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Mr. WALGREN. With that, let me turn to Congressman Brown for any opening comments he may have, both from the view of the Science and Technology Committee, but more specifically as chairman of the subcommittee on the Agriculture Committee with jurisdiction in this area. Mr. Brown.

Mr. BROWN. Thank you very much, Mr. Chairman.

There is not much I can add to what you have already stated. Both of our subcommittees have longstanding interest and jurisdictional responsibility in the area of nutrition research, and we have used these hearings as a means of providing some degree of congressional monitoring over the activities that are going on.

I share with you a slight feeling of discomfort that our concern for improved coordination in the area of nutrition research has not yet seemed to result in an executive branch consensus on what the proper way to approach this problem is. Hopefully we will hear more about the changes that you have referred to in the testimony of the witnesses this morning.

It has been a longstanding interest of mine that the executive branch find ways to look at this problem of coordinating complex interagency programs as the generic problem. It is not just nutrition, as all of you know, it extends into many different areas.

If I had my druthers I would suggest that you have a confident scientist in the field of bureaucratic management involved in each one of these efforts to look at it as a process, and how to make the process function more adequately; then write a nice paper on it and we could all benefit from what we had learned.

I don't think that is likely to happen but, nevertheless, I still think it is a good idea.

I have received some additional statements from the Association of State and Territorial Public Health Nutrition Directors and from the State of Michigan Department of Public Health regarding the subject of our hearings today and I would like to request unanimous consent to insert these statements in the record, if I may, Mr. Chairman.

Mr. WALGREN. Without objection.
[The statements mentioned above follow:

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The Association of State and Territorial Public Health Nutrition Directors (ASTPHND) shares the concern of the Agriculture Committee and the Committee on Science and Technology on the subject of federal leadership in human nutrition research, the focus of your hearing on July 14. We are appreciative of the attention you have maintained on this fundamental subject.

This Association, an affiliate of the Association of State and Territorial Public Health Officials (ASTHO), is composed of directors and State designees for public health nutrition in the 50 States and seven Territories. Thus, we are in an intermediary position between federal and local government, and we interact with all elements of nutrition interest: medical schools, schools of public health, non-profic agencies, foundations, and private, for-profit firms. Our responsibilities include monitoring thė nutritional problems of our State's population; developing, implementing and evaluating nutrition service programs; and maintaining accountability for the expenditure of public funds in our area of responsibility. We are in continual contact with agencies of USDA and HHS, both nationally and in our State. From this experience, we wish to share our views on the subject of this hearing.

Public health nutrition is founded upon basic nutritional and medical sciences; but in addition, since its mission is to improve the health of population groups through better dietary intake, it depends just as heavily upon the behavioral sciences. These include education, sociology, psychology and the epidemiology of how people eat. We are vitally involved with changes in diet and nutritional health due to secular trends and in what methods are most effective in influencing dietary habits for the better.

ASTPHND is increasingly concerned about the growing disparity between basic nutrition knowledge and its application to people. Current scientific evidence

suggests that there may be deficiencies in major and micro-nutrients in significant segments of our population, a dramatic potential for chronic disease prevention through dietary change, and a fundamental interaction between nutrition and mental health. The application of such knowledge to health policy is a vital link between science and its application to people through public health efforts. Examples of such application include the development of major publications about nutrition, pregnancy and child health which have been funded under the auspices of Maternal and Child Health, Title V, research monies over an extended period of time. These publications have focused public health efforts and resulted in giant strides toward improved pregnancy outcome and better child health. We are most apprehensive that: resources in this area are diminishing, or they have disappeared entirely.

Public health nutrition requires a population data base containing information about nutritional status, including dietary intake, of the entire population and of high risk subgroups. Such data are now avaiable nationally principally through the Health and Nutrition Examination Survey (HANES) and the U.S.D.A. Food Consumption Survey (FCS). Reports generated from these surveys quantify problems and thereby assist planners to monitor change and better direct scarce resources.

In addition, we are in desperate need of improved survey and statistical methods that provide subnational area data. For example, we would like to meet the nutrition targets described in the HHS 1990 Objectives for the Nation, but it is reality that the great majority of States have no means for determining even baseline measures. ASTPHND is beginning to work on this problem, but without resources for such "applied research", our chances of success are not high.

It is our view that HANES and the FCS could, and should, become required
federal research surveys, to be sceduled 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.

Many States participate in the Nutrition Surveillance Program of the U.S. Centers for Disease Control, and those who do find it invaluable for program management and planning. It also has the potential for expansion to include more population groups and add more nutritional health outcome measures, including dietary indices. However, States are experiencing increased difficulty maintaining their level of support for its operation, and new States find it difficult to afford joining the Program. This CDC Program should be funded to permit more epidemiologic research and to provide for coopeative agreements for additional State participation.

In addition, in at least a half a dozen States, anecdotal reports of malnutrition have come from medical centers and church groups. It is an embarrassment to States that no rapid methods of investigating such problems are avaialble. Surely, this cannot be excused in a country with enough technology to send a space vehicle entirely out of our solar system!

These are problems of basic and applied nutrition research faced by States. While we stand ready to assist as advisors and collaborators, we depend upon federal leadership and resources in these areas. States and localities are unable to assume this role, and within the private sector it is difficult to envision any appropriate segment that would support sustained, incremental committment to these needs. Clearly, this area is one in which the federal government must maintain and better organize its efforts, including strengthening the participation of States.

The Association of State and Territorial Public Health Nutrition Directors has welcomed this opportunity to share its concerns and applauds the Agriculture and Science and Technology Committees for their continued vigilance. Please call on us if we can provide further information.

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Your joint hearing on "The Role of the Federal Government in Human Nutrition Research" may be another beginning step toward achieving a greater federal commitment for continuous exploration in the area of human nutrition research. · I think that there is a definite responsibility for the federal government to conduct both basic and applied research in nutrition. As all of us associated with government realize, health care cost containment is a major public concern. Nutrition status is clearly associated with health, productivity and the quality of life of citizens. National nutrition research is required in a multiplicity of forms, but basic to public health service delivery for health promotion and disease prevention is a national nutrition monitoring system. It is clearly the role of the federal government to monitor the food, nutrition and health status of the nation. This responsibility can be achieved by improving survey methodology, disseminating findings in a timely manner, conducting nutrition epidemiological investigations, maintaining and distributing nutrient data bank information and periodically studying especially vulnerable subgroups of the population. State and local governments may be able to conduct localized monitoring within their jurisdictions but only if acceptable nationally methodology, reference population standards and nutrient information is readily accessible. In 1978 Michigan's public health law included the state responsibility of establishing "a comprehensive health information system providing for the collection, compilation, coordination, analysis indexing, dissemination and utilization of both purposefully collected and extant health-related data and

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