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

Keynote Speech: 2005 National Early Childhood Conference
Hosted by U.S. Department of Education, Office of Special Education Programs

Monday, February 7, 2005
9:00 a.m.
Washington, D.C.

"The Value and Promise of Every Child"

Thank you for that kind introduction. It's an honor to be here with all of you.

I was told that I was the first Surgeon General to be invited here. I'll tell you, that's quite a privilege for me.

You all have untold influence every day. As parents and professionals, you touch children's lives every day.

Your impact is felt through the children and families you reach through your dedication and hard work. And that impact is poured through the generations.

You are building the foundation of success not only for your patients and students, but also for our nation.

And you know that every life has value and every person has promise. As a parent and as the Surgeon General, I thank you for all you do to provide our youngest children with the hope of achievement and independence.

The quality of early childhood care and education sets the foundation for school readiness, socialization, and all future success.

I grew up in a neighborhood that didn't value education. And we didn't have the type of services that you provide. Too often, too many of us were struggling to just survive.

And those who needed a helping hand didn't get one. Their lives were forever impacted…and unfortunately, most of them never met their full potential.

There's no turning back the hands of time. But when I think about all that could have done to improve and save the lives of children in my neighborhood, I wish that we could turn back the clock.

More than 50 years ago a Chilean teacher named Gabriela Mistral said, "Many things can wait. Children cannot. Today their bones are being formed, their blood is being made, their senses are being developed. To them we cannot say 'tomorrow.' Their name is today."

People say that children are our future. I say that children are also our present. They are today.

Their dreams are today's dreams.

Their hopes are today's hopes.

Their needs are today's needs.

Because of that, we cannot put off their needs until tomorrow.

We cannot overlook them when they are falling behind in their development.

To help today's children grow to be healthy and self-sufficient members of society, we must work together to promote good health in all its forms - mental, physical, and spiritual.

Child Find

I know, at the Department of Education, you have the Child Find effort. You are helping to meet the needs of children by identifying and referring them to services as early as possible.

In my past life as a nurse and a physician's assistant, and more recently a trauma surgeon and public health director, I worked alongside my colleagues to convince our patients and our communities to recognize and then help the children who needed referrals to early childhood services.

We knew the earlier a child could receive the help they need, the better off they would be. But too often there was a wall between us and the children who needed help. It was a wall of confusion, stigma, and misunderstanding built by well-meaning adults who didn't have the information or resources to help a child get the assessment or treatment she needed, when it would be the most useful.

Now my mission as Surgeon General is to promote and protect the health and safety of the American people.

All American people.


When President Bush nominated me to be Surgeon General, he asked me to focus on three priorities. They are:

  • First, Prevention. - What each of us can do in our own lives and communities to make ourselves and our families healthier.

  • Second, and new to the Office of the Surgeon General: Public Health Preparedness. We are investing resources to prevent, mitigate, and respond to all-hazards emergencies.


  • Third, Eliminating Health Care Disparities, an issue that the President is also passionate about.

Woven through each of these priorities is improving health literacy. It is the currency for everything that I am doing as Surgeon General.

Health Literacy

By improving health literacy, we can save lives through prevention and early diagnosis.

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

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

Not every American is a scientist or a health care professional, and we can't expect everyone to understand what it takes doctors, nurses, pharmacists, and other health care professionals years of training to learn.

In particular, we must help the parents and caregivers of young children to recognize and act when they notice that a child is experiencing a physical, emotional, or cognitive setback.

This is what you are doing through Child Find, and what you do every day as you improve understanding in your communities and raise the level of the national dialogue about Americans with disabilities, particularly children.

To support your efforts, this year I will issue the "Surgeon General's Call to Action To Improve the Health and Wellness of Persons with Disabilities."

I'm almost ashamed to say that the medical profession has too often sent people with disabilities to the back of the bus. The reality is that for too long we have provided lesser care to developmentally and physically disabled people.

Too often, the stigma of a difficult patient precludes the value of providing sound patient care.

Everyone knows of the "gaps" within our society. There is an achievement gap, health care gap, housing gap, and employment gap…usually a person is affected by just one or sometimes two of these gaps. But the developmentally and physically disabled are affected by all of them.

"Surgeon General's Call to Action To Improve the Health and Wellness of Persons with Disabilities"

I hope that this Surgeon General's Call to Action becomes a shining light on the importance of caring for people with disabilities.

Too many people with disabilities never achieve access to disease prevention and health promotion services, as required by the Americans with Disabilities Act of 1990.

But not only is it required by our nation's law… it's also required by our nation's conscience.

My Call to Action will focus the nation's and the world's attention on how we must work together to overcome the barriers to health and wellness faced by individuals with disabilities.

To close the gaps, eliminate the disparities, and re-balance the equation. Unfortunately, the imbalance of care and treatment includes children.

The Year of the Healthy Child

The prosperity and future of our nation rest upon the health and well-being of ALL 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 rates are 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 still have some troubling problems.

That is why this year I will be taking a hard look at ways to improve the health of children both domestically and internationally. By improving the holistic health of our children, we can ensure a healthier population for the next generation.

The 2005 agenda of the Office of the Surgeon General can be summed up in six words: "The Year of The Healthy Child."

This is the most comprehensive agenda ever set forward by a 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.

I will need your help to achieve the objectives of the agenda, across all sectors of society.

A healthy child begins before birth, so we will highlight steps that women should take to keep themselves healthy, especially when they are considering becoming pregnant. This includes a healthful diet, exercise, and eliminating tobacco use and alcohol consumption. We are also highlighting the contributions and the role of fathers. Every person has to come to the table to ensure the health and well-being of every child.

Birth defects affect more than 150,000 new babies in our nation every year and are the leading cause of infant death. On February 21, I will participate in Birth Day Live! on the Discovery Health Channel, and will explain how every mom- and dad-to-be can help prevent birth defects and premature birth.

In addition to pre-pregnancy, we will also focus attention on prenatal care and childbirth and early childhood development, as part of this 2005 agenda.

As a child grows, so do the child's health needs, so we will address - among other things - breastfeeding, on-time immunizations, oral health, drug and alcohol use prevention, youth violence prevention, and safe teen driving.

We will also continue working on many other issues related to child health, including:

  • Injuries. More than 5,000 children die and 90,000 are permanently disabled each year by motor vehicle injuries, drowning, burns, suffocation and choking, firearm injuries, falls, poisoning, and other preventable injuries. As a trauma surgeon, I treated thousands of children whose injuries could have been prevented with child safety seats, seatbelts, helmets, smoke alarms, pool alarms, and other simple measures. This year, we will push back this leading cause of death and disability.

  • Overweight. One of every seven kids is overweight, which can lead to type 2 diabetes and cardiovascular disease. We must teach our children to enjoy healthy foods and 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.

  • Child abuse. While we should equip our children to face threatening situations, we must also prevent the abuse that hurts so many children. In March, I will convene some of the best minds in criminal justice, medicine, child welfare, and education at a Surgeon General's Workshop on Child Maltreatment to help end this scourge.

  • Mental health. Every year, 5 to 9 percent of American children have a serious emotional disturbance. President Bush 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." Despite investments that have led to many effective treatments for mental illness, many American children are not benefiting. We will work to correct that injustice.

  • Indoor environment. One in five schools in America has indoor air quality problems. Each year 4 million American children have asthma attacks, making this lung condition a leading cause of emergency room visits and missed schooldays. Last month I convened the first-ever Surgeon General's Workshop on Healthy Indoor Environment and began collaborations with engineers, designers, architects, and builders to improve the air in schools and other buildings across America.

We will also focus on the child's growing mind. Through my "50 Schools in 50 States" Initiative, we are working with school districts and other partners 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, areas in which the United States is falling behind.

Finally, we will focus on spirit. The enthusiasm of children and teens is often overlooked in their communities. We must work to harness their energy and partner them with local and national organizations to promote volunteerism, civic responsibility, and patriotism.

We can ensure the best possible health, and the greatest productivity and independence for every child. And I hope that you will join me in this effort.

I need you - your expertise, your experience, and your passion.

Charge and Closing

Many of you have capabilities and competencies to bridge the gaps so that more children and families will have access to good health information and services. You interact with the families on a regular basis, you know them, and you know their cultures.

Whether it is working with the early care and education community, places of worship, community-based organizations, partnering with community health centers or other provider organizations, health must always be included as a component of early childhood care and services.

In closing, I want to share a story with you.

Many years ago, a child named Jim was diagnosed with cystic fibrosis. He was three months old. One of the first questions the diagnosing doctor asked Jim's mother was, "Where do you want your son to be in 20 years?"

Asked to think about a future for a child just diagnosed with a genetic disorder that, at the time, limited life expectancy to 14 years, Jim's mother articulated her hope that her son could go to college.

Together, the physician and Jim's mother began planning for his future and for college. Part of that thinking was finding ways to help Jim learn to assume responsibility for his own health care - and not just for the management of his cystic fibrosis.

By age 2 and a half, Jim was encouraged to ask questions about his health.

Jim says, "I was never looked down on because I was younger or sick. I was always asked the most serious questions about my health. And they valued what I had to say." Throughout his childhood, with the help of his family, teachers, and health care providers, Jim was able to take on increasing levels of responsibility for his own health care for his cystic fibrosis and for other routine health problems, such as colds and sprained ankles.

He also learned skills to promote his wellness - exercise, healthy diet, and avoiding alcohol and tobacco.

Today, Jim is 24, recently married, working, and preparing to buy a home. He has been able to enjoy a full life with - not despite - his increasingly disabling cystic fibrosis.

I know the influence that you have every day in the lives of people like Jim.

And I know that we can and must do more as a nation to treat all people with disabilities as people with a future - not just a disability - from the day that they are diagnosed.

Your work strengthens the American spirit. You are serving people who truly need and appreciate your help. I am confident that through your leadership, expertise, and dedication, you will continue to improve the long-term health of ALL children and families. We can and must become a nation that recognizes the need to break down barriers to health and wellness for people with disabilities.

Working together, we can take this even further: we must be a nation that makes health and wellness for people with disabilities a PRIORITY.

Thank you for all you're doing, and I look forward to continuing to work with you.


Last revised: January 8, 2007