Remarks by

DAVID SATCHER, M.D., PH.D.
Assistant Secretary for Health and Surgeon General
Office of Public Health and Science



KEYNOTE ADDRESS

"Building the Next Generation of Healthy People"

National Healthy People Consortium Meeting and Public Hearing
Washington, DC
Friday, November 12, 1998
11:30 a.m.

This text is the basis for the Assistant Secretary for Health and Surgeon General's oral remarks. It should be used with the understanding that some material may be added or omitted during presentation.

Acknowledgments

• Good afternoon.
• It is a pleasure for me to be here with you today.
• Welcome to "Building the Next Generation of Healthy People," our National Healthy People Consortium Meeting and Public Hearing. This is the 11^th convocation - what many of you have come to know as the "Healthy People Family Reunion."
• We have but a year to go before the dawn of the new millennium. It is good to be with you as we review our progress on Healthy People 2000 and as we look forward to Healthy People 2010. This is truly a critical moment in time, when we pause to assess where we are and where we need to go over the next decade.
• For those of you who were here last evening, you know that it was in 1979 when the concept of Healthy People was introduced. Surgeon General Julius Richmond -- who, by the way, was also Assistant Secretary for Health and the only other person who has had both titles -- introduced the concept of forecasting health goals in his landmark Surgeon General's Report on Health Promotion and Disease Prevention. That report led to objectives for 1990, which gave us focus and 10-year targets for where we want to go in terms of the nation's health.

Appreciation to Consortium Members

• We are here because we know we must examine the nation's health needs in order for us to address them most effectively. We know that unless we take advantage of opportunities to identify those needs, and unless we gear up to be in a position to respond, we will never reach our goals.
• Let me personally commend all of you and thank you for your involvement in Healthy People. Without you, we could not have arrived at this point, nor could we claim the successes we have achieved.

Regional Meetings and the Internet

• I should also mention how gratifying the public's response has been both in person during our Regional Meetings, and electronically through the Internet.
• We have held three regional public hearings on the 2010 draft -- one in Philadelphia, New Orleans, and Chicago. Two more are scheduled in Seattle and Sacramento in early December. Thus far, we have received tremendous response. It's the kind of response that underscores the importance of what we are doing here.
• We have also had a huge volume of Internet activity on the Healthy People Web site. I understand that more than 15,000 people are using this site every month and we have received more than electronic 1,000 comments on the 2010 draft.
• It is up to us to refine the 2010 proposal by taking what we hear from these meetings and listening, learning, and responding.

Our Foundation: Accomplishments of HP 2000

It occurred to me that this whole Healthy People process is similar to building a house. With the previous sets of goals and objectives, we have a clear blueprint in place and have laid a good, solid foundation. For example:

• Currently, 47 are states actively involved in Healthy People 2000, tailoring the objectives to meet their own needs and setting their own targets. And "healthy city and healthy community" initiatives are being pursued throughout the country.
• Hundreds of national organizations, including the ones you lead, have reviewed the Year 2000 objectives and have adopted them as their own.

  For example, the American Dental Association adopted the Healthy People oral targets. (I should note that we have a panel of people working on a Surgeon General's Report on Oral Health, which should be ready by the year 2000.)

  The American Public Health Association used the objectives to develop what they call "model standards" for communities throughout the country.

  Additionally, there are many schools, work sites, and senior citizen groups that have selected objectives and have really been working to accomplish them.

• In revisiting the Year 2000 goals, our successes are clear in areas like (1) increasing the span of healthy life; (2) reducing health disparities; and (3) achieving access to preventive services.
• I am pleased to report that we have been successful in reaching more than 60 percent of the HP 2000 goals.

On some accounts, we have done better than we had hoped. For example, teenage pregnancy is coming down. Homicide is decreasing. For some groups, we have made a great deal of progress with suicide and most cancer deaths. And we are close to reaching our targets for infant mortality, breast feeding, influenza immunizations for older adults, mammography screening, regular dental visits and getting Americans to eat five fruits and vegetables a day.

On other accounts, we have done worse. In areas like obesity, diabetes, and low birthweight babies, we still have a long way to go.

And, still, in many instances, because we don't have the data, we are not sure where we are. But it is clear that overall we are making tremendous strides because of Healthy People 2000. In this final year of the 1990s, let us continue the push toward fulfilling more of our Healthy People 2000 goals.

Setting the Framework: Where We're Going from Here

Now that the foundation is in place, it's important for us to plan how we are to build the framework for the next set of Healthy People objectives.

We have proposed the two overriding goals for the Year 2010. One, to expand the years and the quality of life, and two, to eliminate disparities in health. This leads me to a discussion of some of the major challenges we face today.

These new challenges, which are part of the Healthy People 2010 draft, represent opportunities for the future improvements that we did not include before. We need your comments on the following new proposals.

1. The first is health communication. The objectives here seek to increase the quality and content of health communication messages. We have got to find better ways to relay our messages to the public.
2. The second deals with the public health infrastructure. We struggled with this question while I was director of CDC: How do you improve the public health infrastructure? How do you ensure that public health organizations at federal, state, and local levels have the capacity to provide essential services?

• Ten years ago, the Institute of Medicine issued a report stating that the public health infrastructure in this country is deteriorating. These proposed HP 2010 objectives give us the framework for monitoring that capacity. They are the much-needed tools for us to use in ensuring that we are working to strengthen public health.

3. Third, Healthy People 2010 brings into greater focus disabling conditions like arthritis, osteoporosis, and chronic back conditions, as well as respiratory diseases. As the population ages, we cannot in good conscience fail to address these conditions.
4. And that leads to the new focus on disability and the prevention of secondary health conditions. I believe that the 2010 draft objectives can bring greater attention to depression and physical pain among persons with disabilities. The question here is: How do we manage disabilities? HP 2010 gives us a framework to eliminate health disparities between people with disabilities and the total United States population.

Challenges of Today and the Future

Many of these areas represent very important health concerns. And it is in this spirit that we gather here today. How do we identify and take on new challenges for the Year 2010? How do we deal with the increasing diversity in our society? How do we respond to the fact that the fastest growing age group in this country is the elderly - really, those over 80 years of age? What are the implications of that for the future? What are the implications of the fact that in the area of mental health we have had a tripling of suicides among teenagers since 1950? -That for every two people killed by homicide, three people take their own lives? What do these facts imply for the future, and how do we prevent stem the growth of these troubling patterns? For example,

• Obesity is at an all-time high, even among teenagers. Almost 15% of teenagers are overweight; about 36% of adults are overweight. In fact, half of all African-American and Hispanic women are overweight.
• Despite some reductions, smoking is all too common with more than 25%; 3,000 new teenagers become smokers each day.
• Virtually no state in the Union requires Physical Education in grades K-12.
• Too few Americans consume five servings of fruits and vegetables each day.
• Too few persons with high blood pressure are diagnosed and treated, and too few have their blood pressure controlled.
• Too few diabetics are diagnosed and adequately treated.
• Too few physicians are putting prevention into practice-National Prevention Service Task Force Reassembled.

These problems will not be solved unless we develop a stable and accessible community health system. What we need is a public health approach to solving our nation's ailments -- an approach that calls for serious commitment to health promotion, disease prevention, early diagnosis and access to care.

Shortly after I was sworn in this past February, my staff and I set out to identify the major areas of emphases during my tenure as Surgeon General. We put together what I call the Surgeon General's "evolving priorities." They are designed to help alleviate some of these national health problems. Allow me to use this opportunity to share them with you. It is my hope that you will not only listen, but that you will respond by telling us whether you think the 2010 objectives will move us toward achieving these priorities.

Every child should be given the opportunity for a healthy start in life. Getting a healthy start in life means several things, relates to healthy parents, healthy babies, and healthy environments. It means ensuring healthy pregnancies by making sure mothers have access to quality prenatal care. It means addressing teen pregnancy so that babies are born to parents who are ready to be parents. It means a safe and nurturing environment for babies.

• Tell us whether the maternal, infant and child health objectives proposed for 2010 are moving us toward these desired outcomes.

Promoting healthy lifestyles. When we talk about promoting healthy lifestyles, we are mainly talking about four areas: nutrition, avoiding toxins, responsible sexual behavior, and physical activity. Promoting good oral health is also critically important and relates to larger health issues.

• Half of premature mortality is preventable, because it is related to behaviors such as poor diet and lack of physical activity, tobacco use, alcohol and drug abuse, and unsafe sexual behavior.

We're not talking about running marathons or becoming an all-star athlete. But by engaging in simple consistent physical activities like walking, gardening, swimming, and cycling, we can improve the nation's physical health significantly.

• Again, tell us whether the physical activity, nutrition, tobacco, and substance abuse objectives are pointing us in the right direction.

We must communicate with the American people about the community health system and how best to access quality health care and services. This initiative is two-fold. First, one of my responsibilities is helping people understand how they can best use the health care system for themselves and their families. At the same time, I must communicate with the American people, as well as the Administration and Congress, about what we need to do to provide all people with access to quality care. We know that managed care is not the answer to America's health care problem; but we must also recognize that it is not the villain we make it out to be.

• I am pleased that the Healthy People 2010 proposal includes a focus area on Improving Access to Quality Health Care with objectives that address primary care, preventive care, emergency services, as well as long-term care and rehabilitative services.
• Tell us whether you think these objectives are leading us in the right direction.

Together we must get the best from our public health system, and together we must make it better.

Improving mental health in the nation. No priority yet has generated as much interest and enthusiasm as this one on mental health. We must remove the blame and stigmatization that surrounds mental health in this nation. Mental health problems often relate to other serious health problems we face in this country, including substance abuse and violence.

• Approximately 40 million Americans, from the ages of 15 to 54, have experienced some type of mental disorder in the past year.
• Clinical depression affects 1 in 7 women, and 1 in 13 men over a lifetime.
• In a study of 6 major physical disorders, only cardiovascular disease was found to be more disabling and result in more hospital stays and lost days of productivity than depression.

  Last month, we held the first-ever national conference on suicide prevention. It was hosted by the Centers for Disease Control and Prevention (CDC), the Substance Abuse and Mental Health Services Administration (SAMSHA), and the Health Resources and Services Administration (HRSA). It was the first time health professionals, suicide survivors, and policy makers have been brought under one roof, in an effort to shape a different future for this country as it relates to suicide and mental health. We hope to gain out of that a Surgeon General's Conference Report on Suicide Prevention. And in the next year or so, we anticipate a Surgeon General's Report on mental health.

• Help us make this set of 2010 Objectives on mental health and mental disorders forward thinking and a framework that can be widely used over the next decade.

Global health must be a concern of this and all nations. We cannot protect the health of the American people unless we think globally. It now takes an individual a mere 24 to 36 hours to travel around the globe, increasing significantly the threat of outbreaks of disease. Beyond that, tobacco and violence are increasingly becoming larger health concerns. As we approach the 21^st century, our efforts will be focused on a maintaining a system of global health surveillance, particularly with regard to (1) coordinating the national response to emerging infectious diseases, (2) leading the national response to health consequences of bioterrorism, and (3) promoting the safety and availability of the nation's food and blood supply.

• Healthy People 2010 is the United States' contribution to the World Health Organization's call to the nations of the world to renew their commitment to health for all in the 21^st Century.
• Are the Healthy People goals moving us in the right direction in terms of global health?

Eliminating Disparities in Health. An overriding factor of each of these objectives is the goal of eliminating racial disparities in health. Back in February of this year, the President unveiled his Initiative on Race and Health. In it, he announced a goal of eliminating racial disparities in health by 2010, coinciding with the Healthy People 2010 Initiative. This means that we have proposed one target for all population groups. For all the medical breakthroughs we have seen in the past century, we still see significant disparities in the medical conditions of racial groups in this country.

It is important to note here that eliminating disparities is not a zero sum game. We are not taking anything from anyone when we ensure everyone's good health. We know that the entire nation benefits when we protect the health of those most vulnerable and at risk. The Public Health Services was founded on this premise 200 years ago.

What Happens Next?

"Life is full of golden opportunities carefully disguised as irresolvable problems." -John Gardner

Partnerships — We believe that the development of meaningful partnerships is key. That includes partnerships with faith-based organizations, civic clubs, local private or public groups and so on. This public comment period is an opportunity to start the synergy among public, private, and public-private organizations and individuals. We're all in this together, and if we are to succeed it will be based on all of our efforts.

Creativity — Let me suggest that states use Public Health Week in April 2000 as a time to release their own versions of Healthy People 2010. Let's take these messages to the public in a way that they've never heard it before so that they reach the cities and the suburbs, the barrios and the reservations, the outer areas and the inner cities.

People often ask me what I'd like to be remembered for as Surgeon General. My response is always the same: I want to be remembered as the Surgeon General who listened to the American people. I recognize how important it is to work toward a shared vision, and it is my goal in this process and others to make sure that we are working toward creating a healthy and whole "national community."

Where Is Our Community?

This reality can really best be illustrated by telling you about a conversation I had with some teenagers during the Eighth International Conference on AIDS in Africa, which was held in Morocco some years ago. After I had questioned them about seemingly high risk behavior of teenagers throughout the world, I asked them for an explanation. They responded with a question: "Dr Satcher, If it takes a community or village to raise a child, where in the 1990s is our community?" And today, as we approach the next millennium, it is still appropriate to ask:

"Where is the community?" This is our chance to say to those children and to our own here at home who, by the way, are raising the same question, "Here we are."

As we wrap of this millennium, we must also lay to rest the disparity issues that confront us, and open wide the door for a new and much needed community health system. I am optimistic about what the future holds for us health-wise, and I look forward to hearing your comments and to working together to make this a healthier nation.