Epidemic Services Authorizing Legislation Sections 301, 307, 310, 311, 322, 325, 327, 352, 353, 361 thru 369, and 1102 of the Public Health Service Act (PHS). Funding levels for the last five fiscal years were as follows: The objectives of the epidemic services activity are to: о Provide for the prevention and control of epidemics and protect O Maintain surveillance systems, analyze data, and respond to public Train public health epidemiologists. о Carry out the quarantine program as required by regulations. Improve the quality of life in developing countries through reduced The epidemic services are an integral part of this Nation's approach to protecting its civilian population from outbreaks of disease and from misuse of chemicals and biological agents. These programs are carried out by: maintaining surveillance systems, epidemic investigators and laboratory capabilities for identifying and investigating potential problems; collecting and analyzing data; and recommending appropriate actions to protect the health and lives of the American people. ($3,777,000 and 45 FTEs) 97 Bringing public health problems to rapid and successful conclusions prevents costly morbidity and mortality. Even without considering the human factor involved, the costs effectiveness of these epidemic services has been well documented. Activities continue to range from identifying cases of food poisoning from contaminated food to the large investigations, such as Legionnaires Disease and Toxic Shock Syndrome. CDC efforts will continue to provide the U.S. with a ready and competent staff to travel to any part of the world to investigate epidemics which impact on the health of the U.S. population. ($6,392,000 and 117 FTEs) Early recognition of adverse health conditions and rapid application of prevention and control measures are fundamental to CDC's contribution to protecting the health of the American people. To support this CDC-wide response capability, a number of epidemic services are required: disease diagnosis; rapid reporting; surveillance; and epidemiologic investigations. ($515,000 and 24 FTEs) Epidemic aid activities require CDC to maintain competence in many diseases that seldom occur, such as plague, small pox, Lassa Fever, etc., and provide laboratory capabilities to support disease investigations. In FY 1990 CDC is conducting a program of scientific inquiry and research to solve practical public health problems and support selected programs to assist States, health organizations, and others in two priority areas: infant health and reproductive health. ($270,000 and 5 FTEs) 1991 Request In FY 1991, an increase of $11,500,000 and 25 FTEs is requested for CDC's Epidemic Services Infant Health activities. CDC carries out surveillance and epidemiologic investigations, and provide technical assistance in program development and evaluation to reduce perinatal, neonatal, and postneonatal mortality and morbidity associated with low birthweight (LBW), sudden infant death syndrome (SIDS), birth defects, prematurity, and complications of pregnancy. These health problems account for over 1.9 million years of potential life lost each year. In partnership with States, efforts are directed toward reducing adverse pregnancy outcomes by identifying risk factors, and applying appropriate interventions to reduce those risk factors. Major emphasis is being placed on maternal factors related to LBW, and on the causes of differences in LBW and infant mortality among blacks and whites. In addition, assistance is being provided to States in implementing smoking cessation programs in public prenatal clinics and WIC clinics. Over 900,000 children are born each year to women who smoke, a practice that doubles the risk of LBW and increases the risk of stillbirth or neonatal death by up to 100 percent. Early results show a 50 percent increase in the number of pregnant women who quit smoking in intervention sites compared to control sites. The The CDC has assisted States in developing two ongoing systems to monitor modifiable health and nutrition risks, such as cigarette and alcohol use, stress factors, and inadequate access to maternity and well-baby care. population-based Pregnancy Risk Assessment Monitoring System, now operating in six States, provides Statewide data. The improved program-based Pregnancy Nutrition Surveillance System is now being demonstrated in eight States, and provides detailed information on high-risk women. Under the Congressionally-mandated National Nutrition Monitoring System, CDC conducts State-based surveillance activities directed towards infants and children. Among these activities are the Pediatric Nutrition Surveillance System which continuously monitors major indicators of the nutritional status of low-income, high-risk children serviced in delivery programs such as Maternal and Child Health (MCH), and the Special Supplemental Food Program for Women, Infants, and Children. The Severe Pediatric Undernutrition System (SPUN) is assessing the technical feasibility of determining the prevalence of severe pediatric undernutrition as well as associated etiologies and risk factors in four States. The FY 1991 Infant Health Initiative provides for expanded efforts to reduce infant mortality, with particular emphasis on improved State capability for surveillance and targeted investigations of black/white gaps in infant mortality and Fetal Alcohol Syndrome. CDC will augment support for national surveillance efforts, direct assistance through assignees, and statistical and epidemiological assistance and consultation. CDC will rapidly implement (1) enhanced State-based surveillance and technical assistance to improve data availability and use; (2) augmented State MCH epidemiologic and analytic capability and support; and (3) assistance to interested States for widespread dissemination of smoking cessation programs for high risk, low-income, pregnant women. State personnel will be trained to implement smoking cessation programs in public prenatal and WIC clinics and to monitor the quit rates and prevention of LBW in the recipients. Reproductive Health Surveillance, investigation, and technical assistance are carried out to help reduce morbidity and mortality related to contraception, pregnancy, and human reproduction. 99 Increase BA -$378,000 +38,000 -349,000 -349,000 Reflects proposed reprogramming of $1.4 million from Immunization parent/patient notification to Health Statistics. 1991 Authorization: Authorization expires September 30, 1990. An extension The National Center for Health Statistics (NCHS) is the nation's principal health statistics agency, mandated to monitor the nation's health and use of health services and to explore the relationships between risk factors and disease. A clear understanding of health problems and their impact on the population and economy serve as the foundation of the Nation's public health, health research, and health policy efforts. Health officials and researchers in CDC, the Department, State/Local governments, and the private sector rely heavily on NCHS data for fundamental measures of the nation's health, such as: Infant mortality, low birth weight, access to prenatal care, and risk factors associated with pregnancy. Death from cancer, heart disease, and other causes of death. 101 The use of hospitals, nursing homes, physician services, and other health services. The impact of disease and disability on the nation's people, economy, and health system. Personal habits that affect health, such as smoking, alcohol abuse, and nutrition. Public awareness of health risks, such as transmission of HIV. New demands are increasingly being placed on the nation's health statistics system. Changes in the population, new emphasis on setting and achieving national health objectives, and changes in the financing and delivery of health care require close monitoring and analysis. Examples of these include: The Year 2000 Objectives for the Nation place special emphasis on surveillance and statistics, and a majority of the objectives rely on NCHS data to track progress. Each priority area (e.g., HIV, Infant Mortality, Nutrition) identifies specific data needed for tracking, and the final priority area focuses exclusively on improving surveillance and data systems. Health problems of minorities and other vulnerable population groups continue to be the focus of attention. NCHS has been instrumental in calling attention to gaps between whites and blacks, and faces a growing challenge in adequately assessing the health of Hispanics and other rapidly growing population groups. The aging of U.S. population has become recognized as a phenomenon that has significant implications for quality of life and independent living, and for the demand for long term care and other health services. Longitudinal surveys conducted by NCHS are among efforts to better understand factors that predict disability, dependency, and institutionalization. Issues relating to the family, including the social, economic, and physical health, are increasingly the focus of consideration in the formation of health and social policy. Increasingly, information is sought on the formation and dissolution of families, reproductive health and planning, access to insurance and health care, and the impact of illness on the family unit. Cost and financing considerations dominate consideration of health policy. In order to address issues of payment mechanisms and quality of care, and to assess the impact of new policies, it is essential that accurate statistics on the use of health care services be obtained. As programs become more sophisticated and resources more scarce, there is a greater recognition of the need to target public health interventions to population groups at greatest health risk. 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