Mr. Chairman, since its inception in fiscal year 1988, the National Vaccine Program (NVP) has provided coordination of all PHS vaccine activities and has provided added impetus to activities aimed at developing and introducing safer, improved acellular pertussis vaccines. A comprehensive, long-range National Vaccine Plan is being developed. We are looking forward to submitting the plan to Congress.

The fiscal year 1991 request of $6.9 million is an increase of $1 million over the fiscal year 1990 appropriation which provided $3 million for a pertussis vaccine field trial, and $1.5 million for research on the development of new candidate vaccines. In addition to this budget request, $7 million is requested in the PHS agencies to address high priority NVP activities.

For the management and direction of the Public Health Service, we are requesting $21.1 million and 274 FTEs. This staff assists me with the development of PHS policy and the coordination of a myriad of management functions. In fiscal year 1989 through the efforts of the debt management staff, $79 million was collected and paid into the U.S. Treasury. The fiscal year 1991 request provides resources to support the current level of management efforts.

Retirement pay and medical benefits for commissioned officers: The retirement pay and medical benefits for commissioned officers request of $118.1 million provides retirement payments to Public Health Service commissioned officers, payments to survivors of officers who elected to receive a reduced annuity, and for medical care of active duty and retired officers, their dependents and survivors. With regard to the Agency for Health Care Policy and Research, the budget request includes $110.2 million in obligations. The Agency for Health Care Policy and Research was formerly known as the National Center for Health Services Research and Health Care Technology Assessment. The purpose of the new agency is to enhance the quality, appropriateness, and effectiveness of health care services and access to such services through scientific research, promotion of improvements in clinical practice, and in the organization, financing, and delivery of health care services.

The Medical Treatment Effectiveness Program is a Presidential initiative to improve our understanding of the effects of health care practices on patient outcomes. The ultimate goal of the program is to provide information to patients and practitioners that will improve the health of our population and optimize the utilization of scarce health care resources.

In fiscal year 1991 $48.5 million in obligational authority is requested for the Medical Treatment Effectiveness Program, an increase of $11 million over fiscal year 1990. The increase for this important Presidential initiative will continue the momentum given to the program in 1990.

The budget request for general health services research and health care technology assessment is $51.2 million in obligations. Specific research activities include health care services in rural areas, clinical practices, health care technologies, health care costs, productivity and market forces, primary care, long-term care, delivery of health services to minorities and the disadvantaged, and medical liability.

We are also requesting $10.5 million for health services research on AIDS and HIV related illnesses, an increase of $2 million over 1990. The Agency for Health Care Policy and Research will support research to study the availability, cost, and utilization of services for different HIV risk groups, populations, geographic areas, and stages of illness and treatment modalities. The increase of $2 million will expand the AIDS Cost and Service Utilization Survey to address the health resource utilization of the asymptomatic population.

Mr. Chairman, I will be pleased to answer any questions you may have. [The information follows:]

JAMES 0. MASON

Assistant Secretary for Health

Department of Health and Human Services

James O. Mason, M.D., Dr. P.H., was sworn in April 21, 1989, as Assistant Secretary for Health, Department of Health and Human Services. Dr. Mason was nominated by President Bush April 7, 1989, and confirmed by the Senate April 19, 1989.

Before assuming responsibility for the U.S. Public Health Service, Dr. Mason had served, since 1983, as director of the Centers for Disease Control and administrator of the Agency for Toxic Substances and Disease Registry. During his tenure at CDC, Dr. Mason also served as acting Assistant Secretary for Health from February to December 1985. Dr. Mason served as executive director of the Utah Department of Health, with responsibility for health and health care financing, from 1979 to 1983. He was associate professor and chairman of the Division of Community Medicine, Department of Family and Community Medicine, at the University of Utah College of Medicine from 1978 to 1979. He directed a multiple-hospital health care corporation owned by The Church of Jesus Christ of Latterday Saints from 1970 to 1975.

As Assistant Secretary for Health, Dr. Mason directs the activities of the Public Health Service, which includes eight agencies: the Alcohol, Drug Abuse and Mental Health Administration; the Centers for Disease Control; the Agency for Toxic Substances and Disease Registry; the Food and Drug Administration; the Health Resources and Services Administration; the National Institutes of Health; the Indian Health Service; and the Agency for Health Care Policy and Research.

Dr. Mason provides policy guidance as well for HHS programs outside of PHS, and maintains relationships with other government and private agencies concerned with health. He advises and assists the Secretary on health policy and on all health-related activities of the department.

Dr. Mason was born June 19, 1930, in Salt Lake City, Utah. He received his B.A. and M.D. degrees from the University of Utah in 1954 and 1958. He received his master of public health and doctorate of public health from the Harvard School of Public Health in 1963 and 1967. Dr. Mason served his internship at Johns Hopkins Hospital in Baltimore from 1958 to 1959, and was an internal medicine resident at Peter Bent Brigham Hospital, Harvard Medical Service, in Boston from 1961 to 1962.

He has received numerous honors and awards. Among these are the Public Health Service Distinguished Service Medal (1988) and the University of Utah's Distinguished Alumni Award (1973). He is a member of a number of honorary and professional societies including the American Medical Association, the Institute of Medicine of the National Academy of Sciences, and the American Public Health Association. He has served on many national and international committees, councils, boards and task forces, including the United Nations Development Program/World Bank/World Health Organization Special Program for Research and Training in Tropical Diseases, Scientific and Technical Advisory Committee; and the National Institutes of Health Recombinant DNA Advisory Committee.

Dr. Mason is certified by the American Board of Preventive Medicine. He has written numerous articles and book chapters on a wide range of subjects related to the prevention and control of disease. He is a national spokesperson on the prevention and control of infectious disease, chronic disease and injury, and a leading architect of public policies concerning these health problems.

Dr. Mason and his wife, the former Marie Smith, have five sons and two daughters: James, Susan, Bruce, Ralph, Samuel, Sara and Benjamin.

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Statement of the Assistant Secretary for Health

on

Budget Request for the Office of the Assistant Secretary for Health

Mr. Chairman and Members of the Committee

I appreciate the opportunity to appear here today to discuss the FY 1991 budget request of $206 million for the Office of the Assistant Secretary for Health (OASH) appropriation and the Retirement Pay and Medical Benefits for Commissioned Officers request of $118.1 million.

The FY 1991 budget request includes $19.6 million for the Office of Minority Health; $4.6 million of this amount is for AIDS activities. This is an increase of $11.6 million over the FY 1990 appropriation, ⚫ and includes $10 million for the Secretary's Minority Health Initiative to improve the health status of minorities.

The Office of Minority Health was established in 1985 to implement the recommendations of the Task Force Report on Black and Minority Health. Some improvements in minority health status have been achieved. However, despite numerous efforts, there continue to be large disparities in almost every category of mortality, death rates for minorities continue to be uniformly higher than for whites. Even more telling, life expectancy for Black American males is actually declining, and is now six years shorter than life expectancy for white males. We must not allow this trend to continue. The Office of Minority Health faces the great challenge of reversing this disparity and has assumed increasing responsibilities as the Department's advocate in issue areas which impact on the health of minority populations.

The Office of Minority Health acts as a catalyst to spur PHS and other public and private agencies to identify opportunities where existing programs and resources can be directed to promoting health and preventing disease among minority populations and to develop innovative strategies to improve the health status of minorities. The increase for FY 1991 will allow us to significantly expand these cooperative activities. In addition to this catalytic and coordinative role, the Office administers two grant programs which are based on the premise that health promotion and disease prevention efforts can be more effective by expanding the base of community awareness and involvement in disease risk reduction efforts. Through one grant program, we have funded 26 minority community coalition demonstration projects. The second grant program has supported 38 AIDS/HIV education/prevention projects for developing culturally sensitive health education materials and strategies for reducing the risk for acquiring and transmitting the HIV infection and AIDS.

The budget request presented to you today includes $9.4 million to support the Adolescent Family Life (AFL) program's demonstration and research program at the 1990 level. This is the only Federal program solely focused on the complex issues and problems of early adolescent sexuality, pregnancy and parenting. Engaging in sexual activity places teens at risk not only of pregnancy, but also of sexually transmitted diseases, some of which are incurable, may cause sterility or even death. Premature pregnancy among unmarried teens places both the teen mother and her baby at increased risk of adverse health as well as for poverty and economic dependency.

AFL prevention programs develop family-centered approaches to encourage teens to abstain from sexual activity, while AFL care programs provide comprehensive services to pregnant and parenting teens and their babies. Adoption counseling and information is provided by all care projects to help teens decide whether to parent their child or make adoption plans. Evaluations indicate that AFL care projects have a positive effect in improving birth outcomes and improving the educational and occupational prospects of teen mothers. Evaluations of AFL prevention projects show that these projects change teens' knowledge about the risks of premature sexual activity and improve their attitudes toward postponing sexual activity.

In FY 1991, $139.1 million is requested to support the Administration's proposal for a State administered family planning program authorized under Title X of the Public Health Service Act. This is the same level of support as that provided in FY 1990 for the family planning discretionary grant program. Under the Administration's proposal, all Title X funds would be awarded directly to States and territories. This would enable States to better integrate Title X funds with other programs to provide primary health care and to improve access to maternal and child health programs. This proposal would also offer States increased flexibility to meet local needs and establish policies which reflect local standards for the provision of family planning services.

This has

Since its inception in FY 1988, the National Vaccine Program (NVP) has provided coordination of all PHS vaccine activities and has provided added impetus to activities aimed at developing and introducing safer, improved acellular pertussis vaccines. included sponsoring studies in the United States and abroad such as the large scale pertussis vaccine field trial carried out in Sweden. In FY 1991 the NVP will continue to place priority on development of pertussis vaccines as well as other activities leading to "optimal prevention of infectious diseases through immunization and optimal prevention against adverse reactions to vaccines". The FY 1991 request of $6.9 million is an increase of $1 million over the FY 1990 appropriation which provided $3 million for a pertussis vaccine field trial, and $1.5 million for basic and applied research on the development of new candidate vaccines. In FY 1991 the increase of $1.0 million for the NVP will support an expansion in basic and applied research and support additional staffing. In addition to this budget request, $7 million is requested in the PHS Agencies to address other high priority NVP activities, including $4.5 million for NIH to carry out an additional pertussis field trial, as well as additional basic and applied research on pertussis vaccines. The balance of $2.5 million will be used for monitoring vaccine safety, developing antibody tests and developing additional conjugated vaccines to prevent childhood meningitis.

The Office of Disease Prevention and Health Promotion's budget request of $4.5 million will provide Federal leadership for public and private action toward implementing the Year 2000 prevention goals and objectives; enable follow-up of the Surgeon General's Report on Nutrition and Health with key nutrition policy initiatives; strengthen the delivery of critical preventive services in medical practice and disseminate health information to the public.

The FY 1991 budget request includes $1.5 million to continue the program activities of the President's Council on Physical Fitness and Sports. This program consists of a variety of initiatives designed to promote knowledge and understanding about physical fitness, sports and health and to encourage participation in