunt of the backlog crisis for
disability claims and appeals at Social Security. Behind the numbers
are individuals with disabilities whose lives have unraveled while
waiting for decisions--families are torn apart; homes are lost; medical
conditions deteriorate; once stable financial security crumbles; and
many individuals die. NAMI congratulates this subcommittee on the
progress made since 2008 with the appropriation for SSA's Limitation on
Administrative Expenses (LAE), boosting it to $11.447 billion for
fiscal year 2010. This investment, along with ARRA funds to improve
information technology has allowed SSA to hire new staff, reduce
processing times and make progress on the reducing the disability
claims backlog. NAMI urges the subcommittee to continue this progress
and support the President's recommendation for an LAE of $12.521
billion for fiscal year 2011.
Conclusion
Chairman Harkin, thank you for the opportunity to share NAMI's
views on the Labor, Health and Human Services, and Education, and
Related Agencies Subcommittee's fiscal year 2011 bill. NAMI's consumer
and family membership thanks you for your leadership on these important
national priorities.
______
Prepared Statement of the National AHEC Organization
The National AHEC Organization (NAO) is the professional
organization representing Area Health Education Centers (AHECs). Our
message is simple:
--The Area Health Education Center program is effective and provides
vital services and national infrastructure.
--Area Health Education Centers are the workforce development,
training and education machine for the nation's healthcare
safety-net programs.
AHEC is one of the Title VII Health Professions Training programs,
originally authorized at the same time as the National Health Service
Corps (NHSC) to create a complete mechanism to provide primary care
providers for Community Health Centers (CHCs) and other direct
providers of healthcare services for underserved areas and populations.
The plan envisioned by creators of the legislation was that the CHCs
would provide direct service. The NHSC would be the mechanism to fund
the education of providers and supply providers for underserved areas
through scholarship and loan repayment commitments. The AHEC program
would be the mechanism to recruit providers into primary health
careers, diversify the workforce, and develop a passion for service to
the underserved in these future providers, i.e., Area Health Education
Centers are the workforce development, training and education machine
for the Nation's healthcare safety-net programs. The AHEC program is
focused on improving the quality, geographic distribution and diversity
of the primary care healthcare workforce and eliminating the
disparities in our Nation's healthcare system.
AHECs develop and support the community based training of health
professions students, particularly in rural and underserved areas. They
recruit a diverse and broad range of students into health careers, and
provide continuing education, library and other learning resources that
improve the quality of community-based healthcare for underserved
populations and areas.
The Area Health Education Center program is effective and provides
vital services and national infrastructure. Nationwide, in 2006, AHECs
introduced more than 308,000 students to health career opportunities,
and more than 41,000 mostly minority and disadvantaged high school
students received more than 20 hours each of health career programs and
academic enhancement. AHECs support health professional training in
more than 19,000 community based practice settings, and more than
111,000 health professional students received training at these sites.
Further, over 368,000 health professionals received continuing
education through AHECs. AHECs perform these education and training
services through collaborative partnerships with Community Health
Centers (CHCs) and the National Health Service Corps (NHSC), in
addition to Rural Health Clinics (RHCs), Critical Access Hospitals,
(CAHs), Tribal clinics and Public Health Departments.
While our partner programs, the National Health Service Corps and
the Community Health Centers program have received much recognition of
late and are identified as Presidential Initiatives, the AHEC program
has been overlooked. AHEC is designed to meet the needs of the
communities it serves, and to bridge the resources of universities,
state and Federal programs, bringing those resources to the community.
As a program with a national network, AHEC has a significant
infrastructure. This infrastructure can provide the mechanism for
information dissemination for Clinical and Translational Services to
reduce the time it takes for bench science findings to become part of
medical practice. AHECs can deliver minority health programs and
already focus on recruiting minorities into health careers.
In the past decade many new programs have been developed by Federal
initiatives which compete with the mission of AHEC and utilize Federal
resources to duplicate the AHEC infrastructure. Public resources would
be better spent by utilizing the national network that AHEC represents,
rather than reproducing the infrastructure through the creation of
other programs.
AHEC was recently reauthorized in the Patient Protection and
Affordable Care Act of 2010. We were pleased to that this program was
reauthorized for the first time since 1998, and reauthorized at $125
million.
Community Health Centers and the National Health Service Corps
CHCs are dedicated to providing preventive and ambulatory
healthcare to uninsured and underinsured populations. A March 2006
study published in the Journal of the American Medical Association
(JAMA) found that CHCs report high percentages of provider vacancies,
including an insufficient supply of dentists, pharmacists,
pediatricians, family physicians and registered nurses. These shortages
are particularly pronounced in CHCs that serve rural areas. The study
serves as an important reminder that the success of CHCs is highly
dependent upon a well-trained clinical staff to provide care. Because
title VII programs, including AHECs, have a successful record of
training providers to work in underserved areas, the study recommends
increased support for the Title VII Health Professions Training
programs as the primary means of alleviating the health professions
shortage in rural CHCs. In 2006, 46 percent of AHEC training sites were
CHCs, and an additional 25 percent of placements were in Rural Health
Clinics.
The scope of collaborative activities between AHECs and CHCs is
substantial and the populations served through these activities are
culturally and geographically diverse.
The interrelationships between AHECs and CHCs are numerous, and the
added-value to the community from the unique contributions of each is
undeniable in terms of access to quality healthcare.
AHECs collaborate with CHCs by:
--Assisting CHCs with the development of community boards of
directors and often serving as board members;
--Recruiting health professionals/staff;
--Facilitating clinical training opportunities for health professions
students/trainees within CHC clinic sites;
--Conducting continuing education programs and other library and
learning resources for health and human services professionals
employed at CHC clinic sites.
AHECs also undertake a variety of programs related to the placement
and support of National Health Service Corps scholars and loan
repayment recipients. NHSC scholars and loan repayment recipients
commit to practicing in an underserved area, and are focused on
improving health by providing comprehensive team-based healthcare that
bridges geographic, financial and cultural barriers. As contractors of
the NHSC Student/Resident Experiences and Rotations in Community Health
(SEARCH) program, AHECs help to expand the NHSC by placing students and
residents in rotations in rural areas. These students and residents are
then more likely to return to rural and underserved areas as a NHSC
scholar or loan repayment recipient since health professionals who
spend part of their training providing care for rural and underserved
populations are 3 to 10 times more likely to practice in rural and
underserved areas after graduation or program completion.
AHECs frequently place health professions students in sites that
are approved for NHSC personnel. NHSC scholars and loan repayers serve
as preceptors or these students. These sites give the students a view
of working in communities with great need, seeing the potential for a
fulfilling career, thus strengthening the connection between these
students and service to the underserved through the NHSC.
Justification for Recommendations
By improving the quality, geographic diversity, and diversity of
the healthcare workforce, the United States can eliminate healthcare
disparities. An October 2006 study by the Health Resources and Services
Administration (HRSA) entitled ``The Rationale for Diversity in the
Health Professions: A Review of the Evidence'' shows the importance of
the programs like AHEC. This study found that minority health
professionals disproportionately serve minority and other medically
underserved populations, minority populations tend to receive better
care from practitioners of their own race or ethnicity, and non-English
speaking patients experience better care, greater comprehension, and
greater likelihood of keeping follow-up appointments when they see a
practitioner who speaks their own language.
In order to continue the progress that the Title VII Health
Professions Training programs, especially AHECs, have already made
towards their goal, an additional Federal investment is required. NAO
recommends that the AHEC program is funded at $125 million, consistent
with its recent reauthorization amount.
______
Prepared Statement of the National Association for Public Health
Statistics and Information Systems
The National Association for Public Health Statistics and
Information Systems (NAPHSIS) welcomes the opportunity to provide this
written statement for the public record as the Labor, Health and Human
Services, and Education, and Related Agencies Appropriations
Subcommittee prepares its fiscal year 2011 appropriations legislation.
NAPHSIS represents the 57 vital records jurisdictions that collect,
process, and issue birth and death records in the United States and its
territories, including the 50 States, New York City, the District of
Columbia and the 5 territories. NAPHSIS coordinates the activities of
the vital records jurisdictions among the jurisdictions and with
Federal agencies by developing standards, promoting consistent
policies, working with Federal partners, and providing technical
assistance to the jurisdictions.
NAPHSIS respectfully requests that the subcommittee provide the
National Center for Health Statistics' (NCHS) National Vital Statistics
System $11 million in fiscal year 2011--consistent with the President's
request--to support the States and territories as they implement the
2003 birth and death certificates and electronic data collection
systems.
Collection of birth and death data through vital records is a State
function and thus governed under State laws. NCHS purchases birth and
death data from the States to compile national data on vital events--
births, deaths, marriages, divorces, and fetal deaths. These data are
used to monitor disease prevalence and our nation's overall health
status, develop programs to improve public health, and to evaluate the
effectiveness of those interventions. For example, birth data have been
used to:
--Establish the relationship of smoking and adverse pregnancy
outcomes;
--Link the incidence of major birth defects to environmental factors;
--Establish trends in teenage births;
--Determine the risks of low birth weight; and
--Measure racial disparities in pregnancy outcomes.
Just as fundamentally, death data are used to:
--Monitor the infant mortality rate as a leading international
indicator of the Nation's health status;
--Track progress and regress in reducing mortality from the leading
causes of death, such as heart disease, cancer, stroke, and
diabetes;
--Document racial disparities; and
--Otherwise provide sound information for programmatic interventions.
Most recently, vital statistics have grabbed headlines with Amnesty
International's report of increases in pregnancy related deaths.
Years of chronic underfunding at NCHS have threatened the
collection of these important data on the national level, to the extent
that in fiscal year 2007, NCHS would have been unable to collect a full
12 months of vital statistics data from States. Had the subcommittee
not intervened with a small but critical budget increase to continue
vital statistics collection, the United States would have been the
first Nation in the industrialized world to be without a complete
year's worth of vital data. Countless national programs and businesses
that depend on vital events information would have been immeasurably
affected.
Since that time, the subcommittee has continually supported NCHS's
vital statistics cooperative with the States. NAPHSIS and the broader
public health community deeply appreciate these efforts. This year, we
are pleased the President is following the subcommittee's lead in
seeking to build a 21st century national statistical agency, requesting
a $23 million increase for NCHS in fiscal year 2011, including $11
million targeted for the modernization of the National Vital Statistics
System. This increase will support states as they upgrade their
outdated and vulnerable paper-based vital statistics systems,
addressing critical needs for activities that have been on hold or
curtailed because of budget constraints.
As we make significant strides in implementing and meaningfully
using health information technology, it is imperative that we similarly
invest in building a modern vital statistics system that monitors our
citizens' health, from birth until death. The requested $11 million in
funding will move us toward a timelier and more comprehensive vital
statistics infrastructure where all states collect the same data and
all States collect these data electronically. Two forms of birth and
death certificates are in use by States--the older 1989 standard
certificate and the newer 2003 standard certificate This more recent
birth certificate revision includes data on insurance and access to
prenatal care, education level of parents, labor and delivery
complications, delivery methods, congenital anomalies of the newborn,
maternal morbidity, mother's weight and height, breast feeding status,
maternal infections, and smoking during pregnancy, among other factors.
The 2003 death certificate includes data on smoking-related, pregnancy-
related, and job-related deaths.
Currently, only 75 percent of the States and territories use the
2003 standard birth certificate and 65 percent have adopted the 2003
standard death certificate. Many States continue to rely on paper-based
records, a practice which compromises the timeliness and
interoperability of these data. Jurisdictions that had planned and
budgeted to upgrade their certificates and systems have seen funding
for these projects erode as States face severe budget shortfalls. These
jurisdictions need the Federal Government's help to complete building a
21st century vital statistics system. The President's requested down
payment will help in this regard, allowing all jurisdictions to
implement the 2003 birth certificate and electronic birth record
systems. Approximately $30 million is needed to modernize the death
statistics system; but the President's request of $3 million is
nonetheless an important first step. However, we request that the
subcommittee not require a State match for funds to modernize death
certificates, as proposed by the President. NAPHSIS's members most in
need of Federal support have indicated that a State-match requirement
would inadvertently prevent jurisdictions from applying for these
funds. Indeed, if States had available funds to invest in system
improvements they would do so.
As the historic Patient Protection and Affordable Care Act is
implemented, the vital statistics purchased by NCHS from States are
needed more than ever to track Americans' health and evaluate our
progress in improving it. The President's request of $11 million for
the National Vital Statistics System will lead to vast improvements in
data collection and further enable us to better compare critical
information on a local, State, regional, and national basis. Without
additional funding, a potential erosion of State data infrastructure
and lack of standardized data will undeniably create enormous gaps in
critical public health information and may have severe and lasting
consequences on our ability to appropriately assess and address
critical health needs.
NAPHSIS appreciates the opportunity to submit this statement for
the record and looks forward to working with the subcommittee.
______
Prepared Statement of the National Association of People With AIDS and
VillageCare
The National Association of People with AIDS (NAPWA) and
VillageCare are submitting joint written comments on the appropriations
for domestic HIV programs for Federal fiscal year 2011. Overall, NAPWA
and VillageCare believe that the President's request for fiscal year
2011 spending on domestic HIV programs, while including some increases
in funding, is insufficient to meet the needs of persons living with
HIV/AIDS in this country. We urge you to increase funding for domestic
HIV/AIDS programs in the fiscal Labor, Health and Human Services, and
Education, and Related Agencies; Transportation and Housing and Urban
Development, and Related Agencies; and Financial Services and General
Government bills for the upcoming fiscal year.
Founded in 1983, NAPWA is the first coalition of people living with
HIV/AIDS in the world, as well as the oldest AIDS organization in the
United States. NAPWA is a trusted, independent voice representing the
more than 1 million people living with HIV/AIDS in America.
VillageCare is a community-based organization serving seniors,
persons living with HIV and AIDS, and others who face chronic and
disabling conditions. Founded in New York's Greenwich Village nearly 35
years ago, the not-for-profit organization developed some of the first
care and program responses to the AIDS epidemic in the 1980s, and has
created a number of innovative programs and services, including the
first AIDS day treatment program in the country and the largest AIDS
skilled nursing facility.
With more than 56,000 new HIV infections annually and the United
States already having more than 1.1 million people living with HIV,
coupled with the rising cost of medical care and other services, we
urgently need to allocate sufficient resources to address unmet care
and treatment needs of persons living with HIV. It is estimated that 29
percent of persons living with HIV/AIDS in the United States are
uninsured. The HIV epidemic also continues to have a disproportionate
impact on communities of color and on low-income individuals.
For nearly a decade, the HIV epidemic in the United States has
faced serious underfunding, as the previous administration chose not to
focus priorities on the Nation's own HIV challenges. Increases in
funding are desperately needed to make up for these years of neglect.
While passage of healthcare reform promises to contribute
significantly to filling the gap in health coverage, the most critical
provisions in the new law do not kick in until 2014. This means that
over the next 4 years, there will be persons living with HIV who will
have to wait for access to treatment that could save their lives.
During this gap in time, it is vital for Congress to act to fill
the void in resources that would connect people to care.
We offer the following recommendations where Congress can move to
address vital HIV care and treatment needs.
Increase Funding in the Ryan White Program by $810.8 Million, for Total
Funding of $3,101.5 Billion
This includes a breakdown of funding as follows:
--Part A.--Increase of $225.9 million for total of $905 million.
--Part B: Care.--Increase of $55.9 million for a total of $474.7
million.
--Part B: AIDS Drug Assistance Program.--Increase of $370.1 million
for a total of $1,205.1 million.
--Part D.--Increase of $131 million for a total of $337.9 million.
--Part F: AIDS Education Training Centers.--Increase of $15.2 million
for a total of $50 million.
--Part F: Dental.--Increase of $5.4 million for a total of $19
million.
--Part F: Special Projects of National Significance.--Support funding
of $25 million (level funding).
In many regions of the country, financing through Ryan White is
often the only means to pay for healthcare and supportive services for
many persons living with HIV/AIDS. Unfortunately, the President's
proposed funding for the Ryan White HIV/AIDS program was increased by
only $40 million, with many parts of the Ryan White program remaining
flat-funded. Advocates in the HIV community have called upon the
administration to provide at least $810 million in new resources to
meet growing demand. The Nation needs continued aggressive action if we
are to close the gap in access to treatment and care that exists for
many persons living with HIV. Ryan White programs serve approximately
577,000 low-income, uninsured, and underinsured individuals each year.
For many people living with HIV, Ryan White-funded programs are the
sole lifeline to HIV care, treatment and services.
Support Emergency Supplemental Funding in Fiscal Year 2010 for the AIDS
Drug Assistance Program (ADAP) in the Amount of $126 Million
Eleven States have waiting lists with more than 850 people waiting
to get access to life saving HIV medications. In addition, many States
have greatly restricted the drugs covered by the ADAP and restricted
eligibility so that fewer people quality for ADAP benefits. Urgent,
immediate emergency supplemental ADAP funding that would flow to these
programs during the current fiscal year will help address this crisis.
Expand Access to Housing by Increasing Housing Opportunities for People
With AIDS (HOPWA) Funding by $75 Million, for a Total of $410
Million
Access to safe and affordable housing is essential to improving
individual health outcomes and promoting public health. Improved
housing status is strongly associated with increased access and
adherence to care and with lowered rates of HIV risk behaviors. Demand
for AIDS housing far exceeds availability and increased HOPWA funding
is needed to support efforts to address this critical component of the
HIV care continuum. In the light of flat funding across many Federal
programs, the President's proposed HOPWA increase of $5 million is far
too small to make any meaningful impact on the rising numbers of
persons who are without access to stable housing.
Increase Efforts To Respond to the Disproportionate Impact of HIV Among
Communities of Color by Increasing Funding for the Minority
AIDS Initiative (MAI) by $207.1 Million, for Total Funding of
$610 Million
Targeted funding is urgently needed to address the huge disparities
in HIV infection among communities of color. MAI funding improves
access to culturally and linguistically appropriate outreach,
education, prevention, care and treatment programs and services.
Support new Investments in HIV Prevention Education by Increasing
Funding at the Centers for Disease Control and Prevention (CDC)
by $878 Million, for Total Funding of $1,606 Million
A significant increase in funding of HIV prevention initiatives is
needed to reduce the number of new HIV infections, which have remained
unchanged at about 56,000 per year since 2001. State and local health
departments and community-based organizations need adequate resources
to strengthen and expand HIV testing, outreach and prevention education
programs.
Increase Funding for AIDS Research at the National Institutes of Health
(NIH) by $410 Million, for Total Funding of $3.5 Billion
A lack of sufficient funding for the NIH has slowed important
research efforts aimed at ending the HIV/AIDS epidemic in the United
States. To reverse this trend, funding increases are needed for the
Office of AIDS Research at NIH.
Support the $1.4 Million in Appropriations for National HIV/AIDS
Strategy Implementation, Coordination, Evaluation, and
Monitoring
The National Strategy will be unveiled this year and this
appropriation will be needed to achieve its goals. As National HIV/AIDS
Strategy implementation begins, Congress must renew this $1.4 million
appropriation, which is contained in the Financial Services and General
Government appropriations bill. In each of fiscal year 2009 and fiscal
year 2010, Congress appropriated $1.4 million for the White House
Office of National AIDS Policy to help fund the cost of developing a
comprehensive national HIV/AIDS strategy.
VillageCare and NAPWA look forward to working with Congress and the
administration to find more resources to address the significant unmet
need for HIV primary medical care and supportive services that exists
across the United States. We and others in the HIV community were
extremely pleased with the steps taken by the Obama administration in
the first year. The President has expressed and demonstrated leadership
on behalf of the HIV community with such actions as the 4-year
extension of the Ryan White Care Act and ending the HIV travel ban.
At the same time, the Federal budget for fiscal year 2011 will need
significant modification and additions if we are to fulfill the vision
of the President and others to end the AIDS epidemic in the United
States.
Thank you.
______
Prepared Statement of the National Assembly on School-Based Health Care
I am grateful for this opportunity to submit written testimony on
behalf of the National Assembly on School-Based Health Care, an
organization representing the interests of school-based health centers
(SBHCs). SBHCs ensure that 1.7 million children and adolescents across
the country gain access to comprehensive medical care, mental health
services, preventive care, social services, and youth development.
These services are provided without concern for students' ability to
pay in a location that meets children and adolescents where they are:
at school.
The Patient Protection and Affordable Care Act (Public Law111-148)
includes a Federal authorization for SBHCs in section 4101(b)--a huge
victory for vulnerable children and adolescents and for SBHCs.
Secretary Sebelius agrees: ``We are thrilled that part of the [health
reform] legislation calls for an expanded foot print of school-based
health clinics . . . I can't think of a better way to deliver primary
care and preventive care to not only students but their families than
through school-based clinics.'' \1\
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\1\ U.S. Department of Health and Human Services Secretary Kathleen
Sebelius, during her opening plenary remarks at the Coalition for
Community School's national forum in Philadelphia; April 7, 2010.
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However, the School-Based Health Clinic authorization needs to be
appropriated if SBHCs are to continue to serve our Nation's youth.
Until funds are appropriated, only limited Federal support exists for
SBHC operations, leaving little hope for the expansion that is called
for by Secretary Sebelius.
SBHCs are designed to meet the healthcare needs of students, and
are considered one of the most effective strategies for delivering high
quality, comprehensive, and culturally competent primary and preventive
care to children and adolescents. At SBHCs, developmentally appropriate
health services are provided by qualified health professionals,
incorporating the principles and practices of pediatric and adolescent
healthcare recommended by the American Medical Association, the
American Academy of Pediatrics, and the American Association of Family
Physicians. A recent study showed that SBHCs have positive impacts on
student achievement--particularly increasing grade point averages and
attendance.\2\
---------------------------------------------------------------------------
\2\ ``Impact of School-Based Health Center Use on Academic
Outcomes,'' Journal of Adolescent Health 46 (2010) 251-257.
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We respectfully request a $50 million appropriation to fund the
SBHC authorization for Federal fiscal year 2011. These funds could
provide the full operations budget of up to 200 school-based health
centers for a year, but will likely be used to support many more. In
the current economic climate, many State programs are struggling to
maintain support for the SBHCs they currently fund, much less expand
operations. We hear with increasing frequency from SBHCs about the need
for expanded primary care hours, oral health, and expanded mental
health services. Regrettably, some SBHCs have already had to close
their doors, due to lack of funding for healthcare services.
We would also like to share our concern that without support for
the operational costs needed to support a clinic, the effectiveness of
the capital money already allocated to SBHCs in the Affordable Care Act
under section 4101(a) will be greatly limited. The funds allocated in
section 4101(a), although important, are limited to capital
improvements and equipment purchases. Expenditures for healthcare
services and personnel are specifically excluded. The present risk and
largest difficulty for SBHCs is the cost of care. The capital funds
could allow some SBHCs to be built or expanded, but clinics need a
sustainable source of operations funding in order to provide services
for the children and adolescents who depend on them for care.
Only a fraction (28 percent) of SBHCs can be supported in any way
by the funds allocated in the healthcare reform legislation for
community health centers. The majority of SBHCs are sponsored by
entities ineligible for community health center funding, such as
hospitals.
The original House-passed bill identified a $50 million
appropriation for the newly authorized school-based health center
program. These funds will give critical resources to communities that
desire to open health clinics at their schools and keep their existing
clinics open.
For the above reasons, we respectfully request that a $50 million
appropriation be provided for the SBHC Authorization for fiscal year
2011. Thank you for this opportunity.
______
Prepared Statement of the National Alliance of State & 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.
On behalf of NASTAD, we urge your support for increased funding for
Federal HIV/AIDS and viral hepatitis programs in the fiscal year 2011
Labor, Health and Human Services, and Education, and Related Agencies
Subcommittee bill. We ask the subcommittee on Labor, Health and Human
Services, and Education to demonstrate its commitment to addressing the
domestic HIV epidemic and ramp up support for a much larger blood-borne
epidemic, that of chronic viral hepatitis. We thank you once again for
the increases provided to HIV/AIDS and hepatitis programs in fiscal
year 2010 and ask for consideration of the following critical funding
needs for HIV/AIDS, viral hepatitis and STD programs in fiscal year
2011.
HIV/AIDS Care and Treatment Programs
The Health Resources and Services Administration (HRSA) administers
the $2.2 billion Ryan White Program that providing health and support
services to more than 500,000 HIV-positive individuals. NASTAD requests
a minimum increase of $426 million in fiscal year 2011 for State Ryan
White part B grants, including an increase of $56 million for the part
B Base and $370 million for AIDS Drug Assistance Programs (ADAPs). With
these funds 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. In 2008, it is estimated that ADAPs nationwide
served nearly 165,000 HIV-infected individuals, nearly one-quarter of
people with HIV/AIDS estimated to be receiving care. This is due to a
number of factors including, increased testing efforts and
unemployment.
State ADAPs provide medications to low-income individuals with HIV
disease who have limited or no coverage from private insurance or
Medicaid. With the rise in unemployment and individuals losing their
insurance, ADAPs are increasingly in crisis. As of April 2010, 10
States report that 859 individuals are on a waiting list to receive
their life-sustaining medications through ADAP:
--Idaho.--25 individuals
--Iowa.--62 individuals
--Kentucky.--191 individuals
--Montana.--17 individuals
--North Carolina.--356 individuals
--South Carolina.--33 individuals
--South Dakota.--32 individuals
--Tennessee.--55 individuals
--Utah.--74 individuals
--Wyoming.--14 individuals
Sixteen States have additional cost containment measures in place
or are anticipating implementing measures.
ADAPs with Other Cost-containment Strategies (instituted since April 1,
2009)
--Arizona.--Reduced formulary
--Arkansas.--Reduced formulary, lowered financial eligibility to 200
percent of FPL
--Colorado.--Reduced formulary
--Hawaii.--Individuals with CD4>350 not currently on ARV therapy are
not being enrolled
--Iowa.--Reduced formulary
--Kentucky.--Reduced formulary
--Missouri.--Reduced formulary
--North Carolina.--Reduced formulary
--North Dakota.--Cap on Fuzeon
--Utah.--Reduced formulary, lowered financial eligibility to 250
percent of FPL
--Washington.--Client cost sharing, reduced formulary (for uninsured
clients only)
ADAPs Considering New/Additional Cost-containment Measures (before
March 31, 2011)
Arizona.--Waiting list
Hawaii.--Waiting list
Illinois.--Waiting list, reduced formulary, lowered financial
eligibility, capped enrollment, monthly expenditure cap
Kentucky.--Reduced formulary
Louisiana.--Capped enrollment
North Carolina.--Lowered financial eligibility
North Dakota.--Waiting list, reduced formulary, capped enrollment,
annual expenditure cap
Oregon.--Waiting list, reduced formulary
South Dakota.--Reduced formulary
Wyoming.--Lowered financial eligibility, annual expenditure cap
In fiscal year 2009, 48 percent of ADAPs experienced cuts in State
contributions to their programs and at least 35 percent of programs are
anticipating cuts to their ADAPs in fiscal year 2010. Program
restrictions can lead to dangerous treatment interruptions, which
encourage drug resistance and discourage patient retention in care,
both of which have profound effects on public health. As discretionary
programs, ADAPs are dependent on annual Federal and State
appropriations to serve all those in need of treatment.
Ryan White part B Base programs include ambulatory medical
services, case management, laboratory services, and primary care
networks that improve the overall HIV care systems in States. Primary
care and the provision of drug treatments are inextricably linked.
People living with HIV need access to trained HIV clinicians and a full
range of support services to live as healthy a life as possible to
ensure adherence to complicated treatment regimens. Unfortunately,
limited funding has resulted in waits of up to 6 months for a primary
care visit.
HIV/AIDS Prevention and Surveillance Programs
NASTAD requests an increase of $181 million for State and local
health department cooperative agreements in order to provide
comprehensive prevention programs. To be successful, health departments
must expand outreach, HIV testing, and linkage into care targeting
high-risk populations including gay men of all races, black women,
persons who inject drugs, and youth. 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 and HIV testing
recommendations. In order to maximize prevention efforts, partners of
persons being tested need to be identified, notified, and counseled. In
addition, health departments need resources to educate the mass public
by reinforcing accurate, evidence-based information and beginning to
reduce the stigma associated with the disease.
An estimated 56,300 new infections occur every year while State and
local HIV prevention cooperative agreements have been cut by $23
million over the last decade. NASTAD surveyed States and found that in
fiscal year 2009, State HIV/AIDS programs were cut by $170 million.
Seventy-four percent of States responding to NASTAD's survey reported
cuts to HIV prevention programs. States also reported that almost 200
HIV/AIDS staff positions have been cut or gone unfilled. These cuts
make the Federal resources for prevention all the more critical to
mounting an effective response to the epidemic.
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. To be successful, 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 and HIV testing recommendations. In
order to maximize prevention efforts, partners of persons being tested
need to be identified, notified, and counseled. 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. In addition, health departments need resources to
educate the mass public by reinforcing accurate, evidence-based
information and beginning to reduce the stigma associated with the
disease.
NASTAD also supports the President's request of $26.9 million for a
new initiative targeting gay men and other men who have sex with men
(MSM). We believe this funding should come out of HIV funding and not
STD and viral hepatitis increases as proposed.
NASTAD requests that $48 million be allocated to health departments
to maintain the Expanded Testing Initiative (ETI). In fiscal year 2009,
CDC awarded $40.2 million to 20 States and 5 cities to support routine
testing in clinical settings targeting highly impacted populations,
particularly African Americans. In fiscal year 2010, the ETI will be
expanded to 24 States and 6 cities funded at $47.5 million targeting
African Americans, Latinos, gay and bisexual men of all races, and
persons who inject drugs. NASTAD supports maintaining $48 million for
health departments of the $65 million for the entire initiative so that
more individuals can learn of their HIV status and be linked into care.
NASTAD also support the President's request of $10 million for Program
Collaboration and Service Integration (PCSI) to all health departments
to integrate prevention services for HIV, STD, viral hepatitis, and TB
at the client level.
Viral Hepatitis Prevention Programs
NASTAD requests an increase of $30.7 million for a total of $50
million in fiscal year 2011 for the CDC's Division of Viral Hepatitis
(DVH) to enable State and local health departments to provide basic
core public health services for viral hepatitis. Funds are needed for
hepatitis B and C counseling, testing, and medical referral. States
receive on average $90,000 for adult hepatitis prevention. DVH provides
$5 million to fund the position of an Adult Viral Hepatitis Prevention
Coordinator in 49 States, 5 cities, and the District of Columbia. This
is only enough for the position and not for the provision of prevention
services. Therefore, NASTAD requests a doubling of funding to the state
adult viral hepatitis prevention coordinators from $5 to $10 million.
Due to lack of funding, CDC must treat hepatitis outbreaks as
sentinel events rather than systematically addressing hepatitis B and C
epidemics with more than 6 million Americans infected. Addressing one
outbreak at a time is not cost-effective nor is it preventive. The
first step to controlling infectious diseases such as hepatitis B and C
is establishing a surveillance system to monitor disease incidence,
prevalence, and trends. While there is no vaccine for hepatitis C,
investing in hepatitis A and B vaccines is essential to providing
prevention for high-risk adults and the elimination of both diseases.
Hepatitis disproportionately impacts minorities and must be addressed
in the context of health disparities. Approximately half of persons
with chronic HBV are Asian Americans. Furthermore, HBV is most
prevalent among immigrants from HBV-endemic countries (Asia and sub-
Saharan Africa) who were infected at birth or childhood. Of the 24,000
HBV-infected women who give birth every year, half are Asian Americans.
HCV infection is 2 to 3 times as prevalent in African Americans as it
is in whites.
The recently released IOM report, Hepatitis and Liver Cancer: A
National Strategy for Prevention and Control of Hepatitis B and C found
that the public health response needs to be significantly ramped up.
IOM's report attributes low public and provider awareness to the lack
of public resources. The report makes 17 out of 22 recommendations
specific to State health departments. In order to implement these
recommendations to improve the Federal response, resources must be
increased to health departments who provide the frontline response to
these epidemics. For example, hepatitis C is the most common blood-
borne, chronic viral disease in the United States with up to 4 million
Americans suffering from chronic HCV infection-nearly four times the
amount of those with HIV. Although transmission of hepatitis C has
significantly decreased in the United States over the past 20 years,
the incidence of liver disease and liver cancer is rising, as persons
infected with hepatitis C decades ago begin to develop complications of
their infection. Without increased resources for counseling, testing
and medical referral services, the CDC predicts that deaths due to HCV
will double by 2020.
STD Prevention Programs
NASTAD supports an increase of $213.5 million for a total of $367.4
million in fiscal year 2011 for STD prevention, treatment and
surveillance activities undertaken by state and local health
departments. CDC's Division of STD Prevention has prioritized four
disease prevention goals-Prevention of STD-related infertility, STD-
related adverse pregnancy outcomes, STD-related cancers and STD-related
HIV transmission. STD prevention programs at CDC have been cut by $6
million since fiscal year 2004 while the number of persons infected
continues to climb. CDC estimates that 19 million new infections occur
each year, almost half of them among young people ages 15 to 24. In one
year, the United States spends more than $8 billion to treat the
symptoms and consequences of STDs. Untreated STDs contribute to infant
mortality, infertility, and cervical cancer. Additional Federal
resources are needed to reverse these alarming trends and reduce the
Nation's health spending.
Minority AIDS Initiative
NASTAD also supports total funding of $610 million for the Minority
AIDS Initiative (MAI) in fiscal year 2011. The MAI provides targeted
resources to address the HIV/AIDS epidemic in hard-hit communities of
color. MAI resources supplement the funding to states to address the
epidemic in these communities. The data from CDC on the
disproportionate impact on African American continues to be staggering.
Support for the MAI along with the traditional funding streams that
serve these populations is essential.
Comprehensive Sex Education
NASTAD supports the teen pregnancy prevention initiative and asks
that it be expanded to include prevention of HIV and STDs and funded at
the President's request of $134 million. Programs targeted to youth in
and out of school require an inter-departmental approach through the
collaboration of HHS agencies, including the Agency for Children and
Families, CDC's Division of Adolescent and School Health, and the
Office of Population Affairs. We also support an increase of $20
million, for a total of $60.2 million, for the Division of Adolescent
and School Health's HIV Prevention Education Program to increase access
to evidence-based and comprehensive approach to sex education. Programs
targeted to youth in and out of school require an inter-departmental
approach through the collaboration of HHS agencies, including the
Office of Adolescent Health, the Office of Population Affairs, the
Agency of Children and Families, and CDC's Division of Adolescent and
School Health.
As you craft the fiscal year 2011 Labor, Health and Human Services,
and Education 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 Association of Workforce Boards
Thank you for the opportunity to comment on the administration's
proposed 2011 budget for the Department of Labor. The National
Association of Workforce Boards (NAWB) is a member association, which
represents a majority of the 575 local employer-led Workforce
Investment Boards and their nearly 13,000 employer member volunteers.
We write in support of the administration's fiscal year 2011
overall appropriations request for the Training and Employment Services
account under the Department of Labor. Adequate funding for the public
workforce system has never been more critical. We are in the midst of
the worst economic downturn in our lifetimes and the public workforce
system has been stretched to its capacity, but continues to respond
during this time of crisis.
Our employment crisis is not expected to ease in the foreseeable
future. The annual Economic Report of the President released in
February indicated that unemployment would remain above 8 percent
through 2012. Federal Reserve Chairman Ben Bernanke was also
pessimistic in his testimony before the Joint Economic Committee on
April 14 regarding any large scale employment growth in the near term:
``As you know, the labor market was particularly hard hit by the
recession. Recently, we have seen some encouraging signs that layoffs
are slowing and that employment has turned up. Manufacturing employment
increased for a third month in March, and the number of temporary
jobs--often a precursor of more permanent employment--has been rising
since last October. New claims for unemployment insurance continue on a
generally downward trend. However, if the pace of recovery is moderate,
as I expect, a significant amount of time will be required to restore
the 8\1/2\ million jobs that were lost during the past 2 years. I am
particularly concerned about the fact that, in March, 44 percent of the
unemployed had been without a job for 6 months or more. Long periods
without work erode individuals' skills and hurt future employment
prospects. Younger workers may be particularly adversely affected if a
weak labor market prevents them from finding a first job or from
gaining important work experience''.
Workforce Investment Act programs have been on the front lines of
assisting job seekers impacted by the recession. Over the past year,
the Workforce Investment Act (WIA) system has seen over 7.6 million
American workers turn to it for help in navigating the labor market in
search of jobs and/or the training individuals need to be competitive
in their labor market. This is a 60.2 percent increase in the number of
people served through Employment and Training Administration programs
over the previous year. In comparison, 4.1 million workers were
assisted during the same period the previous year.
Despite six job seekers nationally for every available job, those
who received WIA services were likely to find jobs, with the likelihood
increasing the higher the service level:
Performance Results:
--Workforce Investment Act Adult Program:
--Entered Employment Rate--68.1 percent
--Employment retention rate--83.3 percent
--Average 6 months' earnings--$14,695
--Workforce Investment Act Dislocated Worker Program:
--Entered employment rate--70 percent
--Employment retention rate--85.9 percent
--Average 6 months' earnings--$16,304
--Workforce Investment Act Youth Program:
--Placement in employment or education rate--66.7 percent
--Attainment of degree or certificate rate--58.2 percent
The ability of the pubic workforce system to maintain this level of
success on behalf of job seekers and employers seeking skilled workers
is incumbent upon the continuation of adequate funding. We encourage
the subcommittee to fund WIA formula programs at a minimum at the
administration's request levels, as we expect to continue to face the
challenges brought about by high unemployment for the foreseeable
future.
Workforce Innovation Fund
We applaud the administration's proposal for a $322 million
Workforce Innovation Fund. We believe that the State and local
workforce boards have developed a host of promising practices since WIA
was enacted in 1998, particularly in helping address the large numbers
of persons dislocated during this recession or shut-out of the labor
market due to a lack of appropriate skills. The Workforce Innovation
Fund will allow local areas to engage with community partners and
quickly scale effective practices on behalf of jobseekers in need.
However, we strongly urge the subcommittee to fully fund the
administration's request for WIA formula programs before allocating
funding for the Workforce Innovation Fund, as these formula funds are
essential to our ability to provide services to job seekers at the
local level around the Nation.
The protection of the WIA formula programs is particularly
important this year with the diminution of the remaining workforce
funding in the American Recovery and Reinvestment Act, which have been
heavily invested in providing training for job seekers. The bulk of
these funds have been fully obligated at the local level, leaving
little funding to commit for new trainees who seek services in the
coming year. This funding ``cliff'' will provoke a large measure of
frustration for individuals who are seeking services and are eligible,
but for whom there are no funds available.
We suspect this is a well hidden policy issue since our current
system of financial tracking counts expenditures but lacks the capacity
to account for monies that are obligated by contract but not invoiced
by the provider and paid by the fiscal agent.
Summer Youth employment
While our testimony is focused on fiscal year 2011 funding, we
would be remiss if we did not express our appreciation for the
Chairman's inclusion of ARRA funding for WIA Youth programs which
allowed 313,000 young people to have summer jobs last year who
otherwise would not have been employed. Most of these ARRA funding for
WIA Youth have been expended at this point, but local workforce
programs are in the process of preparing for another expanded summer
youth program with the limited funds they currently have available.
We hope that any emergency spending bill enacted this work period
will include additional funding for WIA Youth programs to allow us to
better address the looming crisis we are facing in youth employment
this summer.
Policy Riders
NAWB would strongly encourage the subcommittee to continue the
policy riders that prohibit the redesignation of local areas or changes
to the definition of administrative costs until WIA is reauthorized.
There have been instances where there has been arbitrary action to
reconfigure local areas and NAWB believes these riders will prevent any
State v. local conflict until reauthorization.
We urge the subcommittee to continue to provide the support
necessary for the workforce system to help our jobseekers retool for
employment in high demand sectors and maintain our global
competitiveness.
Thank you for the opportunity to testify.
______
Prepared Statement of the Nursing Community
The Nursing Community is a forum for professional nursing and
related organizations to collaborate on a wide spectrum of healthcare
and nursing issues including practice, education, and research. These
53 organizations are committed to promoting America's health through
nursing care. Collectively, the Nursing Community represents more than
850,000 Registered Nurses (RNs), Advanced Practice Registered Nurses
(APRNs), nurse executives, nursing students, nursing faculty, and nurse
researchers. Together, our organizations work collaboratively to
increase funding for the Nursing Workforce Development programs,
authorized under title VIII of the Public Health Service Act (42 U.S.C.
296 et seq.) so that American nurses have the support needed to provide
high-quality care to their patients.
The National Nursing Shortage Continues to Impact Quality Care
Since 1998, the United States has experienced a significant
shortage of RNs, which has dramatically impacted the quality of care
provided by our Nation's healthcare delivery system. In March 2007, a
comprehensive report initiated by the Federal Agency for Healthcare
Research and Quality was released on Nursing Staffing and Quality of
Patient Care. The authors found that the shortage of RNs, in
combination with an increased workload, poses a potential threat to the
quality of nursing care. In settings with inadequate nurse staffing,
patient safety was compromised. However, increases in RN staffing were
associated with reductions in hospital-related mortality and failure to
rescue, as well as reduced lengths of stay. A robust supply of well-
educated nurses is essential to ensure that all Americans receive
quality healthcare and that our Nation has the nurses necessary to meet
the current and future demands.
The demand for nurses will continue to grow as the baby-boomer
population ages, nurses retire, and the need for healthcare
intensifies. According to the U.S. Bureau of Labor Statistics (BLS),
nursing is the Nation's top profession in terms of projected job growth
with more than 581,000 new nursing positions being created through 2018
(a 22 percent increase in the workforce). Further, BLS analysts project
that more than 1 million new and replacement nurses will be needed by
2016.
Currently, RNs comprise the largest group of health professionals
with approximately 3.1 million providers offering essential care to
patients in a variety of settings, including hospitals, long-term care
facilities, community or public health areas, schools, workplaces, and
home care. In addition, many nurses receive graduate degrees that allow
them to practice autonomously as APRNs; become nurse faculty, nurse
researchers, nurse administrators, and public health nurses; and work
in the policy area to help shape healthcare delivery. With the new
health reform law focused on creating a system that will increase
access to quality care, emphasize prevention, and decrease cost, it is
critical that a substantial investment be made in our healthcare
workforce, particularly an investment in nurses. RNs and APRNs are
vital to ensuring direct availability to high-quality, cost-effective
healthcare in a reformed system. Nurses are involved in every aspect of
healthcare, and if the nursing workforce is not strengthened, the
healthcare system will continue to suffer.
Reversing the Nursing Shortage: A Federal Solution
Throughout previous nursing shortages, particularly in the 1960s
and 1970s, the Federal Government has offered relief to nursing schools
and students to reverse the negative trend. In particular, the Nursing
Workforce Development programs offered viable solutions to nursing
shortages, expanded nursing school programs, increased the number of
nurse faculty, and helped ensure nurses were practicing in areas with a
critical shortage. As Congress searches for programs to address the
nursing shortage now and in the future, the title VIII programs have
been and continue to be a proven solution.
Nursing Workforce Development Programs
The Nursing Workforce Development programs have supported the
supply and distribution of qualified nurses to meet our Nation's
healthcare needs since 1964. Over the last 46 years, these programs
have addressed all aspects of nursing shortages--education, practice,
retention, and recruitment. The title VIII programs bolster nursing
education at all levels, from entry-level preparation through graduate
study, and provide support for institutions that educate nurses for
practice in rural and medically underserved communities. Between fiscal
year 2006 and 2008, the title VIII programs supported 214,575 nurses
and nursing students as well as numerous academic nursing institutions,
and healthcare facilities. Today, the title VIII programs are essential
to solving the current national nursing shortage.
Title VIII Effectiveness
Results from the American Association of Colleges of Nursing's
(AACN) 2009-2010 Title VIII Student Recipient Survey included responses
from 1,420 students who noted that these programs played a critical
role in funding their nursing education. The survey showed that three-
quarters of the students receiving title VIII funding are attending
school full-time. By supporting full-time students, the title VIII
programs are helping to ensure that students enter the workforce
without delay. The programs also address the current demand for primary
care providers. A high percentage of the students surveyed (49.1
percent) reported that their career goal is to become a nurse
practitioner. Approximately 80 percent of nurse practitioners provide
primary care services throughout the United States. Additionally, the
nurse faculty shortage continues to inhibit the ability of nursing
schools to increase student capacity and address the shortage. Of the
students who responded to the survey, 40.5 percent stated their
ultimate career goal was to become nurse faculty.
Nursing Students Supported by Title VIII Funding
Of the title VIII student recipients surveyed, 39 percent reported
that they received between $1,001-$3,000 in funding over 1 year. Sixty-
seven percent reported that this funding supported a portion of their
tuition, and 35.8 percent reported that the funding was dedicated to
books and educational materials. Fifty-two percent of the students
responded that the title VIII funding paid for 25 percent or less of
their total student loans. Of those students, 26 percent stated that
the funding paid for less than 5 percent of their total nursing student
loans. When asked how the title VIII programs could be improved, the
overwhelming response from students was to increase the funding in
order to provide higher levels of support for their education.
Nursing students rely upon support through title VIII to complete
their degree and offset their considerable educational expenses.
Continued and increased support for the title VIII programs can help
address the demand for nursing services.
The Nursing Community respectfully request $267.3 million (a 10
percent increase) for the Nursing Workforce Development programs
authorized under title VIII of the Public Health Service Act in fiscal
year 2011. Last year, your subcommittee provided a significant funding
boost for title VIII that helped support the Loan Repayment program and
Scholarship and Nurse Faculty Loan program. These increases will
bolster the pipeline of nurses and nurse faculty, which is so critical
to reversing the nursing shortage. We feel it is extremely important to
maintain last year's funding level for these critical programs in
fiscal year 2011 and direct the 10 percent requested increase for the
four title VIII program that have not kept pace with inflation since
fiscal year 2005. The Advanced Education Nursing, Nursing Workforce
Diversity, Nurse Education, Practice, and Retention, and Comprehensive
Geriatric Education programs expand nursing school capacity and
increase patient access to care. These programs would greatly benefit
from the 10 percent increase awarded in proportion to their fiscal year
2010 funding level. Below is a description of these four critical
programs.
Advanced Education Nursing (AEN) Grants (section 811) support the
preparation of RNs in master's and doctoral nursing programs. The AEN
grants help to prepare our Nation's nurse practitioners, clinical nurse
specialists, nurse midwives, nurse anesthetists, nurse educators, nurse
administrators, public health nurses, and other nurse specialists
requiring advanced education. In fiscal year 2008 (most current data
available), these grants supported the education of 5,649 students.
--AEN Traineeships assist graduate nursing students by providing full
or partial reimbursement for the costs of tuition, books,
program fees, and reasonable living expenses. In fiscal year
2008, this funding helped support 6,675 graduate nurses and
APRNs.
--Nurse Anesthetist Traineeships (NAT) support the education of
students in nurse anesthetist programs. In some States,
Certified Registered Nurse Anesthetists (CRNAs) are the sole
anesthesia providers in almost 100 percent of rural hospitals.
Much like the AEN Traineeships, the NAT provides full or
partial support for the costs of tuition, books, program fees,
and reasonable living expenses. In fiscal year 2008, the
program supported 2,145 future CRNAs.
Workforce Diversity Grants (section 821) prepare disadvantaged
students to become nurses. This program awards grants and contract
opportunities to schools of nursing, nurse managed health centers,
academic health centers, State or local governments, and nonprofit
entities looking to increase access to nursing education for
disadvantaged students, including racial and ethnic minorities under-
represented among RNs. In fiscal year 2008, the program supported
11,638 students.
Nurse Education, Practice, and Retention Grants (section 831) help
schools of nursing, academic health centers, nurse-managed health
centers, State and local governments, and healthcare facilities
strengthen programs that provide nursing education. In fiscal year
2008, the priority areas under this program supported 42,761 with an
additional 455 students supported by the Integrated Nurse Education
Technology program.
Comprehensive Geriatric Education Grants (section 855) are awarded
to schools of nursing or healthcare facilities to better provide
nursing services for the elderly. These grants are used to educate RNs
who will provide direct care to older Americans, develop and
disseminate geriatric curriculum, prepare faculty members, and provide
continuing education. In fiscal year 2008, this program supported 6,514
nurses and nursing students.
Without an adequate supply of nurses to care for our Nation,
including our growing aging population, the healthcare system is not
sustainable. The Nursing Community's request of $267.3 million in
fiscal year 2011 for the HRSA Nursing Workforce Development programs
will help ensure access to quality care provided by America's nursing
workforce.
Members of the Nursing Community Submitting this Testimony
Academy of Medical-Surgical Nurses
American Academy of Ambulatory Care Nursing
American Academy of Nurse Practitioners
American Academy of Nursing
American Association of Colleges of Nursing
American Association of Nurse Anesthetists
American College of Nurse Practitioners
American College of Nurse-Midwives
American Nurses Association
American Organization of Nurse Executives
American Psychiatric Nurses Association
American Society for Pain Management Nursing
Association of Community Health Nursing Educators
Association of Nurses in AIDS Care
Association of periOperative Registered Nurses
Association of Rehabilitation Nurses
Association of Women's Health, Obstetric and Neonatal Nurses
Commissioned Officers Association of the U.S. Public Health Service
Dermatology Nurses' Association
Gerontological Advanced Practice Nurses Association
Hospice and Palliative Nurses Association
Infusion Nurses Society
National Association of Clinical Nurse Specialists
National Association of Hispanic Nurses
National Association of Nurse Practitioners in Women's Health
National Association of Pediatric Nurse Practitioners
National Black Nurses Association
National Nursing Centers Consortium
National Organization of Nurse Practitioner Faculties
National Student Nurses' Association, Inc.
Nurses Organization of Veterans Affairs
Oncology Nursing Society
Preventive Cardiovascular Nurses Association
Public Health Nursing Section, American
Public Health Association
Society of Urologic Nurses and Associates
Wound, Ostomy and Continence Nurses Society
______
Prepared Statement of the National Council for Diversity in the Health
Professions
Mr. Chairman and members of the subcommittee, thank you for the
opportunity to present my views before you today. I am Dr. Wanda
Lipscomb, President of the National Council for Diversity in the Health
Professions (NCDHP) and the Director of the Center of Excellence for
Culture Diversity in Medical Education at Michigan State University.
NCDHP, established in 2006, is a consortium of our Nation's majority
and minority institutions that once house the Health Resources and
Services (HRSA) Minority Centers of Excellence (COE) and Health Careers
Opportunities Programs (HCOP) when there was more funding. These
institutions are committed to diversity in the health professions. In
my professional life, I have seen firsthand the importance of health
professions institutions promoting diversity and the Title VII Health
Professions Training programs.
Mr. Chairman, time and time again, you have encouraged your
colleagues and the rest of us to take a look at our Nation and evaluate
our needs over the next 10 years. I want to say that minority health
professional institutions and the Title VII Health Professionals
Training programs address a critical national need. Persistent and
severe staffing shortages exist in a number of the health professions,
and chronic shortages exist for all of the health professions in our
Nation's most medically underserved communities. Furthermore, our
Nation's health professions workforce does not accurately reflect the
racial composition of our population. For example while blacks
represent approximately 15 percent of the U.S. population, only 2-3
percent of the Nation's health professions workforce is black. Mr.
Chairman, I would like to share with you how your committee can help
NCDHP continue our efforts to help provide quality health professionals
and close our Nation's health disparity gap.
There is a well-established link between health disparities and a
lack of access to competent healthcare in medically underserved areas.
As a result, it is imperative that the Federal Government continue its
commitment to minority health profession institutions and minority
health professional training programs to continue to produce healthcare
professionals committed to addressing this unmet need.
An October 2006 study by the Health Resources and Services
Administration (HRSA), entitled ``The Rationale for Diversity in the
Health Professions: A Review of the Evidence'' found that minority
health professionals serve minority and other medically underserved
populations at higher rates than nonminority professionals. The report
also showed that; minority populations tend to receive better care from
practitioners who represent their own race or ethnicity, and non-
English speaking patients experience better care, greater
comprehension, and greater likelihood of keeping follow-up appointments
when they see a practitioner who speaks their language. Studies have
also demonstrated that when minorities are trained in minority health
profession institutions, they are significantly more likely to: (1)
serve in rural and urban medically underserved areas; (2) provide care
for minorities; and (3) treat low-income patients.
As you are aware, Title VII Health Professions Training programs
are focused on improving the quality, geographic distribution and
diversity of the healthcare workforce in order to continue eliminating
disparities in our Nation's healthcare system. These programs provide
training for students to practice in underserved areas, cultivate
interactions with faculty role models who serve in underserved areas,
and provide placement and recruitment services to encourage students to
work in these areas. Health professionals who spend part of their
training providing care for the underserved are up to 10 times more
likely to practice in underserved areas after graduation or program
completion.
Institutions that cultivate minority health professionals, like the
NCDHP members, have been particularly hard-hit as a result of the cuts
to the Title VII Health Profession Training programs in fiscal year
2006, fiscal year 2007, and fiscal year 2008. Given their historic
mission to provide academic opportunities for minority and financially
disadvantaged students, and healthcare to minority and financially
disadvantaged patients, minority health professions institutions
operate on narrow margins. The cuts to the Title VII Health Professions
Training programs amount to a loss of core funding at these
institutions and have been financially devastating. We have been
pleased to see efforts to revitalize both COE and HCOP in recent fiscal
years, but it is important to fully fund the programs at least at the
fiscal year 2004 level so that more diversity is achieved in our health
professions.
Earlier this year with the passage of health reform, the Congress
showed the importance of the many of the title VII programs, including
the COE and HCOP, by reauthorizing the programs.
COE.--COEs focus on improving student recruitment and performance,
improving curricula in cultural competence, facilitating research on
minority health issues and training students to provide health services
to minority individuals. COEs were first established in recognition of
the contribution made by four historically black health professions
institutions (the Medical and Dental Institutions at Meharry Medical
College; The College of Pharmacy at Xavier University; and the School
of Veterinary Medicine at Tuskegee University) to the training of
minorities in the health professions. Congress later went on to
authorize the establishment of ``Hispanic'', ``Native American'' and
``Other'' Historically black COEs. For fiscal year 2011, I recommend a
funding level of $33.6 million for COEs.
HCOP.--HCOPs provide grants for minority and nonminority health
profession institutions to support pipeline, preparatory and recruiting
activities that encourage minority and economically disadvantaged
students to pursue careers in the health professions. Many HCOPs
partner with colleges, high schools, and even elementary schools in
order to identify and nurture promising students who demonstrate that
they have the talent and potential to become a health professional.
Collectively, the absence of HCOPs will substantially erode the
number of minority students who enter the health professions. Over the
last three decades, HCOPs have trained approximately 30,000 health
professionals including 20,000 doctors, 5,000 dentists and 3,000 public
health workers. For fiscal year 2011, I recommend a funding level of
$35.6 million for HCOPs.
Mr. Chairman, please allow me to express my appreciation to you and
the members of this subcommittee. With your continued help and support,
NCDHP member institutions and the Title VII Health Professions Training
programs can help this country to overcome health and healthcare
disparities. Congress must be careful not to eliminate, paralyze or
stifle the institutions and programs that have been proven to work.
NCDHP seeks to close the ever widening health disparity gap. If this
subcommittee will give us the tools, we will continue to work towards
the goal of eliminating that disparity everyday.
Thank you, Mr. Chairman, and I welcome every opportunity to answer
questions for your records.
______
Prepared Statement of the 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, in this testimony, NFCB:
--Thanks the subcommittee for its role in providing $25 million
station fiscal stabilization in light of the difficult economy
in last year's appropriation;
--Requests $604 million in funding for CPB for fiscal year 2013 and
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
the radio ``minority consortia'' dedicated to Native American,
Latino and African-American radio stations;
--Requests $59.5 million in fiscal year 2011 for conversion of public
radio and television to digital technology;
--Supports CPB's funding for rural stations and assistance with new
technologies and requests report language regarding rural and
minority stations in this regard
--Supports CPB programs focused on ensuring public radio is able to
fulfill its important mission of public safety during
emergencies; and
--Supports CPB's role as a convener that can address questions and
important future trends across all public media.
Community radio fully supports the forward funding appropriation of
$604 million in Federal funding for the Corporation for Public
Broadcasting in fiscal year 2013. Money allocated to the Corporation
for Public Broadcasting assists NFCB member stations throughout the
country through community service grants. Community service grants are
the core way that CPB uses to support radio stations--particularly
targeted to stations offering the first public radio service to a
community in a rural area, or to stations serving particular
demographic constituencies. CPB's focus on these areas is critical to
ensuring that public radio does not focus solely on higher-income
audiences, but serves every American no matter their background or
their location. These targeted 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. CPB 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 importantly,
the insulation that advance funding provides is of critical importance
in eliminating both the risk of and the appearance of undue
interference with and control of public broadcasting.
Community radio supports CPB activities in facilitating programming
to Native American, Latino, and African-American radio stations. CPB
has played a critical role in providing support and assistance to radio
stations serving communities of color, particularly communities that
could be better served by noncommercial radio. While CPB has long
supported television programming focused on underserved communities,
its programs for radio are newer and are very welcome. Given the
importance and accessibility of radio in many underserved communities,
NFCB urges the subcommittee to endorse the long-term viability of these
radio minority consortia.
Specifically, with important support from CPB, Native Public Media
(NPM) has burst on to the scene to ensure that Native Americans have
access to noncommercial broadcast and new technologies alike. NPM has
worked in the last few years to facilitate applications for
noncommercial radio stations by almost 40 applicants from tribal and
native entities, bringing many of these service areas within the reach
of a public radio signal for the first time. NPM has undertaken
research to identify the spectrum allocations currently serving Indian
Country in order to target better service in the future, releasing a
report called The New Media, Technology and Internet Use in Indian
Country: Quantitative and Qualitative Analyses, which included a usage
survey and case study that contains the first valid and credible data
on Internet use among Native Americans. In addition, NPM was able to
play a critical role in ensuring that tribal entities have the ability
to obtain new radio stations in the future by successfully
demonstrating to the FCC the need and legal justification for a tribal
priority in radio.
In addition, in the last year the newest minority consortium has
been started--the Latino Public Radio Consortium. The Latino Public
Radio Consortium is an organization that represents and supports 33
public radio stations. It recognizes that Latinos are underrepresented
in the Nation's public broadcasting institutions, decisionmaking
structures, that there is little programming in English or in Spanish
produced by Latinos or with a Latino focus and, as a consequence,
Hispanics are vastly underrepresented among public radio's news and
public affairs audiences.\1\ To illustrate, a study by Station Resource
Group's Grow the Audience project showed that, for public radio to
acquire a representative share of the college-educated market for
Latinos, it would need to triple its audience.\2\
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\1\ Latino Public Radio Consortium, Brown Paper, p. 1 available at
http://www.latinopublicradioconsortium.org/index.php?s=41.
\2\ Station Resource Group, Grow the Audience, Listening by Black
and Hispanic College Graduates (2008) at p. 17, available at http://
www.srg.org/GTA/GTA%20Black%20Hispanic%20Report.pdf.
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During this funding year the Consortium has established the
communications and governance structure to enable the Hispanic stations
to support each other and to develop additional resources. An important
new project that is indicative of future work is the development of
Historias, a partnership with Story Corps, a national oral history
project of the Library of Congress and public radio. Through this
collaboration, Story Corps Historias will gather and record 900
individual interviews with Latinos around the country.
This year CPB is funding new services for African American public
radio stations designed to improve and increase public media's service
to the American public. NFCB believes that this project, like the other
consortia, is vital to ensure that all Americans benefit from public
funds and the breadth and depth of public radio. In addition to the
minority consortia, CPB supports Satelite Radio Bilinge which 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. CPB also supports Native Voice One (NV1), which
is distributing politically and culturally relevant programming to
Native American stations.
Community radio supports $59.5 million in fiscal year 2011 for the
conversion to digital technology. While public television's digital
conversion needs were 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.
This development of second and third audio channels will potentially
double or triple the service that public radio can provide listeners,
particularly in unserved and underserved communities. In addition,
public radio is in great need of CPB's leadership and resources to
transition to new media platforms, in particular through such projects
as the American Archive, which will make existing programming
accessible to all and on all platforms.
Community radio supports CPB's funding for rural stations and
assistance with new technologies. 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 so that 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.
A good example of CPB's role is the Public Media Innovation grant
CPB gave KAXE, one of NFCB's rural members, a chance to experiment with
the concept of becoming ``a web operation that owned a radio station.''
PMI described this project as one of the most visionary proposals they
funded. As part of the grant, KAXE began the development of Northern
Community Internet, which would provide hyper-local news content to
more than a dozen communities in northern Minnesota. Through this
project, KAXE learned many important things about how to create content
that is relevant and accessible across a web site, radio station, and
social media. The journalists involved continue to be very interested
in the project, even though the current pilot is over.
Community radio supports CPB programs focused on ensuring public
radio is able to fulfill its important mission of public safety during
emergencies. CPB funding has supported an important new project led by
NFCB called Station Action for Emergency Readiness (SAFER). NFCB, in
partnership with NPR and with support from CPB, has developed a step-
by-step manual that stations can use to develop and/or supplement their
own emergency readiness plans; a set of digital tools that stations can
embed in their own websites to keep community members informed; and
links to national and local resources that can supplement station's
coverage. This project was inspired by the experience of NFCB member
WWOZ in New Orleans as a result of Katrina and was furthered by the
work of NFCB member KWMR in Point Reyes Station, California. KWMR is
small and local community and provided absolutely critical life-saving
information to its community during terrible floods of 2004-2005.
Community radio supports CPB's role as a convener that can address
questions and important future trends across all public media. CPB
plays an extremely important role in the public and Community Radio
system: it convenes 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.
Thank you for your consideration of our testimony. If the
subcommittee has any questions or wishes to follow up on any of the
points expressed above, please contact:
______
Prepared Statement of the National Coalition for Literacy
Mr. Chairman and members of the subcommittee, thank you for the
opportunity to submit the views of the National Coalition for Literacy
on appropriations for adult education and family literacy, under the
Workforce Investment Act, title II.
The National Coalition for Literacy represents 24 national
organizations concerned about adult education and family literacy. We
request a significant increase in funding and investment for adult
education and family literacy to at least $750 million in order to
address critical, immediate needs, such as:
--Clear Waiting Lists.--It would cost at least $160 million to clear
existing waiting lists for instruction.
--Increase Access to Adult English Language Learning Programs.--We
need to create opportunities for more than 11 million
immigrants to learn English.
--Increase Access to Professional Development.--Adult education
practitioners need increased access to professional development
in order to ensure quality services.
--Improve Professional Quality of the Adult Education Workforce.--
Eighty percent of teachers are part time; thousands are
volunteers. We must create the conditions needed to attract and
retain a full-time workforce.
--Create a National Center for Adult Education, Literacy, and
Workforce Skills.\1\ A Center would address the continued need
for research and innovation in our field.
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\1\ NCL Proposal for a National Center for Adult Education,
Literacy, and Workforce Skills http://www.ncladvocacy.org/
NationalCenterPolicyPrinciples_FINAL.pdf.
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These critical, urgent needs require scaled investments that will
provide adults important opportunities to acquire the skills they need
to find family sustaining work.
Need and Demand for Adult Education
The 2003 National Assessment of Adult Literacy found that there are
approximately 93 million adults in the United States who do not have
the literacy skills to reach their full potential. Thirty million
adults have such low levels of literacy that it impedes their ability
to fully function at home, at work, and in society. One in seven adults
in our Nation can barely read a newspaper, a job application, a
prescription label, or an election ballot.\2\ Many live in poverty,
experience complex health problems, and have extreme difficulty
supporting their children's education. Eleven million adults cannot
communicate in English.
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\2\ ProLiteracy www.proliteracy.org.
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Taking into consideration all Federal, State, and local and
philanthropic funding, the adult education system serves only 2.5
million of 93 million adults each year who would benefit from literacy
and English language instruction. Despite this, adult education has
been nearly flat funded for a decade. An increase in fiscal year 2009-
10 was a one-time adjustment to correct for a funding calculation error
that occurred from 2003-2008.
According to this year's congressional justification, the
administration built its budget request on 2006 waiting list data.\3\
However, the National Council of State Directors of Adult Education has
since published a March 2010 report, demonstrating that waiting lists
and wait time have doubled in the last 2 years, during this economic
crisis. Seventy-two percent of the programs reporting, from 50 of the
51 States and territories, confirmed waiting lists. Approximately
160,000 adults want to access services but cannot.\4\ Additionally,
community-based and volunteer literacy programs around the country
report increased demand for services while traditional sources of
funding are becoming more scarce.
---------------------------------------------------------------------------
\3\ Congressional Justification for Career, Technical, and Adult
Education 2010 http://www2.ed.gov/about/overview/budget/budget11/
justifications/n-careered.pdf.
\4\ 2009-2010 Adult Student Waiting List Survey http://
www.ncladvocacy.org/2010AdultEducationWaitingListReport.pdf.
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The congressional justification also cited 2000 census data
demonstrating an 11 percent dropout rate nationwide. Adult education
programs serve as a key pipeline for these dropouts, keeping them on
course to a high school equivalent and postsecondary education or job
training. Adult education provides a last resort for helping these
youths get back on track.
Investing in Adult Education is a Workforce Investment
We commend the administration for proposing to invest more through
the Workforce Innovation Fund. Adult education and job training can
underpin economic recovery and open opportunities for low-skilled
workers by helping today's workforce develop the skills they need for
both work and community life. As literacy and educational attainment
rise, so do adults' income and chances of stable employment.
According to the Bureau of Labor Statistics, unemployment decreases
as education levels increase: \5\
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\5\ Education Pays, Bureau of Labor Statistics http://www.bls.gov/
emp/ep_chart_001.htm.
------------------------------------------------------------------------
Median weekly
Unemployment rate in 2008 Education attained earnings in
(percentage) 2008 (dollars)
------------------------------------------------------------------------
2................................. Doctoral degree..... $1,561
1.7............................... Professional degree. 1,531
2.4............................... Master's degree..... 1,233
2.8............................... Bachelor's degree... 1,012
3.7............................... Associate degree.... 757
5.1............................... Some college, no 699
degree.
5.7............................... High-school graduate 618
9................................. Less than a high 453
school diploma.
------------------------------------------------------------------------
Note: Data are 2008 annual averages for persons age 25 and over.
Earnings are for full-time wage and salary workers.
Source: Bureau of Labor Statistics, Current Population Survey.
The Bureau of Labor Statistics estimates that by 2013, 90 percent
of the fastest-growing jobs, 60 percent of all new jobs, and 40 percent
of manufacturing jobs will require some form of postsecondary
education. However, only 2 percent of this need can be met by high
school graduates.\6\ 94 percent of today's workforce will still be in
the workforce in 2013; we must increase the skills of the current adult
workforce for these high-demand jobs. Adult education is an important
re-entry point for unemployed and underemployed adults who wish to
raise their basic education skills or improve their English. However,
the adults who want to become job and career-ready for these high-
skilled, high-demand jobs are unable to get into instruction.\7\
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\6\ U.S. Census, www.census.gov.
\7\ Investing in the Adult Workforce http://www.ncladvocacy.org/
StateAlignmentInitiativesVolumeII/InvestingInTheAdultWorkforce.doc.
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Meeting the President's College Graduation Goal
The President has articulated a goal of the United States having
the highest proportion of college graduates in the world by 2020. Even
if every State reached the same levels of high school graduation and
college enrollment for high school graduates as the highest-performing
States, we would not reach this goal without a substantial effort to
bring adult education students into the pipeline.
English Language Acquisition
We must create opportunities for immigrants to learn English and
civics by building and enhancing the capacity of current adult
education programs. Between 1970 and 2005, the U.S. foreign-born
population tripled to an estimated 35.8 million individuals, accounting
for 12.4 percent of the country's population. At least 67 percent of
the growth in the U.S. workforce in the past 3 years is comprised of
new immigrants. It is estimated that between 2010-2030 first and second
generation immigrants together will account for all the growth in the
U.S. workforce.\8\ According to U.S. Census Bureau estimates, nearly 1
in 5 adults in the United States speaks a language other than English
at home, and more than 17 million speak English less than ``very
well.'' \9\
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\8\ Kirsch, I., Braun, H., Yamamoto, K. (2007) America's Perfect
Storm: Three Forces Changing Our Nation's Future. Princeton, NJ:
Education Testing Service.
\9\ U.S. Census Bureau (2003). Language Use and English-Speaking
Ability: 2000. Washington, DC: Author.
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Investing in Quality
Increasing funds to clear waiting lists is a start. But if the
adult education system is to help prepare adults for 21st century jobs,
transition adults to college, and meet or exceed performance goals, we
must invest in quality of the profession as well as the numbers of
learners served. The 21st century adult educator needs to:
--Prepare adults to be digital age learners using existing and new
technologies.
--Prepare adults with the basic adult literacy and critical thinking
skills they need to be competitive in the 21st century
workforce.
--Teach adults with learning and other disabilities to close the life
outcomes gap.
--Prepare adults to transition into postsecondary and vocational
credit-bearing classes.
--Instruct a linguistically diverse classroom to improve their
language proficiency.
--Increase political literacy and civic participation among our
nation's adults.
--Strengthen programs to be scalable and flexible to meet new demands
in communities.
Only 1 in 5 adult education teachers are full time; thousands are
volunteers; most are funded on year-to-year grant programs. Stable job
status that facilitates a dedicated, professional workforce is critical
to raising student achievement outcomes. Career ladders are virtually
nonexistent in adult education; a national credential in adult
education does not exist. Many practitioners are not paid to attend
professional development opportunities in order to meet these demands
upon them. Developing the professional quality of the workforce is
vital if we are to help adult learners achieve. We must increase access
to professional development, provide credentialing and career
advancement opportunities, improve working conditions, and conduct
research in professional development. Increasing appropriations will
allow the field to do that.
Return on Investment
Adult education is a good investment. On January 21, 2010, the
United States Department of Labor's Bureau of Labor Statistics reported
that there was a $9,828 wage differential for full-time workers with a
high school diploma (or GED) over those who did not graduate.\10\ The
following is the potential return on investment for adults in 2008-2009
who received a GED in adult education programs. Over a 5-year period,
the original $39,164,868 spent on the 165,637 GED students shows a
potential return on investment of $1,220,910,325 (3,017 percent).
---------------------------------------------------------------------------
\10\ Bureau of Labor Statistics (January 2010). Retrieved February
16, 2010 from http://www.bls.gov/news.release/wkyeng.nr0.htm.
------------------------------------------------------------------------
------------------------------------------------------------------------
Number of GEDs achieved in 2008-2009................. \1\ $165,637
Average dollars invested in student.................. $236.45
------------------
Total.......................................... $39,164,868
Number of GEDs achieved in 2008-2009................. 165,637
Income differential.................................. $9,828
------------------
Total increase in taxable income per year...... $1,627,880,436
Federal tax rate (percent)........................... 15
------------------
Potential return on investment per year........ $244,182,065
One-year return on investment (percent).............. 523
------------------
Potential 5-year return on investment.......... $1,220,910,325
------------------------------------------------------------------------
\1\ Office of Vocational and Adult Education reporting Web site.
Retrieved February 16, 2010.
The current levels of funding have not and will not allow the field
to grow to serve more adults, to improve and innovate practice, and
meet existing and increasing demands. For these reasons, we strongly
urge the Senate Appropriations Subcommittee on Labor, Health and Human
Services, and Education, and Related Agencies to support a significant
increase for programs provided by the Adult Education and Family
Literacy Act, to at least $750 million or more.
______
Prepared Statement of the National Consumer Law Center
The Federal Low Income Home Energy Assistance Program (LIHEAP) \1\
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. The demand for LIHEAP assistance remains at record high
levels. In fiscal year 2010, the program is expected to help a record 9
million low-income households afford their energy bills, a 15 percent
increase from the prior fiscal year. 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 2011 and that advance
funding of $5.1 billion be provided for the program in fiscal year
2012.
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\1\ 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 at Record High Levels
Residential heating expenditures remain at high levels. U.S.
average residential heating expenditures this winter are expected to be
around the same for natural gas, about 24 percent higher for heating
oil, 21 percent higher for propane, and 23 percent higher for
electricity when compared to the 5-year average for 2003-2008.\2\ The
years of steady, high-energy bills are hitting low-income households
struggling in this serious economic downturn. Low-income residential
consumers, on average, pay a substantial amount of their income on
residential energy, especially when compared to non-low-income
households, 13.5 percent versus 3.6 percent, respectively.\3\ Because
LIHEAP is targeted to the most vulnerable low-income households, LIHEAP
recipient households have an average energy burden of 16 percent.\4\
---------------------------------------------------------------------------
\2\ Derived from data in the Energy Information Agency, Short-Term
Energy Outlook (March 2010), Table WF01.
\3\ US HHS, ACF, OCS, LIHEAP Home Energy Notebook For Fiscal Year
2007, June 2009 at Table A-3b. Residential energy: Average annual
expenditure, by amount (dollars) and mean individual burden (percent of
income), for all, non-low-income, low income, and LIHEAP recipient
households, by Census region and main heating fuel, fiscal year 2007.
\4\ Id.
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The number of households that are struggling to make ends meet
remains very high. According a Pew Economic Policy Group report, in
March 2010 more than 44 percent of the 15 million unemployed Americans
had been unemployed for 6 months or longer.\5\ This is the highest rate
of long-term unemployment since World War II. The ``underemployment''
rate in March 2010 is 16.9 percent.\6\ CBO's budget and economic
outlook report projects that unemployment will average 9.5 percent in
fiscal year 2011.\7\ The hardship low-income households face is also
apparent in the data below on the number of households falling behind.
---------------------------------------------------------------------------
\5\ Pew Economic Policy Group Fiscal Analysis Initiative, A Year or
More: The High Cost of Long-Term Unemployment, April 2010, Executive
Summary.
\6\ Id. Underemployment captures workers who became discouraged and
stopped looking for work, older workers who opted to retire early
instead of seeking work, young people delaying entering the work force
and those workers who want full-time work, but have been forced to
accept part-time work instead.
\7\ CBO, The Budget and Economic Outlook: Fiscal Years 2010 to
2020, January 2010 at Summary Table 2.
---------------------------------------------------------------------------
States' Data On Electric and Natural Gas Disconnections and Arrearages
Show That More Households Are Falling Behind
States are Predicting Record LIHEAP Participation.--With the
downturn in the economy, the States continue to experience record
demand for LIHEAP assistance. NEADA reports that for fiscal year 2010,
17 States have projected increases in participation of at least 20
percent, with Mississippi estimating a 68 increase, followed by
Washington (42 percent), Michigan (38 percent), Nevada (34 percent),
New Jersey (31 percent), West Virginia (28 percent), Colorado (26
percent), Kansas (25 percent), New Hampshire (25 percent), Wisconsin
(25 percent), Montana (21 percent), California (20 percent), Oregon (20
percent), South Carolina (20 percent), South Dakota (20 percent), Texas
(20 percent) and Rhode Island (20 percent).\8\ As jobs lag behind
economic recovery, we fully expect the need for fully funded LIHEAP
program in the States in fiscal year 2011.
---------------------------------------------------------------------------
\8\ NEADA press release, Record Numbers of Households Seek
Assistance: States Call for the Release of Emergency Funds and
Supplemental Assistance, February 22, 2010. (Hereinafter, ``NEADA Feb.
22, 2010 Press Release.'')
---------------------------------------------------------------------------
The steady and dramatic rise in residential energy costs has
resulted in increases in electric and natural gas arrearages and
disconnections. The National Energy Assistance Directors' Association
reports that households experiencing natural gas shut offs increased
from 4.1 million in 2008 to 4.3 million in 2009.\9\
---------------------------------------------------------------------------
\9\ NEADA press release, Record Number of Households Receive Energy
Assistance: Shut-Offs Exceed 4.3 million Households in 2009, December
18, 2009. See also 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). This national survey 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 May 2008.
---------------------------------------------------------------------------
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 disconnection peaks 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.
California.--California has experienced a dramatic increase in
LIHEAP participation from fiscal year 2008 to fiscal year 2010, with
166,000 households served in fiscal year 2008; 434,000 in fiscal year
2009 and projects serving 521,000 in fiscal year 2010.\10\ The rise in
the State's unemployment and foreclosure rates led the State Division
of Ratepayer Advocates (DRA) to take a look at whether households are
able to maintain access to natural gas and electric service. DRA found
that low-income residential customers were experiencing a 19 percent
increase in disconnections over the past year and that the disparity
between low-income disconnections and non-low-income disconnections is
the worst in 3 years.\11\ In February 2010, the California Public
Utilities Commission opened a docket to address electric and natural
gas disconnections.\12\
---------------------------------------------------------------------------
\10\ NEADA Feb. 22, 2010 Press Release.
\11\ California Division of Ratepayer Advocates, Status of Energy
Utility Service Disconnections in California, November 2009, Executive
Summary and pages 5 and 10.
\12\ CPUC, Order Instituting Rulemaking To Establish Ways to
Improve Customer Notification and Education to Decrease the Number of
Gas and Electric Utility Service Disconnections, R.10-02-005, Issued
February 5, 2010.
---------------------------------------------------------------------------
Iowa.--Iowa has experienced a steady increase in enrollment for the
regular LIHEAP program from fiscal year 2008 to fiscal year 2010 with
85,000 households served in fiscal year 2008; 95,000 in fiscal year
2009 and 100,000 projected in fiscal year 2010.\13\ The average monthly
number of LIHEAP households in arrears in fiscal year 2009 was 12
percent higher than the monthly average over the 5-year period from
fiscal year 2004 through fiscal year 2008. However, as a testament to
the importance of LIHEAP, the average monthly number of all households
in arrears in fiscal year 2009 was 14 percent higher than the monthly
average for all households in arrears over the previous 5-year
period.\14\
---------------------------------------------------------------------------
\13\ NEADA Feb. 22, 2010 Press Release and Iowa Bureau of Energy
Assistance.
\14\ Based on data provided by the Iowa Bureau of Energy
Assistance.
---------------------------------------------------------------------------
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 6 percent from January 2009 to
January 2010.\15\ The increase is an even more dramatic 98 percent
between January 2003 and January 2010. The total dollar amount owed
(arrearage) by low-income PIPP customers increased 5 percent from
January 2009 to January 2010 and 118 percent when comparing PIPP
customer arrears from January 2003 to January 2010. Ohio has
experienced a steady increase in enrollment for the regular LIHEAP
program from fiscal year 2008 to fiscal year 2010 with 387,000
households served in fiscal year 2008; 394,000 in fiscal year 2009 and
projects 418,000 in fiscal year 2010.\16\
---------------------------------------------------------------------------
\15\ Public Utilities Commission of Ohio.
\16\ NEADA Feb. 22, 2010 Press Release.
---------------------------------------------------------------------------
Pennsylvania.--Pennsylvania has also experienced a steady increase
in enrollment for the regular LIHEAP program from fiscal year 2008 to
fiscal year 2010, with 371,000 households served in 2008; 547,000 in
fiscal year 2009, and a projected 602,000 in fiscal year 2010.\17\
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 21,029 households entered the current
heating season without heat-related utility service. This number
includes about 3,992 households who are heating with potentially unsafe
heating sources such as kerosene or electric space heaters and kitchen
ovens. In mid-December 2009, an additional 14,332 residences where
electric service was previously terminated were vacant and more than
7,438 residences where natural gas service was terminated were vacant.
In 2009, the number of terminations increased 65 percent compared with
terminations in 2004. As of December 2009, 18.2 percent of residential
electric customers and 15.8 percent of natural gas customers were
overdue on their energy bills.\18\
---------------------------------------------------------------------------
\17\ Id.
\18\ Pennsylvania Public Utilities Commission.
---------------------------------------------------------------------------
LIHEAP Is a Critical Safety Net Program for the Elderly, the Disabled
and Households With Young Children
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.\19\ 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.\20\ 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.\21\ Clearly, families are going without food during the winter to
pay their heating bills, and their children fail to thrive and grow. A
2007 Colorado study found that the second leading cause of homelessness
for families with children is the inability to pay for home energy.\22\
---------------------------------------------------------------------------
\19\ 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.
\20\ 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.
\21\ 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).
\22\ 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).
---------------------------------------------------------------------------
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, ovens and
burners, all of which are fire hazards. Space heaters pose 3 to 4 times
more risk for fire and 18 to 25 times more risk for death than central
heating. In 2007, space heaters accounted for 17 percent of home fires
and 20 percent of home fire deaths.\23\ 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 persons 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.\24\ The CDC
also notes that air-conditioning is the number one protective factor
against heat-related illness and death.\25\ 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.
---------------------------------------------------------------------------
\23\ John R. Hall, Jr., Home Fires Involving Heating Equipment
(Jan. 2010) at ix and 33. Also, 40 percent of home space heater fires
involve devices coded as stoves.
\24\ CDC, ``Heat-Related Deaths--United States, 1999-2003'' MMWR
Weekly, July 28, 2006.
\25\ CDC, ``Extreme Heat: A Prevention Guide to Promote Your
Personal Health and Safety'' available at http://emergency.cdc.gov/
disasters/extremeheat/heat_guide.asp.
---------------------------------------------------------------------------
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 2011 in light of high
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
2012 advance funding would facilitate the efficient administration of
the State LIHEAP programs. Advance funding provides 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 for Osteoporosis and
Related Bone Diseases
Mr. Chairman and members of the subcommittee: Thank you for the
opportunity to submit testimony to this subcommittee. The National
Coalition for Osteoporosis and Related Bone Diseases (``Bone
Coalition'') was organized in the early 1990s and is dedicated to
increasing Federal research funding for bone diseases through advocacy
and education. The Bone Coalition members are five leading national
bone disease groups, consisting of two professional societies and three
national voluntary health organizations: American Academy of
Orthopaedic Surgeons; American Society for Bone and Mineral Research;
National Osteoporosis Foundation; Osteogenesis Imperfecta Foundation;
and The Paget Foundation.
Bone diseases do not discriminate. Osteoporosis and related bone
diseases affect people of all ages, ethnicities, and gender. Related
bone diseases include Paget's disease of bone, osteogenesis imperfecta,
and a number of rare bone diseases. Osteoporosis is a condition in
which the bones become weak and can break from a minor fall, or in
serious cases, from a simple action such as a sneeze. About 10 million
Americans already have the disease, and another 34 million people have
low bone density, which puts them at risk for osteoporosis and bone
fractures. Approximately 80 percent of those affected by osteoporosis
are women.
Bone diseases drastically affect the way people function.
Individuals who suffer broken bones as a result of osteoporosis can
suffer severe pain, loss of height, and stooped posture that can affect
breathing and digestion. One in five patients who walked before their
hip fracture needs long-term care afterward. It is interesting to note
that although the rate of hip fractures is 2 to 3 times higher in
women, after 1 year, the death rate in men is nearly twice as high.
Studies conclude that musculoskeletal disorders and diseases are the
leading cause of disability in the United States. Studies further
indicate that more than 1 in 4 Americans have a musculoskeletal
condition requiring medical attention. The annual direct and indirect
costs for bone and joint health are $849 billion--which is 7.7 percent
of the U.S. gross domestic product. Bone health is critical to the
overall health and quality of life for Americans, and greater efforts
are needed from Congress, States, providers, and patients to address
the burdens associated with osteoporosis and related bone diseases.
Information regarding the impact of bone diseases is included at the
end of this statement.
National Institutes of Health (NIH) Funding
The Bone Coalition is grateful for the additional funding the
President has included in his budget for the NIH. His agenda recognizes
the role that medical research plays in building better healthcare and
economic revitalization. We join the hundreds of organizations
dedicated to health and medical research to now urge Congress to
provide additional funds--$35 billion--for the NIH. This increase will
create substantial opportunities for scientific and health advances as
well as provide a key economic role in communities across the Nation.
In addition, even with NIH's budget increase proposed by the President,
not all NIH Institutes and programs will receive proportional
increases. The Bone Coalition encourages the subcommittee to provide a
proportional increase in funding to the National Institute of Arthritis
and Musculoskeletal and Skin Diseases. The Coalition would like to draw
attention to areas of bone disease research which merit funding.
An internal analysis of fiscal year 2009 NIH funded grants revealed
only 1 percent of the NIH budget was allotted toward bone research.
This statistic is startling when one considers the number of
individuals afflicted with bone diseases. Bones provide mobility,
support, and protection for the body. The previous statistics mentioned
in this testimony describe a compelling reason to support bone disease
research. Furthermore, without additional bone disease research, the
costs associated with treating bone diseases will continue to burden
our healthcare system.
The Coalition has identified several areas where supplemental
research is needed and urges the NIH Institutes and other agencies to
give priority consideration to the below research topics.
Office of the Director.--The Coalition urges NIH to make support
research that leads to targeted therapies to improve the density,
quality, and strength of bone for all Americans. We also encourage
investments in mechanisms that foster increased interdisciplinary
research between bone and muscle, fat, and the central nervous system,
as well as research that improves the identification of populations who
might require earlier treatment because they are at risk of rapid bone
loss due to obesity, diabetes, chronic renal failure and low glomerular
filtration rates, cancer, HIV, conditions that affect absorption of
nutrients or medications, and addiction to tobacco, alcohol or other
opiates.
Furthermore, the Coalition urges NIH to support research on the
effects of bone therapies on the skeleton, including factors
predisposing individuals to osteonecrosis of the jaw and atypical
subtrochanteric fractures of the femur. Regarding cancer and bone,
studies need to be expanded on prevention and repair of bone defects
caused by cancer cells and the biology of tumor dormancy and
therapeutic resistance. Further studies are needed to determine optimal
levels of calcium and Vitamin D to achieve optimal bone health as well
as the relationship between Vitamin D and morbidity and mortality in
chronic kidney disease. Other research needs include: knowledge to
advance the ability to diagnose and treat bone diseases and disorders
through bone imaging; advancing tissue engineering strategies to
replace and regenerate bone and soft tissue; developing assessments for
determining fracture risk; and better defining the causes of age-
related bone loss and fractures, reduced physical performance and
frailty.
Finally, the Coalition encourages NIH to expand genetics and other
research on rare bone diseases, including: osteogenesis imperfecta,
Paget's disease of bone, fibrous dysplasia, osteopetrosis, fibrous
ossificans progressiva, melhoreostosis, X-linked hypophosphatemic
rickets, multiple hereditary exostoses, multiple osteochondroma,
Gorham's disease, and lymphangiomatosis.
National Institute of Arthritis and Musculoskeletal and Skin
(NIAMS).--The Coalition suggests additional research is needed into the
pathophysiology of bone loss in diverse populations in order to develop
targeted therapies to reduce fractures and improve bone density, bone
quality, and bone strength. This includes resolving what are
appropriate levels of calcium and vitamin D for bone health at
different life stages. Research is also needed in the assessment of
bone microarchitecture and remodeling rates for determining fracture
risk, anabolic approaches to increase bone mass, novel molecular and
cell-based therapies for bone and cartilage regeneration, and
discerning the clinical utility of new, noninvasive bone imaging
techniques to measure bone architecture and fragility. Support for
studies on the molecular basis of bone diseases such as Paget's
disease, osteogenesis imperfecta and other rare bone diseases should
also be a priority.
National Cancer Institute (NCI).--The Coalition requests continued
research on how to repair bone defects caused by cancer cells,
mechanisms by which cancer cells affect the bone's endogenous cells,
and the biology of tumor dormancy and the role of tumor stroma in
conferring therapeutic resistance. Additionally, research is needed to
discern the impact of metastasis on the biomechanical properties of
bone, how inadequate levels of vitamin D affect bone as a result of
hard and soft tissue sarcoma, and the mechanisms by which bone marrow
derived cells and tumor associated macrophages can influence metastatic
growth, survival and therapeutic resistance.
National Institute on Aging (NIA).--The Coalition encourages
research to better define the causes of age-related bone loss and
fractures, reduced physical performance and frailty, including
identifying epigenetic changes, with the aim of translating basic and
animal studies into novel therapeutic approaches. Critical research is
also needed on changes in bone structure and strength with aging,
periosteal biology, identifying cell autonomous changes versus
alterations in the bone microenvironment and the relationship of age-
related changes in other organ systems and their affects/interactions
with bone. The prevention and treatment of other metabolic bone
diseases, including osteogenesis imperfecta, glucocorticoid-induced
osteoporosis, and bone loss due to kidney disease should also be
priority research areas.
National Institute of Child Health and Human Development (NICHD).--
The Coalition urges research in the new, emerging field of metabolic
disease and bone in children and adolescents, especially childhood
obesity, anorexia nervosa and other eating disorders. Research is also
needed on what the optimal Vitamin D levels should be in children to
achieve maximal bone health, and the implications of chronic or
seasonal Vitamin D deficiency to the growing skeleton. Development and
testing of therapies and bone building drugs for pediatric patients are
also a pressing clinical need.
National Institute of Dental and Craniofacial Research (NIDCR).--
The Coalition urges continued research support on the effects of
systemic bone active therapeutics on the craniofacial skeleton,
including factors predisposing individuals to osteonecrosis of the jaw,
as well as novel approaches to facilitate bone regeneration.
National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK).--The Coalition supports research on the relationship between
Vitamin D and morbidity and mortality in chronic kidney disease.
Research is also needed on the value of anti-resorptive therapies, the
link between renal insufficiency and diabetic bone disease, the
differences in calcification of blood vessels, the mechanisms of
metastasis of renal cell carcinoma, and diseases that occurs in
patients with end stage chronic renal disease on hemodialysis.
National Institute of Neurological Disorders and Stroke (NINDS).--
The Coalition encourages research support into the pathophysiology of
spinal cord, brachial plexus, and peripheral nerve injuries in order to
develop targeted therapies to improve neural regeneration and
functional recovery.
National Institute of Biomedical Imaging and Bioengineering
(NIBIB).--The Coalition encourages critical research to advance our
ability to treat bone diseases and disorders through bone imaging, as
well as managing the loss of bone and soft tissue associated trauma by
advancing tissue engineering strategies to replace and regenerate bone
and soft tissue.
Mr. Chairman and members of the subcommittee, the Bone Coalition
appreciates the subcommittee's work over the years, especially your
recognition of the need to fund research addressing disease prevention
and treatment. With your assistance, NIH could provide the Federal
support to ensure that bone research and bone health are priorities.
Thank you for the opportunity to submit testimony to the
subcommittee.
______
Prepared Statement of the National Coalition of STD Directors
The National Coalition of STD Directors is a nonprofit, nonpartisan
association of public health sexually transmitted (STD) program
directors in the 65 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 Centers for Disease Control and Prevention (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 3 to 5
fold 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. Men who have sex with men (MSM) have
historically experienced high rates of all STDs, including HIV/AIDS. In
2008, 63 percent of all primary and secondary syphilis cases were among
MSM. The syphilis rate among males is now five 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/Alaskan Natives, and Hispanics are also at higher risk
of contracting STDs. In 2008, the rate of Chlamydia among African
Americans was 9 times that of whites, for American Indian/Alaskan
Natives it was 5 times higher than whites, and for Hispanics it was 3
times higher than whites. African American women experience syphilis
rates 15 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 declined more
than 22 percent since fiscal year 2003, when adjusted for inflation to
2009 U.S. dollars. 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.
The National Coalition of STD Directors requests an fiscal year
2011 funding level of $367.4 million, an increase of $213.5 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 (+$33 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,
dramatic 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 (+$25 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 (PS) 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 H1N1 outbreak.
The versatile expertise of DIS make them indispensable during a public
health crisis, but also highlight 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. Between 1999 and 2009, STD
programs across the nation have experienced a 20 percent reduction in
DIS staff.
Expand Chlamydia Screening and Infertility Prevention (+$61.5 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 HHS, 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 (USPSTF),
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 (+$40 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 20 times greater than that of
whites in 2008. African American men aged 15 to 19 years old experience
gonorrhea rates 40 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 2007, 14.6 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 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 (+$44 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 114
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 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
men who have sex with men (MSM) and minority populations, and expanded
screening in correctional facilities.
Build a Response to Viral STDs (Herpes, HPV, Hepatitis B) (+$10
million)
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.
The National Coalition of STD Directors also supports the
President's fiscal year 2011 funding request of $133.7 million for the
Teen Pregnancy Prevention Initiative, within the Office of Adolescent
Health (OAH).
We need to invest in programs that provide all of our young people
with complete, accurate, and age-appropriate sex education that helps
them reduce their risk of HIV, other STDs, and unintended pregnancy. In
these tight budget times, we are pleased that the President's fiscal
year 2011 budget increased funding for the new teen pregnancy
prevention initiative. However, by focusing the funding on teen
pregnancy prevention, and not including the equally important health
issues of STDs and HIV, we think the administration has missed an
opportunity to provide true, comprehensive sex education that promotes
healthy behaviors and relationships for all young people, including
LGBT youth. So many negative health outcomes are inter-related and we
need to strategically and systemically provide youth with the
information and services they need to make responsible decisions about
their sexual health. We request that the teen pregnancy prevention
initiative be broadened to address HIV and other STDs, in addition to
the prevention of unintended teen pregnancy. We are pleased that the
President's budget has once again included zero funding for failed
abstinence-only-until-marriage programs and we encourage the
subcommittee not to include funding for these ineffective programs.
We urge the subcommittee to substantially increase resources to
protect our Nation from the devastating consequences of STDs. The CDC
has developed programs that have significantly reduced STD rates and
the associated costs to society. We know how to prevent, control, and
treat sexually transmitted diseases; however, without additional funds,
the CDC cannot establish these programs to scale in all 50 States, U.S.
territories, and directly funded cities.
______
Prepared Statement of the National Council of State Directors of Adult
Education
Mr. Chairman, thank you for the opportunity to submit testimony
regarding the need for additional appropriations for adult education
programs.
Adult education programs serve a large number of our Nation's at-
risk citizens, from those who are unemployed to immigrants who lack the
literacy skills needed to succeed in their new home country.
At the present time our country is heavily investing in efforts to
put Americans back to work. For many of our Nation's unemployed, their
jobs have disappeared, only to be replaced by new jobs with
requirements they cannot meet because they have low literacy skills and
lack a high school diploma.
To meet the needs of these individuals, adult education programs
across the Nation are partnering with programs under title I of the
Workforce Investment Act to develop career pathways that integrate
adult education and occupational training programs. In addition, there
are programs focused on transitioning participants from adult education
programs to postsecondary education.
But current funding levels, coupled with funding from the State and
local level, prevent us from serving more than 2.3 million individuals
a year. A 2010 survey demonstrates that there are waiting lists in
every State. According to the National Assessment of Adult Literacy,
there are approximately 93 million individuals who lack the literacy
skills to reach their full potential. Thirty million individuals are at
the lowest level of literacy and cannot perform basic tasks such as
reading a bus schedule.
With the wide gap between the number of Americans who are in need
of improved literacy/education skills and the number that can be served
by the current system, we strongly encourage you to increase funding
for adult education programs to $750 million which would enable us to
at least erase the waiting list.
Mr. Chairman, adult education programs help put Americans back to
work, provide new immigrants with English language skills, assist in
transitioning individuals to higher education, and provide parents with
the skills they need to help their children succeed in school.
Adult education programs provide a wide range of services to many
individuals but are currently limited in the number of individuals we
can serve because of limited funding. While we understand the budget is
tight, we believe increased funding for adult education will provide a
strong return on your investment in our programs while we serve
undereducated adults.
Thank you again for the opportunity to submit testimony regarding
funding for adult education programs.
______
Prepared Statement of the National Down Syndrome Society
Mr. Chairman and members of the subcommittee: As Vice President 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 2011.
There are more than 400,000 people living with Down syndrome in the
United Statement, 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 other genetic
disorders, 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 for them and
others with chromosomal disorders. On behalf of the National Down
Syndrome Society, we recommend that you appropriate $5 million in the
fiscal year 2011 to the Centers for Disease Control & Prevention (CDC)
to implement the requirements of the Prenatally and Postnatally
Diagnosed Conditions Awareness Act of 2007.
As you know, Congress passed the Prenatally and Postnatally
Diagnosed Conditions Awareness Act of 2007 in October of 2008. 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, websites, 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 and the need to communicate complex information to the
more than 4 million women who are now offered prenatal screening and
testing and must weigh this information in order to give informed
consent for these new procedures.
As recently reported in an article entitled ``Changing Practice of
Obstetricians'', published in the American Journal of Obstetrics and
Gynecology in April 2009, only 36 percent of obstetricians feel ``well
qualified to counsel patients who screen positive'' for Down syndrome.
About half (51 percent) thought the training they received during
residency regarding screening and diagnosis for Down syndrome was
adequate, whereas 40 percent thought it was less than adequate and 9
percent thought it was comprehensive. Only ``29 percent of physicians
provide the pregnant woman with printed educational materials'' if the
fetus is diagnosed with Down syndrome.
In another study also published in the American Journal of
Obstetrics and Gynecology, the largest and most comprehensive study on
prenatally diagnosed Down syndrome to date, recommendations made by
mothers included: screening results should be clearly explained as a
risk assessment, not as a ``positive'' or ``negative'' result;
physicians should discuss all reasons for prenatal diagnosis including
reassurance, advance awareness before delivery of the diagnosis of Down
syndrome, adoption, as well as pregnancy termination; up-to-date
information on Down syndrome should be available; results from
amniocentesis or CVS, chorionic villi sampling, should, whenever
possible, be delivered in person, with both parents present; sensitive
language should be used when delivering a diagnosis of Down syndrome;
if obstetricians rely on genetic counselors or other specialists to
explain Down syndrome, sensitive, accurate, and consistent messages
must be conveyed; contact with local Down syndrome support groups
should be offered, if desired. A 29-member Down Syndrome Diagnosis
Study Group published an article in the American Journal of Medical
Genetics in 2009 which added to the previously mentioned
recommendations. This study recommended that the conversation where in
the diagnosis was delivered should provide answers to the questions:
What is Down Syndrome? What causes the condition? What healthcare
conditions go along with the condition? What are realistic expectations
for a child with Down syndrome living today? Also the study recommends
that healthcare professionals should use non-directive language and the
healthcare professionals should arrange for a follow-up appointment
with the parents, including any desired meetings with subspecialists.
By including $5 million in the fiscal year 2011 Labor, Health &
Human Services, 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 National Eczema Association
Dear Chairman Harkin: Chairman Harkin and Members of the Senate
Appropriations Subcommittee on Labor, Health and Human Services,
Education and Related Agencies, I am Julie Block, Chief Executive
Officer of the National Eczema Association (NEA).
As member of the Senate who strongly value the role of the National
Institutes of Health (NIH), I am writing first to express to you my
deep gratitude for your past support. The NIH is our Nation's
preeminent medical research institution and represents our best hope
for finding cures, improving treatments, and gaining a better
understanding of the diseases and conditions that affect millions of
Americans. On behalf of the NEA, I respectfully request your continued
support for NIH funding.
I would also like to thank you for inviting us to submit testimony
on our own behalf. The NEA is a 501(c)(3) nonprofit organization that
receives no Federal grants or sub grants, nor do we receive Federal
contracts or subcontracts. Our mission is to help improve the health
and quality of life of persons living with eczema/atopic dermatitis,
including those who have the disease and their loved ones. This is a
family disease. Through programs focused on advocacy, education, and
research, we involve both public and private sectors in addressing
these needs. In these current times, there is much the public does not
know or understand about how devastating this disease can be.
There are many types of eczemas, with atopic dermatitis (AD)
recognized as the most severe and chronic. Atopic dermatitis is a
genetic skin disease that affects over 30 million people in the United
States; 10 percent of the American populations have some form of atopic
dermatitis.
Atopic dermatitis falls into a category of disease called atopy,
which includes asthma and hay fever. The three together are known as
the ``Atopic Triad.'' Atopic dermatitis almost always begins in
childhood, usually during infancy. However, it is important to remember
that atopic dermatitis is not just a childhood disease, as is commonly
believed. For most people afflicted with the disease it becomes a
lifelong sentence. The skin becomes dry, scaly, red and intensely
itchy. It cracks, bleeds, weeps, and often gets infected.
For many patients with eczema, one of the worst consequences of the
disease is the isolation and withdrawal from other people and
community. Patients are often treated as if they were lepers even
though atopic dermatitis is not contagious. Some patients choose not to
have children, fearful of passing on a life of suffering to yet another
generation. Some patients feel this choice so strongly they submit to
voluntary sterilization in young adulthood. Atopic dermatitis is an
extremely isolating disease, regardless of whether that isolation stems
from internal or external factors, and many severe atopics do not leave
their homes.
Others, like the young heroine of the story I'm about to relate,
somehow find within themselves the courage to keep going, to keep
fighting, to keep believing there is a place for them in the larger
community. I hope her story not only inspires you, but inspires you to
action.
This is Angeline's story. Angeline is an adult atopic, having
eczema since birth. Her nickname in school was ``Spot''--she would hide
in the bathrooms during recess and lunchtime and scratch. She would try
with all her might not to scratch during class, not to flake skin over
her desk, not to crack and bleed. Constant, intolerable, itching has
led to lifelong use of steroid treatments, both orally and topically,
to assuage the itching and ``treat'' the eczema wounds. The constant
itching, skin flaking off in sheets, dead, dry skin, and oozing
abhorrent looking skin are just part of everyday life for Angeline.
Her eczema has resulted in severe infections, and this physical
trauma is accompanied by a level of psychic trauma few of us ever have
to confront. She has had too many days when she can literally not get
out of bed--the skin gets so bad that it eventually becomes a huge task
to even move her legs and arm joints. On top of all that, her skin
looks absolutely gruesome.
Angeline has shed many tears, and at times wondered how she would
go on. The years of bandaged hands to stop the scratching, steroid
withdrawal, bank accounts spent on creams and miracle cures, vitamins
and doctors appointments. When will it end? Some days Angeline is not
at all available to ``face the world''.
And people will tell you eczema is just a rash!
As Angeline's story suggests, doctors, researchers, and scientists
consistently underestimate the emotional consequences of this disease,
its treatments, and its complications. The general public understands
it even less. Before we can offer alternatives that will truly improve
the quality of life for eczema sufferers, we must understand the
disease mechanism and how it works. Committed physicians and ongoing
research gives us all hope.
The NEA is dedicated to raising awareness of these issues. The
Association publishes a quarterly newsletter called The Advocate,
oversees a volunteer Support Network program, distributes educational
materials to patients and medical professionals, and conducts an annual
Patient and Family Conference. As vocal advocates for atopic patients
and their families, our staff attends several professional meetings
each year, and educates governmental officials at local, State and
national levels to provide input to the budget, research, and policy
decisions about atopic dermatitis/eczema patients. In past years, the
NEA educated public officials during the Government's smallpox
vaccination campaign regarding the life-and-death consequences to
atopic patients. We have been on Capitol Hill for NIAMS day many years
in a row as a member of the National Institutes of Arthritis and
Musculoskeletal and Skin Diseases Coalition to educate legislators on
our disease.
The NEA can boast many exciting accomplishments, including over
$400,000 spent on eczema research since the inception of its research
program in 2004. One of the NEA-funded grants to Dr. Gil Yosipovitch,
MD of Wake Forest University has resulted in a major NIH grant to
continue his work on itch. We anticipate yet another NIH award for NEA-
funded research to continue exciting work on prevention of atopic
dermatitis in high-risk infants.
The NIH and the research it supports are critical to the
advancement of improved atopic dermatitis/eczema treatment and eventual
cure. As part of the Coalition of Skin Disease, we believe that when a
cure is found for any of these skin diseases, there is a good chance it
will improve our ability to find a cure for other diseases. The recent
boost in NIH funding in 2009 and 2010 was a very important step toward
regaining the lost potential of the last several years.
As you work to finalize the fiscal year 2011 appropriations, on
behalf of the NEA, I respectfully request a funding increase of at
least 7 percent for the National Institutes of Health (NIH) compared to
the fiscal year 2010 baseline level.
Help us give eczema patients and their families hope for the
pleasure of everyday life, and being good in the skin their in!
And again, thank you for your past support of biomedical research
funding.
______
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, in this testimony, NFCB:
--Thanks the subcommittee for its role in providing $25 million
station fiscal stabilization in light of the difficult economy
in last year's appropriation;
--Requests $604 million in funding for CPB for fiscal year 2013 and
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
the radio ``minority consortia'' dedicated to Native American,
Latino, and African-American radio stations;
--Requests $59.5 million in fiscal year 2011 for conversion of public
radio and television to digital technology;
--Supports CPB's funding for rural stations and assistance with new
technologies and requests report language regarding rural and
minority stations in this regard
--Supports CPB programs focused on ensuring public radio is able to
fulfill its important mission of public safety during
emergencies; and
--Supports CPB's role as a convener that can address questions and
important future trends across all public media.
Community radio fully supports the forward funding appropriation of
$604 million in Federal funding for CPB in fiscal year 2013. Money
allocated to the Corporation for Public Broadcasting assists NFCB
member stations throughout the country through community service
grants. Community service grants are the core way that CPB uses to
support radio stations--particularly targeted to stations offering the
first public radio service to a community in a rural area, or to
stations serving particular demographic constituencies. CPB's focus on
these areas is critical to ensuring that public radio does not focus
solely on higher-income audiences, but serves every American no matter
their background or their location. These targeted 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. CPB 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 importantly,
the insulation that advance funding provides is of critical importance
in eliminating both the risk of and the appearance of undue
interference with and control of public broadcasting.
Community radio supports CPB activities in facilitating programming
to Native American, Latino, and African-American radio stations. CPB
has played a critical role in providing support and assistance to radio
stations serving communities of color, particularly communities that
could be better served by noncommercial radio. While CPB has long
supported television programming focused on underserved communities,
its programs for radio are newer and are very welcome. Given the
importance and accessibility of radio in many underserved communities,
NFCB urges the subcommittee to endorse the long-term viability of these
radio minority consortia.
Specifically, with important support from CPB, Native Public Media
(NPM) has burst on to the scene to ensure that Native Americans have
access to noncommercial broadcast and new technologies alike. NPM has
worked in the last few years to facilitate applications for
noncommercial radio stations by almost 40 applicants from tribal and
native entities, bringing many of these service areas within the reach
of a public radio signal for the first time. NPM has undertaken
research to identify the spectrum allocations currently serving Indian
country in order to target better service in the future, releasing a
report called The New Media, Technology and Internet Use in Indian
Country: Quantitative and Qualitative Analyses, which included a usage
survey and case study that contains the first valid and credible data
on Internet use among Native Americans. In addition, NPM was able to
play a critical role in ensuring that tribal entities have the ability
to obtain new radio stations in the future by successfully
demonstrating to the FCC the need and legal justification for a tribal
priority in radio.
In addition, in the last year the newest minority consortium has
been started--the Latino Public Radio Consortium. The Latino Public
Radio Consortium is an organization that represents and supports 33
public radio stations. It recognizes that Latinos are under-represented
in the Nation's public broadcasting institutions, decisionmaking
structures, that there is little programming in English or in Spanish
produced by Latinos or with a Latino focus and, as a consequence,
Hispanics are vastly underrepresented among public radio's news and
public affairs audiences.\1\ To illustrate, a study by Station Resource
Group's Grow the Audience project showed that, for public radio to
acquire a representative share of the college-educated market for
Latinos, it would need to triple its audience.\2\
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\1\ Latino Public Radio Consortium, Brown Paper, p.1 available at
http://www.latinopublic radioconsortium.org/index.php?s=41.
\2\ Station Resource Group, Grow the Audience, Listening by Black
and Hispanic College Graduates (2008) at p. 17, available at http://
www.srg.org/GTA/GTA%20Black%20Hispanic%20 Report.pdf.
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During this funding year the Consortium has established the
communications and governance structure to enable the Hispanic stations
to support each other and to develop additional resources. An important
new project that is indicative of future work is the development of
Historias, a partnership with Story Corps, a national oral history
project of the Library of Congress and public radio. Through this
collaboration, Story Corps Historias will gather and record 900
individual interviews with Latinos around the country.
This year CPB is funding new services for African-American public
radio stations designed to improve and increase public media's service
to the American public. NFCB believes that this project, like the other
consortia, is vital to ensure that all Americans benefit from public
funds and the breadth and depth of public radio. In addition to the
minority consortia, CPB supports Satelite Radio Bilingue which 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. CPB also supports Native Voice One (NV1), which
is distributing politically and culturally relevant programming to
Native American stations.
Community radio supports $59.5 million in fiscal year 2011 for the
conversion to digital technology. While public television's digital
conversion needs were 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.
This development of second and third audio channels will potentially
double or triple the service that public radio can provide listeners,
particularly in unserved and underserved communities. In addition,
public radio is in great need of CPB's leadership and resources to
transition to new media platforms, in particular through such projects
as the American Archive, which will make existing programming
accessible to all and on all platforms.
Community radio supports CPB's funding for rural stations and
assistance with new technologies. 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 so that 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.
A good example of CPB's role is the Public Media Innovation grant
CPB gave KAXE, one of NFCB's rural members, a chance to experiment with
the concept of becoming ``a web operation that owned a radio station.''
PMI described this project as one of the most visionary proposals they
funded. As part of the grant, KAXE began the development of Northern
Community Internet, which would provide hyper-local news content to
more than a dozen communities in northern Minnesota. Through this
project, KAXE learned many important things about how to create content
that is relevant and accessible across a Web site, radio station, and
social media. The journalists involved continue to be very interested
in the project, even though the current pilot is over.
Community radio supports CPB programs focused on ensuring public
radio is able to fulfill its important mission of public safety during
emergencies. CPB funding has supported an important new project led by
NFCB called Station Action for Emergency Readiness (SAFER). NFCB, in
partnership with NPR and with support from CPB, has developed a step-
by-step manual that stations can use to develop and/or supplement their
own emergency readiness plans; a set of digital tools that stations can
embed in their own Web sites to keep community members informed; and
links to national and local resources that can supplement station's
coverage. This project was inspired by the experience of NFCB member
WWOZ in New Orleans as a result of Katrina and was furthered by the
work of NFCB member KWMR in Point Reyes Station, California. KWMR is
small and local community and provided absolutely critical life-saving
information to its community during terrible floods of 2004-2005.
Community radio supports CPB's role as a convener that can address
questions and important future trends across all public media. CPB
plays an extremely important role in the public and Community Radio
system: it convenes 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.
Thank you for your consideration of our testimony.
______
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 the $2.4 billion for the
Consolidated Health Centers Program in fiscal year 2011, as included in
the administration's budget proposal.
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 HCH Program--administered by the Health Resources and
Services Administration (HRSA)--currently supports 207 HCH projects in
all 50 States, the District of Columbia, and Puerto Rico. Congress
established Health Care for the Homeless 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 more than 1 million
patients in 2009--a sizable number, but far below the estimated 4
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, to include through the American Recovery and
Reinvestment Act of 2009. 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.
Investments in Community Health Centers contained the Patient
Protection and Affordable Care Act will also be a significant tool that
will help clinics grow to meet the needs of patients seeking primary
care, especially as the Medicaid expansion provisions are enacted in
2014. This Medicaid expansion will be a greatly needed improvement for
our homeless patients, since most are currently ineligible for
coverage.
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, the
unemployment rate was 9.7 percent in March 2010. Given the prevalence
of employer-sponsored health coverage, high unemployment leaves many
Americans without health coverage, thus creating a greater need for
safety net services provided by community health centers.
Fiscal Year 2011 Appropriations.--In recognition of the growing
need for primary healthcare services, the House Committee on
Appropriations along with other Members of Congress has been supportive
of strengthening and expanding community health centers. In the
President's fiscal year 2011 budget proposal, the Community Health
Center program receives $2.4 billion--$290 million above the fiscal
year 2010 appropriation. This includes a total of $209 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 the $2.4 billion for the Community
Health Center program (including $209 million for the HCH program), as
contained in the administration's fiscal year 2011 budget proposal.
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 Kidney Foundation
The National Kidney Foundation (NKF) appreciates the opportunity to
present public witness testimony for the written record in support of
fiscal year 2011 funding for the Centers for Disease Control and
Prevention.
Kidney disease is the ninth leading cause of death in the United
States. More than 26 million American adults are estimated to have some
level of chronic kidney disease (CKD), yet most of them are
undiagnosed. Early detection and treatment can prevent or slow the
progression to irreversible kidney failure, or end-stage renal disease
(ESRD). Many do not even reach end stage; late-stage CKD patients are
far more likely to die of cardiovascular disease than to reach ESRD,
and early detection is beneficial here also.
Approximately 70 percent of new ESRD cases are directly
attributable to diabetes or hypertension (with diabetes alone the cause
of nearly half of all new cases annually). Furthermore, ESRD increases
dramatically with age, and the prevalence among racial and ethnic
minorities is much higher than among whites. Medicare covers dialysis
or transplantation regardless of age or other disability (the only
disease-specific coverage under the program) and the ESRD Program has
saved millions of lives. However, the cost is substantial and
disproportionate to the Medicare population. Less than 7 percent of the
Medicare population carries a diagnosis of CKD, but they account for 21
percent of Medicare expenditures.
Despite the social and economic impact, no national public health
program focusing on early detection and treatment of CKD existed until
2005, when Congress provided funding for fiscal year 2006 to initiate a
Chronic Kidney Disease Program at the CDC. The CKD program, which has
received approximately $2 million annually, will build capacity and
infrastructure at CDC for a kidney disease public health program. The
objectives of the initiative are to assess and monitor the burden of
CKD and its risk factors; develop methods to identify high risk
populations; develop public health strategies to prevent the
development of CKD and reduce its progression to kidney failure; and,
develop models to assess the economic burden of CKD.
In 2008 and 2009, the CDC and NKF collaborated on a demonstration
project to detect individuals with or at high risk of CKD. The CKD
Health Evaluation and Risk Information Sharing project (CHERISH) uses
diabetes, hypertension, and age (older than 50) as risk factors to
select participants for the screenings. Eight screenings of more than
800 individuals in four States detected CKD in over one-quarter of the
individuals, who demonstrate the need for better risk factor control of
high blood pressure, diabetes, and high cholesterol. Awareness of
kidney disease remains very low.
Early detection and intervention of chronic kidney disease is not
difficult and intervention tools to treat early CKD are widely
available. The level of progression to chronic kidney failure or ESRD
and the rate of premature cardiovascular death are unacceptable.
Continued support, as requested by the administration in its 2011
budget request, will promote comprehensive public health approaches in
CKD by the CDC, including screening, surveillance, economic analysis,
coordination with ongoing internal activities (cardiovascular disease
and stroke prevention, diabetes, obesity, family history/genetics,
communicable disease such as hemodialysis catheter infections),
interagency collaboration (NIH, AHRQ, and HHS) and ultimately
implementation through state departments of health to impact care,
improve outcomes and reduce costs.
______
Prepared Statement of the National Minority Consortia
The National Minority Consortia (NMC) submits this statement on the
fiscal year 2013 appropriation for the Corporation for Public
Broadcasting (CPB). The NMC is a coalition of five national
organizations dedicated to bringing the unique voices and perspectives
from America's diverse communities into all aspects of public
broadcasting and to other media, including content transmitted
digitally over the Internet. The role we fulfill in this regard has
been crucial to public broadcasting's mission for more than 30 years.
We are unique as organizations and as a coalition of organizations in
the services we provide in access, training, and support for important
and timely public interest content to our communities and to public
broadcasting. We ask the subcommittee to:
--Direct CPB to increase its efforts for diverse programming with
commensurate increases for minority programming and for
organizations and stations located within underserved
communities;
--Direct CPB to establish a percentage basis for biennial funding of
the NMC to permit long-range financial and strategic
planning;\1\
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\1\ Currently funding for the NMC, in the aggregate, represents
only 1.2 percent of CPB's request. We suggest increasing that
percentage to an amount equal to not less than 20 percent of the amount
requested for television programming, or approximately $20 million, to
be split equally among the five groups listed here and beginning
immediately upon enactment of this legislation.
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--Direct CPB to establish an annual ``report card'' on diversity to
track efforts to better represent the full breadth of the
American people and their experiences through public
television, public radio and nonprofit media online;
--Direct CPB to publish on the Internet clear and enforced guidelines
for all CPB-directed funding, including funds jointly
administered by PBS and NPR, and end the closed-door funding
processes historically in place, especially as the current
practices favor existing relationships and can be seen as
biased against minority applicants, in particular.
Report Language.--We ask for report language, specifically an
addition to report language from the fiscal year 2006 Appropriations
Act (and also included in the fiscal year 2007 Senate report), which
recognizes the contribution of the NMC and directs that the CPB
partnership with us be expanded. The Report stated:
``The Committee recognizes the importance of the partnership CPB
has with the National Minority Public Broadcasting Consortia, which
helps develop, acquire, and distribute public television programming to
serve the needs of African American, Asian American, Latino, Native
American, Pacific Islander, and many other viewers. As many communities
in the Nation welcome increased numbers of citizens of diverse ethnic
backgrounds, the local public television stations should strive to meet
these viewers' needs. With an increased focus on programming to meet
local community needs, the Committee encourages CPB to support and
expand this critical partnership.'' (S. Rpt. 109-103, p. 298)
We request that the above language be modified to direct CPB to
increase its funding of the NMC and the various minority radio
consortia to a level equal, in the aggregate, to 20 percent of funds
allocated to television production.
Fiscal Year 2013 Appropriation.--We support a fiscal year 2013
advance appropriation for CPB of $604 million, which recognizes the
need to develop content that reaches across traditional media
boundaries, such as those separating television and radio. However, we
feel strongly that should CPB receive this appropriation, CPB should be
directed to engage in transparent and fair funding practices that
guarantee all applicants equal access to these public resources. In
particular, we urge Congress to direct CPB to insert language in all of
its funding guidelines that encourages and rewards public media that
fully represents and reaches a diverse American public.\2\
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\2\ According to the 2008 Public Radio Tech Survey, 90 percent of
public radio listeners are White. Of those, 84 percent are college
educated, with 48 percent having graduate degrees. This compares to
just 9 percent of Americans who have postgraduate degrees. It is
therefore mandatory that we prioritize actually ``reaching'' a diverse
audience of Americans and not simply reflecting diverse and often
misleading staffing numbers to measure public media's effectiveness in
serving all of the American taxpayers that fund CPB.
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While public broadcasting continues to uphold strong ethics of
responsible journalism and thoughtful examination of American history,
life and culture, including the ways we are a part of a global society,
it has not kept pace with our rapidly changing public as far as
diversity is concerned. Members of minority groups continue to be
underrepresented on both the programming and oversight levels within
public broadcasting as well as on the content production side. There
are fewer than five executives of diverse background at the highest
levels in the three leading organizations within public broadcasting.
This is unacceptable in America today, where minorities comprise more
than 35 percent of the population.
Public broadcasting has the potential to be particularly important
for our Nation's growing minority and ethnic communities, especially as
we transition to a broadband-enabled, 21st century workforce that
relies on the skills and talent of all of our citizens. While there is
a niche in the commercial broadcast and cable world for quality
programming about our communities and our concerns, it is in the public
broadcasting sphere where minority communities and producers should
have more access and capacity to produce diverse high-quality
programming for national audiences. We therefore, urge Congress to
insert strong language in this act to ensure that this is the case and
that these opportunities are made available to minorities and other
underserved communities.
About the NMC.--With primary funding from the CPB, the NMC serves
as an important component of American public television as well as
content delivered over the Internet. By training and mentoring the next
generation of minority producers and program managers as well as
brokering relationships between content makers and distributors (such
as PBS, APT, and NETA), we are in a perfect position to ensure the
future strength and relevance of public television and radio television
programming from and to our communities. However, these efforts are
vulnerable because of chronic underfunding and lack of meaningful and
ongoing representation within CPB's decisionmaking processes. This
instability, coupled with what is essentially a decrease in our funding
over time, are the primary reasons that have led to a public media that
has become less diverse over the past 5 years.\3\
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\3\ CPB funding for the NMC remained flat for 13 years until fiscal
year 2008, at approximately $1 million per year per consortia. At that
time, we received a one-time increase of $150,000 per organization. In
fiscal year 2009, we received another one-time increase of
approximately $500,000 each, but have been told that does not reflect a
permanent increase. Over this same 13-year period, CPB's budget nearly
doubled.
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This is obviously not the case in the rest of America. With
minority populations already estimated at more than 35 percent of the
U.S. population, it is more important that our public institutions
reflect this reality.
Individually, each NMC organization is engaged in cultivating
ongoing relationships with the independent producer community by
providing technical assistance and program funding, support and
distribution. Often the funding we provide is the initial seed money
for a project, thus allowing it to develop. We also provide numerous
hours of programming to individual public television and radio
stations, programming that is beyond the production reach of most local
stations. To have a real impact, we need funding that recognizes and
values the full extent of minority participation in public life.
While the NMC organizations work on projects specific to their
communities, the five organizations also work collaboratively. An
example of a joint production in which the NMC provided the initial
seed money is ``Unnatural Causes: Is Inequality Making Us Sick?'', a
multi-part series that uncovers the roots of racial and socio-economic
disparities in health and spotlights community initiatives to achieve
health equality. Our seed money enabled the project to go forward and
to attract additional funding. We are also co-producers of and
presenters in this series, which originally aired in 2008 and was
rebroadcast just this year. Additionally, we jointly funded an online
initiative around the Presidential election in 2008 and continue to
explore as a group other topics of national importance.
CPB Funds for the NMC.--The NMC receives funds from two portions of
the CPB budget: organizational support funds from the Systems Support
and programming funds from the Television Programming funds. The
organizational support funds we receive are used for operations
requirements and also for programming support activities and for
outreach to our communities and system-wide within public broadcasting.
The programming funds are re-granted to producers, used for purchase of
broadcast rights and other related programming activities. Each
organization solicits applications from our communities for these
funds. A brief description of our organizations follows:
Center for Asian American Media.--CAAM's mission is to present
stories that convey the richness and diversity of Asian-American
experiences to the broadest audience possible. We do this by funding,
producing, distributing, and exhibiting works in film, television, and
digital media. Over our 25-year history we have provided funding for
more than 200 projects, many of which have gone on to win Academy, Emmy
and Sundance awards, examples of which are Daughter from Danang; Of
Civil Rights and Wrongs: The Fred Korematsu Story; and Maya Lin: A
Strong Clear Vision. CAAM presents the annual San Francisco
International Asian American Film Festival and distributes Asian
American media to schools, libraries, and colleges.
Latino Public Broadcasting (LPB).--LPB supports the development,
production, and distribution of public media content that is
representative of Latino people, or addresses issues of particular
interest to Latino Americans. LPB provides a voice to the diverse
Latino community throughout the United States. Since its creation in
1998 by Edward James Olmos, LPB has provided more than 200 hours of
programming to public television, including Roberto Clemente, the
Sundance award winners Farmingville and El General, and Emmy-nominated
The Life and Times of Frida Kahlo. LPB has organized more than 100
workshops for the advancement of Latino producers and launched the
first Latino anthology series on public television, VOCES, which aired
its second season in 2009 on PBS stations across the country. LPB has
received the Imagen Award and the National Council of La Raza's Alma
Award.
The National Black Programming Consortium (NBPC).--NBPC develops,
produces, and funds television and more recently audio and online
programming about the Black experience for American public media
outlets. Since its founding in 1979, NBPC has provided hundreds of
broadcast hours documenting African- American history, culture, and
experience to public television and launched major initiatives that
have brought important public media content to diverse audiences. In
2006, NBPC launched the New Media Institute (NMI) a program designed to
train makers of public media to provide real value to communities using
digital platforms. Currently, NBPC is preparing to launch the Public
Media Corps, a highly visible, national, broadband-based program
designed to extend the reach of taxpayer funded diverse content into
the digital realm, to recruit the next generation of content makers,
innovators and other stakeholders coming from all of America's
communities, and to empower all Americans with relevant, critical, and
timely information.
Native American Public Telecommunications (NAPT).--NAPT shares
Native stories with the world through support of the creation,
promotion, and distribution of Native media. Founded in 1977, through
various media-public television and radio, and the Internet-NAPT brings
awareness of Indian and Alaska Native issues. Through the CPB-funded
Production Fund, 5 to 10 new projects are supported each year. Last
year, we worked with American Experience in the award winning We Shall
Remain, a five-part Native history series. NAPT operates the AIROS
Native Network, a 24/7 Internet radio station that features music,
news, interviews, documentaries, and audio theater. We also feature
downloadable podcasts with Native filmmakers, musicians, and tribal
leaders. VisionMaker Video is now the premier source for quality Native
educational and home videos. Profits made from video sales are invested
in new NAPT productions. All aspects of our programs encourage the
involvement of young people to learn more about careers in the media--
to be the next generation of storytellers. Through our location at the
University of Nebraska--Lincoln, we offer student employment,
internships, and fellowships. Reaching the general public and the
global market is the ultimate goal for the dissemination of Native-
produced media.
Pacific Islanders in Communications (PIC).--Since 1991, PIC has
delivered programs and training that bring voice and visibility to
Pacific Islander Americans. PIC presented the broadcast premier of the
award-wining film, Whale Rider, on PBS--the story of young girl who
confronts years of tribal tradition to fulfill her destiny as the
leader of her people. Other PBS broadcasts include Time and Tide, about
the devastating effects of global warming on the Pacific Islands and
Polynesian Power the story of Pacific Islanders in the NFL. Currently
PIC is developing a multi-part series, Expedition: Wisdom, in
partnership with the National Geographic Society. PIC offers a wide
range of development opportunities for Pacific Island producers through
travel grants, seminars and media training. Producer training programs
are held in the U.S. territories of Guam and American Samoa, as well as
in Hawai`i, on a regular basis.
Thank you for your consideration of our recommendations. We see new
opportunities to increase diversity in programming, production,
audience, and employment in the new media environment, and we thank
Congress for support of our work on behalf of our communities.
______
Prepared Statement of the National Marfan Foundation
Mr. Chairman, thank you for the opportunity to submit testimony
regarding the fiscal year 2011 budget for the National Heart, Lung and
Blood Institute, the National Institute of Arthritis, Musculoskeletal
and Skin Diseases, and the Centers for Disease Control and Prevention.
The National Marfan Foundation is grateful for the subcommittee's
strong support of the National Institutes of Health (NIH) and the
Centers for Disease Control and Prevention, 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.
fiscal year 2011 appropriations recommendations
National Institutes of Health
Mr. Chairman, NMF joins with other voluntary patient and medical
organizations in recommending an appropriation of $35 billion for the
National Institutes of Health in fiscal year 2011. This level of
funding will ensure continued expansion of research on rare diseases
like Marfan syndrome and build upon the significant investment provided
to the NIH in the American Recovery and Reinvestment Act.
National Heart, Lung and Blood Institute
Pediatric Heart Network Clinical Trial
NMF applauds the National Heart, Lung and Blood Institute 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.
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 the
growth factor TGF-beta plays 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.
Over the past 4 years, more than 500 Marfan syndrome patients (age
6 months to 25 years) have been enrolled in this study. Patients are
randomized onto either losartan or atenolol (a beta blocker that is the
current standard of care for Marfan patients with an enlarged aortic
root). We are on schedule to meet the trial's enrollment target of 604
patients by the end of this year. This is a noteworthy accomplishment
in itself given the rarity of Marfan syndrome. We anxiously await the
results of this first-ever clinical trial for our patient population.
It is our hope that losartan will emerge as the new standard-of-care
and greatly reduce the need for surgery in at-risk patients.
Mr. Chairman, NMF is proud to actively support the losartan
clinical trial in partnership with the Pediatric Heart Network.
Throughout the life of the trial we have provided 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.
Evaluation of Surgical Options for Marfan Syndrome Patients
Mr. Chairman, we are grateful for the subcommittee's
recommendations in the fiscal year 2010 bill encouraging NHLBI to
support research on surgical options for Marfan syndrome patients.
For the past several years, the NMF has supported an innovative
study looking at outcomes in Marfan syndrome patients who undergo
valve-sparing surgery compared with valve replacement. Initial findings
were published last year in the Journal of Thoracic and Cardiovascular
Surgery. Some short term questions have been answered, most importantly
that valve-sparing can be done safely on Marfan patients by an
experienced surgeon. The consensus among the investigators however is
that long-term durability questions will not be answered until patients
are followed for 10 years.
As a result, the principal investigators involved in the study
recently submitted an RO-1 grant proposal to the NHLBI seeking support
for this effort. Confirming the utility and durability of valve sparing
procedures will save our patients a host of potential complications
associated with valve replacement surgery. We encourage the
subcommittee to continue its support for this much-needed research in
fiscal year 2011.
NHLBI ``Working Group on Research in Marfan Syndrome and
Related Conditions''
In 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.''
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.
National Institute of Arthritis and Musckuloskeletal and Skin Diseases
NMF is proud of its longstanding partnership with the National
Institute of Arthritis and Musculoskeletal and Skin Diseases. Dr.
Steven Katz has been a strong proponent of basic research on Marfan
syndrome during his tenure as NIAMS director and has generously
supported several ``Conferences on Heritable Disorders of Connective
Tissue.'' Moreover, the Institute has provided invaluable support for
Dr. Dietz's mouse model studies. The discoveries of fibrillin-1, TGF-
beta, and their role in muscle regeneration and connective tissue
function were made possible in part through collaboration with NIAMS.
As the losartan trail continues to move 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 on this and other
research.
Centers for Disease Control and Prevention
Mr. Chairman, we are very grateful to you and the subcommittee for
your support of a Marfan syndrome awareness project currently being
developed by the NMF and the CDC. 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.
Our collaboration with the CDC in fiscal year 2010 will enable us to
expand our outreach to the general public and healthcare providers and
ultimately save lives.
It is a hopeful time in our community as we reach out to at-risk
populations about the cardiovascular complications associated with
Marfan syndrome. Just last month, the American College of Cardiology
and the American Heart Association issued landmark practice guidelines
for the treatment thoracic aortic aneurysms and dissections. The NMF is
promoting awareness of the new guidelines in collaboration with other
organizations through a new Coalition known as TAD; the Thoracic Aortic
Disease Coalition. We hope to partner with the CDC in fiscal year 2011
to increase awareness of the guidelines so all patients will be
adequately diagnosed and treated.
For fiscal year 2011, NMF joins with the CDC Coalition in
recommending an appropriation of $8.8 billion for the CDC. We also join
with the Friends of the National Center on Birth Defects and
Developmental Disabilities in recommending a funding level of $163.5
million for NCBDD in 2011. NCBDD and its single-gene disorders program
serve as the home within CDC for the Marfan syndrome community.
______
Prepared Statement of the National Postdoctoral Association
Mr. Chairman and members of the subcommittee: Thank you for this
opportunity to testify in regard to the fiscal year 2011 funding for
the National Institutes of Health (NIH). We are writing today in regard
to support for postdoctoral scholars, specifically in support of the 6
percent increase in NIH training stipends, as requested in the
President's budget.
Background: Postdocs are the Backbone of U.S. Science and Technology
According to estimates by The National Science Foundation (NSF)
Division of Science Resource Statistics, there are approximately 89,000
postdoctoral scholars in the United States \1\. The NIH and the NSF
define a ``postdoc'' as: An individual who has received a doctoral
degree (or equivalent) and is engaged in a temporary and defined period
of mentored advanced training to enhance the professional skills and
research independence needed to pursue his or her chosen career path.
The number of postdocs has been steadily increasing. The incidence of
individuals taking postdoc positions during their careers has risen,
from about 25 percent of those with a pre-1972 doctorate to 46 percent
of those receiving their doctorate in 2002-2005 \2\. Moreover, the
number of science and engineering doctorates awarded each year is
steadily rising with doctorates awarded in the medical/life sciences
almost tripling between 2003 and 2007 \3\.
---------------------------------------------------------------------------
\1\ National Science Foundation Division of Science Resource
Statistics. (January 2010). Science and engineering indicators 2010.
Arlington, VA: National Science Board.
\2\ Ibid.
\3\ Ibid.
---------------------------------------------------------------------------
Postdocs are critical to the research enterprise in the United
States and are responsible for the bulk of the cutting edge research
performed in this country. Consider the following:
--Fully 43 percent of first authors on Science papers are
postdocs.\4\
---------------------------------------------------------------------------
\4\ Davis, G. 2005. Doctors without orders. American Scientist
93(3, supplement). http://postdoc.sigmaxi.org/results/.
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--According to the National Academies, postdoctoral researchers
``have become indispensable to the science and engineering
enterprise, performing a substantial portion of the Nation's
research in every setting.'' \5\
---------------------------------------------------------------------------
\5\ COSEPUP. (June 2001). Enhancing the postdoctoral experience for
scientists and engineers. Washington, D.C.:National Academy Press. p.
10.
---------------------------------------------------------------------------
--Postdoctoral training has become a prerequisite for many long-term
research projects.\6\ In fact, the postdoc position has become
the de facto next career step following the receipt of a
doctoral degree in many disciplines.
---------------------------------------------------------------------------
\6\ COSEPUP. (June 2001). Enhancing the postdoctoral experience for
scientists and engineers. Washington, D.C.: National Academy Press. p.
11.
---------------------------------------------------------------------------
--The retention of women and under-represented groups in scientific
research depends upon their successful and appropriate
completion of the postdoctoral experience.
--Postdoctoral scholars carry the potential to solve many of the
world's most pressing problems; they are the principal
investigators of tomorrow.
Unfortunately, postdocs are routinely exploited. They are paid a
low wage relative to their years of training and are often ineligible
for workman's compensation, disability insurance, paid maternity or
paternity leave, employer-sponsored medical benefits, and retirement
accounts.
The NPA advocates for policies that support postdoctoral training.
We advocate for policy change within the research institutions that
host postdoctoral scholars. More than 150 institutions, including the
National Institutes of Health (NIH) and the National Science Foundation
(NSF) have adopted portions of the NPA's recommended practices.
Problem: Postdoc Salaries/Stipends Don't Meet Cost-of-Living Standards
The NIH leadership has been aware that these stipends are too low
since 2001, after the publication of the results of the study Enhancing
the Postdoctoral Experience for Scientists and Engineers conducted by
The National Academies' Committee on Science, Engineering and Public
Policy (COSEPUP). In response, the NIH pledged (1) to increase entry-
level stipends to $45,000 by raising the stipends at least 10 percent
each year and (2) to provide automatic cost-of-living increases each
year thereafter to keep pace with inflation.
Without sufficient appropriations from Congress, the NIH has not
been able to fulfill its pledge. In 2007, the stipends were frozen at
2006 levels and since then have only been raised twice: by 1 percent
each year in 2009 and 2010. The 2010 entry-level training stipend is
$37,740, the equivalent of a GS-8 position in the Federal Government
(NIH Statement NOT-OD-10-047), despite the postdocs' advanced degrees
and specialized technical skills. Furthermore, this stipend remains far
short of the promised $45,000. Certainly, it is not reflective of any
cost-of-living increases.
The NPA's research has shown that the NIH training stipends are
used as a benchmark by research institutions across the country for
establishing compensation for postdoctoral scholars. In order to keep
the ``best and the brightest'' scientists in the U.S. research
enterprise, the NPA believes that it is extremely important that
Congress appropriate funding for the 6 percent increase in training
stipends.
Please consider the following requests from scientists in other
countries:
--In 2009, the NPA was approached by a scientist from Qatar for help
in recruiting U.S. scientists, and the Qatar Foundation is
prepared to offer compensation and benefits that would far
exceed those received by most postdocs in the United States.
--Scientists from Canada, China, Japan, and Australia, among other
countries, have been seeking the NPA's advice and have asked
the NPA to establish partnerships with their organizations.
And the following statistics:
--Although the 2007 U.S. expenditures on Research and Development
(R&D) exceeded that of any other country/region, from 1996 to
2007, the U.S. R&D/GDP ratio held steady, while China's ratio
doubled.\7\
---------------------------------------------------------------------------
\7\ National Science Foundation Division of Science Resource
Statistics. (January 2010). Science and engineering indicators 2010.
Arlington, VA: National Science Board.
---------------------------------------------------------------------------
--From 1996 to 2007, the R&D growth rate for the Asia/Pacific region
increased from 24 to 31 percent, while the North American
region's growth rate decreased from 40 to 35 percent.\8\
---------------------------------------------------------------------------
\8\ Ibid.
---------------------------------------------------------------------------
--From 1996 to 2007, the United States average annual growth of R&D
expenditures averaged 5 percent, whereas China's average annual
growth topped 20 percent.\9\
---------------------------------------------------------------------------
\9\ Ibid.
---------------------------------------------------------------------------
If the United States is to stay competitive in the global research
enterprise, there needs to be continued, steady increases in NIH
funding. If the U.S. research enterprise is to keep the best and
brightest of postdoctoral scholars, there needs to be a significant
increase in training stipends, sooner rather than later.
Solution: Keep the NIH's Original Promise To Raise the Minimum Stipends
In the 2010 NIH budget request, H.R. 3293 contained a 2-percent
increase in the NRSA Stipend level. The Senate version of the bill
contained no increase. In December 2009 the House-Senate Subcommittee
reached a consensus and approved a 1-percent increase in the NRSA
stipend level.
The NPA would ask the subcommittee to recognize that such small
increases are simply not enough. We ask the subcommittee to honor the
President's request (NIH Summary of the Fiscal Year 2011 President's
Budget):
Ruth L. Kirschstein National Research Service Awards.--A total of
$824.4 million, which is a 6 percent increase more than the fiscal year
2010, will be directed to training stipends. This increase sends a
clear message to both existing and ``would be'' scientists that their
efforts are valued.
The NPA believes it is fair, just, and necessary to reward the new
scientists who will do the bulk of the research discovering cures for
disease and developing new technologies to improve the quality of life
for millions of people in the United States. Accordingly, we also
recommend that the NIH:
--Review the base stipend amount in terms of what it should be today,
9 years after the pledge was made.
--Provide cost-of-living adjustments for postdoctoral scholars
located in regions with higher costs of living.
--Develop a funding mechanism to provide supplemental funding for
postdoctoral scholars on research grants that would help to
ensure equitable compensation for all of the NIH-funded
postdoctoral scholars.
Finally, 10 years have passed since the National Academies' COSEPUP
study on the postdoc. The NPA applauds the changes that have taken
place to improve the postdoc situation but also recognizes that many
serious issues remain unresolved that may, and most probably will,
negatively affect the future U.S. research workforce. Thus, the NPA
recommends that the Senate mandates and appropriate funds for a follow-
up study that would provide information about the state of the
postdoctoral community today.
Thank you for your consideration.
______
Prepared Satement of the National Psoriasis Foundation
introduction and overview
The National Psoriasis Foundation (the Foundation) appreciates the
opportunity to submit written testimony for the record regarding fiscal
year 2011 Federal funding needs for psoriasis and psoriatic arthritis
research. The Foundation serves as the world's largest patient-driven,
nonprofit, voluntary organization committed to finding a cure for and
eliminating the devastating effects of psoriasis and psoriatic
arthritis through research, advocacy, and education. Psoriasis--the
Nation's most prevalent autoimmune disease, affecting as many as 7.5
million Americans--is a genetic, chronic, inflammatory, painful,
disfiguring, and life-altering disease that requires life-long,
sophisticated medical intervention and care. Psoriasis imposes serious
adverse effects on affected individuals and families, and 30 percent of
people with psoriasis also develop psoriatic arthritis, which causes
pain, stiffness, and swelling in and around the joints and can lead to
permanent disability.
The Foundation seeks to advance public and private efforts to
improve treatment of psoriasis and psoriatic arthritis, 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
normal lives with the highest possible quality of life. We work 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. To that end, we are most grateful
that, in fiscal year 2010, Congress addressed the need to collect
epidemiological data about psoriasis, by appropriating $1.5 million for
researchers at the Centers for Disease Control and Prevention's (CDC)
National Center for Chronic Disease Prevention and Health Promotion
(NCCDPHP) to begin the process of developing a national psoriasis and
psoriatic arthritis data collection and patient registry. Considerable
progress has been made, in the short amount of time since the initial
appropriation, to develop this registry in a thoughtful and deliberate
manner. We respectfully request that Congress continue to support this
important initiative, by appropriating $2.5 million in fiscal year 2011
to allow this national psoriasis data collection initiative to move
into the implementation phase. With additional fiscal year 2011
funding, researchers can begin to collect data and increase our
understanding of the co-morbidities, such as diabetes and heart attack,
which are associated with psoriasis; examine the relationship of
psoriasis to other public health concerns (e.g., smoking and obesity);
and gain important insight into the long-term impact and treatment of
psoriasis and psoriatic arthritis.
In addition, the Foundation supports the President's fiscal year
2011 budget request for a $1 billion increase in funding for the
National Institutes of Health (NIH). The Foundation urges the
subcommittee to provide a total fiscal year 2011 allocation of $32.2
billion to NIH; this funding will help 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 expand on
our nascent understanding of psoriasis and psoriatic arthritis
patients' myriad co-morbid conditions.
the impact of psoriasis and psoriatic arthritis
Psoriasis typically first strikes between the ages of 15 and 25,
but can develop at any time and usually lasts a lifetime. Total direct
and indirect healthcare costs of psoriasis are calculated at more than
$11.25 billion 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 still are 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
psoriatic arthritis and other co-morbidities, such as Crohn's disease,
diabetes, metabolic syndrome, obesity, hypertension, heart attack,
cardiovascular disease, and liver disease. Recent studies have found
that people with severe psoriasis have a 50 percent higher mortality
risk and die 3 to 6 years younger than those who do not have psoriasis.
Studies have found 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 effective, safe, long-term, and
affordable therapies to allow them to live normally and improve the
overall quality of their lives. Due to the nature of the disease,
patients have to cycle through available treatments, which often stop
working. While there are an increasing number of methods to control the
disease, there is no cure. Often the treatments have serious side
effects and can pose long-term risks for patients (e.g., suppress the
immune system, deteriorate organ function, etc.). The lack of viable,
long-term methods of control for psoriasis could be addressed through
an increased Federal commitment to epidemiological, genetic, clinical
and basic research. NIH and CDC research, taken together, hold the key
to improved treatment of these diseases, better diagnosis of psoriatic
arthritis and eventually a cure for psoriatic conditions.
the role of cdc in psoriasis and psoriatic arthritis research
Despite our increased understanding of the auto-immune
underpinnings of psoriasis and its treatments, there is a dearth of
population-based epidemiology data on psoriatic disease. The majority
of existing epidemiological studies of psoriasis are based on case
reports, case series and cross-sectional studies. Several analytical
studies have been performed to identify potentially modifiable risk
factors (e.g., smoking, diet, etc.) and some have yielded conflicting,
or inconsistent, results. In addition, most case-controlled studies
have been hospital-based, or specialty clinic-based, and, therefore,
are limited in their value. Broadly representative population-based
studies of psoriasis are lacking and needed.
There is enormous opportunity to investigate the epidemiology of
psoriasis, as there are still wide gaps in our knowledge of this
disease. For example, there is a critical need to better understand the
natural progress of chronic plaque psoriasis in order to identify which
patients may experience spontaneous remissions and which patients may
experience flares of their disease--and when and why. Large, broadly
representative population-based studies can expand our understanding of
the potential risk factors for developing psoriasis, and future
interventional trials can determine if altering modifiable risk
factors, such as smoking and obesity, leads to a lower risk of
psoriasis. Research into triggers and causes of psoriatic disease is
also likely to be useful in determining advancements for other auto-
immune disorders. Finally, determining the relative importance of
psoriasis, its treatments and its associated behaviors with the risk of
developing co-morbidities--such as cardiovascular disease, cancer, and
other diseases--will allow health professionals to better counsel
patients and help them interpret long-term safety of novel therapies
for psoriasis. The data collection and registry underway at the CDC
will significantly advance our understanding of psoriatic disease and
help answer some of the most pressing and perplexing questions facing
researchers, clinicians, and patients.
psoriasis and psoriatic arthritis research at nih
It has taken nearly 30 years to understand that psoriasis is, in
fact, not solely a disease of the skin but also of the immune system.
In recent years, scientists have finally identified the immune cells
involved in psoriasis. The last decade has seen a surge in our
understanding of these diseases accompanied by new drug development.
Scientists are poised as never before to make major breakthroughs.
Within the NIH, the National Institute of Arthritis and
Musculoskeletal and Skin Diseases, 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--or have funded--
psoriasis research. Additionally, research activities that relate to
psoriasis or psoriatic arthritis also have been undertaken at the
National Cancer Institute; however, the Foundation maintains that many
more NIH Institutes and Centers have a role to play, especially with
respect to the myriad co-morbidities of psoriasis, as noted earlier.
Although overall NIH funding levels improved for psoriasis research in
fiscal year 2010, and funding was boosted through stimulus funding
awards of $3 million in fiscal year 2009 and (an estimated) $2 million
in fiscal year 2010, the Foundation remains concerned that, generally,
total NIH funding is not keeping pace with psoriasis and psoriatic
arthritis research needs. Further, the Federal Government's investment
in psoriasis and psoriatic arthritis research is not commensurate with
the impact of the disease. An analysis of longitudinal Federal funding
data shows that, on average, NIH has spent approximately $1 per person
with psoriasis--per year--over the past decade. We commend NIH for the
increased fiscal year 2009 psoriasis research investment, which is
currently estimated at approximately $1.70 per psoriasis patient.
According to Psoriasis Foundation scientific advisors, approximately
$37.5 million in NIH sponsored grants (about $5 per psoriasis patient
per year) over 5 years is the Federal biomedical investment needed to
achieve the next phase of progress toward improved psoriasis and
psoriatic arthritis treatments and a cure.
Adequate investment in psoriasis and psoriatic arthritis research
in fiscal year 2011 and beyond is imperative, because a rare
convergence of findings reached through various research studies only
recently has elucidated new ideas about the mechanisms involved in
psoriasis. 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; understanding the relationship of
psoriasis to co-morbidities, such as heart attack, diabetes, increased
mortality, and lymphoma; 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.
funding request summary
The Foundation recognizes that Congress and the Nation currently
face unprecedented fiscal challenges. However, we also believe that
greater fiscal year 2011 investment in biomedical and epidemiologic
research at NIH and CDC will prove stimulative to the economy, by
supporting researchers and academic institutions across the Nation.
Further, researchers are poised, as never before, to 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 fiscal year 2011 funding allocations:
--$2.5 million to the NCCDPHP within the CDC to continue to collect
data on psoriasis and psoriatic arthritis and to implement a
patient registry to improve the knowledge base of the
longitudinal impact of these diseases on the individuals they
affect, as well as increase understanding of disease triggers
and co-morbid conditions; and
--$32.2 billion to NIH and its Institutes and Centers with
encouragement to expand their psoriasis and psoriatic arthritis
research portfolios, with an emphasis on understanding more
about common co-morbid conditions.
conclusion
On behalf of the Foundation's Board of Trustees and the 7.5 million
individuals who suffer from psoriasis and psoriatic arthritis, whom we
represent, thank you for affording us the opportunity to submit written
testimony regarding the fiscal year 2011 funding levels necessary to
ensure that our Nation adequately addresses the needs of those who
suffer with psoriasis and psoriatic arthritis, by improving therapies
and eventually finding a cure. We believe that additional research
undertaken at the NIH, coupled with epidemiologic efforts at the CDC,
will help advance the Nation's efforts to improve treatments and
identify a cure for psoriatic conditions. 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 fiscal year 2011 requests.
______
Prepared Statement of National Public Radio
Thank you Chairman Harkin and Senator Cochran for the opportunity
to support funding for public broadcasting. As NPR's president and CEO,
I am testifying on behalf more than 850 public radio station partners,
producers and distributors of public radio programming including
American Public Media (APM), Public Radio International (PRI), the
Public Radio Exchange (PRX), and many stations, both large and small
that create and distribute content through the Public Radio Satellite
System (PRSS).
The public radio system and the tens of millions of Americans who
listen to public radio programming every week are grateful, Chairman
Harkin and Senator Cochran, for your decades of support for public
broadcasting funding. We are also grateful for the additional $25
million in funding provided by Congress last year to help stations
offset the devastating financial impact of the country's economic
crisis.
Public radio's service to America is a story of continuing success,
increasing dedication to news, journalism, public affairs and cultural
programming, and expanding deployment of technology to improve our
reach and impact. The nearly 34 million people tuning weekly into
public radio programming is more than the total combined circulation of
USA Today, the Wall Street Journal, The New York Times, Los Angeles
Times, The Washington Post, and the next top 62 newspapers. Twenty-five
NPR member stations in the top 30 markets rank in the top three most
listened to stations for news. We are serving the American public
through our broadcast stations, through our websites and Internet
streaming and through applications for the iPhone, iPad, Droid,
Blackberry, and other mobile devices.
Consider the contributions made by these public radio stations
whose local public service illustrates a system-wide commitment to
community service:
--Iowa Public Radio.--WOI AM and FM at Iowa State University, WSUI-AM
and KSUI-FM at the University of Iowa, and KUNI-FM and KHKE-FM
at the University of Northern Iowa are at the center of the
newly consolidated State operation. With combined revenues of
about $6 million annually and about 60 employees, roughly one-
third of staff is devoted to news. Iowa Public Radio enhances
civic and cultural connections across the State, strengthening
communities and reflecting Iowa's sense of place. The weekend
program Iowa Roots is aired statewide and features stories,
music and talk with traditional artists from a variety of
ethnic, geographic, occupational, and religious groups found in
Iowa.
--WXPR.--A community-licensed public radio station with studios in
Rhinelander, WXPR serves about a 70-mile diameter area of
Wisconsin, plus some bits of Michigan's Upper Peninsula. On the
air since 1983, WXPR would never have been built, nor continued
to serve the local community today without the continuing
effort and generosity of many people in the Northwoods, plus
the support of the Corporation for Public Broadcasting. WXPR is
proud to provide the only radio service to large, sparsely
populated rural areas of the State and is planning to expand
coverage with two small repeater stations in Ironwood and Iron
Mountain, Michigan.
--Mississippi Public Broadcasting.--More than 127,000 Mississippians
listen to MPB radio programming each week. More than 7,000
blind and print-impaired people in the State use the Radio
Reading Service of Mississippi through MPB which provides on-
the-air readings of newspapers, books and magazines for persons
who are unable to read the printed word, either because of
visual handicaps or because of other physical handicaps, such
as the inability to turn pages. MPB also serves as primary
source of emergency information and news during crisis
situations and was nationally recognized for its coverage
during Hurricanes Gustav, Rita, and Katrina.
--Minnesota Public Radio (MPR).--MPR operates a regional network of
38 stations, covering Minnesota and parts of Wisconsin, the
Dakotas, Michigan, Iowa, and Idaho. With 850,000 listeners each
week, MPR has the largest audience of any regional public radio
network and an expanding news department of 76 that is
committed to improving local and regional coverage. MPR is a
leader in classical and current music, and in a growing online
news service, NewsQ.
Stations like these, operating in every State and congressional
district in the country, have become living embodiments of journalistic
excellence, providing news, information, and cultural programming as
other sources of media are contracting or retreating from local
coverage. Many are the only locally owned and operated news
organization in their community.
Public Funds for Public Media
The Corporation for Public Broadcasting (CPB) is an indispensable
public funding source for public radio, accounting for roughly 12
percent of an average public radio station's annual budget. The public
broadcasting community is urging Congress to appropriate $604 million
in 2-year advanced funding for fiscal year 2013.
Journalism, news, information, and cultural programming are the
cornerstones of public radio. And we are expanding in these areas, as
many commercial news organizations contract. For example, public
broadcasting stations have launched Local Journalism Centers (LJCs),
combining funds from CPB and resources of 27 station entities to expand
and improve journalism on the regional level. A primary goal of this
initiative is to replace some of the traditional newsgathering capacity
that has been lost amid the recent cutbacks, to take full advantage of
developing technology in order to nourish and support the creation of
new journalistic endeavors, and to ensure that there are no barriers to
the distribution of public media content.
A second recent joint initiative--Project Argo--is aimed at
bringing expanding information on topics critical to communities and
the Nation. This project, supported by CPB and the John S. and James L.
Knight Foundation, provides a pilot group of 12 NPR stations with the
resources to expand original reporting, and to curate, distribute and
share online content about high-interest, specialized subjects. The 2-
year pilot will help a dozen stations establish themselves as
definitive sources of news on a topic selected by each one as most
relevant to its community, such as city politics, the changing economy,
healthcare, immigration, and education. These online reports will help
fill the growing gap in local news offerings.
Digital Funding
Broadcasting's Digital Transition
Broadcasting remains the principle distribution path for public
radio programs. By the end of 2009, 463 stations were on the air with
digital signals and more than 180 were multicasting (sending out two or
more program streams) to their communities and listeners. Recent action
by the Federal Communications Commission permitting public radio
stations to boost HD signal power and provide expanded signal coverage
creates another compelling reason to continue conversion funding. Many
public radio stations will be seeking to boost power to better serve
their communities in the coming year. Public broadcasting's funding
request to continue our digital transformation in fiscal year 2011 is
$59.5 million.
Public Radio is using digital broadcasting as a tool to improve and
broaden the reach of our programming to poorly served and un-served
audiences. Radio reading services for the blind and deaf are becoming
more accessible. Stations' service to communities during times of local
and regional emergencies will benefit from digital broadcasting's more
flexible and adaptable features. Digital broadcasting technology has
enabled public radio stations to:
--Provide Increased Local Services to Communities.--Stations are
doubling and tripling programming offerings by multicasting
through HD radio channels 2 and 3 options while super-serving
existing and new groups of listeners.
--Increase the Diversity of Programming by Providing Additional
Content for Current Audience.--Use of HD radio channels 2 and 3
means more news programming options, music and entertainment
for listeners. The additional HD radio channels allow stations
to add public affairs programming, educational instruction,
international news, specialty music streams (jazz, classical,
bluegrass, folk, rock, pop, international, etc.), and non-
English language news.
--Bring the Content Rich World of Public Radio to Blind and Deaf
Audiences.--Relying often on small armies of volunteers, more
than 120 stations provide 24-hour life-line service consisting
of news education and readings from daily newspapers and
magazine articles. Text information services such as emergency
warnings and public service alerts may also be incorporated
into the signal to enable display of this data.
The New Network: Internet, Web and Mobile Platforms
The 1967 Public Broadcasting Act Gave Enduring Reality to two
Important Concepts.--Public funds for public broadcasting and the
creation of a national, independent, not-for-profit network of
television and radio broadcasters to serve the American public. More
than four decades later, as public broadcasting's embrace of new
technologies to serve and engage a wider and more diverse audience
quickens its transformation into Public Media, a New Network for the
digital era must be fostered. This New Network, built upon a Public
Media Platform and utilizing the success and assets of public
broadcasting as its core, will enable the next generation of content
creation and distribution so that the American public can benefit from
a larger vision of service from Public Media.
Public radio is embracing the networked environment as a primary
platform for audience and community service. To ensure that the
American public continues to have free and universal access to public
media content, high-speed and affordable broadband access is simply a
necessity. Congressionally appropriated digital transition funds are
essential to help ensure our success in providing a larger, more
diverse and more inclusive service to the American public.
Among the many station and national network initiatives underway,
these are worth highlighting:
--NPR's API.--In July 2008, NPR released an open Application
Programming Interface, (API), a new pathway for content and
functions to be widely shared on the web. NPR was one of the
first major national media organizations to launch an API and
it is an integral component of our mission to create a more
informed public. It allows public radio stations and individual
users to play a direct role in broadening web access to public
radio content. The principle of openness encompassed in this
web tool is a fundamental extension of the standards of free
and universal access that are common to more traditional
distribution of public radio content. Utilization of the API by
stations enables the creation of content that more closely
matches local community needs and interests, and facilitates
diverse, more creative presentations of content, again to
connect local information needs with content generated by
other, collaborating communities.
--The Public Media Platform.--Realizing public media's full potential
requires a strategic investment in an information architecture
that brings together fragmented digital assets. The Public
Media Platform, under development by NPR in partnership with
CPB, APM, PRI, PBS and the Public Radio Exchange (PRX), will
allow content from a wide variety of independent and
institutional producers to be combined in a common back-end
system; and then for that content to be extracted and displayed
on a wide variety of digital platforms based on business rules
set by the producers. It is in essence and in practice the
digital equivalent of the satellite distribution network that
serves public radio's broadcast audience with the powers of
search, social media tools, analytics, and data.
Thank you again for continuing to support funding for public
service media.
______
Prepared Statement of the 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, 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 recommend that you maintain this
support for NIH in fiscal year 2011 by providing an increase of 3.5
percent more than fiscal year 2010. Within this proposed increase the
NPRCs also respectfully request that the subcommittee provide the
National Center for Research Resources (NCRR) with the resources to
continue a robust construction, renovation, and instrumentation grant
program as begun through the American Recovery and Reinvestment Act,
which as explained in this testimony, would help to ensure that the
NPRCs and other animal research resource programs continue to serve
effectively in their role as a vital national resource. Additionally,
the NPRCs request that Congress provide NCRR no less than $86,412,000
for the NPRC P51 (base grant) program, the amount equal to the
President's budget request. This program supports a portion of the
operational costs of the eight NPRCs.
The NPRCs' Role as a National Resource and in the NIH Director's Five
Themes
The NPRCs collaborate as a transformative and innovative network to
support the best science and act as a resource to the biomedical
research community as efficiently as possible. There is an exceptional
return on investment in the NPRC program; $10 is leveraged for every $1
of research support for the NPRCs. It is important to sustain funding
for the NPRC program and the NIH as a whole to continue to grow and
develop the innovative plan for the future of NIH. The NPRCs have a
commitment from NCRR to develop a 5-year strategic plan to further
enhance the capabilities of the NPRCs by building on current progress.
NIH Director Dr. Francis Collins laid out his vision for the future
of the agency in terms of five ``themes.'' The NPRCs as a consortium
and as a resource to the biomedical research community currently play
an important role in each of the five themes.
High-throughput Technologies.--The NPRCs have been leading the
development of a new Biomedical Informatics Research Network (BIRN) for
linking brain imaging, behavior, and molecular informatics in nonhuman
primate preclinical models of neurodegenerative disease. Using the
cyberinfrastructure of the BIRN project for data-sharing, this project
will link research and information to other primate centers, as well as
other geographically distributed research groups.
Translational Research.--Nonhuman primate models bridge the divide
between basic biomedical research and implementation in a clinical
setting. Currently, 7 of the 8 NPRCs are affiliated with and
collaborate with the NCRR Clinical and Translational Science Awards
(CTSA) Program through their host institution. Specifically, the
nonhuman primate models at the NPRCs often provide the critical link
between research with small laboratory animals and studies involving
humans. As the closest genetic model to humans, nonhuman primates serve
in the development process of new drugs, treatments, and vaccines, to
ensure safe and effective use for the Nation's public.
Using Science To Enable Healthcare Reform.--Animal models are an
essential tool for bridging basic biomedical research and patient
healthcare, and the NPRCs are a national resource which supports the
achievement of this goal. 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.
Global Health.--Primate models are necessary for research on global
infectious diseases. Primates have served as the best model for various
types of HIV research, and their availability for use has resulted in
at least 14 licensed anti-viral drugs for treatment of HIV infection.
Primate models will continue to be necessary to defend the world
against possible future epidemics such as SARS, West Nile Virus, and
avian flu; and they are critical to current efforts to create vaccines
for Ebola and Marburg viruses, and for infectious agents that could be
used by terrorists. They also serve as the best model for development
of vaccines for tuberculosis and malaria.
Although the number of chimpanzees essential to biomedical research
is very few, chimpanzees remain the only valid research model for
developing vaccines that prevent infection by the hepatitis C virus,
from which millions of people worldwide suffer. Researchers do not
embark upon the use of chimpanzees in research without due
consideration, and are acutely aware of the ethical challenges and
moral responsibilities of such research. But the fact remains that
chimpanzee models have led to major medical advances; as a case in
point, thanks to chimpanzee research, there are vaccines for hepatitis
A and B.
Reinvigorating the Biomedical Research Community.--The success of
the U.S. Government's efforts in enhancing public health is contingent
upon the quality of research resources that enable scientific research
ranging from the most basic and fundamental to the most highly applied.
Biomedical researchers have relied on one such resource--the National
Primate Research Centers--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.
The NPRCs are also supportive of getting students interested in the
biomedical research workforce pipeline at an early age. For example,
Yerkes NPRC supports a program that connects with local high schools
and colleges in Atlanta, Georgia, and invites students to participate
in research projects taking place at their field station location.
The Need for Facilities Support
As exemplified in the NPRCs' role in the future direction of NIH,
the program is a vital resource for enhancing public health and
spurring innovative discovery. In an effort to address many of the
concerns within the scientific community regarding the need for funding
for infrastructure improvements, the NPRCs support the continuation of
a robust construction and instrumentation grant program at NCRR.
The NPRCs thank Congress for appropriating $1.3 billion of NIH
Recovery Act funds for construction (C06), renovation (G20), and
instrumentation (S10) grants. The number of applications received by
NCRR illustrated the pent up need for facilities funding in the
biomedical research community. Some of our centers received awards but
a number of primate centers (and many other animal facilities) did not.
Animal facilities, especially primate facilities, are expensive to
maintain and are subject to abundant ``wear and tear.'' In prior years,
funding was set aside that fulfilled the infrastructure needs of the
NPRCs and other animal research facilities. The NPRCs ask the
subcommittee to provide an appropriation of no less than $125 million
to NCRR for construction and renovation of animal facilities through
C06 and G20 programs. Without proper infrastructure, the ability for
animal facilities, including the NPRCs, to continue to meet the high
demand of the biomedical research community will be unattainable.
Thank you for the opportunity to submit this written testimony and
for your attention to the critical need for primate research and the
continuation of infrastructure support, as well as our recommendations
concerning funding for NIH in the fiscal year 2011 appropriations bill.
______
Prepared Statement of the National Respite Coalition
Mr. Chairman, I am Jill Kagan, Chair of the ARCH National Respite
Coalition, a network of respite providers, family caregivers, State and
local agencies and organizations across the United States who support
respite. Twenty-five State respite coalitions are also affiliated with
the NRC. This statement is presented on behalf of the these
organizations, as well as the Lifespan Respite Task Force, a coalition
of more than 80 national and 100 State and local groups who supported
the passage of the Lifespan Respite Care Act (Public Law 109-442).
Together, we are requesting that the subcommittee include funding for
the Lifespan Respite Care Program administered by the U.S.
Administration on Aging in the fiscal year 2011 Labor, Health and human
Service, and Education, and Related Agencies appropriations bill at its
modest authorized level of $94.8 million. This will enable:
--State replication of best practices in Lifespan Respite systems to
allow all family caregivers, regardless of the care recipient's
age or disability, to have access to affordable respite, and to
be able to continue to play the significant role in long-term
care that they are fulfilling today;
--Improvement in the quality of respite services currently available;
--Expansion of respite capacity to serve more families by building
new and enhancing current respite options, including
recruitment and training of respite workers and volunteers; and
--Greater consumer direction by providing family caregivers with
training and information on how to find, use and pay for
respite services.
who needs respite?
In 2009, a national survey found that more than 65 million family
caregivers are providing care to individuals of any age with
disabilities or chronic conditions (Caregiving in the U.S. 2009.
Bethesda, MD: National Alliance for Caregiving and Washington, DC:
AARP, 2009). It has been estimated that these family caregivers provide
$375 billion in uncompensated care, an amount almost as high as
Medicare spending ($432 billion in 2007) and more than total spending
for Medicaid, including both Federal and State contributions and both
medical and long-term care ($311 billion in 2005) (Gibson and Hauser,
2008).
While the aging population is growing rapidly, increasing the need
for family caregiver support for this age group, the majority of family
caregivers are caring for someone under age 75 (56 percent); 28 percent
of family caregivers care for someone between the ages of 50-75, and 28
percent are caring for someone under age 50, including children (NAC
and AARP, 2009). Family caregiving is not just an aging issue, but also
a lifespan issue for the majority of the Nation's families.
Compound this picture with the growing number of caregivers known
as the ``sandwich generation'' caring for young children as well as an
aging family member. It is estimated that between 20 and 40 percent of
caregivers have children under the age of 18 to care for in addition to
a parent or other relative with a disability. And in the United States,
6.7 million children, with and without disabilities, are in the primary
custody of an aging grandparent or other relative.
Families of the wounded warriors--those military personnel
returning from Iraq and Afghanistan with traumatic brain injuries and
other serious chronic and debilitating conditions--are at risk for
limited access to respite. Together, these family caregivers are
providing an estimated 80 percent of all long-term care in the United
States. This percentage will only rise in the coming decades with an
expected increase in the number of chronically ill veterans returning
from war, greater life expectancies of individuals with Down's Syndrome
and other disabling and chronic conditions, the aging of the baby boom
generation, and the decline in the percentage of the frail elderly who
are entering nursing homes.
what is respite need?
State and local surveys have shown respite to be the most
frequently requested service of the Nation's family caregivers
(Evercare and NAC, 2006). Yet respite is unused, in short supply,
inaccessible, or unaffordable to a majority of the Nation's family
caregivers. The 2009 NAC/AARP survey of caregivers found that a
majority (51 percent) have medium or high levels of burden of care,
measured by the number of activities of daily living with which they
provide assistance, and 31 percent of all family caregivers were
identified as ``highly stressed''. Half of all family caregivers (53
percent) say that their caregiving takes time away from family and
friends. Of those who sacrificed this time, 47 percent feel high
emotional stress. Moreover, the 2009 survey found that despite the fact
that among caregivers' most frequently reported unmet needs were
``finding time for myself'' (32 percent), ``managing emotional and
physical stress'' (34 percent), and ``balancing work and family
responsibilities'' (27 percent), only 11 percent of caregivers of
adults 18+ make use of respite. This represents an increase from 5
percent in 2004, but still far less than the percentage who could
benefit from respite. Of six proposed national policies or programs
presented to help caregivers, 3 in 10 selected respite as the preferred
service (NAC and AARP, 2009). According to another survey in 2006, the
percentage of family caregivers able to make use of respite in rural
areas was only 4 percent (Easter Seals and NAC, 2006). In a study of a
nationally representative profile of noninstitutionalized children ages
0-17 who were receiving support from the Supplemental Security Income
(SSI) program because of a disability, only 8 percent reported using
respite, but three-quarters of families had unmet respite needs (Rupp,
K, et al, 2005-2006).
Barriers to accessing respite include reluctance to ask for help,
fragmented and narrowly targeted services, cost, and the lack of
information about how to find or choose a provider. Even when respite
is an allowable funded service, a critically short supply of well-
trained respite providers may prohibit a family from making use of a
service they so desperately need.
Twenty of 35 State-sponsored respite programs surveyed in 1991
reported that they were unable to meet the demand for respite services.
The 25 State coalitions and other National Respite Network members
confirm that long waiting lists or turning away of clients because of
lack of resources is still the norm. A study conducted by the Family
Caregiver Alliance identified 150 family caregiver support programs in
all 50 States and Washington, DC, funded with State-only or State/
Federal dollars. Most of the funding comes from the Federal National
Family Caregiver Support Program. As a result, programs are
administered by local area agencies on aging, primarily serve the
aging, and provide only limited respite, if at all. Only about one-
third of the 150 identified programs serve caregivers who provide care
to adults age 18-60 who must meet stringent eligibility criteria. As
the report concluded, ``State program administrators see the lack of
resources to meet caregiver needs in general and limited respite care
options as the top unmet needs of family caregivers in the States.''
While most families take great joy in helping their family members
to live at home, it has been well documented that family caregivers
experience physical and emotional problems directly related to
caregiving responsibilities. Three-fifths of family caregivers age 19-
64 surveyed recently by the Commonwealth Fund reported fair or poor
health, one or more chronic conditions, or a disability, compared with
only one-third of noncaregivers (Ho, Collins, Davis and Doty, 2005). A
study of elderly spousal caregivers (aged 66-96) found that caregivers
who experience caregiving-related stress have a 63 percent higher
mortality rate than noncaregivers of the same age (Schulz and Beach,
December 1999).
For the millions of families of children with disabilities, respite
has been an actual lifesaver. However, for many of these families,
their children will age out of the system when they turn 21 and they
will lose many of the services, such as respite, that they currently
receive. In fact, 46 percent of U.S. State units on aging identified
respite as the greatest unmet need of older families caring for adults
with lifelong disabilities.
Disparate and inadequate funding streams exist for respite in many
States. But even under the Medicaid program, respite is allowable only
through State waivers for home and community-based care. Under these
waivers, respite services are capped and limited to narrow eligibility
categories. Long waiting lists are the norm.
Respite may not exist at all in some States for adult children with
disabilities still living at home, or individuals under age 60 with
conditions such as ALS, MS, spinal cord or traumatic brain injuries, or
children with serious emotional conditions. In Tennessee, a young woman
in her twenties gave up school, career and a relationship to move in
and take care of her 53 year-old mom with MS when her dad left because
of the strain of caregiving without any support.
respite benefits families and is cost saving
Respite has been shown to be a most effective way to improve the
health and well-being of family caregivers that in turn helps avoid or
delay out-of-home placements, such as nursing homes or foster care,
minimizes the precursors that can lead to abuse and neglect, and
strengthens marriages and family stability. A recent report from the
U.S. Department of Health and Human Services prepared by the Urban
Institute found that higher caregiver stress among those caring for the
aging increases the likelihood of nursing home entry. Reducing key
stresses on caregivers, such as physical strain and financial hardship,
through services such as respite would reduce nursing home entry.
(Spillman and Long, USDHHS, 2007)
Budgetary benefits that accrue from respite are just as compelling.
Delaying a nursing home placement for just one individual with
Alzheimer's or other chronic condition for several months can save
thousands of dollars. In an Iowa survey of parents of children with
disabilities, a significant relationship was demonstrated between the
severity of a child's disability and their parents missing more work
hours than other employees. It was also found that the lack of
available respite interfered with parents accepting job opportunities.
(Abelson, A.G., 1999)
Moreover, data from ongoing research at Oklahoma State University
found that the number of hospitalizations, as well as the number of
medical care claims decreased as the number of respite days increased
(Fiscal Year 1998 Oklahoma Maternal and Child Health Block Grant Annual
Report, July 1999). A Massachusetts social services program designed to
provide cost-effective, family-centered respite care for children with
complex medical needs found that for families participating for more
than 1 year, the number of hospitalizations decreased by 75 percent,
physician visits decreased by 64 percent, and antibiotics use decreased
by 71 percent (Mausner, S., 1995).
In the private sector, the most recent study by Metropolitan Life
Insurance Company and the National Alliance for Caregivers found that
U.S. businesses lose from $17.1 billion to $33.6 billion per year in
lost productivity of family caregivers (MetLife and National Alliance
for Caregiving, 2006). Offering respite to working family caregivers
could help improve job performance and employers could potentially save
billions
lifespan respite care program will help
The Lifespan Respite Care Act is based on the success of statewide
Lifespan Respite programs in Oregon, Nebraska, Wisconsin, and Oklahoma.
Arizona and Texas both recently passed State legislation to establish
Lifespan Respite Programs, but Arizona's program was cut due to State
budget shortfalls. Twelve States, including Arizona, began
implementation in 2009 with the first wave of Federal Lifespan Respite
funding.
Lifespan Respite, which is a coordinated system of community-based
respite services, helps States use limited resources across age and
disability groups more effectively. Pools of providers can be
recruited, trained and shared, administrative burdens can be reduced by
coordinating resources, and savings used to fund new respite services
for families who may not qualify for any existing Federal or State
program.
The first State Lifespan Respite programs in Oregon, Nebraska,
Wisconsin, and Oklahoma provide best practices on which to build a
national respite policy. The programs have been recognized by the
National Conference of State Legislatures, which recommended the
Nebraska program as a model for State solutions to community-based
long-term care, the National Governors Association, and the President's
Committee for People with Intellectual Disabilities. The White House
Conference on Aging recommended Congressional support for the Lifespan
Respite Care Act.
The purpose of the law is to expand and enhance respite services,
improve coordination, and improve respite access and quality. Under a
competitive grant program, States are required to establish State and
local coordinated Lifespan Respite care systems to serve families
regardless of age or special need, provide new planned and emergency
respite services, train and recruit respite workers and volunteers and
assist caregivers in gaining access to services. Those eligible would
include family members, foster parents or other adults providing unpaid
care to adults who require care to meet basic needs or prevent injury
and to children who require care beyond that required by children
generally to meet basic needs.
The Federal Lifespan Respite program is administered by the U.S.
Administration on Aging, Department of Health and Human Services (HHS).
AoA provides competitive grants to State agencies in concert with Aging
and Disability Resource Centers working in collaboration with State
respite coalitions or other State respite organizations. The program
was authorized at $53.3 million in fiscal year 2009 rising to $95
million in fiscal year 2011. Congress appropriated $2.5 million in
fiscal year 2009 and again in fiscal year 2010. In fiscal year 2009, 12
States received 36-month $200,000 grants to implement Lifespan Respite.
In these States, that represents less than $.18 per caregiver.
The administration recommended $5 million for Lifespan Respite as
part of its Middle Class Initiative. We are heartened to see that
support for family caregiving is recognized as a critical component of
a typical family's economic and social well-being. However, the focus
of the administration's request was on support for family caregivers of
the aging population. While this is an issue of growing concern, we
must not neglect that fact that at least half of the Nation's family
caregivers are caring for someone with MS, ALS, traumatic brain or
spinal cord injury, mental health conditions, developmental
disabilities or cancer who are under the age of 60 and $5 million will
not address their need for respite. This is also the population most
likely to be ineligible for any existing State or Federal respite
resources.
No other Federal program mandates respite as its sole focus. No
other Federal program would help ensure respite quality or choice, and
no current Federal program allows funds for respite start-up, training,
or coordination or to address basic accessibility and affordability
issues for families. We urge you to include $94.8 million in the fiscal
year 2011 Labor, Health and Human Services, and, Education, and Related
Agencies appropriations bill so that Lifespan Respite Programs can be
replicated in the States and more families, with access to respite,
will be able to continue to play the significant role in long-term care
that they are fulfilling today.
______
Prepared Statement of the National REACH Coalition for the Elimination
of Health Disparities
The National REACH Coalition represents more than 40 communities
and coalitions in 22 States working to eliminate racial and ethnic
health disparities and improve the health of African American, Asian
Pacific Islander, Native American, and Latino populations and
communities. The coalition is an outgrowth of the Racial and Ethnic
Approaches to Community Health (REACH U.S.) 2010 initiative, started a
decade ago by the Centers for Disease Control and Prevention (CDC).
REACH programs are on the front lines, providing coordination and
leadership for the advancement and translation of community-based
participatory research into evidence-based practices, policies, and
community empowerment.
For the fiscal year 2011 funding cycle the National REACH Coalition
encourages the Labor, Health and Human Services, and Education, and
Related Agencies (Labor-HHS) Subcommittee to increase funding for the
Racial and Ethnic Approaches to Community Health program to $60
million, an increase of $20.356 million more than fiscal year 2010.
The NRC gratefully acknowledges the strong bipartisan support that
the Senate Subcommittee on Labor-HHS has provided to the REACH U.S.
program in recent years, most REACH programs were not eligible for
additional funding provided by the American Recovery and Reinvestment
Act and yet are working in communities that are among the hardest hit
by the recession. With significant budget challenges at the State/local
levels, REACH programs provide an important safety net to help
eliminate racial and ethnic health disparities and close the health
equity gap.
Chronic diseases are the Nation's leading causes of morbidity and
mortality and account for 75 percent of every $1 spent on healthcare in
the United States. Collectively, they account for 70 percent of all
deaths nationwide. Thus, it is highly likely that nearly 3 of 4 persons
living in your district will be likely to develop a chronic condition
requiring long-term and costly medical intervention. Moreover, chronic
diseases account for the largest health gap among racial and ethnic
minority populations. African Americans have higher mortality rates for
cardiovascular disease and stroke, and cancer of the lung, colon/
rectum, breast, cervix, and prostate than Whites, American Indians/
Alaska Natives, Asian/Pacific Islanders, and Hispanic Americans.
REACH U.S. programs are working hard to eliminate these health
disparities and many have proven success in their communities.
Collectively as the National REACH Coalition, our programs have engaged
hundreds of local coalition members and touched the lives of thousands
of program participants in this nationwide campaign against health
disparities. As a result, the REACH communities are testing, evaluating
and implementing practice and evidence-based interventions that reduce
the human and financial cost of these preventable diseases and
associated risk factors by:
--In South Carolina, the REACH Charleston and Georgetown Diabetes
Coalition reports that a 21 percent gap in blood sugar testing
between African Americans and whites has been virtually
eliminated. Amputations among African-American males with
diabetes have been reduced by more than 33 percent. Each
avoided amputation avoids at least $40,000 in expenditures;
expanding this program could substantially reduce South
Carolina's annual diabetes-related financial burden of more
than $900 million.
--The REACH for Wellness program in Georgia's Atlanta Empowerment
Zone reports that from 2002 to 2004 the percentage of adults
who regularly participated in moderate to vigorous physical
activity increased from 25.4 percent to 28.7 percent; the
percentage who reported checking their total blood cholesterol
increased from 69.1 percent to 79.7 percent, and the percentage
of adults who smoked decreased from 25.8 percent to 20.8
percent.
--The REACH Alabama Breast and Cervical Cancer Coalition in Macon
County reports that disparities in mammography screening
between white and African American women decreased from 15
percent to 2 percent from 1998 to 2003.
--In Massachusetts, the Greater Lawrence Family Health Center, a
REACH Center of Excellence in Eliminating Health Disparities,
has been able to demonstrate long-term disparity reductions
among Latinos on five measures of diabetic care and outcomes.
--Data from the REACH Risk Factor Survey show that the REACH program
is having a significant impact in key areas of risk reduction
and disease management:
--From 2001 to 2004, African Americans transitioned from being less
likely to more likely than whites to have their cholesterol
checked.
--In REACH communities, the sizable gap in cholesterol screening
between Hispanics and the national average is closing.
--In REACH communities, the proportion of American Indians with
high blood pressure who take medication increased from 67
percent in 2001 to 74 percent in 2004.
--Cigarette smoking among Asian men in REACH communities decreased
from 35 percent in 2001 to 24 percent in 2004.
REACH U.S. communities have spent the last decade leveraging CDC
funding with public private partnerships in order to effectively
address health disparities. Using innovative science-based approaches
we have demonstrated that health disparities once considered expected
are not intractable. REACH U.S. has provided a sound return on
investment, but we could do a lot more. In 2007, more than 200
communities applied for funding in the last CDC REACH U.S. program
application cycle, but only 40 were funded. While we are extremely
grateful for the $4 million increase REACH U.S. received in fiscal year
2010, without additional support REACH U.S. will not be able to extend
its successful, cost-effective evidence- and practice-based programs to
communities bearing a disproportionate share of the national chronic
disease burden.
Providing a $20.356 million increase, for a total of $60 million in
fiscal year 2011 for REACH U.S. programs will ensure investment and
sustainability in the bread and butter of prevention and wellness
programs--community-led and community-driven interventions.
Furthermore, health disparities and health equity will continue to be
addressed and REACH U.S. programs will have the ability to be expanded
in our Nation's most underserved communities. We strongly urge the
subcommittee to consider this request to strengthen the capacity of the
REACH U.S. program.
We thank you for this opportunity to present our views to this
subcommittee. We look forward to working with you to improve the health
and safety of all Americans.
______
Prepared Statement of the National Recreation and Park Association
Thank you Chairman Harkin, Ranking Member Cochran, and other
honorable members of the subcommittee for the opportunity to submit
written testimony on the importance of funding the Centers for Disease
Control and Prevention's (CDC) Healthy Communities Program. We
respectfully request funding of $30 million in the fiscal year 2011
Labor, health and Human Services, and Education, and Related agencies
appropriations bill.
NRPA is a 501(c)3 national nonprofit organization with more than
21,000 members. We represent both citizens and park and recreation
professionals. Our mission is to advance parks, recreation and
environmental conservation for the benefit of all people. Because we
represent the public park and recreation agencies in the United States,
we touch the lives of more than 300 million people in virtually every
community. Park and recreation agencies play a major role in the fight
against obesity and are poised and capable of doing even more through
the creation of new cross-cutting partnerships that promote health
lifestyle choices for children and adults.
Our Nation currently faces an obesity epidemic that is claiming the
lives of adults and children. According to the CDC, the obesity rate in
children ages 6 to 11 doubled from 6.5 percent in 1980 to 17 percent in
2006; and tripled among those ages 12 to 19 to 17.6 percent during the
same time period. More than one-third of U.S. adults--more than 72
million people--were obese in 2005-2006.
Obesity also has a crippling effect on our Nation's economy and is
largely responsible for the exuberant rise in healthcare costs. CDC
reports that data from the 1998 and 2006 Medical Expenditure Panel
Surveys (MEPS) revealed that obesity increased medical costs by 37
percent from 1998 to 2006. A 2009 study released by RTI, a nonprofit
research firm, showed that obese Americans cost the country about $147
billion in weight-related medical bills in 2008, double what it was a
decade ago. Obesity now accounts for about 9.1 percent of medical
spending in our country.
The obesity and chronic disease epidemics plaguing our Nation did
not manifest themselves overnight. These epidemics grew to be national
issues of concern by impacting one individual, one family, and one
community at a time. A multitude of factors such as lack of physical
activity, poor diet, and excessive tobacco and alcohol use have led to
this national epidemic. The good news is that many of the health risk
factors that contribute to the development of chronic disease and
obesity are preventable. However, the only way we will truly reduce
obesity is to employ a comprehensive strategy that addresses these
factors where people live, work, learn and recreate. In order for us to
effectively combat these epidemics, local communities must be armed
with the necessary tools and resources to implement policy,
environmental and systematic changes geared towards promoting increased
physical activity, nutritious foods, and the prevention of chronic
disease in children, youth, and adults.
Investment in prevention and wellness was one of President Obama's
eight core principles guiding healthcare reform. Congress also stressed
the importance of prevention at the community level throughout the
health reform debate and through inclusion of various prevention
measures in the Patient Protection and Affordable Care Act and
Education Affordability Reconciliation Act. The economics of community
level prevention are clear. As noted by the Trust For America's Health,
for 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, the country could save more than $16
billion annually within 5 years. This is a return of $5.60 for every $1
spent. Prevention programs provide proven returns on investment. We are
asking this subcommittee to further invest in prevention through
increased fiscal year 2011 appropriations for CDC's Healthy Communities
Program.
Through its Healthy Communities program, CDC facilitates the
collaboration of local and State health departments, national
organizations with extensive reach into communities and a wide range of
community leaders and stakeholders to develop, activate and spread
policy, systems and environmental changes that prevent chronic disease
by changing behavior and increasing the opportunities for healthier
lifestyles. These community leaders and stakeholders represent local
elected officials, city and county health officials, tribal programs,
parks and recreation departments, local YMCAs, health-related
coalitions, and education, business, health, planning, and
transportation sectors. This collaboration results in proven community-
based programs and environmental changes that encourage people to be
more physically active, improve nutrition, and abstain from tobacco
use.
To date, more than 240 communities have received funding and
technical support through CDC's Healthy Communities Program which has
resulted in measurable changes at the local level. An additional 170
communities will receive funding to improve the health of their
communities during the next 3 years.
Davenport, Iowa has recently received Healthy Communities funding,
and has allowed the formation of a broad coalition of stakeholders that
has begun work to prevent chronic disease. In Davenport, Iowa the top
five leading causes of death are heart disease (26.6 percent), cancer
(23 percent), other conditions (19.7 percent), stroke (7.8 percent),
and chronic lung/respiratory disease (6.3 percent). Efforts to reverse
these trends include identifying means of increasing the usage of
Davenport parks and trails; promoting healthier lifestyles in
workplaces by engaging employers in encouraging employees to use stairs
instead of elevators; making all Davenport parks tobacco-free; and
increasing student wellness in Davenport schools by revising school
wellness policies.
Chicago, Illinois is a great example of the impact and success of
the Healthy Communities program. The city has noted that 26 percent of
their children and 25 percent of their adult populations are obese by
national standards. Contributing to the poor health of this community
is the lack of opportunities for physical activity and the fact that
the west side of Chicago lacks grocery stores which has caused it to
become a ``food desert''. This, in turn causes residents to utilize
fast food chains and convenience stores as a main source of
nourishment. Recognizing the health and financial implications of an
obese population, Chicago is taking proactive steps to ensure a
healthier a community. The park district has introduced new fitness
classes in parks throughout the city and is now offering a minimum of
60 minutes of moderate to vigorous activity for all children's programs
offered through parks. Through the leadership of the Mayor's office, a
healthy vending policy has been initiated at all park facilities and
the park district is implementing community produce gardens which will
be maintained by local youth. Additionally, smoking has been banned on
all Chicago Park District Property, indoors and out including beaches.
Thanks to funding provided through CDC's Healthy Communities program,
the city of Chicago will be able to implement more policy, systems and
environmental changes, such as these, to combat chronic disease and
obesity throughout the city.
Funding for the CDC's Healthy Communities program is vital to
successfully combating chronic disease and obesity at the local level
in communities across the country. Previous funding levels have been
inadequate. The Healthy Communities program has gone from $46.6 million
in fiscal year 2005 to only $22.7 million in fiscal year 2010. As a
result, hundreds of eligible communities have applied for highly
competitive projects but remain unfunded due to limited Federal
resources.
Given the health implications and the fiscal hardship associated
with chronic disease and obesity, we can no longer afford to be a
nation that simply treats the problem. Now, more than ever Congress
must increase its investment in community prevention programs such as
this. NRPA respectfully requests that this committee provide increased
funding for CDC's Healthy Communities program to $30 million in the
fiscal year 2011 appropriations bill.
Thank you for this opportunity to submit testimony.
______
Prepared Statement of the National Sleep Foundation
Summary of Fiscal Year 2011 Recommendations
Provide $2 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 fund additional States to collect essential national and State-
specific surveillance data; to support targeted public awareness
initiatives; to create training materials for healthcare professionals;
and build and test public health interventions.
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 healthcare 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 admit 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.
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 7 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 twenty 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
3 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 8 States to include an optional sleep module in
their data collection efforts through the Behavioral Risk Factor
Surveillance System (BRFSS). Recent analysis of the core data found
that more than 1 in 10 Americans report having insufficient sleep or
rest every day for the past 30 days. Significantly, sleep problems were
found to be more prevalent in southeastern States in what is commonly
referred to as the ``stroke belt.'' This region has an unusually high
incidence of stroke, cardiovascular disease, diabetes, obesity,
depression, and quality of life, which are associated with inadequate
sleep quality and quantity. The CDC is currently recruiting up to 14
States and hopes to expand the data collection to all 50 States if
appropriate funding is obtained.
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 supported and actively participated in
NSF's ongoing national public awareness initiatives including National
Sleep Awareness Week and Drowsy Driving Prevention Week. The year, with
CDC's support and guidance, NSF launched a new initiative called Sleep
Health and Safety Conference 2010 designed to educate clinicians and
other healthcare professionals about sleep disorders in order to
increase better diagnosis and treatment.
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.
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 aimed at promoting sleep as a
health behavior, treatment of obstructive sleep apnea, and
drowsy driving as well as the goals and activities of the
National Sleep Awareness Roundtable.
--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.
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 subcommittee will provide funding of $2,000,000 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
I am pleased to present the fiscal year 2011 budget request for
NTID, one of eight colleges of RIT, in Rochester, New York. Created by
Congress by Public Law 89-36 in 1965, we provide university technical
and professional education for students who are deaf and hard-of-
hearing, leading to successful careers in high-demand fields for a sub-
population of individuals historically facing high rates of
unemployment and under-employment. We also provide baccalaureate and
graduate level education for hearing students in professions serving
deaf and hard-of-hearing individuals. As of fall 2009, NTID served a
total 1,474 students from across the nation, including 1,307 deaf and
hard-of-hearing students and 167 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 42 years.
budget request
As shown below, NTID's fiscal year 2011 budget request was
$66,252,000 in operations and $3,640,000 in construction, for a total
of $69,892,000; the President's request is $63,037,000 in operations
and $1,640,000 in construction, for a total of $64,677,000.
FISCAL YEAR 2011 BUDGET REQUEST STATUS
[In thousands of dollars]
----------------------------------------------------------------------------------------------------------------
Operations Construction Total
----------------------------------------------------------------------------------------------------------------
NTID request.................................................... 66,252 3,640 69,892
President's request............................................. 63,037 1,640 64,677
-----------------------------------------------
Difference................................................ 3,215 2,000 5,215
----------------------------------------------------------------------------------------------------------------
For the last 2 fiscal years (2009 and 2010), NTID's operations
budget has been level-funded at $63,037,000; the President's
recommended budget for fiscal year 2011 would mark a third consecutive
year of level funding.
For these past 2 years, NTID has been able to absorb level-funding
in operations primarily due to two factors: (1) a self-initiated
budget-reduction/revenue enhancement campaign from fiscal year 2003
through fiscal year 2007; and (2) a withholding of salary increased by
RIT for fiscal year 2010. However, realized savings from the campaign
now have been re-allocated and are no longer available, and RIT
recently has announced a 2 percent salary increase for fiscal year
2011.
While NTID certainly would benefit from a budget increase to
support upcoming strategic initiatives (see below), we understand the
resource challenges facing the subcommittee this year. While an
additional $1,640,000 beyond the President's recommended operations
funding for fiscal year 2011 is needed, we are amenable to meeting this
need by shifting funds designated in the President's 2011 budget from
construction to operations. This would ensure NTID stays within the
total allocation proposed in the President's 2011 budget of
$64,677,000, and still fully meet our Operations needs. We will seek
alternative funding for needed construction items.
enrollment
In fiscal year 2010 (fall 2009), we attracted the largest
enrollment in our 42-year history. Truly a national program, NTID
enrolls students from all 50 States. Our current enrollment is 1,474.
Over the last 3 years our enrollment has increased 18 percent (224
students). For fiscal year 2011, NTID anticipates maintaining this
record high enrollment level. Our enrollment history over the last 5
years is shown below:
NTID ENROLLMENTS: FIVE-YEAR HISTORY
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Deaf/hard-of-hearing students Hearing students
----------------------------------------------------------------------------------------------------------------
Fiscal year Interpreting Grand total
Undergrad Grad RIT MSSE Subtotal program MSSE Subtotal
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
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
2010............................................................ 1,237 38 32 1,307 138 29 167 1,474
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
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 demonstrably positive effect on
students' earnings over a lifetime, and results in a noteworthy
reduction in dependence on Supplemental Security Income (SSI), Social
Security Disability Insurance (SSDI), and public assistance 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 that graduating from NTID 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 withdrew before graduation. Students who withdrew 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 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 not admitted continued to
participate in the SSI program. Graduates also accessed SSDI, an
unemployment benefit, at far lesser rates than students who withdrew;
by age 50, 34 percent of nongraduates were receiving SSDI, while 22
percent of baccalaureate graduates and 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.
strategic initiatives beginning fiscal year 2011
NTID has just completed Strategic Decisions 2020, a strategic plan
based on our founding mission statement. This statement sets forth our
institutional responsibility to work with students to develop their
academic, career, and life-long learning skills as future contributors
in a rapidly changing world. It also recognizes our role as a special
resource for preparing individuals who are deaf and hard-of-hearing,
for conducting applied research in areas critical to the advancement of
individuals who are deaf and hard-hard-of hearing, and for
disseminating our collective and cumulative expertise.
Strategic Decisions 2020 establishes key initiatives responding to
future challenges and shaping future opportunities. These initiatives,
scheduled for implementation beginning in fiscal year 2011, include:
--Pursuing enrollment targets and admissions and programming
strategies that will result in increasing numbers of our
graduates achieving baccalaureate degrees and higher, while
maintaining focus and commitment to quality associate-level
degree programs leading directly to the workplace;
--Improving services to under-prepared students through working with
regional partners to implement intensive summer academic
preparation programs in selected high-growth, ethnically
diverse areas of the country. Through this initiative, NTID
will identify those students demonstrating promise for success
in career-focused degree-level programs and beyond, and provide
consultation to others regarding postsecondary educational
alternatives;
--Expanding NTID's role as a National Resource Center of Excellence
regarding the education of deaf and hard-of-hearing students in
senior high school (grades 10, 11, and 12) and at the
postsecondary level education. Components of this role as a
National Resource Center of Excellence will include:
--Center for Excellence in STEM Education.--NTID currently is
working to develop an externally funded Center of
Excellence on STEM Education for Deaf and Hard of Hearing
Students. This is an example of making our expertise
available nationally and enhancing deaf and hard-of-hearing
students' access to STEM fields.
--NTID Research Centers.--NTID will organize research resources
into Research Centers focused on the following strategic
areas of research: Teaching and Learning; Communication;
Technology, Access, and Support Services; and Employment
and Adaptability to Social Changes and the Global
Workplace.
--Outreach Programs Extending.--Outreach activities to junior and
senior high school students who are deaf and hard-of-
hearing, many of who represent AALANA populations, to
expand their horizons regarding a college education. We
also support other colleges and universities serving
students who are deaf and hard-of-hearing, as well as
postcollege adults who are deaf and hard-of-hearing.
--Enhancing efforts to become a recognized national leader in the
exploration, adaptation, testing, and implementation of new
technologies to enhance access to, and support of, learning by
deaf and hard-of-hearing individuals.
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. NTID also is expanding the number of its transfer
associate degree programs, currently numbering seven, to better serve
the higher achieving segment of our student population seeking
bachelors and masters degrees in an increasingly demanding marketplace.
These transfer programs provide seamless transition to baccalaureate
studies in the other colleges of RIT. In support of those deaf and
hard-of-hearing students enrolled in the other RIT colleges, NTID
provides a range of access services (including interpreting, real-time
speech-to-text captioning, and note-taking) as well as tutoring
services. One of NTID's greatest strengths is our outstanding track
record of assisting high-potential students to gain admission to, and
graduate from, the other colleges of RIT at rates comparable to their
hearing peers.
Student Life
Our activities foster student leadership and community service, and
provide opportunities to explore a wide range of other educational
interests. Emphasis is placed on coordination between academic faculty
and student development professionals in supporting college success for
students.
summary
It is extremely important that our funding be provided at the full
level requested by the President as we continue our mission to prepare
deaf and hard-of-hearing people to enter the workplace and society. We
ask only that the funds provided by the President for Construction be
moved into operations.
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 SSI, SSDI, and public assistance 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 people who are deaf
and hard-of-hearing, remains deserving of your support and confidence.
______
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 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 at
institutions of higher education, education and training for clean
energy and ``green'' jobs, environmental education at the K-12 level,
and national service programs that we believe are vital to NWF's
mission to inspire Americans to protect wildlife for our children's
future. The National Wildlife Federation 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 Aeronautics and Space
Administration, National Oceanic and Atmospheric Administration, and
U.S. Department of the Interior.
SUMMARY OF RECOMMENDATIONS
[In millions of dollars]
----------------------------------------------------------------------------------------------------------------
Fiscal year
Agency Program 2011 Fiscal year
recommendation 2010 level
----------------------------------------------------------------------------------------------------------------
Education............................ University Sustainability Program........ $50 ( \1\ )
Healthy High Performance Schools......... 25 ..............
Labor................................ Green Jobs Act........................... 125 $50
CNCS................................. Clean Energy Service Corps............... 100 ..............
----------------------------------------------------------------------------------------------------------------
\1\ See under Department of Education.
Funding for these programs is supported broadly through the
Campaign for Environmental Literacy's Green Education Budget and the
conservation community's Green Budget documents.
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 pass comprehensive climate change legislation this
year, a priority that the National Wildlife Federation strongly
supports. To be successful and remain competitive as a Nation in a new
clean energy economy, we must have an environmentally literate and
well-trained 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.
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 through comprehensive climate change
legislation. Unfortunately, some still mistakenly see environmental
protection programs as a costly burden on prosperity. In fact, the
challenge posed is an entrepreneur's dream. 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, in our Nation's K-12 schools,
through conservation corps programs that educate and train at-risk
youth for careers in clean energy, and through green workforce
education and training programs at the Department of Labor.
department of education
University Sustainability Program
The National Wildlife Federation supports funding the University
Sustainability Program (USP) at $50 million in fiscal year 2011.
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 the National Wildlife Federation 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 University Sustainability Program (USP)
at the Department of Education as part U of the 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.
In fiscal year 2010 Congress appropriated $28.8 million for the
University Sustainability Program and five other programs as
``invitational priorities'' under the Fund for Improvement in
Postsecondary Education. We recommend that in fiscal year 2011 Congress
fund the University Sustainability Program as a standalone program at
$50 million.
Healthy High Performance Schools Program
The National Wildlife Federation supports funding the Healthy High
Performance Schools Program at $25 million in fiscal year 2011. 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. This
program has yet to be funded by Congress. While it would seem to be a
given that we are providing our children with a healthy learning
environment, many of the Nation's 150,000 public school buildings fall
far short of this standard. Research clearly shows that improving
specific factors such as school indoor environmental quality improves
attendance, academic performance, and productivity.
Pre-K-12 Environmental Education--No Child Left Inside Act
While not yet authorized, the National Wildlife Federation strongly
supports authorization of and full funding at $100 million per year for
the No Child Left Inside (NCLI) Act (H.R. 2054), which the support of
more than 1,600 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 pre-K-12 education system. These
State plans in NCLI support training and professional development
opportunities for teachers and capacity building for environmental
education at both the State and district level. In the past 12 years,
an impressive base of research has been developed that demonstrates the
positive effects that environmental and nature education programs have
on improving academic performance and overall student learning. These
data, collected from many peer-reviewed sources, include: improved
statewide test results, higher scores in science and mathematics,
higher student interest in science, greater real-world relevancy, fewer
discipline problems in the classroom, and a more even playing field for
students in under-resourced schools.
The House passed a modified version of the bill in the 110th
Congress by a bipartisan vote of 293-109. This strong support continues
today with 90 current sponsors of H.R. 2054. Additionally, the
Department of Education's A Blue Print for Reform: The Reauthorization
of the Elementary and Secondary Education Act seeks to encourage
schools to provide a well-rounded education through grants that support
strengthening teaching and learning in environmental education. In
fiscal year 2011, ``environmental education'' was also included in the
President's budget request under a ``Well-Rounded Education.''
The National Wildlife Federation also supports a priority for
funding green career and technical education programs and initiatives
at the Department of Education.
department of labor
The National Wildlife Federation supports a priority for green jobs
education and training at the Department of Labor through the Workforce
Investment Act's Energy Efficiency and Renewable Energy Worker Training
Program and the Community Based Job Training Program. NWF believes that
community colleges are critical partners in training and educating the
next generation of Americans for green jobs.
Energy Efficiency and Renewable Energy Worker Training Program
The National Wildlife Federation supports funding the Energy
Efficiency and Renewable Energy Worker Training Program at $125 million
in fiscal year 2011. NWF greatly appreciates this subcommittee's first-
time investment in Green Jobs Education and Training in the recent
American Recovery and Reinvestment Act and the $50 million provided in
fiscal year 2010. This unprecedented investment will help jumpstart the
education and training needed to prepare Americans for the clean energy
economy. We hope that the Committee will continue to fund this program,
authorized by the Green Jobs Act (GJA), title X of the Energy
Independence and Security Act, at $125 million in fiscal year 2011. 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'' and
responds to already existing skill shortages.
corporation for national and community service
Clean Energy Service Corps
The National Wildlife Federation supports funding the Clean Energy
Service Corps at $100 million in fiscal year 2011. 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.
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. Thank you again for providing the National
Wildlife Federation with the opportunity to provide testimony.
______
Prepared Statement of The Ovarian Cancer National Alliance
The Ovarian Cancer National Alliance (the Alliance) appreciates the
opportunity to submit comments for the record regarding the Alliance's
fiscal year 2011 funding recommendations. We believe these
recommendations are critical to ensure advances to help reduce and
prevent suffering from ovarian cancer. For 13 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 49 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 2009, 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 (FDA) 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 reasons, 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 2011.
The Alliance also fully supports Congress in taking action on
educating Americans about ovarian cancer through providing funding for
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 2011.
Further, the Alliance urges Congress to continue funding the
Specialized Programs of Research Excellence (SPOREs), including the
five 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 $5.795
to the National Cancer Institute for fiscal year 2011.
centers for disease control and prevention (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.
The CDC's Ovarian Cancer Control conducts research about early
detection, treatment and survivorship nationwide to increase
understanding of ovarian cancer. Some ongoing research includes
studying: the relationship between recorded symptoms, time to
diagnosis, and ovarian cancer histology, the availability of
gynecologic oncologists for ovarian cancer care, and frequency of
symptoms in women aged 65 years and older with ovarian cancer as
compared to a matched cohort of cancer-free women, among many other
research projects.
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.
Thanks to funding under Johanna's Law, more women are learning how
to identify the signs and symptoms of gynecologic. The CDC have
developed and disseminated over 275,000 fact sheets on gynecologic
cancers in English and Spanish, created a Web page dedicated to
information about these diseases that receive more than 1,500 hits a
day, and are producing public service announcements for television
scheduled to air beginning in September 2010. We must ensure that
lifesaving information about gynecologic cancers continues to reach
women.
With continued funding, the CDC will be able to continue to print
and distribute brochures, maintain and update the Web resources,
develop additional educational materials such as posters for physician
offices, complete continuing education materials for healthcare
providers, and reach out to women beyond the original 40-60 year-old
initial target group.
nci
Specialized Programs of Research Excellence (SPORE) in the National
Institutes of Health
The SPOREs were created by the NCI in 1992 to support
translational, organ site-focused cancer research. The ovarian cancer
SPOREs began in 1999. There are five currently funded Ovarian Cancer
SPOREs located at the MD Anderson Cancer Center, the Fred Hutchinson
Cancer Research Center, the Fox Chase Cancer Center, the Dana Farber/
Harvard Cancer Center and the Mayo Clinic 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
The 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, 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 2011 funding for the CDC's Ovarian Cancer
Control Initiative and $10 million in fiscal year 2011 funding for
Johanna's Law as well as your continued support of the SPORES program,
an appropriation of $5.795 billion to NCI.
______
Prepared Statement of the Oncology Nursing Society
The Oncology Nursing Society (ONS) appreciates the opportunity to
submit written comments for the record regarding fiscal year 2011
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 1.48 million Americans will be diagnosed with
cancer, and more than 562,340 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 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.
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\1\ American Cancer Society. Cancer Facts and Figures 2009. http://
www.cancer.org/downloads/STT/500809web.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 2011 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 decline 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.
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\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.
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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 greatly appreciates the increase in funding in fiscal year
2010. This represents an investment in patient care. ONS joins our
colleagues from all nursing sectors and specialties to request $267.3
million, a 10 percent increase over last year's level, for the Health
Resources and Services Administrations (HRSA) title VIII programs in
fiscal year 2011. The title VIII programs received a substantial
increase in fiscal year 2010. Funding for these programs increased from
$171.03 million to $243.872 million, a 42.6 percent increase. In
particular the Nursing Faculty Loan Program received a 117 percent
increase and the Loan Repayment and Scholarship program received a 152
percent increase. However, the Advanced Education Nursing, Nursing
Workforce Diversity, Comprehensive Geriatric Education, and Nurse
Education, Practice, and Retention programs, which help complement the
Loan Repayment and Scholarship programs, have not kept pace with
inflation since fiscal year 2005 and did not receive any increases last
year. Therefore, ONS along with the Nursing Community is requesting
that the 10 percent increase in funding be awarded to these four
programs.
With additional funding in fiscal year 2011, the HRSA Workforce
Development Programs will have much-needed resources to address the
multiple factors contributing to the nationwide nursing shortage.
Advanced nursing education programs play an integral role in supporting
registered nurses interested in advancing in their practice and
becoming faculty. As such, these programs must be adequately funded in
the coming year.
ONS strongly urges Congress to provide HRSA with a minimum of
$267.3 million in fiscal year 2011 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.
The National Coalition for Cancer Research (NCCR), a nonprofit
organization comprised of 23 national cancer organizations, and One
Voice Against Cancer (OVAC), a collaboration of 39 national nonprofit
organizations, are also advocating $267.3 million in fiscal year 2011
for the Nurse Reinvestment Act. 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 13.5 percent
increase ($35.210 billion) for NIH in fiscal year 2011. 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 $5.795 billion to the
National Cancer Institute (NCI), as well as $240 million to the
National Center for Minority Health and Health Disparities in fiscal
year 2011 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 2011 allocation of $160 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 2011 funding levels for the
following CDC programs:
--$255 million for the National Breast and Cervical Cancer Early
Detection Program;
--$65 million for the National Cancer Registries Program;
--$50 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 Gynecologic Cancer and Education and Awareness
(Johanna's Law);
--$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 groups, 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 2011 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, Chairman Harkin, 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 (Bureau ).
Background on the Population Association of America/Association of
Population Centers (PAA/APC) and Demographic Research
The PAA is a scientific organization comprised of more than 3,000
population research professionals, including demographers,
sociologists, statisticians, and economists. The 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
nationwide.
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 on
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 2011, HRS will
collect biomarkers, enhancing its ability to track the onset and
progression of diseases and conditions affecting the elderly.
Currently, the NIA payline is 9 percent, and its operating line is
flat. As research costs increase, NIA faces the prospect of funding
fewer grants to sustain larger ones in its commitment base. With
additional support in fiscal year 2011, the NIA BSR program could fully
fund its large-scale projects, including the existing centers programs
and ongoing surveys, without resorting to cost-cutting measures, such
as cutting sample size, while continuing to support smaller
investigator initiated projects. NIA could also sustain training and
research opportunities for new investigators--especially those who
received funding from the American Recovery and Reinvestment Act
(ARRA).
NICHD
Since its establishment in 1968, the Eunice Kennedy Shriver 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 2011, NICHD could restore
full funding to its large-scale surveys, which serve as a resource for
researchers nationwide. Furthermore, the NICHD 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), the 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 recent steady funding increases, 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 were
cut, while other surveys, most notably the National Hospital Discharge
Survey, were not fielded. In 2009, NCHS 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.
Fortunately, Congress and the new administration worked together to
give NCHS adequate resources and avert implementation of these
draconian measures. Nonetheless, the agency continues to operate in a
precarious state.
The administration recommends NCHS receive $161.9 million in fiscal
year 2011. PAA and APC, as members of The Friends of NCHS, support the
administration's request. The increased funding will be used to support
a number of initiatives, including: (1) restore the National Health
Interview Survey to 87,000; (2) fund 12 months of vital statistics data
collection; and (3) implement re-engineered Web-based birth certificate
data in 6 States and 4 territories; and (4) phase in electronic death
certificate registration in States willing to enter a cost-sharing
arrangement with the agency.
BLS
During these turbulent economic times, data produced by the 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 $645 million in fiscal year 2011. According to the agency, this
funding level would enable BLS to improve the Consumer Expenditure
Survey and reduce variance in the Consumer Price Index. Also, BLS could
improve data used to measure occupational wage and employment growth
and identify trends policymakers need to understand the turbulent labor
market. Finally, the agency could support its work on developing an
alternative poverty measure.
Summary of Fiscal Year 2011 Recommendations
As members of the Ad Hoc Group for Medical Research, PAA and APC
are asking Congress to provide NIH with an appropriation of $35 billion
in fiscal year 2011--$3 billion more than the administration's request.
Although the administration's request for NIH reflects inflation, we
feel NIH needs additional support to sustain the new research capacity
created by ARRA.
PAA and APC, as members of the Friends of NCHS, ask that NCHS
receive $161.9 million in fiscal year 2011, 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, $645
million, for the BLS, in fiscal year 2011.
Thank you for considering our requests and for supporting Federal
programs that benefit the population sciences.
______
Prepared Statement of the Physician Assistant Education Association
On behalf of its membership, the 149 accredited physician assistant
(PA) education programs in the United States, the Physician Assistant
Education Association (PAEA) is pleased to submit these comments on the
fiscal year 2011 appropriations for PA education programs that are
authorized through title VII of the Public Health Service Act.
PAEA is a member of the Health Professions and Nursing Education
Coalition (HPNEC) and we support the HPNEC recommendation for funding
of at least $600 million in fiscal year 2011 for the health professions
education programs authorized under title VII and VIII of the Public
Health Service Act and administered through the Health Resources and
Services Administration (HRSA).
PAEA is grateful to the subcommittee for the recent funding
increases for Title VII Health Professions programs in the Consolidated
Appropriations Act, 2010 (Public Law 111-117) and for your support of
Title VII health professions programs.
Need for Increased Federal Funding
Faculty development is one of the profession's critical needs. In
order to attract the best qualified to teaching, PA education programs
must have the resources to train faculty in academic skills, such as
curriculum development, teaching methods, and laboratory instruction.
The challenges of teaching are broad and varied and include
understanding different pedagogical theories, writing instructional
objectives, and learning and applying educational technology. Most
educators come from clinical practice and these skills are essential to
transitioning to teaching. Educators are a critical element of meeting
the Nation's demand for an increased supply of primary care clinicians.
Generalist training, workforce diversity, and practice in
underserved areas are key priorities identified by HRSA. It is
increasingly important that the health workforce better represents
America's changing demographics, as well as addresses the issues of
disparities in healthcare. PA programs have been successful in
attracting students from underrepresented minority groups and
disadvantaged backgrounds. Studies have found that health professionals
from underserved areas are 3 to 5 times more likely to return to
underserved areas to provide care.
Physician Assistant Practice
Physician assistants (PAs) are licensed health professionals who
practice medicine as members of a team with their supervising
physicians. PAs exercise autonomy in medical decisionmaking and provide
a broad range of medical and therapeutic services to diverse
populations in rural and urban settings. In all 50 States, PAs carry
out physician-delegated duties that are allowed by law and within the
physician's scope of practice and the PA's training and experience.
Additionally, PAs are delegated prescriptive privileges by their
physician supervisors in all 50 States, the District of Columbia, and
Guam. This allows PAs to practice in rural, medically underserved areas
where they are often the only full-time medical provider.
Physician Assistant Education
There are currently 149 accredited PA education programs in the
United States, which together graduate nearly 6,000 PA students each
year. PAs are educated as generalists in medicine; their flexibility
allows them to practice in more than 60 medical and surgical
specialties. More than one-third of PA program graduates practice in
primary care.
The average PA education program is 27 months in length. Typically,
1 year is devoted to classroom study and approximately 15 months is
devoted to clinical rotations. The typical curriculum includes 400
hours of basic sciences and nearly 600 hours of clinical medicine.
The profession is expected to continue to grow as a result of the
projected shortage of physicians and other healthcare professionals,
the growing demand for professionals from an aging population, and the
continuing strong PA applicant pool, which has grown by more than 10
percent each year since the year 2000. The Bureau of Labor Statistics
projects a 39 percent increase in the number of PA jobs between 2008
and 2018. With its relatively short initial training time and the
flexibility of generalist-trained PAs, the PA profession is well-
positioned to help fill projected shortages in the numbers of
healthcare professionals.
Currently there are almost 20 new PA programs in the accreditation
pipeline. The continued growth of the profession heightens the need for
additional resources. Additional resources will help meet the
challenges of recruiting qualified faculty, shortages of preceptors and
clinical sites, and the need to continue our work to increase the
diversity of faculty and program applicants.
Title VII Funding
Title VII funding is the only opportunity for PA programs to apply
for Federal funding and plays a crucial role in developing and
supporting PA education programs.
Title VII funding fills a critical need for curriculum development
and faculty development. Funding enhances clinical training and
education, assists PA programs with recruiting applicants from minority
and disadvantaged backgrounds, and funds innovative programs that focus
on educating a culturally competent workforce. Title VII funding
increases the likelihood that PA students will practice in medically
underserved communities with health professional shortages. The absence
of this funding would result in the loss of care to patients in
underserved areas.
Title VII support for PA programs has been strengthened with the
enactment of the Patient Protection and Affordable Health Care Act
(Public Law 111-148), which provides a 15 percent carve out in the
appropriations process for PA programs. This funding will enhance
capabilities to train a growing PA workforce and is likely to increase
the applicant pool for faculty positions as a result of PA programs now
being eligible for faculty loan repayment. Huge loan burdens serve as
barriers for PAs' entry into academia.
Here we provide several examples of how PA programs have used Title
VII funds to creatively expand care to underserved areas and
populations, as well as to develop a diverse PA workforce.
--One Texas program has used its PA training grant to support the
program at a distant site in an underserved area. This grant
provides assistance to the program for recruiting, educating,
and training PA students in the largely Hispanic South Texas
and mid-Texas/Mexico border areas and supports new faculty
development.
--A Utah program has used its PA training grant to promote
interprofessional teams--an area of strong emphasis in the
Patient Protection and Affordable Care Act--by creating a model
geriatric curriculum that includes didactic and clinical
education. The grant has also allowed the program to optimize
its relationship with three service-learning partners and
develop new partnerships with three service-learning sites.
--An Alabama program used its PA training grant to update and expand
the current health behavior educational curriculum and HIV/STD
training. They were also able to include PA students from other
programs who were interested in rural, primary care medicine
for a 4-week comprehensive educational program in HIV disease
diagnosis and management.
--A South Carolina program has developed a model program that offers
a 2-year academic fellowship for recent PA graduates with at
least 1 year of clinical experience. To further enhance an
evidence-based approach to education and practice, two specific
evidence-based practice projects were embedded in the
fellowship experience. Fellows direct and evaluate PA students'
involvement in the ``Towards No Tobacco'' curriculum, aimed at
fifth graders, and the PDA Patient Data experience, aimed at
assessing healthcare services.
Recommendations on Fiscal Year 2011 Funding
The Physician Assistant Education Association requests the
Appropriations Committee to support funding for title VII and VIII
health professions programs at a minimum of $600 million for fiscal
year 2011. This level of funding is crucial to support the Nation's
demand for primary care practitioners, particularly those who will
practice in medically underserved areas and serve vulnerable
populations. Additionally we encourage support for the new programs and
responsibilities contained in the Patient Protection and Affordable
Care Act (Public Law 111-148), including a minimum of $10 million to
support PA education programs. We thank the members of the subcommittee
for their continued support of the health professions and look forward
to your continued support of solutions to the Nation's health workforce
shortage. We appreciate the opportunity to present the Physician
Assistant Education Association's fiscal year 2011 funding
recommendation.
______
Prepared Statement of the Patient Alliance for Neuroendocrineimmune
Disorders Organization for Research and Advocacy
Dear Chairman of the subcommittee on Labor, Health and Human
Services, and Education, and Related Agencies: On behalf of our
organization I want to share with you a matter of great importance to
our patient advocacy organization. It is related to the CFS Advisory
Committee (CFSAC), a congressional committee overseen by the Department
of Health and Human Services established to provide science-based
advice and recommendations to the Secretary of Health and Human
Services and the Assistant Secretary for Health on a broad range of
issues and topics pertaining to chronic fatigue syndrome (CFS). It has
been at least 6 years since our organization has attended and provided
input during CFSAC meeting and yet not one single crucial
recommendation has been implemented or enacted. Currently the CFSAC is
due to expire on September 5, 2010.
We need to call you attention why is so important that this
appropriation committee provide funding for research, patient care,
physician education, and clinical trial within a center of excellence
format. The CFSAC has consistently year after year as far back as
September 2004 recommended the following:
In September 2004--Recommendation 1.--We would urge the DHHS to
direct the NIH to establish five Centers of Excellence within the
United States that would effectively utilize state of the art knowledge
concerning the diagnosis, clinical management, treatment and clinical
research of persons with CFS. These Centers should be modeled after the
existing Centers of Excellence program, with funding in the range of
$1.5 million per center per year for 5 years.
In August 2005--Recommendation 1.--We would urge the DHHS to direct
the NIH to establish five Centers of Excellence within the United
States that would effectively utilize state-of-the-art knowledge
concerning the diagnosis, clinical management, treatment, and clinical
research of persons with CFS. These Centers should be modeled after the
existing Centers of Excellence program, with funding in the range of
$1.5 million per center per year for 5 years.
In November 20-21, 2006.--The Committee skipped recommending again
because it was told that it needed to wait till the Secretary of Health
could reply on the earlier recommendations therefore CFSA then provided
recommendation 3--The committee recommends that CFS be included in the
Roadmap Initiative of the NIH.
In May 16-17, 2007--Recommendation 1.--There have been basic
science advances which should be leading to new treatment strategies,
yet progress in translating these advances into effective treatments
has been slow. This is in large part due to a complete lack of clinical
care centers and research centers. Investigators are frustrated by a
lack of access to representative patient populations, and patients are
frustrated by a lack of accessible expert clinical treatment centers.
Funding mechanisms to develop new centers for either clinical care or
centers for research are shrinking, but the needs of this underserved
very ill patient population are unmet and growing.
Therefore, the CFSAC recommends that the Secretary use the
resources and talent of the agencies that make up the HHS to find ways
to meet these needs. One starting point is our request that the HHS
establish 5 regional clinical care, research, and education centers,
centers which will provide care to this critically underserved
population, educate providers, outreach to the community, and provide
effective basic science, translational and clinical research on CFS.
The advisory committee understands that fiscal exigencies have to date
prevented the formation of these previously recommended centers, but it
is our hope the Secretary will use the full weight of his office to
effectively fund this program through existing funding mechanisms that
might be available or new programs.''
In November 28-29, 2007.--CFSAC voted unanimously to send the
following recommendations to the Assistant Secretary for Health for
transmittal to the Secretary:
--It is recommended that a representative of AHRQ be added as an ex
officio member to CFSAC effective immediately, but at least in
advance of the next CFSAC meeting. The next CFSAC meeting is
scheduled to be held in May 2008.
--It is recommended that the CDC effort on CFS be restructured to
reflect a broader expertise on the multifaceted capabilities
required to execute a comprehensive program that incorporates
the following elements:
--an extramural effort directed by the Office of the Director;
--sufficient funds for a program for which the authority and
accountability is housed at the level of a coordinating
center director;
--a lab-based component that maintains the current search for
biomarkers and pathophysiology;
--the recommendations of the external CDC Blue Ribbon panel,
including developing, analyzing, and evaluating new
interventions and continuing support for longitudinal
studies; and
--an expanded patient, healthcare provider, and family caregiver
education effort that is managed by staff with appropriate
expertise in clinical and public education strategies.
In May 5-6, 2008.--The committee unanimously recommended 4 items.
For the purpose of my testimony I quote: ``CFSAC recommends to the
Secretary of Health and Human Services that the Administrator of HRSA
communicate with each Area Health Education Center (AHEC) regarding the
critical need for provider education of CFS. HRSA has the potential to
disseminate information on CFS to a wide range of providers,
communities and educational institutions. HRSA should inform these
groups that persons with CFS represent an underserved population and
that there is a dramatic need for healthcare practitioners who can
provide medical services to CFS patients. HRSA should further inform
these groups that the CDC offers a web based CME program on CFS at
www.cdc.gov/cfs; and encourage AHEC providers to participate in this
CME program. Additionally, HRSA should alert AHECs of the availability
of a CDC CFS provider toolkit.''
In October 28-29, 2008.--Several recommendations were made. For the
purpose of our testimony we quote:
--``It is recommended that DHHS solicit the Department of Education's
cooperation on issues relating to pediatric CFS.
--``It is recommended that the Transition report to the new
Administration and Secretary include the background of the
CFSAC and CFS and a list of the recommendations that have been
developed by this Committee over the past two chartered
periods, with any action taken on each point.
--``CFSAC endorses the planned State of the Knowledge Conference to
be developed by the NIH.
--``CFSAC recognizes that much can be done to ensure that every child
with CFS has the best possible access to support and treatment
and asks that the Secretary facilitate a taskforce or working
group to establish an ongoing interagency and interdepartmental
effort to coordinate school, family, financial, and healthcare
support for children and young adults with CFS.''
In October 29-30, 2009--Recommendation 1.--Establish Regional
Centers funded by DHHS for clinical care, research, and education on
CFS. (Resubmitted from May 2009)
As you can see, year after year, the same recommendation is being
made, and yet there has not been any progress for the past 6 years in
the most important recommendation from the CFSAC to the Secretary of
Health regarding chronic fatigue syndrome. Therefore we urge you--our
congressional leadership--to ensure funding for the
Neuroendocrineimmune (NEI) CenterTM and to the Whittemore
Peterson Institute. Please allocate funding for scientific research,
clinical trials, patient registry, physician education, public
education and social services to an estimated 20 million Americans
stricken with neuroendocrineimmune disorders such as chronic fatigue
syndrome (CFS) and related illnesses. Throughout the United States, day
after day we witness great suffering being inflicted on individuals,
children, teenagers, adults and the elderly. We witness children being
taken from their families simply because they ``have failed to find a
primary physician to treat their child'' (Baldwin Family vs. DSS
Buncombe County, North Carolina). Too much suffering because it seems
that no one in our government cares to take courageous step and stand
up for individuals with CFS.
We urge you to provide funding to The NEI CenterTM, a
patient-driven community initiative in the State of New Jersey
(hopefully in Florida as well), which will address all of the issues
mentioned on the CFSAC recommendation in addition to addressing
patient's quality of life issues. The cornerstone of the NEI
CenterTM (www.neicenter.com) is that discoveries and
advances made in any one of the neuroendocrineimmune illnesses: chronic
fatigue syndrome (CFS), myalgic encephalomyelitis or encephalopathy
(ME), fibromyalgia (FM), Gulf War syndrome/illness (GWS/GWI), multiple
chemical sensitivity (MCS), environmental illness (EI), chronic or
persistent Lyme disease (CLD-PLD), Alzheimer's Disease (AD), and
autism, will be applicable and beneficial to other neuroendocrineimmune
illnesses, thereby bringing us closer to a cure.
I ask you why hasn't this crucial issue be addressed promptly? Why
has our government failed to address such injustice? I urge you to
stand by the side of millions of Americans who presently do not have a
voice. Their future depends on your vision. Help us to restore their
health and their hopes. Please provide funding to the NEI
CenterTM and or similar efforts in the United States. This
committee has the power. You can do it. And as one of the many
individuals stricken with CFS, I thank you for this opportunity to
share the plight of so many. We need a hero, and you have the
opportunity to demonstrate vision, courage and foresight by allocating
funding for future centers of excellence for CFS and other
neuroendocrineimmune disorders. Thank you.
______
Prepared Statement of the Program for Appropriate Technology in Health
Program for Appropriate Technology in Health (PATH) appreciates the
opportunity to submit written testimony regarding fiscal year 2011
funding for global health research and development to the Senate Labor,
Health and Human Services, and Education, and Related Agencies
Appropriations Subcommittee. PATH is an international nonprofit
organization that creates sustainable, culturally relevant solutions,
enabling 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.
The ongoing 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 impoverished countries, 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.
Such discoveries will require increased funding for global health
research and development (R&D). Although the U.S. Government remains
one of the most important investors in the development of new
technologies, the need overshadows the contribution.
When looking at U.S. spending on R&D writ large over the last four
decades, Federal spending on all R&D, expressed as a percentage of
gross domestic product (GDP), has declined by more than 60 percent:
from just under 2 percent of GDP in 1965 to less than 1 percent in
2007.\1\ During a speech delivered in early 2009, President Obama
expressed a desire to reverse that trend by requesting a Federal R&D
budget of $147.6 billion for fiscal year 2010 and by setting a goal of
increasing national investment in R&D to more than 3 percent of GDP.\2\
Seizing upon this momentum, in fiscal year 2010 Congress appropriated
$150.4 billion for national research and development--a 2.4 percent
increase from 2009 funding. While global health R&D is just one
component of the overall national R&D budget, PATH thanks you for this
allocation and believes that this is a significant step towards
achieving our country's global health goals.
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\1\ National Science Foundation. Gross domestic product and
research and development (federally funded, non-Federal, and total):
1953-2007. Arlington, VA: NSF; 2008. Available at: http://www.nsf.gov/
statistics/nsf08318/pdf/tab13.pdf.
\2\ Speech to NAS, April 27, 2009. http://www.whitehouse.gov/
the_press_office/Remarks-by-the-President-at-the-National-Academy-of-
Sciences-Annual-Meeting/.
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Robust and sustained R&D funding is crucial to continued global
health advancements. Developing a single drug--from basic discovery to
clinical testing to product licensure--can cost as much as $800 million
and may take up to a decade.\3\ Developing more complex products may
take even longer and be even more expensive--as much as $1.2
billion.\4\ R&D costs rise as products advance through clinical
testing. In order to test whether a vaccine is safe and effective in
humans, for example, researchers require thousands of volunteers and
hundreds of health workers. As a result, late-stage trials are
typically more expensive to complete than earlier trials.
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\3\ Conference Report to Accompany H.R. 2997. September 30, 2009.
http://www.rules.house.gov/111/LegText/111_agcr_txt.pdf, p. 84.
\4\ Tufts Center for the Study of Drug Development. Research
Milestones. June 19, 2009. http://csdd.tufts.edu/Research/
Milestones.asp http://www.accessdata.fda.gov/scripts/opdlisting/oopd/
index.cfm.
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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. Several
programs funded in the Labor, Health and Human Services, and Education,
and Related Agencies 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 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 from the widely dispersed populations they
serve. Specialized equipment, personnel, and safe waste-disposal
systems are often not available. Without diagnostic testing, healthcare
professionals have to rely solely on symptoms to diagnose and treat
illness--an imperfect method given the similarity of symptoms among
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.
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 such 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.
Without sufficient funding for NIH and CDC, much of the cutting-
edge R&D 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, neglected diseases such as Chagas disease, and other
conditions whose heaviest burden falls on the developing world do not
have a significant commercial market to incentivize research and
development. Without investment by the U.S. Government, efforts to
develop lower cost, easy to use, and appropriate 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.
One promising area of innovation is nucleic acid (NA) amplification
and detection, which is the most accurate way to diagnose many diseases
that affect global health. Low-cost, highly accurate tests of this type
are usually not available in low-resource settings. The small numbers
of centralized laboratories that exist in developing countries tend to
be in urban areas and cater primarily to the affluent. In contrast,
rural healthcare facilities commonly have only basic equipment, and
health workers have limited training and little ability to maintain
equipment and handle reagents. Unreliable electric power to run the
tests is also a major obstacle.
Research conducted by PATH with support from NIH and CDC has
pointed to the technical feasibility of a new, low-cost, disposable
diagnostic platform for NA tests that can be used for detection of a
wide variety of infectious diseases, including infant HIV and
tuberculosis (TB). Other combinations of diagnostic technologies are
also being explored with support from USAID and private funders. Small,
portable, low-cost, instrument-free NA amplification tests that do not
require electricity would have a vital impact on the ability of health
workers and clinicians in developing countries to correctly and quickly
diagnose disease. Patients who come from long distances and often
cannot wait a few days to receive test results would be able to receive
a diagnosis and treatment regimen on site at the point of care. Such
tests could potentially replace the need for multi-million dollar
central laboratory facilities.
Another area where agencies funded by this subcommittee are making
a significant contribution to global health is 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 these deaths 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 R&D for malaria vaccines,
in partnership with the PATH Malaria Vaccine Initiative (MVI). NIH
supports much of the basic research that underpins malaria drug and
vaccine development efforts; the National Institute of Allergy and
Infectious Diseases, an institute within NIH, is a particularly central
player in malaria vaccine development efforts. CDC performs
epidemiological research and international disease surveillance of
malaria, providing critical data on the prevalence and spread of each
of the four strains of the malaria parasite and the effectiveness of
existing interventions.
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. Due in part
to investments by the U.S. Government, there is one malaria vaccine
candidate that, if proven, is just 5 years or so from introduction. In
May 2009, RTS,S--developed by GlaxoSmithKline Biologicals--entered a
large-scale phase 3 clinical trial, which is typically one of the final
steps before licensure. The trial is being conducted at 11 African
study centers in seven countries. Two of the centers, both in Kenya,
are partnered with U.S. Government agencies, including the CDC and the
Walter Reed Army Institute of Research. Results from one phase 2
clinical study show that RTS,S reduced the risk of clinical malaria by
53 percent in children aged 5 to 17 months. Although this is exciting
news, it represents not an end, but a beginning for malaria vaccine
development. In order to develop more effective vaccines towards the
ultimate goal of eradication, increased investment in research and
development at NIH and CDC must continue.
The U.S. Department of Health and Human Services is also using its
investments in science and technology to facilitate pandemic influenza
preparedness. With support from the Biomedical Advanced Research and
Development Authority (BARDA), PATH is supporting the enhancement of
sustainable influenza vaccine production capacity in Vietnam as part of
global preparedness efforts for a future pandemic. We are collaborating
with various partners in Vietnam, including the Government of Vietnam
and vaccine manufacturers, to assist in the production and clinical
evaluation of affordable, high-quality influenza vaccines. The project
builds upon support that BARDA is currently providing to the World
Health Organization to assist Vietnam in preparing for eventual
licensure and commercial-scale manufacturing of influenza vaccines and
is an important step toward increasing local and regional vaccines
supplies. This is part of a long-term strategy of international
capacity building. As the H1N1 outbreak demonstrated, the emergence of
a pandemic strain is unpredictable and the public health response needs
are to rapidly create, manufacture, and distribute novel vaccines.
Because of global travel and our interconnected world, international
cooperation on influenza preparedness has direct relevance for health
here in the United States.
Continued progress in our Nation's effort to improve global health
requires the development of new tools and technologies, which are
heavily reliant on research performed and supported by NIH, CDC, and
BARDA. For these reasons, we respectfully request robust funding for
NIH, CDC, and BARDA to allow the agencies to maximize global health
efforts, which each has stated as a priority for fiscal year 2011.
Funding for these agencies is critical to moving forward research on
HIV/AIDS, TB, malaria, and other diseases which disproportionately
impact low-income countries. We support the President's budget request
as the minimum amount needed for the Labor, Health and Human Services,
and Education, and Related Agencies account for fiscal year 2011.
We very much appreciate the subcommittee's consideration of our
views, and we stand ready to work with subcommittee members and staff
to ensure continued support for these important issues which are
essential to achieving our country's global health goals.
______
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 2011
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 2011 to help promote eye health and prevent eye disease and
vision loss:
--$5 million for the Vision Health Initiative at the Centers for
Disease Control and Prevention (CDC);
--$1.2 million in fiscal year 2011 to support the Maternal and Child
Health Bureau's (MCHB) National Universal Vision Screening for
Young Children's Coordinating Center (Center);
--$730 million in fiscal year 2011 for the title V Maternal and Child
Health (MCH) Services Block Grant; and
--Increased fiscal year 2011 funding 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\
---------------------------------------------------------------------------
\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.
---------------------------------------------------------------------------
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 meaningful Federal
funding for: programs that help promote eye health and prevent eye
disease, vision loss, and blindness; needed services and increased
access to vision screening; and vision and eye disease research. We
thank the subcommittee for its consideration of our specific fiscal
year 2011 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.
---------------------------------------------------------------------------
\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.
---------------------------------------------------------------------------
The CDC reports that ``vision disability is one of the top ten
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 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.
---------------------------------------------------------------------------
--Supporting the eye evaluation component of the National Health and
Nutrition Examination Survey (NHANES) that provides current,
nationally representative data and helps assess progress for
vision objectives contained within Healthy People 2010 and the
future efforts for Healthy People 2020.
--Utilizing 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.
--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.
--Under the leadership of researchers at Johns Hopkins University
investigating the best methods for identifying patients who
need eye care services and providing linkages to follow-up
care within community health centers.
--In coordination with researchers at Duke University evaluation of
strategies in primary care and pediatric settings to
improve the detection of childhood vision conditions and
diseases.
--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 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.
In fiscal year 2010, PBA requested $4.5 million to sustain and
expand the Vision Health Initiative. In the final fiscal year 2010
Consolidated Appropriations Act, Congress allocated $3.229 million a
$7,000 increase from fiscal year 2009. 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 respectfully requests the subcommittee provide a
$5 million allocation for the Vision Health Initiative. This level of
investment will help the CDC sustain and expand its efforts to address
the growing public health threat of preventable vision loss among at-
risk and underserved populations. Additional fiscal year 2011 resources
will support: strengthen State-based public health efforts to address
vision and eye health; development of additional evidence-based public
health interventions that improve eye health among the Nation's most
at-risk and underserved; and expand initiatives to address the growing
problem of diabetes among children and the associated impacts of
diabetic retinopathy, which can develop later in life.
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.
---------------------------------------------------------------------------
In 2009, the Maternal and Child Health Bureau created the National
Universal Vision Screening for Young Children Coordinating Center, a
national vision health collaborative effort aimed at developing the
public health infrastructure necessary to promote eye health and ensure
access to a continuum of eye care for young children. PBA is requesting
$1.2 million in fiscal year 2011 for the National Universal Vision
Screening for Young Children Coordinating Center.
With this level of funding, the Center, will continue to:
--Partner with public and private entities--including State title V
programs for Children with Special Health Care Needs,
pediatricians and primary care providers, families and parent
organizations, professional societies and associations, Family-
to-Family Health Information Centers, and State and community
agencies such as Healthy Start, Head Start, and elementary
schools--to expand the cadre of key stakeholders interested in
promoting young children's vision health and improving early
identification of vision problems in young children.
--Develop and implement a statewide strategy to achieve universal
screening of children by age 4.
--Determine a mechanism for uniform collection and reporting of
children's vision care and eye health data.
With fiscal year 2011 funding, the Center also will be able to:
--Broaden partnerships and expand coordination between the Center,
the State agencies that administer the title V Maternal and
Child Health Block Grant, and other State public health
entities to improve the early identification of vision problems
in children.
--Support a consensus conference involving MCHB, CDC, the Agency for
Healthcare Research and Quality, NEI, and the Office of Head
Start to establish national standards for vision screening in
young children.
In addition, States need increased resources to sustain and expand
the provision of critical healthcare services to millions of pregnant
women, infants, and children, including those with vision and eye care
needs. Beyond direct services, the Maternal and Child Health (MCH)
Services Block Grant supports vital public health services and systems
that promote optimal health and help prevent disease. Therefore,
Prevent Blindness America supports appropriating $730 million in fiscal
year 2011 for the title V MCH Services Block Grant.
Advance and Expand Vision Research Opportunities
PBA calls upon the subcommittee to increase its support 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. Research
is critical to ensure that new treatments and interventions are develop
to help reduce and eliminate vision problems and potentially blinding
eye diseases facing consumers across the country. In 2009, Congress
commended the NEI's leadership in basic and translational research
through H. Res. 366 and S. Res. 209, which recognized NEI's 40 years as
the National Institutes of Health Institute that leads the Nation's
commitment to save and restore vision. The resolutions also designated
2010-2020 as the Decade of Vision in recognition of the increasing
health and economic burden of eye disease, mainly as a result of an
aging population.
The NEI will be able to continue to grow its efforts to:
--Expand capacity for research, as demonstrated by the significant
number of high-quality grant applications submitted in response
to ARRA opportunities.
--Address unmet need, especially for programs of special promise that
could reap substantial downstream benefits, as identified by
new NIH Director Dr. Francis Collins.
--Fund research to reduce healthcare costs, increase productivity,
and ensure the continued global competitiveness of the United
States.
By increasing funding for the NEI at the NIH, essential 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, treatment efforts, and health information
dissemination will be bolstered.
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 2011
funding for the CDC's Vision Health Initiative, the Maternal and Child
Health Bureau's National Universal Vision Screening for Young Children
Coordinating Center and title V MCH Block Grants and the 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. 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 the Pancreatic Cancer Action Network
Mr. Chairman and members of the subcommittee: First and foremost, I
want to thank you for your leadership and support for medical research
carried out under the auspices of the National Institutes of Health
(NIH). Your continuing support recognizes that the basic resource of
this country is its people, and the Nation's strength can be no greater
than the health of its citizenry.
On behalf of the patients, families and scientists who make up the
Pancreatic Cancer Action Network, I especially thank you for helping to
shine a spotlight on the fourth leading cause of cancer death in the
United States and one of the most lethal forms of cancer: pancreatic
cancer. Your vigilance and encouragement is helping to correct that
situation. Unfortunately, of the more than 42,000 diagnosed with
pancreatic cancer last year, statistically, 76 percent died within 12
months of their diagnosis and 95 percent will die within 5 years. We
therefore still have a long way to go before the diagnosis does not
nearly guarantee a death sentence. And we have a long way to go before
the only major cancer with a 5-year survival rate still in the single
digits enjoys the progress made against so many other forms of cancer.
Two years ago some of you and your colleagues met with Dr. Randy
Pausch, whose book, The Last Lecture, inspired millions of us to live
our dreams. He inspired us even though he was facing his toughest life
challenge; he was battling pancreatic cancer.
Dr. Pausch's last appearance on Capitol Hill was in March 2008. He
died 4 months later. His message was that we must change the research
paradigm at NIH by providing more funding for the hardest research
problems like pancreatic cancer because if we tackle the hardest
problems, it will help us solve the easier problems.
Since Dr. Pausch's death there has been increased publicity of this
deadly disease with the subsequent diagnosis and death of actor Patrick
Swayze, and the diagnosis of U.S. Supreme Court Justice Ruth Bader
Ginsberg. Despite this publicity, the cold, hard fact remains that the
number of new cases diagnosed and the number of deaths caused by
pancreatic cancer are increasing. In fact, according to some experts,
the number of new pancreatic cancer cases was projected to rise by 12
percent in 2009, and to grow by 55 percent by the year 2030. These are
startling numbers. We must take action now to not only change the
current statistics, but to ensure that we have the tools for the
future.
But what patients, families, and advocates find most troubling is
that while remarkable progress has been made against so many other
forms of cancer, the progress we have made to detect or treat
pancreatic cancer has changed little over the past 40 years:
--There is no early detection for pancreatic cancer and many of the
risk factors are benign. As a result, the disease is usually
diagnosed in its late stages, often after it has metastasized
to other organs.
--There are no effective treatment options, except for a surgical
procedure called the Whipple that only approximately 15 percent
of all pancreatic cancer patients are eligible for and 80
percent of patients who have the surgery have a recurrence and
die within 5 years.
So, why has progress in pancreatic cancer been so slow in coming?
The answer is two-fold. The pancreas is complex and, because of its
location, a difficult organ to study. But frankly, the real obstacle is
the failure to make this a priority. Despite the fact that pancreatic
cancer is the fourth-leading cause of cancer death in the United
States, historically less than 2 percent of the National Cancer
Institute's (NCI's) budget is devoted to research in this field. I have
included for the record a chart of NCI funding for the top five cancer
killers--which includes pancreatic cancer--and their respective
survival rates. This chart demonstrates in very dramatic fashion that
there is a clear correlation between low investment in research and
poor survival rates. When an investment has been made, the 5-year
survival rates reflect those efforts.
In the absence of a concerted, well-focused scientific agenda,
promising research applications go unfunded; opportunities to explore
early screening techniques and more effective therapeutic agents are
forgone; and investigators become discouraged and move to other fields
of study.
Recommendations
How can the problem be corrected? Yes, funding for the NCI must be
increased. In that regard, we join with our partners in the One Voice
Against Cancer Coalition to ask that you provide $5.79 billion in
funding for the NCI in fiscal year 2011--an increase of $691 million
over the fiscal year 2010 appropriation.
But steps must also be taken to mount a sustainable research effort
against pancreatic cancer. Far more resources--money which will attract
more scientists--must be brought to bear in order to find early
detection tools and more effective treatments. To those ends, we
strongly recommend that:
--a pancreatic cancer research grant program be established, like the
program outlined in the H.R. 745 The Pancreatic Cancer Research
and Education Act, to support prioritized research projects
focused on basic research, finding more precise diagnostic and
early detection tools and innovative clinical trials on
promising therapeutic agents;
--a policy of ``exceptions'' funding for grant applications whose
primary focus is on pancreatic cancer needs to be re-instituted
at the NCI; and
--there must be more pancreatic cancer experts included on scientific
review panels.
Though the pool of NCI-funded researchers investigating pancreatic
cancer has gradually expanded in recent years, it still remains
disproportionately miniscule when compared to the number of researchers
in the other leading cancer fields. The recommendations I have outlined
will help remedy that problem. They will also challenge the research
community to rely less on ``safe bets'' and tackle difficult, high-risk
problems, such as pancreatic cancer.
Thank you for your time and consideration.
______
Prepared Statement of the Pew Children's Dental Campaign
The Pew Children's Dental Campaign, a campaign of the Pew Center on
the States, would like to thank the Subcommittee Chairman for allowing
the submission of this testimony in support of fiscal year 2011
appropriations for oral health programs.
The Pew Campaign works primarily at the State level to ensure that
more children receive dental care and benefit from policies proven to
prevent tooth decay. We are also mounting a national campaign to raise
awareness of the problem, recruit influential leaders to call for
change, and showcase states that have made progress and can serve as
models for pragmatic, cost-effective reform.
The Cost of Delay, recently released by The Pew Center on the
States, found that 10 years after the 2000 report by the U.S. Surgeon
General called dental disease a ``silent epidemic,'' too little has
changed. The report finds that two-thirds of the States are failing to
ensure that disadvantaged children get the dental healthcare they need.
The good news is that this problem can be solved. At a time when State
budgets are strapped, children's dental health presents a rare
opportunity for Federal policy makers to make meaningful investments
without breaking the bank-while delivering a strong return to
taxpayers.
The consequences of poor dental health among children are far
worse--and longer lasting--than most policy makers and the public
realize.
--Early growth and development.--Having healthy baby teeth is vital
to proper nutrition and speech development and sets the stage
for a lifetime of dental health.
--School readiness and performance.--In a single year, more than 51
million hours of school may be missed because of dental-related
illness.
--Overall health.--A growing body of research indicates that
periodontal disease--gum disease--is linked to cardiovascular
disease, diabetes and stroke.
--Economic consequences.--An estimated 164 million work hours each
year are lost because of dental disease. Dental problems can
hinder a person's ability to get a job in the first place
Adequately funding Federal oral health programs will provide
critical resources to States to plan, develop, coordinate, and operate
cost-effective dental programs that prevent dental disease. Two ongoing
Federal grant programs housed in the Centers for Disease Control and
Prevention and the Human Resources and Services Administration directly
support The Pew Campaign's goals, as do several new oral health
prevention and workforce programs established by Public Law 111-148--
Patient Protection and Affordable Care Act.
The Pew Center on the States asks that the Subcommittee consider
the following fiscal year 2011 funding requests:
Support the expansion of established Federal grant programs:
--CDC State Grants Program, Surveillance, and Technical Assistance--
Division of Oral Health.--With CDC support, States can better
promote oral health and efficiently administer scarce
resources, monitor oral health status and problems, and conduct
and evaluate prevention programs. This funding is critical to a
State's ability to prevent problems before they occur, rather
than treating them when they are painful and expensive. These
programs also support State community water fluoridation
programs and school-based dental sealant programs.
For example, research shows that community water fluoridation
offers one of the greatest return-on-investment of any preventive
healthcare strategy. For most cities, every $1 invested in water
fluoridation saves $38 in dental treatment costs. More than $1 billion
could be saved annually if the remaining water supplies in the United
States were fluoridated, according to the Centers for Disease Control.
Pew supports expansion of this grant program to $33 million per
year in order to reach all 50 States and the District of Columbia; an
increase of $18 million more than the fiscal year 2010 appropriation.
This program is authorized under section 4102 of Public Law 111-148
as an amendment to the Public Health Service Act. Funding for this
program fits the criteria for uses of the Public Health and Prevention
Fund (fiscal year 2011 = $750 million). Please recommend and approve
the transfer of $18 million of the Public Health and Prevention Fund to
fulfill the program's authorization to support all 50 States.
HRSA Dental Health Improvement Grants.--This program provides
grants to States to support oral health workforce activities, under
section 340G of the Public Health Service Act, and provide the
opportunity for States to implement a range of innovative approaches to
improve access to oral health services including, projects that address
the oral health workforce needs of underserved areas in both urban and
rural locations. For example, Florida used its Human Resources and
Services Agency workforce grant for a task force that resulted in a
regulatory change to expand the use of hygienists to improve the
efficiency of sealant programs. Kansas is using these resources for
several objectives, including promoting extended care permit
utilization for dental hygienists and funding loan repayment programs
for professionals working in underserved areas among other goals.
Pew supports a grant program that is funded to reach all 50 States
and the District of Columbia at a level of $20 million per year.
Fully fund newly authorized or expanded oral health prevention
programs in Public Law 111-148:
School-based Sealant Programs--Establishment of school-based dental
sealant programs.--The law requires that each of the 50 States and
territories receive a grant for school-based dental sealant programs as
well as to provide funding to Indian tribes. Sealants-clear plastic
coatings applied by a hygienist or dentist-cost one-third as much as
filling a cavity, and have been shown after just one application to
prevent 60 percent of decay in molars. In The Cost of Delay, Pew finds
that only 17 States have sealant programs that reach even one-quarter
of their high-risk schools, and 11 reported having no programs at all.
This program is authorized under section 4102 of Public Law 111-148
as an amendment to the Public Health Service Act and is an eligible use
of funding from the Public Health and Prevention Fund (fiscal year 2011
= $750 million). Please recommend and approve the transfer of $312.5
million of the Public Health and Prevention Fund to fulfill the program
authorization to fund all 50 states. The estimated cost for fiscal year
2011 provides for rapid acceleration and start-up funding along with
information technology and evaluation. The annual costs in fiscal year
2013 and beyond should be significantly less as the programs integrate
with insurance payment options. This estimate assumes full funding of
the CDC State Grants Program request (above) to support the additional
expertise and management necessary for these programs.
Alternative Dental Health Care Providers Demonstration Project.--
The law establishes/authorizes a 5-year, demonstration program
beginning within 2 years of enactment (no later than March 23, 2012) to
train or employ alternative dental healthcare providers in order to
increase access to dental healthcare services in rural and other
underserved communities. Each grant shall equal not less than $4
million (for the life of the project).
Pew requests $16 million for the first year of this program with at
least a 2-year period of availability. The $16 million will allow up to
four eligible entities to plan and implement a demonstration project
funded at $4 million over the 5-year project. Pew supports ramping up
the appropriations for this program in fiscal year 2012 to support
additional eligible entities to apply for demonstration projects.
The U.S. Department of Health and Human Services has designated
more than 4,000 areas across the country as Dental Health Professional
Shortage Areas (DHPSAs). More than 46 million people live in DHPSAs
across the United States, an estimated 30 million of whom lack access
to a dentist.
In 2006, roughly 4,500 new dentists graduated from the United
States' 56 dental schools. But it would take more than 6,600 dentists
choosing to practice in DHPSAs to provide care for those 30 million
people. More than 10 percent of those are needed in Florida alone,
where it would take at least 751 new dentists to close the access gap.
These dentist shortages are projected to worsen. Although several
dental schools have opened in the past few years, the number of
dentists retiring every year will soon exceed the number of new
dentists graduating and entering practice. In 2006, more than one-third
of all practicing dentists were older the age of 55 and edging toward
retirement. The Federal expansion of Medicaid and public insurance
including dental services will also compound the relative shortage of
dentists and further limit access to care. In 2009, Minnesota became
the first state in the country to authorize a new primary care dental
provider called a dental therapist at both a basic and advanced level.
At least 12 States are considering similar models.
Oral Healthcare Prevention Education Campaign.--The law establishes
a 5-year national, public education campaign that is focused on oral
healthcare prevention and education. The campaign is required to use
science-based strategies to convey oral health prevention messages that
include, but are not limited to, community water fluoridation and
dental sealants.
This program is authorized under section 4102 of Public Law 111-148
as an amendment to the Public Health Service Act and is an eligible use
of funding from the Public Health and Prevention Fund (fiscal year 2011
= $750 million). Please recommend and approve the transfer of $2
million of the Public Health and Prevention Fund to fulfill the program
mandate. This estimate assumes that planning and testing of messages
occurs during fiscal year 2011 while the major public education
campaign would take place in fiscal year 2012 and beyond.
In total the Pew Center on the States asks the committee to make
the following investment in improving oral health for children in the
fiscal year 2011 budget:
[In millions of dollars]
------------------------------------------------------------------------
Amount
------------------------------------------------------------------------
Total fiscal year 2011 request......................... 383.5
Increase over 2010 appropriations for existing programs 351
Amount of increase funded by the Prevention and Public 332.5
Health Fund...........................................
Increased investment in oral health out of the 302(b) 51
subcommittee budget allocation........................
------------------------------------------------------------------------
By making targeted Federal investments in effective policy
approaches, States can help eliminate the pain, missed school hours and
long-term health and economic consequences of untreated dental disease
among kids. A handful of States are leading the way, but all States can
and must do more to ensure access to dental care for America's children
most in need. Thank you for your consideration of this testimony.
______
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, and Health Resources and Services Administration. 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 pulmonary hypertension (PH) community.
I particularly want to thank the subcommittee for the unprecedented
support you provided to the NIH as part of the American Recovery and
Reinvestment Act. PH research has benefited substantially from that
investment with more than 17 PH-specific projects receiving ARRA
funding.
I am honored today to represent the hundreds of thousands of
Americans who are fighting a courageous battle against a devastating
disease. Pulmonary hypertension 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 impacts
patients of all races, genders, and ages. Preliminary data from the
REVEAL Registry suggests that the ratio of women to men who develop PH
is 4:1. 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 Pulmonary Hypertension Association, there were less than 200
diagnosed cases of this disease. It was virtually unknown among the
general population and not well known in the medical community. They
soon realized that this was unacceptable, and formally established PHA,
which is headquartered in Silver Spring, Maryland.
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.
the pulmonary hypertension community
Mr. Chairman, I am privileged to serve as the President of the
Pulmonary Hypertension Association and to interact daily with the
patients and family members who are seeking to live their lives to the
fullest in the face of this deadly, incurable disease.
Carl Hicks is a former Army Ranger and a retired Colonel who led
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 30, 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 seven 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
pulmonary hypertension 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 pulmonary
hypertension 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 2011 appropriations recommendations
National Heart, Lung and Blood Institute
In 2008, 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 seven 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.
We are grateful to the National Heart, Lung and Blood Institute for
their leadership in advancing research on PH. Our Association is proud
to jointly sponsor investigator training grants (K awards) with NHLBI
aimed at supporting the next generation of pulmonary hypertension
researchers.
Moreover, we were very pleased that NHLBI recently convened some of
the community's leading scientists for a Working on Group on Pulmonary
Hypertension. This panel is charged with developing recommendations
that will guide PH research in the coming years. An overview of the
Working Group's plan will be published in the American Journal of
Respiratory and Critical Care Medicine this year and we encourage the
subcommittee to support its implementation by NHLBI.
Mr. Chairman, expanding clinical research remains a top priority
for patients, caregivers, and PH investigators. We are particularly
interested in establishing 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. We encourage the NHLBI to move forward with
the establishment of a PH network in fiscal year 2011.
For fiscal year 2011, PHA joins with other voluntary patient and
medical organizations in recommending an appropriation of $35 billion
for NIH. This level of funding will ensure continued expansion of
research on rare diseases like pulmonary hypertension and build upon
the significant investment made in the NIH as part of the American
Recovery and Reinvestment Act.
Centers for Disease Control and Prevention
Mr. Chairman, we are grateful to you and the subcommittee for
providing funding in fiscal year 2010 for the continuation of PHA's
Pulmonary Hypertension Awareness Campaign. 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. More needs to be done to educate both the general public
and healthcare providers if we are to save lives.
To that end, PHA has utilized the funding provided through the CDC
to: (1) launch a successful media outreach campaign focusing on both
print and online outlets; (2) expand our support programs for
previously underserved patient populations; and: (3) establish PHA
Online University, an interactive curriculum-based Web site for medical
professionals that targets pulmonary hypertension experts, primary care
physicians, specialists in pulmonology/cardiology/rheumatology, and
allied health professionals. The site is continually updated with
information on early diagnosis and appropriate treatment of pulmonary
hypertension. It serves as a center point for discussion among PH-
treating medical professionals and offers Continuing Medical Education
and CEU credits through a series of online classes.
``Gift of Life'' Donation Initiative at HRSA
PHA applauds the success of the Health Resources and Services
Administration's ``Gift of Life'' Donation Initiative. This important
program is working to increase organ donation rates across the country.
Unfortunately, the only ``treatment'' option available to many late-
stage PH patients is a lung, or heart and lung, transplantation. This
grim reality is why PHA established ``Bonnie's Gift Project.''
``Bonnie's Gift'' was started in memory of Bonnie Dukart, one of
PHA's most active and respected leaders. Bonnie battled with PH for
almost 20 years until her death in 2001 following a double lung
transplant. Prior to her death, Bonnie expressed an interest in the
development of a program within PHA related to transplant information
and awareness. PHA will use ``Bonnie's Gift'' as a way to disseminate
information about PH, transplantation, and the importance of organ
donation, as well as organ donation cards, to our community.
PHA has had a very successful partnership with HRSA's ``Gift of
Life'' Donation Program in recent years. Collectively, we have worked
to increase organ donation rates and raise awareness about the need for
PH patients to ``early list'' on transplantation waiting lists. For
fiscal year 2011, PHA recommends an appropriation of $30 million for
this important program.
______
Letter from Public Health--Seattle and King County
March 19, 2010.
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, Healthy and Human Services, and
Education, and Related Agencies,
Washington, DC.
Dear Senators Harkin and Cochran: As a large public health agency
serving King County, Washington we urge your subcommittee to invest in
programs that provide all of our Nation's youth with comprehensive,
medically accurate, and age-appropriate sex education that helps them
reduce their risk of unintended pregnancy, HIV, and other sexually
transmitted infections (STIs).
For the first time in more than a decade, the Nation's teen
pregnancy rate rose 3 percent in 2006. During this time, teens were
receiving less information about contraception in schools and their use
of contraceptives was declining. While making up only one-quarter of
the sexually active population, young people aged 15-24 account for
roughly half of the approximately 19 million new cases of STIs each
year. Those aged 13-24 account for one-sixth of new HIV infections, the
largest share of any group.
We are pleased that the President's fiscal year 2011 budget request
once again included funding for more comprehensive and evidence-based
approaches to sex education. However, by focusing the funding on teen
pregnancy prevention, and not including the equally important health
issues of STIs including HIV, the administration has missed an
opportunity to provide true, comprehensive sex education that promotes
healthy behaviors and relationships for all young people, including
lesbian, gay, bisexual, and transgender youth. We must strategically
and systemically provide young people with all the information and
services they need to make responsible decisions about their sexual
health. Therefore, we request that the teen pregnancy prevention
initiative be broadened to address STIs, including HIV, in addition to
the prevention of unintended teen pregnancy.
Most of the evidence-based programs that have been proven effective
at reducing risk factors associated with unintended teenage pregnancy
and STIs by delaying sexual activity and increasing contraceptive use
emphasize abstinence as the safest choice and also discuss
contraceptive use as a way to avoid pregnancy and sexually transmitted
infections, including HIV. In light of the evidence and recognizing
more than half of young people have had sexual intercourse by the age
of 18 and are at risk of both unintended pregnancy and STIs, we request
that the subcommittee direct the Office of Adolescent Health to
prioritize funds to programs that are more comprehensive in scope
insofar as they encourage abstinence but also encourage young people to
always use condoms or other contraceptives when they are sexually
active. Leading public health and medical professional organizations--
including the American Medical Association, the American Academy of
Pediatrics, the Society of Adolescent Medicine, and the American
Psychological Association--support a comprehensive approach to
educating young people about sex. In addition, the vast majority of
parents want the Federal Government to fund programs that are medically
accurate, age-appropriate, and educate youth about both abstinence and
contraception.
Congress should continue to act in the best interest of young
people by supporting public health and education policies that are
comprehensive, rooted in the best science, and reflect mainstream
values. We urge you to include in the Subcommittee on Labor, Healthy
and Human Services, and Education, and Related Agencies appropriations
bill the strongest possible initiative that will meet the needs of all
young people and help them achieve healthier and safer lives.
Sincerely,
Matthew Golden, MD, MPH,
Director, HIV/STD Program,
Public Health--Seattle and King County.
______
Prepared Statement of the PKD Foundation
Mr. Chairman, Ranking Member, and members of the subcommittee:
Thank you for the opportunity to provide testimony on behalf of the PKD
Foundation and the more than 600,000 Americans and 12.5 million people
world-wide suffering from polycystic kidney disease (PKD). This
subcommittee's commitment to advancing the great work of the National
Institutes of Health (NIH) is legendary, and it must be continued. To
meet that need, the PKD Foundation supports funding NIH at $35 billion
in fiscal year 2011. Underfunding NIH will only slow the pace and
progress of scientific discoveries for PKD patients and all people
living with a life-threatening disease or chronic condition.
The PKD Foundation also supports an appropriation of $500 million
to the newly authorized Cures Acceleration Network (CAN) as established
under the Patient Protection and Affordable Care Act (Public Law 11-
148; title X: sec. 10409). In order to help bridge the biomedical
research ``valley of death,'' CAN and other innovative initiatives
aimed at improving translational research and regulatory science at NIH
must be fully funded.
PKD Essentials
Polycystic kidney disease or PKD is one of the world's most
prevalent, life-threatening, genetic diseases affecting more than
600,000 Americans including newborns, children and adults regardless of
gender, age, race or ethnicity. With the presence of PKD, cysts develop
in both kidneys, leading to an increase in kidney size and weight.
Cysts can range in size from a pinhead to a grapefruit or a football.
They may also cause a normal kidney to grow from the size of a person's
fist to that of a football or a basketball and weigh as much as 38
pounds each. Early in the disease, patients often do not experience
symptoms and many do not realize they have PKD until other organs
become affected. Deterioration in every PKD patient varies, but
ultimately more than half will end up in renal failure and require
dialysis or a kidney transplant. Currently, there is no treatment or
cure for PKD.
PKD Research Today
PKD is the most therapy-ripe of all kidney diseases; research in
PKD is progressive and robust. According to Dr. Francis Collins, NIH
Director and former director of the Human Genome Research Institute,
PKD research offers a tremendous ``return on investment.'' Dr. Collins
called ``PKD [is] one of the hottest, most promising areas of research
in all of biochemistry.'' In 1994, scientists discovered the genes that
cause PKD, and currently, more than 20 clinical trials are underway to
help uncover a treatment.
Even with such success, PKD research is at a critical juncture.
Akin to other diseases and chronic conditions, PKD researchers,
patients and families are facing the biomedical research ``valley of
death,'' the chasm in which basic research can languish. The ``valley
of death'' is the point in the drug development pipeline where
scientists work to develop prototype designs or invest in preclinical
development. Because these processes are risky, funding is inconsistent
and good ideas are often stopped in their tracks. The PKD Foundation
seeks to overcome this chasm by developing systems to help advance and
investing in translational research.
The PKD Foundation believes there are three components necessary
for bridging the ``valley of death.'' Those include: (1) purpose driven
research with milestone gated research targets; (2) catalyzing and de-
risking the drug development process to help encourage pharmaceutical
and biotechnology companies and major donors to invest; and, (3)
mobilizing impatient patients who will not accept the status quo.
Efforts to Bridge the ``Valley of Death"
On February 24, 2010, the NIH and the Food and Drug Administration
(FDA) announced a collaborative initiative aimed at accelerating the
drug development process by helping translate basic science into the
availability of new and innovative drugs and devices. The NIH-FDA
Initiative involves two interrelated scientific disciplines:
translational research and regulatory science. Translational research
involves shaping basic scientific discoveries into potential
treatments. Regulatory science focuses on developing and using tools
and standards to more efficiently aid in the development of therapeutic
products. Improved regulatory science will help the FDA more
effectively evaluate products for their safety and efficacy and help
NIH scientists better understand what types of data and information
should be collected for advancing basic research through the drug
development process.
The PKD Foundation fully supports this initiative and applauds the
Department of Health and Human Services (HHS) for taking a bold step in
addressing a lagging component in the drug development process. Both
translational research and regulatory science are imperative for
turning basic biomedical discoveries into therapies that will improve
the health and well-being of patients. Providing a platform for purpose
driven research is a necessary step in building a bridge over the
``valley of death.''
In addition to the NIH-FDA Initiative on translational and
regulatory science, the PKD Foundation applauds Congress for
authorizing the Cures Acceleration Network (CAN) through the Patient
Protection and Affordable Care Act. Housed within the Office of the
Director of NIH, CAN will work to bridge the ``valley of death'' by
helping identify and advance basic research via translational
scientific discoveries through a new grant making system.
The PKD Foundation is confident that the role and programmatic
functions of CAN will help address the unmet needs of our impatient
patients. We are optimistic that CAN will help catalyze and de-risk the
drug development process, thereby encouraging pharmaceutical and
biotechnology companies to reach back and invest in developing safe and
effective therapies. In order to realize the great potential of CAN,
the PKD Foundation urges the Subcommittee to fund CAN at its $500
million authorizing level.
Conclusion
The NIH-FDA Initiative on translational and regulatory science and
the Cures Acceleration Network are innovative ideas aimed at bridging
the biomedical research ``valley of death.'' Coupling these innovative
public endeavors with the efforts of private entities, such as the PKD
Foundation's Drug Discovery Project, should help PKD patients and
families rest a bit easier. Together we are working to advance the
basic science and understanding of PKD, speed the discovery of
treatments, and perhaps one day find a cure for PKD. To that end, the
PKD Foundation supports $35 billion for NIH in fiscal year 2011 and
$500 million for the Cures Acceleration Network. Funding NIH and its
important initiatives and programs is one key to the future success of
PKD research. Thank you.
______
Prepared Statement of ProLiteracy Worldwide
Chairman Harkin, Vice Chairman Cochran, and members of the
subcommittee, on behalf of the millions of adult learners working to
improve their basic skills and pursue greater economic opportunity for
themselves and their families, thank you for the opportunity to provide
written testimony regarding the President's fiscal year 2011 budget
request for adult education and family literacy, provided for under the
Workforce Investment Act, title II. We would be pleased to testify and
participate in any future hearings regarding adult literacy and basic
education.
At a time when millions of Americans are struggling to find work
and billions of dollars are being invested in job creation and in
retraining our workforce, it is essential to also invest in adult
learning in order to maximize our return on these investments and put
more American families on the road to self-sufficiency and economic
security. We strongly urge you to provide at least $750 million for
Adult Basic and Literacy Education in fiscal year 2011 to better assist
the one in seven adults nationally who struggle with illiteracy.
Background: ProLiteracy
ProLiteracy Worldwide is the world's oldest and largest
organization of adult literacy and basic education programs in the
United States. ProLiteracy traces its roots to two premiere adult
literacy organizations: Laubach Literacy International and Literacy
Volunteers of America, Inc. In 2002, these two organizations merged to
create ProLiteracy.
ProLiteracy now represents more than 1,200 community-based
organizations and adult basic education programs in the United States,
and we partner with literacy organizations in 50 developing countries.
In communities across the United States, these organizations use
trained volunteers, teachers, and instructors to provide one on one
tutoring, classroom instruction, and specialized classes in reading,
writing, math, technology, English language skills, job-training and
workforce literacy skills, GED preparation, and citizenship. Our
members are located in all 50 States and in the District of Columbia.
Through education, training and advocacy, ProLiteracy supports the
frontline work of these organizations through regional conferences and
other training events; credentialing; and the publication of materials
and products used to teach adults basic literacy and English as a
second language and to prepare adults for the U.S. citizenship exam and
GED tests.
The Urgent Need to Invest in Adult Education
In 2003, the U.S. Department of Education conducted the National
Assessment of Adult Literacy (NAAL) in order to gauge the English
reading and comprehension skills of individuals in the United States
older than the age of 16 on daily literacy tasks such as reading a
newspaper article, following a printed television guide, and completing
a bank deposit slip. The results indicated that 30 million adults--14
percent of this country's adult population--had below basic literacy
skills; that is, their ability to read was so poor, they could not
complete a job application without help or follow the directions on a
medicine bottle. An additional 63 million adults read only slightly
better.
Due to funding constraints, the adult education system currently
only has the capacity to serve approximately 2.5 million of these 93
million adults each year. Adult education has been nearly flat funded
for a decade, seeing only a modest overall increase from 2001-2009.\1\
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\1\ U.S. Department of Education Budget History http://www2.ed.gov/
about/overview/budget/history/edhistory.pdf.
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The high percentage of low-literate adults can be connected to
almost every socioeconomic problem this country faces. According to the
U.S. Department of Education, an estimated 60 percent of prison inmates
are barely literate. Struggling readers are also more likely to be
unemployed and require public assistance. Low literacy also has a
significant impact on public health and healthcare costs. The 2003 U.S.
Department of Education National Assessment of Adult Literacy (NAAL)
estimates that 36 percent of the adult U.S. population has Basic or
Below Basic health literacy levels. Low health literacy is a major
source of economic inefficiency in the U.S. healthcare system: it is
estimated that the cost of low health literacy to the U.S. economy is
between $106 billion to $238 billion annually. This represents between
7 percent and 17 percent of all personal healthcare expenditures.\2\
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\2\ Low health literacy: implications for national health policy.
Available at: http://npsf.org/askme3/pdfs/Case_Report_10_07.pdf.
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The Proposed Adult Basic and Literacy Education Budget
The proposed fiscal year 2011 budget includes several significant
features that we strongly support. First, the President requested
$612.3 million for State grants for adult education through the
Workforce Investment Act (WIA), title II, an increase of $30 million
compared to the 2009 appropriation. While ProLiteracy welcomes this
overall increase to base funding, we agree with the National Coalition
for Literacy's (of which we are a member) request for at least $750
million for title II of WIA in fiscal year 2011, for the following
reasons:
--Although the President's proposal does increase base funding, it is
actually a $15.9 million decrease from last year's total
appropriation because of a one-time adjustment to correct for a
funding calculation error that occurred from 2003-2008. Many
States will receive a lower appropriation than in fiscal year
2010, at a time when many States are dramatically cutting
funding at the State and local levels due to budget deficits.
--The President's proposal would not substantially increase the
current number of students being served. We estimate that an
increase to $750 million would serve an additional 500,000
students--still a very small percentage of the millions of
adults in the United States in need of adult literacy services,
but a substantial and measurable boost in the number of adults
ready to succeed in postsecondary education or occupational
training.
--We support the President's goal of having the highest proportion of
college graduates in the world by the year 2020. However, even
if every State's graduation rates reached the level of the
highest-performing States, we cannot reach the President's goal
without a substantial increase in the number of out of school
adults entering into postsecondary education. Adult education
and literacy programs are an important component in the
development of a broader pipeline of learners entering into
postsecondary education.
Workforce Innovation
In addition to an increase in State funding, the administration's
budget includes a proposal to establish a new Partnership for Workforce
Innovation between the Department of Labor (DOL) and the Department of
Education (ED), providing a total of $321 million to support jointly
administered competitive Adult and Youth Innovation grants to States
and localities to test and replicate innovative workforce practices. A
$30 million increase to the Office of Vocational and Adult Education's
(OVAE) National Leadership funding represents OVAE's contribution to
the fund.
ProLiteracy applauds the administration's commitment to innovation.
We urge the subcommittee to ensure that innovation funding will benefit
adults at all skill levels, particularly the millions who are estimated
to possess less than basic literacy skills. In order for these adults
benefit from this fund, we recommend the following:
--Both the Adult and Youth Workforce Innovation Funds should
encourage integration between title I and II programs.
The Workforce Innovation Fund is a unique opportunity for the DOL
and ED to develop coordinated approaches to build upon what works at a
scale that can make a tangible difference to jobseekers. We suggest
that the DOL and ED funds be combined to expand successful, integrated
approaches to serving the lowest level learners and ensure eligible
entities under this funding stream have a demonstrated capacity of
serving adult learners.
Adult education providers should also be eligible to apply for the
funding contributed by DOL to both the Workforce Innovation Fund and
the Youth Innovation Fund. This would help address a common criticism
that Workforce Investment Act title I and II programs are too
disconnected from each other and fail to provide well-integrated
workforce development and adult education services. Grants to local
adult literacy providers, working in partnership, for example, with
local workforce investment boards, could develop more effective
replicable practices to improve the lowest level learners placement and
retention in employment.
We also recommend that any definition of underserved populations in
the DOL Workforce Innovation Fund include adult learners, particular
those at the lowest levels of literacy, and that eligible entities
under this funding stream should include those with a demonstrated
capacity of serving adult learners via services that are linked to
income, work, and academic supports and to better connect these systems
with employers and postsecondary education.
Also, because a significant number of young adults ages 16-24
receive education services from adult education programs, we recommend
that the DOL's Youth Innovation Fund explicitly define adult and family
literacy services as an allowable education activity under this funding
stream.
--Eligibility for Workforce Innovation Fund grants should include
community-based organizations and other entities with
demonstrated capacity to assist adults at the lowest literacy
levels and their families, and include wraparound services.
--The need for innovation should not come at the expense of the
existing WIA title II formula funds.
As noted above, while the President is calling for an overall
increase to base funding, some States will receive a substantially
smaller appropriation--at a time when many States are dramatically
cutting funding at the State and local level due to budget deficits.
ProLiteracy urges the subcommittee to ensure that the Workforce
Innovation Fund is funded on top of annual WIA formula funds, rather
than as a carve out of existing formula funds.
Thank you for the opportunity to present this testimony. We would
be happy to respond to any questions that you may have.
______
Prepared Statement of the Railroad Retirement Board
Mr. Chairman and members of the subcommittee: We are pleased to
present the following information to support the Railroad Retirement
Board's (RRB) fiscal year 2011 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 the past
year, the RRB has also administered special economic recovery payments
and extended unemployment benefits under the American Recovery and
Reinvestment Act of 2009 (ARRA), and more recently, extended
unemployment benefits under the Worker, Homeownership, and Business
Assistance Act of 2009.
During fiscal year 2009, the RRB paid $10.5 billion, net of
recoveries, in retirement/survivor benefits and vested dual benefits to
about 589,000 beneficiaries. We also paid $154.1 million in net
unemployment/sickness insurance benefits under the Railroad
Unemployment Insurance Act to more than 40,000 claimants. In addition,
the RRB paid benefits on behalf of the Social Security Administration
amounting to $1.3 billion to about 115,000 beneficiaries, and we paid
about $129.5 million in Economic Recovery Payments and $10.3 million in
temporary extended unemployment benefits under ARRA to about 518,700
beneficiaries and 3,100 claimants, respectively.
proposed funding for agency administration
The President's proposed budget would provide $110,573,000 for
agency operations, which would enable us to maintain a staffing level
of 891 full-time equivalent staff years in 2011. The proposed budget
would also provide $1,500,000 for information technology investments.
This includes $850,000 for costs related to an upgrade of the agency's
mainframe computer. The remaining IT funds would be used for
information security and privacy, E-Government initiatives, systems
modernization, network operations, and some infrastructure replacement.
agency staffing
The RRB's dedicated and experienced workforce is the foundation for
our tradition of excellence in customer service and satisfaction. Like
many Federal agencies, however, the RRB has a number of employees at or
near retirement age. Nearly 70 percent of our employees have 20 or more
years of service at the agency, and about 40 percent of the current
workforce will be eligible for retirement by fiscal year 2012.
To prepare for expected staff turnover in the near future, we are
focusing on activities related to workforce planning and development.
During the past year, the agency drafted a formal human capital plan
that adheres to guidance issued by the Office of Personnel Management.
The plan identifies demographic features of the agency's workforce and
the skills needed to fulfill our mission. The plan also establishes a
framework of actions over the next few years to recruit, retain, and
develop talented employees. We have also drafted a succession plan that
specifies staffing needed to meet organizational goals, identifies
competency gaps and develops strategies to address overall human
capital needs.
In connection with these workforce planning efforts, our budget
request for fiscal year 2011 includes a legislative proposal to enable
the RRB to utilize various hiring authorities available to other
Federal agencies. Section 7(b)(9) of the Railroad Retirement Act
contains language requiring that all employees of the RRB, except for
one assistant for each board member, must be hired under the
competitive civil service. We propose to eliminate this requirement,
thereby enabling the RRB to use various hiring authorities offered by
the Office of Personnel Management.
information technology improvements
In recent 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. In
fiscal year 2009, we began a multi-year initiative to modernize our
application systems, starting with Medicare processing systems. This
effort will enable the RRB to maintain the capability of our business
operations in the event of expected staff turnover, and to upgrade
agency systems by building on the improvements that we have already
completed. Much of the work related to this initiative will be
completed by in-house staff. Our budget request for fiscal year 2011
includes $150,000 for minimal contractual services related to the
initiative.
In order to keep pace with these planned improvements, it will be
necessary to increase the capacity of our mainframe computer. In fiscal
year 2008, a new mainframe computer was installed with scalability to
provide for additional processing capacity as demand increases. Since
then, demand for additional processing capacity has increased an
average of 18 percent each year with the completion of various
automation initiatives. Our fiscal year 2011 budget request includes
$850,000 to upgrade the RRB's mainframe computer software in order to
meet the rising demand for capacity.
Our proposed budget also includes an additional $500,000 for other
information technology investments. This funding will provide for
essential equipment and services needed to maintain our network
operations and infrastructure in fiscal year 2011, and to continue with
other initiatives, such as E-Government and information security and
privacy.
The President's proposed budget includes $57 million to fund the
continuing phase-out of vested dual benefits, plus a 2 percent
contingency reserve, $1,140,000, 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 Web site.
The market value of Trust-managed assets on September 30, 2009, was
approximately $23.3 billion, a decrease of $2 billion from the previous
year. Since its inception, the Trust has transferred approximately $8.9
billion to the RRB for payment of railroad retirement benefits.
In June 2009, we released the 24th Actuarial Valuation, including
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 actuarial valuation
indicates that cash flow problems occur only under the most pessimistic
assumption. Even under that assumption, the cash flow problems do not
occur until the year 2031. The long-term stability of the system,
however, is not assured. Under the current financing structure, actual
levels of railroad employment and investment performance over the
coming years will determine whether additional corrective action is
necessary.
Railroad Unemployment Insurance Account.--The equity balance of the
Railroad Unemployment Insurance (RUI) Account at the end of fiscal year
2009 was $27.8 million, a decrease of $72.1 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 2009. The
report indicated that even as maximum daily benefit rates rise 43
percent (from $61 to $87) from 2008 to 2019, experience-based
contribution rates are expected to keep the unemployment insurance
system solvent, except for small, short-term cash flow problems in 2010
and 2011 under the moderate and pessimistic assumptions. Projections
show a quick repayment of loans even under the most pessimistic
assumption.
Unemployment levels are the single most significant factor
affecting the financial status of the railroad unemployment insurance
system. However, the system's experience-rating provisions, which
adjust contribution rates for changing benefit levels, and its
surcharge trigger for maintaining a minimum balance, help to ensure
financial stability in the event of adverse economic conditions. No
financing changes were recommended at this time by the report.
Due to the increased level of unemployment insurance payments
during fiscal year 2009 and anticipated for fiscal year 2010, loans
from the Railroad Retirement (RR) Account to the RUI Account became
necessary beginning in December 2009. Transfers from the RR Account to
the RUI Account through February 2010 amounted to $24.5 million.
Current projections indicate that additional loans from the RR Account
to the RUI Account during fiscal year 2010 could amount to
approximately $43.5 million, for a total of $68 million during the
fiscal year.
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. I would like to thank you, Mr. Chairman, and the members of the
subcommittee for your continued support of the Office of Inspector
General.
budget request and background information
I wish to describe our fiscal year 2011 appropriations request and
our planned activities. The Office of Inspector General (OIG)
respectfully requests funding in the amount of $8,936,000 to ensure the
continuation of its independent oversight of the Railroad Retirement
Board (RRB).
The RRB's central mission is to pay accurate and timely benefits.
During fiscal year 2009, the RRB paid approximately $10.5 billion in
retirement and survivor benefits to 589,000 beneficiaries. RRB also
paid roughly $154.1 million in net unemployment and sickness insurance
benefits to almost 24,000 unemployment insurance beneficiaries and
18,000 sickness insurance beneficiaries.
The RRB contracts with a separate Medicare Part B carrier, Palmetto
GBA, to process the Medicare Part B claims of qualified railroad
retirement beneficiaries. As of September 30, 2009, there were about
468,000 such beneficiaries enrolled in the Medicare Part B program
through the RRB. During fiscal year 2009, Palmetto, GBA paid over $900
million in benefits.
During fiscal year 2011, the OIG will focus on areas affecting
program performance; the efficiency and effectiveness of agency
operations; and areas of potential fraud, waste, and abuse.
operational components
The OIG has three operational components: the immediate Office of
the Inspector General, the Office of Audit (OA), and the Office of
Investigations (OI). The OIG conducts operations from several
locations: the RRB's headquarters in Chicago, Illinois; an
investigative field office in Philadelphia, Pennsylvania; and three
domicile investigative offices located in Arlington, Virginia; Houston,
Texas; and San Diego, California. These domicile offices provide more
effective and efficient coordination with other Inspector General
offices and traditional law enforcement agencies with which the OIG
works joint investigations.
office of audit
It is OA's mission to:
--promote economy, efficiency, and effectiveness in the
administration of RRB programs and
--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 2011, 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, including activities of
Palmetto, GBA; and
--Security, privacy, and information management.
During fiscal year 2011, 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 2011, OA will complete the audit of the RRB's
fiscal year 2010 financial statements and begin its audit of the
agency's fiscal year 2011 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 fiscal year 2011, the
cost of this contract is expected to increase significantly over the
current contract amount.
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 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's investigative results for fiscal year 2009 are:
------------------------------------------------------------------------
Item Amount
------------------------------------------------------------------------
Civil judgments......................................... 29
Indictments/informations................................ 78
Convictions............................................. 48
Recoveries/collections.................................. $7,056,086
------------------------------------------------------------------------
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 and the Social Security
Administration with RRB benefits paid data. 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 Office of
Audit.
Presently, disability and Railroad Medicare fraud cases constitute
more than 60 percent of OI's total caseload. These cases often involve
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 surveillance,
numerous witness interviews, or more sophisticated investigative
techniques. Additionally, these fraud investigations are extremely
document-intensive and involve complicated financial analysis.
During fiscal year 2011, OI anticipates an ongoing caseload of more
than 400 investigations. 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.
conclusion
In fiscal year 2011, 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's 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 its 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
introduction
I am Dr. Kathleen Clanon, an HIV physician and Medical Director of
the HIV ACCESS program in Oakland, California. I am submitting written
testimony on behalf of the Ryan White Medical Providers Coalition.
Thank you for the opportunity to discuss the important HIV/AIDS
care conducted at Ryan White Part C-funded programs nationwide.
Specifically, the Ryan White Medical Provider Coalition, the HIV
Medicine Association, the CAEAR Coalition, and the American Academy of
HIV Medicine estimate that approximately $407 million is needed to
provide the standard of care for all part C program patients. (This
estimate is based on the current cost of care and the number of
patients that part C clinics serve.) While these are exceptionally
challenging economic times, we request $338 million for Ryan White Part
C programs in fiscal year 2011. This $131 million funding increase
would help meet the goal of providing the standard of care to all
patients who need it.
The Ryan White Medical Providers 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. We speak for those who often
cannot speak for themselves and we advocate for a full range of primary
care services for these patients. Sufficient funding for part C is
essential to providing appropriate care for individuals living with
HIV/AIDS.
Part C of the Ryan White Program funds comprehensive HIV care and
treatment, services that are directly responsible for the dramatic
decreases in AIDS-related mortality and morbidity over the last decade.
The Centers for Disease Control and Prevention estimate that there are
more than 1.1 million persons living with HIV/AIDS, and in 2008
approximately 240,000, or almost 1 in 4, of these individuals received
services from part C medical providers--a dramatic 30 percent increase
in patients in less than 10 years.
The recent passage of healthcare reform is a great achievement, but
many of the legislation's provisions and programs will not take effect
for several years. In the meantime, part C clinics need additional
resources today to continue delivering lifesaving and cost-effective
care to the growing number of people living with HIV.
the cost of care is reasonable; the reimbursement for care isn't
On average it costs $3,501 per person per year to provide the
comprehensive outpatient care and treatment available at part C-funded
programs, including lab work, STD/TB/Hepatitis screening, ob/gyn care,
dental care, mental health and substance abuse treatment, and case
management. Part C funding covers only a small percentage of the total
cost of this comprehensive care, with some programs receiving $450 (12
percent of the total cost) or less per patient per year to cover the
cost of care.
part c programs save both lives and money
Investing in part C services improves lives and saves money. In the
United States, nearly 50 percent of persons living with HIV/AIDS who
are aware of their status are not in regular care. Early and reliable
access to HIV care and treatment both helps patients with HIV live
relatively healthy and productive lives and is more cost effective. One
study from the Part C Clinic at the University of Alabama at Birmingham
found that patients treated at the later stages of HIV disease required
2.6 times more healthcare dollars than those receiving earlier
treatment meeting Federal HIV treatment guidelines.
patient loads are increasing at an unsustainable rate
Patient loads have been increasing at part C clinics nationwide,
despite the fact that there has not been significant new Federal
funding, and in many cases, State and/or local funding has been cut. A
steady increase in patients has occurred on account of higher diagnosis
rates and declining insurance coverage resulting in part from the
economic downturn. The CDC reports that the number of HIV/AIDS cases
increased by 15 percent from 2004 to 2007 in 34 States.\1\
---------------------------------------------------------------------------
\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/.
---------------------------------------------------------------------------
For example, a clinic in Henderson, North Carolina, has seen its
patient load increase almost nine fold from 35 patients in 2000 to
nearly 300 today, yet the clinic is receiving less funding now than 10
years ago. This clinic is the only facility of its kind for people with
HIV within 45 miles and it is struggling to deliver the complex care
these patients need. At another clinic in Greensboro, North Carolina,
the number of patients more than doubled from 321 patients in 2002 to
more than 800 in 2009. The clinic continues to deliver care in the same
space with the same staffing as in 2002 despite the 250 percent
increase in patients. Meeting this growing demand requires the maximum
effort of existing staff, and position vacancies prevented enrollment
of new patients for several months during 2009. In Sonoma County,
California, funding has become so scarce that the Part C Clinic there
is closing its doors, forced to patch together new medical homes in
other locations for 350 patients.
Our patients struggle in times of plenty, and during this economic
downturn they have relied on part C programs more than ever. While
these programs have been underfunded for years, State and local
economic pressures are creating a crisis in our communities. Clinics
are discontinuing primary care and other critical medical services,
such as laboratory monitoring; suffering eviction from their clinic
locations; operating only 4 days per week; and laying off staff just to
get by. Years of nearly flat funding combined with large increases in
the patient population and the recent economic crisis are negatively
impacting the ability of part C providers to serve their patients.
The following graph demonstrates the growing disparity between
funding for part C and the increasing patient population. I refer to
this gap between funding and patients as the ``Triangle of Misery''
because it represents both the thousands of patients who deserve more
than we can offer and the part C programs nationwide that are
struggling to serve them with shrinking resources.
conclusion
These are challenging economic times, and we recognize the severe
fiscal constraints Congress faces in allocating limited Federal
dollars. However, Congress itself has recognized the need to
substantially increase part C funds in its recent passage of the
reauthorization of the Ryan White Program in September 2009. In this
law, Congress recommended funding Ryan White Part C Programs at $259
million in fiscal year 2011, a $52 million increase more than the
fiscal year 2010 funding level.
The significant financial and patient pressures that we face in our
clinics at home propel us to request a substantial Federal investment
of $338 million in fiscal year 2011 for Ryan White Part C programs to
support medical providers nationwide in delivering appropriate and
effective HIV/AIDS care to their patients. Thank you for your time and
consideration of our request.
______
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 2011 to help improve quality-of-life for
people with Spina Bifida:
--$7.5 million for the National Spina Bifida Program within 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.
--$5.126 million for the CDC's national folic acid education and
promotion efforts to support the prevention of Spina Bifida and
other neural tube defects.
--$26.342 million to strengthen the CDC's National Birth Defects
Prevention Network.
--$163.5 million in overall funding for the CDC's National Center on
Birth Defects and Developmental Disabilities.
--$611 million for the Agency for Healthcare Research and Quality
(AHRQ).
--$32.2 billion for the National Institutes of Health (NIH) to
support biomedical research.
background and overview
On behalf of the estimated 166,000 individuals and their families
who are affected by all forms of 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 2011 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 SBF
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.
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, such as transitioning from
pediatric to adult healthcare providers, 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, 3,000
pregnancies are affected by Spina Bifida, resulting in 1,500 babies
born each year with the condition, 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. 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
Since, 2001, SBA has worked with Members of Congress and staff at
the CDC 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 National Spina Bifida Program established the National Spina
Bifida Resource Center housed at the SBA, which provides 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 given the
skills and information they need 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 166,000 individuals living with all forms of Spina
Bifida, with the goal being living well with Spina Bifida.
An important resource to better determine best clinical practices
and the most cost effective treatments for Spina Bifida is the National
Spina Bifida Registry, now in its second year. Nine sites throughout
the Nation are collecting patient data, which supports the creation of
quality measures and will assist in improving clinical research that
will truly save lives, while also realizing a significant cost savings.
In fiscal year 2010, SBA requested that $7 million be allocated to
support and expand the National Spina Bifida Program. In the final
fiscal year 2010 Omnibus Appropriations Act, Congress provided $6.242
million for this program, a slight increase 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 $7.5 million in fiscal year 2011 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. 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.
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. 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. 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 2011, 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 $7.5 million fiscal year 2011 allocation for the
National Spina Bifida Program, SBA urges the subcommittee to provide
$5.126 million for the CDC's national folic acid education and
promotion efforts to support the prevention of Spina Bifida and other
neural tube defects; $26.342 million to strengthen the CDC's National
Birth Defects Prevention Network; and $163.5 million to fund 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 $611 million fiscal year 2011 allocation for AHRQ, so it can
continue to provide guidance and support to the National Spina Bifida
Patient Registry and help improve quality of care and outcomes for
people with Spina Bifida.
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 increased
funding in fiscal year 2011. 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 the following
language in the report accompanying the fiscal year 2011 LHHS
appropriations measure:
``The Committee encourages NIDDK, NICHD, and NINDS to study the
causes and care of the neurogenic bladder in order to improve the
quality of life of children and adults with Spina Bifida; to support
research to address issues related to the treatment and management of
Spina Bifida and associated secondary conditions, such as
hydrocephalus; and to invest in understanding the myriad co-morbid
conditions experienced by children with Spina Bifida, including those
associated with both paralysis and developmental delay.''
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 2011 funding for programs that will improve the quality-of-
life for the 166,000 Americans and their families living with all forms
of Spina Bifida.
______
Prepared Statement of Status C Unknown
Status C Unknown (SCU) is a nonprofit organization. SCU's mission
is to educate those impacted by HCV about treatment options and promote
enhanced HCV awareness among the general public, healthcare
communities, and policymakers. Our strategic focus is prevention
education, support and advocacy. We are a multi-program organization
with primary focus on legislative activities and programs, both
statewide and nationally. We have led the way in hepatitis C advocacy
since 2005 in collaboration and partnerships with other community based
organizations, service providers, New York State Department of Health
(NYSDOH) and New York City Department of Health and Mental Hygiene (NYC
DOHMH).
As you craft the fiscal year 2011 Labor-HHS-Education
appropriations legislation, we urge you to consider the following
critical funding needs of viral hepatitis programs:
Specific funding needs:
--We are requesting an increase of $30.7 million for a total of $50
million for the Centers for Disease Control and Prevention
(CDC) Division of Viral Hepatitis (DVH).
--At least $20 million for an adult hepatitis B vaccination
initiative through the CDC Section 317 Vaccine Program.
--$10 million for the Substance Abuse and Mental Health Services
Administration (SAMHSA) to fund a project within the Programs
of Regional and National Significance (PRNS) to reach persons
who use drugs with viral hepatitis prevention services.
General funding needs:
--Increase funding for Community Health Centers to increase their
capacity to serve people with chronic viral hepatitis;
--Increase funding for the Ryan White Program to adequately cover
persons co-infected with viral hepatitis through additional
case management, provider education and coverage of viral
hepatitis drug therapies;
--Increase funding for the National Institutes of Health to support
their Action Plan for Liver Disease Research.
Specific Funding Needs
Division of Viral Hepatitis--Fiscal Year 2011 Request:
$30.7 million
The recently released Institute of Medicine (IOM) report,
``Hepatitis and Liver Cancer: A National Strategy for Prevention and
Control of Hepatitis B and C'' found that the public health response
needs to be significantly ramped up. The IOM report attributes low
public and provider awareness to the lack of public resources.
Seventeen of the 22 recommendations in the report are specific to CDC
DVH and State health departments. In order to implement these
recommendations to improve the Federal response, resources must be
increased to health departments which are the backbone of the Nation's
public health system and coordinate the response to these epidemics.
President Obama's budget proposal includes a $1.8 million increase
for the Division of Viral Hepatitis (DVH) at CDC, which is woefully
insufficient to address infectious diseases of this magnitude. While
operating on the smallest Division budget for the prevention of
infectious diseases within CDC, DVH will never be able to sufficiently
prevent and manage these epidemics under its current fiscal
constraints. States and cities receive an average funding award from
DVH of $90,000. This is only enough for a single staff position and is
not sufficient for the provision of core prevention services. These
services are essential to preventing new infections, increasing the
number of people who know they are infected, and following up to help
those identified to remain healthy and productive. We believe this
increase is an important first step to making hepatitis prevention
services more widely available. The expanded services should include
hepatitis B and C education, counseling, testing, and referral in
addition to delivering hepatitis A and B vaccine, and establishing a
surveillance system of chronic hepatitis B and C.
Section 317 Vaccine Program--Fiscal Year 2011 Request: $20
million
CDC identified funds through program cost savings in the Section
317 Vaccine Program, allocating $20 million in fiscal year 2008 and $16
million in fiscal year 2009 for purchase of the hepatitis B vaccine for
high-risk adults. We commend CDC for prioritizing high-risk adults with
this initiative, but relying on the availability of these cost savings
is not enough. Additionally, this initiative does not support any
infrastructure or personnel and health departments need additional
funding to support the delivery of this vaccine. We request a
continuation of $20 million in fiscal year 2011 for an adult hepatitis
B vaccination initiative through the CDC's Section 317 Vaccine Program.
Substance Abuse and Mental Health Services Administration--
Fiscal Year 2011 Request: $10 Million
Persons who use drugs are disproportionately impacted by hepatitis
B and C. The Substance Abuse and Mental Health Services Administration
(SAMHSA) Center for Substance Abuse Prevention (CSAP) and Center for
Substance Abuse Treatment (CSAT) are uniquely positioned to reach
populations at risk for hepatitis B and C. The existing infrastructure
of substance abuse prevention and treatment programs in the United
States provides an important opportunity to reach Americans at risk or
living with viral hepatitis. We urge you to provide $10 million to
SAMHSA to fund a project within the Programs of Regional and National
Significance (PRNS) to reach persons who use drugs with viral hepatitis
prevention services.
General Funding Needs
Medical Management and Treatment
Access to available treatments and support services are critical to
combat viral hepatitis mortality. While we are supportive of the
President's efforts to modernize and expand access to healthcare, we
also support increased funding for existing safety net programs. Low-
income patients who are uninsured or underinsured can and do seek
services at Community Health Centers (CHCs). With the growing
importance of CHCs as a safety net in providing frontline support for
these individuals, we support increasing resources for CHCs to increase
their capacity to serve people with chronic viral hepatitis.
Many low-income individuals co-infected with viral hepatitis and
HIV can obtain services through the Ryan White Program, however only
half of the State AIDS Drug Assistance Programs (ADAPs) are able to
provide viral hepatitis treatments to co-infected clients. We urge you
to increase Ryan White funding so States can provide adequate coverage
for co-infected clients. Increased resources are also needed to improve
provider education on viral hepatitis medical management and treatment,
to cover additional case management for patients undergoing treatment
and to allow more states to add viral hepatitis therapies and viral
load tests to their ADAP formularies. While Ryan White providers offer
lifesaving care to co-infected clients, they also have the expertise
and infrastructure to provide limited services to viral hepatitis mono-
infected clients.
Research
Finally, research is needed to increase understanding of the
pathogenesis of hepatitis B and C. Further research to improve
hepatitis B and C treatments that are currently difficult to tolerate
and have low ``cure'' rates are also needed. The development of
clinical strategies to slow the progression of liver disease among
persons living with chronic infection, especially to those who may not
respond to current treatment must be addressed. With effective vaccines
against hepatitis A and B, it is important to continue to work towards
the development of a vaccine against hepatitis C infection. The Liver
Disease Branch, located within the National Institute of Diabetes and
Digestive and Kidney Diseases (NIDDK) at the National Institutes of
Health (NIH), has developed an Action Plan for Liver Disease Research.
We request full funding for NIH to support the recommendations and
action steps outlined in this Action Plan for Liver Disease Research.
It is absolutely essential and urgent that we act aggressively to
address the threat of viral hepatitis in the United States. In 2007
alone, the CDC estimated that 43,000 Americans were newly infected with
hepatitis B and 17,000 with hepatitis C. Unfortunately, it is believed
that these estimates of hepatitis B and C infections are just the tip
of the iceberg. Most people living with hepatitis B and more than
three-fourths of people living with hepatitis C do not know that they
are infected. It is estimated that the baby boomer population currently
accounts for two out of every three cases of chronic hepatitis C. It is
also estimated that this epidemic will increase costs by billions of
dollars to our private insurers and public systems of health such as
Medicare and Medicaid, and account for billions lost due to decreased
productivity from the millions of American workers suffering from
chronic hepatitis B and C.
As you continue to draft the fiscal year 2011 Labor, Health and
Human Services, and Education, and Related Agencies appropriations
bill, we ask that you consider a generous increase for viral hepatitis
prevention to counter several years of flat or inadequate growth in
funding. A strong public health response is needed to meet the
challenges of these costly infectious diseases. The viral hepatitis
community welcomes the opportunity to work with you and your staff on
this important issue.
______
Prepared Statement of the Society for Neuroscience
introduction
Mr. Chairman and Members of the Subcommittee, I am Michael E.
Goldberg, M.D. I am the David Mahoney Professor of Brain and Behavior,
in the Departments of Neuroscience, Neurology, Psychiatry, and
Ophthalmology; as well as the Director of the Mahoney-Keck Center for
Brain and Behavior Research at Columbia University and President of the
Society for Neuroscience (SfN). My area of specialization is the
physiology of cognitive processes: visual attention, spatial
perception, and decisionmaking.
On behalf of the 40,000 members of the Society for Neuroscience, I
would like to thank you for your past support of neuroscience research
at the National Institutes of Health (NIH). Research funded by NIH has
returned significant dividends in terms of improved patient care as
well as the development of prevention programs for brain and nervous
system disorders. In this testimony, I will highlight how taxpayers
have benefited from this investment, and how a sustained investment can
enhance medical research, health, and economic strength.
fiscal year 2011 budget request
The entire scientific community is deeply grateful for the historic
investment in NIH through the American Recovery and Reinvestment Act
(ARRA), which is now funding high quality research, while creating and
preserving jobs. This investment in innovation and science is not only
setting a path to new discoveries, but also helping to stimulate the
national and local economies, preserving or creating an estimated
50,000 new high-wage, hi-tech jobs at a critical time for U.S.
research, and producing an estimated 2.5 return on investment for local
communities. To continue this exciting scientific and economic momentum
and maintain the current research capacity, the Society respectfully
requests that Congress provide a fiscal year 2011 appropriation in the
amount of $35 billion for NIH. This level of funding will build on the
research activities supported by the regular 2010 appropriations and
ensure that the Nation's universities do not lose scientific ground,
and be forced to lay off thousands of U.S. scientists and their support
staffs, when the ARRA funding ends this year. A strong investment in
the scientific enterprise will ensure that there is not a dramatic drop
in research activity and more job losses, as well as serve strong
encouragement to keep our young researchers in the training pipeline
and keep the programmers, technicians, and engineers so critical to
biomedical research in their jobs.
what is the society for neuroscience?
The Society for Neuroscience (SfN) is a nonprofit membership
organization of basic scientists and physicians who study the brain and
nervous system. SfN's mission is to:
--Advance the understanding of the brain and the nervous system.
--Provide professional development activities, information, and
educational resources for neuroscientists at all stages of
their careers.
--Promote public information and general education about the nature
of scientific discovery and the results and implications of the
latest neuroscience research.
--Inform legislators and other policymakers about new scientific
knowledge and recent developments in neuroscience research and
their implications for public policy, societal benefit, and
continued scientific progress.
what is neuroscience?
Neuroscience is the study of the nervous system--including the
brain, the spinal cord, and networks of sensory nerve cells, or
neurons, throughout the body. Humans contain roughly 100 billion
neurons, the functional units of the nervous system. Neurons
communicate with each other by sending electrical signals long
distances and then releasing chemicals called neurotransmitters which
cross synapses--small gaps between neurons.
The nervous system consists of two main parts. The central nervous
system is made up of the brain and spinal cord. The peripheral nervous
system includes the nerves that serve the neck, arms, trunk, legs,
skeletal muscles, and internal organs.
Critical components of the nervous system are molecules, neurons,
and the processes within and between cells. These are organized into
large neural networks and systems controlling functions such as vision,
hearing, learning, breathing, and, ultimately, all of human behavior.
Through their research, neuroscientists work to:
--Describe the human brain and how it functions normally.
--Determine how the nervous system develops, matures, and maintains
itself through life.
--Find ways to prevent or cure many devastating neurological and
psychiatric disorders.
nih-funded brain research successes
The funds provided in the past have helped neuroscientists make
significant progress in diagnosing and treating neurological disorders.
Today, thanks to NIH-funded research, scientists and healthcare
providers have a much better understanding of how the brain functions.
The following are a few of the many success stories in neuroscience
research:
--Post-traumatic Stress Disorder (PTSD).--For years it was thought
that those who survived or witnessed a trauma should be able to
tough it out and move on. But scientific studies funded by the
NIH helped reveal that PTSD is a serious brain disorder with
biological underpinnings. Healthcare practitioners today are
better able than ever to help those who have suffered a
traumatic event to cope, thanks to research over the past 20
years. Yet much remains to be done, and this research must
continue aggressively in light of returning veterans'
healthcare needs in coming generations. NIH-funded studies on
the brain chemicals and structures altered in PTSD offer
particular hope for developing effective treatments. One
approach is to target the corticotrophin-releasing factor
(CRF), a brain chemical that plays a crucial role in
coordinating the body's response to stress. And NIH-funded
studies showed that drugs called selective serotonin reuptake
inhibitors improved the memory of patients with PTSD and
reduced shrinkage of brain tissue in the part of the brain
involved in memory and emotion, helping PTSD patients better
deal with traumatic memories.
--Age-related Macular Degeneration.--As you grow older, you may some
day notice your vision becoming blurry or distorted. Straight
lines appear wavy, and it becomes more difficult to recognize
familiar faces. These signs may point to age-related macular
degeneration, or AMD, the leading cause of blindness and vision
impairment among older Americans. AMD is a form of
neurodegeneration that affects the light-sensitive nerve cells
in the retina at the back of the eye. AMD causes nerve cells in
the macula, the central region of the retina, to break down,
and abnormal deposits accumulate beneath the retina. Many
elderly people with AMD become socially isolated from friends
and family and can no longer participate in the activities they
once enjoyed. Thanks to work supported by NIH, scientists have
made rapid advances in understanding AMD and are beginning to
develop new treatments. Getting older remains the strongest
risk factor, but scientists now know that AMD results from a
complex interaction among genetic and environmental factors.
For example, smoking increases the risk. One recent NIH study
found that supplementing the diet with high levels of
antioxidants and zinc reduced patients' risk of developing the
advanced form of AMD disease by about 25 percent. The first
drug to treat AMD was approved by the FDA in 2000. When this
drug is activated by the application of laser light, it
eliminates the faulty blood vessels underneath the retina and
reduces further loss of vision. Doctors also may treat the
disease directly with laser surgery, destroying new blood
vessels and sealing leaks. Scientists have found important
similarities between deposits that form in the eye in AMD and
deposits in the brain in age-related neurodegenerative diseases
such as Alzheimer's and Parkinson's. The deposits are found in
some types of kidney disease as well. Because the effects of
treatments are easier to visualize in the eye, studies of AMD
may lead to improved treatment of these other diseases.
--New Treatments From Nature's Poisons.--Neuroscientists have
uncovered an unlikely source of new treatments for neurological
disorders and diseases--the toxins and venoms of fish, snails,
frogs, scorpions, and other creatures of land and sea. Brain
researchers are finding that what makes these poisonous
substances dangerous in the wild may also make them useful
tools in the clinic. Already, they are helping to relieve
chronic pain, and they may one day prove effective in treating
brain cancer. One deadly venom--that of the giant yellow
Israeli scorpion aptly nicknamed the ``deathstalker''--is being
studied as a possible tool in the treatment of glioma, the most
common type of brain tumor. Each year, about 22,000 Americans
are diagnosed with this quickly spreading cancer, and many die
within 12 months. Glioma cells spread throughout the brain,
including into its narrowest spaces, with the help of special
ion channels not found in healthy brain cells. A chemical in
the deathstalker's venom, chlorotoxin, binds to these ion
channels, an action that slows down the cancer's growth without
harming nearby healthy cells. Other research suggests that
chlorotoxin may be able to help kill gliomas and perhaps other
cancerous tumors through a different mechanism--by shutting off
their blood supply. A non-narcotic synthetic form of a
poisonous compound found in the venom of cone snails is already
helping to relieve chronic neuropathic pain in humans.
Neuroscientists are currently investigating whether other
chemicals in cone snail venom might help block the surge of
electrical brain activity that triggers epileptic seizures.
The above success stories required a close working collaboration
between the basic researcher discovering new knowledge and the
clinical-physician researcher translating those discoveries into new
and better treatments. Much other research in neuroscience is dedicated
to understanding basic phenomena, which, although motivated by clinical
problems, are not yet at the stage where they can be translated into
cures. For example, patients with lesions in the parietal lobe, a part
of the cerebral cortex, are devastated by deficits in visual attention
and spatial perception. NIH-supported research in my own laboratory has
illuminated much of the signal processing by which the parietal lobe
enables subjects to locate objects in space and attend to them. We now
understand why patients with parietal lesions behave as they do;
helping them is the next step. Other groups in the Mahoney-Keck Center
at Columbia University are doing NIH-supported research into the basic
mechanisms of how subjects assign value to objects in the world, and
make choices based on that value. A clinically relevant example of
these processes is the question of why a drug addict assigns high value
to drugs and then decides to acquire them. This research will
illuminate the neurobiology of processes like drug-seeking, and may
lead to better treatment,
conclusion
The field of neuroscience research holds great potential for
addressing the numerous neurological illnesses that strike more than 50
million Americans annually. As noted by my institution's (Columbia
University) Mind, Brain and Behavior Initiative: ``In the 20th century,
scientists discovered a great deal about the brain. They discovered
what happens to individual neurons when memories are made and created
powerful tools to image brain function. But while they made great
strides toward understanding molecules, cells, and brain circuitry,
scientists continue to unearth how these circuits come together in
systems to record memories, illuminate sight and produce language. We
have entered an era in which knowledge of nerve cell function has
brought us to the threshold of a more profound understanding of
behavior and of the mysteries of the human mind. Many believe that the
next level of understanding will come from analyses not of single cells
but of ensembles of neurons whose concerted actions must underlie the
complexity of human behavior and thought. Neural circuits must, in some
way, account for high-level functions such as memory, self-awareness,
language, joy, depression, and anger. Taking this research to the next
level through collaborations with the social sciences will illuminate
and identify the role of social interactions in normal and abnormal
brain function.'' However, this can only be accomplished by a
consistent and strong funding source.
An NIH appropriation of $35 billion for fiscal year 2011 is
required to take this research to the next level in order to improve
the health of Americans and to sustain the Nation's global
competitiveness. Additionally, the new research capacity must be
sustained to realize the scientific outcomes initiated by the Recovery
Act dollars and to ensure the next generations of scientists will have
opportunities in research. A strong scientific investment not only
produces ground breaking medical treatments and discoveries; it
supports national economic recovery, by creating thousands of jobs and
forming the foundation for a stronger national economy based on
technology and innovation.
Thank you for the opportunity to submit this testimony.
______
Prepared Statement of The Society for Healthcare Epidemiology of
America
The Society for Healthcare Epidemiology of America (SHEA)
appreciates this opportunity to express its support for Federal efforts
to prevent and reduce healthcare-associated infections. SHEA was
founded in 1980 to advance the application of the science of healthcare
epidemiology. The Society works to achieve the highest quality of
patient care and healthcare personnel safety in all healthcare 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 diseases 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 and the Federal Healthcare Infection Practices
Advisory Committee, and the Council of State and Territorial
Epidemiologists (CSTE) 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. In 2008, SHEA
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 Society also contributes expert
scientific advice to quality improvement organizations such as the
Institute for Healthcare Improvement, the National Quality Forum, and
State-based task forces focused on infection prevention and public
reporting issues.
SHEA applauds the Congress for its support of HAI prevention and
reduction activities through the American Recovery and Reinvestment Act
(ARRA) in 2009. SHEA continues to collaborate with the Department of
Health and Human Services (HHS) and the CDC to translate agency goals
and objectives for HAI funds into actions at the bedside that can
achieve meaningful reductions in preventable HAIs. However, there is a
critical need for ongoing congressional support of a national
prevention strategy to address a problem estimated by CDC to be one of
the top ten causes of death in the Nation and one that poses a
significant economic burden on the Nation's healthcare system.
CDC
The CDC plays a critical role in public health protection through
its health promotion, prevention, preparedness, and research
activities. As you consider fiscal year 2011 funding levels for the
CDC, SHEA urges your support of at least $8.8 billion for CDC's ``core
programs'' 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. CDC's leadership was
especially critical in efforts to provide support and guidance to State
and local health departments as well as the public in its response to
the 2009 H1N1 influenza virus. 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, improving the
public's health, and providing much-needed unbiased education on HAIs
and their prevention.
SHEA is particularly concerned about CDC's Infectious Diseases
program budget, which supports critical management and coordination
functions for infectious diseases research, policy development, and
intervention programs including related specific epidemiology and
laboratory activities. SHEA recommends an fiscal year 2011 funding
level of $2.3 billion for CDC's Infectious Diseases programs.
Within the Emerging and Zoonotic Infectious Disease programs'
proposed budget, the agency's Antimicrobial Resistance budget would be
cut dramatically by $8.6 million, or just more than 50 percent. This
vital program is necessary to help combat the rising crisis of drug
resistance, one of the most pressing problems and greatest challenges
that healthcare providers will confront during the coming decade. As
bacteria and other micro-organisms are becoming more resistant to
antimicrobials, our current therapeutic options are dwindling and
research and development of new antibiotics is lagging. For the first
time since the discovery and introduction of penicillin in the 1940s,
we are dangerously close to a return to the pre-antibiotic era.
Antimicrobial resistance is a very real problem that extends to
every segment of the healthcare community. Yet the President's fiscal
year 2011 budget would allow only 20 State/local health departments and
healthcare systems to be funded for surveillance, prevention, and
control of antimicrobial resistance, down from 48 this past year. It
would also eliminate all grants to States for the successful Get Smart
in the Community program to combat improper uses of antibiotics. These
cuts would be devastating at a time when we need to be fully committed
to the goals of antimicrobial stewardship, to the research needed to
define the most effective interventions and to educating the next
generation of stewards.
CDC's antimicrobial resistance activities including State-based and
local surveillance and educational initiatives are so critical to
protecting Americans from serious and life-threatening infections that
SHEA urges you to double funding for CDC's antimicrobial resistance
activities to at least $40 million in fiscal year 2011.
SHEA strongly supports the proposed fiscal year 2011 increase of
$12.3 million in the Preparedness, Detection and Control of Infectious
Diseases line item to allow for the expansion of the National
Healthcare Safety Network from 2,500 to 5,000 hospitals. 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. It
is an enormously important national resource and effective funding and
support is essential to expand its implementation. The proposed
increase will allow CDC to build on progress made with fiscal year 2009
ARRA funds to leverage the NHSN and support the dissemination of HHS
evidence-based practices within hospitals to reduce these infections
and save lives. These funds are also intended to allow CDC to build the
workforce capacity, laboratory facilities, and skills sets within State
and local health departments to enhance the ability to detect and
control emerging infectious diseases. It should be noted that this
funding level is not sufficient to sustain the NHSN and State and local
health department activities in this area.
SHEA urges you to increase the funding for CDC's budget line for
Emerging Infections by $25 million in fiscal year 2011. In fiscal year
2010, $11.7 million of this budget line were allocated to the Division
of Healthcare Quality and Promotion. The additional $25 million should
be used to support State and local health department HAI surveillance
and prevention activities and provide a means for sustaining and
expanding the important HAI initiatives that have been started using
ARRA funds. Given the condition of State economies, it is unlikely that
State funding will be available and the benefits of most programs will
be lost at the end of 2011 without continued Federal support. As we
seek to strengthen our public health infrastructure and reorient our
health system toward prevention and preparedness, a strong Federal role
should be part of a comprehensive approach to reduce HAIs and costs in
line with the goals of healthcare reform.
On a related note, recognizing that currently 21 States mandate the
use of NHSN for State public reporting and this number is expected to
grow, immediate efforts should be made to enable interfaces between
electronic health records (EHRs) and NHSN. In this way, additional
burdens are not placed upon healthcare entities from either an
infection prevention and control or information technology (IT)
perspective as the desirability for national database integration
proceeds.
SHEA is pleased with the proposed establishment and funding ($10
million) of a new workforce program, the Health Prevention Corps,
within the CDC to enhance the capacity of the public health
infrastructure to respond to current and emerging health threats. This
program is intended to recruit new talent for State/local health
departments with a focus on disciplines with known workforce shortages,
such as epidemiology. This investment is very timely, as a recently
released report from the CSTE documented a 10 percent decline in the
number of State-based epidemiologists over the last 3 years, with a 40
percent deficit in the overall number of epidemiologists needed for
full capacity across the 50 States. Clearly, our ability to reduce and
prevent HAIs is highly dependent upon a continued strong investment in
hospital infrastructure and qualified personnel for infection
prevention and control.
National Institutes of Health (NIH)
SHEA is very pleased that ARRA infused the NIH 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. It is critical that
we maintain this momentum for medical research capacity. Accordingly,
SHEA supports an overall funding level of $35 billion for NIH in fiscal
year 2011.
While SHEA is very pleased with the proposed major investment in
Agency for Healthcare Research and Quality (AHRQ) for research focused
on HAIs (discussed below), support for basic, translational, and
epidemiological HAI research has not been a priority of the NIH.
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 on funding for HIV/AIDS research, approximately $2 billion on
cardiovascular disease research, about $664 million on obesity research
and, by comparison, National Institute of Allergy and Infectious
Diseases (NIAID) 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 2011 to ensure adequate support for the
research foundation that holds the key to addressing the multifaceted
challenges presented by HAIs.
AHRQ
SHEA strongly supports the proposed investment of $34 million by
AHRQ in fiscal year 2011 to reduce and prevent HAIs. Funds made
available through AHRQ (and CDC) 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 Health Research and
Educational Trust projects (for example, Public Health Research
Institute 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 thanks the subcommittee for this opportunity to share our
priorities with respect to fiscal year 2011 funding for HHS, CDC, NIH,
and AHRQ. SHEA is pleased to serve as a resource to the committee going
forward on issues related to healthcare epidemiology.
______
Prepared Statement of the Sexuality Information and Education Council
of the United States
SIECUS, the Sexuality Information and Education Council of the
United States, has served as a strong national voice for sexuality
education, sexual health, and sexual rights for more than 45 years.
SIECUS affirms that sexuality is a fundamental part of being human,
one that is worthy of dignity and respect. We advocate for the right of
all people to accurate information, comprehensive education about
sexuality, and sexual health services. SIECUS works to create a world
that ensures social justice and sexual rights.
president's teen pregnancy prevention initiative at the office of
adolescent health
As an organization committed to the health and education of our
Nation's young people, we urge the subcommittee to invest in programs
that provide all of our Nation's youth with comprehensive, medically
accurate, and age-appropriate sex education that helps them reduce
their risk of unintended pregnancy, HIV, and other sexually transmitted
infections (STIs), as well as teach them about healthy relationships
and communication and decisionmaking skills so they can make
responsible decisions and lead safe and healthy lives.
For the first time in more than a decade, the Nation's teen
pregnancy rate rose 3 percent in 2006. During this time, teens were
receiving less information about contraception in schools and their use
of contraceptives was declining. Moreover, while making up only one-
quarter of the sexually active population, young people aged 15-24
account for roughly one-half of the approximately 19 million new cases
of sexually transmitted infections (STIs) each year. Those aged 13-24
account for one-sixth of new HIV infections, the largest share of any
age group.
We are pleased that the President's fiscal year 2011 budget request
once again included funding for more comprehensive and evidence-based
approaches to sex education. However, by focusing the funding on teen
pregnancy prevention, and not including the equally important health
issues of STIs including HIV, the Administration has missed an
opportunity to provide true, comprehensive sex education that promotes
healthy behaviors and relationships for all young people, including
lesbian, gay, bisexual, and transgender (LGBT) youth. We must
strategically and systemically provide young people with all the
information and services they need to make responsible decisions about
their sexual health. Therefore, we request that the teen pregnancy
prevention initiative be broadened to address STIs, including HIV, in
addition to the prevention of unintended teen pregnancy.
Most of the evidence-based programs that have been proven effective
at reducing risk factors associated with unintended teenage pregnancy
and STIs by delaying sexual activity and increasing contraceptive use
emphasize abstinence as the safest choice and also discuss
contraceptive use as a way to avoid pregnancy and STIs, including HIV.
In light of the evidence and recognizing more than one-half of young
people have had sexual intercourse by the age of 18 and are at risk of
both unintended pregnancy and STIs, we request that the committee
direct the Office of Adolescent Health to prioritize funds to programs
that are more comprehensive in scope insofar as they encourage
abstinence but also encourage young people to always use condoms or
other contraceptives when they are sexually active.
Leading public health and medical professional organizations--
including the American Medical Association, the American Academy of
Pediatrics, the Society of Adolescent Medicine, and the American
Psychological Association--support a comprehensive approach to
educating young people about sex. Focusing on more comprehensive
approaches is both good policy and good politics. It is good policy
because it is based on scientific considerations and takes into account
the reality of teens' lives. In sharp contrast to abstinence-only-
until-marriage programs, there is strong evidence that more
comprehensive approaches do help young people both to withstand the
pressures to have sex too soon and to have healthy, responsible, and
mutually protective relationships when they do become sexually active.
Importantly, the evidence is strong that sex education programs that
promote abstinence as well as the use of condoms do not increase sexual
behavior. Studies show that when teens are educated about condoms and
have access to the method, levels of condom use at first intercourse
increase while levels of sex stay the same.
Moreover, the CDC's Task Force on Community Preventive Services
recently reviewed Comprehensive Risk Reduction programs and found
sufficient evidence to recommend their use and support a conclusion
that Comprehensive Risk Reduction interventions can have a beneficial
effect on public health. The recommendation is based on sufficient
evidence of effectiveness in: reducing a number of self-reported risk
behaviors, including (1) engagement in any sexual activity, (2)
frequency of sexual activity, (3) number of partners, and (4) frequency
of unprotected sexual activity; (5) increasing the self-reported use of
protection against pregnancy and STIs; and (6) reducing the incidence
of self-reported or clinically-documented sexually transmitted
infections.
In addition, the vast majority of parents want the Federal
Government to fund programs that are medically accurate, age-
appropriate, and educate youth about both abstinence and contraception.
Nationwide polls show that 8 in 10 voters want young people to receive
a comprehensive approach to sex education that includes teaching about
both abstinence and contraception. Furthermore, according to the
results of a 2005-2006 nationally representative survey of U.S. adults,
published in the Archives of Pediatrics and Adolescent Medicine, there
is far greater support for comprehensive sex education than for the
abstinence-only approach, regardless of respondents' political leanings
and frequency of attendance at religious services. Overall, 82 percent
of those polled supported a comprehensive approach, and 68 percent
favored instruction on how to use a condom; only 36 percent supported
abstinence-only programs.
In these tight budget times, we are pleased that the President's
fiscal year 2011 budget increased funding for the new teen pregnancy
prevention initiative by $19.2 million, for a total of $133.7 million.
We urge the committee to fund the initiative at least at the
President's requested level of $133.7 million. We are also pleased that
the President's budget has once again included zero dedicated funding
for failed abstinence-only-until-marriage programs, and we encourage
the subcommittee not to include funding for these ineffective programs.
Congress should continue to act in the best interest of young
people by supporting public health and education policies that are
comprehensive, rooted in the best science, and reflect mainstream
values.
hiv prevention at the centers for disease control and prevention (cdc)
President Obama proposed an increase of $31 million for HIV
prevention programs at the Centers for Disease Control and Prevention
(CDC). While we are grateful for this proposed increase during such
difficult economic times, this amount is far from what is needed to
reduce the number of new infections in the United States, which still
stands at more than 56,000 per year. State and local health departments
and community-based organizations need increased resources to
strengthen and expand outreach, education, HIV testing, and prevention
programs targeting high-risk populations. The CDC believes that in
order to adequately address the HIV epidemic in this Nation, an
additional $878 million is needed over each of the next 5 years. We are
requesting an increase of $878 million for a total of $1.6 billion for
CDC HIV prevention activities in fiscal year 2011.
With increased funding, other crucial prevention efforts can be
augmented such as the delivery and evaluation of behavioral
interventions, social marketing campaigns, surveillance, and other
preventative education programs. Community based organizations and
State and local health departments are all facing severe financial
challenges. Through budget cuts, hiring freezes, layoffs, and
furloughs, health departments across the Nation continue to curtail
core public health functions including those that prevent the spread of
HIV and other infectious diseases. Additional Federal resources are
absolutely necessary if we are to reverse the increase of new
infections. Investing in HIV prevention will result in billions of
dollars in reduced healthcare costs in the future. Moreover, given the
strong epidemiological link between HIV and other STDs, including high
rates of co-infection among certain populations such as African
Americans and men who have sex with men, an increased investment in STD
programs (through the Division of STD Prevention) is an essential
component of scaling up HIV prevention efforts. The cost of treating
new cases of HIV each year that is attributable to Chlamydia,
gonorrhea, syphilis, and genital herpes is more than $1 billion per
year.
We also request an increase of $20 million, for a total of $60.2
million, for the Division of Adolescent and School Health's HIV
Prevention Education. Recent estimates suggest that while representing
25 percent of the ever sexually active population, 15-24 year-olds
acquire nearly one-half of all new STDs. Each year, one in four
sexually active teenagers contracts a sexually transmitted disease. In
addition, nearly 15 percent of the 56,000 annual new cases of HIV
infections in the United States occurred in youth ages 13 through 24 in
2006. This means that an average of one young person every hour of
every day is infected with HIV in the United States. It is essential
that we provide schools with the resources they require to build and
strengthen their capacity to improve child and adolescent health.
title x family planning program at the office of population affairs
We request that funding for the title X family planning program be
increased to $700 million over the next 5 years, beginning with an
increase of $76.5 million in fiscal year 2011.
Title X is a vital part of our Nation's healthcare infrastructure.
The Institute of Medicine (IOM), in their recent review of the program,
found title X to be a ``valuable program'' providing ``critical
services'' to those in need, but also noted that the program is not
currently receiving the funds needed to fulfill its mission. As the
Administration and Congress work to reform our healthcare system, the
President has stated that we must build on what works. Title X is a
prime example of the type of successful programs that should be
expanded. We appreciate the President's leadership in providing a $10
million increase for title X in his fiscal year 2011 budget request.
However, in spite of the program's critical role and proven
effectiveness, funding for title X continues to fall well short of what
is needed.
Title X serves nearly 5 million low-income women and men at more
than 4,500 health centers each year. Title X services help women and
men plan the number and timing of their pregnancies, thereby helping to
prevent nearly 1 million unintended pregnancies each year, nearly one-
half of which would otherwise end in abortion. In addition to providing
contraceptive services and supplies, title X health centers provide
basic preventive health services, education, and counseling. For
example, in 2007, title X centers provided 2.2 million Pap tests and
2.4 million clinical breast exams. Not only do the services provided
through title X promote public health, they also save tax dollars. For
every public dollar invested in title X, $4.02 is saved in Medicaid-
related costs alone.
conclusion
We urge you to include in the Labor, Health and Human Services, and
Education, and Related Agencies appropriations bill the strongest
possible teen pregnancy prevention and sex education initiative that
will meet the needs of all young people and help them achieve healthier
and safer lives. We also urge you to adequately fund HIV prevention at
the CDC and the title X family planning program so that the health
goals of our Nation can be met.
______
Prepared Statement of the Society for Maternal-Fetal Medicine
Mr. Chairman and members of the subcommittee: The Society for
Maternal-Fetal Medicine is pleased to have the opportunity to submit
testimony in support of the fiscal year 2011 budget for the Eunice
Kennedy Shriver National Institute of Child Health and Human
Development (NICHD). We are grateful for your strong and sustained
commitment to the National Institutes of Health (NIH), in particular
the NICHD. Through the programs of the NICHD, ground-breaking research
advances have been made that have changed the practice of obstetrics.
Established in 1977, the Society for Maternal-Fetal Medicine (SMFM)
is dedicated to improving maternal and child outcomes; and raising the
standards of prevention, diagnosis, and treatment of maternal and fetal
disease.
Maternal-fetal medicine specialists, also known as MFM specialists,
perinatologists and high-risk pregnancy physicians, are highly trained
obstetricians/gynecologists with advanced expertise in obstetric,
medical, and surgical complications of pregnancy and their effects on
the mother and fetus. The complex problems faced by these mothers may
lead to death or problems, both short-term and life-long for both the
mothers and their babies. Only through research can complications
involving the mother or unborn fetus be understood, treated, prevented
and eventually solved.
The mission of NICHD is to ensure that every child is born healthy
and that women suffer no harmful effects from reproductive processes.
NICHD supports a blend of basic, clinical, translational, and
multidisciplinary research studies that address a myriad of issues in
pregnancy such as:
--Preterm Birth.--Preterm birth (delivery before 37 weeks' gestation)
is associated with increased risks of death in the immediate
newborn period as well as in infancy, and can cause long-term
complications including devastating disabilities. About 20
percent of premature babies die within the first year of life,
and although the survival rate is improving, many preterm
babies have life-long disabilities, including cerebral palsy,
mental retardation, respiratory problems, and hearing and
vision impairment. Preterm birth occurs in nearly 13 percent of
all deliveries in the United States, a higher rate than in
other developed countries (5-9 percent). The total cost of
preterm birth in the United States is $26 billion a year,
according to a 2006 report of the Institute of Medicine.
--Stillbirth.--Stillbirth defined as the death of a fetus at 20 or
more weeks of gestation, complicated nearly 26,000 pregnancies
in the United States in 2005. Considerable racial disparity
exists--stillbirth is more than twice as common among African
Americans than Caucasian women (11.1 versus 4.8 per 1,000).
Other maternal risk factors for stillbirth include advanced
age, obesity, and co-existing medical disorders such as
diabetes or hypertension. The possible impact of environmental
exposures on stillbirth risk remains unknown. Of known
stillbirth causes, the most common are genetic abnormalities,
alterations in the number or structure of the chromosomes,
maternal infection, hemorrhage, and problems with the umbilical
cord or placenta. However, the cause remains unknown in about
one-half of all stillbirths.
--Hypertensive Diseases in Pregnancy.--High blood pressure
(hypertension) during pregnancy endangers the health of both
the mother and the baby and is increasingly common as women
delay pregnancy until they are older, and as they are more
frequently overweight. Hypertension in pregnancy is the second
leading cause of maternal death in the United States,
accounting for 15 percent of all deaths. For the mother, it is
associated with early delivery, increased need for labor
induction because of pregnancy complications, stroke, pulmonary
or heart failure, and death. The likelihood and severity of
these complications increases as the severity of the
hypertension increases, and if pre-eclampsia develops. Pre-
eclampsia is characterized by high blood pressure and the
presence of protein in the urine. Its cause, or causes, remains
one of the greatest mysteries in obstetrics and is a major
cause of maternal, fetal, and neonatal mortality worldwide.
--Pregestational and Gestational Diabetes.--The hormonal changes of
pregnancy can seriously worsen pre-existing diabetes and often
bring about a diabetic state (gestational diabetes) in
predisposed women. Whether diabetes mellitus existed before
conception or gestational diabetes develops during pregnancy,
maternal glucose intolerance can have significant medical
consequences for both mother and baby. Poorly controlled
diabetes is associated with miscarriage, congenital
malformations, abnormal fetal growth, stillbirth, obstructed
labor, increased cesarean delivery, and neonatal complications.
Up to 200,000 pregnancies are affected by gestational diabetes
each year.
Great strides are being made through NICHD-supported research to
address the complex situations faced by mothers and their babies. One
of the most successful approaches for testing research questions
related to preterm birth is the NICHD research networks, which allow
researchers from across the country to coordinate their work and share
data. The networks deal with different aspects of the problem of
preterm birth and its consequence. For example:
--Maternal-Fetal Medicine Units Network.--To achieve a greater
understanding and pursue development of effective treatments
for the prevention of preterm births, low birth weight infants
and medical complications during pregnancy, in 1986 the NICHD
established the Maternal-Fetal Medicine Units Network (MFMU).
The MFMU Network has changed obstetrical practice by
identifying new effective therapies and putting an end to
practices that are not useful. It is the only national research
infrastructure capable of performing the much needed large
trials that provide the evidence on which sound medical
practice is based. The MFMU Network is also the ideal vehicle
to collaborate with other NIH networks, as well as
international networks in order to improve global health. Since
its inception, the Network has made several exciting scientific
advancements and has been able to rapidly turn laboratory and
clinical research into diagnostic examinations and treatment
procedures that directly benefit those affected.
--A major advance in the prevention of preterm birth has been the
use of progesterone in the second and third trimesters,
which resulted in a substantial reduction in the rate of
preterm delivery among women who had a previous preterm
birth and also reduced the risk of newborn complications.
The annual savings of preventing recurrent preterm delivery
by progesterone treatment in the United States has been
estimated at more than $2 billion. Research into
progesterone use in women with other risk factors is
continuing. So far studies have shown that progesterone
treatment is not effective in twin or triplet pregnancies,
but it may reduce the rate of preterm birth in women with a
short cervix. If effective for this indication,
progesterone treatment would be particularly helpful for
identifying women at risk in their first pregnancy. Ongoing
study is needed to identify the optimal populations for
treatment and the best treatment regimens.
--A significant development in clinical care, antenatal
corticosteroid administration promotes fetal lung maturity.
It is one of the most effective means of preventing newborn
complications, including respiratory distress,
intraventricular hemorrhage, and death, when preterm birth
occurs. Though a single course of treatment is effective if
given before preterm birth, the effect appears to decline
over time if the pregnancy remains undelivered. Research
over the past decade has shown that repeated doses of
antenatal corticosteroids, either weekly or on alternate
weeks, is associated with negative effects on fetal growth
that could potentially outweigh their benefits. Current
research is evaluating the potential benefits of a single
``rescue course'' of corticosteroids for undelivered women
who have a second episode of threatened preterm delivery.
--Large trials have suggested that magnesium sulfate treatment,
given when preterm delivery is expected before 32-34 weeks,
results in a reduction in cerebral palsy. Because cerebral
palsy is the most prevalent chronic motor disability, with
an estimated lifetime cost of nearly $1 million per
individual, its prevention is of great significance to
patients, their family and to society. While current
evidence is encouraging, further study is needed to
determine the optimal treatment regimen and which
pregnancies would benefit most from this intervention.
Though novel and important research areas have emerged to improve
the outcomes of mothers and babies, there are still many challenges
that face us:
--Translation of Genomics and Proteomics into Preterm Birth and
Stillbirth.--Preterm birth and stillbirth represent two of the
most important complications of pregnancy. Prevention of
preterm birth and stillbirth depends on identifying women at
risk and understanding the mechanisms of disease. It is
imperative that NICHD take advantage of high throughput
technologies to understand the causes of preterm birth and
stillbirth and support genomics, proteomics, and metabolomics
studies focusing on prediction and prevention of preterm birth
and stillbirth, as well as the use of existing biobanks. The
promise of these new technologies is that a better
understanding of the biologic processes involved in pregnancy
and pregnancy complications will lead to improved prediction,
prevention, and treatment strategies that will improve maternal
and infant health.
--Severe, Early Adverse Pregnancy Outcomes.--Women with severe, early
adverse pregnancy outcome, such as multiple losses, demises,
and severe pre-eclampsia, are at increased risk for long-term
chronic health problems, including hypertension, stroke,
diabetes, and obesity. Studies have shown that women who have
had pre-eclampsia are more likely to develop chronic
hypertension, to die from cardiovascular disease and to require
cardiac surgery later in life. In addition, approximately 50
percent of women with gestational diabetes will develop
diabetes later in life. Pregnancy can be considered as a window
to future health and the immediate postpregnancy period
provides a unique opportunity for prevention of chronic
diseases later in life. Studies to identify women at risk for
long term morbidity, and to develop strategies to prevent long
term adverse outcomes in these women are urgently needed.
--Maternal Fetal Medicine Units (MFMU)Network.--Vigorous support of
the MFMU Network is needed so that therapies and preventive
strategies that have significant impact on the health of
mothers and their babies will not be delayed. Until new options
are created for identifying those at risk and developing cause
specific interventions, preterm birth will remain one of the
most pressing problems in obstetrics.
As the subcommittee moves forward with deliberations on the fiscal
year 2011 budget, we urge you to provide greater resources to NIH, and
in particular to NICHD. Research is the cornerstone for improving our
understanding of the physiology and pathophysiology of pregnancy, the
interrelationship between the mother and fetus, the impact of medical
conditions on pregnancy and the impact of medical diseases and
pregnancy outcomes on the long term health of both mother and child.
With your support, researchers can continue to peel away the layers of
complex problems of pregnancy that have such devastating consequences.
Recommendations.--The Society for Maternal Fetal Medicine
recommends:
--An appropriation of $35 billion for the NIH in fiscal year 2011.
--A funding level of $1.5 billion for NICHD.
--NICHD sustain the research investment in the MFMU Network to
facilitate resolution of the myriad of problems that affect
high-risk mothers and their fetuses.
--NICHD support genomics, proteomics, and metabolomics studies
focusing on prediction and prevention of preterm birth and
stillbirth.
--NICHD identify women at risk for long-term morbidity and develop
strategies to prevent long-term adverse outcomes.
Thank you for the opportunity to present our views.
______
Prepared Statement of the Society for Public Health Education
The Society for Public Health Education (SOPHE) is a professional
health education organization founded in 1950 to promote the health of
all people by stimulating research on the theory and practice of health
behavior; translating sound science into practice; and supporting high-
quality standards for professional preparation. SOPHE is the only
independent professional organization devoted exclusively to health
education and health promotion. SOPHE's 4,000 national and chapter
members work daily to improve health outcomes and promote wellness in a
variety of settings, including schools, universities, healthcare
organizations, corporations, voluntary health agencies and Federal,
State, and local government. There are currently 20 SOPHE chapters
covering more than 30 States and regions across the country.
SOPHE's broad membership enables us to advocate and understand the
need for increased resources targeted at the most pressing public
health issues. For the fiscal year 2011 funding cycle, SOPHE encourages
the Labor, Health and Human Services, Education, and Related Agencies
(Labor-HHS) Subcommittee to increase funding for public health programs
that focus on preventing chronic disease and other illnesses;
eliminating health disparities; and promoting the coordinated school
health model. In particular, SOPHE would like to request the following
fiscal year 2011 funding levels for Labor-HHS programs:
--$969.85 million for the National Center for Chronic Disease
Prevention and Health Promotion;
--$50 million for the Centers for Diseases Control and Prevention
(CDC) and CDC Racial and Ethnic Approaches to Community Health
(REACH U.S.) program;
--$77.64 million for CDC Division of Adolescent and School Health,
$33.9 million of which shall be specifically appropriated for
the coordinated school health program; and
--$30 million for the CDC Healthy Communities Program.
SOPHE gratefully acknowledges the strong bipartisan support that
the Senate Labor-HHS Subcommittee has provided to the CDC in recent
years, including the funding dedicated to the Prevention and Wellness
Fund in the American Recovery and Reinvestment Act of 2009. The field
of health education and health promotion, which is some 100 years old,
uses sound science to plan, implement, and evaluate interventions that
enable individuals, groups, and communities to achieve personal,
environmental, and population health. There is a robust, scientific
evidence-base documenting not only that various health education
interventions work but that they are also cost-effective. These
principles serve as the basis for our support for the programs outlined
below.
Preventing Chronic Disease
The data are clear: chronic diseases are the Nation's leading
causes of morbidity and mortality and account for 75 percent of every
dollar spent on healthcare in the United States. Collectively, they
account for 70 percent of all deaths nationwide. Thus, it is highly
likely that 3 of 4 persons living in the districts of the Labor-HHS
Subcommittee members will develop a chronic condition requiring long-
term and costly medical intervention in their lifetime. In 2008, heart
disease and stroke were estimated to cost $448 billion in medical
expenditures and lost productivity. In 2009, U.S. healthcare
expenditures exceeded $7,200 for every man, woman, and child, primarily
for diagnosis and treatment of chronic diseases.
SOPHE is requesting a fiscal year 2011 funding level of $969.85
million for CDC's National Center for Chronic Disease Prevention and
Health Promotion (NCCDPHP) in order to adequately address the cost of
chronic disease care and prevent it from further burdening our Nation's
citizens and productivity. NCCDPHP is at the forefront of the U.S.
efforts to prevent and control chronic diseases. The Center was
substantially cut in 2006, and then has essentially been level-funded
and has decreasing resources due to across the board rescissions--while
chronic disease rates have continued to soar.
Studies show that spending as little as $10 per person on proven
preventive interventions could save the country more than $16 billion
in just 5 years. The public overwhelmingly supports increased funding
for disease prevention and health promotion programs. Small investments
now in community-led, innovative programs will help to increase our
Nation's productivity and performance in the global market; decrease
rates of infant mortality, deaths due to cancer, cardiovascular
disease, diabetes, and HIV/AIDS, and; increase immunization rates.
SOPHE is requesting a fiscal year 2011 funding level of $30 million
for CDC's Healthy Communities Program to advance policy and
environmental change strategies in support of healthy eating, active
living, and chronic disease and obesity prevention. Through the Healthy
Communities Program, CDC collaborates with local and State health and
park departments, national organizations with extensive community
outreach, and community leaders to prevent chronic disease. Among the
many successes of the program since its inception are restoring
physical education to the school day; requiring physical activity and
healthy snacks in child care sites; changing zoning requirements to
include sidewalks to promote physical activity; and enhancing farmers
markets and community gardens to for wider access to fruits and
vegetables.
Chronic disease prevention programs, like those delivered by
NCCDPHP, are especially needed among our Nation's youth. In the last 20
years, the percentage of overweight youth has more than doubled, and
for the first time in two centuries, children may have a shorter life
expectancy than their parents. Fifteen percent of children and
adolescents are overweight and more than one-half of these children
have at least one cardiovascular disease risk factor, such as elevated
cholesterol or high blood pressure. Almost 80 percent of young people
do not eat the recommended five servings of fruits and vegetables each
day. Daily participation in high school physical education classes
dropped from 42 percent in 1991 to 32 percent in 2001. Patterns of poor
nutrition, lack of physical activity, and other behaviors such as
alcohol and tobacco use established during youth often continue into
adulthood and contribute markedly to costly, chronic conditions.
CDC's Coordinated School Health Programs have been shown to be
cost-effective in improving children's health, their behavior, and
their academic success. This funding builds bridges between State
education and public health departments to coordinate health education,
nutritious meals, physical education, mental health counseling, health
services, healthy school environments, health promotion of faculty, and
parent and community involvement. Gallup polls show strong parental,
teacher, and public support for school health education.
SOPHE urges this subcommittee to support an appropriation of $33.9
million in fiscal year 2010 for CDC's Division of Adolescent and School
Health, Coordinated School Health Programs. In 2008, 43 States (plus
five tribal governments and four territorial education agencies)
applied for such funding; however, because of limited resources, only
22 States and 1 tribal government were funded. A funding level of $33.9
million would allow capacity building grants to an additional of up to
17 States (from 23 to 40).
Chronic diseases account also for the largest health gap among
populations and increase health disparities among racial and ethnic
minority groups. As the U.S. population becomes increasingly diverse,
the Nation's health status will be heavily influenced by the morbidity
of racial and ethnic minority communities. African Americans, Alaskan
Natives, American Indians, Asian Americans, Hispanic Americans, and
Pacific Islanders are more likely than whites to have poorer health and
to die prematurely, especially from chronic conditions.
SOPHE strongly urges an allocation of $50 million for CDC's REACH
U.S. initiative to eliminate health disparities among urban and rural
communities in the areas of cardiovascular disease, immunizations,
breast and cervical cancer screening and management, diabetes, HIV
infections/AIDS, and infant mortality. A funding level of $50 million
would allow for the distribution of monies to support at least 10 2-
year planning grants for communities to implement evidence- and
practice-based approaches to reducing chronic disease rates.
Launched in 2007, REACH U.S. is the next evolution of REACH 2010,
which was developed by HHS and CDC to find ``out of the box''
community-driven solutions to address health disparities. REACH U.S. is
unique because it works across public and private sectors to conduct
community based prevention research and demonstration projects that
address social determinants of health. REACH U.S. programs are time-
tested, community-led interventions that have proven success in
decreasing health disparities. President Obama highlighted a need to
address health disparities in his fiscal year 2011 budget blueprint,
and with increased funding REACH U.S. programs can address his call to
action.
Thank you for this opportunity to present our views to this
subcommittee. We look forward to working with you to improve the health
and quality of life for all Americans.
______
Prepared Statement of the Society for Women's Health Research
On the behalf of the Society for Women's Health Research (SWHR) and
the Women's Health Research Coalition (WHRC), we are pleased to submit
the following testimony in support of Federal funding of biomedical
research, and specifically women's health research.
SWHR, a national nonprofit organization based in Washington DC, is
widely recognized as the thought leader in research on sex differences
and is dedicated to improving women's health through advocacy,
education, and research. SWHR was founded in 1990 by a group of
physicians, medical researchers, and health advocates who wanted to
bring attention to the myriad of diseases and conditions that affect
women uniquely.
In 1999, the WHRC was established by SWHR to give a voice to
scientists and researchers from across the country that are committed
to improving women's health research. WHRC now has more than 650
members, including leaders within the scientific community and medical
researchers from many of the country's leading universities and medical
centers, as well as leading voluntary health associations, and
pharmaceutical and biotechnology companies.
SWHR and WHRC are committed to advancing the health of women
through the discovery of new, targeted scientific knowledge. We believe
that sustained funding for biomedical and women's health research
programs conducted and supported across the Federal agencies is
absolutely essential if we are to meet the health needs of women, and
men, and advance the Nation's research capability.
In this testimony we address the clinical successes and financial
hardships of five key agencies and subgroups doing the important work
of sex-based research: National Institutes of Health (NIH), NIH's
Office of Research on Women's Health (ORWH), Health and Human Services'
Office of Women's Health (HHS), the Centers for Disease Control and
Prevention (CDC), and the Agency for Healthcare and Research Quality
(AHRQ). If America wants to remain a leader in healthcare advancement,
if we are serious about the advancement of personalized medicine, if we
are ready to stop wasting healthcare dollars on inappropriate
treatments or the costs that come with guessing versus knowing-then we
implore Congress to supply these agencies with the tools needed to
accomplish these goals.
National Institutes of Health
Past congressional investment and support for NIH has positioned
the United States as 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. The 111th
Congress saw the importance of increasing funds to NIH in the 2009
American Recovery and Reinvestment Act (ARRA). This funding is having
an enormous impact on research and research facilities throughout the
United States, creating new jobs, new innovations and improved
technologies. However, the U.S.'s position as world leaders in
biomedical research is threatened by a budget that does not continue to
provide significant funding to NIH. Flat-lining NIH funding, or worse,
cutting funds and not keeping up with inflation, threatens the
developments started by ARRA, and puts the innovative research
practices and reputation that America is known for in jeopardy.
When faced with budget cuts, NIH has shown that it is left with no
other option but to reduce the number of grants it is able to fund.
When not including the one-time ARRA infusion of funds, the number of
new grants funded by NIH had dropped steadily with budgets growing at
less than that of inflation since fiscal year 2003. A shrinking pool of
available grants has a significant impact on scientists who depend upon
NIH support to cover both salaries and laboratory expenses to conduct
high-quality biomedical research, putting both medical advancement and
job creation at risk. Failure to obtain a grant decreases publishing of
new finds and decreases the number of scientists gaining experience in
research, both reducing a scientist's likelihood of achieving tenure in
a university setting. New and less established researchers are forced
to consider other careers, the end result being the loss in academia of
the skilled bench scientists and researchers so desperately needed to
sustain America's cutting edge in biomedical research.
SWHR recommends Congress to set a laudable goal of reaching $40
billion in NIH funding in the next 3 years. To meet this goal, SWHR
urges you to exceed the administration's fiscal year 2011 request of a
$1 billion increase and to allocate an additional $3 billion in funding
for the NIH in fiscal year 2011, resulting in a total research budget
of $34 billion.
In addition, SWHR requests that Congress strongly encourage the NIH
to utilize ARRA funding as well as appropriated dollars to ensure that
women's health research receives resources sufficient to meet the
health needs of all women. SWHR further recommends that NIH, with the
funds provided, report sex differences in all research findings. With
the tools the NIH already has available, it should seek to expand its
inclusion of women in basic, clinical and medical research to phase I,
II, and III studies. By currently only mandating sufficient female
subjects in phase III, science misses out on the chance to look for
variability by sex in the early phases of research, where scientists
look at treatment safety and determine safe dose levels for new
medications. By raising the bar, NIH can continue to serve as a role
model for industry research, as well as other nations. Only by gaining
more information on how therapies work in women will medicine be able
to advance more targeted and effective treatments for all patients, men
and women alike.
Only within the past decade have scientists begun to uncover
significant biological and physiological differences between women and
men, as it impacts health and medicine. Sex-based biology, the study of
biological and physiological differences between women and men, 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. Medications can have different effects in
woman and men, based on sex specific differences in absorption,
distribution, metabolism, and elimination. It is imperative that
research addressing these important differences be supported and
encouraged. Congress clearly recognizes these important sex differences
and NIH should as well.
Office of Research on Women's Health
The NIH's Office of Research on Women's Health (ORWH) has a
fundamental role in coordinating women's health research at NIH:
advising the NIH Director on matters relating to research on women's
health 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 female biomedical scientists and engineers in both the NIH
and external research 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). The BIRCWH program, created in 2000, 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. SCORs,
established in 2003, are designed to increase the transfer of basic
research findings into clinical practice by housing laboratory and
clinical studies under one roof. 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. 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. Each SCOR
program costs $1 million per year and results in unique research.
Additionally, Advancing Novel Science in Women's Health Research
(ANSWHR) was created by ORWH in 2007 to promote innovative new concepts
and interdisciplinary research in women's health research and sex/
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, 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.
In order for ORWH's programs and research grants to continue to
expand and thrive, Congress must direct that NIH continue its support
of ORWH and provide it with $2 million dollar budget increase, bringing
its fiscal year 2011 total to $44.9 million.
Health and Human Services' (HHS) Office of Women's Health (OWH)
The HHS 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. Without OWH's actions, the task of translating
research into practice would and will be only more difficult and
delayed.
Under HHS, several agencies have Federal offices specific to
women's health. Agencies currently with offices, advisors, or
coordinators for women's health or women's health research include the
Food and Drug Administration, Centers for Disease Control and
Prevention, Agency for Healthcare Quality and Research, Indian Health
Service, Substance Abuse and Mental Health Services Administration,
Health Resources and Services Administration, and Centers for Medicare
and Medicaid Services. It is imperative that these offices are funded
at levels adequate for them to perform their assigned missions, and are
sustainable so as to support needed changes in the long term. We ask
that the Committee Report reflect Congress's supports of the permanent
existence of these various Federal women's health offices, recommending
that they are appropriately funded on a permanent basis to ensure that
these programs can continue and be strengthened in the coming fiscal
year.
It is only through continued and increased funding that the OWH
will be able to achieve its goals. The budget for fiscal year 2010, as
in recent years, flatlined OWH budget at $33.7 million. This was, 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, a total $35.7 million
requested for fiscal year 2011.
Centers for Disease Control and Prevention (CDC)
SWHR supports the national and international work of the CDC, and
especially the work of CDC's OWH. While aware of unavoidable cuts in
many sectors of the fiscal year 2011 budget, SWHR is concerned that the
proposed CDC budget cuts and project eliminations jeopardize a number
of programs that benefit women, leaving them with even fewer options
for sound clinical information. Research and clinical medicine are
still catching up from decades of a male-centric focus, and when
diseases strike women, there is a paucity of basic knowledge on how
diseases affect female biology, a lack of drugs that have been
adequately tested in women, and now even fewer options for information
through the many educational outreach programs of the CDC.
Cutting funding for programs on blood disorders, specifically for
von Willebrand's disease, which has disproportionate impact on women,
ending awareness campaigns on gynecological cancers funded by Johanna's
Law, and eliminating specific funds dedicated to projects on
Inflammatory Bowel Disease and Interstitial Cystitis (IC) will all
result in women losing an advocate and a partner in advancing women's
health. The proposed cuts to IC programs, in particular, equate to a
loss of approximately half of its budget. These reductions translate to
more than just a significant cut in total CDC budget. They create
losses in jobs and in advocacy efforts led by patients suffering from
these diseases, particularly IC, and their advocacy organizations,
eliminating important education toward diagnosis and treatment. SWHR
hopes that there will be serious consideration of the impact
eliminating these programs will have on women, and men, who suffer
these diseases, and encourages reviewing alternate sources of funding
as a means to continue these important programs. The total savings
realized by eliminating these programs is less than one half of 1
percent of the total programmatic resources budget for the CDC, and
their elimination will have ramifications on patients and providers, as
well as incalculable effects on advocacy groups, jobs, and information
campaigns.
Agency for Healthcare and Research Quality (AHRQ)
The Agency for Healthcare Research and Quality'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. Through AHRQ's research projects, lives have
been saved. For example, it was AHRQ who first discovered that 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, including funds from
ARRA, are moving AHRQ in the right direction. However, more core
funding is needed to help AHRQ continue doing the research that helps
patients and doctors make better medical decisions.
AHRQ's budget for fiscal year 2009 was $372 million, $397 million
for fiscal year 2010. Such modest annual increases will not offer
results that improve decisionmaking by doctors and patients for
improved health outcomes. 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 the administration's proposed
$611 million for fiscal year 2011, an increase of $214 million more
than the fiscal year 2010 level. The lion's share of this increase will
appropriately focus on patient-centered health research. This will
ensure that adequate resources are available for high-priority
research, including women's healthcare, sex and gender-based analyses,
and health disparities-information that can help to better personalize
treatments and improve outcomes for female and male patients
nationwide.
Summary of Recommendations
--NIH fiscal year 2011--Additional $3 billion funding, $34 billion
total. Increased focus on women's health research. Inclusion of
women in all phases of NIH research.
--OWHR fiscal year 2011--Additional $2 million funding, $44.9 million
total.
--HHS fiscal year 2011--Permanent funding of Federal women's health
offices throughout HHS. Additional $2 million for OWH, $35.7
million total.
--CDC fiscal year 2011--Restored or alternate funding for 4 select
projects.
--AHRQ fiscal year 2011--Match the administration's proposed budget
of $611 million.
In conclusion, SWHR and the WHRC would like to thank the Chair 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.
As you craft the fiscal year 2011 Labor, Health and Human Services,
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. Moreover, as you work with the Department of
Health and Human Services to allocate funding from the Prevention and
Public Health Fund, I urge you to use this funding to support the long-
term transformation of the Nation's public health system.
Community Prevention
The United States spends more than any other Nation in the world on
healthcare costs but lags behind other nations in certain indicators of
health. To improve health across the country, we must transform
communities to remove barriers to healthy lifestyles and ensure that
Americans have access to healthy environments, nutritious foods and
venues for physical activity. TFAH was pleased with the unprecedented
investment that was made in community prevention via the American
Recovery and Reinvestment Act (ARRA). Through its Communities Putting
Prevention to Work Initiative, we'll begin to sow the seeds of
transformation. In addition, programs at the CDC, in particular Healthy
Communities and Racial and Ethnic Approaches to Community Health Across
the U.S. (REACH-U.S.), prioritize the health of communities and support
innovative approaches to addressing disparities and improving health.
In fiscal year 2011, TFAH supports a total of $52 million for the
Healthy Communities Program and $60 million for the REACH program to
expand these successful programs to additional communities.
School Health
More than 23 million children in the United States are overweight
or obese. To improve their health, we must reach them where they spend
a great deal of time, and that includes schools. The Division of
Adolescent and School Health's (DASH) Coordinated School Health Program
provides funding to 22 States and one tribal government to strengthen
the ability of State and local education agencies to address critical
health issues, including obesity, asthma, tobacco use, HIV, STDs, and
teen pregnancy, by building the capacity of funded partners to support
science-based, cost-effective health programming. The President's
fiscal year 2011 budget proposes to increase funding for DASH by $3.875
million. We strongly support an increase for DASH's School Health
Program and hope that at a minimum, the program will receive an
additional $20 million in fiscal year 2011 to enable CDC to fund 15
additional State education agencies and 25 additional local education
agencies to reach more children and youth through quality school health
programs.
Pandemic Influenza
The recent H1N1 flu outbreak demonstrated how rapidly a new strain
of flu can emerge and spread around the world. H1N1 provided a real-
world test that showed our strengths and vulnerabilities to respond to
a major infectious disease outbreak. Prior pandemic preparedness
investments resulted in the development of medical countermeasures that
have been used in the H1N1 response. In addition, supplemental
appropriations have been used for response activities, including
vaccine production, distribution and administration; antiviral drugs;
surveillance; communications and community mitigation; and laboratory
support for virus detection. TFAH supports continuing funding for our
annual pandemic flu preparedness activities in fiscal year 2011 at CDC
($156 million), the National Institutes of Health (NIH) ($35 million),
the Food and Drug Administration (FDA) ($45 million) and the Office of
the Secretary ($66 million) in order to strengthen our preparedness and
response during any future outbreaks.
TFAH also urges appropriators to explore means to incorporate
pandemic preparedness funds for State and local health departments into
annual funding streams, such as the CDC Public Health Emergency
Preparedness and ASPR Hospital Preparedness Program cooperative
agreements. There is no annually recurring funding to support State and
local pandemic preparedness. Yet, pandemic and all-hazards preparedness
requires sustainable lab capacity, modernized disease surveillance
systems, a well-trained workforce, effective medical countermeasures
delivery and administration, surge capacity, and continuous exercising
and improvement of response plans.
Another critical funding stream is the Biomedical Advanced Research
and Development Authority (BARDA), which provides incentives and
guidance for research and development of products to counter
bioterrorism and pandemic flu. The President's budget proposes $476
million for BARDA, with funding made available from current BioShield
Special Reserve Fund balances. These funds would support research on
countermeasures for biological threat agents, volatile nerve agents and
radiological and nuclear threats. TFAH supports an increase in funding
for BARDA and recommends that in fiscal year 2011, at least $500
million is provided, with the acknowledgement that higher levels of
funding must ultimately be allocated and sustained.
Global Disease Detection (GDD)
Despite remarkable breakthroughs in medical research and
advancements in immunization and treatments, infectious diseases are
undergoing a global resurgence that threatens health. 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. For
fiscal year 2011, TFAH recommends $56 million for the GDD Program to
enable CDC to increase the number of GDD centers and expand capacity at
existing Centers. Funding would bring Thailand, Kenya, China and
Guatemala to full capacity, support Egypt and Kazakhstan as basic
centers and establish four additional developing centers.
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. TFAH supports an
additional $19.6 million for the Environmental Health Laboratory's
biomonitoring capacity in fiscal year 2011 in order to fund 7 to 10
grantees to conduct biomonitoring, increase the number of chemicals
measured in CDC's National Report on Human Exposure to Environmental
Chemicals, enable CDC to provide training and quality assurance for
State laboratories awarded funds, and support the National Report on
Biochemical Indicators of Diet and Nutrition.
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. The Tracking Network helps build our capacity to respond to
environmental health issues and helps document links between
environmental hazards and chronic disease. The National Network
launched in July of 2009. CDC now funds just 22 States and one city to
build and implement State-based tracking networks that will feed into
the National Network. One additional State will be funded due to the
increase in the fiscal year 2010 appropriations for this program. In
order for the Network to be truly national in scope, it must be
expanded to all States. To build toward that vision, TFAH recommends
providing $50 million for CDC's Environmental and Health Outcome
Tracking Network to expand it to up to 13 additional grantees and
support the continued development of a sustainable Network.
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 fiscal
year 2010 for the Climate Change Program at CDC. To enable CDC to fund
20-25 States and localities for climate change needs assessment and
planning, in addition to supporting other climate change preparedness
activities, TFAH recommends at least $15,000,000 for CDC's Climate
Change Program in fiscal year 2011. Ultimately, $50 million is needed
to develop a credible and effective Climate Change Program.
Public Health Workforce
A final area of critical importance to our Nation's health is our
public health workforce. The latest job loss survey by the National
Association of County and City Health Officials (NACCHO) found that
local health departments lost 8,000 jobs in the second half of 2009--
compounding the loss of another 8,000 positions in the first half of
the year. To address the workforce shortages in State and local health
departments, the President's budget proposes a new workforce program,
the Health Prevention Corps, which will recruit new talent into service
for State and local health departments. The program will target
disciplines with known shortages, such as epidemiology, environmental
health and laboratory. Fiscal year 2011 funding would be used to
establish a management plan for staffing and program administration,
convene stakeholders to establish the program framework, and develop a
curriculum for Corps members. TFAH supports the President's request of
$10 million for the Health Prevention Corps in fiscal year 2011.
The Prevention and Public Health Fund
The Prevention and Public Health Fund, established by the Patient
Protection and Affordable Care Act (Public Law 111-148), provides $500
million in fiscal year 2010 and $750 million in fiscal year 2011 for
programs authorized by the Public Health Service Act for prevention,
wellness, and public health activities. This funding should be used to
support the long-term transformation of the Nation's public health
system. Investments from the Fund should be used in a manner that
leverages change throughout the public health system--with a move away
from a stove-piped, disease-by-disease approach to one that addresses
the determinants of health in a cross-cutting manner.
The overarching goal should be to optimize the health of everyone
by creating healthier, more resilient communities, through policy,
systems, organizational, and environmental change. Investments from the
Fund should be science informed or evidence based, have measurable
health outcomes and policy goals, promote innovation, focus on the
determinants of health and health equity, and be held accountable. The
National Prevention Strategy should become the basis for defining the
goals of a transformed public health system, identifying gaps in the
current system, and how the Fund can be used to help close these gaps.
Expenditure of Initial Funds
As the National Prevention Strategy is developed over the next
year, expenditures under the Fund for fiscal year 2010 and fiscal year
2011 should be consistent with the following categories of expenditure,
which were included in the House-passed bill. These include:
--Community Prevention.--A focus on community prevention is the
centerpiece of a transformed public health system. The focus
should reflect cross-cutting approaches to reducing the risks
that affect health and safety. In addition to chronic diseases,
attention should be given to other critical health issues, such
as injury and violence prevention, reproductive health,
infectious diseases, emergency preparedness, mental health,
birth defects and developmental disabilities, and environmental
health. While State and local health departments must be
central players in community prevention, grant funding is also
needed to support the work of nongovernmental organizations.
--Core Capacity (For Both Health Departments and Others Doing
Community Prevention).--Health departments have varying levels
of expertise and competency to design and manage community
interventions that focus on policy, systems, organizational,
and environmental change. All health departments should be
supported in their efforts to expand the role of community
prevention in addressing the health needs of their populations,
but particular effort should be made to close the geographic
gap in capacity to build healthier, safer, and more resilient
communities. This can be done at least in part through the
support of the accreditation process, which is focused on
building these capacities and thresholds. Even with
accreditation, we will need to provide funding to build a
public health workforce able to serve in these accredited
health departments.
--Research, Development, and Dissemination of Best Practices.--There
is a continuing need to expand the science base of prevention,
with particular emphasis on translation into practice and data
to do appropriate program evaluation. This would include
ramping up the capacity of the task forces on community and
clinical prevention, creating the research and technical
support for innovation in community prevention, and
establishing the newly authorized program in public health
services and systems research, with a particular emphasis on
data collection and analysis.
______
Prepared Statement of the 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 2011 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 many
Americans.
hiv/aids
HIV/AIDS remains one of the world's worst health pandemics in
history. According to the Centers for Disease Control and prevention
(CDC), 583,298 people have died of AIDS in the United States. In 2008,
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.
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.
We are keenly aware of budget constraints and competing interests
for limited dollars. Unfortunately, despite the growing need, domestic
HIV/AIDS programs have experienced only very minor increases in recent
years. We are pleased that President Obama continues to focus on
domestic HIV/AIDS programs and has proposed increases for prevention
and treatment. We hope you will support the President's desire and
increase funding for these important public health programs. Federal
funding is particularly critical at this time since State and local
budgets are being severely cut during this economic downturn. Many
States and local governments have greatly cut their HIV prevention and
HIV/AIDS care programs at the very same time demand for services are
escalating.
Below are The AIDS Institute's program requests and supporting
explanation:
Centers for Disease Control and Prevention--HIV Prevention and
Surveillance
[In millions of dollars]
------------------------------------------------------------------------
Amount
------------------------------------------------------------------------
Fiscal year 2010............................................. 728
Fiscal year 2011 community request........................... 1,606
------------------------------------------------------------------------
New infections are particularly occurring in certain populations,
including African-American men and women and men who have sex with men.
In order to address the specific needs of these populations and the
increased number of people infected, CDC is going to need additional
funding. Currently, the United States spends only about 4 percent of
its domestic HIV/AIDS spending on prevention.
The AIDS Institute is extremely supportive of President Obama's
budget request to ``begin a focused initiative to prevent HIV through
holistic and integrated approached to protect the health of gay,
bisexual, and other MSM.'' We congratulate the President for proposing
additional funding and for focusing it on gay men, which represent a
majority of HIV cases in the United States and is the only group in
which HIV incidence is increasing.
Unfortunately, the $31 million increase for fiscal year 2011
requested by the President is far from what is needed to significantly
reduce the number of new HIV infections. According to the CDC's
professional judgment budget, an additional $878 million for each of
the next 5 years is necessary to improve HIV prevention efforts and
reduce HIV transmission in the United States. Therefore, The AIDS
Institute supports an increase for CDC HIV prevention funding by $878
million in fiscal year 2011.
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.
At a time when State and local HIV prevention budgets are being
cut, just to keep at the current funding levels will require a level of
resources greater than what has been proposed. The AIDS Institute is
concerned about any effort that would actually reduce the level of HIV
prevention dollars at the State level. That is why we are opposed to
language requested by the administration that would allow States to
move up to 10 percent of its CDC funding, including HIV funding, to
address the top six leading causes of death.
Ryan White HIV/AIDS Programs
[In millions of dollars]
------------------------------------------------------------------------
Amount
------------------------------------------------------------------------
Fiscal year 2010............................................. 2,290.9
Fiscal year 2011 community request........................... 3,101.5
------------------------------------------------------------------------
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 a million low-income,
uninsured, and underinsured people each year. In fiscal year 2010, the
Program received an increase of $53 million, or just 2.3 percent. This
increase does not even cover the rate of inflation. 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 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.
--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 State HIV/AIDS
funding reductions totaling more than $170 million occurred in
29 States during fiscal year 2009. The situation for this year
and next will be even worse. Thirty-three States who
participated in the survey anticipate a decrease in State
funding this year.
--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 $225.9 million, for a total
of $905 million.
--Part B base provides essential services including diagnostic, viral
load testing and viral resistance monitoring and HIV care to
all 50 States, the District of Columbia, Puerto Rico, and the
territories. We are requesting a $55.9 million increase, for a
total of $474.7 million.
--The AIDS Drug Assistance Program (ADAP) provides life-saving HIV
drug treatment to more than 150,000 people, the majority of
whom are people of color (59 percent) and very poor (74 percent
are at or below 200 percent of the Federal poverty level).
Currently, ADAPs are experiencing unprecedented growth. The
monthly growth of 1,271 clients is an increase of 80 percent
from fiscal year 2008 when ADAPs experienced an average monthly
growth of 706 clients. Due to a lack of funding, States have
instituted waiting lists and have reduced the number of drugs
on their formularies, reduced eligibility and capped
enrollment. There are currently 859 people in 10 States on ADAP
waiting lists. In order to address the ADAP funding crisis,
which will grow even worse in fiscal year 2011, we are
requesting an increase of $370.1 million for a total of
$1,205.1 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 $131 million increase, for
a total of $337.9 million.
--Part D provides care to more than 84,000 women, children, youth,
and families living with and affected by HIV/AIDS. We are
requesting a $7 million increase, for a total of $84.8 million.
--Part F includes the AIDS Education and Training Centers (AETCs)
program and the Dental Reimbursement program. We are requesting
a $15.2 million increase for the AETC program, for a total of
$50 million, and a $5.4 million increase for the Dental
Reimbursement program, for a total of $19 million.
For fiscal year 2011, the President requested an increase of only
$39.5 million, or just 1.7 percent, for the entire Ryan White Program
and no increase for Parts A and D of the Program. The AIDS Institute
urges the subcommittee to consider the growing needs of all Parts of
the Ryan White Program and provide the necessary resources it requires
to meet the needs of people living with HIV/AIDS in the United States.
National Institutes of Health--AIDS Research
[In billions of dollars]
------------------------------------------------------------------------
Amount
------------------------------------------------------------------------
Fiscal year 2010............................................. 3.1
Fiscal year 2011 community request........................... 3.5
------------------------------------------------------------------------
The National Institutes Health (NIH) conducts research to better
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. 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
President Obama and Congress took steps toward implementing
comprehensive sexual education in fiscal year 2010 by ending
discretionary funded abstinence-only until marriage programs and
creating the Teen Pregnancy Prevention Initiative. We urge the Congress
to continue no funding for abstinence only education programs.
Additionally, we believe the Teen Pregnancy Prevention Initiative
should be expanded so that it addresses other aspects of sexual health,
including HIV and STD prevention.
Syringe Exchange Programs
By eliminating the Federal funding ban on syringe exchange programs
in fiscal year 2010, Congress allowed funding of a proven method to
reduce the transmission of HIV and other infectious diseases. The AIDS
Institute requests that you work to ensure that this ban is not
reinstated.
Minority AIDS Initiative
The AIDS Institute supports increased funding for the Minority AIDS
Initiative (MAI), which is funded by numerous Federal agencies. MAI
funds services nationwide that address the disproportionate impact that
HIV has on communities of color. We are requesting a $207.1 million
increase across the MAI's programs, for a total of $610 million.
viral hepatitis
The Institute of Medicine (IOM) recently released a report
``Hepatitis and Liver Cancer: A National Strategy for Prevention and
Control of Hepatitis B and C.'' It outlines a number of recommendations
on how the incidence of Hepatitis B and C infections can be decreased.
These recommendations include increased public awareness campaigns,
heightened testing and vaccination programs, continued research, along
with improved surveillance and other prevention programs.
According to the IOM, 3.5-5.3 million people, or 1-2 percent of the
U.S. population are living with chronic Hepatitis B or C. Because of
their asymptomatic nature, the vast majority of infected people are
unaware of their infection. There are an estimated 43,000 new acute
Hepatitis B infections each year in the United States. The CDC
estimates that 10 percent of people with Hepatitis B are co-infected
with HIV and 25 percent of people with Hepatitis C are co-infected with
HIV. Congress currently funds CDC's Viral Hepatitis Division at only
$19.3 million. Given the huge impact that Hepatitis B and C have on the
health of so many people, and the large treatment costs, The AIDS
Institute requests an increase of $30.7 million, for a total of $50
million.
The AIDS Institute asks that you give great weight to our testimony
as you deliberate over the fiscal year 2011 appropriation bill.
______
Prepared Statement of the Tri-Council for Nursing
The Tri-Council for Nursing, comprising the American Association of
Colleges of Nursing, the American Nurses Association, the American
Organization of Nurse Executives, and the National League for Nursing,
respectfully requests $267.3 million (a 10 percent increase) for the
Nursing Workforce Development programs authorized under title VIII of
the Public Health Service Act (42 USC 296 et seq.) in fiscal year 2011.
The Tri-Council is a long-standing alliance focused on leadership
and excellence in the nursing profession. The Nation is currently in
the twelfth year of the nurse and nurse faculty shortages, contributing
to a workforce deficit that diminishes the quality of patient care in
the United States. As the Nation looks towards reforming the healthcare
system by focusing on expanding access, decreasing cost, and improving
quality, a significant investment must be made in strengthening the
nursing workforce.
In fiscal year 2010, your subcommittee provided a considerable
funding boost for title VIII that helped support the Loan Repayment and
Scholarship program and Nurse Faculty Loan program. These increases
will help bolster the pipeline of nurses and nurse faculty, which are
so critical to reversing the nursing shortage. It is extremely
important to maintain last year's funding level for these crucial
programs in fiscal year 2011. The Tri-Council believes the 10 percent
requested increase should be directed to the four title VIII programs
that have not kept pace with inflation since fiscal year 2005. These
programs include the Advanced Education Nursing, Nursing Workforce
Diversity, Nurse Education, Practice, and Retention, and Comprehensive
Geriatric Education programs, which help expand nursing school capacity
and increase patient access to care. The 10 percent increase awarded to
these programs in proportion to their fiscal year 2010 funding level
would be a wise investment of Federal resources.
four nursing workforce growth areas: critical title viii programs that
provide solutions
A Shortage of Providers Needed to Meet Increasing Healthcare Demands
With healthcare access expanded through the newly passed reforms,
more providers will be needed. According to the U.S. Bureau of Labor
Statistics (BLS), nursing is the Nation's top profession in terms of
projected job growth with more than 581,000 new nursing positions being
created through 2018 (a 22 percent increase in the workforce).
Moreover, healthcare professionals with knowledge and expertise in
primary, transitional, and preventative care will be in great demand.
Registered Nurses (RNs), Advanced Practice Registered Nurses (APRNs),
and RNs with advanced education have the skills and are licensed to
provide these vital services. The Advanced Education Nursing Grants and
Traineeships help to educate the next generation of these providers in
addition to the faculty who educate them.
Advanced Education Nursing (AEN) Grants (section 811) support the
preparation of RNs in master's and doctoral nursing programs. The AEN
grants help to prepare our Nation's nurse practitioners, clinical nurse
specialists, nurse midwives, nurse anesthetists, nurse educators, nurse
administrators, public health nurses, and other nurse specialists
requiring advanced education. In fiscal year 2008 (the most recent year
for which data are available), these grants supported the education of
5,649 students.
--AEN Traineeships assist graduate nursing students by providing full
or partial reimbursement for the costs of tuition, books,
program fees, and reasonable living expenses. In fiscal year
2008, this funding helped support 6,675 graduate nurses and
APRNs.
--Nurse Anesthetist Traineeships (NAT) support the education of
students in nurse anesthetist programs. In some States,
Certified Registered Nurse Anesthetists (CRNAs) are the sole
anesthesia providers in almost 100 percent of rural hospitals.
Much like the AEN Traineeships, the NAT provides full or
partial support for the costs of tuition, books, program fees,
and reasonable living expenses. In fiscal year 2008, the
program supported 2,145 future CRNAs.
Increasing Nursing Diversity to Improve Patient Care
According to an April 2000 report prepared by the National Advisory
Council on Nurse Education and Practice, a culturally diverse nursing
workforce is essential to meeting the healthcare needs of the Nation's
population. However, the initial findings from the 2008 National Sample
Survey of Registered Nurses show that while RN graduates entering the
profession represent greater cultural diversity, when compared to the
U.S. population, the profession still does not represent the current
demographics of this country. Nurses from racial and ethnic minorities
underrepresented in nursing contribute significantly to the provision
of healthcare services and are leaders in the development of models of
care that address the unique needs of our Nation's populations. The
Workforce Diversity Grants under title VIII help to ensure a nursing
workforce is developed to meet the healthcare needs of all patients.
Workforce Diversity Grants (section 821) prepare students from
disadvantaged backgrounds to become nurses. This program awards grants
and contract opportunities to schools of nursing, nurse-managed health
centers, academic health centers, State or local governments, and
nonprofit entities looking to increase access to nursing education for
disadvantaged students, including racial and ethnic minorities
underrepresented among RNs. In fiscal year 2008, the program supported
11,638 students.
Education, Practice, and Retention: Enhancing and Maintaining the
Knowledge Base of Nursing
Advances in healthcare technology, practice, and systems influence
the way nurses deliver quality care. Like other health professions,
nurses must continually expand their knowledge base to adapt to the
changing healthcare environment. Higher learning and continued
education for nurses are expected of all RNs as the profession strives
for excellence in patient care. The Nurse Education, Practice, and
Retention Grant program is designed to ensure RNs obtain additional
knowledge in the discipline by expanding their entry-level education,
improving their practice, and retaining seasoned clinicians in the
profession.
Nurse Education, Practice, and Retention Grants (section 831) help
schools of nursing, academic health centers, nurse-managed health
centers, State and local governments, and healthcare facilities
strengthen programs that provide nursing education. The three priority
areas under this program help to:
--Expand the enrollment in baccalaureate nursing programs;
--Develop and implement internship and residency programs to
encourage and mentor, as well as for the development of
specialties;
--Provide education in new technologies, including distance learning
methodologies;
--Establish or expand nursing practice arrangements in
noninstitutional settings to demonstrate methods to improve
access to primary healthcare in medically underserved
communities;
--Provide care for underserved populations and other high-risk groups
such as older adults, individuals with HIV/AIDS, individuals
with substance use disorders, people who are homeless, and
those who are victims of domestic violence;
--Provide managed care, quality improvement, and other skills needed
to practice in existing and emerging organized healthcare
systems;
--Develop cultural competencies among nurses;
--Offer grants for career ladder programs to promote career
advancement for nursing personnel and to assist individuals in
obtaining education and training required to enter the nursing
profession and advance within the profession; and
--Provide grants that enhance patient care delivery systems and are
directly related to nursing activities by enhancing
collaboration and communication among nurses and other
healthcare professionals, and promote nurse involvement in the
organizational and clinical decisionmaking processes of a
healthcare facility.
In fiscal year 2008, the priority areas under this program
supported 42,761 nurses and nursing students.
Increased Nursing Care Needed for an Aging Population
Today, more than at any other time in our Nation's history, nurses
face an unprecedented challenge-caring for an aging population that is
growing at an exponential rate. According to the U.S. Census Bureau,
36.3 million Americans are older the age of 65, which represents 12
percent of the total population. It has been projected that by 2050,
86.5 million Americans will be older the age of 65. This represents a
147 percent increase between the years 2000 and 2050.
The National Center for Healthcare Statistics has reported that
older adults account for 50 percent of hospital days, 60 percent of
ambulatory adult primary care visits, 70 percent of all home care
visits, and 85 percent of residents in nursing homes. Moreover, 63
percent of newly licensed nurses report that older adults comprise a
majority of their patient loads. Clearly, more RNs are needed with
expertise in geriatric nursing. The Comprehensive Geriatric Education
Grants help to educate the next generation of these practitioners.
Comprehensive Geriatric Education Grants (section 855) are awarded
to schools of nursing or healthcare facilities to better provide
nursing services for older adults. These grants are used to educate RNs
who will provide direct care to older Americans, develop and
disseminate geriatric curriculum, prepare faculty members, and provide
continuing education. In fiscal year 2008, this program supported 6,514
nurses and nursing students.
With increased funding, these four programs can help address many
issues currently impacting the nursing shortage. Therefore, the Tri-
Council respectfully request $267.3 million (a 10 percent increase) for
the Nursing Workforce Development programs in fiscal year 2011.
______
Prepared Statement of The Endocrine Society
The Endocrine Society is pleased to submit the following testimony
regarding fiscal year 2011 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.
Each year, the NIH funds thousands of research grants, facilitating
the discovery of methods of prevention, treatment, and cure for
debilitating diseases that negatively impact the health of the Nation's
citizens and fuel rising healthcare costs. Nearly half of all Americans
have a chronic medical condition, and these diseases now cause more
than half of all deaths worldwide. Deaths attributed to chronic
conditions could reach 36 million by 2015 if the trend continues
unabated.
Congress and President Obama recognized the contributions of NIH to
the health of the Nation and the Nation's economy by awarding the
agency more than $10 billion through the American Recovery and
Reinvestment Act (ARRA). These funds supported more than 12,000 grants
and created more than 50,000 jobs. ARRA funds have allowed the NIH to
award grants, including those described in the bulleted list below,
which will lead to breakthroughs in hundreds of disease areas,
including those chronic diseases that result in the death of so many
people each year.
--A project is using information from a clinical trial in people with
type 2 diabetes and heart disease to examine the association
between fat cell hormones and CVD, including their potential
usefulness in prognosis, monitoring effects of therapy, and
identifying risk.
--A project will conduct research in mice to develop a vehicle to
deliver a specific gene that may prevent type 1 diabetes.
--A grant to provide insights into the mechanisms by which diet and
exercise reduce abdominal fatness and improve cardiovascular
health in overweight and obese persons with type 2 diabetes.
These mechanisms include systemic inflammation, insulin
sensitivity, and aerobic and strength fitness.
--Researchers will define how certain carbohydrate molecules affect
hormone function, to better understand reproductive
development, and development of breast and prostate cancer.
--Scientists will assess how a specific gene helps trigger the
development of stem cells into sperm, which could lead to new
treatments for male infertility or new contraceptive targets.
--A project will investigate the role of developmental exposure to
Bisphenol A (BPA) on obesity and metabolic syndrome.
Most of these grants would not have been funded through the regular
grant approval process, and without the ARRA funds, the discoveries
that are expected to result from these projects would never have a
chance to be made. Furthermore, many of the scientists funded through
these grants may never have received the funds necessary to start or
continue their careers, including many first-time awardees. As the
United States continues to lose its place as the world leader in
innovation, we cannot miss out on opportunities to award bright young
scientists and engage them in the research process.
Unfortunately, the grants and jobs created will disappear at the
end of fiscal year 2010 if Congress does not sustain the momentum
created by the ARRA funds with a significant increase in the fiscal
year 2011 budget. While it is not feasible to expect that the NIH
budget can be increased in 1 year to a level that will sustain the
12,000 grants awarded through the ARRA funds, Congress must do what it
can to ensure that NIH receives steady, sustainable, predictable
increases that avoid the boom and bust cycle that NIH experienced with
the doubling of its budget, and now faces again with the end of the
ARRA funds.
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
recommends that NIH receive $37 billion in fiscal year 2011 to prepare
for the poststimulus era and ensure the steady and sustainable growth
necessary to continue building on the advances made by scientists
during the past decade.
______
Prepared Statement of the Telehealth Leadership Initiative
The Telehealth Leadership Initiative (TLI)--a nonprofit
organization that represents the telehealth and e-health stakeholders
before legislative, administrative, and judicial branches of local,
State, and national governments and the entire telehealth community--
appreciates the opportunity to submit written testimony to the Senate
Labor, Health and Human Services, Education, and Related Agencies
Appropriations Subcommittee. We respectfully request that the
subcommittee maintain last year's funding levels and continue to
provide $11.6 million for the Office for the Advancement of Telehealth
(OAT), in the fiscal year 2011 Labor, Health and Human Services,
Education, and Related Agencies appropriations bill. These resources
will support access to quality healthcare services, through telehealth
technologies, for remote, rural and underserved populations.
telehealth overview
Telehealth, also known as telemedicine, is the providing of
healthcare, health information, and health education across a distance,
using telecommunications technology, and specially adapted equipment.
It allows physicians, nurses, and healthcare specialists to assess,
diagnose and treat patients without requiring both individuals to be
physically in the same location, regardless of whether that distance is
across a street, across a city, across the State, or across continents.
There are many applications for telehealth, such as:
--Monitoring patients with chronic conditions or at-risk populations;
--Medical care for home-bound patients or those in rural, remote, or
frontier locations;
--Mental telehealth for incarcerated populations;
--Access to medical care in areas with provider shortages;
--Access to healthcare services for those in correctional facilities;
and
--Availability of expert consultations via satellite for individuals
on the battlefield, cruise ships, space stations, research
stations, and other inaccessible locations.
Telehealth has been used to successfully accomplish the following:
--Prevent unnecessary delays in receiving treatment;
--Reduce or eliminate travel expenses;
--Reduce or eliminate the separation of families during difficult and
emotional times;
--Utilize the services of healthcare providers in locales where the
supply of physicians may be adequate or at a surplus; and
--Allow patients to spend less time in waiting rooms.
Currently, telehealth is practiced in many settings, such as rural
hospitals, school districts, home-health settings, nursing homes,
cruise ships, on the battlefield, and even on NASA space missions.
Telehealth is well-established in certain disciplines, such as
radiology and dermatology, and is being expanded in other disciplines,
for example, home telehealth, mental telehealth, ocular telehealth,
teledermatology, telepathology, telerehabilitation. It is being
utilized further for specific populations, including individuals who
are incarcerated or live or are stationed in remote locations.
oat overview
The Office for the Advancement of Telehealth (OAT), which is a
grant making agency at the Department of Health and Human Services, is
responsible for promoting the use of telehealth technologies for
healthcare delivery, education, and health information services.
Through its programs, OAT helps bring access to care to those living in
remote, rural and underserved populations.
requested funding levels for fiscal year 2011
Over the years, telehealth has improved a patient's access to
timely specialty care, reduced medical errors, and saved our healthcare
system money. Last year, Congress funded telehealth initiatives at
$11.6 million for fiscal year 2010. This year, the TLI urges the Senate
to maintain the same funding level for fiscal year 2011.
We feel strongly that an $11.6 million funding level for OAT is
essential to ensuring that millions of Americans have access to quality
healthcare services. Maintaining these funding levels will allow these
programs to continue to work with and support communities, in their
efforts to develop cost-effective uses of telehealth technologies.
These initiatives, carried out through OAT, are especially valuable
in a time when millions of Americans are struggling to access quality
healthcare services.
credentialing and privileging
In fiscal year 2010, the subcommittee expressed its concern about a
process soon to be enforced by the Centers for Medicare and Medicaid
Services that would require all telemedicine originating sites where
the patient is located to credential and privilege all telemedicine
practitioners. For many small hospitals receiving telemedicine
services, this could mean credentialing and privileging tens, if not
hundreds, of telemedicine practitioners. It is a cost and personnel
burden that essentially would force the closure of many telemedicine
programs throughout the country. It is the single greatest threat to
the expansion of telemedicine.
Since passage of the fiscal year 2010 appropriations, some positive
developments have occurred. CMS has reached out to the telemedicine
community and appears to be actively seeking a solution to the impact
of this credentialing and privileging requirement. We urge the
Committee to continue to exert it's oversight on this issue to ensure
that CMS develops a workable policy that does not cripple the delivery
of telehealth services, while at the same time protects patient safety,
a goal that the telehealth community shares with CMS.
conclusion
Thank you for you attention to this important healthcare matter. We
know you face many challenges in choosing funding priorities, but we
hope you will continue to keep telehealth a priority and maintain last
year's funding levels of $11.6 million, in this year's fiscal year 2011
appropriations' process. TLI appreciates the opportunity to share its
views, and we thank you for your consideration of our request.
______
Prepared Statement of the NephCure Foundation
One Family's Story
Mr. Chairman 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 one
of two filter diseases called Minimal Change Disease (MCD) 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 NCF has been very helpful to my family. They have provided us
with educational information about NS, MCD, 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 NIH. 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-10-113).
Mr. Chairman, on behalf of the thousands of people suffering from
NS and FSGS and the NephCure Foundation (NCF), thank you for this
opportunity to submit this testimony to the subcommittee and for your
consideration of my request.
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 along with the National
Institutes of Health (NIH) to support the establishment of the
Nephrotic Syndrome Rare Disease Clinical Research Network. This network
is a new collaboration between research institutions, the NCF, and NIH
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, including populations for clinical
trials. 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 2007, is glomerular-disease specific.
The announcement will utilize the R01 mechanism to award researchers
funding. In February 2010 the PA was re-released for a further 3 years.
We ask the subcommittee to encourage the ORDR to continue to
support the Nephrotic Syndrome Rare Disease Clinical Research Network
to expand FSGS research. We also ask the subcommittee to encourage
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.
It would be of great benefit for CDC to begin raising public
awareness of the glomerular diseases in an attempt to diagnose patients
earlier.
We ask the subcommittee to encourage CDC to establish a glomerular
disease education and awareness program aimed at both the general
public and healthcare providers.
Glomerular Disease Strikes Minority Populations
Nephrologists tell us that glomerular disease strikes African
Americans nearly 5 times more frequently than white Americans. No one
knows why this is, but some studies have suggested that the MYH9 gene,
which is 5 times more prevalent in African Americans, may be linked to
susceptibility to FSGS. NIDDK will be sponsoring a conference on this
issue on April 19-20, 2010.
We ask that the NIH pay special attention to why this disease
affects African Americans to such a large degree and often in a more
severe manner. The NCF wishes to work with the NIDDK and the National
Center for Minority Health and Health Disparities (NCMHD) to encourage
the creation of programs to study the high incidence of glomerular
disease within the African-American population.
There is also evidence to suggest that the incidence of glomerular
disease is higher among Hispanic Americans than in the general
population. An article in the February 2006 edition of the NIDDK
publication Recent Advances and Emerging Opportunities, discussed the
case of Frankie Cervantes, a 6-year-old boy of Mexican and Panamian
descent. Frankie has FSGS 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.
The Nephrotic Syndrome Rare Disease Clinical Research Network
offers an excellent opportunity for NCMHD to collaborate with a wide
variety of researchers and institutions to increase knowledge of NS/
FSGS. The addition of NCMHD would add additional insight into the
minority community, which is so disproportionately impacted by FSGS.
We ask the subcommittee to encourage ORDR, NIDDK, and NCMHD to
collaborate on research that studies the incidence and cause of this
disease among minority populations. We also ask the subcommittee to
urge NIDDK and the NCMHD undertake culturally appropriate efforts aimed
at educating minority populations about glomerular disease.
______
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 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.
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.
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.
Unfortunately, support for scleroderma research at the National
Institutes of Health over the past several years has been relatively
flat funded at $20 million in fiscal year 2008, $21 million in fiscal
year 2009, and an estimated $22 million in fiscal year 2010. This slow
rate of increase is extremely frustrating to our patients who recognize
biomedical research as their best hope for a better quality of life. It
is also of great concern to our researchers who have promising ideas
they would like to explore if resources were available.
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 (SSc)
There are two major types of systemic sclerosis or 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
half an 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 2011 appropriations recommendations
An increase in funding for the National Institutes of Health (NIH)
to $35 billion.
--An increase for the National Institute of Arthritis and
Musculoskeletal and Skin Diseases (NIAMS) concurrent with the
overall increase to NIH.
--Committee 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 United Tribes Technical College
For 41 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. Unemployment among the Great Plains tribes,
where most of our students are from, typically run at about 75 percent.
We are governed by the five tribes located wholly or in part in North
Dakota; we are not part of the North Dakota State college system and do
not have a tax base or State-appropriated funds on which to rely. We
have consistently had excellent retention and placement rates and are a
fully accredited institution. Section 117 Perkins funds represent about
half of our operating budget and provide for our core instructional
programs. The request of the United Tribes Technical College Board is
for the following authorized programs:
--$10 million for base funding authorized under section 117 of the
Carl Perkins Act (20 U.S.C. 2327). This is $1.8 million above
the fiscal year 2010 level. These funds are shared via a
formula by UTTC and Navajo Technical College.
--$36 million as requested by the American Indian Higher Education
Consortium for title III (section 316) of the Higher Education
Act (Strengthening Institutions program) that provides
construction funds for facilities at tribally controlled
colleges. This is $4 million more than the fiscal year 2010
level. Among UTTC's pressing facility needs is funding for
phase II of our science and technology building and for student
housing. We are working to cobble together various sources of
funding to complete the science and technology building and to
build student housing.
--$973 million for the TRIO programs nationally which is $120 million
more than the requested amount. This would replace the $57
million in mandatory funding that is expiring for the Upward
Bound program plus provide an increase for other TRIO programs.
Base Funding.--Funds requested under section 117 of the Perkins Act
above the fiscal year 2010 level are needed to: (1) maintain 100-year-
old education buildings and 50-year-old housing stock for students; (2)
upgrade technology capabilities; (3) provide adequate salaries for
faculty and staff (who have not received a cost of living increase this
year and who are in the bottom quartile of salary for comparable
positions elsewhere); and (4) fund program and curriculum improvements,
including at least three 4-year degree programs.
Acquisition of additional base funding is critical as UTTC has more
than tripled its number of students within the past 6 years, but actual
base funding for educational services has increased only 25 percent in
that period. Our Perkins funding provides a base level of support
allowing the college to compete for discretionary contracts and grants
leading to additional resources annually for the college's programs and
support services.
Title III (Section 316) Strengthening Institutions.--We need title
III construction funds for:
--Science and Technology Building.--UTTC provides education for more
than 1,000 students in 100-year old former military buildings
(Fort Abraham Lincoln), along with one 33-year old ``skills
center'' which is inadequate for modern technology and science
instruction. We have completed phase I of the building and now
look to complete phase II. We have raised $5 million, including
$1 million in private funding, $3 million from the U.S.
Department of Education and $1 million in borrowed funds. The
total project cost is expected to be around $12 million. Our
current facility lacks laboratories with proper ventilation and
other technologies which are standard in science education. We
lack a modern auditorium/lecture hall with features such as
computer Internet access and electrical outlets and a library
with appropriate computer stations. Our present library has
been cited by the accrediting agency as being inadequate.
--Student Housing.--We are constantly in need of more student
housing, including family housing. We would like to educate
more students but lack of housing has at times limited the
admission of new students. With the expected completion of a
new Science and Math building on our South Campus on land
acquired with a private grant, we urgently need housing for up
to 150 students, many of whom have families. New housing on the
South Campus could also accommodate those persons we expect to
enroll in a new police training programs.
While UTTC has constructed three housing facilities using a
variety of sources in the past 20 years, approximately 50
percent of students are housed in the 100-year-old buildings of
the old Fort Abraham Lincoln, as well as in duplexes and
single-family dwellings that were donated to UTTC by the
Federal Government along with the land and Fort buildings in
1973. These buildings require major rehabilitation. New
buildings for housing are actually cheaper than trying to
rehabilitate the old buildings that now house students.
TRIO Programs.--UTTC currently has no TRIO funding. We are in
particular need of funding from the student Support Services Program to
improve retention, transfer, and graduation rates for our Pell Grant
recipients. Our students need tutoring, mentoring, academic counseling
and career development services to help them successfully complete
their academic courses of study. Our study body meets the eligibility
requirements of TRIO's Student Support Services program.
--83 percent of students meet the low-income criteria for TRIO's
Student Support Services.
--68 percent of our students are first generation college attendees.
--17 percent of all UTTC applicants in 2008 had a Graduate
Equivalency Diploma.
--74 percent of our students need remediation in math, reading and
composition.
--80 percent of our students have Limited English proficiency.
With regard to our students with a Limited English background, we
note that although not all UTTC students speak their Native language
fluently, many speak forms of English that differ from Standard English
because of the influence of other languages' vocabulary, intonation,
and vernacular. Although UTTC strongly supports the preservation and
use of Native languages, our students tend to have difficulty reading,
writing, and speaking the Standard English as is required of them by
the College and the workplace.
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.
Below are some important things we would like you to know about our
UTTC:
--UTTC Performance Indicators.--UTTC has:
--An 85 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 one of only two
tribal colleges accredited to offer accredited on-line
(Internet-based) associate degrees.
--More than 20 percent of graduates go on to 4-year or advanced
degree institutions.
--Our Students.--Our students are from Indian reservations throughout
the Nation, with a significant portion of them being from the
Great Plains area. Our students have had to make a real effort
to attend college; they 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 Perkins funds, 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. We are
currently serving 168 students in our elementary school and 169
youngsters in our child development centers.
--UTTC Course Offerings and Partnerships with Other Educational
Institutions.--We offer accredited vocational/technical
programs that lead to 17 2-year degrees (Associate of Applied
Science and 11 1-year certificates, as well as a 4-year degree
in elementary education in cooperation with Sinte Gleska
University in South Dakota. We intend to expand our 4-year
degree programs. While full information may be found on our Web
site (www.uttc.edu), among our course offerings are:
--Licensed Practical Nursing.--This program results in great demand
for our graduates; students are able 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.--This 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. This program has in
the past been supported by the IHS, and is the only degree-
granting Injury Prevention program in the Nation. Given the
overwhelming health needs of Native Americans, we continue
to seek resources for training of 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. 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.
--Criminal Justice.--Our criminal justice program leads many
students to a career in law enforcement, and as noted
elsewhere in this testimony, we are actively working on
establishing a police training academy at UTTC.
--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.--We help meet the challenge of
fighting diabetes and other health problems in Indian
Country through education and research. 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. There
are few Indian professionals in the country with training
in these areas. We have also established a Diabetes
Education Center that assists local tribal communities, our
students and staff to decrease the prevalence of diabetes
by providing food guides, educational programs, training
and materials.
Our Perkins and Bureau of Indian Education funds provide for nearly
all of our core postsecondary educational programs. Very little of the
other funds we receive may be used for core career and technical
educational programs; they are competitive, often one-time supplemental
funds which help us provide the services our students need to be
successful. We cannot continue operating without Perkins funds.
Thank you for your consideration of our requests.