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The next chart shows reported measles cases in the United States. It shows what happened after the measles vaccine was licensed and what happened as a result of school entrance laws. In the small side graph you see what an extremely contagious disease it is. If we do not maintain immunization and if we are not able to get immunization into children at 1 year of age for measles immunization, then we may soon have an epidemic again.

So the only way to keep measles and diseases like it under control is eternal vigilance in getting those vaccine doses in at an early time, and our appropriations request will enable CDC working collaboratively with State and local governments to do that. I know that Dr. Roper will go into that.


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Dollars in Millions






FY 1989 FY 1990 FY 1991 FY 1992

SMOKING PREVENTION The next chart is on CDC smoking prevention and simply indicates the concern of this administration. The amount of money going into the Office on Smoking and Health is nearly doubled so that we can assist States with tobacco education programs, getting out to those kids and adolescents to see that they never start, addressing special needs of minorities, women, blue collar workers' and things of that nature.


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TRENDS IN SMOKING The next chart simply indicates the trends in smoking prevalence in the United States for persons age 20 and above. It shows the trend coming down. We are making progress. The stars on the right-hand side show the targets for the year 2000. Certainly, I would like to not only meet the targets but exceed them. I think this Nation has the capacity to exceed those targets, but we wanted this to be realistic in the context of what we were doing today. As I have said before, we need to do more. This is the leading cause of preventible death in the United States.


BY CAUSE - PER 100,000


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The next chart just brings AIDS into the picture. We wanted to indicate to you that AIDS is appearing on the scene of the major causes of death. This is a chart of death rates per 100,000 for 25through 44-year-old women by cause for all races. You will notice how AIDS is creeping up and is becoming one of the major causes of death in women of this age. DEATH RATES FOR 25-44 YEAR OLD MEN

BY CAUSE - PER 100,000


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Deaths Per 100,000 Population

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Data Source: NCHS, COC
*Provisional Data for 1909, based on 10% sample

DEATH RATES FOR MEN OF THE SAME AGE This next chart shows the death rates for men of the same age, and AIDS is already one of the significant causes of death in men aged 25 through 44. This is why we are investing in the research, prevention, and treatment of AIDS. This is an extremely serious problem and we need to keep working on it.

Let me conclude. You have been very patient. I could go on all day and there is not time for that.


Senator HARKIN. Dr. Mason, thank you. Those were good charts, very descriptive. Let me just follow that up with one question. We said about one-half of the 1990 objectives were met.

Do you have a plan for meeting or exceeding some of these goals for the year 2000? In other words, looking back at what happened the last 10 years, seeing where we are, we now have the goals for the year 2000. Do you have a long-range plan that you could talk with us about as to what the role of the Federal Government would be and what kind of funding will be required in the initial stages, understanding that we have to start now to reach some of those goals, and what increases in funding should be made to insure the success in different areas? Is that represented in your budget, or are there other areas that we ought to be looking at?

Dr. MASON. There are a number of things that we need to do if we are going to meet those goals, which we intend to do. I said that about 50 percent of our 1990 goals were met, approximately 25 percent will not be met, and 25 percent we will never know because we did not have the surveillance systems to measure them.

I would say, No. 1, as we move toward “Healthy People 2000" we have learned enough to put into place the tracking and surveillance systems. They are either in place or will very rapidly be put in place. An increase in the budget of the National Center for Health Statistics will assist us with the tracking systems. In our 1992 budget there is a $15 million increase for the preventive health services block grant. There was a $9 million increase last year.

I have already mentioned the increases at CDC, almost $100 million for prevention, whether it is immunization, lead poisoning, or STD's. All of those will be targeted. Many of those will go out as grants to States and communities to assist with that process.

Now we need to do more than have tracking systems and increased resources. We need to involve the whole Nation. These are not Federal goals. They are national goals, and they were developed by cooperatively working with over 300 private and voluntary organizations, and health departments at the State and local level. We have involved the health care industry. If we are going to accomplish these goals and objectives, it will be because we as a Nation at the Federal, State, local, private, and voluntary levels, all ante in with resources.

But more than resources, we are going to have to change behavior and get right down to peer pressure. I think we have a plan in place that will develop and grow over the next 10 years, and I think we can succeed.

Senator HARKIN. As you correctly state, Dr. Mason, it is going to take a concerted effort by Federal, State, and local, private business entities, families, and schools.

Dr. MASON. All of us.


Senator HARKIN. All of us are going to have to be involved.

Let me just ask you this question. You prodded my thinking on it. I am very interested in getting businesses throughout the United States to have a wellness program and a health promotion program as part of their internal structure in their business entity, regardless of what that business may be.

I have looked at a few business entities in different parts of the country, some small, some large, in which the owners decided at some point to have a prevention and wellness program. At least in each of the cases that I have looked at where they have had it for over at least 10 years, their insurance rates are lower, their absenteeism is less, their productivity is higher per person, and their turnover rate is lower.

You might say, well, with all of that it would seem to me in the best interest of business to do that. You can show this. I have shown this sort of data to friends of mine who run businesses, and they say fine but the startup costs are something I cannot do. We are just sort of skimming along right now. There is a recession on, and to invest that kind of money in that kind of program requires some up-front money that we just cannot find right now even though the end payoff may be greater.

Again, I see you nodding your head. You understand this, and anyone in the health field understands this. How do we get from you to the tax writing committees, let us say, and to others to promote businesses in setting up these programs, to give them the kind of up-front expensing, tax writeoffs, whatever it might be to get them to do this? It is in our national interest to do it; not just in their interest, in all of our interests.

Dr. MASON. You are absolutely right. We cannot afford not to do it.

Senator HARKIN. That is right. So I am trying to get from the health field and this kind of a knowledge base and support base and shift it to the business groups and tell them that they should do it. I think they all want to do it. It is a matter of up-front cost. It would seem to me that we ought to start talking about this in terms of our tax policy in this country. Perhaps that is one way, give them first-year expensing or 2 years expensing or something like that in the initial stages where they can write it off rapidly. We might promote that.

I am trying to think of how you in the Department might interface with something like that?

Dr. MASON. When we went through the 3-year process of developing "Healthy People 2000," we asked the Institute of Medicine to convene a consortium of 300 organizations, many of whom were in the private business sector. We certainly have worked very energetically to encourage them. We have a number of large committees that meet directly under the auspices of our Office of Disease Prevention and Health Promotion that includes different medical spe

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