U.S. Department of Health & Human Services
Improving the health, safety, and well-being of America
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U.S. Department of Health & Human Services |
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Improving the health, safety, and well-being of America |
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| December 31, 2001 | Contact: | HHS Press Office (202) 690-6343 |
Secretary Thompson, sworn in as Secretary of Health and Human Services on Feb. 2, 2001, navigates the department's broad response to terrorism and continues to ensure that critical health programs and initiatives are established and put into place, a need that is stronger today than ever. With a fiscal year 2001 budget of $429 billion, HHS took vital steps to protect Americans this year:
On September 11, HHS acted instantly to support the health care and emergency needs of New York, Washington, D.C., and Somerset, Pa. When anthrax mail attacks occurred, HHS agencies delivered the health and scientific leadership that prevented more lives from being lost. For comprehensive information, visit www.hhs.gov/hottopics/healing/biological.html.
HHS Rushes Disaster Assistance to Overwhelmed Areas. Within minutes of the Sept. 11 attacks, HHS Secretary Thompson declared a national health emergency and placed the National Disaster Medical System (NDMS) ready for deployment. Beginning that day, the HHS Office of Emergency Preparedness (OEP) deployed more than 1,000 medical and support personnel from around the nation to support the overwhelmed local resources. Some 50 tons of backup medical supplies were provided to New York on Sept. 11. More than $126 million in financial relief for local health and emergency entities was announced Sept. 21, part of the President's relief efforts.
HHS Agencies Protect Americans in Anthrax Attacks. For the first time in history, anthrax was used in mail attacks. The surreptitious attacks were discovered early, with leadership from HHS' Centers for Disease Control and Prevention, which alerted state and local health agencies on Sept. 11 to be watchful for unusual symptoms. Operating in uncharted medical terrain, CDC acted quickly to prevent even more people from being sickened, by developing and refining new recommendations on use of antibiotics to protect those who might have been exposed. Fast action by the Food and Drug Administration helped ensure that adequate supplies of effective antibiotics would be available. HHS provided hundreds more support personnel as well as thousands of antibiotic doses to back up local health departments in treating those who might have been exposed. CDC issued a series of national health alerts to ensure that health departments were aware of the latest actions and recommendations. With teams dispatched to help local health departments deal with anthrax situations, CDC also investigated numerous reports in other states, which proved to be negative. CDC and its partner labs worked around the clock to test samples and protect the public. HHS' OEP sent personnel from the NDMS and the Public Health Service Commissioned Corps Readiness Force to test and provide medications to Capitol Hill staff.
HHS Builds Bioterrorism Force. On November 1, 2001, Secretary Thompson named Donald A. Henderson, M.D., to serve as director of a newly created Office of Public Health Preparedness, which coordinates national response to public health emergencies. Henderson, who was previously director of the Center for Civilian Biodefense Studies at John Hopkins University, also directed the World Health Organization's global smallpox eradication campaign and was instrumental in initiating WHO's global program on immunization. Additionally, Phillip Russell, a retired U.S. Army major general who directed the Army's Medical Research Institute of Infectious Diseases, joined HHS as special advisor on vaccine development and production. Rounding out the team is Scott Lillibridge, the Secretary's special assistant on bioterrorism. Lillibridge is a physician and has coordinated CDC's bioterrorism preparedness and response program since 1998.
HHS Makes Unprecedented Investment. HHS negotiated purchases of more than a billion doses of antibiotics and 155 million doses of smallpox vaccine, to be fully prepared for the possibility of future bioterrorist attacks. Purchases would also expand the number of emergency "Push Packages" in the National Pharmaceutical Stockpile. HHS continued funding local emergency preparedness efforts in American cities, and the President proposed $1.5 billion in new spending to prepare for bioterrorism, including $300 million for support of state and local efforts and strengthening the national health information and laboratory network.
HHS Addresses the Nation's Mental Health and Substance Abuse Needs. Secretary Thompson convened a national summit in New York City on November 14-16, 2001, to examine and enhance the local, state and federal role in addressing the mental health and substance abuse needs of individuals and communities before, during, and after acts and threats of terrorism. Forty-two governor appointed state teams of mental health, substance abuse and related health and human services professionals attended the summit. Five U.S. territories and the District of Columbia as well as over 100 representatives of national public service, faith, and community organizations also participated in the summit. The summit was sponsored by HHS' Substance Abuse and Mental Health Services Administration (SAMHSA). The state teams met and refined their current disaster plans to ensure readiness of mental health and substance abuse services for the ongoing war on terrorism and in the event of future attacks on the homeland.
HHS Supports Bioterrorism Bill. HHS worked with Congress toward legislation to bolster national efforts to combat bioterrorist attacks and prepare for public health emergencies. The Public Health Security and Bioterrorism Response Act of 2001will authorize expansion of national stockpiles of medicines and supplies, support for local communities and hospitals and for CDC to upgrade facilities, and funds for FDA to increase food safety measures.
HHS Acts to Ensure Protection for the Future. CDC is also working with state and local officials on a new Model Emergency Health Powers Act. The goal is to strengthen the nation's public health infrastructure by developing a consensus-based model of legislation to assist states that are considering creating and implementing new emergency public health legislation. States may then tailor model legislation to meet their individual needs and to help protect their citizens.
Under the leadership of Secretary Thompson, HHS has implemented several initiatives to improve overall public health, and the level of excellence in HHS performance.
HHS Prevention Initiative. In 2001, Secretary Thompson unveiled three initial campaigns of a multi-faceted Prevention Initiative, aimed at helping Americans achieve their full potential for health and wellness through adopting healthy lifestyle behaviors:
HHS Rural Task Force. HHS is addressing the special challenges associated with providing health and social services to residents of rural and isolated areas. In July 2001, Secretary Thompson announced the creation of the HHS Rural Task Force that focuses on existing health and social service programs serving rural communities; administrative, regulatory and statutory barriers to serving persons in rural communities; and the impact of HHS funding on rural economies. This group will also make recommendations to strengthen health care and social services and their delivery system infrastructures in rural America.
Safe and Stable Families Initiative. President Bush's proposal to reauthorize and expand the Promoting Safe and Stable Families program was passed by the Congress and cleared for the President's signature December 13, 2001. This legislation expands services to strengthen families, creates and expands mentoring programs for children whose parents are in prison, and enhances educational opportunities for children leaving foster care. More specifically, the bill reauthorizes and substantially expands the resources available to states and Indian Tribes to strengthen families at risk and ensure the safety and permanency of placements of vulnerable children through the Promoting Safe and Stable Families program. The legislation authorizes the Promoting Safe and Stable Families program at $505 million a year, an historic increase in spending of $200 million annually, and specifically allows these funds to be used for services that strengthen parental relationships and promote healthy marriages. The legislation also authorizes an initial $67 million in fiscal years 2002 and 2003 for projects that mentor children of prisoners, and authorizes an additional $60 million of annual funding to states, specifically for educational and training vouchers for youth between the ages of 16 and 21.
New Freedom Initiative. As part of the President's New Freedom Initiative, the federal government was directed to assist states and localities to swiftly implement the U.S. Supreme Court decision in Olmstead v. L.C., stating that the country is committed to community-based alternatives for individuals with disabilities. As part of this effort, Secretary Thompson is heading the Interagency Council on Community Living, a special task force supported by HHS, the departments of Education, Justice, Labor, Housing and Urban Development, and the Social Security Administration, charged with evaluating the programs, statutes and regulations of their respective agencies to determine whether they should be revised or modified to improve the availability of community-based services for qualified individuals with disabilities.
HHS Faith-Based and Community Initiatives. Within the first 100 days of the new Bush administration, and in response to the President's Executive Order, Secretary Thompson created a Center for Faith and Community Based Initiatives at HHS. The Center was established to create a level playing field for all faith-based community organizations applying for federal grants.
Gift of Life Donation Initiative. Recognizing the shortage of viable organs for donation, Secretary Thompson launched the Gift of Life Donation Initiative in April 2001, a nationwide campaign to encourage organ and tissue donation, as well as registration for marrow donation, and donation of blood. Initial phases of the campaign included the Workplace Partnership for Life, a public/private network of employers, unions and other employee organizations promoting the goals of the campaign. Additionally, Secretary Thompson released a model donor card for organ donation, called for a major review of existing organ donor registries, and offered support to create a national Gift of Life medal recognizing all families who consent to donation. HHS is also developing a model organ donation curriculum for drivers' education classes to be offered to state and local education systems. For more information, visit www.organdonor.gov.
Comprehensive access to health care services and information is one of the most vital challenges of the day. Many individuals in rural areas, as well as persons facing social and economic disadvantages often lack appropriate health care. Secretary Thompson and the Bush administration are implementing swift changes to help all Americans achieve their full potential for health.
Presidential Proposal to Expand Community Health Centers. The Health Resources and Services Administration funds more than 3,000 community and migrant health center sites across the nation, including sites in rural, hard-to-serve areas. The community and migrant health center program (CHC) was developed to provide access to family-oriented preventive and primary health care services for people living in medically underserved communities. About 60 percent of HRSA's CHC patients live in rural areas. President Bush's proposed fiscal year 2002 budget calls for improving and strengthening this program with a $124 million increase in funding for health centers to enable them to serve up to 1 million more individuals through approximately 100 new sites and expanding service capacity at 100 existing sites. This request is part of the President's multi-year initiative to increase the number of community health center sites nationwide by 1,200 and to eventually double the number of people served.
Expanded Coverage Options for the Uninsured. HHS issued guidance aimed at providing health coverage to more children in the U.S. The rule gives states increased flexibility under SCHIP to provide coverage and enables states to use streamlined enrollment procedures. Under this new model waiver process, CMS expects millions more children to gain access to needed health services. The SCHIP program covers more than 3 million children who would otherwise not have health insurance. The law pledges $40 billion in federal funds over 10 years to help states find, enroll and insure children whose families earn too much to be eligible for traditional Medicaid, but not enough to afford private insurance plans. The changes promote greater state flexibility in order to encourage states to develop approaches similar to those used by the private insurance industry that address the needs of children and families in their states.
HHS Clears Backlog of Medicaid State Plan Amendments. By October 2001, HHS cleared a backlog of nearly 400 amendments to state Medicaid programs, many of which had been pending for several years. These changes, plus other approved Medicaid and State Children's Health Insurance Program (SCHIP) plan amendments and waivers, are estimated to have expanded eligibility to more than 1.8 million people and enhanced benefits for about 4.5 million people. The effort ultimately helps more people obtain health coverage by giving states the flexibility to strengthen their Medicaid and SCHIP programs.
Health Facilities for American Indians and Alaska Natives. The Indian Health Service opened a new ambulatory primary health care addition to the David C. Wynecoop Memorial Clinic in Wellpinit, Wash. The new clinic will be the primary source of health care for members of the Spokane Tribe of Indians and the Kalispel Tribe of Indians, with a projected patient load of more than 20,000 visits per year. About 3,000 people in this remote area of northeastern Washington will now have consistent access to modern health care at this new clinic. In addition, Navajo Nation women in the Tuba City area of the reservation began receiving state-of-the-art digital mammography services as a result of a collaboration between HHS, Department of Defense, the medical services industry and academia.
A second clinic in Kamiah, Idaho, will provide ambulatory medical, dental, pharmaceutical, nutritional, public health nursing and behavioral health services to the Nez Perce tribal population in rural northern Idaho. Also, a new health care center for the Colorado River Indian Tribes in rural southwest Arizona will support a health care delivery program for a projected user population of more than 6,200 and 29,700 outpatient visits annually. The new facility has 17 inpatient beds, a 24-hour emergency room, and space for a full range of ambulatory and community health services.
HHS has taken broad steps in 2001 to mobilize efforts to increase health care quality - particularly with respect to the elderly - and to augment support systems for patient and consumer safety. HHS agencies are on the forefront of new and dynamic efforts.
Nursing Home Quality. Beginning in January 2002, the Centers for Medicare & Medicaid Services (CMS) will begin a six-state demonstration to identify, collect and publish nursing home quality information in Colorado, Maryland, Ohio, Rhode Island, Washington and Florida. CMS will begin publishing the information in April 2002 to help make people aware of how performance differs across nursing homes. The information will be available online at www.medicare.gov and will be promoted through local Quality Improvement Organizations (QIOs), formerly known as Medicare's Peer Review Organizations. Following the pilot project, CMS will refine and expand the initiative to include risk-adjusted quality information from nursing homes in every state. The national project is scheduled to begin in October 2002. In addition, the QIOs will actively help people to better use the quality performance data by making sure that their interests and priorities are reflected in these new efforts to improve the quality of care.
HHS Patient Safety Task Force. On April 23, 2001, HHS formally established a new Patient Safety Task Force, led by the Agency for Healthcare Research and Quality (AHRQ), CDC, FDA and CMS. The purpose of the task force is to identify and collect data that will be useful for healthcare providers, states, and other health agencies to improve patient safety. CDC, FDA, and CMS presently operate a number of systems to collect information that helps to monitor health care safety; compliance with existing regulations on blood products, devices, drugs; and the safety of patients in Medicare-funded institutions. The Task Force will be studying ways to implement a user-friendly Internet-based patient safety reporting format. This will enable faster cross-matching and electronic analysis of data, and more rapid responses to patient safety problems. HHS' fiscal year 2002 budget proposal includes up to $72 million, an increase of $15 million over fiscal year 2001, for efforts to improve patient safety and reduce adverse events.
Patient Safety Research. On October 11, 2001, HHS announced the release of $50 million to fund 94 new research grants, contracts and other projects to reduce medical errors and improve patient safety. The initiative, funded by HHS' AHRQ, represents the federal government's largest single investment to address patient deaths related to medical errors, which a November 1999 Institute of Medicine report estimates to be between 44,000 and 98,000 annually. The 94 projects now being funded will be carried out at state agencies, major universities, hospitals, outpatient clinics, nursing homes, physcians' offices, professional societies and other organizations across the country.
National Family Caregiver Support Program (NFCSP). In November 2000, Congress created the new caregiver program as part of the Older Americans Act Amendments of 2000, setting the stage for HHS' National Family Caregiver Support Program, launched in February 2001 to help family members provide care for the elderly at home. As the largest new support program under the Older Americans Act since 1972, states received $113 million in grants to run programs that provide critical support, including home and community-based services, to help families maintain their caregiver roles. The NFCSP also supports grandparents and other relatives raising grandchildren under the age of 18 as well as caregivers of persons with mental retardation and developmental disabilities. In fiscal year 2001, approximately $6 million was awarded for 34 projects to develop innovative approaches to assist families and informal caregivers of older persons, as well as grandparents and older relatives who are caregivers of children. The NFCSP also provides support for caregivers of Native American elders. Comprehensive program guidance was developed by the department's Administration on Aging (AoA).
Earlier this year, Secretary Thompson and CMS Administrator Tom Scully announced the beginning of a series of initiatives to reform and strengthen the Centers for Medicare & Medicaid Services (CMS), formerly the Health Care Financing Administration. One of the highest priorities of the administration is to create within CMS a "culture of responsiveness" to the needs and concerns of the nearly 70 million people who rely on Medicare and Medicaid, and the doctors, nurses and other healthcare providers who provide such valuable resources.
Restructuring and Renaming. The CMS name change was implemented to clearly reflect the agency's lines of business: traditional fee-for-service Medicare, Medicare+Choice, and state administered programs, such as Medicaid and SCHIP. This resulted in the creation of three new operational divisions: the Center for Medicare Management, the Center for Beneficiary Choices, and the Center for Medicaid and State Operations.
Improving Access to Information for Beneficiaries. In the fall of 2001, CMS launched a nationwide educational initiative, including a $30 million advertising campaign, to highlight the health care options and information resources available to beneficiaries. The ad campaign, created in English and Spanish, includes the creation of www.medicare.gov, and 24-hour service expansion of 1-800-MEDICARE (1-800-633-4227). As a result, more than 20,000 calls are received into the call centers daily, with a peak of more than 60,000 calls in one day.
And the efforts to make the agency more responsive are working: the 2001 American Customer Service Index found a significant increase in beneficiary satisfaction, making it the 3rd highest rating of federal agency consumer satisfaction.
Easing Regulatory Burden. CMS created a new, streamlined enrollment form that will make it easier for qualified physicians and other health-care providers to become eligible for Medicare reimbursement for the care and services that they provide on behalf of Medicare beneficiaries. The forms reflect extensive input from physicians and allow doctors and other providers to fill out only the portions relevant to their practices.
Increasing Medicaid Accountability. HHS will begin in 2002 to phase out a Medicaid loophole that costs federal taxpayers billions of dollars a year in excessive payments to states for matching state Medicaid costs that may not pay for Medicaid services. The final regulation will revise Medicaid's "upper payment limit" rules to prevent states from increasing the federal share of Medicaid costs. The new rule would limit state Medicaid program payments for services provided at certain hospitals to the estimated amount that the Medicare program would pay for the same services. The final rule is projected to save an estimated $55 billion over the next 10 years.
Fighting Fraud and Abuse. During fiscal year 2001, the AoA worked in partnership with CMS, the Office of Inspector General, Department of Justice, and other federal, state and local partners in a coordinated effort to educate and inform older Americans about how they can play an important role in protecting the benefit integrity of the Medicare and Medicaid programs. AoA and its nationwide network of agencies support community education activities designed to assist older Americans and their families recognize and report potential errors or fraudulent situations. This year, AoA's 52 Senior Medicare Patrol projects recruited and trained more than 10,000 senior volunteers, who directly educated more then 300,000 beneficiaries.
The Bush administration maintained the commitment to doubling funding for the National Institutes of Health by 2003. The President's NIH Budget request for fiscal year 2002 was $23 billion, a 13.5 percent increase over fiscal year 2001- the largest single year dollar increase in the institute's history.
NIH Launches Stem Cell Research Program. On August 9th, President Bush announced that federal funds may be awarded for research using human embryonic stem cell lines that meet certain criteria. Such research is now eligible for federal funding as long as the derivation process (which begins with the destruction of the embryo) was initiated prior to 9:00 p.m. EDT on August 9, 2001. These stem cells must have been derived from an embryo that was created for reproductive purposes and was in excess of clinical need. In addition, informed consent must have been obtained for the donation of the embryo and that donation must not have involved financial inducements.
The NIH has expeditiously implemented the President's new policy by creating a Human Embryonic Stem Cell Registry that lists the holders of the 72 human embryonic stem cell lines, and provides information about the cells and how to contact the holders. The Registry is available at escr.nih.gov/.
Additionally, NIH and the WiCell Research Institute, Inc., of Madison, Wis., announced the signing of a Memorandum of Understanding for research use of WiCell's existing five human embryonic stem cell lines that meet the criteria articulated by the President in his August 9 address. This agreement allows scientists from NIH to access these cell lines to explore new avenues of research in this emerging field of technology.
NIH Clinical Research Center. The new Mark O. Hatfield Clinical Research Center at NIH is well under way. When completed, it will include 250 beds for inpatient care and 100 day-hospital stations for outpatient care, and research laboratories, expanding opportunities for physicians and patients to participate in cutting-edge research and scientific advances. The new center will connect to the current facility, which opened its doors to patients in 1953. The new facility will provide a crucial link in rapidly moving biomedical findings in the laboratory into the mainstream of medical practice.
CDC Approved Facility. CDC is engaged in an ongoing effort to improve aging offices and laboratories. In 2001, CDC received $175 million as part of its 10-year Master Plan for constructing and renovating buildings and facilities located in Atlanta. Construction of Phase I and II of the Roybal Infectious Disease Laboratories is completed and is fully operational. The Emerging Infectious Disease Lab and West Campus Central Utility Plant are currently under design/construction. Located at the CDC's Chamblee Campus, a three-story Environmental Health Lab has been completed and is scheduled to be occupied in early 2002. This new Environmental Health Lab will be the new work site for approximately 100 environmental health laboratorians. Construction of these new laboratories are critical to support CDC's mission and worldwide efforts to help control disease outbreaks and prevent illness.
In 2001, cases of BSE (bovine spongioform encephalopathy) or "mad cow disease" continued to occur in a number of Western European countries, and in September 2001, Japan announced its first confirmed case of BSE. First identified in the U.K. in 1986, the brain-wasting disease is fatal and is believed to be transmissible to people who consume infected beef products. HHS, the U.S. Department of Agriculture, and other partners are heading comprehensive efforts to safeguard the nation's food supply and strengthen protections already in place.
HHS Action Plan to Combat Mad Cow Disease. Mad Cow Disease belongs to a family of diseases called TSEs, or transmissible spongioform encephalopathies, named for the sponge-like gaps that develop in the brain tissue of diseased animals or people. One TSE disease that affects humans is called Creutzfeldt-Jakob Disease (CJD), and a form of this disease, variant CJD (vCJD). To date, there are no reported cases of BSE or vCJD in the U.S. To further strengthen the nation's food supply, Secretary Thompson released a four-point action plan in August 2001 to increase protections for Americans against BSE. The effort allows coordination with other government agencies, the private sector, and the international community to contain the epidemic and assist those affected by it.
U.S./Mexico Cooperative Agreement. The FDA, U.S. Department of Agriculture and Mexico's Secretar�a de Agricultura, Ganader�a, Desarrollo Rural, Pesca y Alimentacin (SAGARPA) and Secretar�a de Salud signed a cooperative agreement in September to enhance existing food safety measures through expanding programs, sharing information and coordinating specific activities. The agreement will operate to share information on the sources of fresh produce and to investigate the causes of any contamination of these products. The USDA's Food Safety and Inspection Service and Foreign Agriculture Service and SAGARPA will take steps to ensure the safety of meat, poultry and egg products in both countries. These efforts are expected to ensure that borders remain open and that safe products continue to flow freely between the countries. The agencies will also collaborate on other specific projects to achieve common understanding on issues of mutual concern.
During the past year, HHS has continued to make strides in the areas of disease prevention, promotion, delivery and research. Many programs and studies resonate within communities nationwide.
Women's Health
Women and Smoking: A Report of the Surgeon General. On March 27, 2001, U.S. Surgeon General David Satcher released a new report which provided a composite overview of smoking and health issues among women and girls in the United States. The report, Women and Smoking: A Report of the Surgeon General, summarized patterns of tobacco use among women, factors associated with starting and continuing to smoke, the health consequences of smoking, tobacco marketing targeted at women, and cessation and prevention interventions. The report was prepared by the CDC, and is an update of the original 1980 Surgeon General's report on women and smoking. The report calls for stronger national and local efforts, particularly from women's groups, to implement proven solutions to reduce and prevent tobacco use among women and girls. To view the report, go to www.cdc.gov/tobacco/sgr_forwomen.htm.
Women's HIV Clinical Guide. In May 2001, HHS' Health Resources and Services Administration released The Clinical Guide for the Care of Women with HIV, believed to be the first manual specifically written for the medical treatment of women with HIV. The manual provides practical, experience-based advice and authoritative treatment guidelines for clinicians treating women with HIV. For ordering information, visit hab.hrsa.gov/.
Children and Youth
Child Immunization Rates. CDC data showed that because of high levels of childhood vaccinations diseases and deaths associated with varicella, diphtheria, pertussis, tetanus, measles, mumps, rubella and Hib are at, or near, all time lows in the United States. Significant increases in the varicella (chickenpox) vaccine has resulted in the reduction of disease transmission among children. During the late 1990s, varicella and cases of varicella requiring hospitalization declined by approximately 80 percent in a number of U.S. communities. The greatest decline in cases occurred among preschool age children.
Youth Drug Use. Secretary Thompson released findings of the Substance Abuse and Mental Health Services Administration's 2000 National Household Survey on Drug Abuse, showing that overall rates of current use of illicit drugs were relatively unchanged, although drug use did decline among early teenagers. Leading indicators for drug use -- including rates of use among the youngest age group and the number of new users -- suggest possible future declines. Among youths aged 12 and 13, a key target audience of the National Youth Anti-Drug Media Campaign, the rate of past month illicit drug use declined from 3.9 percent in 1999 to 3.0 percent in 2000. The estimated number of new marijuana users has declined from a recent peak of 2.6 million in 1996 to 2 million in 1999. Illicit drug use includes marijuana, cocaine, heroin, hallucinogens and inhalants.
Racial and Ethnic Health Disparities
REACH 2010. In 2001, Congress appropriated $35 million to help community coalitions address racial and ethnic health disparities in the United States. CDC's Racial and Ethnic Approaches to Community Health (Reach 2010) is a demonstration project that targets six health priority areas: infant mortality, breast and cervical cancer screening and management, cardiovascular disease, diabetes, child and/or adult immunization levels, and HIV/AIDS. REACH 2010 community coalitions mobilize and organize their resources in support of effective and sustainable community-driven strategies. These new strategies will serve as models which will be disseminated widely to eliminate the health disparities of racial and ethnic minorities throughout the U.S. Funding is provided to support the implementation and evaluation of 31 demonstration projects. NIH contributed $5 million to support five of the 31 demonstration projects. Two additional projects are funded by the California Endowment through the CDC Foundation. Four projects serving the elderly are managed through an interagency agreement with the Administration on Aging. Finally, also under REACH 2010, CDC has launched a new program for capacity building of American Indian/Alaska Native tribes and tribal organizations. Five such organizations received funding under this program in fiscal year 2001.
Combating HIV/AIDS in America. The department's HIV/AIDS Initiative provides special focus on communities of color. Since 1998, HHS, the Congressional Black Caucus and the Congressional Hispanic Caucus have collaborated on a special package of programs to reduce the disproportionate HIV/AIDS impact in these communities. Congress increased appropriated funds by more than $100 million in fiscal year 2001, to reach $358 million. Specifically funds are divided as follows:
$109.2 million primarily for the Health Resources and Services Administration's Ryan White
Comprehensive AIDS Resources Emergency Act activities, which provide funding to states,
public and private organizations to deliver essential HIV/AIDS health care and support services
to medically underserved individuals and families;
$88 million for community-based prevention activities at CDC;
$95 million to expand mental health and substance abuse treatment services to persons with
HIV/AIDS; and
$65 million to enhance programs at NIH and HHS' Office of Minority Health, including funds
for infrastructure and development, technical assistance, prevention, treatment and education.
Mental Health Treatment Disparity. Striking disparities in access, quality and availability of mental health services exist for racial and ethnic minority Americans, according to a new report of the Surgeon General Mental Health: Culture, Race and Ethnicity. The report, a supplement to the 1999 first-ever Surgeon General's report on mental health, highlights the role culture and society play in mental health, mental illness, and the types of mental health services people seek. It finds that, although effective, well-documented treatments for mental illnesses are available, racial and ethnic minorities are less likely to receive quality care than the general population. Overall, one in three Americans who needs mental health services currently receives care. A critical consequence of this disparity is that racial and ethnic minority communities bear a disproportionately high burden of disability from untreated or inadequately treated mental health problems and mental illnesses. To view the report, visit www.surgeongeneral.gov/library/mentalhealth/.
Medical Research for American Indians and Alaska Natives. Recognizing the need for American Indian and Alaska Native perspective and participation in medical research, Secretary Thompson supported the collaboration between NIH's National Institute of General Medical Sciences and the Indian Health Service (IHS) to establish the Native American Research Centers for Health. In September 2001, $3 million was awarded to establish eight centers. This program brings positive attention and solutions to improve the health status of Indian people.
Diabetes
Landmark Diabetes Study Concluded in 2001. On August 8, 2001, Secretary Thompson and NIH's National Institute of Diabetes & Digestive & Kidney Diseases announced results of the Diabetes Prevention Program, a major clinical trial comparing diet and exercise to treatment with diabetes drug metformin in more than 3,200 people with impaired glucose tolerance, a condition that often precedes diabetes. The study showed that people at high risk for type 2 diabetes can sharply lower their chances of getting the disease with diet and exercise - more than individuals treated with metformin, the oral diabetes drug. The $174 million study proves that diet and exercise - as little as 30 minutes a day - can surpass the effectiveness of drug treatment efforts.
Indian Health Service Model Diabetes Program. The IHS Model Diabetes Programs, consisting of 19 comprehensive projects located around the country, continue to develop expertise in the prevention and treatment of diabetes for sharing with other tribes and communities. The "Special Diabetes Program for Indians," a congressionally established network of 333 grants for multi-faceted diabetes treatment and prevention projects, rely heavily on community-based efforts. The Special Diabetes Program for Indians grant programs and the Model Diabetes Programs, in cooperation with local community leadership, encourage physical activities and healthy lifestyles, especially among Indian youth, to reduce the devastating effects of diabetes in Indian communities.
Cancer
Gleevec Approval. On May 10, 2001 the FDA announced its approval of the drug Gleevec as an oral treatment for chronic myelogenous leukemia (CML), a cancer characterized by too many white blood cells in the bone marrow. Bone marrow transplantation in the initial chronic phase of the disease is the only known cure for CML. Gleevec represents a new class of cancer drugs designed to zero in on specific cancer-causing molecules, eliminating cancer cells while avoiding serious damage to other, noncancerous cells. The FDA's rapid approval of Gleevec was based on three short-term clinical trials indicating higher cancer remission rates for patients.
Innovative Health Resources
Healthfinder Espa�ol. This year, HHS launched healthfinder� espa�ol, a Spanish-language Web site that helps consumers track down reliable health information quickly and easily on the Internet. Available at www.healthfinder.gov/espanol, the new site creates an easy-to-use Spanish-language consumer resource modeled after the award-winning healthfinder� site. The new Spanish version Web-site offers health information on over 300 topics from 70 government agencies and nonprofit organizations, including those health issues of greatest concern to those of Hispanic heritage. The site offers both a Spanish text search and a list of topics in Spanish that can be browsed.
Guide for Clinicians. On December 13, 2001, the Agency for Healthcare Research and Quality (AHRQ) released A Step-by-Step Guide to Delivering Clinical Preventive Services: A Systems Approach. This new publication, the newest from AHRQ's Put Prevention Into Practice Program, will help guide clinicians in the development of a system for delivering clinical preventive services in the primary care setting. The guide breaks the process of delivering clinical preventive services into small, manageable tasks and provides practical tools such as worksheets, health risk profiles, and preventive care flow sheets that can be customized for use in various clinical settings.
HHS continues to take a lead role in advancing the overall health of the nation's children and families, supporting specific programs and initiatives.
Continued Welfare Caseload Decline. In September 2001, HHS announced that the number of families nationally receiving assistance under Temporary Assistance for Needy Families (TANF) program declined 3 percent, from about 2.2 million to 2.1 million. The number of individual TANF recipients declined 4.4 percent, from more than 5.7 million to fewer than 5.4 million. Overall, there has been a 57 percent decline in the number of people enrolled in TANF since Congress enacted welfare reform in August 1996. Congress will consider reauthorization of the TANF program in 2002. TANF is administered by HHS' Administration for Children and Families.
Child Poverty, Teen Birth Rates Decline. Every year, the government's Federal Interagency Forum on Child and Family Statistics, presents a comprehensive look at critical areas of child well-being, including economic security, health status, behavior, social environment, and education. In their fifth annual report, America's Children: Key National Indicators of Well-Being, 2001, the Forum report showed that the state of the nation's children had improved on several fronts. Among highlights -- the percentage of children living in households with at least one parent employed full-time increased from 1998 to 1999, adolescent birth rates declined for a second year in a row, and more children had health insurance in 1999 than in 1998. Members of the public may access the report at childstats.gov.
Toolkit to End Violence Against Women. In October 2001, HHS and the Department of Justice announced the creation of the Toolkit to End Violence Against Women, a Web-based program offering recommendations for strengthening prevention efforts and improving services for female victims of violence. The Toolkit, develop by the National Advisory Council on Violence Against Women, combines input from leaders and practitioners around the country with expertise in domestic violence, sexual assault and stalking. To learn more about the Toolkit, view toolkit.ncjrs.org/.
Youth Violence. In November and December 2001, the Surgeon General traveled to Chicago, Atlanta, Los Angeles and Philadelphia to engage in community discussions on youth violence. The forums served as a follow-up to the January report, Youth Violence: A Report of the Surgeon General. It is the first Surgeon General report dedicated exclusively to the topic.
The movement of millions of people each day across national borders increases health risks for the spread of infectious disease. HHS expanded several health programs in 2001 to keep pace with the rapid globalization movement.
Global AIDS Fund. This year, The Global Fund to Fight AIDS, Tuberculosis and Malaria was created to attract, manage and disburse financial resources to reduce infections, illness and death caused by HIV/AIDS, tuberculosis (TB) and malaria. According to the Fund, AIDS, TB and malaria claim nearly 6 million deaths per year. The Bush administration played a key role in supporting contributions to the Fund, making an initial U.S. contribution of $100 million. The first board meeting of the Fund will be in January 2002. Visit the Global Fund Web site at www.globalfundatm.org/news/.
Global HIV/AIDS Care and Treatment Activities. With additional funds, HRSA will develop training programs and materials for health care professionals and other caregivers, and provide technical assistance and consultation in palliative care, home and community-based care, clinical care to countries that have been affected by HIV/AIDS.
CDC Expands Global AIDS Program. In June 2001, CDC announced that the agency was expanding its Global AIDS Program to address the HIV/AIDS epidemic in the Caribbean and Latin America. CDC will work in partnership with the Caribbean Epidemiology Center (CAREC), assisting them with their HIV prevention efforts throughout the Caribbean. CAREC is one of eight scientific centers within the Pan American Health Organization and is a leading public health institution in the region.
HIV/AIDS Services Along the U.S.-Mexico Border. HRSA is working through the U.S.-Mexico Border Health Initiative on the cross-border problems of HIV/AIDS and is targeting $13 million over five years in grant funds for people with HIV disease and AIDS who live in the U.S. along the 2,000 mile area of the U.S.-Mexico border. The agency also provided support for the translation and Web casting of the Fourth Annual Brazil-Johns Hopkins Conference on HIV/AIDS, the largest HIV/AIDS conference in Latin America.
HIV/AIDS Web Portal at NIH. In recognition of World AIDS Day - December 1, 2001 - NIH launched a new Web resource that provides comprehensive information about the diverse array of NIH-supported HIV/AIDS research at its Maryland campus, across the U.S., and around the world. The site features information for researchers, health care workers and the general public. Included are links to the NIH fiscal year 2003 Plan for HIV-Related Research, information on clinical trials, scientific and medical literature, on-line order forms for publications, counseling resources, plus seminar information for the general community. Support for HIV/AIDS-related programs at NIH totaled approximately $2.2 billion in fiscal year 2001. Visit the Web site at worldaidsday.nih.gov/worldaidsday/december1.htm.
International Tobacco Control. HHS continues its collaboration with the World Health Organization (WHO) on international tobacco control efforts, and in May 2001, announced the expansion of tobacco programs into Southeast Asia, particularly Vietnam, Laos and Malaysia. The CDC/WHO Collaborating Center for Smoking and Health will help to implement studies, conduct epidemiologic research and monitoring, provide training and technical assistance for country-level surveillance of tobacco use, and support the development of national plans of action for tobacco control. In November 2001, HHS Assistant Surgeon General Dr. Kenneth Bernard led the U.S. Delegation at the Negotiating Session for the International Framework Convention on Tobacco Control. The issues in the framework include preventing smoking initiation, promoting cessation, protecting non-smokers from exposure to passive smoke, and educating the public about the health consequences of tobacco use.
HHS Launches Web Site Dedicated to Global Health Issues. Secretary Thompson announced the launch of globalhealth.gov, a new, departmental Web portal providing information on the HHS' work on global health issues, as well as worldwide health statistics, reports and publications, and links to the department's global health partners. The site was developed to be a portal of global health information for policymakers, researchers, doctors and the general public, and highlights vital information on HIV/AIDS, malaria, tuberculosis and tobacco use. The site is administered by the department's Office of International and Refugee Health. Visit the Web site at www.globalhealth.gov.
World Assembly on Aging. The Administration on Aging has been designated to lead HHS efforts related to the World Assembly on Aging, scheduled to take place in Madrid, Spain, in 2002. AoA will coordinate the international plan of action, which includes issues related to global health.
Secretary Thompson and the cross-section of departmental leadership continue to use the President's Management Agenda as a strategic basis for creating an efficient and effective health and human services agency. To that end, several enhancements have been implemented to improve HHS performance along all organizational lines.
HHS Management Reorganization. Effective October 7, 2001, HHS realigned several key administrative functions to establish a more effective focal point for leadership and management. The long-standing Office of the Assistant Secretary for Management and Budget was redesigned into two strategic divisions - the Office of the Assistant Secretary for Administration and Management (ASAM) and the Office of the Assistant Secretary for Budget, Technology and Finance (ASBTF). The ASAM office spearheads human resource policy, grants management, acquisitions and department operations, while ASBTF provides leadership on the financial and budgetary concerns of HHS, as well departmental investments in e-government and technology.
Federal Grant Streamlining Program. HHS serves as the lead agency for the Federal Grant Streamlining Program, which makes it easier for states, universities, nonprofit organizations and other businesses to apply for and take advantage of federal programs involving grants and cooperative agreements. HHS awards roughly half of the $325 billion in grants issued each year. Secretary Thompson launched the government-wide plan in May 2001.
Tribal Consultations Reach All-Time High. During 2001, HHS increased consultations with the tribal governments and tribal organizations. In April, Secretary Thompson invited all national tribal organization leadership to HHS to discuss tribal priorities and needs. This year, HHS held national and regional consultations with tribal, state, local government and nongovernmental organizations to solicit views on an HHS Tribal Self-Governance Determination Project Feasibility Study. In June, HHS held the Third Annual Tribal Budget Consultation Session to hear the views of tribal governments and national tribal organizations regarding the budget needs of local tribal communities. In August, HHS leadership traveled to meet with American Indian and Alaska Native Tribal Leaders in their home state and tribal reservations in Alaska, Michigan, Montana, Wisconsin and South Dakota. HHS also held a national tribal reauthorization listening session on Temporary Assistance to Needy Families (TANF), and a workshop to solicit the views of tribes and tribal organizations regarding the upcoming reauthorization of the TANF program.
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