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REMARKS BY: DONNA E. SHALALA, SECRETARY OF HEALTH AND HUMAN SERVICES PLACE: UCLA Center for Healthier Children, Families and Communities, Los Angeles, California DATE: April 22, 1996
Because right now, the future of our country is a 12-year-old girl in Boyle Heights picking up a gun and throwing away her future.
The future of our country is a 16-year-old boy in Compton who doesn't eat right, doesn't exercise and is 30 pounds overweight.
And the future of our country is a 14-year-old girl in North Hollywood who found out the hard way that sex won't buy you love and getting pregnant won't make you an adult.
Today, you are using the power of public-private partnerships to create a model of health care for these young people and their families: Repairing bodies and repairing lives. Healing families and healing communities.
As you open the doors at UCLA's Center for Healthier Children, Families, and Communities, you are combining the best of all worlds: You are combining the best academic research, the best leaders, and the best prevention strategies to provide a one-two-three punch for our children, our families and our country. And we don't have a minute to waste.
Every day in America, about 15 children die in gun-related accidents, suicides, and homicides. Every day, approximately 25 young people are infected with HIV. Every day, more than 1,000 young people give birth out-of-wedlock. Every day, 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 among 12- to 17-year olds -- the monthly usage rate has nearly doubled 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 a major report released by the Carnegie Corporation of New York last fall. The report found 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 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.
What's the use? They speak of emptiness in what should be a time of exploration. They speak of resignation in what should be a period 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 public 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 that 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 -- especially 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. We must relegate the term pre-existing condition to the chronicles of history!
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.
From 1984 to 1990, it was Congressman Henry Waxman who won the battle to expand Medicaid coverage to all poor children -- not just those on welfare.
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.
The President believes it is costly and counterproductive to ignore the health needs of children and adolescents -- and we will not do it.
I'm not saying our health care programs don't need change. They do.
But, we need to reform -- not repeal Medicaid.
And reform is exactly what the President's plan is all about. 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 insurance -- of coverage and benefits for all vulnerable Americans -- especially children.
We demonstrated that commitment again last week with our Medicaid waiver to Los Angeles County that received so much news coverage.
It provides $364 million to help stabilize the Los Angeles County health care system and assist the long-term restructuring process. It makes good on the commitment the President made last September to State and County government officials. And it reinforces your goal of saving precious lives and precious resources by focusing on preventive care -- especially for our most vulnerable citizens.
We think this waiver is a big step forward in addressing the current crisis here. But let's be clear. In the long run, we must focus on fixing the entire Medicaid system -- not just in Los Angeles, but all across the country -- to create long-term stability and build healthy futures for our children.
Because when it comes to the health of our young people, our commitment to parents cannot begin or end at the hospital doors.
That's why we have developed a new public health strategy for young people that we call "Safe Passages." "Safe Passages" is our comprehensive approach to tackling tough challenges like substance abuse, tobacco use, teen pregnancy, sexually transmitted diseases, violence, diet and physical activity.
It's about 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, overly programmatic federal approach to solving problems. Instead, we are defining the federal role more clearly: to serve as the glue that holds together and empowers our various partners, and to fill gaps that would become gaping holes without our collective efforts.
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 children's mental health is just as important as physical health.
It means moving away from the old "model program" approach of 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 national health campaigns in areas like tobacco use, drug prevention, physical activity 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.
I've never met an American teenager who has read a brochure.
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 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.
In fact, just this morning, I had breakfast at Universal Studios with a powerful group of television producers and executives to enlist their help in our Safe Passages agenda: so that together we can help stop teens from smoking, using drugs and getting pregnant and start them down the right road -- the healthy road -- in life.
Some people say that we're wasting our time trying to work with the entertainment industry. They say that the industry will never change and that the proper role for government is merely to shake a finger at them. But I strongly disagree.
I don't have the luxury or the desire to give up on people who speak to millions of children every day. Anyone who pays attention to broadcast and cable television knows there are plenty of good health messages mixed in with the bad.
As health and community 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.
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.
Our proposals would, for example, limit all the easy ways that children get tobacco; restrict placement of tobacco billboards; take the Marlboro Man out of publications read by children; and, prohibit tobacco companies from using the allure of their name brands when they sponsor sporting and entertainment events.
To help spread the message, we recently 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 includes television ads that will air wherever the team travels, sending a clear message to millions of children: 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 children are getting their information about tobacco from their parents -- not from Joe Camel!
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 -- and the President will not let them be overturned!
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 system worked out with the entertainment industry -- 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, public health leaders, clergy, employers, media figures, government officials, and, of course, young people themselves.
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.
Because, when all is said and done, and the historians have written about the footsteps we left and the contributions we made, how will they judge us? By our guts and courage -- to do the right thing.
I am reminded of that wonderful scene in the movie, Apollo 13. The NASA staff has just realized that the mission must be terminated, and there isn't enough battery power to make the trip back home. The mission director calls the staff into a briefing room and tells them that they must squeeze every amp of power out of the spacecraft. And, then in case there was any confusion, he tells them pointedly, "Failure is not an option."
Failure is not an option.
Failure has never been an option.
Not when children are at risk.
Not when families are at risk.
Not when the future of our country is at risk.
Thank you.