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Remarks as prepared; not a transcript Vice Admiral Richard H. Carmona, M.D., M.P.H, FACS Thank you. It's an honor to be here with you. When I met earlier today with Secretary Frenk, we talked about the outstanding work you are doing here at the Instituto Nacional de Salud Pública. Having spent some of my surgical career as a researcher, particularly in the area of burn trauma, I am truly grateful to all the men and women in our two nations who have dedicated themselves to advancing research and delivering the results of those advances to the people. The research and outreach you are doing is so important, and I commend you for all the great partnerships you have with the Department of Health and Human Services, in particular our National Institutes of Health and Centers for Disease Control and Prevention. The highly productive collaborative relationship between NIH and Mexico spans many years and a broad range of research topics, including cancer, HIV/AIDS, tuberculosis, and other infectious diseases, heart and pulmonary diseases, and maternal and child health. In 2003, NIH invested more than $5.5 million in U.S.-Mexican collaborations. Over the past few years, more than 100 Mexican researchers have trained at NIH through the NIH Visiting Program, and U.S. scientists have of course also trained here in Cuernavaca. Our two nations have truly embraced the reality that health and science have no borders.
When President Bush and Secretary Thompson nominated me to be Surgeon General,
they charged me with three priorities, and all three are applicable to the more
than 290 million Americans in my practice — as well as to every man, woman, and
child in our global village.
and
Woven through all these issues is health literacy, which I will also address
today. Tobacco use is still the single most preventable cause of death and disease, causing over 440,000 deaths each year. And now, obesity-related illness is the fastest-growing killer of Americans. A study by the Centers for Disease Control and Prevention, just reported in this week's Journal of the American Medical Association, indicates that deaths due to poor diet and physical inactivity rose by 33 percent over the past decade and may soon overtake tobacco as the leading preventable cause of death. 400,000 deaths in the U.S. in 2000 [17 percent of all deaths] were related to poor diet and physical inactivity. Only tobacco use caused more deaths [435,000]. Today, nearly 2 out of 3 of all Americans are overweight and obese; that's a 50 percent increase from just a decade ago. [129.6 million Americans, or 64 percent, are overweight or obese] 15 percent of American children and teenagers are already overweight. That's 9 million children. One of every seven American kids. Unless we do something now, they will grow up to be overweight adults, condemned to a lifetime of excess weight and its co-morbidities, including heart disease and diabetes. And as you know, diabetes is now the leading cause of mortality in Mexico. And you are experiencing many of the same problems as we are in the United States. Not only do we have approximately the same rates of tobacco use, now obesity is also sweeping through Mexico at nearly the same rate as it is affecting Americans.
The numbers alone tell us there is no greater imperative in health care than switching from a treatment-oriented society, to a prevention-oriented society. We simply must invest more in prevention, from the time it's easiest: childhood. In fact, this month I testified before a U.S. Senate Subcommittee about the growing problem of childhood obesity and what to do about it. The recommendations I always give for reducing overweight and obesity are achievable: eat healthy foods in healthy portions and get some physical activity every day. All of us — government, business, education, and the media — must work together to encourage families and individuals to adopt healthier lifestyles.
Obesity Research The strategy will intensify research to better understand, prevent, and treat obesity through:
As we all know, there is no single cause of all human obesity, so the research
agenda will explore prevention and treatment approaches that encompass many
aspects, such as behavioral, sociocultural, socioeconomic, environmental,
physiologic, and genetic factors. NIH funding for obesity research is currently
$400 million, and we've requested a 10 percent increase over this year. Some of
that funding should be dedicated to collaborative research between our two
nations. The Healthy Lifestyles & Disease Prevention initiative encourages Americans to make small activity and dietary changes, such as taking the stairs instead of riding in an elevator, or taking a walk instead of watching television. I brought a few of the television ads to show you today, and I would be interested in hearing about Mexico's efforts and outcomes with any outreach you have attempted on this topic. The PSAs were created pro bono by a New York agency through the non-profit Ad Council. They will air in advertising time and space that is donated by the media. 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.
Further studies show that people of all ages, races, incomes, and education levels are challenged by low health literacy. The problem has grown as patients have been asked to assume more responsibility for self-care in a complex health care system. Another compounding factor is that most patients hide any confusion from their doctors, because they're too ashamed and intimidated to ask for help. Not everyone 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. More than 30 years ago, I was a medic and weapons specialist on a Special Forces A-Team in Vietnam. I learned first-hand that how I communicated with a patient and her family could have a direct effect on my patient's health. It's a lesson I'll never forget. We were working with Montagnard people. They are wonderful people of great character and dignity, and their language at that point was only spoken. This was very early in my career; I was just shy of my 20th birthday. By that point in my life, I had taken care of gunshot wounds already, I had taken care of parasitic diseases, I had set up a sanitation system for the village, and I didn't realize at the time how important those lessons would be to me years later. In any case, we went into the village to do a Medical Civil Action Program, what we called a MED CAP. When you go into the village as Americans, you just want to run sick call. You want to line everybody up and start diagnosing and treating their medical complaints. Well, the Montagnard village leaders didn't want us meeting anybody or touching anybody until they knew who we were. So we had to sit for a while with the village chief and his family and get to know each other. We talked through an interpreter…the Montagnard interpreter. We had learned a little Montagnard, but not enough to fully converse. The Montagnard interpreter would field questions from the village chief. The questions were largely, "Who are you?, Where are you from?, Are you married?, Do you have children?, What's your value system?" They wanted to know who we were. Today, Americans are still on a fast track all the time. But that's not necessarily the best way to understand what is really happening with someone, within their culture. I sat down and learned that lesson. I had to share food with the village chief, which I did. To this day I'm not sure what I was eating, but I smiled. And that wasn't all. We were in these thatched huts. They were on stilts, so that when the monsoons came, the water would run below and the houses wouldn't get washed away. But underneath the chief's house; buried into the ground; connected with long, thin pieces of bamboo was this ceremonial wine that fermented through generation after generation. So we sat in the middle of the house, and the bamboo straw came up, and we sat in a circle with the healer and the village chief, and we had to sip this stuff. Well, as soon as we smelled it, it was enough to just knock us out. And I wasn't a drinker. I had learned from my parents' bad habits, so I just pretended like I sipped it. And we sat there for what seemed like an extraordinarily long period of time drinking this stuff. When it was all over, the village healer started to bring some people in, because we had offered to look at them for conditions that the healer was not able to treat. The first person who came up was the granddaughter of the village chief. I don't know how old she was, maybe 7 or 8. In their language, they don't have words for time or days or years. It's sunrise, sundown. Passage of time is related to the crops and the cattle. So when I saw her walking toward me, I thought, "I'm going to look brilliant." Her arm was covered with scabs, and I immediately recognized it as impetigo. Even as a 19-year-old Special Forces medic, I was thinking that I was going to look pretty good with this diagnosis and treatment. For those of you who have been around for a while, you remember that we used to have these big green buckets of Phisohex. They weighed about 10 pounds. So I put some of this Phisohex in a bottle that the villagers had. They didn't have running water, so we said, "Go down to the river, wash with this, don't pick at the scabs, let them fall off. Oh, and by the way, take these." Back in 1969/1970 we only had two antibiotics — penicillin and streptomycin. So I gave them a little bottle of the PenVK and said, "Take one of these four times a day." There were 28 pills in the bottle, and I said, "I'll be back in a week or 10 days, and I'll check up on you when we come through the village." So I went away, and then came back in about a week. We went through the whole ceremonial thing again with the food and wine and talking. Then the little girl was introduced as the first patient. She looked wonderful. The scabs were coming off her arm. The village chief thanked me. They brought me some things. I got a Montagnard bracelet, a Montagnard ring, they gave me a crossbow, and made me an honorary member of the family. The village chief thanked me for all I was doing for his people. And then he showed me a little box and said, "And we thank you for this gift that you have given us." He opened the box, and there was a necklace of 28 Pen VK pills. Then the interpreter told me that now when people are ill, they wear the necklace so that it will ward off the disease. I thought I was a pretty good communicator. Obviously I wasn't, and I learned a lot that day. More than 30 years later I still think of that and what an invaluable lesson I leaned about never assuming that someone understands what you're talking about. The Montagnard villagers had no idea what questions to ask me about the pills. This was the first time that they had ever seen a pill. To them, it looked like a bead. A medicine bead. So they treated the vial of pills as a bottle of beads. And to take it four times a day, there was really nothing in the language to say that. I wish I could have anticipated the misunderstanding. As a relative stranger to their culture and their way of life, I didn't even consider that the Montagnard people would see a pill as anything other than a pill. Opportunities For health literacy to improve, we need health professionals, policymakers, researchers, and the public to collaborate. I need you to work with colleagues in community health improvement to reach out to people who have the greatest needs. With your partnership, we can bring the dialogues about health literacy into greater focus among health professionals and our societies. Health literacy can save lives, save money, and improve the health and well being of people throughout the world. It is a global need and a global good. There is so much that we can accomplish together — so much that we can do to improve global public health. Why Global Health Matters Global efforts identified this disease. Scientists working together throughout the world attacked SARS early, coordinating the response, marshalling political will, and recognizing that every nation on earth is responsible for protecting its own population and the global community from SARS. Because of the transmission of communicable diseases like SARS, what happens in one nation may eventually happen in all nations. This must be addressed by the medical research and clinical care communities. Hippocrates put it better than I ever can. Recall these words: "I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm." Hippocrates was making the humanitarian argument for the importance of global health. Empathy for our fellow human beings. Whether it is on humanitarian, security, or economic grounds, global health makes good sense. I want to take this opportunity to remind all of us that one person can make a difference. Meeting with great leaders as I have today and will tomorrow here in your country, I am reminded that the most important aspect of any man or woman is ultimately character. We must set our goals out of our apparent reach and our standards above reproach. We must make a commitment to change the world. I am proud to serve with President Bush and Secretary Thompson, who demonstrate their character by respecting the health of every man, woman, and child everywhere, regardless of income or geography. The President and the Secretary have asked me to develop a "Surgeon General's Report on Global Health." My commitment to you today is that this new report will focus attention on why global health matters. Reports of previous Surgeons General on tobacco, nutrition, violence, and mental health — to name but a few — have heightened Americans' awareness of these important public health issues and generated major public health initiatives. They have also provided impetus for better public health in nations throughout the world. I am proud that President Bush and Secretary Thompson recognize that disease has no borders and that we need to work together, exchanging medical information and technology to lead to a healthier world. I ask you to continue to mobilize biomedical research to improve the health of all people, everywhere. This is a formidable task, but no less than you are capable of, and no less than what humanity deserves from you. I look to each you for your help and support as we work together to develop the Surgeon General's Report on Global Health, as we increase health literacy, and as we address the future public health needs of our two great nations. Thank you. Last Revised: April 27, 2004 |
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