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

Hispanic Heritage Month Celebration — United States Library of Congress

Wednesday, September 17, 2003

"Hispanic Americans: Honoring Our Past, Surpassing Our Present, and Leading Our Future"

Buenos días y bienvenidos a todos.  It's really a pleasure to be here with you.  I'm so happy to have been invited to the Library of Congress to be part of this wonderful celebration that celebrates our diversity and recognizes the importance of diversity in all our lives.

As you heard from General Scott, my route to becoming Surgeon General has been more or less a circuitous one, but really one that was driven by opportunities that were afforded me as a young man.

As a 17-year-old high school drop out, I was running the streets of New York City.  I grew up in Harlem and Washington Heights and came from a poor Latino family.  I have two brothers and a sister.  I'm the oldest of four kids, and we all dropped out of school.  In the 'hood where I grew up in, high school graduation was a reportable event.  So the fact that Richie Carmona dropped out of high school was no big thing, because there were not many kids who graduated at that time.

But I was fortunate, and I recognize now that there were certain critical junctures in my life when somebody extended a hand to me; someone tried to educate me; to show me the right way. 

Some of the most important lessons I learned as a child were about culture; were about the value of diversity.  They were taught to me not by professionals, they were taught to me by my abuelita, who came to this country in the 1930s when she had 27 children, with no money, because she saw opportunity.  She spoke no English when she arrived in New York, and until the day she died, she spoke very little English.

The lessons she taught me about dignity, about culture, and about diversity are ones that I draw on every single day now as your Surgeon General.  As a child, I didn't appreciate the messages that she attempted to impart to me.  And as is the case with many young men and women, when you're growing up, those lessons are not as important at the moment, but in retrospect you see how important they were, and they become defining moments in your life. 

I have a succession of those events that I'll just run through very briefly for you.  I would like to tell you that I started out in life working diligently with a great deal of perseverance with the goal of becoming Surgeon General.  The fact of the matter is, it was a series of fortuitous events.  Some people would call it luck, but I've come to understand what luck is the intersection of preparedness and opportunity.  We all make our own luck.  Lots of opportunity passes by us: if you're not prepared to accept it, if you're not prepared to see it, you miss the opportunity.

As a young boy growing up in the streets, it wasn't a good thing to speak Spanish.  So many of us became, closet Hispanics, closet Latinos.  And my grandmother as I told you, my abuelita, who was about 95 pounds soaking wet, but to this day, probably the strongest woman I have ever met in my life because of the values she had; the dignity, and how she loved her culture and valued the Latino culture.

When I was ashamed to speak Spanish and when I was exposed to those times where people of color were not as accepted as they should have been, she was the one who told me, you need to get an education because the education will set you free.  She was the one that told me the value of our culture.  And she was the one who refused to speak English to me.  And I used to be very frustrated because she would say to me, "Ricardo, si tienes hambre, necesita que pideme en Español," which means, "Richard, if you're hungry, you have talk to me in Spanish."

Then she would say: "Si quieres dinero, necesita que pideme en Español," which means, "So you want some money?  You have to talk to me in Spanish."

Years later, I recognized what she was trying to do; she was trying to preserve the culture and the language in her family. Although very poor and living on the margins of society for many years, as was the whole family, she did that with a great deal of dignity.  At 6 years old, when I was first homeless and she took us in because we were in the street, the fact of the matter is, that, although poor, when you stepped into her home, you felt like you were in a mansion, because it was clean.  There was dignity, there was love, there was caring.  There was an understanding of God and religion and their relationships to all other people.  There was an understanding of how we all need to live together in this world.  Again, lessons that were missed by a young boy who was just trying to survive in the streets.  But years later those lessons became much more important to me, especially now, as I serve the people, President, and the Secretary as Surgeon General.

Until age 17, I was in out of school, a truant, a drop-out.  As I said, my brothers and my sister, my friends did.  But at 17, I met a young Special Forces officer who happened to be passing through the 'hood who, over a couple of days, gave me my first reality check and encouraged me to go back to school.

I told him I couldn't go back to school, I was too old, I had been out for too long.  So he gave me a card of a friend of his who was a recruiter.  And I went and spoke to the recruiter.  And the recruiter welcomed me in and had me take some tests.  And he said, "Young man, you are very bright.  And the Army can make you all you can be."  He said — this is mid-'60s — he said, "Now, if you just sign this paper, we will take care of you." And you know what?  They took care of me in ways that I could never have expected. 

It was still the best thing I ever did because the Army took a chance on a young Latino kid who had very little education.  The Army gave me the opportunity to get an equivalency diploma; educated me so I could become an NCO and a leader; taught me about accountability, responsibility.  It taught me to appreciate diversity.  It taught me to live in a colorblind military.

When I left for basic training, I went to South Carolina and then to Alabama in the mid-1960s.  I saw things that I never, ever understood.  Because in the 'hood where we grew up, we were all people of color and we were colorblind.  We did the usual things that kids do, but it was never a race issue.  We were just poor kids.  But to go down into the South and see that you couldn't ride on the bus and you had to go in certain entrances and you couldn't drink in certain water fountains, that was something very foreign to me.  I had never seen anything like that.  I couldn't imagine how that was.

I had read about this stuff that Bobby Kennedy was doing at the time and transforming.  But that hadn't captured itself down there, yet.  So it was an awakening for me.  I learned some very significant lessons and I'm always grateful to the Army because what the Army gave me was one of the most valuable assets I have today.  It gave me a platform to be successful the rest of my life; to understand responsibility, accountability, mission, focus, allegiance, duty, honor.

When I look back it, those were the same things my abuelita was trying to teach me as a little boy, but they passed over my head.  It took some tough drill sergeant telling me I was ugly and having me do lots of push-ups to get that through.

I thought I would make the military a career, but my colleagues encouraged me to go out for college, go to medical school, because I had this dream.  And when I decided to apply, I couldn't get into college, because I had no SATs, I had no PSATs, I had no college preparation.  But abuelita and the Army prepared me because what they gave me was this unyielding spirit.

What I came to understand was that God doesn't give everything to everybody.  I had average intelligence.  But I had a great deal of tenacity and perseverance.  I won't give up.  So I looked at another way to get in to college and, fortunately, there was an open enrollment program for Vietnam veterans who had a GED.  And I got to college and I did very well and I became an honor student.  Not because I was the smartest, but because I worked the hardest.  Because I understood it was a mission.  So I looked at: What resources do I need?   How much time do I need to allocate?  What's the expected outcome?

When I came home after Vietnam, I had matured a decade.  I had been wounded in combat a couple of times.  I lost very good friends in Vietnam.  And when I came back on the block to see my friends, two of my best friends from the 'hood had died.  One was shot in a drug deal and one drowned in the river high on drugs.

When I went to my abuelita's house, which was now being run by my aunts because my grandmother had died, I made the announcement that I was going to college and I wanted to go to medical school.  Well, I learned another lesson.  My senior uncle, Reynaldo, who is now 92 years old, got up and he looked at me and then said in Spanish — and, as you know, Latinos, when they get upset, they start talking almost in a machine-gun kind of Spanish — "What's the matter with you?  Have you lost your mind?  Do you have a head injury?" 

I said, "What do you mean, Tio Reynaldo?"  And what he said to me, has stayed with me my whole life.  He said, "Our people don't do those kind of things."  He said, "You need to get a job, you need to get married and have a family and be like the rest of us."  What that meant was that they all had nice little apartments.  Nobody had a car.  There were no vacations.  But they had improved their lot in life significantly from where they came from.  They were all good taxpayers, almost all my uncles were in the military, served their country — Second World War, Korea.  And they went back home humbly, just like the tradition within the Latino population.

They told me that I had honored them by serving in the Army, and that I had made up for my indiscretions as a child.  And my uncle said, "I have a job for you in the electrical union, you can be an apprentice and work on a construction site and learn to be an electrician."  So when I said that I wanted to be a doctor ... well, you have to understand, this is a family who has never gone beyond high school.  And I'm thinking these lofty things. 

What that taught me is that sometimes our culture binds us.  We need to think outside of the box.  Latinos are the largest minority population, but even if, numerically, we become the largest segment of society, we will always be minorities unless we think beyond everything that holds us down.

We must think beyond the culture that has bound us.  And sometimes it is us that bind ourselves, because we don't think of those lofty ideas: that we can be generals and admirals and be a part of running this country and have significant responsibility in the United States.  And I was one of those dreamers.  They laughed at me and they didn't think I was going to be able to do it.  In fact, the family said, "He'll be back, and we'll have the job for him."

I never came back.  My uncle is still living in Washington Heights.  And he forgave me.  As I grew up and studied, I became more successful in life — I became a professor, a teacher, a police officer, a paramedic, a registered nurse, a physician's assistant.  I loved doing those things, but the fact was I had to work because there was no money to continue the education.  Every one of those jobs impact on my job today as the Surgeon General, but no more or no less important than the importance of culture and diversity in everything I do.

Because I recognize that, ultimately, my job is now to take the science that the world has to offer and translate it to the people.  My job is also to advise the President, the Secretary, and Congress, when they say, "Surgeon General, what do we need to do to deal with this problem?"  I serve as their consultant.  I recognize the huge responsibility I have to be able to be honest and true; to be able to deliver the message where it may not want to be heard sometimes, but is important so that our elected officials can generate policy for our benefit.

It's a huge responsibility and after 14 months in this job, I feel like I'm aging in dog years.  I've never worked so hard in my whole life.  And part of the aging is because you recognize the absolutely unbelievable responsibility that is on your shoulders.  Every word you say, every word you don't say; every action, every inaction is part of a public record.  280 million people depend on the Surgeon General for good health information, for safety, for preparedness.  These are just some of the things that the President and the Secretary have assigned to me.

The world also depends on us now, because we've truly learned that health knows no borders.  Geopolitical borders are ignored by health issues.  Health issues drive the economy, up or down.  As we learned with monkeypox and SARS and the threats of smallpox, borders mean nothing. 

The fact of the matter is, geopolitical lines have very little meaning.  Understanding the culture; understanding the culture of our Latino peers; understanding the culture of Arab Americans; understanding the culture that's involved with terrorism is of utmost importance to making the world a better place.  So we must embrace culture.

Fourteen months after being in the job, I still rise every morning in awe.  I pinch myself.  I can't believe that I was selected.  People say to me, "How did you do it, Rich?  Did you know the President?  Did you know the Vice President?" 

The truth is that I had no ties other than professional and military ties of peers that I've worked with over the years.  I didn't run in political circles.  So for somebody like me to be chosen as the Surgeon General is extremely farfetched.  In fact, I tell my colleagues jokingly, "The reason I was selected as Surgeon General is probably the most farfetched in government at all.  I was qualified."

I only wish I had some strings to pull, but I really didn't know anybody.  I'm eternally grateful to the President for taking a chance on this high school drop-out who capitalized on the wonderful opportunities that this country has to offer.   As I serve, I'm more humbled every day at the huge responsibility that I have. 

The priorities before me are very different than previous Surgeons General in many respects.  Prevention is number one.  President Bush and Secretary Thompson are wise men who have embraced that concept and led on it.  Prevention has to be number one, because the fact of the matter is that a great proportion of the disease burden that we spend money on today is preventable.  We're never going to solve the health care crisis until we remove from society those illnesses and injuries that are preventable.

As prevention relates to our populations and as it relates to people of color, especially Latinos, African Americans, and Native Americans, there are huge health disparities.

When we look at diabetes, heart disease, asthma, and obesity, there are much higher rates in people of color.  For example, we have an obesity epidemic before us now.  Nine million American children are overweight or obese.  We spend $117 billion a year on diseases related to overweight and obesity.  If we don't break that cycle, these young people today who are overweight or obese will be our middle-aged people in 20 to 30 years.  They will be obese, have type 2 diabetes; have accelerated cardiovascular disease, and we will have a sick, sedentary society.

The President and Secretary also asked me to focus on the issue of preparedness, which is new to the Office of the Surgeon General.  We are preparing a country of 280 million people to understand and appropriately respond to the new threats that have been thrust upon us.  Terrorism — the tools of the terrorists, weapons of mass destruction.

The third area, which I was thrilled that the President and the Secretary embraced, is eliminating health disparities.  They say that we can no longer tolerate this discrepancy between our Anglo populations and our people of color.  And the President said to me in no uncertain terms, as did Secretary Thompson, "We don't only want to decrease disparities, we want to eliminate them." 

It's almost as if I was training for this position my whole life.  I've been a soldier, a police officer, a nurse, a doctor, and I've worked to understand and respond to acts of terrorism.  Every one of those things is so important.  Equally important are the teachings of an elderly lady who spoke no English, who I called abuelita, who taught me about diversity, taught me about culture.  Every day now, when I take great science and package it in a culturally competent manner to deliver it to populations in hopes of changing their behavior; to reduce morbidity and mortality, or increase health and wellness, I'm relying on abuelita's lessons. 

I'm using and understanding the importance and embracing diversity to make sure those messages get delivered in a transformational way so these populations who need this information will take action and make themselves healthier.  When we look at the currency to make those changes — we call that health literacy — we see that until the public is educated as to what a calorie is; what a gram of fat is; how to read a food label; and, ultimately, what is means stay healthy, we'll have problems.

When you look at the people of color and the Latino population, there is lower health literacy.  Why?  Because the educational levels tend to be lower.  Why?  Because over a third of our Latino children drop out of high school, over a third.  You must step up with me and make sure we don't let any kid drop out of high school.  I was fortunate enough to sneak out of the 'hood.  But there were 10 kids like me who never made it, and who were at least as smart if not smarter than me, and could have made it.  But because of socioeconomic problems, because of a host of other things, they got lost.  We lost them.  And then they become a burden on society rather than an asset  to society.

My colleagues, fellow Surgeons General in the Army, Navy, and Air Force, are deeply concerned because these young men and women are also our future soldiers and sailors.  If we don't keep them healthy; if we don't make sure that our people of color stay educated and move into the workforce, we won't have a strong, diverse workforce.  We won't have a strong, diverse military.  We won't have a strong, diverse health care system.  We won't have a strong, diverse society or economy. 

We must make sure that we understand the importance of the diversity.  All of the laws and regulations at the other end will have no bearing if we don't have qualified people to put in the right leadership positions.  That starts in grade school.  It's too late when you try and pass a law to get a kid into medical school or law school later on to compensate for 20 years of poor performance because of problems.  We've got to get them when they're kids, and build a passion inside of them to learn; to become leaders; to come back to their communities and change the world. 

It is possible, because we live in the greatest country in the world.  That's why we're all here today embracing diversity and appreciating the contribution of Latinos.  My grandmother has been dead many years.  I only wish she was still here so she could hear me say the words that she taught me about the importance of diversity and how it makes us all better people and the world a better place.  Thank you so much.

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Last revised: January 9, 2007