[Congressional Record Volume 150, Number 127 (Friday, October 8, 2004)]
[Senate]
[Pages S10851-S10855]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mrs. CLINTON (for herself, Mr. Chafee, and Mr. Reid):
  S. 2953. A bill to amend the Public Health Service Act to establish a 
Coordinated Environmental Health Network, and for other purposes; to 
the Committee on Health, Education, Labor, and Pensions.
  Mrs. CLINTON. Mr. President, I rise to introduce today a bill to 
authorize the development of the Coordinated Environmental Health 
Network. I am pleased to have Senators Chafee and Reid as cosponsors.
  Environmental public health tracking of chronic diseases began in FY 
2002 when the CDC awarded $17 million to 17 states and 3 local health 
departments to develop the Program and establish 3 Centers of 
Excellence. These funds were for capacity building and demonstration 
projects over 3 years. Efforts included correlation of asthma in young 
adults to air pollution from traffic exhaust or indoor air quality in 
schools, correlation of adverse pregnancy outcomes and air pollution 
measurements, PCBs in water supplies, etc and biomonitoring for blood 
lead and hair mercury with exposure databases. In FY 2003, CDC awarded 
$18.5 million to continue this program and expand to three additional 
states as in Florida to link statewide surveillance systems for asthma, 
autism, mental retardation, cancers, and birth defects

[[Page S10852]]

with EPA's Toxic Release Inventory, statewide air monitoring data, and 
data from the statewide well water surveillance program. 24 states now 
have efforts to track asthma. FY 2004 funding reached $27 million, and 
an additional $28 million pending in the Fiscal Year 2005 Labor-Health 
and Human Services-Education Appropriations bill.
  Our bill would build on these efforts, and would eventually cover all 
priority chronic conditions including birth defects, developmental 
disabilities (such as cerebral palsy, autism, and mental retardation), 
asthma and chronic respiratory diseases, neurological diseases, such as 
Parkinson's disease, multiple sclerosis, and Alzheimer's disease, and 
autoimmune diseases such as Lupus. It would also eventually reach as 
many of the States as possible; already the EPA and DHHS (CDC) have 
signed a Memorandum of Understanding to coordinate exposure databases 
with the CDC's nationwide chronic disease tracking network and the 
State grantees.
  Our current public health surveillance systems were developed when 
the major threats to health were infectious agents. Currently, 50 
infectious diseases are tracked on a national basis. However, chronic 
diseases, such as cancer and cardiovascular disease are now the 
nation's number one killers, and there is evidence that rates of some 
chronic diseases and conditions are rising. More than 1.3 million new 
cancer cases were diagnosed in 2003. One in 33 U.S. babies born has a 
birth defect, and about 17 percent of children under 18 years of age 
have a developmental disability. In 2001, an estimated 31.3 million 
Americans reported having been diagnosed with asthma during their 
lifetime, and 14 million adults reported physician-diagnosed chronic 
obstructive pulmonary disease. Chronic diseases cost Americans 
$750,000,000,000 in health care expenses and lost productivity and 
affect 100 million Americans. Yet our systems for tracking chronic 
diseases are woefully underdeveloped.
  All across our nation are communities where disease clusters such as 
birth defects, cancers and asthma raise questions about the role of 
environmental factors in chronic diseases. In order to improve the 
health of our nation and lower health care costs, we need to develop 
the infrastructure to study the relationship between environment and 
chronic disease.
  The Coordinated Environmental Health Network Act would create the 
infrastructure necessary to collect, analyze, and report data on the 
rate of disease and the presence of relevant environmental factors and 
exposures. The Network would also coordinate national, State, and local 
efforts to bolster our public health system's capacity to investigate 
and respond aggressively to environmental exposures that threaten 
health. In addition, the Coordinated Environmental Health Network will 
alert health officials when there is a sudden increase in any disease 
or condition, including those associated with a biological or chemical 
attack.
  Once fully operational, the network will coordinate national, state, 
and local efforts to inform communities, public health officials, 
researchers, and policymakers of potential environmental health risks, 
and to integrate this information with other parts of the public health 
system.
  The Coordinated Environmental Health Network Act is supported by the 
Trust for America's Health, American Public Health Association, 
Citizens for a Cleaner Environment, March of Dimes, American Lung 
Association, U.S. Public Interest Research Group, The Breast Cancer 
Fund, Physicians for Social Responsibility, and many others.
  I ask unanimous consent that the text of the legislation be printed 
in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 2953

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Coordinated Environmental 
     Health Network Act of 2004''.

     SEC. 2. FINDINGS AND PURPOSE.

       (a) Findings.--Congress finds that--
       (1) approximately 7 out of every 10 deaths in the United 
     States are attributable to chronic diseases;
       (2) with 100,000,000 people suffering from chronic diseases 
     each year, and $750,000,000,000 lost in health care costs as 
     a result, the national cost of chronic disease is extremely 
     high and must be appropriately addressed;
       (3) the rates of many chronic diseases, including asthma, 
     some birth defects, cancers, and autism, appear to be 
     increasing;
       (4) there is a growing amount of evidence that 
     environmental factors are strongly linked with specific 
     chronic disease;
       (5) a major gap in critical knowledge exists regarding the 
     prevalence and incidence of chronic diseases;
       (6) States, local communities, territories, and Indian 
     tribes need assistance with public health efforts that would 
     lead to prevention of chronic disease, including the 
     establishment and maintenance of necessary infrastructure for 
     disease and environmental hazard exposure surveillance; and
       (7) a Coordinated Environmental Health Network will help 
     target resources to areas of chronic disease prevention most 
     in need.
       (b) Purposes.--It is the purpose of this Act to--
       (1) develop, operate, and maintain a Coordinated 
     Environmental Health Network, State Environmental Health 
     Networks, and rapid response capabilities so that the Federal 
     Government, States, local governments, territories, and 
     Indian tribes can more effectively monitor, investigate, 
     respond to, research, and prevent increases in the incidence 
     and prevalence of certain chronic diseases and relevant 
     environmental and other risk factors;
       (2) provide information collected through the Coordinated 
     and State Environmental Health Networks to government 
     agencies, public health practitioners and researchers, policy 
     makers, and the public;
       (3) expand and coordinate among existing surveillance and 
     data collection systems and other infrastructure for chronic 
     diseases and relevant environmental, and other risk factors, 
     including those relevant to bioterrorism;
       (4) improve coordination between the areas of public 
     health, environmental protection, and chemical, radiological 
     and biological terrorism; and
       (5) provide necessary support to ensure the availability of 
     a sufficient number of well-trained environmental health and 
     public health personnel to participate and provide leadership 
     in the development and maintenance of the Coordinated and 
     State Environmental Health Networks.

     SEC. 3. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.

       The Public Health Service Act (42 U.S.C. 201 et seq.) is 
     amended by adding at the end the following:

         ``TITLE XXIX--COORDINATED ENVIRONMENTAL HEALTH NETWORK

     ``SEC. 2900. DEFINITIONS.

       ``In this title:
       ``(1) Administrators.--The term `Administrators' means the 
     Director of the Centers for Disease Control and Prevention 
     Coordinating Center for Environmental Health, Injury 
     Prevention, and Occupational Health, and the Administrator of 
     the Environmental Protection Agency.
       ``(2) Committee.--The term `Committee' means the Advisory 
     Committee established under section 2901(d).
       ``(3) Director.--The term `Director' means the Director of 
     the Centers for Disease Control and Prevention.
       ``(4) Medical privacy regulations.--The term `medical 
     privacy regulations' means the regulations promulgated under 
     section 264(c) of the Health Insurance Portability and 
     Accountability Act of 1996.
       ``(5) Coordinated network.--The term `Coordinated Network' 
     means the Coordinated Environmental Health Network 
     established under section 2901(a).
       ``(6) Priority chronic condition.--The term `priority 
     chronic condition' means a condition to be tracked in the 
     Coordinated Network and the State Networks, including birth 
     defects, developmental disabilities (such as cerebral palsy, 
     autism, and mental retardation), asthma and chronic 
     respiratory diseases, neurological diseases (such as 
     Parkinson's disease, multiple sclerosis, Alzheimer's disease, 
     and amyotrophic lateral sclerosis), autoimmune diseases (such 
     as lupus), cancer, juvenile diabetes, and such other priority 
     chronic conditions as the Secretary may specify.
       ``(7) State network.--The term `State Network' means a 
     State Environmental Health Network established under section 
     2901(b).
       ``(8) State.--The term `State' means a State, territory, or 
     Indian tribe that is eligible to receive a health tracking 
     grant under section 2901(b).

     ``SEC. 2901. ESTABLISHMENT OF COORDINATED AND STATE 
                   ENVIRONMENTAL HEALTH NETWORKS.

       ``(a) Coordinated Environmental Health Network.--
       ``(1) Establishment.--Not later than 36 months after the 
     date of the enactment of this title, the Secretary, acting 
     through the Director and in consultation with the 
     Administrators, State and local health departments, and the 
     Committee, shall establish and operate a Coordinated 
     Environmental Health Network. In establishing and operating 
     the Coordinated Network, the Secretary shall--
       ``(A) identify, build upon, expand, and coordinate among 
     existing data and surveillance systems, surveys, registries, 
     and other

[[Page S10853]]

     Federal public health and environmental infrastructure 
     wherever possible, including--
       ``(i) the National Electronic Disease Surveillance System;
       ``(ii) State birth defects surveillance systems as 
     supported under section 317C;
       ``(iii) State cancer registries as supported under part M 
     of title III;
       ``(iv) State asthma surveillance systems as supported under 
     section 317I;
       ``(v) the National Health and Nutrition Examination Survey;
       ``(vi) the Behavioral Risk Factor Surveillance System;
       ``(vii) the Hazardous Substance Release/Health Effects 
     Database;
       ``(viii) the Hazardous Substances Emergency Events 
     Surveillance System;
       ``(ix) the National Exposure Registry;
       ``(x) the Health Alert Network; and
       ``(xi) the State vital statistics systems as supported 
     under section 306;
       ``(B) provide for public access to an electronic national 
     database that accepts data from the State Networks on the 
     incidence and prevalence of priority chronic conditions and 
     relevant environmental and other factors, in a manner which 
     protects personal privacy consistent with the medical privacy 
     regulations;
       ``(C) not later than 36 months after the date of the 
     enactment of this title, and annually thereafter, prepare and 
     publish, in accordance with paragraph (2), a Coordinated 
     Environmental Health Network Report to provide the public 
     with the findings of the Coordinated Network;
       ``(D) operate and maintain a National Environmental Health 
     Rapid Response Service within the Epidemic Intelligence 
     Service to carry out the activities described in paragraph 
     (3);
       ``(E) provide for the establishment of State Networks, and 
     coordinate the State Networks as provided for under 
     subsection (b);
       ``(F) provide technical assistance to support the State 
     Networks, including providing--
       ``(i) training for environmental health investigators 
     appointed or hired under subsection (b)(3)(D);
       ``(ii) technical assistance as needed to States to build 
     necessary capacity and infrastructure for the establishment 
     of a State Network, including a computerized data collection, 
     reporting, and processing system, and additional assistance 
     identified by the States under subsection (b)(5)(C) as 
     necessary for infrastructure development; and
       ``(iii) such other technical assistance as the Secretary, 
     in consultation with the Administrators, determines to be 
     necessary;
       ``(G) not later than 12 months after the date of the 
     enactment of this title, acting through the Director and 
     consulting with the Administrators, the Surgeon General, the 
     Director of the National Institutes of Health, and States, 
     develop minimum standards and procedures in accordance with 
     paragraph (4) for data collection and reporting for the State 
     Networks, to be updated not less than annually thereafter; 
     and
       ``(H) in developing the minimum standards and procedures 
     under subparagraph (G), include mechanisms for allowing the 
     States to set priorities, and allocate resources accordingly, 
     among the factors described in subparagraphs (A), (B), and 
     (C) of paragraph (4).
       ``(2) Coordinated environmental health network report.--
     Each Coordinated Environmental Health Network Report prepared 
     under paragraph (1)(C) shall include--
       ``(A) a statement of the activities carried out under this 
     title;
       ``(B) an analysis of the incidence, prevalence, and trends 
     of priority chronic conditions and potentially relevant 
     environmental and other factors by State and census tract (or 
     other political or administrative subdivision determined 
     appropriate by the Secretary in consultation with the 
     Administrator of the Environmental Protection Agency) for the 
     calendar year preceding the year for which the report is 
     prepared;
       ``(C) the identification of gaps in the data of the 
     Coordinated Network, including diseases of concern and 
     environmental exposures not tracked; and
       ``(D) recommendations regarding high risk populations, 
     public health concerns, response and prevention strategies, 
     and additional tracking needs;
       ``(3) National environmental health rapid response 
     service.--The National Environmental Health Rapid Response 
     Service operated under paragraph (1)(D) shall--
       ``(A) work with environmental health investigators 
     appointed or hired under subsection (b)(3)(D) to develop and 
     implement strategies, protocols, and guidelines for the 
     coordinated, rapid responses to actual and perceived higher 
     than expected incidence and prevalence rates of priority 
     chronic conditions and to acute and potential environmental 
     hazards and exposures;
       ``(B) conduct investigations into higher than expected 
     incidence and prevalence rates of priority chronic conditions 
     or environmental exposures after an individual requests, 
     through a process established by the Secretary, the 
     intervention of the Service;
       ``(C) coordinate activities carried out under this title 
     with activities carried out under sections 319 through 319G; 
     and
       ``(D) coordinate activities carried out under this title 
     with the Administrators, the Surgeon General, and the 
     Director of the National Institutes of Health.
       ``(4) Data collection and reporting by state networks.--The 
     minimum standards and procedures referred to in paragraph 
     (1)(G) shall include--
       ``(A) a list and definitions of the priority chronic 
     conditions to be tracked through the State Networks;
       ``(B) a list and definitions of relevant environmental 
     exposures of concern to be tracked, to the extent 
     practicable, through the State Networks, including--
       ``(i) hazardous air pollutants (as defined in section 
     302(g) of the Clean Air Act);
       ``(ii) air pollutants for which national primary ambient 
     air quality standards have been promulgated under section 109 
     of the Clean Air Act;
       ``(iii) pollutants or contaminants (as defined in section 
     101 of the Comprehensive Environmental Response, 
     Compensation, and Liability Act of 1980);
       ``(iv) toxic chemicals (as described in section 313 of the 
     Emergency Planning and Community Right-to-Know Act of 1986);
       ``(v) substances reported under the Toxic Substances 
     Control Act Inventory Update Rule as provided for in part 710 
     of title 40, Code of Federal Regulations, or successor 
     regulations;
       ``(vi) pesticides (as defined in section 2(u) of the 
     Federal Insecticide, Fungicide, and Rodenticide Act); and
       ``(vii) such other potentially relevant environmental 
     factors as the Secretary may specify;
       ``(C) a list and definitions of potentially relevant 
     behavioral, socioeconomic, demographic, and other risk 
     factors, including race, ethnic status, gender, age, 
     occupation, and primary language, to be tracked through the 
     State Networks;
       ``(D) procedures for the complete and timely collection and 
     reporting of data to the Coordinated Network by census tract, 
     or other political subdivision determined appropriate by the 
     Secretary, in consultation with the Administrator of the 
     Environmental Protection Agency, regarding the factors 
     described in subparagraphs (A), (B), and (C);
       ``(E) procedures for making data available to the public 
     and researchers, and for reporting to the Coordinated 
     Network, while protecting the confidentiality of all personal 
     data reported, in accordance with medical privacy 
     regulations;
       ``(F) standards and procedures for the establishment and 
     maintenance of at least 7 regional biomonitoring 
     laboratories, including providing for an equitable geographic 
     distribution, by entering into cooperative agreements with 
     States, groups of States, and academic institutions or 
     consortia of academic institutions, in order to expand the 
     scope and amount of biomonitoring data collected by the 
     Centers for Disease Control and Prevention;
       ``(G) criteria for the environmental health investigators 
     as required under subsection (b)(3)(D); and
       ``(H) procedures for record and data maintenance and 
     verification.
       ``(b) State Environmental Health Networks.--
       ``(1) Grants.--Not later than 24 months after the date of 
     the enactment of this title, the Secretary, acting through 
     the Director, in consultation with the Administrators, and 
     taking into consideration the findings of the Committee, 
     shall award grants to States, local governments, territories, 
     and Indian tribes for the establishment, maintenance, and 
     operation of State Environmental Health Networks in 
     accordance with the minimum standards and procedures 
     established by the Secretary under subsection (a)(4).
       ``(2) Specialized assistance.--The Coordinated Network 
     shall provide specialized assistance to grantees in the 
     establishment, maintenance, and operation of State Networks.
       ``(3) Requirements.--A State, local government, territory, 
     or Indian tribe receiving a grant under this subsection shall 
     use the grant--
       ``(A) to establish an environmental health network that 
     will provide--
       ``(i) for the complete tracking of the incidence, 
     prevalence, and trends of priority chronic conditions and 
     potentially relevant environmental and other factors as set 
     forth in subsection (a), as well as any additional priority 
     chronic conditions and potentially related environmental 
     exposures of concern to that State, local government, 
     territory, or Indian tribe;
       ``(ii) for identification of priority chronic conditions 
     and potentially relevant environmental and other factors that 
     disproportionately impact low income and minority 
     communities;
       ``(iii) for the protection of the confidentiality of all 
     personal data reported, in accordance with the medical 
     privacy regulations;
       ``(iv) a means by which confidential data may, in 
     accordance with Federal and State law, be disclosed to 
     researchers for the purposes of public health research;
       ``(v) the fullest possible public access to data collected 
     by the State Network or through the Coordinated Network, 
     while ensuring that individual privacy is protected in 
     accordance with subsection (a)(1)(B); and
       ``(vi) for the collection of exposure data through 
     biomonitoring and other methods, including the entering into 
     of cooperative agreements with the Coordinated Network in the 
     establishment of the regional biomonitoring laboratories;
       ``(B) to develop a publicly available plan for establishing 
     the State Network in order to meet minimum standards and 
     procedures as developed by the Coordinated Network under 
     subsection (a)(4), including the State's

[[Page S10854]]

     priorities within the minimum standards, a timeline by which 
     all the standards will be met, and a plan for coordinating 
     and expanding existing data and surveillance systems within 
     the State including any pilot projects established through 
     the Centers for Disease Control and Prevention prior to the 
     date of the enactment of this title;
       ``(C) to appoint a lead environmental health department or 
     agency that will be responsible for the development, 
     operation, and maintenance of the State Network, and ensure 
     the appropriate coordination among State and local agencies 
     regarding the development, operation, and maintenance of the 
     State Network;
       ``(D) to appoint or hire an environmental health 
     investigator who meets criteria established by the Secretary 
     under subsection (a)(4)(G) and who will coordinate the 
     development and maintenance of the rapid response protocol 
     established under subparagraph (E);
       ``(E) to establish a rapid response protocol, coordinated 
     by the grantee's environmental health investigator, in order 
     to respond in a timely manner to actual and perceived 
     incidence and prevalence rates of priority chronic diseases 
     that are higher than expected, acute and potential 
     environmental hazards and exposures, and other environmental 
     health concerns, including warning the public when emergent 
     public health concerns are detected through the State 
     Network, and concerns regarding vulnerable subpopulations and 
     disproportionately impacted subpopulations;
       ``(F) to establish an advisory committee to ensure local 
     community input to the State Network; and
       ``(G) to recruit and train public health officials to 
     continue to expand the State Network.
       ``(4) Limitation.--A State, local government, territory, or 
     Indian tribe that receives a grant under this section may not 
     use more than 10 percent of the funds made available through 
     the grant for administrative costs.
       ``(5) Application.--To seek a grant under this section, a 
     State, local government, territory, or Indian tribe shall 
     submit to the Secretary an application at such time, in such 
     form and manner, and accompanied by such information as the 
     Secretary may specify. The Secretary may not approve an 
     application for a grant under this subsection unless the 
     application--
       ``(A) contains assurances that the State, local government, 
     territory, or tribe will--
       ``(i) use the grant only in compliance with the 
     requirements of this title; and
       ``(ii) establish such fiscal control and fund accounting 
     procedures as may be necessary to ensure the proper 
     disbursement and accounting of Federal funds paid to the 
     State, local government, territory, or tribe under the grant;
       ``(B) contains the assurance that the State, local 
     government, territory, or tribe will establish a State 
     Network as required by this subsection; and
       ``(C) contains assurances that if the State, local 
     government, territory, or tribe is unable to meet all of the 
     requirements described in this subsection within the 
     prescribed time period, the State, local government, 
     territory, or tribe will use grant funds to increase the 
     public health infrastructure of the State, local government, 
     territory, or tribe, acting in cooperation with the 
     Coordinated Network, in order to implement and maintain a 
     State Network within 24 months of the receipt of such grant.
       ``(c) Pilot Projects.--
       ``(1) In general.--Beginning in fiscal year 2005, a State, 
     local government, territory, or Indian tribe may apply for a 
     grant under this subsection to implement a pilot project that 
     is approved by the Secretary, acting through the Director and 
     in consultation with the Administrators and the Committee.
       ``(2) Activities.--A State, local government, territory, or 
     Indian tribe shall use amounts received under a grant under 
     this subsection to carry out a pilot project designed to 
     develop State Network enhancements and to develop programs to 
     address specific local and regional concerns, including--
       ``(A) the expansion of the State Network to include 
     additional chronic diseases or environmental exposures;
       ``(B) the conduct of investigations of local concerns of 
     increased incidence or prevalence of priority chronic 
     conditions and environmental exposures; and
       ``(C) the carrying out of other activities as determined to 
     be a priority by the State or consortium of regional States, 
     local government, territory, or tribe and the Secretary.
       ``(3) Results.--The Secretary may consider the results of 
     the pilot projects under this subsection for inclusion into 
     the Coordinated Network.
       ``(d) Advisory Committee.--
       ``(1) Establishment.--Not later than 3 months after the 
     date of the enactment of this title, the Secretary acting 
     jointly with the Administrators, shall establish an Advisory 
     Committee in accordance with the Federal Advisory Committee 
     Act.
       ``(2) Composition.--The Advisory Committee shall be 
     composed of 16 members to be appointed by the Secretary. Each 
     member of the Advisory Committee shall serve a 3-year term, 
     except that the Secretary may appoint the initial members of 
     the Advisory Committee for lesser terms in order to comply 
     with the following sentence. In appointing the members of the 
     Advisory Committee, the Secretary shall ensure that the terms 
     of 5 or 6 members expire each year. The Advisory Committee 
     shall include at least 9 members that have experience in the 
     areas of--
       ``(A) public health;
       ``(B) the environment, especially toxic chemicals and human 
     exposure;
       ``(C) epidemiology; and
       ``(D) biomonitoring and other relevant exposure 
     technologies.
       ``(3) Reporting.--The Advisory Committee shall not later 
     than 12 months after the date of the enactment of this title, 
     and at least once every 12 months thereafter, report to 
     Congress on the progress of the Coordinated Network.
       ``(4) Hearings.--The Advisory Committee shall hold such 
     hearings, sit and act at such times and places, take such 
     testimony, and receive such evidence as the Committee 
     considers appropriate to carry out the objectives of the 
     Coordinated Network.
       ``(5) Duties.--The Advisory Committee shall--
       ``(A) review and provide input for the Coordinated 
     Environmental Health Network Report prior to publication, and 
     make recommendations as to the progress of the Coordinated 
     Network, including identifying information gaps in the 
     network;
       ``(B) assist in developing the minimum standards and 
     procedures for the State Networks under subsection (a)(4); 
     and
       ``(C) provide ongoing public input to the Coordinated 
     Network.
       ``(e) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section 
     $100,000,000 for fiscal year 2005 and such sums as may be 
     necessary for each of fiscal years 2006 through 2009.

     ``SEC. 2902. INCREASING PUBLIC HEALTH PERSONNEL CAPACITY.

       ``(a) Schools or Programs of Public Health Centers of 
     Excellence.--
       ``(1) Grants.--Beginning in fiscal year 2005, the Secretary 
     may award grants to at least 5 accredited schools or programs 
     of public health for the establishment, maintenance, and 
     operation of Centers of Excellence for research and 
     demonstration with respect to chronic conditions and relevant 
     environmental factors.
       ``(2) Activities.--A Center of Excellence established or 
     operated under paragraph (1) shall undertake research and 
     development projects in at least 1 of the following areas:
       ``(A) Investigating causal connections between chronic 
     conditions and environmental factors.
       ``(B) Increasing the understanding of the causes of higher 
     than expected incidence and prevalence rates of priority 
     chronic conditions and developing more effective intervention 
     methods for when such elevated rates occur.
       ``(C) Identifying additional chronic conditions and 
     environmental factors that could be tracked by the 
     Coordinated Network.
       ``(D) Improving translation of Coordinated Network tracking 
     results into effective prevention activities.
       ``(E) Improving the training of public health workforce in 
     environmental epidemiology.
       ``(F) Establishing links to the Coordinated Network and the 
     State Networks to identify associations that warrant further 
     study.
       ``(3) Requirements for centers of excellence.--To be 
     eligible to receive a grant under paragraph (1), a school or 
     program of public health shall provide assurances that the 
     school or program--
       ``(A) meets the minimum requirements as established by the 
     Secretary in consultation with the Director;
       ``(B) maintains privacy for public health information if 
     appropriate to the project; and
       ``(C) makes public information regarding the findings and 
     results of the programs.
       ``(4) Authorization of appropriations.--There is authorized 
     to be appropriated to carry out this subsection $5,000,000 
     for each of fiscal years 2005 through 2009.
       ``(b) John H. Chafee Public Health Scholar Program.--
       ``(1) In general.--The Secretary shall award scholarships, 
     to be known as John H. Chafee Public Health Scholarships, to 
     eligible students who are enrolled in an accredited school of 
     public health or medicine. The Secretary shall determine both 
     the criteria and eligibility requirements for such 
     scholarships, after consultation with the Committee.
       ``(2) Authorization of appropriations.--There is authorized 
     to be appropriated to carry out this subsection $2,500,000 
     for each of fiscal years 2005 through 2009.
       ``(c) Applied Epidemiology Fellowship Programs.--
       ``(1) In general.--Beginning in fiscal year 2005, the 
     Secretary, acting through the Director, shall enter into a 
     cooperative agreement with the Council of State and 
     Territorial Epidemiologists to train and place, in State and 
     local health departments, applied epidemiology fellows to 
     enhance State and local epidemiology capacity in the areas of 
     environmental health, chronic disease, and birth defects and 
     development disabilities.
       ``(2) Authorization of appropriations.--There is authorized 
     to be appropriated to carry out this subsection $2,500,000 
     for fiscal year 2005, and such sums as may be necessary in 
     each of fiscal years 2006 through 2009.

     ``SEC. 2903. GENERAL PROVISIONS.

       ``(a) Internal Monitoring and Coordination Regarding CDC.--
     The Secretary, acting

[[Page S10855]]

     through the Director, shall place primary responsibility for 
     the coordination of the programs established under this title 
     in the Office of the Director. The officers or employees of 
     the Centers for Disease Control and Prevention who are 
     assigned responsibility for monitoring and coordinating the 
     activities carried out under this title by the Director shall 
     include officers or employees within the Office of the 
     Director.
       ``(b) Funding Through Appropriations Account for Public 
     Health Improvement.--All authorizations of appropriations 
     established in this title are authorizations exclusively for 
     appropriations to the account that, among appropriations 
     accounts for the Centers for Disease Control and Prevention, 
     is designated `Public Health Improvement'.
       ``(c) Date Certain for Obligation of Appropriations.--With 
     respect to the process of receiving applications for and 
     making awards of grants, cooperative agreements, and 
     contracts under this title, the Secretary, acting through the 
     Director, shall to the extent practicable design the process 
     to ensure that amounts appropriated under this title for such 
     awards for a fiscal year are obligated not later than the 
     beginning of the fourth quarter of the fiscal year, subject 
     to compliance with section 1512 of title 31, United States 
     Code (relating to deficiency or supplemental appropriations), 
     and other applicable law regarding appropriations accounting.
       ``(d) Coordination With Agency for Toxic Substances and 
     Disease Registry.--In carrying out this title, the Secretary, 
     acting through the Director, shall coordinate activities and 
     responses with the Agency for Toxic Substances and Disease 
     Registry.
       ``(e) Coordination With Existing Pilot Projects Through 
     CDC.--The Secretary shall integrate the enactment of this 
     title with all environmental health tracking pilot projects 
     funded prior to the date of enactment of this title.''.
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