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FY 2005 Budget in Brief
Centers for Disease Control and Prevention
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The FY 2005 budget requests a total program level of $6.9 billion for the Centers for Disease Control and Prevention (CDC), a net decrease of $58 million below FY 2004. This net change includes $341 million in expansions of on-going programs such as Steps To A Healthier US and the National Breast and Cervical Cancer Early Detection Program; new detection initiatives for bioterrorism and naturally occurring infectious diseases; improvements in childhood immunizations; and a major reinvestment in the health statistics needed for decision-making in both government and the private sector. The increases are partially offset by the completion of some new facilities, earmarked projects, and retargeting of funds in some areas. The FY 2005 budget for CDC also includes $1.4 billion in mandatory immunization funding and $249 million in Public Health Service evaluation transfer funds.
Chronic Disease Prevention and Health Promotion
More than 1.7 million Americans die of chronic diseases - such as heart disease, cancer, and diabetes - each year, accounting for 79 percent of all U.S. deaths. Although chronic diseases are among the most common and costly health problems, they are also among the most preventable. The budget includes $915 million for Chronic Disease Prevention and Health Promotion, a net increase of $62 million over FY 2004.
Steps To A Healthier US Initiative: The FY 2005 Budget includes $125 million, an increase of $81 million for the Steps To A Healthier US Initiative. Of this request $115 million, (including $71 million of the increase) will be used to expand the State and community grant program initiated this past September to reduce the prevalence of diabetes, obesity, and asthma-related complications through prevention initiatives. Existing grantees will receive funding to carry out the plans they are preparing to implement, and new projects will be started in additional States, cities, and tribes. The initial 12 grants reach 23 communities including seven large cities, one Tribal consortium, and four State-based grants that cover 15 smaller cities and rural areas. These funds will help implement community-based programs targeting those at high risk for diabetes, obesity, and asthma. Philadelphia plans to expand supervised physical activity programs aimed at students with chronic diseases at schools. In Michigan, a consortium of American Indian Tribes will implement a program that seeks to encourage the consumption of highly nutritious traditional foods and pass on wisdom and cultural practices about them. New Orleans will develop neighborhood walking and bicycling plans to build a more "walkable and bikeable city. A total of $10 million will be used to expand the Diabetes Detection Initiative, which targets at-risk populations to identify undiagnosed diabetes. The aim of this initiative is to reach these populations where they live, work, and play through a customized, tailored approach with the aim of identifying undiagnosed diabetes. The program design promotes the self-identification of risk status, follow up to a health provider to assess the need for a diagnostic test, and the administration of appropriate diagnostic tests, if indicated.
National Breast and Cervical Cancer Early Detection Program: CDC's National Breast and Cervical Cancer Early Detection Program (NBCCEDP) has helped to increase mammography use by women aged 50 and older by 20 percent since the program's inception in 1991. NBCCEDP targets low-income women with little or no health insurance and has helped to reduce disparities in screening for women from racial and ethnic minorities. CDC will increase support to States in order to conduct outreach and pay for additional breast and cervical cancer screens for underserved women. The budget for NBCCEDP is $220 million for FY 2005, an increase of $10 million. With the requested increase, CDC projects providing an additional 32,000 diagnostic and screening services to women who are hard-to-reach, have rarely, or have never been screened for these cancers.
Youth Media Campaign: The budget requests $5 million for the VERB It's What You Do Youth Media Campaign targeted to increase and maintain regular physical activity among tweens (youth ages 9-13) through paid media, partnerships, and community efforts. These funds will enable CDC to maintain a library of proven media messages for distribution as public service announcements.
The budget contains $184 million to maintain ongoing environmental disease prevention programs. The National Center for Environmental Health (NCEH) assists State and local health agencies in developing and increasing their ability and capacity to address environmental health problems, especially asthma and childhood lead poisoning. Additionally NCEH provides complete, timely, and accessible data on environmentally related diseases and conditions, including asthma, childhood lead poisoning and genetic diseases; improves the understanding of risk factors for, and causes of, environmentally related diseases and conditions; and develops effective prevention programs. The CDC's state of the art environmental laboratories use modern technology to assess human exposure to environmental chemicals, and its effects.
The budget requests $150 million for Health Statistics, an increase of $22 million over FY 2004. This investment reflects the importance of the data systems of the National Center for Health Statistics (NCHS) to track our progress and inform solutions on a myriad of problems in the public and private health sector. This increase will position the surveys of NCHS to meet new challenges. This new investment will preserve and modernize the Nation's vital statistics system. CDC will expand contracts with States to purchase birth and death data and move forward with e-government initiatives to update the content of birth and death records. The increase will also provide the robust sample sizes necessary for the National Health and Nutrition Examination Survey (NHANES) and the National Health Interview Survey (NHIS) to provide needed information on a wide range of conditions, diseases, and population subgroups. Additionally funds will address major emerging data gaps in the National Health Care Survey, such as long-term care and assisted living facilities.
A significant health goal of the Nation is to ensure that at least 90 percent of all two-year olds receive the full series of vaccines. The budget request of $1.9 billion includes two streams of funding to improve immunization rates. The mandatory Vaccines for Children (VFC) program provides free vaccine to Medicaid recipients, the uninsured, American Indians and Alaskan Natives, and children with limited health coverage that does not cover specific immunizations. The discretionary Section 317 program provides funds for State immunization operational costs and many of the vaccines provided in public health clinics.
The budget includes three important immunization initiatives. First, under current law, CDC will continue to build a six-month, vendor-managed stockpile of all routinely recommended childhood vaccines. In FY 2003, CDC invested $168 million in the VFC program to begin building these stockpiles of varicella, Hepatitis A and B, pneumococcal conjugate (PCV), and (Hib) vaccines. Between FY 2004 and FY 2006, CDC plans to invest an additional $583 million to meet the target quantities for a six-month stockpile. The stockpile serves dual purposes. Vaccines from the stockpile can be distributed in the event of a disease outbreak. The stockpile will also mitigate the effect of any supply disruptions that might occur on the manufacturing side. Second, with $40 million in each of fiscal years 2004 and 2005, CDC will, for the first time, create a stockpile of children's influenza vaccine under the VFC program. The flu season of 2003-2004 was a reminder of the need for rapid access to vaccines. This stockpile would provide a vendor-managed supply of between 4 to 6 million doses of vaccine, enough to provide the high-risk population of children aged 6–23 months with the two doses each would need. The flu vaccine stockpile could also be made available for older children as needed.
Finally, in FY 2005 legislation will be proposed to improve access to VFC vaccines for children already entitled to them, through two changes. First, the proposed legislation will expand the number of access points for children whose private insurance does not cover immunizations by allowing them to receive their VFC vaccines at State and local public health clinics. Currently, these children must go to specially designated Federally Qualified Health Centers to receive VFC vaccines – even if they visit a different public health clinic for all of their other medical needs. The second change proposed in this VFC legislation will restore tetanus and diphtheria vaccines to the VFC program. The VFC statute, as enacted in 1993, caps prices for the three vaccines that were in use prior to enactment of the legislation. The price caps are so low, however, that the tetanus booster vaccine was removed from the VFC program in 1998 when no vendor would bid on the contract. With these legislative changes, an additional $165 million will be added annually to the VFC budget to cover the additional vaccines that will be provided under this program. These changes will reduce by $110 million the demand for Vaccines financed through the Discretionary 317 Immunization Program.
The immunization budget will continue to provide $151 million for global immunization activities, including polio eradication. While tremendous progress has been made with the number of polio-endemic countries declining from 120 in 1988 to seven in 2003, a major international effort continues to strive for the goal set by the World Health Organization: global polio eradication by 2005.
HIV/AIDS, Sexually Transmitted Diseases, and Tuberculosis: HIV/AIDS, sexually transmitted diseases (STDs) and tuberculosis (TB) are among the most prevalent, costly and preventable infectious diseases in the United States. The request for HIV, STD, and TB Prevention budget activity is $1,143 million.
Global AIDS Program (GAP): Through the Global AIDS Program (GAP), CDC works in partnership with USAID, HRSA, the Department of State and other federal agencies, and multilateral and bilateral partners to ameliorate the devastation caused by HIV/AIDS. The budget requests a total of $143 million in CDC for on-going prevention care, treatment, surveillance, and capacity-building programs in 25 countries in Asia, Africa, Latin America, and the Caribbean.
The expertise and infrastructure established in GAP are being utilized to support the President's Emergency Plan for AIDS Relief (PEPFAR) announced in the State of the Union address in January 2003. The Emergency Plan, authorized by Congress, incorporates the President's International Mother to Child HIV Prevention Initiative. Fourteen of the Global AIDS Program countries are part of the President's International Mother to Child HIV Prevention Initiative, jointly implemented with USAID and other Federal Agencies. For greater government-wide integration under the direction of the Global AIDS Coordinator, the FY 2005 President's Budget will present Mother to Child Prevention Initiative Activities in the Department of State. Although there has been a shift in the placement of funding, CDC will continue to be a major implementing agency for this vital initiative.
Domestic HIV/AIDS Prevention: The budget requests a total of $790 million for CDC's Domestic HIV/AIDS Prevention and Research activities, of which $696 million is in the National Center for HIV, STD, and TB Prevention (NCHSTP) and $94 million is in the National Center for Infectious Diseases (NCID) and the National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP). CDC's HIV prevention activities over the past two decades have focused on helping uninfected persons at high risk for HIV change and maintain behaviors to keep them uninfected. Despite these efforts, the number of new HIV infections is estimated to have remained stable, and the number of people living with HIV continues to increase. Therefore, the CDC has launched a new prevention initiative, Advancing HIV Prevention: New Strategies for a Changing Epidemic (AHP). AHP is aimed at reducing barriers to the early diagnosis of HIV infection, and if positive, increasing access to quality medical care, treatment, and ongoing prevention services. AHP emphasizes the use of proven public health approaches to reduce the incidence and spread of diseases, as well as capitalizing on new rapid test technologies, interventions that bring persons unaware of their HIV status to HIV testing, and behavioral interventions that provide prevention skills to people living with HIV. This new intervention will help CDC and its partners to target funds more efficiently and directly to those people greatest in need.
Epidemic Services and Response/Infectious Diseases
Although modern advances have conquered some diseases, the outbreaks of severe acute respiratory syndrome (SARS) and West Nile Virus are recent reminders of the extraordinary ability of microbes to adapt and evolve. In response to these events, CDC has developed a new Global Disease Detection Initiative within its Epidemic Services and Response and Infectious Disease Control Programs. The overall FY 2005 budget request for Epidemic Services and Response includes $92 million to coordinate public health surveillance at CDC and provide support to the "disease detectives" that determine the cause of outbreaks and develop the countermeasures that stem the spread of illness. The Infectious Disease Control request is $401 million, an increase of $31 million over FY 2004. The increases in Infectious Disease Control target $2 million for State and local health departments for surveillance, response, and research for West Nile Virus activities. An additional $27 million increase is for the new global disease detection initiative in coordination with existing programs in Epidemic Services and Response. This new initiative's total funding for FY 2005 is $51 million and it will implement a comprehensive system of surveillance by expanding CDC programs in five countries (Kenya, China, Brazil, Kazakhstan, and Thailand) and creating new sites in six countries (Uganda, Zimbabwe, Botswana, Ghana, Cote d'Ivoire, and Guatemala). Additionally, the Global Disease Detection Initiative will improve early warning systems, research new viral strains, and aid in collaborations with multinational organizations. The goals of this initiative are to recognize infectious disease outbreaks faster, improve the ability to control and prevent outbreaks, and to detect emerging microbial threats.
The President's Budget includes $1.1 billion for bioterrorism preparedness, the same level as FY 2004. Within this amount, funds will be redirected to carry out a new interagency biosurveillance initiative to prepare against a potential bioterrorist attack. CDC, in coordination with FDA, the Department of Homeland Security and the Department of Agriculture, will be working to improve the response to bioterrorism through early detection. CDC's budget includes $130 million in FY 2005 for its role in this initiative, the largest component of which is an investment of $100 million in its human health surveillance project, "BioSense" BioSense is an advanced approach to infectious disease surveillance that, unlike traditional approaches, does not rely upon mandatory or voluntary case reports from healthcare providers to public health officials, but uses automated analysis techniques on electronically available health data to highlight a potential public health problem. This will be integrated into a unified system.In addition to developing better surveillance capacity, CDC will invest an additional $20 million to improve laboratory reporting capacity and to advance integration between public health and commercial laboratories. The remaining $10 million will increase the number of border health and quarantine stations from 8 to up to 25.
CDC's commitment to State and local preparedness remains strong; between FY 2002 and FY 2004, CDC invested a total of $2.9 billion in this activity. This year, CDC has budgeted another $829 million. In FY 2005, HHS will be re-targeting preparedness resources, making modest reductions in awards to States, and concentrating efforts in more directed investments that will benefit States and communities as well as the Nation as a whole. A specific example is the biosurveillance initiative. CDC will be entering into contracts directly with health departments and health systems to build a more complete network of health information, which will assist in earlier threat detection. It will provide public health officials with a sense for the health status of their community and support them in providing early and effective public health response.
Investments in States have markedly improved capacity: the Laboratory Response Network (LRN) now consists of 109 reference laboratories distributed throughout all 50 States. There are also 59 Biosafety level 3 (BSL-3) laboratories located in 50 States -- nearly three times the number reported in 1999. Fifty members (46 percent) of the LRN are now able to rule out the existence of smallpox, and 24 (22 percent) laboratories can test for the existence of the smallpox virus on a real-time basis.
In addition to assistance to States and communities, CDC will invest $150 million to continue to upgrade its internal capacities by improving epidemiological expertise in the identification and control of diseases caused by terrorism, including better electronic communication, distance learning programs, and cooperative training between public health agencies and local hospitals. Investments in CDC's Health Alert Network now mean that 89 percent of all health departments across the country receive instant electronic messages about emerging health threats and public health emergencies. Additionally, in 2002 and 2003, CDC produced and delivered 35 smallpox education and training programs. CDC currently estimates reaching approximately 1.3 million health professionals through a multimedia approach to smallpox training. CDC will continue to fund the 22 university-based Centers for Public Health Preparedness (CPHP) to ensure that frontline public health workers have the competencies to respond to emerging health threats.
Working in collaboration with the U.S. Department of Agriculture (USDA), CDC implemented the notification of possession of select agents and published an interim final rule in the Federal Register on December 13, 2002 for facilities that possess, use, or transfer agents or toxins deemed a threat to public health and to animal or plant products. CDC has a goal to inspect 300 laboratories in accordance with the rule in 2004.
Preventive Health and Health Services Block Grant
Since 1981 the Preventive Health and Health Services Block Grant has provided its 61 grantees (States, Tribes, and territories) with funds to tailor prevention and health promotion programs to address their particular needs. The budget for FY 2005 is $133 million. States use these funds to carry out a variety of activities including: helping rural health departments to eliminate food and water contamination, supporting childhood lead poisoning testing, and providing statewide public health education.
Injury Prevention and Control
Injuries are the primary killer of children and young adults in the United States. Injury is a fundamental threat to human health and life, and CDC employs the same scientific methods that prevent infectious diseases to prevent injuries - defining the health problem, identifying the risk and protective factors, and developing and testing prevention strategies. The budget for FY 2005 includes $154 million to support programs focused on residential fire deaths, intimate partner violence, non-fatal fall traumatic brain injury, child abuse and neglect, rape prevention and education, and other injury prevention and control initiatives.
Birth Defects, Developmental Disabilities, Disabilities and Health
Birth defects are the leading cause of infant mortality in the United States. Additionally, the direct and indirect costs associated with disabilities in the United States exceeds $300 billion annually. CDC's National Center for Birth Defects, and Developmental Disabilities works to identify the cause of birth defects and developmental disabilities, to help children develop and reach their full potential, and to promote the health and well-being among people of all ages with disabilities. The budget for FY 2005 includes $113 million for these activities. This funding will be used for many disability programs including those related to Fetal Alcohol Syndrome, Autism, Attention-Deficit/ Hyperactivity Disorder (ADHD), Duchenne and Becker Muscular Dystrophy, Disability and Health, monitoring development disabilities, limb loss, and spina bifida.
Public Health Improvement
The budget for FY 2005 requests a total of $113 million. The $59 million reduction from FY 2004 reflects one-time Congressional projects that are not being continued in 2005 and funding for research activities at $16 million. Funding is maintained for REACH 2010 (Racial and Ethnic Approaches to Community Health) which is intended to help racial and ethnic minority communities mobilize and organize their resources to support effective and sustainable programs that will contribute to the elimination of health disparities. The National Electronic Disease Surveillance System (NEDSS) is also included in the Public Health Improvement Line.
Occupational Safety and Health
The estimated annual cost of occupational injuries in the United States is more than $240 billion. The National Institute of Occupational Safety and Health (NIOSH) is the primary federal entity responsible for conducting research and making recommendations for the prevention of work-related illness and injury. NIOSH translates knowledge gained from research into products and services that benefit workers safety and health in settings from corporate offices to construction sites and coal mines. The budget for FY 2005 includes $279 million for NIOSH activities including work on the National Occupational Research Agenda (NORA); and personal protective technology and respirator research for the nation's 50 million miners, firefighters, emergency responders, and health care, agricultural, and industrial workers. In addition to its ongoing activities, NIOSH assists in the implementation of the Energy Employees Occupational Illness Compensation Act of 2000; funds for this activity are provided by the Department of Labor.
Office of the Director
The budget for the Office of the Director (OD) for FY 2005 is $60 million. This includes funds for the Public Health Information Network (PHIN), which will build upon and integrate existing public health communication systems and will create public health data standards necessary for interoperability between the health care sector and local, State, and federal public health authorities. CDC and the Office of the Director will also continue to coordinate management attention to achieving results in accordance with the President's Management Agenda.
Modern and Secure Laboratories and Facilities
CDC is continuing its work to modernize its physical
infrastructure. In 2003 CDC completed the critical Environmental
Health Laboratory and the Parasitology Laboratory. Between 2002
and 2003, CDC is completing more than 1.6 million square feet of
laboratory and other facility space. The Environmental Health
Laboratory completed in FY 2003 specializes in biomonitoring; this
new laboratory enabled staff to develop a rapid toxic scree n to
quickly analyze up to 150 chemicals likely to be used by
terrorists. In 2005, CDC will complete an Infectious Disease
Laboratory, the Scientific Communications Center, the Headquarters
and Emergency Operations Center, and the Environmental Toxicology
Laboratory. The request for Buildings and Facilities in FY 2005
includes $81.5 million to complete the Fort Collins, Colorado Bio
Safety Level 3 Laboratory; to continue work on the East Campus
Laboratory Consolidation Project; and to provide for nation-wide
maintenance, repairs, and improvements.
ATSDR is managed as part of CDC and is the lead agency responsible for public health activities related to Superfund sites. ATSDR develops profiles of the health effects of hazardous substances, assesses health hazards at specific Superfund sites, and provides consultations to prevent or reduce exposure and related illnesses. ATSDR also maintains the World Trade Center Exposure Registry to track the health effects of 100,000 to 200,000 individuals who may have been impacted by exposure to substances at the World Trade Center site. The President's Budget for FY 2005 for ATSDR is $77 million, a $4 million increase over FY 2004. Increases in the budget will be directed to ATSDR's work with EPA and other federal, State, and local environmental public health agencies to evaluate sites that received vermiculite from Libby, Montana, to identify past and present exposure pathways and to determine whether a public health hazard, has existed or continues to exist. Increases will also fund the maintenance costs of the World Trade Center Exposure Registry. A recent PART review determined that ATSDR had strong program design and management practices. The PART review suggested some improvements that ATSDR has undertaken. ATSDR is reviewing and clarifying its long term goals and measures to directly capture the impact of the agency on mitigating disease. CDC has eliminated administrative and management redundancies between ATSDR and CDC's National Center for Environmental Health.
Last revised: March 1, 2004
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