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developed and the infrastructure for abatement increases, which will allow more homes to be abated for a given amount of money.
The Administration's 1992 budget for the Department of Housing & Urban Development (HUD) calls for an increase of $25 million to be earmarked for abatement. Using the same estimate of $6,500 to abate a unit, this increase would pay for around 4,000 abatements. Lead abatement is also an eligible activity under many other HUD assistance programs, such as public housing modernization, property improvement loans, and community development action grants. However, since lead abatement is not the only purpose of these programs, it is difficult to estimate how much of their funds are used for lead abatement.
Question. At these funding levels, how long will it take to eliminate childhood lead poisoning in this country?
Answer. The Strategic Plan envisions that a concerted society-wide effort could virtually eliminate childhood lead poisoning in 20 years. However, the funding levels called for in the Strategic Plan are for a shared effort by the private and public sectors, not just for Federal government costs.
Question. The Strategic Plan addresses the childhood lead poisoning problem. While children are obviously the number one priority of a lead poisoning prevention program, lead poisoning is a serious problem for adults as well. The work place, food and water have been identified as major sources of lead exposure for adults and older children. Adverse effects of lead may include impaired reproductive capabilities and high blood pressure. Senior adults may be at particular risk due to the mobilization of lead in their bones during osteoporosis or as part of the normal aging process.
Do you agree that we also need a strategic plan to address adult lead poisoning prevention?
Answer. Occupational lead poisoning is a significant public health problem, although childhood lead poisoning is a higher priority public health concern. Workers in certain industries and certain specific work places are highly exposed (blood levels greater than 25 micrograms per deciliter of whole blood). Based on case reports of elevated blood lead levels from seven state health departments, NIOSH estimates that more than 16,000 workers nationwide are highly exposed. Larger populations of workers are exposed at lower levels for which health effects have not been proven safe. The Department of Housing and Urban Development (HUD) has organized an interagency task force of policy-level officials to discuss lead exposure issues of common concern and map a joint strategy for mitigating this hazard. Dr. James O. Mason, the Assistant Secretary for Health and head of the Public Health Service, is the designate representative for our Department to this task force. We believe that the issue of occupational lead exposure will be an appropriate agenda item of this group since solutions to this problem, like the problem of childhood poisoning from lead-based paint, will require coordinated actions from a number of Government agencies.
Question. How quickly could such a plan be developed?
Answer. It is too early to say what the timetable of this interagency task force will be for developing recommendations, but we expect that it would take a minimum of eight months or more to conduct the necessary discussions, research, and consultations with the public and scientific communities in order to reach a consensus on a feasible plan of action.
Question. Will HHS commit to preparing to such a plan?
Answer. HHS is committed to working with HUD, EPA, and the other interagency task force members in developing strategies to address this public health concern.
Question. Can we really expect lead screening of young children to become universal when testing methods are so clumsy, time-consuming, and expensive? I agree with your statement that one of our immediate research needs is to develop new, cheap blood lead testing methods. How much money is in the Department's budget for development of such a new blood lead test?
Answer. Although venous blood sampling takes more skill than capillary sampling, parental acceptance of it has been very good. For example, in the Chicago screening program, all samples are venous. In a door-to-door survey in California, the preferred method of blood sampling was changed from capillary to venous part way through the survey because of a high rate of false positives. The investigators reported no change in the rate of participation when this change was made.
The Centers for Disease Control (CDC) is doing several things to make blood lead testing easier. We are working with 4 manufacturers of instruments for measuring lead levels to develop a cheap, easy-to-use method for measuring lead levels in blood. We will also be funding a study of methods for collecting capillary blood that is not contaminated with lead. If such a method can be shown to work, it will obviate the need for collecting a venous blood sample. In addition to work being conducted by state and local governments, the CDC is putting $30,000 in extramural funds into this effort. We estimate that we will be spending around $100,000 in intramural resources (mostly for staff time and laboratory processing). The private sector is also expending funds. We believe that this spending will be adequate to address this issue.
Question. Shouldn't we be spending a substantial amount of money on this effort?
Answer. We believe that this spending will be adequate to address these issues. We will be assessing our progress in answering these important questions and will put more resources into this work if it is necessary.
Question. The public does not appear to be as aware of lead hazards as it is of other health hazards like smoking, alcohol or perhaps even radon. In addition, there appears to be resistance by private physicians to performing blood lead tests.
It seems that the time is right for a major public education campaign to alert parents, teachers, day care center operators and other about the dangers of lead and the ways to protect against it. Also, encouraging private doctors to routinely screen their young patients for lead would seem to be a highly cost effective way to increase the number of screened children, since the government would generally not have to pay the testing costs.
Does the Department's FY 1992 budget (or that of any other agency) contain funding for such public and private physician education efforts?
Answer. In 1990 ATSDR released the Environmental Case Study on Lead, one of ATSDR's Case Studies in Environmental Medicine. This publication describes the health effects of lead and appropriate evaluation and clinical management of childhood lead poisoning. It has been distributed to over 30,000 pediatricians. In addition, some of the State childhood lead poisoning prevention screening programs funded by CDC also provide health care practitioner education. States may also use program funds for public education about childhood lead poisoning.
QUESTIONS SUBMITTTED BY SENATOR ARLEN SPECTER
CHILDHOOD LEAD POISONING
Question. Dr. Roper, how significant a problem is lead poisoning in our nation?
Answer. In 1984, the last year for which estimates are available, between 3 and 4 million children in the United States had blood lead levels above 15 ug/dL. These are levels high enough to cause decreased intelligence, behavioral disturbances, developmental delays, and a host of other adverse effects.
Question. Will the increase proposed in the President's budget be used both for expansion of existing programs as well as supporting new ones?
Answer. The President's budget for FY 1992 proposes $14.949 million for an increase of $7.159 million over 1991, the expansion of CDC's childhood lead poisoning prevention grant program. This will permit CDC to continue funding the 7 State and local program initially funded in FY 1990 and the additional 6 or more programs we will fund in this fiscal year. In addition, it will allow support for around 10 new state- and community-based programs.
Question. In your judgement, how much would be required to initiate screening in all communities suspected to be at risk for lead contamination?
Answer. It is difficult to estimate how much would be required to initiate screening in all communities suspected to be at risk for lead contamination. The Department's recently released Strategic Plan for the elimination of childhood lead poisoning states that the combined National costs of financial assistance to these States and communities with the highest priority of demonstrated significant childhood lead poisoning problems would be $25 million for prevention activities in the first year of a 20year effort involving a shared commitment of both public and private sectors to eliminate this disease. The portion of such funds involving increases of Federal assistance beyond the 92% increase proposed in the 1992 President's budget would require offsetting reductions of other programs within the domestic discretionary cap.
Question. Dr. Roper, is it your intention to continue the AIDS prevention cooperative agreements with the six cities?
Answer. CDC will continue to provide funds directly to the six cities (Chicago, Houston, Los Angeles, New York City, Philadelphia, and San Francisco) as directed by the Congress through the HIV/AIDS prevention cooperative agreements. In FY 1992, the funds currently awarded to the states and the six cities for counseling, testing, referral and partner notification (CTRPN) will be awarded through a formula grant for the early intervention services (EIS) cited in the Comprehensive AIDS Resources Emergency (CARE) Act of 1990. In FY 1992-1995, the six cities will continue to receive an amount for EIS which is equal to the amount they received for CTRPN in FY 1990.
Senator BUMPERS. Thank you very much. The subcommittee will stand in recess to reconvene at 2 p.m., when we will continue our hearings on the administration's budget request, including Alcohol, Drug Abuse, and Mental Health Administration, the Health Resources and Services Administration, and one related agency, the National Council on Disability.
[Whereupon, at 2:22 p.m., Tuesday, March 12, the subcommittee was recessed, to reconvene at 2 p.m., the same day.]
(AFTERNOON SESSION, 2 P.M., TUESDAY, MARCH 12, 1991)
The subcommittee met at 2 p.m., in room SD-192, Dirksen Senate Office Building, Hon. Tom Harkin (chairman) presiding. Present: Senators Harkin, Bumpers, Cochran, Specter, and Gor
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ALCOHOL, DRUG ABUSE, AND MENTAL HEALTH ADMINISTRATION STATEMENT OF FREDERICK K. GOODWIN, M.D., ADMINISTRATOR ACCOMPANIED BY:
ALAN I. LESHNER, PH.D., ACTING DIRECTOR, NATIONAL INSTITUTE OF MENTAL HEALTH
CHARLES R. SCHUSTER, PH.D., DIRECTOR, NATIONAL INSTITUTE ON DRUG ABUSE
ENOCH GORDIS, M.D., DIRECTOR, NATIONAL INSTITUTE ON ALCOHOL ABUSE AND ALCOHOLISM
BENY J. PRIMM, M.D., DIRECTOR, OFFICE FOR TREATMENT IMPROVEMENT
ELAINE M. JOHNSON, PH.D., DIRECTOR, OFFICE FOR SUBSTANCE ABUSE AND PREVENTION
STEPHEN W. LONG, DIRECTOR, DIVISION OF FINANCIAL MANAGEMENT
DENNIS WILLIAMS, DEPUTY ASSISTANT SECRETARY, BUDGET, OFFICE OF THE SECRETARY, DEPARTMENT OF HEALTH AND HUMAN SERVICES
OPENING REMARKS OF SENATOR HARKIN
Senator HARKIN. Good afternoon. The Subcommittee on Labor, Health and Human Services, Education, and Related Agencies will come to order.
And again, I apologize to Dr. Goodwin and the rest of you here for my delay. Actually, we were talking about appropriations matters, as a matter of fact, over at the caucus.
Today, the subcommittee's hearings on the administration's fiscal year 1992 budget request continue with the examination of the proposals for the Alcohol, Drug Abuse, and Mental Health Administration; the Health Resources and Services Administration; and the National Council on Disability, one of the related agencies funded by this subcommittee.
Our first witness is Dr. Frederick Goodwin, the Administrator of ADAMHA. For ADAMHA, the administration has requested $3 billion, $3.048 billion to be exact, an increase of $101 million over last year. ADAMHA research would rise $83 million or 8.4 percent over last year.
This funding request supports the important research to fulfill the promise of the decade of the brain as well as essential research on alcohol and drug abuse. But the increases proposed for research