This tool is available online at hhs.gov/emergency

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

We don't just want to reduce them, we must eliminate health disparities.

It is unacceptable 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.

The foundation for all of these priorities is based on research and on meeting the needs of the American people.

Health Literacy
And woven through all of these priorities is an issue we call health literacy.

It is the currency for success in everything that we are doing in the Office of the Surgeon General.

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

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

• More than 90 million Americans don't know how to take care of their own health, or how to prevent disease.
• Low health literacy is a threat to the health and well-being of Americans.
• And the low health literacy crosses all sectors of our society.
• People of all ages, races, incomes, and education levels are challenged by it.

Basic health literacy is fundamental to the success of each interaction between health care professionals and patients - every prescription, every treatment, and every recovery.

And once again, let me be clear.

It is a concern, not only for those we serve, but also for those of us who provide and influence the health care system.

For example, it's critically important that we transfer knowledge and discoveries about health from biomedical 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 the pain suffered - needlessly.

We can start correcting this problem by improving our nation's health literacy and incorporating health education into everything that we do.

Every day, researchers and health professionals are witnessing the health literacy gap…the chasm of knowledge between what professionals know and what patients understand.

We have to make sure that good health information is getting into the hands of the people who need it.

From researchers…to publishers… to practitioners…to patients…we all have a role to play.

We have tremendous influence on the health messages that professionals and consumers receive, and we must communicate the messages effectively, so that the people we serve can put the concepts into action.

I am the first to say that at H-H-S, we support some of the best research in the world…..

But the challenge is getting that science into the hands of the American people in ways that they can understand and use.

Not every American is a scientist or academician, so it is our job to help all Americans put the best health research into practice at home and at work, and as a part of daily life.

At H-H-S we are taking steps to improve Americans' health literacy.

All Surgeon General communications are written in plain language that people can understand.

For example, when we issue a Surgeon General Report or Call to Action, we also issue a full-color People's Piece that make the science in those communications clear to the average American.

Before we had the People's Piece, we knew that Surgeon Generals' Reports were useful to health professionals, but we wanted to speed the transfer of knowledge to all sectors of society.

We wanted to make sure that the Reports are not relegated to becoming shelf fillers.

So when we issue a 700-page Report that captures and communicates the best science, we also issue a much shorter People's Piece, with all the scientific messages communicated in easy-to-read language and with interesting and colorful graphics.

And each People's Piece includes information on what the research means to Americans and their health.

It also provides specific tips on how to put this information into action.

The input we've received from community health leaders throughout the nation and around the world tells us that the People's Pieces have had a tremendous impact on people of all ages and educational levels.

Surgeon General's Workshop
We are serious about finding creative and effective ways to reach people with important health messages.

And we have recently launched a national health literacy initiative designed to improve the health literacy of all Americans, including:

• the young,
• the old,
• the highly educated,
• the undereducated,
• the underserved,

and

• minorities.

A key component of this initiative was the 2006 Surgeon General's Workshop on Improving Health Literacy.

This was the first-ever workshop of its kind in the history of H-H-S.

Held in September, the workshop helped to identify the most important public health issues and research needs in health literacy from a variety of perspectives.

We listened to the perspectives of health care organizations and health professionals, as well as the research community, educators, and the public.

And we used the workshop as an opportunity to gather the best evidence from experts in the field to enhance understanding of the public health consequences of limited health literacy.

In 2007, we will issue a summary and next steps related to this historic workshop, and I encourage all of you to join me in reaching out to every sector of society to collaborate on new ways to improve health literacy.

The U.S. Surgeon General's Family History Initiative
The Office of the Surgeon General and the National Human Genome Research Institute at the N-I-H have also teamed up to create a health literacy tool that transfers what we know about genetics into something that people can use to improve their health.

This tool is part of an initiative that I want to mention today, and ask you to participate in because I think that your participation could make a tremendous difference.

It relates to the very center of our community: family.

As you know, your family health history can be a strong indicator of your personal health future.

The human genome is a blueprint of health susceptibilities and risk areas, as well as built-in strengths.

As we look into the future, it is not inconceivable that all of the variations in our genome could someday be tested.

This information will allow us to:

• predict disease risk,
• treat illnesses pre-symptomatically,
• guide prevention,

and

• target treatments.

The way medicine is practiced in 10 or 20 years will look completely different than the way it is practiced now.

But we can also take steps today to use the information we have.

This H-H-S initiative focuses on helping people to understand why certain diseases "run in the family" and what they can do about those greater risks.

It is called "The U.S. Surgeon General's Family History Initiative."

If you know that breast cancer runs in your family, mothers and daughters should get tested earlier than doctors usually recommend for the general population.

Or if the men in your family die young from heart disease, then fathers and sons should be monitored for cholesterol and high blood pressure earlier than usual.

Surveillance can lead to early detection.

And early detection can lead to more effective treatments. It's a simple and well-proven strategy.

It can also make the difference between life and death.

But many people don't take preventive action because they don't think they are at risk.

And health care professionals don't always have all of the information they need to make the best recommendations about preventive screenings.

The message is simple: Knowing your family's medical history can save your life.

It can help you know whether you are at higher risk for certain diseases.

And then, with a professional's help, anyone can figure out what to do to prevent health problems.

That's why we created a new computer-based tool called "Your Family Health Portrait."

The portrait is a software program that you can download onto your own computer; so you control all the information.

It's available at www.surgeongeneral.gov

It walks you through a series of steps that help you collect and organize medical information about your family.

When you're done, you can print it out and take it to a health care professional to discuss what it means to you.

You can also ask that it be included in your medical records.

As researchers learn more and more about the human genome, we will be able to connect specific genes with specific diseases - and specific family histories.

This should lead to a time when diagnosing one family member with a particular problem allows doctors to diagnose all family members at risk for the problem.

And, ultimately, this knowledge will lead to specific treatments that cure the problem, not just treat the symptoms.

The effort of prevention is a small price for the value of sustained and healthy life.

We are also keenly aware that one size doesn't fit all when it comes to reaching Americans.

America is a diverse nation and the way we communicate with the public must reflect our demographics.

Not everyone speaks English and not everyone has a computer.

That is why we have adapted this tool for Spanish-speaking audiences.

And when we have important health messages, we can not follow the "build it and they will come" strategy.

We are taking English and Spanish paper versions to community health centers, libraries, and anywhere people gather.

Eliminating Health Disparities
These outreach strategies are particularly important in reaching minority populations who have diverse ways of gathering, learning, and acting on health information.

We must make sure that we are communicating with these populations in ways they can relate to and in languages they understand.

And when we don't ….that's when health disparities arise.

While we strive for equality in all aspects of our governance, we recognize that there are significant disparities in our health care system.

Most Americans believe that disparities in health care should not exist.

But the truth is that most Americans are unaware that there actually is a disparities problem.

In fact, more than 65% of Americans are unaware of the disparities between racial and ethnic minorities and the rest of population.

America can - and should - be a place where all citizens have access to high-quality, affordable health care.

We believe that to truly eliminate health disparities we must create awareness about disparities.

We must awaken the nation to the realities of health disparities.

We must move the agenda of eliminating health disparities beyond that of a minority issue to a national platform.

And we strongly believe that improving health literacy will help in our efforts to eliminate health disparities.

We must be successful, because the truth is that we can not afford lose.

The stakes are very high.

Put simply, minorities are dying at higher rates when compared to white Americans from many causes.

And H-I-V / AIDS is one of the major causes of death among minority communities.

This disease is taking its toll on America and the entire global community.

World AIDS Day
On this World AIDS Day, we pay homage to the more than 25 million lost souls due to AIDS since 1981.

AIDS is a global epidemic that keeps making even deeper inroads into human security.

• AIDS kills the young and middle-aged.
• It delivers death to people in the prime of life.
• It kills in America's cities and rural heartlands.
• It acts slowly, and its victims suffer greatly.

Few of us have escaped having a friend or family member ravaged by the disease.

We know that H-I-V / AIDS disproportionately affects African Americans and Hispanic Americans in our nation, just as it affects our brothers and sisters in Africa, Latin America, and the Caribbean.

This has little to do with genetics. More than 99% of the genetics of everyone, everywhere are the same.

Many factors have led to disparities in H-I-V / AIDS.

One important factor is low health literacy.

The reality is that in many minority and poor communities, people have not truly accepted that they can become infected with AIDS ….. that they are not immune.

And some don't have the tools in place help reduce the risk of H-I-V in their communities.

This is low health literacy in action.

When people do not have the ability to access, understand, and use health-related information and services to make appropriate health decisions ….. we all lose.

From Harlem, New York, to Haarlem, South Africa, men, women, and children of color are being infected with the AIDS virus in disproportionate numbers.

• The estimated total number of H-I-V-positive people worldwide has reached its highest level ever, toppling 40 million cases just last year.
• And there are more than one million people living with H-I-V and AIDS in the United States.

Something that often lies buried among the statistics and all the research reports about H-I-V is a staggering piece of information that could turn the tide in preventing H-I-V:

• Infections transmitted by people who are unaware that they are H-I-V positive account for more than half of new H-I-V infections each year.

We must encourage individuals to seek out and know their H-I-V status.

There are far too many people who choose ignorance over knowledge; they walk away from the knowledge about health and safety that leads to empowerment. And some are too scared to find out.

But when it comes to H-I-V / AIDS, what you don't know can definitely hurt you and the people around you.

The first step to effective treatment is early detection.

Knowing your status can not only help reduce the transmission of H-I-V, but can also allow infected individuals to seek treatment.

In 2005, President Bush directed more than $90 million to the purchase and distribution of rapid H-I-V tests, to support testing for more than 3 million Americans.

Test kits are being distributed in areas of the country with the highest rates of newly discovered H-I-V cases and the highest suspected rates of undetected cases.

And when it comes to addressing the global community, we have gone back to health literacy basics.

The A-B-C approach has proven to be one of our most powerful preventive weapons against the spread of the virus.

The basis of the A-B-C program was developed from the East African country of Uganda, where it has meant a significant decline in H-I-V and AIDS.

The A-B-C program emphasizes Abstinence, Being Faithful and the proper use of Condoms.

The lessons from this program have been numerous.

• First, we realized that in order to fight a global health crisis, we had to erase geographic boundaries and use the best practices available to us.
• Second, we realized that a "one size fits all" approach to health education wouldn't work. We can borrow globally but must tailor our message locally.

The Office of the Surgeon General helped create tailored programs, designed to reach out to the specific concerns of each community.

And, these efforts are working.

In the first randomized controlled trial of a culturally tailored A-B-C educational program for Hispanic adolescents, scientists reported long-term success in reducing risky sexual behavior among this group.

An N-I-H-funded study found that adolescents reported a lower frequency of sexual intercourse, fewer sexual partners, and an increased use of condoms for up to 12 months after completing the program.

Finally, the A-B-C program has shown us that educational efforts make a difference.

For all those who doubt we can change behavior, or positively affect the rates of new infections, the evidence shows otherwise.

We are also looking at new creative ways to help reduce H-I-V / AIDS, including television programming.

A recent article in the Los Angeles Times, based on a number of surveys from the Centers for Disease Control and Prevention, showed that an increasing numbers of Americans get their health information - including information about H-I-V and AIDS - from fictional prime-time television shows.

According to one of these surveys, more than half of people who watch prime-time T-V at least twice a week said that they trusted the health information they saw to be accurate, while a quarter of those surveyed said that prime-time T-V was one of their top three sources for health information.

We are certainly seeing more H-I-V-related themes showing up in mainstream media, and this is generally a positive movement for removing social stigmas that have long prevented people from seeking out testing or treatment.

We are making strides towards increasing health literacy, but we need to do even more.

We need to improve health literacy and health knowledge both here and abroad. By working together to support local messaging in a global community, we can reach those who need to hear our message.

Today, on the 18^th annual World AIDS Day, and every day of the year, we need to relay the facts:

1. Anyone who might be at risk should be tested for H-I-V.
2. There is no cure, no vaccine. But there are drugs that can enhance the lives of people living with H-I-V / AIDS
3. While AIDS doesn't discriminate, there are communities with an even greater need to hear our message. We must address the social and cultural stigmas that discourage testing; and
4. We must provide access to a range of services that will educate and test those who are at highest risk.

Charge and Closing
As you can tell by now, we're passionate about improving Americas' health literacy.

As acting Surgeon General, I'm charged with educating the public on important public health issues.

But, I know that I can not do it alone. Everyone has a role to play.

And I am here to ask for your continued support in this effort.

Please continue working toward a more health-literate society by educating professionals and the public about important research, with a special focus on transferring science into public health practice.

Working together, we can remove the obstacles that prevent understanding about health issues from reaching Americans across all sectors.

In closing, I challenge all of us to become a new type of leader.

Collectively you represent more than 850 journals, 6,500 publications, and countless health professionals across the country.

Your work is so important, and your societies and journals reach millions of people.

Together, we can lead the transformation in how we communicate health information… and in how we prevent and manage disease.

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

Thank you for your continuing work, and for your commitment to improving the health of our great nation.

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Last revised: January 19, 2007