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Remarks as prepared; Speaker will deviate from prepared text Vice Admiral Richard H. Carmona, M.D., M.P.H, FACS Thank you, Dennis, (Dennis O'Leary, M.D., JCAHO President) for that terrific introduction. It's great to be here with all of you today. Today's topic: closing the gap between the more than 83,000 people who need an organ to save or enhance their lives, and the donations needed from fellow citizens and family members who can give the Gift of Life, is one that is very important to me and to my boss, Secretary Thompson. My official title may be Surgeon General, but one of my most important titles is 'Organ Donor',... and my family knows about it! I have seen this issue from a very basic level. As a trauma surgeon in an emergency room, I watched when family members facing the most difficult crisis of their lives — the loss of a child or spouse — also wrestled with the difficult decision of whether or not to donate that child or spouse's organs and tissues. Those of you who have been through it yourselves know that it is both heartbreaking and life-giving at the same time. Families devastated by the loss of a loved one can take comfort in knowing that their loved one's organs and tissues have saved or improved up to 50 other lives. And now, of course, I am seeing the issue from a new vantage point — that of Surgeon General. I see the numbers — more than 83,000 people waiting for transplants, 18 of whom die each day. Those numbers represent real people, with real lives, with loved ones who wait expectantly, and hopefully, and perhaps fearfully, knowing they cannot control the outcome but must depend on the good will of others. I see the discrepancies between donation levels at various major hospitals. I hear the myths surrounding the issue of organ donation, which prevent innumerable people from giving the Gift of Life. And like Secretary Thompson, whose very first initiative as leader of Health and Human Services was to implement the Gift of Life Donation Initiative, I want to work hard to close the gap. When President Bush and Secretary Thompson nominated me to be Surgeon General, they asked me to focus on three priorities to maintain and improve the health of the American people. All three of my priorities are evidence-based. They are: prevention, public health preparedness, and eliminating health care disparities. Woven through all these issues that constitute my portfolio is health literacy. Today I will speak about health literacy and the relationship of all these priorities to organ donation. Prevention There is no greater imperative in American health care than switching from a treatment-oriented society, to a prevention-oriented society. Right now we've got it backwards. We wait years and years, doing nothing about unhealthy eating habits and lack of physical activity, or poor choices about smoking, alcohol and drugs, until people get sick. Then we spend lots of money on costly treatments to make them well, often when it is already too late. The paradox of modern health care is this: while medical technology is pushing forward at a breathtaking rate, helping us to save more lives than ever, our behavior as individuals has not kept pace. In 1954, surgeons removed a kidney from one identical twin and placed it in the other. That was the first organ transplant. Just 50 years ago. In 2002, almost 25,000 transplants were performed. Organ transplantation is truly a miracle of modern medicine. But as our ability to perform these operations more successfully grows, so does the need for them, as illnesses leading to organ failure, such as diabetes and high blood pressure, continue to increase. Tobacco-related illness kills 435,000 American a year. Obesity-related illness is catching up quickly, now resulting in 400,000 deaths each year. Yesterday the Secretary announced an innovative public awareness and education campaign called Healthy Lifestyles & Disease Prevention. The campaign encourages American families to take small, manageable steps within their current lifestyle — versus drastic changes — to ensure effective, long-term weight control. Also, NIH is developing a Strategic Plan for Obesity Research which will explore prevention and treatment approaches that encompass behavioral, socio-cultural, environmental and genetic factors contributing to obesity. As we bring about change in the lifestyles and choices of Americans — a long, difficult process to be sure — we will very gradually reduce the need for organ donation. Public Health Preparedness We are investing the resources at the federal, state, and local levels to strengthen the public health system and to prevent, mitigate, and respond to all-hazards emergencies. As we prepare for emergencies by funding hospitals, state and local trauma and EMS systems and other partners, we are also building a stronger public health system. And we are better prepared to meet traditional public health needs, such as emerging illness and immunization. Eliminating Health Care Disparities The scientific evidence is crystal clear: Many individuals from minority communities suffer a greater burden of death and disease from breast cancer, prostate cancer, cervical cancer, cardiovascular disease and other illnesses. At HHS we are working hard to eliminate health disparities through our research institutes, such as the National Center on Minority Health and Health Disparities and the National Cancer Institute and our outreach efforts such as Take a Loved One to the Doctor Day. And the President has kept his commitment to expand Community Health Centers to serve more people, many in communities of color. In the last three years, we have expanded access for an additional 3 million people through 614 new and expanded sites. We need to do more to eliminate disparities, which are also present when it comes to organ donation. Finding a matching donor is much easier when the patient and donor share a similar heritage or ethnicity. While minorities have typically donated in proportion to their percentages of the population, they have a higher need for transplants due to the higher incidence of disease they face. Health Literacy The problem is low health literacy. Health literacy is the ability of an individual to access, understand, and use health-related information and services to make appropriate health decisions. Consider this: A recent study of English-speaking patients in public hospitals revealed that one-third were unable to read basic health materials. 26% of the patients could not read their appointment slips, and 42% did not understand the labels on their prescription bottles. Further studies show that people of all ages, races, incomes, and education levels are challenged by low health literacy. Not every American is a scientist or a health care professional, and we can't expect everyone to understand what it takes health care professionals years of training to learn. National efforts to increase public awareness and donations Many Americans simply do not know the facts about organ donation. And as we know, in the absence of good information, bad information thrives. The myths out there about organ donation range from the 'seemingly logical' — "I have a history of illness; you wouldn't want my organs" — to the absurd, "If the hospital knows I am a donor, they will not try to save my life if I am in an accident." How do we overcome those myths? Better information. And better information will lead to increased donation. According to a 2001 study by the Agency for Healthcare Research and Quality (AHRQ), organ donations increase when families have good information about the donation process. The study found that:
So Secretary Thompson has made increasing public awareness and promoting organ, tissue, marrow and blood donation the heart of his Gift of Life Donation Campaign. His goal is to reach all Americans through:
We are also working to increase public awareness through the media. Last fall, the HHS-funded PBS documentary "No Greater Love," which highlighted the critical need for donors, won an Emmy. We have done special media targeting in minority communities — $2 million in the last year in radio ads and printed materials in 15 media markets with the highest numbers of Hispanics and African Americans. These are only some of the ways we are working to 'get the word out' — to improve health literacy — about organ donation. Many of you here today also are engaged in a myriad of activities to promote donation in communities, schools, hospitals and other venues. And it is working. Secretary Thompson announced last month that organ donation is up 4.8 percent for the first 11 months of 2003. This is the most significant organ donation increase since 1998. There is also very promising news when it comes to minorities: in 2003, donations among Hispanics increased by nearly 14%, and donations among African-Americans increased by more than 11%. National efforts to increase donation through the
Secretary’s Organ Donation Breakthrough Collaborative Most hospitals have donation rates ranging from 30 - 55% of their potential donors. Some hospitals, though, have donation rates over 75%, so clearly there are discrepancies in the way the donation process works in various hospitals. We are working to 'close this gap' as well. Last fall Secretary Thompson joined leaders of large hospitals and organ procurement organizations to release a study profiling the practices being used by these successful organizations to achieve high organ donation rates. At the same time, leaders from other hospitals spent two days learning about these 'best practices' and returned to their institutions to design and implement changes to increase donation rates. We are pleased with the progress of the Secretary's Organ Donation Breakthrough Collaborative, and the support the Join Commission has shown for this initiative. Charge
Greater love has no one than this, than to lay down one's life for his friends (John 15:13) Americans are the most generous people on earth, and my belief is that when they know the facts about organ donation, and when we provide them the means to indicate their wishes in a simple way, they will respond overwhelmingly in their willingness to give the gift of life to others if their own lives are cut tragically short. Let's keep working together on this most noble cause. Thank you. ### Last Revised: April 27, 2004 |
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