ask you to summarize or at least make the high points. I would ask of all of you, what are the three, four, five-I am not going to put any limit on it, but what are the things that you really think are important for us to really know here today? Dr. Mason, welcome back. [The statement follows:] STATEMENT OF DR. JAMES O. MASON I appreciate the opportunity to appear here today to discuss the FY 1991 budget request of $206 million for the Office of the Assistant Secretary for Health (OASH) appropriation and the Retirement Pay and Medical Benefits for Commissioned Officers request of $118.1 million. The FY 1991 budget request includes $19.6 million for the Office of Minority Health; $4.6 million of this amount is for AIDS activities. This is an increase of $11.6 million over the FY 1990 appropriation, and includes $10 million for the Secretary's Minority Health Initiative to improve the health status of minorities. The Office of Minority Health was established in 1985 to implement the recommendations of the Task Force Report on Black and Minority Health. Some improvements in minority health status have been achieved. However, despite numerous efforts, there continue to be large disparities - in almost every category of mortality, death rates for minorities continue to be uniformly higher than for whites. Even more telling, life expectancy for Black American males is actually declining, and is now six years shorter than life expectancy for white males. We must not allow this trend to continue. The Office of Minority Health faces the great challenge of reversing this disparity and has assumed increasing responsibilities as the Department's advocate in issue areas which impact on the health of minority populations. The Office of Minority Health acts as a catalyst to spur PHS and other public and private agencies to identify opportunities where existing programs and resources can be directed to promoting health and preventing disease among minority populations and to develop innovative strategies to improve the health status of minorities. The increase for FY 1991 will allow us to significantly expand these cooperative activities. In addition to this catalytic and coordinative role, the Office administers two grant programs which are based on the premise that health promotion and disease prevention efforts can be more effective by expanding the base of community awareness and involvement in disease risk reduction efforts. Through one grant program, we have funded 26 minority community coalition demonstration projects. The second grant program has supported 38 AIDS/HIV education/prevention projects for developing culturally sensitive health education materials and strategies for reducing the risk for acquiring and transmitting the HIV infection and AIDS. The budget request presented to you today includes $9.4 million to support the Adolescent Family Life (AFL) program's demonstration and research program at the 1990 level. This is the only Federal program solely focused on the complex issues and problems of early adolescent sexuality, pregnancy and parenting. Engaging in sexual activity places teens at risk not only of pregnancy, but also of sexually transmitted diseases, some of which are incurable, may cause sterility or even death. Premature pregnancy among unmarried teens places both the teen mother and her baby at increased risk of adverse health as well as for poverty and economic dependency. AFL prevention programs develop family-centered approaches to encourage teens to abstain from sexual activity, while AFL care programs provide comprehensive services to pregnant and parenting teens and their babies. Adoption counseling and information is provided by all care projects to help teens decide whether to parent their child or make adoption plans. Evaluations indicate that AFL care projects have a positive effect in improving birth outcomes and improving the educational and occupational prospects of teen mothers. Evaluations of AFL prevention projects show that these projects change teens' knowledge about the risks of premature sexual activity and improve their attitudes toward postponing sexual activity. In FY 1991, $139.1 million is requested to support the Administration's proposal for a State administered family planning program authorized under Title X of the Public Health Service Act. This is the same level of support as that provided in FY 1990 for the family planning discretionary grant program. Under the Administration's proposal, all Title X funds would be awarded directly to States and territories. This would enable States to better integrate Title X funds with other programs to provide primary health care and to improve access to maternal and child health programs. This proposal would also offer States increased flexibility to meet local needs and establish policies which reflect local standards for the provision of family planning services. Since its inception in FY 1988, the National Vaccine Program (NVP) has provided coordination of all PHS vaccine activities and has provided added impetus to activities aimed at developing and introducing safer, improved acellular pertussis vaccines. This has included sponsoring studies in the United States and abroad such as the large scale pertussis vaccine field trial carried out in Sweden. In FY 1991 the NVP will continue to place priority on development of pertussis vaccines as well as other activities leading to optimal prevention of infectious diseases through immunization and optimal prevention against adverse reactions to vaccines". The FY 1991 request of $6.9 million is an increase of $1 million over the FY 1990 appropriation which provided $3 million for a pertussis vaccine field trial, and $1.5 million for basic and applied research on the development of new candidate vaccines. FY 1991 the increase of $1.0 million for the NVP will support an expansion in basic and applied research and support additional staffing. In addition to this budget request, $7 million is requested in the PHS Agencies to address other high priority NVP activities, including $4.5 million for NIH to carry out an additional pertussis field trial, as well as additional basic and applied research on pertussis vaccines. The balance of $2.5 million will be used for monitoring vaccine safety, developing antibody tests and developing additional conjugated vaccines to prevent childhood meningitis. In The Office of Disease Prevention and Health Promotion's budget request of $4.5 million will provide Federal leadership for public and private action toward implementing the Year 2000 prevention goals and objectives; enable follow-up of the Surgeon General's Report on Nutrition and Health with key nutrition policy Initiatives; strengthen the delivery of critical preventive services in medical practice and disseminate health information to the public. The FY 1991 budget request includes $1.5 million to continue the program activities of the President's Council on Physical Fitness and Sports. This program consists of a variety of initiatives designed to promote knowledge and understanding about physical fitness, sports and health and to encourage participation in physical fitness activities. In FY 1991, emphasis will be placed on fitness for older adults, Native Americans, the protective services, the military, the family, and minorities, while continuing to promote physical fitness for all age groups. The FY 1991 budget includes $3.9 million for the National AIDS Program Office. This Office is the PHS component responsible for coordinating all PHS efforts to prevent and control the occurrence and spread of AIDS and HIV infection. The Office serves as the primary staff support to the Assistant Secretary for Health for PHS policies and activities concerning HIV/AIDS activities and programs. For the management and direction of the Public Health Service (PHS), we are requesting $21.1 million and 274 FTEs. This staff assists the Assistant Secretary for Health, in his role as line manager of the PHS, with the development of PHS policy and the coordination of a myriad of management functions. In FY 1989 through the efforts of the debt management staff, $79 million was collected and paid into the U.S. Treasury. The FY 1991 request provides resources to support the current level of management effort. RETIREMENT PAY AND MEDICAL BENEFITS FOR COMMISSIONED OFFICERS The Retirement Pay and Medical Benefits for Commissioned Officers appropriation provides retirement payments to Public Health Service Commissioned officers, payments to survivors of officers who elected to receive a reduced annuity, and for the costs of medical care of active duty and retired officers, their dependents and survivors. Mr. Chairman, I will be pleased to answer any question you may have. Mr. Chairman, members of the committee, I am pleased to be here today to present President Bush's budget proposal for the Public Health Service (PHS) and to report briefly on some of our activities and plans. - and for For the PHS programs within this subcommittee's Our The 1991 increase of $484 million will enable us Investing in the Future An increase of $436 million is requested for the research and development programs of NIH and ADAMHA for a total of $8.9 billion. This request will enable us to support a total of 22,842 research project grants, the highest level in history and an increase of 184 over 1990. This includes AIDS and drug related programs. This level of support will provide for a continued emphasis on basic research as well as increases for infrastructure repairs at the NIH campus. This includes an increase of $48 million for the Human Genome Initiative, a long-term effort to map and sequence the entire complement of genetic material that determines human life. It is expected to dramatically improve our ability to treat more than 3,500 diseases of known genetic origin, and allow us to better understand many other diseases. New technologies discovered during the course of the initiative will also have applications in agriculture and environmental science. Also, ADAMHA will be able to address its major research initiatives including the implementation of the National Plan for Research on Schizophrenia and the Brain, and a formal program for the development of medications for the addictive and mental disorders. The budget request includes $110 million (in obligations) for the Agency for Health Care Policy and Research, formerly known as the National Center for Health Services Research and the Health Care Technology Assessment. Spending for this new agency will include $49 million to expand the Medical Treatment Effectiveness program, an increase of $11 million over 1990. The Medical Treatment Effectiveness program is a comprehensive and a multi-agency effort to study the outcomes, effectiveness, and the appropriateness, of health care services and procedures, to find out what difference medical care makes with respect to outcomes. In addition, the Medical Treatment Effectiveness program will develop new data bases to answer this question, disseminate research findings, and support the development of practice guidelines. Anti-Drug Abuse Activities The Administration's commitment to reducing the demand for illegal drugs is emphasized in National Drug Control Strategy II and the ADAMHA budget request. Recent surveys reveal that the drug abusing population has diminished, however, the battle is far from being won. ADAMHA anti-drug abuse programs will spend $1.4 billion in FY 1991, a net increase of $179 million over FY 1990. This level will provide increases over FY 1990 in almost all aspects of our efforts to curb and prevent drug abuse. The request includes an |