Remarks as prepared; not a transcript.

Rear Admiral Kenneth P. Moritsugu, M.D., M.P.H.
Acting Surgeon General
U.S. Department of Health and Human Services

Keynote Address
Indiana University Can Serve an Essential Role in Improving the Health and Prosperity of Hoosiers and the Nation

Indiana University School of Health, Physical Education, and Recreation

Wednesday, November 29, 2006
9:30 a.m.

Keynote Length: 25 minutes, followed by 15-20 minutes of Q&A
(see questions provided by Indiana University)

Introduction: Dr. Michael McRobbie, Indiana University Provost

Opening and Acknowledgements
Good morning.

Thank you, Provost McRobbie, for that kind introduction.

Dr. Torabi, Dean Gallahue, Commissioner Monroe, members of the Indiana General Assembly, local health officers, other distinguished guests: It is my distinct privilege to join you today for this celebration of the 60^th anniversary of the School of Health, Physical Education, and Recreation at Indiana University.

You certainly have much to be proud of in the Hoosier state.

I am impressed by the leadership I see in this room and throughout your great state to make a difference to protect the health, vitality, and economic prosperity of all Hoosiers.

Your Governor, Mitch Daniels, leads by example to promote his agenda for health. I understand he is fresh back from his successful second Indiana Health Summit on obesity, which took place Monday - and through his INShape Indiana initiative, he continues to challenge Hoosiers to eat less, move more, and avoid tobacco.

Governor Daniels also took the bold step of proposing a tax on tobacco, with the proceeds used to advance the health of all Hoosiers. I wish you and the Governor every success in this initiative.

One mark of a good leader is the people he selects to surround himself. In Commissioner Judith Monroe, Governor Daniels has selected a woman of skill, experience, compassion and wisdom who brings a new level of enlightened leadership to public health in Indiana. One of the greatest testimonies to her effectiveness is her success in partnering with local public health officers in every quarter of the state - including many of you here today.

In fact, Dr. Monroe and I have a historical connection that dates back two decades. She was in the National Health Service Corps, providing health care to an underserved Appalachian mountain community, from 1986-1990, when I was the Director of the National Health Service Corps. She served the community then, and she serves the Indiana community now.

Greetings
I also bring you a message of gratitude and encouragement from the U.S. Department of Heath and Human Services, and my bosses Secretary Mike Leavitt and Assistant Secretary for Health Admiral John Agwunobi, who ask you to continue the path you are on to serve our fellow Americans.

U.S. Public Health Service Commissioned Corps
I want to encourage all of you, and especially the students, to consider a career in public health, especially the Commissioned Corps.

We are one of the United States' seven uniformed services, like the Army, Navy, Air Force, and Marines.

We are a Corps of more than 6,000 public health professionals, dedicated to the mission of promoting, protecting, and advancing the health and safety of the nation.

Our officers work in their communities, and are sometimes deployed to national and international disaster locations and Special National Security Events.

But not only do they deploy - our officers lead.

You can do just about anything in the Corps.

• Officers work in under-served areas, such as Brownsville-Harlingen, Texas; or Pine Ridge, South Dakota; or Aniak, Alaska.
• Officers conduct research at the N-I-H or C-D-C, and help translate and transport that research into our communities.
• Officers advise the health care decision-makers of our great nation.
• Officers build bridges through health diplomacy, reaching out across borders to help our friends and allies in times of crisis.

Think about it: You can help improve the health of all people, across the globe.

I will be providing Dr. Torabi with more information about the Commissioned Corps and other public health service programs, and invite you to consider them for your careers.

Priorities
I want to tell you about the priorities we are focused on at H-H-S and the Office of the Surgeon General.

The topics you are considering here in Indiana intersect with the three priorities that President Bush has assigned to the Office of the Surgeon General.

• First, Prevention. - What each of us can do in our own lives and communities to make ourselves and our families healthier.

  Right now we've got it backwards.

  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.

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

• Second, Public Health Preparedness. H-H-S is investing resources at the local, state, regional, and federal levels to improve public health preparedness.

  We are improving public health preparedness for all hazards: manmade disasters such as bioterrorism, and natural disasters, such as hurricanes, floods, and ice storms, and pandemic flu.

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

  Notice that President Bush didn't just charge us with reducing health disparities. He said we should eliminate health disparities.

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

Prevention
During my time with you today, however, let me focus and expand on the first priority, prevention.

Nationally, we spend more than two TRILLION dollars a year on health care - more than 16% of our Gross Domestic Product, and far higher than the median of around 9% for industrialized countries. By 2015 - less than a decade away - health care spending is projected to reach four billion dollars and 20 percent of our GDP.

In 2003, the U.S. spent $5,635 per person on health care -- two-and-a-half times the average among industrialized countries. U.S. spending was 48% higher than Norway, which was the second-highest spender per capita at $3,807.

Yet in 2002 the World Health Organization reported that populations of 28 other nations enjoyed healthier life expectancies than the population of the United States.

There's something fundamentally wrong here. Our investment in health care in this country has not yielded a fair payoff.

Clearly, we must continue searching for better pharmaceuticals, better surgical procedures, and better medical devices. But we also must move faster and farther upstream in health protection - preventing the onset of disease processes and controlling their progression before they manifest themselves in illness, suffering, and early death. In short, we need to focus on primary prevention wherever we can so that we have less to do downstream to repair the damage.

As Hippocrates noted so wisely two dozen centuries ago: "The function of protecting and developing health must rank even above that of restoring it when it is impaired."

If anything, Hippocrates' observation is truer now than it was in ancient Greece. Our failure to protect and develop health has resulted in an epidemic of chronic disease that threatens the health and economic viability of Indiana, the nation, and the world.

• Every year, chronic diseases like heart disease, stroke, cancer, and diabetes claim the lives of more than 1.7 million Americans.
• They are responsible for 7 of every 10 deaths in the United States.
• They cause major limitations in daily living for almost 1 of every 10 Americans, or about 30 million people.
• They account for about 83 percent of expenditures for health care. And nearly every dollar of Medicare spending is for people with chronic conditions.

But this very bad news shares a solution that is very good news: Most of the illness, suffering, disabilities, deaths, and resulting economic costs we as a nation pay can be entirely prevented by effective public health programs. The same four underlying risk factors contribute to the prevention of most chronic diseases: tobacco control, good nutrition, physical activity, and maintenance of normal weight. And we have evidence-based strategies to improve each of these risk factors.

By and large, we know what to do to act now. 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 knowledge into action.

Life Sciences at Indiana University
As I reflect on the occasion for our celebration here today, I am extremely impressed by the amazing advancements in life sciences that have emerged from academic institutions like Indiana University. I also am reminded, however, of the critical need for all of us to enter into new learning partnerships - joining with all sectors of society to look at health issues in new, fresh, and innovative ways.

Why is this important?

Let me quote from the 2002 Institute of Medicine report, "The Future of the Public's Health in the 21st Century":

"Several trends . . . may help explain why the nation seems to fall far short of its potential. The vast majority of health spending, as much as 95 percent by some estimates, is directed toward medical care and biomedical research. However, there is strong evidence that behavior and environment" - that is, the natural, social, physical and economic environments- "are responsible for more than 70 percent of avoidable mortality, and health care is just one of the determinants of health.

Furthermore, the benefits of our current investment in health care are inaccessible to many due to lack of insurance or access to services."

Moreover, the effects of this mismatch between health burden and health investment are seen in every state of the nation.

These troubling National statistics are largely reflections of a common underlying cause: an epidemic of chronic disease that affects all segments of the population regardless of age, sex, race, ethnicity, income, education, or geography.

Indiana Examples of Morbid Behavior
Unfortunately, we see a similar trend here in Indiana. To provide a brief illustration, among all adults in Indiana, smoking increased from 25 percent in 2004 to 27 percent in 2005. Among all states, Indiana moved from seventh-ranked in 2004 to second-ranked in 2005 for its percentage of adult smokers. In 1998, annual smoking-attributable health expenditures cost Hoosiers more than 1.6 billion dollars; and (averaging years 1997-2001) annual productivity losses attributable to smoking cost Hoosiers an additional 2.3 billion dollars.

Next, overweight and obesity: More than 62 percent of Hoosiers are overweight or obese. In 2005, Indiana ranked as the eighth most overweight and obese state in the nation. Unfortunately, 29 percent of Indiana's high school students already are either overweight or obese.

I think you see the trend - too much damage to treat downstream because of too little attention to prevention upstream. For virtually every chronic condition and every risk factor monitored in Indiana, we must do better.

Two Critical Ingredients
Two critical ingredients are necessary for turning the corner on chronic diseases: an adequate and well prepared public health workforce, and an informed public.

Public Health Workforce Issues
Let me start with the public health workforce. We need professionals trained in surveillance, epidemiology, research translation, program development and delivery, health education, and marketing and communications. But here again, Indiana - along with the rest of the nation - faces some serious challenges.

At the national level, there are roughly 158 public health workers per 100,000 population. Indiana's 56 public health workers per 100,000 population is the lowest ratio of any state in the region and lower than almost every other state in the nation.

But behind the bad news, there again is good news. We know what works to build our workforce to meet the urgent realities of public health in our Nation and in this state.

And it is here that I would like to shine the spotlight squarely on Indiana University.

I was gratified to read in the IU Life Sciences Strategic Plan that Goal Number 7 is directed toward preventing injury and preventing diseases related to such lifestyle choices as nutrition, physical activity, smoking, and drug use. The goal states, "Indiana University should engage in research and education that will help residents of the State of Indiana to lead healthier, better, and longer lives."

In a society of limited resources and increasing needs, the contribution of prevention to the health of all Hoosiers can be a solid value in costs avoided and in lives saved - not to mention the quality of those lives.

While I applaud that goal, I encourage you to expand it and give priority to investing in prevention:

• in early population interventions that can make a significant and important positive impact on the long term health of Indiana citizens, families, and economic future, and
• in approaches that facilitate and support positive personal health choices - in short, to make healthy choices the easy choices.

To address the compelling health problems of the 21st century, academic researchers, from public health, medicine, law, informatics, marketing, along with public health agencies, and community members must come together to collaborate on developing effective strategies.

I encourage you to examine how you can directly increase the public health workforce, right here in Indiana, to address these public health needs, building on the strong capabilities of the your current programs,

The need is great. The opportunity is present. The time to act is now.

Health Literacy
As we are building the public health workforce, we must also help all Americans accept, embrace, and put health information into practice at home, at work, and at play, as part of daily life.

I describe health literacy as the ability to communicate in such a way that those we serve hear, understand, embrace, and put into action, the science and information we provide to help them achieve and sustain better health.

People of all ages, races, incomes, and education levels suffer from low health literacy.

This is particularly true among minority populations who, on average, make fewer visits to the doctor and receive less guidance on health matters.

The reality is that today we are largely a health-illiterate society, and this impacts every aspect of our lives.

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 present and future health professionals, you will have many opportunities to improve people's lives by helping them to understand the importance of prevention.

You can offer information that will help them make good health choices, for themselves and for their community.

What we do today, determines our future health: we will reap the benefits of good choices, and suffer the consequences of unhealthy ones.

With our increasing longevity, we want to assure that we not only live longer, but also live healthier -- to enjoy both the length and the quality of that longer life.

Spheres of Influence
We are also personally responsible to make a difference in our spheres of influence.

• If we are parents, we have tremendous influence. Let's work to create healthy home environments, and model good choices. How often do our children fail to listen to what we say; but how often do they imitate what we do.
• If we are teachers, we have tremendous influence. Let's work to create healthy school environments.
• If we are employers, we have tremendous influence. Let's work to create healthy work environments.
• And if we are community leaders, we have tremendous influence. Let's work to create healthy communities, that encourage and incentivize good, healthy choices.

One contemporary and timely example is this very week. In addition to being your birthday, this is also National Influenza Vaccination Week - a week in which each one of us can engage in prevention - for ourselves, and for those with whom we live, study, work and play. Get a flu shot, and encourage others to get one as well.

Charge and Closing
In closing, together, we must lead the transformation in how we prevent as well as manage disease.

I can think of no greater challenge, and no more noble pursuit in our time.

Ralph Waldo Emerson might as well have been talking about all of us here today when he said,

"There is always someone to tell you that you are wrong. There are always difficulties arising which tempt you to believe that your critics are right. To map out a course of action and follow it to an end requires courage."

I challenge you to map out a course of action and involve others in achieving it. I believe that is why you are here today.

Keep thinking imaginatively and critically. Keep educating, innovating and collaborating. Build bridges, not barriers.

Keep asking the right questions: those that need to be answered, not just those that can be easily answered.

Our success in asking - and answering - the right questions will be measured in the health of Indiana, and of our Nation.

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

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Last revised: January 9, 2007