Page images
PDF
EPUB

cated to the so-called demand side rehabilitation education contrasted with the supply side interdiction, strike forces, et cetera.

There were quite a few of us on the Judiciary Committee who urged a 50-50 split, and I would be interested in your view as to what an appropriate division would be, and I might say that I ask that question with the hope that we can increase the division to 50-50 and can look to some advocacy from your Department in that regard.

Secretary SULLIVAN. Thank you, Senator Specter.

As Governor Martinez may have mentioned to you, we look at the dollars devoted to demand reduction. My Department has a major responsibility in that area which includes treatment, prevention, education, and research. We compare the dollars for law enforcément, and the dollars for preventing drugs from coming into the country involving our State Department, military, Coast Guard, and others. It breaks down into roughly thirds. Of the $11 billion now in the drug program we are spending approximately one-third, or around 30 percent, for demand reduction activities.

My budget has an increase of $128 million for treatment which would add some 9,000 drug treatment slots. If the States match our dollars on the ratio that they have in the past, we would increase the number of people who can be treated by 200,000. I can get those specific figures back to you.

Senator SPECTER. Are you satisfied with a 70–30 split—70 for law enforcement? I understand that is what it is. It is not too far from two-thirds/one-third, with an even slightly more, as I understand it, balance for supply side. Are you satisfied with-we will take your figure-one-third for demand, two-thirds for supply?

Secretary SULLIVAN. We have had significant increases in funding for demand reduction. We have doubled our research budget and increased dollars for treatment.

The problems we are running into are not related to a shortage of funding. The major problem

is getting drug treatment facilities established in communities. What we have seen all over the country is the objection of people to having such facilities in their communities.

Senator SPECTER. Are you saying you cannot utilize any more funding on the demand side?

Secretary SULLIVAN. We think that with the dollars that we have now, we will be reaching virtually everyone who is on drugs who is ready for treatment. I will be happy to get these figures back to you with the methodology used to derive them. With the funds we have requested, we would be able to reach the majority of addicts who are ready for treatment. [The information follows:)

ANTIDRUG ABUSE ACTIVITIES The $1.8 billion requested in my fiscal year 1992 budget for antidrug abuse activities represents a five-fold increase in HHS antidrug abuse activities since 1986. This is significant. Recent data such as the High School Senior Survey and the National Household Survey show that we are making progress in the War on Drugs, but we still need more treatment services than are currently available. However, it is important to ensure that additional treatment dollars go to those areas most in need. That is why my budget proposes a new $99 million treatment program that will provide grants to States based on community needs assessment and the State's plan for providing drug treatment services. Expanding drug treatment capacity through

this mechanism is preferable to the Alcohol, Drug Abuse and Mental Health Services Block Grant because it allows us to target our resources to communities which need them the most.

ALLOCATION OF DRUG FUNDING Senator SPECTER. Senator Biden has asked for an additional $3 billion, with a significant part of that to go to the demand side. Are you of the opinion that—well, I am asking you the same question, and I am not quite sure what your answer was—are you getting all of the money that you can effectively utilize on the demand side?

Secretary SULLIVAN. Senator Specter, given the budget agreement we would have to take $3 billion from something else in our Department. I would say that that would be totally inappropriate.

Senator SPECTER. That is a different question about priorities, and I understand that you are a Cabinet officer of an administration which has a policy, and maybe you are bound by the policy, so that is that.

But we have to make an evaluation from a congressional point of view in the Senate as to what the priorities ought to be, and it is not an easy matter to evaluate how well we are doing in Peru, how well we are doing in Columbia, what the effect of strike forces is, the overall balance—and I know the administration has come up with two-thirds, one-third, or a 70–30 split, and I have a judgment which is contrary to that.

I think there is a growing body of sentiment in the Congress that the educational aspect is probably the most cost effective, even more so than rehabilitation, and we are putting a tremendous sum of money into drugs. We added $1.8 billion in the 1986 legislation, $2.7 billion in 1988, and the funding now is $1 billion over last year. We are up to $11.7 billion.

Let me ask you to do this. Let me ask you to take a look at the allocation and you and I will be around to discuss this next year, but I would urge you to take a look at a greater proportion on demand, and perhaps it might be possible to have some sort of an evaluation somewhere.

Maybe we might request this, Senator Harkin, from one of the agencies, telling us what we are getting for the extra dollar on interdiction or law enforcement. Maybe one of the agencies could give us some evaluation, because it is very hard to make a call on it. But I think there is more to be said for that kind of a balance.

Let me take up one other question, because the hour is growing late, Dr. Sullivan, and this has just come to my attention, and it is an unusual problem which has arisen in Pittsburgh, where the Urban League of Pittsburgh, Inc., received a letter from you dated December 31 congratulating them on being selected as a grantee for the community coalition to support health and human service needs of the minority male grant program.

They took this letter to mean approval of a demonstration program for black males. Then they received another letter from Dr. Harold L. Kelly, Chief of Special Initiatives of your Department, on February 4, advising them that the issue of the demonstration project for black males was under consideration and that the prior letter had been a grant for a conference on black males.

Acting on the conclusion that the first letter was the grant for the demonstration project on black males, they made a number of commitments and announcements and acquisition of an operative van for health purposes, and I am told some other commitments.

I would appreciate it if you would take a look at this and see if the unique circumstances might not weigh heavily on an award for the demonstration program for the black males, so that they will have the resources to support the commitments which have allocated in that direction.

I know you have not had any notice of this, and as I say, found out about it today. It seems like every time a Secretary appears we get an emergency call from some locale where some critical problem has just arisen.

I just

MINORITY MALE GRANT PROGRAM

Secretary SULLIVAN. Sometimes we are rain makers, Senator. I will be happy to get a response back to you. I learned about this problem earlier today, and I will be happy to look into it. There are really two applications from the Urban League.

The first was for the conference grant and the second for the program grant. The second is still in process. The review process is still underway. We expect to be making some decisions this spring, but I will be happy to get this back to you in writing.

[The information follows:]

GRANT AWARD

I regret that there has been some confusion relating to the award of a grant to the Pittsburgh Urban League. In the fall of 1990, the Pittsburgh Urban League received a grant award for a conference grant in connection with our Minority Male Initiative. The Urban League received notification of its receipt of the award at that time. However, because of my keen interest in the Minority Male Initiative, that announcement was followed by a personal letter from me. Unfortunately, because my letter arrived after the official notification of grant award, it was interpreted that I was referring to a different application which the Urban League had submitted for a 3-year coalition demonstration grant, another component of the Minority Male Initiative. That application is now under review and we expect to make our final selection later this Spring.

HEALTH OBJECTIVES 2000

Senator SPECTER. Well, Mr. Secretary, my final comment is, I compliment you on your extraordinary staff, because my extraordinary staff of Earthamae Isaac, Craig Higgins, and Bettilou Taylor just told me about it, and with your staff operating as fast, you have got a very good staff. [Laughter.]

Secretary SULLIVAN. We are the kinder, gentler Department, Senator.

Senator SPECTER. Thank you, Mr. Chairman.

Senator HARKIN. I just have a couple, I am cognizant of the time here.

One is on prevention. You mentioned the Health Objectives 2000 Act, passed last year here in Congress to incorporate your health objectives 2000. As you pointed out, we are spending over $600 bil

lion a year:

Let us look at the past. How about the health objectives for 1990? Instead of eliminating tuberculosis, which is one of the goals,

38-711 0-91--2

a disease that has been curable and preventable for about 40 years, the number of cases actually increased. We are seeing an increased number of measles outbreaks and deaths from measles. Now we have the year 2000 health objectives, setting forth a fairly comprehensive set of goals for improving the health of Americans by the turn of the century.

Has the Department developed a comprehensive plan laying out for each objective which changes in Federal programs or increases in Federal funding should be made so that we can achieve in the year 2000 what we did not achieve in 1990? You have got the goals out there. Are you looking at the specific Federal programs saying these have to be increased, these have to be emphasized to achieve those goals?

Secretary SULLIVAN. Senator Harkin, the goals for 1990, which were established in 1980, involved 280 hard objectives as health goals for the Nation. We reached about one-half of those goals.

This was the first time we set goals for the Nation. About onequarter of the goals we did not reach, infant mortality being one, but the experience that we gained from this prior iteration has been very helpful to us in developing the goals for the year 2000.

These goals we refer to as national goals. They are goals which call for not only the Federal Government but State and local governments, the private sector, individuals themselves, philanthropic organizations, et cetera, to participate. We will not reach these goals with the Federal Government acting alone.

We feel very confident that the goals we have established for the year 2000—some 298 goals in 22 priority areas-are realistic. They can be reached. The experience that we gained from the prior effort will be very helpful. They include such things as bringing infant mortality down to 7 infant deaths per 1,000 live births. We know we can reach that.

Japan is already at six. At the end of World War II, Japan had an infant mortality rate much higher than ours, but they made the concerted effort, and they have been successful.

Another goal is to reduce the incidence of smoking to less than 15 percent of our population. Right now it is around 27 or 28 percent. Again, we feel that we can reach that goal, but we have to do a number of things to reach it.

We are focusing more funds on prevention, as well as trying to mobilize our citizens to understand the power that they have to influence their own health futures. By that I refer to the fact that the Public Health Service estimates that we could reduce by onethird all causes of acute disability and by two-thirds all causes of chronic disability by changing health behavior involved in the top 10 causes of death and disability in our society.

I feel optimistic that we will reach those goals. There are specific timetables. Our Assistant Secretary, Dr. Mason, can fill you in in more detail than I. He meets every 2 weeks, and goes over several of those objectives with members of his staff and others. During the course of a year all 298 objectives are reviewed in terms of the progress that has been made toward them, any problems, and the resources and organization required.

We feel optimistic and are pushing, because that has to be a central part of our efforts to improve the health of our citizens, as well as to control costs of a health care system.

HEALTH OBJECTIVES 2000

Senator HARKIN. Well, I hope that you might work with us here—we both have the same objectives—and see what we can do to assist and help in any way in terms of providing the emphasis in those areas. The health objectives really focus us toward prevention and health promotion by the year 2000.

Secretary SULLIVAN. We welcome cooperation with you, and look forward to working with you.

Senator HARKIN. If you have those, you can either submit them or just send them up, or ask Dr. Mason to work with our staff on whatever we can do to start planning ahead for next year, even, to start meeting some of those, whatever they might be.

Secretary SULLIVAN. Mr. Chairman, one other thing about the "Healthy People 2000” report is that it represents the first time, to my knowledge, that any nation has had a comprehensive series of health objectives.

I have alluded to these objectives at meetings with ministers of health from other countries. At the World Summit for Children last September I distributed goals for the health of children along with the educational goals that came out of the educational summit the President had with the Governors.

That has attracted a lot of interest from other nations who are now looking at this process and are developing their own variations. We will be happy to report to you in more detail as to how that program is working.

[The information follows:)

HEALTHY PEOPLE 2000 Consistent with the concepts that Healthy People 2000 represents a set of national, and not just Federal, goals and objectives, and that their achievement will require efforts by not only the Federal government, but also by State and local governments, the private sector, community and non-profit organizations, and by individuals themselves, it is not feasible to develop one comprehensive implementation plan. Instead, each of these actors is developing its own plans that address its share of responsibility required to ensure that these goals and objectives are met by the year 2000. The Department is leading this process by designing its own plans and by offering to provide technical assistance to others as they draw up their own. The Public Health Service (PHS), for example, is currently developing its own implementation plans covering each of the 22 priority areas for each of its constituent agencies. PHS expects to have completed this document some time this fall, and we should be able to share it with you once it is published.

However, it is also important to note that we have not waited for more plans to be developed to begin our implementation efforts. In formulating the budget request now before you, we were very cognizant of the Healthy People 2000 goals and objectives. I know that the unprecedented emphasis and budget increases for preventive activities in the 1992 President's budget are a reflection of this concern. The strategies cited in Healthy People 2000 have helped guide our selection of priorities for the 1992 budget request, and thus our resources are proposed to be focused on expanding proven prevention services targeted to childhood and other health problems particularly affecting the poor and disadvantaged; and improving the ability of Federal, State, and local governments to understand and respond to such health problems. This is demonstrated by the significant budget increases requested in 1992 in numerous prevention areas, such as infant mortality reduction, childhood immunization, breast and cervical cancer screenings, lead poisoning prevention, injury con

« PreviousContinue »