660 
pacted communities, through public health interven-
tions and related activities. 
(3) Coordinate with the Centers for Disease 
Control and Prevention, the Indian Health Service, 
the Health Resources and Services Administration, 
and the Department of Veterans Affairs to develop 
pilot programs to demonstrate best practices for the 
diagnosis and management of chronic obstructive 
pulmonary disease. 
(4) Develop improved techniques and identify 
best practices, in coordination with the Secretary of 
Veterans Affairs, for assisting chronic obstructive 
pulmonary disease patients to successfully stop 
smoking, including identification of subpopulations 
with different needs. Initiatives under this para-
graph may include research to determine whether 
successful smoking cessation strategies are different 
for chronic obstructive pulmonary disease patients 
compared to such strategies for patients with other 
chronic diseases. 
(e) ENVIRONMENTAL AND OCCUPATIONAL HEALTH 
PROGRAMS.—The Director of the Centers for Disease 
Control and Prevention shall— 
(1) support research into the environmental and 
occupational causes and biological mechanisms that 
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contribute to chronic obstructive pulmonary disease; 
and 
(2) develop and disseminate public health inter-
ventions that will lessen the impact of environmental 
and occupational causes of chronic obstructive pul-
monary disease. 
(f) DATA COLLECTION.—Not later than 180 days 
after the enactment of this Act, the Director of the Na-
tional Heart, Lung, and Blood Institute and the Director 
of the Centers for Disease Control and Prevention, acting 
jointly, shall assess the depth and quality of information 
on chronic obstructive pulmonary disease that is collected 
in surveys and population studies conducted by the Cen-
ters for Disease Control and Prevention, including wheth-
er there are additional opportunities for information to be 
collected in the National Health and Nutrition Examina-
tion Survey, the National Health Interview Survey, and 
the Behavioral Risk Factors Surveillance System surveys. 
The Director of the National Heart, Lung, and Blood In-
stitute shall include the results of such assessment in the 
national action plan under subsection (b). 
(g) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
such sums as may be necessary for each of fiscal years 
2017 through 2021. 
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Subtitle H—Osteoarthritis and 
Musculoskeletal Diseases 
SEC. 781. FINDINGS. 
The Congress finds as follows: 
(1) Eighty percent of African-American women 
and nearly 74 percent of Hispanic men are either 
overweight or obese, speeding the onset and progres-
sion of arthritis. 
(2) Arthritis affects 46 million Americans, and 
that number will rise to 67 million by the year 2030. 
(3) Twenty-seven million Americans suffer from 
osteoarthritis, the most common form of arthritis, 
making it the leading cause of disability in the 
United States. Osteoarthritis is sometimes referred 
to as degenerative joint disease. 
(4) Obesity accelerates the onset of arthritis: 70 
percent of obese adults with mild osteoarthritis of 
the knee at age 60 will develop advanced end-stage 
disease by age 80. In contrast, just 43 percent of 
non-obese adults will have end-stage disease over the 
same time period. 
(5) Arthritis affects one in five Americans, and 
is the single greatest cause of chronic pain and dis-
ability in the United States. 
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(6) Women, African-Americans, and Hispanics 
have more severe arthritis and functional limitations. 
These same individuals are more likely to be obese, 
diabetic, and have higher incidence of heart dis-
ease—medical conditions that can be improved with 
physical activity. Instead of moving; however, these 
groups have an inactivity rate of 40 to 50 percent, 
which continues to increase. 
(7) Arthritis costs $128 billion a year, including 
$81 billion in direct costs (medical) and $47 billion 
in indirect costs (lost earnings). Each year, $309 bil-
lion in direct and indirect costs is lost due to dis-
parities in osteoarthritis and musculoskeletal dis-
eases. 
(8) Obesity and other chronic health conditions 
exacerbate the debilitating impact of arthritis, lead-
ing to inactivity, loss of independence, and a per-
petual cycle of comorbid chronic conditions. 
(9) Sixty-one percent of arthritis sufferers are 
women, and women represent 64 percent of an esti-
mated 43 million annual visits to physicians’ offices 
and outpatient clinics where arthritis was the pri-
mary diagnosis. Women also represented 60 percent 
of approximately 1 million hospitalizations that oc-
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curred in 2003 for which arthritis was the primary 
diagnosis. 
(10) Women ages 65 and older have up to 21⁄2 
times more disabilities than men of the same age. 
Higher rates of obesity and arthritis among this 
group explained up to 48 percent of the gender gap 
in disability, above all other common chronic health 
conditions. 
(11) The primary indication for total knee 
arthroplasty (TKA), also known as knee replace-
ment, is relief of significant, disabling pain caused 
by severe arthritis. 
(12) Knee replacement is surgery for people 
with severe knee damage. Knee replacement can re-
lieve pain and allow you to be more active. When 
you have a total knee replacement, the surgeon re-
moves damaged cartilage and bone from the surface 
of your knee joint and replaces them with a man- 
made surface of metal and plastic. In a partial knee 
replacement, the surgeon only replaces one part of 
your knee joint. 
(13) Total hip replacement, also called total hip 
arthroplasty (THA), is used if your hip pain inter-
feres with daily activities and more-conservative 
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