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REMARKS BY:      LOUISE W. SULLIVAN, M.D., SECRETARY OF HEALTH AND
                    HUMAN SERVICES
PLACE:           "Healthy Start" Press Conference
DATE:             1991 Conference

True, our infant mortality rate does continue downward. But the rate of improvement is too slow. And in some areas of the country, infant disease and mortality remain disgracefully high.

Why are we moving so slowly toward better infant health? With all the federal, state and local programs that exist to support maternal and child health, why isn't America among the nations with the lowest infant mortality rates?

Among many different reasons, one especially stands out for me. Too often we have failed to look at infant health through the most important set of eyes, the eyes of the young mother herself.

We have created program after program to provide medical, nutritional and other help for that young mother. But have we done enough to help her access those programs? Have we done enough to make those programs work together, for her benefit?

We have significantly expanded Medicaid eligibility to provide coverage to a wider range of poor women and children. But have we done enough to ensure that Medicaid "eligibility" really means "access to care?" Can't we simplify the bureaucratic maze that too often stands at the entrance to Medicaid programs? And can't we do more to help ensure that health professionals will accept Medicaid patients?

Likewise, we have carried out extensive medical research to improve infant and maternal health. But are we drawing enough attention to the most common behavioral threats to infant health, which so many young women must confront -- especially maternal smoking, alcohol abuse, illegal drug use, teen pregnancy, and nutrition? And shouldn't we also be supporting these young women and their children by vigorously promoting the responsibility of fathers to be involved with their children, and the important role of strong, loving families?

We must indeed look at our efforts through new eyes, the eyes of the low-income pregnant woman whose babies are most often the victims of early disease and death. And we must try new approaches. Some 40,000 American babies die each year -- yet that number could be lowered by a full 25 percent simply through better application of what we already know about maternal and infant health.

We can do better -- by targeting communities where infant mortality is highest, by enlisting fuller community support, by encouraging innovation, and by concentrating first and last on the real world of our "clients," young low-income women and their children.

These are the principles behind "Healthy Start," President Bush's initiative to re-energize our progress toward better infant health. "Healthy Start" calls on government not merely to provide resources, but also to take active new steps to develop usable model programs that work. Likewise, "Healthy Start" asks families and communities to dedicate the kind of commitment and moral support for women and children that transcends government programs.

"Healthy Start" will begin with federally funded demonstration projects in about ten areas where infant mortality rates are especially high. This focused approach will target new resources where help is needed most. In addition, as we award funds for this initiative, we will look for community-wide commitment, as well as innovative and even unconventional approaches.

We will be providing unprecedented levels of federal support to these communities, and we want this to attract new support from state, local and private sources as well. Through these efforts, we hope to achieve at least 50 percent reduction in infant mortality in the targeted communities within five years.

Moreover, we intend to apply the successful approaches to other communities across the country.

Some of the results we're looking for:

• Put services where the need is. High infant mortality is often clustered in inner city or identifiable rural areas. We need to reach actively into those areas with the specific resources that are needed.

• Integrating services and "one-stop shopping." The women who need our help often need a variety of related services. We should make more services available to them with less "hassle." We can also make the application process for Medicaid and other programs faster and simpler. We need to bend our bureaucracies to fit the needs of those whom bureaucracy is supposed to serve.

• Tailor services to specific community need. In addition to being "user-friendly," services should fit the needs of the individual community. Where women are not taking advantage of available care, communities can provide outreach and home visitation. Where transportation and child care needs pose a problem, the community can concentrate on solutions tailored to local resources. Community commitment and direction are the key to identifying and targeting local needs.

• Emphasize behavior change as well as medical care. One tenth of infant deaths can be traced to smoking, and some 10 percent of pregnant women are abusing drugs. In fact, some hospitals report that as many as 40 percent of newborns are drug-exposed. Alcohol consumption can also affect infant health. If we're serious about impacting infant health, we must confront these behavior-related problems. We must help young women avoid, and when necessary help them confront and overcome, harmful addictions.

We also need to tell our teens and preteens, without hesitation or embarrassment, that the healthy and smart decision is to delay sexual activity until both father and mother are ready to commit to marriage and child-rearing. This piece of wisdom may be ancient, but it is not out-dated.

Indeed, we need to cultivate in our nation what I call a "culture of character," a recognition that so much of the mortality and disease in America today is the result of our own choices and behaviors. We need to support one another, through our families and communities, toward healthful behavior choices and productive lives.

Infant mortality is recognized as a telltale of broader health status. It is, equally, a measure of our commitment to some of the most fundamental of human values -- our willingness to invest in our children, our readiness to bend our lives and institutions to their needs, and our confidence that we can shape the future positively through our efforts on their behalf.

Those values are still strong in America. But they must be proclaimed, and supported, by individuals and government alike. "Healthy Start" is just such a proclamation and commitment.

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