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REMARKS BY:	DONNA E. SHALALA, SECRETARY OF HEALTH AND HUMAN SERVICES
PLACE:		University of Illinois School of Public Health, Chicago, Illinois
DATE:		May 7, 1999

Graduates. Family and friends. Alumni. Faculty and staff: I'm delighted to be here to share your joy, achievement - and relief in graduating from the University of Illinois School of Public Health.

I love Chicago. This is not only the City of Big Shoulders. It is the City of Big Ideas - and Big Contributions to Public Health. Since becoming Secretary of Health and Human Services, I've come to Chicago for a National Congress on Medicine and Public Health; for the opening of a new AIDS center at Cook County Hospital; for a national tobacco control conference; and to visit a model child care center with the Mayor.

But nothing pleases me more than to come to Chicago to witness your ascendance to public health leadership. If public health was the Sears Tower - you'd be on top of it.

You could have made another choice. We're experiencing one of the strongest economies in memory. Opportunity isn't just knocking - it's beating down the door. With your intelligence and creativity, no brass ring was beyond your reach. But instead of looking out for yourselves - you've decided to look out for others.

The value - the moral courage - of that choice will probably never win you a table in the private dinning room at Michael Jordan's Restaurant. Or a seat in the Cubs dugout next to Sammy Sosa. Or a guest spot on Saturday Night Live to praise "da Bears." But you have won a place in the hearts of countless people whose lives will be longer and healthier because of the path you now walk.

So congratulations and take a look around: You are the real Chicago Hope.

While you're looking - take a moment to thank all the people who made this day possible. Theirs are the truly big shoulders. And you're standing on them. I'm talking about your families. Your friends. Your teachers. And the taxpayers of Illinois who help support this great public institution.

Since you will soon leave the relative comfort of academic life, I thought I'd take a minute to offer you some guidance on starting your career. So with inspiration from David Letterman, I offer you Donna Shalala's top ten list of things UIC School of Public Health grads SHOULD write on their resumes to prove they're serious about working in public health.

Number 10. My idea of a hot date is 3 hours of uninterrupted regression analysis.

Number 9. I named my dog MMWR.

Number 8. I wrote Death of a Salesman II where Willie Loman doesn't die; he just becomes statistically insignificant.

Number 7. In Shakespeare in Love, I shouted at the screen: "Romeo! You can wear tights and still be abstinent!"

Number 6. The letters C-D-C on my transcript: Those aren't my grades; I just want to work there.

Number 5. I went on Jerry Springer for a show called: Viruses and the UIC Grads Who Stalk Them.

Number 4. I started my own public health chat room: WWW.SAY-AHHH.COM

Number 3. I thought Baywatch was a show about cleaning up Lake Michigan.

Number 2. For the Final Jeopardy clue: "Profession people are clueless to explain," I wrote, "What is an epidemiologist?"

And the Number 1 thing each of you should be writing down on your resumes: "I received the best public health education in the world right here at UIC!"

I remember my own graduation very well. The sheer joy. The anxiety. The fear that our commencement speaker would never stop talking. Salvador Dali gave the shortest speech of all time when he stood and said, "I will be so brief, I'm already finished." I won't be quite that short because I want to talk today about what we must do together to meet the challenges of a changing public health system.

Three weeks ago, the new face of public health was drawn in stark relief in Littleton, Colorado. We've seen the terrible pictures. We've heard the plaintive cries of "Why?" If "Why" is a spiritual question - only God has the answer. But if "Why" is a public health question - it's up to us to find the answer.

Violence is now the second leading cause of death among young people 10 to 24. But we are not helpless to stop it. I repeat: We are not helpless.

On Monday, President Clinton will hold an important roundtable discussion on adolescent violence. Although we have much to learn, we know that this public health crisis responds to public health interventions. We know that from research on violence prevention at the CDC. We know that from school-based programs like "Building Your Life" here at UIC - where you are helping adolescents build self-esteem, control anger, and resist risky behavior. And we know that from our own experience talking to - and working with - young people.

The fact is: There is nothing inevitable about two boys walking into a school - armed to the teeth - and killing 12 classmates and a teacher. But we need to watch for warning signs - such as rage and depression; unusual attention to violent images in movies and the Internet; lack of empathy - and easy access to guns.

My point is this: From extensive research, we know what to look for. And we know that tragedies like Littleton - as well as other public health crises - can be prevented. Not by you alone. But certainly not without you.

You have already demonstrated your unique skills by working in clinics, shelters, hospitals and homes throughout the Chicago area. After today some of you will stay in Chicago. And some will return to places you lived before coming to UIC - including other countries. But wherever fate, ambition and opportunity lead you - your expertise and humanity are needed as never before.

Here are just a few of the problems we must solve together.

How do we get the message to young people that life really is beautiful? How do we keep infectious diseases from devastating whole populations? How do we eliminate the gaps in health outcomes that still plague minority communities?

I want to be clear: I don't have all the answers. But I do have ten broad principles that can guide us as we look forward to a new century of unprecedented good health and long life.

First. Public health must join the communications revolution

. A couple of years ago I gave a speech to the first joint meeting of the AMA and APHA. I told these two groups that they had to stop viewing themselves as two trains running down parallel tracks. I emphasized that our goal must be to build a seamless system that gives equal weight to medicine and public health. To do that, we need to improve our health information infrastructure so that it leads to well informed decisions by all health care professionals. This infrastructure should include national standards - as well as strong privacy and security protections.

A smart public health strategy also demands modern communication tools - especially when the audience is young. I've never known a single teenager whose behavior was changed by a public health brochure. The way to reach young people is through the Internet, music, sports and peer groups.

Second. We must focus like a laser on prevention.

When I became Secretary of Health and Human Services - I can't tell you how many people told me that any attempt to increase vaccination rates was doomed to fail. But the President and I refused to accept this verdict. Instead, we came up with an immunization plan - and leadership, money and partnerships with cities like Chicago - and companies like McDonalds - to make it work. Today, immunization rates in the United States are at an all time high - and the infant mortality is at an all time low.

We're also promoting health and preventing disease among young people through our new Children's Health Insurance Program. We call it "CHIP." CHIP is for the children of working families who cannot afford health care. My message to you about CHIP is simple: You'll soon be working in clinics, schools and communities. Use those opportunities to help us find CHIP-eligible children and enroll them.

Let me add that our victories on behalf of children have not slowed our march toward the graying of America.

We're living longer and - dying more frequently - from chronic diseases rooted in personal behavior. That's why from flu vaccines, to keeping up the fight against tobacco, to encouraging a healthy diet and physical activity, we must teach life-long prevention.

Third. We must make sure that research not only survives, but thrives.

I believe HHS has the strongest science and public health team ever assembled. But hiring the most brilliant leaders in science and public health is not enough. We must make sure that our research institutions are supported by stable funding - and watched over by tough management. The Administration has already agreed to increase the budget of the National Institutes of Health by 50 percent over 5 years, and next we're asking for a 7-percent increase for the CDC - and a 21-percent increase for the Agency for Health Care Policy and Research.

When it comes to science, we must cast our net far and wide - making sure it pulls in research on behavior, the environment, health outcomes, service delivery and clinical trials targeted to whole populations. These areas - which you are so familiar with - must not be shortchanged!

At the same time, in a health care world that emphasizes prevention from infancy to old age - every citizen must be literate in science and health. That means the ability to understand great scientific breakthroughs; the urgency of investing in health; and the critical link between good medicine and good public health.

Fourth. We must eliminate the shame of health disparities.

Last month the CDC, the National Cancer Institute and the American Cancer Society reported that the overall death rate from cancer is falling. The same report noted that African Americans have the highest rates of lung cancer, prostate cancer and colon cancer. Similarly, AIDS recently fell out of the top ten killers of Americans. But it remains the leading cause of death among African American men 25-44 - and the second leading cause among African American women in the same age group. Go right down the list of major killers - and the story is the same. African Americans, Hispanics, Native Americans, Asian Americans, Pacific Islanders almost always have worse health outcomes than whites.

We have been - and we remain - two nations: One majority, one minority - separated by the quality of our health care. That must change. And that is why the President has called for the elimination of health disparities in six critical areas by 2010 - a goal that will lead to better health outcomes for all Americans.

Fifth. We must train tomorrow's workforce today.

Here, I expect, I'm preaching to the choir.

In some health fields we have an excess of qualified professionals. But in others - particularly primary care and public health - we face a real shortage. We need more investigators trained to pick up the trail of infectious diseases and limit their spread. We need more disease prevention specialists. We need more experts in the unique health care problems of the inner city, rural communities and tribal lands. And we need more health care professionals with the skills and sensitivity necessary to care for the coming Senior Boom.

Which brings me to my sixth principle. We need to protect the treasure of our academic health centers.

Our academic health centers are the envy of the world - and the places we will train the next generation of researchers, doctors and public health professionals. They are also where citizens least able to care for themselves go for health care. So the mandate of academic health centers is unique. As a country we must address the complex - and potentially devastating - financial pressures that these centers are currently under. Let me be blunt: If we lose our academic health centers, we won't just be cutting costs, we'll be cutting our best chance for a healthier America. I'm not talking about walling off academic health centers from the revolution in managed care. But I am talking about preserving the irreplaceable role these institutions play in training, treatment and clinical research.

On to my seventh principle. All of us need to look beyond our professional backyards.

This principle goes back to my original point about the importance of medicine and public health working together. Here's an example - one that is all too relevant today: Several years ago a trauma resident at Cook County Hospital named John May was desperately trying to save young men from gunshot wounds. He noticed that in and around the hospital there were numerous public health messages about heart disease, diet and cancer, but nothing about violence.

So he started a campaign to teach other doctors how to prevent violence. That campaign has now reached communities across America. One doctor, looking beyond the borders of his training, saw a public health gap and made a commitment to close it. That's what we must all do.

Eighth. Our bioethics must be as sophisticated as our science

. Our revolutions in health care raise serious ethical questions. We must never create a world in which our genetic map is used to deny jobs or health insurance. We must never create a world where medical breakthroughs simply widen the gap between the haves and have-nots. And above all: We must never create a world where our science gets ahead of our ethics, or eclipses our fundamental sense of humanity, fairness and values. When the practice of public health is decoupled from the ethics of public health, anything can happen - and in 1932 in Tuskegee, Alabama it did. In Tuskegee, the U.S. Public Health Service allowed 399 African American men with syphilis to go untreated. President Clinton has formally apologized, on behalf of our nation, for this shameful history. Still, we must never unlearn the lessons of Tuskegee.

On to my ninth principle: We must help the rest of the world build a public health infrastructure.

Infectious diseases do not recognize borders. A sick child in the Chinese heartland can quickly lead to a sick child in the American heartland. So it's in the interest of our country to have a strong public health system in every other country. Let me just tell you a few startling facts:

There are already 5 million HIV cases in India. By 2010, 40 million children in the developing world will be orphans. Think about that: Forty million children without love, guidance or hope. Fifty percent of HIV related mortality in the developing world is due to TB - yet most of these countries can't afford the 25- cents a week needed to treat one TB patient.

With numbers like these: The moral imperative for waging a worldwide battle against infectious diseases is beyond dispute. But there are practical reasons as well. Millions of orphans are an invitation to political instability. New arrivals in this country are a major source of new infections. Caring for millions of people with HIV threatens to bankrupt countries in the developing world - which means fewer markets for our goods.

So it is in our national and economic security interest to invest in a public health infrastructure around the world. That is why the President on World AIDS Day announced new investments in the international struggle against HIV - including support of AIDS orphans. That's why we're committed to finding an AIDS vaccine. That's why the CDC is working with the World Health Organization to build regional centers for monitoring disease. And that's why the time has come for all of us to work for world health in order to assure world peace.

Which brings me my tenth and last principle: All of us must leave our mark. This is a day of great celebration for you and your families. But as Winston Churchill said, "It is not the end. It is not even the beginning of the end. But is, perhaps, the end of the beginning."

The question is: Where do we go from here?

How do we make sure that as we open the door on the next century, we close the door on the biggest killers of this century? The answer goes beyond public health education and practice.

Principle number ten is really about morality.

It's about making sure that the shame of Tuskegee is never repeated.

It's about believing in our hearts that good health for each of us depends on good health for all of us.

It's about being friends to the friendless - and the outstretched hand of hope to those who fear they will never see hope again.

It's about using the love of your families, teachers and friends to light your way through every dark corner of pain you've committed yourselves to end.

And most important: It's about wearing your invaluable training as public health professionals as a badge of honor; a sacred trust; and a sign that the healing arts, in your well-prepared minds and skilled hands, will endure forever.

Congratulations on your remarkable achievements - and thank you .