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know, this major health problem will be the topic of the Surgeon

General's Conference in Des Moines, Iowa, next month.

Mr. Chairman, with your support for this budget request of

$1,396,927,000 in new budget authority, we will be able to reach

more Americans with our prevention programs and make a difference

in the health of this country and the world.

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feb. 1989-
Teb, 1990

Deputy Assistant to the President for Domestic Policy,
Director, White House Office of Policy Development

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Assistant State Health Officer, Alabama Department of
Public Health, Birmingham, Alabama


Health Officer, Jefferson County Department of Health,
Birmingham, Alabama

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Cononunity Fellow, Department of Health and Hospitals,
city and County of Denver, Colorado

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Resident in Pediatrics, University of Colorado Medical
Center, Denver, Colorado



American Academy of Pediatrics
American Medical Association
American Public Health Association
Medical Association of the State of Alabama
Jefferson County Medical Society

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rlorida College:

Phi Theta Kappa, Junior College honorary
Who's Who Among Students in American Junior Colleges


University of Alabama :

Phi Beta Kappa
Outstanding Senior in Chemistry
Distinguished Undergraduate Scholar of the College
of Arts and Sciences

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University of Alabama School of Medicine:

State Merit Scholar
Alpha Omega Alpha

Senator HARKIN. Dr. Roper, thank you very much.

I wonder. I have these charts here. Could we kind of just go through those, and could you highlight those for me?

Dr. ROPER. Sure.
Senator HARKIN. I would appreciate that.

Dr. ROPER. Again, this chart shows three priorities. CDC's making prevention a practical reality, improving the health of children, and strengthening the Nation's public health system.

The second chart makes a point that I hope is not lost on this committee, if I can be blunt about it. This deals with our budget over the decade of the 1980's. The top of those bars is the overall budget for the Centers for Disease Control, left hand 1981 fiscal year and the President's budget for 1992 at the right hand.

As you can see, we have grown from almost $300 million to $1.4 billion, truly stupendous growth over that period. However, if you look within the numbers, it tells a different story. The red portion of the bar is AIDS funding. It is an important activity. We are spending the money well, we believe, but a large part of our budget growth is directed at AIDS and HIV.

The green is programs that were newly added to our activities; that is, things like Lyme disease which you mentioned in your question earlier on injury control. Those were activities that were not there in 1981. So most of our expansion has gone into those

The blue portion of the bar is what I want to draw your attention to particularly. That is what we call our core programs. Those are the nongrant programs which represent CDC's ability to meet unexpected problems should they come along.

Over this 12-year period, core programs have actually gone down in nominal dollars and has surely gone down when you apply the biomedical price deflator, which is represented by the black line. That erosion of our core is what has lead us to take a number of economy measures over this 12-year period. We are to the point that we are starving to death internally while at the same time enjoying this rich abundance of cash for new activity. It is a problem that we have had a chance to talk with your staff about in great detail, and I would welcome a chance to visit with you more.

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We badly need the support for CDC's own infrastructure, meaning people and laboratories and equipment and so on, if we are going to be the leaders in prevention that we and you want us to be.

Let me just quickly go through the remainder of the charts.


Dr. Mason mentioned the CARE funding, the AIDS funding. This chart makes the point that under the CARE legislation some States will enjoy an increase in funding. However, most of them will see a decrease in funding because of the way the formula in the chart reapportions the flow of dollars.

When you look within the total at the amount of funding that goes for counseling and testing, you see in red those States that will have a decrease in funding, and the increases are hard to find.

"HEALTHY PEOPLE 2000" Then the final chart, if I may draw one other analogy to Desert Storm. People these days in their op-ed columns are telling us what the lessons are to be drawn from Desert Storm. One of them is to have clear objectives. You just talked about "Healthy People 2000.” These are the objectives where we want to go in prevention.

The second, insuring popular and political support, is why we are having this hearing. We are trying to convince each other and, through you and us, the Nation, that prevention is a powerful idea whose time has come.

Third, there are some of us who presume to be public health generals or admirals, and we would like the ability to do our job just as Powell and Schwarzkopf were allowed to do their job. However, we have to be just as successful in delivering results as they were if we ars going to be able to be given reign to do our jobs in the future.

Finally, the effort in the gulf was successful because they applied massive effort against a problem. Again, sir, that is why we are here today, trying to get some of this massive effort that we can use in fighting the battle for prevention.

Thank you, sir.
Senator HARKIN. Thank you, Dr. Roper.
I would recognize Senator Specter.


Senator SPECTER. Thank you, Mr. Chairman. I regret my unavailability for most of the hearing today. I came in a short while ago. We had a hearing on the Defense Appropriations Subcommittee. We have multiple hearings going on all the time, but there were two major issues there, a carrier fleet which impacts on the Philadelphia Navy_Yard, and the V-22, which impacts very heavily on my State. These required my primary attention this morning.

When you made a comment about agency programs you had funding for but now some new programs you have funds available that

you will be inquiring into, I did not fully understand what you said on that, Doctor.

Dr. ROPER. It is a general point that I am sure you have heard from other agencies, Senator. We typically receive funding directed

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at newly discovered problems or hot issues, hot topics. While we are happy to get that directed funding, what we especially need is support for our base program, because it is that core that allows us to be ready for unexpected problems.

Last year, for example, we had a real scare about a new virus that could have been a major public health threat in this country. It was brought in through monkeys being imported into the country. Nobody could have predicted that problem. We need the capability to be prepared to deal with these unexpected issues when they come along.



Senator SPECTER, Dr. Roper, one issue which has received a fair amount of notoriety and has been a matter of concern in Scranton, PA, has been the question as to whether high voltage electrical lines are related to cancer incidence or, more specifically, to leukemia.

Dr. ROPER. Yes, sir.

Senator SPECTER. I would be interested to know if you have any insights into that issue.

Dr. ROPER. I do not have personal insights. I am quite familiar with the issue, Senator, The National Institute on Occupational Safety and Health, one of CDC's agencies, is conducting several studies about electromagnetic fields and their potential to cause health problems and has recently convened a national meeting on the subject. The National Cancer Institute is similarly conducting studies in that area, and I think the summary statement is the jury is out on the issue of power lines and their effect on health.

Senator SPECTER. I had made an inquiry about the possibility of a study as it relates to a specific locale, which is Scranton, an area I had visited. It illustrates the problem, very high powered lines and representations by people in the community. who are alarmed to the maximum extent about cancer, leukemia, illnesses of people in that immediate vicinity.

What is the reality, Dr. Roper, on the availability of your organization to make an inquiry on such an issue to try to make a factual determination as to whether that is a cause of the maladies or illnesses in the area?

Dr. ROPER. I am not aware of the Scranton request in particular. I would love to get it and discuss it with you or your staff and the people locally there in Scranton. We do those kinds of studies, and other parts of the Public Health Service do them as well. We would like to take a look at it carefully.

Senator SPECTER. I had written to you, Dr. Roper, back on November 20 concerning this issue. Let me make this correspondence available to you.

Dr. ROPER. Yes, sir.

Senator SPECTER. I realize that you have a very heavy volume, but I would appreciate your reviewing this—

Dr. ROPER. I would be happy to, sir.

Senator SPECTER [continuing). And making a response as promptly as you can.

Dr. ROPER. Yes, sir.
Senator SPECTER. Thank you very much.

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Thank you, Mr. Chairman, .
Senator HARKIN. Thank you, Senator Specter.
Can I ask a nice softball, leading question here, Dr. Roper.
Dr. ROPER. Yes, sir.


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Senator HARKIN. The Centers for Disease Control is the central agency on disease prevention and health promotion. In an effort to give proper recognition of this work and to better showcase the Federal Government's growing commitment to prevention-as you said, its time has come, and I had not thought of it that way, but I think you are right-would it make sense for CDC's name to include prevention?

We talked about that. I do not know. Some people say, well, it is not that big a deal. I am sensitive to the fact that Centers for Disease Control is a name that is well recognized. People know what it is. It has a very cognitive recognition right away.

Dr. ROPER. Yes, sir.

Senator HARKIN. I am just wondering if adding that word “prevention" in there, Centers for Disease Prevention and Control, might heighten the awareness of people on prevention and also to give you a stature there you are already doing the work—to highlight that portion of your work.

Dr. ROPER. It is a good question, and I may take a minute to answer you.

CDC has been around for 45 years. We are the Nation's prevention agency, and I want to stress that point. There are a lot of people who are happy to jump on the prevention bandwagon. We have been doing prevention for 45 years and want to do much more of it. You can be sure of that.

In Dr. Mason's presentation to you showing the portion of the PHS budget that is devoted to prevention, all of our budget was in there because it is generally recognized and appropriately so that everything we do is prevention.

Your question is, would we be advantaged by changing our name to include the word "prevention." I confess that the very reservation you mentioned was utmost in my mind when I first heard of your bill; that is, we have a name that means something to people, just like the initials NIH and FDA and whatever conveys something to folks. But if that is what it takes to get the message across that we are prevention and we are the Nation's prevention agency, I have to say I have an open mind leaning toward enthusiasm and appreciate your support.

Senator HARKIN. Thank you. I am sensitive to it. You do not want to just change something that people recognize, but if it will help and really promote it and get you out there in the public's mind on this, well, then, maybe it is something we ought to do. I wanted to discuss it with you and see if that is the direction in which we might want to go.

I have to tell you in response to what you just said that I recognize what you have been in the Centers for Disease Control for all these years. You say you want to do more in that area, and if I have anything to say about-and I think I will have some say about it-I can guarantee you that for the next 5 or 6 years we are

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