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

Meeting of American Public Health Association International Health Section

Wednesday, November 10, 2004
8 a.m.
Washington, D.C.

"Global Health"

Good morning. Thank you, Dr. Caine, for that wonderful introduction.

It's a pleasure to be here this morning with all of you.

As you know, Secretary Thompson and I have worked together on many issues related to global health. We are committed and passionate about this issue.

We appreciate the work of all our colleagues in these efforts, and particularly want to thank APHA for all you've done to support, motivate, and strengthen our collaborations.


Everyone here knows that disease and public health challenges recognize no borders.

I saw this every day in the Southwest United States, working with colleagues along the U.S.-Mexico Border to improve quality of life - whether it was improving sanitation, increasing immunization rates, and expanding prenatal care.

Every day, goods, vehicles, and people crossed back and forth across the border, and every day that meant that diseases crossed back and forth - diseases that were a potential threat to health on both sides of arbitrary line drawn in the middle of the desert separating our two countries.

When I came to Washington, I appreciated where I had come from and also noted the new challenges ahead of us.

I began to see my role as U.S. Surgeon General as that of a global Surgeon General.

President Bush and Secretary Thompson have supported this view. We know that my main job as Surgeon General is to advise our elected leaders and the American people about the health issues that are of greatest importance. It is the job of the surgeon general to protect and advance the health and safety of the American people.

But we recognized early on that many countries look to the United States and our activities as a model for how to advance health and medicine. This means we have a global responsibility, too.

Office of Global Health Affairs and the Expert Group

In an effort to address all this, last year I asked the HHS Office of Global Health Affairs to recommend the best format for a publication about global health from the Office of the Surgeon General. I asked them to think outside of the box.

They started involving some of the global health experts and we were lucky. The experts saw the benefit to such an effort.

They also recognized that this particular project would be different from many others developed by my predecessors in the Office of the Surgeon General - simply because it could not be about a specific disease, or condition, or problem.

Rather, we would have to address the most significant public health issues facing us globally. This is a tall order. After all, we don't need an encyclopedia of everything that falls under the label "Global Health." There are already excellent textbooks on the subject, and we do not need to reinvent that wheel.

The Office of Global Health Affairs systematically gathered opinions and decided to form a small advisory group to get started.

Many of the members of that group are here today. They are leaders from across government, academia, non-governmental organizations, and international organizations.

We wanted to bring together a cross-section of experts that would be small enough to be workable, but diverse enough to bring multiple viewpoints to the table. I want to thank the members of that group for their generous assistance. They've been incredibly committed and helpful.

As you know, based on these discussions, Secretary Thompson and I have decided to develop the first-ever Surgeon General's Call to Action on Global Health.

It is intended to generate interest both domestically and internationally on the topic of global health.

Call to Action

A Surgeon General's Call to Action tends to generate ideas, input, and action around a topic of importance.

We want to use this particular Call to Action as the catalyst for developing a Surgeon General's Report on Global Health.

The group has come to consensus on an overall structure, outline, and key messages that I have tentatively approved.

It is subject to change as this process develops, but the basic structure is as follows:

  1. An introduction that will address the definition of global health and identify the stakeholders
  2. A section outlining why global health is important
  3. A section assessing the current situation of global health and the underlying situations
  4. And finally

  5. The big question: Where do we go from here as a nation and as a world to address issues of global health? What are the priorities? Where should we focus?

Of course, we may shift things as the Call to Action develops.

Right now, we have a preliminary draft for review by our advisory Group. The draft will then go through additional revisions and broader circulation for review.

We expect to start agency review by early 2005 so that the Call to Action can be issued next year.


The group also looked at the audience for this latest Call to Action.

Traditionally Surgeons General have communicated to the American people via Calls to Action, and Conference Reports and Proceedings, and Reports.

But who is really the audience for these publications? When I started my tenure as Surgeon General, that was one of my questions. Depending on whom I asked, I got different answers.

Some said public health experts, some said researchers and scientists, some said the American public, some said just the Department of Health and Human Services, and some said they really didn't know.

Well, we owe it to the public to produce materials that they can understand and that matter to them.

The publications developed as Surgeon General Calls to Action and Reports are a compilation of the latest in science and public health - and far too often they became bookshelf decoration or doorstops.

We can do better. I'm proud that the two Surgeon General Reports that we issued this year have been accompanied by a "People's Piece."

The "People's Piece" is written for the American public in plain language that communicates the key messages and health information from the hundreds of pages of a Report.

We issued the first "People's Piece" in May with the Surgeon General's Report on Smoking, and the second last month with the first-ever Surgeon General's Report on Bone Health and Osteoporosis.

As you can tell, I'm passionate about this, as I'm passionate about improving health literacy on the topic of global health. Of course, we will develop a "People's Piece" to for global health.

Health Diplomacy

Another topic related to global health is health diplomacy.

Health is a powerful, underutilized common bond for all people, all nations. Health diplomacy can help to bring peace, safety, and security to an unstable world. I hope that will be part of what we help to extend with this Call to Action.

Thank you, and I would be happy to answer any questions you may have.


Last revised: January 9, 2007