[Congressional Record Volume 144, Number 95 (Thursday, July 16, 1998)]
[Senate]
[Pages S8416-S8418]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




               BICENTENNIAL OF THE PUBLIC HEALTH SERVICE

 Mr. FRIST. Mr. President, I rise to commemorate the 
bicentennial of the Public Health Service. On July 16, 1798, the Fifth 
Congress passed, and President John Adams signed, an Act which 
established the Public Health Service. The Public Health Service was 
originally established to provide medical care to sick and disabled 
seamen. Today the scope of their service includes educational 
activities, the provision of medical care, and activities on the 
forefront of biomedical research. I commend the members of the Public 
Health Service not only for their commitment to public health, but also 
their willingness to serve, and to contribute to the prevention and 
eradication of diseases.
  Before being elected to the Senate in 1994, I was a heart and lung 
transplant surgeon for many years. The question I'm most often asked 
is, ``Why would you leave medicine for politics?'' My simple answer is: 
I didn't ``leave.'' I'm away only for awhile. The deeper answer is that 
while--on the surface--politics seems so different from medicine, the 
underlying motivation is exactly the same. Medicine exists to improve 
the life of another human being. The primacy of the patient is the 
central focus of all that physicians do. The same can be said of public 
service and public policy. They exist to serve the best interest of the 
citizenry. As a physician, I had the opportunity to help

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one person at a time. As a United States Senator, I have the chance--
every day--to improve the lives of millions of Americans in Tennessee 
and throughout the country, as well as help secure the future of the 
next generation.
  The Officers of the Commissioned Corps of the Public Health Service 
have a long history of service to the American people. For two 
centuries, the physicians of the Public Health Service have been on the 
forefront of protecting America from disease. As Fitzhugh Mullen 
chronicled in his book ``Plagues and Politics,'' PHS officers have 
played a leading role in the control of infectious diseases--from 
plague control measures, to the eradication of smallpox, to the 
continuing response to outbreaks that threaten the public health, such 
as Legionnaire's disease and hantavirus.
  As the leader of the Commissioned Corps, the Surgeon General has a 
critical role in promoting public health. I have been a strong 
supporter of the position of Surgeon General. I believe America needs a 
physician who will champion public health messages. We need a physician 
to focus national and international attention on public health 
problems. Reports from the Surgeon General have such credibility they 
are repeated by the media, health professionals, medical journals, and 
health educators. As chronic diseases such as heart disease and 
diabetes affect more Americans, we need a medical voice we can trust to 
talk to us about the need for prevention. We need a physician to 
educate the American people about the links between personal behavior 
and illness.
  In Dr. David Satcher, America's new Surgeon General, we have the 
voice we need. I had the privilege of knowing Dr. Satcher from his time 
in Nashville. Because of his knowledge of population-based medicine, 
family medicine, and public health, he is eminently qualified to be our 
messenger to the American people on health issues. This past April, I 
had the privilege of introducing Dr. Satcher when he presented his 
first Surgeon General's report--a report on tobacco use among US racial 
and ethnic minority groups.
  Surgeons General have led the fight against smoking for more than 30 
years, and I'm pleased to see that the health consequences from tobacco 
use are also high on Dr. Satcher's agenda. Since the first report on 
the dangers of smoking by Surgeon General Luther Terry in 1964, there 
have been 24 reports on smoking, including the latest on smoking and 
minority populations. This most recent report notes the increasing 
rates of smoking among African-American and Hispanic teenagers, and 
cites the need for further research into prevention and cessation 
activities. Between 1991 and 1997, smoking among African American 
teenagers increased from 12.6 percent to 22.7 percent--an increase of 
80 percent! Among Hispanic teenagers, smoking prevalence increased from 
25 percent in 1991 to 34 percent in 1997. But teen smoking is not just 
a problem among minority populations. In 1997, cigarette smoking among 
white teenagers was nearly 40 percent--up from 31 percent in 1991. Teen 
smoking is a public health crisis that must be addressed.
  There has been a great deal of attention given to reaching an 
agreement with the tobacco companies to reduce teen smoking. There is 
no silver bullet to stop young people from smoking. It will require a 
comprehensive approach that addresses three aspects: access, public 
health, and advertising.
  Today, children and teenagers have ready access to cigarettes. 
Limiting that access includes everything from raising the price of a 
pack of cigarettes to restricting their ability to purchase 
cigarettes--including their access to vending machines. The cost must 
be high enough to discourage teenagers from smoking, but not high 
enough to create a black market.
  The second aspect is the need for strong public health initiatives, 
including research, treatment, and surveillance. We must deal with the 
issue of nicotine addiction--through a better understanding of the 
physiology of addiction; through the best research programs--including 
basic science and behavioral research; and through effective programs 
that not only keep people from starting, but help them quit.
  The third component is advertising. Society can no longer tolerate 
the specific targeting of young people by tobacco companies. This 
raises a Constitutional issue--the freedom to advertise versus what I 
regard as the wrongful targeting of children--8,9,10,12 years-old--in 
order to encourage them to smoke.
  In the beginning of the 105th Congress, I was honored to assume the 
chairmanship of a newly established subcommittee on public health and 
safety, with jurisdiction over many agencies of the Department of 
Health and Human Services. In establishing the Subcommittee on Public 
Health and Safety, the Senate recognized the importance of public 
health. As Chairman, I've been able to bring public awareness to health 
issues facing this nation and to address the reauthorization of public 
health programs and agencies.
  This past March, I was pleased to chair a subcommittee hearing on 
Global Health. We live in a global society. To paraphrase the Institute 
of Medicine's report, ``America's Vital Interest in Global Health,'' we 
can consider no site too remote, no person too removed, and no organism 
too isolated to affect our citizens.
  Last January, I spent a week on a medical missionary tour of Africa, 
specifically Kenya, South Sudan, and the Democratic Republic of the 
Congo. I was struck by how medical care and services varied--from 
sophisticated Western-style hospitals with adequate laboratory capacity 
to small hospitals without electricity and running water. Several of 
the small hospitals are in remote areas that were virtually impossible 
to reach, except by small plane. While in Kenya, I heard about an 
ongoing epidemic of Rift Valley Fever where more than 300 people had 
already died. I saw first-hand patients with infectious health problems 
common in much of the world: tuberculosis, HIV, malaria and other 
parasitic infections.
  The United States is uniquely poised to look beyond our borders and 
reach out to other countries. As a world leader in medical science, 
biomedical research, and pharmaceutical drug development, we can play a 
leadership role in global health issues through our federal agencies. 
However, the development of an effective global disease surveillance 
and response network requires the involvement of all countries and a 
partnership between the public and private sectors.
  This past year, the subcommittee has also addressed the 
reauthorization of the Agency for Health Care Policy and Research 
(AHCPR), the nation's leading agency on health services research. The 
current debate on health care quality has led us to reexamine the 
federal role in supporting innovation and promoting quality in health 
care. We need solutions that are not only based on sound science but 
also serve the interests of patients. While there are many good private 
sector initiatives, there is a role for the federal government in 
implementing biomedical research results. As we reauthorize AHCPR, we 
will focus on health care quality, public-private partnerships, and 
advancing the science of quality improvement efforts.
  This past March, I introduced ``The Women's Health Research and 
Prevention Amendments of 1998''--a bill with broad bipartisan support 
that addresses diseases that affect women. I'm very pleased that, since 
1993, we have developed guidelines to include women and minorities in 
NIH-sponsored trials. However, we must continue to do more. We must 
continue to review the women's health research agenda as we set 
research priorities. We need to incorporate new scientific knowledge on 
women's health. The women's health bill reauthorizes NIH programs for 
vital research activities into the causes, prevention, and treatment 
for some of the major diseases affecting women--including osteoporosis, 
breast and ovarian cancer, heart disease, as well as research into the 
aging processes of women. Our bill also reauthorizes several programs 
at the CDC for prevention and education activities on women's health 
issues. CDC's programs provide critical health services in each of our 
States to detect, prevent, and diagnose diseases such as breast and 
cervical cancer. Also, CDC programs--such as those at the National 
Center for Health Statistics--provide data that can assist us in making 
informed policy decisions about health care.
  In conjunction with Senators from both sides of the aisle, I 
introduced

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``The Health Professions Education Partnerships Act''--a bill that 
represents an opportunity to help improve the quality of, and access 
to, health care for millions of Americans. The Bill reauthorizes the 
programs funded through title VII and title VIII of the Public Health 
Service Act. For many years, this legislation has helped our nation's 
schools of health better serve the health needs of their communities, 
and better prepare the practitioners of the future. The Bill strives to 
increase the number of health practitioners, including physicians, 
dentists, and nurses, in underserved areas and to improve the 
representation of minorities and disadvantaged individuals in the 
health professions. These programs have often been the assistance of 
last resort for many disadvantaged students seeking careers in health.
  Equally important is the legislation's goal to meet the need of 
underserved communities, often in rural or inner-city areas. Programs 
funded through this bill support the infrastructure which facilitates 
the training and practice of health care providers in underserved 
areas. Patients in underserved areas depend on these programs for their 
health care. Training providers in these areas greatly increases the 
likelihood that they will work in these areas when they complete their 
education. The Bill would also allow the Secretary of HHS to make 
grants to certain health professions schools designated ``Centers of 
Excellence''--to assist these schools in supporting health professions 
education for under represented minority individuals. To qualify, these 
schools would: have a significant number of underrepresented minorities 
enrolled in the school; been effective in assisting minorities to 
complete their degree programs; and have been effective in recruiting 
underrepresented minorities as students and as faculty. ``Centers of 
Excellence'' are currently designated at Historically Black Colleges 
and Universities. This bill establishes Hispanic and Native American 
Centers of Excellence to increase the number of Hispanic and Native 
American health professionals.
  Mr. President, for the past two centuries, the Public Health Service 
has been contributing unique ideas, ethics, and skills to public 
service. I congratulate the Public Health Service as it celebrates 200 
years of public health and science. As the Public Health Service rises 
to meet the challenges of the next 200 years, I know they'll be every 
bit as successful as they have been in the past.

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