Remarks as prepared; not a transcript.
Vice Admiral Richard H. Carmona, M.D., M.P.H, FACS
Thank you, Surgeon General Satcher, for that wonderful introduction. It's an honor to be here with you tonight. From the beginning of your tenure as our nation's 16th Surgeon General, you knew that we needed to focus more energy and resources on eliminating health disparities. As Surgeon General, you helped to lead the Department of Health and Human Service's effort to eliminate racial and ethnic disparities in health. Your initiative was incorporated as one of the two major goals of Healthy People 2010, the nation's health agenda for the next 10 years. You also released Surgeon General's reports on a variety of important health topics, including tobacco, mental health, oral health, youth violence prevention, and overweight and obesity.
Today, the work that you are doing at Morehouse School of Medicine and beyond is so important to the health and well-being of our nation. Our nation is healthier and safer because of your selfless efforts, and especially your dedication to eliminating health disparities - no matter the barriers.
Thank you for suggesting that the Foundation invite me to speak here today. It is always a pleasure to spend time with America's future health leaders.
David, I'm sure that you know what I'm talking about when I say that 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.
The funny thing is that when I meet people for the first time, they seem to assume that I always planned to be Surgeon General. Nothing could be further from the truth. My career progression has been anything but a straight line to the Surgeon General's office.
As a high-school drop-out, I sold hot dogs at Yankee Stadium and Shea Stadium in New York City. I have also been a U.S. Army Special Forces medic, a lifeguard, a registered nurse, a paramedic, a physician's assistant, a researcher, a trauma surgeon, a law enforcement officer, a university professor, and a public health system CEO.
I've also been a poor Latino street kid who had difficulty accessing care. I was what is now called a healthcare disparity. I've had the experience as a child of being hungry and homeless.
I grew up in New York City, the oldest of four kids. I was homeless for their first time when I was 6 years old. My parents were good people, but they struggled with serious substance abuse problems. Because my parents were dealing with their own issues, my grandmother helped raise my brothers and sister and me. Although she was poor and not educated, she was one of the strongest people I've ever known.
My grandmother - or Abuelita in Spanish - was the matriarch of our family. She weighed about 90 pounds soaking wet, but was the toughest person I've ever known. Very late in life, she came to New York seeking a better life for her 27 children and their children. Abuelita spoke no English when she arrived in New York. Although living on the margins of society for many years, as was the whole family, she lived with a great deal of dignity.
In Abuelita's home, there was love, and there was caring. There was an understanding of how we all need to live together in this world. She was the one who told me, "You need to get an education because the education will set you free."
I know what it's like to be on the fringes of society, to be someone who people were willing to forget and leave alone. But Abuelita believed in me and had great hopes for me.
I disappointed her by dropping out of high school, but I think that today she is looking down on me and smiling. I know that someone has been looking out for me because all along the way, I have been blessed with opportunity.
Like many of you, I understand health disparities because I've lived them. There was nothing academic about not being able to go to the dentist when I had a toothache as a kid. I know the indignity of standing in a long line at a public hospital, waiting.
Community Health Centers
Every time I see someone suffering because of lack of access to healthcare, it hurts me more than I can possibly explain. One of the greatest privileges of being Surgeon General is that I get to visit community health centers across our nation. Some of you may work at a community health center someday. Community health centers supported by the U.S. Department of Health and Human Services deliver preventive and primary care to patients regardless of their ability to pay. They are a safety net for many Americans. More than 60 percent of community health center patients are minorities. President Bush's 2006 budget completes his five-year commitment to create 1,200 new or expanded sites to serve an additional 6.1 million people by 2006. The President's budget requests $2 billion to complete funding on nearly 4,000 community health centers. Those centers will care for 16 million Americans who would otherwise go without care.
Making these community health centers a reality wasn't easy. It took intense dedication and persistence from our President and his team.
If you look inside yourselves, you will learn that you also have it in you to accomplish anything. Even if you've gotten off to a rough start, the experiences you have - even the tough ones - can teach you something.
You can learn a lot outside the classroom. That doesn't mean you shouldn't study! I could have spared myself years of grief if I had just buckled down in school. But think about what you're learning in your lives that is not directly related to algebra or chemistry or literature or another subject. If you're doing your homework, and turning it on time, you are learning responsibility.
If you are watching others around you make some mistakes, and not repeating their behavior, you are learning self-discipline.
If you have made some mistakes, but have learned from them and are not repeating them, you are learning maturity.
I learned about maturity when I did a tour of duty in Vietnam with the U.S. Army. I wanted to go into Special Forces and be a medic. To do that, you had to have a high school diploma. That was my first barrier. I had to get my GED.
My experiences in the Special Forces as a teenager helped shape my life. I learned leadership lessons such as accountability, responsibility, and respect. As a 19- and 20-year-old I saw more firsthand than many people ever do in terms of tropical diseases and trauma wounds. I also delivered babies for the first time at age 19, a set of twins. Our team of 12 American soldiers worked on counterinsurgency and intelligence gathering. My job as the medic was to take care of the team.
I was injured twice, and in wartime a firefight isn't like a movie. In real life a battle isn't always won and the hero doesn't always walk into the sunset. In one year, I matured a decade. You will also have years like that. You will be tested in ways you cannot now possibly foresee, whether it is through a war, a difficult job, or a traumatic family situation.
That time I spent in Vietnam taught me more about leadership, teamwork, loyalty, and how to get a job done than anything I've learned before or since.
And I've taken another leadership lesson with me throughout the years: confidence. I believe I can accomplish anything I set my mind to accomplish.
When I got home from Vietnam, I decided I wanted to be a doctor. My family thought I was crazy. My uncle had already gotten me a job as an electrician's apprentice. But I wanted to go to medical school. It wasn't easy. I went to community college, then college and medical school - juggling my schoolwork with different jobs to support myself and my family. But I knew how important it was to stay focused on my education and get good grades. I had failed at that during the first half of my life.
I was determined not to fail again. I got into community college through an open enrollment program for veterans, and just kept doing well. Then I went to college and medical school at the University of California San Francisco. I graduated first in my class, and was chosen for a general vascular surgery residency at the San Francisco Mission General Hospital. It was a wonderful place to train. The residency provided the resources of the university, the ability to work in a county hospital, a world-class research setting, and the facilities for tertiary care.
I trained among very talented colleagues, including Julie Gerberding, who is now director of the Centers for Disease Control and Prevention. The patients were a diverse group of people of all ages and ethnicities, and the hospital provided an introduction to global health, minority health, and emerging health issues.
The 1980s was an interesting time to be a young surgeon. I remember that I started seeing a lot of patients with unexplained bowel obstructions, unusual cancers, and other serious symptoms. Many of these patients were young men who would die extraordinarily painful deaths caused by symptoms that we couldn't trace to any logical origin. We couldn't explain their illnesses or their deaths to their families and loved ones. At best, we treated symptomatically. It was frustrating and sad for us, and for our patients' families. Although we didn't know it at the time, San Francisco General was at the heart of America's nascent AIDS epidemic.
I learned a lot from my mentors and colleagues in San Francisco, who were among those who led the way in understanding HIV/AIDS. Keep in mind that throughout your education, you could be at the leading edge of something that could change the world of medicine, or the world at large. I hope that we never see another epidemic like AIDS, but seeing its' early and deadly appearances taught me that in practicing medicine, we must always remember that the diseases that have been studied and catalogued are just part of the story. Working in medicine, dentistry, pharmacy, or veterinary science is a process of discovery, a process that still offers the hope of future cures and better treatments.
After medical school and residency, I moved to Arizona to be the chief of the trauma center there. Over the course of 17 years in Arizona, I did a lot of different jobs, working in trauma care, law enforcement, border health, as a college professor, and raising four wonderful children with my wife. I was very happy.
But then this job came along - ironic, because I couldn't have planned it better if I'd tried. As it turns out, all my different, seemingly unrelated experiences became important following 9/11. President Bush needed a person in this position who had experience with law enforcement and the military as well as healthcare.
The fact that somebody like me could serve in this position is absolutely incredible. If Richie from the block can make it, there's no reason you can't do the same thing.
Healthcare Workforce Opportunities
Keep reaching for opportunities. Assume that where there is a will there's a way. Don't ever, ever give up. If you think that you can't afford college and graduate school, think again. The U.S. Department of Health and Human Services has dozens of programs and fellowships to help you get the education and training you want and need. Right now, I want you to take a pen or pencil and write down this phone number: 1-800-444-6472. That's the number for the HHS Office for Minority Health Resource Center. Call them. It's a toll-free number.
Again: that number is 1-800-444-6472. If you prefer to go online, visit them at www.omhrc.gov
That brings me to another lesson: be prepared. Do you know what luck is? It's the intersection of preparedness and opportunity. Good opportunities will come your way occasionally in life. But you have to be prepared to take them. Be ready to say "yes" to opportunity, like the U.S. Surgeon General giving you a phone number to call and talk with his colleagues about money for college and beyond.
An important part of being prepared is making the right decisions to stay healthy. I have an army of people helping me with this. They're called the U.S. Public Health Service Commissioned Corps.
U.S. Public Health Service Commissioned Corps
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.
We helped the people of Asia and East Africa to recover and rebuild from the devastating tsunami that hit in December. I am truly proud of these officers. When our men and women in uniform show their dedication and compassion to our neighbors throughout the world, they become the embodiment of the best of the American spirit.
The PHS officers deployed to Indonesia had a wide variety of expertise and responsibilities. They provided health and medical services: vaccinations, primary care services, environmental services (such as making water suitable for drinking), and mental healthcare.
As you know, in this new era of modern travel, it doesn't take long for a local disease or infection to spread to neighboring communities and nations, so it's critical that public health be practiced around the globe. We can most effectively defend our nation's borders against emerging diseases by treating them on the front lines, wherever they may be. In doing so, we can save and improve the lives of people not just at home, but also abroad.
I want to encourage the students here today to consider joining the Public Health Service Commissioned Corps. 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.
To join us, go online to www.surgeongeral.gov and find out how you can become an officer in the Public Health Service Commissioned Corps.
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:
We are doing a lot to address these priorities, and we are seeing success. The currency for success in all these priorities is health literacy.
Low health literacy affects Americans of all races, ages, incomes, and education levels. Health literacy is the ability of an individual to access, understand, and use health-related information to make appropriate health decisions. More than 90 million Americans cannot understand basic health information. Among minority communities, education levels and language and cultural barriers are also a factor in low health literacy.
As a minority healthcare professional, you will be a tremendous asset to the communities you serve because you can help increase health literacy. You can help eliminate health disparities. Every day, we're finding better ways to fight disease and untimely death.
But 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.
That includes understanding how different cultural practices can, and should, be a part of overall medical care.
Culturally competent healthcare and communication alone cannot change systemic problems related to health - such as poverty, environmental degradation, or lack of access to healthcare. 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 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.
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, particularly the youngest members of our society.
The Year of the Healthy Child
Throughout my years in healthcare, I have learned that what we teach our children today carries them into adulthood.
As you enter your careers, you will be busy. Paperwork will pile up. You will have too little sleep and too much work. I ask you to try to keep sight of the reasons that you entered the field of medicine, and always remember the children.
People say that children are our future. I say that children are also our present, as well as our present - our gift - to the future. 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. But we still have some troubling problems. That is why this year I am taking a hard look at ways to improve the holistic health of children both domestically and internationally.
We have declared the 2005 agenda of the Office of the Surgeon General to be "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.
As you know, a healthy child begins before birth, so we are promoting steps that women should take to keep themselves healthy. 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.
Our goal is to address every aspect of a child's life, including 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:
We will also focus on the child's growing mind. I will continue my "50 Schools in 50 States" Initiative this year to reach into schools across the nation to speak with young people - from preschool to high school. I encourage them to not follow my example as a high school dropout. I tell them there's a better path: stay in school. I am also encouraging students, especially minorities, to focus on excelling in math and in the hard sciences, areas in which the United States is falling behind.
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.
I hope that you will join us. We need you - your expertise, your experience, and your passion. Never forget, one person can make a difference. You can be that person.
Make the right choices about your own health: exercise, eat right. Don't smoke. Don't drink. I saw what substance abuse did to my parents' lives and I said, "I don't want this for myself." You need to make the same decision. I know it's tough being a kid. I had a very tough time. I am sure you are facing all kinds of temptations.
Alcohol, Drugs, Smoking
Let me be clear: drinking is a mistake, drinking and driving is a huge mistake, and riding in a car with anyone who has been drinking is also a huge mistake.
Some of you might live in a household where a parent or other family member drinks too much, too often. I grew up in a household like that. Think of the terrible consequences of that addiction on the whole family: embarrassment, secrets, lies, financial problems, and the inability of that person to cope with problems or other people. Think of that, and vow to do better for yourself and your own future family.
I know that because you're interested in health and healthcare, you're aware of the problems of drug and alcohol use. Across the nation, one in eight students ages 12 to 17 have smoked marijuana in the past month. One in 50 have used cocaine in the past year… That's not a badge of honor. Just like smoking is not a "rite of passage."
You are becoming young adults. You have a lot of freedom to make choices. Make sure the choices you make are the healthy choices.
All of you have already shown you can make the right choice about education. You have been selected to participate in this symposium because a teacher or counselor believes in you. Reward that trust by saying thank-you to that teacher or counselor, and then by becoming a leader in health and healthcare. You have taken up one of the best challenges available to any young American: you are focusing your studies on science. What's really interesting is the times you are living in right now are the greatest ever for science. For most of the past century biology was a descriptive science - you may have learned to name the parts of a dissected frog, for example.
But now with the completion of the Human Genome Project you will have the chance to learn how the human body works. And with that knowledge your generation may find the cures to cancer, prevent heart attacks, and be better informed on how to eat right and stay physically fit.
Fort Knox, Kentucky, is where our government stores billions of dollars worth of gold as collateral for our country to be able to borrow money. None of us has the key to Fort Knox. But I do have the key to another treasure and I can offer it to you for free.
This treasure contains 3 billion letters that are written into instructions contained in almost every cell of your body. These instructions, taken all together called a genome, have been read over the past decade and now can be looked up on a computer. In fact, all of the letters of your genome will fit on a compact disk, and you can look up this "book of life" on any computer connected to the Internet. But you must learn to read the DNA, and the only way to do that is through education.
We need smart, talented, energetic people like you because there is so much to learn. There are many different opportunities.
You can become a researcher. We also need nurses and genetic counselors to explain genetic tests and interpret the risk of disease. Or you may find you are more interested in the political process. In Washington, D.C., my colleagues and I work on the public policy of health. We advise the President, Secretary of Health and Human Services, and members of Congress about how laws and policies can be written to help improve health.
Charge and Closing
Congratulations on your successes to this point. Stay strong. There will be days that demand more of you than anything you have ever experienced.
The sacrifices you make will return great rewards. Never forget or underestimate the immense privilege and responsibility you will have as healthcare professionals … to each patient and to your community. You have the ability - literally and figuratively - to enter the hearts, minds, and souls of our fellow citizens. You bring new life into the world, compassionately comfort those leaving, and all needs in between. Strive to maintain the purity and passion you have today while gaining knowledge and wisdom.
Keep learning every day. And pay attention to those who came before you. One of the most important things I've ever learned is that I'm not alone. A philosopher named Thomas Merton said, "My successes are not my own. The way to them was prepared by others. The fruit of my labors is not my own: for I am preparing the way for the achievements of another."
I am standing on the shoulders of some great men and women. Starting with my grandmother, continuing through the leaders I met in the Army and in school, and now I am following on the great legacy of the 16 Surgeons General who preceded me in this position.
There are relatively few minority healthcare professionals. Those of us who are fortunate enough to succeed in our chosen career have a responsibility to help others succeed. Remember, when you take the elevator to the top floor, don't forget to send it back down.
One person can make a difference. I charge each of you to be that person. Set your goals out of your apparent reach and your standards above reproach - make a commitment to change the world. Thank you.
Last revised: January 8, 2007