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REMARKS BY:	DONNA E. SHALALA, SECRETARY OF HEALTH AND HUMAN SERVICES
PLACE:		Fedele and Iris Fauri Memorial Lecture, University of Michigan, Ann Arbor, Michigan
DATE:		September 18, 1997

That, of course, is what we want for all our children. Not simply those for whom great institutions like Ann Arbor or Madison are within reach from birth. But those whose faces remain pressed up against the window pane of the American dream. Children growing up in inner city Detroit. In old mining towns in the Upper Peninsula. In the Mississippi delta. In the barrios of Los Angeles. And on Native American reservations. These are the children that Fedele and Iris Fauri devoted their lives to.

Fedele grew up in the Upper Peninsula. And even as his love for horses and harness racing grew - so too did his love for the children of this state, and his determination to fight for their future.

As the former Chancellor of the University of Wisconsin, there is one story about Fedele that I particularly cherish. Apparently, Fedele sometimes joked that salary raises for faculty should be based, at least in small part, on how many children the particular faculty member had to support. Children, he and Iris obviously believed, must come first.

That's why he spent so much of his life giving a voice in Washington to the powerless, and training a powerful generation of social workers - a profession that next year will celebrate its centennial. Today, the legacy of Fedele and Iris Fauri continues in the scholarly work of this institution's faculty - and in the commitment of its graduates to rewrite the fate of poor children.

Earlier this month, the world lost two women who had this same love for - and dedication to - children. Princess Diana and Mother Teresa both showed the extraordinary good one person can do to help children. Although from vastly different backgrounds, they shared a common love for the weakest among us, and a common belief that doing is better than talking. They walked among the poor and held the sick.

And they measured success not with new theories - or even by the world wide attention they brought their cause - but by looking into the eyes of each child they cared for and asking: Have I made this child healthier? Have I helped lift this child out of poverty? These two women, like Iris and Fedele Fauri, held themselves to the only standard that counts: healthier children. And we must do the same.

You've probably heard the expression, `We did everything right, we just didn't get the results we wanted.' Well, when it comes to children, that kind of thinking - that kind of self-satisfaction - just won't cut it.

Today, everything we do to improve the lives and destinies of children, whether it's research, policy, management or just good intentions, is secondary to making sure we get the right outcomes. That's what the social work discipline did when it responded to Joel Fischer's book, Is Social Work Effective? You went out and did the research, and now we can say emphatically, "yes," your interventions on behalf of people do work - and we know it.

Similarly, I've steered the Department toward making sure that what we do works. That means, customer service, accountability, and measurable change. Because the fact is, if a policy doesn't make a difference in the well-being of people, then anything else it has going for it - cost-effectiveness, political support, an agreed upon process for implementation - doesn't matter.

That's why, despite my training as an academic, and my deep respect for cutting edge research and scholarship, this will not be a lecture that surveys the latest theories about child welfare and child development. It will be a pragmatic lecture about the status of children today; the areas where we're achieving the outcomes we want; the gaps that remain to be filled; and what we must do to fill them. But it will not be a lecture simply about what government must do. It will be about what all of us must do - states, communities, businesses, schools, and families - to improve the health of children.

Let me start by saying that by focusing on outcomes we do more than fulfill our moral obligation to children, we force ourselves to use scarce resources wisely; to develop objective standards that we can use to demand accountability; and to put ourselves in a position to achieve even better results in the future.

I mentioned that I've been steering the Department toward a view that the only bottom line that counts is results. It hasn't been quite as tough as turning an oil tanker around in the middle of ocean. But in order to make real improvements in the welfare of America's children; in order to know what our goals for children should be - and what we need to do to achieve those goals - we have made some real changes in the way we do business.

We know that we can't have good outcomes for children if we don't have good data on children. Although this may surprise many people, historically we've probably had a clearer picture of how well the next corn crop was doing than how well the next crop of American leaders was doing.

That's because until recently, accurate and timely information about the condition of our most valuable resource - children - has been scattered at best, and inadequate at worst.

President Clinton changed that when he signed an Executive Order setting up the Interagency Forum on Child and Family Statistics to collect in one annual report all of the important information about the state of our children's health and economic security. Last year our Department put out its own report called, Trends in the Well-being of America's Children, and we will soon be releasing the 1997 edition.

Another way we're changing is by attacking problems with multiple - and sometimes non-traditional - strategies. That means teaming up with states, localities, and the private sector in new and creative ways.

For example, I've spoken to both talk show hosts and soap opera producers about how they can help to get good public health messages to young people. We're also using leading experts from outside the Department. And, practicing tough management that demands accountability - even toward programs we admire.

Head Start proves my point. It's a program that I love and has strong bi-partisan support. We've increased its funding and expanded it to serve 0 to 3 year-olds. But at the same time, we've also closed down Head Start centers that just weren't measuring up to the high quality standards we've set for places that take care of children.

Let me say: We have made great strides. Today, we see teen pregnancy rates inching down for the sixth straight year. More children enrolled in Head Start. Perinatal transmission of HIV cut significantly. The percentage of women receiving pre- natal care is at a record high - in part because of our expansion of Healthy Start. And the number of special needs children being adopted is up by over 60 percent since 1993.

But two of our biggest success stories are the results we've achieved on childhood immunization and infant mortality. I'll always remember that the very first issue the President talked to me about in December 1992 was childhood immunization. So two months into the Administration, we announced a comprehensive strategy that we called the Childhood Immunization Initiative. The heart of that strategy was a clearly defined goal of immunizing 90 percent of all two year-olds with the most critical doses.

This year we achieved that goal - and we did it by attacking the problem from all angles: By improving immunization services; reducing the cost of vaccines for lower income families; increasing outreach; improving surveillance; and improving vaccines.

We will use this same powerful combination to reach our next goal: To immunize, by the year 2000, 90 percent of all two year-olds with the full series of vaccines.

Then there's infant mortality. In 1996, infant mortality hit a record low of 7.2 deaths per 1,000 live births. This is due in large part to a steep drop in Sudden Infant Death Syndrome. As recently as 1992, SIDS was claiming the lives of 5,000 infants a year. There are still many things we don't know about SIDS, but thanks to the American Academy of Pediatrics, we learned that putting babies to sleep on their backs reduces the likelihood of SIDS.

So we had a critical health challenge: We needed to take complex scientific information and translate it into a simple, yet powerful, message. We needed to combine research, resources, creative partnerships, and non-traditional ways of communication. And that's what we've been doing with our Back to Sleep campaign.

Between 1992 and 1995, SIDS deaths decreased a full 30 percent in part because of Back to Sleep. These results are dramatic, but we knew we couldn't rest on our laurels. Which is why we announced that Mrs. Gore would serve as our national spokesperson. And why we are entering a new partnership with Gerber Foods to use cereal boxes, direct mail and a toll-free line to get the Back to Sleep message into the homes and hearts of all Americans with children.

But for all the progress we've made, there are still major gaps in the health and economic security of children. I like to put these gaps into three broad categories: Children's health and safety, economic security, and the dangerous obstacles of adolescence.

Today, there are 10 million children in our country who do not have health insurance. And they are not necessarily the poorest of the poor - because most of those children receive Medicaid. For the most part, the uninsured are children of working families who make too much to qualify for Medicaid - but not enough to qualify for private insurance. They're less likely to get the primary care they need, and more likely to require costly emergency services.

That's why the President made children's health insurance one of his top priorities during last summer's budget negotiations.

Under the new budget, we will invest $24 billion dollars to insure up to 5 million - that's half - of America's uninsured children. This won't be a new program from Washington. The money will be passed through to the states so they can use it to create a new insurance program - or build on an existing program such as Medicaid. But we will very closely verify the results: Will children who are sick or hurt have access to care they need? Will our kids be healthier?

Lack of adequate health insurance isn't the only unmet health need of children. Every day, children are being abused, neglected and abandoned in every part of our country, in every type of family, in every kind of community. Children denied basic care -- and basic caring.

While we know that in 1995, there were one million officially substantiated cases of abuse and neglect in our nation, we also know that many kids in trouble never even make it onto our radar screen. In fact our 1996 National Incidence Study of Child Abuse and Neglect confirms our worst suspicions.

The study estimates that there were 2.8 million abused and neglected children in 1993. That's double the number in 1986. What's even more heartbreaking is that almost three-fourths of those children were never served by an overwhelmed child protective service.

There is no quick fix for what ails our child welfare system and the families it serves. But, over the past few decades, we have learned a great deal. We know that child abuse often goes hand in hand with drug and alcohol abuse.

While abuse rears its ugly head in all kinds of families, we know it is more likely in single-parent families; families living in poverty; or families where one or both parents was abused themselves. To end this national nightmare, we have to do away with both ideology and myth.

The worst myth is that federal rules prohibit local agencies from protecting children. It is not true. There are no federal rules that prohibit ANYONE from protecting the safety of a child - or from disclosing information to those who need it. As for ideology, for a long time the pendulum shifted back and forth between family preservationists and those who believe that a policy of keeping families together endangers children.

We wanted to end this false debate by charting a common sense, and balanced, policy that increases adoptions and strengthens families - so that every child has a permanent and safe home. We must operate on two tracks: Supporting existing families when possible, and creating new families when necessary. But the bottom line is always the same: We must protect the child's safety and welfare.

The second important gap is how do we give all children economic security - especially as we move from a culture of welfare to a culture of work? We know that there are approximately 14 million impoverished children. That's about one in five. And we know that about 8 percent of these poor children live in families with incomes at least 50 percent below the poverty line.

We have already made important progress - especially in making work pay. We expanded child care and the Earned Income Tax Credit. We insisted on tough new child support enforcement provisions in the welfare bill. We raised the minimum wage. And we allowed states to experiment with ways of helping families become self-sufficient, granting waivers to 43 states even before we enacted national welfare legislation.

Michigan was a leader in this movement. As a result of all this creativity and change - and the strong economy - welfare caseloads are down dramatically. Now we must continue to use tools such as child care, health care and child support enforcement to strengthen the entry level jobs - and make work a better deal than welfare.

Research tells us that the brain of a 0 to 3 year old child develops in response to a nurturing and stimulating environment. And it tells us that quality child care can provide that kind of stimulation and cognitive development in children. This kind of research should - and often does - drive policy. That's why our $20 billion dollar commitment to child care spending through 2002 includes a commitment to improving quality.

At the same time, we know that one of the biggest reasons for poverty and welfare is the failure of one parent to pay child support. We've tackled this problem head on - increasing collections by 50 percent since 1992 and nearly doubling paternity establishments. But too many kids are still being shortchanged - and not enough parents are taking financial responsibility for them. That's in part because the old system of child support collection rewards stands for efficiency not effectiveness, and process not the bottom line.

When we sat down with states earlier this year, we kept hearing the same thing: We need a system that rewards results. That's true. As the welfare system changes, we must go beyond asking how many dollars were saved - and start asking how many families were saved.

That's why we recommended that states will be paid based on their performance in 5 key areas: How many paternities were established? How many parents were ordered to pay up? How much current child support has been collected? How much past due child support has been collected? Is the program cost effective? I'm proud that two days ago, bi-partisan legislation was introduced that will set up just this kind of child support collection system.

Even with all the progress we've made in moving families from welfare to work, we cannot be complacent. We must now work with states to make sure welfare reform accomplishes its most important goal: To lift children out of poverty. But it's not only poor children we have to worry about.

Children from all income groups face the dangerous obstacles of adolescence - in particular, drug abuse, smoking and teen pregnancy. On drug abuse, we're seeing glimmers of hope. Teenage marijuana use has leveled off after skyrocketing for three years. And overall, teen drug use is down for the first time since 1992.

But there's bad news too. More teens are trying heroin for the first time. More of them are using hallucinogens. And fewer understand that cocaine can harm them.

There's no one reason why. But clearly, not enough adults are sitting their teens down and saying, "Drugs are not cool. Drugs are not safe. Drugs will tear apart you family and kill your dreams."

The fact is, we need to reach kids when they're younger with clear no-use messages over and over and over again. That why we're entering into new partnerships with states - offering them incentive grants that can be used to leverage other resources in our anti-drug fight.

But we don't just need innovative programs. We need better data. That's why we want to expand the National Drug Survey so that it gives a state by state breakdown of drug use among young people - because we know that drug problems in Michigan are not necessarily the same as those in New York, Florida or other states.

Tobacco is also a clear and present danger to teens. Every day, 3,000 young people light up their first cigarette. One-third of these children will eventually die of their addiction. So we set the ambitious goal of cutting teen smoking in half within 7 years.

Fortunately, for the first time, we have a President with the courage to stand up to tobacco companies. If it wasn't for the President's leadership, Joe Camel would still be in our children's lives - instead of in the history books where he belongs. We would not have a new tobacco regulation requiring retailers to check ID before selling tobacco products - and the money to enforce that regulation. And we would not have tough new proposals for federal legislation.

As you know, the President yesterday announced that he was challenging Congress to enact comprehensive tobacco legislation that that has one goal in mind: a dramatic reduction in teen smoking.

There are other key elements that must be at the heart of this legislation. Tough penalties on the tobacco companies as an incentive to reduce teen smoking. Full authority of the FDA to regulate tobacco products. Prohibitions on the marketing of tobacco to children. And the protection of tobacco farmers and their communities.

This legislation must be sweeping - and it must demand results.

The last obstacles of adolescence I want to mention is teen pregnancy. I already mentioned that we've been moving in the right direction for six years. So, the message - get smart, get strong, and don't get pregnant - seems to be getting through to many young people.

But this is not the time for self-congratulations. Teen pregnancy is still a major problem. And that means children raising children; children dropping out of school; and children mired in poverty.

To beat teen pregnancy, we need to attack it on all fronts. And that's what our teen pregnancy strategy does. We're providing money to support local abstinence programs; using welfare reform as an opportunity to prevent teen pregnancy; building partnerships with everyone who plays a part in the lives of children; and supporting research so that we understand the problem better.

But to close these gaps - and to make the 21st century an era of good health and economic opportunity for all children - we must do more than create narrow goals for particular programs. We need an all out attack that is supported by good social science research and sets a very high standard for success. A standard of good health, economic security, safety and access to appropriate care for all American children.

To meet that standard, we must end the racial disparities that plague too many of our American communities. And we must make all the pieces of our children's strategy fit together in a seamless system of prevention, care and security. For example, we knew that child support enforcement and quality child care had to be part of any real welfare reform. That age and gender specific messages; partnerships; and tough regulations all had to be part of our fight against tobacco. And we knew that because of the law unintended consequences, one worthwhile program can sometimes end up shifting costs to another equally worthwhile program.

So, what specifically must we do to put this kind of seamless system in place?

First, always keep in mind that government doesn't raise children, families do. Government must be in the business of offering tools and lending a hand to struggling families - and only imposing its will when necessary.

Second, we must offer flexibility while demanding accountability not just from states and localities, but schools, businesses, and community organizations. I'm a big believer in unsentimental management. If states and localities want more control, for the most part they should have it. But like the federal government, they should also be prepared to carefully evaluate what they do. And if a program isn't working, it should be changed or eliminated.

Third, we must use new methods of communication to reach young people. I've never known a single teenager who reads brochures. They listen to music, watch TV and log on to the Internet - and that's how we have to reach them.

Fourth, let's invest in programs that have survived the tough scrutiny of social science research.

Fifth, keep children above politics. Republicans and Democrats proved we could do that for children's health insurance and child care. We can also do it for drugs, teen pregnancy, and tobacco.

And sixth, get ahead of the curve and stay there. That means anticipate future gaps - as we did with child care. Because the best outcome of all is a problem that's prevented before it begins.

I was thinking about Fedele Fauri as I traveled here today. He, like I, worked both sides of the fence - serving in government and academia. And he, like I, knew both sides have a very important role to play in protecting children.

I hope you will never give up on your role. That you will challenge conventional wisdom. I hope you will hold our feet to the fire by making sure that the research and debates that happen here become part of the national dialog on children's health. And I hope you will never let research become more important than training and inspiring high quality social workers to carry on the tradition of this great school, and the life work of Fedele and Iris Fauri.

Because in the end, it is the heart and hand of individuals like you that dig deep into the lives of children and plant the outcome that matters most: The promise of a human life fulfilled.

Thank you.