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an expanded audience that will specifically target racial/ethnic minorities, women, children and adoloscents, 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 proventable.

Studios 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 Provention 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 somoone

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

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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

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.

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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 Prosidont', budget includes an additional $2 million for assessing provention 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.

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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.

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Immunization.

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 vaccino-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 incroase 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 incroase of $5

million, we will expand our support to statos 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 groups CDC targets for smoking cessation offorts.
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 incroase can be

attributed to widespread use of the new case definition, the

upward trend is nevertheless cloar.

with an incroase 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 scroening 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 loadership in

prevention.

We also need to be able to a88688 our progress in

improving public health, and especially our progress in working towards the Yoar 2000 Health Objectives for the Nation set out in

Healthy People 2000.

Preventive Health and Health Services Block Grant.

CDC'

Preventivo Hoalth and Hoalth services Block Grant will servo

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

reporting.

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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