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economically disadvantaged populations. Increases will provide funds for CDC programs on smoking and health, breast and cervical cancer mortality prevention, injury control, tuberculosis control, and prevention effectiveness.

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CDC will also emphasize programs that focus on the health of children, such as elimination of lead poisoning, immunization, reduction of infant mortality, and prevention of congenital syphilis. CDC will also work to improve the Nation's public health system a need demonstrated by the Institute of Medicine's report, The Future of Public Health. With increased funds for the Preventive Health and Health Services block grant, CDC will be better able to track progress toward the disease prevention and health promotion objectives set out in Healthy People 2000. Other PHS agencies, not under the jurisdiction of this Subcommittee (the Food and Drug Administration, the Indian Health Service and the Agency for Toxic Substances and Disease Registry) will also play strong health promotion and disease prevention roles in our efforts to achieve the objectives included in Healthy People 2000.


The benefits of biomedical research lead directly to improvements in the Nation's health status and reductions in the societal cost of illnesses. Biomedical research builds for the future, enhances the competitiveness of the United States in science and technology, yields innovations that can be developed by industry, and contributes to a climate of increased private sector investment in applied and

developmental research. Basic research is also the bedrock of prevention activities for the future.

In the research area, the FY 1992 budget requests $8.8 billion for the National Institutes of Health (NIH) and $1.1 billion for the Alcohol, Drug Abuse and Mental Health Administration (ADAMHA). This request continues the

Administration's investment in biomedical research and research training, while at the same time, enhancing biomedical science opportunities and promoting science education and literacy in the United States.


Investigator initiated research continues to be a very high priority of the PHS. The FY 1992 budget request will support 24,291 research project grants, 665 more than in FY 1991. NIH portion of this request (21,818 grants, a 632 grant increase) represents the highest grant level ever funded. addition, we will be able to increase the amount of the average award by

5.6 percent.


The Agency for Health Care Policy Research will continue to support research studies to improve the effectiveness and appropriateness of health care by enhancing our understanding as to what medical and surgical interventions are most effective.


The "War on Drugs" continues to show success. Current overall drug use has declined 11 percent from 1988 to 1990. Adolescent drug use has declined 13 percent during the same period of time. Occasional cocaine use has declined 29 percent and frequent cocaine use has declined 23 percent. Current

adolescent cocaine use has declined 49 percent. Drug related medical emergencies have been reduced 18 percent.

This budget proposal continues the PHS commitment to_the "War on Drugs" by requesting an additional $117 million for anti-drug abuse activities aimed at research, treatment and prevention in ADAMHA and FDA. Long term, stable, and concerted efforts are beginning to show that improved prevention and treatment programs and techniques can be developed.


A new $99 million Treatment Capacity Expansion Program will be instrumental in closing the gap in treatment services. purpose of this program is to assist states to expand effective and comprehensive drug treatment. Special emphasis will be placed on high-risk populations, with careful attention to the unique needs of racial and ethnic minorities, pregnant and postpartum women and their substance-exposed infants, the homeless, residents of public housing, and adolescents (particularly those involved with the criminal justice system). The new program, together with other ADAMHA programs, will increase FY 1991 treatment levels by about 25,000 people.


The PHS budget includes $485 million of activities that directly impact minority health, a $47 million increase over FY 1991. Highlights of this request include: $15 million to provide extramural construction at Historical Black Colleges and Universities and similar institutions so that researchers at minority institutions may be better able to compete for NIH research grants; recapitalizing HRSA's Health Professions Student Loan program ($12 million) and expanding the National Health Service Corps scholarship and loan repayment program ($5 million) to provide additional loan repayments and scholarships to disadvantaged and minority health professionals; and $9 million for NIH HIV/AIDS research activities.


AIDS continues to be a major public health problem in the nation and around the world. In the last 12 months, more than 42,000 new cases were reported. Women are now almost 12 percent of new cases. Almost 800 new cases in children were reported last year; nearly 90 percent of them were born to an infected woman.

The epidemic continues to ravage our racial and ethnic minority populations: Among men, more than 41 percent of cases are in minorities. For women, the figure is more than

73 percent, and for children with AIDS it is above 78 percent. Most cases continue to occur in the large cities of our Nation, but increasingly reports of cases are coming from smaller cities, towns and rural areas across our country.

In the face of these problems, our budget request of $1.9 billion for AIDS reflects a continuing emphasis on the basic areas in which we have the best opportunity for longterm benefits (basic research, development and testing of new therapies and vaccines, and risk assessment, education, and prevention programs). We have also requested monies to continue treatment programs authorized under the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act. Also, we are requesting money for CDC prevention programs under Title III of the CARE Act. We are concerned, however, that this

authorization divides the money between traditional prevention efforts and early intervention activities for people who are infected, thus, reducing monies available for counseling, testing, and partner notification programs.


The major programs funded in the FY 1992 budget request for the Office of the Assistant Secretary for Health (OASH), focus on finding approaches that encourage healthy behavior and lifestyle changes. The Adolescent Family Life (AFL) Program, with a budget request of $12 million, is the only Federal program solely focused on the complex issues and problems of early adolescent sexual behavior, adolescent pregnancy and parenting. An increase of $4 million in the AFL program will permit support of evaluation intensive projects to measure the effects of new and innovative approaches; increase the geographic scope and range of intervention model demonstrations; and increase the number of research projects.

The Office of Disease Prevention and Health Promotion oversees, coordinates and manages the "Healthy People 2000" objectives. In implementing the objectives, the office provides special focus to school health and worksite health promotion. The Office also is responsible for coordinating the Department's nutrition policy with the Department of Agriculture. The FY 1992 President's Budget includes $4.6 million for these efforts.

The President's Council of Physical Fitness and Sports, with a $1.4 million budget request, is responsible for promoting knowledge and understanding about physical fitness, sports and health as well as encouraging participation in physical fitness activities.

The Office of Minority Health has assumed increasing responsibilities as the Department's advocate in issue areas which impact on the health of minority populations. In FY 1990, the Office assumed a leadership role for implementing the Secretary's initiatives for minority males and is continuing in this role in FY 1991. The Office also acts as a catalyst to spur PHS agencies and other public and private entities to identify opportunities where existing programs and resources can be directed to promoting health and preventing disease among minority populations, and to develop innovate strategies to improve the health status of minorities. The

FY 1992 request of $20 million will allow us to continue these cooperative activities and to develop a network of private and public partnerships to address minority health needs.

Finally, OASH is requesting $2.3 million for coordination of PHS immunization activities by the National Vaccine Program Office (NVPO). The decrease of $7 million in this program is offset by corresponding increases in the budgets of CDČ, NIH and FDA to support vaccine initiatives that were previously funded by NVPO.

Mr. Chairman, I will be happy to answer any questions you

may have.


James O. Mason, M.D., Dr. P.H., was sworn in April 21, 1989, as Assistant Secretary for Health, Department of Health and Human Services. Dr. Mason was nominated by President Bush April 7, 1989, and confirmed by the Senate April 19, 1989.

Before assuming responsibility for the U.S. Public Health Service, Dr. Mason had served, since 1983, as director of the Centers for Disease Control and administrator of the Agency for Toxic Substances and Disease Registry. During his tenure at CDC, Dr. Mason also served as acting Assistant Secretary for Health from February to December 1985. Dr. Mason served as executive director of the Utah Department of Health, with responsibility for health and health care financing, from 1979 to 1983. He was associate professor and chairman of the Division of Community Medicine, Department of Family and Community Medicine, at the University of Utah College of Medicine from 1978 to 1979. He directed a multiple-hospital health care corporation owned by The Church of Jesus Christ of Latterday Saints from 1970 to 1975.

As Assistant Secretary for Health, Dr. Mason directs the activities
of the Public Health Service, which includes eight agencies: the
Alcohol, Drug Abuse and Mental Health Administration; the Centers
for Disease Control; the Agency for Toxic Substances and Disease
Registry; the Food and Drug Administration; the Health Resources and
Services Administration; the National Institutes of Health; the
Indian Health Service; and the Agency for Health Care Policy and

Dr. Mason provides policy guidance as well for HHS programs outside of PHS, and maintains relationships with other government and private agencies concerned with health. He advises and assists the Secretary on health policy and on all health-related activities of the department.


Dr. Mason was born June 19, 1930, in Salt Lake City, Utah. received his B.A. and M.D. degrees from the University of Utah in 1954 and 1958. He received his master of public health and doctorate of public health from the Harvard School of Public Health in 1963 and 1967. Dr. Mason served his internship at Johns Hopkins Hospital in Baltimore from 1958 to 1959, and was an internal medicine resident at Peter Bent Brigham Hospital, Harvard Medical Service, in Boston from 1961 to 1962.

He has received numerous honors and awards. Among these are the Public Health Service Distinguished Service Medal (1988) and the University of Utah's Distinguished Alumni Award (1973). He is a member of a number of honorary and professional societies including the American Medical Association, the Institute of Medicine of the National Academy of Sciences, and the American Public Health Association. He has served on many national and international committees, councils, boards and task forces, including the United Nations Development Program/World Bank/World Health Organization Special Program for Research and Training in Tropical Diseases, Scientific and Technical Advisory Committee; and the National Institutes of Health Recombinant DNA Advisory Committee.

Dr. Mason is certified by the American Board of Preventive Medicine. He has written numerous articles and book chapters on a wide range of subjects related to the prevention and control of disease. He is a national spokesperson on the prevention and control of infectious disease, chronic disease and injury, and a leading architect of public policies concerning these health problems.

Dr. Mason and his wife, the former Marie Smith, have five sons and two daughters: James, Susan, Bruce, Ralph, Samuel, Sara and Benjamin.


Dr. MASON. Thank you, Mr. Chairman, Senator Stevens. I am pleased to appear before you to discuss the fiscal year 1992 budget request for the Public Health Service. With your permission, Mr. Chairman, I am submitting for the record a more detailed statement on our proposal and our priorities. Let me take just a few minutes here to give you an overview as to what is embodied in that proposal.

As you have stated, the discretionary budget request for Public Health Service agencies under the jurisdiction of this subcommittee totals $15.3 billion, an increase of $542 million or 3.7 percent over fiscal year 1991 appropriations.

Senator HARKIN. If I might just stop you right there. I said $15.6 billion. I understand the difference in those two represents the mandatory programs; is that right?

Dr. MASON. Right.

Senator HARKIN. Thank you. I just wanted to clear that up.

Dr. MASON. This budget represents a deep commitment on the part of the President and the Secretary to the major health problems that we face as a nation. For fiscal year 1992 we have grouped our spending priorities around three principal themes: First, the prevention of disease with special emphasis on health promotion and prevention of infant mortality and childhood diseases; second, the stabilization and enhancement of basic biomedical research and behavioral research; and third, the enhancement of efforts to prevent and treat drug abuse.

Many of the details in this budget center around "Healthy People 2000," our Nation's new master plan for increasing the span of healthy life, reducing health disparities among Americans, and achieving access to preventive services for all Americans. The master plan includes 300 realistic and measurable objectives. The PHS will expand its health promotion activities to change behavior and expand high-priority health protective activities and preventive


The budget proposes several new initiatives, including ones that address infant mortality, lead poisoning, immunization, and breast and cervical cancer prevention and control. This budget proposal makes major new investments in biomedical and behavioral research, science education, and science literacy, all of which are investments we must make to enhance the quality of health care services in our country and to improve our Nation's competitiveness in science and technology and to ensure that our Nation will have a steady stream of bright new scientific minds to meet today's and tomorrow's needs.

This budget proposal seeks to build on our past successes in the war on drugs by expanding research and treatment resources with special emphasis on the Nation's high-risk populations. I believe that our fiscal year 1992 budget request shows this administration's commitment to the health priorities of our Nation.


I would be very pleased now with the help of these individuals that are here with me, Mr. Dennis Williams representing the As

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