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

Young Epidemiology Scholars (YES) Competition

Monday, April 16, 2007
Washington, DC

"The Role of Public Health and How it Makes a Difference in People’s Lives"

Opening and Acknowledgements
Good morning. Thank you, Dr. McGinnis, for that kind introduction. [J. Michael McGinnis, M.D., MPP, Senior Vice President and Director of the Health Group, Robert Wood Johnson Foundation]

It is truly an honor to join you here today.

I always enjoy the opportunity to meet with our nation's future leaders.

You are truly our nation's hope.

I am inspired by your energy, your eagerness to research the unknown ... and your desire to contribute to our great nation and the world.

I have no doubt that you will make a difference and improve the health, vitality, and economic prosperity of all Americans.

To the parents here today — thank you. You have done a fine job.

As the proud father of three daughters, I am aware that being a parent is the most difficult job in the world.

We want our children to have better lives than ours, an easier time of everything.

But the reality is that sticking to what's easy isn't always the best way to become engaged in and involved in the world around us.

As the noted anthropologist Roger Lewin has said, "Too often we give children answers to remember rather than problems to solve."

I believe that every young person in this room today has been inspired to solve problems, and that inspiration is precisely what will make our world a better place for future generations.

I also want to acknowledge the College Board and the Robert Wood Johnson Foundation for creating the Young Epidemiology Scholars research and scholarship opportunity.

Dr. McGinnis, Jim and Pamela, thank you for all the important work you're doing to inspire tomorrow's epidemiologists and public health leaders. [Jim Montoya, M.A., Vice President, Higher Education Relationship Development, The College Board; Pamela Ruso, Senior Program Officer Robert Wood Johnson Foundation]

The YES Competition is proof that it is never too soon to begin engaging students in solving our nation's most pressing public health challenges.

From obesity to underage drinking, to infectious diseases like H-I-V and emerging threats like pandemic flu ... many of the Young Epidemiology Scholars' research projects intersect with the issues that the Department of Health and Human Services is working on every day.

I'm impressed by the research topics you have chosen to study. You didn't shy away from the difficult questions of our times.

And I am encouraged by many of the solutions you have proposed.

My bosses, Department of Heath and Human Services Secretary Mike Leavitt and Assistant Secretary for Health Admiral John Agwunobi, both asked me to bring you their best wishes.

They are strong advocates for developing our nation's students and emerging leaders.

When we discussed that I would be here with you today, they asked what I would share with you.

I told them that I would speak with you about the same issues that the three of us — Secretary Leavitt, Admiral Agwunobi, and I — discuss and debate with our colleagues here in D.C., throughout the nation, and around the world.

Public Health
First, let's take a look at the current state of public health.

Public health is about:

• promoting health;
• preventing diseases before they happen;
• monitoring populations through epidemiology;
  and
• ultimately saving lives.

I want to encourage all of you to consider a career in public health. Your talent is needed.

And I'll be completely open and transparent about my agenda:

I want to encourage all of you to consider a career in the United States Public Health Service Commissioned Corps.

U.S. Public Health Service Commissioned Corps
I've been proud to serve in the Public Health Service for more than three decades.

And as Acting Surgeon General, I now have the privilege of leading the day-to-day operations of the Commissioned Corps.

We are a Corps of more than 6,000 public health professionals, dedicated to our mission of promoting, protecting, and advancing the health and safety of the nation.

We are one of the nation's uniformed services, and we serve alongside our brothers and sisters in uniform in small communities and large cities throughout the world.

Our officers are sometimes deployed to national and international disaster locations and Special National Security Events.

But not only do they deploy — our officers lead.

You can do just about anything in the Corps.

Just ask me.

• I'll tell you about working in under-served areas.
• I'll tell you about the research you can do at the National Institutes of Health or the Centers for Disease Control and Prevention.
• I'll tell you about the work that you can do to advise the health care decision-makers of our great nation.
• I'll tell you about the bridges that you can build through global health diplomacy, reaching out across borders to help our friends and allies in times of crisis.

These are not "just jobs" for our officers. In fact, we are all very passionate about our work.

I'd like you to consider your next steps and other opportunities that will build upon your experiences here.

Consider joining the U.S. Public Health Service and truly unleashing your leadership capabilities.

We have opportunities for you to join throughout your professional development, beginning in college.

COSTEP and the Epidemic Intelligence Service
For example, the Junior Commissioned Officer Student Training and Extern Program, also known as Junior CO-STEP, allows students to gain valuable professional experience early in their education.

And Senior CO-STEP assists students financially during their senior year of college in return for an agreement to join the U.S. Public Health Service.

And post graduation, you can become a full-fledged Commissioned Corps Officer.

We also have a very special program designed specifically for health professionals interested in epidemiology called the Epidemic Intelligence Service.

The E-I-S is a paid two-year, post-graduate training program in applied epidemiologic skills.

E-I-S officers help the C-D-C conduct epidemiologic investigations, research, and public health surveillance throughout the United States and around the globe. You can find out more information about the Commissioned Corps at usphs.gov.

I have rearranged my schedule so that I can spend some extra time with you today to continue this discussion.

And I would be happy to answer any questions you may have.

Priorities
Our Commissioned Officers are committed to improving our nation's health.

And they also support the Office of the Surgeon General's public health priorities for a healthy nation.

The President assigned three priorities to the Office of the Surgeon General, and I'll share some examples of how these priorities impact our nation.

The first priority is Prevention. — What each of us can do in our own lives and communities to make ourselves and our families healthier.

The second is Public Health Preparedness. H-H-S is investing resources at the local, state, regional, and federal levels to improve public health preparedness.

We are improving public health preparedness for all hazards: manmade disasters and natural disasters.

The third priority we're focusing on relentlessly is Eliminating Health Disparities.

We don't just want to reduce health disparities; we must eliminate health disparities.

Prevention
Prevention is an essential component of public health and it is the cornerstone of everything that we do at H-H-S.

Expenditures for health care in the United States continue to rise. And each year millions of Americans die from preventable causes.

Today more than 90 million Americans live with chronic diseases, and treating those patients costs approximately $1.5 trillion a year.

And, about 70% of deaths in our country are caused by chronic diseases.

We spend a lot of money on treatment on the back end of disease, and not nearly enough on the front end.

Beyond the financial costs, these statistics represent tragic situations for families and communities.

These are not just numbers.

They are our grandparents, mothers, fathers, sisters, brothers, friends, and community leaders who suffer and die unnecessarily.

As a nation, we are spending too little on preventing these conditions, and we are losing too many lives.

Right now we live in a treatment-oriented society. We need to change to a prevention-oriented society. I have great hope that you can help us lead this cultural shift.

Our health care system can not thrive in a treatment-oriented society. We must turn the tide and embrace prevention.

Right now we spend lots of money on costly treatments to try to make people well, often when it is already too late.

Until we truly embrace public health ... until we approach prevention and staying healthy with the same rigor that we have for treatment after we are sick, this problem will persist.

We need to refocus our efforts on preventing disease, illness, and injury.

Five key public health steps can prevent most chronic diseases:

• Tobacco control,
• Good nutrition,
• Physical activity,
• Maintenance of a healthy weight,
  and
• Regular health screenings.

And we have evidence-based strategies to improve each of these factors.

By and large, we know what to do to act now.

The challenge is to move our research and knowledge into action.

I want to tell you today about one major barrier in our ability to translate the best science and research we have into action that will improve the health and well-being of all Americans.

It's called "health literacy."

Health Literacy
The reality is that we are largely a health-illiterate society, and this fact impacts every aspect of our lives.

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

Why is health literacy important? Low health literacy impacts health.

People with low health literacy are:

• Less likely to know how to navigate the health care system,
• less likely to understand basic health information,
• less likely to get preventive health care services,
  and
• more likely to use expensive emergency care services.

Unfortunately, our low health literacy is a major problem:

• Nearly 9 out of 10 American adults lack the skills needed to take care of their own health.

And low health literacy impacts all sectors of our society.

People of all ages, races, incomes, and education levels are challenged by it.

For the past four years, I've been working with colleagues throughout the nation to improve Americans' health literacy.

Last September, we held the first-ever "Surgeon General's Workshop on Improving Health Literacy."

I firmly believe that by improving health literacy, we can save lives.

The more people know about health, the better they can take care of themselves, their friends, their families, and their communities.

Basic health literacy is fundamental to the success of each interaction between health care professionals and patients — every prescription, every treatment, and every recovery.

Your commitment to public health and your continued interest in solving the issues that affect our society today are vital to increasing health literacy in our country.

We have to make sure that good health information is getting into the hands of the people who need it.

Secondhand Smoke
One of the major prevention and health literacy efforts that we are focusing on is secondhand smoke.

Our goal is to increase understanding of the need to reduce exposure to secondhand smoke.

By increasing health literacy about the dangers of secondhand smoke, we can ensure that the best available science is put to use.

After all, we have spent a lot of time gathering the best research on tobacco and its impact on health.

The work we are now doing is the next logical step: Communicating that science to the American people.

When it comes to smoking, the science is clear:

• Smoking is the largest preventable cause of disease, disability, and death in the United States.

The Office of the Surgeon General has a long history of exposing the risks of tobacco use.

I want to tell you about one of my personal role models ... who also happened to be a Surgeon General.

He was a man who had vision and spoke out in the face of adversity ... because it was important to the health of American people.

In 1964, over 40 years ago, Surgeon General Luther Terry issued the groundbreaking Report on smoking and health.

You may not know that back in 1964, nearly half of all Americans smoked.

The job of the Surgeon General is to protect and maintain the health of the American people.

And once he had the scientific evidence before him about the dangers of smoking, Surgeon General Terry knew that he would have to change how our country viewed tobacco.

Dr. Terry also knew that by issuing the results of the research — research showing that smoking causes three deadly diseases — he was taking aim at one of the pervasive symbols of American life: the cigarette.

So there he is in 1964 ... half of all Americans smoke.

As a matter of fact, until he started work on his smoking Report, Surgeon General Terry was a smoker.

Needless to say, when he released the Report, Dr. Terry quit smoking.

One day he was a smoker, and the next day he wasn't.

The science was clear. Smoking is bad for your health, especially your lungs.

And that compelling evidence influenced his decision to quit.

In the past 42 years, we've learned more about smoking.

Scientific evidence shows us that smoking causes disease in nearly every organ in the body, at every stage of life, here and around the world.

The statistics that epidemiologists have collected are compelling:

• Today, more than 44 million American adults smoke. This year alone 440,000 people will die prematurely of a tobacco-related illness.
• And for every person who dies, 20 more are living with at least one serious tobacco-related illness.
• And this is something that troubles me very much: every day, 4,000 teens and preteens people will start smoking for the first time. We really need your help in this area.
• Finally — and this fact simply cannot be emphasized enough — tobacco use is the leading preventable cause of death in the United States.

Last summer, the Office of the Surgeon General released our latest Report: "The Health Consequences of Involuntary Exposure to Tobacco Smoke."

The research in this Report put an end to the debate:

• Secondhand smoke is not just a nuisance — it is a serious health hazard.
• And smoking not only impacts the smoker, but often non-smokers who just happen to be around the smoker.

More than 40 years after the first Surgeon General's report on tobacco called for a dramatic shift in the way American's viewed tobacco, this new Report again fundamentally challenges conventional practices.

Many of us have been in non-smoking sections of public places, only to see the clouds of smoke travel across the room.

An important new conclusion of this Report is that smoke-free environments are the ONLY approach to effectively protect non-smokers from the dangers of secondhand smoke.

Secondhand smoke causes tens of thousands of heart disease deaths and approximately 3,000 lung cancer deaths among American nonsmokers ..... every year.

And we are working to get these new findings to the American people in ways that they can understand and use.

We know that not every American is a scientist or a health care professional.

It is our job to help all Americans put the best health research into practice at home and at work, and as a part of daily life.

All the research that we do at H-H-S means nothing if it sits on bookshelves.

People's Piece
That's why when we issued the Surgeon General's Report last year, we also issued this <<>> full-color magazine-style People's Piece that makes the science in the Report clear to the average American.

We now create a People's Piece for every Report.

Each People's Piece includes information about what the Surgeon General's Reports mean to our health as individuals, families, communities ... and as a nation.

Each People's Piece also provides specific tips about how to put information into action.

By placing the conclusions of the Report into the hands of all people, we ensure that the Report has an impact that extends beyond the scientific community.....into people's daily lives.

We are doing everything we can to make sure that the risk of secondhand smoke exposure and the steps we can all take to prevent it are heard... understood... embraced... and ultimately put into action.

We have already seen the power of public health knowledge when it is shared.

All across the United States and around the world, communities are mobilizing for smoke-free air. And we have seen a surge in the number of laws that require all workplaces and public places to be smoke-free.

Here in the United States, more than 16 states, Washington D.C., and Puerto Rico have passed smoke-free laws.

I want to be clear — The Office of the Surgeon General is not a policy office.

But we have the privilege of providing the best science, which often has an impact on policy development and community action.

And despite the fact that the position of Surgeon General is for the United States, what we do here has an impact throughout the world.

We have already begun receiving requests from other countries to discuss the latest Surgeon General's Report on Secondhand Smoke.

Countries across the globe are taking steps to protect non-smokers from secondhand smoke.

We are seeing change and new laws in Uruguay, Bermuda, Bhutan, England, France, Ireland, and Italy.

I am proud of the history of leadership that the Office of the Surgeon General has taken to reduce one of the biggest contributors to preventable deaths.

Charge and Closing I know that many of you want a make a positive impact on our world ... you want to influence change for the better.

And I'll be the first to tell you that you don't have to be a Surgeon General to influence the health of our great nation.

You already have tremendous influence.

With the health issues we face every day, we need passionate and committed individuals like you to advance the current research and to make positive changes in people's lives.

I hope that you will consider a career in public health to help us tackle issues like smoking and the many other health challenges affecting our nation today.

Whether you decide to work in public health as an epidemiologists or health educator ... you can make a difference.

And you will have many opportunities to improve people's lives by helping them to understand the importance of prevention.

Remember that you are all leaders. You are all winners. What ever you want to be, whatever dreams and goals you have — write them down today.

Consider this: In a survey of 1,000 Harvard students who were graduating:

• 84% of them had no particular defined goals.
• About 13% of the students had goals, but hadn't written them down.
• Only 3% of the students had written goals.
• Ten years later, the same students were surveyed again. Those who had goals in writing were more likely to meet their goals and be successful.

The moral of the story is to write down your goals.

Dream big, develop a plan, share it with others, and remember to work toward your goals every day.

So many opportunities await you.

Never lose that passion and enthusiasm that you have in your hearts right now.

And most importantly, never lose sight of the fact that you are in the service of others.

It is the responsibility of leaders like you to map out a course of action and involve others in achieving it.

Please keep doing the things that led you to this stage of the competition:

• Keep thinking imaginatively and critically.
• Keep learning, innovating, and collaborating.
• Keep asking the right questions: those that need to be answered, not just those that can be answered easily.

Like my role model Surgeon General Terry, we must be able look beyond what is conventional.

We must have vision, and we must be able to speak out in the face of adversity because speaking out, and then always doing the right thing, is the only way to secure the health, vitality, and prosperity of our nation.

Thank you.

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Last revised: June 18, 2007