Lorillard
Statement by J. Michael Mcginnis, M.D. Deputy Assistant Secretary for Health (Special Health Initiatives) Before the Subcommitee on Health and Scientific Research Committee on Human Resources United States Senate
Fields
- Author
- Mcginnis, J.M.
- Area
- LEGAL DEPT FILE ROOM
- Alias
- 03603279/03603303
- Type
- SPCH, SPEECH/PRESENTATION
- NEWS, NEWSPAPER ARTICLE
- Named Person
- Califano
- Foege
- Kennedy
- Mckeon, T.
- Millar, D.
- Quinn, T.
- Richmond
- Schweiker
- Foege
- Named Organization
- Bureau of Foods
- Bureau of Health Education
- Cdc
- Center for Disease Control
- Cooperative Extension Service of Nh
- Departmental Task Force on Preventi
- FDA, Food and Drug Administration
- Ftc, Federal Trade Commission
- Health Education Center
- Natl Center for Health Statistics
- Natl Heart Lung Blood Inst
- Natl High Blood Pressure Education
- NCI, Natl Cancer Inst
- New England Health Promotion Counci
- Nm Health Education Coalition
- Office of Health Information + Heal
- Phs
- Presidents Commission on Privacy
- Presidents Council on Physical Fitn
- Regional Medical Program
- Stanford Heart Disease Program
- Univ School of Public Health
- Usda, U.S. Dept of Agriculture
- Bureau of Community Health Services
- Bureau of Health Education
- Recipient (Organization)
- Comm on Human Resources
- Subcomm on Health + Scientific Rese
- Date Loaded
- 05 Jun 1998
- Request
- R1-004
- R1-037
- Litigation
- Stmn/Produced
- Author (Organization)
- Hew, Dept of Health Education and Welfare
- Site
- N14
- Master ID
- 03603272/4564
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products, as well as increasing the number of persons
under hypertensive medication. Most importantly,
reduction in the incidence of'stroke and myocardial
infarction for the middle-aged population has been
reported.
Another systematic effort which may be bearing fruit
on a national scale is the National High Blood Pressure
"Education Program which the Department has been sponsoring
since 1972'. This program1has promoted appropriate therapiess
for a high proportion of the 35 million Americans %ith
high blood pressure. At least partial]1y as a result of
this program, 50'percent more patients visit the doctor
to have their high blood pressure treated and the proportion
of people with untreated high blood pressure has dropped
f rom 49 percent, estimated in 19'72 to 30 percent in 19'74,
based on astudy of'fourteen communities. More importantly,
since 1972', the death rate from stroke has fallen by over
20 percent and from1heart attack by over 15 perceni"~. Life
expectancy in the Black population has increased almost
three years in the last f ive years. Part of this gain can
.be attributed to improved hypertension control. The
Administration concurs in your identification of the
importance of these activities and has requested $11 million
to support its hypertension activities in,1979.
the budgetary provisions contained in S. 3115 have
substantial implications for FY 198:0~and beyond', and
the Department has Just begun to formulate its budget
recommendations for FY 1980. Certain general comments
can, however, be made today.
Title I -
Title I of S. 3115 establiishesformu~la and' project
g;rantsfarpreventivehealthservices:.The:heallth,promotion and
disease prevention~activities proposed in Title I incorporate
many of the activiti.es currently underway in~HEW and proposed
for consolidation in S. 3099.
As you ltnowr Mr. Chairman, you have recently introduced
the Administration's services proposal, S. 3'09'9, which
consolidates a number of the authorities, coveredlin.
Title I of S. 3115, into a comprehensive grant which
woul'd provide States with sufficient flexibility to
determine their ownipriorities for usingiFederal funds.
We appreciate your introduction of this measure and'would'
urge your consideration of' the approach embodied in the
Administration bill.-
0
C
In addition, I would like to note the key role provided
for the States as mediator in the preventive programs
of S. 3115. We have also stressed the importance of'
this Federal/State relationship in the consolidated
grant authorities proposed~lin our bill. We feel it is,
essential to revive the strong Federal/State alliance
whi;chwas~forged earlier thhiscenturyin the:faceof a
dramatic toll of death and disease from communicable
diseases through environmental measures to improve
sewage disposal andd water purification, measures to
assure a safe food and milk supply, and mass immunization
campaigns. The record of this strong Federal/'State
partnership was impressive.
However, as the disease profile for the country changed
and chronic diseases and accidents became the leading
cause of morbidity and mortality, the close public
health relationship between the States and the Federal
government changedialso. Change in disease patterrrs
toward chronic diseases does not preclude aggressive
prevention programs aimed at lifestyle and environmental
factors. Some of the States have already begun to ~
exhibit leadership inithis effort and the Federal govern-
ment should do what it can tolpromote their activities.
Our proposal would consolidate a number, of'current
.preventive health authorities into a single program of
State formula grants for preventive health activities,
with funds earmarked'for immunization activities.
~
Programs consolidated by the Administration proposal
would include currently authorized immunization, disease
control, venereal d'ise se, rat control, and lead-based
paint authorities. The consolidation would also incorporate
public health~grants _to gtates, with the excepti=of
hypertension and mental health programs. Formula grant
funds would be distributed so that each~State would be
allocated at least the amount it had received from funds
appropriated under these authorities in~FY 1978.
iWe are well aware, Mr. Chairman, that this proposal does
not comprise a comprehensive prevention program. For the
immediate future--that is, for FY 1979--however, we have
determined that the combination of current budget priorities
skyrocketing hospital costs, and'the imminent prospect of
developingia national health program prevent us fromm
entertaining significantly larger appropriations at this
time. The mand'ate of'our Task Force on Prevention, however,,
is to fully analyze all present and future preventive healthh
needs, in order to make legislative, administrative and
budgetary proposals for the future.
C
In addition, Mr. Chairman, we also have a number of
specific suggestions regarding provisions of Title I
which we would b happy to share with your staff.
For example, Mr. Chairman, we have reservations
regarding the requirement that States use their formula
grant funds for programs aimed at one or more of the
five leadingicauses of death withinitheir States.
Priorities set by either mortality or morbidity would
vary with different age and ethnic groups and with
different classification schemes. Other factors also.
complicate the use of simple mortality levels as program
doterminants and we believe States should.have greater
flexibility in determining program priorities.
The wordingifor the medical record confidentiality
requirements set out in sections 315 ('h) _and 317 (g) of your
proposal appears to have beenitaken from the confidentiality
provision found in the venereal disease provisions of the PHS
Act. However, venereal disease programs/have significantly
different confidentiality requirements than the rest of the
PHS Act. Yet this language in S. 3115 would be app~ied to a
far broader range of activities and programs.
- 11 -
Mr. Chairman, thus far I have focused primarily on
%he importance of lifestyle factors in disease
prevention and health promotion. I would ailsoili}ce.
to note the importance the Department ascribes to
environmental efforts and other preventive services.
With your support, the Department will continue to
strengthen its efforts to protect the Nation's~
children against the immuniaable diseases, to promote
expanslon of fluoridation of the Nation''s water
supplies, to reduce the threat of lead-basedipaint
as a poison to the physical and mental health of
children, to eliminate rat infestation and to reduce
the broad range of' occupatiional and environmental
hazards which imperil our health.
Administration Views on S. 3115
Clearly we share a similar objective--to:focusattention
on preventive measures as a key element in our health care
strategy. We read the same statistics and share the same
disappointment in the health status improvement achieved
throughuniprecedented expenditures,on health~services.
Yet, while we support many of the objectives of S. 31151,.
analysis of alternative approaches to design of a compre-
hei~sive prevention program are currently beinqanalyzed by
the Departmental Task Force on Prevention. Purthermore,
As Senator Schweiker is well aware, this innovative program
-of Public Health, the major voluntary agencies,, industries and
prIvate philanthropy, have been~combined to provide a wide
range of educational and health promotional services. The
Center conducts classes, for,bothyoung,peopleand adu~ltsin many aspects of prevention and lifestyle
education, operates
one of the Nation's best dial-access systems for the general
public, provides technical consultation in health education
and preventionito health planning agencies~in the region, andd
has been developed almost entirely throughilocal resources.
Resources of the public health agencies, the University School
has become in a very few years a widely recognized resource.
At the State level, a less fully developed but highly
promising activity is underway in New Mexico. The
New Mexico,Health Education Coalition was established
several years ago throughithe Regional Medical Program,
and supported in part by contracts with the Bureau of
Health Education at the Center for Disease Control
and more recently by the'National Cancer Institute. This
formal confederation of public and voluntary health
:.
agencies has d~irectedparticularattention to problems
of healthipromotion and disease preventioniamong,
Mexican-American and American Indian communities in.
New Mexico..
=~ ,-~ -~.-~-._
As I am sure you are aware, considerable thought has gone
into the issue of' medical record confidentiality since
this provision was first drafted--much of it reflected inn
th Report of the President's Commission onlP'rivacy. As aa
result of that attention, we are now in the process of
preparing comprehensive medical record confidentiality
proposals, and would urge youlto postpone consideration
of these particular provisions until that legislation has
been submitted.
Title II of S~_ 3115 ca~llsfor the provision ofresources for disease prevention and health
promotion,
including the development of five regional centers for
health promotion, the development of'community-based
demo strations of preventive health services, and the
formulation of periodic national disease prevention data
profile. Mr. Chairman, the Administration is acutely aware
of the needs addressed'by these provisions. Disease
prevention, health promotion and heallth education are essentially
community affairs. They are, to a great extent, the product'
of'the li:festyles of individuals and families - the,,environment
surrounding them and the services available tolthem..
There are a growing number of community activities developing M
~
throughout the country. For example, at the local level, a
Health Education Center has been developed in Pittsburgh.
In your own Region, Mr. Chairman, the New Eng an Health
Promotion Council, initiated three years ago with the
heTp of'a CDC contract, is providing a focus for inter-
agency planning and activity in the six New England
States. A,mong the significant spin-offs of this very
modest endeavor has been the effective involvement of'
the Cooperative Extension Service of'New Hampshire in
the State's childhoodimmunization program, which in
turn has provided a model for other States.
The three examples I-have cited!are not unique, nor a_e they
illustrative of' the full range of problems implicit in disease
prevention andlhealth promotion. They do, however, point to
the potential for local, State and regional collaboration in
these fields. We need to work with, and through, the resources
in our communities. We would oppose, however, the specific
.mandate to develop five centers, in order to provide the
Secretary the flexibility to use the funds most appropriately..
I am~ pleased to note, Mr. Chairman, that the Office jf Health
Information and Heailth Promotion, established as a result of
your leadership in enacting Public Law 9'4-317, is undertaking
a number of activities to strengthen the Federal support of
locally-based! health promotionlefforts,
the national data base for prevention. Specifically, a series
0.-:
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. ~.
~:' ~ ;
We also support the requirement that colors be specifically
identified on food labels. Indeed earlier this year FDA
Commissioner Kennedy wrote to the presidents of the major
food companies and urged that they voluntarily undertake to
disclose the use of colors in their products. In addition, we
support the provision of discretionary authority to require
declaration of'individual spices and flavors on labels'.
The bill also provides explicit authority to require
nutrition labeling. Under present authority FDA has
issued regulations requiringinutritional labeling
where nutrients are added or where nutritional claims
are made for the product in labeling or advertising.
The bill would extend FDA's authority and enable us.
to require nutritional labeling
support this provision,although
m2ndi that for some foods (e.g.,
on all foods. We
it should be kept in
condiments such as~
salt and pepper) nutritional labeling,would be
unnecessary and we would not intend to require it.
However,_we do not favor the requirement in the bill
to list certain specific nutrition information. Nutrition
s
labe~lingiscurrently aldynamicsubject areawhichis
