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 expan-
sion of health promotion programs through the Depart-
ment of Health and Human Services. 
Be it enacted by the Senate and House of Representa-
tives 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: 
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(1) Lifestyle factors are responsible for almost 
half of the premature deaths in developed nations 
and a large portion of the deaths in developing na-
tions. 
(2) Lifestyle factors are a primary cause of the 
6 leading causes of death in the United States, in-
cluding heart disease, cancer, stroke, respiratory dis-
eases, accidents, and diabetes, which account for al-
most 75 percent of all deaths in the United States. 
(3) A significant portion of the health dispari-
ties in the United States are caused by lifestyle fac-
tors, 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 sed-
entary 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 
42nd in the world in life expectancy. 
(6) Medical care costs are second only to edu-
cation in State government budgets. 
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(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 liv-
ing with chronic conditions caused by tobacco. To-
bacco accounts for at least $96,000,000,000 in di-
rect medical expenditures. 
(10) Significant gaps exist in the basic and ap-
plied research base of health promotion regarding 
how to best reach and serve people of color, low-in-
come people, people with little formal education, chil-
dren, and older adults, how to create long-term 
health improvements, how to create supportive envi-
ronments, 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 syn-
thesis and dissemination of results can reduce these 
gaps. 
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(12) Health promotion is the art and science of 
motivating people to enhance their lifestyles to 
achieve complete health, not just the absence of dis-
ease. Complete health involves a balance of physical, 
mental, and social health. 
(13) Health promotion programs focus on prac-
tices 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 pro-
grams include a combination of strategies to in-
crease awareness, enhance motivation, facilitate be-
havior change, and develop cultures and physical en-
vironments that encourage and support healthy life-
style practices. 
(15) Health promotion programs can be pro-
vided in family, clinical, child care, school, work-
place, 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 med-
ical complexes, as well as facilities for fitness and 
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recreational facilities and in some cases to grocery 
stores. 
(17) Individuals with physical disabilities re-
spond very well to exercise treatment. This is a core 
component of all high quality physical therapy pro-
grams. However, additional research and more in-
tensive efforts to disseminate information in this 
area are necessary. 
SEC. 3. HEALTH PROMOTION RESEARCH AND DISSEMINA-
TION. 
The Public Health Service Act (42 U.S.C. 201 et 
seq.) is amended by adding at the end the following: 
‘‘TITLE 
XXXI—HEALTH 
PRO-
MOTION RESEARCH AND DIS-
SEMINATION 
‘‘Subtitle A—Coordination of Pro-
grams 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 ac-
cordance with this section for activities of the Department 
of Health and Human Services relating to health pro-
motion. The plan shall include provisions for coordinating 
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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 informa-
tion and health promotion, preventive health serv-
ices, and education in the appropriate use of health 
care; 
‘‘(2) analyze the necessary and available re-
source for implementing the goals and strategy for-
mulated pursuant to paragraph (1), and recommend 
appropriate educational and quality assurance poli-
cies for the needed manpower resources identified by 
such analysis; 
‘‘(3) undertake and support necessary activities 
and programs to— 
‘‘(A) incorporate appropriate health pro-
motion 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 liv-
ing; and 
‘‘(C) establish systematic processes for the 
exploration, development, demonstration, and 
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evaluation of innovative health promotion con-
cepts; and 
‘‘(4) undertake and support research and dem-
onstration 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 devel-
oped under subsection (a) shall contain provisions to ad-
dress 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 re-
sources most qualified to pursue each of the compo-
nents 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: 
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‘‘(1) Protocols for ongoing monitoring of all 
health promotion research. 
‘‘(2) Preparation of systematic reviews and 
meta-analyses. 
‘‘(3) Distillation of findings into practice guide-
lines for programs offered in clinical, workplace, 
school, home, neighborhood, municipal, and State 
settings. 
‘‘(4) Strategies to incorporate findings into col-
lege, university, and continuing educational cur-
riculum for all related health professions. 
‘‘(5) Communication of key findings to policy 
makers in business, government, educational and 
community settings who influence investment deci-
sions. 
‘‘(6) Identification of the optimal combination 
of government agencies to coordinate the matters re-
ferred 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 PROFES-
SIONAL AND SCIENTIFIC COMMUNITY.—The plan devel-
oped under subsection (a) shall contain provisions to ad-
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dress how to best support and develop the health pro-
motion professional and scientific community through en-
hancement of existing or development of new professional 
organizations. 
‘‘(f) INTEGRATION OF HEALTH PROMOTION; INTER-
NAL
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 EXTER-
NAL 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 pro-
motion 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 
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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 Transpor-
tation, the Secretary of the Treasury, the Secretary of 
Homeland Security, the Secretary of Veterans Affairs, and 
the Secretary of Housing and Urban Development to de-
velop 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 ac-
tivity, enhancing access to more nutritious foods at more 
affordable prices, and reducing exposure to toxic sub-
stances 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 ap-
proaches 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 per-
spectives from individuals representing a diverse range of 
disciplines, including the following areas: 
‘‘(1) Agriculture. 
‘‘(2) Anthropology. 
‘‘(3) Child development. 
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‘‘(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 Re-
search, shall develop, and periodically review and as appro-
priate revise, a plan on how to best develop the science 
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of health promotion through the NIH agencies. The plan 
shall be consistent with and shall elaborate upon applica-
ble 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 com-
pliance 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 pro-
motion given the current and evolving level of science on 
health promotion, and the relative cost of conducting re-
search on health promotion compared to other areas of 
research. 
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‘‘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 re-
garding health promotion. 
‘‘Subtitle C—Applied Research Pro-
grams Through Centers for Dis-
ease 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 re-
garding 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 Pro-
motion (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 Pro-
motion shall retain the authority to specify the qualities 
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of entities it deems to be most important in performing 
the responsibilities of Centers and shall retain the respon-
sibility 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) business; 
‘‘(B) city planning; 
‘‘(C) education; 
‘‘(D) nursing; 
‘‘(E) psychology; 
‘‘(F) public policy; 
‘‘(G) transportation; 
‘‘(H) social work; 
‘‘(I) agriculture; 
‘‘(J) nutrition; 
‘‘(K) engineering; 
‘‘(L) architecture; 
‘‘(M) exercise science; 
‘‘(N) health promotion; 
‘‘(O) population health; 
‘‘(P) preventive medicine; 
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‘‘(Q) public health; and 
‘‘(R) any other program that can make a 
compelling connection to improving the health 
of the public; 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 SCI-
ENTISTS AND PRACTITIONERS; DEVELOPING 
HEALTH PROMOTION INFRASTRUCTURE. 
‘‘(a) MODIFICATION OF AWARDS APPLICATION PROC-
ESS.—In awarding grants, cooperative agreements, and 
contracts under this title, the Secretary shall modify the 
application process to attract the most qualified individ-
uals and organizations. 
‘‘(b) GENERAL PRIORITY OF DEVELOPING HEALTH 
PROMOTION INFRASTRUCTURE.—The Secretary shall en-
sure that programs carried out pursuant to this title are 
consistent with the general priority of developing the 
health promotion infrastructure among universities, non-
profit organizations, and for-profit organizations, rather 
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