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 Society of Military Engineers (SAME) National Education and Training Conference

Thursday, May 19, 2005
Louisville, Kentucky

“Call to the Posts The Role of Engineers in Improving Prevention and Public Health Preparedness and Eliminating Health Disparities”

Good morning.

Thank you, General Fox, for that wonderful introduction. [SAME President Major General Dean Fox, United States Air Force Civil Engineer]

It’s great to be among so many friends. I want to thank the Society of American Military Engineers for asking me to join you today.

On behalf of President Bush and Health and Human Services Secretary Mike Leavitt, thank you for all you do to keep our nation safe, secure, and healthy. And you do so much to keep our economic engines going.

I think I met personally with many of you last night. Those 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 General Fox, it wasn’t so long ago that I was a regular guy in Arizona, working as a trauma surgeon, law enforcement officer and first responder, college professor, and public health officer. 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.

Now as Surgeon General, 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. 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.

This is like a homecoming for me, because the Society has truly embraced the Public Health Service, and welcomed it wholeheartedly into the family. I want to thank my chief of staff, RADM Bob Williams, and CAPT Sven Rodenbeck of the Centers for Disease Control and Prevention for all they do to continue the partnership between the Society and the Public Health Service.

And before I get into my remarks I want to express my appreciation to the men and women in uniform who are serving our country today. I also want to salute the veterans in the audience today. I served in the Army Special Forces in Vietnam as a medic and weapons specialist. I’ve seen the horror of war up close and personal. But I’ve also seen the hope that Americans can bring to a repressed people.

I learned many lessons as a young man serving in Army Special Forces: integrity, responsibility, and respect. What I learned in the Army is that every success requires a team of professionals working together - much like SAME, uniformed services and industry working together, a diversity of disciplines, united by a commitment and dedication to safety and security.

USPHS Commissioned Corps
Since 1913, PHS engineers have been on the forefront protecting the health and safety of the people of this nation. Since becoming Surgeon General, I’ve come to more fully appreciate the difference that engineers make each and every day. Our PHS engineers:

  • Ensure the safety of medical devices;
  • Conduct research to prevent workplace injuries; and
  • Assess the impact of hazardous waste sites.

As we move to joint interoperability, the value of engineers becomes even more apparent. PHS and Navy combined forces on the U.S. Navy Ship Mercy to provide humanitarian relief to Indonesia after the devastating tsunami and subsequent earthquake that hit area of the world. We deployed doctors, nurses, mental health providers, and engineers. I found the following message from one of the officers on the Mercy to be particularly interesting:

“Of all the USPHS personnel deployed on board the Mercy hospital ship, it was not the highly trained clinicians that had everybody on the ship talking. It was CDR Hung Trinh, a PHS biomedical engineer, who had the Indonesians, the Navy, and the civilians from Project Hope singing his praises. The CDR is a completely unassuming guy who was sent over to help put medical equipment back into working order, and get it properly calibrated. In fact, he has literally rebuilt every device that was put in front of him. A single engineer may have made as great an impact on the long term public health capacity of Aceh province as whole teams of others. One day he even fixed five broken air conditioners onboard the ship (it was 110 degrees during this assignment), so every sailor on the ship was grateful.”

That’s pretty impressive, but the reality is that engineers are like that everywhere they go. Engineers are problem solvers: they don’t say never and they never quit. I’m very proud to serve with the PHS engineers and to support their efforts in public health.

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. Prevention is everyone’s mission. Without healthy and fit Americans, we will not be able to continue to excel as a great nation. Prevention of disease and illness requires prospective thinking, upfront preparation, and intervention to solve problems; it takes teamwork. It is about what each of us can do in our own lives and communities to make ourselves and our families safer and healthier.
  • Second, Public Health Preparedness. We are investing resources at the local, state, and federal levels. None of my predecessors as Surgeon General had to deal with public health preparedness the way that we do today. Now the world we live in requires us to be prepared to respond to many different scenarios - we must be knowledgeable, credible, and prepared at the federal, state, and local level to respond to all hazards emergencies. Although rarely in the limelight, engineers are always there to assure that the appropriate support systems are available. In addition, your problem solving and organizational skills have frequently resulted in the successful completion of many responses - to the World Trade Center attack, the anthrax attacks, the recovery efforts in Iraq and the tsunami and earthquake response, just to name a few. Engineers are prepared and engineers make responses happen quickly and efficiently. This Society is dedicated to the national security through readiness. You are closely associated with preparedness, bringing together industry, government, uniformed services to protect against all hazards and emergencies.
  • 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 should eliminate 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. 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. 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:
    - 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.

    Engineers are a part of that solution in so many ways. The PHS engineers have made a world of difference by working with tribes and villages to improve the mind, body, and spirit of American Indian and Alaska Natives through water supply, sanitation , and health facilities construction. Our engineers have really excelled, bringing drastic decreases in postneonatal mortality and gastroenteric mortality in Indian Country through the provision of safe water and wastewater disposal.

I want to thank this Society for making great strides in eliminating disparities, especially through education. You reach beyond yourselves into communities, and many of the programs you offer emphasize mentoring. I’m very impressed by the SAME Summer Engineering and Construction Camps for youth. The students learn and perform basic engineering tasks. And, they are physically active. Building sheds or busting concrete beams, you ensure they have some daily activity and show them that being physically fit can contribute to their success.

The Year of the Healthy Child
I want to ask you to join us in helping more children. They are the segment of our population that probably needs our help the most. That is why the 2005 agenda for the Office of the Surgeon General is “The Year of The Healthy Child.”

We kicked off the year in January with the first-ever Surgeon General’s Workshop on Healthy Indoor Environment. Led by engineers, including RADM Williams and CAPT Rodenbeck, this workshop brought together the medical and building construction communities to discuss how to make our indoor environments safer and healthier. Healthy indoor environments are key to improving children’s health. Today one in five schools in America has indoor air quality problems. And each year 4 million American children have asthma attacks, making this lung condition a leading cause of emergency room visits and missed schooldays. Through the Workshop on Healthy Indoor Environment, we are strengthening collaborations to improve the air in schools and other buildings across America.

I am also taking a hard look at other ways to improve the health of children both domestically and internationally. This agenda 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. This includes the importance of breastfeeding, on-time immunizations, oral health, drug and alcohol use prevention, smoking prevention, safe teen driving, youth violence prevention, preventing child injury, preventing overweight and obesity, preventing child abuse, improving mental health, and maintaining healthy indoor environments.

We are also focusing 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 are focusing 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.

Our children are our future. They will take our place, whether in uniform service or other service to the nation, or as champions of industry and corporate progress. And they will take our place only if they are safe and healthy. Without changes in their behavior, we risk an even more unhealthy young and middle-aged population. And from where will we get our soldiers, sailors, and airmen? Where will we get our corporate managers and production directors?

We must do more to ensure our children’s health and well-being today.

In closing, I want to ask that when you go back home, and continue your efforts on behalf of this great nation, remember that you are always setting an example for the next generation, whether as a parent or in your professional capacities.

During his tenure, General Fox has emphasized the theme of “Back to the Post.” It is a call to energize the local level involvement in the Society. It is a powerful concept. In most aspects of prevention, preparedness, and response, everything is local. All disasters are local. Public health is local. The PHS and the Department recognize that.

To put it plainly, your mission is our mission. We all have a role in ensuring the health and security of this nation. Collaboration, among disciplines, between public and private sector - this is what it will make America healthier, safer, and stronger for generations to come.

President Bush has given all of us who work for him 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.

The improvements to healthcare, the reforms that Secretary 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 transformation and success.

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 continue to renew, reform, and improve.

That is what this Society is all about, and I look forward to working with you in the months and years ahead. Thank you.


Last revised: January 10, 2008