Remarks as prepared; not a transcript

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

Interagency Committee on Smoking and Health meeting

Tuesday, March 9, 2004
9 a.m.
Howard University

"Opening of meeting: Tobacco-Related Disparities Among Racial and Ethnic Groups"

Good morning.  Welcome to today's meeting of the Interagency Committee on Smoking and Health.

I want to thank Howard University for hosting us today. The issues we're meeting to discuss are community issues, and it's great to have our first field visit here at Howard — a community that is as respected for its scientific work as for its commitment to community involvement.

This meeting will focus on Tobacco-Related Disparities Among Racial and Ethnic Groups.

The Problem
Tobacco use remains the leading preventable cause of death and disease in the United States and continues to pose a formidable challenge to the public health community.

Each year more than 440,000 adults die of a smoking-attributable illness in this country.
But this is only one part of the story, because for every person who dies, there are 20 people suffering with at least one serious illness from smoking. In addition, the burden of tobacco use is not evenly distributed throughout the population.

Differences exist among specific population groups along a number of key measures — including:

• differences in the risk of starting to use tobacco;
• differences in quit rates;
• differences in the incidence of tobacco-related diseases;
• differences in morbidity and mortality from these diseases;
  and
• differences in exposure to secondhand tobacco smoke.

In addition, there are important differences in the capacity and infrastructure of organizations to address tobacco control and in people's access to prevention and cessation resources. For example, American Indians and Alaska Natives smoke at higher rates than any other group.

HHS Efforts
Eliminating such disparities in health has been highlighted in many federal initiatives. During my interviews with President Bush and Secretary Thompson for this job, they impressed upon me the importance of eliminating health disparities. Not just reducing them — but eliminating them.

One key HHS initiative is called "Closing the Health Gap."  It's an educational campaign designed to help make good health a critical priority among racial and ethnic minority populations.

In the specific area of smoking cessation, last month Secretary Thompson announced a national network of smoking cessation quit lines to provide all smokers in the United States access to the support and latest information to help them quit smoking.

In addition, the recently published National Healthcare Disparities Report, developed by the Agency for Healthcare Research and Quality, is the first national comprehensive effort to measure differences in access and use of health care services by various populations.

The report provides 7 key findings:

1. Inequality in health care persists.
2. Disparities come at a personal and societal price.
3. Differential access may lead to disparities in quality.
4. Opportunities to provide preventive care are frequently missed.
5. Knowledge of why disparities exist is limited.
6. Improvement is possible.
   and
7. Data limitations hinder targeted improvement efforts.

These findings were consistent with those published in a 2002 Institute of Medicine report, titled "Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care."

The IOM report concluded that to reduce racial and ethnic disparities in health care, we must increase awareness about them among the general public, health care providers, insurance companies, and policymakers. The report also recommended that consistency and equity of care should be promoted through the use of evidence-based guidelines.

On the specific issue of tobacco-related disparities, I'd like to mention two HHS publications of special interest.

The first is the 1998 Surgeon General's report on smoking, which was entitled "Tobacco Use Among U.S. Racial/Ethnic Minority Groups."  The report concluded that cigarette smoking is a major cause of disease and death in each of the four population groups studied in the report — African American, Hispanic, American Indians and Alaska Natives, and Asian Americans and Pacific Islanders.

Today's meeting will serve as an informal update to that report. The 1998 report emphasized that no single factor determines the patterns of tobacco use among racial/ethnic minority groups, but rather, multiple factors are at work.

It went on to say that we need to improve our understanding of racial and ethnic smoking patterns and to identify strategic tobacco-control opportunities. Only then can we be most effective in developing appropriate community-based programs to address the factors involved.

The second publication I'd like to mention is very recent — an article in the January 30, 2004, issue of CDC's Morbidity and Mortality Weekly Report. The article was entitled, "Prevalence of Cigarette Use Among 14 Racial/Ethnic Populations — United States, 1999 to 2001."

Information from the HHS National Survey on Drug Use & Health from 1999, 2000, and 2001 was used to develop this article. The Survey provided a first-ever snapshot of national smoking prevalence data for youth and adults.

The conclusions of the article are consistent with the conclusions of the 1998 Surgeon General's Report — and offer an even finer level of detail that we had 6 years ago.

Closing
In closing, I want to mention that today's meeting is an opportunity for us to better understand the magnitude of the tobacco-use burden in communities of color by looking at scientific data and hearing from communities.

There are many partners who work on the issue of tobacco-related disparities.

•  Some are represented on the distinguished panel of speakers you will be hearing from this morning and afternoon.
• There are also committee members, representatives from organizations, and members of the public here today.
• And others are back in their communities working to reduce the burden of tobacco-related disparities.

Today's discussion is just one piece of a large puzzle and we are open to having further discussions on this topic. Now let's begin by having each of the members introduce themselves.
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Last Revised: April 27, 2004

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