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[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 1001 Introduced in Senate (IS)]

111th CONGRESS
  1st Session
                                S. 1001

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

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                              May 7, 2009

Mr. Lugar (for himself and Mr. Bingaman) introduced the following bill; 
     which was read twice and referred to the Committee on Health, 
                     Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL

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

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Health Promotion Funding Integrated 
Research, Synthesis, and Training Act'' or the ``Health Promotion FIRST 
Act''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) Lifestyle factors are responsible for almost half of 
        the premature deaths in developed nations, and a large portion 
        of the deaths in developing nations.
            (2) Lifestyle factors are a primary cause of the 6 leading 
        causes of death in the United States, including heart disease, 
        cancer, stroke, respiratory diseases, accidents, and diabetes, 
        which account for almost 75 percent of all deaths in the United 
        States.
            (3) A significant portion of the health disparities in the 
        United States are caused by lifestyle factors, which could be 
        improved by health promotion programs.
            (4) The United States is experiencing epidemics in diabetes 
        and obesity among adults and children, at the same time a 
        majority of the population is sedentary and eats an unhealthy 
        diet.
            (5) Per capita medical care costs in the United States are 
        more than double those of all but 4 other countries in the 
        world, yet the United States ranks 42d in the world in life 
        expectancy.
            (6) Medical care costs are second only to education in 
        State government budgets.
            (7) Lifestyle factors are responsible for at least 25 
        percent of employer's medical care costs in the United States.
            (8) National costs of obesity account for 9.1 percent of 
        all medical costs, reaching $93,000,000 in 2002. Approximately 
        \1/2\ of these costs were paid by the Medicare & Medicaid 
        programs.
            (9) More than 440,000 people die each year from tobacco use 
        and more than 12,000,000 are living with chronic conditions 
        caused by tobacco. Tobacco accounts for at least 
        $96,000,000,000 in direct medical expenditures.
            (10) Significant gaps exist in the basic and applied 
        research base of health promotion regarding how to best reach 
        and serve people of color, low-income people, people with 
        little formal education, children, and older adults, how to 
        create long-term health improvements, how to create supportive 
        environments, and how to address gender issues. More focused 
        research can reduce these gaps.
            (11) Significant gaps exist between the best and the 
        typical health promotion programs. Better synthesis and 
        dissemination of results can reduce these gaps.
            (12) Health promotion is the art and science of motivating 
        people to enhance their lifestyles to achieve complete health, 
        not just the absence of disease. Complete health involves a 
        balance of physical, mental, and social health.
            (13) Health promotion programs focus on practices such as 
        exercising regularly, eating a nutritious diet, maintaining a 
        healthy weight, managing stress, avoiding dangerous substances 
        such as tobacco and illegal drugs, drinking alcohol in 
        moderation or not at all, driving safely, being wise consumers 
        of health care, and a number of other health-related practices.
            (14) The most effective health promotion programs include a 
        combination of strategies to increase awareness, enhance 
        motivation, facilitate behavior change, and develop cultures 
        and physical environments that encourage and support healthy 
        lifestyle practices.
            (15) Health promotion programs can be provided in family, 
        clinical, child care, school, workplace, Federal, State, and 
        community settings.
            (16) People living in rural areas have additional unique 
        challenges of high risk work environments, more limited access 
        to major educational and medical complexes, as well as 
        facilities for fitness and recreational facilities and in some 
        cases to grocery stores.
            (17) Individuals with physical disabilities respond very 
        well to exercise treatment. This is a core component of all 
        high-quality physical therapy programs. However, additional 
        research and more intensive efforts to disseminate information 
        in this area are necessary.

SEC. 3. HEALTH PROMOTION RESEARCH AND DISSEMINATION.

    The Public Health Service Act (42 U.S.C. 201 et seq.) is amended by 
adding at the end the following:

       ``TITLE XXXI--HEALTH PROMOTION RESEARCH AND DISSEMINATION

``Subtitle A--Coordination of Programs of the Department of Health and 
                             Human Services

``SEC. 3101. PLAN FOR HEALTH PROMOTION PROGRAMS.

    ``(a) In General.--The Secretary shall develop, and periodically 
review and as appropriate revise, a plan in accordance with this 
section for activities of the Department of Health and Human Services 
relating to health promotion. The plan shall include provisions for 
coordinating all such activities of the Department, including 
activities under section 1701 to--
            ``(1) formulate national goals, and a strategy to achieve 
        such goals, with respect to health information and health 
        promotion, preventive health services, and education in the 
        appropriate use of health care;
            ``(2) analyze the necessary and available resources for 
        implementing the goals and strategy formulated pursuant to 
        paragraph (1), and recommend appropriate educational and 
        quality assurance policies for the needed manpower resources 
        identified by such analysis;
            ``(3) undertake and support necessary activities and 
        programs to--
                    ``(A) incorporate appropriate health promotion 
                concepts into our society, especially into all aspects 
                of education and health care;
                    ``(B) increase the application and use of health 
                knowledge, skills, and practices by the general 
                population in its patterns of daily living; and
                    ``(C) establish systematic processes for the 
                exploration, development, demonstration, and evaluation 
                of innovative health promotion concepts; and
            ``(4) undertake and support research and demonstration 
        programs relating to health information and health promotion, 
        preventive health services, and education in the appropriate 
        use of health care.
    ``(b) Basic and Applied Science.--The plan developed under 
subsection (a) shall contain provisions to address how to best develop 
the basic and applied science of health promotion, including--
            ``(1) a research agenda;
            ``(2) an identification of the best combination of Federal 
        agency, university, and other community resources most 
        qualified to pursue each of the components of such agenda;
            ``(3) protocols to facilitate ongoing cooperation and 
        collaboration among the Federal agencies to pursue the agenda; 
        and
            ``(4) budgetary requirements with respect to the agenda.
    ``(c) Dissemination of Information.--The plan developed under 
subsection (a) shall contain provisions to address how to best 
synthesize and disseminate health promotion research findings to 
scientists, professionals, and the public, including provisions for the 
following:
            ``(1) Protocols for ongoing monitoring of all health 
        promotion research.
            ``(2) Preparation of systematic reviews and meta-analyses.
            ``(3) Distillation of findings into practice guidelines for 
        programs offered in clinical, workplace, school, home, 
        neighborhood, municipal, and State settings.
            ``(4) Strategies to incorporate findings into college, 
        university, and continuing educational curriculum for all 
        related health professions.
            ``(5) Communication of key findings to policy makers in 
        business, government, educational, and community settings who 
        influence investment decisions.
            ``(6) Identification of the optimal combination of 
        government agencies to coordinate the matters referred to in 
        paragraphs (1) through (5).
    ``(d) Rural and Low Income Needs.--The plan developed under 
subsection (a) shall contain strategies to best meet the health 
promotion needs of individuals in rural areas and low income inner city 
areas.
    ``(e) Support and Development of Professional and Scientific 
Community.--The plan developed under subsection (a) shall contain 
provisions to address how to best support and develop the health 
promotion professional and scientific community through enhancement of 
existing or development of new professional organizations.
    ``(f) Integration of Health Promotion; Internal Department 
Activities.--The plan developed under subsection (a) shall contain 
provisions to address how resources, policies, structures, and 
legislation within the Department of Health and Human Services can best 
be modified or developed to integrate health promotion into all health 
professions and sectors of society and make health promoting 
opportunities available to all members of the public.
    ``(g) Integration of Health Promotion External Activities.--The 
plan developed under subsection (a) shall contain provisions to address 
how overall Federal Government policies, structures, and legislation 
external to the Department of Health and Human Services can best be 
modified or developed to integrate health promotion into all health 
professions and sectors of society and to make health promoting 
opportunities available to all individuals.
    ``(h) Other Federal Strategic Plans.--The Secretary shall request 
the Secretary of Agriculture, the Secretary of the Interior, the 
Secretary of Commerce, the Attorney General, the Secretary of Defense, 
the Secretary of Labor, the Secretary of Education, the Secretary of 
State, the Secretary of Energy, the Secretary of Transportation, the 
Secretary of the Treasury, the Secretary of Homeland Security, the 
Secretary of Veterans Affairs, and the Secretary of Housing and Urban 
Development to develop strategic plans for the use by each respective 
Federal agency of the resources and authorities of such agency to 
enhance the health and well-being of the American people by providing 
access to more opportunities for physical activity, enhancing access to 
more nutritious foods at more affordable prices, and reducing exposure 
to toxic substances such as secondhand smoke. Each such Secretary shall 
solicit suggestions and advice from experts of the type described in 
subsection (i).
    ``(i) Perspectives.--Due to 30 years of experience showing that 
traditional medical and educational approaches are not sufficient to 
motivate people to make and sustain basic health behavior changes, in 
developing the plan under subsection (a), the Secretary shall seek 
perspectives from individuals representing a diverse range of 
disciplines, including the following areas:
            ``(1) Agriculture.
            ``(2) Anthropology.
            ``(3) Child development.
            ``(4) City planning.
            ``(5) Commerce.
            ``(6) Economics.
            ``(7) Environmental planning and design.
            ``(8) Exercise physiology.
            ``(9) Financial analysis.
            ``(10) Health education.
            ``(11) Health policy.
            ``(12) Individual psychology.
            ``(13) Management.
            ``(14) Medicine.
            ``(15) Nursing.
            ``(16) Nutrition.
            ``(17) Organization psychology.
            ``(18) Taxation.
            ``(19) Transportation planning.

  ``Subtitle B--Science Programs Through National Institutes of Health

``SEC. 3111. SCIENCE OF HEALTH PROMOTION.

    ``(a) Plan.--The Director of the National Institutes of Health 
(referred to in this subtitle as `NIH'), acting through the Office of 
Behavioral and Social Sciences Research, shall develop, and 
periodically review and as appropriate revise, a plan on how to best 
develop the science of health promotion through the NIH agencies. The 
plan shall be consistent with and shall elaborate upon applicable 
provisions of the Departmental plan under section 3101(a).
    ``(b) Certain Components of Plan.--The plan developed under 
subsection (a) shall include the following provisions:
            ``(1) A research agenda to develop the science of health 
        promotion.
            ``(2) Recommendations on funding levels for the various 
        areas of research on such agenda.
            ``(3) Recommendations on the best combination of NIH 
        agencies and non-Federal entities to carry out research under 
        the agenda.
    ``(c) Allocation of Resources.--Subject to compliance with 
appropriation Acts, the plan developed under subsection (a) shall 
provide for the allocation of resources for research under such plan 
relative to other areas of health, as appropriate taking into account 
the burden of lifestyle factors on morbidity and mortality, and the 
progress likely in advancing the science of health promotion given the 
current and evolving level of science on health promotion, and the 
relative cost of conducting research on health promotion compared to 
other areas of research.

``SEC. 3112. EARLY RESEARCH PROGRAMS.

    ``The Director of NIH, acting through the Office of Behavioral and 
Social Sciences Research, shall conduct or support early research 
programs and research training regarding health promotion.

  ``Subtitle C--Applied Research Programs Through Centers for Disease 
                         Control and Prevention

``SEC. 3121. RESEARCH AGENDA.

    ``The Secretary, acting through the Director of the Centers for 
Disease Control and Prevention (referred to in this subtitle as the 
`Director of CDC'), shall develop, and periodically review and as 
appropriate revise, a plan that establishes for such Centers a research 
agenda regarding health promotion. The plan shall be consistent with 
and shall elaborate upon applicable provisions of the Departmental plan 
developed under section 3101(a).

``SEC. 3122. PREVENTION RESEARCH CENTERS.

    ``(a) In General.--The Director of the National Center for Chronic 
Disease Prevention and Health Promotion (referred to in this section as 
the `Director') shall expand the eligibility of entities for Prevention 
Research Centers (referred to in this section as `Centers') grants to 
include the entities described in subsection (b). The Center for 
Chronic Disease Prevention and Health Promotion shall retain the 
authority to specify the qualities of entities it deems to be most 
important in performing the responsibilities of Centers and shall 
retain the responsibility for judging which organizations possess these 
qualities.
    ``(b) Entities Described.--The entities described in this 
subsection include--
            ``(1) institutions of higher education;
            ``(2) public and private research institutions;
            ``(3) departments or schools of--
                    ``(A) agriculture;
                    ``(B) architecture;
                    ``(C) business;
                    ``(D) city planning;
                    ``(E) education;
                    ``(F) engineering;
                    ``(G) exercise science;
                    ``(H) health promotion;
                    ``(I) nursing;
                    ``(J) nutrition;
                    ``(K) population health;
                    ``(L) preventive medicine;
                    ``(M) psychology;
                    ``(N) public health;
                    ``(O) public policy;
                    ``(P) social work; and
                    ``(Q) transportation; and
            ``(4) private research, membership, or service 
        organizations.

               ``Subtitle D--Other Programs and Policies

``SEC. 3131. MODIFICATION OF APPLICATIONS AWARD PROCESS TO ATTRACT MOST 
              QUALIFIED SCIENTISTS AND PRACTITIONERS; DEVELOPING HEALTH 
              PROMOTION INFRASTRUCTURE.

    ``(a) Modification of Awards Application Process.--In awarding 
grants, cooperative agreements, and contracts under this title, the 
Secretary shall modify the application process to attract the most 
qualified individuals and organizations.
    ``(b) General Priority of Developing Health Promotion 
Infrastructure.--The Secretary shall ensure that programs carried out 
pursuant to this title are consistent with the general priority of 
developing the health promotion infrastructure among universities, 
nonprofit organizations, and for-profit organizations, rather than 
increasing the size of State or local governments or the Federal 
Government.''.
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