Remarks as prepared; not a transcript

Vice Admiral Richard H. Carmona, M.D., M.P.H, FACS
Acting Assistant Secretary for Health
United States Surgeon General
U.S. Department of Health and Human Services

U.S. Mexico Border Health Association Annual Meeting

Friday, May 30, 2003

"Border Health is Public Health"

Thank you, it is great to be home.

Many of you know that San Diego, and the border area, have been home to me for many years. I feel deeply connected to the people here and know first-hand how complex the issues truly are. There are no easy solutions.

Since I was sworn in as Surgeon General ten months ago, not a day has gone by that I don't feel the enormity of the job that I have had the privilege to come into, the responsibility that I have.

Little more than a year ago, I was a surgeon and professor at the University of Arizona.

It didn't take long to realize what a big job this is. In October I represented the United States at international health meetings in Santiago, Chile. There were health ministers from just about every Latin American country. We were trying to forge agreements, and sharing all kinds of information, both intelligence information and traditional public health information. Last week, I attended the 2003 World Health Assembly. The first World Health Congress was held in 1947, just a few years before I was born. We've grown up together - the WHA is now an annual gathering of health ministers and government leaders from throughout the world.

The Surgeon General is called "America's Doctor." While that's true, this job is also, in many ways, a doctor to the world. My meetings in Chile and in Geneva reconfirmed to me that public health has no borders. With communications and travel becoming global, there is less and less separating all of us. The spread of SARS shows how very small the world really is. We all have common needs, and common problems. While my primary focus is on improving health care for Americans, what we do here will have a global impact. Here in the border region, we have significant public health challenges. But I am committed to meeting those 'head on.'

As Surgeon General, I have been tasked by the President with three priorities: public health preparedness, prevention, which I'll say more about in a few minutes, and closing the gap in health care disparities for minority groups, which are particularly severe in the border region. Through the partnership of PAHO, the U.S.-Mexico Border Health Association, and the Department of Health and Human Services, we have developed Healthy Border 2010, a model adapted from Healthy People 2010, to prevent disease and promote health in the border region.

Now I would like to speak to some specific issues we're addressing. Closing the Gap America's health care system is the envy of the world. But for too long we've seen chronic illnesses affect minorities at a higher rate than whites.

You know that I am of Puerto Rican descent. I was raised in a poor section of Harlem, and dropped out of high school and ran the streets. I know health disparities, because I lived them. Eliminating health care disparities is not just an issue for me. It's part of who I am, and where I came from. It is very important to me to make progress in this area. The current situation is unacceptable.

Diabetes, AIDS, and many chronic illnesses affect minority groups disproportionately. Just a few statistics: From the very beginning of life, children of color are at a disadvantage. Our infant mortality rates are higher. We are more likely to have low-birthweight babies, which can cause a lot of health problems. Our immunization rates are lower. Hispanics and African Americans account for roughly 75 percent of all adult AIDS cases, though they comprise only 25 percent of the U.S. population. Hispanic Americans are almost twice as likely to have diabetes than whites of similar age. Cardiovascular disease accounts for 31% of all deaths in the Hispanic population. Mexican American women are more likely than non-Hispanic white women to have high blood pressure. Among all who have high blood pressure, Mexican Americans are the most likely to be unaware of the condition, or have it treated.

These problems are even worse in the border region.

We've obviously got a lot of work to do.

More than a race issue, I think, it is really, an education issue and an access issue. For instance, we need to improve access to health care to all Americans, period, especially those who live in areas that have been traditionally underserved - rural areas and inner cities. President Bush and Secretary Thompson have made strengthening the health care safety net a fundamental goal of the Department of Health and Human Services. The President has committed to increasing the number of community health centers by 1,200 over the next five years and eventually doubling the number of people they serve to reach at least 22 million low-income Americans from the inner cities to rural communities.

We've expanded the S-CHIP program to reach more low-income children. This will benefit many minority kids. S-CHIP now covers 5.3 million children in all 50 states who otherwise would not have access to regular health care. as you know, Most of these children come from working families whose income is too high to qualify for Medicaid, but do not earn enough to purchase private health insurance.

President Bush and Secretary Thompson are also calling for an expansion of the Vaccines for Children program to help underinsured children get the vaccines they need.

The three initiatives of the expansion are:
1. expanding the number of clinics that can provide vaccines at no cost,
2. restoring tetanus and diptheria vaccines to the program, and
3. increasing the emergency stockpile of childhood vaccines.

By doing these three things, we will provide free vaccinations to hundreds of thousands of American children.

On the domestic HIV/AIDS front, President Bush has requested $16 billion in next year's budget for domestic HIV prevention, care, and treatment - a 7% increase over last year.

That includes a $93 million increase for AIDS research and $100 million more to support the AIDS Drug Assistance Program, which provides funding to purchase medicines for people who do not have health coverage. We're also planning to fund NIH's National Center for Minority Health and Health Disparities at an 18% increase next year. We really need to do more research in this area.

And we also need to bring more people from minority communities into health care professions. The Public Health Service Commissioned Corps, which I lead as Surgeon General, could serve as a model for this. About 30% of Commissioned Corps officers have self-reported that they are part of an ethnic minority groups.

That 30% far exceeds the percentage of minority health care professionals in the United States generally. It is so important that people feel comfortable with their doctors. Many people, understandably, want a doctor or nurse who shares his or her language or culture. Many women prefer female doctors. Many men prefer male doctors. The diversity in the PHS helps meet this need. I'm encouraging this diversity in the Corps and beyond.

We are working hard to close the gap. But government can only do so much. That's why I think all Americans - including those in the border region - will also benefit from the prevention agenda of this Administration, which is so important to me.


So many of our chronic, debilitating illnesses can be prevented through lifestyle choices.

Do you know the fastest-growing cause of illness and death in America today? The answer may surprise you. It is not smoking, drug abuse, or alcoholism, as terrible as those things are. It is being overweight or obese.

Nearly two out of three of all Americans are overweight or obese: that's a 50% increase from just a decade ago! Nearly 15% of our children and teenagers are overweight; and overweight children usually grow up to be overweight adults.

Hispanics in the United States are faring worse than the overall population: 23.4% of Hispanics are obese, up from 16.8% in 1995.

We don't have specific obesity rates and maps for the border area, but I can tell you that 15 to 19% of the population in Arizona, New Mexico, and California are obese, and more than 20% of Texans are obese.

Being overweight and obese invites a host of health problems, including diabetes, certain types of cancer, stroke and heart attack.

The cost of these illnesses is high. Personal costs include lost opportunities, disability, death and grieving for those who suffer with them and their families. The economic costs are also high - stretching into the hundreds of billions of dollars - for those paying health insurance costs and benefits, and those who must compensate for the lost productivity of workers.

One particular health problem that has hit the border hard is diabetes. Nearly 5,000 border residents die each year from diabetes, with about 2,300 fatalities in the United States, and 2,500 in Mexico.

Why do we have such a large and growing problem with diabetes? There are several reasons for the border region. The first is improper nutrition and obesity. Other reasons include the aging of the population, and the growth of population groups, especially Hispanics, with a predisposition to develop diabetes.

The U.S.-Mexico Border Health Commission has identified diabetes control and prevention as one of its objectives in Healthy Borders 2010. As obesity continues to rise, more and more residents here will be at risk for developing this serious chronic disease.

I don't want to see that happen.

Government has a role in prevention, but government is not the whole story. We can provide information on things like nutrition, fitness, and health care.

And we need to do a better job of getting the word out through the media, and through health providers. In order to make progress we need to remember that language and culturally-appropriate, culturally-competent messages are very important. We know that one size does not fit all.

That's why, for example, the HHS campaign "Si Tiene Diabetes - Cuide Su Corazon," contains culturally competent messages targeted specifically to Hispanics with diabetes.

It's tough in this area. Life in the border region is a daily struggle to achieve what most Americans take for granted: immunizations, clean water, ample food and clothing and access to health care.

We need to work together to ensure access to essential health-care needs for Hispanics throughout America and in the border region.

But government can only do so much. Each person has choices to make on a daily basis that will determine whether he or she is healthy or unhealthy. Exercise and proper nutrition will prevent many chronic illnesses.

More than 25% of children in America spend four or more hours every day watching television or playing video games. More than a third of American high-schoolers don't engage in any vigorous physical activity. Ever!

We've got to teach our kids the benefits of physical activity: not just sports but things like taking the stairs, walking from the back of the parking lot, even playing!

I'll be the first to say it won't be easy. I have four kids. I know that families live such busy lives now that it's tough to prepare healthy meals and have enough time to get in some physical activity. And in some areas of the border region, people face real challenges in their daily lives that impair their ability to prepare healthy meals and get some physical activity.

But we've got to get the message out about how important it is, and we've got to figure out ways to enable people to do it. I'm counting on your help. As health providers, you have the opportunity to share the prevention message with your patients on a daily basis.

Why our efforts matter The work of the U.S.-Mexico Border Health Association is so important, because it is a terrific example of how two nations and two cultures can come together to solve common problems. Collaboration like this between countries grows more important each day.

SARS is the latest reminder of linkages and interconnectedness and of the fact that all health issues are ultimately global issues. SARS paralyzes hospitals, undermines economies, and kills one of six people it infects. News coverage has spread panic and fear, compelling entire societies to try to protect themselves with masks.

Global efforts identified this disease. Scientists working together throughout the world attacked SARS early, coordinating the response, marshalling political will, and recognizing that every nation on earth is responsible for protecting its own population and the global community from SARS.

Because of the transmission of communicable diseases like SARS across borders, across countries, and across continents, what happens in one nation will eventually happen in all nations. This must be addressed by the medical research and clinical care communities.

In addition to SARS, there are many other reasons why global health matters to all of us, including the threat of terrorism and use of weapons of mass destruction against innocent people.

But perhaps Hippocrates, whose oath many of us have taken, put it better than I ever can. Recall these words: "I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm."

In closing, I am still profoundly humbled by this extraordinary opportunity and responsibility that President Bush afforded me. I will dedicate myself to creating a legacy of positive change for the border region, for America, and for the global community. With your help, we can make a difference. Thank you.


Last revised: January 9, 2007