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going to be the leaders in prevention that we and you want us to


Let me just quickly go through the remainder of the charts.


Dr. Mason mentioned the CARE funding, the AIDS funding. This chart makes the point that under the CARE legislation some States will enjoy an increase in funding. However, most of them will see a decrease in funding because of the way the formula in the chart reapportions the flow of dollars.

When you look within the total at the amount of funding that goes for counseling and testing, you see in red those States that will have a decrease in funding, and the increases are hard to find.


Then the final chart, if I may draw one other analogy to Desert Storm. People these days in their op-ed columns are telling us what the lessons are to be drawn from Desert Storm. One of them is to have clear objectives. You just talked about "Healthy People 2000." These are the objectives where we want to go in prevention.

The second, insuring popular and political support, is why we are having this hearing. We are trying to convince each other and, through you and us, the Nation, that prevention is a powerful idea whose time has come.

Third, there are some of us who presume to be public health generals or admirals, and we would like the ability to do our job just as Powell and Schwarzkopf were allowed to do their job. However, we have to be just as successful in delivering results as they were if we are going to be able to be given reign to do our jobs in the future.

Finally, the effort in the gulf was successful because they applied massive effort against a problem. Again, sir, that is why we are here today, trying to get some of this massive effort that we can use in fighting the battle for prevention.

Thank you, sir.

Senator HÁRKIN. Thank you, Dr. Roper.

I would recognize Senator Specter.


Senator SPECTER. Thank you, Mr. Chairman. I regret my unavailability for most of the hearing today. I came in a short while ago. We had a hearing on the Defense Appropriations Subcommittee. We have multiple hearings going on all the time, but there were two major issues there, a carrier fleet which impacts on the Philadelphia Navy Yard, and the V-22, which impacts very heavily on my State. These required my primary attention this morning.

When you made a comment about agency programs you had funding for but now some new programs you have funds available that you will be inquiring into, I did not fully understand what you said on that, Doctor.

Dr. ROPER. It is a general point that I am sure you have heard from other agencies, Senator. We typically receive funding directed

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at newly discovered problems or hot issues, hot topics. While we are happy to get that directed funding, what we especially need is support for our base program, because it is that core that allows us to be ready for unexpected problems.

Last year, for example, we had a real scare about a new virus that could have been a major public health threat in this country. It was brought in through monkeys being imported into the country. Nobody could have predicted that problem. We need the capability to be prepared to deal with these unexpected issues when they come along.


Senator SPECTER. Dr. Roper, one issue which has received a fair amount of notoriety and has been a matter of concern in Scranton, PA, has been the question as to whether high voltage electrical lines are related to cancer incidence or, more specifically, to leuke


Dr. ROPER. Yes, sir.

Senator SPECTER. I would be interested to know if you have any insights into that issue.

Dr. ROPER. I do not have personal insights. I am quite familiar with the issue, Senator. The National Institute on Occupational Safety and Health, one of CDC's agencies, is conducting several studies about electromagnetic fields and their potential to cause health problems and has recently convened a national meeting on the subject. The National Cancer Institute is similarly conducting studies in that area, and I think the summary statement is the jury is out on the issue of power lines and their effect on health. Senator SPECTER. I had made an inquiry about the possibility of a study as it relates to a specific locale, which is Scranton, an area I had visited. It illustrates the problem, very high powered lines and representations by people in the community.who are alarmed to the maximum extent about cancer, leukemia, illnesses of people in that immediate vicinity.

What is the reality, Dr. Roper, on the availability of your organization to make an inquiry on such an issue to try to make a factual determination as to whether that is a cause of the maladies or illnesses in the area?

Dr. ROPER. I am not aware of the Scranton request in particular. I would love to get it and discuss it with you or your staff and the people locally there in Scranton. We do those kinds of studies, and other parts of the Public Health Service do them as well. We would like to take a look at it carefully.

Senator SPECTER. I had written to you, Dr. Roper, back on November 20 concerning this issue. Let me make this correspondence available to you.

Dr. ROPER. Yes, sir.

Senator SPECTER. I realize that you have a very heavy volume, but I would appreciate your reviewing this

Dr. ROPER. I would be happy to, sir.

Senator SPECTER [continuing]. And making a response as promptly as you can.

Dr. ROPER. Yes, sir.

Senator SPECTER. Thank you very much.

Thank you, Mr. Chairman.

Senator HÁRKIN. Thank you, Senator Specter.

Can I ask a nice softball, leading question here, Dr. Roper.
Dr. ROPER. Yes, sir.


Senator HARKIN. The Centers for Disease Control is the central agency on disease prevention and health promotion. In an effort to give proper recognition of this work and to better showcase the Federal Government's growing commitment to prevention-as you said, its time has come, and I had not thought of it that way, but I think you are right-would it make sense for CDC's name to include prevention?

We talked about that. I do not know. Some people say, well, it is not that big a deal. I am sensitive to the fact that Centers for Disease Control is a name that is well recognized. People know what it is. It has a very cognitive recognition right away.

Dr. ROPER. Yes, sir.

Senator HARKIN. I am just wondering if adding that word "prevention" in there, Centers for Disease Prevention and Control, might heighten the awareness of people on prevention and also to give you a stature there-you are already doing the work-to highlight that portion of your work.

Dr. ROPER. It is a good question, and I may take a minute to an

swer you.

CDC has been around for 45 years. We are the Nation's prevention agency, and I want to stress that point. There are a lot of people who are happy to jump on the prevention bandwagon. We have been doing prevention for 45 years and want to do much more of it. You can be sure of that.

In Dr. Mason's presentation to you showing the portion of the PHS budget that is devoted to prevention, all of our budget was in there because it is generally recognized and appropriately so that everything we do is prevention.

Your question is, would we be advantaged by changing our name to include the word "prevention." I confess that the very reservation you mentioned was utmost in my mind when I first heard of your bill; that is, we have a name that means something to people, just like the initials NIH and FDA and whatever conveys something to folks. But if that is what it takes to get the message across that we are prevention and we are the Nation's prevention agency, I have to say I have an open mind leaning toward enthusiasm and appreciate your support.

Senator HARKIN. Thank you. I am sensitive to it. You do not want to just change something that people recognize, but if it will help and really promote it and get you out there in the public's mind on this, well, then, maybe it is something we ought to do. I wanted to discuss it with you and see if that is the direction in which we might want to go.

I have to tell you in response to what you just said that I recognize what you have been in the Centers for Disease Control for all these years. You say you want to do more in that area, and if I have anything to say about-and I think I will have some say about it-I can guarantee you that for the next 5 or 6 years we are

going to be working very closely with you on this whole area of prevention.

Dr. ROPER. Right. If I can just put in a commercial now, when you think prevention think CDC. [Laughter.]

Senator HARKIN. You are right. Do not worry, I will.

I really want to also get a better handle on this. I was just talking to staff about this core support thing. You are right. We come in and we say we want you to focus on AIDS, we want you to focus on this and start targeting all these things. Not to say that is bad, but if we start going out there after all these individual things and your whole core support out there erodes, we might be setting ourselves up for a really bad situation if we have an outbreak here of whatever it might be.

Dr. ROPER. Yes, sir; and I surely do not want to be the CDC Director hauled before a committee of the Congress and beat upon for not being ready. We want to be prepared for even unexpected problems to come along.

Your colleague, Senator Bumpers, was down to see us back in January, and we took him through some of our laboratory facilities that are doing good work for the Nation. Those laboratories were designed in the fifties and are badly in need of upgrading to be state-of-the-art science. That is part of this issue about the core that I was telling you about.

Senator HARKIN. He beat me to it, but I want you to get ready for a visit by me. I am coming down there shortly. Dr. ROPER. Thank you, sir.

Senator HARKIN. I will give you plenty of notice.
Dr. ROPER. Give us 1 hour, and we will be ready.


Senator HARKIN. I will give you more notice than that.

I am glad you are doing that conference on the farm safety and stuff like that.

Dr. ROPER. It is a problem that has largely gone unrecognized, but farming is a very hazardous occupation, and we are anxious to highlight to the public what can be done to make tractors safer and a variety of other things.


Senator HARKIN. Remind me to send to Dr. Roper-a nurse in Iowa whose name is Carolyn Kern did a study.

Do I have it there? That is it. I did not know you had it. I was not prepared to talk about this, but Carolyn Kern did a research paper on farm-related injuries to children. It was a study that was not, how do I say, a full study, but just to see if there really is something there worth looking into. She wrote an article about it. Her conclusion substantiates the suspicion that farm safety for Iowa's children is a problem. She did it only in Iowa. I recommend it to you. Perhaps during your time in Iowa you might want to bring her in.

Dr. ROPER. I would love to visit with her.

Senator HARKIN. She is a registered nurse, and she is also the wife of a farmer and lives on a farm. When I was reading the arti

cle, it really is quite startling, the number of kids who are hurt on farms.

Again, I will just tell you that what has happened is that our machinery has gotten bigger, it has gotten quicker, it is more mechanized, and things just work a lot faster than they used to. A lot of these kids are out there and are either around the machinery or they are working on weekends and Saturdays and after school, and a lot of serious injuries are occurring to these kids. So I would really appreciate your looking at that. I will send along this study

Dr. ROPER. Just to make your point, if I could, Senator, 300 children per year die from farm-related accidents. That is a sizable number.


Senator HARKIN. Are you looking at steps that should be taken to get a health or education program into schools that are basically in rural areas to prevent injuries to children living on farms?

Dr. ROPER. Yes, sir; part of this whole effort on farm safety and health is to develop educational outreach capabilities. In another part of CDC, over the last couple of years, we have developed close relationships with the schools in our HIV and AIDS education efforts. We are anxious to marry those to deliver messages on farm safety and health in the schools.


Senator HARKIN. One other thing. It is my understanding that birth defects are the leading cause of infant mortality in rural States and that studies have shown an association between those birth defects and chemicals used in farming.

Is CDC doing anything to look at this problem?

Dr. ROPER. Yes, sir; we have, as part of the farm safety and health activity, a study underway surveying the health problems on the farm, including birth defects. We will have more to report to you on that score later, but we are investigating it.


Senator HARKIN. Very good. I wanted to ask you about smoking, but I covered that pretty well with Dr. Mason. If you have any observations on this

Dr. ROPER. I would just say that your ardor, your ire, if you will, is appropriate. We ought to stop this Nation from killing so many people through smoking. It is a national tragedy that should be a real embarrassment to us. We have a long way to go.


Senator HARKIN. Yes; we do, and I have stuck my neck out a couple of times on this, and I am going to stick it out again here today. I will probably get my head taken off, but that is all right. We have public policies in this country.

You know, right now we spend all this money in the Government to try to cut down on people smoking. We know it is a health risk.

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