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108th CONGRESS
2d Session
H. R. 5335
To amend the Public Health Service Act to establish a Coordinated
Environmental Health Network, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
October 8, 2004
Ms. Pelosi (for herself, Mrs. Jones of Ohio, Ms. Slaughter, Mr. Brown
of Ohio, Mr. George Miller of California, Mr. Markey, Ms. Schakowsky,
Ms. Solis, Ms. McCarthy of Missouri, Mr. Clyburn, Ms. DeLauro, Mr.
Kennedy of Rhode Island, Ms. Roybal-Allard, Mr. Serrano, Mrs. Maloney,
Mr. Van Hollen, Mr. Crowley, Mr. Kucinich, Ms. McCollum, Mr. Kildee,
Ms. Baldwin, Mr. Owens, Mrs. Christensen, Mr. Moran of Virginia, Mr.
Grijalva, Mr. Israel, Mr. Jackson of Illinois, Mr. Gonzalez, and Mr.
Tierney) introduced the following bill; which was referred to the
Committee on Energy and Commerce
_______________________________________________________________________
A BILL
To amend the Public Health Service Act to establish a Coordinated
Environmental Health Network, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Coordinated Environmental Health
Network Act of 2004''.
SEC. 2. FINDINGS AND PURPOSE.
(a) Findings.--Congress finds that--
(1) approximately 7 out of every 10 deaths in the United
States are attributable to chronic diseases;
(2) with 100,000,000 people suffering from chronic diseases
each year, and $750,000,000,000 lost in health care costs as a
result, the national cost of chronic disease is extremely high
and must be appropriately addressed;
(3) the rates of many chronic diseases, including asthma,
some birth defects, cancers, and autism, appear to be
increasing;
(4) there is a growing amount of evidence that
environmental factors are strongly linked with specific chronic
disease;
(5) a major gap in critical knowledge exists regarding the
prevalence and incidence of chronic diseases;
(6) States, local communities, territories, and Indian
tribes need assistance with public health efforts that would
lead to prevention of chronic disease, including the
establishment and maintenance of necessary infrastructure for
disease and environmental hazard exposure surveillance; and
(7) a Coordinated Environmental Health Network will help
target resources to areas of chronic disease prevention most in
need.
(b) Purposes.--It is the purpose of this Act to--
(1) develop, operate, and maintain a Coordinated
Environmental Health Network, State Environmental Health
Networks, and rapid response capabilities so that the Federal
Government, States, local governments, territories, and Indian
tribes can more effectively monitor, investigate, respond to,
research, and prevent increases in the incidence and prevalence
of certain chronic diseases and relevant environmental and
other risk factors;
(2) provide information collected through the Coordinated
and State Environmental Health Networks to government agencies,
public health practitioners and researchers, policy makers, and
the public;
(3) expand and coordinate among existing surveillance and
data collection systems and other infrastructure for chronic
diseases and relevant environmental, and other risk factors,
including those relevant to bioterrorism;
(4) improve coordination between the areas of public
health, environmental protection, and chemical, radiological
and biological terrorism; and
(5) provide necessary support to ensure the availability of
a sufficient number of well-trained environmental health and
public health personnel to participate and provide leadership
in the development and maintenance of the Coordinated and State
Environmental Health Networks.
SEC. 3. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.
The Public Health Service Act (42 U.S.C. 201 et seq.) is amended by
adding at the end the following:
``TITLE XXIX--COORDINATED ENVIRONMENTAL HEALTH NETWORK
``SEC. 2900. DEFINITIONS.
``In this title:
``(1) Administrators.--The term `Administrators' means the
Director of the Centers for Disease Control and Prevention
Coordinating Center for Environmental Health, Injury
Prevention, and Occupational Health, and the Administrator of
the Environmental Protection Agency.
``(2) Committee.--The term `Committee' means the Advisory
Committee established under section 2901(d).
``(3) Director.--The term `Director' means the Director of
the Centers for Disease Control and Prevention.
``(4) Medical privacy regulations.--The term `medical
privacy regulations' means the regulations promulgated under
section 264(c) of the Health Insurance Portability and
Accountability Act of 1996.
``(5) Coordinated network.--The term `Coordinated Network'
means the Coordinated Environmental Health Network established
under section 2901(a).
``(6) Priority chronic condition.--The term `priority
chronic condition' means a condition to be tracked in the
Coordinated Network and the State Networks, including birth
defects, developmental disabilities (such as cerebral palsy,
autism, and mental retardation), asthma and chronic respiratory
diseases, neurological diseases (such as Parkinson's disease,
multiple sclerosis, Alzheimer's disease, and amyotrophic
lateral sclerosis), autoimmune diseases (such as lupus),
cancer, juvenile diabetes, and such other priority chronic
conditions as the Secretary may specify.
``(7) State network.--The term `State Network' means a
State Environmental Health Network established under section
2901(b).
``(8) State.--The term `State' means a State, territory, or
Indian tribe that is eligible to receive a health tracking
grant under section 2901(b).
``SEC. 2901. ESTABLISHMENT OF COORDINATED AND STATE ENVIRONMENTAL
HEALTH NETWORKS.
``(a) Coordinated Environmental Health Network.--
``(1) Establishment.--Not later than 36 months after the
date of the enactment of this title, the Secretary, acting
through the Director and in consultation with the
Administrators, State and local health departments, and the
Committee, shall establish and operate a Coordinated
Environmental Health Network. In establishing and operating the
Coordinated Network, the Secretary shall--
``(A) identify, build upon, expand, and coordinate
among existing data and surveillance systems, surveys,
registries, and other Federal public health and
environmental infrastructure wherever possible,
including--
``(i) the National Electronic Disease
Surveillance System;
``(ii) State birth defects surveillance
systems as supported under section 317C;
``(iii) State cancer registries as
supported under part M of title III;
``(iv) State asthma surveillance systems as
supported under section 317I;
``(v) the National Health and Nutrition
Examination Survey;
``(vi) the Behavioral Risk Factor
Surveillance System;
``(vii) the Hazardous Substance Release/
Health Effects Database;
``(viii) the Hazardous Substances Emergency
Events Surveillance System;
``(ix) the National Exposure Registry;
``(x) the Health Alert Network; and
``(xi) the State vital statistics systems
as supported under section 306;
``(B) provide for public access to an electronic
national database that accepts data from the State
Networks on the incidence and prevalence of priority
chronic conditions and relevant environmental and other
factors, in a manner which protects personal privacy
consistent with the medical privacy regulations;
``(C) not later than 36 months after the date of
the enactment of this title, and annually thereafter,
prepare and publish, in accordance with paragraph (2),
a Coordinated Environmental Health Network Report to
provide the public with the findings of the Coordinated
Network;
``(D) operate and maintain a National Environmental
Health Rapid Response Service within the Epidemic
Intelligence Service to carry out the activities
described in paragraph (3);
``(E) provide for the establishment of State
Networks, and coordinate the State Networks as provided
for under subsection (b);
``(F) provide technical assistance to support the
State Networks, including providing--
``(i) training for environmental health
investigators appointed or hired under
subsection (b)(3)(D);
``(ii) technical assistance as needed to
States to build necessary capacity and
infrastructure for the establishment of a State
Network, including a computerized data
collection, reporting, and processing system,
and additional assistance identified by the
States under subsection (b)(5)(C) as necessary
for infrastructure development; and
``(iii) such other technical assistance as
the Secretary, in consultation with the
Administrators, determines to be necessary;
``(G) not later than 12 months after the date of
the enactment of this title, acting through the
Director and consulting with the Administrators, the
Surgeon General, the Director of the National
Institutes of Health, and States, develop minimum
standards and procedures in accordance with paragraph
(4) for data collection and reporting for the State
Networks, to be updated not less than annually
thereafter; and
``(H) in developing the minimum standards and
procedures under subparagraph (G), include mechanisms
for allowing the States to set priorities, and allocate
resources accordingly, among the factors described in
subparagraphs (A), (B), and (C) of paragraph (4).
``(2) Coordinated environmental health network report.--
Each Coordinated Environmental Health Network Report prepared
under paragraph (1)(C) shall include--
``(A) a statement of the activities carried out
under this title;
``(B) an analysis of the incidence, prevalence, and
trends of priority chronic conditions and potentially
relevant environmental and other factors by State and
census tract (or other political or administrative
subdivision determined appropriate by the Secretary in
consultation with the Administrator of the
Environmental Protection Agency) for the calendar year
preceding the year for which the report is prepared;
``(C) the identification of gaps in the data of the
Coordinated Network, including diseases of concern and
environmental exposures not tracked; and
``(D) recommendations regarding high risk
populations, public health concerns, response and
prevention strategies, and additional tracking needs;
``(3) National environmental health rapid response
service.--The National Environmental Health Rapid Response
Service operated under paragraph (1)(D) shall--
``(A) work with environmental health investigators
appointed or hired under subsection (b)(3)(D) to
develop and implement strategies, protocols, and
guidelines for the coordinated, rapid responses to
actual and perceived higher than expected incidence and
prevalence rates of priority chronic conditions and to
acute and potential environmental hazards and
exposures;
``(B) conduct investigations into higher than
expected incidence and prevalence rates of priority
chronic conditions or environmental exposures after an
individual requests, through a process established by
the Secretary, the intervention of the Service;
``(C) coordinate activities carried out under this
title with activities carried out under sections 319
through 319G; and
``(D) coordinate activities carried out under this
title with the Administrators, the Surgeon General, and
the Director of the National Institutes of Health.
``(4) Data collection and reporting by state networks.--The
minimum standards and procedures referred to in paragraph
(1)(G) shall include--
``(A) a list and definitions of the priority
chronic conditions to be tracked through the State
Networks;
``(B) a list and definitions of relevant
environmental exposures of concern to be tracked, to
the extent practicable, through the State Networks,
including--
``(i) hazardous air pollutants (as defined
in section 302(g) of the Clean Air Act);
``(ii) air pollutants for which national
primary ambient air quality standards have been
promulgated under section 109 of the Clean Air
Act;
``(iii) pollutants or contaminants (as
defined in section 101 of the Comprehensive
Environmental Response, Compensation, and
Liability Act of 1980);
``(iv) toxic chemicals (as described in
section 313 of the Emergency Planning and
Community Right-to-Know Act of 1986);
``(v) substances reported under the Toxic
Substances Control Act Inventory Update Rule as
provided for in part 710 of title 40, Code of
Federal Regulations, or successor regulations;
``(vi) pesticides (as defined in section
2(u) of the Federal Insecticide, Fungicide, and
Rodenticide Act); and
``(vii) such other potentially relevant
environmental factors as the Secretary may
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