Convocation Address by

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

to the

University of Medicine and Dentistry of New Jersey
New Jersey Medical School
Newark, NJ

Sunday, May 21, 2000

[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.]

Thank you very much for that very kind introduction, Dr. Lourenzo, and thank you for such a warm reception. To President Cook, members of the board, other administrators and faculty, to family members and friends, and especially to the Class of 2000, I am delighted to be here. I’m delighted to be able to join you on this very special occasion in the history of this institution and especially in your lives. I'm having trouble because I am so overwhelmed by that statement by Christopher Reeve. Why don't we give him another hand? (Applause)

I mean, just think of the courage that it takes each of us just to get through the day, every day, and just imagine the courage that he has had to muster to be able to arrive at this point in his recovery and to speak to you today. That type of courage is a source of hope and inspiration for all of us. And I must say I think that if we continue the research that he has worked so hard to support by lobbying Congress and elsewhere, I think the day will indeed come when we will be able to overcome many of the real challenges that we face in the health of people of this country, including his paralysis.

Let me say that I bring you greetings from Washington, DC, from the Department of Health and Human Services, and especially from the Office of the Surgeon General. We all congratulate you as you prepare to leave this great institution. I was fortunate enough to receive an honorary degree here in 1995 and, at that time, your Dean said to me, "David, I hope that one day you will come back and speak to our graduating class." Neither of us knew then that I would no longer be Director of the CDC, but the Surgeon General and Assistant Secretary for Health, or that he would be in his last year here, but I am delighted to be here and to be able to share with you today.

I want to say three things to you. The first is congratulations, of course. I want to really commend you for all of the hard work and dedication that has brought you to this point in your life and career.

I also want to say I hope that you will celebrate. As one who has a reputation for not taking enough time to celebrate, I want to encourage you to stop and celebrate the significance of this day and to somehow bring to closure the outstanding period in your life that has brought you to this point and that has prepared you to move on to the next very important period in your life. It is, indeed, time to celebrate—time to celebrate with friends and families, time to reflect on the past, time to contemplate the future. So I encourage you to celebrate.

And then I want to encourage you to continue. Continue your dreams, continue your goals. Moses, in the Dreamworks production of "The Prince of Egypt," when he had decided to go back to Egypt, was asked by his wife, Zipporah, "What is it that you want for your people anyway?" He thought about that and said, "I want them to have hopes and dreams and a promise of a future with dignity." I'm convinced that you're here today, not only because of your hard work, but because of your hopes and dreams, and also the hopes and dreams of a lot of other people, many of them in this audience today. And I hope that you will continue your hopes and dreams, just as Christopher Reeve said.

Langston Hughes, in one of his outstanding poems, said, "Hold fast to dreams, for if dreams die, life is like a broken-winged bird that cannot fly. Hold fast to dreams, for if dreams go, life is like barren land, covered with snow."

So as you leave here today and face all of the challenges that you know you will face out there in the practice of medicine, don't lower your standards. Don't give up your dreams. Hold fast to dreams.

I want to ask your help, before I sit down today, in an area that's very important to me. It reminds me of the story, which I'm sure many of you have heard, of the college basketball player who was just outstanding. Everybody knew his name. So when he graduated, he was drafted very early by the Chicago Bulls and went to play right along with Michael Jordan. He worked very hard. He was determined to make the team and sure enough, one day the coach said to him, "Tonight you're going to start the game, right along with Michael Jordan." So he was excited, he got in the game, he worked hard. On that particular night, Michael Jordan was at his best. He scored 60 points. The rookie scored one point, a free throw. When the game was over, the press was anxious to interview both Michael Jordan and the rookie. Michael was great. They all had one question for the rookie, "How will you remember tonight?" And he responded by saying, "I will remember this as the night when Michael Jordan and I combined for 61 points."

I am convinced that there is no limit to what you can accomplish when you combine with the right people. And one of the reasons I am excited about being here is because I am excited about combining with you to work toward the goals of Healthy People 2010, the next ten-year plan for the health of the American people. Let me just mention those two goals, which we announced three months ago in Washington.

One is to work to improve the quality of life of the American people. We acknowledge that we have made a lot of progress in extending the years of life. In the last century, life expectancy increased by 30 years. In fact, the fastest growing group of people in this country today are people over 80 years of age. But while we have been successful in increasing the years of life, we're concerned about our progress related to the quality of life. So we want to put more emphasis on managing disabilities and more research in dealing with disabilities. We want to put more emphasis on the treatment of diseases, such as arthritis and osteoporosis, the management of chronic pain, and the aggressive diagnosis and management of depression in the elderly—things to improve the quality of life of all people in this country.

The second goal of Healthy People 2010 is interesting because it grows out of President Clinton's Race Initiative, which he announced almost three years ago. But as a part of that initiative, he asked each cabinet head to develop some strategy for supporting the race initiative. In our Department, we decided to make a commitment to work toward the elimination of disparities in health among different racial and ethnic groups. And those are the two goals that I want you to help us to achieve.

Let me give you just some examples of disparities. I’m sure you have seen them in your work. Today in this country, an African American baby is more than twice as likely to die in the first year of life than his or her white counterpart. An American Indian baby is at least one-and-a-half times more likely to die. Thus, infant mortality is a critical area of disparity. Newark, in particular, and the state of New Jersey as a whole, of course, have made a serious commitment to eliminate disparities in infant mortality, and we are very pleased to work with your Department of Health.

The second area is cancer. Today in this country, African American men are twice as likely to die from prostate cancer. Vietnamese women are more than five times as likely to suffer cervical cancer. And while white women have the highest incidence of breast cancer of any group in this country, African American women have the highest death rates from breast cancer. Asian Americans are three to five times as likely to suffer liver cancer, often associated with untreated hepatitis. So cancer is a major area of concern, because, despite the fact that we're making progress in treating cancer, we still have a long way to go toward eliminating disparities in health.

In the area of diabetes, we have one of the most dramatic examples. Of our American Indian populations, the Pima group of Phoenix, Arizona, has the highest risk of diabetes of any known group in the world. As a whole, American Indians in this country are three times as likely as the majority population to become diabetic; Hispanics are twice as likely. African Americans, because of the combination of diabetes and hypertension, are at great risk for end-stage renal disease.

Even HIV/AIDS, which started out as primarily an epidemic of white, gay men, is today becoming increasingly an epidemic of people of color, of women, and of the young.

I could go on and on with many other examples of disparities, but what’s important for us to note is that by working together, we believe we can eliminate them. Since we announced our commitment, we have formed several strategic public/private partnerships. For example, Grantmakers in Health, which represents over 200 foundations, has made the elimination of disparities in health a major priority. In addition, the American Public Health Association has agreed to partner with our Department to work toward the elimination of disparities.

But I guess a question that should be in your mind is, "How do we best eliminate disparities in health?" I wish that we had all of the answers. I do know that some of them will require more research. In addition, we decided for Healthy People 2010 to do something that we have not done in the past 20 years of Healthy People. We decided to develop what we call "10 Leading Health Indicators," which are similar to leading economic indicators. We will monitor these indicators on a year-to-year basis. Let me briefly share them with you. Five of them relate to the health care system and five to lifestyles.

In the health system, obviously the most pressing concern is access to quality health care. We spend more than $1.5 trillion a year on health care in this country. Yet we have almost 45 million people uninsured and many others who are underinsured; then there are those who are among the underserved and the underrepresented—all of them fall into categories that impair access to quality health care. Together we must work to solve this problem and the very problem which Mr. Reeve mentioned in terms of what's happening in health care in this country. It's not unrelated to the fact that what we need in this country is a balanced community health system, a system that balances health promotion, disease prevention, early detection, and universal access to health care. That's the critical problem that we are facing. And while we attempt to cut costs, we cannot continue to do things that in fact discriminate against patients and their need for quality health care. So we need a balanced community health system. But we also need a new kind of partnership between public health and medicine and I appreciate the work of this institution in the development of the International Center for Public Health. We need a balanced research agenda, which balances biomedical, basic, clinical, health services, behavioral, and community-based prevention research.

In the area of health systems, the only other area that I would mention today is mental health. We released the Surgeon General's Report on Mental Health in December, and the response from the American people and globally has been overwhelming. We pointed out that one in five Americans experiences some form of mental illness every year in this country. The good news, of course, is that because of the science of the last 25 to 30 years, we can treat mental illness 80 to 90 percent of the time. We can return people to productive lives and positive relationships. The bad news is that fewer than one-half of the people who experiences a mental disorder each year even seek care, and many of those who seek it have trouble finding quality mental health services. So we're committed to, number one, de-stigmatizing mental illness in this country, and number two, to developing a system of parity of access to mental health services.

The other three health system areas are environmental quality, injury and violence prevention, and immunizations. But I'll leave those with you, because I want to spend the remainder of my time discussing lifestyles.

There are five lifestyle leading health indicators. They are physical activity, overweight and obesity, tobacco use, substance abuse, and responsible sexual behavior. Together, these lifestyle issues account for more than half of the deaths that we see in this country every year. Now I have to tell you that these five leading health indicators are on par with the Surgeon General's Prescription, which we have been writing in this country for over a year-and-a-half. (So that you won't miss it, this is a blown-up version.) There are no medications on the Surgeon General's Prescription. Let me read to you the four things we prescribe:

• One says physical activity at least five days a week, 30 minutes a day.
  
  
• Two, good nutrition. Eat at least five servings of fruits and vegetables per day and increase your intake of grain. As you know, the American diet is loaded with fats and sweets and deficient in fruits and vegetables and grains. During the last decade, overweight and obesity rose to an all-time high in this country and even childhood obesity doubled since 1980.
  
  
• The third thing on the Surgeon General's Prescription is avoid toxins, beginning with tobacco. Now, tobacco should be a no-brainer. The first ever Surgeon General's Report in 1964 was on smoking and health. And we have made progress. And yet today there are still far too many Americans who smoke, damaging their own health and the health of others around them. David Kessler, as head of FDA, declared smoking a pediatric disease and I want to join him in that. Most of the people who smoke in this country begin smoking as children. They are addicted to cigarettes before the age of 18, when they are legally old enough to buy them; so smoking is indeed a pediatric disease and we have a responsibility to protect our children. I hope that in your practice, in your community, and also for all of your patients who smoke, that you will be as diligent about writing a prescription for them to quit as you will about treating any disease.
  
  
• Four is responsible sexual behavior. In the face not only of AIDS but teenage pregnancy and other sexually transmitted diseases, we need to talk more about responsible sexual behavior, including abstinence when not involved in a meaningful relationship and protecting yourself and others against unwanted pregnancy and disease when sexually active.
  
  

That's the Surgeon General's Prescription. I encourage you to adopt it as your own and distribute it to your patients and in the communities in which you live and work because that will make a great difference in the health of the American people.

Well, even if you are not able to achieve all of your goals in life, I want to encourage you to aim high. Let me leave you with this quote from Benjamin Elijah Mays, who was president of Morehouse College for about 27 years, including the 4 years that I was a student there.

"It must be borne in mind that the tragedy of life doesn’t lie in not reaching your goal. The tragedy lies in having no goal to reach. Don’t be afraid to dream. It isn’t calamity to die with dreams unfulfilled, but it is a calamity not to dream. It is not a disaster to be unable to capture your ideal, but it is a disaster to have no ideal to capture. Reach for the stars. It is not a disgrace to fail to reach the stars, but it is a disgrace to have no stars to reach for. Not failure, but low aim is sin."

Thank you.