Page images


Frederick K. Goodwin, M.D., is Administrator of the Alcohol, Drug Abuso, and Mental Health Administration of the Department of Health and Human Services. ADAMHA is comprised of three research Institutes--the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Drug Abuse, and the National Institute of Mental Health--and two offices charged with public health applications of research--the Office for Substance Abuse Prevention and the Office for Treatment Improvement. As Administrator, Dr. Goodwin directs federal efforts to contribute scientific solutions to the public health problems associated with mental illness, alcoholism, and drug abuse. He was appointed by President Reagan, confirmed by the U.S. Senate, and subsequently reappointed by President Bush. He is the first federal scientist to have risen through the ranks to attain this high post. A physician-scientist specializing in psychiatry and psychopharmacology. Dr. Goodwin served previously as Scientific Director of the National Institute of Mental Health (NIMH) and Director of NIMH'S Intramural Research Program, the largest montal health and neuroscience research and research training program in the world. He joined tho NIMH In 1965.

Dr. Goodwin is an Intematonally recognized authority in the research and treatment of major depression and manic depressive illness. He was first to report tho antidepressant effects of lithlum in a controlled study, and was a leader in tho development of sato, effective techniques utilizing cerebrospinal fluid to measure changes in brain chemistry. Although he has made seminal scientific contributions in diverse areas, his research characterized by key constants: attentiveness to the interaction of biological and psychological factors in mental illness; a focus on longitudinal observation of patients experiences over the course of illness; and a commitment to scholarship. A graduate of Georgetown University, Dr. Goodwin received his M.D. from the St Louis University, and completed his psychiatric residency at the University of North Carolina in Chapel Hill. Among his many professional affiliations, he is a Member of the Institute of Medicine of the National Academy of Sciences. He serves on the editorial boards of key scientific journals, including the Archives of General Psychiatry, and is founder and coeditor-in-chief of Psychiatry Research.

Dr. Goodwin is a recipient of the major research awards in his field: the Hofheimer Prize from the American Psychiatric Association, the A.E. Bennett Award from the Society of Biological Psychiatry, the Taylor Manor Award, the Internatonal Anna-Monika Prize for Research In Depression, and the Edward A. Strecker Award. In 1986, President Reagan conferred upon Dr. Goodwin the highest honor avallable to a member of the career Federal service: The Presidential Distinguished Executive Award. In 1989. he was the first recipient of a new award: Psychiatrist of the Year (Best Teacher in Psychiatry) from the Psychiatrie Times. The author of more than 375 publications, Dr. Goodwin now has In press, with Oxford University Press, a comprehensive textbook on manic-depressive Illness, co-authored with Dr. Kay R. Jamison. He is one of five psychlatrists on the Current Contents' list of the most frequently cited scientists in the world, and one of 12 psychiatrists listed in the Best Doctors in the U.S. He is married to Rosemary Goodwin, a clinical social worker with expertso in alcohol and drug abuse treatment. They have three children.

Senator HARKIN. Dr. Goodwin, thank you very much. I will have some questions about that. I remember you were in my office and we talked about this some time ago.

We will see what progress has been made on those drugs. I know FDA has got some. They are under clearance process right now.

Dr. Goodwin. Yes; we are getting good cooperation from FDA and they are treating the drug abuse area more like they have been treating the AIDS area in terms of acceleration.

Senator HARKIN. We discussed that.
Dr. Harmon, the new Director of HRSA, welcome.



Dr. HARMON. Thank you, Mr. Chairman. This is my second week on the job and as I left Missouri, where I was the State Health Director, I received a number of plaques and so forth. I told my colleagues: These plaques are fine; what I would really like is a house in Bethesda. (Laughter.]

I do bring the State and local perspective. I also was a local health officer in Arizona previously, and I will be working closely with Dr. Mason and Dr. Sullivan to improve the working relationship of the Federal Government with the States and the localities.

The 1991 budget for HRSA continues the agency's preeminent role in providing health care and education to the underserved, the disadvantaged, and minorities. This budget of $1.6 billion will meet our commitments through community and migrant health centers, maternal and child health block grant, treatment programs for persons with black lung, Hansen's disease, AIDS, and other conditions, support for health professions students and institutions, and a wide variety of other activities dealing with organ transplantation, vaccine injury compensation, health care services for the homeless, and the initiative to reduce infant mortality,

I would like to direct your attention briefly to several new or expanded activities that we will be undertaking. We are seeking $107 million for the new minority health initiative, which includes expanded and revitalized programs on loan repayments and scholarships for service in underserved areas, a program to provide a full range of health care and social services in our public housing units, community-based recruitment of minorities and disadvantaged into health professions careers, and institutional support and faculty development to sustain minority enrollment levels at health professions schools.

We are proposing $25 million as an increase in the MCH block grant for the one-stop shopping approach to provide health care, financial assistance, social services, and other community support to pregnant women and to children. We are also expanding the infant mortality prevention project in community health centers, at $4 million. We will continue HRSA's strong involvement in fighting the AIDS epidemic through grants in areas with a high incidence of AIDS, pediatric service demonstration projects, education and training centers to instruct health care providers in better AIDS treatment, grants to community and migrant health centers for treatment of HIV-infected persons, and renovation grants for facilities to deliver better intermediate and long-term care.


We will focus our health professions support on programs designed to assist the minority and disadvantaged students as a top priority. In 1991 HRSA will address many opportunities and numerous challenges. I believe the budget we are presenting to you will enable us to take advantage and meet those challenges.

Thank you.
[The statement follows:]


I am pleased to appear before you today to discuss the fiscal year 1991 budget request for the Health Resources and Services Administration (HRSA).

HRSA's clients are:

mothers and children,
the homeless,
the poor and disadvantaged,
the medically underserved,
migrant workers,
health professions students,
persons with AIDS, chronic lung disease and Hansen's
those in need of organ transplants,
those who are too sick to leave their homes.



[ocr errors]
[ocr errors]

HRSA programs span a wide range of activities. They:

provide grants or support for personal health services
to numerous special populations,
aid in improving the education, supply, distribution,
and quality of the Nation's health professionals; and
provide technical assistance to enhance the utilization
of the nation's health resources and facilities to
support these efforts.

In fiscal year 1991, we are requesting approximately $1.6 billion and 1,528 full-time-equivalent positions. Our partners in this effort are State and local health departments, universities, private non-profit organizations, and many other participants in our nation's public health system.

Since 1982, when the HRSA was formed, its mission has continued to rapidly adapt to a changing environment. While our agency's essential focus has remained ensuring health services to persons who might not otherwise receive care, the agency has developed new and innovative approaches to providing that care. At the same time HRSA has accepted responsibility for new programs dressing current public health needs.

Community Health Centers

The FY 1991 request includes $438 million to continue support of approximately 550 grantees providing primary health care services to over 5 million medically underserved people. These underserved individuals include those without access to care because they lack insurance, live in communities without sufficient health resources, have health concerns not met by traditional medical care, or face other barriers to care. The request also includes funding to improve compensation packages for center physicians.

Migrant Health Centers

The FY 1991 request for Migrant Health Centers includes $48 million for the continued support of services to migrant and seasonal farmworkers and their families. Access to health care for this

group is very difficult to achieve because of the lifestyle, language, culture, and economic status of most migrant and seasonal farmworkers. Services to approximately 500,000 individuals will be supported. The request also includes funds for improving the compensation for center physicians.

Infant Mortality

In 1991 we are expanding the Infant Mortality Prevention Initiative to $36 million, an increase of $4 million above the 1990 appropriation. This request will support an additional 22 community and migrant health centers to provide case managed services to 75,000 high-risk pregnant women. It also will expand overall perinatal capacity in community and migrant health centers to approximately 190,000 pregnant women per year. This will be accomplished through a proven case-managed, comprehensive approach that will focus on the coordination of appropriate services throughout the high risk mother's child bearing years.

Minority Health Initiative

The FY 1991 budget includes $107 million to launch a Minority Health Initiative. This initiative is made up of several programs designed to increase the number of minority health professionals and to reduce the health disparities between minority populations and nonminority populations as outlined in the 1986 Report of the Secretary's Task Force on Black and Minority Health.

These programs are designed to increase the number of health practitioners serving minority/disadvantaged populations. Key components include:

the revitalized NHSC loan repayment/scholarship program
($55 million), which focuses support for loan repayments
and special scholarships to financially disadvantaged
students to serve in the community with which they are
a new program, Health Services in underserved
neighborhoods ($35 million), will provide a full range
of health services in association with public housing
The Health Professions Institutional Development program
($12 million), providing funds for faculty development
and general institutional support to maintain minority
enrollment levels,
Community Based Recruitment ($5 million), to support
innovative efforts to recruit minority health

[ocr errors]

Maternal and Child Health

The Maternal and child Health block grant allocates funds to States to provide a wide range of health services to mothers and children, including preventive and primary care and rehabilitative services which help alleviate infant mortality problems and provide better access to health care. Our 1991 request is for $579 million, an increase of $25 million above the 1990 current estimate. The request includes:


$471 million for State Block grants,
$83 million for special projects of regional and
national significance (SPRANS) in the categories of
research, training, hemophilia, genetic diseases, and
maternal and child health improvement, and
$25 million for One-Stop shopping to improve the
delivery of health care services for pregnant women and


National Health Service Corps

The National Health Service Corps program is designed to improve the capacity to provide health services in Health Manpower Shortage Areas (HMSA) and improve acces8 to health care in these areas through the placement and support of health professionals. This program, and the related recruitment effort play a critical role in the attempt to reduce physician shortages in the most difficult to staff areas throughout the country. The budget request of $42 million will continue the program at approximately the 1990 level.

National Health Service Corps Recruitment

The budget request for NHSC recruitment is $64 million to support scholarships and loan repayments to health professionals and health professions students in exchange for service in a HMSA. The request includes an increase of $55 million associated with the Minority Health Initiative to support scholarships and loan repayments for disadvantaged and minority students.


The 1991 budget provides $34 million in new budget authority for a total program level of $46 million for health care to the homeless. This request will support a broad range of primary care, alcohol and substance abuse, and mental health services to approximately 335,000 homeless individuals in approximately 92 health care for the homeless programs. Emphasis will be placed on providing preventive as well as curative services to a broad sector of the homeless including runaway adolescents, homeless pregnant women and children, and individuals with chronic substance abuse and mental health problems. Grants will be made to applicants demonstrating broad community participation and linkages with other community providers of critical support needs of the homeless and effective and efficient provision of care.

Health Professions

At the end of fiscal year 1990 the cumulative Federal investment in Health Professions will total nearly $9 billion. This investment has increased the supply of health professionals. Also, beginning in the late 1970's and through the 1980's, it has addressed more targeted objectives such as primary care, disadvantaged assistance, and improvement in advanced and specialized nurse training.

In recognition of these successes in programs the Administration proposes to shift the emphasis from health professions training to other targeted HRSA priorities such as reducing infant mortality, increasing the number of minority health professionals, providing

« PreviousContinue »