Remarks as prepared; not a transcript.

Vice Admiral Richard H. Carmona, M.D., M.P.H, FACS
United States Surgeon General
U.S. Department of Health and Human Services

J.P. Morgan 23rd Annual Healthcare Conference

Tuesday, January 11, 2005
San Francisco, California

"2005: The Year of the Healthy Child"

Thank you, David, for that kind introduction. [David Golden, Director of JP Morgan Western Region]

It is an honor to be our nation's 17th Surgeon General and have the opportunity to meet with and address distinguished audiences. I've served in this position for nearly two-and-a-half years, and have delivered more than 500 speeches to audiences throughout the world.


I'm fortunate to work for two bosses who understand the importance of health. Across America and around the world, President Bush and Secretary Tommy Thompson insist that evidence and the best science always guide our policy and what I do.

When President Bush and Secretary Thompson nominated me to be Surgeon General, they asked me to focus on three priorities. All three of my priorities are very strongly evidence-based. They are:

  • First, Prevention. - What each of us can do in our own lives and communities to make ourselves and our families healthier.
  • Second, Public Health Preparedness. We are investing resources at the federal, state, and local levels to prevent, mitigate, and respond to all-hazards emergencies. and
  • Third, Eliminating Health Care Disparities. I am so proud that President Bush charged me with working with him and all of you to eliminate health disparities. Notice that he didn't just charge me with reducing health disparities. He said we will eliminate health disparities.

Woven through each of these priorities is improving Americans' health literacy. The greatest science in the world isn't worth the paper it's proved on if it can't be translated into real use.

Science for the sake of science is nice for scientists, but not for the general population. I want to ensure that medical discovery doesn't languish in the laboratory. I want to bring it to the people.

For those of you who don't know me, I'm a "recovering" surgeon. I say that because I strongly believe, and many of you may agree, that at times surgery can be considered a barbaric process, especially in light of the new scientific knowledge that is rapidly evolving. Someday, med students may cringe in horror at the tactics that we use today in an attempt to save human life. Someday, simply by altering the genotype of a host, an organ will resist disease or heal itself.

It was a tremendous honor for me to be appointed by President Bush, and it's great to be able to do the things that a Surgeon General does. Like coming here to talk with some of the greatest minds in business and healthcare. To think that just a couple years ago, I was just another guy in Tucson, Arizona, working as a trauma surgeon, a professor, a public health officer, and on the development of the Southwest region's bioterrorism response plan. We don't always know what the future holds. We don't in our lives, and we certainly don't in science.

One of my duties as the United States Surgeon General is to find the best science and articulate it to the public for better health. My greatest challenge is getting people to realize that health - whether good or bad - doesn't just happen to them. It's a result of the choices they make. . . every day!

There is tremendous challenge in healthcare for the nation and the world in the next few decades. We must understand that leadership in scientific research and education, in scientific investment and development, in innovation, and in competitive entrepreneurship is an enduring quest, an ongoing process.

The Year of the Healthy Child

In many ways, the men and women in this room hold the keys to a healthier America. You affect change every day; you make leadership decisions that impact individuals, families, and communities across America.

For all those reasons, and because it's the beginning of the year, I want to take this opportunity to announce the 2005 agenda for the Office of the Surgeon General.

Our theme for 2005 is "The Year of the Healthy Child." I believe that it is the most comprehensive agenda ever set forward by any U.S. Surgeon General for a single year.

It includes all aspects of a child's life: body, mind, and spirit, starting with prenatal care and going through the developmental stages of childhood and adolescence.

What the Office of the Surgeon General will highlight throughout "2005: The Year of the Healthy Child" is that as a nation, we can and must do more to ensure that every baby is born healthy and that all children have the chance to achieve their full potential for healthy and productive lives, free from disease or disability.

Working together as a nation that cherishes its children, we will ensure the best possible health, and the greatest productivity and independence for every individual child. This will lead to a healthier America for generations to come.

The prosperity and the future of our nation rests upon the health and well-being of our children.

The good news is that 82 percent of our nation's 70 million children are in very good or excellent health. Childhood immunization is at an all-time high. Our children are less likely to smoke and less likely to give birth as teenagers.

These are important gains in pediatric health. But we also have some very troubling issues - some new, some that have plagued us for years.

That is why we are focusing this year on children. We are partnering with government leaders, academics, health care professionals, corporations, and communities. We are especially determined that the messages will resonate across all regions, and all cultures.

We have already encountered tremendous enthusiasm and support from a wide range of partners, including the March of Dimes, The American Academy of Pediatrics, Nike, Shaping America's Youth, The Boy Scouts of America, NASA, SAFEKIDS, the Department of Education, and of course our colleagues across the Department of Health and Human Services, from the CDC to the National Institutes of Health.

And today I'm here to ask you to join us.

Since becoming Surgeon General, I've traveled the nation and world meeting with healthcare professionals, business and political leaders, public health leaders, first responders, moms, dads, and lots and lots of kids. The kids are my favorite. Maybe because I'm a dad, maybe because I just like to hear what kids are saying and check on what they're into.

As part of my "50 Schools in 50 States" initiative and because of partnerships with organizations such as the Boys & Girls Clubs of America and the YMCA, I have visited with tens of thousands of children to talk about health and how they can help themselves, their families, and their communities be healthier every day.

It's the same message I bring to adults, but with the kids there's more cheering. And a whole lot more hugging and laughing.


To improve the health of all children, we need to start before pregnancy, with their mothers.

Next month I will participate in a live television show called Birth Day Live! on the Discovery Health channel. Discovery Health will broadcast this 10-hour program to follow deliveries in three U.S. hospitals. I will focus much of my on-air time talking to Americans about steps they can take to prevent birth defects.

Unfortunately, birth defects affect 150,000 new babies in our nation every year, and are the leading cause of infant death in the United States. Some racial and ethnic groups are affected more than others. Today, more than 25 percent of African American women and more than 30 percent of American Indian women receive no prenatal care in the first trimester.

While we are ensuring access to prenatal care, we must also do a better job of ensuring that all American women recognize the importance of prenatal care and follow the advice their doctors give them.

In addition to birth defects, nearly half of a million babies are born pre-term. That's one in eight babies born in this country. The complications of preterm birth cause death, disability, and tremendous sorrow for many American families.

We must redouble our efforts to find causes of preterm labor. We need to look at where the needs are greatest. For example, why do African Americans have the highest rate of premature birth? Premature birth is leading cause of neonatal mortality and morbidity in African-Americans. It is the second-leading cause of infant death among all Americans, of all races.

We must rededicate ourselves to ensuring that all children have a healthy start in life. We already know that simple preventive measures can help reduce the risk of many birth defects. For example, vaccinations against measles, mumps, and rubella prevent birth defects by reducing the risk of a pregnant woman becoming infected with these diseases that can increase her baby's risk of being born with deafness, developmental disabilities, heart defects, and blindness. Thanks to high rates of immunization, these infections are now rare occurrences in America.

We also know that good nutrition can help reduce the risk of birth defects. Serious defects, including spina bifida and anencephaly, can be prevented when women get 400 micrograms of folic acid each day. Two-thirds of women in the United States do not consume enough folic acid. All women of reproductive age should consume folic acid.

And women who are pregnant or planning a pregnancy should not smoke or drink alcohol, and should consult a healthcare professional before taking any medicine - prescription or over-the-counter.

We must remember, there is no safe cigarette during pregnancy or at any other time in life - and if you won't stop smoking for yourself, the least you can do is keep your smoke away from pregnant women and children.

Tobacco and Children

On the topic of smoking, we are also going to focus this year on preventing and reducing smoking among teenagers. To put the problem into perspective, more than 4,000 teens will try their first cigarette today. Every day, more than 2,000 kids become new regular, daily smokers. That's unacceptable, and preventable.

Childhood Obesity

We are also going to continue working to reduce childhood obesity. Today, 15 percent of our children are overweight - that's more than 9 million children. One out of every seven kids. And the problem doesn't go away when children grow up. Nearly three out of every four overweight teenagers will become overweight adults.

The facts are staggering:

  • Today, obesity is the fastest-growing cause of disease and death in our nation - and we are now seeing that it is a growing problem around the world.
  • In the year 2000, the total annual cost of obesity in the United States was $117 billion.

The health crisis of childhood obesity can be solved - and it will take a wide range of adjustments in the lives of our children. To maximize the likelihood of success, all sectors of our society need to have access to the most current information.

I encourage you to join the fight against childhood obesity. We must teach our children to enjoy healthy foods in healthy portions. We must encourage all children to be physically active for at least 60 minutes a day. Not only sports, but simple things like taking the stairs, riding their bikes, and just getting out and playing.

The average American child spends more than four hours a day watching television, playing video games, or surfing the web. We are seeing a generation of kids who grew up off the playground and on the PlayStation.

And this weight gain has long-term health consequences. For the first time in history, we're seeing kids in doctors' offices with type 2 diabetes and high blood pressure. We must reverse this trend, or we will have an overburdened healthcare system that simply cannot afford to treat the maladies of the day.

Childhood Injury

Another area that we will focus on this year is childhood injury. Death from unintentional injury among children has declined more than 40 percent in the past 15 years. The problem is that this isn't nearly enough progress. Injuries are still the leading cause of death in the United States among children ages 14 and under.

Each year, approximately 5,000 children die from motor vehicle injuries, including being struck while walking or riding a bike; drowning; fires and burns; suffocation and choking; firearm injuries; falls; and poisoning. Injury rates vary, and younger children, boys, and poor children suffer disproportionately. In addition to the more-than 5,000 children who die each year from injury, more than 90,000 are permanently disabled.

Injury is the leading cause of medical spending for children. In one year, injuries to children ages 10 and under result in nearly $6 billion in direct medical costs. The prevention message is that as many as 90 percent of childhood injuries can be prevented through child safety seats, bicycle helmets, poison control education, smoke and carbon monoxide alarms, pool alarms and pool fences. We will need your help to increase awareness of these simple preventive steps.

An issue that we will also explore is the high rate of crashes among teen drivers. Some of the crashes are due to alcohol or other substances - the driver is high - some are due to inexperience behind the wheel. We owe it to our kids to address this public health problem before it gets any worse, and the Office of the Surgeon General will work with the National Highway Traffic Safety Administration and other partners to address the questions, and find the answers.

Child Maltreatment

Another area that leads to death and disability for children is one that we must shine a light on more effectively, and from which we cannot ever, ever turn away. While most American children grow up healthy and happy, some are deeply wounded by emotional, physical, and sexual abuse.

While child maltreatment has traditionally been thought of as a criminal justice issue, it is also very much a public health issue. I've seen it from both sides: as a law enforcement officer and as a trauma surgeon. The cycle of abuse is debilitating. I have known adult abusers who were abused as children, and are continuing the cycle of violence that was visited on them decades earlier. For too long, we have hidden child abuse in the locked room of family secrets for generations. It's time to break open that door, to shine the bright light of hope and healing for children and adults.

It is a problem within American families that can affect any race, ethnicity, or socio-economic group. And the wrenching mental and physical health effects of child maltreatment continue long after the abused child is placed in a safe environment. The child who is abused becomes the teenager who is violent toward his peers, and then the man who is violent toward his wife and children.

Young people who experience maltreatment are at increased risk for experiencing adverse health effects and behaviors as adults, including alcoholism, drug abuse, physical inactivity, severe obesity, depression, suicide, and sexual promiscuity.

While our children should be equipped to face potentially threatening situations, we must also determine how adults can intervene more effectively to prevent the abuse from occurring.

That is why this spring I am convening some of the best minds in criminal justice, medicine, child welfare, and education in a Surgeon General's Workshop on Child Maltreatment, to help determine next steps to end this scourge on our society.

Indoor Environment

Tomorrow, I will convene a different workshop designed to protect children's health. The first-ever Surgeon General's Workshop on Healthy Indoor Environment will bring together national experts in producing healthy indoor space. We've all heard of "sick buildings."

We as Americans spend between 85 and 95 percent of our time indoors - including at home, in a vehicle, in school, or at the office or other workplace. As you know, secondhand smoke, lead, radon, and asbestos are threats to the indoor environment.

But the reality is that our work is just begun. For example, we now know that one in five schools in America has indoor air quality problems. That is affecting millions of children who don't even realize it. We need to get to the bottom of the problem, then work with engineers, designers, architects, and builders to solve this troubling issue.


Speaking of schools, that takes me to our next priority. About 18 months ago, I announced my "50 Schools in 50 States" initiative. In 2005, the Office of the Surgeon General will continue to work with partners and school districts, to reach into classrooms across the country to encourage students to stay in school. In addition, we will encourage more students, especially minorities, to focus on excelling in math and in the hard sciences.

As technology increases, borders become less important. Disease does not respect international boundaries, and in our global economy there is financial fluidity between nations.

In the United States, elementary and secondary education in science and math is not improving fast enough for an information society that is increasingly dependent on those skills. All sectors - higher education, industry, and government - must assume greater responsibility for achieving educational excellence.

The United States cannot be a victim of technology and science. We must expand and improve because of it. With this leadership comes immense global responsibility. . . to reach out and be compassionate while making the world a better place. We have, we continue to do so, and we, the United States, have an enviable and unparalleled record in this regard.

We will also join with others to promote the mental health of children and adolescents.

Mental Health

Mental illnesses affect almost every American family. It can occur at any stage of life, from childhood to old age. No community is unaffected by mental illnesses; no school or workplace is untouched.

Every year, between 5 to 9 percent of American children have a serious emotional disturbance. These figures mean that millions of children are disabled by mental illnesses every year.

President Bush has said, "Americans must understand and send this message: mental disability is not a scandal - it is an illness. And like physical illness, it is treatable, especially when the treatment comes early."

Over the years, science has broadened our knowledge about mental health and illnesses, showing the potential to improve the way in which mental health care is provided. However, despite substantial investments that have enormously increased the scientific knowledge base and have led to developing many effective treatments, many Americans are not benefiting from these investments.

Suicide is still the third leading cause of death among 15- to 24-year-old Americans. Suicide costs us more than 30,000 lives each year. That's almost one person every 15 minutes. And once every 45 seconds someone else attempts suicide. And even if the life is spared, the heartache and pain is so severe that the spirit may never fully heal. Like so much of the death and disease in our nation, suicide is preventable. It's prevented by understanding and identifying risks and then taking the necessary protective measures. Working together, we can save these lives.


And finally, I want to touch on the spirit of our nation's youth. Their optimism and hope carry the day.

I want to congratulate all the children and teenagers across our nation. Too often, when we hear bad news about kids, we ask what went wrong with them. Then, when we hear good news about kids, we congratulate the teachers, counselors, and parents who made it happen. The teachers, counselors, and parents certainly deserve praise.

But let me also say this to the young people - and I mean it from the bottom of my heart - Thank you.

  • Thank you for not smoking.
  • Thank you for not drinking and doing drugs.
  • Thank you for being good students and staying in school.
  • Thank you for volunteering for good causes and helping younger children in your family and your community to be safe, happy, and healthy.

The enthusiasm of children and teens is often overlooked within their communities. The Office of the Surgeon General will work to harness their energy and partner them with local institutions to promote volunteerism, civic responsibility, and patriotism.

Charge and Closing

John Whitehead said that "Children are the living message we send to a time we will not see." What kind of message will we send? We share a common desire to send children healthy and happy into their future. Let's redouble our commitment to give them the tools they need and will one day use when we are gone.

And my friends, the needs of children don't end at the water's edge. Today, millions of children around the globe are struggling for survival. We think of the 11 million children in Africa who have lost their parents to AIDS. And we all have heard the stories of children orphaned by the tsunami who have been taken captive to slave labor or put into the sex trade.

Unfortunately evil creeps in, when good fails to shine its light. As Americans, we have the opportunity to be light in the world.

As you know, the United States is leading an international coalition to help with immediate humanitarian relief, rehabilitation, and long-term reconstruction efforts. President Bush announced on December 31 that the United States government is committing $350 million toward the relief effort, which also includes emergency response resources and military assets. The United States is providing food, water, shelter and medical aid to the millions of people in the affected region.

The business community has an opportunity to play a special role in alleviating suffering in Asia, and I appreciate all of your leadership to provide aid to the region. I want to congratulate the businesses that have already come together to donate nearly $200 million to tsunami victims.

It is an honor for me to bring to you President Bush's personal thanks for all that your companies and organizations have done. Your generosity, individually and collectively, represents the best of America, and we thank you.

Looking around this room, I know that through your efforts, and through what I hope will be a new partnership around "2005: The Year of The Healthy Child," we can ensure better health and greater happiness for all children.

I want to thank you very much for your dedication. I stand here ready and prepared to work with you to improve the body, mind, and spirit of the newest generation of Americans. This is one area in which we can do a lot of real good - for people who really need us. All of us must take action. As adults and as a nation we have an obligation to be responsive to the needs of all children.

Thank you.


Last revised: January 8, 2007