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

Commission on Children at Risk
Report Release of Hardwired to Connect: The New Scientific Case for Authoritative Communities
Hart Senate Office Building, Washington, D.C.

Tuesday, September 9, 2003

"Connecting for Children’s Health"

Thanks for that terrific introduction.

It is an honor to be with you today. I appreciate the opportunity to be among so many medical, scientific and advocacy colleagues who make the well-being of children your life’s work.

I commend your dedication to improving the lives of children. I believe the information you have assembled will help inform our policymaking for years to come.

As those of us concerned with children are always asking: what kind of legacy are we leaving our children? In America, we want the best for our kids. We want them to have the best there is – the best opportunities, the best education, the greatest happiness. We want them to be better off than we are. As the father of four, I feel this with my whole heart, my very being.

And as Surgeon General – now the top doctor with responsibility for all American children – I want all of our children to be as healthy as possible, physically and mentally.

It’s a commitment I share with the leaders I work for: President Bush and Health and Human Services (HHS) Secretary Tommy Thompson. And it is a commitment that is evident throughout the Department of Health and Human Services. You heard this morning from Dr. Wade Horn, Assistant Secretary for Children and Families, who, along with health folks from my side of the street, is working to implement Positive Youth Development, a strategy to help kids avoid high-risk behavior by building their connections to family and community.

Indeed, at HHS we already have a Department-wide commitment to many of the ideas you have stressed in this report.

Under the leadership of former Surgeons General, my office has been actively involved in mental health, issuing a Surgeon General’s Report, a Call to Action to prevent suicide, a report on children’s mental health and National Strategy for Suicide Prevention.

Your report emphasizes the importance of viewing child development and childhood problems holistically and with a focus on prevention. Treatment is important – as doctors we know that – but treatment alone is not enough.

Our goal must be treatment and prevention.

To paraphrase the great analogy you use in this report: we need to get better not only at pulling drowning children out of the river, but also at figuring out why so many of our children are in the river in the first place, and what we can and must do upstream to reduce that number.

This report stresses the need for a caring community to help provide ‘connectedness’ and meaning in a child’s life.

This is more than just an academic issue for me. I’ve lived it. I was a kid in the river. I dropped out of high school and ran the streets. If it weren’t for a few adults in my community reaching out to me critical junctures in my life, I might not have made it.

I was connected to the wrong kind of community as a child, which led to my truancy, and lack of direction.

The importance of strong role models, whether parents, or other adults in a child’s life, cannot be overstated. I know this anecdotally from my own life; now, thanks to this report, we are developing the science to back it up.

Children need caring communities to survive and to thrive. And the presence or absence of a caring community has implications for a child’s physical as well as emotional health.

This lack of connectedness among children, especially teenagers, can lead to serious health consequences, through drinking, drug use, violence, and sexual risk taking.

The child without connections is more prone to be the child who gets behind the wheel of the car after drinking, the child who has unprotected sex, the child who overdoses on drugs.

As the scientific evidence you’ve presented concludes, "Nurturing environments, or the lack of them, influence the development of brain circuitry and the way genes affect behavior."

Further, the science you’ve presented tells us "The human brain appears to be organized to ask ultimate questions and seek ultimate answers." Children seek meaning in their world. They need to develop spiritually as well as physically and emotionally.

This report makes the case for preventive strategies in helping children and teens avoid specific health risks. And it goes further by showing the linkage between a child’s emotional connections and avoiding harmful risks altogether.

And, it emphasizes the importance of broad-based prevention strategies, not just those that focus on a particular ‘at-risk’ child or group. We need to keep all of our children ‘out of the river,’ to use your analogy.

President Bush and Secretary Thompson have provided strong leadership in broad-based prevention through HealthierUS.

HealthierUS says, "Let’s teach all our kids the fundamentals of good health: exercise, healthy eating, getting check-ups, and avoiding risky behavior." And HealthierUS recognizes it will take partnerships between individuals and communities throughout society to get the message out: from government, to business, to schools, to youth organizations, to sports stars to moms and dads.

Preventing kids from using alcohol is one example of how HHS is already ‘on board’ with the findings in this report. We have already developed a strong research and evaluation base showing the need for prevention strategies in fighting underage drinking and drug use.

According to research by NIH’s National Institute on Alcohol Abuse and Alcoholism, kids who drink are more likely to be victims of violent crime. They are also more likely to be involved in alcohol-related traffic crashes, and to have serious school-related problems. Early drug and alcohol use is also unfortunately linked to suicide.

And it starts very early. 40% of children who begin using alcohol before age 13 will eventually become alcoholics.

As HHS’ Substance Abuse and Mental Health Services Administration (SAMHSA) research found last summer, the younger children are when they first use marijuana, the more likely they are to use cocaine and heroin and become drug-dependent as adults.

We’ve got to reach them early, in middle school and even before. President Bush has asked me to speak to our young people about the dangers of substance abuse.

So, through an initiative called "50 Schools in 50 States," I tell kids all over the country my own story of overcoming hardship in a poor family where there was substance abuse.

I tell them how to avoid risk: "don’t smoke; don’t drink, and don’t ever do drugs."

And it’s not just the ‘don’ts’ that are important. It’s the ‘do’s.’ I tell them to persevere, to keep getting back up if they fall down, it’s not too late if they’ve already made some mistakes. It’s never too late to turn around.

But I’m just one man. A middle-aged guy in a white uniform who a kid might listen to or might not, using the example of my own eleven year old!

We need partners in spreading the prevention message throughout society, especially parents, teachers and coaches. In fact, it is the adult role models closest to children, and not government programs or figures, which have the most influence on children.

More than 20 years of research conducted by HHS’ National Institute on Drug Abuse on drug use prevention has shown that the most effective programs enhance ‘protective factors’ and reduce ‘risk factors.’

What’s the most important protective factor? Strong family ties and parental supervision. And if that’s not there, strong bonds with school and religious organizations can help fill in the gap.

In fact, the best prevention programs involve the family and school, and help train young people in skills to resist drugs when offered.

These are just a few examples of what we’re doing at HHS to prevent drug and alcohol use among our children and teenagers. And there is evidence that our prevention efforts are paying off.

According to a SAMHSA survey released last week, over 83 percent of youth ages 12 – 17 reported having seen or heard alcohol or drug prevention messages outside of school in the past year. And those who had heard those messages reported lower usage of illicit drugs! (11.3% to 13.3%)

We could also go down the line and talk about other health problems kids face and our prevention strategies to deal with them: sexual risk-taking, violence, overeating and eating disorders, and the like.

We tend to talk about these issues separately, and may have separate strategies to deal with each of them. The strength of the ideas report, I think, and where it breaks new ground is where it asks us to look at a child not just from the perspective of treating or preventing a particular health problem or risk, but as a ‘whole’ child, whose well-being in any given area will be related to his or her ability to connect with the adults in his life and find meaning.

I look forward to working with all of you in this room and with Senators and Members of Congress on policies that will take this science into account, looking at the whole child as we develop prevention models to keep all American children healthy and out of trouble.

This report also shows that we must individually and collectively make the decision to be connected with and mentor the children in our own lives – whether we are their parents, step-parents, neighbors, teachers or coaches.

We must also reach out to children who need mentors, through our churches, or by volunteering in community organizations like the YMCA and ‘Big Brothers/Big Sisters.’

Many of you are familiar with the work of Fred Rogers, a calm and reassuring presence in the lives of children for three decades on the show Mr. Rogers Neighborhood. Rogers was committed to supporting the developmental needs of children, including their search for meaning. In fact, President George W. Bush awarded him the Presidential Medal of Freedom in 2002 for his contributions to children’s education and well-being.

I wouldn’t be surprised if you told me Mr. Rogers had influenced your work – so close are his views to yours. He also felt strongly about a child’s need for good mentors. "We live in a world in which we need to share responsibility. It's easy to say 'It's not my child, not my community, not my world, not my problem.' Then there are those who see the need and respond. I consider those people my heroes."

Our kids – all over America – are counting on us. We can’t let them down.

Keeping America’s kids healthy – giving them a better future than our own – is my driving passion, and I know it is yours also. Working together and persevering in this effort, we can rescue kids who are already in the river, and keep many more from falling in.


Last revised: January 9, 2007