100TH CONGRESS 1st Session REPORT SENATE 100-167 PREVENTIVE HEALTH AND HEALTH SERVICES BLOCK GRANT PROGRAM AMENDMENTS SEPTEMBER 23 (legislative day, SEPTEMBER 22), 1987.-Ordered to be printed Mr. KENNEDY, from the Committee on Labor and Human REPORT [To accompany S. 1579] The Committee on Labor and Human Resources, to which was referred the bill (S. 1579) to amend the Public Health Service Act to revise and extend the block grant program, and for other purposes, having considered the same, reports favorably thereon with an amendment and recommends that the bill as amended do pass. I. SUMMARY OF THE BILL As reported by the Committee, S. 1579 amends title XIX, part A of the Public Health Service (PHS) Act to extend and amend the authority for the Preventive Health and Health Services (PHHS) Block Grant. The bill extends the block grant for 3 years, through fiscal year 1990. It also includes programs designed to reduce the incidence of chronic diseases among the activities for which States may use their block grant allotments. The bill requires States to include in the description prepared by them on intended uses of block grant payments a description of the objectives to be attained and the programs and activities to be supported and services to be provided, and the numbers and populations to whom such programs, activities, and services will be directed to meet such objectives. The bill amends the provision regarding annual block grant application requirements. The amendment requires each State to describe how it will evaluate the progress made in reaching stated objectives under the block grant and how it will evaluate the programs, activities, and services conducted with payments from the block grant. It also requires assurances that the State will report periodically to the Secretary on the results of such evaluations. As reported by the Committee, S. 1579 also amends section 1910 of the PHS Act (Emergency Medical Services for Children) to provide for the establishment of a National Center for Pediatric Emer-: gency Medical Services and regional centers for such services. The bill authorizes grants to States, public and nonprofit private entities, and academic institutions for the development, establishment, and operation of regional centers for pediatric emergency medical services. Each such regional center shall train health professionals, provide for the appropriate use of bilingual personnel, conduct research, and conduct prevention activities, including the dissemination of information and public education through print and broadcast media. In making grants for such regional centers, the Secretary shall give priority to (1) States and medical schools which received grants under section 1910 as in effect on September 31, 1987; (2) applicants that will provide pediatric emergency medical services in rural areas; and (3) States that have only one designated trauma center. No grant shall be less than $500,000 for a fiscal year. A grant shall be made for a 1-year period and may be renewed for two additional 1-year periods. Section 1910 as amended by the bill directs the Secretary to make a grant for fiscal year 1988 for a study on the feasibility and advisability of establishing and operating a National Center for Pediatric Emergency Medical Services. The Secretary shall request the Institute of Medicine (IOM) of the National Academy of Sciences to apply for such grant, and, if the application is acceptable, to award such grant to the IOM. If the IOM does not submit an acceptable application, the Secretary shall request that appropriate nonprofit private entities apply and shall make the grant to the entity which submits the best acceptable application. Within 12 months after enactment of the bill, the grant recipient shall report to the Secretary on the results of the study and include recommendations on the feasibility and advisability of establishing a National Center. If, after reviewing the report and after consulting with the American Academy of Pediatrics and the American College of Emergency Physicians, the Secretary determines it feasible and advisable to establish a National Center, the Secretary is authorized to make grants for fiscal year 1988 and succeeding years for the establishment of a National Center. Such a National Center shall develop and disseminate appropriate standards for the provision of pediatric emergency medical services and for appropriate mechanisms to assure quality of such care; conduct activities to facilitate training of health professionals to provide pediatric emergency medical services, including minority health professionals; and develop and disseminate, through print and broadcast media, public information on prevention of, and appropriate responses to, pediatric emergency medical services, including information on available national, State, and local pediatric emergency medical services. II. BACKGROUND AND NEED FOR LEGISLATION "Improvement in the health status of our citizens will not be made predominantly through the treatment of disease, but rather through its prevention," stated the 1979 Surgeon General's report on Health Promotion and Disease Prevention, Healthy People. Program activities in the areas of disease prevention and health promotion, risk reduction, health education, improvements in lifestyle, proper nutrition, exercise and physical fitness are playing an increasingly important role in improving the health status of Ameri cans. A major source of Federal funding for States to use in addressing preventive health needs is the Preventive Health and Health Services Block Grant, which was created with the enactment of the Omnibus Budget Reconciliation Act of 1981, Public Law 97-35. That legislation consolidated various categorical health programs into four health block grants. The Preventive Health and Health Services Block Grant consolidated eight Federal categorical health program into a single authority of grants to the States. Under this block, States have been the recipients of allotments which they use for purposes similar to the activities conducted under the categorical authorities consolidated in the block. Specifically, States may use their allotments, under this block for: (1) Preventive health service programs for the control of rodents; (2) Preventive health service programs for school-based fluoridation programs; (3) Establishing and maintaining screening, detection, diagnosis, prevention, treatment, and follow-up programs for hypertension; (4) Community-based programs for demonstrating and evaluating optimal methods for organizing and delivering comprehensive preventive health services to defined populations, comprehensive programs designed to deter smoking and the use of alcoholic beverages among children and adolescents, and other risk-reduction and health education programs; (5) Comprehensive public health services; (6) Encouraging the establishment of home health agencies in areas where the services of such agencies are not available; (7) Feasibility studies and planning for emergency medical services systems and the establishment, expansion, and improvement of such systems; and (8) Providing services to rape victims and for rape prevention. Each State's allotment of appropriations under the PHHS block grant is based on the proportion of funds it received under the various categorical programs consolidated in the block. The block grant took effect in fiscal year 1982 and the funding formula is based on each State's share of the combined categorical programs in fiscal year 1981. For services for rape victims and for rape prevention, the block contains a special set-aside: of the amount appropriated in any fiscal year for the PHHS Block Grant, at least $3.5 million must be allotted to the States on the basis of population and made available for these services. The effectiveness of preventive health measures has been demonstrated time and again across the Nation. The control of high blood pressure, for instance, has been shown to be one of the most effective measures for reducing death rates from heart disease and stroke. Since 1978 the death rate from heart disease has fallen 10 percent; the death rate from stroke has fallen 25 percent. Achievements in control of high blood pressure, including a high level of public awareness of the dangers of this disease and the possibilities for its control, have contributed to these declining death rates. The introduction and widespread use of vaccines have resulted in dramatic declines in the incidence of the seven major childhood infectious diseases-measles, mumps, rubella, polio, diphtheria, pertussis, and tetanus. Preventive health and health promotion measures have helped to contribute to declines in accidental deaths. In 1984, the overall motor vehicle death rate was down almost 20 percent from the 1978 rate. Decreases in motor vehicle deaths are attributable to many factors, including motor vehicle design, improved road conditions, improved medical care for crash victims, increased public awareness of the risk of drunk driving, and increased use of safety belts and child safety seats. The changes in smoking behavior among the population of the U.S. since the release in 1964 of the first Surgeon General's report on Smoking and Health demonstrate how health promotion and disease prevention efforts can help people change their behavior to improve the health. Public health activities to inform the public concerning the dangers of tobacco use have helped convince millions of persons either to stop smoking or not to start. Since the mid-1960s, more than 35 million smokers have quit smoking. Between 1979 and 1985 the proportion of adult smokers 18 years of age and over declined from 34 percent to 30 percent. Data from a survey of high school seniors show a dramatic decline in daily use of cigarettes among this group, from 25.4 percent of high school seniors reporting daily use in 1979 to 19.5 percent in 1985. States use their allotments under the PHHS Block Grant for a variety of activities designed to prevent disease and promote health among their populations. For instance, as reported by the Association of State and Territorial Health Officers, Alaska plans activities to reduce the use of smokeless tobacco by 15 percent among preschool and school-aged children who are presently "chewing." Arkansas will provide pamphlets and other support materials to physicians who provide comprehensive patient education on smoking, alcohol and drug abuse, exercise, nutrition, and stress. Iowa will offer smoking cessation courses for State employees. Maryland plans to provide high blood pressure detection referral, follow-up, and education programs aimed at all males under 50 and black males over 50 in nine local health departments and through four area agencies. Mississippi will provide accessible care of appropriate level to all patients with tuberculosis whose medical condition requires hospitalization. New Hampshire hopes to improve public access to emergency medical care, improve radio communication between hospital, pre-hospital personnel and public safety communications center. Ohio proposes to increase to 50 the number of local health departments conducting comprehensive health risk appraisal programs in their respective communities. Public Law 98-555 in 1984 extended the authority for the PHHS Block Grant for 3 years, through fiscal year 1987. In addition, the 1984 reauthorization legislation established new authority for the Secretary to make grants to not more than four States to support a |