Remarks to the First Annual Cervical Cancer-Free America Forum
U.S. Department of Health & Human Services
HRSA Press Office: (301) 443-3376
by HRSA Administrator Mary K. Wakefield
May 5, 2011
Thank you for inviting me today for this inaugural session of the Cervical Cancer-Free America forum.
I appreciate the opportunity to talk about the strides HRSA is making in addressing women’s health, generally, and cervical cancer, specifically. But first I want to just take a moment to say how important I think it is that you have joined together in this cause.
Efforts at early detection have improved dramatically in the last 30 years – thanks in part to an array of federal efforts – including The National Breast and Cervical Cancer Early Detection Program run by the Centers for Disease Control and Prevention in partnership with HRSA and 7 other federal agencies.
However, while we have seen sharp declines in mortality, certain segments of the population continue to bear a disproportionate burden of cervical cancer, particularly women in rural areas, the elderly, those with less formal education, and women of color.
The mortality rate for African-American and Vietnamese women, for example, continues to be twice as high as for white women – and about 50 percent higher for Latinas. Meanwhile, in rural communities, uninsured white women have some of the poorest access to routine screening of any patient population.
As was mentioned, this is a preventable disease that strikes hardest at the uninsured and those living in underserved communities in which health care services are scarce. Like so many other conditions – HIV and diabetes both come to mind – the CDC has documented that cervical cancer is disproportionately a disease of poverty.
For lack of timely prevention, the Nation spends $1.4 billion per year on cervical cancer treatment.
It is disparities like this that engage you and that the Affordable Care Act will explicitly help to address.
As most of you likely know by now, the Affordable Care Act is already directly addressing Women’s Health and health care:
As a resource for on-going changes – and for a complete list of improvements in women’s health services under the ACA – I highly recommend that you visit www.Healthcare.gov, then click on the word “individuals,” then “women.”
Beyond these broader policy changes, HRSA also has been charged under the ACA with advancing women’s health in very practical and immediate ways. So I want to just take a moment to quickly outline what HRSA does and where we fit in the battle line protecting the health of women and in the fight against cervical cancer.
HRSA is part of HHS, and has a set of programs largely dedicated to improving access to high quality health care for vulnerable populations.
Its total budget authority has risen steadily from about $6.9 billion in FY 2008 to over $9 billion today, and we got a huge boost from the Recovery Act in 2009.
With this budget, HRSA funds 80 different grant programs in partnership with state, local and community organizations across the country – several of which contain a cervical cancer prevention component.
I’ll just mention some of them now, and say a bit more in a moment:
In recognition of National Women’s Health Week – May 8-14 – I have asked HRSA Grant Program Directors to encourage women to use health centers for their preventive screenings, including Pap tests. The clinics are open, and the services are available, so I would likewise urge everyone here today to encourage women to use them, regardless of the financial status.
When I arrived at HRSA in early 2009, Congress had just passed the Recovery Act, which invested $2 billion in the national health center network, and another $500 million in strengthening HRSA programs to expand the health care workforce. That pushed us all into overdrive.
A year later came the Affordable Care Act, which pushed my agency into hyper-overdrive. Congress assigned 50 provisions of the Affordable Care Act to HRSA to implement.
One of those 50 items is a directive to expand the number of health centers sites and the range of services they offer.
This investment has the potential to significantly improve access to high-quality, primary and preventive health care in every corner of the nation – particularly for women.
By 2015, HRSA’s health center grantees are expected to serve many more patients – over and above the 19 million in calendar year 2009. To give you some idea of what the impact of this expansion may be on women’s health, let me share a few benchmarks:
Clearly, if these trends hold, expansion of the health center system will extend these benefits and others to many more women. So the time has never been better to re-double our efforts to bring more women into the system, particularly those in geographically isolated or economically fragile circumstances.
And while we’re on the subject, I’d like to mention that HRSA makes it easy to access these services. Simply go to www.HRSA.Gov and click “Find-A-Health Center,” or download the free “Find-A-Health-Center” app for your I-Phone through the HRSA web site.
As we work to expand access to health center sites and services, we are working just as hard to improve the quality of care that health centers deliver.
For example, the expansion of services stimulated by the Recovery Act and ACA investments is increasing health centers’ ability to “treat the whole patient” in one place, at one time, magnifying their impact on patient’s lives.
While not directly related to today’s topic, you might be interested to know that two-thirds of our health centers now provide mental and behavioral health services that reach more than 750,000 people every year. And a third provide substance abuse treatment and counseling that reaches more than 115,000 patients.
Health centers also have ramped up their oral health component – a 131 percent increase over the past decade.
We’re also improving the way we measure performance at health centers. Earlier this year HRSA added four more clinical performance measures to the six we collect annually from our health center grantees. The new measures cover weight screening, asthma treatment rates and tobacco cessation interventions.
As many of you likely know, tobacco use has been implicated in HPV’s progression into cervical cancer.
We continue to collect data on performance measures specific to women, including the number who receive prenatal care, cervical cancer screenings and mammograms. We also collect data on other measures impacting women, including diabetes, hypertension and STD testing.
To staff this expanding primary care infrastructure – and strengthen primary care in other settings that serve the underserved – the ACA provides for doubling the ranks of the National Health Service Corps.
The NHSC is comprised of advanced practice nurses, physicians, dentists, psychologists and others who agree to provide primary care in medically underserved areas for at least two years in exchange for academic debt relief.
In 2009, the NHSC had only 3,600 providers in the field. Today – thanks to investments from the Recovery Act and the Affordable Care Act – the field strength of the Corps has grown by 57 percent to 7,530 clinicians. That’s the largest expansion in the Corps’ 39-year history.
Under President Obama’s leadership, we are planning for the Corps’ ranks to grow even further by the end of 2011. And we expect that about half of those clinicians will work in the Health Centers I was talking about a moment ago.
The Corps is all about increasing access to primary health care. And here’s what the recent expansion has meant for women’s health and women clinicians:
Here again, I’m sure we are all familiar with the importance of female practitioners in matters of reproductive health, particularly within certain populations.
The Affordable Care Act also authorizes $1.5 billion over five years for the Maternal, Infant, and Early Childhood Home Visitation Program.
Under this program, nurses, social workers and others will visit expectant mothers and their families in high-risk communities. There, they will provide counseling and intervention services designed to improve health outcomes for mothers, infants and families; school readiness for children; parenting skills and economic self-sufficiency.
The evidence behind the program clearly indicates that providing these interventions sooner decreases the need for more costly clinical care and social services later.
For too long, we have watched unprepared young mothers and their newborns leave the health care system after delivery with few if any resources or skills to meet their new role as parents – only to watch them return days, weeks or months later through the emergency room door.
Home visitation not only focuses on addressing a host of deficits to improve maternal and infant health outcomes – including routine screenings – but also improves every mother’s long-term prospects through evidence-based programs designed to help them stop smoking, adopt healthier lifestyles, and combat post-partum depression. The program also puts in place community resources to decrease domestic violence and crime, and improve educational opportunities.
All 50 States, the District of Columbia, Puerto Rico and five other U.S. Territories received grants last summer to fund statewide assessments to identify existing home visiting programs and areas of high need within their borders.
This year, the program will get underway nationwide, supported by a first installment of $227 million in funding.
As a new vehicle for expanding care into populations at highest risk for HPV and cervical cancer, Home Visitation has obvious groundbreaking potential – as many more expectant mothers and their infants will be guided into routine screening and primary care.
It’s our opinion at HRSA that the time is right to really advance in a meaningful way Women’s Health. In addition to what I’ve already described, we now have authorization under the ACA to establish:
As part of this effort, HHS is currently involved in developing guidelines for women’s preventive services under a contract with the Institute of Medicine, and I certainly want to recognize your efforts – and the efforts of so many other women’s advocates – to have HPV and cervical cancer screening included.
The IOM has conducted a series of hearings to get input from relevant organizations and the public, and is expected to issue guidelines by mid-July. The Department will then release the final guidelines sometime in August.
I’m glad to be here today to contribute to the conversation, and I offer HRSA as a partner in your very important work.