different from those found in Canada and most European countries and warrant careful analysis. Finally, the body of scientific knowledge upon which to base primary care has never been adequately developed. Wide variations abound among the disciplines that practice primary care and between primary care and specialty practitioners. Therefore, the primary care arena represents fertile ground for medical effectiveness and health systems research. AHCPR's immediate goal is to begin to build the existing primary care research portfolio into a more comprehensive program focusing on ways to use available resources to efficiently and effectively serve the needs of underserved populations. This will include development of practice-based research laboratories in primary care, expanded research on managed care systems, and on improved integration of effectiveness research and information dissemination. The AHCPR's long-term goal in this area is to a) increase the capacity for research in primary care and b) expand the knowledge base that supports the organization, practice, and evaluation of primary care programs and practices. While considerably broadening the scope of primary care research issues is encouraged, AHCPR will continue to stress health care services for underserved populations (including rural, minority and disadvantaged populations), infant mortality, HIV/AIDS, and delivery system issues (including comprehensive care and managed care). CENTERS FOR DISEASE CONTROL STATEMENT OF DR. WILLIAM O. ROPER, DIRECTOR ACCOMPANIED BY CLAUDE PICKELSIMER, DIRECTOR, FINANCIAL MANAGEMENT OFFICE BUDGET REQUEST Senator HARKIN. Next is the Centers for Disease Control. Senator HARKIN. Good morning, Dr. Roper. The fiscal year 1992 budget request for the Centers for Disease Control is $1.39 billion, an increase of $85.3 million over 1991. I am pleased to note that the fiscal year 1992 budget does include some increases in funding for programs that have not only had strong support from Congress but are programs that the Congress has initiated such as lead poisoning, breast and cervical cancer prevention programs, immunization, et cetera. Again, I know that we owe these increases to your leadership, Dr. Roper, and I am pleased that we are moving forward in these important areas. However, considering the billions of dollars we spend each year on medical care and research, the budget before us today I am concerned may not go far enough. When I consider that only about 1 percent of our health care dollars is spent on prevention and intervention programs, that is what raises my question as to whether or not we are doing enough. I do not need to go through again my feelings on disease prevention and health promotion, but, again, as you probably heard me say, I think that is really our best bet to improving the quality of life for all Americans, reaching down at the earliest possible stages of life and getting that health promotion attitude. Inasmuch as the primary mission of the Centers for Disease Control is prevention and intervention, I would like to discuss with you today what more needs to be done. I look forward to your professional judgment in this regard. We have had a long association together, Dr. Roper. You have been a great leader in this area for a long time. I am glad you are where you are, and I look forward to working with you in this area. I will leave the record open at this point for any statements by ranking member Senator Specter. Welcome to the subcommittee, and please proceed as you so desire. SUMMARY STATEMENT Dr. ROPER. Thank you, sir. It is a delight to be with you again. I have enjoyed my association with you in HCFA and in the White House, and I am appreciative of the opportunity to visit with you now and in the future. I guess I would begin by saying that prevention is an issue whose time has come, and it seems as though everybody, or at least almost everybody, is anxious to move ahead in prevention. I agree with your conclusion that we are not investing nearly enough in prevention activities, but we have sure come a long way fast. I would just begin by pointing out to you that this is the President's budget for fiscal year 1992; the subject we are talking about today has a chapter entitled "Focusing on Prevention and the Next Generation." This is the first President's budget in the history of the United States that has a chapter on prevention. I would just read from the highlight section in this chapter. It talks about issues such as childhood immunizations, infant mortality reduction, breast and cervical cancer prevention, smoking cessation, physical fitness and nutrition, injury prevention, access to health care, family planning, lead poisoning prevention, substance abuse prevention, and evaluation of prevention programs. CDC has activities in all of those areas, and in most of them we are the lead agency. As you have just said in your introduction, CDC is the Nation's prevention agency. We are pleased that you recognize that and we are anxious to pursue with you an even more vigorous prevention agenda for the Nation. With that enthusiasm goes a sense of responsibility. We have to deliver tangible results with the resources you give us. What I am here to talk with you about today, sir, is not pie in the sky dreams but practical programs that are proven in their effectiveness. We want to expand them more broadly to make prevention a practical reality for all of our Nation. Part of what CDC does is to be ready for unknown and unpredicted problems that come along, new organisms in the infectious disease area, new problems in other parts of our health system. I would just draw a quick analogy to what we have just witnessed in the Persian Gulf war, Desert Storm. Because of building the capability to fight that kind of a war, it went very well. We would like to fight that kind of war on prevention, and it requires investments not only on specific activities that may be popular this year and not popular next year, but it requires investment in a public health system, as you said in your earlier questions to Dr. Mason, that will deliver time and time again. Let me just draw your attention quickly to three priorities that we have set for ourselves at CDC. I have already mentioned the first, making prevention a practical reality. It is not enough simply to give nice speeches about prevention. It is important that we deliver services not only to people like my wife and myself who have a car with seat belts and know to use them. We need to make prevention a practical reality for people who cannot afford a car and who are in many ways not plugged in to doing things for themselves and preventing health problems. The second priority is improving the health of children. We have touched on immunization programs, and I want to come back to those later. It is an overarching priority. As I said, the President's budget focuses on investing for the future and the health of our children. Then finally the third area of building a public health system, strengthening the Nation's public health system is a major priority. Within prevention, HIV and AIDS activities make up a substantial portion of our budget, and I would be happy to comment on those in detail if you should wish. I would close my prepared remarks by drawing attention, sir, to this brochure which is the Surgeon General's Conference on Agricultural Safety and Health which will be held in Des Moines the first of May. I look forward to seeing you in Iowa. We are having this conference because of your leadership and look forward to that which occurs in the 20th year of the National Institute on Occupational Safety and Health's existence. NIOSH, as you know, is a part of CDC, and we want to celebrate their 20th anniversary with this conference that we are going to have in your home State. PREPARED STATEMENT Again, I would stress that CDC is the Nation's prevention agency. We are pleased to have this recognition that you have given us with your legislation, that the President has given us with his budget. There is much that remains to be done. Thank you, sir, very much. [The statement follows:] 44 STATEMENT OF DR. WILLIAM O. ROPER Mr. Chairman, it is a pleasure to be here today at the beginning of my second year as Director of the Centers for Disease Control (CDC). I am particularly pleased to be able to testify on behalf of the exceptional budget the Administration has proposed for CDC. It is a budget that shows that President Bush shares your view and ours that prevention is a prime means of protecting the health of our citizens. This is the first time that any President's budget has devoted an entire chapter to prevention programs throughout the Federal government. are exciting and challenging times. Simply put, these One of the most rewarding aspects of my first year as CDC Director has been to work closely with the talented and dedicated professionals who are the heart and soul of CDC. As I have traveled throughout the country and recently to Africa, I have learned the main reasons for the agency's distinction are its commitment to prevention and its willingness to be held accountable to the public. CDC realizes that public resources come with responsibility, a responsibility to get the maximum benefit out of what you have given us. We know we must deliver what we have promised. CDC willingly accepts that responsibility. Prevention is CDC's mission. It makes sense, not only in terms of improved health and quality of life, but also in fiscal terms. An investment in prevention is an investment in the future, and CDC will use the public funds entrusted to us to fulfill our responsibilities by improving the health of the American people. We know the importance of being ready to meet the new prevention challenges that continually emerge. It is incumbent upon us to think about the future even as we cope with present problems affecting the lives and health of Americans. To remain in a |