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

Reserve Officers Association

Monday, January 20, 2003

"Partnerships, Prevention and Preparedness"

Thank you for that kind introduction.

It is a great honor to be here today among the uniformed men and women of the Reserve Officers Association. And before I get into my remarks, I want to thank each and every one of you for your service to your country. For putting yourselves in harm’s way and for risking your health, your life, and your future to help secure a stronger nation today and a brighter tomorrow for generations of Americans to come.

The ROA and its members have served America for the past eighty years. Your history, like America’s, is a proud history. Your founding was predicated on the growing realization – more than two generations ago – that to live in peace, we had to be prepared for war.

Many of us in this room have seen war. When I was 17, I enlisted in the U.S. Army; I received my GED in the army. While serving in the U.S. Army Special Forces in Vietnam, I got my start in the medical field as a combat medic.

During my tour in Vietnam as a Special Forces medic and weapons specialist, I saw more first-hand than most physicians do in a lifetime. Our A-TEAM worked on insurgency, counterinsurgency, intelligence gathering and other operations. It was unconventional warfare in Southeast Asia, never knowing when you fell asleep at night if it would be your last. In one year, I matured at least a decade.

Many of you have had similar experiences so you know what I’m talking about. My experiences in the Army taught me more about leadership, teamwork, loyalty, and how to get a job done than anything I’ve learned before or since. In fact I credit the successes I have had in life directly to my Army experiences and training as an NCO. That strong foundation gave me a great start and it is the structure that I still build on today.

Since that time I have always felt like a soldier, being prepared for any inevitability – and being focused on the mission at hand.

At the age of 19, I delivered my first babies, a set of twins; I saw my first buddy die in combat; and I received my first wounds in combat.

Those of us who have seen war, know that in war, death does not discriminate. Those of us who have experienced war know that our greatest mandate is to prevent war if at all possible.

That is why the decision to fight is so difficult. And that is why we are so fortunate that we have a man of honor . . . of character . . . and of principle serving as our Commander-in-Chief.

President Bush is an outstanding American who has assembled an incredible team. . . from Vice President Cheney to my boss Secretary Tommy G. Thompson to the speaker you’re going to hear from later this morning, Secretary Rumsfeld.

It’s an honor for me to be a part of President Bush’s team.

President Bush and Secretary Thompson have charged me with educating and leading the nation in three general areas:

Prevention – what each of us can do in our own lives to make ourselves and our families healthier;

Preparedness – working with national, state, and local leaders as well as health care providers in ensuring a strong and secure medical and public health response system; and

Closing the gap in health disparities among our nation’s minority population.

Each of these is essential to the long-term health and strength of our nation. But today, I would like to talk specifically about the importance of preparedness.

Today our nation’s health and our nation’s defense 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 – the possibility of Saddam Hussein, Osama bin Laden, or Kim Jong-Il – unleashing weapons of mass destruction causing immediate, cataclysmic civilian casualties means we now need to combine the disciplines of medicine, law enforcement and the uniformed services.

We must be bold and "think out of the box." Recently the president met with his leadership and challenged us to be relentless in our pursuit of excellence and integrity in all we do. Secretary Thompson often says to his leadership, "if you are not living on the edge, then you are taking up too much space!"

It’s something of a paradox that the news of the day – the day we commemorate the birth of the champion of nonviolent resistance, Martin Luther King, Jr. – is all about war. But the United States is a peace-loving country. Our enemies have brought a war to us, to our own soil. We did not ask for this war. But we will defend America, both at home and abroad.

Dr. King, said, "We must learn to live together as brothers, or perish together as fools." I think that this is particularly applicable to our uniformed services, where we serve as one color, Americans, the best the world has to offer!

Nowhere is learning to live together more important than in the defense of our country. And in the uniformed services, I think, we can lead the way for the rest of America. We know that in combat, our very lives depend upon our ability to trust our fellow soldiers, sailors and airmen like brothers.

Our personal preparedness – our health and fitness as soldiers – is absolutely fundamental to America’s military readiness and to securing our homeland.

The broader prevention challenge is building a homeland defense and a public health infrastructure that can identify, mitigate or control any weapons of mass destruction used by our enemies to attack America.

This won’t be easy. But it is possible. And we’re going to do it.

Our efforts will be complicated by fear. Part of this is fear of the unknown. The American public has never dealt with a threat like this before.

The only way the American people will have faith in us is if we are prepared to meet the threat and communicate that preparedness through the media and to the general public.

If they see that we are prepared and competent to meet the challenges posed by weapons of mass destruction, the fear – though it will still exist - will be manageable. It will just be fear, not terror. We must build resiliency into our citizens and communities.

There is a chapter in Rudy Giuliani’s new book, Leadership, titled "Prepare Relentlessly." As Mayor, Giuliani had each city agency map out and rehearse what to do in the face of a chemical attack or a biomedical attack, a plane crash or terrorist attack on a large gathering, before 9/11.

While they had not anticipated having planes turned into guided missiles, the partnerships and the preparation is what enabled the police, fire department, even the sanitation department, to perform so heroically and effectively.

It was that competence and preparedness that both enabled the city to respond to the attack, and to calm people after the attack on the World Trade Centers and subsequent anthrax crisis. We must prepare relentlessly.

Secretary-designate Ridge, Secretary Thompson, Attorney General Ashcroft and many others of us will be responsible for helping to prepare America on our own soil.

President Bush asked in last year’s State of the Union address that we double funding for a sustained strategy of homeland security, focusing on bioterrorism preparedness, and emergency response.

The president asked us to develop vaccines to fight anthrax and other deadly diseases, and to help states and communities train and equip our heroic police, emergency medical technicians and firefighters.

We have started doing all these things as well as trying to develop surge capacity in our already overburdened hospitals.

President Bush and Secretary Thompson provided states with $1.1 billion last year to strengthen the state and local public health infrastructure.

That was the largest one-time investment in our nation's public health system. Ever.

Those of us in the medical community will have to be prepared to treat those who are injured by weapons of mass destruction.

And President Bush and Secretary Thompson are looking to continue to strengthen our nation. For this year, the president and secretary have proposed $4.3 billion to support a variety of activities to prevent, identify, and respond to incidents of bioterrorism.

Through this additional funding the federal government will partner with state and local governments and research laboratories across the nation to strengthen our response network and expand the availability of vaccines and drugs, while protecting our food supply and enhance research.

But the government cannot do it all. If we’re attacked again, our first line of response preparedness may very well be in places like Tulsa, Oklahoma, St. Louis, Missouri, or Tuscon, Arizona.

It’s the local communities that will respond first. After all, all disasters are local events.

So we need to make sure that we are prepared as communities but also as citizens. And one of the primary ways that we can become prepared is to take better care of ourselves, physically, on a daily basis.

There is no question that the nation’s increasing epidemic of obesity has a major impact on civilian preparedness and military readiness.

My fellow surgeons general in the Army, Air Force and Navy have discussed the huge and potentially catastrophic impact that this epidemic could have on the future of our uniformed services, if we allow it to go unchecked.

On September 11, we saw firefighters and police officers scale the steps of the World Trade Towers to usher thousands of people out of the buildings to safety. Had these brave souls not been in excellent physical condition, they never would have been successful.

Today in America, two out of three Americans are now overweight, and one in three is obese. Fifteen percent of our children and teenagers are overweight. 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? It’s 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 teens’ overall health. Better health will ultimately make for better citizens and, indeed, better soldiers. And we will need our soldiers to be healthy and resilient, prepared to meet whatever threats the future may hold.

I charge each of you to lead by example in your own homes, and in your workplaces. As members of the uniformed services, we have both the honor and the responsibility of adhering to a higher standard. 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!

America is a huge nation, both in terms of population and physical size. Terrorists could strike anywhere, anytime.

The reality of this is that today, there will be no ‘special forces’ elite unit immediately available from the federal government to contain a biological or chemical attack.

Instead, local EMS, police and fire units will be the first to respond. In the case of bioterrorism, emergency room and hospital personnel will be on the frontlines as the first point of contact for casualties, as we saw last fall for anthrax.

Local public health professionals will need to be prepared to determine quickly if the event is a terrorist attack, or another type of threat.

We must forge partnerships between the uniformed services, law enforcement and health practitioners – groups that have not traditionally worked together - so that everyone is aware of the possible threats and trained to meet them. We must create seamless response systems, from federal, state and local assets where there may have been little previous communication.

Forging partnerships is my piece of it. That’s what I’m going to be relentless about. I will speak to conferences of medical professionals all over the country. I will participate in exercises and simulations in small counties and in large cities. I will work with the medical and political leadership throughout the country to make this happen.

Just as those of us in the different branches of the uniformed services need to work together, we need to reach out in partnership with law enforcement and the health community.

No matter our service, regardless of the color of our uniforms, we all have the same mission: to protect and defend our nation no matter the threat. We must also now organize and join together in ways never anticipated.

For some of us that will mean going to far away lands to work, to fight, and perhaps even to die.

For others it will mean going to all corners of our great nation to care for and support our citizens in their times of need. However, no matter the mission, nor the place, we are all joined together in the defense and care of our citizens and their way of life.

Another step I encourage you to take – those of you who have some experience in health care: join your local Medical Reserve Corps (MRC). This is the health component of President Bush’s volunteer effort known as Freedom Corps, and the one I lead as Surgeon General. These units, based on the local level, will be made up of volunteers – nurses, doctors, paramedics – who are trained to respond to health crises.

These medical volunteers will be trained to complement and assist full time emergency first responders during large-scale disasters.

For instance, these volunteers could be called upon to staff triage and decontamination sites, casualty collection centers, or mass immunization sites.

The Medical Reserve Corps nationally are critical to our efforts on preparedness. They’ll provide assistance and depth to the good emergency teams already in place.

I encourage each of you to become members of your local MRC.

The task of readying ourselves will not be easy. Already it has cost billions of dollars, and thousands of man-hours. But preparedness is not cheap – and it’s not something that should be done on the cheap. While the price of preparedness may be great, the price of not being prepared is even greater.

I’d like to draw an historical parallel to the situation we now face. We have the benefit of looking back to World War II with 20/20 hindsight.

In fact, as those who lived through that time will tell you, it was by no means certain that the Allies would prevail.

President Roosevelt did his very best to try to keep America out of the war before Pearl Harbor, because he knew the American people, tired from the Great Depression, were not prepared to face it.

But then, on December 7, 1941, Pearl Harbor was attacked and more than 2,000 soldiers and civilians were killed.

The American people decided it was time to fight. That surprise attack gave the president the political will and capital he needed to prepare for war. At that point the threat was literally at our doorstep, and time was short.

We had to rapidly convert our civilian industrial base to the job of building the weapons we needed to fight the war. In other words, we had to work full speed to catch up with our enemies.

The historical parallels between then and now are striking. Many of us have known of the threat weapons of mass destruction in the hands of terrorists pose to Americans. Many of us have been working on these issues quietly for years.

But most of America simply did not recognize the threat until it came home, on September 11th.

Now we are working full speed to fight terrorism and those like Osama Bin Laden who seek to destroy our country. Through prevention, preparedness and partnerships, we will prevail.

And fifty years from now when our grandchildren ask us about this time and the terrorist threat, we will be able to say, we responded to the call, and met the challenge of our time.

The Reserve Officers Association, founded in 1922, echoed the voice of our nation’s first president, George Washington. In January 1790 President Washington warned Congress and the citizens of the newly freed United States of America that, "To be prepared for war, is one of the most effectual means of preserving peace."

My fellow officers, as we stand here today, on the brink of another military escalation to protect the liberty of freedom loving people – we summon the greatness of our generations past and grasp the hope of generations to come – and ask them to guide us and protect us as a nation.

A nation founded on liberty . . .to protect liberty . . .and to spread liberty.

May our beacon of liberty forever shine and may our hope in freedom never wane and may God continue to bless America.

Thank you.


Last revised: January 9, 2007