conduct nutrition surveillance activities in develping countries around the world. So I have faculty with expertise in helping individual countries set up nutrition surveillance systems. I think we have been more successful in getting interest in nutrition surveillance outside of the United States than we have within the United States.

But the point that we have always tried to make in working with the nutrition surveillance system is to point out that it is not enough just to gather the data, you have to link the system of monitoring and surveillance to some kind of way of making policy that is going to deal with the issue. In other words, gathering data for data-gathering sake is not a very useful exercise. And I think that one of the things that the Congress has asked for is assistance in helping make nutrition decisions, policy decisions. If you make that on the basis of knowledge-the question you asked this morning, Mr. MacKay, about what is the nutrition status of the people of the United States, is a very relevant question in terms of trying to make the decisions that you have to deal with in this regard.

So I think that any nutrition surveillance system that we set up has got to be linked with those concerns that you have in trying to make those kinds of decisions.

Mr. BROWN. Dr. Nesheim, haven't we actually learned a great deal about the role of nutrition and health, as well as some other things, based upon what we have learned from other countries, such as the impacts of certain dietary habits on the health of the Japanese or the Chinese?

Dr. NESHEIM. Absolutely. You have to do nutrition research on an international scale because the laboratory to do that is really found throughout the world, and you can get a lot of information from outside this country.

Mr. BROWN. Again, gentlemen, you have been very helpful to us. Without objection, I will include in the record the policy statement of the NNC and the annual report which you submitted, Dr. Hurt.

Mr. BROWN. We may want to propose some additional questions to you in writing, if you don't object to answering them.

I think this is an appropriate place to close the hearing, since we have another rollcall on the floor.

Thank you very much.

The subcommittees will be adjourned.

[Whereupon, at 1:07, the subcommittees were adjourned.]

APPENDIX A

The Role of the Federal Government in

Human Nutrition Research

Hearing by the Subcommittee on Science, Research and Technology
and the Subcommittee on Department Operations, Research
and Foreign Agriculture

July 14, 1983

Follow-Up Questions for Department of Health and Human Services

1. National Nutrition Monitoring System

a.

b.

What was the role of DHHS in obtaining Advisory Council status for the Evaluation Committee of the Nutrition Status Monitoring System? Why did the clearance take one year? Since the Evaluation Committee has not met, when can Congress expect to receive the report on the nutritional status of the population originally scheduled for FY '84?

Answer: In planning for the Joint Nutrition Monitoring
Evaluation Committee, it was decided that the Department of
Agriculture would take the lead in obtaining approval for the
committee. The charter for the committee was developed by staff
of the Human Nutrition Information Service, USDA, and the
National Center for Health Statistics, DHHS. The charter
required approval by both Departments before being submitted by
USDA to the General Services Administration for clearance and to
the Office of Management and Budget for approval. The time
required to obtain approval for the Committee was long because
of the necessity for clearance by two Departments and because of
the need to address questions raised by OMB staff. The Congress
should receive the report on schedule, probably late in FY '84.
During the time that the charter was in clearance, potential
members were identified and agency staff began to assemble the
information that the Committee will require.

What is the probability of beginning the first coordinated National Nutrition Monitoring System surveys in 1987 as called for in the Implementation Plan? When will the interlocking survey design be completed? What impact will the FY '83 and FY '84 budgets have on the Department's ability to conduct the first coordinated survey in 1987?

Answer: At this point, planning for the third National Health
and Nutrition Examination Survey (NHANES III) has started and no
obstacles are foreseen to beginning the survey in coordination
with the Nationwide Food Consumption Survey in FY '87. Survey
design will be completed in FY '86. The budget in FY '83 and
'84 is adequate for planning NHANES III. FY '83 and '84 budgets
will support the planning required to conduct a survey
coordinated with the Nationwide Food Consumption Survey in FY
'87. Operating budgets for 1985, 1986 and 1987 have not been
developed.

(197)

C.

d.

DHHS belatedly joined USDA in a contract to address user needs of national food consumption data. Do you plan to hold a workshop on the user needs of nutritional status data? Do the user needs of both types of data require review prior to determining the most effective design for the 1987 coordinated surveys?

Answer: In planning for NHANES III, the needs of users of the
health and nutritional status data will be ascertained through a
series of activities. The needs of users of health, food
consumption and nutritional status data require review in
planning the next NHANES, and in improving coordination between
NHANES and the Nationwide Food Consumption Survey. We will seek
review by a group of nutritionists and physicians of the
nutritional status assessment planned for NHANES III. We have
not yet decided on a final plan, but among the additional
methods that will be used are:

letters to Federal agencies soliciting topics to be
included. Follow-up personal contacts will be used to obtain
more specific information on items which appear to be
reasonably good prospects for inclusion in the survey;

nutritional status data users workshop. Such a workshop could be held in conjunction with meetings of professional societies such as the American Public Health Association, the American Institute of Nutrition, or the American Society for Clinical Nutrition;

advertisements in professional journals. This approach would seek to obtain a wide range of opinions from health planners, health and nutrition researchers, medical care providers, and health and nutrition educators.

What is the view of the timeliness of data and analysis for
NHANES (National Health and Nutrition Examination Survey)? What
resources would be needed to complete analysis and
interpretation of NHANES I and NHANES II data by FY '85?

Answer: Improvements in timeliness are notable and the data are
being widely used. Increased speed in making the data available
to even more users remains, however, a high priority task.
Completing analysis of NHANES I and II data by the end of FY
'85, would require considerable investment of resources. A
proposal developed by staff of FDA and NCHS calls for analytic
contracts, upgrading computer software for easier data
accessibility, development of consultant panels to review issues
of data interpretation, validity and analysis, increased
computer and support personnel, and other items to facilitate
data analysis on a continuing basis. This comprehensive

proposal is being reviewed, including an assessment of possible
required resources.

e.

The National Center for Health Statistics has already taken steps to improve the timeliness of releasing NHANES and Hispanic HANES results:

a microdata tape release program has resulted in distribution of over 1,000 data tapes to universities, private organizations and Federal agencies. Articles appearing in the literature document the growing success of this effort;

technical assistance is provided to data users of the
microdata tapes and data-users meetings are being conducted
regularly to encourage appropriate analyses of the NHANES
data, and to encourage grant applications to funding agencies
with programmatic interests;

collaborative analysis efforts with staffs of the Food and
Drug Administration, Environmental Protection Agency, the
National Institutes of Health, and the Centers for Disease
Control are under way;

NHANES II and Hispanic HANES data have been, or are being, processed soon after data collection and will be released on a much more rapid schedule than their NHANES I counterparts. The Subcommittees received a statement for the record from the Association of State and Territorial Public Health Nutrition Directors which reads, "It is our view the HANES and the NFCS could, and should, become required Federal research surveys, to be scheduled and budgeted at reasonable intervals, and mandated to develop improved survey methods that would not only increase the utility of the data to State and local users but also advance the state-of-the-art for economic small surveys in states and other smaller areas." Would you comment on the feasibility of implementing this recommendation?

Answer: HANES is not specifically mandated in legislation at the present time, and there is no specific budget line item for HANES. However, sufficient authority exists for the continued conduct of the survey in the legislative authority for the National Center for Health Statistics (Section 306 of the Public Health Service Act); similarly, detailed budget information is submitted to the Appropriations Committee in the annual Congressional Justification of the President's Budget, affording the Congress the level of detail necessary to make decisions on the HANES program. It is our view that current legislative authority and budget procedures are sufficient, and that additional specificity is unnecessary; HANES is given high priority both within NCHS and the Department, and no other NCHS data collection activity is specifically mandated by name.

Staff of NCHS, FDA, CDC, NIH and other Public Health Service
agencies are considering long term research activities to