April 10, 2012
I’m glad to be with you this morning because I believe nothing is more important to America’s future than our health. On a national level, you can look at any of our biggest goals as a country – increasing productivity and economic growth, making our businesses more competitive around the world, helping our children succeed in school, reducing our government deficits. Improving health contributes to every single one of them.
On an individual level, health is fundamental to opportunity. The healthier we are, the more freedom we have to pursue our dreams and contribute to our families and communities. A healthier country is one in which many more Americans have the chance to reach their full potential.
We have a clear and powerful national interest in promoting our country’s health. And we know from decades of research that the most effective way to do that is prevention. It’s not only easier to keep people healthy than treat them once they get sick. It’s usually less costly too.
And yet, as you know better than anyone, we have often treated prevention as an afterthought in this country. When this Administration came into office, prevention and public health accounted for less than 4 cents out of every health care dollar.
There were many reasons for this. The benefits of prevention can take a while to appear. When a dramatic surgery saves the life of a heart attack victim, we see the results right away. When a healthy diet helps prevent a deadly heart attack, it may not show up until years later as a data point in a study.
Health promotion is also complicated. There is no prevention pill. Instead, we know that health can be affected by everything from the air we breathe, to the food we eat, to the neighborhood we live in, to our job and income, to our family background. It can be hard to know where to start.
As a result, prevention too often became a talking point – an idea that generated lots of conversation but not enough action, especially from the federal government.
Today, I’m proud to say that this is changing. While much more work remains to be done, this Administration has made prevention a top priority – and an integral part of our health strategy – beginning in our first days in office.
From the First Lady’s historic Let’s Move campaign, to the Recovery Act’s community health investments, to the health care law, to a new emphasis on environmental justice, to a first of its kind National Prevention Strategy – we have made prevention a focus for the federal government over the last three years in a way it has never been before.
And that means the entire federal government. Prevention is no longer just the work of health agencies. Our National Prevention Strategy was developed with input from the Departments of Transportation, Education, Housing and Urban Development and more. And it gives these agencies responsibilities too.
So for those of you working on the front lines to promote better health in cities and towns across the country, my pledge to you this morning is that this Administration is going to be your partner. And today, I want to focus on one of the areas where we have the biggest opportunity to make a difference together, which is our work to reduce tobacco use.
It has now been nearly 50 years since the first Surgeon General’s report on the dangers of smoking. Back then, in the America I grew up in, smoking was everywhere: on airplanes, in offices, at the dinner table. Nearly half of all Americans were smokers.
The work we have done since then to reduce smoking rates is one of the great health triumphs of the last century. A report from the National Cancer Institute earlier this year found that between 1975 and 2000, these efforts saved the lives of 800,000 Americans who would have otherwise died of lung cancer. And that’s looking at a single disease in a 25 year window.
In the late 90s, it looked like this progress would continue as states invested money from the master settlement agreement and tobacco excise taxes in anti-tobacco ad campaigns and other prevention efforts. There was a feeling that tobacco use was on an inevitable decline.
But then we saw a pattern that is too familiar in prevention. Budgets tightened, and resources started getting diverted to areas with a more visible and immediate payoff. By the time this Administration came into office, smoking rates that had been falling for decades were stalled.
Today, smoking remains the leading cause of preventable death, killing an estimated 443,000 Americans – more than died in all of World War II – each year. And for every person who dies from smoking, at least two young smokers take their place. In total, nearly 4,000 young people smoke their first cigarette every day, beginning what may become a deadly addiction before they’re even eligible to vote.
This was the challenge facing the country when this Administration came into office. But there was some good news too: we knew what worked. In large part because of the incredible work many of you have done in states and communities, we already had a set of proven interventions that we knew could prevent illness and save lives.
We know comprehensive smoke-free laws work because states and cities that have put them in place have seen hospitalizations from heart attacks drop an average of up to 17 percent.
We know that helping people quit works because when Massachusetts expanded tobacco cessation benefits for Medicaid recipients, their smoking rates were cut by 26 percent.
And we know how effective comprehensive tobacco control programs can be because California’s has brought smoking levels down to near 12 percent.
These interventions save lives. And they save money too. On average, smokers have $2,000 more in health care costs a year than the general population. That means every time we keep a young person from starting, we could be saving more than $100,000 over his or her lifetime. At a time when health care costs have become one of the biggest items on the budgets of families, businesses, and state and federal government, we can’t afford not to expand these efforts.
So over the last three years, that’s exactly what we’ve done. In areas where the federal government can make a difference, we’re stepping up. For example, using the new regulatory powers it got in the 2009 tobacco control legislation, the FDA is now restricting the use of misleading terms like light or low-tar.
Beginning next year, they’ll also require tobacco companies to disclose the quantities of harmful and potentially harmful chemicals that they put in their products. Today, we know everything about the food we put in our bodies down to the food coloring but have little idea what’s in our cigarettes. That’s going to change.
And FDA has also announced a final rule that will require that cigarette packaging and ads to carry new warning graphic warning labels. This is the most significant change to cigarette warnings in 25 years in the United States, and it ensures that when people pick up a pack of cigarettes, they’ll have much better information about the risk they’re taking.
We’re also doing more to help the 45 million Americans who already smoke quit – something nearly 70 percent of them say they want to do. We know from new research that even long-time smokers’ bodies begin to heal almost immediately if they quit. After just 24 hours, their chances of having a heart attack drop. Within a few weeks, their lungs are working better.
So we’re making it easier for people to break their tobacco addictions. All Americans in new health plans can now get smoking cessation counseling without paying a co-pay or deductible. And we’ve changed a Medicare policy that forced beneficiaries to wait until after symptoms started to appear to get help quitting. Now, seniors can get help before they get sick.
Last month, we also did something that the federal government has never done before: we launched a national tobacco control media campaign. We estimate the new ads will lead more than half a million smokers to seek out the resources they need to quit, saving $170 million over the next three years. And I’m happy to report that in the week after the campaign went on the air, we saw the number of calls to our national quit line more than double.
These are all steps it makes sense to take at the federal level. But we also recognize that most of the work in our battle against tobacco use has and will continue to happen at the state and local level. So with funding from the Recovery Act and the health care law, we’re funding proven community efforts like establishing smoke-free policies in parks and housing projects that we hope can become national models. We’re reaching out to employers too, helping them establish smoke-free workplaces that improve health and productivity. And we’re working with states to step up inspections to ensure that retailers don’t sell tobacco products to kids.
Our approach, in other words, is to take every proven intervention we have – and then do them all. That’s important because, personal decisions around tobacco use are not easy. One person may quit because they see an ad on television. Another may stop because of the inconvenience of not being able to smoke at their workplace or favorite restaurant. A third may kick the habit with the help of a counseling program. But more often, it’s a combination of all these factors that helps people break their addictions. That means we need to cover all the bases.
When you put all these steps together, this is the most ambitious federal tobacco control effort in several decades. But there is much more work to be done. If we are going to get tobacco rates falling again, we need to continue to expand smoke-free policies. We need health care providers to treat start treating tobacco addiction like the potentially deadly condition it is and refer their patients to resources that can help them quit. We need more employers to cover tobacco cessation treatment in their health plans, for the sake of their employees and their bottom lines. We need retailers to continue their efforts to avoid selling tobacco to youth.
If we can do all of this, I believe we have a real shot to achieve our Health People 2020 goal of cutting the share of Americans who smoke to 12 percent. It won’t be easy, but the payoff would be huge. Even if we only got halfway to that goal, we would save millions of lives and hundreds of billions of dollars.
And that’s just tobacco. We’re also seeing new progress in areas from HIV/AIDS, where a new national strategy is in place, to childhood obesity, where the First Lady and others have helped inspire a new sense of urgency and spirit of partnership.
In all these prevention efforts, we’re guided by a few key principles.
First, we need to commit the resources. Prevention cannot just be a talking point.
Second, we need to focus those resources on the interventions that have proven to be effective. We need to pay close attention to the latest science – like the recent discovery that HIV/AIDS treatment is itself one of the best forms of prevention – and let that science inform our work.
Third, we can’t rely on any one intervention. There are no silver bullets. We need a comprehensive approach.
Fourth, no organization can do it on its own. It needs to be the federal, state and local government, schools, the business community, health care providers, community-based organizations, researchers, families and individuals all working together.
Fifth, and most important, we need to sustain these efforts. We have seen time and time again in public health, from tobacco to TB to HIV/AIDS, that we cannot coast to better health. We need to keep our foot down on the accelerator.
No one would ever propose giving our kids half an immunization. Or purifying half a city’s water supply. And we should be just as insistent when it comes to sustaining other life-saving prevention programs too.
We know it will not be easy. But we can no longer afford - from a financial perspective or a health perspective – to rely on delivering better care in intensive care units and emergency rooms as our primary strategy for improving health. It’s about time we as a country got serious about prevention, and this Administration is going to work with you every step of the way to make that happen.