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

June 4, 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 evening. I bring you greetings from Washington, DC, the Department of Health and Human Services (HHS) and the Office of the Surgeon General. It’s my pleasure to be here.

Let me begin by commending Population Communications International for hosting this Prime-Time Summit and for their ongoing efforts to foster dialogue and to promote responsible and safe television.

It has been nearly 3 years since Health and Human Services Secretary Donna Shalala spoke to this group. In her speech, she said she did not come to preach, neither did she come to say that nothing needed to change. Rather, she challenged you "to take a larger role in a great national drama to improve the health and lives of all our citizens." She challenged you to think about the responsibility each of you has to public health and the need to show the consequences of risky and unhealthful behaviors. And she offered ways the HHS could help by providing you with timely and accurate data on relevant social issues.

And just like a good soap opera, I want to pick up where she left off by building on that message. When I was growing up, they weren’t called soap operas; instead, people called them "stories." That was really an accurate term, because from week to week they served as a continual story that those in the community who watched could share and talk about.

I know something about the power of stories. Soon after I became Director of the CDC, a reporter who doubted that any good thing could come out of Anniston, Alabama, decided to do some investigative research in preparing to write a story about me. He searched for information about my life and even talked to my boyhood neighbors, family and friends, hoping to find something to spice up his story. As it turned out, he ended up writing a magnificent piece that his editor put on the front page of the Anniston Star.

Shortly after that, I arrived home one evening to receive a bundle of letters with postmarks from Anniston. As it turns out, the article appeared in the paper just about the same time that an 8^th grade teacher from Anniston had been struggling to find some way of giving her students a new outlook. She had them read the story and then write letters to me. At my wife’s insistence, I began reading them.

The first was from a young boy, who said that he had just gotten in a gang, but after reading the story about me, he decided that gang life was not for him and he was going to get out.

The second one was from a young girl, who said that she did not know what she wanted to be when she grew up before she read the article, but after having read it, she now knows that she wants to be the director of the CDC.

The third letter was from a boy who must have been like me when I was growing up. He must have been daydreaming or only half-listening when this assignment was being discussed, because his letter said that he did not know what the CDC was but he sure hoped I found a cure for it!

Stories have been important for centuries. No matter the tradition, no matter the culture, stories have set the stage for how a society would be defined.

Aside from simply being entertaining, stories also have helped to define the traditions, the roles and the morals of our communities. People have depended on them to help them to understand how to build community and maintain connectedness.

And always, the storyteller held a revered place in the community. As the keeper of the message, they had a responsibility to maintain and uphold the tradition through application, accuracy and relevancy.

You here tonight serve as our storytellers, whether it’s a drama, a prime-time sit com or a saga. As the storyteller—the deliverer of the message—you still hold that revered place in society and that awesome responsibility to help us build community through the stories you tell.

My earliest experiences with television were positive ones. I saw the importance of the media first-hand as a child growing up in Alabama at the outset of the Civil Rights movement.

When I was sick as a 2-year-old and near death, the local hospitals were not available to me. While there was a schoolhouse about a mile away, I had to ride on a school bus for more than an hour to go to a black school. I remember when I was 12 years old, my brother ran home one day to tell me he had heard George Wallace give a speech in a park in Anniston, Alabama, in which Wallace said he would deputize every white man in Alabama before he would let one colored person enter the doorway of the University of Alabama.

For decades, African-Americans felt there was little to do about these problems. But community leaders such as Martin Luther King and the SCLC showed us there was not only a way to address them, but there was a non-violent way to resolve them. Meanwhile, the media continued to shine a bright light on those efforts, as well as the injustices being fought. They made people aware of the conditions that existed and the all-too-real consequences of those conditions. Without the media, the civil rights movement of the early 60s would not have succeeded.

I also recall the story of a young African-American actress whose role was Lt. Uhura—a member of the famed crew of Star Trek’s Star Ship Enterprise. At the end of Star Trek’s first season, actress Nichelle Nichols was thinking seriously of leaving the show, until a chance meeting with Rev. Dr. Martin Luther King changed her mind. He told her not to give up and that she was a vital role model for young black women in America. Needless to say, Nichelle Nichols was so moved that she stayed with the show and has appeared in six of seven subsequent movies.

Then there’s the story of another actress who, as a child, was so inspired by the show that she said it changed her outlook on life. "Star Trek is something I wanted to do since I was a little girl. It was the first show that said ‘yes, there’s a future for black folks.’" That actress was Whoopi Goldberg.

Television can have a tremendous impact on our lives. I am sure there are countless other stories reflecting how Hollywood has changed attitudes and given hope to hopeless situations. But we need more.

I come here tonight with the hope of soliciting your input and your feedback and your support. I intend to be as specific as possible about the help we need from you and I hope you will do the same for us.

Many people these days say we should not be pointing fingers about the problems we face in this country. Well, I must tell you that I am here tonight to point fingers—not just fingers of blame, but fingers of responsibility and opportunity.

We cannot be lulled into thinking that the recent tragedy in Littleton, Colorado, is an anomaly. It is, in fact, reflective of a larger persistent problem we face in this country. While it is truly a tragedy that 15 children were killed at Columbine High School, the fact is that violence claims the lives of between 13 and 15 young people in communities across the Nation every day.

Violence has acquired a uniquely American flavor. When you compare youth violence in the U.S. to that in other countries, we’re off the chart. In 1996, 15 children died in Japan from firearms; in Britain, 30; in Canada 105, but in the United States, over 9,000. Comparatively speaking, America is an unsafe place for children.

It is human nature to put distance between ourselves and the perpetrators of horrendous acts, and that has certainly taken place in the area of youth violence.

When 8-year-old Yummy Sanders was killed by gang members in Chicago a few years ago, the media was full of reports about the violent pathology of black families.

When shootings took place at schools in Jonesboro, Paducah, and Pearl, one of our leading news anchors decried the violent culture of the South.

But then something happened—a shooting in an idyllic suburb in Colorado, a place where this was never supposed to happen. Suddenly, the distancing didn’t work; the stereotypes didn’t apply. Suddenly, people began thinking: "Maybe this isn’t just about "them," whomever "they" are. Maybe it’s about us, and about our communities. Maybe it’s time to look at our communities to see how we can prevent such things.

Today, violence is the second leading cause of death for those between the ages of 18 and 24; and for African Americans in that same age group, it is the leading cause of death.

A military psychiatrist named David Grossman—who incidentally was one of the first mental health professionals on the scene of the school shootings in Jonesboro, Arkansas—recently wrote a book, On Killing, about the way the military has systematically trained its recruits since World War II to be desensitized to violence and killing. He notes that some of these techniques now appear in movies and on television and in some of our video games.

When we hear reports like that, nobody can escape the aim of the finger-pointing. This is not a no-fault circumstance we are experiencing. It must be viewed as everyone’s responsibility if we are to rectify it.

Together, we must limit access to weapons of violence; we must reduce the gratuitously violent content of television, movies, and video games, while improving their content; and we must strengthen the role of parents and mentors in helping children to deal with anger, resolve conflict, and have empathy with others.

How can you help? First, we know that your role is to entertain. But we believe that you can entertain as well as educate. You have already demonstrated that on numerous occasions. When I was director of the CDC, we worked with programs such as "E.R." in which you showed America the true face of HIV/AIDS and the growing epidemic of the hepatitis C virus. Like HIV and hepatitis C, violence is also a public health problem, and it is also preventable.

And while we know that violence is entertaining, we also believe that it is important to point out that violence has consequences. Those consequences are real and lasting for the victims, the perpetrators, and certainly for the people who are working in the criminal justice system. We see those consequences every day in the public health system, not only in the form of death but also in the form of unnecessary pain and suffering, chronic disabilities, and chronic dependency.

We want to work with you in educating the American public about these consequences and its preventable nature. We want to help you show the American people that violence is learned, and violence can be unlearned. We must work together to implement this public health agenda.

President Clinton recently asked me to prepare a Surgeon General’s report on youth violence. This will not be the first Surgeon General['s] report on violence. In 1972, a panel of experts put together a report to the Surgeon General demonstrating the impact that television violence has on children. It found that some children imitate the violence they see and some may even be provoked to violence, and while not all children respond the same way to violence, there are some that do respond in a violent way.

I also agree with a 1985 report from a workshop held by Surgeon General Koop, which concluded that it is time to reduce the violent content of our television shows and movies as well as youth access to firearms.

As we work on this latest report, I want it to be a transparent process. I want to invite the entertainment industry to be a part of that process.

But violence is not the only health problem area I want to discuss tonight. There are other ways you can be of help. We are trying to create a balanced community health system that emphasizes health promotion, early detection, treatment, and access to quality care.

A balanced community health system requires the participation of all of the institutions within the community, including the home, the school, the church and faith-based organizations, criminal justice, entertainment and others—not just the health care system. Public health is everybody’s business.

There are several ways you can help us jumpstart this move.

We know that a balanced community health system cannot achieve its goals unless we ensure that every child has an optimal opportunity for a healthy start in life. That requires parents who are ready to be parents, safe pregnancies, access to quality prenatal care, and safe and nurturing environments, including the absence of violence and toxins such as illicit drugs and tobacco.

There have now been 28 Surgeon General reports on smoking and health since 1964. We have made progress among adults, reducing the percentage of smokers from nearly 50 percent in 1964 to about 25 percent today. But every day in this country 3,000 children begin smoking, and 1,000 of them will become addicted before they are old enough to buy cigarettes legally.

We would like to see a decrease in smoking in television programs and movies that is at least comparable to the reduction in smoking since 1964. Especially for our children, we would like to see more emphasis on the consequences of smoking—430,000 deaths per year, 65,000 deaths from second-hand smoke, 26,000 cases of asthma in children, and thousands of deaths from sudden infant death syndrome.

Another important area where we would like to work with you involves mental health. Mental health impacts every area of our lives and relationships. Mental health problems are as common as physical health problems. Yet for too long our attitude toward them has been stigmatization and blame instead of caring and support. It is time for a change.

On Monday the White House will hold the first-ever White House Conference on Mental Health. By the end of the year, we will release the first-ever Surgeon General’s report on Mental Health. The challenge here is to enhance the awareness of the nature and magnitude of mental health problems and the opportunities which we have for prevention, early detection and access to effective treatment.

Sometimes Hollywood depicts people with mental illness as wacky, zany and amusing—like Jack Nicholson’s character in "One Flew Over the Cuckoo’s Nest." Sometimes it portrays them as violent, threatening and menacing—such as Jack Nicholson’s character in "The Shining." And then there are times when they show people who are at neither extreme—but who function in society despite any obstacles posed by their illness—like Jack Nicholson in "As Good As It Gets." We want to help overcome the stereotypes and help people realize that, just as things go wrong with the heart, the liver and the kidney, things can go wrong with the brain, and there should be no shame in that.

Other countries have been successful in taking on this challenge. Australia is one of those countries, and we’ve been talking with officials there to find what lessons we can apply here. I’d like to share with you some public service videos that Australian officials have employed that embody the approach we hope to take.

You can see how the attitudes and reactions conveyed in a script can make an impact on changing perceptions overall.

Let me close by sharing with you the words of Dr. Benjamin Elijah Mays, a friend and mentor of mine who was President of Morehouse College in Atlanta when I was a student there. He was responsible for educating a number of young black men like myself who were born to poor families in the rural South and were not expected to amount to much. Every Tuesday he would address us in chapel. He had a lot of sayings, but I would like to share one particular saying of his with you this evening.

He said: "It must be borne in mind that the great tragedy of life doesn't lie in failing to reach 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."

I look forward to working with you and I hope we will never be guilty of low aim. Thank you and good evening.