Page images
PDF
EPUB

same level provided in FY 1990. funding in FY 1991 will be spent.

Please provide a breakout of how

Answer. CDC currently provides financial and technical assistance to seven Prevention Centers--Columbia University, University of Arizona, University of Hawaii, University of Illinois at Chicago, University of North Carolina, University of Texas Health Science Center at Houston, and University of Washington. Financial assistance varies by Center depending on the number of approved projects and stage of Center development, with newly established centers funded at slightly reduced levels compared to more mature centers.

The funding appropriated for FY 1991 will allow each center to maintain current activities, plus support a meeting of Prevention Center staff to share their project results. We also expect to add an additional project in one of the existing Centers.

Question. What impact will this have on the 7 centers now in

existence?

Answer. In FY 1992, CDC will continue to provide both financial and technical support to existing Centers at the approximate level of FY 1990. Productive prevention research and demonstration activities will continue at all Centers. However, if one assumes that only Federal monies are used, this level of funding may necessitate somewhat of a decrease in current activities, given costs associated with inflation. We believe the States and universities will obviously support such efforts.

Question. What is the cost of establishing a new center?

Answer. Financial assistance has requested ranged from $400,000 to $750,000 to begin activities as new Centers have been established.

BREAST AND CERVICAL CANCER

Question. The FY 1992 budget requests $50 million for the Breast and Cervical Cancer Mortality Prevention Act. How many State grants for comprehensive screening programs will be awarded in FY 1991 and how many will be awarded in FY 1992?

Answer. In FY 1991, the Centers for Disease Control (CDC) anticipates funding seven to nine States for the implementation of comprehensive breast and cervical cancer early detection and control programs. Awards to States in FY 1991 are expected to range from $2.5 to $4.0 million, and will enable States to initiate screening and follow-up activities in selected populations on a statewide basis. With a $50 million appropriation in FY 1992, CDC would increase support to States funded in FY 1991 to allow them to reach a greater number of women in need and would also enable us to add one or two additional States to the program.

Question. Would it make good prevention sense to expand this program to all 50 States?

Answer. Yes, it would make good prevention sense to expand this program to all states. Indeed, the level proposed in the FY 92 budget is a good start in that direction. It is clear that in every state substantial numbers of women are not getting screened for breast and cervical cancer. For many, financial barriers are important. For others, lack of knowledge on the part of the woman or her health care provider may contribute to not being screened. It is important to point out that mortality from breast cancer alone would be reduced by 10-15,000 deaths per year (over a 30 percent reduction) if all women over 40 years of age received a regular mammogram.

It should also be noted that Medicare coverage has been recently expanded to provide for mammography and pap smear screenings for women 65 and older; it is estimated that about 6 million women will be served by this coverage. In addition to expanded Federal efforts, the number of States mandating that public and private health insurers include coverage for breast cancer screenings has increased to at least 33 States.

Question. When will you have data on outcomes of this screening initiative?

Answer. CDC will routinely obtain information from funded States on the number of women who receive screening and follow up services from this program. In order to evaluate the impact of this effort in detecting cancers at earlier stages of development, and ultimately in reducing mortality, States will have to establish surveillance systems that will permit this type of monitoring. CDC will provide assistance to States in the development and implementation of surveillance systems that can monitor the impact of the program over time. Shifts to earlier stage of diagnosis of these cancers, through widespread utilization of these proven screening tests, should lead to mortality changes in time.

Question. Cervical cancer claims about 8,000 lives per year. What effort is CDC undertaking in the area of human papillomavirus, which has been discussed as a cause of cervical cancer?

Answer. Cervical cancer epidemiology shows that the disease behaves as a sexually transmitted disease. This fact has been known for many years. However, since there are numerous factors which contribute to the development of cervical cancer, identification of the sexually transmitted, infectious agent or agents associated with cervical cancer has been difficult. Recent work from numerous laboratories around the world have build a strong case for the human papillomaviruses as the infectious agent involved in cervical cancer. The Center for Infectious Diseases is studying the human papillomaviruses. The work on the human papillomaviruses in the CID focuses on the following areas:

Epidemiology and natural history of HPV infections and
disease. This work centers around epidemiologic studies of
human papillomavirus and disease in selected populations
including HIV infected women, women from areas of high cancer

incidence, and minority women of the southwest. While this work deals with other factors contributing to cervical disease, there is a strong emphasis on infectious agents. Significant emphasis is placed on looking for HPVs with high cancer producing ability and on studying the interaction between infectious agents, notably HIV and HPV.

Molecular techniques to detect HPV in clinical
specimens. This work is focused on the detailed
characterization of the nucleic acids found in HPV in
order to better detect the agent and to better
understand how HPV infection changes the infected
cervical cell and contributes to the development of

cancer.

CARDIOVASCULAR DISEASE

Question. As the population age 65 and older continues to grow, the incidence of cardiovascular disease can only increase. What more needs to be done to promote prevention of cardiovascular disease?

Answer. Many research and educational efforts are presently under way at the community, State, and national levels to address the growing concern of cardiovascular disease and its major risk factors: cigarette smoking, high blood cholesterol, high blood pressure, diabetes, and sedentary lifestyle..

A growing body of evidence demonstrates that changing certain health behaviors, even in old age, can produce definite benefits to health and to the quality of life. Modifiable lifestyle behaviors such as cigarette smoking, sedentary lifestyle, and consumption of high dietary fats are just a few of the behaviors for which aggressive intervention can make a difference in preventing the onset or in diminishing the progression of cardiovascular diseases.

The Year 2000 Objectives report: Healthy People 2000, National Health Promotion and Disease Prevention Objectives establishes a template for action in various prevention arenas, including cardiovascular disease prevention.

While targeted interventions are increasingly needed for high-risk populations, such as older adults and certain ethnic or socioeconomic groups, there is also a continued need for the broader programs which strive to increase awareness and encourage healthy behaviors via nationwide, state-wide, and community-based campaigns and services. CDC continues to provide technical assistance in these areas. Furthermore, the 1992 President's budget proposed an increase of $15 million for the Preventive Health and Health Services Block Grant for such activities. of this increase, $4 million will be used to achieve improved accountability of resources, and improved targeting and evaluation of efforts and national surveillance activities for such chronic diseases.

SPINA BIFIDA

Question. Scientific studies have suggested that the use of multivitamins prior to and early in pregnancy may help prevent birth defects such as spina bifida. CDC is undertaking a study the China Study on the use of multivitamins. How much is required in FY 1992 for the China Study?

-

Answer. CDC expects to continue spending $865,000 in 1992, the same level as supported in 1991 for the pilot study for a controlled randomized trial of the effectiveness of multivitamins in preventing spina bifida. If the pilot study shows the study feasible, CDC will consider funding options and priorities in future budget proposals.

INJURY CONTROL

What

Question. Injury is the leading killer of our children, claiming an estimated 22,000 children under the age of 20. more needs to be done to reduce the number of injuries?

Answer. A national campaign of proven-effective interventions has been identified by the CDC Injury Control program to reduce deaths and injuries to children in motor vehicle and bicycle crashes and a multifaceted campaign to limit unsupervised access of children to firearms. The overall approach of the campaign will be to:

[ocr errors][merged small][ocr errors]

Develop and carry out a public information campaign
that is national in scope;

Work with our partners in the public and private sector in implementing and evaluating the interventions;

Determine the most effective way to implement the
interventions;

Provide information to stimulate appropriate regulatory and legislative changes; and,

Manage and evaluate the campaign.

The 1992 President's budget includes $26.1 million for injury control activities. This is an increase of $2 million, or +8%,

over 1991.

DISASTER PREPAREDNESS

Question. As catastrophic emergencies have occurred, such as hurricanes, flooding, earthquakes, or releases of hazardous materials, a strain is put on local and State health departments. What is CDC's role in emergency preparedness and response?

Answer. CDC is working closely with the other PHS Agencies and Regional Offices to ensure that viable response plans are in place and are tested periodically. We have a dedicated staff of

Emergency Response Coordinators who provide preparedness and health response assistance throughout the U.S. CDC operates a 24-hour emergency response system and response teams can be on-site within hours.

In the near future, an Emergency Response Coordinator will be assigned to assist the Central United State Earthquake Consortium and their seven member States in preparing for earthquakes and other natural disasters.

We are actively involved in natural and technologic disaster response preparations throughout the country.

Question. Does CDC have a reserve on which to draw to respond to such emergencies?

Answer. As part of its mission, CDC makes extensive use of its existing personnel and fiscal resources to respond to routine requests for assistance. In the event of a major disaster requiring extraordinary federal resources, a Presidential disaster declaration would be made and CDC activities would be supported through the Stafford Act. In addition, CDC has access to PHS Commissioned Corps Officers who can be mobilized to respond to respond in emergency situations.

Question. In your professional opinion, what should be the amount of a reserve or contingency fund be from which CDC could draw to respond to natural disasters or threats to the public health?

Answer. In our professional opinion, the American public could be better seved if a $10,000,000 Director's contingency fund were established to respond to natural disasters, threats to the public health, and new and emerging diseases and conditions.

Although this is my professional judgement, I did not request these resources this year within the Administration's process to formulate the 1992 budget, and thus, there was never the opportunity to weigh these increases against other competing priorities within CDC or other parts of the President's budget request.

IMMUNIZATION

Question. Over the last 2 years, many of the measles cases occurred in children less than 24 months of age whose families were participants in low-income assistance programs such as WIC and AFDC. The FY 92 request includes an increase of $8,700,000 to investigate and evaluate the effectiveness of coordinating assistance programs with documented immunization of young children. How will this program be conducted?

Answer. The principal cause for the measles epidemic in 1989 and 1990 was failure to deliver vaccinations to at-risk preschoolaged children at the appropriate age, particularly in inner cities. In 1990, the proportion of cases in preschool-aged children increased to almost half, the highest proportion since the start of national data collection in 1973. Most of these preschool children

« PreviousContinue »