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 Global Health Summit

Sunday, June 5, 2005
8:45 a.m.
Philadelphia, Pennsylvania

"A Priority of Global Health: Why Now?"


Thank you for that kind introduction.

I also would like to thank the U.S. Public Health Service Commissioned Officers Foundation for organizing this global health summit.

I would like to especially thank Rear Admiral Jerry Michael, Rear Admiral Mary Pat Couig, and Captain Gerry Farrell for making this event a reality.

The notion that health is global isn't new or novel, it's as old as the Vikings and the Crusaders. Unwittingly, Christopher Columbus brought viruses with him on the Nina, Pinta, and the Santa Maria that the Native Americans did not have immunity against.

And as new vaccines and treatments come available, we are seeing more and more pathogens strengthening their resolve to survive through mutation.

It's a marvel of the world — the epic struggle of survival, from the mightiest of men to the smallest of bacterium.

The struggle is as timeless as the world itself.

But while these struggles are old, what is new, is the speed and rapidity with which diseases can travel and mutate, as well as the resources and medicines we have to treat them.

It's the great global health paradox of the 21st Century:

The greatest challenge to our technological and medical expertise in treating diseases is getting to the disease before it uses our technology to spread.

Background
Our mission as Commissioned Corps Officers, is to protect, promote and advance the health and safety of the nation. It's a big job.

As members of the public health community, we're together in this mission. Every day in places across the country and around the globe, we all work to protect, promote and advance the health and safety of our fellow citizens.

Fortunately, we have the great privilege to serve under the leadership of President Bush and Secretary Leavitt.

We have even a greater privilege of living in this great land of freedom and opportunities. We have a responsibility to help others achieve freedom and democracy.

In meetings, your Corps leadership had recently with the new secretary, he is excited at the potential of the corps, and is proud of our reputation and in our response.

He had the opportunity to hear about our success, most recently aiding the victims of the tsunami.

Secretary Leavitt is promoting the Department's concept of "medical diplomacy."

As public health professionals and as policymakers, we all agree that the United States is a blessed nation. Often, the world's perception of our country is viewed through the sometimes skewed lenses misinformation and lack of understanding.

But we can use our American generosity, American compassion, medical expertise, and financial resources and to spread hope, health, dignity and vision with a future to nations around the globe.

Again, back to our support in aiding the victims of the tsunami, we're already hearing stories in the news about how our American compassion is improving the way people look at our nation.

And this is happening all over the world, in places like Afghanistan and Iraq: places where President's Bush Administration worked to get hospitals rebuilt and reequipped for people who had no access to care.

And step-by-step we've had Public Health Service Officers working side-by-side with other U.S. agencies, NGO's, communities of faith and caring citizens to improve the health and well being of needy nations.

Before I became Surgeon General, I had already developed a deep appreciation for how global health can affect people, communities and nations.

My understanding of the importance of global health grew from my experiences in Vietnam as an Army Special Forces medic and working as a trauma surgeon in Arizona.

Many of you have heard me talk about my time with the Montagard tribal people in Vietnam. Through these and other experiences I came to appreciate how culture and national views can shape health care that can impact not just one population, but can influence or be influenced by other populations.

And working in Arizona, I saw people who had crossed the U.S./Mexico border to receive health care.

And while I didn't know if the patient would be going back to Mexico, or into the Arizona fields to work, I knew that their health would impact not only themselves and their livelihood, but also that of their family and community.

And of course, over the past few years we've all experienced some great tragedies…

Tragedies like September 11, the anthrax attacks, hurricanes, and the tsunami…

But even in these tragedies, we see the triumph of the human spirit.

Many of you saw the courage of New Yorkers in the shadow of the fallen towers…

Or the compassion of communities pulling together in Florida to make sure people had places to stay and food eat…

Or the will to survive the mountain of water and ensuing floods in Malaysia.

One of our officers tells the story of his work on the USN Mercy and meeting a boy he called Harapan — which in Indonesian means, "hope." Harapan was found clinging to a log after two days floating in the ocean. When the tsunami hit, Harapan nearly drowned, and as a result he got sea water into his lungs. This eventually caused a severe infection in his lungs.

Except for his uncle, his whole family was killed during the tsunami.

And while his fate was initially uncertain, his personal fortitude, like so many of his fellow countrymen, eventually led to his recovery.

Time after time, we see these Herculean feats accomplished by normal people.

After seeing so many people in so many places, it doesn't take too long to see how interconnected we all are. And now in an era of terrorism and the increasing threat of bio-warfare we know that people would do us harm – and that capacity lives not only in their hearts, but also in their actions.

Public health preparedness has become an important issue for all of us.

And this public health issue perhaps more than any other has brought into sharp focus how global health impacts us all.

And as the world's leader in so many things, the United States must be the leader in this essential arena throughout the world.

One of the duties of my office — and one of my greatest challenges — is to help the American people understand the critical health issues facing them today and tomorrow.

Our world is more interdependent every day. Diseases know no boundaries, whether in our human population or, as we are seeing, in our animal kingdom.

We are after all one small world.

The ease of travel, communications and technology have enabled mankind to reach places across the world in a matter of hours before diseases declare themselves.

The compression of time frames in travel present new health challenges in disease prevention and treatment.

The lack of education and resources, political issues, and cultural ideas prevent many of our fellow human beings from enjoying the same benefits we do in America, yet their challenges may be on our doorsteps in a matter of hours.

We need to think differently. We need to share this challenge with the rest of our countrymen. We need to educate Americans of how small the globe is for the quick travel of germs and pestilence.

As public health professionals we know the great impact of global health — but we need to inform the citizens we serve.

The question is how we communicate global health messages into a language that will be receptive to the American people.

How should the Surgeon General convey the importance of global health and the impact it has on everyday lives?

Months ago, I went to the experts — Dr. William Steiger and his staff at the Office of Global Health Affairs in our Department — to help me explore this question. Over the past year, they have done a marvelous job to develop a viable approach to this complicated and complex topic.

We're continuing to develop a document that I hope will begin to outline to the American people not only why global health is important — but also, why they should care. It's important that the Call to Action be a living document that breathes passion into the issue, so that it comes to life for the American people.

The document is based on three assumptions:

First. That the American people need to understand about the broad context of global health issues and the urgency of addressing the critical challenges of the 21st century.

Second. That we need to explain the importance of global health as it affects their daily lives.

Third. That a broader dialogue could help develop a platform for creating and supporting the nation's global health priorities.

Why is Global Health Important to the American People?
The first step in thinking about a Call to Action is to explain why it is important. I think we can explain it using three simple concepts.

Our role in global health is #1 Leadership; #2 Practical; and #3 Diplomatic. We have a responsibility to continue our leadership in global health because it improves lives, it reduces the spread of disease, and contributes to the political world stability.

Leadership Responsibility
Let's talk about first about our leadership responsibility. Most of us grew up with the golden rule of "do unto others as you'd have done to you."

It's based on the premise that we should always be good to others and treat others with respect and compassion, particularly those who are less fortunate.

As kids we probably didn't think too much about disease, but this same principle carries over into adulthood. We largely believe that caring about the health and well being of others is important.

This is not a new concept. We live it every day. When we see people suffering, we help.

If any person is run over on the street and is taken to the emergency room, we treat him or her. Why? Because it's the right thing to do. We value life. We value human dignity. To let someone suffer or die without helping would be inhumane.

The same concept applies globally. We don't want babies to die around the world because of lack of access to the simplest and most cost-effective vaccines. So, we help.

As individuals and as a nation — we have a moral compass that guides policy and actions.

Sure, I'm proud to be the Surgeon General. But I'm also proud to be a public health officer in a nation that cares about the health of people in this country and around the world. We help when help is needed. It's the honor of being in public service.

Practical Responsibility
Second, global health makes practical sense.

Our world is more inter-connected than ever. Our inter-connectedness means that threats to our health can transverse the globe at unprecedented speeds.

Plagues and disease that used to take their time in spreading across continents can now jump and spread as fast as a 727 landing at JFK International Airport in New York or landing in Des Moines, Iowa.

SARS reminded us of this. Almost as quickly as it appeared in Taiwan, it struck half a world away in Toronto.

While globalization enables the spread of disease, it also gives us the tools to respond to these crises. We can rapidly respond to natural or human-made disasters. And we can dispatch health professionals, medicines and supplies globally in a moment's notice.

And as a nation we are updating and improving our training to be more flexible and responsive in times of urgent need.

The bottom line is that disease knows no borders.

And in our global community, our nation's health is only as good as our weakest (sickest) neighbor. Neighbors don't have to be right next door. We are living in a global neighborhood, with neighbors thousands of miles away. We cannot pretend that their issues do not affect us. Their issues are our issues.

Diplomatic Responsibility
This brings me to my last reason for paying attention to global health: Diplomatic responsibility.

This is what Secretary Thompson coined as "medical diplomacy".

And Secretary Leavitt has already embraced this concept. In fact, even as we speak, Secretary Leavitt is preparing for a trip to Russia and the Ukraine to talk to political and health leaders about ways that our nations can work together.

Caring about the health of others is of strategic importance. I believe that only through countries working together can we achieve improved global health.

This, in turn, promotes the opportunity for greater dialogue in to more controversial areas with the potential for growing peace and harmony.

Stable democracies cannot be built on the backs of unhealthy, broken people.

Countries cannot achieve sustainable development when the national life expectancy is only 50.

Peace cannot exist in an area where extreme health and wealth disparities constantly light the match of bitterness and despair.

Health is the common currency among peoples that can be used to help countries achieve their fullest potential.

And as we strive to be a healthier nation, we can help other countries towards that goal.

And all the while, providing a visible, tangible, example of our hope as a nation, and as their global neighbor and partner.

U.S. Leadership
The United States has been a leader in improving global health for decades.

Unfortunately, however, there is a great deal of misunderstanding and lack of knowledge among the American people about what it is that the United States government is actually doing to help.

I view a Surgeon General's Call to Action on Global Health as a step towards educating Americans about some of the many key issues in global health, and to challenge them to become involved.

It also provides the platform to educate the American people on what their government is accomplishing overseas to address global health issues and disparities. .

And it will also outline, broadly, the issues that policymakers must grapple with when making tough decisions about our nation's infinite will to help coupled with our finite resources.

Americans are an incredibly generous people. And our nation's contributions and efforts towards global health, should be the subject of dinnertime conversation.

So by producing this Call to Action, we are informing the public discussion – and hopefully replacing innuendo with facts, and skepticism with science.

Closing
I hope that today's Global Health Summit will be just the beginning of increasing the awareness of global health.

And as we move forward we should — as a nation — remember that global health actually begins and ends in individual tribes and villages and communities and cities all over the world.

It's in this network of villages, and communities, where the true essence of a public health infrastructure can lead to the health and safety of a region, then a nation, then the globe.

So whether you're working on an Indian reservation, or community health center, in disaster relief, or in a Montagard village…by improving the health of each person and each community, we're improving the health of the globe.

On behalf of President Bush, Secretary Leavitt and myself, I thank each of you for your service to your country and to your community and to your world.

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Last revised: January 8, 2007