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REMARKS BY:	DONNA E. SHALALA, SECRETARY  OF HEALTH AND HUMAN SERVICES
PLACE:		Native American Health and Welfare Conference, Tucson, Arizona    
DATE:		OCTOBER 23, 1998

It's no coincidence that the co-sponsors of this conference bear names we associate with integrity, compassion and wisdom - Henry J. Kaiser and Morris Udall, and -- at least in Mo Udall's case - a legendary wit.

Mo Udall has been described as our generation's Will Rogers. Funny, warm-hearted, generous. He never met a man or woman he didn't like - or who didn't like him. Mo always took his work on behalf of people and the environment seriously.but never took himself seriously. He stood tall in Washington - and wasn't afraid to think big.

One day, he stepped off a plane in Alaska, took one look at the beautiful, snow-capped mountain ranges, and proclaimed, "I want it all!" What he meant, of course, was that he wanted to protect the spectacular scenery of Alaska so that all Americans could enjoy its beauty forever.

I'm sure if Mo were to look out over the landscape of America's health today, he would see another spectacular scene; a scene in which a golden age of science is giving us longer and healthier lives. Most of us - but not all of us.

Simply put: Racial and ethnic minorities, by and large, lag behind the rest of America in good health. This is unacceptable. It must not stand.

For Native Americans, the disparities in health are all too familiar. Infant mortality. Cardiovascular disease and diabetes. Alcoholism and suicide -- all continue to plague Native Americans, on and off the reservation.

That's why this conference is so important. We must come together to map out where we must go - and what we must do -- to help build a brighter future for Native American families and children. And we must fulfill the Federal government's solemn obligation to maintain our unique relationship with Native American leadership.

So with Mo Udall's help, I'd like to offer up four common-sense guidelines - Mo's guidelines -- for what the Federal government has done - and must do - as partners in a common future.

The first of Mo's guidelines comes from a story he once related about a congressman who stood up in the House floor to argue for a controversial piece of legislation. Afterwards, an admirer walked up and said, "That was a great speech. Every thinking member of Congress will be voting for your bill." "That's not enough," the Congressman replied, "I need a majority."

Too often in the past, when it came to our country's First Americans, Washington wasn't driven by a majority of thinking members. We all know the relationship between Native Americans and the Federal Government has been long on promises made, and short on promises kept. Too often, the government's answer to sky-high rates of poverty among Native Americans was - "It's an Indian Problem." Too often, the government's answer to the alarming rate of diabetes among Native Americans was - "It's an Indian Problem." Too often, the government's answer to the high rates of alcoholism and suicide in Native American communities was - "It's an Indian Problem."

From day one, President Clinton said, it's not an "Indian problem." It's an American problem when any American is left out in the cold. And he has committed his Administration to bringing all Americans into the fold.

He knew that "business as usual" is not the way for the Federal Government to do business with this nation's First Americans. He knew that the winds of change had come. Change that has meant less centralized government and more opportunities for states, communities and reservations to shape their own destiny. Change that demands more effective use of resources and more accountability. Change that puts the spotlight where it belongs - on the health of racial and ethnic populations.

That's exactly what we're doing.

First, by protecting and strengthening the bridges of understanding and cooperation with Native American sovereign nations. One of the President's first official acts was to direct all Federal departments and agencies to bring tribal governments to the table on matters that directly affect their people. That means more opportunity for Tribal governments to help shape and strengthen our plans.

My Department took the President's charge to heart. I recruited the brightest and most dedicated leaders to lead our efforts. Many of them are now familiar names on reservations across the country. Names like Dr. Phil Lee and Dr. Jo Ivey Boufford. Our current director of the Office of Minority Health, Dr. Clay Simpson, Jr. Bea Bowman, my direct link to Tribal governments. And, of course, our Director of the Indian Health Service, Dr. Michael Trujillo.

In the last several years, my Deputy Secretary, Kevin Thurm, and our nation's great new Surgeon General, Dr. David Satcher, have also taken up the mantle.

With help and insight from these colleagues, I issued a new Tribal Consultation and Participation Policy - the first of any Federal department. This policy directs each agency - from NIH to FDA to CDC and others -- to create its own plan to embrace and engage tribal representation and improve all HHS activities that affect tribes.

Let me be clear: I'm not talking about circulating a memo to a few division directors or adding a program or two. I'm talking about a revolution - a new process of tribal consultation that builds on what is already a long tradition of consultation with the Indian Health Service. I'm talking about a process of tribal consultation that is a routine part of the way HHS does business every day.

Of course, if there's one thing my colleagues have taught me, it's that real change - the kind of change the President and I have wanted from the start - won't come without making sure the consultation is meaningful and valuable. Change will only come by talking with Native Americans, working with Native Americans, and most important, listening to Native Americans.

Which leads me right back to Mo Udall. Mo once said, "Where you stand depends on where you sit."

If we give that phrase a little twist, Mo's guideline number two is simple: You can't stand up for Native Americans unless you're sitting down with them.

We know that there is no one Native American voice. American Indian Tribes and Alaska Native villages have very different traditional cultures, with very different perspectives, with very different priorities.

That's why from the start, our leadership have traveled around the country to meet with Native American leaders on their home turf. And I assigned my right-hand man, Kevin Thurm, to lead these efforts.

Just last week, he hosted the first of four listening councils right down Interstate 10 in Phoenix. The next three councils are set for Bismark, Oklahoma City, and Seattle.

In Phoenix, diabetes and pneumonia topped the list of health concerns. In Bismark, those concerns may center on disease related to soaring tobacco use, particularly among women.

But one common refrain from the listening council last week was this: "Listen and learn. But go back and do."

Which brings me to my third point - and another story Mo Udall used to tell:

A Senator was touring a Native American reservation. To start things off, the Senator made a fine speech full of rosy promises of better things. "We shall see," he said, "a new era of opportunity." To this, the audience gave a ringing cry of "Hoya, hoya!" Encouraged by the cheer, the Senator continued, "We promise better schools and better hospitals!" "Hoya, hoya!" the audience cried once again. Beaming with pride, the senator ended his fine speech by saying, "Trust us. We have only your best interest at heart." The air shook with a long, mighty "Hoya, hoya!"

Greatly pleased by the reception, the senator then began making his tour of the reservation. When he asked if he could inspect the reservation's cattle, his guide answered, "Certainly, come this way.but be careful not to step in the hoya."

Mo Udall certainly had a "no-hoya approach" to his responsibilities in Washington. Which is exactly how I operate. No Hoya. No empty promises. Just get the job done.

That's why, over the last six years, we have worked hard to translate the health concerns of Native Americans into quick action. We elevated and strengthened the structure of Indian health programs throughout the Department - from our Administration on Children and Families to our Administration on Aging.

We continue to find new ways - better ways - to empower Native Americans and provide health and hope to children and families. That means improving the health status of Native American women by focusing on their high rates of injuries, alcoholism, cervical cancer and diabetes. It means working to the brighten the twilight years for the most respected members of the Native American communities -- the elders -- by focusing on improving the quality of elder health care services.

And it means working to build a better future for Native American boys and girls. Making sure that more children who are living without health insurance get the coverage they need. And taking a closer look at critical problems like substance abuse, mental health, teen suicide, and violence in the home and at school.

With the Balanced Budget Act last year - and in partnership with tribes and Urban Indian Health Centers -- we are waging five-year, 150 million dollar battle against diabetes which strikes at the heart of so many Native American communities.

Expanded diabetes prevention and treatment services are now underway at the community level. And earlier testing and intervention efforts are now being aimed at the people in those communities overwhelmed by this devastating disease.

But one of the most important things we've done is to stop looking at looking at disparities among Native Americans as "Native American problems" and start looking at them as "American problems."

That's exactly why we launched our Racial and Ethnic Health Initiative - targeting six key health disparities - infant mortality, diabetes, cancer screening and management, heart disease, AIDS/HIV, and immunizations.

We have signaled an end to separate - and lower - national health goals for minorities in these areas and made a commitment to health equality for all. Our goal is not to "address" the health disparities or to "reduce" the disparities. We've made a commitment to eliminate the health disparities. Because we know - as you do - that eliminating these health disparities will ultimately mean better health for all Americans.

These important efforts are something to take pride in. But you know from conference discussions earlier, today, we have a long way to go. The challenges we face ahead will undoubtedly require collaboration, creativity and unfailing dedication.

Which brings me to my final observation by Mo Udall - one undoubtedly originated in a committee meeting in Congress. "If you can find something everyone agrees on," Mo once said, "it's wrong."

But let me say, it's also true that if you can find something everyone works together on, it will be right.

Helping Native Americans enjoy the promise of health and hope is certainly right and just. Not only for Native Americans, their children, and their families. But also for all Americans.

It will require strong partnerships -- Federal, State, and Tribal -- public and private. Working together, I know we can create a spectacular landscape for the entire world to see: the improved health of all Americans -- no matter who they are or where they live.

As Mo Udall might say, when it comes the health and well-being of the country's First Americans, we not only can have it all. We must have it all.

Thank you.