Unfortunately, for some of our most vulnerable citizens, getting the service of qualified health professionals and learning about and assuming responsibility for one's own health is difficult.

This budget will take an important step toward improving the health of disadvantaged Americans through addressing health access to two crucial problem areas. In the area of infant mortality, the United States continues to rank 22d among all nations. The problem is most dramatic for black infants, who continue to experience twice the risk of infant deaths and low birth weight as do whites.

This request includes an increase of $63 million in PHS programs as part of an initiative for reducing infant mortality for underserved populations. In keeping with the administration's commitment to support the access to health care services for minority populations, the 1991 budget request includes an additional $117 million for a new initiative directed at increasing both the number of minority health professionals and sustaining the faculty at minority medical institutions.

This initiative will support innovative community-based approaches to recruiting minorities into health service careers and creative new strategies to provide health care services for populations in Housing and Urban Development and other public housing projects.

Thank you very much for allowing me to summarize my testimony.

Senator HARKIN. Dr. Mason, thank you very much for a very good summary.

CENTERS FOR DISEASE CONTROL

STATEMENT OF WALTER DOWDLE

Now we'll hear from Dr. Dowdle of the Centers for Disease Control.

Dr. DOWDLE. Thank you, Mr. Chairman. I am pleased to present the President's 1991 budget request for the Centers for Disease Control.

One cannot pick up a paper or a magazine or turn on the television without being reminded of the public's increasing interest and awareness in health and in improving the quality of life. We hope that CDC has played some small part in this awareness.

Unfortunately, it does not apply to all members of our society. This morning's front page story in the Washington Post on blackwhite health differences is a good example of that problem.

Most injuries and illnesses that plague this Nation in these modern times do not have to happen. They can be prevented. Prevention of injuries and diseases and promotion of healthy lifestyles are the most effective steps that we can take to increase human productivity and decrease spiraling medical costs.

Our budget request for 1991 is based on the increasing conviction that we have just begun to take advantage of our prevention and health promotion opportunities. This nearly $1.2 billion prevention budget attempts to hold the line on costs, but it allows for increased cost of living and program increases in two high priority

areas, in keeping with the Secretary's initiative, infant health and HIV infections of children.

I am pleased to be able to summarize this report. Thank you, sir. Senator HARKIN. Dr. Dowdle, I just wanted to make sure before we get into questions that the increased budget request for CDC is $1.172 billion?

Dr. DOWDLE. Yes, sir; $1.172 billion. There is an increase of $81 million. The two initiatives were the $11.5 million initiative for infant health and the $66 million for AIDS.

Senator HARKIN. $66 million for AIDS?

Dr. DOWDLE. Yes, sir.

PREPARED STATEMENT

Senator HARKIN. Thank you very much, Dr. Dowdle. We will place your statement in the record at this point.

[The statement follows:]

STATEMENT OF WALTER REID DOWDLE

Mr. Chairman, it is a pleasure to be here today for CDC's first Appropriations hearing in the new decade. The 1990's promise to be an exciting time for public health, a time when we will march forward toward the elimination of many of the health problems of the past and a time when new technologies will help us build a healthier future for all Americans. As one of the architects of the forthcoming national health objectives for the year 2000, CDC is looking to the future. We know that we cannot be complacent about our accomplishments. energies in the 90's must be directed at seeking increasingly creative ways to not only prevent disease, early death, and injury, but to enhance health and quality of life. Our 1991 budget request has been developed to help focus us in this direction.

Our

Public health faces serious challenges in the 1990's. Infant mortality remains a serious national concern, as the United States has fallen from 7th to 22nd among developed countries in its infant mortality rate over the last two decades. The problem of infant mortality is particularly acute for black infants, who continue to experience twice the risk of infant death and low birth weight than do white infants--ratios that have remained unchanged over two decades. A challenge of the 1990's will be to help those at risk to adopt healthy behaviors that can reduce and prevent the incidence of infant mortality.

Preventing the spread of the human immunodeficiency virus (HIV) also continues to be a high public health priority. While important discoveries have been made that may help prolong the lives of those infected with HIV, a cure or vaccine for the deadly virus is not yet within reach. As the 1990's begin, HIV prevention continues to be the only way of slowing the spread of HIV. CDC directly supports minority and other community-based organizations that represent populations disproportionately affected by AIDS. Last year we developed and disseminated two sets of guidelines on preventing human

immunodeficiency virus infection in the workplace. We supported both teacher training programs and prevention and surveillance programs in virtually every state in the country. Since October 1987, our

National AIDS Public Information Campaign has secured over $36 million in free public service television airtime.

There are other public health challenges ahead in the 1990's. For many infectious diseases, we have diagnostic tests, antimicrobial agents, including several new antiviral drugs, and vaccines, but in some cases, such as influenza, the organisms keep changing. In others, such as AIDS or Lyme disease, entirely new diseases emerge. To be prepared for the future, we must employ the latest technology to develop even better diagnostic tests and newer methods of detecting the microbial changes which will lead to improved vaccines and other prevention strategies, treatments, and more effective ways of getting prevention programs to people. With aggressive leadership on our part and the commitment of our public and private-sector partners, we project that by the year 2000 we can eliminate rubella and measles, reverse the trend in hepatitis B, Lyme disease, and foodborne disease, and move toward our national goal of tuberculosis elimination.

Heart disease, cancer, stroke, and diabetes are examples of health conditions that are preventable; yet we have not applied all that we know to reduce them, particularly among minority groups.

Prevention

of these chronic diseases or their complications can be achieved through smoking cessation, improved nutrition, better physical fitness, and early detection and treatment. Skeptics question our ability to help people adopt healthier behaviors. But major community-based research programs in this country and Europe have proven that community programs that combine media campaigns, counseling, screening, comprehensive school health programs, and environmental changes do lower risk of cardiovascular and other chronic diseases. The challenge for the 1990's is to work with States and communities to adapt these interventions to other chronic diseases

and to the needs of blacks, Hispanics, Native Americans and low-income

populations. If we apply what we already know, we will see major decreases in uncontrolled high blood pressure, high cholesterol, stroke, and breast and cervical cancer deaths by the Year 2000.

One of the hallmarks of the 1980's was the recognition that motor vehicle fatalities, homicide, suicide, and other types of injury are important priorities for the public health community, and that proven public health interventions can be used to reduce their terrible toll on our society. One in four U.S. residents sustains injuries each year. The total lifetime cost of injuries sustained in 1985 was $158 billion. Over the last 5 years, we have delineated many of the causes of injury, identified important risk factors such as alcohol use, and tested ways to prevent not only injuries but also the disability that results from them. Our task for the 1990's is to build the teams from public health, transportation, law enforcement, and other fields that are needed to achieve dramatic reductions in injuries and deaths due to falls, drownings, motor vehicles, homicides, and suicides.

Occupational injuries occur at twice the rate of injuries in the home, and farming is the second most dangerous occupation in the country, after transportation workers. The 9 million farm workers and family members in the United States bear a disproportionate share of injuries and disease. CDC is leading the development of a comprehensive national system to prevent farm-related injuries and diseases. In addition, CDC will sponsor a Surgeon General's conference to exchange information, build consensus, and maximize collaboration in this effort.

The Institute of Medicine report on The Future of Public Health makes it clear that these are just a few of the challenges facing public health during the next decade. This report, published last year, emphasizes the need to strengthen the ability of State and local health departments to cope with this broad and complex array of prevention issues. A strong and efficient network of public health