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(AFTERNOON SESSION, 2:16 P.M., THURSDAY, MARCH 21, 1991)

The subcommittee met at 2:16 p.m., in room SD-192, Dirksen Senate Office Building, Hon. Tom Harkin (chairman) presiding. Present: Senators Harkin, Specter, Stevens, and Gorton.

NATIONAL COMMISSION TO PREVENT INFANT MORTALITY STATEMENT OF LYNDA JOHNSON ROBB

OPENING STATEMENT OF SENATOR HARKIN

Senator HARKIN. Good afternoon. The Appropriations Subcommittee on Labor, Health and Human Services, and Education will come to order.

This afternoon we will hear testimony from the final panel of independent agencies funded under title IV of our appropriations bill.

We will begin this afternoon with testimony from Mrs. Lynda Johnson Robb on behalf of the National Commission to Prevent Infant Mortality.

The Commission's fiscal year 1992 request is $450,000, an increase of $50,000 over last year's level.

We are certainly delighted and honored to have Mrs. Robb with us today. Since her days as First Lady of Virginia, Mrs. Robb has been a vocal and dedicated proponent of both national literacy and children's issues. I want to personally welcome you here today in your first appearance before this subcommittee.

The Commission was created during the chairmanship of my distinguished predecessor, former Senator Lawton Chiles, now Governor of the State of Florida. When it was established in 1987, the Commission's mission was a critical one, and it remains so today. The Commission is responsible for creating a national strategic plan to reduce infant mortality and morbidity in the United States. Recent statistics underscore the need for this kind of dedicated effort. So, I look forward to hearing more about the Commission's current efforts to implement its recommendations and the activities planned for 1992.

At this point, I would ask unanimous consent to keep the record open for any opening statements by Senator Specter.

Again, my apologies to you, Mrs. Robb and to all of you, for being late, but as you know, we just had a vote on the Senate floor and you know what that means.

Ms. ROBB. I'm all too familiar with having things delayed by Senate votes. [Laughter.]

Senator HARKIN. Well, thank you for being here and please proceed with your statement.

Ms. ROBB. Senator Harkin, I want to thank you for this opportunity to appear before you today regarding the ongoing work of the

National Commission to Prevent Infant Mortality. On behalf of Governor Chiles and the other members of the Commission, I want to convey our appreciation for your continuing support of our work. In our testimony I will discuss the Commission's many efforts to promote the health and wellbeing of pregnant women and children. I will also briefly discuss the work we are doing with our private sector support.

As you know, in fiscal year 1989 and through 1991, our appropriation requests have been decreasing. Both this year and last, our funding level has been maintained at $400,000. Each year we have requested either fewer funds or no funding increases because we are committed to obtaining private support to augment our public support. We feel that such public/private partnerships are critical for galvanizing the Nation's creativity and commitment for mothers and children.

We will continue to work closely with the private sector and foundations, but for 1992 we are requesting an increase to $450,000 to accommodate for inflation and necessary salary adjustments that we have been absorbing over the last 3 years. We appreciate your consideration of our request.

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The current work of the Commission is focusing on promoting the recommendations made in our 1988 report to Congress and the President, "Death Before Life: The Tragedy of Infant Mortality. For your reference and for the record, Mr. Chairman, I have included with my testimony a recently completed status report on the Commission's past and current activities and our future plans. As an overall statement, we believe that there is notable progress being made on many of the recommendations of the Commission. For example, financial coverage for health care primarily through increased Medicaid eligibility has been improved for pregnant women and children. Many communities are conducting public awareness activities about prenatal care. States are working with physicians to encourage them to take in low-income patients. More and more business leaders are recognizing that improving maternal and child health makes good business sense.

There also is growing activity in one of the most effective strategies I know of and one that is strongly promoted by the Commission: Resource Mothers. These home visiting programs provide services directly in the home and also link mothers up with the community services that they need. The Resource Mothers programs that I am most familiar with are in Virginia. We have had great success. We serve teenage mothers, and we have been able to reduce the infant mortality rate to 8.4 compared to 14.7 for babies born to teenage mothers not enrolled in Resource Mothers. The low birthweight rate for our babies averages 5 percent compared to 11 percent for those who are not in our program. And our young mothers are much more likely to turn to high school than others. Certainly helping these young women finish high school is one of the best insurance policies that we can ever give her and her child. We have enjoyed working particularly with you to promote Resource Mothers, and we appreciate your joining us in releasing our GAO report on home visiting last year.

Despite this good progress, however, the Nation still has a long way to go. Our country's infant mortality rate is still higher than

that of 20 other nations. We have made no progress in reducing the national rate of low birth weight. And this is interesting. Since the 1960's we have had the same percentage of low birthweight. We are just saving babies that never would have been saved before in high tech medicine, but we are not doing anything about preventing the low birthweight in the first place which is the cause of most babies dying. And tens of thousands of women are still not getting into early prenatal care.

The Infant Mortality Commission sees its continuing role as advising Congress and the public about what works and what steps are needed to improve maternal and child health. We aim our message to decisionmakers to help them see what they can do.

Let me offer just a few examples of some of the projects that we are working on now and that we have planned for next year.

One-stop shopping. We soon will issue a report on one-stop shopping to highlight the importance of integrating health and other services for mothers and children and to recommend policy changes and practical strategies that are needed to accomplish this. It is appalling that we make women grope along through a confusing maze of application forms, service locations, and bureaucratic procedures, and then we are surprised that we have not made much progress in getting them into prenatal care, or that their babies' colds turn into pneumonia. We should be appalled at this mess that we have created.

The National Health/Education Consortium is another exciting project that we have recently started. Over 40 national health and education organizations, with a total of 11 million members, have joined hands with us and our cofounder, the Institute for Educational Leadership, to establish this consortium. Our purpose is to begin to meld the worlds of health and education for children from the policies we make to the work of individual teachers, doctors, and nurses.

As you are well aware, Mr. Chairman, if we want our children to learn in school and become productive citizens, they have to be born as healthy as possible in the first place, and other health and related problems must be prevented or nipped in the bud. The consortium hopes to act as a catalyst to get these problems taken care of and to build bridges between the health and education sectors. With major support from a private foundation and the Departments of Health and Human Services and Education, we have issued two reports and we plan several more. Over the next few years, we also will be putting together conferences in cities and communities around the country to raise awareness and to look at model approaches for blending health and education services for children.

Universal access to care is another central focus of the Commission. That was one of the things that we said was vitally important in our first report. We have been working with the Brookings Institution on a policy report on universal access to care for pregnant women and children. The report will be released this summer and is based on a symposium sponsored by the Commission and Brookings. We feel this kind of report is an important contribution to the growing debate on health care reform. Most reform proposals focus primarily on health insurance as the answer to the problems of

those without access to care. However, as important as this is, an insurance card alone does not make health care happen. We also need to inject other strategies into the system that can make the difference between getting care and not getting care, such as outreach, home visiting, and placing more doctors and nurses in our inner cities and our rural areas.

We also are working with the Pan American Health Organization and the World Health Organization to plan an international health ministers meeting for this fall in Washington. Building on the Commission's hearings at the United Nations back in February 1988, we will use this opportunity to highlight the many lessons that we can learn from other countries about cost-effective, basic approaches to getting primary health care and education to mothers, and children and to reduce infant mortality.

Many of our current activities will carry over into next year. We also hope to work more with States and local leaders and to act as a catalyst to give them ideas and leads for building their commitment to helping mothers and children. For example, we are working with the U.S. Conference of Mayors to develop city-based projects focused on reducing barriers to prenatal and primary care for mothers and children. Also, we plan to build on our work with business organizations, such as the Committee for Economic Development and the Washington Business Group on Health. We will be developing a series of round table meetings in cities and communities to highlight how business can provide further assistance to addressing the concerns of maternal and child health. We also will be developing projects over the coming months on substance abuse during pregnancy and a project on maternal and child health in minority populations.

A final example of our plans is a series of regional seminars for news journalists. We plan to bring journalists together to learn about infant mortality and maternal and child health issues, the facts behind these stories, and the contacts they may want to develop to enhance their ability to write about these important issues.

PREPARED STATEMENT

In conclusion, Mr. Chairman, the Commission has embraced a range of activities to promote policy and practical solutions to improve maternal and infant health. The strategies are out there. It's a matter of putting that knowledge into the hands of those who can make a difference.

We appreciate the opportunity to be here today, and we look forward to working with you. Thank you.

[The statement follows:]

STATEMENT OF LYNDA JOHNSON ROBB

Chairman Harkin and members of the subcommittee, I want the thank you for this opportunity to appear before you today regarding the ongoing work of the National Commission to Prevent Infant Mortality. On behalf of Governor Chiles and the other members of the Commission, I want to convey our appreciation for your continued support of our work. In our testimony I will discuss the Commission's many efforts to promote the health and well-being of pregnant women and children. I will also briefly discuss the work we are doing with our private sector support. As you know, in fiscal years 1989 through 1991, our appropriation requests have been decreasing. This year and last, our funding level has been maintained at

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