[Congressional Record Volume 150, Number 107 (Friday, September 10, 2004)]
[Senate]
[Pages S9066-S9068]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              HEALTH CARE

  Mr. HARKIN. Mr. President, while Congress was in recess, the news 
media have reported several important studies in the field of wellness 
and disease prevention. Collectively, these studies are another loud 
wake-up call. It is time for fundamental change in our approach to 
health care in the United States.
  I have been saying for years that currently we have a sick care 
system, not a health care system. We have a system that, if you get 
sick, you get care.

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But there is precious little support, incentives or otherwise, to keep 
you healthy in the first place. We are paying very dearly for this 
foolish choice of having a sick care system rather than a health care 
system.
  The latest evidence comes from a new study by health economist 
Kenneth Thorpe. Mr. Thorpe found it cost $200 billion more in 2000 to 
treat diseases and conditions in this country than it did in 1987. Just 
15 health conditions accounted for a whopping 56 percent of the growth 
in spending between 1987 and 2000. Indeed, a closer look shows that 
just five conditions accounted for one-third of the $200 billion 
increase: heart disease, pulmonary conditions, mental disorders, 
cancer, and hypertension. What do all these conditions have in common? 
In many if not most cases, these conditions are preventable. The Thorpe 
study also confirmed that chronic conditions, which are responsible for 
more than 75 percent of all health care expenditures, cost tens of 
billions of dollars more than just two decades ago.
  Diabetes is one of those chronic conditions responsible for the 
explosion in health care costs. Yet experts agree that the impact of 
diabetes can be dramatically reduced by encouraging treatment 
guidelines on diet, exercise, and other preventive measures. The same 
is true for other chronic conditions. By emphasizing prevention and by 
following best practices guidelines, we can dramatically reduce health 
spending.
  It is alarming to me that many health experts now predict that the 
generation of kids growing up today will be the first that does not 
live longer than their parents' generation. Let me repeat that. Health 
experts now predict that the generation of kids growing up today will 
be the first generation that does not live longer than their parents' 
generation.
  As many children return to school this month, there is fresh evidence 
that we are failing them in terms of wellness and disease prevention. 
Consider a study released this week by the National Institute for 
Health Care Research and Educational Foundation. The study found that 
only 16 percent of kindergarten programs meet recommendations of the 
Centers for Disease Control and Prevention for daily physical 
education. Instead, about 60 percent of kindergarten programs offer 
physical education less than twice a week; 13 percent offer physical 
education less than once a week. On average, grade school kids spend 
less than an hour a week in PE classes.
  As many of my colleagues know, because of the No Child Left Behind 
Act and its obsession with testing and preparing for tests, many 
schools are eliminating recess in the elementary years and further 
neglecting PE in the middle and senior high school years. Some new 
elementary schools are being built without playgrounds. Make no 
mistake; this neglect of physical education has severe consequences. 
Obesity has nearly tripled since 1970, and about 16 percent of children 
are now overweight. However, the study I just mentioned suggested that 
adding 1 hour of physical education per week could decrease the 
occurrence of overweight by as much as 10 percent. The study also found 
that schools with low-income or minority students have a greater 
likelihood than their peers to have no physical education in 
kindergarten. This is deeply troubling as these groups are especially 
at risk for obesity.

  On a related note, we received further evidence last month about the 
potential risk of diabetes and obesity associated with soft drink 
consumption. A study published in the Journal of the American Medical 
Association shows that women who drink at least one serving of nondiet 
soda or fruit punch per day have a greater risk of gaining weight and 
developing type 2 diabetes than women who do not. Women who consume one 
or more sweetened drinks per day are 83 percent more likely to develop 
diabetes than those who drink less than one serving per month. During 
the period of the study, women who drank at least one serving of 
sweetened drinks per day gained an average of 17 pounds, compared with 
an increase of only 6 pounds for women who drank less than one serving 
per month.
  So why in the world are we allowing the proliferation of vending 
machines filled with unhealthy foods and soft drinks in our schools? We 
are sending all the wrong signals to our kids. We put in all these 
vending machines with soft drinks up and down the hallways in our 
schools. It is saying to our kids, not only is that allowable, it is 
acceptable, it is encouraged that you have a soft drink during the day.
  How many parents know--how many people know? Not even parents, how 
many young people know that one 20-ounce soft drink, sweetened soft 
drink, Coke, Pepsi, RC, whatever, one 20-ounce drink--that is what you 
get out of the vending machines now--contains the equivalent of 16 
teaspoons of sugar?
  I asked someone, you get a 20-ounce Coke or Pepsi--I don't mean to 
pick on one or the other, but when you get a 20-ounce Coke, you think 
nothing about drinking it. What if someone measured out 16 teaspoons of 
sugar into a cup and said: Here, eat this. You would think they were 
crazy. But they will drink a 20-ounce soft drink that has the same 
thing in it. And you wonder why people are getting diabetes.
  The good news this month is that an additional four States will be 
offering the Free Fruit and Vegetable Program I started in the farm 
bill in order to encourage healthier eating habits at the earliest 
possible age. The bad news is that thousands of schools are continuing 
to make room for vending machines selling candy, soda pop, and other 
junk food on school grounds.
  We are missing a prime opportunity to reduce the health risks facing 
our children by not emphasizing prevention, healthy lifestyles. A new 
study published in the Pediatric Journal found that 10 percent of 
pediatric patients were obese; however, only half of those patients 
were noted by the physician to be obese. What this means is we are 
missing a critical opportunity to diagnose obesity and intervene at the 
earliest stage--during childhood--when lifestyle changes can be easier 
to make.
  We also have new information from the American Cancer Society. More 
than a dozen cancers are linked with obesity, and the American Cancer 
Society estimates that of the 563,000 cancer deaths each year, excess 
weight is a factor in more than 16 percent of the cases. While overall 
cancer death rates have decreased over the last few years, we know now 
that obese men and women are at a major increased risk for colorectal 
cancer. A postmenopausal woman's risk of breast cancer increases by 30 
percent if she is overweight and by 50 percent if she is obese.
  We also have new information about high blood pressure, which is a 
major contributor to heart disease and stroke.
  It has skyrocketed over the past decade with almost one-third of 
adults suffering from hypertension. From 1988 to 1994, there was a 30-
percent increase in the incidence of high blood pressure. We know that 
much of this increase is due to the rise in obesity.
  On a variety of fronts, August was not a month of progress for those 
of us who care about wellness and disease prevention. The various 
studies I have cited tell us that we are still heading in the wrong 
direction. Much work needs to be done to transform America's sick care 
system into a true health care system--a system that keeps us out of 
the hospital in the first place.
  As I have said, again and again, it is time for a new paradigm in 
American health care, a prevention paradigm. Again, we have a sick care 
system in this country and we need a genuine health care system focused 
on wellness and prevention and keeping people out of the hospital in 
the first place.
  To that end, I have introduced legislation, the Help America Act, 
also known as the Healthier Lifestyles and Prevention Act, S. 2158. And 
today the Labor, Health and Human Services Appropriations Subcommittee 
has reported our bill for fiscal year 2005. This year's bill has 
especially strong emphasis on wellness and prevention programs.
  For example, we will be providing $440 million for research at the 
National Institutes of Health into the causes and cures of obesity. 
That is a 10-percent increase over last year.
  We have included more than $50 million in grants to States to fund 
programs that address nutrition, physical activity, and obesity.

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  We will provide more than $114 million for tobacco prevention and 
cessation activities at the Centers for Disease Control and Prevention. 
Tobacco use is the single most preventable cause of death and disease 
in our society today.
  Our committee allocated $35 million for public health research at 
CDC. This year we are encouraging the Centers for Disease Control and 
Prevention to pay particular attention to research on business-based 
wellness programs for employees. We want to identify and disseminate 
the best practices in this area, and we have asked the CDC to develop a 
model wellness program for businesses.
  Our appropriations bill also includes $75 million for the Carol White 
Physical Education for Progress Program, otherwise known as the PEP 
Program. This provides grants to school districts to expand physical 
education opportunities for K-to-12 students. Again, bear in mind, as I 
said, the average public school student gets less than 1 hour of 
physical education per week, and many get none at all.
  Our appropriations bill funds a new School Mental Health Services 
Program. This will train public school personnel to recognize early 
warning signs of mental illness, and it will expand student activity to 
high-quality mental health services.
  I would like to add that the bill provides $2 million to support 
implementation of the YMCA's new Activate America initiative, which is 
encouraging cities to develop communitywide approaches to wellness and 
disease prevention. I am most grateful to the National YMCA for their 
great leadership in disease prevention, wellness, and health promotion. 
I am also pleased that our capital city of Des Moines, IA was selected 
as one of the first cities to participate in this program.

  I also want to compliment and commend my chairman, Senator Arlen 
Specter of Pennsylvania, for his great leadership in getting our bill 
together and getting it through our subcommittee. All of the items I 
have mentioned that we are providing for wellness and prevention we 
have worked on together in a true bipartisan fashion. I thank Senator 
Specter for his leadership and for working to make sure we fund these 
programs for wellness and prevention.
  To sum it up, we are making some progress in advancing a broad, 
comprehensive wellness agenda here in Congress. With all of the 
political bickering here on Capitol Hill people sometimes wonder if we 
are accomplishing anything. The Labor, Health and Human Services 
appropriations bill takes real, concrete steps to address problems such 
as obesity and chronic disease--problems that people care deeply about.
  Again, I salute the hard work and leadership of Chairman Specter. He 
too cares passionately about issues of wellness and disease prevention. 
He too realizes that our current sick care system which gives short 
shrift to prevention is leading us off a cliff.
  I am optimistic. I know we will not get everything done this year. 
But hopefully we will make progress and we will make more progress next 
year. What I sense is growing support from both sides of the aisle for 
a new emphasis on wellness and prevention. I am more and more confident 
about the prospects for passing the Help America Act in the next 
Congress.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Tennessee.
  Mr. ALEXANDER. Mr. President, I ask unanimous consent for permission 
to speak in morning business for such time as I may require.
  The PRESIDING OFFICER. Without objection, it is so ordered. We are in 
morning business.
  Mr. ALEXANDER. Thank you, Mr. President.

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