Remarks as Prepared; Not a Transcript.

Vice Admiral Richard H. Carmona, M.D., M.P.H, FACS
United States Surgeon General
U.S. Department of Health and Human Services

National Association of Local Board of Health

July 30, 2004
Denver, Colorado

"Local Boards of Health: Global Vision. Local Leadership."

Thank you for the opportunity to speak to you today. This is a tremendous honor to speak to you as the nation's surgeon general. It's been an incredible journey.

Priorities
I'm fortunate to work for two bosses who understand the importance of health. Both President Bush and Secretary Thompson insist that evidence and the best science always guide our policy and what I do.

When President Bush nominated me to be Surgeon General, he asked me to focus on three priorities.

All three of my priorities are very strongly evidence-based. They are:

• First, Prevention. - What each of us can do in our own lives and communities to make ourselves and our families healthier.

• Second, Public Health Preparedness. We are investing resources at the federal, state, and local levels to prevent, mitigate, and respond to all-hazards emergencies. and

• Third, Eliminating Health Care Disparities. As you know, the chronic health conditions that plague our nation are most pervasive in communities of color and immigrant communities.

It wasn't too long ago that I was charged with running the health system of Pima County in Arizona. As state and local health leaders, we're faced with the challenge of providing the best health services to everyone in the community. Including those who we know will never be able to pay for it.

Our hospitals in Pima County served hundreds of people who came across the border from Mexico just to receive medical care. We stared at the challenge of providing them service in the face of mounting costs, but with the understanding that not only did the law mandate we care for them … and so did our conscience.

Today we face additional challenges with manmade threats of bioterrorism lurking in every town and naturally occurring threats like powerful weather and increasing rates of obesity.

Obesity is the fastest-growing cause of death and disease in our nation. It is only second to smoking in its lethal impact in the U.S. Over the past decade the number of deaths associated with excess weight has increased over 30%, now claiming more than 400,000 American lives each year.

That, coupled with those who die due to smoking, now totals nearly 850,000 souls. How tragic it is that so much of the heartache that is felt throughout our land is caused by completely preventable habits that we've imbued into our culture of excess.

Secretary Thompson was the first to preach the sermon of prevention - now it's become a choir singing in unison.

We all know that by taking simple steps like being physically active every day, eating healthy foods, and not smoking we greatly improve our health and our lives.

And no one is immune. We are seeing more and more of our children outgrowing the waists on their pants, before their lengths.

Due to too many kids playing more on their PlayStations than on their playgrounds they have gone from Generation Y to Generation XL. And this weight gain has long-term health consequences.

We're seeing kids in doctors' offices with type 2 diabetes, high blood pressure, and poor overall health.

And we know that three quarters of these overweight kids will be overweight adults.

This is a trend that we must reverse, or we will have an overburdened health care system that simply cannot afford to treat the maladies of the day. We need to work together across all sectors of American life to address this public health crisis.

Instead of investing resources in finding cures and treatments for terminal diseases like cancer or disabilities like macular degeneration, we are spending money to fix the results of the poor decisions that people make.

As a trauma surgeon, nearly 2 out of 3 emergencies I would see were preventable. Too often the person on the gurney was there because of a bad decision that night, or a series of bad decisions over a lifetime.

As the fraction of our gross domestic product goes to health care increases, we have less for other necessities of our society, including medical research.

As a government we are doing our best to fund the miracles of tomorrow, today.

President Bush fulfilled his campaign promise to complete the doubling of N-I-H's budget, and my friend Dr. Zerhouni has focused that agency's resources into providing the best possible service to the American people.

Research
One of the unsung advances of the National Institutes of Health, especially during this campaign season, is that of stem cell research.

For years, the N-I-H has funded stem cell research among adult stem cells and next week, we will mark the third anniversary of embryonic research supported by the National Institutes of Health.

President Bush was the first president in this country to allow federal stem cell funding.

He made the decision before I became surgeon general, but I remember listening to his speech to America outlining his plan, thinking what a thoughtful framework he was providing.

Embryonic stem cell research may hold untold promise to many people who are suffering from terrible diseases. We don't know yet.

But what we do recognize is the fine line the president, as the leader of the free world, must walk in such moral and ethical dilemmas.

As the president he took a stand for research while protecting the sanctity that he and millions of Americans share.

In addition, this administration has not opposed the private funding of any stem cell research.

And, while the government does a lot of good things, we don't do everything right. In fact, most of our medical discoveries are made by universities and companies around the country.

State Children's Health Insurance Program
One of the things that the government does do well, is insuring children through the S-CHIP program. I know that a lot of you are involved in administering your states' S-CHIP program.

Next week I will join with the Robert Wood Johnson in kicking off a program to help sign more kids up for S-CHIP. I hope you share our goal of signing every eligible child up for S-CHIP.

It's sometimes confounding to some parents, especially those who work. But we want to encourage every parent of every uninsured child to call 1-877-KIDS-NOW to see about their eligibility.

When children have S-CHIP or Medicaid coverage, they have better access to the health care that they need. They can go to the doctor for check-ups, not the E-R as a last resort.

It breaks my heart that every night thousands of American kids are going to bed not feeling well, needing health care.

It's even worse because I know what it's like to be the kid who goes to bed praying to just feel a little bit better in the morning.

Children need health care coverage right now. Not tomorrow, or next week, or after they're sick. Today.

If you know uninsured families in your community, please reach out to them and tell them about 1-877-KIDS-NOW.

And we must ensure that every child, and for that matter every adult, is vaccinated against those diseases that we have vaccines for. We don't want anyone to needlessly suffer or die from a vaccine-preventable disease.

We know that children who are healthier miss less school and, naturally, do better in school. We shouldn't rob a child of a bright tomorrow, by not providing for her health today.

This really is a responsibility of the pubic health community to ensure that we have provided the care that Americans need, children and adults.

One way to take a step in making a community healthier is by improving our nation's health literacy.

Most of the preventable diseases that are cutting healthy years off the lives of people in places like where I grew up in New York City could be eliminated if people had access to better health information, and understood and acted on that information. Eliminating health disparities is predicated on increasing health literacy.

Health Literacy
Our nation's low health literacy is a threat to the health and well-being of Americans and to the health and well-being of the American health care system.

Low health literacy adds as much as $58 billion per year to health care costs. More than 90 million Americans cannot adequately understand basic health information.

Further studies show that people of all ages, races, incomes, and education levels are challenged by low health literacy.

Right now low health literacy is a problem throughout our nation -

• From Native American communities,
• To rural areas of Appalachia,
• To the Great Plains,
• To urban areas.

Even the seemingly simple things that we can all do to stay healthy and safe, such as getting regular medical check-ups and eating healthy foods, can be struggles for many families. The reality is that to be able to do these things, we must have a basic infrastructure and understanding of why these choices are important to our health and safety, as well as our family's health and safety.

Health literacy is the ability of an individual to access, understand, and use health-related information and services to make appropriate health decisions.

By doing this we can alleviate a lot of the health problems that so many people face.

Preparedness
Naturally, there are some things that we, as government and local health leaders must do to improve the overall health of the community.

One thing that President Bush and Secretary Thompson have done, especially since September 11, is to strengthen our public health care infrastructure.

To date, nearly $4 billion has been invested in state and local response systems and hospitals to improve bioterrorism preparedness since 9/11, and President Bush and Secretary Thompson's commitment will continue.

But as we all know, especially those of you who are involved in emergency response, we are much more likely to have to care for an emergency resulting in a natural disaster, like a flood, hurricane, tornado, or snow storm, than we are from a terrorist attack.

What we as a national and public health community have accomplished by investing to combat the threat of bioterrorism has had the effect of strengthening our hospitals, our local surge capacity, our communications efforts, and our laboratory capability.

We are certainly better prepared today, than we were three years ago and we will continue to prepare ourselves for any emergency.

MRC
Many communities across the country are taking this all one step further by organizing a Medical Reserve Corps in their community.

To date, we have more than 200 M-R-Cs throughout the United States at the ready to augment local response activities in the case of any major event needing additional medial and health resources.

After 9/11 the American spirit poured out as millions of Americans asked, "What can I do to help?" President Bush started Freedom Corps to promote this sentiment of volunteerism, and the Medical Reserve Corps is part of that initiative.

The Corps is run out of the office my office, led by the Secretary and guided by President Bush's vision.

I would encourage each of your communities to look into setting up a Medical Reserve Corps in your locality to be there in times of greatest need.

We know that when responding to emergencies, people from the local community are the first on the scene and the last to leave. The M-R-C gives communities a focused and organized way to channel the eagerness to lend a hand into something productive and useful.

Closing
And in closing I would like to thank those volunteers who are serving in our armed forces across the country and around the world.

This great nation has assembled the greatest, all-volunteer armed forces the world has ever seen. And as a Vietnam vet, a father, and a citizen I want to thank all of our young men and women who are fighting to protect freedom far away from our shores.

Since September 11, our brave sons and daughters, mothers and fathers have liberated 50 million people.

These people who lived under the thumb of oppression for decades, some for the first time breathing the fresh air of liberty. By fighting terrorism around the globe, we help those living under the hostilities of dictatorship, but also protect our freedom here.

I know that many of you have loved ones serving in Iraq and Afghanistan and other localities today. And I know that you are all proud of them and their commitment to service and to duty and to liberty.

And next time you talk to them, tell them thanks, from their Surgeon General. Thank you and may God continue to bless America.

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Last revised: January 9, 2007