Remarks at the California Native Hawaiian Pacific Islander Town Hall

Remarks as prepared; not a transcript.

"Promoting Prevention and Health Literacy in the Native Hawaiian and Pacific Islander Community"

Opening and Acknowledgements

Aloha

Thank you, Vaka, for that gracious introduction. (Vaka Faletau, Co-Chair, NHPI Planning Committee)

It is an honor and a privilege to be here with you today, and to address this Native Hawaiian Pacific Islander Town Hall.

Many of you dedicate much of your time to serving the Native Hawaiian Pacific Islander community. I applaud your dedication and commitment.

It's important to see health both from the community perspective - like we're doing today - and also from a national and global perspective.

Last week our nation suffered a terrible tragedy on the Virginia Tech campus, just a few hours outside of Washington, D.C.

As health professionals, we are concerned about the physical injuries of those still recovering and for the mental and emotional health of those friends and families who are grieving today.

Because while geographically Blacksburg, Virginia, and California may be thousands of miles away…at times like these we are all neighbors.

I know that you join me in offering our sympathies to those who have lost loved ones and our shared hope for both physical and emotional healing.

As the nation's acting Surgeon General, I'm fortunate to have the opportunity to come here today.

As many of you may know, I am from Hawaii. I am not Native Hawaiian, but I am a native of Hawaii.

I was born in Honolulu, and spent my formative years there. I studied at Chaminade College and graduated from the University of Hawaii.

And of course, I not only have fond memories of my time living in Hawaii, I still have many friends and family there.

My wife and daughters and I visit Hawaii each and every year.

We particularly enjoy our Thanksgiving visits. Not every American has had this opportunity to give thanks while surrounded by the unparalleled beauty of my home state, but for me it is absolutely the perfect fit.

In addition, I have traveled to most of the Pacific territories and jurisdictions.

The reality is that the problems we are here to discuss are not foreign to me.

• These health issues affect me.
• They affect my friends.
• And they affect my family.

Your concerns are my concerns - not just as the Acting Surgeon General, but as person who identifies himself as a native of our 50^th state.

Before I get into my remarks, I would like to extend a special thanks to the H-H-S Office of Minority Health, and to the California Native Hawaiian and Pacific Islander Town Hall Planning Committee for making this meeting a reality.

Also, thank you to our H-H-S staff, from Washington and from the Regional Office, for being here today.

My bosses, Department of Heath and Human Services Secretary Mike Leavitt and Assistant Secretary for Health John Agwunobi, asked me to bring you their gratitude and best wishes.

They're very thankful for the work you do in the Native Hawaiian Pacific Islander community.

Priorities

I believe that many of your public health priorities mirror those of the Office of the Surgeon General.

And I would like to invest some time today talking with you about our priorities, then discuss the ways that you can help out in your communities, because I know that you are all deeply committed to service.

Our first priority is Prevention - what each of us can do in our own lives and communities to make ourselves and our families healthier.

The second priority we're relentlessly focusing on is Eliminating Health Disparities.

The third priority is Public Health Preparedness.

Prevention

Let's first look at Prevention.

Prevention is the cornerstone of everything that we do at H-H-S.

And this is an interesting discussion - especially for Native Hawaiians and Pacific Islanders.

Because for generations, we have had among the longest life expectancies and traditionally have been believed to be healthier than many other minority groups.

However, that is changing.

For example, Type 2 Diabetes is growing among Native Hawaiians - more than double the rate of their white neighbors.1

This is at least partly due to the Americanization of the native culture.

According to the H-H-S's National Institutes of Health, instead of the traditional plant and fish-based diets, Native Hawaiians and Pacific Islanders are more often choosing foods with more animal protein, animal fats, and processed carbohydrates.

In addition, they have become less physically active.

Also, compared to other ethnic groups, Native Hawaiians/ Pacific Islanders have higher rates of smoking, alcohol consumption, and obesity.

Unfortunately, that has led to the fact that as a group, Hawaii's indigenous people have disproportionately high incidence rates of heart disease, diabetes, cancer, and asthma.2

There is also a staggeringly high and heartbreaking infant mortality rate among Native Hawaiians - nearly 40% higher than the national average.3

In addition, without fluoridated water and limited resources allocated to dental services for the underserved, Hawaii's oral health statistics are among the worst in the nation. 4

And today, more than 22,000 Hawaiian children remain uninsured.5

Taken together, these data demonstrate the need to engage the population in healthy habits - including preventive care.

And these numbers are not just statistics. They are our friends, family, our communities…..our people.

As a nation, millions of Americans die from preventable diseases every year.

And we spend approximately half a billion dollars each year treating patients who suffer from diabetes and cardiovascular disease alone.

When you follow the money trail, you will see that it is heavily weighted toward treatment and end-of-life care.

Right now we live in a treatment-oriented society, but society has it backwards.

We should move toward being a prevention-oriented society.

We know that we can prevent or manage many diseases by modifying behavior.

This includes making healthier food choices, reducing alcohol consumption, adding daily physical activity, getting regular health screenings, and not smoking.

The challenge is to elevate public health as a discipline, as a profession, and as a cause for our focused attention and advocacy.

Ultimately, we need to move our research and knowledge into action in our communities.

This is part of the impact you all have in Native Hawaiian Pacific Islander communities.

Secondhand Smoke

You can help elevate public health issues and continue to ensure that useful, easy-to-understand information is reaching members of your community.

And we in the Surgeon General's Office, as well as my colleagues in the Office of Minority Health, want to make sure you have the health information you need so that you can begin inform your communities.

Just last summer, the Office of the Surgeon General released a Report about the harmful health effects of secondhand smoke.

It showed that smoking not only harms the smoker, but it also harms the people in close proximity to the smoker. Usually this includes the smoker's spouse, children, and friends.

Each year, secondhand smoke causes tens of thousands of heart disease deaths and nearly 3,000 deaths among our nation's nonsmokers.

And children who are exposed to secondhand smoke potentially have dozens of health issues as a result.

Hawaii and California have taken a leading role in the fight against secondhand smoke.

As travel and tourism destinations for so many people, Hawaii's health conscience and California's leadership by example can have profound impacts globally.

Underage Drinking

Another issue that affects every community is underage drinking.

Last month we released "The Surgeon General's Call to Action to Prevent and Reduce Underage Drinking."

The Call to Action was released after nearly two years of collaboration and planning with community leaders, parents, and educators throughout our nation.

The physical consequences of underage alcohol use range from medical problems to death by alcohol poisoning.

In addition, alcohol consumption can lead to risky sexual behavior and various types of injuries. And it could have a damaging affect on brain development.

Underage drinking is everybody's problem, and its solution is everyone's responsibility.

As with every Surgeon General's publication, this "Call to Action" is grounded in science, and the science indicates that underage drinking is putting our children at risk.

Recent research shows that the brain continues to develop well beyond childhood and throughout adolescence.

We are working very hard to get these new findings out to all Americans.

Combating underage drinking, while promoting lifelong healthy habits for all citizens, is something that you all can do you in your communities.

More information can be found at www.surgeongeneral.gov

Suicide Prevention

Prevention doesn't just end by healing the body - we also need to prevent and treat wounds of the mind and spirit.

Native Hawaiian adolescents have a higher risk of suicide than other adolescents, and older Asian American women have the highest suicide rate of all women over age 65 in the United States.

Death from suicide is a terrible, tragic death - and leaves survivors with the pain of the always-lingering question "What could I have done differently?"

The Surgeon General's 1999 Report on Mental Health noted that Asian-Americans and Pacific Islanders have extremely low utilization of mental health services, with only about 17% of people experiencing problems actually getting the care they need.6

To change this, we must offer people more assurance that the stigma of receiving mental health help has passed and that society accepts the benefits that mental health professionals can provide.

Eliminating Health Disparities

Mental health is one of the many health disparities that affect Native Hawaiians and Pacific Islanders.

Eliminating these disparities is another public health priority of the Office of the Surgeon General.

It is unacceptable that in our great nation, with our global leadership in science and medicine, we still have major disparities in health and health care delivery.

All Americans - regardless of their race, heritage, age, or gender - should have access to good health information and health services.

You've heard from Dr. Garth Graham, of our Office of Minority Health.

His office is the federal focal point for improving the health of racial and ethnic minorities and eliminating health disparities through policy and program development.

As Dr. Graham mentioned, the development of partnerships between H-H-S and Native Hawaiian Pacific Islanders is very important to H-H-S.

One important outcome of these partnerships is to help reduce, and ultimately eliminate, health disparities.

One such successful partnership is the Native Hawaiian Center of Excellence at the John A. Burns School of Medicine at the University of Hawaii.

The Center is funded from an H-H-S grant and is designed to improve the health of native Hawaiians wherever they may live throughout our nation …..through research, education, service, and training of Native Hawaiians in medicine.

The Center is doing great work to increase the number of Native Hawaiians who are conducting research, and to educate Native Hawaiians on health issues through their training courses.

In addition, H-H-S's Health Resources and Services Administration supports more than 100 community health centers where Native Hawaiians and Pacific Islanders can see a health practitioner and get the care they need, when they need it.

Health Literacy

One of the tremendous benefits of our nation's community heath center system is their commitment to provide care in a culturally competent, health literate manner.

Health literacy - or its converse health illiteracy - can have a tremendous impact on our minority communities.

Health literacy is the ability of an individual to access, understand, and use health-related information and services to make appropriate health decisions.

More than 90 million people cannot adequately understand basic health information.

The Institute of Medicine's 2004 report, "Health Literacy: A Prescription to End Confusion," found that nearly half of all adults in this country have difficulty understanding and using health information.

The Report also found that there is a higher rate of hospitalization and use of emergency services among patients with limited health literacy.

Working within your communities, I urge you all to remember the importance of being able to translate complicated health information into easy-to-understand information - information that is communicated clearly, accurately, and effectively.

We all have a responsibility to ensure that we translate science into medical and health information that can be heard… understood… embraced… and ultimately put into action - by all people.

Emergency Preparedness

Our ability to communicate effectively will be particularly crucial when preparing our nation for an emergency.

And that brings me to another important component of our prevention efforts: Public Health Emergency Preparedness.

The terrorist attacks of 9/11, the anthrax attacks that started on 10/15, hurricanes Katrina and Rita, and the new threats of pandemic flu have firmly planted emergency preparedness on our nation's health agenda.

Disaster takes many forms - a hurricane, an earthquake, a tornado, a flood, a fire, a pandemic flu, or a hazardous spill … an act of nature or an act of terrorism.

We know that we cannot always prevent emergency situations…. but we can be prepared for them.

Our goal is to be able to prevent as often as possible, and when we cannot prevent - as is often the case with a natural disaster - we must mitigate, respond to, and then recover from emergencies, so that health, education, commerce, and all aspects of life can normalize as soon as possible. We now understand that emergency preparedness can help prevent all-hazards emergency situations from becoming large-scale disasters, and can also help us limit the resulting negative health consequences.

Preparedness involves planning by every level of government, every school, every business, every civic organization, every community - and we at the Federal level count on you to help in these preparedness efforts.

For example, during a time of crisis, we rely on you and your organizations to communicate with our Native Hawaiian Pacific Islander populations the critical health messages in a culturally and linguistically appropriate way.

After 9/11 and 10/15, I was part of the conversations about varying ways we could have been - and needed to be - better prepared.

It was during those discussions that we first considered the idea of a civilian volunteer Medical Reserve Corps.

No one seemed eager to take on the challenge of creating, growing, and overseeing a M-R-C, but the Office of the Surgeon General stepped forward, and picked up the gauntlet.

We foresaw the benefits that would come from a network of volunteers from their communities, ensuring the health and safety of their communities.

I am extremely proud to lead the M-R-C, as powerful partners with the Surgeon General.

We now have over 30 M-R-C units throughout California….some long established and funded, some just beginning their training.

I'm grateful to the health, medical, and administrative volunteers who have stepped up to form and lead these units.

They are very important to the local health and safety.

Closing and Charge

In closing, I want to again thank you for your dedication for helping the healing in your community.

Your attendance here is evidence of your passion.

And I'd like to review a few of the things that I hope you take back with you that, I believe, can help lead to a healthier native community and healthier nation.

First, do all you can to promote prevention.

• Encourage your patients, your family, your friends, your neighbors - actually anyone who will listen - to engage in healthy habits. …..Habits like healthy eating, minimizing alcohol consumption, daily physical activity, and not smoking.

Second, work to make sure health messages are understandable to the populations you know best.

• You are closest to the health needs of your communities. Washington has good information - but we're not always good at messaging.
• That's where you come in. You understand the needs and personalities of your communities. Please continue to help us.

Third, get involved in emergency preparedness efforts.

• There isn't much glamour and it's a lot of hard work and hopefully the time and effort will never have to be used. But in the event that it is needed, your community will be better served.

And finally, use your role as a leader in the community to be a mentor.

We have a duty to encourage our next generation to reach great heights.

Believe me, growing up in Honolulu, I never would've imagined that I would be here today - proudly wearing the uniform of a Public Health Service admiral, talking with you as the acting Surgeon General, and with my very own entry on Wikipedia.

But I'm here, in large part to the influence of my parents, and school teachers, and community leaders who took an interest in my success.

Many people who didn't need to care - did care. And that made all the difference.

Again, thank you for your time. Thank you for your work. And thank you for your commitment to improving the lives of our Native Hawaiian Pacific Islander communities.

Mahalo

1 http://www.ndep.nih.gov/diabetes/pubs/FS_AsAm_Eng.pdf
2 http://www.nativehawaiianhealth.net/moku/stateWide.cfm
3 http://www.omhrc.gov/templates/browse.aspx?lvl=2&lvlID=34
4 http://www.nativehawaiianhealth.net/moku/stateWide.cfm
5 http://www.nativehawaiianhealth.net/moku/stateWide.cfm
6 http://mentalhealth.samhsa.gov/cre/fact2.asp

Last revised: March 13, 2008