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 Office of Juvenile Justice and Delinquency Prevention Workshop

Friday, March 9, 2007
Fairfax, VA

"Strengthen the bridge between the juvenile justice community and other federal agencies"

Greetings and Welcome
Good afternoon. It is truly an honor and a privilege to be here with all of you today.

Thank you for that gracious introduction, Robert. (J Robert Flores, Administrator, Office of Juvenile Justice and Delinquency Prevention)

And thank you for the opportunity to be a part of the Office of Juvenile Justice and Delinquency Prevention Workshop on Juvenile Health Care.

I always enjoy the opportunity to be among professionals who can share a passion for improving the well-being of our nation.

As many of you know, correctional health is very important to me.

Like some of you, I've had a great deal of experience working with individuals who are in our custody.

I had the honor of serving as the assistant bureau director and the medical director of the U.S. Department of Justice Federal Bureau of Prisons. My responsibilities included medical and psychiatric programs, occupational safety and environmental health, and food and nutrition services.

For more than a decade, I saw firsthand the realities of correctional health in our prisons.

These memories will be with me forever, and they continue to inspire and inform my work as Acting Surgeon General.

I know many of you here today have an interest in the continuous care for our youth in the juvenile justice system.

My bosses, President Bush, Department of Health and Human Services Secretary Mike Leavitt, and Assistant Secretary for Health Admiral John Agwunobi, and I truly appreciate your service and dedication to our nation.

Correctional Health = Community Health
As Acting Surgeon General, I am charged with protecting the health and safety of this great Nation, including our young people in the justice system.

And improving the health of our children and adolescents in the Juvenile Justice System helps to secure the health, security, and prosperity of our great nation.

Many of us here in this room understand the link between correctional health and community health.

Unfortunately, there are some who do not fully understand how correctional and community health impact each other.

Let's think about what would happen without correctional health services.

A female teen-ager in the justice system now with tuberculosis will one day return to her family or perhaps foster care.

Possibly she will in be close quarters with other people or in crowded places outside the home, especially if she lives in an urban area.

She passes T-B on to her family and others within her community. Her family goes to work and passes T-B to co-workers and friends.

As you can see, the number of infected individuals goes up….fast. All from one person released from the justice system with an infectious disease. And T-B is just one example.

The young people in the Juvenile Justice System have higher rates of teen pregnancies, sexually transmitted infections, hepatitis, tuberculosis, anemia and dental and vision disorders compared to adolescents in the general population.

This is why to protect our nation, it is absolutely imperative to provide good medical care to our youth in the juvenile justice system.

Juveniles in the justice system deserve these protections.

Priorities
The Pubic Health Service officers also play a central role in supporting the priorities of the Office of the Surgeon General.

I want to take a few moments to tell you about one of our priorities, why we feel it is so important, and how it relates to our continued work with juvenile justice populations.

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

It is a priority for us because every year millions of Americans get sick and die from preventable causes.

We want to change that. But, right now our nation has it backwards.

We live in a treatment-oriented society, where too little time, money, and effort are invested in preventing diseases.

We wait years and years, doing nothing about unhealthy eating 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 illness and injury.

The good news is that there are six key steps that can help prevent disease:

1. Good nutrition,
2. Physical activity,
3. Maintenance of a healthy weight,
4. Regular health screenings,
5. Vaccinations,
   and
6. Preventing exposure to tobacco and secondhand smoke.

Prevention takes on an even more urgent imperative when discussing our incarcerated youth.

As we know and I have pointed out, incarcerated youth have a higher prevalence of health problems than the general youth population.

Many of the young people in our correctional facilities are unable to sustain healthy lives on the outside.

And when they enter our facilities, they bring with them a host of physical and mental health problems.

But wherever there is challenge, there is opportunity.

Many of you help keep society safe, and we care for the adolescents in our justice system.

For these youth, incarceration is an opportunity to access the support they need for their long-standing health conditions — including substance abuse problems and infectious diseases.

This is important work for protecting society because individuals move from the community, through the juvenile justice system, and back into the community in a relatively short time frame.

Providing effective health care interventions helps to ensure that diseases are limited or eliminated before they reach back to homes and communities.

Disease prevention saves lives. It can also save money.

Standards of care
With any discussion of continuity of care for our incarcerated youth, we must remember the underlying principles that need to be set out: standards for which we should be held accountable.

1. Standards of care must be child-focused and based on professionally accepted health care standards for all children and youth.

2. Standards must recognize that all of our nation's children should enjoy the "highest attainable standard of health care." They must also envision health as being integral to the fullest development of human potential, and encompass disease treatment, disease prevention and health promotion.

3. Standards must ensure that youth are afforded the full array of Medicaid's early and periodic screening, diagnostic, and treatment (EPSDT) service.

4. Standards must address continuity of health care for youth transitioning to and from juvenile justice systems, including partnering with parents and community health care providers.

Children and adolescents in the Juvenile Justice System represent a substantial public health concern.

On an average day, approximately 100,000 young people housed in juvenile justice residential facilities and about one-half million are on court-ordered community supervision. An additional 100,000 young people are on informal probation supervision.

These young people are medically underserved in the community; they are underinsured and are less likely to have a medical home.

While we are going to hear in greater detail from the scientists, I would like to highlight more of the differences that exist in disease rates between incarcerated youth and adolescents in the general population.

In addition to T-B, incarcerated youth are more than 100 times likely to have Hepatitis A, B, or C and Syphilis.

They have increased rates of suicide attempts and death by suicide. They are more likely to suffer from Post Traumatic Stress Disorder, and are also more likely to be hospitalized for injuries caused by others.

As these youth move in and out of the juvenile justice system, they are in the community, exposing the general population to their communicable diseases.

Untreated, these diseases created a burden, as with the example of the teenager with T-B being released back into the community.

It's a burden for the adolescent now, in the future, and also on their children and the community at large.

So how do we tackle the problem? One of the first approaches is to partner with our sister agencies within the federal government.

The Department of Health and Human Services' Office of Disease Prevention and Health Promotion plays a vital role in developing and coordinating a wide range of national disease prevention and health promotion strategies, including "Healthy People 2010," "Steps to a Healthier US," and the “Dietary Guidelines for Americans."

In addition, the office oversees national health literacy activities through its "Healthy People 2010 Health Communication Focus Area."

Health literacy is of particular concern for vulnerable populations, such as incarcerated youth.

Health literacy – or should I say, illiteracy – can have a tremendous impact.

I want to take just a moment to explain just what I mean by health literacy.

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

More than 90 million people cannot adequately understand basic health information. And health illiteracy impacts people from all ages, races and education levels.

How can we expect our youth to beat – or even control – chronic illness if they can't understand basic health information?

Good continuity of care includes translating complicated health information into easy to understand information that is communicated clearly, accurately and effectively.

The providers who care for our incarcerated youth, members of the community and the system who deal with them, and the young person in the juvenile system, must all be able to effectively communicate health information. Health information that can be heard… understood… embraced… and ultimately put into action.

Another appropriate partnering agency is the HHS Heath Resources and Services Administration Maternal and Child Health Bureau.

The Bureau, in partnership with the American Academy of Pediatrics, supports an initiative called Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents. It is dedicated to the principle that every child deserves to be healthy, and that optimal health involves a trusting relationship between the health professional, the child, the family, and the community.

Work on the initiative produced a set of comprehensive health supervision guidelines, including recommendations on immunizations, routine health screenings, and anticipatory guidance.

Also related to the Healthy People 2010 initiative is "The National Initiative to Improve Adolescent Health by the Year 2010." The two lead federal agencies supporting this initiative are the Centers for Disease Control and Prevention's Division of Adolescent and School Health and the Maternal and Child Health Bureau's Office of Adolescent Health (OAH).

This initiative focuses on twenty-one objectives addressing mortality reduction, unintentional injury, violence reduction, mental health and substance abuse, reproductive health, and chronic disease.

The Maternal and Child Health Bureau also administers the Title five Block Grant program.

Among the program's objectives are:

1. increase the number of children appropriately immunized against disease;
2. increase the number of children in low-income households who receive assessments and follow-up diagnostic and treatment services;
3. provide and ensure access to comprehensive perinatal care for women; preventative and child care services; comprehensive care, including long-term care services, for children with special health care needs; and
4. facilitate the development of comprehensive, coordinated systems of care for children with special health care needs.

Another program within HHS includes C-D-C's partnership to promote vaccination in juvenile residential facilities. Administered through the Vaccines for Children (VFC) program, vaccines are provided at no cost to eligible children under the age of 18.

Indeed, other HHS agencies like the National Institutes of Health, the Indian Health Service, the Substance Abuse and Mental Health Services Administration, the Agency for Healthcare Research and Quality and the Centers for Medicare and Medicaid Services all have important parts to play in the care of incarcerated youth. We are also pleased to partner with our colleagues at the Office of Juvenile Justice and Delinquency Prevention who struggle with issue on a regular basis.

As I've said, I know everyone in this room cares deeply about how to improve the health of adolescents involved with the justice system.

My hope is that we find better ways to collaborate and partner with one another to ensure that juveniles in the juvenile justice system are provided quality health care and disease prevention services.

Closing and Charge
Please continue to create partnerships, share experiences, and strengthen the bridge between the juvenile justice community and other federal agencies.

Our ability to collaborate and build on our strengths through partnerships will make a tremendous difference.

I look forward to working with all of you as we move ahead in improving the juvenile justice health system.

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Last revised: January 8, 2007