I 

111TH CONGRESS 

1ST SESSION H. R. 2354 

To provide for increased research, coordination, and expansion of health 

promotion programs through the Department of Health and Human Services. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 12, 2009 

Ms. SCHAKOWSKY (for herself, Mr. BURGESS, and Mr. GENE GREEN of 

Texas) introduced the following bill; which was referred to the Committee 

on Energy and Commerce 

A BILL 

To provide for increased research, coordination, and expansion of health promotion programs through the Department of Health and Human Services. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Health Promotion 

5 Funding Integrated Research, Synthesis, and Training 

6 Act’’ or the ‘‘Health Promotion FIRST Act’’. 

7 SEC. 2. FINDINGS. 

8 Congress makes the following findings: 


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1 (1) Lifestyle factors are responsible for almost 

2 half of the premature deaths in developed nations 

3 and a large portion of the deaths in developing na4 tions. 

5 (2) Lifestyle factors are a primary cause of the 

6 6 leading causes of death in the United States, in7 cluding heart disease, cancer, stroke, respiratory dis8 eases, accidents, and diabetes, which account for al9 most 75 percent of all deaths in the United States. 

10 (3) A significant portion of the health dispari11 ties in the United States are caused by lifestyle fac12 tors, which could be improved by health promotion 

13 programs. 

14 (4) The United States is experiencing epidemics 

15 in diabetes and obesity among adults and children, 

16 at the same time a majority of the population is sed17 entary and eats an unhealthy diet. 

18 (5) Per capita medical care costs in the United 

19 States are more than double those of all but 4 other 

20 countries in the world, yet the United States ranks 

21 42nd in the world in life expectancy. 

22 (6) Medical care costs are second only to edu23 cation in State government budgets. 


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1 (7) Lifestyle factors are responsible for at least 

2 25 percent of employer’s medical care costs in the 

3 United States. 

4 (8) National costs of obesity account for 9.1 

5 percent of all medical costs, reaching $93,000,000 in 

2002. Approximately 1 6 ⁄2 of these costs were paid by 

7 the Medicare & Medicaid Programs. 

8 (9) More than 440,000 people die each year 

9 from tobacco use and more than 12,000,000 are liv10 ing with chronic conditions caused by tobacco. To11 bacco accounts for at least $96,000,000,000 in di12 rect medical expenditures. 

13 (10) Significant gaps exist in the basic and ap14 plied research base of health promotion regarding 

15 how to best reach and serve people of color, low-in16 come people, people with little formal education, chil17 dren, and older adults, how to create long-term 

18 health improvements, how to create supportive envi19 ronments, and how to address gender issues. More 

20 focused research can reduce these gaps. 

21 (11) Significant gaps exist between the best and 

22 the typical health promotion programs. Better syn23 thesis and dissemination of results can reduce these 

24 gaps. 


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1 (12) Health promotion is the art and science of 

2 motivating people to enhance their lifestyles to 

3 achieve complete health, not just the absence of dis4 ease. Complete health involves a balance of physical, 

5 mental, and social health. 

6 (13) Health promotion programs focus on prac7 tices such as exercising regularly, eating a nutritious 

8 diet, maintaining a healthy weight, managing stress, 

9 avoiding dangerous substances such as tobacco and 

10 illegal drugs, drinking alcohol in moderation or not 

11 at all, driving safely, being wise consumers of health 

12 care, and a number of other health related practices. 

13 (14) The most effective health promotion pro14 grams include a combination of strategies to in15 crease awareness, enhance motivation, facilitate be16 havior change, and develop cultures and physical en17 vironments that encourage and support healthy life18 style practices. 

19 (15) Health promotion programs can be pro20 vided in family, clinical, child care, school, work21 place, Federal, State, and community settings. 

22 (16) People living in rural areas have additional 

23 unique challenges of high risk work environments, 

24 more limited access to major educational and med25 ical complexes, as well as facilities for fitness and 


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1 recreational facilities and in some cases to grocery 

2 stores. 

3 (17) Individuals with physical disabilities re4 spond very well to exercise treatment. This is a core 

5 component of all high quality physical therapy pro6 grams. However, additional research and more in7 tensive efforts to disseminate information in this 

8 area are necessary. 

9 SEC. 3. HEALTH PROMOTION RESEARCH AND DISSEMINA10 TION. 

11 The Public Health Service Act (42 U.S.C. 201 et 

12 seq.) is amended by adding at the end the following: 

13 ‘‘TITLE XXXI—HEALTH PRO14 MOTION RESEARCH AND DIS15 SEMINATION 

16 ‘‘Subtitle A—Coordination of Pro17 grams of the Department of 

18 Health and Human Services 

19 ‘‘SEC. 3101. PLAN FOR HEALTH PROMOTION PROGRAMS. 

20 ‘‘(a) IN GENERAL.—The Secretary shall develop, and 

21 periodically review and as appropriate revise, a plan in ac22 cordance with this section for activities of the Department 

23 of Health and Human Services relating to health pro24 motion. The plan shall include provisions for coordinating 


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1 all such activities of the Department, including activities 

2 under section 1701 to— 

3 ‘‘(1) formulate national goals, and a strategy to 

4 achieve such goals, with respect to health informa5 tion and health promotion, preventive health serv6 ices, and education in the appropriate use of health 

7 care; 

8 ‘‘(2) analyze the necessary and available re9 source for implementing the goals and strategy for10 mulated pursuant to paragraph (1), and recommend 

11 appropriate educational and quality assurance poli12 cies for the needed manpower resources identified by 

13 such analysis; 

14 ‘‘(3) undertake and support necessary activities 

15 and programs to— 

16 ‘‘(A) incorporate appropriate health pro17 motion concepts into our society, especially into 

18 all aspects of education and health care; 

19 ‘‘(B) increase the application and use of 

20 health knowledge, skills, and practices by the 

21 general population in its patterns of daily liv22 ing; and 

23 ‘‘(C) establish systematic processes for the 

24 exploration, development, demonstration, and 


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1 evaluation of innovative health promotion con2 cepts; and 

3 ‘‘(4) undertake and support research and dem4 onstration programs relating to health information 

5 and health promotion, preventive health services, 

6 and education in the appropriate use of health care. 

7 ‘‘(b) BASIC AND APPLIED SCIENCE.—The plan devel8 oped under subsection (a) shall contain provisions to ad9 dress how to best develop the basic and applied science 

10 of health promotion, including— 

11 ‘‘(1) a research agenda; 

12 ‘‘(2) an identification of the best combination of 

13 Federal agency, university, and other community re14 sources most qualified to pursue each of the compo15 nents of such agenda; 

16 ‘‘(3) protocols to facilitate ongoing cooperation 

17 and collaboration among the Federal agencies to 

18 pursue the agenda; and 

19 ‘‘(4) budgetary requirements with respect to the 

20 agenda. 

21 ‘‘(c) DISSEMINATION OF INFORMATION.—The plan 

22 developed under subsection (a) shall contain provisions to 

23 address how to best synthesize and disseminate health 

24 promotion research findings to scientists, professionals, 

25 and the public, including provisions for the following: 


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1 ‘‘(1) Protocols for ongoing monitoring of all 

2 health promotion research. 

3 ‘‘(2) Preparation of systematic reviews and 

4 meta-analyses. 

5 ‘‘(3) Distillation of findings into practice guide6 lines for programs offered in clinical, workplace, 

7 school, home, neighborhood, municipal, and State 

8 settings. 

9 ‘‘(4) Strategies to incorporate findings into col10 lege, university, and continuing educational cur11 riculum for all related health professions. 

12 ‘‘(5) Communication of key findings to policy 

13 makers in business, government, educational and 

14 community settings who influence investment deci15 sions. 

16 ‘‘(6) Identification of the optimal combination 

17 of government agencies to coordinate the matters re18 ferred to in paragraphs (1) through (5). 

19 ‘‘(d) RURAL AND LOW-INCOME NEEDS.—The plan 

20 developed under subsection (a) shall contain strategies to 

21 best meet the health promotion needs of individuals in 

22 rural areas and low-income inner city areas. 

23 ‘‘(e) SUPPORT AND DEVELOPMENT OF PROFES24 SIONAL AND SCIENTIFIC COMMUNITY.—The plan devel25 oped under subsection (a) shall contain provisions to adVerDate Nov 24 2008 22:35 May 13, 2009 Jkt 059200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H2354.IH H2354

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1 dress how to best support and develop the health pro2 motion professional and scientific community through en3 hancement of existing or development of new professional 

4 organizations. 

5 ‘‘(f) INTEGRATION OF HEALTH PROMOTION; INTER6 NAL DEPARTMENT ACTIVITIES.—The plan developed 

7 under subsection (a) shall contain provisions to address 

8 how resources, policies, structures, and legislation within 

9 the Department of Health and Human Services can best 

10 be modified or developed to integrate health promotion 

11 into all health professions and sectors of society and make 

12 health promoting opportunities available to all members 

13 of the public. 

14 ‘‘(g) INTEGRATION OF HEALTH PROMOTION EXTER15 NAL ACTIVITIES.—The plan developed under subsection 

16 (a) shall contain provisions to address how overall Federal 

17 Government policies, structures, and legislation external 

18 to the Department of Health and Human Services can 

19 best be modified or developed to integrate health pro20 motion into all health professions and sectors of society 

21 and to make health promoting opportunities available to 

22 all individuals. 

23 ‘‘(h) OTHER FEDERAL STRATEGIC PLANS.—The 

24 Secretary shall request the Secretary of Agriculture, the 

25 Secretary of the Interior, the Secretary of Commerce, the 


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1 Attorney General, the Secretary of Defense, the Secretary 

2 of Labor, the Secretary of Education, the Secretary of 

3 State, the Secretary of Energy, the Secretary of Transpor4 tation, the Secretary of the Treasury, the Secretary of 

5 Homeland Security, the Secretary of Veterans Affairs, and 

6 the Secretary of Housing and Urban Development to de7 velop strategic plans for the use by each respective Federal 

8 agency of the resources and authorities of such agency to 

9 enhance the health and well-being of the American people 

10 by providing access to more opportunities for physical ac11 tivity, enhancing access to more nutritious foods at more 

12 affordable prices, and reducing exposure to toxic sub13 stances such as secondhand smoke. Each such Secretary 

14 shall solicit suggestions and advice from experts of the 

15 type described in subsection (i). 

16 ‘‘(i) PERSPECTIVES.—Due to 30 years of experience 

17 showing that traditional medical and educational ap18 proaches are not sufficient to motivate people to make and 

19 sustain basic health behavior changes, in developing the 

20 plan under subsection (a), the Secretary shall seek per21 spectives from individuals representing a diverse range of 

22 disciplines, including the following areas: 

23 ‘‘(1) Agriculture. 

24 ‘‘(2) Anthropology. 

25 ‘‘(3) Child development. 


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1 ‘‘(4) City planning. 

2 ‘‘(5) Commerce. 

3 ‘‘(6) Economics. 

4 ‘‘(7) Environmental planning and design. 

5 ‘‘(8) Exercise physiology. 

6 ‘‘(9) Financial analysis. 

7 ‘‘(10) Health education. 

8 ‘‘(11) Health policy. 

9 ‘‘(12) Individual psychology. 

10 ‘‘(13) Management. 

11 ‘‘(14) Medicine. 

12 ‘‘(15) Nursing. 

13 ‘‘(16) Nutrition. 

14 ‘‘(17) Organization psychology. 

15 ‘‘(18) Taxation. 

16 ‘‘(19) Transportation planning. 

17 ‘‘Subtitle B—Science Programs 

18 Through National Institutes of 

19 Health 

20 ‘‘SEC. 3111. SCIENCE OF HEALTH PROMOTION. 

21 ‘‘(a) PLAN.—The Director of the National Institutes 

22 of Health (referred to in this subtitle as ‘NIH’), acting 

23 through the Office of Behavioral and Social Sciences Re24 search, shall develop, and periodically review and as appro25 priate revise, a plan on how to best develop the science 


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1 of health promotion through the NIH agencies. The plan 

2 shall be consistent with and shall elaborate upon applica3 ble provisions of the Departmental plan under section 

4 3101(a). 

5 ‘‘(b) CERTAIN COMPONENTS OF PLAN.—The plan 

6 developed under subsection (a) shall include the following 

7 provisions: 

8 ‘‘(1) A research agenda to develop the science 

9 of health promotion. 

10 ‘‘(2) Recommendations on funding levels for the 

11 various areas of research on such agenda. 

12 ‘‘(3) Recommendations on the best combination 

13 of NIH agencies and non-Federal entities to carry 

14 out research under the agenda. 

15 ‘‘(c) ALLOCATION OF RESOURCES.—Subject to com16 pliance with appropriation Acts, the plan developed under 

17 subsection (a) shall provide for the allocation of resources 

18 for research under such plan relative to other areas of 

19 health, as appropriate taking into account the burden of 

20 lifestyle factors on morbidity and mortality, and the 

21 progress likely in advancing the science of health pro22 motion given the current and evolving level of science on 

23 health promotion, and the relative cost of conducting re24 search on health promotion compared to other areas of 

25 research. 


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1 ‘‘SEC. 3112. EARLY RESEARCH PROGRAMS. 

2 ‘‘The Director of NIH, acting through the Office of 

3 Behavioral and Social Sciences Research, shall conduct or 

4 support early research programs and research training re5 garding health promotion. 

6 ‘‘Subtitle C—Applied Research Pro7 grams Through Centers for Dis8 ease Control and Prevention 

9 ‘‘SEC. 3121. RESEARCH AGENDA. 

10 ‘‘The Secretary, acting through the Director of the 

11 Centers for Disease Control and Prevention (referred to 

12 in this subtitle as the ‘Director of CDC’), shall develop, 

13 and periodically review and as appropriate revise, a plan 

14 that establishes for such Centers a research agenda re15 garding health promotion. The plan shall be consistent 

16 with and shall elaborate upon applicable provisions of the 

17 Departmental plan developed under section 3101(a). 

18 ‘‘SEC. 3122. PREVENTION RESEARCH CENTERS. 

19 ‘‘(a) IN GENERAL.—The Director of the National 

20 Center for Chronic Disease Prevention and Health Pro21 motion (referred to in this section as the ‘Director’) shall 

22 expand the eligibility of entities for Prevention Research 

23 Centers (referred to in this section as ‘Centers’) grants 

24 to include the entities described in subsection (b). The 

25 Center for Chronic Disease Prevention and Health Pro26 motion shall retain the authority to specify the qualities 


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1 of entities it deems to be most important in performing 

2 the responsibilities of Centers and shall retain the respon3 sibility for judging which organizations possess these 

4 qualities. 

5 ‘‘(b) ENTITIES DESCRIBED.—The entities described 

6 in this subsection include— 

7 ‘‘(1) institutions of higher education; 

8 ‘‘(2) public and private research institutions; 

9 ‘‘(3) departments or schools of— 

10 ‘‘(A) business; 

11 ‘‘(B) city planning; 

12 ‘‘(C) education; 

13 ‘‘(D) nursing; 

14 ‘‘(E) psychology; 

15 ‘‘(F) public policy; 

16 ‘‘(G) transportation; 

17 ‘‘(H) social work; 

18 ‘‘(I) agriculture; 

19 ‘‘(J) nutrition; 

20 ‘‘(K) engineering; 

21 ‘‘(L) architecture; 

22 ‘‘(M) exercise science; 

23 ‘‘(N) health promotion; 

24 ‘‘(O) population health; 

25 ‘‘(P) preventive medicine; 


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1 ‘‘(Q) public health; and 

2 ‘‘(R) any other program that can make a 

3 compelling connection to improving the health 

4 of the public; and 

5 ‘‘(4) private research, membership, or service 

6 organizations. 

7 ‘‘Subtitle D—Other Programs and 

8 Policies 

9 ‘‘SEC. 3131. MODIFICATION OF APPLICATIONS AWARD 

10 PROCESS TO ATTRACT MOST QUALIFIED SCI11 ENTISTS AND PRACTITIONERS; DEVELOPING 

12 HEALTH PROMOTION INFRASTRUCTURE. 

13 ‘‘(a) MODIFICATION OF AWARDS APPLICATION PROC14 ESS.—In awarding grants, cooperative agreements, and 

15 contracts under this title, the Secretary shall modify the 

16 application process to attract the most qualified individ17 uals and organizations. 

18 ‘‘(b) GENERAL PRIORITY OF DEVELOPING HEALTH

19 PROMOTION INFRASTRUCTURE.—The Secretary shall en20 sure that programs carried out pursuant to this title are 

21 consistent with the general priority of developing the 

22 health promotion infrastructure among universities, non23 profit organizations, and for-profit organizations, rather 


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1 than increasing the size of State or local governments or 

2 the Federal Government.’’. 

Æ 


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