Bethesda, Maryland
February 10, 2003

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Good morning.  I am delighted to be here at this meeting of the Advisory Committee on Primary Care Medicine and Dentistry.  Let me commend each of you for your willingness to serve in this most important capacity.  To all of us concerned about the quality of medical education in this country, your work has far-reaching impact.
 
By advising the Secretary and Congress about issues and policies relating to training in the areas of primary care medicine and dentistry, you have a tremendous opportunity to address significant health care training needs that exist in every part of this vast country of ours.
 
Without a doubt, we need continued support for high quality health care training programs that meet real world needs.  Some may question the federal investment in health professions training, but I think the answer is clear.
 
Let's consider the Title VII, section 747 programs that are the focus of your study.  Because of these training initiatives, students in family medicine, internal medicine, pediatrics, dentistry, and physician assistants are better prepared than ever and more willing to serve in areas where health care services are scarce.  The payoff for underserved communities can best be seen in the numbers of people who are able to lead healthier, more productive lives as a direct result of their access to highly skilled health care providers.
 
At this meeting, I know your focus is on completion of your third report – Disparities in Health Care: Implications for Primary Care Education.
 
As you deliberate on your final recommendations, I think it is important that you see how your work complements the work of both the Department and HRSA.
 
As you heard last week when President Bush gave his State of the Union address, the availability of high quality affordable health care is a key goal of his Administration.  "We must work toward a system," he said, "in which all Americans have a good insurance policy, choose their own doctors, and seniors and low-income Americans receive the help they need."  This is the work of HHS and HRSA, and it is a mandate that has guided us since President Bush and HHS Secretary Thompson took office.
 
Under the direction of the President, Secretary Thompson has made a major push to close what he calls the "health gap" in minority communities. In fact, the FY04 HHS budget request includes $6.7 billion to address minority health issues.  The Department is also moving ahead on its Initiative to Eliminate Racial and Ethnic Disparities in Health. This effort aims to reduce the incidence of diabetes, cancer, heart disease, stroke, and HIV/AIDS in minority communities, where rates of these and other chronic diseases are, in general, far worse than for the nation as a whole.

• In November of 2001, Secretary Thompson launched "Closing the Health Gap," a health education and information campaign that used urban radio stations to target communities of color.
• Last September 24, as part of the Closing the Health Gap campaign, HHS sponsored "Take a Loved One to the Doctor Day" to encourage people to take a family member or friend in for a checkup.
• President Bush has increased funding for research.  He proposed an 18 percent increase in (FY) 2003 budget for the National Institutes of Health's National Center for Minority Health and Health Disparities, boosting it to $187 million.
• Last April Secretary Thompson launched a "Prevention Initiative" to encourage Americans – particularly racial and ethnic minorities – to improve their health by making better personal health choices.
• The Secretary has moved to expand coverage of the State Children's Health Insurance Program, known as S-CHIP.  More than 4.6 million children who otherwise would not have had access to health care are now covered under S-CHIP.
• And most importantly for us at HRSA, President Bush and Secretary Thompson are committed to adding 1,200 new community health centers by 2006, largely in communities that serve racial and ethnic minorities.

President Bush has made expansion of the health center network a top priority.  Early in his first year in office, the President launched a five-year initiative to add 1,200 new and expanded health center sites to the current network and increase the number of people served annually from just over 10 million currently to 16 million by 2006.
 
Already HRSA has exceeded the expansion targets we set for 2002 by funding 170 new health center access points and by expanding capacity in 131 centers.
 
In FY 2003, the President is asking for almost $1.5 billion for health centers to continue the expansion.  That's a $114 million increase over FY 2002 and a two-year increase of almost $280 million.
 
To support the Health Center Initiative, President Bush introduced a second initiative to reform the National Health Service Corps and place more of its clinicians in areas of greatest need.  He has asked for an additional $45 million for the NHSC in FY 2003, a figure that would pay for about 1,800 more clinicians.  The request is directly tied to the expansion of the health center network, since about half of NHSC clinicians work in health centers.
 
A third Presidential initiative, the Healthy Communities Innovation Initiative, is an interdisciplinary effort that will bring together experts from throughout HHS to focus on ways to prevent asthma, diabetes and obesity.  These three chronic conditions, among the fastest-growing in the U.S., present severe problems in many minority communities.  The President's 2003 budget proposal asked for $20 million to set up demonstration programs in five communities.  Funds would be used to improve health outcomes in areas where illness and death rates due to asthma, diabetes and obesity are high.
 
Taken together, the President's initiatives to increase the health center network and the number of NHSC doctors and dentists will have an enormous impact on America's capacity to reduce health disparities in communities all across America.
 
Health centers serve 10 percent of the nation's uninsured adults, 15 percent of the nation's uninsured children, and about 30 percent of the nation's uninsured poor people of color, both adults and children.
 
The planned expansion of the system, then, will increase health care to precisely those populations that bear a disproportionate burden of chronic disease.
 
At HRSA we are very excited about our ability to lower rates of chronic disease among our patients because the health centers' expansion occurs at a time when the entire system is involved in a multi-year effort to improve the already-exceptional care it provides.
 
The method we use to improve quality is called "health disparities collaboratives."  They are organized specifically to reduce the impact of diabetes, asthma, cardiovascular disease, obesity, HIV/AIDS, depression and cancer on health center patients. And our next will focus on pregnancy, delivery and the first six months of life.
 
Nationally, 523 of our 750 health centers participate in one or another collaborative to fight chronic diseases.  Our plan at HRSA is to increase the number of health centers involved in collaboratives at the same time we expand the size of the health center system.
 
This is just a brief overview of what we at HHS and HRSA are doing to close the health disparities gap that continues to plague this Nation.  I can assure you that HRSA will continue its work to ensure that an adequate and culturally competent health care workforce is available to meet the health care needs of all Americans, regardless of where they live or how much they make.
 
In closing, let me say I greatly appreciate the work that you have done, and the work that you will do in the future.
 
In the weeks and months ahead, you will be able to count on Kerry and her staff – and the rest of HRSA – to give you the support you need to continue your outstanding work. Again, I thank you for your dedication. There is much that we can accomplish together.