States are the seat of most authority for public health emergency response. Much of the actual work of response falls to local officials. However, the federal government can impose requirements upon states as a condition of federal funding. Since 2002, Congress has provided funding to all U.S. states, territories, and the District of Columbia, to enhance federal, state and local preparedness for public health threats in general, and an influenza ("flu") pandemic in particular. States were required to develop pandemic plans as a condition of this funding.

Through mid-May 2007, the United States had confirmed three cases of bovine spongiform encephalopathy (BSE, or "mad cow disease"): the first in December 2003 in a Canadian-born cow found in Washington state, the second in June 2005 in cow in Texas, and the third in March 2006 in a cow in Alabama.

The Patient Protection and Affordable Care Act (ACA) reauthorized new funding for numerous existing discretionary grant and other programs and activities. ACA also created multiple new discretionary grant programs and activities and provided for each an authorization of appropriations. Funding for all of these programs and activities is subject to action by congressional appropriators. This report summarizes all the discretionary spending provisions in ACA that authorized appropriations for grant programs and other activities. A companion product, CRS Report R41301, Appropriations and Fund Transfers in the Patient Protection and Affordable Care Act (PPACA), summarizes all the mandatory appropriations in the new law. Among the provisions that are intended to strengthen the nation's health care safety net and improve access to care, ACA permanently reauthorized the federal health centers program and the National Health Service Corps (NHSC). The NHSC provides scholarships and student loan repayments to individuals who agree to a period of service as a primary care provider in a federally designated Health Professional Shortage Area. In addition, the new law addressed concerns about the current size, specialty mix, and geographic distribution of the health care workforce. It reauthorized and expanded existing health workforce education and training programs under Titles VII and VIII of the Public Health Service Act (PHSA). Title VII supports the education and training of physicians, dentists, physician assistants, and public health workers through grants, scholarships, and loan repayment. ACA created several new programs to increase training experiences in primary care, in rural areas, and in community-based settings, and provided training opportunities to increase the supply of pediatric subspecialists and geriatricians. It also expanded the nursing workforce development programs authorized under PHSA Title VIII to bolster undergraduate and graduate nursing education and training. As part of a comprehensive framework for federal community-based (i.e., public health) prevention activities, including a national strategy and a national education and outreach campaign, ACA authorized several new grant programs with a focus on preventable or modifiable risk factors for disease (e.g., sedentary lifestyle, tobacco use). The new law also leveraged a number of mechanisms to improve the quality of health care, including new requirements for quality measure development, collection, analysis, and public reporting; programs to develop and disseminate innovative strategies for improving the quality of health care delivery; and support for care coordination programs such as medical homes, patient navigators, and the co-location of primary health care and mental health services. Additionally, ACA authorized funding for programs to prevent elder abuse, neglect, and exploitation; grants to expand trauma care services and improve regional coordination of emergency services; and demonstration projects to implement alternatives to current tort litigation for resolving medical malpractice claims, among other provisions. The Congressional Budget Office estimated that ACA's discretionary spending provisions, if fully funded by future appropriations acts, would result in appropriations of approximately $106 billion over the 10-year period FY2010-FY2019. Most of that funding would be for programs that existed prior to, and whose funding was reauthorized by, ACA. Few new programs created by ACA received funding in FY2011 or FY2012.

Through mid-May 2007, the United States had confirmed three cases of bovine spongiform encephalopathy (BSE, or "mad cow disease"): the first in December 2003 in a Canadian-born cow found in Washington state, the second in June 2005 in cow in Texas, and the third in March 2006 in a cow in Alabama. Shortly after the first case, U.S. Department of Agriculture (USDA) and other officials announced measures to improve existing safeguards against the introduction and spread of BSE. Previously, the major safeguards were: (1) USDA restrictions on imports of ruminants and their products from countries with BSE; (2) a ban on feeding most mammalian proteins to cattle and other ruminants, issued by the Food and Drug Administration (FDA); and (3) a targeted domestic surveillance program by USDA's Animal and Plant Health Inspection Service (APHIS), the agency responsible for animal health monitoring and disease control.

This book presents important analyses of current issues in BSE (bovine spongiform encephalopathy or "mad cow disease") as a fatal neurological disease of cattle, believed to be transmitted mainly by feeding infected cattle parts back to cattle. More than 187,000 cases have been reported world-wide, 183,000 of them in the United Kingdom (UK) where BSE was first identified in 1986. The annual number of new cases has declined steeply since 1992. Humans who eat contaminated beef are believed susceptible to a rare but fatal brain wasting disease, variant Creutzfeldt-Jakob Disease (vCJD). About 160 people have been diagnosed with vCJD since 1986, most in the UK and none linked to any Canadian or U.S. meat consumption.