in education is to make progress in school health. Our children need to enter school healthy and ready to learn, and they must be healthy and ready to learn every day if school is going to be useful. Horace Mann, one of the founders of American education, said: "In the great work of education, our physical condition, if not the first step in point of importance, is the first in order of time. On the broad and firm foundation of health alone, can the loftiest and most enduring structures of the intellect be reared."

It is our responsibility to ensure that that foundation is in place, for only healthy children can maximize their learning potential.

We have all seen the studies on heart disease, obesity, drug abuse, alcoholism, poor nutrition, and even worse, AIDS, where the epidemic that has now spread through the adult community is filtering down to our young people at alarming rates.

Soon, incidence of HIV infection will be as high among youth as it is among adults unless our children are properly educated about the disease. I strongly believe that our best weapon against the AIDS epidemic and many other unfortunate health and lifestyle trends is to institute comprehensive, high-quality health education programs in all our schools, from kindergarten through the 12th grade.

It is with that in mind that Senator Cohen and I introduced S. 2191, the "Healthy Students-Healthy Schools Act." Currently, health education in many of our Nation's high schools is a one-semester course. I believe that health education needs to be a longterm core study, not just an isolated or single topic course that is crammed into the last semester of a student's senior year.

The provisions of S. 2191 are centered around the theme of getting the Federal Government behind State and local efforts to teach comprehensive, lifelong health skills.

I will not go into great detail about the legislation at this point. I think we will have plenty of opportunity in the course of the hearing to discuss that. At this point, let me defer to Senator Cohen for any opening statement he would like to make.

[The prepared statement of Senator Bingaman follows:]

PREPARED STATEMENT OF SENATOR BINGAMAN

I will begin by commending the distinguished chairman of the Senate Labor and Human Resources Committee, Senator Kennedy, for convening today's hearing. It is a privilege for me to chair this hearing in his absence.

Many of us, in the Senate and throughout the country, look to the Chairman for leadership in our effort to help improve the Nation's health status. His commitment to AIDS prevention and education, children's health care, medical research, and health promotion and disease prevention is tremendous. I am grateful to him for sanctioning today's hearing.

The issue we will discuss this morning-creating Healthy American Schools— is one of the most important education and health issues facing our Nation today. With the help of today's witnesses, I am confident we can make "Healthy Schools" a reality for millions of American children.

I am sorry to report that the Department of Education informed us it could not send a representative to this hearing. I believe it is critical that we develop and maintain a healthy partnership between the Department of Education, the Department of Health and Human Services, and our Nation's States and schools. It is unfortunate the Department has chosen to disregard the committee's request to testify about its programs and its commitment to high quality, comprehensive school health education.

Over the past few years, the Congress, the Nation's Governors, and the administration have worked to define a realistic set of national education goals. We have

made tremendous progress recently in this task. But if we expect to achieve the goals we have set, I believe we must first ready our children. We must give them a foundation from which they can reach for these critical goals.

Our children must enter school healthy and ready to learn, and they must be healthy and ready to learn every day of their school years. Horace Mann, the great educator, said:

"In the great work of education-our physical condition, if not the first step in point of importance, is the first in order of time. On the broad and firm foundation of health alone, can the loftiest and most enduring structures of the intellect be reared."

It is our responsibility to ensure that this foundation is in place. We need to help our schools become healthy, wealthy, and wise, in that order. Only healthy children can maximize their learning potential, so health needs to be our first priority.

In my home State of New Mexico, more than half of our schools have a written, comprehensive health education curriculum, but half is not good enough. I would like to be able to say that 100 percent of our schools have comprehensive health education programs in place.

This morning, I am particularly pleased to have Alicia Snyder, the president-elect of the American School Health Association, and the Coordinator of School-based Health Centers for Albuquerque Public Schools, with us today. As a registered nurse and substance abuse specialist in some of New Mexico's most challenging schools, Ms. Snyder's insight will be particularly helpful to me and the other members of this committee.

We all have seen the studies and read the reports: it is a well known fact that half the deaths in this country are related to lifestyle. Heart disease, obesity, drug abuse, alcoholism, poor nutrition are results of the way we live. Even worse, the AIDS epidemic spreading though the adult community today is filtering down to our young people.

Soon, the rate of HIV infection will be as high among youth as it is among adults unless our children are properly educated about this disease. Our children are learning all too well the bad health habits of adults. I strongly believe our best weapon against these unfortunate lifestyle trends is to institute comprehensive, high quality health education programs in all schools, from kindergarten through 12th grade. It is for this reason Senator Cohen, my good friend and colleague from Maine, and I, along with a number of our colleagues, introduced the "Healthy Students-Healthy Schools Act."

Currently, health education in many of our Nation's high schools is a short, one semester course. Although some States mandate a health education curriculum, there is little enforcement or financial support to implement this mandate. I believe health education must be a long-term core study, not just an isolated or single-topic course crammed into a high school senior's last semester. That is too late. Health education must begin early and last a lifetime.

The provisions of S. 2191 are centered around the theme of comprehensive, lifelong learning and skills-building. The bill will establish a "Healthy StudentsHealthy Schools" Office within the Department of Health and Human Services— putting oversight of our children's health concerns where it belongs, in the Department of Health, and establishing a focal point within the Federal Government for coordinating and carrying out health education programs among States and schools. The office would encourage and support programs that stress physical health, well being, and disease prevention as regular parts of the school day.

This office will expedite the use of Federal health research information and promotion; stimulate quality health education programs; encourage community involvement in health education curriculum design; and buttress States and local educational agencies with technical support. Also, and more important, the office will work with other Federal agencies to coordinate school health and physical education programs and provide these programs with up-to-date Federal information.

Second, a national "Healthy Students-Healthy Schools" Advisory Council of experts will be established to determine realistic health education goals for the Nation and develop a model framework and standards for comprehensive sequential school health education programs.

Third, an interagency task force will be officially established, made up of representatives from all the Federal departments and agencies responsible for school health and education. This task force will provide and disseminate scientific and technical advice or school health programs, curricula, and technologies to departments, agencies, States, local educational agencies, and teachers. The task force will also develop a consolidated government-wide school health grant application form.

Fourth, the Secretary of Health and Human Services will be authorized to award incentive grants to local educational agencies to encourage all schools throughout the United States to grow into "Healthy American Schools." The Secretary will annually recognize schools that epitomize the "Healthy Students-Healthy Schools Goals."

Finally, this bill will ensure that the Department of Education's drug-free school money can be used in conjunction with comprehensive school health education programs. After all, substance abuse prevention is health education.

It is time once again to invest in the health and future of our country. The Department of Health and Human Services recognizes this need. Its "Healthy People 2000" report, which set specific health goals for the Nation, states that one of our goals should be to "increase to at least 75 percent the proportion of the Nation's elementary and secondary schools that provide planned and sequential" kindergarten through 12th grade quality school health education."

We, as a country, can no longer wait to take action. Suicide and homicide rates are rising among our young people; teen pregnancies and drug use have reached alarming rates. We are experiencing a resurgence of previously eradicated preventable diseases such as measles and polio.

We, as a country, need to pull together the resources that we have already allocated, in a uniform and coordinated manner.

We need to invest in our schools, providing them with the assistance to make healthy students a top priority.

There is an old saying about the success of societies that look toward the future: "Societies grow great when men and women plant trees under whose shade they will never sit.'

I hope we can work together to help our children grow into healthy adults. It is an enormous task, but one that I believe we can achieve. I am looking forward to a morning of insightful testimony.

OPENING STATEMENT OF SENATOR COHEN

Senator COHEN. Thank you very much, Mr. Chairman.

Let me commend you for holding this hearing and helping to move this legislation forward. I think without your initiative, we are going to continue to see the fragmentation and lack of coordination that currently exists within the Federal Government, as it pertains to the private sector and to our school system.

The health issues facing American children have changed rather dramatically over the past 30 years. Thirty years ago, child and adolescent health was threatened predominantly by contagious diseases. Today, children and adolescents are threatened primarily by their own behavior.

Drinking and driving, tobacco and other drug use, poor nutrition, inadequate physical activity, unintended pregnancy and sexually transmitted disease, and as Senator Bingaman pointed out, certainly HIV and AIDS, all take a major toll on young people and place them at increased risk of chronic disease and disability.

Almost 60 percent of the deaths in this country are attributable to cardiovascular disease and cancer. Unfortunately, American children are increasingly engaging in the three behaviors that contribute directly to these diseases: tobacco use, poor nutrition habits, and insufficient exercise. Newsweek dubbed this generation "the dumpling decade." Apparently today's kids missed out on the fitness craze of the eighties.

But I must tell you I was particularly disturbed by a recent University of Maine study which revealed that the young people of my home State are particularly unfit. Seventy-two percent of Maine boys and 64 percent of Maine girls are below the national norm for cardiovascular fitness. That same study found that 82 percent of

Maine boys and 75 percent of Maine girls have a higher percentage of body fat than the national norm.

I think there is a general recognition that those who learn healthy habits early in life are more likely to practice them as adults. The converse is also true: Tobacco and other substance abuse, poor nutrition, and lack of exercise, also have their roots in childhood.

These particular types of risk do not respond to the traditional kinds of medical treatment. I think effective health education programs are the most important thing that we can do to help our children avoid these high-risk behaviors and develop the healthy habits that will carry over into adulthood.

There is a great deal of discussion going on today about reforming our health care system, and that debate will continue this year and I suspect well into next year. But I think what we've got to do is change the focus to the very earliest years because what we do as children will, in fact, produce either healthy habits and healthy adults, or sick and ill-informed adults, who are going to place a tremendous burden upon our health care system.

Mr. Chairman, we had a hearing in the Senate Governmental Affairs Subcommittee on Oversight of Government Management last fall, and the statistics that were cited at that hearing were alarming. Forty percent of American children aged 5 to 8 are obese, inactive, or have elevated blood pressure or cholesterol, all of them being risk factors associated with cardiovascular disease. Fifty percent of our elementary school children have tried smoking, the number one preventable cause of death in the United States.

I think what is particularly alarming is that children, especially girls, are smoking at younger and younger ages. Ninety percent of all smokers start before they are 21, 60 percent before they are 14, and 22 percent before they are 9.

Thirty-nine percent of our high school seniors reported that they have gotten drunk-meaning they have consumed five or more drinks in a row-within the previous week. In my home State of Maine, an alarming 54 percent of our high school seniors reported getting drunk regularly, and 41 percent reported having driven a car while drinking alcohol or using marijuana. And of course, drinking and driving remains the number one killer of our Nation's adolescents. Ten American teenagers are killed every day in alcohol-related accidents.

At the same time that our adolescent health problems have multiplied, student academic performance is declining. An unacceptable proportion of adolescents fail to complete high school, and even more young people are unable to achieve the high level of math, science and communication skills that will be necessary as we enter the 21st century.

I will submit the rest of my statement for the record, Mr. Chairman, but will say that there is a direct correlation between one's health and one's academic performance, and we are losing out on both scores. We are producing children who are less healthy, less fit, and less academically competent to compete in the race for competitiveness in the 21st century.

We have a crisis well underway that has gone unrecognized and unattended for too long. I hope this legislation will help correct the particular curve we are on.

[The prepared statement of Senator Cohen follows:]

PREPARED STATEMENT OF SENATOR COHEN

Mr. Chairman, I was pleased to join with you in introducing the "Healthy Students-Healthy Schools Act," and I commend you for calling this hearing to help us move the legislation forward. Enactment of the "Healthy Students-Healthy Schools Act" will do much to strengthen the Federal Government's leadership role in promoting health education and prevention through our Nation's schools, and I appreciate the invitation to join the committee this morning.

The health issues facing American children have changed dramatically in recent years. Thirty years ago, child and adolescent health was threatened predominantly by contagious disease. Today, children and adolescents are endangered primarily by their own behavior.

Drinking and driving, tobacco and other drug use, poor nutrition, inadequate physical activity, unintended pregnancy and sexually transmitted disease all take a major toll on young people and place them at increased risk of chronic disease and disability as adults.

Almost 60 percent of the deaths in this country are attributable to cardiovascular disease and cancer. Unfortunately, American children are increasingly engaging in the three behaviors that contribute to these diseases: tobacco use, improper diet, and insufficient exercise.

Dubbed the "dumpling decade" by Newsweek, today's children missed out on the fitness craze of the 1980's.

I was particularly disturbed by a recent University of Maine study which revealed that the young people of my home State are particularly unfit: 72 percent of Maine boys and 64 percent of Maine girls are below the national norm for cardiovascular fitness. The same study found that 82 percent of Maine boys and 75 percent of Maine girls have a higher percentage of body fat than the national norm.

There is a general recognition that people who learn healthy habits early in life are more likely to practice them as adults. Conversely, poor habits-tobacco and other substance abuse, poor nutrition, and lack of exercise-may also have their roots in childhood.

Because these risks do not respond to traditional kinds of medical treatment, effective health education programs in schools can be invaluable in helping our children to avoid high risk behavior and develop healthy habits that will carry over into adulthood.

The Senate Subcommittee on Oversight of Government Management, of which I am the Ranking Republican, held a hearing last year at my request on the Federal Government's role in promoting child health education efforts through the schools. The statistics cited at that subcommittee hearing were alarming:

-Forty percent of American children aged 5 to 8 are obese, inactive, or have elevated blood pressure or cholesterol, all risk factors associated with cardiovascular disease.

-Fifty percent of our elementary school students have tried smoking-the number one preventable cause of death in the United States. What is particularly alarming is that children, especially girls, are smoking at younger and younger ages. Ninety percent of all smokers start before they are 21; 60 percent before they are 14, and 22 percent before they are nine.

-Thirty-nine percent of our high school seniors reported that they had gotten drunk-meaning they had consumed five or more drinks in a row-within the previous week. In my home State of Maine, an alarming 54 percent of our high school seniors reported getting drunk regularly, and 41 percent reported having driven a car while drinking alcohol or using marijuana.

Drinking and driving remains the number one killer of our Nation's adolescents: 10 American teenagers are killed every day in alcohol related traffic accidents. At the same time that our adolescent health problems have multiplied, student academic performance has declined. An unacceptable proportion of adolescents fail to complete high school, and even more young people are unable to achieve the high level of math, science, and communication skills they will need to function productively in the 21st Century.