II 

108TH CONGRESS 

2D SESSION S. 2798 

To provide for increased planning and funding for health promotion programs 

of the Department of Health and Human Services. 

IN THE SENATE OF THE UNITED STATES 

SEPTEMBER 14, 2004 

Mr. LUGAR (for himself, Mr. BINGAMAN, Mr. BUNNING, Mr. CAMPBELL, Ms. 

CANTWELL, Mrs. CLINTON, Mr. COCHRAN, Mr. GRAHAM of South Carolina, and Mr. JEFFORDS) 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 planning and funding for health 

promotion programs of 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) Health promotion programs have been 

19 shown to be effective in improving health knowledge, 

20 attitudes, behaviors and conditions, and delaying dis21 ability in older age. 

22 (6) Per capita medical care costs in the United 

23 States are more than double those of all but 2 other 

24 countries in the world, yet the United States ranks 

25 24th in terms of disability adjusted life expectancy, 
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1 infant mortality, and other positive lifestyle meas2 ures. 

3 (7) Medical care costs are second only to edu4 cation in State government budgets. 

5 (8) Lifestyle factors are responsible for at least 

1 6 ⁄4 of employer’s medical care costs in the United 

7 States. 

8 (9) Health promotion programs have been 

9 shown to be effective in reducing medical costs and 

10 enhancing productivity. 

11 (10) Significant gaps exist in the basic and ap12 plied research base of health promotion regarding 

13 how to best reach and serve people of color, low-in14 come people, people with little formal education, chil15 dren, and older adults, how to create long-term 

16 health improvements, how to create supportive envi17 ronments, and how to address gender issues. More 

18 focused research can reduce these gaps. 

19 (11) Significant gaps exist between the best and 

20 the typical health promotion programs. Better syn21 thesis and dissemination of results can reduce these 

22 gaps. 

23 (12) The genomic revolution will soon allow ge24 netic information to be used to identify individual 

25 susceptibility to common disorders such as heart dis-
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1 ease, diabetes, cancer, stroke, and respiratory dis2 eases, and the most effective method to prevent 

3 many of these diseases will be health promotion. 

4 (13) Health promotion is the most effective 

5 strategy to achieve a majority of the major objec6 tives in Healthy People 2010 Objectives for the 

7 United States developed by the Department of 

8 Health and Human Services. 

9 (14) A significant increase in demand for health 

10 promotion programs is expected in the next decade 

11 and a stable infrastructure must be in place to en12 sure continual development of the health promotion 

13 science base to be able to service this demand effec14 tively. 

15 (15) Health promotion is the art and science of 

16 motivating people to enhance their lifestyles to 

17 achieve complete health, not just the absence of dis18 ease. Complete health involves a balance of physical, 

19 mental, and social health. 

20 (16) Health promotion programs focus on prac21 tices such as exercising regularly, eating a nutritious 

22 diet, maintaining a healthy weight, managing stress, 

23 avoiding dangerous substances such as tobacco and 

24 illegal drugs, drinking alcohol in moderation or not 
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1 at all, driving safely, being wise consumers of health 

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

3 (17) The most effective health promotion pro4 grams include a combination of strategies to in5 crease awareness, facilitate behavior change, and de6 velop cultures and physical environments that en7 courage and support healthy lifestyle practices. 

8 (18) Health promotion programs can be pro9 vided in family, clinical, child care, school, work10 place, Federal, State, and community settings. 

11 SEC. 3. HEALTH PROMOTION RESEARCH AND DISSEMINA12 TION. 

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

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

15 ‘‘TITLE XXIX—HEALTH PRO16 MOTION RESEARCH AND DIS17 SEMINATION 

18 ‘‘Subtitle A—Coordination of Pro19 grams of the Department of 

20 Health and Human Services 

21 ‘‘SEC. 2901. PLAN FOR HEALTH PROMOTION PROGRAMS. 

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

23 periodically review and as appropriate revise, a plan in ac24 cordance with this section for activities of the Department 

25 of Health and Human Services relating to health pro-
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1 motion. The plan shall include provisions for coordinating 

2 all such activities of the Department, including activities 

3 under section 1701 to— 

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

5 achieve such goals, with respect to health informa6 tion and health promotion, preventive health serv7 ices, and education in the appropriate use of health 

8 care; 

9 ‘‘(2) analyze the necessary and available re10 source for implementing the goals and strategy for11 mulated pursuant to paragraph (1), and recommend 

12 appropriate educational and quality assurance poli13 cies for the needed manpower resources identified by 

14 such analysis; 

15 ‘‘(3) undertake and support necessary activities 

16 and programs to— 

17 ‘‘(A) incorporate appropriate health pro18 motion concepts into our society, especially into 

19 all aspects of education and health care; 

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

21 health knowledge, skills, and practices by the 

22 general population in its patterns of daily liv23 ing; and 

24 ‘‘(C) establish systematic processes for the 

25 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) SUPPORT AND DEVELOPMENT OF PROFES20 SIONAL AND SCIENTIFIC COMMUNITY.—The plan devel21 oped under subsection (a) shall contain provisions to ad22 dress how to best support and develop the health pro23 motion professional and scientific community through en24 hancement of existing or development of new professional 

25 organizations. 
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1 ‘‘(e) INTEGRATION OF HEALTH PROMOTION; INTER2 NAL DEPARTMENT ACTIVITIES.—The plan developed 

3 under subsection (a) shall contain provisions to address 

4 how resources, policies, structures, and legislation within 

5 the Department of Health and Human Services can best 

6 be modified or developed to integrate health promotion 

7 into all health professions and sectors of society and make 

8 health promoting opportunities available to all members 

9 of the public. 

10 ‘‘(f) INTEGRATION OF HEALTH PROMOTION EXTER11 NAL ACTIVITIES.—The plan developed under subsection 

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

13 Government policies, structures, and legislation external 

14 to the Department of Health and Human Services can 

15 best be modified or developed to integrate health pro16 motion into all health professions and sectors of society 

17 and to make health promoting opportunities available to 

18 all individuals. 

19 ‘‘(g) PERSPECTIVES.—Due to 30 years of experience 

20 showing that traditional medical and educational ap21 proaches are not sufficient to motivate people to make and 

22 sustain basic health behavior changes, in developing the 

23 plan under subsection (a), the Secretary shall seek per24 spectives from individuals representing a diverse range of 

25 disciplines, including the following areas: 
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1 ‘‘(1) Agriculture. 

2 ‘‘(2) Anthropology. 

3 ‘‘(3) Child development. 

4 ‘‘(4) City planning. 

5 ‘‘(5) Commerce. 

6 ‘‘(6) Economics. 

7 ‘‘(7) Environmental planning and design. 

8 ‘‘(8) Exercise physiology. 

9 ‘‘(9) Financial analysis. 

10 ‘‘(10) Health education. 

11 ‘‘(11) Health policy. 

12 ‘‘(12) Individual psychology. 

13 ‘‘(13) Management. 

14 ‘‘(14) Medicine. 

15 ‘‘(15) Nursing. 

16 ‘‘(16) Nutrition organization psychology. 

17 ‘‘(17) Taxation. 

18 ‘‘(18) Transportation planning. 

19 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—For the 

20 purpose of carrying out this section, there are authorized 

21 to be appropriated $6,000,000 for fiscal year 2004, 

22 $4,000,000 for fiscal year 2005, and $3,000,000 for each 

23 of fiscal years 2006 through 2008. Such authorization is 

24 in addition to other authorizations that are available for 

25 carrying out such purpose. 
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1 ‘‘Subtitle B—Basic Science Pro2 grams Through National Insti3 tutes of Health 

4 ‘‘SEC. 2911. BASIC SCIENCE. 

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

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

7 through the Office of Behavioral and Social Sciences Re8 search, shall develop, and periodically review and as appro9 priate revise, a plan on how to best develop the basic 

10 science of health promotion through the NIH agencies. 

11 The plan shall be consistent with and shall elaborate upon 

12 applicable provisions of the Departmental plan under sec13 tion 2901(a). 

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

15 developed under subsection (a) shall include the following 

16 provisions: 

17 ‘‘(1) A research agenda to develop the basic 

18 science of health promotion. 

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

20 various areas of research on such agenda. 

21 ‘‘(3) Recommendations on the best combination 

22 of NIH agencies and non-Federal entities to carry 

23 out research under the agenda. 

24 ‘‘(c) ALLOCATION OF RESOURCES.—Subject to com25 pliance with appropriation Acts, the plan developed under 
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1 subsection (a) shall provide for the allocation of resources 

2 for research under such plan relative to other areas of 

3 health, as appropriate taking into account the burden of 

4 lifestyle factors on morbidity and mortality, and the 

5 progress likely in advancing the science of health pro6 motion given the current and evolving level of science on 

7 health promotion, and the relative cost of conducting re8 search on health promotion compared to other areas of 

9 research. 

10 ‘‘SEC. 2912. EARLY RESEARCH PROGRAMS. 

11 ‘‘(a) PLAN.—The Director of NIH, acting through 

12 the Office of Behavioral and Social Sciences Research, 

13 shall conduct or support early research programs and re14 search training regarding health promotion. 

15 ‘‘(b) FUNDING.— 

16 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.— 

17 For the purpose of carrying out subsection (a), there 

18 is authorized to be appropriated $30,000,000 for fis19 cal year 2004. Such authorization is in addition to 

20 other authorizations that are available for carrying 

21 out such purpose. 

22 ‘‘(2) RESERVATION.—The Secretary shall re23 serve not less than 90 percent of the amount appro24 priated under paragraph (1) to carry out subsection 

25 (a) through the awarding of grants, cooperative 
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1 agreements, or contracts to public and private enti2 ties, including universities, hospitals, research orga3 nizations and health promotion venders. Of the 

4 amounts so reserved, the Secretary shall designate a 

5 portion of such amounts to support research train6 ing under subsection (a) to enhance the skills and 

7 increase the numbers of scientists trained in health 

8 promotion. 

9 ‘‘Subtitle C—Applied Research Pro10 grams Through Centers for Dis11 ease Control and Prevention 

12 ‘‘SEC. 2921. RESEARCH AGENDA. 

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

14 Centers for Disease Control and Prevention (referred to 

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

16 and periodically review and as appropriate revise, a plan 

17 that establishes for such Centers a research agenda re18 garding health promotion. The plan shall be consistent 

19 with and shall elaborate upon applicable provisions of the 

20 Departmental plan developed under section 2901(a). 

21 ‘‘SEC. 2922. HEALTH PROMOTION RESEARCH CENTERS. 

22 ‘‘(a) AUTHORIZATION.—The Director of the National 

23 Center for Chronic Disease Prevention and Health Pro24 motion (referred to in this section as the ‘Director’) shall 

25 award grants, on a competitive basis, to eligible entities 
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1 to enable such entities to develop Health Promotion Re2 search Centers (referred to in this section as ‘Centers’). 

3 ‘‘(b) ELIGIBLE ENTITY.—In this section, the term 

4 ‘eligible entity’ includes— 

5 ‘‘(1) institutions of higher education; 

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

7 ‘‘(3) departments or schools of— 

8 ‘‘(A) business; 

9 ‘‘(B) city planning; 

10 ‘‘(C) education; 

11 ‘‘(D) nursing; 

12 ‘‘(E) psychology; 

13 ‘‘(F) public policy; 

14 ‘‘(G) transportation; and 

15 ‘‘(H) social work; and 

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

17 organizations. 

18 ‘‘(c) APPLICATION.—An eligible entity that desires to 

19 receive a grant under this section shall submit an applica20 tion to the Director at such time, in such manner, and 

21 containing such information as the Director may require. 

22 An eligible entity may apply for not more than 3 grants 

23 each with a duration of 5-years. 

24 ‘‘(d) AWARDING OF GRANTS.— 
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1 ‘‘(1) NUMBER OF CENTERS.—The Director 

2 shall award grants for the development of not more 

3 than— 

4 ‘‘(A) 5 new Centers in fiscal year 2005; 

5 ‘‘(B) 5 new Centers in fiscal year 2006; 

6 ‘‘(C) 5 new Centers in fiscal year 2007; 

7 ‘‘(D) 5 new Centers in fiscal year 2008; 

8 ‘‘(E) 5 new Centers in fiscal year 2009; 

9 and 

10 ‘‘(F) 5 new Centers in fiscal year 2010. 

11 ‘‘(2) GRANT PERIOD AND AWARD AMOUNT.— 

12 Grants awarded under this section shall be for a pe13 riod of 5 years. A grant award shall be in an 

14 amount not to exceed— 

15 ‘‘(A) $500,000 in the first year of the 

16 grant award; 

17 ‘‘(B) $1,000,000 in the second year of the 

18 grant award; and 

19 ‘‘(C) $2,000,000 in each of the third, 

20 fourth, and fifth years of the grant award. 

21 ‘‘(3) FOCUS OF CENTERS.—In awarding grants 

22 under this section, the Director shall ensure that— 

23 ‘‘(A) not less than 1 Center concentrates 

24 the Center’s efforts on developing the applied 
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1 science of health promotion in each of the fol2 lowing areas: 

3 ‘‘(i) the workplace; 

4 ‘‘(ii) schools; 

5 ‘‘(iii) families; 

6 ‘‘(iv) clinical settings; and 

7 ‘‘(v) community settings; and 

8 ‘‘(B) not less than 1 other Center focuses 

9 the Center’s work on each of the following 

10 areas: 

11 ‘‘(i) program evaluation; 

12 ‘‘(ii) training and support of the 

13 health promotion professional workforce; 

14 and 

15 ‘‘(iii) health promotion policy at the 

16 Federal, State, and local level. 

17 ‘‘(e) USES OF FUNDS.— 

18 ‘‘(1) IN GENERAL.— 

19 ‘‘(A) PROVISION OF ADVICE AND ORGANI20 ZATION.—A Center that is developed from 

21 funds from a grant awarded under this section 

22 shall invest approximately 10 percent of the 

23 Center’s staff time and resources to— 

24 ‘‘(i) forming relationships with, and 

25 providing limited ongoing advice to, health 
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1 departments in the county and State where 

2 the entity is located; and 

3 ‘‘(ii) organizing local networks of sci4 entists, program managers, vendors, and 

5 other professionals interested in health 

6 promotion and disease prevention. 

7 ‘‘(B) USE OF OUTSIDE PROVIDERS.—When 

8 conducting intervention research or research on 

9 other health promotion programs, a Center that 

10 is developed from funds from a grant awarded 

11 under this section shall review the capabilities 

12 of local nonprofit and for-profit program pro13 viders to provide the programming and services 

14 required for the programs. The Center shall use 

15 such program providers if the program pro16 viders provide a clear quality and cost advan17 tage relative to developing such capabilities in18 ternally. 

19 ‘‘(C) ADDRESSING PRIORITIES AND RE20 SEARCH AGENDA.—A Center that is developed 

21 from funds from a grant awarded under this 

22 section shall address the priorities identified in 

23 the health promotion research agendas devel24 oped by the Centers for Disease Control and 

25 Prevention, the National Science Foundation, 
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1 and the Department of Health and Human 

2 Services. 

3 ‘‘(2) PERMISSIVE USES.—An eligible entity that 

4 receives a grant under this section may use the 

5 grant funds for faculty salaries, student fellowships, 

6 outreach to the local community, research, program 

7 development, or program administration. 

8 ‘‘(3) ADMINISTRATIVE COSTS.—An eligible enti9 ty that receives a grant under this section may ex10 pend not more than 15 percent of the grant funds 

11 on administrative costs. 

12 ‘‘SEC. 2923. EXTRAMURAL RESEARCH PROGRAM. 

13 ‘‘(a) OUTREACH.—In carrying out the Extramural 

14 Research Program of the Centers for Disease Control and 

15 Prevention, the Director of CDC shall make an effort to 

16 attract grant applications from groups with extensive ex17 perience in providing programs but limited experience in 

18 developing research grants or conducting research, or 

19 both. Such efforts shall include proactive outreach to such 

20 groups, providing planning grants to fund development of 

21 grant proposals, and providing technical assistance for the 

22 design portion of the grant application. 

23 ‘‘(b) APPLIED SCIENCE OF HEALTH PROMOTION.— 

24 In carrying out the Extramural Research Program of the 

25 Centers for Disease Control and Prevention, the Director 
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1 of CDC shall devote a portion of research funding to devel2 oping the applied science of health promotion for work3 place, school, family, clinical, and community settings. 

4 ‘‘SEC. 2924. WORKPLACE HEALTH PROGRAM. 

5 ‘‘(a) IN GENERAL.—The Director of CDC shall carry 

6 out a program— 

7 ‘‘(1) to develop a research agenda for workplace 

8 health promotion and shall seek perspectives from a 

9 wide range of workplace health promotion program 

10 practitioners and scientists in developing such agen11 da; 

12 ‘‘(2) of research that addresses the important 

13 issues identified in the research agenda under para14 graph (1); and 

15 ‘‘(3) to support synthesis of findings made in 

16 such research and to disseminate information to 

17 educators, practitioners, business leaders, and health 

18 policy leaders. 

19 ‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—For the 

20 purpose of carrying out subsection (a), there are author21 ized to be appropriated $6,000,000 for fiscal year 2004, 

22 $8,000,000 for fiscal year 2005, $11,000,000 for fiscal 

23 year 2006, $15,000,000 for fiscal year 2007, and 

24 $20,000,000 for fiscal year 2008. 
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1 ‘‘SEC. 2925. CERTAIN REQUIREMENTS. 

2 ‘‘(a) GENERAL GOAL OF PROGRAMS.—The Director 

3 of CDC shall ensure that programs carried out pursuant 

4 to this subtitle are consistent with the general goal of de5 veloping the most effective individual and group strategies 

6 for clinical, workplace, school, and community based pro7 grams regarding health promotion. 

8 ‘‘(b) RESERVATION FOR AWARD TO PUBLIC AND PRI9 VATE ENTITIES.— 

10 ‘‘(1) IN GENERAL.—Of the amounts made 

11 available under this subtitle, the Director of CDC 

12 shall reserve not less than 75 percent for the award13 ing of grants, cooperative agreements, or contracts 

14 to public and private entities, including universities, 

15 hospitals, research organizations, and local and na16 tional health promotion venders through collabo17 rative efforts. 

18 ‘‘(2) REQUIREMENT FOR STATE AND LOCAL

19 HEALTH DEPARTMENTS.—Awards made to State 

20 and local health departments pursuant to this title 

21 shall be made on the condition that the departments 

22 develop a basic staff infrastructure to manage the 

23 programs for which the awards are made. With re24 spect to such condition, the departments may con25 tract with providers in the communities involved to 
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1 secure programs and skills required to carry out the 

2 programs. 

3 ‘‘Subtitle D—Other Programs and 

4 Policies 

5 ‘‘SEC. 2931. MODIFICATION OF APPLICATIONS AWARD 

6 PROCESS TO ATTRACT MOST QUALIFIED SCI7 ENTISTS AND PRACTITIONERS; DEVELOPING 

8 HEALTH PROMOTION INFRASTRUCTURE. 

9 ‘‘(a) MODIFICATION OF AWARDS APPLICATION PROC10 ESS.—In awarding grants, cooperative agreements, and 

11 contracts under this title, the Secretary shall modify the 

12 application process to attract the most qualified individ13 uals and organizations, rather than those individuals and 

14 organizations that are most sophisticated with respect to 

15 the applications processes. 

16 ‘‘(b) GENERAL PRIORITY OF DEVELOPING HEALTH

17 PROMOTION INFRASTRUCTURE.—The Secretary shall en18 sure that programs carried out pursuant to this title are 

19 consistent with the general priority of developing the 

20 health promotion infrastructure among universities, non21 profit organizations, and for-profit organizations, rather 

22 than increasing the size of State or local governments or 

23 the Federal Government.’’. 

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