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REMARKS BY: DONNA E. SHALALA, SECRETARY OF HEALTH AND HUMAN SERVICES PLACE: Virginia Commonwealth University, Richmond, Virginia DATE: September 10, 1996
They are not all here today because they're working hard, trying to get the accounts of their small businesses to balance; waiting on tables; standing on the assemblyline; and mining coal. They are working to make sure that Virginia continues its investment in a strong public higher education system. They believe that education and training at the highest level are the best economic investment that this state can make.
And so do I.
So, it is an honor to join the community of Virginia Commonwealth University as you get ready to dedicate your new Medical Sciences Building later today.
I may be a few hours early, but I'm not too early to see that this building is a magnificent portrait of the health care training and research we need to bring us into the 21st century.
You are the future -- because of your cutting edge technology, yes. But more important, because of your cutting edge idea.
The idea was simple: Create a world class academic health center that views medicine, public health and allied sciences as pieces of a greater whole. That may seem like the obvious way to go, but history tells a very different story. In fact, earlier this year I spoke at a conference in Chicago to our nation's top leaders in medicine and public health.
Imagine: Many of them had worked in the same fields and in the same communities for years. And, not only had they never worked together before, in some cases, they had never spoken to each other before.
Why? Because too often public health and medicine have operated as two trains on parallel tracks -- with windows facing opposite directions, looking out on different terrain. The public health train sees the forest: A large population of trees, similar in size -- growing together and weathering the same storms. The medical train sees the individual trees: the subtle differences in size, color, age and health.
Now we must out of two trains forge one -- and send it back to prevent disease and improve health all across America.
Because if we don't craft a seamless partnership among medicine, public health and the research that supports them -- it will be our health system, not the patient, that is, in T.S. Eliot's words, "Etherized upon a table."
We must not let that happen.
What we need is a new health care revolution -- a revolution that exchanges the traditional medical model which focuses on healing with a collaborative health model focused on prevention. This Administration wants to join you in leading that revolution. That's why we've requested increases in the NIH budget -- not one, not two, not three, but four years in a row.
That's why we've recruited some of our country's most brilliant minds to lead our health care agenda, from Phil Lee, our Assistant Secretary for Health to Harold Varmus, the director to NIH. And, from Jo Ivey Boufford, who is shaping our international health strategy, to David Kessler, our extraordinary FDA Commissioner, to David Satcher who's leading the CDC into the next century. And that's why we've tossed out the cookie cutter boxes and created a coordinated, interdisciplinary approach to meet all our health care challenges.
Take the issue of domestic violence.
Domestic violence is not a woman's problem. It is a family problem. It is my problem. It is your problem. It is our problem, and all of us must solve it together. We need a seamless system that reaches out to women where they work, live, and go to school -- a seamless system that leaves no gaps. And that's exactly what we are working to create. With tougher penalties for abusers. Better training for police, prosecutors, judges and doctors. More community policing and prevention.
And now, a new toll free telephone hotline that women all over America can call 24 hours a day -- every day of the year.
That's the right approach. And it's the same approach we've taken with childhood immunizations, AIDS, drug prevention, breast cancer and our historic initiative to kick tobacco out of the lives of our children.
But, these efforts are only the tip of the iceberg.
Our health care system is changing dramatically, creating big challenges, and even greater opportunities -- but only if we work together. So, in the spirit of David Letterman, I offer you Secretary Shalala's top ten list of things we must do together -- to create the 21st century health system that our citizens need and deserve.
10. It's Time to Focus Like a Laser Beam on Prevention.
America in the 21st century will have more seniors, higher health care costs, and fewer hospital beds.
When the vast majority of preventable deaths are caused by tobacco, poor diet and lack of physical activity -- we know that to save money and save lives, all of us must focus on prevention. From flu vaccines to mammography to promoting regular moderate activity, we must foster a dialogue among all health disciplines so that we can identify the problems and create a united front to prevent them -- before they start.
And how do we do that?
9. We Must Hop Onto the Information Superhighway.
Community by community, we need to be able to ask the right questions and get the right answers: Who makes up the fastest growing population of AIDS victims in Richmond, and how are they getting it? Why are breast cancer rates high in one part of a Virginia, and low in another? Are the promising results of one clinical trial applicable and available to another?
To make sure everyone has access to the best information, we envision a health care information network linking federal, state and private sector data bases; a network that has national standards, is easily accessible, and has strong privacy and security protections; a network that gets results.
But, to get those results, we cannot rest on our laurels -- which brings me to number eight:
8. Let's Ensure that Research not only Survives -- but Thrives.
When it comes to developing unique research strategies for our communities, everyone -- from doctors to public health experts to scientists must bring their expertise to the table.
Yes, we must continue to unlock the incremental mysteries in basic science that culminate in blockbuster discoveries over time.
But, we must cast our net wider than that.
From behavioral science to environmental research to nutrition, we must pursue every kind of research that holds the potential to prevent disease and help Americans live healthier lives. But research cannot survive in a world of uncertain budgets. To create real security for research, we have to find more stable ways of financing it, so that the best young minds enter medicine and public health, stay there, and go on to train the next generation of health professionals.
Which brings me to number seven:
7. We Must Train Tomorrow's Workforce Today.
To train a workforce that can solve the health problems of the future, we need to ask ourselves some very basic questions: As our health care system continues to change, who -- from doctors to dentists, and from nurses to allied health professionals -- do we need to work for us tomorrow?
And, how can we find them and train them today? We need professionals who come from a broad spectrum of the community, and understand the social, cultural and economic realities of the people they serve. And when it comes to training, we need to figure out what the workforce of the next century needs to know - - and how can we ensure that we are teaching it today. That means bioethics. Physical and occupational therapy. Social sciences. Health administration. Pharmacology. Epidemiology. Toxicology. Biostatistics.
But, that kind of research and training will not simply survive on its own.
6. We Need to Protect the Treasure of Academic Health Centers.
I don't have to tell you about the impact that cost-cutting is having on these cherished institutions. It is not easy or inexpensive to run an Academic Health Center.
I know, I ran one.
But, our Academic Health Centers are the envy of the world.
They are places like the Medical College of Virginia, where we will educate and train the next generation of researchers, doctors and other health professionals. They are the places where we often take care of our neediest citizens. And, they are the places where we often make some of the most important scientific breakthroughs.
Their mandate is unique and their goals will not simply survive in the marketplace. As a country, we must address the complex -- and potentially devastating -- pressures squeezing Academic Health Centers.
At HHS, we have a working group -- led by Phil Lee -- doing just that. We want to find innovative ways to safeguard the irreplaceable -- absolutely irreplaceable -- contributions that these great institutions make. At the same time, we must ensure that we do not punish progress. It is time to protect and strengthen the treasure of clinical research.
That's why a panel of experts at NIH is looking at how we can protect the critical role -- the "translational role" -- of clinical research. We need to reinforce the link between the laboratories of science and the livingrooms of our citizens, so that the best science in the world reaches people all over the world.
5. Our Bioethics Must be Just as Sophisticated as our Science.
As advances, from data collection to the Human Genome, continue to emerge, they will raise serious ethical questions.
And, those questions must be answered quickly and fairly. Because, we must not create a world where our genetic map is used to deny us jobs or health insurance. We must not create a world where scientific breakthroughs widen the chasm between the haves and have nots. We must not create a world where data systems force Americans to give up their right to privacy and confidentiality. And, we must not create a world where the worthy goal of scientific progress eclipses our fundamental sense of humanity, fairness and values.
What's that going to take?
4. We need to take the long view.
The promise of gene therapy -- while awe inspiring -- is still miles from being realized. That tough wake up call reminded us of some important lessons. It reminded us that we have to invest more in the incremental gifts of basic science.
It reminded us of the importance of honesty and self- criticism, and the ability to change directions, even in mid- sentence, if it will help us meet our goals. And, it reminded us that we have to do a better job of educating the profession and the public about what's really possible right now -- and what's not.
That won't happen unless:
3. Literacy Must Mean Scientific Literacy.
It's not enough to just train the best scientists; every citizen in America must be scientifically literate. That's why we've supported the new science education standards from day one. We need a sophisticated electorate that has the context and intellectual discipline to absorb great breakthroughs; an electorate that understands the historical, social, and economic urgency of investing in health; an electorate that cares deeply about how the changes in health care touch and benefit their lives; and an electorate that understands the critical link between good medicine and good public health.
Which brings me to number 2.
2. All of Us Looking Beyond our Professional Backyards
What do poverty, lack of education, age, minority status, and rural background all have in common? These are often determinants of health -- and all of us must address them.
Because, too often, members of vulnerable populations face an array of evils -- like substance abuse, domestic violence, elder abuse, environmental hazards, poor nutrition, and substandard housing. Together, we must address the needs of all vulnerable populations -- from the women living in poverty to young people living with AIDS and other special health problems.
Together, we must maintain Medicaid and Medicare's historic promises of health care for seniors, children, the poor, and the disabled. And, together, we must team up with other parts of government, educational institutions, and community based organizations -- to look beyond our individual training and apply our skills in new directions.
That's what Dr. Stephanie Ferguson did. She's our Department's new White House fellow -- and an alumni of your great nursing school, class of '87. Stephanie, who is with me today, lived in Richmond for ten years. She has dedicated her unique skills, and innovative ideas, to help reduce teen pregnancy and bring primary care to minority communities. She's even written about the therapeutic uses of humor -- something everyone working in Washington should read! Now she'll be putting her experience and expertise to use at every policy level of our Department.
One nurse, looking beyond the borders of her training, to improve the health of her community and her country. That's something all of us should strive to do.
Which brings me to my final challenge.
1. We Must Bring Everyone to the Table.
All of us must understand the unique health problems our communities face -- and have a coordinated strategy for addressing them. That's what you're doing with the Richmond Urban Primary Care Initiative. But we have to do more.
As future health science professionals; as teachers of future health science professionals; as members of the community you have a responsibility to bring everyone to the table. Not just because it's the right thing to do -- but because it's the only thing that works.
By combining the training and scholarship of 5 different health professions under one roof, and one philosophy, VCU is leading the way -- and making an extraordinary contribution to our nation's health. But ultimately, creating a 21st century American health care system is not about what we say here today.
It's about what we do tomorrow.
So all of us -- teachers, students, researchers, administrators, government officials -- need to look deep inside ourselves and ask: In the future, what will be said of the pathways we cleared and the footprints we left?
Did we train and sustain a new generation of health care professionals?
Did we give our citizens the tools they need to make smart choices about the only lives they'll ever have?
Did we do our absolute best?
Did we embrace a common vision, and move forward on common ground -- the ground on which this inspiring Medical Services Building now rests, and from which the health and hopes of this generation -- and every generation -- will grow.
Thank you.