Testimony of the Arthritis Foundation Submitted to the Senate Committee on Appropriations
Subcommittee on Labor, Health and Human Services, Education, and Related Agencies
April 12, 2010
The Arthritis Foundation greatly appreciates the opportunity to submit testimony in support of increased funding for arthritis prevention at the Centers for Disease Control and Prevention (CDC); additional investment in arthritis research at the National Institutes of Health (NIH); and funding for the Health Resources and Services Administration (HRSA) to commence a loan repayment program for pediatric specialists.
Arthritis is a term used to describe more than 100 different conditions that affect joints as well as other parts of the body. Arthritis is one of the most prevalent chronic health problems and the most common cause of disability in the United States. 46 million people (1 in 5 adults) and almost 300,000 children live with the pain of arthritis every day. The medical and societal impact of arthritis in the United States is staggering at $128 billion, including $81 billion in direct costs for physician visits and surgical interventions and $47 billion in indirect costs for missed work days. Counter to public perception, two-thirds of the people with doctor-diagnosed arthritis are under the age of 65.
By the year 2030, an estimated 67 million or 25% of the projected adult population will have arthritis. Furthermore, arthritis limits the ability of people to effectively manage other chronic diseases. More than 57% of adults with heart disease and more than 52% of adults with diabetes also have arthritis. The Arthritis Foundation strongly believes that in order to prevent or delay arthritis from disabling people and diminishing their quality of life that a significant investment in prevention and intervention strategies is essential. Research shows that the pain and disability of arthritis can be decreased through early diagnosis and appropriate management, including evidence based self-management activities such as weight control and physical activity. The Arthritis Foundation’s Self-Help Program, a group education program, has been proven to reduce arthritis pain by 20% and physician visits by 40%. These interventions are recognized by the CDC to reduce the pain of arthritis and importantly reduce health care expenditures through a reduction in physician visits.
Centers for Disease Control and Prevention
During the past year, the Centers for Disease Control and Prevention has partnered with the Arthritis Foundation and more than 50 organizations to create a National Public Health Agenda for Osteoarthritis. The Agenda states the need to increase availability of evidence-based intervention strategies; increase public health attention for prevention and disease management; and increase research to better understand disease risk factors and other effective disease management strategies.
With CDC funding, twelve state health departments in partnership with other state organizations have successfully increased public awareness of the burden of arthritis and increased the availability of four main interventions. First, self-management education (as described above) is proven to improve the quality of life and health care for people with arthritis and should be expanded to people with symptomatic arthritis. Second, physical activity is the best medicine to fight arthritis pain. The promotion of low-impact aerobic physical activity and muscle strengthening exercises for weight loss and to provide joint support is key. Losing just one pound of weight reduces four pounds of pressure off each knee. Third, preventing joint injuries through existing policies and interventions which have been shown to reduce arthritis related joint injuries. Finally, promoting weight management and healthy nutrition will facilitate the prevention and treatment of arthritis. Now, is the time to make a significant investment to sustain and improve the reach of these proven interventions.
Currently, the CDC’s arthritis program receives $13 million in annual funding and about half of that amount is distributed via competitive grant to 12 states. An additional investment of $10 million would fund 12-14 new states and enable evidence-based prevention programs to reach many more Americans through innovative delivery approaches. The Arthritis Foundation strongly recommends that Congress invest an additional $10 million (total of $23 million) in the CDC’s arthritis program in Fiscal Year 2011 to expand proven prevention and treatment strategies and fund up to 14 new states.
National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases
While new treatment options are available which greatly improve the quality of life for people living with arthritis, the ultimate goal is to find a cure. The Arthritis Foundation firmly believes research holds the key to tomorrow’s advances and provides hope for a future free from arthritis pain. As the largest non-profit contributor to arthritis research, the Arthritis Foundation fills a vital role in the big picture of arthritis research. Our research program complements government and industry-based arthritis research by focusing on training new investigators and pursuing innovative strategies for preventing, controlling and curing arthritis. By supporting researchers in the early stages of their careers, the Arthritis Foundation makes important initial discoveries possible that lead to ultimate breakthrough results.
The mission of the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) is to support research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases, the training of basic and clinical scientists to carry out this research, and the dissemination of information on research progress in these diseases. Research opportunities at NIAMS are being curtailed due to the stagnating and in some cases declining numbers of new grants being awarded for specific diseases. The training of new investigators has unnecessarily slowed down and contributed to a crisis in the research community where new investigators have begun to leave biomedical research careers in pursuit of other more successful endeavors.
The Arthritis Foundation is dedicated to finding a cure for arthritis. However, the investment in NIH research is absolutely crucial to realize this dream. With continued and increased investment in research, the Arthritis Foundation believes a cure is on the horizon. To support research that will lead to improved treatments and a potential cure for arthritis, the Arthritis Foundation urges Congress to provide $603.8 million, a 12% increase, for the National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases.
Health Resources and Services Administration
Juvenile arthritis is the leading cause of acquired disability in children and is the sixth most common childhood disease. Sustaining the field of pediatric rheumatology is essential to the care of the almost 300,000 children under the age of 18 living with a form of juvenile arthritis. Children who are diagnosed with juvenile arthritis will live with this chronic and potentially disabling disease for their entire life. Therefore, it is imperative that children are diagnosed quickly and start treatment before significant irreversible joint damage is done. However, it is a challenge to first find a pediatric rheumatologist, as nine states do not have a single one, and then to have a timely appointment as many states have only one or two to see thousands of patients. Pediatric rheumatology is one of the smallest pediatric subspecialties with less than 200 pediatric rheumatologists actively practicing in the United States. A report to Congress in 2007 stated there was a 75% shortage of pediatric rheumatologists and recommended loan repayment program to help address the workforce issue.
The recent passage of the Patient Protection and Affordable Care Act authorizes the Health Resources and Services Administration to commence a loan repayment program for pediatric specialists and authorizes Congress to appropriate $30 million for this program. A percentage of this funding should be allocated for pediatric rheumatology. The Arthritis Foundation strongly recommends funding this program immediately at the $30 million level to help increase the pediatric rheumatology workforce.
The Arthritis Foundation appreciates the opportunity to submit our recommendations to Congress on behalf of the 46 million people with arthritis. The mission of the Arthritis Foundation is the prevention, control, and cure of arthritis. The Arthritis Foundation urges Congress to focus federal investment through a $23 million appropriation for arthritis prevention at CDC; a $30 million appropriation to help control juvenile arthritis; and a 12% increase toward a cure in arthritis research at the NIH. Each part of the equation—prevention, control, and cure—are an essential part to a future world free of arthritis pain and disability.