Tobacco Documents Online

S 7878 _`CONGi2E5SIOAIAL RECORD-SENATE May 19, 1'978 ._ 1ag.., appropriate rlak aseasmentl mtoo their . wLll bave to- makefar mocee decfelons about tack victims, operations often done uaelessly .. . prepald' aeresystenm.. - - Who aha11 live and Who. ePall be allowed toO now, according to.. atvdiea, . . , . Lappreetatethe opportunity tn contribute d1e, avehealth leadenagreed here this week:. (ymena baeked...such.teattng.~but said the' . today to your consuterstton of:newdtrectiona. , They spoke at a news eonfeeencee at thee are..,hu..m•.....- opposea the Kennedy and for health haaard'& apPratsayL andi I look.for-Amerteaa As.aclatfoa for the Advancement H,oge,sblllsbe®use ma.ny' euchstepe.are al- ~. vsrdto.thepape[sanddlseusstonaesstonsof' ofSctenretounvel3amatorhealthlssVe,out ready beingMten. . . ''tflemaetfng.'Dbank.you.: -tiaaay;, of the aesociattonta' noted weekty HIatC.xeplledthat.theHsrvard'..School.of-., . . . yOUrNoT11a; . :-. . .7nmml8cf®ee_ Public Hea1tII't'. Center for Analysis of . -I nIel:cnde.. Mero;-'bperstioa Ltfeatyle:' Dr. YhiL Abelsan, Sclence's editor and Resatis pnenheadoftheCaraeglerastitutlen.ofWashing- ~ch eea uoet--cenudeend the leeding . . Nna Cancrpts. in Heeirh., FraaeeNaga's of the am uffiteffitfea-asa been ton, wams tnaa mtroductloa tothe Lcsue' censiscenel l . -PraepecttvMediclnMe,~Ocgtober B4SacSetp' foe that curreat Pumaal reseerch aad care mayP far federal suppea~t bruedealte e~tadt'.a. •IILah, 1vaa. Yed7calNemestis:'. The &2pr~ bae focused.d too. strongiyy oa Prolonging:. ..Yet: he ssW, ^Maapann~eat: Practtaes in 'yrlbt4on of H'eaith. Fantheon. Hooks, 197e. . meanlbgiemeyt4acea" at huge; coet; medtcme sad snrgerP havee not tieenn evalu- . •Prlatleon. Sltot.. Dacrorheq Tdperhea- A' But the gtoming problem. of. "ehoshail' ated. Rameat maateetam)"-lemovtng the .. Study of ~feasian, Sac4aF CoxiZrot. New ~- °d~ sftectt msay more penona than preastandadlacent. st:netures-"remamsYarY, >il®evter,197S': - . ,.tbe vergllI wIIOee.ltvesmapseem meaiilngr7 the nwat ooramoaly, prmcticed pro«dure for •Carteon, HlclL The 8nd' of JfedianG 1Q8B' satd De. Homsrd' Hlstt,' deau of thebreast' naeQ. Laoogp', there Ie no pereus- .. -RArvardSchool at.PnaiSaHealtlL IieWYort, Wlley. 1975. . ,. Heranee astther the government nor ln- alveevidence.tIIfyitta.better.thaaaefmpler .•eba,. RenaeC.'"Ihe Medlcatizatlon aad svsennnr Indte11f0a1s mat te.able.to pay for ~~~otudlIectoodes Are, . beolag done lese fre.~ . -'. Demedlcall2salon of Americaa. Society.'" An 'thet8fagadnetasare..learning:toda,"We•.. Daadaircr.Witrter 1977.9-22: - fnevitably sball be aNdng,'whtch af our citt-" q°entl)y butoneoy still seriously questloa': .. .. •8obbiae, Lewls and 8a1f. Jatlk Haor to- yeas, must bedeprivede of Lfe-savmgg mess-theaeed forr close, to amllaon aa year: Last Practiee• Prospeeiine. M'ediciae. IndlanapolLsl, ureaY ^ IDatt es9d.. T am coavlnced wecan- 'ees over g0.fq0 Amerlons had eoronary sur-_ . . Ltdlana,. Metaodfat Heepttsl'of Iadla.na,.1970: aet evade thfs fesas.^ .. BerY stt a cast 1n ezcem af $1, bllllaa." 81att . •Heet, J. tl. and. Steffy, IL--.L "SmoMng. '~It'sgomPF on, now."said'ltobert Ball. ~d. ,. Modification Feoeedlarea'PaIIored.to Snbtect foemen federal8ocfal esromlty, 2ommleslaner: - ffi8Acoets meke it neeeeaary for us-tc .. GRaraetertsttae,'•. Behavior 1'RempF;. 2:$, 3Tb-- noer senior achnlsr at the Idstltute of Medl- . eet prlvrYttea~ aad we need morefaderel eup- ..91,Apr1F187L.. .. .. .. . -.. .,.- afficaf,tIle National Academy of'Sdeneee. I>4rt foa•'the.needed e.amstlbn.,1'he cost of,•Fra~f published reports by the Natlonaf' -"DOCt~prs .24 decfdmg against eztrsordl~- ~~dertetmgsaeh research will be great- , centerforHealth3tatlesfea..US.Department yry~epstobeeppnrsoasallve.Crwhether K~sn~~~~~,. . CfHeatttr, Dlurstfon, and Welfare. PtrbHC ornot.togMthlsorthat Petnon,an orgaa. & . Mr. SMM=Xp_ . pqp- President. L. HeaFGhService,:HealthRSSnutr.esAdmmistra.Itlotmatets.donethan:lsevermadeformai."' ~m tOdgP Sfliaitl4 w16h>~yCOlleBgtieS imn: ~ . . . . -. . . .- -- - .. SuoD: deriatane'sre made °ottea" end, sre •Statement.bySecretaryof Healtli.Educa- aIIecting..ms7fEnnr, eald Dr:. Plaest se.ward;. Ole the S176COtIDO01t0eC nafiBalth: and! tfaa, and. WeHare: beforee the. Subcommittee ptofesanr o[.easlat mediefae at theCinlvereityScieat18C ReseaLt'h 1n gpoflsOPlIIg' a'a b1)ai .on.Healthand,..Eavfronment:Commlttee:on. ofSoruastar:. toa.mendthePAfhltc'HealthServlce'Mt' . : Lutvstat4and Foreign Commerce,. Septenr- This..la bamasethere is "r.tmamg•" of care to IlaprOve0lli ab111tyt0 DroRaete health-. ber 9, 1977. (¢'abrn' fxome data complled.bP'.d parrJ9 by'ehobes..scrosto dnctorsand who ful' beba'Vlor- and.prevent.dfaeaee. - 'theNat6onal'.Centee f~ Hxslth-Stsalettm. esa.pa7w baesM:,'RRmessmpl'e, blacks..only- IamPlea9edtosDaasorthtsbillwhich .. Difenv-Y . .: . . ..~.' . ....-:-gethiprepleeenrnteperattonsai.mne-tentn. seekstoenhaucethero0ealprevenrdoa. .. eeetye Hans. 'Stresaf WftAout Htstreu-. the rate of. Wbftrs, butt tbey have just ass inourhealt]'1 Ceresystli M1:.PresidefLt,. ,. NeerYors, J. $ f.tPpiacot Co... 197~1. '.'-:. ., -toaay'mp.p•oblems: I think 40 or 50 mlllion. 1t'.. is IIICiCdlbleihaLe the'. Onited States %ata SidneY eraf.. The:Eftects of Can~. people areuaderseved by the health syetem tlnuea Care. SLB.' Department of Health- becauae.tdeP don'thavethe meane:' -sDends under 2 percent ofi ff8 healtFi' care „- Mucation, aad'Welfare.: National Center foc - - Coanpared to other agegroups„ the elderly doIIa15on dlseflae prevention and health - Health SeevfeasHesearote and.Develapment... sndeaelPadoleurntsareunderserved.addedd promotion. C1eYrly. tl'if818IDOLley'that December 1972 (I6H8W, pubilcatioa No.Dr.IDSvidHamhaighesd''of'theInstituteaf. reDre9ettte-tSe9oU11de3t.hkY09tIDent we.. ( 7 ) ~ IMd, .: ., . Laf.onde. . .-: -ThentstaaointbmsoIIend'~6y'~. . .. . ~... . caltIDakeiII ihe'16eatthlleFd thexspeak-: .ipydelstrpportalltheefementsof'th1s. r•H[ealornv. Leater and- SomeM Anns R..t ers aad. Hh: O$bert.Omenn„ aseietaut dl'reC- pragr3m~ I wUttld Lke tC, restilct IDy!. '2ifetimeHeaitaMnnltesGng:'APrnctteatAp` torofPeesidentCarteYSOmee.ofSclenee.and proach ta Revcntlve- Medldne"' Mno. 6nq-- '3laanotogy Follcy, arx pnweatloni natfonal.l reL]ar$etO those 11evr or eipaIIded! Dre: .. .. lmid: 7oorrwl' oJ Medicine; 296:11;, eo1-008, -.heaCth-msmsaee:. costt ecatrot and aesese-~graII1A- that'ale't eatabllahed by' thLS' act. -. March 17;.1977: -. .,.. . :.. -.. ,:ment of IIevrmedicst methods to-ellmtnate, . AalOngtheCategOrlcal'PrdlCetgi'at1t5 for .. ~"'IIS. Department of' Health. E'ducatfon„- the.uselese and..wastefu4 . .... . prerentYve healthserYleeBh theaeW or .. :: and': Weltare: Bealth.: - CaitedStaYes~ 1975: . Saward.ceAed the search for'more eBective- expanded prOgrNnsarehypertensioR.. ..-Publ¢o Health, Seralce National Center foe. wayg toPrecent ttlnese: and! accldents.'Yhe'. environmental health and, physical fltr. .. Health Statlwtlra, H.ockvil7e. Maryland.:I975.. queatoftIleneIItdeeade.'• .. .. : .. ...IIess, Hfpert24StOR Is a dL9ease, th8tt u Maeon; Thomas J'~ et't at. Atda.ss of Caneem ' BsFf oelled aatfonsl1 health ~ Insureace Xarpalify for IIB-Ceunties-'1950'-1984.' V.S. esseattsF. and.. esld' it. wu. •'fmportant' Lo- a8e0ts'approbIDBteIy35IDflltoa Alaert-. .~. 3Tepartment of.HealEh, 8ducatlan., andWei- keep~aaR means test ta theabaolute• mlal- can9 anrlOlle wGfCltt$ame3labteh to'.eD11- . fare: Public aeettbservtca. xstionsl Instt-- mm beeavse:M'avery: very dlfficu7t to maln-trol.if- detected'. and the. Patiellt. L2 be- . 'tntes of Healtli,. 1975 (DREW Publication Ift taahJgn9nalfty eertQaefor all ia, aay'pIan gllrton'tIlerapy. 'Ih' t$b511Wou1d double .. (NIBI 75-780)'.. •. . .- -. .... : thst atngles unt taspoor Deople".In asepa.- the budget a72tharity' for: Sh/Sprogram'.. "... e Par4uhar, John W; of at ."Commualty rata . category:'l1ketnday's• Medlcaid whrch,, and extend tt9 author1ea11v1n for 3 years. Edumtlon for : Cardf'ovaaeular Health." . The.. Msold'. aacoti¢uges."Medleala; m117s." . In . edditloID,: bf eeG9CSth1g the: program - ... . Zaaeet- I:8083~:, 1192-d5, June.4. 1977. .. .:. ." ~trol Control of ofaoete; aelwlaes.' he.tbst 14 eaid.'w83-caatrot te0.ufra.,- to. a Pro14'ct we will ail bwaLly the most - .. . Rt3ree.n:,Lawlence.vV."DSlfuatonandAdop- . over AddiDg mefitartotlsD'r06IS01S to be SnDPOrtedl ' tbDaf Innovat3ona'. Related to Cardthvas- . ~y buiitltngs and equlpmeat and , .: -eulaa:8iak Behavior in tlie.PUiN2o.".L Y.Eae- - the. averase of expensive medlcaV specisl-.. htirtherlROre'e iff splltow8 the Statess to~ 1'aw; J. ALan, and J: Headereoa (Eda)-d¢ypjy- I8t8"' choose whether or not theg wish to'o sup. 'img: BehaeioratSclenee to Cardiooaarralar` For etample..be said,.. "the.scope~e off per- porritheSeprOgrBtltt. Biaiw NewYar14 Ameriran Heart AsaaUatlon,. °Onat Preveatlve eervlcaqcovered at the tie-IaCTNagfng(p we ai8learD]IIgof health' .. .E4-t9g, 197s . glnmagPuf e.& aew, nattonalhealth plsn haaattSaIn the a3V We.bteakbe,the w8ter .. ~•Brownell,E:.~D: ..etui.The_Eeato~ ~~tbe:narroW.but'aapectalbaaracautQ.we.drfllk.thefoad'weeBE,andthehouses'. .' Couplea Traisiay and Spoate. Cooperattoet be `~°~a0ahedd to. a.pprove aaatttbnsl serv- welive.. III. The paogcaaxWou1f1 enable. 1tea.for aoverage after ttep have been testedtwasnrtreBehaviorsuTreatmentoJOaeaitg_ And .evaluated,- . - stabestodeslglLDrogramstoddeatifYaadPeqerpeeeentedat the Annual Meeting of tbeHiatt-summariziag an artiCle by Dr. How- preventt huIDan Illness caused by theseAseoclation. for: theAdvancement. of. Be-ard' FraZler and hlmself-urgedd rlgorouss env11'olil9eIIta1 he'atth:prObTela9.h hatfor'1'herapy, . Atlants,. Qeorg7a, 19a7. .- evaluctfoauf~. all medical and surgicat pro-. Physical HtmeSsshOWds be a goal for - xrbld;.Farquhar,.Joha.t4.etat. -ceduresand use only of: those that pass.s alL. AIDerfesma. This aieg. will Provide . . ~ - - me5ter m: beaeecial'l and cost-effecttve.. . grants to. argiAlEe tli• erleoursgeo thede- IFiom the~ Washington Past„ May 19, 19791 He urged GbngresctoPass ablllipruposeda yejoDaieat 01' Cd>'a~ffiIDS1Ve. Dh9s1Ca1 .. Henr.tn aoem'8sva DeeetE oNWuo Sasv.. tiTSCO-Ed°OardM. Semedy (B-Masc)-ors $taPSS DrOgialat TII[i' S$Ollld 1Llerease. L.m,Warr Snetr, f)Q ., samCRllat tes eumpretlensiNe" bill' byHep. ~, a„~naW niP Of tlleJE 19C]11tSC4 [ar at(~ . (8'7~atm'Coha). ', eenterealtb.servicee~renearcha.ItlWould. ~BrtC8D3. _ ~'iLenstlonb hesltlk bill larleing so fasttkasaee tests of nes maasines.. far example, -Reallzlhg' the. tuvermw aIIQi$theg ffiat. lt_tehaetening. the.e dayWhea doctars-eastty coroaaryartery surgeryfor'heartat- BtBtee.theforIDlllagraIItDrogramla.thls

8dag 19, 1978 ' + CONGRESSZ()NeYI. REC©RD-SE1UTE ; ,`S 7,1459 the roleofe the- front-11ue states: Is' like markets., We-are alread',yez{ierieneingy aNowever. it- has.became apparent that more Chamberlain's, legltimlzation of Hitler'a seriousdecline l:n our share of' the~worid additmnal storage space: Will berequlred " rnle in the Munich settlement. market--a& dechnefrorm 50-60 yercent than' envisaged during apprauu and pro- "-. eot Th ~ ld d th v .. e newprocesa- i ed for un er e prol -.-Butthe:IInlted'Stat~:aotoalyaccePta oalva.decadeagoto, 33.PememttodaFfis iug line wut ooeupv almost svncee the so- _"- -their role;, butsingles ou$'t a country like Flue-cured.d tabacco,, forr example:: More- tlcipared erea, the haaeatripping pracess.has '%', . Tanzania..f'or speciaL.honor and favor, overs.thereare:A other ominous market -hadto,be:tranereaedtoa.storagearea•aaa "ya - even whean it goes. directly contrary to signs~ that.are.well understood.by United the temporary shedsw111.nat remaln.servlae- '~ the pocketbookInterests'. af U.S. citizens. States and North CaroIina groweis. The - able after 1980; aawwas enought at. the time - .-. The leader of Tanzania isJules . S'obaeoo Division of: the U.B. Department of appralsac ... . .~•y,`: Nyerere, the self-proc]aimed!promoter of of Agrtculturehas-prepared statistles's at Despite the failures created by doctri- ."Africansocialism."' It i,kdimcult to see: my request which tell the' whole story. .-naire socialism•and'vlolations of human ,rhowPreddentCartef°can.squarehisp>ro- ...The - failure.e of Fresident.Nyerere'9r18ht5, Tanzania now seeks a third loan ' ,- mottonn of . humam rightss withh his's praise policies- ih Tanzania are~ detailedd in. aOf $14 mtill'on: Tbis '.money wouldd be used "~ .t-ofPresSdent.Nyerere. :-.. • . :. ...: :.stafE aPPraisaIl report Prepated for the to purchase plastic bags and bagging • ' i: In ptomotian of, African socialism. tyorldBamk. Actually, the proposed $14- eauipment.set.upgrading centers: build ~~ President. Nyerere has uprooted halfof millioa:.loaa wouldbe the third World. storage buildings with concretefloors. -~ .~-- his people:frome theiY'traditYonall settle- . Banklban made to Increase tobacco pro- and buy tractors and trucks.. , . ,: -ments. tisfng hiss arnLy to drive them out.._ duction, w1th uttle Wshow forlt because Mr. President, here 1s thepeint: We burning their homes, and: forcing: them-of T,_ry,.e=i,., micma^ vement. The two have a State: Department and and ad- : intocollective farms' often at great dis- pr,evious. Ioans were for $9 million andd ministration that lseager to doleuut the ,, tanceas from their, home'e areas. Iaek: of $g..million- ::.:_.. . --. ..... .. . -. American taxpayers' money to Com- ~. ... Planndng, lackk of orgsnlzing: basic serv- .- The language of the staff reportt is sur- munists and Marxists tohelp them un- , ices, tti,e choice:of poor farming.land, and.d prismgly- : h=h; consideringtheeSort - demut~ our ownn tobacco Production, and .. inade9uatettansportation,haveaddedto.international -os•ganiaations make-.to -destroy the Jebs- of North Carolina ...' ,....:. thehardships..:. :' .... :... ......: ..avoiddisturbing Third.World sensibil- farrners.TheTan3anianProlectwasde- . . Presiulent Nyerere-runa a one-party Ities: Spealtin&, of the- emfamed! collec- signed d by the World 8ank to: create to- . ' att Allf th newspers areowned ba fepothot ..ae.. o:eeaps, tivization.. thereport says: ... --.,...: _._.-ccoorar--as a cas crp-no , bythe-:Governmentorbythe'.pat•ty.The. ... galyperformanc> has beenn mlzaa, witn for domestic consumption in Tanzania. ., President 1s the'e editor in chief of. the . ~~eem maome~ reglooa aemoaaaattag.n aa Afterr the. original loans's were made. II.S. me;}oraewspaPers. He has between, 3,000 tmprmivep aburtyy tor mobulze-iccal eupport Praducexs" thought that theY had re-. .- d9000litSlis IJ]]s far fofi lftid tht th Wld an., poca Pronersn.a.r theconstruction osocalareeructun ceve! assurancraaeor Bank , more thanSouth Africa..On a:descendiag. -(such: aa schoots): orproductlve. Infxaetruc- would make nomore such loatis. ' - .. acaleofl-7..FreedomH'ouse-_rsakaTan- ture(euch.as:vivagegsain'andinputetoree). Thereare.32Statesinthiscountry :Zania as 6:C onl}r astepaliove ceuntriea- whilst ctherr villages have shown uttle~sbu- whlch:raioetobaccowandhave:an:intexeat sadists suehas Uganda itytay efcectivelymobuiseresouroesy vu- ih seein m that theiTf ownfarmersn do not ' run b9inaane - g , _, - and E4tiatorial' ~Gu1ne8_,. _ _ iagl~tlDna aaa . brought w1th -ftt probiema have'to flubeldlu' Unfair tompetition - -' whlch are lncreaefnglybeing felt m Tenaanla ., . , . with their tax money_ We:Oluste puta -- Yet.PPPBidentCarter allows PreSidentrn,ecme-arem ofhlgh populatton denslty . Nyerereta dictate: ourPolicy towardd maeglastton.has Iedd to.overgrammg and de- stop to this sort of'thing. . Rhodesi'a, andchosehimas the:8rst planon of aon fertuity., mother areas..there ~' Mr. President: today I am tntrpducAng Afrlcan.leadertovlsltthe-WhiteHouse:'n aresubstantiatd:meconomles.lnthatvniagere- -sbill!whichwouldhelptodoJustthat` .. :.-. ihi Augl7st.197T.,ThePresident haiied t11emust. now travel' further toculttvate delde. Lfdder that bill,., theIIB.. Executive Di- .~Ta.,~nian leadee, as.."a man ofmodesty' cunecteueiwood• and draw potable watsr. ~'-rectors ofiaternationalflnancial tn- .. would have to consider the _. and. greatt aohuevementwhot fu~m my- Moreover„the--socfallst argicultural~..stltnttnna'L oplnion.- holds the key to the- futureof' marketiingsystem has also taken Its toil:extenE towhlth such ]bans'; would have .•peece.e and equalityof treatment and oP:-.. .-The.mutetmg system ies often character_ an adverse effect onindustry and! agrf- ~ .. ;:. por'tunlty andd freedom in:. Africa as.. load bylsct or aompemtwn,.,nigiti marketmgg culture inthe; United States:. Moreover. dearlyaadaselbselyasanypersonallve:"y aoets:poorservnce., and s'iow...paymenta to, an economic Impact statement.t would :'-NOtsia71r1g1rtgly, the Tamzanlsan ecoa-, rarmers'-manT parestatalshave been Provea haveto be'.Prepared' showmgthe.g effect - .-.omrp haa falledto r~pondto*the.e8orts, too beinemcleat wlth-ezcesefroe uverhead of such aeafstance'om II.S. iitdustry and. . ooete. Overallk operattonsemcteney has not Joba. . . ... : - of enforced! callectivization: The dectrl--improved overfnepmtaecaae, and map even .. Mr.. President. II have-gone into the .. naireaPproachtd.agrieultureta.mat:chede have deelfned: ia.somen uaee. a+cesaInem. . '--. by similar misnnaaagement of: other ciencies have resulted mmmeseed trrdmg ¢ase hlstary o[: ibLs. Tanzanlaa loann at sectors; of the econom'i,y. The abridgment marglns,, whihh ]n turn lead to:hlgner, con- some length. becauseit shows in det811 .. of fundamental human' rlghte,, partlcn.- "umor pnces's and/orr lower. producerr pricea, the absurttity andr harm.causedm by for- " Iarl'y hrn the area. ofeeonomlc freedom... Theee, protileme, . haVe Ifeen exacerbated by "e1gII assistaneee toihdustrie8 that will ,: has worked_ considerable hardshipson.- the ehanges outtiaed abava-. compete with, ours.. Butt above and be- -. .. a, eountry - that .. alreadR . has.., poor -The: tobacco-growtag sector was par.- ycndthat, it demonstrates that unsound -performaace_..... ....:. .,.:,..:. : tibularL4 Ihard ltit by t2iechaages: 'Ihe and dangerousforeigaaoliciess policies . ~'1Peverthelesa:;A•esident Carter. ,co,?--»t World Bank loan, oI $9 mi7llon, was that will aHeotmtllione throughout the . _,," worldSOrthe worst,.also have a aegatlve : ~tlnues his .endomement::of, '1"• - _., imtended for llhe.fomed.resettlementrof-,impacton:.ourowmeitlzensathome.0ur polideH At-this very mument, the- V:9.. 15,000 : tobaccogrowers. The World.Bank African Policies are heading tnward , . representative to.the World Banklsspre- Reportsay+s: .. -.. .. ... .-.' = disaster ~ Af3):ca;.; and.ifd that happens paring to support- a, $14, millloa, duRar' The project quickly encountered dimcul'--~ the eonsstiuences wi11 in the ksng run .. loan to balll out . the Tanzaniaan tobacco: tres. The-settlement of fasmers reu'W behina- affect: the : Linited States. Butit eveanaw. ..'~' . industry. As: the single largest contribu- sohedulee as areslrit of government preseurea d er to~ettrryYavor with Marsists, and torr to.the Worid Baak,k the'IInited-6tates. . on, farmemto ,mdertakecoliecttve tobaccw . or ( 'O'PIESid mm'un1et8111Afliba t C ' ' v ea arter cul tivatlanandcnrmg.... ~ ._ .-: eanrlesa weight of endorsement that.goes~. Tobsceoo production. Iromt the'PmJect ln" seems wi111ng to saerifleethelmmediatg ~ , , beyond the Weighted'votiag sYstem. Itt ia.. 1976/TI'laestlmated at anly3o percent cf the- . ]nterests of V.S:. taSpayers. These.polie9ea . hard- too beIIevethatthe WorldBank revised estlmates sud.ls only aaout 10 per- are tiemg. Pushed without regardd to the e ' wo ld tu d ml l T • _ rnn own. a u an¢a ana proPOSa cent of totali Tsaaanian nne-ciaed tbbaccoa eonsequences, based upon some strange : aftertheglowing.trttiutesthathavebeenr production, .ratherthaathec7percentan- ldeological-compuLvion..Bydemonstrat- .paid to Nyerereby President Carter• See-ticipated ... ., thesmount ot-tobaccoso far. iag theimmediate harm these Policies retary, Vance, - and Ambassadar: -Ypung-- . growa.ls,dfesppomting...,.. _ . .: bring;I hope to help my colleaguess to _ Yet the purpose- of this loan isto In- The second loan~ of $S mlIllon, .ap-- understand'd the long-term consequences. ._ cceaseTanz ras_ in*, tobaccaproduction for• provedin 3eptember 1976; . hasaLvoa pro-. Mr. President, IX ask unanimous con= ...exportsales;..competingditectlywlthII.$r. duced fewresults:-- sent that:the text of:f my"bill be Printed .....Aenlm TI.aTn....•..,/n..1.. ....~~.. ' . - m:G1Ve 1n lBprUaryi "" '- lneludes bath: Siue.curedd and hurley._ a#7v. moat conttactes for prolect equtpment ~There being:. ao ob}ection•, the bill was -Theirmarkets-are-the.samre.markets-at hameaawadF been awardea.. and.-macniaery ordered to be printed ia theRScoan...aa - I . F ,3t Glarketa--aad as:NorthCarollaa. Inetsllatton:commeneedn fa. Novembee 1977: followa:. _.

S 7872 .. z~ .. ' CONGRESSIONAI. RECORl? -SE ATE Bfia'2( 19.. t 97R -": Aear forr each.of: the Drov.rams ilsted.in eub-. m the oase of:theLecan ve.e endfne ua i.. of ..,ee~ ..H..,.... ,., _....____.. .. r e u a ee (7).( ) r paymen . an or ore July 1, 1979. m the.case of the amended by (L) strlking"'a Stste's. a11bt:~ grante,under subaseot1oID. (a)) for:establishmg: Lacall yearr endmg. September 30, 1981, 75~j ment;'. m clause (A) and. lnserEfngg in 1)eu snd malntalningprograms Ior the screening, percent of'f the amount of such.eryendltures thereof "thesa:ounti recelved",. (g) atrlking detecnon, dlagnosts, prevention,.referral for m the'..State.'s flsoal.year whlch.ended-on or •'of & State's allotment" in el6use (B)(i) traatment, and follbw.up oncompllance with before. July, 1. 1980, and In theeaseof the and Inserthag m.lieun thereof "received under treatment of', hypertension, there are author- Hacalyear ending September 30,.198R;.10 per- paragraph(4)^ . and (3)etriktn "Stat' ( ) g e ve pu s a es ee ns llc heelth. servleesarithm the meats:. , ,.. .. ' conditions. -State: )n the State's ffeca) year whloh ended (b). Paragraph (6) of sectlon 314(d) Ib ' 1 Pb ffi t ' unde b f St t aetlvltles aeslsted under grants under sub- oE. Stateand.locai.e eapendltures.for compre- any previous everpaymente or.. untlerpay- ~' ctlon aln tontrollm ueb dlae e 6nd il b i ... . IJJ. «+ aeyuunu.,r.:w, sov, e.a perceni or tae amcunt menreas appropriatewlth adjustments for . , tlen oE the..8tate., er Under granta under paragraph (T) oa the (L) msy ante[luto- arrsngementa with ra- . .•• (i) ': may not ezc,eed-the ieeeer.of-.. partment of: Commeree. .. 8ecretery may by regulation prescribe. 1"'(I)i the prodm;tof 61.00: and'.theapopubt- ''(8)The-Sttaetary may makepayments .-^(c)' Centerss asslated. mrder this eectfon i a gg st thee endthereof the follovnng new - . for the:8ecal yearand)ng September 30;.1982. g . .°(3)Par mymentas vaderr subeeetlon(a)~ nseal. year In accordance withv such clause p~%gJ'aph:. . . .. foe.establishfagandmelntaining:aommunity' ~'all State health and mentalhealtl'r-au- ••(C)~ Of.theamount'sppropriated under .. andi echool.based'IIouridanon programa, thorlttea wlth- approved applications; the subparagraPp (A') for anyfiscal ynar the . "- tllere~'are authorized to be spproprleted -total amount of'grants for that fiscal year mr . Semepry slfaLL'U obllgate noct more then - 86,000,000 for the flsast year ending; Sep~ State: health andd mentaU health authorl. 81,000;000 foc the unlform, natlonsf, health . ties shall nat.beLeeg than an amolmt whlch. p re ortm .: en ~~d1ng'SePtember.30I981,fanG88,000,000bears.the eamerr.tio.to theamounta deter- p ~ h(Z1(C)g1l)~~m. referred to lis ... tlle.eacal year ending 9eptember 3q 19@2 for m)nedforsueit authorltfes.- In aecardance.,B..II-~~~CE4FQR DISEASE PRE- . '~. Por paymenta. under aubseetlon (a)' anns suchclause as the amount aPproprf- . ~~ON AND~ . ated under such. paragraph tleare to the - lII^AI•TH PBAM0120N. .'. forr establ)ehing' and. maiata.tmagprogramsamuJunt neededd to make 8tanta, . Sa accord- '~. t>s+rara roa ffiwnra norrormN~ ` .. designed to: prevent flineess esued by fectors'anoe wlth such clause,for such 6sca1 year to Sec. 201. TSt1'eDI of the Publlc, Health Imm pla such ss..oca)IUM.erpoeure.nW toxic sub- _ aII~ State health.and mentall health authorl- Service Act Is amended byy adding after sec- .- erwnces, and'd lmproperstorage ofablld vreatae ueawiRh approvedappBratLLOhs.. .., tion 316 (added by section 109' of ttita Act) and Iueis, Glere sre tuthorlud.to'd besppro-, ,•(B) '. The.. Semetary;at the:, request of tha following newsectlonand beaCing p'r)4ted 812:000,o00'for.the.flecsl yeer.endlhgState health.and,mental healthauthorltles; thereto:: . .' . ... :. September 30i 1980, p12;000:000 for the flacaly may reduae" the: amovaC at the gr ...ants.to1t •t'ansrs roa~7ra. nosrort0ar year ending'. September 30;1981,atml underpamgraph..(1),.by- .. . .. ,.°Sae..318.(a) PbcLne .ofwlaY-'.. ' i19.000.000 tortJle 8ecal. Aear ending.9ep- ..~(i)', thefolr market value of any-suP^ yye.. m P~~eea . tember. S0, 19o: ..' -._ - plies or equipment furnished ench authorl- Ing 8eQ°tarA carrying out sections 315 . ..'°(5) Por. paymeafa tmder'suhscctlon .(a) t8x,aad .. . . .- . . . _. .and 317: providfag such technical and oon- .. fa eetabliahlhg:g and.. mslnminmg ptoga'ams' (h)') the emount off the pay,. allowancee, suYting aestetance aas reelpleMw: of: grants tnprevent diseases Dorae by rodente;M thenand travel expenses of any omcer or em. ~°Qr auch.sectlom msy Srom.tlme to time are.authorffied to be-approprfated.814,000,000'e ployes of the Oovernment'whendetafled,. to re9vire: conducting reaaarch,. etudles and -- forther flsesl year'enAing Septembar 30,.198Q; " the Smte health or mental health authority 0°~~ (Including eaet-eIIecnveneea analy- t14,000i000YOrthe8scalAaar endingSeptem-. and theamount.of anyother costs incurred ~ dQ4entlve hesltn.servlcapeoB~s: .' ber 30. 198I, snd'~ 814.000:000 for the8scal' )n connection wiLh thedeta.tl of'such o0cu PmgapProschee, methodologfee, . aram lo .. . pollefee: and stlantlarda for delivering. p,re-- r yeat'eading8eptember30„1983: , - - - p ye0. _ •..'':.I venttaehealth services, the Secretary etiall .. (6)(A) TheSeeretaryShallestsblleh, afYer" When the rvrni.i„e"of such. suppl100 or by graub assfatpublle orpnvate nunproGt :. eoneultatlonwiththe' Presldent's Council on- eQulPment: or thee detail of such sa omcer eatltlm )a meatmg the coeos. of'plannmg and Physical y7tnms: standardefor comprehen-or employee la& for the convenience of aaddevelopmgnew- oenters, and operathrgg eziat- eive physical Htnem programa. .... . ... at thee request ef the Stete health. or: mentsl ingand new bentem, for multidlsc1p11nary _ `(8)Por payments under.sulieectlon(h)r hesith authority and forther purpose of healthpromotlon. To.theextentpraccGeatlle, - fpr eetabllehingandg matatslnling. comPre-'oarrytug- outt a program' withh respect too the Sersetary shall provide emistanceunder hemivee physical 1ltoees progrsms that are. whlehltsgrant'under pangtaph: (i) la this section so that at leaet',ffve:euch eenters '; consistent wlththestandardeestabDshedmade. The amount bywhlch any suoh..grant .w)]l be'm.operatlon by October.1. 1981. -_ ptasuent.toparagrtph. (A):,. there are_an- la'so redueed.stiaB' be'avallable for payment ..(b),(1) No grant may bemade under this . . thorlred to be appropriated' $10.000.000 for by the--Seeretary of' ths' costs Incurred fa tlb~ tloesl year endlag: SePtemtier 30, 1880; fmafshingthe supDliesor equlpment,, or fn section forplanningbr developing a,center 817,000:000 ter the fiscal year ending: Sep- detalBngthe:personnel,.onwhlchthe.reduo- Unless the8ecxethrydeea'aLnes.thatwhealt . -., -. tember 30, 1981,.and 818;000;000 for ttie.8sca1e tion of such grant.ls bseedij and sueh amount Ls opera2loml it wW'. meet the requirements year ending' 9ePtember 30, 1999:". ..- s11s11- be- dcemedl ea part of'.the . and .~ted.m psragraph (2) and bee ablato pre- - (b) Section 503(a) of Publie. Law 91-e9E'- ymD, be deemed. to have been: palgrd grant the ~~ ~ISoeande dissemination of lh- ' (telanng to authorization forr lead.beaed: 3tate healtH, o[. mmtal health authaMty., formanunn to recipients of grsnte, under eeo- .. -. pstht polsoning- preventioa. Programs) 7s' -(C) For purpoaess of subparagraph (A)i tisoaa316 and 317 ss..provided la.aubaectlbns and Under amended he end t~ereof:e't, 8 4,0before 00.OO0 the tlisftseal 4t).(II).. the. term 'State and local eapentllL thfa section)for operatlomHOf aecentMereumese t ear ending. Septemtier30; 3980, . 814,000,000 ~es:for eemDreLenslwe publle.health,aerv- tbe center meetesuchrequirementiand is y Soss' meana.eapendltures tly SLe.ta-and lacal-atile-~ prcvide.suchaesfstance and..diesemi- . fos the8seal.year.endmgSeptember 301, 1961, . public'health and mcntalhealth authorities '- and 8/.4,000,0000 for the 8aea1 yeerw ending, ~ public heslth' services desfgnated.by the nation of informs.tfe¢ . : September 30: 1983-• -Secretarp but excludes expenditures by such ~(7) Theeequiremenra.ceferred tuln para- ezransmN or ceeril9io axarrs roa ccauM- authorLties- - - gtaph (1) ere as..toBows: >vavsava avsnrc awsa seavmm'. •(i)specl9cally'requlredby Federal statn. -(A)Thero shall be. a: foll-tfinee director . Sse. 104. (a) Paragrapha (4)) aad'(5) of tory law aea.condinon.totherece/ptof Hed1 of'theCenter who posseseee a.demonstrated seenon' 314'(d) areamended toread, as fol-eral ansnclaliaesistance, or capacity for substantial accompll'shment and lows: '(If):) for operatmg. )mpatlent care facilL+-- leadershlp' in hgalthh pramonon, andi there '•(4){A) The tob31. smount of~f grants re= ties, censtructlbn, or mental healthh pro- shall'be euan additional'l profeeslonal staff . eelved by State:.hesithe and mental.healt7ll grsms. -' - , aas:may.beapproprfate: . . authorltiee.undec'Paragrsph (1)foreqyfe-,. "(D) For purposes of eubparagraph (A)' . -(B)~. Thesta6'of the Center shall repre- . calyeershallbe.determtned.by.the.Secretary. populstGonsshall.bedetermined'.onthebasfe WantadlversityofrelevantdlactpLLhee. . . ,: eacept.thatit- -- - of thelateet.flgl¢ea available from.the De•- "(C) Such'additional requlrements'.ae the _-, , her30,. 1981, and..840,000.000 for the Hscal :.,, °(I!), may:notbelesethanthe.greaterof- (e) Sectmn 314(d)(7)(A): I, amended by. ,: year ending.. September30, 1982.. .- -- "(I) thetotai: amount of' grants received striking "s.nd" after '•197R," and Inserting .. (9) phr peyments'under sulisectioa (a)~ by such. authorities under paragraph (1) for before thepertod thereof:. ", 8107,000,000,for for.r establlshing.and.maintafning programs5 the. Qscal year ending September 30; 1979, the Qscat yearenEing, September 306 . 1979, ... to Immunlma chimrenagalnst diseases ()a- or .- . •. . . 8125,000,0000 for the Hscall year.w ending Stlp_ 'tludingg meesles,, rubella, pollomyelltls, diph- '•(11): the:w product of 8.50and the popula- tember 30, 1980;.. 8140,000;000 for the8scal therbs,, pestussta. tetanus; andl mttmpe),, tion of:theState: year ending.September'3 1981, and s150,000,. them are authorized tn be appropriated 836'. Notvrithstsndmgg olause ()1): iff for any ts.- 000 for the ftscsl-yeatL ending September 30, 000;000 for- the Bscal year ending eeptem.. C81 year'the amount a I983'; .. ber30;1980„ 635,000,000 forthew Qaval A~r~~ . PProprlsted forr that .- •endingSeptember 30, 1981. and135,000p,000y~ under P~6+'aph (7), Is leea, tbaa' (d)9ection 314(d) (7) Isameaded'by add. the amouat naetled to maketar th renta t 1h "laad to be appropriated 830;000:000 for the oent ofthe: amount of such, erpendf.turesm almtment" ih clause (8) (lt)'and ingsertfng:f:n - fiscal year ending'9eptember 30. 1980,. $35, the. State'ss fiscall year which ended' on Or Iteu thereof: "amount received under pen- '~ 000;0e0'W for the Hscali year ending 9eptem- before July 1. 1282: : and - graph' (4)" . _ ~ . . . . .. '.. . . . ~ . . ,- .. . _. , - . . . ~ ~ V.JVV.J.6Q!i '~'~~-

-61ay 19, 1978 CONOItBSSIONAP.' RECORD=-SE ATE ~ S!7873 ..avooass or- sastts stsss essocreet'so:wrra-Mr:. President,I' fully support the'articleand'.paper,TllusI..askunanimous ._'- ercoamn asasesrrra eP veazava r.wa oe major Droviaions.ofthis.disease prevea- consent that "Health Hasard.ADprattal: .. ex ,ru sn srsnraca axa wms scas: c® tion package. Iam extremelyy pleased to. Its. Limitat'lons: and. New' Directions for r eoececoenzeea® m eaaraaacreu.uz erx~- seee it Presentedd as a comprehensive ap-~ lttsk A'aseszment,'•" and "Heaith. Costs •~m nm"a:aTSe - a : _.Proach to the promotion of good health~~ Spur Debataoa Who Slaall'~ ISva, Who ~,: s.c, tI, (ap •rhesecretary of Hesatn, adu- for the Nation: I hope my'coileagues will-6hall Die."' be printed fn the Rzcoan. a - d t uc , ar . cetlon,.. and Welfare saau. coa r studies reuge for the conduct of, a study er agree tthatt thesee pl'oDosals ftlLl a major There being noo objection, thee ma- '. . . oi. (I) the relauaeheaithr1sks manatatad. gap 1n ourr health DCannlh8 and delivery terlalwasorderedao heDrimted.ln the with amoktngcigarettes of varying levels of systems„ and that these bills will gather . Rxcoaal as follows: ~-.tar andd nicotine, and (d) the health rlsks the,e strongg support they deserve.R.;Hesczs H-- . s~.: Ira. Iasrreaanns aseoctated with ®oking cig%lettee conntam- * .. Mr. MeQ3OVERN:.. Mr. President, II a+a Nrw Dacccmars:aoa Raaa easzsennrr., mg any substancm cbmmonlyadtled to.com- want to~o take this o to eom-In consld erin tae- broad msndata of P:L Oitunit g pD Y . merciany manofaccsuad cigarrettes- H lth ShaNeLloaBl Coaeume a1Z ' s4 Ia ea • , r - . ' (b) Withm two years of.the date~ot'en:- meZld. SetlBtorSxPNEUYand the staff tormanon and-Heatth.Plomotlom Acc ef 1678,' . antmenti of this part, the Bacretary sEall re- . of the.3ubeommittee on Healthand:3c1- lt beas been.clearto me tnat pexeGn risk as- ort tothe Ooagress theresuitsf the study entifla Research for the development and p. o' nr studies conducted pursuant to subsection _fntrodnetion.n today of . the National eB~ent Ir one of the nawett potent and '(a)i aad any reCnmmenaanoas. for leglsla- Disease Prevention and. HealthPromo- prnwning-alnett embrrooic-tecan/quea bt t d a o:a vaace the statua ot preven- . '~~tecor.admlalbcrsttveactton: L ava9s tion Act of 1978. L8[e 8. 1191, the Na-'..tton,preventive esratcae, tealth.h promotion, _ & Mr. IEGLE. Mr:.President-SenatOr tional Preventive Medicille,. Health health-eduoation, health.lnformatton, and 'S&uN b-TT-MM'I are todayintroducingu Pt•nmohion.Act of,197T, a.bill somee of my the myriad of nther macthms mnndated by . with additional cosponsors, a- full=scale ootleaguesand I introduced principaqv' this important piece of legi,latlon- ... -... .. . prevention. Package designedd to: develop -to address'needed eAangesIn.biomedical alslc, esaeeement; often uemg,.healur nsa« st . t t n l m l ' °ro appr sa ac n ques, vo vee the .. anatibnal strategy to prev,entil}nessand research, this bill is another potentfal. e eom- disability among Americans. This pack- step in the mostt eriticai'~l processofre'- ~a r sn.tyve off tnee pmbebutty ofreduced age-presented In. one comprehensivvediessmge the balance, betweenn eurative°~m°ey~e or dasthh la the next- ten yeara, poeed by the partlnlnar• oonateuettca . bill and In three component proposals- and Dreventivemedleme.-Jvst.tilia ot risk tactara m.sa mdivldueL.It hes.gmc .. utilizes State and.Faderal.resources„ re- morning in:n ttle Washington Post• the. -potenteal for promoting concepts:of weuness search;; and' edueationl experimenYetion importance af altering our current over- and risk tscwrr x.ductton' through chsgea ,. and' proven programs, all: designed to emphasis on-ctlrative medicinewas.high.-s to ilfestyle,: but.1s currently hampered by ,. -reduce theincidence`ofe disease In this- "lighted in.an article ttledl. "Health IIeveralimportant dehctenctee. I sincerely °-I wul not: break Lae dract rula or a hd . p " countrF_ h;oste Spur. Debate on Who Shall Live: . . . : .- . good speaker this morning'by Irritating.or - . Perhaps the most significant part -of: Who.3hall.Dle.." .. . . ... .. .. ... ' i..n„id.± g.. atore than So%',% of the audience. the National Disease PSeventionand. -A%chairm%n'of the:Nutrition Subeom- I: do not want you tothtnt that I bellew _. HealtliPremotionAct.of.1978'~isthe.food. mittee.Iamencouraged..thatoneofthe. I'navedtecovered.mcetofthe.tesues lwih isbeling and nutrition'informatlonsec-n bill•s five key, elements revises the foodl diacustodaF. °-...,. ~-tion, whlch,is based m' large part on the Iabelmgstatutesin order for consumersAS I see tt,. the problem.sre:e witnh hearch his "rdI eppr°lae`t- [anl within four enerat ~ provisions of'S.2540.whlch Imtrodueed. - to'be able tnmake2ully informed choices - g . carles:. -. -, b t th f d th h au e: oo eF Durc ase: on Feb 10ith th cospnsorship a ,ruary' we.eo ~... - :.-WheOalnltaow - ~~ 4.~ ~.~ : ofSenators. S,anraDY, w*rrr.*R'. and. Ialso-note.thatm0!distinguishedicol- :..Wmt•emtmitnow•. . . ,.. _; '-#lacxvaoN.. Senator'SZIaNzDr' and I feei, leaguasfro.n Maseaehusettsemphasized -.Whatlt can do now. - ~ fn.hiv..flmirntatnm,nntth,•n~w.a:vwt'nn-.....Wlvtitr.ouldda ._:. <.:.~. -~ thnt.nane. nn,rtanamf~C~..956ncfinFhnA~~. '`.Amendhlenta Act- of: 1979, deserve aw realized'.potentib.l of.the Office of Health: :..°:a'= •< ovn.r.sconoaaxa< -:-. . ~'promihentmsilionin~anFeomprehensive.Information:and'HealthPromotion',and~Ihave.severaf.overattconc ernewmch.re .' dfseasepreventfon package, and Irthank: -hisexpectatioas that at>,V'-concrete- ad- relevant ta health hazard appnaeal.. .... . the Senator for including many of'these.m1nL5trative proposalh for deallng:.with- Moralism: Aw I:revlewmost of tns(iltarv -~. provisions. At the same time, I:would like disease: prevention and"health address' mre concernmg prevention, heelthpromo- h the Senate: to know that I amcontmufng' the futureof- that office. Iwoulld amplify tian, and wenneae. Ihesr tones of the mw to, work' toward adoption off additional . fils: point by sayingg thatt theDepart-' rengton. Usre l.ai.ande'a talk )aet year epit- .measures d'esignerltoassure that Amer-ment'a- failure to aggressively developcnusas, fa many waye; eucm.marallsm.Wnne ' deeortbmg Important innovative eaorta. m " ican consumersracefve full:aad adeqnate.that affice: to. roatchh the mandate seY. . ee.nads.to implemene.tne operatton Lifestyle . Information concerningthemgredients forth.ih the Nationall:COnsumer Health ptogrem, bemakeq frequent referenaeeto and nutritional.l valueofthefoods: they' -Information' and.Health. Promotion Act. "bad" and."tarproper•r• lifeetyles..and -arong '• '• ° ' and abuse oflifestytet'rhiskind .. buy.andthatthe.Pbod '.and DrugAdmin- of1978.has:impeded.progresaitl..alllareass cnolcea istrationwiQlhavesufficientauthoritytoofdfsease.preventlon-and.health.pro-ofmorallam.haa3ong.beena.p roblem~mpub--combat food contamination and Prevent motionl Furthermore',; in light of such Ub health whsG the where-we publlc eften .hould du. feel we."knonv bet- -' . . consumer deception and^ooffivsfon "-AaDers aa: "Health' Hazard ~p~~~: ter . Failura to Atknowtedge:.Disertng mdlvtd" I alsolodnwith Senator. BxxxxnY m. Its.. Limitations and NewDireetions. for uat values: Acorotlay -to thu.s moreusmn is. ' proposing the- othereomponents of this- Hitir Assassment,:' whiclrwasdevelopeda our frequent fauure~ to acknowledge that _ ~'dlxeaseprevention package.. I am eu-byMS'-JufterFutie.rton. EaterimDirector;. healthfa.not sn end in tteeiff,, but ameans .. thusfastic.about.theopportunity'tobar-c the.Iost.opportu,nitytoobtainvitalpolieytouvlag..the-kln.d af ilfe.one:desrres. Not ness the energy and resources of' ourdtrectionr from the©ffice of Health In-~ ~ eeeryene aalueehealthaadi long llre m the--.. State governments to combat high--formation and'Health Promotion does 'eame way. In partlcuoar, peoplee havn.wldelF .... mortality diseases, utilizing both state- nott appearr to rest with. _t'hee verysmail sarYtng, vatueo- *bout nsk... eome- of- us am - ':avlnl0 and community-basede8orts.. 7a, sBafl.of~._t1ult office'e who have labored ~~Frlak aversi. wmte others sra:not'.so -coaeeraed sCOUt risk, ead virtually nom, ot . additibn: I feel- iC-iS essential. that LDe~ underr aa sevare'e budget constraint.. ._ . us, fas conslatentt acrbeaaa areae, aaaatages. Federal Government expand its own role. MII•., president„ the development of -of b,ir iises In our vatues about.rist and our -in'the- prevention of.f tllsease, both health maihtenanceand promotion as "'°illingness, to maxe ohangeas and' chofces re- _through research aridthrough publle. a.-national', priorityreqaifes.y that both :lated to.rlsk.. We.need'..to tnclude: indivldual- ~ education programs: Andit fs:longpas 4,'ongress and the aflmlaistrationn takepBrcBpdbne ofriskand tudlviGuai values t m eme thne, In this respect,.for the Federal:C.ov- an active role... Thee introduction of'thta about rlak. We muatt recogatze that to so peoPlee tt Un eimplF not "ororth tY' to make ernment to~ put.itsefforts.stronglyon theblllis another indication of the Semate's. - drasttce changess tn iiteetyteoathe basUs of side ofprevent5hg cancer- through per-interest in. proceed'h]g, as - S8Senator . available probab6lity datt. - suasive',eHorta to reduce the incidenceof. SsNNZoz'sreference:toproposed& addi-oyenmedteluzatioa 6 of Prevention and cigarette smoking:. Every American.n tionallegislation,on~biomedlcalresearch, Risk Assessment: s2ost modern. preventibn, shouldd have the. right too smoke, but't the health, manpower and health Insuranee mn my vlew,. ia not: ^memcu,e•• nt an. at least , , -Government should.takebtrong, positive- As we pursue our goal of'incorporatfng-notlnsnywual.eenaeor*astterm..aatnar„ ~ volvee: com- . . actionto reducetheihaideneeof smok- disease: prevention sudd health promo-- yiaz prevention and lnteraatlons risk among reduction m mdivldNals, aoclety "imB-ralated. illness, and-. to ssaurer khat tim ih oyr natloa&1 health Dolicy. I bee .and eoclu. vuuee, andd basith-prcAStonaia-, ~ _aonsmokecs.have.therigpttutireatheair -liever It:would.beuseful to consider the. ~'.free of cigarettee smok.e-In public piaces pointe'. raised in the'above-mentfoned. I~iotaotei~at end of articta .2 .

.Mffy 19, 1973 biIIU aIIows each State• to•focva its efforta orpaneof lts•.fiNereadiTtg cauaesof death:Inaddtiont.lve provide fonds forthede-• '_ celopment of a- 9tatecommuaicateons l. program so~ that~ the. State~maS~ utiLSZe mvdern~~mase.medfa•techni'ques:to•aidin . ... .. - headth prnmotfouanddiseasepreventiom ~ S'z879 reet•: bu'(ti~ theSenateCbmmlttee otr the tooverhaui and': improve e theflaanciai:. Diatrictof COliimbia:deferred acttoa mr management. and.f(scal aceomitabilffy of:f tfl.thecityhadassursnces:thataprihste theNatontaCapital.I consider none, developerwAuldfi)1lgutiII7stfiesite_De- ®ote. fmportaatthaaP.L9i1'-399:1a1975:. tail'edplsnsfoctheproJeet; hauebeenap- ThatlBw createdthe:•L2mporaxy-Finaa-. Pr°ced by lora1 guae~•r+man nak Iand P1ao` e1aT Qversight Commisvion ta imlRoee . . nthg bodies;." oppositiomhaa; beem.eE mauagementt and fiscall systems so, the piBssed.atnamerouspubliemeetings,andfhst,totalaudiL.oftheDistdct's:flnanciaf. heatings; anrladeveloperis prepared to posit,ion caa bee completed in. 1001 and.d commence construotioa this-year.others:ca¢becanri-t nannuaUythere-Th"s Ieglsiattoa:involves no expense to: "after. I chair the Comnnsaioa and it al-y theFederalGnvorament,andmerel3:wt11ready has madeeobsiderableeprogress in :+ theseefforts?wecan.learnr.which- st4aEe- clear a cloud on.tb.eSanrLthathasIin-. est^btish+ng sound 'recnrdkeepdng and . gless ataeHective<•andwhich should be gered fon more than. three °uacters.of a other aecesearyproeedutie&, tlut 1t,t has'. Dursued'.natlonall3. -.. : :-• . ..centa.Lg...Ori¢fa^Lg. theIand was dssia- fnm(d that:tsamreLstfaelq~'minar chaagrs. "'Rsthe: Subcommittee oaHda{th~aad nateda for PubIla.stseets. but, under the In the 1975, act wi1L clazifglts:auth°ritY.. - ScientifieResearefr, on•whioh-tamthe TLTM- Statio.ntAOfaoE1901.and:19a3,.theands will peru>Lt.more eapedittousand: - .... ranltlnB$eputilleau,psaeeedsto.constder.stredsFwerrdoaevfandatiaadoned.andcost-efficientimes:ns.ofac nievln¢tlle;goal., . •. Ta better undetstand how all tAe• eie- :' menteof a.headtlrPromotlon-p'ogramaa- :'« teract in a speeift¢ c°mmuaity, thisa bill `:: woulld establish five commmllty` demom- ~• strattoa•. Programs.. F hopethat- from tcorJCwith us teimprovethepreventYon- Phia, Baltlmore& Washington RaiI- cally.tllechangeawouldpermiatheComN, this=biIL=uPgealFconeerned citfzenstos the land:',wae grantedto, tticPhtiadeL•°fiannuataudits:for the:District.SPeciS- ..of dlseaseandpromotfonoflYeaFth•hrthee road. Co:c andtothe BBItd-more & Ohio.nm*+**-: fixst,, toa negotiate certaiia. :. The PRESIDZNG. OFFICHIR.. Withoutt tha. sitie•- as UcCeax R•enewal Plsa for Settatoa, fr.om Wtashington. (Mr. 7acic-. 'sel£andothers; tuacreatrpragt•mmato.. ThelaadwasbsedprimarilyforswitchCommitteeonGovernentaiAHairs.t ` promote healtB) tmrougfi smekiifg, deter• traclis,. IoadingK docBs,. andd open air stor- - :. rence: belomtlrreferred tetHeCommit-. a&e: As rarl traffle• dirmnished' at mid- ' tees on.Environment and Public~SPMBst; century, the city began considering the •ADDSIZONALCOSPONSORS - . ,. Pinance,: Commerce; Science;, and Tran.c- stte for urbagreaevaal: Ia 1959- theSlis. ... . . . e_sus..I. ,. . . .._portation;andHumaa.Resoorces- .. : ..trictBbardolCoumusat°aers, designated . AL.thereque'st:of:MrBaercorn.the• Mb RABEIL'I•Cr'B4TgA..44Y. Presfdent„ for the perpetusi use°, of the railmads: mentsT with- theDistrdctroa Partieular F ask nna,.+*.oua~ consent that a bil:i~ia- and- in eachange.. they gave more. cen- eontracts_ TBeehsnges atr essentally ttod'nced earlierr bP the-Sena:tor from.._..traAiy-PoeatedproaerGiesto theFederal! r.,,x~ and.IwouldeapectthelegslaR • Massachusetts(DSi•. Swxenr),,.foahim- Government.:- s - tion will be swiftlgconsideredy b8the . . .VnitedStates.. - ~ ... anrJi~.to-theTemnnat.CO:~~.'lhelandwas~i eontraetsaadsecond:~~.to•enter~into-agree- aa nee ~" . tfie: District.of C°Iumbia,,.a.critdcaL pr1-~ -nationaF cooperattbatocombat inter•Ia1900'theDistrictPaid:thePenasylFnat7onai`.tertorism .,.i ~ltyy iss`ea the sasion oz the IocaltasL * _ propertyof the Chfted SYates to.the DIS.at'flrst heliectnr any rnmaa pntn>.Federal'~ ~cyy=°x),.the Semator faam Minnesota .trictofColumbis:.RedevelbPmentISnd titlecouidtiecoaveyed, adn~istrativel,yr (y~,y,H~ssal,andtheSenatonfrom. .~. Agency:. to the- Committee on. Governt under tho' Closed Street~ Act of 1932. PeansgLvanla (Mt:. Hsma). wereadded as ~mentalAgaits. ; - - . . . -. . ..foundbareTegaltttleremalnedunderthe~ponsmsol°..~2236~,.a.btlL'tastn'ngthea. . • Mz EdGLETON. Mr- Ptesidovt•~ for oTiE II~m Stattom Acts and that wm--~;erab.polYciee..and Progtamsand mter+ esaionat aati®i w ded . . .. Sy Mr_ EXGLETOR::' . . . their rights and interests Nmax),. the: Senator isomTennessea (YIr:. ,.5`3tT9-AbilLt°transfetcerYa{areal Asthepro]ectmnvedfonward,the.citY. S/usssa) the:SenatorfiflmMlssourl.(Mr t~ww:wvu,.,u,~s.r.,ruereo=. _. Ar 1982;Pald$r.52h025fathrrailroad§aor sox) ) nne ~_sot: nnmr umo ama. _ ..Gr.am¢),.the Senatna.fxom.Georgla;.6ildz , PrSVate.constructlon_SeLGrellanceshould. , andlim 1973;.it. pa1d:$3A.milIioa for.sa~ At the reauest of Mr.. ANnessoN., the-e hean essentfaLcompanioaoLHOmeRUle ~~ ~ehouse•psoperth tn. com- Senator fromCaIIfornla (Mr. Csnxsxox) .CIearlv...increased- capaeitpbycthe.Dkr plete thesitee bninging too a.totsloC$5. ..~'.added asacosponsoroTS:238®:the. .;tr7cttcrafscits.a~arxra¢enurn•.~¢ilSmeau 37a.9241.it.has-paidto:seeure.thesitr_ ...DUtch.EIm.DiseasrCCntroFRetiol do.•naa..i T9~F7., -. •.. r a~ ; m v . ; oni $ - t - s $ ' hase.througTithe.developmentotneeded . . .• csaea . .. ... . . . earflaterestfae.the~41.000, squarefeet. . . , p snl Rn i l ad 4 xl 3aaf t rJ ht ti le r .. ~ drpe, o„re.. on the: Federal zws„v ,.n .r,v.e.t,.e ... .we. ie...,~~ .r.e. 4 ~ .. • ~ ~ svrs ~ ~ - eg, s a at on. ~.w9Ihit.anuniatentional, roads paid.over~the years,. it.was~the.~-~ProvementACtot197&. ' im edfin nt f l a es acons ra on ana. ou r of the Zc P 1 ' sightly andidlelandwithffithe. ~Dlatslbt. use- ~ .. .t,vn. G. -~ It 1s ~ to: this ~~ end that ~ today I iatrodnce ~~~t to ~ use' tbe paecels.. in Southwest.. fferrn¢aT wss addedl aa. a~. cosponsar of 4• Washmgtonn and'~ of the tasess the~ rai1- S.. 2~475',. the Pubiic Grazmg• I.ands...Ito:.., l ..t l ti~ th , cans s re . o n e r e q mxaca; the., thr°ugh_thedevelopmentof:Presentiyv:r ( Senatorfroax M St t l ide t tt fo C u~..~;~~.•n~s,car,.oesc.oe.aemeuea ..,s,: t n.. d d At the-r ue t fer t of M e d -'th II it C p e c s mng ago FedA.naL land opinionn of the Gbverument's appratsera, s. ssxe . title.thatstands:f¢the.way ofalmosttWC, - ~ . I • . , or.rrocr..an the Sena- A )d ~ mSouthwest.Waslimgton: 3I20: A ~~bilito~enhancetheflexi61T~ty -~ tor~lrom New York~ (1FlY~, M'©.~rms~a )s~a) een Fourthh and Si~ffih Streets, at CC mentto,the,deveTopmentotwhatisnowSenatorfrom West Vlrginia (3Cr. Rosr Street, and is needed' by the Redevelop- a- wastelandd of railroad: tracks ean ~=.C. Bxao)., the SenatorliomF:rkansas-~ ment-Land. eTgenCy oL:theDistrlct to. speedii',}rmave•forwar[&*. - (Ddr: Bussras).,, thesenatorfivm. Ar1- .complete.asitefnrtTie.constructfoaofa zena(IDII-DaCbxcnsr)•,.the8enatorfi•om. .. $40.to~85a.miltioahoteland o~ce~cent'es: ~rylr EAG3' FPSOfC` .. l~lssouri'(Mr E ~ - r ee s m ee aDaarm~)., were added as cosponsor•s~ of - vep, 41:000•s4uarefeetof7and theFederaL. _ft the ratIroad. . .. . P e e .. GOV~~~~~OV~Y°'~`~~' ItiellevethattttIetothe.4'1,OOOsquare: $2~6`~~~'RicesSarvtv°r ~. -raiiroads. at the turn. of the: centurybut- teet shoufd'be comeyed to•, the, Dlstniet ~' P~~eatm Actoi 1978. inmhlch.itstllLretainsabare2egaLtiLle:n saRthatanypeioodonthelandmay;once. ~ ~ 3Ga~G1,'t~'. The4r00Psquarafeet.tvroaghlgtie- andlbs, alCberemavedand, aayfmPOd& ..At.therequestoL.744r..Harsaca t5e, • -- meicisraompT~.Spa^:^^~•.w^",.lt'.w1lIeon.- ~readFhad~patdthe•.eqbivalentvalueof I : ~.~atos from.Nece Hampshlre.~(DGi. the Iandhad th f i - t1tI 6 ~ theDist¢•icL atcrfromPermontSMt SraBroan)', and . develbFoldrathoadvroPertyfntoaeoni-om. 99W hr T975,,.that ottlYe~hem fagsia theHouse. - At the~~reLuest~of b1r..MOxcnx...the~Ben~ -- ~~ ~ d'eeades- of effbrt by tlie Distriot ta~.reu at. ' ; needed'n.,000sq~uarefeetwasconveyed rary!COmmfssmruomE4nanciatOversight bilTto•amenaFtkre:TR•adeActof'1974:V~ ~... Eevoihtion- 39'I: but. at. tha. time, Plansmittee on Governmentai ASa.'ssc c y V~ -~.-•4 Y V..~ V~_.L s~ . 5adnotheeadev - AhtherequestoL Mr. Psts, theSena-. ,. lect sadt~the:4'1•.OOo~p~fosaspectBGpro-• Mr: F,eYGyicTipp= ir4k Presir3ent; ass tor from+ Maryland (bIL Zt~L_*was- 1nd~uded.: 4uarettet:wem mt rhnlm.mn oE the• Senate Committee, on addedtasacosponsorof Senate, Concur~ •the•Dlstribtot.COliimtita( nmwaStiheom. rent Reaalnttba.8g, expresstngthe sense. .. ILi18Z5.theEiouse.ln.8R_ 995SvotedmitteeoSGovesnmentap8gafia:2.have~ otrthe.Conor-w ..thatthePTelsihld 8mat. • -~te transfer Wtief tli 'EO e. ' or: oOSe{par a4 introduced:a~II~ ...,.onoIDt.mesauxu PICGasweIIssinTernatrnm.nra~~,9,..

C CONGRESSIONAL RECORD = SENATE S'786i' - . '•• (6) (A)~ 7.he Secratary shall.l establlbh, ' empLoyee:is for the convenience of and at:the_ the Secretary shalln provide assista.ncae under the Pre5ldent'e requeet of the State health or mmta:lliealtU Lli1a seatloa aa. that aE le9af, flve an¢71 ¢eatere. -- ith . . . after' Wnaultatlon w ' Council: aU Fhyslnal' Bttness, standacde . for authorlty and for tae purpoee of rarrying ottt will be in operation by October 1,. 1981. rehenslve phy?icst'.fftnesaprogramsl a program with respect to which.lts gnn4 "(b)(1) No~grantrmybemadeunder.this 'aom ur: l in e d p eve op g ae n : The amount eectlon tnr Plsnning or .. ede ..n~•YXr:-e~", "(B) Fta• payments under subsectloa(a). nader paragrsph` (1) Is m for eetsbllehing and. malntalningcompre.bywhlchmy sudi graat.fe so:reduced.ahall unless the Searetazy detarmines that when.lt henaivephyaleal Otnesaprogramss that are, be.avallable for payment.by the Seeretary of isopemtionalIt will meet the requiremears ....eonsistent with the standards establisaed, thecosta mcurred.ln furnishing the supplles.. listed inn paragnPh(3) and be able topro- autplor-thePersonael', videasslstaaceaaddi.....,:.,=tionoflnfbrms-. lndetailing or o*equipment taereare A a , . . ):, ( y, .yvravanttoDm'agraP . NM ': biad ta be s.PPropriatsn 810;00O.OOD for thee on~ wmoli Ehe,reductfoi oL sudi grant 1stlon toreclPLente of grants under eecttonss p l ,. " flacal~ 9pr ending Septamber 30. I98(li: 813.' tima~be madaeunder this deemed m Ua aand ~cJ. No graa h ll be d s ~ Of the grsat sa s 1. D00,OW for the fiscal year ending Septem- ald to thaState healthh oe meatell asction for operation of a eeaterr unless the th pscell b f - e aen p or 39g1 andilSOW;000 b 30 ,'sr.,._,. :. : ... 1 - . . ' ceaurmeetasuchrequn2meatnaadLSaelem t ' • hea[thauthord yearr ending September 30, 1983: y., . (ti) Sectioa 303(s) of Public Law 91-895' ••(C) For pnrposes of subparagraph (A) provide:suchamietance and dissemination of (ralstrngg too authortrettons for lesd-bsaed! (1)'.(II).. theterm''State and.loasl erpmdl• informatioa. .. rohensive publmhealth aerv-"(3) The requlr_ements referred to mpara- - I ama)isI t rea for oom ro p p gf u isoning Praventloa paint po amended by m.serting before theperiod'at-- ices'meatu ezpendituresby' State~ md, lbcsl graph (1) are ae fo[laara:'' . the endtJUreof: `„ 814,00p,000 for'theflscal' public health and mental heaSth, authoritles'. °(A). Thereshell be afull-time.direcmr of' asted tlythet11eCenter who paeemsse a demonstrated desi i ' g ces Stb 30 1980 p14000;000 0 forblic health serv yesrw endingepemer.,,, pu for.theflacsl.yearendingSeptember30,1981,: Secretary'butexeludes'erpendlturesbysuch capacidy'forsubetanaatiaceompllahmentandy an,i 814•000,000 for' the Oscal year ending: authorities- . "leadershlp Sn heelth promotion, and there. .September30;.1982".. "(1)apecifleallyrequtredbyFederalststu«elmubesuunh.aQdltlonal,proteselonalataHea. sirsxsroxofEaaesro, srwxzsrva.coa0?aa- tarylawesa,eonditbn.tothereceiptoLFed-7 maybe.approprla:tm . . ffixarvr royao »yy.r>H sesrress. .-. , eralli 8aanclall assistance, or" .. "(B):. Thestaft of trie: Center ehalCrepre-. ...'. 8ee, 106. (a)''. Paragrapil+. (4) and (5)- of. "11i) for operating mpatSmtearefactlltlea:,- Sent a diveretty of relevmtrdlseipliaea:.. () _ congttvctlon,.or mental'health pragrams. "(C) Suah addltionatrequlrementsae theea¢tton,314 dsro ameaded to [ead eaw tol .. oees of subP~gFaph• (A)~ ~'etary may by regulation prescribe. ' Py ' (D) rPur P ..~e: . .. poputatibns shali be determined on the bae]s: •I('~ Centers aeslsted' under this eeeUOn .. aeaole-frum theDe~. ()' yenteriatoarraagemmtswithreclpl- ..°(4)(~A): The total amount oi granG.re' f igures av of tae latest ' ceiven by Stste health, aad.d mental health. -eata of, granta under aectlons 315 and 317. e .. ' ~ ~ rce.. . Comm t of . for Lne~e provlslaa. af apProPriate~.. 6nd aeces- .. lUtlloritlee under paragrsPh' (1) fbr. my'9a-. Partmeat ~'l5) The 9acretar9 may ~epaymeat° eati year easll be determlaed by theSecreta.ry. s~ technlcal aslstance. and (9)) shall ae- . aieepLLliatlt- . :. ... . VmlargranLeilaaerpflrglaPh.(I)¢altileb9allVelopanddleeemnUltetnau¢hreciPientsap- ..'(t) may not esoeed the lesser of- ,:.. oE', euch estimateamd m aueh tastauments. Proe.cnee: metaodoi ea, aolee..and etand: .. •('~ ttie-pruduct.af 81.00 and the popula.. m.aPproPrtaU xlth adjustments for myDre.. ~ds for denveringprovoai va health sarvlces:. .- vmus overpaymenta ot underpeymeats.". ~ ...(d), Fm the .of_maCin a tion~of the State, or purpose g P ym<nta . (ti)' ~TaBraDh(8) 00 sacpon.. 914(d) 1s puxaumt to grants uadersubsecUon (a) di ° . „ ng casaof the as¢al year ea _. (a) 1m.tlle. £eptemtier 30..1080:, 5 percent. of the amounti. amended by (1)) striking 's. Stata's allof~ there are autaorlb<d'' to be - appropriated - ment^-eianae (A) and lasertfag m. lieu Ih ' , 0io ,000,000 for the escal year mdingSep- . ei.. 8tate, andd local .xpendStureas for. com. (2) et21k1ng. ~eamouat recatved" ~ •' t , ym.:ber' 30, 1980;. 810.U00,000 fbr' thefleeaL . bm plellenelre public healtaserviCes withln the Statb in theState'e daeal year whlch.ended. "off a State's allotment" -la clause (8) (I) year myng September 30;, 1981, and. 110, . md Inserting Ln iteu thereof "received under .0006000 . mr the fL+ca11w year eadm Se tem- t-th . g p e Laecese o . on or before Ju1F1n 1979,., m. - flecsl year ending September 30;. 1981,-7+h'. . Paragraph (54F',.and (3) str181ng:••9tate'e at- bw gp: 1987 ^i . . .. . .. . . lotment••' (8) (11) and-lnaert7ng m ¢lause m . .ro~~~ abm.. aeseoxe~nanoxs arnr.. .. pereeat of the emount..of:suell erpendltures, ttisreot: 'amooatraceteed under pars- f . .. ea. , vZN!rXVr PERAaM SxRrtcxS in the State's HseaLyear which ended.on acI ... before July 1„ 198U;I ma m me ca5e m wa. BrC. ROR. (s) 173eSametety of Health, BdU- ;. Oewl year mding:.September:30. 1882• 10 per-(e) Section 314(d) (7)(A): is amended by' ation..md V7anare ahall uadertska or au - "Ip77°'and lnaerting d" ft " - an a er tf'htf'h in atriYing .cea:o.te amounosuc expenditures,... rc throu ts or eeatracte orr tlot) n . .' 000 for Po ( Bh 6>~ " . , 4107,000. the State's fiscal year which eaded on.or be-before tae perlod~ thereof: fore:JUly.l, 1981; and . ` . tasOscaU year endingSeptember: 30;, 1979, five mtenslve.aud comprehenatve:¢ommunltq .. "(Il) msynotbelesa:thmthegreaterof-8135.0011:000 forr the' Oscal year ending' based proglame for the purpose of Qeman. , [l.xtzatm8 and evaluating optimal methods G1 000f 40 000 , , or 0 , "(1) the-totala amount of' granta recelved~ September 30, 2980; i1 :. bysueh authoritieauader paragraph (1)' for ecail yearendtngSeptamber' 80; 1981,. aad.d fbr orgpmzmg md delllvering comprehensive eervM1CesLo detlaedpopu- _ - PF~mtSVe healta~ : year endlag: - the Oscall year ending September 30, 1979. or. 3150;000;0001 fottheo-Secal` : 1982` ~ ...- . . . . . latlona. : • ..: , . . ., . . . . rber3V t S em ep •(II) flie-Product of4d0 md the PaPUIA_.. , tloa,ofSaeState- . (Q) 8ecttann.314(C) ('I}'isamendedbyadd--(b) Rhe. Seeretsryehs1Iy aubmlt to the „ Notwlthstanding clauee.(U)ifforany~lmg' att the end..tilereof the following aew'- Committeem Humm,ReaoUmea.aiF.lie Baa- . . . ate md the: Committee on~ Interstate and . yesr: Lhe: amount appraPriated'tor that flscal- P~a~'aPa: -- -- Forelgm Commeree of' the House of' Sepre'- . year under peregrsph. (7) islesas thann the "(C). Of the amount appropriated undersants.ttvea on January'1', 1981, and oa.Jmu. ' : smount needed ta.makngrautsfartbat ascel subparagrsph. (A) forany . eecsl year thee ary 1 of every seeaad year thereafter a report .. year In., accardanG, with. audi Clsvsetoe all Sscretary: ahslI o1111ge~ao lth h u •. es national Stt hlthdl hlth 000000' for the ,•^ . ~er.eueecoa.~acungunmm« dhtt(Lldi bt tll ae .eah an mentaea authorities, „ withapp'aoved applications, the total amounE pragrsmraPantmg:aysffim referred W la Par-lted ta:. & detaUedd description and fiuavam- of grante~~for~tLat fiscal year for State healtll graph (2) (O)~.(7fY67.. .. .. . . . ation of'tae~. effectiveness oD each, such pro-d and mental healthh authorities etlall~ not be TrZ7m II-x.BSODg;Cy.9~~ FO[t DL4RA8$ PB.E- gram, .....- . . ~~ ~ leq~tbanaa~~amountwmelvbears.the.same -..pMMON~AND'HEAL'1'8':PB.OldOTION ~,.(c) For thapurpoee'of...undbrtaking_oe .. ratlu to:.theemouatsdetermined for auctiL ;. ca+.ros ros. ~xs rr.osaortow aupParnng: demonatrationss mdd evahratlone Such clause Pumusnt toeubeacttoa -(a) tliere are eu- _ , lt!! '' . aeLhe amount app[uprlaiedunder euCll para- t;ec. 201. 21tlrIII of' thaPublie Hea•. tassmmded b7 sdaiagaftersec- A i S ~ 8 erv ce c •hb tthtdd tk 9ttl 30: glapescaoe amoun neeeo mae ee o.+.e.acayearaenngepemer :.. hth OAdi Act) 102 Oi' th1s b tl : yaec on. grsata laaaardance wLthh such: clause for' tton 315 (added : 1980, 9eptemtler30i 1981, September 30; 1982, . such fiscal year toa]3 State health and tnen- the-following now. secttoa and headlag:ttlero-Sepffimbcr 30, 1988, and September 30,. 1984'C tai.health authorities with approved aBphca+ tot- "caarr®a ro4 xsaxoxu, nrasses rasv~rrorr nsA veoras ppyg• . ~, . -- .,..>IIelrrarsontotaoar i . '(B)_The S.cretary, at.the.request of.Stata- "Sac 318:. (a) For the Purposess off aesist- Ssc.703. (a) The Secretar,y, acting through . Iag titie.Secretary'facarryingout sectlbns 915'5 thNatianat Center for Health. Stattatlceor health and mental h lth th itl ea au or esn may , .. reduce the ataounr.of the grants toW it:under and 317:. Pzovidmgg suaa, tecaatcail andd con- 1ta.eqylvalmts shall aubmft tor Caagcaea oa . paragraph (1). by- amting.esafarance.as recipients ofgrmra va- January1..1'981. and on Jmuary1 of every dersueh sectlonsmays from~ tane.to time re-- third year thereafter„ anatlonsl dieeaae pre- i " ) the falr, merket value of any . l supplies oCder toprovldea ' oreqvlpmentfurmshedettchsathotittes,.aad q~' conducting research. studtes' and, -ventlan data Droale m ~.: -^(ii) the smovatt of'thef pay, allowan~s; amiyses. (ineluding coet-efreatlveness amly- data base for thee effective implemmtation r?sndtravel expenses .. of any amcer or em eae) of~preventlve:Lealtll'aervicePTog+'s®;: -of:tnUActandtoinmeasepubllcawarenesss , of' tha. f3oaernmentl when . detailed tolpt~e andd developing aPpraaches; methodologies, of.theprevalmee; Incidenee. aad:my''~ds -. _. $t+te healthh or mental . heslth: authoxSt poucies;.and standards for dellvermg.preven~ m' the preventable uusees of death and dle- { 7 a¢d tlve health services, the Secretary ahsli by ability ln the Dnlted States. Such proEle r. e. .. tYe amounE: ot.mq-other costs mcurred In' glyata aseist.publtc or private nonprofit en-.- shal11ac1udeatamin3mum- -_ -eonnecttoa with the detail. of' such of8eer or tlties Sn meetnlg the eostsof planning, and ,(1) mortality rates fbrpreveatable dlYesees: ' . l oyea : .. ....:!!vmP . . .:. ... . . ... .. .. .. developing new eenters,.and aPerattng: ebat-: . (2) marblidlty rates asaoclatedd rit'h pre= .. whea the m.,.,fxe t„s. of. euch enPPltes.GE - Ing and new ¢enters. for multidisciplinary rentabl'e dl8eaeen; . •.. ...- :: eQWpmant or thedetall of such an aff/eer orw heaTth'promotloa.,1'o the eztentpractlcable;, -(3) the. physfcal- determinants ot health

: dF..... . - . .~ ~-; . ~... C /,"' ' . . . . lll f CbNGRESSZ©NALItECORD -SENlI'<TE 1{?ay 19, .237.8 _ S 7860 .' g siis.. •mmore'tlian.4'.000+ hOspftaLF~% despite our ,_ Some of~ the~.moet ucamLsdnr devetm- .. ~°FaeitenactestgAae.senaraand-EOUae.of- 360~.000phvsfetans,despitemedicareandmentsia~the.aresofpreventio=ncoacern ;~~menta4nronoressasrexnb 47yatcne medicaideaPendituresoly65billionffiis thellnkbetweenlifestYte:andlllness.,and vee.r.wehavefnathis tountrvnonatfonal Zwwidliketa.sharzTrn•..P~ddonr w,,,,e r-. ..1'rastarn' amt+~- n°a ~•" --m.° .'sm3tegpfortnepreventtonofIIlnese-ana oz >ag pprgonal, earltemeab ever recent .~.;.. ecvuva.Dlreotoro-.of ulr In&ernatio»al: Bank dlsabilitFamong our people. E IInd this breaYthxonghs.ln this.ares'.... : . - mentti the ihseto p l . for Remnstruatfua and. ~. rateraauonri Devsiopment. • ei«^n.. In-:.oveidight asticundi:ng: Surely, the pre- .In.theI950'sand early 1980's;thrnugh , ternati.onat. atnanne 6orporatioa.the. mter- ventibnof'1Ilness, and'- the-maintenance the work of 4VFnderaad others; we came American Development Sanlr,.and theAslan of.goodhealthi9thewises~: moeS.COit- fhstt to unde.33tand the' cel3t'ial: role of -' Devetnpmevt saak; and! the.naecutiveDUec-.. effective and:most humanei approach to- clgacetter amokinr in the development tor tetresenaak me'=t@a' seat°: st the reducint;ther bunten- of~ fIlnese. m- this of lung canoer ALevf<yemislater,:thiou8h :. Atrtcanr nesNOemen4PUnd:,liz oetrging aut.. ea„atrv- Fet-: we find that- the=IIhited acork' donein', the edtw nl, Pnaxninohwn:. tn r..i~;tnrirdunee.*a-rnus>m5,gt,atesspend3.feMthatx.Z:perCentoi:.its mpowa Stateoi'.Massaehusetta:.epide-;;f,i,:: .ap ioea c+eeir. or curee utiuz.twa.of the . health dollsas on preventive health. pro- mioiogLSts began to see thee close 1irJrs y..:,•.'nmaaor""°.` grams;and F31at: the FederaL Govern- between eholesterol levels~ highblood. edvenee eeeet ob indratxlee~ incauding- agri- . .' cuiture:, rna omployme~ ta the- unned mentt has no. coordiaated.sttategr for Pressure;'. oand.the.development _ dH^naner mc'gords' LakingadvaatBgE afthem6lt,Qnew Elreak- of ooronal disease. and stroke. [edueing e b ita t q s . es. e . sta . yrodueed in the: vvited. etatea or bs ifterew- ' throughs: ocearrin4 in- this. 8eld- .... The implications of these IIndings were . ' ma tmporm to far untted statee. 'rocarrp : E am tutroducing; ' om behalf of myself .nnciea.r..If stnokinV was, correlated: with.. .. wt tnr playorea ofttne-ACec.f ms.Unlfed andt Senators. Wn'.esnas: CBar>S. A.tx- llmg•eancerand. other disease states,. .. etstmssecusivsrnrectovot eech ema la. oai.rH, Pstit, Cwuvsxox:. Rrssz,. Savms, that: did aotmesn that ending the habit . ::'sutuuon atraa re4peat..a.>sd , thm-t7cued_ SMWEBUM &nrvroe>r Henr wouldproteetagainstthedevelo ' 1KCGOVSm. Pment of . ,: ., .amtermumrtiolsst'BadacoT^~•.'~-sbaii ". +a .+:.,. Fi t t Cancer Or h ~ t dL A d 1t l a r ag m ea r .Etbmkwill seeae n andIlannr; e evated. ,,:, 'iurntsb, a..repon ase4snmgtbe.ticrtF.impact .:~ ~ 1• w . rf such icsnaos owec.emnctat or trcanlcu filZ this inezcosable; ttapin our national oholesterols+and, elevated, blood-.tlresaures sweerece.ontnavetdea-mdemptnxmeatia heall~:poL4egan3:ourna.tionsLhea]th werecorrelated.withtisart-diseasesnd. struktwe- sMlll could not be• sure that -~ s t 2'h :vatt 2 DL rtl P -r' ps em e Sease roves oaa oa lteaasatea the Ttn:. .. . .. ...... . - -_..aia....i>.. A.w..w..._.....r..w .nne..-.... Ynmsanonhnlocf .r m. lwmhtn.. 1.1~i ' - fievelbped witii tha, wise: aseistanee of Preastn•e would proteeta8alnstthe de- l~sr- . )~Y Sfor hiin5elf. OS di .... gg velo ment a di l ' ' ~ ~~ ~ p r sease: c ovarcu ar _ n... .>T..... mr. r~a~,e_aisr - of my colleeattex.L think it pro- . .._I/ . RamoLpg.mr- Ps.....Mr.Rntczz, Aviae3tneessenctal:eiemenworaPn)gram ' tsutotQeptaemtologies-and•dllnicians.. Mr McGovaeM.. Mr_ Haax„ and I which cas dramat7ea.llg reduce through deveTOped' evidence on these Points- as .] . ' ntrr.r.a,s.vs- diseasap=eventfon..thetiurdeboLillnesswetltItbecame.clearthatwhessmokers' S. 3515,. A. bi11 to,estabiLUaa.compre- .. y.~t+r.wunt.ay.: - . . .. .tuw, w.eu' nsx oraeveiapmg cancer ana. disease-Preventiiom.and. health .., Mn.President-wecauprevent.the~dia--heart diseasedecreased- rapidf$:. Slmi- hensive• . .~: penniotioa program intheIInited:States: easer whicis: ki1L most Americans-We larlp;, it tiecame clear ttuvugir studfess tothe Committee on, Htmssa: Resources. have: the means, orwillU shortlFdevelop d'one: bp' the. Veterens" Adinirrlattratton~ ' BPMr- >MNNED'Y (for himself. them. BY1tiI~ reeentl;pwecould not make andelsewhere that treating high bl:ood , Nr_oya`.•,•+r=..Mr_C13nrsa.Mc.. this elaPia. But let nsnow lookattfie Pr~ eouid dramattcallgreducey the. ' gyyoozrs„ Ms- ..y+syi,. yfrr facts I .. '..-. . . ":.-fncidenceofstrokeamong-hFpertensives. Mr:. Raers.. 30i: .. 'Onahundrediyeaa.ago. infectitus. dIs-_ While noo one haa' conclusivelp- demon- ~ Casnsxasa. , . 3evrrs. . nir:. Scavatiataa.150'. eweawerethe:mastTiurdensome'filnmses strated' that Iowering cholesterol levels _- ._ ; S,rarzaao:.. Mr_. McGoanas;, y[r.. in this country, but that'is nolonger the- wilI'pQeventcasdfovascalardlsease: manp-Hsax;and.Mr-.Z.eaaq):-. ~case.,`NehavelearnecFhowtaprevent of our coentrv'x Ieadng', cardiologists. .. 5_ 1116, . Ex bill tor amend.the Public ..manYof the~~inteeCious-d7seasesthrough PredietthatwiIIbethecase:. - Health 3erviceActtoprovideasslatance ItnmunizatYon;, and'titrough- improved IYew evidence Is constantly emergingthmughformnl'a.and.proleet.graatsfnr- saaitatioiratnt nutritionr and wa havw thatlYfrstple ciianges^ca¢adectmorbid- .. preventioa, heaNln. Pragisms. aad fm .-lea.med: hot.v tnheat manxot: the com- ftT andmori.alitp:'B8 recent study demon--...i~#r,~.•.r.other.PUxPOses to the_COmanitteteoa mimicablaedlseases.thraugb.the.use:of- stratedttistmegwha~eaaaiseregularly' - HumanResources:. . ..-- . .. antlbiatiasand.athetmediiations.Norc,.6 and^vigDlvtlsLFredhceLheirrlsk.ofheart " . . Hy. Mr_ 11LECiNEDF @for himself. ehrOmfe disease and violenee atg the-attacgbyrno`perteat:.-: :;. .... 1dsPR'aan~..114r.lneea Bd,i.. leadingkiliersandserippiers'inoursoci-, EYnallY.sstudgby'BeIloaandsBresiow..., Beanoar>£:Mr-Pau.Dfz.Rac>:a, ety::.IS2971F chroalis^affiictionsandvie- demonstated•i¢theeadqi946'sthatIm- It,llW)1firm:and Tence~ accounted• for 833 percent of'all pravedlifestglemightHe-ailletrn~ertend ~ EtR[iav>trm~ .. . . . deaths hr the Ohited States:'. • :. > - Il1tr: eapeetarrcy by' anywhere franx T to ..•. '~S: 3I1R. A . btIIto amend the Ptiod. ~~ 'Heart: disease alone accauated for 38:-.EI Aears IDtug: andCoametie Aet brrCqah,:• ,nuttrl'- Percent of' aRdeaths. Heart disease Pl.us' 'RLW Me unk' in~ the• chaixr was still. .. : , '.t .~: -'Wonad.labelia& of aSfoadsf and for other stroke and other CardiovascuIax diseases misting: Evea, if we knew that redudng Pumosees•;:: tathe• Cbmmtttee:, oa Com- aceotmtedfor• 5P perceat of deaths. cholesterol leveLs,, or cessatYOn of smn - ~...4-.}r.~,. eardiov~cvlardfseaserplus~cancerfor• {JiC.~treatment.of~ure;. . merar. SCfeaeei and 'h~ , ' sportattoa: a: astounding; TP Pereent. Add efrrhasis.-. could reduce hhe.lnctdence of cancer and e d _ o c: arograma. e- dfabetes. erphyscrem andrenal dsrase, hem-'t disease; it was not clear that we~sfgnsd t¢ pmmote heaIth through ercent oE: allcouL3flndacceptabiewafstodndacepeo-. -d t for 78 a O , we cc tm P ~~6.. smoldng.deterrence; totlte Cbmmittee.on deliths. Aecidents. homicide and sulcidePle..to stntrs&Dkine. taget thelthFper-' r S~ Commerce,.SCience..and:Ttansoortation rdwmstr t4c,~.. . a.: / andlhe Com,,,tttee'on Ht=anRCsources, /Inthe`Mite3Statas_y-•~-LL~ theirm diets- ia wags that would_ reduce T !"Jomtlg, by llnanlmnus consen;t- 1 me.V..nr h,l1o n. A.r~~,t rr,e rantnw- tberchotestemL IeveLt 3Zl?..SEIV.•75D'SF;Hn Presideat:: despite.. Yactors whichyunderlie:. thesn.WBUt. re- Citing experlments. tn~receat timesW tLLa~ its size and sophisticatlorr:. o= hea[th- r~eativ.becauseofeoidemiolo¢icaL.break- Iast'Guest'Conu behtganswered: and'the ,~...:._„. . caresystem haamang failivgs_Ztis, ex- throughs.weihaveidentided'.some:of'.theinformation 1s indeed encouragJng... In ,..cessivel4 costRy_ It 1s poorl7c Planned-Zt. hnportant cauaatfve factors• und'erIging C•elifornia, an experimentttiadld by'the. provides: ourpeople unevea' ..qualitg. oP someoftheseconditions We:havebegun.NatHonal! Heart. Lung;,and'. BIood Thsti-C carei It averemPhaeizea. prorisianrof spe- to see the reiatiemship' of involuntaryy tute-haxdemonstrated that an intensive. .,, -- .. elaltycare:Ztgives.insufficientweightto.eaposures-tn the eavironment andd the educational Campaign ttsing the mass. .- .: the-provisibn:ofprimacgcare: . -..-workplaee~to• the developmentot dis-medter and individttai: counseling could. :: -- --. Haweuer:.bfe. President nOnee of tiiese ease. And we have alsoe begtm: tQ see, the reduce chOresterorIevels by 39 to 40- shortcomings Ls more serioos•than the.7mportanceofllfestyleandhealthhablts pereeut,.substantiallylhcreasethenma- . - one:I: rise taaddims today: IIespitethe in causing the- diseases: wtttr,kraccomit•- berof peopLe- gettingtreated• for high - 3I8tT:.btIIfoa: wewllp spend"on persanaYforthe malor-burderrof illnCsa'in ourbloodpreseure, and reduce'tSlenombera. . . health services this year, desptte oorsocietY . . .. . . . .... .. .. ,._ -. smofdng::IIr a simlfarstady (a the'Fhi- . - _ G3603`59~ : _ .

May 19;, 19'78 C CONGItESSIONAL RECORD-SERATE -' S 7877 '-ponentss of the population who are hott mea tton and individual conneeling" ere reoom'. As one erample,, esercisa . emerged aa a par- . effluent, highly educated, and Insurable. Wee mended~ as needed. .. tlcularly important'subetitutet behavlorr in need more intormatlon on.n rlskss to women. Geographic Differences and tKher Non- smoking cessation, dlbtaryrchanges, weight lorr ezample, oneof', the prlnclpal reasonss indivimual: Factors in. Health: T71ehealth management, and strese reduction,. and en- '} that oxerahBH..mortalttyrateafinm.cmcer' haasyd appnaiaa4 dopnot copslder geo- banced thee impact of: counseling and other have not declined 1a the rapid rise in.lung graphic:` variations In healtlr,. which, for laterventions.'The Stanford Progranda]so ln- , cancer, espeClally' among woan:n; but most eiample; as shown in the "Atlae of' Cancer cresaed theeHecttveneas of'.Its mterventions - of our risk data and public edueatlonanaung Mortality for II.B. Countrlee,^ v raa point by emphasizfng, short-termm bene8ts, suchas aancer conttnuee to focus'. on men. We a]soout dtatnatlc differences in mortality. Lates betteramelIingbreath and iacreased.lungra- -know too little and Include.too Bttlem ourIrom this disease. And while. we do not.fulIy paelty foreserolse,.ln addition too reduced'- -~riek asmsameataof thespeclsl rleksof ml-know- the tesaona'e for these diHerencea. !n risk of premature coroaary heart. disease norttles or the poor; soI am pleeaed to see moat casaswe do, knowithettheyoccur coa, snddeath: . a.paper being presented here on.raefal and slatently md.shouldd therefore; be lncurpo. 8ociat cB'matee andd other social supports - ethnic dlIIeiencee in, mortality Ih Hawatl. rated' mpcedlctions af' dlsease. md life ax- play an: lmportant rolb'. m Influencing health _. Factors MotivatUng Young. People:', Moae pectancy. The cnl'y inputeemployed in the promo2ingbehavior; Thai conatructlve par- -r.+~.n attention needs to be given. In riskasseea- health: haurd appzafssl ace: those qumtiII- ticipatloan of spoueein Intermeation efrorta ment to motivatiagfactors.for Foung:peopie- able mortality ratios which ean be.e readily has shownpromlaing resuite lnn obeslty man- Heaeueh on.attltudestoward agingreveSlD, eomputed mto risk facLors. If this were not agemCnt.in work done by Dr. B:elly. Brown- ~r l ude 3075vould5 th thEltl i . that mmypeopener ag-e: caee.e numerca- outpu, appraisal eliv now att the. Dniversityof PennnFvanla, littldthd drop desd: gldtil Bt prefer tove ua, 45 anenpge, woue meaningem:u to aseess a Another promising technique in social sup- - pf:f conrse, thls vievr. often chmges ae. One . peraon'ss health statue= as accurate[y as. poeslL porte is eontingmcyeontractmgwhich hae . approaches 20, but the..tllusloa, af immor- blo; wemuwst beoognif®nt af the fact that bad a: sigomcant adlunct.eSect IncoatroL-n taBty among tae young,highltghts theneed aainy leas'bell qumtiaed md, quantlmable imgblood'preesurn. . . . for'moro slwrt-term and mtermedYSte.goaia faccEorsereof'tromendousslgniIIcanceee.weB'. I amoptimistic about theabllltyof the ' In addit'lonn to reduced mortality,. it health. Dt Is also imperative-e to' dlstrnguish, which general. publia to underatmd. concepis of hsaard appralsal.is.l to become mureusafu4 ot'the fa.etorsaIIectrng health.and health rlNr-beneIIt'.andtheprobabinatic.thlnkingln for a broader agermge of the papulation, Asetstus are primarily seclally and environ. general. If we get:away fromareme imguagv M'aro Lsi.onde oftea. saye, we: need not onlF mentally relatedd md.d whlah. sre.a primarlly and emphaelae the evaryday, rrisk ludgmenta to.bell peoplethate good sez.is healtuF, but smanablb- to lndlvidual actlon. 1'hee healthh that people ma.ke all'the tlme, Ilknetappiag al§o that good health. is;sesyY The-preven- harard apprsUal, dars, verp; welll with theoSnubs,IfeelconIIdbatthatwecaaconvey tlonotpreroatureaging.mdprematurephysl-latter,m but:...does.vistuitly nothing about tlleeecunceptetothepubllc.A.eeriousleeus -cat"deteriorationrepresent promising aP- developLng:soma.,peispectlve.lnthemtllvld- hereis.wbether,weere;,lafact„ssklmg'People ~. proa.OheeM mdd heree the. "appraisal agef•W eon-um about-thosesociaL mdd mvlronmenta6 to.accept wur vsluee.. or to, develop their ewn - ., cept, already' an•. Inisgral.. part: of' health factorss whtchh affect h1m/her. Lt wmrld- be risk lltdgmentt on the baele of better inter- haeard~ appraisal• could ba expsnded toyelpfulif lnterpretatfonsofappraisals could matiem: . '...".. ... . - youngar people. B'ew 25:yearoldawould like . canveythey idea that. somee people are at to thlu[: of thearselvee'se Davingg the,.body higher: rfskbecause offaotors outside their. _:.•bfteDmy discussion of all these isauee md - and.'riakof a.3O or 35 year Old controlmd tbat' the»fore tme ma want ou tbat h t i assure y p ` , y as en n aancecns let ,.. Ma[bldlty:'Ihe mdlLioa olf morb[dity datw.. to payspec.tal attentlmn to developing ~'- I dnd the healthhasnrd appraisal and other• avlllob. taoaes ofttle Wplca.to-tie0onattd at - iateditothoee risk factces Ceamon tbe tm ide e t ~ t t h i ev ne re a g en e rlsk assessmen ec n ques . - .. thla.meering„ wol%'d represaM: a. ma]or. ad which the menbw to enhsn<a - can inLuence ttiemselves develo 8ow- most's romi5in y . p g p .. vsnce ffi e:pandingg the uaatulnea ot heakth !t is nott eaou merelFtoy eaorGpeepla haeeN appraiaal, for: the- populatiunn as s ever. Bh - public understmding. of personal rlak amd whole. The-earliest IdentllLCat7on of-rlet to'ehange theirdletaryprrctlcm It they do pomlbnlneaforpereanal sceloa:.It iseeem- s t]ie Korean PSbt Nam not ksaethe: foodd opefooe, the money, octial too advamce.tme embryonic atete-of-the- aad h 6 t a euc oLS- .. ac .Was autbpsy fladlhgs of, slguiflcmt azterm-: eawantlal snefai supporta md:refntaraemente.' art of'riak ~eeosnseaS' ard to erpmd Its uae--ealerosiatn 7Pr9: servicemen aged 1g-31, ortheAlaa It wlll-be,:aBur comfort to, . people... to- fulaeae ufFrevention.md:hesleh promotion. '"Hnow: Your BodF'•progr'am of tha . Amar-' leern,that they can raduce.theirriak otf pre-- for a wlderrmgeof the populatfon.. .,. . lo>n 8ealth. 8oundatlon; Wmch:. Souaa oaac matora desthbYdrtving fewer mtlea;.l1 tluy . T'he. Office of.. HASith .Intormailom affi-d or moeeoeronery hesrt~disesae riek..llactors.. onnot rHord ta.Bve elosar tothelecwork. HealtmPromotionhae.deveWpedprellminacy' -. !a'3S°6..o1 ehlldren, aged 11-14---lmdbrllnes.. -Also, the Ig?yreductlon in: traf7a tatslltles plam.to help adtlresasomeof theee-preeaing ' tlie . Impeetance., of finding, matiFatlonat. . ft°m 1p73-7.t: resoltedd from': a& set nff sealsl- issues Sn risk aeeoeement. We pim to oemm/e- atesfog[m.fas.7lfmtyle.change.'.very early.Itt detlsionsto.:enacta Nattonal.S6mph:speed. aLemerateof-tha-artpapers.andtavlewworlr- ;. Ilfa .. . 3imfY: wbichh itself accounted for the.e single ahopato develop aad-al......h.te Cmeemws Poaltlve Valuee:: Wellueee.. hlgh teve/a a1' largestt reduction in any' year In aiortallt7(- on therelativeeAcacy of. prevmti.rofater- 'en.ugy'md produemvlty, md lncreased senee^ from asingte.causeia this century. ' veatlons for.various. caUgories: of rlbk.. Dn. ' of.eontrot over one'e 11fe are-Importaat fao- Whnt tt caw dorwur ~ .:e?aluatlon,t tt takestlme=.to.s aeetheshort, mtermedtate.mdloag-LermeHecre; It'wen- t ard tl tb f health ]isz .. ls t la t d ' e goa o o .. ars re : e . s : 8ealtll3farard:appralseL nowrePreaenfe appxelmL ~'hesa: fsotoxa.s retnte to braadac. - quire effectiveaases data too earlp In am..mter- '.m md. marepostilve goalb. Lllantmat of. Juatsummus too action, with. aatlenn dependent vmtlbmm we maydleeard goedd mterventionareadfnese.o[ the individuat to~act sndan on i t t . hterven premyturelyor accept cos ly .. delaying.mortallty:.Brmlow, md.e0mars:out- ions. 11ned eumples af such' guals:In their'"Llfe-the avallsbili.ty of eaective.mterventiona--_ .. that w11I not aabievee long.-teem obJbetlvee. . tAme BeatW1-Manltoring Program,•v, ~s... What_4t dould do: Premtse: )ar,the- firtureAnother important aspeat of such evahLS- ' health assessmentwhile not complete (h: -Health hsaaM apprateal-represeatsl an Sm- tlons, that ehouldd be-borne.in, arknd'. is that ' iteelf elther-le eombined..withd preventive portent cornerstone in our eHorts..toedueate: seculartrenda may obecure Important rlek measured prngrsmmed- to promote optimal. . tliee pubiluc abomt pereonala rlst% asemment analyses: and make It'.partlcularly diffioult.to health. md. development-botht' physlealiynas, one: rnoHVatloa ton action. Much, moseprodum statlstttany signmbmt Dndtmga even .: md emottonauy,, nor' eaeh, age group, goats', needs to be done, however. to. Includb m- when absolute changes can bedocumented,e are. outllned-.which petbam to thehealta, dWidual values aboutt risk md.ttadlnees tofor erample, where oveLallpopuiatton, levels .needsofthat.partt0ularcohortfollowed.by actmto.the.appalsalconcept.. . - ,..ot.serumcliolestarot'.apPaseto.bedeclmlagf reeommendatioae's of apeelHc professionat. 'idore:.poeitiva terminology would help-the-.. Tnese state-of'-the-art. aeeessmenRa. of tbe ,:.. servicestos aocomplLwh: these goals. These-e yealth.haeard appreisalmovemeat. I tlke the relative e®caeytot interventlona should es- ktablish a_basell'ne toadvaacea eommon' meaeuceaueuallF'iavolvetestsfon-commonly f " •• " r e healtll ProaPect9 better thm term occurring problems and preveatlve md-vnderstaadmg o1: the ceebeIIeettveaess-ot_ _ ' reduttion."' butothers: prefec "wettaess^ mdd various approechee toteventlon and risk prVmoLlonal. F age grou: Por example. fa, ..~g1t1Ve healtll:' AB Lhese moro hopeful~ reductioa. Blbk.aaaeasmeatek will.l be essential ehedg'. to 24 ear P;.6oatb arer tarms.ahould'~halp to capltatlze onn the.grow- g the P Prlate intensity 'TO tac111tate-trsnslWOn I[omdepandent: ~ excitement of:.the.CubB¢ about eoncepta ~' determimn a pro . and adolascenca, to mature mdepeadeatt admt-olhealth romotmn. cost of. mterventennsIf we expect to have eood with maximumphyalcal: mental md.. P -- -'_ preventive Satervaatlboa covered by eureant emotloaal resovrers- .(andl to sehleve' The 3tanford. Heart Disease Proaantlon - health insurance ptogaameer la. omr deveI-- useiuli empieyarentt and- maslmum oapsoity Progrsm'° embodied concepts waichcould opmgg aetional health insurance proposals. . for a haalthy marrlege,.PetentaooU md'sa.nelp develop health hasardd apprafsal tech- -We intend to emphselze, tnteraetlne risks ctal relatlons,•• v nlquee. Thiss program tied cho rnncept oi and lnteracttve mterventlons, as I have uead The:seCvicee related toithe9e goals include:. Interactive risk toresulta aChleved with m- those termetodaF, in our educational' eacrta . forr the healthy adultt mn annual physicfam twactive mterventlons. It,builton the bmt with the publlc as wall as with health profee- ,- vlslt with tetanusboeeterr, if nxa.arF. teate, , mowledge.e of.f learatngtheory, communlca, alonals.. I urge: the Society os Prospeetive . for veneiealidieeaee, nutritlonal status:.blood- tionss and media reaeerr,h, and_ developmg.. Medicine to.encoursge..others to, thlak probe- ' presaure. and choleaterol.levels, and "medtcal.-. e4aluation. Whiehh shows that multl-facetedd billstlcally about Ita awnn activities, andd to " and betiavlbral hlstory- -,.. ,.8ealth. edirea. - healtheducation Programsare much more.- work with health maintenance orgmisatlons ' eHectlve thsn single modsllty intervrcntionsi aad other'setttngs toenconrage more than .: H1x.Lartess at ead of'artiele.,. regardless of aperson'b readiness to, act.L*-, lipp servlcewhealth maintenance by adapt- ~9 ---~~-~

S 7$7&. 'as- COAiGItFSSIE)Nl.L RE[O~'RD'-SETNeLTE . 1j4aY 19',: 1978 , and' experts of: many' types. Overmedcalisa- yolloming ' the,.same PrecePts. I. ralsem thi® ax- Lavmral meesrch. teilaM us that raising lte : tlaaas s new termderlved from the radtml- ampie only to rernforcemy concern: and to. spectre la likely to prodnceresiatance: and ".worRof anehpeople sa Ivan'IBleh,'Prted-remind ue, alI' that tt' is3 not only the publfcc bloeking: It 7a'often.tht casetbat we mesa- "~ eoa;" and: Carleon.• aruld receatly the tougtlt- whoEan betame confimed.about the 1nabld/ty utewhat wee eea ^+ ^'t ea911y(<.g...Ilke ~.1 flf Nt Lt•hthrf t thiyLlYiitt tmtaht) . -useeayonee+a, wc.eersooe: to app PaoaA concepsoo speeec mory. aad taen- like ecnnumists, try : ln¢easingg tendencyy to deane.wTthft.p.e ma- mdivLdwla to Perauad® People.that what.we caa meaa. - ususi..t or aaerraat as lllnesa or~diseasn tobeaLange m B,S1t Pactocsover.T(me: Rtsk:k uree fa rhat brtmpamnt. . .. , ,teeated hy.nsdbdn._ , ,.. . fattars ehangeover'tlme in populaclons,.as And what about'the elderiyt Is risk s tel- OQermedicaliSStbnbas' at least two. lm- walt. aa 1n lndtviduals, and this notlon of event noneept: paet mMdle age? f.lte, ex- -= ' and! Uak: asaeasment: overemphasis on the hazard appratsal and,lato public edhcatioa centmq,aa ooattaated to dramatlc cnaages-.; .'.toleofUfe..paAsleianeadivaGaxeatlmaChfg aboutrbC aneardbablfag--la.lftemeee[aneyatblrth!:~ . .. tSx role of Ute'tadhMdnal. person mhosetlek .. Pwr Training of gealtly profemlona.L4 In Wae need . faaooaUVe eoaeeptefor the elder- '~>, 1 S •'-- + : .. + 1c of whom some actloaIs Preventiaa:: Pact of mpy eoncern about the Y as weN sa as t aad S the yomlg to promote whst ._..r..- . . .. • prea+7teqn#ed: Aaerample oLplac orermedtosu+ew .. of Pvetioadk everlevehrof:wemiese uel+oatlbla ~a ,_.-.~n.-renn..n ris:. :. ; Yng undnee...,,na.c.,.on the phyaleian'a m[e redueiton, etema fram: the. poortra[ning' of The Llterstore: The literature on health ~ -. .3'¢ the praveatlvie.pracessaPPasrsht the most health, ptofes.lnnala~d and particularly .p(tp-_hazsrd appraisal IrI1kethc' literature of '. -neeent edlUoa of Iris. Botbius': aad 8aB's aicfane- ihepidemieIDgp;.n bfostatlsUCa, and much ofhealth edacattoa,. elmost' ercIU- ~ '8oz-to PracUee Peospectime. Medicare.^t taeaan-medieal'e determtnantss ofhealtl,- siveiy desertpttve reporta.of suceesatoeles. ~; . 2t mentlona thephyetclan's aoceptaaceof that Ia. 2he very knowledge aad. Concepts.. We needd much moma eaafQaUUn and follow-1'espoIIDkbtlliA 'YOe the total rCsk off an in- whlchaaderBOrleic asSReament and pre- -up aver time, lfwe axe to ieaaethe eQecttve-.. '. ~ dNldual." bnt.lgaares.the: person who hae vennea rfsk reduction. In' addltlon toim- ~~ou~ess and health :, to do, the: changing:The simple truth'.Is. proved.txatelagm theeeHelds,forphystdans ~ promotion. - that't moUrated' People: caa. PracttcePrimary aad' Mses tradittona4-healthprofeselonals, .: .Wkaf...4 aot tatt uaa '•, .. Preventloawlthout health hasard appratsaL§ liealtla.nla..n..a. represent another key tar-- _Socloeeenumia Statne_ Such non-he4th '.. . aad, lntleed, wlthoatt phyplclans. 9n', B:BA get graup f0ranCh training. Determ(naUOn -:parametera u laoomq edueatlon., eex- and - .; . lkof llttla valuee waea'n used to aesesas thosa at approprlate'e national, regtonal. and local rac]aP,. cultural or etbnlecharacteastlca are ... wffio will not act toattempt to aaprove riealthgoals aredependent on an. under- tlgnSgcanUy aseoofated with or-erltical de- h heaith ptaepecfs.. Ptequeai.reparts of poor standln3 of tIIefnll'e range of fectors: which termmanta', of Ilea1W: Phr eaample, receat . '4omptian<W retes, ofIesethan 30: percent. -determme.or retate to..health., . .. . analysls ladieatee that twiceae-manT chil- . ..~.-wlUa Physfr.ffanpreacripttoasdemonstrate -' 871ttem: lfnstheatth,haaardappral+alsanddren In s..,ni.. .. °tth tDe- dlvergenceof phystaian.ss andd patient alak saeemmeatnara aow ueed only ia.popn- will de .-~omesnndM .AS.o00 VerepeeUv~ Tke, popularity of the term 1gUoaswLlcit ere:more affiuent, morehigpl9 veiop etlrnmlr:ieaat dfaeese as those . w(th' fam13A ln®mae nf aa};Ueb: or more: and "ocmplfeaeer Itealf characterizes the. passive . educated and moUrated, w1t11h tha: leisure omldsea ua tonn Umas as.litNA• to have poor eoncepivailmUOa of'the patient's eolela the Ume to devote to fiealth promotion. 74aY or falrr kealt7r lfthelt family mwme le under . pDpsltianJRatfent earnnnter. This 14s espe- lsaaerakesserlooaqnestfcas about the gsa-Q,OqOp: ,.. .. :.. ._ .. .. . ehlllyinapproprlatelnedortatoaHectchange enlhatlon af health hazard appraisal and .. M,.4yUaa/DFet 1n, geiaUonto Health:-.. ,1acomplex: behavior. Physlleiansa7eariT do the esbapotatloBn of' daLs from.m the current $ealth Ilayerdapprebsle rarel7 aaveee an- _ -bave a roleto play f.'n prevention, but not useoi'.thesa~teehniqnes ,- .... -~'tnttematatatosand.awtde.rsnge of.dletary - the prlmary.oney ih tlie prevenfion, process axecisnez.au~svgcvn~.: s,rsrnassassarext praeUees, atthengh Ireigpt foa height and . .Yteelf.. _ . . - .. ._ : . ... • .._. , '.: _...: WRnifsin it:nom~. .. ' ' ,. ahesttlp" la' atlsyt' meaaWed tietanee lt IS , _ Btfectivenese _of Interventions: Bnother easy to.meamreeempared to other sepects.of ttnublesome, t of current, reventioa- ~~~' A systEm' fs only ae good as tta in- - ~pBO p ~formetton., hut a.ellable-dats fat'rlsk aaaf- autriUamLetatvs and dIK MA. preperetloa and r1bksssesement lstheaerT poor success for the Seeond..D[CerruUOna[ Obesttyr Coa- _ rates ofmcat available interventlons: Beme~ h°° °' a®~ aIInoasyatemariR errors. _ . proportlon of people-perhaps 26:30'0 pervent. ~r'eautrulbak from mhase eaparlence ~ me'that me do aoe ~October vr sgwork- . ofthe.poPUiatlon-canandwlR',chan theirmu<h ¢vreeat>tisk, data 1sgeaerated, are not.. - Lfestye: "cold':tutkey,,~'d with mformaU a and ~aractartsUeof thegeneral Posulatlon,l3ey tng deLatUOn oII'abesity, mnch lesea decent .. efttiartstfoas sa tae om . stlmulus'tos ac« tend to be mora's affiuent., more male, more ~~_ ng efrleks related mo obesity. ..~_ Uon. Is hea[th hasardl appralsal, a complete' .~ . ty~,are IBieiyto be at ]oweri~rls athan ~tet to~men, mhlle:BD-66 peaaentof those- . progvestic and moUvaUonsl.meehanbml per' the genrra7:..Population on many factors and mmrmal, trsatmeat progeamsara women. ', ..se:.ur ls':lt.really onlya.flrst step ior.mosthi Idfa BLteealLlfe OD9nge: Very ImPortant ..people?~ It 1a..not teaaeonatile toW eapect in. P~~_ ~t aa otber ffictors : 8fnca the - work: baa been done m receat years based:oa . jprmarlorc atone to changes the mal4rity of ~y used eadsU¢dled. Ehese same: charactee~ the sanriaal wmY of ffins Setye,?e' blghltghting -~ tdlosa at high rlek-.Otherlntersentlons are.-Lmtlmnoerepeescntattveof'tliageneralPopn'- -Melmpurtanceof thecumnlatlve hnpectof .. .- .needed;anlres,aifstodata.wtth.sristatttedr Iattun,whatIsttie.baslstar:ertrapolatlonof -Itfe ahaugee--paeltive or negatlve--aa pre- ' I[Jesty7c change havtrbtm genetsily abysnW:- demT Et-a'apola:UOn errors can work In eitherr cursors otl>mees`and death.. While more wark _Wa.have:Ln.canaidereerlouslywhatwehaae& d'Jrectbaaepeadbagoa-the:sourceofthedatafaneeda'drto~aBdaiatne~ilyona7lfacaanga.. - - toofierpeoplwwhen weatnnulate them aseesement Kalea, thlab addttlont moultl add .-. enirlsltt. rlek' aseessmanm from the geuerall., tbchange;especiallymllglitofresearch.that popppttkaamwtQOVextwtlmatemoctailtyrltr. aalmporraret poteattai toLha.eduratlomi .. 1aW<atea that prealous.Iallnrea at beruvtar' , totAeearreat apeclalhealth haxsrd apprala-.. andA motlvatfnnai Impect. ef heaithLazard ~; ehango, oorrelate wltnh future Iatlures in _ yLpopulatlon, whereas exLCa.polat1on ai cur-_ aPpraLmL -' . ... behsvarr chaaga-` .. . - -.: renthealth'heasrdappralsalilatatothe'gen.. '. Warkplace/'WOtt Bttem*. Ctu'ient asecss-. . Overstatement an EzsggeraUOn of BeneIIte ~en[ Popnlatton monld tend:to underestlmatas ment Instruments raee4y elncidatr important ::.4emPlfeecqletmangeeMany'of'theprasent -aAeraIIrfsk.PfearwearaIaa~sltvattoamuuh BBPettaafaerYeitaat[one.+ne+^^"^gesposure ' f41t reductloa pcagrams may mislead-d psr-_ l6ES tEat of' health mamtenanees mrganres_.. teoocapatioaal paeartle:ofboth'pliyslologtcsL . .-' tfmpam8aboutthe beneats'of.rlak.redhetioas tLana; WncIDU hana.. aleo been' implemented +nd psTChola&at'M character-. which ace aig- .-„ ~ aadthe dtmcukty of chavgh+g comples life- prEmanly amang:.relativelymura arfluent.. Pmcant rSekk faetora, per ee: or mteractt to aipre aehsalms.Islvould haeteato: add thatl eooployed, and lnformed partlelpaati,, and. . increase the lmpaet of athec rbdclactorsk such .' am . a believer- in thebeneflclal. Impact of- - about which data' ate equaltiy dlmcultt to ex-- as. smokfn&. .. : . - .. taltmgg more: centro[ averane's lffe, andmd trapolate tn'.the tatal' population. PYtnees: C@rapE appralgal instrumente efforb to try too tmprove oae's risk status, --Crnnpts:. Our general system for assesstng. -Plsea an andue emphasls oa:forma6 exercise .. and.I try to practice these principles myseelf' rlsk.ta grasslp Inadequate, and I.am' pfeeaedd an@ sports, wfrbnotenoug}t attention.to ez- . mkeephtg with thehtgh v®lue'r plaee on to sea that a at~ber of papers win be pre« . erd'seievelas tn settvlUes oi dally ltvmg..I am 3.elth.Imosry,, however, about some Par•sented here nn improving therisk.predletlone im?~d mLtb tlie potenUal of: the concept .. UeWar: <3 yaac-aid man who may believe technlquea ofhealth haaard appraisat Oor' of'fur^-im+^g statua'.' a developed toassese.. If he stope smoktng,, changesbis dYetaryaml deflolencLees aze- gseatesG when Ltcomes to: the.elderly more rea]faticaily than dlagnoses eaeaeLae patterns, that'.he will not havea: assessinglnteeactive or compeUti4erisks-fora alone Permit:: You could knuw that a person heart att9ek. ae dlettngefshed from uader-. esxmpie,mfti smokmg~g and accupattonal. =y have dlabetes, arthrttia, techemtcheart'. _. standing that- he would be hnprovibghls^a°"°` .Io-atldtttoa, I am troubled by the: dlsease- and reeptratory;: vEdtoa and hcaring' risk category. I reter youhere tothebitter.o wsA emaentrbasesesaments treat alcohol, Impsfrmeatw and. yet know virtually nothing letters m M'odern. PKediclnewrltten by itas coafturnptbon-ffiIICalt 1sclear'thatthere'ts aa about bDw we[I that peraan ts able to, .func- . _ edrtor aws reaomnedcardtologtst, Izving,Page:, ble dlaesenee between' consuming seven ttoa, edbing: 'Yanetleningstatus" aVese- .. t+nrmg bta heepitallzatfon' ftom a.myocardiak& allass 'lbr meek at. a mte, of. one eaeh.h day. . menta of' phyateal and peyehologlcal perform.-- hrfarcdon- after having followed.for manp and:rons;...,essvenaf.onca. .. ... anea could eahance and reSaforee the'rlsk ' yeaasalD:ofthePrlnclpleefoirreducia~ g'ooro-., Sfortalltytmly::Thaezgluslveen..pl,aaison reductioa potenUai of health haaardi .: ... , r ,. . . . .. mryr heart dlhease risk aad' having 6kreat- martatldp arime leavesa~ Iott to be desired . aPPrWs"- .encd.hbPatleatsatthe.Clnveland.,.Cllaluihto...slanedeath}anof.nprlmarymottvattngforce Repreeantatfon uf Tatat Populatlou:Not. . ,- .... formaasApeoph,.partlaalarly'Ehetiyoang;lh en<mghrtskdaiats.menrporated.lncurrent .', Pootnotes at end of artlclR addittaa~whese fear of death is-.hlgh, be- bealtb: Lezsrd sppraleals envarioue oam-. 0.36.036U~

•' . .. . . . .. ' i ~1 ;, S 7866 • . 1VGRESSIONAL RECORD'-;SEN fH Mlpx~ Z9~.Y978 September 30: 1981, 830'AOO.000 fortheflscal' •"(A) that the programte operattagg eHec- -- "(g) ,Ahinformltion obtained' about any - year endlag September 30, 1883, Bfl3.000•000l tively to echfeve. lts stated purPoses,- .. ' indlndual under, any program that fe, bemgg toe the fLUal year ending:September 30:.1983,.. : '(B) that theapplloant', eomphed with carried' out with. aA grant made I under eub- and..835.000,000 fur, the:flscaL.year.endYng' assurances provided with a prior application eeetlon.(a)sball~not, without sueh indlvld- September 30. 1®84:", ....,. .. under eubeectlon (b),, and val•e eonsent,l be:' dfecloeedl. except: that (1) rwtrcr oserrrs roa saxvcnarw >vecra .-: °(C) : that ho-ls..aseul thatthe appllcant 'suchintermation may be disclosed without .. .. _-amvrpw .w111 comply'.vrtth the. ase.urencee'. Proslded auch conaeat if the disclosure~ is.neossssry with 1g3. (a)ffieatlve October i', 1979, aec- ~ the appileatioa unAer-oonsie®ration. . to provide serviee'e to such. ]hdlvldual'or Ia "(2) Whanever the atter'rea- -raqulredbp e lasr' 9bcretary ot a9tate or ol[ttcal' b- , p su ". tlon'91Tend the aeeefngthereto aro ammd- .edLOreadsafollower -. sonablenotice.and.opportunltqforsheanng'division'ot aState,'ayd'(9) Informatton '' to a grant recipient. nnda wlth, respeat too derivedfromany euch program may tie:die-: "veo.iscr cuN•mrors rl~ >uacrn - . funds paid to such reclpient,, that thee pro- closed- .- ' -. . . ,,. . . . . ...smar® raaaseasa . '-: gramIs.. notoperatlag eSectlvelyto achieve. "(A)l fn aummary. 'etatlatlaaL orr other . "'Sst•. 31T. (a) The Seeret,ary,May make.1ts eteted purpoeess or that there Is a fall- form. or -.. ' .. ~ ' •~ grants to -States., politieai aubdivLslonas of ureto.eomply subatantlally with assur. :"(B). foT clinical orresearch, purpoees; • .: Statee, other pubitceatitles.orpnvste enti-.: ances pmvrded undar eabeectlea(b)_vrtth, but.omy if Indlvmtmlly.ldentiflable personal .. ..m tles. to. eesiaf, . themm in meeting tlle' coste of respect't to the recelpt of eueh grant, the: data of:any such mdlvldual'..1s not't d(ecloeed. ' .._provlding preventlvehealthe aervicees pro-. Secretary shall not4fy' the grant reeiplent: . "(h) Nothing in.this sectmn shall limit or . - ; grama aaaet farthllh subesetton (j).. . .-that.further paymentswEll not hemade toW oth®rwlee:reetnettheuseof'.funde.whtch arv , - - "(b):No•grantmaybemadeundersutisec- lt under sueh,gmnt.(or 1nn biag disCletton . granted.to a State orr to an agency-oL a ' ti ()f thatt fut'ther paymentYs willl be: reduaed) Politica[ subdriiotSttd .ona uniess an.applieaton.therefor: hae..s,.vsn oa.ae uner provt- ..been. suAmltted to„ andapproved. by, the..e until he ie satisaedd that the: program will slons of H'edersl law (other thann this eec- Secretany:,Such anapplleatlon sha1l be..in operate. eHectively or therewill.: no longer' tfon) andwhicharaavallablefortheeoaduct . .. ,: suchh form, and be eubmlttedl in auch maa- be auch..a.. faSUre. Untllhe I$ se satls8ed..theof'preventive health seraiceprograme, . from . . ...- m. thn A.nterxnv-aTnn ha wn„ruHnn ..... Secretary aball, make no~o payment. or 1n hiss being u]edm eonnection, with e[Ol eerlbeandahallprovfde-- . meacevo4: rzuuwpar+ueuww cue yrunuaaavwu6 cmollgn gnmrJ. ~tnder' sunaeCaon -.. •. . : ~ '(I) for.adetatledplanof theprogrsmSor recipSeae. . ~~ . . .-. . . is)' ... . .'nhtch.the:apphcantfeseekingsupportunder ~~(1).'1Leamountofa.grantundersub- ••(1) The Secretary'stlall'submit to the. subaeetlon (a).pI section.(a7 shall bedetermmed by'theSec+ Ptesldent.ror submiselon,to, the Congrese on '(7) theamount ok Pederaq State. and~d rotary, Sachsuch, .gront-ahall.be made for'Janusrp1, 1981, and on.JanuarpI of each'other fundsabllgated by thee appheant'Sa, costs-for prevenl health servlcaa in thesuooeedlag yeer a'reporto¢the eztentof ths _Ita latest annuaL accountrng: periodfor thee ona-yesn-period begkonmg' on, the Enst.day probteme presented by the dlseeaee andd con- .. ~ prevlston:ofeaehprogramreierredito(n.par-.-.of.the-tirst.month.beglnafng after the dlttonsreferredto, (naubsectton.(1);anthe' ' agra'aph (1); a. deseription. of: the preventlvee moath-Inh wmchtbe gcsnt ix made.. Pay-. amountot funds obligated under grants un- llcantinh meatsunder.smnhgrantsmayt)emadelnado dereubsection (a)in..the'preceding'flecal .. bealthservlces.provided~bytheap p . .'. weIIprogram.ln aueh penod:'.Lhe. amovnt -rance.on: thebaslae of eetlmatea or bytheyear for each of the. Programe'.lnted ih.sub-. ^'of Federal fuude needed.by the.gpplloantto way of retmGmaemeat, with necessary' ad-sectfoh (J); and on the effectiveness of'taa .. eontiaueprovlding, aueh services. in' eaeh~lustmeath ow account of: undbrpsymenm or ectlerttleseaselated, under^grante underr euh-. on such terme and' condltlonssathe Saore- condYtions. ..' enenges Ih the pmvlelon. Of the servicea'la. any such progesm, the priorities of such pre. tary ends. neceeeary to,earaT out the pur. ."()) (I) ybr payments to States under:.. +' . . . '_ paead.caangee; tiia~ras.omaoressch cnsnges: pO°e8'alsuch granta. -- . :- - grante u.nderr aubesotton. (a)~.-tor eetabuan-. `and:'the amount of'Federal funds needed.by.. '"(e) 'LheSerzetery. at the.request af d L4 andmaintaintng progntms for the. - dWgaoela Rrerontlon: ~°°°III8'• detectlonl - . . reclpientt of a grant under subsection. (a)... Lha~applleantto make suoh ohanges: `"('3) for assursnem satlstactory tm the may reducs theamount of aueh gleat by--referral fortteatmenWr and:d follbw-up on ' °~ppBea rompliancr'withtteamtentofhyperteneion. thefalrmarYetvalue~ofaa7 (1) 8 ' . euretary Lhst.theprevsntlveheal CliaenM1Oes.. . . whloh w1II' bs P~?ded.. wltheunda under a flnuLUding.'vsaciaea aad: othar Prevaativee tkus are authorleed to 1SSaPPropnatedl ..grant under euesectlon (a): wlll bepro_ . agenm)or aquSpment furnished the grant. 830.000:000 for theBeeal year endtng, Sep+..tlded.in amanner consietent with the State- reclptent.. andd tember 30, 1980. {85.0OO,OW'.forl the. Lacal -. .health.pl'an in-eSectundert seetton:1534(c). "('7) the amoun4 of the paY.allowances,. ~Oo0 for endm'g: the tlxsl 8eptember30,. 1081. and'860:-,Bud in those caees wheree theapplicant-1s and. travelexpensee ofany omceror em-9eu endnl8..3eptembei.. ...-... -aStste, that auch alrvlGee wtll be . leyee ofthe: Government when detailed to~. -.30Y 19g2. papmente undec eubaeotiou~ (al ~• (d) ~'r, . . hegrant recipient andd the amount ot' any' _ ~~Mhere aPProprlate.. In a manner conaletanC't b ngand matntalning' programs tt a with th i .. i ~ n n coaaec o ncurred wltheny plans' in efftdiarh otherweM n e,ec unr-pagraps:. . to~hmimlzscnlld ren (b) (D) and (b).(3) of eecdon 318; < detail of such.omcsr or amployee.. -. : a8atnet dleeeeea' (In'elud7ng measles, rulfella,. Ponompeutb: Alpb... . ,•.(4i for sesuna¢see utlsfaetoryr to the° wbenn ttiee furalsbfng' of suah eupplfbn or tbsns, pertueele, tataaus., and mumpa) ~ tbere.. Secretary thatt the:.appnuant wm DrovlA, -equspmentt or tho--deteAL o1' auah'aa oteeen' are.anthorized,.to beapproprlated e38,00u,000. - for euch nxall eonttol.endl fund aacouattngcl empleyee Istorthaeonvenleaea off and forrohe Beml year endng..BePtember 30, 19g0:. _ proceduresae. We. Beaetaryby regulation at the request of auch~ grant recipient and yg6,000.006for the 0scal,yearenQing Septemrl prescrlbms m, essure theproperdlsbune- forr the purpose of carrying out a pragram be!-30. 19811U and', i38•000,000'0 torLhe Hacel. . meat off and aecouat/ng' for fundareonved °rlsn respect too which the grant underr sub- year.r ending Sep4mber 30, 1982. ' nnder Btanta uader auneectloa: aection (a) ismade: Ttis,-emouat Hy-whtcn .••(3) For payments undar subsection (a): . .'(4) for aesuraaem estlsfactorytothe aaysuoh'granVteso.reduoed.shalibeavall- forestabllshfngand.malntalningcommunit~- _SeeretarythattheappBcantwlllmake:sach abte for paymentby the Secretary ofths' end atnool-baeedi Buoradatlon plograms•. _. reporra (in euch form andeontamrng.sueh~ eoerelncurled In fb+'++naiegg tha. supplisa or -there are authorlmd~ to be. approprb.ted (ufermatlonastheSbcretarymay by re~ea- ~~pment: or In deta)Rhg'.the peraanaeL ~.OO0,OO0,forthe.aeCal..year ending Saptem- -.. latlon preaenbe) ae.the Secretary'mayr on wmahh the tednlctioa of' auah gnnt 1a: ber. 3p,. 1p8e..88,g00,000for.the aeoaU year ®ed.sonably require. and~. keep sucll-recoeds: sad~ ®ed. and such amouat eball be daemed asendmg September 30..1981, end {e,00oA00 for. . .. bs • afferd sueh acr,eee.s tbereto. saS the part of the graat. aad sha11', be deemedi to, . thee nsea( yser ending September 30. 1989'. . SeQetary- havsbeen pald.to, the grant reelplaat • ••(;) for payme>~ts under atlbaectfon (a)- maFElnd.hecesesry'toesurttkecorrecthesa-.,(Q)(1):. Each reoipfentt ofa.grant under for-estabhabfng sulf-maiatalningt programa ' ofNandto.vanfy;suahreporta;.~:- 'aubsectiom. (a)shaW keep such recares. asdesigaed to, Prevept illheee.e caused by fac• ..~ (6) for.asaueanceesat26factorptothe..Sec-r the Secretsry'shall' by regulationprescrnbe: tors in the Immedlate iiving:envlronment of .. .. retary that theepplYcant wlll':.complpwlthfneludmg^ recorda, which fullytllselose the: peopla aueh as' [ocanzed, expoeure: to tonc . any' other contlitlonss imposedd byttlfa, sec- amount and d)spmitlon.by such recipient ofsubstances, and- Improper atoragee of: solid lth '. tl t t on:w respec og[anta;; and thcdfhrt th ttlost ofd fle tSre are autnorfaed t b ..e pmees,osuc.gaaseoa c waste anue,eoe^(7) fersuchr other information.ea~ the the undertakmg Ih. connectlon with which' . approprlated: 812.000.000' for: the. Lscal yearFiecretary: mayr by-regulatlon, presCEibe; such grant wesmadeS and the amount'of ending yeptamber 30, 1980;. 512;000.0001 for '"(c) (1)The: Secr,etary shalll review an. that portion ot thee eastof the undertaking, the 8sca1 year' endtngSeptember30, 19g1;, nusRy the setivitfeal undertakel by eaeasuppued by otherr sourres, and suchother.and'. 812:000.000 forr the fiscal year ending, reclpOSnt:.of a:grsnt undersubeeotion (a)) to, . uco('da-as. vri11 faeillmtean. effective audit. September 30; 1982. ." .' detm•mine:If the program assisted.by so:ch a-"(Z) 73e Secretary and the Comptroller "(5) For payments under subeectloa (a)) grant lo- operating enectlvely t'oar.hieve. tte. Qieneral of the United States.. or any eff foreetaibllahing and mamtaiWagProgramsetated purpmeiand:lf.'the grant reciPientthelnduly'autnorized representatives. shalll to.prevent diseases borne by rodentar there. . eempLLed:wlth.theasetranEes:p[ovlded-wlth haee. accmn forr the purpoee.of audit andi" areauthorized.toheaPproPnstAd814.000,000 the. applicatton:.TheSecretaryrshall. not ap= , enm[nation to any books.- documeuts,, for:the Slecal.year ending Beptember30,.19801 . prove an,applmation, submitted' under ebb- papera, and reeords.. ot thereeip(ent of granta. f14.000.000 forr the Eseal! year endlagSep- eeetlbn (b~)unleaa. the Secrstary- deter- ~rndes-subeeet.fon (a)._that.are.partlnent) m: tember 30'. 1981, and 814.000.000 for the-BecY ... .- .