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REMARKS BY:	DONNA E. SHALALA, SECRETARY OF HEALTH AND HUMAN SERVICES
PLACE:		Promoting Women's Health Across Generations Conference, Jerusalem, Israel
DATE:		DECEMBER 2, 1998

This is not the first time that the thoughts and dreams of my country - and the thoughts and dreams your country - have been woven together like the four wicksof the Havdalah candle.

Israel and the United States are both inscribed in the Book of Life as sanctuaries for the persecuted and defenders of religious freedom. That inscription will never be erased, and the ties that bind us together will never be broken.

Yet, in times like these, when the shadow of war grows and recedes - and may grow again - our bond of friendship takes on special meaning.

We have learned over the years, that while all of us must be vigilant to protect our borders from without - as women we must be equally vigilant to protect ourselves from within.

Our bodies. Our minds. Our spirits. Our futures.

Prime Minister Golda Meir once said, "Old age is like a plane flying through a storm. Once you're aboard, there's nothing you can do." I'm not about to start an argument with a truly great Jewish sage, and I can almost hear Prime Minister Meir saying to me, as I know she said to others, "Don't be humble, you're not that great."

Still, I will add a coda to the Prime Minister's view of old age.

There's a lot we can do to make sure we reach old age - and once "on board," to have a comfortable, long and healthy flight. Our goal should be to protect women's health from the first day of life until the last. This is morally right. We are all daughters of Sarah and Miriam - strong, smart and equal partners in God's plan.

But there are practical reasons too.

At the start of the 20th century, the average woman did not live much beyond her childbearing years. As we approach the 21st century, the average woman is living well beyond her daughter's childbearing years. So women are being exposed to more chronic diseases and disabilities. Heart disease and lung cancer among women are on the rise. Osteoporosis is crippling thousands of older women - and as we live longer, the problem is expected to get worse.

Maimonides once said that the goal of good health is to find wisdom. For American women, the goal has been to acquire the wisdom needed to find good health. The Clinton Administration is doing that with courage and pragmatism. And we're getting results. In the United States, our budget for women's health has grown over $1 billion dollars in four years.

We have a 93 percent breast cancer survival rate when the disease is detected early. Mammograms are free for low-income women - and women 65 and older.

We now have an office of women's health inside every major health agency.

We have women's health centers in our major universities.

We have a network of advocacy organizations.

We have a generation of scholars - many of whom have come here for this meeting.

Today I want to tell you where all this progress came from. Let me start with this story from the Talmud. A rabbi saw a widow that he knew lived far away. He asked her: "Is there no synagogue nearer your home?" She answered, "Yes, rabbi, but the more trouble I take, the greater my reward will be."

That is how we made women's health a battle that our national leaders - from both political parties - could not ignore. That doctors could not ignore. That health insurance companies could not ignore. That the media could not ignore.

Heroic women, and men too, fought this battle by lifting their voices and digging in their heels. But, I didn't come to Israel just to tell you to work hard and make your voices heard. You already do that. I've come bearing a package of ten.

Not ten commandments. But ten lessons from our experience putting women's health on the national agenda - and keeping it there. To come up with these ten lessons, I reached back into the annals of Jewish humor, wisdom, and common sense for help.

Lesson One: Remember the past.

The Talmud says, every woman has a mind of her own. But historically, women's health focused on women's reproductive anatomy - and not much else. You can't have a national policy of keeping women healthy throughout their lives when women - and their doctors and nurses - believe that the childbearing years are the only ones that count.

Fortunately, that perception has changed. The change began with a rebellion against women's clothing in the last century. Under the banner of the Popular Reform Movement, the cry heard throughout the land was: "Cast off your corsets!" These crazy contraptions were not only uncomfortable, they were unhealthy.

In the 1960s and 1970s, feminism empowered women to demand more choices -and better information about their health - throughout their lives. A group of women in Boston published a book called, Our Bodies, Our Selves. This revolutionary women's health manual - which has been translated into both Hebrew and Arabic - answered many questions about women's health that doctors couldn't answer - or worse, wouldn't answer.

In the 1980s, women's health moved from outside the barricades to inside the halls of medicine. We experienced large increases in the number of women entering medical school, clinical research, bench science and teaching. At the same time, there was a renewed interest in the importance of maternal health.

Fast forward to the 1990s.

With more women in power - not only in health care but also in the courts, Congress, business and government - the definition of woman's health expanded dramatically. And with that expanded definition, came an expanded agenda. New research. New clinical trials. New screening programs for heart disease, cervical cancer and bone loss. This was a remarkable history. The question became, what do we do with it?

Some would have been content to say: Frame it. Hang it on a wall. And turn out the lights - our work is finished. But not this generation of leaders in the United States. We decided that all that was accomplished was nothing more than a great floor on which to build something better.

Which brings me to Lesson Two: Women must see their whole selves The Baal Shem Tov said, "If the vision of a beautiful woman comes suddenly to mind let a man say to himself: Why be attracted to any part. Better to be drawn to the All."

Exactly. But not just men. Women too.

We wanted women to understand that every attribute of their lives is an attribute of their health. So we opened the door of what it means to be a healthy woman wider than it had ever been opened before. How?

First, by carrying out the Women's Health Initiative at the NIH - the largest clinical trial in history. Second, by looking at women's health as a seamless change of seasons across a lifetime - with no season more or less important than any other. Third, by making prevention a centerpiece of our strategy. And fourth, by declaring that violence against women is a public health problem that is both unacceptable - and preventable.

Just last month, our Centers for Disease Control and Prevention found that 18 percent of women report being the victims of rape or attempted rape in their lifetimes. Numbers like these cry out for a better answer than, `It's is a police problem. Let them deal with it.'

That's why Attorney General Janet Reno and I chair a National Advisory Council on Violence Against Women, and why both my Department and the Justice Department administer the Violence Against Women Act. Justice enforces tough new programs to prosecute

offenders, while we fund shelters, community programs, and research to prevent violence. Even when women see themselves as whole, they still need a way to make their voices heard.

That's Lesson Three: Build an army from the ground up.

A great rabbinic sage said, "Do not mistake talk for action."

The point of this lesson is simple: mobilize, mobilize, mobilize. Israel has a long history of incorporating women into the IDF. In fact your general of the Women's Corps is here. But there is no standing army for women's health. We had to build one, and you will too. That means organizing networks of women's health advocates all over the country.

We started small, with community based organizations. These groups met in living rooms, schools, and houses of worship. They recruited new members, marched, petitioned, and carried their message to local politicians. Eventually they formed the National Women's Health Network - a national organization whose voice today is heard in the halls of Congress and state legislatures.

Other armies were built - many to fight for particular issues. HIV/AIDS created a movement for better therapies, protection against discrimination, and health insurance coverage. Our National Action Plan on Breast Cancer - which I'll mention again shortly - came about in part because 2.6 million women - organized by the National Breast Cancer Coalition - signed a petition drive.

Today, new armies are focusing on making sure women have access to care - and that the care they receive is of the highest quality. Building an army is hard enough. Making sure it marches to victory is even more difficult.

Which brings me to Lesson Four: Pick the right battles and stay focused.

There's a Yiddish proverb that goes: To learn the whole Talmud is a great accomplishment; to learn one good virtue is even greater. Similarly, there is virtue in not trying to do too much at once. Stay on message - as we like to say in American politics.

In the United States, one message was breast cancer. In 1993, working with the National Breast Cancer Coalition and other organizations, we started the National Action Plan on Breast Cancer. At the same time we doubled discretionary spending for breast cancer research, prevention and treatment. The result of years of previous effort and this action plan is, breast cancer mortality is down - and the number of women getting mammograms is up by one-third.

The battle over breast cancer was just one part of a larger battle over research. Because women had often been excluded from clinical trials - we didn't know if the data we were getting applied to women. We didn't know if particular diseases strike women and men differently. We were doing science - but we couldn't say with confidence that it was good science for women.

So we picked this battle. We picked it. We fought it. And we won it. Now, there will never again be federally funded research - about diseases that strike women - which do not include women.

The victory for better research came in part because of Lesson Five: Find a few good friends.

Ecclesiastes says, "Woe to him that is alone when he falls."

Disease pays no attention to political affiliation. So we made women's health bipartisan - and went looking for good friends wherever we could find them. We looked first to Congress, where a handful of powerful voices - Democrat and Republican, male and female - agreed to lead the charge. Then we looked beyond Washington to state legislative bodies, the media, research institutions, the military and the clergy.

We didn't need to bring everyone on board - just a few people with clout. The newspaper editor who is willing to focus on women's health. The leading scientist who decides how research money will be allocated. The nurse or health care worker who interviews patients. The general who knows that the armed forces cannot function without healthy women. The rabbi, priest or minister who gives sermons about protecting women's lives.

Although women's health is bipartisan, in robust democracies like the United States and Israel - good health for women makes good politics. In our recent Senate race in New York, each candidate happily boasted that he had done the most for women's health.On the other hand, women's health transcends politics. So the message is: Women's health can win votes at the same time it is winning a new chance at life for our sisters, mothers and daughters.

On to Lesson Six: There's a woman's health angle for almost every issue.

This lesson boils down to one piece of advice: Make your issue their issue, or as an old Yiddish saying puts it: If you want people to think you're wise, agree with them.

When someone asks me: "Secretary Shalala, aren't issues like Social Security; the economy; and national security more important than women's health?" I always answer: "These issues are women's health." By broadening the definition of women's health, you can actually recruit allies who might otherwise think that women's health has nothing to do with them.

There's another side to this coin. If you're working on issues that are not specifically about women's health - look for ways to build in a women's health component. For example, our Administration is committed to closing racial and ethnic health disparities in six major areas by 2010. But this is not just about minorities. It's about saving women's lives. African American women face greater exposure to HIV/AIDS. They have higher cancer rates, and a lower life expectancy than white women.

The fact is, every social or economic problem has a woman's component. How we solve these problems is answered in part by Lesson Seven: Weave your way around the opposition.

There is a Midrash that says, "Even an angel cannot do two things at the same time."

If an angel can't, what hope is there for the rest of us - especially when opponents who are - let's face it - less than angels stand in the way? So we've learned that when it comes to women's health - go for what's attainable and build new successes on the foundation of old ones. That almost always means anticipating opposition and being ready to - deal it in, cut it off, or wait it out.

Our Administration believes that all women need information about reproductive health - including HIV and sexually transmitted diseases. We also believe that women are entitled to the full range of reproductive rights - including abortions, but that abortions should be safe, legal and rare. Many people believe that this is not the responsibility of government. We disagree, but we know this is a battle that cannot be won overnight. So we're focusing on different, but related, victories - and building partnerships to achieve them. For example, we're partnering with men's organizations - to teach young men to share in the responsibility for preventing unintended pregnancies. The same goes for getting birth control covered by insurance. For some reason insurance companies - which are still run mostly by men - are willing to cover the cost of Viagra, the impotency drug. But they won't cover the cost of birth control devices or pills. In other words, making sure men can have sex is considered a matter of public health. But helping women plan their pregnancies is not. We're weaving our way around this obstacle by requiring all federal employee health plans to cover prescription contraceptives if they cover other prescription drugs.

Tobacco is another area where there is strong opposition to protecting public health - and where women's health is particularly at risk.

So we focused on protecting children - with tough regulations designed to keep kids from ever lighting up. The tobacco companies are still fighting us. But even they say - at least publicly - that they don't want children to smoke. Our fight now is to make their actions fit their words.

On to Lesson Eight: Think global, adapt local.

There's a saying: Nine rabbis cannot make a quorum, but ten shoemakers can.

This saying is not about the power of shoemakers. It's about the power of numbers. We draw strength from our sisters around the world.

In 1994 we met in Cairo and reminded the world that the health of families, communities and nations all depend on the health of women. A year later we went to Beijing where Mrs. Clinton told the world that women's rights are human rights. At one point in Beijing, we literally had to push through a line of Chinese guards that tried to keep us out of an auditorium where Mrs. Clinton was speaking. The message to those guards - and the world - was: There will be no turning back. There will be no unlinking of arms. There will be no rest until victory.

We brought that spirit back to our own country and laid it at the feet of advocates for women's health in communities large and small. We said take this spirit. Adapt it to your needs. Adapt it to your cultures. Adapt it to your cause. Then your cause will be your sister's cause too.

That is Lesson Nine: Support everyday heroines.

For this lesson, I chose a wonderful observation from the Talmud. It says, "A woman of sixty runs after music like a girl of six."

This could be a statement about music. But I prefer to think of it as a statement about women - the lengths to which we're willing to go to achieve something of value. There's no greater value than saving the lives of women. That means those of us in government and the health professions must listen to the voices of ordinary women.

In the 1970s, women protested on the steps of our Capitol building demanding hearings on the safety of the Pill. Today, we have a National Women's Information Center. Women contact it by phone and over the Internet. The number one topic we're hearing about today is not reproductive health or heart disease. It's not cancer. It's not bone disease. It's menopause - which is linked to heart disease, cancer and bone disease. Women want to know what therapies work. And what are their risks. We don't know all the answers. But we're going to get them.

Now you're nine-tenths of the way toward institutionalizing women's health. But remember Lesson Ten: Timing is everything.

There's no resisting the words of Ecclesiastes again: "To everything there is a season, and a time to every purpose under heaven."

One of the reasons the United States has been successful in institutionalizing women's health - maybe the biggest reason - is that women seized the moment. In the 1970s, the Pill and Roe v. Wade, the case legalizing abortion, gave women their reproductive freedom - and the determination to never lose it. The next decade brought a boom in the health industry - better medications, better diagnostics, and more opportunities for women to enter the health professions.

Today we have cutting edge biomedical research; and a President who put women into positions of leadership in science and health - including his most recent appointment of the first woman to head the Food and Drug Administration. These changes brought opportunities to improve the lives and health of women. We didn't let a single one slip by.

Israel is a nation steeped in history and memory. You understand - perhaps better than anyone - what can be built when heroes say, "The time is now." Heroes like each of you.

Which brings me full circle.

Lesson one was, remember the past. But we must all Build for the future.

The Talmud says, "When you teach your son, you teach your son's son."

I don't believe I'm distorting the meaning of this beautiful text when I say, it's also true that when we teach our daughters, we teach our daughter's daughter. So part of building the future is focusing on prevention and healthy habits.

That's why we started our Girl Power! campaign - to help girls 9 to 14 make healthy choices about their future. We have many Girl Power! partners. Marlene Post of Hadassah is one of them.

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 I'm willing to go anywhere - and talk to anyone - who has the power to reach our daughters. I've met with soap opera producers and talk show hosts about using their programs to get out good public health messages.

We teamed up with the great singing group Boyz II Men on an anti-smoking PSA aimed at young people, and with the U.S. Women's National Soccer Team to teach young women to "smoke" their opponents - not tobacco. We even have a partnership with the Women's National Basketball Association. So use soaps and talk shows. Use movies. Use magazines. Use MTV. Use the Internet. Make them all your allies in the fight to protect Israeli girls and young women.

Building for the future also means building for the nations we are becoming. Both the United States and Israel have large immigrant populations. Our faces are changing. Our cultures are mixing. And, in the United States, our population is getting older. We have to be ready for these changes with a blueprint for women's health that matches who we are - and who we will become. Both our nations will struggle to find that blueprint. But perhaps the place to begin is with the words of another Jewish Sage, Ben Hei Hei, who said:

We are here to do, and through doing to learn;

And through learning to know;

And through knowing to experience wonder;

And through wonder to obtain wisdom;

And through wisdom to find simplicity;

And through simplicity to give attention;

And through attention - to see what needs to be done.

For women's health, it is time, again, to see - and do - what needs to be done.

Thank you.