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TROPICAL DISEASES

Question. What is CDC doing to prevent tropical infectious diseases and reduce the threat of newly emerging diseases?

Answer. CDC is deeply concerned with the striking increase in tropical infectious diseases and recognizes that this problem will continue to grow. CDC is utilizing its traditional public health strength in laboratory and epidemiologic science to develop cost effective approaches most likely to have greatest impact. These include carrying out surveillance to identify disease transmission, risk factors, cases and epidemics; developing and improving diagnostic tests; carrying out epidemiologic studies; evaluating interventions, prevention and control strategies; developing and evaluating new vaccines and promoting health through training and education. Some specific examples include: studies to determine control factors which contribute to and prevent transmission of cholera and shiga dysentery; evaluation of new prophylaxis regimens for prevention of drug-resistant malaria and expansion of our network for providing public information on malaria prevention; efforts on development of a dengue vaccine through collaborative relationships with the U. S. Army Medical Research and Development Command and University of Puerto Rico. We are continuing to build our surveillance systems and technical and epidemiologic expertise in order to be ready to identify and respond to new disease problems as they emerge. The complexity of the infectious organisms involved in tropical disease and their propensity to mutate with changing virulence means that we must be able to respond rapidly and effectively to protect our populations.

LABORATORY TESTS

Question. Considerable concern has been expressed over the accuracy of laboratory tests. To address these concerns, the Congress passed the clinical Laboratory Amendments of 1988 (CLIA). It is anticipated that approximately 300,000 laboratories will be subject to CLIA. What role does CDC play in the implementation of CLIA.

Answer. Through a Memorandum of Understanding, CCC provides technical and scientific support to Health Care Financing Administration to develop and implement CLIA '88.

CDC is specifically responsible for assisting HCFA in the development of final regulations for the complexity model including the technical advisory Committee, proficiency testing and cytology aspects of the Amendments. These CDC tasks comprise developing the final rule for CLIA including the reading, coding, and tabulating comments concerning the above aspects and identifying the major issues and regulatory alternatives. In collaboration with FDA, CDC will develop a scientifically supportable set of alternatives and assist HCFA to draft regulatory text.

CDC also provides ongoing technical and scientific support to HCFA for the development of standards, resolution of technical issues, review of proficiency testing provider programs and accrediting organization standards for equivalency, and for the

development and delivery of training interventions identified through the implementation of CLIA.

Question. The practice of public health can often be imprņved by increasing the knowledge and skills possessed by the public health workforce. What is CDC doing to reach public health workers in need of essential training?

Answer. In 1988, The Institute of Medicine Report, The Future of Public Health, indicated numerous weaknesses within the infrastructure of public health in this country and outlined a series of recommendations for strengthening this infrastructure. One of those recommendations stated that public health training should place greater emphasis on managerial and leadership skills such as the ability to communicate important agency values to employees, and enlist their commitment; to sense and deal with important changes in the environment; to plan, mobilize, and use resources effectively; and to relate the operation of the agency to its larger community role. Thus, CDC is currently examining a variety of options to assist high level public health officials in strengthening their management and leadership skills.

CDC is utilizing a variety of modern training and communications techniques to increase the accessibility and efficiency of its training activities. Examples include computerbased electronic bulletin boards for exchange of health information and self study training packages to reach larger, more diverse and geographically disperse audiences.

In 1989, training was implemented at the regional and local level through the establishment of the National Laboratory Training Network which not only delivers training, but also serves as an important resource for information about laboratory training activities and materials which are available nationally and locally to laboratory professionals. CDC developed the National Laboratory Training Network (NLTN) to strengthen the skills, particularly HIV antibody testing, of laboratory workers throughout the country. The NLTN has been a success in reaching a wide variety of laboratory workers in the public and private sectors. CDC is examining its potential as a model for developing a broader public health training network designed to meet the need for improved management and health practice skills of health workers at all levels.

NATIONAL HEALTH INTERVIEW SURVEY

Question. The National Health Interview Survey is a major source of data on the health of the American people, including data on the Year 2000 Health objectives. What is the status of this survey in the FY 1992 request?

Answer. The request contains sufficient resources to fully fund the 1992 National Health Interview Survey (NHIS) ($10.7 million to direct survey costs). Data collection will continue at the full sample size of 50,000 households. In addition to items included in

each year's questionnaire, the 1992 NHIS will focus on adolescent
risk behaviors and other areas relative to the Year 2000
Objectives; cancer epidemiology and control, AIDS/HIV knowledge and
attitudes, and detailed data on income and program participation
for policy research.

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AUTOMATION AND TECHNOLOGY

Question. Your request for FY 1992 includes funding for efforts to improve the timeliness and quality of health statistics, and access to those statistics. What kinds of activities will be supported by these funds?

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Answer. The President's request recognizes that investment in improving our ability to measure our nation's health needs, and to target and measure the effectiveness of public health programs is particularly critical. All public health programs included in the President's budget, as well as medical research and entitlement programs, rely on timely, high quality data.

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The increase in the request of $3,535,000 for automation and technology development will provide the following benefits:

Increased timeliness, with considerably shorter lag time between data collection and release of published reports and electronic data to the public.

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Increased productivity through improved analytic
output, improved access to data by public and
Government researchers, and improved responsiveness in
answering public inquiries.

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Improved quality of data, by reducing the number of manual steps that introduce human error.

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Examples of activities that will be undertaken under the request include expanding the use of laptop computers in home interviews; developing automated coding and data processing systems to speed production of vital statistics; and expanding access to data through increased use of electronic data dissemination products, such as compact disk (CD-ROM) and other PC-oriented tools.

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INFRASTRUCTURE

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Question. The Institute of Medicine Report on the Public Health System stated that if State and local health agencies are to fulfill their mission of providing quality health services, they would need improvements. Dr. Roper, one of your agenda items for CDC includes rebuilding infrastructures. First, would you explain what needs to be done at the State and local health agency level. Second, please explain what needs to be done at CDC to rebuild it's infrastructure to support State and local health agencies.

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Answer. Efforts to strengthen the public health infrastructure need to focus on approaches designed to enhance the capacity of state and local health agencies to carry out the core

functions of public health such as assessment, policy development, and assurance such as defined in the IOM Report.

The ability of State and local health agencies to carry out those functions is determined by: 1) the knowledge, skills, and abilities of the public health workforce: 2) leadership, 3) the availability of resources; and 4) the organizational relationships throughout the system.

The CDC budget request includes funding to support assessment strategies with special reference to building the capacity of State and local health departments.

QUESTIONS SUBMITTTED BY SENATOR ROBERT C. BYRD

OCCUPATIONAL SAFETY AND HEALTH LABORATORY

Question. The FY 1991 appropriation bill provided $24 million to begin construction of the new occupational safety and health laboratory. Please provide a timetable for the completion of this project.

Answer. The architectural and engineering contract for the new laboratory was awarded in September 1990.

We anticipate construction to begin in June 1992 and be completed by November 1994.

MORGANTOWN LABORATORY POSITIONS

Question. I am concerned over the number of positions that remained unfilled at the Appalachian Laboratory on Occupational Safety and Health. What steps are being taken to fill those vacancies?

Answer. CDC has committed to a special recruiting effort for the Morgantown NIOSH laboratory. We have employed a personnel generalist at the facility to plan increased recruitment to address current and future needs. NIOSH is assigning the new occupational safety and health laboratory building team with the responsibility of carrying out recruitment activities according to the plans being developed.

Question. Please provide a list of the number of FTE's at the Appalachian Laboratory on Occupational Safety and Health for FY's 1990, 1991 and the projected number of FTE's for FY 1992. Also include the number of actual people on board as well as a list of vacancies.

Answer.

The number of FTE's and a list of vacancies follows:

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As of Febraury 22, 1991, 212 employees were on board in Morgantown.

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Deputy Director, Division of Respiratory Disease
Studies (DRDS)

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Chief, Safety and Controls Section, Division of Safety & Research (DSR)

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Chief, Science and Policy Coordination Activity (DSR)

Assistant Chief, Certification and Quality Assurance
Branch (DSR)

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