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

2003 NRPA Congress and Exposition
National Recreation and Park Association
St. Louis, Missouri

Wednesday, October 22, 2003

"Making Prevention Fun: Improving Americaís Health through Recreation"

Thank you for that terrific introduction, Jonathan. [Jonathan Korfhage, President, National Recreation and Park Association.]

And many thanks for inviting me here today. Itís a pleasure to be here, and I bring greetings from my bosses President Bush and Health and Human Services Secretary Thompson.

Itís great to be here with all of you this morning in the heart of America. It is an honor and a privilege to serve as your Surgeon General.

Iíve been in this job a little more than a year, and feel like Iíve aged in dog years.

Iíve crisscrossed the country dozens of times, and spoken to Americans in many states about the public health issues of our time. And I love it.

Last year, I was a physician and professor in Arizona, and now I have the opportunity to advise our leaders on many of the most important issues of our time.

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.

Iím fortunate to work with these two leaders who understand the importance of health.

Two leaders who insist that evidence and the best science always guide our policy 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
    16 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.
  • Prevention

    Today I would like to speak about the role of recreation in the health of Americans, and in our nationís health care agenda.

    Americans made 800 million visits to your recreational facilities last year, and if you include games and practices, the number is more like 2.5 billion!

    We hike your trails, bike your paths, dance in your rec centers, play ball on your beaches. Many of our fondest memories as individuals and as part of a family may well be on your grounds or in your facilities.

    As Howard S. Braucher once said, "Recreation is not only for the time. Recreation is forever afterward. Each person has his memory chest."

    Our extensive parks and recreation system is part of what makes America great. In many areas, parks are truly the heart of the community.

    Central Park in my home state of New York is one of the most recognized places in the world. People go there to ice skate, jog, play softball, go to the zoo, the theater, play basketball, or just walk around, or enjoy a picnic.

    In communities across the nation, your parks and recreation centers help improve peopleís lives.

    We have people here today from all over the country ó planners, designers, and managers of everything from golf courses to state beaches to local recreation and sports centers.

    What we all have in common is this: we are partners in the business of disease prevention and health promotion.

    The link between recreation and mental health has been well known since Frederick Law Olmsted designed New Yorkís Central Park, and many of other urban park systems. Olmsted believed public spaces should be accessible to everyone, and that scenery and open areas were psychologically beneficial.

    We now know that physical activity ó whether hiking, swimming, dancing, or simply walking ó can actually reduce feelings of depression, anxiety and stress.

    And, of course, physical activity is a key element in helping us maintain a healthy weight and improving cardiovascular functioning.

    More than ever before, we need the opportunities for physical exercise you help to provide.

    The Need for a Prevention Agenda

    7 of 10 Americans who die each year die of a chronic disease.

    Most of these diseases are preventable by relatively simple steps: healthy eating, being physically active, and not smoking.

    Tobacco use is still the single most preventable cause of death and disease, causing 440,000 deaths each year and resulting in annual cost of more than

    $75 billion in direct medical costs.

    After tobacco-related diseases, obesity-related illness is the leading, and fastest-growing killer of Americans.

    More than 300,000 Americans will die this year alone from heart disease, diabetes, and other illnesses related to overweight and obesity.

    The good news is that obesity and its co-morbidities are preventable through healthy eating ó nutritious foods in appropriate amounts ó and physical activity.

    The bad news is, Americans are not taking steps to prevent obesity and its co-morbidities.

    Put simply, we need a paradigm shift in American health care.

    There is no greater imperative in American health care than switching from a

    treatment-oriented society to a prevention-oriented society.

    As Secretary Thompson says, "95% of the $1.4 trillion America spends on health goes to direct medical services, while only 5% is allocated to preventing disease and promoting health."

    We simply must invest more in prevention, and the time to start is during childhood.

    15% of our children and teenagers are already overweight.

    Unless we do something now, they will grow up to be overweight adults.

    None of us wants to see that happen.

    The science is clear. The fundamental reason that our children are overweight is this: too many children are eating too much and moving too little.

    The average American child spends more than four hours every day watching television, playing video games, or surfing the web.

    Kids need to spend more time on the playground and less on the PlayStation. I want them dancing in your rec centers and hiking your trails.

    As adults, we must lead by example by adopting healthy behaviors in our own lives.

    Weíve got to show kids it doesnít matter whether theyíre picked first or last, only that theyíre in the game.

    Not all kids are going to be athletes, but they can all be physically active.

    Our commitment to disease prevention through healthy eating, physical activity, and avoiding risk is one our entire society must be prepared to make in order for it to be effective.

    HHS Prevention Initiatives

    President Bush is leading the way through the HealthierUS prevention initiative.

    HealthierUS promotes the fundamentals of good health: physical activity, healthy eating, getting check-ups, and avoiding risky behavior."

    Secretary Thompson is leading the Department of Health and Human Servicesí efforts to advance the Presidentís prevention agenda through Steps to a HealthierUS.

    Steps emphasizes community initiatives and cooperation among policy makers, local health agencies, and the public to invest in disease prevention.

    Both the President and Secretary Thompson also lead by example. The President works out every day, and always asks me whether Iíve worked out. The Secretary put himself on a diet, lost over 15 pounds, and challenged all H-H-S employees to get in shape by being physically active for at least 30 minutes a day.

    As important as these efforts are, we cannot switch Americaís health care paradigm from treatment to prevention through government action alone.

    This fight has to be fought one person at a time, a day at a time.

    What better way to encourage Americans to do this than through the types of opportunities you provide?

    The National Recreation and Park Association has become a key partner with the Department of Health and Human Services in our efforts to get Americans moving.

    An exciting joint project is "Hearts Ní Parks," a national, community-based program supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health and your association.

    Through this innovative program, people receive science-based information about lifestyle choices to reduce their risk of heart disease, plus new skills for incorporating heart-healthy behaviors into their lives.

    This information is included in regular activities offered by park and recreation departments and other community-based agencies.

    Hearts Ní Parks aims to reduce the growing trend of obesity and the risk of coronary heart disease by encouraging Americans of all ages to aim for a healthy weight, follow a heart-healthy eating plan, and engage in regular physical activity.

    An evaluation of the Hearts Ní Parks pilot projects showed that participants retained information about heart-healthy behaviors and intended to eat healthier.

    In addition,

  • children reported learning new physical activities and improving their performance in others
  • seniors reported feeling healthier and experiencing less pain in their daily lives by the end of the program.
  • On so many levels, this project is a real success story. Hearts Ní Parks is fun and flexible.

    Each community agency can adapt the program material to their own design, abilities and needs. And itís for everybody ó participants can be young and old, active and non-active.

    Hearts Ní Parks also demonstrates the impact that community park and recreation programs can have on helping people improve and maintain their health.

    On behalf of the Department, we look forward to continuing this great project and other activities.

    Through a Memorandum of Understanding between the Department and the National Recreation and Park Association, we are working together to reduce barriers to physical activity at the community level and to provide opportunities for increased physical activity.

    Your association has done research that indicates that "close to home" access is one of the most relevant factors for determining whether people will take advantage of recreational opportunities.

    This makes sense. We need parks and recreational facilities within a short walk or ride from peopleís homes.

    For planners, this means developing communities with recreation in mind, such as biking and hiking paths.

    In areas where neighborhoods are already well established, this means maximizing the recreational opportunities that may already exist, through new playground equipment or better accessibility for the handicapped. We are working to ensure that people have safe, secure environments to participate in recreational activities.

    Sports and recreational activities can also play an important role in preventing and alleviating depression and anxiety.

    Therapeutic recreation has also been found to improve intellectual, emotional, and physical aspects of health in individuals with mental illnesses or disabilities.

    Your parks and beaches and recreation centers offer the opportunity for Americans to escape the stresses and rigors of life for a time, a change of scenery, and often literally a breath of fresh air.

    Kids can gain a sense of confidence and stability in a sports program that might otherwise be lacking in their home lives.

    Veterans returning home can reconnect with their families through recreational activities.

    Whether your venue is a beach, a state park, or an inner city recreation center, you are partners with us in creating a healthier America.

    Thank you from my bosses, President Bush and Secretary Thompson. We appreciate all you do. They know our countryís strength is in our communities and in organizations like yours.

    Never underestimate the importance of what you do every day. Iím only one Surgeon General. You are the team. We need your continued great work in communities throughout the United States. Like you, we in public health deal with community and population health. Together we can and will make a difference.


    Last revised: January 9, 2007