Washington, D.C.
March 19, 2003

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I am delighted to be with you today to tell you about the work of the Department of Health and Human Services and my agency, the Health Resources and Services Administration, in promoting to all Americans the importance of disease prevention in improving the overall health of the Nation.
 
Before I discuss HRSA, let me speak briefly about the commitment of President Bush and Health and Human Services Secretary Tommy Thompson to the cause of helping all Americans become as strong and healthy as possible. 
 
Secretary Thompson recently announced that President Bush’s fiscal year 2004 budget proposal includes $125 million for the “Steps to a Healthier US” initiative. The Steps initiative envisions a healthy, strong US population where diseases are prevented when possible, controlled when necessary, and treated when appropriate. Steps will focus on lifestyle choices such as poor nutrition and physical inactivity, tobacco use and youth risk taking behaviors. One component of this focuses on a critical effort to prevent diabetes, obesity and asthma by promoting community-based healthier lifestyles.
 
Secretary Thompson has been passionate since he took office about the need to encourage our citizens to make better choices about their health to prevent illness and to improve management of chronic disease.  Why the focus on prevention?  Because we know that preventable diseases take a terrible toll on our everyday lives. And we know that small steps – things like increased exercise and greater attention to a healthy diet – can have a tremendous impact on preventing illness and promoting good health.
 
Take diabetes for example.  Some 17 million Americans have diabetes and another 16 million more have a condition called pre-diabetes.   Diabetes and its complications cost the economy some $100 billion annually in direct and indirect medical costs.   This is simply unacceptable.  With education and a determined effort, we can prevent diabetes.  March 25 is Diabetes Alert Day and Secretary Thompson will be making a special push to raise Americans’ awareness of the simple steps they can take to combat the growing diabetes epidemic in minority populations. 
 
And with the “Steps to a Healthier US” Initiative, we will give communities the support they need for state and local projects that put prevention first.  For fiscal year 2004, our goal is to prevent diabetes for at least 75,000 Americans; to prevent obesity for at least 100,000; and prevent asthma-related hospitalizations for at least 50,000.  These are ambitious goals, but we can meet them with support from organizations like the American Dietetic Association.
 
Now,  I’d like to give you a brief update on our work at HRSA and show you how disease prevention is a critical part of all that we do. Our programs reach into every corner of America , forming the foundation for the safety net of health care services relied on by millions of our fellow citizens.
 
From our community and migrant health centers that are havens for low-income families to our maternal and child health programs that pay for vital care for America’s moms and babies, HRSA opens doors to health care when there is no place else to turn.
 
Our Ryan White CARE Act programs offer hope to people living with HIV/AIDS.  We also oversee the organ and tissue transplant system that furnishes hope to those whose health and survival depend on life-saving transplants.  
 
And we work to make sure that medically underserved urban and rural communities across America have access to well-trained, diverse health care professionals who provide culturally competent care.  Included among these professionals are clinicians who make up the National Health Service Corps, the NHSC.
 
Our mission is a simple and compelling one -- to provide access to essential health care services so Americans can lead healthier, more productive lives.
 
Much of this access is provided at the nation’s 3,400 community health centers and clinics, which are dedicated to providing primary and preventive health care services for people in medically underserved communities – regardless of their ability to pay.  These sites are the front line of the Bush Administration’s fight to reduce the impact of chronic disease on our neediest neighbors.
 
President Bush has made expansion of the health center network a top priority.  Early in his first year in office, the President launched a five-year initiative to add 1,200 new and expanded health center sites to the current network and increase the number of people served annually from just over 10 million currently to 16 million by 2006.
 
And just last month we received our 2003 appropriation—$1.47 billion—to continue our expansion efforts. This year, we expect to fund 90 new health center sites and expand services at some 80 existing sites. In his FY 2004 budget, President Bush has requested $1.63 billion to continue our expansion and add 120 new health center sites and expand services at 110 existing sites.
 
To support the Health Center Initiative, President Bush introduced a second initiative to reform the National Health Service Corps and place more of its clinicians in areas of greatest need.  In FY 2002, just two years ago, NHSC received a record $89.9 million appropriation to support 879 new and continuing loan repayment awards and 405 new and continuing scholarship awards.  Since then, President Bush has continued to invest heavily in the NHSC, requesting $213 million for the Corps in his FY 2004 budget proposal, or more than double the amount received just two years ago. His FY ’04 request represents a $42 million increase over NHSC’s $171 million FY ’03 budget. As you can see from these growing figures, both the President and Secretary have great confidence in NHSC.
 
Taken together, the President’s initiatives to increase the health center network and the number of NHSC doctors and dentists will have an enormous impact on America ’s capacity to treat and prevent chronic diseases, especially among minorities and low-income groups where the problem is most severe.
 
Health centers serve 10 percent of the nation's uninsured adults, 15 percent of the nation's uninsured children, and about 30 percent of the nation's uninsured poor people of color, both adults and children.  The planned expansion of the system, then, will increase health care to precisely those populations that are most troubled by chronic disease.
 
At HRSA we are very excited about our ability to lower rates of chronic disease among our patients because the health centers’ expansion occurs at a time when the entire system is involved in a multi-year effort to improve the already exceptional care it provides.
 
The method we use to improve quality is called “health disparities collaboratives.”   They are organized specifically to reduce the impact of diabetes, asthma, cardiovascular disease, obesity, HIV/AIDS, depression and cancer on health center patients.
 
Collaboratives take a team approach to treating chronic illness.  Here’s how they work:

• Doctors, nurses, outreach workers and health educators are taught how to work more closely together and how to integrate the latest research-based screening techniques and follow-up into their care.
• Patients get more involved in their own health by setting personal goals to manage their conditions.
• And outreach is increased to local organizations to secure discount drugs, space for health promotion classes, and other in-kind contributions.
  

On the strength of the success of these collaboratives, health centers have launched other collaboratives targeting some of America ’s most deadly chronic illnesses: cardiovascular disease, HIV/AIDS, asthma and depression.
 
Last November, HRSA began work on two prototype collaboratives that  address primary prevention activities in health centers -- one on prevention generally and one specifically on diabetes prevention.  Five health centers are participating in each prototype collaborative.
 
The aim of the Prevention Collaborative is to reduce by 75 percent the gap between actual and desired delivery rates for preventive services.  Working in collaboration with the Centers for Disease Control and Prevention and the National Institutes of Health, HRSA will address nutrition and physical activity; cholesterol; blood pressure; immunizations; oral health and lead poisoning.
 
The Diabetes Prevention Prototype Collaborative is designed to prevent or delay the onset of Type 2 diabetes in those people with pre-diabetes.   The focus is on lifestyle interventions with attainable goals such as weight loss of 7 percent at 6 months and physical activity equal to or greater than 150 minutes per week.
 
Nationally, 523 of our 750 health centers participate in one or another collaborative to fight chronic diseases.  Our plan at HRSA is to increase the number of health centers involved in collaboratives at the same time we expand the size of the health center system.
 
HRSA is also working to increase awareness and the use of preventive health services for women through our Bright Futures for Women’s Health and Wellness Initiative.   Now in its second year, this initiative is focused on the development of educational and informative tools for consumers, clinicians, and community organizations around the topics of physical activity and nutrition.
 
In addition, we’ve developed two practice guides "Bright Futures in Practice: Nutrition" and "Bright Futures in Practice: Physical Activity" to help communities and health professionals educate and encourage individuals to adopt healthy eating and physical activity behaviors.
 
To address the unique nutritional needs of people living with HIV/AIDS, we released in January the second edition of the Health Care and HIV: Nutritional Guide for Providers and Clients. This 250-page manual is an easy-to-use guide for health care providers and people with HIV to help them better manage the nutritional aspects of their health care. This comprehensive manual is being translated into Spanish and should be available soon.
 
These are just a few examples of the broad spectrum of preventive care we at HRSA provide in communities all across the Nation. In all that we do, the bottom line is clear. We want to encourage innovation and new ways of thinking.  We urge coordination and collaboration that cut across traditional boundaries.  And we believe that partnerships are the very best way to create healthier individuals and families.
 
In closing, let me say I greatly appreciate the work that the ADA does to educate Americans about good nutrition and its impact on good health. In the months and years ahead, I know we can count on you as we all work to build healthier more productive communities all across America .