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PRESIDENT'S 2003 BUDGET PROPOSALS
FEATURING HHS SECRETARY THOMPSON

HEARING BEFORE THE COMMITTEE ON WAYS AND MEANS
HOUSE OF REPRESENTATIVES
ONE HUNDRED SEVENTH CONGRESS
SECOND SESSION
FEBRUARY 6, 2002

SERIAL 107-55

Questions Submitted by Representative Lloyd Doggett

Question:

Since nicotine addiction is the leading cause of preventable death in America today, what new initiatives have you undertaken as Secretary to reduce this public health epidemic?

Answer:

In fiscal year 2002, the Department of Health and Human Services (HHS) increased its commitment to funding tobacco control programs by 7 percent, for a total of $975 million. The National Institutes of Health¡s (NIH) tobacco control research budget increased by 14 percent to $486 million. Listed below are additional initiatives I have been pleased to be part of:

* An initiative to increase awareness of tobacco use among women and girls. In August, Women and Smoking: A Report of the Surgeon General was released. HHS and our public and private partners have undertaken this initiative to engage women across the country in the fight against tobacco.
* I have taken a number of steps to increase the visibility and coordination of tobacco use cessation and treatment initiatives throughout HHS. The Agency for Healthcare Research and Quality (AHRQ), the Centers for Disease Control and Prevention (CDC), the Centers for Medicare and Medicaid Services (CMS), the Health Resources and Services Administration (HRSA), NIH and the Substance Abuse and Mental Health Services Administration have all collaborated on the development of a national blueprint for disseminating and implementing evidence-based clinical and community strategies to promote tobacco use cessation.
* I have asked the Office of the Surgeon General and CDC to establish a cessation sub-committee to the Interagency Committee on Smoking and Health.

Question:

Tom Novotny, a 23-year employee of your Department was the leader of the US delegation to the International Framework Convention on Tobacco Control (FCTC). Since the August 2001 announcement of his departure, has the US delegation taken any position on any pending public health issue at variance with the position of the tobacco industry? Is so, please describe them.

Answer:

HHS is committed to a strong FCTC. Dr. Kenneth Bernard now serves as the head of the US delegation. Dr. Bernard brings to the delegation a wealth of public health, international, and diplomatic experience. Under Dr. Bernard¡s leadership, the process for developing the US position has remained unchanged. An experienced and active interagency workgroup, comprised of highly qualified professionals from across the Federal government, is the primary vehicle for discussion and debate. In addition, Dr. Bernard and other members of the interagency workgroup have met with a variety of private organizations interested in the FCTC. These organizations include tobacco product manufacturers as well as non-governmental health advocacy organizations. While it is essential that the delegation be informed regarding the issues and concerns of all interested parties, the position of the U.S. government is developed through independent and objective analysis. This position is being developed to ensure an effective framework for reducing tobacco use globally. We continue to believe that the Member States of the World Health Organization must work together to achieve a convention the majority of members can sign. The FCTC will be a strong convention because of its breadth and the large number of members who sign it.

Question:

In your July 2001 response to my prior questions regarding the involvement of your Department in deliberations of an interagency working group related to tobacco trade matters, you stated that HHS played an advisory role in discussions between the United State Trade Representatives (USTR) and the government of the Republic of Korea regarding the privatization of the Korean Government¡s tobacco monopoly and the imposition of import tariffs on cigarettes. Specifically, you stated, ~In considering the potential public health impact, HHS has focused on whether the proposed policies would increase demand for or reduce the price for tobacco product.E

Did your Department conclude that public health would not be adversely affected by any reduction or delay in the imposition of the 40% tobacco import tariff proposed by the Korean government?

Please also provide a full description of HHS analyses and conclusions on this matter, along with any and all documentation. Include in this a complete listing of all agencies and employees within your Department that were involved.

Answer:

HHS is actively involved in the implementation of Executive Order 13193¤Federal Leadership on Global Tobacco Control and Prevention. HHS was involved in the interagency discussions of proposed changes to the Korean Tobacco Business Act and privatization of the Korean Government¡s tobacco monopoly. HHS¡ position in these discussions was based on scientific findings that demonstrate increasing the price is one of the most effective ways to decrease consumption of tobacco products. Based on this scientific evidence, HHS supports policy actions that increase the price of tobacco products. Therefore, the U.S. position in the discussions with Korea was consistent with public health goals because the tariff on tobacco products was increased.

Question:

Aside from the Korean trade proceedings, has the USTR invited your Department to offer advice on any other tobacco-related matters? If so, provide a complete listing of each instance along with a description of the circumstances and include any analyses and conclusions developed by your Department. Include in this material a complete listing of all agencies and employees within your Department that were involved in developing your advice.

Answer:

Since July 2001, USTR has consulted HHS on three matters.

* In September 2001, the USTR considered a request from the Government of Indonesia to designate 12 additional products for benefits under the Generalized System of Preferences (GSP). Tobacco was initially one of the 12 products. HHS recommended excluding tobacco from the list of products for which GSP was granted. After interagency deliberation, tobacco was excluded.
* In February 2002, USTR contacted HHS regarding a request for guidance from the Embassy in Warsaw, Poland regarding correspondence from Phillip Morris that expressed concern over a Government of Poland proposal to raise the tariff on unprocessed tobacco from 30 percent to 105 percent. USTR indicated that their recommendation was that Embassy in Warsaw not make representations to the Government of Poland. HHS concurred with this recommendation.
* USTR requested HHS participation in an interagency meeting as part of the ongoing negotiations on the U.S. Chile Free Trade Agreement. Dr. Stuart Nightingale represented HHS at this meeting, and presented positions developed by CDC in consultation with the U.S. Department of Agriculture. As an adviser to USTR in these matters, HHS requested that its position be noted in all public discussions of the U.S. position, including the summary of the discussions that will be made available to the public at the close of negotiations, as required by Executive Order 13193. Because negotiations are ongoing, this information is considered deliberative. For further information, please contact John Veroneau, Assistant United States Trade Representative for Congressional Affairs, who can set up a briefing for a member of your staff with the appropriate clearance.

Question:

I was also pleased to hear from you that your Department, in accordance with Section 2(c) of Executive Order 13193 ~Federal Leadership on Global Tobacco Control and Prevention,E has made progress with international tobacco control needs assessments. In your July 2001 correspondence with my office, you stated that the CDC would produce the first report on the People¡s Republic of China by December 31, 2001.

Please provide me with a copy of this report. In addition, please update me on the status of the needs assessment on India, which in your July 2001 letter you stated would be ready for peer-review early this year.

Answer:

I am pleased to report that significant progress has been made on the international tobacco control needs assessment. Although the complexity of the tobacco control situation in China and the challenges of coordinating a global peer review process has resulted in some delay, the report currently is undergoing final review. As soon as the report has been finalized, we will provide you with a copy. With respect to the report on India, work has already begun and we project the report will be completed by the end of the year. CDC staff will be in India in April and will use this opportunity to continue discussions with Indian officials and researchers working on the report to advance its progress.

Question:

Regarding Section 2(d) of Executive Order 13193, you stated that the National Institutes of Health (NIH) worked collaboratively with the World Health Organization to issue a Request for Application (RFA) that would solicit research projects on the global burden of tobacco use. Please provide me with a detailed description of any responses to that RFA. Also, please update me on the progress you have made since July 2001 in implementing this initiative.

Answer:

NIH¡s International Tobacco and Health Research and Capacity Building Program is a unique Fogarty International Center program developed in cooperation with several other NIH institutes, including the National Cancer Institute and the National Institute on Drug Abuse. The NIH received 62 applications in response to the RFA. These grant applications were reviewed on March 4 and 5 by an NIH Special Emphasis Panel, organized by the National Cancer Institute, that included scientists with special expertise in tobacco control issues globally. Once scores are available, the Fogarty International Center, and its collaborating partners, will prepare a funding plan based on the number of applications of high scientific merit and available funds.