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Federal Document Clearing House
Congressional Testimony
March 21, 2000, Tuesday
SECTION: CAPITOL HILL HEARING TESTIMONY
LENGTH: 6054 words
HEADLINE:
TESTIMONY March 21, 2000 RENEE JENKINS PROFESSOR AND CHAIRMAN HOWARD UNIVERSITY
COLLEGE OF MEDICINE HOUSE APPROPRIATIONS LABOR, HEALTH AND
HUMAN SERVICES, AND EDUCATION LABOR HHS APPROPRIATIONS
BODY:
RENEE JENKINS, MD, FAAP PROFESSOR AND
CHAIRMAN DEPARTMENT OF PEDIATRICS AND CHILD HEALTH HOWARD UNIVERSITY COLLEGE OF
MEDICINE APPROPRIATIONS LABOR, HEALTH AND HUMAN SERVICES AND EDUCATION March 21,
2000 Mr. Chairman, members of the Committee, I am Dr. Renee Jenkins, a
practicing pediatrician who has taken care of adolescents for over 20 years. I
am also professor and chairman, Department of Pediatrics and Child Health, at
Howard University College of Medicine. On behalf of the American Acadern of
Pediatrics and the endorsing organizations, the Society for Adolescent Medicine
and the Ambulatory Pediatric Association, I would like to thank the Subcommittee
for the opportunity to present this statement. America's children are generally
healthier now than they were only half a generation ago. According to the Annie
E. Casey Foundation's 1999 Kids Count Data Book the national infant mortality
and child death rates and the percent of children living in poverty have all
declined and immunization coverage rates have increased. However, despite these
significant improvements there are still over I I million children who are not
insured. Moreover, racial and ethnic health disparities for many children and
adolescents continue to exist. We both have more to do. As clinicians I must
work with my colleagues to not only diagnosis and treat our patients but also
promote strong preventive interventions to improve the overall health and well-
being of all infants, children, adolescents and young adults. Likewise as
policy-makers, you have an integral role to play with your colleagues to improve
the health of the next generation through sustained and adequate funding of
vital federal programs that support these efforts. A chart at the end of this
statement will offer funding recommendations for several programs that we ask
for your ongoing committment and support. In this statement, I will highlight
just a few of these programs and services. PREVENTION, EARLY INTERVENTION AND
DELIVERY OF PEDIATRIC CARE Centers for Disease Control and Prevention: For over
50 years the CDC, the nation's premiere prevention agency, has been at the
forefront of fighting disease, investigating health problems, promoting health
behaviors and implementing prevention strategies. We believe that these vital
efforts must be maintained and strengthened if it is to continue to do this
important task. Therefore, we join with the CDC Coalition to recommend $4.1
billion for the CDC in FY 2001. In particular, I would like to highlight the
CDC's work in immunizations, injury prevention, and control of underage use of
tobacco as examples of critical programs for children and adolescents that
require further federal investment. Childhood Immunizations: The laudable goal
of CDC to prevent and control disease perhaps is exemplified best by the
unprecedented achievements of the nation's public-private immunization
partnership through the CDC Childhood Immunization program and the Health Care
Financing Administration Vaccine for Children program. Pediatricians, working
alongside public health professionals and other partners, have brought the U.S.
its highest immunization coverage levels in history. As a result, disease levels
are at, or near, record low levels. Haernophilus influenzae type b (Hib)
invasive disease - previously the leading cause of childhood bacterial
meningitis and postnatal mental retardation - serves as a useful and dramatic
example. Prior to licensing of the first Hib vaccines in the mid-1980's, an
estimated 20,000 cases of Hib invasive disease occurred annually. In 1998, 54
cases of Hib disease were reported. Yet, despite this good news for infants and
toddlers in particular, adolescents continue to be adversely affected by vaccine
preventable diseases (e.g. varicella, hepatitis B, measles and rubella). Over 40
million adolescents are at risk of vaccine preventable disease. Comprehensive
adolescent immunization activities at the national, state and local levels are
needed to achieve national disease elimination goals. In addition, continued
investment in CDC efforts to assist states in developing immunization
information systems will serve to maintain high immunization levels by reminding
parents when immunizations are due/overdue. These systems also help
pediatricians and other health care professionals know the immunization status
of the children they serve. Obviously, the ultimate goal of immunizations is
eradication of disease; the immediate goal is prevention of disease in
individuals or groups. We strongly believe that continued investment in CDC
efforts must be sustained. In FY 2001 the American Acadern of Pediatrics and
endorsing organizations recommend at least $615 million for CDC's Childhood
Immunization program. Injury, Prevention: Unintentional and intentional injuries
are the leading causes of death for children and adolescents. The National
Center for Injury Prevention and Control (NCIPQ works to address this issue and
plays a key role in the surveillance, research and training related to
prevention of all types of injury. Every day, children die from injuries, and
countless others are injured or disabled. Injury is costly: Medicaid pays nearly
$1 billion annually in emergency costs for injured children. More important is
the terrible toll that injury, and particularly violence, takes on our nation's
young people. Homicide is the second leading cause of death for young Americans
between 15 and 24 years old and it is the leading cause of death for African
American youth. Moreover, for every violence-related death, there are an
estimated 100 nonfatal injuries caused by violence. Children and youth face
serious short and long-term consequences - cognitively, emotionally and
developmentally - when they experience violence as victims, witnesses or
perpetrators. Additional funding would enable the Center to expand efforts to
reduce physical and sexual abuse and other violence against children and for CDC
to develop a comprehensive youth violence prevention program. We recommend that
the National Center for Injury Prevention and Control be funded at $114 million.
State-based youth tobacco controlprograms: The CDC has a critical leadership
role in implementing and coordinating state-based efforts to prevent and reduce
the use of tobacco. Since the November 1998 tobacco settlement, the role of CDC
has been heightened by the activities of some states to develop comprehensive
and effective youth tobacco control programs. These funds will be used to expand
the capacity of health and education departments and partners to build and
evaluate comprehensive tobacco control programs, to develop and promote health
communication campaigns for target audiences, and to expand school health
programs that equip young people with the skills and knowledge to avoid tobacco
addiction. We support a FY 2001 appropriation of $130 million to assure adequate
funding for CDC's state-based tobacco control and prevention programs. Health
Resources and Services Administration: The Academy and endorsing organizations
join with the Friends of HRSA to recommend $5.1 billion in funding for FY 2001.
1 would like to take a minute to bring your attention to several programs of
particular interest within HRSA that extend access to quality health care for
the nation's children and adolescents. Maternal and Child Health Block Grant:
The Maternal and Child Health Block Grant (MCH) remains the only federal program
that focuses solely on improving the health of all mothers and children.
Currently, it provides preventive and primary care services to over 22 million
women, children and adolescents. The block grant supports a wide range of
activities including reducing infant mortality, preventing injury and violence,
expanding access to oral health care, addressing racial and ethnic health
disparities and providing comprehensive care for children and adolescents with
special health care needs. It also plays a very significant role in the
implementation of the State Child Health Insurance Program (SCHIP). The MCH
Block Grant includes an important set-aside of 15% to support the Special
Projects of Regional and National Significance (SPRANS), which includes MCH
research, training, genetic services, hemophilia diagnostic and treatment
centers, and other similar initiatives. One example is the Healthy Tomorrow's
Partnership for Children Program, a public/private partnership between the MCH
Bureau and the American Academy of Pediatrics. In its I 11th year the program
supports family-centered initiatives in over 90 communities that address: access
to care, community-based health care, preventive health care and service
coordination. Another important component of the MCH Block Grant is that it
addresses interdisciplinary adolescent training and services and research for
both the physical and mental health needs of adolescents. The Office of
Adolescent Health supports programs for vulnerable populations including health
care programs for incarcerated and minority group adolescents and violence and
suicide prevention. To continue to foster similar community-based solutions to
local programs, we support and strongly urge an increase in the funding of the
MCH Block Grant program to $800 million. Family Planning: The consequence of
adolescent pregnancy, sexually transmitted diseases (STI)s), and HIV/A1DS adds
urgency to the need to help adolescents make informed, responsible sexual
decisions. According to a report by Child Trends the percentage of teenagers
having sexual experiences is declining. However, we know that for those teens
that are engaging in sexual activity they are inconsistently using
contraception. In particular, Latina girls are the least likely to use
contraception and therefore are at an increasing risk of becoming pregnant. In
another study by the Kaiser Family Foundation and the Harvard School of Public
Health, 70% of Americans were not familiar with the human papillomavirus (HPV)
and only 2% could name HPV as a sexually transmitted disease. This is a tragedy
when you consider that HPV is the most common STD for sexually active young
people. As a pediatrician, I counsel teens that responsible sexual
decision-making, beginning with abstinence, is the surest way to protect against
sexually transmitted diseases and pregnancy. However, for patients who are
already sexually active, confidential contraceptive services should be available
to male and female adolescents and screening for sexually transmitted diseases
and prevention strategies should be a part of contraceptive health care. We
support a funding level in FY 2001 of $300 million for family planning services.
Title X of the Public Health Service Act. Emergency Medical Services for
Children: While a small investment, we know that HRSA's emergency medical
services for children program (EMSC) has saved many young lives. This grant
program has helped states and localities make significant strides in improving
EMSC through the development of model training programs, ambulance equipment
lists, treatment protocols, and triage and transport systems that address the
unique needs of children. Additional resources would allow the federal EMSC
grant program to spur the development of emergency systems with pediatric
expertise - an especially challenging task in the face of managed care
restrictions on the use of emergency departments and non-network facilities -
and promote research and use of telemedicine in areas without sufficient EMSC
systems. To continue to stimulate life-saving EMSC system improvements. we
recommend funding this prop-ram at $ 9 n-million in FY 2001. Poison Control
Centers: Another growing crisis in this country, including Washington, DC, is
the financial viability of poison control centers, a valuable national resource
that provides life- saving and cost-effective public health services. Each year
more than 2 million poisonings are reported to poison control centers throughout
the United States and more than 90 percent of these poisonings happen in the
home. Alarmingly, 53 percent of poisoning victims are children younger than 6
years of age. The American Academy of Pediatrics supported and actively endorsed
the "Poison Control Enhancement and Awareness Act" (PL 106-174), which
authorizes on-going support of poison control activities through both CDC and
HRSA. We recommend that this program is funded at full authorization levels,
including: $2 million for the establishment of a national toll-free number to be
used to access poison control centers, $600,000 for the establishment of a
nationwide media campaign to educate the public and health care providers about
poison prevention, and $25 million for the establishment of a grant program to
fund certified regional poison control centers. Child Care: The Academy and the
endorsing organizations strongly support efforts to improve the accessibility,
affordability and quality of early child care/education in this country.
Recently published research on early brain development underscores what
pediatricians have known for years -- that a child's care in the earliest years
of life is critical in developing his or her potential to be a healthy and
productive citizen. For older children and teens, after- school programs can
direct their energies to positive activities and away from juvenile crime,
gangs, tobacco, alcohol, drugs, and premature sexual activity. Therefore we
recommend funding the Child Care and Development Block Grant at $2 billion,
allowing for an increased investment for research and improvements in the
quality of child care. We also urge the Committee to fully fund any additional
spending that might be authorized for child care this year including benefits
for parents who choose to stay at home. Substance Abuse and Mental Health
Services Administration: It is estimated that 13.7 million children and
adolescents have a diagnosable mental or emotional disorder and approximately
7.5 million of those children and adolescents under the age of 18 require mental
health services. However, the National Institute of Mental Health estimates that
fewer than one in five receive the help they need. In addition, our schools are
in desperate need of qualified counseling and mental health professionals to
provide comprehensive prevention services. We urge the inclusion of mental
health services, provided by qualified school counselors, school psychologists,
and school social workers, as an allowable use of funds in the Safe and Drug
Free Schools and Communities Program. These qualified school-based mental health
service clinicians provide critical interventions, deter students from
delinquent activity and get them focused on learning. The Academy and the
endorsing organizations recommend that $93 million be allocated in FY 2001 for
the Mental Health Services for Children program to ensure the continued and
growing success of this program for those with serious emotional disturbances.
PEDIATRIC RESEARCH National Institutes of Health: The National Institutes of
Health (NIH) is a vital component in the nation's public health system. Through
the years, the NIH has made dramatic strides that directly improve the quality
of life for infants, children and adolescents through biomedical and behavioral
research. One example is the National Longitudinal Study of Adolescent Health.
Funded by the NICHD, the wealth of data from this survey is so enormous and
important that over 260 papers, manuscripts and presentations have been
generated from the initial survey, providing invaluable information about key
factors in both the home and school context that may protect adolescents from
risky behaviors, such as smoking, drug abuse or underage drinking. A 1999
federal study found that 80 percent of high school seniors reported either
getting drunk, binge drinking or drinking and driving. Furthermore, data from
investigators supported by the National Institute of Alcohol Abuse and
Alcoholism (NIAAA) reveal that initiation of drinking earlier rather than later
in youth is associated with a dramatically higher risk of developing an
alcohol-use disorder later in life. This seems inevitable when we consider the
fact that a study reported in the American Journal of Public Health in January
found that 19 million children between the ages of 0 and 17 are exposed to
familial alcohol dependence (alcoholism), alcohol abuse, or both. We applaud the
leadership of the NIAAA in the Surgeon General's campaign with the Robert Wood
Johnson Foundation, to make prevention of drinking by youth a national priority.
We strongly support the efforts of the NIAAA to reduce underage drinking and
recommend an appropriation of $ 1 0 million for research, prevention and
intervention activities within NIAAA to address underage drinking practices. We
are pleased that again this year the NIH has identified as one of its priorities
the reduction of health disparities. For example, among African American
infants, the rate of stomach sleeping and the rate of Sudden Infant Death
Syndrome (SIDS) is more than double that of white infants. This is despite the
very successful NICHD Back- to- Sleep Campaign in partnership with the MCH
Bureau and the Academy. Since the Academy's recommendation on sleep-positioning
in 1992 coupled with the start of the educational campaign in 1994, deaths due
to SIDS has decreased by more then 40 percent. It is clear that the very
important benefits of this educational campaign placing babies on their back to
sleep -- has not reached all communities including the African American
population. The NICHD is committed to reducing SIDS in all infants and is
working to identify culturally effective ways to communicate the Back- to- Sleep
message in all communities. The pediatric community applauds the ongoing
commitment of Congress, through the leadership of this subcommittee, to increase
NIH funding. We join with the Ad Hoc Group for Medical Research Funding in
recommending a 15% increase for NIH in FY 2001 as the third step in doubling the
NIH by 2003 and join the Friends of NICHD in supporting $1.06 billion for the
NICH.D. Furthermore, we commend this committee's ongoing efforts to make
pediatric research a priority at the highest level of the NIH; therefore, to
increase pediatric biomedical and behavioral research within the NIH, we
recommend $50 n-million for the Pediatric Research Initiative. We believe that
these requests represent the best and most reliable estimate of the level of
funding needed to sustain the high standard of scientific achievement embodied
by the NIH. However, we continue to encourage Congress to explore all possible
options to identify additional sources of funding needed to support these
increases if we are to reach this goal and not weaken any other valuable
component of the public health service. Agency for Healthcare Research and
Quality (AHRQ: AHRQ has embarked on a major program for translating research
into practice (TRIP), using the findings of their research program to influence
how physicians and other health care providers offer care, as a key part of
their agenda to understand how different patterns of care affect the health of
Americans. AHRQ's research agenda emphasizes what works to improve care for
children, adolescents and others in varied clinical settings. A key program of
the Agency is the Medical Expenditure Panel Survey that provides health policy
makers and the public important information regarding the influence of insurance
or health status on expenditures and access to care and helps states make
important decisions regarding expansions in health insurance. Patient safety,
medical errors, and health system improvement, brought to our attention by the
recent Institute of Medicine's report To Err is Human: Building a Safer Health
System, is an issue of great importance to the child and adolescent health care
community. AHRQ has proposed a broad new initiative in FY 2001, to build on
existing knowledge in patient safety, fund new research in the field, develop
and improve tools available to reduce errors, such as medical informatics, and
translate this research into improved patient safety. We will encourage AHRQ to
carefully consider and address child and adolescent health concerns in this
endeavor. As the AHRQ moves forward in this important field, and continue, as to
provide policymakers, health care providers, and patients with the information
to continuously improve health care, we join with the Friends of AHRQ to
recommend funding of $300 million for the AHRQ in FY 2001. EDUCATION OF
TOMORROW'S PEDIATRIC PROVIDERS Health Professions Training Grants: Critical to
building a pediatric workforce to care for tomorrow's children and adolescents
are the Training Grants in Primary Care Medicine and Dentistry, found in Title
VII of the Public Health Service Act. These grants are the only federal support
targeted to the training of primary care professionals and they provide federal
support for innovative pediatric residency training and faculty development
programs throughout the country. For example, in the mid-1990's, the University
of Wisconsin Department of Pediatrics developed a residency primary care track
with Title VII funds. This program placed residents with community pediatricians
and permitted them to take part in a number of community-based training
experiences such as making home visits with public health nurses. In addition,
residents gained primary care experiences in migrant worker camps, Indian
reservations, inner city areas, third-world countries and rural health clinics.
This nationally recognized primary care track continues today as a required
community pediatrics/public health experience. Through the enduring support of
this subcommittee, the Title VII program has continued to finance exciting
educational opportunities in a variety of settings, to educate and train
tomorrow's generalist pediatricians to be culturally competent and to meet the
health care needs of their communities. We recommend FY 2001 funding o at least
$30 million for General Internal Medicine/General Pediatrics and we join with
the Health Professions and Nursing Education Coalition in supporting an
appropriation of at least $335 million in total funding for Titles VII and V111.
We further recommend an increase in funds in FY 2001 for the National Health
Service Corps, a key component of any effort to remove barriers to health care
and to insure an adequate distribution of health care providers across the
country. Independent Children's Teaching Hospitals GME Funding: Equally
important to the future of pediatric education and research is the dilemma faced
by independent children's teaching hospitals. Last year, Congress and the
Administration took the first steps towards providing equitable federal support
for residency training in independent children's hospitals both through
authorizing the new and much needed program and in the same year providing an
appropriation of $40 million. Children's hospitals across the country are
critical to the care of the nation's children and play a significant role in
training tomorrow's pediatricians and pediatric subspecialists. However, these
hospitals qualify for very limited Medicare support, the primary source of
funding for graduate medical education in other inpatient
environments. As you recognized last year, funding is needed to continue the
education and research programs in these child and adolescent -centered
settings. Although we support and recommend funding of this program at the
full-authorized amount of $285 million in EY 2001, we reco2nize that it may be
necessary to implement this program incrementally, and would recommend at a
minimum $125 million. Furthermore, we strongly encourage the committee that this
not come at the expense of valuable Title VII and VIII programs, including grant
support for primary care training. CONCLUSION: Finally, Chairman Porter, in
closing we would like to personally express our thanks to you for your
commitment to and prioritization of children and adolescent issues as
exemplified in your leadership of the subcommittee. We appreciate the
opportunity to present our recommendations for the coming fiscal year and wish
you the best as your retire from Congress and begin to tackle new challenges. In
summary, the following list highlights programs, along with funding
recommendations, of importance to children. The Academy, the Ambulatory
Pediatric Association and the Society for Adolescent Medicine, joins with its
many friends in other organizations and coalitions in presenting these
recommendations.
LOAD-DATE: March 24, 2000, Friday
