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REMARKS BY:	DONNA E. SHALALA, SECRETARY OF HEALTH AND HUMAN SERVICES
PLACE:		Italian Medical Conference - Women's Health in the 3rd Millennium, New York, N.Y. 
DATE:		November 15, 2000

It is a great pleasure for me to join so many of my Italian colleagues for this Women's Health in the Third Millenium conference. This international conference will likely be my last as Secretary. And the occasion could not be more fitting. The subject is women's health. The country and culture is Italy. The spirit behind this conference is Matilda Cuomo - whom I have known and admired for many years. And the place is New York - where millions immigrants from Italy brought their genius and energy to help build our nation and assure its prosperity.

Almost every American dreams of visiting Italy. And who can blame them? But today, what makes me most proud is that so many leading researchers and health professionals from Italy are visiting the United States to talk about women's health.

Shakespeare once suggested that his nation, `limps after in base imitation fashions in proud Italy.' In other words, in Shakespeare's time Italy was an international trendsetter that left the rest of the world trying to catch up. That is still true today. Not just in the women's fashions, but much more important - in how we fashion a seamless system of health care for women in Italy, the United States and around the world.

Building that system has been a goal of the Clinton Administration for the last eight years. Building that system is a goal of this conference. And building that system is a goal that is within our reach - even if it is not yet in our grasp.

Perhaps the most famous words ever spoken by the great Italian astronomer Galileo were, "But it does move." He was referring, of course, to the earth moving around the sun. But his larger point was that not all movement is readily visible. Sometimes you have to take a closer look. That has certainly been true of women's health in the United States. Observe where we were eight years ago - and compare that to where we are today and you can come to only one conclusion: We are moving forward.

In the United States, our budget for women's health has grown by over 1 billion dollars in the last six years. Our breast cancer survival rate is over 90 percent when the disease is detected early. Mammograms are free for low-income women. We now have an office of women's health inside every major health agency. We have women's health centers in our major universities. And we have a network of advocacy organizations that support research and legislation important to women's health.

I am very proud of the progress we have made. Nevertheless, I am reminded of the movie The Agony and the Ecstasy about the painting of the Sistine Chapel. In the movie, Pope Julius II keeps demanding that Michelangelo tell him when the great fresco will be finished. Michelangelo's answer is always the same: It will be finished when it's finished.

In other words, half-measures, intermediate milestones, substantial progress - or even major accomplishments are not good enough. We can only be satisfied when our work is truly finished. And when it comes to women's health - the last brush stroke has still not been painted. Not in the United States. Not in Italy. Not anywhere.

That's why today I want to talk about what I consider the 5 most important health challenges facing women around the world.

The first challenge is particularly familiar to health professionals in Italy - how do we respond to the needs of an aging population, especially women.

According the World Health Organization, among European nations Italy has the smallest proportion of people 14 or younger, and is second only to Sweden in the number of people 65 and older. Furthermore, in 1996 a full 60 percent of Italy's older population were women. The reasons are not hard to find. Italy's birthrate is now the lowest in Europe - and is well below the replacement level of 2.1 children. On the other hand - like the United States - life expectancy in Italy is going up. In fact, in the brief ten-year period of 1983 to1993, life expectancy among Italian women increased by 2.3 years.

But this conference - and the life's work of many researchers in both of our countries - is not simply about demographics. It is about understanding how women age. It is about winning the battle against cancer, osteoporosis, heart disease, Alzheimer's and other diseases associated with growing older. And it is about making sure that leaders around the world never lose sight of the importance of helping women live longer and more productive lives.

Neither of our nations can achieve these goals along. That's why I'm proud of the long history of collaboration between Italy and the United States in the battle to improve women's health. For example, the U.S.-Italy Joint Health Committee meets regularly - and has made aging a top priority. Also, our National Heart Lung and Blood Institute has worked for over a decade with the Giovanni Lorenzini Foundation for Biomedical Research on women's health issues - in particular menopause.

In June 2001, these two leading research organizations will sponsor the 4th International Symposium on Women's Health and Menopause. The first three conferences focused on defining the problem, risk reduction strategies, and prevention. This fourth symposium will focus on what women can do to stay healthy - and will follow the publication next spring of a new report on women and menopause.

Today, the number one topic women want to know about is not reproductive health or heart disease. It's not cancer. It's not bone disease. It's menopause - which has been linked to heart disease, cancer and bone disease. Women want to know what therapies work - and what are their risks. That's why next year's symposium is so important. We must get women the answers they need.

At the same time - like the great Renaissance painters - we need the courage and vision to work on a large canvass. That means not narrowing our focus to any one problem associated with women and aging. Instead, we need to build communities that recognize and support all of the social, medical and emotional needs of women as they age.

I'm talking about giving younger women information that will help them make healthy choices that can stave off hypertension, stroke and osteoporosis later in life.

I'm talking about focusing much more attention on long term care - and on serving people where they live.

I'm talking about supporting working families with tax credits, respite care and better home health services - so they don't have to choose between taking care of their children and taking care of elderly loved ones.

And I'm talking about learning more about chronic diseases that associated with growing old. Not just Alzheimer's. But also Parkinson's, diabetes, joint diseases and depression.

Which brings me to my second challenge - strengthening our investments in women's health research.

This is not just about money. This is also about making sure that women are never again treated as second class citizens when it comes to biomedical research. In the United States, the days when drugs like aspirin were only tested on men are over. Today, there can be no federally funded research on diseases that affect women unless that research includes women. And in Phase III clinical trials, there must be an examination of the differences and similarities between men and women.

At the same time, we are learning invaluable information through the Woman's Health Initiative - the largest clinical trial in history. It will cover all of the major causes of death and disability in older women, including a major focus of this conference - breast cancer. Breast cancer is still the second leading cause of cancer death among women in the United States - and as life expectancy goes up, both here and in Italy, breast cancer rates will likely go up too. That's why we're working overtime to beat this disease - with powerful new treatments, better screening, and a new law President Clinton signed last month that will provide free breast cancer treatment for low-income women.

The third challenge we face in protecting the health of women is preventing the spread of infectious diseases.

AIDS is having a devastating impact around the world - and the western world is not immune. According to the World Health Organization, Italy has the third highest rate of AIDS in Western Europe. Ten years ago, many people in the United States thought of AIDS as a man's disease. Now we know better. In most of the world, HIV/AIDS is a woman's disease. In the United States, women are the fastest growing segment of the HIV/AIDS population. Our total budget request for this fiscal year is 9.2 billion dollars for HIV/AIDS - including 300 million dollars to fight HIV/AIDS abroad.

But our budget does not tell the whole story. We've also set a national goal of finding an AIDS vaccine by 2007. We're putting the health destiny of woman back where it belongs - in the hands of woman - by testing nearly 60 microbicides in pre-clinical and clinical trials. We're testing drugs like nevaripine that have been shown to be highly effective in preventing mother-to-child transmission - at a fraction of the cost of AZT. We're investing 100 million dollars - along with funds from the United Nations and other donor countries - in the International Partnership for AIDS in Africa. And we're proposing a ten-year, one billion dollar, tax credit for companies that develop vaccines for TB, malaria and other infectious diseases.

As you know, TB is a major threat to public health in both the United States and Italy - but not necessarily for the same reasons. In the U.S. the great upsurge in TB that started in the 1980s came from increased homelessness, overcrowding, a larger prison population and new strains of drug resistant TB. In Italy today, and in the United States, the rise in TB - and the threat posed by other emerging infectious diseases - is tied in large part to immigration. In fact, the vast majority of TB cases in Italy are immigrant children. But no matter what the source of the problem - this much we know: Women are at risk, and a solution must be found. That's why the United States is committed to the World Health Organization's STOP TB Initiative. That's why the United States is providing more than 20 million dollars this year to other governments and the World Health Organization to strengthen and expand their TB control programs. And that's why earlier this year, health ministers from around the world met in Amsterdam and called for accelerated world action against TB.

Which brings me to my fourth challenge - violence against women.

Stopping violence against women has been a top priority of President Clinton and our entire administration since day one. And our message has been unambiguous: We need a strong infrastructure of shelters and critical services. We need a truly seamless system of care that responds to all the needs of victims. We need better data. And we need to make sure that our fight against domestic violence is deeply rooted in the community. That means where women live, work, worship and go to school.

But today I want to emphasize that violence against women is an international problem that requires an international response. That's what we said in Cairo in 1994 - and in Beijing a year later where we called on all governments to condemn and punish violence against women, change cultural and social patterns that promote violence against women, train teachers, doctors, educators and law enforcement officers how to identify and treat domestic violence, and fight all forms of discriminations against women. Five years after the Beijing conference, women from around the world came here to New York to celebrate the progress we've made. But in the midst of our celebration, we recognized - and put in writing for all the world to see - this statement: "Violence against women and girls is a major obstacle to the achievement of the objectives of gender equality, development and peace."

So the battle has certainly not been won. That means women and men - from New York to Naples and beyond - must work tirelessly to end the exploitation and protect the dignity of all women.

My fifth and last challenge is to build a healthy future for our daughters.

The great Italian conductor, Arturo Toscanini once said, "I smoked my first cigarette and kissed my first woman on the same day. I have never had time for tobacco since." Perhaps the fact that Toscanini gave up smoking after only one cigarette explains why he lived to the ripe old age of 90. But while most young women in Toscanini's day would not dream of smoking, things are quite different today.

The fact is, too many young girls in both the United States and Italy are making choices that are going to shatter their dreams and shorten their lives. That means using tobacco, drugs and alcohol; eating a poor diet; and not getting enough exercise. We must - I repeat, must - help young girls avoid these risky behaviors. They are the future leaders of both Italy and the United States - and we need the skills, intelligence energy and promise of every one of them.

That's why we started our Girl Power! Campaign - to help girls 9 to 14 make healthy choices about their future. That's why I agreed to be photographed with a milk mustache - to encourage young girls to consume enough calcium to protect themselves from bone disease. That's why for eight years I've been willing to go anywhere - and talk to anyone - who has the power to reach our daughters.

I've spoken with talk show hosts and soap opera producers about using their programs to get out good public health messages. We've teamed up with the U.S. Women's National Soccer Team to teach young women to "smoke" their opponents - not tobacco. I believe in using movies. Using magazines. Using the Internet. Whatever tools we have to help young girls grow up healthy and strong - we need to put them to work.

Maria Montessori, whose ideas on education have been widely copied throughout the United States, once said, "We teachers can only help the work going on." In other words, children are filled with great potential and imagination - and all adults can do is help foster what is already going on inside the minds of young people. That, of course, is true. But my fifth challenge is about taking Montessori's wisdom one step further. All of us not only can help - we must help the work that is going on.

Today there is a young girl - she might be in Milan, she might be in Miami. But wherever she is - all of the cutting edge research on breast cancer, heart disease, and menopause being done here and in Italy, all of our hopes for a cure for Parkinson's, Alzheimer's and osteoporosis, all of our demands that violence against women stop forever, and all of our scientific collaborations like this great conference will not pay their full dividends if we don't make sure girls start life healthy and strong - and stay that way.

After all, that girl in Milan or Miami, and her millions of sisters around the world, will grow up in the third millenium that this conference is dedicated to.

So without their lives and future as part of this conference - our purpose is diminished.

But with them - our purpose is sacred.

Thank you.