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an expanded audience that will specifically target

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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.

with an

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.

Injury control.

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

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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

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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.


Prevention effectiveness.

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

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The information we gain will aid all of us in making better

use of our health resources.

Children's Health

Our children are our most important investment and our future.


number of CDC's programs focus on the health of children.

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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.

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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.

with the

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.

Infant mortality.

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

industrialized nations.

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

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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

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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

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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

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develop a common set of indicators for measuring health in

every community.

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 Infection/AIDS

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

care settings.

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.

As you

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