Remarks as prepared; not a transcript.

RADM Kenneth P. Moritsugu, M.D., M.P.H
Acting Surgeon General
U.S. Department of Health and Human Services

Remarks at the Inside Washington 2007 Academic Seminar

Thursday, January 4, 2007
Washington, D.C.

"The Importance of Disease Prevention and Personal Responsibility"

Greetings and Acknowledgements

Good morning.

Thank you, Dr. Baker, for that kind introduction.
[Ross Baker, PhD, Professor of Political Science, Rutgers University]

It is an honor to join you today for this Inside Washington Academic Seminar.

I always enjoy the opportunity to meet with young people. You are our nation's future leaders.

I am inspired by your energy, your eagerness to learn, and your desire to contribute to our great nation.

I have no doubt that you will make a difference and improve the health, vitality, and economic prosperity of all Americans.

My bosses, Department of Heath and Human Services Secretary Mike Leavitt and Assistant Secretary for Health Admiral John Agwunobi, both asked me to bring you their best wishes.

They are both strong advocates for developing our nation's students and emerging leaders.

Even though it's been a few years, we have all been interns at one point in our lives.

In fact, if you look around the Washington Beltway, many of today's top leaders started out as interns.

And when you're lucky, you find a great mentor… or a great program like the Washington Center for Internships and Academic Seminars to help you discover new possibilities.

I understand that there will be time for some questions and answers today, and I have rearranged my schedule so that I can spend some extra time with you today.

I believe that you are very important. You are important to our nation and you are important to our future.

And I would be happy to answer any questions you may have.

U.S. Public Health Service Commissioned Corps

I'm particularly interested in answering any questions you have about the uniformed service that I've been proud to serve in for more than three decades: the United States Public Health Service Commissioned Corps.

And I'll be completely open and transparent about my agenda:

  • I want to encourage all of you to consider a career in the Commissioned Corps.

We are one of the United States' seven uniformed services, like the Army, Navy, and Air Force.

We are a Corps of more than 6,000 public health professionals, dedicated to our mission of promoting, protecting, and advancing the health and safety of the nation.

Our officers work in their communities, and are sometimes deployed to national and international disaster locations and Special National Security Events. But not only do they deploy - our officers lead.

You can do just about anything in the Corps.

Just ask me.

  • I'll tell you about working in under-served areas.
  • I'll tell you about the research you can do at the National Institutes of Health or the Centers for Disease Control and Prevention.
  • I'll tell you about the work you can do to advise the health care decision-makers of our great nation.
  • I'll tell you about the bridges you can build through health diplomacy, reaching out across borders to help our friends and allies in times of crisis.

These are not "just jobs" for our officers. In fact, we are all very passionate about our work.

Think about it: You can join the U-S-P-H-S and help improve the health of all people, across the globe.

Congratulations on being selected to join the prestigious Washington Center Internship, and participate in this important Seminar.

I'd like you to consider your next steps and other opportunities that will build upon your experiences here.

Consider joining the U.S. Public Health Service and truly unleashing your leadership capabilities.

We have opportunities for you to join throughout every stage in your professional development.


For example, the Junior Commissioned Officer Student Training and Extern Program, also known as Junior CO-STEP, allows students to gain valuable professional experience early in their education.

Junior CO-STEP participants work throughout the nation during their official school breaks for periods from 31 to 120 days.

Another student opportunity is Senior CO-STEP.

Senior CO-STEP assists students financially during their senior year in return for an agreement to become a member of the U.S. Public Health Service.

And post graduation, you can become a full-fledged Commissioned Corps Officer.

As I mentioned, I'll be happy to answer your questions, and you can find more information at the web site:


I'm eager to tell you about the Corps partly because our Commissioned Officers support the Office of the Surgeon General's priorities for a healthy nation.

The President assigned three priorities to the Office, and I'll share some examples of how these priorities impact our nation.

  • The first priority is Prevention. - What each of us can do in our own lives and communities to make ourselves and our families healthier.
  • Second, Public Health Preparedness. H-H-S is investing resources at the local, state, regional, and federal levels to improve public health preparedness.

    We are improving public health preparedness for all hazards: manmade disasters and natural disasters, such as hurricanes, floods, and ice storms.

  • The third priority we're focusing on relentlessly is Eliminating Health Disparities.

    We don't just want to reduce health disparities, we must eliminate health disparities.

    It is unacceptable to President Bush, Secretary Leavitt, Assistant Secretary Agwunobi … and me that in our great nation, with our global leadership role in science and medicine that we still have major disparities in health and health care delivery.


Prevention is the cornerstone of everything that we do at H-H-S.

Expenditures for health care in the United States continue to rise.

And yet, each year millions of Americans die from preventable causes.

Most of the health care costs in the United States can be attributed to the diagnosis and treatment of chronic diseases and conditions such as diabetes, obesity, cardiovascular disease, and asthma.

Let's take a look at the numbers:

  • More than 20 million Americans, over 7% of the U.S. population, suffer from diabetes, which costs the nation approximately $132 billion each year in health care costs and other indirect costs. 1, 2

    People with diabetes lose on average more than 8 days per year from work, accounting for 14 million disability days. 3

  • Heart disease is the leading causes of death in the United States.

    This year alone, cardiovascular diseases will cost the nation nearly $432 billion each year in health care costs and lost productivity. 4

  • In addition, approximately 21.3 million adults and 9 million children have been diagnosed with asthma at some point within their lifetime, which costs the nation $16.1 billion per year in health care and other indirect costs. 5, 6

All that adds up to more than $580 trillion spent each year on diabetes, heart disease, and asthma. And that number doesn't even begin to take into account all the other preventable health conditions that also cause tremendous suffering.

And when you follow the money trail in health care, you will see that it is heavily weighted toward treatment and end-of-life care.

Beyond the financial costs, these statistics represent tragic situations for families and communities.

These are not just numbers. They are grandparents, mothers, fathers, sisters, brothers, friends, and community leaders who suffer and die unnecessarily.

As a nation, we are spending too little on preventing these conditions, and we are losing too many lives.

That's because right now we've got it backwards.

We live in a treatment-oriented society. We need to change to a prevention-oriented society.

We wait years and years, doing nothing about unhealthy habits and lack of physical activity, until people get sick.

Then we spend lots of money on costly treatments to try to make people well, often when it is already too late.

We need to refocus our efforts on preventing disease, illness, and injury.

The good news is that most of the illness, disability, death, and resulting economic and human costs can be entirely prevented by effective public health programs.

Five key steps can prevent most chronic diseases:

  1. Tobacco control,
  2. Good nutrition,
  3. Physical activity,
  4. Maintenance of a healthy weight,


  1. Regular health screenings.

And we have evidence-based strategies to improve each of these factors.

By and large, we know what to do to act now.

The challenge is to move our research and knowledge into action.

I want to tell you today about one major factor in our ability to translate the best science and research we have into action that will improve the health and well-being of all Americans.

It's called "health literacy."

Health Literacy

The reality is that we are largely a health-illiterate society, and this impacts every aspect of our lives.

Health literacy is the ability of an individual to access, understand, and use health-related information and services to make appropriate health decisions.

Unfortunately, our low health literacy is a major problem:

  • More than 90 million Americans don't know how to take care of their own health, or how to prevent disease. 7
  • And low health literacy impacts all sectors of our society. People of all ages, races, incomes, and education levels are challenged by it.

For the past four years, I've been working with colleagues throughout the nation to improve Americans' health literacy.

This past September, we held the first-ever "Surgeon General's Workshop on Improving Health Literacy."

I firmly believe that by improving health literacy, we can save lives.

The more people know about health, the better they can take care of themselves, their friends, their families, and their communities.

Basic health literacy is fundamental to the success of each interaction between health care professionals and patients - every prescription, every treatment, and every recovery.

It is a concern not only for those we serve - the American people - but also for those of us who work in the health care system.

For example, it's critically important that we transfer discoveries about health from biomedical researchers … to practicing professionals … to the general public as quickly as possible.

On average, medical technology and advances languish for 15 to 18 years before coming into practice.

We all know that means lives lost and the pain suffered - needlessly.

We can start correcting this problem by improving our nation's health literacy and incorporating health education into everything we do.

Every day, health care professionals are witnessing the health literacy gap…the chasm of knowledge between what professionals know and what patients understand.

We have to make sure that good health information is getting into the hands of the people who need it.

From researchers…to practitioners… to patients… to Inside Washington Interns… we all have a role to play.

Secondhand Smoke

One of the major prevention and health literacy efforts we are focusing on is secondhand smoke.

Our goal is to increase understanding of the need to reduce exposure to secondhand smoke.

By increasing health literacy about the dangers of secondhand smoke, we can ensure that the best available science is put to use.

After all, we have spent a lot of time gathering the best research on tobacco and its impact on health.

The work we are now doing is the next logical step: Communicating that science to the American people.

When it comes to smoking, the science is clear:

  • Smoking is the largest preventable cause of disease, disability, and death in the United States.

And the Office of the Surgeon General has a long history of exposing the risks of tobacco use.

I want to tell you about one of my personal role models…who also happened to be a Surgeon General.

He was a man who had vision and spoke out in the face of adversity… because it was important to the health and well-being of the American people.

In 1964, over 40 years ago, Surgeon General Luther Terry issued the groundbreaking Report on smoking and health.

You may not know that back in 1964, nearly half of all Americans smoked.

The job of the Surgeon General is to protect and maintain the health of the American people.

And once he had the scientific evidence before him about the dangers of smoking, Surgeon General Terry knew that he would have to call for a fundamental change in how our country viewed tobacco at the time.

Dr. Terry also knew that by issuing the results of the research available to him at the time - research showing that smoking causes three deadly diseases - he was taking aim at one of the pervasive symbols of American life: the cigarette.

So there he is in 1964…half of all Americans smoke.

As a matter of fact, until he started work on his smoking Report, Surgeon General Terry was a smoker.

Needless to say, when he released the Report, Dr. Terry quit smoking.

One day he was a smoker, and the next day he wasn't.

The science was clear. Smoking is bad for your health, especially your lungs.

And that compelling evidence influenced his decision to quit.

In the past 42 years, we've learned more about smoking.

Scientific evidence shows us that smoking causes disease in nearly every organ in the body, at every stage of life, here and around the world.

The statistics are compelling:

  • Today, more than 44 million American adults smoke.
  • This year alone 440,000 people will die prematurely of a tobacco-related illness.
  • And for every person who dies, 20 more are living with at least one serious tobacco-related illness.
  • Finally - and this fact simply cannot be emphasized enough - tobacco use is the leading preventable cause of death in the United States.

Last summer, the Office of the Surgeon General released our latest Report: The Health Consequences of Involuntary Exposure to Tobacco Smoke.

The research in this report put an end to the debate:

  • Secondhand smoke is not just a nuisance - it is a serious health hazard.

And smoking not only impacts the smoker, but often non-smokers who just happen to be around the smoker.

More than 40 years after the first Surgeon General's report on tobacco called for a dramatic shift in the way American's viewed tobacco, this new Report again fundamentally challenges conventional practices.

Many of us have been in non-smoking sections of public places, only to see the clouds of smoke travel across the room.

An important new conclusion of this Report is that smoke-free environments are the ONLY approach to effectively protect non-smokers from the dangers of secondhand smoke.

Secondhand smoke causes tens of thousands of heart disease deaths and approximately 3,000 lung cancer deaths among American nonsmokers ….. every year.

Children and Secondhand Smoke

Our nation's children are also being exposed to secondhand smoke.

And this exposure compromises their health in dozens of ways.

Secondhand smoke is a major cause of respiratory conditions in children.

Secondhand smoke causes our children to suffer from:

  • Acute respiratory infections, such as bronchitis and pneumonia;
  • Respiratory symptoms such as cough, phlegm, wheezing, and breathlessness;
  • More frequent and severe asthma attacks;
  • Slowing of lung growth;


  • Ear infections.

As acting Surgeon General and as a father, this troubles me more than I can say.

Children deserve a healthy start in life.

How many times have you seen a child sitting in the backseat of a car, while a parent lights up a cigarette in the front seat?

That little child is being exposed to harmful toxins.

If you were to ask any parent if he wants his child to grow up healthy and happy… you'd more than likely get a resounding "Yes!"

But some parents don't realize that they are putting their children's health in jeopardy when they smoke around the child.

This is a prime example of an area where we need to increase health literacy.

We are working to get these new findings to the American people in ways that they can understand and use.

We know that not every American is a scientist or a health care professional.

It is our job to help all Americans put the best health research into practice at home and at work, and as a part of daily life.

All the research that we do at H-H-S means nothing if it sits on bookshelves.

People's Piece

That's why when we issued the Surgeon General's Report last year, we also issued a short, full-color magazine-style People's Piece that makes the science in the Report clear to the average American.

We create a People's Piece for every Report.

In the past few years, these little magazines have won numerous awards and been re-printed by many organizations so that more people can have copies.

The People's Pieces are also available at our website:

Each People's Piece includes information on what the Reports mean to our health as individuals, families, communities … and as a nation.

Each People's Piece also provides specific tips about how to put information into action.

The input we've received from community health leaders throughout the nation and around the world tells us that the People's Pieces have had a tremendous impact on people of all ages and educational levels.

By placing the conclusions of the Report into the hands of all people, we ensure that the Report has an impact that extends beyond the scientific community…..into people's daily lives.

We have already seen the power of knowledge when it is shared.

All across the United States and around the world, communities are mobilizing for smoke-free air.

And we have seen a surge in the number of laws that require all workplaces and public places to be smoke-free.

Here in the United States, more than 16 states, Washington D.C., and Puerto Rico have passed smoke-free laws.

And in states that do not have state-wide smoking bans, we are seeing cities and counties that are stepping up to create local smoke-free laws.

I want to be clear - The Office of the Surgeon General is not a policy office.

But we have the privilege of providing the best science, which often has an impact on policy development and community action.

And despite the fact that the position of Surgeon General is for the United States, what we do here has an impact throughout the world.

We have already begun receiving requests from other countries to discuss the latest Surgeon General's Report on Secondhand Smoke.

And countries across the globe are taking steps to protect non-smokers from secondhand smoke.

We are already seeing change and new laws in Uruguay, Bermuda, Bhutan, England, France, Ireland, and Italy.

I am proud of the history of leadership that the Office of the Surgeon General has taken to reduce one of the biggest contributors to preventable deaths.

Charge and Closing

And I hope that I can count on you to help spread this message in your communities.

You are all leaders.

Whether you decide to work in health, economics, journalism, education, the environment, the arts, or national security … you have the ability to influence the lives of others.

And you will have many opportunities to improve people's lives by helping them to understand the importance of prevention.

Personal responsibility for health decisions is at the foundation of our nationwide movement to create a culture of wellness.

But personal responsibility extends beyond our individual health behaviors.

We are also personally responsible for making a difference in our spheres of influence.

And I'll be the first to tell you that you don't have to be a Surgeon General to influence the health of our great nation.

I know that many of you want a make a positive impact on our world… you want to influence change for the better.

In fact, 30% percent of alumni of the Washington Center go on to have careers in public service.

I am here to tell you that you already have tremendous influence.

So many opportunities await you.

Never lose that passion that you have in your hearts right now.

And most importantly, never lose sight of the fact that you are in the service of others.

It is the responsibility of leaders like you to map out a course of action and involve others in achieving it.

Please keep doing the things that led you to this internship:

  • Keep thinking imaginatively and critically.
  • Keep learning, innovating, and collaborating.
  • Keep asking the right questions: those that need to be answered, not just those that can be answered easily.

Like Surgeon General Terry, we must be able look beyond what is conventional.

We must have vision and we must be able to speak out in the face of adversity because speaking out, and then always doing the right thing, is the only way to secure the health, vitality, and prosperity of our nation.

Thank you and I look forward to answering any questions that you may have.


1 American Diabetes Association. 2006 Diabetes Statistics. Available at:
2 Centers for Disease Control and Prevention. 2005 National Diabetes Fact Sheet. Available at:
3 National Diabetes Education Program (NDEP). Making a Difference: The Business Community Takes on Diabetes. NIDDK, National Institutes of Health, Bethesda, MD Available at:
4 American Heart Association. Heart Disease and Stroke Statistics: 2007 Update. Available at:
5 Centers for Disease Control and Prevention. Asthma Fast Stats. Available at:
6 American Lung Association. Asthma in Adults Fact Sheet. Available at:
7 Center for Health Care Strategies, Inc. Impact of Low Health Literacy Skills on Annual Health Care Expenditures Fact Sheet. 2003, Sept. See


Last revised: January 8, 2007