Congressional Committee Reports
Fiscal Year 2004 Appropriations Reports
House of Representatives Report 108-188, July 10, 2003
CENTERS FOR DISEASE CONTROL
DISEASE CONTROL, RESEARCH AND TRAINING
The Committee provides $4,588,671,000 for the Centers for Disease Control and Prevention (CDC), which is $304,031,000 above the fiscal year 2003 comparable level and $321,341,000 above the request. In addition, the Committee provides $13,226,000 in funds made available under Section 241 of the Public Health Service Act and includes a general provision (Sec. 218) that provides for a reduction of $49,982,000 in administrative and information technology expenses. The net effect is to provide a program level for CDC activities in fiscal year 2004 of $4,551,915,000. This is $56,876,000 above fiscal year 2003 and $232,603,000 above the request.
The CDC assists State and local health authorities and other health-related organizations to control and reduce disease and other health problems. The activities of CDC focus on several major priorities, including providing core public health functions, responding to urgent health threats, monitoring the Nation's health using scientific methods, building the Nation's health infrastructure to insure our national security against bioterrorist threats, promoting women's health, and providing leadership in the implementation of nationwide prevention strategies to encourage responsible behavior and adoption of lifestyles that are conducive to good health.
The Committee considers the table accompanying this report to be determinative of the CDC budget. ►Funds should be apportioned and allocated consistent with the table, and any changes in funding are subject to the normal reprogramming and notification procedures.
Birth defects, developmental disabilities, disability and health
The Committee provides $106,339,000 for birth defects, developmental disabilities, disability and health, which is $8,299,000 above the fiscal year 2003 comparable level and $18,877,000 above the request. This program collects, analyzes, and makes available data on the incidence and causes of birth defects and developmental disabilities.
Within the total provided, $2,500,000 above the fiscal year 2003 comparable level is to expand autism and developmental disabilities activities.
Within the total provided, $2,000,000 above the fiscal year 2003 comparable level is to expand surveillance and epidemiological efforts of Duchenne and Becker muscular dystrophy in the United States.
Within the total provided, $500,000 above the fiscal year 2003 comparable level is to support activities related to the National Spina Bifida Program.
Within the total provided, $500,000 above the fiscal year 2003 comparable level is to expand CDC's newborn infant hearing program.
►Within the total provided, $1,000,000 above the fiscal year 2003 comparable level is to continue and expand the partnership between the CDC and the Christopher Reeve Paralysis Foundation.
Within the total provided, $1,500,000 is to establish a public health education initiative related to Tourette Syndrome.
Within the total provided, $300,000 above the fiscal year 2003 comparable level is to enhance the national campaign to increase the number of women taking folic acid daily.
Attention Deficit/Hyperactivity Disorder- The Committee continues to support the National Resource Center on AD/HD and has provided sufficient funds to continue the activities at the Center to better reach special populations in need; to develop on-line educational tools for professionals; and, to enable CDC to expand its population-based research and surveillance.
Autism- The Committee is concerned that the data collection and analysis within this program is not progressing at the anticipated pace and urges the CDC to allocate the resources necessary to gather and release the data, and conclusions in a timely manner. The Committee expects a status report on autism data collection before February 1, 2004.
The Committee is also interested in data demonstrating that early identification for children with autism can be valuable in identifying the appropriate services and treatments. Early intervention for children with autism has shown significant improvement in behavior and function of many children with autism. The Committee encourages the CDC to develop an early identification initiative for autism and other developmental disabilities.
Christopher and Dana Reeve Paralysis Resource Center- In fiscal year 2001, the CDC began support of the Christopher and Dana Reeve Paralysis Resource Center to provide information and support to individuals living with paralysis, their caregivers and their families. ►In order to keep up with the increasing demand for information and support services, the Committee has provided $1,000,000 to augment the CDC's support of the Center. The Committee intends that the full amount of the increase be awarded to the resource center.
Down Syndrome.--The Committee received testimony during the fiscal year 2004 budget hearings regarding Down syndrome. Furthermore, the Committee is aware of proposals for CDC to conduct an epidemiological study on Down syndrome and to plan a multi-site population-based study to document the onset and course of secondary and related developmental disorders and health conditions in individuals with Down syndrome. The Committee encourages the CDC to give careful consideration to these two proposals and to be prepared to report to the Committee during the fiscal year 2005 budget hearings on the need, design, and costs of undertaking these proposals.
Folic Acid Education Campaign- Funds have been provided above the request to expand the national public and health professions education campaign designed to increase the number of women taking folic acid daily. With increased funds, and in collaboration with the National Spina Bifida Program, this campaign should be able to reach more women of childbearing age and their health care providers.
Limb Loss Information Center- The Committee is pleased by the partnership between the CDC and the Amputee Coalition of America (ACA) and the ongoing success of the National Limb Loss Information Center which provides comprehensive resources, peer support and education programs for persons with limb loss, as well as their families, friends and health care professionals. The Committee has provided sufficient funds to support these activities at not less then the fiscal year 2003 level. In addition, the Committee commends the CDC and its partner on the Limb Loss Research and Statistics Program that is enhancing the nation's understanding of the true burden of limb loss in America and has provided funding to expand its initial research efforts.
Sudden Infant Death Syndrome- The Committee notes the work of CDC, the National Institute of Child Health and Human Development and the Health Resources and Services Administration in developing model guidelines for death scene protocol for Sudden Infant Death Syndrome. The Committee encourages CDC to implement projects to demonstrate the effectiveness of the death scene protocol in a variety of locales (urban, suburban, and rural) throughout the nation. The Committee expects CDC to be prepared to report on progress on this initiative during the fiscal year 2005 hearings.
Tourette Syndrome- The Committee is concerned that the public's misunderstanding of the neurological disorder known as Tourette Syndrome has resulted in severe stigma, ridicule and denied learning and employment opportunities for children and adults living with the condition. The Committee has provided $1,500,000 to establish a public health education and research programs in partnership with a national voluntary health association dedicated to assist parents and families of children with Tourette Syndrome. The programs should be designed consistent with the authority and direction in Section 2301 of the Children's Health Act of 2000 (P.L. 106-310).
Chronic disease prevention and health promotion
The Committee provides $862,011,000 for chronic disease prevention and health promotion, which is $72,039,000 above the fiscal year 2003 comparable level and $27,964,000 above the request.
Chronic diseases have had a profound human and economic toll on our nation. Nearly 125 million Americans today are living with some form of chronic condition, including cancer, cardiovascular disease, diabetes, arthritis, obesity and various neurological conditions such as epilepsy. Complications from these conditions include vision loss, kidney disease, limb loss, oral disease and paralysis.
The National Center for Chronic Disease Prevention and Health Promotion at CDC implements research and programs to prevent the leading causes of death and disability (e.g., heart disease and stroke, cancer, diabetes, and arthritis) which are among the most prevalent, costly, and preventable of all health problems. CDC plays a leadership role in coordinating and catalyzing the efforts of numerous public and private partners, which allows CDC to substantially extend its effectiveness in reaching people at highest risk for chronic disease. The Committee recognizes the essential infrastructure that CDC has built in state health departments and encourages CDC to expand its state-based leadership in surveillance, public health education, communications and model programs and research.
Within the total provided, the Committee has included the following amounts above the fiscal year 2003 comparable level:
Heart Disease and Stroke / $4,000,000Diabetes / 4,000,000
Cancer Prevention and Control / 16,000,000
Arthritis / 500,000
Epilepsy / 500,000
BRFSS / 1,300,000
Vision Screening and Education / 1,000,000
School Health / 5,000,000
Oral Health / 800,000
Steps to a Healthier U.S. / 40,000,000
Arthritis- Within the Arthritis and Other Chronic Disease, the Committee recommendation includes $500,000 over fiscal year 2003 to ensure that the CDC arthritis program can expand efforts to confront the burden of arthritis. The amount includes funds to support state-based programs and the collaboration between the agency and relevant voluntary health organizations.
Breast and Cervical Cancer- Within the amount provided for Cancer Prevention and Control, the Committee provides $210,929,000 for the National Breast and Cervical Cancer Early Detection Program. This is $11,558,000 above the fiscal year 2003 comparable level and the same as the request.
Cancer Survivorship- The Committee is aware of the need for additional information and support for cancer survivors, from time of diagnosis through treatment, recovery and long-term care issues. The Committee has provided sufficient funds above the request for the CDC to develop a cancer survivorship resource center focused on post-treatment needs and long-term survivorship/quality of life issues. ►The Committee encourages the CDC to develop the resource center in partnership with the Lance Armstrong Foundation (LAF).
Cardiovascular Health State Program- The Committee is aware that many states do not have a state-based heart disease and stroke prevention program. The amount recommended by the Committee includes funds above fiscal year 2003 for the Heart Disease and Stroke Prevention Program to allow CDC to elevate additional states from planning to program implementation, continue to support the other currently funded states and to initiate critical public and health care provider education, prevention research and evaluation.
Colorectal Cancer- The Committee is pleased with the leadership of CDC's National Colorectal Cancer Roundtable in promoting the availability and advisability of screening to both health care providers and the general public. The Committee encourages CDC to continue to expand its partnerships with state health departments, professional and patient organizations, and private industry to combat this devastating disease.
Diabetes- The Committee recommendation includes funds above the request to enable the CDC to expand the number of state-based diabetes control programs with basic implementation grants.
Division of Adolescent School Health- The Committee requests that the Director emphasize collaboration with prevention programs so that messages of prevention are consistent with one another and that prevention efforts are appropriate for specific populations. The Committee notes that according to CDC's own data, more than half of all adolescents are sexually abstinent. Therefore, DASH programs, in particular, should accommodate approaches that emphasize risk avoidance, abstinence education, and should make every effort to provide accurate information on the efficacy of condoms, as per the 2000 report on condom efficacy from the National Institutes of Health, for all sexually transmitted diseases. The Committee urges that in promoting HIV prevention programs, DASH emphasize those programs and approaches that have been shown to delay sexual debut or have demonstrated positive changes in the knowledge, attitudes, beliefs, and intentions of adolescents regarding the initiation of sexual activity.
Epilepsy- The Committee recognizes epilepsy, a chronic neurological condition, as a serious health concern. Further, the Committee acknowledges that CDC has worked diligently over the last couple of years to promote better public education and treatment of people with epilepsy. The Committee urges CDC to enhance its epilepsy efforts in partnership with a leading non-profit that works on behalf of children and adults affected by seizures through research, education, advocacy and service, and should include activities addressing the relationship between older adults and epilepsy; maximizing public and provider health education programs in the schools, the public sector and in states; and supporting prevention research on stigma and self-esteem.
Inflammatory Bowel Disease- For the past four years, the Committee has encouraged CDC to work in partnership with the IBD community to establish a national IBD epidemiology program to further our understanding of these diseases. The Committee understands that CDC has entered into a partnership with the Crohn's and Colitis Foundation of America to initiate this important program. Now that this project has been established, the Committee encourages CDC to provide funding for this program in fiscal year 2004.
Lupus- Within the amount provided for Arthritis and Other Chronic Diseases, the Committee has provided $1,000,000 for the operation of the National Lupus Patient Registry.
Oral Health- The Committee recognizes that to effectively reduce disparities in oral disease will require improvements at the state and local levels. The Committee has provided additional funding to allow the Division to fully fund the 13 state grants already awarded and to initiate new grants to states to strengthen their capacities to assess the prevalence of oral diseases, to target interventions, like additional water fluoridation and school-linked sealant programs, and resources to the underserved, and to evaluate changes in policies, programs and disease burden. The Committee also expects the Division to advance efforts to reduce the disparities and the health burden from oral cancers and oral diseases that are closely linked to chronic diseases like diabetes and heart disease.
Pulmonary Hypertension- The Committee continues to be interested in pulmonary hypertension, a rare, progressive and fatal disease that predominantly affects women, regardless of age and race. The Committee looks forward to reviewing a report (as requested in the FY03 omnibus appropriations bill) from the CDC outlining the progress that has been made in establishing a pulmonary hypertension awareness campaign focused on the general public and health care providers. Moreover, the Committee encourages CDC to give priority consideration to supporting a cooperative agreement with the pulmonary hypertension community designed to foster greater awareness of the disease.