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Before the House Appropriations Committee, Subcommittee on Labor, Health and Human Services, Education and Related Agencies
February 13, 1997

Good morning, Mr. Chairman and Members of the Sub-committee. I am Dr. David Satcher, Director of the Centers for Disease Control and Prevention (CDC) (chart 1). I am pleased to be here in support of the President's FY 1998 Budget request for CDC. I also would like to thank the Sub-committee for its continuing support of CDC, especially during the last year -- our 50th.

In commemorating its 50th Anniversary in 1996, CDC showcased its scientific articles and accomplishments of historical interest to public health. Two weeks ago, CDC re-published a 1992 Morbidity and Mortality Weekly Report that first described the need for information on the effectiveness, as well as the economic and social impact, of disease and injury prevention strategies. Prevention effectiveness now has been institutionalized as a public health science at CDC and many other public health organizations. Since 1992, CDC has increased substantially its ability to assess scientifically the prevention effectiveness of its programs and strategies. More than ever, we are able to say: Prevention is a wise investment. It works and provides value for the dollar. Yet as the U.S. health care budget approaches $1 trillion, only one percent of health expenditures support population-based prevention (chart 2).

Public health contributes significantly to longer, healthier lives. An infant born in the U.S. today has 30 more years of life expected than in 1900 -- 25 of these years are due to public health efforts (chart 3). Many public health efforts result in considerable financial savings; others carry a net cost but represent an important investment -- and save lives. The signature feature of CDC's public health programs is that they effectively promote health and quality of life by preventing disease, disability, and injury.

POSITIONING FOR THE FUTURE

CDC over the years consistently has shown the effectiveness of its public health efforts. For example, CDC has led efforts to prevent such diseases as smallpox, malaria, tuberculosis, Legionnaire's disease, and polio. In more recent years, CDC also has addressed contemporary threats to health, such as injury, environmental and occupational hazards, behavioral risks, and chronic diseases.

Bearing the imprint of lessons learned during our 50 year history, CDC today is preparing for challenges it will encounter in our next five decades. Our budget request is based on four basic assumptions (chart 4): 1) Microorganisms will continue to be a threat; 2) Human behavior and demographics will create new public health challenges; 3) Pressure to reduce health care costs will lead to a need for more prevention and applied research; and 4) New technologies will increase opportunities for prevention.

I also would like to point out that as we meet and overcome some of these challenges, attention and resources can be directed toward other areas. For example, global eradication of polio would save the United States more than $230 million each year, and the benefits in both human and economic terms would be enormous and enduring. Moreover, resources currently directed toward the eradication of polio would then be available to address other critical public health priorities.

The President requests $2,315,795,000 in budget authority to enable CDC to sustain present efforts and meet new challenges.

Microorganisms/Emerging Infections: Recent outbreaks of antimicrobial resistant infections, Ebola hemorrhagic virus, E. coli 0157:H7, and other foodborne and waterborne infections, alert us that effective surveillance, prevention, and control systems must be in place to respond to continuing threats to public health, both domestically and globally. Dramatic changes in our global environment create new opportunities for infectious agents to adapt and spread; today's global village makes us increasingly vulnerable to new and emerging diseases, as well as re-emerging diseases. Consequently, despite historical predictions to the contrary, we remain vulnerable to a wide array of infectious diseases.

Infectious Diseases(+$25 million) The Budget includes $15 million to improve existing surveillance systems, strengthen epidemiological and laboratory response capacity, and support efforts to address emerging infectious diseases globally. It also includes $10 million to enhance the early detection of foodborne disease and improve outbreak investigation and response efforts.

Behavior and Demographics: Behavioral risk factors, including tobacco use, poor diet, physical inactivity, sexual behavior, and illicit drug use, are the underlying cause of nearly half of all deaths in the United States. Changing demographics have significant implications for how we design public health initiatives and allocate resources. In recognition of these new challenges, the President's Budget includes three high-priority initiatives:

Preventing Sexually Transmitted Disease (STD) Related Infertility in Women (+$5 Million) STD-related infertility prevention is highly effective and cost-effective. Chlamydia costs the U.S. an estimated $2.4 billion each year. Chlamydia screening and treatment can reduce the rate of pelvic inflammatory disease (PID) by up to 56 %. By averting cases of PID, ectopic pregnancy, and infertility, an estimated $12 is saved for every $1 spent on prevention. This initiative would expand CDC's successful program to include an additional 400,000 women.

HIV/ AIDS Prevention (+$20 Million) The percentage of AIDS cases attributable to injection drug use has nearly tripled since 1981. This initiative will expand activities targeting injection drug users (IDUs) by providing additional funding to state and local health departments, organizations such as national and regional minority organizations, and directly-funded community-based organizations. The initiative will highlight the importance of community planning. It also will establish demonstration programs to improve access to HIV prevention and control services for IDUs within correctional settings (70 % of inmates have a history of IDU or substance abuse).

Preventing Tobacco Use Among Young People (+$15 Million) Each day, more than 3,000 young people become regular smokers -- more than 1 million new smokers each year. Among teens who are regular smokers, 1 in 3 will die from smoking. With this initiative, CDC will support essential surveillance efforts, provide additional financial assistance to state health departments to conduct multifaceted tobacco control programs, and expand important laboratory activities pertaining to tobacco products and the health effects of environmental tobacco smoke.

Reduce Health Care Costs: Dramatic changes occurring in the health care system have brought prevention into a new era of prominence. As the Nation endeavors to promote health but contain the cost of health care, the value of prevention is recognized increasingly by health care providers, purchasers, insurers, and others in the public and private sectors. The President's budget includes two important initiatives that will further increase cost-effective prevention as part of health care.

Preventing and Controlling Diabetes (+$10 Million) Almost 16 million Americans have diabetes, including 8 million who are not aware of it. The American Diabetes Association estimates that this disease costs the Nation $92 billion a year in medical care and lost wages. Through CDC's prevention strategies, devastating effects and complications of the disease -- and associated health care costs -- can be reduced. This targeted initiative will fund diabetes control programs in all states, expand collaborative work to initiate a National Diabetes Education Program, and conduct research focusing on applying findings from recent studies. These efforts will translate the best results of diabetes research into widespread practice.

Breast and Cervical Cancer Screening ( +$2.3 Million) Almost all deaths from cervical cancer and more than 30% of breast cancer deaths can be prevented by early detection. The cost of medical care for a woman whose breast cancer is diagnosed early may be as low as two-thirds of the medical care cost for a woman whose cancer is diagnosed at a later stage. As of 1996, CDC's National Breast and Cervical Cancer Early Detection program provided more than a million screening tests in all 50 states to hard-to-reach, low-income women. Through this budget initiative, CDC will continue to build a collaborative and comprehensive early detection program.

New Technologies: State-of-the-art information technology, telecommunications, data and surveillance systems, laboratory capabilities, and diagnostic methods are essential to CDC's efforts. For example, CDC has pioneered the use of distance learning to provide state-of-the-art public health training to nationwide audiences through its Public Health Training Network (PHTN). In just three years, PHTN has provided training to more than 200,000 health workers in all 50 states. The President's budget includes two initiatives to sustain CDC's leadership role:

National Data Systems (+$2.4 Million) Surveillance and data systems are vital for identifying opportunities for prevention and measuring outcomes. CDC's National Health and Nutrition Examination Survey (NHANES), which collects information from direct physical and biochemical measures, interviews, and nutritional analysis, is the only national source of objectively measured health status data. This initiative will provide full funding for this essential survey.

Occupational Safety and Health Research (+$7.1 Million) In 1995, work injuries alone cost this nation about $120 billion in health care and related costs. Funding for research at CDC's state-of-the-art laboratory in Morgantown, West Virginia, will enable CDC to take advantage of critical scientific and technical advances of the past two decades for the improvement of worker safety and health. This initiative will support multifaceted laboratory research and other efforts, including a new research and prevention effort to address fully preventable injuries and deaths of our nation's fire fighters.

CLOSING

The Nation's public health system faces challenges unforeseen in the past. With continued support for scientific inquiry and applied research, CDC will continue to lead our Nation in meeting these challenges and protecting the public. No other federal, State or local agency, or private organization has the expertise or capacity to assume this public health leadership role.