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REMARKS BY:	DONNA E. SHALALA, SECRETARY OF HEALTH AND HUMAN SERVICES
PLACE:		Loyola University's Forum on the Child, Chicago,  Illinois
DATE:		October 19, 1999

Since this is battle-of-the-budget time in Washington - I have to tell you that I'm considering making what I call my Saint Ignatius proposal. From his Prayer for Generosity - I'm going to suggest to Congress that they "give and not count the cost." In exchange for which, we will "fight and not heed the wounds."

Having spent many Octobers in Madison and my hometown of Cleveland - I have to say that the Midwest is probably my favorite part of the country this time of year. All that is enduring about university life is on display in bold colors - and bright ideas, the kind of ideas that will come out of this Forum the next two days and help change the way our children live and grow up.

I've actually been to Chicago many times to talk about improving the health of children - and their families. And whenever I do, I walk around, look up, and am reminded again why Carl Sandburg called this the City of the Big Shoulders. But I'm also reminded that some of our most difficult social and economic problems are resting squarely on the small shoulders of children. Children - to paraphrase an old Beatles song - have been carrying the weight a long time.

What kind of weight am I talking about?

To find the answer to that question, all you have to do is take a look at movies and television. I don't mean the excellent television work that pioneers like Linda Ellerbee are doing. I mean movies and television that purport to be realistic dramas of American life at the dawn of a new century. What do you see? Struggling families. Alienation. Violence. Drug and alcohol use. Children neglected and abused. In one recent episode of The Practice a young man commits suicide, a week later another young man - a high school dropout - stubbornly confesses to a murder he didn't commit. He does this for money - the kind of money he could easily earn if he was educated and skilled.

My point is not to critique popular culture. That's another speech. Instead, I want to answer a simple question - the same question Jonathan Swift tried to answer in A Modest Proposal, his devastating satire about the treatment of children in 16th century England, what is to be done to protect our children - and to make sure they grow up healthy, educated and ready for 21st century America?

Obviously, we've come a long way from the time when children labored in factories and mines. Compulsory schooling, child labor laws and social insurance have all helped bring an end to the economic exploitation of children in this country. But just because those dark days are over doesn't mean that millions of American children have escaped the shadow of poor schools, no health insurance, long hours left alone, violence and preventable disease. They haven't. So as much as I would like to claim victory - I can't. Not yet.

What I can do is lay out our agenda for reclaiming a childhood that should be - as Simone de Beauvoir said - "a forward, upward movement." If children want fantasy let them find it in Harry Potter books. But when it comes to kindness, tranquility, health and family love - those must be as real for children as stars in the sky.

Richard Riley, the Secretary of Education, and I have both been in the Cabinet since day one. But we share something more important than long service - that is a lifelong commitment to children. So, as you can imagine, we have a great interest - and stake - in each other's success. Nevertheless, our focus is a little different. While Secretary Riley might ask: Is this school, or teacher, ready to teach, the question upper most in my mind is: Is this child ready to learn.

Even the best schools can do little for a child who is sick at home because her parents can't afford to have her asthma treated. Do we need computers in the classroom? Of course. But we also know we need to get handguns out of the schoolyard. Should teacher training be strengthened? Without a doubt. But once it is, there will still be more than 890,000 children in this country with enough lead in their blood to harm their ability to learn and grow.

So we have major challenges sitting in front of us. Enough, I suppose, to make the battle not seem worth fighting. But remember what we're fighting for - an entire generation of children, born in a time of rapid change; deeply in need of intellectual skills; threatened by emerging infectious diseases; and ultimately responsible for the fate of our nation in the next century.

So you tell me. Can we afford not to take on these challenges? I say absolutely not. That's why today I want to talk about our unfinished agenda for children in the 21st century - an agenda with three fundamental goals.

First - With the vigilance of Saint Ignatius, we must focus on the needs of children in the first years of life. Second - We must give working families the tools they need to protect their growing children from a sea of troubles - violence, lack of health insurance and unsupervised time. And third - We must lock arms with communities and work tgether to prepare young people to lead healthy adult lives.

I'm going to talk about all three of these goals. But first I want to acknowledge that much of what we know about how children learn and develop has come from the scholarship and hard work of researchers, advocates and child development specialists. In other words, the reason we have come so far - and can see so far - is that we're standing on the shoulders of people like Susan Mezey, Diane Geraghty, Carol Harding, Barbara Velsor-Friedrich and all of this Forum's other presenters.

Let me start with early childhood. How soon is too soon to make sure children are ready to learn? There is no "too soon." Researchers at our White House Conference on the Brain reported that starting at birth, the child's brain develops in response to nurturing and a stimulating environment.

By the age of three, the human brain reaches 90 percent of its adult-size. That means how children are nurtured from infancy - and protected from disease - can have an enormous impact on the rest of their lives. In 1991, Drs. Lucile Newman at Brown and Stephen Buka of the Harvard School of Public Health reported that 12 percent of preschoolers may be learning impaired as the result of preventable causes ranging from malnutrition to lead poisoning to abuse. This kind of research goes a long way in explaining why we have emphasized immunization, nutrition, and early childhood education. Just last month we were able to report that the overall immunization rate for pre-school children has increased to a record 80 percent.

But taking care of pre-school children goes well beyond getting them vaccinated. We also have to get them thinking right, eating right and doing right, for example, learning how to share the sandbox - not lay claim to it. That's why we've more than doubled funding for Head Start - and began Early Head Start for even younger children.

For those of us who came of age in the 1960s and 1970s - with John Kennedy's challenge to enter public service and do right by our fellow citizens - Head Start is one of our proudest accomplishments. But now it's almost 2000 - and our challenge is to revamp Head Start while keeping true to the pioneering vision of its founders.

In 1993, we formed a special advisory board to recommend measures to update and improve Head Start. We were told that in order to hold on to the original vision of Head Start we needed to improve staff training, career development and wages. We also needed better management - and provide better facilities. Since then we've turned around 200 grantees that we identified as deficient. Another 100 grantees have been terminated or relinquished their Head Start grants. This is the first time in the history of the program that any Head Start program was terminated.

We also launched FACES - the Head Start Family and Child Experiences Survey. The survey is our first opportunity to use performance measures with a nationally representative survey of Head Start programs. Now the results are coming in. We've found that the typical four-year-old completing Head Start gains knowledge and skills in words and numbers - as well as social skills that signify a true readiness to learn. Still, if we're going to meet my first goal for millions of poor children - we must monitor the quality of Head Start. We must demand the highest standards in curriculum, training and programs. And, when a Head Start center isn't working, we must close and replace it.

As you can tell - when it comes to doing what's best for our children - I believe the right approach to programs is tough love.

Which brings me to my second goal - giving a much needed helping hand to working families. Today, 65 percent of American women with children under the age of 6 are in the workforce. For women with children between the ages of 6 and 17 - the number soars to 78 percent.

Most Americans understand the value of quality child care to working parents, although that understanding seems to have escaped the attention of some people in Washington. Frankly, I have a hard time figuring out why. The latest report from the Cost, Quality and Child Outcomes Study found that the quality of child care programs attended by pre-school children had a lasting impact on their school performance. Children in better programs had higher language and math test scores - and fewer behavior problems.

That's why we are proposing the largest single investment in affordable quality child care in the history of this country. Some have questioned whether we need to expand funding for child care - and why we need a national investment in child care quality. The answer is simple: Parent should not have to choose between the security of making a living and the security of knowing their children are safe.

But is a new investment in child care really needed? Yes!

Let me be clear: We have major gaps in child care than must be closed.

Tomorrow we are releasing a report that shows new state-by-state numbers on how many children are currently benefiting from the Child Care Development Block Grant - a federal-state program that subsidizes the child care expenses of low and moderate income families. In an average month in 1998, only 1.5 million children - out almost 10 million eligible - received help through the Child Care and Development Block Grant program. That's a mere 15 percent.

Furthermore, if all states set eligibility limits at the maximum level allowed under federal law - which is just 85 percent of the state median income - almost 15 million children would have been eligible for subsidies in fiscal year 1998 - of whom only 10 percent were served. Illinois is doing a good job of making state investments in child care. Nevertheless, in Illinois, only 27 percent of low income families eligible for Block Grant assistance received any. And if Illinois had set its eligibility limits at the maximum allowed under federal law - that 27 percent would drop to 13 percent.

There is also a connection between child care and other employment goals. A recent Dade County, Florida study found that boosting child care funding increases the probability that welfare recipients will find paid employment, increases the earnings both current and former recipients.

Do low income working families really need help with the cost of child care? Again, the numbers speak for themselves. Child care expenses are typically the second or third largest item in a low-income working family's household budget. In 1993, child care expenses averaged 18 percent of family income for poor families paying for one or more pre-school children. Families earning less than 14,000 dollars were paying even more - a full 25 percent of family income.

Let me give you a specific example: Your neighbor to the north - Michigan. In that state, a hypothetical family earning $15,000 dollars would pay a breathtaking 39 percent of their household income on child care for a single pre-school child. But if that family was lucky enough to get a subsidy - with a 12 to 25 dollar monthly co-pay - it would pay 1.5 to 2.0 percent of their income on child care.

Even when working families can get child care - and afford child care, they still want to know that they can trust their child care. That's why our Child Care Initiative also emphasizes quality. Most parents can walk into a child care center and immediately recognize poor quality. Bad smells. Poor lighting. Lack of supervision. Lack of supplies. Chaos. But quality cannot simply be measured by what's wrong. Quality child care is care that meets a minimum level of performance. Care that we can measure. Care that we can sustain. Care that comes at the hands of trained professionals.

Does this kind of quality make a difference? Absolutely.

One Florida study showed that lowering staff-to-child ratios and increasing the educational qualifications of staff improved cognition and social development in children. All of this data about access, cost and the quality of child care tells us one thing: The time for Congress to act is now! There's bi-partisan support for expanded child care in Congress. Congress should act this year - and give America's working families the ability to bring home a paycheck without worrying about the safety of their children.

Perhaps the only gaps less excusable than the ones we face with child care - are the ones we face with health insurance. Think about it: We are the most prosperous nation in the world - yet we have millions of uninsured children. And the public health consequences are undeniable. Uninsured children are not only less likely to be immunized as pre-schoolers - they're less likely to be treated for illnesses from asthma to tooth decay. Twice as many uninsured children go a full year - or more - without seeing a doctor as children who have health insurance. These children end up using expensive emergency room care - or worse - simply wait at home, sick, without any care at all. According to one study by the State of Florida, uninsured children are 25 times more likely to miss school!

All of this explains why we created our Children's Health Insurance Program - CHIP. Every state and territory now has a CHIP plan. States expect that more than 2.6 million currently uninsured children will have insurance - and the primary care that goes with it - by September 2000. But as the President said last week, CHIP will not work without an effective outreach campaign. That means we need to visit schools, talk to parents, and train health care workers to ask the right questions - and provide the right answers about CHIP eligibility. This Forum is an excellent opportunity to focus on outreach - and the steps advocates, community organizations, schools, health professionals and the media can take to promote CHIP.

No discussion about helping parents keep their children safe can avoid the terrible reality of violence.

The murders at Columbine High School shook America - especially parents - to the core. Although most children are safe in their schools, homicide is the second leading cause for death for young people between the ages of 15 and 24. For African-Americans - it's the number one cause. Youth violence is not limited to big cities like Chicago. Just ask Elizabeth Meyers, a school social worker in a small town outside Lansing, Michigan. She said, "At the white, rural high school where I work, kids talk to me about violence on TV and in music. They think that violence can't be avoided and that anyone who can't see that must be crazy."

What created this culture of violence?

The truth is we don't know all the reasons. Right now Surgeon General Satcher is preparing a special report on youth violence. The White House is even establishing a new Council on Youth Violence. But we do know some of the reasons. The National Longitudinal Study tells us that adolescents who report a close connection with their parents are the least likely to engage in risky behaviors. That's why any effective strategy against adolescent violence must include a long-term commitment to help adults strengthen their parenting skills. Similarly, we now know that how young people interact with their schools, communities and families is a good predictor of future behavior.

So when it comes to keeping children safe, the data - and our own experience - suggests three truths. Number one is that simply adding funds to federal programs - while important - is not enough. We need to build new partnerships with state and local government, community organizations and schools. Number two, as Ms. Meyers suggests, we need to better appreciate how the culture of violence is impacting young people. The best way to do that is to have adolescents themselves participate in crafting our strategies. And number three, all of us need to define our mission less as preventing violence, and more as promoting positive youth development - something government cannot do alone.

Which brings me to my third goal - we have to be on the partnership track. Not the kind of partnership track that lawyers are familiar with. I'm talking about a community partnership - where businesses, universities, research centers, non-profit organizations, parents, clergy and government all contribute to preparing young people to lead healthy lives.

There's no better example of what I'm talking about than this Forum. You are a broad cross section of leading advocates and experts putting your heads together to improve the wellbeing of children. But I want to be clear: Even the best ideas - coming from the best minds - cannot be imposed on communities. We must develop bottom up - not top down - strategies.

That means working with communities to find out what they need - and how we can help. Which health clinics need funding? Which schools lack after-school programs? What information do young girls and boys need - and in what form - to make healthy choices about their future?

I believe my Department has a very good record of doing just that. And we're seeing positive results. For example, teen pregnancy rates are down for the 7th straight year, and we've turned the corner on marijuana use by 12 to 17 year olds.

I've gone to great lengths to enlist the support of anyone and everyone who has the attention of our children. I've spoken to Hollywood writers and producers, and talk show hosts - and encouraged them to use their shows to send positive public health messages to children. The WNBA and the Women's National Soccer Team are teaming up with us to help young girls make smart choices about not smoking, abstaining from sex - and staying physically active.

Do young people really want this kind of help?

When I was Principal for a Day in a New York City high school, I asked the students how we could help them avoid risky behaviors. One young woman stood up and said: "Make me strong inside." Of course, she wasn't just talking to me, she was talking to all of us.

With that thought, let me conclude with a parable I once heard about some people picnicking beside a river. They see an enormous number of children carried down the river by the current. Their first impulse, of course, is to jump in and pull as many children out of the water as they can. But the children keep coming and the rescuers can't save them all. No one thinks to run up the river to find out why they're falling in. Well, as we stand at the threshold of the 21st century, we're seeing millions of children being carried away in a current of neglect. It's our mission as advocates for children to wade in and pull them to dry land - and to work together to make sure that no child falls into that river again.

Thank you.