Transcript of the Healthy People 2010 Regional Meeting
Philadelphia, Pennsylvania
October 5-6, 1998

U.S. Department of Health and Human Services
Office of Disease Prevention and Health Promotion

Comment On:
Framework and Goals

MS. BATMAN: I am Anita Batman, the regional health administrator from the U.S. Public Health Service Region III.

I would like to welcome you to the public hearing on Healthy People 2010.

I would like to acknowledge my colleagues, the regional health administrator from Region II, Guy Alba, who is here, his deputy Bob Davidson, my deputy Dixie Deter, who is in the back row there, Betsy Rosenfeld from Region I Boston.

I would also like to thank Dr. Linda Meyers, the acting director of the Office of Disease Prevention and Health Promotion. I had to stumble over that one. We say ODPHP; it is a lot easier. She has been wonderful to work with.

I would like to acknowledge Linda Bailey, without whom this meeting would not have been held, and all the help that we have had putting this on.

During the fall of this year, there are going to be five meetings. This is the experimental child, the first meeting of those five, where we gather our thoughts on how we did with Healthy People 2000 and hear public comments so that we can draft good goals for 2010.

I want to thank you for attending this meeting, which is an experimental meeting, and in addition to the 2010 comments, I believe ODPHP would appreciate comments on the format of the meeting and how to best get the opinions that we need, the advice that we need to have a good product.

Today is the crux of this whole conference. The purpose of today's session is to hear your comments on the draft of Healthy People 2010, which was made public on September 15.

Your input is vital and it will be used to finalize the health objectives for the nation.

I can't stress how important it is that our public health and health care delivery planning and funding are based on a clear picture of reality.

You have all seen the initiative of the week and the disease of the month. These are all wonderful boosts to help get us going sometimes on something, but we can't let our basic work plan and funding be determined by anything other than what are the real needs, what is the real health picture.

It is as much the initiatives of the Saturday night party, and they pick you up, but knowing what the plan is, knowing what reality is, applying your resources in proportion to the need.

They are just like doing the dishes and cleaning your house every day. If we don't do these things, we won't work well.

I thank you so much for showing up. I thank you for coming to give us your advice and to help us have the best possible set of measures so that we will be measuring the right things, the measurable things, and the things that will give us a good picture of our nation's health status.

Today is a day for oral comments. If you don't get to give your oral comment, feel free to leave written comments at the registration desk.

Your conference material should also have the internet address where you can see the comments. Both the draft and all comments made between September 15 and December 15 of this year will also be posted on the Internet.

Comments sent in on diskette will be appreciated because they are easier to handle that way.

For today, to assure a fair opportunity for everyone to participate, we would like to use the following procedures.

First, if we would initially limit each oral statement to three minutes so that we can hear from the greatest number of people possible.

Second, until everybody has had an opportunity to comment on each chapter and topic, if each organization will just make one comment, and then, after everyone has commented, if there is time you can make your second comment.

When time permits at the end of a session, the floor will be open. At the end of each session, we will hear all the comments we can.

From 8:15 to 9:00, we are going to hear your comments on the framework and the goals and the leading health indicators.

Then at 9:00 o'clock, we will break into the three concurrent sessions. Session I, Promoting Healthy Behaviors and Healthy and Safe Communities will be convened by Betsy Rosenfeld, the deputy regional health administrator from Region I Boston.

That will be in Wyndham A. I believe you have the sheet that tells you which topics are included in which session, so everybody is pretty clear about which session they are going to attend.

Session II, improving systems for personal and public health, will be convened by Guy Alba, the regional health administrator for Region II. That will be in Salon II and III.

Session III, preventing and reducing diseases and disorders will be convened by Linda Meyers, acting director of the Office of Disease Prevention and Health Promotion. That will be in conference center hall.

I want to thank particularly Linda for this, because it is my job and it was really important for me to be here with you.

I am on two months of sick leave, but this is such an important activity that I wanted to honor you all by coming here to stand before you and dignify your work and the help that we need from you in this.

I thank you for sitting in for me on this, because I don't think I could stand for three hours.

That being said, I am going to ask you all to excuse me. I am going to turn the meeting over to Guy Alba, my colleague from New York.


MR. ALBA: Thank you, Anita. It is my privilege to be with you on the dais.

Good morning. I am Guy Alba, regional health administrator from Region II. I would like to welcome you to this session as well.

During the session, I invite you to give your comments on the framework, goals and leading health indicators that are proposed by Healthy People 2010.

The material is found in Section A of the draft for public comment. Dr. Linda Meyers here, the acting director of the Office of Disease Prevention and Health Promotion, will listen to your comments.

I would like to invite her to make a brief opening statement before we hear the comments.

DR. MEYERS: Thank you. Good morning to colleagues and guests. On behalf of the terrific staff of the Office of Disease Prevention and Health Promotion, thank you for participating in this session.

The comments on the framework, the draft framework for Healthy People includes two goals, major sections, focus areas and the figure of Healthy People 2010.

The proposed goals -- I think you all know, but let me remind you -- are to increase the quality and years of healthy life, and to eliminate health disparities.

The leading health indicators are also open for comment during this session. They are intended to be a small number of objectives that could be presented to the general public and to non-health professionals as an introduction to Healthy People. We look forward to hearing your comments on these areas.

MR. ALBA: Now we can begin. I would invite those of you who have comments to queue up behind the microphone here at this point.

For anyone with special needs, please raise your hands, if you would prefer to use a hand-held microphone. Paul Kim is at the back, and for anyone who requires that assistance, we would be glad to make that available.

As to the ground rules, I will ask each of you to introduce yourself by name and state of residence. Also, please let us know if you are commenting on behalf of an organization or as an individual.

Each person will have three minutes for comments. When the light turns yellow, you have one minute to go.

I am going to tell you that there was a debate as to how we would best enforce this rule with respect to the number of minutes available. We decided upon the light system.

At one point there was a suggestion that if anybody went too long, we would cut off their hands. That was rejected, and that was rejected by a vote of 12 to 11. [Laughter.]

Each person will have three minutes for comments, as I mentioned. We will begin at this point and would you please state your name and whether or not you are commenting as an individual or for an organization, sir.

MR. MARGE: I am Michael Marge. I am the president of the American Association on Health and Disability.

I will read very rapidly my written testimony with regard to the goals and leading health indicators.

On behalf of 49 million Americans with disabilities, we acknowledge the significance of a chapter with disability objectives in Healthy People 2010 draft.

In our judgment, this is an historic marker for those public health officials who have recognized the importance of public health issues related to people with disabilities.

Unfortunately, the previous Healthy People planning document, Healthy People 2000 reflected neither an awareness nor a sensitivity to the health needs and disparities of people with disabilities.

A review of Healthy People 2000 reveals very little concern about needs and disparities.

As a member of the key planning group, where we actually worked together for two years to develop 32 objectives, they were almost all rejected on the grounds that our objectives were developmental.

When I reviewed Healthy People 2000 thereafter, there were 10 chapters with developmental objectives.

The question was, why were we excluded as an area of concern by the national planning effort for Healthy People 2000.

Since 1990, a great deal of progress has been realized with regard to the importance of meeting the special health needs of people with disabilities.

Therefore, as president of this association, we commend and express our thanks to the Secretary and Assistant Secretary of Health for their support of a chapter devoted to health objectives for people with disabilities.

I have a critique and briefly, the critique is this: A review of the chapters throughout the draft indicates that, again, the health needs and disparities of people with disabilities are not addressed in the goals, and by most chapters.

The chapter on disability and secondary conditions, which started off with 27 objectives, was actually reduced to 12 objectives. We will have much more comment about that when we present our written testimony.

One last point; the goals one to ten do not reflect the significant population needs of people with disabilities.

I wish to urge you to please reflect those and consider our testimony when the testimony is presented. Thank you very much.

MR. ALBA: Thank you, sir.

MS. KLEIN-WALKER: Deborah Klein-Walker from the state of Massachusetts. I guess I am representing the Massachusetts Health Department.

I will say that I am the president of the Maternal and Child Health Association, and many of these comments are very familiar.

I am talking about the leading health indicators and your criteria for selecting them.

Knowing that you will never have an ideal set, I feel that the criteria that are really key here is you must have indicators that can reflect state and community level outcomes.

If you do, you will have audience interpretability and population applicability. The one that says multilevel trackability I would like to see changed to really two, trackable at the state and community level. That is how we do public health.

If you have national indicators and you report them once a year on national stuff, at the state and local level, we can't work on them unless we know what is happening.

The other piece of that, I think, that is key is that it must be able to be broken out by race, ethnicity and other key groups -- disabilities being one.

Again, even if you track these at the national level, we can't do the business of public health at the state and local level unless we have those at that level.

Next, you talked about profile balance. I would like to see more wording around the social field model. I, for that reason, would like to see one of them be socioeconomic disparities. Poverty is a key indicator that relates to all of these.

Linked objectives, you have linked to 2010 objectives. It has got to be much broader. All of us are responding to performance measures, maternal and child health block grants for one, CDC will be developing others. These objectives have to link with all of those.

Next, I would like to add one, which would be that we strive for these to be accessible on information highways. Technology is here. Public health needs to do that. There are states that have begun to do this. You can put these profiles available so that locals can dial in.

In sum, I know this is a very difficult task. But I would advise you to look at the consensus indicators which we use, and then look at the newest set that the IOM, improving the health of the community group, did, since I think that was a careful consideration of expansions of ones.

The profile I think should be anywhere from 12 to 20 indicators, include health status, socioeconomic indicators, risk behaviors, utilization process.

I think what we have to altogether realize is that no matter what you pick, these are just key issues that we are using for flexibility.

In fact, if we do health in the community, communities are going to be developing other sets of indicators, and that is okay, too.

Even if something doesn't make it into this larger set, people should understand, I believe, that that is okay, that the practice of public health is at the local and state level.

If you were to add new areas, nutrition, physical activity, functional status and environment and mental health, I think, are ones that should be considered.

Frankly, if you do not help to support household surveys in every state, you will never be able to do some of these newer measures. Thank you.

MR. ALBA: Thank you.

DR. KELEPOURIS: My name is Ellie Kelepouris. I am a physician. I am chair of the medical advisory board, and I speak on behalf of the National Kidney Foundation.

I would like to review with you some data and then point out what we feel is largely ignored in this Healthy People 2010 draft.

On behalf of the 450,000 patients with end stage kidney disease, I would just like to point out that kidney disease is increasing at an alarming rate of six to seven percent a year, based on our review of the USRDS.

Now, in your objectives, a leading health indicator that you address is diabetes. Diabetes accounts for only 40 percent of people with end stage renal disease.

Thirty-five percent of people have hypertension, 30 percent glumerial nephritis, and the rest have polycystic kidney disease.

Also, end stage renal disease is distributed largely around or along racial and ethnic causes, with African Americans having twice the rate of end stage renal disease as white populations.

I feel that these causes of kidney disease other than diabetes are largely ignored and should really be addressed, because they present major health diseases, the major health factors for the draft that you are proposing.

Specifically, what really worries us and what really worries me -- and I guess I speak on behalf of the 400,000 -- is the fact that there are several treatments that have been shown scientifically to not only prevent the progression of disease to end stage and transplantation and dialysis, not only in diabetes, but in hypertension and in glumerial nephritis.

Those treatment modalities would probably save the U.S. Government $14.5 billion, which is what is spent to treat people with kidney disease with dialysis and transplantation in 1996.

Those treatment modalities are not outlined in your draft proposal. There are several that are well documented and they really need to be addressed in detail.

I think one of the most important points that I would like to make is that screening for end stage renal disease is not part of the proposal.

I would really urge you to make end stage renal disease a different leading health care indicator than just an appendage to diabetes.

There are ways that we can decrease the number of new cases of chronic kidney disease in the United States. I think that an awareness, a public awareness as well as an awareness on behalf of physicians, to treat patients in a timely fashion and screen large populations at risk for this disease is not only medically prudent, but financially prudent as well. Thank you.

MR. ALBA: Thank you.

MS. MULFORD: My name is Chris Mulford. I represent the International Lactation Consultant Association. I am from Pennsylvania.

At yesterday's breakout, I asked about the politics of nominating a new objective as a leading health indicator.

I was told by Deborah Klein-Walker -- and this makes perfect sense -- that I should try to see the big picture.

With 300 objectives in the document, only one out of 15 will make the leading list, and we want to avoid the spectacle and waste of energy of 300 different programs, diseases and body parts fighting for a place.

I understand this answer. I am a grass roots person, not a public health expert, and I would like to help you see things from my side.

I am a breast-feeding advocate. American breast feeding rates are just about the worst in the world. We heard yesterday that we are the richest country in the world and we spend the most money on health care.

I find it a shameful paradox that a baby in Bangladesh is more likely to have access to the best infant nutrition than a baby in Camden.

Breast-feeding has been seen as private, something that happens behind closed doors. So, we have a problem with lack of visibility, and when you are invisible, you have no voice.

When people believe that a health issue is important enough, they do not hesitate to bring it into the light.

I remind you of Surgeon General Everett Koop, a Philadelphian and a strong breast feeding advocate, who brought distasteful details of sexual behavior into the light, in order to tell Americans how to protect themselves from AIDS.

We need to find the political will to bring breast-feeding into the light.

Breast-feeding is a problem because people don't know where to categorize it. Is it nutrition? Is it preventive health care? Does it belong to pediatrics, obstetrics, to midwifery, to women, to babies?

No one group has taken ownership and spoken up for breast feeding until last year a courageous statement from the American Academy of Pediatrics, which calls on everyone with a stake in mother and infant health, to support breast feeding.

I suggest that it is exactly because breast-feeding belongs on so many agendas, that it should be a leading indicator.

I suggest that breast feeding does address a problem of substantial impact, because of the huge amounts that we spend to treat conditions that could be prevented by breast feeding -- office visits for ear infections, hospitalizations for babies with RSV, orthodontia, speech therapy, diabetes care, and treating necrotizing enterocolitis in NICU babies.

I suggest that breast-feeding is representative. Not one racial, ethnic, economic or regional group has even met the breast feeding objectives for 1990.

Our goals have been virtually the same for 20 years and we are no nearer our targets than we were in 1982.

Our knowledge base has grown exponentially in these two decades, and we have developed social strategies that we know will work, but the political will is lacking.

I suggest that we have unacceptable disparities among ethnic, racial, educational and socioeconomic groups.

I heard yesterday that a 25 percent difference is considered significant. The difference in breast feeding rates between African Americans and whites ranges between 200 and 400 percent; yet everyone wants healthy babies.

Finally, I suggest that breast-feeding can help families achieve access to preventive services in the most basic way.

By breast-feeding, a mother gives preventive health care in her own home 24 hours a day. That is access. Thank you.

MR. ALBA: Thank you.

MR. SOCALARA: Good morning. My name is Sid Socalara. I am a professor emeritus of physiology and biophysics at the University of Miami School of Medicine.

I currently am co-chair of the public policy committee of the Public Health Association of New York City.

I am from the state of New York, and I am speaking on my own behalf this morning.

Yesterday it was pointed out to us that what was originally a goal of reducing disparities in health has been, through popular demand as it were, transformed into eliminating disparities in public health.

None of us, I believe, would dissent from the spirit of that goal, but earlier this morning we were told to hew to reality.

Hewing to reality means understanding the determinants of the things that we are trying to change.

What we now know indicates that eliminating disparities in health means eliminating poverty, eliminating racism, elimination homelessness, just to tick off a few of the leading determinants there.

That is simply not within the powers of the public health establishment as that establishment now stands. That doesn't mean that we aren't interested in achieving those goals, nor does it mean that we can't help achieve them.

It does mean that we need powerful allies. In that sense, we need to let go of public health, as someone put it yesterday, and allow public health to become the property of a broader coalition.

That, for example, is precisely why the World Health Organization, in its strategic organization to the Health for All campaign, emphasizes the importance of an intersectoral approach.

The Healthy People 2010 framework should identify pertinent issues and goals, whether or not they fall within the traditional missions of public health agencies.

Then it should envision a consortium that includes not only health agencies and health workers, but also organizations and individuals that are better prepared to address those additional issues and goals. Failure to include them would seem hard to justify.

For extending the set of enabling goals for objectives, a general heading might be improved socioeconomic health.

I would propose under this to list as focus areas poverty and homelessness, two of the more egregious manifestations of socioeconomic inequality.

The consortium dedicated to the Healthy People 2010 campaign would then need to include organizations and persons with special interest and expertise in community development, housing and job creation, income supports and related areas.

Organizations and scholars in the forefront of efforts to eliminate poverty and homelessness should be engaged in the formulation of the objectives of the campaign. Thank you.

MR. ALBA: Dr. Socalara, thank you very much for your comments.

MS. DE BOCANEGRA: Good morning. I am Heike Thiel de Bocanegra. I work for the New York Task Force on Immigrant Health at New York University.

There are some issues that are cross cutting, so I wanted to mention it here.

One issue is that the surveillance and the monitoring systems that you would put in place in order to see whether objectives are reached or not reached, should really be user friendly and should be able to be broken down at the local level.

We have a big problem in the New York region, that people and data are reported in racial and ethnic categories that are pretty meaningless in New York City, given our diversity of immigrant and U.S.-born populations, the whole issue of misclassification of what happens to persons of mixed heritage.

Our comment and our plea is that systems should really include, on a routine basis, should have country of birth, always asking for country of birth.

Then you can compare U.S. born versus foreign born. Even if it is not necessarily reported at the national level, at least it gives us the possibility of breaking it down at the local level and looking at what was happening.

Breast cancer was mentioned. It is far better in the foreign born than the U.S. born. We just are not able to track it down, and that makes it very difficult.

The second comment that I have in this setting is that we really should perhaps not define another objective, but have a chapter or a part which defines the framework of how we get the objectives.

I saw it in some of the objectives, that they have coalition building, that said you really have to work with the community.

Interestingly, they said, you have to work with the community in doing the projects, but not in defining the research, in one of the parts.

I think community organizations have to be included in everything that you do, in order to reach the objectives.

My suggestion would be to really put it very clearly right from the very beginning, from the outset, to define those criteria of how to reach the objective.

MS. ALBA: Thank you.

MS. HAMLIN: My name is Lisa Hamlin. I am from the Center for Health Care Access at the League for the Hard of Hearing in New York City.

I want to comment also a concern myself, but also for the League for the Hard of Hearing.

There are 28 million people in this country who are hard of hearing or deaf. That is one in 10. While I am happy to see that there is a section on people with disabilities here, I will squeeze myself into that comment group.

In fact, when you talk about people with hearing loss, you talk about across the board comments. So, I would like to take this opportunity to talk to you about that, in fact, there are sections that deal with hearing loss.

In each section, in each goal you need to talk about how do you deal with somebody who is deaf; how do you make communication strategies so that that person can understand.

When you reach out to the community, how do you make it culturally sensitive and decrease disparities for a group that has not really been mentioned in this document, for people who are deaf who have a different culture than other people who have been mentioned.

In hearing health, there is a health loss prevention that has not been mentioned, noise awareness that has not been mentioned.

Newborn screening has been mentioned, and I think that is terrific; that is wonderful, but it is not the only area of prevention for people with hearing loss.

Finally, there is an area of data accessibility. It is wonderful, again, that we have access to the net. As things improve and things become more accessible to other people with disabilities, we want to make sure that people with hearing loss also have access to the data that is presented by Healthy People, and that it continues as the process goes on.

Finally, I also want to mention links with non-profits. I almost feel like I am here by accident. We knew at the last minute what is going on here.

Again, now I will reach out to the Department of Health to find out what is going on with the document in New York State.

I think it needs to be a stronger effort with the departments of health, who can reach out to non-profit groups who can then go to, and know the cultural issues for each community, and we can work together and have a back and forth that I think would be very positive, indeed. I thank you for these three moments to talk to you.

DR. BERNSTEIN: My name is Edward Bernstein. I am an emergency physician for the last 25 years. I work at the Boston Medical Center as both a teacher and researcher and practitioner of Emergency Medicine. I represent the Society for Academic Emergency Medicine.

I would like to comment on the framework and indicator issues. In looking at the framework of promoting healthy behaviors, promoting healthy communities, and prevent and reduce diseases or disorders, I think access is missing here.

I think access to timely, needed and appropriate and quality health services is a critical issue for the American people at this time, not only for the 42 million people who are uninsured, but people who are insured today.

From the front lines of the emergency department, we see daily health care issues that affect people because of lack access, access to primary care, preventive services, the emergency department itself, mental health and substance abuse services, and long-term care.

If access were assured for the American people, a lot of the issues that we see would be mitigated.

I would for people to consider seriously including this as a central core of public health activity in this country, to assure access.

I also think it should be part of our indicators, leading indicators, not only looking at people's source of care, insurance coverage, but I think the broader question that is facing many American people who are insured is whether they do have the care that they need and access to the care in a timely fashion. Thank you.

DR. ALBA: I hope you will be able to join us in our session on access this afternoon as well. We appreciate your comments.

MS. LEE: My name is Myaungja Lee, and I am president of the Korean-American Association for Rehabilitation of the Disabled, 270 mentally retarded and developmentally disabled children, and over 450 disabled adults registered to our agency for the services to meet their basic needs.

Unfortunately, our agency is unable to service their needs due to financial deficit.

When I interview with the families, most of the mentally retarded children had the low birth weight, 95 percent of the mentally retarded children were in an incubator, and their gestation period was 20 weeks to 28 weeks.

Even though there were symptoms during pregnancy recognized by the doctors and the mothers, and developing disabilities, mothers who have a baby first time did not know of this abnormal situation.

Mother did not talk, or could not focus on her complaining to doctor. Education for prenatal care should go on in mother's priority language. Use of the regulation should extend for human beings, not for the regulation itself.

The onset of the stroke due to hypertension is going down to the age of 38 in the Korean community. The ratio of men is higher than women. Hepatitis is also widely spread to young men.

To promote the health and maintain the health, there should be communication with the government and the individuals in the society.

The bottom line of preventive disease is education. How do we educate the individuals in the society if a person cannot understand the languages.

The Congress rejected the bilingual issues for the survey of the Census. Their services for public health are based on census.

Therefore, the public health of minorities did not have an opportunity to improve their condition. I would like to request the review of the language issues.

MR. ALBA: At this point, I would like to ask if there is anyone who has been unable to walk to the microphone who would like to make a comment. Thank you.

MR. FALCON: My name is Adolph Falcon. I am vice president for policy and research for COSSMHO, the National Coalition of Hispanic Health and Human Services Organizations.

I am here today speaking on behalf of our 1,500 community-based organization members. Unfortunately, a lot of what I am going to say we said also in the development of the year 2000 goals and the year 1990 goals. But we are an optimistic group of people and we have great optimism for 2010.

Number one would say the goal of eliminating disparities is a goal that we can't lose. At this point in the process, and in the development of the Healthy People 2000 goals, we were also calling for the elimination of disparities across all major racial and ethnic groups. That eventually became closing the gap.

I sincerely hope that when we get to the year 2010, we are serious about eliminating and do not again revert to just closing the gap.

Secondly, it is our position that it is important to fold the race initiative into the Healthy People 2010 objectives.

If we are asking for significant community input, it just doesn't make sense for us to go out and ask our communities to get involved in two projects that are going on at the same time that are essentially looking to achieve the same goal.

We feel strongly it is important to fold the race initiative into the Healthy People 2010 project, in order to increase the availability of community based organization support.

Along that role, while the race initiative does not include mental health and substance abuse as priority areas, we feel strongly that these are areas that belong for Healthy People 2010 as leading indicators.

In terms of the targets set, we would also like to support strongly the approach that would take the best moving ahead from whoever has achieved, the best goal in terms of whatever objective we are looking at versus just looking at a national average.

In this way, all groups have somewhere to do. We shouldn't assume that all minority groups are going to be lagging behind and it is the non-Hispanic whites that will have the best achieved health status in that area.

In many areas, for example, Hispanic communities have the best health status, be it areas of smoking or be it areas of birth outcomes.

Other communities, including the non-Hispanic white community have much to learn from what we have been able to do right in that area.

With regard to data, we do strongly support using the OMB directive in identifying racial and ethnic groups. We would also like to support that in areas where appropriate, it would go beyond just the Hispanic indicator and look at subgroup data.

For us, we think it is very important, when we report data, that we not just report data available. It is very important that we report data not available.

MR. ALBA: Thank you.

DR. TSOU: I am Dr. Walter Tsou. I am a public health physician. I am on the board of the Pennsylvania Public Health Association. I am speaking for myself.

I want to add my voice to Dr. Bernstein's comment earlier about access to health care. My plea, I guess, is simply that, although access is now chapter 10 as an indicator of an objective, that it actually should become one of the three national goals.

It is one of the striking statements that, in the year 2000, access to basic preventive services for all Americans was made as one of the three over-riding goals. It is no longer in that position.

I believe there is a political statement that must be said for health policy for the next decade, which is simply stating that access to culturally sensitive, quality health care should be one of the three major goals for this nation.

My plea actually is that it be moved from its current status as a chapter 10 indicator, or objective, to one of the over-riding goals.

In many ways it is a statement that demonstrates that the major failure in our health policy today, the one that does not attract the leadership of our politicians, is the fact that no one talks about the fact that 43 million Americans have no health insurance, that it grows at a rate of 100,000 per month and basically it is an ignored issue which will eventually bankrupt virtually every medical institution in this country.

It is not only a financial bankrupt. It is a moral and socially just issue that will bankrupt the moral values of this country.

I believe that we need to make a statement about this and it needs to be relegated to a much more prominent status. That is my statement.

MS. ALBA: Thank you.

MS. LYNCH: My name is Irene Lynch. I am from New Jersey. I am the CEO of the Aleppos Foundation, which is an educational and research foundation run by ex-mental patients for and about mental patients and for the public, in order that we may all better understand what Dr. Socalara called the determinants of what is now called mental illness.

I am speaking for myself, but I also speak for the many thousands who are now joining the Internet, people who before could not afford to even get together to discuss their issues because they were too poor, they were no the streets, they were completely disabled, those who were locked away in institutions or thrown out on the street at homeless.

My feeling is that your goal for this chapter 23 says, to improve the mental health of all Americans. We feel very deeply that this issue is so complex and so over-riding, that it ought to be goal number one.

I will say more on the smaller session. That is really what I have to say. Thank you.

MR. ALBA: Thank you. We have time for one more comment.

MR. GARDESEY: My name is Mawuna Gardesey. I am from Delaware. I work with the Division of Public Health. Because my comments have not been discussed with my colleagues before now, I would consider them personal comments.

I just wanted to speak briefly to the issue of closing the gap versus eliminating disparities. I think the point has been made about eliminating the disparities sounds unrealistic.

I would caution that until we can get to the point where we believe it is possible, we will never come to that task.

We talked yesterday, I believe Dr. Julius Richmond mentioned the fact that we achieved worldwide eradication of smallpox.

Although that was a very, very focused area of health and probably, I believe, it will be argued to the fact that eliminating disparities is a much broader goal, the fact remains that coordinating a worldwide strategy, if we can do that, I see no reason why we couldn't put our mind around the idea of eliminating disparities.

We have to believe that we can do it. It is not going to be easy, but we have to be committed to it. For that reason, I am here to add my voice to the idea that we should look at eliminating disparities, not just closing the gap.

MR. ALBA: Thank you. All of the comments were just excellent and they will be carefully considered as the 2010 document is put in final form.

I invite all of you to participate in the concurrent sessions, which will begin in 15 minutes. Session one, once again, is promoting healthy behaviors and healthy and safe communities, which will be convened in Wyndham A, and Betsy Rosenfeld will be the convener.

Session II, improving systems for personal and public health, I have the privilege of convening that session. That will be in salons III and IV.

Session III, preventing and reducing diseases and disorders will be convened by Linda Meyers, and that will be convened in Conference Center Hall.

Thank you so much. This session is adjourned.

[Whereupon, at 9:00 a.m., the session was adjourned.]

Philadelphia Transcripts and Summaries