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Remarks as prepared; not a transcript. RADM Kenneth P. Moritsugu, M.D., M.P.H Thank you, Sally, for the gracious introduction. Good morning, ladies and gentlemen. It is an honor and privilege to be here and to deliver this address during your plenary session. I want to thank to CHPPM for extending the invitation and giving me an opportunity to share this time with you. I also salute Brigadier General Michael B. Cates, and your entire staff for all of your efforts to plan and convene this important conference. The agenda is indeed an impressive one. My broad responsibilities involve all matters related to the health of the American population; I particularly enjoy the opportunity to address colleagues whose mission:
Your organization and mine are both prevention-oriented and alike in several other ways as well. We share a vision. We share a focus. CHPPM, like the Office of the Surgeon General and the various operating divisions of the U.S. Department of Health and Human Services, is in a specialized business: creating healthier American communities - individuals and families well schooled in preparedness, prevention, and physical activity. H-H-S, like CHPPM, shares specialized knowledge - the health benefits of making appropriate choices as they pertain to food, nutrition, and lifestyle; the value of preventive care. We recognize that good health doesn't just happen. Rather, it's a habit of smart choices and sound clinical care. Disease prevention and wellness are neither civilian nor military constructs. They are both. Preventive medicine…healthy choices…identifying and understanding what makes for good health… these are universally applicable practices. As such, the missions of CHPPM and the Office of the Surgeon General, then, are essentially one: our common cause is motivating people to adopt healthy practices in their everyday lives. I've been in the Public Health Service for more than three decades. During that time, I've worked with the general public as well as specialized sub-populations. I have had the honor of serving as the assistant bureau director and the medical director of the U.S. Department of Justice Federal Bureau of Prisons. For more than a decade, I saw firsthand the realities of correctional health in our prisons. My career experiences, the lessons learned, the instructive memories are with me still; they continue to influence my work as Acting Surgeon General. Moreover, in that capacity, I have the privilege of leading the day-to-day operations of the Public Health Service (PHS) Commissioned Corps. Commissioned Corps personnel, like you and the members of the U.S. Army who receive your services, are motivated, they are loyal, they are purposeful, and they are focused on completing their mission. Like you, we are dentists, dental hygienists, physicians, nurses, physical and speech therapists, audiologists, environmental health officers, environmental engineers, veterinarians, physician assistants, pharmacists, and surgeons. 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. Officers serve the 10 agencies within H-H-S, including:
They also serve non-DHHS agencies and programs including:
We are one of the nation's uniformed services, and, like you in the U.S. Army, we serve alongside our brothers and sisters in uniform in small communities and large cities throughout the world. Our officers, like members of the U.S. Army, are sometimes deployed to national and international disaster locations and Special National Security Events. But not only do they deploy; our officers, like Army, lead. Our missions are many:
For instance, a team of 17 U.S. Public Health Service Commissioned Corps officers is serving on the SNS Comfort, a U.S. Navy hospital ship that departed Norfolk, VA, in June to begin a medical, public health and oral health mission in Latin America and the Caribbean. The 4-month mission of the USNS Comfort is to provide oral and primary care health services in communities near where the ship docks. The Commissioned Corps officers are working with the U.S. Army and Coast Guard, as well as with nonprofit organizations Project Hope and Operation Smile. This joint activity offers a model for future operational coordination with CHPPM and other uniform services colleagues, though hardly the only prospective collaboration. The PHS Commissioned Corps has long coordinated with CHPPM, in Medical Readiness Training Exercises (MEDRETEs), as members of Disaster Medical Assistance Teams (DMATs), in association with Army National Guard training and other service. No matter the mission, members of the Commissioned Corps are all very passionate about our work. I know you, representatives of CHPPM and the broader U.S. Army, likewise display such passion. It is reflected by your service in to answer our country's call. You reflect that passion as you help others, demonstrate unselfishness, a willingness to sacrifice, a commitment to something greater, an appreciation for something more profound: a nation which is safer, healthier and ever more secure in our preparedness. What you do is critical: you support military readiness by keeping soldiers fit to fight, while also promoting wellness among their families, your own loved ones, and the Federal civilian workforce. I applaud you for all that you have done. My bosses, U.S. Department of Health and Human Services Secretary Mike Leavitt, and Assistant Secretary for Health Admiral John Agwunobi, and I truly appreciate your service and dedication to our nation. 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 with anyone responsible for ensuring the health and preparedness of the American population. Our objectives at HHS, like yours, involve improving health and quality of life. These goals are crosscutting, widely shared by all with whom we work, whether civilian or military personnel, scientist or practitioner, professionals affiliated with the Federal government or non-profit and private sector stakeholders with whom we partner. I would like to take a few moments to discuss some of those objectives. But first, let's consider what we mean when by the term "public health." Public health is about promoting health; preventing diseases before they happen; monitoring populations through epidemiology; providing and sustaining an improved quality of life for individuals and families and creating better communities. Ultimately, improved public health is about saving lives. Priorities That definition helps frame our priorities at H-H-S. I'd like to discuss with you three of our top 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. We want to transform our health care system from a treatment-centered entity to an interconnected system. We need a system of seamless entry, one that focuses on preventing disease and treating diseases early, in their most receptive stages. Another priority and one on which we are focusing relentlessly is Public Health Preparedness. This includes readiness and the capability of rapid response to all hazards, including hurricanes, earthquakes and pandemics. The third priority is Eliminating Health Disparities. It is simply unacceptable that in our great nation there are such dramatic differences in health between populations based on race, socioeconomic status, and geography. This must change. Health Literacy However, a widespread problem is seriously inhibiting our progress in all of the three priority areas. It is low health literacy. Improving health literacy is critical. Health literacy is the ability of an individual to access, understand, and use health-related information and services to make sound, thoughtful health decisions. Indisputably, low health literacy impacts health. People with low health literacy are less likely to know how to navigate the health care system, understand basic health information, or get preventive health care services. They are more likely to use expensive emergency care services, and to be hospitalized more often and for longer periods of time. When a patient does not understand that certain factors increase his or her risk for a disease...that is a problem. When parents do not understand the importance of taking prompt action, of the need for immediate attention…when their child suffers heat illness or cold weather injury...that is a problem. When a patient is rushed to the emergency room due to a misunderstanding in how much medicine should be taken… that is a problem. The unfortunate reality is that we are largely a health-illiterate society. Only 12 percent of adults have proficient health literacy. Put another way: nearly 9 out of 10 American adults lack the skills needed to take care of their own health, or know how to prevent disease. Language barriers due to low-English proficiency add another layer of complexity. We all know that ineffective communication between health providers and patients can result in medical errors due to misunderstandings about medications and instructions. Compounding the health literacy problem is the fact that most patients don't readily give up their health information. It is a concern not only for those whom we serve, but also for those of us who work in the health care system. Every day, public health care professionals are witnessing the health literacy gap.... This gap is the chasm of knowledge between what professionals know and what patients understand. And the problem is bigger than many of us perceive. A recent study shows that medical residents overestimate how much their patients understand. The majority of medical residents in the study believed that only 10 percent of patients had literacy problems, when in fact nearly half of their patients failed a health literacy screening. These include patients of all ages, races, incomes, and education levels. Even seemingly highly educated patients can have trouble understanding basic health information. Not every American is a scientist or a doctor or a health care professional, and we can't expect them to understand what it took us years of training to learn. I know that my mechanic doesn't expect me to know how to change the transmission in my car. And I shouldn't expect him to know how to perform surgery. We need to build bridges between what we as health professionals know and what our patients understand. Our nation has some of the world's greatest medical research institutions, but we are not fully benefiting from all the medical advancements and tools we have in our research labs. Even our brightest scientists cannot help people if the information is known only to researchers and health professionals. It's critically important that we transfer health discoveries from researchers ... to practicing professionals ... to the general public as quickly as possible. On average, medical technology and advances languish for 15 to 18 years before coming into practice. We all know that means lives lost and pain suffered - needlessly. In order to sustain a more ready military force, and to contribute to the making of a more literate nation, we can start incorporating health education into everything that we do. We have to make sure that good health information is getting into the hands of the military personnel, the people who need it. We all have a role to play in getting the best available health information science into the hands of people in ways that they can understand and use. Basic health literacy is fundamental to the success of each interaction between health care professionals and patients - every prescription, every treatment, and every recovery. As the Army officers and enlisted personnel whom you serve appreciate and understand health information you provide to them, they will be more equipped to take care of themselves and their unit. As a result, force readiness improves as well. Those benefits and others like them are the reason why health literacy is the currency of everything we do in the Office of the Surgeon General. It is why I am asking that in your work every day, you help us get more people on board. Whether you call it health literacy or not, you and your CHPPM colleagues routinely help to break down communication barriers every day, during every discussion you have with anyone about disease, healthy choices or the value of prevention. Please continue to do so. All of us - soldiers, and civilians - need to work together to improve health literacy. In every interaction that you have with soldiers, prospective patients and their loved ones, look for ways to ensure that people understand that they can make the right choices and that they are aware of what they can do to become and stay healthy. We need you to be health literacy ambassadors and share this information with your colleagues and organizations. This will advance health literacy among military families and across America. All here recognize the critical importance of a healthy, ready and responsive fighting force. Increasing the health literacy of Army officers and enlisted men is and will remain a component essential to maintaining one. Toward that end, I want to also make you aware that HHS has developed a Quick Guide to Health Literacy, a brief and easy-to-use manual for improving healthy literacy. The portal can be found at: www.health.gov/communication/literacy Prevention Let's next take a look at Prevention. It is our foremost common cause as organizations. Prevention is also the linchpin of what we do at HHS. 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 these patients costs approximately $1.5 trillion a year. And, about 70 percent 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. We wait years and years, doing nothing about unhealthy eating habits and lack of physical activity, until people get sick. Then we spend lots of money on costly treatments to try to make people well, often when it is already too late. 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, community and military 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 and like-minded colleagues, together, will help us lead this cultural shift. Our health care system cannot thrive in a treatment-oriented society. Times, technology and expectations are changing. We must turn the tide and embrace prevention. We know that we can prevent or manage many diseases by modifying behavior. Until we truly embrace 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:
Generally, we know what to do to act now - we have evidence-based strategies to improve each of these factors. Eventually, science is likely to advance to the point where prevention can be tailored to an individual's basic genetic makeup. Personalized health care will combine the basic scientific breakthroughs of the human genome with computer-age ability to exchange and manage data. Increasingly, it will give us the ability to deliver the right treatment to the right patient at the right time -- every time. Every one of us is biologically unique. We've always known that, but we haven't had the knowledge or the tools to deliver health care at that kind of individual level. That is changing, and H-H-S is encouraging and supporting these important developments. However, until we get there, until America's scientists move further in the areas of emerging fields of genomics and proteomics, until 'prevention prescriptions' can truly be individually tailored, making healthier food choices, reducing alcohol consumption, daily exercise, routine screenings and not smoking are the best place to start!!! Emergency Preparedness Having a population that is health-literate, that is aware of best practices - and the ability to communicate with them effectively - will be particularly crucial when preparing our nation for an emergency. Americans count on a strong public health system capable of meeting any emergency, whether it is an act of terrorism, an emerging infectious illness, or a weather disaster such as a hurricane or tornado. So it is that emergency preparedness is among the priorities of the Office of the Surgeon General. The terrorist events on 9/11, hurricanes Katrina and Rita, and the new threats of pandemic flu have firmly planted emergency preparedness on our nation's health agenda. September 11 was a tragic event in the history of the United States and the world. It was also a turning point for us in terms of homeland security. And the series of hurricanes that hit the communities of the Gulf Coast over the past few years brought another wave of awakening. We have learned through experience that disasters can strike at anytime, anywhere. Disaster takes many forms - a hurricane, an earthquake, a tornado, a flood, a fire, a pandemic, or a hazardous spill … an act of nature or an act of terrorism. A disaster builds over days or weeks, or hits suddenly, without warning. Federal investigators and emergency response/recovery personnel are working at the site of the Minneapolis bridge disaster as I speak. Our thoughts and prayers are with them. And every year, millions of Americans face disaster, and its terrifying consequences. We know that we cannot always prevent emergency situations, but we can be prepared so that they do not become large-scale disasters… and we can prevent some of the health consequences that arise from disasters. Over the past few years, emergency preparedness has become a major part of our mission to protect, promote, and advance the health and safety of the nation. This again points to the availability and readiness of the Commissioned Corps to respond. These Public Health Service officers are available to respond rapidly to urgent public health challenges and emergencies, and are becoming more highly trained each and every day to respond to all-hazards emergencies. Consider the following extracts from duties described by Corps officers deployed in the aftermath of Hurricane Katrina:
(1) "…I was a motor vehicle driver, epidemiological surveyor, physical activity planner, educator in military bearing and gave classes on use of proper body mechanics and litter bearing.
... Once deployed and on-site, must be extremely flexible and be willing to do any duties and tasks that are required for mission accomplishment…In austere environment things and situations can change on an hourly basis…"
(2) …The primary lesson learned from a disaster deployment is the successful spirit of interdisciplinary cooperation. Professional officers performed their jobs above and beyond the call of duty to ensure mission success... These vignettes speak for themselves. I am reassured by the officers of the Commissioned Corps - their availability, their training, their adaptability. I am immensely proud to lead them. 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. 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. 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. 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 Finally, I would like again to return to a consideration of that which unites us: preventive health practices and their demonstrable value. Prevention improves the health of populations across the board - whether a military unit, community or the public-at-large. More particularly, I would like to reflect upon how CHPPM's preventive medicine "laboratory"- your use and delivery of preventive care - influences our own work at H-H-S. What you do "sets the table" for what we do. Your "footprint" is apparent in all of H-H-S prevention activities: we apply Force Protection principles - practiced, perfected and routinely used by CHPPM - to realize broad-based public health outcomes. Every day, we apply those principles whose lessons you have learned so well: that the reason for emphasizing prevention, for creating a culture of wellness, is truly about the added value of good health. It's about seeing an oncoming disease and having the power to prevent it. It's about the security and confidence that comes with making good choices with better health as a consequence. It's about the pains avoided and the fears diminished. It's about the value that making healthy choices adds to a soldier, to an individual, to a family, to a community. It's about futures that are improved and the horizons that are widened. Frankly, applying the principles of health promotion in a manner that changes a popular culture won't be easy. So changing the culture from one of treating sickness to one of living wellness requires both appealing to people's dreams and emphasizing ways to achieve them. When individuals have sufficient information and the incentive, they are better equipped to take action. This means that it is our job to communicate widely to others that which we have learned - such as effective prevention practices involving how to make healthy choices each day. We also must communicate the measurable rewards and personal benefits of a healthy lifestyle, as well as the negative consequences from an unhealthy lifestyle. Wellness creates a future of healthy minds; health bodies; and healthy spirits. That is the potential for the future of prevention. As CHPPM and H-H-S realize, and anyone who shares our realization of the power of prevention understands, that it is this direction we must go. By working together in every way possible, cooperatively, instructively and with mutual support, it is a direction in which we can go more consistently and more effectively. Your conference title, "Improving Force Health Protection Through Collaboration," captures what is required quite well. I know I speak for the entire PHS Commissioned Corps when I say that we are looking forward to the opportunity to work with CHPPM, to building and strengthening links, to "connecting the dots" in order to sustain a ready fighting force - healthier and more secure in its preparedness because of what we do. We can engender a culture of wellness in the U.S. Army and the broader military. Together, H-H-S and USACHPPM can continue to make a marked difference. Let us collaborate, to change what is possible: together, we can advance technology, improve capability, and boost the soldier's sustainability whether in garrison or when deployed anywhere in the world. Join me in making it happen. Thank you. ### Last revised: August 16, 2007 |
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