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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. About

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 measures 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 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 among teenagers.

Tuberculosis control. Tuberculosis is completely

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
2010. 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 which groups. CDC is evaluating the efficacy of new interventions and comparing the benefits of prevention programs with their costs. The President's budget includes an additional $2 million for assessing prevention effectiveness. With this funding, we will be able to be more aggressive in evaluating new prevention technologies. 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. A number of CDC's programs focus on the health of children.

Elimination of childhood lead poisoning.

CDC had a major

role in developing the Department of Health and Human Services' Strategic Plan for the Elimination of Childhood Lead Poisoning. Almost 6 million children live in houses containing lead-based paint. Our program encompasses many of the activities recommended in the Strategic Plan. Our categorical grant program for screening and referral of 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.


Immunization is the most efficient and

successful method for preventing many childhood diseases.

Immunization is the archetypical example where paying for a prevention program saves money by reducing medical care costs. For example, immunizations were responsible for dramatic decreases in reported cases of vaccine-preventable 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 newborns. 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 groups CDC targets for smoking cessation efforts.
CDC plans to work with states and the Health Resources and
Services Administration to expand the Smoking Cessation in
Pregnancy program to as many states as possible.

Sexually transmitted diseases (STDs).

Reported cases of

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
upward trend is nevertheless clear. With an increase in
funding of $4.6 million for sexually transmitted disease
control, we will expand our intervention strategies for
high-risk women to prevent congenital syphilis. This
increase will allow us to ensure syphilis screening for
pregnant women, improve communications between STD clinics
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's 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 Healthy People 2000.

Preventive Health and Health Services Block Grant. CDC' Preventive Health and Health Services Block Grant will serve 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 states assess their progress.

Surveys. CDC will have a primary role in assessing national
progress toward the Year 2000 Objectives. We have already
begun working with state and local health agencies to
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 healthcare 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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