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Immunization is the most efficient and

successful method for preventing many childhood diseases.

With the

Immunization is the archetypical example where paying for a prevention program saves money by reducing medical care costs. For example, immunizations were responsible for dramatic decreases in reported cases of vaccine-preventable diseases, and it is estimated that savings for each $1 spent on the measles/mumps/rubella vaccine range from $10 to $14. Unfortunately, in some urban areas, only 50 to 70 percent of 2-year-old children may be adequately immunized. requested funding increases, we can reach these children. The President's budget includes an increase of $43.2 million to (1) buy as many vaccine doses as we purchased in 1990, (2) remove administrative barriers to vaccine delivery, (3) reward programs that are most successful in increasing immunization of 2-year-olds, (4) expand outreach demonstrations to evaluate coordination with public assistance programs, and (5) screen for hepatitis B infection in 95 percent of pregnant women who receive prenatal obstetric care in the public sector and immunize about 18,000 infants against this disease.

Infant mortality.

Although the rate of infant mortality reached an all-time low in 1989, the rate of progress has slowed and we still have one of the highest rates among industrialized nations. With the requested increase of $5 million, we will expand our support to states for surveillance and epidemiologic studies of infant mortality, especially as related to racial and ethnic disparities. Medical care costs for each low birth weight baby are between $14,000 and $30,000 more than for larger newborns. Cigarette smoking during pregnancy accounts for 20 to 30 percent of low birth weight infants, about 14 percent of pre-term deliveries, and about 10 percent of infant deaths.

Pregnant women will continue to be one of the specific
population groups CDC targets for smoking cessation efforts.
CDC plans to work with states and the Health Resources and
Services Administration to expand the Smoking Cessation in
Pregnancy program to as many states as possible.

Sexually transmitted diseases (STDs). Reported cases of
congenital syphilis increased from about 650 in 1988 to more
than 7,000 in 1990. Although much of this increase can be
attributed to widespread use of the new case definition, the
upward trend is nevertheless clear. With an increase in
funding of $4.6 million for sexually transmitted disease
control, we will expand our intervention strategies for
high-risk women to prevent congenital syphilis. This
increase will allow us to ensure syphilis screening for
pregnant women, improve communications between STD clinics
and hospitals that deliver large numbers of high-risk
infants, and work with prenatal care providers to identify
high-risk mothers early in their pregnancies.

The Public Health System

Just as we need to have the best professionals and resources at CDC, the nation's state and local public health agencies need to have the best people and programs to provide leadership in prevention. We also need to be able to assess our progress in improving public health, and especially our progress in working towards the Year 2000 Health Objectives for the Nation set out in Healthy People 2000.

Preventive Health and Health Services Block Grant. CDC' Preventive Health and Health Services Block Grant will serve as a major vehicle to provide support to states for addressing the Year 2000 Objectives. The President's budget includes an increase of $10.6 million for the grant itself

as well as $4.1 million for improving reporting and helping states assess their progress.

Surveys. CDC will have a primary role in assessing national progress toward the Year 2000 Objectives. We have already

begun working with state and local health agencies to develop a common set of indicators for measuring health in every community. The President's budget includes an additional $14.8 million to provide full support for all of our existing national health surveys and to expand the use of automation and better technology for data collection and


HIV Infection/AIDS

HIV/AIDS prevention programs remain a high priority for the nation as well as for CDC. We continue to face many challenges, including HIV infection in women and children, slowing the epidemic among high-risk youth, and preventing HIV transmission in rural America, in the criminal justice system, and in healthcare settings. In FY 1991, funding for prevention programs for HIV/AIDS made up more than one-third of CDC's overall budget. The same high level of funding appropriated in FY 1991--$494.7 million--is requested for FY 1992. This represents a 31 percent

increase over FY 1989.

In closing, I'd like to recognize the 20th anniversary of the establishment of CDC's National Institute for Occupational Safety and Health (NIOSH). We are extremely proud of the contributions that NIOSH has made in the last two decades, and we are looking forward to continuing that strong tradition. We have recently undertaken a new challenge to improve farm safety and health. The 9 million farm workers and family members in this country bear a disproportionate share of injuries and disease. As you

know, this major health problem will be the topic of the Surgeon General's Conference in Des Moines, Iowa, next month.

Mr. Chairman, with your support for this budget request of $1,396, 927,000 in new budget authority, we will be able to reach more Americans with our prevention programs and make a difference in the health of this country and the world.

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Feb. 1989-
Feb. 1990

May 1986-
Feb. 1989

Dec. 1983-
May 1986

Sept. 1982Aug. 1983





Director, Centers for Disease Control

Deputy Assistant to the President for Domestic Policy,
Director, White House Office of Policy Development

Administrator, Health Care Financing Administration

Special Assistant to the President for Health Policy

White House Fellow

Assistant State Health Officer, Alabama Department of
Public Health, Birmingham, Alabama

Health Officer, Jefferson County Department of Health,
Birmingham, Alabama

Community Fellow, Department of Health and Hospitals,
City and County of Denver, Colorado

Resident in Pediatrics, University of Colorado Medical
Center, Denver, Colorado


: American Academy of Pediatrics
American Medical Association

American Public Health Association

Medical Association of the State of Alabama

Jefferson County Medical Society

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Phi Theta Kappa, Junior College honorary

Who's Who Among Students in American Junior Colleges

University of Alabama:

Phi Beta Kappa

Outstanding Senior in Chemistry

Distinguished Undergraduate Scholar of the College

of Arts and Sciences

University of Alabama School of Medicine:

State Merit Scholar

Alpha Omega Alpha


Senator HARKIN. Dr. Roper, thank you very much.

I wonder. I have these charts here. Could we kind of just go through those, and could you highlight those for me?

Dr. ROPER. Sure.

Senator HARKIN. I would appreciate that.

Dr. ROPER. Again, this chart shows three priorities. CDC's making prevention a practical reality, improving the health of children, and strengthening the Nation's public health system.

The second chart makes a point that I hope is not lost on this committee, if I can be blunt about it. This deals with our budget over the decade of the 1980's. The top of those bars is the overall budget for the Centers for Disease Control, left hand 1981 fiscal year and the President's budget for 1992 at the right hand.

As you can see, we have grown from almost $300 million to $1.4 billion, truly stupendous growth over that period. However, if you look within the numbers, it tells a different story. The red portion of the bar is AIDS funding. It is an important activity. We are spending the money well, we believe, but a large part of our budget growth is directed at AIDS and HIV.

The green is programs that were newly added to our activities; that is, things like Lyme disease which you mentioned in your question earlier on injury control. Those were activities that were not there in 1981. So most of our expansion has gone into those

new areas.

The blue portion of the bar is what I want to draw your attention to particularly. That is what we call our core programs. Those are the nongrant programs which represent CDC's ability to meet unexpected problems should they come along.

Over this 12-year period, core programs have actually gone down in nominal dollars and has surely gone down when you apply the biomedical price deflator, which is represented by the black line. That erosion of our core is what has lead us to take a number of economy measures over this 12-year period. We are to the point that we are starving to death internally while at the same time enjoying this rich abundance of cash for new activity. It is a problem that we have had a chance to talk with your staff about in great detail, and I would welcome a chance to visit with you more.


We badly need the support for CDC's own infrastructure, meaning people and laboratories and equipment and so on, if we are

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