"Childhood Overweight and Obesity and Underage Drinking: Common Interests, Common Challenge"

Remarks as prepared; not a transcript.

RADM Steven K. Galson, M.D., MPH
Acting Surgeon General
U.S. Department of Health and Human Services

“Presidential Lecture” at Stony Brook University

May 1, 2008
Stony Brook, NY

"Childhood Overweight and Obesity and Underage Drinking:
Common Interests, Common Challenge"

Thank you, Dr. Kenny (Stony Brook University President Dr. Shirley Strum Kenny) for that gracious introduction.

I am delighted to have the opportunity to deliver this Presidential Lecture — and I thrilled to be back on the Stony Brook campus.

As you’ve heard I graduated in 1978. Unfortunately, I have barely been back.

What a difference 30 years has made on this campus. When I arrived in 1974, Stony Brook was — physically — equated with construction MUD, but that was never what I saw.

I was taken at the start with campus life, the academic intensity and being involved with an exciting world of endless options for activities outside the classroom.

I became involved with a student branch of the NY Public Interest Research Group — I helped plan a campus lecture from founder Ralph Nader himself, who I must add, was short-changed in the Student Union cafeteria.

Most of my first year science classes were large but I took a freshman seminar with now Emeritus Professor Elof Carlson — just twelve students — taught in his home — with cookies baked by his wife Nedra.

And that course, “Biology in Society” or some similar title - in retrospect - hooked me on the thrill of science policy development.

Thank You Dr. Carlson — could you stand?

Many of my classes were large but I never felt anonymous - and I graduated in 1978 resolute to go to medical school and make a difference in the world.

I want to start by talking broadly about the federal Department of Health and Human Services vision for American health care, and then tell you about my focus in the Office of the Surgeon General.

Value-Driven Health Care

[Slide 2: Value Driven Health Care]

H-H-S Secretary Michael Leavitt and the leadership of the Department have been talking about the critical need for change in American health care and how important it is that we have a system which is value driven.

As the Secretary says, “…consumers know more about the quality of their television than about the quality of their health care.”

Today, providers cannot offer the best care they are capable of and consumers do not have the ability to consider value when they make their health care purchasing decisions.

At H-H-S, the Secretary is leading an effort to bring about a future in which consumers:

…are able to find out which hospital in their area has the highest success rate for the procedure they need

…can compare doctors, not just on what they charge, but also in the quality of the care they give, and

…approach health care they way they would any other major purchase - by consulting an impartial source of information on quality and cost.

This leads me to the priorities of the Office of the Surgeon General - and how they fit within the Secretary’s vision of value-driven health care.

My Priorities

As Acting Surgeon General, I serve as our nation’s chief “health educator” - responsible for giving Americans the best scientific information available on how to improve their health and reduce the risk of illness and injury.

[Slide 3: Disease Prevention]

My first priority is Disease Prevention. Right now, we spend the vast proportion of our health care dollars in this country treating preventable diseases.

Prevention is the cornerstone of what we do in my office. Our emphasis on prevention is premised on the understanding that we need to change the way we think about health care in America.

We need to move from a treatment-oriented model - where too little time, money and effort are invented tin preventing disease - to a prevention-centered society.

Chronic disease prevention should be our # 1 priority in health care.

Seven of 10 Americans who die each year die of a preventable chronic disease such as heart disease, diabetes and many forms of cancer.

The medical care costs of people with chronic diseases account for more than 75 percent of the nation’s $1.4 trillion medical care costs.

A modest increase what we invest to prevent chronic diseases will save lives and in some cases save precious health dollars.

An enhanced focus on preventive medicine needs to involve many of you in the room — the health science education establishment and future health care practitioners.

[Slide 4: Public Health Preparedness]

My next priority is Public Health Preparedness - we must be prepared to meet and overcome challenges to our health and safety, whether natural or man-made.

Emergency preparedness has increasingly become a major part of the H-H-S mission to protect, promote, and advance the health and safety of the nation.

My office oversees the 6,000-member Commissioned Corps of the United States Public Health Service.

These officers are available to respond rapidly to urgent public health challenges and emergencies, and are becoming more highly trained each and every day to respond to all-hazards emergencies.

There are those in the audience today who may be interested in joining with us in our public health mission. Anyone who is interested can visit www.usphs.gov and learn how to become one of America’s Health Responders.

Medical Reserve Corps

My office also oversees the Medical Reserve Corps - a national system of community-based teams of medical and public health volunteers.

We have organized health professionals who want to donate their time and expertise to prepare for and respond to emergencies,

They also support good health in communities through sponsorship of diabetes and HTN screening/vaccination events and other health promotion activities.

M-R-C units are strengthening the public health infrastructure and improving emergency preparedness.

There are 21 MRC units just here in New York, including several upstate.

I urge you to consider joining this critical part of America’s impressive volunteer force.

Remember: preparedness is multi-dimensional. It must also involve planning by every level of society, including every family.

One important area that we continue to work on is pandemic flu preparedness.

[Slide 5: Pandemic Preparedness/Checklists]

For pandemic flu, we have preparedness checklists you can use on our website.

Still our need to prepare doesn’t stop there.

That is why President Bush has requested $507 million in his fiscal year 2009 budget to achieve the goals of his pandemic flu preparedness plan and another $313 million for ongoing pandemic flu preparedness efforts across H-H-S.

“Bird Flu” and “pandemic flu” may have slipped from the headlines but the threat remains real.

Our work to prepare the country for a possible flu pandemic is just as focused today as it was when the President released the National Pandemic Plan more than two years ago.

There’s a role for everyone and that’s why we created a program called Pandemic Flu: Take the Lead.

The purpose of this program - now being tested in 9 communities - is to help community leaders learn more about pandemic flu and how they can help citizens take a few steps now to prepare.

We’ve created resources and tools for community leaders such as faith leaders, doctors and nurses, and business leaders to help them raise awareness of pandemic planning within their community.

[Slide 6: Health Disparities]

My next priority is the Elimination of Health Disparities. While overall, our nation's health has improved, not all populations have benefited equally - and too many Americans in minority groups still suffer from illnesses at a disproportionate rate.

For instance:

• African Americans are 50 percent more likely than non-Hispanic whites to have high blood pressure.
• Hispanics are 50 percent more likely than non-Hispanic whites to die from diabetes.

And these are just a few examples. Unfortunately, these statistics go on and on.

These health disparities are simply unacceptable.

It is imperative that this change and we need to work collaboratively to ensure that it does.

[Slide 7: Health Literacy]

And woven through all of these priorities is an issue we call Health Literacy.

It is the currency for success in everything that we are doing in the Office of the Surgeon General.

We need to steadily improve the ability of an individual to access, understand, and use information and services to make appropriate health decisions.

We cannot make improvements in health care and prevention if our messages aren’t being understood because of language and education barriers.

Basic health literacy is fundamental to the success of each interaction between health care professionals and patients - every prescription, every treatment, and every recovery.

It is fundamental to putting sound medical guidance into practice.

The ability to understand and put advice into action is fundamental to the ability to effectively serve communities and patients.

Think, for example, how important it is that young people understand food labels.

Consider what a difference it makes when a young person is able to identify Nutrition Facts on a food container and use them to better manage their diet.

The long term consequences of such health literacy could be profound.

I use the food label as an example because food label literacy is related to our ability to eat right.

Unfortunately in the United States, we don’t necessary eat RIGHT, we eat A LOT, contributing to our current epidemic of childhood overweight and obesity.

And that’s one of my major focuses as Acting Surgeon General

Overweight and Obesity

Reducing the prevalence of childhood overweight and obesity is among the foremost health challenges of our time. This short video clip from the American Academy of Orthopedic Surgeons helps put into context the uphill battle we are facing.

[Slide 8: Lawnmower clip]

Childhood Overweight and obesity is a challenge that cuts across geographic areas, age groups, ethnicities, and socio- economic status. There has been a startling trend in adult obesity rates in our country just in the past decade.

[Slide 9: Obesity Maps Slide]

This slide depicts this trend. This is national survey data of the percent of the population of each state with a Body Mass Index greater or equal to 30, or about 30 lbs overweight for a 5’4” person.

[Slide 10: Call to Action Slide]

Back in 2001, the Office of the Surgeon General released a “Call To Action to Prevent Overweight and Obesity.”

The Call to Action strongly urged all sectors of society to take action to prevent and decrease overweight and obesity.

The factors which brought about the CTA remain; some would save they are even MORE pressing today.

We know that 12.5 million children and adolescents - 17.1 percent of people ages 2 to 19 years - are overweight.

And, as they grow older, overweight children and adolescents are more likely to have risk factors associated with cardiovascular disease such as high blood pressure, high cholesterol, and Type 2 diabetes.

Healthy Youth for a Healthy Future

[Slide 11: HYHF Tour Map Slide]

This ominous development is a major reason why I am visiting communities across the country to share this information and encourage adoption of best practices to address this alarming crisis.

This is one part of a federally supported effort that we call “Healthy Youth for a Healthy Future.”

During this “Healthy Youth” tour, I will recognize and bring attention to communities with effective prevention programs that motivate organizations and families to work together to on THREE overriding themes:

[Slide 12: Healthy Quadrants Slides]

1. Help Kids Stay Active
2. Encourage Healthy Eating Habits
3. Promote Healthy Choices

It seems easy to say and much more difficult to do.

However, anyone from student-consumers to medical specialists has a role.

Anyone can, and all of us should, practice (and encourage) good nutrition, exercise, maintaining healthy weight, regular health screening and discourage tobacco use and alcohol misuse.

Our efforts to reduce overweight among our Nation’s children are critical.

And physical activity rates among our youth are also declining: just a quarter of high school students are moderately physically active for 30 minutes a day, 5 days a week which is half the time recommended for youth.

Here in the state of New York:

• 10.5 percent of all high school students were reported overweight in 2005 (Youth Risk Behavior Survey, 2005);
• 29.6 of high school students met currently recommended levels of physical activity that same year. (Youth Risk Behavior Survey, 2005)

Kids should spend less time inside with the remote and more time outside moving around…getting exercise.

Because the factors contributing to overweight and obesity are complex, reversing the epidemic will take concerted action, by parents, educators, and youth - indeed by all sectors of society.

Our “Healthy Youth for a Healthy Future” initiative seeks to change children’s eating and activity habits.

The initiative concentrates on those who influence our children, including parents, providers of health care, schools, the food industry and local community leaders.

It is critical that we identify and share information about approaches that work.

Our success in addressing overweight and obesity will depend on our ability to communicate and collaborate effectively.

For that reason, we must actively recruit parents, families, community organizations, teachers and mentors of kids if we are going to make real progress against the national overweight epidemic.

Our approach must be clinical, educational, and ultimately transformational.

[Slide 13: President’s Challenge Slide]

One example is a new national fitness challenge initiated by the President’s Council on Physical Fitness and Sport;

This “National President’s Challenge” is a 6 week physical activity challenge to get America moving - 30 minutes a day, five days a week.

Value of Partnerships

As useful as the Challenge may be, the federal government cannot be alone in the fight against overweight and obesity.

The food, sports, beverage and entertainment industries must each step up to the plate and do their part.

Yesterday I spoke to the American Beverage Association, who has worked with educational administrators in public schools to establish guidelines which limit beverages available in public school vending machines during the school day.

Local communities are doing likewise.

For instance:

The Austin, Texas School District offers another ‘front’ the fight against childhood overweight. The district has prohibited the sale or distribution of "Foods of Minimal Nutritional Value," during the school day, at all grade levels.

These items include carbonated beverages and particularly sweet products like hard candy and candy-coated popcorn.

These foods cannot be sold or distributed to students during the school day.

During my recent visit to North Carolina, I learned more about one such program which enables kids to have fun and stay healthy at the same time.

The “Be Active HOPS” initiative trains, evaluates, educates and entertains students of all ages while delivering critical health awareness information they need to live healthy, active lives.

Similarly, the state of West Virginia has declared certain of its counties DRY - and it’s not what you think; these are counties throughout the state who have removed high calorie beverages from school vending machines.

There is also the ‘Big Fat Industries and Kidz Bite Back,’ a public awareness campaign in Pinellas County, Florida. Participants learn about food marketing practices and good health science; they are also taught techniques to increase their physical activity and healthy nutrition choices.

I’ve seen other promising, community driven projects to combat childhood overweight in visits to Baltimore, MD, Wilmington, DE, Philadelphia, PA and other locales.

Another good example is the National Football League, Ad Council and H-H-S collaboration to produce a Public Service Announcement designed to motivate young people to get the recommended 60 minutes of daily exercise into practice.

[Slide 14: NFL Video Clip]

[Slide 15: NFL Slide]

In April of 2007, the Robert Wood Johnson Foundation pledged $500 million over the next five years to combat childhood obesity in the US - the largest commitment by any foundation to this issue.

Few organizations have the visibility, resources or stature of the RWJF or the National Football League, but anyone can get on board and join our effort.

Commitments like this - and I expect to see more of them - CAN make a difference.

[Slide 16: We Can! Slide]

However, the process starts in communities.

It starts with the promotion of healthy lifestyle activities in local settings like Stony Brook, or your hometown.

The process is enhanced when an interested partner formally becomes a “WE CAN” community or participant organization, like more than 600 others in the United States. WE CAN is an NIH/NHLBI program to motivate people on the local level to ‘get up and move.’

H-H-S, for our part, is working on a number of fronts to do the same.

Later this year H-H-S will issue inaugural Physical Activity Guidelines for Americans.

The guidelines will provide a consistent message for the American public about physical activity, one which will be flexible enough for use by children as well as other specific population groups.

The guidelines will send the messages that wellness is a hard-won habit, physical activity is important, and the adoption of a healthy lifestyle begins with simple steps.

I have met with the committee working on these guidelines, and they’re really interested in making the key link between activity and overall health.

Their work will be enormously helpful.

Underage Drinking

[Slide 17: PUD slide]

There is another issue I want to discuss and elevate in your minds - the severe problem we have in this country with underage drinking.

Of course, underage drinking is a pressing problem on college campuses — Stony Brook and all over this country.

Universities should be safe places where students can thrive academically, grow personally, and mature socially without peer pressure to use alcohol.

We know that too often, colleges can be settings where underage alcohol use is facilitated, inadvertently or otherwise - and even openly accepted and actively encouraged by some students and organizations.

In fact, some parents and administrators appear to benignly accept a culture of drinking as an integral part of the college experience.

This worries me greatly.

A new report, Quantity and Frequency of Alcohol Use among Underage Drinkers, released by the federal Substance Abuse and Mental Health Services Administration (SAMHSA), underscores that underage drinking continues to be a serious public health problem.

According to the report, combined 2005 and 2006 data indicate that an annual average of 28.3 percent of persons aged 12 to 20 in the United States (an estimated 10.8 million annually) drank alcohol in the past month.

Underage youth who drank in the past month used alcohol an average of nearly 6 days monthly and consumed an average of nearly 5 alcoholic drinks on the days they drank.

We also know that alcohol is the most widely used and abused substance among our Nation’s youth: a higher percentage of young people between the ages of 12 and 20 use alcohol than tobacco or illicit drugs.

Nationally, approximately 5,000 young people under the age of 21 die every year as a result of underage drinking; this includes about 1,900 deaths from motor vehicle crashes,

Findings like these are one reason we released the "Surgeon General’s Call to Action to Prevent and Reduce Underage Drinking" last year.

They illustrate that underage drinking is hardly an innocent right of passage: rather, underage drinking is a dangerous activity.

I am not here to preach to you or to dampen anyone’s enthusiasm for campus parties on Saturday nights.

I am following the underage drinking evidence where it leads and asking you to follow.

The reality is college students and young people at every grade level are being harmed by underage drinking.

Alcohol also plays a significant role in risky sexual behavior including unwanted, unintended and unprotected sexual activity.

It increases the risks of physical and sexual assault.

• Approximately 600,000 students are unintentionally injured while under the influence of alcohol (Hingson et al. 2005).
• An estimated 700,000 students are assaulted by other students who have been drinking (Hingson et al. 2005).
• About 100,000 students are victims of alcohol- related sexual assault or date rape (Hingson et al. 2005).

The data are evidence-based and science-driven.

They confirm that underage drinking is not a harmless “rite of passage.”

The good news, again, is that “change is possible.”

Everybody should help.

So, what can universities do?

The Call to Action identifies efforts that campus communities can become involved in, such as:

• Community-based efforts to hold accountable university and campus groups that encourage and engage in underage drinking;
• Efforts to reduce easy access to alcohol around college campuses, and
• Efforts to restrict drinking in public places.

Collaboration

A perception exists that college students, will as a matter of routine drink alcohol - “no matter what.”

But that perception is wrong.

Remember: when the American people rejected the use of tobacco as a culturally acceptable behavior, the use of those substances declined, and the culture of acceptance shifted to disapproval.

The same change is possible with underage drinking.

In urging you to fully embrace the idea that and attitudinal changes need to take place regarding underage drinking, I am well aware that students are responsible for your own actions and for the individual choices that you make.

Everyone else interested in reducing and preventing underage drinking and its consequences is of like mind: we want young people, students to attain all the success possible.

Every student in my audience today should appreciate that our message can - and should - be yours too.

You are credible messengers.

The message that underage drinking is risky business…a practice that injures and kills…can reach as far as one wishes to carry it.

For more information about the underage drinking campaign, you can go to www.stopalcoholabuse.gov

Closing

In closing, whether we are talking about systemic change in health care, getting a handle on the obesity epidemic, or changing attitudes about underage drinking, the pace of creating cultural and environmental change is deliberate in the best of circumstances.

[Slide 18: Closing slide with family]

The process of making the kind of change we seek may not be glamorous and is certainty difficult.

But the stakes are high.

The stakes make it well worth our effort.

All of us have a stake in improving public health.

All of us can be ambassadors, for:

…health literacy

…disease prevention

…lowering the costs associated with health care

…physical activity

…more fit families and communities

…sustained good health in mind, body and spirit…

Let’s work cooperatively to make it happen.

I look forward to hearing about leadership from the Stony Brook community on these issues.

And I promise not to let another 30 years go by before visiting with you again.

Thank you.

- END -

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Last revised: December 30, 2008