Monday, January 25, 1999

[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.]

Introductory Remarks

Acknowledgments

Good afternoon. Thank you Captain Paul Johnson for that kind introduction.

My pleasure in being here.

Greetings from the Office of Public Health and Science.

Appreciation

It is a pleasure to be here with the Reserve Officers Association for your Mid-Winter Conference and Military Exposition. It is a pleasure not only because the Association represents the full collective of federal health professionals from all the uniformed service health care disciplines, but because the ROA also represents the reserve elements of the two uniformed services for which PHS Commissioned Officers provide direct health and medical support, the Coast Guard and NOAA. Finally, it is a pleasure because of the longstanding special relationship between the ROA and the Public Health Service.

Let me express my gratitude for the dedication each of you in the reserves has shown in caring for this nation by living lives of flexibility and readiness. Your dual role as both military personnel and civilians carries with it a critical responsibility in terms of national security. I am sure I speak for us all, when I say—as citizens, as parents, and as fellow colleagues—how much we appreciate you.

I also want to commend this Association for your ongoing legislative efforts aimed at ensuring that the concerns and needs of the uniformed services are met. These efforts are great assets to have in these tight budgetary times, and we appreciate them.

I look forward to hearing what advances and improvements result from the Plan in the future.

Roles of the PDASH and DSG

Vision is critical to our future health as a nation. Helen Keller once said: "I would rather be blind than to have no vision." She understood that vision was much more the result of an internal focus than a physical capability. As Federal Uniformed Services, we must focus on the vision and share the responsibility of addressing our most challenging issues so that we can share the reward of a healthy and secure nation. Some visions will never happen unless they are shared.

In the DHHS, we recognize the need for close collaboration among the PHS and its Commissioned Corps, the OSG and others as we work side-by-side with the Reserve sections of the various services, and with the various Service chiefs, the other Surgeons General, the Department of Veterans Affairs, and the Uniformed Services University of the Health Sciences. These partnerships will strengthen the health and security of our nation.

To accomplish this, I will be depending on my deputies and senior staff to play a major role:

Dr. Nicole Lurie, the Principal Deputy Assistant Secretary for Health, will be a critical force in helping to develop and implement policies in the future.

And Dr. Kenneth Moritsugu, the Deputy Surgeon General, will be the principal link with the other Uniformed Services.

You will also see a combination of "new" and "old." RADM Mike Blackwell will soon be joining the staff of the OSG to serve as the new Chief of Staff. RADM Art Lawrence, who served as acting DSG, is continuing in the senior ranks on my immediate staff and will provide advice and counsel on reserve affairs.

I will be relying on their wisdom, knowledge, and considerable "brain power" to assist me as we move forward with modernizing our own inactive reserve structure.

With their leadership and our collective vision, I am confident that the nation's security and health will continue to thrive and improve, building on the success of the Public Health Service for the last two centuries.

PHS Bicentennial This Year

The Public Health Service is celebrating its bicentennial. It was in 1798 when President John Adams signed the act of Congress in Philadelphia, giving rise to the Marine Hospital Service. The idea was to provide for the health needs of merchant seamen. At that time in this country, the sea was extremely important for trade and security. When merchant seamen would return home after setting out to sea, they often brought illnesses with them, endangering not only their health, but also the health of their families.

Since that time, we have grown to include eight agencies, with a budget of about $400 billion, 50,000 employees, 6,000 members of the Commissioned Corps. And so this whole idea that has now become the Public Health Service started as a response to those needs. Two centuries later, the driving principle remains the same: to the extent that we provide for the health needs of the most vulnerable among us, we do the most to protect the health of the nation.

Protecting the Security of the Nation

Protecting the security of our nation is more than military action.

Just as many of the federal services gear up each day to protect the nation against national security threats, the Public Health Service has as its mission to protect the nation against threats to the nation's health.

Looking Externally

We must always keep an eye on external threats to the health of our fighting forces; we must stay abreast of the effects of bioterrorism: chemical, biological, nuclear, or radiological warfare; we must learn how to protect our soldiers, sailors, and airmen from those effects, how to treat them if and when they have been affected; and we must focus on ways to prevent this form of warfare and on how to prepare our fighting forces to maintain their capabilities under these conditions; we must set in place global surveillance systems to define and predict threats to our troops in other parts of the world.

Looking Internally

This year, however, we are taking a different view of our services' defense mission. Instead of only looking outside at the potential threats around us, we are turning our attention inward to look at the potential threats within our forces.

For example: We will focus on those internal threats that challenge the integrity of our forces, within both the fighting forces and in our families that support our fighting forces; we will focus on those individuals who make up those fighting forces, and we will focus on our own health, because we know that healthy forces mean we are in a better position to ensure a healthy nation. Whereas at one time our troops were given cigarettes as part of their gear, we must now provide healthy nutrition and healthy behaviors.

Finally, we must not forget the stresses and strains that are placed on the families of those in uniform. Having loved ones who go in harm's way can have serious impact on the family unit.

The Best Weapon: Science

How do we in the Public Health Service do that? We do it with science.

People often refer to me as the nation's doctor. The nation looks to me to provide sound advice about country's health and well-being. Unlike Generals and Admirals in the military who rely on dollars or ships or aircraft or troops as their source of power and authority, the Surgeon General of the United States relies on science - the best available science - to manage and advance the nation's health. As Surgeon General, whenever I make a recommendation regarding health to the nation or to others in the Administration, it is always on the basis of good, sound science, and not on opinion, politics, or religious beliefs. This has been the longstanding tradition of Surgeons General in the past, but it has not always been an easy task.

Nevertheless good science has proven to be a resourceful and strategic tool used through the years to fight some of the internal battles that have posed threats to our nation's health. Quarantines and immunizations are good examples of that.

Surgeon General's Priorities

Since becoming Surgeon General and Assistant Secretary for Health, I have traveled the nation sharing our priorities. Not only have I been talking to people, but I also have been listening to them. Out of those conversations have come some very important developments that are represented in what I call my "evolving priorities." Let me share those priorities with you.

In similar fashion, I hope you will not only listen, but be attentive to ways that you can help make them work, because I'm going to need your help.

Every child should be given the opportunity for a healthy start in life. Getting a healthy start in life means several things. It relates to healthy mothers and healthy parents, healthy babies, and healthy environments. It means healthy pregnancies and access to prenatal care. It means addressing teen pregnancy so that babies are born to parents who are ready to be parents. It means a safe and nurturing environment in which to raise our children.

Our system must promote healthy lifestyles. This relates to nutrition, physical activity, responsible sexual behavior and the avoidance of toxins--including tobacco. We must ask ourselves: How do we convince people of every age to become more physically active? And how do we convince teenagers to resist tobacco or delay sexual activity? Especially when, throughout our entertainment industry, we glamorize smoking and irresponsible sex.

Sometimes people think that disease prevention pertains only to the young. But the science shows that we have just as much ability to significantly improve the quality of life for older people through more physical activity and better nutrition.

We must work to strengthen support for a balanced community health system. That system includes health promotion, disease prevention, early detection and universal access to care. Not only that, it must be undergirded by sound research and be community based.

We know that managed care is not the answer to America's health care problem; but we must also recognize that it is not the villain we make it out to be. What we have is a systems problem, and what we need is a viable community health system that focuses on prevention, access to care, and quality. Together we must get the best from our public health system, and together we must make it better.

We must improve the nation's mental health system. No priority yet has generated as much interest and enthusiasm as this one on mental health. We must remove the blame and stigmatization that surrounds mental health in this nation. Mental health problems often relate to other serious health problems we face in this country, including substance abuse and violence.

Last October, we held the first-ever national conference on suicide prevention. It was hosted by the Centers for Disease Control and Prevention (CDC), the National Institute on Mental Health (NIMH), the Substance Abuse and Mental Health Services Administration (SAMHSA), and the Health Resources and Services Administration (HRSA). It was the first time health professionals, suicide survivors, and policy makers have been brought together under one roof, in an effort to shape a different future for this country as it relates to suicide and mental health. We hope to gain out of that a Surgeon General's Conference Report on Suicide Prevention. And in the next year or so, we anticipate a Surgeon General's Report on Mental Health.

We must keep a global perspective on matters of public health. We cannot protect the health of the American people unless we think globally; it takes an individual under 36 hours to travel around the globe, increasing significantly the threat of outbreaks of disease or violence and the movement of tobacco across borders and seas in a matter of moments. As we approach the 21^st century, our efforts will be focused on a maintaining a system of global health and surveillance, particularly with regard to the following three areas: (1) coordinating the national response to emerging infectious diseases, (2) leading the national response to health consequences of bioterrorism, and (3) promoting the safety and availability of the nation's food and blood supply.

Eliminating Disparities in Health. Back in February of this year, the President unveiled his Initiative on Race and Health. In it, he announced a goal of eliminating racial disparities in health by 2010, coinciding with the Healthy People 2010 Initiative. For all the medical breakthroughs we have seen in the past century, we still see significant disparities in the medical conditions of racial groups in this country.

What we have done through this initiative is to make a commitment--really for the first time in the history of our government--to eliminate, not just reduce, some of the health disparities between majority and minority populations.

We have selected six areas to being our efforts and focus. They are reducing infant mortality, increasing child and adult immunizations, reducing new incidents of HIV, reducing cardiovascular disease, increasing screening and management of breast and cervical cancer, and reducing the risk factors for diabetes that lead to blindness, amputations and end-stage renal disease.

Our goal is to close these gaps by 2010. If we hope to succeed, our greatest chance is through addressing at the community level.

Eliminating disparities is not a zero-sum game. We are not taking anything from anyone when we ensure everyone's good health. We know that the entire nation benefits when we protect the health of those most vulnerable and at risk. The Public Health Services was founded on this premise 200 years ago.

Conclusion

I have spoken today about our vision and goals for the future and many of them are challenging to say the least. But I am confident that we can accomplish them. In the words of my colleague and former Health, Education, and Welfare Secretary John Gardner: "Life is filled with golden opportunities carefully disguised and irresolvable problems."

I look forward to working with all of you. Thank you.