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You extend maternal and child health care services to a pregnant woman from month one through delivery and postdelivery, and you are not going to have low birthweight babies. We know it works. Your Department has the data and the documentation on that$600 for maternal and child health care for 9 months versus $15,000 maybe to take care of a low birthweight baby. We know those programs work. You say money is not the answer? If we fully fund the Maternal and Child Health Care Program, it will work. We have proved that it works.

Head Start-you, yourself, said this is a success program. We have got 25 years now? Twenty-five years of Head Start? We know it works. We have seen the cohorts as they have gone along. We know what happened to the kids in Head Start compared to their counterparts that did not partake of Head Start.

You have asked for an increase in Head Start-$100 million or something like that. And yet we are only servicing 25 percent of the kids today-25 percent get served by head Start. So we have $2.1 billion that we are putting into Head Start. You can correct me if I am wrong on these figures, but I am pretty close-about $2.1 billion into Head Start. We are getting 25 percent of the eligible kids.

Now there are stated goals. I know that I keep hearing them around here. We have a goal of fully funding Head Start by 1994. Did that come out of the administration?

VOICE. That is the Dodd bill.

Senator HARKIN. There are a number of Senators I know here that supported this concept of fully funding Head Start by 1994. That would require $2 billion next year, $2 billion more in 1983, and $2 billion in 1984. That gets us to 100 percent, about $8 billion a year. A $100 million increase in Head Start. I am sorry. That does not do it. That does not do anything. That just sort of keeps it going along. That is not to say that the $2 billion we are spending is wasted. But let us get to all these kids early on when they are 3 years old and 4 years old, so we do not have to remedy it later on.

I guess that is my response to your statement. I like what you have to say, but let us start focusing these things on early childhood. Let us not rob maternal and child health care programs to pay for something else. Let us recognize programs that work. WIC programs-not in your bailiwick, but WIC programs work. Head Start works. The child care bill will work. And we have just got to put more money into it.

And you say money is not the answer. But if that kid does not have his boots, you can preach to him all day long about pulling himself up by his bootstraps and developing character, but if he does not have the boots, he cannot pull himself up.

And so I kind of agree with you and kind of disagree. I agree that money does not solve everything, because the way we spend it does not work. We are trying to remedy things and patch things up later on, after the damage is done. You take a kid that is born, and his mother-her mother-has not had proper nutrition and that baby does not get proper nutrition when it is born. It does not get stimulation in the early years of its life. I do not care how much

remedying you want to do, that kid is stunted the rest of his or her life.

We have to shift the focus. We have to shift it and put it into prevention and early health care promotion. To that extent I am with you to the extent that you want to take it out of maternal and child health care programs, I think we are going to part ways on that.

So your comments got me thinking about that. It was a very provocative statement. I do not mean provocative in a confrontational way-but provoking thinking, and so I appreciate that.


Secretary SULLIVAN. Mr. Chairman, if I might respond.
Senator HARKIN. Yes.

Secretary SULLIVAN. First, on the issue of Head Start, which is a program we all agree works. It is a very important program and we support it. The President's goal was to provide a Head Start or Head Start-like experience for all eligible 4-year-old children. With our proposal we will be able to reach some 60 percent of all of the eligible 4-year-old children. The difference between our position and others is that they propose the Head Start experience for 3 year olds and 5 year olds. That certainly is worth discussing.

We have chosen the goal of all eligible 4 year olds, because we think it is clear that youngsters exposed to a year in Head Start at age 4 make significant gains. It is not clear that expenditure of dollars beyond that year will result in incremental gains.

Senator HARKIN. Excuse me, sir. Beyond that year or 5 years? Is that what you are talking about or are you talking about 3 year olds and 2 year olds?

Secretary SULLIVAN. I am speaking about 3 year olds and 5 year olds. We believe the optimal year for the Head Start program is the year prior to kindergarten. We want to concentrate on the 4 year olds, because the results are very good.

Given limited resources and the many other demands that we have, we are diligently trying to address many issues. We are not disputing that additional dollars to provide Head Start experience for 3- and 5-year-olds would not have some effect. The judgment we have to make is whether the incremental gain would be sufficient if we put the money there as opposed to other programs.

Our position is that even though Federal dollars are important, it takes more than money. We need a real commitment from the leaders in our communities, including political leaders, clergy, vclunteer organizations, et cetera. My Department is a department where the programs for which we are responsible are largely designed to support the family, substitute for the family, buttress the family in times of stress or weakness, et cetera-whether it is health or social services.

To the degree that we can strengthen the family, we can help to avoid some of these problems and minimize them. I fully agree with you on the importance of prevention. We recognize that and are fully supportive of it. Last August we released our health goals for the Nation for the year 2000 as part of our overall prevention efforts, and a number of follow-on activities resulting therefrom are underway.

Senator HARKIN. Thank you, Mr. Secretary. I have some more specific questions on a couple of areas, but before I get into those, I would recognize my colleagues.

Senator Hatfield.


Senator HATFIELD. Thank you, Mr. Chairman.

Mr. Secretary, I would like to associate myself with the chairman's remarks as to the justification of transferring from the Maternal and Child Health Block Grant Program and community health centers some of the money that would go to this new initiative.

I would like to know a little more, and this you may do for the record rather than today, how you arrived at some of the judgments, because it seems to me that all of those agencies are dealing in some part with infant mortality. And I am troubled just from the standpoint of the valuation on the importance of these two existing programs.

I also wondered, Mr. Secretary, and you are going to be just one of many agencies that I ask this question. Could I have my staff work with you on making some random selection? You say you have 250 programs in this category. Maybe picking 10 of those programs. And I would like to know the amount of dollars of overhead to administer the programs in ratio to the dollars that get to the recipient. Now, I am not raising this with any prejudgments.

I happen to sit on an independent board of trustees that has an educational program under its jurisdiction. It is a very small one, but the other day we got the budget for the coming year-$480,000 for administrative costs and $300,000 for the program recipients. Now, that to me is a little disproportionate, especially when this was situated in the context of a university.

Now, I agree that dollars in and of themselves do not often constitute the solution or getting to the problem. But I also am constantly aware of the fact that we have perhaps not maximized the dollars we spend. And, as again I am not suggesting this be predetermined before we look at the statistics, but I do think they can be instructive. They will not tell us everything, but certainly it will help us.

Now, I would like to jump to the other end of the life health problems. Mr. Secretary, are you aware of that, the wandering of victims of Alzheimer's is becoming an increasing problem. Last year in New York State, the Harry Helmsley Foundation granted $300,000 for a trial program aimed at reducing the risk for those victims and their wandering. The project is underway in the Northeast corridor. I think there are about 16 chapters now of Alzheimer's advocate organizations that have implemented this little idea of a bracelet and on the back of this bracelet is the-in this case is the name of L.M. Sullivan. [Laughter.]

L.W. Sullivan-excuse me. HHS Secretary, memory impaired. [Laughter.]

Secretary SULLIVAN. I do not know where I lost it, Senator. [Laughter.]


Senator HATFIELD. I have one here, Mark O. Hatfield. 1-800753-9596. What happens is this is registered in a central registry, and any person that is found with this particular identification, can receive immediate help-it does not solve the problem-but certainly it will help reduce the risks associated with wandering.

My question to you-first of all, will you accept this as a symbol of maybe your continued interest in this cause? And I will have one here of myself as well. But have you conducted any study in your agency or have you made any evaluation of this problem among the estimated 4 million Alzheimer's victims?

Senator HARKIN. I just want to take a look at this. I have never heard of this.

Senator HATFIELD. Sorry, I forgot about you. [Laughter.]
Senator HARKIN. That is all right.

Senator HATFIELD. The question is has this agency addressed this particular part of the Alzheimer's problem and I emphasize it is a very small part? As you know, I have had a long interest in the Alzheimer's problem and have been supportive of those institutes and centers that we have created to conduct research on this disease and am proud to have one located in Portland.

Do you have any thoughts about whether this bracelet project should be replicated or are you familiar with this very small beginning?

Secretary SULLIVAN. Senator, I feel I am not familiar with that specific effort, but I am familiar with similar kinds of braceletsthe medic alert bracelet and others. On the surface it would seem to be a very useful kind of registry because of the problem that we have with some of our Alzheimer's patients. I would be very pleased to have members of my staff review this in more detail because that is a problem.

I am concerned and committed to the problem of Alzheimer's disease. This is the third budget cycle that I have been involved in since becoming Secretary, and during that time our budget for Alzheimer's has gone from $130 million in 1989 to $241 million for fiscal year 1992.

Within that the NIH budget for research on Alzheimer's has gone from $105 million to $209 million, so it is almost double. Dr. Franklin Williams, head of the National Institute on Aging, and his staff who oversee that research are individuals in whom I have great confidence as I do with the various volunteer agencies.

Senator HATFIELD. Thank you for your expressed interest. But more than just reviewing this particular project, which is based upon the medic alert system that has been deployed for other causes, or other reasons, I would hope that you would review just that one facet at least to see what might be done from a national perspective. I am not suggesting we necessarily adopt it as an agency program, but how it might be expanded or improved upon. Because part of this $90-some billion that we are spending this year for the care of Alzheimer victims will only be controlled and reduced as we find some medical cures and prevention, but also much of that forces the family to put these members of their family into full-time, 24-hour care. It seems to me this is a small step to

try to help reduce that risk of wandering that might even permit that family member to remain in the home rather than to be put into institutional full-time care.

So it is preventive in a sense, and I would like to have you take a look at it from the national perspective and see if there is a system that can be implemented that would at least help diminish the risk of wandering.

Secretary SULLIVAN. I would be very happy to, Senator Hatfield. As we have increased our understanding about Alzheimer's in the last 10 years or so we have been rather stunned to see the number of individuals diagnosed with Alzheimer's. It is a problem of significant magnitude.

We are investing in research to see if there are ways we can understand more about Alzheimer's, with the idea of intervening to prevent this degenerative process.

I think we are all very heartened by reports within the past month coming out of research in Guy's Hospital in London that suggest that they may have further information about the process that leads to the deposition of this amyloid-type protein within the nerve cells in the brain that are associated with this degeneration. With this increased understanding about how this process works we may be able to ultimately reverse it. It may seem farfetched to some, but I believe that this is certainly within the realm of possibility.

By comparison, while we still have much to do before we feel that we have a satisfactory treatment for AIDS, another great problem, we do have some very encouraging research underway with new drugs that seem to extend the therapeutic range with perhaps less toxicity, and promising research on the development of a vaccine.

As we learn more about Alzheimer's, we hope we will be able to find a way to intervene and prevent the onset of this disease so that these individuals will lead happier lives with their families in their senior years.

[The information follows:]


I have recently been made aware of the work of the Alzheimer's Alert Program. I understand that the program utilizes an identification system employing ID bracelets similar to the Medic Alert bracelets used by many individuals, and that a trial program has been initiated in New York City. The identification system is designed to speed the identification and safe return of people who wander, are lost, and cannot adequately identify themselves.

In order to learn more about the problem of wandering, the National Institute on Aging (NIA) recently supported a small study of 106 Alzheimer's disease patients. The study found that about one-quarter of Alzheimer's disease patients were reported by family members to wander. The study also found that half of those afflicted with Alzheimer's disease experience periods of restlessness. Researchers believe that the frequency with which Alzheimer's disease patients wander is affected by the stage of the illness and the patient's living environment.

To begin to address the problem nationally, the National Institute on Aging, in collaboration with the National Center for Nursing Research and the Alzheimer's Association, has initiated a research program to determine how to manage symptoms of Alzheimer's disease such as wandering and other behavioral problems. În response to an NIA issued Request for Applications [RFA], NIA expects to award 7 to 10 research grants for studies aimed at identifying the factors underlying the behavioral symptoms of Alzheimer's related problems such as wandering. The stud

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