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

2004 National Medical Association Meeting

Monday, August 2, 2004
San Diego, California

"Eliminating Health Disparities: Acting Today, Planning for Tomorrow"

Thank you for the opportunity to speak to you today. This is a tremendous honor to speak to you today.

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. I am so proud that President Bush and Secretary Thompson have charged me with working with them and all of you to eliminate health disparities. Notice that they didn't just charge me with reducing health disparities. They said we will eliminate health disparities.

The fourth area that I have been focusing on for the past year is improving Americans' health literacy.

The NMA was making strides and - let's face it - making waves, in improving health literacy before other professions ever heard of it.

You didn't always call it health literacy, because it was part of your overall effort to help patients and their families. But you are some of the original health literacy advocates. I'm just picking up the flag and carrying it forward using this bully pulpit I now have as your United States Surgeon General.

Stroke Belt Elimination Initiative
This month, Secretary Thompson will announce a new initiative that combines three of these priorities: prevention, increasing health literacy, and eliminating health disparities.

As you know, these three priorities are truly intertwined.

The Secretary's Stroke Belt Elimination Initiative is aimed at reducing the high rates of stroke that disproportionately occur among the population of the seven "Stroke Belt" states - Alabama, Arkansas, Georgia, Mississippi, North Carolina, South Carolina, and Tennessee.

This federal funding to a number of communities across the "Stroke Belt" will be used to implement and coordinate stroke prevention and awareness programs locally and across the region.

The initiative includes comprehensive community-wide education programs, as well as partnerships with health professionals and health systems focused on understanding stroke, improving blood-pressure rates, and reducing stroke rates.

Eliminating Health Disparities
We are working at the federal level to eliminate disparities, through programs like the Stroke Belt Initiative and the upcoming third annual Take a Loved One to the Doctor Day, in which we partner with the Tom Joyner Morning Show to get the word out about the importance of getting screenings and check-ups.

Every day, we're finding better ways to fight disease and death. This is good news for America.

But in too many areas, our nation is still two nations, divided when it comes to health. Simply put: America suffers from racial and ethnic disparities in health.

From the very beginning of life, children of color are at a disadvantage.

• Our infant mortality rates are higher.
• If today is like most other days in America, nearly 1 in 4 minority kids will miss at least one of the immunizations they should receive.
• Cancer, cardiovascular disease, obesity, and HIV/AIDS disproportionately impact people of color.

And this has little to do with genetics. 99.9 percent of all our genes are the same.

Things don't get better when the kids grow up:

• Deaths from cardiovascular disease are 30 percent higher among African-Americans than among white Americans.
• And African American males have the highest incidence rate of many cancers including oral cancer, which many in my own family have also suffered and died from.

We obviously have a lot of work to do. Where should we begin? To start, we must never again look at the health gap as:

• An "African American problem."
• An "Asian American problem."
• A "Native American problem." A "Latino problem."
• It is an American problem that demands an American solution.

Obesity
Let's look at a national problem of obesity. It's the fastest-growing cause of death and disease in our nation. Obesity is second only to smoking in its lethal impact.

Over the past decade the number of deaths associated with excess weight has increased over 30 percent, 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 sickle cell anemia, 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 saw 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 NIH 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. I want to thank all of you who have dedicated your lives to finding cures through research.

Health Literacy
I also want to thank all of you who are taking steps to make your community healthier by improving 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.
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.

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.

Closing
And in closing, I would like to thank the volunteers who are serving in our armed forces.

Our nation has assembled the greatest, all-volunteer armed forces the world has ever seen.

And as a Vietnam veteran, a father, and a citizen, I want to thank all of our young men and women who are fighting to protect freedom.

Since September 11, our brave sons and daughters, mothers and fathers have liberated 50 million people. These were people who lived under the thumb of oppression for decades, and some are for the first time breathing the fresh air of liberty.

By fighting terrorism around the world, 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