For

The AHEC partnership involves the other primary care initiatives of the federal government, as well. We have all types of people from the public and private sectors working together in pursuit of a common public policy objective. example, in Arkansas, over 500 of our state's private physicians regularly teach through the AHEC Program, and, across the nation, thousands of private citizens serve on AHEC advisory councils and governing boards.

The AHEC Programs enable students and medical residents at health science schools to take a portion of their clinical training at community hospitals and health centers--an arrangement that ends up benefiting everyone.

In Arkansas, 82 percent of the Family Practice physicians trained in AHEC's have remained in the state, and 37 percent of those have located in towns of fewer than 10,000 persons. A similar pattern has been seen in the north Carolina AHEC Program which has enjoyed strong state and local support since 1974.

The AHEC programs also work with health science schools to offer continuing education and technical assistance to practicing health professionals throughout the state. This service not only helps community-based professionals feel less isolated but also assures them that they can keep up-to-date even if they practice far from the major medical centers.

Mr. Chairman, the National AHEC Program has proven to have been a wise investment for the federal government. Since 1972, federal funding has spurred state and local governments into spending hundreds of millions of dollars for AHEC programs in response to the federal catalyst.

We invite the Subcommittee to review the strong endorsements of the AHEC Program contained in the following studies:

1. The 1980 report to the Congress by the

2.

3.

Secretary of H.E.W.;

The 1980 GMENAC Report;

and

The 1990 Report of the American Institute for
Research commissioned by the Health Resources
and Services Administration.

We in AHEC hope that, in the fiscal year 1991 budget, the Congress will maintain its commitment to a program aimed at ending the maldistribution of physicians and health practitioners in rural and inner-city areas. This commitment allows for funding of statewide AHEC's, regional AHEC's, AHEC special initiatives, infant mortality, and high impact areas. The United States, Mr. Chairman, cannot afford to be without this program.

STATEMENT OF THE COMMUNITY FOOD RESEARCH AND ACTION CENTER

Mr. Chairman: I am submitting this testimony for the record on the Community Food and Nutrition Program for which you have been one of our most ardent and thoughtful supporters. It was a Harkin amendment to the FY86 Labor HHS Ed Appropriations bill which funded the modern day CFNP. We appreciate your efforts on behalf of low income hungry children and their families.

I am Edward M. Cooney, Deputy Director of the Food Research and Action Center, a public interest law and advocacy group, which pursues policies aimed at reducing or eliminating domestic hunger. I am submitting this testimony on behalf of the Community Food and Nutrition Program, a program which has the exclusive purpose of reducing or eliminating domestic hunger. We at FRAC, would urge you to fund CFNP at its fully authorized FY1992 funding level of $15 million which still would be $15 million below what Congress appropriated for CFNP in FY1978. CFNP is funded at $2.4 million for FY1991.

History of the Community Food and Nutrition Program

In FY1978 and FY1979, Congress actually appropriated $30 million for CFNP. The funds went to local, state and national groups (including Native American and Migrant groups) to serve as a catalyst on behalf of the poor and hungry Americans vis-a-vis government agencies responsible for administering federal food and nutrition programs and as a catalyst to assist the poor and hungry to become self sufficient to the maximum extent possible. Funding was awarded by the Community Services Administration in four areas: Access assisting eligible individuals and families in participating in federal food and nutrition programs; Self Help projects designed to develop and improve the ability of low income individuals and groups to produce and distribute their own food stuffs; Nutrition Education designed to assist low income families in understanding the connection between diet and health; and Crisis Relief providing speedy food relief to hungry individuals and families. How successful was CFNP? In a 1980 preliminary report to Congress on CFNP, the Community Services Administration stated "It is the firm belief of CSA and its constituency, as well as of top food officials in USDA, that in carrying out these tasks the CFNP is not only not competitive nor duplicative of USDA food aid programs but is indispensable both to the success of these programs and to the eventual elimination of the problem of hunger in America, at least in its most malignant form. [Emphasis added.] Secretary Sullivan of HHS in a July 3, 1989, letter to the House and Senate Appropriations Chairmen stated that "All of the benefits derived from the competitivelyfunded (CFNP) projects are too numerous to detail". The Secretary went on to state that "the $2.4 million CFNP program mobilized more than $6 million from other public and private sources to combat hunger".

In 1981, the Omnibus Reconciliation Act terminated CFNP, but Congress recreated CFNP in 1984 and appropriated $2.5 in FY1986 as a recognition that this unique program could play an important role in assisting low income Americans in meeting their nutrition needs. Last year, P.L 101 501, the Human Services Reauthorization Act of 1990, reauthorized CFNP at $15 million in FY1992, $20 million in FY1993, and $25 million in FY1994.

The Need for CFNP

The Food Research and Action Center recently released the findings of a new nationwide comprehensive study of childhood hunger, the Community Childhood Hunger Identification Project (CCHIP). One of the most dramatic findings was that there are 5.5 million hungry children in our country and as many as 11.5 million children who are either hungry or at risk of being hungry. The findings of this survey are disturbing since the programs to prevent widespread hunger ... the federal

food programs... are in place but not fully utilized due to lack of information and artificially created barriers to participation. One of the most startling findings in the CCHIP study was that 37% of the families surveyed by CCHIP and who were eligible for Food Stamps were not participating in the program. When asked why they didn't participate, the most frequent response was that the household did not believe that it was eligible. In retrospect, this finding should not be shocking since no federal agency has had any general outreach program in place for any federal food and nutrition program for the last 10 years. Currently only 4.7 of the 8.7 million potentially eligible participants arc enrolled in the WIC program. Only 1.7 of the 12 million children who participate in the free or reduced price School Lunch Program receive a lunch through the Summer Food Program. Slightly more than 4 million of the 24 million children participating in the entire School Lunch Program participate in the School Breakfast Program. That is what makes expanding the Community Food and Nutrition Program so important. CFNP is the sole source of federal funding authorized exclusively to fight hunger through, among other approaches, the process of outreach informing low income individuals and families of what federal nutrition programs and emergency services are available.

In a Senate Agriculture Subcommittee on Nutrition and Investigations Hearing on Hunger and Food Assistance Program, chaired by Senator Harkin, held in Des Moines, Iowa on December 12, 1989, the issues of hunger, outreach and CFNP all were prominently mentioned. In this hearing, excellent and moving testimony on hunger in Iowa was presented by three young female high school students. At the end of their presentations Chairman Harkin asked these students: "if the responsibility were yours, if you had the power to choose, how would you address these programs? In other words, what would you want done more than anything else to ensure that these people get fed?" Heather Burr, a student at North High School in Des Moines stated: "I agree with both of them (the 2 other students). We could cut back on defense and put it toward the outreach program to let the people know [what programs are available], because I know there are people that travel to the homeless people that live under bridges and such downtown." The need for outreach activities, expressed by these high school students, and envisioned by CFNP, was reiterated by Karen Ford, Executive Director of the lowa Food Bank in Des Moines. She stated: "I look back and wonder, like these young girls today, why they care about the hungry, and I guess I always did. But the main training and the best training I had received was from funding that the agency I worked for got through the Community Food and Nutrition Program. And I think it's just an outrage that that was eliminated over the years, and it looks like there's an opportunity now to bring that back, to raise it to a level of funding -- perhaps as much as $25 million over the next four years."

Many of the people that I work with in food banking began in community food nutrition and went on to organize some significant results in their own communities because of that training. It would also help to coordinate private and public sector food programs and to promote the development of new ideas to eliminate hunger in providing for better nutrition, education, and outreach. It's a small thing, but it has creativity, and it has to be an entrepreneurship with the monies available in the federal government."

The inadequacy of CFNP funding was poignantly summarized by Marian Urbanos, then an employee of Woodbury County Community Action Agency of Sioux City when she testified: "And I have to reinforce the Community Food and Nutrition grants. We had that opportunity for years in our agency, but we haven't had any for five or six years now. That money was spent to do outreach to get people on the Food Stamp Program." Jim Thomas, then Director of the Advocator Welfare Answering Service in Waterloo also testified in support of CFNP. This program, which provided service to hundreds of poor people in Iowa on Food Stamps, was funded in part by CFNP. It is now closed for lack of funding.

Mr. Chairman, the problems of hunger faced in Iowa are replicated across this country. Funding the Community Food and Nutrition Program at its $15 million authorization level would be one solid step in forcefully addressing this national tragedy.

STATEMENT OF THE AMERICAN SOCIETY FOR MICROBIOLOGY

The American Society for Microbiology (ASM) would like to submit the following statement for the record on the FY 1992 budget for the Centers for Disease Control (CDC). The CDC plays a national leadership role in the development and implementation of disease prevention strategies in the United States. CDC utilizes the outcome of basic biomedical research and transforms it into practical applications for the detection, prevention and control of diseases.

Based on the Administration's budget request for FY 1992, it is our belief that the CDC will not have sufficient funds to carry out its mission as our nation's primary prevention agency the agency with primary responsibility for activities that include epidemic aid, epidemiologic field investigations, laboratory research, diagnostic reference services, and training. The ASM strongly supports a $230 million increase in funding for the CDC over the FY 1991 funding level.

The ASM is the largest biological life science society in the world, with an active membership of over 38,000. It is from the knowledge and experience of this large membership that we would like to focus our statement on the Center for Infectious Diseases (CID), one of the Centers of the CDC. ASM's particular professional expertise in the diagnosis, prevention and control of infectious disease leads us to some strong recommendations.

The ASM recognizes an urgent need for additional funding for the CID and supports a $90 million increase to allow the accomplishment of essential mission objectives - objectives that bridge the gap between breakthroughs in basic biomedical research and the delivery of health care and public health prevention measures. The CID is struggling to maintain its competence in preventing and controlling over 130 diseases, while its resources remain static static in unadjusted dollars, but actually in sharp decline when calculated in inflation adjusted dollars. (See attached chart) In addition to the cumulative effects of inflation through the 1980's, the CID's core programs are suffering from the effects of increased technology costs, increased personnel costs, and the costs of dealing with complex emerging disease problems.

CDC'8 CENTER FOR INFECTIOUS DISEASES (CID)

In unadjusted dollars, funding of non-AIDS programs in CDC's Center for Infectious Diseases has remained virtually static over the last decade; when looked at in inflation adjusted dollars, this funding level is seen to be in a downward spiral where purchasing power is about half of what it was in 1982. Unfortunately, diseases that CID combats have not declined commensurately in fact, in the last decade we have witnessed the emergence of a number of new diseases, in addition to AIDS, and the resurgence of many others that were thought to be under control. Our changing personal, family and societal behaviors, our changing environment and industries, and our international world of trade and travel have introduced new disease problems. These factors have also changed patterns of spread, requiring new detection and intervention strategies, which can only be achieved through strong applied research programs. The CID must be able to respond to disease outbreaks as they occur, in the United States and around the world, by assisting state, local, national and international organizations and agencies. This ability to respond has eroded due to financial shortfalls in core programs. Resources traditionally used for equipment for developing the

scientific base for emergency response and field and laboratory investigative programs have declined, creating unacceptable vulnerabilities.

The CID must have state-of-the-art equipment for the development and application of modern technologies for the detection and identification of infectious agents in the United States and internationally since there are no longer any barriers to the movement of people. For example, during the recent Desert Storm engagement, the CID contributed its knowledge and resources to programs for the detection of microbial threats in the context of terrorism.

Current funding will not enable CID to remain on the cutting edge of technology. We are experiencing an era of rapid technological advances in microbial agent detection and disease diagnosis. Improved surveillance and reporting achievable through new computer technology and, enhanced opportunities for better data analysis systems, all will require additional funding. Certain technologies, such as the development and application of DNA hybridization and gene probes, cannot be introduced to all CID units, given the funding shortfall. proposed budgetary increase for the CID for fiscal year 1992 does not even meet the cost of inflation for existing programs, much less provide for any new initiatives. In order to match its 1981 level of activity, the CID would have to be operating on a $72 million budget base for 1991, rather than a $48 million base.

The

We commend the Administration for funding focused studies on Lyme disease, chronic fatigue syndrome, and hepatitis B, but there are a host of other emerging diseases which have not received adequate funds for epidemic investigation for prevention and control activities. For example, vaccine research must be intensified: meningitis caused by Hemophilus influenzae type b, measles, and whooping cough are three diseases which continue to attack our young children. Deaths related to measles are on the rise: in 1988, 3,396 cases and three deaths were reported. In 1989, 18,193 cases and 41 deaths were reported; in 1990, 26,527 cases and over 90 deaths were reported. A multifaceted program to deal with this problem is needed.

At

Food borne diseases such as Salmonella enteritidis (diarrhea) and Listeria meningitis have re-emerged in the past decade and must be addressed. The massive epidemic of cholera in South America and the even larger impending epidemic in Bangladesh represent incredible challenges to CID resources. the same time, rapidly fatal streptococcal disease, the disease that killed Jim Henson of Muppets fame, must be studied so that we do not again experience the high mortality rates of the past. In addition, illnesses acquired in day care centers present new problems to the public health sector as parents rely increasingly on out-of-home care for their pre-school children. Hepatitis A, bacterial meningitis, diarrhea, and respiratory infections are increasing problems in child care facilities. To address these problems, strategies must be developed through investigation then intervention initiatives must be developed and funded.

We face burgeoning health care costs, particularly because of the costs of hospitalization. Increasing support of the Hospital Infection Program of the CID makes fiscal, as well as scientific and humane sense. Hospital-acquired infections contribute substantially to costs, morbidity rates and to the discomfort of hospitalized patients. Development of effective hospital infections control programs requires research to determine the causes and routes of dissemination of infectious agents. A CID initiative for the training of hospital personnel