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

Public Safety Wellness Week
Orlando, Florida
January 22, 2003

Thank you for that kind introduction.

It is a real pleasure to be here among friends, and colleagues.

The nationís health and homeland security are more closely intertwined than ever. Never before in history has there been this intersection between public health and public preparedness.

The new threats we face Ė weapons of mass destruction causing immediate large numbers of civilian casualties Ė means we now need to combine the disciplines of medicine and law enforcement and the military. But just as important, all of us in these critical homeland defense positions need to take care of ourselves, and stay in Ďfighting shape,í ready to meet whatever challenges come our way.

For those Americans expecting a soft-spoken top doctor, Iím a big surprise.

This image adjustment has been particularly challenging for the uniformed Public Health Service, which I lead as Surgeon General.

Of course, all the officers know about my experience in the Special Forces in Vietnam and as a SWAT team member in Arizona. So on my first day I was having a briefing, when one of the men handed me a folded up piece of paper and said, "We hope you have a sense of humor."

As I opened it, I saw a cartoon of a paratrooper repelling from a helicopter over the ocean with a shark jumping out of the water.

And beneath it the caption read: Admiral Carmonaís new admissionís test for PHS recruits.

And I said, "Thereís nothing wrong with that. It looks like a good test!"

Iím probably one of the most atypical Surgeons General ever to come along. I did not follow the typical career path. I was born and raised in a poor section of Harlem. I dropped out of high school and ran the streets. Then, I enlisted in the U.S. Army, and got my GED. The Army really helped me turn my life around.

I learned leadership lessons: accountability, responsibility, the importance of sticking with and completing the mission, and loyalty. All of these lessons have stayed with me as Iíve moved through various milestones in my life.

I served in Vietnam as a Special Forces medic. I saw more in one year than most physicians see in a lifetime. At age 19, I delivered my first babies, a set of twins. I saw my buddies die in combat, and I received my first combat wounds. In that single year, I matured more than a decade.

When I got back to the States, I decided I wanted to be a doctor. My family thought I was crazy. They wanted me to join the electrical union.

But I went on to medical school, became a trauma surgeon, and ran a health system.

Along the way I also served as a police officer, paramedic, and nurse in an emergency room. In law enforcement, I got to see the best and worst of society on a daily basis. I saw my peers, men and women just like you, risk their lives on a daily basis.

(Tell some personal stories re: your experiences Ė they really want to hear them.)

The experiences I had as a police officer and EMT was good background for my present position for many reasons. I got to see, from the street level, as a police officer and paramedic, all of the needless things that are preventable in our society: how society tolerates drunk drivers, domestic violence, the "knife and gun club," all of the trauma.

I was on the receiving end, both as a doctor and a cop, like you, of all those things that were preventable.

As a result, my top priority as Surgeon General can be summed up in one word: prevention. Everything I do will have prevention first.

It is no different for law enforcement. We train to stay safe and reduce risk. Whether itís firearms, felony stops, or arrest procedures, our goal is to prevent the unthinkable. Officer safety is directly related our knowledge, training, experience, and health and fitness status.

Today Iím going to talk about disease and injury prevention, particularly obesity and smoking, behaviors that lead to disease, and on the injury side, violence and drunk driving.

You may be wondering: what does disease and injury prevention have to do with law enforcement?

Everything, as it turns out. For too long, public safety officers have worked the long, grueling hours, under very, very difficult circumstances.

We have departed from traditional law enforcement duties and now routinely also function as marriage counselors, priests, rabbis, teachers and guidance counselors among many other jobs, while on the job.

You have often been taken for granted by the communities you serve. But I think that changed on 9/11, when all of America saw the brave fire and police officers charge up the thousands of steps at the World Trade Center and charge into the burning Pentagon to save the lives of other Americans. Since then, I think, America has had a better appreciation for the jobs you do.

And letís remember, Had these brave souls not been in excellent physical condition, they never would have been successful in ushering thousands of office workers out of the buildings to safety.

American teenagers are our pool of future recruits for fire and police. We need them to be healthy.

And those of you in the law enforcement community face all of the same health and injury issues that the American people generally face, perhaps more so, as your jobs are particularly stressful and difficult.

Although many of our departments nationally have abandoned physical fitness standards due to liability, we must individually set our standards high for our partners, the public. Their lives and our own may depend on it!

Let me tell you about a press conference I had recently. President Bush and Secretary Thompson have tasked me with a lot of preparedness responsibilities as well as traditional public health responsibilities, and reporters wanted to talk to me about our national preparedness and weapons of mass destruction, biopreparedness.

One of the reporters asked me "Dr. Carmona, what is the most pressing issue in health facing the United States today?" She thought I was going to talk about weapons of mass destruction.

But I said obesity. She was stunned. I mean, she couldnít say a word for 30 seconds, because she didnít expect to hear Ďobesity.í She had a line of questions for preparedness, weapons of mass destruction, but when I said obesity, it threw her.

Obesity

Letís look at a threat that is very real, and already here: obesity.

Obesity is an epidemic now, and itís growing. If we donít do anything about it, we will have a morbidly obese dysfunctional population that we cannot afford to care for, because obesity leads to hypertension, heart disease, and Type 2 diabetes.

Nearly 2 out of 3 of all Americans are overweight and obese; thatís a 50% increase from just a decade ago!

More disturbing: nearly 15% of our children and teenagers are overweight; and overweight children will grow up to be overweight adults.

What is stunning is the rate at which this epidemic is growing. The proportion of overweight adolescents has tripled since 1980, now accounting for 9 million young people, with millions more at risk.

Type 2 diabetes, unheard of in young people just twenty years ago, is trickling into our schools and left unchecked, it leads to serious illness and possible death.

Why are we facing this health catastrophe? Itís almost entirely preventable through proper diet and exercise. But one-fourth of children in America spend four hours or more every day watching television.

Only 27 percent of students in grades 9 through 12 get the recommended 30 minutes of exercise a day on five or more days of the week.

We are seeing a generation of kids who grew up off the playground and on the PlayStation.

We need to focus on getting children and their parents excited about increasing the amount of physical activity in their lives, while helping parents, coaches and teachers see the importance of physical activity to teensí overall health. Better health will ultimately make for better citizens and, for those who choose this career path, better public safety officer.

If we are asking our kids to get out there and exercise, we need to do it ourselves.

James Baldwin captured the essence of this when he said that we spend a lifetime trying to get our kids to listen to us, but they never fail to imitate us!

Of course, being overweight or obese directly impacts job performance when youíre in a public safety position.

Remember: when you are called upon will you be ready to back up your partner or save a citizen? To me, failing at this calling when challenged would be a fate worse than death if I know I could have prepared myself. (Examples)

But it is possible that you are also more susceptible to being overweight in the first place because of working irregular, long hours under high stress.

There is a concept known as "abdominal obesity," or fat around the middle. Medical research shows that stress actually changes your nervous system and hormones in ways that encourage fat accumulation around the waist. This type of fat has been linked to increased rates of hypertension, heart disease, and diabetes.

National Fire Protection Association data show that heart attacks caused by overexertion or stress caused 40 percent of all firefighter deaths in 2001. This is the number 1 cause of line of duty deaths.

This means public safety departments need to redouble their efforts to help reduce stress and help officers cope with stress.

But we canít use stress as an excuse. We still have to get out there and try to work out every day, and try to eat healthy. Take advantage of whatever stress reduction programs your department offers: whether it is a workout at the gym, yoga, or perhaps even counseling.

Eating healthy does not mean Krispy Kreme instead of Dunkin Donuts. Or milk instead of coffee!

Smoking

You know, sometimes we think weíve kicked the smoking habit for good, but when 400,000 Americans still die each year from their habit, we still have a long way to go. What is particularly disturbing is trends among children teenagers. Just today, 3,000 kids in the U.S. will start to smoke. Weíve got to get them to stop starting.

Treating smoking related diseases costs $50-73 billion a year, or six to eight percent of annual personal health costs.

Violence

Violence continues to be a big problem in our society.

What is particularly disturbing is that it is so prevalent among youth and teens.

The rate of child homicide in the United States is 2.6 per 100,000 children under age 15, about five times greater than the rate of 25 other industrialized countries combined. Although the homicide death rate among children and adolescents decreased 30% between 1990 and 1998, homicide is still the leading cause of death among adolescents aged 15 to 19.

Suicide is the third leading cause of death among adolescents in this country. Almost 20% of high school students had suicidal thoughts, according to CDCís most recent Youth Risk Behavior Survey.

You see the terrible destructiveness of the various forms of violence on a daily basis.

The fact that America does so poorly compared to other industrialized countries shows that violence, too, is a preventable problem. It is not Ďnaturally-occurring.í

Alcohol Ė Drunk Driving

The Centers for Disease Control (CDC) estimates that Americans drive under the influence of alcohol about 115 million times a year! These episodes result in about 16,000 deaths, and more than 300,000 injuries due to alcohol-related crashes. Of the 16,000 deaths, 9,000 are the drinkers, and 7,000, many of them children, are passengers in their cars or in another vehicle.

While drunk-driving deaths have been significantly reduced in the last 20 years, last year the number went up, according to Mothers Against Drunk Driving.

Americans still use and abuse alcohol at levels that are too high. And public safety officers arenít immune from this problem. It is difficult to find data, because public safety officers as a sub-group arenít studied all that extensively, but an Australian study of 852 police officers found that 48% of males and 40% of females consumed alcohol excessively.

Childrenís Injuries

Unintentional injuries are the leading cause of death in the United States for people aged 1-34. Each year, more than 90,000 people die in our country as a result of unintentional injuries. During an average year in the U.S., unintentional injuries account for nearly 31 million emergency room visits.

Most of us in this room have children. We all know the seizure of panic we feel when we see one of our toddlers careen into the sharp edge of a coffee table Ö fall down a flight of stairs Ö or knock a tooth out from falling against a windowsill.

Nothing is more tragic than treating a young child. It haunts you.

I think often of a patient I had nearly a decade ago: Alicia Sandback. (Tell story)

While Aliciaís story has a happy ending, itís still very sad because her injuries were so preventable. And, unfortunately, her story isnít that unusual. She was just one of five young children attacked by dogs that I treated that year. Each injury was so preventable and tragicÖ

Each year, up to 25 percent of all children sustain an injury sufficiently severe to require medical attention, missed school or bed rest. For every death caused by injury, there are 34 hospitalizations, 1,000 emergency room visits and innumerable trips to see doctors and nurses.

Of course, this doesnít include all the first aid administered by Dr. Mom and Dr. Dad Ė Bandaids, Bactine and a lot of hugs and kisses.

There are things we can do to mitigate these problems, like making sure our children are safely buckled into their car seats and driving defensively as we travel around. We can attach rubber edges to our tables Ö put up barriers to staircases Ö and simply watch our children like hawks, keeping them away from hot stoves, putting helmets on their heads as they ride their bikes and keeping a close eye on them when theyíre in the water.

Treatment Oriented vs. Prevention Oriented

As I see it, we can no longer, as a society, afford to tolerate the poor choices that have given us this huge disease and injury burden and huge costs.

We have a health care crisis now, in terms of cost. Everyoneís trying to decide how we pay for diagnosis and treatment. Letís move the money from this account to that account. We have people blaming each other for the problem. The bottom line is, there is no solution thatís simple for this problem.

There are perverse incentives in the system. We are a treatment-oriented society. We wait for people to get sick. We reward caretakers for doing extraordinary things that are very costly, to save somebody who largely could have made decisions years before that would have prevented that from occurring, or maybe decisions on that very day, for instance, if it was a drunk driver. The incentives are perverse. And the pendulum has to swing to the other side.

How do we bridge the cultural divide from a treatment society to a prevention society?

It has to happen. We cannot afford what we have today, and itís going to double in the next decade. We push 15 percent of our gross national product in the direction of health care. Is that acceptable? Absolutely not, especially when we spend the most of most civilized countries, yet our outcomes are sometimes no better than some of the poorer countries.

The law enforcement community can lead by example, in my view. Put in practice the behavioral guidelines that we know work. Encourage your fellow police, fire and EMT officers to eat right, exercise, stop smoking and drinking.

I believe the American people will make healthy choices when they have the information, and the incentive. Look whatís happened in the war on smoking. Itís taken decades, but a steady drumbeat about the negative effects of smoking has caused many Americans to quit smoking and many more not to start. The same is true with heart disease. Now weíve got to work on some of the other things that are holding us back from being the best society we can be: obesity and overweight, violence.

Members of law enforcement are leaders in homeland defense. You can also be lead by example in your own lives to make America healthier by not smoking, eating well and not being obese.  Those of us in government, law enforcement and the military have a higher standard to adhere to. It is our patriotic duty to be in the best shape we can possibly be, mentally and physically.

You have the toughest jobs in America. You protect and serve, keeping our communities safe. Our country is in your debt, every single day. Thank you for your hard work.

Take care of yourselves!

Thank you.

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Last revised: January 9, 2007