Dr. BRABHAM. They are literally nationwide. We can provide you with a list of all those training programs. We would pleased to do so, sir. Senator REID. That would be great. Thank you very much for your testimony. STATEMENT OF WILLIAM WALLACE, M.D., M.P.H., HEALTH COMMIS- Senator REID. We will hear from Dr. William Wallace, who is the health commissioner from the State of West Virginia, representing the Association of State and Territorial Health Officials. Dr. Wallace? He did not tell me so, but I am sure he would want to. Being from the State of West Virginia, the full committee chairman would say hello and give you every best wish. Dr. WALLACE. Yes, thank you, Mr. Chairman. I am Dr. Wallace, commissioner of public health for the State of West Virginia. I have only been in the State of West Virginia for 6 months, but prior to that time I was 91⁄2 years the State health director for the State of New Hampshire. So, in representing the Association of State and Territorial Health Officials, I have had experience in two different States and over 10 years of experience as to the importance of the Federal health dollar in supporting State public health activities. The United States, as we all know, has the best medical care in the world. There is no question about that. But the United States does not have the best health care system in the world, and our unacceptably high mortality rate is evidence of this. Why is our health care system not the best? Because we have no comprehensive national health policy and no clearly defined prevention strategy. While we spend better than 10 percent of our GNP on health-it is up to about 12 percent now-only 3 percent goes for prevention. The other 97 percent goes for treatment or to a large extent mopping, as I like to refer to it. I appreciate the comments of the earlier chairman, Senator Bumpers, about the importance of prevention. We have polled our ASTHO membership and new resources required to address health needs across the Nation total $1.7 billion. Now, I would not be presumptuous enough to come here and ask for your consideration of a magnitude of increase of $1.7 billion. In my written statement, which you have received, I have enumerated a number of special need areas. I want to highlight just a couple of those. First of all, the Centers for Disease Control has historically led the Nation's efforts in prevention, and they need to be fully funded. I cannot begin to tell you what a value they have been to me over the past 10 years as a State official in two different States. In addition, they are the lead agency in the preventive health block grant, the immunization program, and sexually transmitted disease activities. And all three of these we believe need increased fund support. The prevention block grant is the very backbone of State chronic disease and health promotion efforts. In addition, in most States it provides the bulk of the funding for emergency medical services activities. An increase of $60 million over the President's $107.5 million is needed. In fact, if the block grant had received a 4.5-percent increase each year since it was established 10 years ago, and adjustments for inflation were made, the current appropriation would be approximately $170 million, which is what ASTHO feels we would like to ask for this year. And that really is just 10 percent of the $1.7 billion that we have estimated to be our need. I have a chart that indicates that, depicts that, and I will leave copies of that with the committee. Second, the rates of sexually transmitted diseases [STD's] continue to rise, and some vital resources have been redirected to AIDS activities. While AIDS is a sexually transmitted disease primarily, we cannot forget the other STD's, syphilis, gonorrhea and chlamydia, which continue to increase. And we believe an additional $37 million is needed to adequately address those areas. AIDS does continue to be one of the Nation's top concerns and treatment costs may well break the bank if we do not intensify our preventive efforts. I have noted in my statement the problems with the Ryan White CARE Act and the potential shifting of much needed prevention resources to treatment activities. I do request your close scrutiny of this issue and what it may mean to 40 States if no changes are made in that allocation. We are appreciative of the administration's efforts in the area of lead poisoning prevention and the lead poisoning program; $15 million is requested. We believe actually $25 million is needed to really get the job done, and we appreciate your support of this kind of activity. And finally, immunizations, an additional $80 million over the President's request is needed in order to adequately address the problems of H-flu meningitis, hepatitis B, and measles which continue to plague our children, our youth, and now our college campuses with measles and the need for second dose. PREPARED STATEMENT I thank you for the opportunity to be before you for these few minutes, and I urge you to think seriously about making prevention a priority in our Nation, remembering that prevention really is cheaper than a cure. [The statement follows:] STATEMENT OF WILLIAM WALLACE I would like to thank Chairman Harkin and the other members of the committee for providing me with the opportunity to testify before you today. I am Bill Wallace, Health Commissioner for the State of West Virginia. I am here today on behalf of my state as well as the Association of State and Territorial Health Officials which represents the chief health officer in the various states and territories. Americans are far healthier now than 100 years ago because of a virtual revolution in public health and preventive medicine during this century. We can now prevent measles, tuberculosis, hepatitis B, polio and other major diseases. We have sophisticated sanitation, fluoridation and environmental programs which protect our society from a large number of diseases and infections. We can diagnose and effectively treat many types of cancers, heart disease, sexually transmitted diseases, hypertension and diabetes. As a nation, we are becoming more health conscious. While Congress, the administration and the nation support the concept of prevention, the sad truth is that there is no set prevention strategy in this country. There are also inadequate resources. Only 3 percent of Federal spending is currently going into prevention activities. The other 97% goes for curative activities. The tragedy in public health is that we accept our failures. We put billions of dollars into hightech perinatal care and we cheat our prevention efforts by not putting more resources into prenatal care. We accept unimmunized children more as the norm than the exception in our funding policies. Measles is a preventable disease, yet we are embarassed by high rates this past year because children have not been adequately immunized. And there is not yet funding for the second dose of measles which is now recommended. We tolerate the rampant spread of sexually transmitted diseases while we earmark small amounts for intervention. And now as AIDS has exposed all of the vulnerabilities of the public health system we are expected to pump billions into care and treatment when much of this may have been prevented. ASTHO has solicited from its membership a listing of programs which are critical to the member's state, but which are receiving little or no funding because of a lack of resources. The response from the states has been overwhelming and the total estimate of new resources needed to address the problems totals more than $1.7 billion nationally. West Virginia estimates that we would need $24 million above current resources to fully support the public health services throughout the state. lowa estimated that it needed $12 to $15 million in additional resources: $52 million for South Carolina, $4 million for North Dakota, $3 million for Hawaii, and $60 million for Nevada. The information which ASTHO collected will soon be shared with Congressional members in a special report. If we are to fulfill our Nation's commitment to enhancing prevention efforts, it is essential that Congress provide adequate funds for a variety of prevention programs. This funding level should include $2 billion for the Centers for Disease Control. CDC has always led our nation's efforts in the area of prevention and is the lead agency for a variety of prevention initiatives including the Prevention Block Grant, Iminunizations, Sexually Transmitted Diseases, and Chronic Diseases. The services provided by the CDC are critical to this nation's health. Underfunding of the CDC and its programs will directly affect the health of present and future generations of Americans. Priority areas for funding include: PREVENTION BLOCK GRANT - The Preventive Health and Health Services Block Grant is the backbone for many state public health programs. The Block Grant helps fund essential services such as water fluoridation, hypertension screening and rape crisis intervention to a large group of individuals. In addition, this funding source is the foundation of many state health promotion and chronic disease efforts. The President's Budget for FY 1992, recognizes the importance of this prevention program. The President requested an increase of $15 million for the Block Grant raising the appropriations level from $92.5 million to $107.5 million. This emphasis is to be commended. However, the increase is not sufficient enough to have a major impact on the ability of the states to provide services under the Grant. Based on ASTHO's survey of its membership, ASTHO encourages the Committee to fund this important program at a minimum level of $170 million. This increase, which is only 10% of what the states have indicated they need to adequately address critical public health problems, will begin to ensure that state health departments are able to provide much needed prevention services to a large number of individuals. MINORITY HEALTH ACTIVITIES - Seven major diseases and problems more adversely affect minority populations than other Americans. These problems are responsible for 80 percent of the excess deaths among minorities in the United States: cancer, cardiovascular disease and stroke, diabetes, substance abuse, homicide, suicide, and unintentional injuries and infant mortality. ASTHO supports funding Increases above inflation in all of these problem areas. ASTHO also recommends a funding level of $24 million for the Public Health Service Office of Minority Health which serves as an advocate for and coordinator of health program activities addressing minority issues. BREAST AND CERVICAL CANCER Breast and Cervical Cancer are two of the most curable forms of cancer. Without adequate resources directed to the CDC Breast and Cervical Cancer Program millions of women will continue to suffer needless and painful treatment and ultimate death because of the lack of available screening opportunities and treatment options. ASTHO recommends that the CDC Breast and Cervical Cancer treatment program be funded at $80 million in FY 1992. SEXUALLY TRANSMITTED DISEASES - The rates of sexually transmitted diseases such as chlamydia, syphilis and gonorrhea have risen sharply during the last few years even through they are treatable and preventable diseases. Vital resources needed to combat these diseases have been redirected into AIDS treatment. However, other sexually transmitted diseases must not be ignored. ASTHO therefore supports an increase of $37 million over the FY 1991 funding level of $85 million for the Centers for Disease Control STD/HIV Prevention Division. Of this amount, we recommend that $12 million go towards control of syphilis and $25 million go for infertility prevention, specifically focused on control of chlamydia. LEAD POISONING SCREENING - The Administration has placed prevention of lead poisoning among young children as one of its top priorities. And Senator Harkin is to be commended for his bill reauthorizing this important program. The President's budget contained an increase for the CDC lead screening program and EPA and HHS have released a strategic plan for addressing the issue of lead poisoning. While the Administration's request for $15 million for the CDC lead poisoning program is a move in the right direction, more resources are needed to adequately implement the Administration's strategic plan and to adequately fund the Harkin reauthorization initiative. ASTHO recommends a funding level of $25 million for the CDC Lead Poisoning program. AIDS ACTIVITIES - Title III of the Ryan White CARE Act authorizes CDC grants to States for counseling, testing, referral, partner notification and early intervention services for individuals affected by HIV. Because of the new formula distribution and the requirements on use of Title Ill funds mandated by the CARE Act, 40 states, the District of Columbia and the Territories of Guam and the Virgin Islands will suffer substantial losses of prevention resources unless a hold-harmless provision is made in authorizing legislation and additional funds are made available to supplement the $102 million requested in the FY92 President's Budget. To ensure continuity of existing prevention programs and availability of adequate early intervention services, ASTHO favors a rigorous review of the statutory authority for Title III and supports additional resources for states to implement early intervention programs. As a secondary priority, ASTHO recommends a significant increase in appropriations for Title II Care Grants for States for AZT, consortia, home and community-based care and continuation of health insurance for HIV positive individuals. IMMUNIZATIONS - While ASTHO commends the President for his proposed increase of $40 million for the CDC Childhood Immunization program, we believe it falls short of the actual need. Communicable childhood diseases are on the rise in this country even though preventable vaccines exist. Without adequate resources, we will continue to see these numbers rise. We recommend that the CDC Childhood Immunization program appropriation be $336.8 million for FY 92. This amount should Include $5.8 million for HiB, $24 million for second dose MMR, and $15 million for the first year of a three-five year phase in for Hepatitis B. $30 million should be directed for CDC infrastructure to support the outreach and demonstration needs as well as $4 million for the vaccine stockpile. ASTHO also supports increased appropriations for Tuberculosis Control, Injury Control, and the Maternal and Child Health Block Grant. Unfortunately, there are many other public health programs which were not mentioned today which also need increased resources. The fact still remains while this nation, Congress and the Administration talk about the importance of prevention, state agencies must receive new resources if we are to apply our public health skills to reduce morbitiy and mortality and produce the kind of prevention interventions for which we are capable. We will continue to do our part in our respective states, but we need more support from the federal level. ASTHO challenges the Congress to make prevention a priority and to provide adequate and needed resources for prevention activities. The systems to eradicate many diseases and disabilities are in place, the trained personnel are available and the techniques for conquering disease and promoting prevention are known and accessible. What is needed is a responsible commitment of resources from which to provide improved quality of life to this nation's citizens. Again, thank you for the opportunity to testify. I am available to answer any questions. LEAD POISONING Senator REID. Dr. Wallace, as you mentioned, lead poisoning is something that I have worked on extensively during the past couple of years. We reported out of the Environment and Public Works Subcommittee yesterday a lead abatement bill that we hope to pass the Congress and give to the President this year. I note, as you have already indicated in your oral testimony, that the request of the administration is $14.9 million and that your request is for $25 million or more. I am confident that the children of our country need the more. We have significant problems. As you know, over 3 million children are lead poisoned as we speak. Those people, once lead poisoned, are poisoned forever, adversely affecting their lives. Dr. WALLACE. The subtle learning disabilities issue that is associated with that that is not often recognized. Senator REID. There are some who believe that the reason we have an extensive number of high school dropouts, especially in our major cities, is because of lead poisoning. They simply cannot learn. They cannot keep up. So, we are going to do more about that, and I am glad you have recognized that. Dr. WALLACE. Thank you. I appreciate that. Senator REID. Also, there are other important things you have spoken of not only orally, but in your written testimony. The Centers for Disease Control breast and cervical cancer screening. Certainly we need to do more there. In the administration's request, we have to acknowledge that they have requested more money this year. It is inadequate, but I am thankful they have asked for more. We are going to try to do a little better than that because this is a real dreaded disease that does not appear to be getting much better. Thank you very much for your testimony. We look forward to trying to satisfy some of the needs that you have pointed out to us. STATEMENT OF KATHERINE MCCARTER, PRESIDENT, COALITION FOR HEALTH FUNDING Could I ask Katherine McCarter, the president of the Coalition of Health Funding, to now come forward please? Ms. MCCARTER. Good morning, Mr. Chairman. Ms. MCCARTER. I am Katherine McCarter, President of the Coalition for Health Funding, which is a 20-year-old alliance of national organizations. We are kind of an umbrella group in that we represent all areas of the health community, and consequently, our focus is a very broad one. Our recommendations deal with the entire Public Health Service budget and the funding that is important and necessary in order to achieve our goals. I would like to begin by expressing the appreciation of the health community for the subcommittee's ongoing support for health initiatives, and we urge the members to continue this support as we look at the fiscal year 1992 budget. Attached to our statement is a table which outlines the coalition's recommendations for the fiscal year 1992 funding of the U.S. Public Health Service. Our recommendations are based on our re |