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 Address at Congress of Healthcare Management: American College of Healthcare Executives

Monday, March 14, 2005
9:00 a.m.
Chicago, Illinois

"Today's Leaders Addressing Tomorrow's Challenges"

Good morning.

Thank you, Sam, for that wonderful introduction. [Samuel Odle, FACHE; Chairman of the American College of Healthcare Executives]

It's great to be among so many friends.

I want to thank the American College of Healthcare Executives for this tremendous honor.

It's very special to receive this honorary fellowship from you, my peers.

The work that you do is so important to the health and well-being of our nation. And your integrity-focused approach, based in your Code of Ethics, makes this award one of the finest honors I have received as a healthcare professional.

I will do my best to live up to all that it means to be an honorary fellow of the American College of Healthcare Executives. I hope to continue earning your friendship and support for all that we are doing together to make our nation safer and healthier.

We've spent a lot of time together the past day or so. In fact, I think I met personally with many of you. These conversations have been very enlightening. I've heard your concerns and your good ideas. And several common themes have emerged from our time together.

Most important, we share a fundamental commitment to our communities and our nation.

In the two-and-a-half years since I became the Surgeon General, I feel like I've aged in dog years. I've crisscrossed the country dozens of times, and spoken to thousands of Americans about the public health issues of our time.

And the truth is, I love it. But as you heard from Sam, it wasn't so long ago that I was a regular guy in Arizona, working as a trauma surgeon, a college professor, law enforcement officer, and health plan and hospital executive.

I was pretty happy with my life. I worked with some of the best people around, and was able to care for people from a variety of backgrounds. But then a very unexpected nomination came from President Bush asking me to serve as United States Surgeon General.

I couldn't believe it. There I was - just minding my business, doing my job in the anonymous way most of us go about our professional lives - and the President of the United States was asking me to join his team.

It's an honor to again serve my country, to give back some of what I had been given, to care for people on a broader level than I have ever done before.

It's given me the opportunity to speak with people like you - truly dedicated professionals.

My mission as Surgeon General is to protect, promote, and advance the health and safety of the Nation. It's a big job. Fortunately, I have the great privilege to serve under leadership whose integrity and compassion make it possible to maintain the high standards set by my predecessors - the 16 former Surgeons General who established the credibility of this position.

I'm not saying it's easy: the position of Surgeon General is in many ways the true intersection of politics and public health. The reality is that there are infinite needs and finite resources.

Like you, I recognize that we must all focus efforts and resources where they are most needed, and where they can do the most good.

That was a lesson I learned well in the Army: I know that if I have the right plan and the right resources, I can accomplish any mission. That is the approach that I now bring to the Office of the Surgeon General.

U.S. Public Health Service Commissioned Corps

For example, part of my job, by statute, is to lead the United States Public Health Service Commissioned Corps on behalf of the Secretary of Health and Human Services.

The Public Health Service is one of our nation's seven uniformed services, like the Army and Navy. We are a Corps of public health professionals, dedicated to our mission of protecting and advancing the health and safety of the nation.

Our officers work around the world to help in times of disaster, provide day-to-day healthcare for underserved populations in our nation, and to build capacitance and resilience through infrastructure building.

I want to encourage the students here today to consider joining the Public Health Service. It's a tremendous career opportunity for any healthcare professional, and it's especially gratifying because of the level of support that we receive from our Commander in Chief.

Priorities

When President Bush nominated me to be Surgeon General, he asked me to focus the Commissioned Corps and the Office of the Surgeon General on three priorities. I'm fortunate to work with a leader who understands the importance of health, who insists that evidence and the best science always guide our policies and what I do.

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, and new to the Office of the Surgeon General, as none of my 16 predecessors had to deal with these issues: Public Health Preparedness.
• The third priority I'm focusing on relentlessly is Eliminating Health Disparities, an issue that is very near to my heart and the President's. Notice that President Bush didn't just charge me with reducing health disparities. He said we will eliminate health disparities.

Health Disparities

Part of racial equality is health equality. Every day, we're finding better ways to fight disease and untimely death.

This is good news for America. And we must ensure that every American has access to these great medical advances. We must ensure that every American can get medical care and treatment.

In too many areas, our nation is still two nations, divided when it comes to health. Simply put: America suffers from racial and ethnic disparities in health.

To put a new twist on something that a great man - Dr. Martin Luther King, Jr. - once said: the inseparable twin of racial injustice is health injustice.

We all know that is true. It is why we must continue to work together to build longer, healthier lives for ALL Americans.

Differences exist among specific population groups along a number of key measures.

• The infant mortality rate is 2.5 times higher for African Americans than white Americans. and
• Hispanic and Asian children are 3 to 4 times more likely to lack a regular source of healthcare.

These problems don't go away when the children grow up:

• Cancer mortality rates are 22 percent higher in African Americans.
• Americans Indians are nearly 3 times more likely to have Type 2 diabetes.
• 30 percent of Hispanic Americans and almost 17 percent of African Americans lack a regular source of healthcare.

We obviously have a lot of work to do. So where should we begin? To start, we must never again look at the health gap as:

• A "Native American problem."
• A "Latino problem."
• An "African American problem."
• An "Asian American problem."
• It is an American problem that demands an American solution.

That includes understanding how different cultural practices can, and should, be a part of overall medical care.

It includes ensuring that the people who need it most have access to good healthcare.

Medicare Improvements

For example, nearly 8 million minority Americans covered by Medicare. That was definitely part of the equation when President Bush signed the Medicare Modernization Act in 2003 - improving Medicare improves healthcare for people of color. The proof is in the benefits:

• Beginning this year, new Medicare beneficiaries are covered for a "Welcome to Medicare" physical exam. That exam is an excellent way to get up to date on important screenings and immunizations, and to talk with a healthcare professional about family health history.
• Medicare services also now include cardiovascular screening. When you think about the fact that heart disease is the leading killer of Americans, I think that Dr. King would consider these new benefits a big step in the right direction.
• Medicare services also now include diabetes screenings. And for the millions of minority beneficiaries who are at risk for diabetes, this is not just unprecedented - it's about time. Time to diagnose the disease, and treat it.

I need your help to continue this great march forward. Along with my good friend Dr. Mark McClellan, Administrator for the Centers for Medicare and Medicaid Services, I am calling on you to help.

The new law opens the door for Medicare to make healthcare more affordable.

It also means expanded health plan options.

And it means better healthcare access for rural Americans. To those of you serving Americans in rural areas, I want to say thank-you. Please maintain your dedication.

Perhaps most importantly, the new Medicare provides prescription drug coverage that can mean a savings of more than 50 percent for the average senior without current coverage.

As you know, when Medicare was created back in 1965, it only provided services to diagnose and treat illness or injury. The value of preventive services was not well understood 40 years ago, and preventive services to keep people healthy were not covered by Medicare.

Now, we know better. It's a cost-benefit equation. We know that a healthy lifestyle means eating healthy foods and being physically active, as well as using preventive diagnostic services that can find health problems early, when treatment is most likely to be effective.

Prevention is part of everything that I am doing as Surgeon General.

Right now we've got it backwards. 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 make them well, often when it is already too late.

Health Literacy

I believe that part of the prevention solution is to improve our nation's health literacy.

Most of the preventable diseases that are cutting healthy years off lives could be eliminated if people had access to better health information, and understood and acted on that information. Our nation's low health literacy is a threat to the health and well-being of Americans and to the health and well-being of the American healthcare system.

Low health literacy adds as much as $58 billion per year to health care costs.

More than 90 million Americans cannot adequately understand basic health information.

People of all ages, races, incomes, and education levels are challenged by low health literacy.

Even the seemingly simple things that we can all do to stay healthy and safe, such as getting regular medical check-ups and eating healthy foods, can be struggles for many people.

The reality is that to be able to do these things, we must have a basic infrastructure and understanding of why these choices are important to our health and safety.

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

Health communication alone cannot change systemic problems related to health - such as poverty, environmental degradation, or lack of access to health care. But comprehensive health programs must clearly communicate health information to populations across our diverse nation.

I'm asking public health educators to keep following the science to develop communications that capture people's attention and imagination.

We're also training community health workers to help increase health literacy among groups that have traditionally lacked understanding about health and the healthcare system. They may be called community health advocates, lay health educators, community health representatives, or, in Spanish, promotores de salud. We need these knowledgeable people to serve as connectors between community members and healthcare professionals in culturally competent ways.

Communications issued by the Office of the Surgeon General for the general public are now tested to be sure that they are at a fifth- or sixth-grade reading level, so that people can understand and use the information.

When we issue the highly scientific Surgeon General Reports, we now issue magazine-style, full-color "People's Pieces," with the science presented in a way that moms and dads can understand and sit down with their kids and explain. I'm very proud that these publications - the "People's Pieces - are winning awards and are being reprinted by public and private organizations to share with their constituents.

We are a diverse nation, enriched with many cultures, and we must respond every day to our communities' and patients' diverse needs. That is why the People's Pieces are available in several languages, and why the work that many of you are doing to deliver health information in a culturally competent manner is so very important.

Improving health literacy must be part of our response to the injustice of health disparities. It will save lives, save money, and improve the health and well-being of millions of people. Health literacy is the currency of success for everything I am doing as Surgeon General.

The Year of the Healthy Child

Health literacy is a key component of my 2005 agenda: "The Year of the Healthy Child."

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. 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.

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 Year of The Healthy Child" 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 are highlighting 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.

We are focusing attention this year on every aspect of a child's life. We are addressing - among other things - breastfeeding, on-time immunizations, oral health, drug and alcohol use prevention, smoking prevention, youth violence prevention, and safe teen driving.

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

• Child Injury. More than 5,000 children die each year because of completely preventable injuries: motor vehicle injuries, drowning, burns, suffocation and choking, firearm injuries, falls, and poisoning. We are on the right track to reducing those injuries, and we will keep fighting to protect our kids.
• Overweight. 1 of every 7 kids is overweight. We must teach our children to enjoy healthy foods in healthy portions and be physically active for at least 60 minutes a day. This morning, I will visit a Head Start facility that is part of Casa Central here in Chicago. They are participating in a new program that Nike is launching at Head Start schools across the nation to encourage our youngest children to be active for at least an hour a day. It's a great program, and an important example of corporate America stepping up to help stop this epidemic of obesity we are seeing in our children. In the 1960s, just over 4 percent of kids were overweight. Today, 15 percent of our children are overweight - that's over 9 million children. Nearly 3 out of every 4 overweight teenagers will become overweight adults. Our children deserve much better than a lifetime of expensive and potentially fatal medical complications associated with excess weight.
• Child abuse. Later this month, I will convene some of the best minds in criminal justice, medicine, child welfare, and education at a Surgeon General's Workshop on Prevention of Child Maltreatment to help end this scourge.
• Mental health. Every year, 5 to 9 percent of American children have a serious emotional problem. 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." 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 four million American children have asthma attacks, making this lung condition a leading cause of emergency room visits and missed schooldays. In January, 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. The Head Start school I will visit this morning is the Illinois stop on my tour of "50 Schools in 50 States."

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.

I am grateful to the American College of Healthcare Executives for your commitment to diversity and for all you are doing to encourage young people of color, who have traditionally been underrepresented in our field, to study and excel in healthcare management.

Your commitment is shown in the fact that the College was one of the founding members of the Institute for Diversity in Healthcare Management, following your groundbreaking study of race and careers in the field. Please keep opening doors. Our profession and our nation will be made stronger through your commitment.

The final area that we will focus on during "The Year of the Healthy Child" is 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.

Together, with your help, we can ensure the best possible health, and the greatest productivity and independence for every child. We are already working with the American Academy of Pediatrics, the March of Dimes, Nike, The YMCA, The Boy Scouts of America, Discovery Health, NASA, SAFE KIDS, the Department of Education, and numerous other partners. I hope that you will join us. We need you - your expertise, your experience, and your passion.

Charge and Closing

In closing, I want to thank you for the wonderful work each and every one of you do. I ask you to continue working to improve health and well-being across the amazing spectrum of life, from in utero to senior.

And if you ever doubt whether your work matters, consider this: the cost of failing to prevent illness and injury is about much more than dollars and cents. It's about a mother who can no longer provide for her children. It's about a child who can no longer ask a father for advice.

It's about real human costs: millions of American lives lost each year to smoking-related and obesity-related diseases, families devastated by alcohol abuse, and children whose lives are cut tragically short because of completely preventable illnesses and injuries.

Let's keep working on increasing prevention and improving health literacy, particularly for the newest generation.

The President has given all of us who work for him at the Department of Health and Human Services a clear charge: to help Americans live longer, healthier lives and to do it in a way that maintains our economic competitiveness as a nation.

This will require a transformation of our healthcare system.

The improvements to Medicare, the Medicaid reforms that Health and Human Services Secretary Mike Leavitt is working on with state and national leaders, and the steps we can all take to increase prevention and improve health literacy are vital to healthcare transformation.

Secretary Leavitt shared something with me recently that I think you will all appreciate.

An entrepreneur he respects once told him that in an atmosphere of change and transformation, there are three ways you can respond:

• You can fight it and die.
• You can accept it and survive.
• Or you can lead it and prosper.

Now is the time for us to lead.

And for the sake of the people we serve, we must renew and reform the old ways of practicing healthcare.

That is what the American College of Healthcare Executives is all about, and I look forward to working with you in the months and years ahead.

Thank you.

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Last revised: January 8, 2007