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functions of public health such as assessment, policy development, and assurance such as defined in the IOM Report.

The ability of State and local health agencies to carry out those functions is determined by: 1) the knowledge, skills, and abilities of the public health workforce: 2) leadership, 3) the availability of resources; and 4) the organizational relationships throughout the system.

The CDC budget request includes funding to support assessment strategies with special reference to building the capacity of State and local health departments.



Question. The FY 1991 appropriation bill provided $24 million to begin construction of the new occupational safety and health laboratory. Please provide a timetable for the completion of this project.

Answer. The architectural and engineering contract for the new laboratory was awarded in September 1990.

We anticipate construction to begin in June 1992 and be completed by November 1994.


Question. I am concerned over the number of positions that remained unfilled at the Appalachian Laboratory on Occupational Safety and Health. What steps are being taken to fill those vacancies?

Answer. CDC has committed to a special recruiting effort for the Morgantown NIOSH laboratory. We have employed a personnel generalist at the facility to plan increased recruitment to address current and future needs. NIOSH is assigning the new occupational safety and health laboratory building team with the responsibility of carrying out recruitment activities according to the plans being developed.

Question. Please provide a list of the number of FTE's at the Appalachian Laboratory on Occupational Safety and Health for FY's 1990, 1991 and the projected number of FTE's for FY 1992. Also include the number of actual people on board as well as a list of vacancies.


The number of FTE's and a list of vacancies follows:

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As of Febraury 22, 1991, 212 employees were on board in Morgantown.

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Deputy Director, Division of Respiratory Disease
Studies (DRDS)

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Chief, Safety and Controls Section, Division of Safety & Research (DSR)


Chief, Science and Policy Coordination Activity (DSR)


Assistant Chief, Certification and Quality Assurance
Branch (DSR)

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Question. The Congress provided funding in FY 1990 and in FY 1991 to begin a breast and cervical cancer screening initiative. West Virginia received planning funds in FY 1990. What funding level will West Virginia receive in FY 1991, and what is the projected amount that the State will receive in FY 1992?

Answer. In FY 1990, the West Virginia project was approved for funding through a competitive review process. The State was awarded $400,000 in direct and financial assistance to begin preparatory activities that would enable them to establish a comprehensive breast and cervical screening program in subsequent years.

In FY 1991, West Virginia will be eligible to receive up to $2.5 million to implement the more comprehensive program, which includes actual provision of screening and follow-up services. The actual amount of the award will depend on West Virginia's request and their ability to meet the matching requirement as described in Public Law 101-354.

Given the anticipated appropriation of $50 million in FY 1992, each State funded in FY 1991 will receive increased funding to enable them to expand their screening efforts to reach additional women in a wider geographic area. West Virginia will be eligible for up to $5 million, depending on their request and ability to meet the matching requirement.


Question. West Virginia is a rural State that has a myriad of health problems, including high incidence of lung cancer, diabetes, perinatal and infant mortality, and a shortage of physicians in many areas of the State. What is CDC currently doing in West Virginia in the areas of prevention/intervention and in your professional judgment, what more needs to be done?

Answer. West Virginia ranks second only to Michigan in ageadjusted chronic disease mortality. More than half of all deaths in the nation can be attributed to one of nine chronic diseases: stroke, coronary heart disease, chronic obstructive lung disease (COPD), lung cancer, breast cancer, cervical cancer, colorectal cancer and cirrhosis. In West Virginia, the pattern is similar, with 537 of the deaths due to these nine diseases. Specifically, West Virginia has been found to rank 3rd in cervical cancer rates, 4th in lung cancer rates, 6th in diabetes, 7th in coronary heart disease and 15th in stroke.

In response to these needs, the Centers for Disease Control has established two collaborative programs with the West Virginia Department of Health. First, in 1985 West Virginia was one of the early participants in the Planned Approach to Community Health (PATCH) program that now involves eight counties. In this program, local agencies and citizens are provided technical assistance to enable them to plan chronic disease prevention and health promotion programs that address leading health problems. Second, the CDC's Office of Surveillance and Analysis provides funding and technical assistance to carry out Behavioral Risk Factor Surveillance. This survey of the prevalence of ma jor risk factors for the leading causes of mortality and morbidity helps agency planners to target the State's most serious health problems. And, third, the Division of Chronic Disease Control and Community Intervention collaborates with the West Virginia Department of Health in the delivery of a school-based program that addresses the high prevalence of cardiovascular risk factors among elementary and secondary school children.

In our professional judgement, additional efforts could be directed toward ensuring that currently existing intervention methods and materials are designed to address the special needs of the citizens of West Virginia. CDC also works with State and local agencies in the areas of AIDS/HIV, diabetes, immunization, occupational safety and health, sexually transmitted disease, and tuberculosis.



Question. Dr. Roper, how much counseling and testing will your FY 91 appropriation support?

Answer. If trends since 1988 continue through FY 1991, CDC projects that nearly 1.9 million HIV-antibody tests will be administered at publicly funded counseling and testing sites in 1991, and approximately 72,500 will be positive.

Question. In FY 92, with the addition of early intervention services requirements but level funding requested by the President, how much less counseling and testing will be supported?

Answer. Although the CARE legislation requires grantees to expend at least 35 percent of their formula grant awards on

counseling, testing, referral and partner notification (CTRPN) related activities, they are also required to expend at least 35 percent on other early intervention services. However, grantees will have a great deal of latitude on allocating the remaining 30 percent, i.e., they may expend all or a portion of it on CTRPNrelated services or other early intervention services or a variety of optional services. If the states only allocate the required minimum 35 percent of CARE grant funds for HIV-antibody counseling and testing (C/T) in FY 1992, then an estimated 1,235,000 fewer tests would be performed compared to FY 1991. However, if all states expend all of their allowable discretionary funds (30 percent) for C/T in addition to the 35 percent minimum mandated by the CARE Act, an estimated 665,000 fewer tests will be performed.

Question. In the professional estimation of the CDC, how much additional money would be required in Title III to maintain the current level of testing and counseling AND provide early intervention services for those who need them?

Answer. If one assumes that all of the States will choose to expend only the minimum required 35% of their CARE formula grant funds on CTRPN-related services, then, in our professional judgement, it would take an additional $189.4 million above the requested $102 million to ensure that no State receives less funds in 1992 under the CARE Act for CTRPN-related activities than was received in 1991. On the other hand, if one assumes that all of the States will choose to make maximum use of their allowable 30% discretionary funding under the CARE Act for CTRPN-related services, then it would take $54.9 million above the requested $102 million to maintain CTRPN funding at 1991 levels. In either case, such funding levels would, of course, require offsetting reductions in other programs within the domestic discretionary spending cap.



Question. In his February 21, 1991, testimony before the Toxic Substances Subcommittee that I chair, Assistant Secretary for Health Ma son stated that "we have the tools to eliminate childhood lead poisoning in the next 20 years" and that "we do not need new technology to complete this task." I agree--the government and people have the willingness, especially the financial willingness, to do so.

While the Administration's budget proposal represents a major increase over current budgeted expenditures, isn't it inadequate to meet the goals of the Strategic Plan?


Answer. Implementation of this plan is going to require a combined effort among all levels of government and the private

The CDC budget requests $14.9 million in FY 1992 for support of State and local childhood lead poisoning prevention programs. This is an increase of $7.1 million (+92%) over 1991 appropriations. We believe these funds, in addition to the funds being requested for lead abatement activities by the Department of

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