[Congressional Record Volume 146, Number 90 (Thursday, July 13, 2000)]
[Senate]
[Pages S6681-S6687]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. FRIST (for himself, Mr. Jeffords, Mr. Kennedy, Mr. Dodd, 
        Mr. DeWine, Mr. Reed,

[[Page S6682]]

        Mrs. Murray, Mr. Bond, Mr. Hatch, Mr. Gorton, Mr. Abraham, and 
        Mr. Durbin):
  S. 2868. A bill to amend the Public Health Service Act with respect 
to children's health; to the Committee on Health, Education, Labor, and 
Pensions.


                  children's public health act of 2000

  Mr. FRIST. Mr. President, I am pleased to be joined by Senators 
Jeffords, Kennedy, Dodd, DeWine, Reed, Murray, Bond, Hatch, Gorton, 
Abraham, and Durbin to introduce the Children's Public Health Act of 
2000.
  This bill is the result of months of close collaboration begun last 
fall between members of the Health, Education, Labor and Pensions 
Committee, and in discussion with Congressmen Bliley and Bilirakis to 
begin an effort to address children's health issues this Congress.
  I am pleased that the House has already passed a companion bill to 
the one which we introduce today, and I look forward to working with 
the House to ensure that we enact this needed bill by the end of the 
year.
  The Children's Public Health Act of 2000 has four overriding themes 
represented in its four titles: Injury Prevention, Maternal and Infant 
Health, Pediatric Health Promotion, and Pediatric Research. I view 
these four themes as critical to ensuring that we are able to promote 
the health of our Nation's children.
  In the first title we address the critical problem of unintentional 
injuries. According to the CDC, unintentional injuries are the leading 
cause of death for every age group between 1 and 19 years of age. 
Unintentional injuries comprise 26 deaths per 100,000 children aged 1-
14 and 62 deaths per 100,000 children aged 15-19. In addition, more 
than 1,500,000 children in the United States sustain a brain injury 
each year. To help address this problem, the bill would reauthorize and 
strengthen the Traumatic Brain Injury programs at the Centers for 
Disease Control (CDC) and Prevention, the National Institutes of Health 
(NIH) and the Health Resources and Services Administration (HRSA).
  The bill also includes a provision which I originally introduced with 
Senator Dodd in March of this year, to address the issue of child care 
health and safety. In my own state of Tennessee, there have been 4 
deaths in the past 3 years in child care settings, and 1 in 15 child-
care programs in the Nashville area were found by state inspectors to 
have potentially put the health and safety of children at risk during 
1999. In addition, in 1997, 31,000 children aged 4 and younger were 
treated in hospital emergency rooms for injuries sustained in child 
care or school settings across this nation. Therefore, the bill 
contains child care safety and health grants to assist states to fund 
specific activities to increase safety and health in child care 
settings.
  To address the tragic fact that birth defects are the leading cause 
of infant mortality and are responsible for about 30 percent of all 
pediatric hospital admissions, the second title of the bill focuses on 
maternal and infant health. According to the CDC, an estimated 3,000 
birth defects have been identified, of which 70 percent have no known 
cause. To provide national leadership to combat birth defects, the bill 
would establish a National Center for Birth Defects and Developmental 
Disabilities at the CDC, which is strongly supported by the March of 
Dimes and other birth defects groups, to collect, analyze, and 
distribute data on birth defects. In addition, the bill authorizes the 
Healthy Start program for the first time, which is designed to reduce 
the rate of infant mortality and improve perinatal outcomes by 
providing grants to areas with a high incidence of infant mortality and 
low birth weight. This bill also contains folic acid education programs 
to spread the knowledge of the positive health effects of folic acid in 
the diet of pregnant women.

  To address the fact that over 3,000 women experience serious 
complications due to pregnancy and that 2 to 3 of these women will die 
from pregnancy complications, the bill would develop a national 
monitoring and surveillance program to better understand the burden of 
material complications and mortality and to decrease the disparities 
among populations at risk of death and complications from pregnancy.
  The third title addresses the promotion of pediatric health by 
focusing on screening and prevention programs to combat some of the 
most common childhood diseases and conditions. This bill helps to 
combat asthma, the most common chronic disease of childhood, affecting 
nearly 5 million children under the age of 18 in the United States, by 
providing comprehensive asthma services to children and to coordinate 
the wide range of asthma prevention programs in the federal government.
  We also focus on childhood obesity, which has increased by 100% among 
children in just the past 15 years, and has resulted in 4.7 million 
children and adolescents ages 6-19 years becoming seriously overweight. 
To address this obesity epidemic, the bill provides programs to support 
the development, implementation, and evaluation of state and community-
based programs to promote good nutrition and increased physical 
activity among American youth.
  In examining the problems affecting children across the nation and in 
Tennessee, I was very concerned to learn that in Memphis, Tennessee, 
over 12 percent of children under the of age of 6 have screened 
positive for lead poisoning. At high levels, lead can cause a variety 
of debilitating health problems, including seizure, coma, and even 
death. At lower levels, lead can contribute to learning disabilities, 
loss of intelligence, hyperactivity, and behavioral problems. This bill 
includes physician education and training programs on current lead 
screening policies, tracks the percentage of children in the Health 
Centers program who are screened for lead poisoning, and conducts 
outreach and education for families at risk of lead poisoning.
  This bill also targets pediatric oral health, which was recently 
highlighted by the May 2000, Surgeon General report which focused on 
the fact that oral health is inseparable from overall health, and that 
while there have been great improvements in oral health for a majority 
of the population, there are disparities that primarily affect poor 
children and those who live in underserved areas of our country, with 
80 percent of all dental cavities found in 20 percent of children. This 
bill would support community-based research and training to improve the 
understanding of etiology, pathogenesis, diagnoses, prevention, and 
treatment of pediatric oral, dental, and craniofacial diseases. In 
addition, the bill would provide state grants to increase community 
water fluoridation and to provide school-based dental sealant services 
to children in low income areas.
  The last title of this bill is a focus on strengthening pediatric 
research efforts in the country. To give us a fuller understanding of 
how we can help promote the health of our children we establish a 
Pediatric Research Initiative within the National Institutes of Health 
to enhance collaborative efforts, provide increased support for 
pediatric biomedical research, and ensure that opportunities for 
advancement in scientific investigations and care for children are 
realized. The bill would also expand research into autism, which 
affects 1 in 500 children, establish a long term Child Development 
Study at the NIH to evaluate the effects of both chronic and 
intermittent exposures on human development.
  Mr. President, this bill is comprehensive; it systematically 
addresses several critical childhood health issues and I am committed 
to ensure that it will be enacted before the end of this Congress. I 
would like to thank Senator Jeffords, the chairman of the Senate 
Health, Education, Labor and Pensions Committee and Senator Kennedy and 
their staffs for their critical collaboration which has led to the 
development of a strong bipartisan bill. I would also like to thank 
Senators Dodd, DeWine, Reed, Murray, Bond, Hatch, Gorton, Abraham, and 
Durbin, for their work on selected provision's in this bill and to 
their commitment to children's health issues. I would also like to 
thank Mr. Bill Baird, from the Office of Senate Legislative Counsel, 
for his great work in drafting this bill. I ask unanimous consent that 
a full summary of the bill appear in the Record following my remarks.
  There being no objection, the summary was ordered to be printed in 
the Record, as follows:

[[Page S6683]]

           The Children's Public Health Act of 2000--Summary

       In an effort to address the health and well being of our 
     most precious resource, the Children's Public Health Act of 
     2000 amends the Public Health Service Act to revise, extend, 
     and establish programs with respect to children's health 
     research, health promotion and disease prevention activities 
     conducted through Federal public health agencies. The Act 
     contains four titles to address critical issues in the areas 
     of children's health; including Injury Prevention, Maternal 
     and Infant Health, Pediatric Public Health Promotion, and 
     Pediatric Research.


                       title I--injury prevention

     Subtitle A--Traumatic Brain Injury
       Traumatic Brain Injury (TBI) is a term descriptive of 
     injury occurring to the brain as a result of external forces. 
     These injuries may include intracranial (inside the skull) or 
     intraparenchymal (inside the brain tissue) hemorrhage, 
     parenchymal edema, or shear injury. The CDC Center for Injury 
     Prevention estimates that more than 1,500,000 children in the 
     US sustain a brain injury each year, and many more are living 
     with the consequences. According to the CDC National Center 
     for Health Statistics, unintentional injuries including TBI 
     are the leading cause of death for every age group from 1 to 
     19 years of age, comprising 26 deaths per 100,000 children 
     aged 1-14 and 62 deaths per 100,000 children aged 15-19. 
     Younger children and infants are at an increased risk of 
     brain injury because the size and weight of their heads is 
     greater in proportion to their body size. Young children also 
     lack mature muscle control, which contributes to an increased 
     risk of head injury.
       This provision would reauthorize the Traumatic Brain Injury 
     Act of 1996 to extent the authority for CDC to support 
     research into strategies for the prevention of TBI and 
     implementing public information and education programs for 
     the prevention of TBI. NIH research is expanded to cognitive 
     disorders and neurobehavioral consequences arising from TBI. 
     The bill authorizes HRSA to make grants for community support 
     services to develop, change, or enhance service delivery 
     systems. Grants may be used to educate consumers and 
     families, train professionals, improve case management, 
     develop best practices in the areas of family support, return 
     to work, and housing for people with traumatic brain injury.
     Subtitle B--Child Care Safety and Health Grants
       Of the 21 million children under the age of 6 in the United 
     States, almost 13 million spend some part of their day in 
     child care. There is alarming evidence to suggest that more 
     must be done to improve the health and safety of children in 
     child care settings. For example, a 1998 Consumer Product 
     Safety Commission Study revealed that two-thirds of the 200 
     licensed child care settings investigated exhibited safety 
     hazards, such as insufficient child safety gates, cribs with 
     soft bedding, and unsafe playgrounds. In 1997 alone, 31,000 
     children age 4 and younger were treated in hospital emergency 
     rooms for injuries sustained in child care school settings. 
     Even more tragically, since 1990 more than 56 children have 
     died in child care settings.
       To address the need for increased safety of child care 
     facilities, this provision would give the Secretary of Health 
     and Human Services the authority to provide grants to states 
     to carry out activities related to the improvement of the 
     health and safety of children in child care settings. Grants 
     may be used for two or more of the following activities: 
     train and educate child care provides to prevent injuries and 
     illnesses and to promote health-related practices; strengthen 
     and enforce child care provider licensing, regulation, and 
     registration; rehabilitate child care facilities to meet 
     health and safety standards; provide health consultants to 
     give health and safety advice to child care providers; 
     enhance child care providers' ability to serve children with 
     disabilities; conduct criminal background checks on child 
     care providers; provide information to parents on choosing a 
     safe and healthy setting for their children; or improve the 
     safety of transportation of children in child care.


                  title ii--maternal and infant health

     Subtitle A--Safe Motherhood and Infant Health Prevention
       Every day, 2-3 women die from pregnancy complications and 
     over 3,000 women experience serious complications due to 
     pregnancy. Despite nearly 4 million deliveries in the United 
     States each year, we have little information about unintended 
     health consequences related to pregnancy and childbirth. The 
     nation's infant mortality rate has steadily declined over the 
     last decade, but the percentage of women who die in 
     childbirth has remained unchanged. Maternal mortality rates 
     reveal significant disparities between African American and 
     white women, but the reasons for those differences are not 
     well understood. When compared with white women, black women 
     continue to have four times the risk for dying from 
     complications of pregnancy and childbirth.
       The provision would authorize the Secretary of HHS to 
     develop a national monitoring and surveillance program to 
     better understand the burden of maternal complications and 
     mortality and to decrease the disparities among populations 
     at risk of death and complications from pregnancy. The 
     provision would also allow the Secretary to expand the 
     Pregnancy Risk Assessment Monitoring System program to 
     provide surveillance and data collection in each of the 50 
     States. Furthermore, the provision would expand research 
     concerning risk factors, prevention strategies, and the roles 
     of the family, health care providers, and the community in 
     safe motherhood. The provision also authorizes public 
     education campaigns on healthy pregnancies, education 
     programs for health care providers, and activities to promote 
     community support services for pregnant women. Finally, the 
     provision provides grant funding for research initiatives and 
     prevention programs on drug, alcohol, and smoking prevention 
     and cessation for pregnant women.
     Subtitle B--Healthy Start Initiative
       The Healthy Start initiative began as a demonstration 
     project in 1991 to help mothers from disadvantaged 
     neighborhoods improve their chances of having a healthy 
     pregnancy and, ultimately, a healthy baby. This provision 
     authorizes the Healthy Start program for the first time. 
     Healthy Start is designed to reduce the rate of infant 
     mortality and improve perinatal outcomes by providing 
     grants to areas with a high rate of infant mortality and 
     low birth weight. Newly authorized services include 
     expanding access to surgical services to the fetus, 
     pregnant woman, and infant during the first year after 
     birth.
     Subtitle C--National Center for Birth Defects and 
         Developmental Disabilities
       Birth defects are the leading cause of infant mortality and 
     are responsible for about 30% of all pediatric hospital 
     admissions. According to the CDC, of the estimated 3,000 
     different birth defects that have been identified, up to 70% 
     without a known cause. Of the four million babies born each 
     year in the United States, approximately 150,000 are born 
     with one or more serious birth defects. About 17% of U.S. 
     children under 18 years of age have a developmental 
     disability. In the United States, 12 out of every 1,000 
     school children have mental retardation, approximately 10,000 
     infants born each year develop cerebral palsy, and as many as 
     1 in every 500 children under 15 years of age may have one of 
     the autism spectrum disorders.
       This provision would create a National Center for Birth 
     Defects and Developmental Disabilities within the CDC. The 
     purpose of this Center would be to collect, analyze, and 
     distribute data on birth defects including information on 
     causes, incidence, and prevalence; conduct applied 
     epidemiological research on the prevention of such defects; 
     and provide information to the public on proven prevention 
     activities.
     Subtitle D--Folic Acid Education Programs
       Each year, an estimated 2,500 infants are born in the 
     United States with serious birth defects of the brain and 
     spine, called neural tube defects. The most common neural 
     tube defects are spina bifida, which is due to an incomplete 
     closure of the spinal column, and anencephaly, a fatal 
     condition where an infant is born with a severely 
     underdeveloped brain and skull. Spina bifida is the leading 
     cause of childhood paralysis. As many as 70 percent of all 
     neural tube birth defects could be prevented if all women of 
     childbearing age consumed 400 micrograms of folic acid daily, 
     beginning before pregnancy. Folic acid is a B vitamin found 
     naturally in leafy green vegetables, beans, citrus fruits, 
     and juices. Since January 1998, the Food and Drug 
     Administration has required that all foods containing 
     enriched flour, such as breads, pasta, and breakfast cereal, 
     be fortified with folic acid. In addition to consuming a diet 
     high in folate-rich foods, a daily multivitamin is one of the 
     most reliable sources of folic acid. A majority of women are 
     not aware of this prevention opportunity, nor are they 
     consuming the recommended daily amount. A national folic 
     campaign is needed to urge women to take this simple step to 
     prevent neural tube defects.
       This provision would establish a national folic acid 
     education program to prevent birth defects. CDC, in 
     partnership with the States and local, public, and private 
     entities, is authorized to launch an education and public 
     awareness campaign; conduct research to identify effective 
     strategies for increasing folic acid consumption by women of 
     reproductive capacity; and evaluate the effectiveness of 
     these strategies.


              title iii--pediatric public health promotion

     Subtitle A--Asthma
       Asthma is the most common chronic disease of childhood. It 
     affects nearly five million children under the age of 18 in 
     the United States, and the incidence is dramatically 
     increasing. Several studies suggest that between 1980 and 
     1994, asthma increased 160% among children under age 4, and 
     74% among children aged 5-14. According to the National 
     Center for Health Statistics, children under 18 years of age 
     miss nearly 72 out of every 1,000 school days due to asthma. 
     This is more than three times the number of missed school 
     days than their unaffected peers accounting for almost 10 
     million missed days each year.
       This provision would authorize the Secretary to award 
     grants to provide comprehensive asthma services to children, 
     equip mobile care clinics, conduct patient and family 
     education on asthma management, and identify children 
     eligible for Medicaid, the State Children's Health Insurance 
     Program, and other children's health programs. This provision 
     amends the Preventive Health and Health Services Block Grant 
     program to provide for the establishment, operation, and 
     coordination of effective and cost-

[[Page S6684]]

     efficient systems to reduce the prevalence of asthma and 
     asthma-related illnesses among urban populations, especially 
     children, by reducing the level of exposure to cockroach 
     allergen through the use of integrated pest management. This 
     provision also requires HHS to establish a coordinating 
     committee to identify all Federal programs that carry out 
     asthma-related activities; develop, in consultation with 
     appropriate Federal agencies, professional and voluntary 
     health organizations, a Federal plan for responding to 
     asthma; and submit recommendations to Congress within 12 
     months after enactment regarding ways to strengthen and 
     improve the coordination of asthma-related Federal 
     activities.
     Subtitle B--Childhood Obesity Prevention
       Obesity has increased by more than 50 percent among adults 
     and 100 percent among children in just the past 15 years. 
     Approximately 4.7 million children, or 11% of youths ages 6-
     19 years are seriously overweight. Obesity is associated with 
     many of the leading causes of death and disability, including 
     heart disease, diabetes, certain forms of arthritis, and 
     cancer. Research shows that 60% of overweight 5 to 10 year 
     old children already have at least one risk factor for heart 
     disease (hyperlipidemia, hypertension, or altered insulin 
     levels). Almost 25 percent of young people ages 6-17 are 
     overweight, and the percentage who are seriously overweight 
     has doubled in the last 30 years. Part of the reason for 
     youth inactivity is the reduction of daily participation in 
     high school physical education classes has declined from 42 
     percent in 1991 to 27 percent in 1997.
       This provision would authorize the CDC to administer a 
     competitive grant program to support the development, 
     implementation, and evaluation of state and community-based 
     programs to promote good nutrition and increased physical 
     activity among American children and adolescents. States 
     would be required to develop comprehensive, inter-agency 
     school- and community-based approaches to encourage and 
     promote nutrition and physical activity in local 
     communities. The proposal would allow CDC to provide 
     states with technical support as well as disseminate 
     information about effective prevention strategies and 
     interventions in treating obesity.
       The CDC will coordinate and conduct research to improve our 
     understanding of the relationship between physical activity, 
     diet, health, and other factors that contribute to obesity. 
     Research will also focus on developing and evaluating 
     effective strategies for the prevention and treatment of 
     obesity and eating disorders, as well as study the prevalence 
     and cost of childhood obesity and its effects into adulthood.
       The CDC in collaboration with State and local health, 
     nutrition, and physical activity experts, will develop a 
     nationwide public education campaign regarding the health 
     risks associated with poor nutrition and physical inactivity, 
     and will promote information on effective ways to incorporate 
     good eating habits and regular physical activity into daily 
     living.
       The CDC, in collaboration with HRSA, will develop and carry 
     out a program to train health professionals in effective 
     strategies to better identify, assess, and counsel (or refer) 
     patients with obesity, an eating disorder, or who are at risk 
     of becoming obese or developing an eating disorder. They will 
     also develop and carry out a program to educate and train 
     educators and child care professionals in effective 
     strategies to teach children and their families about ways to 
     improve dietary habits and levels of physical activity.
     Subtitle C--Childhood Lead Prevention
       At high levels, lead can cause a variety of debilitating 
     health problems, including seizure, coma, and even death. At 
     lower levels, lead can contribute to learning disabilities, 
     loss of intelligence, hyperactivity, and behavioral problems. 
     Screening is a critical element in eliminating childhood lead 
     poisoning because in most cases there are no distinctive or 
     obvious symptoms. Children with elevated blood lead levels 
     are seven times more likely to drop out of high school and 
     six times more likely to have reading disabilities. It costs 
     an average of $10,000 more a year to educate a lead-poisoned 
     child.
       This provision requires HRSA to report annually to the 
     Congress on the percentage of children in the Health Centers 
     program who are screened for lead poisoning. Requires HRSA to 
     work with the CDC and HCFA to conduct physician education and 
     training programs on current lead screening policies along 
     with the scientific, medical, and public health basis for 
     such policies.
       This provision requires CDC to issue recommendations and 
     establish requirements for its grantees to ensure uniform and 
     complete reporting of blood lead levels from laboratories to 
     State and local health departments and to improve data 
     linkages between health departments, CDC, WIC, Early Head 
     Start, and other federally funded means-tested public benefit 
     programs.
       This provision authorizes new funding through the Maternal 
     and Child Health Block Grant to states with a demonstrated 
     need (based on local surveillance data) to conduct outreach 
     and education for families at risk of lead poisoning, provide 
     individual family education designed to reduce exposures to 
     children with elevated blood lead levels, implement community 
     environmental interventions, and ensure continuous quality 
     measurement and improvement plans for communities committed 
     to comprehensive lead poisoning prevention.
     Subtitle D--Oral Health
       In May 2000, the Surgeon General of the United States 
     published the landmark report, Oral Health in America: A 
     Report of the Surgeon General. The report focuses on the fact 
     that oral health is inseparable from overall health. However, 
     tooth decay is the most prevalent preventable chronic disease 
     of childhood and only the common cold, the flu and onitis 
     media occur more often among young children. And while there 
     have been great improvements in oral health for a majority of 
     the population, there are disparities that primarily affect 
     poor children and those who live in underserved areas of our 
     country, with 80 percent of all dental cavities found in 20 
     percent of the children. ``The devastating consequences of 
     untreated disease can affect children's health and well 
     being, causing pain and suffering, time lost from school, 
     loss of permanent teeth, self-consciousness and loss of self-
     esteem, and even more complications in children with 
     coexisting medical conditions.'' The United States must 
     improve and enhance the training of dental health 
     professionals to meet the increasing need for dental services 
     for children .
       This provision would require the Secretary of HHS to 
     support community-based research and training to improve the 
     understanding of etiology, pathogenesis, diagnoses, 
     prevention and treatment of pediatric oral, dental and 
     craniofacial diseases and conditions. The Secretary of HHS is 
     authorized to provide grants to States to increase community 
     water fluoridation and to provide school-based dental sealant 
     services to children in low income areas.


                      title vi--pediatric research

     Subtitle A--Pediatric Research Initiative
       The rapidly expanding knowledge base in genetics and 
     biomedicine affords an unparalleled opportunity to understand 
     gene-environment interactions and to apply this knowledge to 
     the benefit of children and society. Findings in pediatric 
     research not only promote and maintain health throughout a 
     child's lifespan, but also contribute significantly to new 
     insights and discoveries that will aid in the prevention and 
     treatment of illnesses and conditions among adults. A growing 
     body of evidence shows that risk factors for diseases such as 
     coronary artery disease and stroke begin in childhood and 
     persist through adulthood.
       This provision would establish a Pediatric Research 
     Initiative within the National Institutes of Health (NIH) to 
     enhance collaborative efforts, provide increased support for 
     pediatric biomedical research, and ensure that expanding 
     opportunities for advancement in scientific investigations 
     and care for children are realized.
       The Secretary of Health and Human Services (HHS) will make 
     available enhanced support for activities relating to the 
     training and career development of pediatric researchers, 
     including  general authority for loan repayment of a portion 
     of education loans.
     Subtitle B--Autism
       Autism and autism spectrum disorders are biologically-based 
     neurodevelopment diseases that cause severe impairments in 
     language and communication. These disorders often manifest in 
     young children sometime during the first two years of life. 
     Estimates indicate that 1 in 500 children born today will be 
     diagnosed with an autism spectrum disorder and that 400,000 
     Americans have autism or an autism spectrum disorder.
       Under this provision, the Director of NIH shall expand, 
     intensify, and coordinate the activities of the NIH with 
     respect to research on autism. The Director of NIH will carry 
     out through NIMH and other agencies that may be appropriate, 
     and establish not less than five Centers of Excellence on 
     autism research. Each center will conduct basic and clinical 
     research into the cause, diagnosis, early detection, 
     prevention, control and treatment of autism, including 
     research in the fields of developmental neurobiology, 
     genetics and psychopharmacology. The Director shall provide 
     for the coordination of information among centers. A center 
     may provide individuals referrals for health and other 
     services and patient care services as required for research. 
     The Director shall provide for a program under which samples 
     of tissues and genetic materials that are of use in research 
     on autism are made available for this research.
       The proposal also establishes through the CDC, at least 
     three regional centers of excellence in autism and pervasive 
     developmental disabilities epidemiology to collect and 
     analyze information on the number, incidence, and causes of 
     autism and related developmental disabilities would be 
     established. The Secretary shall establish a program to 
     provide information on autism to health professionals and the 
     general public, and establish an Autism Coordinating 
     Committee to coordinate all efforts within HHS on autism.
     Subtitle B--Child Development Study
       Findings in pediatric research not only promote and 
     maintain health throughout a child's lifespan, but also 
     contribute significantly to new insights and discoveries that 
     will aid in the prevention and treatment of illnesses and 
     conditions among adults. A growing body of evidence shows 
     that risk factors for diseases such as coronary artery 
     disease and stroke begin in childhood and persist through 
     adulthood. Children are more vulnerable to physical, 
     chemical, biological, safety, and psychosocial exposures than 
     adults. Evidence-based policies and effective

[[Page S6685]]

     prevention and health promotion strategies to achieve a 
     healthy and safe environment for children and families, are 
     best derived from a federal multi-agency longitudinal study.
       Authorizes NICHD to convene and direct a consortium of 
     federal agencies, including CDC and EPA, to plan, develop and 
     implement a prospective cohort study to evaluate the effects 
     of both chronic and intermittent exposures on human 
     development, and to investigate basic mechanisms of 
     developmental disorders and environmental factors, both risk 
     and protective, that influence growth and development 
     processes. The study will incorporate behavioral, emotional, 
     educational, and contextual consequences to enable a complete 
     assessment of the physical, chemical, biological and 
     psychosocial environmental influences on children's well-
     being.
       The study shall include diverse populations, before birth, 
     to gather data on environmental influences and outcomes until 
     at least age 21, and shall consider health disparities.
     Subtitle D--Research on Rare Diseases
       This Provision would require the NIH Director to report to 
     Congress within 180 days of enactment regarding activities 
     conducted and supported by the NIH during Fiscal Year 2000 
     with respect to rare diseases in children and the activities 
     that are planned to be conducted and supported by the NIH 
     with respect to such diseases during the Fiscal Years 2001 
     through 2005.
     Subtitle E--GME in Children's Hospitals
       The health of the nation's children depends upon a steady 
     supply of well-trained pediatricians and pediatric 
     specialists. Independent children's hospitals train about 
     half of all pediatric specialists, and 30 percent of 
     pediatricians. Graduate medical education (GME) activities 
     have historically been supported by Medicare, but, because 
     these hospitals serve very few Medicare patients, they 
     receive very little financial support for this important and 
     costly activity. Children's hospitals are an important 
     resource for all children. The training, pediatric research, 
     and primary and specialty care services that occur in these 
     facilities should be preserved and strengthened. 
     Unfortunately, however, many of these hospitals are 
     struggling to maintain their missions. Last year, a new 
     program was authorized to provide discretionary support for 
     pediatric GME activities in free-standing children's 
     hospitals. This provision extends the authorization to 2005.

  Mr. JEFFORDS. Mr. President, it gives me great pleasure to join my 
colleagues today in introducing the Children's Health Act of 2000. This 
bill authorizes a variety of programs and initiatives that promise to 
significantly improve the health of children in this nation. I want to 
commend Senators Frist, Kennedy, Dodd, Gregg, DeWine, Reed, Bond, 
Gorton, Abraham, and Durbin for their work and commitment to protecting 
and improving the health of our children.
  This bill takes a multifaceted approach in addressing the most 
pressing healthcare problems facing our children today, such as brain 
injury, birth defects, asthma, and obesity. The bill authorizes 
prevention programs, educational programs, clinical research, and 
direct clinical care services. It also enhances the training and 
knowledge base of pediatric healthcare researchers through training and 
loan repayment programs. In the face of so many dangerous diseases and 
conditions, the holistic approach taken by this bill offers the best 
hope for protecting and improving our children's health.
  This bill provides funding for critical research on children's heath. 
The Pediatric Research Initiative, based in the National Institutes of 
Health, will lay the foundation for comprehensive, cross cutting 
pediatric biomedical research. Such a center has the potential to yield 
valuable new information on child growth and development.
  The Child Development Study, a long term study of environmental 
influences on children's health, will also yield important insights 
into the environmental factors that influence the growth and 
development of our children. This understanding will play a critical 
role in shaping future policy and programs for children's health. This 
research, in addition to other research opportunities provided in this 
bill promises to significantly improve our ability to protect the 
health of our children.
  In addition to research, this bill provides resources for care and 
prevention programs. For example, this bill authorizes aggressive 
programs to prevent and treat one of the most challenging childhood 
health problems, traumatic brain injury. The Centers for Disease 
Control and Prevention is directed to conduct research on prevention 
and to implement public education and information programs. The Health 
Research and Services Administration is authorized to fund community 
support services to develop support or enhance care systems for 
individuals with brain injuries. These programs, coupled with research 
at NIH, address both the causes and the consequences of traumatic brain 
injury.
  This bill authorizes the creation of a National Center for Birth 
Defects and Developmental Disabilities to collect, analyze, and 
distribute data on birth defects. This provision will allow for 
important data to be developed to guide the development of programs and 
policies to assist children and families coping with disabilities. 
Having worked for many years to improve the quality of life of people 
living with disabilities, I strongly support this effort to address the 
challenges of disabilities at the earliest age possible. This center 
will help to coordinate and focus our approach, and serve as a 
clearinghouse for information that will improve both healthcare and 
quality of life for children with disabilities.
  By targeting asthma, the most common chronic disease of childhood, 
this bill will make a difference in the lives of thousands of children 
and young people who suffer with this disease across the nation. Asthma 
jumped by 75 percent in the general population between 1980 and 1994. 
Among children under four there was a rise of 160 percent. It is 
estimated that this condition debilitates about 33,000 Vermonters 
(22,000 adults and 11,000 children). Grant programs authorized under 
this bill will fund comprehensive asthma services, mobile health care 
clinics, and patient and family education to reduce the impact of this 
dangerous disease. As this disease continues to strike more and more of 
our youth, it is critical that programs to reduce asthma have priority.
  Oral health is also improved under this legislation, which targets 
the disparities in access to dental care and preventive therapies among 
poor children. In addition to direct care services, this provision 
enhances community based research and training to improve our knowledge 
of effective clinical and preventive measures. With 20 percent of 
children experiencing 80 percent of the dental cavities, it is time we 
focus on this neglected population and make a difference in their 
health.
  An investment in the health of the nation's children will undoubtedly 
have long term rewards, as we move our understanding of and ability to 
treat childhood diseases far beyond current capabilities. Clearly, the 
time has come to comprehensively and aggressively tackle the primary 
causes of poor health for our children. I strongly support this 
legislation. The health of the nation rests on the health of our 
children, and we must do all we can to prevent and treat diseases that 
strike at the most vulnerable members of society.
  Mr. KENNEDY. Mr. President, it is a privilege to join Senator Frist 
and our other colleagues in introducing the Children's Public Health 
Act of 2000. This bipartisan legislation will help millions of children 
in the years ahead. It takes needed action to improve children's health 
by expanding pediatric research and calling for specific steps to deal 
with a wide range of childhood illness, disorders, and injuries. 
Coordinated action in these areas can lead to significant benefits for 
all children.
  Senator Frist and I have worked closely with many of our Democratic 
and Republican colleagues on this legislation. We have talked with 
experts and advocates in the children's health community. We believe 
this legislation will lead to significant progress in addressing some 
of today's most pressing pediatric public health problems.
  The legislation includes a variety of new and reauthorized children's 
health provisions that are organized under four broad categories--
injury prevention, maternal and infant health promotion, public health 
promotion, and research.
  Traumatic brain injury is the leading cause of death and disability 
in young Americans. The Centers for Disease Control and Prevention has 
estimated that 5.3 million Americans are living with long-term, severe 
disability as a result of brain injuries, and each year 50,000 people 
die as a result of such injuries. The Children's Public Health Act 
revises and extends the authorization for the important programs 
enacted in 1996 to deal with these injuries. This reauthorization will 
assure

[[Page S6686]]

continued progress toward our understanding, treating and preventing 
them.
  Improving and protecting the safety of child care environments should 
also be a high priority for Congress. This legislation creates a new 
program to improve the safety of children in child care settings, and 
to encourage child care providers to take steps to prevent illness and 
injuries and protect the health of the children they serve.
  In addition, this legislation includes programs to improve the health 
of pregnant women and prenatal outcomes, including prevention of birth 
defects and low birth weight. It establishes a new Center for Birth 
Defects and Developmental Disabilities at the Centers for Disease 
Control and Prevention in order to focus the nation's activities more 
effectively in these important areas. The new center will be especially 
helpful for children and families affected by these conditions.
  The bill also takes a number of steps to address other prevalent 
childhood conditions. Asthma is the most common chronic childhood 
illness, affecting more than seven percent of all American children. 
The death rate for children with asthma increased by 78 percent between 
1980 and 1993, and asthma-related costs total nearly $2 billion 
annually in direct health care for children. The nation is handicapped 
by a lack of basic information on where and how asthma strikes, what 
triggers it, and how effectively our current health care system is 
responding to those who suffer from this chronic disease. Our bill will 
provide greater asthma services to children, including mobile clinics, 
and patent and family education, and it will help to reduce allergens 
in housing and public facilities.
  Poor nutrition and lack of physical activity are also hurting many 
American children and contributing to lifelong health problems. The 
nation spends $39 billion a year--equal to six percent of overall U.S. 
health care expenditures--on direct health care related to obesity. 
Twenty percent of American children--one in five--are overweight. 
Unhealthy eating habits and physical inactivity in childhood can lead 
to heart disease, cancer and other serious illnesses decades later. 
Children and adolescents who suffer from eating disorders, such as 
anorexia nervosa and bulimia, can have wide-ranging physical and mental 
health impairments. Our legislation establishes new grant programs to 
reduce childhood obesity and earing disorders, promote better 
nutritional habits among children, and encourage an appropriate level 
of physical activity for children and adolescents.
  Last May, the Surgeon General published a landmark report on oral 
health in America, emphasizing the need to consider oral health as an 
essential part of total health. There is no question that oral and 
dental health care should be included in our primary care. Tooth decay 
is the most common childhood infectious disease, and it can lead to 
devastating consequences, including problems with eating, learning and 
speech. Twenty-five percent of children in the United States suffer 80 
percent of the tooth decay, with significant racial and age 
disparities. The number of dentists in the country has been declining 
since 1990, and is projected to continue to decline through the year 
2020.
  According to a 1995 report by the Inspector General, only one in five 
Medicaid-eligible children receive dental services annually, and the 
shortage of dentists exacerbates the problem of unmet needs. Yet tooth 
decay is largely preventable. More effective efforts to educate parents 
and children about the causes of tooth decay, and initiatives to 
prevent and treat it can lead to lasting public health improvements. 
Our legislation includes a variety of approaches to deal with this 
silent epidemic.
  Research has long shown that childhood lead poisoning can have 
devastating effects on children, causing reduced IQ and attention span, 
stunted growth, behavior problems, and reading and learning 
disabilities. Yet too children remain unscreened and untreated, and 
adequate services often are not available for children with elevated 
levels of lead in their blood. There is no excuse for not taking 
greater steps to eliminate childhood lead poisoning. Our bill includes 
screening for early detection and treatment, professional education and 
training programs, and outreach and education activities for at-risk 
children.

  Pediatic research discoveries promote and maintain health throughout 
a child's life span, and also contribute significantly to new insights 
that aid in the prevention and treatment of illnesses and conditions 
among adults. A growing body of evidence shows that risk factors for 
conditions such as coronary artery disease and stroke begin in 
childhood and persist through adulthood. Congress has a strong history 
of promoting basis and clinical research, and the steps taken in this 
legislation continue that priority.
  The legislation establishes a pediatric research initiative, 
authorized at $50 million annually, that will increase support for 
pediatric biomedical research at the National Institutes of Health, 
including an increase in collaborative efforts among multidisciplinary 
fields in areas that are promising for children. The legislation also 
requires coordination with the Food and Drug Administration to increase 
the number of pediatric clinical trails, and to provide greater 
information on safer and more effective use of prescription drugs in 
children.
  Children have unique health care needs. They are not simply small 
adults. Nothing is more important to the future health of America's 
children than maintaining a steady supply of pediatricians, pediatric 
specialists and pediatric-focused scientists.
  Our legislation takes two important steps to improve the growth and 
development of a pediatric-focused medical community. First, it 
enhances support by the National Institute for Child Health and Human 
Development expressly for training and career development activities of 
pediatric researchers, and it establishes a loan repayment program for 
pediatricians who conduct research.
  Second, it extends the authorization of a new program that supports 
graduate medical education activities at independent children's 
hospitals. These hospitals train half of all pediatric specialists, and 
30 percent of all pediatricians. However, because GME activities have 
historically been supported by Medicare and because these hospitals 
serve very few Medicare patients, they receive very little financial 
support for this important and costly activity. As a result, children's 
hospitals are struggling to maintain the important training, pediatric 
research, and primary and specialty care services that they provide. 
Children's hospitals should be treated like all other teaching 
hospitals when it comes to support for their GME activities. I have 
sponsored another legislative proposal to guarantee full funding each 
year, without being subject to the appropriations process. That 
proposal is awaiting consideration in the Finance Committee. Until it 
is enacted, we owe it to America's children to invest in their future 
health care by improving our support for pediatric GME activities.
  The bill also authorizes a new study to monitor and evaluate 
development of children through adulthood. The kind of information that 
will be obtained by this study is long-overdue. Children are more 
vulnerable to physical, chemical, biological, and other risks than 
adults, and we must make a major commitment to learning more about the 
influences and effects of the environment.
  Finally, this legislation also includes a program to address the 
unique needs of children with autism and related disorders. I look 
forward to working with Chairman Frist, members of the Committee and 
others to assure that the needs of children with Fragile X are met in 
the final legislation.
  This legislation deserves to be a major public health priority for 
the nation. Congress should send the President a strong bill on these 
issues before the end of this year.
  Mr. DeWINE. Mr. President, I rise today as a co-author of the 
``Children's Public Health Act of 2000.'' The sad fact is that far too 
many children never realize success as adults or even reach adulthood 
because of debilitating or life-threatening disease. That is why we 
must build a health care system that is responsive to the unique needs 
of children. The ``Children's Public Health Act of 2000'' is a big step 
in the right direction, and I commend my colleagues, Senators Frist, 
Jeffords, and Kennedy for their efforts to construct a bill that can 
really make a positive difference in the health and the lives of 
children.

[[Page S6687]]

  Mr. President, I am especially pleased that the ``Children's Public 
Health Act'' contains several important initiatives that my colleagues 
and I had already introduced as separate bills. One such initiative--
the Pediatric Research Initiative--would help ensure that more of the 
increased research funding at the National Institutes of Health (NIH) 
is invested specifically in children's health research.
  While children represent close to 30 percent of the population of 
this country, NIH devotes only about 12 percent of its budget to 
children, and, in recent years, that proportion has been declining even 
further. We must reverse this disturbing trend. It simply makes no 
sense to conduct health research for adults and hope that those 
findings also will apply to children. A ``one-size-fits-all'' research 
approach just doesn't work. The fact is that children have medical 
conditions and health care needs that differ significantly from adults. 
Children's health deserves more attention from the research community. 
That's why the Pediatric Research Initiative is such an important part 
of the ``Children's Public Health Act.'' It would provide the federal 
support for pediatric research that is so vital to ensuring that 
children receive the appropriate and best health care possible.
  The Pediatric Research Initiative would authorize $50 million 
annually for the next five years for the Office of the Director of NIH 
to conduct, coordinate, support, develop, and recognize pediatric 
research. By doing so, we will be able to ensure that researchers 
target and study child-specific diseases. With more than 20 Institutes 
and Centers and Offices within NIH that conduct, support, or develop 
pediatric research in some way, this investment would promote greater 
coordination and focus in children's health research and should 
encourage new initiatives and areas of research.
  The ``Children's Public Health Act'' also would authorize funding 
through the National Institutes of Child Health and Human Development 
(NICHD)--for pediatric research training grants to support training for 
additional pediatric research scientists and would provide funding for 
loan forgiveness programs. Trained researchers are essential if we are 
to make significant advances in the study of pediatric health care, 
especially in light of the new and improved Food and Drug 
Administration (FDA) policies that encourage the testing of medications 
for use by children.
  Additionally, the ``Children's Public Health Act'' includes the 
``Children's Asthma Relief Act,'' which Senator Durbin and I introduced 
last year. The sad reality for children is that asthma is becoming a 
far too common and chronic childhood illness. From 1979 to 1992, the 
hospitalization rates among children due to asthma increased 74 
percent. Today, estimates show that more than seven percent of children 
now suffer from asthma. Nationwide, the most substantial prevalence 
rate increase for asthma occurred among children aged four and younger. 
Those four and younger also were hospitalized at the highest rate among 
all individuals with asthma.
  According to 1998 data from the Centers for Disease Control (CDC), my 
home state of Ohio ranks about 17th in the estimated prevalence rates 
for asthma. Based on a 1994 CDC National Health Interview Survey, an 
estimated 197,226 children under 18 years of age in Ohio suffer from 
asthma. This is a serious health concern among children--and we must 
address it.
  The ``Children's Public Health Act'' would help ensure that children 
with asthma receive the care they need to live healthy lives. The bill 
would authorize $50 million annually for five years for the Secretary 
of Health and Human Services (HHS) to award grants to eligible entities 
to develop and expand projects that would provide asthma services to 
children. These grants also may be used to equip mobile health care 
clinics that provide asthma diagnosis and asthma-related health care 
services; educate families on asthma management; and identify and 
enroll uninsured children who are eligible for, but are not receiving 
health coverage under Medicaid or the State Children's Health Insurance 
Program (SCHIP). The ability to identify and enroll children in these 
programs will ensure that children with asthma receive the care they 
need.
  Since research shows that children living in urban areas suffer from 
asthma at such alarming rates and that allergens, such as cockroach 
waste, contribute to the onset of asthma, this bill also adds urban 
cockroach management to the current preventive health services block 
grant which currently can be used for rodent control.
  To better coordinate federal activities related to asthma, the 
Secretary of HHS would be required to identify all federal programs 
that carry out asthma research and develop a federal plan for 
responding to asthma. To better monitor the prevalence of pediatric 
asthma and to determine which areas have the greatest incidences of 
children with asthma, this bill would require the CDC to conduct local 
asthma surveillance activities to collect data on the prevalence and 
severity of asthma and to publish data annually on the prevalence rates 
of asthma among children and on the childhood mortality rate. This 
surveillance data will help us better detect asthmatic conditions, so 
that we can treat more children and ensure that we are targeting our 
resources in an effective and efficient way to reverse the disturbing 
trend in the hospitalization and death rates of asthmatic children.
  Finally, Mr. President, the bill we are introducing today includes 
language that I strongly support to re-authorize funding for children's 
hospitals' Graduate Medical Education (GME) programs for four 
additional years. Last year, as part of the ``Health Care Research and 
Quality Act,'' which was signed into law, we authorized funding for two 
years for children's hospitals' GME programs. The teaching mission of 
these hospitals is essential. Children's hospitals comprise less than 
one percent of all hospitals, yet they train five percent of all 
physicians, nearly 30 percent of all pediatricians, and almost 50 
percent of all pediatric specialists. By providing our nation with 
highly qualified pediatricians, children's hospitals can offer children 
the best possible care and offer parents peace of mind. They serve as 
the health care safety net for low-income children in their respective 
communities and are often the sole regional providers of many critical 
pediatric services. These institutions also serve as centers of 
excellence for very sick children across the nation. Federal funding 
for GME in children's hospitals is a sound investment in children's 
health and provides stability for the future of the pediatric 
workforce.
  Mr. President, as the father of eight children and the grandfather of 
five, I firmly believe that we must move forward to protect the 
interests--and especially the health--of all children. The ``Children's 
Public Health Act of 2000'' makes crucial investments in our country's 
future--investments that will yield great returns. If we focus on 
improving health care for all children today, we will have a generation 
of healthy adults tomorrow.
  I urge my colleagues to support this vital children's health care 
bill.
                                 ______