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Within prevention, HIV and AIDS activities make up a substantial portion of our budget, and I would be happy to comment on those in detail if you should wish.

I would close my prepared remarks by drawing attention, sir, to this brochure which is the Surgeon General's Conference on Agricultural Safety and Health which will be held in Des Moines the first of May. I look forward to seeing you in Iowa.

We are having this conference because of your leadership and look forward to that which occurs in the 20th year of the National Institute on Occupational Safety and Health's existence. NIOSH, as you know, is a part of CDC, and we want to celebrate their 20th anniversary with this conference that we are going to have in your home State.


Again, I would stress that CDC is the Nation's prevention agency. We are pleased to have this recognition that you have given us with your legislation, that the President has given us with his budget. There is much that remains to be done. Thank you, sir, very much.

[The statement follows:]


Mr. Chairman, it is a pleasure to be here today at the beginning of my second year as Director of the Centers for Disease Control (CDC). I am particularly pleased to be able to testify on behalf of the exceptional budget the Administration has proposed for CDC. It is a budget that shows that President Bush shares your view and ours that prevention is a prime means of protecting the health of our citizens. This is the first time that any President's budget has devoted an entire chapter to prevention programs throughout the Federal government.

are exciting and challenging times.

Simply put, these

One of the most rewarding aspects of my first year as CDC Director has been to work closely with the talented and dedicated professionals who are the heart and soul of CDC. As I have traveled throughout the country and recently to Africa, I have learned the main reasons for the agency's distinction are its commitment to prevention and its willingness to be held accountable to the public. CDC realizes that public resources come with responsibility, a responsibility to get the maximum benefit out of what you have given us. We know we must deliver what we have promised. CDC willingly accepts that responsibility.

Prevention is CDC's mission. It makes sense, not only in terms of improved health and quality of life, but also in fiscal terms. An investment in prevention is an investment in the future, and CDC will use the public funds entrusted to us to fulfill our responsibilities by improving the health of the American people.

We know the importance of being ready to meet the new prevention challenges that continually emerge. It is incumbent upon us to think about the future even as we cope with present problems affecting the lives and health of Americans. To remain in a


state of readiness requires constant vigilance. We will continue to update antiquated equipment and repair aging structures. know that improving our basic capabilities lacks the glamour of fighting a new deadly virus. But to continue to handle emergency situations effectively, as we did last year when a potentially lethal filovirus entered this country in monkeys, we must also continue to invest in the technology and trained personnel required to maintain our competence.

As the national prevention agency, many of the steps CDC will take in FY 1992 will contribute to our attaining the national objectives in Healthy People 2000. CDC also has three broad goals that define our leadership responsibilities:

making prevention a practical reality,

improving the health of children, and

strengthening the nation's public health system.

We believe we can make a difference in each of these areas with our FY 1992 budget request of $1,430,727,000 in CDC program activities,

This represents a net increase of $100,141,000 over FY 1991. Of this total request, $1,396,927,000 is proposed as new budget authority.


The increases in CDC's FY 1992 budget will enable us to expand the application of proven prevention strategies, with special attention to children and adolescents, women, and economically disadvantaged populations.

Smoking and health.

Tobacco use is responsible for more than one of every six deaths in the country and is the most important single preventable cause of death and disease in our society. With our requested increase of $3.5 million, we plan to send our message of the hazards of tobacco use to

an expanded audience that will specifically target

racial/ethnic minorities, women, children and adolescents, and blue collar workers--groups that have relatively high rates of smoking.

Breast and cervical cancer mortality prevention.


Studies in the United

50,000 women die of breast or cervical cancer each year, and many of these deaths are preventable. States and Sweden demonstrated the cost-effectiveness of

screening and early detection of these cancers. In passing the Breast and Cervical Cancer Mortality Prevention Act of 1990, Congress provided the framework for CDC's national breast and cervical cancer control program. With an

increase of $20.7 million for this program, CDC will be able to fund comprehensive programs in approximately 10 states in 1992 and ensure laboratory and X-ray quality assurance measures are implemented in all 50 states.

Injury control.

Unintentional injuries constitute the

fourth leading cause of death in this country and account for more than 2.3 million years of premature death. Every 51 seconds someone is treated in an emergency room for injuries from a bicycle crash, and every 10 hours someone dies from those injuries. With an additional $2 million for our injury control program in 1992, we will develop an information campaign aimed at increasing the use of child safety seats, seat belts, bicycle helmets, and other protective equipment. In this campaign we will also

emphasize the role alcohol plays in injuries, especially among teenagers.

Tuberculosis control.

Tuberculosis is completely

preventable, and yet since 1984 more than 31,000 cases have

occurred above expected levels. The Department of Health

and Human Services has published a strategic plan to
eliminate tuberculosis in the United States by the year
2010. To work toward meeting this goal, with the
President's request for an additional $3.2 million, CDC will
increase the number of grants for tuberculosis control,
increase the number of outreach workers by 20 percent, and
expand programs providing preventive therapy by 40 percent.

Prevention effectiveness.

If prevention is to become an

integral part of our nation's health care system, we must expand our knowledge of what works, in what settings, for which groups. CDC is evaluating the efficacy of new interventions and comparing the benefits of prevention programs with their costs. The President's budget includes an additional $2 million for assessing prevention effectiveness. With this funding, we will be able to be more aggressive in evaluating new prevention technologies. The information we gain will aid all of us in making better use of our health resource


Children's Health

Our children are our most important investment and our future. A number of CDC's programs focus on the health of children.

Elimination of childhood lead poisoning.

CDC had a major

role in developing the Department of Health and Human Services' Strategic Plan for the Elimination of Childhood Lead Poisoning. Almost 6 million children live in houses containing lead-based paint. Our program encompasses many of the activities recommended in the Strategic Plan. Our categorical grant program for screening and referral of children will reach about 14 states by the end of this year. With an additional $6.8 million, we will be able to expand the program to 23 states in 1992.

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