Spreading the Practice of Exercise as Medicine

Remarks as prepared; not a transcript.

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

Address to the American College of Sports Medicine (ACSM) Annual Meeting

May 28, 2008
Indianapolis, IN

Thank you, Bob (Robert Sallis, American College of Sports Medicine President) for that gracious introduction.

I am honored to address your annual conference.

Department of Health and Human Services Secretary Michael Leavitt, and Assistant Secretary for Health Dr. Joxel Garcia, also extend their greetings.

I am always pleased to spend time and compare notes with fellow health professionals – and I am especially grateful to have the opportunity to share my thoughts with representatives of the American College of Sports Medicine.

Your role in preserving and advancing the health of young people, adolescents and adults is important to the Nation for many reasons.

Your leadership, as well as your support and use of best practices that promote the physical fitness of patients - of every age sends the right message to our health care system.

Moreover, the A-C-S-M and H-H-S share a common cause.

Both seek to create a Nation in which individuals live longer and more productive lives.

To borrow from the A-C-S-M mission statement, both of our organizations work to maintain and enhance physical ‘performance, fitness, health, and quality of life.

Both our organization realize that ‘Healthy People Make a Healthy Society.’

Advancing the science of exercise is your organizational heritage: promoting physical fitness is what ACSM has been about since its founding more than 50 years ago.

You appreciate the function of exercise as medicine.

As advocates and practitioners of this concept, the A-C-S-M membership is at the forefront of the fight against America's youth obesity epidemic.

Before I elaborate on the topic of childhood overweight and obesity and its consequences, I want to talk about the H-H-S vision for American health care, and then briefly discuss the focus of 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.”

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 discuss the priorities that we have in the Office of the Surgeon General - and where 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.

What we see is the need for profound change, a cultural, systemic change.

There is a need to move from a treatment-oriented framework of public health - where too little time, money and effort are invested in preventing disease - to a prevention-centered society in which healthy lifestyles are promoted and sustained.

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

Seven of 10 Americans 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 in the time, emphasis and resources we invest to prevent chronic diseases will save lives and in some cases save precious health dollars.

Yet, much work remains if we are to move from a treatment-based system of health care delivery to one which emphasis preventive medicine.

[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.

In fact, 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.

And 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.

For that reason, we have created and maintain resources for doctors and nurses, the faith community, business people and others to help 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:

- In 2004, African American men were 30 percent more likely to die from heart disease, as compared to non-Hispanic white men; African Americans are also 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.

- In American Indian and Alaska Native populations, the infant mortality rate is 51 percent higher than in non-Hispanic whites. American Indian/Alaska Natives Sudden Infant Death Syndrome (SIDS) rate is 1.9 times the mortality among non-Hispanic whites.

And these are just a few examples.

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.

In 2003, an estimated 77 million American adults, about 36 percent of the population, were reported to be at or below basic health literacy levels (Source: National Center for Education Statistics, Institute for Education Sciences).

This means that approximately 33 million adults could not, for example, read a set of short instructions and identify what is permissible to drink before a medical test.

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

We must 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.

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

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.

I use the food label as an example because it relates 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.

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]

Sharing information about the overweight and obesity epidemic is a primary reason I am here today.

[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, nationally, 12.5 million children and adolescents - 17.1 percent of people ages 2 to 19 years - are overweight.

Moreover, additional confirmation is not far away.

Some15 percent of Indiana high schools students were reported overweight in 2005 (Youth Risk Behavior Survey).

At the same time, 32 percent of Indiana high school students did not meet recommended levels of physical activity (Youth Risk Behavior Survey).

Making early progress against overweight and obesity is crucial.

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.

What does this mean? It means more patients on dialysis, more premature blindness and disabilities of many other types.

It means our youth may not live as long as we do and

Healthy Youth for a Healthy Future

[Slide 11: HYHF Tour Map Slide]

These ominous developments are a major reason why I am visiting communities across the country; I am sharing this information and encouraging 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]

- Help Kids Stay Active

- Encourage Healthy Eating Habits
- Promote Healthy Choices

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.

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

As they do so, they will learn what the A-C-S-M knows: that “Exercise is Medicine.”

And as they do, they will also begin to appreciate how ‘Medicine Can Be Fun.’

Until then, however, it is important to remember that obesity is complex, so reversing the epidemic will take concerted action.

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

To those ends, 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.

Value of Partnerships

As useful as these programs and others are, the federal government cannot be alone in the fight against overweight and obesity.

I know that the A-C-S-M has entered into collaboration with the Mayo Clinic, and undertaken other activities to combat obesity. I commend you for this.

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

One example of this:

The American Beverage Association has worked with public schools to establish guidelines which limit beverages available in public school vending machines during the school day.

Local communities are also setting great examples:

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.

There are numerous other promising, community driven projects as well.

The “Healthy Stores” projects in Baltimore, MDand elsewhere aim to improve health and prevent obesity and disease in low-income communities through culturally appropriate store-based interventions that increase the supply of healthy foods and promote their purchase.

The “5-2-1-Almost None” child health initiative in Wilmington, DE encourages:

Eating at least five servings of fruits and vegetables a day,

Watching two or fewer hours of screen time a day,

Getting one or more hours of physical activity a day, and drinking almost no sugary beverages.

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]

Always, the process starts in communities.

It starts with the promotion of healthy lifestyle activities in local settings like where you live or work.

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.

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 message is 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.

Closing

In closing, whether we are talking about modifying the health care system or getting a handle on the obesity epidemic, dramatic change is slow to take place in the best of circumstances.

But, we will make progress, thanks to commitments from A-C-S-M health professionals and others like you.

[Slide 18: Closing slide with family]  

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

We need only summon and maintain the will required to make change.

I look forward to working your membership in every possible way.

All of us have a stake in improving public health. 

Everyone here can be an advocate for …disease prevention …for health literacy…for preventing childhood overweight and obesity…for increasing daily physical activity levels.

And, each of us can widely discuss the importance of diet and nutrition, and broadly spread the word: healthy choices will add years and quality to an individual’s life.

Let’s work to make it happen.

Thank you.

###