Remarks as prepared; not a transcript

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

2003 Luther Terry Lecture
Commissioned Officers Association of the Public Health Service Meeting

Wednesday, June 18, 2003

"The Commissioned Corps: 'Walking the Talk' of One Department — Critical Junctures in the Path to Corps Transformation"

Thank you for the honor of speaking with you today.

Surgeon General Terry was a man who always "walked the talk." Many of us know of Dr. Luther Terry first and foremost as the Surgeon General who issued the 1964 "Report on Smoking and Health." What you might not know is that Dr. Terry was a lifelong cigarette smoker.

That is, until he issued the groundbreaking "Report on Smoking and Health." Surgeon General Terry knew that, as the man who was telling everyone that smoking is harmful to your health, he could not be smoker. The need for change was fundamental, and as a leader he knew that there was no clearer expression of his commitment to the science of his report than to lead by example.

So he quit! One day he was a smoker, the next day he wasn’t.

Any of you who either were smokers, or still are know first hand the difficulty of what Dr. Terry did. There was a man who knew the importance of "walking the talk."

Surgeon General Terry was a great leader in public health and a strong advocate for the Commissioned Corps. I want to talk with you today about change, and I hope to honor him today as I outline for you some of the new realities and challenges that the Corps faces.

I also hope that you will join me today in another journey that will embrace cultural change in a way that will take us to a better place, a place that will strengthen the Corps, not just in our eyes, but in the eyes of those we serve — the public.

Over the course of time while we undertake this journey, we will have to emulate Dr. Terry by our attitudes and actions. In so doing we will, like him, "walk the talk."

A short examination of our current leaders yields a glimpse of the overall direction of our journey. There are even some specifics that relate to the changes in store for public health professionals. President Bush in each State of the Union Address has talked about strengthening the public health infrastructure. He has spoken of the need for public health to reach into areas that are largely underserved, where people don’t have access to care.

When we look at Secretary Thompson, we see a man who truly leads by example. He cares passionately about health promotion and disease prevention, as well as the direct return from taking personal responsibility for the life choices we as individuals make every day. He has devoted his life to public service. He served as Governor of Wisconsin for 14 years, now as Secretary of one of the largest government departments. He’s a busy guy. To him a 16-hour day is a vacation!

Because he understands the value of choices and the role of leaders in our society, Secretary Thompson exercises every day. He actually changed his habits, and is setting an example not just for the Department but for the American people. In the bargain, he has lost over 16 pounds. As someone personally committed to physical activity, I can tell you — the Secretary is in great shape.

The Secretary has also provided the leadership to see the value in redefining this diverse and organizationally fractured department by its common mission. Forging "One Department" is a task that many Secretaries have attempted, but none has had the clear vision and persistence that Secretary Thompson brings to the task. That sense of "walking the talk" is present and accounted for, and "One Department" is beginning to take hold.

I believe, and I know the Secretary believes, that the Commissioned Corps is a Department-wide resource. The Corps can effectively demonstrate and address Secretary Thompson’s overarching vision for "One Department." The Commissioned Corps can be the visible embodiment of the "One Department" concept. That’s the way he views us, and it is up to us to embrace that view. What we do, where we are deployed, how we look are constant examples of how we "walk the talk."

Over the years, we all have had the opportunity to use our God-given talents. I am no exception. In a career that ranges from Special Forces medic, registered nurse, to paramedic, professor, and surgeon, I have been blessed with opportunity.

These days I often describe myself as a "recovering surgeon." It is my belief, and many of the surgeons here may agree, that at times surgery can be considered a barbaric process, especially in light of new, rapidly evolving scientific knowledge.

For example, we are now screening genetic information and targeting appropriate interventions to help people avoid diseases years before their first symptoms would have otherwise appeared. Future health care professionals may cringe in horror at the tactics that we use today in our attempts to save human life. Someday, simply by altering the genotype of a host, an organ will resist disease or heal itself.

This is the future of medicine and the future of public health. It is an exciting future, and many of you here today have helped create it. We will all benefit from it.

The President has the vision to see the inherent value in this progress. The Secretary has focused on the Commissioned Corps and challenged us, and we have a unique opportunity to seize this moment in time. The challenge? Let’s look at it.

As Commissioned Corps officers, we must be ready for the future of medicine and the future of public health. This will require updating of our culture. The path there will undoubtedly be the road least traveled. It will perhaps be a perilous journey at times — but well worth the risk.

In April of this year, Secretary Thompson issued a letter to HHS leadership praising the Corps’ long and distinguished history and calling for us "to meet the public health needs of the 21st century." He stated: "The end product will be a visible, physically fit, highly motivated, and expert mobile uniformed service of public health professionals."

Over its long and proud history, our Corps has been consistently characterized by adaptability. From our beginning as a service to provide health care for merchant seamen, we have evolved, and continue to evolve, in ways that serve the American people as well as other communities far from our roots as a maritime service.

To be candid, the service that has taken us in so many directions has left the Commissioned Corps fractured and decentralized. The President and the Secretary now call on us to restructure, revitalize, and once again become "One."

The Corps needs to be strengthened in size and in leadership capacity. Even before the tragedy of 9/11, the Corps was being called upon to address some of the most pressing public health needs of our nation. Too many people live in areas where health care resources are lacking. The President has called for strengthening the Community Health Centers system across the nation.

In a post-9/11 world, we must focus not only on addressing traditional public health needs, but also on readiness for unpredictable attacks from an enemy that threatens our social fabric. This is the beginning of a resurgence in public health and provides us with the opportunity to marshal the resources to transform ourselves. This adversity gives us unparalleled opportunity to transform.

It will encourage our political leaders to support the public health infrastructure at the state and local levels and, in part through the judicious assignment of officers to assist state and local officials, we can strengthen the capacity of our nation to address both disease prevention and emergency preparedness.

Our recruitment, placement, and mentoring efforts will be dictated by a process and concepts of contemporary force management. The Corps will emerge as a cadre of public health professionals, better able to determine requirements based on mission demands and needs — not simply filling positions.

Personnel requirements will be determined through a consciously developed plan for professional human resource needs projected for the future. In this process, parity with the other uniformed services will be maintained as appropriate. Recruitment will be targeted to address the increased interest among health professionals to serve their nation and their community. To capitalize on this interest, we need to be openly supportive of new public health programs to encourage increases in the universe of well-qualified applicants to the Corps. Through this effort we will begin to grow again, and grow with purposeful direction and meaning.

We need to broaden the experience base of every officer, so that from the time of recruitment to senior placement, more officers are open to the prospect of different types of assignments and more broadly defined career pathways. Every officer — assisted by his or her chief professional officer and discipline Professional Advisory Committees — should have, consistent with our mission, the opportunity inherent in a diverse career path with full professional career satisfaction while serving the nation.

Deployability and timely response to natural and man-made emergent situations is critical. The Corps must be even better prepared then we are today to respond to our nation’s needs. I am certain that you are aware of the increased emphasis on CCRF qualification. Beginning later this year, we will reform deployment criteria to create a more flexible system that encompasses all officers, recognizing that each of us has a role to play in the nation’s health readiness.

We will fully activate the Commissioned Corps Readiness Force. By distinguishing varying levels of capability, we can, and will, qualify every officer to be a deployable member of CCRF.

The rewards of embracing these changes are real. Promotions will take levels of training and deployment capacity into account. Commissioned Officer Effectiveness Reports will change and reflect clear objective endpoints of professionalism and visible uniformed leadership.

Our emergency response capability is part of ensuring that the Corps becomes an even stronger nationwide and global public health resource, with ready communication and access to all officers at all times. We need to strengthen our capacity to recruit for the future; train and maintain professionals; stimulate leadership capacity at the senior, mid-, and junior officer level; promote readiness skills as a total force capacity; and stimulate career leadership and rotational opportunities for all officers in every discipline. For example, Basic Officer Training, Advanced Officer Training, and CCRF training will be required of all officers at the beginning of and at various points throughout their careers.

Building on the experience and resources of the private sector, academia, and our fellow uniformed services, the Corps will engage with all these entities through cooperative internships, joint research, and operational and training efforts.

We have an unprecedented opportunity with unprecedented support for our mission.

These steps are all part of ensuring that we are more prepared to respond to public health needs — particularly in emergencies. A portion of this opportunity lies in recognizing that we have much to learn from and emulate in the other uniformed services.

One example is our uniform. It is a visible and outward symbol of the oath we swear and the internal values we hold dear. Our uniform reminds others and ourselves of the professional standards we uphold. The issue is not the wearing of a uniform itself, but our proud outward and visible expression of who we are. It allows us to be a highly visible health force, performing the most important job in the United States — protecting and advancing the health of our nation.

There are already some great examples. PHS officers assigned to the U.S. Coast Guard are in uniform 24/7. Officers assigned to the Bureau of Prisons have had a 24/7 uniform policy for more than15 years. Corps officers in the Immigration Health Services are always in uniform, and next month officers assigned to CMS will adopt the 24/7 uniform policy. Rear Admiral Chuck Grim of the Indian Health Service will soon issue a new uniform policy. I challenge all of you to come on board.

All officers, regardless of where we are assigned, represent the PHS Commissioned Corps, HHS, and the Secretary’s "One Department" vision and mission. Our uniform represents our commonality of purpose. It also represents our responsibility and accountability as public health leaders. In the causes of disease prevention and health promotion, nothing is more important than leadership by example.

The road ahead of us will be challenging. It will require of each of us to do a major rethinking of our current situation. There will be those among us who may reject this transformation, but I am confident from speaking with many of you that the vast majority crave this change and will welcome it as long overdue.

We will transform the Corps with the greatest sensitivity and attention to the needs and desires of the majority of our officers.

"Walking the talk" isn’t the path of least resistance. As Luther Terry showed us, it is the right path and the honorable path.

"Walking the talk" will take us into the 21st century as a vital and useful Corps with purpose and value to the President, the Secretary, and the American people.

Every officer has an obligation to fulfill the role you are assigned to the best of your ability.

Leadership comes in many forms. However, the privilege of leadership has a common thread: leaders are responsible for the destiny of others. All of you are leaders locally, nationally, and globally.

Today more than ever, we need every officer to be a leader within the professional Corps. The SARS outbreak is one of many recent reminders of how much your service contributes to maintaining public health and how important it is that you are ready to respond to future health threats.

In many ways, you represent the future face of our great nation. The Corps has diversity of ethnicity and diversity of professions. Our diversity is a great strength, enabling us to understand and be responsive to the many communities we serve.

I trust that you will join me in action and in spirit, with an open mind and a willing heart, to serve your community, uphold the integrity of your chosen profession, and lead the uniformed and visible Corps into the 21st century.

The adjustments we will soon make to the Corps will create significant change in our culture. We will call on one of the greatest strengths of the Commissioned Corps, our ability to adapt to the changing demands of public health. We will once again strongly demonstrate the adaptability of the Corps, which has transformed on so many occasions to meet the demands of the times.

The Corps helped to lead the antibiotic revolution and the war on cancer. We adapted to meet the demands of the largest global migration in the history of the world; and we reconfigured to meet new challenges of improved health care and the Hill-Burton Expansion Act. And we met the challenges of 9/11, anthrax, and SARS.

We can create a future as noble as our past. We need to reconfigure and revitalize ourselves in light of new realities — intentionally and with an eye to the future.

Join me on this journey. It will test you, and next year at this time the joy of achievement will fill this room. The future holds great promise for the Corps. It is the continuation of a great past, and the Corps will be better for your effort, as will the United States and the world we serve.

The challenge and future are before you. How do we transform and create a unified, visible, and uniformed culture of service to serve our nation’s needs in the 21st century? How do we best serve our customers — the public — in a visible, professional, efficient and cost-effective manner? We are at a critical juncture, and — unlike Yogi Berra who said, "When you come to a fork in the road, take it." — we must make a decision. Do we strike out boldly and take that path less traveled, or settle for the well-paved, secure, and mediocre path?

Do we wait for others to determine our destiny? Or do we seize this moment in time to create our future by individually and collectively setting the bar high — not just adhering to but voluntarily exceeding our policies and standards, such as grooming and uniforms that are the external exemplification of who we are.

In the world that I hope you direct me to, I will not have to issue directives regarding uniforms, grooming, or other professional issues — rather, I will just codify the extraordinary standards you set by your deeds, actions, and words. The few who see the world differently will clearly stand out from all of you who refuse mediocrity, complacency, and the status quo.

You must refuse to allow us to be fragmented or divided by geography or work assignment. Our peers in the other uniformed services have achieved this successfully. We are no different, and by embracing the culture of the Corps we will enhance our visibility and effectiveness, thereby serving our customers exceedingly well.

In closing, the President and Secretary have given me the unique and extraordinary distinction of serving as the 17th Surgeon General of this great nation, and as your leader. Leadership always involves risk, for without risk there is little chance of advancement. I am willing to accept the risk and take the hits, but only because when I turn around I have a professional, uniformed, and committed Corps of good officers at my "six" — sharing a common vision.

Ladies and gentlemen, the future is before us. Our destiny is the prize. I say let’s roll; give them something to talk about; and make this the best, most professional uniformed service of the United States.

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Last revised: January 9, 2007