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

Remarks at the National Association of State Alcohol and Drug Abuse Directors, Inc Conference
Friday, June 8, 2007
Burlington, VT

"Fostering Changes that Help Prevent and Reduce Underage Drinking"

Thank you Dave for that gracious introduction (Dave Wanser, NASADAD President)

It is an honor and a privilege to be here with you today, and to address the National Association of State Alcohol and Drug Abuse Directors Conference.

I am always delighted to spend time with fellow public health professionals who dedicate their lives to serving others.

I applaud each of you for your commitment to fostering the development of effective alcohol drug abuse and prevention treatment programs in your states.

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're very grateful for your work on behalf of all Americans.

Because of you, we are reducing the risk of disease for countless Americans.

Your work has shown prevention, early intervention, treatment and recovery support services for substance use disorders pay off in terms of reduced HIV/AIDS, crime, violence, suicide, homelessness, injuries, and health care costs, and increased productivity, employment, and community participation. Data confirms that the human and economic cost is much lower when we prevent or intervene early with the best research-based tools available.

Individuals with substance use disorders, and co-occurring disorders can and do recover. When they take that brave step toward seeking help and the right services and treatment take hold, the bright promise of recovery can unfold.

Today recovery is no longer the privilege of a few exceptional people, but a possibility for all. Helping to promote and advance the new recovery paradigm is the understanding that the public health approach is key.

Your priorities clearly align your agenda with the priorities of the Office of the Surgeon General I want to take a few moments to tell you about two of those priorities.

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

Prevention
Let's look at Priority number one: Prevention.

Like many of you, prevention is the cornerstone of everything that we do at H-H-S. It is a priority for us because of the fact that each year millions of Americans die from preventable causes.

These deaths, as well as the health care costs related to caring for our fellow Americans who are suffering from completely preventable diseases, are causing tremendous strains.

Most health care costs are focused on treating chronic diseases and conditions such as diabetes, obesity, cardiovascular disease, and asthma.

• More than 17 million Americans - over 6% of the U.S. population - suffer from diabetes, which costs the nation approximately $132 billion.
• People with diabetes lose on average more than 8 days per year from work, accounting for 14 million disability days each year.
• Heart disease is the leading cause of death in the United States. Cardiovascular diseases, many of which are preventable, cost the nation more than $300 billion each year.

And when you follow the money trail, you will see that it is heavily weighted toward treatment and end-of-life care.

Many of you know that too little is spent on preventing these conditions.

Right now we've got it backwards.

We live in a treatment-oriented society.

We need to change to a prevention-oriented society.

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

And prevention also means stopping drug and alcohol abuse before they start - I don't have to tell you that it is the best strategy for reducing the tragic public and individual health consequences they bring.

Because alcohol and drug addiction are such complex and pervasive health issues, we must continue to strengthen our public health approach to addressing them.

Such an approach must include extensive efforts in the areas of prevention, education, early intervention, treatment, and research -- many of the areas that this Association advocates for.

Many agencies at H-H-S are dealing with the problem, including SAMHSA, the Centers for Disease Control, the National Institutes of Health, and the National Institute on Alcohol Abuse and Alcoholism.

We fund treatment programs for the addicted, conduct research on the effects of drugs and alcohol among various populations, and provide information to the public about what they can do to get help if they have a problem, or someone they love has a problem.

But federal government, alone, can only do so much. We need the partnership of the State substance abuse directors and the national prevention network representatives.

The people and organizations in your networks - play a key role in prevention - and help us strengthen our efforts to address addiction problems.

The challenge is to elevate public health as a discipline, as a profession, and as a cause for our focused attention and advocacy - to move our research and knowledge into action.

Eliminating Health Disparities
As I mentioned, another public health priority is the elimination of health disparities.

While overall our nation's health has improved, not all populations have benefited equally.

Many Americans who are members of racial and ethnic minority groups experience disparities in health outcomes and health care.

It is unacceptable that in our great nation, with our global leadership in science and medicine, we still have major disparities in health and health care delivery.

A closer look at some of the challenges that minority communities face reveals that:

• African Americans are 1.5 times as likely as non-Hispanic whites to have high blood pressure.
• Cancer is the second leading cause of death for most racial and ethnic minorities in the United States. For Asians and Pacific Islanders, it is the number one killer.
• And Hispanic women are 2.2 times more likely to be diagnosed with cervical cancer than non-Hispanic white women.
• Diabetes affects more than 20 million people above the age of 20 in the United States. An estimated 15.1 percent of American Indians and Alaska Natives have diabetes.

All Americans - regardless of their race, heritage or gender - should have access to good health information and health services.

We are addressing these issues with numerous programs and initiatives and by increasing public awareness through programs.

I encourage you to visit the H-H-S Office of Minority Health website to learn more about what we are doing in the Department to combat disparities in health delivery. The web address is www.omhrc.gov

Health Literacy
Health literacy - or should I say, illiteracy - can also have a tremendous impact on our minority communities.

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

More than 90 million people cannot adequately understand basic health information. And health illiteracy is not only impacting our minority communities, it is impacting those from all ages, races and education levels.

How can we expect people to beat - or even control - chronic illness if they can't understand basic health information?

Here in the United States, much attention has been paid to health literacy.

For instance, The Institute of Medicine's 2004 report, Health Literacy: A Prescription to End Confusion, found that nearly half of all American adults have difficulty understanding and using health information, and there is a higher rate of hospitalization and use of emergency services among patients with limited health literacy.

Building upon that report, last year the Institute of Medicine convened a quarterly Roundtable on Health Literacy

The roundtable brings together various H-H-S agencies, the National Cancer Institute, the American Academy of Family Physicians Foundation, and the American College of Physicians Foundation - just to name a few.

Participants this year will continue to discuss challenges facing health literacy practice and research AND to also identify approaches to promote health literacy.

As state substance abuse directors, many of you understand the importance of being able to translate complicated health and research information into easy to understand information that is communicated clearly, accurately and effectively

You know it's important, because people must have the opportunity to make the best decisions about their health.

We depend on the communication skills of our substance abuse directors.

It's important that in your mission of supporting substance abuse prevention - that your messages are understood by the individuals you are trying to reach.

We all have a responsibility to ensure that we translate the science and data into medical and health information that can be heard... understood... embraced... and ultimately put into action.

The fight to end health illiteracy should start with substance abuse programs that promote health literacy, education and promotion.

These programs should be developed with involvement from the people who will use them.

And these prevention and treatment efforts must also take into consideration the cultural and language barriers many in our Nation face.

Care systems, the media, and education and community programs can all join the effort in promoting a more health literate nation.

Call to Action
Many of you are aware that in March we released the Surgeon General's Call to Action to Prevent and Reduce Underage Drinking.

Underage drinking is a significant public health and safety problem.

Underage drinking is not just about spring break, and it's not just about parties. As early as ages 8 and 9, our children are confronted with decisions about alcohol on a regular basis in many settings - including at home and at school.

The 2005 National Survey on Drug Use and Health estimates that there are almost 11 million underage drinkers in the United States.

We also know that drinking and binge drinking ramp up during the teen years. Nearly 20 percent of 14 year olds say they have been drunk at least once.

This needs to stop.

Underage drinking is everybody's problem - and its solution is everyone's responsibility.

Unfortunately, too many Americans see underage drinking as a rite of passage ... kids just being kids. The reality is our young people are being harmed by underage drinking. That's why this Call to Action is attempting to change the culture and attitudes toward underage drinking in America.

We can no longer ignore what alcohol is doing to our children. The adverse consequences of underage drinking are wide-ranging, and include academic failure, risky sexual behavior, injuries, and even death.

In fact, each year, more than 5,000 deaths of people under age 21 are linked to underage drinking. That is the total student body of a small college or university. Think about it! Every year, another college or university, wiped clean of its students due to underage drinking. And it is all preventable!

As with every Surgeon General's publication, this Call to Action is grounded in science. The science indicates that underage drinking is putting our children at risk.

Recent research shows that the brain continues to develop well beyond childhood - and throughout adolescence. This research raises concerns that underage drinking may affect short-term and long-term cognitive functioning, and may change the brain in ways that can lead to future alcohol dependence.

Research also shows that young people who start drinking before the age of 15 are five times more likely to have alcohol-related problems later in life.

The bottom line is that research provides more reasons than ever before for parents and other adults to be concerned about the effects of underage drinking on our nation's children, and to take steps to prevent and reduce underage drinking.

This Call to Action is a call to every American to join with the Surgeon General in a national effort to address underage drinking early, continuously, and in context of human development.

Goals of the Call to Action
This Call to Action identifies six goals that we will be joining with all sectors of society to address:

1. Foster changes in society that facilitate healthy adolescent development and that help prevent and reduce underage drinking.
2. Engage parents, schools, communities, all levels of government, all social systems that interface with youth, and youth themselves in a coordinated national effort to prevent and reduce underage drinking and its consequences.
3. Promote an understanding of underage alcohol consumption in the context of human development and maturation that takes into account individual adolescent characteristics as well as environmental, ethnic, cultural, and gender differences.
4. Conduct additional research on adolescent alcohol use and its relationship to development.
5. Work to improve public health surveillance on underage drinking and on population-based risk factors for this behavior. And finally:
6. Work to ensure that policies at all levels are consistent with the national goal of preventing and reducing underage alcohol consumption.

Guides to Action
As many of you know, the Office of the Surgeon General is committed to providing the best scientific information in a way that people can use and understand.

By making health information easier to understand, we allow people to actively take steps to increase their health and wellness and to actually prevent disease as a result of healthy choices.

In addition to this Call to Action, we recently released several “Guides to Action” with the science presented in a way that Americans can understand and apply to their individual, educational and family circumstances.

I am confident that the information in this Call to Action, when broadly disseminated and discussed among parents, teachers, community leaders, and young people themselves will literally save lives.

With this Call to Action, I am asking every American to join in a national effort to change attitudes and behaviors regarding underage drinking. Our children deserve nothing less.

At the federal level, I am pleased to be a member of the Interagency Coordination Committee on the Prevention of Underage Drinking.

The committee consists of representatives from 13 federal agencies and is chaired by SAMHSA Administrator Terry Cline, who you will hear from later today.

In addition, members of my staff work routinely with the committee's representatives.

At the state level, I strongly encourage you to reach out to your counterparts in State government to develop a comprehensive, interagency approach to preventing and reducing underage drinking.

• Those of you with a SAMHSA Strategic Prevention Framework Grant already have a head start and others have already been working for years to prevent and reduce underage drinking.
• I am working with members of the Leadership to Keep Children Alcohol Free to do State roll-outs of the CTA. If one of these visits is scheduled for you State, we will make sure that you are involved in the event.

Closing and Charge
Thank you to all of you for your dedication to expanding access to prevention and treatment programs and for ensuring that Americans receive clinically appropriate care.

And thank you for your continuing work, and for your commitment to improving the health of all Americans.

Today I want to ask for your continued leadership in fostering changes in society that help prevent and reduce underage drinking.

Looking around this room, I know that through your efforts, and by bringing together all of our strong and growing partnerships and networks, we can ensure better health and safety for all Americans.

I look forward to working with you during this meeting and beyond.

Thank you for your dedication, your commitment, your leadership to improving the health and well being of people everywhere.

Together, we can improve the health of all Americans – health of body, health of mind, and health of spirit!

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Last revised: July 30, 2007