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James O. Mason, M.D., Dr. P.H., was sworn in April 21, 1989, as Assistant Secretary for Health, Department of Health and Human Services. Dr. Mason was nominated by President Bush April 7, 1989, and confirmed by the Senate April 19, 1989.

Before assuming responsibility for the U.S. Public Health Service, Dr. Mason had served, since 1983, as director of the Centers for Disease Control and administrator of the Agency for Toxic Substances and Disease Registry. During his tenure at CDC, Dr. Mason also served as acting Assistant Secretary for Health from February to December 1985. Dr. Mason served as executive director of the Utah Department of Health, with responsibility for health and health care financing, from 1979 to 1983. He was associate professor and chairman of the Division of Community Medicine, Department of Family and Community Medicine, at the University of Utah College of Medicine from 1978 to 1979. He directed a multiple-hospital health care corporation owned by The Church of Jesus Christ of Latterday Saints from 1970 to 1975.

As Assistant Secretary for Health, Dr. Mason directs the activities
of the Public Health Service, which includes eight agencies: the
Alcohol, Drug Abuse and Mental Health Administration; the Centers
for Disease Control; the Agency for Toxic Substances and Disease
Registry; the Food and Drug Administration; the Health Resources and
Services Administration; the National Institutes of Health; the
Indian Health Service; and the Agency for Health Care Policy and

Dr. Mason provides policy guidance as well for HHS programs outside of PHS, and maintains relationships with other government and private agencies concerned with health. He advises and assists the Secretary on health policy and on all health-related activities of the department.


Dr. Mason was born June 19, 1930, in Salt Lake City, Utah. received his B.A. and M.D. degrees from the University of Utah in 1954 and 1958. He received his master of public health and doctorate of public health from the Harvard School of Public Health in 1963 and 1967. Dr. Mason served his internship at Johns Hopkins Hospital in Baltimore from 1958 to 1959, and was an internal medicine resident at Peter Bent Brigham Hospital, Harvard Medical Service, in Boston from 1961 to 1962.

He has received numerous honors and awards. Among these are the Public Health Service Distinguished Service Medal (1988) and the University of Utah's Distinguished Alumni Award (1973). He is a member of a number of honorary and professional societies including the American Medical Association, the Institute of Medicine of the National Academy of Sciences, and the American Public Health Association. He has served on many national and international committees, councils, boards and task forces, including the United Nations Development Program/World Bank/World Health Organization Special Program for Research and Training in Tropical Diseases, Scientific and Technical Advisory Committee; and the National Institutes of Health Recombinant DNA Advisory Committee.

Dr. Mason is certified by the American Board of Preventive Medicine. He has written numerous articles and book chapters on a wide range of subjects related to the prevention and control of disease. He is a national spokesperson on the prevention and control of infectious disease, chronic disease and injury, and a leading architect of public policies concerning these health problems.

Dr. Mason and his wife, the former Marie Smith, have five sons and two daughters: James, Susan, Bruce, Ralph, Samuel, Sara and


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Dr. MASON. Thank you, Mr. Chairman, Senator Stevens. I am pleased to appear before you to discuss the fiscal year 1992 budget request for the Public Health Service. With your permission, Mr. Chairman, I am submitting for the record a more detailed statement on our proposal and our priorities. Let me take just a few minutes here to give you an overview as to what is embodied in that proposal.

As you have stated, the discretionary budget request for Public Health Service agencies under the jurisdiction of this subcommittee totals $15.3 billion, an increase of $542 million or 3.7 percent over fiscal year 1991 appropriations.

Senator HARKIN. If I might just stop you right there. I said $15.6 billion. I understand the difference in those two represents the mandatory programs; is that right?

Dr. MASON. Right.

Senator HARKIN. Thank you. I just wanted to clear that up.

Dr. MASON. This budget represents a deep commitment on the part of the President and the Secretary to the major health problems that we face as a nation. For fiscal year 1992 we have grouped our spending priorities around three principal themes: First, the prevention of disease with special emphasis on health promotion and prevention of infant mortality and childhood diseases; second, the stabilization and enhancement of basic biomedical research and behavioral research; and third, the enhancement of efforts to prevent and treat drug abuse.

Many of the details in this budget center around "Healthy People 2000," our Nation's new master plan for increasing the span of healthy life, reducing health disparities among Americans, and achieving access to preventive services for all Americans. The master plan includes 300 realistic and measurable objectives. The PHS will expand its health promotion activities to change behavior and expand high-priority health protective activities and preventive services.

The budget proposes several new initiatives, including ones that address infant mortality, lead poisoning, immunization, and breast and cervical cancer prevention and control. This budget proposal makes major new investments in biomedical and behavioral research, science education, and science literacy, all of which are investments we must make to enhance the quality of health care services in our country and to improve our Nation's competitiveness in science and technology and to ensure that our Nation_will have a steady stream of bright new scientific minds to meet today's and tomorrow's needs.

This budget proposal seeks to build on our past successes in the war on drugs by expanding research and treatment resources with special emphasis on the Nation's high-risk populations. I believe that our fiscal year 1992 budget request shows this administration's commitment to the health priorities of our Nation.


I would be very pleased now with the help of these individuals that are here with me, Mr. Dennis Williams representing the As

sistant Secretary for Management and Budget; Dr. Robinson, who heads our Office of Minority Health; Mr. Harell Little in my Budget Office; and Dr. McGinnis, who heads the Office of Disease Prevention and Health Promotion; and I have other resources behind


Senator HARKIN. It is always nice to have those resources behind you, is it not? [Laughter.]

Dr. MASON. It is good to have them.


Senator HARKIN. I know what you mean.

Dr. Mason, thank you again. Speaking for myself and, I think, for other members of the subcommittee, I congratulate you on the fine job you are doing down there. We may have some differences here in some approaches and perhaps funding, but that is to be worked out, and that is what we are all about here.

I had given to me different charts and things that you had prepared, and I would like to share those with the people here today and the staff. We share a strong interest in giving higher priority to disease prevention and health promotion. I am glad you listed that as No. 1. I appreciate that. That is good.

Could you give the committee an update on the status of disease prevention and health promotion initiatives of the Department?

Dr. MASON. Thank you. I would be very pleased to do this. I will be working from these charts, and I believe you have a handout as well.

Senator HARKIN. You can turn those a little bit more if you like. Has staff got these?

We have those, and maybe people out there would like to see them.

Dr. MASON. We could turn them.

Does Senator Stevens have a copy of that as well?

Senator STEVENS. I do. Thank you, sir.

Senator HARKIN. Yes; he does. So just turn it more the other way so people out there can see it.

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* Injuries include unintentional injuries, homicides, and suicides

Dr. MASON. The first chart shows deaths caused by selected diseases in the United States in 1988; these are the big killers and cripplers in our country. You will notice that many of these affect people in adulthood or their senior years, while others occur when a person is very young, infant mortality as an example.


Selected Diseases/Causes

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Represents years of life lost before age 65.

Injuries include unintentional injuries, homicides, and suicides.

The second chart shows selected diseases and their causes with regard to potential years of life lost before age 65. This really highlights those diseases and conditions where we can do a great deal to prevent both disability and disease.

Notice the higher percentage for infant mortality, for example, on this chart versus the first one that deals with the total crude death rate. This also holds true for injuries and AIDS, which takes on a greater proportionality when you look at years of potential life lost before age 65.

By Major Risk Factor

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** Attributable to AIDS deaths.

50 100 150 200 250 300 350 400 450

On the third chart, which is estimated annual deaths by major risk factor, the lefthand side of the chart lists the various risk factors that are playing havoc with our health here in the United States. One really has to gasp when you look at the pall that tobacco smoke casts over our land with 434,000 deaths occurring because of the use of tobacco, most of which are preventable.

This chart also demonstrates the influence of diet, alcohol, unintentional injuries, suicide, and violence. We have put on this chart for the first time what we are categorizing as unsafe sex, although we do not have a very good measure as to the annual deaths associated with unsafe sex. These are just those attributable to AIDS deaths in the year the chart was formulated. It minimizes the problems associated with infant mortality, sexually transmitted diseases, cancer of the cervix, and other causes of death that we have not been able to place under unsafe sex.


Senator HARKIN. Dr. Mason, let us look at tobacco. I mean, it is startling if you look at the estimated annual deaths. The "Healthy Youth 2000" plan aims to reduce the proportion of young people who have used alcohol, marijuana, and cocaine, increase the proportion of high school seniors who perceive a social disapproval as

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