Prepared Remarks of Elizabeth M. Duke, Ph.D.
Administrator, Health Resources and Services Administration
Washington D.C.
July 10, 2002
It’s a pleasure to welcome you all to this summer meeting of the
Secretary’s Advisory Committee Meeting on Infant Mortality. I especially
want to thank Peter and Kerry, whose leadership has helped make sure
that this committee’s recommendations receive the focus and visibility
they deserve. And I thank all of you for your sustained commitment to
us at HRSA. Your work supports our fundamental mission of ensuring greater
access to quality health care for our country’s most vulnerable
individuals and families.
You know Secretary Thompson sees your work as critically important.
Your recommendations inform his decision-making in the area of maternal
and child health. Several of you saw evidence of this first-hand at
our meeting with him at the end of last month. During that meeting,
Secretary Thompson discussed several issues, including this Committee’s
Low Birthweight Report, your report on early postpartum discharge
as well as your recommendations for the Healthy Start Initiative. He
told us that the Department would soon begin putting together an Interagency
Coordinating Council and a Department-wide research agenda on the impact
of low birthweight. This is such good news for HRSA and for all of you
on this advisory committee. This is the culmination of years of painstaking
effort and enduring professional dedication.
Also, next month in the Journal of Public Health, MCHB's Michael
Kogan and other researchers will publish a new study titled: “The
Impact of Increasing Number of Multiple Births on the Rates of Preterm
Birth and Low Birthweight.” We look forward to reading about this
study’s findings as we increase our knowledge in the area of low
birthweight.
During this two-day session, I know you’ll be looking at disparities
in health care utilization, a problem that continues to plague the Nation’s
health care system. Earlier this morning, you heard a presentation
about the Institute of Medicine’s recent study that found minorities
in America receive lower-quality health care than whites. And you discussed
recent HRSA research by MCHB authors Christina Park, Mary Overpeck,
and Michael Kogan, published in May’s Pediatrics, that showed
that African American children with frequent ear infections were less
likely than white children to get specialized medical care or surgery,
even when they had health insurance and regular care. Studies like these
help clarify the reality of health disparities and underscore how much
work we still have left to do to ensure that all Americans have access
to quality health care services. Working to close these gaps in care
is a top priority for all HRSA programs and for the Secretary.
Let me briefly discuss how HRSA’s new initiatives will help us
close the health disparities gap and improve health care for women and
children everywhere.
As I told you at your last meeting, President Bush has put HRSA at
the core of an unprecedented push to increase direct health care to
uninsured and underinsured Americans. He and Secretary Thompson have
given us the responsibility to implement three presidential directives.
First, the Health Centers Presidential Initiative, is a five-year plan
to create 1,200 new and expanded Health Centers and increase annual
patient visits to 16 million by 2006, up from just over 10 million currently.
For fiscal year 2003, the President is asking for almost $1.5 billion
for health centers – that’s a $114 million increase over this
year’s budget and a two-year increase of almost $280 million.
These Health Center increases will not only expand access to care,
they’ll also reduce health disparities. Because almost two-thirds
of Health Center patients come from minority groups, members of these
groups will benefit most from the increased access to care and the expansion
of available health care services. This will improve health and reduce
disparities in health outcomes between minority and majority populations.
We also expect the initiative will look to the successes of the Bureau
of Primary Health Care’s Health Disparities Collaboratives, which
bring together staff from dozens of health centers to target improvements
in the management of common chronic diseases. So far, the collaboratives
have shown impressive results in treating diabetes, cardiovascular disease,
asthma and depression. They are just starting one on cancer, and –
I’ll share a secret with you – I’ve instructed them to
turn immediately after the cancer launch to development of a prenatal,
delivery, and early life collaborative. This will take time to develop,
so just know it is coming and that your work contributed to my decision
on this.
These collaboratives transform the centers’ delivery of care by
changing the way doctors and other health professionals deliver care.
One of the most important aspects of the collaboratives is that they
emphasize greater patient involvement in their own treatment plans.
Health centers involved in the depression collaborative not only educate
patients about depression, they encourage them to set personal goals
for improving their condition. And because depression is so common among
those with other chronic illnesses, HRSA has integrated depression assessment
into its other collaboratives.
The second presidential initiative involves expansion and accompanying
reforms within the National Health Service Corps. Part of the President
and Secretary Thompson’s plan to increase direct health care for
America’s medically underserved means getting more NHSC clinicians
to “front-line” areas of greatest need.
The FY 2002 budget contained an increase for the NHSC of about $20
million, to a total of $145 million. The President’s 2003 budget
proposal would give the Corps an increase of another $45 million to
a total of just over $191 million. These added funds would provide scholarships
or loan assistance to about 1,800 professionals practicing in underserved
areas -- an increase of more than 500 participants over the current
fiscal year. With more culturally and linguistically competent
health providers in underserved communities, which HRSA really pushes
for, we trust that prenatal care will improve while disparities in health
outcomes decrease.
And the President’s third initiative -- the Healthy Communities
Innovation Initiative – is modeled on the Healthy Start demonstration
projects of which we’re so proud.
If Congress appropriates requested funds for Fiscal Year 2003 –
HRSA will set up demonstration programs to combat asthma, diabetes and
obesity and improve health outcomes in five communities where illness
and death rates due to these diseases are high.
I emphasize these three presidential initiatives because they represent
the foundation of our current and future efforts to expand access to
health care and close the health disparities gap. As you continue your
work, I ask you to consider how your recommendations can both enhance
and support the three presidential initiatives underway here at HRSA.
Before wrapping up my remarks, I also want to mention that we are making
progress on the Healthy Start evaluation, but you’ll hear more
about this tomorrow morning. Healthy Start is making great strides in
reducing infant mortality and helping mothers to have healthy infants.
Beginning with prenatal care and continuing through the infant’s
second year of life, Healthy Start communities are implementing evidence-based
practices to reduce disparities and promote healthy outcomes for young
women and their families.
And, as you know, for fiscal year 2003, the President has maintained
funding for the Healthy Start program at the FY 2002 level of $99 million.
This is a tribute to your dedicated efforts on behalf of healthy mothers
and babies across the nation.
Before I close, I want to tell you a bit about HRSA’s new Deputy
Administrator, Dennis Williams. Dennis was for more than a year the
Department’s chief financial officer and chief information officer
as Acting Assistant Secretary for Budget, Technology and Finance. Prior
to HHS service, Dennis earned a PhD. in international affairs from Johns
Hopkins and served in Turkey as a member of the Peace Corps. Dennis’
wife is with the World Bank and they have two daughters – one is
a student at Johns Hopkins and the other is a professional ballerina
with the Washington Ballet. Dennis is one of the best people I know.
He is a consummate professional and a model public servant. We could
not have a better deputy.
In closing, I commend you all for your willingness to devote your time
and effort to improving the health status of mothers and babies. After
all, as health professionals, what could be more important than making
sure our youngest get a good start in life. At HRSA, we value your expert
advice and counsel as we continue the fight to take down the barriers
to quality prenatal care. And, as always, we look forward to your continuing
recommendations.
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