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

March of Dimes Volunteer Leadership Conference
Washington, D.C.

Friday, October 17, 2003

"The March of Dimes and the U.S. Department of Health and Human Services: Partners in Preventing Birth Defects and Infant Mortality"

Thank you, Jennifer, for that kind introduction. [Jennifer Howse, President of March of Dimes]

Good afternoon, everyone.

I want to thank all of you on behalf of my bosses President Bush and Secretary Thompson for your leadership in preventing birth defects and reducing infant mortality. The March of Dimes continues to be one of our most important and effective partners.

I admire your commitment and passion, and Iím grateful to you. No matter what else I might achieve in life, my most important title is "Dad." I take that opportunity most seriously of all. The work that you all do to make sure we have healthy babies is so important.

You did a great job mobilizing support for the passage of the Childrenís Health Act. That was the brainchild of our friend Senator Kit Bond, and created CDCís National Center on Birth Defects and Developmental Disabilities, which has in turn raised existing programs to more prominence and opportunity for growth.

I would be remiss if I didnít acknowledge a very important person here today who is working shoulder-to-shoulder with you. Admiral Josť Cordero is friend, colleague, Assistant Surgeon General in the Public Health Service Commissioned Corps, and the Director of CDCís National Center on Birth Defects and Developmental Disabilities. As you all know, Dr. Cordero is a world leader and authority on all the issues that you are all so passionate about and committed to. Thank you, Josť, for your leadership.

Another wonderful example of March of Dimesí partnership with HHS is the folic acid campaign and the work done to establish a national partnership organization to oversee it, the National Council on Folic Acid, which HHS strongly supports.

As you know, there is so much more work yet to be done. Today I bring you three messages:

  • First, we can and must do better at preventing birth defects. That includes understanding why preterm labor occurs and how to prevent it. Preterm birth increased from 9% of deliveries in 1980 to 12% of deliveries in 2002. This is a growing public health problem that we must address.
  • Second, we must keep working until we know what causes all birth defects and how to prevent them. I am grateful that science is moving us forward quickly. Think of this: 50 years ago, we didnít know what DNA was. Today, we are already beginning to screen genetic information and target appropriate interventions to help people avoid physical and mental conditions and diseases years before their first symptoms would have otherwise appeared. Someday, simply by altering the genotype of a host, an organ will resist disease or heal itself. Someday, we will look back and only remember when we worried about birth defects.
  • Third, we must do a better job of ensuring that individuals living with disabilities have healthy and fulfilling lives.
  • Priorities

    When President Bush and Secretary Thompson nominated me to be Surgeon General, they asked me to focus on three priorities to maintain and improve the health of the American people. The President and Secretary insist that the best science always guide our policies and what I do. All three of my priorities are very strongly evidence-based. They are:

    • First, Prevention. ó What each of us can do in our own lives and communities to make ourselves and our families healthier.
    • Second, and new to the Office of the Surgeon General, as none of my predecessors had to deal with these issues: Public Health Preparedness. We are investing resources at the federal, state, and local levels to prevent, mitigate, and respond to all-hazards emergencies.
    • Third, Eliminating Health Care Disparities. I am so happy and proud that the President and Secretary charged me with working with them and all of you to eliminate health disparities. Notice that they didnít just charge me with reducing health disparities. They said we will eliminate health disparities.

    Woven through all these three priorities issues is health literacy, what I call the common currency to achieving success in all of those priorities.

    Health Literacy and Prevention

    We must work together to increase Americansí health literacy.

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

    America has the best health care system in the world. Medical discovery is advancing at a rate unequaled in any previous era. Yet many Americans do not know how to use these advances to help their families stay healthy and safe. In fact, many Americans ó particularly in communities of color like where I grew up ó still donít know about the dangers of drinking alcohol during pregnancy. And many Americans in communities of color donít get the prenatal care they need. Itís tragic that nearly 30% of American Indian mothers-to-be do not receive any prenatal care in their first trimester. The good news is that because of the availability of Medicaid, more women than ever are receiving prenatal care and education.

    We must do more to increase Americansí health literacy. To do that, we need your help. What the March of Dimes has done to increase understanding of the need for folic acid is health literacy at its best. The research that showed how folic acid prevents birth defects was a major step forward in prevention.

    Your continued support of this effort will ensure that more women get the folic acid message, and that more children are born healthy. Again, the power of health literacy.

    Preterm Birth

    Now we need to study another source of death, disability, and tremendous sorrow for American families: preterm birth. Today, when families ask why their baby was born early, most of the time, the only answer the doctor can give is Ö.. we donít know.

    We must redouble our efforts to find causes of preterm labor. And we need to look at where the needs are greatest. This is part of eliminating health disparities. For example, why do African Americans have the highest rate of premature birth? Premature birth is leading cause of neonatal mortality and morbidity in African Americans. And it is the second-leading cause of infant death among all Americans, of all races.

    Despite some wonderful and heartwarming stories that occasionally appear in the media about a premature infant surviving, the long-term outlook faced by very premature infants can be very bleak.

    The good news is that weíve had some exciting scientific news recently in this area: researchers with NIHís National Institute of Child Health and Human Development discovered that weekly injections of a hormone called progesterone can lower premature birth by more than one-third among women who are at risk of premature delivery. The results were so dramatic that the scientists halted the study early and immediately started disseminating these extremely promising results.

    Future of Life

    The next area for progress is in genetics, genomics, and proteomics. Scientists are nearly finished mapping the human genomeís three billion chemical letters ó this work will have untold benefits throughout the future of humanity. Already, researchers have identified "susceptibility" genes for disease states, including many cancers.

    Now, for the first time, the human genome project has provided us with the basis for a new technology called microarrays. This will allow us to compare the active genes from pregnant women who begin labor prematurely with genes from women who deliver their babies at full term.

    This comparison will help us to identify the gene products that are responsible for initiating labor. Armed with this knowledge, we can learn how to postpone labor. Through science, which you support and nurture, we have within our reach the hope of addressing preterm labor. This is the future of science, and the future of life.

    Caring for People with Birth Defects and Developmental Disabilities

    We have made extraordinary advances in reducing birth defects in recent decades. But until the day when all babies are born free of birth defects, and when we can prevent the many injuries that result in lifelong disabilities, the number of people living with a disability will continue to grow.

    More than 50 million Americans live with a disability today and that number will likely increase to nearly 75 million by the year 2010. Americans with disabilities are living healthier lives, but there are significant disparities among racial and ethnic groups.

    One example is the survival of individuals with Down syndrome. A recent CDC study compared survival of children with Down syndrome in 1967 to 1997. In 1967, the median age of death was 1 year. By 1997 it had reached 50 years. Thatís truly incredible. But the study found major racial disparities: African American children with Down syndrome survival was 25 years, not the 50 years reported for white children. For children with Down syndrome of other races, the median age of death was even lower, only 11 years. Much research is needed to explain those differences, and HHS is committed to that work.

    State and federal education departments spend over $40 billion each year on special education programs for individuals from 3 to 21 years of age. Individuals with disabilities have a greater share of depression, hospitalizations, and less access to health promotion activities ó from physical activity to preventive health care, such as mammograms. HHS is funding programs that promote wellness among individuals with disabilities, and these programs work. The people who are enrolled in these programs have fewer hospital visits, and if they are admitted to the hospital, their stay is shorter.

    Charge and Closing

    It is clear that together we have accomplished so much. The science is moving forward, the care systems and infrastructure are in place, and we have every reason to be hopeful that we can reach a day when all babies are born free of birth defects and developmental disabilities.

    Because of the March of Dimes and our partnerships with you, we can dream of a day when birth defects no longer occur. It was 50 years ago that Watson and Crick discovered the DNA double helix. Look at all we have learned in 50 years. A few months ago I sat at a table during a dinner at the Library of Congress to celebrate the discovery of DNA. On one side of the table was Dr. James Watson, and at the other side was Dr. Francis Collins. Right before me I had the human genome project, at the same table. Thatís the way it struck me.

    Someday, you wonít have to hold this meeting about the problem of birth defects. Science will have solved this problem, just as you helped science eliminate polio.

    All of us ó government, academia, health care professionals, corporations, and communities ó need to work together to join this quest to eliminate birth defects and developmental disabilities.

    Looking around this room, I know that through your individual efforts, your work with the March of Dimes nationally and in your communities, and through your partnerships with the President, Secretary Thompson, me, and all of us at HHS; we can make this a reality.

    I want to thank you very much for your dedication. I stand here ready and prepared to work with you to achieve all these goals that you are so passionately committed to accomplishing for all Americans. Thank you.


    Last revised: January 9, 2007