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REMARKS BY:	DONNA E. SHALALA, SECRETARY OF HEALTH AND HUMAN 
		    SERVICES
PLACE:          The Society of Adolescent Medicine, Arlington, VA
DATE:		March 21, 1996

Whether you're repairing broken bones and broken lives, conducting research into the mysteries of adolescent health, or training the next generation of health professionals, you are putting the interests of young people exactly where they belong -- first.

And I am honored to join you today to talk about the future of our country.

Because, right now the future of our country is a 10-year-old in Chicago who struggles with the physical, emotional, and psychological toll of AIDS -- her tender, young body infected by the disease at birth.

For this little girl, reaching Sweet 16 would be a dream come true, yet she envisions sunshine, not clouds, as she writes:

"I believe in angels, don't you see

They are all around us

Watching after you and

Taking care of me ...

I believe in angels

Don't you see

They are God's helpers

Taking the pain away from you and me.

You are those angels here on earth.

But, being angels today means that while fitting a plaster cast on a young girl's broken leg, you may also have to tell her where to go for help if she's feeling lonely and depressed.

It means that while giving a 10th grade boy a physical, you may have to talk to him about sexual responsibility.

And it means, while questioning a 9th grade girl about her diet, you may also have to look for signs of drug use or violence -- and know what to do when you see them.

You know that adolescents are not just big children or small adults -- they have unique problems that demand unique solutions.

And you know that to tackle those challenges, we must compliment the medical model -- which focuses on treating illnesses -- with the health model -- which focuses on prevention.

And we don't have a minute to waste.

Every day in this country, 15 children die in gun-related accidents, suicides, and homicides.

More than 1,000 young people give birth out-of-wedlock.

More than 3,000 young people start smoking.

And more than 2 million 12- to 17-year-olds have at least five alcoholic drinks.

A recent report to the President showed that at least one American teenager is becoming infected with HIV every hour of every day.

And then there's the resurgence of marijuana smoking among 12- to 17-year-olds -- with rising usage rates every year since 1991.

Make no mistake, if we don't act fast, we could lose an entire generation of young people.

That was the key message of the major report, "Great Transitions: Preparing Adolescents for a New Century," released by the Carnegie Corporation of New York last fall.

The report finds that at least one-half of our teenagers are at risk for dangerous behaviors that could seriously diminish their lives.

We're talking about millions and millions of young people.

These aren't somebody else's children, and this isn't somebody else's problem.

This is our problem -- an American problem that touches the lives of each and every family -- regardless of race, religion, region, and economic background.

But don't take my word that something must be done. Let's hear it first-hand, from young people themselves:

A 16 year-old girl says: "I'd like to be a model. Smoking burns off a lot of calories."

A college sophomore says: "I'm not even a heavy drinker, except every time I drink, I get drunk."

A high school freshman says, "I like violence. I like seeing violence. I just really like watching violence" -- especially video games.

And then there's a 16-year-old boy dealing drugs in New York City. He says, "My father would always say 'Stay in school. Don't drop out. Don't drink or do drugs.' But he never did anything about it himself, so what's the use?"

What's the use?

In the mouths of our teens, those may be the three saddest words in the English language.

They speak of emptiness in what should be a time of exploration.

They speak of resignation in what should be a time of wonder.

They speak of a hopelessness that makes people numb to all they are and can be.

Why do young Americans who are for many years on the right track end up veering off course and diminishing their lives?

Lots of reasons.

Part of it is poverty and the lack of opportunity -- primary indicators of a child's future health and future life chances in this country. As Marian Wright Edelman likes to say, "opportunity is the best contraceptive."

Part of it is the dangerous messages some parts of our culture send to the young, messages like:

"Smoking is glamorous."

"Marijuana is cool."

"Everybody's having sex."

"A gun gets you respect."

Part of it is that we who are health leaders have to do a better job educating and inspiring each new generation to live healthy lives. We can never give up.

But critically important is something else:

I have a teenage advisory group -- 17 young people from all walks of life who meet with me about once a month.

Whether we're talking about preventing drug use or depression, smoking or sex, they consistently say the same thing: They say that parents are by far the most influential people in their lives.

They say parents and families can do the most to save them.

And -- despite the aura of independence that teenagers project so well -- they say that most young people need and want the everyday love, attention, involvement, and, yes, discipline of their parents.

We all know that my teenage advisors are right -- the family is the core institution in this country -- and yet somehow we have evolved into a society in which a gauntlet of factors keep mothers and fathers from raising their children the way they would like.

Parents are working longer hours with less job security. They have less time to spend with their children. They're finding it harder to pay today's grocery bills while saving for tomorrow's college bills.

There are more families in which both parents are working.

There are more single-parent families. There are more parents who walk away from the children they created.

There are fewer families that feel connected to strong, supportive communities. And there is more competition for their children's attention.

So there you have it: It has become harder and harder for parents to raise their children -- at the precise moment when children need their parents -- and other caring adults -- more than ever. No wonder so many parents are terrified.

One mother in suburban Virginia put it best when she said, "I went from wanting my son to win the Nobel Prize to wanting him to survive."

As a society, we have to lock arms to help that mother and all parents, and that means -- first and foremost -- creating a health care system that meets the needs of all Americans -- all young people.

This President -- this Administration -- has demonstrated a powerful commitment to doing just that.

That's why we're working to ensure that managed care becomes an opportunity -- not an obstacle -- to develop high quality, low cost care in the 21st century.

That's why we're addressing the complex pressures squeezing our cherished academic health centers.

That's why we're fighting to enact the Kennedy-Kassebaum bill so that we can wave goodbye to the days when insurance companies could drop you because you changed jobs, or had a pre-existing condition.

And that's why the President has used his veto pen to say: We will not replace Medicaid's historic guarantee of health care for our most vulnerable children -- with an ill-conceived, underfunded block grant.

I'm not saying our health care programs don't need change. They do.

But, we need to reform -- not ruin Medicaid.

And that's exactly what the President's plan does.

It maintains our historic federal-state partnership. It gives states unprecedented flexibility to meet the needs of their citizens. And, it still preserves a real federal guarantee of coverage and benefits for all vulnerable Americans -- especially children.

We have serious concerns about a provision in the Governors' Medicaid proposal that repeals phased-in coverage for 13- to 18-year-olds whose families live below the poverty line.

It's counterproductive and ultimately costly to ignore the health needs of teenagers.

All young people need our attention -- and they must continue to receive it.

But our commitment to parents must go beyond meeting their children's health care needs.

I'd like to talk to you about a new public health strategy -- a new youth development strategy -- a comprehensive, collaborative approach that I call, "Safe Passages."

Safe Passages means working in partnership with all the different adults and institutions in young people's lives -- to help them steer their precious young people through the sometimes rocky waters of adolescence.

This is not the old top-down, heavy-handed, overly programmatic approach to solving problems.

Instead, we need to define our role more clearly -- to serve as the glue that holds together our various partners and fills gaps that would become gaping holes without state-federal- community partnerships.

So what does Safe Passages mean specifically?

It means increasing our capacity to support major research on all aspects of adolescent health and development -- from HIV infection to violence and from teen pregnancy prevention to understanding the evolving needs of vulnerable populations.

It means increasing the children's mental health budget twelvefold in three years -- because we believe that mental health is just as important as physical health.

It means moving away from the old "model program" approach to federal grants -- where we tell communities what they need.

Instead, we're using federal, state and private resources to catalyze community coalitions to develop comprehensive plans for youth development -- plans that understand that teenage drug use, violence, sexual activity, and other problems are related to one another, and to overarching social problems like poverty.

And it means sponsoring major new national health campaigns in areas like AIDS prevention, drug prevention and the nutrition food labels -- to empower teenagers and their parents with critical information needed to choose healthy lives.

Let me say something about how we reach teenagers and parents with life-saving messages.

I come from a Washington world in which people honestly believe that the only way to communicate with the American public is through brochures and posters.

Let's not be naive: The brochure approach to public health communications is a relic from a bygone era. Most teenagers don't spend five minutes per year reading brochures.

What they do is absorb popular culture by the ton.

They rent videos. They play interactive video games. They log onto the Internet. They watch TV -- no, they interact with TV -- channel surfing through cable stations at the speed of sound; shouting back at the television; tuning into talk shows in which the audience is as important as the guests; and continuously incorporating popular culture into their own speech and their own thinking.

I do believe that groups like the Ad Council and the Partnership for a Drug Free America do get it: Their public service announcements always seem to keep up with where kids are, but for the most part we need to bring public health communications into the 21st century -- and into our teenagers' heads and hearts.

And the first step is to candidly admit that we health experts can't do this alone and certainly shouldn't try.

That's why, as a part of Safe Passages, we're teaming up with leaders throughout the media and entertainment industries -- from daytime talk show hosts to TV scriptwriters to the editors of all the popular magazines.

As health leaders, we need to challenge and cajole and ultimately help the media industries to use their enormous access into American homes to promote real dialogue between parents and teenagers, and to get rid of the mixed messages that cause so much confusion to families around the kitchen table.

Perhaps the administration effort that most clearly reflects our Safe Passages strategy is the children's tobacco initiative, which is ultimately about giving power back to parents.

As we were developing our proposal, some people said we can't afford to incur the wrath of a Goliath-like power like the tobacco industry.

We said, we can't afford not to.

There are more than 400,000 tobacco-related deaths per year in this country -- and the vast majority of those people began smoking regularly in their teens -- or younger.

You will hear a lot more about smoking and adolescence tomorrow morning from FDA Commissioner David Kessler.

We believe the tobacco culture has essentially functioned as a "third parent" for American children -- enticing them with attractive images, playing upon their desire to be glamorous, alluring them with T-shirts and trinkets, and giving them easy ways to obtain cigarettes from vending machines, the mail, and even free give-aways.

There's not a parent in this country who wants their children to endure the suffocating death grip of emphysema or lung cancer.

That's why we have proposed both to limit the access and the appeal of tobacco products to children under age 18 with what are -- I believe -- some of the boldest public health proposals this country has ever seen.

And that's why last week we teamed up with the U.S. Soccer Federation to kick off the Smoke Free Kids and Soccer Campaign.

Featuring the U.S. Women's National team, this campaign will include television ads that will travel with the team as they make their way across America, sending a clear message to millions of young people: like oil and water, tobacco and fitness don't mix.

Some might say, "Can't parents take care of their children?"

The answer is, of course they can.

That's precisely the point of our proposal -- to make sure that parents -- not the tobacco culture -- are in control when it comes to educating children about an addiction that could take years off their lives.

That's why we are standing with parents and saying, "Yes, we will help you protect your child.

"Yes, we will put your interests before the special interests" -- and not just with tobacco.

We are a safer country because of the Brady Handgun Law and the assault weapons ban.

We are a healthier country because we didn't let the extreme right abolish family planning services under Title X.

And we will be a wiser country when parents are able to take advantage of the V-chip and voluntary ratings -- to control the level of violence that their children are exposed to on TV.

Time and time again, this Administration has taken on the tough issues and the powerful special interests because that's what's good for parents and their children.

That's the right role for the federal government, the national government, the people's government -- in partnership with states, counties, cities, communities, schools, and parents.

The fact is, government alone can't solve the galaxy of health problems our children face.

The real passports to safe passage must come from people who share the everyday worlds of our children and teenagers --primarily parents -- but also other caring adults: grandparents, older siblings, doctors, teachers, coaches, counselors, clergy, employers, media figures, community leaders, and, of course, young people themselves.

And we all must testify. We all must preach a pro-youth message from our own personal bully pulpits: A message that inspires our communities to create the presence of opportunity for young people -- strong schools, meaningful jobs, safe streets, and real opportunities to serve. And a message that shows young people how much we value them and want to hear their views.

No audience is too small. No pulpit is too close to the ground. And no voice can ever be too soft to save a life.

As healers and educators and leaders, you have a special role to play.

You see the human face of public health tragedies like AIDS, violence and substance abuse.

You know the complexities of teenage life. You know the importance of prevention. You know the value of comprehensive, community-based solutions. And you know that the imperative of reaching kids early -- gaining their trust -- giving them our ears -- getting our arms around them -- and never letting go.

Because, the truth is, our success will depend not on what we say today -- but on what all of us do tomorrow.

We need your leadership as part of a national crusade on behalf of our youth -- one that goes community by community, block by block, home by home -- making sure that children and teens become hooked on hope and too strong for wrong.

I am reminded of that wonderful scene in the movie Apollo 13, where the air filtering system has broken down and the mission is in trouble.

On the ground, the NASA staff gathers up everything that is collectible on the spacecraft and dumps it into a room with their top engineers. The director looks them in the eye and tells them they have one hour to find a way to build a new air filter that works.

And then, in case there was any confusion, he adds, "Failure is not an option."

Failure is not an option -- not when we work together, and not when the lives of our children are at stake.

Thank you.