David Satcher, M.D., Ph.D.
Assistant Secretary for Health and Surgeon General
Office of Public Health and Science

Tuesday, January 25, 2000
9:30 a.m.

[This text is the basis for the Assistant Secretary for Health and Surgeon General's oral remarks. It should be used with the understanding that some material may be added or omitted during presentation.]

Good morning. I am delighted to be here, and I want to join Secretary Shalala, Secretary Sullivan, and Dr. Richmond in welcoming you to this historic event.

The fact that each one of them is here on the platform today is testimony to the fact that something special is going on here today. Zora Neale Hurston said that "The present is an egg laid by the past that has the future in its shell." Today, under the watchful and nurturing eye of Dr. Shalala, Dr. Sullivan, Dr. Richmond, Dr. Lee, Dr. Duval, Dr. Windom, Dr. Mason and so many others, we are witnessing the birth of another Healthy People that will grow and develop over the next 10 years. Today, we are witnessing the progression of the Healthy People process — a process that is built on a solid past, a vibrant present and a hopeful future. We have an obligation to keep it moving forward, all the while working to improve it so that we can create a healthier America.

As you know, this is the third iteration of Healthy People, and we think it represents an exciting document. What makes it so special? It is by far the largest and most comprehensive document we've launched thus far, with 28 focus areas and 467 objectives.

Healthy People 2010's two overarching goals of increasing years and quality of life and of eliminating racial and ethnic disparities in health are also indicative of our connection to the past and the major achievements we hope to see by the end of this decade.

Of special distinction and importance in Healthy People 2010 are the new set of 10 leading health indicators developed with the users in mind. That means they are clear, understandable and user-friendly. It's the first time they've ever been released with Healthy People and they offer a great deal of promise for our ability to communicate goals and to measure progress.

But that's not all. What makes Healthy People so significant is the expanded opportunity it provides for public and private sector involvement in addressing the most preventable threats to health. Through health promotion and disease prevention, we will be working on creating tomorrow's generations of healthy people today.

Given our time limitations, let me focus on three areas: the Healthy People goals of eliminating disparities and increasing quality and years of healthy life and the Leading Health Indicators.

We have heard from many people who have told us that our goal of eliminating disparities by 2010 is overly ambitious. We have responded by saying that in the 21^st century, neither history nor humanity can settle for less. That commitment to eliminate disparities has already galvanized communities, states, and non-governmental organizations throughout the country to develop their own commitments and strategies.

Eliminating disparities is not only good for our country, it not only makes sense, but it is fundamentally right. It is something that we can and something that we must accomplish. It is not a zero-sum game. The pursuit of this goal will bring Americans closer together in health and commitment and it will improve our system of medicine and public health.

This begs the question of "how?" Or, to put it more broadly, how will we accomplish our objectives. In short, by working together at every level of government and community, with a balanced community health approach.

Those of us in leadership have both a great opportunity and obligation to set the direction for the nation. But setting the direction is only part of the responsibility.

To reduce disparities in the nation, we must reach out to communities. They're the ones who are really at the heart of this plan. We must listen to them and learn from them. We must work with them to provide resources, information and technical assistance to make a difference in their own health status. And we must help them to successfully navigate their way through the complexities of our health system. In short, we must create real and meaningful partnerships with communities.

Together, as a nation, we must move toward a balanced community health system — one that makes access to quality care available to all; that balances early detection of disease with health promotion and disease prevention; that draws on the involvement of the community, including homes, community schools, churches and other faith-based organizations, and civic and local groups.

The other Healthy People goal, of increasing years and quality of life, is equally as timely as our population gets older. In the last 100 years, we have added 30 years to overall life expectancy, increasing it from 47 to 77 years old. But just adding years to life is not enough without also adding quality. So, we have to ask ourselves: How do we improve the quality of all of our years? How can we better manage chronic illnesses, disabilities, pain and depression so that all of our years are the best they can be?

We realize that the sheer size of the Healthy People 2010 document can be daunting to some, but we wanted to make it comprehensive enough for state leaders and health care professionals to be able to adopt areas that will help them tailor the initiative to meet their needs.

In an effort to communicate clearly and involve everyone, we created what you might call the "reader's digest version." Healthy People 2010's new counterpart, the Leading Health Indicators, is succinct and readable enough for most people. It details the key steps that individuals and communities can take to enhance their health and the health of their families.

The Ten Leading Health Indicators are divided into lifestyle challenges and system enhancement challenges. The lifestyle challenges are physical activity, overweight and obesity, tobacco use, substance abuse and responsible sexual behavior. The system challenges are mental health, injury and violence, environmental quality, immunizations and access to health care.

These areas undoubtedly represent some of the most important challenges facing public health today.

For example, the leading preventable cause of death in the United States is tobacco use. Each year, 430,000 deaths are attributed to tobacco. This is especially alarming considering that 3,000 teens become new smokers every day. We are calling upon Americans —individuals, families, and collective communities — to work to change this, and we are prepared to monitor our progress.

The second leading preventable cause of death is attributed to dietary factors and physical inactivity. Over 300,000 deaths each year are attributed to these factors. Again, our children are at increasing risk as the prevalence of overweight and obesity continue to rise overall, but especially among our children. If, as a society, we don't do something soon to address this issue, the recent advances we have seen in our death rates may begin to take a turn in the wrong direction. Again, we are prepared to monitor our progress in physical inactivity and good nutrition and report to the American people on a regular basis.

We are working in the area of mental health, where just last month we released the landmark Surgeon General's Report on Mental Health, where we announced that 1 in 5 Americans suffers from a mental disorder. Of all the areas I've been involved in as Surgeon General and Assistant Secretary for Health, none has garnered more enthusiasm and interest than mental health. I am sure that as a Leading Health Indicator, this area will make a huge difference in the lives of so many in the nation. We will monitor the progress of states, while we also monitor federal programs to provide equity of access and mental health services.

But so will we monitor all of these leading health indicators. We hope this will allow states and communities to evaluate their health status, assist in prioritizing what actions they want to take, and help them assess their success over time.

Let me add, however, that it will not be possible for states to achieve these goals without addressing the health concerns and needs of incarcerated populations. Increasingly, we are taking programs from the Centers for Disease Control and Prevention and the Health Resources and Services Administration, as well as the priorities of the Assistant Secretary for Health and Surgeon General's into corrections institutions.

In a moment, I will present Secretary Shalala with the Healthy People 2010 document that will officially launch this campaign. As I place it in her hands, I want you to consider your part in this launch. This is not a project of the government alone. It is not a program of associations and organizations alone. It is not something we can simply leave up to health care professionals alone. And it's surely not something that communities can do alone.

We must work together.

So I challenge you to look closely at Healthy People 2010 and find the areas where there is mutual concern between what this national plan wants to accomplish and what you want to accomplish.

Then, let's talk. Come back to us and let us know how we can achieve mutual goals. That's what made this process so successful in the first place. And it's what has gotten us to this point today.

To help communicate our message, we will be distributing throughout the country the Surgeon General's Prescription for Healthy Lifestyles, which covers all of the lifestyle Leading Health Indicators.

During the span of Healthy People 2000, 46 states adopted plans of their own. Our goal this time is to ensure that all 50 states are enrolled. In fact, our hope is that by next year this time, we will have identified one or more partner organizations for most, if not all, of the objectives — partners who are willing to work with us and with others to help achieve these objectives.

We are proud of the commitment we've already seen from associations like the American Public Health Association, where Dr. Muhammad Akhter and the membership have named eliminating disparities as its number one priority, and states like Minnesota, where Governor Ventura announced last year that it would make eliminating disparities one of the state's top priorities. Not only did they make the announcement, they have developed the programs to achieve it.

So we're well on our way.

The American Association of Academic Health Centers has found a group of health promotion institutions. Likewise, Grantmakers in Health has joined us to find communities to develop models for eliminating disparities. With these kinds of partnerships, I am certain that Healthy People 2010 can serve as the driving force for creating tomorrow's healthy people today.

That's just the beginning. And that's why I am so excited about Healthy People 2010's potential. It's also the reason why I am so proud to formally present this document to the Secretary of the Department of Health and Human Services.

Madam Secretary, if you will join me here —

I am delighted to present you with this first official copy of Healthy People 2010. You will note that not only am I presenting you with the two volume set, I am also presenting you with the shorter book, Understanding and Improving Health, that includes the Leading Health Indicators. But perhaps most reflective of the times in which we live and your leadership, is this — the first CD-ROM version of Healthy People 2010.

So, it's official. Thank you.