[Senate Hearing 112-]
[From the U.S. Government Publishing Office]
DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND
RELATED AGENCIES APPROPRIATIONS FOR FISCAL YEAR 2012
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U.S. Senate,
Subcommittee of the Committee on Appropriations,
Washington, DC.
[Clerk's note.--The subcommittee was unable to hold
hearings on departmental and nondepartmental witnesses. The
statements and letters of those submitting written testimony
are as follows:]
DEPARTMENTAL WITNESSES
Prepared Statement of the Corporation for Public Broadcasting
Chairman Harkin, Ranking Member Shelby, and members of the
subcommittee, thank you for allowing me to submit testimony on behalf
of our Nation's public media system.
Every day across the country, people turn to public radio and
television for programs that inform and inspire; for lifelong
education; for local news and information; for arts and cultural
content, and for a variety of other services. Public broadcasting, or
what should more accurately be called ``public media,'' has many faces,
and employs around 24,000 people, but is best-known by the 1,300 local
public radio and television stations across the country that provide
unique local service to their communities. These stations collectively
reach more than 98 percent of the U.S. population with free, over-the-
air television and radio programming and other services. When Congress
appropriates money to the Corporation for Public Broadcasting (CPB), it
is benefitting the 170 million Americans who use public broadcasting
each month by supporting the stations that serve them.
CPB distributes Federal funds in accordance with a statutory
formula contained in the Public Broadcasting Act of 1967, under which
more than 70 percent of our funds go directly to local public
television and radio stations. CPB also supports the creation of
programming for radio, television, and digital media. The statute
ensures diversity in this programming by requiring CPB to fund
independent and minority producers. CPB fulfills these obligations by
funding the Independent Television Service and the five Minority
Consortia in television (which represent African American, Latino,
Asian American, Native American, and Pacific Islander producers) and
similar organizations in radio. CPB funds the National Program Service
at PBS, which supports signature programs like ``PBS NewsHour'',
``NOVA'' and ``American Experience''; as well as educational,
scientifically researched, impactful and trusted children's programming
like ``Sesame Street'', ``Curious George'', and ``Word Girl''.
In addition, CPB spends 6 percent of its funds on projects that
benefit the entire public broadcasting community, befitting its role as
the only entity responsible for and answerable to the entirety of the
public media system. CPB negotiates and pays music royalties for all of
public broadcasting, for example, and funds research to explore
audience needs and technological opportunities. Added together, these
efforts account for 95 percent of the funds appropriated to CPB (which
is limited by law to an administrative budget of no more than 5
percent).
Some have suggested that public broadcasting can easily do without
Federal funding. Let me briefly explain the critical importance of
Federal funding to public media as it exists today, and what the impact
would be if it were to go away. Congress designed the public media
system in this country as a public-private partnership, where minimal
Federal dollars are leveraged to the maximum extent to ensure universal
service to every American and every community. While CPB's
appropriation accounts for around 15 percent of the entire cost of
public broadcasting, this ``lifeblood'' funding leverages critical
investments from State and local governments, universities, businesses,
foundations and from viewers and listeners of local stations. Put
simply, CPB funding is the foundation on which the entire system is
built. Undermining the foundation puts the entire structure in
jeopardy.
CPB funding is particularly important to minority-owned public
stations and stations in rural areas, which are more challenging to
operate due to low population density of viewers and listeners; the
need to operate multiple transmitters to reach far-flung populations;
and the limited disposable incomes and potential for private support
often found in rural America. In fiscal year 2009, individual donations
represented 17 percent of an average rural station's total revenue,
versus almost 28 percent for the industry as a whole. The
disproportional importance of Federal funding to stations in rural
areas is clear--in fiscal year 2009, 108 rural stations relied on CPB
for at least 25 percent of their revenue; while 22 rural stations, many
on Native American reservations, relied on CPB funding for at least 50
percent of their revenue.
Finally, CPB funding is also the only funding source without a
station cost associated with it--all other fundraising costs money (for
stations and for any nonprofit). For example, in fiscal year 2008 it
costs the average station 40 cents on the dollar to raise funds from
individuals and local businesses.
Numerous studies, including one conducted by the Government
Accountability Office (GAO), have shown that the loss of Federal
funding would create a void not easily filled by other sources of
funding. For the vast majority of stations, this would mean a drastic
and immediate cutback in service, local programming and personnel, and
in many cases stations would ``go dark.'' Further, the loss of Federal
funding would have a severe impact on a station's ability to acquire
national programming, such as ``The Electric Company'', ``Super Why!'',
``NOVA'', ``American Experience'', ``Frontline'', ``PBS NewsHour'',
Marketplace and many others, from PBS, NPR, American Public Media and
other sources. Federal funding has been the basis for this highly
successful public media model since CPB was created nearly 45 years
ago. Without it, public media ceases to exist as its creators intended.
Core System Support
One of CPB's core responsibilities is to preserve, protect, and
advance public media. Public television and radio stations are facing
an unprecedented array of challenges. These include the challenging
economy, reductions in Federal and State support, shifting community
demographics, fracturing audiences and emerging patterns in the way
content is delivered and consumed. Public television has been hit
especially hard. Over the past two years, the public television economy
has declined by $250 million, and CPB projects a further $250 million
decline over the next two years. In addition, while the digital
conversion in public television has provided exciting new opportunities
for service, digital equipment becomes obsolete much more quickly than
the analog equipment it replaced. The more or less constant cost of
equipment replacement is further affecting public television. To cope
with declining revenue and increasing equipment expenses, many stations
have been forced to cut local service. As a result, the need to
maintain infrastructure is draining resources from content and local
service at stations.
CPB is working in two areas to help the system begin to facilitate
collaboration and operational efficiencies: mergers and consolidations,
and joint master control operations.
Mergers and Consolidation.--Most communities are served by one or
more stand-alone public broadcasting stations. While independent local
stations theoretically have a great deal of flexibility in choosing how
to serve their community, the limited scale of many stand-alone
operations drives up operating costs and constrains stations' ability
to offer local service.
State networks like Iowa Public Television and Alabama Public
Television have demonstrated the advantage of taking an alternative
approach. Combining management and back office operations to serve
multiple communities can increase efficiency and free resources for
additional local service. CPB plans to continue to work with stations
to explore operating models that bring multiple stations together as an
important focus of our work. Our efforts include offering informal
advice to stations considering mergers and, once stations issue a
formal intent to merge, providing some financial assistance with
merger-related costs.
Central Master Control.--A master control room is the central hub
of a television station's technical operation, the point where content
sources come together to be routed to the station transmitter. In the
past, each television station has needed a master control room. Digital
technology now allows the master control function to be provided from a
remote location. A single master control facility can now serve
multiple stations. This is important because master controls are
expensive; they are both capital- and people-intensive. Combining
master control operations can yield significant cost savings, increase
productivity, and encourage station collaboration in other back-office
areas.
CPB is supporting the design and construction of multi-station
master control facilities. We are also exploring the practicality of
creating a nationwide ``master plan'' for master control facilities. As
the specifics of a new consolidated master control function evolve,
there is an opportunity to realize cost savings, reduce the capital
burden on stations, and improve efficiency for public television.
American Graduate
In the words of our statute, ``[I]t is in the public interest to
encourage . . . the use of [public] media for instructional,
educational, and cultural purposes.'' Education continues to be a core
value of the public broadcasting community, as it has been since its
inception. For over 40 years, public broadcasting stations have made a
robust and vital contribution to education and an informed and
strengthened civil society, and these contributions are reflected in
CPB's recently-launched American Graduate initiative.
American Graduate is a significant new public media initiative to
help improve our Nation's high school graduation rates. Every year,
more than 1 million students drop out of high school. If that trend
continues, over the next 10 years, it will cost the Nation more than $3
trillion in lost wages, productivity and taxes. American Graduate
expands on public media's record of success in early childhood
education to reach students in middle school--a critical point when the
disengagement that leads to dropping out in high school often begins.
Local public radio and television stations are at the core of this
initiative and are uniquely positioned to educate and engage various
stakeholders on the dropout problem, rally support and help coordinate
efforts in communities, something experts say is crucial to a solution.
CPB's Requests for Appropriations
Public media stations continue to evolve, both operationally and
more importantly in the myriad ways they serve their communities.
Stations are committed to reaching viewers and listeners on whatever
platform they use--from smart phones to iPads to radios to television
sets. While stations can and will continue to adapt and thrive in the
digital age, without sufficient support they cannot provide service on
evolving platforms. As the Federal Communications Commission's National
Broadband Plan noted, ``Today, public media is at a crossroads . . .
[it] must continue expanding beyond its original broadcast-based
mission to form the core of a broader new public media network that
better serves the new multi-platform information needs of America. To
achieve these important expansions, public media will require
additional funding.''
CPB Base Appropriation (Fiscal Year 2014).--CPB has requested a
$495 million advance appropriation for fiscal year 2014, to be spent in
accordance with the Public Broadcasting Act's funding formula. The two-
year advance appropriation for public broadcasting, in place since
1976, is the most important part of the ``firewall'' that Congress
constructed between Federal funding and the programs that appear on
public television and radio. President Gerald Ford, who initially
proposed a 5-year advance appropriation for CPB, said it best when he
said that advance funding ``is a constructive approach to the sensitive
relationship between Federal funding and freedom of expression. It
would eliminate the scrutiny of programming that could be associated
with the normal budgetary and appropriations processes of the
government.''
Our fiscal year 2014 request balances the fiscal reality facing our
Nation with the stark fact that stations are struggling to maintain
service to their communities in the face of shrinking non-Federal
revenues--a $218 million, or 9.2 percent, drop between fiscal year 2008
and 2009 alone. Even with these challenges, public broadcasting
contributes to American society in many ways that are worthy of greater
Federal investment. In fiscal year 2014, CPB will continue to support a
range of programming and initiatives through which stations provide a
valuable and trusted service to millions of Americans.
CPB Digital Funding (Fiscal Year 2012).--CPB requests $48 million
for CPB Digital for fiscal year 2012, $11.5 million less than requested
in fiscal year 2011. The digital conversion of public media is a much
more extensive process than simply replacing analog with digital
equipment. Digital conversion requires the development of new
organizational models optimized for the digital environment, with new
workflows, multi-channel services, and multi-platform distribution. CPB
Digital funding, which can fund a wider range of projects than our
formula-governed main account, has led to some of the most important
innovation in public broadcasting's history. The continuing
availability of this funding is critical to public broadcasting's
progress toward a true, digital public service media.
Ready To Learn (Fiscal Year 2012).--CPB requests that the U.S.
Department of Education's Ready To Learn (RTL) program be funded at
$27.3 million, the same level as fiscal year 2011. A partnership
between the Department, CPB, PBS and local public television stations,
RTL leverages the power of digital television technology, the Internet,
gaming platforms and other media to help millions of young children
learn the reading and math skills they need to succeed in school. The
partnership's work over the past few years has demonstrably increased
reading scores particularly among low-income children and has erased
the performance gap between children from low-income households and
their more affluent peers. An appropriation of $27.3 million in fiscal
year 2012 will enable RTL to develop tools to improve children's
performance in math as well as reading and bring on-the-ground,
station-convened early learning activities to more communities.
All told, the Federal contribution to public media through CPB
amounts to $1.39 per American per year and, in a model private-public
partnership, the public media system takes each of these dollars and
raises six dollars more. The returns for taxpayers are exponential.
They include in-depth news and public affairs programming on the local,
State, national and international level; unmatched, commercial-free
children's programming; formal and informal educational instruction for
all ages; and inspiring arts and cultural content.
Mr. Chairman and Ranking Member, thank you again for allowing CPB
to submit this testimony. We are under no illusions about the pressures
you face on a daily basis as Congress works to address our country's
perilous fiscal situation. As such, on behalf of the public
broadcasting community, including the stations in your states and those
they serve, we sincerely appreciate your support.
______
Prepared Statement of the Railroad Retirement Board
We are pleased to present the following information to support the
Railroad Retirement Board's (RRB) fiscal year 2012 budget request.
The RRB administers comprehensive retirement/survivor and
unemployment/sickness insurance benefit programs for railroad workers
and their families under the Railroad Retirement and Railroad
Unemployment Insurance Acts. The RRB also has administrative
responsibilities under the Social Security Act for certain benefit
payments and Medicare coverage for railroad workers. During the past 2
years, the RRB has also administered special economic recovery payments
and extended unemployment benefits under the American Recovery and
Reinvestment Act of 2009 (Public Law 111-5). More recently, we have
administered extended unemployment benefits under the Worker,
Homeownership, and Business Assistance Act of 2009 (Public Law 111-92),
and the Tax Relief, Unemployment Insurance Reauthorization, and Job
Creation Act of 2010 (Public Law 111-312).
During fiscal year 2010, the RRB paid $10.8 billion, net of
recoveries, in retirement/survivor benefits to about 582,000
beneficiaries. We also paid $156.3 million in net unemployment/sickness
insurance benefits to some 38,000 claimants. Unemployment benefits
included $19.4 million under Public Law 111-92, and about $0.8 million
under Public Law 111-5. In addition, the RRB paid benefits on behalf of
the Social Security Administration amounting to $1.3 billion to about
116,000 beneficiaries.
PROPOSED FUNDING FOR AGENCY ADMINISTRATION
The President's proposed budget would provide $112,239,000 for
agency operations, which would enable us to maintain a staffing level
of 902 full-time equivalent staff years (FTEs) in 2012. The proposed
budget would also provide $1,810,000 for information technology (IT)
investments. This includes $700,000 for costs related to systems
modernization and e-Government, and $654,000 for improvements related
to cyber security and continuity of operations. The remaining $456,000
would be used for network operations, infrastructure replacement and
emergency restoration services.
AGENCY STAFFING
The RRB's dedicated and experienced workforce is the foundation for
our tradition of excellence in customer service and satisfaction. Like
many Federal agencies, however, the RRB has a number of employees at or
near retirement age. Nearly 70 percent of our employees have 20 or more
years of service at the agency, and about 40 percent of our current
workforce will be eligible for retirement by January 1, 2013. To help
prepare for the expected staff turnover in the near future, we are
placing increased emphasis on strategic management of human capital.
Our human capital plans provide for employee support and knowledge
transfer, which will enable the RRB to continue achieving its mission.
In addition, with the agency's formal human capital plan, succession
plan and various action plans in place, we are ensuring that succession
management supports a systematic approach to ensuring a continuous
supply of the best talent through helping individuals develop to their
full potential.
In connection with these workforce planning efforts, our budget
request includes a legislative proposal to enable the RRB to utilize
various hiring authorities available to other Federal agencies. Section
7(b)(9) of the Railroad Retirement Act contains language requiring that
all employees of the RRB, except for one assistant for each Board
Member, must be hired under the competitive civil service. We propose
to eliminate this requirement, thereby enabling the RRB to use various
hiring authorities offered by the Office of Personnel Management.
INFORMATION TECHNOLOGY IMPROVEMENTS
We are actively pursuing further automation and modernization of
the RRB's various processing systems to support the agency's mission to
administer benefit programs for railroad workers and their families.
Key capital initiatives for fiscal year 2012 include projects to add
new reporting services to our Employer Reporting System, and to
continue with long-term system modernization efforts. In recent years,
the agency has moved to a relational database environment and optimized
the data that reside in the legacy databases. In fiscal year 2012, our
staff will work with an experienced DB2 Database Administrator to
ensure that the master database remains platform independent and to
develop stored procedures that will be used by reengineered mainframe
programs that access the master database. We also plan to move forward
with reengineering the applications to the agency's LAN enterprise
program platform, several of which are programmed in outdated,
commercially unsupported technologies.
Our budget request also provides for cyber security improvements to
ensure that the RRB continues to control the risks that threaten the
agency's critical assets and to meet the security requirements set
forth in the Federal Information Security Management Act (FISMA) of
2002, and infrastructure investments to maintain our operational
readiness and provide a firm foundation for our target enterprise
architecture.
OTHER REQUESTED FUNDING
The President's proposed budget includes $51 million to fund the
continuing phase-out of vested dual benefits, plus a 2 percent
contingency reserve, $1,020,000, which ``shall be available
proportional to the amount by which the product of recipients and the
average benefit received exceeds the amount available for payment of
vested dual benefits.'' In addition, the President's proposed budget
includes $150,000 for interest related to uncashed railroad retirement
checks.
FINANCIAL STATUS OF THE TRUST FUNDS
Railroad Retirement Accounts.--The RRB continues to coordinate its
activities with the National Railroad Retirement Investment Trust
(Trust), which was established by the Railroad Retirement and
Survivors' Improvement Act of 2001 (RRSIA) to manage and invest
railroad retirement assets. Pursuant to the RRSIA, the RRB has
transferred a total of $21.276 billion to the Trust. All of these
transfers were made in fiscal years 2002 through 2004. The Trust has
invested the transferred funds, and the results of these investments
are reported to the RRB and posted periodically on the RRB's website.
The net asset value of Trust-managed assets on September 30, 2010, was
approximately $23.8 billion, an increase of $0.5 billion from the
previous year. As of April 2011, the Trust had transferred
approximately $11 billion to the Railroad Retirement Board for payment
of railroad retirement benefits.
In June 2010, we released the annual report on the railroad
retirement system required by Section 22 of the Railroad Retirement Act
of 1974, and Section 502 of the Railroad Retirement Solvency Act of
1983. The report addressed the 25-year period 2010-2034, and included
projections of the status of the retirement trust funds under three
employment assumptions. These indicated that barring a sudden,
unanticipated, large decrease in railroad employment or substantial
investment losses, the railroad retirement system would experience no
cash flow problems for the next 23 years. Even under the most
pessimistic assumption, the cash flow problems would not occur until
the year 2033. The report did not recommend any change in the rate of
tax imposed by current law on employers and employees.
Railroad Unemployment Insurance Account.--The RRB's latest annual
report on the financial status of the railroad unemployment insurance
system was issued in June 2010. The report indicated that even as
maximum daily benefit rates rise 39 percent (from $64 to $89) from 2009
to 2020, experience-based contribution rates are expected to keep the
unemployment insurance system solvent, except for small, short-term
cash-flow problems in 2010 and 2011. Projections show a quick repayment
of loans even under the most pessimistic assumption.
Unemployment levels are the single most significant factor
affecting the financial status of the railroad unemployment insurance
system. However, the system's experience-rating provisions, which
adjust contribution rates for changing benefit levels, and its
surcharge trigger for maintaining a minimum balance, help to ensure
financial stability in the event of adverse economic conditions. No
financing changes were recommended at this time by the report.
Due to the increased level of unemployment insurance payments
during fiscal years 2009 and 2010, loans from the Railroad Retirement
(RR) Account to the RUI Account became necessary beginning in December
2009. The balance of loans from the RR Account was $47.4 million at the
end of fiscal year 2010, including $0.9 million in accrued interest.
The estimated loan balance at the end of fiscal year 2011, is $3.0
million, and full repayment of the loans is expected during fiscal year
2012.
Thank you for your consideration of our budget request. We will be
happy to provide further information in response to any questions you
may have.
______
Prepared Statement of the Inspector General, Railroad Retirement Board
My name is Martin J. Dickman and I am the Inspector General for the
Railroad Retirement Board. I would like to thank you, Mr. Chairman, and
the members of the Subcommittee for your continued support of the
Office of Inspector General.
BUDGET REQUEST
I wish to inform you of our fiscal year 2012 appropriations request
and describe our planned activities. The Office of Inspector General
(OIG) respectfully requests funding in the amount of $9,259,000 to
ensure the continuation of its independent oversight of the Railroad
Retirement Board (RRB). During fiscal year 2012, the OIG will focus on
areas affecting program performance; the efficiency and effectiveness
of agency operations; and areas of potential fraud, waste and abuse.
OPERATIONAL COMPONENTS
The OIG has three operational components: the immediate Office of
the Inspector General, the Office of Audit (OA), and the Office of
Investigations (OI). The OIG conducts operations from several
locations: the RRB's headquarters in Chicago, Illinois; an
investigative field office in Philadelphia, Pennsylvania; and five
domicile investigative offices located in Arlington, Virginia; Houston,
Texas; San Diego, California; Miami, Florida; and New York, New York.
These domicile offices provide more effective and efficient
coordination with other Inspector General offices and traditional law
enforcement agencies with which the OIG works joint investigations.
OFFICE OF AUDIT
The mission of the Office of Audit is to promote economy,
efficiency, and effectiveness in the administration of RRB programs and
detect and prevent fraud and abuse in such programs. To accomplish its
mission, OA conducts financial, performance, and compliance audits and
evaluations of RRB programs. In addition, OA develops the OIG's
response to audit-related requirements and requests for information.
During fiscal year 2012, OA will focus on areas affecting program
performance; the efficiency and effectiveness of agency operations; and
areas of potential fraud, waste, and abuse. OA will continue its
emphasis on long-term systemic problems and solutions, and will address
major issues that affect the RRB's service to rail beneficiaries and
their families. OA has identified four broad areas of potential audit
coverage: Financial Accountability; Railroad Retirement Act & Railroad
Unemployment Insurance Act Benefit Program Operations; Railroad
Medicare Program Operations; and Security, Privacy, and Information
Management.
During fiscal year 2012, OA must accomplish the following mandated
activities with its own staff: Audit of the RRB's financial statements
pursuant to the requirements of the Accountability of Tax Dollars Act
of 2002 and evaluation of information security pursuant to the Federal
Information Security Management Act (FISMA).
During fiscal year 2012, OA will complete the audit of the RRB's
fiscal year 2011 financial statements and begin its audit of the
agency's fiscal year 2012 financial statements. OA contracts with a
consulting actuary for technical assistance in auditing the RRB's
``Statement of Social Insurance'', which became basic financial
information effective in fiscal year 2006. In addition to performing
the annual evaluation of information security, OA also conducts audits
of individual computer application systems which are required to
support the annual FISMA evaluation. Our work in this area is targeted
toward the identification and elimination of security deficiencies and
system vulnerabilities, including controls over sensitive personally
identifiable information. OA will also conduct an audit of employer
compliance with the provisions of the Railroad Retirement and Railroad
Unemployment Insurance Acts. Our work in this area is designed to
verify the completeness and accuracy of the external reviews performed
by the RRB's compliance group.
OA undertakes additional projects with the objective of allocating
available audit resources to areas in which they will have the greatest
value. In making that determination, OA considers staff availability,
current trends in management, Congressional and Presidential concerns.
OFFICE OF INVESTIGATIONS
The Office of Investigations (OI) focuses its efforts on
identifying, investigating, and presenting cases for prosecution,
throughout the United States, concerning fraud in RRB benefit programs.
OI conducts investigations relating to the fraudulent receipt of RRB
disability, unemployment, sickness, and retirement/survivor benefits.
OI investigates railroad employers and unions when there is an
indication that they have submitted false reports to the RRB. OI also
conducts investigations involving fraudulent claims submitted to the
Railroad Medicare Program. These investigative efforts can result in
criminal convictions, administrative sanctions, civil penalties, and
the recovery of program benefit funds.
OI INVESTIGATIVE RESULTS FOR FISCAL YEAR 2010
------------------------------------------------------------------------
------------------------------------------------------------------------
Civil Judgments......................................... 19
Indictments/Informations................................ 47
Convictions............................................. 50
Recoveries/Receivables.................................. $29,296,188
------------------------------------------------------------------------
OI anticipates an ongoing caseload of about 450 investigations in
fiscal year 2012. During fiscal year 2010, OI opened 244 new cases and
closed 210. To date in fiscal year 2011, OI has opened 188 new cases
and closed 135. At present, OI has cases open in 47 States, the
District of Columbia, and Canada with estimated fraud losses of over
$37 million. Disability fraud cases represent the largest portion of
Ol's total caseload. These cases involve more complicated schemes and
often result in the recovery of substantial amounts for the RRB's trust
funds. They also require considerable resources such as travel by
special agents to conduct surveillance, numerous witness interviews,
and more sophisticated investigative techniques. Additionally, these
fraud investigations are extremely document-intensive and require
forensic financial analysis.
During fiscal year 2012, OI will continue to coordinate its efforts
with agency program managers to address vulnerabilities in benefit
programs that allow fraudulent activity to occur and will recommend
changes to ensure program integrity. OI plans to continue proactive
projects to identify fraud matters that are not detected through the
agency's program policing mechanisms.
CONCLUSION
In fiscal year 2012, the OIG will continue to focus its resources
on the review and improvement of RRB operations and will conduct
activities to ensure the integrity of the agency's trust funds. This
office will continue to work with agency officials to ensure the agency
is providing quality service to railroad workers and their families.
The OIG will also aggressively pursue all individuals who engage in
activities to fraudulently receive RRB funds. The OIG will continue to
keep the Subcommittee and other members of Congress informed of any
agency operational problems or deficiencies.
The OIG sincerely appreciates its cooperative relationship with the
agency and the ongoing assistance extended to its staff during the
performance of their audits and investigations. Thank you for your
consideration.
______
NONDEPARTMENTAL WITNESSES
Prepared Statement of ADAP Advocacy Association
Thank you on behalf of the ADAP Advocacy Association (aaa+) and its
board of directors for the opportunity to submit our written testimony
to the Senate Committee on Appropriations, Subcommittee on Labor,
Health and Human Services and Education (LHHSE) about the AIDS Drug
Assistance Programs (ADAPs). aaa+ is a national 501(c)(3) nonprofit
organization incorporated in the District of Columbia to promote and
enhance the AIDS Drug Assistance Programs and improve access to care
for persons living with HIV/AIDS. We appreciate the opportunity to
share our testimony on fiscal year 2010 appropriations.
State ADAPs are primarily federally funded under Part B of the Ryan
White Comprehensive AIDS Resources Emergency (CARE) Act. ADAPs provide
medications to treat HIV disease and prevent and treat AIDS-related
opportunistic infections to low income, uninsured and underinsured
individuals living with HIV/AIDS in the 50 States, District of
Columbia, Puerto Rico, Guam, U.S. Virgin Islands, American Samoa,
Marshall, and Northern Marianas Islands. Additional funding is directed
toward State ADAPs from other Ryan White CARE Act funds, including Part
A Eligible Metropolitan Area (EMA) funds. Many States also directly
contribute funding. ADAPs represent the ``access to treatment'' window
for the community-based continuum of HIV/AIDS healthcare so carefully
built and supported by all the parts of the Ryan White CARE Act, which
was reauthorized for 4 years by both Houses of Congress and signed into
law by President Barack Obama on October 30, 2009. The law in general
has enjoyed strong bipartisan support since it was first passed in the
1990s, and ADAPs specifically have been a Return on Investment (ROI)
model since the Federal Government began pumping money into them when
President Bill Clinton and Speaker Newt Gingrich were in office.
At the time when our testimony is being submitted to the
subcommittee for its consideration, there are 7,553 people living with
HIV/AIDS in 11 States on ADAP waiting lists--including 31 people in
Arkansas, 3,848 people in Florida, 1,221 people in Georgia, 11 people
in Idaho, 816 people in Louisiana, 21 people in Montana, 177 people in
North Carolina, 303 people in Ohio, 560 people in South Carolina, 563
people in Virginia and 2 people in Wyoming. Overall, 95.54 percent of
these people reside in the South. Additionally, it is being submitted
for the people living with HIV/AIDS who are the ``invisible'' waiting
lists because they have been kicked-off the program due to changes in
eligibility requirements--including 99 people in Arkansas, 257 people
in Ohio, and 89 people in Utah, as well as the 6,500+ people in Florida
who have been transitioned off the program.
Faced with the ``Perfect Storm'' that is being fueled by high
unemployment, record number of uninsured, State budgetary cutbacks,
high cost of medications and inadequate Federal funding, there are a
historic number of people being denied access to treatment. Without the
subcommittee's leadership and fortitude to recognize the ROI from
ADAPs, several thousand people living with HIV/AIDS will be at risk of
developing Opportunistic Infections (OIs), and thousands of others who
are HIV-negative will be at greater risk of contracting the virus
because their HIV-positive counterparts are more infectious when not
taking Highly Active Anti-Retroviral Therapy (HAART).
Each year a sophisticated pharmacoeconomic model is employed by the
ADAP Coalition--a unique coalition of AIDS advocates, community-based
organizations and representatives of research-based pharmaceutical and
biotechnology companies--referencing the data collected from ADAPs from
the previous 2 years to forecast the dollar resources that will be
needed for the coming 2 years to enable ADAPs to provide HAART
(combination antiretroviral therapy) to Americans living with HIV
disease.
Many are familiar with this process and its remarkable accuracy
over the past 12 years. The Congress and White House have provided us
with support very close to the amounts we projected in fiscal year
1996, 1997, 1998, 1999, 2000, always in amounts above the original
Administration budget requests; funding in subsequent fiscal year 2001-
05 was sustainable, but often short of the necessary amounts needed to
avert waiting lists. Between 2000 and 2008, States increased their
share of the ADAP budget by 155 percent while the Federal Government
increased its share by only 46 percent overall. The chart shows the
increase by each party each year over the previous fiscal year in
percentage points. States have basically increased--as well as
pharmaceutical rebates--while the Federal commitment has gone down!
The ongoing ADAP crisis is being fueled, by in large, because
Federal spending has been inadequate--despite small budget increases
under both President George W. Bush and President Obama since 2005. The
Federal share of ADAP funding has fallen steadily over the last several
years. In fiscal year 2003 the Federal earmark was 72 percent of the
overall ADAP budget. In fiscal year 2009, the Federal share had fallen
to 49 percent of the ADAP budget. ADAPs have long had a strong State-
Federal partnership; however despite the economic downturn many States
have increased funding in fiscal year 2010 by an additional $121
million for a total of $346.2 million. Pharmaceutical manufacturers
have also helped to alleviate fiscal challenges for ADAP by agreeing to
lower drug prices and enhance rebates, which amounted to $259 million
in saving for fiscal year 2009. Supplemental agreements will save an
additional $160 million per year starting in July 2010.\1\
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\1\ The ADAP Coalition, ADAP Need Fiscal Year 2012, January 2011.
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ADAPs truly need an increase of $410 million in fiscal year 2012 to
maintain their programs and fill the structural deficits that have
built up over the last several years. In fiscal year 2012, the HIV/AIDS
community is asking for an increase of $131 million to continue to
serve an average of 1,312 new clients per month. The funding level of
$991 million is the authorized level in the Ryan White reauthorization
of 2009.\2\
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\2\ The ADAP Coalition, ADAP Need Fiscal Year 2012, January 2011.
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A large gap remains for ADAPs in fiscal year 2010. Included in the
fiscal year 2011 need number was a revised estimate for the ADAP
Federal need number for fiscal year 2010 of $961 million, an increase
of $126 million over the current funding level. The fiscal year 2010
need number was revised based upon new survey data. Coupled with
estimated State funding, this funding will provide continued services
to a total of 153,875 clients in fiscal year 2010, including the
ability to enroll 15,760 new clients and eliminate waiting lists. This
includes individuals who are fully covered by ADAP and those who
receive assistance with Medicare Part D cost sharing requirements or
private insurance continuation. The fiscal year 2010 need number has
been adjusted from the previous level to account for the $20 million
already received through the fiscal year 2010 Congressional
appropriations process.\3\ This problem is only worsens moving into
fiscal year 2012.
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\3\ The ADAP Coalition, ADAP Need Fiscal Year 2010 & Fiscal Year
2011, January 2010.
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The problem of growing ADAP waiting lists is exacerbated because we
are facing an American HIV/AIDS epidemic of devastating proportion.
According to some estimates, the number of people living with HIV/AIDS
in the United States was approximately 2 million by the end of 2010.
These numbers are not due to decrease in the near future. In 2006
alone, the Centers for Disease Control and Prevention (CDC) estimated
that there have been more than 56,000 new HIV infections per year for
the last decade. If this was not severe enough, the disease is far from
color blind. Currently, the incidence rate of new HIV infection among
African American men and women is seven times that of the Caucasian
population. Furthermore, racial disparities are echoed regionally as
the epidemic has seen its most recent unfettered growth in southern
States, which often times have smaller State budgets and fewer access
points to comprehensive care.
The ADAP need is being driven by simple factors. As we all know
HAART AIDS treatments has dropped U.S. death rates from AIDS by about
75 percent starting in 1996. Whereas annual AIDS deaths use to run
about 40,000 a year, now 15,000 to 17,000, even less in areas of very
good medical care.
While dramatic improvements in lifespan and quality of life are
almost miraculous, HAART treatments must continue for ADAP patients.
Therefore patients living longer will likely require ADAP services for
medications longer. There are 200,000 to 300,000 Americans who are
unaware that they are HIV+. Extensive multi-million dollar efforts for
outreach and HIV testing are going on all over the country, and the CDC
now urges routine testing for those at risk for HIV. Funded by
churches, foundations, Minority Health Initiatives, pharmaceutical
companies and AIDS service groups, these efforts are identifying ``hard
to reach'' populations many of whom lack adequate health insurance.
These individuals, when identified, must look to ADAP to cover the
costs of their drugs. For most, access to Medicaid is limited. State
Medicaid programs typically require disease progression to full-blown
AIDS to meet the Social Security definition of disabled. U.S.
Government treatment guidelines consider progression to full-blown AIDS
to be months and years too late for optimum treatments. As we decided
in Congress to allow timely early treatment of breast and cervical
cancers in women, so too should we allow States the option to provide
early treatments for HIV through Medicaid to both men and women.
While we hope that Congress will pass the Early Treatment for HIV
Act (ETHA) to allow States the option to provide HIV care and
treatments through Medicaid early in the disease process when health
benefits are greater and costs are less, for now we are stuck with
folks who can't qualify for Medicaid looking to ADAP for basic
coverage. Increases in private sector health insurance costs forces
steady streams of HIV+ patients from private health insurance programs
to State ADAPs. This is a result of rising costs in premiums and co-
payments that become unaffordable, and in some instances by HMO-type
providers with drug benefits leaving the market for more profitable
locations. These factors together, ensure need for State ADAPs for the
coming years. The increasing rate of need will be substantial until key
provisions of the Patient Protection and Affordable Care Act (PPACA)
can provide adequate benefits to our entire senior, elderly and
disabled populations. As the profile of the American AIDS epidemic has
expanded further into communities of color, marginalized populations,
rural areas, and particularly to women of color in their child bearing
years, ADAPs feel these additional strains from groups which
traditionally may work low-paying jobs with inadequate health insurance
or no healthcare benefits.
In the past 12 months, 20 State ADAPs have instituted other cost-
containment strategies. ADAPs with other cost-containment strategies
instituted since April 1, 2009, as of February 2, 2011) include:
Arizona: Reduced formulary, Arkansas: Reduced formulary, lowered
financial eligibility to 200 percent of FPL, (disenrolled 99 clients in
September 2009), Colorado: Reduced formulary, Florida: Reduced
formulary, lower financial eligibility to 300 percent FPL, transition
clients to Welvista from 2/14-3/31/11, Georgia: Reduced formulary,
implemented medical criteria, continued participation in the
Alternative Method Demonstration Project (AMDP), Idaho: Capped
enrollment, Illinois: Reduced formulary, instituted monthly expenditure
cap, Kentucky: Reduced formulary, Louisiana: Discontinued reimbursement
of laboratory assays, North Carolina: Reduced formulary, North Dakota:
Capped enrollment, instituted annual expenditure cap, lowered financial
eligibility to 300 percent FPL, Ohio: Reduced formulary, lowered
financial eligibility to 300 percent of FPL (disenrolled 257 clients),
Puerto Rico: reduced formulary, South Carolina: Lowered financial
eligibility to 300 percent FPL, Utah: Reduced formulary, lowered
financial eligibility to 250 percent of FPL (disenrolled 89 clients),
Virginia: Reduced formulary, only distribute 30-day prescription
refills, Washington: Instituted client cost sharing, reduced formulary
(for uninsured clients only), only pay insurance premium for clients
currently on antiretrovirals, and Wyoming: Reduced formulary,
instituted client cost sharing.
As previously stated, ADAP waiting lists--as well as the
aforementioned cost-containment strategies put the lives of people
living with HIV/AIDS at risk (e.g., developing OIs), as well as put
HIV-negative people at higher risk of becoming infected (e.g., HIV-
positive people are more infectious when not properly treated with
HAART). Without congressional leadership and adequate Federal funding,
current circumstances could easily lead to a public health emergency
that will only cost the taxpayers much more.
In hindsight, it becomes easy to argue that ADAPs have historically
been underfunded. In reality however, it is the emergence of highly
active anti-retroviral therapy over the past 7 years and the successes
of these treatment options that have made dramatic changes in people's
lives; that have made access to HIV treatment and care such a dramatic
national policy concern. We now understand how HIV replicates in the
body, beginning its destructive impact on the immune system from the
moment of infection. Where in the recent past we divided people into
categories such as asymptomatic and symptomatic in order to make
treatment decisions, current treatments dictates that we no longer make
these distinctions in our approach to therapy. The latter simply
reflects a more advanced state of immune damage.
The standard of care today recommends that patients start on
antiretroviral therapy with a combination of drugs earlier in the
disease in order to preserve immune function. It also presumes the
earliest possible knowledge of HIV status and informed medical care to
decide the exact timing of treatment commencement and treatment type
selection. Improved immune function has a direct impact on those topics
you are most likely interested in today, saving and improving the
quality of lives and cost savings to the healthcare system.
By now it is really not necessary to explain the benefits of
antiretroviral treatments or even its cost effectiveness. Everyone
knows these things. In fact thousands of people are dedicated to seeing
that the ``AIDS miracles'' of the last few years available in the
United States are delivered to the rest of the world before societal
damage in excess of the plagues of the Middle Ages is inflicted upon
whole countries in the Caribbean, Africa, Asia and parts of the former
Soviet Union. In sharing the wealth of the medical knowledge and
expertise, which the United States have lead in developing we must not,
and should not forget the homeland. We must make sure that no American
with HIV is forgotten and allowed to fall through the cracks. The time
has come to end the wait for people living with HIV/AIDS.
In closing the following two hypothetical examples demonstrate the
ROI of the AIDS Drug Assistance Program:
--Charlie is a 29-year old black single father living in Gadsden
County Florida. He and his wife found out they were infected
with HIV when she died from complications of AIDS related
pneumonia the previous year. Charlie is on a waiting list to
receive AIDS drugs but between his depression and efforts to
care for his children he is unable to access the help he needs
to navigate the Patient Assistance Programs. He himself gets
sick. He enters an emergency room in Tallahassee, Florida and
is subsequently admitted for a 5-day stay. His emergency room
visit is near the average for this hospital at $2,783 (source
Florida Heath Finder.org.) The hospital stay is near the
national average of $24,000. He receives additional bills from
doctors, radiologists and therapists for $750. You can compare
this total to the cost of the AIDS drug he would need for an
entire year. Charlie is what is known as therapy naive so the
most inexpensive combination therapy drugs would be effective
in reducing the virus to undetectable levels. The annual drug
cost would be around $15,000 per year. Compare that to $33,830
in 6 days for hospitalization.
--Now consider Patricia. She has had AIDS for 20 years and the AIDS
virus she carries is resistant to all but the most expensive
AIDS drugs. She has fallen out of care and is now getting
progressively sicker. She goes to ADAP at the nearest county
health department which is 20 miles away only to be told that
she has been wait listed due to budget shortfalls. Patricia
falls ill while trying to navigate assistance programs and is
hospitalized. Her ER costs are similar to that of Charlie's but
she stays in the hospital for 20 days and then dies. Her costs
are well over $100,000 not including funeral and burial costs.
Her drugs would have cost $30,000 per year.
We urge to you fully fund the ADAP program in fiscal year 2012 with
an increase of $131 million. No one need be denied the new standard of
care for HIV disease. We have come too far as a Nation to turn our
backs on HIV/AIDS now. Please make sure that the resources are there
for every HIV-positive American to be treated regardless of their
financial resources or ability to access adequate health insurance
coverage.
______
Prepared Statement of the Ad Hoc Group for Medical Research
The Ad Hoc Group for Medical Research is a coalition of more than
300 patient and voluntary health groups, medical and scientific
societies, academic and research organizations, and industry. The Ad
Hoc Group appreciates the opportunity to submit this statement in
support of enhancing the Federal investment in biomedical, behavioral,
and population-based research supported by the National Institutes of
Health (NIH).
We are deeply grateful to the Subcommittee for its long-standing,
bipartisan leadership in support of NIH. These are difficult times for
our Nation and for people all around the globe, but the affirmation of
science is the key to a better future. To improve Americans' health and
strengthen America's innovation economy, the Ad Hoc Group for Medical
Research recommends $35 billion for NIH in fiscal year 2012.
The partnership between NIH and America's scientists, medical
schools, teaching hospitals, universities, and research institutions
continues to serve as the driving force in this Nation's search for
ever-greater understanding of the mechanisms of human health and
disease. More than 83 percent of NIH research funding is awarded to
more than 3,000 research institutions located in every State. These are
funded through almost 50,000 competitive, peer-reviewed grants and
contracts to more than 350,000 researchers.
The foundation of scientific knowledge built through NIH-funded
research drives medical innovation that improves health and quality of
life through new and better diagnostics, improved prevention
strategies, and more effective treatments. NIH research has contributed
to dramatically increased and improved life expectancy over the past
century. A baby born today can look forward to an average life span of
nearly 78 years--almost three decades longer than a baby born in 1900,
and life expectancy continues to increase. People are staying active
longer, too: the proportion of older people with chronic disabilities
dropped by nearly a third between 1982 and 2005. Thanks to insights
from NIH-funded studies, the death rate for coronary heart disease is
more than 60 percent lower--and the death rate for stroke, 70 percent
lower--than in the World War II era.
NIH research continues to create dramatic new research
opportunities, offering hope to the millions of patients awaiting the
possibility of a healthier tomorrow. For example, a new ability to
comprehend the genetic mechanisms responsible for disease already is
providing insights into diagnostics and identifying a new array of drug
targets. We are entering an era of personalized medicine, where
prevention, diagnosis, and treatment of disease can be individualized,
instead of using the standardized approach that all too often wastes
healthcare resources and potentially subjects patients to unnecessary
and ineffective medical treatments and diagnostic procedures.
Peer-reviewed, investigator-initiated basic research is the heart
of NIH research. These inquiries into the fundamental cellular,
molecular, and genetic events of life are essential if we are to make
real progress toward understanding and conquering disease. The
application of the results of basic research to the detection,
diagnosis, treatment, and prevention of disease is the ultimate goal of
medical research. Clinical research not only is the pathway for
applying basic research findings, but it also often provides important
insights and leads to further basic research opportunities. Additional
funding is needed to sustain and enhance basic and clinical research
activities, including increasing support for current researchers and
promoting opportunities for new investigators and in those areas of
science that historically have been underfunded.
Ongoing efforts to reinvigorate research training, including
developing expanded medical research opportunities for minority and
disadvantaged students, continue to gain importance. For example, the
volume of data being generated by genomics research, as well as the
increasing power and sophistication of computing assets on the
researcher's lab bench, have created an urgent need, both in academic
and industrial settings, for talented individuals well-trained in
biology, computational technologies, bioinformatics, and mathematics to
realize the promise offered by modern interdisciplinary research.
To move forward, it will be essential to maintain the talent base
and infrastructure that has been created to date. Large fluctuations in
funding will be disruptive to training, to careers, long range projects
and ultimately to progress. The research engine needs a predictable,
sustained investment in science to maximize our return.
Further, NIH-supported research contributes to the Nation's
economic strength by catalyzing private sector growth and creating
skilled, high-paying jobs; new products and industries; and improved
technologies. Industries and sectors that benefit include the high-
technology and high value-added pharmaceutical and biotechnology
industries, among others. In particular, the NIH funds ``enabling
science'' that explores and identifies discoveries at a point earlier
than businesses often invest, stoking and sustaining the discovery
pipeline.
The investment in NIH not only is an essential element in restoring
and sustaining both national and local economic growth and vitality,
but also is essential to maintaining this Nation's prominence as the
world leader in medical research. As Raymond Orbach, former Under
Secretary for Science at the Department of Energy for President George
W. Bush, noted in a recent editorial in Science, ``Other countries,
such as China and India, are increasing their funding of scientific
research because they understand its critical role in spurring
technological advances and other innovations. If the United States is
to compete in the global economy, it too must continue to invest in
research programs.'' To succeed in the information-based, innovation
driven world-wide economy of the 21st century, we must recommit to
long-term sustained growth in medical research funding.
The ravages of disease are many, and the opportunities for progress
across all fields of medical science to address these needs are
profound. In this challenging budget environment, we recognize the
painful decisions Congress must make. The community appreciates that
this subcommittee always has recognized that discoveries gained through
basic research yield the medical advances that improve the fiscal and
physical health of the country. Strengthening the Nation's commitment
to medical research is the key to ensuring the future of America's
medical research enterprise and the health of her citizens.
The Ad Hoc Group for Medical Research respectfully requests that
NIH be recognized as an urgent national priority as the subcommittee
prepares the fiscal year 2012 appropriations bills.
______
Prepared Statement of the AIDS Healthcare Foundation
On behalf of the over 1 million Americans with HIV/AIDS, and the
over 56,000 Americans who will become infected with HIV this year, AIDS
Healthcare Foundation (AHF) submits the following recommendations and
proposals for funding domestic HIV/AIDS programs for fiscal year 2012.
AHF is the largest HIV/AIDS nonprofit in the United States. For
over 20 years, it has delivered high quality medical care, pharmacy
services, research, and HIV prevention and testing services throughout
the country. It currently provides medical care to over 150,000 people
with HIV/AIDS in 22 countries around the world.
Based on this experience, it is clear to AHF that the battle
against HIV/AIDS is winnable, and that the keys to winning this fight
are:
Find those Americans who have HIV, but don't know it.
It is estimated that approximately 20 percent of all Americans who
have HIV do not know they are infected. It is not surprising that this
group unwittingly is the source of up to 70 percent of all HIV
infections in the United States--if you don't know you have HIV, you
don't take steps to protect others, and you don't get treatment.
Provide AIDS drug treatment to all Americans with HIV/AIDS who need
it.
It cannot be stressed enough--treatment is prevention. AIDS
treatment is one of the most effective tools we have to prevent new
infections. The point of treatment is to reduce the amount of the HIV
virus in a person. People with HIV/AIDS who are on treatment are less
infectious, and simply are far less able to transmit the virus. AIDS
treatment is 92 percent effective in preventing new infections.
If we could find those who don't know they have HIV, and get them
treatment, new HIV infections would plummet. Not only would these
people be healthier and able to work and care for their families, but
we would save tens of billions per year in future medical costs.
Currently, there are approximately 56,000 new HIV infections in the
United States every year. As the lifetime medical cost (the majority of
which will be borne by the Federal Government via Medicare, Medicaid,
or the Ryan White CARE Act) for each HIV infection is over $600,000,
the United States accrues over $36 billion in future medical costs
every year due to new HIV infections.
Therefore, effectively battling the AIDS epidemic requires
prioritizing scarce funds into two main areas: Testing (to find those
who are unaware they have HIV) and treating (providing AIDS drugs and
medical care to the newly diagnosed, to prevent new infections).
AHF recognizes the prevailing economic and budget climate, and
understands that finding new money to pay for these necessary programs
is extremely challenging. AHF therefore makes the following
recommendations that would free up existing funding to focus more on
testing and treatment:
Re-prioritize AIDS prevention funding within the Centers for
Disease Control toward HIV testing.
Yearly new HIV infections have not declined for well over a decade.
As a result, it is time to re-think the CDC's approach to HIV
prevention. In recent times CDC has spent approximately 30 percent of
its HIV prevention budget on HIV testing. AHF recommends that, for
fiscal year 2012 and beyond, the CDC be required to spend at least 50
percent of its prevention budget on testing. The more tests the CDC
performs, the more people who are unaware of their HIV status will be
found, which is the first step in preventing new infections.
Increase funding for the AIDS Drug Assistance Program (ADAP) by
$108 million.
ADAP is a lifeline for thousands of Americans who cannot afford
AIDS treatment, which can cost well in excess of $12,000 per year.
Nationwide, ADAP serves over 165,000 people, approximately one-third of
all people on AIDS treatment in the United States.
Ensuring access to treatment is the backbone in our fight against
HIV/AIDS. Without treatment, people with AIDS become sicker. Without
treatment, new infections will increase, and every new infection
carries with over $600,000 in lifetime medical costs. For these
reasons, it is of grave concern that access to care for thousands of
Americans is now at risk.
Currently, there are over 7,800 Americans on ADAP waiting lists
across the country--7,800 people who cannot get access to these drugs
due to budgetary constraints. This list continues to grow as infections
continue, State financial support is reduced, and drug prices increase.
To reverse this trend, AHF supports the consensus of the AIDS
community that ADAP funding should be increased by $108 million for a
total of $991 million. In the absence of new money, AHF proposes
funding this increase via the following means:
Implement administrative and overhead caps within CDC, HRSA, and
NIH AIDS programs, and redirect the savings to ADAP.
In tight budgetary times, Government must become more cost
effective. Currently, Government agencies like HRSA require that
contractors spend no more than 10 percent of grants on administrative
overhead. These agencies, which are tasked with implementing ADAP and
other AIDS programs, spend a combined $2.3 billion on administration
and overhead. As a recipient of Government funds that has operated
under these requirements, AHF submits that these caps should be applied
to these agencies as well. Controlling administrative costs will free
up money that can be spent on services, not bureaucracy.
Secure additional drug price discounts/rebates from AIDS drug
manufacturers.
Drug price increases are one of the main causes of the current ADAP
crisis. Additional discounts would mean ADAPs could serve everyone who
needs it without new funding. Moreover, given the unique nature of
ADAP, these discounts would not have any significant impact on drug
company profitability, as they would not impact price calculations for
other drug programs or reduce drug company revenues.
AIDS Healthcare Foundation (AHF) supports increasing Federal
funding for ADAP. However, additional funding must go hand in hand with
changes to ADAP that protect the program from high drug prices. To
achieve this, AHF proposes that for every dollar of additional Federal
funding drug companies contribute $2 in additional rebates or price
cuts. This would effectively triple the purchasing power of each
additional ADAP dollar, and ensure the sustainability of this vital
program. Congress can implement this solution by directing the
Secretary of Health and Human Services to negotiate the drug company
contribution as a condition of receiving new money for ADAP.
Call for the National Institutes of Health to make an independent
review of prevention interventions being supported by CDC to determine
their effectiveness.
Even though the AIDS epidemic is over 25 years old, there is still
very little evidence concerning what prevention programs work, and are
cost effective. In order to better target scarce resources to the most
effective interventions, AHF recommends that $1 million of NIH's fiscal
year 2012 AIDS research budget be spent on determining which HIV
prevention methods are in fact cost-effective ways of reducing HIV
infections.
The implementation of the recommendations would forcefully re-
orient America's AIDS response in a way that would significantly reduce
new infections, save billions of dollars, and improve the health of
hundreds of thousands of Americans.
______
Prepared Statement of AIDS United
On behalf of AIDS United and our diverse partner organizations I am
pleased to submit this testimony to the Members of this Subcommittee on
the urgency of needed funding for the fiscal year 2012 domestic HIV/
AIDS portfolio. AIDS United is a national organization that seeks to
end the AIDS epidemic in the United States by combining private-sector
fundraising, philanthropy, coalition building, public policy expertise,
and advocacy--as well as a network of passionate local and State
partners--to effectively and efficiently respond to the HIV/AIDS
epidemic in the communities most impacted by it. Through its unique
Community Partnerships program, Public Policy Committee and targeted
special grant-making initiatives, AIDS United represents over 400
grassroots organizations. These organizations provide HIV prevention,
care, treatment, and support services to underserved individuals and
populations most impacted by the HIV/AIDS epidemic including
communities of color, women and people living with HIV/AIDS in the
United States as well as education and training to providers of
treatment services.
June 5, 2011 marks the 30th year since the Centers for Disease
Control and Prevention (CDC) reported the first cases of what later
became identified as HIV disease. Sadly, the HIV/AIDS epidemic in the
United States is characterized by needless mortality, inadequate access
to care, persistent levels of new infection, and stark population and
regional disparities. Although improved treatment has made it possible
for people with HIV disease to lead longer and healthier lives, these
stark realities remain.
HIV Remains a Major Public Health Danger
More than 1.2 people are living with HIV or AIDS; nearly one-half
living with HIV/AIDS are not in care.
56,300 people are estimated to have been newly infected with HIV in
the United States in 2006, the year for which the most recent data is
available--one new infection every 9\1/2\ minutes. According to the
Centers for Disease Control and Prevention (CDC) the HIV infection rate
has not fallen in 16 years.
There is neither a cure nor a vaccine for HIV and current
treatments do not work for everyone.
HIV Severely Affects African Americans, Latinos, Women and Gay Men
African Americans represent 13 percent of the United States
population but nearly 50 percent of all newly reported HIV infections.
Hispanics/Latinos represent 13 percent of the United States
population but account for 18 percent of newly reported cases of HIV.
The percentage of newly reported HIV/AIDS cases in the United
States among women tripled from 8 percent to 27 percent between 1985
and 2007. AIDS is a leading cause of death among black women aged 15-
54.
Gay, bisexual, and other men who have sex with men, especially in
communities of color, are the population most severely affected by HIV.
AIDS United Supports the Goals of the National HIV/AIDS Strategy
The Federal Government has created a first ever National HIV/AIDS
Strategy that commits to four basic goals: reducing the number of
people who become infected with HIV; increasing access to care and
optimizing health outcomes for people living with HIV; reducing HIV-
related health disparities; and achieving a more coordinated national
response to the HIV Epidemic.
AIDS United strongly supports achievement of these goals and
strongly urges the Labor, Health and Human Services, and Education
Subcommittee of the Senate Appropriations Committee to ensure that
meeting these goals is a top priority. Unfortunately given the growth
in the epidemic, meeting these goals, particularly lowering the new HIV
infection rate, will require greater funding than has been made
available. The Federal Government's commitment to HIV domestic funding
is even more important this year as we see many States lowering their
State funding contributions due to the economic realities States are
facing. AIDS United strongly urges Congress to meet this challenge
through the good work of this subcommittee and to recognize and address
the true funding needs of the programs in the HIV/AIDS portfolio.
AIDS Budget and Appropriations Coalition HIV Community Fiscal Year 2012
Request (Increases Over Fiscal Year 2010)
The HIV community has come together under the umbrella of the AIDS
Budget and Appropriations Coalition with the community funding request
for the HIV/AIDS domestic portfolio for fiscal year 2012, the
comparisons are based on fiscal year 2010 finals. We fully understand
the budgetary constraints that are impacting this time, but we feel it
is imperative to let this subcommittee know of the true needs in the
HIV community.
HIV Prevention.--According to CDC estimates contained in the
agency's 2009 HIV/AIDS Surveillance Report, since the beginning of the
epidemic there have been 1,142,714 AIDS cases reported with a total of
617,025 deaths in the United States. Based on previous CDC estimates
more than 1.2 million people are living with HIV/AIDS and that an
estimated 21 percent of people living with HIV are unaware of their HIV
status and could unknowingly transmit the virus to another person.
Prior to fiscal year 2010 funding had remained flat for more than 8
years. As a result, grants to States and local communities have
decreased significantly even as the United States seeks to increase
prevention and testing services. To begin to reach the goals of the
National HIV/AIDS Strategy the Congress must give the CDC the necessary
funding to invest in meaningful prevention. AIDS United requests an
increase of at least $57.2 million to $857.6 million in fiscal year
2012 to address the true need of $1,324.6 billion.
Education.--The National HIV/AIDS Strategy acknowledges the need to
educate all Americans about the threat of HIV and how to prevent it.
The United States must invest in programs that provide our young people
with complete, accurate, and age-appropriate sex education that helps
them reduce their risk of HIV, other STDs, and unintended pregnancy.
AIDS United supports the Administration's teen pregnancy prevention
initiative but urges Congress to find opportunities to fund true,
comprehensive sex education that promotes healthy behaviors and
relationships for all young people, including LGBT youth. Negative
health outcomes are related to lack of knowledge and we must provide
youth with the information and services they need to make responsible
decisions about their sexual health. AIDS United requests that the teen
pregnancy prevention initiative funding increase by $6.7 million to a
level of $161.4 million. AIDS United also requests an increase of $10
million, for a total of $50 million, for the Division of Adolescent and
School Health's HIV Prevention Education at the CDC. AIDS United is
pleased that the President's budget includes zero funding for failed
abstinence-only-until-marriage programs and urges the subcommittee also
to ensure that funding is not included for these ineffective programs.
Policy Rider, Syringe Exchange.--CDC estimates that approximately
13 percent of all HIV cases and 60 percent of all hepatitis C cases in
the United States are related to intravenous drug use. Eight Federal
studies and numerous scientific peer reviewed papers have conclusively
established that syringe exchange programs reduce the incidence of HIV
among people who inject drugs and their sexual partners and that
syringe exchange reduces drug abuse. Syringe exchange programs connect
people who use drugs to healthcare services including substance abuse
treatment, HIV and viral hepatitis prevention services and testing,
counseling, education, and support. AIDS United recommends that the
Subcommittee maintain the current compromise language letting local
jurisdictions make their own decision about using Federal funds to
prevent HIV and viral hepatitis through the use of proven syringe
exchange programs.
HIV/AIDS Treatment.--The Ryan White HIV/AIDS Treatment Extension
Act, administered by the Health Resources and Services Administration
(HRSA) provides services to more than 529,000 people living with and
affected by HIV throughout the United States and its territories. It is
the largest source of Federal funding solely focused on the delivery of
HIV services and has provided the framework for our national response
to the HIV epidemic. In recent years, funding for the Ryan White
Program has not kept pace with the growing epidemic leading to waiting
lists and other cost containment measures for the AIDS Drug Assistance
Program (ADAP), increasing wait times to receive medical appointments
and loss of some support services. Ryan White Programs are designed to
compliment each other. As such, all parts of the Ryan White Program
require substantial increased funding to address the true needs of the
hundreds of thousands of people living with HIV who are uninsured,
underinsured, or who lack financial resources for healthcare and
require Ryan White Program services. AIDS United recommends that the
Ryan White Program funding level be increased by $369.7 million to a
total of $2.686 billion in fiscal year 2012.
Ryan White Programs, Part A.--This Part of the Ryan White Programs
provides physician visits, laboratory services, case management, home-
based and hospice care, and substance abuse and mental health services
in the jurisdictions most affected by HIV/AIDS. These core medical and
supportive services are critical to ensuring patients have access to
and can effectively utilize life-saving therapies. AIDS United
recommends funding for Part A at $751.9 million, an increase of $73.8
million in fiscal year 2012.
Ryan White Programs, Part B (base).--This program ensures a
foundation for HIV related healthcare services in each State and
territory, including the critically important ADAP. Part B base grants
(excluding ADAP). AIDS United recommends funding for Part B base grants
at $495.0 million, an increase of $76.2 million in fiscal year 2012.
Ryan White Programs, Part B (ADAP).--The AIDS Drug Assistance
Program provides medications for treating people with HIV who cannot
access Medicaid or private health insurance. According to the 2011
National ADAP Monitoring Project, ADAP provided drugs to about 190,936
clients in fiscal year 2009, including 33,672 new clients. As of April
15, 2011, 11 State ADAPs had waiting lists of 7,885 individuals and an
additional 8 States had taken or were considering taking cost-
containment measures. According to a respected pharmacoeconomic study
that measures the funds needed to let State ADAPs provide a minimum
clinical standard formulary the actual need for increases last year was
more than $370.1 million. The community recognizes the difficult budget
environment and asks for a much lower amount. AIDS United recommends
$991 million, the authorized amount for ADAP, an increase of $131
million, in fiscal year 2012.
Ryan White Programs, Part C.--This Part awards grants to community-
based clinics and medical centers, hospitals, public health
departments, and universities in 22 States and the District of Columbia
under the Early Intervention Services program. These grants are
targeted toward new and emerging sub-populations impacted by the HIV
epidemic. Part C funds are particularly needed in rural areas where the
availability of HIV care and treatment is still relatively new. AIDS
United requests $272.2 million, the authorized amount for Part C an
increase of $65.8 million, in fiscal year 2012.
Ryan White Programs, Part D.--Part D awards grants under the
Comprehensive Family Services Program to provide comprehensive care for
HIV positive women, infants, children, and youth and their affected
families. These grants fund the planning of services that provide
comprehensive HIV care and treatment and the strengthening of the
safety net for HIV positive individuals and their families. AIDS United
requests $83.1 million, an increase of $5.5 million, for Part D.
Ryan White Programs, Part F, the AIDS Education and Training
Centers (AETCs).--The AETCs train Ryan White program doctors, advanced
practice nurses, physicians' assistants, nurses, oral health
professionals, and pharmacists about HIV treatment, testing, viral
hepatitis and more. The AETCs also ensure that education is available
to primary healthcare providers who do not specialize in HIV but are
asked to treat the increasing numbers of HIV positive patients who
depend on them for care. AIDS United requests a total of $50 million, a
$15.2 million increase in fiscal year 2012.
Ryan White Programs, Part F, Dental Care.--Dental care is a crucial
service needed by people living with HIV disease. Oral health problems
are often an early manifestation of HIV disease. Unfortunately oral
health is often neglected by those who cannot afford, or do not have
access to, proper medical care creating missed opportunities to find
early HIV infections. AIDS United request $19 million, a $5.4 million
increase, for this program in fiscal year 2012.
Department of Health and Human Services, Minority AIDS
Initiative.--The Minority AIDS Initiative directly benefits racial and
ethnic minority communities that are the most deeply affected by HIV/
AIDS infection rates with grants to provide technical assistance,
infrastructure support and strengthen the capacity of minority
community based organizations to deliver high-quality HIV healthcare
and supportive services. Communities of color are deeply affected by
the HIV epidemic. The Minority AIDS Initiative funds needed programs
throughout HHS agencies and is included in every Part of the CARE Act.
It was authorized within the Ryan White Program for the first time in
2006. AIDS United requests a total of $610 million for the Minority
AIDS Initiative.
HIV/AIDS Research.--Research to prevent, treat and ultimately cure
HIV is vital to the domestic and global control of the disease. The
United States through the National Institute of Health (NIH) must
continue to take the lead in the research and development of new
medicines to treat current and future strains of HIV. The NIH's Office
of AIDS Research must continue its groundbreaking research in both
basic and clinical science to develop a preventative vaccine,
microbicides, and other scientific, behavioral, and structural HIV
prevention interventions. Commitment to research will ultimately help
to bring the epidemic under control decreasing the funds that must be
spent on care and treatment of HIV. AIDS United requests that the NIH
be funded at $35 billion in fiscal year 2012 and the AIDS portfolio be
funded at $3.5 billion, a $410 million increase.
The HIV epidemic is a continuing health crisis in the United
States. We must expand resources for our domestic HIV prevention,
treatment and care, and research efforts to meet the goals of the
National HIV/AIDS Strategy. On behalf of our more than 400
participating organizations, HIV positive Americans and those affected
by this disease, AIDS United urges the subcommittee help us save lives
by to fully funding the domestic response to the ongoing, tragic, HIV
epidemic in the United States.
______
Prepared Statement of the Adult Congenital Heart Association
Introduction
The Adult Congenital Heart Association (ACHA)--a national non-for-
profit organization dedicated to improving the quality of life and
extending the lives of adults with congenital heart disease (CHD)--is
grateful for the opportunity to submit written testimony regarding
fiscal year 2012 funding for congenital heart research and
surveillance. We respectfully request $3 million for CHD surveillance
at the Centers for Disease Control and Prevention (CDC) as well as
additional CHD research at the National Heart, Lung and Blood Institute
(NHLBI).
Adult Congenital Heart Disease
Congenital heart defects are the most common group of birth defects
occurring in approximately 1 percent of all live births, or 40,000
babies a year. These malformations of the heart and structures
connected to the heart either obstruct blood flow or cause it to flow
in an abnormal pattern. This abnormal heart function can be fatal if
left untreated. In fact, congenital heart defects remain the leading
cause of birth defect related infant deaths.
Many infants born with congenital heart problems require
intervention in order to survive. Intervention often includes one or
multiple open-heart surgeries; however, surgery is rarely a long-term
cure. The success of childhood cardiac intervention has created a new
chronic disease--CHD. Thanks to the increase in survival, of the nearly
2 million people alive today with CHD, more than half are adults,
increasing at an estimated rate of 5 percent each year. Few congenital
heart survivors are aware of their high risk of additional problems as
they age, facing high rates of neuro-cognitive deficits, heart failure,
rhythm disorders, stroke, and sudden cardiac death, and many survivors
require multiple operations throughout their lifetime. 50 percent of
all congenital heart survivors have complex problems for which life-
long care from congenital heart specialists is recommended, yet less
than 10 percent of adult congenital heart patients receive recommended
cardiac care. Delays in care can result in premature death and
disability. In adults, this often occurs during prime wage-earning
years.
ACHA
ACHA serves and supports the more than 1 million adults with CHD,
their families and the medical community--working with them to address
the unmet needs of the long-term survivors of congenital heart defects
through education, outreach, advocacy, and promotion of ACHD research.
In order to promote life-saving research and accessible,
appropriate and quality interventions which, in turn, will reduce the
public health burden of this chronic disease, ACHA advocates for
adequate funding of CDC initiatives relating to CHD, and encourages
funding within the National Institutes of Health (NIH) for CHD
research. ACHA continues to work with Federal and State policy makers
to advance policies that will improve and prolong the lives of those
living with CHD.
ACHA is also a founding member of the Congenital Heart Public
Health Consortium (CHPHC). The CHPHC is a group of organizations
uniting resources and efforts to prevent the occurrence of CHD and
enhance and prolong the lives of those with CHD through targeted public
health interventions by enhancing and supporting the work of the member
organizations. Representatives of Federal agencies serve in an advisory
capacity. In addition to ACHA, the Alliance for Adult Research in
Congenital Cardiology, American Academy of Pediatrics, American College
of Cardiology, American Heart Association, March of Dimes Foundation,
National Birth Defects Prevention Network, and the National Congenital
Heart Coalition are all members of the CHPHC.
Federal Support for Congenital Heart Disease Research and Surveillance
Despite the prevalence and seriousness of the disease, CHD data
collection and research are limited and almost non-existent for the
adult CHD population. In 2004, the NHLBI convened a working group on
CHD, which recommended developing a research network to conduct
clinical research and establishing a national database of patients.
In March 2010, the first CHD legislation passed as part of Patient
Protection and Affordable Care Act (ACA).\1\ The ACA calls for the
creation of The National Congenital Heart Disease Surveillance System,
which will collect and analyze nationally representative, population-
based epidemiological and longitudinal data on infants, children, and
adults with CHD to improve understanding of CHD incidence, prevalence,
and disease burden and assess the public health impact of CHD. It also
authorized the NHLBI to conduct or support research on CHD diagnosis,
treatment, prevention and long-term outcomes to address the needs of
affected infants, children, teens, adults, and elderly individuals.
These provisions included in the ACA were originally in the Congenital
Heart Futures Act (H.R. 1570/S.621, 111th Congress), which garnered bi-
partisan support in both the House and Senate and was championed by
Senators Richard Durbin (D-IL) and Thad Cochran (R-MS), Representative
Gus Bilirakis (R-FL) and former Representative Zack Space (D-OH).
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\1\ Patient Protection and Affordable Care Act, Sec. 10411(b).
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Recently, the National Center on Birth Defects and Developmental
Disabilities included preventing congenital heart defects and other
major birth defects, in its recently published 2011-2015 Strategic
Plan, specifically recognizing the need for understanding the
contribution of birth defects to longer term outcomes (i.e., beyond
infancy) and the economic impact of specific birth defects.
The National Congenital Heart Disease Surveillance System at CDC
As survival improves, so does the need for population-based
surveillance across the lifespan. Funding to support the development of
the National Congenital Heart Disease Surveillance System through both
a pilot adult surveillance program, and the enhancement of the existing
birth defects surveillance system will be instrumental in driving
research, improving interventional outcomes, improving loss to care,
and assessing healthcare burden. In turn, the National Congenital Heart
Disease Surveillance System can serve as a model for all chronic
disease states.
The current surveillance system is grossly inadequate. There are
only 14 States currently funded by the CDC to gather data on birth
defects, presenting limitations in generalizing the information across
the entire population. Thus, there are significant inconsistencies in
the methods of collection and reporting across the various State
systems which limits the value of the data. Given the absence of
population-based data across the lifespan, the data we do have excludes
anyone diagnosed after the age of one, as well as those who are lost to
care. It is this population, those lost to care, that is of greatest
concern, and most difficult to identify. Evidence indicates that those
with CHD are at significant risk for heart failure, rhythm disorders,
stroke, and sudden cardiac death as they age, requiring ongoing
specialized medical care. For those who are lost to care, for reasons
such as limited access to affordable or appropriate care or poor
education about the need for ongoing care, they often return to the
system with preventable advanced illness and/or disability. Population
based surveillance across the life span is the only method by which
these patients can be identified, and, as a result, appropriate
intervention can be planned. ACHA is currently working with the CDC to
address these concerns through the National Congenital Heart Disease
Surveillance System.
ACHA requests that Congress provide the CDC $3 million in fiscal
year 2012 to support data collection to better understand CHD
prevalence and assess the public health impact of CHD. This level of
funding will support a pilot adult surveillance system and allow for
the enhancement of the existing birth defects surveillance system.
Funding of Research Related to Congenital Heart Disease at NIH
Our Nation continues to benefit from the single largest funding
source for CHD research, the NIH. Yet, as a leading chronic disease,
congenital heart research is significantly underfunded.
The NHLBI supports basic and clinical research to establish a
scientific basis for the prevention, detection, and treatment of
congenital heart disease. The Bench to Bassinet Program is a major
effort launched by the NHLBI to hasten the pace at which heart research
on genetics and basic science can be developed into new treatments
across the life span for people with congenital heart disease. The
overall goal is to provide the structure to turn knowledge into
clinical practice, and use clinical practice to inform basic research.
ACHA urges Congress to support the NHLBI in efforts to continue its
work with patient advocacy organizations, other NIH Institutes, and the
CDC to expand collaborative research initiatives and other related
activities targeted to the diverse life-long needs of individuals
living with congenital heart disease.
Summary
Thank you for the opportunity to highlight this important disease.
We know that you face many difficult funding decisions for fiscal year
2012 and hope that you consider addressing the life-long needs of those
with CHD. By making an investment in the research and surveillance of
CHD, the return will be seen through reduced healthcare costs,
decreased disability and improved productivity in a population quickly
approaching 2 million.
______
Prepared Statement of the Alliance for Aging Research
Chairman Harkin and members of the Subcommittee, for 25 years the
not-for-profit Alliance for Aging Research has advocated for medical
research to improve the quality of life and health for all Americans as
we grow older. Our efforts have included supporting Federal funding of
aging research by the National Institutes of Health (NIH), through the
National Institute on Aging (NIA) and other NIH institutes and centers.
The Alliance appreciates the opportunity to submit testimony
highlighting the important role that the NIH plays in facilitating
aging-related medical research activities and the ever more urgent need
for increased Federal investment and focus to advance scientific
discoveries to keep individuals healthier longer.
Research toward healthier aging has never been more critical for so
many Americans. In January 2011, the first of the baby boomers began
turning age 65. Older Americans now make up the fastest growing segment
of the population. According to the U.S. Census Bureau, the number of
people age 65 and older will more than double between 2010 and 2050 to
88.5 million or 20 percent of the population; and those 85 and older
will increase three-fold, to 19 million, according to the U.S. Census
Bureau. Late-in-life diseases such as type 2 diabetes, cancer,
neurological diseases, heart disease, and osteoporosis are increasingly
driving the need for healthcare services in this country. Many diseases
of these aging are expected to become more prevalent as the number of
older Americans increases. Preventing, treating or curing chronic
diseases of the aging, is perhaps the single most effective strategy in
reducing national spending on healthcare.
Consider that the number of Americans age 65 and older with
Alzheimer's disease is projected to more than double by 2030. A report
in the Journal of Clinical Oncology projected cancer incidence will
increase by about 45 percent from 2010-2030, accounted for largely by
cancer diagnoses in older Americans and minorities, and by 2030, people
aged 65 and older will represent 70 percent of all cancer diagnoses in
the United States. Currently, the average 75-year old has three chronic
health conditions and takes five prescription medications. Six
diseases--heart disease, stroke, cancer, diabetes, Alzheimer's and
Parkinson's diseases--cost the United States over $1 trillion each
year. In the absence of new discoveries to better treat and prevent
osteoporosis, it is estimated to cost the United States $25.3 billion
per year by 2025. According to an Alzheimer's Association report from
2010, research breakthroughs that slow the onset and progression of
Alzheimer's disease could yield annual Medicare savings of $33 billion
in 2020 and as much as $283 billion by 2050.
The rising tide of chronic diseases of aging threatens to overwhelm
the U.S. healthcare system in the coming years. Research which leads to
a better understanding of the aging process and human vulnerability to
age-related diseases could be the key to helping Americans live longer,
more productive lives, and simultaneously reduce the need for care to
manage costly chronic diseases. Scientists who study aging now
generally agree that aging is malleable and capable of being slowed.
Rapid progress in recent years toward understanding and making use of
this malleability has paved the way for breakthroughs that could
increase human health in later life by opposing the primary risk factor
for virtually every disease we face as we grow older--aging itself.
Better understating of this ``common denominator'' of disease could
usher in a new era of preventive medicine, enabling interventions that
stave off everything from dementia to cancer to osteoporosis. As we now
confront unprecedented aging of our population and staggering increases
in chronic age-related diseases and disabilities, a modest extensions
of healthy lifespan could produce outsized returns of extended
productivity, reduced caregiver burdens, lessened Medicare spending,
and more effective healthcare in future years.
The NIA leads national research efforts within the NIH to better
understand the aging process and ways to better maintain the health and
independence of Americans as they age. NIA is poised to accelerate the
scientific discoveries. The science of aging is showing increasing
power to address the leading public health challenges of our time.
Leaders in the biology of aging believe it is now realistically
possible to develop interventions that slow the aging process and
greatly reduce the risk of many diseases and disabilities, including
cancer, diabetes, Alzheimer's disease, vision loss and bone and joint
disorders. While there has been great progress in aging research, a
large gap remains between promising basic research and healthcare
applications. Closing that gap will require considerable focus and
investment. Key aging processes have been identified by leading
scientists as potentially yielding crucial answers in the next 3-10
years. These include stress response at the cellular level, cell
turnover and repair mechanisms, and inflammation.
A central theme in modern aging research--perhaps its key insight--
is that the mutations, diets, and drugs that extend lifespan in
laboratory animals by slowing aging often increase the resistance of
cells, and animals, to toxic agents and other forms of stress. These
discoveries have two main implications, each of which is likely to lead
to major advances in anti-aging science in the near future.
First is the suggestion that stress resistance may itself be the
facilitator (rather than merely the companion) of the exceptional
lifespan in these animal models, hinting that studies of agents that
modulate resistance to stress could be a potent source of valuable
clinical leverage and preventive medicines. Second is the observation
that the mutations that slow aging augment resistance to multiple
varieties of stress--not just oxidation, or radiation damage, or heavy
metal toxins, but rather resistance to all of these at the same time.
The implication is that cells have ``master switches,'' which, like
rheostats that can brighten or dim all lights in a room, can tweak a
wide range of protective intracellular circuits to tune the rate of
aging differently in long-lived versus short-lived individuals and
species. If this is correct, research aimed at identifying these master
switches, and fine-tuning them in ways that slow aging without unwanted
side-effects, could be the most effective way to postpone all of the
physiological disorders of aging through manipulation of the aging rate
itself. Researchers have formulated, and are beginning to pursue, new
strategies to test these concepts by analysis of invertebrates, cells
lines, laboratory animals and humans, and by comparing animals of
species that age more quickly or slowly.
One hallmark of aging tissues is their reduced ability to
regenerate and repair. Many tissues are replenished by stem cells. In
some aged tissues, stem cell numbers drop. In others, the number of
stem cells changes very little--but they malfunction. Little is
currently known about these stem cell declines, but one suspected cause
is the accumulation of ``senescent'' cells. Cellular senescence stops
damaged or distressed cells from dividing, which protects against
cancer. At advanced ages, however, the accumulation of senescent cells
may limit regeneration and repair, a phenomenon that has raised many
questions. Do senescent cells, for instance, alter tissue
``microenvironments,'' such that the tissue loses its regenerative
powers or paradoxically fuel the lethal proliferation of cancer cells?
A robust research initiative on these issues promises to illuminate
the roots of a broad range of diseases and disabling conditions, such
as osteoporosis, the loss of lean muscle mass with age, and the age-
related degeneration of joints and spinal discs. The research is also
essential for the development of stem cell therapies, the promise of
which has generated much public excitement in recent years. This is
because implanting stem cells to renew damaged tissues in older
patients may not succeed without a better understanding of why such
cells lose vitality with age. Importantly, research in this area would
also help determine whether interventions that enhance cellular
proliferative powers would pose an unacceptable cancer risk.
Acute inflammation is necessary for protection from invading
pathogens or foreign bodies and the healing of wounds, but as we age
many of us experience chronic, low-level inflammation. Such insidious
inflammation is thought to be a major driver of fatal diseases of
aging, including cancer, heart disease, and Alzheimer's disease, as
well as of osteoporosis, loss of lean muscle mass after middle age,
anemia in the elderly, and cognitive decline after 70. Just about
everything that goes wrong with our bodies as we age appears to have an
important inflammatory component, and low-level inflammation may well
be a significant contributor to the overall aging process itself. As
the underlying mechanisms of age-related inflammation are better
understood, researchers should be able to identify interventions that
can safely curtail its deleterious effects beginning in mid-life,
broadly enhancing later-life, and with negligible risk of side effects.
While important advances have been made toward the goal of adding
healthy years to life, it cannot be achieved in a timely way without
significant financial support. In stark contrast to the rapidly rising
costs of healthcare for the aging, we as a Nation are making a
miniscule, and declining, investment in the prevention, treatment or
cure of chronic diseases of aging. Out of each dollar appropriated to
NIH only 3.6 cents goes toward supporting work of the NIA. Between
fiscal year 2003 and fiscal year 2010, NIA-funded scientists saw a
series of nominal increases and cuts that amounted to a 14.7 percent
reduction in constant dollars. The November 11, 2010 issue of Nature
notes that ``[a]lthough the funding situation is tight all around for
NIH-supported investigators, the NIA is in an exceptional predicament .
. . . As both the United States and global populations age, the
prevalence of chronic diseases such as cancer, heart disease and
diabetes will also grow, along with neurodegenerative ailments . . .
The NIA deals with age-related aspects of all of these.''
An increase in funding for aging research is urgently needed to
enable scientists to capitalize on the field's recent exciting
discoveries. Advocates for age-related diseases like Alzheimer's
disease and cancer in the past have called for congressional
appropriations of $2 billion annually in order to achieve major
breakthroughs in treating and curing those diseases. Thus, a goal of $2
billion annually in Federal funding for aging research on the basic
underpinnings of aging over the next 3 to 10 years seems modest
considering its great potential to lower overall disease risk
(including Alzheimer's, cancer, and more) and add healthy years to
life. For the NIA in particular, an increase in funding would enable
flexibility in supporting high-quality grant proposals that fall within
the 20th percentile of submitted grants. In recent years, the percent
of grant applications receiving funding by the NIA has dropped
precipitously and currently only the top 9 percent are being funded.
This means that many valuable projects are being set aside due to
budget constraints, and many talented scientists who might make major
contributions to aging research are being dissuaded from making this
their life's work.
In addition to increased resources, the field would also benefit
greatly from the creation of a trans-NIH initiative that could improve
the quality and pace of research that advances the understanding of
aging, its impact on age-related diseases, and the development of
interventions to extend human healthspan. The initiative would be most
effective if it included the representatives from the National
Institute on Aging (NIA) and the major-disease focused institutes that
have some role in aging research such as the National Institute of
Neurological Disorders and Stroke (NINDS), National Heart, Lung, and
Blood Institute (NHLBI), National Institute of Diabetes and Digestive
and Kidney Diseases (NIDDK), and the National Cancer Institute (NCI).
The field of aging research is poised to make transformational
gains in the near future. Few if any areas for investing research
dollars offer greater potential returns for public health. The Alliance
for Aging Research supports funding the NIH at $35 billion in fiscal
year 2012 with a minimum of $1.4 billion in funding for the NIA
specifically. This level of support would allow the NIH and the NIA to
adequately fund new and existing research projects, accelerating
progress toward findings which could prevent, treat, slow the
progression or even possibly cure conditions related to aging. With a
Silver Tsunami of age driven chronic ailments looming as our population
grows older, an increased emphasis on NIH's aging research activities
has never been more urgent, with potential to impact so many Americans.
The payoffs from such focused attention and investment would be
large and lasting. Therapies that delay aging would lessen our
healthcare system's dependence on the relatively inefficient strategy
of trying to redress diseases of aging one at a time, often after it is
too late for meaningful benefit. They would also address the fact that
while advances in lowering mortality from heart attack and stroke have
dramatically increased life expectancy, they have left us vulnerable to
other age-related diseases and disorders that develop in parallel, such
as Alzheimer's disease, diabetes, and frailty. Properly focused and
funded research could benefit millions of people by adding active,
healthy, and productive years to life. Furthermore, the research will
provide insights into the causes of and strategies for reducing the
periods of disability that generally occur at the end of life.
Mr. Chairman, the Alliance for Aging Research thanks you for the
opportunity to outline the challenges posed by the aging population
that lie ahead as you consider the fiscal year 2012 appropriations for
the NIH and we would be happy to furnish additional information upon
request.
______
Prepared Statement of the Alliance of Information and Referral Systems
The Alliance of Information and Referral Systems (AIRS) thanks you
for providing the opportunity to submit testimony as you consider an
fiscal year 2012 Labor-HHS, Education Appropriations bill. AIRS is the
national voice of Information and Referral/Assistance (I&R/A) services
and we provide a professional umbrella for over 1,200 I&R/A providers
in both public and private organizations. Our primary purpose for
submitting this testimony is to urge you not to cut Title IIIB funding
of the Older Americans Act (OAA) as this provides Federal funding to
the States for I&R. President Obama's proposed fiscal year 2012 budget
emphasizes an increase in funding of $48 million for Title IIIB of the
OAA.
Information and Referral brings people and services together. When
people don't know where to turn, I&R/A is there for them. Last year,
AIRS members answered more than 20 million calls for help.
Comprehensive and specialized I&R/A programs help people in every
community and operate as a critical component of the health and human
services delivery system. I&R/A organizations have databases of
programs and services and disseminate information through a variety of
channels to individuals and communities. People in search of critical
services such as, food, shelter, child care, work and job training,
mental health support often do not know where to begin. More often than
not, I&R/A organizations provide the answers.
We encourage you to support a $48 million increase in funding for
Title III of the Older Americans Act and at a very minimum, not cut
funding for I&R/A services. Thank you for your consideration.
______
Prepared Statement of Alluviam LLC
As a small business, we're writing to you today to bring to your
attention what we feel is an urgent issue regarding the National
Library of Medicine (NLM) decision to enter and unfairly compete with
private industry in the market for software for firefighters and other
emergency responders.
It has come to our attention that NLM has been funding development
of a software program (``WISER'') that they then give away at no cost
to first responders. Apparently, NLM has been funding this effort for
the last several years; in spite of the fact that there are at least 6
other companies within this market segment that provide similar
decision support tools for first responders, and have been doing so
prior to NLM entering the marketplace.
Providing government funding to a program that competes with an
established segment of private industry kills jobs, stifles innovation
and seems inherently unfair and contrary to the long term best interest
of the emergency response community and a poor use of taxpayer money.
With NLM's continued practices, there will cease to be any private
industry R&D, innovation or other commercial investment in this market
segment, effectively killing innovative technologies like ours, and the
other companies currently providing products to this market. We have
attempted to raise this issue to the attention of NLM without success,
even though OMB circular A-76 (revised), supra note 182 at A-3
articulates a ``Red Light for On-Line and Informational Government
Activity: Principle 10: The government should exercise substantial
caution in entering markets in which private-sector firms are active.''
We feel that NLM is acting far outside its charter as a library
information service. While we certainly applaud their efforts to
provide concise and useful chemical and health related information to
emergency responders and the public, it seems clear that with the
development of software that they then give away, NLM has crossed the
line of what it has been chartered to do, and is in conflict with OMB
A-76, whose basic tenets are that ``in the process of governing, the
Government should not compete with its citizens'' and that ``a
commercial activity is not a governmental function.'' These principles
provide fundamental policy direction to agencies that the Government
should not be in the business of providing commercial goods and
services in competition with private markets.
We've attempted to contact NLM directly, but their position has
been that they are fulfilling their duty of publishing Government
information. We feel that developing and distributing analytical
software, running focus groups to solicit user feedback, then promoting
the software at the same industry trade shows that we attend is not
consistent with publishing Government data. In fact, it is quite
disingenuous, as if their intent was to publish the information, they
could make the information widely available in any number of portable
document or html formats that would be accessible from a range of
devices, from laptops to smartphones, and would not put them in direct
competition with private industry.
The Government doesn't provide emergency responders free emergency
response vehicles, protective clothing, respirators, radios or chemical
detectors, and neither should the Government be competing with
established private industry companies that are already providing
decision support software to emergency responders. I'm sure that
Microsoft would take umbrage with the Department of Commerce if
Commerce decided to develop and then give away a free spreadsheet
program simply because they thought it would benefit U.S. business.
We respectfully request that you look into defunding this NLM
program and get NLM out of the business of competing with private
industry for this type of software. Since NLM started promoting their
software, we've had existing customers and potential clients wonder why
they should pay for software that NLM makes available for free.
By way of background, as part of the Homeland Security Act of 2002,
Public Law 107-296, known as the SAFETY ACT, Congress passed the Act as
a mechanism to foster and support the development of innovative and
effective anti-terrorism technology. Today, our company is one of a few
companies in the United States that has a CBRNE/IED decision support
system that has earned SAFETY ACT certification and designation as an
approved anti-terrorism technology. We've spent over 5 years, and
nearly 25,000 man hours--all at our own private expense, developing,
fielding and deploying our technology. Today our technology,
HazMasterG3 is deployed with the FBI, the Secret Service Presidential
Protective Detail, every CST/WMD team in the country, the USMC's CBIRF,
DHS, US Special Forces, and many civilian fire departments, HAZMAT
teams and bomb squads throughout the United States.
______
Prepared Statement of the American Academy of Family Physicians
The American Academy of Family Physicians representing 97,600
family physicians, residents, and medical students nationwide, is
pleased to submit this statement for the record in support of our
funding priorities for inclusion in the fiscal year 2012 appropriations
bill.
The AAFP urges the Senate Appropriations Subcommittee on Labor,
Health and Human Services, and Education to make a robust fiscal year
2012 investment in our Nation's primary care physician workforce in
order to ensure that it is adequate to provide efficient, effective
healthcare delivery addressing access, quality and value.
We recognize the difficult decisions which our Nation's budgetary
pressures present and remain confident that wise Federal investment
will help to transform healthcare to achieve optimal, cost-efficient
health for everyone. Specifically, we recommend that the Committee
provide the Health Resources and Services Administration and the Agency
for Healthcare Research and Quality with the fiscal year 2012 funding
levels called for in the President's budget request.
Health Resourses and Services Administration
HRSA is the Federal agency chiefly responsible for improving access
to healthcare services for Americans who are uninsured, isolated or
medically vulnerable. HRSA's mission also calls for a skilled health
workforce, and the AAFP supports their efforts to train the necessary
primary care physician workforce. Primary care physicians will serve as
a strong foundation for a more efficient and effective healthcare
system.
The AAFP recommends that the Committee provide at least $449.5
million for all of the Health Professions Training Programs authorized
by Title VII of the Public Health Service Act and administered by the
Health Resources and Services Administration (HRSA) as requested in the
President's fiscal year 2012 budget.
Within that line, we urge you to provide at least:
--$140 million for Health Professions Primary Care Training and
Enhancement authorized under Title VII, Section 747 of the
Public Health Service Act;
--$10 million for Teaching Health Centers development grants
authorized by Title VII, Section 749A; and
--$4 million for Title VII, Section 749B Rural Physician Training
Grants.
Title VII Health Professions Training Programs
As the only medical specialty society devoted entirely to primary
care, the AAFP appreciates this Committee's commitment to a strong
primary care physician workforce. We are concerned that a failure to
provide adequate funding for the Title VII, Section 747, the Primary
Care Training and Enhancement (PCTE) program, would destabilize ongoing
efforts to increase education and training support for family
physicians, exacerbating primary care shortages and further straining
the Nation's healthcare system.
Title VII, Section 747 primary care training grants to medical
schools and residency programs have for decades helped to increase the
number of physicians who select primary care specialties and work in
underserved areas. A study published in the Annals of Family Medicine
on the impact of Title VII training programs on community health center
staffing and national health service corps participation found that
physicians who work with the underserved in CHCs and NHSC sites are
more likely to have trained in Title VII-funded programs.\1\ Title VII
primary care training grants are vital to departments of family
medicine, general internal medicine, and general pediatrics; strengthen
primary care curricula; and offer incentives for training in
underserved areas.
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\1\ Rittenhouse DR, et al. Impact of Title VII training programs on
community health center staffing and National Health Service Corps
participation. Ann Fam Med. 2008;6(5):397-405.
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In the coming years, medical services utilization is likely to rise
given the increasing and aging population as well as the insured status
of more of the populace. These demographic trends will cause primary
care physician shortages to worsen. We urge the Committee to increase
the level of Federal funding for primary care training to reinvigorate
medical education, residency programs, as well as academic and faculty
development in primary care to prepare physicians to support the
patient centered medical home.
Teaching Health Centers
The AAFP has long called for reforms to graduate medical education
programs in order to encourage the training of primary care residents
in non-hospital settings where most primary care is delivered. An
excellent first step is the innovative Teaching Health Centers program
authorized under Title VII, Section 749A to increase primary care
physician training capacity now administered by HRSA.
Federal financing of graduate medical education has led to training
which occurs mainly in hospital inpatient settings in spite of the fact
that most patient care is delivered outside of hospitals in ambulatory
settings across the Nation. The Teaching Health Center program provides
resources to any qualified community based ambulatory care setting that
operates a primary care residency program including federally Qualified
Health Centers or federally Qualified Health Centers Look Alikes, Rural
Health Clinics, Community Mental Health Centers, a Health Center
operated by the Indian Health Service, or a center receiving Title X
grants.
We were pleased that the Patient Protection and Affordable Care Act
authorized a mandatory appropriations trust fund of $230 million over 5
years to fund the operations of Teaching Health Centers. However, if
this program is to be effective, there must be funds for the planning
grants to establish newly accredited or expanded primary care residency
programs.
Rural Health Needs
Another important HRSA Title VII grant program is the Rural
Physician Training Grants program to help medical schools to recruit
students most likely to practice medicine in rural communities. This
modest program authorized by Title VII, Section 749B will help provide
rural-focused training and experience and increase the number of recent
medical school graduates who practice in underserved rural communities.
National Health Service Corps
The National Health Service Corps (NHSC) recruits and places
medical professionals in Health Professional Shortage Areas to meet the
need for healthcare in rural and medically underserved areas. The NHSC
provides scholarships or loan repayment as incentives for practitioners
to enter primary care and provide healthcare to Americans in Health
Professional Shortage Areas. By addressing medical school debt burdens,
the NHSC also helps to ensure wider access to medical education
opportunities.
The Government Accountability Office (GAO-01-1042T) described the
NHSC as ``one safety-net program that directly places primary care
physicians and other health professionals in these medically needy
areas.'' Currently most of the more than 7 million people who rely on
NHSC clinicians for their healthcare needs would not have access to
care without the NHSC.
Since its inception in 1972, the NHSC has helped place 37,000
primary care health professionals in underserved communities across the
country, many of whom remain in these areas following the completion of
their service. According to the fiscal year 2009 Health Resources and
Services Administration budget justification, over 75 percent of the
clinicians placed by the NHSC in underserved areas continued to serve
in their position for at least 1 year after the completion of their
service obligation.
Today, there are over 9,000 vacancies at NHSC approved sites across
the country with more added every day, yet funding is inadequate to
fill all of these needed slots.
The AAFP recommends that Committee provide at least the President's
requested level of $418.5 million for the National Health Service Corps
for fiscal year 2012 to include $295 million in funds made available
for NHSC operations, scholarships and loan repayments by the Affordable
Care Act.
Agency for Heatlhcare Research and Quality
The mission of the Agency for Healthcare Research and Quality
(AHRQ)--to improve the quality, safety, efficiency, and effectiveness
of healthcare for all Americans--closely mirrors the AAFP's own
mission. AHRQ is a small agency with a huge responsibility for research
to support clinical decisionmaking, reduce costs, advance patient
safety, decrease medical errors and improve healthcare quality and
access. Family physicians recognize that AHRQ has a critical role to
play in patient-centered outcomes research also known as comparative
effectiveness research.
Patient-Centered Outcomes Research
AHRQ's investment in patient-centered outcomes research will help
Americans make the informed decisions we must make to focus on paying
for quality rather than quantity. By determining what has limited
efficacy or does not work, this important research can spare patients
from tests and treatments of little value. Today, patients and their
physicians face a broad array of diagnostic and treatment options
without the scientific evidence needed to know what procedure or which
drug is most likely to succeed or how best to time a given therapy.
AHRQ is supporting research to answer those questions so that
physicians and their patients can make the choices about care that are
most likely to succeed. AHRQ also supports the essential research into
the prevention of medical errors and reducing hospital-acquired
infections.
Medical Liability Demonstrations
Solving the professional medical liability has long been one of the
AAFP's highest priorities. Although the medical liability
demonstrations announced by AHRQ in fiscal year 2010 are quite modest,
we support the effort to find alternatives to the current medical tort
system.
Primary Care Extension Program
The AAFP supports the Primary Care Extension Program to be
administered by AHRQ to provide support and assistance to primary care
providers about evidence-based therapies and techniques so that
providers can incorporate them into their practice. As AHRQ develops
more scientific evidence on best practices and effective clinical
innovations, the Primary Care Extension Program will disseminate them
to primary care practices across the Nation in much the same way as the
Federal Cooperative Extension Service provides small farms with the
most current information and guidance.
The AAFP recommends that the Committee provide at least $405
million for AHRQ in fiscal year 2012. In addition, we ask that the
Primary Care Extension program receive the authorized level of $120
million in fiscal year 2012.
______
Prepared Statement of the American Academy of Physician Assistants
On behalf of the nearly 80,000 clinically practicing physician
assistants in the United States, the American Academy of Physician
Assistants is pleased to submit comments on fiscal year 2012
appropriations for Physician Assistant (PA) educational programs that
are authorized through Title VII of the Public Health Service Act.
AAPA believes that the Title VII Health Professions Programs are
essential to placing health professionals in medically underserved
communities. According to the Health Resources and Services
Administration, an additional 301,000 healthcare practitioners are
needed to alleviate existing professional shortages. One of three
healthcare professions providing primary medical care in the United
States, the PA profession is deemed by many economists to be among the
fastest growing professions. Title VII will not only encourage greater
numbers of students to enter PA educational programs; it will also help
increase access to care for millions of Americans who live in medically
underserved areas.
As a member of the Health Professions and Nursing Education
Coalition (HPNEC), AAPA respectfully supports the coalition's request
to fund Title VII health professions education program at the
President's request of $449,454,000.
AAPA recommends that Congress continue its support to grow the PA
primary care work force. The U.S. healthcare system will require a
much-expanded primary healthcare workforce, both in the private and
public healthcare markets. For example, the National Association of
Community Health Centers' March 2009 report, Primary Care Access: An
Essential Building Block of Health Reform, predicts that in order to
reach 30 million patients by 2015, health centers will need at least an
additional 15,585 primary care providers, just over one-third of whom
are non-physician primary care professionals.
A review of PA graduates from 1990-2009 demonstrates that PAs who
have graduated from PA educational programs supported by Title VII are
67 percent more likely to be from underrepresented minority populations
and 47 percent more likely to work in a rural health clinic than
graduates of programs that were not supported by Title VII.
Additionally, a study by the UCSF Center for California Health
Workforce Studies found a strong association between physician
assistants exposed to Title VII during their PA educational preparation
and those who reported working in a federally qualified health center
or other community health center.
Title VII programs are essential to the development and training of
primary healthcare professionals and, in turn, provide increased access
to care by promoting healthcare delivery in medically underserved
communities. Title VII funding is especially important for PA programs
as it is the only Federal funding available on a competitive
application basis to these programs.
We wish to thank the members of this subcommittee for your
historical role in supporting funding for the health professions
programs, and we hope that we can count on your support to maintain
funding to these important programs in fiscal year 2011 at the
President's request.
Overview of Physician Assistant Education
Physician assistant educational programs are located within schools
of medicine or health sciences, universities, teaching hospitals, and
the Armed Services. All PA educational programs are accredited by the
Accreditation Review Commission on Education for the Physician
Assistant.
The typical PA program consists of 26 months of instruction, and
the typical student has a bachelor's degree and about 4 years of prior
healthcare experience. The first phase of the program consists of
intensive classroom and laboratory study. More than 400 hours in
classroom and laboratory instruction are devoted to the basic sciences,
with over 75 hours in pharmacology, approximately 175 hours in
behavioral sciences, and nearly 580 hours of clinical medicine.
The second year of PA education consists of clinical rotations. On
average, students devote more than 2,000 hours, or 50 to 55 weeks, to
clinical education, divided between primary care medicine--family
medicine, internal medicine, pediatrics, and obstetrics and
gynecology--and various specialties, including surgery and surgical
specialties, internal medicine subspecialties, emergency medicine, and
psychiatry. During clinical rotations, PA students work directly under
the supervision of physician preceptors, participating in the full
range of patient care activities, including patient assessment and
diagnosis, development of treatment plans, patient education, and
counseling.
After graduation from an accredited PA program, physician
assistants must pass a national certifying examination developed by the
National Commission on Certification of Physician Assistants. To
maintain certification, PAs must log 100 continuing medical education
hours every 2 years, and they must take a recertification exam every 6
years.
Physician Assistant Practice
By design, PAs always practice in teams with physicians, extending
the reach of medicine and the promise of improved health to the most
remote and in-need communities in our Nation. The PA profession's
patient-centered, team-based approach reflects the changing realities
of healthcare delivery and fits well into the patient-centered medical
home model of care, as well as other integrated models of care
management.
PAs practice in various medical setting across the country and in a
recent survey conducted by the AAPA it is estimated that:
--Nineteen percent of all PAs practice in non-metropolitan areas
where they may be the only full-time providers of care (State
laws stipulate the conditions for remote supervision by a
physician);
--41 percent of PAs work in urban and inner city areas;
--40 percent of PAs are in primary care;
--44 percent of PAs worked in group practices or solo physician
offices: and
--80 percent of PAs practice in outpatient settings.
Nearly 300 million patient visits were made to PAs in 2009. PAs
often provide autonomous medical care, have their own patient panels,
and are granted prescribing authority in all 50 States.
Critical Role of Title VII Public Health Service Act Programs
Title VII programs promote access to healthcare in rural and urban
underserved communities by supporting educational programs that train
health professionals in fields experiencing shortages, improve the
geographic distribution of health professionals, increase access to
care in underserved communities, and increase minority representation
in the healthcare workforce.
Title VII programs are the only Federal educational programs that
are designed to address the supply and distribution imbalances in the
health professions. Since the establishment of Medicare, the costs of
physician residencies, nurse training, and some allied health
professions training have been paid through Graduate Medical Education
(GME) funding. However, GME has never been available to support PA
education. More importantly, GME was not intended to generate a supply
of providers who are willing to work in the nation's medically
underserved communities--the purpose of Title VII.
Furthermore, Title VII programs seek to recruit students who are
from underserved minority and disadvantaged populations, which is a
critical step toward reducing persistent health disparities among
certain racial and ethnic U.S. populations. Studies have found that
health professionals from disadvantaged regions of the country are
three to five times more likely to return to underserved areas to
provide care.
Title VII Support of PA Educational Programs
Federal support for Title VII is authorized through section 747 of
the Public Health Service Act. It is the only Federal funding available
to PA educational programs. This funding is specifically targeted for
primary care education and training programs and is designed to train
PAs for practice in urban or rural medically underserved areas. The
program is essential to the development and training of the Nation's
health workforce and is critical to providing continued health services
to both underserved and minority communities. It also encourages PAs to
return to these environments with the greatest need after they have
completed their training, being one of the best recruitment tools to
date.
Title VII was last reauthorized in 2010 under the Patient
Protection and Affordable Care Act. Now there is a critical need to
fund the Title VII program through the appropriations process to
increase the supply, diversity, and distribution of PAs and primary
care practitioners in medically underserved communities.
Support for educating PAs to practice in underserved communities is
particularly important given the market demand for physician
assistants. Without Title VII funding to expose students to underserved
sites during their training, PA students are far more likely to
practice in the communities where they were raised or attended school.
Title VII funding is a critical link in addressing the natural
geographic maldistribution of healthcare providers by exposing students
to underserved sites during their training, where they frequently
choose to practice following graduation. Currently, 36 percent of PAs
met their first clinical employer through their clinical rotations.
Changes in the healthcare marketplace reflect a growing reliance on
PAs as part of the healthcare team. Currently, the supply of physician
assistants is inadequate to meet the needs of society, and the demand
for PAs is expected to increase. A 2006 article in the Journal of the
American Medical Association (JAMA) concluded that the Federal
Government should augment the use of physician assistants as physician
substitutes, particularly in urban Community Health Centers (CHCs)
where the proportional use of physicians is higher. The article
suggested that this could be accomplished by adequately funding Title
VII programs. Additionally, the Bureau of Labor Statistics projects
that the number of available PA jobs will increase 39 percent between
2008 and 2018.
Title VII funding has provided a crucial pipeline of trained PAs to
underserved areas. Recognizing that the PA educational programs
received significantly less funding than other programs in the cluster
on primary care medicine and dentistry, the 111th Congress established
a 15 percent set-aside for PA education within the section 747 cluster
on primary care during reauthorization of the Title VII Programs.
Recommendations on Fiscal Year 2012 Funding
The American Academy of Physician Assistants urges members of the
Appropriations Committee to consider the inter-dependency of all public
health agencies and programs when determining funding for fiscal year
2012. For instance, while it is critical, now more than ever, to fund
clinical research at the National Institutes of Health (NIH) and to
have an infrastructure at the Centers for Disease Control and
Prevention (CDC) that ensures a prompt response to an infectious
disease outbreak or bioterrorist attack, the good work of both of these
agencies will go unrealized if the Health Resources and Services
Administration (HRSA) is inadequately funded.
HRSA administers the ``people'' programs, such as Title VII, that
bring the results of cutting edge research at NIH to patients through
providers such as PAs who have been educated in Title VII-funded
programs. Likewise, the CDC is heavily dependent upon an adequate
supply of healthcare providers to be sure that disease outbreaks are
reported, tracked, and contained.
Thank you for the opportunity to present the American Academy of
Physician Assistants' views on fiscal year 2012 appropriations.
______
Prepared Statement of the American Academy of Sleep Medicine
Dear Chairman Harkin and Members of the Committee: The American
Academy of Sleep Medicine (AASM), an organization composed of over
9,700 sleep care professionals and the accrediting agent for over 2,200
accredited sleep care centers, is pleased to provide our views on the
HHS research budget for fiscal year 2012. As the leader in setting
standards and promoting excellence in evidence-based sleep medicine
healthcare, education, and research, we can attest to the fact that the
work of the National Institutes of Health (NIH) has proven to be vital
in allowing our members to provide effective sleep care services.
The AASM supports funding levels for the NIH that will allow the
careful continuation of the current research agenda. Savings should be
realized from speeding the research process, vigilant screening of new
research proposals, and an honest examination of spending for ongoing
research. Key criteria in reviewing ongoing research should include
both the potential patient benefit and whether a stoppage today will
result in a restart on some future tomorrow that will duplicate the
initial research and correspondingly duplicate the previously incurred
expenses.
Even in this economic climate, the value of the NIH as an incubator
for advancing scientific and healthcare knowledge has to be recognized.
Efforts need to be made to continue spending that: Enhances our ability
to identify and provide beneficial patient care services; moves
information from the white coats of the research laboratory to the
white coats at the patient's bedside; and ensures a continual pipeline
of research professionals.
Even with this realization, however, we are not blind to the
reality of the need to pare the Federal budget. We accept the fact that
the totality of NIH spending is not immune to budget cuts. The key in
looking at this budget is to take steps that do not fall into the
category of being unexamined cuts that are made without taking into
account the repercussions of these budget-based actions. While across-
the-board cuts provide a clean and arguably simple process for trimming
the budget, taking a budget axe to the NIH has the very real counter-
productive potential of stopping prominent, patient oriented research
in mid-stream and creating a gap in the research field. These
unintended consequences carry significant negative implications that
our patients and our society can ill afford.
Examples of ongoing sleep related and other research recently
funded by the NIH illustrate the difficulty of budget slashing that
fails to take into account the three above noted bullet points. The
sleep related research identified at this site (set out below) provides
clear examples of ongoing research with indisputable patient care
implications. This is the type of research that needs to be completed
and not simply restarted at some future point with duplicated expenses.
It also bears noting that the research funding on the connection
between sleep apnea treatment and cardiovascular disease resulted in 12
new jobs. These are the types of jobs that build the cadre of future
key researchers. The importance of this cannot go unnoticed. For the
future vitality of our society, we can ill afford another ``Sputnik
moment'' by failing to maintain the research pipeline and the personnel
that are essential to its maintenance and growth.
The American Academy of Sleep Medicine urges careful consideration
when addressing budget issues; the Academy is available as a resource
on how those issues are connected with care for patients with sleep
disorders. Please feel free to direct questions for the AASM to Bruce
Blehart, Director of Health Policy and Government Relations, at
[email protected].
Nirinjini Naidoo, Ph.D.
Research Assistant Professor of Medicine, University of Pennsylvania,
Philadelphia, PA
Biomarker for Sleep Loss: A Proteomic Determination
Administered by the NHLBI Division of Lung Diseases, Lung Biology and
Disease Branch
Fiscal Year 2009 Recovery Act Funding: $500,000
Additional Funding
Biomarker for Sleep Loss: A Proteomic Determination
Administered by the NHLBI Division of Lung Diseases, Lung Biology
and Disease Branch
Fiscal Year 2010 Recovery Act Funding: $500,000
Total funding: $1,000,000
Dr. Nirinjini Naidoo grew up in South Africa, where she drew daily
inspiration from her family. Her father, a classical scholar, fed the
young Dr. Naidoo's desire to read voraciously. Over time, she was drawn
to books about energetic, creative women in science like Marie Curie
and Rosalind Franklin. ``Those stories really stuck with me,'' Dr.
Naidoo said, noting that she is intensely curious and always ``wants to
know.'' The attributes suit her well as a frontier scientist in the
world of sleep research. They may be at odds with her getting sleep,
though, she admitted. ``I sometimes wake up at 3 a.m. and send myself
an e-mail about a newly hatched experiment.''
Research Focus.--Humans spend about one-third of their lives
asleep. But according to Dr. Naidoo, many of us do not appreciate that
sleep is a vital part of healthy living and that our bodies accomplish
several important tasks during that time. ``Sleep is definitely not
just an `off' state,'' Dr. Naidoo said. ``Research is telling us that
our bodies are actually very busy when we sleep--re-stocking cellular
components, consolidating memories, and strengthening connections
between nerve cells in the brain.'' Dr. Naidoo's research interest in
sleep came fairly recently. A chemist who specializes in studying the
structures and functions of proteins, she did postdoctoral research in
the area of circadian rhythms--the 24-hour cycles that tune body
systems with the light-and-dark cycle of our environment. Matching her
scientific skills to what she saw as a fascinating question, Dr. Naidoo
decided to look at the molecular features of sleep. What proteins are
talking to each other? Which genes and molecules are active . . . or
asleep themselves?
Grant Close-Up.--Dr. Naidoo's Recovery Act grant is a comprehensive
search for ``biomarkers'' of sleep loss. Biomarkers are substances that
indicate a particular state or process. They can be used to signify
health problems--high cholesterol is one, for example. Or, biomarkers
can denote a normal activity, like growth or sleep. But as useful as
they sound, accurate biomarkers can be very difficult to find. That's
because so many factors can affect how the body functions: our diet,
whether we exercise, what medicines we take, and our genetic make-up.
All these components can influence body systems independently of each
other, which makes finding telltale biomarkers challenging.
You could think of Dr. Naidoo's approach as a variant on the
childhood matching game ``same and different.'' In earlier experiments,
she and other researchers identified people who were different types of
sleepers. Some recovered quickly and fully from sleep deprivation and
could easily pass a question-and-answer knowledge test. Others, Dr.
Naidoo explained, reacted very differently and made several mistakes on
the same relatively simple test. In that earlier experiment, she and
leading sleep researcher Allan I. Pack, Ph.D., also at the University
of Pennyslvania, collected blood samples from all the study
participants. They will now use a high-tech chemical analytical tool
called mass spectrometry to search for molecules that differ between
the two different types of sleepers.
After 2 years, Dr. Naidoo plans to have a profile of sleepiness--a
snapshot of all the proteins and other molecules in blood that define
sleepy or non-sleepy. In general, biomarkers can useful non-invasive
tools for detecting illness and spotting disease risk. She hopes the
sleep biomarkers will help researchers and physicians track sleep
deprivation or the role of sleep loss in various diseases.
Economic Impact.--Dr. Naidoo used Recovery Act funds to buy several
pieces of state-of-the-art scientific equipment, such as a powerful
microscope and machines that screen blood and other fluids for their
component proteins. She is especially excited about the fact that this
funding is enabling her to bring new blood into the field of sleep
research. ``One of my new research specialists working on this
project--a recent chemistry graduate--is now applying to graduate
school to study sleep,'' said Dr. Naidoo. ``It's so important that we
get new thinking and new methods into understanding one of the most
fundamental processes in our daily lives.''
By Alison Davis, Ph.D.--Last Updated: August 10, 2010
Susan Redline, M.D., M.P.H.
Professor, Case Western Reserve University, Cleveland, Ohio
PHASE II Trial of Sleep Apnea Treatment to Reduce Cardiovascular
Morbidity
Administered by the NHLBI Division of Lung Diseases, National Center on
Sleep Disorders Research
Fiscal Year 2009 Recovery Act Funding: $2,190,865
Research Focus.--More than 12 million American adults have sleep
apnea, a disorder where breathing repeatedly pauses or becomes shallow
during sleep. The condition can double or even quadruple a person's
risk of heart disease, high blood pressure, and stroke. Despite sleep
apnea's prevalence and risks, an estimated 1 in 10 patients isn't
diagnosed or treated. One reason for the low treatment rate is that
doctors lack evidence about which sleep apnea therapies actually reduce
cardiovascular disease risk. On top of that, some patients who do get
diagnosed may not follow through with their prescribed treatment
because they think it's uncomfortable or awkward-looking.
Grant Up Close.--Supported by an NHLBI Recovery Act funded Grand
Opportunity grant, Susan Redline, M.D., M.P.H., is leading the first
large-scale study in the United States to determine whether two common
sleep apnea treatments reduce patients' risk of cardiovascular disease.
Her team is recruiting 1,400 cardiovascular clinic patients who have
moderate to severe sleep apnea and monitoring their sleep at home.
One group of patients will receive extra oxygen at night. Dr.
Redline wants to know if this simple therapy reduces the health risks
of sleep apnea by compensating for lost breaths, or raises the risks by
not increasing patients' breath rates. A second group of patients will
receive another common sleep apnea treatment, continuous positive
airway pressure (CPAP), in which a machine blows air into the throat
each night through a mask worn over the nose and mouth. Although both
CPAP and oxygen therapy are widely used, researchers haven't yet
established whether using them to treat sleep apnea reduces
cardiovascular disease risk. Dr. Redline's team will conduct
comparative effectiveness research into the two treatments. A third
group of patients will not undergo sleep apnea treatment.
All three groups will have their early signs of cardiovascular
disease treated. Together, these groups will help Dr. Redline's team
begin to determine whether treating sleep apnea can change patients'
risk of cardiovascular disease. The results of the study will also set
the stage for advanced clinical trials. Her goal is to help doctors
integrate sleep medicine into routine cardiology care and develop
evidence-based treatment guidelines, ultimately lowering deaths from
sleep apnea-related heart disease.
``A true multidisciplinary team''.--The study includes
cardiologists and sleep medicine experts from four sites across the
country. Some of them already collaborate through the NHLBI's Sleep
Heart Health Study, a multi-center population study examining the
cardiovascular effects of sleep apnea. ``My colleagues include
engineers, informaticians, physiologists, geneticists, epidemiologists
and clinicians,'' said Dr. Redline. ``I meet regularly with these
diverse and talented people to review our common or overlapping
goals.''
Economic Impact.--Thanks to Recovery Act funds, the team was able
to create 12 new jobs. They also bought new equipment, including
portable devices to measure patients' blood pressure and other
responses to sleep apnea treatments. Because the trial involves several
sites, the team developed an advanced web-based data management
platform. Researchers beyond the study can adapt it to their own needs
so they can start new studies faster and manage them more efficiently.
Broadening her Dream.--``As a child, I wanted to be a general
physician, with a shingle on my door, and simply help people feel
better,'' said Dr. Redline. She was accepted into an accelerated 6-year
medical honors program when she was just 15 years old. Then her dream
began to evolve. ``As I was exposed to academic medicine and powerful
epidemiological methods, I realized that I wanted to work on broad
issues that impact the health of the community, especially the
underserved,'' she said. Learning about how the environment can impact
people's lung health, and seeing how common but poorly understood sleep
disorders were, Dr. Redline decided that researching sleep medicine was
the way she could help improve public health.
Outside the Lab.--Dr. Redline likes to spend time reading, biking,
and kayaking.
Aiming High.--Dr. Redline wants to find a practical treatment for
sleep apnea that improves people's sleep quality and lowers their risk
of heart disease; and to uncover genes that contribute to sleep apnea,
so researchers can develop better targeted treatments.
By Stephanie Dutchen--Last Updated: August 10, 2010.
______
Prepared Statement of the American Association for Cancer Research
The American Association for Cancer Research (AACR) is the world's
oldest and largest scientific organization focused on every aspect of
high-quality, innovative cancer research. The mission of the AACR and
its more than 33,000 members is to prevent and cure cancer through
research, education, communication and collaboration. We thank the
United States Congress for its longstanding, bipartisan support for the
National Institutes of Health (NIH) and for its commitment to funding
cancer research.
The AACR urges the Senate to continue this commitment to NIH in the
coming fiscal year. To sustain the momentum generated through past
investments in biomedical research and to improve the health of all
Americans, the AACR recommends $35 billion for the NIH, including
$5.795 billion for the National Cancer Institute (NCI) in fiscal year
2012. This level of funding is needed to sustain the momentum generated
through regular appropriations and the additional funds from the
American Recovery and Reinvestment Act of 2009.
Cancer research saves lives
The Nation's historical investment in cancer research is
unquestionably having a remarkable impact. We are in a time of
unprecedented scientific opportunity: we are now able to accelerate
progress against cancer by translating a wealth of scientific
discoveries, such as the mapping of the human genome, into new
treatments and preventive strategies for cancer. We can continue to
make significant advances--but only if we continue to allocate the
required resources to do so. Reversing recent cuts and providing
stable, increased funding will greatly aid a full-scale national effort
to lessen the burden of the more than 200 diseases we collectively call
cancer.
This year marks the 40th anniversary of the enactment of the
National Cancer Act. In the four decades since President Richard M.
Nixon signed this landmark legislation: Annual cancer death rates in
the United States have declined steadily; the 5-year survival rate for
all cancers combined has improved to more than 65 percent; the 5-year
survival rate for all childhood cancers combined has increased from 30
percent in 1976 to 80 percent today; and 12 million Americans have
become cancer survivors, compared with only 3 million in 1971.
These remarkable achievements are a direct result of our national
commitment to funding cancer research, screening, and treatment
programs at the NCI, NIH, and other agencies across the Federal
Government. Yet this substantial progress will be slowed if the Federal
commitment to funding for critical cancer research priorities is not
maintained.
In the last 40 years, innumerable advances in basic science, cancer
prevention and detection, therapeutic development and clinical cancer
management have been achieved. While these advances are too numerous to
list here, the following cancer research advancements occurred in 2010
alone, as a direct result of funding by the NIH:
--12 new cancer drugs or cancer drug uses were approved by the FDA,
including the first-ever therapeutic vaccine, Provenge, which
was approved for men with metastatic prostate cancer; and
--biological knowledge of tumor genes and the tumor microenvironment
has led to the development of drugs that inhibit specific
genetic targets, which may result in new treatments for
multiple types of cancers, including melanoma and lymphoma.
The opportunities and the science currently underway promise many
more successes in improved treatment and prevention of cancer.
Currently, there are: More than 800 cancer therapies from industry in
some step of the trial process; more than 2,000 clinical trials
accepting children and young adults in progress; and more than 200
cancer prevention trials open.
Right now, we are facing a precipice with cancer. The biological
knowledge and the technological advances have positioned scientists at
an inflection point. To pull back from Federal investment is to abandon
science in a time when scientists will be able to make quantum leaps in
prevention and treatment of cancer. It is imperative that sustained
appropriations be provided to the NIH so that these opportunities and
other promising areas such as personalized medicine and cancer
prevention do not slip from our grasp.
Cancer remains a significant public health challenge
We have made significant progress against cancer in recent years,
but as long as cancer remains the leading cause of death for Americans
under age 85 and the second-leading cause of death overall, we cannot
afford to slow down. In 2011, 1.5 million new cancer cases will be
diagnosed and more than half a million American lives will be lost to
this terrible collection of diseases.
Moreover, the United States is facing what some have termed a
``cancer tsunami'' as the baby boom generation reaches age 65 this
year. More than three-quarters of all cancers are diagnosed in
individuals aged 55 and older, and the number of cancer cases is
estimated to approach 2 million new cases per year by 2025. This will
dramatically exacerbate the current problems with the healthcare system
and it will undoubtedly hit those who can least afford it--elderly,
medically underserved, and minority populations--the hardest.
Beyond the enormous toll cancer takes on the lives of affected
individuals and their loved ones, cancer places a heavy burden on the
U.S. economy, costing an estimated $228 billion in direct medical costs
and indirect costs associated with lost productivity due to illness and
premature death.
Targeted therapies as the future of cancer treatment
The future of cancer treatment lies in the ability to treat
patients based on the specific characteristics of a patient and his or
her cancer--often referred to as personalized medicine. Cancer research
is leading the way toward the realization of personalized medicine, in
no small part thanks to Federal investment in deciphering the
fundamental biology of cells, such as the Human Genome Project and,
more recently, The Cancer Genome Atlas, an NCI project that is
identifying important genetic changes involved in cancer.
The NCI is investing in efforts that will facilitate the
translation of this wealth of basic knowledge into new treatments,
including validating cancer biomarkers for prognosis, metastasis,
treatment response, and progression; accelerating the identification
and validation of potential cancer molecular targets; minimizing the
toxicities of cancer therapy; and integrating the clinical trial
infrastructure for speed and efficiency.
Accelerating progress in cancer prevention
The AACR has long been a supporter of cancer prevention research
aimed at identifying effective strategies to prevent cancer through
lifestyle changes, chemoprevention, and early detection and treatment.
Prevention is the keystone to success in the battle against cancer
because preventing the disease is far more desirable--and cost-
effective--than treating it. More than half of all cancers are related
to modifiable behavioral factors, including tobacco use, diet, physical
inactivity and sun exposure. Furthermore, many cancers can be halted in
the early stages if individuals have access to, and take advantage of,
screening tests. Vaccination--one of the most successful approaches for
preventing disease--is one of the most promising areas of ongoing
cancer prevention research.
Research on cancer prevention at the NCI focuses on three main
areas: Risk assessment, including understanding and modifying lifestyle
factors that increase cancer risk; developing medical interventions
(chemoprevention), such as drugs or vaccines, to prevent or disrupt the
carcinogenic process; and developing early detection and screening
strategies that result in the identification and removal of
precancerous lesions and early-stage cancers.
Cancer biology intersects with several areas and disciplines of
cancer prevention, pointing to opportunities for, and the importance
of, integrative, interdisciplinary efforts to advance clinical cancer
prevention through hard-won science. The breadth and excitement of
these current opportunities have never been greater.
Addressing and conquering cancer health disparities
Certain minority and underserved population groups continue to
suffer disproportionately from cancer. Conquering cancer health
disparities will contribute significantly to reducing the Nation's
overall cancer burden, and this issue has been an important focus of
both the NCI and the AACR. The NCI's investments in this area include:
studying the factors that cause cancer health disparities; working with
underserved communities to develop targeted interventions; developing
the knowledge base for integrating cancer services to the underserved;
collaborating to implement culturally appropriate information and
dissemination approaches to underserved populations; and examining the
role of health policy in eliminating cancer health disparities.
One size does not fit all in cancer treatment and prevention--
certain populations may require specialized approaches to achieve
success. We must make every effort to reduce and equalize cancer rates
across all populations. The AACR urges sustained funding for these
programs to ensure that all people benefit from cancer research and
that these disparities are eliminated.
Fighting cancer in challenging fiscal times
We are acutely aware of the difficult decisions Congress must make
as it seeks to improve the Nation's fiscal stability. However, it is
imperative that such efforts be grounded in the goal of securing the
prosperity and well-being of the American people. It is not by chance
that the United States is the world leader in cancer research and the
development of lifesaving treatments. Our preeminence is a direct
result of the steadfast determination of the American public and the
U.S. Congress to reduce the burden of this devastating disease by
supporting and investing in research through the NIH and NCI.
Consider the following:
--Biomedical research is essential to maintaining American global
competitiveness. While our Nation has been the undisputed
leader in research and innovation, other countries are catching
up. According to the Organisation for Economic Co-operation and
Development (OECD), national expenditures for research and
development as a percentage of gross domestic product (GDP)
remained static for the United States between 2001 and 2008
while growing nearly 60 percent in China and 34 percent in
South Korea. If this trend continues, we risk losing our global
preeminence in biomedical research.
--Biomedical research has a strong positive impact on State and local
economies. NIH dollars are creating and preserving high-wage,
high-tech jobs at a critical time for the U.S. economy. A
recent report issued by United for Medical Research estimated
that in fiscal year 2010, NIH awards led to the creation of
488,000 jobs across the country, producing $68 billion in new
economic activity. The NCI alone funds more than 6,500 research
grants at more than 150 cancer centers and specialized research
facilities located in 49 States. In over half the States,
grants and contracts to institutions exceed $15 million
annually.
--Biomedical research is an effective and efficient use of public
dollars. NIH funding does not stay inside the Beltway. More
than 80 percent of the dollars appropriated to the NIH are
distributed throughout the United States to research projects
that have undergone rigorous review for scientific merit. NIH
has consistently received the highest possible ranking of
``effective'' under the Office of Management and Budget's
Program Assessment Rating Tool (PART), demonstrating that its
programs set ambitious goals, achieve results, and are well-
managed and efficient.
Recent cuts to the NIH jeopardize scientific progress
The $320 million in cuts to the NIH enacted in the full-year
continuing appropriations of 2011, which included $45 million in cuts
to the NCI, will yield harmful consequences for cancer research and
cancer patients. This loss of funding will result in the following: a
10 percent reduction in the number of new grants that can be awarded
this year; a 3 percent cut to existing grants; and as much as a 5
percent cut to funding for NCI-designated cancer centers. These cuts
mean that success rates for grants could fall into the single digits,
leaving numerous meritorious grant proposals, which could be the key to
new therapies, unfunded at a time of unprecedented scientific
opportunity. Furthermore, cancer centers and research laboratories may
have to lay off workers as a result of reduced funding, which would
negatively impact local economies across the Nation. Budget cuts and
low success rates for grant proposals also discourage young scientists
from entering the field, putting the future scientific workforce at
risk.
The NIH needs stable, predictable increases in funding
Although cancer remains a costly burden in terms of its human and
economic toll, previous investments have led to an abundance of
promising research opportunities, and it is crucial that such
possibilities are not lost. We thank Congress for its past support for
the NIH and cancer research and urge Congress to continue its
longstanding, bipartisan commitment. The American people are depending
on Congress to ensure the Nation does not lose the health and economic
benefits that result from our extraordinary commitment to medical
research. The AACR looks forward to working with you to assure that our
collective commitment to ending the pain and suffering inflicted by
cancer is upheld and that researchers have the resources needed to
continue to deliver hope and tangible progress.
______
Prepared Statement of the American Association for Dental Research
Introduction
Mr. Chairman and Members of the Subcommittee, I am Jeff Ebersole,
Director of the Center for Oral Health Research at the University of
Kentucky College of Dentistry. My testimony is on behalf of the
American Association for Dental Research, where I currently serve as
President.
I thank the Subcommittee for this opportunity to testify about the
exciting advances in oral health science. With the support of this
Committee, the research funded by the National Institute of Dental and
Craniofacial Research (NIDCR) has not only returned dividends in terms
of improvements in oral health across the U.S. population, but also in
a wide array of other health issues ranging from craniofacial birth
defects to chronic orofacial pain to oral cancer. The investments we
make today will create an exciting tomorrow for the treatment and
prevention of oral health diseases and disorders.
What is the American Association for Dental Research?
The American Association for Dental Research is headquartered in
Alexandria, Virginia. It is a nonprofit organization with more than
4,000 members in the United States. Its mission is to: (1) advance
research and increase knowledge for the improvement of oral health; (2)
support and represent the oral health research community; and (3)
facilitate the dissemination and application of research findings. The
AADR is the largest Division of the International Association for
Dental Research.
Why is Oral Health Important?
Oral health is an essential component of health across the
lifespan. Poor oral health and untreated oral diseases and conditions
can have a significant impact on social development, economic
accomplishment, and the quality of life. They can affect the most basic
human needs including the ability to eat and drink, swallow, maintain
proper nutrition, smile and communicate.
Over the past 50 years, there has been a dramatic improvement in
oral health. Still oral diseases remain a major concern. Tooth decay
and gum disease represent the predominant infections facing the public,
although complete tooth loss, oral cancer, trauma to the mouth, and
congenital facial anomalies also contribute to the ongoing importance
of oral health research and care.
Employed adults in the United States lose more than 164 million
hours of work each year as a result of oral health problems and
children are estimated to lose 54 million school hours.\1\
Approximately 25 percent of adults over the age of 60 have lost all of
their natural teeth.\2\ Americans with the poorest oral health are
usually those who are economically disadvantaged, lack insurance, or
are members of racial and ethnic minorities. Moreover, as the Nation
ages oral health issues, particularly gum disease and the oral health
impact of medical treatments and medicines will continue to increase.
---------------------------------------------------------------------------
\1\ Centers for Disease Control Publication, ``Oral Health for
Adults,'' December 2006.
\2\ Ibid.
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Research Accomplishments
Salivary Diagnostics.--For many decades researchers have known that
saliva is important for more than chewing, tasting, swallowing, and as
the first step in digestion. A multitude of proteins and other
molecules in saliva also play vital roles in protecting us from
bacteria and viruses that are constantly entering through the mouth and
can cause disease.
Now, scientists are well on their way to understanding how saliva
contributes to broader health functions. In 2008, an NIDCR supported
team of biologists, chemists, engineers and computer scientists at five
research institutions across the country mapped the salivary proteome--
a ``catalogue and dictionary'' of proteins present in human saliva.
This saliva database is an important first step toward being able
to use biomarkers in saliva to diagnose or predict oral and systemic
diseases. Saliva tests based on these biomarkers offer many advantages
over blood tests that require a needle stick and can pose contamination
risks from blood-borne diseases. However, much effort is still
required. It is crucial that the research community have the resources
necessary to refine and enrich the ``dictionary'' of proteins present
in human saliva. Saliva tests could prove to be a potentially
lifesaving alternative to detect diseases where early diagnosis is
critical-- as in the case of oral cancer or heart attacks.
Oral Cancer.--Oral cancer affects approximately 38,000 Americans
each year. Oral cancer is any cancerous tissue growth located in the
mouth. The death rate associated with this cancer is especially high
due to delayed diagnosis. Only 60 percent of those with this cancer
will survive more than 5 years.
Researchers are developing a Point of Care diagnostic system (real-
time) for rapid onsite detection of saliva-based tumor markers. Early
detection of oral cancer will increase survival rates, improve the
quality of care for patients, and it will result in a significant
reduction in healthcare costs.
Resources must be available to permit researchers to complete work
on the Point of Care diagnostic systems, and to develop new therapeutic
approaches. It should also be noted that several new drug candidates
are now becoming available to treat oral cancer. It is believed that at
least one of these drugs will be ready for FDA approval in the very
near future.
Health Disparities.--Health Disparities are the persistent gaps
between the health status of minorities and non-minorities in the
United States. Predicted causes of health disparities are related to
educational, socioeconomic, and environmental characteristics of
different ethnic and racial groups, and most recently recognized in
historically underserved rural populations of the United States.
The NIDCR is one of the leading institutes at NIH supporting health
disparities research. The program at NIDCR takes a multidisciplinary
approach to solving the complex problem of health disparities by
addressing it from a holistic health prospective. The institute funded
investigations engage behavioral and social scientists, health policy
experts, economists, and basic and clinical dental and medical
researchers. NIDCR has supported new health centers which focus on
numerous populations at risk, including African Americans, Hispanic/
Latinos, Native Americans and rural communities. The centers partner
with other academic health centers, State and local health agencies,
community and migrant health centers, and institutions that serve these
targeted populations.
The physical and economic burden due to health disparities is real
and efforts must continue in order to eliminate them. I am proud to say
that dental researchers are leading this charge.
Conclusion
As you can see Mr. Chairman, much has been accomplished with the
resources provided by this committee; however, there is much yet to be
done. Science is advancing rapidly and the next generation of
technological innovation may greatly accelerate the next breakthroughs
in oral, dental and craniofacial research. Researchers have already
created prototypes for ``labs-on-a-chip,'' bioengineered tissue
replacements, and developed powerful molecular imaging tools that
provide a new window into complex biological systems about which we
continue to learn. This emerging wave of knowledge and tools will
accelerate the development of molecular-based oral healthcare. As
importantly, the NIDCR provides the resources for training the next
generation of biomedical scientists focusing or oral health issues as
well as the future academics to train the next generation of dentists
for the United States. Thus, it is vital that NIDCR have the resources
to support a diverse portfolio of research and training. The AADR
representing each of these constituencies respectfully requests a
fiscal year 2012 budget of $468 million for NIDCR.
Thank you.
______
Prepared Statement of the American Association for Geriatric Psychiatry
The American Association for Geriatric Psychiatry (AAGP)
appreciates this opportunity to comment on issues related to fiscal
year 2012 appropriations for mental health research and services. AAGP
is a professional membership organization dedicated to promoting the
mental health and well-being of older Americans and improving the care
of those with late-life mental disorders. AAGP's membership consists of
geriatric psychiatrists as well as other health professionals who focus
on the mental health problems faced by aging adults. Although we
generally agree with others in the mental health community about the
importance of sustained and adequate Federal funding for mental health
research and treatment, AAGP brings a unique perspective to these
issues because of the elderly patient population served by our members.
A National Health Crisis: Demographic Projections and the Mental
Disorders of Aging
The aging of the baby boomer generation will result in an increase
in the proportion of persons over 65 from 12.7 percent currently to 20
percent in 2030, with the fastest growing segment of the population
consisting of age 85 and older. During the same period, the number of
older adults with major psychiatric illnesses will more than double,
from an estimated 7 million to 15 million individuals, meeting or
exceeding the number of consumers in discrete, younger age groups.
Center for Mental Health Services
It is critical that there be adequate funding for the mental health
initiatives under the jurisdiction of the Center for Mental Health
Services (CMHS) within the Substance Abuse and Mental Health Services
Administration (SAMHSA). While research is of critical importance to a
better future, today's patients must also receive appropriate treatment
for their mental health problems.
Evidence-based Mental Health Outreach and Treatment for the
Elderly
AAGP was pleased that the final budgets for the last 9 years have
included $5 million for evidence-based mental health outreach and
treatment to the elderly, the only federally funded services program
dedicated specifically to the mental healthcare of older adults. AAGP
is concerned that this program was eliminated in the President's fiscal
year 2012 budget proposal. It is critical that SAMHSA and CMHS ensure
that, as they design programs to promote prevention and recovery from
mental illness, the senior citizen cohort not be ignored. AAGP asks the
Committee to restore the funding for this critical program as well as
ensure that all of CMHS's programs assure a life-span approach by
specifically including the older adult population as a targeted
population.
Centers of Excellence for Depressive and Bipolar Disorders
PPACA also included authorization for a new national network of
centers of excellence for depressive and bipolar disorders, which will
enhance the coordination and integration of physical, mental and social
care that are critical to the identification and treatment of
depression and other mental disorders across the lifespan. The work of
these centers will help to disseminate and implement evidence-based
practices in clinical settings throughout the country. AAGP strongly
supports funding for the centers authorized by this legislation and is
disappointed that the Administration has not recommended funding them.
With respect to older adults, these centers would be able to focus on
new models of care that integrate evidenced-based depression care into
real world primary care and home care to improve the outcomes; specific
combinations of medications and talk therapy that successfully treat
depression and prevent relapse in older adults; specific clinical and
biological factors that link depression and risk of Alzheimer's disease
in some older depressed patients; and prevention of depression in older
people at risk. AAGP recommends that these centers be funded at $10
million for fiscal year 2012.
Preparing a Workforce to meet the Mental Health Needs of the Aging
Population
In 2008, the Institute of Medicine (IOM) released a study of the
readiness of the Nation's healthcare workforce to meet the needs of its
aging population. The Re-tooling for an Aging America: Building the
Health Care Workforce called for immediate investments in preparing our
healthcare system to care for older Americans and their families. AAGP
is deeply grateful to this subcommittee and its House counterpart for
providing, in the appropriations bill for fiscal year 2010, funding for
a follow-up study of the current and projected mental and behavioral
healthcare needs for aging Americans. This study, which is now
underway, will complement the 2008 IOM study in providing in-depth
consideration of the mental health needs of geriatric and ethnic
minority populations that were precluded by the broad scope of the
earlier one.
Virtually all healthcare providers need to be fully prepared to
manage the common medical and mental health problems of old age. In
addition, the number of geriatric health specialists, including mental
health providers, needs to be increased both to provide care for those
older adults with the most complex issues and to train the rest of the
workforce in the common medical and mental health problems of old age.
The small numbers of specialists in geriatric mental health, combined
with increases in life expectancy and the growing population of the
Nation's elderly, foretells a crisis in healthcare that will impact
older adults and their families nationwide.
Already, there are programs administered by the Bureau of Health
Professions in the HHS Health Resources and Services Administration
(HRSA) administers that are aimed to help to assure adequate numbers of
healthcare practitioners for the Nation's geriatric population,
especially in underserved areas. These are the only Federal programs
that seek to increase the number of faculty with geriatrics expertise
in a variety of disciplines, and the breadth of the programs has been
strengthened by provisions included in the Patient Protection and
Affordable Care Act (PPACA).
The geriatric health professions program supports these important
initiatives:
--The Geriatric Education Center (GEC) program provides
interdisciplinary training for healthcare professionals in
assessment, chronic disease syndromes, care planning, emergency
preparedness, and cultural competence unique to older
Americans. PPACA authorizes $10.8 million in supplemental
grants for the GEC Program to support training in geriatrics,
chronic care management, and long-term care for faculty in a
broad array of health professions schools, as well as direct
care workers and family caregivers. GECs receiving these grants
are required to develop and include material on depression and
other mental disorders common among older adults, medication
safety issues for older adults, and management of the
psychological and behavioral aspects of dementia in all
appropriate training courses.
--The Geriatric Training for Physicians, Dentists, and Behavioral and
Mental Health Professionals (GTPD Program) provides fellows
with exposure to older adult patients in various levels of
wellness and functioning and from a range of socioeconomic and
racial/ethnic backgrounds.
--The Geriatric Academic Career Awards (GACA) support the academic
career development of geriatric specialists in junior faculty
positions who are committed to teaching geriatrics in
professional schools. PPACA expands the disciplines eligible
for the awards. GACA recipients are required to provide
training in clinical geriatrics, including the training of
interdisciplinary teams of healthcare professionals.
--PPACA authorized a new Geriatric Career Incentive Awards Program in
Title VIII of the Public Health Service Act for grants to
foster great interest among a variety of health professionals
in entering the field of geriatrics, long-term care, and
chronic care management. This program was authorized for $10
million over 3 years.
--A new program, authorized by PPACA at $10 million for 3 years, will
provide advanced training opportunities for direct care workers
in the field of geriatrics, long term-care or chronic care
management.
AAGP strongly supports increased funding for the existing programs,
particularly as the disciplines included have been expanded, and
funding to fully authorized levels for the new programs.
National Institutes of Health (NIH) and National Institute of Mental
Health (NIMH)
With the graying of the population, mental disorders of aging
represent a growing crisis that will require a greater investment in
research to understand age-related brain disorders and to develop new
approaches to prevention and treatment. Even in the years in which
funding was increased for NIH and the NIMH, these increases did not
always translate into comparable increases in funding that specifically
address problems of older adults. For instance, according to figures
provided by NIMH, NIMH total aging research amounts decreased from
$106,090,000 in 2002 to $85,164,000 in 2006 (dollars in thousands:
$106,090 in 2002, $100,055 in 2003, $97,418 in 2004, $91,686 in 2005,
$85,164 in 2006).
The critical disparity between federally funded research on mental
health and aging and the projected mental health needs of older adults
is continuing. If the mental health research budget for older adults is
not substantially increased immediately, progress to reduce mental
illness among the growing elderly population will be severely
compromised. While many different types of mental and behavioral
disorders occur in late life, they are not an inevitable part of the
aging process, and continued and expanded research holds the promise of
improving the mental health and quality of life for older Americans.
This trend must be immediately reversed to ensure that our next
generation of elders is able to access effective treatment for mental
illness. Federal funding of research must be broad-based and should
include basic, translational, clinical, and health services research on
mental disorders in late life.
AAGP believes that it is critical that NIH begin to invest
increased funding in future evidence-based treatments for our Nation's
elders. Annual increases of funds targeted for geriatric mental health
research at NIH should be used to: (1) identify the causes of age-
related brain and mental disorders to prevent mental disorders before
they devastate lives; (2) speed the search for effective treatments and
efficient methods of treatment delivery; and (3) improve the quality of
life for older adults with mental disorders.
Participation of Older Adults in Clinical Trials
Federal approval for most new drugs is based on research
demonstrating safety and efficacy in young and middle-aged adults.
These studies typically exclude people who are old, who have more than
one health problem, or who take multiple medications. As the population
ages, that is the very profile of many people who seek treatment. Thus,
there is little available scientific information on the safety of drugs
approved by the Food and Drug Administration (FDA) in substantial
numbers of older adults who are likely to take those drugs. Pivotal
regulatory trials never address the special efficacy and safety
concerns that arise specifically in the care of the Nation's mentally
ill elderly. This is a critical public health obligation of the
Nation's health agencies. Just as the FDA has begun to require
inclusion of children in appropriate studies, the agency should work
closely with the geriatric research community, healthcare consumers,
pharmaceutical manufacturers, and other stakeholders to develop
innovative, fair mechanisms to encourage the inclusion of older adults
in clinical trials. Clinical research must also include elders from
diverse ethnic and cultural groups. In addition, AAGP urges that
Federal funds be made available each year for support of clinical
trials involving older adults.
Study on NIH Funding for Mental Disorders among Older
Adults
As little emphasis has been placed on the development of new
treatments for geriatric mental disorders, AAGP encourages NIH to
promote the development of new medications specifically targeted at
brain-based mental disorders of the elderly. AAGP urges this Committee
to request a GAO study on spending by NIH on conditions and illnesses
related to the mental health of older individuals. NIH is already
working to enhance cooperative activities among NIH Institutes and
Centers that support research on the nervous system. A GAO study of the
work being done by these institutes in areas that predominately involve
older adults could provide crucial insights into possible new areas of
cooperative research, which in turn will lead to advances in prevention
and treatment for these devastating illnesses.
Conclusion
AAGP recommends:
--Increased funding for the geriatric health professions education
programs under Title VII of the Public Health Service Act and
full funding for new programs authorized by the PPACA;
--Funding to support clinical trials involving older adults;
--A GAO study on spending by NIH on conditions and illnesses related
to the mental health of older individuals;
--$5 million in funding to continue evidence-based geriatric mental
health outreach and treatment programs at CMHS;
--$10 million in funding for Centers of Excellence for Depressive and
Bipolar Disorders.
______
Prepared Statement of the American Association of Colleges of Nursing
The American Association of Colleges of Nursing (AACN) respectfully
submits this testimony highlighting funding priorities for nursing
education and research programs in fiscal year 2012. AACN represents
667 schools of nursing with baccalaureate and graduate nursing programs
that educate over 337,000 students and employ more than 15,000 full-
time faculty members. These institutions educate approximately half of
our Nation's Registered Nurses (RNs) and all of the Advanced Practice
Registered Nurses (APRNs), nurse faculty, and researchers.
The programs outlined in this testimony play an integral role in
continuing to shape, advance, and promote a professional nursing
workforce to meet the needs of America's patients. An emphasis on two
key components of the profession--education and research--will be
necessary to sustain and enhance the quality of nursing care in the
United States. The release of the landmark Institute of Medicine's
(IOM) report, The Future of Nursing: Leading Change, Advancing Health,
outlines specific priorities for the profession and identifies expanded
Federal support to meet the goals of preparing a more highly educated
nursing workforce, removing barriers so all nurses can practice to the
full scope of their education, and enabling nurses to serve as equal
partners in the redesign of the healthcare system.
The ongoing reform of our healthcare system will continue to
increase access to care, requiring a surge in the number of nurses and
other health professionals. RNs and APRNs will be in high demand given
the needs of an aging population, the increased complexity of care, and
significant growth in the number of patients with chronic diseases.
More specifically, the U.S. Bureau of Labor Statistics projects a
demand on our delivery system that will necessitate the creation of
581,000 new positions by 2018, a 22 percent increase in the nursing
workforce. Without increased attention to the challenges facing nursing
education, schools of nursing will be unable to meet this demand,
further jeopardizing access to quality care.
The current supply and demand of nurses demonstrates two distinct
challenges. First, due to the present and looming need for healthcare
by American consumers, the supply of nurses is not growing at a pace
that will adequately meet long-term projections, including the demand
for primary care provided by APRNs. This issue is further compounded by
the number of nurses who will retire or leave the profession in the
near future, ultimately reducing the nursing workforce. Currently, over
1 million of the total 2.6 million practicing nurses are over the age
of 50. More striking yet, over 275,000 RNs are over the age of 60
according to the 2008 National Sample Survey of Registered Nurses.
Second, the supply of nurses nationwide is stretched thin due, in
large part, to capacity barriers in schools of nursing. According to
AACN, 67,563 qualified applications were turned away from baccalaureate
and graduate nursing programs in 2010, primarily due to budget
constraints which impact the insufficient number of faculty, clinical
sites, classroom space, and clinical preceptors. As the ability of most
States to support the needs of higher education has decreased, Federal
support for nursing education has become even more critical. National
reform goals cannot be met without an adequate number of nurses to
provide the cost-effective and quality care associated with the nursing
discipline.
nursing workforce development programs: a proven solution
For nearly 50 years, the Title VIII Nursing Workforce Development
Programs (42 U.S.C. 296 et seq.) have supported hundreds of thousands
of nurses and nursing students. Between fiscal year 2006 and 2009, the
Title VIII programs supported over 347,000 nurses and nursing students
as well as numerous academic nursing institutions and healthcare
facilities. As the largest source of dedicated funding for nursing, the
Title VIII programs award grants to nursing education programs, as well
as provide direct support through loans, scholarships, traineeships,
and programmatic grants. The programs also favor institutions that
educate nurses for practice in rural and medically underserved
communities and help to develop a more diverse nursing workforce to
meet the cultural healthcare needs of our Nation's population.
Additionally, programs funded through Title VIII contribute to the
promotion of academic progression, a major goal highlighted in the
IOM's Future of Nursing report.
Of specific interest to AACN, the Title VIII programs support
future nurse faculty, a significant barrier to addressing the nursing
care needs in the United States. The nurse faculty shortage has grown
critical as the national vacancy rate is 6.9 percent for schools
offering baccalaureate and graduate nursing programs according to an
AACN Survey on Vacant Faculty Positions for Academic Year 2010-2011. Of
those schools reporting vacancies, the number of positions left
unfilled was 803. Regionally, schools of nursing are struggling to
recruit and hire faculty. Compared to the North Atlantic (9.2 percent),
Southern (9.5 percent), and Mid-Western (9.2 percent) regions of the
country, the West Coast (11.7 percent) has the highest faculty vacancy
rate.
Title VIII Effectiveness
The Nursing Workforce Development Programs are effective and meet
their authorized mission. AACN's 2010-2011 Title VIII Student Recipient
Survey included responses from 1,459 students who noted that these
programs played a critical role in funding their nursing education,
which will ultimately help them to achieve future career goals. The
students responding to the Title VIII survey have career aspirations
that meet the direct needs of the healthcare system and the profession.
Nearly one-third (32.8 percent) of the respondents reported that their
career goal is to become a nurse practitioner. Given the demand for
primary care providers, the Title VIII funds are helping to support the
next generation of these essential practitioners. Moreover, the nurse
faculty shortage continues to inhibit the ability of nursing schools to
increase student capacity. Of the students who responded to the survey,
an additional 33.2 percent stated their ultimate career goal was to
become nurse faculty. Providing support for Title VIII is the key to
help schools expand student capacity, fill vacant nursing positions,
and, in turn, improve healthcare quality.
Demand for Title VIII
While millions of Americans are struggling during this economic
downturn and thousands of students need loans to finance their
education, Federal support is necessary. Nursing students depend on
Federal loans like Title VIII to pay for their education. AACN's Title
VIII Student Recipient Survey also indicated that 73 percent of the
undergraduate and 62.6 percent of the master's students responding to
the question regarding funding for nursing education noted that they
will pay for their education through Federal loans. The average loan
amount that students reported they would take (private/Federal) to
support their education was $19,336 for undergraduate students and
$55,698 for master's students. These students also noted that the total
amount they will pay for their education is $32,307 for undergraduates
and $64,734 for master's. Given this information, it is interesting to
note that 65.6 percent of the students reported that the amount of
support they received from Title VIII was $3,000 or less in one fiscal
year.
Over the last 47 years, Congress has used the Title VIII
authorities as a mechanism to address past nursing shortages. When the
need for nurses was great, such as in the 1970s, appropriations were
higher. Congress provided $160.61 million to the Title VIII programs in
1973. Adjusting for inflation, $160.61 million in 1973 dollars would be
equivalent to $841.371 million in 2011 dollars. The fiscal year 2011
investment of $242.387 million represents a 70 percent reduction in
buying power for the Title VIII programs, at a time when our Nation
faces historic demands on our nursing workforce.
AACN respectfully requests $313.075 million for the Nursing
Workforce Development Programs authorized under Title VIII of the
Public Health Service Act in fiscal year 2012 as recommended in the
President's budget proposal.
NURSING RESEARCH: SUPPORTING HEALTH PROMOTION AND DISEASE PREVENTION
The National Institute of Nursing Research (NINR) is one of the 27
Institutes and Centers at the National Institutes of Health (NIH). As
the Nation's nucleus for nursing science, NINR funds research that
establishes the scientific basis for health promotion, disease
prevention, and high quality nursing care to individuals, families, and
populations. Often working collaboratively with physicians and other
researchers, nurse scientists are vital in setting the national
research agenda. NINR focuses on four strategic areas which include
promoting health and preventing disease, eliminating health
disparities, improving quality of life, and setting directions for end-
of-life research.
NINR's fiscal year 2011 funding level of $144.381 million is
approximately 0.47 percent of the overall $30 billion NIH budget.
Spending for nursing research is a modest amount relative to the
allocations for other health science institutes and for major disease
category funding. For NINR to adequately continue and further its
mission, the institute must receive additional funding. Cuts in funding
have impeded the institute from supporting larger comprehensive studies
needed to advance nursing science and improve the quality of patient
care. With increased appropriations for NINR, more comprehensive,
complex, and longitudinal studies could be funded in the critical areas
of their mission while maintaining their portfolio of current goals,
projects, and priorities of the institute.
Additionally, considering that NINR presently allocates 6 percent
of its budget to training that helps develop the pool of nurse
researchers, increased funding would support NINR's efforts to prepare
faculty researchers desperately needed to educate new nurses. AACN
respectfully requests $163 million for the National Institute of
Nursing Research in fiscal year 2012.
NURSE-LED PRACTICE MODELS: INVESTING IN NURSE-MANAGED HEALTH CLINICS
The Affordable Care Act amended Sec. 330 of the Public Health
Service Act, allowing Nurse- Managed Health Clinics (NMHCs) to apply
for grant funds to help cover the costs of operating these unique
community-based settings. NMHCs are nurse-practice arrangements and are
managed by APRNs who provide primary care or wellness services to
underserved or vulnerable populations through clinics located in places
like public housing, churches, Native American reservations, rural
communities, senior citizen centers, elementary schools, and
storefronts. Each of these clinics is associated with a school,
college, university or department of nursing, federally qualified
health center, or independent nonprofit health or social services
agency, and serves as safety net of providers for vulnerable
populations. Moreover, NMHCs play a valuable role as teaching and
practice sites for nursing students. AACN respectfully requests $20
million for the Nurse-Managed Health Clinics authorized under Title III
of the Public Health Service Act in fiscal year 2012 as recommended in
the President's budget proposal.
CAPACITY GRANTS: SOLUTIONS TO GROW ENROLLMENT
According to AACN's latest enrollment and graduation survey, the
major barriers to increasing student capacity in nursing schools are
insufficient numbers of faculty, admission seats, clinical sites,
classroom space, and clinical preceptors, as well as budget
constraints. The Capacity for Nursing Students and Faculty Program, a
section of the Higher Education Opportunity Act of 2008, offers
capitation grants (formula grants based on the number of students
enrolled/or matriculated) to nursing schools allowing them to increase
the number of students. Schools of nursing continue to face budget cuts
at the State level, and capacity grants are a proven method for meeting
the needs of nursing education. AACN respectfully requests $25 million
for this program in fiscal year 2012.
CONCLUSION
AACN acknowledges the fiscal challenges facing this Subcommittee
and Congress, but would be remiss in not highlighting the benefits of
these programs. Title VIII has a long and successful record of
providing dedicated support for the nursing workforce. The National
Institute of Nursing Research invests in developing the scientific
basis for quality nursing care. Nurse-Managed Health Clinics provide
services to the underserved and training and practice settings for
nursing students. The Capacity for Nursing Students and Faculty Program
would allow schools to increase student capacity.
To be effective in meeting the critical goals outlined in the IOM's
report, The Future of Nursing: Leading Change, Advancing Health, and
the larger health reform goals of the Nation, these programs must
receive additional funding. AACN respectfully requests $313.075 million
for Title VIII programs, $163 million for NINR, $20 million for Nurse-
Managed Health Clinics, and $25 million for the Capacity for Nursing
Students and Faculty Program in fiscal year 2012. Additional funding
for these programs will assist schools of nursing to expand their
educational and research programs, educate more nurse faculty, increase
the number of practicing RNs, and ultimately improve the patient care
provided in our healthcare system.
______
Prepared Statement of the American Association of Colleges of
Osteopathic Medicine
On behalf of the American Association of Colleges of Osteopathic
Medicine (AACOM), I am pleased to submit this testimony in support of
increased funding in fiscal year 2012 for programs at the Health
Resources Services Administration (HRSA), the National Institutes of
Health (NIH), and the Agency for Healthcare Research and Quality
(AHRQ). AACOM represents the administrations, faculty, and students of
the Nation's 26 colleges of osteopathic medicine at 34 locations in 26
States. Today, more than 19,000 students are enrolled in osteopathic
medical schools. Nearly one in five U.S. medical students is training
to be an osteopathic physician.
Title VII
The health professions education programs, authorized under Title
VII of the Public Health Service Act and administered through HRSA,
support the training and education of health practitioners to enhance
the supply, diversity, and distribution of the healthcare workforce,
acting as an essential part of the healthcare safety net and filling
the gaps in the supply of health professionals not met by traditional
market forces. Title VII and Title VIII nurse education programs are
the only Federal programs designed to train clinicians in
interdisciplinary settings to meet the needs of special and underserved
populations, as well as increase minority representation in the
healthcare workforce.
According to HRSA, an additional 33,000 health practitioners are
needed to alleviate existing health professional shortages. Combined
with faculty shortages across health professions disciplines, racial
and ethnic disparities in healthcare, a growing, aging population and
the anticipated demand for access to care, these needs strain an
already fragile healthcare system. While AACOM appreciates the
investments that have been made in these programs, we recommend
increasing funding to $449.4 million, the same funding level requested
by the President, in fiscal year 2012 for the Title VII programs.
Investment in these programs, including the Primary Care Training and
Enhancement Program, the Health Careers Opportunity Program, and the
Centers of Excellence, is necessary to address the primary care
workforce shortage. Strengthening the workforce has been recognized as
a national priority, and the investment in these programs recommended
by AACOM will help meet the demand for a well-trained, diverse
workforce that this country will witness as a result of healthcare
reform.
Teaching Health Centers
The Teaching Health Center Graduate Medical Education Program
(THCGME) is the first of its kind to shift graduate medical education
(GME) training to community-based care settings that emphasize primary
care and prevention. It is uniquely positioned to provide much needed
primary care training in underserved populations. However, because the
program is the first of its kind, most community-based settings do not
have existing infrastructure to provide this training. AACOM strongly
supports the President's budget request of $10 million to fund the THC
Development Grants. This funding would allow potential THC training
sites to develop the infrastructure needed to administer residency
training programs.
National Health Service Corps
Approximately 50 million Americans live in communities with a
shortage of health professionals, lacking adequate access to primary
care. Through scholarships and loan repayment, the National Health
Service Corps (NHSC) supports the recruitment and retention of primary
care clinicians to practice in underserved communities. At the close of
fiscal year 2010, the NHSC provided a network of 7,500 primary
healthcare professionals in 10,000 sites in underserved communities.
However, this still fell approximately 20,000 practitioners short of
fulfilling the need for primary care, dental and mental health
practitioners in Health Professional Shortage Areas (HPSAs). Growth in
HRSA's Community Health Center Program must be complemented with
increases in the recruitment and retention of primary care clinicians
to ensure adequate staffing, which the NHSC provides. AACOM supports
the President's budget request of $418 million for this program. This
includes $295 million from the Affordable Care Act (ACA) fund for the
NHSC and $24.695 million in appropriated dollars for field placements
and $98.7 million in appropriated dollars for recruitment.
National Institutes of Health
Research funded by the NIH leads to important medical discoveries
regarding the causes, treatments, and cures for common and rare
diseases, as well as disease prevention. These efforts improve our
Nation's health and save lives. To maintain a robust research agenda,
further investment will be needed. AACOM recommends $32 billion in
fiscal year 2012 for the NIH. While the need is significantly greater,
approximately $35.0 billion, anything less than the President's request
will result in a reduction in real dollars dedicated to research.
With today's increasingly demanding and evolving medical
curriculum, there is a critical need for more research geared toward
evidence-based osteopathic medicine. AACOM believes that it is vitally
important to maintain and increase funding for biomedical and clinical
research in a variety of areas related to osteopathic principles and
practice, including osteopathic manipulative medicine and comparative
effectiveness. In this regard, AACOM supports the President's budget
request of $131.002 million for NIH's National Center for Complementary
and Alternative Medicine to continue fulfilling this essential research
role.
Agency for Healthcare Research and Quality
AHRQ supports research to improve healthcare quality, reduce costs,
advance patient safety, decrease medical errors, and broaden access to
essential services. AHRQ plays an important role in producing the
evidence base needed to improve our Nation's health and healthcare. The
incremental increases for AHRQ's Patient Centered Health Research
Program in recent years, as well as the funding provided to AHRQ in the
ARRA, will help AHRQ generate more of this research and expand the
infrastructure needed to increase capacity to produce this evidence.
More investment is needed, however, to fulfill AHRQ's mission and
broader research agenda, especially research in patient safety and
prevention and care management research. AACOM recommends $405 million
in fiscal year 2012 for AHRQ. This investment will preserve AHRQ's
current programs while helping to restore its critical healthcare
safety, quality, and efficiency initiatives.
AACOM is grateful for the opportunity to submit its views and looks
forward to continuing to work with the Subcommittee on these important
matters.
______
Prepared Statement of the American Association of Colleges of Pharmacy
AACP and its member colleges and schools of pharmacy appreciate the
continued support of the U.S. House of Representatives Appropriations
Subcommittee on Labor, Health and Human Services, and Education. Our
Nation's 124 accredited colleges and schools of pharmacy are engaged in
a wide-range of programs supported by grants and funding administered
through the agencies of the Department of Health and Human Services
(HHS) and the Department of Education. We also understand the difficult
task you face annually in your deliberations to do the most good for
the Nation and remain fiscally responsible to the same. AACP
respectfully offers the following recommendations for your
consideration as you undertake your deliberations.
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES SUPPORTED PROGRAMS AT
COLLEGES AND SCHOOLS OF PHARMACY
Agency for Healthcare Research and Quality (AHRQ)
AACP supports the Friends of AHRQ recommendation of $405 million
for AHRQ programs in fiscal year 2012.
Pharmacy faculty are strong partners with the Agency for Healthcare
Research and Quality (AHRQ).
--Vincent J. Willey, Associate Professor at the University of the
Sciences in Philadelphia, was appointed to the Comparative
Effectiveness Research Pharmacy Workgroup.
--AHRQ Effective Healthcare programs including the Center for
Education and Research on Therapeutics (CERTs) and the
Developing Evidence to Inform Decisions about Effectiveness (
DEcIDE) support pharmacy faculty researchers focused on
improving the effectiveness of healthcare services.
--Researcher faculty at The University of Arizona College of
Pharmacy's Center for Health Outcomes and PharmacoEconomic
Research, support the Arizona CERT and its mission to improve
therapeutic outcomes and reduce adverse events caused by drug
interactions and drugs that prolong the QT interval, especially
those affecting women. Researchers determined that certain drug
combinations increased the risk of death. Published research
from this CERT includes the 2010 Women's Health Research:
Progress, Pitfalls and Promise, for the Institute of Medicine
and a comparison study on the U.S. Department of Veterans
Affairs drug-drug interactions compared to two standard
compendia. #U18 HS17001
--Almut G. Winterstein, University of Florida, has received a 2-year
$482,000 award from the Agency for Healthcare Research and
Quality for ``Comparative Safety and Effectiveness of
Stimulants in Medicaid Youth with ADHD.'' #5R01HS018506-02
--Sean D. Sullivan, University of Washington, received a $2.45
million grant from AHRQ to implement the multidisciplinary
Mentored Clinical Scientist Comparative Effectiveness Research
Career Development (K12) Program in collaboration with research
partners at Group Health Research Institute, the Fred
Hutchinson Cancer Research Center, and the Veterans'
Administration Health Services Research and Development Center
of Excellence. #1K12HS019482-01
--Daniel C. Malone, University of Arizona, received a 3-year grant
from AHRQ for $1.25 million, to evaluate awareness of CER
guides by pharmacists and physicians and identify critical
skills needed to use these reviews to support and encourage
safe and effective prescribing of medications. #1R18HS019220-01
Centers for Disease Control and Prevention (CDC)
AACP supports the CDC Coalition recommendation of $7.7 billion for
CDC core programs in fiscal year 2012 and the Friends of NCHS
recommendation of $162 million for the National Center for Health
Statistics.
The educational outcomes of a pharmacist's education include those
related to public health. When in community-based positions,
pharmacists are frequently providers of first contact. The opportunity
to identify potential public health threats through regular interaction
with patients provides public health agencies such as the CDC with on-
the-ground epidemiologists. Pharmacy faculty are engaged in CDC-
supported research in areas such as immunization delivery, integration
of pharmacogenetics in the pharmacy curriculum and inclusion of
pharmacists in emergency preparedness. Information from the National
Center for Health Statistics (NCHS) is essential for faculty engaged in
health services research and for the professional education of the
pharmacist.
--Katie J. Suda, faculty member at the University of Tennessee, was
supported by CDC funding to conduct a national analysis of
outpatient anti-infective prescribing patterns. She also
prepared a continuing education program in partnership with the
CDC entitled, ``Weighing in on Antibiotic Resistance: Community
Pharmacists Tip the Scale,'' featured on the CDC Web site:
http://www.cdc.gov/getsmart/specific-groups/hcp/ce-course.html.
The program details the CDC's Get Smart program, focused on
decreasing the amount of unnecessary antibiotics in the
community.
--Grace Kuo, Associate Professor of Clinical Pharmacy at the
University of California San Diego, founded
PharmGenEdTM, an evidence-based pharmacogenomics
education program designed for pharmacists and physicians,
pharmacy and medical students, and other healthcare
professionals and is supported by funding from CDC.
#IU38GD000070
Health Resources and Services Administration (HRSA)
AACP supports the Friends of HRSA recommendation of $7.65 billion
for fiscal year 2012.
HRSA is a Federal agency with a wide-range of policy and service
components. Faculty at colleges and schools of pharmacy are integral to
the success of many of these. Colleges and schools of pharmacy are the
administrative units for interprofessional and community-based linkages
programs including geriatric education centers and area health
education centers. Pharmacy faculty research issues related to rural
health delivery. Student pharmacists benefit from diversity program
funding including Scholarships for Disadvantaged Students.
Office of Pharmacy Affairs
AACP recommends a program funding of $5 million for fiscal year
2012 for the Office of Pharmacy Affairs.
AACP member institutions are actively engaged in Office of Pharmacy
Affairs (OPA) efforts to improve the quality of care for patients in
federally qualified health centers and entities eligible to participate
in the 340B drug discount program. The success of the HRSA Patient
Safety and Clinical Pharmacy Collaborative is a direct result of past
OPA actions linking colleges and schools of pharmacy with federally
qualified health centers. The result of these links has been the
establishment of medical homes that improve health outcomes for
underserved and disadvantaged patients through the integration of
clinical pharmacy services.
Office of Telehealth Advancement
Technology is an important component for improving healthcare
quality and maintaining or increasing access to care. Colleges and
schools of pharmacy utilize technology to increase access to care,
improve care quality and to increase the reach of education to student
and practicing pharmacists.
--Keri H. Naglosky, Marcia M. Worley, Timothy P. Stratton and Randall
D. Seifert University of Minnesota, received a $63,000 grant
for their study, ``Pilot Study to Determine the Effectiveness
of Pharmacist Provided MTM Using Face-to-Face and TeleMTM in
the Treatment of Long-Haul Drivers with Hypertension Department
of Transportation Classifications Stage 1, 2 and 3.''
--Leigh Ann Ross and Sarah Fontenot, faculty at the University of
Mississippi, work with The Delta Health Alliance on many
projects including its HRSA telehealth grant and as members of
the HRSA Patient Safety Collaborative, receiving the Clinical
Pharmacy Services Improvement Award in 2010. Five Delta
hospitals have telemedicine capabilities as a result of its
funding and 86,083 individuals received medical or health
education services during the 2009-2010 fiscal year.
#H2AIT16626
Poison Control Centers
HRSA grant funding supports the management of 10 of the 57 poison
control centers by pharmacy faculty.
--In 2010, the Maryland Poison Center, headed by Bruce Anderson,
faculty at the University of Maryland, answered 36,000 human
exposure calls, 2,000 animal exposures and 25,000 requests
for poison or drug information and over 70 percent of the human
exposure calls were managed on site, avoiding treatment at a
healthcare facility. This year, Paul Starr, also at the
University of Maryland, was recognized for his 20 years as a
certified specialist in poison information. #H4BHS15526
Bureau of Health Professions (BHPr)
AACP supports the Health Professions and Nursing Education
Coalition (HPNEC) recommendation of $762.5 million for Title VII and
VIII programs in fiscal year 2012.
AACP member institutions are active participants in BHPr programs.
Two colleges of pharmacy are current grantees in the Centers of
Excellence program (Xavier University School of Pharmacy). This program
focuses on increasing the number of underserved individuals attending
health professions institutions. Colleges and schools of pharmacy are
also part of Title VII interprofessional and community-based linkages
programs including Geriatric Education Centers and Area Health
Education Centers. These programs are essential for creating the
educational approaches necessary for the Institute of Medicine's
recommendations of improving quality through team-based, patient-
centered care and serve as valuable experiential education sites for
student pharmacists.
--Gayle A. Hudgins, faculty at the University of Montana, was awarded
an ARRA supplement of $132,446 from HRSA, Bureau of Health
Professions, for equipment to enhance training for health
professionals.
Food and Drug Administration (FDA)
AACP recommends a funding level of $3.7 billion for FDA programs in
fiscal year 2012.
The FDA sees the colleges and schools of pharmacy as essential
partners in assuring the public has access to a healthcare professional
well versed in the science of safety. Pharmacy faculty partner with the
FDA to improve the drug manufacturing process through the National
Institute for Pharmaceutical Technology and Education (NIPTE) and
increase the science-base for decisions regarding drug and device
safety and effectiveness.
--Dianne M. Cappelletty, Associate Professor at The University of
Toledo, was recently appointed to serve on the advisory
committee to the Division of Anti-Infective and Ophthalmology
Products.
--James E. Polli, University of Maryland, received $1,099,990 from
the FDA for ``Pharmacokinetic Studies of Epileptic Drugs:
Evaluation of Brand & Generic Antiepileptic Drug Products in
Patients.''
National Institutes of Health (NIH)
AACP supports the Ad Hoc Group for Medical Research recommendation
of $35 billion for fiscal year 2012.
Pharmacy faculty are supported in their research by nearly every
institute at the NIH. The NIH-supported research at AACP member
institutions spans theresearch spectrum from the creation of new
knowledge through the translation of that new knowledge to providers
and patients. In 2010, pharmacy faculty researchers received more than
$358 million in grant support from the NIH. AACP member institutions
are concerned, as are other health professions education organizations,
of the need to increase the number of biomedical researchers.
--At the University of California, San Francisco, Kathleen M.
Giacomini and co-lead Deanna L. Kroetz received $15.1 million
in funding over the next 5 years from the NIH for research into
the genetics behind membrane transporters and a branch project
from that research that will focus on the genetic factors that
determine responses to the anti-diabetic drug, metformin in
African American patients with type 2 diabetes. #2U19GM061390-
11
--Alice M. Clark and Ameeta K. Agarwal, University of Mississippi,
received $388,221 from the National Institute of Allergy and
Infectious Diseases to study New Drugs for Opportunistic
Infections. #5R01AI027094-21
--Eugene D. Morse, the University at Buffalo, received two grants:
$952,000 in funding for, ``Clinical Pharmacology Quality
Assurance and Quality Control'' funded by the National
Institute of Allergies and Infectious Diseases/Division of AIDS
and $2.3 Million for, ``Clinical Pharmacology Lab from NIH to
Promote HIV Research in Africa.'' #272200800019C-4-0-1
--Jordan K. Zjawiony and Charles L. Burandt, the University of North
Carolina, received $71,500 from the NIH to study Chemistry and
Pharmacology of Newly Emerging Psychoactive Plants-Year 2.
#5R03DA023491-02
U.S. DEPARTMENT OF EDUCATION SUPPORTED PROGRAMS AT COLLEGES AND SCHOOLS
OF PHARMACY
AACP supports the Student Aid Alliance's recommendations for:
--Pell Grant maximum be maintained at $5,550;
--Gaining Early Awareness and Readiness for Undergraduate Programs
(GEAR UP) should be funded at $333 million; and
--Maintaining the in-school interest subsidy for graduate program
loans.
AACP recommends a funding level of $160 million for the Fund for
the Improvement of Post Secondary Education (FIPSE).
The Department of Education supports the education of healthcare
professionals by:
--assuring access to education through student financial aid
programs;
--supporting educational research allows faculty to determine
improvements in educational approaches; and
--maintaining the oversight of higher education through the approval
of accrediting agencies.
AACP actively supports increased funding for undergraduate student
financial assistance programs. Admission to into the pharmacy
professional degree program requires at least 2 years of undergraduate
preparation. Student financial assistance programs are essential to
assuring colleges and schools of pharmacy are accessible to qualified
students. Likewise, financial assistance programs that support graduate
education are an important component meeting our Nation's need for
scientists and educators.
______
Prepared Statement of the American Association of Immunologists
The American Association of Immunologists (AAI), a not-for-profit
professional association representing more than 7,000 of the world's
leading experts on the immune system, appreciates having this
opportunity to submit testimony regarding fiscal year 2012
appropriations for the National Institutes of Health (NIH). The vast
majority of AAI members, whose crucially important discoveries help to
prevent, treat and cure disease, depends on NIH funding to support
their work.\1\
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\1\ AAI members work in academia, government, and industry. Many
members receive grants from the National Institute of Allergy and
Infectious Diseases, the National Cancer Institute, the National
Institute on Aging, and the National Institute of Arthritis and
Musculoskeletal and Skin Diseases, as well as other NIH Institutes and
Centers.
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For more than 50 years, NIH has been envy of the world and has been
instrumental in promoting science, better health, and discovery. Unlike
many Federal agencies, NIH distributes most of its funding to
scientists working in all 50 States. In fact, about 80 percent of the
$31.2 billion NIH budget is awarded to scientists working at research
institutions throughout the United States, making NIH funding the
foundation of our Nation's biomedical research infrastructure and a key
factor in local and national economic growth.\2\ In addition to its
positive economic impact on a community, NIH funding supports highly
skilled jobs that focus on improving human health.\3\ NIH funding also
helps train the next generation of inventors and innovators, crucial to
the nation's future job creation and pipeline of new therapeutics.
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\2\ NIH funding supports ``almost 50,000 competitive grants to more
than 325,000 researchers at over 3,000 universities, medical schools,
and other research institutions in every State and around the world.''
See http://www.nih.gov/about/budget.htm (3/9/11). According to NIH
Director Francis Collins M.D., Ph.D., ``every dollar that NIH gives out
in a grant returns over $2 in investments in terms of economic goods
and services that are produced within just 1 year.'' ``Francis S.
Collins,'' April 26, 2010, http://pubs.acs.org/cen/coverstory/88/
8817cover.html.
\3\ ``[E]very grant that NIH gives creates seven high-quality,
high-paying jobs that sustain American leadership in science.''
``Francis S. Collins,'' April 26,2010, http://pubs.acs.org/cen/
coverstory/88/8817cover.html.
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The role of the immune system
The immune system's job is to protect its human or animal host from
a wide range of infectious and chronic diseases. When the immune system
works, the host remains healthy. But many infectious diseases,
including influenza, HIV/AIDS, malaria, tuberculosis, salmonella, and
the common cold, challenge and sometimes overcome the defenses mounted
by the immune system. And many chronic diseases, including cancer,
diabetes, multiple sclerosis, rheumatoid arthritis, asthma,
inflammatory bowel disease, and lupus, are either caused by--or due in
large part to--an overactive (autoimmune) or underactive immune
response.\4\ Advances in immunological research have already yielded
progress in preventing, diagnosing, and treating some of these
diseases, but further progress depends on increased knowledge in the
field of immunology.
---------------------------------------------------------------------------
\4\ The immune system works by recognizing and attacking bacteria
and viruses inside the body and by controlling the growth of tumor
cells. A healthy immune system can protect its human or animal host
from illness or disease either entirely--by destroying the virus,
bacterium, or tumor cell--or partially, resulting in a less serious
illness. It is also responsible for the rejection response following
transplantation of organs or bone marrow. The immune system can also
malfunction, causing the body to attack itself, resulting in an
``autoimmune'' disease, such as Type 1 diabetes, multiple sclerosis,
lupus or rheumatoid arthritis.
---------------------------------------------------------------------------
A young and evolving discipline,\5\ immunology has already answered
many key questions and is now needed to explore urgent new challenges
to community and global health, including understanding the human and
animal immune response to: (1) pathogens that threaten to become the
next pandemic, (2) man-made and natural infectious organisms that are
potential agents of bioterrorism (including plague, smallpox, and
anthrax),\6\ (3) environmental threats, and (4) cancer. While
researchers and public health professionals must respond quickly to
these emergent threats, AAI believes that the best preparation is to
support consistent, ongoing research rather than to ``ramp up''
research in times of emergency.\7\
---------------------------------------------------------------------------
\5\ 5 Although the first vaccine (against smallpox) was developed
in 1798, most of our basic understanding of the immune system has
developed in the last 50 years, and the pace of discovery is rapidly
increasing.
\6\ To best protect against bioterrorism, scientists should focus
on basic research, including working to understand the immune response,
identifying new and potentially modified pathogens, and developing
tools (including new and more potent vaccines) to protect against these
pathogens.
\7\ For example, to best protect against a pandemic, scientists
should focus on basic research to combat seasonal flu, including
building capacity, pursuing new production methods, and seeking
optimized flu vaccines and delivery methods.
---------------------------------------------------------------------------
Recent advances in immunological research
Immunological research has led to unprecedented medical advances in
recent years, including new treatments for lupus and malignant
melanoma, and new vaccines against influenza and cervical cancer.
The value of vaccination against disease and the importance of
continued research and evaluation cannot be overstated. Recent
expansion of the influenza vaccine to all U.S. children ``may induce
herd immunity against influenza for older adults and has the potential
to be more beneficial to older adults than the existing policy of
preventing influenza by vaccinating older adults themselves.'' \8\ A
recent study has shown the efficacy of vaccinating older adults,
whether healthy or with chronic diseases, against shingles, a painful
blistering skin rash caused by the varicella-zoster virus, the virus
that causes chickenpox.\9\ Most recently, a new vaccine against
rotavirus has greatly reduced hospital admissions in the United States
in babies with infectious diarrhea and markedly decreased deaths in
infants in the developing world.\10\ Thousands of children will not die
due to the results of immunological and infectious disease research
originally funded by the NIH on this killer virus.
---------------------------------------------------------------------------
\8\ Cohen SA, Chui K, Naumova E, ``Influenza Vaccination in Young
Children Reduces Influenza-associated Hospitalizations in Older Adults,
2002-2006,'' Journal of the American Geriatrics Society, 2011;
59(2):327-332.
\9\ Tseng HF, Smith N, Harpaz R, Bialek SR, Sy LS, Jacobsen SJ,
``Herpes zoster vaccine in older adults and the risk of subsequent
herpes zoster disease,'' Journal of the American Medical Association,
2011 Jan 12; 305(2):160-166.
\10\ Esposito DH, Tate JE, Kang G, Parashar UD, ``Projected impact
and cost-effectiveness of a rotavirus vaccination program in India,
2008,'' Clinical Infectious Diseases, 2011; 52 (2):171-177. Gagneur A,
Nowak E, Lemaitre T, Segura JF, Delaperriere N, Abalea L, Poulhazan E,
Jossens A, Auzanneau L, Tran A, Payan C, Jay N, de Parscau L, Oger E,
``Impact of rotavirus vaccination on hospitalizations for rotavirus
diarrhea: The IVANHOE study,'' Vaccine, 2011 March 25, doi:10.1016/
j.vaccine.2011.03.035.
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Recently, immunologists have advanced the understanding of the
exquisitely precise regulation of the immune system and are very
hopeful that this understanding will allow for therapeutic manipulation
of the immune system. This important discovery about immune-system
regulation could lead to new approaches for the prevention and
treatment of numerous autoimmune diseases, including lupus (systemic
lupus erythematosus),\11\ a serious chronic autoimmune disease
affecting about 1.5 million Americans. Finally, new monoclonal
antibodies (highly specific immune molecules) that block the immune
response of people with autoimmune diseases (in which one's immune
system attacks one's own body) show enormous promise in improving these
debilitating diseases.
---------------------------------------------------------------------------
\11\ Kim HJ, Verbinnen B, Tang X, Linrong L, Cantor H, ``Inhibition
of follicular T-helper cells by CD8+ regulatory T cells is essential
for self tolerance,'' Nature, 2010 July 22; 467: 328-322.
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Sustaining NIH Funding in a Difficult Fiscal Climate
AAI greatly appreciates the strong historical support of this
subcommittee for biomedical research, from doubling the NIH budget
(fiscal year 1999 to fiscal year 2003), to passing the Appropriations
Acts for fiscal year 2009 and 2010, to including in the American
Recovery and Reinvestment Act of 2009 (``ARRA'') a $10.4 billion
supplemental appropriation for NIH. As a result of this generous
support, NIH has been able to fund many excellent, innovative projects
with great promise for advancing human health, and to invest in the
Nation's research infrastructure. AAI--and the entire biomedical
research community--are deeply grateful for this support and for the
subcommittee's strong bipartisan commitment to advancing medical
research. And yet, AAI comes to you this year deeply concerned about
efforts to cut, rather than invest in, the NIH budget. Imminent
advances may not come to fruition if the fiscal year 2012
appropriations level is unable to support NIH's current functional
capacity ($34.4 billion), made possible in large part by this
subcommittee's prior support. AAI remains concerned that investment in
biomedical research continues unfettered by our global competitors,
while our challenged budget makes it difficult for us to attract the
best and brightest to these crucial scientific fields. The AAI funding
recommendation for fiscal year 2012 is premised on these concerns.
NIH Funding for Fiscal Year 2012
AAI greatly appreciates the President's proposed increase for NIH
for fiscal year 2012 ($31.98 billion, or 4 percent increase over the
regular fiscal year 2011 appropriations level). More is required,
however, for NIH to be able to support existing research projects and
fund a reasonable number of excellent new ones. AAI therefore urges the
subcommittee to provide NIH with a fiscal year 2012 budget of $35
billion to enable NIH to maintain its current functional capacity and
to provide a small funding boost for important new research. Sustained
funding, particularly in this challenging fiscal climate, would not
only stabilize ongoing research projects and the overall research
enterprise, but also inspire confidence in the system among many of our
brightest young students who are considering (but due to such limited
grant funding, are fearful to begin) careers in biomedical research.
NIH priorities for Fiscal Year 2012
AAI believes strongly that the engine for biomedical innovation and
discovery is individual investigator-initiated research. Researchers
working in laboratories around the country, with their scientific
collaborators around the world, are the best source of scientific
advancement and progress. ``Top-down'' science, where Government
directives force the research in specified directions, is less likely
to achieve the desired goals than funding the best, most promising,
ripest grant applications.
AAI strongly supports the President's request for a $436 million
increase in funding for individual research project grants (RPGs) that
fund individual scientists. Unfortunately, this increase will only
support approximately 43 additional RPGs. AAI notes that the
President's budget includes $100 million to establish the Cures
Acceleration Network (CAN). AAI recommends a significantly smaller
appropriation for the first year of this program, with the remainder
going to support additional RPGs.
AAI supports the President's request for $300 million for the
Global Fund to Fight AIDS, Tuberculosis, and Malaria--infectious
diseases which devastate people and communities around the world.
AAI supports the President's proposed 4 percent increase for the
National Research Service Awards, a long-needed training stipend
increase for young scientists who are the next generation of research
leaders.
AAI urges this subcommittee to do all it can to reduce the time-
consuming, distracting, and unnecessary administrative burden that too
often accompanies the receipt of Government funds.
AAI recommends strongly against any legislative effort to determine
the size and number of NIH grants. Such a decision should be a
scientific one made by NIH.
AAI supports the President's request for $1.538 billion for NIH
Research, Management, and Services (RM&S) to fund the management,
monitoring, and oversight of all research activities. Only through
adequate funding of this account will NIH be able to supervise and
oversee its large and complex portfolio.
The NIH Public Access Policy
AAI requests that the subcommittee require NIH to publicly report
on the current and historical cost of the NIH Public Access Policy
(``Policy''), and receive the response of private scientific publishers
to this information. AAI continues to believe that the Policy
duplicates publications and services which are already provided cost-
effectively and well by the private sector, including not-for-profit
scientific societies. AAI and other private sector publishers already
publish--and make publicly available--thousands of scientific journals
with millions of articles that report cutting-edge research funded by
NIH and other entities. AAI urges that the subcommittee require NIH to
partner with, rather than compete with, private publishers to enhance
public access while addressing publishers' key concerns, including
respecting copyright law and ensuring journals' continued ability to
provide quality, independent peer review of NIH-funded research.
Conclusion
AAI thanks the subcommittee for its strong support for biomedical
research, the NIH, and the biomedical researchers who devote their
lives to scientific discovery and the prevention, treatment, and cure
of disease.
______
Prepared Statement of the American Association of Nurse Anesthetists
FISCAL YEAR 2012 APPROPRIATIONS REQUEST SUMMARY
----------------------------------------------------------------------------------------------------------------
Fiscal year--
--------------------------------------- AANA fiscal
2012 year 2012
2010 actual 2011 budget budget request
----------------------------------------------------------------------------------------------------------------
HHS/HRSA/BHPr Title VIII Advanced Education Nursing, Nurse \1\ $3,500, ( \2\ ) ( \2\ ) \3\ $4,000,
Anesthetist Education Reserve.............................. 000 000
Total for Advanced Education Nursing, from Title VIII....... 64,440,000 64,440,000 104,438,000 104,438,000
Title VIII HRSA BHPr Nursing Education Programs............. 243,872,000 243,872,000 313,075,000 313,075,000
CDC/Division of Healthcare Quality and Promotion............ ........... ........... ( \4\ ) ( \4\ )
----------------------------------------------------------------------------------------------------------------
\1\ Awards amounted to approximately.
\2\ Grant allocations not specified.
\3\ For nurse anesthesia education.
\4\ Maintain level funding.
The American Association of Nurse Anesthetists (AANA) is the
professional association for the 44,000 Certified Registered Nurse
Anesthetists (CRNAs) and student nurse anesthetists practicing today,
representing over 90 percent of the nurse anesthetists in the United
States. Today, CRNAs deliver approximately 32 million anesthetics to
patients each year in the United States. CRNA services include
administering the anesthetic, monitoring the patient's vital signs,
staying with the patient throughout the surgery, and providing acute
and chronic pain management services. CRNAs provide anesthesia for a
wide variety of surgical cases and in some States are the sole
anesthesia providers in 100 percent of rural hospitals, affording these
medical facilities obstetrical, surgical, and trauma stabilization, and
pain management capabilities. CRNAs work in every setting in which
anesthesia is delivered, including hospital surgical suites and
obstetrical delivery rooms, ambulatory surgical centers (ASCs), pain
management units and the offices of dentists, podiatrists and plastic
surgeons. Nurse anesthetists are experienced and highly trained
anesthesia professionals whose record of patient safety in the field of
anesthesia was bolstered by the Institute of Medicine report in 2000,
which found that anesthesia is 50 times safer than in the 1980s. (Kohn
L, Corrigan J, Donaldson M, ed. To Err is Human. Institute of Medicine,
National Academy Press, Washington DC, 2000.) Nurse anesthetists
continue to set for themselves the most rigorous continuing education
and re-certification requirements in the field of anesthesia. Relative
anesthesia patient safety outcomes are comparable among nurse
anesthetists and anesthesiologists, with a recent Health Affairs
article, ``No Harm Found When Nurse Anesthetists Work without
Supervision by Physicians'' finding that adverse outcomes were no more
prevalent in States that opted out of the Medicare physician
supervision requirement of nurse anesthetists than those States that
didn't opt-out (Dulisse B, Cromwell J. No Harm Found When Nurse
Anesthetists Work Without Supervision By Physicians. Health Aff.
2010;29(8):1469-1475).
In addition, a study published in Nursing Research indicates that
obstetrical anesthesia, whether provided by CRNAs or anesthesiologists,
is extremely safe, and there is no difference in safety between
hospitals that use only CRNAs compared with those that use only
anesthesiologists. (Simonson, Daniel C et al. Anesthesia Staffing and
Anesthetic Complications During Cesarean Delivery: A Retrospective
Analysis. Nursing Research, Vol. 56, No. 1, pp. 9-17. January/February
2007). In addition, a recent AANA workforce study showed that CRNAs and
anesthesiologists are substitutes in the production of surgeries.
Through continual improvements in research, education, and practice,
nurse anesthetists are vigilant in our efforts to ensure patient
safety.
CRNAs provide the lion's share of anesthesia care required by our
U.S. Armed Forces through active duty and the reserves. For decades,
CRNAs have staffed ships, remote U.S. military bases, and forward
surgical teams without physician anesthesiologist support. In addition,
CRNAs predominate in rural and medically underserved areas, and where
more Medicare patients live.
Importance of Title VIII Nurse Anesthesia Education Funding
The nurse anesthesia profession's chief request of the Subcommittee
is for $4 million to be reserved for nurse anesthesia education and
$104.438 million for advanced education nursing from the Title VIII
program. We feel that this funding request is well justified, as we
know that more baby boomers retiring will not only reduce our nurse
workforce from retirements but will increase the demand from an aging
population requiring care. The Title VIII program is an effective means
to help address the nurse anesthesia workforce demand.
Increasing funding for advanced education nursing from $64.44
million in fiscal year 2010 to $104.438 million is necessary to meet
the continuing demand for nursing faculty and other advanced education
nursing services throughout the United Staes. The program provides for
competitive grants that help enhance advanced nursing education and
practice and traineeships for individuals in advanced nursing education
programs. This funding is critical to meet the nursing workforce needs
of Americans who require healthcare, particularly as we see more
patients enter the system with health reform. More APRNs will be needed
to fill the gap to ensure access to care. In addition, this funding
provides a two-fold benefit for the nurse workforce. It not only seeks
to increase the number of providers in rural and underserved America
but also prepares providers at the master's and doctoral levels,
increasing the number of clinicians who are eligible to serve as
faculty.
There continues to be high demand for CRNA workforce in clinical
and educational settings. The supply of clinical providers has
increased in recent years, stimulated by increases in the number of
CRNAs trained. Between 2000-2009, the number of nurse anesthesia
educational program graduates doubled, with the Council on
Certification of Nurse Anesthetists (CCNA) reporting 1,075 graduates in
2000 and 2,375 graduates in 2010. This growth is leveling off somewhat,
but is expected to continue. However, even though the number of
graduates has doubled in 8 years, the demand for nurse anesthetists
continues to rise as the population ages, the number of clinical sites
requiring anesthesia services grows, and CRNA retirements increase.
The problem is not that our 111 accredited programs of nurse
anesthesia are failing to attract qualified applicants. It is that they
have to turn them away by the hundreds. The capacity of nurse
anesthesia educational programs to educate qualified applicants is
limited by the number of faculty, the number and characteristics of
clinical practice educational sites, and other factors. A qualified
applicant to a CRNA program is a bachelor's educated registered nurse
who has spent at least 1 year serving in an acute care healthcare
practice environment.
Recognizing the important role nurse anesthetists play in providing
quality healthcare, the AANA has been working with the 111 accredited
nurse anesthesia educational programs to increase the number of
qualified graduates. In addition, the AANA has worked with nursing and
allied health deans to develop new CRNA programs. To truly meet the
nurse anesthesia workforce challenge, the capacity and number of CRNA
schools must continue to grow. With the help of competitively awarded
grants supported by Title VIII funding, the nurse anesthesia profession
is making significant progress, expanding both the number of clinical
practice sites and the number of graduates.
The AANA is pleased to report that this progress is extremely cost-
effective from the standpoint of Federal funding. Anesthesia can be
provided by nurse anesthetists, physician anesthesiologists, or by
CRNAs and anesthesiologists working together. As mentioned earlier, the
Health Affairs study by Dulisse and Cromwell indicates the safety of
CRNA care. Another study published recently in Nursing Economic$
indicates that costs of educating and training a CRNA from
undergraduate education through graduate education is roughly 15
percent of the cost of educating and training an anesthesiologist
(Hogan, PF, Seifert RF, Moore CS, Simonson BE, Cost Effectiveness
Analysis of Anesthesia Providers, Nurs Econ. 2010;28(3): 150-169.) This
study also found that among anesthesia delivery models, CRNAs acting
independently provide anesthesia services at the lowest economic cost;
costs for this model are 25 percent less than the second lowest cost
model in which an anesthesiologist supervises six CRNAs. Nurse
anesthesia education represents a significant educational cost-benefit
for supporting CRNA educational programs with Federal dollars vs.
supporting other, more costly, models of anesthesia education.
To further demonstrate the effectiveness of the Title VIII
investment in nurse anesthesia education, the AANA surveyed its CRNA
program directors to gauge the impact of the Title VIII funding. Of the
eleven schools that had reported receiving competitive Title VIII Nurse
Education and Practice Grants funding from 1998 to 2003, the programs
indicated an average increase of at least 15 CRNAs graduated per year.
They also reported on average more than doubling their number of
graduates. Moreover, they reported producing additional CRNAs that went
to serve in rural or medically underserved areas.
We believe the Subcommittee should allocate $4 million for nurse
anesthesia education for several reasons. First, as this testimony has
documented, the funding is cost-effective and needed. Second, this
particular funding meets a distinct need not met elsewhere; nurse
anesthesia for rural and medically underserved America is not affected
by increases in the budget for the National Health Service Corps and
community health centers, since those initiatives are for delivering
primary and not surgical healthcare. Third, this funding meets an
overall objective to increase access to quality healthcare in medically
underserved America.
Title VIII Funding for Strengthening the Nursing Workforce
The AANA joins The Nursing Community and the Americans for Nursing
Shortage Relief (ANSR) Alliance in support of the Subcommittee
providing a total of $313.075 million in fiscal year 2012 for nursing
shortage relief through Title VIII. AANA asks that of the $313.075
million, $104.438 million go to Advanced Education Nursing and $4
million go to nurse anesthesia education to help increase clinicians in
underserved communities and those eligible to serve as faculty. The
AANA appreciates the support for nurse education funding in fiscal year
2010 and past fiscal years from this Subcommittee and from the
Congress.
In the interest of patients past and present, particularly those in
rural and medically underserved parts of this country, we ask Congress
to invest in CRNA and nursing educational funding programs and to
provide these programs the sustained increases required to help ensure
Americans get the healthcare that they need and deserve. Quality
anesthesia care provided by CRNAs saves lives, promotes quality of
life, and makes fiscal sense. This Federal support for Title VIII and
advanced education nurses will improve patient access to quality
services and strengthen the Nation's healthcare delivery system.
Safe Injection Practices
As a leader in patient safety, the AANA has been playing a vigorous
role in the development and projects of the Safe Injection Practices
Coalition, intended to reduce and eventually eliminate the incidence of
healthcare facility acquired infections. Provider education and
awareness, detection, tracking and response are all extremely important
to preventing healthcare-associated infections. In the interest of
promoting safe injection practice and reducing the incidence of
healthcare facility acquired infections, we recommend the Committee
maintain its level of funding for CDC's Division of Healthcare Quality
and Promotion so they can address outbreaks and promote innovative ways
to adhere to injection safety and infection control guidelines. We also
hope the committee will support the CDC's efforts around provider
education and patient awareness activities, as this issue transcends
provider type and it's important to educate all types of providers and
patients alike. In light of the recent healthcare-associated
transmission of blood-borne pathogens in California, North Carolina,
Florida, Colorado, and Nevada, the CDC needs resources to use the
knowledge they have gained on detection and be able to develop new
strategies to prevent healthcare associated transmission of blood borne
pathogens.
______
Prepared Statement of the American Congress of Obstetricians and
Gynecologists
The American Congress of Obstetricians and Gynecologists,
representing 54,000 physicians and partners in women's healthcare, is
pleased to offer this statement to the Senate Committee on
Appropriations, Subcommittee on Labor, Health and Human Services, and
Education. We thank Chairman Harkin, and the entire Subcommittee for
the opportunity to provide comments on important programs to women's
health. Today, the United States lags behind other nations in healthy
births, yet remains high in birth costs. ACOG's Making Obstetrics and
Maternity Safer (MOMS) Initiative seeks to improve maternal outcomes
through more research and better data, and we urge you to make this a
top priority in fiscal year 2012.
Research is critically needed to understand why our maternal and
infant mortality rate remains comparatively high. Having better data
collection methods and comprehensive maternal mortality reviews has
shown maternal mortality rates in some States, such as California, to
be higher than previously thought. States without these resources are
likely underreporting maternal and infant deaths and complications from
childbirth. Without accurate data, the full range of causes of these
deaths remains unknown. Effective research based on comprehensive data
is a key MOMS element to developing and implementing evidence-based
interventions.
The President's budget for fiscal year 2012 takes a positive first
step toward this goal, including a $1 billion increase for NIH, and
ACOG requests the Subcommittee build on these increases to sustain the
investment for women's health. Please note that given the current
fiscal climate, our requests are more conservative this year and do not
reflect the actual need in the health community. ACOG asks for a 1.7
percent increase over fiscal year 2010 to the NICHD within NIH to
$1.352 billion, a 2.3 percent increase for HRSA to $7.65 billion, a 19
percent increase for CDC to $7.7 billion, and a 2 percent increase for
AHRQ to $405 million.
Funding of research and programs in the following areas are vital
to the MOMS Initiative:
Maternal Mortality Reviews at HHS
National data on maternal mortality is inconsistent and incomplete
due to the lack of standardized reporting definitions and mechanisms.
To capture the accurate number of maternal deaths and plan effective
interventions, maternal mortality should be addressed through multiple,
complementary strategies. ACOG recommends that HHS fund States in
implementing maternal mortality reviews that would allow them to
conduct regular reviews of all deaths within the State to identify
causes, factors in the communities, and strategies to address the
issues. Combined with adoption of the recommended birth and death
certificates in all States and territories, CDC could then collect
uniform data to calculate an accurate national maternal mortality rate.
Results of maternal mortality reviews will inform research needed to
identify evidence based interventions addressing causes and factors of
maternal mortality and morbidity.
ACOG urges Congress to provide $10 million to Health and Human
Services to assist States in setting up maternal mortality reviews.
ACOG also urges Congress to provide $50,000 to NIH to hold a workshop
to identify definitions for severe maternal morbidity and $100,000 to
HHS to develop a research plan to identify and monitor severe maternal
morbidity.
Maternal/Child Health Research at the NIH
The Eunice Kennedy Shriver National Institute of Child Health and
Human Development (NICHD) conducts the majority of women's health
research. Despite the NIH's critical advancements, reduced funding
levels have made it difficult for research to continue.
ACOG supports a 1.7 percent increase in funds over fiscal year 2010
to $1.352 billion for the NICHD. A modest increase, these funds will
assist the following research areas critical to the MOMS Initiative:
Reducing the Prevalence of Premature Births.--There is a known link
between pre-term birth and infant mortality, and women of color are at
increased risk for delivering pre-term. NICHD is helping our Nation
understand how adverse conditions and health disparities increase the
risks of premature birth in high-risk racial groups, and how to reduce
these risks. Prematurity rates have increased almost 35 percent since
1981, accounting for 12.5 percent of all births, yet the causes are
unknown in 25 percent of cases. Preterm births cost the Nation $26
billion annually, $51,600 for every infant born prematurely. Direct
healthcare costs to employers for a premature baby average $41,610, 15
times higher than the $2,830 for a healthy, full-term delivery.
Additional research is critically needed to understand how we can
drive down our prematurity rates and NICHD conducts the majority of
this research. For example, a 2003 NICHD study showed that progesterone
supplementation reduces preterm birth in a select group of women,
paving the way for its widespread clinical use. Today, around 139,000
(3.3 percent) women are candidates for this therapy. Among these women,
22 percent, or about 30,500, are likely to have a recurrent preterm
birth without this treatment. With treatment, about one-third, or
10,000, of these preterm births can be prevented. The prevention of all
10,000 preterm births would result in direct medical cost savings of
$334 million and total medical cost savings of $519 million. However,
further studies are needed to determine if progesterone therapy can be
designed to help prevent preterm delivery in other ways, including
optimal preparation, dosage, and route of administration. The high cost
of prematurity and past successful research at NICH highlights the need
to sustain investments to reduce the rate of prematurity.
ACOG supports the Surgeon General's effort to make the prevention
of pre-term birth a national public health priority, and urges Congress
to allocate $1 million to NICHD to create a Trans-disciplinary Research
Center on Prematurity to help streamline efforts to reduce pre-term
births.
Obesity Research, Treatment and Prevention.--Obese pregnant women
are at higher risk for poor maternal and neonatal outcomes. Additional
research and interventions are needed to address the increased risk for
poor outcomes in obese women receiving infertility treatment, the
increased incidence of birth defects and stillbirths in obese pregnant
women, ways to optimize outcomes in obese women who become pregnant
after bariatric surgery, and the increased future risk of childhood
obesity in their offspring.
ACOG is grateful to the NIH for making obesity a priority and
initiating trans-disciplinary approaches to combat obesity. The recent
release of the Strategic Plan for NIH Obesity Research offers some
innovative and promising directions for obesity research, and sustained
funding is critical to implement the plan.
Training Programs.--The average investigator is in his/her forties
before receiving their first NIH grant, a huge dis-incentive for
students considering bio-medical research as a career. Complicating
matters, there is a gap between the number of women's reproductive
health researchers being trained and the need for such research. The
NICHD-coordinated Women's Reproductive Health Research (WRHR) Career
Development program seeks to increase the number of ob-gyns conducting
scientific research in women's health in order to address this gap. To
date 170 WRHR Scholars have received faculty positions, and 7 new and
competing WRHR sites were added in 2010.
Additional funding to add new sites can help sustain this low-
dollar, large impact training program while at the same time shoring up
the women's reproductive research workforce.
Maternal/Child Health Programs at CDC
CDC funds programs that are critical to providing resources to
mothers and children in need. Where NIH conducts research to identify
causes of pre-term birth, CDC funds programs that provide resources to
mothers to help prevent pre-term birth, and help identify factors
contributing to pre-term birth and poor maternal outcomes.
ACOG supports a 19 percent increase in funds over fiscal year 2010
to $7.7 billion to increase CDC's ability to bring prevention,
treatment and interventions to more women and children in need, and to
help enact some of the important provisions within healthcare reform.
This funding will help the following programs important to the MOMS
Initiative:
Electronic Birth Records and Death Records, National Center for
Health Statistics (NCHS), National Vital Statistics System (NVSS).--
NCHS is the Nation's principal health statistics agency; it collects,
analyzes and reports on data critical to all aspects of our healthcare
system. NCHS collects State data needed to monitor maternal and infant
health, such as use of prenatal care, and smoking during pregnancy.
This data allows investigators to monitor maternal and child health
objectives, and develop efficient prevention and treatment strategies.
Uniform consistent data from birth and death records is critical to
conducting research and directing public programs to combat maternal
and infant death. Only 75 percent of States and territories use the
2003 recommended birth certificates and 65 percent have adopted the
2003 recommended death certificate. The President recently issued a
Memorandum to all departments and agencies encouraging expanded data
collection on maternal mortality by using the 2003 U.S. standard birth
certificate and updating to electronic systems, noting that until all
States adopt the same data standards it will be difficult to formulate
national maternal mortality ratios.
ACOG urges Congress to allocate $11 million for States to modernize
their birth and death records systems to the 2003 recommended
guidelines. It is a low cost that will yield enormous gains in CDC's
ability to collect accurate data nationally and better direct medical
research and best practice for physicians.
Safe Motherhood/Infant Health.--Two to three women a day die from
delivery complications. The Safe Motherhood Program supports CDC's work
to identify and gather information on pregnancy-related deaths; collect
and provide information about women's health and health behaviors
around pregnancy; and expand the use of guidelines on preconception
care into everyday practice and healthcare policy.
Safe Motherhood also tracks infant morbidity and mortality
associated with pre-term birth. ACOG is concerned with recent trends
particularly among rates of late pre-term births. Increased funding is
needed for CDC to improve national data systems to track pre-term birth
rates and expand epidemiological research that focuses especially on
the causes and prevention of preterm birth and births at 37-38 weeks
gestation.
ACOG urges Congress to include a 23.7 percent increase in funds to
$55.4 million for Safe Motherhood, consistent with the President's
fiscal year 2011 budget.
Maternal/Child Health Programs at HRSA
HRSA delivers critical resources to communities to improve the
health of mothers and children. ACOG urges a 2.3 percent increase in
funds over fiscal year 2010 to $7.65 billion to increase the scope of
HRSA programs, ultimately bringing more resources to more mothers and
children. This funding will help expand the following programs
important to the MOMS Initiative:
Fetal Infant Mortality Reviews, Healthy Start Program.--The U.S.
infant mortality rate is again on the rise and is particularly severe
among minority and low-income women. The infant mortality rate among
African-American women has been increasing since 2001 and reached 14.2
deaths per 1,000 births in 2004. There also has been a startling rise
in infant mortality in the South in the past few years.
The Healthy Start Program through HRSA promotes community-based
programs that focus on infant mortality and racial disparities in
perinatal outcomes. These programs are encouraged to use the Fetal and
Infant Mortality Review (FIMR) which brings together ob-gyn experts and
local health departments to help solve problems related to infant
mortality. Today more than 220 local programs in 42 States find FIMR a
powerful tool to help solve infant mortality.
ACOG urges Congress to include $.5 million for Healthy Start
Programs to include FIMR.
Maternal Child Health Block Grant (MCH)
The MCH is the only Federal program that exclusively focuses on
improving the health of mothers and children. State and territorial
health agencies and their partners use MCH Block Grant funds to reduce
infant mortality, deliver services to children and youth with special
healthcare needs, support comprehensive prenatal and postnatal care,
screen newborns for genetic and hereditary health conditions, deliver
childhood immunizations, and prevent childhood injuries.
These early healthcare services help keep women and children
healthy, eliminating the need for later costly care. For example, every
$1 spent on preconception care programs for women with diabetes can
reduce health costs by up to $5.19 by preventing costly complications
in both mothers and babies. Studies also suggest that every $1 spent on
smoking cessation counseling for pregnant women saves $3 in neonatal
intensive care costs.
ACOG urges Congress to increase funding for MCH $700 million, a
5.74 percent increase over fiscal year 2010.
Title X Family Planning
The Title X program provides contraceptive services, immunizations
and other preventive healthcare, including screenings for STDs, HIV,
breast cancer, cervical cancer, high blood pressure, and anemia to more
than 5 million low-income men and women at more than 4,500 service
delivery sites. These programs improve maternal and child health
outcomes, prevent unintended pregnancies, and reduce the rate of
abortions. Every $1 spent on family planning results in a $4 savings to
Medicaid. Services provided at Title X clinics accounted for $3.4
billion in healthcare savings in 2008 alone.
ACOG supports a 3.15 percent increase in funds for Title X to $327
million, consistent with the President's budget.
Again, we would like to thank the Committee for its consideration
of funding for programs to improve women's health, and we urge you to
consider our MOMS Initiative in fiscal year 2012.
______
Prepared Statement of the American Dental Education Association
The American Dental Education Association (ADEA) \1\ respectfully
submits this statement for the record and for your consideration as you
begin to prioritize fiscal year 2012 appropriation requests. ADEA urges
you to preserve the funding and fundamental structure of Federal
programs that provide prevention of dental disease, access to oral
healthcare for underserved populations, and access to careers in
dentistry and oral health services.
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\1\ The American Dental Education Association represents all 61
U.S. dental schools, 700 dental residency training programs, nearly 600
allied dental programs, as well as more than 12,000 faculty who educate
and train the nearly 50,000 students and residents attending these
institutions. It is at these academic dental institutions that future
practitioners and researchers gain their knowledge, where the majority
of dental research is conducted, and where significant dental care is
provided.
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As you know, ADEA's membership is comprised of all 61 dental
schools in the United States. These academic dental institutions make
substantial contributions to the oral health and well-being of the
Nation. Services are provided through campus and offsite dental clinics
where students and faculty provide patient care as dental homes to the
uninsured and underserved populations. However, in order to continue to
provide these services, there must be adequate funding. Therefore, it
is critical that funding for oral healthcare, delivery of services, and
research be preserved in order to ensure the level of care that is
necessary for all segments of the population.
ADEA's requests build upon funding from the American Economic
Recovery and Reinvestment Act (ARRA), the Labor, Health and Human
Services and Education fiscal year 2010 Appropriations, and the
Continuing Resolution for fiscal year 2011. We are asking the committee
to maintain adequate funding for the dental programs in Title VII of
the Public Health Service Act; the National Institutes of Health and
the National Institute of Dental and Craniofacial Research; the Dental
Health Improvement Act; Part F of the Ryan White HIV/AIDS Treatment and
Modernization Act: the Dental Reimbursement Program and the Community-
Based Dental Partnerships Program; and State-Based Oral Health Programs
at the Centers for Disease Control and Prevention. These programs
enhance and sustain State oral health departments, fund public health
programs proven to prevent oral disease, fund research to eradicate
dental disease, and fund programs to develop an adequate workforce of
dentists with advanced training to serve all segments of the population
including children, the elderly, and those suffering from chronic and
life-threatening diseases.
$30 million for Primary Oral Healthcare Workforce Improvements (HHS)
The dental programs in Title VII, Section 748 of the Public Health
Service Act that provide training in general, pediatric, and public
health dentistry and dental hygiene are critical. Support for these
programs will help to ensure there will be an adequate oral healthcare
workforce to care for the American public. The funding supports
predoctoral oral health education and postdoctoral pediatric, general,
and public health dentistry training. The investment that Title VII
makes not only helps to educate dentists and dental hygienists, but
also expands access to care for underserved communities.
Additionally, Section 748 addresses the shortage of professors in
dental schools with the dental faculty loan repayment program and
faculty development courses for those who teach pediatric, general, or
public health dentistry or dental hygiene. There are currently almost
400 open faculty positions in dental schools. These two programs
provide schools with assistance in recruiting and retaining faculty.
$35 billion for the National Institutes of Health, including $468
million for the National Institute of Dental and Craniofacial
Research (NIDCR)
Discoveries stemming from dental research have reduced the burden
of oral diseases, led to better oral health for millions of Americans,
and uncovered important associations between oral and systemic health.
Dental researchers are poised to make breakthroughs that can result in
dramatic progress in medicine and health, such as repairing natural
form and function to faces destroyed by disease, accident, or war
injuries; diagnosing systemic disease from saliva instead of blood
samples; and deciphering the complex interactions and causes of oral
health disparities involving social, economic, cultural, environmental,
racial, ethnic, and biological factors. Dental research is the
underpinning of the profession of dentistry. With grants from NIDCR,
dental researchers in academic dental institutions have built a base of
scientific and clinical knowledge that has been used to enhance the
quality of the nation's oral health and overall health.
Also, dental scientists are putting science to work for the benefit
of the healthcare system through translational research, comparative
effectiveness research, health information technology, health research
economics, and further research on health disparities. NIDCR continues
to make disparities a priority with continued funding for the Centers
for Research to Reduce Disparities in Oral Health at Boston University,
the University of California, San Francisco, and the University of
Colorado at Denver, the University of Florida, and the University of
Washington.
$20 million for the Dental Health Improvement Act (DHIA)
Section 340G of the Public Health Service Act created the Grants to
States to Support Oral Health Workforce Activities as authorized by the
Dental Health Improvement Act. This program supports the development of
innovative dental workforce programs specific to the State's dental
workforce needs and increases access to dental care for underserved
populations.
In 2010, Congress provided at total of $17.5 million to assist
States in developing flexible dental workforce programs tailored to
meet States' individual workforce needs. Grants are being used to
support a variety of initiatives including, but not limited to: loan
repayment programs to recruit culturally and linguistically competent
dentists to work in underserved communities; rotating residents and
students in rural areas; recruiting dental school faculty; training
pediatricians and family medicine physicians to provide oral health
services (screening exams, risk assessments, fluoride varnish
application, parental counseling, and referral of high-risk patients to
dentists); and supporting tele-dentistry. We expect fiscal year 2011
appropriations to continue to fund the fiscal year 2010 awarded grants,
many of which are 3-year projects.
$19 million for Part F of the Ryan White HIV/AIDS Treatment and
Modernization Act: Dental Reimbursement Program (DRP) and the
Community-Based Dental Partnerships Program
Patients with compromised immune systems are more prone to oral
infections like periodontal disease and tooth decay. By providing
reimbursement to dental schools and schools of dental hygiene, the
Dental Reimbursement Program (DRP) provides access to quality dental
care for people living with HIV/AIDS while simultaneously providing
educational and training opportunities to dental residents, dental
students, and dental hygiene students who deliver the care. DRP is a
cost-effective Federal/institutional partnership that provides partial
reimbursement to academic dental institutions for costs incurred in
providing dental care to people living with HIV/AIDS. Congress,
recognizing that dental care is a ``core medical service'' needed by
HIV patients provided $13.6 million to fund Part F in 2010.
$107 million for Diversity and Student Aid
$24 million for Centers of Excellence (COE)
$60 million for Scholarships for Disadvantaged Students (SDS)
$22 million for Health Careers Opportunity Program (HCOP)
$1.2 million for Faculty Loan Repayment Program (FLRP)
Title VII Diversity and Student Aid programs play a critical role
in helping to diversify the health profession's student body and
thereby the healthcare workforce. For the last several years, these
programs have not enjoyed adequate funding to sustain the progress that
is necessary to meet the challenges of an increasingly diverse U.S.
population.
$25 million for Oral Health Programs at the Centers for Disease Control
and Prevention (CDC)
The CDC Oral Health Program expands the coverage of effective
prevention programs. The program increases the basic capacity of State
oral health programs to accurately assess the needs of the State,
organize and evaluate prevention programs, develop coalitions, address
oral health in state health plans, and effectively allocate resources
to the programs. This strong public health response is needed to meet
the challenges of oral disease affecting children, and vulnerable
populations.
As the oral health programs at the CDC are so important, we have
serious concerns about the proposal to downgrade the status of the
Division of Oral Health (DOH) at the CDC to a branch. We request that
you do everything you can to prevent this move.
Thank you for your consideration of this request. ADEA looks
forward to working with you to ensure the continuation of congressional
support for these critical programs. Please feel free to use us a
resource on any issue affecting the oral healthcare of the nation.
If you should have any questions regarding the aforementioned,
please contact Deborah Darcy, ADEA Director of Congressional Affairs at
(202) 289-7201 x 163.
______
Prepared Statement of the American Dental Hygienists' Association
On behalf of the American Dental Hygienists' Association (ADHA),
thank you for the opportunity to submit testimony regarding
appropriations for fiscal year 2012. ADHA appreciates the
Subcommittee's past support of programs that seek to improve the oral
health of Americans and to bolster the oral health workforce. Oral
health is a part of total health and authorized oral healthcare
programs require appropriations support in order to increase the
accessibility of oral health services, particularly for the
underserved.
ADHA is the largest national organization representing the
professional interests of more than 152,000 licensed dental hygienists
across the country. Dental hygienists are primary care providers of
oral health services and are licensed in each of the 50 States.
Hygienists are committed to improving the Nation's oral health, a
fundamental part of overall health and general well-being. In order to
become licensed as a dental hygienist, an individual must graduate from
an accredited dental hygiene education program and successfully
complete a national written and a State or regional clinical
examination.
In the past decade, the link between oral health and total health
has become more apparent and the significant disparities in access to
oral healthcare services have been well documented. At the State and
local level, policymakers and consumer advocates have been pioneering
innovations to extend the reach of the oral healthcare delivery system
and improve oral health infrastructure. At this time, when tens of
millions of Americans struggle to obtain the oral healthcare required
to remain healthy, Congress has a great opportunity to support oral
health prevention, infrastructure and workforce efforts that will make
care more accessible and cost-effective.
ADHA urges full funding of all authorized oral health programs and
describes some of the key oral health programs below:
Title VII Program Grants to Expand and Educate the Dental Workforce--
Fund at a level of $25 million in fiscal year 2012
A number of existing grant programs offered under Title VII support
health professions education programs, students, and faculty. ADHA is
pleased that dental hygienists are now recognized as primary care
providers of oral health services and are included as eligible to apply
for several grants offered under the ``General, Pediatric, and Public
Health Dentistry'' grants.
With millions more Americans eligible for dental coverage in coming
years, it is critical that the oral health workforce is bolstered.
Dental and dental hygiene education programs currently struggle with
significant shortages in faculty and there is a dearth of providers
pursuing careers in public health dentistry and pediatric dentistry.
Securing appropriations to expand the Title VII grant offerings to
additional dental hygienists and dentists will provide much needed
support to programs, faculty, and students in the future.
ADHA recommends funding at a level of $25 million for fiscal year
2012.
Alternative Dental Health Care Provider Demonstration Project Grants--
Fund at a level of $30 million in fiscal year 2012
States have increasingly been pioneering new dental delivery models
to extend access to oral healthcare services to those currently unable
to access needed care. The Alternative Dental Health Care Provider
Demonstration Project grants support State-level efforts to better
utilize the existing oral health workforce as well as develop new
provider models.
A number of dental hygiene-based models are listed as eligible for
the grants, including advanced practice hygienists, public health
hygienists, and independent dental hygienists.
Grants could also be awarded to dental therapist models, programs
where physicians/other medical providers deliver basic dental services
and other models deemed appropriate by the Secretary of Health and
Human Services. Funding would also allow HRSA to fulfill its statutory
requirement to contract with the Institute of Medicine to conduct a
study of the demonstration projects.
Currently, more than 30 States have statutes and rules that allow
dental hygienists to work in community-based settings (like public
health clinics, schools, and nursing homes) to provide oral health
services without the presence or direct supervision of a dentist. These
models extend the reach of dental professionals beyond the private
dental office.
The American Dental Education Association supports funding of this
program. The PEW Charitable Trusts Children's Dental Campaign also
supports funding of this program. Indeed, more than 60 organizations
have called for funding this important program. Without the appropriate
supply, diversity and distribution of the oral health workforce, the
current oral health access crisis will only be exacerbated.
ADHA recommends funding at a level of $30 million for fiscal year
2012 to support these vital demonstration projects.
Oral Health Prevention and Education Campaign--Fund at a level of $5
million in fiscal year 2012
A targeted national campaign led by the Centers for Disease Control
to educate the public, particularly those who are underserved, about
the benefits of oral health prevention could vastly improve oral health
literacy in the country. While significant data has emerged over the
past decade drawing the link between oral health and systemic diseases
like diabetes, heart disease, and stroke, many remain unaware that
neglected oral health can have serious ramifications to their overall
health. Data is also emerging to highlight the role that poor oral
health in pregnant women has on their children, including a link
between periodontal disease and low-birth weight babies.
ADHA advocates an allocation of $5 million in fiscal year 2012 for
a national oral health prevention and education campaign.
School-Based Sealant Programs--Fund at a level sufficient to ensure
school-based sealant programs in all 50 States
Sealants have long-proven to be low-cost and effective in
preventing dental caries (cavities), particularly in children. While
most dental disease is fully preventable, dental caries remains the
most common childhood disease, five times more common than asthma, and
more than half of all children age 5-9 have a cavity or filling.
The CDC has noted that data collected in evaluations of school-
based sealant programs indicates the programs are effective in stopping
and preventing dental decay. Significant progress has been made in
developing best practices for school-based sealant programs, yet most
States lack well developed programs as a result of funding shortfalls.
ADHA encourages the transfer of funding from the Public Health and
Prevention Fund sufficient to allow CDC to meaningfully fund school-
based sealant programs in all 50 States in fiscal year 2012.
Oral Health Programming within the Centers for Disease Control--Fund at
a level of $25 million in fiscal year 2012
ADHA joins with others in the dental community in urging $25
million for oral health programming within the Centers for Disease
Control. This funding level will enable CDC to continue its vital work
to control and prevent oral disease, including vital work in community
water fluoridation. Federal grants to facilitate improved oral health
leadership at the State level, support the collection and synthesis of
data regarding oral health coverage and access, promote the integrated
delivery of oral health and other medical services, enable States to
innovate new types of oral health programs and promote a data-driven
approach to oral health programming.
ADHA joins with others in the oral health community to express
concern with plans to fold the Division of Oral Health at CDC into the
Division of Adult and Community Health, and asks the subcommittee to
urge CDC to maintain the Division of Oral Health as a separate entity
within the chronic disease center so that the Division of Oral Health
can continue to improve the oral health of Americans from inception to
old age.
ADHA advocates for $25 million in funding for grants to improve and
support oral health infrastructure and surveillance.
Dental Health Improvement Grants--Fund at a level of $20 million in
fiscal year 2012
HRSA administered dental health improvement grants are an important
resource for States to have available to develop and carry out State
oral health plans and related programs. Past grantees have used funds
to better utilize the existing oral health workforce to achieve greater
access to care. Previously awarded grants have funded efforts to
increase diversity among oral health providers in Wisconsin, promote
better utilization of the existing workforce including the extended
care permit (ECP) dental hygienist in Kansas, and in Virginia implement
a legislatively directed pilot program to allow patients to directly
access dental hygiene services.
ADHA supports funding of HRSA dental health improvement grants at a
level of $20 million for fiscal year 2012.
National Institute of Dental and Craniofacial Research--Fund at a level
of $468 million in fiscal year 2012
The National Institute of Dental and Craniofacial Research (NIDCR)
cultivates oral health research that has led to a greater understanding
of oral diseases and their treatments and the link between oral health
and overall health. Research breeds innovation and efficiency, both of
which are vital to improving access to oral healthcare services and
improved oral status of Americans in the future.
ADHA joins with others in the oral health community to support
NIDCR funding at a level of $468 million in fiscal year 2012.
Conclusion
ADHA appreciates the difficult task Appropriators face in
prioritizing and funding the many meritorious programs and grants
offered by the Federal Government. In addition to the items listed,
ADHA joins other oral health organizations in support for continued
funding of the Dental Reimbursement Program (DRP) and the Community-
Based Dental Partnerships Program established under the Ryan White HIV/
AIDS Treatment and Modernization Act ($19 million for fiscal year 2012)
as well as block grants offered by HRSA's Maternal Child Health Bureau
($8 million for fiscal year 2012).
ADHA remains a committed partner in advocating for meaningful oral
health programming that makes efficient use of the existing oral health
workforce and delivers high quality, cost-effective care.
______
Prepared Statement of the American Diabetes Association
Thank you for the opportunity to submit this testimony on behalf of
the American Diabetes Association. As someone who has lived with
diabetes for over thirty years, I am proud to be a representative of
the nearly 105 million American adults and children living with
diabetes or prediabetes.
Every minute, three more people are diagnosed with diabetes. While
nearly 26 million Americans have diabetes today, this number is
expected to grow to 44 million in the next 25 years if present trends
continue. Every 24 hours, 230 people with diabetes will undergo an
amputation, 120 people will enter end-stage kidney disease programs and
55 people will go blind from diabetes. Every single day, diabetes costs
our country over a half a billion dollars, yet, that is but a fraction
of the costs we face unless we immediately take action to stop the
march of this epidemic.
Given the toll the diabetes epidemic imposes on the Nation's health
and economy and the promise of public diabetes research and public
health initiatives, the American Diabetes Association (Association)
respectfully requests programs at the National Institute of Diabetes
and Digestive and Kidney Diseases (NIDDK) at the National Institutes of
Health (NIH) and the Division of Diabetes Translation (DDT) at the
Centers for Disease Control and Prevention (CDC) be top priorities in
fiscal year 2012. As the Nation's leading non-profit health
organization providing diabetes research, information and advocacy, the
Association believes Federal funding for diabetes prevention and
research is critical, not only for the 26 million American adults and
children (8 percent of the population) who currently have diabetes, but
for the 79 million more with prediabetes, a condition placing them at
high risk for developing diabetes.
The Association acknowledges the challenging fiscal climate and
supports fiscal responsibility, but not at the expense of America's
health and well-being. Simply put, our country cannot afford the
consequences of failing to adequately fund diabetes research and
programs, a cost paid in expensive complications and death. We cannot
afford to turn our backs on the promising research which provides tools
to prevent diabetes, better manage it and prevent complications, and
bring us closer to a cure.
Therefore, the Association urges the Senate LHHS Subcommittee to
invest in research and prevention proportionate to the magnitude of the
burden diabetes has on our country and, by doing so, to change the
future of diabetes in America.
Diabetes is a chronic disease that impairs the body's ability to
use food for energy. The hormone insulin, which is made in the
pancreas, is needed for the body to change food into energy. In people
with diabetes, either the pancreas does not create insulin, which is
type 1 diabetes, or the body does not create enough insulin and/or
cells are resistant to insulin, which is type 2 diabetes. If left
untreated, diabetes results in too much glucose in the blood stream.
The majority of diabetes cases, 90 to 95 percent, are type 2, while
type 1 diabetes accounts for 5 percent of diagnosed cases.
Additionally, based on new diagnostic criteria, it is now estimated
that 18 percent of pregnancies are affected by gestational diabetes. In
the short term, blood glucose levels that are too high or too low (as a
result of medication to treat diabetes) can be life threatening. The
long-term complications of diabetes are widespread, serious--and
deadly. In those with prediabetes, blood glucose levels are higher than
normal and taking action to reduce their risk of developing diabetes is
essential.
The Centers for Disease Control and Prevention (CDC) has identified
diabetes as a disabling, deadly epidemic, which is on the rise. Between
1990 and 2001, the prevalence of diabetes increased by 60 percent.
According to the CDC, one in three adults will have diabetes in 2050 if
present trends continue. This number is even greater among minority
populations, where nearly one in two adults will have diabetes in 2050.
Additionally, type 2 diabetes, traditionally seen in older
patients, is beginning to reach a younger population, due in part to
the surge in childhood obesity. Approximately one in every 400 children
and adolescents has diabetes, and an alarming 2 million adolescents (or
1 in 6 overweight adolescents) aged 12-19 have prediabetes. The impact
diabetes has on individuals and the healthcare system is enormous and
continues to grow at a shocking rate. Diabetes is the leading cause of
kidney failure, new cases of adult-onset blindness and non-traumatic
lower limb amputations as well as a significant cause of heart disease
and stroke.
In addition to the physical toll, diabetes also attacks our
pocketbooks. A study by the Lewin Group found when factoring in the
additional costs of undiagnosed diabetes, prediabetes, and gestational
diabetes, the total cost of diabetes and related conditions in the
United States in 2007 was $218 billion ($18 billion for undiagnosed
diabetes; $25 billion for prediabetes; $623 million for gestational
diabetes). In 2007, medical expenditures due to diabetes totaled $116
billion, including $27 billion for diabetes care, $58 billion for
chronic diabetes-related complications, and $31 billion for excess
general medical costs. Indirect costs resulting from increased
absenteeism, reduced productivity, disease-related unemployment
disability and loss of productive capacity due to early mortality
totaled $58 billion. Approximately one out of every five healthcare
dollars is spent caring for someone with diagnosed diabetes, while one
in ten healthcare dollars is directly attributed to diabetes. Further,
one-third of Medicare expenses are associated with treating diabetes
and its complications.
Despite these numbers, there is hope. A greater Federal investment
in diabetes research at the National Institute of Diabetes and
Digestive and Kidney Diseases (NIDDK) at the National Institutes of
Health (NIH), and prevention, surveillance, control, and research work
currently being done at the Division of Diabetes Translation (DDT) at
the CDC is crucial for finding a cure and improving the lives of those
living with, or at risk for, diabetes. Additionally, the National
Diabetes Prevention Program is poised to dramatically cut the number of
new diabetes cases in high-risk individuals. Accordingly, for fiscal
year 2012, the American Diabetes Association is requesting:
--$2.209 billion for the NIDDK, an increase of $267 million over the
fiscal year 2011 level. This additional funding will act to
offset years of decreased or flat funding combined with
inflation that has lead to cutbacks in promising research. It
will also demonstrate Congress's commitment to science and
research in the face of this deadly epidemic.
--$86.1 million for the DDT, which represents a total increase of
$21.3 million over the fiscal year 2011 level for the DDT's
critical prevention, surveillance and control programs. Even as
proposals to consolidate the CDC's chronic disease programs
including DDT circulate, expanded investment in the DDT will
produce much larger savings in reduced acute, chronic, and
emergency care spending.
--$80 million for the implementation of the National Diabetes
Prevention Program through the Prevention and Public Health
Fund.
NIH's National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK)
The NIDDK is poised to make major discoveries to prevent diabetes,
better treat its complications, and--ultimately--find a cure.
Researchers supported by the NIH are working on a variety of projects
representing hope for the millions of individuals with both type 1 and
type 2 diabetes. While the list of advances in treatment and prevention
is long, much more can be achieved for people with diabetes with an
increased investment in scientific research at the NIDDK.
Thanks to research at the NIDDK, people with diabetes now manage
their disease with a variety of insulin formulations and regimens far
superior to those used in decades past. The result is the ability to
live healthier lives with diabetes. Because of these advances, my
hemoglobin A1C, which provides a snapshot of an individual's blood
glucose, went from 12.9 percent, a very dangerous level, to 5.9
percent, an accomplishment that provides me with hope of avoiding
diabetes's devastating complications. This is a dramatic development
for me and proof of the importance of NIDDK's work.
Recent discoveries at the NIDDK include the ability to predict type
1 diabetes risk, new drug therapies for type 2 diabetes, and the
discovery of genetic markers explaining the increased burden of kidney
disease among African Americans. The NIDDK funded the Diabetes
Prevention Program, a multicenter clinical research trial, which found
modest weight loss through dietary changes and increased physical
activity could prevent or delay the onset of type 2 diabetes by 58
percent. While great strides have been made in diabetes research, there
are many unanswered questions about the disease meriting further study.
Diabetes researchers across the country are poised to expand the base
of knowledge of diabetes in order to make new discoveries transforming
diabetes prevention and care.
Increased fiscal year 2012 funding would allow the NIDDK to support
additional research in order to build upon past successes, improve
prevention and treatment, and close in on a cure. For example,
additional funding will support a new comparative effectiveness
clinical trial testing different medications for type 2 diabetes, a
process that is instrumental in finding the most effective treatments
for type 2 diabetes. fiscal year 2012 funding will also support
researchers who are studying how insulin-producing beta cells develop
and function, with an ultimate goal of creating therapies for replacing
damaged or destroyed beta cells in people with diabetes. Finally,
additional funding will support ongoing studies outlining environmental
triggers of disease, which could identify an infectious cause of type 1
diabetes and lead to a vaccine.
CDC's Division of Diabetes Translation (DDT)
The Senate Appropriations Committee's fiscal year 2011 bill
provided increased resources to address chronic diseases through the
creation of the Chronic Disease Initiative (CDI) at CDC. In approving
the fiscal year 2011 LHHS bill, the full Committee acknowledged chronic
disease programs, including the diabetes programs traditionally
operated through the DDT, have been woefully underfunded to adequately
address the trajectory and scope of diabetes and other diseases
including heart disease, stroke and arthritis.
This year, ideas continue to circulate to consolidate programs at
CDC, including DDT. While we think coordination across chronic disease
programs at CDC is an important endeavor, Congress must ensure the
needs of people with, and at risk for, diabetes are adequately
addressed. Given DDT funding has not kept pace with the magnitude of
the growing diabetes epidemic, the Federal investment in DDT programs
should be substantially increased--at a minimum to $86.1 million in
fiscal year 2012--regardless of the organization of chronic disease
programs at CDC or in any consolidation plan. As the dialogue continues
about how best to address chronic disease prevention, DDT should be the
centerpiece in the Federal Government's efforts in this regard and its
State and national expertise should be maintained.
Preserving the DDT's expertise is vital. The Division works to
eliminate the preventable burden of diabetes through proven educational
programs, best practice guidelines and applied research. It performs
vital work in both primary prevention of diabetes and in preventing its
complications. Both key missions must continue. Funds appropriated to
DDT focus on developing and maintaining State-based Diabetes Prevention
and Control Programs (DPCPs), supporting the National Diabetes
Education Program (NDEP), defining the diabetes burden through the use
of public health surveillance, and translating research findings into
clinical and public health practice. Our request of an additional $21.3
million will allow these programs at DDT to reach more at-risk
Americans and help to prevent or delay this destructive disease and its
complications.
DDT's Diabetes Prevention and Control Programs, located in all 50
States, the District of Columbia, and U.S. territories, work to prevent
diabetes, to lower blood glucose and cholesterol levels and to reduce
diabetes-related emergency room visits and hospitalizations. DDT also
plays a leadership role in the dissemination of diabetes prevention and
treatment information through the National Diabetes Education Program,
a joint effort of DDT and NIDDK. Funding for the DDT also supports
vital and groundbreaking translational research like the Search for
Diabetes in Youth study, collaboration between DDT and NIDDK designed
to determine the impact of type 2 diabetes in youth in order to improve
prevention efforts aimed at young people. DDT is also engaged in
efforts to eliminate diabetes related disparities in vulnerable
populations that bear a disproportionate burden of the disease in urban
and rural areas. Finally, DDT maintains vital diabetes data at the
State and national levels through the National Diabetes Surveillance
System, which helps determine how best to deploy resources in the most
appropriate and cost-effective way.
Although DDT has played an instrumental role in fighting the
diabetes epidemic, the reach of the Division could be significantly
broader with additional fiscal year 2012 funding. With an additional
$21.3 million, the DDT will be able to expand the reach of DPCPs in
every State and territory. Given the dramatic decreases in funding for
State and local health departments, supporting the work of the DPCPs is
more critical than ever to ensure access to diabetes care and services.
Increased funding for DDT is needed to allow the Division to build
upon its work in reducing health disparities through vital programs
such as the Native Diabetes Wellness Program, furthering the
development of effective health promotion activities and messages
tailored to American Indian/Native Alaskan communities. Additional
resources will enable the DDT to expand its translational research
studies, leading to improved public health interventions.
The National Diabetes Prevention Program
Further studies of the Diabetes Prevention Program by the CDC have
shown this groundbreaking intervention can be replicated in community
settings for a cost of less than $300 per participant. With this in
mind, the National Diabetes Prevention Program was authorized by the
Patient Protection and Affordable Care Act of 2010. This program will
provide funding to the CDC to expand such evidence-based programs
across the country. We ask the Committee to direct $80 million from the
Fund for the National Diabetes Prevention Program.
The National Diabetes Prevention Program supports the creation of
community-based sites where trained staff will provide those at high
risk for diabetes with cost-effective, group-based lifestyle
intervention programs. Local sites will be required to provide detailed
program plans, ensure adequate training, and be rigorously evaluated
based on the achievement of required standards and goals. The program
also includes applied research grants, which will advance the national
strategy for community-based programs and improve communication
strategies for high-risk communities.
The Fund seeks to make a national investment in prevention and
public health programs, both to improve the health of Americans and to
rein in healthcare costs. The National Diabetes Prevention Program is
exactly the program the Fund should be supporting. The NIH did research
in the clinical setting--it worked. The CDC translated this research to
the community setting--it worked. It is an amazingly inexpensive proven
means of combating a growing epidemic. Indeed, the Urban Institute has
estimated a nationwide expansion of this type of diabetes prevention
program will save a total of $190 billion over 10 years. Based on
estimates that a large portion of burden of chronic disease falls on
the poor and elderly, the Institute's report assumes 75 percent of this
savings would be savings to Medicare or Medicaid.
Conclusion
As you consider the fiscal year 2012 appropriation for NIDDK, and
DDT, and the National Diabetes Prevention Program, we ask you to
consider diabetes is an epidemic growing at an astonishing rate, which
will overwhelm the healthcare system with tragic consequences unless we
take action. To change this future, we must increase our commitment to
research and prevention to reflect the burden diabetes poses both for
us and for our children. Our fight against diabetes must be
significantly expanded. Your leadership in combating this growing
epidemic is essential. Thank you for your commitment to the diabetes
community and for the opportunity to submit this testimony. The
Association is prepared to answer any questions you might have on these
important issues.
______
Prepared Statement of the American Foundation for Suicide Prevention
Chairman Harkin, Ranking Member Shelby and members of the
Committee. The American Foundation for Suicide Prevention (AFSP) thanks
you for the opportunity to provide testimony on the funding needs of
Federal Agencies and programs that play a critical role in suicide
prevention efforts.
AFSP is the leading national not-for-profit organization
exclusively dedicated to understanding and preventing suicide through
research, education and advocacy, and to reaching out to people with
mental disorders and those impacted by suicide. You can find more
information at www.asfp.org and www.spanusa.org.
Preliminary data from the Centers for Disease Control for 2009
shows that suicide is the 10th leading cause of death in the United
States (36,547) and the third leading cause of death in teens and young
adults from ages 15-24. Nearly 1.1 million Americans attempt suicide
each year and another 8 million have suicidal thoughts. Suicide in 1
year costs the United States $13 billion in lost earnings, 1 million
years of lost life and suicide attempts requiring hospitalization
amount to $3.54 billion in lost medical and work-loss costs.
In order to more effectively combat this public health crisis, AFSP
urges the Committee approve funding at the levels requested for the
following programs/agencies for fiscal year 2012:
Garrett Lee Smith Memorial Act Programs
We respectfully request that Garrett Lee Smith Memorial Act (GLSMA)
youth suicide prevention grant programs receive $53.2 million for
fiscal year 2012.
Since 2005, the Substance Abuse and Mental Health Services
Administration (SAMHSA) has awarded GLSMA grants to 45 State programs,
12 tribal programs, and 78 colleges and universities for programs to
help reduce youth suicides rates. State grantees include: Alaska,
Arizona, Colorado, Connecticut, District of Columbia, Delaware,
Florida, Georgia, Guam, Hawaii, Iowa, Idaho, Indiana, Kentucky,
Louisiana, Massachusetts, Maryland, Maine, Michigan, Missouri,
Mississippi, North Carolina, North Dakota, Nebraska, New Hampshire, New
Mexico, Nevada, New York, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode
Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia,
Vermont, Washington, Wisconsin, West Virginia, and Wyoming.
Funding for the Act is directed to three programs administered by
SAMHSA. We request $5 million for the Suicide Prevention Technical
Assistance Center to support its mission of providing technical
assistance and support to grantees. We request $42 million for the
Youth Suicide Early Intervention and Prevention Strategies grant
program. These grants help States and tribes develop and implement
statewide youth suicide early intervention and prevention strategies
that will raise awareness and educate people about mental illness and
the risk of suicide, help young people at risk of suicide take the
first step toward seeking help, and allow States to expand access to
treatment options. Finally, we request $6.2 million to fund the Mental
and Behavioral Health Services on Campus matching-grant program for
colleges and universities to help raise awareness about youth suicide,
as well as enable those institutions to train students and faculty to
identify and intervene when youth are in crisis, and develop a system
to refer students for care.
Support Federal Investment in Suicide Prevention Research at NIMH for
Fiscal Year 2012
Strategic investments in disease research have produced declines in
deaths, and the same types of investments are necessary to reduce
deaths by suicide. In fiscal year 2010 (latest data) only $41 million
was devoted directly to suicide research. AFSP urges Congress to
increase the investment in suicide prevention research at the National
Institutes of Mental Health by 15 percent, or $6.15 million.
It is illuminating to compare the number of suicide deaths with the
number of deaths in several major disease categories against the direct
dollars spent on research in those areas (see below). In fact, the
Institute of Medicine, in their 2002 report ``Reducing Suicide: A
National Imperative,'' stated the following: ``There is every reason to
expect that a national consensus to declare war on suicide and to fund
research and prevention at a level commensurate with the severity of
the problem will be successful, and will lead to highly significant
discoveries as have the wars on cancer, Alzheimer's disease, and
AIDS.''
Maintain Vital Funding for SAMHSA Suicide Prevention Programs and
Mental Health Services
As the lead Government agency charged with implementation of
suicide prevention initiatives, AFSP urges this Committee to provide
$3.387 billion for SAMHSA in fiscal year 2012. By this action Congress
will recognize the important role SAMHSA plays in healthcare delivery
and mental health services.
As the lead Government agency charged with implementation of
suicide prevention initiatives, SAMHSA has supported the establishment
of a national toll-free hotline (the National Suicide Prevention
Lifeline), a technical assistance center (the Suicide Prevention
Resource Center), and a youth suicide prevention grant program for
States and colleges (authorized and funded under the Garrett Lee Smith
Memorial Act). Since its launch in January 2005, the Suicide Prevention
Lifeline has answered more than 1 million calls and has 140 active
crisis centers in 48 States. Beginning in 2008, SAMHSA's National
Survey on Drug Use and Health asked respondents about suicide attempts
and whether or not they had previously acknowledged major depression.
This was an important first step forward in suicide surveillance,
promoting greater attention to the interrelationship of suicide,
substance abuse and depression. Moreover, the Agency also has been
supporting the identification, development and promotion of best
practices in suicide prevention, focusing on risk and protective
factors related to suicide, with particular attention to mental health
and substance abuse issues affecting suicide risk.
Support Federal Investment in Data Collection in Fiscal Year 2012
To design effective suicide prevention strategies, we must first
have complete, accurate and timely information about deaths by suicide.
The National Violent Death Reporting System (NVDRS) provides this
information, which is essential to improve State and Federal suicide
prevention activities. Current funding of $3.5 million allows only 18
States to participate in this program. This Committee approved an
additional $1.5 million in fiscal year 2011; however, the bill never
got signed into law. AFSP urges this Committee to appropriate the full
$5 million for the NVDRS in fiscal year 2012.
Provide Funding for Depression Centers of Excellence (DCOE)
This Committee included $10 million for the DCOE in the fiscal year
2011 mark up as a down payment toward studying Depression, the most
common psychiatric diagnosis associated with suicide. AFSP urges
Congress to appropriate funds to the DCOE at the highest levels
possible in fiscal year 2012.
Depression Centers of Excellence would increase access to the most
appropriate and evidence-based depression care and develop and
disseminate evidence-based treatment standards to improve accurate and
timely diagnosis of depression and bipolar disorders. Additionally,
they would create a national database for large-sample effectiveness
studies and a repository of evidence-based interventions and programs
for depression and bipolar disorders. They would also utilize the
network of centers as an ongoing national resource for public and
professional education and training, with the goal of advancing
knowledge and eradicating stigma of these mental disorders.
Chairman Harkin, Ranking Member Shelby and Members of the
Committee. AFSP once again thanks you for the opportunity to provide
testimony on the funding needs of Federal Agencies and programs that
play a critical role in suicide prevention efforts.
Suicide robs families, communities and societies of tens of
thousands of its citizens. In a single year, in the United States
alone, suicide is responsible for the deaths of over 36,000 people of
all ages and costs an estimated $13 billion in lost income. With your
help, we can assure those tasked with leading the Federal Government's
response to this public health crisis will have the resources necessary
to effectively prevent suicide.
______
Prepared Statement of the American Geriatrics Society
Mr. Chairman and Members of the Subcommittee: We are writing on
behalf of the American Geriatrics Society (AGS), a nonprofit
organization of over 6,000 geriatrics healthcare professionals
dedicated to improving the health, independence and quality of life of
all older Americans. As the Subcommittee begins to work on its Labor-
HHS-Education Appropriations bill, we ask that you prioritize funding
for the geriatrics education and training programs under Title VII and
Title VIII of the Public Health Service Act and for research funding
within the National Institute on Aging in fiscal year 2012.
Continued Federal investments are needed to support the training of
the healthcare workforce and to foster groundbreaking medical research
so that our Nation is prepared to meet the unique healthcare needs of
the rapidly growing population of seniors. While we fully recognize the
fiscal challenges facing our Nation, we also recognize that sustained
and enhanced Federal investments in these initiatives are essential to
fulfilling the promise of health reform to deliver higher quality and
better coordinated care to our Nation's seniors.
We ask that the subcommittee consider the following recommended
funding levels for these programs in fiscal year 2012 $46.5 million for
Title VII Geriatrics Health Professions Programs, $5 million for Title
VIII Comprehensive Geriatric Education Nursing Program, and $1.4
billion for the National Institute on Aging.
Summarized and broken down below are the American Geriatrics
Society's funding priorities in these areas for fiscal year 2012.
Programs to Train Geriatrics Health Care Professionals
This year, the first wave of baby boomers turn 65, signaling the
start of a significant demographic shift in America's population.
According to the Institute of Medicine's (IOM) ground-breaking 2008
report, Retooling for an Aging America: Building the Healthcare
Workforce, America's healthcare workforce is woefully ill-prepared to
care for the growing and unprecedented number of seniors, especially
those with multiple chronic and complex medical conditions.
The increase in the older adult population is expected to be even
greater in rural America, which are more likely to experience poor
health and a shortage of healthcare resources. Not only are
geriatricians few in number, but they are largely concentrated in urban
areas. Of further concern, our Nation is facing a critical shortage of
geriatrics faculty and healthcare professionals across disciplines. At
the same time, the Title VII and VIII geriatrics programs under the
Public Health Service Act have remained essentially level-funded since
fiscal year 2007 and in each subsequent year the geriatrics programs
have received an even smaller percentage of funding provided to Title
VII and VIII programs.
This trend must be reversed if we are to provide our seniors with
the quality care they need and deserve. AGS believes it is critical
that Congress increase the percentage of Title VII and VIII funding
that is devoted to supporting increasing the capacity of America's
healthcare workforce to care for older adults. Care provided by
geriatric healthcare professionals, who understand the most complex
cases and the most frail elderly, has shown to reduce those common and
costly conditions that are often preventable with appropriate care,
such as falls, polypharmacy, and delirium.
Title VII Geriatrics Health Professions Programs ($46.5
million)
Funding for Title VII Geriatrics Health Professions Programs is a
proven investment in ensuring that older adults receive high quality
healthcare now and in the future. These programs support three
initiatives: the Geriatric Academic Career Awards (GACAs), the
Geriatric Education Center (GEC) program, and geriatric faculty
fellowships, the only programs specifically designed to address the
evident shortage of geriatrics healthcare professionals in the United
States. Strong and sustained investments are important to reversing the
chronic under-funding of these essential programs at a time when our
Nation is facing a critical shortage of geriatrics healthcare
professionals across disciplines. We ask the subcommittee to provide a
fiscal year 2012 appropriation of $46.5 million for Title VII
Geriatrics Health Professions Programs.
Our funding request of $46.5 million breaks down as follows:
--Geriatric Academic Career Awards (GACAs) ($5.3 million).--GACAs
support the development of newly trained geriatric physicians
in academic medicine who are committed to teaching geriatrics
in medical schools across the country. GACA recipients are
required to provide training in clinical geriatrics, including
the training of interdisciplinary teams of healthcare
professionals. Under ACA, GACAs have been expanded to a variety
of new disciplines beyond physicians, including those in
nursing, social work, psychology, dentistry, and pharmacy. AGS
has long advocated for this change. We must now ensure that
there is adequate funding to meet the increased demand given
the greater number of disciplines eligible for the award. A
budget of $5.3 million would support 68 awardees at $78,000 per
award.
Program Accomplishments.--In Academic Year 2009-2010, there were
84 non-competing continuation awards. GACA awardees provided
interdisciplinary training in geriatrics training to about
60,000 health professionals. These awardees provided culturally
competent quality healthcare to over 525,000 underserved and
uninsured patients in acute care services, geriatric ambulatory
care, long-term care, and geriatric consultation services
settings.
--Geriatric Education Centers (GECs) ($22.7 million).--GECs provide
grants to support collaborative arrangements involving several
health professions, schools and healthcare facilities to
provide multidisciplinary training in geriatrics, including
assessment, chronic disease syndromes, care planning, emergency
preparedness, and cultural competence unique to older
Americans. Under ACA, Congress authorized $10.8 million over 3
years for a supplemental grant award program that will train
additional faculty through an intensive short-term fellowship
program and also requires faculty to provide training to family
caregivers and direct-care workers. Our funding request of
$22.7 million includes continued support for the core work of
45 GECs and for up to 24 GECs to be funded to undertake the
work through the supplemental grant program.
Program Accomplishments.--In Academic Year 2009-2010, the GEC
grantees provided clinical training to 54,167 health
professional students and to 20,791 interdisciplinary teams in
multiple settings.
--Geriatric Training Program for Physicians, Dentists, and Behavioral
and Mental Health Professions ($8.5 million).--This program is
designed to train physicians, dentists, and behavioral and
mental health professionals who choose to teach geriatric
medicine, dentistry or psychiatry. The program provides fellows
with exposure to older adult patients in various levels of
wellness and functioning, and from a range of socioeconomic and
racial/ethnic backgrounds. Our funding request of $8.5 million
will allow 13 institutions to continue this important faculty
development program.
Program Accomplishments.--In Academic Year 2009-2010, 11 non-
competing continuation grants were supported. Forty-nine
physicians, dentists, and psychiatric fellows provided
geriatric care to 20,078 older adults across the care
continuum. Geriatric physician fellows provided healthcare to
12, 254 older adults. Geriatric dental fellows provided
healthcare to 4,073 older adults. Geriatric psychiatry fellows
provided healthcare to 3,751 older adults.
--Geriatric Career Incentive Awards Program ($10 million).--This is a
new grant award program created under ACA to foster greater
interest among a variety of health professionals in entering
the field of geriatrics, long-term care, and chronic care
management. AGS supports the President's fiscal year 2012
request of $10 million to implement this new program.
Title VIII Comprehensive Geriatric Education Nursing
Program ($5 million)
The American healthcare delivery system for older adults will be
further strengthened by Federal investments in Title VIII Nursing
Workforce Development Programs, specifically the comprehensive
geriatric education grants, as nurses provide cost-effective, quality
care. Increasing funding for the nursing comprehensive geriatric
education program would be highly cost effective. This program supports
additional training for nurses who care for the elderly, development
and dissemination of curricula relating to geriatric care, and training
of faculty in geriatrics. It also provides continuing education for
nurses practicing in geriatrics.
Under the new health reform law, this program is being expanded to
include advanced practice nurses who are pursuing long-term care,
geropsychiatric nursing or other nursing areas that specialize in the
care of older adults. Our funding request of $5 million includes funds
to continue the training of nurses caring for older Americans offer 200
traineeships to nurses under this newly expanded program.
Program Accomplishments.--In Academic Year 2009-2010, 27 CGEP
grantees provided education and training to 3,030 Registered Nurses/
Registered Nursing Students; 260 Advanced Practice Nurses; 221 Faculty;
110 Home Health Aides; 483 Licensed Practical/Vocational Nurses & LPN
students; 730 Nurse Assistants/Patient Care Associates; 810 Allied
Health Professionals and 929 lay persons, guardians, activity
directors. The CGEP grantees provided 459 educational course offerings
in the care of the elderly on a variety of topics to 6,846
participants.
Research Funding Initiatives
National Institute on Aging ($1.4 billion)
The NIA leads a broad scientific effort to understand the nature of
aging and to extend the healthy, active years of life. Robust medical
research in aging is critical to the development of medical advances
which will ultimately lead to higher quality and more efficient
healthcare. Continued Federal investments in scientific research,
including comparative effectiveness initiatives, will ensure that the
NIA has the resources to succeed in its mission to establish research
networks, assess clinical interventions and disseminate credible
research findings to patients, providers and payers of healthcare.
As a member of the Friends of the NIA, a broad-based coalition of
more than 45 aging, disease, research, and patient groups committed to
the advancement of medical research that affects millions of older
Americans, AGS asks that NIA receive $1.4 billion in fiscal year 2012.
Alternatively, in light of our Nation's immediate budget constraints,
we request that that the NIA be funded at no less than the $1.29
billion, as requested in the President's fiscal year 2012 budget.
According to the Congressional Research Service, in fiscal year
2003, NIH reached the peak of its purchasing power from regular
appropriations when Congress completed a 5-year doubling of the NIH
budget. In each year since then, NIH's buying power has declined
because its annual appropriations have grown at a lower rate than the
inflation rate for medical research.
Essentially flat funding of NIH since 2003 has additionally led to
declining numbers of young investigators choosing research careers,
given the scarcity of funding to support their career development. We
must provide the resources and tools to support the next generation of
investigators and expand the pool of clinical researchers focused on
advancing aging research.
The ongoing Federal commitment to investments in science, research,
and technology lead to cutting-edge breakthroughs in medicine and
improved patient care. AGS urges Congress to maintain this commitment
in fiscal year 2012 and beyond, so that we may continue to advance
medicine to improve the quality of care of our Nation's older adults
and the long-term goals of health reform can be fully achieved.
In closing, geriatrics is at a critical juncture, with our Nation
facing an unprecedented increase in the number of older patients with
complex health needs. Strong support such as yours will help ensure
that the promise of health reform is fulfilled and every older American
is able to receive high-quality healthcare.
Thank you for your consideration.
______
Prepared Statement of the American Heart Association
Over the past 50 years, major progress has been made in the battle
against heart disease, stroke and other forms of cardiovascular disease
(CVD). Improved diagnosis and treatment have been remarkable--as has
the survival rate. According to the National Institutes of Health
(NIH), since the 1960s, 1.6 million lives have been saved that would
have been lost to CVD. Americans can now expect to live on average 4
years longer due to the reduction in heart-related deaths.
Yet, one startling fact remains. Heart disease and stroke are still
respectively the No. 1 and No. 3 killers in the United States. Nearly
2,200 people die of CVD each day--one death every 39 seconds. CVD is a
major cause of disability and costs our Nation more than any disease--a
projected $287 billion in medical expenses and lost productivity for
2007. Today, an estimated 83 million adults suffer from CVD. Moreover,
CVD risk factors such as obesity and high blood pressure are on the
rise. At age 40, the lifetime risk for CVD is 2 in 3 for men and over 1
in 2 for women.
Moreover, a new study projects that more than 40 percent of adults
in the United States will live with the consequences of CVD at a cost
to exceed $1 trillion annually by the year 2030. The graying of
Americans combined with the explosive growth in medical spending are
the main drivers of increased costs. Our country is truly facing a
crisis. Without prevention on a nationwide scale, managing CVD will be
an enormous challenge. Clearly, there must be a greater emphasis on
prevention and evidence-based approaches to healthy behaviors. This
will require strategies to reach people where they live, work and play.
Prevention must be an integral part of our toolkit to promote heart
healthy and stroke-free habits and wellness at an early age.
Yet, in the face of these statistics, heart disease and stroke
research, treatment and prevention programs remain woefully underfunded
and money for NIH is unpredictable for the continuity of effort needed
for key advances to redefine disease, ramp up prevention and promote
best care.
Given CVD is the No. 1 killer in each State and preventable and
treatable risk factors continue to rise, many are surprised that the
Centers for Disease Control and Prevention (CDC) invests on average
only 16 cents per person on heart disease and stroke prevention. Also,
only 20 States are funded for WISEWOMAN--a proven heart disease and
stroke prevention program that serves uninsured and under-insured low-
income women with a high prevalence of CVD risk factors.
Where you live could also affect if you survive a very deadly form
of heart disease--sudden cardiac arrest (SCA). Only 21 States received
funding in fiscal year 2010 for the Health Resources and Services
Administration's (HRSA) Rural and Community Access to Emergency Devices
Program designed to save lives from sudden cardiac death.
The American Heart Association applauds the administration and
Congress for providing hope to the 1 in 3 adults in the United States
who live with CVD by wisely investing in the NIH and in the Prevention
and Public Health Fund. These resources have provided a much needed
boost to improve our Nation's physical and fiscal health. However,
stable and sustained funding is critical for fiscal year 2012 to
advance heart disease and stroke research, prevention and treatment.
FUNDING RECOMMENDATIONS: INVESTING IN THE HEALTH OF OUR NATION
Heart disease and stroke risk factors continue to rise, yet
promising research to stem this tide goes unfunded. Too many Americans
die from CVD, while proven prevention efforts beg for resources for
widespread implementation. Now is the time to boost research,
prevention and treatment of America's No. 1 and most costly killer. If
Congress fails to build on progress of the past half century, Americans
will pay more in lives lost and higher healthcare costs. Our
recommendations address these issues in a comprehensive and fiscally
responsible manner.
Capitalize on Investment for the National Institutes of Health (NIH)
NIH research has revolutionized patient care and holds the key to
finding new ways to prevent, treat and even cure CVD, resulting in
longer, healthier lives and reduced healthcare costs. NIH invests
resources in every State and in 90 percent of congressional districts.
According to a 2008 study, the typical NIH grant paid the salaries of
about 7 mainly high-tech full-time or part-time jobs in fiscal year
2007. Further, every dollar that NIH distributes in a grant returns
$2.21 in goods and services to the local community in 1 year.
American Heart Association Advocates.--We advocate for a fiscal
year 2012 appropriation of $35 billion for NIH to capitalize on the
investment to save lives, advance better health, spur our economy and
spark innovation. NIH research prevents and cures disease, generates
economic growth and preserves the U.S. role as the world leader in
pharmaceuticals and biotechnology.
Enhance Funding for NIH Heart and Stroke Research: A Proven and Wise
Investment
From 1997 to 2007, death rates for coronary heart disease and
stroke fell nearly 28 percent and 45 percent, respectively. However,
there is still much more to be done to improve the lives of heart
disease and stroke patients--and more importantly to prevent CVD and
stroke in the first place. Research will help lead the way. These
declines in mortality are directly related to NIH heart and stroke
research, with scientists on the verge of exciting discoveries that
could lead to new treatments and even cures. For example, the biggest
U.S. stroke rehabilitation study showed that patients who receive home
physical therapy improve walking skills just as effectively as those
treated in a program and that the progress continued up to 1 year post-
stroke. NIH research has also demonstrated that over-zealous blood
pressure lowering and combination lipid drugs did not cut
cardiovascular disease in adult diabetics more than standard evidence-
based care. Moreover, studies have defined the genetic basis of risky
responses to vital blood-thinners.
In addition to saving lives, NIH-funded research can cut healthcare
costs. For example, the original NIH tPA drug trial resulted in a 10-
year net $6.47 billion reduction in stroke healthcare costs. Also, the
Stroke Prevention in Atrial Fibrillation Trial 1 produced a 10-year net
savings of $1.27 billion. Yet, in the face of such solid returns on
investments and other successes, NIH still invests a meager 4 percent
of its budget on heart research, and a mere 1 percent on stroke
research.
Cardiovascular Disease Research: National Heart, Lung, and Blood
Institute (NHLBI)
Even in the face of progress and promising research opportunities,
there is no cure for CVD. As our population ages, demand will only
increase to find better ways for Americans to live healthy and
productive lives despite CVD. Stable and sustained funding is needed to
allow NHLBI to build on investments that provided grants to use
genetics to identify and treat those at greatest risk from heart
disease; hasten drug development to treat high cholesterol and high
blood pressure; and create tailored strategies to treat, slow or
prevent heart failure. Other key studies include an analysis of whether
maintaining a lower blood pressure than currently recommended further
reduces risk of heart disease, stroke, and cognitive decline. This
information is vital to manage the burden of heart disease and stroke.
Sustained critical funding will allow for aggressive implementation of
other initiatives in the NHLBI and cardiovascular strategic plans.
Stroke Research: National Institute of Neurological Disorders and
Stroke (NINDS)
An estimated 795,000 people in this country will suffer a stroke
this year, and more than 135,950 will die. Many of the 7 million
survivors face severe physical and mental disabilities, emotional
distress and huge costs--a projected $41 billion in medical expenses
and lost productivity for 2007. A new study projects stroke prevalence
will increase 25 percent over the next 20 years, striking more than 10
million individuals. Over the same time period, direct medical costs
will rise 238 percent.
Stable and sustained funding is required for NINDS to capitalize on
investments to prevent stroke, protect the brain from damage and
enhance rehabilitation. This includes initiatives to: (1) determine if
MRI brain imaging can assist in selecting stroke victims who could
benefit from the clot busting drug tPA beyond the 3-hour treatment
window; (2) assess chemical compounds that might shield brain cells
during a stroke; and (3) advance stroke rehabilitation by studying if
the brain can be helped to ``rewire'' itself after a stroke. Enhanced
funding will also allow for proactive initiation and implementation of
the NINDS' novel stroke planning process (a result of its Stroke
Progress Review Group) to assess the stroke research field and develop
priorities to advance the most promising prevention, treatment,
recovery and rehabilitation research.
The American Heart Association Advocates.--While AHA supports
increased funding for the 18 Institutes and centers that conduct heart
and stroke research, including the National Institute of Diabetes, and
Digestive and Kidney Diseases; and the National Institute on Aging, we
have specific funding recommendations for the NHLBI and the NINDS. AHA
advocates for an fiscal year 2012 appropriation of $3.514 billion for
NHLBI; and $1.857 billion for NINDS.
Increase Funding for the Centers for Disease Control and Prevention
(CDC)
Prevention is the best way to protect the health of all Americans
and reduce the economic burden of CVD. Yet, effective prevention
strategies and programs are not being implemented due to insufficient
resources. The President's 2012 budget proposes a Coordinated Chronic
Disease Prevention and Health Promotion Grant Program. AHA supports
some consolidation of chronic disease programs, but with some important
modifications and caveats. First, CDC must preserve the Division for
Heart Disease and Stroke Prevention. A consolidation must ensure more
predictable and adequate funding to all 50 States, including an annual
share of the Prevention and Public Health Fund, with resources
allocated by formula on the basis of burden, including cost, mortality,
morbidity, and prevalence. These programs must be evidence-based and
targeted, with a focus on capacity, evaluation and surveillance,
including measurable outcomes and a higher level of accountability. To
preserve the best elements of existing programs, funding should
preserve evidenced-based outcomes work across the full spectrum of
prevention and clinical care, including primary and secondary
prevention, acute treatment, rehabilitation and continuous quality
improvement (CQI). Each State must retain staff expertise to
effectively address heart disease and stroke. State-based advisory
groups of stakeholders from each constituency should be formed to help
with plan implementation. A national advisory committee of
constituencies should be created to foster stakeholder involvement.
Matches, including in-kind, should be required when possible to build
support in State health departments. Plans should use some funding for
at least one program on common risk factors to consolidated diseases
that can show a measurable, population-based impact. The rest of the
funds should be spent on effective, evidence-based projects aimed at
secondary prevention, acute treatment, rehabilitation, and CQI.
This CDC division administers WISEWOMAN that serves uninsured and
under-insured low-income women ages 40 to 64 in 20 States. This program
helps them avoid heart disease and stroke by providing preventive
health services, referrals to local healthcare providers, as needed,
and lifestyle counseling and interventions tailored to their identified
risk factors to promote lasting, healthy behavior modifications. From
July 2008 to June 2010, WISEWOMAN reached more than 70,000 low-income
women. During this time period, 89 percent of them had a least one risk
factor and 28 percent had three or more risk factors for heart disease
and stroke. However, more than 43,000 of these women participated in at
least one lifestyle intervention session.
The American Heart Association Advocates.--AHA joins with the CDC
Coalition in advocating for $7.7 billion for the CDC's ``core
programs,'' including increases for the Division of Heart Disease and
Stroke Prevention and WISEWOMAN. AHA recommends $37 million to expand
WISEWOMAN to more States and serve more eligible women in already
funded States. We join the Friends of the NCHS in asking for $162
million for the National Center for Health Statistics.
Restore Funding for Rural and Community Access to Emergency Devices
(AED) Program
About 92 percent of sudden cardiac arrest (SCA) victims die outside
of a hospital. But, prompt CPR and defibrillation, with an automated
external defibrillator (AED), can more than double their chances of
survival. Communities with comprehensive AED programs have reached
survival rates of about 40 percent. HRSA's Rural and Community AED
Program provides grants to States, competitively, to buy AEDs, train
lay rescuers and first responders in their use and place AEDs where SCA
is likely to occur. From September 2007 to August 2008, 3,051 AEDs were
bought and 10,287 people were trained. And, 795 patients were saved
between August 1, 2009 and July 31, 2010. Due to insufficient budgets,
only 21 states received funds for this program in fiscal year 2010.
The American Heart Association Advocates.--For fiscal year 2012,
AHA advocates restoring HRSA's Rural and Community AED Program to its
fiscal year 2005 level of $8.927 million.
Increase Funding for the Agency for Healthcare Research and Quality
(AHRQ)
AHRQ develops scientific evidence to improve healthcare for
Americans. AHRQ provides patients and caregivers with valuable
scientific evidence to make the right healthcare decisions. AHRQ's
research also enhances quality and efficiency of healthcare, providing
the basis for protocols that prevent medical errors and reduce
hospital-acquired infections, and improve patient confidence,
experiences, and outcomes.
The American Heart Association Advocates.--AHA joins Friends of
AHRQ in advocating for $405 million for AHRQ to preserve its vital
initiatives, boost the research infrastructure, spur innovation,
nurture the next generation of scientists and help reinvent health and
healthcare.
CONCLUSION
Cardiovascular disease continues to inflict a deadly, disabling and
costly toll on Americans. Yet, our funding recommendations for NIH, CDC
and HRSA outlined above will save lives and cut rising healthcare
costs. The American Heart Association urges Congress to seriously
consider our suggestions during the fiscal year 2012 appropriations
process. These proposed resources represent a wise investment for our
nation and for the health and well-being of this and future
generations.
______
Prepared Statement of the American Indian Higher Education Consortium
Summary of Requests.--Summarized below are the fiscal year 2012
recommendations of the Nation's Tribal Colleges and Universities
(TCUs), covering three areas within the Department of Education and one
in the Department of Health and Human Services, Administration for
Children and Families' Head Start Program.
DEPARTMENT OF EDUCATION PROGRAMS
Higher Education Act Programs
Strengthening Developing Institutions.--Section 316 of HEA Title
III-A, specifically supports TCUs' grant programs. The TCUs request
that the Subcommittee appropriate $30 million for this critically
important program, the same level included in the President's fiscal
year 2012 budget request.
TRIO Programs.--Retention and support services are vital to
achieving the national goal of having the highest percentage of college
graduates globally by 2020. The President's fiscal year 2012 budget
request includes funding for TRIO programs at fiscal year 2010 levels,
which is not enough to sustain even the current level of program
services. The TCUs support building on the President's fiscal year 2012
budget request for TRIO programs and technical assistance funding so
that these essential program services can be, at a minimum, maintained
at current levels.
Pell Grants.--TCUs urge the Subcommittee to sustain the current
Pell Grant maximum.
Perkins Career and Technical Education Programs
Section 117 of the Carl D. Perkins Career and Technical Education
Act provides a competitively awarded grant opportunity for tribally
chartered and controlled career and technical institutions. AIHEC
requests $8,200,000 to fund grants under Section 117 of the Perkins
Act. Additionally, TCUs strongly support the Native American Career and
Technical Education Program (NACTEP) authorized under Sec tion 116 of
the Perkins Act.
Elementary and Secondary Education Act and Workforce Investment Act
Programs
American Indian Teacher and Administrator Corps.--Authorized in
Title IX of the Elementary and Secondary Education Act (ESEA) the
American Indian Teacher Corps and the American Indian Administrator
Corps offer professional development grants designed to increase the
number of American Indian teachers and administrators serving their
reservation communities. The TCUs request that the Subcommittee
maintain funding for these programs at the fiscal year 2010 level.
Adult and Basic Education.--Despite the loss of Federal funding for
tribal adult basic education (ABE) in fiscal year 1996, there remains
an extremely high demand for ABE programs in the communities that are
home to the TCUs. While TCUs continue to offer adult education; GED;
remediation and literacy services for American Indians, without
dedicated funding these efforts cannot begin to meet demand. The TCUs
request that the Subcommittee direct that $5 million of the funds
appropriated each year for the Adult Education State Grants be made
available to make competitive awards to TCUs to support the vitally
needed reservation-based adult and basic education programs.
DEPARTMENT OF HEALTH AND HUMAN SERVICES PROGRAM
Tribal Colleges and Universities Head Start Partnership Program (DHHS-
ACF)
Tribal Colleges and Universities are ideal partners to help achieve
the goals of Head Start in Indian Country. The TCUs request that the
Subcommittee direct the Head Start Bureau to make available $5 million,
of the more than $8.1 billion for Head Start included in the
President's fiscal year 2012 budget request or of the amount ultimately
appropriated in fiscal year 2012, for the TCU-Head Start Partnership
program grants. These funds will help to ensure that each of the TCUs
has the opportunity to compete for these much-needed partnership funds,
thereby giving a jump start to the education successes of more American
Indian children growing up in poor and isolated tribal communities.
BACKGROUND ON TRIBAL COLLEGES AND UNIVERSITIES
The Nation's 36 Tribal Colleges and Universities, operating over 75
sites, provide access to quality higher education to 80 percent of
Indian Country. TCUs are accredited by independent, regional
accreditation agencies and like all institutions of higher education,
must undergo stringent performance reviews on a periodic basis to
retain their accreditation status. In addition to college level
programming, they provide high school completion (GED), basic
remediation, job training, college preparatory courses, and adult
education and literacy programs. TCUs fulfill additional roles within
their respective reservation communities functioning as community
centers, libraries, tribal archives, career and business centers,
economic development centers, public meeting places, and child and
elder care centers. Each TCU is committed to improving the lives of its
students through higher education and to moving American Indians toward
self-sufficiency.
Tribal Colleges and Universities, chartered by their respective
tribal governments, were established in response to the recognition by
tribal leaders that local, culturally based institutions are best
suited to help American Indians succeed in higher education. TCUs
effectively blend traditional teachings with conventional postsecondary
curricula. They have developed innovative ways to address the needs of
tribal populations and are overcoming long-standing barriers to success
in higher education for American Indians. Since the first TCU was
established on the Navajo Nation just over 40 years ago, these vital
institutions have come to represent the most significant development in
the history of American Indian higher education, providing access to,
and promoting achievement among, students who may otherwise never have
known postsecondary education success.
JUSTIFICATIONS FOR FISCAL YEAR 2012 APPROPRIATIONS REQUESTS FOR TCUS
Tribal colleges and our students are already disproportionately
impacted by efforts to reduce the Federal budget deficit and control
Federal spending. The final fiscal year 2011 continuing resolution
eliminated all of the Department of Housing and Urban Development's MSI
community-based programs, including a critical TCU-HUD facilities
program. TCUs were able to maximize leveraging potential, often
securing even greater non-Federal funding to construct and equip Head
Start and early childhood centers; student and community computer
laboratories and public libraries; and student and faculty housing in
rural and remote communities where few or none of these facilities
existed. Important STEM program operated by the National Science
Foundation and NASA were cut and for the first time since the program
was established in fiscal year 2001, no new TCU-STEM awards, our sole
STEM education program, are scheduled to be made in fiscal year 2011.
Additionally, TCUs and our students suffer the impact of cuts to
programs such as GEAR-UP, TRIO, SEOG, and year-round Pell more
profoundly than do mainstream institutions of higher education, which
have large endowments, alternative funding sources, including the
ability to charge higher tuition rates, enroll more financially stable
students, and affluent alumnae. The loss of opportunity that cuts to
DoEd, HUD, and NSF programs represent to TCUs, and to other MSIs, is
magnified by cuts to workforce development programs within the
Department of Labor, nursing and allied health professions tuition
forgiveness and scholarship programs operated by the Department of
Health and Human Services, and an important TCU-based nutrition
education program planned by USDA. Combined, these cuts strike at the
most economically disadvantaged and health-challenged Americans.
Higher Education Act
In 1998, section 316 within Title III-A of the Higher Education Act
launched a new program specifically for the Nation's Tribal Colleges
and Universities. Programs under Titles III and V of the Act support
institutions that enroll large proportions of financially disadvantaged
students and that have low per-student expenditures. TCUs, which are
truly developing institutions, are providing access to quality higher
education opportunities to some of the most rural, impoverished, and
historically underserved areas of the country. Seven of the Nation's 10
poorest counties are served by TCUs. A stated goal of the Higher
Education Act Title III programs is ``to improve the academic quality,
institutional management and fiscal stability of eligible institutions,
in order to increase their self-sufficiency and strengthen their
capacity to make a substantial contribution to the higher education
resources of the Nation.'' The TCU Title III-A program is specifically
designed to address the critical, unmet needs of their American Indian
students and communities, in order to effectively prepare them to
succeed in a global, competitive workforce. Yet, in fiscal year 2011
this critical program was cut by 11 percent. The TCUs urge the
Subcommittee to appropriate $30 million in fiscal year 2012 for HEA
Title III-A section 316, which is slightly less than the fiscal year
2010 appropriated funding level and the same as the President's fiscal
year 2012 budget request.
Retention and support services are vital to achieving the national
goal of having the highest percentage of college graduates globally, by
2020. The TRIO-Student Support Services program was created out of
recognition that college access was not enough to ensure advancement
and that multiple factors worked to prevent the successful completion
of higher education for many low-income and first-generation students
and students with disabilities. Therefore, in addition to maintaining
the maximum Pell Grant award level, it is critical that Congress also
sustains student assistance programs such as Student Support Services
and Upward Bound so that low-income and minority students have the
support necessary to allow them to persist in and complete their
postsecondary courses of study.
The importance of Pell Grants to TCU students cannot be overstated.
U.S. Department of Education figures show that the majority of TCU
students receive Pell Grants, primarily because student income levels
are so low and our students have far less access to other sources of
financial aid than students at State-funded and other mainstream
institutions. Within the TCU system, Pell Grants are doing exactly what
they were intended to do--they are serving the needs of the lowest
income students by helping them gain access to quality higher
education, an essential step toward becoming active, productive members
of the workforce. The TCUs urge the Subcommittee to continue to fund
this critical program at the highest possible level.
Carl D. Perkins Career and Technical Education Act
Tribally Controlled Postsecondary Career and Technical
Institutions.--Section 117 of the Carl D. Perkins Career and Technical
Education Act provides a competitively awarded grant opportunity for
tribally chartered and controlled career and technical institutions.
AIHEC requests $8,200,000 to fund grants under Section 117 of the
Perkins Act, the same level included in the President's fiscal year
2012 budget request.
Native American Career and Technical Education Program.--The Native
American Career and Technical Education Program (NACTEP) under Section
116 of the Act reserves 1.25 percent of appropriated funding to support
American Indian career and technical programs. The TCUs strongly urge
the Subcommittee to continue to support NACTEP, which is vital to the
continuation of the career and technical education programs offered at
TCUs that provide job training and certifications to remote reservation
communities.
Greater Support of Indian Education Programs
American Indian Adult and Basic Education (Office of Vocational and
Adult Education).--This program supports adult basic education programs
for American Indians offered by State and local education agencies,
Indian tribes, agencies, and TCUs. Despite a lack of funding, TCUs must
find a way to continue to provide much-in-demand basic adult education
classes for those American Indians that the present K-12 Indian
education system has failed. Before many individuals can even begin the
course work needed to learn a productive skill, they first must earn a
GED or, in some cases, even learn to read. There is an extensive need
for basic adult educational programs and TCUs must have adequate and
stable funding to provide these essential activities. TCUs request that
the Subcommittee direct that $5 million of the funds appropriated
annually for the Adult Education State Grants be made available to make
competitive awards to TCUs to help meet the growing demand for adult
basic education and remediation program services on their respective
reservations.
American Indian Teacher/Administrator Corps (Special Programs for
Indian Children).--American Indians are greatly underrepresented in the
teaching and school administrator ranks nationally. TCUs are community
based institutions of higher education making them ideal catalysts for
these two initiatives because of their current work in this area and
the existing articulation agreements they hold with 4-year degree
granting institutions. The TCUs request that the Subcommittee maintain
these two programs at the fiscal year 2010 appropriated levels to
continue to produce well-qualified American Indian teachers and school
administrators in and for Indian Country.
DEPARTMENT OF HEALTH AND HUMAN SERVICES/ADMINISTRATION FOR CHILDREN AND
FAMILIES/HEAD START
Tribal Colleges and Universities (TCU) Head Start Partnership
Program.--The TCU-Head Start Partnership has made a lasting investment
in our Indian communities by creating and enhancing associate degree
programs in Early Childhood Development and related fields. This
program has afforded American Indian children Head Start programs of
the highest quality. A clear barrier to the ongoing success of this
partnership program is the lack of stable funds for the Partnership.
The TCUs request that the Subcommittee direct the Head Start Bureau to
designate $5 million, of the more than $8.1 billion included in the
President's fiscal year 2012 budget request for programs under the Head
Start Act, be made available for the TCU-Head Start Partnership
program.
CONCLUSION
Tribal Colleges and Universities are providing access to high
quality higher education opportunities to many thousands of American
Indians and essential community services and programs to many more. The
modest Federal investment in TCUs has already paid great dividends in
terms of employment, education, and economic development and
continuation of this solid investment makes sound moral and fiscal
sense. TCUs need your help if they are to sustain programs and achieve
their missions to serve their students and communities.
Thank you again for this opportunity to present our funding
requests. We respectfully ask the Members of the Subcommittee for their
continued support of the Nation's Tribal Colleges and Universities and
full consideration of our fiscal year 2012 appropriations needs and
recommendations.
______
Prepared Statement of the American Institute for Medical and Biological
Engineering
Mister Chairman and Members of the Subcommittee: The American
Institute for Medical and Biological Engineering (AIMBE) appreciates
the opportunity to submit testimony to advocate for funding for
research within the National Institutes of Health (NIH) broadly, and
specifically research funding within the National Institute for
Biomedical Imaging and Bioengineering (NIBIB). NIH and NIBIB provide
avenues for research funding that are vital to the Nation's efforts to
support medical and biological engineering (MBE) innovation. AIMBE
represents 50,000 individuals and organizations throughout the United
States, including major healthcare companies, academic research
institutions and the top 2 percent of engineers, scientists and
clinicians whose discoveries and innovations have touched the health of
nearly every American. While today's testimony focuses on the impact
MBE has on improving the health and well-being of Americans, it is
important to note that MBE can also have a positive impact on many of
the other important issues facing us today; ranging from improvements
to the environment by finding green-energy solutions, to solving
problems relating to hunger, disease prevention, diagnosis and
treatment of disease; to economic growth spurred by the innovation of
new health products.
AIMBE was founded in 1991 to establish a clear and comprehensive
identity for the field of medical and biological engineering--which
applies principles of engineering science and practice to imagine,
create, and perfect the medical and biological discoveries that are
used to improve the health and quality of life of Americans and people
across the world. AIMBE's vision is to ensure MBE innovations continue
to develop for the benefit of humanity.
AIMBE applauds the past support of this committee to provide
funding to NIH, and was particularly pleased at the strong investment
in NIH provided by the American Recovery and Reinvestment Act. However,
we were concerned over recent cuts by the continuing resolution budget
for fiscal year 2011. We believe more stable, adequate, and reliable
funding is necessary to ultimately ensure America remains competitive
and continues to develop innovations that improve human health. An
increase in funding will support important work which is highly
translatable or applicable research into products that are life-saving,
and life enhancing. NIBIB is the only institute at the NIH with the
specific purpose of supporting and conducting biomedical engineering
research, which impacts all sectors of health across many disease
states. Research conducted within NIBIB is on the cutting edge of
biomedical engineering and has the potential to save lives and reduce
healthcare costs.
While each Institute within the NIH plays a vital role researching
and identifying disease prevention and treatment; the NIBIB plays a
unique role and has not benefited from large-scale NIH funding
increases, such as the doubling of the budget in 2004. First
appropriated with its own funding in 2004 (fiscal year 2003 and fiscal
year 2004 were funded through transfers from other Institutes within
NIH), the mission of NIBIB is to improve health by leading the
development and accelerating the application of biomedical
technologies. The NIBIB is committed to integrating the physical and
engineering sciences with the life sciences to advance basic research
and medical care. This is achieved through research and development of
new biomedical imaging and bioengineering techniques and devices to
fundamentally improve the detection, treatment, and prevention of
disease; enhancing existing imaging and bioengineering modalities;
supporting related research in the physical and mathematical sciences;
encouraging research and development in multidisciplinary areas;
supporting studies to assess the effectiveness and outcomes of new
biologics, materials, processes, devices, and procedures; developing
non-imaging technologies for early disease detection and assessment of
health status; and developing advanced imaging and engineering
techniques for conducting biomedical research at multiple scales
through modeling and simulation. Finally, the NIBIB plays an important
role in providing engineering research resources to the entirety of the
NIH. As the only engineering research arm within the NIH, NIBIB is
often relied upon to partner with other institutes at the NIH to
provide engineering expertise. The Laboratory of Molecular Imaging and
Nanomedicine, and Laboratory of Bioengineering and Physical Science are
two examples of NIBIB's role as a partner for researchers working at
other Institutes at the NIH.
We strongly recommend that early-stage, proof-of-concept projects
for translational research be funded at an enhanced level, ideally 0.5
percent of all external research budgets, at all Institutes. This is
critical to maintaining the U.S. lead in innovation by moving new
discoveries and novel systems to the stage where third-party private
funding can take them through development to the marketplace where they
help patients and the health of Americans. Publicly-held companies
cannot invest in this stage of work due to stockholder pressures, so
the Federal Government is critical to ensuring the viability of this
innovation pipeline.
NIBIB as a Stimulus for Innovation/Cost Effectiveness
Due in large part to the Great Recession, private industry and
private investors have been less likely to invest in high-risk
research, potentially slowing the pace of innovation. NIBIB fills a
void by providing funding for high-risk, high-reward research that
leads to the development of new technologies. Often times, private
investors in biomedical innovation are unwilling to invest in this type
of research, particularly in our current fiscal climate, because of the
risks involved. However, NIBIB can be a mechanism to bring new
technologies to market and fills the void left by a lack of private
capital.
The NIBIB's Quantum Grants program, for example, challenges the
research community to propose projects that have a highly focused,
collaborative, and interdisciplinary approach to solve a major medical
problem or to resolve a highly prevalent technology-based medical
challenge. The program consists of a 3-year exploratory phase to assess
feasibility and identify best approaches, followed by a second phase of
5 to 7 years. Major advances in medicine leading to quantifiable
improvements in public health require the kind of funding commitment
and intellectual focus found in the Quantum Grants program at NIBIB,
because early stage investors are reluctant to invest in high-risk
research. Additionally, the Quantum Grants offer a place for Government
to invest in translational research, potentially solving huge medical
problems facing Americans today.
The five currently funded Quantum Grants focus on: stem cell
therapies for patients suffering from the effects of diabetes and
stroke; the utilization of nanoparticles to help visualize brain tumors
so that surgeons can easily see and remove a cancerous mass in a
patient's brain; the development of an implantable artificial kidney
offering an improved quality of life for patients currently undergoing
dialysis treatment; and a microchip to capture circulating tumor cells
for clinicians to diagnose cancer earlier than ever before, giving
patients a greater hope for recovery thanks to earlier detection and
treatment. All these projects, in their early stages of funding, have
demonstrated promise for improving patient outcomes in the laboratory
setting.
An increase of funding to NIBIB and the Quantum Grants program may
offer opportunities to expedite research beyond laboratory study and
move to clinical trial. For example, if the artificial kidney research
is successful and brought to market, the cost to a person with kidney
disease would radically decrease because it would eliminate the need
for dialysis, which is a expensive, painful, and resource heavy
procedure typically done in an out-patient hospital setting.
The Fundamental Role of Engineering Research
Advances in the process of engineering research, in a variety of
fields, are a part of technological innovation. Medical and biological
engineering draws from research specialties across disciplines
(including mechanical, electrical, material, medical and biological
engineering, and clinicians), bringing together teams to create unique
solutions to the most pressing health problems. Engineering is the
practical application of science and math to solve problems. For
example, the insulin pump, which is the primary device used by patients
with diabetes who requires continuous insulin infusion therapy, is the
result of multi-disciplinary effort by engineers to develop a more
efficient way to manage diabetes. The science to develop and perfect an
insulin pump existed well before the creation of the medical device;
however it took biomedical engineers to apply the basic science toward
product development.
The first insulin pump to be manufactured was released in the late
70's. It was known as the ``big blue brick'' because of its size and
appearance. It sparked interest among healthcare professionals who saw
it as a device that would render syringes obsolete for people who have
daily insulin injection needs. While the technology was promising, the
first commercial pump lacked the controls and interface to make it a
safe alternative to manual injections. Dosage was inaccurate thus
making the device more of a danger than a solution.
It was only in the beginning of the 1990's that biomedical
engineers began to develop more user-friendly models that could be used
by diabetics. Advances in biomedical engineering research focused on
reducing device size, increasing energy efficiency (and thus improving
battery life), and improving reliability. Such improvements were of
great benefit to insulin pump manufacturers who were able to make their
models smaller, more affordable, and easier for patients to use.
Insulin pumps enable many diabetic patients to live productive lives
due to fewer absences from work and reduced hospitalizations.
A similar advancement in the treatment of atherolosclerosis through
MBE is the use of angioplasty with an arterial stent which releases
drugs directly to the coronary artery (referred to as a drug eluting
stent). This advancement has replaced more then 500,000 bypass
surgeries a year, at an annual cost savings of $4 billion, and an
immeasurable improvement in the quality of life of patients receiving
this treatment.
Engineering research in human physiology, specifically in range of
motion and function, has increased the function for artificial limbs.
The decreasing mortality and increasing number of disabled war veterans
highlights the need for more highly functional prosthetics. Engineering
research and development processes have taken the strapped wooden leg
to a realistic synergic leg and foot transtibial prosthetic that
employs advanced biomechanics and microelectronic controls to allow a
fuller range of motion, including running. Basic engineering research
in polymers and materials science has changed the look and feel of
prosthetic limbs so they are no longer easily discernable, reducing the
stigma, and making them more durable, lessening the cost of maintenance
and replacement. Researchers in Baltimore, Cleveland, and Chicago are
developing the next generation of prosthetic limbs, utilizing cutting
edge biomedical engineering research to develop prostheses that are
more sensitive, more responsive, and more lifelike then anything
developed in the past. These new ``bionic limbs'' are giving patients
pieces of their body back, pieces taken from them through traumatic
injury or disease. Increases in funding to NIBIB, who uniquely partners
with other Federal agencies such as the Department of Veterans Affairs
and Department of Defense, may lead to biomedical engineering
innovations to improve the quality of life of warfighters injured on
the battlefield as well as civilians.
The engineering research process has played a large part in
extending and deploying innovative imaging technologies such as
magnetic resonance imaging (MRI) and ultra-fast computed tomography (CT
scan). These technologies facilitate early detection of disease and
dysfunction, allowing for earlier treatment and slowing the progression
of disease. When prescribed correctly these technologies can reduce the
costs of healthcare by diagnosing diseases earlier, allowing for
earlier clinical intervention and reduced hospitalizations with faster
recovery times.
The Nation deserves a strong return on its investment in the basic
medical research funded by NIH. Additional engineering research,
including translation of basic research into new devices and more
efficient medical procedures, is a critical part of ensuring that
return. This combination of basic scientific studies and engineering
research, will in turn, lead to many technological innovations which
will improve the quality of life and well-being of Americans. The
Government needs to continue to fund the vital research at NIH and
NIBIB to continue to be a leader in healthcare innovation, and for the
creation of jobs in the healthcare segment of our national economy.
AIMBE looks forward to the opportunity to continue this dialogue
with all of you individually. Thank you again for your time and
consideration on this important matter.
______
Prepared Statement of the American Lung Association
SUMMARY OF PROGRAMS
Centers for Disease Control and Prevention (CDC)
Increased overall CDC funding--$7.7 billion
--Funding Healthy Communities--$52.8 million
--Office on Smoking and Health--$110 million
--National Asthma Control Program--$31 million
--Environment and Health Outcome Tracking--$32.1 million
--Tuberculosis programs--$231 million
--CDC influenza preparedness--$160 million
--NIOSH--$315.3 million
--Prevention and Public Health Fund--$1 billion, with $330 million
for tobacco control initiatives
National Institutes of Health (NIH)
Increased overall NIH funding--$35 billion
National Heart, Lung and Blood Institute--$3.514 billion
National Cancer Institute--$5.725 billion
National Institute of Allergy and Infectious Diseases--$5.395
billion
National Institute of Environmental Health Sciences--$779.4 million
National Institute of Nursing Research--$163 million
National Institute on Minority Health & Health Disparities--$236.9
million
Fogarty International Center--$78.4 million
For more information about this testimony, please contact Erika
Sward at [email protected].
The American Lung Association is pleased to present our
recommendations for fiscal year 2012 to the Labor, Health and Human
Services, and Education Appropriations Subcommittee. The public health
and research programs funded by this committee will prevent lung
disease and improve and extend the lives of millions of Americans who
suffer from lung disease.
The American Lung Association is the oldest voluntary health
organization in the United States, with national offices and local
associations around the country. Founded in 1904 to fight tuberculosis,
the American Lung Association is the leading organization working to
save lives by improving lung health and preventing lung disease through
education, advocacy and research.
A Sustained and Sustainable Investment
Mr. Chairman, investments in prevention and wellness can and will
pay near term and long term dividends for the health of the American
people and people everywhere. That is why the American Lung Association
strongly supports the Prevention and Public Health Fund established in
the Affordable Care Act. This fund will provide billions of dollars to
critical public health initiatives, like community programs that help
people quit smoking, support groups for lung cancer patients, and
classes that teach people how to avoid asthma attacks.
The United States must also maintain its commitment to medical
research. A growing, sustained, predictable and reliable investment in
the NIH provides hope for millions afflicted with lung disease. While
our focus is on lung disease research, we strongly support increasing
the investment in research across the entire National Institutes of
Health.
Lung Disease
Each year, almost 400,000 Americans die of lung disease. It is
America's number three killer, responsible for one in every six deaths.
More than 37 million Americans suffer from a chronic lung disease. Each
year lung disease costs the economy an estimated $173 billion. Lung
diseases include: lung cancer, asthma, chronic obstructive pulmonary
disease (COPD), tuberculosis, pneumonia, influenza, sleep disordered
breathing, pediatric lung disorders, occupational lung disease and
sarcoidosis.
Improving Public Health
The American Lung Association strongly supports investments in the
public health infrastructure. In order for the Centers for Disease
Control and Prevention (CDC) to carry out its prevention mission and to
assure an adequate translation of new research into effective State and
local programs to improve the health of all Americans, we strongly
support increasing the overall CDC funding to $7.7 billion.
We strongly encourage improved disease surveillance and health
tracking to better understand diseases like asthma. We support an
appropriations level of $32.1 million for the Environment and Health
Outcome Tracking Network to allow Federal, State and local agencies to
track potential relationships between hazards in the environment and
chronic disease rates.
We strongly support investments in communities to bring together
key stakeholders to identify and improve policies and environmental
factors influencing health in order to reduce the burden of chronic
diseases. These programs lead to a wide range of improved health
outcomes including reduced tobacco use. We strongly recommend at least
$52.8 million in funding for the Healthy Communities program and it
remaining a separate, stand alone program.
Tobacco Use
Tobacco use is the leading preventable cause of death in the United
States, killing more than 443,000 people every year. Smoking is
responsible for one in five U.S. deaths. The direct healthcare and lost
productivity costs of tobacco-caused disease and disability are also
staggering, an estimated $193 billion each year.
Given the magnitude of the tobacco-caused disease burden and how
much of it can be prevented; the CDC Office on Smoking and Health (OSH)
should be much larger and better funded. Historically, Congress has
failed to invest in tobacco control--even though public health
interventions have been scientifically proven to reduce tobacco use.
This neglect cannot continue if the nation wants to prevent disease and
promote wellness.
The American Lung Association urges that $110 million be
appropriated to OSH for fiscal year 2012 and that OSH receive an
additional one-third, or $330 million, of funds from the Prevention and
Public Health Fund.
Asthma
The American Lung Association strongly opposes the proposal in the
President's budget request that would merge the National Asthma Control
Program with the Healthy Homes/Lead Poisoning Prevention Program--and
then slash the combined programs by more than 50 percent. The Lung
Association asks this Committee to retain the National Asthma Control
Program as a stand-alone program and that $31 million be appropriated
to it for fiscal year 2012.
It is estimated that almost 25 million Americans currently have
asthma, of whom 7.1 million are children. Asthma prevalence rates are
over 37 percent higher among African Americans than whites. Studies
also suggest that Puerto Ricans have higher asthma prevalence rates and
age-adjusted death rates than all other racial and ethnic subgroups.
Asthma is the third leading cause of hospitalization among children
under the age of 15 and is a leading cause of school absences from
chronic disease--accounting for over 10.5 million lost school days in
2008. Asthma costs our healthcare system over $50.1 billion annually
and indirect costs from lost productivity add another $5.9 billion, for
a total of $56 billion annually.
We recommend that the National Heart, Lung and Blood Institute
receive $3.514 billion and the National Institute of Allergy and
Infectious Diseases be appropriated $5.395 billion, and that both
agencies continue their investments in asthma research in pursuit of
treatments and cures.
Lung Cancer
An estimated 370,000 Americans are living with lung cancer. During
2010, an estimated 222,520 new cases of lung cancer were diagnosed, and
158,664 Americans died from lung cancer in 2009. Survival rates for
lung cancer tend to be much lower than those of most other cancers.
African Americans are the most likely to develop and die from lung
cancer than persons of any other racial group.
Lung cancer receives far too little attention and focus. Given the
magnitude of lung cancer and the enormity of the death toll, the
American Lung Association strongly recommends that the NIH and other
Federal research programs commit additional resources to lung cancer.
We support a funding level of $5.725 billion for the National Cancer
Institute and urge more attention and focus on lung cancer.
Chronic Obstructive Pulmonary Disease
Chronic obstructive pulmonary disease, or COPD, is the third
leading cause of death in the United States. It has been estimated that
13.1 million patients have been diagnosed with some form of COPD and as
many as 24 million adults may suffer from its consequences. In 2009,
133,737 people in the United States died of COPD. The annual cost to
the Nation for COPD in 2010 was projected to be $49.9 billion. This
includes $29.5 billion in direct healthcare expenditures, $8.0 billion
in indirect morbidity costs and $12.4 billion in indirect mortality
costs. Medicare expenses for COPD beneficiaries were nearly 2.5 times
that of the expenditures for all other patients.
The American Lung Association strongly recommends that the NIH and
other Federal research programs commit additional resources to COPD
research programs. We strongly support funding the National Heart, Lung
and Blood Institute and its lifesaving lung disease research program at
$3.514 billion. The American Lung Association also asks the Committee
to direct the National Heart, Lung and Blood Institute to work with the
CDC and other appropriate agencies to prepare a national action plan to
address COPD, which should include public awareness and surveillance
activities.
Influenza
Influenza is a highly contagious viral infection and one of the
most severe illnesses of the winter season. It is unpredictable, with
seasonal death estimates ranging from 3,000 to 49,000 over the last 30
years. Further, the emerging threat of a pandemic influenza is looming
as the recently emerging strain of H1N1 reminded us. Public health
experts warn that 209,000 Americans could die and 865,000 would be
hospitalized if a moderate flu epidemic hits the United States. To
prepare for a potential pandemic, the American Lung Association
supports funding the Federal CDC Influenza efforts at $160 million.
Tuberculosis
Tuberculosis primarily affects the lungs but can also affect other
parts of the body. There are an estimated 10 million to 15 million
Americans who carry latent TB infection. Each has the potential to
develop active TB in the future. About 10 percent of these individuals
will develop active TB disease at some point in their lives. In 2009,
there were 11,545 cases of active TB reported in the United States.
While declining overall TB rates are good news, the emergence and
spread of multi-drug resistant TB pose a significant threat to the
public health of our Nation. Continued support is needed if the United
States is going to continue progress toward the elimination of TB. We
request that Congress increase funding for tuberculosis programs at CDC
to $231 million for fiscal year 2012.
Conclusion
The American Lung Association also would like to indicate our
strong support for CDC and NIH, particularly those programs that impact
lung health. We strongly support an across the board increase for NIH
with particular emphasis on the National Heart, Lung and Blood
Institute, the National Cancer Institute, the National Institute of
Allergy and Infectious Diseases, the National Institute of
Environmental Health Sciences, the National Institute of Nursing
Research, the National Institute on Minority Health & Health
Disparities and the Fogarty International Center.
Lung disease is a continuing, growing problem in the United States.
It is America's number three killer, responsible for one in six deaths.
Progress against lung disease is not keeping pace with other major
causes of death and more must be done. The level of support this
committee approves for lung disease programs should reflect the urgency
illustrated by these numbers.
______
Prepared Statement of the American National Red Cross
Chairman Tom Harkin, Ranking Member Richard Shelby, and Members of
the Subcommittee, the American Red Cross and the United Nations
Foundation appreciate the opportunity to submit testimony in support of
measles control activities of the U.S. Centers for Disease Control and
Prevention (CDC). The American Red Cross and the United Nations
Foundation recognize the leadership that Congress has shown in funding
CDC for these essential activities. We sincerely hope that Congress
will continue to support the CDC during this critical period in measles
control.
In 2001, CDC--along with the American Red Cross, the United Nations
Foundation, the World Health Organization, and UNICEF--founded the
Measles Initiative, a partnership committed to reducing measles deaths
globally. The current U.N. goal is to reduce measles deaths by 95
percent by 2015 compared to 2000 estimates. The Measles Initiative is
committed to reaching this goal by proving technical and financial
support to governments and communities worldwide.
The Measles Initiative has achieved ``spectacular'' \1\ results by
supporting the vaccination of more than 700 million children. Largely
due to the Measles Initiative, global measles mortality dropped 78
percent, from an estimated 733,000 deaths in 2000 to 164,000 in 2008
(the latest year for which data is available). During this same period,
measles deaths in Africa fell by 92 percent, from 371,000 to 28,000.
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\1\ The Lancet, Volume 8, page 13 (January 2008).
Working closely with host governments, the Measles Initiative has
been the main international supporter of mass measles immunization
campaigns since 2001. The Initiative mobilized more than $700 million
and provided technical support in more than 60 developing countries on
vaccination campaigns, surveillance and improving routine immunization
services. From 2000 to 2008, an estimated 4.3 million measles deaths
were averted as a result of these accelerated measles control
activities at a donor cost of $184/death averted, making measles
mortality reduction one of the most cost-effective public health
interventions.
Nearly all the measles vaccination campaigns have been able to
reach more than 90 percent of their target populations. Countries
recognize the opportunity that measles vaccination campaigns provide in
accessing mothers and young children, and ``integrating'' the campaigns
with other life-saving health interventions has become the norm. In
addition to measles vaccine, Vitamin A (crucial for preventing
blindness in under nourished children), de-worming medicine (reduces
malnutrition), and insecticide-treated bed nets (ITNs) for malaria
prevention are distributed during vaccination campaigns. The scale of
these distributions is immense. For example, more than 40 million ITNs
were distributed in vaccination campaigns in the last few years. The
delivery of multiple child health interventions during a single
campaign is far less expensive than delivering the interventions
separately, and this strategy increases the potential positive impact
on children's health from a single campaign.
The extraordinary reduction in global measles deaths contributed
nearly 25 percent of the progress to date toward Millennium Development
Goal #4 (reducing under-five child mortality). However, since 2009,
Africa has experienced outbreaks affecting 28 countries, resulting in a
four-fold increase in reported measles cases. These outbreaks highlight
the fragility of the last decade's progress. If mass immunization
campaigns are not continued, measles deaths will increase rapidly with
more than half a million deaths estimated for 2013 alone.
To achieve the 2015 goal and avoid a resurgence of measles the
following actions are required:
--Fully implementing activities, both campaigns and strengthening
routine measles coverage, in India since it is the greatest
contributor to the global burden of measles.
--Sustaining the gains in reduced measles deaths, especially in
Africa, by strengthening immunization programs to ensure that
more than 90 percent of infants are vaccinated against measles
through routine health services before their first birthday as
well as conducting timely, high quality mass immunization
campaigns.
--Securing sufficient funding for measles-control activities both
globally and nationally. The Measles Initiative faces a funding
shortfall of an estimated $212 million for 2012-2105.
Implementation of timely measles campaigns is increasingly
dependent upon countries funding these activities locally. The
decrease in donor funds available at global level to support
measles elimination activities makes increased political
commitment and country ownership of the activities critical for
achieving and sustaining the goal of reducing measles mortality
by 90 percent.
If these challenges are not addressed, the remarkable gains made
since 2000 will be lost and a major resurgence in measles deaths will
occur.
By controlling measles cases in other countries, U.S. children are
also being protected from the disease. Measles can cause severe
complications and death. A resurgence of measles occurred in the United
States between 1989 and 1991, with more than 55,000 cases reported.
This resurgence was particularly severe, accounting for more than
11,000 hospitalizations and 123 deaths. Since then, measles control
measures in the United States have been strengthened and endemic
transmission of measles cases have been eliminated here since 2000.
However, importations of measles cases into this country continue to
occur each year. The costs of these cases and outbreaks are
substantial, both in terms of the costs to public health departments
and in terms of productivity losses among people with measles and
parents of sick children. For example in 2008, 2 hospitals in Arizona
spent an estimated $800,000 responding and containing 7 measles
cases.\2\ The United States is currently on track to have more measles
cases in 2011 than any year in more than a decade.
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\2\ Chen SY, Anderson S, Kutty PK, et al. J of Infect Dis 2011;
203: 1517-1525.
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The Role of CDC in Global Measles Mortality Reduction
Since fiscal year 2001, Congress has provided approximately $43.6
million annually in funding to CDC for global measles control
activities. These funds were used toward the purchase of measles
vaccine for use in large-scale measles vaccination campaigns in more
than 60 countries in Africa and Asia, and for the provision of
technical support to Ministries of Health. Specifically, this technical
support includes: Planning, monitoring, and evaluating large-scale
measles vaccination campaigns; conducting epidemiological
investigations and laboratory surveillance of measles outbreaks; and
conducting operations research to guide cost-effective and high quality
measles control programs.
In addition, CDC epidemiologists and public health specialists have
worked closely with WHO, UNICEF, the United Nations Foundation, and the
American Red Cross to strengthen measles control programs at global and
regional levels. While it is not possible to precisely quantify the
impact of CDC's financial and technical support to the Measles
Initiative, there is no doubt that CDC's support--made possible by the
funding appropriated by Congress--was essential in helping achieve the
sharp reduction in measles deaths in just 8 years.
The American Red Cross and the United Nations Foundation would like
to acknowledge the leadership and work provided by CDC and recognize
that CDC brings much more to the table than just financial resources.
The Measles Initiative is fortunate in having a partner that provides
critical personnel and technical support for vaccination campaigns and
in response to disease outbreaks. CDC personnel have routinely
demonstrated their ability to work well with other organizations and
provide solutions to complex problems that help critical work get done
faster and more efficiently.
In fiscal year 2011, Congress appropriated approximately $49
million to fund CDC for global measles control activities, this
represented at $2.6 million decrease from the previous year. The
American Red Cross and the United Nations Foundation respectfully
request a return to fiscal year 2010 funding levels ($52 million) for
fiscal year 2012 for CDC's measles control activities to protect the
investment of the last decade, and prevent a global resurgence of
measles and a loss of progress toward Millennium Development Goal #4.
Your commitment has brought us unprecedented victories in reducing
measles mortality around the world. In addition, your continued support
for this initiative helps prevent children from suffering from this
preventable disease both abroad and in the United States.
Thank you for the opportunity to submit testimony.
______
Prepared Statement of the American Nurses Association
The American Nurses Association (ANA) appreciates the opportunity
to comment on fiscal year 2012 appropriations for the Title VIII
Nursing Workforce Development Programs and Nurse-Managed Health
Clinics. Founded in 1896, ANA is the only full-service professional
association representing the interests of the Nation's 3.1 million
registered nurses (RNs) through its State nurses associations, and
organizational affiliates. The ANA advances the nursing profession by
fostering high standards of nursing practice, promoting the rights of
nurses in the workplace, and projecting a positive and realistic view
of nursing.
As the largest single group of clinical healthcare professionals
within the health system, licensed registered nurses are educated and
practice within a holistic framework that views the individual, family
and community as an interconnected system that can keep us well and
help us heal. Registered nurses are fundamental to the critical shift
needed in health services delivery, with the goal of transforming the
current ``sick care'' system into a true ``healthcare'' system. RNs are
the backbone of hospitals, community clinics, school health programs,
home health and long-term care programs, and serve patients in many
other roles and settings. The ANA gratefully acknowledges this
Subcommittee's history of support for nursing education. We also
appreciate your continued recognition of the important role nurses play
in the delivery of quality healthcare services, including Nurse-Managed
Health Clinics (NMHCs).
The Nursing Shortage
A sufficient supply of nurses is critical in providing our Nation's
population with quality healthcare. Registered Nurses (RNs) and
Advanced Practice Registered Nurses (APRNs) play an integral role in
the delivery of primary care and help to bring the focus of our
healthcare system back where it belongs--on the patient and the
community. The current U.S. nursing shortage is already having a
detrimental impact on our healthcare system, and it is expected to grow
to a 260,000 nurse shortfall by 2025. A shortage of this magnitude
would be twice as large as any shortage experienced by this country
since the 1960s. Cuts to Title VIII funding would be detrimental to the
healthcare system and the patients we serve.
As noted above, the nursing shortage is having a detrimental impact
on the entire healthcare system. Numerous studies have shown that
nursing shortages contribute to medical errors, poor patient outcomes,
and increased mortality rates. A study published in the March 17, 2011
issue of the New England Journal of Medicine shows that inadequate
staffing is tied to higher patient mortality rate. The study supports
findings of previous studies and finds that higher than typical rates
of patient admissions, discharges, and transfers during a shift were
associated with increased mortality--an indication of the important
time and attention needed by RNs to ensure effective coordination of
care for patients at critical transition periods.
Nursing Workforce Development Programs
The Nursing Workforce Development programs, authorized under Title
VIII of the Public Health Service Act (42 U.S.C. 296 et seq.) support
the supply and distribution of qualified nurses to meet our Nation's
healthcare needs. Over the last 46 years, Title VIII programs have
addressed each aspect of the nursing shortages--education, practice,
retention, and recruitment.
--Title VIII provides the largest source of Federal funding for
nursing education, offering financial support for nursing
education programs, individual students, and nurses.
--These programs bolster nursing education at all levels, from entry-
level preparation through graduate study.
--Title VIII programs favor institutions that educate nurses for
practice in rural and medically underserved communities.
--In fiscal year 2008, these programs provided loans, scholarships,
traineeships, and programmatic support to 77,395 nursing
students and nurses.
The 107th Congress recognized the detrimental impact of the
developing nursing shortage and passed the Nurse Reinvestment Act
(Public Law 107-205). This law improved the Title VIII Nursing
Workforce Development programs to meet the unique characteristics of
today's shortage. These programs were also strengthened and
reauthorized with the adoption of the Affordable Care Act. This
achievement holds the promise of recruiting new nurses into the
profession, promoting career advancement within nursing and improving
patient care delivery. However, this promise cannot be met without a
significant investment. ANA strongly urges Congress to increase funding
for Title VIII programs to a total of $313.075 million in fiscal year
2012. This is also the amount requested in President Obama's fiscal
year 2012 budget.
Current funding levels are clearly failing to meet the need. In
fiscal year 2008 (most recent year statistics are available), the
Health Resources and Services Administration (HRSA) was forced to turn
away 92.8 percent of the eligible applicants for the Nurse Education
Loan Repayment Program (NELRP), and 53 percent of the eligible
applicants for the Nursing Scholarship program due to a lack of
adequate funding. These programs are used to direct RNs into areas with
the greatest need--including departments of public health, community
health centers, and disproportionate share hospitals.
Title VIII includes the following program areas:
Nursing Education Loan Repayment Program and Scholarships.--This
line item is comprised of the Nurse Education Loan Repayment Program
(NELRP) and the Nursing Scholarship Program (NSP). In fiscal year 2010,
the Nurse Education Loan Repayment Program and Scholarships received
$93.8 million.
The NELRP repays up to 85 percent of a RN's student loans in return
for full-time practice in a facility with a critical nursing shortage.
The NELRP nurse is required to work for at least 2 years in a
designated facility, during which time the NELRP repays 60 percent of
the RN's student loan balance. If the nurse applies and is accepted for
an optional third year an additional 25 percent of the loan is repaid.
In fiscal year 2008, HRSA received 3,039 applications for the
nursing scholarship. Due to lack of funding, a mere 177 scholarships
were awarded. Therefore, 2,862 nursing students (94 percent) willing to
work in facilities with a critical shortage were denied access to this
program.
Nurse Faculty Loan Program.--This program establishes a loan
repayment fund within schools of nursing to increase the number of
qualified nurse faculty. Nurses may use these funds to pursue a
master's or doctoral degree. They must agree to teach at a school of
nursing in exchange for cancellation of up to 85 percent of their
educational loans, plus interest, over a 4-year period. In fiscal year
2010, this program received $25 million.
This program is vital given the critical shortage of nursing
faculty. America's schools of nursing cannot increase their capacity
without an influx of new teaching staff. Last year, schools of nursing
were forced to turn away tens of thousands of qualified applicants due
largely to the lack of faculty. In fiscal year 2008, HRSA funded 95
faculty loans.
Nurse Education, Practice, and Retention Grants.--This section is
comprised of many programs designed to support entry-level nursing
education and to enhance nursing practice. The education grants are
designed to expand enrollments in baccalaureate nursing programs,
develop internship and residency programs to enhance mentoring and
specialty training, and provide new technologies in education including
distance learning. All together, the Nurse Education, Practice, and
Retention Grants supported 42,761 nurses and nursing students in fiscal
year 2008. The program received $39.8 million in fiscal year 2010.
Nursing Workforce Diversity.--This program provides funds to
enhance diversity in nursing education and practice. It supports
projects to increase nursing education opportunities for individuals
from disadvantaged backgrounds--including racial and ethnic minorities,
as well as individuals who are economically disadvantaged. In fiscal
year 2008, 85 applications were received for workforce diversity
grants, 51 programs were funded. In fiscal year 2010, these programs
received $16 million.
Advanced Nursing Education.--Advanced practice registered nurses
(APRNs) are nurses who have attained advanced expertise in the clinical
management of health conditions. Typically, an APRN holds a master's
degree with advanced didactic and clinical preparation beyond that of
the RN. Most have practice experience as RNs prior to entering graduate
school. Practice areas include, but are not limited to: anesthesiology,
family medicine, gerontology, pediatrics, psychiatry, midwifery,
neonatology, and women's and adult health. Title VIII grants have
supported the development of virtually all initial State and regional
outreach models using distance learning methodologies to provide
advanced study opportunities for nurses in rural and remote areas. In
fiscal year 2009, 5,649 advanced education nurses were supported
through these programs. In fiscal year 2010, these programs received
$64.4 million.
Comprehensive Geriatric Education Grants.--This authority awards
grants to train and educate nurses in providing healthcare to the
elderly. Funds are used to train individuals who provide direct care
for the elderly, to develop and disseminate geriatric nursing
curriculum, to train faculty members in geriatrics, and to provide
continuing education to nurses who provide geriatric care. In fiscal
year 2008, 6,514 nurses and nursing students were supported through
these programs. In fiscal year 2010, these grants received $4.5
million. The growing number of elderly Americans and the impending
healthcare needs of the baby boom generation make this program
critically important.
Nurse-Managed Health Clinics
A healthcare system must value primary care and prevention to
achieve improved health status of individuals, families and the
community. As Congress recognized through the passage of the Affordable
Care Act (ACA) money, resources and attention must be reallocated in
the health system to highlight importance of, and create incentives
for, primary care and prevention.
Nurses are strong supporters of community and home-based models of
care. We believe that the foundation for a wellness-based healthcare
system is built in these settings and reduces the amount of both money
and human suffering. ANA supports the renewed focus on new and existing
community-based programs such as Nurse Managed Health Centers (NMHCs).
Currently, there are more than 200 Nurse Managed Health Centers
(NMHCs) in the United States which have provided care to over 2 million
patients annually. ANA believes that Nurse Managed Health Centers
(NMHCs) are an efficient, sensible, cost-effective way to deliver
primary healthcare services. These clinics are also used as clinical
sites for nursing education. The nurse-managed care model is especially
effective in disease prevention and early detection, management of
chronic conditions, treatment of acute illnesses, health promotion, and
more. Nurse Managed Health Centers (NMHCs) can also provide a medical
home for underserved individuals as well as partnering with the Federal
Government to reduce health disparities.
ANA was pleased to see that the Affordable Care Act (ACA) provided
grant eligibility to Nurse-Managed Health Clinics (NMHCs) to support
operating costs. ACA also authorized up to $50 million a year to
support operating costs. ANA strongly urges Congress to provide $20
million for the Nurse-Managed Health Clinics authorized under Title
VIII of the Public Health Service Act in fiscal year 2012 as
recommended in President Obama's fiscal year 2012 budget.
Conclusion
While ANA appreciates the continued support of this Subcommittee,
we are concerned that Title VIII funding levels have not been
sufficient to address the growing nursing shortage. In preparation for
the implementation of healthcare reform initiatives, which ANA
supports, we believe there will be an even greater need for nurses and
adequate funding for these programs is even more essential. Registered
Nurses (RNs) and Advanced Practice Nurses (APRNs) are key providers
whose care is linked directly to the availability, cost, and quality of
healthcare services. ANA asks you to meet today's shortage with a
relatively modest investment of $313.075 million in fiscal year 2012
for the Health Resources and Services Administration Nursing Workforce
Development programs and $20 million for Nurse-Managed Health Clinics.
Thank you.
______
Prepared Statement of the American Physical Therapy Association
On behalf of more than 77,000 physical therapists, physical
therapist assistants, and students of physical therapy, the American
Physical Therapy Association (APTA) thanks you for the opportunity to
submit official testimony regarding recommendations for the fiscal year
2012 appropriations. APTA's mission is to improve the health and
quality of life of individuals in society by advancing physical
therapist practice, education, and research. Physical therapists across
the country utilize a wide variety of federally funded resources to
work collaboratively toward the advancement of these goals. APTA's
recommendations for Federal funding, as outlined in this document,
reflect a commitment toward these priorities for the good of society
and the rehabilitation community.
Department of Health and Human Services
National Institutes of Health (NIH)
Rehabilitation research was funded at $458 million within NIH's
approximately $31.2 billion budget in fiscal year 2010. This represents
roughly 1 percent of NIH funds for an area of biomedical research that
impacts a growing percentage of our Nation's seniors, persons with
disabilities, young persons with chronic disease or traumatic injuries,
and children with development disabilities. The Institute of Medicine
(IOM) estimates that 1 in 7 individuals have an impairment or
limitation that significantly limits their ability to perform
activities of daily living. Investment in and recognition of
rehabilitation within NIH is a necessary step toward continuing to meet
the needs of these individuals in our population. Through the American
Recovery and Reinvestment Act (ARRA), rehabilitation research was able
to take advantage of an extra infusion of approximately $75 million in
fiscal year 2009 and $93 million in fiscal year 2010. However, APTA
believes that rehabilitation research at NIH has been under-funded for
many years. The funds currently utilized are well-invested for the
impact that rehabilitation interventions will have on the quality of
lives of individuals. Continued investment and greater recognition and
coordination of rehabilitation research among Institutes and across
Federal departments will enhance the returns the Federal Government
receives when investing in this area. Taking this into consideration,
APTA recommends $31.829 billion (a $629 million increase over fiscal
year 2010) for NIH in fiscal year 2012 to ensure that the momentum is
maintained that was gained under the ARRA investment to improve health,
spur economic growth and innovation, and advance science. APTA
recognizes the extraordinary circumstances that exist during these
tough budgetary times, however it still remains crucial that Federal
investments in healthcare research are preserved and at least kept on
pace with the rate of inflation.
Specifically, the physical therapy and rehabilitation science
community recommends that Congress allocate crucial funding
enhancements in the following institutes:
--$1.356 billion (a 2 percent increase over fiscal year 2010) for the
Eunice Kennedy Shriver National Institute of Child Health and
Human Development (NICHD) which houses the National Center for
Medical Rehabilitation Research (NCMRR), the only entity within
NIH explicitly focused on the advancement of rehabilitation
science. NCMRR fosters the development of scientific knowledge
needed to enhance the health, productivity, independence, and
quality-of-life of people with disabilities. A primary goal of
the Center-supported research is to bring the health-related
problems of people with disabilities to the attention of the
best scientists in order to capitalize upon the myriad advances
occurring in the biological, behavioral, and engineering
sciences.
--$1.66 billion (a 2 percent increase over fiscal year 2010) for the
National Institute of Neurological Disorders and Stroke
(NINDS). This funding level is required to enhance existing
initiatives and invest in new and promising research to prevent
stroke and advance rehabilitation in stroke treatment. Despite
being a major cause of disability and the number three cause of
death in the United States, NIH invests only 1 percent of its
budget in stroke research. However, APTA recognizes the
advancements that NIH-funded research has achieved in the
specific area of stroke rehabilitation. APTA commends this area
of leadership at NIH and encourages a continued focus on
rehabilitation interventions and physical therapy to maximize
an individual's function and quality of life after a stroke.
--$550 million for the National Institute of Arthritis and
Musculoskeletal and Skin Diseases (NIAMS) for arthritis and
musculoskeletal research.
Centers for Disease Control and Prevention (CDC)
APTA was disappointed to see the cuts that have been implemented
within CDC for fiscal year 2011. The contributions of CDC to the lives
of countless individuals are limited only by the resources available
for carrying out its vital mission. Our Nation and the world will
continue to benefit from further improvement in public health and
investment in scientific advancement and prevention. APTA recommends
Congress provide at least $7.7 billion for CDC's fiscal year 2012
``core programs'' in the fiscal year 2012 Labor-HHS-Education
Appropriations bill. This request reflects the support CDC will need to
fulfill its core missions for fiscal year 2012. APTA strongly believes
that the activities and programs supported by CDC are essential in
protecting the health of the American people. APTA supports the
Prevention and Public Health Fund (PPHF) and its underlying purpose of
providing supplemental funding as an investment to expand
infrastructure for prevention initiatives. We are not supportive of
efforts to use the PPHF to supplant current programmatic funding within
the budgets of agencies, such as CDC.
Physical therapists play an integral role in the prevention,
education, and assessment of the risk for falls. The CDC is currently
only allocating $2 million per year to address the increasing
prevalence of falls, a problem costing more than $19.2 billion a year.
Among older adults, falls are the leading cause of injury deaths. This
is why APTA respectfully requests that $21.7 million be provided in
funding for the ``Unintentional Injury Prevention'' account to allow
CDC's National Center for Injury Prevention and Control (NCIPC) to
comprehensively address the large-scale growth of older adult falls.
CDC has made great strides in developing and laying the groundwork for
evidence-based falls prevention programs that link clinical
intervention with community-based programs to make an impactful benefit
for American society in addressing this expensive and burdensome
healthcare problem. Without an increase in resources, CDC is unable to
effectively scale-up and expand infrastructure beyond the few cities in
which the programs have currently been developed to begin reaching all
communities across the United States.
Traumatic Brain Injury (TBI) is a leading cause of death and
disability among young Americans and continues to be the signature
injury of the conflicts in Iraq and Afghanistan. CDC estimates that at
least 5.3 million Americans, approximately 2 percent of the U.S.
population, currently require lifelong assistance to perform activities
of daily living as a result of TBI. High quality, evidence-based
rehabilitation for TBI is typically a long and intensive process. From
the battlefield to the football field, American adults and youth
continue to sustain TBIs at an alarming rate and funding is desperately
needed for better diagnostics and evaluation, treatment guidelines,
improved quality of care, education and awareness, referral services,
State program services, and protection and advocacy for those less able
to advocate for themselves. APTA recommends at least $10 million in
fiscal year 2012 for CDC's TBI Registries and Surveillance, Brain
Injury Acute Care Guidelines, Prevention, and National Public
Education/Awareness programs, specifically with the great work that has
been produced through the ``Heads Up'' concussions initiative.
CDC's Well-Integrated Screening and Evaluation for Women Across the
Nation (WISEWOMAN) programs screens uninsured and under-insured low-
income women ages 40 to 64 for heart disease and stroke risk and those
with abnormal results receive counseling, education, referral and
follow up. WISEWOMAN reached over 70,000 women in only 20 States from
July 2008 to June 2010. Of these women, nearly 90 percent were found to
have one or more heart disease or stroke risk factors and about 30
percent had at least three. More than 60 percent of the women
participated in a minimum of one behavioral modification session, and
among those WISEWOMAN participants who were re-screened one year later,
average blood pressure and cholesterol levels had decreased
considerably. APTA recommends $37 million ($16.3 million increase over
fiscal year 2010) for CDC's WISEWOMAN Program in fiscal year 2012.
Health Resources and Services Administration (HRSA)
With the passage of healthcare reform legislation, it becomes more
important now than ever that America is able to supply an adequate and
well-trained healthcare workforce to meet the demands of an expanded
market of U.S. citizens that have health insurance coverage. APTA urges
you to provide at least $7.65 billion for HRSA in fiscal year 2012.
While we recognize the reality of the current fiscal climate, this
amount reflects the minimum amount necessary for the agency to
adequately meet the needs of the populations it serves. The relatively
level funding HRSA has received over the past several years has
undermined the ability of its successful programs to grow and be
expanded to represent professions that shape the entire healthcare
team, such as physical therapy. Any shortage areas of physical
therapists and rehabilitation professionals may become more accentuated
as the percentage of the U.S. population that has health coverage
increases and demand rises. It is crucial that efforts are undertaken
to strengthen the healthcare workforce and delivery across the whole
spectrum of an individual's care--from onset through rehabilitation.
More resources are needed for HRSA to achieve its ultimate mission of
ensuring access to culturally competent, quality health services;
eliminating health disparities; and rebuilding the public health and
healthcare infrastructure.
In conjunction with the importance of funding TBI efforts within
CDC, APTA also recommends $8 million for the HRSA Federal TBI State
Grant Program and $4 million for the HRSA Federal TBI Protection &
Advocacy (P&A) Systems Grant Program.
Department of Education
In 2008, as part of the reauthorization of the Higher Education Act
(Public Law 110-315), the Loan Forgiveness for Service in Areas of
National Need (LFSANN) program was created. This program would provide
a modest amount of loan forgiveness for a variety of education and
healthcare professional groups, including physical therapists, upon a
commitment to serve in targeted populations that were identified as
areas of crucial importance and national need. However, the program has
not been implemented because it has not received any funding. APTA
commends the recent efforts of Congress to reform the higher education
loan industry. The lowering of the limit on the income-based repayment
plan for consolidated Federal Direct Loans will assist the burdensome
payments for all higher education loan borrowers. However, this program
still fails to meet the most important impact of LFSANN--channeling
providers and professionals into areas where there are demonstrated
shortages and high need, such as physical therapy care for veterans and
children and adolescents. APTA strongly urges Congress to take action
and provide $10 million in initial funding for this vital LFSANN
program that will impact the healthcare and education services of those
most in need.
National Institute for Disability and Rehabilitation
Research (NIDRR)
NIDRR has been one of the longest standing agencies to focus on
federally funded medical rehabilitation research. Rehabilitation
research makes a difference in the lives of individuals with
impairments, functional limitations, and disability. Advancements in
rehabilitation research have led to greater quality of life for
individuals who have spinal cord injuries, loss of limb, stroke and
other orthopedic, neurological, and cardiopulmonary disorders.
Investment in NIDRR is a necessary step toward continuing to meet the
needs of individuals in our population who have chronic disease,
developmental disabilities or traumatic injuries. Therefore, APTA
recommends at least $20 million per year for NIDRR to support research
and development, capacity building, and knowledge translation in
health, rehabilitation, and function.
APTA also requests $11 million for NIDRR's TBI Model Systems
administered by the Department of Education. The TBI Model Systems of
Care program represents an already existing vital national network of
expertise and research in the field of TBI, and weakening this program
would have resounding effects on both military and civilian
populations. The TBI Model Systems are the only source of non-
proprietary longitudinal data on what happens to people with brain
injury. They are a key source of evidence-based medicine and
rehabilitation care for this crucial and growing population.
Conclusion
As previously stated, APTA recognizes the extraordinarily tough
budgetary pressures that are facing the U.S. Federal Government.
However, there are certain programs and agencies that are essential and
vital to the health of Americans. APTA looks forward to working with
the Subcommittee and the various agencies outlined above to advance the
capability of meeting the rehabilitation needs of society. If the
Subcommittee has questions or needs additional resources, please
contact Nate Thomas, Associate Director of Federal Government Affairs
at APTA, at [email protected] or 703-706-8527. APTA's mailing address
is provided on the letterhead of the first page of this document.
______
Prepared Statement of the American Psychological Association
This statement is the testimony of the American Psychological
Association (APA), the largest scientific and professional organization
representing psychology in the United States and the world's largest
association of psychologists. APA's membership includes more than
154,000 researchers, educators, clinicians, consultants and students.
Through its divisions in 54 subfields of psychology and affiliations
with 60 State, territorial and Canadian provincial associations, APA
works to advance psychology as a science, as a profession and as a
means of promoting health, education and human welfare. APA welcomes
the opportunity to bring to your attention some priority requests and
concerns for the fiscal year 2012 appropriations bill.
Health Resources and Services Administration
Bureau of Health Professions
The APA requests that the Subcommittee include $5 million for the
Graduate Psychology Education Program (GPE) within the Health Resources
and Services Administration. This nationally competitive grant program
provides integrated healthcare services to underserved rural and urban
communities and individuals with the least access to much needed mental
and behavioral health services and support (e.g., children, older
adults, and chronically ill persons, victims of abuse or trauma,
including veterans). To date there have been over 100 grants in 32
States to universities and hospitals throughout the Nation. All
psychology graduate students who benefited from GPE funds are expected
to work with underserved populations and over 80 percent will work in
underserved areas immediately after completing the training.
Currently GPE is authorized under the Public Health Service Act
[Public Law 105-392 Section 755(b)(1)(J)] and funded under the ``Allied
Health and Other Disciplines'' account in the Labor-HHS Appropriations
Bill. An authorization of Appropriations of $10 million was included in
the Patient Protection and Affordable Care Act. It was also included in
the fiscal year 2011 Omnibus bill, which did not pass, for $7 million;
and it has been included in H.R. 1 for fiscal year 2011 and the Senate
2011 continuing resolutions, as well as the President's budget (for a
number of years). Established in 2002, GPE grants have supported the
interdisciplinary training of over 3,000 graduate students of
psychology and other health professions to provide integrated
healthcare services to underserved populations. The fiscal year 2012
GPE funding request will focus especially on providing services to
returning military personnel and their families, unemployed persons and
older adults in underserved communities. Also the GPE funding request
will also be used to create training opportunities at our Nation's
federally Qualified Health Centers, which play a critical role in
meeting the healthcare needs of our Nation's underserved persons.
National Institutes of Health (NIH)
As a member of the Ad hoc Group for Medical Research Funding and
the Coalition for Health Funding, APA encourages the Subcommittee to
provide a minimum of $31.8 billion for the NIH. Sustained growth for
NIH will build on the Nation's longstanding, bipartisan commitment to
better health, which has established the United States as the world
leader in medical research and innovation. NIH research means hope for
patients. Potentially revolutionary new avenues of research hold
promise for new early screenings and new treatments for disease. Recent
funding has created dramatic new research opportunities in areas
ranging from genetics to the behavioral research conducted by APA
members. In addition, NIH research is boosting the economies of
communities nationwide, at over 3,000 universities, medical schools,
teaching hospitals and other research institutions. This committee
should take justifiable pride in the progress and promise that NIH
research is engendering.
There are several issues at NIH to which APA would draw the
Subcommittee's attention:
--Addictions Research Institute.--NIH research on alcohol and
substance abuse has shed important light on critical policy
issues ranging from the rehabilitation of drug-addicted felons
to treatment of children exposed to substances in utero. APA is
closely monitoring NIH's proposal to create a new combined
institute that would fund research on both alcohol and
substance abuse. In our view this research is significantly
underfunded when weighed against the public health and public
safety impacts of alcohol, tobacco and illicit substance use,
and we are concerned that research funding be maintained and
increased as the new institute is created. We urge the
Subcommittee to insist that NIH establish rigorous and
transparent baselines of current funding levels and the
allocation of those funds across the existing NIH Institutes
and Centers to better assess and understand the proposed
organizational change. The continued active involvement of
extramural scientists at every stage of this process, as well
as that of the Office of Behavioral and Social Sciences
Research, will help ensure that the new institute has the right
infrastructure to truly optimize the conduct of addiction
research.
--Funding for OppNet.--For fiscal year 2012, APA supports a budget of
$38.2 million for OBSSR. This sum reflects the Administration's
request of $28 million for OBSSR and includes $10 million
needed to support the NIH-wide commitment to carry out OppNet,
an initiative strongly supported by the Subcommittee. The
OppNet initiative has made significant progress since its
start. Thus far, OppNet has awarded 35 competitive revisions to
add basic science projects to existing research project grants.
Eight competitive revisions to Small Business Innovation
Research/Small Business Technology and Transfer projects have
been awarded. OppNet has also provided much-needed training in
basic social and behavioral sciences research.
--National Center to Advance Translational Sciences.--APA believes
firmly that the proposed new National Center to Advance
Translational Sciences should include sufficient staff
expertise and resources to manage research on the translation
of behavioral interventions into communities. Just as it is
critical for NIH to speed the translation of research into drug
or technology development, it is critical for behavioral
interventions on diet, exercise, and psychotherapy to be
translated and disseminated to communities in need of them.
Centers for Disease Control and Prevention
As a member of the Centers for Disease Control and Prevention (CDC)
Coalition, APA supports an appropriation of $7.7 billion for CDC's
``core programs'' for fiscal year 2012. In addition to playing a key
role in maintaining a strong public health infrastructure and
protecting Americans from public health threats and emergencies, CDC
programs play a crucial role in reducing healthcare costs and
strengthening the Nation's health system. This request reflects the
minimum amount CDC will need to fulfill its core missions for fiscal
year 2012.
National Center for Health Statistics.--APA endorses the
President's fiscal year 2012 request of $162 million in funding for
NCHS. NCHS is the Nation's principal health statistics agency, and the
health data collected by NCHS are an essential part of the Nation's
statistical and public health infrastructure. The Subcommittee's
support is helping NCHS rebuild after years of underinvestment and
restore the collection of essential health data. With your continued
support, NCHS will modernize its data collection efforts to produce
higher quality, more timely data.
Prevention Research Centers.--APA recognizes the importance of a
focus on prevention in improving health in America and the significant
contributions of the Prevention Research Centers network of community,
academic, and public health partners to research on evidenced based
approaches in health promotion. APA urges Congress to allocate the
resources necessary to support the Prevention Research Centers so that
this network of academic institutions and organizations can continue to
contribute as widely and effectively to prevention science. APA opposes
any program consolidation that would lead to disproportionate funding
cuts for the Prevention Research Centers. Insofar as consolidation of
programs as proposed in the fiscal year 2012 President's budget occurs,
APA requests that Congress designate specific funding for Prevention
Research Centers.
Substance Abuse and Mental Health Services Administration (SAMHSA)
APA is highlighting three requests for the Committee's support at
SAMHSA's Center for Mental Health Services:
--First, APA strongly recommends that Congress allocate the fully
authorized amount ($50 million) for SAMHSA's National Child
Traumatic Stress Network (NCTSN) program which works to aid the
recovery of children, families, and communities impacted by a
wide range of trauma, including physical and sexual abuse,
natural disasters, sudden death of a loved one, the impact of
war on military families, and much more. Specifically, APA
recommends that SAMHSA increase the number of NCTSN grantees
and maintain the collaborative model envisioned in the original
authorization.
--Second, APA urges the Committee to increase its support for the
Minority Fellowship Program. Racial and ethnic minorities are
projected to represent 40 percent of our Nation's population in
upcoming years. Therefore, APA urges Congress to increase
funding for the Minority Fellowship Program by $2.6 million.
This unique workforce development initiative trains ethnic
minority healthcare professionals to bring mental and
behavioral healthcare services to rural and underserved
minority communities.
--Third, APA encourages Congress to provide at least level support
for the three programs authorized under the Garrett Lee Smith
Memorial Act, especially the Campus Suicide Prevention Program.
These programs make suicide prevention initiatives and mental
health support available to populations in need and merit
continued appropriations.
Administration on Aging
Mental health.--Older adults are one of the fastest growing
segments of the U.S. population and approximately 25 percent of older
Americans have a mental or behavioral health problem. In particular,
older white males (age 85 and over) currently have the highest rates of
suicide of any group in the United States. Accordingly, APA urges an
expanded effort to address the mental and behavioral health needs of
older adults including implementation of the mental and behavioral
health provisions in the Older Americans Act Amendments of 2006, to
provide grants to States for the delivery of mental health screening,
and treatment services for older individuals and programs to increase
public awareness and reduce the stigma associated with mental disorders
in older individuals. APA also recommends that AoA designate an officer
to administer mental health services for older Americans.
Caregivers.--Family caregivers play an essential role in providing
long-term services and supports for the chronically ill and aging. For
this reason APA supports the Lifespan Respite Care Program and urges
Congress to appropriate $50 million for this initiative in fiscal year
2012. In addition, the Secretary of HHS should ensure that State
agencies and Aging and Disability Resource Centers (ADRCs) use the
funds to serve all age groups, chronic conditions and disability
categories equitably and without preference.
The agencies under this Subcommittee's jurisdiction provide
critical support to APA's members, their home institutions, and their
students and patients. The APA commends the Committee for accepting
written testimony from public witnesses.
______
Prepared Statement of the American Public Health Association
The American Public Health Association (APHA) is the oldest and
most diverse organization of public health professionals and advocates
in the world dedicated to promoting and protecting the health of the
public and our communities. We are pleased to submit our views on
Federal funding for public health activities in fiscal year 2012.
Recommendations for Funding the Public Health Service
APHA's budget recommendations for the Public Health Service
includes funding for the Centers for Disease Control and Prevention
(CDC), the Health Resources and Services Administration (HRSA), the
Substance Abuse and Mental Health Services Administration (SAMHSA), the
Agency for Healthcare Research and Quality (AHRQ), and the National
Institutes of Health (NIH). Together all of these agencies play a
critical role in keeping Americans healthy.
CDC
APHA believes that Congress should support CDC as an agency--not
just the individual programs that it funds. In the best judgment of the
CDC Coalition--given the challenges and burdens of chronic disease, a
potential influenza pandemic, terrorism, disaster preparedness, new and
reemerging infectious diseases and our many unmet public health needs
and missed prevention opportunities--we believe the agency will require
funding of at least $7.7 billion for CDC's ``core programs'' in fiscal
year 2012. This request represents a 36 percent increase over fiscal
year 2011 and a 31 percent increase over the President's fiscal year
2012 request. We are deeply disappointed with the more than $740
million in cuts to CDC's budget authority included in the proposed
fiscal year 2011 continuing resolution (CR). While CDC programs will
receive significant new funding from the Prevention and Public Health
Fund in fiscal year 2011, we are concerned that this funding would
essentially supplant cuts made to CDC's budget authority. As you know
the Prevention and Public Health Fund was intended to supplement and
not supplant the base funding of our public health agencies and
programs.
The President's fiscal year 2012 budget proposes to consolidate a
number of chronic disease programs within CDC. APHA and other advocates
are currently engaged in conversations with CDC and members of Congress
to better understand what this consolidation will mean for the funding
that is passed on to our State and local health agencies and the
various programs our members have supported in the past. We look
forward to working with Congress, the Administration and CDC to ensure
that any effort to consolidate the programs leads to best health
outcomes for the American people. We must ensure that CDC's National
Center for Chronic Disease Prevention and Health Promotion has the
resources it needs to assist our States and communities in their
efforts to reduce the burden of chronic disease.
By translating research findings into effective intervention
efforts, CDC has been a key source of funding for many of our State and
local programs that aim to improve the health of communities. Perhaps
more importantly, Federal funding through CDC provides the foundation
for our State and local public health departments, supporting a trained
workforce, laboratory capacity and public health education
communications systems.
CDC also serves as the command center for our Nation's public
health defense system against emerging and reemerging infectious
diseases. With the potential onset of a worldwide influenza pandemic,
in addition to the many other natural and man-made threats that exist
in the modern world, the CDC has become the Nation's--and the world's--
expert resource and response center, coordinating communications and
action and serving as the laboratory reference center. States and
communities rely on CDC for accurate information and direction in a
crisis or outbreak. This has been demonstrated most recently by CDC's
quick response and ongoing investigation into human infections with
H1N1 flu (swine flu) in the United States and internationally.
CDC's National Center for Injury Prevention and Control works to
prevent unintentional and violence-related injuries to minimize the
consequences of injuries when they occur by researching the problem;
identifying the risk and protective factors; developing and testing
interventions; and ensuring widespread adoption of proven strategies.
We urge you to ensure the agency has the resources it needs to address
these leading causes of death and disability.
We must address the growing disparity in the health of racial and
ethnic minorities. CDC is helping States address serious disparities in
infant mortality, breast and cervical cancer, cardiovascular disease,
diabetes, HIV/AIDS and immunizations. APHA is committed to ending
health disparities and we encourage the Subcommittee to provide
adequate funds for these efforts.
We also encourage the Subcommittee to provide adequate funding for
CDC's National Center for Environmental Health. We ask that the
Subcommittee to continue its recent efforts to expand and enhance CDC's
capacity to help the Nation prepare for and adapt to the potential
health effects of climate change by providing CDC with $15 million for
climate change and health activities. Expanded funding would allow CDC
to provide technical assistance, training and tools to help State and
local health officials and improve coordination and integration of
climate change across CDC. We also urge the Committee to closely
evaluate the significant cut made to CDC's Healthy Homes/Lead Poisoning
Prevention and the National Asthma Control programs in the President's
budget to ensure these programs have adequate funding to provide States
and localities with the funding they need to protect public health.
HRSA
We request an overall funding level of $7.65 billion for HRSA in
fiscal year 2012. This recommendation represents a 22 percent increase
over fiscal year 2011 and a 12 percent increase over the President's
fiscal year 2012 request. We believe this level of funding is the
minimum amount necessary for HRSA to continue to meet the healthcare
needs of the American public. Over the past several years, HRSA has
received mostly level funding, undermining the ability of its
successful programs to grow. Additionally we are deeply disappointed
with the more than $1.2 billion in cuts made to the agency in the final
fiscal year 2011 continuing resolution and the potential negative
consequences for public health. Our fiscal year 2012 requested minimum
level of funding will better allow the agency to carry out critical
public health programs and services that reach millions of Americans,
including training for public health and healthcare professionals,
providing primary care services through community health centers,
improving access to care for rural communities, supporting maternal and
child healthcare programs, providing healthcare to people living with
HIV/AIDS, and many more. However, much more is needed for the agency to
achieve its ultimate mission of ensuring access to culturally
competent, quality health services; eliminating health disparities; and
rebuilding the public health and healthcare infrastructure.
HRSA operates programs in every State and thousands of communities
across the country and is a national leader in providing health
services for individuals and families. The agency serves as a health
safety net for the medically underserved, including the 50 million
Americans who were uninsured in 2009 and 50 million Americans who live
in neighborhoods where primary healthcare services are scarce.
The $7.65 billion fiscal year 2012 HRSA funding request is based
upon recommendations provided by public health professionals to support
HRSA programs including:
--Health Professions programs support the education and training of
primary care physicians, nurses, dentists, optometrists,
physician assistants, nurse practitioners, public health
personnel, mental and behavioral health professionals,
pharmacists, and other allied health providers; improve the
distribution and diversity of health professionals in medically
underserved communities; and ensure a sufficient and capable
health workforce able to provide care for all Americans and
respond to the growing demands of our aging and increasingly
diverse population. In addition, the Patient Navigator Program
helps individuals in underserved communities, who suffer
disproportionately from chronic diseases, navigate the health
system.
--Primary Care programs support more than 7,000 community health
centers in every State and territory, improving access to
preventive and primary care in geographically isolated and
economically distressed communities. In addition, the health
centers program targets populations with special needs,
including migrant and seasonal farm workers, homeless
individuals and families, and those living in public housing.
--Maternal and Child Health Flexible Maternal and Child Health Block
Grants, Healthy Start and other programs provide services,
including prenatal and postnatal care, newborn screening tests,
immunizations, school-based health services, mental health
services, and well-child care for more than 34 million
uninsured and underserved women and children not covered by
Medicaid or the Children's Health Insurance Program, including
children with special needs.
--HIV/AIDS programs provide assistance to metropolitan and other
areas most severely affected by the HIV/AIDS epidemic; support
comprehensive care, drug assistance and support services for
people living with HIV/AIDS; provide education and training for
health professionals treating people with HIV/AIDS; and address
the disproportionate impact of HIV/AIDS on women and
minorities.
--Family Planning Title X programs provide reproductive healthcare
and other preventive services for more than 5 million low-
income women at over 4,500 clinics nationwide. These programs
improve maternal and child health outcomes, prevent unintended
pregnancies, and reduce the rate of abortions.
--Rural Health programs improve access to care for the 60 million
Americans who live in rural areas. Rural Health Outreach and
Network Development Grants, Rural Health Research Centers,
Rural and Community Access to Emergency Devices Program, and
other programs are designed to support community-based disease
prevention and health promotion projects, help rural hospitals
and clinics implement new technologies and strategies, and
build health system capacity in rural and frontier areas.
--Special Programs include the Organ Procurement and Transplantation
Network, the National Marrow Donor Program the C.W. Bill Young
Cell Transplantation Program, and National Cord Blood
Inventory. Strong funding would facilitate an increase in
organ, marrow and cord blood transplantation.
Greater investment is necessary to sufficiently fund HRSA services
and programs that continue to face increasing demands. We urge you to
consider HRSA's role in building the foundation for health service
delivery and ensuring that vulnerable populations receive quality
health services, while continuing to strengthen our Nation's health
safety net programs. By supporting, planning for and adapting to change
within our healthcare system, we can build on the successes of the past
and address new gaps that may emerge in the future.
AHRQ
We request a funding level of at least $405 million for AHRQ for
fiscal year 2012. This level of funding is needed for the agency to
fully carry out its Congressional mandate to conduct, support, and
disseminate research and translate research into knowledge and
information that can be used to improve the health of all Americans.
AHRQ focuses on improving healthcare quality, eliminating racial and
ethnic disparities in health, reducing medical errors, and improving
access and quality of care for children and persons with disabilities.
SAMHSA
APHA supports a funding level of $3.671 billion for SAMHSA for
fiscal year 2012. This funding level would provide support for
substance abuse prevention and treatment programs, as well as continued
efforts to address emerging substance abuse problems in adolescents,
the nexus of substance abuse and mental health, and other serious
threats to the mental health of Americans.
NIH
APHA supports a funding level of $35 billion for the NIH for fiscal
year 2012. The translation of fundamental research conducted at NIH
provides some of the basis for community based public health programs
that help to prevent and treat disease.
Conclusion
In closing, we emphasize that the public health system requires
stronger financial investments at every stage. Successes in biomedical
research must be translated into tangible prevention opportunities,
screening programs, lifestyle and behavior changes, and other
interventions that are effective and available for everyone. Without a
robust and sustained investment in our Nation's public health agencies,
we will fail to meet the mounting health challenges facing our Nation.
______
Prepared Statement of the American Public Power Association
The American Public Power Association (APPA) appreciates the
opportunity to submit this statement supporting funding for the Low-
Income Home Energy Production Assistance Program (LIHEAP) for fiscal
year 2012.
APPA has consistently supported an increase in the authorization
level for LIHEAP. The Administration's fiscal year 2012 budget requests
$2.57 billion for LIHEAP. APPA supports extending the current level of
$5.1 billion for the program.
APPA is the national service organization representing the
interests of over 2,000 municipal and other State and locally owned
utilities throughout the United States (all but Hawaii). Collectively,
public power utilities deliver electricity to 1 of every 7 electricity
consumers (approximately 46 million people), serving some of the
Nation's largest cities. However, the vast majority of APPA's members
serve communities with populations of 10,000 people or less.
APPA is proud of the commitment that its members have made to their
low-income customers. Many public power systems have low-income energy
assistance programs based on community resources and needs. Our members
realize the importance of having in place a well-designed low-income
customer assistance program combined with energy efficiency and
weatherization programs in order to help consumers minimize their
energy bills and lower their requirements for assistance. While highly
successful, these local initiatives must be coupled with a strong
LIHEAP program to meet the growing needs of low-income customers. In
the last several years, volatile home-heating oil and natural gas
prices, severe winters, high utility bills as a result of dysfunctional
wholesale electricity markets and the effects of the economic downturn
have all contributed to an increased reliance on LIHEAP funds. Even at
$5.1 billion, LIHEAP cannot provide assistance to all who qualify for
the program. Cutting this program by $2.5 billion would have very
serious consequences for those who rely on the program.
Also when considering LIHEAP appropriations this year, we encourage
the subcommittee to provide advanced funding for the program so that
shortfalls do not occur in the winter months during the transition from
one fiscal year to another. LIHEAP is one of the outstanding examples
of a State-operated program with minimal requirements imposed by the
Federal Government. Advanced funding for LIHEAP is critical to enabling
States to optimally administer the program.
Thank you again for this opportunity to relay our support for
increased LIHEAP funding for fiscal year 2012.
______
Prepared Statement of the American Society for Microbiology
The American Society for Microbiology (ASM) is pleased to submit
the following testimony on the fiscal year 2012 appropriation for the
Centers for Disease Control and Prevention (CDC). The ASM is the
largest single life science organization in the world with over 38,000
members. The ASM mission is to enhance the science of microbiology, to
gain a better understanding of life processes and to promote the
application of this knowledge for improved health and environmental
well being.
The ASM supports the proposed fiscal year 2012 budget of $11.3
billion for the CDC, a 3.4 percent increase over the fiscal year 2010
funding level. The budget recognizes the importance of maintaining a
strong infrastructure to address infectious disease prevention and
control. The CDC's role, in partnership with State and local health
departments and international partners, is to monitor for known and
emerging infectious disease threats through surveillance and laboratory
diagnosis, and to develop control and prevention strategies for these
diseases. Examples include vaccine preventable diseases, foodborne
diseases, pandemic influenza, vectorborne and zoonotic diseases,
healthcare acquired infections (HAIs) and antimicrobial resistance. The
proposed fiscal year 2012 budget addresses these threats and provides
targeted resources for them.
The fiscal year 2012 proposed budget includes an increase in
funding for HIV/AIDS, sexually transmitted diseases (STD), tuberculosis
(TB), and hepatitis, and gives the States added flexibility to shift
funding among these programs based on local priorities. The ASM
supports this approach. The ASM also supports the $68 million increase
in funding for emerging and zoonotic diseases, including $40 million in
funding from the Prevention and Public Health Fund to enhance
epidemiology and laboratory capacity in State health departments.
However, caution must be taken regarding any reductions in effort
for ``low impact, disease specific programs'' as proposed in the fiscal
year 2012 budget. Experience indicates that an emerging public health
threat can occur with almost any pathogen, and capacity must be
sustained with this possibility in mind. Examples of such complacency
include the reemergence of drug resistant tuberculosis in the 1990s and
West Nile virus in 1999. The proposed elimination of prion activities
at CDC could have such an impact, as these diseases are related to
human variant Creutzfeld Jakob Disease (vCJD) and to chronic wasting
disease, which is an emerging animal health problem in several areas of
the United States.
The ASM supports investments to address healthcare associated
infections. CDC provided resources through the American Recovery and
Reinvestment Act (ARRA) to develop programs for surveillance and
prevention of HAIs, which have resulted in substantial HAI reductions
in these infections with significant cost savings to the healthcare
system. These investments must be sustained after ARRA funding ends,
and the proposed $47 million for HAIs would accomplish this goal.
The ASM supports the $8.7 million increase in funding for food
safety. The CDC recently released new estimates of foodborne diseases,
concluding that 1 in 6 people in the United States get sick each year
(about 48 million people). The delayed recognition of the widespread
outbreaks of salmonellosis associated with eggs during 2010
demonstrates the need to sustain and enhance vigilance for foodborne
outbreaks. In that outbreak, over 1,900 confirmed illnesses were
reported (likely a small percentage of actual cases) and 500 million
eggs were recalled. CDC's surveillance systems will also play a pivotal
role in assessing the success of programs developed as a result of the
recently passed Food Safety Modernization Act.
The ASM is concerned about the following proposed reductions in the
fiscal year 2012 CDC budget:
--There is a substantial decline in preparedness funding, including a
$72 million cut in funds for State and local preparedness
grants. Such declines will have a significant impact on the
ability of frontline public health workers to be able to
respond to all hazard emergencies at a time of restrained
budgets at the State and local level. The ASM recommends such
grants be maintained at fiscal year 2010 funding levels.
--The proposed elimination of funding for the CDC genomics program
should be restored. Public health genomics is an area of
growing importance, including the ability to identify risk
factors for enhanced susceptibility or resistance to infectious
diseases. Such genetic factors have important implications for
disease prevention and treatment, and must be tied to
epidemiologic investigations and disease surveillance efforts.
--The ASM does not endorse the elimination of targeted funding for
CDC's antimicrobial resistance (AR) activities and the transfer
of these funds into the overall budget for emerging infections.
While ASM appreciates the need for funding flexibility,
antimicrobial resistance is a substantial public health problem
that leads to significant morbidity and death and markedly
increases healthcare costs. To address this threat, sustained
dedicated funding is necessary.
CDC Infectious Disease Programs Protect Public Health
Infectious diseases cause about one-fourth of all deaths globally,
more than 11 million people, over half of them children. In the United
States, influenza and pneumonia account for more than 56,000 deaths
each year. Of the 1.1 million people living in the United States living
with HIV/AIDS, about 21 percent do not know that they are HIV positive;
there are more than 56,000 new HIV infections annually. Last year, the
CDC responded to multiple disease outbreaks and incidents that included
surveillance of cholera in post earthquake Haiti and activation of
CDC's Emergency Operations Center as part of the Federal response to
the gulf oil spill.
In the United States, the economic and societal costs of infectious
diseases are significant, exacerbated by previously unknown microbial
pathogens, rising drug resistance among pathogens and increasing travel
and commerce between geographic areas. The CDC Office of Infectious
Diseases leads United States efforts to stop or minimize the onslaught
of infectious diseases, with highly qualified personnel at three
national centers that specialize in (1) Emerging and Zoonotic
Infectious Diseases; (2) HIV/AIDS, Viral Hepatitis, STD, and TB
Prevention; or (3) Immunization and Respiratory Diseases.
The ASM endorses the proposed fiscal year 2012 budget for key
programs at CDC, including the following:
Emerging Infectious Diseases/Antimicrobial Resistance.--CDC is a
world leader in detecting and preventing emerging and reemerging
infectious diseases, a role which depends on strong science
capabilities and readiness to confront the unexpected. CDC's
infrastructure and partnerships have dealt quickly with the more than
three dozen new human pathogens of medical significance identified in
the past 30 years. Recent CDC advances include developing one of the
first candidate vaccines against all four species of dengue virus, now
in human trials, and a plan to screen U.S. blood donations for West
Nile virus. fiscal year 2012 funding will support planned EID
activities like the development and deployment of improved diagnostic
tests for plague, dengue and chikungunya. About 75 percent of recently
emerging human infectious diseases originated in animals, making
zoonotic diseases another high priority at CDC, along with vectorborne
diseases spread by mosquitoes, ticks, fleas and other vectors. Two
reports last year illustrate the critical nature of CDC's EID
activities: In Florida, an estimated 5 percent of Key West's population
showed recent exposure to the dengue fever virus; and the new
antimicrobial resistance gene called New Delhi metallo b lactamase
(NDM-1), first detected in 2008, is spreading to additional countries.
Increased fiscal year 2012 funding will support CDC efforts against
the alarming (and rising) number of pathogens now resistant to
antimicrobial drugs. As part of the U.S. Interagency Task Force on
Antimicrobial Resistance, CDC distributes both intramural and
extramural AR funding for surveillance, prevention, and research
activities. Agency surveillance networks routinely collect data on
cases of resistant pathogens. CDC provides epidemiology and laboratory
support for outbreaks of AR organisms, and distributes educational
materials to promote appropriate use of antimicrobials. Investments in
AR programs are cost effective; one study estimated that the additional
medical cost per U.S. patient infected with an AR pathogen ranges from
about $19,000 to nearly $30,000. Another estimate concluded that
preventing a single case of multidrug resistant (MDR) tuberculosis can
save up to $700,000. In fiscal year 2010, CDC diagnosed and treated
about 1,000 cases of tuberculosis (including 40 MDR) among overseas
immigrant applicants and U.S. bound refugees, saving States an
estimated $45 million.
HIV/AIDS.--Scientific advances announced last year have added new
tools to CDC's numerous HIV prevention activities; using a vaginal
microbicide or daily doses of an oral antiretroviral drug (PrEP) both
lowered risk of infection in clinical trials. In July 2010, the
Administration released its National HIV/AIDS Strategy for the United
States (NHAS). Proposed fiscal year 2012 budget increases would invest
substantially in the NHAS 5 year goals to reduce new infections: (1)
lower the annual number of new infections by 25 percent, from 56,300 to
42,225; (2) reduce the HIV transmission rate by 30 percent, from 5
persons infected per 100 people with HIV to 3.5 persons infected; and
(3) increase from 79 to 90 the percentage of people living with HIV who
know their serostatus.
Viral Hepatitis.--Proposed fiscal year 2012 increases for viral
hepatitis prevention would boost CDC surveillance in 10 high burden
State and local health departments. Prevention of viral hepatitis has
been successful in recent years, in large part due to vaccines against
hepatitis A and B viruses. HAV incidence has decreased approximately 92
percent nationwide since 1995; rates of HBV have been reduced far below
the original Healthy People 2010 goal of 4.5 cases per 100,000. In the
first half of fiscal year 2010, CDC funded health departments
administered over 130,000 doses of HBV vaccine to at risk adults and
ensured that 87 percent of infants born to HBsAg+ women were
vaccinated. Incidence of hepatitis C infections has dropped from more
than 45,000 cases annually to an estimated 20,000, primarily as a
result of screening the U.S. blood supply and falling case numbers
among intravenous drug users. However, 2.7-3.9 million Americans have
HCV, most unaware of their infection. The fiscal year 2012 budget would
address last year's Institute of Medicine report, which concluded that
public health programs have insufficient hepatitis related resources
and that efforts to prevent and control viral hepatitis are not
adequate.
Sexually Transmitted Diseases.--Fiscal year 2012 increases would
strengthen CDC's STD infrastructure, which supports 65 State and local
prevention programs, and sustain the CDC's surveillance of drug
resistant STD pathogens like that causing gonorrhea. Reducing STD
infections is highly cost effective; for example, CDC estimates that
reductions in gonorrhea and syphilis from 1990 to 2003 saved the U.S.
economy $5 billion. Cost savings with chlamydia screening in sexually
active young women are an estimated $2,500-$37,000 per year. Aggressive
public health efforts to prevent STDs have had positive results; for
instance, from 1999 to 2009, rates of primary and secondary syphilis
among females declined by 30 percent, while congenital syphilis dropped
32 percent. Yet, in general, STDs in the United States persist at
unacceptable levels: CDC estimates that there are approximately 19
million new STD infections each year, which cost the U.S. healthcare
system $16.4 billion annually (2009 figures).
CDC Campaigns Prevent Disease in the United States, Worldwide
Healthcare Associated Infections.--In the United States, 1 in 20
hospital patients get an infection during medical treatment. Of the
nearly 2 million infections acquired in some type of healthcare setting
annually, almost 100,000 are fatal. A 2009 CDC report estimates that
each year U.S. hospitals spend between $28 billion and $35.7 billion to
treat often preventable HAIs. Depending on the effectiveness of
infection control interventions used, the CDC expects that prevention
measures could save from $5.7 billion-$31.5 billion of these costs. To
illustrate, intensive care units have reduced bloodstream infections in
patients with central lines by 58 percent since 2001, using CDC
recommended infection control procedures and saving up to 27,000 lives
and $1.8 billion. The proposed fiscal year 2012 budget would
significantly increase support for the CDC's HAI activities and its
National Health Care Safety Network (NHSN) that had provided monitoring
capacity to more than 3,900 health facilities by the end of 2010. With
the increased funding, routine NHSN participation will expand from
2,500 to 6,500 healthcare settings (5,500 hospitals; the rest include
hemodialysis and long-term care facilities). In March this year, the
CDC awarded $10 million for HAI research at five academic medical
centers, as part of its Prevention Epicenter program.
Immunization.--The Administration's fiscal year 2012 CDC budget
invests substantial resources into vaccine preventable diseases,
continuing national immunization campaigns against diseases like
seasonal and pandemic influenza. The number of lives saved and medical
costs reduced can be considerable. According to the CDC, ``for every
birth cohort who receives seven [routine childhood] vaccines . . .
society saves $9.9 billion in direct medical costs; over 33,500 lives
are saved; and 14 million cases of disease are prevented.'' Other
examples of returns on CDC investment include vaccination against
Haemophilus influenzae type b (Hib), responsible for a 99 percent
decline in this leading cause of bacterial meningitis in children under
age 5, for an estimated medical cost savings of $950 million per year
plus another $1.14 billion of retained earnings by unpaid caregivers.
In the past year, CDC reported that 3 years of rotavirus vaccinations
had reduced severe rotavirus disease by 85 percent, and helped develop
the guidelines for deploying the new pneumococcal vaccine expected to
greatly reduce pneumonia and ear infections among children. In
December, CDC launched its Vaccine Tracking System to follow vaccine
orders from manufacturer to distributor to health providers.
Global Health.--Lower respiratory tract infections, diarrheal
diseases, HIV/AIDS, TB and malaria together account for nearly one-
fifth of deaths globally. CDC is a lead partner in the Administration's
Global Health Initiative, underscoring the importance of infectious
diseases no matter where outbreaks occur. The fiscal year 2012 budget
includes increase of funds for global polio eradication, an
international campaign begun in 1988 that is nearing victory with only
four countries still harboring endemic disease. Last year, there were
about 900 cases reported, declining from more than 350,000 in 1988.
fiscal year 2012 funds will purchase 254 million doses of oral polio
vaccine for use in mass immunization campaigns in Southeast Asia,
Africa and Europe, to achieve CDC's target of zero polio endemic
countries by the end of 2012. Funding will support the CDC vaccination
campaign toward a 90 percent reduction in global measles related
mortality; by 2008, CDC and its partners had helped reduce measles
deaths by 78 percent, from an estimated 733,000 in 2000 to about
164,000.
Quarantine and migration related activities also are part of the
agency's multi level strategies in global health; CDC operates 20 U.S.
quarantine stations and responds to outbreaks in refugee camps
overseas. Travel and trade allow pathogens to move quickly. The 2009
``swine flu'' spread to 30 countries within 6 weeks. About 1.8 million
airline passengers cross international borders daily, and about half of
international travelers worldwide have some kind of health problem
while traveling. An estimated 50,000-70,000 refugees and 1.2 million
immigrants resettle in the United States each year, while more than 2
million people travel to or through this country by air, sea, or land
daily.
______
Prepared Statement of the American Society for Microbiology
The American Society for Microbiology (ASM) wishes to submit the
following written testimony on the fiscal year 2012 appropriation for
the National Institutes of Health (NIH). The ASM is the largest single
life science organization with over 38,000 members. Its mission is to
enhance the science of microbiology, to gain a better understanding of
life processes and to promote the application of this knowledge for
improved health and environmental well being.
The ASM urges Congress to support strong Federal funding for
biomedical research and to provide $35 billion in funding for the NIH
in fiscal year 2012. Continued investments in science and public health
programs are critical to the Nation's health, economic growth, national
security and global leadership. Acquiring knowledge at the frontiers of
science is the basis for new technologies, medical discoveries, new
industries and high value jobs. Investments in biomedical research lead
to more effective treatments, preventions and cures for chronic and
infectious diseases, improving the quality of life for people
everywhere. Reducing funding for research project grants will slow
medical progress on a myriad of diseases, adversely affecting human
life. Attracting and retaining scientists and maintaining the vitality
of the research enterprise will become more difficult if the Nation
does not remain committed to sustained and predictable funding for
research and training. We, therefore, urge Congress to make increased
appropriations for biomedical research a national priority as the
Federal budget is considered for the coming fiscal year.
NATIONAL INSTITUTES OF HEALTH: A CRUCIAL INVESTMENT FOR THE FUTURE
The NIH is a primary contributor to growing the Nation's economy
and ensuring U.S. leadership in science. The NIH expends 97 percent of
its annual budget on R&D activities through its 27 centers and
institutes. NIH funding helps foster innovation among more than 300,000
research personnel at over 3,000 universities and research
institutions, with about 6,000 scientists working in NIH's own
laboratories.
Life saving successes in biomedical research depend on NIH support:
for example, the development last year of a new 2 hour diagnostic test
for tuberculosis and drug resistant TB bacteria; a potential drug
against malaria parasites, evidence that an anti-HIV treatment could
also prevent infection, research suggesting a role for intestinal
bacteria in obesity, and the 2010 Nobel Prize winning methods to
synthesize compounds that have already proven effective against HIV and
herpes virus. NIH funded research improves the health of our
communities, represents investment in local and national economic
growth and advances U.S. science and medicine.
Investing in Scientific Innovation, Advancing Medical Knowledge
NIH funded research has repeatedly reshaped medicine and continues
to enhance public health. NIH routinely identifies new research
initiatives and pursues transformative research. NIH recently
delineated five priority areas with particular promise for safeguarding
our future, including:
--High throughput technologies.--DNA sequencing, nanotechnology and
other computer supported technologies can generate massive data
sets that enable comprehensive approaches to disease, like the
NIH microbiome project to understand how interactions with the
microbes that live on and in the human body influence health
and disease.
--Translational medicine.--NIH programs will increasingly focus on
translating basic scientific discoveries into new clinical
diagnostics and treatments (bench to bedside).
--Informing healthcare reform.--With U.S. expenditures on healthcare
approaching 20 percent of our gross domestic product, NIH
research areas like personalized medicine and pharmacogenomics
seek cost effective solutions through disease treatment and
prevention tailored to individual patients.
--Global health.--In addition to NIH's ongoing efforts against AIDS,
tuberculosis and malaria, more resources will go toward
combating neglected tropical diseases that devastate low income
countries.
--Reinvigorating the biomedical research community.--NIH is
reevaluating the Nation's future scientific workforce needs in
terms of its own training programs, as well as optimizing NIH's
extramural research investments to more effectively discover
innovative medical solutions.
THE IMPORTANCE OF INVESTIGATOR INITIATED RESEARCH
The majority of NIH funds are distributed across the country to
extramural researchers through grants, contracts and fellowships.
Investigator initiated, competitively awarded Research Project Grants
(RPGs) are the single most effective mechanism for ensuring research
innovation. Early in the decade, an average of 1 out of 3 grant
applications were funded. In recent years, the success rate has fallen
to roughly 1 in 5, with only a 15 percent success rate estimated for
fiscal year 2011, despite an abundance of research opportunities.
Scientific advances require investigator inspiration and
persistence often over years of research. For example, a large share of
the research awarded the 2010 Nobel Prize in Chemistry occurred in a
laboratory supported since 1979 by the National Institute of General
Medical Sciences (NIGMS). Success developing the DNA based TB rapid
diagnostic test announced last year followed more than 8 years of
National Institute of Allergy and Infectious Diseases (NIAID) support.
NIH funding also enables transformative research that has a higher
degree of risk for failure, but potential for huge scientific rewards,
like recipients of the relatively new EUREKA program (Exceptional,
Unconventional Research Enabling Knowledge Acceleration) managed by
NIGMS. Among this year's new NIGMS grants are projects designed to
decipher the genetic code in yeast and to use bacterial components to
induce patient specific stem cells that facilitate gene therapy.
At NIH, long range strategies for research success include
workforce development and mentoring young researchers. NIAID, for
example, met its own target of supporting ``new investigators'' in
fiscal year 2009 by funding about 20 percent of those who applied for
R01 grants as first time principal investigator. NIGMS, which
distributes 70 percent of its budget to research project grants,
contributes an additional 10 percent to underwrite institutional
training grants and fellowships that specifically fulfill its mission
to train the next generation of medical scientists. In addition, NIGMS
funds approximately 50 percent of Ph.D. research training positions at
NIH, including the Medical Scientist Training (M.D.-Ph.D.) program.
Additional NIH grant programs focus on K-12 education in science,
technology, engineering and mathematics (STEM), to foster a future
technical workforce.
The NIH regularly identifies research intended to ultimately
produce public health benefits. In fiscal year 2009, NIAID released 33
new funding opportunity announcements that are already producing
results in selected areas, including innovative approaches to vaccine
development against HIV, malaria and hepatitis C, and clinical trials
specifically designed to counter the threat of antimicrobial resistance
among pathogens. Research concepts reviewed periodically by NIAID
advisory councils may anticipate potential research initiatives for
upcoming funding cycles. For example, concepts approved in September
2010 included research to prevent the spread of drug resistant
pathogens; support for Functional Genomics Research Centers that will
generate massive genetic data sets readily available to the broad
scientific community; improved diagnostics for Lyme disease; and a
``pluripotent approach'' for sexual and reproductive health that might
combine contraceptive methods with microbicides, vaccine or other
disease preventives.
NIH Research to Address Threats of Infectious Diseases and
Antimicrobial Resistance
Infectious diseases cause approximately 26 percent of all deaths
worldwide, more than 11 million people annually. Each year infectious
diseases kill approximately 6.5 million children, most in developing
countries. These preventable diseases also greatly impact public health
systems in the United States. For example, influenza and pneumonia
account for more than 56,000 deaths annually, while each year there are
more than a million new cases of sexually transmitted diseases. Despite
ground breaking triumphs against infectious diseases over decades of
research, both predictable and unexpected infectious agents continue to
challenge medical science. In recent years of flat funding, NIAID has
had to respond to additional public health threats like bioterrorism
and unforeseen infectious diseases, by steadily expanding its research
portfolio and its capabilities to recognize and quickly counter newly
emerging and reemerging diseases in the United States and elsewhere.
The scope and significance of NIAID sponsored research cannot be
overstated.
The emergence of drug resistant microbial pathogens seriously
complicates efforts to stop or minimize infectious diseases. The
magnitude of the problem elevates the public health significance of
antimicrobial resistance. Examples of clinically important microbes
that are rapidly developing resistance to available drugs include
bacteria that cause pneumonia, ear infections and meningitis, skin,
bone, lung and bloodstream infections, urinary tract infections,
foodborne infections and infections in healthcare settings. In recent
years there have been dramatic examples like chloroquine resistant
malaria, methicillin resistant Staphylococcus aureus (MRSA) infection
and multidrug resistant and extensively drug resistant tuberculosis.
Ten percent of all hospitalized patients in this country have or
develop resistant infections, adding $55 billion in annual healthcare
costs. The public health burden of MRSA is enormous with over 90,000
MRSA infections per year in the United States. As a result, more NIH
funding must be allotted to relevant research. In 2010 NIAID announced
four new contracts for large scale clinical trials (making a total of
eight trials) focused on treatment alternatives for diseases for which
antibiotics are prescribed most often (e.g., middle ear infections).
Also in 2010, NIAID reported a newly identified MRSA toxin, the only
MRSA toxin currently known to destroy specific human immune cells and a
possible target of future drugs.
HIV/AIDS.--Since 1981, when the U.S. epidemic began, HIV/AIDS has
killed more than 565,000 people in the United States. Each year there
are about 2 million AIDS related deaths worldwide and an additional 2.7
million become newly infected, including about 56,000 new infections
annually in the United States. An estimated 33 million are living with
HIV/AIDS, over 1 million of those in this country. In large part due to
NIH support, medical science now offers rising hope amidst these grim
statistics, as those with HIV/AIDS live longer and better. In 2010,
NIAID funded researchers reported several studies that have been called
landmarks in the fight against this difficult disease:
--Preexposure prophylaxis (PrEP) with a daily dose of an approved
anti-HIV drug reduces the risk of infection among men who have
sex with men; studies of other at risk populations continue.
--After nearly 15 years of research, scientists discovered the first
vaginal microbicide gel that gives women some protection
against HIV infection.
--Various research groups have discovered at least eight antibodies
that can stop HIV from infecting human cells in the laboratory,
which could help scientists design effective vaccines.
--A study in Cambodia demonstrated that people coinfected with HIV
and tuberculosis can benefit from starting antiretroviral
therapy earlier than originally believed (antiretroviral
treatment can worsen the symptoms of coinfections, so timing is
critical).
Emerging Infectious Diseases.--Since 2003, NIAID has had principal
responsibility for NIH's research and development of medical
countermeasures against radiological, nuclear, chemical and biological
terrorist threats. NIAID's programs on biodefense and emerging/
reemerging infectious diseases are inevitably intertwined. Researchers
study hemorrhagic fevers caused by Ebola and other viruses, West Nile
virus, prion diseases, influenza viruses, anthrax, and dozens of other
infectious diseases, seeking vaccines, therapeutics, and diagnostics to
prevent or curb disease outbreaks. Last year, for instance, NIAID
scientists announced a new, quick method called real time quaking
induced conversion assay (RT QuIC) to detect prions, which cause fatal
brain diseases like mad cow disease in cattle, Creutzfeldt Jakob
disease in humans, and scrapie in sheep. Other researchers discovered a
new form of murine prion disease that resembles a form of human
Alzheimer's disease.
Last August, after more than a decade of work by NIAID scientists,
a dengue vaccine began human clinical testing; the virus infects about
50 million to 100 million people annually. NIAID also awarded new
contracts to private industry to develop delivery systems for new
vaccines against anthrax and dengue fever; clinical trials of the three
vaccines should begin within 3 years. Two other experimental vaccines
showed promise against Marburg virus (cause of hemorrhagic fever with a
fatality rate up to 80 percent) and Ebola virus (up to 90 percent
fatality).
National Security and Research.--Beginning in the late 1990s and
especially following 2001, funding for research in the Department of
Defense related to global diseases that impact U.S. military on foreign
soil as well as protection against biothreats on U.S. soil decreased.
This research is now primarily entrusted to NIAID and other NIH
institutes, FDA and CDC. Research related to defense is interdependent
on advances in other areas of research, especially those related to
emerging infections. Reports issues recently by the Institute of
Medicine and the National Biodefense Science Board emphasize the need
to properly fund these agencies for medical countermeasure development.
Genomics.--NIAID and NIGMS sponsor genomic research for improving
human health. At NIGMS, investigators are using human genetic
information to explain and identify individuals' reactions to certain
drugs--research called pharmacogenetics, which is focused on the NIH
goal of cost effective ``predictive, personalized, and preemptive
medicine.'' NIAID supported genomic research programs include genome
sequencing centers and bioinformatics resource centers. By the end of
2010, the Institute's two Structural Genomics Centers for Infectious
Diseases had determined 500 3-D protein structures from microorganisms
on the NIAID Category A-C priority lists or otherwise considered major
human pathogens.
Global Health.--Infectious diseases travel easily across
international borders, and the economic stability of nations can be
shaken by high rates of morbidity and mortality from such diseases.
Fiscal year 2009 marked the 30th anniversary of the Institute's
International Collaborations in Infectious Disease Research (ICIDR)
program. That year NIAID supported 643 international projects in 97
countries, with 72 percent of the funds invested in HIV/AIDS research.
In mid 2010, NIAID announced funding to establish 10 new malaria
research centers around the world. NIAID supported researchers recently
developed a chemical that may prove to be a new malaria drug; it has
more than a decade since the last new class of antimalarials became
available against a disease that kills nearly 1 million people every
year. Preliminary data suggest that the new compound might be effective
as a single dose, rather than the current standard treatment of
multiple doses over several days. Also last year, other NIAID grantees
described a previously unknown metabolic pathway used by malaria
parasites to survive inside human blood cells.
CONCLUSION
For over a century, NIH funded discoveries have saved lives,
stimulated private industry and fostered the next generation of
scientists and physicians. More than 130 Nobel Prize winners have
received support from NIH, but more importantly, the health of millions
worldwide has been improved through NIH programs. NIH investments have
also yielded remarkable financial rewards, from basic research that
helped launch the biotech industry to the recent development of a
highly effective meningitis vaccine that each year saves an estimated
$950 million in medical costs and another $1.14 billion in patient/
caregiver earnings. The ASM strongly recommends that Congress support
innovation in the medical sciences and increase funding for the
National Institutes of Health in fiscal year 2012.
______
Prepared Statement of the American Society for Nutrition
The American Society for Nutrition (ASN) appreciates the
opportunity to submit testimony regarding fiscal year 2012
appropriations for the National Institutes of Health (NIH) and the
National Center for Health Statistics (NCHS). ASN is the professional
scientific society dedicated to bringing together the world's top
researchers, clinical nutritionists and industry to advance our
knowledge and application of nutrition to promote human and animal
health. Our focus ranges from the most critical details of nutrition
research to broad societal applications. ASN respectfully requests $35
billion for NIH, and we urge you to adopt the President's request of
$162 million for NCHS in fiscal year 2012.
Basic and applied research on nutrition, nutrient composition, the
relationship between nutrition and chronic disease, and nutrition
monitoring are critical to the health of all Americans and the U.S.
economy. Awareness of the growing epidemic of obesity and the
contribution of chronic illness to burgeoning healthcare costs has
highlighted the need for improved information on dietary components,
dietary intake, strategies for dietary change and nutritional
therapies. The health costs of obesity alone are estimated at $147
billion each year. This enormous health and economic burden is largely
preventable, along with the many other chronic diseases that plague the
United States. It is for this reason that we urge you to consider these
recommended funding levels for two agencies under the Department of
Health and Human Services that have profound effects on nutrition
research, nutrition monitoring, and the health of all Americans--the
National Institutes of Health and the National Center for Health
Statistics.
National Institutes of Health
The National Institutes of Health (NIH) is responsible for
conducting and supporting 90 percent (approximately $1 billion) of
federally funded basic and clinical nutrition research. Nutrition
research, which makes up about 4 percent of the NIH budget, is truly a
trans-NIH endeavor, being conducted and funded across multiple
Institutes and Centers. In order to fulfill the full potential of
biomedical research, including nutrition research, ASN recommends an
fiscal year 2012 funding level of $35 billion for the agency, a modest
increase over the current funding level of $34 billion (including
supplemental appropriations). This increase is necessary to maintain
both the existing and future scientific infrastructure. Although the
discovery process produces tremendous value, it often takes a lengthy
and unpredictable path. Economic stagnation is disruptive to training,
careers, long range projects and ultimately to progress. NIH needs
sustainable and predictable budget growth to achieve the full promise
of medical research to improve the health and longevity of all
Americans and continue our Nation's dominance in this area.
NIH and its grantees have played a major role in the growth of
knowledge that has led to an unprecedented number of scientific
breakthroughs that have transformed our understanding of human health,
helping Americans to live longer, healthier and more productive lives.
Many of these discoveries are nutrition-related and have impacted the
way clinicians prevent and treat heart disease, cancer, diabetes and
other chronic diseases. By 2030 the number of Americans age 65 and
older is expected to grow to 72 million, and the incidence of chronic
disease will also grow. Sustained support for nutrition research is
required if we are to successfully confront the healthcare challenges
associated with an older population.
CDC National Center for Health Statistics
The National Center for Health Statistics (NCHS), housed within the
Centers for Disease Control and Prevention (CDC), is the Nation's
principal health statistics agency. The NCHS provides critical data on
all aspects of our healthcare system, and it is responsible for
monitoring the Nation's health and nutrition status through surveys
such as the National Health and Nutrition Examination Survey (NHANES).
Nutrition and health data are essential for tracking the nutrition,
health and well being of the American public, especially for observing
nutritional and health trends in our Nation's children. Through
learning both what Americans eat and how their diets directly affect
their health, the NCHS is able to monitor the prevalence of obesity and
other chronic diseases in the United States and track the performance
of preventive interventions, as well as assess consumption of
``nutrients of concern'' such as Vitamin D and calcium. Data such as
these are critical to guide policy development in the area of health
and nutrition.
To continue support for the agency and its important mission, ASN
recommends an fiscal year 2012 funding level of $162 million for the
agency. Flat and decreased funding levels threaten the collection of
this important information, most notably vital statistics and the
NHANES. Moreover, nearly 30 percent of the funding for NHANES comes
from other Federal agencies such as the NIH and the USDA Agricultural
Research Service. When these agencies face flat budgets or worse,
budget cuts, they withdraw much-needed support for NHANES, placing this
valuable resource in peril. Sustained funding for NCHS can help to
ensure uninterrupted collection of vital health and nutrition
statistics.
Thank you for your support of the National Institutes of Health
(NIH) and the National Center for Health Statistics (NCHS), and thank
you for the opportunity to submit testimony regarding fiscal year 2012
appropriations. Please contact Sarah Ohlhorst, MS, RD, Director of
Government Relations, if ASN may provide further assistance. She can be
reached at address: 9650 Rockville Pike, Bethesda MD 20814; telephone
number: 301.634.7281 or email address: [email protected].
______
Prepared Statement of the American Society for Pharmacology &
Experimental Therapeutics
The American Society for Pharmacology and Experimental Therapeutics
(ASPET) is pleased to submit written testimony in support of the
National Institutes of Health (NIH) fiscal year 2012 budget. ASPET is a
5,100 member scientific society whose members conduct basic and
clinical pharmacological research within the academic, industrial and
government sectors. Our members discover and develop new medicines and
therapeutic agents that fight existing and emerging diseases, as well
as increase our knowledge regarding how therapeutics affects humans.
For fiscal year 2012, ASPET supports a $35 billion budget for the
NIH. Research funded by the NIH improves public health, helps stimulate
our economy and improves global competitiveness. Sustained growth for
the NIH should be an urgent national priority. Flat funding or cuts to
the NIH budget will delay cures, eliminate jobs, and jeopardize
American leadership and innovation in biomedical research.
A $35 billion budget for the NIH in fiscal year 2012 will help
restore some of the lost opportunities and purchasing power since 2003,
when Congress finished a bipartisan effort of doubling the NIH budget.
Currently, the NIH cannot begin to fund all the high quality research
that needs to be done. At the moment only one-in-five research projects
can be supported. The situation has now reached a critical point:
--Over the past 6 years, the number of research project grants funded
by NIH has declined almost every year.
--NIH funds 2,000 fewer grants in total than in fiscal year 2004.
--NIH made 1,000 fewer competing (new and renewed) awards in 2010
than it did in 2003.
--Success rates for new applications have fallen for three straight
years.
If flat funding continues, or if additional cuts are made to the
NIH budget for fiscal year 2012, important research that improves the
quality of life, offers life-saving new therapeutics, and ultimately
reduces healthcare costs will be delayed or stopped. International
competitors will continue to gain on this highly innovative U.S.
enterprise, and we will lose a generation of young scientists who see
no prospects for careers in biomedical research. Flat or reduced
funding for NIH will mean that the agency would have to dramatically
reduce new awards and many research projects in progress would not
receive sufficient funding to complete the work, thus representing a
waste of valuable research resources.
An fiscal year 2012 NIH budget of $35 billion would help to restore
momentum to NIH funding. Scientific discovery takes time. As recent
experience has shown from the post-doubling experience and more recent
stimulus funding in 2009 and 2010, ``boom and bust'' cycles of rapid
funding followed by significant periods of stagnation or retraction in
the NIH budget diminish scientific progress. A $35 billion fiscal year
20121 NIH budget will help the agency manage its research portfolio
effectively without too much disruption of existing grants to
researchers throughout the country. The NIH, and the entire scientific
enterprise, cannot rationally manage boom or bust funding cycles. Only
through steady, sustainable and predictable funding increases can NIH
continue to fund the highest quality biomedical research to help
improve the health of all Americans and continue to make significant
economic impact in many communities across the country. An fiscal year
2012 NIH budget of $35 billion will help the NIH move to more fully
exploit promising areas of biomedical research and translate the
resulting findings into improved healthcare.
Investing in NIH Improves Human Health
Diminished funding for NIH will mean a loss of scientific
opportunities to discover new therapeutic targets and will create
disincentives to young scientists to commit to careers in biomedical
science. A $35 billion fiscal year 2012 NIH budget would provide the
various institutes that make up the NIH with an opportunity to fund
more high quality and innovative research in many disease areas.
Earlier and significant investments in NIH research have been
instrumental in improving human health:
--Parkinson's disease is estimated to afflict over 1 million
Americans at an annual cost of $26 billion. The discovery of
Levodopa was a breakthrough in treating the disease and allows
patients to lead relatively normal, productive lives. It is
estimated that treatments slowing the progress of disease by 10
percent could save the United States $327 million a year.
Current treatments slow progression of disease, but more
research is needed to identify the causes of the disease and
develop better therapies.
--More than 38 million Americans are blind or visually impaired, and
that number will grow with an aging population. Eye disease and
vision loss cost the United States $68 billion annually. NIH
funded research has developed new treatments that delay or
prevent diabetic retinopathy, saving $1.6 billion a year.
Discovery of gene variations in age related macular
degeneration could result in new screening tests and preventive
therapies.
--Almost 5 million Americans suffer from Alzheimer's disease at
annual costs of more than $100 billion. It is estimated that by
2050 more than 14 million Americans will live with the disease.
There are over 28 new drugs for Alzheimer's disease in
development, but more basic research is needed to keep the
pipeline for new drugs robust. Inadequate funding could delay,
prevent, and improve the treatment of the disease.
--Heart disease and stroke are the number one and three killers of
Americans, respectively. Cardiovascular disease costs the
United States more than $350 billion annually. Since 1970,
death rates from cardiovascular disease have fallen by 50
percent, but still remain the leading cause of death. Statin
drugs that reduce cholesterol help to prevent heart disease and
stroke, decrease recurrence of heart attacks and improve
survival rates for heart transplant patients.
--Cancer is the second leading cause of death in the United States.
The NIH estimates that the annual cost of the disease is over
$228 billion. NIH research has shown that human papillomavirus
(HPV) vaccines protect against persistent infection by the two
types of HPV that cause approximately 70 percent of cervical
cancers. NIH funded researchers are using nanotechnology to
develop probes that could pinpoint the location of tumors and
deliver drugs directly to cancer cells.
NIH-funded studies have also indicated that adopting intensive
lifestyle changes delayed onset of type-2 diabetes by 58 percent, and
that progesterone therapy can reduce premature births by 30 percent in
at-risk women. Historically, our past investment in basic biological
research has led to many innovative medicines. The National Research
Council reported that of the 21 drugs with the highest therapeutic
impact, only five were developed without input from the public sector.
The significant past investment in the NIH has provided major gains in
our knowledge of the human genome, resulting in the promise of
pharmacogenomics and a reduction in adverse drug reactions that
currently represent a major worldwide health concern. Already, there
are several examples where complete human genome sequence analysis has
pinpointed disease-causing variants that have led to improved therapy
and cures. Although the costs for such analyses have been reduced
dramatically by technology improvements, widespread use of this
approach will require further improvements in technology that will be
delayed or obstructed with inadequate NIH funding.
Unless NIH can maintain an adequate funding stream, scientific
opportunities will be delayed, lost, or forfeited to other countries.
This investment in NIH also will directly support jobs for U.S.
citizens and residents and help to stimulate the economy.
Investing in NIH Helps America Compete Economically
A $35 billion budget in fiscal year 2012 will also help the NIH
train the next generation of scientists. This investment will help to
create jobs and promote economic growth.
Worldwide, other nations continue to invest aggressively in
science. China has grown its science portfolio with annual increases to
the research and development budget averaging over 23 percent annually
since 2000. And while Great Britain has imposed strict austerity
measures to address that Nation's debt problems, the British
conservative party had the foresight to keep its strategic investments
in science at current levels. Investment in research and development as
a percentage of gross domestic product has remained static for the
United States in the first decade of the 21st century, while growing by
nearly 60 percent in China and 34 percent in South Korea.
NIH research funding helps to catalyze private sector growth. More
than 83 percent of NIH funding is awarded to over 3,000 universities,
medical schools, teaching hospitals and other research institutions in
every State. NIH also helps form the key scientific foundations for the
pharmaceutical and biotechnology industries.
Inadequate funding for NIH means more than a loss of scientific
potential and discovery. Failing to help meet the NIH's scientific
potential will mean a significant reduction in research grants, the
resulting phasing-out of high quality research programs and jobs lost.
Conclusion
ASPET has full awareness for the many competing and important
priorities facing the subcommittee. However, NIH and the biomedical
research enterprise face a critical moment and the agency's
contribution to the economic and physical well being of American's
health should make it one of the Nation's top priorities. With enhanced
and sustained funding, NIH has the potential to address many of the
more promising scientific opportunities that currently challenge
medicine. A $35 billion fiscal year 2012 NIH budget will allow the
agency to begin moving forward again to prevent, diagnose and treat
disease, restoring the NIH to its role as a national treasure that
attracts and retains the best and brightest to biomedical research, and
providing hope to millions of individuals afflicted with illness and
disease.
______
Prepared Statement of the American Society of Nephrology
Introduction
The American Society of Nephrology (ASN) thank you for the
opportunity to submit a statement for the record to the Senate
Appropriations Subcommittee on Labor, Health and Human Services,
Education, and Related Agencies (LHHS Subcommittee). ASN urges the LHHS
subcommittee to support robust funding for medical research in the
fiscal year 2012 Federal budget.
ASN is a not-for-profit professional society of more than 11,000
scientists and physicians dedicated to cutting-edge medical research
and delivering the highest quality therapies to patients. Foremost
among ASN's concerns is the continued support of basic, translational,
and clinical nephrology research.
The society's statement focuses on those issues and programs that
most immediately fall under the committee's jurisdiction and assist our
members in finding breakthrough treatments and cures for patients with
kidney disease. We want to express our strong support for advancing
programs supported by the National Institutes of Health (NIH) and the
Agency for Healthcare Research and Quality (AHRQ). The ASN thanks the
Subcommittee for its steadfast support of these programs and requests
continued support of medical research in fiscal year 2012.
The Face of Kidney Disease
Chronic kidney disease now is a major public health problem in the
United States, with as many as one in nine Americans or 26 million
people suffering from kidney disease of some degree. This number is
projected to rise, underscoring that support of medical research into
the causes and treatments of kidney disease is essential to protecting
public health. A growing population, a significant and growing cohort
of Americans above age 65, the combined epidemics of cardiovascular
disease, diabetes, and hypertension all lead to an increasing number of
Americans with chronic kidney disease.
Chronic kidney disease affects people regardless of age, race, sex,
socio economic background, or geographic location. It is estimated that
at least 15 million people suffer from CKD, meaning that they have lost
at least 50 percent of their kidney function. Most don't know it.
Another 20 million more Americans are at increased risk of developing
kidney disease. Again, most are unaware. Hypertension and diabetes are
leading causes of kidney disease, with diabetes accounting for 44
percent of new cases of complete kidney failure. With both diabetes and
hypertension on the rise, the need for additional kidney disease
research takes on greater importance.
Kidney disease is also a major risk factor for cardiovascular
disease, with half of patients with kidney failure dying from
cardiovascular disease. Research at NIH continues to disentangle the
relationship between kidney disease, cardiovascular disease, diabetes
and hypertension.
Without treatment chronic kidney disease often progresses to
complete kidney failure also known as end stage renal disease (ESRD),
or permanent kidney failure. Patients with ESRD require dialysis or
transplantation to survive for which Medicare covers the cost for
almost all patients. Nearly 500,000 Americans have ESRD, and that
continues to grow. Additionally, African-Americans, Native Americans,
and Hispanics are at greater risk of developing ESRD than Caucasians.
NIH research is helping to unlock the reasons behind these health
disparities.
Economics Costs
Although no dollar amount can be affixed to human suffering or the
loss of human life, economic data can help to identify and quantify the
current and projected future financial costs associated with ESRD. The
annual average cost per ESRD patient on dialysis is approximately
$71,000. This major cost to Medicare highlights the need to investigate
new, and better apply, recently proven strategies for preventing and
slowing the progress of kidney disease.
In short, we can treat and maintain patients who are at risk for
losing their kidney function but the critical need is to prevent the
loss of kidney function and its complications in the first place.
Meeting this vital goal can only be accomplished through more concerted
research and education.
Kidney Disease Research
National Institutes of Health (NIH)
NIH research is vital to the public and economic health of the
United States. As such, ASN supports the Administration's program level
request of $31.987 billion for NIH in fiscal year 2012. Recognizing the
economic challenges of the country's current fiscal situation, ASN
nonetheless submits that maintaining level funding for NIH is
imperative to the future health and well-being of the Nation. Research
supported by NIH helps discover new cures and treatments for the
millions of Americans with kidney disease and improves the lives of
patients across the country. Medical research funded through NIH means
hope for patients with kidney disease.
NIH research also serves as a vital economic engine. More than 80
percent of NIH funding flows back to States, maintaining jobs and
promoting economic vitality. Support for NIH research helps ensure that
the United States remains the world leader in cutting edge treatments
for chronic disease. NIH grants and research fund the cures of
tomorrow, and also fund researchers who form the backbone of our global
competitiveness in the medical field. A drop in funding, even one that
is short lived could have drastic consequences for the future research
workforce.
In fiscal year 2012 an NIH budget of $31.987 billion will allow
research funding to keep pace with inflation, sustain the invaluable
research projects currently underway, and allow the research workforce
to remain adequately supported and protect a valuable investment in
human talent.
Agency for Health Care Research and Quality (AHRQ)
Complementing the medical research conducted at NIH, AHRQ sponsors
health services research designed to improve the quality of healthcare,
decrease healthcare costs, and provide access to essential healthcare
services by translating research into measurable improvements in the
healthcare system. AHRQ supports emerging critical issues in healthcare
delivery and addresses the particular needs of at risk populations. ASN
firmly believes in the value of AHRQ's research and quality agenda,
which continues to provide healthcare providers, policymakers, and
patients with critical information needed to improve healthcare and
treatment of chronic conditions such as kidney disease. AS such ASN
supports the Administration's budget request of $366 million for AHRQ
in fiscal year 2012.
Conclusion
The progression of chronic kidney disease to kidney failure can be
slowed, with further research, treatments for stopping progression or
even reversing it can be envisioned. Meanwhile, millions of Americans
face a gradual decline in their quality of life because of kidney
disease. Treatments of kidney failure including transplantation
increase the ability of patients to be productive citizens. In many
cases, abnormalities associated with early stage chronic renal disease
remain undetected and are not diagnosed until the late stages. Chronic
kidney disease requires our serious and immediate attention.
Medical research undertaken at NIH and AHRQ is essential to the
health of patients with kidney disease, both present and future. As
such, ASN urges the Subcommittee to adopt level funding for these
programs in fiscal year 2012.
Thank you for your continued support for medical research and
kidney disease. The society appreciates the opportunity to submit
written testimony in support of NIH and AHRQ. To discuss this written
testimony, ASN, medical research or kidney disease, please contact ASN
Director of Policy and Public Affairs Paul Smedberg.
______
Prepared Statement of the American Society of Plant Biologists
On behalf of the American Society of Plant Biologists (ASPB) we
would like to thank the Subcommittee for its support of the National
Institutes of Health (NIH).
ASPB and its members recognize the difficult fiscal environment our
Nation faces, but believe investments in scientific research will be a
critical step toward economic recovery. ASPB asks that the Subcommittee
Members encourage increased support for plant biology research within
NIH, which has contributed in innumerable ways to improving the lives
of people throughout the world.
The American Society of Plant Biologists is an organization of
approximately 5,000 professional plant biology researchers, educators,
graduate students, and postdoctoral scientists with members in all 50
States and throughout the world. A strong voice for the global plant
science community, our mission--achieved through work in the realms of
research, education, and public policy--is to promote the growth and
development of plant biology, to encourage and communicate research in
plant biology, and to promote the interests and growth of plant
scientists in general.
Plant Biology Research and America's Future
Plants are vital to our very existence. They harvest sunlight,
converting it to chemical energy for food and feed; they take up carbon
dioxide and produce oxygen; and they are the primary producers on which
all life depends. Indeed, plant biology research is making many
fundamental contributions in the areas of domestic fuel security and
environmental stewardship; the continued and sustainable development of
better foods, fabrics, pharmaceuticals, and building materials; and in
the understanding of basic biological principles that underpin
improvements in the health and nutrition of all Americans. In fact, the
2009 National Research Council (NRC) report A New Biology for the 21st
Century placed plant biology at the center of urgent priorities in
energy, food, health, and the environment.
For example, because plants are the ultimate source of both human
nutrition and nutrition for domestic animals, plant biology has the
potential to contribute greatly to reducing healthcare costs as well as
playing an integral role in discovery of new drugs and therapies.
Although the National Institutes of Health does offer some funding
support to plant biology research, additional support would enable
plant biologists to offer much more to advance the missions of the
National Institutes of Health.
The importance of disciplinary and agency integration is a central
theme of several recent NRC reports including A New Biology for the
21st Century, Research at the Intersection of the Physical and Life
Sciences, and Inspired by Biology: From Molecules to Materials to
Machines. ASPB encourages NIH to continue and expand its partnerships
with other Federal science agencies--including the National Science
Foundation, Department of Agriculture and Department of Energy--in
advancing understanding about living systems that has application to a
range of areas including human health.
Plant Biology and the National Institutes of Health
The mission of the NIH is to pursue ``fundamental knowledge about
the nature and behavior of living systems and the application of that
knowledge to extend healthy life and reduce the burdens of illness and
disability.'' Plant biology research is highly relevant to this
mission.
Plants are often the ideal model systems to advance our
``fundamental knowledge about the nature and behavior of living
systems,'' as they provide the context of multi-cellularity while
affording ease of genetic manipulation, a lesser regulatory burden, and
inexpensive maintenance requirements than the use of animal systems.
Many basic biological components and mechanisms are shared by both
plants and animals. For example, a molecule named cryptochrome that
senses light was identified first in plants and subsequently found to
also function in humans, where it plays a central role in regulating
our biological clock. Several human genetic disorders are linked to the
malfunctioning of this clock--not to mention the effect of jet lag. As
another example, some fungal pathogens can infect both humans and
plants, and the molecular mechanisms employed by both the pathogen and
its targeted host can be very similar.
More recently, a property known as RNA interface was first noted in
plants; plant biologists trying to increase the color intensity of
petunias by introducing a gene inducing pigment production instead
observed a loss of color. RNA interface, which has potential
application in the treatment of human disease, was further elucidated
in other plants and animals and earned two American scientists--Andrew
Fire and Craig Mello--the 2006 Nobel Prize in Physiology or Medicine.
Health and Nutrition
Plant biology research is also central to the application of basic
knowledge to ``extend healthy life and reduce the burdens of illness
and disability.'' This connection is most obvious in the inter-related
areas of nutrition and clinical medicine. Without good nutrition, there
cannot be good health. Indeed, one World Health Organization study on
childhood nutrition in developing countries concluded that over 50
percent of the deaths of children less than 5 years of age could be
attributed to malnutrition's effects in exacerbating common illnesses
such as respiratory infections and diarrhea. Strikingly, most of these
deaths were not linked to severe malnutrition but only to mild or
moderate nutritional deficiencies. Plant biology researchers are
working today to improve the nutritional content of crop plants by, for
example, increasing the availability of nutrients and vitamins such as
iron, vitamin E, and vitamin A. (Up to 500,000 children in the
developing world go blind every year as a result of vitamin A
deficiency).
By contrast, obesity, cardiac disease, and cancer take a striking
toll in the developed world. Among many plant biology initiatives
relevant to these concerns are research to improve the lipid
composition of plant fats and efforts to optimize concentrations of
plant compounds that are known to have anti-carcinogenic properties,
such as the glucosinolates found in broccoli and cabbage, and the
lycopenes found in tomato. Beta-glucans from certain cereals reduce
serum cholesterol and insulin demand in diabetics. And scientists are
able to use the fundamental knowledge of protein structures to reduce
non-nutritious compounds, increasing the density and quality of
proteins in some grains. Ongoing development of crop varieties with
tailored nutraceutical content is an important contribution that plant
biologists are making toward realizing the goal of personalized
medicine, especially personalized preventative medicine.
Drug Discovery
Plants are also fundamentally important as sources of both extant
drugs and drug discovery leads. In fact, over 10 percent of the drugs
considered by the World Health Organization to be ``basic and
essential'' are still exclusively obtained from flowering plants. Some
historical examples are quinine, which is derived from the bark of the
cinchona tree and was the first highly effective anti-malarial drug;
and the plant alkaloid morphine, which revolutionized the treatment of
pain. These pharmaceuticals are still in use today.
A more recent example of the importance of plant-based
pharmaceuticals is the anti-cancer drug taxol. The discovery of taxol
came about through collaborative work involving scientists at the
National Cancer Institute within NIH and plant biologists at the U.S.
Department of Agriculture. The plant biologists collected a wide
diversity of plant materials, which were then evaluated for anti-
carcinogenic properties. It was found that the bark of the Pacific yew
tree yielded one such compound, which was isolated and named taxol
after the tree's Latin name, Taxus brevifolia. Originally, taxol could
only be obtained from the tree bark itself, but additional research led
to the elucidation of its molecular structure and eventually to its
chemical synthesis in the laboratory.
On the basis of a growing understanding of metabolic networks,
plants will continue to be sources for the development of new medicines
to help treat cancer and other ailments. Taxol is just one example of a
plant secondary compound. Since plants produce an estimated 200,000
such compounds, they will continue to provide a fruitful source of new
drug leads, particularly if collaborations such as the one described
above can be fostered and funded. With additional research support,
plant biologists can lead the way to developing new medicines and
biomedical applications to enhance the treatment of devastating
diseases.
Conclusion
Despite the fact that plant biology research underlies so many
vital practical considerations for our country, the amount invested in
understanding the basic function and mechanisms of plants is small when
compared with broader impacts.
The NIH does recognize that plants are a vital component of its
mission. However, because the boundaries of plant biology research are
permeable and because information about plants integrates with many
different disciplines that are highly relevant to NIH, ASPB hopes that
the Subcommittee will provide direction to NIH to support additional
plant biology research in order to help pioneer new discoveries and new
methods in biomedical research.
Thank you for your consideration of our testimony on behalf of the
American Society of Plant Biologists. Please do not hesitate to contact
ASPB if we can be of any assistance in the future; ASPB Public Affairs
Director Dr. Adam P. Fagen can be reached at 301-296-0898 (phone), 301-
296-0899 (fax), or [email protected].
______
Prepared Statement of the American Society of Tropical Medicine and
Hygiene
The American Society of Tropical Medicine and Hygiene--the
principal professional membership organization representing, educating,
and supporting scientists, physicians, clinicians, researchers,
epidemiologists, and other health professionals dedicated to the
prevention and control of tropical diseases--appreciates the
opportunity to submit testimony to the Senate Labor, Health and Human
Services, and Education Appropriations Subcommittee.
We understand the fiscal constraints we as a country are in and are
sensitive to the job Congress must do. The benefits of U.S. investment
in tropical diseases are not only humanitarian, they are diplomatic as
well. With this in mind, we respectfully request that the Subcommittee
fund the following agencies in the fiscal year 2012 LHHS Appropriations
bill to allow them to maintain their current programs and research
priorities while ensuring a continued U.S. Government investment in
global health and tropical medicine research and development:
National Institutes of Health, specifically:
--Malaria and neglected tropical disease treatment, control, and
research and development efforts within the National Institute
of Allergy and Infectious Diseases;
--An expanded focus on the treatment, control, and research and
development for new tools for diarrheal disease within the NIH;
specifically the inclusion of enteric infections on the
Research, Condition, and Disease Categorization (RCDC) process
on the Research Portfolio Online Reporting Tools (RePORT)
website; and,
--Research capacity development in countries where populations are at
heightened risk for malaria, NTDs, and diarrheal diseases
through the Fogarty International Center.
The Centers for Disease Control and Prevention, including:
--CDC global health programs such as the CDC malaria program and
providing direct funding to the CDC for NTD and diarrheal
disease work; and
--Preserving and funding the activities of the CDC Vector Borne
Disease Program as they merge with the Emerging and Infectious
Disease Program to protect the United States from new and
emerging infections.
RETURN ON INVESTMENT OF U.S.-FUNDED RESEARCH
CDC and NIH play essential roles in research and development for
tropical medicine and global health. Both agencies are at the forefront
of the new science that leads to tools to combat malaria and NTDs. This
research provides jobs for American researchers and an opportunity for
the United States to be a leader in the fight against global disease,
in addition to lifesaving new drugs and diagnostics to some of the
poorest, most at-risk people in the world.
For example, in Illinois, where ASTMH is based, 57,000 people are
employed in bioscience research, which includes global health research.
Illinois receives over $700 million in funding from NIH and over $200
million from CDC.\1\ New Jersey also has a high level of investment in
health-related research and development, with over 211,000 jobs
supported by global health, and an economic impact of more than $60
billion on the State in 2009.\2\ Small investments in global health and
tropical medicine research and development can yield big returns for
State economies and research institutions.
---------------------------------------------------------------------------
\1\ Research America, ``Global Health R&D, A Smart Investment for
Illinois,'' http://www.researchamerica.org/uploads/
ILGHeconomicsheet.pdf.
\2\ Research America, ``Global Health R&D, A Smart Investment for
New Jersey,'' http://www.researchamerica.org/uploads/
NewJerseyFactSheet.pdf.
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TROPICAL DISEASE
Most tropical diseases are prevalent in either sub-Saharan Africa,
parts of Asia (including the Indian subcontinent), or Central and South
America. Many of the world's developing nations are located in these
areas; thus, tropical medicine tends to focus on diseases that impact
the world's most impoverished individuals.
Malaria.--Malaria remains a global emergency affecting mostly poor
women and children; it is an acute, sometimes fatal disease. Despite
being treatable and preventable, malaria is one of the leading causes
of death and disease worldwide. Approximately every 30 seconds, a child
dies of malaria--a total of about 800,000 under the age of 5 every
year. The World Health Organization estimates that one half of the
world's people are at risk for malaria and that there are 108 malaria-
endemic countries. Additionally, WHO has estimated that malaria reduces
sub-Saharan Africa's economic growth by up to 1.3 percent per year.
Neglected Tropical Diseases, also known as Diseases of Poverty.--
NTDs are a group of chronic parasitic diseases, such as hookworm,
elephantiasis, schistosomiasis, and river blindness, which represent
the most common infections of the world's poorest people. These
infections have been revealed as the stealth reason why the ``bottom
billion''--the 1.4 billion poorest people living below the poverty
line--cannot escape poverty, because of the effects of these diseases
on reducing child growth, cognition and intellect, and worker
productivity.
Diarrheal disease.--The child death toll due to diarrheal illnesses
exceeds that of AIDS, tuberculosis, and malaria combined. In poor
countries, diarrheal disease is second only to pneumonia as the cause
of death among children under 5 years old. Every week, 31,000 children
in low-income countries die from diarrheal diseases.
The United States has a long history of leading the fight against
tropical diseases that cause human suffering and pose financial burden
that can negatively impact a country's economic and political
stability. Tropical diseases, many of them neglected for decades,
impact U.S. citizens working or traveling overseas, as well as our
military personnel. Furthermore, some of the agents responsible for
these diseases can be introduced and become established in the United
States (like West Nile virus), or might even be weaponized.
NATIONAL INSTITUTES OF HEALTH
National Institute of Allergy and Infectious Diseases.--A long-term
investment is critical to achieve the drugs, diagnostics, and research
capacity needed to control malaria and NTDs. NIAID, the lead institute
for malaria research, plays an important role in developing the drugs
and vaccines needed to fight malaria. The NIH, through NIAID, also
conducts research to better understand NTDs, through its own basic and
clinical studies as well as extramural research.
ASTMH encourages the subcommittee to:
--Increase funding for NIH to expand the agency's investment in
malaria, NTD, diarrheal disease research and to coordinate that
work with other government agencies to maximize resources and
ensure development of basic discoveries into usable solutions;
--Specifically invest in NIAID to support its role at the forefront
of these efforts to developing the next generation of drugs,
vaccines, and other interventions; and,
--Urge NIH to include enteric infections and neglected diseases in
its RCDC process on the RePORT website to outline the work that
is being done in these important research areas.
Fogarty International Center (FIC).--Biomedical research has
provided major advances in the treatment and prevention of malaria,
NTDs, and other infectious diseases. These benefits, however, are often
slow to reach the people who need them most. FIC plays a critical role
in strengthening science and public health research institutions in
low-income countries. FIC works to strengthen research capacity in
countries where populations are particularly vulnerable to threats
posed by malaria, NTDs, and other infectious disease. This maximizes
the impact of U.S. investments and is critical to fighting malaria and
other tropical diseases.
ASTMH encourages the subcommittee to:
--Allocate sufficient resources to FIC in fiscal year 2012 to
increase these efforts, particularly as they address the
control and treatment of malaria, NTDs and diarrheal disease.
THE CENTERS FOR DISEASE CONTROL AND PREVENTION
Malaria Efforts.--Malaria has been eliminated as an endemic threat
in the United States for over fifty years and CDC remains on the
cutting edge of global efforts to reduce the toll of this deadly
disease. CDC efforts on malaria fall into three broad categories:
prevention, treatment, and monitoring/evaluation of efforts. The agency
performs a wide range of basic research within these categories, such
as:
--Conducting research on antimalarial drug resistance to inform new
strategies and prevention approaches;
--Assessing new monitoring, evaluation, and surveillance strategies;
--Conducting additional research on malaria vaccines, including field
evaluations; and
--Developing innovative public health strategies for improving access
to antimalarial treatment and delaying the appearance of
antimalarial drug resistance.
ASTMH encourages the subcommittee to:
--Fund a comprehensive approach to effective and efficient malaria
control, including adequately funding the important
contributions of CDC.
NTD Programs.--CDC currently receives zero dollars directly for NTD
work; however this should be changed to allow for more comprehensive
work to be done on NTDs at the CDC. CDC has a long history of working
on NTDs and has provided much of the science that underlies the global
policies and programs in existence today. This work is important to any
global health initiative, as individuals are often infected with
multiple NTDs simultaneously.
ASTMH encourages the subcommittee to:
--Provide direct funding to CDC to continue its work on NTDs; and
--Urge CDC to continue its monitoring, evaluation, and technical
assistance in these areas as an underpinning of efforts to
control and eliminate these diseases.
Vector-borne Disease Program (VBDP).--The President's fiscal year
2012 budget folds the CDC Vector Borne Disease Program into the newly
configured Emerging and Zoonotic Infectious Diseases program at CDC.
Through the VBDP, researchers are able to practice essential
surveillance and monitoring activities that protect the United States
from deadly infections before they reach our borders. The world is
becoming increasingly smaller as international travel increases and new
pathogens are introduced quickly into new environments. We have seen
this with SARS, avian influenza, and now, dengue fever, in the United
States. Arboviruses like dengue, and others, such as chikungunya, are a
constant threat to travelers, and to Americans generally.
Dengue fever, a disease with increased risk for Americans as the
weather warms and dengue cases increase, is an example of why it is
imperative that CDC be able to continue its disease monitoring and
surveillance activities to protect the country from new and emerging
threats like dengue and other arboviruses. Dengue fever, a viral
disease transmitted by the Aedes mosquito, recently reemerged as a
threat to Americans, with documented cases in the Florida Keys. Dengue
usually results in fever, headache, and chills, but hemorrhagic dengue
fever can cause severe internal bleeding, loss of blood, and even
death. Because the Aedes mosquito is urban dwelling and often breeds in
areas of poor sanitation, dengue is a serious concern for poor
residents of costal, urban areas in Texas, Louisiana, Mississippi,
Alabama, and Florida.
ASTMH encourages the subcommittee to:
--Ensure that CDC maintain these important activities by continuing
CDC funding for VBDP activities and require the program receive
at least their fiscal year 2010 level of funding.
CONCLUSION
Thank you for your attention to these important U.S. and global
health matters. We know Congress and the American people face many
challenges in choosing funding priorities, and we hope you will provide
the requested fiscal year 2012 resources to those programs identified
above that meet critical needs for Americans and people around the
world. ASTMH appreciates the opportunity to share its expertise, and we
thank you for your consideration of these requests that will help
improve the lives of Americans and the global poor.
______
Prepared Statement of the American Thoracic Society
SUMMARY: FUNDING RECOMMENDATIONS
[In millions of dollars]
------------------------------------------------------------------------
Amount
------------------------------------------------------------------------
National Institutes of Health............................. 35,000
National Heart, Lung and Blood Institute.............. 3,514
National Institute of Allergy and Infectious Disease.. 5,395
National Institute of Environmental Health Sciences... 779.4
Fogarty International Center.......................... 78.4
National Institute of Nursing Research................ 163
Centers for Disease Control and Prevention................ 7,700
National Institute for Occupational Safety & Health... 332.4
Asthma Programs....................................... 31
Div. of Tuberculosis Elimination...................... 231
Office on Smoking and Health.......................... 330
National Sleep Awareness Roundtable (NSART)........... 1
------------------------------------------------------------------------
The American Thoracic Society (ATS) is pleased to submit our
recommendations for programs in the Labor Health and Human Services and
Education Appropriations Subcommittee purview. Founded in 1905, the ATS
is an international education and scientific society of 15,000
specialists focused on respiratory, critical care and sleep medicine.
Lung Disease in America
Diseases of breathing constitute the third leading cause of death
in the United States, responsible for one of every seven deaths.
Diseases affecting the respiratory (breathing) system include chronic
obstructive pulmonary disease (COPD), lung cancer, tuberculosis,
influenza, sleep disordered breathing, pediatric lung disorders,
occupational lung disease, sarcoidosis, asthma, and critical illness.
COPD is now the third leading cause of disease death. The number of
people with asthma in the United States has surged over 150 percent
since 1980 and the root causes of the disease are still not fully
known.
Despite the rising lung disease burden, lung disease research is
underfunded. In fiscal year 2010, lung disease research represented
just 22.6 percent of the National Heart Lung and Blood Institute's
(NHLBI) budget. Although COPD is the third leading cause of death in
the United States, research funding for the disease is a small fraction
of the money invested for the other three leading causes of death. In
order to stem the devastating effects of lung disease, research funding
must continue to grow.
National Institutes of Health
The NIH is the world's leader in groundbreaking biomedical health
research into the prevention, treatment and cure of diseases such as
lung cancer, COPD and tuberculosis. Eighty-five percent of the NIH
budget is invested in U.S. communities through universities, medical
schools, hospitals and innovative small businesses, creating jobs and
economic productivity. The American Reinvestment Recovery Act (ARRA)
has generated remarkable scientific innovation that is paving the way
for medical advances to improve patient outcomes. Without a funding
increase in fiscal year 2012 to sustain the research pipeline, the NIH
will be forced to reduce the number of research grants funded, which
will result in the halting of vital research into diseases affecting
millions around the world. We ask the subcommittee to provide $35
billion in funding for the NIH in fiscal year 2012.
Centers for Disease Control and Prevention
In order to ensure that health promotion and chronic disease
prevention are given top priority in Federal funding, the ATS supports
a funding level for the Centers for Disease Control and Prevention
(CDC) that enables it to carry out its prevention mission, and ensure a
translation of new research into effective State and local public
health programs. We ask that the CDC budget be adjusted to reflect
increased needs in chronic disease prevention, infectious disease
control, including TB control to prevent the spread of drug-resistant
TB, and occupational safety and health research and training. The ATS
recommends a funding level of $7.7 billion for the CDC in fiscal year
2012.
COPD
COPD is the third leading cause of death in the United States and
the third leading cause of death worldwide, yet the disease remains
relatively unknown to most Americans. COPD is the term used to describe
the limitation in breathing due mainly to emphysema and chronic
bronchitis. CDC estimates that 12 million patients have COPD; an
additional 12 million Americans are unaware that they have this life
threatening disease. In 2010, the estimated economic cost of lung
disease in the United States was $186 billion, including $117 billion
in direct health expenditures and $69 billion in indirect morbidity and
mortality costs.
Despite the growing burden of COPD, the United States does not
currently have a comprehensive public health action plan on the
disease. The ATS urges Congress to direct the NHLBI to develop a
national action plan on COPD, in coordination with the Centers for
Disease Control and Prevention (CDC) to expand COPD surveillance,
development of public health interventions and research on the disease
and increase public awareness of the disease. The NHLBI has shown
successful leadership in educating the public about COPD through the
COPD Education and Prevention Program.
CDC has an additional role to play in this work. We urge CDC to
include COPD-based questions to future CDC health surveys, including
the National Health and Nutrition Evaluation Survey (NHANES), the
National Health Information Survey (NHIS) and the Behavioral Risk
Factor Surveillance Survey (BRFSS).
Tobacco Control
Cigarette smoking is the leading preventable cause of death in the
United States, responsible for one in five deaths annually. The ATS is
pleased that the Department of Health and Human Services has made
tobacco use prevention a key priority. The CDC's Office of Smoking and
Health coordinates public health efforts to reduce tobacco use. In
order to significantly reduce tobacco use within 5 years, as
recommended by the subcommittee in fiscal year 2010, the ATS recommends
a total funding level of $330 million for the Office of Smoking and
Health in fiscal year 2012, which includes an allocation of $220
million from the Prevention and Public Health Fund.
Pediatric Lung Disease
The ATS is pleased to report that infant death rates for various
lung diseases have declined for the past 10 years. In 2007, of the 10
leading causes of infant mortality, 4 were lung diseases or had a lung
disease component. Many of the precursors of adult respiratory disease
start in childhood. It is estimated that close to 22 million people
suffer from asthma, including an estimated 7.1 million children. The
ATS encourages the NHLBI to continue with its research efforts to study
lung development and pediatric lung diseases.
Asthma
Asthma is a significant public health problem in the United States.
Approximately 23 million Americans currently have asthma, including 7.1
million children. In 2009, 3,445 Americans in 2009 died as a result of
asthma exacerbations. Asthma is the third leading cause of
hospitalization among children under the age of 15 and is a leading
cause of school absences from chronic disease. The disease costs our
healthcare system over $50.1 billion per year. African Americans have
the highest asthma prevalence of any racial/ethnic group.
The President's fiscal year 2012 budget request proposes to merge
the CDC's National Asthma Control Program with the Healthy Homes/Lead
Poisoning Prevention Program and recommends funding cuts to the
combined programs of over 50 percent. The ATS is deeply concerned that
this proposal would drastically reduce States' capacity to implement a
proven public health response to this disease. Asthma public health
interventions are cost-effective. A study published in the American
Journal of Respiratory Critical Care recently found that for every
dollar invested in asthma interventions, there was a $36 benefit. We
urge the subcommittee to ensure that CDC's National Asthma Control
Program remains a stand-alone program and receives an appropriation of
$31 million for fiscal year 2012.
Sleep
Several research studies demonstrate that sleep-disordered
breathing and sleep-related illnesses affect an estimated 50-70 million
Americans. The public health impact of sleep illnesses and sleep
disordered breathing is still being determined, but is known to include
increased mortality, traffic accidents, lost work and school
productivity, cardiovascular disease, obesity, mental health disorders,
and other sleep-related comorbidities. Despite the increased need for
study in this area, research on sleep and sleep-related disorders has
been underfunded. The ATS recommends a funding level of $1 million in
fiscal year 2012 to support activities related to sleep and sleep
disorders at the CDC, including for the National Sleep Awareness
Roundtable (NSART), surveillance activities, and public educational
activities. The ATS also recommends an increase of funding for research
on sleep disorders at the Nation Center for Sleep Disordered Research
(NCSDR) at the NHLBI.
Tuberculosis
Tuberculosis (TB) is the second leading global infectious disease
killer, claiming 1.7 million lives each year. It is estimated that 9-12
million Americans have latent tuberculosis. Drug-resistant TB poses a
particular challenge to domestic TB control due to the high costs of
treatment and intensive healthcare resources required. The global TB
pandemic and spread of drug resistant TB presents a persistent public
health threat to the United States.
Despite declining rates, persistent challenges to TB control in the
United States remain. Specifically: (1) racial and ethnic minorities
continue to suffer from TB more than majority populations; (2) foreign-
born persons are adversely impacted; (3) sporadic outbreaks occur,
outstripping local capacity; (4) continued emergence of drug
resistance; and (5) there are critical needs for new diagnostics,
treatment and prevention tools.
The Comprehensive Tuberculosis Elimination Act (CTEA, Public Law
110-392), enacted in 2008, reauthorized programs at CDC with the goal
of putting the United States back on the path to eliminating TB. The
ATS, recommends a funding level of $231 million in fiscal year 2012 for
CDC's Division of TB Elimination, as authorized under the CTEA, and
encourages the NIH to expand efforts, as requested under the CTEA, to
develop new tools to reduce the rising global TB burden.
Critical Illness
The burden associated with the provision of care to critically ill
patients is anticipated to increase significantly as the population
ages. Approximately 200,000 people in the United States require
hospitalization in an intensive care unit because they develop a form
of pulmonary disease called Acute Lung Injury. Despite the best
available treatments, 75,000 of these individuals die each year from
this disease. Investigation into diagnosis, treatment and outcomes in
critically ill patients should be a high priority, and the NIH should
be encouraged and funded to coordinate investigation related to
critical illness in order to meet this growing national imperative.
Fogarty International Center
The Fogarty International Center (FIC) at NIH provides training
grants to U.S. universities to teach AIDS treatment and research
techniques to international physicians and researchers. Because of the
link between AIDS and TB infection, FIC has created supplemental TB
training grants for these institutions to train international health
professionals in TB treatment and research. The ATS recommends Congress
provide $78.4 million for FIC in fiscal year 2012, to allow expansion
of the TB training grant program from a supplemental grant to an open
competition grant.
Researching and Preventing Occupational Lung Disease
The National Institute of Occupational Safety and Health (NIOSH) is
the sole Federal agency responsible for conducting research and making
recommendations for the prevention of work-related diseases and injury.
The ATS recommends that Congress provide $364.3 million in fiscal year
2012 for NIOSH to expand or establish the following activities: the
National Occupational Research Agenda (NORA); tracking systems for
identifying and responding to hazardous exposures and risks in the
workplace; emergency preparedness and response activities; and training
medical professionals in the diagnosis and treatment of occupational
illness and injury.
Conclusion
Lung disease is a growing problem in the United States. The level
of support this subcommittee approves for lung disease programs should
reflect the urgency illustrated by these numbers. The ATS appreciates
the opportunity to submit this statement to the subcommittee.
______
Prepared Statement of the Americans for Nursing Shortage Relief
The undersigned organizations of the ANSR Alliance greatly
appreciate the opportunity to submit written testimony regarding fiscal
year 2012 appropriations for the Title VIII Nursing Workforce
Development Programs at the Health Resources and Services
Administration (HRSA) and the Nurse Managed Health Clinics as
authorized under Title III of the Public Health Service Act. We
represent a diverse cross-section of healthcare and other related
organizations, healthcare providers, and supporters of nursing issues
that have united to address the national nursing shortage. ANSR stands
ready to work with Congress to advance programs and policy that will
ensure our Nation has a sufficient and adequately prepared nursing
workforce to provide quality care to all well into the 21st century.
The Alliance, therefore, urges Congress to:
--Appropriate $313 million in funding for Nursing Workforce
Development Programs under Title VIII of the Public Health
Service Act at the Health Resources and Services Administration
(HRSA) in fiscal year 2012.
--Appropriate $20 million in fiscal year 2012 for the Nurse Managed
Health Clinics as authorized under Title III of the Public
Health Service Act.
The Nursing Shortage
Nursing is the largest healthcare profession in the United States.
According to the National Council of State Boards of Nursing, there
were nearly 3.780 million licensed RNs in 2009. Nurses and advanced
practice nurses (nurse practitioners, nurse midwives, clinical nurse
specialists, and certified registered nurse anesthetists) work in a
variety of settings, including primary care, public health, long-term
care, surgical care facilities, and hospitals. The March 2008 study,
The Future of the Nursing Workforce in the United States: Data, Trends,
and Implications, calculates a projected demand of 500,000 full-time
equivalent registered nurses by 2025. According to the U.S. Bureau of
Labor Statistics, employment of registered nurses is expected to grow
by 22 percent from 2008 to 2018, much faster than the average for all
occupations and, because the occupation is very large, 581,500 new jobs
will result. Based on these scenarios, the shortage presents an
extremely serious challenge in the delivery of high quality, cost-
effective services, as the Nation looks to reform the current
healthcare system. Even considering only the smaller projection of
vacancies, this shortage still results in a critical gap in nursing
service, essentially three times the 2001 nursing shortage.
The Desperate Need for Nurse Faculty
Nursing vacancies exist throughout the entire healthcare system,
including long-term care, home care and public health. Even the
Department of Veterans Affairs, the largest sole employer of RNs in the
United States, has a nursing vacancy rate of 10 percent. In 2006, the
American Hospital Association reported that hospitals needed 116,000
more RNs to fill immediate vacancies, and that this 8.1 percent vacancy
rate affects hospitals' ability to provide patient care. Government
estimates indicate that this situation only promises to worsen due to
an insufficient supply of individuals matriculating in nursing schools,
an aging existing workforce, and the inadequate availability of nursing
faculty to educate and train the next generation of nurses. At the
exact same time that the nursing shortage is expected to worsen, the
baby boom generation is aging and the number of individuals with
serious, life-threatening, and chronic conditions requiring nursing
care will increase. Consequently, more must be done today by the
government to help ensure an adequate nursing workforce for the
patients/clients of today and tomorrow.
A particular focus on securing and retaining adequate numbers of
faculty is essential to ensure that all individuals interested in--and
qualified for--nursing school can matriculate in the year that they are
accepted. The National League for Nursing found that in the 2009-2010
academic year,
--42 percent of qualified applications to prelicensure RN programs
were turned away.
--One in four (25.1 percent) of prelicensure RN programs turned away
qualified applicants.
--Four out of five (60 percent) of prelicensure RN programs were
considered ``highly selective'' by national college admissions
standards, accepting less than 50 percent of applications for
admission.
Aside from having a limited number of faculty, nursing programs
struggle to provide space for clinical laboratories and to secure a
sufficient number of clinical training sites at healthcare facilities.
ANSR supports the need for sustained attention on the efficacy and
performance of existing and proposed programs to improve nursing
practices and strengthen the nursing workforce. The support of research
and evaluation studies that test models of nursing practice and
workforce development is integral to advancing healthcare for all in
America. Investments in research and evaluation studies have a direct
effect on the caliber of nursing care. Our collective goal of improving
the quality of patient care, reducing costs, and efficiently delivering
appropriate healthcare to those in need is served best by aggressive
nursing research and performance and impact evaluation at the program
level.
The Nursing Supply Impacts the Nation's Health and Economic Safety
Nurses make a difference in the lives of patients from disease
prevention and management to education to responding to emergencies.
Chronic diseases, such as heart disease, stroke, cancer, and diabetes,
are the most preventable of all health problems as well as the most
costly. Nearly half of Americans suffer from one or more chronic
conditions and chronic disease accounts for 70 percent of all deaths.
In addition, increased rates of obesity and chronic disease are the
primary cause of disability and diminished quality of life.
Even though America spends more than $2 trillion annually on
healthcare--more than any other nation in the world--tens of millions
of Americans suffer every day from preventable diseases like type 2
diabetes, heart disease, and some forms of cancer that rob them of
their health and quality of life. In addition, major vulnerabilities
remain in our emergency preparedness to respond to natural,
technological and manmade hazards. An October 2008 report issued by
Trust for America's Health, entitled ``Blueprint for a Healthier
America,'' found that the health and safety of Americans depend on the
next generation of professionals in public health. Further, existing
efforts to recruit and retain the public health workforce are
insufficient. New policies and incentives must be created to make
public service careers in public health an attractive professional
path, especially for the emerging workforce and those changing careers.
The Institute of Medicine report, Hospital-Based Emergency Care: At
the Breaking Point, notes that nursing shortages in U.S. hospitals
continue to disrupt hospitals operations and are detrimental to patient
care and safety. Hospitals and other healthcare facilities across the
country are vulnerable to mass casualty incidents themselves and/or in
emergency and disaster preparedness situations. As in the public health
sector, a mass casualty incident occurs as a result of an event where
sudden and high patient volume exceeds the facilities resources. Such
events may include the more commonly realized multi-car pile-ups, train
crashes, hazardous material exposure in a building or within a
community, high occupancy catastrophic fires, or the extraordinary
events such as pandemics, weather-related disasters, and intentional
catastrophic acts of violence.
Since 80 percent of disaster victims present at the emergency
department, nurses as first receivers are an important aspect of the
public health system as well as the healthcare system in general. The
nursing shortage has a significant adverse impact on the ability of
communities to respond to health emergencies, including natural,
technological and manmade hazards.
Summary
The link between healthcare and our Nation's economic security and
global competitiveness is undeniable. Having a sufficient nursing
workforce to meet the demands of a highly diverse and aging population
is an essential component to reforming the healthcare system as well as
improving the health status of the Nation and reducing healthcare
costs. To mitigate the immediate effect of the nursing shortage and to
address all of these policy areas, ANSR requests $313 million in
funding for Nursing Workforce Development Programs under Title VIII of
the Public Health Service Act at HRSA and $20 million for the Nurse
Managed Health Clinics under Title III of the Public Health Service Act
in fiscal year 2012.
LIST OF ANSR MEMBER ORGANIZATIONS
Academy of Medical-Surgical Nurses
American Academy of Ambulatory Care Nursing
American Association of Critical-Care Nurses
American Association of Nurse Assessment Coordinators
American Organization of Nurse Executives
American Society for Pain Management Nursing
American Society of PeriAnesthesia Nurses
Association for Radiologic & Imaging Nursing
Association of Community Health Nursing Educators
Association of Pediatric Hematology/Oncology Nurses
Emergency Nurses Association
Infusion Nurses Society
International Nurses Society on Addictions
National Association of Clinical Nurse Specialists
National Association of Hispanic Nurses
National Association of Nurse Practitioners in Women's Health
National Council of State Boards of Nursing
National Council of Women's Organizations
National League for Nursing
National Nursing Centers Consortium
National Student Nurses' Association, Inc.
Nurses Organization of Veterans Affairs
Society of Trauma Nurses
______
Prepared Statement of the Arthritis Foundation
The Arthritis Foundation greatly appreciates the opportunity to
submit testimony in support of increased investment for arthritis
research, prevention and programs at the Centers for Disease Control
and Prevention (CDC); National Institutes of Health (NIH); Agency for
Healthcare Research and Quality (AHRQ); and for the Health Resources
and Services Administration (HRSA).
Arthritis is a complex family of musculoskeletal disorders with
many causes, not yet fully understood, and so far there are no cures.
It consists of more than 100 different diseases or conditions that
destroy joints, bones, muscles, cartilage and other connective tissue
which hampers or halts physical movement. Arthritis is one of the most
prevalent chronic health problems and the most common cause of
disability in the United States. 50 million people (1 in 5 adults) and
almost 300,000 children live with the pain of arthritis every day.
Arthritis limits the daily activities of 21 million Americans and
accounts for $128 billion annually in economic costs, including $81
billion in direct costs for physician visits and surgical interventions
and $47 billion in indirect costs for missed work days. Counter to
public perception, two-thirds of the people with doctor-diagnosed
arthritis are under the age of 65. The pain, cost and disability
associated with arthritis is simply unacceptable.
By the year 2030, an estimated 67 million or 25 percent of the
projected adult population will have arthritis. Furthermore, arthritis
limits the ability of people to effectively manage other chronic
diseases. More than 57 percent of adults with heart disease and more
than 52 percent of adults with diabetes also have arthritis. The
Arthritis Foundation strongly believes that in order to prevent or
delay arthritis from disabling people and diminishing their quality of
life that a significant investment in proven prevention and
intervention strategies is essential.
The following items summarize the Arthritis Foundation fiscal year
2012 funding recommendations for health agencies under the
Subcommittee's jurisdiction.
Centers for Disease Control and Prevention
The Arthritis Foundation recommends a level of $7.7 billion for
CDC's core programs in fiscal year 2012. This amount is representative
of what CDC needs to fulfill its core public health mission in fiscal
year 2012; activities and programs that are essential to protect the
health of the American people. CDC continues to be faced with
unprecedented challenges and responsibilities, ranging from chronic
disease prevention, eliminating health disparities, bioterrorism
preparedness, to combating the obesity epidemic. More than 70 percent
of CDC's budget actually flows out to States and local health
organizations and academic institutions, many of which are currently
struggling to meet growing needs with fewer resources.
The President's fiscal year 2012 budget request proposed to
collapse existing programs for the top five leading chronic disease
causes of death and disability--arthritis, cancer, diabetes, and heart
disease and stroke--into a single State Block Grant program along with
State funding for public health activities related to nutrition,
physical activity, obesity and school health. These Administration
proposals also rely on funding from the Prevention and Public Health
Fund to support these activities.
In light of the fiscal challenges facing the Nation and the need to
reduce inefficiencies from Federal program overlap and lack of
coordination, the Arthritis Foundation recognizes that the CDC must
combat chronic disease through careful coordination and collaboration
across strategic programs. However, at the same time, agency leadership
must ensure that the vital public health infrastructure that has been
developed over the past two decades for combating arthritis should not
be dismantled.
The clear need to ensure that the burgeoning number of Americans
with arthritis are served by effective efforts, lead the Arthritis
Foundation to conclude that, as proposed, the Administration's
consolidated chronic disease prevention program is not in the best
interest of those with arthritis. To sustain and build on the
achievements and progress made to date in combating arthritis, it is
critical that arthritis-specific activities are preserved and
strengthened in any approach to combating chronic disease.
As the fiscal year 2012 funding process continues, the Arthritis
Foundation appreciates the opportunity to evaluate any consolidated
chronic disease program proposal to ensure that the following
priorities are addressed:
--Programs should be designed around similar target populations,
including people with or at risk of arthritis, the Nation's
most common cause of disability and a major barrier to physical
activity.
--Any consolidation must be limited to programs with clear
programmatic and operational overlap.
--CDC and states must retain staff expertise in disease areas and the
infrastructure to support them;
--Programs must be supported by State-based advisory groups made up
of stakeholders from the impacted disease areas;
--A national advisory committee at CDC should be created to foster
stakeholder involvement from arthritis and other chronic
disease communities.
The CDC's arthritis program received $13.1 million in fiscal year
2011 funding and about half of that amount will be distributed via
competitive grant to 12 States. Research shows that the pain and
disability of arthritis can be decreased through early diagnosis and
appropriate management, including evidence-based self-management
activities that enable weight control and physical activity. The
Arthritis Foundation's Self-Help Program, a group education program,
has been proven to reduce arthritis pain by 20 percent and physician
visits by 40 percent. These evidence-based interventions are recognized
by the CDC to reduce the pain of arthritis and importantly reduce
healthcare expenditures through a reduction in physician visits. For
arthritis prevention to grow to include another 12-15 States an
investment of an additional $10 million is required.
National Institutes of Health/National Institute of Arthritis and
Musculoskeletal and Skin Diseases
The Arthritis Foundation supports $35 billion in fiscal year 2012
for NIH to invest in improving the health and quality of life for all
Americans. NIH-funded research drives scientific innovation and
develops new and better diagnostics, improved prevention strategies,
and more effective treatments. Approximately 83 percent of appropriated
funds for NIH research are sent to every State in the Nation in the
form of merit based peer review grants. These investigator initiated
grants enable the highest quality of research to be conducted at
research facilities and hospitals all across the Nation employing
hundreds of thousand of individuals and representing an integral part
of hundreds of local communities. Congress should recognize the unique
role NIH plays as the economic engine in the biomedical industry.
NIH-funded research has led to new treatments, which have greatly
improved the quality of life for people living with arthritis; however,
the ultimate goal is to find a cure. The Arthritis Foundation firmly
believes research holds the key to tomorrow's advances and provides
hope for a future free from arthritis pain. As one of the largest non-
profit contributors to arthritis research, the Arthritis Foundation
fills a vital role in the big picture of arthritis research. Our
research program complements government and industry-based arthritis
research by focusing on training new investigators and pursuing
innovative strategies for preventing, controlling and curing arthritis.
The mission of the NIH/National Institute of Arthritis and
Musculoskeletal and Skin Diseases (NIAMS) is to support research into
the causes, treatment, and prevention of arthritis and musculoskeletal
and skin diseases and the training of basic and clinical scientists to
carry out this research. Research opportunities at NIAMS are being
curtailed due to the stagnating and in some cases declining numbers of
new grants being awarded. The training of new investigators has
unnecessarily slowed down and contributed to a crisis in the research
community where new investigators have begun to leave biomedical
research careers. The Arthritis Foundation urges Congress to prioritize
NIAMS funding to address the Nations most chronic, disabling and costly
diseases.
Last year, scientists supported by the National Institutes of
Health developed a technique that lead to the successful re-growth of
damaged leg joints in animals. The accomplishment shows that it's
possible to lure the body's own cells to injured regions and generate
new tissues, such as cartilage and bone. The finding could point the
way toward joint renewal in humans, which could be a dramatic and less
costly alternative to the 1 million joint replacement surgeries each
year.
Juvenile arthritis afflicts 300,000 children in the United States
and when left untreated, it can cause permanent damage to joints and
tissues throughout the body. Juvenile arthritis has serious
consequences that can limit a young person's ability to grow properly,
learn, and become a productive citizen in the workforce. With a dire
critical shortage of pediatric rheumatologists to treat these children,
it is vital that the NIH and NIAMS continue supporting a national
network of cooperating clinical centers for the care and study of
children with arthritis through the Childhood Arthritis and
Rheumatology Research Alliance (CARRA). This NIH funded project is in
the beginning stages of collecting data from the largest group of
children with juvenile rheumatic diseases nationwide. The data will be
available to pediatric rheumatologists throughout the United States.
The collection and distribution of such disease data are crucial to the
understanding of the progression of juvenile arthritis and specific
outcomes related to treatment. NIH must continue to fund this
invaluable resource to improve the outcomes and lives of children with
juvenile arthritis as is currently done for children with cancer. The
Arthritis Foundation has also invested our research dollars in this
CARRA initiative.
Public investment in biomedical research holds the real promise of
improving the lives of millions of Americans with arthritis. An
investment in NIH funded research is an investment in our Nation's
future.
Health Resources and Services Administration
The Arthritis Foundation strongly recommends funding a loan
repayment program for pediatric specialist at the $30 million level
within HRSA for fiscal year 2012. A pediatric loan repayment program
was authorized by Congress in 2010 (in the Affordable Care Act) and
requires funding to commence. HRSA is essential to developing the
healthcare workforce that is so critical in primary care as well as
shortages in specialty care, like pediatric rheumatology.
Juvenile arthritis is the leading cause of acquired disability in
children and is the sixth most common childhood disease. Sustaining the
field of pediatric rheumatology is essential to the care of the almost
300,000 children under the age of 18 living with a form of juvenile
arthritis. Children who are diagnosed with juvenile arthritis will live
with this chronic and potentially disabling disease for their entire
life. Therefore, it is imperative that children are diagnosed quickly
and start treatment before significant irreversible joint damage is
done. However, it is a challenge to first find a pediatric
rheumatologist, as nine States do not have a single one, and then to
have a timely appointment as many States have only one or two to see
thousands of patients. Pediatric rheumatology is one of the smallest
pediatric subspecialties with less than 200 pediatric rheumatologists
actively practicing in the United States. A report to Congress in 2007
stated there was a 75 percent shortage of pediatric rheumatologists and
recommended loan repayment program to help address this critical
workforce shortage issue. The Affordable Care Act included authorizing
HRSA $30 million to establish a loan repayment program for pediatric
specialists including pediatric rheumatologists. The Arthritis
Foundation strongly recommends the Subcommittee provide an initial
appropriation to begin this critical program.
Agency for Healthcare Research and Quality (AHRQ)
The Arthritis Foundation recommends an overall funding level of
$405 million for AHRQ in fiscal year 2012. AHRQ funds research and
programs at local universities, hospitals, and health departments that
improve healthcare quality, enhance consumer choice, advance patient
safety, improve efficiency, reduce medical errors, and broaden access
to essential services. Specifically, the science funded by AHRQ
provides consumers and their healthcare professionals with valuable
evidence to make the right healthcare decisions for themselves and
their families.
The Arthritis Foundation appreciates the opportunity to submit our
recommendations for fiscal year 2012 to Congress on behalf of the 50
million adults and 300,000 children with arthritis and looks forward to
working with the Subcommittee in the coming months.
______
Prepared Statement of ASME International
The NIH Task Force (``Task Force'') of the ASME Bioengineering
Division is pleased to provide comments on the bioengineering-related
programs contained within the National Institutes of Health (NIH)
fiscal year 2012 budget request. The Task Force is focused on the
application of mechanical engineering knowledge, skills, and principles
for the conception, design, development, analysis and operation of
biomechanical systems.
The Importance of Bioengineering
Bioengineering is an interdisciplinary field that applies physical,
chemical, and mathematical sciences, and engineering principles to the
study of biology, medicine, behavior, and health. It advances knowledge
from the molecular to the organ levels, and develops new and novel
biologics, materials processes, implants, devices, and informatics
approaches for the prevention, diagnosis, and treatment of disease, for
patient rehabilitation, and for improving health. Bioengineers have
employed mechanical engineering principles in the development of many
life-saving and life-improving technologies, such as the artificial
heart, prosthetic joints, diagnostics, and numerous rehabilitation
technologies.
Background
The NIH is the world's largest organization dedicated to improving
health through medical science. During the last 50 years, NIH has
played a leading role in the major breakthroughs that have increased
average life expectancy by 15 to 20 years.
The NIH is comprised of different Institutes and Centers that
support a wide spectrum of research activities including basic
research, disease and treatment-related studies, and epidemiological
analyses. The mission of individual Institutes and Centers varies from
either study of a particular organ (e.g. heart, kidney, eye), a given
disease (e.g. cancer, infectious diseases, mental illness), a stage of
life (e.g. childhood, old age), or finally it may encompass
crosscutting needs (e.g., sequencing of the human genome). The National
Institute of Biomedical Imaging and Bioengineering (NIBIB) focuses on
the development, application, and acceleration of biomedical
technologies to improve outcomes for a broad range of healthcare
challenges.
Fiscal Year 2012 NIH Budget Request
The total fiscal year 2012 NIH budget request is $31.98 billion, or
2.4 percent above the $31.08 billion fiscal year 2010 appropriated
amount and 4.1 percent above the $30.7 billion provided for fiscal year
2011. The Task Force recognizes that this proposed increase is
significant given the Administration's commitment to reducing the
Federal deficit. However, the Task Force notes that the
Administration's 2.4 percent increase to the overall NIH budget from
fiscal year 2010 to fiscal year 2012 is less than the up to 3 percent
projected increase in medical research costs due to inflation for
fiscal year 2012 alone--as predicted by the Biomedical Research and
Development Price Index (BRDPI). This inflationary pressure is
compounded with the $30.7 billion appropriation for fiscal year 2011, a
$260 million or 0.8 percent reduction in funding from the previous
fiscal year, and a BRDPI of 2.9 percent for fiscal year 2011, resulting
in a significant decrease in funding for the NIH over fiscal year 2010
to fiscal year 2012.
NIH is enacting policies to guide investments while limiting the
impact of these inflationary cost increases, including a 1 percent
increase in the average cost of competing and non-competing Research
Project Grants (RPGs); a 1 percent increase in Research Centers and
Other Research; and a 1 percent increase for Intramural Research and
Research Management and Support; and constraints on staffing levels.
However, these policies alone are not sufficient to offset the need for
additional support for critical areas of health research, especially
given reduction in funding and high inflation rate for fiscal year
2011. We therefore fully support the President's proposed fiscal year
2012 budget level for the NIH given current budget constraints, but
further recommend out-year budget increases well beyond BRDPI inflation
rates.
The Task Force further notes that NIH received $10.4 billion as
part of the American Recovery and Reinvestment Act (ARRA) of 2009
(Public Law 111-5), an important influx for several key divisions of
NIH over the fiscal year 2009 and fiscal year 2010 funding cycles,
particularly the NIBIB, which received $78 million--less than 1 percent
of the $10.4 billion ARRA budget assigned to the NIH for the fiscal
year 2009 and fiscal year 2010 funding cycles. NIBIB has already
exhausted this budget, leaving no additional ARRA funding to leverage
through the fiscal year 2011 budget cycle and underscoring the need for
more robust investment in bioengineering at NIBIB. While this one-time
influx of funding for health research and infrastructure was justified,
the Task Force notes that the unstable nature of such funding inhibits
the potential impact on the economy and should not be viewed as a
viable substitute for steady and consistent support from Congress for
these critical national research priorities.
The Administration estimates 9,158 Research Project Grants (RPG)
will be supported under the fiscal year 2012 budget for NIH-wide RPGs.
From fiscal year 2010 to fiscal year 2011, inflationary pressures and
budget factors combined to result in a decrease of 652 in the number of
competing RPGs. The Task Force commends the Administration for again
focusing on funding RPGs in fiscal year 2012, resulting in an increase
of 424 supported grants over the fiscal year 2011 level of competing
RPGs. We reiterate again however, that the number of RPGs supported
from fiscal year 2010 to fiscal year 2012 will still decline by 228
under this austere fiscal year 2012 budget scenario.
NIBIB Research Funding
The Administration's fiscal year 2012 budget request supports $322
million for the NIBIB, an increase of $5.6 million or 1.8 percent from
the fiscal year 2010 appropriated amount. The mission of the NIBIB is
to seek to improve human health by leading the development and
application of emerging and breakthrough technologies based on a
merging of the biological, physical, and engineering sciences. As noted
above, this increase is well under the 3 percent projected increase in
research costs due to inflation (predicted by the BRDPI index) and, as
a consequence, actually results in an effective decrease in funding for
NIBIB compared to fiscal year 2010.
The budget for NIBIB Research Grants would remain flat at $262.7
million. Funding for intramural research would increase 7.3 percent to
$11.8 million from $11 million in fiscal year 2010. NIBIB's Research
Management and Support request is $17.3 million, a 3 percent increase
over fiscal year 2010.
NIBIB funds the Applied Science and Technology (AST) program, which
supports the development and application of innovative technologies,
methods, products, and devices for research and clinical application
that transform the practice of medicine. The fiscal year 2012 request
for AST is $170.6 million, a $2.2 million increase or 1.3 percent
increase from fiscal year 2010.
Additionally, NIBIB funds the Discover Science and Technology (DST)
program, which is focused on the discovery of innovative biomedical
engineering and imaging principles for the benefit of public health.
The fiscal year 2011 request for DST is $95.3 million, a $1.2 million
or 1.3 percent increase from fiscal year 2010.
The Technological Competitiveness-Bridging the Sciences program,
which funds interdisciplinary approaches to research, would receive
$25.9 million in fiscal year 2012, a $0.9 million increase or 3.6
percent over the fiscal year 2010 enacted level.
Task Force Recommendations
The Task Force is concerned that the United States faces rapidly
growing challenges from our counterparts in the European Union and Asia
with regards to bioengineering advancements. While total health-related
U.S. research and development investments have expanded significantly
over the last decade, investment in bioengineering at NIBIB have
remained relatively flat over the last several years. In fact, the
fiscal year 2012 budget actually represents a small reduction in
funding when the fiscal year 2003 NIBIB appropriation of $280 million
is adjusted for inflation--$329 million in 2010 dollars--leaving NIBIB
with an effective reduction in funding of $7 million since 2003.
The Task Force wishes to emphasize that, in many instances,
bioengineering-based solutions to healthcare problems can result in
improved health outcomes and reductions in healthcare costs. For
example, coronary stent implantation procedures cost approximately
$20,000, compared to bypass graft surgery at double the cost. Stenting
involves materials science (metals and polymers), mechanical design,
computational mechanical modeling, imaging technologies, etc. that
bioengineers work to develop. Not only is the procedure less costly,
but the patient can return to normal function within a few days rather
than months to recover from bypass surgery, greatly reducing other
costs to the economy. Therefore, we strongly urge Congress to consider
increased funding for bioengineering within the NIBIB and across NIH,
and work to strengthen these investments in the long run to reduce U.S.
healthcare costs and support continued U.S. leadership in
bioengineering.
Even during these challenging fiscal times, the NIBIB must obtain
sustained funding increases, both to accelerate medical advancements as
our Nation's population ages, and to mirror the growth taking place in
the bioengineering field. The Task Force believes that the
Administration's budget request for fiscal year 2012 is not aligned
with the long-term challenges posed by this objective; a 1.8 percent
budget increase will not keep up with current inflationary increases
for biomedical research, eroding the United States' ability to lay the
groundwork for the medical advancements of tomorrow.
While the Task Force supports Federal proposals that seek to double
Federal research and development in the physical sciences over the next
decade, we believe that strong Federal support for bioengineering and
the life sciences is essential to the health and competitiveness of the
United States. The supplemental funding that NIH received as part of
ARRA and the budget request by the Administration does not erase the
past several years of disappointing budgets. Congress and the
Administration should work to develop a specific plan, beyond President
Obama's call for ``innovations in healthcare technology'' to focus on
specific and attainable medical and biomedical research priorities
which will reduce the costs of healthcare and improve healthcare
outcomes. Further, Congress and the Administration should include in
this strategy new mechanisms for partnerships between NSF and the NIH
to promote bioengineering research and education. The Task Force feels
these initiatives are necessary to build capacity in the U.S.
bioengineering workforce and improve the competitiveness of the U.S.
bioengineering research community.
______
Prepared Statement of the Association for Professionals in Infection
Control and Epidemiology (APIC) and the Society for Healthcare
Epidemiology of America (SHEA)
The Association for Professionals in Infection Control and
Epidemiology (APIC) and The Society for Healthcare Epidemiology of
America (SHEA) thank you for this opportunity to submit testimony on
Federal efforts to eliminate healthcare-associated infections (HAIs).
APIC's mission is to improve health and patient safety by reducing
the risk of HAIs and related adverse outcomes. The organization's more
than 14,000 members, known as infection preventionists, direct
infection prevention and control programs that save lives and improve
the bottom line for hospitals and other healthcare facilities
throughout the United States and around the globe. Our association
strives to promote a culture within healthcare institutions where all
members of the healthcare team fully embrace the elimination of HAIs.
We advance these efforts through education, research, collaboration,
practice guidance, public policy, and support for credentialing.
SHEA was founded in 1980 to advance the application of the science
of healthcare epidemiology. The Society works to achieve the highest
quality of patient care and healthcare personnel safety in all
healthcare settings by applying epidemiologic principles and prevention
strategies to a wide range of quality-of-care issues. SHEA is a growing
organization, strengthened by its membership in all branches of
medicine, public health, and healthcare epidemiology. SHEA and its
members are committed to implementing evidence-based strategies to
prevent HAIs. SHEA members have scientific expertise in evaluating
potential strategies for eliminating preventable HAIs.
APIC and SHEA collaborate with a wide range of infection prevention
and infectious diseases societies, specialty medical societies in other
fields, quality improvement organizations, and patient safety
organizations in order to identify and disseminate evidence-based
practices. The Centers for Disease Control and Prevention (CDC), its
Division of Healthcare Quality Promotion (DHQP) and the Federal
Healthcare Infection Control Practices Advisory Committee (HICPAC), and
the Council of State and Territorial Epidemiologists (CSTE) have been
invaluable Federal partners in the development of guidelines for the
prevention and control of HAIs and in their support of translational
research designed to bring evidence-based practices to patient care.
Further, collaboration between experts in the field (epidemiologists
and infection preventionists), the CDC and the Agency for Healthcare
Research and Quality (AHRQ) plays a critical role in defining and
prioritizing the research agenda. In 2008, APIC and SHEA aligned with
The Joint Commission and the American Hospital Association to produce
and promote the implementation of evidence-based recommendations in the
Compendium of Strategies to Prevent Healthcare-Associated Infections in
Acute Care Hospitals (http://www.shea-online.org/about/compendium.cfm).
APIC and SHEA also contribute expert scientific advice to quality
improvement organizations such as the Institute for Healthcare
Improvement (IHI), the National Quality Forum (NQF), and State-based
task forces focused on infection prevention and public reporting
issues.
HAIs are among the leading causes of preventable death in the
United States, accounting for an estimated 1.7 million infections and
99,000 associated deaths in 2002. In addition to the substantial human
suffering caused by HAIs, these infections contribute $28 billion to
$33 billion in excess healthcare costs each year.
The good news is that some of these infections are on the decline.
In particular, bloodstream infections associated with indwelling
central venous catheters, or ``central lines,'' are largely preventable
when healthcare providers use the CDC infection prevention
recommendations in the context of a performance improvement
collaborative. Healthcare professionals have reduced these infections
in hospital intensive care unit (ICU) patients by 58 percent since
2001, which represents up to 27,000 lives saved. In spite of this
notable progress, there is a great deal of work to be done to achieve
the goal of HAI elimination. These additional opportunities to save
lives and improve patient safety involve settings outside ICUs and
those patients who need hemodialysis.
To build and then sustain these winnable battles against HAIs, we
urge you, in fiscal year 2012, to support the CDC Coalition's request
for $7.7 billion for the CDC's ``core programs.'' Within that broader
area, the CDC is currently involved in a number of projects that have
allowed for significant progress to be made in reducing HAIs. In light
of this important work, we ask that you provide the CDC with its
requested amount of $47.4 million for HAI prevention activities.
Included among these activities is support for State-based programs
to expand facility enrollment in the CDC's National Healthcare Safety
Network (NHSN), an important reporting and monitoring tool that enables
officials to track where HAIs are occurring and identify where
improvements need to be made. NHSN's data analysis function helps our
members analyze facility-specific data and compare rates to national
metrics. Importantly, the patients we serve throughout the United
States have established expectations that reported reductions in the
frequency of HAIs are accurate. APIC and SHEA have, through their
respective networks of members, identified limitations in other
measures of performance. These studies have consistently identified
that data from the CDC's NHSN provides a more precise picture of
performance relative to reduction of HAIs. Many States consider NHSN to
be the best option for implementing standardized reporting of HAI data.
The CDC has also been supporting research networks to address important
scientific gaps in HAI prevention, improvement in HAI tracking and
monitoring methodologies, as well as responding to requests for
assistance from health departments and healthcare facilities. It is
vital to ensure that the NHSN meets these expectations from patients
and that our successes are real and tangible improvements in the care
provided.
In addition, we request that the Subcommittee provide $50 million
for antimicrobial resistance activities. As the CDC states in its
request, ``repeated and improper uses of antibiotics are important
factors in the increase in drug-resistant bacteria, viruses, and
parasites,'' and ``preventing infections and decreasing inappropriate
antibiotic use are the best strategies to control resistance.''
Ensuring the effectiveness of antibiotics well into the future is vital
for the nation's public health. It is essential, therefore, that the
CDC maintains the ability to monitor organism resistance in healthcare
and promote appropriate antibiotic use. This has become even more
critical due to two recent developments. First, pharmaceutical
manufacturers have largely abandoned development of newer antibiotics
because there are several market-based disincentives to investing in
this research and development. Second, there is an epidemic of
infections caused by Clostridium difficile, a bacterium that is
triggered by use of antibiotics. These infections are widespread,
disproportionately affect older adults, and can be fatal. There are
several examples in the scientific literature that demonstrate the rate
of C. difficile infections drops in facilities with active, effective
antimicrobial stewardship programs.
We also support the Administration's $5 million request for HAI
activities. This funding will allow HHS, under the HHS Action Plan to
Prevent Healthcare-Associated Infections (HAI Action Plan), to
prioritize recommended clinical practices, strengthen data systems, and
develop and launch a nationwide HAI prevention campaign. APIC and SHEA
members have been engaged in this partnership for HAI prevention under
the leadership of HHS Assistant Secretary for Health, Dr. Howard Koh
and Deputy Assistant Secretary for Healthcare Quality, Dr. Don Wright.
We believe the development of the HAI Action Plan and the funding
to support these activities has been critical to the effort to build
support for a coordinated Federal plan and message on preventing
infections. Additionally, we strongly believe that the CDC has the
necessary expertise to define appropriate metrics through which the HAI
Action Plan can best measure its efforts.
APIC and SHEA also request that the Subcommittee approve $10.7
million for the Centers for Medicare and Medicaid Services (CMS)
surveys of ambulatory surgical centers (ASCs) as part of the budget
request addressing direct survey costs. CMS's survey process, jointly
developed with the CDC in this case, consists of targeting infection
control deficiencies in ASCs with a frequency of every 4 years. Due to
the increasing number of surgeries performed in outpatient settings,
and the need to ensure that basic infection prevention practices are
followed, APIC believes continuation of this survey tool is essential.
This support will also protect patients' lives as there have been
several outbreaks in ASCs involving transmission of bloodborne
pathogens, such as hepatitis C, due to unsafe practices.
Also within the direct survey costs portion of CMS's request, the
agency indicates plans to launch an HAI pilot program as part of the
HHS HAI strategic plan. This promises to produce a significant amount
of feedback on HAI prevention as CMS intends to survey critical access
hospitals and smaller hospitals across 10 to 25 States. This will allow
officials to gather information from facilities whose practices and
data have not traditionally been monitored or widely shared.
APIC and SHEA are pleased with the Administration's continued
support of biomedical research by providing an increase of almost $32
billion for the National Institutes of Health (NIH) in fiscal year
2012, a 2.4 percent increase over fiscal year 2010 levels. The NIH is
the single largest funding source for infectious diseases research in
the United States and the life-source for many academic research
centers. The NIH-funded work conducted at these centers lays the ground
work for advancements in treatments, cures, and medical technologies.
It is critical that we maintain this momentum for medical research
capacity.
Unfortunately, support for basic, translational, and
epidemiological HAI research has not been a priority of the NIH.
Despite the fact that HAIs are among the top ten annual causes of death
in the United States, scientists studying these infections have
received relatively less funding than colleagues in many other
disciplines. In 2008, NIH estimated that it spent more than $2.9
billion on funding for HIV/AIDS research, approximately $2 billion on
cardiovascular disease research, and about $664 million on obesity
research. By comparison, the National Institute of Allergy and
Infectious Diseases (NIAID) provided $18 million for MRSA research.
APIC and SHEA believe that as the magnitude of the HAI problem becomes
an increasing part of our public health dialogue, it is imperative that
the Congress and funding organizations put significant resources behind
this momentum.
The limited availability of Federal funding to study HAIs has the
effect of steering young investigators interested in pursuing research
on HAIs toward other, better-funded fields. While industry funding is
available, the potential conflicts of interest, particularly in the
area of infection prevention technologies, make this option seriously
problematic. These challenges are limiting professional interest in the
field and hampering the clinical research enterprise at a time when it
should be expanding.
Our field is faced with the need to bundle, implement and adhere to
interventions we believe to be successful while simultaneously
conducting basic, epidemiological, pathogenetic and translational
studies that are needed to move our discipline to the next level of
evidence-based patient safety. The current convergence of scientific,
public and legislative interest in reducing rates of HAIs can provide
the necessary momentum to address and answer important questions in HAI
research. APIC and SHEA strongly urge you to enhance NIH funding for
fiscal year 2012 to ensure adequate support for the research foundation
that holds the key to addressing the multifaceted challenges presented
by HAIs.
Finally, we support the $34 million in the Administration's fiscal
year 2012 budget that would continue, and allow expansion of, funding
for AHRQ grants related to HAI prevention in multiple healthcare
settings, including surgical and dialysis centers. Infections are one
of the leading causes of hospitalization and death for patients on
hemodialysis. According to the CDC, approximately 37,000 bloodstream
infections occurred in hemodialysis outpatients with central lines
(2008). AHRQ's plans to broaden research support in ambulatory and
long-term care settings to align with the HHS HAI Action Plan represent
another positive step in addressing HAIs in a comprehensive fashion.
We thank you for the opportunity to submit testimony and greatly
appreciate this Subcommittee's assistance in providing the necessary
funding for the Federal Government to have a leadership role in the
effort to eliminate HAIs.
______
Prepared Statement of the Association for Research in Vision and
Ophthalmology
Congressional and Presidential support for biomedical research
In 2009, Congress spoke volumes in passing S. Res. 209 and H. Res.
366, which designated the years 2010 to 2020 as The Decade of Vision,
in which the majority of 78 million Baby Boomers will face the greatest
risk for aging eye disease. This decade is not the time for a less-
than-inflationary increase for a community that lost 20.1 percent
purchasing power over the course of the last 10 years.\1\
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\1\ Calculations were based solely upon annual biomedical research
and development price index (BRDPI) and annual appropriated amounts.
Fiscal year 2011 funding levels and fiscal year 2011 BRDPI were not
part of the calculation.
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As President Obama has stated repeatedly, most recently during the
2011 State of the Union Address, biomedical research reduces healthcare
costs, increases productivity, and it ensures global competitiveness of
the United States.
ARVO has two major requests for Senate:
--For Senate to budget NIH in fiscal year 2012 at $35 billion.
This amount: Is a $3 billion increase over the President's
proposed budget; maintains NIH net funding levels from fiscal
year 2009 and fiscal year 2010; and ensures that NIH can
maintain funding for existing grants and award the same number
of new grants.
--For Senate to make vision health a priority and fund NEI in fiscal
year 2012 above the 1.8 percent increase over last year that
was proposed by the President.
--We request this even if Congress does not fund NIH at $35
billion.
--Why? Investing in research is a short term investment, with a
2.2-fold economic return from innovation. It has a long
term pay-off that can reduce healthcare spending on eye
diseases that are increasing in aging populations and
growing minority populations that have vision health
disparities (e.g. glaucoma and diabetic retinopathy). The
majority of research grant budgets pay for good paying
positions. Very little of the budget goes towards supplies
and equipment. It addresses one of American's greatest
fears: fear of losing eye sight.
Grant review eliminates budget excess
ARVO stands behind member John Ash, Ph.D., who stated the following
during January 2011 ARVO Advocacy Day visits to Capitol Hill: ``We
understand the need for budget cuts, but we should be cutting budgets
similar to how U.S. citizens trim their household budgets, not across
the board, but rather where there is waste and inefficiency. We
challenge you to find another government agency that uses money more
efficiently than the National Institutes of Health.''
The strategic plan for NIH grant programs (for example, the NEI
strategic plan) represents the collective vision of hundreds of
scientists throughout the United States. Funding decisions for
individual grant applications are awarded based on scientific merit and
past progress. Specifically, experts review grant applications and
assign scores based on the quality and impact of the proposed research.
Scientific merit and funding decisions are based on applicant
competitiveness among peers. An additional level of scrutiny and
guidance is provided by an NEI program panel of experts, the National
Advisory Eye Council. Progress on funded projects is monitored annually
by NIH, and excess budgets are trimmed taking into consideration
ongoing development of other projects. Thus, the process is highly
competitive from conception of a project through completion.
Cost of vision impairment
Vision disorders are the fourth most prevalent disability in the
United States and the most frequent cause of disability in children.
NEI estimates that vision impairment and eye disease cost the United
States $68 billion annually. However, this number does not factor in
the impact of indirect healthcare costs, lost productivity, reduced
independence, diminished quality of life, increased depression, and
accelerated mortality.
NEI's fiscal year 2010 baseline funding of $707 million reflects
just a little more than 1 percent of the annual costs of eye disease.
The continuum of vision loss presents a major public health problem, as
well as a significant financial challenge to the public and private
sectors.
Prevention saves money long term
Seventy-seven percent of Americans agree that research is part of
the solution to rising healthcare costs, and 84 percent understand that
prevention and wellness reduce healthcare costs (Your Candidates-Your
Health Poll, August 2010). Less-than-inflationary budget increases
represent short term cost-cutting that will cost taxpayers more money
in the long term. Prevention can save Medicare/Medicaid payments for
vision care in the aging population and in minority populations with
disproportionate incidence of eye disease (e.g. glaucoma and diabetic
retinopathy). NEI funding is a vital investment in overall health and
vision health of our Nation that prevents health expenditures.
Maintaining vision allows people to remain independent and employed,
reduces family burdens, and ultimately, improves the safety of
individuals and the entire community (driving safety being a prime
example).
Research is an economic investment
Merely 2 percent of Americans think research is not important to
the U.S. economy (National Poll, May 2010). The largest portion of NIH
grant budgets is for salaries distributed across the country, and many
of the positions funded are for good paying jobs. The lower paying jobs
are an investment in training the future biomedical research work
force. To learn about the economic impact of research by state, visit
http://www.researchamerica.org/economic_impact.
Vision research improves eye care
Below are three of the top vision success stories since 2003, as
reported by nearly 400 U.S.-based ARVO members, who work at NEI-funded
institutions. Examples come from responses to an ARVO survey about the
NEI strategic plan. There were too many vision achievements to list
them all.
Drug therapies for macular degeneration (AMD).--Vision researchers
developed a therapy to treat the most aggressive form of AMD (``wet''
AMD) that works much better than even hoped for. Not only is vision
loss stopped, in many cases sight is partially regained. The therapy is
so successful that it is now being used for other eye complications
(e.g., eye infections, injuries and diabetes). Furthermore, a National
Eye Institute-funded clinical trial (Comparison of AMD Treatments
Trial), comparing safety and effectiveness of two drugs to treat
advanced AMD, shows that a $50 drug (Avastin) is as effective as a
$2,000 drug (Lucentis). Since 250,000 patients are treated each year
for AMD, this will reduce Medicare and other government health
spending. http://1.usa.gov/jZpZyv
Gene therapies for eye disease.--Vision researchers developed gene
therapies for three retinal diseases: Leber congenital amaurosis, color
blindness and retinitis pigmentosa. They also identified important
genetic risk factors for age-related eye diseases, including age-
related macular degeneration and glaucoma. Critically, these
discoveries are the first ``pay-off'' of any kind from the Human Genome
Project for patients and taxpayers.
Cellular and molecular therapies.--Using regenerative medical
approaches, vision researchers made important progress in repairing
damaged eye tissues (e.g., cornea and retina). By repairing damaged
tissues vision function is rescued.
Continued vision research needs
ARVO members expressed continued need for research support for the
following areas (and many additional areas not covered here).
--Aging eye disease.--Accelerate our efforts in basic and
translational research to discover the causes of and new
treatments for macular degeneration, diabetic retinopathy and
other vision-robbing diseases whose risks of occurrence and
severity increase with age.
--Children's vision.--Find noninvasive ways to detect vision problems
in children early enough to start treatment before vision is
lost or their education is affected.
--Brain and eye injury.--Develop ways to rapidly seal wounds and
trauma encountered by civilians and the military, so ocular and
brain function can be maintained.
--Eye pain.--Understand the basis of eye pain and develop therapies
to treat it.
--Eye infections.--Identify better ways to identify and treat drug-
resistant eye-infections with antibiotics and anti-viral
medications. Certain infections can destroy eye tissues in just
24 hours.
--Invest in shared therapeutic targets.--Identify common, shared
causes for common eye diseases and common systemic diseases.
Establish meaningful collaborations between researchers, so
shared therapeutic strategies may be developed that can treat
multiple diseases.
--Identify at-risk groups and raise awareness.--Support development
of educational tools to raise awareness and treatment
compliance in people in age groups or ethnic groups, who are
more susceptible to certain eye diseases.
Understand environmental factors that make it more likely to
develop eye disease and educate people on how to prevent eye
disease.
--Eye surgery.--Identify circumstances when the risk of performing
eye surgery is greater than the benefit. Develop ways to treat
sight problems without surgery, including facilitating natural
wound healing.
Resources
Facts about State vision health: http://apps.nccd.cdc.gov/DDT_VHI/
VHIHome.aspx.
Fact sheet about vision and blindness: http://
www.researchamerica.org/uploads/factsheet16vision.pdf.
The Silver Book: Vision Loss. http://www.eyeresearch.org/pdf/
VisionLossSilverbook.pdf.
About ARVO
ARVO is the world's largest international association of vision
scientists (scientists who study diseases and disorders of the eye).
About 80 percent of members from the United States (>7,000 total) are
supported by NIH grant funding. Vision science is a multi-disciplinary
field, but the National Eye Institute is the only freestanding NIH
institute with a mission statement that specifically addresses vision
research. ARVO supports increased fiscal year 2011 and fiscal year 2012
NIH funding.
ARVO is also a member of the National Alliance for Eye and Vision
Research, and supports their testimony. www.eyeresearch.org
______
Prepared Statement of the Association of American Cancer Institutes
The Association of American Cancer Institutes (AACI), representing
94 of the Nation's premier academic and free-standing cancer centers,
appreciates the opportunity to submit this statement for consideration
by the United States Senate Subcommittee on Labor, Health and Human
Services, Education and Related Agencies, Committee on Appropriations.
AACI thanks the administration, Congress and the Subcommittee for
their long-standing commitment to ensuring quality care for cancer
patients, as well as for providing researchers with the tools that they
need to develop better cancer treatments and, ultimately, to cure this
disease.
President Obama's fiscal year 2012 budget calls for $31.829 billion
for NIH. This is an increase of $1.045 billion (3.4 percent) over the
fiscal year 2010 comparable level of $30.784 billion. The President's
proposed budget for the National Cancer Institute would be increased by
$95 million, to $5.2 billion.
Sustaining progress against cancer requires a Federal commitment to
funding research through the NIH and NCI at a level that at least keeps
pace with medical inflation. With that in mind, AACI is joining with
its colleagues in the biomedical research community in supporting the
proposed increases for NIH and NCI and in calling on Congress to
further strengthen the impact of the President's request by increasing
funding to $35 billion for NIH and to $5.9 billion for NCI. The
requested increases account for lost funding due to discontinuation of
the American Recovery and Reinvestment Act of 2009, and the ongoing
shortfall in NIH and NCI funding in relation to annual changes in the
Biomedical Research and Development Price Index (BRDPI), which
indicates how much the NIH budget must change to maintain purchasing
power.
Taking a closer look at the President's proposed fiscal year 2012
budget, as with so many complicated and vitally important matters, the
devil is in the details. While the President's budget includes a
proposed increase of $95.31 million over fiscal year 2010 for NCI, the
line item funding for Cooperative Clinical Research remains the same as
fiscal year 2010--$254.487 million. Other NCI line items show funding
decreases, including Comprehensive/Specialized Cancer Centers ($46.001
million decrease) and Research and Development Contracts ($39.409
million decrease).
AACI and its members are acutely aware of the difficult fiscal
environment that the country is facing. The vast majority of our cancer
centers exist within universities that are undergoing drastic budget
reductions and as a consequence, directors at our member cancer centers
are already facing extreme budgetary challenges. Furthermore, many of
our senior and most promising young investigators are now without NCI
funding and are requiring significant bridge funding from private
sources. In recent years, however, it has become more challenging to
raise philanthropic and other external funds. As a result, we continue
to be highly dependent on Federal cancer center grants.
Recent developments at one member center, the Nevada Cancer
Institute (NVCI), illustrate that need. Serving 15,000 patients since
it opened in 2005, NVCI has recently lain off half of its 300
employees. In a local news report, NVCI officials cited a number of
reasons for the layoffs, including a miserable economy that has hurt
fundraising, a worsening reimbursement environment that provides less
money from government and private insurance entities for services
rendered, and fewer Federal grant dollars in the recession. (``Debt
puts Nevada Cancer Institute on heels'', Las Vegas Review-Journal,
April 8, 2011.)
Cancer centers are already challenged to provide the infrastructure
necessary to support funded researchers, and cuts in Federal grants
will limit our ability to provide well functioning shared resources to
investigators who depend on them to complete their research. For most
matrix cancer centers, the majority of NCI grant funds are used to
sustain the shared resources so essential to basic, translational,
clinical and population cancer research, or to provide matching dollars
which allow departments to recruit new cancer researchers to a
university and support them until they receive their first grants.
As highlighted by NCI Director Harold Varmus in a January ``town
hall'' meeting with NCI staff, independent investigator research is a
particularly valuable resource, particularly in the area of genomics
and molecular epidemiology. Such research is highly dependent on state-
of-the-art shared resources like tissue processing and banking, DNA
sequencing, microRNA platforms, proteomics, biostatistics and
biomedical informatics. This infrastructure is expensive, and it is not
clear where cancer centers would turn for alternative funding if NCI
grant contributions to these efforts were reduced.
An investigator and medicinal chemist at a large AACI member center
spent 7 years developing two new targeted drugs that are now in
clinical trial testing. One agent shows promise in cancers of the
blood; the other against breast, colon, lung and prostate tumors.
Research on these agents required advanced technologies provided by the
center's shared resources, including analytical cell-sorting,
microarray assays, and toxicopathological evaluations of mouse models,
which are an essential part of drug discovery. If budget cuts had
forced the closure of one or more of these shared resources, these new
targeted therapies might never have made it to the patients who are now
benefiting from them. The researcher has 8 to 10 more compounds in the
pipeline, the fate of which hinges largely on the 2012 budget.
Unfortunately, hundreds of other promising cancer researchers across
the U.S. share this troubling uncertainty.
Cancer Research: Benefiting Americans' Health and Economic Well-being
Cancer's financial and personal impact on America is substantial
and growing--one in two men and one in three women will face cancer in
their lifetimes, and cancer cost our Nation more than $228 billion in
2008 (Centers for Disease Control and Preventions, Addressing The
Cancer Burden: At A Glance 2010).
The U.S. Centers for Disease Control & Prevention's latest report
on cancer survivorship, ``Cancer Survivors-United States, 2007'', shows
that the number of cancer survivors in the United States increased from
3 million in 1971 to 9.8 million in 2001 and 11.7 million in 2007--an
increase from 1.5 percent to 4 percent of the U.S. population. Cancer
survivors largely consist of people who are 65 years of age or older
and women. More than a million people were alive in 2007 after being
diagnosed with cancer 25 years or more earlier. Of the 11.7 million
people living with cancer in 2007, 7 million were 65 years of age or
older, 6.3 million were women, and 4.7 million were diagnosed 10 years
earlier or more
Investing in cancer research is a prudent step--both for the health
of our Nation and for its economic well-being. Cancer research,
conducted in academic laboratories across the country, saves money by
reducing healthcare costs associated with the disease, enhances the
United States' global competitiveness, and has a positive economic
impact on localities that house a major research center.
In May 2011, AACI engaged Tripp Umbach, a research firm
specializing in economic impact studies, to conduct an analysis of
potential effects on statewide and national economic activity and
employment resulting from NCI funding cuts to AACI cancer centers. Two
reduced funding levels were considered: (1) a ``conservative'' 0.8
percent reduction, as implemented in the 2011 continuing resolution for
the Federal budget, passed by Congress in March, and, (2) an
``aggressive'' 5.3 percent cut, reflecting an overall fiscal year 2012
budget reduction proposed by some members of Congress. This reduction
would rollback NCI funding to 2008 levels. The impact of the 0.8
percent cut is already being felt: NCI announced on May 5 that it would
need to cut funding for the NCI cancer centers program by 5 percent.
The report estimates that the total economic decline resulting from
a 0.8 percent cut in NCI funding would result in a loss of at least
$84.5 million to the U.S. economy, with a 5.3 percent funding drop
causing a $564.7 million economic loss nationwide. The economic impact
is even greater when overall NIH funding is considered. A 0.8 percent
reduction in NIH funding would mean a $530.8 million loss to the U.S.
economy, with a 5.3 percent reduction leading to a $3.5 billion loss.
Employment declines from the 0.8 percent NCI funding reduction
would total at least 629 jobs while 4,200 jobs would be lost with a 5.3
percent funding cut. Applying the same calculations to total NIH
appropriations would eliminate nearly 4,000 jobs based on the
conservative reduction, increasing to 26,300 jobs lost with a 5.3
percent cut. It is important to note that research and health sciences
jobs are generally high-paying and the loss of even a handful of such
jobs can have a measurable effect on local economic activity.
While the economic aspects of cancer research are important, what
cannot be overstated is the impact cancer research has had on
individuals' lives--lives that have been lengthened and even saved by
virtue of discoveries made in cancer research laboratories at cancer
centers across the United States.
Biomedical research has provided Americans with better cancer
treatments, as well as enhanced cancer screening and prevention
efforts. Some of the most exciting breakthroughs in current cancer
research are those in the field of personalized medicine. In
personalized medicine for cancer, not only is the disease itself
considered when determining treatments, but so is the individual's
unique genetic code. This combination allows physicians to better
identify those at risk for cancer, detect the disease, and treat the
cancer in a targeted fashion that minimizes side effects and refines
treatment in a way to provide the maximum benefit to the patient.
In the laboratory setting, multi-disciplinary teams of scientists
are working together to understand the significance of the human genome
in cancer. For instance, the Cancer Genetic Markers of Susceptibility
initiative is comparing the DNA of men and women with breast or
prostate cancer with that of men and women without the diseases to
better understand the diseases. The Cancer Genome Atlas is in
development as a comprehensive catalog of genetic changes that occur in
cancer.
Illustrating the successes realized by cancer research, NCI's most
recent Annual Report to the Nation on the Status of Cancer reported
that rates of death in the United States from all cancers for men and
women continued to decline between 2003 and 2007, the most recent
reporting period available. The report also finds that the overall rate
of new cancer diagnoses for men and women combined decreased an average
of slightly less than 1 percent per year for the same period.
Despite those improvements, ``cancer disparities'' abound, with
different groups of cancer sufferers and cancer types showing little
improvement or higher rates of incidence. For example, childhood cancer
incidence rates (rates of new diagnoses) continued to increase while
death rates in this age group decreased. Childhood cancer is classified
as cancers occurring in those 19 years of age or younger. And there are
several other forms of cancer (e.g. pancreatic, lung) and patient
populations (racial and ethnic minorities, the poor, those with
psychosocial issues) with high rates of cancer mortality and morbidity.
Furthermore, with the increased incidence and survival comes higher
morbidity because two-thirds of this surviving patient population
experience late effects that are classified as serious to life-
threatening.
The Nation's Cancer Centers
The nexus of cancer research in the United States is the Nation's
network of cancer centers represented by AACI. These cancer centers
conduct the highest-quality cancer research anywhere in the world and
provide exceptional patient care. The Nation's research institutions,
which house AACI's member cancer centers, receive an estimated $3.71
billion from the National Cancer Institute (NCI) to conduct cancer
research in fiscal year 2010; more than two-thirds of NCI's total
budget (U.S. Department of Health and Human Services, National
Institutes of Health, National Cancer Institute 2010 Fact Book). In
fact, approximately 84 percent of NCI's budget supports research at
nearly 650 universities, hospitals, cancer centers, and other
institutions in all 50 States. Because these centers are networked
nationally, opportunities for collaborations are many--assuring wise
and non-duplicative investment of scarce Federal dollars.
In addition to conducting basic, clinical, and population research,
the cancer centers are largely responsible for training the cancer
workforce that will practice in the United States in the years to come.
Much of this training depends on Federal dollars, via training grants
and other funding from NCI. Sustained Federal support will
significantly enhance the centers' ability to continue to train the
next generation of cancer specialists--both researchers and providers
of cancer care.
By providing access to a wide array of expertise and programs
specializing in prevention, diagnosis, and treatment of cancer, cancer
centers play an important role in reducing the burden of cancer in
their communities. The majority of the clinical trials of new
interventions for cancer are carried out at the nation's network of
cancer centers.
Conclusion
These are exciting times in science and, particularly, in cancer
research. The AACI cancer center network is unrivaled in its pursuit of
excellence, and places the highest priority on affording all Americans
access to superior cancer care, including novel treatments and clinical
trials. It is through the power of collaborative innovation that we
will accelerate progress toward a future without cancer, and research
funding through the NIH and NCI is essential to achieving our goals.
______
Prepared Statement of the Association of American Medical Colleges
The Association of American Medical Colleges (AAMC) is a not-for-
profit association representing all 134 accredited U.S. and 17
accredited Canadian medical schools; nearly 400 major teaching
hospitals and health systems; and nearly 90 academic and scientific
societies. Through these institutions and organizations, the AAMC
represents 128,000 faculty members, 75,000 medical students, and
110,000 resident physicians. The association appreciates the
opportunity to address four programs that play critical roles in
assisting medical schools and teaching hospitals to fulfill their
missions of education, research, and patient care: the National
Institutes of Health (NIH); the Agency for Healthcare Research and
Quality (AHRQ); health professions education funding through the Health
Resources and Services Administration (HRSA)'s Bureau of Health
Professions; and the National Health Service Corps. The AAMC
appreciates the Subcommittee's longstanding, bipartisan efforts to
strengthen these programs.
National Institutes of Health.--The NIH is one of the Nation's
greatest achievements. The Federal Government's unwavering support for
medical research through the NIH has created a scientific enterprise
that is the envy of the world and has contributed greatly to improving
the health and well-being of all Americans--indeed of all humankind.
The AAMC is grateful to the Subcommittee for its efforts to
prioritize NIH funding in fiscal year 2011 and supports the budget
request of $31.748 billion for NIH in fiscal year 2012. More than 83
percent of NIH research funding is awarded to more than 3,000 research
institutions in every State; at least half of this funding supports
life-saving research at America's medical schools and teaching
hospitals. This successful partnership not only lays the foundation for
improved health and quality of life, but also strengthens the Nation's
long-term economy.
The foundation of scientific knowledge built through NIH-funded
research drives medical innovation that improves health and quality of
life through new and better diagnostics, improved prevention
strategies, and more effective treatments. NIH research has contributed
to dramatically increased and improved life expectancy over the past
century. A baby born today can look forward to an average life span of
nearly 78 years--almost three decades longer than a baby born in 1900,
and life expectancy continues to increase. People are staying active
longer, too: the proportion of older people with chronic disabilities
dropped by nearly a third between 1982 and 2005. Thanks to insights
from NIH-funded studies, the death rate for coronary heart disease is
more than 60 percent lower--and the death rate for stroke, 70 percent
lower--than in the World War II era.
For example, a new ability to comprehend the genetic mechanisms
responsible for disease is already providing insights into diagnostics
and identifying a new array of drug targets. We are entering an era of
personalized medicine, where prevention, diagnosis, and treatment of
disease can be individualized, instead of using the standardized
approach that all too often wastes healthcare resources and potentially
subjects patients to unnecessary and ineffective medical treatments and
diagnostic procedures.
Peer-reviewed, investigator-initiated basic research is the heart
of NIH research. These inquiries into the fundamental cellular,
molecular, and genetic events of life are essential if we are to make
real progress toward understanding and conquering disease. Additional
funding is needed to sustain and enhance basic research activities,
including increasing support for current researchers and promoting
opportunities for new investigators and in those areas of biomedical
science that historically have been underfunded.
The application of the results of basic research to the detection,
diagnosis, treatment, and prevention of disease is the ultimate goal of
medical research. Clinical research not only is the pathway for
applying basic research findings, but it often provides important
insights and leads to further basic research opportunities. The AAMC
supports additional funding for the continued expansion of clinical
research and clinical research training opportunities, including
rigorous, targeted post-doctoral training; developmental support for
new and junior investigators; and career support for established
clinical investigators, especially to enable them to mentor new
investigators.
Anecdotal evidence suggests that changes in healthcare delivery
systems and other financial factors pose a serious threat to the
research infrastructure of America's medical schools and teaching
hospitals, particularly for clinical research. The AAMC supports
efforts to enhance the research infrastructure, including resources for
clinical and translational research; instrumentation and emerging
technologies; and animal and other research models.
Among the areas NIH has identified as ripe for investment and
integral to the health of the American people is enhancing the evidence
base for healthcare decisions. NIH's long-standing investment in
Comparative Effectiveness Research (CER) has informed the clinical
guidelines that assist physicians and their patients in making better
decisions about the most effective care. Knowledge from NIH-supported
CER has changed the way diabetes, atrial fibrillation, hypertension,
HIV/AIDS, schizophrenia, and many other conditions are treated. In
addition to diagnostic and treatment trials, knowing more about the
performance of disease prevention initiatives and medical care delivery
will improve health.
The AAMC supports efforts to reinvigorate research training,
including developing expanded medical research opportunities for
minority and disadvantaged students. For example, the volume of data
being generated by genomics research, as well as the increasing power
and sophistication of computing assets on the researcher's lab bench,
have created an urgent need, both in academic and industrial settings,
for talented individuals well-trained in biology, computational
technologies, bioinformatics, and mathematics to realize the promise
offered by modern interdisciplinary research.
The AAMC is heartened by the Administration's proposals to provide
a four percent stipend increase for predoctoral and postdoctoral
research trainees supported by NIH's Ruth L. Kirschstein National
Research Service Awards program. These stipend increases are necessary
if medical research is to remain an attractive career option for the
brightest U.S. students. Attracting the most talented students and
postdoctoral fellows is essential if the United States is to retain its
position of world leadership in biomedical and behavioral research.
As Raymond Orbach, former Under Secretary for Science at the
Department of Energy for President George W. Bush, noted in a recent
editorial in Science, ``Other countries, such as China and India, are
increasing their funding of scientific research because they understand
its critical role in spurring technological advances and other
innovations. If the United States is to compete in the global economy,
it too must continue to invest in research programs.''
Agency for Healthcare Research and Quality.--Complementing the
medical research supported by NIH, AHRQ sponsors health services
research designed to improve the quality of healthcare, decrease
healthcare costs, and provide access to essential healthcare services
by translating research into measurable improvements in the healthcare
system. The AAMC firmly believes in the value of health services
research as the Nation continues to strive to provide high-quality,
efficient, and cost-effective healthcare to all of its citizens. The
AAMC joins the Friends of AHRQ in recommending $405 million for the
agency in fiscal year 2012.
As the lead Federal agency to improve healthcare quality, AHRQ's
overall mission is to support research and disseminate information that
improves the delivery of healthcare by identifying evidence-based
medical practices and procedures. The Friends of AHRQ funding
recommendation will allow AHRQ to continue to support patient-centered
health research and other valuable research initiatives including
strategies for translating the knowledge gained from patient-centered
research into clinical practice, healthcare delivery, and provider and
patient behaviors. These research findings will better guide and
enhance consumer and clinical decisionmaking, provide improved
healthcare services, and promote efficiency in the organization of
public and private systems of healthcare delivery.
Health Professions Funding.--The Title VII and VIII health
professions and nursing education programs are the only Federal
programs designed to improve the supply, distribution, and diversity of
the Nation's healthcare workforce. For almost 50 years, Title VII and
Title VIII have provided education and training opportunities to a wide
variety of aspiring healthcare professionals, both preparing them for
careers in the health professions and helping bring healthcare services
to our rural and underserved communities. Through loans, loan
guarantees, and scholarships to students, and grants and contracts to
academic institutions and non-profit organizations, the Title VII and
Title VIII programs fill the gaps in the supply of health professionals
not met by traditional market forces. The AAMC supports the fiscal year
2012 request of $762.5 million for these important workforce programs
in the upcoming fiscal year.
Since 1963, the Title VII and Title VIII education and training
programs have helped the workforce adapt to the evolving healthcare
needs of the ever-changing American population. In an effort to renew
and update Titles VII and VIII to meet current workforce challenges,
the programs were reauthorized in 2010--the first reauthorization in
the past decade. Reauthorization not only improved the efficiency of
the Title VII and Title VIII programs, but also laid the groundwork for
innovative programs with an increased focus on recruiting and retaining
professionals in underserved communities.
The AAMC appreciates the Subcommittee's longstanding support of the
Title VII and Title VIII programs, as well as bipartisan recognition
that a strong healthcare workforce is essential to the continued health
and prosperity of the American people, particularly in the face of
unprecedented existing and looming provider shortages. However,
recognition alone will not solve the significant disparities between
the needs of the American people and the number of providers willing
and able to care for them. To ensure that the Nation's already fragile
healthcare system is able to care for the expanding elderly population;
meet the unique needs of the country's sick and ailing children and
minority populations; and provide essential primary care services to
the neediest amongst us, it is essential that Congress prioritize the
healthcare workforce with a strong commitment to the Title VII and
Title VIII health professions programs in fiscal year 2012.
In addition to funding for Title VII and Title VIII, HRSA's Bureau
of Health Professions also supports the Children's Hospitals Graduate
Medical Education program. This program provides critical Federal
graduate medical education support for children's hospitals to prepare
the future primary care workforce for our Nation's children and for
pediatric specialty care--the greatest workforce shortage in children's
healthcare. The AAMC has serious concerns about the President's plan to
eliminate support for this essential program in fiscal year 2012, as
well as the $48.5 million (15 percent) cut imposed on the program in
fiscal year 2011. At a time when the Nation faces a critical doctor
shortage and more Americans are about to enter the health insurance
system, any cuts to funding that supports physician training will have
serious repercussions for Americans' health. We strongly urge
restoration to $317.5 million in fiscal year 2012.
National Health Service Corps.--The AAMC lauds the commitment of
the Affordable Care Act to address health professional workforce
shortages by authorizing up to $535.1 million for the NHSC in fiscal
year 2012. The NHSC is widely recognized--both in Washington and in the
underserved areas it helps--as a success on many fronts. It improves
access to healthcare for the growing numbers of underserved Americans,
provides incentives for practitioners to enter primary care, reduces
the financial burden that the cost of health professions education
places on new practitioners, and helps ensure access to health
professions education for students from all backgrounds. Over its 39-
year history, the NHSC has offered recruitment incentives, in the form
of scholarship and loan repayment support, to more than 37,000 health
professionals committed to serving the underserved.
In spite of the NHSC's success, demand for health professionals
across the country remains high. At a field strength of 7,530 in fiscal
year 2010, the NHSC fell over 24,000 practitioners short of fulfilling
the need for primary care, dental, and mental health practitioners in
Health Professions Shortage Areas (HPSAs), as estimate by HRSA. While
the ``American Recovery and Reinvestment Act of 2009'' (Public Law 111-
5) provided a temporary boost in annual awards, this increase must be
sustained to help address the health professionals workforce shortage
and growing maldistribution.
The AAMC supports the president's fiscal year 2012 budget request
of $124 million, which returns the NHSC to fiscal year 2008
discretionary levels. The president's budget also assumes that the NHSC
has access to $295 million in additional dedicated funding through the
HHS Secretary's CHC Fund. This additional funding is necessary to
sustain the increased NHSC field strength and help address current
health professional workforce shortages. The AAMC further recommends
that the Subcommittee include report language directing the Secretary
to provide this enhanced funding for the NHSC over the fiscal year 2008
level, as directed under healthcare reform.
______
Prepared Statement of the Association of American Veterinary Medical
Colleges
The Association of American Veterinary Medical Colleges (AAVMC) is
pleased to submit this statement for the record in support of the
fiscal year 2012 budget request of $449.5 million for the health
professions education programs authorized under Title VII of the Public
Health Service Act and administered through the Health Resources and
Services Administration (HRSA). AAVMC is also pleased to provide
comments on the pending transfer of authorities of the National Center
for Research Resources (NCRR) within the National Institutes of Health
(NIH).
AAVMC provides leadership for and promotes excellence in academic
veterinary medicine to prepare the veterinary workforce with the
scientific knowledge and skills required to meet societal needs through
the protection of animal health, the relief of animal suffering, the
conservation of animal resources, the promotion of public health, and
the advancement of medical knowledge. AAVMC provides leadership for the
academic veterinary medical community, including in the United States
all 28 colleges of veterinary medicine, nine departments of veterinary
science, eight departments of comparative medicine, two other
veterinary medical educational institutions; and internationally, all
five veterinary medical colleges in Canada, eleven international
colleges of veterinary medicine, and three international affiliate
colleges of veterinary medicine.
The Title VII and VIII health professions and nursing programs
provide education and training opportunities to a wide variety of
aspiring healthcare professionals, including veterinarians. An
essential component of the healthcare safety net, the Title VII and
Title VIII programs are the only Federal programs designed to train
healthcare providers in interdisciplinary settings to meet the needs of
the country's special and underserved populations, as well as to
increase minority representation in the healthcare workforce.
While we are keenly aware that the Subcommittee continues to face
difficult decisions as it seeks to improve the Nation's fiscal health,
a continued Congressional commitment to programs supporting healthcare
workforce development is essential to the physical health and
prosperity of the American people.
The two areas within HRSA of greatest importance to AAVMC members
are the Public Health Workforce Development programs and Student
Financial Assistance.
The Public Health Workforce Development programs are designed to
increase the number of individuals trained in public health, to
identify the causes of health problems, and to respond to such issues
as managed care, new disease strains, food supply, and bioterrorism.
The Public Health Traineeships and Public Health Training Centers seek
to alleviate the critical shortage of public health professionals by
providing up-to-date training for current and future public health
workers, particularly in underserved areas. The Title VII
reauthorization reorganized this cluster to include a focus on loan
repayment as an incentive for public health professionals to practice
in disciplines and settings experiencing shortages. The Public Health
Workforce Loan Repayment Program provides loan repayment for public
health professionals accepting employment with Federal, State, local,
and tribal public health agencies.
AAVMC is also working to amend these authorizations so that
veterinarians engaged in public health are explicitly included and
prioritized for funding as their counterparts in human medicine and
dentistry are. On March 8, 2011 the United States House of
Representatives passed H.R. 525, the Veterinary Public Health
Amendments Act. AAVMC is eager to see this legislation pass the Senate
and become law so that the urgent workforce needs of veterinarians
engaged in public health are fully recognized and supported, as the
needs of their counterparts in human medicine are.
The loan programs under Student Financial Assistance support
financially needy and disadvantaged medical and nursing school students
in covering the costs of their education The Health Professional
Student Loan (HPSL) program provides loans covering the cost of
attendance for financially needy health professions students based on
institutional determination. The HPSL program is funded out of each
institution's revolving fund and does not receive Federal
appropriations. The Loans for Disadvantaged Students program provides
grants to health professions institutions to make loans to health
professions students from disadvantaged backgrounds.
AAVMC would also like to express concern over the pending
reorganization and possible elimination of NCRR programs over the
coming fiscal year. We recognize the importance of the NIH's initiative
to create the National Center for Advancing Translational Sciences
(NCATS) and welcome the potential benefits to our Nation's health of an
invigorated focus on translational medicine and therapeutics. AAVMC's
faculty members are proud of their significant contributions toward
improving human health through transdisciplinary involvement and
collaboration in translational research and comparative medicine. The
support offered by NCRR programs and resources to our institutions and
faculty have made possible their important contributions to our
Nation's health.
To successfully fulfill its mission of accelerating the development
and delivery of new, more effective therapeutics, NCATS will rely on a
diverse team of appropriately trained laboratory scientists and
clinical researchers capitalizing on the development of tools and
technologies and making discoveries at molecular and cellular levels
that can be tested and proven in animal-based studies. Although a
logical and rational argument can be made for including NCRR's Clinical
and Translational Science Award (CTSA) program, which is designed to
develop teams of investigators from various fields of research who can
transform scientific discoveries made in the laboratory into treatments
and strategies for patients in the clinic, into the new NCATS, the same
cannot be said for excluding and dismembering other components of NCRR,
such as animal resources, training programs, and high-end
instrumentation and technologies which are so critical to NCATS
mission.
Further, as indicated in the NCRR Task Force Straw Model, proposing
to subdivide these other NCRR components disrupts the extant scientific
synergies that have been demonstrated meritorious to date, and forfeits
the strategic relationships that have been built between programs over
the last 20 years. For example, splitting the animal resources into
different administrative structures erects a bureaucratic obstacle that
needlessly hinders the flow of basic scientific discoveries made in
induced genetic mutations in mice to clinically applicable mechanisms-
of-action studied and tested in non-human primates.
Although it is expected that following this restructuring NCRR will
no longer exist as a center, a rational consideration would be to
maintain a large component of NCRR programs together after reassignment
of the CTSA program within the new NCATS. Those charged with making
these decisions should be mindful that NCRR's unique, cross-cutting
programs are and have been successful through careful planning,
thoughtful leadership, and effective management by its administrative
and scientific staff, program officers, and officials who understand
these programs and are most qualified to ensure continued success of
their respective programs and initiatives.
We urge members of this committee to examine the issues raised
above and seek answers from the Administration as you conduct the
constitutionally mandated responsibility of overseeing Federal agencies
and their actions, such as the proposed reorganization within NIH.
Thank you for the opportunity to provide comments on the fiscal
year 2012 budget for the Department of Health and Human Services. AAVMC
is please to serve as a resource to Congress as you debate these
important issues. Please feel free to contact me directly at 202-371-
9195 x. 117 or by writing to [email protected].
______
Prepared Statement of the Association of Independent Research
Institutes
The Association of Independent Research Institutes (AIRI)
respectfully submits this written testimony for the record to the
Senate Appropriations Subcommittee on Labor, Health and Human Services,
Education and Related Agencies. AIRI appreciates the commitment that
the members of this Subcommittee have made to biomedical research
through your strong support for the National Institutes of Health
(NIH), and recommends that you maintain this support for NIH in fiscal
year 2012 by providing $31.987 billion for NIH in fiscal year 2012,
which represents a 3.4 percent increase above the fiscal year 2011
level.
AIRI is a national organization of more than 80 independent, non-
profit research institutes that perform basic and clinical research in
the biological and behavioral sciences. AIRI institutes vary in size,
with budgets ranging from a few million to hundreds of millions of
dollars. In addition, each AIRI member institution is governed by its
own independent board of directors, which allows our members to focus
on discovery-based research while remaining structurally nimble and
capable of adjusting their research programs to emerging areas of
inquiry. Researchers at independent research institutes consistently
exceed the success rates of the overall NIH grantee pool, and receive
about 10 percent of NIH's peer-reviewed, competitively awarded
extramural grants.
In recent years, Congress has taken important steps to jump start
the Nation's economy through investments in science. Simultaneously,
the NIH community is advancing and accelerating the biomedical research
agenda in this country by focusing on scientific opportunities to
address public health challenges. However, flat NIH budgets since 2003
have affected the agency's ability to pursue new, cutting-edge
opportunities. This funding uncertainty is disruptive to training,
careers, long-range projects, and ultimately, to research progress. The
research engine needs a predictable, sustained investment in science to
maximize the Nation's return.
Not only is NIH research essential to advancing health, it also
plays a key economic role in communities nationwide. More than 83
percent of NIH funding is spent in communities across the Nation,
creating jobs at more than 3,000 independent research institutions,
universities, teaching hospitals, and other institutions in every
State. NIH research also supports long-term competitiveness for
American workers. NIH funding forms one of the key foundations for
sustained U.S. global competitiveness in industries like biotechnology,
medical device and pharmaceutical development, and more.
Highlighted below are examples of how independent research
institutes uniquely contribute to the NIH mission and activities.
Translating Research into Treatments and Therapeutics.--To further
its primary goal of improving health, NIH is engaged in a significant
reorganization process focused on advancing translational science. AIRI
looks forward to collaborating with NIH in this area as independent
research institutes are particularly adept at translating basic
discoveries into therapeutics, often partnering with industry. As a
network of efficient, nimble independent research institutes that have
been conducting translational research for years, AIRI is well-
positioned to be a strong partner in bringing research from the bench
to the bedside.
Currently, over 15 AIRI member institutions are affiliated and
collaborate with the Clinical and Translational Science Awards (CTSA)
program. Many AIRI institutes also support research on human embryonic
stem cells (hESC) with the hope of discovering new and innovative
disease interventions. However, uncertainty surrounding NIH funding and
hESC research will hinder the agency's efforts to advance the
introduction of new, life-saving cures and treatments into the
marketplace.
Fostering the Next Generation Scientific Workforce.--The biomedical
research community is dependent upon a knowledgeable, skilled, and
diverse workforce to address current and future critical health
research questions. While the primary function of AIRI member
institutions is research, most are highly involved in training the next
generation of biomedical researchers and ensuring that a pipeline of
promising scientists are prepared to make significant and potentially
transformative discoveries in a variety of areas.
AIRI supports policies that promote the United States' ability to
maintain a competitive edge in biomedical science. Initiatives focusing
on career development and recruitment of a diverse scientific workforce
are important to innovation in biomedical research and the public
health of the Nation. The cultivation and preservation of this
workforce is dependent upon several factors:
--The ability to recruit scientists and students globally is
essential to maintaining a strong workforce.
--Training programs both in basic and clinical biomedical research,
initiatives focusing on career development, and recruiting a
diverse scientific workforce are important to innovation in
biomedical research for the benefit of public health.
--The continued national emphasis on promoting education in the
fields of science, technology, engineering, and mathematics
(STEM) is key to bolstering the pipeline.
Pursuing New Knowledge.--The NIH model for conducting biomedical
research, which involves supporting scientists at universities, medical
centers, and independent research institutes, provides an effective
approach to making fundamental discoveries in the laboratory that can
be translated into medical advances that save lives. Moreover, efforts
to expand the knowledge base in medical and associated sciences bolster
the Nation's economic well-being and ensure a continued high return on
the public investment in research.
AIRI member institutions are private, stand-alone research centers
that set their sights on the vast frontiers of medical science,
specifically focused on pursuing knowledge about the biology and
behavior of living systems and the application of that knowledge to
improve human life and reduce the burdens of illness and disability.
Additionally, AIRI member institutes have embraced technologies and
research centers to collaborate on biological research for all
diseases. Using advanced technology platforms or ``cores,'' AIRI
researchers use genomics, imaging, and other broad-based technologies
to advance therapeutics development and drug discovery.
Providing Efficiency and Flexibility.--AIRI member institutes'
small size and flexibility provide an environment that is particularly
conducive to creativity and innovation. Independent research institutes
possess a unique versatility and culture that encourages them to share
expertise, information, and equipment across all research institutions
and elsewhere. These collaborative activities help minimize bureaucracy
and increase efficiency, allowing for fruitful partnerships with
entities in a variety of disciplines and industries. Also, unlike
institutes of higher education, independent research institutes are
able to focus solely on scientific inquiry and discoveries, allowing
them to respond quickly to the research needs of the country.
Supporting Local Economies.--AIRI is unique from other biomedical
research organizations in that our membership consists of institutions
located in regions not traditionally associated with cutting-edge
research. AIRI members are located in 25 States, including many smaller
or less-populated States that do not have major academic research
institutions. In many of these regions, independent research institutes
are major employers and economic engines, and exemplify the positive
impact of investing in research and science.
AIRI thanks the Subcommittee for its important work dedicated to
ensuring the health of the Nation, and we appreciate this opportunity
to urge the Subcommittee to provide $31.987 billion for NIH in the
fiscal year 2012 appropriations bill. AIRI looks forward to working
with Congress to support research that improves the health and quality
of life for all Americans.
______
Prepared Statement of the Association of Maternal & Child Health
Programs
Chairman Harkin and distinguished subcommittee members: On behalf
of the Association of Maternal & Child Health Programs (AMCHP), I am
pleased to submit testimony describing AMCHP's request for $700 million
in funding for fiscal year 2012 for the Title V Maternal and Child
Health Services block grant, a 5 percent increase over fiscal year
2010. The Maternal and Child Health (MCH) Services Block Grant supports
a wide range of programs that meet State and locally determined needs.
In 2008, over 40 million individuals were served by maternal and child
health programs supported through the MCH Services Block Grant.
AMCHP did not develop this request lightly and our members are very
cognizant of the many important and urgent discussions about reducing
the Federal deficit and Government spending. However, we strongly
contend that with the recent economic downturn and increased need to
provide services to vulnerable populations a $700 million request is
worthy of serious consideration by the Committee.
The MCH Services Block Grant provides support and services to
millions of American women, infants and children, including children
with special healthcare needs. It has been proven a cost effective,
value-based, and flexible funding source used to address the most
pressing and unique needs of each State. States and jurisdictions use
the MCH Services Block Grant to design and implement a wide range of
maternal and child health programs that meet national and State needs.
Although specific initiatives may vary among the 59 States and
jurisdictions, all of them work to accomplish the following:
--Reduce infant mortality and incidence of disabling conditions among
children;
--Increase the number of children appropriately immunized against
disease;
--Increase the number of children in low-income households who
receive assessments and follow-up diagnostic and treatment
services;
--Provide and ensure access to comprehensive perinatal care for
women; preventative and child care services; comprehensive
care, including long-term care services, for children with
special healthcare needs; and rehabilitation services for blind
and disabled children; and
--Facilitate the development of comprehensive, family centered,
community-based, culturally competent, coordinated systems of
care for children with special healthcare needs.
The MCH Services Block Grant improves the health of America's women
and children by:
--Supporting programs that work. The MCH Services Block Grant earned
the highest program rating by the Office of Management and
Budget's (OMB) Program Assessment Rating Tool (PART). OMB found
that MCH Services Block Grant funded programs helped to
decrease the infant mortality rate, prevent disabling
conditions, increase the number of children immunized, increase
access to care for uninsured children, and improve the overall
health of mothers and children. Reduced MCH Services Block
Grant funding threatens the ability of these programs to carry
on this work. Our results are available to the public through a
national website known as the Title V Information System. Such
a transparent system is remarkably rare for a Federal program
and we are proud of the progress we have made in demonstrating
results.
--Addressing the growing health needs of women, children and
families. As States face economic hardships and face limits on
their Medicaid and CHIP programs, more women and children seek
care and preventive services through MCH Services Block Grant
funded programs. Resources are needed to reduce infant
mortality, provide a range of preventive health and early
intervention services to those in need, improve oral
healthcare, reach more children and youth with special
healthcare needs, and reduce racial disparities in healthcare.
--Supporting and integrating other federally funded programs such as
Community Health Centers, Healthy Start, WIC, CHIP and
Medicaid. The MCH Services Block Grant helps identify areas of
need in a State and works with all State and Federal programs
to complement healthcare services and promote disease
prevention for women, children, and families.
To help illustrate the importance of MCH Services Block Grant
funding I would like to share Michelle's story. Michelle is a young
girl from Iowa who was helped by Iowa's MCH Services Block Grant
supported programs.
Katrina is the mother of Michelle, an energetic, 10 year old girl
from Spencer, Iowa who loves listening to music, riding and playing
with horses. While enrolling her daughter into school, Katrina got a
``mother's feeling'' that something just wasn't quite right with her
daughter and despite the family pediatrician telling her that there was
nothing wrong, she reached out to the Child Health Specialty Clinic
(CHSC) in Sioux City for help. It was at that Title V funded clinic
that it was discovered by a professional geneticist that her child was
suffering from Phelan-McDermid Syndrome (PMS). PMS is caused by damage
to, or deletion of, specific genes and impacts normal childhood
development. Frequently, individuals with PMS have intellectual
disabilities along with little or no expressive language and often
there can be a large variety of moderate and even some severe physical
disabilities.
Because of the proper diagnosis from the geneticist at the
specialty clinic, Katrina is able to get her daughter proper physical
rehabilitation treatments twice a week from her local hospital back
home in Spencer. A diagnosis of this kind could not have been found
without the aid of CHSC staff and the clinic in Sioux City, which along
with all Iowan CHSC clinics, are funded by the Title V Maternal & Child
Health Block Grant. Title V is so valuable because CHSC clinics provide
direct clinical services to children when services are not readily
available in the community. CHSC clinics also provide care
coordination, family support and infrastructure building, all in an
effort to continue to improve healthcare for children and families
across the entire state.
Thanks to Child Health Specialty Clinics, Iowan families are able
to receive testing and diagnosis that they can find nowhere else. Not
only are the people at these clinics determined to help children
medically, they also make a point to get to know the children on a
personal level. Katrina describes the people at the clinic by stating:
``They know each and every child when they arrive, and they truly love
the kids they see.'' If you were to ask Katrina how she felt about
Iowa's Title V funded specialty clinics she wouldn't shy away from
telling you that, ``They help so much. The people there really do
care.''
The MCH Services Block Grant supports a similar network in every
State and none of this could happen without the MCH Services Block
Grant. We hope that all our Nation's citizens are as proud as Katrina
because of the work of MCH Services Block Grant supported programs and
professionals.
America has made huge strides in advancing the health of women and
children but our country faces huge challenges in improving maternal
and child health outcomes and addressing the needs of vulnerable
children. On the sentinel measures of how well our society is doing to
protect women and children we compare badly to other industrialized
countries. Today, the United States ranks 30th in infant mortality
rates and 41st in maternal mortality. Sadly, every 18 minutes a baby in
America dies before his or her first birthday and each day in America
we lose 12 babies due to a Sudden Unexpected Infant Death. There are
places in this country where the African-American infant mortality rate
is double, and in some places even triple, the rate for whites.
Preventable injuries remain the leading cause of death for all
children. Nationwide we still fail to adequately screen all young
children for developmental concerns, and childhood obesity has reached
epidemic proportions threatening to reverse a century of progress in
extending life expectancy to our Nation's very future.
Without adequate funding MCH Services Block Grant programs will be
overwhelmed by the mismatch between State needs and available
resources. AMCHP members ask for your leadership in making the
important decision to fund the MCH Services Block Grant at $700 million
for fiscal year 2012. State maternal and child health programs have a
long track record of demonstrating our positive impact on MCH outcomes
and are fully accountable for the funds that we receive. Maintaining
vital funding for the MCH Services Block Grant is an effective and
efficient way to support our Nation's women, children, and families.
In closing Mr. Chairman and distinguished members, I ask you to
imagine with me an America in which every child has the opportunity to
live until his or her first birthday; a Nation where our Federal and
State partnership has effectively moved the needle on our most pressing
maternal and child health issues such as infant mortality. Imagine all
American parents being as proud as Katrina. Imagine a day when we are
celebrating significant reductions or even the total elimination of
health disparities by creatively solving our most urgent maternal and
child health challenges.
The MCH Services Block Grant aims to do just that using resources
effectively to improve the health of all of America's women and
children. Supporting the MCH Services Block Grant is a cost-effective
investment in our Nation's future. We appreciate you support and
leadership in funding it at $700 million for Federal fiscal year 2012.
Thank you.
______
Prepared Statement of the Association of Minority Health Professions
Schools
Mr. Chairman and members of the subcommittee, thank you for the
opportunity to present my views before you today. I am Dr. Wayne J.
Riley, Chairman of the Board of Directors of the Association of
Minority Health Professions Schools (AMHPS) and the President and Chief
Executive Officer of Meharry Medical College. AMHPS, established in
1976, is a consortium of our Nation's 12 historically black medical,
dental, pharmacy, and veterinary schools. The members are two dental
schools at Howard University and Meharry Medical College; four schools
of medicine at The Charles Drew University, Howard University, Meharry
Medical College, and Morehouse School of Medicine; five schools of
pharmacy at Florida A&M University, Hampton University, Howard
University, Texas Southern University, and Xavier University; and one
school of veterinary medicine at Tuskegee University. In all of these
roles, I have seen firsthand the importance of minority health
professions institutions and the Title VII Health Professions Training
programs.
Mr. Chairman, I want to welcome you to this new role of leading the
L-HHS Subcommittee. I speak for our institutions, when I say that the
minority health professions institutions and the Title VII Health
Professionals Training programs address a critical national need.
Persistent and severe staffing shortages exist in a number of the
health professions, and chronic shortages exist for all of the health
professions in our Nation's most medically underserved communities.
Furthermore, even after the landmark passage of health reform, it is
important to note that our Nation's health professions workforce does
not accurately reflect the racial composition of our population. For
example while blacks represent approximately 15 percent of the U.S.
population, only 2-3 percent of the Nation's health professions
workforce is black. Mr. Chairman, I would like to share with you how
your committee can help AMHPS continue our efforts to help provide
quality health professionals and close our Nation's health disparity
gap.
There is a well established link between health disparities and a
lack of access to competent healthcare in medically underserved areas.
As a result, it is imperative that the Federal Government continue its
commitment to minority health profession institutions and minority
health professional training programs to continue to produce healthcare
professionals committed to addressing this unmet need--even in austere
financial times.
An October 2006 study by the Health Resources and Services
Administration (HRSA), entitled ``The Rationale for Diversity in the
Health Professions: A Review of the Evidence'' found that minority
health professionals serve minority and other medically underserved
populations at higher rates than non-minority professionals. The report
also showed that; minority populations tend to receive better care from
practitioners who represent their own race or ethnicity, and non-
English speaking patients experience better care, greater
comprehension, and greater likelihood of keeping follow-up appointments
when they see a practitioner who speaks their language. Studies have
also demonstrated that when minorities are trained in minority health
profession institutions, they are significantly more likely to: (1)
serve in rural and urban medically underserved areas, (2) provide care
for minorities and (3) treat low-income patients.
As you are aware, Title VII Health Professions Training programs
are focused on improving the quality, geographic distribution and
diversity of the healthcare workforce in order to continue eliminating
disparities in our Nation's healthcare system. These programs provide
training for students to practice in underserved areas, cultivate
interactions with faculty role models who serve in underserved areas,
and provide placement and recruitment services to encourage students to
work in these areas. Health professionals who spend part of their
training providing care for the underserved are up to 10 times more
likely to practice in underserved areas after graduation or program
completion.
In fiscal year 2012, funding for the Title VII Health Professions
Training programs must at the very least be maintained, especially the
funding for the Minority Centers of Excellence (COEs) and Health
Careers Opportunity Program (HCOPs). In addition, the funding for the
National Institutes of Health (NIH)'s National Institute on Minority
Health and Health Disparities (NIMHD), as well as the Department of
Health and Human Services (HHS)'s Office of Minority Health (OMH),
should be preserved.
Minority Centers of Excellence.--COEs focus on improving student
recruitment and performance, improving curricula in cultural
competence, facilitating research on minority health issues and
training students to provide health services to minority individuals.
COEs were first established in recognition of the contribution made by
four historically black health professions institutions to the training
of minorities in the health professions. Congress later went on to
authorize the establishment of ``Hispanic'', ``Native American'' and
``Other'' Historically black COEs. For fiscal year 2012, I recommend a
funding level of $24.602 million for COEs.
Health Careers Opportunity Program (HCOP).--HCOPs provide grants
for minority and non-minority health profession institutions to support
pipeline, preparatory and recruiting activities that encourage minority
and economically disadvantaged students to pursue careers in the health
professions. Many HCOPs partner with colleges, high schools, and even
elementary schools in order to identify and nurture promising students
who demonstrate that they have the talent and potential to become a
health professional. For fiscal year 2012, I recommend a funding level
of $22.133 million for HCOPs.
National Insitutes of Health
Research Centers at Minority Institutions.--The Research Centers at
Minority Institutions program (RCMI), currently administered by the
National Center for Research Resources, has a long and distinguished
record of helping our institutions develop the research infrastructure
necessary to be leaders in the area of health disparities research.
Although NIH has received unprecedented budget increases in recent
years, funding for the RCMI program has not increased by the same rate.
Therefore, the funding for this important program grow at the same rate
as NIH overall in fiscal year 2012.
National Institute on Minority Health and Health Disparities.--The
National Institute on Minority Health and Health Disparities (NIMHD) is
charged with addressing the longstanding health status gap between
minority and nonminority populations. The NIMHD helps health
professions institutions to narrow the health status gap by improving
research capabilities through the continued development of faculty,
labs, and other learning resources. The NIMHD also supports biomedical
research focused on eliminating health disparities and develops a
comprehensive plan for research on minority health at the NIH.
Furthermore, the NIMHD provides financial support to health professions
institutions that have a history and mission of serving minority and
medically underserved communities through the Centers of Excellence
program. For fiscal year 2012, I recommend funded increases
proportional with the funding of the over NIH.
Department of Health and Human Services
Office of Minority Health.--Specific programs at OMH include:
assisting medically underserved communities with the greatest need in
solving health disparities and attracting and retaining health
professionals; assisting minority institutions in acquiring real
property to expand their campuses and increase their capacity to train
minorities for medical careers; supporting conferences for high school
and undergraduate students to interest them in healthcareers, and
supporting cooperative agreements with minority institutions for the
purpose of strengthening their capacity to train more minorities in the
health professions.
The OMH has the potential to play a critical role in addressing
health disparities. For fiscal year 2012, I recommend a funding level
of $65 million for the OMH.
Department of Education
Strengthening Historically Black Graduate Institutions.--The
Department of Education's Strengthening Historically Black Graduate
Institutions (HBGI) program (Title III, Part B, Section 326) is
extremely important to AMHPS. The funding from this program is used to
enhance educational capabilities, establish and strengthen program
development offices, initiate endowment campaigns, and support numerous
other institutional development activities. In fiscal year 2012, an
appropriation of $65 million is suggested to continue the vital support
that this program provides to historically black graduate institutions.
Mr. Chairman, please allow me to express my appreciation to you and
the members of this subcommittee. With your continued help and support,
AMHPS' member institutions and the Title VII Health Professions
Training programs and the historically black health professions schools
can help this country to overcome health disparities. Congress must be
careful not to eliminate, paralyze or stifle the institutions and
programs that have been proven to work. The Association seeks to close
the ever widening health disparity gap. If this subcommittee will give
us the tools, we will continue to work towards the goal of eliminating
that disparity everyday.
Thank you, Mr. Chairman, and I welcome every opportunity to answer
questions for your records.
______
Prepared Statement of the Association of Public Television Stations
On behalf of America's 361 public television stations, we
appreciate the opportunity to submit testimony for the record on the
importance of Federal funding for local public television stations.
Corporation for Public Broadcasting--Fiscal Year 2014 Request: $495
MILLION, 2-YEAR ADVANCE FUNDED
More than 40 years after the inception of public television, local
stations continue to serve as the treasured cultural institutions
envisioned by their founders, reaching America's local communities with
unsurpassed programming and services.
Public broadcasting serves the public good--in education, public
affairs, public safety, cultural affairs and many other areas--and
richly deserves public support. The overwhelming majority of Americans
agree. In a recent bi-partisan poll conducted by Hart Research
Associates/American Viewpoint, nearly 70 percent of American voters,
including majorities of self-identifying Democrats, Independents, and
Republicans, support continued Federal funding for public broadcasting.
In addition, the same poll shows that Americans consider PBS to be the
second most appropriate expenditure of public funds, behind only
national defense. Federal support for CPB and local public television
stations has resulted in a nationwide system of locally owned and
controlled, trusted, community-driven and community responsive media
entities.
Furthermore, the power of digital technology has enabled stations
to greatly expand their delivery platforms to reach Americans where
they are increasingly consuming media--online and on-demand--in
addition to on-air. At the same time that stations are expanding their
services and the impact they have in their communities, stations are
also facing unprecedented funding challenges--presenting them with the
greatest financial hurdles in their 40 year history. Every revenue
source upon which our operations depend is under tremendous pressure.
State funding support is in a wholesale free-fall. Despite serving as a
long-time example of the incredible work that can be accomplished by a
public-private partnership, this model is in peril as the current
economic climate has put immense pressure on private funding sources.
Continued Federal support for public broadcasting is more important now
than ever before.
More than 70 percent of funding appropriated to CPB reaches local
stations in the form of Community Service Grants (CSGs). On average,
Federal spending makes up approximately 15 percent of local television
station's budgets. However, for many smaller and rural stations,
Federal funding represents more than 30-50 percent (and in a handful of
instances, an even larger percentage) of their total budget. For all
stations, this Federal funding is the ``lifeblood'' of public
broadcasting, providing critical seed money to local stations which
leverage each $1 of the Federal investment to raise over $6 from state
legislatures, private foundations and their viewers.
Funding through CPB is absolutely essential to public television
stations. Stations rely on the Federal investment to develop local
programming, operate their facilities, pay their employees and provide
community resources on-air, on-line and on-the-ground. This funding is
particularly important to rural stations who struggle to raise local
funds from individual donors due to the smaller and often economically
strained population base. At the same time it is often more costly to
serve rural areas due to the topography and distances between
communities.
A 2007 GAO report concluded that Federal funding, such as CSGs, is
an irreplaceable source of revenue, and that ``substantial growth of
nonFederal funding appears unlikely.'' It also found that ``cuts in
Federal funding could lead to a reduction in staff, local programming
or services.''
At an annual cost of about $1.39 per year for each American, public
broadcasting is a smart investment. This successful public-private
partnership creates important economic activity while providing an
essential educational and cultural service. Public broadcasting
directly supports over 21,000 jobs, and of the vast majority of them
are in local public television and radio stations in hundreds of
communities across America.
In addition, the advent of digital technology has created enormous
potential for stations, allowing them to bring content to Americans in
new, innovative ways while retaining our public service mission. Public
television stations are now utilizing a wide array of digital tools to
expand their current roles as educators, local conveners and vital
sources of trusted information at a time when their communities need
them most.
For example, in an effort to confront the dropout crisis in
America's high schools, CPB has just announced a significant investment
and partnership with local stations and their communities to address
this daunting problem that could have disastrous effects on America's
future if it is not soon addressed. Together with schools and
organizations that are already addressing the dropout crisis, the
stations will provide their resources and services to raise awareness,
coordinate action with community partners, and work directly with
students, parents, teachers, mentors, volunteers and leaders to lower
the drop-out rate in their respective communities.
In order for our stations to continue playing this vital role in
their communities, APTS and PBS respectfully request $495 million for
CPB, two-year advance funded for fiscal year 2014.
Advance funding is essential to the mission of public broadcasting.
This longstanding practice, which was enacted by President Ford in
1976, allows stations the ability to maximize fundraising efforts to
leverage the promise of Federal dollars for local impact--ensuring the
continuation of this strong public-private partnership. The 2-year
advance funding mechanism also gives stations critical lead time needed
to plan and produce high-quality programs. Additionally, the 2-year
advance funding mechanism insulates programming decisions from
political influence, as President Ford and the Congress intended in
their initial proposal for advance funding.
Ready To Learn--Fiscal Year 2012 Request: $27.3 million (Department of
Education)
The Ready to Learn Television program's success in improving
children's literacy and preparing them for school is proven and
unquestioned.
Ready To Learn combines the power of public media's on-air and
online educational content with on-the-ground local station community
engagement to build the reading skills of children between the ages of
two and eight, especially those from low-income families or those most
lacking reading skills.
Over the last 5 years, 60 independent studies have proven the
effectiveness of the Ready To Learn approach. For example, in one study
pre-schoolers who were exposed to a curriculum composed of programming
and interactive games from top Ready To Learn programs, including SUPER
WHY!, Between the Lions and Sesame Street, outscored children who
received a comparison (science) curriculum in all five measures of
early literacy.
In addition to being research-based and teacher tested, the Ready
To Learn Television program also provides excellent value for our
Federal dollars. In the last five-year grant round, public broadcasting
leveraged an additional $50 million in funding to augment the $73
million investment by the Department of Education for content
production. Without the investment of the Federal Government, this
supplemental investment would likely end.
The President's budget proposes consolidating public broadcasting's
signature early education initiative, the Ready To Learn Television
program, into a larger grant program. APTS and PBS are concerned that
the consolidation of this program could lead to, at worst, the
elimination of this critical program that has been the driving force
behind the creation of public television's unparalleled children's
educational programming. At best, the proposed budget would remove the
mechanisms that have provided for the tremendously efficient and
effective nature in which the Ready To Learn Television program has
successfully operated.
Consolidation or elimination of the Ready To Learn Television
program would severely affect the ability of local stations to respond
to their communities' educational needs, removing the needed resources
provided by this program for children, parents and teachers.
Ready To Learn is public television. This program is a shining
example of a public-private partnership as Federal funds are leveraged
to create the most popular and impactful children's educational content
that is supplemented by on-line and on-the-ground resources. Without
the Ready To Learn Television program, millions of families would lose
access to this incredible high-quality education content, especially
low-income and underserved households for whom this program is
targeted.
We urge the Committee to maintain the Ready To Learn Television
program as a stable line-item in the fiscal year 2012 budget and resist
the calls for consolidation. APTS and PBS respectfully request level
funding of $27.3 million for the Ready To Learn Television program in
fiscal year 2012.
CPB Digital Funding--Fiscal Year 2012 Request: $36 million
Public television stations have been at the forefront of the
digital transition, embracing the technology early and recognizing its
benefits to their viewers. Fortunately, Congress wisely recognized that
the federally mandated transition to digital broadcast would place a
hardship on public television's limited resources. Since 2001, Congress
has provided public television stations with funds to ensure that they
have the ability to continue to meet their public service mission and
deliver the highest quality educational, cultural and public affairs
programming post-transition.
Although the federally mandated portion of the transition is
complete, what remains to be finished is the ability of stations to
fully replicate their analog services in digital. As stations have
completed the transition of their main transmitters, they will continue
to convert their master controls, digital storage equipment and other
studio equipment--necessary to produce and distribute local educational
programming. The CPB Digital program is also critical to providing
funds that can be invested in interactive public media that maximizes
investments in digital infrastructure--including such content
investments as the American Archive.
Public television has used this new public digital spectrum to
maximize programming choices by offering an array of new channel
options, including the national offerings of Vme (the first 24-hour,
Spanish-language, educational channel), World, and Create.
More importantly, stations have also used these multicast
capabilities to expand their local offerings with digital channels
dedicated to community or State-focused programming. Some stations have
even utilized this technology to provide gavel-to-gavel coverage of
their State legislatures. In addition, digital broadcasting has enabled
stations to double the amount of noncommercial, children's educational
programming offered to the American public.
APTS and PBS respectfully request $36 million in CPB Digital
funding for fiscal year 2012 to enable stations to fully leverage this
groundbreaking technology.
______
Prepared Statement of the Association of Rehabilitation Nurses
Introduction
On behalf of the Association of Rehabilitation Nurses (ARN), I
appreciate having the opportunity to submit written testimony to the
Senate L-HHS Appropriations Subcommittee regarding funding for nursing
and rehabilitation related programs in fiscal year 2012. ARN represents
more than 5,700 Registered Nurses (RNs) who work to enhance the quality
of life for those affected by physical disability and/or chronic
illness. ARN understands that Congress has many concerns and limited
resources, but believes that chronic illnesses and physical
disabilities are heavy burdens on our society that must be addressed.
Rehabilitation Nurses and Rehabilitation Nursing
Rehabilitation nurses help individuals affected by chronic illness
and/or physical disability adapt to their condition, achieve their
greatest potential, and work toward productive, independent lives. They
take a holistic approach to meeting patients' nursing and medical,
vocational, educational, environmental, and spiritual needs.
Rehabilitation nurses begin to work with individuals and their families
soon after the onset of a disabling injury or chronic illness. They
continue to provide support and care, including patient and family
education, which empowers these individuals when they return home, or
to work, or school. The rehabilitation nurse often teaches patients and
their caregivers how to access systems and resources.
Rehabilitation nursing is a philosophy of care, not a work setting
or a phase of treatment. These nurses base their practice on
rehabilitative and restorative principles by: (1) managing complex
medical issues; (2) collaborating with other specialists; (3) providing
ongoing patient/caregiver education; (4) setting goals for maximum
independence; and (5) establishing plans of care to maintain optimal
wellness. Rehabilitation nurses practice in all settings, including
freestanding rehabilitation facilities, hospitals, long-term subacute
care facilities/skilled nursing facilities, long-term acute care
facilities, comprehensive outpatient rehabilitation facilities, home
health, and private practices, just to name a few.
With the Affordable Care Act's focus on creating a system that will
increase access to quality care, emphasize prevention, and decrease
cost, it is critical that a substantial investment be made in the
nursing workforce programs and in the scientific research that provides
the basis for nursing practice. To ensure that patients receive the
best quality care possible, ARN supports Federal programs and research
institutions that address the national nursing shortage and conduct
research focused on nursing and medical rehabilitation, e.g., traumatic
brain injury. Therefore, ARN respectfully requests that the
Subcommittee provide increased funding for the following programs:
Nursing Workforce and Development Programs at the Health
Resources and Services Administration (HRSA)
ARN supports efforts to resolve the national nursing shortage,
including appropriate funding to address the shortage of qualified
nursing faculty. Rehabilitation nursing requires a high-level of
education and technical expertise, and ARN is committed to assuring and
protecting access to professional nursing care delivered by highly-
educated, well-trained, and experienced Registered Nurses (RNs) for
individuals affected by chronic illness and/or physical disability.
According to the Health Resources and Services Administration
(HRSA), in 2010, our healthcare workforce experienced a shortage of
more than 400,000 nurses.\1\ The demand for nurses will continue to
grow as the baby-boomer population ages, nurses retire, and the need
for healthcare intensifies. Implementation of the new health reform law
will also increase the need for a well-trained and highly skilled
nursing workforce. The Institute of Medicine has released
recommendations on how to help the nursing workforce to meet these new
demands, but we are destined to fall short of these lofty goals if
there are not enough nurses to facilitate change.
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\1\ http://bhpr.hrsa.gov/healthworkforce/reports/nursing/
rnbehindprojections/4.htm.
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According to the U.S. Bureau of Labor Statistics, nursing is the
Nation's top profession in terms of projected job growth, with more
than 581,500 new nursing positions being created through 2018.\2\ These
positions are in addition to the existing jobs that healthcare
employers have not been able to fill. Educating new nurses to fill
these gaping vacancies is a great way to put Americans back to work and
simultaneously enhance an ailing healthcare system.
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\2\ http://www.bls.gov/oco/ocos083.htm#outlook.
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ARN strongly supports the national nursing community's request of
$313.075 million in fiscal year 2012 funding for Federal Nursing
Workforce Development programs at HRSA.
National Institute on Disability and Rehabilitation
Research (NIDRR)
The National Institute on Disability and Rehabilitation Research
(NIDRR) provides leadership and support for a comprehensive program of
research related to the rehabilitation of individuals with
disabilities. As one of the components of the Office of Special
Education and Rehabilitative Services at the U.S. Department of
Education, NIDRR operates along with the Rehabilitation Services
Administration and the Office of Special Education Programs.
The mission of NIDRR is to generate new knowledge and promote its
effective use to improve the abilities of people with disabilities to
perform activities of their choice in the community, and also to expand
society's capacity to provide full opportunities and accommodations for
its citizens with disabilities. NIDRR conducts comprehensive and
coordinated programs of research and related activities to maximize the
full inclusion, social integration, employment and independent living
of individuals of all ages with disabilities. NIDRR's focus includes
research in areas such as: employment, health and function, technology
for access and function, independent living and community integration,
and other associated disability research areas.
ARN strongly supports the work of NIDRR and encourages Congress to
provide the maximum possible fiscal year 2012 funding level.
National Institute of Nursing Research (NINR)
ARN understands that research is essential for the advancement of
nursing science, and believes new concepts must be developed and tested
to sustain the continued growth and maturation of the rehabilitation
nursing specialty. The National Institute of Nursing Research (NINR)
works to create cost-effective and high-quality healthcare by testing
new nursing science concepts and investigating how to best integrate
them into daily practice. Through grants, research training, and
interdisciplinary collaborations, NINR addresses care management of
patients during illness and recovery, reduction of risks for disease
and disability, promotion of healthy lifestyles, enhancement of quality
of life for those with chronic illness, and care for individuals at the
end of life. NINR's broad mandate includes seeking to prevent and delay
disease and to ease the symptoms associated with both chronic and acute
illnesses. NINR's recent areas of research focus include the following:
End of life and palliative care in rural areas; research in multi-
cultural societies; bio-behavioral methods to improve outcomes
research; and increasing health promotion through comprehensive
studies.
ARN respectfully requests $163 million in fiscal year 2012 funding
for NINR to continue its efforts to address issues related to chronic
and acute illnesses.
Traumatic Brian Injury (TBI)
According to the Brain Injury Association of America, 1.7 million
people sustain a traumatic brain injury (TBI) each year.\3\ This figure
does not include the 150,000 cases of TBI suffered by soldiers
returning from wars in Afghanistan and conflicts around the world.
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\3\ http://www.biausa.org/living-with-brain-injury.htm.
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The annual national cost of providing treatment and services for
these patients is estimated to be nearly $60 million in direct care and
lost workplace productivity. Continued fiscal support of the Traumatic
Brain Injury Act will provide critical funding needed to further
develop research and improve the lives of individuals who suffer from
traumatic brain injury.
Continued funding of the TBI Act will promote sound public health
policy in brain injury prevention, research, education, treatment, and
community-based services, while informing the public of needed support
for individuals living with TBI and their families.
ARN strongly supports the current work being done by the Centers
for Disease Control and Prevention (CDC) and HRSA on TBI programs.
These programs contribute to the overall body of knowledge in
rehabilitation medicine.
ARN urges Congress to support the following fiscal year 2012
funding requests for programs within the TBI Act: $10 million for CDC's
TBI registries and surveillance, prevention and national public
education and awareness efforts; $8 million for the HRSA Federal TBI
State Grant Program; and $4 million for the HRSA Federal TBI Protection
and Advocacy Systems Grant Program.
Conclusion
ARN appreciates the opportunity to share our priorities for fiscal
year 2012 funding levels for nursing and rehabilitation programs. ARN
maintains a strong commitment to working with Members of Congress,
other nursing and rehabilitation organizations, and other stakeholders
to ensure that the rehabilitation nurses of today continue to practice
tomorrow. By providing the fiscal year 2012 funding levels detailed
above, we believe the Subcommittee will be taking the steps necessary
to ensure that our Nation has a sufficient nursing workforce to care
for patients requiring rehabilitation from chronic illness and/or
physical disability.
______
Prepared Statement of the Brain Injury Association of America
Thank you for the opportunity to submit this written testimony with
regard to the fiscal year 2012 Labor-HHS-Education appropriations bill.
My testimony is on behalf of the Brain Injury Association of America
(BIAA), our national network of State affiliates, and hundreds of local
chapters and support groups from across the country.
In the civilian population alone every year, more than 1.7 million
people sustain brain injuries from falls, car crashes, assaults and
contact sports. Males are more likely than females to sustain brain
injuries. Children, teens and seniors are at greatest risk.
Recently, we are seeing an increasing number of service members
returning from the conflicts in Iraq and Afghanistan with TBI, which
has been termed one of the signature injuries of the war. Many of these
returning service members are undiagnosed or misdiagnosed and
subsequently they and their families will look to community and local
resources for information to better understand TBI and to obtain vital
support services to facilitate successful reintegration into the
community.
For the past 13 years Congress has provided minimal funding through
the HRSA Federal TBI Program to assist States in developing services
and systems to help individuals with a range of service and family
support needs following their loved one's brain injury. Similarly, the
grants to State Protection and Advocacy Systems to assist individuals
with traumatic brain injuries in accessing services through education,
legal and advocacy remedies are woefully underfunded. Rehabilitation,
community support and long-term care systems are still developing in
many States, while stretched to capacity in others. Additional numbers
of individuals with TBI as the result of war-related injuries only adds
more stress to these inadequately funded systems.
BIAA respectfully urges you to provide States with the resources
they need to address both the civilian and military populations who
look to them for much needed support in order to live and work in their
communities.
With broader regard to all of the programs authorized through the
TBI Act, BIAA specifically requests:
--$10 million (+$4 million) for the Centers for Disease Control and
Prevention TBI Registries and Surveillance, Brain Injury Acute
Care Guidelines, Prevention and National Public Education/
Awareness
--$8 million (+$1 million) for the Health Resources and Services
Administration (HRSA) Federal TBI State Grant Program
--$4 million (+$1 million) for the HRSA Federal TBI Protection &
Advocacy (P&A) Systems Grant Program
CDC--National Injury Center.--The Centers for Disease Control and
Prevention's National Injury Center is responsible for assessing the
incidence and prevalence of TBI in the United States. The CDC estimates
that 1.7 million TBIs occur each year and 3.4 million Americans live
with a life-long disability as a result of TBI. In addition, the TBI
Act as amended in 2008 requires the CDC to coordinate with the
Departments of Defense and Veterans Affairs to include the number of
TBIs occurring in the military. This coordination will likely increase
CDC's estimate of the number of Americans sustaining TBI and living
with the consequences.
CDC also funds States for TBI registries, creates and disseminates
public and professional educational materials, for families, caregivers
and medical personnel, and has recently collaborated with the National
Football League and National Hockey League to improve awareness of the
incidence of concussion in sports. CDC plays a leading role in helping
standardize evidence based guidelines for the management of TBI and $1
million of this request would go to fund CDC's work in this area.
HRSA TBI State Grant Program.--The TBI Act authorizes the HHS,
Health Resources and Service Administration (HRSA) to award grants to
(1) States, American Indian Consortia and territories to improve access
to service delivery and to (2) State Protection and Advocacy (P&A)
Systems to expand advocacy services to include individuals with
traumatic brain injury. For the past 13 years the HRSA Federal TBI
State Grant Program has supported State efforts to address the needs of
persons with brain injury and their families and to expand and improve
services to underserved and unserved populations including children and
youth; veterans and returning troops; and individuals with co-occurring
conditions
In fiscal year 2009, HRSA reduced the number of State grant awards
to 15, in order to increase each monetary award from $118,000 to
$250,000. This means that many States that had participated in the
program in past years have now been forced to close down their
operations, leaving many unable to access brain injury care.
Increasing the program to $8 million will provide funding necessary
to sustain the grants for the 15 States currently receiving funding
along with the 3 additional States added this year and to ensure
funding for 4 additional States. Steady increases over 5 years for this
program will provide for each State including the District of Columbia
and the American Indian Consortium and territories to sustain and
expand State service delivery; and to expand the use of the grant funds
to pay for such services as Information & Referral (I&R), systems
coordination and other necessary services and supports identified by
the State.
HRSA TBI P&A Program.--Similarly, the HRSA TBI P&A Program
currently provides funding to all State P&A systems for purposes of
protecting the legal and human rights of individuals with TBI. State
P&As provide a wide range of activities including training in self-
advocacy, outreach, information and referral and legal assistance to
people residing in nursing homes, to returning military seeking
veterans benefits, and students who need educational services.
Effective Protection and Advocacy services for people with
traumatic brain injury is needed to help reduce Government expenditures
and increase productivity, independence and community integration.
However, advocates must possess specialized skills, and their work is
often time-intensive. A $4 million appropriation would ensure that each
P&A can move toward providing a significant PATBI program with
appropriate staff time and expertise.
NIDRR TBI Model Systems of Care.--Funding for the TBI Model Systems
in the Department of Education is urgently needed to ensure that the
Nation's valuable TBI research capacity is not diminished, and to
maintain and build upon the 16 TBI Model Systems research centers
around the country.
The TBI Model Systems of Care program represents an already
existing vital national network of expertise and research in the field
of TBI, and weakening this program would have resounding effects on
both military and civilian populations. The TBI Model Systems are the
only source of non-proprietary longitudinal data on what happens to
people with brain injury. They are a key source of evidence-based
medicine, and serve as a ``proving ground'' for future researchers.
In order to make this program more comprehensive, Congress should
provide $11 million (+$1.5 million) in fiscal year 2011 for NIDRR's TBI
Model Systems of Care program, in order to add one new Collaborative
Research Project. In addition, given the national importance of this
research program, the TBI Model Systems of Care should receive ``line-
item'' status within the broader NIDRR budget.
We ask that you consider favorably these requests for the CDC, the
HRSA Federal TBI Program, and the NIDRR TBI Model Systems Program to
further data collection, increase public awareness, improve medical
care, assist States in coordinating services, protect the rights of
persons with TBI, and bolster vital research.
______
Prepared Statement of the CAEAR Coalition
On behalf of the tens of thousands of individuals living with HIV/
AIDS to whom members of the Communities Advocating Emergency AIDS
Relief (CAEAR) Coalition provide care, I thank Chairman Harkin and
Ranking Member Shelby for affording us the opportunity to submit
testimony regarding increased funding for the Ryan White HIV/AIDS
Program.
The Communities Advocating Emergency AIDS Relief (CAEAR) Coalition
is a national membership organization which advocates for sound Federal
policy, program regulations, and sufficient appropriations to meet the
care, treatment, support service and prevention/wellness needs of
people living with HIV/AIDS and the organizations that serve them,
focusing on ensuring access to high quality healthcare and the evolving
role of the Ryan White Program.
A Wise Investment in a Program That Works
The Ryan White Program works. In its Program Assessment Rating Tool
(PART), the White House Office of Management and Budget (OMB) gave the
Ryan White Program its highest possible rating of ``effective''--a
distinction shared by only 18 percent of all programs rated. According
to OMB, effective programs ``set ambitious goals, achieve results, are
well-managed and improve efficiency.'' Even more impressively, OMB's
assessment of the Ryan White Program found it to be in the top 1
percent of all Federal programs in the area of ``Program Results and
Accountability.'' Out of the 1,016 Federal programs rated--98 percent
of all Federal programs--the Ryan White Program was one of seven that
received a score of 100 percent in ``Program Results and
Accountability.''
The Ryan White Program serves as the indispensable safety net for
thousands of low-income, uninsured or underinsured people living with
HIV/AIDS.
--Part A provides much-needed funding to the 52 major metropolitan
areas hardest hit by the HIV/AIDS epidemic with severe needs
for additional resources to serve those living with HIV disease
in their communities.
--Part B assists States and territories in improving the quality,
availability, and organization of healthcare and support
services for individuals and families with HIV.
--The AIDS Drug Assistance Program (ADAP) in Part B provides life-
saving, urgently needed medications to people living with HIV/
AIDS in all 50 States and the territories.
--Part C provides grants to 349 faith- and community-based primary
care health clinics and public health providers in 49 States,
Puerto Rico and the District of Columbia. These clinics play a
central role in the delivery of HIV-related medical services to
underserved communities, people of color, and rural areas where
Part C funded clinics provide the only HIV specific medical
services available in the region.
--Part F AETC supports training for healthcare providers to identify,
counsel, diagnose, treat, and manage individuals with HIV
infection and to help prevent high-risk behaviors that lead to
infection. It has 130 program sites with coverage in all 50
States.
CAEAR Coalition's fiscal year 2012 funding requests for Part A,
Part B base and ADAP, and Part C reflect the amounts authorized by
Congress in the most recent authorization of the program.
There continues to be an increasing gap between the number of
people living with HIV/AIDS in the United States in need of care and
the Federal resources available to serve them. Between 2001 and 2008
the number of people living with AIDS grew 35 percent and yet funding
for medical care and support services in communities with the greatest
burden of HIV disease grew less than 12 percent between 2001 and 2011.
Similarly, funding for Part C-funded, faith and community-based primary
care clinics, which provide medical care for people living with HIV/
AIDS in remote, rural and geographically isolated, urban communities
nationwide, grew by only 11 percent between 2001 and 2011 as the number
of people they care for grew by 52 percent. The authorized amounts we
request would not fully address these funding deficiencies, but would
begin to reduce the still growing gaps in funding.
We thank you in advance for your consideration of our comments and
our request for:
--$751.9 million for Part A to support grants to the cities where
most people with HIV/AIDS live and receive their care and
treatment.
--$495 million for Part B base to provide additional needed resources
to the States to bolster the public health response statewide
regardless of location.
--$991 million in funding for the ADAP line item in Part B so
uninsured and underinsured people with HIV/AIDS can access the
anti-HIV and other prescribed medications they need to survive.
--$272.2 million for Part C to support grants to faith- and
community-based organizations, healthcare agencies, and
clinics.
--$50 million to fund the 11 regional centers funded under by Part F
AETC to offer specialized clinical education and consultation
to frontline providers.
Sufficient Funding for Ryan White Programs Saves Money and Saves Lives
Increased funding for Ryan White Programs will reap a significant
health return for minimal investment. Data show that Part A and Part C
programs have reduced HIV-related hospital admissions by 30 percent
nationally and by up to 75 percent in some locations. The programs
supported by the Ryan White HIV/AIDS Program also have been critical in
reducing AIDS mortality by 70 percent. The Ryan White Program works,
resulting in both economic stimulus and social savings by helping keep
people, stable, healthy and productive.
Growing Needs as More Tested and Entering Care
The Centers for Disease Control and Prevention (CDC) estimates that
as of 2006 there were 1,106,400 persons living with HIV/AIDS in the
United States. Approximately one-half were not in care and receiving
treatment. New CDC recommendations for routine HIV testing have
increased the influx of newly diagnosed individuals into care, but with
56,000 newly diagnosed individuals per year, the Federal resources have
not kept pace with the burgeoning need.
The fiscal year 2012 appropriation presents a crucial opportunity
to provide the Ryan White Program with the levels of funding needed to
address a growing epidemic in young men, as the CDC continues to
increase efforts to expand HIV testing so people living with HIV know
their status, control their health, and protect others.
CAEAR Coalition supports efforts to help individuals infected with
HIV learn their status at the earliest possible time. However, CAEAR
Coalition is concerned about the unmet demand for services created by
insufficient resources at the Federal level. Researchers estimate that
CDC's expanded HIV testing guidelines will bring an additional 46,000
people into care over 5 years and significantly reduce the 21 percent
of people living with HIV who do not know they are infected and
therefore are not in care. Bringing these individuals into care will
save large sums of money in the long run, but requires an initial
investment now. Research clearly shows that averting a single HIV
infection saves $221,365 in lifetime healthcare costs \1\, and getting
people on anti-HIV treatment early lowers levels of HIV circulating in
the body and reduces potential transmissions \2\--saving lives and
money in the long term--but we must invest now in care and treatment to
reap those rewards. Caring for individuals early in their disease will
increase the cost of care by $2.7 billion over 5 years and the majority
of those costs will fall to Federal discretionary programs like the
Ryan White Program and will not be offset by entitlement programs.\3\
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\1\ Holtgrave DR, Briddell K, Little E, Bendixen AV, Hooper M,
Kidder DP, et al. Cost and threshold analysis of housing as an HIV
prevention intervention. AIDS & Behavior.(2007)11(Suppl 2), S162-S166.
\2\ Montaner J, Lima VD, Barrios R, et al. Association of highly
active antiretroviral therapy coverage, population viral load, and
yearly new HIV diagnoses in British Columbia, Canada: a population-
based study. The Lancet (2010) 376(9740): 532-539.
\3\ Martin EG, Paltiel AD, Walensky, RP, Schackman BR, Expanded HIV
Screening in the United States: What Will It Cost Government
Discretionary and Entitlement Programs? A Budget Impact Analysis. Value
in Health (2010) 13: 893--902.
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Community-based providers are stretched to provide high-quality
care with the scarce resources available. CAEAR Coalition is concerned
that many HIV expert medical staff are scheduled to retire and the
persistent financial pressures may accelerate the loss of trained
professionals in the field. This additional pressure on an already
overburdened system will leave many of the more than 200,000 HIV-
infected individuals who do not know their HIV status without access to
the care they need.
State budget cuts have created a continuing and growing ADAP
funding crisis as a record number of people are in need of ADAP
services due to the economic downturn. As of May 2011, there are 8,100
people on ADAP waiting lists in 13 States. Additionally, ADAP waiting
lists and other cost-containment measures, including limited
formularies, reducing eligibility, or removing already enrolled people
from the program, are clear evidence that the need for HIV-related
medications continues to outstrip availability. ADAPs are forced to
make difficult trade-offs between serving a greater number of people
living with HIV/AIDS with fewer services or serving fewer people with
more services. Additional resources are needed to reduce and prevent
further use of cost-containment measures to limit access to ADAPs and
to allow all State ADAPs to provide a full range of HIV antiretrovirals
and treatment for opportunistic infections.
The number of clients entering the 349 Part C community health
centers and outpatient clinics has consistently increased over the last
5 years. Over 247,000 unduplicated persons living with HIV/AIDS receive
medical care in Part C-funded community health centers and clinics each
year. These faith- and community-based HIV/AIDS providers are
staggering under the burden of treatment and care after years of
funding cuts prior to the modest increase in recent years. The success
of the CDC's routine HIV testing recommendations has generated new
clients for Part C-funded health centers and clinics too, but
unfortunately with no increase in funding to provide the high quality
healthcare services and treatment access people with HIV/AIDS require.
Ryan White-Funded Programs are Economic Engines in their Communities
Ryan White--funded programs, including many community health
centers, are small businesses providing jobs, vendor contracts and
other types of economic development to low-income, urban and rural
communities, frequently serving as anchors for existing and new
businesses and investments. These organizations employ people in their
communities, providing critical entry-level jobs, community-based
training and career building.
For example, a large, urban community health center brings an
estimated economic impact of $21.6 million, employing 281 people, and a
small, rural health center has an estimated economic impact of $3.9
million, employing 52 people. Investing in AIDS care and treatment is
an investment in jobs and community development in communities that
need it most.
Ryan White Program Key to Meeting the Goals of the National HIV/AIDS
Strategy
CAEAR Coalition is eager to work with Congress to meet the
challenges posed by the HIV/AIDS epidemic. In 2012, we have the
collective chance to implement the community-embraced healthcare goals
and policies in the National HIV/AIDS Strategy (NHAS). The National
Strategy is an opportunity to reinvigorate the Nation's response to the
HIV/AIDS epidemic and stop its relentless movement into our
communities. The Ryan White HIV/AIDS Program is key to reaching the
NHAS goals of reducing new HIV infections, increasing access to care
and improving health outcomes for people living with HIV/AIDS, and
reducing HIV-related health disparities. Ryan White provides HIV/AIDS
care and treatment services to a significantly higher proportion of
racial/ethnic minorities and women than their representation among
reported AIDS cases--suggesting the programs and resources are targeted
to underserved and marginalized populations. Early care and treatment
are more critical than ever because we can help those infected learn
their status and get into care and treatment in order to improve their
own health and the health of their communities.
The Ryan White Program's history of accomplishments for public
health and people living with HIV/AIDS is a wonderful legacy for the
U.S. Congress. There continues to be a vast need for additional
resources to address the healthcare and treatment needs of people
living with HIV across the country. In recognition of its high level of
effectiveness and validation over time from credible Federal Government
institutions, CAEAR urges the committee to provide the Ryan White HIV/
AIDS Program with the funding levels authorized by Congress for fiscal
year 2012.
______
Prepared Statement of the Centers for Disease Control and Prevention
(CDC) Coalition
The CDC Coalition is a nonpartisan coalition of more than 140
organizations committed to strengthening our Nation's prevention
programs. Our mission is to ensure that health promotion and disease
prevention are given top priority in Federal funding, to support a
funding level for the Centers for Disease Control and Prevention (CDC)
that enables it to carry out its prevention mission, and to assure an
adequate translation of new research into effective State and local
programs. Coalition member groups represent millions of public health
workers, clinicians, researchers, educators, and citizens served by CDC
programs.
The CDC Coalition believes that Congress should support CDC as an
agency--not just the individual programs that it funds. In the best
judgment of the CDC Coalition--given the challenges and burdens of
chronic disease, a potential influenza pandemic, terrorism, disaster
preparedness, new and reemerging infectious diseases and our many unmet
public health needs and missed prevention opportunities--we believe the
agency will require funding of at least $7.7 billion for CDC's ``core
programs'' in fiscal year 2012. This request represents a 36 percent
increase over fiscal year 2011 and a 31 percent increase over the
President's fiscal year 2012 request. We are deeply disappointed with
the more than $740 million in cuts to CDC's budget authority included
in the proposed fiscal year 2011 continuing resolution (CR). While CDC
programs will receive significant new funding from the Prevention and
Public Health Fund in fiscal year 2011, we are concerned that this
funding would essentially supplant cuts made to CDC's budget authority.
As you know the Prevention and Public Health Fund was intended to
supplement and not supplant the base funding of our public health
agencies and programs.
By translating research findings into effective intervention
efforts, CDC has been a key source of funding for many of our State and
local programs that aim to improve the health of communities. Perhaps
more importantly, Federal funding through CDC provides the foundation
for our State and local public health departments, supporting a trained
workforce, laboratory capacity and public health education
communications systems.
CDC also serves as the command center for our Nation's public
health defense system against emerging and reemerging infectious
diseases. With the potential onset of a worldwide influenza pandemic,
in addition to the many other natural and man-made threats that exist
in the modern world, the CDC has become the Nation's--and the world's--
expert resource and response center, coordinating communications and
action and serving as the laboratory reference center. States and
communities rely on CDC for accurate information and direction in a
crisis or outbreak.
The Multiple Roles of CDC
CDC serves as the lead agency for bioterrorism and other public
health emergency preparedness and must receive sustained support for
its preparedness programs in order for our Nation to meet future
challenges. Given the challenges of terrorism and disaster
preparedness, and our many unmet public health needs and missed
prevention opportunities we urge you to provide adequate funding for
State and local capacity grants. We ask the Subcommittee to ensure that
our States and local communities are prepared in the event of an act of
terrorism or other public health threat this year and in future years.
Unfortunately, this is not a threat that is going away.
Addressing the Leading Causes of Death and Disability
The President's fiscal year 2012 budget proposes to consolidate a
number of chronic disease programs within CDC. Members of the CDC
Coalition are currently engaged in conversations with CDC and members
of Congress to better understand what this consolidation will mean for
the funding that is passed on to our State and local health and
education agencies and the various programs our members have supported
in the past. We look forward to working with Congress, the
administration and CDC to ensure that any effort to consolidate
programs leads to the best health outcomes for the American people. We
must ensure that CDC's National Center for Chronic Disease Prevention
and Health Promotion has the resources it needs to assist our States
and communities in their efforts to reduce the burden of chronic
disease.
Heart disease remains the Nation's No. 1 killer. In 2007, over
616,000 people in the United States died from heart disease, accounting
for nearly 25 percent of all U.S. deaths. More women than men die of
heart disease each year, and in 2007, females had higher rates of
inpatient heart attack mortality than males. Stroke is the third
leading cause of death and is a leading cause of disability. In 2007,
stroke killed more than 135,000 people (61 percent of them women),
accounting for about 1 of every 18 deaths.
Cancer is the second most common cause of death in the United
States. There were an estimated 1,529,560 new cancer cases and 569,490
deaths from cancer in 2010. The financial cost of cancer is also
significant. According to the National Institutes of Health (NIH), in
2008 the overall cost for cancer in the United States was more than
$228.1 billion: $93.2 billion for direct medical costs, $18.8 billion
for lost worker productivity due to illness, and $116.1 billion for
lost worker productivity due to premature death.
Among the ways CDC is fighting cancer, is through funding the
National Breast and Cervical Cancer Early Detection Program that helps
low-income, uninsured and medically underserved women gain access to
lifesaving breast and cervical cancer screenings and provides a gateway
to treatment upon diagnosis. CDC also funds grants to States to develop
Comprehensive Cancer Control (CCC) plans, bringing together a broad
partnership of public and private stakeholders to set joint priorities
and implement specific cancer prevention and control activities
customized to address each State's particular needs.
Although more than 25.8 million Americans have diabetes, nearly 7
million cases are undiagnosed. In 2010, about 1.9 million people aged
20 years or older were newly diagnosed with diabetes. Diabetes is the
leading cause of kidney failure, nontraumatic lower-limb amputations,
and new cases of blindness among adults in the United States. The total
direct and indirect costs associated with diabetes were $178 billion in
2007. Preventive care such as routine eye and foot examinations, self-
monitoring of blood glucose, and glycemic control could reduce these
numbers.
Over the last 25 years, obesity rates have doubled among adults and
children, and tripled in teens. Obesity, diet and inactivity are cross-
cutting risk factors that contribute significantly to heart disease,
cancer, stroke and diabetes. CDC funds programs to encourage the
consumption of fruits and vegetables, encourage sufficient exercise,
and to develop other habits of healthy nutrition and activity.
An estimated 443,000 people die prematurely every year due to
tobacco use. CDC's tobacco control efforts seek to prevent tobacco
addition in the first place, as well as help those who want to quit. We
must continue to support these vital programs and reduce tobacco use in
the United States.
Each day more than 3,900 young people initiate cigarette smoking.
At the same time, according to CDC, only 3.8 percent of elementary
schools, 7.9 percent of middle schools and 2.1 percent of high schools
provide daily physical education or its equivalent for the entire
school year. Almost 90 percent of young people do not eat the
recommended number of servings of fruits and vegetables, while nearly
30 percent of young people are overweight or at risk of becoming
overweight. And every year, almost 800,000 adolescents become pregnant
and nearly 4 million teens are infected with a sexually transmitted
disease. CDC plays a critical role in ensuring good public health and
health promotion in our schools.
CDC provides national leadership in helping control the HIV
epidemic by working with community, State, national, and international
partners in surveillance, research, prevention and evaluation
activities. CDC estimates that about 1.1 million Americans are living
with HIV, 21 percent of who are undiagnosed. Also, the number of people
living with HIV is increasing, as new drug therapies are keeping HIV-
infected persons healthy longer and dramatically reducing the death
rate. Prevention of HIV transmission is the best defense against the
AIDS epidemic that has already killed more than 617,000 in the United
States and dependant areas and is devastating populations around the
globe.
The United States has the highest rates of sexually transmitted
diseases (STDs) in the industrialized world. More than 19 million new
infections occur each year, almost half of them among young people. CDC
estimates that STDs, including HIV, cost the U.S. healthcare system as
much as $15.3 billion annually. Over the past several years,
significant ground has been lost in the fight against STDs. While
syphilis was on the verge of elimination in the United States at the
start of the decade, rates have increased by 114 percent since 2000. An
adequate investment in STD prevention could save millions in annual
healthcare costs in the future.
CDC and its National Center for Health Statistics collect data on
chronic disease prevalence, health disparities, emergency room use,
teen pregnancy, infant mortality and causes of death. The health data
collected through the Behavioral Risk Factor Surveillance System, Youth
Risk Behavior Survey, Youth Tobacco Survey, National Vital Statistics
System, and National Health and Nutrition Examination Survey are an
essential part of the Nation's statistical and public health
infrastructure. Adequate funding for these activities is essential for
tracking America's health as a nation and developing targeted and
appropriate public health policies and prevention interventions.
We must address the growing disparity in the health of racial and
ethnic minorities. CDC is helping States address serious disparities in
infant mortality, breast and cervical cancer, cardiovascular disease,
diabetes, HIV/AIDS and immunizations. Our members are committed to
ending the disparities and we encourage the Subcommittee to provide
adequate funds for these efforts.
CDC oversees immunization programs for children, adolescents and
adults, and is a global partner in the ongoing effort to eradicate
polio worldwide. The value of adult immunization programs to improve
length and quality of life, and to save healthcare costs, is realized
through a number of CDC programs, but there is much work to be done and
a need for sound funding to achieve our goals. Influenza vaccination
levels remain low for adults. Levels are substantially lower for
pneumococcal vaccination and significant racial and ethnic disparities
in vaccination levels persist among the elderly. In addition,
developing functional immunization registries in all States will be
less costly in the long run than maintaining the incomplete systems
currently in place.
Childhood immunizations provide one of the best returns on
investment of any public health program. For every dollar spent on
seven vaccines recommended in the childhood series, $16.50 is saved in
direct and indirect costs. An estimated 14 million cases of childhood
disease and 33,000 deaths are prevented each year through timely
immunization. Despite the incredible success of the program, it faces
serious financial challenges.
Injuries are the leading causes of death for persons aged 1-44
years. Unintentional injuries and violence such as older adult falls,
unintentional drug poisonings, child maltreatment and sexual violence
accounts for over 35 percent of emergency department visits annually.
Annually, injury and violence cost the United States approximately $406
billion in direct and indirect medical costs including lost
productivity. Unintentional injury consistently remains the leading
cause of death among young Americans ages 1-34 with 37.1 percent of
unintentional fatal injuries caused by motor vehicle traffic
fatalities. Conversely, violence related injuries are also substantial
with homicide being the second leading cause of death for persons 15-24
years, while suicide is the 11th leading cause of death across all age
groups. The consequences of these injuries can be far reaching from
physical, emotional, financial turmoil to long term disability. CDC's
Injury Center works to prevent unintentional and violence-related
injuries to minimize the consequences of injuries when they occur by
researching the problem; identifying the risk and protective factors;
developing and testing interventions; ensuring widespread adoption of
proven strategies and gathering data to assist States and communities
to develop prevention programs and practices through the use of
surveillance systems like the National Violent Death Reporting System.
One in every 33 babies born each year in the United States is born
with one or more birth defects. Birth defects are the leading cause of
infant mortality. Children with birth defects who survive often
experience lifelong physical and mental disabilities. More than 50
million people in the United States currently live with a disability,
and 17 percent of children under the age of 18 have a developmental
disability. The National Center on Birth Defects and Developmental
Disabilities at CDC conducts programs to protect and improve the health
of children and adults by preventing birth defects and developmental
disabilities; promoting optimal child development and health and
wellness among children and adults with disabilities.
We also encourage the Subcommittee to provide adequate funding for
CDC's Center for Environmental Health to revitalize environmental
public health services at the national, State and local level and
sustain current programs. These services are essential to protecting
and ensuring the health and well being of the American public from
threats associated with West Nile virus, climate change, terrorism, E.
coli, lead-based paint and other hazards.
We appreciate the Subcommittee's past support for CDC programs in a
climate of competing priorities. We thank you for considering our
fiscal year 2012 request for $7.7 billion for CDC's ``core programs.''
______
Prepared Statement of the Charles R. Drew University of Medicine and
Science
Mr. Chairman and members of the Subcommittee, thank you for the
opportunity to present you with testimony. The Charles Drew University
is distinctive in being the only dually designated Historically Black
Graduate Institution and Hispanic Serving Institution in the Nation. We
would like to thank you, Mr. Chairman, for the support that this
subcommittee has given to our University to produce minority health
professionals to eliminate health disparities as well as do
groundbreaking research to save lives.
The Charles Drew University is located in the Watts-Willowbrook
area of South Los Angeles. Its mission is to prepare predominantly
minority doctors and other health professionals to care for underserved
communities with compassion and excellence through education, clinical
care, outreach, pipeline programs and advanced research that makes a
rapid difference in clinical practice. The Charles Drew University has
established a national reputation for translational research that
addresses the health disparities and social issues that strike hardest
and deepest among urban and minority populations.
Health Resources and Services Administration
Title VII Health Professions Training Programs.--The health
professions training programs administered by the Health Resources and
Services Administration (HRSA) are the only Federal initiatives
designed to address the longstanding under representation of minorities
in healthcareers. HRSA's own report, ``The Rationale for Diversity in
the Health Professions: A Review of the Evidence,'' found that minority
health professionals disproportionately serve minority and other
medically underserved populations, minority populations tend to receive
better care from practitioners of their own race or ethnicity, and non-
English speaking patients experience better care, greater comprehension
and greater likelihood of keeping follow-up appointments when they see
a practitioner who speaks their language. Studies have also
demonstrated that when minorities are trained in minority health
professions institutions, they are significantly more likely to: (1)
serve in medically underserved areas, (2) provide care for minorities
and (3) treat low-income patients.
Minority Centers of Excellence.--The purpose of the COE program is
to assist schools, like Charles Drew University, that train minority
health professionals, by supporting programs of excellence. The COE
program focuses on improving student recruitment and performance;
improving curricula and cultural competence of graduates; facilitating
faculty and student research on minority health issues; and training
students to provide health services to minority individuals by
providing clinical teaching at community-based health facilities. For
fiscal year 2012, the funding level for COE should be $24.602 million.
Health Careers Opportunity Program.--Grants made to health
professions schools and educational entities under HCOP enhance the
ability of individuals from disadvantaged backgrounds to improve their
competitiveness to enter and graduate from health professions schools.
HCOP funds activities that are designed to develop a more competitive
applicant pool through partnerships with institutions of higher
education, school districts, and other community based entities. HCOP
also provides for mentoring, counseling, primary care exposure
activities, and information regarding careers in a primary care
discipline. Sources of financial aid are provided to students as well
as assistance in entering into health professions schools. For fiscal
year 2012, the HCOP funding level of $22.133 million is recommended.
National Institutes of Health
National Institute on Minority Health and Health Disparities.--The
NIMHD is charged with addressing the longstanding health status gap
between under-represented minority and non minority populations. The
NIMHD helps health professional institutions to narrow the health
status gap by improving research capabilities through the continued
development of faculty, labs, telemedicine technology and other
learning resources. The NIMHD also supports biomedical research focused
on eliminating health disparities and developed a comprehensive plan
for research on minority health at NIH. Furthermore, the NIMHD provides
financial support to health professions institutions that have a
history and mission of serving minority and medically underserved
communities through the COE program and HCOP. For fiscal year 2012, an
increase proportional to NIH's increase is recommended for NIMHD to
support these critical activities.
Research Centers At Minority Institutions.--RCMI at the National
Center for Research Resources (NCRR) has a long and distinguished
record of helping institutions like The Charles Drew University develop
the research infrastructure necessary to be leaders in the area of
translational research focused on reducing health disparities research.
Although NIH has received some budget increases over the last 5 years,
funding for the RCMI program has not increased by the same rate.
Therefore, the funding for this important program grow at the same rate
as NIH overall in fiscal year 2012.
Department of Health and Human Services
Office of Minority Health.--Specific programs at OMH include:
assisting medically underserved communities, supporting conferences for
high school and undergraduate students to interest them in
healthcareers, and supporting cooperative agreements with minority
institutions for the purpose of strengthening their capacity to train
more minorities in the health professions. For fiscal year 2012, I
recommend a funding level of $65 million for OMH to support these
critical activities.
Department of Education
Strengthening Historically Black Graduate Institutions.--The
Department of Education's Strengthening Historically Black Graduate
Institutions program (Title III, Part B, Section 326) is extremely
important to MMC and other minority serving health professions
institutions. The funding from this program is used to enhance
educational capabilities, establish and strengthen program development
offices, initiate endowment campaigns, and support numerous other
institutional development activities. In fiscal year 2012, an
appropriation of $65 million is suggested to continue the vital support
that this program provides to historically black graduate institutions.
Conclusion
Despite all the knowledge that exists about racial/ethnic, socio-
cultural and gender-based disparities in health outcomes, the gap
continues to widen. Not only are minority and underserved communities
burdened by higher disease rates, they are less likely to have access
to quality care upon diagnosis. As you are aware, in many minority and
underserved communities preventative care and research are inaccessible
either due to distance or lack of facilities and expertise. As noted
earlier, in just one underserved area, South Los Angeles, the number
and distribution of beds, doctors, nurses and other health
professionals are as parlous as they were at the time of the Watts
Rebellion, after which the McCone Commission attributed the so-named
``Los Angeles Riots'' to poor services--particularly access to
affordable, quality healthcare. The Charles Drew University has proven
that it can produce excellent health professionals who 'get' the
mission--years after graduation they remain committed to serving people
in the most need. But, the university needs investment and committed
increased support from Federal, State and local governments and is
actively seeking foundation, philanthropic and corporate support.
Even though institutions like The Charles Drew University are
ideally situated (by location, population, community linkages and
mission) to study conditions in which health disparities have been well
documented, research is limited by the paucity of appropriate research
facilities. With your help, the Life Sciences Research Facility will
translate insight gained through research into greater understanding of
disparities and improved clinical outcomes. Additionally, programs like
Title VII Health Professions Training programs will help strengthen and
staff facilities like our Life Sciences Research Facility.
We look forward to working with you to lessen the huge negative
impact of health disparities on our Nation's increasingly diverse
populations, the economy and the whole American community.
Mr. Chairman, thank you again for the opportunity to present
testimony on behalf of The Charles Drew University. It is indeed an
honor.
______
Prepared Statement of the Children's Environmental Health Network
On behalf of the Children's Environmental Health Network (CEHN), a
national multi-disciplinary organization whose mission is to protect
the fetus and the child from environmental health hazards and promote a
healthy environment, I thank you for the opportunity to submit
testimony in support of fiscal year 2012 appropriations for U.S.
Department of Health and Human Services (HHS) for activities that
protect children from environmental hazards.
CEHN appreciates the wide range of needs that you must consider for
funding. We urge you to give priority to those programs that directly
protect and promote children's environmental health. In so doing, you
will improve not only our children's health and development, but also
their educational outcomes and their future.
The world in which today's children live has changed tremendously
from that of previous generations, including a phenomenal increase in
the substances to which children are exposed. Every day, children are
exposed to a mix of chemicals, most of them untested for their effects
on developing systems. In general, children have unique vulnerabilities
and susceptibilities to toxic chemicals. In some cases, an exposure
which may cause little or no harm to an adult may lead to irreparable
damage to a child. Exposure to neurotoxicants in utero or early
childhood can result in life-long learning and developmental delays.
Investments in programs that protect and promote children's health
will be repaid by healthier children with brighter futures. Protecting
our children--those born as well as those yet to be born--from
environmental hazards is truly a national security issue. Cutting or
weakening programs that protect children from harmful chemicals in
their environment is not only very costly to our Nation (for example,
the Clean Air Act Amendments of 1990 have saved $1 trillion in
healthcare costs\1\), such cuts will reduce the number of exceptionally
bright children in future generations. Our Nation's future will depend
upon its future leaders. As our experience with removing lead from
gasoline illustrates (removing lead in gasoline has saved the United
States an estimated $200 billion each year since 1980 in the form of
higher IQs for that year's newborns) \2\, when we protect children from
harmful chemicals in their environment, we help to assure that they
will reach their full potential. We have a responsibility to our
Nation's children, and to the Nation that they will someday lead, to
provide them with a healthy environment.
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\1\ Health and Welfare Benefits Analyses to Support the Second
Section 812 Benefit-Cost Analysis of the Clean Air Act, Final Report,
prepared by Industrial Economics for the U.S. EPA, February 2011.
\2\ ``Economic Gains Resulting from the Reduction in Children's
Exposure to Lead in the United States,'' Grosse SD, Matte TD, Schwartz
J, Jackson RJ, Environ Health Perspectives 2002, 110(6): doi:10.1289/
ehp.02110563
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Additionally, American competiveness depends on having healthy
educated children who grow up to be healthy productive adults. Yet,
growing numbers of our children are diagnosed with chronic and
developmental illnesses and disabilities. The National Academy of
Sciences estimates that toxic environmental exposures play a role in 28
percent of neurobehavioral disorders in children and this does not
include other conditions such as asthma or cancers. Thus it is vital
that the Federal programs and activities that protect children from
environmental hazards receive adequate resources. Key programs in your
jurisdiction which CEHN urges you to support include:
Centers for Disease Control and Prevention (CDC)
The CDC is the Nation's leader in public health promotion and
disease prevention, and should receive top priority in Federal funding.
CDC continues to be faced with unprecedented challenges and
responsibilities. CEHN applauds your support for CDC in past years and
urges you to support a funding level of $7.7 billion for CDC's core
programs in fiscal year 2012.
Within CDC, the National Center for Environmental Health (NCEH) is
particularly important to protecting the environmental health of young
children. NCEH programs, such as its efforts to continue and expand
biomonitoring and its national report card on exposure information, are
key national assets. CEHN is thus deeply concerned about the proposed
severe cuts to CDC's environmental public health programs in the
President's fiscal year 2012 budget. We join with many others in
strongly opposing the proposal to consolidate CDC's Healthy Homes/Lead
Poisoning Prevention and the National Asthma Control Programs and
reducing funding for these programs by more than half.
The CDC's National Environmental Public Health Tracking Program
helps to track environmental hazards and the diseases they may cause
and to coordinate and integrate local, State and Federal health
agencies' collection of critical health and environmental data. Public
health officials need integrated health and environmental data so that
they can protect the public's health. We urge you to reverse the CDC
operating plan for fiscal year 2011, which eliminates all budget
authority for this vital program. We urge you to support additional
funding for the program in fiscal year 2012.
The Built Environment and Health Program (also known as the Healthy
Community Design Initiative) would be abolished. Other cuts to the
center's core environmental work include its radiation activities and
building capacity in local health departments. We urge you to oppose
these cuts.
CEHN also strongly supports CDC's Environmental Health Laboratory
and its biomonitoring activities, which allow us to measure with great
precision the actual levels of more than 450 chemicals and nutritional
indicators in people's bodies. This information helps public health
officials to determine which population groups are at high risk for
exposure and adverse health effects, assess public health
interventions, and monitor exposure trends over time.
National Institutes of Health (NIH)
CEHN joins others in the health field in requesting that the
Committee provide $35 billion for the National Institutes of Health
(NIH) in fiscal year 2012, including $779.4 million for the National
Institute of Environmental Health Sciences (NIEHS).
NIEHS is the leading institute conducting research to understand
how the environment influences the development and progression of human
disease. Children are uniquely vulnerable to harmful substances in
their environment, and the NIEHS plays a critical role in uncovering
the connections between environmental exposures and children's health.
Thus it plays a vital role in our efforts to understand how to protect
children, whether it is identifying and understanding the impact of
substances that are endocrine disruptors or understanding childhood
exposures that may not affect health until decades later.
CEHN therefore urges you to provide $779.4 million for NIEHS in
fiscal year 2012.
Children's Environmental Health Research Centers of Excellence
The Children's Environmental Health Research Centers, jointly
funded by the NIEHS and the EPA, play a key role in providing the
scientific basis for protecting children from environmental hazards.
With their modest budgets, which have been unchanged for more than 10
years, these centers generate valuable research. A unique aspect of
these Centers is the requirement that each Center actively involves its
local community in a collaborative partnership, leading both to
community-based participatory research projects and to the translation
of research findings into child-protective programs and policies. The
scientific output of these centers has been outstanding. For example,
findings from four Centers clearly showed that prenatal exposure to a
widely used pesticide affected developmental outcomes at birth and
early childhood. This was important information to EPA's decision
makers in their regulation of this pesticide.
Several Centers have established longitudinal cohorts which have
resulted in valuable research results. The Network is concerned that as
a Center's multi-year grant ends and the Center is shuttered, these
cohorts and the invaluable information they can provide are being lost.
The Network urges the Committee to assure that NIEHS has the funding
and the direction to support Centers in continuing these cohorts.
The work of these Centers has also shown us that, in addition to
research regarding a specific pollutant or health outcome, research is
desperately needed in understanding the totality of the child's
environment--for example, all of the exposures the child experiences in
the home, school, and child care environment--and how to evaluate those
multiple factors. CEHN urges you to support these Centers, to assure
they receive full funding and are extended and expanded as described
above.
National Children's Study
CEHN urges the Committee to assure stable support for the National
Children's Study (NCS) for all Institutes involved in this landmark,
evidence-based longitudinal study examining the effects of
environmental influences on the health and development of more than
100,000 children across the United States. This study may be the only
means that we will have to understand the links between exposures and
the health and development of children and to identify the antecedents
for a healthy adulthood. 2012 will be a critical year for the NCS. It
is vital that the funding is in place to launch the main study
involving all of the centers. Already approximately 700 babies have
been born into the study.
We urge the Committee to assure that the NCS retains on its
original focus on environmental chemicals. While the NCS is housed at
NIH, it must be a multi-agency study and it must be responsive to its
mission and to the lead agencies, in and out of NIH
CEHN also asks the Committee to direct NIH to ensure that protocols
are in place within NCS for measuring exposures in child care and
school settings; it is critically important to understand how school
and child care exposures differ from home exposures very early in the
study process.
Pediatric Environmental Health Specialty Units
Funded jointly by the Agency for Toxic Substances and Disease
Registry (ATSDR) and the U.S. Environmental Protection Agency (EPA),
the Pediatric Environmental Health Specialty Units (PEHSUs) form a
valuable resource network, with a center in each of the U.S. Federal
regions. PEHSU professionals provide medical consultation to healthcare
professionals on a wide range of environmental health issues, from
individual cases of exposure to advice regarding large-scale community
issues. PEHSUs also provide information and resources to school, child
care, health and medical, and community groups to help increase the
public's understanding of children's environmental health, and help
inform policymakers by providing data and background on local or
regional environmental health issues and implications for specific
populations or areas. For example, following the gulf oil spill in
2010, the PEHSUs quickly produced and released a series of factsheets
and advisories in multiple languages for local patients and health
professionals. We urge the Committee to fully fund ATSDR's portion of
this program in fiscal year 2012.
In conclusion, investments in programs that protect and promote
children's health will be repaid by healthier children with brighter
futures, an outcome we can all support. That is why CEHN asks you to
give priority to these programs. Thank you for the opportunity to
comment. CEHN's staff and I would be happy to answer any questions you
may have.
______
Prepared Statement of the Coalition for Health Funding
The Coalition for Health Funding is pleased to provide the Senate
Labor, Health and Human Services, Education and Related Agencies
Appropriations Subcommittee with a statement for the record on fiscal
year 2012 funding levels for health agencies and programs. Since 1970,
the Coalition for Health Funding has advocated for sufficient and
sustained discretionary funding for the public health continuum to meet
the mounting and evolving health challenges confronting the American
people.
Our Nation's strength is inextricably linked to our health.
Evidence abounds--from the Department of Defense to the U.S. Chamber of
Commerce--that healthy Americans are stronger on the battlefield, have
higher academic achievement, and are more productive in school and on
the job. Federal funding helps discover cures and fuel innovation,
ensure the safety of our drugs, food, water, and air, prevent disease,
protect and respond in times of crisis, train healthcare professionals,
and provide care to our Nation's most vulnerable. Much of what public
health does--and the impact of Federal investment in it--is such a part
of Americans' daily living that it is often invisible and almost always
taken for granted. For example, Federal health funding has:
--Improved and saved the lives of many of those suffering from
illnesses through scientific innovation and discovery.
--Prevented unnecessary and costly injuries through seat belt and
helmet laws, mandatory airbags, and car seats for infants and
toddlers.
--Promoted safe and healthy foods through dietary guidelines and food
labeling that help Americans better understand what we eat and
how to eat better.
--Improved the health of mothers and reduced birth defects and infant
deaths through recommendations to take folic acid during early
stages of pregnancy, place babies on their backs to prevent
Sudden Infant Death Syndrome, and avoid tobacco and alcohol use
during pregnancy.
--Combated tobacco addiction by regulating advertisements, imposing
age limits on tobacco purchases, and instituting smoking bans
in public places, cutting smoking rates by nearly half and
reducing the number of smoking-related deaths and illnesses and
the opportunity and real costs associated with them.
--Treated and eradicated infectious diseases through vaccines,
preventing epidemics and saving lives.
--Improved the environment through bans on asbestos in household
products and lead in paint and gasoline.
--Protected the American people in all communities from infectious,
occupational, environmental, and terrorist threats.
These are just some of the ways in which Federal funding for public
health has changed our lives and those of our children for the better.
Still, Federal funding is necessary to further improve, save, and
protect those in America and around the world. The treatments and cures
for many devastating diseases are just out of reach. Racial,
socioeconomic, and geographic health disparities persist. Costly and
often preventable chronic conditions such as asthma, diabetes, heart
disease and obesity--particularly among young people--are on the rise
and threaten military readiness, academic achievement, and societal
productivity. The failure to prioritize behavioral health issues
continues to have stunning, debilitating social and economic
consequences. Oral health is still not widely recognized as a
healthcare priority in spite of the fact that tooth decay remains a
common chronic disease among all ages and is preventable.
The Coalition for Health Funding's 70 national, member
organizations--representing the interests of more than 100 million
patients, healthcare providers, public health professionals, and
scientists--support the belief that the Federal Government is an
essential partner with State and local governments and the nonprofit
and private sectors in improving health. A pressing and immediate goal
is to build the capacity of our public health system to address
America's mounting health needs under the weight of a fragile economy,
an aging population, a health workforce shortage, and persisting
declines in health status.
Given current fiscal challenges, the Coalition for Health Funding
appreciates the efforts of the President and Congress to maintain
funding for many critical health programs in the final fiscal year 2011
spending legislation. Nevertheless, the Coalition remains concerned
about prospects for future cuts to health programs. The Coalition
supports fiscal responsibility, but not at the expense of America's
health and well-being. Cuts to federally funded health services and
scientific research will not significantly reduce the deficit, nor make
a dent in the national debt; discretionary health spending represents
less than 2 percent of all Federal spending. These cuts adversely
affect American families, cost jobs, and ultimately compromise
America's global competitiveness and economic growth.
The Coalition for Health Funding organized more than 470 national,
State, and local organizations and six former Surgeons General in a
letter that urged Congress to increase discretionary health funding.
The following list summarizes the Coalition for Health Funding's fiscal
year 2012 funding recommendations for health agencies under the
subcommittee's jurisdiction.
National Institutes of Health (NIH)
The Coalition supports $35 billion in fiscal year 2012 for NIH, a
14.4 percent increase over the fiscal year 2011 funding level and a 10
percent increase over the President's fiscal year 2012 request. The
partnership between NIH and America's scientific research community is
a national investment in improving the health and quality of life of
all Americans. As the primary Federal agency responsible for conducting
and supporting medical research, NIH-funded research drives scientific
innovation and develops new and better diagnostics, improved prevention
strategies, and more effective treatments.
NIH-funded research also contributes to the Nation's economic
strength by creating skilled, high-paying jobs; new products and
industries; and improved technologies. More than 83 percent of NIH
research funding is awarded to more than 3,000 universities, medical
schools, teaching hospitals, and other research institutions, located
in every State. The Nation's longstanding, bipartisan commitment to NIH
has established the United States as the world leader in medical
research and innovation. Other countries, such as China and India, are
increasing their funding of scientific research because they understand
its critical role in spurring technological advances and other
innovations. If the United States is to continue to compete in a
global, information-based economy, it too must continue to invest in
research programs such as NIH.
Centers for Disease Control and Prevention (CDC)
The Coalition for Health Funding recommends a level of $7.7 billion
for CDC's core programs in fiscal year 2012, a 36 percent increase over
fiscal year 2011 and a 31 percent increase over the President's fiscal
year 2012 request. This amount is representative of what CDC needs to
fulfill its core mission in fiscal year 2012; activities and programs
that are essential to protect the health of the American people. CDC
continues to be faced with unprecedented challenges and
responsibilities, ranging from chronic disease prevention, eliminating
health disparities, bioterrorism preparedness, to combating the obesity
epidemic. In addition, CDC funds community programs in injury control;
health promotion efforts in schools and workplaces; initiatives to
prevent diabetes, heart disease, cancer, stroke, and other chronic
diseases; improvements in nutrition and immunization; programs to
monitor and combat environmental effects on health; prevention programs
to improve oral health; prevention of birth defects; public health
research; strategies to prevent antimicrobial resistance and infectious
diseases; and data collection and analysis on a host of vital
statistics and other health indicators. It is notable that more than 70
percent of CDC's budget flows out to States and local health
organizations and academic institutions, many of which are currently
struggling to meet growing needs with fewer resources.
Health Resources and Services Administration (HRSA)
The Coalition for Health Funding recommends an overall funding
level of $7.65 billion for HRSA in fiscal year 2012, a 22 percent
increase over fiscal year 2011 and a 12 percent increase over the
President's fiscal year 2012 request. HRSA operates programs in every
State and thousands of communities across the country. It is a national
leader in providing health services for individuals and families,
serving as a health safety net for the medically underserved.
Over the past several years, HRSA has received mostly level
funding, undermining the ability of its successful programs to grow.
Additionally, the deep cuts made to the agency in the final fiscal year
2011 continuing resolution will likely have negative consequences for
public health. Therefore, the requested minimum level of funding for
fiscal year 2012 is critical to allow the agency to carry out critical
public health programs and services that reach millions of Americans,
including developing the public health and healthcare workforce;
delivering primary care services through community health centers;
improving access to care for rural communities; supporting maternal and
child healthcare programs; providing healthcare to people living with
HIV/AIDS; and many more. However, much more is needed for the agency to
achieve its ultimate mission of ensuring access to culturally
competent, quality health services; eliminating health disparities; and
rebuilding the public health and healthcare infrastructure.
Substance Abuse and Mental Health Services Administration (SAMHSA)
The Coalition for Health Funding recommends an overall funding
level of $3.671 billion for SAMHSA in fiscal year 2012, an 8.6 percent
increase over fiscal year 2011 and an 8.4 percent increase over the
President's fiscal year 2012 request. According to recent results from
a national survey conducted by SAMHSA, 45.1 million American adults in
the United States have experienced mental illness over the past year.
However, only two-thirds of adults in the United States with mental
illness in the past year received mental health services.
In fact, suicide claims over 34,000 lives annually, the equivalent
of 94 suicides per day; one suicide every 15 minutes. In the past year,
8.4 million adults aged 18 or older thought seriously about committing
suicide, 2.3 million made a suicide plan, and 1.1 million attempted
suicide. The funding for community mental health services from SAMHSA
has never been more critical especially in light of the $2.2 billion
reduction in State mental health funding for programs serving this
vulnerable population.
Agency for Healthcare Research and Quality (AHRQ)
The Coalition for Health Funding recommends an overall funding
level of $405 million for AHRQ in fiscal year 2012, a 9 percent
increase over fiscal year 2011 and a 10 percent increase over the
President's fiscal year 2012 request. AHRQ funds research and programs
at local universities, hospitals, and health departments that improve
healthcare quality, enhance consumer choice, advance patient safety,
improve efficiency, reduce medical errors, and broaden access to
essential services--transforming people's health in communities in
every State around the Nation. Specifically, the science funded by AHRQ
provides consumers and their healthcare professionals with valuable
evidence to make the right healthcare decisions for themselves and
their families. AHRQ's research also provides the basis for protocols
that reduce hospital-acquired infections, and improve patient
confidence, experiences, and outcomes.
The Coalition for Health Funding appreciates this opportunity to
provide its fiscal year 2012 discretionary health funding
recommendations and looks forward to working with the Subcommittee in
the coming weeks and months.
______
Prepared Statement of the Coalition for Health Services Research
The Coalition for Health Services Research (Coalition) is pleased
to offer this testimony regarding the role of health services research
in improving our Nation's health. The Coalition's mission is to support
research that leads to accessible, affordable, high-quality healthcare.
As the advocacy arm of AcademyHealth, the Coalition represents the
interests of more than 4,000 scientists and policy experts throughout
the country and 160 organizations that produce and use research that
improves health and healthcare. We advocate for the funding to support
health services research and health data; better access to data and
information to use in producing this research; and more transparent
dissemination of the results of this research.
Health services research studies how to make the healthcare system
work better and deliver improved outcomes for more people, at great
value. These scientific findings improve healthcare by informing
patient and healthcare provider choices; enhancing the quality,
efficiency, and value of the care patients receive; and improving
patients' access to care. Health services research both uncovers
critical challenges confronting our Nation's healthcare system, and
seeks ways to address them. For example, health services research tells
us:
--Only 55 percent of adults receive recommended care and 47 percent
of children receive indicated care (McGlynn et al, 2003;
Mangione-Smith et al, 2007).
--The increased prevalence of obesity is responsible for almost $40
billion of increased medical spending through 2006, including
$7 billion in Medicare prescription drug costs (Finkelstein,
2009).
--How hospitals were able to achieve more than 60 percent reduction
in rates of bloodstream infections in very sick patients
(Pronovost et al, 2006).
--More than 83,000 excess deaths each year could be prevented in the
United States if the health disparities could be eliminated
(Satcher et al, 2005).
--The percentage of heart attack patients receiving needed
angioplasties within the recommended 90 minutes of arriving at
the hospital improved from just 42 percent in 2005 to 81
percent by 2008 (Agency for Healthcare Research and Quality,
2011).
The primary economic rationale for a Government role in funding
health services research is that the private market would not
adequately supply for it, since the full economic value of the evidence
is unlikely to accrue solely to its discoverer. Like any corporation
making sure it is developing and providing high quality products
through R&D, the Federal Government has a responsibility to get the
most out of every taxpayer dollar it spends on Federal health
programs--Medicare, Medicaid, veterans' and service members'
healthcare--by funding research that helps enhance their performance.
Finding new ways to get the most out of every healthcare dollar is
critical to our Nation's long-term fiscal health. Funding for research
on the quality, value, and organization of the health system will
deliver real savings for the Federal Government, employers, insurers,
and consumers. Research into the merits of different policy options for
delivery system transformation, patient-centered quality improvement,
community health, and disease prevention offers policymakers in both
the public and private sectors the information they need to improve
quality and outcomes, identify waste, eliminate fraud, increase
efficiency and value, and promote personal responsibility.
Despite the positive impact health services research has had on the
U.S. healthcare system, and the potential for future improvements in
quality and value, the United States spends less than 1 cent of every
healthcare dollar on this research; research that can help Americans
spend their healthcare dollars more wisely and make more informed
healthcare choices.
The Coalition for Health Services Research greatly appreciates the
subcommittee's efforts to increase the Federal investment in health
services research and health data. We respectfully ask that the
subcommittee further strengthen capacity of health services research to
address the pressing challenges America faces in providing access to
high-quality, efficient care for all its citizens. The following list
summarizes the Coalition's fiscal year 2012 funding recommendations for
agencies that support health services research and health data under
the subcommittee's jurisdiction.
Agency for Healthcare Research and Quality (AHRQ)
AHRQ funds research and programs at local universities, hospitals,
and health departments that improve healthcare quality, enhance
consumer choice, advance patient safety, improve efficiency, reduce
medical errors, and broaden access to essential services--transforming
people's health in communities in every State around the Nation. The
science funded by AHRQ provides consumers and their healthcare
professionals with valuable evidence to make the right healthcare
decisions for themselves and their families. AHRQ's research also
provides the basis for protocols that prevent medical errors and reduce
hospital-acquired infections, and improve patient confidence,
experiences, and outcomes in hospitals, clinics, and physician offices.
The Coalition joins the Friends of AHRQ--an alliance of more than
250 health professional, research, consumer, and employer organizations
that support the agency--in recommending an overall funding level of
$405 million for AHRQ in fiscal year 2012, a 9 percent increase over
fiscal year 2011 and a 10 percent increase over the President's fiscal
year 2012 request. Within the funding provided to AHRQ, the Coalition
recommends that the subcommittee support:
--A Breadth of Research Topics.--During the last decade, AHRQ's
research portfolio has focused predominantly on patient safety
and healthcare quality. There has been less investment in
research that provides evidence to improve the efficiency and
value of the healthcare system itself. The Coalition is
grateful to the subcommittee for its leadership in building a
more balanced research agenda at AHRQ, and requests continued
support for all aspects of research outlined in AHRQ's
statutory mission, including the ways in which healthcare
services are organized, delivered, and financed.
--Innovation through Competition.--Many of the sentinel studies that
have changed the face of health and healthcare in the United
States--diagnosis-related groups for hospital payments, check-
lists for improved patient safety, geographic variation in
healthcare, re-hospitalizations among Medicare beneficiaries--
are the result of ingenuity on the part of investigators and
rigorous, scientific competition. Federal support for
innovative approaches to problem solving increases
opportunities for constructive competition and creative
solutions. The Coalition is grateful to the subcommittee for
its leadership in recognizing the value of investigator-
initiated research at AHRQ and requests sustained momentum for
these competitive, innovative grants that advance discovery and
the free marketplace of ideas.
--The Next Generation of Researchers.--At the direction of the
subcommittee, AHRQ has doubled its investment in training
grants for the next generation of researchers. Still, training
grants for new researchers--both physicians and non-
physicians--fall far short of what is needed to meet growing
public and private sector demands for health services research.
The Coalition appreciates the subcommittee's continuing support
of the next generation of researchers and requests that funding
for training grants be increased to ensure America stays
competitive in the global research market.
--Research Translation and Dissemination.--Health services research
has great potential to improve health and healthcare when
widely used by patients, providers, and policymakers. The
Coalition recommends that the subcommittee support AHRQ's
research translation and dissemination activities, including
patient forums, practice-based research centers, and learning
networks. These programs are designed to move the best
available research and decisionmaking tools into healthcare
practice and thus enhance patient choice and improve healthcare
delivery.
Centers for Disease Control and Prevention (CDC)
The National Center for Health Statistics (NCHS) is the Nation's
principal health statistics agency. Housed within CDC, NCHS provides
critical data on all aspects of our healthcare system through data
cooperatives and surveys that serve as a gold standard for data
collection around the world. The Coalition appreciates the
subcommittee's leadership in securing steady and sustained funding
increases for NCHS in recent years. Such efforts have allowed NCHS to
reinstate some data collection and quality control efforts, continue
the collection of vital statistics, and enhance the agency's ability to
modernize surveys to reflect changes in demography, geography, and
health delivery.
We join the Friends of NCHS--a coalition of more than 250 health
professional, research, consumer, industry, and employer organizations
that support the agency--in endorsing the President's fiscal year 2012
request of $162 million, a funding level that will build on previous
investments and put the agency on track to become a fully functioning,
21st century, national statistical agency.
The Patient Protection and Affordable Care Act recognizes the need
for linking the medical care and public health delivery systems by
authorizing a new CDC research program to study public health systems
and service delivery. If funded in fiscal year 2012, this program will
identify effective strategies for organizing, financing, and delivering
public health services in real-world community settings by, for
example, comparing State and local health department structures and
systems in terms of effectiveness and costs. The Coalition urges you to
appropriate $35 million in fiscal year 2012 for Public Health Services
and Systems Research at CDC, enabling us to study ways to improve the
efficiency and effectiveness of public health service delivery.
National Institutes of Health (NIH)
NIH reports that it spent $1.1 billion on health services research
in fiscal year 2010--roughly 3.6 percent of its entire budget--making
it the largest Federal sponsor of health services research. For fiscal
year 2012, the Coalition joins the Ad Hoc Group for Medical Research in
requesting $35 billion for NIH in fiscal year 2012, which would, based
on historical funding levels, provide roughly $1.3 billion for the
agency's health services research portfolio. The Coalition believes
that NIH should increase the proportion of its overall funding that
goes to health services research to ensure that discoveries from
clinical trials are effectively translated into health services. We
also encourage NIH to foster greater coordination of its health
services research investment across its institutes.
Centers for Medicare and Medicaid Services (CMS)
Steady funding reductions for the Office of Research, Development
and Information have hindered CMS's ability to meet its statutory
requirements and conduct new research to strengthen public insurance
programs--including Medicare, Medicaid, and the Children's Health
Insurance Program--which together cover nearly 100 million Americans
and comprise almost half of America's total health expenditures. As
these Federal entitlement programs continue to pose significant budget
challenges for both Federal and State governments, it is critical that
we adequately fund research to evaluate the programs' efficiency and
effectiveness and seek ways to manage their projected spending growth.
The Coalition supports an fiscal year 2012 base funding level of
$40 million for CMS's discretionary research and development budget.
This funding is a critical down payment to help CMS restore research to
evaluate its programs, analyze pay for performance and other tools for
updating payment methodologies, and further refine service delivery
methods.
In conclusion, the accomplishments of health services research
would not be possible without the leadership and support of this
subcommittee. Health services research will continue to yield valuable
scientific evidence in support of improved quality, accessibility, and
affordability of healthcare. We urge the subcommittee to accept our
fiscal year 2012 funding recommendations for the Federal agencies
funding health services research and health data.
If you have questions or comments about this testimony, please
contact our Washington, DC, representative, Emily Holubowich at
[email protected].
______
Prepared Statement of the Coalition for International Education
Mr. Chairman and Members of the Subcommittee: We are pleased to
submit the views of the Coalition for International Education on fiscal
year 2012 funding for the Higher Education Act, Title VI and the Mutual
Educational and Cultural Exchange Act, Section 102(b)(6), commonly
known as Fulbright-Hays. The Coalition for International Education
consists of over 30 national higher education organizations with
interest in the U.S. Department of Education's international and
foreign language education programs. The Coalition represents the
Nation's 3,300 colleges and universities, and organizations
encompassing various academic disciplines, as well as the international
exchange and foreign language communities.
We express our deep appreciation for the Subcommittee's long-time
support for the U.S. Department of Education's premier international
and foreign language education programs noted above. We recognize the
difficult decisions Congress and the Administration faced on education
spending cuts for the remainder of fiscal year 2011, and now face for
fiscal year 2012. However, we are deeply concerned over the severe and
disproportionate $50 million or 40 percent cut to the Title VI/
Fulbright-Hays programs under H.R. 1473, the final fiscal year 2011
Continuing Resolution agreement. Title VI/Fulbright-Hays contain 14
small ``pipeline'' programs, 12 of which are under $20 million. A cut
of this magnitude will seriously weaken our Nation's world-class
international education capacity, which has taken decades to build and
would be impossible to easily recapture. Among the first casualties
likely will be the high-cost, low-enrollment critical language programs
needed for national security, such as Pashto or Urdu.
Today we strongly urge the Appropriations Committee to safeguard
these programs by providing funding for them that is equal to their
fiscal year 2010 funding levels in the fiscal year 2012 appropriations
bill. For the International and Foreign Language Studies account, we
urge a total of $125.881 million, which includes $108.360 million for
Title VI-A&B; $15.576 million for Fulbright-Hays 102(b)(6); and $1.945
million for the Institute for International Public Policy, Title VI-C.
After 9/11, Congress began a decade of enhancements to Title VI/
Fulbright because of the sudden awareness of an urgent need to improve
the Nation's in-depth knowledge of world areas and transnational
issues, and fluency of U.S. citizens in foreign languages.
Unfortunately these gains and many program enhancements on strategic
world areas will be eliminated unless funding is restored to fiscal
year 2010 levels.
We believe maintaining a strong Federal role in these programs is
critical to supporting our Nation's long-term national security, global
leadership, economic competitiveness capabilities, as well as mutual
understanding and collaboration around the world. Successful U.S.
engagement in these areas, at home or abroad, relies on Americans with
global competence, including foreign language skills and the ability to
understand and function in different cultural and business
environments.
Background and Federal Role
In 1958 at the height of the cold war, Congress created NDEA-Title
VI out of a sense of crisis about U.S. ignorance of other countries and
cultures. Fulbright 102(b)(6) was created in 1961 and placed with Title
VI to provide complementary overseas training. These programs have
served as the lynchpin for producing international specialists for more
than five decades, and continue to do so. Improving over time to
address new global challenges and expanded needs across the Nation's
workforce, 14 Title VI/Fulbright-Hays programs support activities to
improve capabilities and knowledge throughout the educational pipeline,
from K-12 through the graduate levels and advanced research, with
emphasis on the less commonly-taught languages and areas, such as
China, Russia, India and the Muslim world. Today they are the Federal
Government's most comprehensive programs supporting the development of
high quality national capacity in international, foreign language and
business education and research. A March 2007 report by the National
Academies of Sciences (NAS) concluded, ``Title VI/Fulbright-Hays serve
as our Nation's foundational programs for building U.S. global
competence.''
This Federal-university partnership ensures resources and knowledge
are available to meet national needs that are not priorities of
individual States or universities. Federal resources are essential
incentives to develop and sustain high-cost programs in the less
commonly-taught languages and world areas, and provide extensive
outreach and collaboration among educational institutions, government
agencies, and corporations. Most of these programs would not exist
without Federal support, especially at a time when State/local
governments and institutions of higher education are financially
strapped.
Why Investing in Title VI/Fulbright-Hays Is Important
The NAS reported in 2007: ``A pervasive lack of knowledge about
foreign cultures and foreign languages in this country threatens the
security of the United States as well as its ability to compete in the
global marketplace and produce an informed citizenry.''
Government Needs.--The quantity, level of expertise, and
availability of U.S. personnel with high-level expertise in foreign
languages, cultures, and political, economic and social systems
throughout the world do not match our national strategic needs at home
or abroad. Some 80 Federal agencies depend in part on proficiency in
more than 100 foreign languages; in 1985, only 19 agencies identified
such requirements.
``Foreign language skills are vital to effectively communicate and
overcome language barriers encountered during critical operations and
are an increasingly key element to the success of diplomatic efforts,
military operations, counterterrorism, law enforcement and intelligence
missions, as well as to ensure access to Federal programs and services
to Limited English Proficient (LEP) populations within the United
States.'' David Maurer Testimony on Foreign Language Capabilities.
Departments of Homeland Security, Defense, and State Could Better
Assess their Foreign Language Needs and Capabilities and Address
Shortfalls, GAO, July 2010
``As of October 31, 2008, 31 percent of Foreign Service officers in
overseas language-designated positions (LDP) did not meet both the
foreign languages speaking and reading proficiency requirements for
their positions. State continues to face foreign language shortfalls in
regions of strategic interest--such as the Near East and South and
Central Asia, where about 40 percent of officers in LDPs did not meet
requirements. Past reports by GAO, State's Office of the Inspector
General, and others have concluded that foreign language shortfalls
could be negatively affecting U.S. activities overseas.'' Comprehensive
Plan Needed to Address Persistent Foreign language Shortfalls, GAO,
September 2009.
Workforce Needs.--National security is increasingly linked to
commerce, and U.S. business is widely engaged around the world with
joint ventures, partnerships, and economic linkages that require its
employees to have international expertise both at home and abroad.
``Most of the growth potential for U.S. businesses lies in overseas
markets. Already, one in five U.S. manufacturing jobs is tied to
exports. Foreign consumers, the majority of whom primarily speak
languages other than English, represent significant business
opportunities for American producers, as the United States is home to
less than 5 percent of the world's population. American companies lose
an estimated $2 billion a year due to inadequate cross-cultural
guidance for their employees in multicultural situations.'' Education
for Global Leadership, Committee for Economic Development, 2006.
Education Needs.--Education institutions at all levels are
challenged to keep up with rapidly expanding 21st century needs for
global competence.
-- Although higher education foreign language enrollments have
increased and diversified over the past decade, according to
the Modern Language Association's 2010 survey, enrollments are
only 8.7 percent of total student enrollments, well behind the
1960 high point of 16 percent.
-- Only 5 percent of all higher education students taking foreign
languages study non-European languages spoken by roughly 85
percent of the world's population.
-- Less than 2 percent of students in U.S. postsecondary education
study abroad, and only about half studied outside Western
Europe. Yet, an educational experience abroad is an essential
element for achieving foreign language fluency, learning how to
function in other cultures, and developing mutual understanding
with others beyond our borders.
-- U.S. educational institutions from K-16 face a shortage of
teachers and faculty with international knowledge and expertise
across the professions and across types of higher education
institutions. This problem is especially acute for foreign
language teachers of the less commonly taught languages.
What Title VI/Fulbright-Hays Programs Do
Title VI/Fulbright programs produce U.S. experts, prepare Americans
for the global workplace, and generate knowledge on the foreign
languages and business, economic, political, social, cultural and
regional affairs of other countries and world areas. Grantees also
engage in extensive outreach and collaboration across the educational
spectrum, and with business, government, the media and the general
public. Title VI-funded centers are relied upon for their expertise by
Federal agencies, corporations, and local school districts. Their many
accomplishments include the following:
Language and Culture
Through several pipeline programs, Title VI institutions provide
the major, and often the only, source of national expertise and
research on non-European countries and their languages.
Title VI institutions account for 21 percent of undergraduate
enrollment and 56 percent of graduate enrollment in the less commonly
taught languages (LCTLs) such as Arabic and Chinese. For the least
commonly taught languages such as Pashto and Urdu, Title VI
institutions account for 49 percent of undergraduate and 78 percent of
graduate enrollments.
Title VI institutions provide instruction and R&D in over 130
languages and in all world areas, and have the capacity to teach over
200 languages. Because of the high cost per student, many of these
languages would not be taught on a regular basis but for Title VI/
Fulbright support. In contrast, the Defense Language Institute (DLI)
and the Foreign Service Institute (FSI) together offer instruction in
only 75 LCTLs.
Title VI/Fulbright programs support advanced research abroad in
international, area and language studies--such as through the Fulbright
programs and overseas research centers--that otherwise would have few
or no other funding sources.
Title VI programs support the development and maintenance of world
class digital information resources in international, area and foreign
language studies--using modern technologies for accessibility--that
exist no where else in the world.
Title VI/Fulbright programs provide opportunity and access to all
types of institutions of higher education, including minority-serving
institutions, community colleges, and small and medium-sized 4-year
institutions. With seed funding from the Undergraduate International
Studies and Foreign Language, Institute for International Public Policy
and Fulbright programs, training, fellowship, scholarship and study
abroad opportunities are provided to students, faculty and
administrators.
With enhancements provided by Congress between 2000-08, Title VI
National Resource Centers increased annual job placements in key
sectors. 2008 placements and percent increase over 2000: Federal
Government 1,515 (+32 percent), U.S. military 552 (+20 percent),
international organizations 1,567 (+22 percent), and higher education
3,414 (+51 percent).
During this same period, the NRCs have seen triple digit increases
in courses and enrollments in critical languages. Between 2000 and
2008, enrollments in Arabic increased from 5,218 to 16,721, in Chinese
from 9,637 to 23,724, in Persian from 1,231 to 3,878, in Turkish from
594 to 1,602, and in Urdu from 221 to 904.
Examples of renowned graduates include Secretary of Defense Robert
Gates, General John Abizaid, former Ambassador to Russia James Collins,
advisor to six Secretaries of State Aaron David Miller, and NY Times
Pulitzer prize-winning journalist Anthony Shadid.
International Business
Title VI supports two important programs that internationalize
business education, train Americans for the global workplace, and help
U.S. small and mid-size businesses engage emerging markets: Centers for
International Business Education and Research (CIBERs) and Business and
International Education (BIE).
CIBERs offer training at all levels of education in all 50 States,
including training for managers already active in the workforce, and
research on cutting edge issues affecting the U.S. business
environment, the Nation's global economic competitiveness and homeland
security.
Before these programs were established, few business education
programs in the United States incorporated a global dimension. Over 2
million students have taken international business courses through
CIBER programs and over 160,000 faculty have gained international
business and cultural expertise through faculty programs, domestically
and abroad.
Over 42,000 language faculty have participated in over 900
international business language workshops, and 4.5 million students
across the United States have benefited from enhanced commercial
foreign language instruction.
Outreach
Title VI/Fulbright grantees provide access to international
knowledge to other institutions of higher education, government,
business, K-12 and the public through web resources, seminars, training
and other means. Many educators, government agencies, nonprofit groups
and corporations depend on these resources. Without Title VI/Fulbright
funding, this outreach would disappear.
Title VI National Resource Centers provide training and
consultation for foreign language and area staff in many government
agencies. For example, the U.S. Army Foreign Area Officer (FAO) Program
sends its officers to Title VI centers for their M.A. in language and
area studies training and has done so since the inception of the FAO
program three decades ago.
Title VI Language Resource Centers (LRC) train an estimated 2,000
teachers annually, and develop resources in critical languages used by
educators and government agencies. For example, an LRC recently
developed a free iPad app that provides tutorials in Pashto for U.S.
soldiers in Afghanistan.
CIBER and BIE grantees work closely with the U.S. Department of
Commerce and with the local District Export Councils on export
development. In response to President Obama's 2010 National Export
Initiative (NEI), the CIBERs continue to expand the global knowledge
base of U.S. companies, enabling and assisting them to export their
goods and services especially to the BRIC and other emerging markets.
By enabling small and mid-sized U.S. business to increase exports,
CIBER/BIE activities support job creation in America and reduction of
the trade deficit.
Title VI grantees also work extensively with minority-serving
institutions of higher education, community colleges and K-12 on
language and culture programs, as well as with the media to promote
citizen understanding of complex global issues.
Clearly, this Federal-higher education partnership pays dividends
that vastly outweigh the small 0.2 percent investment within the
Department of Education's budget.
______
Prepared Statement of the Coalition for Workforce Solutions
I represent The Coalition for Workforce Solutions (CWS), a national
organization exclusively representing employers, workforce development
providers, vendors and service organizations that operate and utilize
One-Stop Career Centers, Temporary Assistance for Needy Families
initiatives, career and technical education programs and workforce
investment services. Members of CWS are proud to play a role in our
workforce system as it promotes economic growth while giving
unemployed, underemployed and disadvantaged workers an opportunity to
gain new skills.
Today, while the Nation faces many complex challenges in light of
mass layoffs and business realignments, the private sector is showing
signs of recovery and businesses new and old need increased assistance
in addressing their workforce needs. And our national network of WIA
supported workforce services is in a unique position not only to train
workers for economic recovery, but to match large and small employers
with qualified workers in advanced manufacturing, healthcare, energy
and other high-growth sectors. As the economy grows, our workforce
system should be maintained and strengthened, not reduced or targeted
for elimination.
We understand the budget issues and the need for debt reduction. We
are confident that through integration of workforce services there is
the capacity to maintain the existing level of service to the job
seekers and employers. We look to the State of Florida and Texas as the
model of integrated services for replication nationwide. This will
ensure our workforce development and job-training system continues its
vital support for businesses of all sizes to create and retain jobs,
provide needed skills and transition assistance to workers, and enhance
economic growth through the private sector in thousands of communities
around the country.
Our Nation's workforce systems funded through WIA have become
critical partners in regional economic development efforts--from
directly supporting efforts to recruit new businesses (by offering
access to skilled workers and employment and training incentives), to
saving money for local businesses as they begin to rehire workers. The
programs also assist businesses to avert layoffs through skills
upgrading, and support businesses that are closing or downsizing. These
partnerships with employers and economic development services are
critical to helping businesses survive and contribute to regional
economic growth and prosperity. Now is not the time to take away these
vital services when economic growth is paramount to our recovery and
competitiveness.
WIA has experienced a 234 percent increase in demand for services
since the onset of the recession and demand remains steady as the
economy grows. It is easy to see why this is so: the one-stop system
supported with WIA funds fosters community partnerships that drive job
creation and economic recovery efforts while also providing vital labor
market information, skills assessments, career guidance, counseling,
employment assistance, support and training services to jobseekers and
workers who need help in getting good jobs.
In every State and region, the workforce system addresses the needs
of business so that local companies can remain competitive. By building
relationships with community development organizations and local
officials, businesses are provided with a collaborative network of
support that is best-suited to the needs of employers. Only this system
can provide businesses with the resources they can use to survive and
thrive in this difficult economic time.
In fact, the workforce system is the only system of its kind to
engage employers and address the kind of compelling challenges that
business face in the following areas:
--Reducing turnover in entry level occupations in high growth
industries such as healthcare through early immersion and
career ladder programs.
--Finding the talent that advanced manufacturing companies need to
compete by training workers in new skills and providing the
next generation of workers a path to the modern workforce.
--Supporting economic development and business attraction activities
so that new employers and manufacturers get assistance in
determining local infrastructure, specific fits for training
needs, and whatever it takes to be successful.
--Preparing youth in high demand IT careers as well as providing soft
skills training, job search preparation, coaching and the life
transforming skills that businesses need to develop a stable,
high-quality workforce.
--Improving hiring efficiency such that employers improve their
application conversion rate by 50 percent through collaborative
partnerships with the workforce system that produce qualified
candidates with the right skill-sets, dedication and motivation
that employers need.
Businesses as well as jobseekers and workers benefit from WIA
services. Research indicates that the workforce system produces a high
return on investment. Last year, over 8 million job-seekers utilized
the workforce system and over 4.3 million of them got jobs. While this
is less than the normal 80 to 85 percent placement rate common in
stronger economic times, the recent job environment had four jobseekers
for every one vacancy. However, when jobs were simply not available,
the system placed many of the unemployed in education and training
programs that will lead to good new jobs.
The system is also effective. According to an Upjohn Institute
Study, positive and statistically significant results were found for
WIA Adult Program participants and for the Dislocated Worker Program.
Furthermore, these employment and training services were shown to
reduce reliance on public assistance. The average duration on TANF
public assistance also was reduced by several percentage points for
those participating in WIA or TANF welfare-to-work programs. One can
conclude from a variety of studies that WIA training services raise
employment rates and earnings while reducing reliance on TANF.
Many CWS members are private businesses that struggle everyday with
budgets, so we can appreciate the need to make tough decisions. Since
job creation is a priority for the Congress and since workers pay taxes
and reduce pressure on public programs, maintaining support for the
workforce system should remain a top priority. The workforce system is
a critical partner in the Nation's economic recovery as it trains and
retrains workers to meet the demands of our changing economy. In our
judgment, this system is essential to addressing the employment needs
of the more than 14 million unemployed in this country--we cannot
afford to lose this valuable resource.
Nevertheless, Congress recently reduced WIA's three State/local
program sections by about $307 million below the fiscal year 2010
levels enacted in Public Law 111-117. Overall, the last CR provides
about $2.8 billion for job-training State grants for adult employment,
youth activities, and dislocated workers. The more than $1 billion in
reductions to key job training and education programs equate to more
than 10 percent less than fiscal year 2010 enacted levels.
While funding for Program Year 2011 is now set, the spending
agreement covers only the first quarter of the next WIA program year
ending September 30, 2011. Funding for the final three quarters will be
contained in the fiscal year 2012 appropriations.
Many WIA programs have received funding reductions in real dollar
terms in recent years--these programs are significantly underfunded
already relative to their mission. Congress should use the findings of
duplication and overlap in workforce programs not to make further
reductions but rather to work with the House Education and Workforce
Committee to achieve better coordination and integration of services.
Despite the significant cuts in the latest CR, the bill represents
substantial progress for thousands of jobseekers and employers across
the country who informed their policymakers on the critical benefits of
our workforce system. We are encouraged to see that Congress has
rejected the severest cuts proposed early this year and we hope there
is a more accurate picture for fiscal year 2012 emerging of how WIA
programs help employers find qualified workers and train workers for
new careers.
In short, CWS will work with Members of this Committee, the
authorizing committees and other Members of Congress as they consider
policies to better align planning and service delivery, and strengthen
the overall system. As issues develop, there will be discussions about
expectations for the future of the workforce system. Here are some
issues of primary importance to CWS:
--Enhancing WIA accountability and driving high performance;
--Empowering Workforce Investment Boards to play a strategic role
that promotes coordination and integration of services across
federally funded systems;
--Serving disadvantaged and underserved populations; and
--Sharing and promoting best practices throughout the system.
CWS believes that WIA's core services and training have paid off in
terms of higher employment rates and improved earnings for dislocated
workers, the unemployed and disadvantaged youth and adults. As Members
of the Committee examine the facts concerning WIA services, we trust
that they will agree that the workforce system provides vital services
to businesses and jobseekers. Thank you for your consideration of my
testimony.
______
Prepared Statement of the Coalition for the Advancement of Health
Through Behavioral and Social Science Research
Mr. Chairman and Members of the Subcommittee, the Coalition for the
Advancement of Health Through Behavioral and Social Science Research
(CAHT-BSSR) appreciates and welcomes the opportunity to comment on the
fiscal year 2012 appropriations for the National Institutes of Health
(NIH). CAHT-BSSR includes 14 professional organizations, scientific
societies, coalitions, and research institutions concerned with the
promotion of and funding for research in the social and behavioral
sciences. Collectively, we represent more than 120 professional
associations, scientific societies, universities, and research
institutions.
CAHT-BSSR would like to thank the Subcommittee and the Congress for
their continued support of the NIH. Strong sustained funding is
essential to national priorities of better health and economic
revitalization. Providing adequate resources in fiscal year 2012 that
allow the NIH to keep up with the rising costs of biomedical,
behavioral, and social sciences research will help NIH begin to prepare
for the era beyond recovery. We recognize that these are difficult
times for our Nation, but at the same time, it is essential that
funding in fiscal year 2012 and beyond allow the agency to resume
steady, sustainable growth of the foundation of knowledge built through
NIH-funded research at more than 3,000 universities, medical schools,
teaching hospitals, and research institutions. CAHT-BSSR supports the
NIH fiscal year 2012 request of $31.7 billion, at a minimum, and joins
the Ad Hoc Group for Medical Research in its request for $35 billion in
funding for NIH in fiscal year 2012.
NIH Behavioral and Social Sciences Research.--NIH supports
behavioral and social science research throughout most of its 27
institutes and centers. The behavioral and social sciences regularly
make important contributions to the well-being of this Nation. Due in
large part to the behavioral and social science research sponsored by
the NIH, we are now aware of the enormous contribution behavior makes
to our health. At a time when genetic control over diseases is
tantalizingly close but not yet possible, knowledge of the behavioral
influences on health is a crucial component in the Nation's battles
against the leading causes of morbidity and mortality: obesity, heart
disease, cancer, AIDS, diabetes, age-related illnesses, accidents,
substance use and abuse, and mental illness.
As a result of the strong congressional commitment to the NIH in
years past, our knowledge of the social and behavioral factors
surrounding chronic disease health outcomes is steadily increasing. The
NIH's behavioral and social science portfolio has emphasized the
development of effective and sustainable interventions and prevention
programs targeting those very illnesses that are the greatest threats
to our health, but the work is just beginning.
From global warming to unlocking the secrets of memory; from self
destructive behavior, such as addiction, to lifestyle factors that
determine the quality of life, infant mortality rate and longevity; the
grandest challenge we face is understanding the brain, behavior, and
society. Nearly 125 million Americans are living with one or more
chronic conditions, like heart disease, cancer, diabetes, kidney
disease, arthritis, asthma, mental illness and Alzheimer's disease.
Significant factors driving the increase in healthcare spending in the
United States are the aging of the U.S. population, and the rapid rise
in chronic diseases, many of which can be caused or exacerbated by
behavioral factors. Obesity may be the result of sedentary behavior and
poor diet; and addictions, resulting in health problems caused by
tobacco and other drug use. Behavioral and social sciences research
supported by NIH is increasing our knowledge about the factors that
underlie positive and harmful behaviors, and the context in which those
behaviors occur.
CAHT-BSSR continues to applaud the Congress' and NIH's recognition
that the ``scientific challenges in developing an integrated science of
behavior change are daunting.'' The agency's efforts to launch the
basic behavioral and social science research trans-NIH initiative,
Opportunity Network for Basic Behavioral and Social Sciences Research
(OppNet), likewise, is applauded. OppNet is designed to examine the
important scientific opportunities that cut across the structure of NIH
and designed to look for strategic opportunities to build areas of
research where there are gaps that have the potential to affect the
missions of multiple institutes and centers. Research results could
lead to new approaches for reducing risky behaviors and improving
health.
Equally, we commend the agency's support of the ``Science of
Behavior Change'' Common Fund Initiative included in the third cohort
of research areas for the Common Fund. We agree with the goals of this
Common Fund Pilot to ``establish the groundwork for a unified science
of behavior change that capitalizes on both the emerging basic science
and the progress already made in the design of behavioral interventions
in specific disease areas. By focusing basic research on the
initiation, personalization, and maintenance of behavior change, and by
integrating work across disciplines, this Common Fund effort and
subsequent trans-NIH activity could lead to an improved understanding
of the underlying principles of behavior change. This should drive a
transformative increase in the efficacy, effectiveness, and (cost)
efficiency of many behavioral interventions.''
With the recent passage of healthcare reform legislation, there has
been the accompanying and appropriate attention to the issue of
personalized healthcare. CAHT-BSSR believes that personalization needs
to reflect genes, behaviors, and environments. And as the agency has
acknowledged with its recent support of the Science of Behavior Change
initiative, assessing behavior is critical to helping individuals see
how they can improve their health. It is also critical to helping
healthcare systems see where to put resources for behavior change.
Fortunately, the NIH acknowledges the need to focus less on finding the
``magic answer'' and, at the same time, recognizes that healthcare is
different from region to region across the country. Full
personalization needs to consider the environmental, community, and
neighborhood circumstances that govern how individuals' genes and
behavior will influence their health. For personalized healthcare to be
realized, we need a sophisticated understanding of the interplay
between genetics and the environment, broadly defined.
In fiscal year 2012, NIH priorities include establishment of the
National Center for Advancing Translational Sciences (NCATS) intended
to align and bring together a number of trans-NIH programs that do not
have a specific disease focus in one organization. As with development
of more effective drugs, surgical techniques and medical devices, the
development of more powerful health-related behavioral interventions is
dependent on improving the understanding of human behavior, and then
translating that knowledge into new and more effective interventions
with enduring effects. It is critical that the NIH support for
translational research extends to translation research designed to
adapt findings from basic behavioral and/or social science research to
develop behavioral interventions directed at improving health-related
behaviors such as adequate physical activity and nutrition, learning
and learning disabilities, and preventing or reducing health-risking
behaviors including tobacco, alcohol, and/or drug abuse, and
unprotected sexual activity. CAHT-BSSR strongly believes that the
translation of behavioral interventions is a critical part of the NCATS
initiative and must be accompanied by sufficient staff expertise and
resources to manage research on the translation of behavioral
interventions into communities.
CAHT-BSSR applauds the NIH's recognition of a unique and compelling
need to promote diversity in health-related research. The agency
expects these efforts to lead to: the recruitment of the most talented
researchers from all groups; an improvement in the quality of the
educational and training environment; a balanced perspective in the
determination of research priorities; an improved ability to recruit
subjects from diverse backgrounds into clinical research; and an
improved capacity to address and eliminate health disparities. Numerous
studies provide evidence that the biomedical and educational enterprise
will directly benefit from broader inclusion.
NIH recognizes that developing a more diverse and academically
prepared workforce of individuals in STEM (science, technology,
engineering, and math) disciplines will benefit all aspects of
scientific and medical research and care. CAHT-BSSR applauds the
agency's recognition that, to remain competitive in the 21st century
global economy, the Nation must foster new opportunities, approaches,
and technologies in math and science education.
This recognition extends to the need for a coordinated effort to
bolster STEM education nationwide, starting at the earliest stages in
education. Unfortunately, the narrow perception of ``science''
persists, and the social and behavioral sciences are often excluded in
discussion of STEM issues and remain outside of the science education
curriculum. The considerable activity on STEM education provides the
opportunity to improve the recognition of social and behavioral
sciences as ``science.''
In 2010, the NIH commissioned the Institute of Medicine (IOM) to do
a study surrounding LGBT (lesbian, gay, bisexual, and transgender)
health issues, research gaps and opportunities. The recently released
study, The Health of Lesbian, Gay, Bisexual, and Transgender People,
examined the current state of knowledge on LGBT health, including
general health concerns and health disparities, identified research
gaps and opportunities; and outlined a research agenda which reflects
the most pressing areas, specifically demographic research, social
influences, healthcare inequities, intervention research, and
transgender-specific health needs.
NIH OFFICE OF BEHAVIORAL AND SOCIAL SCIENCES RESEARCH
The NIH Office of Behavioral and Social Sciences Research (OBSSR),
authorized by Congress in the NIH Revitalization Act of 1993 and
established in 1995, serves as a convening and coordinating role among
the institutes and centers at NIH. In this capacity, OBSSR develops,
coordinates, and facilitates the social and behavioral science research
agenda at NIH; advises the NIH director and directors of the 27
institutes and centers; informs NIH and the scientific and lay publics
of social and behavioral science research findings and methods; and
trains scientists in the social and behavioral sciences. For fiscal
year 2012, CAHT-BSSR supports a budget of $38.2 million for OBSSR. This
sum reflects the Administration's request of $28 million for OBSSR and
includes the $10 million needed to support the NIH-wide commitment to
carry out OppNet, an initiative strongly supported by the Subcommittee.
The OppNet initiative has made significant progress since its start.
Thus far, OppNet has awarded 35 competitive revisions to add basic
science projects to existing research project grants. Eight competitive
revisions to Small Business Innovation Research/Small Business
Technology and Transfer projects have been awarded. OppNet has also
provided the much-needed training in basic social and behavioral
sciences research.
In fiscal year 2012, OBSSR intends partner with the NIH institutes
and centers and other Federal agencies to fund Mobile Technology
Research (mHealth) to Enhance Health. Recent advances in mobile
technologies and the use of these technologies in daily life have
created opportunities for research applications that were not
previously possible, such as assessing behavioral and psychological
states in real time. To make use of this technology as effective as
possible there is a need to integrate the behavioral, social sciences,
and clinical research fields. The NIH mHealth Summer Institute is
designed to address the lack of integration of these fields.
Over the years, OBSSR has sponsored summer training institutes for
scientists interested in social and behavioral science research areas.
The interest in these training sessions have been overwhelming and have
exceeded the Office's capacity to provide the opportunity for
scientists and researchers to gain critical training in these areas.
These institutes include training in: systems science methodology and
health; randomized clinical trials involving behavioral interventions;
dissemination and implementation research in health; and mobile health.
The Dissemination and Implementation Research in Health training
institute, for example, features a faculty of leading experts from a
variety of behavioral and social science disciplines and is designed to
empower scientists to conduct this research. Drawing from these
disciplines, dissemination and implementation research uses approaches
and methods that in the past have not been taught comprehensively in
most graduate degree programs. Given the demand for the training these
institutes provide and the potential this research has for propelling
the science forward, CAHT-BSSR believes that greater collaboration with
the NIH institutes and centers is needed to meet the demand.
CAHT-BSSR would be pleased to provide any additional information on
these issues. Below is a list of coalition member societies. Again, we
thank the Subcommittee for its generous support of the National
Institutes of Health and for the opportunity to present our views.
CAHT-BSSR
American Association of Geographers
American Educational Research Association
American Psychological Association
American Sociological Association
Association of Population Centers
Consortium of Social Science Associations
Council on Social Work Education
Federation of Associations in Behavioral & Brain Sciences
National Association of Social Workers
National Communication Associations
Population Association of America
Society for Behavioral Medicine
Society for Research in Child Development
The Alan Guttmacher Institute (AGI)
______
Prepared Statement of the Coalition of Heritable Disorders of
Connective Tissue
Chairman Tom Harkin, Chairman, and Richard Ranking Member Shelby,
and members of the Subcommittee: the Coalition of Heritable Disorders
of Connective Tissue thanks you for the opportunity to submit testimony
regarding the fiscal year 2012 budget for the National Heart, Lung and
Blood Institute (NHLBI), the National Institute of Arthritis,
Musculoskeletal and Skin Diseases, (NIAMS), and the NIH Office of
Research Information Services/Office of Extramural Research. We are
extremely grateful for the Subcommittee's strong support of the NIH,
particularly as it relates to life threatening genetic disorders such
as Heritable Disorders of Connective Tissue. Thanks to your leadership,
we are at a time of unprecedented hope for patients with these
diseases.
It is estimated that over 1 million people in the United States are
affected by Heritable Disorders of Connective Tissue (HDCT). These
disorders manifest themselves in many areas of the body, including the
heart, eyes, skeleton, lungs and blood vessels. Connective tissue is
the ``glue'' that holds the body together. These disorders are
progressive conditions caused by genetic mutations and cause
deterioration in each of these body systems. The most life-threatening
are those which affect the aorta and the heart--the most disabling are
orthopedic and ophthalmological.
Some 60 years ago, Victor McKusick, the ``father'' of modern
medical genetics, described and coined the term ``heritable disorders
of connective tissues.'' These disorders included over 200 such rare
disorders, among which were the Marfan syndrome, Weill-Marchesani
syndrome, Ehlers-Danlos syndrome, Cutis Laxa, Osterogenesis imperfecta,
the chondrodysplasias, and Pseudoxanthoma elasticum (Heritable
Disorders of Connective Tissue, McKusick, Va 1972).
Awareness of these disorders has grown through the years due to
collaborative research. Clues to the underlying causes of these
diseases were obtained from the major manifestations found in the
connective tissue and elaboration of connective tissue pathways
involving identified disease genes and their protein products uncovered
additional disease genes with related connective tissue manifestations.
Identification of disease genes have led to surprising new information
regarding important connective tissue pathways depending on the history
of the particular disorder. Thus, the concept of the heritable
disorders of connective tissue have reiterated and epitomized important
lessons regarding how the connective tissue integrates cellular and
organ function.
National Heart Lung and Blood Institute
Thanks to research funded by the NHLBI, we have seen amazing
responses to HDCT disorders with cardiovascular disease. In the 1960s
there was no intervention available, not even surgery for heart defects
and dissection, this before the development of the ``heart-lung''
machine. It was not so long ago, when in the early 1960s, a 13 year old
girl with Marfan syndrome was sent home from the hospital to die since
there was no surgical intervention possible for her dissecting
aneurysm. Early on, surgery required replacing the aortic valve with an
animal's heart, further research used a mechanical valve, and then came
the sturdy composite graft, which became the ``Cadillac'' of surgical
repair. Although the valve sparing method was used throughout this
time, it has been continually improved to address the compromised
tissue regarding longevity. Now we are seeing additional
``translational'' clinical trials, which look at therapies for
prevention as well as surgical response. It is important to remember
these amazing leaps and bounds in medical, surgical and technological
advancement.
NHLBI support has been essential in promoting research
collaboration. The Pediatric Heart Network, a cooperative network of
pediatric cardiovascular clinical research centers, serves as a data
coordinating center to promote the exchange of information to evaluate
therapeutic and management strategies for children and adults with
congenital and genetic heart defects.
NHLBI funded Clinical Trials in the use of Losarton have led to
exciting new findings and pointed the way in future research
directions. It has inspired current concepts of architectural and
signaling pathways underlying the various heritable disorders of
connective tissue in order to integrate these concepts in new
productive ways. For example, can the recent advances in treating
Marfan syndrome with TGF beta inhibitors and Losarton be applied to
other heritable disorders of connective tissue? Does TGF beta signaling
play pathological roles in other disorders? For another example, is
there an important adhesion junction of architectural pathway that
connects the vascular smooth muscle cell to the extracellular matrix?
And, again: How do cell surface receptors (integrin and growth factor
receptors) coordinate architectural and signaling pathways in
connective tissue disorders? All pointing to future research avenues.
National Institute of Arthritis, Musculoskeletal and Skin Diseases
The collaboration of NHLBI and NIAMS has provided an even greater
overview of the information gleaned from the Losarton clinical trial
and a global view of these mult-system disorders. The muscular and
orthopedic involvement is being addressed by the NIAMS. Through NIAMS
support, there is a meeting in July, which is devoted to
``Translational'' avenues grown of current research progress in the
understanding of heritable disorders of connective tissue. Great
progress in the understanding of HDCT has been made over the past 15
years through NIAMS supported workshops on Heritable Disorders of
Connective Tissue. Symposia have been convened in 1990, 1995, and 2000.
In 1990 and 1995, the emphasis was on finding the genes for the various
heritable disorders and understanding whether mutations could be
correlated with specific phenotypes. Many of these goals have been met,
due to research supported in large part by the NIAMS. In 2000, meeting
themes were intentionally broader, focusing on multidisciplinary
approaches and common themes in matrix biology in order to (1) promote
a better understanding of pathogenesis of connective tissue disorders,
(2) stimulate new collaborations between investigators, and (3)
identify areas in which rapid progress could be made. In the decade
since the 2000 Workshop, tremendous progress has been made, leading
notably to new therapies. An example of this is Marfan syndrome, for
which a clinical trial is underway to test for a therapy, which may
prove to play a pivotal role in preventing heart disease. Epidermolysis
bullosa is another disease--for which a research has improved prospects
for new therapies, as well as for a number of other heritable disorders
of connective tissue.
Research has emphasized an understanding of the role of cells in
developing treatments for connective tissue disorders. The success of
bone marrow transplantation in treating Epidermolysis Bullosa has
called attention to this area. While connective tissue researchers have
been interested in stem cell treatments--Osteogenesis imperfecta, for
example--more discussion and emphasis in this area are needed.
The impact of this collaboration between these similar disease
entities in heritable disorders of connective tissue continues to be of
major importance. We are moving rapidly from the ``bench to the
patient,'' from basic research to the important translational benefit
of research findings to treatments which directly benefit the patient.
The collaboration between the basic research and clinical studies is
what we are able to focus on in these disorders for the benefit of all
disease groups.
NIH/Office of Research Information Services/Office of Extramural
Research--RePorter
The National Institute of Health (NIH) has established the NIH
RePorter, or research/condition/disease category (RCDC) which provides
easy retrieval of information on scientific projects and studies. This
excellent new tool provides information on research results, expediting
access and the avoidance of duplication and is located in the Office of
Research Information Services/Office of Extramural Research. It
provides access to research information on all disease groups. We urge
the inclusion of the category ``Heritable Disorders of Connective
Tissue'' (HDCT) in order to facilitate the exchange of information in
the research community of these similar disorders.
What is so important about the study of these disorders is their
very complexity--with genetic origins, requiring basic science for
understanding, and clinical trials in order to maximize the
translational advantages of this research. The mutations of HDCT affect
all body systems and require particular depth of investigation. This
very complexity informs the researcher, as well as contributes to the
understanding of other more common disorders. Research on these
disorders in all of the body systems, will ``spill'' over into research
into many of the categories identified in both the short range and the
long range strategic plans for NHLBI and NIAMS, and provide benefits
for many diseases beyond the scope of HDCT.
About the Coalition of Heritable Disorders of Connective Tissue (CHDCT)
The CHDCT is a nonprofit voluntary health organization founded in
1989, dedicated to saving lives and improving the quality of life for
individuals and families affected by any 1 of the over 200 Heritable
Disorders of Connective Tissue. The mission is to raise awareness of
these disabling and often deadly disorders and to support and promote
research and collaboration between researchers in the field.
We thank you for this opportunity to thank the Committee for its
past support and to voice the interests and concerns of the CHCDT
member organizations relating to future priorities of NHLBI and the
NIAMS.
______
Prepared Statement of the Commissioned Officers Association of the U.S.
Public Health Service
On behalf of the Commissioned Officers Association of the U.S.
Public Health Service, Inc. (COA), and in the context of the
President's fiscal year 2012 budget request, I respectfully ask to
submit this statement for the record. I speak for our Association's
members, all of whom are active-duty or retired officers of the
Commissioned Corps of the U.S. Public Health Service (USPHS).
We respectfully make two funding requests: Support for a pilot
program to recruit and train public health doctors, dentists, and
nurses for careers in the Commissioned Corps of the U.S. Public Health
Service (USPHS), and support for the establishment of a USPHS Ready
Reserve component. Congress authorized both programs last year, and
directed the Department of Health and Human Services to implement them.
U.S. PUBLIC HEALTH SCIENCES TRACK
First, we ask this subcommittee to approve $30 million to establish
a scaled-back version of the public health workforce training program
for would-be USPHS officers that was authorized by the Patient
Protection and Affordable Care Act (Public Law 111-148). This pilot
program would be based first at the Uniformed Services University of
the Health Sciences (USUHS), which is the dedicated medical school and
research institute for uniformed services personnel (Army, Navy, Air
Force, Public Health Service.) Additional schools would be selected by
the Surgeon General as provided for in law.
Background and Rationale
USPHS health professionals serve the health needs of the Nation's
most underserved populations. They also serve side-by-side with Armed
Forces personnel at home and abroad, on joint training missions, and
even in forward operating bases in combat zones. USPHS psychiatric
nurses have treated injured soldiers under fire in Afghanistan. At
home, USPHS psychologists and other mental health specialists have been
detailed to the military to treat returning soldiers and Marines
suffering from traumatic brain injury and post-traumatic stress
disorder. The PHS Commissioned Corps is a public health and national
security force multiplier.
The original proposal, set forth in Section 5315 of PPACA, would
have established a ``U.S. Public Health Sciences Track'' providing for
a total of 850 annual scholarships for medical, dental, nursing, and
public health students who commit to public service careers in the
USPHS. Such a program would be the first of its kind, the first
dedicated pipeline into the USPHS Commissioned Corps.
Funding
The PPACA provisions authorizing the U.S. Public Health Sciences
Track also identified an existing source of funds within the Department
of Health and Human Services (DHHS). Support was to come from the
Public Health and Social Services Emergency Fund. The law directed the
DHHS Secretary to ``transfer from the Public Health and Social Services
Emergency Fund such sums as may be necessary'' (Sec. 274). The language
in the PPACA is clear and straightforward, but, for reasons unknowable
to this Association, the directed funding transfer has not occurred.
USPHS READY RESERVE
This Association's second request is for sufficient funding to
establish a Ready Reserve component within the USPHS Commissioned
Corps. We ask the subcommittee to appropriate $12,500,000 annually
through fiscal year 2014 for this purpose. Creation of a USPHS Ready
Reserve was approved by Congress last year as part of the PPACA
(Section 5210). Lawmakers wanted to bring the structure of the USPHS
into line with that of its sister services in the Department of
Defense; that objective is articulated several times in the text of the
legislation.
The text of the law speaks to congressional intent with unusual
specificity. Lawmakers wanted to establish a USPHS Ready Reserve Corps
``for service in time of national emergency;'' that is, to enhance the
capability of the USPHS to respond to natural disasters, terrorist
incidents, and other public health emergencies ``both foreign and
domestic.'' This reflects the growing realization that protection of
the public's health is a fundamental component of national security.
Congress intended that USPHS Ready Reserve personnel would be
``available on short notice.'' They would be ``available and ready for
involuntary calls to active duty during national emergencies and public
health crises.'' They would be available for ``backfilling critical
positions left vacant'' when active-duty USPHS personnel are deployed
in response to public health emergencies, both foreign and domestic''
and, finally, they would also ``be available for service assignments in
isolated, hardship, and medically underserved communities.'' Absent the
appropriated funding necessary to meet these legal obligations, the
Nation has no public health emergency response capacity.
CONCLUSION
This Association recognizes, of course, that start-up and even
continued funding of various provisions of PPACA are a matter of
ongoing debate and very much in doubt. But these two provisions--
creation of a USPHS Ready Reserve and establishment of a pilot program
at USUHS--warrant broad bipartisan support. They are modest, practical,
and well thought-through, and they speak to the short-term and long-
term national security needs of this country.
I would be pleased to expand on these points or to answer any
questions. I can be reached at the COA offices at 301-731-9080, ext.
211.
______
Prepared Statement of the Council of Academic Family Medicine
On behalf of the Council of Academic Family Medicine (CAFM)
(Association of Departments of Family Medicine, Association of Family
Medicine Residency Directors, North American Primary Care Research
Group, and Society of Teachers of Family Medicine), we are pleased to
submit testimony on behalf of several programs under the jurisdiction
of the Health Resources and Services Administration (HRSA) and the
Agency for Healthcare Research and Quality (AHRQ). We thank you for
your continued support for programs that encourage the development of
primary care physicians to serve our countries healthcare needs. Your
fiscal year 2011 committee passed budget was encouraging as a signal of
your recognition for the need to invest in these important health
professions and workforce programs.
Members of both parties agree there is much that must be done to
support primary care production and nourish the development of a high
quality, highly effective primary care workforce to serve as a
foundation for our healthcare system. Providing strong funding for
these programs is essential to the development of a robust workforce
needed to provide this foundation.
Primary Care Training and Enhancement
The Primary Care Training and Enhancement Program (Title VII
Section 747 of the Public Health Service Act) has a long history of
providing indispensible funding for the training of primary care
physicians. With each successive reauthorization, Congress has modified
the Title VII health professions programs to address relevant workforce
needs. The most recent authorization directs the Health Resources and
Services Administration (HRSA) to prioritize training in the new
competencies relevant to providing care in the patient-centered medical
home model. It also calls for the development of infrastructure within
primary care departments for the improvement of clinical care and
research critical to primary care delivery, as well as innovations in
team management of chronic disease, integrated models of care, and
transitioning between healthcare settings.
Key advisory bodies such as the Institute of Medicine (IOM) and the
Congressional Research Service (CRS) have also called for increased
funding. The IOM (December 2008) pointed to the drastic decline in
Title VII funding and described these health professions workforce
training programs as ``an undervalued asset.'' The CRS found that
reduced funding to the primary care cluster has negatively affected the
programs during a time when more primary care is needed (February
2008).
According to the Robert Graham Center, (Title VII's decline:
Shrinking investment in the primary care training pipeline, Oct. 2009),
``the number of graduating U.S. allopathic medical students choosing
primary care declined steadily over the past decade, and the proportion
of minorities within this workforce remains low.'' Unfortunately, this
decline coincides with a decline in funding of primary care training
funding--funding that we know is associated with increased primary care
physician production and practice in underserved areas. The report goes
on to say that ``the Nation needs renewed or enhanced investment in
programs like Title VII that support the production of primary care
physicians and their placement in underserved areas.''
Title VII has a profound impact on States across the country and is
vital to the continued development of a workforce designed to care for
the most vulnerable populations and meet the needs of the 21st century.
Attached are just a few examples of the impact Title VII has across the
country in States like Alabama, Kansas, Ohio, Rhode Island, Tennessee,
Texas, and Washington. Included are examples of opportunities lost
through the lack of robust funding for the program.
We urge the Congress to appropriate at least $140 million for the
health professions program, Primary Care Training and Enhancement
authorized under Title VII, Section 747 of the Public Health Service
Act in fiscal year 2012 as requested in the President's budget.
Rural Physician Training Grants
``Rural Physician Training Grants,'' Title VII Section 749B of the
Public Health Service Act, were developed to increase the supply of
rural physicians by authorizing grants to medical schools which
establish or expand rural training. The program would provide grants to
produce rural physicians of all specialties. It would help medical
schools recruit students most likely to practice medicine in
underserved rural communities, provide rural-focused training and
experience, and increase the number of medical graduates who practice
in underserved rural communities.
According to a July 2007 report of the Robert Graham Center
(Medical school expansion: An immediate opportunity to meet rural
healthcare needs), data show that although 21 percent of the U.S.
population lives in rural areas, only 10 percent of physicians practice
there. The Graham Center study describes the educational pipeline to
rural medical practice as ``long and complex.'' There are multiple
tactics needed to reverse this situation, and this grant program
includes several of them. Strategies to increase the number of
physicians practicing in rural areas include ``increasing the number of
rural-background students in medical school, selecting the ``right''
students and giving them the ``right'' content and experiences to train
them for rural practice.'' This is exactly what this grant program is
designed to do.
We request the Committee provide the fully authorized amount of $4
million in fiscal year 2012 for Title VII Section 749B Rural Physician
Training Grants.
Teaching Health Centers
Teaching Health Centers (THC) are community health centers or other
similar venues that sponsor residency programs and provide residents
with their ambulatory training experiences in the health center. This
training in the community, rather than solely at the hospital bedside
is one of the hallmarks of family medicine training. However, payment
issues have always caused a tension and struggle between the hospital,
which currently receives reimbursement for residents it sponsors when
they train in the hospital, and programs that require training in non-
hospital settings. This program is designed to provide residency
programs and community health centers grant funding to plan for a
transition in sponsorship, or the establishment of new programs. There
are already 11 community-based entities from states across the country
that have committed to train 44 primary care residents, demonstrating
early success in this program.
We are pleased that THC's operations are currently funded through a
mandatory appropriations trust fund of $230 million over 5 years, and
it is essential that these important centers continue to be funded
through this mandatory appropriation. Despite the positive impact that
family medicine and other primary care residency training programs have
on those community-based entities that initiate them, a multitude of
challenges make it clear that many of these entities would have
difficulty doing the same without adequate and predictable financing.
Converting this program to discretionary funding also would deter other
entities from making the business decisions necessary to expand
residency training (e.g., securing commitments from key stakeholders to
agree to train new or additional residents, applying for accreditation
if not already part of an eligible consortia, and hiring new faculty)
since funding over the next few years would be subject to the annual
appropriations process.
Teaching Health Center Development Grants
If this program is to be effective, there must be funds for the
planning grants to establish newly accredited or expanded primary care
residency programs. Teaching Health Center Development Grants are
important to help establish these innovative programs.
We recommend the Committee appropriate the full authorized amount
for the new Title VII Teaching Health Centers development grants of at
least $10 million for fiscal year 2012.
AHRQ
Research related to the most common acute, chronic, and comorbid
conditions that primary care clinicians care for on a daily basis is
lacking. Research in these areas is vital because the overall health of
a population is directly linked to the strength of its primary
healthcare system. AHRQ supports research to improve healthcare
quality, reduce costs, advance patient safety, decrease medical errors,
and broaden access to essential services. This research is key to
helping create a robust primary care system for our Nation--one that
delivers higher quality of care and better health while reducing the
rising cost of care. Despite this need, little is known about how
patients can best decide how and when to seek care, introduce and
disseminate new discoveries into real life practice, and how to
maximize appropriate care. Ample funding for AHRQ can help researchers
address these problems confronting our health system today.
We recommend the Committee fund AHRQ at a level of at least $405
million for fiscal year 2012
Primary Care Extension Program
The Primary Care Extension Program was modeled after the successful
United States Agriculture Extension Service. This program, under Title
III of the Public Health Service Act, is designed to support and assist
primary care providers with the adoption and incorporation of
techniques to improve community health. As the authors of an article
describing this concept (JAMA, June 24, 2009) have stated, ``To
successfully redesign practices requires knowledge transfer,
performance feedback, facilitation, and HIT support provided by
individuals with whom practices have established relationships over
time. The farming community learned these principles a century ago.
Primary care practices are like small farms of that era, which were
geographically dispersed, poorly resourced for change, and inefficient
in adopting new techniques or technology but vital to the Nation's
well-being.''
Congress agreed with the authors that ``practicing physicians need
something similar to the agricultural extension agent who was so
transformative for farming,'' and authorized this program at $120
million for fiscal year 2011 and 2012.
We recommend the Committee fund the Primary Care Extension program
at the authorized level of $120 million for fiscal year 2012.
Title VII Testimonials from the field
Brown University.--``Our Title VII grant is devoted to training
students in the care of the underserved. In our first year, we have
already recruited two new Community Health Center clinical training
sites for our medical students. Our first student at one of the two
sites decided, after his family medicine rotation, to change his career
path from Urology to Family Medicine.'' An additional grant has allowed
for the development of a curriculum centered around the Patient
Centered Medical Home and Practice transformation and has started
transforming family medicine practices in Rhode Island. David Anthony,
Director of Medical School Education, and Jeffrey Borkan, MD, PhD,
Chair, Department of Family Medicine
East Tennessee State University.--We were able to use a Title VII
grant to establish health fairs, including health screening exams, for
rural and underserved communities in northeast Tennessee and southwest
Virginia. We started small, but now there are 6 health fairs per year,
including 2-3 days per event. During the fairs, the average number of
visits per site is 180 and we estimate 27,000 visits in 11 years (1999-
2010). John Franko MD, Chair and Professor, Department of Family
Medicine
The Ohio State University.--With Title VII grants, ``We were able
to establish a four-track university program--university, academic,
urban, and rural, which allowed us to provide a unique training
experience involving a diverse population. We have been able to
successfully match students in all tracks. We have also been able to
provide primary care to the community in settings that were previously
physician shortage areas. Finally, we were able to develop training
modules for community medicine that address real issues, such as
domestic violence, alcohol and substance abuse, teenage pregnancy,
obesity, etc.'' W. Fred Miser, MD, Associate Professor of Family
Medicine
University of Kansas School of Medicine.--The school applied for
but did not receive funding for a program designed to help educate
volunteer community physician educators. 29 percent of Kansas Medical
students go into family medicine but the school has struggled with
faculty development education, this is necessary to teach our community
physicians the skills necessary to efficiently and effectively teach.
Rick Kellerman MD, Professor and Chair, Department of Family and
Community Medicine
University of South Alabama.--The Department of Family Medicine
applied for but did not receive funding for a program designed to allow
us to train residents in a simulated environment to ensure experiences
with patients with disability, access and mental health problems. Allen
Perkins, MD, MPH, Professor and Char, Department of Family Medicine
University of Texas Health Science Center at San Antonio.--Title
VII grants are helping the program transition to be core transitional
laboratories for the NIH's Clinical and Translational Science Awards
(CTSA) efforts and have helped in getting support for a new a Practice
Based Research Network Resource Center for community engagement. Carlos
Roberto Jaen, MD PhD FAAFP, Professor of Epidemiology and Health
Statistics
WWAMI (a partnership between the University of Washington School of
Medicine and the States of Wyoming, Alaska, Montana, and Idaho).--Title
VII grants have helped fund over 30 faculty positions across the States
of Washington, Wyoming, Alaska, Montana, and Idaho. These grants have
helped fund the development of areas of scholarship for residency
programs in Montana, assisted in the training of fellows that became
Residency Directors at other programs, and funded faculty development
programs delivered with televideo to rural areas in Wyoming. Ardis
Davis MSW,University of Washington Department of Family Medicine,
Teaching Associate
Thomas Jefferson Medical School.--Title VII grants have allowed us
to expand our successful rural Physician Shortage Area and Urban
Underserved Programs, teach all of our students about the Patient
Centered Medical Home in all 4 years of medical school, and train over
1,400 students, residents, and faculty in community medicine and
population health. We have also expanded the infrastructure and rigor
of our research fellowship, doubling the publication outcomes of our
research fellows over the past 2 years. Howard Rabinowitz, Department
of Family and Community Medicine
______
Prepared Statement of the Council on Social Work Education
On behalf of the Council on Social Work Education (CSWE), I am
pleased to offer this written testimony to the Senate Appropriations
Subcommittee on Labor, Health and Human Services, Education, and
Related Agencies for inclusion in the official Committee record. I will
focus my testimony on the importance of fostering a skilled,
sustainable, and diverse social work workforce to meet the healthcare
needs of the Nation through professional education, training and
financial support programs at the Department of Health and Human
Services (HHS) and the Department of Education (ED).
CSWE is a nonprofit national association representing more than
3,000 individual members as well as 650 master's and baccalaureate
programs of professional social work education. Founded in 1952, this
partnership of educational and professional institutions, social
welfare agencies, and private citizens is recognized by the Council for
Higher Education Accreditation (CHEA) as the single accrediting agency
for social work education in the United States. Social work education
focuses students on leadership and direct practice roles helping
individuals, families, groups, and communities by creating new
opportunities that empower people to be productive, contributing
members of their communities.
Social work is rooted in a tradition of social justice, with a
central mission of eliminating inequities by helping vulnerable
populations navigate societal and personal challenges. Social workers
are embedded in a variety of settings, such as schools, hospitals,
Veteran health facilities, rehabilitation centers, social service
agencies, child welfare organizations, assisted living centers, nursing
homes, and faith-based organizations, which allows us to reach diverse
segments of the population and play a significant role in the lives of
Americans from all walks of life. For example, we provide psychosocial
support for individuals and families to help them cope with disease,
such as Alzheimer's disease and cancer; we assist families who struggle
with homelessness and un- or underemployment; we work with families
dealing with domestic violence, including child and spousal abuse; and
we work with children in school or afterschool settings to ensure that
they meet their full academic potential and to help them cope with
issues they may be experiencing in their home lives. As you can see,
social workers have an important role to play in all aspects of daily
life.
Unfortunately, recruitment and retention in social work continues
to be a serious challenge that threatens the workforce's ability to
meet societal needs. The U.S. Bureau of Labor Statistics estimates that
employment for social workers is expected to grow faster than the
average for all occupations through 2018, particularly for social
workers specializing in the aging population and working in rural
areas. In addition, the need for mental health and substance abuse
social workers is expected to grow by almost 20 percent over the 2008-
2018 decade.\1\
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\1\ U.S. Bureau of Labor Statistics. 2009. Occupational Outlook
Handbook, 2010-11 Edition: Social Workers, http://data.bls.gov/cgi-bin/
print.pl/oco/ocos060.htm. Retrieved April 13, 2011.
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Recruitment into the social work profession faces many obstacles,
the most prevalent being low wages coupled with high educational debt.
For example, the median annual wage for child, family, and school
social workers in May 2008 was $39,530, while the wage for mental
health and substance abuse social workers was $37,210. While a
bachelor's degree (BSW) is necessary for most entry-level positions, a
master's degree (MSW) is the terminal degree for social work practice,
which significantly contributes to the debt load of social work
graduates entering careers with low starting wages. According to the
2007-2008 National Postsecondary Student Aid Study conducted by the
National Center for Education Statistics at ED, 72 percent of students
graduating from MSW programs incurred debt to earn their graduate
degree. The average debt was approximately $35,500. The percentage of
MSW students borrowing money is 17 percent higher than the average for
all master's degrees and the amount borrowed is approximately $5,000
higher than the average for all master's degrees. These difficult
realities have made recruitment and retention of social workers an
ongoing challenge.
CSWE understands and appreciates the tough funding decisions
Congress is faced with this year. However, we urge you to consider the
needs of our frontline workforce if we are to see real progress in
meeting the healthcare and societal demands of the Nation. The below
recommendations for fiscal year 2012 would help to ensure that we are
fostering a sustainable, skilled, and diverse workforce that will be
able to keep up with the increasing demand for social work services.
health resources and services administration (hrsa) title vii and title
VIII HEALTH PROFESSIONS PROGRAMS
CSWE urges the Subcommittee to provide $762.5 million for the Title
VII and Title VIII health professions programs at HRSA in fiscal year
2012. HRSA's Title VII and Title VIII health professions programs
represent the only Federal programs designed to train healthcare
providers in an interdisciplinary way to meet the healthcare needs of
all Americans, including the underserved and those with special needs.
These programs also serve to increase minority representation in the
healthcare workforce through targeted programs that improve the
quality, diversity, and geographic distribution of the health
professions workforce. The Title VII and Title VIII programs provide
loans, loan guarantees and scholarships to students, and grants to
institutions of higher education and nonprofit organizations to help
build and maintain a robust healthcare workforce. Social workers and
social work students are eligible for Title VII funding.
The Title VII and Title VIII programs were reauthorized in 2010,
which helped to improve the efficiency of the programs as well as
enhance efforts to recruit and retain health professionals in
underserved communities. Allow me to highlight a few of the programs
that are of critical importance to the training of social workers.
--Mental and Behavioral Health Education and Training.--Recognizing
the severe shortages of mental and behavioral health providers
within the healthcare workforce, a new Title VII program was
authorized in the Patient Protection and Affordable Care Act
(Public Law 111-148). This program--Mental and Behavioral
Health Education and Training Grants--would provide grants to
institutions of higher education (schools of social work and
other mental health professions) for faculty and student
recruitment and professional education and training. The
President's budget request includes $17.9 million for these
grants in fiscal year 2012. This funding would allow for
approximately 10 grants in graduate social work education, 17
grants in graduate psychology education, 12 grants for
professional child and adolescent mental health education, and
6 grants for paraprofessional child and adolescent mental
health. This is the only program in the Federal Government that
is explicitly focused on recruitment and retention of social
workers and other mental and behavioral health professionals.
CSWE strongly urges the Subcommittee to provide $17.9 million
for the Title VII Mental and Behavioral Health Education and
Training Grants in fiscal year 2012.
--Geriatrics Health Professions Training.--Within the overall request
for HRSA's Title VII and Title VIII programs, CSWE urges the
Subcommittee to appropriate $46.5 million for Geriatrics Health
Professions Programs. This includes the Geriatric Academic
Career Incentive Awards (GACA), Geriatric Education Centers
(GEC), and Geriatric Career Incentive Awards. As mentioned
earlier, the reauthorization that occurred last year made
enhancement to the Title VII and Title VIII programs.
Specifically, the reauthorization enhanced the geriatrics
programs to allow additional health professions--such as social
workers and other mental healthcare providers--to participate.
Rapid job growth is anticipated for gerontological social
workers. In fact, the demand for geriatric social workers is
expected to increase by 45 percent by 2015, faster than the
average of all other occupations \2\. Additional funding for
these programs is needed to ensure that the geriatric workforce
is adequately equipped to deal with the aging population, which
is only expected to grow to breaking-point levels within the
next several years.
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\2\ Hooyman, N., and Unutzer, J. 2011. ``A Perilous Arc of Supply
and Semand: How Can America Meet the Multiplying Mental Health Care
Needs of an Again Populations.'' Generations 34 (4): 36-42.
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SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION (SAMHSA)
MINORITY FELLOWSHIP PROGRAM
The goal of the SAMHSA Minority Fellowship Program (MFP) is to
achieve greater numbers of minority doctoral students preparing for
leadership roles in the mental health and substance abuse fields.
According to SAMHSA, minorities make up approximately one-fourth of the
population, but only about 10 percent of mental health providers are
ethnic minorities. CSWE is a grantee of this critical program and
administers funds to exceptional minority social work students. For
fiscal year 2012, CSWE urges the Subcommittee to appropriate $7.5
million to the SAMHSA Minority Fellowship Program. This would include
$6.882 million for the Center for Mental Health Services, where the
majority of MFP funds are administered; $71,000 for the Center for
Substance Abuse Prevention; and $547,000 for the Center for Substance
Abuse Treatment.
The program has helped support doctoral-level professional
education for over 1,000 ethnic minority social workers, psychiatrists,
psychologists, psychiatric nurses, and family and marriage therapists
since its inception. Still, the program continues to struggle to keep
up with the demands that are plaguing our health professions. Severe
shortages of mental health professionals often arise in underserved
areas due to the difficulty of recruitment and retention in the public
sector. Nowhere are these shortages more prevalent than in Indian
Country, where mental illness and substance abuse go largely untreated
and incidences of suicide continue to increase. Studies have shown that
ethnic minority mental health professionals practice in underserved
areas at a higher rate than non-minorities. Furthermore, a direct
positive relationship exists between the numbers of ethnic minority
mental health professionals and the utilization of needed services by
ethnic minorities.
The $7.5 million request would be used to substantially increase
access to professional education and training for additional minority
mental health and substance abuse professionals, in turn helping to
ensure that underserved minority populations receive the mental health
and substance abuse services they so desperately need. President
Obama's fiscal year 2012 budget request includes flat funding for the
MFP at about $4.9 million. Funding the MFP at $7.5 million would
directly encourage more social workers of minority backgrounds to
pursue doctoral degrees in mental health and substance abuse and will
turnout more minority mental health professionals equipped to provide
culturally competent, accessible mental health and substance abuse
services to diverse populations.
DEPARTMENT OF EDUCATION STUDENT AID PROGRAMS
CSWE supports full funding to keep the maximum Pell Grant at $5,550
in fiscal year 2012. While Congress is understandably focused on
identifying a solution that will place the Pell Grant program on solid
ground in regards to its fiscal future, we urge you to remember that
these grants help to ensure that all students, regardless of their
economic situation, can achieve higher education. Moreover, as
described above with regard to the SAMHSA Minority Fellowship Program,
one goal of social work education is recruiting students from diverse
backgrounds (which includes racial, economic, religious, and other
forms of diversity) with the hope that they will return to serve
diverse communities once they have completed their education. In many
cases, this includes encouraging social workers to return to their own
communities and apply the skills they have acquired through their
social work education to individuals, groups, or families in need.
Without support such as Pell Grants, many low-income individuals would
not be able to access higher education, and in turn, would not acquire
skills needed to best serve in the communities that would most benefit
from their service.
The Graduate Assistance in Areas of National Need (GAANN) program
provides graduate traineeships in critical fields of study. Currently,
social work is not defined as an area of national need for this
program; however it was recognized by Congress as an area of national
need in the Higher Education Opportunity Act of 2008. We are hopeful
that ED will recognize the importance of including social work in the
GAANN program in future years. Inclusion of social work would help to
significantly enhance graduate education in social work, which is
critically needed in the country's efforts to foster a sustainable
health professions workforce. CSWE urges the Subcommittee to provide
$31 million for the GAANN Program. However, if social work was to be
added by the Department as a new area of national need, additional
resources would need to be provided so as not to take funding away from
the already determined areas of national need.
Thank you for the opportunity to express these views. Please do not
hesitate to call on the Council on Social Work Education should you
have any questions or require additional information.
______
Prepared Statement of the Crohn's and Colitis Foundation of America
Mr. Chairman and members of the Subcommittee, thank you for the
opportunity to submit testimony on behalf of the 1.4 million Americans
living with Crohn's disease and ulcerative colitis. My name is Gary
Sinderbrand and I have the privilege of serving as the Chairman of the
National Board of Trustees for the Crohn's and Colitis Foundation of
America. CCFA is the Nation's oldest and largest voluntary organization
dedicated to finding a cure for Crohn's disease and ulcerative
colitis--collectively known as inflammatory bowel diseases.
Let me express at the outset how appreciative we are for the
leadership this Subcommittee has provided in advancing funding for the
National Institutes of Health.
Mr. Chairman, Crohn's disease and ulcerative colitis are
devastating inflammatory disorders of the digestive tract that cause
severe abdominal pain, fever and intestinal bleeding. Complications
include arthritis, osteoporosis, anemia, liver disease and colorectal
cancer. We do not know their cause, and there is no medical cure. They
represent the major cause of morbidity from digestive diseases and
forever alter the lives of the people they afflict--particularly
children. I know, because I am the father of a child living with
Crohn's disease.
Seven years ago, during my daughter, Alexandra's sophomore year in
college, she was taken to the ER for what was initially thought to be
acute appendicitis. After a series of tests, my wife and I received a
call from the attending GI who stated coldly: Your daughter has Crohn's
disease, there is no cure and she will be on medication the rest of her
life. The news froze us in our tracks. How could our vibrant, beautiful
little girl be stricken with a disease that was incurable and has
ruined the lives of countless thousands of people?
Over the next several months, Alexandra fluctuated between good
days and bad. Bad days would bring on debilitating flares which would
rack her body with pain and fever as her system sought equilibrium. Our
hearts were filled with sorrow as we realized how we were so incapable
of protecting our child.
Her doctor was trying increasingly aggressive therapies to bring
the flares under control.
Asacol, Steroids, Mercaptipurine, Methotrexate and finally
Remicade. Each treatment came with its own set of side effects and
risks. Every time A would call from school, my heart would jump before
I picked up the call in fear of hearing that my child was in pain as
the flares had returned. Ironically, the worst call came from one of
her friends to report that A was back in the ER and being evaluated by
a GI surgeon to determine if an emergency procedure was needed to clear
an intestinal blockage that was caused by the disease. Several hours
later, a brilliant surgeon at the University of Chicago, removed over a
foot of diseased tissue from her intestine. The surgery saved her life,
but did not cure her. We continue to live every day knowing that the
disease could flare at any time with devastating consequences.
Mr. Chairman, I will focus the remainder of my testimony on our
appropriations recommendations for fiscal year 2012.
RECOMMENDATIONS FOR FISCAL YEAR 2012
Centers For Disease Control And Prevention
Inflammatory Bowel Disease Epidemiology Program
As I mentioned earlier, CCFA estimates that 1.4 million people in
the United States suffer from IBD, but there could be many more. We do
not know the exact number due to the complexity of these diseases and
the difficulty in identifying them. The Centers for Disease Control and
Prevention's Inflammatory Bowel Disease Program is helping answer this
and many other important questions related to these challenging
conditions. This program is the only one of its kind and its
accomplishments have been applauded by the CDC.
CCFA has been a proud partner with CDC in conducting the research
funded under the epidemiology program. For the first 2 years of the
project the Foundation worked collaboratively with Kaiser Permanente in
California to better understand the incidence and prevalence of IBD,
the natural history of the disease, and why patients respond
differently to the same therapy. This research has resulted in 11
publications to date and another 11 papers to be submitted to high-
quality peer-reviewed journals. Topics include but are not limited to
the following:
--Incidence and Prevalence of IBD
--Patterns of Care and Outcomes in IBD
--Qualitative study of provider opinions
--Utilization of biologics (Infliximab)
--Disparities in Mortality
--Myelosuppression during Thiopurine Therapy for Inflammatory Bowel
Disease: Implications for Monitoring Recommendations
--Severity and Flare Algorithms
--Disparities in Surveillance for Colorectal Cancer
--Pediatric Epidemiology
In 2007, our focus shifted to the establishment of the ``Ocean
State Crohn's & Colitis Area Registry'' or OSCCAR. Under the leadership
of Dr. Bruce Sands, this study is being conducted jointly by
investigators at the Massachusetts General Hospital and Rhode Island
Hospital/Brown University. The State of Rhode Island is an excellent
location to conduct a population-based IBD study because; (1) it is a
small State geographically; (2) it has a diverse ethnic and
socioeconomic population that does not tend to migrate out of State:
and (3) a small number of gastroenterologists treat essentially all IBD
patients within the State. Since 2007, Dr. Sands has been able to
recruit virtually all GI physicians in Rhode Island to refer patients
into the study. To date, almost 310 patients have been recruited, 89 of
whom are pediatric patients. All of this progress will be lost if the
program is eliminated in 2012.
The goals of the OSCCAR study moving forward are to: (1) describe
the age and sex adjusted incidence rate of Crohn's disease and
ulcerative colitis; (2) describe variations in presenting symptoms
among children, men and women with newly diagnosed disease; (3)
identify factors that predict resistance to steroids, including
clinical characteristics and blood test markers that could be useful to
treating physicians; (4) identify predictors of the need for surgery;
and (5) describe factors that predict either impaired quality of life
or a benign course of disease. Mr. Chairman, to ensure that this
important epidemiological work moves forward in fiscal year 2012, CCFA
recommends an appropriation of $680,000 (fiscal year 2010 level).
Pediatric Inflammatory Bowel Disease Patient Registry
Mr. Chairman, the unique challenges faced by children and
adolescents battling IBD are of particular concern to CCFA. In recent
years we have seen an increased prevalence of IBD among children,
particularly those diagnosed at a very early age. To combat this
alarming trend CCFA, in partnership with the North American Society for
Pediatric Gastroenterology, Hepatology and Nutrition, has instituted an
aggressive pediatric research campaign focused on the following areas:
--Growth/Bone Development.--How does inflammation cause growth
failure and bone disease in children with IBD?
--Genetics.--How can we identify early onset Crohn's disease and
ulcerative colitis?
--Quality Improvement.--Given the wide variation in care provided to
children with IBD, how can we standardize treatment and improve
patients' growth and well-being?
--Immune Response.--What alterations in the childhood immune system
put young people at risk for IBD, how does the immune system
change with treatment for IBD?
--Psychosocial Functioning.--How does diagnosis and treatment for IBD
impact depression and anxiety among young people? What
approaches work best to improve mood, coping, family function,
and quality of life.
The establishment of a national registry of pediatric IBD patients
is central to our ability to answer these important research questions.
Empowering investigators with HIPPA compliant information on young
patients from across the Nation will jump-start our effort to expand
epidemiologic, basic and clinical research on our pediatric population.
We encourage the Subcommittee to support our efforts to establish a
Pediatric IBD Patient Registry with the CDC in fiscal year 2012.
National Institutes of Health
Throughout its 40 year history, CCFA has forged remarkably
successful research partnerships with the NIH, particularly the
National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK), which sponsors the majority of IBD research, and the National
Institute of Allergy and Infectious Diseases (NIAID). CCFA provides
crucial ``seed-funding'' to researchers, helping investigators gather
preliminary findings, which in turn enables them to pursue advanced IBD
research projects through the NIH. This approach led to the
identification of the first gene associated with Crohn's--a landmark
breakthrough in understanding this disease.
Mr. Chairman, NIDDK-sponsored research on IBD has been a remarkable
success story. In 2008, a consortium of researchers from the United
States, Canada, and Europe identified 21 new genes for Crohn's disease.
This discovery, funded in part by the NIDDK, brings the total number of
known genes associated with Crohn's disease to more than 30 and
provides new avenues for the development of promising treatments. We
are grateful for the leadership of Dr. Stephen James, Director of
NIDDK's Division of Digestive Diseases and Nutrition, for aggressively
pursuing this and other promising areas of research.
CCFA's scientific leaders, with significant involvement from NIDDK,
have developed an ambitious research agenda entitled ``Challenges in
Inflammatory Bowel Diseases.'' In addition, CCFA-affiliated
investigators played a leading role in developing the recommendations
on IBD in the new NIH National Commission on Digestive Diseases
strategic plan. We look forward to working with the NIDDK to advance
the cutting-edge science called for in these two roadmaps.
For fiscal year 2012, CCFA joins with other voluntary patient and
medical organizations in recommending an appropriation of $35 billion
for the NIH. Once again Mr. Chairman, thank you very much for the
opportunity to submit our views for your consideration.
______
Prepared Statement of the Cystic Fibrosis Foundation
On behalf of the Cystic Fibrosis Foundation and the 30,000
Americans with cystic fibrosis (CF), we are pleased to submit the
following testimony with our requests for fiscal year 2012 Labor,
Health and Human Services, and Education Appropriations.
ABOUT CYSTIC FIBROSIS
Cystic fibrosis is a life-threatening genetic disease for which
there is no cure. People with CF have two copies of a defective gene,
known as CFTR, which causes the body to produce abnormally thick,
sticky mucus that clogs the lungs and results in fatal lung infections.
The thick mucus in those with CF also obstructs the pancreas, making it
difficult for patients to absorb nutrients from food.
Since its founding, the CF Foundation has maintained its focus on
promoting research and improving treatments for CF. More than 30 drugs
are now in development to treat CF; some treat the basic defect of the
disease, while others target its symptoms. Through the research
leadership of the Cystic Fibrosis Foundation, people with CF are living
into their 30s, 40s and beyond. This improvement in the life expectancy
for those with CF can be attributed to research advances and to the
teams of CF caregivers who offer specialized care. Although life
expectancy has improved dramatically, we continue to lose young lives
to this disease.
The promise for people with CF lies in research. In the past 6
years, the Cystic Fibrosis Foundation has invested over $1 billion in
its medical programs of drug discovery, drug development, research, and
care focused on life-sustaining treatments and a cure for CF. A greater
investment is necessary, however, to accelerate the pace of discovery
and development of CF therapies.
SUSTAINING THE FEDERAL INVESTMENT IN BIOMEDICAL RESEARCH
This Committee and Congress are to be commended for their support
for biomedical research through the years. It is vital that we continue
to sufficiently fund the NIH, so that it can capitalize on scientific
advances and maintain the momentum generated by the doubling of funds
and the infusion from the American Recovery and Reinvestment Act
(ARRA). These increases in funding brought a new era in drug discovery
that has benefited all Americans.
Cutting discretionary health spending by 13.5 percent, as has been
proposed, would halt this progress. Deep cuts would have a detrimental
effect on the fight against many of our most serious diseases, stifle
scientific opportunities, and result in high-wage job loss in all 50
States. In 2007, NIH grants and contracts created and supported more
than 350,000 jobs across the United States, an important contribution
to the American economy.
We urge this Committee and Congress to maintain robust investment
in biomedical research at the NIH so it can fund critical research
today that will provide the care and cures of tomorrow.
STRENGTHENING CLINICAL RESEARCH AND DRUG DEVELOPMENT
The Cystic Fibrosis Foundation has been recognized for its unique
research approach, which encompasses everything from basic research
through Phase 4 post-marketing monitoring of drug safety, and has
created the infrastructure required to accelerate the development of
new CF therapies. As a result, we now have a pipeline of more than 30
potential therapies that are being examined to treat people with CF.
One such treatment is VX-770, a drug being developed by Vertex
Pharmaceuticals that was discovered in collaboration with CFF. This
promising therapy targets the physiological defect that causes CF in
patients with a particular type of genetic mutation, as opposed to only
addressing symptoms of the disease. In late February 2011 we learned
that Phase 3 clinical trial data of VX-770 showed profound improvements
in lung function and other health measures in CF patients, and a New
Drug Application is expected to be submitted to the FDA for review
later this year. This new treatment is a direct result of the
Foundation's innovative research agenda, advancing from bench to
bedside through the Foundation's research program which speeds the
creation of new CF therapies.
The Foundation is a leader in creating a clinical trials network to
achieve greater efficiency in clinical investigation. Because the CF
population is small, a higher proportion of people with the disease
must partake in clinical trials than in most other diseases. This
unique challenge prompted the Foundation to streamline our clinical
trials processes. As a result, research conducted by the Foundation is
more efficient than ever before and we are a model for other disease
groups.
While the CF Foundation has made great progress in creating a more
efficient drug development process for cystic fibrosis, still more
needs to be done for other rare diseases, many of which have no
treatments available. The Federal Government has the opportunity to
make a real difference in this regard, and we are hopeful that the
Committee will direct the national health agencies to encourage all
investigators and institutions receiving Federal funding to advance
novel methodologies and mechanisms for translating basic research into
therapies that can benefit patients.
Advancing Translational Science
The CF Foundation strongly urges this Committee and Congress to
support funding for NIH's proposed National Center for Advancing
Translational Sciences (NCATS), which will house the Institutes'
existing translational science programs while establishing and
providing a more focused, integrated, and systematic approach for
linking basic discovery to therapeutic development.
The existing programs to be housed under NCATS are integral to
translating basic science into treatments and will benefit from funding
for the new center. These programs include Clinical and Translational
Science Awards (CTSA), discussed in further detail below, and the newly
authorized Cures Acceleration Network (CAN), both designed to transform
the way in which clinical and translational research is conducted and
funded. The Therapeutics for Rare and Neglected Diseases (TRND) program
will also be housed in the new center. NIH Director Collins has
specifically cited the Cystic Fibrosis Foundation's Therapeutics
Development Network (TDN), which plays a pivotal role in accelerating
the development of new treatments for cystic fibrosis patients, as an
exemplar for TRND's innovative therapeutics development model.
The Foundation's investment in pharmaceutical and biotech companies
can also serve as a model for the new center's overall mission. NCATS,
like CFF, will promote public-private partnerships and convene cross-
sector collaborations between industry, government, academia, and
others to advance drug development, as well as provide services and
resources for high throughput screening, assay development, and
preclinical modeling. Prioritizing these initiatives through a
standalone center at NIH has the potential to greatly accelerate the
development of drugs for diseases that have historically received
little pharmaceutical industry attention. In addition, integrating
translational science programs from throughout NIH into one center will
help bring greater efficiency to the Institutes' pursuit of this
important research. Once again, we applaud NIH Director Collins for
spearheading NCATS and look forward to working with him as this new
initiative is implemented.
Clinical and Translational Science Awards (CTSA)
The CTSA program, soon to be housed in NCATS, encourages novel
approaches to clinical and translational research, enhances the
utilization of informatics, and strengthens the training of young
investigators. Key to the success of CTSAs is the parallel maintenance
of infrastructure support for Clinical Research Centers (CRC). Without
a mechanism to offset clinical research costs, young investigators or
Principle Investigators (PIs) studying rare diseases for which there is
limited funding will not be able to continue to conduct clinical
research. It is important that all NIH institutes recognize that there
is a significant cost associated with the conduct of well designed and
safe clinical trials, and not all of these costs can be borne by the
CTSAs. Congress should direct the NIH to cover costs that used to be
borne by the General Clinical Research Centers (GCRCs) through
individual research grants.
Support should also be directed toward the continuation and
expansion of research networks, such as NIH's pediatric liver disease
consortium at the National Institute of Diabetes, Digestive, and Kidney
Diseases (NIDDK). This successful collaboration is helping researchers
discover treatments not only for CF liver disease but for other
diseases that affect thousands of children each year.
SUPPORTING DRUG DISCOVERY
The Cystic Fibrosis Foundation's clinical research is fueled by a
vigorous drug discovery effort comprised of early stage translational
research into successful treatments for this disease. Several research
projects at the NIH will expand our knowledge about the disease, and
could eventually be the key to controlling or curing cystic fibrosis.
Opportunities in Animal Models
The Cystic Fibrosis Foundation is encouraged by the NIH's
investment in a research program at the University of Iowa to study the
effects of CF in a pig model. The program, funded through research
awards from both the National Heart, Lung, and Blood Institute (NHLBI)
and the Cystic Fibrosis Foundation, bears great promise to help make
significant developments in the search for a cure. While a company has
been established to produce the animals, the infrastructure and
extensive animal husbandry required to keep the animals alive and
conduct research on them is available at few academic institutions.
Such barriers have greatly limited widespread adoption of these
valuable research tools. We urge additional funding to create a common
facility that would enable researchers from multiple institutions to
conduct research with these models.
Understanding CFTR Folding and Trafficking
The data that emerged from the VX-770 Phase 2 and 3 clinical
trials, discussed above, is proof that the way in which this drug
targets the physiological defect that causes CF, called CFTR protein
function modulation, is a viable therapeutic approach. However, this
exciting data was obtained from patients with a specific CF mutation
which affects only approximately 4 percent of CF patients. More
research is needed to understand other genetic mutations, the most
common of which is called F508del. F508del causes multiple negative
effects, including misfolding and poor activation properties of the
CFTR protein. We encourage the Committee to increase investment in
genetic research that can help scientists to better understand the
F508del mutation. This will facilitate CF drug discovery and has the
potential to benefit not just those with cystic fibrosis, but also
those with other protein misfolding diseases.
Personalized Medicine
Strong Federal and private investment in research is bringing
personalized medicine into the forefront. As we gain a deeper
understanding of many diseases and their accompanying genetic profiles,
we understand the great challenge of personalizing therapies. While
exciting and promising for patients, it is also expensive, complex, and
scientifically challenging. For instance, CF doctors are facing
difficulties in delivering appropriate care to CF patients, as
insurance providers will not cover certain combinations of medicines
that clinicians have found are effective for cystic fibrosis in
particular when there is no formal clinical data to support it. This
puts patients in a difficult position, as these clinical trials are
expensive and unlikely to be performed by pharmaceutical companies,
especially for treatment of a small, targeted population. As such we
urge the Committee to provide sustained Federal investment in
personalized medicine, to help move this burgeoning field forward and
advance exciting scientific discoveries.
SUPPORTING GREATER ACCESS TO QUALITY HEALTH CARE
We are making remarkable strides in our fight against cystic
fibrosis, but people who live with it face greater obstacles each year,
as high medical costs can prevent them from accessing appropriate
medical care. Healthcare for a CF patient costs $64,000 per year on
average, 15 times more than that of the average person. Because of high
costs, nearly a quarter of CF patients delay getting medical care or
skip treatments their providers recommend to enhance and lengthen their
life.
The Foundation sees some promise in a number of provisions in the
new healthcare reform law that increase access to health insurance
coverage for those with rare and chronic diseases, a critical tool in
decreasing out of pocket costs for patients. These provisions include
those allowing children to remain on their parents' insurance until
they are 26; prohibiting insurance companies from denying or rescinding
coverage based on a pre-existing condition; banning annual and lifetime
caps on coverage; and the expansion of Medicaid eligibility.
The new law is not perfect, however, and we are concerned that
while the provisions listed above will ensure continuity of coverage
and greater access to care for those with CF and other chronic
diseases, more must be done to reduce the financial burden so many
families face in affording their care, especially in these challenging
economic times.
While we urge Congress to explore new options to help make care
more affordable and reduce shifting costs to patients, we ask that
provisions that have the potential to provide desperately needed relief
to people with cystic fibrosis be retained, and that they are
sufficiently funded so that those with rare and chronic diseases can
access the care they need.
In addition, the Foundation wishes to applaud the formation of the
Patient Centered Outcomes Research Institute (PCORI) and urges the
Committee to support this important entity. PCORI, a private non-profit
institute created by the Patient Protection and Affordable Care Act,
will support and direct research that gives patients, doctors, and
others the information they need make informed decisions about the most
effective and appropriate methods for preventing and treating health
conditions. The CF Foundation has had great success in improving
quality of care for cystic fibrosis patients through the development
and administration of a comprehensive patient registry and the
collection of comprehensive data on outcomes and practice patterns for
use in comparative effectiveness research, and we are confident that
dedicating a national institute to such pursuits will improve care for
all Americans.
The Cystic Fibrosis Foundation has devoted our own resources to
developing treatments through drug discovery, clinical development, and
clinical care. Several of the drugs in our pipeline show remarkable
promise in clinical trials and we are increasingly hopeful that these
discoveries will bring us even closer to a cure. However, sufficient
investment in basic science, translational science, clinical research,
and drug development programs at NIH is needed to continue these
successes not only for CF but for all rare diseases. Additionally,
funding for programs that promote access and quality of care will help
achieve a greater quality of life for those living with chronic
diseases like cystic fibrosis.
We urge the Committee to consider these factors as you craft the
fiscal year 2012 Labor, Health and Human Services, and Education
Appropriations legislation, and stand ready to work with NIH and
Congressional leaders on the challenging issues ahead. Thank you for
your consideration.
______
Prepared Statement of the Digestive Disease National Coalition
Summary of Fiscal Year 2012 Recommendations
$35 billion for the National Institutes of Health (NIH) at an
increase of 12 percent over fiscal year 2011. Increase funding for the
National Cancer Institute (NCI), the National Institute of Diabetes and
Digestive and Kidney Diseases (NIDDK) and the National Institute of
Allergy and Infectious Diseases (NIAID) by 12 percent.
Continue focus on digestive disease research and education at NIH,
including the areas of inflammatory bowel disease (IBD), hepatitis and
other liver diseases, irritable bowel syndrome (IBS), colorectal
cancer, endoscopic research, pancreatic cancer, and celiac disease.
$50 million for the Centers for Disease Control and Prevention's
(CDC) hepatitis prevention and control activities.
$50 million for the Center for Disease Control and Prevention's
(CDC) colorectal cancerscreening and prevention program.
Chairman Rehberg, thank you for the opportunity to again submit
testimony to the Subcommittee. Founded in 1978, the Digestive Disease
National Coalition (DDNC) is a voluntary health organization comprised
of 29 professional societies and patient organizations concerned with
the many diseases of the digestive tract. The DDNC promotes a strong
Federal investment in digestive disease research, patient care, disease
prevention, and public awareness. The DDNC is a broad coalition of
groups representing disorders such as Inflammatory Bowel Disease (IBD),
Hepatitis and other liver diseases, Irritable Bowel Syndrome (IBS),
Pancreatic Cancer, Ulcers, Pediatric and Adult Gastroesophageal Reflux
Disease, Colorectal Cancer, and Celiac Disease.
Mr. Chairman, the social and economic impact of digestive disease
is enormous and difficult to grasp. Digestive disorders afflict
approximately 65 million Americans. This results in 50 million visits
to physicians, over 10 million hospitalizations, collectively 230
million days of restricted activity. The total cost associated with
digestive diseases has been conservatively estimated at $60 billion a
year.
The DDNC would like to thank the Subcommittee for its past support
of digestive disease research and prevention programs at the National
Institutes of Health (NIH) and the Centers for Disease Control and
Prevention (CDC).
Specifically the DDNC recommends: $2.16 billion for the National
Institute of Diabetes and Digestive and Kidney Disease (NIDDK); and $35
billion for the NIH.
We at the DDNC respectfully request that any increase for NIH does
not come at the expense of other Public Health Service agencies. With
the competing and the challenging budgetary constraints the
Subcommittee currently operates under, the DDNC would like to highlight
the research being accomplished by NIDDK which warrants the increase
for NIH.
Inflammatory Bowel Disease
In the United States today about 1 million people suffer from
Crohn's disease and ulcerative colitis, collectively known as
Inflammatory Bowel Disease (IBD). These are serious diseases that
affect the gastrointestinal tract causing bleeding, diarrhea, abdominal
pain, and fever. Complications arising from IBD can include anemia,
ulcers of the skin, eye disease, colon cancer, liver disease,
arthritis, and osteoporosis. The cause of IBD is still unknown, but
research has led to great breakthroughs in therapy.
In recent years researchers have made significant progress in the
fight against IBD. The DDNC encourages the subcommittee to continue its
support of IBD research at NIDDK and NIAID at a level commensurate with
the overall increase for each institute. The DDNC would like to applaud
the NIDDK for its strong commitment to IBD research through the
Inflammatory Bowel Disease Genetics Research Consortium. The DDNC urges
the Consortium to continue its work in IBD research. Therefore the DDNC
and its member organization the Crohn's and Colitis Foundation of
America encourage the CDC to continue to support a nationwide IBD
surveillance and epidemiological program in fiscal year 2012.
Viral Hepatitis: A Looming Threat to Health
The DDNC applauds all the work NIH and CDC have accomplished over
the past year in the areas of hepatitis and liver disease. The DDNC
urges that funding be focused on expanding the capability of State
health departments, particularly to enhance resources available to the
hepatitis State coordinators. The DDNC also urges that CDC increase the
number of cooperative agreements with coalition partners to develop and
distribute health education, communication, and training materials
about prevention, diagnosis and medical management for viral hepatitis.
The DDNC supports $50 million for the CDC's Hepatitis Prevention
and Control activities. The hepatitis division at CDC supports the
hepatitis C prevention strategy and other cooperative nationwide
activities aimed at prevention and awareness of hepatitis A, B, and C.
The DDNC also urges the CDC's leadership and support for the National
Viral Hepatitis Roundtable to establish a comprehensive approach among
all stakeholders for viral hepatitis prevention, education, strategic
coordination, and advocacy.
Colorectal Cancer Prevention
Colorectal cancer is the third most commonly diagnosed cancer for
both men and woman in the United States and the second leading cause of
cancer-related deaths. Colorectal cancer affects men and women equally.
The DDNC recommends a funding level of $50 million for the CDC's
Colorectal Cancer Screening and Prevention Program. This important
program supports enhanced colorectal screening and public awareness
activities throughout the United States. The DDNC also supports the
continued development of the CDC-supported National Colorectal Cancer
Roundtable, which provides a forum among organizations concerned with
colorectal cancer to develop and implement consistent prevention,
screening, and awareness strategies.
Pancreatic Cancer
In 2006, an estimated 33,730 people in the United States will be
found to have pancreatic cancer and approximately 32,300 will die from
the disease. Pancreatic cancer is the fifth leading cause of cancer
death in men and women. Only lout of 4 patients will live 1 year after
the cancer is found and only 1 out of 25 will survive 5 or more years.
The National Cancer Institute (NCI) has established a Pancreatic
Cancer Progress Review Group charged with developing a detailed
research agenda for the disease. The DDNC encourages the Subcommittee
to provide an increase for pancreatic cancer research at a level
commensurate with the overall percentage increase for NCI and NIDDK.
Irritable Bowel Syndrome (IBS)
IBS is a disorder that affects an estimated 35 million Americans.
The medical community has been slow in recognizing IBS as a legitimate
disease and the burden of illness associated with it. Patients often
see several doctors before they are given an accurate diagnosis. Once a
diagnosis of IBS is made, medical treatment is limited because the
medical community still does not understand the pathophysiology of the
underlying conditions.
Living with IBS is a challenge, patients face a life of learning to
manage a chronic illness that is accompanied by pain and unrelenting
gastrointestinal symptoms. Trying to learn how to manage the symptoms
is not easy. There is a loss of spontaneity when symptoms may intrude
at any time. IBS is an unpredictable disease. A patient can wake up in
the morning feeling fine and within a short time encounter abdominal
cramping to the point of being doubled over in pain and unable to
function.
Mr. Chairman, much more can still be done to address the needs of
the nearly 35 million Americans suffering from irritable bowel syndrome
and other functional gastrointestinal disorders. The DDNC recommends
that NIDDK increase its research portfolio on Functional
Gastrointestinal Disorders and Motility Disorders.
Digestive Disease Commission
In 1976, Congress enacted Public Law 94-562, which created a
National Commission on Digestive Diseases. The Commission was charged
with assessing the state of digestive diseases in the United States,
identifying areas in which improvement in the management of digestive
diseases can be accomplished and to create a long-range plan to
recommend resources to effectively deal with such diseases.
The DDNC recognizes the creation of the National Commission on
Digestive Diseases, and looks forward to working with the National
Commission to address the numerous digestive disorders that remain in
today's diverse population.
Conclusion
The DDNC understands the challenging budgetary constraints and
times we live in that this Subcommittee is operating under, yet we hope
you will carefully consider the tremendous benefits to be gained by
supporting a strong research and education program at NIH and CDC.
Millions of Americans are pinning their hopes for a better life, or
even life itself, on digestive disease research conducted through the
National Institutes of Health. Mr. Chairman, on behalf of the millions
of digestive disease sufferers, we appreciate your consideration of the
views of the Digestive Disease National Coalition. We look forward to
working with you and your staff.
Digestive Disease National Coalition
The Digestive Disease National Coalition was founded 30 years ago.
Since its inception, the goals of the coalition have remained the same:
to work cooperatively to improve access to and the quality of digestive
disease healthcare in order to promote the best possible medical
outcome and quality of life for current and future patients with
digestive diseases.
______
Prepared Statement of the Dystonia Medical Research Foundation
Summary of recommendations for fiscal year 2012:
--$35 Billion for the National Institutes of Health (NIH) and
concurrent percentage increases across its institutes and
centers.
--Expand dystonia research at NIH through the National Institute on
Neurological Disorders and Stroke (NINDS), the National
Institute on Deafness and other Communication Disorders
(NIDCD), the National Eye Institute (NEI), and the National
Institute on Child Health and Human Development (NICHD).
--Continue to advance dystonia research through partnerships with the
Office of Rare Diseases Research (ORDR) and the Rare Diseases
Clinical Research Network (RDCRN).
--$100 million for the Cures Acceleration Network (CAN)
Dystonia is a neurological movement disorder characterized by
involuntary muscle spasms that cause the body to twist, repetitively
jerk, and sustain postural deformities. Focal dystonia affects specific
parts of the body, while generalized dystonia affects multiple parts of
the body at the same time. Some forms of dystonia are genetic but
dystonia can also be caused by injury or illness. Although dystonia is
a chronic and progressive disease, it does not impact cognition,
intelligence, or shorten a person's life span. Conservative estimates
indicate that between 300,000 and 500,000 individuals suffer from some
form of dystonia in North America alone. Dystonia does not
discriminate, affecting all demographic groups. There is no known cure
for dystonia and treatment options remain limited.
Although little is known regarding the causes and onset of
dystonia, two therapies have been developed and proved particularly
useful to control patients' symptoms. Botulinum toxin (Botox/Myobloc)
injections and deep brain stimulation (DBS) have shown varying degrees
of success alleviating dystonia symptoms. Until a cure is discovered,
the development of management therapies such as these remains vital,
and more research is needed to fully understand the onset and
progression of the disease in order to better treat patients.
Dystonia Research at the National Institutes of Health (NIH)
Currently, dystonia research at NIH is conducted through the
National Institutes on Neurological Disorders and Stroke (NINDS), the
National Institute on Deafness and Other Communication Disorders
(NIDCD), the National Eye Institute (NEI), and the Office of the
Director.
The majority of dystonia research at NIH is conducted through
NINDS. NINDS has utilized a number of funding mechanisms in recent
years to study the causes and mechanisms of dystonia. These grants
cover a wide range of research including the genetics and genomics of
dystonia, the development of animal models of primary and secondary
dystonia, molecular and cellular studies in inherited forms of
dystonia, epidemiology studies, and brain imaging. DMRF works to
support NINDS in conducting critical research and advancing the
understanding of dystonia.
NIDCD has funded many studies on brainstem systems and their role
in spasmodic dysphonia. Spasmodic dysphonia is a form of focal dystonia
which involves involuntary spasms of the vocal cords causing
interruptions of speech and affecting voice quality. In addition, NEI
focuses some of its resources on the study of blepharospasm.
Blepharospasm is an abnormal, involuntary blinking of the eyelids which
can cause blindness due to a patient's inability to open their eyelids.
DMRF encourages partnerships between NINDS, NIDCD and NEI to further
dystonia research.
When ORDR initiated the second phase of the Rare Disease Clinical
Research Network at NIH, they provided funding for an additional 19
grants aimed at studying the natural history, epidemiology, diagnosis,
and treatment of rare diseases. This includes the Dystonia Coalition,
which facilitates collaboration between researchers, patients, and
patient advocacy groups to advance the pace of clinical research on
cervical dystonia, blepharospasm, spasmodic dysphonia, craniofacial
dystonia, and limb dystonia. Working primarily through NINDS and ORDR,
the RDCRN holds great hope for advancing understanding and treatment of
primary focal dystonias.
Treatment for dystonia is highly individualized, and many dystonia
patients do not respond to the current available therapies. The study
of potential dystonia therapies is critical for the community. The
Cures Acceleration Network (CAN) promises to advance the development of
``high need cures,'' particularly by reducing the barriers between
research discovery and clinical trials in areas that the private sector
is unlikely to pursue in an adequate or timely way. DMRF supports this
initiative and asks that it be funded at $100 million, as requested in
the President's budget.
In summary, the DMRF recommends the following for fiscal year 2012:
--$35 billion for NIH and a proportional increase for its Institutes
and Centers.
--Increased portfolio of dystonia research at NIH through the
National Institute on Neurological Disorders and Stroke, the
National Institute on Deafness and Other Communication
Disorders, the National Eye Institute, and the National
Institute on Child Health and Human Development.
--Continued partnerships on dystonia research between the Office of
Rare Diseases Research, other NIH Institutes and Centers, the
Rare Diseases Clinical Research Network, and the dystonia
patient community.
--$100 million for the Cures Acceleration Network
The Dystonia Medical Research Foundation (DMRF)
The Dystonia Medical Research Foundation was founded over 30 years
ago and has been a membership-driven organization since 1993. Since our
inception, the goals of DMRF have remained to advance research for more
effective treatments of dystonia and ultimately find a cure; to promote
awareness and education; and support the needs and well being of
affected individuals and their families.
Thank you for the opportunity to present the views of the dystonia
community, we look forward to providing any additional information.
______
Prepared Statement of the Elder Justice Coalition
The Elder Justice Coalition (EJC) thanks you for providing an
opportunity to submit testimony as you consider an fiscal year 2012
Labor-HHS and Education Appropriations bill. The EJC is a 705 member
strong, non-partisan organization dedicated to advocating for funding
for the Elder Justice Act (EJA), a bipartisan bill authored by Rep.
Pete King (NY) and sponsored by Rep. Tammy Baldwin (WI) and Rep. Janice
Schakowsky (IL). Senator Orrin Hatch (UT) was the sponsor of the Senate
version of the bill. The EJA was passed over a year ago. Authorized
funding for the EJA is $195 million per year for 4 years, but first
time funding has yet to be appropriated.
Since passage of the EJA, a year later, vulnerable older adults who
should be protected by the law are confronted with the same threats
they faced a year ago. This is a sad reality given the increasing
severity of elder abuse in this country. The most recent study
estimates that 14.1 percent of non-institutionalized older adults
nationwide had experienced some form of elder abuse in the past year.
According to a recent National Institute of Justice study, almost 11
percent of people ages 60 and older (5.7 million) faced some form of
elder abuse in 2009. Financial exploitation of older adults is
increasingly alarming. A 2009 report by the MetLife Mature Market
Institute and the National Committee for the Prevention of Elder Abuse
(NCPEA) estimates that seniors lose a minimum of $2.5 billion each
year. A study of financially exploited older persons in one State found
that 9 percent of the victims had to turn to Medicaid for their care
after their own funds were stolen. Elder financial exploitation
undoubtedly represents a large drain on Medicaid throughout the
country.
In his proposed budget for fiscal year 2012, President Obama
included $21.5 million for Elder Justice Act funding. The proposed
funding would benefit States and local communities and create jobs. Of
the $21.5 million, $16.5 million was included for State adult
protective services, the first and front line responders to cases of
elder abuse in the home. Of these funds, $1.5 million would be used to
prevent and address elder abuse within Tribal nations.
APS workers are faced with increasing and complex caseloads while
both Federal and State funding for these programs lag behind.
Currently, there is no dedicated Federal funding stream for State APS
agencies. A recently released report outlines the challenges APS faces
and notes that Federal leadership on elder abuse prevention is lacking.
Another report points to an overall increase in calls to adult
protective services. Over $100 million is authorized for State APS
programs in fiscal year 2012 and we urge the Subcommittee to use the
President's budget proposal, $21.5 million, as the minimum amount for
APS funding. Strengthening APS will enhance its ability to protect both
older victims and their assets before it is too late.
The President also included an increase of $5 million for the Long-
Term Care Ombudsman Program to improve resident advocacy to elders and
adults with disabilities who reside in a long-term care setting. The
Long-Term Care Ombudsman Program is a critical tool in the fight
against elder abuse yet, consistently underfunded.
We urge you to include a minimum appropriation of $21.5 million for
the Elder Justice Act in your fiscal year 2012 Labor-HHS Appropriations
bill. We thank you for your consideration and please feel free to
contact me with questions or concerns.
______
Prepared Statement of the Eldercare Workforce Alliance
Mr. Chairman and Members of the Subcommittee: We are writing on
behalf of the Eldercare Workforce Alliance (EWA), which is comprised of
28 national organizations united to address the immediate and future
workforce crisis in caring for an aging America. As the Subcommittee
begins consideration of funding for programs in fiscal year 2012, the
Alliance \1\ asks that you consider $54.9 million in funding for the
geriatrics health professions and direct-care worker training programs
that are authorized under Titles VII and VIII of the Public Health
Service Act as follows: $46.5 million for Title VII Geriatrics Health
Professions Programs; $3.4 million for direct care workforce training;
and $5 million for Title VIII Comprehensive Geriatric Education
Programs.
---------------------------------------------------------------------------
\1\ The positions of the Eldercare Workforce Alliance reflect a
consensus of 75 percent or more of its members. This testimony reflects
the consensus of the Alliance and does not necessarily represent the
position of individual Alliance member organizations.
---------------------------------------------------------------------------
Geriatrics health profession and direct-care worker training
programs are integral to ensuring that America's healthcare workforce
is prepared to care for the Nation's rapidly expanding population of
older adults.
The first of the baby boomers began to turn 65 this year. Within 20
years, one in five Americans will be over 65; 90 percent of those
Americans will have one or more chronic conditions. Despite the growing
need for services, there is a growing shortage of health professionals
and direct-care workers with specialized training in geriatrics and an
even greater shortage of the geriatrics faculty needed to train the
entire workforce.
In 2008, the Institute of Medicine (IOM) issued a ground-breaking
report, Retooling for an Aging America: Building the Health Care
Workforce, which spotlighted these shortages and their impact on
eldercare. The report called for an expansion of geriatrics faculty
development awards to include additional professional disciplines,
increased training for the direct-care workforce, and other efforts to
create a healthcare workforce with adequate capacity to care for older
adults. The Eldercare Workforce Alliance was established to encourage
policymakers to act on the IOM's recommendations for addressing the
eldercare workforce crisis.
The enactment of the Patient Protection and Affordable Care Act
(ACA) was a historic moment for healthcare in this country. ACA makes
important strides toward addressing the severe and growing shortages of
healthcare providers with the skills and training to meet the unique
healthcare needs of our Nation's growing aging population.
ACA includes provisions from the Retooling for an Aging America Act
(S. 245 and H.R. 468 in the 111th Congress), sponsored by Senator Kohl
(D-WI) and Representative Schakowsky (D-IL). These provisions enhance
existing and establish new geriatrics programs in an effort to build
the capacity of the healthcare workforce needed to care for older
adults, as recommended in the IOM report.
We very much appreciate the funding for the Title VII Geriatrics
Health Professions programs that President Obama included in his fiscal
year 2012 budget. We urge you to appropriate adequate funds for
geriatrics training programs in fiscal year 2012 so that we can
immediately begin to realize the healthcare workforce goals set forth
in health reform. Specifically, the Eldercare Workforce Alliance
requests $54.9 million in total funding for the following programs
under Title VII and VIII of the Public Health Service Act:
Title VII Geriatrics Health Professions Appropriations Request: $46.5
Million
Title VII Geriatrics Health Professions programs are the only
Federal programs that: (1) increase the number of faculty with
geriatrics expertise in a variety of disciplines; and (2) offer
critically important geriatrics training to the entire healthcare
workforce.
--Geriatric Academic Career Awards (GACA).--The goal of this program
is to promote the development of academic clinician educators
in geriatrics.
Program Accomplishments.--In Academic Year 2009-2010, GACA funded
84 non-competing continuation awards. GACA awardees provided
approximately 60,000 health professionals with
interdisciplinary geriatrics training. In turn, these trainees
provided culturally competent quality healthcare to over
525,000 underserved and uninsured patients in acute care
services, geriatric ambulatory care, long-term care, and
geriatric consultation services settings.
In 2010, HRSA expanded the awards to be available to more
disciplines. EWA advocated for this expansion and we now want
to ensure that there is adequate funding for this vital
program. Our request of $5.3 million, as reflected in the
President's budget, includes necessary support for 68 Geriatric
Academic Career Awardees, promoting the development of
clinician educators.
--Geriatric Education Centers (GEC).--The goal of the Geriatric
Education Centers is to provide quality interdisciplinary
geriatric education and training to geriatrics specialists and
non-specialists, including family caregivers and direct care
workers.
Program Accomplishments.--In Academic Year 2009-2010, the GEC
grantees provided clinical training to 54,167 health
professional students and to 20,791 interdisciplinary teams in
multiple settings.
As part of the ACA, Congress authorized a supplemental grant
award program that will train additional faculty through a
mini-fellowship program. The program requires awarded faculty
to provide training to family caregivers and direct care
workers. Our funding request of $22.7 million, as reflected in
the President's budget plus $2.7 million for the supplemental
grants, includes support for the core work of 45 GECs and for
the 24 GECs that would be funded to undertake development of
mini-fellowships under the supplemental grants program included
in ACA.
--Geriatric Training Program for Physicians, Dentists, and Behavioral
and Mental Health Professions.--The goal of the GTPD is to
increase the supply of quality and culturally competent
geriatric clinical faculty and to retrain mid-career faculty in
geriatrics. This program supports training additional faculty
in medicine, dentistry, and behavioral and mental health so
that they have the expertise, skills and knowledge to teach
geriatrics and gerontology to the next generation of health
professionals in their disciplines.
Program Accomplishments.--In Academic Year 2009-2010, 11 non-
competing continuation grants were supported. Forty-nine
physicians, dentists, and psychiatric fellows received support
to provide geriatric care to 20,078 older adults across the
care continuum. Geriatric physician fellows provided healthcare
to 12,254 older adults. Geriatric dental fellows provided
healthcare to 4,073 older adults. Geriatric psychiatry fellows
provided healthcare to 3,751 older adults.
Our funding request of $8.5 million, as reflected in the
President's budget, includes support for 13 institutions to
continue this important faculty development program.
--Geriatric Career Incentive Awards Program.--Congress has authorized
this new program created through the ACA, which offers grants
to foster greater interest among a variety of health
professionals in entering the field of geriatrics, long-term
care, and chronic care management. President Obama included $10
million in his fiscal year 2012 budget to establish this awards
program. Our funding request of $10 million, as reflected in
the President's budget, includes support for implementation of
this new program.
Title VII Direct-Care Worker Training Program Appropriations Request:
$3.4 million
Direct-care workers help older adults who need long-term services
and supports including assistance with activities of daily living (e.g.
eating, bathing, dressing, toileting). Expanded training opportunities
for these essential workers are critical to ensuring an adequate
geriatrics workforce. According to current employment projections, more
than 1 million new direct care workers will be needed by 2018 in order
to meet the growing need for care.
--Training Opportunities for Direct Care Workers.--As part of the
ACA, Congress approved an advanced training program for direct
care workers, administered by HHS. Although President Obama's
budget did not include this vital training program, EWA urges
Congress to fund it in order to enhance direct care worker
skills and knowledge, and thereby, improve the quality of care
for older adults. EWA's funding request of $3.4 million
includes support to establish this unique grant program at
community colleges as they look to increase the geriatrics
knowledge and expertise of the direct care workforce.
Title VIII Geriatrics Nursing Workforce Development Programs
Appropriations Request: $5 million
These programs, administered by the HRSA, are the primary source of
Federal funding for advanced education nursing, workforce diversity,
nursing faculty loan programs, nurse education, practice and retention,
comprehensive geriatric education, loan repayment, and scholarship.
--Comprehensive Geriatric Education Program.--The goal of this
program is to provide quality geriatric education to
individuals caring for the elderly. This program supports
additional training for nurses who care for the elderly;
development and dissemination of curricula relating to
geriatric care; and training of faculty in geriatrics. It also
provides continuing education for nurses practicing in
geriatrics.
Program Accomplishments.--In Academic Year 2009-2010, 27 CGEP
grantees provided education and training to [suggest adding all
of these together--total of x professionals in nursing, home
health, as well as lay people] 3,030 Registered Nurses/
Registered Nursing Students; 260 Advanced Practice Nurses; 221
Faculty; 110 Home Health Aides; 483 Licensed Practical/
Vocational Nurses & LPN students; 730 Nurse Assistants/Patient
Care Associates; 810 Allied Health Professionals and 929 lay
persons, guardians, activity directors. The CGEP grantees
provided 459 educational course offerings in the care of the
elderly on a variety of topics to 6,846 participants.
--Traineeships for Advanced Practice Nurses.--Through the ACA, the
Comprehensive Geriatric Education Program is being expanded to
include advanced practice nurses who are pursuing long-term
care, geropsychiatric nursing or other nursing areas that
specialize in care of elderly.
Our funding request of $5 million, as reflected in the
President's budget, includes funds that will continue the
training of nurses caring for the elderly and offer 200
traineeships to nurses under the newly implemented traineeship
program.
Without additional funds in these programs, we will fail to ensure
that America's healthcare workforce will be prepared to care for older
Americans. We understand that the Committee faces difficult budget
decisions. However, we strongly believe that by investing in these
programs, which create geriatrics faculty and offer the training that
is needed to ensure a competent workforce, we will be delivering better
care to America's older adults. Healthcare dollars will be saved from
better care coordination and health outcomes, and the workforce will
grow as more people are trained, recruited and retained in the field of
geriatrics.
On behalf of the members of the Eldercare Workforce Alliance, we
commend you on your past support for geriatric workforce programs and
ask that you join us in expanding the geriatrics workforce at this
critical time--for all older Americans deserve quality of care, now and
in the future.
Thank you for your consideration.
______
Prepared Statement of the FSH Society, Inc.
Honorable Senator Harkin, Mr. Chairman, Honorable Senator Shelby,
Ranking Member, Subcommittee members and members of the U.S. Senate
Appropriations Committee, Subcommittee on Labor, Health and Human
Services, Education and Related Agencies thank you for the opportunity
to submit this testimony.
I am Daniel Paul Perez, of Bedford, Massachusetts, President and
CEO of the FSH Society, Inc. and an individual who has lived with
facioscapulohumeral muscular dystrophy (FSHD) for 48 years. FSHD is
also known as facioscapulohumeral muscular disease, FSH muscular
dystrophy and Landouzy-Dejerine muscular dystrophy. For hundreds of
thousands of men, women, and children the major consequence of
inheriting the most prevalent form of muscular dystrophy is a lifelong
progressive and severe loss of all skeletal muscles. FSHD is a
crippling and life shortening disease. No one is immune, it is
genetically and spontaneously (by mutation) transmitted to children and
it affects entire family constellations.
My testimony seeks to address the urgent need for NIH to redress
and increase funding for research on FSHD.
A consortium of European partners known as Orphanet, led by the
French government research agency, INSERM (Insitut National de la Sante
et de la Recherche Medicale), that is comparable to the United States.
NIH, which includes both government and private members, has issued new
epidemiology and prevalence data for hundreds of diseases that ranks
FSHD as the first and most prevalent muscular dystrophy. The ``Orphanet
Series'' report November 2010, ``Prevalence of Rare Diseases'' report
can be found at Internet web site: (http://www.orpha.net/orphacom/
cahiers/docs/GB/Prevalence_of_rare_diseases_by_alphabetical_list.pdf).
FSHD is presented as the third most prevalent muscular dystrophy in the
Muscular Dystrophy Community Assistance, Research and Education
Amendments of 2001 and 2008 (the MD-CARE Act). This new data changes
the findings as listed in the MD-CARE Act. FSHD is 40 percent more
prevalent than Duchenne muscular dystrophy (DMD), now recognized as the
second most prevalent dystrophy.
------------------------------------------------------------------------
Cases/
Estimated Prevalence 100,000
------------------------------------------------------------------------
Facioscapulohumeral muscular dystrophy (FSHD)............. 7
Duchenne (DMD) and Becker dystrophy (BMD)................. 5
Steinert myotonic dystrophy (DM).......................... 4.5
------------------------------------------------------------------------
Figures from the online NIH database RCDC RePORT and the NIH
Appropriations History for Muscular Dystrophy report provided by NIH/OD
Budget Office & NIH OCPL show that from the inception of the MD CARE
Act 2001, funding has more than quadrupled from $21 million to $86
million in fiscal year 2010 for muscular dystrophy. In fiscal year
2010, total muscular dystrophy funding grew by 3.6 percent ($3 million/
$83 million) over the previous fiscal year.
In fiscal year 2010, FSHD funding represented 7 percent of the NIH-
wide muscular dystrophy budget ($6 million/$86 million). In the
previous year, FSHD represented 6 percent of the total muscular
dystrophy funding ($5 million/$83 million). FSHD funding as a
percentage of overall NIH muscular dystrophy funding has been level
over the last 9 years.
NATIONAL INSTITUTES OF HEALTH (NIH) FSHD FUNDING AND APPROPRIATIONS
[Dollas in millions]
------------------------------------------------------------------------
FSHD as a
Percentage
of Total
Fiscal Year FSHD NIH
Research Muscular
Dystrophy
Funding
------------------------------------------------------------------------
2006......................................... $1.7 4
2007......................................... 3 5
2008......................................... 3 5
2009......................................... 5 6
2010......................................... 6 7
------------------------------------------------------------------------
Sources: NIH/OD Budget Office & NIH OCPL & NIH RCDC RePORT.
We highly commend the NIH on the ease of use and the continued
accuracy of the Research Portfolio Online Reporting Tool (RePORT)
report ``Estimates of Funding for Various Research, Condition, and
Disease Categories (RCDC)'' with respect to reporting projects on
muscular dystrophy.
Now that FSHD has been established as the most prevalent muscular
dystrophy, and in light of recent advances in research it makes no
sense that FSHD remains the most underfunded dystrophy by the NIH and
in the Federal research agency system (CDC, DOD and FDA). Given FSHD's
prevalence, disease burden, the overall percentage of funding of the
muscular dystrophy research portfolio and major mechanistic
breakthroughs on FSHD etiology in 2010 and 2011, we ask Congress to
urge NIH to provide a catalyst for scientific opportunity in FSHD.
Inter-dystrophy funding changes and comparisons year after year
clearly depicts that NIH FSHD funding needs to be increased and set
right. Intra-dystrophy funding changes are misleading as a large change
in a small number is still an anemic amount. In fiscal year 2010, the
most prevalent muscular dystrophy, FSHD, received a $1 million increase
from NIH to $6 million, up 20 percent from $5 million. In fiscal year
2010, the second most prevalent, Duchenne (DMD/BMD) type, received a $5
million increase from NIH to $38 million, up 15 percent from $33
million. In fiscal year 2010, the third most prevalent myotonic
dystrophy (DM) type, received $1 million less from NIH to $12 million
down 8 percent from $13 million. There is an obvious funding disparity
as the first and third most prevalent dystrophies combined, each with
major breakthroughs in the past 2 years, are receiving less than half
of NIH funding that the second prevalent dystrophy with its disease
causing gene being discovered 25 years ago.
The MD CARE Act mandates the NIH Director to intensify efforts and
research in the muscular dystrophies, including FSHD, across the entire
NIH. It should be very concerning that: (1) in the last 9 years
muscular dystrophy has quadrupled to $86 million and that FSHD has
remained on average at 5 percent of the NIH muscular dystrophy
portfolio; (2) FSHD, the most prevalent muscular dystrophy is far
underrepresented based on percentage of overall NIH dystrophy funding
given its prevalence and disease burden; and (3) that both FSHD and DM
have had extraordinary major breakthroughs in understanding the disease
mechanism in the current and past fiscal years and NIH funding remains
level in one and has declined in the other.
[Dollars in millions]
----------------------------------------------------------------------------------------------------------------
NIH Funding Percentage of Total MD
-------------------------- funding at NIH
Muscular Dystrophy Type -------------------------
Fiscal Year Fiscal Year Fiscal Year Fiscal Year
2009 2010 2009 2010
----------------------------------------------------------------------------------------------------------------
FSHD........................................................ $5 $6 6 7
DMD/BMD..................................................... 33 38 40 44
DM.......................................................... 13 12 16 14
----------------------------------------------------------------------------------------------------------------
Two major breakthroughs on FSHD occurred in fiscal year 2010 and
fiscal year 2011 that make it urgent for the NIH to redress funding for
FSHD. On August 19, 2010, a paper titled, ``A Unifying Genetic Model
for Facioscapulohumeral Muscular Dystrophy'' [Science 24 September
2010: Vol. 329 no. 5999 pp. 1650-1653] was published online in the top-
rated journal by a group of researchers who started their careers in
FSHD research with post-doctoral fellowships from the FSH Society. This
paper was a major breakthrough in understanding how FSHD works. It made
the front page of the New York Times on the following day. The Times
article ``Reanimated `Junk' DNA Is Found to Cause Disease,'' quoted Dr.
Francis Collins, a human geneticist and Director of the National
Institutes of Health saying, ``If we were thinking of a collection of
the genome's greatest hits, this would go on the list.'' Dr. Collins
went on to say, ``Well, my gosh, . . . here's a simple disease with an
incredibly elaborate mechanism. To come up with this sort of mechanism
for a disease to arise--I don't think we expected that.'' Professor
David E. Housman, FSH Society Scientific Advisory Committee Chairman
and a geneticist at Massachusetts Institute of Technology (M.I.T.), was
quoted saying, ``Scientists will now be looking for other diseases with
similar causes, and they expect to find them. As soon as you understand
something that was staring you in the face and leaving you clueless,
the first thing you ask is, `Where else is this happening?' ''
Two months later, another paper was published that originated with
seminal funding from the FSH Society that made a second critical
advance in determining the cause of FSHD. ``Facioscapulohumeral
Dystrophy: Incomplete Suppression of a Retrotransposed Gene'' was
published in PLoS Genetics, October 28, 2010, that made a second
critical advance in FSHD. The research shows that FSHD is caused by the
inefficient suppression of a gene that may be normally expressed only
in early development. The international team of researchers led by
Stephen Tapscott, M.D., Ph.D., a member of the Hutchinson Center's
Biology Division thinks that the work will lead to new approaches for
therapy and new insights into human evolution of disease.
The international FSHD clinical and research community recently
came together at the DHHS NIH Eunice Kennedy Shriver National Institute
of Child Health and Human Development (NICHD) Boston Biomedical
Research Institute Senator Paul D. Wellstone MD CRC for FSHD. Almost 90
scientists working on FSHD globally met at the 2010 FSH Society FSHD
International Research Consortium, held October 21-22, 2010 to identify
areas of scientific opportunity in FSHD that need funding. The summary
and recommendations of the group state that given the recent
developments in our definition of FSHD, that within 1 to 2 years
evidence-based intervention strategies, therapeutics, and trials need
to be planned and conducted. Our immediate priorities should be to
confirm that the DUX4 gene hypothesis is valid. Then we must understand
the normal DUX4 function. Finally, we must understand the naturally
occurring variability to enable us to manipulate the disease in our
favor. We need to be prepared for this new era in the science of FSHD
by accelerating efforts in the following 10 areas: Shareable protocols;
common and shareable materials and data by the whole community;
corroborate and verify DUX4 finding; FSHD alleles in context of
population genetics need to be defined; biomarkers; FSHD clinical
evaluation scales/systems need be defined under one agreed standard;
Working Groups/animal and mouse model working group consortium; model
systems for mechanistic, intervention work and advancement to clinical
trials; Epigenetics/Genetics; clinical trials readiness.
To read the expanded summary and recommendations of the group
please go to online file at: http://www.fshsociety.org/assets/pdf/
IRCWorkshop2010WorkingConsensusOfPrioritiesGalley.pdf.
It is impossible to justify the current low level of FSHD funding
in the current context of muscular dystrophy budget at the NIH. We have
worked hard with our scientific colleagues and member patients and
families to build the corpus of knowledge to understand FSHD. We have
made great progress in understanding our own disease. We have worked
side by side with the NIH directors, program and legislative staff the
whole distance to these remarkable discoveries. Still, there has been a
confounding and recalcitrant lack of traction at NIH for funding in
FSHD. Our request to the NIH--increase FSHD funding now!
NIH constantly reminds us that the NIH system of peer-review
delivers the best science from investigator initiated grant
applications, thus delivering quality science to the American taxpayer.
NIH is receiving more and more grant applications on FSHD. As a
nonprofit volunteer health agency that funds breakthrough research
based on peer-review mechanics and on a shoe-string compared to NIH, we
appreciate the need for peer review, the need to fund the best science
and also the need to recalibrate the process to ensure that pragmatic
and necessary choices are being pursued in the advent of paradigmatic
changes in a disease. We FSHD patients and fellow citizens appreciate
this as taxpayers as well.
What it comes down to is--the choice of ``the best science'' in a
disease area and how this has been achieved. This is difficult to
measure except in hindsight e.g. what hypotheses represent the best
science. The Director of NIH said, set this down, take note, this is 1
of the 10 greatest discoveries in human genomics and that we never
expected diseases to be caused by unwanted RNA from reanimated junk
DNA. The implications are enormous. FSHD has an incredibly elaborate
mechanism that we did not expect. We now know that inadvertent
expression of DUX4 from a stretch of reactivated ``junk-DNA'' causes
muscle disease known as FSHD. It is clear that this type of research
does not and has not done well in peer-review and it is obvious by the
fact that funding is dwarfed. Looking back at the recent NIH Request
For Proposals (RFAs) that covered FSHD we can see that all of the
breakthrough D4Z4 DUX4 gene grant applications went unfunded by NIH.
Perhaps the study sections need to be pulled apart and examined in the
broader context of muscular dystrophy. Perhaps comparing Duchenne,
Myotonic and FSHD is now much akin to determining the best science in
computer science and biology combined. Computer science and biology
seems an obvious apples to oranges comparison. We are saddened that the
most brilliant work on FSHD was turned away by the NIH. It is crystal
clear, if not completely black and white, that FSHD is not achieving
the goals of parity in funding as set down in mandates set forth in the
MD CARE Acts 2001/2008 and by the NIH Action Plan for the Dystrophies
submitted to the Congress by the NIH.
As you know, we are impressed with the efforts of NIH staff and
Muscular Dystrophy Coordinating Committee (MDCC) on behalf of the
community of patients and their families with muscle disease and the
research community pursuing solutions for all of us. We recognize in
particular the efforts and hard work of the following NIH staff: Story
Landis, Ph.D. and John D. Porter, Ph.D. of National Institute of
Neurological Disorders and Stroke (NINDS); Stephen I. Katz, M.D., Ph.D.
and Glen H. Nuckolls, Ph.D. and Vittorio Satorelli, Ph.D., National
Institute of Arthritis and Musculoskeletal and Skin Disease (NIAMS);
James W. Hanson, M.D. and Ljubisa Vitkovic, M.D., Ph.D., (NICHD).
The pace of discovery and numbers of experts in the field of
biological science and clinical medicine working on FSHD are rapidly
expanding. Many leading experts are now turning to work on FSHD not
only because it is one of the most complicated and challenging problems
seen in science, but because it represents the potential for great
discoveries, insights into stem cells and transcriptional processes and
new ways of treating human disease.
We request this year in fiscal year 2012, immediate help for those
of us coping with and dying from FSHD. We ask NIH to fund research on
facioscapulohumeral muscular dystrophy (FSHD) at a level of $35 million
in fiscal year 2012. In view of the tremendous breakthroughs in FSHD
research that may rewrite genetics, we implore the NIH to immediately
address the inadequacy in FSHD muscular dystrophy funding.
We implore the Appropriations Committee to request that the
Director of NIH, the Chair, and Executive Secretary of the Federal
advisory committee MDCC to increase the amount of FSHD research and
projects in its portfolios using all available passive and pro-active
mechanisms and interagency committees.
We request that NIH be more proactive in facilitating grant
applications (unsolicited and solicited) from new and existing
investigators and through new and existing mechanisms, special
initiatives, training grants and workshops--to bring knowledge of FSHD
to the next level.
We ask NIH to consider increasing the scope and scale of the
existing DHHS U.S. NIH Senator Paul D. Wellstone Muscular Dystrophy
Cooperative Research Centers (U54) to double or triple their size--they
are financially under-powered as compared to their potential. These
centers have provided an excellent source of human biomaterials and are
a catalyst for research, clinical research and training on muscular
dystrophy. We ask NIH to develop funding mechanisms to help expand work
from NIH Wellstone Centers outward to address needs and priorities of
the scientific communities.
We ask NIH for more than one Wellstone center solely dedicated to
FSHD. There needs to be one-half dozen groups with 6 to 10 people
solely working on FSHD across the United States to assure continuity in
FSHD efforts.
We strongly support research discovery through the use of post-
doctoral and clinical training fellowships--a model that has worked
very effectively for us. It produces results and progeny. Yet, NIH has
only a few fellows in dystrophy. We request that NIH issue an RFA to
exclusively fund 12 new post-doctoral fellows and four clinical fellows
a year on an ongoing basis for the next 5 years on FSHD. We ask that
FSHD be the pilot dystrophy for such initiative.
We request that the Director of the NIH initiate solely for FSHD an
RFA for Specialized Centers (P50s) to encourage multidisciplinary
research approaches on the complexity of FSHD.
We request that the Director of the NIH redress the low level of
funding in FSHD by issuing an RFA exclusively for FSHD to allow it to
be a prototype disease in the newly forming National Center for
Advancing Translational Sciences. This will help advance the
translational science in FSHD and catalyze the development of novel
diagnostics and therapeutics for FSHD.
We request that the Directors of the NIH develop, through an RFA
for FSHD, a central place where clinical trials can be designed and run
on animal models of FSHD (mouse, dog, sheep, etc.). It is cost
prohibitive to have each U54, P01, P50 funding infrastructure to
support these resources. We ask that FSHD be the proof-of-concept
disease for such a facility.
Thanks to your efforts and the efforts of your Committee, Mr.
Chairman, the Congress, the NIH and the FSH Society are all working to
promote progress in FSHD. Our successes are continuing and your support
must continue and increase.
Mr. Chairman, thank you for this opportunity to testify before your
committee.
______
Prepared Statement of the Federation of American Societies for
Experimental Biology
The Federation of American Societies for Experimental Biology
(FASEB) urges Congress to make investment in the National Institutes of
Health (NIH) an urgent national priority and respectfully requests an
appropriation of $35 billion for the agency in fiscal year 2012. This
figure represents an increase that responds to the effects of inflation
on the current program level and is needed to continue ongoing
initiatives and prevent severe damage to the Nation's capacity for
innovation in its fight against disease.
As a federation of 23 scientific societies, FASEB represents more
than 100,000 life scientists and engineers, making it the largest
coalition of biomedical research associations in the United States.
FASEB's mission is to advance health and welfare by promoting progress
and education in biological and biomedical sciences, including the
research funded by NIH, through service to its member societies and
collaborative advocacy. FASEB enhances the ability of scientists and
engineers to improve--through their research--the health, well-being,
and productivity of all people.
NIH is the driving force behind our Nation's leadership in
biomedical science and the dramatic improvements in our health and
quality of life. Because of NIH and the research it supports, we stand
on the brink of an era of enormous potential progress against the
ravages of disease. NIH funds the research of more than 325,000
scientists at over 3,000 universities, medical schools, and other
research institutions across the United States. Eighty percent of NIH
funding is distributed through competitive grants to researchers in
nearly every congressional district and the U.S. territories. More than
130 Nobel Prize winners have received support from the agency. NIH
considers many different perspectives in establishing scientific
priorities and identifies and, within the limits of its budget, funds
the most promising and highest quality research to address them. NIH is
also training the next generation of researchers to ensure that the
United States continues to be a global leader in advancing medical
science.
Improving Health, Saving Lives
Research funded by NIH has produced an outstanding legacy. NIH-
funded discovery has meant that more than 1 million lives per year are
saved due to therapies to prevent heart attacks and stroke. That alone
has increased American life expectancy by 4 years. Biomedical research
discovery has also meant that since 2002 deaths from cancer have
steadily declined; and in the past 30 years, survival rates for
childhood cancers have increased from less than 50 percent to over 80
percent. More recent advances include:
--Improving Treatments for Acute Myeloid Leukemia (AML).--
Investigators have discovered mutations in a gene that affects
the treatment prognosis for some patients with AML, an
aggressive blood cancer that kills 9,000 Americans annually.
The findings may help guide future treatment strategies for
individuals with AML, as well as lead to more effective
therapies for patients who carry the mutations.
--Increasing Pediatric Cancer Survival Rates.--A new form of
immunotherapy has significantly improved survival rates of
children with neuroblastoma, a deadly nervous system cancer
responsible for 12 percent of all cancer deaths in children
under age 15. The new therapy has dramatically increased the
percentage of children who were alive and free of disease
progression after 2 years.
--Reversing Aspects of Aging.--Researchers have reversed age-related
degeneration in a mouse model of aging. While the findings
don't prove that natural aging could be halted or reversed,
they may lead to new strategies to combat certain age-related
conditions.
--Rapidly Detecting Tuberculosis (TB).--Scientists have developed an
automated test that can rapidly and accurately detect TB and
drug-resistant TB in patients. The finding could pave the way
for earlier diagnosis and more targeted treatment of this
disease. TB kills about 1.8 million people each year, and drug-
resistant TB is a growing threat. The new test makes it
possible to detect TB and drug resistance in a single clinic
visit and perhaps begin treatment immediately.
Predictable and Sustainable Funding Will Drive Innovation and Progress
Our leadership in biomedical research has made us the envy of the
rest of the world. Our dominant position in the discovery of new drugs
and therapies is the result of research conducted by scientists and
engineers in academia and in the biotech firms that they have
started.\1\ A study published in the February 9 issue of the New
England Journal of Medicine found that 153 new drugs approved by the
U.S. Food and Drug Administration during the past 40 years were
discovered at least in part by public sector research institutions
(universities, research hospitals, nonprofit research institutes, and
Federal laboratories), highlighting the increasingly important role of
the public sector in the development of pharmaceuticals and other
medical interventions.\2\ At present, the NIH budget is insufficient to
fund all of the promising research that needs to be done. Less than one
in five research proposals can be funded. Over the past 6 years, the
number of research project grants funded by NIH has declined in almost
every year, and the agency is now funding 2,000 fewer grants that it
did in 2004. Due to the extreme competition for support, NIH grant
applicants have pared their funding requests to the bare minimum needed
to fulfill the goal of their research.
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\1\ R. Kneller, Nature Reviews: Drug Discovery 9 (November) 2010.
\2\ Ashley J. Stevens, D.Phil., Jonathan J. Jensen, M.B.A., Katrine
Wyller, M.B.E., Patrick C. Kilgore, B.S., Sabarni Chatterjee, M.B.A.,
Ph.D., and Mark L. Rohrbaugh, Ph.D., J.D. The Role of Public-Sector
Research in the Discovery of Drugs and Vaccines, New England Journal of
Medicine, February 9, 2011.
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If we fail to continue to capitalize on our investment, others
will. We have built laboratories, trained young researchers, and
initiated exciting new projects. Potentially revolutionary new avenues
of research hold promise for earlier screening and better therapies,
but these advances will not become a reality unless the NIH budget is
sustained and enhanced to meet inflation's demands. Failure to continue
our commitment to biomedical research will terminate important
scientific investigations, stunt graduate training, and discourage
young scientists who are the key to our future.
The NIH budget is currently $34 billion (including supplemental
appropriations). Exciting new initiatives at NIH are poised to
accelerate our progress in the search for cures, and it would be tragic
if we could not capitalize on the many opportunities before us. A
modest increase over the current program level is needed to continue
ongoing initiatives and prevent severe damage to our capacity for
innovation. Maintaining our current level of effort requires an
increase equal to the biomedical research and development price index
(BRDPI), which the Bureau of Economic Analysis in the U.S. Department
of Commerce estimates will be 3 percent in fiscal year 2012.
A small fraction of our Federal budget, research funding generates
an enormous return in new technologies and improved quality of life.
Boom and bust cycles are wasteful and inefficient strategies for
funding science. The Nations medical research agency needs sustainable
and predictable budget growth to maximize the return on this investment
in the health and longevity of all Americans. To that end, FASEB
recommends an appropriation of $35 billion for NIH in fiscal year 2012.
Thank you for the opportunity to offer FASEB's support for NIH.
______
Prepared Statement of Friends of the Health Resources and Services
Administration
The Friends of HRSA is a nonprofit and non-partisan alliance of
more than 180 national organizations, collectively representing
millions of public health and healthcare professionals, academicians
and consumers. The coalition's principal goal is to ensure that HRSA's
broad health programs have continued support in order to reach the
populations presently underserved by the Nation's patchwork of health
services.
HRSA operates programs in every State and territory and thousands
of communities across the country and is a national leader in providing
health services for individuals and families. The agency serves as a
health safety net for the medically underserved, including the 50
million Americans who were uninsured in 2009 and 60 million Americans
who live in neighborhoods where primary healthcare services are scarce.
To respond to these challenges, it is the best professional judgment of
the members of the Friends of HRSA that the agency will require an
overall funding level of at least $7.65 billion for fiscal year 2012.
While we recognize the reality of the current fiscal climate, our
request of $7.65 billion represents the minimum amount necessary for
HRSA to continue to meet the healthcare needs of the American public.
Anything less will undermine the efforts of HRSA programs to improve
access to quality healthcare for millions of our neediest citizens.
Additionally, the Friends of HRSA coalition members remain concerned
about the deep cuts made to the agency in the final fiscal year 2011
Continuing Resolution and the negative consequences for public health.
Therefore, the requested minimum level of funding for fiscal year 2012
is essential to allow the agency to carry out critical public health
programs and services that reach millions of Americans, including
training for public health and healthcare professionals, providing
primary care services through community health centers, improving
access to care for rural communities, supporting maternal and child
healthcare programs, and providing healthcare to people living with
HIV/AIDS. However, much more is needed for the agency to achieve its
ultimate mission of ensuring access to culturally competent, quality
health services; eliminating health disparities; and rebuilding the
public health and healthcare infrastructure.
Our $7.65 billion fiscal year 2012 HRSA funding request is based
upon recommendations provided by coalition members to support HRSA
programs including:
--Health Professions programs support the education and training of
primary care physicians, nurses, dentists, dental hygienists
physician assistants, nurse practitioners, public health
personnel, mental and behavioral health professionals,
optometrists, pharmacists, and other allied health providers;
improve the distribution and diversity of health professionals
in medically underserved communities; and ensure a sufficient
and capable health workforce able to provide care for all
Americans and respond to the growing demands of our aging and
increasingly diverse population. In addition, the Patient
Navigator Program helps individuals in underserved communities,
who suffer disproportionately from chronic diseases, navigate
the health system.
--Primary Care programs support community health centers operating in
more than 8,000 communities in every State and territory,
improving access to cost-effective and high-quality primary and
preventive care in rural and urban underserved areas. In
addition, the Health Centers program targets the country's most
vulnerable populations, including migrant and seasonal farm
workers, homeless individuals and families, and those living in
public housing.
--Maternal and Child Health Flexible Maternal and Child Health Block
Grants, Healthy Start and other programs provide services,
including prenatal and postnatal care, newborn screening tests,
immunizations, school-based health services, mental health
services, and well-child care for more than 34 million
uninsured and underserved women and children not covered by
Medicaid or the Children's Health Insurance Program, including
children with special needs.
--HIV/AIDS programs provide assistance to metropolitan and other
areas most severely affected by the HIV/AIDS epidemic; support
comprehensive care, drug assistance and support services for
people living with HIV/AIDS; provide education and training for
health professionals treating people with HIV/AIDS; and address
the disproportionate impact of HIV/AIDS on women and
minorities.
--Family Planning Title X programs provide reproductive healthcare
and other preventive services for more than 5 million low-
income women at over 4,500 clinics nationwide. These programs
improve maternal and child health outcomes, prevent unintended
pregnancies, and reduce the rate of abortions.
--Rural Health programs improve access to care for the 60 million
Americans who live in rural areas. Rural Health Outreach and
Network Development Grants, Rural Health Research Centers,
Rural and Community Access to Emergency Devices Program, and
other programs are designed to support community-based disease
prevention and health promotion projects, help rural hospitals
and clinics implement new technologies and strategies, and
build health system capacity in rural and frontier areas.
--Special Programs include the Organ Procurement and Transplantation
Network, the National Marrow Donor Program the C.W. Bill Young
Cell Transplantation Program, and National Cord Blood
Inventory. Strong funding would facilitate an increase in
organ, marrow, and cord blood transplantation.
Greater investment is necessary to sufficiently fund HRSA services
and programs that continue to face increasing demands. We urge you to
consider HRSA's role in building the foundation for health service
delivery and ensuring that vulnerable populations receive quality
health services, while continuing to strengthen our Nation's health
safety net programs. By supporting, planning for and adapting to change
within our healthcare system, we can build on the successes of the past
and address new gaps that may emerge in the future.
We appreciate the Subcommittee's hard work in advocating for HRSA's
programs in a climate of competing priorities. The members of the
Friends of HRSA thank you for considering our fiscal year 2012 request
for $7.65 billion for HRSA in the fiscal year 2012 Labor, Health and
Human Services, Education, and Related Agencies Appropriations bill and
are grateful for this opportunity to present our views to the
Subcommittee.
______
Prepared Statement of Friends of the National Center on Birth Defects
and Developmental Disabilities Advocacy Coalition
The Friends of NCBDDD Advocacy Coalition recommends that Congress
provide at least $144 million in fiscal year 2012 to sustain the vital
programs and activities funded by NCBDDD. Furthermore, we call on
Congress to ensure any program modifications do no harm for children
and adults currently served by the Center and that funds intended to
directly benefit the targeted populations not be diverted.
CDC's National Center on Birth Defects and Developmental
Disabilities (NCBDDD) works to prevent birth defects and developmental
disabilities and help people with disabilities and blood disorders live
the healthiest life possible. It is the only CDC Center whose primary
mission is focused on birth defects, disability and blood disorders.
2011 marks the 10th year of the Center's accomplishments.
NCBDDD impacts millions of our Nation's most vulnerable: infants
and children, people with disabilities, and people with blood
disorders. During times of increasing fiscal constraint, NCBDDD is
committed to finding strategic approaches to support and strengthen
core public health activities for these vulnerable and underserved
populations. Public health is the science and art of preventing disease
and disability, promoting physical and behavioral wellness, supporting
personal responsibility, and prolonging life in communities where
people live, work, and learn. Building upon the latest science and
evidence-based research, the Center has identified key priorities to
these populations to ensure continued public health advancements are
made, as well as demonstrating sound returns on investments.
Child Health and Development--Assuring Child Health
Division of Birth Defects and Developmental Disabilities
Success in this NCBDDD program area includes rapidly translating
research findings into prevention strategies that prevent birth defects
and developmental disabilities, focusing attention on the importance of
early care and special intervention services for children born with a
birth defect or developmental disability, and supporting parents in
helping their children grow into healthy, safe, productive members of
society.
Health and Development for People with Disabilities--Improving the
Health of People with Disabilities
Division of Human Development and Disability
This spectrum of NCBDDD activities promotes healthy development and
reduces health disparities across the life course for persons with or
at risk of disability. Program goals include: Improving the health and
developmental outcomes for children, improving the quality of life and
life expectancy for people with disabilities, and eliminating health
disparities faced by persons of all ages living with disabilities.
Public Health Approach to Blood Disorders
Division of Blood Disorders
The history of NCBDDD activities in this area includes bleeding and
clotting disorders, hemoglobinopathies and blood product safety. The
future of blood disorders is predicated on building upon our past
successes and expanding our public health activities to begin
addressing the most prevalent, costly, and debilitating bleeding and
clotting disorders.
CDC's National Center on Birth Defects and Developmental Disabilities
(NCBDDD) Focus on Public Health-Social Impact-Safety Net Need
of the Populations Served
The Friends advocacy coalition calls on congressional appropriators
and the administration to continue to focus the Center's programs on
outcomes that affect positive public health, positive social impact,
and the safety net purpose. These include:
Assuring Child Health
Decrease or eliminate birth defects and developmental disabilities
occurring due to known causes.
Improve longer term outcomes of children with birth defects,
autism, and other developmental disabilities, and eliminate racial/
ethnic disparities in these outcomes.
Identify preventable risk factors of birth defects and
developmental disabilities, and develop appropriate interventions to
reduce these risks.
Increase early identification and intervention for infants and
young children with disabling conditions.
Mediate the impact of poverty on developmental outcomes for young
children.
Improving the Health of People with Disabilities
Change individual health behaviors to improve health in children,
youth, and adults with disabilities.
Improve healthcare access and screening for children, youth, and
adults with disabilities.
Reduce the incidence of secondary conditions by increasing health
promotion and wellness interventions for children and adults with
disabilities.
Improve public health surveillance systems to track the health,
development, and participation of persons with disabilities across the
life course.
Implement fully the Section 4302 ``Patient Protection and
Affordable Care Act'' intent, expectations, and requirements in
``Understanding Health Disparities: Data Collection and Analysis''
including ``disability status'' as well as Section 5307 ``Cultural
Competency, Prevention, and Public Health'' including ``individuals
with disabilities training.''
Public Health Approach to Blood Disorders
Improve the life expectancy of people with Sickle Cell Disease.
Reduce the morbidity and mortality related to bleeding disorders in
women.
Reduce the incidence of DVT/PE, and prevent related mortality and
serious morbidity.
Prevent emerging morbidities of people with bleeding disorders.
Positive Outcomes
These outcomes should positively affect several social impact goals
to improve the life situation of persons with disabilities and other
challenges. These include:
--Seamless, positive, and helpful transitions from one of life's
stages to the next stage in life, such as the transition from
high school to adulthood and work.
--Promotion and support of independent living in the community--a
community participation that encourages and promotes self-
direction.
--Continued coordinated efforts to assist parents and consumers make
informed medical and life decisions.
--Focused activities with the goal of reducing the severity of
disability.
______
Prepared Statement of the Friends of the National Institute on Aging
(NIA)
The Friends of the NIA is a coalition of 50 academic, patient-
centered and not-for-profit organizations that conduct, fund or
advocate for scientific endeavors to improve the health and quality of
life for Americans as we age. As a coalition, we support the
continuation and expansion of NIA research activities and seek to raise
awareness about important scientific progress in the area of aging
research currently sponsored by the Institute.
To ensure that progress in Nation's biomedical, social, and
behavioral research is sustained, the Coalition endorses the NIH fiscal
year 2012 request, $31.7 billion, as a floor and joins the Ad Hoc Group
for Medical Research in supporting $35 billion for NIH as a ceiling.
Given the unique funding challenges facing the NIA, and the range of
promising scientific opportunities in the vast, diverse field of aging
research, the Friends of NIA ask the subcommittee to recommend NIA
receive $1.4 billion in fiscal year 2012--an amount endorsed by the
Leadership Conference on Aging.
The NIA Mission
Established in 1974, NIA leads the national scientific effort to
understand the nature of aging in order to promote the health and well
being of older adults. NIA's mission is three-fold: (1) Support and
conduct genetic, biological, clinical, behavioral, social, and economic
research related to the aging process, diseases and conditions
associated with aging, and other special problems and needs of older
Americans; (2) Foster the development of research- and clinician-
scientists for research on aging; and (3) Communicate information about
aging and advances in research on aging with the scientific community,
healthcare providers, and the public. The NIA fulfills this mission by
supporting both extramural research at universities and medical centers
across the United States and intramural research at laboratories in
Baltimore and Bethesda, Maryland.
Research Activities and Advances
Adding to its strong record of progress throughout its 37-year
history, recent NIA-supported activities and advances have contributed
to improving the health and well-being of older people worldwide. Below
is a summary of some of these most recent activities and advances.
Alzheimer's Disease
Alzheimer's disease (AD) is the most common cause of dementia in
the elderly. Between 2.6 million and 5.1 million Americans aged 65
years and older may have AD, with a predicted increase to 13.2 million
by 2050. While researchers have achieved greater understanding of the
disease, there is no cure. In light of the exploding aging population,
which by 2030 is expected to reach 72 million Americans ages 65 or
older, scientists are in a race against time to prevent an
unprecedented AD epidemic threatening our older population.
NIA is the lead Federal research agency for Alzheimer's disease
(AD). In this regard, the Institute coordinates trans-NIH AD
initiatives and encourages collaboration with other Federal agencies
and private research entities. As illustration of its leadership role,
NIA partnered with the McKnight Brain Research Foundation to support
the 2010 Cognitive Aging Summit. This meeting, a follow-up to a 2007
summit, brought together experts in a variety of research fields to
discuss advances in understanding brain and behavioral changes
associated with normal aging, including clinical translational research
for prevention of age-related cognitive decline.
As part of its ongoing AD Neuroimaging Initiative (ADNI), the
largest public-private partnership currently in AD research, NIA-funded
researchers continued to make important progress in 2010. Phase two is
underway to define changes in brain structure and function as people
transition from normal cognitive aging to mild cognitive impairment
(MCI is often a precursor to Alzheimer's) to AD. Using imaging
techniques and biomarker measures in blood and cerebrospinal fluid
(CSF), ADNI investigators have already established a method and
standard of testing levels of AD characteristic tau and beta-amyloid
proteins in the CSF, correlated levels of these proteins with changes
in cognition over time, and determined that changes in these two
protein levels in the CSF may signal the onset of mild AD.
Genetic research on AD is also yielding important insights into the
disease. In 2009 and 2010, several new candidate risk factors gene,
including CR1, CLU, PICALM and SORL1, were identified. Identification
of new pathways that contribute to the development of AD will provide
novel avenues for drug targeting. As part of another initiative, the AD
Translational Initiative, 40 compounds are being studied. In addition,
industry partners are considering several compounds that NIH funded in
the pre-clinical phase for full-scale clinical testing. In total, NIH
currently supports 38 clinical trials, including both pilot and large
scale trials, of a wide range of interventions to prevent, slow, or
treat AD and/or cognitive decline. Any one or more of these trials may
hold the key to curing or preventing this terrible disease.
In a major announcement, revised clinical diagnostic criteria for
AD dementia were published in the April 19, 2011 issue of Alzheimer's &
Dementia: The Journal of the Alzheimer's Association, marking the first
time in 27 years clinical diagnostic criteria and research guidelines
for earlier stages of AD have been revised. The revised guidelines
cover the full spectrum of the disease as it gradually changes over
many years. They describe the earliest pre-clinical stages of the
disease, mild cognitive impairment, and dementia due to AD's pathology.
The guidelines also address the use of imaging and biomarkers in blood
and spinal fluid that may help determine whether changes in the brain
and those in body fluids are due to AD. The guidelines outline some new
approaches for clinicians and provide scientists with more advanced
guidelines for moving forward with research on diagnosis and
treatments.
Increasing Healthy Life Span
Through its Division of Aging Biology, NIA supports research to
improve understanding of the basic biological mechanisms underlying the
process of aging and age-related diseases. The program's primary goal
is to provide the biological basis for interventions in the process of
aging, which is the major risk factor for many chronic diseases
affecting older people. Recent significant findings that could help
advance understanding of a range of chronic diseases, include the
discovery of the drug rapamycin, which has been shown to extend median
lifespan in a mouse model. Grantees supported by this program have also
identified genetic pathways that regulate the maintenance of the stem
cell microenvironment in aging tissues.
In fiscal year 2012, the Institute intends to continue supporting
the Interventions Testing Program to extend median and/or maximal life
span in a mouse model; an initiative to determine cell fates in various
tissues of aged mammals, under both normal and injury conditions; and
studies to identify neural, neuroendocrine, and other mechanisms that
influence age-related changes in bone metabolism and health.
Behavioral and Social Science Research
The Division of Behavioral and Social Research Program supports
social and behavioral research to increase understanding of the aging
process at the individual, institutional, and societal levels. Research
areas include the behavioral, psychological, and social changes
individuals undergo throughout the adult lifespan; participation of
older people in the economy, families, and communities; the development
of interventions to improve the health and cognition of older adults;
and the societal impact of population aging and of trends in labor
force participation, including fiscal effects on the Medicare and
Social Security programs. The Division also leads numerous trans-NIH
behavioral and social science research initiatives, such as the ongoing
Behavioral Economics initiatives.
One of the Division's signature projects, the Health and Retirement
Study (HRS), is recognized as the Nation's leading source of combined
data on health and financial circumstances of Americans over age 50.
HRS data have been cited in over 1,700 scientific papers and have
informed findings regarding the effects of early-life exposures on
later-life health, variables associated with cognitive and functional
decline in later life, and trends in retirement, savings, and other
economic behaviors. In 2010, NIA expanded the HRS to increase minority
representation and conduct genome-wide scans of a subset of
participants. Also, in 2010, HRS data were used by scientists who found
that older adults who survive hospitalization involving severe sepsis,
a serious medical condition caused by an overwhelming immune response
to severe infection, are at higher risk for cognitive impairment and
physical limitations than older adults hospitalized for other reasons.
Funding Challenges
In November 2010, Nature magazine featured an article, ``Funding
crisis hits U.S. ageing research,'' describing funding challenges
facing the NIA and the field of aging research. The article reported
that ``in 2010, a researcher submitting a grant application for any
single deadline had only an 8 percent chance of winning funding''--
falling from 12 percent in 2009. Dr. Richard Hodes, NIA Director, is
quoted as saying the currently funding dilemma ``threaten[s] the
viability of ageing research'' and expresses concern, in particular,
about the effect the declining success rates could have on the morale
of the next generation of scientists and on their ability to compete
successfully for an NIA grant. The dire implications of the Institute's
declining success rates is one reason, among others, that the Friends
of NIA ask the Subcommittee to support $1.4 billion, an increase of
$300 million, for the Institute in fiscal year 2012.
Conclusion
We thank you, Mr. Chairman, and the Subcommittee for supporting the
NIA and, again, for the opportunity to express our support for the
Institute and its important research.
______
Prepared Statement of Futures Without Violence
Futures Without Violence, formerly Family Violence Prevention Fund,
has worked for 30 years to end violence against women and children
around the world, and is proud to be a co-chair the nonpartisan Funding
to End Domestic and Sexual Violence Coalition, a coalition of over 30
national organizations committed to domestic violence, dating violence,
sexual assault, and stalking. As the National Health Resource Center on
Domestic Violence, we provide critical information to thousands of
healthcare providers, institutions, domestic violence service
providers, government agencies, researchers and policy makers each
year. Our public education campaigns, conducted in partnership with The
Advertising Council, have shaped public awareness and changed social
norms for 15 years.
Violence Against Women Health Initiative (HHS Office of Women'
Health).--I wish to request $3.375 million for the Violence Against
Women Health Initiative as authorized by the Violence Against Women and
Department of Justice Reauthorization Act of 2005 (Public Law 109-162);
the President's fiscal year 2012 budget requested $3 million for this
Initiative. The Violence Against Women Health Initiative is a
consolidation of two Violence Against Women Act 2005 programs (Grants
to Foster Public Health Partnerships and Education and Training of
Health Care Providers), and a top LHHS priority by the Funding to End
Domestic and Sexual Violence Coalition. The Violence Against Women
Health Initiative through the Office of Women's Health, with additional
support by the Administration on Children and Families, provides
funding to public health programs that integrate domestic and sexual
violence assessment and intervention into basic care, as well as
encourages collaborations between healthcare providers, public health
programs, and domestic and sexual violence programs. The field is
already seeing impressive results. We strongly support the continued
need to engage health providers to prevent and respond to violence and
abuse. Our other priorities are listed at the end of my testimony.
Domestic and sexual violence is a critical healthcare problem and
one of the most significant social determinants of health for women and
girls. Nearly one in four women in the United States reports
experiencing violence by a current or former spouse or boyfriend at
some point in her life, and one in six women reported experiencing a
completed sexual assault. The Centers for Disease Control and
Prevention (CDC) conservatively estimates that intimate partner rape,
physical assault and stalking costs the healthcare system $8.3 billion
annually from direct injuries and services. In addition to the
immediate trauma caused by abuse, it contributes to a number of chronic
health problems. The CDC classifies violence and abuse as a
``substantial public health problem in the United States.''
Children who experience childhood trauma, including witnessing
incidents of domestic violence, are at a greater risk of having serious
adult health problems including tobacco use, substance abuse, cancer,
heart disease, depression and a higher risk for unintended pregnancy.
Twenty years of research links childhood exposure to violence with
chronic health conditions including obesity, asthma, arthritis, and
stroke. It is worth noting that victims, particularly of sexual
violence, are linked with obesity. A meta-analysis of research on the
impact of adult intimate partner violence finds that victims of
domestic violence are at increased risk for conditions such as heart
disease, stroke, hypertension, cervical cancer, chronic pain including
arthritis, neck and pain, and asthma. In addition to injuries, adult
intimate partner violence also contributes to a number of mental health
problems including depression and PTSD, risky health behaviors such as
smoking, alcohol and substance abuse, and poor reproductive health
outcomes such as unintended pregnancy, pregnancy complications, post
partum depression, poor infant health outcomes and sexually transmitted
infections including HIV.
But early identification and treatment of victims can financially
benefit the healthcare system. Initial findings from one study found
that hospital-based domestic violence interventions may reduce
healthcare costs by at least 20 percent. Preventing abuse or associated
health risks and behaviors clearly could have long term implications
for decreasing chronic disease and costs. Because of the long-term
impact of abuse on a patient's health, the Violence Against Women
Health Initiative is integrating assessment for current and lifetime
physical or sexual violence exposure and interventions into routine
care. Regular, face-to-face screening of patients by skilled healthcare
providers markedly increases the identification of victims of intimate
partner violence, as well as those who are at risk for verbal,
physical, and sexual abuse. Routine inquiry of all patients, as opposed
to indicator-based assessment, increases opportunities for both
identification and effective interventions, validates violence and
abuse as a central and legitimate healthcare issue, and enables
providers to assist both victims and their children.
When victims or children exposed to violence and abuse are
identified early, providers may be able to break the isolation and
coordinate with domestic or sexual violence advocates to help patients
understand their options, live more safely within the relationship, or
safely leave the relationship. Expert opinion suggests that such
interventions in adult health settings may lead to reduced morbidity
and mortality. Assessment for exposure to lifetime abuse has major
implications for primary prevention and early intervention to end the
cycle of violence.
Just as the healthcare system has always played an important role
in identifying and preventing other serious public health problems, I
believe it can and must play a pivotal role in domestic and sexual
violence prevention and intervention. It is clear that by funding these
innovative and life-saving health provisions, we can help save the
lives of victims of violence and greatly reduce healthcare expenses.
In order to advance necessary and needed health goals, I urge you
to fund the following LHHS programs accordingly:
Violence Against Women Health Initiative at $3.375 million
The existing program, entitled ``Project Connect: A Coordinated
Public Health Initiative to Prevent Violence Against Women,'' is
working with two southern California tribes and eight States (Arizona,
Georgia, Ohio, Iowa, Maine, Michigan, Texas, Virginia) to change how
adolescent health, reproductive health, and home visiting programs
respond to sexual and domestic violence. The Initiative is developing
and distributing education and training materials to respond to abuse
across the lifespan. Research demonstrates that women in these programs
are at high risk for abuse, and that there are evidence-based
interventions that can improve maternal and child health, and decreases
the risks for unplanned pregnancy, poor pregnancy outcomes and further
abuse. These sites provide much-needed services for women in abusive
relationships including historically medically underserved communities
that have high rates of domestic and sexual violence, such as rural/
frontier areas, immigrant women, and Native Americans. UC Davis School
of Medicine is implementing an evaluation plan to measure the
effectiveness of both the clinical intervention and policy change
efforts.
The approach includes creating and disseminating:
--Enhanced clinical interventions to respond to domestic and sexual
violence, including training and supporting materials for
providers and health systems,
--Patient education materials on the connection between abuse and
their health,
--Policy and systems change at the local, State and national level,
--National training of providers through an eLearning platform,
--Pilot programs to offer basic health services within domestic and
sexual violence programs, and
--Evaluation and research on the health impact of abuse and the
impact of health-based interventions.
In the first year using fiscal year 2009 funding, the Initiative
had a significant impact:
--With over 1,500 providers from 50 clinical sites receiving
training, programs serving over 200,000 women will integrate
assessment for abuse into routine care and offer help when
needed, using an evidence-based and setting-specific clinical
intervention.
--New education materials for providers and patients/clients have
been developed, including:
--New training curriculum for home visitation programs
--New safety cards for adolescents talking about healthy
relationships
--Twelve new video vignettes an electronic distance learning platform
that will be used to train providers in adolescent,
reproductive and maternal and child health programs nationwide.
--Coordinated State level teams of public health and domestic and
sexual violence partners have been formed to create lasting
health policy and coordinated response to victims. Examples of
policy change include adding assessment of domestic and sexual
violence into statewide nursing guidelines, and improving data
collection by adding new questions about domestic and sexual
violence to statewide surveillance systems.
This year, the sites are continuing this work but building on the
momentum by:
--Implementing an e-learning platform to train tens of thousands of
additional physicians, nurses, and students. Beginning in
Spring 2011, the free online CME trainings will be offered to
Project Connect sites, as well as national health associations,
such as the American College of Obstetricians and
Gynecologists.
--Offering basic health services on site in select domestic and
sexual violence programs in each Project Connect site. Program
strategies include: utilizing mobile health vans, stationing
public health nurses in family violence programs, integrating
basic health assessment questions into domestic violence
shelter intake, and partnering with local providers for ongoing
care.
--Evaluating the impact of Project Connect's clinical intervention on
the health and safety of victims of abuse. In addition to the
initiative-wide evaluation of provider behavior change, four
sites have partnered with local universities to conduct an in-
depth evaluation of the effect that integrating the assessment
of domestic and sexual violence into clinical settings has on
clients.
--Disseminating information on best practice models for integration
in other States/tribes and service settings. Plans include an
educational briefing and development of a report outlining
model programs.
Report Language under Centers for Disease Control and Prevention
Injury Prevention and Control regarding Domestic and Sexual
Violence
In VAWA 2005, Congress approved a program entitled ``Research on
Effective Interventions to Address Violence Against Women'' at $5
million through CDC and ARHQ to support research and evaluation on
effective interventions in the healthcare setting to improve victim's
health and safety and prevent initial victimization. This authorized
program from Public Law 109-162 has not been funded. The President's
fiscal year 2012 budget recommends $20 million of the Prevention and
Public Health Fund go to unintentional injuries through CDCs Injury
Prevention and Control. To fulfill the need recognized by the earlier
VAWA program, I respectfully recommend the following report language:
``The Committee finds that domestic and sexual violence is a
healthcare problem and one of the most significant social determinants
of health for women and girls. In addition to the immediate trauma
caused by abuse, it contributes to a number of chronic health problems.
The CDC classifies violence and abuse as a ``substantial public health
problem in the United States.'' As part of the budget request to fund
unintentional injury prevention activities from the Prevention and
Public Health Fund, the Committee supports a portion of the funding
support the prevention of intentional injuries from lifetime exposure
to intimate partner violence, child maltreatment, youth violence, and
sexual violence.''
Proposed Report Language under HHS Office of Adolescent Health
regarding Teen Dating Violence and Communities of Color
The work by the Office of Adolescent Health to create and
administer the Teen Pregnancy Prevention Program in such a short time
period has been remarkable. That said, adolescents from communities of
color are disproportionately affected by teenage pregnancy, and
research also shows that teenage dating violence and abuse are
associated with higher levels of teenage pregnancy and unplanned
pregnancy. Adolescent girls in physically abusive relationships are
three times more likely to become pregnant than non-abused girls. To
fulfill the promise of the Office of Adolescent Health to holistically
address teen pregnancy prevention, I respectfully recommend the
following report language:
``The Committee strongly urges the Secretary, through the Office of
Adolescent Health, to include teen dating violence prevention and
healthy relationship strategies within existing adolescent health
working groups and better integrate preventing violence and abuse as a
strategy to prevent teen and unplanned pregnancy within communities of
color. Further, the Committee strongly urges the Secretary, though the
Office of Adolescent Health, to conduct a review of the evidence-based
programs chosen by the Teen Pregnancy Prevention Program and issue a
report to determine which programs address teen dating violence and
healthy relationship strategies as a means to prevent teen pregnancy.''
In addition, I ask that you at least meet the President's fiscal
year 2012 request of $135 million for the Family Violence Prevention
and Services Act (FVPSA) under ACF, the Nation's only designated
Federal funding source for domestic violence shelters and services. As
we are all committed to both the prevention of violence and abuse and
to the health and safety of victims, I urge you to fund these critical
programs.
______
Prepared Statement of the Global Health Technologies Coalition
Chairman Harkin, Ranking Member Shelby and members of the
Committee, thank you for the opportunity to provide testimony on the
fiscal year 2012 appropriations funding for the National Institutes of
Health (NIH) and the Centers for Disease Control and Prevention (CDC).
We appreciate your leadership in promoting the importance of
international development, in particular global health. We hope that
your support will continue. I am submitting this testimony on behalf of
the Global Health Technologies Coalition (GHTC), a group of nearly 40
nonprofit organizations working together to advance U.S. policies which
can accelerate the development of new global health innovations--
including new vaccines, drugs, diagnostics, microbicides, and other
tools--to combat global health diseases. The GHTC's members strongly
believe that to meet the global health needs of tomorrow, it is
critical to invest in research today so that the most effective health
solutions are available when we need them, and that the U.S. Government
has a historic and unique role in doing so. My testimony reflects the
needs expressed by our member organizations \1\ which include nonprofit
advocacy organizations, policy think-tanks, implementing organizations,
and many others. One-third of our members are also nonprofit product
development partnerships, which work with partners in the private
biotechnology and pharmaceutical and medical device sectors, as well as
public research institutions, academia, and nongovernmental
organizations to develop new and more effective life-saving
technologies for the world's most pressing health issues. We strongly
urge the Committee to continue its established support for global
health research and development (R&D) by (1) sustaining and protecting
the U.S. investment in global health research and product development,
(2) instructing NIH and CDC, in collaboration with other agencies
involved in global health, to continue their commitment to global
health in their R&D programs, and (3) requiring leaders at U.S.
agencies to put plans in place to ensure that global health R&D is
efficient, coordinated and streamlined.
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\1\ GHTC member list: http://www.ghtcoalition.org/coalition-
members.php.
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Critical need for new global health tools
Our Nation's investments have made historic strides in promoting
better health around the world: nearly 6 million people living with
HIV/AIDS now have access to life-saving medicines, new, cost-effective
tools help us diagnose diseases quicker and more efficiently than ever
before, and innovative new vaccines are making significant dents in
childhood mortality. While we must increase access to these and other
proven, existing health tools to tackle global health problems, it is
just as critical that we continue to invest in developing the next
generation of tools to stamp out disease and address current and
emerging threats. For instance, newer, more robust, and easier to use
antiretroviral drugs, particularly for infants and young children, are
needed to treat (and prevent) HIV and even a 50 percent effective AIDS
vaccine could prevent 1 million HIV infections every year. Drug-
resistant tuberculosis is on the rise globally, including in the United
States, however the only vaccine on the market is insufficient at 90
years old, and most therapies are more than 50 years old, extremely
toxic, and exorbitantly expensive. New tools are also urgently needed
for fatal neglected tropical diseases such as sleeping sickness for
which diagnostic tools are inadequate, and the few drugs that are
available are toxic and difficult to use. There are many very promising
technology candidates in the R&D pipeline to address these and other
health issues; however, these tools will never be available if the
support needed to continue R&D is not protected and sustained.
Research and US global health efforts
The United States is at the forefront of innovation in global
health technologies. For example, as recently as December, a new
meningitis vaccine costing less than 50 cents per dose developed by the
Meningitis Vaccine Project--a partnership between the World Health
Organization and the international nonprofit PATH--was distributed for
the first time in Africa--the development and implementation of which
was supported through strategic funding and scientific expertise from
the CDC, NIH, U.S. Food and Drug Administration (FDA), and the U.S.
Agency for International Development (USAID).
The NIH is the largest funder of global health research in the U.S.
Government, and the agency has recently demonstrated a growing interest
in global health issues. NIH Director Francis Collins made global
health one of his top five priorities for the future of NIH, stating,
``. . . the world has seen us as the soldier to the world. Might we not
do better both in terms of our benevolence and our diplomacy by being
more of a doctor to the world? \2\ The NIH's Fogarty International
Center recently began collaborating with the Department of Health and
Human Services' Health Research Services Administration and the U.S.
Department of State's Office of the U.S. Global AIDS Coordinator on the
Medical Education Partnership Initiative to develop, expand, and
enhance models of medical education. This includes enhancing the
capacity of local individuals to conduct research on global health
diseases. Also recently, the Therapeutics for Rare and Neglected
Diseases (TRND) program at the NIH launched five pilot projects to spur
drug development for diseases including schistosomiasis and hookwoom.
Each of these efforts build on the historic work carried out by the
agency which contributes to improved health around the world.
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\2\ NIH all-hands town meeting, 17 August 2009. http://
videocast.nih.gov/Summary.asp?File=15247.
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With operations in more than 54 countries, the CDC is engaged in
many global health research efforts. The work of CDC scientists has led
to major advances against devastating diseases, including the
eradication of smallpox and early identification of the disease that
became known as AIDS. Although CDC is known for its expertise and
participation in HIV, TB, and malaria programs, it also operates
several activities for neglected diseases in its National Center for
Zoonotic, Vector-Borne, and Enteric Diseases.
Leveraging the private sector for innovation
NIH, CDC, USAID and other agencies involved in global health R&D
regularly collaborate with the private sector in developing,
manufacturing, and introducing important technologies such as those
described above through public-private partnerships, including product-
development partnerships. These partnerships leverage public-sector
expertise in developing new tools, partnering with academia, large
pharmaceutical companies, the biotechnology industry, and governments
in developing countries to drive greater development of products for
neglected diseases for which private industries have not historically
invested. This unique model has generated twelve new global health
products and has enormous potential for continued success if robustly
supported.
In order to more fully engage the private sector in developing
products for global health R&D, additional market-based incentives are
needed. With little-to-no commercial drive to develop new drugs and
vaccines for diseases that primarily affect the developing world,
financial incentives and innovative financing must be pursued. No
single incentive scheme or financing mechanism is capable of filling
all the gaps and encouraging the full range of R&D activities across
all of the diseases and products that the developing world urgently
needs. A portfolio of incentives and financing mechanisms that can fill
the multiple gaps in the product development pipeline for multiple
diseases is needed. NIH should be applauded for its participation in
the small business innovation research awards and a patent pool for HIV
medicines, and additional efforts in this area are encouraged. The
development of new incentive strategies is critical for long-term,
meaningful private-sector engagement in global health.
Innovation as a smart economic choice
Global health R&D brings life-saving tools to those who need them
most, however the benefits these efforts bring are much broader than
preventing and treating disease. Global health R&D is also a smart
economic investment in the United States, where it drives job creation,
spurs business activity, and benefits academic institutions. Biomedical
research, including global health, is a $100 billion enterprise in the
United States. In a time of global financial uncertainty, it is
important that the United States support industries, such as global
health R&D, which build the economy at home and abroad.
History has shown that investing in global health research not only
saves lives but is also a cost-effective approach to addressing health
challenges. And an investment made today can help save significant
money in the future. In the United States alone, for example, polio
vaccinations during the last 50 years have resulted in a net savings of
$180 billion, funds that would have otherwise been spent to treat those
suffering from polio. In addition, new therapies to treat drug-
resistant tuberculosis have the potential to reduce the price of
tuberculosis treatment by 90 percent and cut health system costs
significantly. The United States has made smart investments in research
in the past that have resulted in lifesaving breakthroughs for global
health diseases, as well as important advances in diseases endemic to
the United States. We must now build on those investments to turn those
discoveries into new vaccines, drugs, tests, and other tools.
Recommendations
In this time of fiscal constraint, support for global health
research that improves the lives of people around the world--while at
the same time creating jobs and spurring economic growth at home--
should unquestionably be one of the Nation's highest priorities. In
keeping with this value, the GHTC respectfully requests that the
Committee do the following:
--Sustain and protect U.S. investments in global health research and
product development within both the CDC and NIH budgets. We ask
that this not come at the expense of robust funding for the
entire set of global public health accounts, all of which
complement each other and ultimately serve the common goal of
building a healthier and more prosperous world.
--Instruct all U.S. agencies in its jurisdiction to continue their
commitment to global health in their R&D programs by developing
actions plans, including metrics to measure progress. The
Committee shall request that leaders at NIH and CDC work with
leaders at other U.S. agencies to ensure that efforts in global
health R&D are coordinated, efficient, and streamlined by
establishing transparency mechanisms designed to show what
global health R&D efforts are taking place and how U.S.
agencies are collaborating with each other to make efficient
use of the U.S. investment.
--Request relevant agencies report on their progress to Congress and
be made publicly available. Past accounting of the health R&D
activities at individual agencies, such as Research, Condition,
and Disease Categorization at NIH, have been very helpful in
coordinating efforts between agencies and informing the public
and such efforts should be expanded to include neglected
disease categorization and extended to provide a comprehensive
picture of this investment from all agencies involved in global
health R&D.
We respectfully request that the Committee consider inclusion of
the following language in the report on the fiscal year 2012 State and
Foreign Operations appropriation legislation:
``The Committee recognizes the urgent need for new global health
technologies in the fight against global health diseases, and the
critical contribution that the NIH, CDC, and FDA make to this cause
through their health research and training portfolios, operations
research and regulatory capabilities. The Committee also acknowledges
the urgent need to sustain and protect U.S. investment in this
important research by fully funding these three agencies to carry out
their work.
``New global health products such as drugs, vaccines, diagnostics,
and devices are cost-effective public health interventions that play an
important role in improving global health and are vital in stopping
pandemics. The Committee understands the positive impact that global
health research and development has on the U.S. economy through the
creation of U.S. jobs and the development of foreign markets for U.S.
products. NIH is widely recognized as the world leader in basic
research, and has supplied invaluable breakthroughs that have led to
new health tools, saving millions of lives globally. Through its
Fogarty International Center, NIH harnesses its wealth of expertise to
train the next generation of health scientists.
``The Committee directs the CDC, FDA, and NIH to each create
metrics to measure progress and to develop concrete plans to prioritize
and incorporate global health research, product development, and
regulation into their U.S. global health and development strategies.
The Committee directs CDC, FDA, and NIH to work with each other as well
as the Department of State, the U.S. Agency for International
Development, and the Office of the U.S. Global AIDS Coordinator to
ensure that these efforts are coordinated, efficient, and streamlined
across the agencies involved in implementing the President's Global
Health Initiative. CDC, FDA, and NIH shall each make the documentation
and results of these efforts available to Congress and the public.''
As a leader in science and technology, the United States has the
ability to capitalize upon our strengths to help reduce illness and
death and ultimately eliminate disabling and fatal diseases for people
worldwide, contributing to a healthier world and a more stable global
economy. Sustained investments in global health research to develop new
drugs, vaccines, tests, and other health tools--combined with better
access to existing methods to prevent and treat disease--present the
United States with an opportunity to dramatically alter the course of
global health while building political and economic security across the
globe.
On behalf of the members of the GHTC, I would like to extend my
gratitude to the Committee for the opportunity to submit written
testimony for the record.
______
Prepared Statement of Goodwill Industries International
Mr. Chairman, Ranking Member, and Members of the Subcommittee, on
behalf of Goodwill Industries International (GII), I appreciate this
opportunity to submit written testimony on Goodwill's priorities for
fiscal year 2012 funding programs administered by the U.S. Departments
of Labor, Health and Human Services, and Education.
Goodwill Industries International (GII) represents 158 local and
autonomous Goodwill Industries agencies in the United States that help
people with barriers to employment to participate in the workforce. One
of Goodwill Industries' greatest strengths continues to be its
entrepreneurial approach to sustaining its mission. In 2010, Goodwill
raised more than $4 billion in its retail stores and other social
enterprises and invested 84 percent of its privately raised revenues to
supplement Federal investments in programs that give people the skills
they need to reenter the workforce. Goodwill provided job training,
employment services, and supportive services to nearly 2.5 million
people, placing more than 170,000 people in jobs and employing 97,000.
Nearly 160,000 people were referred to Goodwill from the workforce
system or a State Vocational Rehabilitation Agency. In addition to our
efforts to help people find jobs and advance in careers, Goodwill
understands that many people need additional supportive services--child
care, reliable transportation, stable housing, counseling and
assistance in adjusting to the workplace, assistive technology--to
ensure their success.
Now more than ever, with unemployment slowly declining from the
highest levels experienced in a generation, local Goodwill agencies are
on the front lines of the fragile recovery assisting people with
employment barriers, including individuals with disabilities, older
workers, and Temporary Assistance to Needy Families (TANF) recipients
who are struggling to find and keep jobs during a stubbornly tight job
market. In addition in 2010, Goodwill's collective investment in these
services eclipsed the Department of Labor's combined investment in
WIA's adult, youth, and dislocated workers.
While Goodwill is proud of these and other achievements, they are
truly the result of a public-private partnership. As the fragile
recovery from the worst recession since the Great Depression continues
and unemployment rates slowly decline from near 10 percent, Goodwill
understands the difficult challenge that appropriators face as they
struggle to reduce the deficit while stretching limited resources to
support an ever-increasing list of national priorities. Reducing the
deficit is a serious issue that will require all to make sacrifices to
address the Nation's spending problem while investing in integrated
strategies that build upon and leverage existing resources that will
address our Nation's revenue problem. Therefore, Goodwill was very
concerned about the drastic cuts to the workforce system that were
proposed in the fiscal year 2011 continuing resolution (H.R. 1) that
was passed by the House of Representatives earlier this year, and
thanks the Senate for its efforts to mitigate the cuts in the final
fiscal year 2011 spending deal. As Congress works to develop its
spending bills for fiscal year 2012, Goodwill is again concerned
because the House budget allocation for Labor, Health and Human
Services, and Education is $18 billion less than the amount agreed to
in the final fiscal year 2011 budget deal.
Goodwill is aggressively moving to increase its capacity to do more
to help people find jobs and advance in careers during and after these
difficult times. Goodwill is working to open more stores and attended
donation centers in order to create jobs and generate more privately
raised revenues to invest in people who are facing employment
challenges in the communities that local Goodwill agencies serve. In
addition, Goodwill is more committed than ever to partnering with
stakeholders at the Federal, State, and local levels by contributing
the resources and expertise of local Goodwill agencies in support of
public efforts and investments.
While our agencies care about a range of Federal funding sources,
Goodwill urges Congress to provide funding for the Department of
Labor's Senior Community Service Employment Program (SCSEP); the
Workforce Investment Act's adult, dislocated worker, and youth funding
streams; summer jobs for youth; and the Department of Education's
Vocational Rehabilitation programs.
Senior Community Service Employment Program (SCSEP)
Workers who are 55 and older have multiple barriers to employment
and will be among the last rehired as the economy improves.
Furthermore, according to the Bureau of Labor Statistics, the
unemployment rate for older workers (over 55 years old) was 6.2 percent
in April, 2011. While older workers are less likely to be unemployed
than their younger counterparts, older workers who do lose their jobs
face significant odds of finding another one. The average time spent
looking for a job by someone between the ages of 55 and 64 is 44.6
weeks. Those over the age of 64 also spend nearly 1 year seeking work
for an average of 43.9 weeks. Older workers are more likely to be laid
off from industries that are in structural decline. This population may
be less likely to go back to school as they have other financial
burdens and are less mobile due to home ownership. Finally, these
workers may face age discrimination when applying for a new job.
Therefore, Goodwill is alarmed by the Administration's proposal to cut
funding for the Community Services Employment for Older Americans
program (also called the Senior Community Service Employment Program)
by 45 percent which will result in the elimination of services to
nearly 50,000 low income older workers who badly in need of assistance.
SCSEP helps provide low-income older workers with community
services employment and private sector job placements. Preserving SCSEP
funding is critical as it is the only program targeted to helping low
income seniors regain employment, as this population is experiencing
the toughest employment prospects in a generation. Goodwill is a
national SCSEP grantee with providers around the country. While many
individuals assume that SCSEP is for much older workers and question
the type of training received, 42 percent of Goodwill's SCSEP
participants are between the ages of 55 and 59. In 2010, SCSEP
participants contributed nearly 1.4 million community service hours and
our private sector placements averaged a starting wage of $9.75 per
hour.
In recent years, Congress has demonstrated its commitment to older
workers by providing an additional $120 million for SCSEP in the
Recovery Act, and a $250 million increase in fiscal year 2010. These
funds have allowed local Goodwill agencies to better address our
waiting list of participants and help many older workers with part-time
employment. Private sector placement wages also increased. Goodwill
very much appreciates the monumental investment that the Congress has
placed on helping older workers to survive the economic crisis.
However, as SCSEP program providers prepare for a cut in funding,
community service hours have been cut, new enrollees have not been
accepted, and additional classroom training that has an added cost have
been reduced or eliminated. Should SCSEP be cut further, it will result
in a loss of professional staff and it will be more difficult to get
out to non-urban areas since rural communities will have fewer slots.
Goodwill urges the Subcommittee to reject the Administration's
proposed cuts to SCSEP. At a minimum Congress should fund SCSEP at no
less than $600 million, which will allow a restoration of assistance to
an additional 24,000 participants, nearly half of the participants cut
from the program by funding reductions in the fiscal year 2011
Continuing Resolution.
Workforce Investment Act
Funding for the Workforce Investment Act's youth, adult, and
dislocated worker formulas is one of Goodwill's top funding priorities
for fiscal year 2012. Most Goodwill agencies have people referred to
them through the workforce system. In addition, several agencies are
one-stop lead operators or operators in association with other service
providers, and are active on state and local workforce boards.
It should be noted that, in 2002, when the unemployment rate was
5.8 percent, combined funding for WIA's youth, adult, and dislocated
worker funding streams was more that $3.67 billion. Since then, funding
has steadily eroded; and nearly 10 years later, at a time when the
unemployment rate remains much higher--around 9 percent--the
Administration proposes just $2.96 billion for WIA's three main funding
streams, nearly 20 percent less than the fiscal year 2002 level.
Furthermore, the Administration proposes to divert 8 percent to
contribute to the creation of a Workforce Innovation Fund to ``support
and test promising approaches to training, and breaking down program
silos, building evidence about effective practices, and investing in
what works.''
Goodwill believes that a Workforce Innovation Fund is a promising
idea, is very interested in the details, and is encouraged by the
Administration's efforts to increase interagency collaborations and
leverage resources provided by community-based organizations, however
the proposed Workforce Innovation Funds should be paid for with funds
in addition to, rather than at the expense of, existing WIA formula
funds--in fiscal year 2012 and beyond.
In 2010, the workforce system served more than 8 million people,
placing more than half in jobs while helping others to access education
and training aimed at improving their future employment prospects. As
noted earlier, Goodwill is doing all it can to help people who have
been affected by the recession. In fact in 2010, Goodwill's collective
investment in job training and employment services eclipsed the
Department of Labor's combined investment in WIA's adult, youth, and
dislocated workers. Some agencies have, in fact, been doing more than
they can by deliberately using their reserves in order to provide help
to more people than their current revenues support. If not now, when?
Therefore, Goodwill is very concerned the continued delay in
reauthorizing WIA may put the whole system at risk, causing many
Goodwill agencies to wonder how they would respond to the dramatic
increase in requests for services if the workforce system were to be
dismantled completely. Most agencies would be forced to turn away
people in need or risk being overleveraged to the brink.
Goodwill understands that this Subcommittee faces a difficult
challenge in stretching limited resources to cover a range of
priorities; however the workforce system is vastly under-funded and
preservation of WIA's formula funding streams should be a high
priority. Therefore, Goodwill urges Congress to sustain WIA's adult,
dislocated worker, and youth funding streams at current funding levels
at a minimum. Before diverting funds from WIA's already underfunded
programs, Congress should reauthorize WIA and include provisions that
would establish the Workforce Innovation Fund without jeopardizing
existing funds for WIA's three core funding streams.
Vocational Rehabilitation (VR) Funding
Goodwill Industries has a long history of helping people with
disabilities to participate in the workforce despite the challenges
their disabilities present. Years of inadequate funding for VR have
left the system stretched much too thin to serve all who are eligible
for assistance. As a result, most State VR agencies have Orders of
Selection, a provision within the Rehabilitation Act that requires
State VR agencies, when faced with a shortage of funds to meet the
demand for services, to prioritize the provision of services to
eligible people based on the severity of people's disabilities. In
addition, reduced funding for WIA has placed an additional strain on
mandatory partner programs, including VR, which are being asked to
contribute more funding to pay for infrastructure and other costs
associated with the operation of one-stop centers.
Goodwill supports the Administration's intent to increase multi-
system collaboration and support for youth with disabilities who are
transitioning from education to the workforce. The Administration's
fiscal year 2012 budget proposes to increase funding for VR State
agencies by $57 million, while diverting $30 million of VR's State
grant funds to contribute to a new Workforce Innovation Fund. Funding
for the Rehabilitation Services Administration's Migrant and Seasonal
Farmworker program, Projects with Industry, and Supported Employment
would be eliminated, thus offsetting the increase by $50 million.
For more than two decades, Goodwill has offered supported
employment as a part of its service array. According to Goodwill
Industries International's Annual Statistical Report, participation in
local Goodwill agencies' supported employment programs has grown
dramatically in recent years from providing 270,000 coaching sessions
in 2007 to 630,000 sessions in 2009.
Goodwill is intrigued by the Administration's proposal to stimulate
system collaboration by creating a Workforce Innovation Fund; however,
Goodwill believes that funding for the Workforce Innovation Fund should
not come at the expense of existing and already inadequate funds for
the VR system.
Goodwill thanks the Subcommittee for considering these requests,
and looks forward to working with the Subcommittee to help government
meet the serious challenges our nation faces.
______
Prepared Statement of the Harlem Children's Zone
Thank you for this opportunity to support comprehensive services
for poor children and the U.S. Department of Education's (ED) Promise
Neighborhoods program which we believe will break the cycle of
generational poverty for hundreds of thousands of poor children.
Like the work at the Harlem Children's Zone (HCZ), the Promise
Neighborhoods program has already begun to transform the odds for
entire communities. High-achieving schools are at the core of Promise
Neighborhoods, but it is not only about creating a successful school.
It is about programs for children from birth through college and
career, supporting families and rebuilding community. Doing this
changes the trajectory of an entire community.
In the mid-1990s it became clear to the HCZ team that despite
heroic efforts at saving poor children, success stories remained the
exception. Our piecemeal approach was of limited value against a
perfect storm of problems and challenges. So the HCZ Project was
created in Central Harlem to work with kids, their families and their
community. Starting with one building, HCZ has grown to 97 blocks. Last
year, the HCZ Project served 15,508 clients including 8,838 youth and
6,670 adults. HCZ, Inc., which includes the HCZ Project plus our Beacon
Centers and Preventive Foster Care programs, served 23,556 clients
including 10,541 youth and 13,015 adults.
Now, over a decade later, the Children's Zone model is working.
Parents are reading more to their children. Four year olds are ready
for kindergarten. Students are closing the black-white achievement gap
in several subjects. Teenagers are graduating from high school and this
school year, over 600 of them who attended traditional public schools
are in college. HCZ helps parents file for taxes including the Earned
Income Tax Credit (EITC) and last tax season, families collectively
received over $8 million.
HCZ's theory of change is embodied in the application of all of the
following five principles:
--Serve an entire neighborhood comprehensively and at scale.
--Create a pipeline of high-quality programs that starts from birth
and continues to serve children until they graduate from
college. Provide parents with supports as well.
--Build community among residents, institutions, and stakeholders,
who help to create the environment necessary for children's
healthy development.
--Evaluate program outcomes; create a feedback loop that cycles data
back to management for use in improving and refining program
offerings; and hold people accountable.
--Cultivate a culture of success rooted in passion, accountability,
leadership, and teamwork.
The HCZ model is not cheap. On average, HCZ spends $5,000 per
child each year to ensure children's success. For far less money than
is already spent, just on incarceration, we can educate, graduate our
children, and bring them back to our communities ready to be
successful, productive citizens. We think the choice is obvious.
HCZ's achievements are not magic. They are a result of hard work
and a comprehensive effort.
This same type of hard work and comprehensive effort is happening
in countless communities across the country. To provide a sense of the
level of interest in the Promise Neighborhoods program, when the
Department of Education offered the first round of planning grants in
fiscal year 2010's budget, over 339 communities competed for just 21
grants. Additionally, over 100 of these communities scored over 80,
leading Secretary of Education Arne Duncan to note that there would
have been more grants if resources were available. Just 7 months later,
these communities are going strong. For example:
Buffalo, New York
The Buffalo Promise Initiative, which is led by M&T's Westminster
Foundation, is collaborating with the John R. Oishei Foundation, Read
to Succeed Buffalo, the City of Buffalo, Buffalo Public Schools, United
Way of Buffalo and Erie County, Catholic Charities, Buffalo Urban
League, and the University at Buffalo to serve 11,000 residents in a 1-
square mile, low-income neighborhood. The Buffalo Promise Initiative is
a vital counterpoint to the challenges brought about in Buffalo due to
a shift away from industrially focused jobs, a shrinking population,
and increasing poverty. A comprehensive approach is blooming,
addressing the needs and hopes of children and their families in a
changing Buffalo.
Indianola, Mississippi
The Indianola Promise Community (IPC) is located in Indianola,
Mississippi, in the heart of the Mississippi Delta and the birthplace
of musician B.B. King. The Delta Health Alliance is the lead agency for
this unique public policy initiative. The Indianola Promise Community
unites healthcare, education, community, and faith-based services to
provide Indianola residents the chance to realize their promise as
active members and leaders in their town and neighborhoods. The Delta
Health Alliance has teamed up with a number of nonprofit organizations
and government agencies, including the local school district, the
municipal government, Mississippi State University, the county
hospital, and the Children's Defense Fund, to develop a comprehensive
collaborative with the ability to take on a number of pressing
challenges.
Although Indianola has a number of obstacles to overcome, leaders
from all aspects of the community have joined together to make the IPC
a success. The Delta Health Alliance is integrating more than a dozen
of their preexisting services and adding new programs and new partners
into a robust set of resources. The goal is to create a set of
integrated services for children and their families. The IPC engages
with all community service providers to prevent the duplication of
resources and highlight service gaps. Community members also serve on
the Steering Committee that oversees the work of the project.
Northern Cheyenne Reservation
The rich and deep history of the Northern Cheyenne community and
their commitment to engage their members is apparent in their plans to
develop a thriving Promise Neighborhood for their community. The
Promise Neighborhood is located on the Northern Cheyenne Reservation
and the surrounding communities of Colstrip and Ashland in southeast
Montana. The land is sprawling, approximately 700 square miles, and
approximately 7,300 people live within the Neighborhood.
The Boys and Girls Club of Northern Cheyenne Nation (BGCNCN), the
Promise Neighborhood lead partner, believes in ``systemic,
collaborative, strengths-based and culturally appropriate approaches''
to youth and community development that will comprehensively address
the disadvantages that the community faces.
The Boys and Girls Club has established relationships with local
communities, and thus is an excellent lead partner for this initiative.
All of the primary institutions that serve young people in the area are
involved in collaborating during this planning year. The Promise
Neighborhood has the full support of the Northern Cheyenne government,
local schools and agencies, Chief Dull Knife College, and a number of
nonprofits. All are working together to specifically create and
implement in- and out-of-school strategies and services that will
support the academic achievement, healthy development, cultural
awareness and connectedness, and college and career success of the
Neighborhood's children. Some of the BGCNCN's programs for youth
include a Native American Mentoring Program, a diabetes prevention
program, leadership groups, and a computer lab. The planning phase has
brought these groups together to begin a more concerted effort to
assess and develop a pipeline of programs that will benefit the youth
and community.
San Antonio, Texas
The Eastside Promise Neighborhood in San Antonio, Texas is led by
the United Way and has a strong partnership with the City of San
Antonio. San Antonio Mayor Julian Castro and other community leaders
are major supporters of the initiative. The Promise Neighborhood
initiative is part of the City's larger plan to support the struggling
Eastside, including the development of affordable housing, education,
environment, and other supports, and developing a strategic framework
that speaks to the community's core problems.
The Promise Neighborhood initiative, with its set of partners like
the San Antonio Independent School District, Family Service
Association, Housing Authority, City Year, Trinity University, San
Antonio for Growth on the Eastside (SAGE), and the Urban Land
Institute, is working hard to coordinate the supports and resources in
the neighborhood to activate their collective vision for community
transformation. The planning and coordination of resources going into
the community as a part of the Promise Neighborhood initiative fits
into the City's broader Eastside Reinvestment Plan aiming to shift away
from siloed and uncoordinated services on the Eastside.
Because parents are a key element to their children's success,
Eastside Promise Neighborhood has a commitment to parental engagement
and capacity-building through focus groups, community meetings during
which the community shapes the agenda, and parentally focused career
and empowerment groups through initiatives like the United Way's
Family-School-Community Partnership.
This asset-based approach and vision ensures more efficient and
effective use of neighborhood talent, resources, rich opportunities for
young people through high quality neighborhood schools and engaged
parents, and a solid physical infrastructure including high-quality
housing in the neighborhood to support the community. The community
looks to be on the right path toward stabilizing and empowering the
Eastside to stay, grow, graduate and . . . stay.
To support all of the Promise Neighborhoods' efforts, HCZ,
PolicyLink and the Center for the Study of Social Policy joined
together to create the Promise Neighborhoods Institute at PolicyLink
(PNI). Supported solely by private philanthropic dollars, PNI provides
communities with a system of support, resources, and information to
help them in local Promise Neighborhoods efforts. PNI is already
supporting 38 Promise Neighborhoods--including 21 funded by the U.S.
Department of Education. PNI has three goals:
--Ensure the 21 Federal planning grantees are successful and
transition to implementation.
--Support an additional 17 communities in their planning efforts and
transition to implementation.
--Foster a national learning network that enable communities to learn
from their peers and leverage resources in order to
significantly improve the educational and developmental
outcomes of children and youth in the Nation's most distressed
communities.
To accomplish these goals, PNI offers:
--Site visits designed to assess community need and implement a
comprehensive and personalized package of technical assistance
services that help communities learn, make systemic,
organizational and programmatic improvements and achieve
measurable and sustainable results.
--Promise Neighborhood Network conferences to share best practices.
--Trainings on topics such as how to attract funding and talk to the
media.
--Webinars and discussions moderated by experts in the field.
--A website--PromiseNeighborhoodsInstitute.org--featuring in-depth
resources and tools.
Since its launch, PNI has:
--Developed a rich menu of technical assistance that is based on what
works.
--Grown a robust community of practice that is being accessed by more
than 2,000 people.
--Implemented a feedback loop to continually refine city, county,
State, and Federal public policy and philanthropic approaches.
--Mobilized neighborhood leaders to advocate for integrated
neighborhood revitalization investments to become the norm in
solving some of the Nation's most intractable problems
affecting poor children and families.
In the current planning phase, Promise Neighborhoods are getting
ready to apply for full implementation. They are developing strategic
business plans to estimate revenues and cover costs. Part of this
includes the development of data systems for how they will track and
evaluate data to make sure that they can document success, and catch
and deal with challenges. In addition, they are developing powerful
partnerships with schools and with organizations and agencies so they
can provide children and families with the supports and services that
are needed for success from cradle to college and career. We look
forward to continuing to work with the Promise Neighborhoods grantees
and others as they transition from planning to implementation. And, we
look forward to seeing the results of their efforts.
We urge the Committee to support Promise Neighborhoods with
resources for new sites to engage in planning, and for robust support
for implementation in communities across the country. Thank you for
your consideration. If you should need additional information about The
Promise Neighborhoods program please contact Judith Bell from
PolicyLink ([email protected]) or Katie Shoemaker at HCZ
([email protected]).
______
Prepared Statement of the Health Professions and Nursing Education
Coalition
The members of the Health Professions and Nursing Education
Coalition (HPNEC) are pleased to submit this statement for the record
in support of the fiscal year 2012 budget request of $762.5 million for
the health professions education programs authorized under Titles VII
and VIII of the Public Health Service Act and administered through the
Health Resources and Services Administration (HRSA). HPNEC is an
informal alliance of more than 60 national organizations representing
schools, programs, health professionals, and students dedicated to
ensuring the healthcare workforce is trained to meet the needs of the
country's growing, aging, and diverse population. For a complete list
of HPNEC members, visit http://www.aamc.org/advocacy/hpnec/members.htm.
As you know, the Title VII and VIII health professions and nursing
programs provide education and training opportunities to a wide variety
of aspiring healthcare professionals, both preparing them for careers
in the health professions and helping bring healthcare services to our
rural and underserved communities. An essential component of the
healthcare safety net, the Title VII and Title VIII programs are the
only Federal programs designed to train healthcare providers in
interdisciplinary settings to meet the needs of the country's special
and underserved populations, as well as increase minority
representation in the healthcare workforce. Through loans, loan
guarantees, and scholarships to students, and grants and contracts to
academic institutions and nonprofit organizations, the Title VII and
Title VIII programs fill the gaps in the supply of health professionals
not met by traditional market forces.
Authorized since 1963, the Title VII and Title VIII education and
training programs are designed to help the workforce adapt to the
evolving healthcare needs of the ever-changing American population. In
an effort to renew and update Titles VII and VIII to meet current
workforce challenges, the programs were reauthorized in 2010--the first
reauthorization in the past decade. Reauthorization not only improved
the efficiency of the Title VII and Title VIII programs, but also laid
the groundwork for innovative programs with an increased focus on
recruiting and retaining professionals in underserved communities.
HPNEC is grateful for the Subcommittee's longstanding support of
these important workforce programs. While we are keenly aware that the
Subcommittee continues to face difficult decisions as it seeks to
improve the Nation's fiscal health, a continued congressional
commitment to programs supporting healthcare workforce development is
essential to the physical health and prosperity of the American people.
The country faces a critical disparity between the supply of practicing
healthcare providers and the increasing demand for care, with HRSA
estimating that over 33,000 additional health practitioners are needed
to alleviate existing shortages. Destabilizing funding for the Title
VII and Title VIII programs would reduce education and training support
for primary care physicians, nurses, and other health professionals,
exacerbating shortages and further straining the Nation's already
fragile healthcare system. We recognize that relative to other Federal
programs, HRSA's fiscal year 2011 operating plan imposes modest cuts to
most Title VII and Title VIII programs, and we look forward to working
with the subcommittee to prevent any further erosion to Federal support
for health professions training.
Failure to fully fund the programs would jeopardize activities to
train professionals across all disciplines to coordinate care for the
Nation's expanding elderly population; limit training opportunities for
providers to meet the unique needs of the Nation's sick and ailing
children; severely impact the distribution of professionals practicing
in rural and underserved communities; and hinder efforts to recruit and
retain a diverse and culturally competent workforce. To ensure the
healthcare workforce is equipped to address these issues, a strong
commitment to the Title VII and Title VIII programs is essential.
The existing Title VII and Title VIII programs can be considered in
seven general categories:
--The Primary Care Medicine and Oral Health Training programs, now
authorized separately, provide for the education and training
of primary care physicians, physician assistants, and dentists,
to improve access and quality of healthcare in underserved
areas. Two-thirds of all Americans interact with a primary care
provider every year. Approximately one-half of primary care
providers trained through these programs go on to work in
underserved areas, compared to 10 percent of those not trained
through these programs. The General Pediatrics, General
Internal Medicine, and Family Medicine programs provide
critical funding for primary care training in community-based
settings and have been successful in directing more primary
care physicians to work in underserved areas. They support a
range of initiatives, including medical student training,
residency training, faculty development and the development of
academic administrative units. These programs also enhance the
efforts of osteopathic medical schools to continue to emphasize
primary care medicine, health promotion, and disease
prevention, and the practice of ambulatory medicine in
community-based settings. Recognizing that all primary care is
not only provided by physicians, the primary care cluster also
provides grants for Physician Assistant programs to encourage
and prepare students for primary care practice in rural and
urban Health Professional Shortage Areas. The General
Dentistry, Pediatric Dentistry, and Public Health Dentistry
programs provide grants to dental schools and hospitals to
create or expand primary care and public health dental
residency training programs.
--Because much of the Nation's healthcare is delivered in areas far
removed from health professions schools, the Interdisciplinary,
Community-Based Linkages cluster provides support for
community-based training of various health professionals. These
programs are designed to provide greater flexibility in
training and to encourage collaboration between two or more
disciplines. These training programs also serve to encourage
health professionals to return to such settings after
completing their training. The Area Health Education Centers
(AHECs) provide clinical training opportunities to health
professions and nursing students in rural and other underserved
communities by extending the resources of academic health
centers to these areas. AHECs, which have substantial State and
local matching funds, form networks of health-related
institutions to provide education services to students, faculty
and practitioners. Geriatric Health Professions programs
support geriatric faculty fellowships, the Geriatric Academic
Career Award, and Geriatric Education Centers, which are all
designed to bolster the number and quality of healthcare
providers caring for our older generations. Given America's
burgeoning aging population, there is a need for specialized
training in the diagnosis, treatment, and prevention of disease
and other health concerns of older adults. The Mental and
Behavioral Health Education and Training Programs help mitigate
the growing shortages of mental and behavioral health providers
by providing grants for training social workers, child and
adolescent mental health professionals, and paraprofessionals
working with children and adolescents. They also provide grants
to doctoral, internship, and postdoctoral programs through the
Graduate Psychology Education program, which supports
interdisciplinary training of psychology students with other
health professionals for the provision of mental and behavioral
health services to underserved populations (i.e., older adults,
children, chronically ill, and victims of abuse and trauma,
including returning military personnel and their families),
especially in rural and urban communities.
--The purpose of the Minority and Disadvantaged Health Professionals
Training programs is to improve healthcare access in
underserved areas and the representation of minority and
disadvantaged healthcare providers in the health professions.
Minority Centers of Excellence support programs that seek to
increase the number of minority health professionals through
increased research on minority health issues, establishment of
an educational pipeline, and the provision of clinical
opportunities in community-based health facilities. The Health
Careers Opportunity Program seeks to improve the development of
a competitive applicant pool through partnerships with local
educational and community organizations. The Faculty Loan
Repayment and Faculty Fellowship programs provide incentives
for schools to recruit underrepresented minority faculty. The
Scholarships for Disadvantaged Students make funds available to
eligible students from disadvantaged backgrounds who are
enrolled as full-time health professions students.
--The Health Professions Workforce Information and Analysis program
provides grants to institutions to collect and analyze data on
the health professions workforce to advise future
decisionmaking on the direction of health professions and
nursing programs. The Health Professions Research and Health
Professions Data programs have developed a number of valuable,
policy-relevant studies on the distribution and training of
health professionals, including the Eighth National Sample
Survey of Registered Nurses, the Nation's most extensive and
comprehensive source of statistics on registered nurses. In
conjunction with the reauthorization of the Title VII programs
and in recognition of the need for better health workforce data
to inform both public and private decisionmaking, the National
Center for Workforce Analysis serves as a source of data and
information on the health workforce for the Nation.
--The Public Health Workforce Development programs are designed to
increase the number of individuals trained in public health, to
identify the causes of health problems, and respond to such
issues as managed care, new disease strains, food supply, and
bioterrorism. The Public Health Traineeships and Public Health
Training Centers seek to alleviate the critical shortage of
public health professionals by providing up-to-date training
for current and future public health workers, particularly in
underserved areas. Preventive Medicine Residencies, which
receive minimal funding through Medicare GME, provide training
in the only medical specialty that teaches both clinical and
population medicine to improve community health. The Title VII
reauthorization reorganized this cluster to include a focus on
loan repayment as an incentive for health professionals to
practice in disciplines and settings experiencing shortages.
The Pediatric Subspecialty Loan Repayment Program offers loan
repayment for pediatric medical subspecialists, pediatric
surgical specialists, and child and adolescent mental and
behavioral health specialists, in exchange for services in
areas where these types of professionals are in short supply.
The Public Health Workforce Loan Repayment Program provides
loan repayment for public health professionals accepting
employment with Federal, State, local, and tribal public health
agencies.
--The Nursing Workforce Development programs under Title VIII provide
training for entry-level and advanced degree nurses to improve
the access to, and quality of, healthcare in underserved areas.
These programs provide the largest source of Federal funding
for nursing education, providing loans, scholarships,
traineeships, and programmatic support that, between fiscal
year 2006 and 2009, supported over 347,000 nurses and nursing
students as well as numerous academic nursing institutions, and
healthcare facilities. Healthcare entities across the Nation
are experiencing a crisis in nurse staffing, caused in part by
an aging workforce and capacity limitations within the
educational system. Each year, nursing schools turn away tens
of thousands of qualified applications at all degree levels due
to an insufficient number of faculty, clinical sites, classroom
space, clinical preceptors, and budget constraints. At the same
time, the need for nursing services and licensed, registered
nurses is expected to increase significantly over the next 20
years. The Advanced Education Nursing program awards grants to
train a variety of advanced practice nurses, including nurse
practitioners, certified nurse-midwives, nurse anesthetists,
public health nurses, nurse educators, and nurse
administrators. Workforce Diversity grants support
opportunities for nursing education for students from
disadvantaged backgrounds through scholarships, stipends, and
retention activities. Nurse Education, Practice, and Retention
grants are awarded to help schools of nursing, academic health
centers, nurse-managed health centers, State and local
governments, and other healthcare facilities to develop
programs that provide nursing education, promote best
practices, and enhance nurse retention. The Loan Repayment and
Scholarship Program repays up to 85 percent of nursing student
loans and offers full-time and part-time nursing students the
opportunity to apply for scholarship funds. In return these
students are required to work for at least 2 years of practice
in a designated nursing shortage area. The Comprehensive
Geriatric Education grants are used to train RNs who will
provide direct care to older Americans, develop and disseminate
geriatric curriculum, train faculty members, and provide
continuing education. The Nurse Faculty Loan program provides a
student loan fund administered by schools of nursing to
increase the number of qualified nurse faculty.
--The loan programs under Student Financial Assistance support
financially needy and disadvantaged medical and nursing school
students in covering the costs of their education. The Nursing
Student Loan (NSL) program provides loans to undergraduate and
graduate nursing students with a preference for those with the
greatest financial need. The Primary Care Loan (PCL) program
provides loans covering the cost of attendance in return for
dedicated service in primary care. The Health Professional
Student Loan (HPSL) program provides loans covering the cost of
attendance for financially needy health professions students
based on institutional determination. The NSL, PCL, and HPSL
programs are funded out of each institution's revolving fund
and do not receive Federal appropriations. The Loans for
Disadvantaged Students program provides grants to health
professions institutions to make loans to health professions
students from disadvantaged backgrounds.
By improving the supply, distribution, and diversity of the
Nation's healthcare professionals, the Title VII and Title VIII
programs not only prepare aspiring professionals to meet the country's
workforce needs, but also help to improve access to care across all
populations. The multi-year nature of health professions education and
training, coupled with unprecedented existing and looming provider
shortages across many disciplines and in many communities, necessitate
a strong, continued, and reliable commitment to the Title VII and Title
VIII programs.
While HPNEC members understand of the immense fiscal pressures
facing the Subcommittee, we respectfully urge support for $762.5
million for the Title VII and VIII programs, a commitment essential not
only to the development and training of tomorrow's healthcare
professionals but also to our Nation's efforts to provide needed
healthcare services to underserved communities. We forward to working
with Senators to prioritize the health professions programs in fiscal
year 2012 and into the future.
______
Prepared Statement of the Hepatitis B Foundation
Highlighting the urgent need to address the public health
challenges of chronic hepatitis B by strengthening programs at the
Centers for Disease Control and Prevention, and the National Institutes
of Health.
Mr. Chairman, my name is Dr. Timothy Block, and I am the President
and Co-Founder of the Hepatitis B Foundation and its research
institute, the Institute for Hepatitis and Virus Research. I also serve
as the President of the Pennsylvania Biotechnology Center and am a
professor at Drexel University College of Medicine. My wife Joan, and
I, and another couple, Paul and Janine Witte, from Pennsylvania started
the Hepatitis B Foundation 20 years ago to find a cure for this serious
chronic liver disease and provide information and support to those
affected.
Thank you for giving the Hepatitis B Foundation (HBF) the
opportunity to provide testimony to the Subcommittee as you begin to
consider funding priorities for fiscal year 2012. We are grateful to
the Members of this Subcommittee for their interest and strong
leadership for efforts to control and find cures for hepatitis B.
Today, the HBF is the only national nonprofit organization solely
dedicated to finding a cure and improving the lives of those affected
by hepatitis B worldwide through research, education and patient
advocacy. Our scientists focus on drug discovery for hepatitis B and
liver cancer, and early detection markers for liver cancer. HBF staff
manages a comprehensive website which receives almost 1 million
visitors each year, a national patient conference and outreach
services. HBF public health professionals conduct research initiatives
to advance our mission.
The hepatitis B virus (HBV) is the world's major cause of liver
cancer--and while other cancers are declining, liver cancer is the
fastest growing in incidence in the United States. Without
intervention, as many as 100 million worldwide will die from a HBV-
related liver disease, most notably liver cancer. In the United States,
up to 2 million Americans have been chronically infected and more than
5,000 people die each year from complications due to HBV.
HBV is 100 times more infectious than the HIV/AIDS virus. Yet,
hepatitis B can be prevented with a safe and effective vaccine.
Unfortunately, for those who are chronically infected with HBV, the
vaccine is too late. There are, however, promising new treatments for
HBV. We are getting close to solutions but lack of sustained support
for public health measures and scientific research is threatening
progress. New research has confirmed that early detection and treatment
significantly reduces healthcare costs, morbidity and mortality. The
growing incidence of liver cancer, while most other cancer rates are on
the decline, represents examples of serious shortcomings in our system.
In the United States, 20,000 babies are born to mothers infected with
HBV each year, and as many as 1,200 newborns will be chronically
infected with the hepatitis B virus. More needs to be done to prevent
new infections.
HHS Interagency Working Group on Viral Hepatitis
Last year, the Department of Health and Human Services put together
an Interagency Working Group on Hepatitis to put together an Action
Plan on Viral Hepatitis. This action plan will describe opportunities
for HHS to respond to the 2010 Institute of Medicine (IOM) review of
the viral hepatitis challenge in the United States and the IOM
recommendations to prevent and build the capacity and collaborations
essential for reducing the number of viral hepatitis infections and
ameliorating the health and economic consequences of viral hepatitis
among persons chronically infected. The Hepatitis B Foundation is very
supportive of the efforts of the Working Group and is hopeful that its
recommendations will result in actions to address the chronic
underfunding of viral hepatitis prevention, research and outreach
programs within the Department. We look forward to the release of the
Hepatitis Action Plan in May of this year.
Mr. Chairman, as you know the two Federal agencies that are
critical to the effort to help people concerned with hepatitis B are:
the Centers for Disease Control and Prevention (CDC), and the National
Institutes of Health (NIH).
The Centers for Disease Control
CDC's Division of Viral Hepatitis (DVH), the centerpiece of the
Federal response to controlling, reducing and preventing the suffering
and deaths resulting from viral hepatitis, is chronically underfunded.
DVH is included in the National Center for HIV/AIDS, Viral Hepatitis,
STD, and TB Prevention at the CDC, and is responsible for the
prevention and control of viral hepatitis. DVH is currently (prior to
finalization of the fiscal year 2011 continuing resolution) funded at
$19.8 million, approximately $6 million less than its funding level in
fiscal year 2003. In the President's fiscal year 2012 budget proposal,
DVH is funded at $25 million, an increase of $5.2 million. The HBF is
very supportive of this increase and joins the hepatitis community in
urging the Committee to fund the President's request for the Division
of Viral Hepatitis.
The responsibility for addressing the problem of hepatitis should
not lie solely with the Division. In view of the preventable nature of
these diseases, the Hepatitis B Foundation feels that the National
Center for Chronic Disease Prevention should also include a targeted
effort focused on the prevention of chronic viral hepatitis which
adversely impacts 5 million Americans. Specifically, we ask that the
Committee include language urging the Center to help insure that the
Prevention and Public Health Funds, particularly the Community
Transformations Grants, are available to support viral hepatitis
prevention projects.
Furthermore, there are 400 million people chronically infected with
hepatitis B worldwide, with more than 120 million of these individuals
in China. While hepatitis B transmission requires direct exposure to
infected blood, worldwide misinformation about the disease has fueled
inappropriate discrimination against individuals with this vaccine-
preventable and treatable bloodborne disease. HBF urges the Committee
to instruct the CDC to initiate global programs to increase the rate of
vaccination, reduce mother-child transmission and promote educational
programs to prevent the disease and to reduce discrimination targeted
against individuals with the disease.
The National Institutes of Health
We depend upon the NIH to fund research that will lead to new and
more effective interventions to treat people with hepatitis B and liver
cancer. The Hepatitis B Foundation joins with the Ad Hoc Group for
Biomedical Research and requests a funding level of $35 billion for the
National Institutes of Health in fiscal year 2012.
We thank the Committee for their continued investment in the NIH.
Sustaining progress in medical research is essential to the twin
national priorities of smarter healthcare and economic revitalization.
With additional investment, the Nation can seize the unique opportunity
to build on the tremendous momentum emerging from the strategic
investment in NIH made through the 2009 American Recovery and
Reinvestment Act (ARRA). NIH invested those funds in a range of
potentially revolutionary new avenues of research that will lead to new
early screenings and new treatments for disease.
In fiscal year 2010, NIH spent approximately $70 million on
hepatitis B funding overall including $4 million of onetime funding
from the American Recovery and Reinvestment Act. It is estimated that
in fiscal year 2011 hepatitis B funding will return to the base level
of $66 million. Additional funding could make transformational advances
in research leading to better treatments for HBV. The Hepatitis B
Foundation recommends that at a minimum, funding allocated for HBV
research in fiscal year 2012 be increased at the same rate recommended
for NIH overall and, therefore, funded at $75.7 million.
The current leadership of the NIH has performed admirably with the
limited resources they are provided; however, more is needed. While a
number of cancers have achieved 5-year survival rates of over 80
percent and the average 5-year survival rate for all cancers has
increased from 50 percent in 1971 to 66 percent, significant challenges
still remain for other types of cancers, particularly the most deadly
forms of cancer. In fact, nearly half of the 562,340 cancer deaths in
2009 were caused by eight forms of cancer with 5-year relative survival
rates of less than 50 percent: ovary (45.5 percent), brain (35.0
percent), myeloma (34.9 percent), stomach (24.7 percent), esophagus
(15.8 percent), lung (15.2 percent), liver (11.7 percent), and pancreas
(5.1 percent). It is no coincidence that cancers with significantly
better 5 year survival rates, such as breast, prostate, colon,
testicular, and chronic myelogenous leukemia, also have early detection
tools, and in many cases, several effective treatment options thanks to
research programs championed and supported by Congress. By contrast,
research into the cancers with the lowest 5-year survival rates has
been relatively under-funded, and as a result, these cancers have no
early detection or treatment tools.
The Hepatitis B Foundation requests the establishment of a targeted
cancers program at the National Cancer Institute (NCI) for the high
mortality cancers. It should include a strategic plan for progress, an
annual report from NCI to Congress, and a new grant program
specifically focused on the deadly cancers. Additionally, the Hepatitis
B Foundation urges a stronger focus on liver cancer and urges the
funding of a series of Specialized Programs of Research Excellence
(SPOREs) focused on liver cancer. While SPOREs currently exist for
every other major cancer, none currently exist that are focused on
liver cancer.
Prevention Fund
The Patient Protection and Affordable Care Act included the
creation of a Prevention and Public Health Fund, to be used to reduce
chronic disease rates and to address health disparities. To further
clarify the intended use of these funds, earlier this year, the
National Prevention, Health Promotion and Public Health Council that
was established to advice on the use of these funds, released a report
with recommendations. Included in the report were recommendations that
``opportunities be expanded within communities and populations at
greatest risk for diseases such as Viral Hepatitis B and C'' and that
there be an increased use of the ``the most effective and highest
impact evidence-based clinical preventive services and medications,
such as screening and treatment for chronic viral hepatitis.''
Therefore, it is our view that insuring the Prevention Funds resources
can be used for viral hepatitis prevention projects would help address
this urgent need to help close the gap between diagnosis and access to
care for hepatitis patients. We urge the Committee to include language
in both the Office of the Secretary and the CDC's National Center for
Chronic Disease Prevention to insure that Prevention Funds,
specifically Community Transformation Grants, be eligible to viral
hepatitis initiatives.
SUMMARY AND CONCLUSION
While the HBF recognizes the demands on our Nation's resources, we
believe the ever-increasing health threats and expanding scientific
opportunities continue to justify higher funding levels for the CDC's
Division of Viral Hepatitis and the National Institutes of Health.
Significant progress has been made in developing better treatments
and cures for the diseases that affect humankind due to your leadership
and the leadership of your colleagues on this Subcommittee. Significant
progress has also similarly been made in the fight against hepatitis B.
In conclusion, we specifically request the following for fiscal
year 2012:
--Fund the CDC's Division of Viral Hepatitis at $25 million;
--Language urging the HHS and the National Center for Chronic Disease
Prevention to help insure that the Prevention and Public Health
Funds, particularly the Community Transformations Grants, are
available to support viral hepatitis prevention projects.
--Initiate global programs at the CDC to increase the rate of
vaccination, reduce mother-child transmission and promote
educational programs to prevent the disease and to reduce
discrimination targeted against individuals with the disease;
--Provide $35 billion for the National Institutes of Health,
including a $9.7 million increase per year for hepatitis B
research;
--Establish a targeted cancers program at the NCI; and
--Fund a series of Specialized Programs of Research Excellence
(SPOREs) focused on liver cancer at the NCI.
The Hepatitis B Foundation appreciates the opportunity to provide
testimony to you on behalf of our constituents and yours.
______
Prepared Statement of the HIV Medicine Association
The HIV Medicine Association (HIVMA) of the Infectious Diseases
Society of America (IDSA) represents more than 4,500 physicians,
scientists and other healthcare professionals who practice on the
frontline of the HIV/AIDS pandemic. Our members provide medical care
and treatment to people with HIV/AIDS throughout the United States,
lead HIV prevention programs and conduct research to develop effective
HIV prevention and treatment options. We work in communities across the
country and around the globe as medical providers and researchers
dedicated to the field of HIV medicine.
We appreciate the importance of addressing the fiscal challenges
facing our Nation, but the continued fragile state of the economy makes
it imperative to set priorities to ensure that our Nation has a strong
healthcare safety-net, effective programs for preventing infectious
diseases like HIV and a robust scientific research agenda.
The U.S. investment in HIV/AIDS programs has revolutionized HIV
care globally, making HIV treatment one of the most effective medical
interventions available. A vibrant research agenda and rapid public
health implementation of scientific findings have transformed the HIV
epidemic, reducing morbidity and mortality due to HIV disease by nearly
80 percent in the United States.
Implementation of healthcare reform and the administration's plans
for a National HIV/AIDS Strategy offer promise for making significant
progress in reducing the impact of the domestic HIV epidemic. However,
their success will depend on maintaining adequate investments in the
healthcare safety net, and in prevention, public health and research
programs. The funding requests in our testimony largely reflect the
consensus of the Federal AIDS Policy Partnership (FAPP), a coalition of
HIV organizations from across the country, and are estimated to be the
amounts necessary to sustain and strengthen our investment in
combatting HIV disease.
Health Care Reform
We urge full funding of the President's fiscal year 2012 request
level for healthcare reform programs supported with discretionary
funding under the Patient Protection and Affordable Care Act (ACA), in
particular: health workforce education and training programs under
Titles VII and VIII of the Public Health Service Act (PHSA); healthcare
quality improvement programs, and the Community Health Centers program.
HIV/AIDS Bureau of the Health Resources and Services Administration
We urge you to increase funding for the Ryan White program by $371
million in fiscal year 2011 with at least an increase of $65.8 million
over the fiscal year 2010 level for Part C. At minimum, we strongly
urge you to support the President's proposed fiscal year 2012 increase
of $88.3 million for the Ryan White program, including a $5.1 million
increase for Part C. Part C of the Ryan White Program funds
comprehensive HIV care and treatment--services that are directly
responsible for the dramatic decreases in AIDS-related mortality and
morbidity over the last decade. On average it costs $3,501 per person
per year to provide the comprehensive outpatient care and treatment
available at Part C funded programs, including lab work, STD/TB/
Hepatitis screening, ob/gyn care, dental care, mental health and
substance abuse treatment, and case management. Part C funding covers a
small percentage of the total cost of providing comprehensive care with
some programs receiving $450 or lower per patient per year to cover
care.
The Ryan White Program generally is underfunded and Part C of the
program is disproportionately and severely underfunded. The Centers for
Disease Control and Prevention estimate that there are more than 1.1
million persons living with HIV/AIDS and approximately 240,000, or
almost 1 in 4, of these individuals receive services from Part C
medical providers. Of the 240,000 patients, approximately 1 out of 3 is
uninsured, and 2 out of 3 are underinsured.
While the patient caseload in Part C programs has been rising,
funding for Part C has effectively decreased due to flat funding and
funding cuts at the clinic level. Part C programs expect a continued
increase in patients due to higher diagnosis rates and economic-related
declines in insurance coverage. During this economic downturn people
with HIV across the country are relying on Part C comprehensive
services more than ever. As a result of consistently increasing
caseloads and limited funding, Part C clinics are taking dramatic steps
that adversely impact their ability to serve patients, including:
Limiting primary care services; discontinuing critical services such as
laboratory monitoring; suffering eviction from institutional-based
clinic sites; laying off staff; and operating only 4 days/week.
The HIV medical clinics funded through Part C have been in dire
need of increased funding for years, but new pressures are creating a
crisis in communities across the country. An increase in funding is
critical to prevent additional staffing and service cuts and ensure the
public health of our communities.
National Institutes of Health (NIH)--Office of AIDS Research
HIVMA supports the medical research community's requested increase
of $4 billion over the fiscal year 2010 level for all research programs
at the NIH, including at least a $400 million increase for the NIH
Office of AIDS. This level of funding is vital to sustain the pace of
research that will improve the health and quality of life for millions
of Americans. At minimum, we urge you to support the President's
proposed fiscal year 2012 increase of $1 billion for the NIH.
A continued robust AIDS research portfolio is essential to sustain
and to accelerate our progress in offering more effective prevention
technologies; developing new and less toxic therapy; and supporting the
basic research necessary to continue our work developing a vaccine that
may end the deadliest pandemic in human history.
We appreciate the many difficult decisions that Congress faces this
year, but urge you to recognize the importance of investing in HIV
prevention, treatment and research now to avoid the much higher cost
that individuals, communities and broader society will incur if we fail
to support these programs. We must seize the opportunity to limit the
toll of this deadly infectious disease on our planet and to save the
lives of millions who are infected or at risk of infection here in the
United States and around the globe.
Center for Disease Control and Prevention's (CDC) National Center for
HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP)
HIVMA strongly urges total fiscal year 2012 funding of $1.953
billion for the CDC's NCHHSTP, an increase of $834.1 million over the
fiscal year 2010 level, including increases of: $515.3 million for HIV
prevention and surveillance, $20.2 million for viral hepatitis and
$85.9 million for tuberculosis prevention.
Every 9\1/2\ minutes a new HIV infection happens in the United
States with more than 60 percent of new cases occurring among African
Americans and Hispanic/Latinos. Despite the known benefit of effective
treatment, 21 percent of people living with HIV in the United States
are still not aware of their status and as many as 36 percent of people
newly diagnosed with HIV progress to AIDS within 1 year of diagnosis. A
sustained commitment to HIV prevention funding is critical to enhance
HIV/AIDS surveillance and expand HIV testing and linkage to care, in
order to lower HIV incidence and prevalence in the United States. We
appreciate that the President proposed a $68.8 million increase for HIV
prevention at the CDC, and at a bare minimum we strongly urge the
Committee to at least meet this request.
Finally, we strongly support adequate funding for science-based,
comprehensive sex education programs. We are pleased that the fiscal
year 2011 continuing resolution provides $109 million for the Teen
Pregnancy Prevention Program, which focuses on reducing the risks of
pregnancy and sexually transmitted diseases through proven and
successful models. We urge the Committee to adopt report language
supporting true, comprehensive sex education that promotes healthy
behaviors and relationships for all young people, including lesbian,
gay, bisexual, and transgender youth, including an explicit focus on
prevention of HIV and other STDs.
CDC--Tuberculosis
Tuberculosis is the major cause of AIDS-related mortality worldwide
and the second leading infectious disease killer. Congress passed
landmark legislation in the Comprehensive Tuberculosis Elimination Act
of 2008 to shore up State TB control programs, to enhance U.S. capacity
to address drug-resistant tuberculosis; and to develop new drugs,
diagnostics and vaccines.
State budget cuts have hit local TB control programs hard, and the
CDC Division of TB Elimination has seen some budget reductions in the
last 2 fiscal years. Our ability to respond to TB within our own
borders is being compromised as a result. We must do better. Finally,
we are beginning to see exciting new tools to combat tuberculosis after
decades of little or no productive research and development in this
area. We have an exciting new diagnostic test that can identify drug-
susceptible and drug-resistant TB very quickly. There are a number of
new drugs in clinical trials for both drug resistant and drug-
susceptible TB. There are promising new TB vaccine candidates being
tested. Now, resources are needed more urgently than ever to follow
through on the research and development in progress and to ensure that
these new tools reach the public health officials on the ground who
need them. We respectfully request fiscal year 2012 funding for the CDC
Division of TB Elimination at a level of $231 million. At minimum, we
urge full funding of the President's fiscal year 2012 budget request of
$143.6 million for this program.
CDC--Viral Hepatitis
A much more substantial commitment to Hepatitis co-infection is
urgently needed, in addition to funding for core public health services
and tracking of chronic cases of hepatitis. Co-infection is a serious
health threat for nearly one-third of our HIV patients, and has an
enormous impact on morbidity and mortality. Furthermore, with the
advent of the recently approved protease inhibitors, providing funding
to enable this population to receive treatment and/or access clinical
trials becomes absolutely critical. We strongly urge you to boost
funding for viral hepatitis at the CDC by $20.2 million over the fiscal
year 2010 level million for a total funding of $40 million. At the very
least, we urge you to support the President's proposed fiscal year 2012
increase of $5.2 million to respond to the viral Hepatitis epidemic.
Agency for Health Care Quality and Research (AHRQ)
HIVMA urges the Committee to provide $2.2 million, a $200,000
increase over the fiscal year 2010 level for the HIV Research Network
(HIVRN), the only significant HIV work being done at AHRQ. The HIVRN is
a consortium of 18 HIV primary care sites co-funded by AHRQ and HRSA to
evaluate healthcare utilization and clinical outcomes in HIV infected
children, adolescents and adults in the United States. The Network
analyzes and disseminates information on the delivery and outcomes of
healthcare services to people with HIV infection. These data help to
improve delivery and outcomes of HIV care in the United States and to
identify and address disparities in HIV care that exist by race,
gender, and HIV risk factor. The HIVRN is a unique source of
information on the cost and cost-effectiveness of HIV care in the
United States at a time when data on comparative cost and effectiveness
of healthcare is particularly needed to inform health systems reform
and the development and implementation of a National HIV/AIDS Strategy.
______
Prepared Statement of Howard University
Mr. Chairman and members of the subcommittee, thank you for the
opportunity to present my views before you today. I am Dr. Eve
Higginbotham, Senior Vice-President and Executive Dean for Howard
University Health Sciences. I am the senior health official at Howard,
with responsibilities for our College of Medicine, College of
Dentistry, College of Pharmacy, Nursing, and Allied Health, Louis
Stokes Health Sciences Library, and the Howard University Hospital.
Howard University is the only Historically Black College or University
(HBCU) with so many aspects of the health sciences housed at one
institution. For that reason, we are poised to continue to impact the
education of minorities and others dedicated to improving the health of
all Americans.
Mr. Chairman, Howard University Health Sciences has made historic
contributions to the reduction of health disparities, and it is because
of programmatic activity like the Title VII Health Professionals
Training programs that we are able to address a critical national need.
Persistent and severe staffing shortages exist in a number of the
health professions, and chronic shortages exist for all of the health
professions in our Nation's most medically underserved communities.
Furthermore, even after the landmark passage of health reform, it is
important to note that our Nation's health professions workforce does
not accurately reflect the racial composition of our population. For
example while blacks represent approximately 15 percent of the U.S.
population, only 2-3 percent of the Nation's health professions
workforce is black. Mr. Chairman, I would like to share with you how
your committee can help HUHS continue our efforts to help provide
quality health professionals and close our Nation's health disparity
gap.
There is a well established link between health disparities and a
lack of access to competent healthcare in medically underserved areas.
As a result, it is imperative that the Federal Government continue its
commitment to minority health professions institutions and minority
health professional training programs to continue to produce healthcare
professionals committed to addressing this unmet need--even in austere
financial times.
An October 2006 study by the Health Resources and Services
Administration (HRSA), entitled ``The Rationale for Diversity in the
Health Professions: A Review of the Evidence'' found that minority
health professionals serve minority and other medically underserved
populations at higher rates than non-minority professionals. The report
also showed that; minority populations tend to receive better care from
practitioners who represent their own race or ethnicity, and non-
English speaking patients experience better care, greater
comprehension, and greater likelihood of keeping follow-up appointments
when they see a practitioner who speaks their language. Studies have
also demonstrated that when minorities are trained in minority health
profession institutions, they are significantly more likely to: (1)
serve in rural and urban medically underserved areas, (2) provide care
for minorities and (3) treat low-income patients.
As you are aware, Title VII Health Professions Training programs
are focused on improving the quality, geographic distribution and
diversity of the healthcare workforce in order to continue eliminating
disparities in our Nation's healthcare system. These programs provide
training for students to practice in underserved areas, cultivate
interactions with faculty role models who serve in underserved areas,
and provide placement and recruitment services to encourage students to
work in these areas. Health professionals who spend part of their
training providing care for the underserved are up to 10 times more
likely to practice in underserved areas after graduation or program
completion.
In fiscal year 2012, funding for the Title VII Health Professions
Training programs must at the very least be maintained, especially the
funding for the Minority Centers of Excellence (COEs) and Health
Careers Opportunity Program (HCOPs). In addition, the funding for the
National Institutes of Health (NIH)'s National Institute on Minority
Health and Health Disparities (NIMHD), as well as the Department of
Health and Human Services (HHS)'s Office of Minority Health (OMH),
should be preserved.
Minority Centers of Excellence.--COEs focus on improving student
recruitment and performance, improving curricula in cultural
competence, facilitating research on minority health issues and
training students to provide health services to minority individuals.
COEs were first established in recognition of the contribution made by
four historically black health professions institutions to the training
of minorities in the health professions. Congress later went on to
authorize the establishment of ``Hispanic'', ``Native American'' and
``Other'' Historically black COEs. For fiscal year 2012, I recommend a
funding level of $24.602 million for COEs.
Health Careers Opportunity Program (HCOP).--HCOPs provide grants
for minority and non-minority health profession institutions to support
pipeline, preparatory and recruiting activities that encourage minority
and economically disadvantaged students to pursue careers in the health
professions. Many HCOPs partner with colleges, high schools, and even
elementary schools in order to identify and nurture promising students
who demonstrate that they have the talent and potential to become a
health professional. For fiscal year 2012, I recommend a funding level
of $22.133 million for HCOPs.
National Institutes of Health
Research Centers at Minority Institutions.--The Research Centers at
Minority Institutions program (RCMI), currently administered by the
National Center for Research Resources, has a long and distinguished
record of helping our institutions develop the research infrastructure
necessary to be leaders in the area of health disparities research.
Although NIH has received unprecedented budget increases in recent
years, funding for the RCMI program has not increased by the same rate.
Therefore, the funding for this important program grow at the same rate
as NIH overall in fiscal year 2012.
National Institute on Minority Health and Health Disparities.--The
National Institute on Minority Health and Health Disparities (NIMHD) is
charged with addressing the longstanding health status gap between
minority and nonminority populations. The NIMHD helps health
professions institutions to narrow the health status gap by improving
research capabilities through the continued development of faculty,
labs, and other learning resources. The NIMHD also supports biomedical
research focused on eliminating health disparities and develops a
comprehensive plan for research on minority health at the NIH.
Furthermore, the NIMHD provides financial support to health professions
institutions that have a history and mission of serving minority and
medically underserved communities through the Centers of Excellence
program. For fiscal year 2012, I recommend funded increases
proportional with the funding of the over NIH.
Department of Health and Human Services
Department of Health and Human Services' Office of Minority
Health.--Specific programs at OMH include: assisting medically
underserved communities with the greatest need in solving health
disparities and attracting and retaining health professionals;
assisting minority institutions in acquiring real property to expand
their campuses and increase their capacity to train minorities for
medical careers; supporting conferences for high school and
undergraduate students to interest them in healthcareers, and
supporting cooperative agreements with minority institutions for the
purpose of strengthening their capacity to train more minorities in the
health professions. The OMH has the potential to play a critical role
in addressing health disparities. For fiscal year 2012, I recommend a
funding level of $65 million for the OMH.
Department of Education
Howard University Academic, Research, and Hospital Support.--The
Department of Education maintains support for Howard University's
academic programs, research programs, construction activities, and the
Howard University Hospital. Howard University has played a historic
role in providing access to postsecondary educational opportunities for
students from traditionally underrepresented backgrounds, especially
African Americans. For this reason, and others, Howard is supported
annually with a Federal appropriation. The direct Federal appropriation
accounts for approximately 50 percent of the Howard University's
operating costs, including nearly $29 million for the operation of the
Howard Hospital--a staple of care for residents in Northwest
Washington, DC. In fiscal year 2012, an appropriation of $235 million
is suggested to continue the vital programs and services which we
provide.
Mr. Chairman, please allow me to express my appreciation to you and
the members of this subcommittee. With your continued help and support,
Howard University's Health Sciences can help this country to overcome
health disparities. Congress must be careful not to eliminate, paralyze
or stifle programs that have been proven to work. HUHS seeks to close
the ever widening health disparity gap. If this subcommittee will give
us the tools, we will continue to work towards the goal of eliminating
that disparity everyday.
Thank you, Mr. Chairman, and I welcome every opportunity to answer
questions for your records.
______
Prepared Statement of the International Foundation for Functional
Gastrointestinal Disorders
Thank you for the opportunity to present the views of the
International Foundation for Functional Gastrointestinal Disorders
(IFFGD) regarding the importance of functional gastrointestinal (GI)
and motility disorders research.
Established in 1991, IFFGD is a patient-driven nonprofit
organization dedicated to assisting individuals affected by functional
GI disorders, and providing education and support for patients,
healthcare providers, and the public at large. The IFFGD also works to
advance critical research on functional GI and motility disorders, in
order to provide patients with better treatment options, and to
eventually find a cure. IFFGD has worked closely with NIH on a number
of priorities, including the NIH State-of-the-Science Conference on the
Prevention of Fecal and Urinary Incontinence in Adults through NIDDK,
the National Institute of Child Health and Human Development (NICHD),
and the Office of Medical Applications of Research (OMAR). I have
served on the National Commission on Digestive Diseases (NCDD), which
released a long-range road map for digestive disease research in 2009,
entitled Opportunities and Challenges in Digestive Diseases Research:
Recommendations of the National Commission on Digestive Diseases.
The need for increased research, more effective and efficient
treatments, and the hope for discovering a cure for functional GI and
motility disorders are close to my heart. My own personal experiences
of suffering from functional GI and motility disorders motivated me to
establish IFFGD 20 years ago. I was shocked to discover that despite
the high prevalence of these conditions among all demographic groups
worldwide, such an appalling lack of dedicated research existed. This
lack of research translates into a dearth of diagnostic tools,
treatments, and patient supports. Even more shocking is the lack of
awareness among both the medical community and the general public,
leading to significant delays in diagnosis, frequent misdiagnosis, and
inappropriate treatments including unnecessary medication and surgery.
It is unacceptable for patients to suffer unnecessarily from the
severe, painful, life-altering symptoms of functional GI and motility
disorders due to a lack of awareness and education.
The majority of functional GI disorders have no cure and treatment
options are limited. Although progress has been made, the medical
community still does not completely understand the mechanisms of the
underlying conditions. Without a known cause or cure, patients
suffering from functional GI disorders face a lifetime of chronic
disease management, learning to adapt to intolerable, disruptive
symptoms. The medical and indirect costs associated with these diseases
are enormous; estimates range from $25-$30 billion annually. Economic
costs spill over into the workplace, and are reflected in work
absenteeism and lost productivity. Furthermore, the emotional toll of
these conditions affects not only the individual but also the family.
Functional GI disorders do not discriminate, effecting all ages, races
and ethnicities, and genders.
Irritable Bowel Syndrome (IBS)
IBS, one of the most common functional GI disorders, strikes all
demographic groups. It affects 30 to 45 million Americans,
conservatively at least 1 out of every 10 people. Between 9 to 23
percent of the worldwide population suffers from IBS, resulting in
significant human suffering and disability. IBS as a chronic disease is
characterized by a group of symptoms that may vary from person to
person, but typically include abdominal pain and discomfort associated
with a change in bowel pattern, such as diarrhea and/or constipation.
As a ``functional disorder'', IBS affects the way the muscles and
nerves work, but the bowel does not appear to be damaged on medical
tests. Without a definitive diagnostic test, many cases of IBS go
undiagnosed or misdiagnosed for years. It is not uncommon for IBS
suffers to have unnecessary surgery, medication, and medical devices
before receiving a proper diagnosis. Even after IBS is identified,
treatment options are sorely lacking and vary widely from patient to
patient. What is known is that IBS requires a multidisciplinary
approach to research and treatment.
IBS can be emotionally and physically debilitating. Due to
persistent pain and bowel unpredictability, individuals who suffer from
this disorder may distance themselves from social events, work, and
even may fear leaving their home. Stigma surrounding bowel habits may
act as barrier to treatment, as patients are not comfortable discussing
their symptoms with doctors. Because IBS symptoms are relatively common
and not life-threatening, many people dismiss their symptoms or attempt
to self-medicate using over-the-counter medications. In order to
overcome these barriers to treatment, ensure more timely and accurate
diagnosis, and reduce costly unnecessary procedures, educational
outreach to physicians and the general public remain critical.
Fecal Incontinence
At least 12 million Americans suffer from fecal incontinence.
Incontinence is neither part of the aging process nor is it something
that affects only the elderly. Incontinence crosses all age groups from
children to older adults, but is more common among women and the
elderly of both sexes. Often it is a symptom associated with various
neurological diseases and many cancer treatments. Yet, as a society, we
rarely hear or talk about the bowel disorders associated with spinal
cord injuries, multiple sclerosis, diabetes, prostate cancer, colon
cancer, uterine cancer, and a host of other diseases.
Courses of fecal incontinence include: damage to the anal sphincter
muscles; damage to the nerves of the anal sphincter muscles or the
rectum; loss of storage capacity in the rectum; diarrhea; or pelvic
floor dysfunction. People who have fecal incontinence may feel ashamed,
embarrassed, or humiliated. Some don't want to leave the house out of
fear they might have an accident in public. Most attempt to hide the
problem for as long as possible. They withdraw from friends and family,
and often limit work or education efforts. Incontinence in the elderly
burdens families and is the primary reason for nursing home admissions,
an already huge social and economic burden in our aging population.
In November 2002, IFFGD sponsored a consensus conference entitled,
Advancing the Treatment of Fecal and Urinary Incontinence Through
Research: Trial Design, Outcome Measures, and Research Priorities.
Among other outcomes, the conference resulted in six key research
recommendations including more comprehensive identification of quality
of life issues; improved diagnostic tests for affecting management
strategies and treatment outcomes; development of new drug treatment
compounds; development of strategies for primary prevention of fecal
incontinence associated with childbirth; and attention to the stigmas
that apply to individuals with fecal incontinence.
In December 2007, IFFGD collaborated with NIDDK, NICHD, and OMAR on
the NIH State-of-the-Science Conference on the Prevention of Fecal and
Urinary Incontinence in Adults. The goal of this conference was to
assess the state of the science and outline future priorities for
research on both fecal and urinary incontinence; including, the
prevalence and incidence of fecal and urinary incontinence, risk
factors and potential prevention, pathophysiology, economic and quality
of life impact, current tools available to measure symptom severity and
burden, and the effectiveness of both short and long term treatment.
For fiscal year 2012, IFFGD urges Congress to review the Conference's
Report and provide NIH with the resources necessary to effectively
implement the report's recommendations.
Gastroesophageal Reflux Disease (GERD)
Gastroesophageal reflux disease, or GERD, is a common disorder
affecting both adults and children, which results from the back-flow of
acidic stomach contents into the esophagus. GERD is often accompanied
by persistent symptoms, such as chronic heartburn and regurgitation of
acid. Sometimes there are no apparent symptoms, and the presence of
GERD is revealed when complications become evident. One uncommon but
serious complication is Barrett's esophagus, a potentially pre-
cancerous condition associated with esophageal cancer. Symptoms of GERD
vary from person to person. The majority of people with GERD have mild
symptoms, with no visible evidence of tissue damage and little risk of
developing complications. There are several treatment options available
for individuals suffering from GERD. Nonetheless, treatment response
varies from person to person, is not always effective, and long-term
medication use and surgery expose individuals to risks of side-effects
or complications.
Gastroesophageal reflux (GER) affects as many as one-third of all
full term infants born in America each year. GER results from an
immature upper gastrointestinal motor development. The prevalence of
GER is increased in premature infants. Many infants require medical
therapy in order for their symptoms to be controlled. Up to 25 percent
of older children and adolescents will have GER or GERD due to lower
esophageal sphincter dysfunction. In this population, the natural
history of GER is similar to that of adult patients, in whom GER tends
to be persistent and may require long-term treatment.
Gastroparesis
Gastroparesis, or delayed gastric emptying, refers to a stomach
that empties slowly. Gastroparesis is characterized by symptoms from
the delayed emptying of food, namely: bloating, nausea, vomiting, or
feeling full after eating only a small amount of food. Gastroparesis
can occur as a result of several conditions, including being present in
30 percent to 50 percent of patients with diabetes mellitus. A person
with diabetic gastroparesis may have episodes of high and low blood
sugar levels due to the unpredictable emptying of food from the
stomach, leading to diabetic complications. Other causes of
gastroparesis include Parkinson's disease and some medications,
especially narcotic pain medications. In many patients the cause of the
gastroparesis cannot be found and the disorder is termed idiopathic
gastroparesis. Over the last several years, as more is being found out
about gastroparesis, it has become clear this condition affects many
people and the condition can cause a wide range of symptom severity.
Cyclic Vomiting Syndrome
Cyclic vomiting syndrome (CVS) is a disorder with recurrent
episodes of severe nausea and vomiting interspersed with symptom free
periods. The periods of intense, persistent nausea, vomiting, and other
symptoms (abdominal pain, prostration, and lethargy) lasts hours to
days. Previously thought to occur primarily in pediatric populations,
it is increasingly understood that this crippling syndrome can occur in
a variety of age groups including adults. Patients with these symptoms
often go for years without correct diagnosis. The condition leads to
significant time lost from school and from work, as well as substantial
medical morbidity. The cause of CVS is not known. Better understanding,
through research, of mechanisms that underlie upper gastrointestinal
function and motility involved in sensations of nausea, vomiting and
abdominal pain is needed to help identify at risk individuals and
develop more effective treatment strategies.
Support for Critical Research
IFFGD urges Congress to fund the NIH at level of $35 billion for
fiscal year 2012, an increase of 13 percent over fiscal year 2011. This
funding level will help preserve the initial investment in healthcare
innovation established by the American Recovery and Reinvestment Act of
2009. Strengthening and preserving our Nation's biomedical research
enterprise fosters economic growth, and supports innovations that
enhance the health and well-being of the Nation.
Concurrent with overall NIH funding, the IFFGD supports growth of
research activities on functional GI and motility disorders,
particularly through NIDDK and the Office of Research on Women's Health
(ORWH). Increased support for NIDDK and ORWH will facilitate necessary
expansion of the research portfolio on functional GI and motility
disorders necessary to grow the medical knowledge base and improve
treatment. Such support would also expedite the implementation of
recommendations from the National Commission on Digestive Diseases. It
is also vitally important for NIDDK to work to expand its research on
the impact these disorders have on pediatric populations, in addition
the adult population.
Following years of near level-funding at NIH, research
opportunities have been negatively impacted across all NIH Institutes
and Centers, including NIDDK. With the expiration of funding from the
American Recovery and Reinvestment Act of 2009, medical researchers run
the risk of ``falling off a cliff'', stalling, if not losing promising
research from that 2 year period. For this reason, IFFGD encouraged
support for initiatives such as the Cures Acceleration Network (CAN),
authorized in the Patient Protection and Affordable Coverage Act. IFFGD
urges the Subcommittee to show strong leadership in pursuing a
substantial funding increase for CAN through the fiscal year 2012
appropriations process.
Thank you for the opportunity to present the views of the
functional GI disorders community.
______
Prepared Statement of the International Myeloma Foundation
The International Myeloma Foundation (IMF) appreciates the
opportunity to submit written comments for the record regarding fiscal
year 2012 funding for myeloma cancer programs. The IMF is the oldest
and largest myeloma foundation dedicated to improving the quality of
life of myeloma patients while working toward prevention and a cure.
To ensure that myeloma patients have access to the comprehensive,
quality care that they need and deserve, the IMF advocates ongoing and
significant Federal funding for myeloma research and its application.
The IMF stands ready to work with policymakers to advance policies and
programs that work toward prevention and a cure for myeloma and for all
other forms of cancer.
Myeloma Background
The second most common blood cancer worldwide, multiple myeloma (or
myeloma) is a cancer of plasma cells in the bone marrow. It is called
``multiple'' myeloma because the cancer can occur at multiple sites in
multiple bones. Each year approximately 20,000 Americans are diagnosed
with myeloma and 10,000 lose their battle with this disease.
Although the incidence of many cancers is decreasing, the number of
myeloma cases is on the rise. Once a disease of the elderly, it is now
being found in increasing numbers in people under the age of 65. The
2009 President's Cancer Panel Report suggests that much of the increase
in cancer incidence is being caused by environmental toxins. To give
just one example supporting this hypothesis, a recently published study
in The Journal of Occupational and Environmental Medicine, suggests a
link between blood cancers like myeloma and exposure to the toxic dust
at Ground Zero.
In recent years significant gains have been made, extending myeloma
patients' lives and improving their quality of life. Furthermore,
progress begun in myeloma is already helping patients with other blood
cancers and even solid tumors. It is important to maintain that
momentum.
--There is no cure for myeloma.
--Remissions are not always permanent.
--Additional treatment options are essential.
Living with the disease, myeloma patients can suffer debilitating
fractures and other bone disorders, severe side effects of certain
treatments, and other problems that profoundly affect their quality of
life, and significantly impact the cost of their healthcare.
Sustain and Seize Cancer Research Opportunities
Myeloma research is producing extraordinary breakthroughs--leading
to new therapies that translate into longer survival and improved
quality of life for myeloma patients and potentially those with other
forms of cancer as well. Myeloma was once considered a death sentence
with limited options for treatment, but today myeloma is an example of
the progress that can be made and the work that still lies ahead in the
war on cancer. Many myeloma patients are living proof of what
innovative drug development and clinical research can achieve--
sequential remissions, long-term survival, and good quality of life.
Our Nation has benefited immensely from past Federal investment in
biomedical research at the National Institutes of Health (NIH) and the
IMF advocates $35 billion for NIH in fiscal year 2012.
A study in the Journal of Clinical Oncology projects that the
number of new cancer cases diagnosed each year will jump 45 percent
over the next 20 years. In multiple myeloma an even greater increase
(57 percent) is projected, and we are already seeing increasing
diagnoses in patients under age 65, including patients in their 30s, in
what was once a rare disease of the elderly.
While a number of cancers have achieved 5-year survival rates of
over 80 percent since passage of the National Cancer Act of 1971,
significant challenges still remain for other cancers. In fact, nearly
half of the 562,490 cancer deaths in 2010 were caused by just eight
forms of cancer with 5-year survival rates of 45 percent or less--one
of which is myeloma. Yet, myeloma and these other cancers have
historically also received the least amount of Federal funding. As we
have seen mortality rates of diseases such as breast cancer, prostate
cancer, AIDS, and childhood leukemia greatly reduced through targeted,
comprehensive, and well-funded programs that have led to earlier
detection and superior forms of treatment, so too must we shine a
brighter light on myeloma and the other seven deadly cancers to achieve
this same goal for them. The IMF urges Congress to allocate $5.740
billion to the National Cancer Institute (NCI) in fiscal year 2012 to
continue our battle against myeloma.
Boost Our Nation's Investment in Myeloma Prevention, Early Detection,
and Awareness
As the Nation's leading prevention agency, the Centers for Disease
Control and Prevention (CDC) plays an important role in translating and
delivering at the community level what is learned from research.
Therefore, the IMF advocates $6 million for the Geraldine Ferraro Blood
Cancer Program. Authorized under the Hematological Cancer Research
Investment and Education Act of 2002, this program was created to
provide public and patient education about blood cancers, including
myeloma.
With grants from the Geraldine Ferraro Blood Cancer Program, the
IMF has successfully promoted awareness of myeloma, particularly in the
African-American community and other underserved communities. IMF
accomplishments include the production and distribution of more than
4,500 copies of an informative video which addresses the importance of
myeloma awareness and education in the African-American community to
churches, community centers, inner-city hospitals, and Urban League
offices around the country, increased African-American attendance at
IMF Patient and Family Seminars (these seminars provide invaluable
treatment information to newly diagnosed myeloma patients), increased
calls by African-American myeloma patients, family members, and
caregivers to the IMF's myeloma Hotline, and the establishment of
additional support groups in inner city locations in the United States
to assist underserved areas with myeloma education and awareness
campaigns. Furthermore, the more than 90 IMF-affiliated patient support
groups in the United States also made this effort their main goal
during Myeloma Awareness Week in October 2005.
An allocation of $6 million in fiscal year 2012 will allow this
important program to continue to provide patients--including those
populations at highest risk of developing myeloma--with educational,
disease management and survivorship resources to enhance treatment and
prognosis.
Additionally, the IMF is concerned about the consolidation plan for
chronic disease programs at the CDC outlined in the President's fiscal
year 2012 budget. This would be a substantial change in the chronic
disease program where the Geraldine Ferraro Blood Cancer Program is
currently housed. While we agree that there are health issue areas that
share risk factors such as healthy eating and maintaining an active
lifestyle that make sense to consolidate, unfortunately those are not
risk factors for myeloma. We urge the CDC to maintain the programs like
the Geraldine Ferraro Blood Cancer Program as a stand-alone program
which would cease to exist under the proposed consolidation plan.
Conclusion
The IMF stands ready to work with policymakers to advance policies
and support programs that work toward prevention and a cure for
myeloma. Thank you for this opportunity to discuss the fiscal year 2012
funding levels necessary to ensure that our Nation continues to make
gains in the fight against myeloma.
______
Prepared Statement of the Interstate Mining Compact Commission
We are writing in support of the fiscal year 2012 budget request
for the Mine Safety and Health Administration (MSHA), which is part of
the U.S. Department of Labor. In particular, we urge the Subcommittee
to support a full appropriation for grants to States for safety and
health training of our Nation's miners pursuant to section 503(a) of
the Mine Safety and Health Act of 1977. MSHA's budget request for State
grants is $8.941 million. This is the same amount that has been
appropriated for State training grants by Congress over the past 2
fiscal years and, as such, does not fully consider inflationary and
programmatic increases being experienced by the States. We therefore
urge the subcommittee to restore funding to the statutorily authorized
level of $10 million for State grants so that States are able to meet
the training needs of miners and to fully and effectively carry out
State responsibilities under section 503(a) of the Act.
The Interstate Mining Compact Commission is a multi-state
governmental organization that represents the natural resource,
environmental protection and mine safety and health interests of its 24
member States. The States are represented by their Governors who serve
as Commissioners.
IMCC's member States are concerned that without full funding of the
State grants program, the federally required training for miners
employed throughout the United States will suffer. States are
struggling to maintain efficient and effective miner training and
certification programs in spite of increased numbers of trainees and
the incremental costs associated therewith. State grants have flattened
out over the past several years and are not keeping place with
inflationary impacts or increased demands for training. The situation
is of particular concern given the enhanced, additional training
requirements growing out of the recently enacted MINER Act and MSHA's
implementing regulations.
As you consider our request to increase MSHA's budget for State
training grants, please keep in mind that the States play a
particularly critical role in providing special assistance to small
mine operators (those coal mine operators who employ 50 or fewer miners
or 20 or fewer miners in the metal/nonmetal area) in meeting their
required training needs.
We appreciate the opportunity to submit our views on the MSHA
budget request as part of the overall Department of Labor budget.
Please feel free to contact us for additional information or to answer
any questions you may have.
______
Prepared Statement of the Interstitial Cystitis Association
Thank you for the opportunity to present the views of the
Interstitial Cystitis Association (ICA) regarding the importance of
public awareness activities and the importance of interstitial cystitis
(IC) research.
ICA was founded in 1984 and remains the only nonprofit organization
dedicated to improving the lives of those living with IC. The
Association provides an important avenue for advocacy, research, and
education in matters relating to IC. Since its founding, ICA has acted
as a voice for those living with IC, including support groups and
empowering patients. ICA advocates for the expansion of the IC
knowledge-base and the development of new treatments, including
investigator initiated research. Finally, ICA works doggedly to educate
patients, healthcare providers, and the public at large about IC,
including educational forums and information on how to live with this
terrible condition.
IC is a condition that consists of recurring pain, pressure, or
discomfort in the bladder and pelvic region and is often associated
with urinary frequency and urgency. An estimated 4-12 million Americans
have IC, approximately two-thirds of whom are women. The cause of IC is
unknown and treatment options are limited. Diagnosis is made only after
excluding other urinary/bladder conditions, possibly causing 1 or more
years delay between onset of the symptoms and treatment. When
healthcare providers are not properly educated about IC, patients may
suffer for years before receiving an accurate diagnosis and appropriate
treatment.
The effects of IC are pervasive and insidious, damaging work life,
psychological well-being, personal relationships, and general health.
The impact of IC on quality of life is equally as severe as rheumatoid
arthritis and end-stage renal disease. Health-related quality of life
in women with IC is worse than in women with endometriosis, vulvodynia,
and overactive bladder. IC patients have significantly more sleep
dysfunction, higher rates of depression, increased catastrophizing,
anxiety, and sexual dysfunction.
Public Awareness and Education
As IC is a condition that often takes long periods to diagnosis,
and this late diagnosis has such a major impact on the lives of
patients, it is vitally important to continue to educate both the
public and healthcare providers. The IC Education and Awareness Program
at the Centers for Disease Control and Prevention (CDC) has played a
major role in increasing the public's awareness of the devastating
disease and is the only program in the Nation which promotes public
awareness of IC. The public outreach of the CDC program includes public
service announcements on major television networks and the Internet.
Further, the CDC program has provided resources to make information on
IC available to patients and the public though videos, booklets,
publications, presentations, educational kits, websites, blogs,
Facebook pages, and a YouTube channel. For providers, this program has
included the development of an IC newsletter with information on IC
treatments, research, news, and events; targeted mailings to providers;
and exhibits at national medical conferences.
In order to continue these vitally important initiatives, which
have reached thousands of Americans, it is critical that the CDC IC
Education and Awareness Program be continued and receive a specific
appropriation of $660,000 for fiscal year 2012.
Research Through the National Institutes of Health
The National Institutes of Health (NIH), mainly through the
National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK), maintains a robust research portfolio on IC, including five
recent major studies yielding significant new information. The RAND IC
Epidemiology (RICE) study found that nearly 2.7-6.7 percent of adult
women have symptoms consistent with IC and will prove important to the
future development of clinical trials and epidemiological studies. The
IC Genetic Twin study found environmental factors, rather than genetic
factors, to be substantial risk factors of developing IC. The Events
Preceding Interstitial Cystitis (EPIC) study has yielded significant
information linking non-bladder conditions and infectious agents to the
development of IC in many newly diagnosed IC patients. The findings of
the EPIC study have been reinforced in a Northwestern University study
which found that an unusual form of toxic bacterial molecule (LPS) has
an impact the development of IC as a result of an infectious agent.
Finally, the Urologic Pelvic Pain Collaborative Research Network
(UPPCRN) has indicated promising results for a new therapy for IC
patients.
Research currently underway and expected to begin in the near
future also holds great promise to increase our understanding of IC,
and thus find new treatments and cure. The Multidisciplinary Approach
to the Study of Chronic Pelvic Pain (MAPP) Syndrome Research Network
holds great potential to understanding the underlying issues related to
IC, other conditions possibly associated with IC, and new information
related to flares of the condition. Additionally, the investigator-
initiated research portfolio will continue to support research relating
to fundamental issues relating to IC and pelvic pain, including new
avenues for interdisciplinary research and new treatment options.
Finally, NIH will continue to focus on developing new treatment and
therapies to relieve this condition.
In order for this positive research to reach its full potential, it
is essential NIH continue to receive funding which will allow it to
continue and expand on past and current research. For this reason we
recommend a funding level of $35 billion for fiscal year 2012. We also
recommend the continuation of the MAPP study and collaboration between
NIDDK and the Office of Women's Health on issues related to IC.
Thank you for the opportunity to present the views of the
interstitial cystitis community.
______
Prepared Statement of the Iowa Statewide Independent Living Council
I am contacting you regarding the proposed restructuring of the
Independent Living funding that is outlined in President Obama's 2012
budget.
The seven Iowa Centers for Independent Living, along with all the
other Centers for Independent Living across the country, need your
help.
As you may know, Centers for Independent Living (CILs) are
nonprofit organizations run by people with disabilities for people with
disabilities. They are authorized by the Federal Rehabilitation Act.
CILs help people with disabilities to remain independent in their own
homes and communities, being productive and contributing members of
society. CILs work to help people remain independent so they are not
forced to live in institutions such as nursing homes. As I am sure you
are aware, in the vast majority of cases it is much less costly for a
person with a disability to remain in their own home and community
rather than pay for them to be institutionalized, and even more
importantly people with disabilities have the same right to live
independently as do people who do not have a disability.
The Independent Living movement, CILs, and SILCs promote the
philosophy of consumer control. Consumers, who are people with
disabilities, control the operations of CILs and SILCs.
I would like to provide you with some education about the reality
of what the President's proposed restructuring of Independent Living
funding will do to many Centers for Independent Living (CILs). I am
opposed to this restructuring because of the damage it will do to many
CILs, including the very real possibility that many CILs will have to
close their doors as they will not be able to fiscally operate under
this new structure.
Currently, under the Federal Rehabilitation Act, CILs receive their
Part C Federal Independent Living funding directly from the Federal
Rehabilitation Services Administration (RSA). The Federal Part B funds
are given to the States, in most cases to the State Vocational
Rehabilitation Services (VR) agency, and the VR does contracts with the
CILs and the Statewide Independent Living Council (SILC) for these Part
B Federal funds. The Federal Part C funds do not require a State match
as they come directly from RSA at the Federal level to the individual
CILs. The Part B funding does require a State match as it comes
directly to the state VR agency.
Combining the Federal Part B and the Federal Part C Independent
Living funding, and making these funds into a new block grant to States
for Independent Living funding, is not acceptable for a number of
reasons, and I would like to outline those reasons.
Combining these funds into a block grant and giving them to States
will significantly reduce, if not eliminate, consumer control of
independent living programs. Prior to the Part C funds being given to
RSA to distribute directly to CILs, the funds were given out in grants
to States. There were numerous problems with the State administering
these grant funds, which is why the funding structure was changed to
Part C going directly from RSA to CILs. Here are some examples of what
happened in the past, and these problems will also occur under the
President's proposed block grant funding:
--Under the past IL grant process, if the State had a freeze on
hiring or travel, they would also make the CILs have a freeze
on travel and hiring. This meant the CILs could not hire staff
when needed, nor could they travel when needed. So even though
the consumer controlled CIL Board directed the CIL Executive
Director to hire a new staff, or directed that staff was to
travel to attend a national conference, the State would not
allow the CIL to do these things and would not provide the
money to do these things, even though these things were an
allowable use of the Federal grant funds. The State agency
controlled the CIL, the Consumer Board did not have any
control.
--In many States, the Vocational Rehabilitation Services agency has
procedures for reimbursing funds to the CILs, and in many
States CILs would submit documentation for reimbursement and it
would take 3, 4 or 5 months for the VR agency to get the money
back to the CIL, which caused a great hardship for CILs to be
able to keep their doors open. Here is one true example. One
CIL Director re-financed his own house to take out a loan to
meet staff payroll until the CIL received the reimbursement
funds for their expenses from the State VR agency. Currently, I
know this is an issue with the Federal Part B funds that the VR
agencies give to CILs. It can take up to 4 or 5 months for a
CIL to get reimbursed for their Part B funds. Fortunately, many
of those CILs also get Federal Part C funds directly from RSA
so they have money to cover their expenses until they get the
Part B reimbursement check from VR. If the President's proposal
becomes reality, there are many CILs that will most likely have
to close as they will not have the working capital to pay their
bills and then wait 4-5 months to get reimbursed by the VR
agency.
There are additional concerns to consider.
--VR agencies are already under stress from State budget cuts, and it
takes VR staff time to be able to do contracts and
reimbursements for CILs. If these contracts become bigger, VRs
will have to hire additional staff to manage these funds and do
the contracts with the CILs. Where will the money come from for
the VR agency to do this? Will it be taken out of the combined
Part B and Part C funds, which means less funds going to CILs
for direct consumer partner services, and less money to SILCs
to be able to operate?
--Currently only the Part B funds require a State match. If you
combine B and C into one block grant, will State match be
required for this total amount? If so, where are States going
to get the State funds to match the additional Part C funds?
Many States can barely find the match for the Part B funds, so
it is possible that States will not have funds to match the
Part C funds too. That means the State will not get the Part C
funds, and Centers will not have enough funding to keep their
doors open.
--Providing direct funding to CILs is required by the Federal
Rehabilitation Act, and for the President's budget proposal to
be enacted, the Rehabilitation Act would have be significantly
altered and then reauthorized.
These are very real and disturbing concerns. I would like to know
that President Obama, as well as the Federal legislators, are looking
at these concerns and how to address them before going ahead with the
President's proposed restructuring. There must be a better way to do
this that will maintain consumer partner control of CIL operations, and
that will allow CILs to fiscally operate without risk of having to
close their doors, and/or reduce staff and services to consumer
partners.
______
Prepared Statement of the Joint Advocacy Coalition of the: Association
for Clinical Research Training, Association for Patient-Oriented
Research, and Clinical Research Forum
The Association for Clinical Research Training (ACRT), the
Association for Patient-Oriented Research (APOR), the Clinical Research
Forum (CR Forum), and the Society for Clinical and Translational
Science (SCTS) represent a coalition of professional organizations
dedicated to improving the health of the public through increased
clinical and translational research, and clinical research training.
United by the shared priorities of the clinical and translational
research community, ACRT, APOR, CR Forum, and SCTS advocate for
increased clinical and translational research at the National
Institutes of Health (NIH), the Agency for Healthcare Research and
Quality (AHRQ), and other Federal science agencies.
On behalf of ACRT, APOR, CR Forum, and SCTS, I would like to thank
the Subcommittee for their continued support of clinical and
translational research, and clinical research training. The creation of
the Patient-Centered Outcomes Research Institute and National Center
for the Advancement of Translational Science in healthcare reform will
provide a much-needed and greatly appreciated boost to comparative
effectiveness research (CER) at the Federal level, as well as the
organization of the new National Center for Translational Science
(NCATS). As outlined by NIH Director Dr. Francis Collins in his five
priorities for NIH, the translation of basic science to clinical
treatment is an integral component of modern biomedical research, and a
necessity to developing the treatments and cures of tomorrow.
Today, I would like to address a number of issues that cut to the
heart of the clinical and translational research community's
priorities, including the Clinical and Translational Science Awards
program (CTSA) at NIH, career development for clinical researchers, and
support for CER at the Federal level.
As our Nation's investment in biomedical research expands to
provide more accurate and efficient treatments for patients, we must
continue to focus on the translation of basic science to clinical
research. The CTSA program at NIH is quickly becoming an invaluable
resource in this area, but full funding is needed if we are to truly
take advantage of the CTSA infrastructure.
Fully Funding and Support for the CTSA Program at NIH
With its establishment in 2006, the CTSA program at NIH began to
address the need for increased focus on translational research, or
research that bridges the gap between basic scientific discoveries and
the bedside. Originally envisioned as a consortium of 60 academic
institutions, the CTSA program currently funds 55 academic medical
research institutions nationwide, and is set to expand to the full 60
by the end of 2011. The CTSAs have an explicit goal of improving
healthcare in the United States by transforming the biomedical research
enterprise to become more effectively translational. Specifically, the
CTSA program hopes to (1) improve the way biomedical research is
conducted across the country; (2) reduce the time it takes for
laboratory discoveries to become treatments for patients; (3) engage
communities in clinical research efforts; (4) increase training and
development in the next generation of clinical and translational
researchers; and (5) accelerate T1 translational science.
Although the promise of the CTSA program is recognized both
nationally and internationally, it has suffered from a lack of proper
funding along with NIH, and the National Center for Research Resources
(NCRR). In 2006, 16 initial CTSAs were funded, followed by an
additional 12 in 2007 and 14 in 2008, 4 in 2009, and 9 in 2010. Level-
funding at NIH curtailed the growth of the CTSAs, preventing recipient
institutions from fully implementing their programs and causing them to
drastically alter their budgets after research had already begun. If
budgets continue to decline, the CTSAs risk jeopardizing not only new
research but also the research begun by first, second, and third
generation CTSAs. Professional judgments have determined full funding
to be at a level of $700 million.
We recognize the difficult economic situation our country is
currently experiencing, and greatly appreciate the commitment to
healthcare Congress has demonstrated through stimulus funding, the
fiscal year 2011 appropriations process, and through healthcare reform.
The CTSAs are currently funding 55 academic research institutions
nationwide at a level of $464 million, with the goal of full
implementation by late 2011. In order to reach full implementation of
60 CTSAs by late 2011, and to realize the promise of the CTSAs in
transforming biomedical research to improve its impact on health, it is
imperative that the CTSA program receive funding at the level of $700
million in fiscal year 2012. Without full funding, more CTSAs will be
expected to operate with fewer resources, curtailing their
transformative promise.
A major part of the CTSA program's promise lies in its synergy with
all of NIH's Institutes and Centers (ICs), and the acceleration and
facilitation of the ICs' impact. The translation of laboratory research
to clinical treatment directly benefits patients suffering from complex
diseases and all fields of medicine. The CTSA program has created
improved translational research capacity and processes from which all
NIH's ICs stand to benefit. The development of a formal NIH-wide plan
to link all ICs to the CTSA program would efficiently capitalize on NIH
investment and the new opportunities presented by the advent of NCATS
for clinical and translational science.
It is our recommendation that the Subcommittee support full
implementation of the CTSA program by providing $700 million in fiscal
year 2011, and we ask that the Subcommittee support the development of
a formal NIH-wide plan to integrate the CTSAs to all of NIH's Institues
and Centers.
Continuing Support for Research Training and Career Development
Programs Through the K Awards
The future of our Nation's biomedical research enterprise relies
heavily on the maintenance and continued recruitment of promising young
investigators. Clinical investigators have long been referred to as an
``endangered species'', as financial barriers push medical students
away from research. This trend must be arrested if we are to continue
our pursuits of better treatments and cures for patients.
The K Awards at NIH and AHRQ provide much-needed support for the
career development of young investigators. As clinical and
translational medicine takes on increasing importance, there is a great
need to grow these programs, not reduce them. Career development grants
are crucial to the recruitment of promising young investigators, as
well as to the continuing education of established investigators.
Reduced commitment to the K-12, K-23, K-24, and K-30 awards would have
a devastating impact on our pool of highly trained clinical
researchers. Even with the full implementation of the CTSA program, it
will be critical for institutions without CTSAs to retain their K-30
Clinical Research Curriculum Awards, as the K-30s remain a highly cost-
effective method of ensuring quality clinical research training. ACRT,
APOR, CRF, and SCTS strongly support the ongoing commitment to clinical
research training through K Awards at NIH and AHRQ.
We ask the Subcommittee to continue their support for clinical
research training and career development through the K Awards at NIH
and AHRQ, in order to promote and encourage investigators working to
transform biomedical science.
Continuing Support for CER
Comparative effectiveness research or ``CER'' emerged at the
forefront of the healthcare reform debate, capturing the interest of
lawmakers and the American people. CER is the evaluation of the impact
of different options that are available for treating a given medical
condition for a particular set of patients. This broad definition can
include medications, behavioral therapies, and medical devices among
other interventions, and is an important facet of evidence-based
medicine. On behalf of ACRT, APOR, CR Forum, and SCTS, I would like to
thank the Senate for the creation of the Patient-Centered Outcomes
Research Institute in the Patient Protection and Affordable Care Act,
as well as the $1.1 billion included for CER at NIH and AHRQ in the
American Recovery and Reinvestment Act (ARRA). Both AHRQ and NIH have
long histories of supporting CER, and the standards for research
instituted by agencies like NIH and AHRQ serve as models for best
practices worldwide. Not only are these agencies experienced in CER,
they are universally recognized as impartial and honest brokers of
information.
We are pleased that Congress recognizes the importance of these
activities and believe that the peer review processes and
infrastructure in place at NIH and AHRQ ensure the highest quality CER.
We believe that collaboration between the Patient-Centered Outcomes
Research Institute, NIH, and AHRQ will motivate all Federal CER
efforts. In addition to support for the CTSA program at NIH, we
encourage the Subcommittee to provide continued support for Patient-
Centered Health Research at AHRQ.
Thank you for the opportunity to present the views and
recommendations of the clinical research training community. On behalf
of ACRT, APOR, CR Forum, and SCTS, I would be happy to be of assistance
as the appropriations process moves forward.
______
Prepared Statement of Lions Clubs International
Lions Clubs International (LCI) its official charity arm, Lions
Clubs International Foundation (LCIF), have been world leaders in
serving the vision, hearing, youth development, disability and
humanitarian needs of millions of people in America and around the
world, and we work closely with other NGOs. Since LCIF was founded in
1968, it has awarded more than 9,000 grants, totaling more than $700
million for service projects ranging from affordable hearing aids to
diabetes-prevention. All Administrative costs are paid for through
interest earned on investments, allowing LCIF to maximize out impact on
the community and demonstrating the motto ``We Serve.''
Our current 1.35 million-member global membership, representing
over 206 countries, serves communities through the following ways:
protect and preserve sight; provide disaster relief; combat disability;
promote health; and serve youth. The 12,000 individual clubs
representing over 375,000 individual citizens in North America are
constantly expanding to add new programs and its volunteers are working
to bring health services to as many communities as possible.
LCI represents the largest and most effective NGO service
organization presence in the world. Awarded and recognized as the #1
NGO organization for partnership globally by The Financial Times 2007,
LCI also holds a four star (highest) rating from the
CharityNavigator.com (an independent review organization).
Today, we face many complex challenges in the health and education
sector, from preventable diseases that cause blindness in children to
bullying, violence, and drug use among school-aged children. I will
offer a brief summary of recommendations in programs under the general
jurisdiction of the Labor-HHS-Education Subcommittee.
HEALTH AND HUMAN SERVICES
Domestic Sight Services
Through our network of foundations and programs across America, LCI
remains the single largest provider of charitable vision care,
eyeglasses and hearing care services to needy and indigent people. Some
of our major sight initiatives include:
--The Sight for Kids Program in collaboration with Johnson and
Johnson. The program has provided 6 million vision screenings
and eye-health education programs for children.
--Core 4 Preschool Vision Screening program enables LCI to conduct
screenings for children in preschools. The program strives to
deliver early detection and treatment for the most common
vision disorders that can lead to amblyopia or ``lazy eye.''
LCIF has also provided grants and services to those affected by
eye conditions that cannot be improved medically.
--LCI Clubs sponsored ``United We Serve Health Week'' events around
the country. These Health Week efforts, in conjunction with the
White House, were effective in bringing awareness to vision
health issues.
National Eye Institute--Vision Health Recommendations
LCI believes that vision loss is a major public health problem that
increases healthcare costs and reduces productivity and quality of life
for millions of Americans. LCI played an important role in the creation
of a free-standing eye institute separate from the then-National
Institute for Neurological Diseases and Blindness. The National Eye
Institute Act was signed into law by President Johnson in 1968 as the
Nation's lead Institute within the NIH to prevent blindness and save
and restore vision of all Americans. NEI-funded research is resulting
in treatments and therapies that save vision and restore sight,
resulting in reduced healthcare costs and higher productivity.
LCI is concerned that proposals to reduce NIH funding to fiscal
year 2008 levels would result in NEI funding for fiscal year 2011 at
$667 million, or a $30 million loss. This would result in 43 fewer
investigator-initiated research grants to save or restore vision.
According to the National Association Eye and Vision Research, this
funding reflects little more than 1 percent of the $68 billion annual
cost of eye disease and vision impairment in the United States.
LCI supports fiscal year 2012 NIH funding at $35 billion. This
funding level would ensure that NIH can maintain the number of multi-
year investigator-initiated research grants, and enables NEI to build
upon its record of basic clinical/translational research. We also
support an increase in NEI funding above the 1.8 percent proposed by
the President.
Vision 2020 USA Partnership
VISION 2020 USA members, including Lions Clubs International, share
a commitment to blindness prevention, preserving sight, and ensuring
that all individuals receive the vision and eye healthcare they need
and deserve. We are particularly interested in ensuring that Congress
provides for fiscal year 2012 to support the following programs and
initiatives:
--Sustainment of at least $3.23 million for vision and eye health
initiatives at the Centers for Disease Control and Prevention
(CDC)
--Support of the Maternal and Child Health Bureau's (MCHB) National
Center for Children's Vision and Eye Health
Vision-related conditions affect people across the lifespan from
childhood through elder years. Fortunately, in children, many serious
ocular conditions--such as amblyopia, nearsightedness, farsightedness,
and astigmatism--are treatable, if diagnosed at an early stage. Yet,
too many children do not receive vision screenings or follow-up
comprehensive eye examinations and treatment. More than 80 million
Americans are at risk for a potentially blinding eye disease such as
diabetic retinopathy, glaucoma, cataract, and age-related macular
degeneration. If nothing is done, the number of blind Americans is
expected to double by 2030.
With fiscal year 2012 appropriations that maintain current funding
for vision and eye health efforts of the CDC and increased resources
for the NIH and NEI, these Federal vision and eye health partners will
have the resources they need to sustain and expand their respective
efforts and programs to advance the prevention, diagnosis, and
treatment of vision problems and eye disease.
Lions Affordable Hearing Aid Project (AHAP)
LCI is committed to fighting hearing loss as well as blindness. By
listening to community health organizations across the country, Lions
Clubs International and their volunteer members became aware of the
lack of quality and affordable hearing care, especially for people with
incomes below or at 200 percent of the poverty level. Many people have
been unable to access other personal and family resources to purchase
hearing aids, and have been denied State and Federal assistance.
Fourteen centers have been working to expand output in this area as
demand continues to rise with a network of mobile health units and
community based programs that screen more than 2 million people each
year and provide hearing aids to 14,000 low income patients.
The statistics are unacceptable: 31 million persons in the United
States experience some form of hearing loss, yet only 7.3 million opt
to use hearing aids. According to audiology researchers, the market
penetration for hearing aids is about 23.6 percent. For every four
patients that enter a practice needing hearing aids, only one will
purchase them. The median price tag is $1,900 (2005) for a digital
hearing aid and prices go as high as $4,000. State Foundations, public
health departments, and aging departments are in need of assistance in
this area.
With the recent 25-30 percent increase in people seeking assistance
for hearing aids, there is an immediate public imperative to address
the problem. Federal dollars are stretched, but Federal support in this
area would have significant public health dividends in difficult
economic times.
``LIONS QUEST''/EDUCATION/HEALTH PROGRAMS
LCIF's youth development initiatives, known collectively as ``Lions
Quest,'' have been a prominent part of school-based K-12 programs since
1984. Fulfilling its mission to teach responsible decisionmaking,
effective communications and drug prevention, Lions Quest has been
involved in training more than 350,000 educators and other adults to
provide services for over 11 million youth in programs covering 43
States. LCIF currently invests more than $2 million annually in
supporting life skills training and service learning, and that funding
is matched by local Lions, schools and other partners.
Lions Quest curricula incorporate parent and community involvement
in the development of health and responsible young people in the areas
of: life skills development (social and emotional learning), character
education, drug prevention, service learning, and bullying prevention.
There is even a physical fitness component to this program that can
assist Federal goals of reducing obesity in school-aged children.
These Lions Quest programs provide strong evidence of decreased
drug use, improved responsibility for students own behavior, as well as
stronger decisionmaking skills and test scores in math and reading. In
August 2002, Lions Quest received the highest ``Select'' ranking from
the University of Illinois at Chicago-based Collaborative for Academic,
Social and Emotional Learning (CASEL) for meeting standards in life
skills education, evidence of effectiveness and exemplary professional
development.
Lions Quest has extensive experience with Federal programs. Lions
Quest Skills for Adolescence received a ``Promising Program'' rating
from the U.S. Department of Education Safe and Drug Free Schools and a
``Model'' rating from the U.S. Department of Health and Human Services
Substance Abuse and Mental Health Services Administration (SAMHSA).
Lions Quest also has extensive experience of partnering with State
service commissions to reach more schools and engage more young people
in service learning. Successful partnerships have been active in
Michigan, New York, Oklahoma, Tennessee and West Virginia with progress
being made in Texas and Ohio.
Social and Emotional Learning Programs
In addition, Lions Clubs recommends Congressional support for
social and emotional learning (SEL) programs that stimulate growth
among schools nationwide through distribution of materials and teacher
training, and to create opportunities for youth to participate in
activities that increase their social and emotional skills. Not only do
SEL curricula contribute to the social and emotional development of
youth, but they also provide invaluable support to students' school
success, health, well-being, peer and family relationships, and
citizenship. While still conducting scientific research and reviewing
the best available science evidence, over time Lions Clubs and its SEL
partners have increasingly worked to provide SEL practitioners,
trainers and school administrators with the guidelines, tools,
informational resources, policies, training, and support they need to
improve and expand SEL programming.
Overall, SEL training programs and curricula have outstanding
benefits for school-aged children:
--SEL prevents a variety of problems such as alcohol and drug use,
violence, truancy, and bullying. SEL programs for urban youth
emphasize the importance of cooperation and teamwork.
--Positive outcomes increase in students who are involved in social
and emotional learning programming by an average of 11
percentile points over other students.
--With greater social and emotional desire to learn and commit to
schoolwork, participants benefit from improved attendance,
graduation rates, grades, and test scores.
CONCLUSION
Lions Clubs remains committed to domestic activities such as major
sight initiatives and positive youth development and youth service
programs. Today we face great health and educational challenges, and
Lions Clubs International understands the importance not only of
community service but of instilling those among members of our next
generation. The success of nonprofit entities such as Lions Clubs show
what the service sector can do for economic and social development of
communities that are especially hard hit by the recession, and we are
committed to forming more effective alliances and partnerships to
increase our domestic impact.
______
Prepared Statement of the March of Dimes Foundation
The 3 million volunteers and nearly 1,300 staff members of the
March of Dimes Foundation appreciate the opportunity to submit Federal
funding recommendations for fiscal year 2012.
The March of Dimes was founded in 1938 by President Franklin D.
Roosevelt to support research to prevent polio. Today, the Foundation
aims to improve the health of women, infants and children by preventing
birth defects, premature birth, and infant mortality through scientific
research, community services, education and advocacy.
The March of Dimes is a unique partnership of scientists,
clinicians, parents, members of the business community and other
volunteers affiliated with 51 chapters and 213 divisions in every
State, the District of Columbia and Puerto Rico. Additionally, in 1992,
the March of Dimes extended its mission globally and now operates
through partnerships in 33 countries on four continents.
The March of Dimes is aware that the current fiscal environment
necessitates restrictions on Federal funding increases and program
expansions. However, it is our hope that these budgetary limitations
will not put at risk our vital mission on which affected families rely.
Therefore, the March of Dimes recommends the following funding levels
for programs and initiatives that are essential investments in maternal
and child health.
PRETERM BIRTH
In 2008, one in eight infants was born preterm (before 37 weeks).
Preterm birth is the leading cause of newborn mortality (death within
the first month) and the second leading cause of infant mortality
(death within the first year). In 2009, the National Center for Health
Statistics (NCHS) reported that the primary reason for the higher
infant mortality rate in the United States compared to other high
resource countries is the greater percentage of preterm births--12.4
percent in the United States compared to 5.5 percent in Ireland. But
survival alone does not necessarily result in good health for these
infants. Among those who survive, one in five faces health problems
that persist for life. Prematurity-related conditions include cerebral
palsy, intellectual disabilities, chronic lung disease, blindness and
deafness. A comprehensive report published by the Institute of Medicine
in 2007 estimated that preterm births cost the United States more than
$26 billion in 2005 alone, with costs climbing each year.
As a result of legislation enacted in 2006 (Public Law 109-450),
the U.S. Surgeon General sponsored a conference in 2008 of more than
200 of the country's foremost experts that convened for 2 days to
develop a strategy to address the costly and serious problems of
preterm birth. The meeting resulted in an action plan that included
several overarching themes and recommendations. Among the most
important were the enhancement of biomedical and epidemiological
research and strengthening our Nation's data resources that document
the health status of pregnant women and infants. The Foundation's
funding requests regarding preterm birth are based on these
recommendations.
National Institutes of Health
The March of Dimes commends members of the Subcommittee for their
continuing support of the National Children's Study (NCS). For fiscal
year 2012, the Foundation supports the President's funding
recommendation of $193.9 million for the NCS and we urge the
Subcommittee to support this recommendation as well. The NCS is the
largest and most comprehensive study of children's health and
development ever planned in the United States. The 37 ``vanguard
centers'' have recruited nearly 3,000 participants thus far and more
than 650 children have been born into the study. When fully
implemented, this study will follow a representative sample of 100,000
children in the United States from before birth until age 21. The data
from this important study will help scientists at universities and
research organizations across the country and around the world identify
precursors of diseases and develop new strategies for treatment and
prevention. Specifically, the first data generated by the NCS will
provide information concerning disorders of birth and infancy,
including preterm birth and its health consequences. The Foundation
remains committed to supporting a well-designed NCS that promotes
research of the highest quality and asks the Subcommittee to do the
same.
Eunice Kennedy Shriver National Institute of Child Health and Human
Development (NICHD)
For fiscal year 2012, the March of Dimes recommends at least $1.35
billion for the NICHD. This $30 million increase compared to the fiscal
year 2011 enacted level will enable NICHD to expand its support for
preterm birth-related research through the Maternal-Fetal Medicine
Units, Neonatal Research Network, and Genomic and Proteomic Network for
Preterm Birth Research. In addition, it will allow for planning grants
to begin establishing a network of integrated trans-disciplinary
research centers, as recommended by the Institute of Medicine report
and the aforementioned 2008 Surgeon General's Conference. The causes of
preterm birth are multi-faceted and necessitate a coordinated and
collaborative approach integrating many disciplines. These trans-
disciplinary centers would serve as a national resource for
investigators to design and share new research approaches and
strategies to comprehensively address preterm birth.
Centers for Disease Control and Prevention--Preterm Birth
The National Center for Chronic Disease Prevention and Health
Promotion's Safe Motherhood Program works to promote optimal
reproductive and infant health. In 2009, CDC created a robust research
agenda to prevent preterm birth by improving derivation of accurate
data to understand preterm birth; developing, implementing and
evaluating prevention methods; and conducting targeted etiologic and
epidemiologic studies. For fiscal year 2012, the March of Dimes
recommends a $6 million increase in the CDC's preterm birth budget
compared to the fiscal year 2011 enacted level (for a total of $8
million) to strengthen our national data systems and to expand preterm
birth research as authorized by the PREEMIE Act (Public Law 109-450).
Centers for Disease Control and Prevention--National Center for Health
Statistics
The National Center for Health Statistics' (NCHS) vital statistics
program collects birth and death data that are used to monitor the
Nation's health status, set research and intervention priorities, and
evaluate the effectiveness of existing health programs. It is
imperative that data collected by NCHS be comprehensive and timely.
Unfortunately, one-quarter of the States and territories lack the
capacity to use the most recent (2003) birth certificate format and
only two-thirds have adopted the most recent (2003) death certificate
format. The March of Dimes supports the President's recommendation to
provide $162 million for the NCHS in fiscal year 2012 and urges the
Subcommittee to support this recommendation in both the bill language
and in the accompanying committee report as well.
Health Resources and Services Administration--Healthy Start
The Maternal and Child Health Bureau's Healthy Start Program is a
collection of community-based projects focused on reducing infant
mortality, low birth weight, and racial disparities in perinatal
outcomes among high-risk populations by strengthening local health
systems and resources. Communities with Healthy Start programs have
seen significant improvements in perinatal health outcomes. The March
of Dimes supports the President's recommendation to provide $105
million for Healthy Start in fiscal year 2012 and urges the
Subcommittee to support this recommendation as well.
BIRTH DEFECTS
According to the Centers for Disease Control and Prevention, an
estimated 120,000 infants in the United States are born with major
structural birth defects each year. Genetic or environmental factors,
or a combination of both, can cause various birth defects; yet the
causes of more than 70 percent are unknown. Many birth defects result
in childhood and adult disability that require costly, lifelong
treatments and special care. Additional Federal resources are sorely
needed to support research to discover causes of all birth defects and
for the development of effective interventions to prevent or at least
reduce their prevalence.
CDC's National Center on Birth Defects and Developmental Disabilities
(NCBDDD)
The NCBDDD conducts programs to protect and improve the health of
children by preventing birth defects and developmental disabilities and
by promoting optimal development and wellness among children with
disabilities. For fiscal year 2012, the March of Dimes requests at
least $144 million for NCBDDD. In addition, we encourage the
Subcommittee to allocate an additional $5 million specifically to
support birth defects research and surveillance and an additional $2
million specifically to support folic acid education. A source for this
$7 million in additional funding could be the Prevention and Public
Health Fund. Investing in the work of the NCBDDD will promote wellness
and preventive strategies aimed at children, reduce health disparities,
and enable CDC to more effectively support transition to adulthood for
children with lifelong disabilities.
Allocating an additional $5 million to support genetic analysis of
the research samples already obtained through the NCBDDD's National
Birth Defects Prevention Study--the largest case-controlled study of
birth defects ever conducted--would be a sound investment. This
analysis would enable researchers to begin the work needed to translate
their findings into effective birth defects intervention and treatment
programs. The study has already yielded rich results. In 2009 alone, 29
articles regarding risk factors for birth defects--for example maternal
diabetes, obesity, use of certain medications, and smoking--were
published in medical and health journals. In addition, this investment
would make possible the continuation of NCBDDD's State-based birth
defects surveillance grant program. Surveillance is the backbone of the
public health network and its support should be a Subcommittee
priority. Because of the current fiscal situation facing many States,
funding for State-based surveillance systems is in jeopardy and
requires increased Federal support to ensure the survival of essential
birth defects surveillance programs.
Allocating an additional $2 million to NCBDDD will allow the CDC to
expand its effective national education campaign aimed at reducing the
incidence of spina bifida and anencephaly by promoting consumption of
folic acid. Since the institution of fortification of U.S. enriched
grain products with folic acid, the rate of neural tube defects has
decreased by 26 percent. However, CDC estimates that up to 70 percent
of neural tube defects could be prevented if all women of childbearing
age consumed 400 micrograms of folic acid daily. To raise awareness
among women of childbearing age and thereby increase the use of folic
acid, NCBDDD's national education campaign must be expanded.
The March of Dimes is very concerned about the Administration's
recommendation that the NCBDDD's budget lines be consolidated into
three categories: Child Health and Development, Health and Development
for People with Disabilities, and Public Health Approach to Blood
Disorders. As proposed, the Birth Defects and Developmental
Disabilities budget line would be renamed Child Health and Development
and existing sub-categories would be eliminated (e.g. Birth Defects,
Fetal Alcohol Syndrome, Folic Acid). While the March of Dimes
recognizes and supports program flexibility for CDC management, we are
concerned that the title ``Child Health and Development'' fails to make
clear the overall purpose of the programs covered, masking the urgency
and importance of the need for ongoing support from Congress. We urge
the Subcommittee to modify the Administration's proposal by retaining
the term ``Birth Defects'' as a sub-line with the category ``Child
Health and Development.'' We believe this adjustment is needed to
ensure that the content of these essential programs to reduce birth
defects is clearly articulated.
NEWBORN SCREENING
Newborn screening is a vital public health activity used to
identify genetic, metabolic, hormonal and functional disorders in
newborns so that treatment can be provided. Screening detects
conditions in newborns that, if left untreated, can cause disability,
developmental delays, intellectual disabilities, serious illnesses or
even death. If diagnosed early, many of these disorders can be
successfully managed. Across the Nation, State and local governments
are experiencing significant budget shortfalls. Because of this fiscal
pressure, discontinuing screening for certain conditions or postponing
the purchase of necessary technology is a serious threat that, if left
unresolved, will put infants at risk of permanent disability or even
death. For fiscal year 2012, an additional $5 million for HRSA's
heritable disorders program, as authorized by the Newborn Screening
Saves Lives Act (Public Law 110-204), is necessary to increase support
for State efforts to improve screening, enhance counseling, and
increase capacity to reach and educate health professionals and parents
about newborn screening programs and follow-up services.
OTHER
Agency for Health Research and Quality (AHRQ)
AHRQ supports research to improve healthcare quality, reduce costs
and broaden access to essential health services. For fiscal year 2012,
the March of Dimes recommends $405 million total for AHRQ to continue
its important work, including the development and dissemination of
maternal and pediatric quality measures and comparative effectiveness
research. Moreover, with the historic enactment of health reform last
year, AHRQ's research is needed more than ever to build the evidence-
base that will be used to improve health and healthcare coverage.
Health Resources and Services Administration--Maternal and Child Health
Block Grant
Title V of the Social Security Act, the Maternal and Child Health
Block Grant, supports a growing number of community-based programs
(e.g. home visiting, respite care for children with special healthcare
needs, and supplementary services for pregnant women and children
enrolled in Medicaid and the State Children's Health Insurance
Program), but Federal support has not kept pace with increased
enrollment and demand for these services. For fiscal year 2012, the
March of Dimes recommends $700 million for the Maternal and Child
Health Block Grant--$44 million more than the fiscal year 2011 enacted
level.
CDC National Immunization Program
Infants are particularly vulnerable to infectious diseases, which
is why it is critical to protect them through immunization. In 2008,
the national estimated immunization coverage among children 19-35
months of age was 76 percent. The CDC's National Immunization Program
supports States, communities and territorial public health agencies
through grants to reduce the incidence of disability and death
resulting from vaccine-preventable diseases. The March of Dimes is
requesting $685 million in fiscal year 2012 for the National
Immunization Program.
CDC Polio Eradication
Since its creation as an organization dedicated to research and
services related to polio, the March of Dimes has been committed to the
eradication of this disabling disease. We support the Administration's
Global Polio Eradication Strategic Plan for the remaining endemic
countries, and urge the Subcommittee to approve the President's request
for $112 million in fiscal year 2012 to support CDC's Polio Eradication
Program.
CLOSING
Thank you for the opportunity to testify on the federally supported
programs of highest priority to the March of Dimes. The Foundation's
volunteers and staff in every State, the District of Columbia and
Puerto Rico look forward to working with Members of this Subcommittee
to secure the resources needed to improve the health of the Nation's
mothers, infants and children.
MARCH OF DIMES FISCAL YEAR 2012 FEDERAL FUNDING PRIORITIES
------------------------------------------------------------------------
Fiscal year
2011 funding
(w/prevention March of Dimes
Program fund add-on fiscal year
where 2012 request
applicable)
------------------------------------------------------------------------
National Institutes of Health (Total)... $30.77 B $35 B
National Children's Study........... 191.05 M 193.9 M
Common Fund......................... 543.02 M 556.9 M
National Institute of Child Health 1.32 B 1.35 B
and Human Development..............
National Human Genome Research 511.5 M 524.8 M
Institute..........................
National Center on Minority Health 209.71 M 214.6 M
and Disparities....................
Centers for Disease Control and 6.26 B 7.7 B
Prevention (Total).....................
Birth Defects Research & 20.3 M 25.3 M
Surveillance.......................
Folic Acid Campaign................. 2.8 M 4.8 M
Immunization........................ 525.57 M 685 M
Polio Eradication................... 101.6 M 112 M
Preterm Birth (Safe Motherhood)..... 1.97 M 8 M
National Center for Health 168.68 M 162 M
Statistics.........................
Health Resources and Services 6.29 B 7.65 B
Administration (Total).................
Maternal and Child Health Block 656.32 M 700 M
Grant..............................
Newborn Screening................... 9.95 M 15 M
Newborn Hearing Screening........... 18.88 M 19 M
Community Health Centers............ 2.48 B 2.56 B
Healthy Start....................... 104.36 M 105 M
Agency for Healthcare Research and 392.05 M 405 M
Quality (Total)........................
------------------------------------------------------------------------
______
Prepared Statement of the Meals On Wheels Association of America
Thank you for the opportunity to present testimony to your
subcommittee concerning fiscal year 2012 funding for Senior Nutrition
Programs administered by the Administration on Aging (AoA) within the
U.S. Department of Health and Human Services (HHS). I am Enid A.
Borden, President and CEO of the Meals On Wheels Association of America
(MOWAA), the oldest and largest national organization representing
local, community-based Senior Nutrition Programs--both congregate and
home-delivered (commonly referred to as Meals On Wheels)--and the only
national organization and network dedicated solely to ending senior
hunger in America. I speak on behalf not only of that national network
of Senior Nutrition Programs but also for the hundreds of thousands of
seniors in communities across this Nation who depend upon those
programs for access to nutritious meals. I speak for them because many
are behind closed doors, invisible and without a voice of their own.
But it is not only for those particular seniors that I bring our
concerns before you. I also speak for those other seniors who like
their peers need meals, but who do not receive them, not because we
lack the infrastructure and expertise to serve them but because our
Senior Nutrition Programs lack the adequate financial resources to
provide them. At MOWAA we call those individuals the hidden hungry, and
we call the situation that lets them remain so a national tragedy and
morally unacceptable circumstance in the richest Nation on earth.
Those, I realize, are strong words. But they are also carefully chosen
and in no way hyperbolic. Later I will attempt to put impartial numbers
to those words, and then some humanity.
But before I do that, let me stop and offer MOWAA's sincere thanks
to this Subcommittee, and in particular to you, Mr. Chairman, for your
longstanding support of Senior Nutrition Programs as well as for your
leadership in ensuring that these programs received increases in
appropriations the past several fiscal years. We are quite mindful that
the chairman's mark of the Senate version of the fiscal year 2011 bill,
crafted by this Subcommittee and approved by the full Committee,
contained increases of $38 million above the fiscal year 2010 level for
these programs. We are grateful for those actions at the same time that
we are extremely disheartened that the final fiscal year 2011
continuing resolution did not provide for any increases.
Today Senior Nutrition Programs are struggling to maintain
services; many are unable to do so and therefore are forced to reduce
services. That is today, and as prices of gasoline and food continue to
climb, more and more programs will find themselves in that predicament.
More starkly, homebound seniors who cannot shop and prepare meals for
themselves, who have no other access to nutritious food, will be forced
to go without meals. The consequences of that are something for which
we will all pay. I use the word ``pay'' both literally and
figuratively. If we leave frail seniors languishing in their homes
without proper nutrition, their health will inevitably fail. If they
survive, they will end up hospitalized or institutionalized at a cost
to the Government that far exceeds the cost of providing adequate funds
to Senior Nutrition Programs to enable them to furnish seniors meals in
the homes and other settings. Senior Nutrition Programs can provide
meals for nearly 1 year for roughly the cost of one Medicare day in the
hospital. We can quantify the savings that can accrue when seniors
receive nutritious meals immediately following a hospital stay for an
acute condition.
Our evidence in this regard is based on 2006 data (in 2006 dollars)
from a special project that MOWAA carried out in partnership with a
major national insurance company. The findings were presented in
December 2006 in Washington at a Leadership Summit sponsored by AoA.
Through the special partnership, Medicare Advantage patients in select
markets across the United States were offered without cost to
themselves 10 meals, delivered by local Meals On Wheels programs,
immediately following hospital discharge. Participation was purely
voluntary. Individuals who chose to receive the service were typically
sicker than those who declined it. Despite this, the insurance data
show that those seniors who received meals had first month post-
discharge healthcare costs on average $1,061 lower than those who did
not. The beneficial affects were also lasting. The third month after
receiving those meals, the average per person savings were $316.
Individuals who did not receive meals had both more inpatient hospital
days and more inpatient admissions per 1,000 than those who did receive
meals. I cannot calculate the savings had meals been provided to every
senior who was discharged from the hospital, or even to half of them,
but I know that it is significant. According to PricewaterhouseCoopers,
preventable hospital readmissions cost the Nation approximately $25
billion each year. One out of every five Medicare patients discharged
from a hospital is readmitted within 30 days at an annual cost to
Medicare of $17 billion. Given these facts, providing adequate funds
for Senior Nutrition Programs can only be regarded as a strong and
demonstrable value proposition. Beyond that, from a human and humane
perspective, and from the perspective of the value of individuals and
their liberty--principals on which this Nation was founded and for
which it still stands--it is the only acceptable and right thing to do.
As you are well aware, however, the President's fiscal year 2012
budget proposes continued funding for these programs for another fiscal
year at the fiscal year 2010 level. If that occurs it will not only be
costly on the other side of the Federal ledger but it will also be
nothing less than disastrous for seniors who are already vulnerable. So
we appeal to this Subcommittee to provide substantial increases above
the President's request for Title III C1 (Congregate Meals), Title III
C2 (Home-Delivered Meals) and Nutrition Services Incentive Program
(NSIP). We ask knowing that the fiscal context in which you are working
for this fiscal year 2012 appropriation bill is extraordinarily
challenging, and we ask knowing that providing increases to our
programs means reducing or eliminating others. But we also ask knowing
that without such increases vulnerable seniors will go hungry.
One of the great strengths of community-based Senior Nutrition
Programs is that they are strong public-private partnerships that rely
on the community to contribute significant financial support to augment
those Federal funds furnished through this Labor, Health and Human
Services, Education and Related Agencies appropriation bill. A host of
partners give generously, and without them Senior Nutrition Programs
could not operate. But without a strong Federal commitment in the form
of adequate appropriations most Senior Nutrition Programs could not
leverage these other funds effectively. In fiscal year 2009, the last
year for which AoA has data, only 28.4 percent of the expenditures for
Title III C2 home-delivered meals were Title III dollars. The remainder
was from other sources. For Title III C1 congregate meals the Title III
share was 41 percent. Funds are not the only invaluable resources that
communities contribute to Senior Nutrition Programs. The programs
typically rely on volunteers to perform many of the critical functions
of the operation, such as meal delivery. We are proud to claim what we
believe to be the largest volunteer army in the world, numbering in the
neighborhood of 1.7 million individuals each year. Despite all of these
assets Senior Nutrition Programs will fail to reach the most vulnerable
elderly in their communities without adequate Federal financial
support.
Simply put, Senior Nutrition Programs are lifelines to those men
and women they serve. Regrettably they are reaching only a small
proportion of the population needing services. A February 2011
Government Accountability Office (GAO) report prepared for Senator Herb
Kohl paints a grim picture. The GAO (GAO-11-237) found that ``. . .
approximately 9 percent of an estimated 17.6 million low-income older
adults received meal services like those provided by Title III
programs. However, many more older adults likely needed services, but
did not receive them . . . For instance, an estimated 19 percent of
low-income older adults were food insecure and about 90 percent of
these individuals did not receive any meal services [emphasis added].
Similarly approximately 17 percent of those with low incomes had two or
more types of difficulties with daily activities that could make it
difficult to obtain or prepare food. An estimated 83 percent of those
individuals with such difficulties did not receive meal services
[emphasis added].
As dire as this report is, we wish to point out that it undercounts
the percentage of the population needing services that fail to receive
them. This is due to the fact that the GAO confined their investigation
to low-income seniors. Title III and NSIP funded meal programs are
explicitly prohibited by the Older Americans Act (OAA) from means-
testing and many individuals with incomes above the Federal poverty
line receive services based on their physical condition, homebound
status, social or geographic isolation and other factors that create an
inability to access nutritious food from any other source. If you
factor individuals meeting these criteria into the equation, the
percentage of seniors needing meal services but who do not get them
will certainly increase. Surely our Federal and national commitment to
our most vulnerable elders should reach more than 10 percent of those
needing meals.
Given the current economic situation and the exponential growth of
the aging population, if funding remains static it is unavoidable that
the percentage of people needing services to whom Senior Nutrition
Programs will be able to provide services will erode substantially.
Sky-rocketing food and fuel prices are having a deleterious impact on
programs that are dependent upon these two items. MOWAA has determined
that every 1 cent increase in the price of gasoline results in a
$250,000 increase in the cost of providing services. Gasoline prices
for the week of May 9, 2011 were $1.06 higher than for the same week of
2010. This means that costs nationally of delivering services based on
this factor alone increased by $26,500,000. It is true that some, but
not all, of these costs are borne by volunteers who donate the use of
their vehicles, but as gas prices increase many of these individuals, a
number of whom are older and on fixed incomes themselves, are either
requesting reimbursement from programs or suspending their volunteer
activities. When this happens, Senior Nutrition Programs often must
bear the costs. The point is that factors far outside the control of
Senior Nutrition Programs are increasing their costs; so flat funding
will translate into a significant reduction or curtailment of nutrition
services to our most vulnerable seniors.
Last year, MOWAA engaged an expert actuary to examine Federal
funding for Senior Nutrition Programs for the past two decades. Looking
at population data and appropriations, he determined a per capita
commitment to seniors and Senior Nutrition Programs in fiscal year
1992. Then, taking into account the growth in the ages 60+ and the 85+
population and the changes in the CPI-U, he projected what the fiscal
year 2012 total appropriation for Title III C1, Title III C2 and NSIP
would be in fiscal year 2011 if that per capita commitment were
maintained. The current year (fiscal year 2011) figure would be
$1,275,571,000 based on the 60+ population and $1,743,182,000 based on
the 85+ population. We are not asking for either of those funding
levels, the latter of which be more than double the current year
appropriation of $819,474,000 for the three line items combined. But we
do believe that this provides a reasonable context in which to make
decisions. Surely the senior citizens of today are as valuable and
deserving of life sustaining meals as those seniors of two decades ago
were. Meals are not dispensable. To live and live healthily people must
eat. To ensure that frail seniors do, Congress must increase funding
for Senior Nutrition Programs. We respectfully request that increases
of no less than your Subcommittee originally approved for fiscal year
2011, that is of at least $38 million for Title III C combined with a
commensurate increase for NSIP, should be the baseline.
In closing I would like to thank this Subcommittee again for its
longstanding support, acknowledge that MOWAA understands the difficulty
of your task and the boldness of our ``ask'' in this difficult budget
year. We mean no disrespect. But part of our role, in addition to
supporting our member Senior Nutrition Programs in providing meals, is
to call attention to the need to afford those older adults, who
contributed so much to this Nation, the respect that they are due. It
is in that spirit that we make our request. As you consider it and as
you make the difficult funding decisions that the Subcommittee must, we
respectfully request that you think of Senior Nutrition Programs not
simply as one of the hundreds of programs supported through the Labor,
Health and Human Services, Education and Related Agencies appropriation
bill, but instead as an essential service. For what is more essential
to the sustaining of life than nutritious food and hydration? Those are
the fundamental services Senior Nutrition Programs deliver.
Again, we thank you for the opportunity to present this testimony
to you.
______
Prepared Statement of the Medical Library Association and Association
of Academic Health Sciences Libraries
SUMMARY OF RECOMMENDATIONS FOR FISCAL YEAR 2011
Continue the commitment to the National Library of Medicine (NLM)
by increasing funding levels to $402 million for fiscal year 2012.
Continue to support the medical library community's role in NLM's
outreach, telemedicine, disaster preparedness and health information
technology initiatives and the implementation of healthcare reform.
INTRODUCTION
The Medical Library Association (MLA) and the Association of
Academic Health Sciences Libraries (AAHSL) thank the Subcommittee for
the opportunity to submit testimony regarding fiscal year 2012
appropriations for the National Library of Medicine (NLM), a division
of the National Institutes of Health. Working in partnership with other
parts of the NIH and other Federal agencies, NLM is the key link in the
chain that translates biomedical research into practice, making the
results of research readily available worldwide.
MLA is a nonprofit, educational organization with approximately
4,000 health sciences information professional members worldwide.
Founded in 1898, MLA provides lifelong educational opportunities,
supports a knowledge base of health information research, and works
with a global network of partners to promote the importance of quality
information for improved health to the healthcare community and the
public. AAHSL is composed of the directors of 123 libraries of
accredited U.S. and Canadian medical schools, and 26 associate members.
AAHSL's goals are to promote excellence in academic health sciences
libraries and to ensure that the next generation of health
practitioners is trained in information seeking skills that enhance the
quality of information delivery. Together, MLA and AAHSL address health
information issues and legislative matters of importance to both our
organizations.
THE IMPORTANCE OF ANNUAL FUNDING INCREASES FOR NLM
We are pleased that the fiscal year 2010 appropriations package
contained funding increases for NIH and NLM which
bolstered their baseline budgets, and that the proposed fiscal year
2011 budget included increases. In today's challenging budget
environment, we recognize the difficult decisions Congress faces as it
seeks to improve our Nation's fiscal stability. We appreciate and thank
the Subcommittee for its commitment to strengthening the NIH and NLM
budget.
MLA and AAHSL believe that increased funding for NLM is essential
to maximize the return on the investment in research conducted by the
NIH and other organizations. By collecting, organizing, and making the
results of biomedical information more accessible to other researchers,
clinicians, business innovators, and the public, NLM enables such
information be used more efficiently and effectively to drive
innovation and improve the national's health. This role has become more
important as the volume of biomedical data produced each year expands
exponentially driven by the influx of data from high-throughput genome
sequencing systems and genome-wide association studies. NLM plays a
critical role in accelerating nationwide deployment of health
information technology, including electronic health records (EHRs) by
leading the development, maintenance and dissemination of key standards
for health data interchange that are now required of certified EHRs.
NLM also contributes to Congressional priorities related to drug safety
through its efforts to expand its clinical trial registry and results
database in response to recent legislation requirements, and to the
nation's ability to prepare for and respond to disasters.
We encourage the Subcommittee to continue to provide meaningful
annual increases for NLM in the coming years and recommend an increase
to $402 million for fiscal year 2012. Recovery funding and the fiscal
year 2010 budget increases stimulated the economy and biomedical
research. For NLM, Recovery Act funding allowed timely and much needed
increases in support of leading edge research and training in
biomedical informatics--the kinds of programs that will influence
future health information technology developments. In fiscal year 2012
and beyond, it is critical to augment NLM's baseline budget to
accommodate expansion of its information resources, services, and
programs which must collect, organize, and make accessible rapidly
expanding volumes of biomedical knowledge.
Growing Demand for NLM's Basic Services
The National Library of Medicine is the world's largest biomedical
library and the source of trusted health information. Every day,
medical librarians across the Nation assist clinicians, students,
researchers, and the public in accessing the information they need to
save lives and improve health. NLM delivers more than a trillion bytes
of data to millions of users every day to help researchers advance
scientific discovery and accelerate its translation into new therapies;
provides health practitioners with information that improves medical
care and lowers its costs; and gives the public access to resources and
tools that promote wellness and disease prevention. Without NLM, our
Nation's medical libraries would be unable to provide the quality
information services that our Nation's health professionals, educators,
researchers and patients have come to expect.
NLM's data repositories and online integrated services such as such
as GenBank, PubMed, and PubMed Central are helping to revolutionize
medicine and advance science to the next important era which includes
individualized medicine based on an individual's unique genetic
differences. GenBank, with its international partners, has become the
definitive source of gene sequence information and organizing, along
with NLM's other genetic databases, the volumes of data that are needed
to detect associations between genes and disease and translate that
knowledge into better diagnosis and treatments. PubMed, with more than
20 million citations to the biomedical literature, is the world's most
heavily used source of information about published results of
biomedical research. Approximately 700,000 new citations are added each
year, and it is searched more than 2.2 million times each day. PubMed
Central, NLM's freely accessible digital repository of biomedical
journal articles, has become a valuable resource for researchers,
clinicians, consumers and librarians. On a typical weekday more than
420,000 users download 740,000 full-text articles. We commend the
Appropriations Committee for its support of the NIH public access
policy which requires all NIH-funded researchers to deposit their
final, peer-reviewed manuscripts in NLM's PubMed Central database
within 12 months of publication. This highly beneficial policy is
improving access to timely and relevant scientific information,
stimulating discovery, informing clinical care, and improving public
health literacy. We ask the Committee to remain a strong voice in
support of the NIH policy and to support the extension of public access
policies to other Federal science and education agencies because this
would bring the benefits of public access to other research disciplines
and because research in other fields is increasingly relevant to
biomedicine.
As the world's largest and most comprehensive medical library,
NLM's traditional print and electronic collections continue to steadily
increase each year. These collections stand at more than 11.4 million
items--books, journals, technical reports, manuscripts, microfilms,
photographs and images. By selecting, organizing and ensuring permanent
access to health science information in all formats, NLM is ensuring
the availability of this information for future generations, making it
accessible to all Americans, irrespective of geography or ability to
pay, and ensuring that each citizen can make the best, most informed
decisions about their healthcare.
Clearly, NLM is a national treasure which is making a difference in
patients' lives and healthcare outcomes. For example, an MLA member
shared that recently a surgeon came to the library 12 minutes before
surgery to find an article on the complex procedure he was about to
perform. By searching NLM's PubMed/Medline database, the librarian
found illustrations that guided the surgeon during surgery enabling him
to save the man's foot.
encourage nlm partnerships with the medical library community
Outreach and Education
NLM's outreach programs are of interest to both MLA and AAHSL.
These activities are designed to educate medical librarians, health
professionals and the general public about NLM's services and to train
them in the most effective use of these services. NLM has taken a
leadership role in promoting educational outreach aimed at public
libraries, secondary schools, senior centers and other consumer-based
settings. Furthermore, NLM's emphasis on outreach to underserved
populations assists the effort to reduce health disparities among large
sections of the American public. One example of NLM's leadership is the
``Partners in Information Access'' program which is designed to improve
the access of local public health officials to information needed to
prevent, identify and respond to public health threats. With nearly
6,000 members in communities across the country, the National Network
of Libraries of Medicine (NNLM) is well positioned to ensure that every
public health worker has electronic health information services that
can protect the public's health.
NLM is also at the forefront of efforts to provide consumers with
trusted, reliable health information. Its MedlinePlus system provides
consumer-friendly information on more than 80 topics in English and
Spanish and has become a top destination for those seeking information
on the Internet, attracting more than half-million visitors per day.
Librarians at Louisiana State University's Health Sciences Center
Medical Library in Shreveport provide in-person support for patients
and the public seeking health information and have also established
``healthelinks.org'', a website with information on diseases and
conditions, medicines, procedures and surgical operations, lab tests,
and more from NLM's MedlinePlus system. With help from Congress, NLM,
NIH and the Friends of NLM launched NIH MedlinePlus Magazine in
September 2006. This quarterly publication is distributed in doctors'
waiting rooms and provides the public will access to high-quality,
easily understood health information. Its readership is now estimated
at 5 million people nationwide and is poised to grow thanks to the
launch of a Spanish/English version, NIH MedlinePlus Salud, in January
2009. NLM also continues to work with medical librarians and health
professionals to encourage doctors to provide MedlinePlus ``information
prescriptions'' to their patients, directing them to relevant
information on NLM's consumer-oriented MedlinePlus information system.
This initiative also encourages genetics counselors to prescribe the
use of NLM's Genetic Home Reference website. Using NLM's new
MedlinePlus Connect utility, a growing number of clinical care
organizations are implementing specific links from their electronic
health record systems to relevant patient education materials in
MedlinePlus, enabling them to achieve an emerging criterion for
achieving meaningful use of health information technology. MedinePlus
Connect was recently named a winner in the HHS Innovates competition.
NLM also provides access to information about clinical research for
a wide range of diseases. Launched in February 2000, ClinicalTrials.gov
contains registration information for some 105,000 trials. The database
is a free and invaluable resource for patients and families who are
interested in participating in cutting-edge treatments for serious
illnesses. In recent years, it has become more valuable for patients,
clinicians, researchers, and others, including librarians, who help
patients identify relevant trials and provide clinicians and
researchers with access to information about specific products such as
new drugs under study. In response to the Food and Drug Administration
Amendments Act of 2007, NLM has expanded ClinicalTrials.gov to accept
summary results of clinical trials, including adverse events. Such
information is not available systematically from other publicly
accessible resources, and all too often is not published in the
scientific literature. The system currently contains results for more
than 3,200 trials, and the Library receives approximately 50 new
results submission each week. More than 50,000 users visit the site ach
day.
MLA and AAHSL applaud the success of NLM's outreach initiatives,
particularly those initiatives that reach out to the medical libraries
and health consumers. We ask the Committee to encourage NLM to continue
to coordinate its outreach activities with the medical library
community in fiscal year 2012.
Emergency Preparedness and Response
NLM has a long history of programs and resources that support
disaster preparedness and response activities. Building on its
experiences in responding to Hurricane Katrina, NLM established a
Disaster Information Management Research Center to collect and organize
disaster-related health information, ensure effective use of libraries
and librarians in disaster planning and response, and develop
information services to assist responders. MLA and NLM are developing a
Disaster Information Specialization (DIS) program aimed at building the
capacity of librarians and other interested professionals to provide
disaster-related health information outreach. Earlier this year, NLM
convened a Disaster Information Outreach Symposium for information
professionals across the country. This highly successful program
addressed strategies for assessing and meeting the information needs of
disaster managers and responders; communications, social media and
disasters; using library facilities to support disaster needs during
response and recovery, workforce development; disaster resources for
librarians; and tools for providing disaster health information.
Working with libraries and American publishers, NLM has established an
Emergency Access Initiative that makes available free full-text
articles from hundreds of biomedical journals and reference books for
use by medical teams responding to disasters. This initiative has been
activated multiple times in the last 15 months to assist relief efforts
in Japan, Pakistan, and Haiti. It organized and made available health
information resources relevant to the Gulf Oil spill. MLA and AAHSL see
a clear role for NLM and the Nation's health sciences libraries in
disaster preparedness and response activities, and we ask the
Subcommittee to support NLM's role in this initiative which has a major
objective of ensuring continuous access to health information and
effective use of libraries and librarians when disasters occur.
MLA and AAHSL see a clear role for NLM and the Nation's health
sciences libraries in disaster preparedness and response activities,
and we ask the Subcommittee to support NLM's role in this initiative
which has a major objective of ensuring continuous access to health
information and effective use of libraries and librarians when
disasters occur.
Health Information Technology and Bioinformatics
NLM has played a pivotal role in creating and nurturing the field
of medical informatics which is the intersection of information
science, computer science and healthcare. Health informatics tools
include computers, clinical guidelines, formal medical terminologies,
and information and communication systems. For nearly 35 years, NLM has
supported informatics research, training and the application of
advanced computing and informatics to biomedical research and
healthcare delivery including a variety of telemedicine projects. Many
of today's informatics leaders are graduates of NLM-funded informatics
research programs at universities across the country. Many of the
country's exemplary electronic and personal health record systems
benefits from NLM grant support.
The importance of NLM's work in health information technology
continues to grow as the Nation moves toward more interoperable health
information technology systems. A leader in supporting, licensing,
developing and disseminating standard clinical terminologies for free
United States-wide use (e.g., SNOWMED), NLM works closely with the
Office of the National Coordinator for Health Information Technology
(ONCHIT) to promote the adoption of interoperable electronic records,
It has developed tools to make it easier for EHR developers and users
to implement accepted health data standards in their systems.
MLA and AAHSL encourage the Subcommittee to continue their strong
support for NLM's medical informatics and genomic science initiatives,
at a point when the linking of clinical and genetic data holds
increasing promise for enhancing the diagnosis and treatment of
disease. MLA and AAHSL also support health information technology
initiatives in ONCHIT that build upon initiatives housed at NLM.
Building and Facility Needs
The tremendous growth in NLM's basic functions related to the
acquisition, organization and preservation of its ever-expanding
collection of biomedical literature, combined with its growing
contributions to healthcare reform, health information technology, drug
safety, and exploitation of genomic information is straining the
Library's physical resources. During times of economic hardship, NLM's
role becomes increasingly important and it often serves as an archive
of last resort for medical libraries looking for ways to cut back and
trim their own collections.
NLM now houses 1,100 staff in a facility built to accommodate 650.
This increase in the volume of biomedical information and in the number
of personnel has led to a serious space shortage. Digital archiving--
once thought to be a solution to the problem of housing physical
collections--has only added to the challenge, as materials must often
be stored in multiple formats and as new digital resources consume
increasing amounts of data center storage space. As a result, the space
needed for computing facilities has also grown, and a new facility is
urgently needed. This need has been recognized by the NLM Board of
Regents as well as the Subcommittee in Senate Report 108-345 that
accompanied the fiscal year 2005 appropriations bill. However, the
economic challenges of the last several years have hampered movement on
this project.
While Congress continues to face tremendous funding challenges in
fiscal year 2012, MLA and AAHSL encourage the Subcommittee to
acknowledge the need for construction of the new building to take place
when the Federal budget stabilizes so that information-handling
capabilities and biomedical research are not jeopardized. At a time
when medical and health science libraries across the Nation face
growing financial and space constraints, ensuring that NLM continues to
serve as the archive of last resort for biomedical collections is
critical to the medical library community and the public we serve.
Thank you again for the opportunity to present the views of the
medical library community.
______
Prepared Statement of the Meharry Medical College
Mr. Chairman and members of the subcommittee, thank you for the
opportunity to present my views before you today. I am Dr. Wayne J.
Riley, President and CEO of Meharry Medical College in Nashville,
Tennessee. I have previously served as vice-president and vice dean for
health affairs and governmental relations and associate professor of
medicine at Baylor College of Medicine in Houston, Texas and as
assistant chief of medicine and a practicing general internist at
Houston's Ben Taub General Hospital. In all of these roles, I have seen
firsthand the importance of minority health professions institutions
and the Title VII Health Professions Training programs.
Mr. Chairman, time and time again, you have encouraged your
colleagues and the rest of us to take a look at our Nation and evaluate
our needs over the next 10 years. I took you seriously and came here
prepared to offer my best judgments. First, I want to say that it is
clear that health disparities among various populations and across
economic status are rampant and overwhelming. Over the next 10 years,
we will need to be able to deliver more culturally relevant and
culturally competent healthcare services. Bringing healthcare delivery
up to this higher standard can serve as our Nation's own preventive
healthcare agenda keeping us well positioned for the future.
Minority health professional institutions and the Title VII Health
Professions Training programs address this critical national need.
Persistent and severe staffing shortages exist in a number of the
health professions, and chronic shortages exist for all of the health
professions in our Nation's most medically underserved communities. Our
Nation's health professions workforce does not accurately reflect the
racial composition of our population. For example, African Americans
represent approximately 15 percent of the U.S. population while only 2-
3 percent of the Nation's healthcare workforce is African American.
There is a well established link between health disparities and a
lack of access to competent healthcare in medically underserved areas.
As a result, it is imperative that the Federal Government continue its
commitment to minority health profession institutions and minority
health professional training programs to continue to produce healthcare
professionals committed to addressing this unmet need.
An October 2006 study by the Health Resources and Services
Administration (HRSA), entitled ``The Rationale for Diversity in the
Health Professions: A Review of the Evidence'' found that minority
health professionals serve minority and other medically underserved
populations at higher rates than non-minority professionals. The report
also showed that; minority populations tend to receive better care from
practitioners who represent their own race or ethnicity, and non-
English speaking patients experience better care, greater
comprehension, and greater likelihood of keeping follow-up appointments
when they see a practitioner who speaks their language. Studies have
also demonstrated that when minorities are trained in minority health
profession institutions, they are significantly more likely to: (1)
serve in rural and urban medically underserved areas, (2) provide care
for minorities and (3) treat low-income patients.
As you are aware, Title VII Health Professions Training programs
are focused on improving the quality, geographic distribution and
diversity of the healthcare workforce in order to continue eliminating
disparities in our Nation's healthcare system. These programs provide
training for students to practice in underserved areas, cultivate
interactions with faculty role models who serve in underserved areas,
and provide placement and recruitment services to encourage students to
work in these areas. Health professionals who spend part of their
training providing care for the underserved are up to 10 times more
likely to practice in underserved areas after graduation or program
completion.
Institutions that cultivate minority health professionals have been
particularly hard-hit as a result of the cuts to the Title VII Health
Profession Training programs in fiscal year 2006 and fiscal year 2007
funding resolution passed earlier this Congress. Given their historic
mission to provide academic opportunities for minority and financially
disadvantaged students, and healthcare to minority and financially
disadvantaged patients, minority health professions institutions
operate on narrow margins. The cuts to the Title VII Health Professions
Training programs amount to a loss of core funding at these
institutions and have been financially devastating.
Mr. Chairman, I feel like I can speak authoritatively on this issue
because I received my medical degree from Morehouse School of Medicine,
a historically black medical school in Atlanta. I give credit to my
career in academia, and my being here today, to Title VII Health
Profession Training programs' Faculty Loan Repayment Program. Without
that program, I would not be the president of my father's alma mater,
Meharry Medical College, another historically black medical school
dedicated to eliminating healthcare disparities through education,
research and culturally relevant patient care.
Minority Centers of Excellence.--COEs focus on improving student
recruitment and performance, improving curricula in cultural
competence, facilitating research on minority health issues and
training students to provide health services to minority individuals.
COEs were first established in recognition of the contribution made by
four historically black health professions institutions (the Medical
and Dental Institutions at Meharry Medical College; The College of
Pharmacy at Xavier University; and the School of Veterinary Medicine at
Tuskegee University) to the training of minorities in the health
professions. Congress later went on to authorize the establishment of
``Hispanic'', ``Native American'' and ``Other'' Historically black
COEs. For fiscal year 2012, I recommend a funding level of $24.602
million for COEs.
Health Careers Opportunity Program (HCOP).--HCOPs provide grants
for minority and non-minority health profession institutions to support
pipeline, preparatory and recruiting activities that encourage minority
and economically disadvantaged students to pursue careers in the health
professions. Many HCOPs partner with colleges, high schools, and even
elementary schools in order to identify and nurture promising students
who demonstrate that they have the talent and potential to become a
health professional. Over the last three decades, HCOPs have trained
approximately 30,000 health professionals including 20,000 doctors,
5,000 dentists and 3,000 public health workers. For fiscal year 12, I
recommend a funding level of $22.133 million for HCOPs.
National Institutes of Health (NIH)
Research Centers at Minority Institutions.--The Research Centers at
Minority Institutions program (RCMI) at the National Center for
Research Resources has a long and distinguished record of helping our
institutions develop the research infrastructure necessary to be
leaders in the area of health disparities research. Although NIH has
received unprecedented budget increases in recent years, funding for
the RCMI program has not increased by the same rate. Therefore, the
funding for this important program grow at the same rate as NIH overall
in fiscal year 2012.
National Institute on Minority Health and Health Disparities.--The
National Institute on Minority Health and Health Disparities (NIMHD) is
charged with addressing the longstanding health status gap between
minority and nonminority populations. The NIMHD helps health
professional institutions to narrow the health status gap by improving
research capabilities through the continued development of faculty,
labs, and other learning resources. The NIMHD also supports biomedical
research focused on eliminating health disparities and develops a
comprehensive plan for research on minority health at the NIH.
Furthermore, the NIMHD provides financial support to health professions
institutions that have a history and mission of serving minority and
medically underserved communities. For fiscal year 2012, I recommend
that this Institute's funding grow proportionally with the funding of
the NIH.
Department of Health and Human Services
Office of Minority Health: Specific programs at OMH include:
-- Assisting medically underserved communities with the greatest need
in solving health disparities and attracting and retaining
health professionals,
--Assisting minority institutions in acquiring real property to
expand their campuses and increase their capacity to train
minorities for medical careers,
--Supporting conferences for high school and undergraduate students
to interest them in healthcareers, and
--Supporting cooperative agreements with minority institutions for
the purpose of strengthening their capacity to train more
minorities in the health professions.
The OMH has the potential to play a critical role in addressing
health disparities. For fiscal year 2012, I recommend a funding level
of $65 million for the OMH.
Department of Education
Strengthening Historically Black Graduate Institutions Program.--
The Department of Education's Strengthening Historically Black Graduate
Institutions program (Title III, Part B, Section 326) is extremely
important to MMC and other minority serving health professions
institutions. The funding from this program is used to enhance
educational capabilities, establish and strengthen program development
offices, initiate endowment campaigns, and support numerous other
institutional development activities. In fiscal year 2012, an
appropriation of $65 million is suggested to continue the vital support
that this program provides to historically black graduate institutions.
Mr. Chairman, please allow me to express my appreciation to you and
the members of this subcommittee. With your continued help and support,
Meharry Medical College along with other minority health professions
institutions and the Title VII Health Professions Training programs can
help this country to overcome health and healthcare disparities.
Congress must be careful not to eliminate, paralyze or stifle the
institutions and programs that have been proven to work. Meharry and
other minority health professions schools seek to close the ever
widening health disparity gap. If this subcommittee will give us the
tools, we will continue to work towards the goal of eliminating that
disparity as we have done for 1876.
Thank you, Mr. Chairman, for this opportunity.
______
Prepared Statement of the Morehouse School of Medicine
Mr. Chairman and members of the subcommittee, thank you for the
opportunity to present my views before you today. I am Dr. John E.
Maupin, President of Morehouse School of Medicine (MSM) in Atlanta,
Georgia. I have previously served as President of Meharry Medical
College, executive vice-president at Morehouse School of Medicine,
director of a community health center in Atlanta, and deputy director
of health in Baltimore, Maryland. In all of these roles, I have seen
firsthand the importance of minority health professions institutions
and the Title VII Health Professions Training programs.
I want to say that minority health professional institutions and
the Title VII Health Professionals Training programs address a critical
national need. Persistent and sever staffing shortages exist in a
number of the health professions, and chronic shortages exist for all
of the health professions in our Nation's most medically underserved
communities. Furthermore, our Nation's health professions workforce
does not accurately reflect the racial composition of our population.
For example while blacks represent approximately 15 percent of the U.S.
population, only 2-3 percent of the Nation's health professions
workforce is black. Morehouse is a private school with a very public
mission of educating students from traditionally underserved
communities so that they will care for the underserved. Mr. Chairman, I
would like to share with you how your committee can help us continue
our efforts to help provide quality health professionals and close our
Nation's health disparity gap.
There is a well established link between health disparities and a
lack of access to competent healthcare in medically underserved areas.
As a result, it is imperative that the Federal Government continue its
commitment to minority health profession institutions and minority
health professional training programs to continue to produce healthcare
professionals committed to addressing this unmet need.
An October 2006 study by the Health Resources and Services
Administration (HRSA), entitled ``The Rationale for Diversity in the
Health Professions: A Review of the Evidence'' found that minority
health professionals serve minority and other medically underserved
populations at higher rates than non-minority professionals. The report
also showed that; minority populations tend to receive better care from
practitioners who represent their own race or ethnicity, and non-
English speaking patients experience better care, greater
comprehension, and greater likelihood of keeping follow-up appointments
when they see a practitioner who speaks their language. Studies have
also demonstrated that when minorities are trained in minority health
profession institutions, they are significantly more likely to: (1)
serve in rural and urban medically underserved areas, (2) provide care
for minorities and (3) treat low-income patients.
As you are aware, Title VII Health Professions Training programs
are focused on improving the quality, geographic distribution and
diversity of the healthcare workforce in order to continue eliminating
disparities in our Nation's healthcare system. These programs provide
training for students to practice in underserved areas, cultivate
interactions with faculty role models who serve in underserved areas,
and provide placement and recruitment services to encourage students to
work in these areas. Health professionals who spend part of their
training providing care for the underserved are up to 10 times more
likely to practice in underserved areas after graduation or program
completion.
Given the historic mission, of institutions like MSM, to provide
academic opportunities for minority and financially disadvantaged
students, and healthcare to minority and financially disadvantaged
patients, minority health professions institutions operate on narrow
margins. The slow reinvestment in the Title VII Health Professions
Training programs amounts to a loss of core funding at these
institutions and have been financially devastating.
Mr. Chairman, I feel like I can speak authoritatively on this issue
because I received my dental degree from Meharry Medical College, a
historically black medical and dental school in Nashville, Tennessee. I
have seen first hand what Title VII funds have done to minority serving
institutions like Morehouse and Meharry. I compare my days as a student
to my days as president, without that Title VII, our institutions would
not be here today. However, Mr. Chairman, since those funds have been
slowly replenished, we are standing at a cross roads. This committee
has the power to decide if our institutions will go forward and thrive,
or if we will continue to try to just survive. We want to work with you
to eliminate health disparities and produce world class professionals,
but we need your assistance.
Minority Centers of Excellence: COEs focus on improving student
recruitment and performance, improving curricula in cultural
competence, facilitating research on minority health issues and
training students to provide health services to minority individuals.
COEs were first established in recognition of the contribution made by
four historically black health professions institutions (the Medical
and Dental Institutions at Meharry Medical College; The College of
Pharmacy at Xavier University; and the School of Veterinary Medicine at
Tuskegee University) to the training of minorities in the health
professions. Congress later went on to authorize the establishment of
``Hispanic'', ``Native American'' and ``Other'' Historically black
COEs. For fiscal year 2012, I recommend a funding level of $24.602
million for COEs.
Health Careers Opportunity Program (HCOP): HCOPs provide grants for
minority and non-minority health profession institutions to support
pipeline, preparatory and recruiting activities that encourage minority
and economically disadvantaged students to pursue careers in the health
professions. Many HCOPs partner with colleges, high schools, and even
elementary schools in order to identify and nurture promising students
who demonstrate that they have the talent and potential to become a
health professional. Over the last three decades, HCOPs have trained
approximately 30,000 health professionals including 20,000 doctors,
5,000 dentists and 3,000 public health workers. For fiscal year 2012, I
recommend a funding level of $22.133 million for HCOPs.
National Institutes of Health (NIH)
National Institute on Minority Health and Health Disparities.--The
National Institute on Minority Health and Health Disparities (NIMHD) is
charged with addressing the longstanding health status gap between
minority and nonminority populations. The NIMHD helps health
professional institutions to narrow the health status gap by improving
research capabilities through the continued development of faculty,
labs, and other learning resources. The NIMHD also supports biomedical
research focused on eliminating health disparities and develops a
comprehensive plan for research on minority health at the NIH.
Furthermore, the NIMHD provides financial support to health professions
institutions that have a history and mission of serving minority and
medically underserved communities through the Minority Centers of
Excellence program. For fiscal year 2012, I recommend a funding
increase proportional to any increase given to the NIH for the NIMHD.
Research Centers at Minority Institutions.--The Research Centers at
Minority Institutions program (RCMI), currently administered at the
National Center for Research Resources, has a long and distinguished
record of helping our institutions develop the research infrastructure
necessary to be leaders in the area of health disparities research.
Although NIH has received unprecedented budget increases in recent
years, funding for the RCMI program has not increased by the same rate.
Therefore, the funding for this important program grow at the same rate
as NIH overall in fiscal year 2012.
Department of Health and Human Services
Office of Minority Health.--Specific programs at OMH include: (1)
Assisting medically underserved communities with the greatest need in
solving health disparities and attracting and retaining health
professionals; (2) Assisting minority institutions in acquiring real
property to expand their campuses and increase their capacity to train
minorities for medical careers; (3) Supporting conferences for high
school and undergraduate students to interest them in healthcareers,
and (4) Supporting cooperative agreements with minority institutions
for the purpose of strengthening their capacity to train more
minorities in the health professions. The OMH has the potential to play
a critical role in addressing health disparities, and with the proper
funding this role can be enhanced. For fiscal year 2012, I recommend a
funding level of $65 million for the OMH.
Department of Education
Strengthening Historically Black Graduate Institutions.--The
Department of Education's Strengthening Historically Black Graduate
Institutions program (Title III, Part B, Section 326) is extremely
important to MSM and other minority serving health professions
institutions. The funding from this program is used to enhance
educational capabilities, establish and strengthen program development
offices, initiate endowment campaigns, and support numerous other
institutional development activities. In fiscal year 2012, an
appropriation of $65 million is suggested to continue the vital support
that this program provides to historically black graduate institutions.
Mr. Chairman, please allow me to express my appreciation to you and
the members of this subcommittee. With your continued help and support,
Morehouse School of Medicine along with other minority health
professions institutions and the Title VII Health Professions Training
programs can help this country to overcome health and healthcare
disparities. Congress must be careful not to eliminate, paralyze or
stifle the institutions and programs that have been proven to work. MSM
and other minority health professions schools seek to close the ever
widening health disparity gap. If this subcommittee will give us the
tools, we will continue to work towards the goal of eliminating that
disparity as we have since our founding day.
Thank you, Mr. Chairman, and I welcome every opportunity to answer
questions for your records.
______
Prepared Statement of the National AHEC Organization
The National AHEC Organization (NAO) is the professional
organization representing Area Health Education Centers (AHECs). Our
message is simple:
--The Area Health Education Center program is effective and provides
vital services and national infrastructure.
--Area Health Education Centers are the workforce development,
training and education machine for the Nation's healthcare
safety-net programs.
AHEC is one of the Title VII Health Professions Training programs,
originally authorized at the same time as the National Health Service
Corps (NHSC) to create a complete mechanism to provide primary care
providers for Community Health Centers (CHCs) and other direct
providers of healthcare services for underserved areas and populations.
The plan envisioned by creators of the legislation was that the CHCs
would provide direct service. The NHSC would be the mechanism to fund
the education of providers and supply providers for underserved areas
through scholarship and loan repayment commitments. The AHEC program
would be the mechanism to recruit providers into primary health
careers, diversify the workforce, and develop a passion for service to
the underserved in these future providers, i.e. Area Health Education
Centers are the workforce development, training and education machine
for the Nation's healthcare safety-net programs. The AHEC program is
focused on improving the quality, geographic distribution and diversity
of the primary care healthcare workforce and eliminating the
disparities in our Nation's healthcare system.
AHECs develop and support the community based training of health
professions students, particularly in rural and underserved areas. They
recruit a diverse and broad range of students into health careers, and
provide continuing education, library and other learning resources that
improve the quality of community-based healthcare for underserved
populations and areas.
The Area Health Education Center program is effective and provides
vital services and national infrastructure. Nationwide, over 379,000
students have been introduced to health career opportunities, and over
33,000 mostly minority and disadvantaged high school students received
more than 20 hours each of health career exposure. Over 44,000 health
professions students received training at 17,530 community-based sites,
and furthermore; over 482,000 health professionals received continuing
education through AHECs. AHECs perform these education and training
services through collaborative partnerships with Community Health
Centers (CHCs) and the National Health Service Corps (NHSC), in
addition to Rural Health Clinics (RHCs), Critical Access Hospitals,
(CAHs), Tribal clinics and Public Health Departments.
Justification for Recommendations
Imbalances in our healthcare system result in marked inequities in
access to and quality of healthcare services. This perpetuates
disparities in health status and the under-representation of minority
and disadvantaged individuals in the healthcare workforce. AHEC
programs play a key role in correcting these inequities and
strengthening the Nation's healthcare safety net.
In order to continue the progress that the Title VII Health
Professions Training programs, especially AHECs, have already made
toward their goal, an additional Federal investment is required. NAO
recommends that the AHEC program is funded at $75 million. Investment
at this level and at this time will be the first step toward full
investment at the authorized level of $125 million.
______
Prepared Statement of the National Alliance for Eye and Vision Research
EXECUTIVE SUMMARY
NAEVR requests fiscal year 2012 NIH funding at $35 billion, which
reflects a $3 billion increase over President Obama's proposed funding
level of $32 billion. Funding at $35 billion, which reflects NIH net
funding levels in both fiscal year 2009 and fiscal year 2010, ensures
it can maintain the number of multi-year investigator-initiated
research grants, the cornerstone of our Nation's biomedical research
enterprise.
The vision community commends Congress for $10.4 billion in NIH
funding in the American Recovery and Reinvestment Act (ARRA), as well
as fiscal year 2009 and fiscal year 2010 funding increases that enabled
NIH to keep pace with biomedical inflation after 6 previous years of
flat funding that resulted in a 14 percent loss of purchasing power.
Fiscal year 2012 NIH funding at $35 billion enables it to meet the
expanded capacity for research--as demonstrated by the significant
number of high-quality grant applications submitted in response to ARRA
opportunities--and to adequately address unmet need, especially for
programs of special promise that could reap substantial downstream
benefits, as identified by NIH Director Francis Collins, M.D., Ph.D. in
his top five priorities. As President Obama has stated repeatedly, most
recently during the 2011 State of the Union Address, biomedical
research has the potential to reduce healthcare costs, increase
productivity, and ensure the global competitiveness of the United
States.
NAEVR requests that Congress increase NEI funding above the 1.8
percent proposed by the President--even if it does not fund NIH at $35
billion--since the proposed increase does not match biomedical
inflation.
In 2009, Congress spoke volumes in passing S. Res. 209 and H. Res.
366, which designated 2010-2020 as The Decade of Vision, in which the
majority of 78 million Baby Boomers will turn 65 years of age and face
greatest risk of aging eye disease. This is not the time for a less-
than-inflationary increase that nets a loss in the NEI's purchasing
power, which eroded by 18 percent in the fiscal year 2003-fiscal year
2008 timeframe. NEI-funded research is resulting in treatments and
therapies that save vision and restore sight, which can reduce
healthcare costs, maintain productivity, ensure independence, and
enhance quality of life.
THE BIPARTISAN NIH SUPPORT DISPLAYED AT THE SUBCOMMITTEE'S MARCH 30
HEARING WITH SECRETARY SEBELIUS DEMONSTRATES THE VALUE OF INCREASED AND
TIMELY APPROPRIATIONS
NAEVR was pleased to hear the level of bipartisan support expressed
for NIH at the March 30 Senate L-HHS Appropriations Subcommittee
hearings with Department of Health and Human Services (DHHS) Secretary
Kathleen Sebelius and was especially impressed by two sets of comments:
--Senate Ranking Member Richard Shelby (R-AL) cautioned against
across-the-board cuts and urged Congress to sustain programs
that are effective--where he cited NIH as ``one of the most
results-driven aspects of our entire Federal budget.'' He added
that ``research conducted at NIH reduces disabilities, prolongs
life, and is an essential component to the health of all
Americans. NIH programs consistently meet their performance and
outcomes measures, as well as achieve their overall mission.''
These comments are stated so well that NAEVR will not expand
upon them, other than to cite vision examples in the next
sections.
--Senator Barbara Mikulski (D-MD) noted that a government shutdown,
NIH cuts, or delayed appropriations, individually or in
combination, will have far-reaching consequences, especially
for academic Institutions across the country which receive
funding.
To demonstrate that point, in late January 2011, NAEVR hosted 11
domestic and 6 international members of the Association for
Research in Vision and Ophthalmology (ARVO) in Capitol Hill
visits. They educated staff that a cutback to the fiscal year
2008 level would reduce NEI funding by $30 plus million and
reduce the number of grants by 43--any one of which could hold
the key to saving or restoring vision. The advocates also
described the impact of delayed appropriations, in terms of
continuity of research and retention of trained staff. If a
department does not have bridge or philanthropic funding to
retain staff while awaiting full funding of awards, it will
need to let staff go, and that usually means a highly trained
person is lost to another area of research or an institution in
another State, or even another country.
FISCAL YEAR 2012 NIH FUNDING AT $35 BILLION ENABLES THE NEI TO BUILD
UPON THE IMPRESSIVE RECORD OF BASIC AND CLINICAL/TRANSLATIONAL RESEARCH
THAT MEETS NIH'S TOP FIVE PRIORITIES AND WAS FUNDED THROUGH FISCAL YEAR
2009/2010 ARRA AND INCREASED ``REGULAR'' APPROPRIATIONS
NEI's research addresses the preemption, prediction, and prevention
of eye disease through basic, translational, epidemiological, and
comparative effectiveness research which also address the top five NIH
priorities, as identified by Dr. Collins: genomics, translational
research; comparative effectiveness; global health, and empowering the
biomedical enterprise.
With respect to translational research, in June 2010, NEI hosted a
Translational Research and Vision conference as the last of a series of
NIH-campus based educational events recognizing its 40th anniversary
(previous events addressed genetics/genomics, optical imaging, stem
cell therapies, and the latest glaucoma research). In keynote comments,
Dr. Collins recognized NEI as a leader in translational research. He
specifically cited NEI's leadership in ocular genetics, noting that NEI
has worked collaboratively with other NIH Institutes, especially the
National Human Genome Research Institute (NHGRI) to elucidate the basis
of eye disease and to develop treatments. As NEI Director Paul Sieving,
M.D., Ph.D. has stated, one-quarter of all genes identified to date are
associated with eye disease/visual impairment.
Dr. Collins also lauded the NEI's use of Genome-Wide Association
Studies (GWAS) to determine the increased risk of developing age-
related macular degeneration (AMD) from gene variants in the Complement
Factor H (CFH) immune pathway, noting that ``this was the first
demonstration that GWAS is a useful tool to make the connection between
gene variants and disease conditions.'' He added that, ``Twenty years
ago we could do little to prevent or treat AMD. Today, because of new
treatments and procedures based on NIH/NEI research, 1.3 million
Americans at risk for severe vision loss from AMD over the next 5 years
can receive potentially sight-saving therapies.''
With increased ``regular'' fiscal year 2009/2010 appropriations and
ARRA funding, NEI has been able to build upon past research in two
important areas:
Genetic Basis of AMD.--In 2010, NEI initiated the International AMD
Genetics Consortium, reflecting researchers on five continents who will
be sharing and analyzing GWAS results to further elucidate the genetic
basis of AMD. This may lead to new diagnostics and treatments for this
leading blinding eye disease, growing in incidence with the aging of
the population and with potential significant costs to the Medicare
program.
Treatment of Diabetic Macular Edema.--In May 2010, the NEI's
Diabetic Retinopathy Clinical Research (DRCR) Network--a multi-center
network dedicated to facilitating clinical research into diabetic
retinopathy, diabetic macular edema, and associated conditions--
reported results of a comparative effectiveness trial. The study
confirmed that laser treatment for diabetic macular edema, when
combined with injections of the Food and Drug Administration (FDA)-
approved anti-angiogenic drug Lucentis, is more effective than laser
treatment alone, the latter of which has been the standard of care for
the past 25 years. With NIH's recent announcement of a new strategic
plan to combat diabetes, led by the National Institute of Diabetes and
Digestive and Kidney Diseases (NIDDK), this research is more important
than ever within the larger context of NIH priorities. The current DRCR
Network is a successor to several previous networks, all of which
involved NEI-NIDDK collaboration. NEI's emphasis on diabetic
retinopathy reflects the fact that it is the leading cause of vision
loss in the working-age population and occurs with disproportionately
greater incidence in the Hispanic population.
IF CONGRESS DOES NOT INCREASE FISCAL YEAR 2012 NIH FUNDING ABOVE THE
PRESIDENT'S REQUEST, IT IS EVEN MORE VITAL TO IMPROVE UPON THE PROPOSED
1.8 PERCENT INCREASE FOR NEI
The NIH budget proposed by the administration and finalized by
Congress during the second year of the congressionally designated
Decade of Vision should not contain a less-than-inflationary increase
for the NEI due to the enormous challenges it faces in terms of the
aging population, the disproportionate incidence of eye disease in
fast-growing minority populations, and the visual impact of chronic
disease (e.g., diabetes). If Congress is unable to fund NIH at $35
billion in fiscal year 2012 (NEI level of $794.5 million) and adopts
the President's proposal, the 1.8 percent increase in funding must be
increased to at least an inflationary level of 2.4 percent to prevent
any further erosion in NEI's purchasing power. NEI funding is an
especially vital investment in the overall health, as well as the
vision health, of our Nation. It can ultimately delay, save, and
prevent health expenditures, especially those associated with the
Medicare and Medicaid programs, and is, therefore, a cost-effective
investment.
VISION LOSS IS A MAJOR PUBLIC HEALTH PROBLEM: INCREASING HEALTHCARE
COSTS, REDUCING PRODUCTIVITY, DIMINISHING LIFE QUALITY
The NEI estimates that more than 38 million Americans age 40 and
older experience blindness, low vision, or an age-related eye disease
such as AMD, glaucoma, diabetic retinopathy, or cataracts. This is
expected to grow to more than 50 million Americans by year 2020. The
economic and societal impact of eye disease is increasing not only due
to the aging population, but to its disproportionate incidence in
minority populations and as a co-morbid condition of chronic disease,
such as diabetes.
Although the NEI estimates that the current annual cost of vision
impairment and eye disease to the United States is $68 billion, this
number does not fully quantify the impact of indirect healthcare costs,
lost productivity, reduced independence, diminished quality of life,
increased depression, and accelerated mortality. NEI's fiscal year 2010
baseline funding of $707 million reflects just a little more than 1
percent of this annual costs of eye disease. The continuum of vision
loss presents a major public health problem, as well as a significant
financial challenge to the public and private sectors.
NAEVR URGES CONGRESS TO FUND THE NIH AT $35 BILLION IN FISCAL YEAR 2012
WHICH WILL ENSURE THE MOMENTUM OF BREAKTHROUGH NEI-FUNDED VISION
RESEARCH AND THE RETENTION OF TRAINED PERSONNEL
ABOUT NAEVR
The National Alliance for Eye and Vision Research (NAEVR) is a
501(c)4 nonprofit advocacy coalition comprised of 55 professional
(ophthalmology and optometry), patient and consumer, and industry
organizations involved in eye and vision research. Visit NAEVR's Web
site at www.eyeresearch.org.
______
Prepared Statement of the National Alliance of State & Territorial AIDS
Directors
The National Alliance of State & Territorial AIDS Directors
(NASTAD) represents the Nation's chief State health agency staff who
have programmatic responsibility for administering HIV/AIDS and viral
hepatitis healthcare, prevention, education, and supportive service
programs funded by State and Federal governments. On behalf of NASTAD,
we urge your support for increased funding for Federal HIV/AIDS and
viral hepatitis programs in the fiscal year 2012 Labor-HHS-Education
Appropriations bill, and thank you for your consideration of the
following critical funding needs for HIV/AIDS, viral hepatitis and STD
programs in fiscal year 2012. These funding needs support activities
aligned with the goals set forth in the National HIV/AIDS Strategy
(NHAS)--a game-changing blueprint for tackling the Nation's HIV/AIDS
epidemic.
As we approach 30 years into the HIV/AIDS epidemic, we must be
mindful that HIV/AIDS is still a crisis in the United States, not just
a global issue. HIV/AIDS is an emergency and while there are life-
saving medications that did not exist 20 years ago, there is still no
cure, and we still see new infections--about 56,000 annually. The
Nation's prevention efforts must match our commitment to the care and
treatment of infected individuals. First and foremost we must address
the devastating impact on racial and ethnic minority communities,
particularly African Americans and Latinos, as well as gay men and
other men who have sex with men (MSM) of all races and ethnicities,
substance users, women and youth. To be successful, we must expand
outreach, scale-up and consider new and innovative approaches to arrest
the epidemic here at home.
The President's fiscal year 2012 budget proposal provides increases
to HIV/AIDS prevention, care and the Ryan White Program in support of
the National HIV/AIDS Strategy for a total investment of $3.5 billion.
The Budget prioritizes HIV/AIDS resources within high burden
communities and among high-risk groups, including MSM, African
Americans and Hispanics, and realigns resources within CDC, HRSA,
SAMHSA, and the Office of the Secretary to support the National HIV/
AIDS Federal Implementation Plan. Additionally, the budget allows CDC
and States to transfer up to 5 percent across HIV/AIDS, tuberculosis,
STD and viral hepatitis programs to improve coordination and
integration.
HIV/AIDS Care and Treatment Programs
The Health Resources and Services Administration (HRSA) administers
the $2.2 billion Ryan White Program that provides health and support
services to more than 500,000 persons living with HIV/AIDS (PLWHA). The
President's budget includes an increase of $63 million for a total of
$2.4 billion for the entire Ryan White Program. The Budget also
includes $940 million for AIDS Drug Assistance Programs (ADAPs), an
increase of $55 million.
NASTAD requests a minimum increase of $183 million in fiscal year
2012 for State Ryan White Part B grants compared to the President's
budget of flat funding Part B at its fiscal year 2010 level of $418.8
million and requesting a $55 million increase or a total of $940
million for ADAPs. We are requesting an increase of $77 million for the
Part B Base and $106 million or a total of $991 million for ADAPs.
ADAPs truly need an increase of $360 million in fiscal year 2012 to
maintain their programs and fill the structural deficits that have
built up during the last several years. With these funds States and
territories provide care, treatment and support services to PLWHA, who
need access to HIV clinicians, life-saving and life-extending
therapies, and a full range of support services to ensure adherence to
complex treatment regimens. All States have reported to NASTAD a
significant increase in the number of individuals seeking Part B Base
and ADAP services.
State ADAPs provide medications to low-income uninsured or
underinsured PLWHA. In fiscal year 2009, over 213,000 clients were
enrolled in ADAPs nationwide. Due to many factors such as unemployment,
economic challenges, increased HIV testing and linkages to care, and
new HIV treatment guidelines calling for earlier therapeutic
treatments, program demand has increased dramatically, and thus ADAPs
are ever more in crisis. As of May 19, 2011, there 8,310 individuals
are on waiting lists in 13 States to receive their life-sustaining
medications through ADAP:
--Alabama: 15 individuals
--Arkansas: 59 individuals
--Florida: 3,938 individuals
--Georgia: 1,520 individuals
--Idaho: 14 individuals
--Louisiana: 696 individuals
--Montana: 26 individuals
--North Carolina: 242 individuals
--Ohio: 413 individuals
--South Carolina: 693individuals
--Utah: 6 individuals
--Virginia: 684 individuals
--Wyoming: 4 individuals
Last year, as of April 2010, there were 10 States with less than
900 individuals on waiting lists. Thus, we have seen an over 900
percent increase in individuals on waiting lists in the last year.
HIV/AIDS Prevention and Surveillance Programs
One of the major goals of the NHAS is to lower the annual number of
new infections from 56,300 to 42,225 by 2015. In order to meet this
ambitious goal, NASTAD requests an increase of $90 million above fiscal
year 2011 funding levels for a total of $555 million compared to the
President's request of a $4 million increase for State and local health
department HIV prevention and surveillance cooperative agreements in
order to provide comprehensive prevention programs. By providing
adequate resources to State and local health departments to scale up
HIV prevention and surveillance programs, we will be closer to meeting
the NHAS goal of reducing new HIV infections by 25 percent by 2015. In
addition, NASTAD fully supports the President's request to allocate
$30.4 million from the Prevention and Public Health Fund for HIV
prevention activities consistent with the allocation of these resources
in fiscal year 2010.
Of the total increase requested, NASTAD supports an increase of $60
million above fiscal year 2011 levels compared to the President's
request of a $6.4 million increase for the HIV prevention cooperative
agreements with health departments in order to scale up effective
prevention programs and enable CDC to implement a new funding formula
that would provide equitable funding to all jurisdictions based on
disease burden without dismantling existing prevention efforts in some
jurisdictions. Moreover, these additional resources will allow health
departments to increase their efforts in a variety of areas such as:
expanding the reach of activities targeting men who have sex with men
(MSM). According to the September 2010 CDC Fact Sheet HIV/AIDS Among
Gay and Bisexual Men, MSM account for nearly half (48 percent) of the
more than 1 million people living with HIV/AIDS and account for 53
percent of new infections. Young men from racial and ethnic minority
communities bear a disproportionate burden of the disease and there are
more new HIV infections among young Black MSM (aged 13-29) than among
any other age and racial group of MSM. Additional funding will allow
heath departments to continue developing and implementing innovative,
cost effective and evidence-based prevention programming. Increased
funding will also allow health departments to expand services to other
disproportionately impacted populations including Black women, persons
who inject drugs and youth. With additional funding, health departments
will expand outreach, targeted and routine HIV testing, partner
services and linkage to care and other evidence-based prevention
interventions. Increased funding will also allow for the expansion of
additional core prevention services such as partner services (the
identification, notification and counseling of partners of persons whom
have tested HIV positive), capacity building and technical assistance
to implement routine HIV testing and highly targeted behavior change
interventions to community-based organizations and healthcare providers
as well as public education campaigns to reinforce accurate, evidence-
based information and begin to reduce the stigma associated with the
disease.
In addition, NASTAD believes increased funding should be directed
toward critical HIV surveillance efforts and requests an increase of
$30 million above fiscal year 2011 levels compared to the President's
request of a decrease of nearly $2 million. Additional resources will
allow improvements in core surveillance and expand surveillance for HIV
incidence, behavioral risk, and receipt of care information including
CD4 and viral load reporting. HIV surveillance data are the mechanism
through which the success at achieving the goals of the NHAS will be
measured. The completeness of national HIV surveillance activities is
critical to monitor the HIV/AIDS epidemic and to provide data for
targeting with greater precision the delivery of HIV prevention, care,
and treatment services.
The funding increase will also allow for the continuation of the
Expanded Testing Program, Enhanced Comprehensive HIV Prevention
Planning (ECHPP) and Program Collaboration and Service Integration
(PCSI) activities. NASTAD supports maintaining funding at $70 million
to health departments to continue the highly successful Expanded
Testing Program (ETP), which targets African Americans, Latinos, gay
and bisexual men of all races and ethnicities, and persons who inject
drugs. For the 30 jurisdictions currently funded for ETP, the program
has been an effective way to implement routine HIV testing in clinical
settings--increasing the number of people who know their HIV status and
linking those with HIV to care and treatment. During the first 3 years
of the program approximately 2.6 million tests were conducted with an
estimated 28,000 being confirmed HIV positive. Reducing new HIV
infections relies heavily on ``knowing your status.'' This program
should be preserved with adequate funding to ensure that more
individuals learn their HIV status and are linked to care.
The first step in the NHAS is to ``intensify HIV prevention efforts
in communities where HIV is most heavily concentrated.'' In response,
in August 2010, the CDC funded ECHPP. Eligible jurisdictions were
awarded on September 30, 2010 with an average award of $960,000.
Through ECHPP, these highly impacted urban areas were awarded resources
to test and evaluate new approaches to integrate planning, monitoring
and delivering HIV prevention and care services in their specific
localities. NASTAD supports continuing ECHPP funding at $12 million in
order to fund the next round of State health departments for this
important activity.
NASTAD also requests continued support for Program Collaboration
and Service Integration (PCSI) to enable health departments to
integrate prevention services for HIV, STD, viral hepatitis, and TB at
the client level. Currently six jurisdictions are funded by CDC for
PCSI activities.
HIV School-based Prevention for Youth
NASTAD also supports an increase for evidence-based programs for
youth funded through the CDC. An increase of $10 million above the
President's fiscal year 2012 level of $40 million should be supported
for HIV school health for a total of $50 million. CDC currently funds
HIV school health programs through the Division of Adolescent and
School Health (DASH). The President's budget proposal moves HIV-
specific DASH funding to the National Center for HIV/AIDS, Viral
Hepatitis, STD and TB Prevention to ensure closer coordination with
other HIV prevention programs, which NASTAD supports. One-third of all
new infections are among young people under the age of 29, the largest
share of any age group of new infections.
Viral Hepatitis Prevention Programs
NASTAD requests an increase of $40 million for a total of $59.8
million in fiscal year 2012 compared to the President's request of $5.2
million for a total of $25 million. Funding increases would go to the
CDC's Division of Viral Hepatitis (DVH) to support the HHS Action Plan
on Viral Hepatitis for a national testing, education and surveillance
initiative as outlined in the Division's professional judgment budget
submitted to Congress last year. While we are hopeful about the first-
ever HHS Viral Hepatitis Action Plan, funding is needed to support
increased capacity at the HHS Office of the Assistant Secretary for
Health (ASH) for supporting the implementation of this plan.
We believe that testing to identify over 3 million people or 65-75
percent of chronic hepatitis B and C patients who do not know they are
infected is the highest priority for reducing illness and death related
to viral hepatitis. Testing must accompany education efforts to reach
those already infected and at high risk of death and of spreading the
disease. Surveillance is needed to monitor disease trends and evaluate
evidence-based interventions. Unlike other infectious diseases, viral
hepatitis lacks a national surveillance system. Further this funding
would enhance the role of Adult Viral Hepatitis Prevention Coordinators
(AVHPCs) based in State health departments to implement and integrate
testing, education and surveillance into the existing public health
infrastructure. States and cities receive an average funding award from
DVH of $90,000, which supports a single staff position and is not
sufficient for the provision of core prevention services. Therefore,
NASTAD requests funding to State adult viral hepatitis prevention
coordinators be increased from $5 to $10 million.
In addition, we encourage Congress to work with CDC to provide
adequate hepatitis B vaccination through the Section 317 program as
proposed in CDC's fiscal year 2012 budget. In years past, cost-savings
from the Section 317 program supported an at-risk adult hepatitis B
vaccine initiative with a funding high of $20 million. While this
funding went to vaccine-purchase only and not staff capacity or
infrastructure, it was a highly successful initiative at administering
nearly 1 million doses of vaccine. Unfortunately cost-savings for the
program were expended in fiscal year 2011.
Further we encourage the utilization of health reform's Prevention
and Public Health Fund to support a broad testing and screening
initiative that would include neglected diseases such as viral
hepatitis in order to capture patients before they progress in their
liver disease and increase costs to public healthcare systems.
STD Prevention Programs
NASTAD supports an increase of $212.7 million for a total of $367.4
million in fiscal year 2012 compared to the President's request of a $7
million increase for STD prevention, treatment and surveillance
activities undertaken by State and local health departments. CDC's
Division of STD Prevention has prioritized four disease prevention
goals--Prevention of STD-related infertility, STD-related adverse
pregnancy outcomes, STD-related cancers and STD-related HIV
transmission. CDC estimates that 19 million new infections occur each
year, almost half of them among young people ages 15 to 24. In one
year, the United States may spend over $8 billion to treat the symptoms
and consequences of STDs. Untreated STDs contribute to infant
mortality, infertility, and cervical cancer. Additional Federal
resources are needed to reverse these alarming trends and reduce the
Nation's health spending. The teen pregnancy prevention initiative
should be expanded to include prevention of HIV and STDs and funded at
$20 million above the President's 2012 request of $114.5 million. Such
an increase would allow providers to serve an additional 100,000 youth.
As you contemplate the fiscal year 2012 Labor, HHS and Education
Appropriations bill, we ask that you consider all of these critical
funding needs. We thank the Chairman, Ranking Member and members of the
Subcommittee, for their thoughtful consideration of our
recommendations. Our response to the HIV, viral hepatitis and STD
epidemics in the United States defines us as a society, as public
health agencies, and as individuals living in this country. There is no
time to waste in our Nation's fight against these infectious and often
chronic diseases. The Nation's prevention efforts must match our
commitment to the care and treatment of infected individuals.
______
Prepared Statement of the National Association for Public Health
Statistics and Information Systems
The National Association for Public Health Statistics and
Information Systems (NAPHSIS) welcomes the opportunity to provide this
written statement for the public record as the Labor, Health and Human
Services (HHS), Education and Related Agencies Appropriations
Subcommittee prepares its fiscal year 2012 appropriations legislation.
NAPHSIS represents the 57 vital records jurisdictions that collect,
process, and issue birth and death records in the United States and its
territories, including the 50 States, New York City, the District of
Columbia and the five territories. NAPHSIS coordinates and enhances the
activities of the vital records jurisdictions by developing standards,
promoting consistent policies, working with Federal partners, and
providing technical assistance.
NAPHSIS respectfully requests that the Subcommittee provide the
National Center for Health Statistics (NCHS) $162 million, consistent
with the President's budget request. This funding will enable the
National Vital Statistics System to support States and territories as
they implement the 2003 Standard Certificates of Birth, Death, and
Fetal Deaths and move toward electronic collection of vital events
data. This infrastructure investment will address the Healthy People
2020 goal of increasing the number of States that record vital events
using the latest U.S. standard certificates (PHI-10.1-10.3).
Ultimately, this investment will lead to timelier, richer data that
will facilitate public health planning, surveillance, service delivery,
and evaluation. Specifically, such data will facilitate tracking of
other Healthy People 2020 objectives in maternal, infant, and child
health, cancer, diabetes, heart disease, respiratory disease, injury
and prevention, and substance abuse, among others.
Collection of birth and death data through vital records is a State
function and thus governed under State laws. NCHS purchases birth and
death data from the States to compile national data on vital events--
births, deaths, marriages, divorces, and fetal deaths. These data are
used to monitor disease prevalence and our Nation's overall health
status, develop programs to improve public health, and evaluate the
effectiveness of those interventions. For example, birth data have been
used to:
--Establish the relationship of smoking and adverse pregnancy
outcomes;
--Link the incidence of major birth defects to environmental factors;
--Establish trends in teenage births;
--Determine the risks of low birth weight; and
--Measure racial disparities in pregnancy outcomes.
Just as fundamentally, death data are used to:
--Monitor the infant mortality rate as a leading international
indicator of the Nation's health status;
--Track progress and regress in reducing mortality from the leading
causes of death, such as heart disease, cancer, stroke, and
diabetes;
--Document racial disparities; and
--Otherwise provide sound information for programmatic interventions.
Years of chronic underfunding at NCHS have threatened the
collection of these important data on the national level, to the extent
that in fiscal year 2007 NCHS would have been unable to collect a full
12 months of vital statistics data from States. Had the Subcommittee
not intervened with a small but critical budget increase to continue
vital statistics collection, the United States would have been the
first nation in the industrialized world to be without a complete
year's worth of vital data. Countless national programs and businesses
that depend on vital events information would have been immeasurably
affected.
Since that time, the Subcommittee has continually supported NCHS's
vital statistics cooperative with the States. NAPHSIS and the broader
public health community deeply appreciate these efforts. We are pleased
that the President has once again followed the Subcommittee's lead in
seeking to build a 21st century national statistical agency, requesting
a $23 million increase for NCHS in fiscal year 2012, and directing NCHS
to support the modernization of the National Vital Statistics System.
This funding increase will support States as they upgrade their
outdated and vulnerable paper-based vital statistics systems,
addressing critical needs for activities that have been on hold or
curtailed because of budget constraints.
As we make significant strides in implementing and meaningfully
using health information technology, it is imperative that we similarly
invest in building a modern vital statistics system that monitors our
citizens' health, from birth until death. The requested funding will
move us toward a timelier and more comprehensive vital statistics
infrastructure where all States collect the same data and all States
collect these data electronically. Two forms of birth and death
certificates are in use by States--the older 1989 standard certificate
and the newer 2003 standard certificate This more recent birth
certificate revision includes data on insurance and access to prenatal
care, labor and delivery complications, delivery methods, congenital
anomalies of the newborn, maternal morbidity, mother's weight and
height, breast feeding status, maternal infections, and smoking during
pregnancy, among other factors. The 2003 death certificate includes
data on smoking-related, pregnancy-related, and job-related deaths.
Currently, only 75 percent of the States and territories use the
2003 standard birth certificate and 65 percent have adopted the 2003
standard death certificate (see Table 1). Many States continue to rely
on paper-based records, a practice which compromises the timeliness and
interoperability of these data. Jurisdictions that had planned and
budgeted to upgrade their certificates and systems have seen funding
for these projects erode as States face severe budget shortfalls. These
jurisdictions need the Federal Government's help to complete building a
21st century vital statistics system. The President's requested down
payment will help in this regard, allowing all jurisdictions to
implement the 2003 birth certificate and electronic birth record
systems. Approximately $30 million is needed to modernize the death
statistics system; but the President's budget request is nonetheless an
important first step.
TABLE 1.--JURISDICTIONS REQUIRING SUPPORT TO MODERNIZE VITAL STATISTICS SYSTEM
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Incomplete Electronic Birth Incomplete Electronic Death
No 2003 Birth Certificate No Electronic Birth Records Records \1\ No 2003 Death Certificate No Electronic Death Records Records \2\
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Total = 20 Total = 17 Total = 4 Total = 19 Total = 24 Total = 27
Alabama Alaska Alabama Alabama Alaska Alabama
Alaska American Samoa Hawaii Alaska American Samoa Arizona
American Samoa Arizona Mississippi American Samoa Arkansas Delaware
Arizona Arkansas Rhode Island Colorado Colorado Washington, DC
Arkansas Connecticut Guam Connecticut Georgia
Connecticut Guam Iowa Florida Hawaii
Guam Louisiana Louisiana Iowa Idaho
Louisiana Maine Maryland Kentucky Illinois
Maine Massachusetts Massachusetts Louisiana Indiana
Massachusetts Minnesota Mississippi Maine Michigan
Minnesota New Jersey North Carolina Maryland Minnesota
Mississippi Northern Mariana Northern Mariana Massachusetts Montana
New Jersey North Carolina Pennsylvania Mississippi Nebraska
Northern Mariana Puerto Rico Puerto Rico Missouri Nevada
North Carolina Virgin Islands Tennessee New York New Hampshire
Rhode Island West Virginia Virgin Islands North Carolina New Jersey
Virgin Islands Wisconsin Virginia Oklahoma New Mexico
Virginia West Virginia Pennsylvania New York City
West Virginia Wisconsin Rhode Island North Dakota
Wisconsin Tennessee Ohio
Virginia Oregon
Washington South Carolina
West Virginia South Dakota
Wisconsin Texas
Utah
Vermont
Wyoming
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\1\ Has an electronic birth record but does not collect all 2003 data items; requires funding to modify the electronic birth record to collect the 2003 data items.
\2\ Has an electronic death record but requires funding to finish enrolling physicians and funeral directors in the system.
Source: NAPHSIS Survey of Vital Statistics Jurisdictions.
The data NCHS collects are needed to track Americans' health and
evaluate our progress improving it. The President's requested increase
of $23 million for NCHS and the National Vital Statistics System will
move us toward a timelier and more comprehensive system where all
States collect the same data and all States collect these data
electronically, enabling us to better compare critical information on a
local, State, regional, and national basis. Without additional funding,
a potential erosion of State data infrastructure and lack of
standardized data will undeniably create enormous gaps in critical
public health information and may have severe and lasting consequences
on our ability to appropriately assess and address critical health
needs.
NAPHSIS appreciates the opportunity to submit this statement for
the record and looks forward to working with the Subcommittee. If you
have questions about this statement, please do not hesitate to contact
NAPHSIS Executive Director, Patricia W. Potrzebowski, Ph.D., at
[email protected] or (301) 563-6001. You may also contact our
Washington representative, Emily Holubowich, at [email protected]
or (202) 484-1100.
______
Prepared Statement of the National Association of Community Health
Centers
Introduction
Chairman Harkin, Ranking Member Shelby, and Distinguished Members
of the Subcommittee: My name is Dan Hawkins, and I am the Senior Vice
President for Public Policy and Research at the National Association of
Community Health Centers. On behalf of the 23 million patients served
nationwide by health centers; 150,000 full-time health center staff;
and countless volunteer board members; I would like to express my
heartfelt appreciation to the Subcommittee for your support of
America's healthcare safety net, and specifically of our mission to
deliver affordable and accessible care to all Americans. I am pleased
to have an opportunity to submit testimony for your consideration as
you prepare the fiscal year 2012 Labor-Health and Human Services-
Education and Related Agencies Appropriations bill.
About Community Health Centers
Health centers offer cost-effective, high-quality, and patient-
directed primary and preventive care in 8,000 rural and urban
underserved communities across the United States. In Iowa and Alabama,
respectively, health centers deliver care to 154,020 patients in 108
communities and 315,670 patients in 140 communities.\1\ By statute,
health centers must be located in a medically underserved area (MUA) or
serve a medically underserved population (MUP) and provide
comprehensive primary care services to all community residents
regardless of insurance status--offering care on a sliding fee scale.
Because of this, health centers serve as the ``healthcare home'' for
America's most vulnerable populations, including one-third of
individuals living below poverty, one in seven Medicaid beneficiaries,
and one in seven of America's uninsured. And nearly half of health
center organizations are located in our Nation's rural areas.
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\1\ See http://www.nachc.com/state-healthcare-data-list.cfm for
State Fact Sheets on Health Centers.
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Presidents of both parties and Senators on both sides of the
aisle--including many members of this Subcommittee--have long-
recognized the value of health centers. As a result and with bipartisan
support, health centers have been on an expansion path for over a
decade. Within the past 2 years, and as a result of investments this
Subcommittee made through the American Recovery and Reinvestment Act,
127 new health centers opened and over 4.3 million new patients
received access to care at virtually every health center in the
country. I'd like to elaborate on why the Health Centers program is
such a worthwhile investment that produces documented savings to the
entire health system--a primary reason this program has been able to
count on the Subcommittee's support for several decades.
Health centers save the country money by keeping patients out of
costlier healthcare settings (like emergency departments and
hospitals), coordinating care amongst providers of many health
disciplines, and effectively managing chronic conditions. Medicaid
beneficiaries who rely on health centers for routine care are 19
percent less likely to use the emergency department (ED) and 11 percent
less likely to be hospitalized for ambulatory care-sensitive (ACS)
conditions when compared to beneficiaries who see other providers.\2\
Additionally, counties with at least one health center have 25 percent
fewer ED visits for ACS conditions than counties without a health
center presence.\3\ By providing timely and appropriate care, health
centers save over $1,200 per person per year, lowering costs across the
healthcare system--from ambulatory care settings to hospital stays.\4\
All told, health centers currently generate $24 billion in savings each
year. This is all possible through an investment of just $1.67 per
patient per day.\5\
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\2\ Falik M, et al. ``Comparative Effectiveness of Health Centers
as Regular Source of Care.'' January-March 2006 Journal of Ambulatory
Care Management 29(1):24-35.
\3\ Rust G, et al. ``Presence of a Community Health Center and
Uninsured Emergency Department Visit Rates in Rural Counties.'' Winter
2009 Journal of Rural Health 25(1):8-16.
\4\ Ku L, et al. Strengthening Primary Care to Bend the Cost Curve:
The Expansion of Community Health Centers Through Health Reform. Geiger
Gibson/RCHN Community Health Foundation Collaborative at the George
Washington University. June 30 2010. Policy Research Brief No. 19.
\5\ Bureau of Primary Health Care, Health Resources and Services
Administration, DHHS. 2009 Uniform Data System.
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Health centers meet or exceed national practice standards for
chronic condition treatment and ensure that their patients receive more
recommended screening and health promotion services than patients of
other providers--despite serving underserved and traditionally at-risk
populations.\6\ The Institute of Medicine (IOM) and the U.S. Government
Accountability Office (GAO) have recognized health centers as models
for screening, diagnosing, and managing a wide array of relatively
common and costly chronic conditions such as diabetes, cardiovascular
disease, asthma, depression, cancer, and HIV.\7\ Specifically related
to diabetes, a leading cause of death and disability, health centers
significantly reduce the expected lifetime incidence of diabetes
complications, including blindness, kidney failure, and certain forms
of heart disease.\8\ America's health centers also play an important
role in improving access to prenatal care and improving birth outcomes.
Health centers have demonstrated their ability to reduce the disparity
of low birth weight by at least 50 percent compared to the national
average.\9\
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\6\ Shi L, Tsai J, Higgins PC, Lebrun La. (2009). Racial/ethnic and
socioeconomic disparities in access to care and quality of care for
U.S. health center patients compared with non-health center patients.
Journal of Ambulatory Care Management 32(4): 342-50. Hing E, Hooker RS,
Ashman JJ. (2010). Primary Health Care in Community Health Centers and
Comparison with Office-Based Practice. Journal of Community Health.
2010 Nov 3 epublished.
\7\ U.S. General Accounting Office. (2003). Healthcare: Approaches
to address racial and ethnic disparities. Publication No. GAO-03-862R.
Institute of Medicine. Unequal Treatment: Confronting Racial and Ethnic
Disparities in Healthcare. Washington, DC: National Academy of Sciences
Press; 2003.
\8\ Huang E, et al. ``The Cost-effectiveness of Improving Diabetes
Care in U.S. Federally Qualified Community Health Centers.'' 2007
Health Services Research, 42(6): 2174-93.
\9\ Politzer R, Yoon J, Shi L, Hughes R, Regan J, and Gaston M.
``Inequality in America: The Contribution of Health Centers in Reducing
and Eliminating Disparities in Access to Care.'' 2001 Medical Care
Research and Review 58(2):234-248.
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A key driver of the success of the health center model is that each
non-profit entity is locally-owned and directed by a patient majority
board that ensures the health center is accountable and responsive to
the needs of the community it serves. Research has demonstrated that
this type of consumer participation on governing boards ensures higher
quality care, lower costs of services, and better results.\10\ In
addition to tailoring their services to make healthcare delivery
individualized to unique local circumstances, health centers also have
a substantial and positive economic impact on their communities. In
2009 alone, health centers generated $20 billion in total economic
benefit and created 189,158 jobs.\11\
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\10\ Crampton P, et al. ``Does Community-Governed Nonprofit Primary
Care Improve Access to Services?'' 2005 International Journal of Health
Services 35(3): 465-78.
\11\ NACHC, Capital Link. Community Health Centers as Leaders in
the Primary Care Revolution. August 2010. www.nachc.com/research-
data.cfm.
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Funding Background
The Health Resources and Services Administration (HRSA) fiscal year
2011 spending or operating plan, pursuant to Section 1863 of Public Law
112-10, provides $1.581 billion in discretionary funding for the Health
Centers program--a reduction of $604.4 million relative to the fiscal
year 2010-enacted level of $2.185 billion. Together with the $1.0
billion in fiscal year 2011 funding available for health centers
through the Affordable Care Act (ACA), health centers have a net
increase of $395.6 million in total programmatic funding for fiscal
year 2011.
While we await word from HRSA about how available fiscal year 2011
programmatic funding will be allocated between existing and new health
center efforts, we are heartened that there should be no interruption
of existing health center activities, including the new centers and
patients added in the past 2 years. We strongly support prioritizing
fiscal year 2011 funding to maintain existing health center activities.
It is worth noting, however, that most of the nearly $400 million
programmatic increase in the fiscal year 2011 CR is needed to continue
ongoing operations--leaving very limited funding to support expansion
efforts that would otherwise have been possible if the $1.0 billion in
new ACA resources were not being redirected to continue existing
operations.
Currently, 60 million Americans lack access to a routine source of
care.\12\ And even with implementation of ACA, it is imperative that as
more Americans become insured, they have access to care through a
healthcare home in their community. Prior to the completion of fiscal
year 2011 appropriations, health centers were on track to double their
capacity and serve 40 million patients over the next 5 years, reaching
a sizeable portion of the medically underserved individuals who would
otherwise be forced to seek care in EDs, or delay care until
hospitalization is the only option.
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\12\ NACHC, the Robert Graham Center, and Capital Link. Access
Granted: The Primary Care Payoff. August 2007. www.nachc.com/
accessreports.cfm.
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HRSA previously announced several fiscal year 2011 funding
opportunities, including grants for new health centers and support for
expanded capacity at virtually every existing health center nationwide.
These opportunities produced: (1) over 800 applications submitted for
350 New Access Point (new health center) awards in communities not
currently served by existing health centers, demonstrating the great
need across the country for new centers to serve patients who most need
access to primary care; and (2) nearly 1,100 health center grantee
applications submitted to expand health center services to reach
additional individuals in need in their current communities, adding new
medical, oral, behavioral, pharmacy, and vision capacity. The reduction
to the Health Center program's fiscal year 2011 discretionary funding
leaves HRSA far short of the funding needed to make their previously-
announced awards at this time.
Fiscal Year 2012 Funding Request
Health centers stand ready to continue working to ensure that
everyone has access to primary and preventive healthcare services. In
fiscal year 2012, we respectfully ask that the Subcommittee provide a
discretionary funding level of no less than $1.79 billion for the
Health Centers program. This funding level, together with ACA funding
available in fiscal year 2012, will allow health centers to extend
cost-effective primary care over 3 million Americans this year alone.
It will also allow HRSA to fund remaining and worthwhile applications
that will go unfunded in fiscal year 2011, including over 200 new
health center applications and funding for expanded medical, oral,
behavioral, pharmacy, and vision health services at existing health
centers.
Conclusion
As the Congress works to tackle our Nation's deficit, I understand
Members of this Subcommittee are faced with incredibly difficult
decisions about funding levels for the programs within the fiscal year
2012 Labor-Health and Human Services-Education and Related Agencies
Appropriations bill. However, health centers have proven time and time
again that the Federal investment in the Health Centers program is
prudent--translating to improved health outcomes for our most
vulnerable Americans and reduced healthcare expenditures for this
Nation. I'd ask for this Subcommittee's support in continuing the
bipartisan expansion of health centers in fiscal year 2012 to ensure
that our shared goal of improved access to high-quality and cost-
effective care is realized.
______
Prepared Statement of the National Association of County and City
Health Officials
Summary
The National Association of County and City Health Officials
(NACCHO) represents the Nation's 2,800 local health departments (LHDs).
These governmental agencies work every day in their communities to
protect people, prevent disease, and promote wellness. Local health
departments have a unique and distinctive role and set of
responsibilities in the larger health system and within every
community. The Nation depends upon the capacity of local health
departments to play this role well.
The Nation's current financial challenges are compounded by those
in State and local government further diminishing the ability of local
health departments to measure population-wide illness, take steps to
prevent disease and prolong quality of life, and to serve the public in
ways others don't. Repeated rounds of budget cuts and lay-offs continue
to erode local health department capacity. NACCHO surveys have found
that from 2008 to 2010, local health departments have lost 29,000 jobs
due to budget reductions. This represents a nearly 20 percent reduction
in local public workforce. These are jobs in local communities
nationwide.
On a fraying shoestring, local health departments continue to
respond to an ever changing set of challenges, including ongoing public
health emergency threats like floods, hurricanes, oil spills,
infectious and chronic disease epidemics. The protection offered by
local health departments can't be taken for granted. To help maintain
the stability of LHDs, the Federal Government should invest in the
following programs in fiscal year 2012 appropriations: National Public
Health Improvement Initiative, Public Health Emergency Preparedness
cooperative agreements, Advanced Practice Centers, Public Health
Workforce Development, Chronic Disease Prevention and Health Promotion
Grants, and Community Transformation Grants.
Public Health Recommendations
National Public Health Improvement Initiative
NACCHO request: $50 million
Fiscal Year 2012 President's Budget: $40.2 million
Fiscal Year 2010: $50 million
The National Public Health Improvement Initiative (NPHII) increases
local health departments' capability to meet national public health
standards and conduct effective performance management. This initiative
promotes the effective and efficient use of resources in local health
departments across the country while strengthening our public health
infrastructure. In addition, these funds improve public health policies
and decisionmaking crucial to protecting our communities from public
health threats. NPHII boosts the ability of local health departments to
reengineer their systems to meet 21st century challenges including
implementation of the full range of science-based approaches to
improving community health. As local health departments prepare to meet
newly established national accreditation standards, NACCHO recommends
$50 million in funding for fiscal year 2012 to continue to improve
efficiency and effectiveness at local health departments.
Public Health Workforce Development
NACCHO request: $73 million
Fiscal Year 2012 President's Budget: $73 million
Fiscal Year 2010: $38 million
The Nation suffers an acute shortage of trained public health
professionals, including epidemiologists, laboratorians, public health
nurses, and public health informaticians. This investment in public
health education and training is essential to maintain a prepared and
sustainable public health workforce. With the increasing variety and
magnitude of public health threats, it is vital to train new public
health staff and provide continuous education for existing staff in
order to maintain and upgrade the skills needed to protect our
communities. This funding also supports the Centers for Disease Control
and Prevention (CDC) Prevention Corps, a workforce program to recruit
and train new talent for assignments in State and local health
departments. This new program will also address retention by requiring
professionals to commit to a designated timeframe in State and local
health departments as a condition of the fellowship. NACCHO recommends
$73 million in funding for fiscal year 2012 to bolster the public
health workforce.
Emergency Preparedness Recommendations
Public Health Emergency Preparedness Cooperative Agreements
NACCHO request: $730 million
Fiscal Year 2012 President's Budget: $643 million
Fiscal Year 2010: $715 million
Constant readiness for both new and emerging public health threats
requires an established local public health team that can plan, train,
and practice on a regular basis. Emergency response capabilities and
tasks, such as distributing medical countermeasures, addressing the
needs of at-risk individuals, conducting drills, and organizing
collaboration among staff in public health departments, schools,
businesses and with volunteers, requires continuous attention and
ongoing preparation. These are not supplies purchased once and stored
until needed. If a community is not prepared to respond to multiple
hazards, capacity to respond will not be immediately available when
disasters happen. Valuable time will be lost and people will suffer,
particularly the elderly, disabled and disenfranchised, low-income
residents, vulnerable populations. The only way to ensure that local
health departments and their community partners are ready to respond to
emergencies is to maintain consistent funding. With this funding, local
health departments can sustain their level of readiness to meet
benchmarks that align with the Pandemic and All Hazards Preparedness
Act.
With recent progress in nationwide preparedness, now is not the
time to reduce Federal funding that helps health departments continue
their progress and address new, emerging threats. Especially when local
health departments are under great stress from the loss of over 29,000
jobs in the last few years, the Nation cannot afford to lose the gains
made by recent Federal investment in public health. Continuous training
and exercising of all health department staff so that they are all
ready for the next emergency must continue. A loss of readiness is
inevitable if the level of Federal investment is reduced.
The safety and well-being of America's communities is dependent on
the capacity of their health departments to respond in any emergency
that threatens human health, including bioterrorism, infectious disease
outbreaks, nuclear emergencies and natural disasters. The CDC has
explicitly adopted an ``all-hazards'' approach to preparedness,
recognizing that the capabilities necessary to respond to differing
public health threats have many common elements. Through the Public
Health Emergency Preparedness cooperative agreements CDC supports State
and local health departments so that they can adequately prepare for
and respond to such emergencies. NACCHO recommends $730 million in
funding for fiscal year 2012 to continue to support emergency
preparedness in our communities.
Advanced Practice Centers
NACCHO request: $5.4 million
Fiscal Year 2012 President's Budget: 0
Fiscal Year 2010: $5.4 million
The Advanced Practice Center program started as a CDC pilot project
in 1999, and has since expanded to a national program. The APC program
funds exemplary local health departments to be innovative leaders in
public health preparedness to develop, evaluate, and promote products
and resources that other local health department practitioners can use
to meet the preparedness requirements expected for their organization
or community. Since its inception, the APC program has created over 150
products and hosted numerous workshops, webinars, and other
presentations to local health departments. NACCHO recommends level
funding in fiscal year 2012 of $5.4 million for the Advanced Practice
Center program administered by CDC's Office of Public Health
Preparedness and Response.
Disease Prevention Recommendations
Chronic Disease Prevention and Health Promotion Grants
NACCHO request: $705 million
Fiscal Year 2012 President's Budget: $705 million
Chronic diseases such as heart disease, cancer, stroke and diabetes
are responsible for 7 of 10 deaths among Americans each year and
account for 75 percent of healthcare spending. The President's budget
consolidates several previously existing grants for disease prevention
and health promotion to provide State and local health departments with
greater flexibility to target funds to those diseases that most burden
their jurisdictions, using the most effective strategies for the
populations they serve. The program recognizes that many chronic
diseases have common risk factors such as obesity and physical
inactivity.
Supporting effective approaches to reducing contributing factors
and therefore rates of chronic disease will not only make our
communities healthier, but save money for taxpayers and the Government
in the long run. NACCHO recommends $705 million in funding for fiscal
year 2012 to reduce chronic disease in our communities and looks
forward to working with Congress on the array of details that will
ensure successful, efficient, accountable implementation of a
consolidated grant program that enables communities to address their
chronic disease burden.
Community Transformation Grants
NACCHO request: $221 million
Fiscal Year 2012 President's Budget: $221 million
This program builds on the success of its predecessors: Healthy
Communities, Racial and Ethnic Approaches to Community Health, and
Communities Putting Prevention to Work. These funds are awarded on a
competitive basis to State or local government agencies, territories,
national networks of community based organizations, State or local
nonprofit organizations and Indian tribes or tribal organizations to
reduce health disparities and leading causes of death. Communities will
use these resources to invest in evidence-based approaches to creating
a healthy population by promoting smoking cessation, active living,
healthy eating, and prevention of injuries. NACCHO recommends an
allocation process which makes these funds available to communities of
all sizes. NACCHO recommends $221 million in funding for fiscal year
2012 to continue proven approaches to protecting public health in our
communities.
As the Subcommittee drafts the fiscal year 2012 Labor-Health and
Human Services-Education Appropriations bill, we ask for consideration
of NACCHO's recommendations for these programs that are critical to
protecting people and improving the public's health. We are fully aware
of the budgetary challenges facing Congress and the need to reduce
deficit spending. Budgetary cuts must be made carefully to cause the
least disruption to critical public health functions and protect the
health of the U.S. population.
NACCHO thanks the Subcommittee members for their previous support
of public health initiatives that support work in local communities and
welcomes the opportunity to discuss these requests further.
______
Prepared Statement of the National Association of Nutrition and Aging
Services Programs
On behalf of NANASP, the National Association of Nutrition and
Aging Services Programs, I thank you for providing an opportunity to
submit testimony as you consider an fiscal year 2012 Labor-HHS and
Education Appropriations bill. NANASP is a national membership
organization for persons across the country working to provide older
adults healthful food and nutrition through community-based services.
NANASP has 14 members in Iowa and 17 members in Alabama.
I am writing today to urge you to provide a much needed increase to
President Obama's fiscal year 2012 funding proposal for two major
programs in the Older Americans Act: the senior nutrition programs and
Community Service Employment for Older Adults.
The congregate and home-delivered (Meals on Wheels) nutrition
programs and the Nutrition Services Incentive Program (NSIP) are the
largest and most visible component of the Older Americans Act. Next
year, the senior nutrition program celebrates its 40th anniversary of
helping to keep millions of the vulnerable elderly healthy and
independent in their homes and communities. This is a much more
fiscally sound solution than having our seniors institutionalized
because of the detrimental effects of hunger and malnutrition.
The President's budget proposes no increase for the senior
nutrition programs in fiscal year 2012. This is extremely alarming as
these same programs were deemed worthy of increases for the past 5
fiscal years. The need for an increase in funding for meals for our
seniors remains today. According to the Administration on Aging (AoA),
flat funding for the nutrition programs means that 36 million fewer
home-delivered and congregate meals will be served in fiscal year 2012
compared to fiscal year 2010. These meals are especially critical for
the health of the 58 percent of congregate and 60 percent of home-
delivered meal participants who report that they receive the majority
of their daily food intake from the nutrition program.
The second major program we ask you to consider for increased
funding is the Community Service Employment for Older Adults, also
known as the Senior Community Service Employment Program or SCSEP.
Administered by the Labor Department, SCSEP provides part-time jobs to
thousands of low-income seniors, about one-fourth of them working in
senior nutrition and other programs serving the elderly. These
disadvantaged and previously unemployed seniors earn the minimum wage
as they re-enter the job market.
In fiscal year 2012, the President's budget proposes to reduce the
number of SCSEP participants by 25 percent below the fiscal year 2008
level. SCSEP is the only Federal job training program targeted for
older workers, who continue to suffer in today's economy. While the
current unemployment rate among older adults is lower than among
younger workers, older workers are less likely to find new employment,
and when they do find new jobs, their job search has taken longer. For
example, nearly 30 percent of unemployed people aged 55+ were jobless
for an entire year or more, a rate that exceeds that of all other age
groups. Such a drastic cut in funding would not only eliminate over
22,000 job opportunities for older workers, but also take away 12
million hours of staffing for senior nutrition and other programs
serving the community.
At NANASP we always say, ``It is more than just a meal.'' Our
programs provide much needed socialization for older adults and the
link between nutrition and health is irrefutable. The senior nutrition
and community service employment programs play a key role in health
promotion and disease prevention. Our programs keep the very vulnerable
elderly healthy, engaged, and independent and out of expensive long-
term care institutions that are very costly to the Medicaid program. We
hope you will strongly consider an increase in funding for the
nutrition and community service employment programs in your Labor-HHS,
Education Appropriations bill for fiscal year 2012.
______
Prepared Statement of the National Association of State Comprehensive
Health Insurance Plans
The National Association of State Comprehensive Health Insurance
Plans (NASCHIP) appreciates the opportunity to submit testimony as you
consider an fiscal year 2012 Labor-HHS and Education Appropriations
bill. NASCHIP represents the State high risk pools which were
established by statute initially passed 10 years before the Federal
high risk pool program (PCIP) was created by the ACA, the Affordable
Care Act. Our programs operate in 35 States including your States, Mr.
Chairman and Mr. Shelby. We serve more than 200,000 people providing
them with insurance notwithstanding their preexisting conditions. This
number reflects a 7 percent increase from 2009 levels which we consider
a significant indicator of the value and necessity of our programs.
We are here to urge that you support a level of $75 million for the
Federal grant program for State high risk pool programs for fiscal year
2012. This was the authorization level contained in our statute the
State High-Risk Pool Funding Extension Act of 2006. This funding allows
many States to provide means based premium subsidies to their citizens
who might otherwise not be able to afford coverage.
We consider this level of funding the essential minimum for us to
continue to do our work of providing a vital safety net to individuals
who might otherwise be uninsured. For the current fiscal year, the
Federal grant program for State high risk pool programs has $55 million
in available funding which represents only a fraction of the total
costs of care for State high risk pools. In fact, total State pool
expenses in 2009 were approximately $2.2 billion.
We were disappointed that the President only requested $44 million
in funding for the Federal grant program for State high risk pools in
his fiscal year 2012 budget proposal. It was based in part on an
incorrect premise that as enrollments grow in the PCIP program it would
lessen enrollment in our programs. The request also ignores the reality
of increased enrollment into our programs in 2010. Only by receiving
$75 million in funding for fiscal year 2012 would we stand a chance of
serving the individuals we need to serve.
The issues related to the PCIP program and either lower or higher
than expected enrollments should have no bearing on the funding level
we request. We have and will continue to work with administration
officials to improve enrollments in PCIP as we want to see this program
succeed. However, the State high risk pools serve a growing population
and are in need of continued funding. We urge you to include $75
million in your Labor-HHS and Education appropriations bill for fiscal
year 2012.
______
Prepared Statement of the National Association of State Head Injury
Administrators
Thank you for this opportunity to submit testimony regarding the
fiscal year 2012 budget as it pertains to funding for programs
authorized by the Traumatic Brain Injury (TBI) Act of 1996, as amended
in 2008. The TBI Act authorizes funding to the U.S. Department of
Health and Human Services (HHS) to carry out the intent of the Act
through the (1) Centers for Disease Control and Prevention (CDC) for
purposes of brain injury surveillance, prevention and education; and
the (2) Health Resources and Services Administration (HRSA) for grants
to State governmental agencies and to Protection and Advocacy Systems
to improve and increase access to rehabilitation services and community
services and supports for individuals with TBI and their families.
NASHIA is a nonprofit organization representing State governmental
officials who administer an array of short-term and long-term
rehabilitation and community services and supports for individuals with
TBI and their families. These services are generally financed through
an array of Federal, State and dedicated funds (State trust funds) with
the HRSA Federal TBI grants used to support and improve the necessary
infrastructure to support these service systems. While NASHIA is well
aware that Federal funds are becoming increasingly difficult to obtain,
NASHIA is recommending increased funding for the Federal TBI Act
programs because:
--The number of Americans who sustain a TBI is increasing, especially
among the elderly and young children, and among our men and
women in uniform as a result of the wars in Iraq and
Afghanistan, while at the same time,
--States are experiencing significant budget cuts impacting
rehabilitation and community services and supports for
individuals with TBI, yet
--The number of States receiving grants has been reduced from 49 to
21 due to recent changes in HRSA policy and the level of
appropriations to support State grant activities.
These factors, as well as the overall economy, are creating a
strain on State TBI systems. As the TBI Act program is the only Federal
funding to help States to better serve individuals with TBI, NASHIA
recommends:
--$10 million for the CDC programs to support TBI registries and
surveillance; to develop Brain Injury Acute Care Guidelines,
and to expand prevention and public education regarding injury
prevention, including sports-related concussions (mild TBI);
--$ 8 million for the HRSA Federal TBI State Grant Program to
increase the number of grants to States; and
--$ 4 million for the HRSA Federal TBI Protection & Advocacy (P&A)
Systems Grant Program to increase the amount of grant awards.
hrsa federal tbi state grant program
Since 1997, HRSA has awarded grants to 48 States, District of
Columbia and one Territory to develop and improve services and systems
to address the short-term and long-term needs. These grants have been
time limited and are relatively small. Two years ago, HRSA increased
the amount of the award from approximately $100,000 to $250,000 to make
it more feasible for States to carry out their grant goals and the
legislative intent. While this increased amount is more attractive to
States, this change reduced the number of grantees from 49 to 21--less
than half of the States and Territories. As a result, States that do
not have Federal funding are finding it increasingly more difficult to
sustain their previous efforts, let alone expand and improve, due to
other budget constraints in their States.
Over the course of the grant program, States, depending on
individual State needs, have developed State plans for improving
service delivery; information and referral systems; service
coordination systems; outreach and screening among unidentified
populations such as children, victims of domestic violence, and
veterans; and training programs for direct care workers and other
staff. States have also conducted public awareness and educational
activities that have helped States to leverage and coordinate funding
in order to maximize resources to the benefit of individuals with TBI.
In keeping with the HRSA Federal TBI State Grant Program most
States have identified a lead State agency responsible for providing
and coordinating services and an advisory board to plan and coordinate
public policies to better serve individuals who frequently needs
assistance from multiple agencies and funding streams in order to
address the complexity of their needs.
state collaborative efforts to address the needs of veterans
The HRSA grant funding has been used to address the needs of
returning service members and veterans with TBI and their families.
Since service members and veterans first began to return from Iraq and
Afghanistan, States have been contacted by families and returning
servicemembers, especially those who served in the National Guard and
Reserves, to obtain community resources in order to return to work,
home and community.
NASHIA and some individual States have reached out to U.S.
Department of Veterans Affairs (VA), particularly staff from individual
Polytrauma Centers, to promote collaboration in order to better
understand VA benefits for veterans that may be seeking State services,
and for VA to understand what is available in the communities. In
addition, some States have added representatives from VA, National
Guard and Reserves, State Veterans Affairs, and/or veterans
organizations to serve on their State advisory board in order to
improve communications and policies across these programs.
THE INCIDENCE AND PREVALENCE OF TBI IS ON THE RISE
CDC released new data last year showing that the incidence and
prevalence of TBI in the United States is on the rise. CDC reported
that each year, an estimated 1.7 million people sustain a TBI. Of that
amount: 52,000 die; 275,000 are hospitalized; and 1.365 million (nearly
80 percent) are treated and released from an emergency department. TBI
is a contributing factor to a third (30.5 percent) of all injury-
related deaths in the United States. About 75 percent of TBIs that
occur each year are concussions or other forms of mild TBI. The number
of people with TBI who are not seen in an emergency department or who
receive no care is unknown.'' (www.cdc.gov/TraumaticBrainInjury/
statistics.hml)
The data collected by CDC relies heavily on State data, gathered
through State registries and hospital discharge data. These numbers do
not include the veterans who sustained TBIs in Iraq or Afghanistan and
now use private or State funded resources for care, or undiagnosed
TBIs.
ABOUT STATE RESOURCES AND SERVICES
Since the 1980s, States have developed services and supports
largely in response to families who often seek help in crisis
situations, such as loss of job due to TBI; or out of control behaviors
or substance abuse that may result in family violence or dangerous
situations to self and others; and the need for overall help in
providing care to their family members who have extensive medical,
behavioral and cognitive problems. A critical service that States
provide is service coordination to help coordinate and maximize
resources and supports for individuals with TBI and their families.
Over the past 25 years, States have developed service delivery
systems that generally offer information and referral, service
coordination, rehabilitation, in-home support, personal care,
counseling, transportation, housing, vocational and other support
services for persons with TBI and their families. These services are
funded by State appropriations, designated funding (trust funds),
Medicaid and Rehabilitation Act programs and are administered by
programs located in the State public health, Vocational Rehabilitation,
mental health, Medicaid, developmental disabilities, education or
social services agencies.
Approximately half of all States have a dedicated funding
mechanism, mainly through traffic related fines, and about half of all
States also administer a Medicaid Home and Community-Based Services
(HCBS) Waiver for individuals with brain injury who are Medicaid
eligible. Individuals with TBI are also served in other State waiver
programs designed for physical disabilities, developmental
disabilities, elderly and other populations. Some States have the
advantage of both waiver and trust fund programs, in addition to other
State and Federal resources.
As private insurance generally does not provide for extended
rehabilitation and long-term care, supports and services, most long-
term services and supports for persons with TBI are administered by the
States. These programs are funded mainly through the shared Federal/
State Medicaid Home and Community-based Services Waivers (HCBS) program
and Medicaid State Plan services, such as personal assistance, nursing
homes and in-home care.
Medicaid HCBS Waivers for Individuals with TBI have grown
significantly in recent years, doubling from 5,400 individuals served
in 2002 to 11,214 in 2006, at a cost of $155 million in 2002 to $327
million in 2006 (Kaiser Commission on Medicaid and the Uninsured (2007,
December); Medicaid Home and Community-Based Service Programs: Data
Update, The Henry J. Kaiser Family Foundation, Washington, DC).
Without appropriate services and supports, individuals with TBI may
become homeless, or inappropriately placed in institutional settings or
end up in State or local Correctional facilities due to their cognitive
and behavioral disabilities. A recent report issued by the Centers for
Disease Control and Prevention (CDC) cited other jail and prison
studies indicating that 25-87 percent of inmates report having
experienced a TBI as compared to 8.5 percent in a general population
reporting a history of TBI.
ABOUT NASHIA
The mission of NASHIA is to assist State government in promoting
partnerships and building systems to meet the needs of individuals with
brain injury and their families. Since 1990, NASHIA has held an annual
State-of-the-States conference, and has served as a resource to State
TBI program managers. NASHIA also maintains a website (www.nashia.org)
containing State program contacts and other resources. NASHIA members
include State officials administering public TBI programs and services,
and associate members who are professionals, provider agencies, State
affiliates of the Brain Injury Association of America (BIAA), family
members and individuals with brain injury.
Should you wish additional information on State services and
resources, or other information, please do not hesitate to contact
Rebeccah Wolfkiel, Governmental Consultant at 202-480-8901 (office) or
[email protected]. You may also contact Susan L. Vaughn,
Director of Public Policy, at 573-636-6946 or [email protected]
or William A.B. Ditto, Chair of the Public Policy Committee, at
[email protected].
Thank you.
______
Prepared Statement of the National Association of Workforce Boards
Thank you for the opportunity to comment on the Administration's
proposed 2012 budget for the Department of Labor. The National
Association of Workforce Boards (NAWB) is a member association, which
represents a majority of the 575 local employer-led Workforce
Investment Boards and their nearly 13,000 employer member volunteers.
We write in support of the Administration's fiscal year 2012
overall appropriations request for the Training and Employment Services
account under the Department of Labor. Adequate funding for the public
workforce system has never been more critical. While the worst of the
economic downturn seems behind us, one-stop centers across the Nation
continue to deal with large numbers of unemployed individuals who seek
advice about career options and whose skills need upgraded. In short,
our employment crisis is not expected to ease in the foreseeable
future.
The annual Economic Report of the President indicated that
unemployment would remain above 8 percent through 2012. In April of
this year the rate stood at 9 percent. Federal Reserve Chairman Ben S.
Bernanke said the unemployment rate is likely to remain high ``for some
time'' even after the biggest 2-month drop in the jobless rate since
1958.
Mr. Bernanke appearing before the House Budget Committee in
February 2011, said that while the declines in the jobless rate in
December and January ``do provide some grounds for optimism,'' he
cautioned that ``with output growth likely to be moderate for a while
and with employers reportedly still reluctant to add to their payrolls,
it will be several years before the unemployment rate has returned to a
more normal level.''
Workforce Investment Act programs have been on the front lines of
assisting job seekers impacted by the recession. Over the past year,
Title I of the Workforce Investment Act (WIA) system has seen over 8
million American workers turn to it for help in navigating the labor
market in search of jobs and/or the training individuals need to be
competitive in their labor market. This continues the trend of an over
234 percent increase in the numbers of people who have sought
assistance over the last two reporting years.
Despite a ratio of four/five job seekers nationally for every
available job, over 4 million were helped back into the labor force. In
short, those who received WIA services were likely to find jobs with
the likelihood increasing the higher the service level. Information for
the quarter ending September 30, 2010 shows the following results:
Performance Results
Workforce Investment Act Adult Program
--Entered Employment Rate 53.1 percent
--Employment Retention Rate 75.3 percent
--Average 6 months Earnings $13,482
Workforce Investment Act Dislocated Worker Program
--Entered Employment Rate 50.3 percent
--Employment Retention Rate 79 percent
--Average 6 months Earnings $17,227
Workforce Investment Act Youth Program
--Placement in Employment or Education rate 59.5 percent
--Attainment of Literacy and Numeracy gains 49.5 percent
The ability of the pubic workforce system to maintain this level of
success on behalf of job seekers and employers seeking skilled workers
is incumbent upon the continuation of adequate funding. We encourage
the Subcommittee to fund WIA formula programs at a minimum at the
administration's request levels, as we expect to continue to face the
challenges brought about by high unemployment for the foreseeable
future.
Program Funding
We applaud the Administration's proposal for a Workforce Innovation
Fund. We believe that the State and local workforce boards have
developed a host of promising practices since WIA was enacted in 1998,
particularly in helping address the large numbers of persons dislocated
during this recession or shut-out of the labor market due to a lack of
appropriate skills. The Workforce Innovation Fund will allow local
areas to engage with community partners and quickly scale effective
practices on behalf of jobseekers in need.
However, we strongly urge the Subcommittee to fully fund the
administration's request for WIA formula programs before allocating
funding for the Workforce Innovation Fund, as these formula funds are
essential to our ability to provide services to job seekers at the
local level around the Nation.
The protection of the WIA formula programs to support the locally
delivered services is critical as the system continues to deal with
large numbers of individuals seeking work. The Continuing Resolution
passed in April contained budget reductions that are already having the
impact of local areas having to close and consolidate local career one-
stop centers.
Policy Riders
NAWB would strongly encourage the committee to continue the policy
riders that prohibit the re-designation of local areas or changes to
the definition of administrative costs until WIA is reauthorized. There
have been instances where there has been arbitrary action to
reconfigure local areas and NAWB believes these riders will prevent any
State v. local conflict until reauthorization.
We urge the Subcommittee to continue to provide the support
necessary for the workforce system to help our jobseekers retool for
employment in high demand sectors and maintain our global
competitiveness.
Summer Youth employment
While our testimony is focused on fiscal year 2012 funding, we
would be remiss if we did not express our support for summer youth
funding. Youth unemployment remains at all-time highs. The unemployment
rate in April 2011 was listed as 9 percent for the total civilian labor
force, but for youth the rate is over 24 percent for 16-19 year olds.
In summer 2009 utilizing ARRA funding for WIA Youth programs, 313,000
young people had a summer job. Youth reported to us that their wages
provided much needed income to the household for basic needs of their
family and for the expenses in returning to school. Lack of youth funds
imperils business finding job-ready youth to fill their employment
needs as the ``boomer'' generation begins to retire. Serving youth that
are at-risk and/or school drop-outs with the level of service needed
requires intense intervention that combines academic, as well as,
experiential learning techniques. The summer youth employment project
allowed the system to provide youth practical work experience that
reinforced classroom academics. Without it, employers in the private
sector become the work-ready trainers; training that we have reason to
believe employers are ill-prepared and/or unwilling to provide.
We understand these budget times, but would hope that at some point
the Congress would take-up the issue of youth unemployment and we are
prepared to assure Congress that any additional funding for WIA Youth
programs would allow us to better address the crisis we are facing in
youth employment.
Thank you for the opportunity to testify.
______
Prepared Statement of the National Coalition for Cancer Survivorship
It is my pleasure to submit this statement regarding fiscal year
2012 funding for the National Institutes of Health (NIH) and the
Centers for Disease Control and Prevention (CDC) on behalf of the
National Coalition for Cancer Survivorship (NCCS) and the 12 million
cancer survivors living in the United States. NCCS advocates for
quality healthcare for survivors of all forms of cancer, and we believe
the Federal Government should play a strong leadership role, through
basic and clinical cancer research and delivery of survivorship
services, to boost the quality of cancer care from diagnosis and for
the balance of life. These research and survivorship programs should be
conducted in partnership with private sector organizations.
In this statement, NCCS will focus on the need for a balanced
program of basic, translational, and clinical research at the National
Institutes of Health (NIH) and the National Cancer Institute (NCI) as
well as the urgent need for Centers for Disease Control and Prevention
(CDC) leadership to strengthen educational and informational services
for survivors and improve access to cancer screening for the medically
underserved.
Two recent reports--the Annual Report to the Nation on the Status
of Cancer, 1975-2007, Featuring Tumors of the Brain and Other Nervous
System and the Morbidity and Mortality Weekly Report of March 11, 2011,
reporting on the number of cancer survivors in 2007--provide a
compelling portrait of the progress the Nation has made in the fight
against cancer, the work still to be done, and the pressing needs of
millions of cancer survivors who are still in active treatment or
living as long-term survivors.
The Annual Report notes that the incidence of cancer is decreasing;
the decrease is statistically significant for women although not for
men, because of a recent increase in prostate cancer incidence. The
cancer death rates are decreasing for both sexes. The decreases in
incidence and mortality are attributed to progress in cancer
prevention, early detection, and treatment. Despite the overall
progress, there are increasing incidence rates for some cancers and low
survival for certain forms of cancer. For example, pediatric cancer
incidence is increasing, although death rates are down. The survival
from melanoma, pancreatic cancer, liver cancer, and many forms of
malignant brain tumors remains much too short.
Those who do survive cancer experience a myriad of late and long-
term effects. In the editorial note accompanying the Morbidity and
Mortality Weekly Report that found almost 12 million American cancer
survivors, CDC stressed the need for more research to identify those
cancer survivors at risk of recurrence, second cancers, and the late
effects of cancer and its treatment. CDC also recommended that special
attention be paid to the burden of survivorship for the medically
underserved and the older cancer survivor.
Recommendations for Fiscal Year 2012 Funding
NCCS recommends smart, effective, and aggressive Federal
investments in initiatives to improve the quality of care and quality
of life for cancer survivors. We recommend:
--A strong and sustained investment in NIH and NCI in fiscal year
2012 to support basic, translational, and clinical research
aimed at answering fundamental questions about cancer,
advancing new and improved cancer treatments, identifying the
side effects of cancer treatments, and strengthening
interventions for the late and long term effects of cancer and
treatment. No reductions should be made in NIH funding in
fiscal year 2012, in order to prevent interruption of both
basic and clinical studies and to sustain the progress in
cancer treatment that we are making through research.
--Steady progress in the overhaul of the NCI clinical trials system.
The Institute of Medicine (IOM) has outlined a plan for
modernizing the clinical trials system and eliminating
inefficiencies, and NCI leaders have taken steps to implement
the IOM recommendations. We urge completion of this reform
effort, to guarantee that patients are willing to enroll in
clinical research studies because they know they will be
studies of high quality investigating important issues and
treatments. An improved system will also ensure that research
studies are efficiently completed and questions related to new
treatments are answered without delay.
--A strong investment in survivorship research that will discover
those at risk of late and long-term effects from cancer and
treatment and appropriate interventions for those individuals.
--A sustained commitment to basic research aimed at detecting
subtypes of cancer and contributing to the development of
targeted, or personalized, cancer therapies.
--Maintenance of the Federal cancer screening programs--including the
breast and cervical cancer screening program and the colorectal
cancer screening program--in a manner that will support
services to medically underserved individuals and ensure early
detection and diagnosis. The proposal to create a block grant
of chronic disease programs should not include the screening
programs, which do not lend themselves to effective
administration through a block grant.
--A strong program of education and information regarding
survivorship services for the 12 million cancer survivors
living in the United States. CDC has provided grant funding to
support a survivorship resource center, and we urge that steps
be taken to ensure that the services offered through the center
reflect the latest knowledge about the problems of survivors
and the most appropriate interventions. Morever, special
populations, including the medically underserved and the
elderly, should be provided adequate and appropriate
information and services.
Federal research and survivorship programs have yielded better
treatments and enhanced quality of life for millions of American cancer
patients. These programs should be sustained through continued Federal
support so that the needs of a growing population of cancer survivors
can be met.
______
Prepared Statement of the National Coalition for Osteoporosis and
Related Bone Diseases
The National Coalition for Osteoporosis and Related Bone Diseases
(Bone Coalition) would like to take this opportunity to thank you all
for your continued visionary support of the National Institutes of
Health--the Nation's biomedical research agency. Because of your past
efforts and your appreciation of the potential and value of medical
research, new scientific opportunities are being pursued that hold
potential for better diagnosis, treatment, prevention and eventually
cures for diseases such as osteoporosis, osteogenesis imperfecta,
Paget's disease of bone, and a wide range of rare bone diseases.
Recommendation.--The National Coalition for Osteoporosis and
Related Bone Diseases joins with hundreds of health and medical
organizations of the Ad Hoc Group for Medical Research Funding in
urging the Committee to provide an appropriation of $35 billion in
fiscal year 2012 for the National Institutes of Health. This increase
will create substantial opportunities for scientific and health
advances, while also providing key economic scientific support in
communities across the Nation.
Organized in the early 1990s, the Bone Coalition is dedicated to
increasing Federal research funding for bone diseases through advocacy
and education. Five leading national bone disease groups comprise the
Bone Coalition: two professional societies, the American Academy of
Orthopaedic Surgeons and the American Society for Bone and Mineral
Research; and three voluntary health organizations, the National
Osteoporosis Foundation, the Osteogenesis Imperfecta Foundation, and
the Paget Foundation for Paget's Disease of Bone and Related Disorders.
Osteoporosis and related bone diseases are omnipresent--affecting
people of all ages, ethnicities, and gender. These diseases profoundly
alter the quality of life and constitute a tremendous burden to
patients, society and the economy--causing loss of independence,
disability, pain and death. The annual direct and indirect costs for
bone and joint healthcare are $849 billion--7.7 percent of the U.S.
gross domestic product.
--Osteoporosis is a bone-thinning disease in which the skeleton can
become so fragile that the slightest movement, even a cough or
a sneeze can cause a bone to fracture. About 10 million
Americans already have the disease, and another 34 million
people have low bone density, which puts them at risk for
osteoporosis and bone fractures. According to estimated
figures, osteoporosis was responsible for more than 2 million
fractures in 2005, including hip, spine, wrist, and other
fractures. The number of fractures due to osteoporosis is
expected to rise to more than 3 million by 2025. Approximately
1 in 2 women and up to 1 in 4 men over age 50 will break a bone
because of osteoporosis, and an average of 24 percent of hip
fracture patients age 50 and older will die in the year
following their fracture. Individuals with certain diseases are
at higher risk of developing osteoporosis. For example:
diabetes patients are at increased risk for developing an
osteoporosis-related fracture; cancer patients are at increased
risk because many cancer therapies, such as chemotherapy and
corticosteroids, have direct negative effects on bone; and
certain cancers, including prostate and breast cancer, may be
treated with hormonal therapy, which can cause bone loss.
--Osteogenesis imperfecta, or ``brittle bone disease,'' is an
inherited genetic disorder characterized by fragile bones which
fracture easily, often from no apparent cause. A severely
affected child begins fracturing before birth. Hundreds of
fractures can be experienced in a lifetime, as well as hearing
loss, short stature, skeletal deformities, weak muscles and
respiratory difficulties. As many as 50,000 Americans may be
affected by this disease.
--Paget's disease of bone is a geriatric disorder that results in
enlarged and deformed bones in one or more parts of the body.
Excessive bone breakdown and formation can result in bone which
is structurally disorganized, resulting in an overall decrease
in bone strength and an increase in susceptibility to bowing of
limbs and fractures. Pain is the most common symptom. Other
complications include arthritis and hearing loss if Paget's
disease affects the skull. Paget's disease of bone affects 1\1/
2\ to 8 percent of older adults depending on a person's age and
where he or she lives. Approximately 700,000 Americans over the
age of 60 are affected.
Past investments in NIH by your Committee have paid dividends for
patients in the many advances in the bone research field, and these
investments have had significant impact on public health. In just one
example, researchers have recently discovered that bisphosphonate drugs
commonly prescribed for osteoporosis and Paget's disease significantly
reduce death rates by preventing fractures among older adults,
producing mortality rates five times lower than those over 60 taking no
bone medications. Years of basic research by NIH established the
scientific foundation for development of this type of medication now
producing significant results.
And while progress to date has clearly been impressive, there is
still no cure for osteoporosis, osteogenesis imperfecta, Paget's
disease or numerous other diseases and conditions that affect the
skeleton. Depending on the disease, the opportunity to build on recent
discoveries for new treatments, cures and preventive measures has never
been greater. With that in mind, the Coalition has identified the
following areas where further intensive investigation is warranted:
Office of the NIH Director.--The Coalition urges the Director to
work with all relevant Institutes to enhance interdisciplinary research
leading to targeted therapies for improving the density, quality and
strength of bone for all Americans. More scientific knowledge is needed
in a number of key areas involving bone and muscle, fat, and the
central nervous system. Research is also urgently needed to improve the
identification of populations who might require earlier treatment
because they are at risk of rapid bone loss due to a wide range of
conditions or diseases: obesity, diabetes, chronic renal failure,
cancer, HIV, conditions that affect absorption of nutrients or
medications, or addiction to tobacco, alcohol or other opiates. The
Coalition encourages NIH to develop a plan to expand genetics and other
research on rare bone diseases, including: osteogenesis imperfecta,
Paget's disease of bone, fibrous dysplasia, osteopetrosis, fibrous
ossificans progressiva, melorheostosis, X-linked hypophosphatemic
rickets, multiple hereditary exostoses, multiple osteochondroma,
Gorham's disease, and lymphangiomatosis.
National Institute of Arthritis and Musculoskeletal and Skin
Diseases (NIAMS).--The Coalition urges support for research into the
pathophysiology of bone loss in diverse populations. The information
gained will be critical in developing targeted therapies to reduce
fractures and improve bone density, quality and strength. Efforts are
needed to determine appropriate levels of calcium and vitamin D for
bone health at different life stages. Research is also needed in
assessing bone microarchitecture and remodeling rates for determining
fracture risk, anabolic approaches to increase bone mass, novel
molecular and cell-based therapies for bone and cartilage regeneration,
and discerning the clinical utility of new, non-invasive bone imaging
techniques to measure bone architecture and fragility. Support for
studies on the molecular basis of bone diseases such as Paget's
disease, osteogenesis imperfecta and other rare bone diseases should
also be a priority.
National Cancer Institute (NCI).--The Coalition urges
investigations on how to repair bone defects caused by cancer cells.
Translational research is also needed to understand the impact of
metastasis on the biomechanical properties of bone and the mechanisms
by which bone marrow and tumor derived cells can influence metastatic
growth, survival and therapeutic resistance.
National Institute on Aging (NIA).--The Coalition encourages
research to better define the causes of age-related bone loss and
fractures, reduced physical performance and frailty, including
identifying epigenetic changes, with the aim of translating basic and
animal studies into new therapeutic approaches. Critical research is
also needed on changes in bone structure and strength with aging, and
the relationship of age-related changes in other organ systems. The
prevention and treatment of other metabolic bone diseases, including
osteogenesis imperfecta, glucocorticoid-induced osteoporosis, and bone
loss due to kidney disease should also be priority research areas.
National Institute of Child Health and Human Development (NICHD).--
The Coalition urges research in the new, emerging field of metabolic
disease and bone in children and adolescents, especially childhood
obesity, anorexia nervosa and other eating disorders. Research is also
needed on what the optimal Vitamin D levels should be in children to
achieve bone health, and the implications of chronic or seasonal
Vitamin D deficiency to the growing skeleton. Development and testing
of therapies and bone building drugs for pediatric patients are also a
pressing clinical need. The committee is encouraged by results thus far
from the Bone Mineral Density in Childhood Study (BMDCS) that will
serve as a valuable resource for clinicians and investigators to assess
bone deficits in children and risk factors for impaired bone health.
However the committee is concerned that without further funding to
continue the study, there will be inadequate data on bone development
in adolescents and different ethnic groups. Therefore the committee
encourages NIH to extend the study and to explore research that will
lead to better understanding and prevention of osteopenia and
osteoporosis.
National Institute of Dental and Craniofacial Research (NIDCR).--
The Coalition urges continued research support on the effects of
systemic bone active therapeutics on the craniofacial skeleton,
including factors predisposing individuals to osteonecrosis of the jaw,
as well as new approaches to facilitate bone regeneration. The
Coalition commends NIDCR for its longstanding intramural program on
fibrous dysplasia.
National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK).--The Coalition encourages support for research on the
relationship between Vitamin D and morbidity and mortality in chronic
kidney disease. Research is also needed on the value of anti-resorptive
therapies, the link between renal insufficiency and diabetic bone
disease, the differences in calcification of blood vessels, the
mechanisms of metastasis of renal cell carcinoma, and diseases that
occurs in patients with end stage chronic renal disease on
hemodialysis.
National Institute of Neurological Disorders and Stroke (NINDS).--
The Coalition encourages research support into the pathophysiology of
spinal cord, brachial plexus, and peripheral nerve injuries in order to
develop targeted therapies to improve neural regeneration and
functional recovery.
National Institute of Biomedical Imaging and Bioengineering
(NIBIB).--The Coalition encourages critical research to advance our
ability to treat bone diseases and disorders through bone imaging, as
well as managing the loss of bone and soft tissue associated with
trauma by advancing tissue engineering strategies to replace and
regenerate bone and soft tissue.
Centers for Disease Control and Prevention
On another front, prevention is of major concern to the Coalition.
As the population ages and the ranks of senior citizen Baby Boomers
expand, the annual cost of acute and long-term care for osteoporosis,
alone, is projected to increase dramatically from $19 billion annually
to more than $25 billion by 2025. Without significant intervention now,
chronic diseases such as osteoporosis will overwhelm efforts to contain
healthcare costs. Thanks to medical research better diagnosis,
prevention and screening strategies and treatment therapeutics are now
available to address the growing problem of osteoporosis.
The recent HHS report, ``Enhancing Use of Clinical Preventive
Services Among Older Adults: Closing the Gap,'' calls attention to the
potential of preventive measures for osteoporosis. The report shows new
data outlining critical gaps with a high percentage of women on
Medicare reporting never having received osteoporosis screenings. Yet,
as the report states, studies have proven that osteoporosis screening
using hip scans and follow-up management can reduce hip fractures by 36
percent. In 1999 alone, Medicare spent more than $8 billion to treat
injuries to seniors, with fractures accounting for two-thirds of the
spending.
The Coalition, therefore, urges the Director of the Centers for
Disease Control to develop an education and outreach plan in
consultation with the patient and medical community to begin laying the
ground work to address osteoporosis on a public health basis.
______
Prepared Statement of the National Consumer Law Center
The Federal Low Income Home Energy Assistance Program (LIHEAP) \1\
is the cornerstone of Government efforts to help needy seniors and
families stay warm and avoid hypothermia in the winter, as well as stay
cool and avoid heat stress (even death) in the summer. LIHEAP is an
important safety net program for low-income, unemployed and
underemployed families struggling in this economy. The demand for
LIHEAP assistance remains at record high levels for a third year in a
row. In fiscal year 2011, the program is expected to help an estimated
9 million low-income households afford their energy bills. The
unemployment and poverty forecasts for fiscal year 2012 indicate that
the number of struggling households will also remain at these high
levels. In light of the crucial safety net function of this program in
protecting the health and well-being of low-income seniors, the
disabled, and families with very young children, we respectfully
request that LIHEAP be fully funded at its authorized level of $5.1
billion for fiscal year 2012 and that advance funding of $5.1 billion
be provided for the program in fiscal year 2013.
---------------------------------------------------------------------------
\1\ 42 U.S.C. Sec. Sec. 8621 et seq.
---------------------------------------------------------------------------
LIHEAP Provides Critical Help With Home Energy Bills for The Large
Number of Low-Income Households Struggling to Move Forward in
These Difficult Economic Times
Funding LIHEAP at $5.1 billion for the regular program in fiscal
year 2011 is essential in light of the sharp increase in poverty and
unemployment and the steady climb in home energy prices in recent
years.\2\ One indicator of the growing need for energy assistance is
the growing number of disconnections. In States like Ohio that track
utility disconnections, the disconnection numbers for gas and electric
residential customers have increased by 23.9 percent over 5 years. For
the year ending December 2010, there were 452,221 disconnections. For
the year ending December 2006, there were 364,912 gas and electric
disconnections. For the years ending December 2009, 2008, and 2007,
there were 476,490, 424,952, and 424,411 gas and electric
disconnections respectively. LIHEAP helps bring the cost of essential
heating and cooling within reach for an estimated 9 million low-income
households and helps keep these struggling households connected to
essential utility service.
---------------------------------------------------------------------------
\2\ See, Chad Stone, Arloc Sherman and Hannah Shaw,
Administration's Rational For Severe Cut in Low-Income Home Energy
Assistance is Weak, Figure 2 (CBPP calculation of winter fuel price
index from EIA) Center on Budget and Policy Priorities, February 18,
2011.
---------------------------------------------------------------------------
The demand for LIHEAP increases when residential home energy prices
increase, such as the fly up in home heating oil and propane in the
winter of fiscal year 2011.\3\ Since the winter of 2005-2006, energy
costs have increased from $1,337 to $2,291 for households heating with
home heating oil; $1,275 to $2,040 for households heating with propane,
and $723 to $947 for households heating with electricity. Households
heating with natural gas have experience more moderate increases from
$813 to $990. Home energy is also more expensive during prolonged
periods of extreme temperatures because households use more fuel to
keep the home at safe temperatures. For example, a colder than normal
winter can result in higher heating bills than in years past. The third
variable that drives up the demand for LIHEAP is the number of
households that are struggling with unemployment, underemployment and
the number of households in poverty.
---------------------------------------------------------------------------
\3\ Id.
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Unfortunately, the number of households that are struggling to make
ends meet remains very high. According a Pew Fiscal Analysis Initiative
report, as of December 2010, 30 percent of the 14 million unemployed
have been unemployed for a year or longer.\4\ While long-term
unemployment has affected all age groups, older workers have been hit
particularly hard by this downturn.\5\ CBO's budget and economic
outlook report projects that unemployment will be 8.2 percent by the
fourth quarter in fiscal year 2012, far from the 5.3 percent that CBO
estimates is the natural rate of unemployment.\6\ A recent Brookings
Center on Children & Families analysis looks at the correlation between
unemployment rates and poverty rates and estimates that the poverty
rate will increase to over 15 percent in 2012.\7\ Thus indications are
that the demand for LIHEAP in fiscal year 2012 will remain very strong
as this program helps struggling households in a number of ways. LIHEAP
protects the health and safety of the frail elderly, the very young and
those with chronic health conditions, such as diabetes, that increase
susceptibility to temperature extremes. LIHEAP assistance also helps
keep families together by keeping homes habitable during the bitter
cold winter and sweltering summers.
---------------------------------------------------------------------------
\4\ Pew Economic Policy Group Fiscal Analysis Initiative, Addendum:
A Year or More: The High Cost of Long-Term Unemployment, January 27,
2011.
\5\ Id. (``More than 40 percent of unemployed workers older than 55
have been out of work for at least a year'').
\6\ CBO, The Budget and Economic Outlook: Fiscal Years 2011 to
2021, Summary (January 2011 at Summary Table 2).
\7\ Emily Monea and Isabel Sawhill, An Update to ``Simulating the
Effect of the `Great Recession' on Poverty'', Brookings Center on
Children and Families (September 16, 2010).
---------------------------------------------------------------------------
LIHEAP Is a Critical Safety Net Program for the Elderly, the Disabled
and Households With Young Children
Dire Choices and Dire Consequences.--Recent national studies have
documented the dire choices low-income households face when energy
bills are unaffordable. Because adequate heating and cooling are tied
to the habitability of the home, low-income families will go to great
lengths to pay their energy bills. Low-income households faced with
unaffordable energy bills cut back on necessities such as food,
medicine and medical care.\8\ The U.S. Department of Agriculture has
released a study that shows the connection between low-income
households, especially those with elderly persons, experiencing very
low food security and heating and cooling seasons when energy bills are
high.\9\ A pediatric study in Boston documented an increase in the
number of extremely low weight children, age 6 to 24 months, in the 3
months following the coldest months, when compared to the rest of the
year.\10\ Clearly, families are going without food during the winter to
pay their heating bills, and their children fail to thrive and grow. A
2007 Colorado study found that the second leading cause of homelessness
for families with children is the inability to pay for home energy.\11\
---------------------------------------------------------------------------
\8\ See e.g., National Energy Assistance Directors' Association,
2008 National Energy Assistance Survey, Tables in section IV, G and H
(April 2009) (to pay their energy bills, 32 percent of LIHEAP
recipients went without food, 42 percent went without medical or dental
care, 38 percent did not fill or took less than the full dose of a
prescribed medicine, 15 percent got a payday loan). Available at http:/
/www.neada.org/communications/press/2009-04-28.htm.
\9\ Mark Nord and Linda S. Kantor, Seasonal Variation in Food
Insecurity Is Associated with Heating and Cooling Costs Among Low-
Income Elderly Americans, The Journal of Nutrition, 136 (Nov. 2006)
2939-2944.
\10\ Deborah A. Frank, MD et al., Heat or Eat: The Low Income Home
Energy Assistance Program and Nutritional and Health Risks Among
Children Less Than 3 years of Age, AAP Pediatrics v.118, no.5 (Nov.
2006) e1293-e1302. See also, Child Health Impact Working Group,
Unhealthy Consequences: Energy Costs and Child Health: A Child Health
Impact Assessment Of Energy Costs And The Low Income Home Energy
Assistance Program (Boston: Nov. 2006) and the Testimony of Dr. Frank
Before the Senate Committee on Health, Education, Labor and Pensions
Subcommittee on Children and Families (March 5, 2008).
\11\ Colorado Interagency Council on Homelessness, Colorado
Statewide Homeless Count Summer, 2006, research conducted by University
of Colorado at Denver and Health Sciences Center (Feb. 2007).
---------------------------------------------------------------------------
When people are unable to afford paying their home energy bills,
dangerous and even fatal results occur. In the winter, families resort
to using unsafe heating sources, such as space heaters, ovens and
burners, all of which are fire hazards. Space heaters pose 3 to 4 times
more risk for fire and 18 to 25 times more risk for death than central
heating. In 2007, space heaters accounted for 17 percent of home fires
and 20 percent of home fire deaths.\12\ In the summer, the inability to
keep the home cool can be lethal, especially to seniors. According to
the CDC, older adults, young children and persons with chronic medical
conditions are particularly susceptible to heat-related illness and are
at a high risk of heat-related death. The CDC reports that 3,442 deaths
resulted from exposure to extreme heat during 1999-2003.\13\ The CDC
also notes that air-conditioning is the number one protective factor
against heat-related illness and death.\14\ LIHEAP assistance helps
these vulnerable seniors, young children and medically vulnerable
persons keep their homes at safe temperatures during the winter and
summer and also funds low-income weatherization work to make homes more
energy efficient.
---------------------------------------------------------------------------
\12\ John R. Hall, Jr., Home Fires Involving Heating Equipment
(Jan. 2010) at ix and 33. Also, 40 percent of home space heater fires
involve devices coded as stoves.
\13\ CDC, ``Heat-Related Deaths--United States, 1999-2003'' MMWR
Weekly, July 28, 2006.
\14\ CDC, ``Extreme Heat: A Prevention Guide to Promote Your
Personal Health and Safety'' available at http://emergency.cdc.gov/
disasters/extremeheat/heat_guide.asp.
---------------------------------------------------------------------------
LIHEAP is an administratively efficient and effective targeted
health and safety program that works to bring fuel costs within a
manageable range for vulnerable low-income seniors, the disabled and
families with young children. LIHEAP must be fully funded at its
authorized level of $5.1 billion in fiscal year 2012 in light of
unaffordable, but essential heating and cooling needs of millions of
struggling households due to the record high unemployment levels.
In addition, fiscal year 2013 advance funding would facilitate the
efficient administration of the State LIHEAP programs. Advance funding
provides certainty of funding levels to States to set income guidelines
and benefit levels before the start of the heating season. States can
also better plan the components of their program year (e.g., amounts
set aside for heating, cooling and emergency assistance,
weatherization, self-sufficiency and leveraging activities) if there is
forward funding. Forward funding is critical to LIHEAP running
smoothly.
______
Prepared Statement of the National Council of Social Security
Management Associations
On behalf of the National Council of Social Security Management
Associations (NCSSMA), thank you for the opportunity to submit our
written testimony on the fiscal year 2012 funding for the Social
Security Administration (SSA) to the Subcommittee. I am the President
of NCSSMA and have been the District Manager of the Social Security
office in Newburgh, New York for 10 years. I have worked for the Social
Security Administration for 31 years, with 27 years in management.
NCSSMA is a membership organization of nearly 3,400 SSA managers
and supervisors who provide leadership in 1,299 community based Field
Offices and Teleservice Centers throughout the country. We are the
front-line service providers for SSA in communities all over the
Nation. We are also the Federal employees with whom many of your staff
members work to resolve problems and issues for your constituents who
receive Social Security retirement, survivors and disability benefits,
and Supplemental Security Income. Since the founding of our
organization over 41 years ago, NCSSMA has considered our top priority
to be a strong and stable Social Security Administration, one that
delivers quality and prompt locally delivered service to the American
public. We also consider it a top priority to be good stewards of the
taxpayers' moneys.
Appropriations to the Social Security Administration are an
excellent investment and return on taxpayer dollars. We are very
appreciative of the support for SSA funding the Subcommittee has
provided in recent years. The additional funding SSA received in fiscal
years 2008-2010 helped significantly to prevent workloads from
spiraling out of control and assisted with improving service to the
American public.
NCSSMA strongly supports the President's fiscal year 2012 budget
request for SSA. The total SSA budget request is $12.667 billion, which
includes $12.522 billion in administrative funding through the
Limitation on Administrative Expenses (LAE) account. We respectfully
request that the Subcommittee provides at the least the President's
full budget request for SSA in fiscal year 2012. Full funding of this
request is critical to maintain staffing in SSA's front-line
components, cover inflationary increases, continue efforts to reduce
hearing and disability backlogs, and increase deficit-reducing program
integrity work.
Current State of SSA Operations
NCSSMA has critical concerns about the dramatic growth in SSA
workloads, and the need to receive necessary funding to maintain
service levels vital to 60 million Americans. Despite agency strategic
planning, expansion of online services, significant productivity gains,
and the best efforts of management and employees, SSA is still faced
with many challenges to providing the service that the American public
has earned and deserves.
Over the last 7 years, SSA has experienced a dramatic increase in
Retirement, Survivor, Dependent, Disability, and Supplementary Security
Income (SSI) claims. The additional claims receipts are driven by the
initial wave of the nearly 80 million baby boomers who will be filing
for Social Security benefits by 2030--an average of 10,000 per day!
Concurrently, there has been a surge in claims filed due to poor
economic conditions and rising unemployment levels.
The need for resources in SSA Field Offices is critical to process
these additional claims and provide other vital services to the
American public. Field Offices are responsible for processing 2.4
million SSI redeterminations in fiscal year 2011, a 100 percent
increase compared to fiscal year 2008. Nationally, visitors to Field
Offices increased from 41.9 million in fiscal year 2007 to 45.4 million
in fiscal year 2010. SSA is also experiencing unprecedented telephone
call volumes, and in fiscal year 2010, SSA completed 67 million
transactions over the 800 number network--the most ever. In addition to
the transactions over the 800 number network, NCSSMA estimates that
Field Offices receive 32 million public telephone contacts annually.
SSA Funding for Fiscal Year 2011
NCSSMA strongly supported the President's fiscal year 2011 budget
request of $12.379 billion for SSA's administrative expenses. Much of
this increase was needed to cover inflationary costs for fixed
expenses. Funding at this level would have assured that SSA could meet
its public service obligations. Despite SSA's enormous challenges, with
the Federal deficit concerns, attaining this level of funding was not
possible. SSA's fiscal year 2011 appropriation for administrative
funding through the LAE account was $10.7755 billion, which is $25
million below the fiscal year 2010 enacted level and $275 million was
rescinded from SSA's Carryover Information Technology funds.
Inadequate funding of SSA in fiscal year 2011 and additional
rescissions will have major repercussions for SSA including a hiring
freeze, reduction of overtime, and postponements of initiatives to
improve efficiency. Reducing resources at the same time SSA workloads
are increasing is a prescription for making a very productive agency
that efficiently uses the taxpayers' moneys into one with significant
service delays and backlogs. Service deterioration and backlogs
resulting from inadequate fiscal year 2011 funding levels will have a
collateral negative impact on fiscal year 2012.
Field Office Service Delivery Challenges
SSA Field Offices are experiencing tremendous stress because of
increased workloads and additional visitors. The effect of funding SSA
in fiscal year 2011 below fiscal year 2010 levels exacerbates the
situation and has already had a significant impact on local Field
Offices around the country.
--Frontline feedback from our busiest urban offices indicates that
some have seen their visitor traffic explode with overflowing
reception areas and increased waiting times.
--Most of SSA has been under a hiring freeze because of the current
funding situation. A hiring freeze for all of fiscal year 2011
could result in a loss of over 2,500 SSA Federal employees.
--A November 2010, Office of the Inspector General (OIG) Report,
``Threats against SSA employees or Property,'' indicates, ``SSA
has experienced a dramatic increase in the number of reported
threats against its employees or property. The number of
threats . . . increased by more than 50 percent in fiscal year
2009 and by more than 60 percent in fiscal year 2010.''
--SSA projects 50 percent of its employees, including 66 percent of
supervisors, will be eligible to retire by fiscal year 2018.
Serious concerns exist about SSA's ability to sustain service
levels with the tremendous loss of institutional knowledge from
front-line personnel.
--Geographical staffing disparities will occur with attrition leaving
some offices significantly understaffed. This is problematic
for rural SSA Field Offices, whose customers often live vast
distances away, may have no Internet service, and lack access
to public transportation.
SSA Online eServices to Assist with Service Delivery Challenges
The expansion of services available to the American public via the
Internet has helped to alleviate the number of visitors and telephone
calls to SSA. However, the Internet is not keeping pace with the
increasing demand for service. High-volume transactions, such as Social
Security cards and benefit verifications are not available on the
Internet, or are only being used to a limited degree. This represents
over 40 percent of the 45.4 million visitors to SSA Field Offices.
NCSSMA believes that SSA must be properly funded in fiscal year
2012 and beyond so that it may continue to invest in improved user-
friendly online services to allow more online transactions. If
individuals were able to successfully transact their request for
services online, this would result in fewer contacts with Field
Offices, improved efficiencies, and better public service.
Disability Workload Processes
Nationwide, over 3.2 million new disability claims were filed and
sent to State Disability Determination Services in fiscal year 2010.
This surge of increased claims has created backlogs. At the end of
fiscal year 2010, the number of pending initial disability claims was
at an all-time high of 824,192 cases--a 46 percent increase from the
end of fiscal year 2008. SSA's largest backlogs are hearings, appealing
initial disability decisions processed by the Office of Disability
Adjudication and Review. Hearing receipts continue to rise, and through
April 2011, 734,666 hearings were pending which is over 29,000 more
hearings than at the end of fiscal year 2010.
Despite these unprecedented challenges, SSA continues to make
progress. In March 2011, the average processing time for a hearing was
359 days, the lowest level since December 2003. Unfortunately, the
number of claims and hearings pending is still not acceptable to
Americans who need Social Security to support their families. Progress
was undermined by the fiscal year 2011 budget impasse, resulting in the
suspension of opening eight planned Hearing Offices in Alabama,
California, Indiana, Michigan, Minnesota, Montana, New York, and Texas.
This significantly threatens to prevent SSA from eliminating the
hearings backlog by fiscal year 2013.
It is important to understand that annual appropriated funding
levels for SSA have a critical impact on the hearings backlog. One of
the most significant reasons for the increase in the hearings backlog
was the significant underfunding of SSA from fiscal year 2004 through
fiscal year 2007.
President's Proposed Fiscal Year 2012 SSA Budget
NCSSMA strongly supports the President's fiscal year 2012 budget
request for SSA and requests that Congress provide full funding to
sustain the momentum achieved to allow the agency to:
--Reduce the initial disability claims backlog to 632,000 by
processing over 3 million claims;
--Conduct disability hearings for 822,500 cases and reduce the
waiting time for a hearing decision below a year for the first
time in a decade;
--Reduce pending hearings to 597,000 from the fiscal year 2010 level
of 705,367; and
--Complete additional program integrity workloads yielding nearly
$9.3 billion in savings over 10 years, including Medicare and
Medicaid savings--process 592,000 medical Continuing Disability
Reviews (CDRs) and 2.6 million SSI redeterminations.
SSA issues $800 billion in benefit payments annually to 60 million
people and the agency takes its stewardship responsibilities seriously.
The fiscal year 2012 budget request includes $938 million dedicated to
program integrity. Investment in program integrity reviews saves
taxpayer dollars and is fiscally prudent in reducing the Federal budget
and deficit.
--CDRs determine whether an individual is still disabled, or if
benefits should be ceased because of medical improvement. SSA
has accumulated a backlog of nearly 1.5 million CDRs. Medical
CDRs yield $10 in lifetime program savings for every $1 spent.
--SSI redeterminations review nonmedical factors of eligibility, such
as income and resources, to identify payment errors. SSI
redeterminations yield a return on investment of $7 in program
savings over 10 years for each $1 spent, including Medicaid
savings accruals.
NCSSMA recommends consideration of legislative proposals included
in the fiscal year 2012 budget request, which can improve the effective
administration of the Social Security program, with minimal effect on
program dollars. We believe these proposals have the potential to
reduce operational costs and increase administrative efficiency. This
includes enacting the Work Incentives Simplification Pilot, requiring
quarterly reporting of wages, workers compensation automatic reporting,
and developing an automated system to report state and local pensions.
Conclusion
NCSSMA recognizes in the current budget environment that it will be
difficult to provide adequate funding for SSA. However, Social Security
is one of the most successful Government programs in the world and
touches the lives of nearly every American family. We are a very
productive agency and a key component of the Nation's economic safety
net for the aged and disabled, but sufficient resources are necessary.
A strong Social Security program equates to a strong America and it
must be maintained as such for future generations.
NCSSMA sincerely appreciates the Subcommittee's interest in the
vital services Social Security provides, and your ongoing support to
ensure SSA has the resources necessary to serve the American public. We
respectfully request your support of full funding of the President's
fiscal year 2012 budget request on behalf of our agency and the
American public we serve. We remain confident increased investments in
SSA will benefit our entire Nation.
On behalf of NCSSMA members nationwide, thank you for the
opportunity to submit this written testimony. We respectfully ask that
you consider our comments, and would appreciate any assistance you can
provide in ensuring the American public receives the critical and
necessary service they deserve from the Social Security Administration.
______
Prepared Statement of the National Head Start Association
Chairman Harkin, Ranking Member Shelby, and Members of the
Subcommittee, thank you for allowing the National Head Start
Association (NHSA) to submit written testimony in support of funding
for Head Start and Early Head Start. As the Head Start community's
voice, NHSA believes that Head Start centers nationwide need the
resources necessary to provide quality school readiness opportunities
for young children and their families. The essence of Head Start is a
national commitment to provide critical early education, health,
nutrition, child care, parent involvement and family support services
in return for a lifelong measurable impact on the low-income children
and families enrolled in Head Start. Today, as our Nation's children
face greater obstacles than ever before, there is a significant need to
prepare the next generation for success in school and later in life,
and Head Start has a proven track record of accomplishing this. The
Head Start community is pleased to offer the following recommendation
to Congress as it begins its consideration of fiscal year 2012 funding
levels.
NHSA is grateful that the President and Congress made a solid
commitment to quality early childhood education in the fiscal year 2011
Continuing Resolution by providing the funds necessary to at least
maintain services for children currently served by Head Start and Early
Head Start programs across the country. Quality early education
prepares the Nation's youngest children for a lifetime of learning. In
fact, studies show that for every $1 invested in a Head Start child,
society earns at least $7 back through increased earnings, employment,
and family stability; and decreased welfare dependency, crime costs,
grade repetition, and special education. NHSA supports President
Obama's fiscal year 2012 budget request for $8.1 billion for Head Start
and Early Head Start. These funds will enable Head Start and Early Head
Start centers to continue to serve the entire, increasingly vulnerable
Head Start community for an additional school year, and complete some
necessary program improvements both to ensure accountability and
quality, as well as meet the requirements of the 2007 Head Start
Reauthorization Act.
Increased Needs of an Increased At-Risk Population
One of Head Start's greatest challenges is an increasingly needy
population--both among those served and those eligible for service.
Today more than one in five children are born into poverty--less than
$22,050 per year for a family of four. In many areas, Head Start
directors are seeing a rapid increase of homeless families/children
enrolled. The Administration's request aims to address some of this
growing need by allocating a significant portion of the additional
funds to increasing the number of available Migrant and Seasonal, and
American Indian and Alaskan Native spaces.
Though funding for Head Start has increased in recent budget years,
the cost of serving families has risen at a much faster pace. When
surveyed, a full 83 percent of Head Start centers reported that their
costs have increased just over the past year--in fact, 25 percent of
those who responded report that their fixed costs, including
maintenance, transportation, and insurance, have increased by more than
11 percent over the last 12 months. This puts many local centers in the
awkward position of choosing between serving fewer children and
families better and according to the statutory quality standards, or
serving as many as possible with perhaps lesser quality.
Additionally, Head Start and Early Head Start centers often do not
have adequate resources during the enrollment process to perform a
comprehensive needs assessment on all potential enrollees.
Specifically, targeted funds would enable center directors to
coordinate more fully with families before enrollment to determine
their needs and match those needs with the capacity of the center, and
work with partner organizations that may be better equipped to handle
special issues. In Kansas City, Kansas, the Project EAGLE Community
Programs has implemented a sort of ``community triage'' system, whereby
families are assessed more fully, and dollars are spent much more
wisely. This approach may also enable many more at-risk families that
were previously on Head Start waiting lists to receive assistance from
a multitude of partnering organizations--placing perhaps a higher
income, yet still impoverished family to a more fitting type of service
provider and providing a waiting list slot for a needier family.
Though Head Start and Early Head Start centers are able to accept a
limited number of children from families with incomes slightly above
the poverty threshold (up to 130 percent, or $29,055 for a family of
four) and are required to accept children with special needs, the Head
Start community shares a commitment to identifying and targeting
resources, especially in these economic circumstances, to the absolute
neediest of families. Additional program funds to enable better
monitoring, needs-assessments, and collaboration will assist Head Start
providers in meeting this goal.
Necessary Accountability Improvements
Head Start and Early Head Start directors are also eager for the
Administration on Children and Families to fully implement the quality
improvement provisions included in the 2007 Head Start Reauthorization.
The law put in place new minimum education requirements for Head Start
and Early Head Start teachers and caretakers. Though employing highly
qualified individuals is a goal shared by the National Head Start
Association, the education requirements necessitate a higher salary
range in many areas to attract and keep these highly educated
professionals, putting a strain on the administrative budgets of Head
Start and Early Head Start Centers. Head Start directors, when
surveyed, report that they are having difficulty competing with other
educational entities in their services areas; in many cases, they
cannot match the salaries provided to qualified individuals in the K-12
system or in other private pre-schools.
One of the most anticipated provisions yet to be implemented will
require Head Start grantees designated as low-performing to compete for
continuation of their grant. This competition is an enormous
undertaking for the Office of Head Start and will certainly require
additional funds to design, fully staff, and execute.
However, the law also enables the creation of rigorous performance
standards for each Head Start and Early Head Start center. These have
not yet been publicly drafted or finalized, though the Head Start
community is eager to work with Office of Head Start to inform the
effective design and implementation of these performance standards.
Further, we hope that the centers can be evaluated against these new
standards, particularly as they relate to the impending recompetition/
redesignation. We very much hope that Congress includes report language
directing the Administration to ensure that Head Start and Early Head
Start grantees are given the opportunity to realign and monitor
themselves against the full set of new performance standards before
being judged as to whether they will be subject to a recompetition/
redesignation. This will ensure that all grantees, in all areas, are
judged on consistent standards in competitions going forward.
Maintenance of Quality
Lastly, the National Head Start Association supports the
Administration's proposal to provide $202 million for Training and
Technical Assistance Activities. Within those funds, we suggest that
Congress direct the Administration to continue supporting the 10
Centers of Excellence in Early Childhood that were named last year--in
the following localities: Greensburg, Pennsylvania; Baltimore,
Maryland; Mount Vernon, Ohio; Houghton, Michigan; Owensboro, Kentucky;
Morganton, North Carolina; Birmingham, Alabama; Denver, Colorado;
Albuquerque, New Mexico; and Dunkirk, New York. Head Start directors
very much value the advice of fellow practitioners, and the resources
and tools these Centers have designed and provided to the Head Start
community are considered effective, well-designed, and serve as models
for other Head Start and Early Head Start programs to emulate. Their
innovative practices and collaborative community approaches will be in
more demand as practitioners adjust to the requirements of the 2007
law.
Head Start Works
Since 1965, Head Start (and now Early Head Start as well) has been
providing a proven, evidence-based comprehensive program to prepare at-
risk children and families for a stable, successful life. Head Start
improves the odds and the options for at-risk kids for a lifetime. Kids
that have been through Head Start and Early Head Start are healthier,
more academically accomplished, more likely to be employed, commit
fewer crimes, and contribute more to society. Head Start is a smart
investment--one of the smartest and most effective we make. Study after
study has demonstrated that Head Start has yielded a benefit-cost ratio
as large as $7 to $1.\1\
---------------------------------------------------------------------------
\1\ Ludwig, J. and Phillips, D. (2007). The Benefits and Costs of
Head Start. Social Policy Report. 21 (3: 4); Meier, J. (2003, June 20).
Interim Report. Kindergarten Readiness Study: Head Start Success.
Preschool Service Department, San Bernardino County, California.
---------------------------------------------------------------------------
Head Start saves our hard-earned tax dollars by decreasing the need
for children to receive special education services in elementary
schools.\2\ For example, data analysis of a recent Montgomery County
Public Schools evaluation found that a MCPS child receiving full-day
Head Start services requires 62 percent fewer special education
services and saves taxpayers $10,100 per child annually.\3\ States can
save $29,000 per year for each prisoner that they incarcerate because
Head Start children are 12 percent less likely to have been charged
with a crime.\4\
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\2\ Barnett, W. (2002, September 13). The Battle Over Head Start:
What the Research Shows. Presentation at a Science and Public Policy
Briefing Sponsored by the Federation of Behavioral, Psychological, and
Cognitive Sciences.
\3\ NHSA Public Policy and Research Department analysis of data
from a Montgomery County Public Schools evaluation. See Zhao, H. &
Modarresi, S. (2010, April). Evaluating lasting effects of full-day
prekindergarten program on school readiness, academic performance, and
special education services. Office of Shared Accountability, Montgomery
County Public Schools.
\4\ Reuters. (2009, March). Cost of locking up Americans too high:
Pew study; Garces, E., Thomas, D. and Currie, J. (2002, September).
Longer-term effects of Head Start. American Economic Review, 92 (4):
999-1012.
---------------------------------------------------------------------------
Head Start families with increased health literacy experience
immediate healthcare benefits, including lower Medicaid costs--on
average $232 lower per family. The program has also reduced mortality
rates for 5- to 9-year olds by as much as 50 percent.\5\ Studies have
shown that the program reduces healthcare costs for employers and
individuals because Head Start children are less obese, \6\ 8 percent
more likely to be immunized, \7\ and 19 to 25 percent less likely to
smoke as an adult.\8\
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\5\ Ludwig, J. and Phillips, D. (2007) Does Head Start improve
children's life chances? Evidence from a regression discontinuity
design. The Quarterly Journal of Economics, 122 (1): 159-208.
\6\ Frisvold, D. (2006, February). Head Start participation and
childhood obesity. Vanderbilt University Working Paper No. 06-WG01.
\7\ Currie, J. and Thomas, D. (1995, June). Does Head Start Make a
Difference? The American Economic Review, 85 (3): 360.
\8\ Anderson, K.H., Foster, J.E., & Frisvold, D.E. (2009).
Investing in health: The long-term impact of Head Start on smoking.
Economic Inquiry, 48 (3), 587-602.
---------------------------------------------------------------------------
And these benefits last a lifetime. Head Start produces measurable,
long-term results such as school-readiness, increased high school
graduation rates, and reduced needs for special education. And the more
than 27 million Head Start graduates are working every day in our
communities to make our country and our economy strong.
The Head Start community understands the budgetary pressures the
Federal Government is facing and while reductions in early childhood
education may produce short-term savings, as a Nation we cannot afford
the lasting impact such cuts would impose on our most vulnerable
children today and on our children's futures. The research shows that
the ``achievement gap'' is apparent as early as the age of 18 months--
we will spend substantially more downstream if these same young people
are not prepared to graduate high-school, attend college and lead
prosperous lives. We urge the Subcommittee to fully fund the
President's budget request of $8.1 billion for Head Start and Early
Head Start in fiscal year 2012.
Thank you for your time and consideration.
______
Prepared Statement of the National Health Council
The National Health Council (NHC) is the only organization of its
kind that brings together all segments of the healthcare community to
provide a united voice for the more than 133 million people with
chronic diseases and disabilities and their family caregivers. Made up
of more than 100 national health-related organizations and businesses,
its core membership includes approximately 50 of the Nation's leading
patient advocacy groups, which control its governance. Other members
include professional societies and membership associations, nonprofit
organizations with an interest in health, and major pharmaceutical,
medical device, biotechnology, and insurance companies.
The NHC is well aware of the challenging fiscal environment facing
the Subcommittee--indeed the entire country. We recognize that Federal
resources must be carefully targeted to ensure that such investments
produce the greatest good for the American people. This will involve
very tough decisions on healthcare priorities by the Subcommittee.
As work begins on the fiscal year 2012 Labor-HHS appropriations
bill, the NHC urges the Subcommittee to take a ``global'' view of the
healthcare system as it identifies funding priorities for the coming
year. The NHC and its membership, particularly those groups
representing the patient community, stress that no one aspect of the
healthcare system--research, public health, healthcare delivery--can be
considered as a separate, stand-alone component. For a true benefit and
service to the American people, especially those living with chronic
conditions, the healthcare system must function through the effective
and productive interaction of its many parts.
NHC's members have specific interests that span the entire
healthcare system. However, a recent survey of our members demonstrated
that they share a common concern for the entire continuum of the
healthcare system.
One aspect of the healthcare system that is of concern to the NHC
is patient access to care. With healthcare costs rising and a growing
number of uninsured Americans, far too many people living with chronic
conditions are not able to access the care needed to maintain their
health and productivity. This is a concern not just for each individual
patient but the health system as a whole, which will face greater costs
due to declining public health. While the NHC views the entire
healthcare system as important, we recognize that the most vitally
important piece is for patients to be able to obtain high quality,
patient-focused care. Without this, the various components are unable
to serve their intended function and the system as a whole falters.
Another large concern of the patient community is the lack of
effective cures and treatments. Too many people who are facing serious
and life-threatening conditions are doing so without the hope of a cure
or even a treatment for their symptoms. Funding for biomedical research
at the National Institutes of Health (NIH) offers this hope. But the
drug development pipeline does not end with the NIH. Many therapeutics
are taking longer to reach patients due to a backlog at the Food and
Drug Administration (FDA). While the scope of FDA regulation has grown
to the point that it is now regulating one-third of the U.S. economy,
the agency's funding has remained relatively consistent. This fact is
troubling to the patient advocacy organizations that represent people
who lack effective cures and treatments. Both NIH and FDA must be
adequately funded to increase the likelihood that these patients will
live longer, healthier, and more productive lives.
The NHC appreciates the opportunity to submit this written
testimony to the Subcommittee. We understand that you face many hard
decisions and again urge that you focus on the healthcare system as
continuum that patients must be able to access in order to best serve
the needs of Americans living with chronic conditions.
______
Prepared Statement of the National Healthy Mothers Healthy Babies
Coalition
Highlighting the urgent need to address the startling infant
mortality rates in the United States by strengthening programs at
HRSA's Maternal and Child Health Bureau.
Mr. Chairman and Members of the Subcommittee, thank you for giving
the National Healthy Mothers, Healthy Babies Coalition (HMHB) the
opportunity to provide testimony as the Subcommittee begins to consider
funding priorities for fiscal year 2012. My name is Judy Meehan and I
am the Chief Executive Officer of HMHB, an organization founded in
1981, prompted by the U.S. Surgeon General's conference on infant
mortality. Since its founding, HMHB has become a recognized leader and
resource in maternal and child health, reaching an estimated 10 million
healthcare professionals, parents, and policymakers annually through
its membership of over 100 local, State and national organizations.
Mr. Chairman, I would like to limit my testimony today to discuss
an exciting program of HMHB, referred to as the text4baby program. This
program is focused on improving the health outcomes of mothers and
babies and demonstrating the potential of mobile health technology to
reach underserved populations with critical health information. Of the
33 countries that the International Monetary Fund describes as
``advanced economies'' the United States now has the highest infant
mortality rate according to data from the World Bank. In 1980, we were
13th and in 2000 we were 2d. In the United States approximately 28,000
babies die before their first birthday, despite a volume of science
around behaviors that improve a baby's chances for a healthy birth and
opportunity to thrive. The text4baby program was launched to help
address this problem.
Though the text4baby program has been financed by generous funding
from Founding Sponsor Johnson & Johnson, with technical and in-kind
support from Voxiva and CTIA--The Wireless Foundation, we are hopeful
that with your leadership, the Health Resources and Services Maternal
and Child Health Bureau can commit to helping us expand this program in
two States where there is demonstrated and significant need. The
Maternal and Child Health Block Grant program provides a flexible
source of funding that allows States to target their most urgent
maternal and child health needs. The program supports a broad range of
activities including reducing infant mortality. HMHB recommends that
funding from within the base of the block grant's Special Projects of
Regional and National Significance (SPRANS) be provided to text4baby so
that enrollment in this program could be expanded to targeted and
special populations in Louisiana and Mississippi, the two States that
have the worst infant mortality outcomes. Mr. Chairman, HMHB also
recommends fiscal year 2012 funding for the Maternal and Child Health
Block Grant program of $695 million, an increase of $33 million or 5
percent above the level provided in the fiscal year 2011 continuing
resolution.
Text4baby Program
Text4baby, a free mobile information service designed to promote
maternal and child health, was developed to deliver evidence-based
health information to the women who need it most: the 1.5 million women
on Medicaid who give birth each year. While many of these women may
lack access to the Internet and other sources of health information,
the vast majority of them do have a cell phone, and a reported 80
percent of Medicaid beneficiaries are active texters. Text4baby
provides pregnant women and new moms with information they need to take
care of their health and give their babies the best possible start in
life. Women who sign up for the service receive free SMS text messages
each week, timed to their due date or baby's date of birth. Since its
launch in February 2010, text4baby has enrolled over 157,000 users and
delivered over 12 million evidence-based tips to help them women keep
themselves and their babies healthy. That's a great start but it's not
enough. Thanks to the grassroots efforts of more than 500 text4baby
partners across the country, we are on track to achieve our goal of
bringing the service to 1 million moms by 2012 and delivering over 100
million timely and relevant health messages.
The text4baby program was developed in collaboration with the
Centers for Disease Control and Prevention (CDC), Health Resources and
Services, Administration (HRSA), American Academy of Pediatrics (AAP),
and other experts. Text4baby messages cover topics like immunization,
nutrition, smoking cessation, safe sleep, and the importance of early
prenatal care. The content also connects women to services such as
health insurance, childcare, and toll-free ``quitlines'' for assistance
in becoming smoke- and drug-free. Text4baby has also delivered urgent
infant product alerts at the request of the Food and Drug
Administration and outbreak and immunization alerts at the request of
CDC. Just last month, text4baby moms saw: ``Breaking news! The American
Academy of Pediatrics announced new car seat guidelines. Kids should
now ride in rear facing-car safety seats until age 2.''
Evaluation of the Program
Mr. Chairman, we know that the program is effective. Over 96
percent of those enrolled in the program say they would refer a friend
to the service. Also, preliminary data analysis indicates that
text4baby is reaching the target audience: for example, analysis of
enrollment data in Virginia in October, 2010 showed that text4baby
utilization is highest in zip codes with lower income levels and higher
incidence rates of low birth weight babies. However, we also want to
understand if and how text4baby is improving knowledge and changing
behavior. There are currently six formal evaluations underway to
examine text4baby's impact. The largest study, funded by the Department
of Health and Human Services (HHS) and conducted by Mathematica Policy
Research, is a mixed mode study and includes a mobile survey of
text4baby users, focus groups, a community survey, electronic health
record review, and interviews with key partners. This study will assess
utilization of recommended care during prenatal and postpartum periods
(considering things such as prenatal visits, postpartum visit, well-
child visits, dental visits, and immunization); adherence to
recommended health practices (such as breastfeeding and infant sleep
position); and adoption of healthy behaviors (such as smoking
cessation, healthy eating and exercise).
Even before the formal study results are in, we know that
delivering over 12 million important evidence-based health tips to over
160,000 individuals (and, by the end of next year, 100 million messages
to 1 million moms) is an important national service.
Expanding the Program
Glaring disparities in infant mortality exist within certain
populations in the United States suggesting the need for a targeted
expansion of the program. For example, babies born to African American
mothers are most at risk with a rate of 13.5 deaths per 1,000 births.
The States with the highest rates of infant mortality are Louisiana (10
babies per 1,000 died before their first birthday) and Mississippi
(10.5 babies per 1,000 died before their first birthday). In order to
demonstrate the full impact of text4baby, HMHB proposes a targeted
outreach and support initiative in those two States. Specifically, HMHB
proposes to leverage its great array of activities at the national,
regional, State, and local level to meet the ultimate goal of seeing
that every woman in Louisiana and Mississippi who is pregnant or a
mother of a child less than 1 year enrolls in the service and receives
the valuable health information she needs. This targeted outreach will
include the development of state-wide implementation teams, technical
assistance in the way of event planning and media relations,
fulfillment of requests for information, speakers and promotional
materials, and support for local data and assessment activities. It
will also include targeted outreach for African-American and Hispanic
communities. HMHB's zip-code based analysis will allow tracking of the
impact of targeted outreach activities with enrollment in real time.
Mississippi and Louisiana Statistics
Since its launch in February 2010, text4baby has enlisted 1,276
users in Mississippi and over 2,768 users in Louisiana; however, in
2007, 46,491 babies were born in Mississippi and 66,301 babies were
born in Louisiana. So, clearly, there is work to be done to increase
enrollment in these States. Unfortunately, these two States are among
the bottom in the Nation in terms of preterm births, low birth weight,
and rates of death among children before their first birthday. They are
also among the top in terms of smoking and obesity rates (see table
below). These are two States in desperate need of a new way to receive
information to help them care for their health and give their babies
the best possible start in life.
[In percent]
----------------------------------------------------------------------------------------------------------------
Mississippi Louisiana National
----------------------------------------------------------------------------------------------------------------
Preterm......................................................... 18.3 16.6 12.7
Low birth weight................................................ 12.3 11.2 8.2
IMR............................................................. 10.5 10.0 6.7
Women smokers................................................... 21.9 22.1 19.6
Men smokers..................................................... 27.2 25.1 19.6
Obesity in women................................................ 37.1 31.5 24.4
----------------------------------------------------------------------------------------------------------------
Summary and Conclusion
Mr. Chairman, again we wish to thank the Subcommittee for the
opportunity to submit testimony and for your leadership in these
difficult times. While HMHB recognizes the demands on our Nation's
resources, we believe the continuing decline of our Nation's health and
the increase in infant mortality justifies a targeted and specific
effort. In conclusion, we specifically urge that funding from within
the Maternal and Child Health Bureau's SPRANS program be made available
for a targeted effort to increase program enrollment among
disproportionately impacted populations in Louisiana and Mississippi,
the two States with the worst overall outcomes. We also recommend that
$695 million be provided in fiscal year 2012 for the Maternal and Child
Health Block Grant Program, an increase of $33 million or 5 percent
over the fiscal year 2011 continuing resolution.
______
Prepared Statement of the National Hispanic Council on Aging (NHCOA)
Thank you for the opportunity to submit written testimony. The
National Hispanic Council on Aging (NHCOA) is the leading organization
working to improve the lives of Hispanic older adults, their families,
and caregivers--the fastest growing segment of the U.S.'s rapidly
expanding aging population. For more than 30 years, NHCOA has been a
strong voice dedicated to ensuring our Nation's Hispanic seniors enjoy
healthy and happy golden years. Alongside its nearly 40 local
affiliates across the country, NHCOA reaches ten million Hispanics each
year.
Hispanic older adults experience myriad challenges as they seek to
obtain a good quality of life in their later years, including health
inequities and economic insecurity. They are disproportionately
affected by several health afflictions--among them diabetes,
hypertension, obesity, and Alzheimer's disease. Exacerbating these
problems is the low rate of access to preventative care. Hispanics are
disproportionately employed in low-paying jobs that require low levels
of formal education or skills and often depend on Social Security as
their sole source of income later in life.
NHCOA writes to you today to urge an increase in the funding for
the Corporation for National and Community Service's Senior Corps and
the Administration on Aging's Older Americans Act Programs. Senior
Corps' three programs, the Retired Senior Volunteer Program (RSVP), the
Foster Grandparent Program, and the Senior Companion Program, keep the
elderly active and allow the community to benefit from their years of
wisdom and experience. RSVP connects seniors to volunteer opportunities
available in their communities. Foster Grandparents tutor and mentor
at-risk children. The Senior Companion Program provides support to
volunteers ages 55+ who provide care and friendship to frail elderly.
Increasing funding to Senior Corps would provide valuable services to
communities while saving Federal funds. According to Pamela Carre of
Senior Volunteer Services in Broward County, Florida, during fiscal
year 2009, the volunteer work provided by Senior Volunteer Services
valued $6.3 million. All of this work came from Senior Corps
volunteers. The Older Americans Act provides a wide variety of
nutrition, caretaking, and training programs to thousands of service
providers across the country.
The Older Americans Act's National Family Caregiver Support Program
and Senior Corps' Senior Companion Program are particularly effective
and beneficial for Hispanic older adults. Additional funding to these
programs will help meet the needs of Hispanic older adults in a
culturally sensitive and effective manner while also easing the
financial burden on Medicare and Medicaid.
The Senior Companion program reduces the isolation that can easily
trap an elderly person. The Program trains volunteers ages 55+ to
assist vulnerable elderly people. In addition to training and
placement, the Program also provides a stipend of $2.65 an hour,
reimbursed travel expenses, and accident and liability insurance.
Senior Companions assist the elderly, whether by accompanying them on
visits to the doctor or running their errands. Administrators of the
Senior Companion Program, like Ms. Carre, highlight the importance of
the flexible and individualized service these companions provide to
other older adults. The main service that all Senior Companions provide
is friendship.
The Senior Companion Program benefits the elderly and the economy.
Senior Companions provide assistance that allows elderly people to
remain independent and out of institutionalized care. Keeping the
elderly out of nursing homes and assisted living facilities reduces the
cost of healthcare and keeps people from using Medicaid funds.
According to Ms. Carre, it costs $4,800 to support one Senior Companion
annually, while one year in a nursing home costs over $70,000.
Additionally, Senior Companions can act as home health aides, providing
assistance in the basic activities of daily living. Senior Companions
are able to cook for elders, remind them to take their medication,
perform housekeeping, and keep family aware of their loved one's needs
and condition. This service, also offered by Medicaid and Medicare, can
be fulfilled in a cost-effective manner through the Senior Companion
Program. In a conversation about the value of senior volunteer
programs, Becky Snider, of Pacific Retirement Services in Medford,
Oregon, explained that State and local governments recognize the great
value these programs provide.
The Senior Companion program has the potential to effectively serve
Hispanic older adults in a way that other programs cannot. Many in this
group view formal service providers as impersonal and lacking in
cultural sensitivity. A dearth of services able to adequately provide
assistance to Hispanic older adults further exacerbates this problem.
The Senior Companion program can effectively serve Hispanic older
adults by offering them friendly and linguistically and culturally
sensitive services in their own homes. Senior Companions can help
Hispanic older adults manage their health while also providing
attention and friendship in a way that home health aides and doctors do
not. Ms. Leticia Martinez, the administrator of Senior Companion
Volunteer Service of Los Angeles, states that she has heard from many
older adults that Senior Companions are often the only people they see
on a regular basis and that, ``they wouldn't be around without their
Senior Companion.'' Instead of receiving treatment from a home health
aide, Senior Companions provide a daily visit from a good friend.
Like a good friend, Senior Companions advocate for, and protect,
the older adults with whom they interact. Ms. Martinez stressed that
many Senior Companions helped their clients identify and avoid
financial abuse. The Senior Companion Program saves money for our
seniors.
Although the Senior Companion program can improve the health of
seniors and our economy, it is underfunded. The Edward M. Kennedy Serve
America Act authorized $55 million to be appropriated in fiscal year
2010, however, only $46.9 million was appropriated that year. In fact,
the Senior Companion program has not received a substantial increase in
funding in at least 10 years. The Senior Companion program deserves an
appropriation of at least $55 million in order to carry out its
important duties.
Similar to the Senior Companion Program, the Administration on
Aging's National Family Caregiver Support Program (NFCSP) plays a vital
role in protecting older adults. The NFCSP provides grants to States to
create programs to assist people who care for elderly relatives. These
programs support family members in providing the best care possible.
The Administration on Aging grants funds for five broad categories: (1)
providing information to caregivers about effective caretaking methods
and available services; (2) assistance in accessing services; (3)
creation of caregiver support groups and training sessions; (4) funds
for home health aides to give respite to family caregivers; and (5) on
a limited basis, supplemental services.
The NFCSP reduces the financial strain on Medicare and Medicaid. By
focusing on maintenance of health and prevention of serious problems,
the NFCSP can keep Hispanic older adults out of nursing homes and off
Medicaid. Additionally, the ability of NFCSP to provide funding for
home health aides and training and respite for family caregivers makes
it less likely for older adults to require a Medicare-financed home
health aide.
The NFCSP is perfectly suited to help Hispanic older adults, their
families, and caregivers. There are valuable, effective programs
available to help older adults afford healthcare and nursing home
treatment, but many Hispanics feel that traditional healthcare and
nursing home programs are too impersonal. The NFCSP addresses this
problem by providing respite care and training for effective caregiving
and by improving access to caregiving services. Delivering effective,
personalized care for older adults in their homes can help manage
health issues in a comfortable setting. Furthermore, home health aide
services can provide enough respite care for a family caregiver to take
on a part-time job, reducing the likelihood that the family will have
to turn to Medicaid or other forms of public assistance.
The NFCSP provides support to people who are unexpectedly drawn
into helping an older family member. While cleaning and errands may be
the first help given to an elderly loved one, these tasks can quickly
multiply. The NFCSP teaches family members how to effectively care for
their elderly relatives and cope with the stress of such care.
Regarding the value of caregiver training and support groups, Mr. Jose
Perez, Executive Director of Senior Community Outreach Services in
Alamo, Texas says, ``I have seen people break down into tears because
the stress of caring for their father and how close it brought them to
physically abusing their loved one. Training and support groups help
them ease this burden.''
President Obama's fiscal year 2012 budget request recognizes the
importance of the NFCSP and requests a substantial funding increase. In
the last several years, the program has received between $153 million
and $155 million. For fiscal year 2012, President Obama has requested
over $192 million for the NFCSP. This increased funding will help to
reduce healthcare costs for seniors while also allowing them to
maintain their independence and receive effective treatment from those
who know them best. Hispanic older adults will benefit from increased
NFCSP funding due to the program's ability to deliver culturally
sensitive care to a group that traditional healthcare providers have
thus far struggled to adequately serve.
Mr. Perez describes the effectiveness of these two programs with a
simple phrase: ``Everybody wins.'' Senior Companions win the
satisfaction of helping their fellow citizens and the pride of earning
wages for productive work. The elderly win by receiving the care and
attention that they deserve. Families win when they learn how to care
for their loved ones. The government wins because these programs keep
the elderly healthy, independent, and off Medicaid.
NHCOA urges you to appropriate at least $55 million for the
Corporation for National and Community Service's Senior Companion
Program. Additionally, we request that you follow President Obama's
recommendation and appropriate at least $192 million for the
Administration on Aging's National Family Caregiver Support Program.
These two programs will not only effectively serve Hispanic older
adults in a way other programs do not, but they will also ease the
financial strain on Medicare and Medicaid. Thank you for your
consideration, and please feel free to contact NHCOA with any questions
or concerns.
______
Prepared Statement of the National Kidney Foundation
In 2008, the number of Americans with End Stage Renal Disease
(ESRD), which requires dialysis or a kidney transplant to survive,
reached 535,000. In that year alone, 110,000 progressed to ESRD.
Medicare covers dialysis or transplantation regardless of age or other
disability, the only disease-specific coverage under the program.
Despite this social and economic impact, no national public health
program focusing on early detection and treatment existed until fiscal
year 2006, when Congress provided $1.8 million for the first of 5 years
of support to initiate a Chronic Kidney Disease Program at the Centers
for Disease Control and Prevention (CDC). Congressional concern
regarding kidney disease education and awareness also is found in Sec.
152 of the Medicare Improvements for Patients and Providers Act of 2008
(MIPPA, Public Law 110-275), in which it directed the Secretary to
establish pilot projects to increase screening for Chronic Kidney
Disease (CKD) and enhance surveillance systems to better assess the
prevalence and incidence of CKD. Treatments exist to potentially slow
progression of kidney disease and prevent its complications, but only
if individuals are diagnosed before the latter stages of CKD.
The CDC program is designed to identify members of populations at
high risk for CKD, develop community-based approaches for improving
detection and control, and educate health professionals about best
practices for early detection and treatment. The National Kidney
Foundation respectfully urges the Committee to maintain line-item
funding in the amount of $2.1 million for the Chronic Kidney Disease
Program in the CDC's Division of Diabetes Translation. We are
encouraged by the fiscal year 2011 Operating Plan for CDC, which
recommends only a $39,000 reduction from the fiscal year 2010
appropriation for the CKD program. Continued support will benefit
kidney patients and Americans who are at risk for kidney disease,
advance the objectives of Healthy People 2020 and the National Strategy
for Quality Improvement in Health Care, and fulfill the mandate created
by Sec. 152 of MIPPA.
The prevalence of CKD in the United States, when last measured, was
higher than a decade earlier. This is partly explained by the
increasing prevalence of the related diseases of diabetes and
hypertension. It is estimated that CKD affects 26 million adult
Americans \1\ and that the number of individuals in this country with
CKD who will have progressed to kidney failure, requiring chronic
dialysis treatments or a kidney transplant to survive, will grow to
712,290 by 2015 \2\. Furthermore, a task force of the American Heart
Association noted that decreased kidney function has consistently been
found to be an independent risk factor for cardiovascular disease (CVD)
outcomes and all-cause mortality and that the increased risk is present
with even mild reduction in kidney function.\3\ Therefore addressing
CKD is a way to achieve one of the priorities in the National Strategy
for Quality Improvement in Health Care: Promoting the Most Effective
Prevention and Treatment of the Leading Causes of Mortality, Starting
with Cardiovascular Disease.
---------------------------------------------------------------------------
\1\ Josef Coresh, et al. ``Prevalence of Chronic Kidney Disease in
the United States,'' JAMA, November 7, 2007.
\2\ D.T. Gilbertson, et al., Projecting the Number of Patients with
End-Stage Renal Disease in the United States to the Year 2015. J Am Soc
Nephrol 16: 3736-3741, 2005.
\3\ Mark J. Sarnak, et al. Kidney Disease as a Risk Factor for the
Development of Cardiovascular Disease: A Statement from the American
Heart Association Councils on Kidney in Cardiovascular Disease, High
Blood Pressure Research, Clinical Cardiology, and Epidemiology and
Prevention. Circulation 2003: 108: 2154-69.
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Despite the extent of the problem, CKD is an under-recognized and
under-treated public health challenge in the United States.
Accordingly, Healthy People 2020 Objective CKD-2 is to ``increase the
proportion of persons with chronic kidney disease (CKD) who know they
have impaired renal function.'' One reason CKD is neglected is that it
is often asymptomatic, especially in the early stages, and, therefore,
laboratory testing is required to detect it. Increasing the proportion
of persons with CKD who know they are affected requires expanded public
and professional education programs and screening initiatives targeted
at populations who are at high risk for CKD. Thanks to the interest
that this Committee has expressed in CKD in the past, through directed
appropriations, the National Center for Chronic Disease Prevention and
Health Promotion at CDC has instituted a series of projects that could
assist in attaining the Healthy People 2020 objective. However, this
forward momentum will be stifled and CDC's investment in CKD to date
jeopardized if line-item funding is not continued.
As noted in CDC's Preventing Chronic Disease: April 2006, Chronic
Kidney Disease meets the criteria to be considered a public health
issue: (1) the condition places a large burden on society; (2) the
burden is distributed unfairly among the overall population; (3)
evidence exists that preventive strategies that target economic,
political, and environmental factors could reduce the burden; and (4)
evidence shows such preventive strategies are not yet in place.
Furthermore, CDC convened an expert panel in March 2007 to outline
recommendations for a comprehensive public health strategy to prevent
the development, progression, and complications of CKD in the United
States.
The CDC Chronic Kidney Disease program consists of three projects
to promote kidney health by identifying and controlling risk factors,
raising awareness, and promoting early diagnosis and improved outcomes
and quality of life for those living with CKD. These projects include
the following:
-- Establishing a surveillance system for Chronic Kidney Disease in
the United States.
--Demonstrating effective approaches for identifying individuals at
high risk for chronic kidney disease through State-based
screening (CKD Health Evaluation and Risk Information Sharing,
or CHERISH).
--Conducting an economic analysis by the Research Triangle Institute,
under contract with the CDC, on the economic burden of CKD and
the cost-effectiveness of CKD interventions.
Pursuant to CHERISH, individuals at high risk for CKD have been
screened in eight locations in four States. The goals of the
demonstration project have been:
--To educate providers and the public that simple tests can be used
to identify CKD in the target population and to assess risk
factors for intervention (obesity, hypertension, cardiovascular
disease, lipid disorders, diabetes, and glycemic control).
--Evaluate whether providers change practice patterns after being
consulted by a person who went through the detection program.
The demonstration project should be replicated at eight sites in
four additional States in order to confirm initial findings. If we fail
to do so, we could be forfeiting the valuable insight that has been
gained thus far.
We believe it is possible to distinguish between the CKD program
and other categorical chronic disease initiatives at CDC, because the
CKD program does not provide funds to State health departments.
Instead, CDC has been making available seed money for feasibility
studies in the areas of epidemiological research and health services
investigation. Because the CKD program does not provide funds to State
health departments, we maintain it should be exempted from the changes
in the structure and budget of the National Center for Chronic Disease
Prevention and Health Promotion, at least until surveillance planning,
and studies of detection feasibility and economic impact are completed.
Thank you for your consideration of our testimony.
______
Prepared Statement of the National League for Nursing
The National League for Nursing (NLN) is the premiere organization
dedicated to promoting excellence in nursing education to build a
strong and diverse nursing workforce to advance the Nation's health.
With leaders in nursing education and nurse faculty across all types of
nursing programs in the United States--doctorate, master's,
baccalaureate, associate degree, diploma, and licensed practical--the
NLN has more than 1,200 nursing school and healthcare agency members,
34,000 individual members, and 24 regional constituent leagues.
The NLN urges the subcommittee to fund the following Health
Resources and Services Administration (HRSA) nursing programs:
--The Nursing Workforce Development Programs, as authorized under
Title VIII of the Public Health Service Act, at $313.075
million in fiscal year 2012; and
--The Nurse Managed Health Clinics, as authorized under Title III of
the Public Health Service Act, at $20 million in fiscal year
2012.
Nursing Education is a Jobs Program
According to the U.S. Bureau of Labor Statistics (BLS), the
registered nurse (RN) workforce will grow by 22 percent from 2008 to
2018, resulting in 581,500 new jobs. This growth will be much faster
than the average for all occupations. The April 1, 2011 BLS Employment
Situation Summary--March 2011 likewise reinforces the strength of the
nursing workforce to the Nation's job growth. While the Nation's
overall unemployment rate was little changed at 8.8 percent for March
2011, the employment in healthcare increased in March with the addition
of 37,000 jobs (i.e., a 36.6 percent rise from February 2011) at
ambulatory healthcare services, hospitals, and nursing and residential
care facilities.
Nursing is the predominant occupation in the healthcare industry,
with more than 3.78 million active, licensed RNs in the United States
in 2009. BLS notes that healthcare is a critically important industrial
complex in the Nation. Growing steadily even during the depths of the
recession, healthcare is virtually the only sector that added jobs to
the economy on a net basis since 2001. Over the last 12 months,
healthcare added 283,000 jobs, or an average of 24,000 jobs per month.
The Nursing Workforce Development Programs provide training for
entry-level and advanced degree nurses to improve the access to, and
quality of, healthcare in underserved areas. These Title VIII nursing
education programs are fundamental to the infrastructure delivering
quality, cost-effective healthcare. The NLN applauds the subcommittee's
bipartisan efforts to recognize that a strong nursing workforce is
essential to a health policy that provides high-value care for every
dollar invested in capacity building for a 21st century nurse
workforce.
Yet, the current $243.872 million in fiscal year 2010 for the Title
VIII programs falls short of the healthcare inequities facing our
Nation. Absent consistent support, recent boosts to Title VIII will not
fulfill the expectation of paying down on asset investments to generate
quality health outcomes; nor will episodic increases in funding fill
the gap generated by a 13-year nurse shortage felt throughout the
entire U.S. health system.
The Nurse Pipeline and Education Capacity
Although the recession resulted in some stability in the short-term
for the nurse workforce, policy makers must not lose sight of the long-
term growing demand for nurses in their own districts and States. For
the complete perspective, the NLN's findings from the Annual Survey of
Schools of Nursing--Academic Year 2009-2010 cast a wide net on all
types of nursing programs, from doctoral through diploma, to determine
rates of application, enrollment, and graduation. The survey creates a
true picture of nursing education. Key findings include:
--Expansion of nursing education programs impeded by shortage of
faculty and clinical placements. The overall systemic capacity
of prelicensure nursing education continues to fall well short
of demand. Fully 42 percent of all qualified applications to
basic RN programs were met with rejection in 2010. Associate
degree in nursing (ADN) programs rejected 46 percent of
qualified applications, compared with 37 percent of
baccalaureate of science in nursing (BSN) programs. Notably,
the Nation's practical nursing (PN) programs turned away 40
percent of qualified applications.
--Yield rates continued to grow. Yield rates--a classic indicator of
the competitiveness of college admissions--remain
extraordinarily high among both pre- and post-licensure nursing
programs. A stunning 94 percent of all applicants accepted into
ADN programs, and 93 percent of those accepted in PN programs,
went on to enroll in 2010. Yield rates among the other program
types were nearly as high, averaging 89 percent for RN-to-BSN
programs; 86 percent for RN diploma programs, master's in
nursing (MSN) programs, and doctoral programs; and 84 percent
for BSN programs.
Nurse Shortage Affected by Faculty Shortage
A strong correlation exists between the shortage of nurse faculty
and the inability of nursing programs to keep pace with the demand for
new RNs. Increasing the productivity of education programs is a high
priority in most States, but faculty recruitment is a glaring problem
that likely will grow more severe. Without faculty to educate our
future nurses, the shortage cannot be resolved.
The NLN's findings from the 2009 Faculty Census show that:
--Shortages of faculty and clinical placements impeded expansion. A
shortage of faculty continues to be cited most frequently as
the main obstacle to expansion by RN-to-BSN and doctoral
programs--indicated by 47 and 53 percent, respectively. By
contrast, prelicensure programs are more likely to point to a
lack of available clinical placement settings as the primary
obstacle to expanding admissions.
--Inequities in faculty salaries added to shortage difficulties.
Despite a national shortage of nurse educators, in 2009 the
salaries of nurse educators remained notably below those earned
by similarly ranked faculty across higher education. At the
professor rank nurse educators suffer the largest deficit with
salaries averaging 45 percent lower than those of their non-
nurse colleagues. Associate and assistant nursing professors
were also at a disadvantage, earning 19 and 15 percent less
than similarly ranked faculty in other fields, respectively.
Title VIII Federal Funding Reality
Today's undersized supply of appropriately prepared nurses and
nurse faculty does not bode well for our Nation. The Title VIII Nursing
Workforce Development Programs are a comprehensive system of capacity-
building strategies that provide students and schools of nursing with
grants to strengthen education programs, including faculty recruitment
and retention efforts, facility and equipment acquisition, clinical lab
enhancements, and loans, scholarships, and services that enable
students to overcome obstacles to completing their nursing education
programs. HRSA's Title VIII data below provide perspective on a few of
the current Federal investments.
Nurse Education, Practice, Quality, and Retention Grants (NEPQR).--
NEPQR funds projects addressing the critical nursing shortage via
initiatives designed to expand the nursing pipeline, promote career
mobility, provide continuing education, and support retention. In
fiscal year 2010, NEPQR funded 108 infrastructure grants, including the
launching of 22 nurse-managed health centers, four nurse internships,
and five new accelerated baccalaureate programs. Also in fiscal year
2010, the program expanded with the Nursing Assistant (NA) and Home
Health Aide (HHA) program awarding grants to 10 colleges or community-
based training programs.
Comprehensive Geriatric Education Program (CGEP).--CGEP funds
training, curriculum development, faculty development, and continuing
education for nursing personnel who care for older citizens. In
academic year 2009-2010, 27 CGEP grantees provided education and
training to 3,030 RNs/RN students; 260 advanced practice registered
nurses (APRNs); 221 faculty; 110 HHSs; 483 LPNs/LPN students; 730 NAs;
810 allied health professionals; and 929 laypersons, guardians,
activity directors.
Advanced Nursing Education (ANE) Program.--ANE supports
infrastructure grants to schools of nursing for advanced practice
programs preparing nurse-midwives, nurse anesthetists, clinical nurse
specialists, nurse administrators, nurse educators, public health
nurses, or other advanced level nurses. In addition, the Advanced
Nursing Education Expansion (ANEE) program provides grants to schools
of nursing to accelerate the production of primary care advanced
practice nurses. In fiscal year 2009, 151 schools of nursing received
grants through the ANE Program and enrolled 7,518 advanced nursing
education students. In fiscal year 2010, 26 schools of nursing received
grants under ANEE to support the production of over 600 primary care
APRNs.
Nurse Managed Health Clinics (NMHC)
Most leading authorities recognize that there will be a shortage of
primary care providers over the next decade. With the recent growth of
NMHCs, APRNs have demonstrated their flexibility as they practice
independently or collaborate with physicians in both primary care and
specialty areas. This shift suggests that professionals' practice can
be directed to changing workforce and population needs as the increased
use of APRNs holds the potential for improving access, reducing costs
for high-value care, and changing patterns of care.
NMHCs deliver comprehensive primary healthcare services, disease
prevention, and health promotion in medically underserved areas for
vulnerable populations. Approximately 58 percent of NMHC patients
either are uninsured, Medicaid recipients, or self-pay. The complexity
of care for these patients presents significant financial barriers,
heavily affecting the sustainability of these clinics.
In fiscal year 2010, HRSA awarded $15,268,000 for 10 3-year
infrastructure grants to community-based NMHCs. While providing access
points in areas where primary care providers are in short supply, the
expansion of the NMHCs also increased the number of structured clinical
teaching sites available to train nurses and other primary care
providers. These clinics funded by HRSA in fiscal year 2010 expect to
train 900 primary care nurse practitioners during their 3-year grants.
Appropriating $20 million in fiscal year 2012 to NMHCs would increase
access to primary care for thousands of uninsured people in rural and
underserved urban communities. The funding of additional NMHCs likewise
will enable schools of nursing to increase innovative clinical teaching
site opportunities for nursing students, which will directly expand the
capacity of nursing school enrollments.
The NLN can state with authority that the deepening health
inequities, inflated costs, and poor quality of healthcare outcomes in
this country will not be reversed until the concurrent shortages of
nurses and qualified nurse educators are addressed. Your support will
help ensure that nurses exist in the future who are prepared and
qualified to take care of you, your family, and all those who will need
our care. Without national efforts of some magnitude to match the
healthcare reality facing our Nation today, a calamity in nurse
education and in healthcare generally may not be avoided.
The NLN urges the subcommittee to strengthen the Title VIII Nursing
Workforce Development Programs by funding them at a level of $313.075
million in fiscal year 2012. We also recommend that the Nurse Managed
Health Clinics, as authorized under Title III of the Public Health
Service Act, be funded at $20 million in fiscal year 2012.
______
Prepared Statement of the National Marfan Foundation
Mr. Chairman, thank you for the opportunity to submit testimony
regarding the fiscal year 2012 budget for the National Heart, Lung and
Blood Institute, the National Institute of Arthritis, Musculoskeletal
and Skin Diseases, and the Centers for Disease Control and Prevention.
The National Marfan Foundation is grateful for the subcommittee's
strong support of the NIH and CDC, particularly as it relates to life-
threatening genetic disorders such as Marfan syndrome. Thanks in part
to your leadership we are at a time of unprecedented hope for our
patients.
It is estimated that 200,000 people in the United States are
affected by Marfan syndrome or a related condition. Marfan syndrome is
a genetic disorder of the connective tissue that can affect many areas
of the body, including the heart, eyes, skeleton, lungs and blood
vessels. It is progressive condition and can cause deterioration in
each of these body systems. The most serious and life-threatening
aspect of the syndrome is a weakening of the aorta. The aorta is the
largest artery carrying oxygenated blood from the heart. Over time,
many Marfan syndrome patients experience a dramatic weakening of the
aorta which can cause the vessel to dissect and tear.
Early surgical intervention can prevent a dissection and strengthen
the aorta and the aortic valves. If preventive surgery is performed
before a dissection occurs, the success rate of the procedure is over
95 percent. If surgery is initiated after a dissection has occurred,
the success rate drops below 50 percent. Aortic dissection is a leading
killer in the United States, and 20 percent of the people it affects
have a genetic predisposition, like Marfan syndrome, to developing the
complication.
Fortunately, new research offers hope that a commonly prescribed
blood pressure medication might be effective in preventing this
frequent and devastating event.
FISCAL YEAR 2012 APPROPRIATIONS RECOMMENDATIONS
National Institutes of Health
Mr. Chairman, hope for a better quality of life for patients with
Marfan syndrome and related connective tissue disorders lies in NIH-
sponsored biomedical research. With that in mind, NMF joins with other
voluntary patient and medical organizations in recommending an
appropriation of $35 billion for the National Institutes of Health in
fiscal year 2012. , This level of funding will ensure continued
expansion of research on rare diseases like Marfan syndrome and build
upon the significant investment provided to the NIH in the American
Recovery and Reinvestment Act.
National Heart, Lung, and Blood Institute
Pediatric Heart Network Clinical Trial
NMF applauds the National Heart, Lung and Blood Institute for its
leadership in advancing a landmark clinical trial on Marfan syndrome.
Under the direction of Dr. Lynn Mahoney and Dr. Gail Pearson, the
institute's Pediatric Heart Network (PHN) has spearheaded a multicenter
study focused on the potential benefits of a commonly prescribed blood
pressure medication (losartan) on aortic growth in Marfan syndrome
patients.
Dr. Hal Dietz, the Victor A. McKusick Professor of Genetics in the
McKusick-Nathans Institute of Genetic Medicine at the Johns Hopkins
University School of Medicine, and the director of the William S.
Smilow Center for Marfan Syndrome Research, is the driving force behind
this groundbreaking research. Dr. Dietz uncovered the role that the
growth factor TGF-beta plays in aortic enlargement, and demonstrated
the benefits of losartan in halting aortic growth in mice. He is the
reason we have reached this time of such promise and NMF is proud to
have supported Dr. Dietz's cutting-edge research for many years.
After 4 years of recruitment and patient screening, the PHN trial
reached its enrollment target of 604 subjects on February 2, 2011.
Marfan syndrome patients (age 6 months to 25 years) are enrolled in the
study. Patients are randomized onto either losartan or atenolol (a beta
blocker that is the current standard of care for Marfan patients with
an enlarged aortic root).
We anxiously await the results of this first-ever clinical trial
for our patient population. It is our hope that losartan will emerge as
the new standard-of-care and greatly reduce the need for surgery in at-
risk patients.
Mr. Chairman, NMF is proud to actively support the losartan
clinical trial in partnership with the Pediatric Heart Network.
Throughout the life of the trial we have provided support for patient
travel costs, coverage of select echocardiogram examinations, and
funding for ancillary studies. These ancillary studies will explore the
impact that losartan has on other manifestations of Marfan syndrome.
Evaluation of Surgical Options for Marfan Syndrome Patients
Mr. Chairman, we are grateful for the subcommittee's previous
recommendations encouraging NHLBI to support research on surgical
options for Marfan syndrome patients.
For the past several years, the NMF has supported an innovative
study looking at outcomes in Marfan syndrome patients who undergo
valve-sparing surgery compared with valve replacement. Initial findings
were published last year in the Journal of Thoracic and Cardiovascular
Surgery. Some short term questions have been answered, most importantly
that valve-sparing can be done safely on Marfan patients by an
experienced surgeon. The consensus among the investigators however is
that long-term durability questions will not be answered until patients
are followed for at least 10 years.
Confirming the utility and durability of valve sparing procedures
will save our patients a host of potential complications associated
with valve replacement surgery. We hope to partner with the NIH on this
important work moving forward.
NHLBI ``Working Group on Research in Marfan Syndrome and
Related Conditions''
In 2007, NHLBI convened a ``Working Group on Research in Marfan
Syndrome and Related Conditions.'' Chaired by Dr. Dietz, this panel was
comprised of experts in all aspects of basic and clinical science
related to the disorder. The panel was charged with identifying key
recommendations for advancing the field of research in the coming
decade. The recommendations of the Working Group are as follows:
Scientific opportunities to advance this field are conferred by
technological advances in gene discovery, the ability to dissect
cellular processes at the molecular level and imaging, and the
establishment of multi-disciplinary teams. The barriers to progress are
addressed through the following recommendations, which are also
consistent with Goals and Challenges in the NHLBI Strategic Plan.
--Existing registries should be expanded or new registries developed
to define the presentation, natural history, and clinical
history of aneurysm syndromes.
--Biological and aortic tissue sample collection should be
incorporated into every clinical research program on Marfan
syndrome and related disorders and funds should be provided to
ensure that this occurs. Such resources, once established,
should be widely shared among investigators.
--An Aortic Aneurysm Clinical Trials Network (ACTnet) should be
developed to test both surgical and medical therapies in
patients with thoracic aortic aneurysms.
--The identification of novel therapeutic targets and biomarkers
should be facilitated by the development of genetically defined
animal models and the expanded use of genomic, proteomic and
functional analyses. There is a specific need to understand
cellular pathways that are altered leading to aneurysms and
dissections, and to develop robust in vivo reporter assays to
monitor TGFb and other cellular signaling cascades.
--The developmental underpinnings of apparently acquired phenotypes
should be explored. This effort will be facilitated by the
dedicated analysis of both prenatal and early postnatal tissues
in genetically defined animal models and through the expanded
availability to researchers of surgical specimens from affected
children and young adults.
We look forward to working closely with NHLBI to pursue these
important research goals and ask the Subcommittee to support the
recommendations of the Working Group.
National Institute of Arthritis and Musckuloskeletal and Skin Diseases
NMF is proud of its longstanding partnership with the National
Institute of Arthritis and Musculoskeletal and Skin Diseases, which is
celebrating its 25th anniversary this year. Dr. Steven Katz has been a
strong proponent of basic research on Marfan syndrome during his tenure
as NIAMS director and has generously supported several ``Conferences on
Heritable Disorders of Connective Tissue.'' Moreover, the Institute has
provided invaluable support for Dr. Dietz's mouse model studies. The
discoveries of fibrillin-1, TGF-beta, and their role in muscle
regeneration and connective tissue function were made possible in part
through collaboration with NIAMS.
As the losartan trial continues to move forward, we hope to expand
our partnership with NIAMS to support related studies that fall under
the mission and jurisdiction of the Institute. One of the areas of
great interest to researchers and patients is the role that losartan
may play in strengthening muscle tissue in Marfan patients. We would
welcome an opportunity to partner with NIAMS on this and other
research.
Centers for Disease Control and Prevention
Mr. Chairman, one of the most important things we can do to prevent
untimely deaths from aortic aneurysms is to increase awareness of
Marfan syndrome and related connective tissue disorders.
Last year, the American College of Cardiology and the American
Heart Association issued landmark practice guidelines for the treatment
of thoracic aortic aneurysms and dissections. The NMF is promoting
awareness of the new guidelines in collaboration with other
organizations through a new Coalition known as TAD; the Thoracic Aortic
Disease Coalition. We hope to partner with the CDC in fiscal year 2012
to increase awareness of the guidelines so all patients will be
adequately diagnosed and treated. For fiscal year 2012, NMF joins with
the CDC Coalition in recommending an appropriation of $7.7 billion for
CDC's core-programs.
______
Prepared Statement of the National Minority AIDS Council
The National Minority AIDS Council (NMAC) represents a coalition of
over 3,000 community based organizations and AIDS service organizations
delivering HIV/AIDS services in communities of color nationwide. Our
constituents are on the front lines of the HIV epidemic and are the
most affected when funding for HIV/AIDS programs are reduced or
eliminated.
Our Nation is facing difficult decisions on how to stabilize the
economy and pass a sensible Federal budget. Although we support
efficient, cost-effective spending, we cannot support reducing
healthcare funding which would adversely affect the health and well
being of the most vulnerable: minority communities, with higher rates
of poverty where poor health outcomes are often linked to poor access
to care. While budget negotiations often focus on cold numbers, it is
easy to lose sight of the fact that human lives are at stake.
Cost-effective research and prevention programs that prevent life-
threatening diseases such as HIV/AIDS, as well as life-saving access to
care and medications for those already infected are critical in
preventing avoidable infections, serious illness, and deaths. Although
funding has failed to keep up with demand, it is impossible to deny the
strides in prevention, research, and treatment of HIV/AIDS that has
been supported by previous appropriations.
We now have a National HIV/AIDS Strategy which sets attainable
goals in reducing the devastation caused by this epidemic. The Strategy
calls for a reduction of new infections by 25 percent in the next 5
years as well as improved access to care for those already infected. As
we continue to move forward in trying to reduce new infections and
saving precious lives through the Strategy, it is imperative that the
existing public health and safety net infrastructure be adequately
funded.
Health Care Reform
In addition to the Strategy, implementation of healthcare reform
offers a monumental opportunity to make progress in reducing the impact
of the domestic HIV epidemic by greatly increasing the number of
Americans eligible for healthcare access. As such, we request full
funding of the President's fiscal year 2012 budget request for
healthcare reform programs aimed at reducing health disparities. Many
of the programs under the Patient Protection and Affordable Care Act
(ACA) are funded through discretionary budgets. Increased access to
medical care through venues such as Community Health Centers are
welcomed as they provide care in cost effective settings when compared
to the emergency room, which are too often the primary source of
medical care for communities of color.
Minority AIDS Initiative (MAI)
MAI programs seek to improve HIV-related health outcomes for racial
and ethnic minority communities that are disproportionately affected by
HIV/AIDS. Central to these goals is the MAI's focus on efforts to
strengthen the organizational capacity of community-based providers, in
particular minority providers; improve the quality of HIV services; and
expand the pool of HIV service providers. NMAC strongly recommends this
Committee fund MAI programs at $610 million for fiscal year 2012 as
minority communities continue to carry a disproportionate burden of the
epidemic. NMAC does appreciate the President's fiscal year 2012 budget
request of $430.7 million as a minimum budget for MAI.
HIV/AIDS Bureau of the Health Resources and Services Administration
(HRSA)
The number of people living with HIV in the United States has grown
to over 1.1 million people. That fact coupled with the skyrocketing
costs of medical care creates a dire need for substantial increases in
funding for care and treatment. We urge you to increase funding for the
Ryan White program by $350 million in fiscal year 2012. At minimum, we
strongly urge you to support the President's proposed fiscal year 2012
increase of $69.3 million for the Ryan White program over fiscal year
2010.
As a payer of last resort, Ryan White provides critical access to
treatment and medications to under-insured and uninsured people. Part A
funds are used to provide a continuum of care for people living with
HIV disease. To support this critical component, we request an increase
of $74.2 million when compared to fiscal year 2010. Part B funds are
provided to States to improve their capacity to provide medical care.
It also funds the AIDS Drug Assistance program (ADAP), which currently
has a wait list of over 8,100 people with no other means to access
medications. Eleven States have implemented waiting lists and many
others have implemented cost containment strategies since funding is
not keeping up with demand. We request an increase of $76.8 million in
funding to States as compared to fiscal year 2010 and an increase of
$106 million for ADAP.
Centers for Disease Control and Prevention's (CDC) National Center for
HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP)
With over 56,000 new infections annually, a renewed emphasis on
prevention and early HIV screening is critical at this juncture. NMAC
urges total fiscal year 2012 funding of $1,983.9 million for the CDC's
NCHHSTP. This includes funding of $1,325.7 million for HIV prevention
and surveillance, $59.8 million for viral hepatitis and $231 million
for tuberculosis prevention. We appreciate that the President proposed
a $1,178.5 million budget for HIV prevention at the CDC, and at a bare
minimum we urge the Committee to meet this request.
National Institutes of Health (NIH)--Office of AIDS Research
HIV/AIDS research has made great strides in understanding and
improving HIV treatment, viral suppression, and various prevention
tools. Continued commitment to a thorough AIDS research portfolio is
necessary to build on past innovation. In order to build on this
research and continue to see how these interventions affect communities
of color, NMAC requests $3.5 billion to support the Office of AIDS
Research. Additionally, NMAC believes that $35 billion to fund NIH's
overall programs and infrastructure.
Investments in prevention, treatment and research for HIV, as well
as co-morbidities, must keep pace with the epidemic if we are to see
real progress in reducing new infections, disease burden, and untimely
deaths due to this devastating disease.
______
Prepared Statement of the National Minority Consortia
The National Minority Consortia (NMC) submits this statement on the
fiscal year 2014 Advance appropriation for the Corporation for Public
Broadcasting (CPB). The NMC is a coalition of five national
organizations dedicated to bringing the unique voices and perspectives
from America's diverse communities into all aspects of public
broadcasting and to other media, including content transmitted
digitally over the Internet. The role we fulfill in this regard has
been crucial to public broadcasting's mission for over 30 years. We are
unique as organizations and as a coalition of organizations in the
services we provide in access, training and support for important and
timely public interest content to our communities and to public
broadcasting. We ask the Committee to:
--Direct CPB to increase its efforts for diverse programming with
commensurate increases for minority programming and for
organizations and stations located within underserved
communities;
--Direct CPB to establish a percentage basis for biennial funding of
the National Minority Consortia to permit long range financial
and strategic planning;
--Direct CPB to establish an annual ``report card'' on diversity to
track efforts to better represent the full breadth of the
American people and their experiences through public
television, public radio and non-profit media online;
--Direct CPB to publish on the Internet clear and enforced guidelines
for all CPB-directed funding, including funds jointly
administered by PBS and NPR, and end the closed-door funding
processes historically in place, especially as the current
practices favor existing relationships and can be seen as
biased against minority applicants, in particular.
Report Language.--We ask for report language, which recognizes the
contribution of the NMC and directs that the CPB partnership with us be
expanded. Specifically:
``The Committee recognizes the importance of the partnership CPB
has with the National Minority Public Broadcasting Consortia, which
helps develop, acquire, and distribute public television programming to
serve the needs of African American, Asian American, Latino, Native
American, Pacific Islander, and many other viewers. As many communities
in the Nation welcome increased numbers of citizens of diverse ethnic
backgrounds, the local public television stations should strive to meet
these viewers' needs. With an increased focus on programming to meet
local community needs, the Committee encourages CPB to support and
expand this critical partnership.''
Fiscal Year 2014 Appropriation.--We support a fiscal year 2014
advance appropriation for CPB of $495 million, which recognizes the
need to develop content that reaches across traditional media
boundaries, such as those separating television and radio. However, we
feel strongly that should CPB receive this appropriation, CPB should be
directed to engage in transparent and fair funding practices that
guarantee all applicants equal access to these public resources. In
particular, we urge Congress to direct CPB to insert language in all of
its funding guidelines that encourages and rewards public media that
fully represents and reaches a diverse American public.\1\
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\1\ According to the 2008 Public Radio Tech Survey, 90 percent of
public radio listeners are white. Of those, 84 percent are college-
educated, with 48 percent having graduate degrees. This compares to
just 9 percent of Americans who have postgraduate degrees. It is
therefore mandatory that we prioritize actually ``reaching'' a diverse
audience of Americans and not simply reflecting diverse and often
misleading staffing numbers to measure public media's effectiveness in
serving all of the American taxpayers that fund CPB.
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While public broadcasting continues to uphold strong ethics of
responsible journalism and thoughtful examination of American history,
life and culture, including the ways we are a part of a global society,
it has not kept pace with our rapidly changing public as far as
diversity is concerned. Members of minority groups continue to be
underrepresented on both the programming and oversight levels within
public broadcasting as well as on the content production side. There
are fewer than five executives of diverse background at the highest
levels in the three leading organizations within public broadcasting.
This is unacceptable in America today, where minorities comprise over
35 percent of the population.
Public broadcasting has the potential to be particularly important
for our Nation's growing minority and ethnic communities, especially as
we transition to a broadband-enabled, 21st century workforce that
relies on the skills and talent of all of our citizens. While there is
a niche in the commercial broadcast and cable world for quality
programming about our communities and our concerns, it is in the public
broadcasting sphere where minority communities and producers should
have more access and capacity to produce diverse high-quality
programming for national audiences. We therefore, urge Congress to
insert strong language in this act to ensure that this is the case and
that these opportunities are made available to minorities and other
underserved communities.
About the National Minority Consortia.--With primary funding from
the CPB, the NMC serves as an important component of American public
television as well as content delivered over the Internet. By training
and mentoring the next generation of minority producers and program
managers as well as brokering relationships between content makers and
distributors (such as PBS, APT and NETA), we are in a perfect position
to ensure the future strength and relevance of public television and
radio television programming from and to our communities. However,
these efforts are vulnerable because of chronic underfunding and lack
of meaningful and ongoing representation within CPB's decisionmaking
processes. This instability, coupled with what is essentially a
decrease in our funding over time, are the primary reasons that have
led to a public media that has become less diverse over the past 5
years.\2\
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\2\ CPB funding for the NMC remained flat for 13 years until fiscal
year 2008, at approximately $1 million per year per consortia. At that
time, we received a one-time increase of $150,000 per organization. In
fiscal year 2009, we received another one-time increase of
approximately $500,000 each, but have been told that does not reflect a
permanent increase. Over this same 13-year period, CPB's budget nearly
doubled.
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This is obviously not the case in the rest of America. With
minority populations already estimated at over 35 percent of the U.S.
population, it is more important that our public institutions reflect
this reality.
Individually, each Consortia organization is engaged in cultivating
ongoing relationships with the independent producer community by
providing technical assistance and program funding, support and
distribution. Often the funding we provide is the initial seed money
for a project, thus allowing it to develop. We also provide numerous
hours of programming to individual public television and radio
stations, programming that is beyond the production reach of most local
stations. To have a real impact, we need funding that recognizes and
values the full extent of minority participation in public life.
While the Consortia organizations work on projects specific to
their communities, the five organizations also work collaboratively. An
example of a joint production in which the NMC provided the initial
seed money is ``Unnatural Causes: Is Inequality Making Us Sick?'', a
multi-part series that uncovers the roots of racial and socio-economic
disparities in health and spotlights community initiatives to achieve
health equality. Our seed money enabled the project to go forward and
to attract additional funding. We are also co-producers of and
presenters in this series. Additionally, we jointly funded an online
initiative around the Presidential Election in 2008 and continue to
explore as a group other topics of national importance.
CPB Funds for the National Minority Consortia.--The NMC receives
funds from two portions of the CPB budget: organizational support funds
from the Systems Support and programming funds from the Television
Programming funds. The organizational support funds we receive are used
for operations requirements and also for programming support activities
and for outreach to our communities and system-wide within public
broadcasting. The programming funds are re-granted to producers, used
for purchase of broadcast rights and other related programming
activities. Each organization solicits applications from our
communities for these funds. A brief description of our organizations
follows:
Center for Asian American Media (CAAM).--CAAM's mission is to
present stories that convey the richness and diversity of Asian
American experiences to the broadest audience possible. We do this by
funding, producing, distributing and exhibiting works in film,
television and digital media. Over our 25-year history we have provided
funding for more than 200 projects, many of which have gone on to win
Academy, Emmy and Sundance awards, examples of which are Daughter from
Danang; Of Civil Rights and Wrongs: The Fred Korematsu Story; and Maya
Lin: A Strong Clear Vision. CAAM presents the annual San Francisco
International Asian American Film Festival and distributes Asian
American media to schools, libraries and colleges. CAAM's newest
department, Digital Media is becoming a respected leader in bringing
innovative content and audience engagement to public media. CAAM is
partnering with Pacific Islanders in Communications on a documentary
about YouTube ukulele sensation Jake Shimabukuro.
Latino Public Broadcasting (LPB).--LPB supports the development,
production and distribution of public media content that is
representative of Latino people, or addresses issues of particular
interest to Latino Americans. Since 1998, LPB has awarded over $6
million to Latino Independent Producers, provided over 120 hours to
public television, funded over 200 projects and conducted over 150
professional development workshops. LPB also produces Voces, the only
Latino anthology series on public television, which showcases the
impact of Latino culture on American life through music, sports,
education and public service. In addition, LPB had several high profile
programs on PBS including the concert special, In Performance at the
White House: Fiesta Latina, that was re-broadcast on Telemundo and V-me
and Latin Music USA, a four part series about the history and impact of
Latino music on American culture which reached 14.7 million viewers, 16
percent of whom were Hispanic households (well above the PBS average).
This past year, LPB launched the Equal Voice Community Engagement
Campaign using the documentary film Raising Hope: The Equal Voice
Story, a film about strategies to overcome poverty. The community
engagement campaign helped PBS stations demonstrate how they too can
become advocates for their communities. Currently, LPB is working on a
6 hour series titled The Latino Americans, about the history of Latinos
in the United States.
The National Black Programming Consortium (NBPC).--NBPC develops,
produces and funds television and more recently audio and online
programming about the black experience for American public media
outlets. Since its founding in 1979, NBPC has provided hundreds of
broadcast hours documenting African American history, culture and
experience to public television and launched major initiatives that
have brought important public media content to diverse audiences. In
2010, the National Black Programming Consortium launched an ambitious
new project designed to re-engineer public media to better involve and
inform diverse users in the digital era: The Public Media Corps (PMC).
The PMC is a new national public media service that helps local
stations to forge relationships with underserved communities through
content production, local events, and digital media training. By
recruiting, training and supporting the work of young, tech savvy
``fellows'' from these communities the PMC provides both stations and
community partner organizations with a blueprint for not only
connecting with audiences who have traditionally not found public
broadcasting relevant to their lives, but also by providing them with
access to emerging participatory platforms.
Native American Public Telecommunications (NAPT).--NAPT shares
Native stories with the world through support of the creation,
promotion and distribution of Native media. Founded in 1977, through
various media--public television and radio, and the Internet--NAPT
brings awareness of Indian and Alaska Native issues.
In 2010 NAPT presented eight Native American documentaries to PBS
stations nationwide and launched a search capable educational micro-
site featuring educational guides, post-viewer discussion guides,
digital media clips, and interactive time lines. NAPT offered producers
numerous workshops related to media maker topics such as preparation
for broadcast, marketing your film on a budget, station carriage,
online promotional tools, podcasting and more through nationwide media
maker training offerings and conference attendance opportunities. In
addition NAPT launched the Multimedia Fellowship Program, where two
full-time Native American journalists wrote and produced multimedia
projects about national Native American issues. Through our location at
the University of Nebraska-Lincoln, we offer student employment,
internships and fellowships. Reaching the general public and the global
market is the ultimate goal for the dissemination of Native-produced
media.
Pacific Islanders in Communications (PIC).--Since 1991, PIC has
delivered programs and training that bring voice and visibility to
Pacific Islander Americans. PIC produced the award winning film One
Voice which tells the story of the Kamehameha Schools Song Contest.
Other PBS broadcasts include There Once Was an Island, about the
devastating effects of global warming on the Pacific Islands and
Polynesian Power: Islanders in Pro Football. Currently PIC is
developing a multi-part series, Expedition: Wisdom, in partnership with
the National Geographic Society. PIC offers a wide range of development
opportunities for Pacific Island producers through travel grants,
seminars and media training. Producer training programs are held in the
U.S. territories of Guam and American Samoa, as well as in Hawai`i, on
a regular basis.
Thank you for your consideration of our recommendations. We see new
opportunities to increase diversity in programming, production,
audience, and employment in the new media environment, and we thank
Congress for support of our work on behalf of our communities.
______
Prepared Statement of the National Multiple Sclerosis Society
Multiple sclerosis (MS), an unpredictable, often disabling disease
of the central nervous system, interrupts the flow of information
within the brain, and between the brain and body. Symptoms range from
numbness and tingling to blindness and paralysis. The progress,
severity, and specific symptoms of MS in any one person cannot yet be
predicted, but advances in research and treatment are moving us closer
to a world free of MS. Most people with MS are diagnosed between the
ages of 20 and 50, with at least two to three times more women than men
being diagnosed with the disease. MS affects more than 400,000 people
in the United States.
The National MS Society recommends the following funding levels for
agencies and programs that are of vital importance to Americans living
with MS in fiscal year 2012.
Lifespan Respite Care Program
Respite care services are a critical part of ensuring quality home-
based care for people living with MS. Because of the importance of
these services, the National MS Society requests the inclusion of $50
million in the fiscal year 2012 Labor-HHS-Education appropriations bill
to fund lifespan respite programs. The Lifespan Respite Care Program,
enacted in 2006, provides competitive grants to states to establish or
enhance statewide lifespan respite programs, improve coordination, and
improve respite access and quality. States provide planned and
emergency respite services, train and recruit workers and volunteers,
and assist caregivers in gaining access to services. Perhaps the most
critical aspect of the program for people living with MS is that
Lifespan Respite serves families regardless of special need or age--
literally across the lifespan. Much existing respite care has age
eligibility requirements and since MS is typically diagnosed between
the ages of 20 and 50, Lifespan Respite Programs are often the only
open door to needed respite services.
Up to one-quarter of individuals living with MS require long-term
care services at some point during the course of the disease. Often, a
family member steps into the role of primary caregiver to be closer to
the individual with MS and to be involved in care decisions.
Approximately 65 million family caregivers in the Nation are
responsible for 80 percent of long-term care. The value of
uncompensated family care giving services keeps growing and is
currently estimated at $375 billion per year--more than total Medicaid
spending and almost as high as Medicare spending. Family caregiving,
while essential, can be draining and stressful, with caregivers often
reporting difficulty managing emotional and physical stress, finding
time for themselves, and balancing work and family responsibilities.
The impact is so great, in fact, that American businesses lose an
estimated $17.1 to $33.36 billion each year due to lost productivity
costs related to caregiving responsibilities. Providing $50 million for
Lifespan Respite in fiscal year 2012 would provide the critical
infrastructure to states to improve access to respite services,
allowing family caregivers to take a break from the daily routine and
stress of providing care, improve overall family health, and help
alleviate the monstrous financial impact that caregiver strain
currently has on American businesses.
National Institutes of Health
We urge Congress to continue its investment in innovative medical
research that can help prevent, treat, and cure diseases such as MS by
providing $35 billion for the National Institutes of Health (NIH) in
fiscal year 2012.
The NIH conducts and sponsors a majority of the MS related research
carried out in the United States. Approximately $151 million of fiscal
year 2010 and Recovery Act appropriations were directed to MS-related
research. An invaluable partner, the NIH has helped make significant
progress in understanding MS. NIH scientists were among the first to
report the value of MRI in detecting early signs of MS, before symptoms
even develop. Advancements in MRI technology allow doctors to monitor
the progression of the disease and the impact of treatment.
Research during the past decade has enhanced knowledge about how
the immune system works, and major gains have been made in recognizing
and defining the role of this system in the development of MS lesions.
These NIH discoveries are helping find the cause, alter the immune
response, and develop new MS therapies that are now available to modify
the disease course, treat exacerbations, and manage symptoms. The NIH
also directly supports jobs in all 50 States and 17 of the 30 fastest
growing occupations in the United States are related to medical
research or healthcare. More than 83 percent of the NIH's funding is
awarded through almost 50,000 competitive grants to more than 325,000
researchers at over 3,000 universities, medical schools, and other
research institutions in every State. To continue the forward momentum
in the ability to aggressively combat, treat, and one day cure diseases
like MS, the National MS Society requests Congress provide $35 billion
for the NIH in fiscal year 2012.
Centers for Medicare & Medicaid Services
Medicare
Medicare programs are a lifeline for people living with MS, as
approximately one-quarter of people living with MS rely on Medicare for
access to essential medical care. These programs ensure that
individuals living with MS have access to doctors, diagnostic
equipment, durable medical devices, MRIs, and prescription drugs among
other lifesaving treatments. Medicare also ensures full access to home
healthcare, which is vital for keeping individuals with disabilities,
like MS, in their communities and in their homes. Without Medicare,
people living with MS may not have access to some forms of medical care
and their quality of life may decrease.
The National MS Society is concerned about recent budget proposals
that would essentially convert Medicare from an entitlement program to
a voucher-type program. While proponents of these proposals believe
that they will cut costs of the program, in reality the voucher system
would primarily shift costs from the Medicare program to patients and
consumers. In fact, the Congressional Budget Office has estimated that
by 2030, the typical Medicare beneficiary would be required to pay more
than two-thirds of their medical costs. Additionally, according the
Kaiser Family Foundation, a typical 65-year-old retiring in 2022 would
be expected to devote nearly half their monthly Social Security checks
toward healthcare costs, more than double what they would spend under
current Medicare law.
Beginning in 2022, the proposed system would give new beneficiaries
money to purchase insurance from the private market, under the
assumption that beneficiaries can make better and more cost-effective
decisions about healthcare than the government and that this open
market will create competition that will help keep costs down. However,
the size of Medicare allows the program to impose lower rates on
medical services and thus, private plans on average are more expensive.
Therefore, the proposed voucher system may reduce costs within the
Medicare program but not within the overall healthcare system because
it will shift more cost to some of the most vulnerable patients in the
healthcare system. In order to continue to provide the adequate and
necessary care individuals with MS and other disabilities require,
Medicare must maintain its status as an entitlement program.
Medicaid
The National MS Society urges Congress to maintain funding for
Medicaid and reject proposals to cap or block grant the program.
Approximately 10 percent of people living with MS rely on Medicaid.
The program has a strong track record of providing services that grant
individuals with disabilities access to employment, cost-effective
health services, home- and community-based services, and long-term
care.
Capping or block-granting Medicaid will merely shift costs to
states, forcing states to shoulder a seemingly insurmountable financial
burden or cut services on which our most vulnerable rely. Capping and
block-granting could result in many more individuals becoming
uninsured, compounding the current problems of lack of coverage, over
flowing emergency rooms, limited access to long term services, and
increased healthcare costs in an overburdened system. By capping funds
that support home- and community-based care, such proposals would also
likely lead to an increased reliance on costlier institutional care
that contradicts the principles laid forth in the 1999 U.S. Supreme
Court Olmstead decision of integrating and keeping people with
disabilities in their communities.
While the economic situation demands leadership and thoughtful
action, the National MS Society urges Congress to remember people with
MS and all disabilities, their complex health needs, and the important
strides Medicaid has made for persons living with disabilities,
particularly in the area of community-based care and not modify the
program to their detriment.
Social Security Administration
The National MS Society urges Congress to provide $12.522 billion
for the Social Security Administration's (SSA) Limitations on
Administrative (LAE) Expenses to fund SSA's day-to-day operational
responsibilities and make key investments in addressing increasing
disability and retirement workloads, in program integrity, and in SSA's
Information Technology (IT) infrastructure.
Because of the unpredictable nature and sometimes serious
impairment caused by the disease, SSA recognizes MS as a chronic
illness or ``impairment'' that can cause disability severe enough to
prevent an individual from working. During such periods, people living
with MS are entitled to and rely on Social Security Disability
Insurance (SSDI) or Supplemental Security Income (SSI) benefits to
survive. People living with MS, along with millions of others with
disabilities, depend on SSA to promptly and fairly adjudicate their
applications for disability benefits and to handle many other actions
critical to their well-being including: timely payment of their monthly
benefits; accurate withholding of Medicare Parts B and D premiums; and
timely determinations on post-entitlement issues, e.g., overpayments,
income issues, prompt recording of earnings.
With an expected increase in disability claims of nearly 29 percent
between fiscal year 2008 and fiscal year 2010, SSA faces an
unprecedented backlog in unprocessed disability claims. The average
processing time is fortunately improving due to recent investments in
and appropriations to SSA and as of March 2010, was approximately 437
days or a little more than 14 months. This progress must continue.
Providing at least $12.522 billion for the SSA is necessary to
continue these programs and advancements, which are integral parts of
efficiently and effectively getting benefits to individuals with
disabilities, including those with MS.
Food and Drug Administration
Because of the tremendous impact the FDA has on the development and
availability of drugs and devices for individuals with disabilities,
the National MS Society requests that Congress provide a 15 percent
increase over the fiscal year 2011 budget.
Advancements in medical technology and medical breakthroughs play a
pivotal role in decreasing the societal costs of disease and
disability. The FDA is responsible for approving drugs for the market
and in this capacity has the ability to keep healthcare costs down.
Each dollar invested in the life-science research regulated by the FDA
has the potential to save upwards of $10 in health gains. Breakthroughs
in medication and devices can reduce the potential costs of disease and
disability in Medicare and Medicaid and can help support the healthier,
more productive lives of people living with chronic diseases and
disabilities, like MS. The approval of low-cost generic drugs saved the
healthcare system $140 billion last year and nearly $1 trillion over
the past decade. However, recent funding constraints have resulted in a
2 year backlog of generic drug approval applications and could
potentially cost the Federal Government and patients billions of
dollars in the coming years. The potential for these cost-saving
medical breakthroughs and overall healthcare savings relies on a
vibrant industry and an adequately funded FDA. Therefore, Congress is
urged to provide the FDA with a 15 percent increase to address this
backlog.
Conclusion
The National MS Society thanks the Committee for the opportunity to
provide written testimony and our recommendations for fiscal year 2012
appropriations. The agencies and programs we have discussed are of
vital importance to people living with MS and we look forward to
continuing to working with the Committee to help move us closer to a
world free of MS.
______
Prepared Statement of the National Network to End Domestic Violence
Introduction
I am submitting testimony to request a targeted investment of $196
million in the Family Violence Prevention and Services Act (FVPSA) and
the Violence Against Women Act (VAWA) programs administered by the U.S.
Department of Health and Human Services fiscal year 2012 budget
(specific requests detailed below).
Labor, Health and Human Services Chairman Harkin, Ranking Member
Shelby, Chairman Inouye, Ranking Member Cochran and distinguished
members of the Appropriations Committee, thank you for this opportunity
to submit testimony to the Committee on the importance of investing in
FVPSA and VAWA programs. I sincerely thank the Committee for its
ongoing support and investment in these lifesaving programs. These
investments help to bridge the gap created by an increased demand and a
lack of available resources.
I am the President of the National Network to End Domestic Violence
(NNEDV), the Nation's leading voice on domestic violence. We represent
the 56 State and territorial domestic violence coalitions, including
those in Iowa, Alabama, Hawaii and Mississippi, their 2,000 member
domestic violence and sexual assault programs, as well as the millions
of victims they serve. Our direct connection with victims and victim
service providers gives us a unique understanding of their needs and
the vital importance of continued Federal investments.
Incidence, Prevalence, Severity and Consequences of Domestic and Sexual
Violence
The crimes of domestic and sexual violence are pervasive, insidious
and life-threatening. Nearly one in four women are beaten or raped by a
partner during adulthood \1\ and 2.3 million people are raped and/or
physically assaulted by a current or former spouse or partner each
year.\2\ One in six women and 1 in 33 men have experienced an attempted
or completed rape.\3\ Of course the most heinous of these crimes is
murder. Every day in the United States, an average of three women are
killed by a current or former intimate partner.\4\In 2005 alone, 1,181
women were murdered by an intimate partner in the United States \5\ and
approximately one-third of all female murder victims are killed by an
intimate partner.\6\
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\1\ AU.S. Department of Justice, National Institute of Justice and
Centers for Disease Control and Prevention. (July 2000). Extent,
Nature, and Consequences of Intimate Partner Violence: Finding from the
National Violence Against Women Survey. Washington, DC. Tjaden, Pl., &
Thoennes., N.
\2\ Ibid.
\3\ U.S. Department of Justice, Prevalence, Incidence, and
Consequences of Violence Against Women: Findings from the National
Violence Against Women Survey (1998).
\4\ Bureau of Justice Statistics (2008). Homicide Trends in the
U.S. from 1976-2005. Dept. of Justice.
\5\ Ibid.
\6\ Bureau of Justice Statistics, Homicide Trends from 1976-1999.
(2001)
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The cycle of intergenerational violence is perpetuated as children
are exposed to violence. Approximately 15.5 million children are
exposed to domestic violence every year.\7\ One study found that men
exposed to physical abuse, sexual abuse and adult domestic violence as
children were almost 4 times more likely than other men to have
perpetrated domestic violence as adults.\8\
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\7\ McDonald, R., et al. (2006). ``Estimating the Number of
American Children Living in Partner-Violence Families.'' Journal of
Family Psychology, 30(1), 137-142.
\8\ Greenfield, L. A. (1997). Sex Offences and Offenders: An
Analysis of Date on Rape and Sexual Assault. Washington, DC. Bureau of
Justice Statistics, U.S. Department of Justice.
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In addition to the terrible cost domestic and sexual violence have
on the lives of individual victims and their families, these crimes
cost taxpayers and communities. In fact, the cost of intimate partner
violence exceeds $5.8 billion each year, of which $4.1 billion is for
direct medical and mental healthcare services.\9\ Research shows that
intimate partner violence costs a health insurance plan $19.3 million
each year for every 100,000 women between the ages of 18 and 64 who are
enrolled.\10\ Domestic violence costs U.S. employers an estimated $3 to
$13 billion annually.\11\ Between one-quarter and one-half of domestic
violence victims report that they lost a job, at least in part, due to
domestic violence.
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\9\ National Center for Injury Prevention and Control. Costs of
Intimate Partner Violence Against Women in the United States. Atlanta
(GA): Centers for Disease Control and Prevention; 2003.
\10\ Ibid.
\11\ Bureau of National Affairs Special Rep. No. 32, Violence and
Stress: The Work/Family Connection 2 (1990); Joan Zorza, Women
Battering: High Costs and the State of the Law, Clearinghouse Rev.,
Vol. 28, No. 4, 383, 385; Supra, see endnote 10.
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Despite this grim reality, we know that when a coordinated response
is developed and immediate, essential services are available, victims
can escape from life-threatening violence and begin to rebuild their
shattered lives. Funding these programs is fiscally sound, as they save
lives, prevent future violence, keep families and communities safe, and
save our Nation money. While Federal funding cannot meet all the needs
of victims, it leverages State, private and local dollars to provide
consistent funding streams to lifesaving services. To address unmet
needs and build upon its successes, VAWA/FVPSA should receive targeted
investments in fiscal year 2012.
Family Violence Prevention and Services Act (FVPSA) (Administration
for Children and Families)--$140 million request. Since its passage in
1984 as the first national legislation to address domestic violence,
FVPSA has remained the only funding directly for shelter programs. For
more than 25 years, FVPSA has made substantial progress toward ending
domestic violence. Despite the progress and success brought by FVPSA, a
strong need remains for FVPSA-funded services for victims.
Domestic violence is more than a crime--it is a public health
issue. To address this issue, there are more than 2,000 community-based
domestic violence programs for victims and their children
(approximately 1,500 of which are FVPSA-funded through State formula
grants). These programs offer services such as emergency shelter,
counseling, legal assistance, and preventative education to millions of
women, men and children annually and are at the heart of our Nation's
response to domestic violence.\12\ These effective programs save and
rebuild lives. A recently released multi-state study conclusively shows
that the Nation's domestic violence shelters are addressing victims'
urgent and long-term needs and are helping victims protect themselves
and their children. This same study indicated that, if shelters did not
exist, the consequences for victims would be dire, including
``homelessness, serious losses including children [or] continued abuse
or death.''
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\12\ National Coalition Against Domestic Violence, Detailed Shelter
Surveys (2001).
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According to a report by the National Network to End Domestic
Violence, in one day in 2010, more than 70,000 victims of domestic
violence received services, of which 50 percent found refuge in
emergency shelters and transitional housing. Of the 23,743 victims in
emergency shelter that day, more than 50 percent were children.
However, on that same day, more than 9,500 requests for services by
adults and children were unmet due to lack of funding.
Addressing the Needs of Children and Breaking the Intergenerational
Cycle of Violence
In addition to providing crisis services to adults fleeing
violence, FVPSA helps to break the intergenerational cycle of violence.
Approximately one-half to two-thirds of residents in domestic violence
shelters are children. In 2010, Congress reauthorized FVPSA that
included a newly authorized program, Specialized Services for Abused
Parents and Their Children. In fiscal year 2010, Congress appropriated
nearly $131 million for FVPSA, which for the first time triggered
spending dedicated to specialized service for children who witness
domestic violence.
The newly authorized Children's program is an important step in the
Federal Government's response to domestic violence. It will build an
evidence base for services, strategies, advocacy and interventions for
children and youth exposed to domestic violence. Although many domestic
violence programs currently serve children, this program will expand
the capacity of domestic violence programs to address the needs of
children and adolescents coming into emergency shelters. To ensure that
children's needs are met in the community, the program will create
statewide and local improvements in systems and responses to children
and youth exposed to domestic violence. Finally, the program will
eventually lead to nationwide dissemination of lessons learned and
strategies for implementation in communities across the country.
Currently, four States have received modest funding grants to build
upon their work and lay groundwork for the national project. The New
Jersey Coalition for Battered Women will expand an established model
program, Peace: A Learned Solution (PALS), which provides children ages
3 through 17 with creative arts therapy to help them heal from exposure
to domestic violence. The Wisconsin Coalition Against Domestic Violence
will launch the Safe Together Project, which will increase the capacity
of Wisconsin domestic violence programs, particularly those serving
under-represented or culturally specific populations, to support non-
abusing parents and mitigate the impact of exposure to domestic
violence on their children. The Alaska Network on Domestic Violence and
Sexual Assault will improve services and responses to Alaska's families
by addressing the lack of coordination between domestic violence
agencies and child welfare systems. Together, grantees will serve as
leaders for expanding a broader network for support; developing
evidence-based interventions for children, youth and parents exposed to
domestic violence; and building national implementation strategies that
will lead to local improvements in domestic violence program and
community systems interventions.
Unfortunately, the rescission in the final fiscal year 2011 budget
cut all funding for the new children's program. If the funding is not
restored to at least $140 million in fiscal year 2012, these innovative
and cost-saving projects will be in jeopardy.
The Increased Need for Funding
Many programs across the country use their FVPSA funding to keep
the lights on and their doors open. We cannot overstate how important
this is: victims must have a place to flee to when they are escaping
life-threatening violence. Countless shelters across the country would
not be able to operate without FVPSA funding. As increased training for
law enforcement, prosecutors and court officials has greatly improved
the criminal justice system's response to victims of domestic violence,
there is a corresponding increase in demand for emergency shelter,
hotlines and supportive services. Additionally, demand has increased as
a result of the economic downturn and victims with fewer personal
resources become increasingly vulnerable. Since the economic crisis
began, three out of four domestic violence shelters have reported an
increase in women seeking assistance from abuse.\13\ As a result,
shelters overwhelmingly report that they cannot fulfill the growing
need for these services.
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\13\ Mary Kay's Truth About Abuse. Mary Kay Inc. (May 12, 2009).
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In the current economic climate, the demand for domestic violence
services has increased precisely at the time when programs are
struggling to maintain State and private funding to meet the demand. In
fact, the National Domestic Violence Census found that in 2010, 1,441
(82 percent) domestic violence programs reported a rise in demand for
services, while at the same time, 1,351 (77 percent) programs reported
a decrease in funding.\14\ Between 2009 and 2010, domestic violence
programs laid off or did not replace nearly 2,000 staff positions
including counselors, advocates and children's advocates, and a number
of shelters around the country closed. In 2009, although FVPSA-funded
domestic violence programs provided shelter and nonresidential services
to more than 1 million victims, an additional 167,069 requests for
lifesaving shelter went unmet due to lack of capacity. In Alabama, the
problem reflects the rest of the Nation. More than 30 percent of
Alabama programs reported that they did not have enough funding for
needed programs and services and 17 percent reported no available beds
or funding for hotels. In Iowa, nine programs statewide have already
closed their doors due to funding shortages and many other programs
have been forced to reduce the types of services provided, including
eliminating child advocate positions and prevention programs dedicated
to breaking the cycle of violence.
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\14\ Domestic Violence Counts 2010: A 24-Hour census of domestic
violence shelters and services across the United States. The National
Network to End Domestic Violence. (Jan. 2011).
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We cannot allow the gap between available resources and the
desperate need of victims to widen. For those individuals who are not
able to find safety, the consequences can be extremely dire, including
continued exposure to life-threatening violence or homelessness. It is
absolutely unconscionable that victims cannot find safety for
themselves and their children due to a lack of adequate investment in
these services. In order to meet the immediate needs of victims in
danger and to continue to break the intergenerational cycle of
violence, FVPSA funding must be increased to at least $140 million in
fiscal year 2012.
Additional Requests
National Domestic Violence Hotline (Administration for
Children and Families)--$5 million request
For the past 15 years the Hotline has provided 24-hour, toll-free
and confidential services, immediately connecting callers to local
service providers. During this economic downturn, crisis calls to the
Hotline have increased. Additionally, to address the specific needs of
dating violence victims, the Hotline launched the National Dating Abuse
Helpline, which has seen increased traffic recently.
DELTA Prevention Program (Centers for Disease Control and
Injury Prevention)--$6 million request
DELTA is one of the only sources of funding for domestic violence
prevention work. The program supports statewide projects that integrate
primary prevention principles and practices into local coordinated
community responses that address and reduce the incidence of domestic
violence. Currently, DELTA funds 56 Coordinated Community Response
Coalitions nationwide. In the first 3 years that DELTA funded these
projects, the primary prevention activities in communities increased
ten-fold. Nineteen States, including Alabama and Iowa, are currently
funded as DELTA Prep states by the Robert Wood Johnson Foundation.
Without additional DELTA funding, these States, ready in 2012 to fully
participate, may not be able to access CDC funding.
Rape Prevention and Education (RPE) (Centers for Disease
Control and Injury Prevention)--$42.6 million
request
This VAWA program administered through CDC strengthens national,
State and local sexual violence prevention efforts and the operation of
rape crisis hotlines. RPE funding provides formula grants to States and
territories to support rape prevention and education programs conducted
by rape crisis centers, State sexual assault coalitions and other
public and private nonprofit entities. Funding also supports the
National Sexual Violence Resource Center, which provides up-to-date
information regarding sexual violence to policymakers, Federal and
State agencies, college campuses, sexual assault and domestic violence
coalitions, local programs, the media, and the general public. Despite
its critical work, RPE has faced funding decreases since fiscal year
2006.
Violence Against Women Health Initiative (Office of Women's
Health)--$2.3 million request
This eight State and two tribe initiative promotes public health
programs that integrate domestic and sexual violence assessment and
intervention into basic care. Congress has included the program in the
last 3 fiscal years, but after the first year, the funding has not been
on top of the agency's overall budget. As a result, HHS has been forced
to cut other violence prevention activities to fund the program.
Funding is needed to identify best practices, conduct general
evaluation and disseminate the results to the field so that victims
nationwide can benefit.
Conclusion
Together, these LHHS programs work to prevent and end domestic and
sexual violence. While our country has made continued investments in
the criminal justice response to these heinous crimes, we need an equal
investment in the human service, public health and prevention response
in order to holistically address and end violence against women. We
know that our Nation is facing a difficult financial time and that
there is pressure to reduce spending. Investments in these vital, cost-
effective programs, however, help break the cycle of violence, reduce
related social ills and will save our Nation money now and in the
future.
______
Prepared Statement of the National Postdoctoral Association
Thank you for this opportunity to testify in regard to the fiscal
year 2012 funding for the National Institutes of Health (NIH). We are
writing today in regard to support for postdoctoral scholars,
specifically in support of the 4-percent increase in the NIH Ruth L.
Kirschstein National Research Service Awards (NRSA) training stipends,
as requested in the President's budget.
Background: Postdocs are the Backbone of U.S. Science and Technology
According to estimates by The National Science Foundation (NSF)
Division of Science Resource Statistics, there are approximately 89,000
postdoctoral scholars in the United States\1\. The NIH and the NSF
define a ``postdoc'' as: An individual who has received a doctoral
degree (or equivalent) and is engaged in a temporary and defined period
of mentored advanced training to enhance the professional skills and
research independence needed to pursue his or her chosen career path.
The number of postdocs has been steadily increasing. The incidence of
individuals taking postdoc positions during their careers has risen,
from about 25 percent of those with a pre-1972 doctorate to 46 percent
of those receiving their doctorate in 2002-05 \2\. Moreover, the number
of science and engineering doctorates awarded each year is steadily
rising with doctorates awarded in the medical/life sciences almost
tripling between 2003 and 2007 \3\.
---------------------------------------------------------------------------
\1\ National Science Foundation Division of Science Resource
Statistics. (January 2010). Science and engineering indicators 2010.
Arlington, VA: National Science Board.
\2\ Ibid.
\3\ Ibid.
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Postdocs are critical to the research enterprise in the United
States and are responsible for the bulk of the cutting edge research
performed in this country. Consider the following:
--According to the National Academies, postdoctoral researchers
``have become indispensable to the science and engineering
enterprise, performing a substantial portion of the Nation's
research in every setting.'' \4\
---------------------------------------------------------------------------
\4\ COSEPUP. (June 2001). Enhancing the postdoctoral experience for
scientists and engineers. Washington, D.C.: National Academy Press. p.
10.
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--Postdoctoral training has become a prerequisite for many long-term
research projects.\5\ In fact, the postdoc position has become
the de facto next career step following the receipt of a
doctoral degree in many disciplines.
---------------------------------------------------------------------------
\5\ COSEPUP. (June 2001). Enhancing the postdoctoral experience for
scientists and engineers. Washington, D.C.: National Academy Press. p.
11.
---------------------------------------------------------------------------
--The retention of women and under-represented groups in biomedical
research depends upon their successful and appropriate
completion of the postdoctoral experience.
--Postdoctoral scholars carry the potential to solve many of the
world's most pressing problems; they are the principal
investigators of tomorrow.
Unfortunately, postdocs are routinely exploited. They are paid a
low wage relative to their years of training and are often ineligible
for workman's compensation, disability insurance, paid maternity or
paternity leave, employer-sponsored medical benefits, and retirement
accounts.
The National Postdoctoral Association (NPA) advocates for policies
that support and enhance postdoctoral training. NPA members advocate
for policy change on the national level and also within the research
institutions that host postdoctoral scholars. To date, more than 150
institutions have adopted portions of the NPA's recommended practices,
but low compensation remains one of the serious issues faced by the
postdoctoral community.
Problem: NRSA Stipends are Low and Don't Meet Cost-of-Living Standards;
For Better or Worse, Postdoc Compensation is Based on NRSA
Stipends
The NIH leadership has been aware that the NRSA training stipends
are too low since 2001, after the publication of the results of the
National Academy of Sciences (NAS) study, Addressing the Nation's
Changing Needs for Biomedical and Behavioral Scientists. In response,
the NIH pledged (1) to increase entry-level stipends to $45,000 by
raising the stipends at least 10 percent each year and (2) to provide
automatic cost-of-living increases each year thereafter to keep pace
with inflation. Most recently, the 2011 NAS study, Research Training in
the Biomedical, Behavioral, and Clinical Research Sciences, called for,
among other recommendations, increased funding to support more NRSA
positions and to fulfill the NIH's 2001 commitment to increase pre-
doctoral and postdoctoral stipends.
Without sufficient appropriations from Congress, the NIH has not
been able to fulfill its pledge. In 2007, the stipends were frozen at
2006 levels and since then have not been significantly increased. The
stipends were increased by 1 percent each year in 2009 and 2010 and by
2 percent in 2011. The 2011 entry-level training stipend remains low,
at $38,496, the equivalent of a GS-8 position in the Federal Government
(NIH Statement NOT-OD-10-047), despite the postdocs' advanced degrees
and specialized technical skills. Furthermore, this stipend remains far
short of the promised $45,000. Certainly, it is not reflective of any
cost-of-living increases (please see Figure 1).
Figure 1
It is not only the NRSA fellows who remain undercompensated; the
impact of the low stipends extends beyond the NRSA-supported postdocs.
The NPA's research has shown that the NIH training stipends are used as
a benchmark by research institutions across the country for
establishing compensation for postdoctoral scholars. Thus, an
unintended consequence is that institutions undercompensate all of
their postdocs, who must then struggle to make ends meet, which in turn
affects their productivity and undermines their efforts to solve the
world's most critical problems. Additionally, many are leaving their
research careers behind because of the low compensation. In order to
keep the ``best and the brightest'' scientists in the U.S. research
enterprise, the NPA believes that it is crucial that Congress
appropriate funding for the 4-percent increase in training stipends, as
a moderate yet substantial step toward reaching the recommended entry-
level stipend of $45,000.
Solution: Keep the NIH's Original Promise to Raise the Minimum Stipends
We ask the Subcommittee to appropriate $794 million for the 4-
percent stipend increase, as requested in the President's proposed
budget (http://www.nih.gov/about/director/budgetrequest/
NIH_BIB_020911.pdf): As part of the President's initiative in fiscal
year 2012 to emphasize support for science, technology, engineering,
and mathematics (STEM) education programs, the budget proposes a 4
percent stipend increase for predoctoral and postdoctoral research
trainees supported by NIH's Ruth L. Kirschstein National Research
Service Awards program. A total of $794 million is requested in fiscal
year 2012 for this training program. The proposed increase in stipends
will allow NIH to continue to attract high quality research trainees
that will be available to address the Nation's future biomedical,
behavioral, and clinical research needs.
The NPA believes it is fair, just, and necessary to increase the
compensation provided to these new scientists, who make significant
contributions to the bulk of the research discovering cures for disease
and developing new technologies to improve the quality of life for
millions of people in the United States. Please do not hesitate to
contact us for more information. Thank you for your consideration.
______
Prepared Statement of the National Primate Research Centers
The Directors of the eight National Primate Research Centers
(NPRCs) respectfully submit this written testimony for the record to
the Senate Appropriations Subcommittee on Labor, Health and Human
Services, Education and Related Agencies. The NPRCs appreciate the
commitment that the Members of this Subcommittee have made to
biomedical research through your support for the National Institutes of
Health (NIH) and recommend that you provide $31.987 billion for NIH in
fiscal year 2012, which represents a 3.4 percent increase above the
fiscal year 2011 level. Within this proposed increase the NPRCs also
respectfully request that the Subcommittee provide strong support for
the NPRC P51 (base grant) program, which is essential for the
operational costs of the eight NPRCs. This support would help to ensure
that the NPRCs and other animal research resource programs continue to
serve effectively in their role as a vital national resource.
The mission of the National Primate Research Centers is to use
scientific discovery and nonhuman primate models to accelerate progress
in understanding human diseases, leading to better health. The NPRCs
collaborate as a transformative and innovative network to support the
best science and act as a resource to the biomedical research community
as efficiently as possible. There is an exceptional return on
investment in the NPRC program; $10 is leveraged for every $1 of
research support for the NPRCs. It is important to sustain funding for
the NPRC program and the NIH as a whole to continue to grow and develop
the innovative plan for the future of NIH.
NPRCs Contributions to NIH Priorities
The NPRCs activities are closely aligned with NIH's priorities. In
fact, NPRC investigators conduct much of the Nation's basic and
translational nonhuman primate research, facilitate additional vital
nonhuman primate research that is conducted by hundreds of
investigators from around the country, provide critical scientific
expertise, train the next generation of scientists, and advance
cutting-edge technologies. The NPRCs currently are engaged with NIH
staff in a comprehensive strategic planning process to further enhance
the capabilities of the NPRCs to serve as a resource across all NIH
institutes and centers. The NPRC consortium strategic plan has as its
center and driving force the scientific priorities that drive
translational work into better interventions and diagnostics for
improved human health. Outlined below are a few of the overarching
goals of the plan, including specifics of how the NPRCs are striving to
achieve these through programs and activities across the centers.
Advance Translational Research Using Animal Models.--Nonhuman
primate models bridge the divide between basic biomedical research and
implementation in a clinical setting. Currently, seven of the eight
NPRCs are affiliated and collaborate with NIH Clinical and
Translational Science Awards (CTSA) program through their host
institution. Specifically, the nonhuman primate models at the NPRCs
often provide the critical link between research with small laboratory
animals and studies involving humans. As the closest genetic model to
humans, nonhuman primates serve in the development process of new
drugs, treatments, and vaccines to ensure safe and effective use for
the Nation's public.
Strengthen the Research Workforce.--The success of the Federal
Government's efforts in enhancing public health is contingent upon the
quality of research resources that enable scientific research ranging
from the most basic and fundamental to the most highly applied.
Biomedical researchers have relied on one such resource--the NPRCs--for
nearly 50 years for research models and expertise with nonhuman
primates. The NPRCs are highly specialized facilities that foster the
development of nonhuman primate animal models and provide expertise in
all aspects of nonhuman primate biology. NPRC facilities and resources
are currently used by over 2,000 NIH funded investigators around the
country.
The NPRCs are also supportive of getting students interested in the
biomedical research workforce pipeline at an early age. For example,
the Yerkes NPRC supports a program that connects with local high
schools and colleges in Atlanta, Georgia, and invites students to
participate in research projects taking place at their field station
location.
Offer Technologies to Advance Translational Research and Expand
Informatics Approaches to Support Research.--The NPRCs have been
leading the development of a new Biomedical Informatics Research
Network (BIRN) for linking brain imaging, behavior, and molecular
informatics in nonhuman primate preclinical models of neurodegenerative
diseases. Using the cyberinfrastructure of BIRN for data-sharing, this
project will link research and information to other primate centers, as
well as other geographically distributed research groups.
Translational Science at the NPRCs
Animal models are an essential tool for translating basic
biomedical research to treatments and cures for patients, and the NPRCs
are a national resource instrumental to this effort. The network of the
eight NPRCs collaborates across many disciplines and institutions, with
the goal of advancing biomedical knowledge to understand disease and
improve human and animal health. Below are specific examples of
translational research conducted at each of the eight NPRCs.
In work conducted at the California National Primate Research
Center, Immunoglobulin G (IgG) antibodies purified from mothers of
children with autism and mothers of typically developing children were
injected into pregnant rhesus monkeys. The offspring were then
evaluated both neurologically and behaviorally. Offspring of mothers
who received IgG from mothers of children with autism demonstrated
significantly higher levels of repetitive behaviors than the offspring
who received control antibodies. There are currently no diagnostic
tests for autism. This research identifies one potential autoimmune
cause of autism. Moreover, detection of the maternal autoantibodies may
become an early diagnostic test for increased risk of having a child
with autism. This research, which relied on treating pregnant rhesus
monkeys, could not have been conducted without the facilities provided
by the national primate center.
Rhesus monkeys are widely used as animal models across many fields
of biomedical research because of their genetic, physiological,
behavioral, and anatomical similarities to humans. Scientists at the
New England National Primate Research Center are taking advantage of
the genetic similarity between rhesus monkeys and humans to create the
first monkey model of alcoholism genetics. Recent studies in human
alcoholics who are treated with naltrexone, a leading medication for
alcohol dependence, have shown that the medication works better in
people who have a specific genetic variant in the OPRM1 gene.
Scientists at the New England NPRC identified a similar genetic change
in the rhesus monkey OPRM1 gene, and have shown that monkeys with the
genetic change not only drink more alcohol but also have a comparable
genetically determined response to naltrexone to that seen in some
human alcoholics. This animal model gives scientists a new way to
create personalized medications for the treatment of alcoholism.
A new technique developed by a research team at the Oregon National
Primate Research Center offers a way for women with mitochondrial
diseases to have their own children without passing on defective
genetic material. According to the scientists, defective genes in
mitochondria can be passed to children at a frequency of 1 in 4,000
births and can lead to a variety of diseases. Symptoms of these
potentially fatal illnesses include dementia, movement disorders,
blindness, hearing loss, and problems of the heart, muscle, and kidney.
Following this successful study in a nonhuman primate model, scientists
believe that the technique could be applied quickly to humans to
prevent devastating diseases.
In 2005, researchers were looking for an animal model in which to
test a prototype device which might ameliorate degenerative disc
disease, a major cause of disability in working-age adults. The baboon
was chosen as an appropriate animal model for safety testing of the new
device because of its upright posture and the high magnitude of forces
placed on the vertebral column during the baboon's natural movement.
After a small pilot study, two subsequent pre-clinical studies were
performed at the Southwest National Primate Research Center. This was
an international effort in which specialists from Denmark, Canada, and
the United Kingdom visited the Primate Center on numerous occasions to
participate in the studies. The data from these studies along with data
from human clinical trials are now being assembled for submission to
the U.S. Food and Drug Administration for approval to use the
artificial disc in the United States as an alternative for the
treatment of degenerative lumbar spinal disease.
Testing the safety and efficacy of potential compounds in nonhuman
primates is virtually essential to advancing microbicide candidates to
clinical trials to prevent HIV transmission. There are far too many
microbicide candidates in development for all of them to be tested in
human trials. Over the years, the Tulane National Primate Research
Center has facilitated microbicide studies in nonhuman primates that
have led to human clinical trials, and have been the only successful
predictor of success or failure of compounds in these trials.
Furthermore, candidates that were not sufficiently tested in nonhuman
primates prior to human trials were shown to fail, and later studies,
once performed in macaques, confirmed they would have been predictive
of failure.
Studies completed at the Tulane NPRC have resulted in Merck
releasing one of these compounds to the International Partnership for
Microbicides (IPM) for microbicide development and human clinical
testing. Based on the positive results in macaque studies, the IPM also
has been granted license to pursue topical development of Pfizer's
Maraviroc as a microbicide. Nonhuman primate testing has resulted in a
wealth of information that has prevented expensive clinical trials in
humans that would have otherwise been fruitless.
Recovery of function after stroke, traumatic brain injury or spinal
cord injury is a significant medical challenge for millions of patients
in the United States. A promising new treatment for many of these
disabled survivors is an implantable recurrent brain-computer interface
(R-BCI). The Washington National Primate Research Center developed R-
BCI, a ``neurochip'' that records neural activity from the brain and
transforms that activity into stimuli delivered to the brain, spinal
cord, or muscles during free behavior. R-BCI technology has the
clinical potential to aid patients paralyzed by ALS or spinal cord
injury to regain some motor control directly from cortical cells and
may also be used to strengthen weak connections impaired by stroke.
Researchers and physicians are getter closer to a novel diagnostic
test for polycystic ovary syndrome (PCOS), which has staggering adverse
physiological, psychological, and financial consequences for women's
reproductive health. Scientists at the Wisconsin National Primate
Research Center are studying the profile of metabolites in both monkey
and patient samples of blood, urine, sweat, and breath molecules to
identify signals in the body's internal chemistry that are consistent
with the syndrome. From the vast pool of metabolites in their samples,
they have found a handful that rise to the surface as indicators of
PCOS. These telltale molecules could become the basis for the first-
ever diagnostic test for the syndrome.
A recent study based on work conducted at the Yerkes National
Primate Research Center with nonhuman primates illustrates the promise
of the Visual Paired Comparison (VPC) task for the detection of mild
memory impairment associated with Alzheimer's disease (AD). To
investigate this possibility, the Yerkes NPRC recently extended their
collaborations to include the Department of Computer Sciences at Emory
University. The results show that eye movement characteristics
including fixation duration, saccade length and direction, and re-
fixation patterns can be used to automatically distinguish impaired and
normal subjects. Accordingly, this generalized approach has proven
useful for improving early detection of AD, and may be applied, in
combination with other behavioral tasks, to examine cognitive
impairments associated with other neurodegenerative diseases.
Researchers at the Yerkes NPRC have developed two patents based on this
work.
The Need for Facilities Support
The NPRC program is a vital resource for enhancing public health
and spurring innovative discovery. In an effort to address many of the
concerns within the scientific community regarding the need for funding
for infrastructure improvements, the NPRCs support the continuation of
a robust construction and instrumentation grant program at NIH.
Animal facilities, especially primate facilities, are expensive to
maintain and are subject to abundant ``wear and tear.'' In prior years,
funding was set aside that fulfilled the infrastructure needs of the
NPRCs and other animal research facilities. The NPRCs ask the
Subcommittee to provide strong support for construction and renovation
of animal facilities through C06 and G20 programs. Without proper
infrastructure, the ability for animal facilities, including the NPRCs,
to continue to meet the high demand of the biomedical research
community will be unattainable.
Thank you for the opportunity to submit this written testimony and
for your attention to the critical need for primate research and the
continuation of infrastructure support, as well as our recommendations
concerning funding for NIH in the fiscal year 2012 appropriations bill.
______
Prepared Statement of the National Psoriasis Foundation
INTRODUCTION AND OVERVIEW
The National Psoriasis Foundation (the Foundation) appreciates the
opportunity to submit written public witness testimony regarding fiscal
year 2012 Federal funding for psoriasis and psoriatic arthritis data
collection and research. The Foundation is the largest psoriasis
patient advocacy organization and charitable funder of psoriatic
disease research worldwide, and has a primary mission of finding a cure
for psoriasis and psoriatic arthritis. Psoriasis, the Nation's most
prevalent autoimmune disease, affecting as many as 7.5 million
Americans, is a noncontagious, chronic, inflammatory, painful and
disabling disease for which there is no cure. It appears on the skin,
most often as red, scaly patches that itch, can bleed and require
sophisticated medical intervention. Up to 30 percent of people with
psoriasis also develop potentially disabling psoriatic arthritis that
causes pain, stiffness and swelling in and around the joints. There are
other serious risks associated with psoriasis--for example, diabetes,
cardiovascular disease, stroke and some cancers. Of serious concern is
that, beyond its terrible physical and psychosocial toll on
individuals, psoriasis also costs the Nation $11.25 billion annually.
The Foundation works with the research community and policymakers
at all levels of government to advance policies and programs that will
reduce and prevent suffering from psoriasis and psoriatic arthritis. In
2009, after examining existing scientific literature, clinical practice
and other components of psoriasis and psoriatic arthritis research and
care, the Foundation's medical and scientific advisors recommended the
creation of a federally organized, public health research program for
psoriasis and psoriatic arthritis to collect the information necessary
to address the key scientific questions in the study and treatment of
psoriatic disease. Responding to this recommendation, recognizing the
significant economic and social costs of psoriasis and psoriatic
arthritis and acknowledging the sizeable gap in the understanding of
these devastating conditions, in fiscal year 2010, Congress provided
$1.5 million to the Centers for Disease Control and Prevention (CDC) to
commence the first-ever Government effort to collect data on psoriasis
and psoriatic arthritis. Following this initial investment, in its
fiscal year 2011 Labor, Health and Human Services, Education (LHHS)
funding bill, the Senate provided a second allocation of $1.5 million
to continue these critical public health efforts. While that measure
was not enacted, we want to thank you and your colleagues for
recognizing the importance of psoriasis data collection and ask for
your support again in fiscal year 2012.
Since the initial appropriation, considerable progress has been
made in developing this data collection program in a thoughtful and
deliberate manner, and we commend CDC for its excellent methodology and
undertaking of this important effort. Thus far, Federal investment in
this effort has allowed the CDC, along with other Federal stakeholders,
to identify the key gaps in psoriatic disease data, including:
prevalence, age of onset, health-related quality of life, healthcare
utilization, burden of disease (employment, work, etc.), direct and
indirect costs, health disparities (age, gender, racial and ethnic),
comorbidities and an understanding of the course of the disease over
time. To uncover these important public health issues, in 2010, CDC
researchers collaborated with the Foundation's scientific and medical
advisors to establish a process by which a common basis for defining
and diagnosing psoriasis will be created and validated. This work, in
turn, will provide the insight, information and tools CDC researchers
need to determine the key psoriasis and psoriatic arthritis public
health questions to be pursued.
While the Foundation acknowledges the fiscal realities currently
facing Congress and this Nation, scientific discovery, at this moment,
is poised to advance the understanding and treatment of psoriasis and
psoriatic arthritis. As such, we respectfully request that Congress
continue to support this important initiative by appropriating level
funding, $1.5 million, in fiscal year 2012, to enable CDC to refine and
implement the psoriasis and psoriatic data collection process that has
been defined with previous funding. With fiscal year 2012 funding, CDC
researchers will be able to build upon the initial investment and
integrate psoriasis and psoriatic arthritis questions into existing
federally funded public health surveys, allowing economies of scale and
leveraging scarce resources to maximum their utility. The information
gleaned from this effort will help improve treatments and disease
management, identify new pathways for future research and drug
development and inform efforts to reduce the burden of disease on
patients, their families and society in general.
In addition, the Foundation urges the Subcommittee to support
robust fiscal year 2012 funding for the National Institutes of Health
(NIH). Sustaining Federal investment in biomedical research will help
support new investigator-initiated research grants for genetic,
clinical and basic research related to the understanding of the
cellular and molecular mechanisms of psoriasis and psoriatic arthritis.
Epidemiologic research at CDC, coupled with biomedical investigations
through NIH, will help further the Nation's understanding of psoriasis
and psoriatic arthritis and contribute to the development of better
therapies, improved treatments and disease management and
identification of ways in which comorbid conditions (e.g., heart
attack, cancer and diabetes) can be prevented or mitigated, in turn,
helping to save money and lives.
THE IMPACT OF PSORIASIS AND PSORIATIC ARTHRITIS ON THE NATION
Psoriasis requires steadfast treatment and lifelong attention,
especially since it most often strikes between ages 15 and 25. People
with psoriasis also have significantly higher healthcare resource
utilization, which costs more than that for the general population. Of
serious and increasing concern is mounting evidence that people with
psoriasis are at elevated risk for myriad other serious, chronic and
life-threatening conditions, including cardiovascular disease,
diabetes, stroke and some cancers. A higher prevalence of
atherosclerosis, chronic obstructive pulmonary disease, Crohn's
disease, lymphoma, metabolic syndrome and liver disease are found in
people with psoriasis, as compared to the general population. In
addition, people with psoriasis experience higher rates of depression
and anxiety, and people with severe psoriasis die 4 years younger, on
average, than people without the disease.
Despite some recent breakthroughs, many people with psoriasis and
psoriatic arthritis remain in need of effective, safe, long-term and
affordable therapies to allow them to function normally without both
physical and emotional pain. Due to the nature of the disease, patients
often have to cycle through available treatments, and while there are
an increasing number of methods to control the disease, there is no
cure. Many of the existing treatments can have serious side effects and
can pose long-term risks for patients (e.g., suppress the immune
system, deteriorate organ function, etc.). The lack of viable, long-
term methods of control for psoriasis can be addressed through Federal
commitment to epidemiological, genetic, clinical and basic research.
NIH and CDC research, taken together, hold the key to improved
treatment of these diseases, better diagnosis of psoriatic arthritis
and eventually a cure.
THE ROLE OF CDC IN PSORIASIS AND PSORIATIC ARTHRITIS RESEARCH
Despite our increased understanding of the autoimmune underpinnings
of psoriasis and its treatments, there is a dearth of population-based
epidemiology data on psoriatic disease. The majority of existing
studies of psoriasis are based on case reports, case series and cross-
sectional studies, which are likely biased toward more severe disease.
Several analytical studies have been performed to identify potentially
modifiable risk factors (e.g., smoking, diet, etc.) and some have
yielded conflicting, or inconsistent, results. Most case-control
studies looking for risk factors have been hospital-based, or specialty
clinic-based, and again may be biased toward more severe disease,
limiting their value for the larger population with psoriasis. Broadly
representative population-based studies of psoriasis reflecting the
full spectrum of disease are lacking and needed because there are still
wide gaps in our knowledge and understanding of psoriatic disease.
The CDC's psoriatic data collection effort will help to provide
scientists and clinicians with critical information to further their
understanding of: (a) how early intervention can prevent or delay the
development of comorbid conditions; (b) what can trigger relapses and
remissions; (c) some of the underlying causes of disease; (d) how
differentiating lifestyle and other environmental triggers might lead
to approaches that minimize exposure to these factors, thus reducing
the incidence and severity of disease; and (e) best practice
treatments, which in turn, would assist in streamlining appropriate
patient care and help reduce the use of ineffective, unnecessary and
costly treatments with challenging side effects.
PSORIASIS AND PSORIATIC ARTHRITIS RESEARCH AT NIH
It has taken nearly 30 years to understand that psoriasis is, in
fact, not solely a disease of the skin, but also of the immune system.
In recent years, scientists finally have identified some of the immune
cells involved in psoriasis. The last decade has seen a surge in our
understanding of these diseases, accompanied by new drug development.
Scientists are poised, as never before, to make major breakthroughs.
Within the NIH, the National Institute of Arthritis and
Musculoskeletal and Skin Diseases (NIAMS) is the principal Federal
Government agency that currently supports psoriasis research. We
commend NIAMS for its leadership role and very much appreciate its
steadfast commitment to supporting psoriasis research. Additionally, we
are pleased that research activities that relate to psoriasis or
psoriatic arthritis also have been undertaken at the National Institute
of Allergy and Infectious Diseases (NIAID), the National Cancer
Institute (NCI), the National Center for Research Resources (NCRR) and
the National Human Genome Research Institute (NHGRI); however, the
Foundation maintains that many more NIH institutes and centers--such as
the National Heart, Lung, and Blood Institute (NHLBI) and the National
Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)--have a
role to play, especially with respect to the myriad comorbidities of
psoriasis, as noted earlier. Although overall NIH funding levels
improved for psoriasis research in fiscal year 2010, and funding was
boosted through stimulus funding awards of $3 million in fiscal year
2009 and (an estimated) $2 million in fiscal year 2010, the Foundation
remains concerned that total NIH funding generally is not keeping pace
with psoriasis and psoriatic arthritis research needs. Our scientific
advisors believe a strong Federal investment in genetic, immunological
and clinical studies focused on understanding the mechanisms of
psoriasis and psoriatic arthritis is needed.
Given the myriad factors involved in psoriatic disease and its
comorbid conditions, the Foundation advocates increasing overall NIH
funding, with a focus on the aforementioned institutes. We recognize
and appreciate that the Nation faces significant budgetary challenges;
however, we maintain that an increased investment in the Nation's
biomedical research enterprise will help strengthen both the economy
and our understanding of psoriasis and psoriatic arthritis.
CONCLUSION/SUMMARY
On behalf of the more than 7.5 million people with psoriasis and
psoriatic arthritis, I want to thank the Committee for affording us the
opportunity to submit written testimony regarding the fiscal year 2012
investments we believe are necessary to ensure that our Nation
adequately addresses the needs of individuals and families affected by
psoriatic disease. By sustaining the Nation's biomedical research
efforts at NIH, coupled with a specific allocation of $1.5 million for
the CDC's psoriasis data collection efforts, Congress will help ensure
that the Nation makes progress in understanding the connection between
psoriasis and its comorbid conditions; uncovering the biologic aspects
of psoriasis and other risk factors that lead to higher rates of
comorbid conditions; and identifying ways to prevent and reduce the
onset of comorbid conditions associated with psoriasis.
Please feel free to contact the Foundation at any time; we are
happy to be a resource to Subcommittee members and your staff. Again,
we very much appreciate the Committee's attention to, and consideration
of, our fiscal year 2012 requests.
______
Prepared Statement of the National REACH Coalition
The National REACH Coalition represents more than 40 communities
and coalitions in 22 States working to eliminate racial and ethnic
health disparities and improve the health of Native American/Native
Hawaiian, African American, Latino, and Asian/Pacific Islander
populations and communities. The coalition is an outgrowth of the
Racial and Ethnic Approaches to Community Health (REACH U.S.) 2010
initiative, launched in 1999 by the Centers for Disease Control and
Prevention (CDC). REACH programs are embedded in communities with
disproportionately higher rates of chronic disease, hospitalization,
and premature death than other cities and counties across the country.
They provide coordination and leadership for the advancement and
translation of community-based participatory research into evidence-
based practices, policies, and community engagement.
For the fiscal year 2012 funding cycle, the National REACH
Coalition requests the Labor, Health and Human Services, Education and
Related Agencies (Labor-HHS) Subcommittee to fully fund, at current
levels, the CDC's REACH program as a discrete line item in CDC's
National Center for Chronic Disease Prevention and Health Promotion or
as a specific initiative within the Public Health and Prevention Trust.
The NRC gratefully acknowledges the strong bipartisan support that
the Senate Labor-HHS Subcommittee has provided to the REACH U.S.
program over the years. Working in communities that are among the
hardest hit by the recession, REACH programs provide a cost effective
strategy to improve health outcomes and close the health gap. We
understand the purpose of the newly established Community
Transformation Grants (CTG) program to address health disparities in
addition to chronic disease. However, the severity of discrepancy in
health conditions among REACH-serving populations requires specific and
intentional interventions and it is not sufficient for this to occur
only through the CTG program. The generalized approach offered by CTG
has been used over the last several decades and has resulted in no
significant reduction in health disparities. Research data support the
conclusion that to effectively close the gap in health outcomes in our
country, there remains a definitive need for a program committed solely
to the elimination of racial and ethnic health disparities.
REACH programs have been successful in mobilizing community
resources, addressing policy, systems, and environmental change, and
creating a shared vision to achieve healthy communities for racial and
ethnic minorities. REACH programs focus on a variety of health issues,
most notably chronic diseases such as cardiovascular disease, diabetes,
HIV/AIDS, and cancer, as well as the contributors to these diseases,
which include smoking, low physical activity, obesity, poor screening
rates, and lack of prevention and disease management activities.
Chronic diseases account for the largest health gap among racial and
ethnic minority populations and are the Nation's leading cause of
morbidity and mortality, accounting for 70 percent of all deaths.
Collectively, chronic diseases are responsible for 75 cents of every
dollar spent on healthcare in the United States.
REACH U.S. programs are working hard to eliminate these health
disparities and many have seen successful outcomes in their
communities. REACH programs nationwide have engaged hundreds of local
coalition members and improved the lives of thousands of program
participants. As a result, REACH communities are testing, evaluating,
and implementing practice and evidence-based interventions that reduce
the human and financial cost of these preventable diseases and
associated risk factors. REACH has achieved significant policy and/or
systems change in public policy, healthcare and preventative services,
and health education.
Some of our recent successes in program intervention and policy
change include:
--In South Carolina, the REACH Charleston and Georgetown Diabetes
Coalition reports that a 21 percent gap in blood sugar testing
between African Americans and the general population has been
virtually eliminated. Amputations among African-American males
with diabetes have been reduced by over 33 percent.
--In Macon County, Alabama, the REACH Alabama Breast and Cervical
Cancer Coalition reports that disparities in mammography
screening between the general population and African American
women decreased from 15 percent to 2 percent within 5 years.
--In Lawrence, Massachusetts, Latino CEED: REACH New England improved
14 healthcare indicators and outcomes for over 3200 Latinos
with diabetes over the past decade, including four indicators
now on par with the U.S. general population. One significant
improvement was the percentage of Latino patients whose blood
sugar was controlled, increasing from 15 percent to 45 percent
as a result of REACH interventions.
--In New York City, Bronx Health REACH led local partners in the ``1
percent Or Less'' campaign to eliminate whole milk and reduce
the availability of sweetened milk in NYC public schools, where
25 percent of children in elementary schools are obese. By
eliminating whole milk, the NYC Department of Health and Mental
Hygiene calculated that per student per year almost 5,960
calories and 619 grams of fat were eliminated, or more than one
pound of weight per child per year.
--In South Los Angeles, Community Health Councils, a REACH grantee,
addressed the lack of healthy food options in a predominantly
African American community by advocating for local policy
changes. These included an incentive package to attract 3 new
grocery stores and sit-down restaurants into vulnerable
communities and the adoption of an ordinance by the city to
prohibit new stand-alone fast food restaurants within one half
mile of an existing fast food chain.
In addition to the individual community improvements, data from the
REACH national behavioral risk factor survey show that the REACH
program is having a significant impact in risk reduction and disease
management across communities and program wide. In 11 REACH communities
evaluated between 2003 and 2009, there was meaningful improvement for
all races in 34 out of 48 health risk factors, which include smoking
prevalence, diabetes management, vaccination, and physical activity.
REACH has demonstrated for the first time at a significant level that
the elimination of health disparities is a ``winnable battle''.
The success of REACH communities in reducing health risk and
improving patient compliance and disease management is particularly
striking when compared to overall U.S. trends. Some recent data trends
include:
--From 2001 to 2009, the smoking prevalence in REACH communities for
Asian men decreased from 30.5 percent to 13.8 percent in
contrast to the 16.9 percent of Asian men that smoke in the
U.S. overall. Smoking prevalence in Hispanic men decreased from
28.8 percent to 17.6 percent in contrast to the 19 percent of
Hispanic men that smoke in the U.S. overall.
--From 2001 to 2004, African Americans transitioned from being less
likely to more likely than the general population to have their
cholesterol checked.
--Health education interventions in REACH communities resulted in
larger rates (as much as 66 percent) of improvement across
racial and ethnic populations for smoking, physical activity,
consumption of fruits and vegetables, etc., than national
trends between 2001 and 2009.
In addition to improving health outcomes, REACH programs also build
capacity in the communities in which they operate. REACH programs train
community and coalition members to work at the grassroots level on
health issues, which can lead to employment opportunities at local
health centers or community outreach programs. REACH also builds the
capacity of local organizations and institutions to better serve their
communities by addressing disparities and distributing resources where
they are most needed. REACH is broadening the field of public health by
engaging the food retail industry, local parks and recreation
departments, city and regional land use, planning, housing, and
transportation agencies, as well as healthcare providers.
REACH communities across the United States have spent the last
decade leveraging CDC funding with public private partnerships in order
to effectively address health disparities. We have demonstrated through
our research and our community programs that health disparities in
racial and ethnic populations, once considered expected, are not
intractable. Though we have made significant progress since REACH's
inception, we could do a lot more. To move forward and eliminate health
disparities, we must continue our work within underserved communities
across the United States and build upon the successes achieved to date.
Without continued funding for REACH programs, communities with high
minority populations will continue to bear a disproportionate share of
the national chronic disease burden. This not only keeps vulnerable
communities at an increased disadvantage, but drives up healthcare
costs by requiring long-term and costly medical intervention to treat
chronic diseases that may have been prevented or better managed.
The success and cost effectiveness of the REACH program would
suggest it both practical and fiscally prudent to increase funding for
the program to expand into additional communities across the country.
However, given the current budget constraints we strongly urge the
Committee to fully fund, at current levels, the CDC's REACH program in
a discrete line item in CDC's National Center for Chronic Disease
Prevention and Health Promotion or as a specific initiative within the
Public Health and Prevention Trust. By doing so, we can continue our
work in underserved communities and achieve marked improvements in the
health of all Americans. We believe that our efforts will help to
decrease the approximately 83,000 deaths that occur each year as a
result of racial and ethnic health disparities, decrease the estimated
$60 billion a year we spend in direct healthcare expenditures as a
result of these disparities, and improve health access, quality, and
outcomes for many people.
We thank you for this opportunity to present our views to this
Subcommittee. We look forward to working with you to improve the health
and safety of all Americans.
______
Prepared Statement of the National Respite Coalition
Mr. Chairman, I am Jill Kagan, Chair of the ARCH National Respite
Coalition, a network of respite providers, family caregivers, State and
local agencies and organizations across the United States who support
respite. Thirty State respite coalitions are also affiliated with the
NRC. This statement is presented on behalf of the these organizations,
as well as the members of the Lifespan Respite Task Force, a coalition
of over 80 national and 100 State and local groups who supported the
passage of the Lifespan Respite Care Act (Public Law 109-442).
Together, we are requesting that the Subcommittee include funding for
the Lifespan Respite Care Program administered by the U.S.
Administration on Aging in the fiscal year 2011 Labor, HHS, and
Education Appropriations bill at $50 million. Given the serious fiscal
constraints facing the Nation, this request has been reduced by one-
half below the previous fiscal year's authorized and requested amount.
This will enable:
--State replication of best practices in Lifespan Respite to allow
all family caregivers, regardless of the care recipient's age
or disability, to have access to affordable respite, and to be
able to continue to play the significant role in long-term care
that they are fulfilling today;
--Improvement in the quality of respite services currently available;
--Expansion of respite capacity to serve more families by building
new and enhancing current respite options, including
recruitment and training of respite workers and volunteers; and
--Greater consumer direction by providing family caregivers with
training and information on how to find, use and pay for
respite services.
Who Needs Respite?
In 2009, a national survey found that over 65 million family
caregivers are providing care to individuals of any age with
disabilities or chronic conditions (Caregiving in the U.S. 2009.
Bethesda, MD: National Alliance for Caregiving (NAC) and Washington,
DC: AARP, 2009). Family caregivers provide an estimated $375 billion in
uncompensated care, an amount almost as high as Medicare spending ($432
billion in 2007) and more than total spending for Medicaid, including
both Federal and State contributions and both medical and long-term
care ($311 billion in 2005) (Gibson and Hauser, 2008).
Family caregiving is not just an aging issue, but a lifespan one
for the majority of the Nation's families. While the aging population
is growing rapidly, the majority of family caregivers are caring for
someone under age 75 (56 percent); 28 percent of family caregivers care
for someone between the ages of 50-75, and 28 percent are caring for
someone under age 50, including children (NAC and AARP, 2009). Many
family caregivers are in the sandwich generation--46 percent of women
who are caregivers of an aging family member and 40 percent of men also
have children under the age of 18 at home (Aumann, Kerstin and Ellen
Galinsky, et al. 2008). And 6.7 million children, are in the primary
custody of an aging grandparent or other relative.
Families of the wounded warriors--those military personnel
returning from Iraq and Afghanistan with traumatic brain injuries and
other serious chronic and debilitating conditions--are at risk for
limited access to respite. Even with enactment of the new VA Family
Caregiver Support Program, the need for respite will remain high among
all veterans and their family caregivers. Among family caregivers of
veterans whose illness, injury or condition is in some way related to
military service surveyed in 2010, only 15 percent had received respite
services from the VA or other community organization within the past 12
months. Caregivers whose veterans have PTSD are only about half as
likely as other caregivers to have received respite services (11
percent vs. 20 percent) (NAC, Caregivers Of Veterans--Serving On The
Homefront, November 2010). Sixty-eight percent of veterans' caregivers
reported their situation as highly stressful compared to 31 percent of
caregivers nationally who feel the same and three times as many say
there is a high degree of physical strain (40 percent vs. 14 percent)
(NAC, 2010). Veterans' caregivers specifically asked for up-to-date
resource lists of respite providers in their local communities and help
to find services--the very thing Lifespan Respite is charged to provide
(NAC, 2010).
National, State and local surveys have shown respite to be the most
frequently requested service of the Nation's family caregivers
(Evercare and NAC, 2006). Other than financial assistance for
caregiving through direct vouchers payments or tax credits, respite is
the number one national policy related to service delivery that family
caregivers prefer (NAC and AARP, 2009). Yet respite is unused, in short
supply, inaccessible, or unaffordable to a majority of the Nation's
family caregivers. The NAC 2009 survey found that despite the fact that
among the most frequently reported unmet needs of family caregivers
were ``finding time for myself'' (32 percent), ``managing emotional and
physical stress'' (34 percent), and ``balancing work and family
responsibilities'' (27 percent), nearly 90 percent of family caregivers
across the lifespan are not receiving respite services at all.
Together, these family caregivers provide an estimated 80 percent
of all long-term care in the United States. This percentage will only
rise in the coming decades with an expected increase in the number of
chronically ill veterans returning from war, greater life expectancies
of individuals with Down's Syndrome and other disabling and chronic
conditions, the aging of the baby boom generation, and the decline in
the percentage of the frail elderly who are entering nursing homes.
Respite Barriers and the Effect on Family Caregivers
Barriers to accessing respite include reluctance to ask for help,
fragmented and narrowly targeted services, cost, and the lack of
information about how to find or choose a provider. Even when respite
is an allowable funded service, a critically short supply of well-
trained respite providers may prohibit a family from making use of a
service they so desperately need. Lifespan Respite is designed to help
States eliminate these barriers through improved coordination and
capacity building.
While most families take great joy in helping their family members
to live at home, however, it has been well documented that family
caregivers experience physical and emotional problems directly related
to their caregiving responsibilities. A majority of family caregivers
(51 percent) caring for someone over the age of 18 have medium or high
levels of burden of care, measured by the number of activities of daily
living with which they provide assistance, and 31 percent of all family
caregivers were identified as ``highly stressed'' ((NAC and AARP,
2009). While family caregivers of children with special healthcare
needs are younger than caregivers of adults, they give lower ratings to
their health. Only 4 out of 10 consider their health to be excellent or
very good (44 percent) compared to 6 in 10 (59 percent) caregivers of
adults; 26 percent say their health is fair or poor, compared to 16
percent of those caring for adults. Caregivers of children are twice as
likely as the general adult population to say they are in fair/poor
health (26 percent vs 13 percent) (Provisional summary Health
Statistics for US Adults, National Health Interview Survey, 2008, dated
August 2009).
The decline of family caregiver health is one of the major risk
factors for institutionalization of a care recipient, and there is
evidence that care recipients whose caregivers lack effective coping
styles or have problems with depression are at risk for falling,
developing preventable secondary complications such as pressure sores
and experiencing declines in functional abilities (Elliott & Pezent,
2008). Care recipients may also be at risk for encountering abuse from
caregivers when the recipients have pronounced need for assistance and
when caregivers have pronounced levels of depression, ill health, and
distress (Beach et al., 2005; Williamson et al., 2001).
Supports that would ease their burden, most importantly respite,
are too often out of reach or completely unavailable. Even the simple
things we take for granted, like getting enough rest or going shopping,
become rare and precious events. Restrictive eligibility criteria also
preclude many families from receiving services or continuing to receive
services for which they once were eligible. A mother of a 12-year-old
with autism was denied respite by her State DD (Developmental
Disability) agency because she was not a single mother, was not at
poverty level, was not exhibiting any emotional or physical conditions
herself, and had only one child with a disability. As she told us, ``Do
I have to endure a failed marriage or serious health consequences for
myself or my family before I can qualify for respite? Respite is
supposed to be a preventive service.''
For the millions of families of children with disabilities, respite
has been an actual lifesaver. However, for many of these families,
their children will age out of the system when they turn 21 and they
will lose many of the services, such as respite, that they currently
receive. In fact, 46 percent of U.S. State units on aging identified
respite as the greatest unmet need of older families caring for adults
with lifelong disabilities.
Respite may not exist at all in some States for adult children with
disabilities still living at home, or individuals under age 60 with
conditions such as ALS, MS, spinal cord or traumatic brain injuries, or
children with serious emotional conditions. In Tennessee, a young woman
in her twenties gave up school, career and a relationship to move in
and take care of her 53 year-old mom with MS when her dad left because
of the strain of caregiving. Fortunately, she lives in Tennessee with a
State Lifespan Respite Program. Now 31, she wrote, ``And I was young--I
still am--and I have the energy, but--it starts to weigh. Because we've
been able to have respite care, it has made all the difference.''
Respite Benefits Families and is Cost Saving
Respite has been shown to be a most effective way to improve the
health and well-being of family caregivers that in turn helps avoid or
delay out-of-home placements, such as nursing homes or foster care,
minimizes the precursors that can lead to abuse and neglect, and
strengthens marriages and family stability. A U.S. Department of Health
and Human Services report prepared by the Urban Institute found that
higher caregiver stress among those caring for the aging increases the
likelihood of nursing home entry. Reducing key stresses on caregivers,
such as physical strain and financial hardship, through services such
as respite would reduce nursing home entry (Spillman and Long, USDHHS,
2007). The budgetary benefits that accrue because of respite are just
as compelling. Delaying a nursing home placement for just one
individual with Alzheimer's or other chronic condition for several
months can save thousands of dollars. In an Iowa survey of parents of
children with disabilities, a significant relationship was demonstrated
between the severity of a child's disability and their parents missing
more work hours than other employees. It was also found that the lack
of available respite appeared to interfere with parents accepting job
opportunities. (Abelson, A.G., 1999)
Moreover, data from an ongoing research project of the Oklahoma
State University on the effects of respite care found that the number
of hospitalizations, as well as the number of medical care claims
decreased as the number of respite care days increased (Fiscal Year
1998 Oklahoma Maternal and Child Health Block Grant Annual Report, July
1999). A Massachusetts social services program designed to provide
cost-effective family centered respite care for children with complex
medical needs found that for families participating for more than 1
year, the number of hospitalizations decreased by 75 percent, physician
visits decreased by 64 percent, and antibiotics use decreased by 71
percent (Mausner, S., 1995).
In the private sector, the Metropolitan Life Insurance Company and
the National Alliance for Caregivers found that U.S. businesses lose
from $17.1 billion to $33.6 billion per year in lost productivity of
family caregivers. (MetLife and National Alliance for Caregiving,
2006). A more recent study from the National Alliance on Caregiving and
Evercare demonstrated that the economic downturn has had a particularly
harsh effect on family caregivers. Of the 6 in 10 caregivers who are
employed, 50 percent of them are less comfortable during the economic
downturn with taking time off from work to care for a family member or
friend. A similar percentage (51 percent) says the economic downturn
has increased the amount of stress they feel about being able to care
for their relative or friend. Respite for working family caregivers
could help improve job performance and employers could potentially save
billions.
Lifespan Respite Care Program Will Help
The Lifespan Respite Care Program is based on the success of
statewide Lifespan Respite programs in Oregon, Nebraska, Wisconsin and
Oklahoma. The Federal Lifespan Respite program is administered by the
U.S. Administration on Aging, Department of Health and Human Services
(HHS). AoA provides competitive grants to State agencies in concert
with Aging and Disability Resource Centers working in collaboration
with State respite coalitions or other State respite organizations. The
program was authorized at $53.3 million in fiscal year 2009 rising to
$95 million in fiscal year 2011. Congress appropriated $2.5 million in
fiscal year 2009 and again in fiscal year 2010 and fiscal year 2011.
Twenty-four States have received 3-year $200,000 Lifespan Respite
Grants from AoA since 2009. Another 9 or 10 States are expected to
receive grants by August 2011.
The purpose of the law is to expand and enhance respite services,
improve coordination, and improve respite access and quality. States
are required to establish State and local coordinated Lifespan Respite
care systems to serve families regardless of age or special need,
provide new planned and emergency respite services, train and recruit
respite workers and volunteers and assist caregivers in gaining access
to services. Those eligible would include family members, foster
parents or other adults providing unpaid care to adults who require
care to meet basic needs or prevent injury and to children who require
care beyond that required by children generally to meet basic needs.
Lifespan Respite, which is a coordinated system of community-based
respite services, helps States use limited resources across age and
disability groups more effectively, instead of each separate State
agency or community-based organization being forced to reinvent the
wheel or beg for small pots of money. Pools of providers can be
recruited, trained and shared, administrative burdens can be reduced by
coordinating resources, and savings used to fund new respite services
for families who may not qualify for existing Federal or State
programs. For the growing number of veterans returning home with TBI or
other polytrauma, the shortage of staff qualified to provide respite to
this population is especially critical. Lifespan Respite systems can
make all the difference by ameliorating special barriers for this
population. The Government Accountability Office summarized the
innovative activities being taken by the 24 States to implement these
State Lifespan Respite Systems in its report to Congress, Respite Care:
Grants and Cooperative Agreements Awarded to Implement the Lifespan
Respite Care Act. GAO-11-28R, October 22, 2010.
The Administration recommended $10 million for Lifespan Respite in
fiscal year 2012. This is a doubling of the Administration's previous
request in fiscal year 2011 of $5 million as part of their Middle Class
Initiative. We are heartened to see that support for family caregiving
is recognized as a critical component of a typical family's economic
and social well-being and extremely grateful for the Administration's
support. Still, we must not neglect that fact that 90 percent of the
Nation's family caregivers are not receiving respite at all. More than
half of them are caring for someone under age 75 with MS, ALS,
traumatic brain or spinal cord injury, mental health conditions,
developmental disabilities or cancer. $10 million will not address the
need for respite. Based on expenditures by State funded Lifespan
Respite programs in the original best practice States, we estimate that
an average sized State will need at least $1 million to build a
Lifespan Respite System that can better coordinate its services and
funding streams, maximize use of existing resources, and leverage new
dollars in both the public and private sectors to build respite
capacity and serve the unserved.
No other Federal program mandates respite as its sole focus. No
other Federal program would help ensure respite quality or choice, and
no current Federal program allows funds for respite start-up, training
or coordination or to address basic accessibility and affordability
issues for families. We urge you to include $50 million in the fiscal
year 2012 Labor, HHS, Education appropriations bill so that Lifespan
Respite Programs can be replicated in the States and more families,
with access to respite, will be able to continue to play the
significant role in long-term care that they are fulfilling today.
______
Prepared Statement of the National Rural Health Association
The National Rural Health Association (NRHA) is pleased to provide
the Labor, Health and Human Services, Education and Related Agencies
Appropriations Subcommittee with a statement for the record on fiscal
year 2012 funding levels for programs with a significant impact on the
health of rural America.
The NRHA is a national nonprofit membership organization with more
than 20,000 members that provides leadership on rural health issues.
The Association's mission is to improve the health of rural Americans
and to provide leadership on rural health issues through advocacy,
communications, education and research. The NRHA membership consists of
a diverse collection of individuals and organizations, all of whom
share the common bond of an interest in rural health.
The NRHA is advocating for continued full funding for a group of
rural health programs that assist many rural communities in maintaining
and building a strong healthcare delivery system into the future. Most
importantly, these programs help increase the capacity of the rural
healthcare delivery system. Additional capacity that will be absolutely
necessary with the addition of many newly insured Americans under the
Patient Protection and Affordable Care Act. These programs have been
successful in increasing access to healthcare in rural areas, helping
communities create new health programs for those in need and training
the future health professionals that will give care to rural America.
With modest investments, these programs are able to evaluate, study,
and implement quality improvement programs and health information
technology systems.
While recognizing the constraints of the current economic and
budgetary climate, we would like to remind you of the critical
importance of these rural health programs and request modest increases
to ensure that these programs do not lose any ground. Even small
investments in these ``rural health safety net'' programs go a long way
and generate big returns in rural communities. Cuts to these programs
do more hard than good and in the long run the Federal government will
pay a much higher cost should these rural programs go away.
Some important rural health programs supported by the NRHA are
outlined below.
Rural Health Outreach and Network Grants provide capital investment
for planning and launching innovative projects in rural communities
that later become self-sufficient. These grants are unique in the
Federal system as they allow the community to choose what is most
important for their own situation and then build a program around that.
These grants have led to projects dealing with obesity and diabetes,
information technology networks, oral screenings, preventive services,
and many other health concerns. Due to the community nature of the
grants and a focus on self-sustainability after the terms of the grant
have run out--85 percent of the Outreach Grantees continue to deliver
services even 5 full years after Federal funding had ended. Request:
$59.8 million
Rural Health Research and Policy forms the Federal infrastructure
for rural health policy. Without these funds, rural America has no
coordinated voice in the Department of Health and Human Services (HHS).
In addition to the expertise provided to agencies such as the Centers
for Medicare and Medicaid Services, this line item also funds rural
health research centers across the country. These research centers
provide the knowledge and the evidence needed for good policy making,
both in the Federal Government and across the Nation. Additionally, we
urge the Subcommittee to include in report language instructions to the
Office of Rural Health Policy to direct additional funding to the State
rural health associations. The State associations serve to coordinate
rural health activities at the State level and have a strong record of
positive outcomes. Request: $10.76 million
State Offices of Rural Health are the State counterparts to the
Federal rural health research and policy efforts, and form the State
infrastructure for rural health policy. They assist States in
strengthening rural healthcare delivery systems by maintaining a focal
point for rural health within each State and by linking small rural
communities with State and Federal resources to develop long term
solutions to rural health problems. Without these funds, States would
have diminished capacity to administer many of the rural health
programs that are so critical to access to care. Request: $10 million
Rural Hospital Flexibility Grants fund quality improvement and
emergency medical service projects for Critical Access Hospitals across
the country. This funding is essential. CAHs are by definition small
hospitals with fewer than 25 beds; they do not have the size, volume or
the expertise to do the types of quality improvement or information
technology activities that they need to do. These grants allow
statewide coordination and provide expertise to CAHs. Also funded in
this line is the Small Hospital Improvement Program (SHIP), which
provides grants to more than 1,500 small rural hospitals (50 beds or
less) across the country to help improve their business operations,
focus on quality improvement and to ensure compliance provisions
related to health information privacy. Request: $43.46 million
Rural and Community Access to Emergency Devices assists communities
in purchasing emergency devices and training potential first responders
in their use. Defibrillators double a victim's chance of survival after
sudden cardiac arrest, which an estimated 163,221 Americans experience
every year. Request: $3.49 million
The Office for the Advancement of Telehealth supports distance-
provided clinical services and is designed to reduce the isolation of
rural providers, foster integrated delivery systems through network
development and test a range of telehealth applications. Long-term,
telehealth promises to improve the health of millions of Americans,
provide constant education to isolated rural providers and save money
through reduced office visits and expensive hospital care. These
approaches are still new and unfolding and continued investment in the
infrastructure and development is needed. Request: $12.3 million
National Health Service Corps (NHSC) plays a critical role in
providing primary healthcare services to rural underserved populations
by placing healthcare providers in our Nation's most underserved
communities. Invesment in our healthcare workforce is absolutely vital
to support the newly insured population resulting from health reform.
Programs like the NHSC help to maximize the capacity of our health
system to care for patients. The Patient Protection and Affordable Care
Act provided additional funding to the NHSC through the HHS Secretary's
Community Health Center fund. The NRHA is supporting the President's
request, which will ensure that the NHSC has access to the additional
dedicated funding through the CHC Fund. Request: $173.2 million
Title VII Health Professions Training Programs (with a significant
rural focus):
--Rural Physician Pipeline Grants will help medical colleges to
develop special rural training programs and recruit students
from rural communities, who are more likely to return to their
home regions to practice. Newly created under the Patient
Protection and Affordable Care Act, this ``grow-your-own''
approach is one of the best and most cost-effective ways to
ensure a robust rural workforce into the future. Request: $
--Area Health Education and Centers (AHECs) financially support and
encourage those training to become healthcare professionals to
choose to practice in rural areas. Without this experience and
support while in medical school, far fewer professionals would
make the commitment to rural areas and facilities including
Community Health Centers, Rural Health Clinics and rural
hospitals. It has been estimated that nearly half of AHECs
would shut down without Federal funding. The success of this
program was recognized through increased authorized levels in
the Patient Protection and Affordable Care Act. Request: $75
million
--Geriatric Programs train health professionals in geriatrics,
including funding for Geriatric Education Centers (GEC). There
are currently 47 GECs nationwide that ensure access to
appropriate and quality healthcare for seniors. Rural America
has a disproportionate share of the elderly and could see a
shortage of health providers without this program. Request: $
35.6 million
The NRHA appreciates the support throughout the fiscal year 2011
continuing resolution process and the opportunity to provide our
recommendations for your fiscal year 2012 appropriations bill. Our
request for continued funding for the rural health safety net is
critical to maintaining access to high quality care in rural
communities. We greatly appreciate the support of the Subcommittee and
look forward to working with Members of Congress to continue making
these important investments in rural health in fiscal year 2012 and
into the future.
______
Prepared Statement of the National Senior Corps Association
Mr. Chairman, Members of the Committee, I testify today on behalf
of the National Senior Corps Association, representing the interests
and ideals of 500,000 senior volunteers and the directors, staff, and
friends of local Foster Grandparent, Senior Companion, and RSVP
programs throughout the country.
The recent agreement for fiscal year 2011 appropriations included a
20 percent cut in funding for RSVP--a devastating setback that
threatens to deny 100,000 seniors the opportunity to serve their
communities. We urge that this funding be restored, first and foremost,
and that the Corporation for National and Community Service (CNCS) take
particular care to do so in protecting opportunities for senior
volunteers without interruption.
For fiscal year 2012, NSCA requests $111,100,000 for the Foster
Grandparent Program (FGP), $63,000,000 for RSVP, and $47,000,000 for
the Senior Companion Program (SCP). This is an aggregate increase of
$200,000 over the fiscal year 2010 enacted level. In addition, we
support an appropriation of $5 million for demonstration projects to
increase high school graduation rates through the Foster Grandparent
Program and to support independent living for veterans through the
Senior Companion Program.
SENIOR CORPS is a federally authorized and funded network of
national service programs that provides older Americans with the
opportunity to apply their life experiences to volunteer service.
Senior Corps is comprised of the Foster Grandparent Program, RSVP, and
the Senior Companion Program, through which Americans age 55 and older
provide essential services to cost-effectively address critical
community needs.
Foster Grandparent Program.--29,000 Foster Grandparents in 328
projects provide a cost-effective means to reach and support more than
280,000 at-risk children with special or exceptional needs annually who
otherwise may not have the opportunity to receive individual assistance
and attention from a caring adult. In 2009, Foster Grandparents
volunteered 24.3 million hours.
--81 percent of children served demonstrated improvements in academic
performance. Mentored children have reduced truancy resulting
in reduced school costs and, ultimately, reduced high school
dropout rates and increased lifetime earnings.
--90 percent demonstrated increased self-image. This includes
improved health outcomes such as reductions in teen pregnancy
and reduced or delayed use of tobacco, alcohol, or illicit
drugs.
--56 percent reported improved school attendance leading to increased
graduation rates, increased post-secondary education, and
higher lifetime earnings.
--59 percent reported reduction in risky behavior, including reduced
juvenile violence and property crimes, saving victim and court
expenses, costly treatment of juvenile offenders, costs of
adult crime, crime losses of victims and the societal costs of
prosecuting and incarcerating adult offenders.
--In 2009, FGP volunteers mentored 41,767 children and youth, of
which 5,400 were children of prisoners at high risk of
repeating their parent's path.
--FGP intervention reduced need for social services, both short-term
costs of counseling and long-term costs of public assistance.
--Based on conservative assumptions about outcomes and valuations,
studies indicate a return benefit of $2.72 for every dollar of
resources used for mentoring programs. (Analyzing the Social
Return on Investment in Youth Mentoring Programs, prepared by:
Paul A. Anton, Wilder Research; and Prof. Judy Temple,
University of Minnesota).
Foster Grandparent Program Profiles.--Foster Grandparent Birda
Dillon completed the ninth grade, worked doing factory assembly for 25
years, raised 20+ children--14 of her own as well as grandchildren. She
is a remarkable Foster Grandparent as the following remarks from her
teacher in Benton Harbor, Michigan begin to illustrate: ``Grandma is so
good with these students. She knows just how to work with them to get
them to read the words themselves. She is positive and knows how to get
the students to sound the words out. George is reading so much better.
I was surprised when he told me recently, 'I need another book!''' I
can't spend one-on-one time with them, and she can. Birda is one of the
best reading tutors I've encountered in my many years of teaching. She
knows all of the tricks and tools to help the students help themselves.
She said much of what she knows she has learned through her training as
a Foster Grandparent. I appreciate her giftedness very much. We hope we
can be together for a long, long time.'' From Professional Volunteer
who assists with site visits (a retired veteran teacher): ``I
complimented her on her teaching of reading and told her I was a
reading teacher, too. I told her she was a natural! She said she hadn't
had any formal training; she wished she'd been a teacher, and I told
her she was.'' Three of the children Birda tutors have incarcerated
parents.
Foster Grandparent Leila Williams: Leila serves in a first grade
classroom at Washington Elementary School in Coloma, Michigan. ``I had
no idea how rewarding it would be. And I feel so much better. I love
having a schedule, being busy, and I sleep so good at night. Thank you,
for making my life better. I'm 91 years old, and getting younger.''
Leila is matched with two children with parents in active military
service. Leila's teacher reports that as a result of Leila's one-on-one
attention, her two assigned students have developed positive
relationships with Leila, improved socialization skills and have both
improved reading skills, especially sight word recognition and fluency.
RSVP.--405,000 RSVP volunteers contributed 62 million hours of
service in 2009 through 741 projects nationwide working with more than
65,000 community organizations. The average cost to support one RSVP
volunteer is approximately $145 a year, whereas the average annual
value per volunteer is more than $3,000. RSVP volunteers saved local
communities $1.25 billion in 2009.
--RSVP is continually strengthening its leadership role in engaging
volunteers 55+ by providing nonprofit agencies with volunteers
trained to recruit and coordinate other community members in
support of the nonprofits mission and goals. In 2009, RSVP
volunteers recruited 38,000 additional community volunteers.
--RSVP projects demonstrate that their volunteer services increase
literacy scores for the 74,326 children they mentor--the
National Education Association states the lowest hourly rate
for teacher aides is $10.31 reflecting a savings of $16,858,623
in remedial reading assistance.
--24,370 RSVP volunteers increased the capacity of the organizations
where they serve by enhancing both the quality and quantity of
services.
--In 2009, RSVP volunteers mentored 6,400 children of prisoners at
high risk of repeating their parent's path.
--RSVP volunteers provided 23,300 caregivers with respite services. A
recent AARP survey of working caregivers reports that 30
percent of family caregivers either quit their jobs or reduce
their work hours to take on more care giving responsibilities.
--RSVP volunteers supported 509,000 with Independent Living Services.
--30 percent of RSVP volunteers provided at least one service in the
area of Health/Nutrition which includes in-home and congregate
meals, food distribution/collection, immunization, etc. valued
at more than $27 million.
RSVP Program Profile.--The Beginning Alcohol and Addictions Basic
Education Studies (BABES) program has been operating successfully for
many years in districts throughout the Portage County, Wisconsin RSVP
service area. Each year, hundreds of second graders in the various
districts learn from their puppet friends (via the RSVP volunteers)
about complex issues like peer pressure, good decisionmaking, and
asking for help.
In 2009, over 600 second graders participated in the program. The
intermediate outcome states that teachers in the second grade classes
will observe children using phrases from the presentations and
reminding others about the lessons they have learned. In 2009, the
target was exceeded as 21 teachers returned surveys and 90 percent (19)
reported they observed children using phrases from the BABES
presentations. Teacher comments included: (1) ``They have brought up
coping, decisionmaking, peer pressure and self image when we are
reading other stories. They have made a connection from these lessons
to what is going on in their world.'' (2) ``One student came in from
recess and said someone was peer pressuring her to do something on the
playground. It was great hearing the term used!''
The end outcome states that students in second grade classes who
complete the BABES program will show an increase in knowledge about
alcohol and drug use and abuse and seeking help as measured on a pre/
post test. In 2009, the target was exceeded as 74 percent (20 of 27
classes participating in BABES in 2009) of classes improved their
scores on the post test by at least 10 percent.
While the program is successful because volunteers are willing to
present the lessons, the coordination of the program is also an
important piece. The RSVP Intergenerational Coordinator provides annual
volunteer training, ensures volunteers have all the materials they
need, works with the schools to schedule the program, ensures the pre
and post tests are completed and returned and analyzes and reports the
date collected to all the stakeholders.
Senior Companion Program.--15,200 Senior Companions serving in 194
projects provided 12.2 million hours of service helping 68,200 frail,
homebound clients in need of assistance in order to remain living
independently. Senior Companion Program services prevented premature
and costly institutionalization at an annual savings well over $200
million. The national average cost for 1 year in a nursing home is
$72,270; the assisted living facility yearly average cost is $37,572.
One Senior Companion volunteer assists 2-6 homebound clients for the
annual investment of $4,800.
--Senior Companions offered essential respite to nearly 9,000 primary
caregivers who struggle to remain in the regular workforce
while caring for their loved one.
--The Family Caregiver Alliance reports that families with long-term
care responsibilities miss an average of 7.5 workdays each
year.
--The MetLife Caregiving Cost Study of July 2006 reports the
estimated cost to employers of full-time employed intense
caregivers at a total of $17.1 billion in lost productivity
annually as well as absenteeism, workday interruptions, costs
due to crisis in care, supervision costs associated with
caregiver employees, costs with unpaid leave and reducing hours
from full-time to part-time.
--Clients have significant, long-term mental health benefits and
reduced rates of depression saving $50-$75 a month in
medication.
--Cost of stress management therapy for one caregiver ($125 per
session) vs. respite provided by volunteer (4 hours of respite
care = $10.60 plus mileage average cost of $3).
--Cost for a home health aide after a client's release from the
hospital is $21 per hour as compared to $2.65 per hour for a
Senior Companion volunteer (at no cost to clients).
Senior Companion Program Profile.--Julia, an 80 year old woman who
is blind was faced with having to leave her home in Rochester, NY due
to her inability to see and complete the tasks of daily living needed
to stay independent. While she had home health aide service to help her
bathe, dress and clean her apartment, her family wasn't able to be with
her during the day and evening due to their work schedules and their
own family commitments.
Julia was given two Senior Companion (SC) volunteers. One came each
day mid-morning after the home health aide left and stayed until early
afternoon. The SC kept Julia company, escorted her to the bathroom when
needed, fixed lunch and ensured she was okay daily. The second SC came
about 5 p.m. each evening. She fixed dinner, visited, cleaned up after
dinner and helped Julia get ready and into bed each evening.
Between these two volunteers Julia was able to stay living at home
an additional 5+ years. At an average cost of $70,000 annually for long
term care compared to the cost of her SC services at approximately
$4,800 annually per companion, a savings of over $300,000 was saved.
It has been stated that baby boomer and senior volunteers represent
our Nation's single and fastest growing resource. During this
unprecedented economic crisis facing our Nation, the number of baby
boomer and senior volunteers should be greatly expanded and mobilized
as solutions to the problems facing our local communities. NSCA's 2012
budget request will provide the opportunity for thousands more older
adults to serve in their communities and enhance the lives of those
most in need, including children with special needs, the frail and
isolated elderly striving to maintain independence, and expanding the
services of local non-profit agencies.
The 2010 national value of one hour of volunteer service was
estimated at $21.36.
Senior Corps volunteers' 98.2 million service hours in 2010 = $2.1
billion savings.
______
Prepared Statement of the National Technical Institute for the Deaf
Mr. Chairman and Members of the Committee: I am pleased to present
the fiscal year 2012 budget request for NTID, one of eight colleges of
RIT, in Rochester, New York. Created by Congress by Public Law 89-36 in
1965, we provide university technical and professional education for
students who are deaf and hard-of-hearing, leading to successful
careers in high-demand fields for a sub-population of individuals
historically facing high rates of unemployment and under-employment. We
also provide baccalaureate and graduate level education for hearing
students in professions serving deaf and hard-of-hearing individuals.
As of fall 2010, NTID served a total of 1,521 students from across the
Nation, including 1,263 deaf and hard-of-hearing undergraduate students
and 147 hearing undergraduate students. NTID students live, study and
socialize with more than 15,000 hearing students on the RIT campus.
NTID has fulfilled its mission with distinction for 43 years.
Budget Request
As shown below, NTID's fiscal year 2012 budget request was
$64,677,000 in Operations and $2,000,000 in Construction, as part of a
plan that would provide NTID with a total of $10,000,000 in
Construction over the next 5 years to fund needed capital projects. The
NTID request is a total of $66,677,000; the President's request is
$63,037,000 in Operations and $2,000,000 in Construction, for a total
of $65,037,000.
FISCAL YEAR 2012 BUDGET REQUEST STATUS
----------------------------------------------------------------------------------------------------------------
Operations Construction Total
----------------------------------------------------------------------------------------------------------------
NTID Request.................................................... $64,677,000 $2,000,000 $66,677,000
President's Request \1\......................................... 63,037,000 2,000,000 65,037,000
-----------------------------------------------
Difference................................................ 1,640,000 .............. 1,640,000
----------------------------------------------------------------------------------------------------------------
\1\ For fiscal years 2009, 2010 and most likely, 2011, NTID's Operations budget has been funded at $63,037,000;
the President's recommended Operations budget for fiscal year 2012 would mark four consecutive years of
funding at the same amount.
For the past 3 years, NTID has been able to absorb the same level
of funding in Operations primarily due to two factors: (1) a self-
initiated budget-reduction/revenue enhancement campaign from fiscal
year 2003 through fiscal year 2007; and (2) limited RIT-mandated salary
increases in recent years. However, realized savings from the campaign
now have been reallocated and are no longer available. Furthermore, the
limited increases from fiscal year 2009 through fiscal year 2011 mean
that NTID has fallen significantly behind its salary benchmarks. RIT
has mandated a 3 percent salary increase for all faculty and staff in
the coming fiscal year.
While NTID certainly would benefit from a budget increase to
support upcoming strategic initiatives (see below), we understand the
resource challenges facing the Committee this year. While an additional
$1,640,000 beyond the President's recommended Operations funding for
fiscal year 2012 is needed, we are amenable to meeting this need by
shifting funds designated in the President's 2012 budget from
Construction to Operations. This would ensure NTID stays within the
total allocation proposed in the President's 2012 budget of
$65,037,000, and will allow us to better meet our Operations needs. In
the meantime, we will continue to seek non-Federal funding to support
immediate construction/renovation needs while continuing to communicate
about critical long-term construction needs.
Enrollment
In fiscal year 2011 (fall 2010), we attracted the largest
enrollment in our 43-year history. Truly a national program, NTID has
enrolled students from all 50 States. Our current enrollment is 1,521.
Over the last 5 years our enrollment has increased 22 percent (271
students). For fiscal year 2012, NTID anticipates maintaining this
record high enrollment level. Our enrollment history over the last 5
years is shown below:
NTID ENROLLMENTS: FIVE-YEAR HISTORY
--------------------------------------------------------------------------------------------------------------------------------------------------------
Deaf/Hard-of-Hearing Students Hearing Students
--------------------------------------------------------------------------------------------
Fiscal Year Interpreting Grand total
Undergrad Grad RIT MSSE Subtotal Program MSSE Subtotal
--------------------------------------------------------------------------------------------------------------------------------------------------------
2007........................................... 1,017 47 31 1,095 130 25 155 1,250
2008........................................... 1,103 51 31 1,185 130 28 158 1,353
2009........................................... 1,212 48 24 1,284 135 31 166 1,450
2010........................................... 1,237 38 32 1,307 138 29 167 1,474
2011........................................... 1,263 40 29 1,332 147 42 189 1,521
--------------------------------------------------------------------------------------------------------------------------------------------------------
Student Accomplishments
For our graduates, over the past 5 years, an average of 93 percent
have been placed in jobs commensurate with the level of their education
(using the Bureau of Labor Statistics methodology). Of our fiscal year
2009 graduates (the most recent class for which numbers are available),
59 percent were employed in business and industry, 21 percent in
education/nonprofits, and 20 percent in Government.
Graduation from NTID has a demonstrably positive effect on
students' earnings over a lifetime, and results in a noteworthy
reduction in dependence on Supplemental Security Income (SSI), Social
Security Disability Insurance (SSDI) and public assistance programs. In
fiscal year 2007, NTID, the Social Security Administration, and Cornell
University examined approximately 13,000 deaf and hard-of-hearing
individuals who applied and attended NTID over our entire history. We
learned that graduating from NTID has significant economic benefits. By
age 50, deaf and hard-of-hearing baccalaureate graduates earned on
average $6,021 more per year than those with associate degrees, who in
turn earned $3,996 more per year on average than those who withdrew
before graduation. Students who withdrew earned $4,329 more than those
not admitted. Students who withdrew experienced twice the rate of
unemployment as graduates.
The same studies showed 78 percent of these individuals were
receiving SSI benefits at age 19, but when they were 50 years old, only
1 percent of graduates drew these benefits, while on average 19 percent
of individuals who withdrew or were not admitted continued to
participate in the SSI program. Graduates also accessed SSDI, an
unemployment benefit, at far lesser rates than students who withdrew;
by age 50, 34 percent of non-graduates were receiving SSDI, while 22
percent of baccalaureate graduates and 27 percent of associate
graduates were receiving them. Considering the reduced dependency on
these Federal income support programs, the Federal investment in NTID
returns significant societal dividends.
NTID clearly makes a significant, positive difference in earnings,
and in lives.
Strategic Initiatives Beginning Fiscal Year 2011
In 2010, NTID completed Strategic Decisions 2020, a strategic plan
based on our founding mission statement. This statement sets forth our
institutional responsibility to work with students to develop their
academic, career and life-long learning skills as future contributors
in a rapidly changing world. It also recognizes our role as a special
resource for preparing individuals who are deaf and hard-of-hearing,
for conducting applied research in areas critical to the advancement of
individuals who are deaf and hard-of-hearing, and for disseminating our
collective and cumulative expertise.
Strategic Decisions 2020 establishes key initiatives responding to
future challenges and shaping future opportunities. These initiatives,
which began implementation in fiscal year 2011, include:
--Pursuing enrollment targets and admissions and programming
strategies that will result in increasing numbers of our
graduates achieving baccalaureate degrees and higher, while
maintaining focus and commitment to quality associate-level
degree programs leading directly to the workplace;
--Improving services to under-prepared students through working with
regional partners to implement intensive summer academic
preparation programs in selected high-growth, ethnically
diverse areas of the country. Through this initiative, NTID
will identify those students demonstrating promise for success
in career-focused degree-level programs and beyond, and provide
consultation to others regarding postsecondary educational
alternatives;
--Expanding NTID's role as a National Resource Center of Excellence
regarding the education of deaf and hard-of-hearing students in
senior high school (grades 10, 11 and 12) and at the
postsecondary level. Components of this role as a National
Resource Center of Excellence will include:
--Center for Excellence in STEM Education.--NTID currently is
working to develop an externally funded Center of
Excellence on STEM Education for Deaf and Hard-of-Hearing
Students. This is an example of making our expertise
available nationally and enhancing deaf and hard-of-hearing
students' access to STEM fields.
--NTID Research Centers.--NTID will organize research resources
into Research Centers focused on the following strategic
areas of research: Teaching and Learning; Communication;
Technology, Access, and Support Services; and Employment
and Adaptability to Social Changes and the Global
Workplace.
--Outreach Programs.--Extending outreach activities to junior and
senior high school students who are deaf and hard-of-
hearing, many of who represent AALANA populations, to
expand their horizons regarding a college education. We
also support other colleges and universities serving
students who are deaf and hard-of-hearing, as well as post-
college adults who are deaf and hard-of-hearing.
--Enhancing efforts to become a recognized national leader in the
exploration, adaptation, testing, and implementation of new
technologies to enhance access to, and support of, learning by
deaf and hard-of-hearing individuals.
NTID Academic Programs
NTID offers high quality, career-focused associate degree programs
preparing students for specific well-paying technical careers. NTID
also is expanding the number of its transfer associate degree programs,
currently numbering seven, to better serve the higher achieving segment
of our student population seeking bachelor's and master's degrees in an
increasingly demanding marketplace. These transfer programs provide
seamless transition to baccalaureate studies in the other colleges of
RIT. In support of those deaf and hard-of-hearing students enrolled in
the other RIT colleges, NTID provides a range of access services
(including interpreting, real-time speech-to-text captioning, and note-
taking) as well as tutoring services. One of NTID's greatest strengths
is our outstanding track record of assisting high-potential students to
gain admission to, and graduate from, the other colleges of RIT at
rates comparable to their hearing peers.
A cooperative education (co-op) component is an integral part of
academic programming at NTID and prepares students for success in the
job market. A co-op gives students the opportunity to experience a
real-life job situation and focus their career choice. Students develop
technical skills and enhance vital personal skills such as teamwork and
communication, which will make them better candidates for full-time
employment after graduation. Over 250 students each year participate in
10-week co-op experiences that augment their academic studies, refine
their social skills, and prepare them for the competitive working
world.
Summary
It is extremely important that our funding be provided at the full
level requested by the President as we continue our mission to prepare
deaf and hard-of-hearing people to enter the workplace and society. We
ask only that the funds provided by the President for Construction be
moved into Operations.
Our alumni have demonstrated that they can achieve independence,
contribute to society, and find sustainable employment as a result of
NTID. Research shows that NTID graduates over their lifetimes are
employed at much higher rates, earn substantially more (therefore
paying significantly more in taxes), and participate at a much lower
rate in SSI, SSDI, and public assistance programs than those who
withdraw or who apply but do not attend NTID.
We are hopeful that the members of the Committee will agree that
NTID, with its long history of successful stewardship of Federal funds
and outstanding educational record of service with people who are deaf
and hard-of-hearing, remains deserving of your support and confidence.
fiscal year 2012 ntid budget request
FISCAL YEAR 2012 NTID BUDGET STATUS
----------------------------------------------------------------------------------------------------------------
Operations Construction Total
----------------------------------------------------------------------------------------------------------------
NTID fiscal year 2011 funding................................... $65,437,000 $240,000 $65,677,000
NTID original request........................................... 64,677,000 2,000,000 66,677,000
NTID updated request \1\........................................ 65,437,000 1,240,000 66,677,000
----------------------------------------------------------------------------------------------------------------
\1\ Note: Our updated request keeps within the limits of our original request; however, it moves money from our
Construction request to maintain our Operations funding at the 2011 level.
Context
Enrollment is the highest in NTID history with 1,521 students, a 22
percent increase over the past 5 years.
In an effort to maximize non-Federal revenues, NTID increased
tuition by 5 percent for fiscal year 2012. From fiscal year 2006-fiscal
year 2012, student tuition has increased by 40 percent.
Support for NTID is an investment with significant returns in the
form of increased employment and reduced dependence on Federal SSI and
SSDI payments for our students. NTID's employment rate in 2010 was 89
percent in spite of a challenging job market and averages to be 93
percent over the past 5 years.
Prior to fiscal year 2011, NTID had received $63,037,000 in
Operations for 2009 and 2010 and was slated to receive that sum again
in 2011. NTID was able to accommodate level funding in the past through
a combination of additional non-Federal revenues and targeted fiscal
control strategies with minimal impact on services and programs for
students. However, the $65,437,000 that NTID received in Operations for
fiscal year 2011 was crucial in order to offset record student
enrollment and use of access services, prevent enrollment caps, and
avoid the elimination of outreach programs, equipment purchases, and
matching endowments.
NTID's updated budget request for fiscal year 2012 maintains
Operations funding at the fiscal year 2011 level, to support our
increased enrollment, increased provision of services, and upcoming
strategic initiatives. It contains $1,240,000 requested for
Construction to begin major renovations to a building designed 30 years
ago that houses 3 major NTID programs.
Possible actions if less than fiscal year 2011 operations funding
received
Limit admission of new students for Fall 2012.--NTID has never
limited the number of qualified students who can enroll--to do so would
mean denying deaf and hard-of-hearing students the opportunity to
receive a state-of-the-art technical education with the unparalleled
access services found at NTID.
Hiring freeze and possible staff furloughs.--83 percent of NTID's
resources support salaries/wages--NTID would have to reduce
expenditures with a hiring freeze and possible furlough of staff,
leaving positions vacant while serving more students than ever before.
Substantial reduction or elimination of summer outreach programs.--
This would affect deaf and hard-of-hearing pre-college youth,
especially young women and African-American and Latino-American youth,
by eliminating programs that encourage them to continue on to college,
especially in the STEM fields.
Substantial reduction or elimination of equipment purchases.--
NTID's mission is to prepare deaf and hard-of-hearing students for
technical and professional careers in fields characterized by cutting-
edge technologies. Without the most technologically updated equipment
available, the education of our students will be impaired
significantly.
Substantial reduction or elimination of matching endowment funds.--
NTID would be unable to fulfill its commitment to match endowment
donations to the Institute, decreasing the level of scholarship support
for students.
______
Prepared Statement of Nemours
Nemours thanks Chairman Harkin, Ranking Member Shelby and members
of the Subcommittee for the opportunity to submit written testimony on
the fiscal year 2012 Labor, Health and Human Services, Education and
Related Agencies Appropriations bill. Nemours, one of the Nation's
leading child health systems, is dedicated to improving children's
health and well-being by offering a spectrum of clinical treatment,
research, advocacy, educational health, and prevention services
extending to families in the communities it serves.
About Nemours
Nemours has developed a model of care that integrates clinical
preventive and treatment services for children with population-based
prevention initiatives. No other health system in the Nation has made
the same level of investment in community-based prevention programs,
policies and practices to reach all children in the community, not just
those who cross our doors. Nemours Health and Prevention Services
(NHPS) has developed a comprehensive, multi-sector obesity prevention
initiative to reach all children in Delaware. To achieve the greatest
impact, NHPS considers the many places where children and families
spend their time: schools, child care, healthcare settings, community
centers and neighborhoods. The goal is to reinforce consistent messages
through policy and practice changes in each setting to help children
make healthy food and lifestyle choices and to stay physically active.
In school settings, NHPS works with district-level teams of
administrators, teachers, counselors, school nurses, parents and
students to encourage wellness policies and provide training and
educational tools that support policy and environmental changes to
encourage healthier eating and more physical activity on school
campuses. In the child care setting, Nemours worked with government
leaders to help Delaware become a frontrunner for policies that support
healthy eating and physical activity. NHPS provides training and
educational tools to help child care providers promote healthy
behaviors for young children.
In the primary care setting, Nemours convened pediatric primary
care providers from across the State to participate in a learning
collaborative focused on improving office-based weight management and
health promotion skills. Practitioners learned about new interventions
and received tools for use in the office setting, as well as take-home
materials for families. In the community, NHPS works with youth-serving
organizations to promote healthy eating and physical activity and to
develop champions who will model the behavior and help spread the
message. We also work to create an environment that promotes healthy
lifestyles.
Community-based Prevention
As an integrated health system that is very engaged with the
community, Nemours sees first-hand the impact of chronic disease on our
Nation's children. We treat obese young children at our clinics, and we
know that unhealthy habits that contribute to obesity are starting at a
very young age. In fact, nationally, over 24 percent of children ages
2-5 are already overweight or obese. Much of what influences their
health is outside the realm of the healthcare system, which is why we
have made and will continue to make significant investments in
community-based prevention. We believe that investing in clinical and
community-based prevention is an important way to ensure that children
grow up to be healthy adults. We are supportive of the Prevention and
Public Health Fund and urge the Committee to utilize the resources
provided from this Fund to support the integration of clinical and
community-based prevention and to evaluate the outcomes associated with
those investments. In particular, we are supportive of Community
Transformation Grants.
Community Transformation Grants draw upon the best of what we know
works: strong coalitions, multi-sector, public-private partnerships,
evidence-based approaches, and evaluation. In Delaware, Nemours has
successfully used this combination of approaches to stem the rising
childhood obesity curve between 2006 and 2008. These grants allow us to
build upon this foundation and spread what works to other communities.
The purpose of the grants is to support the implementation, evaluation,
and dissemination of evidence-based community preventive health
activities in order to reduce chronic disease rates, prevent the
development of secondary conditions, address health disparities, and
develop a stronger evidence-base of effective prevention programming.
In short, these grants would help us in our efforts to help children
grow up healthy. If we are serious about the commitment to improving
health, then we need to transform the places where children live, learn
and play, which is exactly what these grants are designed to
accomplish. We urge the Committee to provide $221.06 million for
Community Transformation Grants in fiscal year 2012, which is the level
requested by the President.
Children's Hospital Graduate Medical Education
Another important priority for Nemours is the healthcare workforce,
particularly the pediatric workforce. Children's hospitals care for
large numbers of children with complex health conditions. In order to
achieve high quality clinical care and outcomes, these specialty
hospitals need to have well-trained residents and physicians. The
Children's Hospital Graduate Medical Education program (CHGME) provides
support for graduate medical education to freestanding children's
hospitals that train resident physicians. The CHGME program was created
to correct an unintended inequity in the GME financing system, which is
tied to the number of Medicare beneficiaries being treated at a
hospital. Freestanding children's hospitals generally do not provide
care to Medicare-eligible patients, and were therefore largely left out
of the GME financing system. The CHGME program has addressed this
issue.
CHGME supports 55 freestanding children's hospitals that train
approximately 40 percent of all pediatricians, 43 percent of all
pediatric specialists, and many pediatric researchers and physicians
who require pediatric training. In 2009, CHGME supported the training
of 5,439 pediatric resident physicians. This is a very important
contribution to training our pediatric workforce, which continues to
experience shortages, particularly in pediatric specialty care. A 2009
survey by the National Association of Children's Hospitals and Related
Institutions (NACHRI) found that national shortages contribute to
vacancies in children's hospitals that commonly last 12 months or
longer for a number of pediatric specialties. These vacancies often
result in longer wait times for children to see pediatric specialists.
At the Alfred I. duPont Hospital for Children, over 300 residents
are trained each year. Under the supervision of physicians, these
residents provide care for inpatients and also provide primary and
specialty care in outpatient settings, including clinics. In 2010,
CHGME covered approximately 54 percent of the cost of the Nemours
residency program.
Unfortunately, the President's budget proposes to eliminate funding
for this critical program. We urge Congress to reject this short-
sighted cut and to continue to provide support for training the next
generation of pediatricians, pediatric specialists and pediatric
researchers. Nemours urges the Subcommittee to provide $317.5 million
for CHGME in fiscal year 2012, the same amount that was provided in
fiscal year 2010.
Conclusion
Nemours appreciates the opportunity to submit written testimony. As
an integrated child health system, we have prioritized investments in
clinical and community-based prevention and our workforce because we
believe that in the long-run these investments will bend the health
curve and the cost curve. We recognize that the Nation's fiscal
situation requires a close examination of the programs and priorities
that the Federal Government funds. As you make these critical funding
decisions, we hope that prevention and the healthcare workforce will
remain priorities of the Subcommittee in fiscal year 2012.
______
Prepared Statement of the Nephcure Foundation
Nephrotic syndrome (NS) is a collection of signs and symptoms
caused by diseases that attack the kidney's filtering system. These
diseases include focal segmental glomerulosclerosis (FSGS), Minimal
Change Disease (MCD) and Membranous Nephropathy (MN). When affected,
the kidney filters leak protein from the blood into the urine and often
cause kidney failure which requires dialysis or kidney transplantation.
According to a Harvard University report, 73,000 people in the United
States have lost their kidneys as a result of FSGS. Unfortunately, the
causes of FSGS and other filter diseases are very poorly understood.
FSGS is the second leading cause of NS and is especially difficult
to treat. There is no known cure for FSGS and current treatments are
difficult for patients to endure. These treatments include the use of
steroids and other dangerous substances which lower the immune system
and contribute to severe bacterial infections, high blood pressure and
other problems in patients, particularly child patients. In addition,
children with NS often experience growth retardation and heart disease.
Finally, NS caused by FSGS, MCD or MN is idiopathic and can often
reoccur, even after a kidney transplant.
FSGS disproportionately affects minority populations and is five
times more prevalent in the African American community. In a
groundbreaking study funded by NIH, researchers found that FSGS is
associated with two APOL1 gene variants. These variants are common in
African Americans but not in European Americans, and it is thought that
these variants developed as an evolutionary response to African
sleeping sickness.
FSGS also has a large social impact on the United States. FSGS
leads to end-stage renal disease (ESRD) which is one of the most costly
chronic diseases to manage. In 2007, the Medicare program alone spent
$24 billion, 6 percent of its entire budget, on ESRD. In 2005, FSGS
accounted for 12 percent of ESRD cases in the United States, at an
annual cost of $3 billion. It is estimated that there are currently
approximately 20,000 Americans living with ESRD due to FSGS.
Research on FSGS could achieve tremendous savings in Federal
healthcare costs and reduce health status disparities--both critical
and appropriate themes of the current administration. For this reason,
and on behalf of the thousands of families that are significantly
affected by this disease, we recommend the following:
--$35 billion for the National Institutes of Health (NIH) and a
corresponding increase to the National Institute of Diabetes
and Digestive and Kidney Diseases (NIDDK).
--Continue to support the Nephrotic Syndrome Rare Disease Clinical
Research Network at the Office of Rare Diseases Research
(ORDR).
--Support continued expansion of the FSGS/NS research portfolio at
NIDDK and the National Institute on Minority Health and Health
Disparities (NIMHD) by funding more research proposals for
glomerular disease.
--Support awareness activities through the Centers for Disease
Control and Prevention Chronic Kidney Disease Program.
Encourage FSGS/NS Research at NIH
There is no known cause or cure for FSGS and scientists tell us
that much more research needs to be done on the basic science behind
FSGS/NS. More research could lead to fewer patients undergoing ESRD and
tremendous savings in healthcare costs in the United States.
With collaboration from other Institutes and Centers, ORDR
established the Rare Disease Clinical Research Network. This network
provided an opportunity for the NephCure Foundation, the University of
Michigan, and other university research health centers to come together
to form the Nephrotic Syndrome Study Network (NEPTUNE). NEPTUNE is a
relatively new collaboration and has tremendous potential to make
significant advancements in NS and FSGS research because it pools
resources and develops a database of NS patients who are interested in
participating in clinical trials. The addition of Federal resources, as
well as NIH coordination of this important initiative, is crucial to
ensuring the best possible outcomes for RDCRN and NEPTUNE.
The NephCure Foundation is also grateful to the NIDDK for issuing a
program announcement (PA) that serves to initiate grant proposals on
glomerular disease. This PA was issued in March of 2007 and utilizes
utilize the R01 mechanism to award funding to glomerular disease
researchers. In February, 2010 the PA was re-released and is now
scheduled to expire in 2013. We ask the subcommittee to encourage NIDDK
to continue to issue glomerular disease PAs.
Due to the disproportionate burden of FSGS on minority populations,
the NephCure Foundation feels that it is appropriate for NIMHD to
develop an interest in this research. However, NIMHD has not supported
any research on FSGS. We ask the Subcommittee to encourage ORDR, NIDDK,
and NIMHD to collaborate on research that studies the incidence and
cause of this disease among minority populations. We also ask the
Subcommittee to urge NIDDK and the NIMHD undertake culturally
appropriate efforts aimed at educating minority populations about
glomerular disease.
Raise Glomerular Disease Awareness at CDC
When glomerular disease strikes, the resulting NS causes a loss of
protein in the urine and edema. The edema often manifests itself as
puffy eyelids, a symptom that many parents and physicians mistake as
allergies. With experts projecting a substantial increase in nephrotic
syndrome in the coming years, there is a clear need to educate
pediatricians and family physicians about glomerular disease and its
symptoms.
It would be of great benefit for CDC to begin raising public
awareness of the glomerular diseases in an attempt to diagnose patients
earlier.
We ask the Subcommittee to encourage CDC to establish a glomerular
disease education and awareness program aimed at both the general
public and healthcare providers.
______
Prepared Statement of Neurofibromatosis, Inc.
Thank you for the opportunity to submit testimony to the
Subcommittee on the importance of continued funding at the National
Institutes of Health (NIH) for Neurofibromatosis (NF), a terrible
genetic disorder closely linked to many common diseases widespread
among the American population.
On behalf of Neurofibromatosis, Inc., a national coalition of NF
advocacy groups, I speak on behalf of the 100,000 Americans who suffer
from NF as well as approximately 175 million Americans who suffer from
diseases and conditions linked to NF such as cancer, brain tumors,
heart disease, memory loss and learning disabilities. Thanks in large
measure to this Subcommittee's strong and enduring support, scientists
have made enormous progress since the discovery of the NF1 gene in 1990
resulting in clinical trials now being undertaken at NIH with broad
implications for the general population.
What is Neurofibromatosis (NF)?
NF is a genetic disorder involving the uncontrolled growth of
tumors along the nervous system which can result in terrible
disfigurement, deformity, deafness, blindness, brain tumors, cancer,
and even death. NF can also cause other abnormalities such as unsightly
benign tumors across the entire body and bone deformities. In addition,
approximately one-half of children with NF suffer from learning
disabilities. While not all NF patients suffer from the most severe
symptoms, all NF patients and their families live with the uncertainty
of not knowing whether they will be seriously affected because NF is a
highly variable and progressive disease.
NF is not rare. It is the most common neurological disorder caused
by a single gene and three times more common than Muscular Dystrophy
and Cystic Fibrosis combined, but it is not widely known because it has
been poorly diagnosed for many years. Approximately 100,000 Americans
have NF, and it appears in approximately 1 in every 2,500 births. It
strikes worldwide, without regard to gender, race or ethnicity.
Approximately 50 percent of new NF cases result from a spontaneous
mutation in an individual's genes and 50 percent are inherited. There
are three types of NF: NF1, which is more common, NF2, which primarily
involves tumors causing deafness and balance problems, and
schwannomatosis, the hallmark of which is severe pain. In addition,
advances in NF research stand to benefit over 175 million Americans in
this generation alone because NF is directly linked to many of the most
common diseases affecting the general population.
When a child is diagnosed with NF it means tumors can grow anytime,
anywhere on his/her nervous system, from the day he/she is born until
the day he/she dies with no way to predict when or how severely the
tumors will affect his/her body--and no viable way to treat the disease
outside of surgery--which often results in more tumors that grow twice
as fast. That same child then has a 50 percent chance to pass the gene
to his/her children. That is an overwhelming diagnosis and it bears
repeating: NF is one of the most common genetic disorders in our
country and has no cure and no viable treatment. But that is changing.
The immediate future holds real promise.
Link to Other Illnesses
Researchers have determined that NF is closely linked to cancer,
heart disease, learning disabilities, memory loss, brain tumors, and
other disorders including deafness, blindness and orthopedic disorders,
primarily because NF regulates important pathways common to these
disorders such as the RAS, cAMP and PAK pathways. Research on NF
therefore stands to benefit millions of Americans:
Cancer.--NF is closely linked to many of the most common forms of
human cancer, affecting approximately 65 million Americans. In fact, NF
shares these pathways with 70 percent of human cancers. Research has
demonstrated that NF's tumor suppressor protein, neurofibromin,
inhibits RAS, one of the major malignancy causing growth proteins
involved in 30 percent of all cancer. Accordingly, advances in NF
research may well lead to treatments and cures not only for NF
patients, but for all those who suffer from cancer and tumor-related
disorders. Similar studies have also linked epidermal growth factor
receptor (EGF-R) to malignant peripheral nerve sheath tumors (MPNSTs),
a form of cancer which disproportionately strikes NF patients.
Heart disease.--Researchers have demonstrated that mice completely
lacking in NF1 have congenital heart disease that involves the
endocardial cushions which form in the valves of the heart. This is
because the same ras involved in cancer also causes heart valves to
close. Neurofibromin, the protein produced by a normal NF1 gene,
suppresses ras, thus opening up the heart valve. Promising new research
has also connected NF1 to cells lining the blood vessels of the heart,
with implications for other vascular disorders including hypertension,
which affects approximately 50 million Americans. Researchers believe
that further understanding of how an NF1 deficiency leads to heart
disease may help to unravel molecular pathways involved in genetic and
environmental causes of heart disease.
Learning disabilities.--Learning disabilities are the most common
neurological complication in children with NF1. Research aimed at
rescuing learning deficits in children with NF could open the door to
treatments affecting 35 million Americans and 5 percent of the world's
population who also suffer from learning disabilities. In NF1 the
neurocognitive disabilities range includes behavior, memory and
planning. Recent research has shown there are clear molecular links
between autism spectrum disorder and NF1; as well as with many other
cognitive disabilities. Tremendous research advances have recently led
to the first clinical trials of drugs in children with NF1 learning
disabilities. These trials are showing promise. In addition because of
the connection with other types of cognitive disorders such as autism,
researchers and clinicians are actively collaborating on research and
clinical studies, pooling knowledge and resources. It is anticipated
that what we learn from these studies could have an enormous impact on
the significant American population living with learning difficulties
and could potentially save Federal, State, and local governments, as
well as school districts, billions of dollars annually in special
education costs resulting from a treatment for learning disabilities.
Memory loss.--Researchers have also determined that NF is closely
linked to memory loss and are now investigating conducting clinical
trials with drugs that may not only cure NF's cognitive disorders but
also result in treating memory loss as well with enormous implications
for patients who suffer from Alzheimer's disease and other dementias.
Deafness.--NF2 accounts for approximately 5 percent of genetic
forms of deafness. It is also related to other types of tumors,
including schwannomas and meningiomas, as well as being a major cause
of balance problems.
Scientific Advances
Thanks in large measure to this Subcommittee's support; scientists
have made enormous progress since the discovery of the NF1 gene in
1990. Major advances in just the past few years have ushered in an
exciting era of clinical and translational research in NF with broad
implications for the general population.
These recent advances have included:
--Phase II and Phase III clinical trials involving new drug therapies
for both cancer and cognitive disorders;
--Creation of a National Clinical and Pre-Clinical Trials
Infrastructure and NF Centers;
--Successfully eliminating tumors in NF1 and NF2 mice with the same
drug;
--Developing advanced mouse models showing human symptoms;
--Rescuing learning deficits and eliminating tumors in mice with the
same drug;
--Determining the biochemical, molecular function of the NF genes and
gene products; and
--Connecting NF to more and more diseases because of NF's impact on
many body functions.
Congressional support for NF research
The enormous promise of NF research, and its potential to benefit
over 175 million Americans who suffer from diseases and conditions
linked to NF, has gained increased recognition from Congress and the
NIH. This is evidenced by the fact that 12 institutes at NIH are
currently supporting NF research (NCI, NHLBI, NINDS, NIDCD, NHGRI,
NCRR, NIMH, NIGMS, NEI, NIA, NICHD, and OD), and NIH's total NF
research portfolio has increased from $3 million in fiscal year 1990 to
an estimated $24 million in fiscal year 2011. Given the potential
offered by NF research for progress against a range of diseases, we are
hopeful that NIH will continue to build on the successes of this
program by funding this promising research and thereby continuing the
enormous return on the taxpayers' investment.
We respectfully request that you include the following report
language on NF research at the National Institutes of Health within
your fiscal year 2012 Labor, Health and Human Services, Education
Appropriations bill.
Neurofibromatosis [NF].--NF is an important research area for
multiple NIH Institutes; therefore the Committee supports efforts to
increase funding and resources toward NF research and treatment. As NF
is connected to many forms of cancer in children and adults; the
Committee encourages the NCI to substantially increase its NF research
portfolio in pre-clinical and clinical trials by applying newly
developed and existing drugs. The Committee also encourages the NCI to
support NF centers, clinical trials consortia, patient databases, and
biospecimen repositories. The Committee also urges additional focus
from the NHLBI, given NF's involvement with hypertension and congenital
heart disease. Because NF causes tumors to grow on the nerves
throughout the body, the Committee urges the NINDS to continue
aggressive research on nerve damage and repair which has strong
implications not only for NF but for spinal cord and brain injury,
learning disabilities and attention deficit disorders. In addition, the
Committee continues to encourage the NICHD and NIMH to expand funding
of clinical trials for NF patients in the area of learning
disabilities. Children with NF1 are prone to the development of severe
bone deformities, including scoliosis; the Committee encourages NIAMS
to expand its NF1 research portfolio. NF2 accounts for approximately 5
percent of genetic forms of deafness; the Committee therefore
encourages the NIDCD to expand its NF2 research portfolio. The
Committee encourages NEI to expand its NF research portfolio to advance
the cause of treating Optic gliomas, vision loss and cataracts, major
clinical problems associated with NF. The Committee encourages the
NHGRI to expand its NF portfolio given that NF represents an ideal
model to study the genomics of cancer predisposition, learning and
behavior, and bone disease translatable to personalized medicine for
affected individuals.
We appreciate the Subcommittee's strong support for NF research and
will continue to work with you to ensure that opportunities for major
advances in NF research are aggressively pursued. Thank you.
______
Prepared Statement of the Nursing Community
The Nursing Community is a forum for professional nursing
organizations to collaborate on a wide spectrum of healthcare and
nursing issues, including practice, education, and research. These 56
organizations are committed to promoting America's health through
nursing care. Collectively, the Nursing Community represents over
850,000 Registered Nurses (RNs), Advanced Practice Registered Nurses
(APRNs--including certified nurse-midwives, nurse practitioners,
clinical nurse specialists, and certified registered nurse
anesthetists), nurse executives, nursing students, nursing faculty, and
nurse researchers. Together, our organizations work collaboratively to
increase funding for the Nursing Workforce Development programs
(authorized under Title VIII of the Public Health Service Act [42
U.S.C. 296 et seq.]), the National Institute of Nursing Research
(NINR), and to secure authorized funding for Nurse-Managed Health
Clinics so that American nurses have the support needed to provide high
quality healthcare to the Nation.
Nurses are involved in every aspect of healthcare, and if the
nursing workforce is not strengthened, the healthcare system will
continue to suffer. Currently, RNs comprise the largest group of health
professionals with approximately 3.1 million licensed providers. Nurses
offer essential care to patients as well as our Nation's active duty
military and veterans in a variety of settings, including hospitals,
ambulatory care clinics, long-term care facilities, community or public
health areas, schools, workplaces, and private homes. In addition, many
nurses pursue graduate degrees to assume roles as advanced practice
registered nurses who practice autonomously; become nurse faculty,
nurse researchers, nurse administrators, and advanced public health
nurses. Nurses also specialize in areas such as mental and women's
health, pain management, hospice and palliative care, nephrology,
oncology, rehabilitation, forensics, dermatology, urology, and care
coordination. They are critical team members in all departments such as
intensive and critical care, pediatrics, geriatrics, medical surgical,
and operating rooms. RNs and APRNs hold a holistic view of health.
With the Patient Protection and Affordable Care Act [Public Law
111-148] (ACA) focus on creating a system that will increase access to
quality care, emphasize prevention, and decrease cost, it is critical
that a substantial investment be made in our RN and APRN workforce, in
the scientific research that provides the basis for nursing practice,
and in the safety-net facilities they operate.
In an article published in the July/August 2009 issue of Health
Affairs, Dr. Peter Buerhaus, a noted health professions workforce
analyst, and colleagues confirmed that although the economic recession
has led to a temporary easing of the nursing shortage in some parts of
the country, the overall shortfall in the number of nurses needed is
expected to grow to 260,000 by the year 2025. Three major factors
contribute to this growing demand for nursing care. First, over 275,000
practicing RNs are over the age of 60 according to the 2008 National
Sample Survey of Registered Nurses. When the economy rebounds, many of
these nurses will seek retirement. Second, America's population is
aging. Older Americans will seek more healthcare services creating an
influx of consumers and necessitate the need for quality nursing care.
Finally, the ACA will expand the number of individuals seeking care by
32 million.
Furthermore, in a report released by the Institute of Medicine and
Robert Wood Johnson Foundation titled, The Future of the Nursing:
Leading Change, Advancing Health, clear and evidence based guidance was
provided on how to shape nursing's role in healthcare delivery as the
system undergoes considerable changes. The report's key messages
include:
--Nurses should practice to the full extent of their education and
training; scope of practice limitations should be removed.
--Nurses should achieve higher levels of education and training
through an improved education system that promotes seamless
academic progression.
--Nurses should be full partners with other healthcare professionals
in redesigning healthcare in the United States.
--Effective workforce planning and policymaking require better data
collection and an improved information infrastructure.
To achieve these goals, different levels of support will be needed
for all nurses and each of the funding requests outlined below will
help to meet not only the goals of the IOM report, but the larger
national goals of access to high quality, cost effective care.
addressing the demand: nursing workforce development programs
The Nursing Workforce Development programs, authorized under Title
VIII of the Public Health Service Act (42 U.S.C. 296 et seq.), helped
build the supply and distribution of qualified nurses to meet our
Nation's healthcare needs since 1964. Over the last 47 years, these
programs addressed all aspects of supporting the workforce--education,
practice, retention, and recruitment. The Title VIII programs bolster
nursing education at all levels, from entry-level preparation through
graduate study, and provide support for institutions that educate
nurses for practice in rural and medically underserved communities.
Today, the Title VIII programs are essential to ensure the demand for
nursing care is met. Between fiscal year 2006 and 2009, the Title VIII
programs supported over 347,000 nurses and nursing students as well as
numerous academic nursing institutions, and healthcare facilities.
Results from the American Association of Colleges of Nursing's
(AACN) 2010-2011 Title VIII Student Recipient Survey included responses
from 1,459 students who noted that these programs played a critical
role in funding their nursing education. The survey showed that 80
percent of the students receiving Title VIII funding are attending
school full-time. By supporting full-time students, the Title VIII
programs are helping to ensure that students enter the workforce
without delay. The programs also address the current demand for primary
care providers. Nearly one-third of respondents reported that their
career goal is to become a nurse practitioner. Approximately 80 percent
of nurse practitioners provide primary care services throughout the
United States. Additionally, the respondents identified working in
rural and underserved areas as future goals, with becoming a nurse
faculty member, a nurse practitioner, or a certified registered nurse
anesthetist as the top three nursing positions for their career
aspirations.
The Nursing Community respectfully requests $313.075 million for
the Nursing Workforce Development programs authorized under Title VIII
of the Public Health Service Act in fiscal year 2012 as recommended in
the President's fiscal year 2012 budget proposal.
building the science: the national institute of nursing research
As one of the 27 Institutes and Centers at the National Institutes
of Health (NIH), the NINR funds research that establishes the
scientific basis for quality patient care. Nurse researchers make
significant advances in and contributions to health prevention and
care. In addition, they work collaboratively as well as part of
multidisciplinary research teams with colleagues from other fields and
are vital in setting the national research agenda.
The Nursing Community respectfully requests $163 million for the
National Institute of Nursing Research in fiscal year 2012. Nursing
research is an essential part of scientific endeavors to improve the
Nation's health. Knowledge of care across the lifespan is critical to
the present and future health of the Nation. Research funded at the
NINR helps to integrate biology and behavior as well as design new
technology and tools. At a time when healthcare needs are changing,
nursing care must be firmly grounded in nursing science. The four
strategic areas of emphasis for research at NINR are promoting health
and preventing disease, eliminating health disparities, improving
quality of life, and setting directions for end-of-life research.
The science advanced at NINR is integral to the future of the
Nation's healthcare system. Through grants, research training, and
interdisciplinary collaborations, NINR addresses care management of
patients during illness and recovery, reduction of risks for disease
and disability, promotion of healthy lifestyles, enhancement of quality
of life for those with chronic illness, and care for individuals at the
end of life. NINR's research fosters advances in nursing practice,
improves patient care, and attracts new students to the profession.
SUPPORTING SAFETY NET FACILITIES: NURSE-MANAGED HEALTH CLINICS
The ACA amended Sec. 330 of the Public Health Service Act to
provide grant eligibility to Nurse-Managed Health Clinics (NMHCs) to
support operating costs and authorized up to $50 million a year for
this purpose. NMHCs are defined as a nurse-practice arrangement,
managed by APRNs, that provides primary care or wellness services to
underserved or vulnerable populations and that is associated with a
school, college, university or department of nursing, federally
qualified health center, or independent nonprofit health or social
services agency. Nurse-Managed Health Clinics successfully engage
communities and address critical health needs for underserved
populations.
The Nursing Community respectfully requests $20 million for the
Nurse-Managed Health Clinics authorized under Title III of the Public
Health Service Act in fiscal year 2012 as recommended in the
President's fiscal year 2012 budget proposal.
NMHCs provide care to clients and patients in clinics located in
places like public housing, on blighted urban streets, on Native
American reservations, in rural communities, in senior citizen centers,
in elementary schools, in storefronts, and even in churches. The
services these clinics provide include primary care, health promotion,
and disease prevention. Furthermore, NMHCs also act as important
teaching and practice sites for nursing students.
The care provided in these sites directly contributes to positive
health outcomes and savings in the long term. In one U.S. city alone,
nurses at an NMHC see their patients almost twice as frequently as
other providers, and their patients are hospitalized 30 percent less
and use the emergency room 15 percent less often than those of other
healthcare providers. Providing funding for these centers is a direct
investment in the specific health needs of localized communities.
Without a workforce of well-educated nurses providing evidence-
based care to those who need it most, including our growing aging
population, the healthcare system is not sustainable. The Nursing
Community's request of $313.075 million in fiscal year 2012 for the
Title VIII Nursing Workforce Development programs, $163 million for the
NINR, and $20 million for NMHCs will help ensure access to quality care
provided by America's nursing workforce.
MEMBERS OF THE NURSING COMMUNITY SUBMITTING THIS TESTIMONY
Academy of Medical-Surgical Nurses
American Academy of Ambulatory Care Nursing
American Academy of Nurse Practitioners
American Academy of Nursing
American Assembly for Men in Nursing
American Association of Colleges of Nursing
American Association of Critical-Care Nurses
American Association of Nurse Anesthetists
American Association of Nurse Assessment Coordinators
American College of Nurse Practitioners
American College of Nurse-Midwives
American Holistic Nurses Association
American Nephrology Nurses' Association
American Nurses Association
American Organization of Nurse Executives
American Psychiatric Nurses Association
American Society for Pain Management Nursing
American Society of PeriAnesthesia Nurses
Association of Community Health Nursing Educators
Association of periOperative Registered Nurses
Association of Rehabilitation Nurses
Association of State and Territorial Directors of Nursing
Association of Women's Health, Obstetric and Neonatal Nurses
Commissioned Officers Association
Dermatology Nurses' Association
Gerontological Advanced Practice Nurses Association
Hospice and Palliative Nurses Association
Infusion Nurses Society
International Association of Forensic Nurses
International Nurses Society on Addictions
International Society of Psychiatric Nurses
National Association of Clinical Nurse Specialists
National Association of Nurse Practitioners in Women's Health
National Association of Pediatric Nurse Practitioners
National Black Nurses Association
National Coalition of Ethnic Minority Nurse Associations
National Nursing Centers Consortium
National Organization of Nurse Practitioner Faculties
Nurses Organization of Veterans Affairs
Oncology Nursing Society
Public Health Nursing Section, American Public Health Association
Society of Urologic Nurses and Associates
______
Prepared Statement of the Oncology Nursing Society
OVERVIEW
The Oncology Nursing Society (ONS) appreciates the opportunity to
submit written comments for the record regarding fiscal year 2012
funding for cancer and nursing related programs. ONS, the largest
professional oncology group in the United States, composed of more than
35,000 nurses and other health professionals, exists to promote
excellence in oncology nursing and the provision of quality care to
those individuals affected by cancer. As part of its mission, the
Society honors and maintains nursing's historical and essential
commitment to advocacy for the public good.
In 2010, an estimated 1.529 million Americans were diagnosed with
cancer, and more than 569,490 lost their battle to this terrible
disease; at the same time the national nursing shortage is expected to
worsen. Overall, age is the number one risk factor for developing
cancer. Approximately 77 percent of all cancers are diagnosed at age 55
and older.\1\ Despite these grim statistics, significant gains in the
war against cancer have been made through our Nation's investment in
cancer research and its application. Research holds the key to improved
cancer prevention, early detection, diagnosis, and treatment, but such
breakthroughs are meaningless, unless we can deliver them to all
Americans in need. Moreover, a recent survey of ONS members found that
the nursing shortage is having an impact in oncology physician offices
and hospital outpatient departments. Some respondents indicated that
when a nurse leaves their practice, they are unable to hire a
replacement due to the shortage--leaving them short-staffed and posing
scheduling challenges for the practice and the patients. These
vacancies in all care settings create significant barriers to ensuring
access to quality care.
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\1\ American Cancer Society. Cancer Facts and Figures 2010. http://
www.cancer.org/Research/CancerFactsFigures/CancerFactsFigures/cancer-
facts-and-figures-2010.
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To ensure that all people with cancer have access to the
comprehensive, quality care they need and deserve, ONS advocates
ongoing and significant Federal funding for cancer research and
application, as well as funding for programs that help ensure an
adequate oncology nursing workforce to care for people with cancer. ONS
stands ready to work with policymakers at the local, State, and Federal
levels to advance policies and programs that will reduce and prevent
suffering from cancer and sustain and strengthen the Nation's nursing
workforce. We thank the Subcommittee for its consideration of our
fiscal year 2012 funding request detailed below.
SECURING AND MAINTAINING AN ADEQUATE ONCOLOGY NURSING WORKFORCE
Oncology nurses are on the front lines in the provision of quality
cancer care for individuals with cancer--administering chemotherapy,
managing patient therapies and side-effects, working with insurance
companies to ensure that patients receive the appropriate treatment,
providing treatment education and counseling to patients and family
members, and engaging in myriad other activities on behalf of people
with cancer and their families. Cancer is a complex, multifaceted
chronic disease, and people with cancer require specialty-nursing
interventions at every step of the cancer experience. People with
cancer are best served by nurses specialized in oncology care, who are
certified in that specialty.
As the overall number of nurses is expected to decline in the
coming years, we likely will experience a commensurate decrease in the
number of nurses trained in the specialty of oncology. With an
increasing number of people with cancer needing high-quality
healthcare, coupled with an inadequate nursing workforce, our Nation
could quickly face a cancer care crisis of serious proportion, with
limited access to quality cancer care, particularly in traditionally
underserved areas. A study in the New England Journal of Medicine found
that nursing shortages in hospitals are associated with a higher risk
of complications--such as urinary tract infections and pneumonia,
longer hospital stays, and even patient death.\2\ Without an adequate
supply of nurses, there will not be enough qualified oncology nurses to
provide the quality cancer care to a growing population of people in
need, and patient health and well-being could suffer.
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\2\ Needleman J., Buerhaus P., Mattke S., Stewart M., Zelevinsky K.
``Nurse-Staffing Levels and the Quality of Care in Hospitals.'' New
England Journal of Medicine 346:, (May 30, 2002): 1715-1722.
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Of additional concern is that our Nation also will face a shortage
of nurses available and able to conduct cancer research and clinical
trials. With a shortage of cancer research nurses, progress against
cancer will take longer because of scarce human resources coupled with
the reality that some practices and cancer centers' resources could be
funneled away from cancer research to pay for the hiring and retention
of oncology nurses to provide direct patient care. Without a sufficient
supply of trained, educated, and experienced oncology nurses, we are
concerned that our Nation may falter in its delivery and application of
the benefits from our Federal investment in research.
ONS joins our colleagues from all nursing sectors and specialties
to request $313.075 million for the Health Resources and Services
Administrations (HRSA) Title VIII programs in fiscal year 2012, as
recommended in the President's fiscal year 2012 budget. With additional
funding in fiscal year 2012, the HRSA Workforce Development Programs
will have much-needed resources to address the multiple factors
contributing to the nationwide nursing shortage. Advanced nursing
education programs play an integral role in supporting registered
nurses interested in advancing in their practice and becoming faculty.
As such, these programs must be adequately funded in the coming year.
ONS strongly urges Congress to provide HRSA with this amount to
ensure that the agency has the resources necessary to fund a higher
rate of nursing scholarships and loan repayment applications and
support other essential endeavors to sustain and boost our Nation's
nursing workforce. Nurses--along with patients, family members,
hospitals, and others--have joined together in calling upon Congress to
provide this essential level of funding. The National Coalition for
Cancer Research (NCCR), a nonprofit organization comprised of 23
national cancer organizations, and One Voice Against Cancer (OVAC), a
collaboration of 39 national nonprofit organizations, are also
advocating $313.075 million in fiscal year 2012 for the Nurse
Reinvestment Act. ONS and its allies have serious concerns that without
full funding, the Nurse Reinvestment Act will prove an empty promise,
and the current and expected nursing shortage will worsen, and people
will not have access to the quality care they need and deserve.
SUSTAIN AND SEIZE CANCER RESEARCH OPPORTUNITIES
Our Nation has benefited immensely from past Federal investment in
biomedical research at the National Institutes of Health (NIH). ONS has
joined with the broader health community in advocating a $35 billion
for NIH in fiscal year 2012. This level of investment will allow NIH to
sustain and build on its research progress, while avoiding the severe
disruption to advancement that could result from a minimal increase.
Cancer research is producing amazing breakthroughs--leading to new
therapies that translate into longer survival and improved quality of
life for cancer patients. In recent years, we have seen extraordinary
advances in cancer research, resulting from our national investment,
which have produced effective prevention, early detection, and
treatment methods for many cancers. To that end, ONS calls upon
Congress to allocate $5.740 billion to the National Cancer Institute
(NCI), as well as $231 million to the National Center for Minority
Health and Health Disparities in fiscal year 2012 to support the battle
against cancer.
The National Institute of Nursing Research (NINR) supports basic
and clinical research to establish a scientific basis for the care of
individuals across the life span--from management of patients during
illness and recovery, to the reduction of risks for disease and
disability and the promotion of healthy lifestyles. These efforts are
crucial in translating scientific advances into cost-effective
healthcare that does not compromise quality of care for patients.
Additionally, NINR fosters collaborations with many other disciplines
in areas of mutual interest, such as long-term care for older people,
the special needs of women across the life span, bioethical issues
associated with genetic testing and counseling, and the impact of
environmental influences on risk factors for chronic illnesses, such as
cancer. ONS joins with others in the nursing community and NCCR in
advocating a fiscal year 2012 allocation of $163 million for NINR.
BOOST OUR NATION'S INVESTMENT IN CANCER PREVENTION, EARLY DETECTION,
AND AWARENESS
Approximately two-thirds of cancer cases are preventable through
lifestyle and behavioral factors and improved practice of cancer
screening. Although the potential for reducing the human, economic, and
social costs of cancer by focusing on prevention and early detection
efforts remains great, our Nation does not invest sufficiently in these
strategies. The Nation must make significant and unprecedented Federal
investments today to address the burden of cancer and other chronic
diseases, and to reduce the demand on the healthcare system and
diminish suffering in our Nation, both for today and tomorrow.
As the Nation's leading prevention agency, the Centers for Disease
Control and Prevention (CDC) plays an important role in translating and
delivering, at the community level, what is learned from research.
Therefore, ONS joins with our partners in the cancer community in
calling on Congress to provide additional resources for the CDC to
support and expand much-needed and proven effective cancer prevention,
early detection, and risk reduction efforts. Specifically, ONS
advocates the following fiscal year 2012 funding levels for the
following CDC programs:
--$275 million for the National Breast and Cervical Cancer Early
Detection Program;
--$65 million for the National Cancer Registries Program;
--$70 million for the Colorectal Cancer Prevention and Control
Initiative;
--$50 million for the Comprehensive Cancer Control Initiative;
--$25 million for the Prostate Cancer Control Initiative;
--$5 million for the National Skin Cancer Prevention Education
Program;
--$10 million for the Gynecologic Cancer and Education and Awareness
(Johanna's Law);
--$10 million for the Ovarian Cancer Control Initiative; and
--$6 million for the Geraldine Ferraro Blood Cancer Program.
CONCLUSION
ONS maintains a strong commitment to working with Members of
Congress, other nursing and oncology groups, patient organizations, and
other stakeholders to ensure that the oncology nurses of today continue
to practice tomorrow, and that we recruit and retain new oncology
nurses to meet the unfortunate growing demand that we will face in the
coming years. By providing the fiscal year 2012 funding levels detailed
above, we believe the Subcommittee will be taking the steps necessary
to ensure that our nation has a sufficient nursing workforce to care
for the patients of today and tomorrow and that our nation continues to
make gains in our fight against cancer.
______
Prepared Statement of the Ovarian Cancer National Alliance
The Ovarian Cancer National Alliance (the Alliance) appreciates the
opportunity to submit comments for the record regarding the Alliance's
fiscal year 2012 funding recommendations. We believe these
recommendations are critical to ensure advances to help reduce and
prevent suffering from ovarian cancer.
For 14 years, the Alliance has worked to increase awareness of
ovarian cancer and advocate for additional Federal resources to support
research that would lead to more effective diagnostics and treatments.
As an umbrella organization with approximately 50 national, State and
local organizations, the Alliance unites the efforts of survivors,
grassroots activists, women's health advocates and healthcare
professionals to bring national attention to ovarian cancer. The
Ovarian Cancer National Alliance is the foremost advocate for women
with ovarian cancer in the United States. To advance the interests of
women with ovarian cancer, the organization advocates at a national
level for increases in research funding for the development of an early
detection test, improved healthcare practices and life-saving treatment
protocols. The Ovarian Cancer National Alliance educates healthcare
professionals and raises public awareness of the risks, signs and
symptoms of ovarian cancer.
According to the American Cancer Society, in 2010, more than 22,000
American women were diagnosed with ovarian cancer and approximately
15,000 lost their lives to this terrible disease. Ovarian cancer is the
fifth leading cause of cancer death in women. Currently, more than half
of the women diagnosed with ovarian cancer will die within 5 years.
While ovarian cancer has symptoms, there is no reliable early detection
test. Most women are diagnosed in Stage III or Stage IV, when survival
rates are low. If diagnosed early, more than 90 percent of women will
survive for 5 years, but when diagnosed later, less than 30 percent
will.
Only a few treatments have been approved by the Food and Drug
Administration (FDA) for ovarian cancer treatment. These are platinum-
based therapies and women needing further rounds of treatment are
frequently resistant to them. More than 70 percent of ovarian cancer
patients will have a recurrence at some point, underlying the need for
treatments to which patients do not grow resistant.
For all of these reasons, we urgently call on Congress to
appropriate funds to find solutions.
As part of this effort, the Alliance advocates for continued
Federal investment in the Centers for Disease Control and Prevention's
(CDC) Ovarian Cancer Control Initiative. The Alliance respectfully
requests that Congress provide $10 million for the program in fiscal
year 2012.
The Alliance also fully supports Congress in taking action on
educating Americans about ovarian cancer through providing funding for
The Gynecologic Cancer Education and Awareness Act (Johanna's Law)
[Public Law 111-324]. The Alliance respectfully requests that Congress
provide $10 million to implement The Gynecologic Cancer Education and
Awareness Act (Johanna's Law) in fiscal year 2012.
Further, the Alliance urges Congress to continue funding the
Specialized Programs of Research Excellence (SPOREs), including the
five ovarian cancer sites. These programs are administered through the
National Cancer Institute (NCI) of the National Institutes of Health
(NIH). The Alliance respectfully requests that Congress provide $5.74
billion to the National Cancer Institute for fiscal year 2012.
CENTERS FOR DISEASE CONTROL AND PREVENTION
THE OVARIAN CANCER CONTROL INITIATIVE
As the statistics indicate, late detection and, therefore, poor
survival are among the most urgent challenges we face in the ovarian
cancer field. The CDC's cancer program, with its strong capacity in
epidemiology and excellent track record in public and professional
education, is well positioned to address these problems. As the
Nation's leading prevention agency, the CDC plays an important role in
translating and delivering at the community level what is learned from
research, especially ensuring that those populations disproportionately
affected by cancer receive the benefits of our Nation's investment in
medical research.
Congress established the Ovarian Cancer Control Initiative at the
CDC in November 1999 with bipartisan, bicameral support. Congress'
directive to the agency was to develop an appropriate public health
response to ovarian cancer and conduct several public health activities
targeted toward reducing ovarian cancer morbidity and mortality.
The CDC's Ovarian Cancer Control Initiative conducts research about
early detection, treatment and survivorship nationwide to increase
understanding of ovarian cancer. Some of the Ovarian Cancer Control
Initiative's notable studies include: a study of women who died of
ovarian cancer within three managed care organizations to investigate
end-of-life care; the Ovarian Cancer Treatment Patterns and Outcomes
study, which attempted to determined how the stage of cancer, the
specialty of a surgeon and the success of the surgery contributed to
the survival of ovarian cancer patients diagnosed between 1997 and
2000; and a study to examine geographic access to subspecialists for
treating ovarian cancer.
THE GYNECOLOGIC CANCER EDUCATION AND AWARENESS ACT (JOHANNA'S LAW)
It is critical for women and their healthcare providers to be aware
of the signs, symptoms and risk factors of ovarian and other
gynecologic cancers. Often, women and providers mistakenly confuse
ovarian cancer signs and symptoms with those of gastrointestinal
disorders or early menopause. While symptoms may seem vague--bloating,
pelvic or abdominal pain, increased abdominal size and bloating and
difficulty, eating or feeling full quickly, or urinary symptoms
(urgency or frequency)--the underlying disease can be deadly without
proper medical intervention.
In recognition of the need for awareness and education, Congress
unanimously passed Johanna's Law in 2006, enacted in early 2007. This
law provides for an education and awareness campaign that will increase
providers' and women's awareness of all gynecologic cancers including
ovarian. Johanna's Law was reauthorized in 2010.
Thanks to funding under Johanna's Law, more women are learning how
to identify the signs and symptoms of gynecologic. From September 2010
to January 2011, the broadcast PSAs have been played 68,630 times,
generating 154,632,815 audience impressions (the number of times they
have been seen or heard), worth $7,491,846 in donated placements.
Additionally, since October 2010:
--there have been 25,706 plays of the TV PSAS, worth $2,800,805 in
donated airtime,
--there have been 9,701 plays of English TV spots,
--there have been 16,005 plays of Spanish TV spots,
--the PSAs have aired in the top markets, including Los Angeles,
Chicago, Philadelphia, San Francisco, Boston, Dallas/Fort
Worth, Atlanta, Tampa/St. Petersburg, Pittsburgh, PA, Salt Lake
City, Raleigh/Durham, Green Bay, Baltimore, Tucson, Cleveland,
Phoenix, Tulsa, Orlando, Hartford/New Haven, Houston, Spokane,
and Seattle/Tacoma, among others, and
--English spots have aired during popular programs such Today, Good
Morning America, CBS Morning News, Access Hollywood, Cold Case,
Real Housewives of Orange County, The Bachelor, The View, Dr.
Oz Show, Ellen DeGeneres Show, The Doctors, Entertainment
Tonight, and Late Night with David Letterman during the hours
of 8 a.m. to midnight.
With continued funding, the CDC will be able to continue to print
and distribute brochures, maintain and update the web resources,
develop additional educational materials such as posters for physician
offices, complete continuing education materials for healthcare
providers, and reach out to women beyond the original 40-60 year-old
initial target group.
CDC CHRONIC DISEASE PROGRAM CONSOLIDATION
The President's budget proposal for fiscal year 2012 recommends
consolidating all of the Centers for Disease Control and Prevention's
(CDC) chronic disease programs that are focused on heart disease and
stroke, diabetes, cancer, arthritis, nutrition, and other health-
related issues into one competitive grant program. It is our
understanding that the Gynecologic Cancer Education and Awareness Act
(Johanna's Law) and the Ovarian Cancer Control Initiative would be
included in this all-encompassing competitive grant program. These
programs, with congressional support, have been able to increase
understanding and raise awareness of ovarian and other women's cancers
that afflict Americans.
While we support efforts to improve the efficiency of Federal
programs, we oppose shifting control and funding of these programs away
from Congress. Moreover, given that ovarian cancer mortality rates have
remained virtually unchanged for decades and currently there is no
early detection test for the disease, we feel strongly that the CDC
should maintain dedicated efforts focused on reducing ovarian cancer
mortality and morbidity. As such, we recommend that Johanna's Law and
the Ovarian Cancer Control Initiative remain standalone line items in
the fiscal year 2012 Labor, Health and Human Services, and Education
(LHHS) appropriations bill.
NATIONAL CANCER INSTITUTE
The National Cancer Institute is the chief funder of ovarian cancer
research in the United States and the world. In 2009, the National
Cancer Institute funded over 170 studies solely dedicated to bettering
our scientific understanding of ovarian cancer. These studies
investigated diverse topics such as the effect of Vitamin D on ovarian
cancer prevention and treatment, whether Prolactin is a risk biomarker
of ovarian cancer, and whether viruses can be converted into ovarian
cancer-fighting agents. Research investigators who receive funding from
the National Cancer Institute study cancer are located all across the
United States. According to Families USA, every dollar in Federal
research spending generates about $2 in economic activity in local
economies where funded projects are located.
SPECIALIZED PROGRAMS OF RESEARCH EXCELLENCE IN THE NATIONAL INSTITUTES
OF HEALTH
The Specialized Programs of Research Excellence were created by the
NCI in 1992 to support translational, organ site-focused cancer
research. The ovarian cancer SPOREs began in 1999. There are five
currently funded Ovarian Cancer SPOREs located at the MD Anderson
Cancer Center, the Fred Hutchinson Cancer Research Center, the Fox
Chase Cancer Center, the Dana Farber/Harvard Cancer Center and the Mayo
Clinic Cancer Center.
These SPORE programs have made outstanding strides in understanding
ovarian cancer, as illustrated by their more than 300 publications as
well as other notable achievements, including the development of an
infrastructure between Ovarian SPORE institutions to facilitate
collaborative studies on understanding, early detection and treatment
of ovarian cancer.
CLINICAL TRIALS
The National Cancer Institute supports clinical research--the only
way to test the safety and efficacy of potential new treatments for
ovarian cancer. An example of NCI-funded clinical research is a new 5-
year study addressing the lack of knowledge about causes and risk
factors for ovarian cancer in African American women conducted by
University Hospitals Case Medical Center and Case Western Reserve
University School of Medicine. Another study funded by the National
Cancer Institute compared the efficacy and safety of a dose-dense
regimen of single-agent cisplatin with a standard 3-weekly schedule in
first-line chemotherapy for advanced epithelial ovarian cancer. The
study found that increasing dose intensity of cisplatin does not
improve PFS or OS compared with standard chemotherapy.
NCI supports the Gynecology Oncology Group, a more than 50-member
collaborative focusing on cancers of the female reproductive system.
From 2008 until present, the GOG has published 103 articles about
ovarian cancer. An important and recent finding from the GOG, the GOG
218 study, was that women with advanced cancer who received
chemotherapy followed by maintenance use of Avastin increased survival
time without their disease worsening compared to chemotherapy alone.
SUMMARY
The Alliance maintains a long-standing commitment to work with
Congress, the administration, and other policy makers and stakeholders
to improve the survival rate for women with ovarian cancer through
education, public policy, research and communication. Please know we
appreciate and understand that our Nation faces many challenges and
Congress has limited resources to allocate; however, we are concerned
that without increased funding to bolster and expand ovarian cancer
education, awareness and research efforts, the nation will continue to
see growing numbers of women losing their battle with this terrible
disease.
On behalf of the entire ovarian cancer community--patients, family
members, clinicians and researchers--we thank you for your leadership
and support of Federal programs that seek to reduce and prevent
suffering from ovarian cancer. We request your support for our
appropriations requests for fiscal year 2012 that include $10 million
for the CDC's Ovarian Cancer Control Initiative, $10 million for The
Gynecologic Cancer Education and Awareness Act (Johanna's Law) and
$5.74 billion to NCI.
______
Prepared Statement of the Pancreatic Cancer Action Network
Mr. Chairman and members of the Subcommittee: My name is Julie
Fleshman and I am submitting this testimony on behalf of the Pancreatic
Cancer Action Network.
Founded in 1999, the Pancreatic Cancer Action Network is a
nationwide network of individuals dedicated to advancing research,
supporting patients and fostering hope for the families and loved ones
affected by this disease.
Pancreatic cancer continues to be one of the deadliest cancers in
this country. In fact, it is the only cancer tracked by both the
American Cancer Society and the National Cancer Institute (NCI) that
still has a 5-year survival rate in the single digits. This is even
more astounding because the overall 5-year survival rate for all
cancers was 50 percent in the 1970s and is now 68 percent. Last year,
pancreatic cancer struck more than 43,000 Americans and resulted in
36,800 deaths. The similarity of these statistics underscores its
deadliness: indeed, most patients die within months of their diagnosis.
There is no question that we have made important progress in many
forms of cancer. There is also no question that this progress has been
lacking in pancreatic cancer. The fact remains that there are still no
early detection tools or effective treatments. A patient diagnosed
today generally hears the same words as a patient diagnosed 40 years
ago, ``I'm sorry, but there is not much that we can do for you. Go home
and get your affairs in order.'' The Pancreatic Cancer Action Network
believes that the time has come for bold action and has launched a new
mission to double the 5-year survival rate by 2020. This is an
ambitious but achievable goal.
Dismal as the picture is today, unless something is done soon, it
will only get worse. A recently published study in the Journal of
Clinical Oncology predicts that the number of new pancreatic cancer
cases will increase by 55 percent over the next two decades.
Why has there been so little change in the mortality rate
associated with pancreatic--and what can be done about it?
Progress has been slow in large part because the Federal
Government's investment in pancreatic cancer research has been weak.
The Pancreatic Cancer Action Network recently published a report,
``Pancreatic Cancer: A trickle of Federal funding for a river of
need'', analyzing the investment made by the NCI into this disease. The
analysis shows that pancreatic cancer is behind in nearly every
important grant category funded by the Federal Government.
--Currently, research dedicated to pancreatic cancer receives a mere
2 percent of the Federal dollars distributed by the NCI. By
contrast, the other four of the top five cancer killers in the
United States (lung, colon, breast and prostate cancer)
received 2.8 to 6.3 fold more NCI funding in 2009 than
pancreatic cancer.
--The average dollar amount of basic research (R) grants in
pancreatic cancer was 18 to 29 percent less than R grants for
the other four top cancer killers. The R grant mechanisms are
the mainstay of scientific discovery in cancer research.
--Training grant funding in pancreatic cancer decreased by 15 percent
from 2008 to 2009, a decline larger than in any other leading
cancer. Pancreatic cancer trainees were awarded between 2.4 and
6.5 fold less grant money in 2009 than young researchers
studying the other four top cancer killers.
--American Recovery & Reinvestment Act (ARRA) funding represented a
unique opportunity for the NCI to direct research monies toward
the deadliest cancers, including pancreatic cancer.
Unfortunately, this opportunity was missed, as pancreatic
cancer research received only slightly more than 1 percent of
the NCI ARRA budget.
As has been noted by this Subcommittee and others in Congress in
recent years, what is lacking is a well-defined, long-term
comprehensive strategic plan in place to: advance the understanding of
the biology of pancreatic cancer, examine its natural history and the
genetic and environmental factors that contribute to its development;
expand research on ways to screen and detect pancreatic cancer in much
earlier stages; and launch innovative clinical trials to test targeted
therapeutics and novel agents that will extend the survival and improve
the quality of life of patients.
In addition, there must be a robust and sustained commitment of
resources by the NCI and its sister institutes and centers at the
National Institutes of Health (NIH).
Thanks to you and your colleagues, Mr. Chairman, and under the
leadership of Dr. Harold Varmus, NCI has taken some encouraging steps
in the right direction.
In 2010 NCI convened an internal group to develop an action plan
for pancreatic cancer research and training. NCI brought together
pancreatic cancer researchers and program staff from within the
Institute to form the Pancreatic Cancer Action Planning Group, charged
with developing an Action Plan that summarizes the fiscal year 2011
research and training portfolio and identifies research gaps and
opportunities for collaboration within NCI and with other members of
the National Cancer Program, including advocacy groups, academia, and
industry. This Action Plan was developed based on discussions at a
Planning Group meeting held in July 2010 and continued interactions
following the meeting. While it was not the long-term comprehensive
strategic plan that we would still like to see the NCI develop for
pancreatic cancer, we do believe that it was a good first step.
In addition to the initiatives and activities already included in
the fiscal year 2011 portfolio, the Planning Group identified several
opportunities for NCI to advance pancreatic cancer research. Emphasis
was placed on activities with a high likelihood of improving survival
rates, which have remained low despite improvements in many other
cancer types. It was recognized that given the range of research
conducted within and funded by NCI, the Institute is uniquely poised to
support activities and provide services that other stakeholders are
unable or unwilling to do. The Planning Group identified several
opportunities for collaboration with advocacy organizations and the
private sector to gain momentum in pancreatic cancer research.
The Action Plan reviewed the research activities that were planned
for fiscal year 2011. We look forward to hearing from the NCI about the
outcome of these plans. It also identified a few potential new
initiatives such as a program announcement for R01 grants focused on
pancreatic cancer. We strongly believe that a program announcement
would be a positive step in the right direction and would urge you to
find ways to encourage NCI to implement this idea. We hope to have the
opportunity to work with NCI to implement the steps outlined in the
plan.
Some ideas that emerged--such as promoting interaction and
increased use of existing resources--will likely involve only modest
financial investment, while others, like new program announcements,
will require more resources. We therefore join with our colleagues in
the One Voice Against Cancer (OVAC) coalition in highlighting the
important role that NCI plays in our economy and in cancer research
worldwide and ask this Committee to do everything in its power to safe-
guard and expand this important resource.
Mr. Chairman, research is the only hope. We ask that you strongly
urge the National Cancer Institute to put in place a long-term
comprehensive strategic plan for pancreatic cancer research and ensure
that there is funding available to implement that plan.
Thank you.
______
Prepared Statement of the Physician Assistant Education Association
On behalf of its membership, the 156 accredited physician assistant
(PA) education programs in the United States, the Physician Assistant
Education Association (PAEA) is pleased to submit these comments on the
fiscal year 2012 appropriations for PA education programs that are
authorized through Title VII of the Public Health Service Act.
PAEA is a member of the Health Professions and Nursing Education
Coalition (HPNEC) and we support the HPNEC recommendation for funding
of at least $762.5 million in fiscal year 2012 for the health
professions education programs authorized under Title VII and VIII of
the Public Health Service Act and administered through the Health
Resources and Services Administration (HRSA). HPNEC is an informal
alliance of more than 60 national organizations representing schools,
programs, health professionals, and students and dedicated to ensuring
that the healthcare workforce is trained to meet the needs of the
country's growing, aging, and diverse population.
Need for Increased Federal Funding
Faculty development is one of the profession's critical needs. In
order to attract the best qualified to teaching, PA education programs
must have the resources to train faculty in academic skills, such as
curriculum development, teaching methods, and laboratory instruction.
The challenges of teaching are broad and varied and include
understanding different pedagogical theories, writing instructional
objectives, and learning and applying educational technology. Most
educators come from clinical practice and these skills are essential to
transitioning to teaching. Educators are a critical element of meeting
the Nation's demand for an increased supply of primary care clinicians.
Generalist training, workforce diversity, and practice in
underserved areas are key priorities identified by HRSA. It is
increasingly important that the health workforce better represents
America's changing demographics, as well as addresses the issues of
disparities in healthcare. PA programs have been successful in
attracting students from underrepresented minority groups and
disadvantaged backgrounds. Studies have found that health professionals
from underserved areas are three to five times more likely to return to
underserved areas to provide care.
Physician Assistant Practice
Physician assistants (PAs) are licensed health professionals who
practice medicine as members of a team with their supervising
physicians. PAs exercise autonomy in medical decisionmaking and provide
a broad range of medical and therapeutic services to diverse
populations in rural and urban settings. In all 50 States, PAs carry
out physician-delegated duties that are allowed by law and within the
physician's scope of practice and the PA's training and experience.
Additionally, PAs are delegated prescriptive privileges by their
physician supervisors in all 50 States, the District of Columbia, and
Guam. This allows PAs to practice in rural, medically underserved areas
where they are often the only full-time medical provider.
Physician Assistant Education
There are currently 156 accredited PA education programs in the
United States--a growth of 22 percent in less than 5 years; together
these programs graduate nearly 6,000 PA students each year. PAs are
educated as generalists in medicine; their flexibility allows them to
practice in more than 60 medical and surgical specialties. More than
one-third of PA program graduates practice in primary care.
The average PA education program is 27 months in length. Typically,
1 year is devoted to classroom study and approximately 15 months is
devoted to clinical rotations. The typical curriculum includes 400
hours of basic sciences and nearly 600 hours of clinical medicine.
As of today, approximately 20 programs are in the pipeline at
various stages of development, moving toward accredited status. The
growth rate in the applicant pool is even more remarkable. In March
2006, there were a total of 7,608 applicants to PA education programs;
as of March 2011, there were 16,112 applicants to PA education
programs. This represents a 112 percent increase in Centralized
Application Service (CASPA) applicants over the past 5 years.
The PA profession is expected to continue to grow as a result of
the projected shortage of physicians and other healthcare
professionals, the growing demand for professionals from an aging
population, and the continuing strong PA applicant pool, which has
grown by more than 10 percent each year since the year 2000. The Bureau
of Labor Statistics projects a 39 percent increase in the number of PA
jobs between 2008 and 2018. With its relatively short initial training
time and the flexibility of generalist-trained PAs, the PA profession
is well-positioned to help fill projected shortages in the numbers of
healthcare professionals.
The continued growth of the profession heightens the need for
additional resources to help meet the challenges of recruiting
qualified faculty, shortages of preceptors and clinical sites, and
increasing the diversity of faculty and program applicants.
Title VII Funding
Title VII funding is the only opportunity for PA programs to apply
for Federal funding and plays a crucial role in developing and
supporting PA education programs.
Title VII funding fills a critical need for curriculum development
and faculty development. Funding enhances clinical training and
education, assists PA programs with recruiting applicants from minority
and disadvantaged backgrounds, and funds innovative programs that focus
on educating a culturally competent workforce. Title VII funding
increases the likelihood that PA students will practice in medically
underserved communities with health professional shortages. The absence
of this funding would result in the loss of care to patients in
underserved areas.
Title VII support for PA programs has been strengthened with the
enactment of the Patient Protection and Affordable Health Care Act
(Public Law 111-148), which provides a 15 percent carve out in the
appropriations process for PA programs. This funding will enhance
capabilities to train a growing PA workforce and is likely to increase
the pool for faculty positions as a result of PA programs now being
eligible for faculty loan repayment. Huge loan burdens serve as
barriers for physician assistant entry into academia.
Here we provide several examples of how PA programs have used Title
VII funds to creatively expand care to underserved areas and
populations, as well as to develop a diverse PA workforce.
--One Texas program has used its PA training grant to support the
program at a distant site in an underserved area. This grant
provides assistance to the program for recruiting, educating,
and training PA students in the largely Hispanic South Texas
and mid-Texas/Mexico border areas and supports new faculty
development.
--A Utah program has used its PA training grant to promote
interprofessional teams--an area of strong emphasis in the
Patient Protection and Affordable Care Act. The grant allowed
the program to optimize its relationship with three service-
learning partners, develop new partnerships with three service-
learning sites, and create a model geriatric curriculum that
includes didactic and clinical education.
--An Alabama program used its PA training grant to update and expand
the current health behavior educational curriculum and HIV/STD
training. They were also able to include PA students from other
programs who were interested in rural, primary care medicine
for a 4-week comprehensive educational program in HIV disease
diagnosis and management.
--A South Carolina program has developed a model program that offers
a 2-year academic fellowship for recent PA graduates with at
least one year of clinical experience. To further enhance an
evidence-based approach to education and practice, two specific
evidence-based practice projects were embedded in the
fellowship experience. Fellows direct and evaluate PA students'
involvement in the ``Towards No Tobacco'' curriculum, aimed at
fifth graders, and the PDA Patient Data experience, aimed at
assessing healthcare services.
Recommendations on fiscal year 2012 Funding
The Physician Assistant Education Association requests the
Appropriations Committee to support funding for Title VII and VIII
health professions programs at a minimum of $762.5 million for fiscal
year 2012. This level of funding is crucial to support the Nation's
demand for primary care practitioners, particularly those who will
practice in medically underserved areas and serve vulnerable
populations. Additionally we encourage support for the new programs and
responsibilities contained in the Patient Protection and Affordable
Care Act (Public Law 111-148), including a minimum of $10 million to
support PA education programs. We thank the members of the subcommittee
for their support of the health professions and look forward to your
continued support of solutions to the Nation's health workforce
shortage. We appreciate the opportunity to present the Physician
Assistant Education Association's fiscal year 2012 funding
recommendation.
______
Prepared Statement of PolicyLink, The Food Trust, and The Reinvestment
Fund
Chairman and distinguished Senators of the Committee, thank you for
the opportunity to share our support for a Healthy Food Financing
Initiative (HFFI). PolicyLink is a national research and action
institute advancing economic and social equity by Lifting Up What
Works; The Food Trust is a nonprofit organization working to ensure
that everyone has access to affordable, nutritious food; and The
Reinvestment Fund is a Community Development Financial Institution that
creates wealth and opportunity for low-wealth people and places through
the promotion of socially and environmentally responsible development.
Our three organizations, along with a diverse coalition of
stakeholders, which includes representatives from the grocery industry,
health, civil rights, agriculture and the community development finance
community, support the creation of HFFI to address the problem of
``food deserts'' in urban and rural areas across the Nation. This
problem can be solved in many communities using a successful model that
is underway in the State of Pennsylvania and is now being replicated
throughout the country.
HFFI is a program worthy of investment as it promotes health,
creates jobs and sparks economic development. HFFI will provide loan
and grant financing to attract grocery stores and other fresh food
retail to underserved urban, suburban, and rural areas, and renovate
and expand existing stores so they can provide the healthy foods that
communities want and need. Over time, with continued investment, HFFI
could solve the problem of food deserts in urban and rural communities
across the country.
For decades, low-income communities, particularly communities of
color, have suffered from a lack of access to healthy, fresh food. USDA
research determined that more than 23.5 million Americans are living in
communities without access to high-quality, fresh food. Studies
repeatedly show that residents of many low-income neighborhoods must
travel long distances for healthy food, or rely on corner stores and
fast food outlets offering high fat, high sugar foods. For instance, a
recent multistate study found that low-income census tracts had half as
many supermarkets as wealthy tracts, and four times as many smaller
grocery stores. Another multistate study found that 8 percent of
African Americans live in a tract with a supermarket, compared to 31
percent of whites. Nationally, low-income zip codes have 30 percent
more convenience stores, which tend to lack healthy food, than middle
income zip codes.
And, a nationwide analysis found there are 418 rural food desert
counties where all residents live more than 10 miles from a supermarket
or a supercenter--this is 20 percent of rural counties. In rural
communities, inadequate transportation can be a particular challenge.
In Mississippi, which has the highest obesity rate of any State, over
70 percent of food stamp eligible households travel more than 30 miles
to reach a supermarket. Adults living in rural Mississippi food desert
counties are 23 percent less likely to consume the recommended fruits
and vegetables than those in counties that have supermarkets,
controlling for age, sex, race, and education.
Controlling for population density, rural areas have fewer food
retailers of any types compared to urban areas, and only 14 percent the
number of chain supermarkets. For instance, in New Mexico, rural
residents have access to fewer grocery stores than urban residents, pay
more for comparable items, and have less selection. The same market
basket of groceries costs $85 for rural residents versus $55 for urban
residents.
The results of this lack of healthy food options are grim--these
communities have significantly higher rates of obesity, diabetes, and
other related health issues. Over the past decade, obesity rates have
more than doubled in children and tripled in adolescents. In 2010,
PolicyLink and The Food Trust conducted a review of more than 130
studies on the issue of access to healthy food and found a direct
correlation between diet-related diseases and access. A California
study found that obesity and diabetes rates were 20 percent higher for
those living in the least healthy ``food environments.'' In
Indianapolis, a study found that BMI values corresponded with access to
supermarkets and fast food restaurants. Researchers estimated that
adding a new grocery store to a high poverty neighborhood translates
into a 3 pound weight decrease.
Fortunately, changing access changes eating habits. For every
additional supermarket in a census tract, produce consumption increases
32 percent for African Americans and 11 percent for whites, according
to a multistate study. A survey of produce availability in New Orleans'
small neighborhood stores found that for each additional meter of shelf
space devoted to fresh vegetables, residents eat an additional .35
servings per day. In fact, of 14 studies that examine food access and
consumption of healthy foods, all but one of them found a correlation
between greater access and better eating behaviors. This is also true
for food stamp recipients. Proximity to a supermarket was found to be
associated with increased fruit and vegetable consumption.
The problems associated with lack of access go beyond health. Low-
income communities are cut off from all the economic development
benefits that come with a local grocery store: the creation of steady
jobs at decent wages and the sparking of complementary retail stores
and services nearby. Grocery stores operate as important economic
anchors for communities, providing a vital service and bringing
customers that can also support other nearby business. Securing new or
improved local grocery stores can improve local economies and create
jobs.
President Barack Obama's proposed fiscal year 2012 budget includes
a proposal to invest $330 million, including $250 million in New
Markets Tax Credits, in a national HFFI. Specifically, the initiative
would provide:
--$35 million through USDA's Office of the Secretary, with additional
``other funds of Rural Development and the Agricultural
Marketing Service available to support the USDA's portion of
the Healthy Food Financing Initiative'';
--$25 million through the Treasury Department's CDFI Fund;
--$20 million through Health and Human Services; and
--$250 million through the Treasury Department's New Markets Tax
Credits Program.
A Healthy Food Financing Initiative would attract investment in
underserved communities by providing critical loan and grant financing.
These one-time resources will help fresh food retailers overcome the
higher initial barriers to entry into underserved, low-income urban and
rural communities, and would also support renovation and expansion of
existing stores so they can provide the healthy foods that communities
want and need. The program would be flexible and comprehensive enough
to support innovations in healthy food retailing and to assist
retailers with different aspects of the store development and
renovation process.
Grocery industry representatives find that there are obstacles to
grocery store development in underserved low-income communities, but
also that those obstacles can be overcome. The development process for
building a new grocery store is lengthy and complex, and retailers
often find that stores in low-income communities have high start-up
costs, appropriate sites are hard to find, and securing financing is
difficult. Grocery operators in both urban and rural areas cite lack of
access to flexible financing as one of the top barriers hindering the
development of stores in underserved areas.
HFFI is modeled after the successful Pennsylvania Fresh Food
Financing Initiative (FFFI), a public/private partnership launched in
2004. Using a State investment of $30 million, the program has led to:
--projects totaling more than $190 million;
--88 stores built or renovated in underserved communities in urban
and rural areas across the State;
--improved access to healthy food for more than 400,000 residents;
--more than 5,000 jobs created or retained;
--increased local tax revenues; and
--much-needed additional economic development in these communities.
Stores range from full-service 70,000 square foot supermarkets to
900 square food shops; and from traditional grocery stores to farmers'
markets, cooperatives, and corner stores selling healthy food.
Approximately two-thirds of the projects were in rural areas and small
towns with the remainder in urban areas.
HFFI is a viable, effective, and economically sustainable solution
to the problem of limited access to healthy foods. It can bring triple
bottomline benefits, achieving multiple goals: reducing health
disparities and improving the health of families and children; creating
jobs; and, stimulating local economic development in low-income
communities.
HFFI would incorporate the key components that allowed the
Pennsylvania program to be so effective at attracting private dollars,
garnering the commitment of store operators, getting fresh food retail
stores and markets successfully developed, and stimulating local
economies.
The Pennsylvania FFFI has been cited as an innovative model by the
U.S. Centers for Disease Control and Prevention, the National
Conference of State Legislatures, Harvard's Kennedy School of
Government, and the National Governors Association. There is
significant momentum in many States and cities across the country to
address the lack of grocery access in underserved communities. Several
States and/or cities are in the process of replicating the successful
Pennsylvania Fresh Food Financing Initiative Program, and many others
have begun to examine the needs and opportunities in their communities.
For example:
--The State of New York has launched the Healthy Food, Healthy
Communities Initiative, a business financing program to
encourage supermarket and other fresh food retail investment in
underserved areas throughout the State that will provide loans
and grants to eligible projects. New York City has launched a
complementary FRESH program that will encourage supermarket
development through tax and zoning incentives and a single
point of access to city government for supermarket operators.
--The City of New Orleans recently launched the Fresh Food Retailer
Initiative Program (FFRI) that will provide direct financial
assistance to retail businesses by awarding forgivable and/or
low-interest loans to grocery stores and other fresh food
retailers.
--The California Endowment, NCB Capital Impact, and other community,
supermarket industry, and government partners have been working
to create a supermarket financing program in California that is
expected to be launched in the first half of 2011.
A national Healthy Food Financing Initiative could amplify the
impact in each of these States and leverage the work already underway
to ensure swift implementation. Moreover, a national HFFI would insure
that all State and communities could solve their food desert problems
with new stores and other healthy food retail projects.
In the midst of our current economic downturn, the need for a
comprehensive Federal policy to address the lack of fresh food access
in low-income is critical. We urge the Committee to support full
funding for a Healthy Food Financing Initiative, for the benefit of
communities across the Nation. Thank you for the opportunity to share
our perspectives with you today. If you should need additional
information about HFFI please contact Judith Bell from PolicyLink
([email protected]), Pat Smith from The Reinvestment Fund
([email protected]), or John Weidman from The Food Trust
([email protected])
______
Prepared Statement of the Population Association of America/Association
of Population Centers
Background on the PAA/APC and Demographic Research
The Population Association of America (PAA) is a scientific
organization comprised of over 3,000 population research professionals,
including demographers, sociologists, statisticians, and economists.
The Association of Population Centers (APC) is a similar organization
comprised of over 40 universities and research groups that foster
collaborative demographic research and data sharing, translate basic
population research for policy makers, and provide educational and
training opportunities in population studies. Population research
centers are located at public and private research institutions
nationwide.
Demography is the study of populations and how or why they change.
Demographers, as well as other population researchers, collect and
analyze data on trends in births, deaths, and disabilities as well as
racial, ethnic, and socioeconomic changes in populations. Major policy
issues population researchers are studying include the demographic
causes and consequences of population aging, trends in fertility,
marriage, and divorce and their effects on the health and well being of
children, and immigration and migration and how changes in these
patterns affect the ethnic and cultural diversity of our population and
the Nation's health and environment.
The NIH mission is to support research that will improve the health
of our population. The health of our population is fundamentally
intertwined with the demography of our population. Recognizing the
connection between health and demography, the NIH supports extramural
population research programs primarily through the National Institute
on Aging (NIA) and the National Institute of Child Health and Human
Development (NICHD).
National Institute on Aging
According to the Census Bureau, by 2029, all of the baby boomers
(those born between 1946 and 1964) will be age 65 years and over. As a
result, the population age 65-74 years will increase from 6 percent to
10 percent of the total population between 2005 and 2030. This
substantial growth in the older population is driving policymakers to
consider dramatic changes in Federal entitlement programs, such as
Medicare and Social Security, and other budgetary changes that could
affect programs serving the elderly. To inform this debate,
policymakers need objective, reliable data about the antecedents and
impact of changing social, demographic, economic, and health
characteristics of the older population. The NIA Division of Behavioral
and Social Research (BSR) is the primary source of Federal support for
research on these topics.
In addition to supporting an impressive research portfolio, that
includes the prestigious Centers of Demography of Aging and Roybal
Centers for Applied Gerontology Programs, the NIA BSR program also
supports several large, accessible data surveys. One of these surveys,
the Health and Retirement Study (HRS), has become one of the seminal
sources of information to assess the health and socioeconomic status of
older people in the United States. Since 1992, the HRS has tracked
27,000 people, providing data on a number of issues, including the role
families play in the provision of resources to needy elderly and the
economic and health consequences of a spouse's death. HRS is
particularly valuable because its longitudinal design allows
researchers: (1) the ability to immediately study the impact of
important policy changes such as Medicare Part D; and (2) the
opportunity to gain insight into future health-related policy issues
that may be on the horizon, such as HRS data indicating an increase in
pre-retirees self-reported rates of disability. In August 2011, HRS
will release genotyping data, enhancing the ability of researchers to
track the onset and progression of diseases and conditions affecting
the elderly.
Currently, the NIA is paying grant applications requesting less
than $500,000 in direct costs through the 11th percentile, while grants
seeking $500,000 or more are being paid through the 8th percentile--
making it one of the lowest paylines at NIH. As research costs
increase, NIA faces the prospect of funding fewer grants to sustain
larger ones in its commitment base. With additional support in fiscal
year 2012, the NIA BSR program could fully fund its large-scale
projects, including the existing centers programs and ongoing surveys,
without resorting to cost cutting measures, such as cutting sample
size, while continuing to support smaller investigator initiated
projects
Eunice Kennedy Shriver National Institute on Child Health and Human
Development
Since its establishment in 1968, the Eunice Kennedy Shriver NICHD
Center for Population Research has supported research on population
processes and change. Today, this research is housed in the Center's
Demographic and Behavioral Sciences Branch (DBSB). The Branch
encompasses research in four broad areas: family and fertility,
mortality and health, migration and population distribution, and
population composition. In addition to funding research projects in
these areas, DBSB also supports a highly regarded population research
infrastructure program and a number of large database studies,
including the National Longitudinal Study of Adolescent Health (Add
Health), Panel Study of Income Dynamics, and National Longitundinal
Study of Youth.
NIH-funded demographic research has consistently provided critical
scientific knowledge on issues of greatest consequence for American
families: work-family conflicts, marriage and childbearing, childcare,
and family and household behavior. However, in the realm of public
health, demographic research is having an even larger impact,
particularly on issues regarding adolescent and minority health.
Understanding the role of marriage and stable families in the health
and development of children is another major focus of the NICHD DBSB.
Consistently, research has shown children raised in stable family
environments have positive health and development outcomes.
Policymakers and community programs can use these findings to support
unstable families and improve the health and well being of children.
One of the most important programs the NICHD DBSB supports is the
Population Research Infrastructure Program (PRIP). Through PRIP,
research is conducted at private and public research institutions
nationwide. The primary goal of PRIP is ``to facilitate
interdisciplinary collaboration and innovation in population research,
while providing essential and cost-effective resources in support of
the development, conduct, and translation of population research.''
Population research centers supported by PRIP are focal points for the
demographic research field where innovative research and training
activities occur and resources, including large-scale databases, are
developed and maintained for widespread use.
With additional support in fiscal year 2012, NICHD could sustain
full funding to its large-scale surveys, which serve as a resource for
researchers nationwide. Furthermore, the Institute could apply
additional resources toward improving its funding payline, which has
fallen from the 13th percentile in fiscal year 2010 to the 11th
percentile in fiscal year 2011. Additional support could be used to
support and stabilize essential training and career development
programs necessary to prepare the next generation of researchers and to
support and expand proven programs, such as PRIP.
National Center for Health Statistics
Located within the Centers for Disease Control (CDC), the National
Center for Health Statistics (NCHS) is the Nation's principal health
statistics agency, providing data on the health of the U.S. population
and backing essential data collection activities. Most notably, NCHS
funds and manages the National Vital Statistics System, which contracts
with the States to collect birth and death certificate information.
NCHS also funds a number of complex large surveys to help policy
makers, public health officials, and researchers understand the
population's health, influences on health, and health outcomes. These
surveys include the National Health and Nutrition Examination Survey
(NHANES), National Health Interview Survey (HIS), and National Survey
of Family Growth. Together, NCHS programs provide credible data
necessary to answer basic questions about the state of our Nation's
health.
Despite recent steady funding increases, NCHS continues to feel the
effects of long-term funding shortfalls, compelling the agency to
undermine, eliminate, or further postpone the collection of vital
health data. For example, in 2009, sample sizes in HIS and NHANES were
cut, while other surveys, most notably the National Hospital Discharge
Survey, were not fielded. In 2009, NCHS proposed purchasing only ``core
items'' of vital birth and death statistics from the States (starting
in 2010), effectively eliminating three-fourths of data routinely used
to monitor maternal and infant health and contributing causes of death.
Fortunately, Congress and the new Administration worked together to
give NCHS adequate resources and avert implementation of these
draconian measures. Nonetheless, the agency continues to operate in a
precarious state.
The Administration recommends NCHS receive $161.9 million in fiscal
year 2011; however, ultimately, the agency received $23.2 million less
than the Administration requested. This reduced amount has postponed
important initiatives to, for example, re-engineer collection of the
Nation's vital statistics, using standard birth and death certificate
items.
PAA and APC, as members of The Friends of NCHS, support the
Administration's request for fiscal year 2012, $162 million, in hopes
many initiatives proposed by the Administration in fiscal year 2011 can
proceed, including an effort to fully support electronic birth records
in all 50 States.
Bureau of Labor Statistics
During these turbulent economic times, data produced by the Bureau
of Labor Statistics (BLS) are particularly relevant and valued. PAA and
APC members have relied historically on objective, accurate data from
the BLS. In recent years, our organizations have become increasingly
concerned about the state of the agency's funding.
We are pleased the Administration has requested BLS receive a total
of $647 million in fiscal year 2012. According to the agency, this
funding level would enable BLS, for example, to add the Contingent Work
Supplement to the Current Population Survey, making more data available
on changing workplace arrangements and continue its work on developing
an alternative poverty measure.
Summary of fiscal year 2012 Recommendations
In sum, the PAA and APC support the Administration's fiscal year
2012 request for the National Institutes of Health, National Center for
Health Statistics and the Bureau of Labor Statistics. With respect to
the NIH, however, we support the Administration's request as a floor
and encourage the Subcommittee to consider providing the NIH with
funding as high as $35 billion. This amount, endorsed by the Ad Hoc
Group for Medical Research, reflects not only inflation, but also the
additional investment needed to sustain the new research capacity
created by the American Recovery and Reinvestment Act.
Thank you for considering our requests and for supporting Federal
programs that benefit the population sciences.
______
Prepared Statement of Prevent Blindness America
FUNDING REQUEST OVERVIEW
Prevent Blindness America appreciates the opportunity to submit
written testimony for the record regarding fiscal year 2012 funding for
vision and eye health related programs. As the Nation's leading
nonprofit, voluntary health organization dedicated to preventing
blindness and preserving sight, Prevent Blindness America maintains a
long-standing commitment to working with policymakers at all levels of
government, organizations and individuals in the eye care and vision
loss community, and other interested stakeholders to develop, advance,
and implement policies and programs that prevent blindness and preserve
sight. Prevent Blindness America respectfully requests that the
Subcommittee provide the following allocations in fiscal year 2012 to
help promote eye health and prevent eye disease and vision loss:
--Provide at least $3.23 million to maintain vision and eye health
efforts at the Centers for Disease Control and Prevention
(CDC).
--Support the Maternal and Child Health Bureau's (MCHB) National
Center for Children's Vision and Eye Health (Center).
--Provide additional resources for the National Eye Institute (NEI).
INTRODUCTION AND OVERVIEW
Vision-related conditions affect people across the lifespan from
childhood through elder years. Good vision is an integral component to
health and well-being, affects virtually all activities of daily
living, and impacts individuals physically, emotionally, socially, and
financially. Loss of vision can have a devastating impact on
individuals and their families. An estimated 80 million Americans have
a potentially blinding eye disease, 3 million have low vision, more
than 1 million are legally blind, and 200,000 are more severely
visually blind. Vision impairment in children is a common condition
that affects 5 to 10 percent of preschool age children. Vision
disorders (including amblyopia (``lazy eye''), strabismus (``cross
eye''), and refractive error are the leading cause of impaired health
in childhood.
Alarmingly, while half of all blindness can be prevented through
education, early detection, and treatment, the NEI reports that ``the
number of Americans with age-related eye disease and the vision
impairment that results is expected to double within the next three
decades.'' \1\ Among Americans age 40 and older, the four most common
eye diseases causing vision impairment and blindness are age-related
macular degeneration (AMD), cataract, diabetic retinopathy, and
glaucoma.\2\ Refractive errors are the most frequent vision problem in
the United States--an estimated 150 million Americans use corrective
eyewear to compensate for their refractive error.\2\ Uncorrected or
under-corrected refractive error can result in significant vision
impairment.\2\
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\1\ ``Vision Problems in the U.S.: Prevalence of Adult Vision
Impairment and Age-Related Eye Disease in America,'' Prevent Blindness
America and the National Eye Institute, 2008.
\2\ Ibid.
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To curtail the increasing incidence of vision loss in America,
Prevent Blindness America advocates sustained and meaningful Federal
funding for programs that help promote eye health and prevent eye
disease, vision loss, and blindness; needed services and increased
access to vision screening; and vision and eye disease research. We
thank the Subcommittee for its consideration of our specific fiscal
year 2012 funding requests, which are detailed below.
VISION AND EYE HEALTH AT THE CDC: HELPING TO SAVE SIGHT AND SAVE MONEY
The CDC serves a critical national role in promoting vision and eye
health. Since 2003, the CDC and Prevent Blindness America have
collaborated with other partners to create a more effective public
health approach to vision loss prevention and eye health promotion. The
CDC works to:
--Promote eye health and prevent vision loss.
--Improve the health and lives of people living with vision loss by
preventing complications, disabilities, and burden.
--Reduce vision and eye health related disparities.
--Integrate vision health with other public health strategies.
Integrating Vision Health into Broader Disease Prevention and Health
Promotion Efforts
One of the cornerstone activities of the vision and eye health work
at the CDC is its support and encouragement of efforts to better
integrate State-level initiatives to address vision and eye disease by
approaching vision health through other public health prevention,
treatment, and research efforts. Vision loss is associated with a
myriad of other serious chronic, life threatening, and disabling
conditions, including diabetes, depression, unintentional injuries, and
other health problems and behavioral risk factors such as tobacco use.
Leveraging scarce resources and recognizing the numerous connections
between eye health and other diseases, the CDC works to integrate and
connect vision health initiatives to other State, local, and community
health programs.
To advance State-based vision health integration, CDC funds are
supporting a joint effort between the New York State Department of
Health and Prevent Blindness Tri-State, focused on integrating vision-
related services at the State and local level. Working together, these
partners are promoting vision loss prevention strategies within the
State Department of Health. One initiative resulting from this
partnership has been the launch of a statewide tobacco cessation media
campaign highlighting the impact of smoking on potential vision loss.
Other examples include State-based programs to prevent and reduce
diabetes, including efforts to educate patients and healthcare
providers of the relationship between diabetes and certain eye
problems, such as diabetic retinopathy and cataracts. A similar effort
has recently been initiated in Texas.
The goal of these integration efforts is to ensure that vision loss
and eye health promotion are incorporated into all relevant local,
State, and Federal public health interventions, prevention and
treatment programs, and other initiatives that impact causes of--and
factors that contribute to--vision problems and blindness. By
integrating efforts and coordinating approaches in this manner, Federal
and State resources will be used more efficiently, eye health problems
and vision loss can be reduced, and the overall health and well-being
of individuals and communities will be improved.
Identifying and Preventing Vision Problems through Community-Based
Strategies
The CDC supports private sector efforts to develop and evaluate
better ways to identify and treat individuals with potential eye
disease, vision loss, and other ocular conditions. Among other efforts,
CDC funding is currently supporting:
--A study to assess the overall effectiveness and costs associated
with implementing an adult vision and eye health history and
risk assessment/referral program. This study, being conducted
by Johns Hopkins University, in partnership with Prevent
Blindness Ohio, is working in collaboration with the
Physician's Free Clinic in Columbus, Ohio and Akron Community
Health Resources to investigate the best methods for
identifying patients who need eye care services and providing
linkages to follow-up care.
--An initiative spearheaded by Duke University and Prevent Blindness
North Carolina to evaluate the benefit of pediatric and school-
based vision screening. The project identified the need to
ensure proper ongoing training and education of pediatricians
on vision screening. In collaboration with the American Board
of Pediatrics, the project has developed maintenance of
certification module to improve office-based preschool vision
screening.
Data Collection
Understanding the breadth and depth of vision and eye health issues
across the Nation is paramount to ensuring appropriate allocation of
resources and effective deployment of targeted interventions. Thus, the
CDC supports programs and systems that collect, evaluate, and
disseminate critical vision health data.
--The CDC developed the first optional Behavioral Risk Factor
Surveillance System (BRFSS) \3\ vision module, which collects
State-based information on access to eye care and the
prevalence of eye disease and eye injury. Early in 2011, the
CDC will publish a report describing visual impairment as a
serious public health issue affecting more than 2.9 million
Americans. Unfortunately, in part due to insufficient funding,
only 19 States currently use the vision module; this lack of
broad adoption precludes the CDC, Congress, and other
stakeholders from having the information they need to
understand and address the full scope of vision loss and eye
health problems facing the Nation.
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\3\ BRFSS is a State-based system of health surveys that collects
information on chronic disease and injury.
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--CDC funding is supporting a joint endeavor between Duke University
and Prevent Blindness America to conduct a systematic evidence
review to describe the delivery systems of vision-related
services and to identify new areas for policy evaluation or
clinical research. This information will help identify the most
at-risk populations and highlight gaps in care and service
delivery to ensure that public and private resources are
allocated to areas of greatest need.
To that end, Prevent Blindness America respectfully requests the
Subcommittee provide a $3.23 million allocation for vision and eye
health initiatives at the CDC. This level of investment will help the
CDC sustain its efforts to address the growing public health threat of
preventable vision loss among at-risk and underserved populations.
fiscal year 2012 resources will support strengthened State-based public
health integration efforts to address vision and eye health and the
development of additional evidence-based public health interventions
that improve eye health among the Nation's most at-risk and
underserved.
INVESTING IN THE VISION OF OUR NATION'S MOST VALUABLE RESOURCE--
CHILDREN
While the risk of eye disease increases after the age of 40, eye
and vision problems in children are of equal concern. If left
untreated, they can lead to permanent and irreversible visual loss and/
or cause problems socially, academically, and developmentally. Although
more than 12.1 million school-age children have some form of a vision
problem, only one-third of all children receive eye care services
before the age of six.\4\
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\4\ ``Our Vision for Children's Vision: A National Call to Action
for the Advancement of Children's Vision and Eye Health, Prevent
Blindness America,'' Prevent Blindness America, 2008.
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In 2009, the Maternal and Child Health Bureau established the
National Center for Children's Vision and Eye Health, a national vision
health collaborative effort aimed at developing the public health
infrastructure necessary to promote eye health and ensure access to a
continuum of eye care for young children. Prevent Blindness America is
requesting ongoing support for the National Center for Children's
Vision and Eye Health.
With this support the Center, will continue to:
--Provide national leadership in the development of best practices
and guidelines for public health infrastructure, national
vision screening guidelines, and statewide strategies that
ensure early detection, vision screening, and a continuum of
vision and eye healthcare for children.
--Determine mechanisms for advancing State-based performance
improvement systems, screening guidelines, and a mechanism for
uniform data collection and reporting.
--Collaborate with States to develop and implement statewide
strategies for vision screening, establish quality improvement
strategies, and determine mechanisms for the improvement of
data systems and reporting of children's vision and eye health
services.
ADVANCE AND EXPAND VISION RESEARCH OPPORTUNITIES
Prevent Blindness America calls upon the Subcommittee to provide
additional support for the NEI to bolster its efforts to identify the
underlying causes of eye disease and vision loss, improve early
detection and diagnosis of eye disease and vision loss, and advance
prevention and treatment efforts. Research is critical to ensure that
new treatments and interventions are developed to help reduce and
eliminate vision problems and potentially blinding eye diseases facing
consumers across the country. In 2009, Congress commended the NEI's
leadership in basic and translational research through H. Res. 366 and
S. Res. 209 (111th Congress), which recognized NEI's 40 years as the
National Institutes of Health (NIH) Institute that leads the Nation's
commitment to save and restore vision. The Resolutions also designated
2010-2020 as the Decade of Vision in recognition of the increasing
health and economic burden of eye disease, mainly as a result of an
aging population.
Through additional support, the NEI will be able to continue to
grow its efforts to:
--Expand capacity for research, as demonstrated by the significant
number of high-quality grant applications submitted in response
to American Recovery and Reinvestment Act opportunities.
--Address unmet need, especially for programs of special promise that
could reap substantial downstream benefits.
--Fund research to reduce healthcare costs, increase productivity,
and ensure the continued global competitiveness of the United
States.
By providing additional funding for the NEI at the NIH, essential
efforts to identify the underlying causes of eye disease and vision
loss, improve early detection and diagnosis of eye disease and vision
loss, and advance prevention, treatment efforts and health information
dissemination will be bolstered.
CONCLUSION
On behalf of Prevent Blindness America, our Board of Directors, and
the millions of people at risk for vision loss and eye disease, we
thank you for the opportunity to submit written testimony regarding
fiscal year 2012 funding for the CDC's vision and eye health
initiatives, the MCHB's National Center for Children's Vision and Eye
Health, and the NEI. Please know that Prevent Blindness America stands
ready to work with the Subcommittee and other Members of Congress to
advance policies that will prevent blindness and preserve sight. Please
feel free to contact us at any time; we are happy to be a resource to
Subcommittee members and your staff. We very much appreciate the
Subcommittee's attention to--and consideration of--our requests.
______
Prepared Statement of ProLiteracy
Chairman Harkin, Ranking Member Shelby, and members of the
Subcommittee, on behalf of the millions of adult learners working to
improve their basic reading, writing, math, and computer skills and
pursue greater economic opportunity for themselves and their families,
thank you for the opportunity to provide written testimony regarding
the President's fiscal year 2012 budget request for adult education and
family literacy, provided for under the Workforce Investment Act, Title
II. We would be pleased to testify and participate in any future
hearings regarding adult literacy and basic education.
We strongly urge you to approve at the very least, the President's
request of $658.3 million for Adult Basic and Literacy Education in
fiscal year 2012 to better assist the one in seven adults nationally
who struggle with illiteracy. At a time when millions of Americans are
struggling to find work, it is essential to invest in adult learning in
order to put more American families on the road to self-sufficiency and
economic security.
Background: ProLiteracy
ProLiteracy is the world's oldest and largest organization of adult
literacy and basic education programs in the United States. ProLiteracy
traces its roots to two premiere adult literacy organizations: Laubach
Literacy International and Literacy Volunteers of America. In 2002,
these two organizations merged to create ProLiteracy.
ProLiteracy represents more than 1,000 community-based
organizations and adult basic education programs in the United States,
and we partner with literacy organizations in 50 developing countries.
In communities across the United States, these organizations use
trained volunteers, teachers, and instructors to provide one-on-one
tutoring, classroom instruction, and specialized classes in reading,
writing, math, technology, English language skills, job-training and
workforce literacy skills, GED preparation, and citizenship. Our
members are located in all 50 States and in the District of Columbia.
Through education, training and advocacy, ProLiteracy supports the
frontline work of these organizations with regional conferences and
other training events; credentialing; and the publication of materials
and products used to teach adults basic literacy and English-as-a-
second-language and to prepare adults for the U.S. citizenship exam and
GED Tests.
The Urgent Need to Invest in Adult Education
In 2003, the U.S. Department of Education conducted the National
Assessment of Adult Literacy (NAAL) in order to gauge the English
reading and comprehension skills of individuals in the United States
over the age of 16 on daily literacy tasks such as reading a newspaper
article, following a printed television guide, and completing a bank
deposit slip. The results indicated that 30 million adults--14 percent
of this country's adult population--had below basic literacy skills;
that is, their ability to read was so poor, they could not complete a
job application without help or follow the directions on a medicine
bottle. An additional 63 million adults read only slightly better, for
a total of 93 million American adults who are considered low literate.
Because under-educated adults are more likely to be unemployed and
require public assistance, the high percentage of low-literate adults
is having an adverse affect on our Nation's efforts to reduce
unemployment and reduce the deficit. In 2009, 14.6 percent of those
without a high school diploma were unemployed compared to 9.7 percent
of high school graduates; 8.6 percent of those with some college; 6.8
percent with an associate's degree; 4.6 percent with a 4-year degree or
more.\1\ And the trends for these adults are not encouraging. For
example, while 67 percent of the service industry's jobs in 1983
required a high school diploma or less, this percentage is expected to
drop to zero by 2018.\2\
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\1\ http://www.bls.gov/cps/cpsaat7.pdf.
\2\ http://cew.georgetown.edu/(see Figure 4.17, pg. 86).
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In addition, we will fail to meet President Obama's goal of once
again leading the world in college degree attainment unless we support
more adults without college degrees to enroll in post-secondary
education. To meet the President's goal, it is estimated that the
United States will need to move at least 3.4 million adults with high
school diplomas but no college degrees into postsecondary education.\3\
Increasing the number of adults with high-school degrees or
equivalents, and with the skills to succeed in college, will help us
achieve this goal.
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\3\ http://www.womeningovernment.org/files/onemillion_letter.pdf.
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The bottom line is that a greater investment in adult education
will increase employment and postsecondary enrollments, move
individuals off of public assistance, and ultimately reduce the
deficit.
Despite the critical role that adult education plays in reducing
unemployment and increasing postsecondary attainment, the adult
education system currently only has the capacity to serve approximately
2.5 million of these 93 million adults each year. Adult education has
been basically flat funded for a decade, seeing only a modest overall
increase from 2001-2010.\4\ In fiscal year 2011, the number of
individuals served will almost certainly be reduced as a result of the
$32.1 million cut to Title II State grants in the final fiscal year
2011 CR. This cut comes at a time when many States are responding to
drastically declining revenues by slashing budgets for education,
training, and human services, including their investments in adult
education.
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\4\ http://www2.ed.gov/about/overview/budget/history/edhistory.pdf.
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The Proposed Adult Basic and Literacy Education Budget
The proposed fiscal year 2012 budget includes several significant
features that we strongly support. First, the President requested $635
million for State formula grants for adult education through the
Workforce Investment Act (WIA), Title II, an increase of $6.8 million
compared to the 2010 appropriation. As we have discussed above, the
need for increased investment in adult education is clear, and we
welcome the President's call for a modest increase.
We recognize that in the current fiscal environment, the
subcommittee will be reluctant to increase spending in many areas of
the budget above this year's level. If an increase is not possible, it
is critically important to hold spending for adult education and
literacy at current levels. An additional cut to Title II funding on
top of the $31 million cut in fiscal year 2011 would be devastating to
State adult education systems around the country, and, as we have
noted, would likely increase unemployment and contribute to the
deficit.
Workforce Innovation
The administration proposes to set aside $50.8 million from the
State formula funds to support a Workforce Innovation Fund (WIF), which
will also include $30 million in funding from the Rehabilitation
Services and Disability Research account, and almost $298 million from
the Department of Labor.
ProLiteracy applauds the administration's commitment to innovation.
We urge the Subcommittee to ensure that innovation funding will benefit
adults at all skill levels, particularly the millions who are estimated
to possess less than basic literacy skills served by community-based
organizations. We suggest, in fact, competitive priority for proposals
that will address those at the lowest levels of literacy and those with
significant barriers to learning.
However, we also caution that after experiencing a dramatic cut to
State formula funding in fiscal year 2011, care must be taken to ensure
that State formula funding is sufficient to ensure the survival of
existing programs. ProLiteracy urges the Subcommittee to ensure that
the WIF, if it moves forward, is funded on top of annual WIA formula
funds, rather than as a carve out of existing formula funds.
National Leadership
The President's proposal also includes an additional $12 million
for national leadership funds to the Department of Education that would
be used to evaluate the impact of college bridge programs that assist
adult learners in transitioning from adult basic education to
postsecondary education and training, and for building greater
technology infrastructure for adult learners and adult educators.
We believe these ideas reflect real needs in our field, and if
these initiatives lead to new resources and better services on the
ground for learners and the programs that serve them, than this could
be a very positive development. Again, however, we would urge that any
new programming that would not have an immediate, direct, benefit to
adult learners not come at the expense of State formula funds.
WIA Reauthorization and Use of National Leadership Funds
The President's budget request also supports the reauthorization of
WIA, and specifically calls for better alignment between Title I and
Title II. We share the administration's desire for more streamlined
service delivery systems that are more engaged with employers, and the
promotion of innovative career pathways models--but in particular for
those learners at the lowest levels of literacy.
We strongly urge, therefore, expanding funding opportunities for
community-based programs that have successfully implemented strategies
for delivering basic literacy instruction together with employment
training so that they may document and disseminate best practices
related to the integration of title I job training programs with title
II adult literacy programs.
Through both reauthorization of the Workforce Investment Act and
use of national leadership funding, we also recommend that the
Department examine and publish successful strategies and best practices
that can help adults with low literacy levels improve their overall
skills and employment opportunities.
We note that learners at the lowest levels of literacy often
receive literacy instruction at community-based organizations (CBOs)
that utilize trained volunteers. For decades, volunteers, and other
types of non-career instructors such as such as VISTA or AmeriCorps
members, have been a vital component in the delivery of education
services for adults with low literacy in the United States. Volunteers
serve in non-instructional roles as well such as mentoring, counseling,
recruiting students, and serving as teaching aides to paid instructors.
However, adult education career pathway programs are based largely
on traditional career pathways programs that connect secondary and
postsecondary students to further education and work in a specific
industry. As a result, the limited existing research on career pathway
approaches used with adult learners is largely focused on students with
higher-level literacy skills.
We therefore urge the subcommittee to ensure that CBOs that utilize
trained volunteers are integrated into the Department's career pathways
strategies. We suggest that the Department identify and disseminate
successful strategies and best practices that will assist community-
based organizations that utilize adult literacy volunteers to support
the Department's career pathways initiatives; and implement strategies
to increase participation by community-based organizations that utilize
trained volunteers in any related technical assistance efforts.
Thank you for the opportunity to present this testimony. We would
be happy to respond to any questions that you may have.
______
Prepared Statement of the Prostatitis Foundation
We are the unpaid volunteers at the Prostatitis Foundation
representing thousands of men nationwide with prostatitis. Our mission
for 15 years has been to:
--Educate the public about the prevalence of prostatitis by our
website www.prostatitis.org, our newsletters, and newspaper and
magazine articles. It is estimated that 10 percent of all males
suffer from chronic prostatitis/pelvic pain syndrome (CP/PPS)
and 50 percent of men will experience (CP/PPS) during their
lifetime. Symptoms can include severe pelvic pain, urinary and
sexual dysfunction and infertility. The possible connection of
prostatitis to prostate cancer is uncertain and not adequately
researched. Prostatitis is common in young men who are at an
age where they are reluctant to discuss such personal matters
as pelvic pain, voiding problems and sexual dysfunction with
family, friends or co-workers. The result has been an
unpublicized crisis and a costly, hopeless medical condition.
--Encourage research funding. We have worked with the NIH research
team personnel and research centers over three sets of multi-
year clinical trial programs going back to 1996. We are now
assisting with the fourth group of nationwide research centers.
The Map Network is a group of researchers who have been
assembled by National Institute of Diabetes and Digestive and
Kidney Diseases (NIDDK) to include specialties besides urology
to get some basic scientific research that will lead to
determining a cause and cure for (CP/PPS). Everyone has too
much time and expense invested to let these efforts expire
without pushing to complete this search for a cause and cure
for (CP/PPS). If we do not build on the efforts of the three
previous accumulations of data to determine a cause and cure it
will be lost and the next group will have to start at the
beginning again.
We request continuing funding and direction through The National
Institutes of Health (NIH) to National Institute of Diabetes and
Digestive and Kidney Diseases (NIDDK) who are over seeing this Mapp
Network of research centers.
______
Prepared Statement of the Pulmonary Hypertension Association
Mr. Chairman, thank you for the opportunity to submit testimony on
behalf of the Pulmonary Hypertension Association (PHA).
I would like to extend my sincere thanks to the Subcommittee for
your past support of pulmonary hypertension (PH) programs at the
National Institutes of Health, Centers for Disease Control and
Prevention, and Health Resources and Services Administration. These
initiatives have opened many new avenues of promising research, helped
educate hundreds of physicians in how to properly diagnose PH, and
raised awareness about the importance of organ donation and
transplantation within the PH community.
I am honored today to represent the hundreds of thousands of
Americans who are fighting a courageous battle against a devastating
disease. Pulmonary hypertension is a serious and often fatal condition
where the blood pressure in the lungs rises to dangerously high levels.
In PH patients, the walls of the arteries that take blood from the
right side of the heart to the lungs thicken and constrict. As a
result, the right side of the heart has to pump harder to move blood
into the lungs, causing it to enlarge and ultimately fail.
PH can occur without a known cause or be secondary to other
conditions such as: collagen vascular diseases (i.e., scleroderma and
lupus), blood clots, HIV, sickle cell, or liver disease. PH impacts
patients of all races, genders, and ages. Preliminary data from the
REVEAL Registry suggests that the ratio of women to men who develop PH
is 4:1. Patients develop symptoms that include shortness of breath,
fatigue, chest pain, dizziness, and fainting.
Unfortunately, these symptoms are frequently misdiagnosed, leaving
patients with the false impression that they have a minor pulmonary or
cardiovascular condition. By the time many patients receive an accurate
diagnosis, the disease has progressed to a late stage, making it
impossible to receive a necessary heart or lung transplant. PH is
chronic and incurable with a poor survival rate. Fortunately, new
treatments are providing a significantly improved quality of life for
patients with some managing the disorder for 20 years or longer.
In 1990, when three PH patients found each other with the help of
the National Organization for Rare Diseases, and founded the Pulmonary
Hypertension Association, there were less than 200 diagnosed cases of
this disease. It was virtually unknown among the general population and
not well known in the medical community. They soon realized that this
was unacceptable, and formally established PHA, which is headquartered
in Silver Spring, Maryland. I am pleased to report that we are making
good progress in our fight against this deadly disease. Nine
medications for the treatment of PH have been approved by the FDA in
the past 16 years.
Today, PHA includes:
--More than 20,000 members and supporters.
--A network of 230+ patient support groups and an active patient-to-
patient telephone helpline.
--Three research programs that, through partnerships with the
National Heart, Lung and Blood Institute, American Heart
Association and the American Thoracic Society, have leveraged
our donors' funds to commit more than $10 million toward PH
research as of 2011.
--Numerous electronic and print publications, including the first
medical journal devoted to pulmonary hypertension--published
quarterly and distributed to all cardiologists, pulmonologists,
and rheumatologists in the United States.
--A state-of-the-art website(www.phassociation.org) dedicated to
providing educational and support resources to patients,
caregivers, and the public.
--A medical education website (www.phaonlineuniv.org), supported in
part by the CDC, providing accredited medical education and
resources to the medical community
FISCAL YEAR 2012 APPROPRIATIONS RECOMMENDATIONS
National Heart, Lung And Blood Institute
Less than two decades ago, a diagnosis of PH was essentially a
death sentence, with only one approved treatment for the disease.
Thanks to advancements made through the public and private sector,
patients today are living longer and better lives with a choice of nine
FDA approved medications. Recognizing that we have made tremendous
progress, we are also mindful that we are a long way from where we want
to be in (1) the management of PH as a treatable chronic disease, and
(2) a cure.
We are grateful to the National Heart, Lung and Blood Institute for
their leadership in advancing research on PH. Our Association is proud
to jointly sponsor investigator training grants (K awards) with NHLBI
aimed at supporting the next generation of pulmonary hypertension
researchers.
Moreover, we were very pleased that NHLBI recently convened some of
the community's leading scientists for a Working on Group on Lung
Vascular Research. The panel produced recommendations that should guide
pulmonary vascular disease research and treatment, including PH
research, in coming years. Their recommendations, published in the
American Journal of Respiratory and Critical Care Medicine in October,
2010 are as follows:
--Advance basic scientific research in lung vascular biology
utilizing emerging technologies.
--Advance and coordinate basic and clinical knowledge of the
pulmonary circulation-right heart axis through novel research
efforts utilizing multidisciplinary teams.
--Define interactions between lung vascular components and
circulating elements and systemic circulations by fostering
novel collaborations.
--Encourage systems analysis to understand and define interactions
between lung vascular genetics, epigenetics, metabolic
pathways, andmolecular signaling.
--Develop strategies using appropriate animal models to improve the
understanding of the lung vasculature in health and in
conditions that reflect human disease.
--Enhance translational research in lung vascular disease by
comparing cellular and tissue abnormalities identified in
animal models to those in human specimens.
--Improve lung vascular disease molecular and clinical phenotype
coupling.
--Develop in vivo imaging techniques which assess structural changes
in lung vasculature, metabolic shifts, functional cell
responses and right ventricular function.
--Develop research consortia that advance basic, translational, and
clinical studies, allow for multi-center epidemiological study
feasibility, and support junior investigators' training in lung
vascularbiology and disease.
We encourage the Subcommittee to support the full implementation of
these recommendations by the National Institutes of Health.
Mr. Chairman, expanding clinical research remains a top priority
for patients, caregivers, and PH investigators. We are particularly
interested in establishing a pulmonary hypertension research network.
Such a network would link leading researchers around the United States,
providing them with access to a wider pool of shared patient data. In
addition, the network would provide researchers with the opportunities
to collaborate on studies and to strengthen the interconnections
between basic and clinical science in the field of pulmonary
hypertension research. Such a network is in the tradition of the NHLBI,
which, to its credit and to the benefit of the American public, has
supported numerous similar networks including the Acute Respiratory
Distress Syndrome Network and the Idiopathic Pulmonary Fibrosis
Clinical Research Network. We encourage the NHLBI to move forward with
the establishment of a PH network in fiscal year 2012.
For fiscal year 2012, PHA joins with other voluntary patient and
medical organizations in recommending an appropriation of $35 billion
for the National Institutes of Health. This level of funding will
ensure continued expansion of research on rare diseases like pulmonary
hypertension.
Centers For Disease Control And Prevention
Mr. Chairman, we are grateful to the subcommittee for providing
past support of PHA's Pulmonary Hypertension Awareness Campaign. We
know for a fact that Americans are dying due to a lack of awareness of
PH, and a lack of understanding about the many new treatment options.
This unfortunate reality is particularly true among minority and
underserved populations. More needs to be done to educate both the
general public and healthcare providers if we are to save lives.
To that end, PHA has utilized the funding provided through the CDC
to: (1) launch a successful media outreach campaign focusing on both
print and online outlets; (2) expand our support programs for
previously underserved patient populations; and (3) establish PHA
Online University, an interactive curriculum-based website for medical
professionals that targets pulmonary hypertension experts, primary care
physicians, specialists in pulmonology/cardiology/rheumatology, and
allied health professionals. The site is continually updated with
information on early diagnosis and appropriate treatment of pulmonary
hypertension. It serves as a center point for discussion among PH-
treating medical professionals and offers Continuing Medical Education
and CEU credits through a series of online classes.
In fiscal year 2012, we encourage the subcommittee to establish a
specific program at CDC to provide ongoing support for PH education and
awareness activities. This would make a tremendous difference in the
fight against this devastating disease.
``Gift Of Life'' Donation Initiative at HRSA
PHA applauds the success of the Health Resources and Services
Administration's ``Gift of Life'' Donation Initiative. This important
program is working to increase organ donation rates across the country.
Unfortunately, the only ``treatment'' option available to many late-
stage PH patients is a lung, or heart and lung, transplantation. This
grim reality is why PHA established ``Bonnie's Gift Project.''
``Bonnie's Gift'' was started in memory of Bonnie Dukart, one of
PHA's most active and respected leaders. Bonnie battled with PH for
almost 20 years until her death in 2001 following a double lung
transplant. Prior to her death, Bonnie expressed an interest in the
development of a program within PHA related to transplant information
and awareness.
PHA has had a very successful partnership with HRSA's ``Gift of
Life'' Donation Program in recent years. Collectively, we have worked
to increase organ donation rates and raise awareness about the need for
PH patients to ``early list'' on transplantation waiting lists. For
fiscal year 2012, PHA recommends an appropriation of $26 million for
this important program.
Social Security Disability
Finally Mr. Chairman, PHA would like to thank the subcommittee for
its commitment to address the longstanding backlog of disability claims
at the Social Security Administration. We greatly appreciate this
investment as a growing number of our patients are applying for
disability coverage. On a related note, the SSA recently convened an
Institute of Medicine panel to recommend revisions to the disability
criteria for cardiovascular diseases. The IOM worked closely with our
medical experts to update the disability criteria for our patient
population and we were pleased to receive their recommendations earlier
this year. We encourage Congress to support this process moving
forward.
______
Prepared Statement of the Research Working Group of the Federal AIDS
Policy Partnership
Chairman Harkin, Ranking Member Shelby and members of the
Committee, thank you for the opportunity to provide testimony on the
National Institutes of Health (NIH) budget overall and for AIDS
research in fiscal year 2012. Tomorrow's scientific and medical
breakthroughs depend on your vision, leadership and commitment toward
robust NIH funding over the next year. To this end, the Research
Working Group (RWG) urges this Committee to support--at minimum--the
President's NIH budget request and also recommends a funding target of
$35 billion in fiscal year 2012 to maintain the U.S.'s position as the
world leader in medical research and innovation.
Investments in health research via NIH have paid enormous dividends
in the health and well-being of people in the United States and around
the world. NIH funded HIV and AIDS research has supported innovative
basic science for better drug therapies, evidence-based behavioral and
biomedical prevention interventions and vaccines which have saved and
improved the lives of millions and holds great promise for
significantly reducing HIV infection rates and providing more effective
treatments for those living with HIV/AIDS in the coming decade.
Despite these advances, the number of new HIV/AIDS cases continues
to rise in various populations in the United States and around the
world. There are over 1 million HIV-infected people in the United
States, the highest number in the epidemic's 30-year history;
additionally over 56,000 Americans become newly infected every year.
The evolving HIV epidemic in the United States disproportionately
affects the poor, sexual and racial minorities and the most
disenfranchised and stigmatized members of our communities. However,
with proper funding coupled with the promotion of evidence based
policies, 2012 will be a time of great scientific progress in
prevention science, vaccines and finding a cure for HIV as well as
addressing the co-morbid illnesses that affect patients with HIV such
as viral hepatitis and tuberculosis. Further, as Washington, DC is set
to host the International AIDS Conference in the summer of 2012, the
gains in science made by NIH funded research programs will reflect our
preeminence as the world's most powerful research enterprise fighting
this deadly epidemic.
Major advances over the last 2 years in HIV prevention
technologies--in particular with microbicides, HIV vaccines,
circumcision, antiretroviral treatment as prevention and pre exposure
prophylaxis using antiretrovirals (PrEP)--demonstrate that adequately
resourced NIH programs can transform our lives. Federal support for
AIDS research has also led to new treatments for other diseases,
including cancer, heart disease, Alzheimer's, hepatitis, osteoporosis
and a wide range of autoimmune disorders. Over the years, NIH has
sponsored the evaluation of a host of vaccine candidates, some of which
are advancing to efficacy trials. The recent successful iPrEx and HPTN
052 trials have shown the potential of antiretroviral drugs to prevent
HIV infection. Moreover increased funding will support the future
testing of new microbicides and therapeutics in the pipeline via the
implementation of a newly restructured, cross-cutting HIV clinical
trials network which translates NIH funded scientific innovation into
critical quality of life gains for those most affected with HIV.
Increased funding for NIH in fiscal year 2012 makes good bipartisan
economic sense, especially in shaky times. Robust funding for NIH
overall will enable research universities to pursue scientific
opportunity, advance public health, and create jobs and economic
growth. In every State across the country, the NIH supports research at
hospitals, universities, private enterprises and medical schools. This
includes the creation of jobs that will be essential to future
discovery. Sustained investment is also essential to train the next
generation of scientists and prepare them to make tomorrow's HIV
discoveries. NIH funding puts 350,000 scientists to work at research
institutions across the country. According to NIH, each of its research
grants creates or sustains six to eight jobs and NIH supported research
grants and technology transfers have resulted in the creation of
thousands of new independent private sector companies. Strong,
sustained NIH funding is a critical national priority that will foster
better health and economic revitalization.
Let's not jeopardize our future. Since 2003, funding for the NIH
has failed to keep up with our existing research needs--damaging the
success rate of approved grants and leaving very little money to fund
promising new research. The real value of the increases prior to 2003
has been precipitously reduced because of the relatively higher
inflation rate for the cost of research and development activities
undertaken by NIH. According to the Biomedical Research and Development
Price Index--which calculates how much the NIH budget must change each
year to maintain purchasing power--between fiscal year 2003 and fiscal
year 2011, the cost of NIH activities according to the BRDI will have
increased by 32.8 percent. By comparison, the overall budget of the NIH
increased by $3.6 billion or 13.4 percent over fiscal year 2003. So in
real terms, the NIH has already sustained budget decreases of close to
20 percent over the past 9 years due to inflation alone. As such, any
further cuts to NIH will have the clear and devastating effects of
undermining our Nation's leadership in health research and our
scientists' ability to take advantage of the expanding opportunities to
advance healthcare. The race to find better treatments and a cure for
cancer, heart disease, AIDS and other diseases, and for controlling
global epidemics like AIDS, tuberculosis and malaria, all depend on a
robust long term investment strategy for health research at NIH.
In conclusion, the RWG calls on Congress to continue the bipartisan
Federal commitment toward combating HIV as well as other chronic and
life threatening illnesses by increasing funding for NIH to $35 billion
in fiscal year 2012, including funds for transfer to the Global Fund
for HIV/AIDS, Tuberculosis, and Malaria. A meaningful commitment toward
stemming the epidemic and securing the well being of people with HIV
cannot be met without prioritizing the research investment at NIH that
will lead to tomorrow's lifesaving vaccines, treatments and cures.
Thank you for the opportunity to provide these comments.
______
Prepared Statement of Research!America
Thank you for the opportunity to submit testimony regarding fiscal
year 2012 appropriations for the Subcommittee on Labor, Health, and
Human Services, Education and Related Agencies. Research!America is the
Nation's largest 501(c)(3) alliance working to make research to improve
health a higher national priority. Research!America's member
organizations together represent the voices of more than 125 million
Americans. Our mission is grounded in strong and consistent expression
by the American public for robust funding and policies in support of
health research in the public and private sector. We use evidence-based
advocacy to demonstrate the benefits of research that improves public
health, productivity, longevity, and prosperity while solidifying
America's standing as the world's engine of innovation.
Our remarks will focus on funding for the National Institutes of
Health (NIH), the Centers for Disease Control and Prevention (CDC), the
Food and Drug Administration (FDA) and the Agency for Healthcare
Research and Quality (AHRQ)--agencies that play a pivotal role in
advancing the health of Americans and fueling economic growth across
our Nation. In addition to these agencies, Research!America also
advocates for the National Science Foundation (NSF), which fosters
basic science and discovery that also impacts the health of Americans.
Research!America appreciates the subcommittee's past support for
robust research funding conducted and supported by NIH, CDC, FDA, and
AHRQ. Health research is in our Nation's best short- and long-term
interests. Investing in research saves lives, saves dollars, produces
jobs across multiple sectors of our economy, and positions our Nation
for sustained global competitiveness.
The Nation is facing a debt crisis. Our debt burden will increase
if we underfund agencies that drive economic growth and the private
sector innovation critical to our global competitiveness. Robust
support for health research agencies is critical for solving the debt
crisis, reigning in the cost of medical care, and getting the economy
back on track.
NIH, CDC, AHRQ and FDA each contribute in multifaceted ways to
improved health and the economic growth our Nation.
--Research funded by the National Institutes of Health at research
institutions across the country provides the groundwork for new
product development in the private sector, which creates jobs
and pumps dollars into local economies.
--The Centers of Disease Control and Prevention engage in
epidemiological and public health research that stems deadly
and costly pandemics, bolsters our Nation's defenses against
bioterrorism, and addresses public health threats like drug-
resistant infections that increase hospital costs and threaten
lives.
--Research supported by the Agency for Healthcare Research and
Quality improves the efficiency and quality of healthcare in
this country by reducing duplication and waste and improving
healthcare outcomes;
--By ensuring the safety and efficacy of new medicines and medical
devices, The Food and Drug Administration plays a pivotal role
in translating health research into improved treatments for
patients.
As polling commissioned by Research!America clearly demonstrates,
the American public strongly supports robust investment in health and
medical research. A recent poll that surveyed a mix of self-described
conservatives (32 percent), liberals (32 percent) and moderates (36
percent) found that, as we emerge from the recession:
--78 percent of Americans think Federal funding for health research
is important for job creation and the economy;
--61 percent say accelerating our Nation's investment in research to
improve health is a priority;
--76 percent think global health R&D is important to the U.S.
economy;
--84 percent think it is important that the Government plays a role
in research for prevention and wellness; and
--53 percent of Americans think that spending cuts are necessary, but
the United States must invest strategically to improve the
health of the economy.
The poll also confirms that Americans value public/private
collaboration in order to rapidly build on discoveries made in
federally funded labs to bring new drugs and devices to market. Some 84
percent of Americans think it is important to invest in regulatory
science, an increasingly important area of focus at FDA and NIH, to
make the drug and device development process more efficient for
businesses and safer for patients.
Additional findings from Research!America polling include:
--91 percent of Americans think R&D is important to their State's
economy;
--83 percent agree that basic scientific research should be funded by
the Federal government;
--66 percent think research to improve health is part of the solution
to rising healthcare costs.
The American public knows that research not only saves lives, but
money. Disease and disability pose a major economic threat to our
Nation, as the aging of our population and rising obesity rates
increase the prevalence of heart disease, cancer, stroke, diabetes,
Parkinson's disease, Alzheimer's disease and other major illnesses. It
is estimated that chronic disease alone costs the United States $1.7
trillion each year.\1\ Research conducted by both the public and
private sectors is a potent weapon against rising healthcare costs. For
example:
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\1\ Partnership to Fight Chronic Disease, Almanac of Chronic
Disease, 2009.
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--An NIH-sponsored clinical trial showed treatment with aspirin could
reduce stroke in Atrial Fibrillation (AF) victims by 80
percent, resulting in a 10-year net benefit of $1.27
billion.\2\
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\2\ Johnston SC, Rootenberg JD, Katrak S, et. al. Effect of a US
NIH programme of clinical trials on public health and costs. The Lancet
2006;367:1319-1327.
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--A breast cancer diagnostic test developed by a private company
using data from the publicly funded human genome project saves
an estimated $2,000 per patient by reducing the number of women
who are prescribed chemotherapy.\3\
---------------------------------------------------------------------------
\3\ Lyman, G.H. et al. Impact of a 21-gene RT-PCR assay on
treatment decisions in early-stage breast cancer. Cancer. 2007;
109:1011-1118.
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--A recent NIH-funded study shows that vaccinating healthy, employed
adults (ages 18 to 50) against the flu saves as much as $31 per
person.\4\
---------------------------------------------------------------------------
\4\ Lee, Patrick Y. ``Economic Analysis Of Influenza Vaccination
And Antiviral Treatment For Healthy Working Adults.'' Annals of
Internal Medicine 137 (2002): 225-31.
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U.S. research leading to the control and eradication of global
illnesses can dramatically increase global productivity, while helping
to protect Americans. In addition to benefiting our troops abroad, U.S.
research focused on global diseases is actually an investment in the
health of Americans. International travel means that it is not a matter
of if, but when, deadly global threats, such as multiple-drug resistant
tuberculosis reach the United States. Every year, 60 million Americans
travel to other countries and 50 million people from abroad travel to
the United States.\5\
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\5\ ITA (International Trade Administration), Office of Travel and
Tourism Industries, ``Total International Travelers Volume to and from
the U.S. 1995-2005,'' available online at http://tinet.ita.doc.gov/
outreachpages/inbound.total_intl_travel_volume_1995-2005.html.
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In an interconnected world, U.S. global research helps grow our
economy and saves lives at home and abroad.
Both the NIH and the CDC work closely with other agencies, like the
U.S. Agency for International Development (USAID) to support the
development of new biomedical, diagnostic, and other global health-
related technologies. Through public private partnerships (PPP),
including product development partnerships (PDP), these agencies
leverage expertise from academia, private sector, and others to create
new tools to combat neglected diseases throughout the world. This
innovative collaborative PDP model has resulted in 12 novel products
that could prove transformative for global health. We urge the
committee to provide continued and robust support for these programs
that touch every corner of our world, save lives, and strengthen the
U.S. economy.
Whether the goal is to save lives, bend the cost curve by
progressively reducing the cost of treating chronic and life-
threatening health conditions, or promote the kind of innovation that
positions our Nation for global economic leadership now and in the
future, ample funding for NIH, CDC, FDA, and AHRQ is a cost-effective
investment. Research!America appreciates the difficult task facing the
subcommittee and urges that you recognize the return on investment that
these four Federal agencies bring to our country. Investing in these
agencies is the right, and smart, choice.
______
Prepared Statement of Rotary International
Chairman Harkin, members of the Subcommittee, Rotary International
appreciates this opportunity to submit testimony to the in support of
the polio eradication activities of the U.S. Centers for Disease
Control and Prevention (CDC). The Global Polio Eradication Initiative
is an unprecedented model of cooperation among national governments,
civil society and U.N. agencies to work together to reach the most
vulnerable through a safe, cost-effective public health intervention,
and one which is increasingly being combined with opportunistic,
complementary interventions such as the distribution of life-saving
vitamin A drops, oral rehydration therapy, zinc supplements, and even
something as simple as the distribution of soap. The goal of a polio
free world is within our grasp because polio eradication strategies
work even in the most challenging environments and circumstances.
PROGRESS IN THE GLOBAL PROGRAM TO ERADICATE POLIO
Thanks to this committee's leadership in appropriating funds,
progress toward a polio-free world continues.
--Only 4 countries (Nigeria, India, Pakistan and Afghanistan) are
polio-endemic--the lowest number in history.
--The number of polio cases has fallen from an estimated 350,000 in
1988 to less than 1300 in 2010--a more than 99 percent decline
in reported cases.
--As of April 21, 2011, Uttar Pradesh (UP) in India celebrated 1 year
without reporting a single case of polio. The state has
traditionally been a major exporter of virus to other parts of
India and the world, and has been described as one of the most
difficult places to eradicate polio.
--The number of polio cases in the polio endemic countries of India
and Nigeria declined by more than 90 percent in 2010 as
compared to 2009. As of 2011, India has reported only 1 case;
Nigeria--5 cases.
--Incidence of type 3 polio, which accounted for 70 percent of all
polio cases in 2009, decreased significantly in 2010 accounting
for only 8 percent of all cases.
--Bivalent oral polio vaccine, which was introduced at the end of
2009, has proven to effectively target both of the remaining
strains of polio, and has been a major factor in the progress
made in 2010.
--A shortfall in the funding needed for polio eradication activities
in polio affected and at-risk countries continues to pose a
serious threat the achievement of a polio free world.
In summary, significant operational progress was made in 2010
despite funding challenges and outbreaks which, will continue to
threaten polio free countries until polio eradication is achieved.
Rotary, as a spearheading partner of the GPEI, will continue to pursue
aggressive progress as outlined in the Strategic Plan for 2010-12 which
has already demonstrated results in terms of reducing the number of
cases in 2010 and into 2011.
The ongoing support of donor countries is essential to assure the
necessary human and financial resources are made available to polio-
endemic countries to take advantage of the window of opportunity to
forever rid the world of polio. Access to children is needed,
particularly in conflict-affected areas such as Afghanistan and its
shared border with Pakistan. Polio-free countries must maintain high
levels of routine polio immunization and surveillance. The continued
leadership of the United States is essential to ensure we meet these
challenges.
THE ROLE OF ROTARY INTERNATIONAL
Rotary International, a global association of more than 32,000
Rotary clubs in more than 170 countries with a membership of over 1.2
million business and professional leaders (more than 365,000 of which
are in the United States), has been committed to battling polio since
1985. Rotary International has contributed more than US$1 billion
toward a polio free world--representing the largest contribution by an
international service organization to a public health initiative ever.
Rotary also leads the United States Coalition for the Eradication of
Polio, a group of committed child health advocates that includes the
March of Dimes Foundation, the American Academy of Pediatrics, the Task
Force for Global Health, the United Nations Foundation, and the U.S.
Fund for UNICEF. These organizations join us in thanking you for your
staunch support of the Polio Eradication Initiative.
THE ROLE OF THE U.S. CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC)
Rotary commends CDC for its leadership in the global polio
eradication effort, and greatly appreciates the Subcommittee's support
of CDC's polio eradication activities. The investment in this global
effort has helped to make the United States the leader among donor
nations in the drive to eradicate this crippling disease. Due to
congressional support, in fiscal year 2010 and fiscal year 2011 CDC was
able to:
--Support the international assignment of more than 358 long- and
short-term epidemiologists, virologists, and technical officers
to assist the World Health Organization and polio-endemic
countries to implement polio eradication strategies while on
temporary duty travel from Atlanta, and 31 technical staff on
direct 2-year assignments to WHO and UNICEF to assist polio-
endemic and polio-reinfected countries.
--Perform the lead technical monitoring role for the Global Polio
Eradication Initiative (GPEI) Strategic Plan 2010-2012 released
in May 2010. On a quarterly basis, beginning in Q4, 2010, CDC
provided a detailed epidemiologic report and risk assessment on
the progress toward achieving the goals outlined in the
Strategic Plan to the Independent Monitoring Board (IMB) for
policy and decisionmaking.
--Provide $53.4 million in fiscal year 2010 to UNICEF for
approximately 292 million doses of polio vaccine and $7.3
million for operational costs for NIDs in all polio-endemic
countries and other high-risk countries in Asia, the Middle
East and Africa. Most of these NIDs would not take place
without the assurance of CDC's support.
--Collaborate with WHO, UNICEF, Rotary International, U.N. Foundation
and the Bill and Melinda Gates Foundation to facilitate World
Bank financing through its buy-down mechanism for the purchase
of OPV. In 2010, this mechanism provided $14.1 million to
Nigeria and $37.3 million to Pakistan. For 2011, Nigeria has
been approved for $60 million, 1-year credit and Pakistan is
eligible for a $41 million, 1-year credit.
--Provide $30.9 million in fiscal year 2010 to WHO for surveillance,
technical staff and NIDs' operational costs, primarily in
Africa. As successful NIDs take place, surveillance is critical
to determine where polio cases continue to occur. Effective
surveillance can save resources by eliminating the need for
extensive immunization campaigns if it is determined that polio
circulation is limited to a specific locale.
--Train virologists from around the world in advanced poliovirus
research and public health laboratory support. CDC's Atlanta
laboratories are a global reference center and training
facility.
--Provide, as the leading specialize polio reference lab in the
world, the largest volume of operational (poliovirus isolation)
and technologically sophisticated (genetic sequencing of polio
viruses) lab support to the 145 laboratories of the global
polio laboratory network.
--Provide scientific and technical expertise to WHO on research
issues regarding: (1) laboratory containment of wild poliovirus
stocks following polio eradication, and (2) when and how to
stop or modify polio vaccination following global certification
of polio eradication.
--Provide critical support for post-polio-eradication planning
through research, new product development, strategy formulation
and policy development.
--Train and deploy public health professionals to improve AFP
surveillance and to help plan, implement, and evaluate
vaccination campaigns, communications, etc. through CDC's Stop
Transmission of Polio (STOP) program. Since 1999, more than
1,000 STOP team members have participated in 3-month
assignments in 60 countries, providing 262 person-years of
support at the national and State levels. In 2010, the STOP
program deployed 185 professionals to 69 countries.
--Launch a customized N (national)-STOP initiative in March 2011 in
collaboration with the Pakistan Ministry of Health, WHO and the
USAID Mission in Islamabad. Sixteen national epidemiologists
from CDC's Field Epidemiology Training Program (FETP) were
trained and deployed to the highest risk districts for
circulation of wild polio virus in an effort to help improve
the quality of disease surveillance and immunization activities
there and to strengthen routine immunization systems.
--Deploy E (enhanced)-STOP initiative teams to Nigeria, S. Sudan,
Angola, Chad, and DRC. Those serving in E-STOP are assigned to
support efforts in strategic areas, are more experienced, and
serve for a longer durations. As part of E-STOP in 2010, 28
professionals were deployed to Nigeria, 35 to South Sudan, 7 to
Angola, 5 to Chad, and 5 to DRC. This initiative was
facilitated by an expanding partnership with the Organization
of Islamic Conference (OIC) facilitating outreach to Muslim
states and the Pan American Health Organization facilitating
Brazilian and Southern Cone support for Angola. With available
funding, CDC plans to expand the number of participants in E-
STOP in 2011.
--Support global polio eradication by participating in technical
advisory groups, EPI manager and other key meetings. The CDC
also published 14 updates on progress toward polio eradication
in the Morbidity and Mortality Weekly Report (MMWR) and other
peer-reviewed journals.
FISCAL YEAR 2012 BUDGET REQUEST
For fiscal year 2012, we respectfully request that this
subcommittee include $112 million for the targeted polio eradication
efforts of the Centers for Disease Control and Prevention, the same
level included in the President's fiscal year 2012 request. The funds
we are seeking will allow CDC to continue intense supplementary
immunization activities in Asia and to improve the quality of
immunization campaigns in Africa to interrupt transmission of polio in
these regions as quickly as possible. These funds will also help
maintain certification standard surveillance. This will ensure that we
protect the substantial investment we have made to protect the children
of the world from this crippling disease by supporting the necessary
eradication activities to eliminate polio in its final strongholds--in
South Asia and sub-Saharan Africa.
The United States' commitment to polio eradication has stimulated
other countries to increase their support. Other countries that have
followed America's lead and made special grants for the global Polio
Eradication Initiative include the United Kingdom ($900.03 million),
Japan ($418.65 million), Germany ($390.94 million), and Canada ($289.53
million). Since 2002, the members of the G8 have committed to provide
sufficient resources to eradicate polio. G8 member states, many of
which were already leading donors to the Polio Eradication Initiative,
have encouraged other donors to provide support, and have emphasized
the importance of polio eradication when meeting with leaders of polio-
endemic countries. As a result, the base of donor nations that have
contributed to the Global Polio Eradication Initiative has expanded to
include Spain, Sweden, Saudi Arabia, and even contributions from United
Arab Emirates, Kuwait, Hungary, and Turkey.
Endemic nations are also providing funds to support polio
eradication activities. It is noteworthy that India has provided US$692
million in funding for polio eradication activities there since 2003
and Nigeria provided approximately US$61.75 million, and Pakistan has
provided US$50 million.
BENEFITS OF POLIO ERADICATION
Since 1988, over 5 million people who would otherwise have been
paralyzed will be walking because they have been immunized against
polio. Tens of thousands of public health workers have been trained to
manage massive immunization programs and investigate cases of acute
flaccid paralysis. Cold chain, transport and communications systems for
immunization have been strengthened. The global network of 145
laboratories and trained personnel established for polio eradication
also tracks measles, rubella, yellow fever, meningitis, and other
deadly infectious diseases and will do so long after polio is
eradicated. NIDs for polio have also been used to distribute essential
vitamin A, thereby saving the lives of over 1.25 million children since
1988.
A study published in the November 2010 issue of the journal Vaccine
estimates that the global polio eradication initiative to eradicate
polio could provide net benefits of at least $40-50 billion if
transmission of wild polio viruses is stopped within the next 5 years.
Polio eradication is a cost-effective public health investment, as its
benefits accrue forever. On the other hand, more than 10 million
children will be paralyzed in the next 40 years if the world fails to
capitalize on the more than $8 billion already invested in eradication.
Success will ensure that the significant investment made by the United
States, Rotary International, and many other countries and entities, is
protected in perpetuity.
______
Prepared Statement of the Ryan White Medical Providers Coalition
Introduction
I am James Raper, a nurse practioner and Director of the 1917 HIV/
AIDS Outpatient Clinic at the University of Alabama at Birmingham. I am
submitting written testimony on behalf of the Ryan White Medical
Providers Coalition.
Thank you for the opportunity to discuss the important HIV/AIDS
care conducted at Ryan White Part C funded programs nationwide.
Specifically, the Ryan White Medical Provider Coalition, the HIV
Medicine Association, the CAEAR Coalition, and the American Academy of
HIV Medicine estimate that approximately $407 million is needed to
provide the standard of care for all Part C program patients. (This
estimate is based on the current cost of care and the number of
patients that Part C clinics serve.) Because these are exceptionally
challenging economic times, we request $272 million for Ryan White Part
C programs in fiscal year 2012, the amount that Congress authorized for
Part C programs in its 2009 reauthorization of the Ryan White Program.
The Ryan White Medical Providers Coalition was formed in 2006 to be
a voice for medical providers across the Nation delivering quality care
to their patients through Part C of the Ryan White program. We
represent every kind of program, from small and rural to large urban
sites in every region in the country. We speak for those who often
cannot speak for themselves and we advocate for a full range of primary
care services for these patients. Sufficient funding for Part C is
essential to providing appropriate care for individuals living with
HIV/AIDS.
Part C of the Ryan White Program funds comprehensive Early
Intervention Services (EIS) for HIV care and treatment, that are
directly responsible for the dramatic decreases in AIDS-related
mortality and morbidity over the last decade. The Centers for Disease
Control and Prevention estimate that there are more than 1.1 million
persons living with HIV/AIDS, and approximately 240,000, or almost 1 in
4, of these individuals received services from Part C medical
providers--a dramatic 30 percent increase in patients in less than 10
years.
The Cost of Care Is Reasonable; The Reimbursement for Care Isn't
On average it costs $3,501 per person per year to provide the
comprehensive outpatient care and treatment available at Part C funded
programs (excluding medication costs), including lab work, STD/TB/
Hepatitis screening, ob/gyn care, dental care, mental health and
substance abuse treatment, and case management. Part C funding covers
only a small percentage of the total cost of this comprehensive care,
with some programs receiving $450 (12 percent of the total cost) or
less per patient per year to cover the cost of care.
Part C Programs Save Both Lives and Money
Investing in Part C services improves lives and saves money. In the
United States, nearly 50 percent of persons living with HIV/AIDS who
are aware of their status are not in continuing care. Early and
reliable access to HIV care and treatment both helps patients with HIV
live relatively healthy and productive lives and is more cost
effective. One study from my Part C Clinic at the University of Alabama
at Birmingham found that patients treated at the later stages of HIV
disease required 2.6 times more healthcare dollars than those receiving
earlier treatment meeting Federal HIV treatment guidelines.
Patient Loads Are Increasing at an Unsustainable Rate
Patient loads have been increasing at Part C clinics nationwide,
despite the fact that there has not been significant new Federal
funding, and in most cases, State and/or local funding has been cut. A
steady increase in patients has occurred on account of higher diagnosis
rates and declining insurance coverage resulting in part from the
economic downturn. The CDC reports that the number of HIV/AIDS cases
increased by 15 percent from 2004 to 2007 in 34 States.\1\
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\1\ Centers for Disease Control and Prevention. HIV/AIDS
Surveillance Report, 2007. Vol. 19. U.S. Department of Health and Human
Services, Centers for Disease Control and Prevention; 2009:5.
www.cdc.gov/hiv/topics/surveillance/resources/reports/.
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For example, at a clinic in Greensboro, North Carolina, the number
of patients has more than doubled from 321 patients in 2002 to more
than 800 in 2009. The clinic continues to deliver care in the same
space with the same staffing as in 2002 despite the 250 percent
increase in patients. In Sonoma County, California, funding became so
scarce that the Part C clinic there closed its doors, and had to patch
together new medical homes in other locations for 350 patients. In New
York, when St. Vincent's Hospital in New York City closed, including
the HIV/AIDS clinic, a Part C clinic at St. Luke's-Roosevelt Hospital
had to absorb almost the entire St. Vincent's clinic, approximately
1,000 patients, over the course of just a few days.
Our patients struggle in times of plenty, and during this economic
downturn they have relied on Part C programs more than ever. While
these programs have been under-funded for years, State and local
economic pressures are creating a crisis in our communities. Clinics
are discontinuing primary care and other critical medical services,
such as laboratory monitoring; suffering eviction from their clinic
locations; operating only 4 days per week; and laying off staff just to
get by. Years of nearly flat funding combined with large increases in
the patient population and the recent economic crisis are negatively
impacting the ability of Part C providers to serve their patients.
The following graph demonstrates the growing disparity between
funding for Part C and the increasing patient population. I refer to
this gap between funding and patients as the ``Triangle of Misery''
because it represents both the thousands of patients who deserve more
than we can offer and the Part C programs nationwide that are
struggling to serve them with shrinking resources.
Conclusion
These are challenging economic times, and we recognize the severe
fiscal constraints Congress faces in allocating limited Federal
dollars. The significant financial and patient pressures that we face
in our clinics at home propel us to make this funding request for
fiscal year 2012 funding of Ryan White Part C programs. This funding
would help to support medical providers nationwide in delivering
appropriate and effective HIV/AIDS care to their patients. As the
survey below of Part C providers nationwside shows, this Federal
support is urgently needed.
Thank you for your time and consideration of our request. If you
have any questions, please do not hesitate to contact me at the 1917
HIV/AIDS Outpatient Clinic, University of Alabama at Birmingham,
Birmingham, Alabama 35294-2050, e-mail at [email protected].
RWMPC SURVEY: BUDGETARY CONSTRAINTS CONTINUE TO DRIVE CUTBACKS IN HIV
CARE
In January 2011, the Ryan White Medical Providers Coalition, which
represents Ryan White Part C programs nationwide that provide
comprehensive HIV medical care and treatment, asked members to indicate
their top three concerns as well as their frontline experiences
providing HIV care and treatment in the current, constrained economic
environement. The results of the brief survey included:
--The top three concerns (in order of importance):
--Funding cuts/shortfalls
--Sustaining the Ryan White Program and Part C programs and
preparing for health reform
--Clinic management issues, including:
-- HIV medical workforce recruitment and retention
-- Access to medications for patients (including the amount of
work that clinics are doing to secure this access now that
the ADAP crisis has worsened)
-- Increasing patient loads and the fact that clinics are
reaching the limits of what they can do within their
current financial and workforce resources.
--For those who are worried about funding cuts and shortfalls, 57
percent are worried about cuts to Federal funds.
--More than 56 percent of respondents have made cuts or changes to
their programs because of funding cuts or shortfalls (both
state and Federal).
--The types of cuts or changes that have been made include:
--More than 32 percent of clinics have either reduced or cut the
services they provide.
--21.5 percent have either frozen their hiring or laid off staff
--13.5 percent have reduced coverage for lab monitoring
These survey results indicate the need to support and increase the
investment in Part C programs, a valuable, effective and cost efficient
resource that provides medical homes to tens of thousands of persons
with HIV nationwide. Unless Part C programs receive additional funding,
more services and infrastructure will be lost during this critical time
period before the implementation of healthcare reform in 2014. Loss of
such resources and infrastructure would reduce the availability of
quality HIV care and treatment at just the time when the National HIV/
AIDS Strategy is hoping to increase access to these life-saving
services.
______
Prepared Statement of the Scleroderma Foundation
FISCAL YEAR 2012 APPROPRIATIONS RECOMMENDATIONS
Funding for the National Institutes of Health (NIH) at a level of
$35 million.
An increase for the National Institute of Arthritis and
Musculoskeletal and Skin Diseases (NIAMS) concurrent with the overall
increase to NIH.
Committee recommendation encouraging the Centers for Disease
Control and Prevention to partner with the Scleroderma Foundation in
promoting increased awareness of scleroderma among the general public
and healthcare providers.
Mr. Chairman, I am Cynthia Cervantes, I am 12 and in the ninth
grade. I live in Southern California and in October 2006 I was
diagnosed with scleroderma. Scleroderma means ``hard skin'' which is
literally what scleroderma does and, in my case, also causes my
internal organs to stiffen and contract. This is called diffuse
scleroderma. It is a relatively rare disorder effecting only about
300,000 Americans.
About 2 years ago I began to experience sudden episodes of
weakness, my body would ache and my vision was worsening, some days it
was so bad I could barely get myself out of bed. I was taken to see a
doctor after my feet became so swollen that calcium began to ooze out.
It took the doctors (period of time) to figure out exactly what was
wrong with me, because of how rare scleroderma is.
There is no known cause for scleroderma, which affects three times
as many women as men. Generally, women are diagnosed between the ages
of 25 and 55, but some kids, like me, are affected earlier in life.
There is no cure for scleroderma, but it is often treated with skin
softening agents, anti-inflammatory medication, and exposure to heat.
Sometimes a feeding tube must be used with a scleroderma patient
because their internal organs contract to a point where they have
extreme difficulty digesting food.
The Scleroderma Foundation has been very helpful to me and my
family. They have provided us with materials to educate my teachers and
others about my disease. Also, the support groups the foundation helps
organize are very helpful because they help show me that I can live a
normal, healthy life, and how to approach those who are curious about
why I wear gloves, even in hot weather. It really means a lot to me to
be able to interact with other people in the same situation as me
because it helps me feel less alone.
Mr. Chairman, because the causes of scleroderma are currently
unknown and the disease is so rare, and we have a great deal to learn
about it in order to be able to effectively treat it. I would like to
ask you to please significantly increase funding for the National
Institute of Health so treatments can be found for other people like me
who suffer from scleroderma. It would also be helpful to start a
program at the Centers for Disease Control and Prevention to educate
the public and physicians about scleroderma.
OVERVIEW OF THE SCLERODERMA FOUNDATION
The Scleroderma Foundation is a nonprofit organization based in
Danvers, Massachusetts with a three-fold mission: support, education,
and research. The Foundation provides support for people living with
scleroderma and their families through programs such as peer
counseling, doctor referrals, and educational information, along with a
toll-free telephone helpline for patients.
The Foundation also provides education about the disease to
patients, families, the medical community, and the general public
through a variety of awareness programs at both the local and national
levels. Over $1 million in peer-reviewed research grants are awarded
annually to institutes and universities to stimulate progress in the
search for a cause and cure for scleroderma.
WHO GETS SCLERODERMA?
There are many clues that define the susceptibility to develop
scleroderma. A genetic basis for the disease has been suggested by the
fact that it is more common among patients whose family members have
other autoimmune diseases (such as lupus). In rare cases, scleroderma
runs in families, although for the vast majority of patients there is
no other family member affected. Some Native Americans and African
Americans suffer a more severe form of the disease Caucasians. Women
between the ages of 25-55 are more likely to develop scleroderma.
CAUSES OF SCLERODERMA
The cause of scleroderma is unknown. However, we do understand a
great deal about the biological processes involved. In localized
scleroderma, the underlying problem is the overproduction of collagen
(scar tissue) in the involved areas of skin. In systemic sclerosis,
there are three processes at work: blood vessel abnormalities, fibrosis
(which is overproduction of collagen) and immune system dysfunction, or
autoimmunity.
RESEARCH
Unfortunately, support for scleroderma research at the National
Institutes of Health over the past several years has been flat funded
at $19 million since fiscal year 2009, and is again estimated at $19
million for fiscal year 2012. This absence of increase is extremely
frustrating to our patients who recognize biomedical research as their
best hope for a better quality of life. It is also of great concern to
our researchers who have promising ideas they would like to explore if
resources were available.
TYPES OF SCLERODERMA
There are two main forms of scleroderma: systemic (systemic
sclerosis, SSc) that usually affects the internal organs or internal
systems of the body as well as the skin, and localized that affects a
local area of skin either in patches (morphea) or in a line down an arm
or leg (linear scleroderma), or as a line down the forehead
(scleroderma en coup de sabre). It is very unusual for localized
scleroderma to develop into the systemic form.
Systemic Sclerosis (SSc)
There are two major types of systemic sclerosis or SSc: limited
cutaneous SSc and diffuse cutaneous SSc. In limited SSc, skin
thickening only involves the hands and forearms, lower legs and feet.
In diffuse cutaneous disease, the hands, forearms, the upper arms,
thighs, or trunk are affected.
People with the diffuse form of SSc are at risk of developing
pulmonary fibrosis (scar tissue in the lungs that interferes with
breathing, also called interstitial lung disease), kidney disease, and
bowel disease. The risk of extensive gut involvement, with slowing of
the movement or motility of the stomach and bowel, is higher in those
with diffuse rather than limited SSc. Symptoms include feeling bloated
after eating, diarrhea or alternating diarrhea and constipation.
Pulmonary Hypertension (PH) is high blood pressure in the blood
vessels of the lungs. It is totally independent of the usual blood
pressure that is taken in the arm. This tends to develop in patients
with limited SSc after several years of disease. The most common
symptom is shortness of breath on exertion. However, several tests need
to be done to determine if PH is the real culprit. There are now many
medications to treat PH.
Localized Scleroderma
Morphea
Morphea consists of patches of thickened skin that can vary from
half an inch to 6 inches or more in diameter. The patches can be
lighter or darker than the surrounding skin and thus tend to stand out.
Morphea, as well as the other forms of localized scleroderma, does not
affect internal organs.
Linear scleroderma
Linear scleroderma consists of a line of thickened skin down an arm
or leg on one side. The fatty layer under the skin can be lost, so the
affected limb is thinner than the other one. In growing children, the
affected arm or leg can be shorter than the other.
Scleroderma en coup de sabre
Scleroderma en coup de sabre is a form of linear scleroderma in
which the line of skin thickening occurs on the forehead or elsewhere
on the face. In growing children, both linear scleroderma and en coup
de sabre can result in distortion of the growing limb or lack of
symmetry of both sides of the face.
______
Prepared Statement of Senior Service America, Inc.
We urge the subcommittee to restore funding for the Senior
Community Service Employment Program (SCSEP), currently administered by
the Department of Labor, to no less than $600 million for fiscal year
2012. would return funding for this proven and unique Federal
employment and training program to pre-ARRA levels.
SCSEP is the only Federal program targeted at assisting low income
workers over the age of 55 either regain employment or provide minimum
wage employment through community service in communities across the
Nation. A restoration of funding for SCSEP to $600 million would
provide community service employment to an additional 24,000 unemployed
and low-income older workers and at least 7 million lost staffing hours
in participants' community service to local government agencies and
nonprofit organizations meeting basic human needs.
We estimate that the public return on investment is more than
double its appropriations level. The value of the community service by
SCSEP participants would exceed $900 million. In addition to the value
of the this service, SCSEP produces savings to the Federal Government
by helping many thousands of vulnerable older adults to avoid becoming
totally dependent on government transfer payments, including Medicaid,
Supplemental Security Income, and early receipt of Social Security
benefits.
SCSEP's severe cut in fiscal year 2011 will have devastating impact
on older workers and communities.--Restoring funding in fiscal year
2012 would lessen the impact of the 45 percent reduction in SCSEP as a
result of the fiscal year 2011 year-long Continuing Resolution, The cut
of $375 million from fiscal year 2010 is larger than the WIA core
funding cut. As a result, during the year starting July 1, 2011, nearly
50,000 fewer jobless older adults will be employed and almost 35
million staff hours will be lost by over 30,000 local agencies and
programs throughout the 50 States. Using tables from the Independent
Sector, the value of these lost SCSEP community service hours exceeds
$740 million.
SCSEP currently supports a wide range of community services and
local government programs. For example, in 2011 over 1,100 public
libraries (at least one in every State, most in rural areas) employed
at least one SCSEP participant in a variety of library-related
assignments. About one-fourth of all SCSEP community service hours are
performed in service to other older adults, such as senior centers,
nutrition, Meals on Wheels, and adult day care centers.
SCSEP is a unique Federal workforce development program.--According
to a January 2011 GAO report on multiple employment and training
programs, SCSEP is one of only three Federal workforce development
programs that do not overlap with any other program. Since 1998, it is
the only Federal program targeted to assist older adults return to the
workforce and serves almost twice the number of adults 55 and over who
receive training under WIA. Previous research by GAO and others have
documented that WIA has consistently underserved older jobseekers.
Older adults, especially those eligible for SCSEP, continue to
suffer in the current economy. Older workers have been described as the
``new unemployables'' in a recent report by Rutgers University. The
current jobless rate for all older workers continues to be lower than
the rate for all workers, but in 2010 the unemployment rate of older
adults 55-74 years of age eligible for SCSEP was 23 percent, more than
three times the national average for all adult workers. Among displaced
workers 55 and older, the reemployment rate was only 38 percent, the
lowest of any age group, with those from lower income households and
with less than a college education faring the worst. Finally, the
average duration of unemployment among adults 55 and over continued to
increase in April 2011 to 53.6 weeks, with more than half of all older
jobseekers out of work for 27 or more weeks, also an increase from the
prior month. (More information is available from AARP and Senior
Service America websites.)
The job market is not likely to improve significantly for most of
these low-income and disadvantaged older job seekers in the foreseeable
future. Too many will remain out of work and be forced to sustain
themselves by becoming totally reliant on government transfers such as
Medicaid, Supplemental Security Income, and early receipt of Social
Security income benefits. Many will be highly unlikely to return to the
labor force. Restoring SCSEP appropriations to pre-ARRA levels is a
wise investment in a program of demonstrated effectiveness operated by
a network of proven performers.
DOL's SCSEP grantee network consistently achieves its performance
measures.--According to official statistics, in PY2009 the aggregate
performance of the 18 national grantees and 56 State and territorial
grantees achieved 98 percent or more of each of the common performance
measures established for the program by DOL. For example, the grantee
network achieved a 46.2 percent Entered Employment Rate (compared to
the goal of 47 percent established by DOL); 70 percent Retention (68
percent goal); and $6,900 6 month earnings ($6,229 goal). For
comparison, the Entered Employment Rate achieved was 48.1 percent in
PY2008 and 52.4 percent in PY2007.
In addition, ratings by SCSEP participants and participating host
agencies using the American Customer Satisfaction Index have been
consistently higher for SCSEP than for WIA. In PY2009, participants
gave SCSEP an ACSI score of 82.7 and host agencies gave a score of
81.3. Additional information from these independent national surveys:
SCSEP Participants (number of respondents=24,358)
ACSI score of 82.7 (about the same as prior year's score)
Nearly 92 percent of respondents reported that, compared to the
time before they entered SCSEP, their physical health is the same or
better, 73 percent reported that their outlook on life is a little more
positive or much more positive.
Participants were in moderate to strong agreement (7.9 on a scale
of 1 to 10) with the statement that their community service wages have
made a substantial improvement in their quality of life.
SCSEP Host Agencies (number of respondents=10,567)
ACSI score of 81.3 (nearly identical to prior year's score)
75 percent indicated that participation in SCSEP increased their
ability to provide services to the community either ``somewhat'' or
``significantly.''
The impact of the fiscal year 2011 cuts to SCSEP will be felt in
every State. For example:
Impact on Iowa: Loss of nearly $5 million in SCSEP funding and over
$7 million in services.
During fiscal year 2010, about 490 local programs in 153 Iowa towns
and cities hosted at least one SCSEP participant, including: 171 local
and State government agencies; 71 programs serving older adults,
including at least 20 senior centers; 36 schools and post-secondary
institutions; 31 workforce development offices; 24 public libraries and
11 museums; and 10 community action agencies.
----------------------------------------------------------------------------------------------------------------
Current fiscal Final fiscal
year 2010 year 2011 Impact
appropriations funding level
----------------------------------------------------------------------------------------------------------------
Funding Allocation for Iowa (all SCSEP grantees).......... $10.5 million $5.6 million -$4.9 million
Number of Participants in Paid Community Service 1,520 persons 880 persons -640 persons
Employment in Iowa.......................................
Number of SCSEP Hours Serving Iowa Communities............ 944,700 hours 507,700 hours -437,000 hours
Value of SCSEP Hours Serving Iowa Communities @$16.77/hour $15.8 million $8.5 million -$7.3 million
(www.independentsector.org/volunteer_time)...............
----------------------------------------------------------------------------------------------------------------
The U.S. Department of Labor awards SCSEP funding for Iowa to the
AARP Foundation, Experience Works, Senior Service America, Inc., and
the Iowa Dept. on Aging. Local agencies in Iowa that operate SCSEP are
Community Action Agency of Siouxland, Generations Area Agency on Aging,
Hawkeye Area Community Action Program, and West Central Community
Action.
Impact on Alabama: A loss of $6.4 million in SCSEP funding and $10
million in services.
During fiscal year 2010, more than 600 local government and
nonprofit programs hosted at least one SCSEP participant, including:
--Nearly 300 local government agencies and programs, including 35
libraries and 31 senior centers, and
--More than 220 nonprofit organizations, including the American Red
Cross, Boys and Girls Clubs, and Chambers of Commerce.
Starting July 1, 2011, the fiscal year 2011 cut in SCSEP funding
will mean over 800 fewer job opportunities and 568,000 fewer community
service hours to Alabama agencies (valued at least $10 million,
according to tables provided by the Independent Sector).
----------------------------------------------------------------------------------------------------------------
Current fiscal Final fiscal
year 2010 year 2011 Impact
appropriations funding level
----------------------------------------------------------------------------------------------------------------
Funding Allocation for Alabama (all SCSEP grantees)....... $14.5 million $8.1 million -$6.4 million
Number of Participants in Paid Community Service 2,090 persons 1,280 persons -810 persons
Employment in Alabama....................................
Number of SCSEP Hours Serving Alabama Communities......... 1,302,000 hrs. 734,000 hrs. -568,000 hrs.
Value of SCSEP Hours Serving Iowa Communities @$17.70/hour $23 million $13 million -$10 million
(www.independentsector.org/volunteer_time)...............
----------------------------------------------------------------------------------------------------------------
The U.S. Department of Labor provides SCSEP funding to the Alabama
Department of Senior Services, Easter Seals, and Senior Service
America, Inc.
The following local government agencies in Alabama receive SCSEP
funding: Alabama-Tombigbee Regional Commission, East Alabama Regional
Planning and Development Commission, Jefferson County Commission,
Middle Alabama Area Agency on Aging, North-central Alabama Regional
Council of Governments, Northwest Alabama Council of Local Governments,
South Central Alabama Development Commission, Southeast Alabama
Regional Planning and Development Commission, Top of Alabama Regional
Council of Governments, and West Alabama Regional Commission.
Summary
We recognize that these are challenging times for the Subcommittee
and difficult funding decisions must be made. A partial restoration of
SCSEP funding to $600 million will ensure that an additional 24,000 of
the hardest to reemploy, low income older workers will be able to
provide an additional 7 million hours in service to communities across
the Nation, with a return on investment double the appropriations
provided to SCSEP. Thank you for considering this funding request.
About Senior Service America, Inc.
Senior Service America, Inc. (SSAI) has been awarded a national
SCSEP grant from DOL since 1968, including competitive grants in 2003
and 2006. As the third largest national grantee, SSAI operates SCSEP
exclusively through subgrants to 81 local organizations that serve 430
counties in 16 States. Its diverse network of subgrantees includes 25
area agencies on aging, 11 community action agencies, 10 regional
councils of government, 13 workforce development agencies, eight faith-
based organizations, two community colleges, and one local United Way.
For more information, please visit www.seniorserviceamerica.org. or
contact Tony Sarmiento, Executive Director, at 301-578-8469,
[email protected],
______
Prepared Statement of the Sickle Cell Disease Association of America
Mr. Chairman and distinguished Members of the Subcommittee, my name
is Sonja L. Banks. I was recently elected President and Chief Operating
Officer of the Sickle Cell Disease Association of America, Inc (SCDAA).
Since 1971, SCDAA has served as the Nation's only volunteer
organization working full time on a national level to resolve issues
surrounding sickle cell disease. We have grown to approximately 55
community-based member organizations focused on serving the needs of
individuals with Sickle Cell Disease or Sickle Cell Trait, their
families, and over 300 communities nationwide and in Canada.
On behalf of the organization, I am honored to submit this
testimony to your Subcommittee as a public witness in conjunction with
your consideration of fiscal year 2012 Appropriations legislation.
SCDAA respectfully urges the Subcommittee to support President
Obama's continuation of funding for the Sickle Cell Anemia
Demonstration Program, and the Registry and Surveillance System for
Hemoglobinopathy and Hemoglobinopathy Program Initiative. We also urge
the Subcommittee to restore funding to the Sickle Cell Disease and
Newborn Screening Program, a crucial program to fulfilling Secretary
Kathleen Sebelius' charge to the Department of Health and Human
Services (HHS) to make SCD a priority area of focus.
SCD is an inherited blood disorder that is a major problem in the
United States. An estimated 72,000 Americans live with the disease.
More than 2.5 million Americans have the Sickle Cell Trait (SCT),
including 1 in 12 African Americans. The average life span of an adult
with SCD is only 45 years.
Common complications include early childhood death from infection,
stroke in young children and adults, infection of the lungs similar to
pneumonia, pulmonary hypertension, chronic damage to organs such as the
kidney resulting in chronic kidney failure, and frequent severe painful
episodes. These unpredictable, intermittent, devastating pain events
can begin as early as six months of age and can span a lifetime,
impacting school and work attendance.
As the Nation addresses issues associated with healthcare reform, a
real and rare opportunity exists to support, a population in dire need
of treatment and care through innovative research and improved care.
First, we respectfully request that the Subcommittee provide
$4,740,000 for the Sickle Cell Anemia Demonstration Program and Data
Coordination Center. In fiscal year 2011, the Program received an
appropriation of $4,750,000, and for fiscal year 2012 the President's
budget recommends $4,740,000. Funding this national program will
improve the lives of SCD patients through disease management programs
to help them live longer, healthier lives while supporting research
toward a comprehensive cure and providing community education about
this disease and its treatment options.
Second, we respectfully request that the Subcommittee include
$20,165,000 for the Public Health Approach to Blood Disorders Program.
The President's fiscal year 2012 budget request consolidates existing
budget sub-lines into one line called ``Public Health Approach to Blood
Disorders.'' As part of this coordinated effort, a Hemoglobinopathy
Data Center will operate surveillance and registry program entitled
RuSH (Registry and Surveillance System for Hemoglobinopathies) in seven
States for 2 years.
The RuSH health data systems will provide researchers, policy
makers, and the public with imperative information about SCD and SCD-
related diseases that is currently unavailable. The lack of this type
of data system for Sickle-Cell-related diseases limits the research and
treatment communities' ability to fully understand the impact of the
disease and to develop healthcare planning at the local, State, and
national levels. Additionally, funding also will support a multi-agency
collaboration to form an HHS Hemoglobinopathy Program Initiative to
offer more effective care and lower societal and medical costs for
individuals affected by blood disorders such as SCD.
Finally, we respectfully request that the Subcommittee restore
$3,774,000 for the Sickle Cell Disease and Newborn Screening Program
(SCD-NBS). Unfortunately, the President has proposed to eliminate this
program in fiscal year 2012. On the other hand, Secretary Sebelius has
launched an SCD initiative aimed at increasing access to and improving
care. We believe that continuing the SCD-NBS program is critical to the
initiative's goal, and invaluable to families and individuals suffering
from this debilitating disease.
The SCD-NBS Program provides a continuity of medical services,
education and counseling from birth to adulthood for persons afflicted
with Sickle Cell Disease and Sickle Cell Trait. Since 2002, the project
has supported a National Coordinating and Evaluation Center and 17
community-based demonstration sites across the country. Because of
changes in the eligibility requirements for demonstration sites due
next month, we also ask that report language be included in the fiscal
year 2012 Subcommittee bill to direct the Program's funding to
community-based or faith-based organizations involved with Sickle Cell
Disease.
Thank you for considering these requests. We look forward to
working with the Senate Appropriations Subcommittee on Labor, Health,
and Education to fund these three critical programs that will help
African Americans and other historically underserved children and
families with Sickle Cell Disease live longer and healthier lives.
______
Prepared Statement of the Society for Maternal-Fetal Medicine
Mr. Chairman and Members of the Committee: The Society for
Maternal-Fetal Medicine is pleased to have the opportunity to submit
testimony on behalf of the fiscal year 2012 budget for the Eunice
Kennedy Shriver National Institute of Child Health and Human
Development (NICHD). We urge the Committee, as you move forward with
your deliberations on the fiscal year 2012 budget for the National
Institutes of Health (NIH), to keep in mind the enormous lost
opportunities that the NIH, and in particular the NICHD, will
experience if the level of funding is not sustained.
Established in 1977, the Society for Maternal-Fetal Medicine (SMFM)
is dedicated to improving maternal and child outcomes; and raising the
standards of prevention, diagnosis, and treatment of maternal and fetal
disease.
Maternal-fetal medicine specialists, also known as MFM specialists,
perinatologists, and high-risk pregnancy physicians, are highly trained
obstetrician/gynecologists with advanced expertise in obstetric,
medical, and surgical complications of pregnancy and their effects on
the mother and fetus.
The most common medical illnesses managed by MFM's include
hypertension, diabetes, seizure disorders, autoimmune diseases, and
blood clotting disorders. We also provide care for women who are at
increased risk for preterm birth, including multiple gestations, women
with cervical insufficiency who may require a surgery to prevent
preterm birth, and women with placental problems such as bleeding from
premature separation. In addition, MFM specialists are often
responsible for the management of preterm labor, premature rupture of
membranes, and other complications during labor that have the potential
to impact newborn and long-term infant outcomes.
The special problems faced by these mothers may lead to death,
short-term or in some cases life-long problems for their babies. For
example:
--Pre-term birth (birth before the fetus is at 37 weeks'
gestation).--Over half a million children are born preterm each
year. Preterm infants are at high risk for a variety of
disorders, including mental retardation, cerebral palsy, and
vision impairment. These infants are also at risk for long-term
health issues, including cardiovascular disease (heart attack,
stroke, and high blood pressure) and diabetes. The annual cost
to society (medical, educational, and lost productivity) of
preterm birth is at least $26 billion (in 2005 dollars).
--Hypertension.--High blood pressure during pregnancy endangers the
health of both the mother and the baby and is increasingly
common as women delay pregnancy until they are older, and as
they are more frequently overweight. Chronic hypertension
complicating pregnancy is associated with a risk of fetal
growth restriction and a risk of preterm birth. Hypertension in
pregnancy is also the second leading cause of maternal death in
the United States.
--Diabetes.--The hormonal changes of pregnancy often bring about a
diabetic state (gestational diabetes) in predisposed women or
can seriously worsen preexisting diabetes. Whether diabetes
mellitus existed before conception or gestational diabetes
develops during pregnancy, maternal glucose intolerance can
have significant medical consequences. Poorly controlled
diabetes is associated with miscarriage, congenital
malformations, abnormal fetal growth, stillbirth, obstructed
labor, increased cesarean delivery, and neonatal complications.
NICHD's commitment to basic, clinical and translational research
has lead to new ways to treat and improve the health of pregnant women
and infants. One of the most successful approaches for testing research
questions is the NICHD Maternal-Fetal Medicine Units (MFMU) Network
which allows researchers from across the country to coordinate clinical
studies to improve maternal, fetal and neonatal health. The studies to
date have not only identified new therapies and evaluated technologies
used in maternal fetal medicine, but also have helped to abolish
practices that are not useful.
--Researchers supported through the MFMU were responsible for the
groundbreaking finding related to preterm birth and
progesterone. Following a series of studies in the 1970s and
1980s, a national clinical trial showed that progesterone
treatment resulted in a substantial reduction in the rate of
preterm delivery among women who had a previous preterm birth,
reduced the risk of newborn complications, and was effective in
both African American and Non-African American women. This
preventive therapy has been translated into practice. The drug
was widely available through compounding pharmacies at a cost
of $15-$30 per injection or $300 for a 20 week treatment
course. However, in February 2011 the FDA granted KV
Pharmaceutical orphan status for its drug named Makena, a
manufactured version of the identical compound drug. After
which, KV Pharmaceutical increased the price of the drug to
$1,500 per injection, and later reduced it to $690 per
injection. (SMFM is actively engaged in efforts to ensure that
this medication is accessible and affordable to every pregnant
woman who is at risk for recurrent preterm birth.)
--Until recently, there was no evidence to show whether treating the
mild form of gestational diabetes benefited or posed risks for
mothers and infants. A recent Network study found women who
were treated for mild gestational diabetes were half as likely
to have an unusually large baby, and their babies were half as
likely to experience shoulder dystocia, an emergency condition
in which the baby's shoulder becomes lodged inside the mother's
body during birth. Treated women in the study also had fewer
caesarean deliveries. In addition, they had fewer problems with
hypertension and preeclampsia, a life-threatening complication
of pregnancy that can lead to maternal seizures and death.
Research supported by the MFMU provided the first conclusive
evidence that treating pregnant women who have even the mildest
form of gestational diabetes can reduce the risk of common
birth complications among infants, as well as blood pressure
disorders among mothers. These findings will change clinical
practice.
--Recent research conducted by the network found that antenatal
magnesium sulfate, when administered to women at risk of
delivering preterm, reduces the risk of cerebral palsy in
surviving preterm infants by 45 percent. This finding has been
translated into clinical practice.
Cerebral palsy refers to a group of neurological disorders
affecting control of movement and posture and which limit
activity. The brain may be injured or develop abnormally during
pregnancy, birth or in early childhood. The causes of cerebral
palsy are not well understood. Both economically and
emotionally, the burden of cerebral palsy is enormous. The
Centers for Disease Control and Prevention (CDC) estimates the
lifetime costs including direct medical, direct non-medical,
and indirect for all people born with cerebral palsy in 2000 to
be $11.5 billion (in 2003 dollars).
Research that disproves a current therapy or treatment can also
provide valuable guidance to clinicians and their patients.
--Translational research in the 1990s found that the use of
corticosteroids in pregnancies at risk of preterm birth
improved the outcomes for infants born preterm, reducing rates
of breathing problems, bleeding into the brain, and problems
with the intestines. However, NICHD sponsored research that
evaluated the use of repeated doses of corticosteroids found
that repeated doses resulted in smaller birth weights and head
circumstances. Researchers also found a concerning increase in
cerebral palsy in children who were exposed to four or more
courses of corticosteroids. This study, along with an NIH
Consensus Development Conference to pull together all available
data, stopped the routine use of repeated courses of antenatal
corticosteroids.
NICHD is at the forefront of several novel and important research
areas, but there are still many areas about maternal health, pregnancy,
fetal well-being, labor and delivery and the developing child that are
not close to being understood. The challenges of the NICHD to
investigate these problems remain. For example:
--Preterm Birth and Stillbirth.--Preterm birth and stillbirth
represent two of the most important complications of pregnancy.
Prevention of preterm birth and stillbirth depends on
identifying women at risk and understanding the mechanisms of
disease. It is imperative that NICHD take advantage of high
throughput technologies to understand the causes of preterm
birth and stillbirth and support genomics, proteomics, and
metabolomics studies focusing on prediction and prevention of
preterm birth and stillbirth, as well as the use of existing
biobanks. The promise of these new technologies is that a
better understanding of the biologic processes involved in
pregnancy and pregnancy complications will lead to improved
prediction, prevention, and treatment strategies that will
improve maternal and infant health.
--Severe, Early Adverse Pregnancy Outcomes.--Women with severe, early
adverse pregnancy outcome, such as multiple losses, demises,
and severe preeclampsia, are at increased risk for long-term
chronic health problems, including hypertension, stroke,
diabetes, and obesity. Studies have shown that women who have
had preeclampsia are more likely to develop chronic
hypertension, to die from cardiovascular disease and to require
cardiac surgery later in life. In addition, approximately 50
percent of women with gestational diabetes will develop
diabetes later in life. Studies to identify women at risk for
long term morbidity, and to develop strategies to prevent long
term adverse outcomes in these women are urgently needed.
--Maternal Fetal Medicine Units Network.--Vigorous support of the
MFMU Network is needed so that therapies and preventive
strategies that have significant impact on the health of
mothers and their babies will not be delayed. Until new options
are created for identifying those at risk and developing cause
specific interventions, preterm birth will remain one of the
most pressing problems in obstetrics.
SMFM applauds NICHD efforts to move forward with the development of
a scientific vision process for the Institute that will set an
ambitious agenda and inspire the Institute, the research community, and
its many partners to achieve critical scientific goals and meet
pressing public health needs.
Mr. Chairman, we understand the budgetary constraints that are
facing the Congress, but as providers of care for women with high-risk
pregnancies we have seen emerging technologies that have provided
greater opportunity to evaluate and treat the complicated problems
involving the mother and fetus. Without a sustained investment in the
critical medical research being conducted by the National Institutes of
Health, and the National Institute of Child Health and Human
Development in particular, the health of pregnant women and their
babies will be at risk and NICHD's mission of promoting healthy
development throughout the lifespan will be hindered.
Recommendation
The Society for Maternal-Fetal Medicine joins with the Ad Hoc Group
for Medical Research in urging the Committee to provide an
appropriation of $35 billion in fiscal year 2012 for the National
Institutes of Health.
The Society joins with the Friends of the National Institute of
Child Health and Human Development in support of a fiscal year 2012
budget of $1.352 billion for the National Institute of Child Health and
Human Development.
Thank you for the opportunity to submit our concerns to the
Committee.
______
Prepared Statement of the Society for Neuroscience
Introduction
Mr. Chairman and Members of the Subcommittee, my name is Susan
Amara, Ph.D. I am the Thomas Detre Professor of Neuroscience and Chair
of the Department of Neurobiology as well as Co-Director of the Center
for Neuroscience at the University of Pittsburgh and President of the
Society for Neuroscience. My major research efforts have been focused
on the structure, physiology, and pharmacology of a group of proteins
in the brain that are the primary targets for addictive drugs including
cocaine and amphetamines, for the class of therapeutic antidepressants,
known as reuptake inhibitors, and for methylphenidate, which is used to
treat attention deficit hyperactivity disorders.
On behalf of the more than 41,000 members of the Society for
Neuroscience (SfN) and myself, I would like to thank you for your past
support of neuroscience research at the National Institutes of Health
(NIH). Over the past century, researchers have made tremendous progress
in understanding cell biology, physiology, and chemistry of the brain.
Research funded by NIH has made it possible to make advances in brain
development, imaging, genomics, circuit function, computational
neuroscience, neural engineering and many other disciplines. In this
testimony, I will highlight how these advances have benefited taxpayers
and why we should continue to strengthen this investment, even as the
Nation makes difficult budget choices.
Fiscal Year 2012 Budget Request
The Society respectfully requests that Congress provide a fiscal
year 2012 appropriation in the amount of $35 billion for NIH. This
level of funding will enable the field to serve the long-term needs of
the Nation by continuing to improve health for the benefit of the
American people and the world, advance science, and promote America's
near-term and long-range economic strength. This level will build on
the research activities supported under prior year appropriations,
enabling neuroscience-related NIH institutions to aggressively fund
strategic plans that will significantly advance the understanding of
the brain and the nervous system. In so doing, these investments will
contribute to economic growth in hundreds of communities nationwide, as
more than 83 percent of NIH funding is distributed to more than 3,000
institutions in communities in every State. Moreover, it will help
preserve and expand America's role as leader in biomedical research,
which fosters a wide range of private enterprises in the
pharmaceutical, biotechnology, medical device, hospitality industries
as well as many others.
SfN hopes that such an appropriation will be the first step on the
path to providing a consistent and reliable long-term investment in the
NIH and in particular the field neuroscience. This will ensure that
there is not a dramatic drop in research activity or a loss of jobs,
and serve as an inducement to keeping our young researchers in the
training pipeline.
What is the Society for Neuroscience
SfN is a nonprofit membership organization of basic scientists and
physicians who study the brain and nervous system. The SfN mission is
to:
--Advance the understanding of the brain and the nervous system by
bringing together scientists of diverse backgrounds, by
facilitating the integration of research directed at all levels
of biological organization, and by encouraging translational
research and the application of new scientific knowledge to
develop improved disease treatments and cures.
--Provide professional development activities, information and
educational resources for neuroscientists at all stages of
their careers, including undergraduates, graduates, and
postdoctoral fellows, and increase participation of scientists
from a diversity of cultural and ethnic backgrounds.
--Promote public information and general education about the nature
of scientific discovery and the results and implications of the
latest neuroscience research. Support active and continuing
discussions on ethical issues relating to the conduct and
outcomes of neuroscience research.
--Inform legislators and other policymakers about new scientific
knowledge and recent developments in neuroscience research and
their implications for public policy, societal benefit, and
continued scientific progress.
What is Neuroscience?
Neuroscience is the study of the nervous system. It advances the
understanding of human function on every level: movement, thought,
emotion, behavior, and much more. Neuroscientists use tools ranging
from computers to special dyes to examine molecules, nerve cells,
networks, brain system, and behavior. From these studies, they learn
how the nervous system develops and functions normally and what goes
wrong in neurological and psychiatric disorders.
Neuroscience is now a unified field that integrates biology,
chemistry, and physics with studies of structure, physiology, and
behavior, including human emotional and cognitive functions.
Neuroscience research includes genes and other molecules that are the
basis for the nervous system, individual neurons, and ensembles of
neurons that make up systems and behavior. Through their research,
neuroscientists work to demonstrate normal functions of the brain and
determine how the nervous system develops, matures, and maintains
itself through life. They seek to prevent or cure many devastating
neurological and psychiatric disorders.
As the committee works to set funding levels for critical research
initiatives for fiscal year 2012 and beyond we need to do more than
establish a budget that is ``workable'' in the context of the current
fiscal situation. We ask you to help establish a national commitment to
advance the understanding of the brain and the nervous system--an
effort that has the potential to transform the lives of thousands of
people living with brain-based diseases and disorders. Help us to
fulfill our commitment to overcoming the most difficult obstacles
impeding progress, and to identifying critical new directions in basic
neuroscience.
Brain Research and Discoveries
The power of basic science unlocks the mysteries of the human body
by exploring the structure and function of molecules, genes, cells,
systems, and complex behaviors. Every day, neuroscientists are
advancing scientific knowledge and medical innovation by expanding our
knowledge of the basic makeup of the human brain. In doing so,
researchers exploit these findings and identify new applications that
foster scientific discovery which can lead to new and ground-breaking
medical treatments. Basic research funded by the National Institutes of
Health continues to be essential to ensuring discoveries that will
inspire scientific pursuit and medical progress for future generations.
The funds provided in the past have helped neuroscientists make
tremendous strides in diagnosing and treating neurological and
psychiatric disorders. Due to federally funded research, scientists and
healthcare providers now have a much better understanding of how the
brain functions.
As we look ahead to the long-term trajectory for NIH funding,
steady, sustainable growth is essential to maintaining a continuous
research pipeline that spans from basic science to clinical outcomes.
Without a long-term sustainable plan for investing in research,
dramatic swings in the funding cycle have a stifling, often
irreversible impact on progress, shutting down laboratories, driving
away talented young investigators and disillusioning students who have
just discovered a passion for biomedical research. As support declines,
gaps emerge between levels of funding and the need for scientific
advance. There are two kinds of gap--the ones you see and the ones you
don't. In times of limited resources, it is easier to deal
strategically with the gaps you know. For example, with an aging
population it makes sense to maintain support for research on
Alzheimer's and other chronic neurodegenerative diseases. But it's the
gaps we are unaware of that I also worry about. We know from past
experience that it is not always clear where the next critical
breakthrough or innovative approach will come from--progress in science
depends on imaginative curiosity-driven research that makes leaps in
ways no one could have anticipated. Where would neuroscience and cell
biology be without a rainbow of fluorescent proteins from jellyfish,
which are now illuminating neurological diseases and disorders? Where
would cutting edge work in systems neuroscience be today without
research on channel rhodopsins from algae, which now hold promise for
novel, noninvasive treatments for brain disorders? When resources are
limited, balancing support for high-risk high-payoff ideas with
disease-driven translational research presents a huge challenge--it is
easy to see why the latter is important, yet ultimately both kinds of
research have the potential to contribute to the development of life
changing therapies and cures for different diseases. More than ever is
it important to support and fund research at many levels from the most
basic to translational. The following are just two of the many basic
research success stories in neuroscience research emerging now thanks
to strong historic investment in NIH and other research agencies:
Nicotine Addiction
Although tobacco has been used legally for hundreds of years,
nicotine addiction takes effect through pathways similar to those
involving cocaine and heroin. During addiction, drugs activate brain
areas that are typically involved in the motivation for other
pleasurable rewards such as eating or drinking. These addictions leave
the body with a strong chemical dependence that is very hard to get
over. In fact, almost 80 percent of smokers who try to quit fail within
their first year. The lack of a reliable cessation technique has
profound consequences. Tobacco-related illnesses kill as many as
440,000 Americans every year, and thus the human and economic costs of
nicotine addiction are staggering. One out of every five U.S. deaths is
related to smoking.
Past Federal funding has enabled scientists to understand the
mechanisms of nicotine addiction, enabling them develop successful
treatments for smoking cessation. The discoveries that lead to these
findings started back in the 1970's, when scientists identified the
substance in the brain that nicotine acted on to transmit its
pleasurable effects. They found that nicotine was hijacking a receptor,
a protein used by the brain to transmit information. This receptor,
called the nicotinic acetylcholine receptor, regulates the release of
another key transmitter, dopamine, which in turn acts within reward
circuits of the brain to mediate both the positive sensations and
eventual addiction triggered by nicotine consumption. This knowledge
has been the basis for the development of several therapeutic
strategies for smoking cessation: nicotine replacement, drugs that
target nicotine receptors, as well as drugs that prevent the reuptake
of dopamine have all been shown to increase the long-term odds of
quitting by several fold.
More recently, using mice genetically modified to have their
nicotinic acetylcholine receptors contain one specific type of subunit,
scientists determined that some kinds of receptor subunits are more
sensitive to nicotine than others, and because each subunit is
generated from its own gene, this discovery indicated that genetics can
influence how vulnerable a person is to nicotine addiction. Further
research to spot genetic risk factors and to generate genetically
tailored treatment options is ongoing. Other studies are also testing
whether a vaccine that blocks nicotine's effects can help discourage
the habit. Since people who are able to quit smoking immediately lower
their risk for certain cancers, heart disease and stroke, reliable and
successful treatments are clearly needed. Today's continued research
funding can make it possible for these emerging therapies to ultimately
help people overcome the challenges of nicotine addiction.
Brain-machine interface
The brain is in constant communication with the body in order to
perform every minute motion from scratching an itch to walking.
Paralysis occurs when the link between the brain and a part of the body
is severed, and eliminates the control of movement and the perception
of feeling in that area. Almost 2 percent of the U.S. population is
affected by some sort of paralysis resulting from stroke, spinal cord
or brain injury as well as many other causes. Previous research has
focused on understanding the mechanisms by which the brain controls a
movement. Research during which scientists were able to record the
electrical communication of almost 50 nerve cells at once showed that
multiple brain cells work together to direct complex behaviors.
However, in order to use this information to restore motor function,
scientists needed a way to translate the signals that neurons give into
a language that an artificial device could understand and convert to
movement.
Basic science research in mice lead to the discovery that thinking
of a motion activated nerve cells in the same way that actually making
the movement would. Further studies showed that a monkey could learn to
control the activity of a neuron, indicating that people could learn to
control brain signals necessary for the operation of robotic devices.
Thanks to these successes, brain-controlled prosthetics are being
tested for human use. Surgical implants in the brain can guide a
machine to perform various motor tasks such as picking up a glass of
water. These advances, while small, are a huge improvement for people
suffering from paralysis. Scientists hope to eventually broaden the
abilities of such devises to include thought-controlled speech and
more. Further research is also needed to develop non-invasive
interfaces for human-machine communication, which would reduce the risk
of infection and tissue damage. Understanding how neurons control
movement has had and will continue to have profound implications for
victims of paralysis.
A common theme of both these examples of basic research success
stories is that they required the efforts of basic science researchers
discovering new knowledge, of physician scientists capable adapting
those discoveries into better treatments for their patients and of
companies willing to build on all of this knowledge to develop new
medications and devices.
The future of American science
Finally, as the subcommittee considers this year's funding levels
and in future years, I hope that the members will consider that
significant advancements in the biomedical sciences often come from
younger investigators who bring new insights and approaches to bear on
old or intractable problems. Without sustained investment, I fear that
flat or falling funding will begin to take a toll on the imagination,
energy and resilience of younger investigators and I wonder about the
impact of these events on the next generation. America's scientific
enterprise--and its global leadership--has been built over generations,
but without sustained investment, we could lose that leadership
quickly, and it will be difficult to rebuild. When we undermine a
research enterprise--whether a single lab or a national infrastructure
built through decades of Federal funding--it is a loss to us all and
difficult to recover. In the United States--traditionally a pacesetter
for strong investment--threatened cuts in science funding jeopardize a
global training system that fosters and encourages scientific
creativity, flexibility, and enterprise. As a young girl interested in
science, I was inspired by the idea that the United States was a place
where anyone with imagination, drive, and a passion for research could
come, learn, and potentially do something great. Without funding, that
culture of entrepreneurship and curiosity--driven research could be
hindered for decades.
Conclusion
We live at a time of extraordinary opportunity in neuroscience.
When I read an exciting research article, I get a sense of awe and
pride at the extraordinary progress in our field. A myriad of questions
once impossible to consider are now within reach as a consequence of
new technologies, an ever-expanding knowledge base, and a willingness
to embrace many disciplines.
As a result of NIH investments, the field of neuroscience research
holds great potential for making great progress to understand basic
biological principles and for addressing the numerous neurological and
psychiatric illnesses that strike more than 100 million Americans
annually. And we have entered an era in which knowledge of nerve cell
function has brought us to the threshold of a more profound
understanding of behavior and of the mysteries of the human mind.
However, continued progress can only be accomplished by a consistent
and reliable funding source.
An NIH appropriation of $35 billion for fiscal year 2012 and
sustained reliable growth is required to take the research to the next
level in order to improve the health of Americans and to maintain
American leadership in science worldwide. As a field we look forward to
realizing that goal. Thank you for this opportunity to testify.
______
Prepared Statement of the Society for Women's Health Research
The Society for Women's health Research (SWHR) and the Women's
Health Research Coalition (WHRC), is pleased to have the opportunity to
submit the following testimony in support of ongoing Federal funding
for biomedical research--specifically sex differences and total women's
health research--within the Department of Health and Human Services
(HHS) at the National Institutes of Health (NIH), Centers for Disease
Control and Prevention (CDC), and the Agency for Healthcare and
Research Quality (AHRQ).
SWHR and WHRC believe that sustained funding for biomedical and
women's health research programs conducted and supported across the
Federal agencies is absolutely essential if the United States is going
to meet the health needs of women and men. A well-designed and
appropriately funded Federal research agenda does more than avoid
dangerous and expensive ``trial and error'' medicine for patients--it
advances the Nation's research capability, continues growth in a sector
with proven return on investment, and takes a proactive approach to
maintaining America's position as world-wide leader in medical
research, education, and development.
SWHR and WHRC believe that sustained funding for biomedical and
women's health research programs conducted and supported across the
Federal agencies is absolutely essential if the United States is to
meet the health needs of women, and men, and advance the nation's
research capability.
As President Obama stated in his State of the Union Address,
investment in biomedical research ``will strengthen our security,
protect our planet, and create countless new jobs for our people''.
Proper investment in health research will save valuable dollars that
are currently wasted on inappropriate treatments and procedures.
Further, SWHR and WHRC want targeted research into sex differences that
will help in determining targeted treatments that will help women and
men to receive quality appropriate care.
National Institutes of Health
Past Congressional investment for the NIH positioned the United
States as the world's leader in biomedical research and has provided a
direct and significant impact on women's health research and the
careers of women scientists over the last decade. In recent years, that
investment has declined along with America's place as the Number 1 in
biomedical research. These two facts are interrelated. Cutting NIH
funding threatens scientific advancement, substantially delays cures
becoming available in the United States, and puts the innovative
research practices and reputation that America is known for in
jeopardy.
When faced with budget cuts, NIH is left with no other option but
to reduce the number of grants it is able to fund. The number of new
grants funded by NIH had dropped steadily with declining budgets,
growing at a percent less than that of inflation since fiscal year
2003. Cuts to investments in biomedical research also negatively impact
the economy. A shrinking pool of available grants has a significant
impact on scientists who depend upon NIH support to cover both salaries
and laboratory expenses to conduct high quality biomedical research,
putting both medical advancement and job creation at risk. More than 83
percent of NIH funding is spent in communities across the Nation,
creating jobs at more than 3,000 universities, medical schools,
teaching hospitals, and other research institutions in every State.
Reducing the number of grants available to researchers further
decreases publishing of new findings and decreases the number of
scientists gaining experience in research, both reducing a scientist's
likelihood of achieving tenure in a university setting. New and less
established researchers are forced to consider other careers, or take
positions outside the United States, and results in the loss of the
skilled bench scientists and researchers so desperately needed to
sustain America's cutting edge in biomedical research.
While the U.S. deficit requires careful consideration of all
funding and investments, cutting relatively small discretionary funding
within the NIH budget will not make a substantial impact on the
deficit, but will drastically hamper the ability of the United States
to remain the global leader in biomedical research. SWHR and WHRC
recommend that Congress set, at a minimum, a budget that matches the
administration's request for a $1 billion increase for NIH for fiscal
year 2012.
Study of Sex Differences
It has only been within the past decade that scientists have begun
to uncover the significant biological and physiological differences
between women and men and its impact health and medicine. Sex-based
biology, the study of biological and physiological differences between
women and men, has revolutionized the way that the scientific community
views the sexes. Sex differences play an important role in disease
susceptibility, prevalence, time of onset and severity and are evident
in cancer, obesity, heart disease, immune dysfunction, mental health
disorders, and many other illnesses. Medications can have different
effects in woman and men, based on sex specific differences in
absorption, distribution, metabolism and elimination. It is imperative
that research addressing these important differences be supported and
encouraged.
SWHR recommends that NIH, with the funds provided, report sex/
gender differences in all research findings. Further, NIH should seek
to expand its inclusion of women in basic, clinical and medical
research to Phase I, II, and III studies. By currently only mandating
sufficient female subjects in Phase III, researchers often miss out on
the chance to look for variability by sex in the early phases of
research, where scientists look at treatment safety and determine safe
and effective dose levels for new medications. By mandating that sex
differences research occur in earlier phases of clinical research
studies, the NIH can continue to serve as a role model for industry
research, as well as other nations. Only by gaining more information on
how therapies work in women will medicine be able to advance toward
more targeted and effective treatments for all patients, women and men
alike.
Office of Research on Women's Health
The NIH's Office of Research on Women's Health (ORWH) serves as the
focal point for coordinating women's health and sex differences
research at NIH, advising the NIH Director on matters relating to
research on women's health and sex differences research, strengthening
and enhancing research related to diseases, disorders, and conditions
that affect women; working to ensure that women are appropriately
represented in research studies supported by NIH; and developing
opportunities for and support of recruitment, retention, re-entry and
advancement of women in biomedical careers. In September 2010, ORWH
celebrated its 20th anniversary and unveiled a new strategic plan for
women's health and sex difference research, Moving Into The Future With
Dimensions and Strategies: A Vision For 2020 For Women's Health
Research.
BIRCWH and SCOR
The Building Interdisciplinary Research Careers in Women's Health
(BIRCWH) and Specialized Centers of Research on Sex and Gender Factors
Affecting Women's Health (SCOR) are two ORWH programs that benefit the
health of both women and men through sex and gender research,
interdisciplinary scientific collaboration, and provide tremendously
important support for young investigators in a mentored environment.
The BIRCWH program, created in 2000, is an innovative, trans-NIH
career development program that provides protected research time for
junior faculty by pairing them with senior investigators in an
interdisciplinary mentored environment. Each BIRCWH receives
approximately $500,000 a year, most from the ORWH budget. To date, 407
scholars have been trained in 41 centers, and 80 percent of those
scholars are female. The BIRCWH centers have produced over 1,300
publications, 750 abstracts, 200 NIH grants and 85 awards from industry
and institutional sources.
SCORs, established in 2003, are designed to increase innovative,
interdisciplinary research focusing on sex differences and major
medical problems that affect women through centers that facilitate
basic, clinical, and translational research. Each SCOR program results
in unique research and in 2010, resulted in over 150 published journal
articles, 214 abstracts and presentations and 44 other publications.
Additionally, ORWH has created several additional programs to
advance the science of sex differences research and research into
women's health. The Advancing Novel Science in Women's Health Research
(ANSWHR) program, created in 2007, promotes innovative new concepts and
interdisciplinary research in women's health research and sex/gender
differences. The Research Enhancement Awards Program (REAP) supports
meritorious research on women's health that otherwise would have missed
the IC pay line.
In addition to its funding of research on women's health and sex
differences research, ORWH has established several methods for
dissemination information about women's health and sex differences
research. ORWH created the Women's Health Resources web portal in
collaboration (http://www.womenshealthresources.nlm.nih.gov) with that
National Library of Medicine, to serve as a resource for researchers
and consumers on the latest topics in women's health and uses social
media to connect the public to health awareness campaigns.
To allow ORWH's programs and research grants to continue make their
impact on research and the public, Congress must direct that NIH
continue its support of ORWH and provide it with $1 million budget
increase, bringing its fiscal year 2012 total to $43.9 million.
Health and Human Services' Office of Women's Health
The HHS Office of Women's Health (OWH) is the Government's champion
and focal point for women's health issues. It works to redress
inequities in research, healthcare services, and education that have
historically placed the health of women at risk. Without OWH's actions,
the task of translating research into practice would be only more
difficult and delayed.
Under HHS, the agencies currently with offices, advisors or
coordinators for women's health or women's health research include the
Food and Drug Administration, Centers for Disease Control and
Prevention, Agency for Healthcare Quality and Research, Indian Health
Service, Substance Abuse and Mental Health Services Administration,
Health Resources and Services Administration, and Centers for Medicare
and Medicaid Services. It is imperative that these offices are funded
at levels which are adequate for them to perform their assigned
missions, and are sustainable so as to support needed changes in the
long term. We ask that the committee report reflect Congress's support
for these Federal women's health offices, and recommend that they are
appropriately funded on a permanent basis to ensure that these programs
can continue and be strengthened in the coming fiscal year.
It is only through consistent funding that the OWH will be able to
achieve its goals. The budgets for theses offices have been flat-lined
in recent years, which results in effectively a net decrease due to
inflation. Considering the impact of women's health programs from OWH
on the public, we urge Congress to provide an increase of $1 million
for the HHS OWH, a total $34.7 million requested for fiscal year 2012.
Centers for Disease Control and Prevention
SWHR supports the national and international work of the CDC,
especially the work of CDC's Office of Women's Health (OWH). While SWHR
is delighted that the CDC's OWH is now codified in statue, we are
concerned that proposed cuts to the CDC budget by the administration
will significantly jeopardize programs that benefit women, leaving them
with even fewer options for sound clinical information. Research and
clinical medicine are still catching up from decades of a male-centric
focus, and when diseases strike women, there remains a paucity of basic
knowledge on how diseases affect female biology, a lack of drugs that
have been adequately tested in women, and now even fewer options for
information through the many educational outreach programs of the CDC.
The OWH within CDC is fundamental to promoting and improving the
health, safety, and quality of life of women across their lifespan. The
office led the CDC in the collaboration and development of text4baby,
which sends free text messages on health and pregnancy issues, to
pregnant women and new moms. In the year since its launch, over 135,000
subscribers have signed up for the service and millions of text
messages have been sent. More than 300 outreach partners, including
national, State, business, academic, nonprofit, and other groups, help
to promote the service.
With its small budget, the OWH actively participated with others in
CDC, HHS, and the State Department in the early development of the
Global Health Initiative, and routinely collaborates with other
agencies to advance the knowledge and research into women's health
issues. This year, OWH worked closely with HHS OWH on the development
of the Action Agenda on Women's Health: Beyond 2010 and with NIH on the
development of the research conference on Advances in Uterine
Leiomyoma. SWHR and WHRC recommend that Congress provide the CDC OWH
with a 1.06 percent increase for fiscal year 2012, bringing their total
to $478,000.
Agency for Healthcare and Research Quality
The Agency for Healthcare Research and Quality's work serves as a
catalyst for change by promoting the results of research findings and
incorporating those findings into improvements in the delivery and
financing of healthcare. Through AHRQ's research projects, lives have
been saved. For example, it was AHRQ who first discovered that women
treated in emergency rooms are less likely to receive life-saving
medication for a heart attack. AHRQ funded the development of two
software tools, now standard features on hospital electrocardiograph
machines, which have improved diagnostic accuracy and dramatically
increased the timely use of ``clot-dissolving'' medications in women
having heart attacks. As efforts to improve the quality of care, not
just the quantity of care, progress, findings such as these coming out
of AHRQ reveal where relatively modest investments can offer
significant improvement to women's health outcomes, as well as a better
return on investment for scarce healthcare dollars.
While AHRQ has made great strides in women's health research, its
budget has been dismally funded for years, though targeted funding
increases in recent years for dedicated projects, including funds from
the American Recovery and Reinvestment Act (ARRA), moved AHRQ in the
right direction. ARRA funds more than doubled AHRQ's investment in
patient-centered research relevant to women. AHRQ is now supporting
studies that examining comparative effectiveness in diabetes and breast
cancer prevention in women, and comprehensive care for adults with
serious mental illness.
With the ARRA funds, total investment in women's health increased
from $52 million to $109 million, however, more core and sustained
funding is needed to help AHRQ continue doing the research that helps
patients and doctors make better medical decisions. Lack of investment
in AHRQ will hinder advancements that will improve medical
decisionmaking of doctors and patients and will result in improved
health outcomes. Any decreased level of funding seriously jeopardizes
the research and quality improvement programs that Congress mandates
from AHRQ.
SWHR and WHRC recommend Congress fund AHRQ at $405 million for
fiscal year 2012, an increase 2 percent over 2010 enacted levels. This
investment ensures that adequate resources are available for high
priority research, including women's healthcare, sex- and gender-based
analyses, and health disparities--valuable information that can help to
better personalize treatments, lower overall medical spending, and
improve outcomes for female and male patients nationwide.
In conclusion, Mr. Chairman, we thank you and this Committee for
its strong record of support for medical and health services research
and its commitment to the health of the Nation through its support of
peer-reviewed research. We look forward to continuing to work with you
to build a healthier future for all Americans.
______
Prepared Statement of the Spina Bifida Association
Background and Overview
On behalf of the estimated 166,000 individuals and their families
who are affected by all forms of Spina Bifida--the Nation's most
common, permanently disabling birth defect--Spina Bifida Association
(SBA) appreciates the opportunity to submit public written testimony
for the record regarding fiscal year 2012 funding for the National
Spina Bifida Program and other related Spina Bifida initiatives. SBA is
a national voluntary health agency, working on behalf of people with
Spina Bifida and their families through education, advocacy, research
and service. SBA stands ready to work with Members of Congress and
other stakeholders to ensure our Nation mounts and sustains a
comprehensive effort to reduce and prevent suffering from Spina Bifida.
Spina Bifida, a neural tube defect (NTD), occurs when the spinal
cord fails to close properly within the first few weeks of pregnancy
and most often before the mother knows that she is pregnant. Over the
course of the pregnancy--as the fetus grows--the spinal cord is exposed
to the amniotic fluid, which increasingly becomes toxic. It is believed
that the exposure of the spinal cord to the toxic amniotic fluid erodes
the spine and results in Spina Bifida. There are varying forms of Spina
Bifida occurring from mild--with little or no noticeable disability--to
severe--with limited movement and function. In addition, within each
different form of Spina Bifida the effects can vary widely.
Unfortunately, the most severe form of Spina Bifida occurs in 96
percent of children born with this birth defect.
The result of this NTD is that most people with it suffer from a
host of physical, psychological, and educational challenges--including
paralysis, developmental delay, numerous surgeries, and living with a
shunt in their skulls, which seeks to ameliorate their condition by
helping to relieve cranial pressure associated with spinal fluid that
does not flow properly. As we have testified previously, the good news
is that after decades of poor prognoses and short life expectancy,
children with Spina Bifida are now living into adulthood and
increasingly into their advanced years. These gains in longevity,
principally, are due to breakthroughs in research, combined with
improvements generally in healthcare and treatment. However, with this
extended life expectancy, our Nation and people with Spina Bifida now
face new challenges, such as transitioning from pediatric to adult
healthcare providers, education, job training, independent living,
healthcare for secondary conditions, and aging concerns, among others.
Individuals and families affected by Spina Bifida face many
challenges--physical, emotional, and financial. Fortunately, with the
creation of the National Spina Bifida Program in 2003, individuals and
families affected by Spina Bifida now have a national resource that
provides them with the support, information, and assistance they need
and deserve.
As is discussed below, the daily consumption of 400 micrograms of
folic acid by women of childbearing age, prior to becoming pregnant and
throughout the first trimester of pregnancy, can help reduce the
incidence of Spina Bifida, by up to 70 percent. The Centers for Disease
Control and Prevention (CDC) calculates that there are approximately
3,000 NTD births each year, of which an estimated 1,500 are Spina
Bifida, and, as such, with the aging of the Spina Bifida population and
a steady number of affected births annually, the Nation must take
additional steps to ensure that all individuals living with this
complex birth defect can live full, healthy, and productive lives.
Cost of Spina Bifida
It is important to note that the lifetime costs associated with a
typical case of Spina Bifida--including medical care, special
education, therapy services, and loss of earnings--are as much as $1
million. The total societal cost of Spina Bifida is estimated to exceed
$750 million per year, with just the Social Security Administration
payments to individuals with Spina Bifida exceeding $82 million per
year. Moreover, tens of millions of dollars are spent on medical care
paid for by the Medicaid and Medicare programs. Efforts to reduce and
prevent suffering from Spina Bifida will help to not only save money,
but will also save--and improve--lives.
Improving Quality-of-Life through the National Spina Bifida Program
Since 2001, SBA has worked with Members of Congress and staff at
the CDC to help improve our Nation's efforts to prevent Spina Bifida
and diminish suffering--and enhance quality-of-life--for those
currently living with this condition. With appropriate, affordable, and
high-quality medical, physical, and emotional care, most people born
with Spina Bifida will likely have a normal or near normal life
expectancy. The CDC's National Spina Bifida Program works on two
critical levels--to reduce and prevent Spina Bifida incidence and
morbidity and to improve quality-of-life for those living with Spina
Bifida.
The National Spina Bifida Program established the National Spina
Bifida Resource Center housed at the SBA, which provides information
and support to help ensure that individuals, families, and other
caregivers, such as health professionals, have the most up-to-date
information about effective interventions for the myriad primary and
secondary conditions associated with Spina Bifida. Among many other
activities, the program helps individuals with Spina Bifida and their
families learn how to treat and prevent secondary health problems, such
as bladder and bowel control difficulties, learning disabilities,
depression, latex allergies, obesity, skin breakdown, and social and
sexual issues. Children with Spina Bifida often have learning
disabilities and may have difficulty with paying attention, expressing
or understanding language, and grasping reading and math. All of these
problems can be treated or prevented, but only if those affected by
Spina Bifida--and their caregivers--are properly educated and given the
skills and information they need to maintain the highest level of
health and well-being possible. The National Spina Bifida Program's
secondary prevention activities represent a tangible quality-of-life
difference to the estimated 166,000 individuals living with all forms
of Spina Bifida, with the goal being living well with Spina Bifida.
An important resource to better determine best clinical practices
and the most cost effective treatments for Spina Bifida is the National
Spina Bifida Registry, now in its third year. Nine sites throughout the
Nation are collecting patient data, which supports the creation of
quality measures and will assist in improving clinical research that
will truly save lives, while also realizing a significant cost savings.
SBA understands that the Congress and the Nation face unprecedented
budgetary challenges. However, the progress being made by the National
Spina Bifida Program must be sustained to ensure that people with Spina
Bifida--over the course of their lifespan--have the support and access
to quality care they need and deserve. To that end, SBA respectfully
urges the Subcommittee to Congress allocate $6.25 million (level
funding) in fiscal year 2012 to the program, so it can continue and
expand its current scope of work; further develop the National Spina
Bifida Patient Registry; and sustain the National Spina Bifida Resource
Center. Sustaining funding for the National Spina Bifida Program will
help ensure that our Nation continues to mount a comprehensive effort
to prevent and reduce suffering from--and the costs of--Spina Bifida.
Preventing Spina Bifida
While the exact cause of Spina Bifida is unknown, over the last
decade, medical research has confirmed a link between a woman's folate
level before pregnancy and the occurrence of Spina Bifida. Sixty-five
million women of child-bearing age are at-risk of having a child born
with Spina Bifida. As mentioned above, the daily consumption of 400
micrograms of folic acid prior to becoming pregnant and throughout the
first trimester of pregnancy can help reduce the incidence of Spina
Bifida, by up to 70 percent. There are few public health challenges
that our nation can tackle and conquer by nearly three-fourths in such
a straightforward fashion. However, we must still be concerned with
addressing the 30 percent of Spina Bifida cases that cannot be
prevented by folic acid consumption, as well as ensuring that all women
of childbearing age--particularly those most at-risk for a Spina Bifida
pregnancy--consume adequate amounts of folic acid prior to becoming
pregnant.
Since 1968, the CDC has led the Nation in monitoring birth defects
and developmental disabilities, linking these health outcomes with
maternal and/or environmental factors that increase risk, and
identifying effective means of reducing such risks. The good news is
that progress has been made in convincing women of the importance of
folic acid consumption and the need to maintain a diet rich in folic
acid. This public health success should be celebrated, but still too
many women of childbearing age consume inadequate daily amounts of
folic acid prior to becoming pregnant, and too many pregnancies are
still affected by this devastating birth defect. The Nation's public
education campaign around folic acid consumption must be enhanced and
broadened to reach segments of the population that have yet to heed
this call--such an investment will help ensure that as many cases of
Spina Bifida can be prevented as possible.
The goal is to increase awareness of the benefits of folic acid,
particularly for those at elevated risk of having a baby with neural
tube defects (those who have Spina Bifida themselves, or those who have
already conceived a baby with Spina Bifida). With continued funding in
fiscal year 2012, CDC's folic acid awareness activities could be
expanded to reach the broader population in need of these public health
education, health promotion, and disease prevention messages. SBA
advocates that Congress provide adequate funding to CDC to allow for a
targeted public health education and awareness focus on at-risk
populations (e.g., Hispanic-Latino communities) and health
professionals who can help disseminate information about the importance
of folic acid consumption among women of childbearing age.
In addition to a $6.25 million fiscal year 2012 allocation for the
National Spina Bifida Program, SBA urges the Subcommittee to provide
$5.126 million for the CDC's national folic acid education and
promotion efforts to support the prevention of Spina Bifida and other
NTD; $26.342 million to strengthen the CDC's National Birth Defects
Prevention Network; and $144 million to fund the National Center on
Birth Defects and Developmental Disabilities.
Improving Health Care for Individuals with Spina Bifida
As you know, Agency for Health Research and Quality's (AHRQ)
mission is to improve the outcomes and quality of healthcare, reduce
healthcare costs, improve patient safety, decrease medical errors, and
broaden access to essential health services. AHRQ's work is vital to
the evaluation of new treatments, which helps ensure that individuals
living with Spina Bifida continue to receive state-of-the-art care and
interventions. To that end, we request a $405 million fiscal year 2012
allocation for AHRQ, to help improve quality of care and outcomes for
people with Spina Bifida.
Sustain and Seize Spina Bifida Research Opportunities
Our Nation has benefited immensely from our past Federal investment
in biomedical research at the NIH. SBA joins with other in the public
health and research community in advocating that NIH receive increased
funding in fiscal year 2012. This funding will support applied and
basic biomedical, psychosocial, educational, and rehabilitative
research to improve the understanding of the etiology, prevention, cure
and treatment of Spina Bifida and its related conditions. In addition,
SBA respectfully requests that the Subcommittee include the following
language in the report accompanying the fiscal year 2012 L-HHS
appropriations measure:
``The Committee encourages NIDDK, NICHD, and NINDS to study the
causes and care of the neurogenic bladder in order to improve the
quality of life of children and adults with Spina Bifida; to support
research to address issues related to the treatment and management of
Spina Bifida and associated secondary conditions, such as
hydrocephalus; and to invest in understanding the myriad co-morbid
conditions experienced by children with Spina Bifida, including those
associated with both paralysis and developmental delay.''
Conclusion
Please know that SBA stands ready to work with the Subcommittee and
other Members of Congress to advance policies and programs that will
reduce and prevent suffering from Spina Bifida. Again, we thank you for
the opportunity to present our views regarding fiscal year 2012 funding
for programs that will improve the quality-of-life for the estimated
166,000 Americans and their families living with all forms of Spina
Bifida.
______
Prepared Statement of The AIDS Institute
The AIDS Institute, a national public policy research, advocacy,
and education organization, is pleased to comment in support of
critical HIV/AIDS and Hepatitis programs as part of the fiscal year
2012 Labor, Health and Human Services, Education and Related Agencies
appropriation measure. We thank you for your past support of these
programs and hope you will do your best to adequately fund them in the
future in order to provide for and protect the public health.
HIV/AIDS
HIV/AIDS remains one of the world's worst health pandemics in
history. According to the CDC, over 617,000 people have died of AIDS in
the United States and there are 56,300 new infections each year. At the
end of 2007, an estimated 1.1 million people in the United States were
living with HIV/AIDS. Persons of minority races and ethnicities are
disproportionately affected. African Americans account for half of the
cases. HIV/AIDS disproportionately affects the poor and about 70
percent of those infected rely on publicly funded healthcare.
The vast majority of the discretionary programs supporting HIV/AIDS
efforts domestically are funded through your Subcommittee. The AIDS
Institute, working in coalition, has developed funding requests for
each of these programs. We ask that you do your best to adequately fund
them at the requested level.
We are keenly aware of budget constraints and competing interests
for limited dollars, but programs that prevent and treat HIV are
inherently Federal, as they help protect the public health against a
highly infectious virus, which if left untreated will most likely lead
to death and increased infections. Federal funding is particularly
critical at this time since State and local budgets are being severely
cut during the economic downturn.
National HIV/AIDS Strategy
President Obama released a comprehensive National HIV/AIDS Strategy
(NHAS) which seeks to reduce new HIV infections, increase access to
care and improving health outcomes for people living with HIV, and
reduce HIV-related health disparities. The Strategy sets ambitious
goals and seeks a more coordinated national response with a focus on
those communities most affected and on programs that work. In order to
attain the goals, additional investment will be needed and health
reform must be implemented.
The budget proposed by the President requests that up to 1 percent
of HHS discretionary funds appropriated for domestic HIV/AIDS
activities be provided to the Office of the Assistant Secretary for
Health to foster collaborations across HHS agencies and finance high
priority initiatives in support of the NHAS. Such initiatives would
focus on improving linkages between prevention and care, coordinating
Federal resources within targeted high-risk populations, enhancing
provider capacity, and monitoring key Strategy targets. The AIDS
Institute supports this provision and encourages you to include it in
the fiscal year 2012 appropriation measure.
Centers for Disease Control and Prevention--HIV Prevention and
Surveillance
Fiscal year 2011--$800.4 million
Fiscal year 2012 community request--$1,325.7 million
The United Staes allocates only about 4 percent of its domestic
HIV/AIDS spending on prevention. Investing in prevention today will
save money tomorrow. Preventing all the new 56,000 cases in just one
year would translate into an astounding $20 billion in lifetime medical
costs.
The CDC is focused on carrying out several goals of the NHAS by
2015. Specifically, they are seeking to lower the annual number of new
infections by 25 percent, reduce the HIV transmission rate by 30
percent, and increase from 79 to 90 the percentage of people living
with HIV who know their serostatus.
While it is estimated that an increase of over $500 million would
be needed to achieve the goals of the NHAS, The AIDS Institute supports
an increase of at least the $57.2 million over fiscal year 2011 as the
President has proposed, including $30.4 million from the Prevention and
Public Health Fund. We are also supportive of a transfer of $40 million
from the Chronic Disease Prevention and Public Health Promotion for HIV
school health programs to achieve closer coordination of CDC's HIV
prevention programs.
With this funding, the CDC would improve surveillance and use of
community viral load, enhance prevention among most affected
communities, integrate care and prevention, expand HIV testing and
linkage to care, build capacity, develop social marketing campaigns,
and improve monitoring.
Ryan White HIV/AIDS Programs
Fiscal year 2011--$2,336.7 million
Fiscal year 2012 community request--$2,687.0 million
The centerpiece of the Government's response to caring and treating
low-income people with HIV/AIDS is the Ryan White HIV/AIDS Program,
which currently serves over half a million low-income, uninsured, and
underinsured people. In fiscal year 2011, almost all parts of the
Program experienced funding cuts at a time of increased need and
demands on the program. Consider the following:
--Caseloads are increasing. People are living longer due to
lifesaving medications, there are over 56,000 new infections
each year, and increased testing programs identify thousands of
new people infected with HIV. With rising unemployment, people
are losing their employer-sponsored health coverage.
--State and local budgets are experiencing cutbacks due to the
economic downturn. A survey by the National Alliance of State
and Territorial AIDS Directors found that State funding
reductions totaled more than $170 million in 29 States during
fiscal year 2009.
--States are cutting and the Federal Government is proposing massive
cuts to Medicaid. As the payer of last resort cuts to
entitlement programs, such as Medicaid, place further pressure
on the Ryan White Program.
--There are significant numbers of people in the United States who
are not receiving life-saving AIDS medications. An IOM report
concluded that 233,069 people in the United States who know
their HIV status do not have continuous access to Highly Active
Antiretroviral Therapy.
Specifically, The AIDS Institute requests the following funding
levels for each part of the Program:
Part A provides medical care and vital support services for persons
living with HIV/AIDS in the metropolitan areas most affected by HIV/
AIDS. We request an increase of $74.2 million, for a total of $752
million.
Part B base provides essential services including diagnostic, viral
load testing and viral resistance monitoring, and HIV care to all 50
States, District of Columbia, Puerto Rico, and the territories. We are
requesting a $76.8 million increase, for a total of $495 million.
The AIDS Drug Assistance Program (ADAP) provides life-saving HIV
drug treatment to over 200,000 people, or about one in four HIV
positive people in care in the United States. The majority of whom are
people of color and very poor. ADAPs are experiencing unprecedented
growth and are in crisis. Over the course of 1 year, HRSA reported an
increase of over 30,000 new people to the program. Because of a lack of
funding, there are currently 8,100 people in 13 States on waiting
lists, thousands more have been removed from the program due to lowered
eligibility requirements, and drug formularies have been reduced.
According to NASTAD's recent annual ADAP monitoring report, State
funding for ADAPs increased 61 percent in fiscal year 2009 to a total
of $346 million, and drug company rebates grew 5 percent to $522
million. The Federal share of the overall ADAP budget has decreased to
less than 50 percent.
The AIDS Institute is very appreciative of the $50 million increase
to ADAP in fiscal year 2011, but it is far from what is currently
required to meet the growing number of new people needing ADAP
medications in the coming year. The true need is an increase of $360
million. The AIDS Institute requests that you provide an increase that
is as close as possible to that amount. We note the President has
requested an increase of $55 million, which would only provide
medications to fewer than 4,800 people.
Part C provides early medical intervention and other supportive
services to over 248,000 people at over 380 directly funded clinics. We
are requesting a $66.6 million increase, for a total of $272 million.
Part D provides care to over 84,000 women, children, youth, and
families living with and affected by HIV/AIDS. We are requesting a $5.8
million increase, for a total of $83.1 million.
Part F includes the AIDS Education and Training Centers (AETCs)
program and the Dental Reimbursement program. We are requesting a $15.4
million increase for the AETC program, for a total of $50 million, and
a $5.5 million increase for the Dental Reimbursement program, for a
total of $19 million.
National Institutes of Health--AIDS Research
Fiscal year 2011--$3.07 billion
Fiscal year 2012 community request--$3.5 billion
The NIH conducts research to better understand HIV and its
complicated mutations, discover new drug treatments, develop a vaccine
and other prevention programs such as microbicides, and ultimately
develop a cure. The critically important work performed by the NIH not
only benefits those in the United States, but the entire world. This
research has already helped in the development of many highly effective
new drug treatments, prolonging the lives of millions of people. NIH
also conducts the necessary behavioral research to learn how HIV can be
prevented best in various affected communities. We ask the Committee to
fund critical AIDS research at the community requested level of $3.5
billion.
Comprehensive Sexuality Education
Since the vast majority of HIV infection occurs through sex, age
appropriate education on how HIV is transmitted and HIV prevention is
critical. It is for this reason, The AIDS Institute is supportive of
funding the Teen Pregnancy Prevention Initiative for a total of $135
million and we oppose funding of abstinence only education programs,
which have proven not to be effective.
Minority AIDS Initiative
The AIDS Institute supports increased funding for the Minority AIDS
Initiative, which is funded by numerous Federal agencies to address the
disproportionate impact that HIV has on communities of color. For
fiscal year 2012, we are requesting a total of $610 million.
Policy Riders
The AIDS Institute is opposed to using the appropriations process
as a vehicle to repeal or prevent the implementation of current law or
ban funding for certain activities or organizations, such as the
Affordable Care Act and syringe exchange programs which are
scientifically proven to be effective in the prevention of HIV and
Hepatitis.
VIRAL HEPATITIS
The Institute of Medicine (IOM) report Hepatitis and Liver Cancer:
A National Strategy for Prevention and Control of Hepatitis B and C
outlines recommendations on how the incidence of Hepatitis B and C
infections can be decreased. They include increased public awareness
campaigns, heightened testing and vaccination programs, continued
research, along with improved surveillance. The Administration recently
announced the first ever national strategy to eliminate Viral
Hepatitis.
In fiscal year 2011, Congress funded CDC's Viral Hepatitis Division
at only $19.8 million. Given the huge impact that Hepatitis B and C
have on the health of so many people, and the large treatment costs,
and to begin to implement the IOM recommendations and the national
strategy, The AIDS Institute urges the Federal Government to make a
greater commitment to Hepatitis prevention. For fiscal year 2012, we
request a total of $59.8 million.
The AIDS Institute asks that you give great weight to our testimony
as you develop the fiscal year 2012 appropriation bill. Should you have
any questions or comments, feel free to contact Carl Schmid, Deputy
Executive Director, The AIDS Institute or [email protected].
Thank you very much.
______
Prepared Statement of The Endocrine Society
The Endocrine Society is pleased to submit the following testimony
regarding fiscal year 2012 Federal appropriations for biomedical
research, with an emphasis on appropriations for the National
Institutes of Health (NIH). The Endocrine Society is the world's
largest and most active professional organization of endocrinologists
representing more than 14,000 members worldwide. Our organization is
dedicated to promoting excellence in research, education, and clinical
practice in the field of endocrinology. The Society's membership
includes thousands of scientists and clinicians who receive Federal
support for their research and, in turn, contribute greatly to the
Nation's scientific and healthcare advances.
A half century of sustained investment by the United States Federal
Government in biomedical research has dramatically advanced the health
and improved the lives of the American people. The NIH specifically has
had a significant impact on the United State's global preeminence in
research and fostered the development of a biomedical research
enterprise that is unrivaled throughout the world. As the world's
largest supporter of biomedical research, the NIH competitively awards
extramural grants and supports in-house research. However, with the
continued decline in real dollars allocated to biomedical research each
year by the Federal Government, the opportunities to discover life-
changing cures and treatments have already begun to decrease.
Biomedical research funds allocated by the Federal government
support both basic and translational research, ensuring that the
discoveries made in the laboratory become realistic treatment options
for patients suffering from debilitating and life-threatening diseases.
Diabetes is a devastating condition that affects an increasingly large
number of Americans and requires a large proportion of the Nation's
healthcare spending. Almost 26 million people (8.3 percent of the U.S.
population) have diabetes, and the estimated cost of diabetes was $174
billion in 2007.\1\
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\1\ Centers for Disease Control and Prevention. National Diabetes
Fact Sheet, 2011.
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No new diabetes medications would have been developed without
federally supported basic and clinical research. The discovery of
insulin and the collaborative research effort of basic and clinical
scientists eventually led to the approval of a new class of medications
for diabetes, essentially the first new treatments of diabetes in the
past 80 years. Without the continued support of both basic and clinical
research in diabetes, these medications would have never been
developed. Now, with this broadened portfolio of treatments, it is
possible to help most people with diabetes achieve optimal blood sugar
control.
Beyond the multitude of health benefits that result from NIH-funded
research, national and local economies benefit from the dollars that
flow out of NIH into the communities. Researchers in all 50 States and
90 percent of congressional districts receive funding from NIH, and
these funds stimulate local economies through salaries and purchase of
equipment, laboratory supplies, and vendor services. For instance, for
each dollar of taxpayer investment, UCLA generates almost $15 in
economic activity, resulting in a $9.3 billion impact on the Los
Angeles region. The estimated economic impact of Baylor on the
surrounding community in Houston is more than $358 million, generating
more than 3,300 jobs.\2\ The governors of 25 States acknowledged the
economic impact that NIH-funded research has on their States in an
April 2010 letter to House and Senate Budget Committee members. The
letter states,
\2\ Federation of American Societies for Experimental Biology. NIH
Advocacy Slides: California, Texas.
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``During a time of recession, investment in biomedical research
makes sense because it leads to cures and treatments for debilitating
diseases while at the same time generating significant economic
activity for local communities throughout the country.''
The Endocrine Society remains deeply concerned about the future of
biomedical research in the United States without sustained support from
the Federal Government. The Society strongly supports the continued
increase in Federal funding for biomedical research in order to provide
the additional resources needed to enable American scientists to
address the burgeoning scientific opportunities and new health
challenges that continue to confront us. The Endocrine Society
recommends that NIH receive at least $35 billion in fiscal year 2012 to
ensure the steady and sustainable growth necessary to continue building
on the advances made by scientists and physicians during the past
decade.
______
Prepared Statement of The Humane Society of the United States
On behalf of The Humane Society of the United States (HSUS) and the
Humane Society Legislative Fund (HSLF), and our joint membership of
over 11 million supporters nationwide, we appreciate the opportunity to
provide testimony on our top NIH funding priorities for the Senate
Labor, Health and Human Services, Education and Related Agencies
Appropriations Subcommittee in fiscal year 2012.
BREEDING OF CHIMPANZEES FOR RESEARCH
The HSUS requests that no Federal funding be appropriated for the
breeding of chimpanzees for laboratory research. The basis of our
request is as follows:
--The National Center for Research Resources (NCRR) of the National
Institutes of Health (NIH), responsible for the oversight and
maintenance of federally owned and supported chimpanzees,
placed a moratorium on breeding federally owned and supported
chimpanzees in 1995, primarily due to the excessive costs of
lifetime care of chimpanzees in laboratory settings. NCRR
extended the moratorium indefinitely in 2007. As a result, none
of the 500 federally owned chimpanzees should have given birth
or sired infants since 1995.
--There is evidence, however, that at least one laboratory has used
millions of Federal dollars in recent years to support breeding
of government owned chimpanzees. There are major financial
implications to the Federal Government and taxpayers if this
breeding continues. Therefore, we seek to simply reinforce NIH
policy and ensure that no laboratory can use funding provided
by NIH or any other HHS agency for breeding of government-owned
or supported chimpanzees.
--According to records provided by the New Iberia Research Center
(NIRC) and the National Institutes of Health 123 infants were
born to a federally owned mother and/or federally owned father
at NIRC between 2000 and 2009.
--The cost of maintaining chimpanzees in laboratories is exorbitant,
up to $67 per day per chimpanzee; over $1,000,000 per
chimpanzee over an individual's approximately 60-year lifetime.
Breeding of additional chimpanzees into laboratories will only
perpetuate and increase the burdens on the government in
supporting and managing the chimpanzee research colony.
--The U.S. currently has a surplus of chimpanzees available for use
in research due to overzealous breeding for HIV research and
subsequent findings that they are a poor HIV model.\1\
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\1\ NRC (National Research Council) (1997) Chimpanzees in research:
strategies for their ethical care, management and use. National
Academies Press: Washington, D.C.
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--Expansion of the chimpanzee population in laboratories only creates
more concerns than presently exist about their quality of
care--an issue of great public concern.
Background and history
Beginning in 1995, the National Research Council (NRC) confirmed a
chimpanzee surplus and recommended a moratorium on breeding of
federally owned or supported chimpanzees,\1\ which includes nearly all
of the approximately 1,000 chimpanzees available for research in the
United States. On May 22, 2007 the NCRR of NIH indefinitely extended
its moratorium on breeding federally-owned and supported chimpanzees.
Further, it has also been noted that ``a huge number'' of chimpanzees
are not being used in active research protocols and are therefore
``just sitting there.'' \2\ If no breeding is allowed, it is projected
that the government will have almost no financial responsibility for
the chimpanzees it owns within 30 years due to the age of the
population--any breeding today will extend this financial burden to 60
years.
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\2\ Cohen, J. (2007) Biomedical Research: The Endangered Lab Chimp.
Science. 315:450-452.
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There is no justification for breeding of additional chimpanzees
for research; therefore lack of Federal funding for breeding will
ensure that no breeding of federally owned or supported chimpanzees for
research will occur in fiscal year 2012.
Concerns regarding chimpanzee care in laboratories
A nine month undercover investigation by The HSUS at University of
Louisiana at Lafayette New Iberia Research Center (NIRC)--the largest
chimpanzee laboratory in the world--revealed some chimpanzees living in
barren, isolated conditions and documented over 100 alleged violations
of the Animal Welfare Act at the facility regarding conditions for and
treatment of chimpanzees. The U.S. Department of Agriculture (USDA) and
NIH's Office of Laboratory Animal Welfare (OLAW) launched formal
investigations into the facility and NIRC paid an $18,000 stipulation
for violations of the Animal Welfare Act.
Aside from the HSUS investigation, inspections conducted by the
USDA demonstrate that basic chimpanzee standards are often not being
met. Inspection reports for other federally funded chimpanzee
facilities have reported violations of the Animal Welfare Act in recent
years, including the death of a chimpanzee during improper transport,
housing of chimpanzees in less than minimal space requirements,
inadequate environmental enhancement, and/or general disrepair of
facilities. These problems add further argument against the breeding of
even more chimpanzees into this system.
Chimpanzees have often been a poor model for human health research
The scientific community recognizes that chimpanzees are poor
models for HIV because chimpanzees do not develop AIDS even after being
infected with HIV. Similarly, chimpanzees do not model the course of
the human hepatitis C virus yet they continue to be used for this
research, adding to the millions of dollars already spent without a
sign of a promising vaccine. According to the chimpanzee genome, some
of the greatest differences between chimpanzees and humans relate to
the immune system, \3\ calling into question the validity of infectious
disease research using chimpanzees.
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\3\ The Chimpanzee Sequencing and Analysis Consortium/Mikkelsen,
TS, et al.,(1 September 2005) Initial sequence of the chimpanzee genome
and comparison with the human genome, Nature 437, 69-87.
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Ethical and public concerns about chimpanzee research
Chimpanzee research raises serious ethical issues, particularly
because of their extremely close similarities to humans in terms of
intelligence and emotions. Americans are clearly concerned about these
issues: 90 percent believe it is unacceptable to confine chimpanzees
individually in government-approved cages (as we documented during our
investigation at NIRC); 71 percent believe that chimpanzees who have
been in the laboratory for over 10 years should be sent to sanctuary
for retirement \4\; and 54 percent believe that it is unacceptable for
chimpanzees to ``undergo research which causes them to suffer for human
benefit.'' \5\
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\4\ 2006 poll conducted by the Humane Research Council for Project
Release & Restitution for Chimpanzees in laboratories.
\5\ 2001 poll conducted by Zogby International for the Chimpanzee
Collaboratory.
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We respectfully request the following bill or committee report
language:
``No funds made available in this Act, or any prior Act, may be
used for ``The Committee directs that no funds provided in this Act be
used to support the breeding of federally owned or federally supported
chimpanzees for research.''
We appreciate the opportunity to share our views for the Labor,
Health and Human Services, Education and Related Agencies
Appropriations Act for Fiscal Year 2012. We hope the Committee will be
able to accommodate this modest request that will save the government a
substantial sum of money, benefit chimpanzees, and allay some concerns
of the public at large. Thank you for your consideration.
HIGH THROUGHPUT SCREENING, TOXICITY PATHWAY PROFILING, AND BIOLOGICAL
INTERPRETATION OF FINDINGS--NATIONAL INSTITUTES OF HEALTH--OFFICE OF
THE DIRECTOR
In 2007, the National Research Council published its report titled
``Toxicity Testing in the 21st Century: A Vision and a Strategy.'' This
report catalyzed collaborative efforts across the research community to
focus on developing new, advanced molecular screening methods for use
in assessing potential adverse health effects of environmental agents.
It is widely recognized that the rapid emergence of omics technologies
and other advanced technologies offers great promise to transform
toxicology from a discipline largely based on observational outcomes
from animal tests as the basis for safety determinations to a
discipline that uses knowledge of biological pathways and molecular
modes of action to predict hazards and potential risks.
In 2008, NIH, NIEHS and EPA signed a memorandum of understanding
\6\ to collaborate with each other to identify and/or develop high
throughput screening assays that investigate ``toxicity pathways'' that
contribute to a variety of adverse health outcomes (e.g., from acute
oral toxicity to long-term effects like cancer). In addition, the MOU
recognized the necessity for these Federal research organizations to
work with ``acknowledged experts in different disciplines in the
international scientific community.'' Much progress has been made,
including FDA joining the MOU, but there is still a significant amount
of research, development and translational science needed to bring this
vision forward to where it can be used with confidence for safety
determinations by regulatory programs in the government and product
stewardship programs in the private sector. In particular, there is a
growing need to support research to develop the key science-based
interpretation tools which will accelerate using 21st century
approaches for predictive risk analysis. We believe the Office of the
Director at NIH can play a leadership role for the entire U.S.
Government by funding both extramural and intramural research.
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\6\ http://www.genome.gov/pages/newsroom/currentnewsreleases/
ntpncgcepamou121307finalv2.pdf.
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We respectfully request the following committee report language,
which is supported by The HSUS, HSLF, Procter & Gamble, and the
American Chemistry Council.
``The Committee supports the implementation of the National
Research Council's report ``Toxicity Testing in the 21st Century: A
Vision and a Strategy'' to create a new paradigm for chemical risk
assessment based on the incorporation of advanced molecular biological
and computational methods in lieu of animal toxicity tests within
integrated evaluation strategies, and urges the National Institutes of
Health to play a leading role by funding a coordinated, long-term
program of relevant intramural and extramural research. Current
activities at the NIH Chemical Genomics Center, National Institute of
Environmental Health Sciences, the Environmental Protection Agency and
the Food and Drug Administration show considerable potential and the
NIH Director should explore opportunities to augment this effort by
identifying additional resources that could be directed to priority
research projects. The Director shall report on the NIH funding of and
progress on these activities to the Committee commencing September 30,
2012 and annually thereafter.''
______
Prepared Statement of the University of Virginia Medical Center
Mr. Chairman and Members of the Subcommittee, thank you for the
opportunity to submit testimony on behalf of the University of Virginia
Medical Center. As members of this committee you have jurisdiction for
funding the agencies responsible for the delivery of healthcare in the
United States. As a healthcare provider in Virginia and a
representative of a major institution responsible for training the
healthcare providers of tomorrow, I want to use this opportunity to
discuss the vital importance of Federal funding for Graduate Medical
Education (GME) in the United States. I urge you to support an increase
in the number of appropriately trained physicians in the United States
while protecting the integrity and structure of the GME program.
Overview of the University of Virginia Health System
The University of Virginia Health System is an academic medical
center composed of the Hospital and its satellite facilities and
programs, the School of Medicine, School of Nursing, other allied
health programs, and faculty physicians. The University of Virginia
Health System plays a critical role in the Nation's healthcare
structure as well as the healthcare structure of Virginia. We have
multiple key missions: training the next generation of healthcare
workers, caring for the sickest patients and the underserved who have
nowhere to turn, providing innovative treatments with state-of-the-art
technology, and performing medical research. Our key missions are what
distinguish us from regular community hospitals.
The University of Virginia Medical Center and its Graduate Medical
Education training programs provide an essential bridge for medical
school graduates to become well-trained practicing physicians. At the
University of Virginia Medical Center, we continuously provide an
environment of excellence in which our trainees gain the necessary
experience to practice in their specialties in a setting that
emphasizes quality and patient safety.
Our training programs have been recognized by the Accreditation
Council for Graduate Medical Education for their compliance in meeting
the necessary training standards and for their innovative educational
techniques. We currently sponsor 68 accredited core specialty and
subspecialty training programs. All of our programs are fully
accredited, and many have been awarded the maximum accreditation cycle
length.
Our programs are well positioned to meet the growing national
workforce shortages in primary care (Family Medicine, Internal Medicine
including General Medicine, Obstetrics and Gynecology, Pediatrics, and
General Surgery), as well as in those specialties where workforce
shortages have been identified in the Commonwealth of Virginia
(Emergency Medicine, Child and Adolescent Psychiatry).
We have excellent training programs that are well-suited to train
physicians who will care for our aging population, including
Geriatrics, Palliative and Hospice Medicine, Orthopedic Surgery
(including Reconstructive Spine), Endocrinology (Diabetes, Obesity, and
Osteoporosis), Cardiology and Cardiothoracic Surgery, Oncology, and
Neurology (Alzheimer's Disease).
Funding of Graduate Medical Education
Training of future physicians is a core mission that distinguishes
academic medical centers and teaching hospitals like the University of
Virginia Medical Center from other healthcare institutions. Congress
has recognized the critical role that teaching hospitals play in the
training of America's physicians; however, this key endeavor is very
expensive. Consequently, Congress has agreed that teaching hospitals
should be paid for their increased patient care expenses as well as for
their costs associated with GME training programs. This is accomplished
through two mechanisms: Direct Graduate Medical Education (DGME)
payments and the Indirect Medical Education (IME) adjustment.
The Direct Graduate Medical Education payment (DGME) is a Medicare
payment intended to reimburse teaching hospitals directly for resident
stipends, the costs of teaching by attending physicians, the expenses
incurred with educational classrooms and the administrative costs of
the residency program office. Medicare DGME payments are based upon the
number of residents and the number of Medicare beneficiaries in the
hospital (i.e., it does not cover the entire cost of teaching to the
institution.) Currently UVa Medical Center is reimbursed under DGME for
approximately 38 percent of the cost of training each resident.
The Indirect Medical Education adjustment (IME) was created in 1983
by Congress. ``This adjustment is provided in light of doubts . . .
about the ability of the DRG case classification system to account
fully for factors such as severity of illness of patients requiring the
specialized services and treatment programs provided by teaching
institutions and the additional costs associated with the teaching of
residents . . . . The adjustment for indirect medical education costs
is only a proxy to account for a number of factors which may
legitimately increase costs in teaching hospitals.'' (House Ways and
Means Committee Report, No. 98-25, March 4, 1983 and Senate Finance
Committee Report, No. 98-23, March 11, 1983).
The IME adjustment is based on a complex formula that was
empirically determined to be related to the ratio of residents to beds
(IRB). The hospital's IME payment is determined by its individual
intern/resident-to-bed ratio in a formula established under the
Medicare statute. For every Medicare case paid, a teaching hospital
receives an additional IME payment, calculated as a percentage add-on
to the basic price per case. In 1983, payments added 11.59 percent to
each DRG amount for every 10 percent increase in the IRB. The IME
adjustment as originally calculated, in conjunction with DGME payments,
more satisfactorily reimbursed teaching hospitals for the cost of
training the next generation of doctors. However, the Balanced Budget
Act of 1997 (BBA) caused the IME adjustment to substantially decline.
Over time, Congress has periodically reduced the adjustment--by 30
percent since 1997--to the current 5.5 percent adjustment.
According to the American Association of Medical Colleges (AAMC),
the Medicare program annually provides about $3 billion in DGME
payments and $6 billion in IME payments to nearly 1,100 teaching
hospitals. While these payments represent less than 2 percent of total
Medicare payments, for teaching hospitals they are extremely important
in supporting the mission of training physicians. These payments
provide the backbone for our Nation's healthcare system, and they
ultimately contribute to better patient care by providing the support
necessary for excellent training programs.
The BBA also capped the number of resident slots that Medicare will
support. It limited the number of allopathic and osteopathic resident
physicians who may be counted for purpose of calculating IME and DGME
reimbursement to the number that the teaching hospital reported on its
1996 Medicare cost report. This cap is preventing academic medical
centers and teaching hospitals from expanding the number of residents
and fellows even while the Nation continues to suffer a physician
shortage. At a time when we should be producing more physicians,
especially in the key areas mentioned previously, this outdated rule is
thwarting our efforts.
The University of Virginia Medical Center trains more than 750
residents and fellows each year. It is significantly over its Medicare
limit or cap for training slots. For purposes of Direct Graduate
Medical Education, the University of Virginia's cap is 538 residents,
and it is 121 positions over its cap; for purposes of Indirect Graduate
Medical Education, the University of Virginia's cap is 508 residents,
and it is 131 positions over its cap. The cost of training a resident
is approximately $100,000 per year, thus, the University of Virginia
Medical Center is spending about $12,100,000 per year on resident
positions over the cap.
Graduate Medical Education training helps ensure that healthcare
delivery in the United States continues to be the highest quality. The
additional costs incurred at teaching hospitals for the training of
tomorrow's doctors are real and should be reimbursed at a level
commensurate with the expense. Without specific appropriate
reimbursement from Medicare, teaching hospitals will run deficit
budgets and be forced to cut the very programs that differentiate them
and allow them to provide the best and most innovative care.
Challenges Facing Graduate Medical Education
Recently, the National Commission on Fiscal Responsibility and
Reform recommended reducing the IME adjustment from 5.5 percent to 2.2
percent annually, which represents an approximate two-thirds cut in the
IME payment. The potential loss of approximately two-thirds support
from the Federal Government would severely compromise the ability of
the University of Virginia Medical Center, and other academic medical
centers, to fund this crucial educational mission. The estimated impact
of this reduction on the University of Virginia Medical Center is
approximately $26,700,000 per year.
Although we recognize the importance of a balanced Federal budget
and the need to control healthcare spending, reducing the funds
available for training future physicians will lead to a severe lack of
access to healthcare in the near future. This will occur at the very
time that hospitals are being asked to expand access to care.
For example, the Patient Protection and Affordable Care Act (i.e.,
the healthcare reform law) will provide health insurance coverage to 32
million more Americans; however, health insurance does not guarantee
timely access to care. There must be a well trained workforce to care
for the additional patients to ensure that implementation of the new
healthcare reform law is successful. Unfortunately, the United States
is already experiencing a shortage of physicians. As healthcare reform
is fully implemented and the population of the United States continues
to age, the shortage of physicians is expected to worsen. By 2020 the
demand for physicians will significantly outweigh the supply. According
to the AAMC's Center for Workforce Studies, by 2020 there will be a
shortage of 45,000 primary care physicians, and a shortage of 46,000
surgeons and medical specialists.
Only 700 Medicare-funded training slots were awarded during the
most recent reallocation authorized by the healthcare reform law. Most
teaching hospitals, including the University of Virginia, did not
receive any additional Medicare-funded residency slots. Unless the cap
is increased or lifted, it is expected that there will be more medical
school graduates than residency positions in the near future. Indeed,
in its April GME e-letter (http://www.ama-assn.org/resources/doc/med-
ed-products/gmee-04-2011.pdf) the American Medical Association stated
that we may have already reached the point where U.S. medical school
graduates are not able to find a residency position because there are
now more graduates than available GME slots.
Specifically, the University of Virginia School of Medicine, along
with dozens of medical schools nationally, has increased class size to
meet the needs of the impending workforce shortages. However, medical
students looking to join a residency program have begun to face a
significant bottleneck after graduation. While institutions like the
University of Virginia are graduating exceptional medical students, the
University of Virginia Medical Center can only accept a finite number
Medicare-funded residency positions due to the cap. Thus, the shortage
of open residency positions for medical students creates another
barrier to the supply of well-trained physicians.
To address the severe doctor shortage crisis facing the United
States and to ensure that there is a well-trained healthcare workforce
to successfully care and treat the increasing number of patients in the
future, it is critical that Congress support Graduate Medical Education
by increasing the number of resident slots available for medical
students, and continue to invest in Graduate Medical Education. I
respectfully request that this committee do everything within its
jurisdiction to achieve these important goals.
______
Prepared Statement of the Tri-Council for Nursing
The Tri-Council for Nursing, comprised of the American Association
of Colleges of Nursing, the American Nurses Association, the American
Organization of Nurse Executives, and the National League for Nursing,
respectfully request $313.075 for the Nursing Workforce Development
programs authorized under Title VIII of the Public Health Service Act
(42 U.S.C. 296 et seq.) in fiscal year 2012. This is the amount
requested in the recommended funding levels for the President's fiscal
year 2012 budget.
The Tri-Council is a long-standing nursing alliance focused on
leadership and excellence in the nursing profession. This marks the
13th year of the nurse and nurse faculty shortages which have eroded
the ability of the nursing profession to provide the highest quality of
care that all patients rightfully desire and morally deserve. As the
Nation looks toward restructuring the healthcare system by focusing on
expanding access, decreasing cost, and improving quality, a significant
investment must be made in strengthening the nursing workforce, a
profession which The U.S. Bureau of Labor Statistics expects a 22
percent growth in employment through 2018.
______
Prepared Statement of the United Negro College Fund
Mr. Chairman and distinguished Members of the subcommittee, I am
Dr. Michael L. Lomax, President and CEO of UNCF--the United Negro
College Fund. I want to thank you for allowing me to submit funding
recommendations and priorities relevant to the fiscal year 12 Labor-
HHS-Education Appropriations bill.
Statistically, HBCUs graduate a preponderant share of all black
Americans receiving postsecondary degrees. While comprising only 3
percent of the Nation's 4,197 institutions of higher learning, the 106
HBCUs are responsible for producing approximately 25 percent of all
bachelor's degrees, 10 percent of all master's degrees and 26 percent
of all first professional degrees earned by African Americans annually.
UNCF institutions are a critical component and significant subset
of the larger community of HBCUs. Specifically, UNCF is the national
fundraising and advocacy representative for 38 private historically
black colleges and universities. There are more than 350,000 persons
who are counted as alumni of UNCF member colleges and universities. Our
alumni include persons such as Rev. Dr. Martin Luther King, Jr., Brown
University President Dr. Ruth Simmons, three former surgeon generals,
numerous current Members of Congress and a host of noted authors,
poets, attorneys, professors and philanthropists.
UNCF--the Nation's oldest and most successful minority higher
education assistance organization--fulfills its primary goal by
increasing opportunities for access to higher education. During its 66-
year existence, UNCF has raised more than $3 billion to support its
historically black college and university member institutions and
administered nearly 400 programs, including scholarships, mentoring
programs, summer enrichment, study abroad, curriculum, faculty, and
leadership development. Today, UNCF supports more than 65,000 students
at over 900 colleges and universities across the country.
We recognize that working with the Administration and Congress will
continue to be particularly challenging in a budget-constrained
environment where more diverse students with unique academic and
familial circumstances are dependent upon need-based aid. The face of
our Nation is changing and nowhere is the change more evident than in
education. Compared with the last century, we are increasingly changing
with more of us being born in other nations, speaking other languages
and carrying different cultures. Minority
populations are growing more quickly than the U.S. population as a
whole. In keeping with this, UNCF continues to endorse the following
policies and positions as the focal point of its legislative agenda for
fiscal year 2012. These recommendations continue a basic commitment to
enrolling, nurturing, and graduating students, some of whom lack the
social, educational, and financial advantages of other college bound
populations. This agenda reflects what is needed to level the playing
field for both UNCF member schools and students as we continue to
pursue educational excellence.
The following fiscal year 2012 programs are of particular relevance
and importance to UNCF.
Title III, Part B, Strengthening Historically Black Colleges and
Universities--$267 million (Section 323)
Because of its flexibility, this program is the fundamental source
of institutional assistance for HBCUs and is used to support strategic
planning initiatives, academic enhancements, administrative and fiscal
management, student services, physical plant improvements, and general
institutional development.
The current level of funding to Title III, Part B must be
maintained in order to continue to enhance and sustain the quality of
HBCUs, and to meet the national challenges associated with global
competitiveness, job creation and changing demographics. For fiscal
year 2012, UNCF requests $267 million to support Section 323.
Title III, Part D, HBCU Capital Financing Program--a minimum of $20.58
million, plus increase the statutory cap to at least $1.7
billion. Bill language is needed to make funding available to
institutions that have a need but fall into a category that has
exhausted resources within the current cap of $1.1 billion.
Funded through Title III, Part D of the Higher Education Act, the
HBCU Capital Financing Program is intended to provide low-interest
capital financing loans to historically disadvantaged institutions
throughout the HBCU community. In light of economic hardships and
challenges confronting several of our member institutions, UNCF has
worked with national stakeholders, officials at the Department of
Education, and Congressional leadership to propose a comprehensive
revision of the capital financing provisions.
For fiscal year 2012, UNCF requests at least $20.58 million to
allow the Secretary to support the administration of additional loans
through the Capital Financing Program. Further, we request the
assistance of Federal leaders in working with the HBCU Capital
Financing Board to ensure that recommendations made to Congress will
promote increased participation within the program among all eligible
institutions.
The Hawkins Centers of Excellence Program--$40 million
Under this budget proposal, the Administration proposes giving
grants to minority-serving institutions to prepare teachers by
providing extensive training, creating a system for tracking program
graduates and raising exit standards. The Centers are named after the
recently deceased Augustus F. Hawkins in honor of his historic
leadership as a champion for expanding education as well as job
opportunity.
For fiscal year 2012, UNCF requests $40 million to implement the
Hawkins Centers of Excellence Program. This program would help expand
the pool of effective minority teachers thus working to close the
achievement gap for minority students.
Pell Grants Program--$5,550 (current maximum reward)
This program assists so many deserving students in getting into
college. As college costs increase, the amount of jobs available to
solely high school graduates is rapidly decreasing. It is imperative to
preserve the maximum award of $5,550 and continue to fund Pell at the
appropriate level. The budget would call for a cut of $100 billion in
Pell grants over 10 years, paid for by eliminating the ``Two Pell''
benefits and the in-school interest subsidy for graduate and
professional student loans.
For fiscal year 2012, UNCF requests the current maximum awards of
$5,550 to continue the support of the Pell Grants Program. Maintaining
the maximum Pell award is critical to ensure that the growing pool of
first generation and low income college students are provided much
needed financial support to access higher education and minimize the
burden of costly education loans.
UNCF and our member schools have, among them, many years of
experience in making the dream of a college education a reality for
low-income students and the colleges they attend. My staff and I, as
well as the presidents of our member schools, stand ready to continue
to work closely with your committee to formulate and craft a plan that
will work for all the young people who are seek and deserve college
education.
______
Prepared Statement of the United Network for Organ Sharing
Highlighting the urgent need to address the ever-growing waiting
list for organs for transplantation and the number of people that die
every day just waiting for an organ, by strengthening programs at HRSA,
the National Institutes of Health and within the Office of the
Secretary.
Mr. Chairman and Members of the Subcommittee, thank you for giving
the United Network for Organ Sharing (UNOS) the opportunity to provide
testimony as the Subcommittee begins to consider funding priorities for
fiscal year 2012. My name is Mary Ellison and I am the Acting Executive
Director of UNOS, the organization with the Federal contract to
coordinate the Nation's organ transplant system, providing vital
services to meet the needs of men, women and children awaiting
lifesaving organ transplants. Based in Richmond, Virginia, UNOS is a
private, nonprofit membership organization. UNOS members encompass
every transplant hospital, tissue matching laboratory and organ
procurement organization in the United States, as well as voluntary
health and professional societies, ethicists, transplant patients and
organ donor advocates.
Transplantation has saved and enhanced the lives of more than
450,000 people in the United States. It is the leading form of
treatment for many forms of end-stage organ failure. With this success,
however, has come increasing demand for donated organs. Living donation
(transplanting all or part of an organ from a living person) has
increased dramatically in the last few years, helping increase the
number of transplants performed. In addition, UNOS has enacted a number
of policies to encourage more efficient use of available organs, such
as ``splitting'' livers from deceased donors to allow two recipients to
be transplanted. The only long-term solution to the organ shortage,
however, is for more people to agree to become organ donors. UNOS works
closely with medical professionals to increase their understanding and
support of the organ donation process.
Mr. Chairman, as you know the primary Federal agency with
jurisdiction over organ transplantation issues is the Health Resources
Services Administration. However, as we will describe below, the Office
of the Secretary and NIH also have important roles to play to help
people in need of an organ transplant.
Health Resources Services Administration
Even with advances in the use of living liver donors, the increase
in the demand for organs needed for transplantation will continue to
exceed the number available. The need to increase the rate of organ
donation is critical. On April 11, 2011 there were 110,676 men, women
and children on the national transplantation waiting list. Last year an
average of 74 patients were transplanted each day; however a daily
average of 18 patients died because the organ they needed did not
become available in time to save them. HRSA's Division of
Transplantation has a proven track record of successfully increasing
the rate of organ donation with limited resources.
Recognizing the importance of this issue, Congress passed, and the
President signed, the Organ Donation and Recovery Improvement Act of
2004 (Public Law 108-216) authorizing an increase of $25 million for
organ donation activities in the first year, and such sums as necessary
in following years, and yet, it was only last year that additional
funding of $1 million has been provided to implement this legislation.
To address these needs, UNOS recommends that the Division of
Transplantation receive a $2 million increase in fiscal year 2012, to
allow the Division to more aggressively pursue program efforts to
increase the supply of organs available for transplantation.
In addition, the shortage of organs for donation can be positively
impacted by healthcare professionals, particularly physicians, nurse,
and physician assistants that are frequently the first to identify and
refer a potential donor. These professionals also have an established
relationship with the family members that weigh the option to donate
their loved one's organs. In order to improve the knowledge and skills
of the several key health professions, UNOS requests funding to develop
curriculum and continuing medical education programs for targeted
health professions. To launch a new 5 year effort to improve the
competency of health professionals to help meet the goal of increasing
the number or organs available for transplantation $450,000 is
requested for the United Network for Organ Sharing (UNOS) to be made
available from within the base funding of the Division of Health
Professions based on the authority provided in Section 765 of Title VII
to improve the workforce.
Office of the Secretary
On March 3, 2008 the Department published a request for information
in the Federal Register to gather information to assist the Department
to determine whether it should engage in a rulemaking with respect to
vascularized composite allografts (VCAs). Three years later, the
Department still has not finalized this decision. As it currently
stands, the Food and Drug Administration has jurisdiction over VCA
transplants, as they are currently defined as human tissue. However, as
the numbers of these transplants are growing, finalizing the decisions
associated with this issue and allowing HRSA's Division of
Transplantation to have jurisdiction over VCA's will permit this
category of transplants to benefit from the policy oversight and
expertise of the Organ Procurement Transplant Network (OPTN).
Worldwide there have been more than two dozen limb transplants, a
growing number of transplants of portions of the face, and a small
number of transplants of other anatomical parts. Although the body
parts vary significantly, they share important common characteristics
with organ transplantation. As with organs, the VCA graft is subject to
damage or death from the lack of blood flow and the need for
revascularization is done through a surgical reconnection of blood
vessels. Additionally, all the expertise and skills of healthcare
professional trained to work with families, individuals and hospitals
in the organ donation and procurement process are also needed in the
donation and procurement of VCAs. All of these vital activities are
already performed and overseen by the organ transplant community.
Further, for 25 years the OPTN has overseen the processes and crafted
policies to regulate them under Federal contract. It therefore seems
logical, efficient and will serve the best interests of patients and
the Nation's transplant system to bring VCAs under the umbrella of the
OPTN.
UNOS urges the Office of the Secretary to take action on this
decision, and issue the rule and begin the necessary process of
amending the definition of human organs. This is especially critical
given the recent activities of private entities that, lacking Federal
leadership, have begun taking the necessary steps to form registries
for VCAs. As we learned over 20 years ago when the OPTN was
established, it is crucial to have Government oversight over registries
such as this in order to establish fair and ethical distribution of
body parts.
National Institutes of Health
Mr. Chairman, as you know, the National Institute of Allergy and
Infectious Diseases has jurisdiction over transplantation research at
the NIH. Recent research funded by NIAID has resulted in the
development of desensitization protocols related to kidney
transplantation that have shown remarkable progress in helping allow
the most vulnerable of patients live with a transplant. Up to 30
percent of the people on the renal transplant waiting list--without
special intervention--will likely never have the chance to receive a
transplant due to an inability to find a compatible donor. These
patients have become ``sensitized'' to human antigens (HLA) through
pregnancy, transfusions, or prior transplants and therefore must wait
significantly longer for a compatible donor. This added time on the
wait list directly increases both their disease-related complications
and mortality.
To improve access to transplantation for most these broadly
sensitized patients, desensitization protocols have evolved to decrease
the breadth and strength of their antibodies. Survival rates are
excellent, equaling or exceeding the rates for kidney transplantation
generally. It is reasonable to estimate that if these protocols were
confirmed to be as safe and effective as early peer reviewed data has
suggested, a large number of these long-suffering people could be
successfully transplanted and removed from the waiting list each year.
UNOS recommends that NIAID support a multi-center initiative with a
companion data collection and analysis center to facilitate the use of
this protocol at an increasing number of transplant centers across the
country.
Summary and Conclusion
Mr. Chairman, again we wish to thank the Subcommittee for the
opportunity to submit testimony and for your leadership in these
difficult times. While UNOS recognizes the demands on our Nation's
resources, we believe the ever-growing waiting list for organs for
transplantation, and the number of people that die every day just
waiting for an organ, continue to justify higher funding levels for
HRSA's Division of Transplantation.
In conclusion, we specifically request the following for fiscal
year 2012:
--A $2 million increase for HRSA's Division of Transplantation;
--$450,000 from within the base funding of the Division of Health
Professions to develop curriculum and continuing medical
education programs for targeted health professions;
--Report language urging the Office of the Secretary to finalize a
decision to amend the definition of human organs to include
vascularized composite allografts, and allow this category to
come under the umbrella of the OPTN; and
--Report language within the National Institute of Allergy and
Infectious Disease to support a multi-center initiative focused
on ``desensitizing ``patients previously found incompatible
with most human organs.
______
Prepared Statement of the United Tribes Technical College
For 42 years, United Tribes Technical College (UTTC) has provided
postsecondary career and technical education, job training and family
services to some of the most impoverished, high risk Indian students
from throughout the Nation. We are governed by the five tribes located
wholly or in part in North Dakota. We are not part of the North Dakota
State college system and do not have a tax base or State-appropriated
funds on which to rely. We have consistently had excellent retention
and placement rates and are a fully accredited institution. Section 117
Carl Perkins Act funds represent about half of our operating budget and
provide for our core instructional programs. The requests of the United
Tribes Technical College Board for fiscal year 2012 is for the
following authorized Department of Education programs:
--$10 million for base funding authorized under Section 117 of the
Carl Perkins Act for the Tribally Controlled Postsecondary
Career and Technical Institutions program (20 U.S.C. Section
2327). This is $1.8 million above the fiscal year 2010 level
and the President's requests for fiscal years 2011 and 2012.
These funds are awarded competitively and are distributed via
formula.
--$30 million as requested by the American Indian Higher Education
Consortium for Title III-A (Section 316) of the Higher
Education Act (Strengthening Institutions program).
--Maintain Pell Grants at the $5,550 maximum award level.
AUTHORIZATION
United Tribes Technical College began operations in 1969. We
realized that in order to more effectively address the unique needs of
Indian people to acquire the academic knowledge and skills necessary to
enter the workforce we needed to expand our curricula and services. We
were scraping by with small amounts of money from the Bureau of Indian
Affairs, and so decided to work for an authorization in the Department
of Education. That came about in 1990 when the Carl Perkins Act was
reauthorized and it included specific authorization for what is now
called the Tribally Controlled Postsecondary Career and Technical
Institutions program (Section 117). The Perkins Act has been
reauthorized twice since then--in 1998 and in 2006, with Congress each
time continuing the Section 117 Perkins program.
Some Important Facts About United Tribes Technical College.--We
have:
--A dedication to providing an educational setting that takes a
holistic approach toward the full spectrum of student needs--
educational, cultural, necessary life skills--thus enhancing
chances for success.
--Services including campus security, a Child Development Center, a
family literacy program, a wellness center, area
transportation, a K-8 elementary school, tutoring, counseling,
and family and single student housing.
--A semester completion rate of 80-90 percent.
--A graduate placement rate of 94 percent (placement into jobs and
higher education).
--A projected return on Federal investment of 20-1 (2005 study).
--Highest level of accreditation from the North Central Association
of Colleges and Schools.
--Over 30 percent of our graduates move on to 4-year or advanced
degree institutions.
--A student body representing 87 tribes who come mostly from high-
poverty, high unemployment tribal nations in the Great Plains;
many students have children or dependents.
--81 percent of undergraduate students receive Pell Grants, the
highest percentage of Pell Grant recipients of any North Dakota
college.
--21 2-year degree programs, eight 1-year certificates, and 3
bachelor degree programs pending final accreditation this
spring.
--An expanding curricula to meet job-training needs for growing
fields including law enforcement, energy auditing and health
information management. We have also broadened our online
program offerings.
--A critical role in the regional economy. Our presence brings $31.8
million annually to the economy of the Bismarck region.
--A workforce of over 300 people.
--An award-winning annual powwow which last year had participants
from 70+ tribes, featuring over 1,500 dancers and drummers, and
drawing over 20,000 spectators. We annually feature indigenous
dance groups from other countries.
FUNDING REQUESTS
Section 117 Perkins Base Funding.--Funds requested under Section
117 of the Perkins Act above the fiscal year 2010 level are needed to:
(1) maintain 100 year-old education buildings and 50 year-old housing
stock for students; (2) upgrade technology capabilities; (3) provide
adequate salaries for faculty and staff (who have not received a cost
of living increase for the past 2 years and who are in the bottom
quartile of salary for comparable positions elsewhere); and (4) fund
program and curriculum improvements, including at least three 4-year
degree programs.
Acquisition of additional base funding is critical as UTTC has more
than tripled its number of students within the past 8 years while
actual base funding, including Interior Department funding, have not
increased commensurately (increased from $6 million to $8 million for
the two programs combined). Our Perkins funding provides a base level
of support while allowing the college to compete for desperately needed
discretionary contracts and grants leading to additional resources
annually for the college's programs and support services.
Title III-A (Section 316) Strengthening Institutions.--We support
Title III-A funding for tribal colleges. Among its statutorily
allowable uses is facility construction and maintenance. We are
constantly in need of additional student housing, including family
housing. We work hard to cobble together various sources for housing
construction. We would like to educate more students but lack of
housing has at times limited the admission of new students. With the
completion this past year of a new Science and Math building on our
South Campus on land acquired with a private grant, we urgently need
housing for up to 150 students, many of whom have families. New housing
on the South Campus could also accommodate those persons we expect to
enroll in a new police training program.
While UTTC has constructed three housing facilities using a variety
of sources in the past 20 years, approximately 50 percent of students
are housed in the 100-year-old buildings of the old Fort Abraham
Lincoln, as well as in duplexes and single family dwellings that were
donated to UTTC by the Federal Government along with the land and Fort
buildings in 1973. These buildings require major rehabilitation. New
buildings for housing are actually cheaper than trying to rehabilitate
the old buildings that now house students.
Pell Grants.--We support maintaining the Pell Grant maximum amount
to at least a level of $5,550. As mentioned above, 81 percent of our
students are Pell Grant-eligible. This program makes all the difference
in the world of whether these students can attend college. We also
support the continuation of appropriations to fund two scheduled award
years per year, as this has helped many of our students shorten the
time to obtain their degrees.
GOVERNMENT ACCOUNTABILITY OFFICE REPORT
As you know, the Government Accountability Office (GAO) in March of
this year issued two reports regarding Federal programs which may have
similar or overlapping services or objectives (GAO-11-318SP of March 1
and GAO-11-474R of March 18). Funding from the Bureau of Indian
Education (BIE) and the Department of Education's Perkins Act for
Tribally Controlled Postsecondary Career and Technical Institutions
were among the programs listed in the supplemental report of March 18.
The GAO did not recommend defunding these or other programs; in some
cases consolidation or better coordination of programs was recommended
to save administrative costs. We are not in disagreement about possible
consolidation or coordination of the administration of these funding
sources so long as funds are not reduced.
Perkins funds represent about 46 percent of UTTC's core operating
budget. The Perkins funds supplement, but do not duplicate, the BIE
funds. It takes both sources of funding to frugally maintain the
institution. In fact, even these combined sources do not provide the
resources necessary to operate and maintain the college. Therefore,
UTTC actively seeks alternative funding to assist with academic
programming, deferred maintenance of its physical plant and scholarship
assistance, among other things.
Second, as mentioned, UTTC and other tribally chartered colleges
are not part of State educational systems and do not receive State-
appropriated general operational funds for their Indian students. The
need for postsecondary career and technical education in Indian Country
is so great and the funding so small, that there is little chance for
duplicative funding.
There are only two institutions targeting American Indian/Alaska
Native career and technical education and training at the postsecondary
level--United Tribes Technical College and Navajo Technical College.
Combined, these institutions received less than $15 million in fiscal
year 2010 Federal funds ($8 million from Perkins; $7 million from the
BIE). That is not an excessive amount of money for two campus-based
institutions which offer a broad (and expanding) array of programs
geared toward the educational and cultural needs of their students and
toward job-producing skills.
UTTC offers services that are catered to the needs of our students,
many of whom are first generation college attendees and many of whom
come to us needing remedial education and services to address the
sociobehavioral, socioeconomic, and academic characteristics that pose
problems. Our students disproportionately possess more high risk
characteristics than other student populations. We also provide
services for the children and dependents of our students. Although BIE
and Section 117 funds do not pay for remedial education services, UTTC
must make this investment with our student population through other
sources of funding to ensure they succeed at the postsecondary level.
Federal funding for American Indian/Alaska Native employment and
training is barely 1 percent of the annual Federal employment and
training budget but has an enormous impact on the people and
communities it serves.
Perkins funds are central to the viability of our core
postsecondary educational programs. Very little of the other funds we
receive may be used for core career and technical educational programs;
they are competitive, often one-time supplemental funds which help us
provide the services our students need to be successful. We cannot
continue operating without Carl Perkins funds. Thank you for your
consideration of our requests.
______
Prepared Statement of the U.S. Hereditary Angioedema Association
Thank you for the opportunity to present the views of the U.S.
Hereditary Angeioedema Association (USHAEA) regarding the importance of
hereditary angioedema (HAE) research.
USHAEA was founded in 1999 with the express purpose of helping
those living with HAE and their families to live healthy lives, provide
support, and find a cure. The Association provides patient services to
those living with HAE, including referrals to knowledgeable healthcare
providers and information on the disease. USHAEA also provides research
funding to scientific investigators to increase the knowledge base on
HAE. Additionally, USHAEA also provides research materials and forums
to educate the patients and their families, healthcare providers, and
the general public on HAE. Finally, USHAEA acts as a voice for those
living with HAE to the world at large.
HAE is caused by a genetic defect which controls C1-Inhibitor blood
protein, causing an inability to regulate complex biochemical
interactions in blood-based systems involved in disease fighting,
inflammatory response, and coagulation. Episodes of HAE are
characterized by swelling in the body including the hands, feet,
gastrointestinal tract, face, and airway. During an episode, HAE
patients experience abdominal pain, nausea, vomiting, and airway
swelling, which can lead to asphyxiation. Episodes are often caused by
infections, minor injuries or dental procedures, emotional or mental
stress, and certain hormonal or blood medications. HAE impacts
approximately 1 in 10,000 to 1 in 50,000, making proper diagnosis
difficult. Many of the initial HAE episodes occur in children and
adolescents. In families were one parent has HAE, there is a 50 percent
probability that their children will inherit this condition. HAE has an
annual cost which can exceed $500,000 per year per patient in addition
to the human and economic burdens associated with the disease.
Research Through the National Institutes of Health
In years past, HAE research was conducted at the National
Institutes of Health (NIH) through the National Institute of Allergy
and Infectious Diseases, the National Institute of Neurological
Disorders and Stroke, the National Heart, Lung, and Blood Institute,
the National Institute of Child Health and Human Development, National
Center for Research Resources, and the National Institute on Diabetes
and Digestive and Kidney Diseases. However, NIH has not engaged in any
basic or clinical research on HAE since 2009, nor is there any Federal
research as it relates to HAE. As a rare disease, HAE stands to benefit
from from recent NIH commitments such as the Cures Acceleration Network
and the Therapeutics for Rare and Neglected Diseases program, as well
coordination with the Office of Rare Diseases Research.
In order to enable research to resume on HAE, it is vital that NIH
receive increased support in fiscal year 2012. USHAEA recommends an
overall funding level of $35 billion for NIH in fiscal year 2012 and
the inclusion of recommendations emphasizing the importance of HAE
research.
Thank you for the opportunity to present the view of the HAE
community.
______
Prepared Statement of YWCA USA
Thank you Chairman Harkin, Ranking Member Shelby and members of the
Subcommittee for the opportunity to submit testimony. My name is Gloria
Lau, and I am the Chief Executive Officer of the YWCA USA. As Congress
works on the appropriations and priorities for the fiscal year 2012
Federal budget, I am here to speak about one priority in particular
under the jurisdiction of this subcommittee: the critical need for
childcare for women and families.
The YWCA USA is a national not-for-profit (501(c)(3)) membership
organization committed to social service, advocacy, education,
leadership development, economic empowerment and racial justice. The
YWCA is dedicated to eliminating racism, empowering women and promoting
peace, justice, freedom and dignity for all. We represent more than 2
million women and girls, and we can be found in many communities in the
United States. With nearly 300 local associations nationwide, we serve
thousands of women, girls, and their families annually through a
variety of programs; including violence prevention and recovery
programs, housing programs, job training and employment programs,
childcare and early education programs, and more. Our clients include
women and girls from all walks of life, including those escaping
violence, low-income women and children, women veterans, elderly women,
disabled women, and homeless women and their families.
The YWCA is one of the largest providers of childcare in the United
States. Many of our associations provide accessible, affordable, and
high-quality childcare services to working families nationwide. In one
example close to the Nation's Capital, the YWCA of Baltimore, Maryland,
an association committed to providing quality childcare for all
children, serves more than 600 children annually. At this and other
YWCA childcare centers, the day is designed to meet the developmental
needs and the interests of each child. Each day includes a variety of
intellectual, physical, social, emotional, and creative activities as
well as opportunities to interact with other children and adults. In
another example, the childcare program at the YWCA in Lawrence,
Massachusetts has been ranked in the top 10 childcare programs in
Massachusetts by Root Cause, an organization that encourages social
innovation and helps corporations source exceptional programs. Starting
with this program, many children join YWCA as infants or toddlers and
stay in programming into their teen years, which provides continuity of
care for children and siblings. Finally, at the YWCA Greater
Cincinnati, the State of Ohio has recognized that association's
programs with a three-star rating for having met all State benchmarks
for quality. If members of the Subcommittee wish, we can provide you
far more examples of how YWCAs are providing quality childcare critical
to the country's children and their families.
As a major provider of childcare throughout the United States, the
YWCA is a strong supporter of the Childcare Development Block Grant
(CCDBG). Across the country, YWCAs use CCDBG funding for a variety of
programs, including childcare for infants and toddlers, and before- and
after-school care for children in school. CCDBG also provides childcare
subsidies for low-income and moderate-income YWCA clients who attend
our job training programs, live in our housing facilities, or are
served by domestic violence and sexual assault programs. Every day, in
communities across this country, we witness the important role CCDBG
plays in helping parents find and keep employment and in helping
children learn and grow.
Because of our strong support for the CCDBG, the YWCA asks the
Subcommittee to concur--at a minimum--with the President's fiscal year
2012 funding request, which includes $2.9 billion for the CCDBG in the
Department of Health and Human Services. This call for support comes
directly from communities across the country, as local YWCA
associations surveyed in December 2010 identified this vital block
grant as one of their most critical funding sources. We also support
Head Start and Early Head Start, which the President has requested for
fiscal year 2012 at $8.1 billion and which rounds out the continuum of
services for young children and their families.
The YWCA wholeheartedly supports the core purpose of the CCDBG,
which is to help make quality childcare affordable for low-income and
moderate-income women and families, through block grant funding for
States and tribes. CCDBG is not a cookie-cutter/one size fits all
program: it provides States flexibility in developing childcare
programs and policies most appropriate to fulfill the needs of children
and parents within that State, as well as empowers working parents to
make their own decisions on childcare services that best suit their
family's needs. CCDBG helps keep parents educated about their childcare
options through consumer information so that they can make informed
choices, while helping them to achieve economic stability and
independence.
The need is simple--if working parents do not have access to
affordable, quality childcare for their children, they cannot be full
contributors to the economy. Each week, more than 11 million children
under 5 years of age are in some type of childcare setting \1\.
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\1\ U.S. Census Bureau, 2006-2008 American Community Survey. U.S.
Census Bureau. (2008, March). Who's minding the kids? Childcare
arrangements: Spring 2005: Detailed tables. Retrieved April 19, 2010,
from http://www.census.gov/population/www/socdemo/child/ppl-2005.html.
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The problem is: childcare costs are high--compared to family income
and household expenses--and they are growing. The average amount
parents paid for full-time care for an infant in a center ranged from
more than $4,560 in Mississippi to more than $18,773 a year in
Massachusetts ($5,356 in Alabama and $8,273 a year in Iowa) \2\.
Furthermore, the average center-based childcare fees for an infant
exceeded the average annual amount that families spent on food in every
region of the country. In addition, childcare fees per month for two
children of any age exceeded the median monthly amount for rent, and
were nearly as high, or even higher than, the average monthly mortgage
payment in every State. YWCAs offer quality childcare at a low cost to
the families they serve, but many of them would have to turn people
away or simply end programs without State CCDBG funds. This, in turn,
would result in parents losing childcare which would impact their
ability to work and could possibly result in children being placed in
unfit or unsafe childcare situations, further impacting their ability
to learn and grow.
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\2\ Parents and the High Cost of Childcare: 2010 Update from the
National Association of Childcare Resource and Referral Agencies
(provides average costs of childcare for infants, 4-year-olds, and
school-age children in centers and family childcare homes in every
State), http://www.naccrra.org/publications/naccrra-publications/
parents-and-the-high-cost-of-child-care.php.
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Investments in early education are critical to our effort to build
a smarter and stronger country, even in economic times that call for
budget-cutting measures. Quality, affordable early childhood care and
education result in positive outcomes for children, such as preparing
them for school and helping parents find and keep jobs. It also
benefits taxpayers and enhances economic vitality. Research\3\--by
Nobel Prize-winners and Federal Reserve economists, in economic studies
in dozens of States and counties, and in longitudinal studies spanning
40 years--demonstrate that return on public investment in high quality
childhood education is substantial.
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\3\ Early Childhood Education for All: A Wise Investment. U.S.
Census Bureau (2005, April). ``The Economic Impacts of Childcare and
Early Education: Financing Solutions for the Future;'' a conference
sponsored by Legal Momentum's Family Initiative and the MIT Workplace
Center. Retrieved April 7, 2011, from http://web.mit.edu/
workplacecenter/docs/Full%20Report.pdf.
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Specifically, it was found that, in the short term, quality,
affordable childcare provides significant return as an industry:
employing nearly 3 million people nationwide; providing employees wages
to spend, pay taxes and purchase goods and services; and enabling
employers to attract and retain employees and increase productivity. In
the long term, quality, affordable childcare has been found to result
in lower costs for remedial and special education and grade repetition;
higher rates of completing school and building skills; improved job
preparedness and ability to meet future labor force demands; and higher
incomes and tax payments from those who complete school.
As stated in a letter to both of you and the Chair and Ranking
Member of the Senate Appropriations Committee signed by 17 Senators on
February 24, 2011, ``noted economists agree that investing in early
childhood education is fiscally responsible because it yields a
tremendous return on investment, ranging from $3 to $17 for every
dollar invested.'' The letter goes on to state, ``Given these gaps and
the importance of early learning to our country's economic success, the
American Recovery and Reinvestment Act (ARRA) included a prudent and
essential expansion of these programs. We strongly believe that
Congress must build on this progress, not reverse it.'' \4\ The YWCA
strongly believes that as Congress focuses on effective and efficient
uses of Federal funds, Congress should not overlook the benefits of
allocating Federal dollars toward childcare and early education
programs, particularly to cultivate younger generations.
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\4\ The letter includes support for Head Start and Early Head
Start.
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Congress and several Presidential administrations have historically
shown strong bipartisan support for CCDBG. Even so, for the 21 years
CCDBG has been in existence, the program has always been underfunded
and supply has never met demand. Even before the current economic
downturn, it was estimated that only 1 in every 7 children who were
eligible for CCDBG received assistance. It was also not uncommon for
children and their families to be put on waiting lists, to see their
assistance cut, or to see it eliminated altogether. The economic
downturn has exacerbated this already alarming situation as States
continue to cut back social service programs more than they had been
scaled back, prior to economic collapse.
In a positive response, as referred to in the joint Senate letter
to the Appropriations Committee referenced earlier, the ARRA made a
major, $2 billion investment in childcare. The significant increase for
CCDBG included in the President's fiscal year 2012 budget request would
allow children served by ARRA funding to continue receiving services.
This level of funding would allow 1.7 million children to receive
childcare assistance, an increase of 220,000 children--at great relief
to their working parents. The $1.3 billion increase would translate
into an increase of $800 million for discretionary funding (which does
not require a State match) and $500 million for mandatory funding
(which requires a State match. Approving the President's proposed level
of funding will ensure positive impact to the working women and
families that are an essential part of our Nation's economic recovery.
The need for and importance of investments in childcare and early
childhood education, including CCDBG funding, to the viability of our
country is now greater than ever. In addition, the current budget
crises facing States across this Nation illustrate why Federal
investments in quality childcare and early educations programs are both
necessary and vital. For example, the National Women's Law Center
(NWLC) reported on April 7, 2011 \5\, States have begun to cut back on
childcare assistance:
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\5\ Additional Childcare Funding Essential to Prevent State Cuts
from the National Women's Law Center. Retrieved April 8, 2011, from
http://www.nwlc.org/resource/additional-child-care-funding-essential-
prevent-state-cuts.
``Until recently, most States have managed to maintain their
childcare assistance programs, largely thanks to an additional $2
billion in Childcare Development Block Grant (CCDBG) funding for fiscal
year 2009 and fiscal year 2010 from the American Recovery and
Reinvestment Act (ARRA). However, as States exhaust these funds, and as
State budget gaps persist, many will be forced to scale back childcare
assistance for families unless additional Federal funding is provided.
Already, a number of States and communities have begun to cut back on
childcare assistance''. . . .
--California's governor is proposing to eliminate childcare
assistance for 11- and 12-year-olds, lower the income
eligibility limit for childcare assistance from 75 percent of
State median income to 60 percent of State median income, and
reduce reimbursement rates to childcare providers serving
children receiving childcare assistance--which would likely
result in families being forced to make up the difference.
--Florida's waiting list for childcare assistance increased from
approximately 67,000 children in early 2010 to 89,000 children
as of December 2010.
--Maryland will place all families who apply for childcare assistance
after February 28, 2011 on a waiting list.
--North Carolina's waiting list for childcare assistance increased
from approximately 37,900 children in early 2010 to nearly
45,700 children in December 2010.
--New York City's mayor is proposing to cut childcare assistance to
more than 16,600 children.
YWCA childcare programs in these States, and many more States
across the country, are already being impacted by State cutbacks. These
cutbacks will be amplified, and their impacts will be amplified, if
CCDBG funding does not continue at the levels requested by the
President's fiscal year 2012 budget request. For the YWCA, this means
our associations will have to cut vital programs and services, reduce
the number of families served, and possibly even close YWCA facilities
leaving many women and families without affordable, quality, childcare
to allow them to work and provide their children a safe,
developmentally appropriate environment.
The YWCA recognizes these are unique times in our Nation's history
and we agree that our Nation must address its deficit and debt. Yet,
the YWCA believes strongly that investments in childcare and early
education programs are wise uses of Federal funds that provide
substantial returns to our Nation. Childcare and early education
programs help not only our Nation's current workforce, but also help
prepare the next generation our Nation's children. On behalf of YWCAs
nationwide and the many women, children and families we serve, we look
to you for a continued commitment to women and families through the
provision of essential childcare resources. That is why we respectfully
ask you to support the President's fiscal year 2012 budget request for
$1.3 billion in additional funding for CCDBG. Thank you once again for
the opportunity to provide testimony in support of childcare services,
and CCDBG especially, to your Subcommittee. Your attention and
assistance are greatly appreciated.