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highlight this administration's thoughts on how best to confront the many serious economic and health threats to our Nation's children.

Let me begin by telling you about a trip that I made far from our shores. At the request of President Bush, I recently visited eight countries in Africa to assess the catastrophic rates of illness and mortality for children on that vast continent. There, during the month of January, I witnessed almost unimaginable tragedy. Millions upon millions of children dying each year from malnutrition, dehydration, dysentery, malaria, AIĎs, and many other deadly, yet preventable, diseases.

In many of these countries, the family structure has been completely shattered by disease, by poverty, and by despair. In other countries on that continent, civil strife has ripped asunder the traditional sense of family and community that held many of these tribes together. But in spite of that picture and in spite of sorely inadequate resources, I witnessed valiant, dramatic efforts being made by committed professionals and political leaders, and most importantly individuals in local communities to take personal, direct action to solve these problems.

Now, strangely, Mr. Chairman, many of us in this country expect such a picture from abroad. And the magnitude of these problems is truly beyond human comprehension. But the untold story is what is being achieved by local action and personal involvement. When I returned I told President Bush that we must do more to broaden our support for Africa in cooperation with other nations and with international agencies to help these committed people help themselves.

I mention the devastation in Africa and the remarkable successes underway in spite of that, not as a counterpoint to our own problems, but rather to underline the fact that there are similar tragedies here at home within our own borders. And these tragedies need a similar prescription and that is a climate of personal responsibility, of personal involvement to address our Nation's health care concerns.

As you know, Mr. Chairman, we spend more per capita on health care than any other nation on the globe. And most of us have come to expect that our high-tech medical system operated by some of the best trained health professionals in the world sets us apart. But that belief comes from a false sense of security, a profound misunderstanding of our people and of the nature of disease and the impact of our social structures.

As a result, the suffering of our own children is sometimes ignored, often misunderstood. For example, in our country we have a shockingly high rate of infant mortality, higher than that of 23 other countries around the globe. And in the black community, the infant mortality rate is twice that of the white community.

In this country, we also allow as much as one in every five children to live in poverty. Now, many of you know what that means. Once we get beyond the facts and figures, beyond the textbooks, the graphs, the charts, and the hearings-once we get beyond all of that, we find a world of despair, of desperation, anger, and premature death.

In this country, poor health has become epidemic for our children. For many, their daily experience is virtually Third World. It includes poor diet, early and more frequent health problems, untold humiliation and deprivation. And it also includes virtual entrapment in a cycle of poverty, and that ensures that future generations will walk in the same footsteps.

In this country, we are quite familiar with family breakups. One out of every two marriages breaks up, thus many of our children are raised in single parent families. And our children pay a high price for this when a family fails. Because study after study documents that family breakups are correlated with higher rates of illness, of poverty, of domestic violence, of dropping out of school, of teen pregnancy, and trouble with the law. In fact, many of our children come to live in a world of disease, parasitic violence, and gang warfare.

It is shocking that homicide is a leading cause of premature death in our society for those under the age of 65. And homicide is the leading cause of death for young black males between the ages of 15 and 24. Some of our scholars and our social workers and clergy and our community leaders have tried to tell us about this in the past, the breadth and depth of the despair. And we have listened sometimes and at other times we have acted on their wisdom.

But I maintain that we now must listen more carefully and act more wisely. As policymakers and as a Nation, we can no longer afford to be ignorant or to shrug off responsibility or set these problems on a shelf until a more convenient moment arrives.

It is true that we need Federal dollars as part of our response, and I believe that our budget is a sound and prudent step in the right direction. In 1991 alone at HHS, we devoted almost $5 billion for infant and child health services and research. This year we must devote a substantial sum again, and the President has proposed additional funding. But we must work harder to cut the rate of infant mortality. What seems to be missing are innovative, effective programs to persuade and to motivate women in high-risk areas to seek early prenatal and perinatal care.

So in addition to our ongoing efforts, we have determined that funds must be specifically directed to targeted areas where infant mortality is extremely high. Such targeted spending would make a difference and would save the lives of many of our babies.

The 1992 request includes a new initiative for community-oriented programs to reduce barriers to appropriate prenatal and perinatal care for pregnant women and infants. Over $171 million will be directed in fiscal year 1992 to these target areas. Now, some of this money, about $30 million, would come from programs already designed to deal with children's health problems. But most of the money would be new spending authority designed to tackle infant mortality in precisely those areas most in need.

Our new initiative will help high-risk pregnant women in targeted areas to utilize Medicaid and other income-support programs. We will also examine social and nonfinancial barriers that prevent pregnant women from receiving appropriate prenatal and perinatal care for themselves and their infants. We will also work to increase access to care for high-risk women and to develop treatment programs.

After birth, children need access to essential programs. So I am pleased to announce that we are requesting $6 billion in fiscal year 1992 for programs designed to improve access to care for children and youth. This represents an increase of $659 million or 12 percent over fiscal year 1991 levels for activities such as child care, Head Start, child welfare services, and child protective services to abused and neglected children.

As part of this request we are asking for approximately $4 billion for child care and development programs. This represents a $366 million increase, or 11 percent, over fiscal year 1991 and a $2 billion increase, or more than 100 percent, over the 2-year period.

Now Head Start is one of our most important and one of our most successful governmental programs to help our children. Therefore, we are asking for a total of $2.1 billion for Head Start in 1992 which represents an increase of $100 million over fiscal year 1991, and an $817 million, or 66 percent, increase since President Bush took office. This will allow us to reach over 633,000 eligible children, an increase of almost 180,000 during this 3-year period.

State child welfare services agencies cope with family disruption and breakup. The 1992 budget provides $364 million for child welfare services, an increase of $90 million or 33 percent over 1991 funding levels.

We also need to open up our hearts and create homes for many of our children. We believe that the number of children now in foster care exceeds 360,000, so our proposed budget includes $2 billion for 1992 payments to States for foster care and adoption assistance, $203 million more than 1991.

We will also continue our commitment to children in other programs, for example, aid to families with dependent children grows in 1992 to $11.7 billion, an increase of $839 million or 7.4 percent over prior year levels. This increase is the result of ongoing growth in case loads, of increases in States' payment standards, and a full implementation of benefits for unemployed-parent families.

But we need much more than money. The President is doing his part. But all of us have a role to play. We need political as well as moral leadership. We need to revitalize our sense of community and recognize our mutual need and dependence on each other, and develop steadfast resolve to end the suffering, the disease, and the death that we inflict on our own children.

Obviously, one of the most threatening and most subtle evils facing our society is the erosion of basic values and the breakdown of the institutions which teach them, namely family and community. We must work to keep our families together. We must increase our efforts to strengthen our communities. In short, we must all accept our personal responsibility to create a better, a safer, and a healthier environment in which to raise our children. In other words, we must work together individually and as a community on behalf of our children, fostering a culture of character, a climate of personal and societal responsibility.

As we saw so dramatically in Africa in January, Government programs are important, but many of our children and many of the


problems that they have are symptoms of a culture of despair, of indifference, and unconcern. And this requires us to change attitudes, as well as to cure illness, to make better decisions to reduce morbidity and mortality and to increase vitality and fulfillment in all stages of the lives of our citizens.

A culture of character is something that money cannot buy but that our individual decisions can create. It must be a necessary, decisive element in our efforts to help our children survive and to grow into healthy and responsible adults.


So Mr. Chairman and members of the committee, the President and I need your help and we need your support. Surely, our partnership can be a formative first step.

Thank you.

[The statement follows:)

STATEMENT OF Louis W. SULLIVAN Mr. Chairman and members of the committee, thank you for inviting me here today to discuss the President's fiscal year 1992 budget proposal for the Department of Health and Human Services. Our budget totals $525 billion, an increase of $39 billion, or 8 percent over current year spending.

Our appropriation request for HHS programs considered by this Committee totals $161 billion. This is $13 billion over 1991,

or an increase of 9 percent. This budget reflects the President's and my own priorities for the programs and services delivered by this Department and I look forward to working with the Congress for the enactment of this budget.

We find ourselves at a unique time in our ability to address the health care needs of this Nation. We are faced with grave public health challenges such as unacceptably high rates of infant mortality-particularly in our minority communities, the devastating impacts of drug abuse, and far too many deaths from preventable diseases. These problems and others extract an enormous toll from our society in terms of personal suffering as well as spiralling socioeconomic costs. Certainly these problems cannot be solved overnight. However, we can have a tremendous impact by using our resources to improve both the scope and delivery of our health care serv. ices, by expanding our understanding of life processes and disease through research, and by calling on every citizen to take personal responsibility for making positive, healthy choices for their lives.

During 1992, we will continue our work to improve the health and well-being of this Nation by helping children and strengthening families; by improving the health status of minority and low-income Americans; by intensifying disease prevention and health promotion activities; by advancing our scientific understanding of the basic biomedical and behavioral research opportunities before us; and by continuing to improve the delivery of programs and services for which we are responsible.

I would now like to share with you, in greater detail, how our 1992 budget will help us to be responsive to the enormous challenges before us:

During 1992, HHS will provide over $6 billion for child care, child development and child welfare programs for America's families in need. This amount represents an increase of $659 million, or 11 percent over 1991 levels. Let me briefly highlight these programs for you.

The 1992 budget proposes spending $4 billion on child care and development, a $366 million or il percent increase over 1991. These programs recognize the critical role that child care plays in assisting low-income famílies achieve and maintain economic self-sufficiency. Included is $732 million for the new Child Care and Develop; ment Block Grant enacted by Congress last Fall; $300 million for At-Risk Child Care grants which will provide child care to families at risk of becoming dependent on welfare if it were not for child care assistance; $350 million for child care that will support Aid to Families with Dependent Children (AFDC) recipients' efforts to leave welfare; and $83 million for Transitional Child Care to help prevent families from returning to welfare.

As you know, educating our youth is a top priority of this Administration. The Head Start program has been one of the most important and successful govern. mental efforts to help children enter school ready to learn. This budget includes $2


billion for Head Start, an increase of $ 100 million over 1991; the amount of our increase was dictated by our management concerns for the program. These funds will be used not only to expand enrollment in the Head Start program but also, most importantly, to assure the proper management of the huge infusion of funds Head Start has received over the past two years. We are very pleased to report that by the end of fiscal year 1992, the Head Start program will enroll 180,000 more children than we did before President Bush and I came into office.

State Child Welfare Services agencies and Foster Care and Adoption Assistance programs cope with large numbers of troubled children and families and create homes for many of our Nation's children. The 1992 budget includes $2 billion for payments to States for Foster Care and Adoption Assistance, $203 million above the 1991 level, for children currently in foster and adoptive homes. The 1992 budget also provides $364 million for Child Welfare Services, a $90 million or 33 percent increase over 1991, to strengthen efforts to prevent children from entering foster care.

The Department will also enhance efforts to protect children from abuse and neglect. Funds are requested to increase coordination of child abuse and neglect prevention efforts, evaluate treatment innovations, and implement a new National Child Abuse and Neglect Reporting System to further our understanding of the causes and extent of child abuse and neglect.

As Secretary of HHS, one of my top priorities is to lessen the burden of disease, disability and premature death which disproportionately affects many of our poor and minority citizens. Key factors contributing to the continuing disparity in the health status between minority and non-minority Americans are the lack of access to adequate health care and an insufficient number of adequately trained health professionals serving minorities and economically disadvantaged populations.

I, along with many others, am disturbed that the U.S. infant mortality rate continues to be worse than that of nearly every other industrialized country in the world. The rate within our black community is more than twice that within our white community. The 1992 budget requests $5 billion to continue our efforts to reverse this tragic statistic. Included within this total is $171 million for an initiative that targets funds to communities suffering from the highest rates of infant mortality in order to remove the barriers that prevent pregnant women and teenagers from receiving prenatal and perinatal care for themselves and their infants. There is still much work that needs to be done in this area; the additional funds requested are critical in enabling us to save more lives.

Additionally, the 1992 budget request of $170 million represents more than a 28 percent increase in our efforts to train health professionals who are interested in serving minority and low-income populations. Prominent elements of this initiative include significant expansion of the National Health Service Corps recruitment program, recapitalizing the Health Professional Student Loan program, and the establishment of a new Federal construction program to enable historically black colleges, universities, and similar institutions to improve their research infrastructure and increase their competitiveness for Federal research funds.

of equal importance as providing access to health care is preventing disease. Throughout HÅS, we are seeking more than $7 billion for prevention activities, a 9-percent increase over 1991.

Breast cancer remains one of the leading causes of death for women aged 35 to 54. Early detection and diagnosis are key elements to combating these preventable deaths. The 1992 request includes $50 million to assist States and local health departments in offering breast and cervical cancer screening programs for low-income and disadvantaged women, an increase of 71 percent compared to fiscal year 1991. Additionally, for women over 65, mammography screenings are now available as a covered service under Medicare.

Our prevention effort also seeks $258 million for child immunizations, an increase of $40 million or 19 percent over 1991. Under the leadership of the Centers for Dis. ease Control, many childhood diseases, such as tetanus, diphtheria, and polio have been brought almost entirely under control. However, outbreaks of other childhood diseases, such as measles, mumps, rubella, and pertussis still exist, particularly among pre-school, inner-city children. These resources will focus efforts to remove barriers currently hindering delivery of immunization services to poor and disadvantaged children.

Recently, the Centers for Disease Control announced that over 100,000 Americans have died from AIDS. We must continue both our research and education efforts to reach all Americans with understandable and accurate prevention information. In 1992, AIDS research, prevention, and education efforts throughout the Public Health Service will receive almost $2 billion, a 50-percent increase since I took of. sice.

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