Release Date:  May 30, 2000

RFA:  TW-01-001

Fogarty International Center
World Bank
National Institute on Aging
National Institute of Mental Health
National Institute of Dental and Craniofacial Research
National Eye Institute
Office of Behavioral and Social Sciences Research

Letter of Intent Receipt Date:  June 23, 2000
Application Receipt Date:       August 29, 2000


This Request for Applications (RFA) solicits projects that examine the 
effects of health on microeconomic agents (individuals, households and 
enterprises) and aggregate growth (cross-country growth analysis), as 
well as explores how health finance and delivery systems are a source 
of variation in health outcomes.  Studies pursued must be relevant to 
populations in low- and middle-income nations and should preferably be 
either hypothesis testing or hypothesis generating.  Longer-term 
objectives of the program are as follows:

o  support socio-economic surveys with rigorous biomedical and 
psychosocial assessments relating to functional performance and other 
measures of productivity; 
o  improve and expand the quality of psychosocial and biological 
epidemiological data that support studies to measure and model economic 
o  examine the connections between health and the social environment at 
the level of the individual and broader community – including the 
effects of social capital and infant/childhood antecedents of 
adolescent and adult well-being; 
o  assist in the development of a system of metrics that equips 
researchers, service providers and policymakers with information needed 
to inform policy and effectively target public health interventions;
o  improve the quality and availability of health and economic data 
including longitudinal and inter-generational data sets; 
o  establish the relative effectiveness of different financing and 
delivery options at community, regional and national levels to enable 
international comparisons;
o  build institutional capacity in low- and middle-income countries to 
incorporate health data in the measurement and modeling of economic 


The Public Health Service (PHS) is committed to achieving the health 
promotion and disease prevention objectives of “Healthy People 2010,” a 
PHS-led national activity for setting priority areas.  This Request for 
Applications (RFA) International Studies on Health and Economic 
Development, is related to one or more priority areas.  Potential 
applicants may obtain information about “Healthy People 2010” at


Applications may be submitted by domestic and foreign, for-profit and 
non-profit organizations, public and private, such as universities, 
colleges, hospitals, laboratories, units of State and local 
governments, and eligible agencies of the Federal government.  
Racial/ethnic minority individuals, women, and persons with 
disabilities are encouraged to apply as Principal Investigators.


This RFA will use the National Institutes of Health (NIH) individual 
research grant (R01) mechanism.  Responsibility for the planning and 
direction of the proposed project will be that of the applicant.  The 
purpose of the RFA is to stimulate research on the complex dynamics of 
health and productivity in low- and middle-income nations and build a 
theoretical and empirical foundation for future explorations in this 
area.  An applicant may request a project period of up to five years 
and a budget for direct costs of up to $400,000 per year.  Because we 
anticipate that all budget requests will exceed $250,000, the modular 
grants requirements would not apply to this RFA.  Applicants should 
budget to attend an annual networking meeting of awardees at the NIH in 
Bethesda, Maryland.


It is expected that approximately $2 million in total costs (direct 
plus Facilities and Administrative (F & A) costs) per year from all 
supporting collaborating partners for up to five years will be 
available beginning in fiscal year 2001.  This support is dependent 
upon the receipt of a sufficient number of applications of high 
scientific merit. Although this program is provided for in the 
financial plans of the FIC, awards pursuant to this RFA are contingent 
upon the availability of funds from FIC and collaborating partners for 
this purpose. The level of support for these projects may be increased 
if a large number of highly meritorious applications are received and 
if funds are available.


Background and Significance

Over one hundred years after the industrial revolution, a large portion 
of the world remains impoverished.  In the most compelling instance, 
the Organization for Economic Cooperation and Development indicates 
that the per capita income in Africa in 1992 was equivalent to that of 
Western Europe in 1820, and these disparities are widening.  Correlates 
to economic development have been studied vigorously, but only modest 
attention has been paid to the relationship between health or 
demographic status and economic development.  

Over the past three decades the relationship between education and 
poverty (e.g., measured by wage rates) has been replicated in household 
surveys across numerous nations and now frequently is viewed as a 
"causal fact."  These data have influenced development policies at 
national and multilateral levels.  However, health has never ascended 
to a similar footing as a predictive indicator of economic performance.  
The foundations are now strengthening in support of the widely observed 
correlation between health and prosperity.  Studies linking health and 
economic behavior have incorporated several broad avenues of 
investigation:  macroeconomic studies to examine the relationship 
between country-level growth indicators and health; microeconomic 
studies that explore the dynamics of health and productivity at the 
individual or household levels; and studies that examine the effect of 
alternative health policies on economic outcomes.

Health and Economic Welfare

Historical case studies have provided evidence that dietary 
improvements not only extend life spans, but significantly improve 
labor production rates, especially in the lowest quintile of the 
population.  These findings have been reinforced by household surveys 
that positively correlate nutritional status with income and labor 
supply.  For example, in Indonesia, males with anemia have a 20 percent 
lower level of productivity–suggesting that improved nutrition could 
increase household productivity and income.  Studies examining the 
effects of disability on earnings and labor supply in Cote d’Ivoire and 
Ghana also indicate the negative consequences of illness for labor 

Moreover, there is a robust literature on the implications of education 
and other forms of human capital on labor market performance.  Because 
health and education both represent household investments, it is 
important to understand the interdependence of these choices.  Some 
economic studies link childhood health and nutrition to the educational 
attainment of mothers.  However, short expected lifespans also may lead 
households to place a low priority on education.  Careful analysis of 
household decision-making and the policy environment will help shed 
light on the independent and combined effects of such investments.

There is evidence to suggest that exposure to traumatic events such as 
war and violence are among the leading causes of disability adjusted 
life years that are lost at ages 15-44 years.  Victims of trauma and 
violence (physical and social) have been found to be disproportionate 
users of the health care system, and there is evidence for a connection 
between a history of trauma and adverse workplace outcomes such as high 
unemployment and low wages.

At the aggregate level, studies employing cross-country analyses of 
economic growth have examined multiple variables to explain economic 
performance, such as educational levels, disease burdens, fertility 
rates and other demographic factors, rates of national savings and 
natural resource availability.  Macroeconomic models incorporating 
health as an instrumental variable suggest that even modest gains in a 
population's health status may have major positive impacts on a 
society's productivity.  For example, reductions in malaria over 1965-
1990 are associated with meaningful economic growth in cross-country 
regressions.  The importance of the relationship of malaria and 
economic growth suggest the need to explore the economic impact of 
other significant disease burdens, such as poor reproductive health, 
mental health disorders and the omnipresent diarrheal and respiratory 
illnesses affecting populations at risk.

On the other hand, increasing life expectancy is associated with 
population aging.  Over the course of the next 25 years, the age 
structure of the world population will continue to shift, with older 
age groups comprising an increasingly larger share of the total.  Over 
half of the world’s elderly (aged 65 and older) now live in developing 
nations.  By 2030, this proportion is projected to increase to over 70 
percent.  In this context, it is important to consider the impact of 
population aging, and the health of the elderly, on a country’s 
economic performance.  Rapid increases in life expectancy are likely to 
be associated with an increase in chronic diseases.  Disabilities and 
diseases among the over-40 population may affect the ability to work 
prior to retirement and retirement behavior.

Increased economic productivity also has been associated broadly with 
demographic characteristics of a population, especially life 
expectancy.  For example, shifts from high to low rates of fertility 
and overall mortality made possible by improved health maintenance have 
significant effects on population growth rates and economic 
development.  Over time, these downward shifts may expand substantially 
the relative share of the working-age population, a bulge that has been 
coined the “demographic gift” because it carries with it the potential 
for increased economic productivity.  By increasing the working-age 
population and reducing the growth of the economically dependent 
population (under fifteen), indices of economic growth, including rates 
of national savings and investment will likely increase, thereby 
increasing the resources available to invest in the development of 
human capital among children and youth.

However, at both the macro-and microeconomic levels, the precise 
mechanisms and direction of causality have engaged brisk debate, and 
remain a key conceptual and empirical challenge in studies of the 
relationship between human capital, especially health and economic 
development.  The lack of understanding of these relationships has 
impeded the development of effective forms of intervention.  Causality 
likely is a virtuous cycle:  increased income yields increased 
investments in health; and improved health results in greater economic 
productivity.  Rigorous empirical assessment of these relationships 
involving both hypothesis testing and hypothesis generation will 
therefore enable us to more accurately evaluate the impact of health 
interventions on society.

Health and Economic Arrangements

There is a corresponding need to understand how economic arrangements, 
including policies, influence the quality of the social environment and 
human development.  Through empirical studies, economists have 
demonstrated how wealth creation and allocation may influence the 
health and well-being of a population.  For example, research on famine 
and food supply has deepened understanding of social and economic 
arrangements during times of stress and has demonstrated the 
limitations of more traditional indicators of economic performance.  
Similarly, studies among industrialized countries have demonstrated a 
positive relationship between life expectancy and the degree of income 
equity within a society.  The exploration of absolute and relative 
levels of income in society has significant implications for 
understanding the relationships among health, wealth distribution and 
economic growth.

A key element of both empirical and theoretical investigation relates 
to the effects of alternative health financing and delivery policies on 
health and economic outcomes. Lines of investigation include:  1) 
resource allocation within a given system (i.e. primary, secondary, and 
tertiary care); 2) institutional structures, especially financing 
schemes such as deductibles, taxes, mandated social and private 
insurance, user fees, drug revolving funds and community finance and 3) 
health service delivery configurations.  To enable comparative 
assessments, research is needed to establish the relative effectiveness 
of different financing options at the national and regional level.  In 
tandem, research is required to define the optimal mix of public and 
private financing for health systems and means to establish regulations 
and contracts to govern these relationships.  In particular, there is 
increasing interest in the prospect of managed market reforms in low- 
and middle-income nations, stimulated by widespread perceptions of 
public sector inefficiencies.  Studies are required on the 
effectiveness of managed markets in promoting increased provider 
competition, the relative efficiency of contractual as opposed to 
direct management, and cost-benefit analyses, among other areas.

These studies represent promising lines of investigation which converge 
in one summary conclusion:  our conceptual understanding of the long-
term influences on economic development and the formulation of 
effective policies relies on a deepened understanding of the 
determinants and consequences of public health.  If governments and 
donors are to target effectively their investment in health as a 
component of development plans, expanded research is required on the 
dynamics of health and productivity.  This includes the impact on 
economic growth of improved health care and upon health status 
resulting from various economic interventions, as well as the impact on 
health status due to large development projects or policies.

Scientific Objectives

The goal of this RFA is to solicit applications for hypothesis testing 
and hypothesis generating studies that will examine the complex 
linkages between health and economic development.  Categories of study 
may include but are not necessarily limited to:

Microeconomic studies that examine the link between health and economic 
growth at the levels of the individual, household and family.  Examples 

o  Studies to project the impact of population aging or of a particular 
disease or disability burden on individual or household economic 
activity, output and growth, or small enterprise (e.g. HIV, violence, 
malaria, TB, micronutrient deficiencies, mental health disorders, 
craniofacial disfigurement, visual impairment, chronic diseases).

o  Studies to expand the battery of useful physical and functional 
assessments that can be linked to economic indicators.

Cross-sectional surveys or longitudinal panel hypothesis testing or 
hypothesis generating studies of macroeconomic growth.  Examples 

o  Surveys or natural experiments to examine the relationship between 
investment in human resources, particularly education and health, and 
labor market outcomes.  This might include the addition of a health 
module to an ongoing socio-economic survey or incorporating economic 
indicators in an ongoing health survey. 

o  Studies to determine which factors link with macroeconomic growth, 
as for example levels and patterns of educational attainment and 
performance (schooling); health status (life expectancy, mortality 
rates, disease prevalence or age specific biomarkers); population 
growth, density and age structure; personal and government savings 
(investment rates); physical capital stock; trade policy; quality of 
public institutions. 

o  Studies of the impact of nutrition, primary care interventions, 
prevention services, health promotion, etc, on childhood growth and 
development and/or subsequent physical performance and work 

o  Identification of indicator diseases or conditions to detect and 
monitor communities experiencing intense poverty; and the use of these 
indicators to conduct multisectoral studies of the cross-cutting 
effects of essential nutrition and adequate sanitation on both health 
and productivity.

o  Studies of the relationship between health and economic effects of 
traumatic events.

Natural opportunities and experimental approaches to examine the 
effects of alternative health policies on health and economic outcomes.  
Examples include:

o  Research to establish the relative impact of different financing 
options, including national and local taxes, user fees and health 
insurance on health outcome.

o  Research to examine the impact and optimal mix of private and public 
funding for health systems upon health outcome.

o  Research on the impact of decentralization of health systems upon 
health outcome (defined as the transfer of functions, resources and 
authority to local levels of government). This might include studies on 
the theoretical and conceptual background to understanding 
decentralization, the conditions for effectiveness, the study of 
decentralization to hospitals and local health centers and the 
operation of public-sector markets.

o  Research on the economic impact of preventive health policies (e.g., 
integration of mental/physical health services with other trauma victim 
assistance systems).


This program is to generate useful scientific information and also to 
promote collaboration between scientists in the United States and low-
and middle-income nations with shared interests in the consequences of 
health and health policy for economic development.  In this regard, the 
scientific questions should determine the nature of the collaboration.  
To achieve this end, eligible proposals must be jointly developed and 
demonstrate a transnational collaboration between a U.S. 
investigator(s) and an investigator(s) from a low- and middle-income 
nation(s).  In operational terms, this might take the form of 1) a co-
investigator and research staff from low- and middle-income nations 
supported under the protocol, and 2) protocol-related material support 
for a host institution in a low- and middle-income nation to stage 
field studies.  (For operational and analytic purposes, the World 
Bank’s main criterion for classifying economies, gross national product 
per capita, will be employed for this RFA.  A listing of countries 
representing low- and middle-income economies which are eligible for 
this program may be found at  Moreover, 
multidisciplinary approaches to examining the dynamics of health and 
productivity are especially encouraged.  Advances are most likely to be 
achieved through collaborations among disciplines of economics, 
epidemiology, demography, sociology, behavioral science and basic 
biological disciplines.  For example, collaboration among economic and 
biomedical and behavioral scientists may result in more refined 
measurements of instrumental variables, including psychosocial factors.

Applicants are encouraged to collaborate with the World Bank’s Global 
Development Network (GDN).  The GDN is a growing association of 
research and policy institutes whose goal is to generate, share, and 
apply to policy knowledge about development.  To this end, GDN seeks to 
support capacity-building activities in developing countries.  
Information about GDN is available on their web site at  GDN’s research network covers all regions of the 
developing world (see below) and may therefore be a useful source of 
information about potential collaborators from developing countries.

The World Bank’s GDN is providing up to $250,000 which is included in 
the total funds available for support of the NIH program of 
International Studies on Health and Economic Development.

A listing of the GDN regional networks follows:

African Economic Research Consortium (Aerced@Form-Net.Com)

Center for Economic Research and Graduate Education 
East Asian Development Network (Chia@Merlion@ISEAS.Edu.Sg)
Economic Education and Research Consortium (
Economic Research Forum (
Latin American and Caribbean Economic Association (Calvo@Econ.Umd.Edu) 
South Asia Network of Economics Institutes (Director@Icrier.res.In)

GDN hopes to build a strong community of researchers in the developing 
world working on health issues.  To encourage this process, GDN is 
planning to make the economics of healthcare in developing countries 
one of the key themes of its Annual Global Development Conference in 
2001 or 2002 depending on the availability of sufficient research 
output.  This will present researchers from around the world an ideal 
opportunity to share their findings with an important cross-section of 
the development community.

Protection of Research Subjects

Applicants should be aware that provisions for the protection of human 
research subjects and laboratory animals must be met in research done 
in both domestic and foreign institutions including obtaining any 
necessary single project assurances.  Applicants should see Title 45 
CFR, Part 46 for information concerning Department of Health and Human 
Services regulations for the protection of human subjects and the PHS 
Policy on the Humane Care and Use of Laboratory Animals.  These are 
available from the Office for Protection from Research Risks, National 
Institutes of Health, 6100 Executive Boulevard, MSC 7507, Rockville, MD 
20892-7507 (


It is the policy of the NIH that women and members of minority groups 
and their sub-populations must be included in all NIH-supported 
biomedical and behavioral research projects involving human subjects, 
unless a clear and compelling rationale and justification are provided 
that inclusion is inappropriate with respect to the health of the 
subjects or the purpose of the research.  This policy results from the 
NIH Revitalization Act of 1993 (Section 492B of Public Law 103-43).

All investigators proposing research involving human subjects should 
read the "NIH Guidelines for Inclusion of Women and Minorities as 
Subjects in Clinical Research," which was published in the Federal 
Register of March 28, 1994 (FR 59 14508-14513) and in the NIH Guide for 
Grants and Contracts, Vol. 23, No. 11, March 18, 1994, and is available 
on the web at:


It is the policy of NIH that children (i.e., individuals under the age 
of 21) must be included in all human subjects research, conducted or 
supported by the NIH, unless there are scientific and ethical reasons 
not to include them.  This policy applies to all initial (Type 1) 
applications submitted for receipt dates after October 1, 1998.

All investigators proposing research involving human subjects should 
read the "NIH Policy and Guidelines" on the Inclusion of Children as 
Participants in Research Involving Human Subjects that was published in 
the NIH Guide for Grants and Contracts, March 6, 1998, and is available 
at the following URL address:

Investigators also may obtain copies of these policies from the program 
staff listed under INQUIRIES.  Program staff may also provide 
additional relevant information concerning the policy.


All applications and proposals for NIH funding must be self-contained 
within specified page limitations.  Unless otherwise specified in an 
NIH solicitation, Internet addresses (URLs) should not be used to 
provide information necessary to the review because reviewers are under 
no obligation to view the Internet sites.  Reviewers are cautioned that 
their anonymity may be compromised when they directly access an 
Internet site.


Prospective applicants are asked to submit a letter of intent that 
includes a descriptive title of the proposed research, the name, 
address, and telephone number of the Principal Investigator, the 
identities of other key personnel and participating institutions, and 
the number and title of the RFA in response to which the application 
may be submitted.  Although a letter of intent is not required, is not 
binding, and does not enter into the review of a subsequent 
application, the information that it contains allows NIH staff to 
estimate the potential review workload and plan the review.

The letter of intent is to be sent to the program person listed under 
INQUIRIES by the letter of intent receipt date listed.


The research grant application from PHS 398 (rev. 4/98) is to be used 
in applying for these grants.  These forms are available at most 
institutional offices of sponsored research and from the Division of 
Extramural Outreach and Information Resources, National Institutes of 
Health, 6701 Rockledge Drive, MSC 7910, Bethesda, MD 20892-7910, 
telephone 301/710-0267, email:

The RFA label available in the PHS 398 (rev. 4/98) application form 
must be affixed to the bottom of the face page of the application.  
Type the RFA number on the label.  Failure to use this label could 
result in delayed processing of the application such that it may not 
reach the review committee in time for review.  In addition, the RFA 
title and number must be typed on line 2 of the face page of the 
application form and the YES box must be marked.

The sample RFA label available at: has been 
modified to allow for this change.  Please note this is in pdf format.

Submit a signed, typewritten original of the application, including the 
Checklist, and five signed, photocopies, in one package to:

6701 ROCKLEDGE DRIVE, ROOM 1040 - MSC 7710
BETHESDA, MD  20892-7710
BETHESDA, MD  20817 (for express/courier service)

Applications must be received by August 29, 2000.  If an application is 
received after that date, it will be returned to the applicant without 
review.  The Center for Scientific Review (CSR) will not accept any 
application in response to this RFA that is essentially the same as one 
currently pending initial review, unless the applicant withdraws the 
pending application.  CSR will also not accept any application that is 
essentially the same as one already reviewed.  This does not preclude 
the submission of previously reviewed applications with substantial 
revisions.  Such applications must include an introduction addressing 
the previous critique.


Upon receipt, applications will be reviewed for completeness by the CSR 
and responsiveness by FIC, the World Bank, NIA, NIMH, NIDCR, NEI, and 
OBSSR.  Incomplete and/or non-responsive applications will be returned 
to the applicant without further consideration.  

Applications that are complete and responsive to the RFA will be 
evaluated for scientific and technical merit by an appropriate peer 
review group convened by the CSR in accordance with the review criteria 
stated below.  As part of the initial merit review, all applications 
will receive a written critique and undergo a process in which only 
those applications deemed to have the highest scientific merit, 
generally the top half of the applications under review, will be 
discussed, assigned a priority score, and receive a second level review 
by the FIC Advisory Board.

Review Criteria

The goals of NIH-supported research are to advance our understanding of 
biological systems, improve the control of disease, and enhance health.  
In the written comments reviewers will be asked to discuss the 
following aspects of the application in order to judge the likelihood 
that the proposed research will have a substantial impact on the 
pursuit of these goals.  Each of these criteria will be addressed and 
considered in assigning the overall score, weighting them as 
appropriate for each application.  Note that the application does not 
need to be strong in all categories to be judged likely to have major 
scientific impact and thus deserve a high priority score.  For example, 
an investigator may propose to carry out important work that by its 
nature is not innovative but is essential to move a field forward.

(1)  Significance:  Does this study address an important problem?  If 
the aims of the application are achieved, how will scientific knowledge 
be advanced?  What will be the effect of these studies on the concepts 
or methods that drive this field?

(2)  Approach:  Are the conceptual framework, hypotheses, design, 
methods, and analyses adequately developed, well-integrated, and 
appropriate to the aims of the project?  Does the applicant acknowledge 
potential problem areas and consider alternative tactics?

(3)  Innovation:  Does the project employ novel concepts, approaches or 
methods?  Are the aims original and innovative?  Does the project 
challenge existing paradigms or develop new methodologies or 

(4)  Investigators:  Are the investigators appropriately trained and 
well suited to carry out this work?  Is the work proposed appropriate 
to the experience level of the Principal Investigator and other 
researchers (if any)?

(5)  Environment:  Does the scientific environment in which the work 
will be done contribute to the probability of success?  Do the proposed 
experiments take advantage of unique features of the scientific 
environment or employ useful collaborative arrangements?  Is there 
evidence of institutional support?

(6)  Research Capacity-Building:  Does the proposed program contribute 
to the capacity of scientists and/or institutions in low- and middle-
income nations to perform research related to health and economics 
(e.g. health outcomes and economic linkages; microeconomics of health 
care)?  Does the proposed program contain explicit strategies or plans 
to strengthen this capacity through training, career development or 
other modes?

In addition to the above criteria, in accordance with NIH policy, all 
applications will also be reviewed with respect to the following:

o  The adequacy of plans to include both genders, minorities and their 
subgroups, and children as appropriate for the scientific goals of the 
research.  Plans for the recruitment and retention of subjects will 
also be evaluated.

o  The reasonableness of the proposed budget and duration in relation 
to the proposed research.

o  The adequacy of the proposed protections for human participants, 
particularly the risks that may be posed to groups as well as 
individuals, animals or the environment, to the extent they may be 
adversely affected by the project proposed in the application.


Letter of Intent Receipt Date:    June 23, 2000
Application Receipt Date:         August 29, 2000
Peer Review Date:                 October/November 2000
Council Review:                   December 2000
Earliest Anticipated Start Date:  December 2000


Award criteria that will be used to make award decisions include:

o  Scientific merit (as determined by peer review);
o  Responsiveness of the proposed project to achieve the goals of this 
o  Balance among projects to respond to the questions included in this 
o  Availability of funds
o  Programmatic priorities


Inquiries concerning this RFA are encouraged.  The opportunity to 
clarify any issues or questions from potential applicants is welcome.

Direct inquiries regarding programmatic issues to:

Dr. Kenneth Bridbord
Division of International Training and Research
Fogarty International Center
Building 31, Room B2C39
31 Center Drive, MSC 2220
Bethesda, MD  20892-2220
Telephone:  (301) 496-2516
Fax:  (301) 402-0779

Programmatic inquiries can also be addressed to the NIH program 
contacts listed on the FIC web site 
( for the International Studies on 
Health and Economic Development RFA.  Frequently asked questions and 
responses to these inquiries will also be listed at this website.

Direct inquiries regarding ISHED fiscal matters to:

Ms. Susan Bettendorf
Grants Management Specialist
Fogarty International Center
Bldg. 31, Room B2C39
31 Center Drive, MSC 2220
Bethesda, MD  20892-2220
Telephone:  (301) 496-1653
FAX:  (301) 402-0779

Direct inquiries regarding review issues to:

Dr. Robert Weller
Center for Scientific Review
6701 Rockledge Drive 
Room 3160, MSC 7770
Bethesda, MD  20892-7770
Telephone:  (301) 435-0694
FAX:  (301) 480-3962

Awards are made under authorization of Sections 301 and 405 and Title 
IV, Part A, as amended (42 USC 241, 284, and 287) of the Public Health 
Services Act, and administered under NIH grants policies and Federal 
Regulations 42 CFR 52 and 45 CFR Parts 74 and 92s.  This program is not 
subject to the intergovernmental review requirements of Executive Order 
12372 or to Health Systems Agency review.

The PHS strongly encourages all grant and contract recipients to 
provide a smoke-free workplace and promote the non-use of all tobacco 
products.  In addition, Public Law 103-227, the Pro-Children Act of 
1994, prohibits smoking in certain facilities (or in some cases, any 
portion of a facility) in which regular or routine education, library, 
day care, health care or early childhood development services are 
provided to children.  This is consistent with the PHS mission to 
protect and advance the physical and mental health of the American 

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