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REMARKS BY:  DONNA E. SHALALA, SECRETARY OF HEALTH AND 	
	     HUMAN SERVICES
PLACE:       PATRICIA HARRIS PUBLIC AFFAIRS PROGRAM AT HOWARD UNIVERSITY

DATE:        March 13, 1998

It is a great honor to come to Howard University for the 10th anniversary of this program and dinner in honor of Patricia Roberts Harris. Let me start by congratulating Howard University for your many contributions to this neighborhood and the people of Washington, and your long history of shaping the destinies of leading African American scholars, writers, professionals and public servants.

One of those extraordinary leaders was Patricia Harris - a woman I'll always remember as a mentor, a friend, and a hero.

Dr. Martin Luther King once said, "Whether we realize it or not, each of us lives 'eternally in the red.' We are everlasting debtors to known and unknown men and women."

We are all debtors to Patricia Harris.

Keeping alive her memory and spirit is like holding a burning torch in a dark cave. The torch, like Pat Harris, brings us enlightenment to better see and understand the world.

Patricia Harris was certainly a light for my life, and for a generation of women who came to public service at a time when most women couldn't hope to break the glass ceiling because their careers were anchored to the floor. We needed someone who was ahead of her time - to bring the values of equality and shared opportunity into our time. We needed someone whose idealism, drive and intelligence could not be stopped by intolerance or indifference. We needed someone with a moral core - and tough exterior - who wasn't afraid to speak for the voiceless and challenge conventional wisdom.

Patricia Harris met all of these needs - and for that she deserves a very special place in our hearts, and this program to pass on her talents and her dreams.

As everyone in the Howard University family knows, Secretary Harris was a great teacher and a lawyer's lawyer - exacting, demanding, decisive and very smart. Believe me, you never wanted to go into a meeting with Patricia Harris unprepared - or thinking you knew more about a particular subject than she did. She was always two steps ahead - and wondering when you were going to catch up. These qualities of discipline and intellectual rigor - along with her honesty, integrity and courage - made it a privilege for me to work with Pat Harris.

When she was Secretary for the Department of Housing and Urban Development, I was her Assistant Secretary for Policy Development and Research. It was a challenging position because Pat Harris did not make her common sense decisions by whim, intuition or guesswork. She made them with the benefit of solid research, in-depth analysis - and, of course, courage and experience.

But what I most admired about Patricia Harris was that she used her extraordinary legal mind - and management skills - as a sword to fight for people too weak to fight for themselves, not as a shield to protect vested interests or the status quo. I'll give you one example from when she ran the Department of Health and Human Services.

She wanted Medicare to pay for heart transplants - a move that at the time almost everyone in the Department opposed. Too risky. Too experimental. Too expensive, she was told. You're being too timid. Too shortsighted. Maybe even too uncaring, she answered. Then, after reading the Medicare statute for herself, she decided she had the legal authority to investigate whether heart transplantation worked. It does. And now Medicare beneficiaries over 65 who could never afford this life saving heart surgery have access to it.

But let me tell you something about heart disease that you might not know.

It has to do with racial health disparities.

The next time you go to a movie theater where the audience is about half African American and half white, take a look around. Everyone might look equally healthy. But chances are, more of the African Americans in that theater will eventually need a heart transplant than the white Americans. That's because heart disease strikes African Americans more often than whites. The same is true for cancer - which took the life of Patricia Harris - and many other diseases.

Go right down the list of some of our major killers. The story is the same.

Infant mortality: The rate is nearly 21/2 times higher for African Americans - and 11/2 times higher for Native Americans - than whites. Heart disease and stroke: African Americans are hit twice as hard. Tuberculosis: Three times as hard. If you're Native American, your rate of diabetes is three times the national average. Vietnamese women are 5 times more likely to face cervical cancer than white women. Hispanics suffer from stomach cancer at 2 to 3 times the rate of whites. And Chinese Americans are 4 to 5 times more likely to be victims of liver cancer. Research also shows that racial and ethnic minorities tend to be less frequently immunized, screened for cancer, or recipients of regular primary care.

With these numbers, we can only draw one conclusion: we have been - and remain - two nations: one majority, one minority - separated by the quality of our health.

I want to be clear: There are exceptions. For example, Native Americans, Asian Americans and Pacific Islanders have significantly lower rates of coronary heart disease than whites.

Remember too that racial and ethnic health disparities did not come about because of some pernicious law. Or even intentional neglect. We have, however, sometimes treated the problem of health disparities as an unavoidable fact of life - a problem with no solution. We have even, at times, set different national health goals for whites and minority groups.

We do not know all the reasons for these health disparities, although poverty is certainly an important factor. Inadequate education, lack of access to - or discrimination in - the delivery of health services, diet and cultural differences might also be involved. But we do know that the time has come to stop accepting disparities with resignation - and to start fighting them with determination.

We should do this because it is morally right and just.

Because - as Patricia Harris knew - great nations cannot long bear the weight of great injustices.

And because closing the health disparities among different racial and ethnic groups will lead to better health for all Americans.

Our nation is actually making real progress against our worst public health killers. Childhood immunizations are at an all-time high - and infant mortality has hit a record low. The AIDS death rate is actually falling for the first time in the history of the epidemic. Just yesterday we announced that overall incidence - and death rates - for all cancers combined declined between 1990 and 1995. That reverses a 20 year trend. More women are having regular mammograms and clinical breast exams - and Medicare will now pay for mammograms for women 40 and over.

These trends tend to be true for all groups - which means as a nation we are living longer and healthier lives. Think of two nearly parallel lines slanting upward. The two lines represent the generally improved health of whites and minorities, including African Americans, Hispanics, Asians, Pacific Islanders and Native Americans. But the gap between whites and non-whites that exists for many diseases remains about the same.

It's that gap that we must close.

And our President is committed to doing just that.

As part of his national Initiative on Race, the President just announced a goal of eliminating, by the year 2010, health disparities in six critical areas. They are: infant mortality, diabetes, cancer screening and management, heart disease, HIV/AIDS and child and adult immunizations. I want to be straight with you - just as Patricia Harris would be: Today, we don't know precisely how to close all six of these disparities.

I wish we did - and in time I know we will. But right now, it's a mixed bag. For immunizations, we know what works and what we need to do. For cancer and heart disease, we need a lot more research to guide our efforts. So we have a huge challenge in front of us. But that doesn't mean we're starting from square one. Far from it.

First, we already know a great deal about the importance of prevention to maintaining good health and long life. The fact is, as our new Surgeon General, Dr. David Satcher, points out, the vast majority of preventable deaths are linked to just three personal behaviors: smoking, poor diet and lack of physical activity. That means that people from every race and ethnic group can lower their risk of premature death by kicking tobacco out of their lives, eating right and staying active.

And that's why we have tough new rules prohibiting the sale of tobacco to minors - and why Congress must, let me repeat, MUST, pass comprehensive tobacco legislation that will cut youth smoking.

Second, we know that difficult problems like health disparities cannot be solved in isolation. Policy-making has to cross boundaries - with creative ideas combined from many disciplines. This interdisciplinary approach was central to the way Patricia Harris thought about - and implemented - policy, and it's central to our goal of eliminating health disparities. That's why our focus must include biomedical research, cultural studies, drug addiction, childhood development, education - and poverty.

As I suggested earlier, the disproportionate number of African Americans living on the economic margins is almost certainly one of the reasons they are more frequent victims of serious health problems. So in the noble tradition of Patricia Harris, we're making the fight against poverty - and increasing access to health insurance - part of our overall strategy for eliminating health disparities.

And we've already made important progress.

The booming economy and the first balanced budget in 30 years have helped bring the poverty rate down. Unemployment is now less than 5 percent, and the number of welfare recipients fell below 10 million for the first time in more than 25 years. Today, fewer than 4 percent of Americans are on welfare.

But we cannot simply rely on a strong economy to pull people out of poverty - and into longer and healthier lives. We also need to make sure work pays. That's why we raised the minimum wage last year - and want to raise it again. We expanded the Earned Income Tax Credit. We passed the Kassebaum-Kennedy legislation to improve the availability of health insurance for working families and their children. And now we have set our sights on ensuring that every child in America has access to quality health insurance before the end of this century.

In 1995, over 13 percent of white children, over 15 percent of African American children - and almost 27 percent of Hispanic children - did not have health insurance. But last summer we took a big step toward reducing these numbers. As part of the balanced budget agreement, we made an unprecedented $24 billion dollar commitment over five years to cover up to half of our nation's 10 million uninsured children. That's five million kids - mostly from working poor families - who will now have new hope for a long and healthy life.

But its not just children who need greater access to health insurance. Ironically, as we grow older - and our health becomes more vulnerable - so does our health insurance. That's why this year the President is proposing to allow Americans 55 to 64 - who have lost their jobs or retirement benefits through no fault of their own - to buy into the Medicare system.

Making prevention a public health priority, fighting poverty and increasing access to health insurance are all important steps toward eliminating racial and ethnic health disparities. But they won't get us across the finish line. That's going to take bold new moves - the kind of moves the President outlined when he announced his goal of eliminating these disparities by 2010.

The first move is to set interim goals for the year 2000. If you want to draw a comparison: Thurgood Marshall became a great litigator before he became a great Supreme Court Justice.

Where do our new interim health goals come from?

From a process that dates back four Presidents. Starting in 1979 - the same year Patricia Harris became Secretary - the Department began setting specific health targets in ten year increments. Each set of targets became a report for the upcoming decade called Healthy People. So, our interim goals are drawn from Healthy People 2000. They include cutting African American infant mortality by 22 percent. Increasing to at least 60 percent the proportion of women from all racial and ethnic groups who have received a clinical breast exam and mammogram within the previous two years. Cutting the death rate for African Americans from heart disease 25 percent and stroke 40 percent. And assuring early and equal access to health care and appropriate drug therapies for at least 75 percent of low income people living with HIV/AIDS.

But as I said, these are interim steps. The prize we're really after is the elimination of health disparities by 2010.

And we're going to do it by setting high national goals for ALL Americans. We'll set forth the specific goals when President Clinton unveils Healthy People 2010 in just two years. In the meantime, we're working in partnership with states, communities, minority doctors, local hospitals and clinics, and researchers on a five step strategy to eliminate disparities.

Step one. Dr. David Satcher will be traveling America with critical treatment and prevention messages - paying special attention to racial and ethnic minorities.

Step two. We're going to ask Congress to invest $400 million dollars over five years to help us get the job done. That's $150 million dollars in grants to 30 communities to develop innovative programs to improve minority health, and another $250 million to strengthen public health programs with a proven record of effectiveness.

Step three. We're teaming up with Grantmakers in Health - a coalition of health foundations - on a conference for later this year that will explore ways to build public-private partnerships that can eliminate health disparities.

Step four. A new committee and work groups - led by Dr. Peggy Hamburg, and made up of the best minds from the CDC, NIH, other public health agencies, and minority communities, will develop a long-term plan that will make health disparities a story for the history books.

And step five. The President issued a challenge to all of us - employers, schools, foundations, clinics, nurses and doctors, and places of worship - to join this fight by, making sure children and adults are immunized, and finding children who are eligible for Medicaid and CHIP; by encouraging health screenings like mammograms and monitoring blood pressure; by spreading the word that putting babies to sleep on their backs greatly reduces the risk of Sudden Infant Death Syndrome; by performing top quality data collection and research, while ensuring that minorities are fully represented in clinical trials; and perhaps most important, by recognizing that this is not just a battle for our nation's health - it is a battle for our nation's soul.

Because we must be - as the President has said many times - One America, a goal that we cannot reach unless millions of our African American, Native American, Hispanic, and Asian brothers and sisters are brought inside the house of long and healthy life.

I believe that. And I'm certain Patricia Harris would too.

Because she believed that government service - on the both national and local - is much more about performance than it is about party, and that the American people are right to expect not only admirable goals - but real results.

Patricia Harris was head of HHS when President Carter lost the election to Ronald Reagan in November 1980. On the morning after the election, her top staff were demoralized and dejected. She called them into a meeting and gently - but pointedly - reminded them that in our nation, the American people choose their leaders, and that we can always serve the public even when we're not serving in government.

It was that kind of attitude toward public service that made Patricia Harris a woman for all seasons.

A woman who would insist on ending racial disparities in health - and then demand a down-to-earth plan for getting the job done.

A woman who in life never stopped learning - and who in death has never stopped teaching.

Be proud of the mark she left on this great school. Listen to her wise words. And most important, never cease following in her footsteps.

Thank you.