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an expanded audience that will specifically target
racial/ethnic minorities, women, children and adolescents,
and blue collar workers--groups that have relatively high
rates of smoking.
Breast and cervical cancer mortality prevention.
50,000 women die of breast or cervical cancer each year, and
many of these deaths are preventable.
Studies in the United
States and Sweden demonstrated the cost-effectiveness of
screening and early detection of these cancers. In passing the Breast and cervical Cancer Mortality Prevention Act of
1990, Congress provided the framework for CDC's national
breast and cervical cancer control program.
increase of $20.7 million for this program, CDC will be able
to fund comprehensive programs in approximately 10 states in
1992 and ensure laboratory and X-ray quality assurance
are implemented in all 50 states.
Unintentional injuries constitute the
fourth leading cause of death in this country and account for more than 2.3 million years of premature death. Every
51 seconds someone is treated in an emergency room for
injuries from a bicycle crash, and every 10 hours someone
dies from those injuries.
with an additional $2 million for
our injury control program in 1992, we will develop an
information campaign aimed at increasing the use of child
safety seats, seat belts, bicycle helmets, and other
protective equipment. In this campaign we will also emphasize the role alcohol plays in injuries, especially
preventable, and yet since 1984 more than 31,000 cases have
occurred above expected levels.
The Department of Health
and Human Services has published a strategic plan to
eliminate tuberculosis in the United States by the year
To work toward meeting this goal, with the
President's request for an additional $3.2 million, CDC will
increase the number of grants for tuberculosis control, increase the number of outreach workers by 20 percent, and
expand programs providing preventive therapy by 40 percent.
If prevention is to become an
integral part of our nation's health care system, we must
expand our knowledge of what works, in what settings, for
The information we gain will aid all of us in making better
use of our health resources.
Our children are our most important investment and our future.
number of CDC's programs focus on the health of children.
children will reach about 14 states by the end of this year.
with an additional $6.8 million, we will be able to expand
the program to 23 states in 1992.
diseases, and it is estimated that savings for each $1 spent
on the measles/mumps/rubella vaccine range from $10 to $14.
Unfortunately, in some urban areas, only 50 to 70 percent of
2-year-old children may be adequately immunized.
requested funding increases, we can reach these children.
The President's budget includes an increase of $43.2 million
to (1) buy as many vaccine doses as we purchased in 1990,
(2) remove administrative barriers to vaccine delivery, (3)
reward programs that are most successful in increasing
immunization of 2-year-olds, (4) expand outreach
demonstrations to evaluate coordination with public
assistance programs, and (5) screen for hepatitis B
infection in 95 percent of pregnant women who receive
prenatal obstetric care in the public sector and immunize
about 18,000 infants against this disease.
Although the rate of infant mortality
reached an all-time low in 1989, the rate of progress has
slowed and we still have one of the highest rates among
With the requested increase of $5
million, we will expand our support to states for
surveillance and epidemiologic studies of infant mortality,
especially as related to racial and ethnic disparities.
Medical care costs for each low birth weight baby are
between $14,000 and $30,000 more than for larger nowborns.
Cigarette smoking during pregnancy accounts for 20 to 30
percent of low birth weight infants, about 14 percent of
pre-term deliveries, and about 10 percent of infant deaths.
Pregnant women will continue to be one of the specific population groupe CDC targets for smoking cessation efforts. CDC plans to work with states and the Health Resources and
congenital syphilis increased from about 650 in 1988 to more
than 7,000 in 1990.
Although much of this increase can be
attributed to widespread use of the new case definition, the
and hospitals that deliver large numbers of high-risk
infants, and work with prenatal care providers to identify high-risk mothers early in their pregnancies.
The Public Health System
Just as we need to have the best professionals and resources at
CDC, the nation'.8 state and local public health agencies need to
have the best people and programs to provide leadership in prevention. We also need to be able to assess our progress in
improving public health, and especially our progress in working towards the Year 2000 Health Objectives for the Nation set out in
as a major vehicle to provide support to states for addressing the Year 2000 Objectives. The President's budget includes an increase of $10.6 million for the grant itself
as well as $4.1 million for improving reporting and helping
develop a common set of indicators for measuring health in
The President's budget includes an
additional $14.8 million to provide full support for all of
our existing national health surveys and to expand the use
of automation and better technology for data collection and
HIV/AIDS prevention programs remain a high priority for the
nation as well
as for CDC.
We continue to face many challenges,
including HIV infection in women and children, slowing the
epidemic among high-risk youth, and preventing HIV transmission
in rural America, in the criminal justice system, and in health
In FY 1991, funding for prevention programs for
HIV/AIDS made up more than one-third of CDC's overall budget.
The same high level of funding appropriated in FY 1991--$494.7
million--is requested for FY 1992.
This represents a 31 percent
increase over FY 1989.
In closing, I'd like to recognize the 20th anniversary of the
establishment of CDC'S National Institute for Occupational Safety
and Health (NIOSH).
We are extremely proud of the contributions
that NIOSH has made in the last two decades, and we are looking
forward to continuing that strong tradition.
We have recently
undertaken a new challenge to improve farm safety and health.
The 9 million farm workers and family members in this country
bear a disproportionate share of injuries and disease.