Address to Children’s Marcy Hospital Clinicians and Students

Remarks As Prepared, Not a Transcript

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

Address to Children’s Mercy Hospital Clinicians and Students 

September 4, 2008
Kansas City, Missouri

Good morning. Thank you, Sarah (Dr. Sarah Hampl, Director of Weight Management, Children’s Mercy Medical Center) for that gracious introduction.

And I thank you also, John, (RADM John Babb, Regional Health Administrator) for all that your office does and especially for your hard work to make today’s event a successful one.

Region VII is in excellent hands.

Department of Health and Human Services Secretary Michael Leavitt and Assistant Secretary for Health Dr. Joxel Garcia also extend their greetings and best wishes to all of you.

I am always pleased to spend time and compare notes with fellow health professionals – from specialists to institutional veterans to fledgling medical residents.

I am especially grateful to have the opportunity to share my thoughts with you - representatives of a facility considered for good reason to be a premier referral hospital for children in this region.

Some of you may think my address to you is like preaching to the choir, and there’s an aspect of this, but improving communication among the Office of the Surgeon General, professional groups, and the Officers of H-H-S Regional Health Administrators is critically important to me.

Similarly important is the commitment of my hosts today: your dedication to advancing the health of children, adolescents and adults in Missouri and Kansas is important to the people of your great state and to the Nation.

I salute you for this.

Your visibility is essential.

Your support in encouraging the use of best practices that secure the health status of young people is sending the right messages to our health care system.

In a real sense, you are on the front lines of the fight against America’s youth obesity epidemic.

Children’s Mercy Hospital has been a visionary leader. I know you - the clinical staff and students - have helped to make it so. I’m well aware of the widespread respect your hospital enjoys among medical colleagues and the public alike. It is a respect that I share.

Whether you recognize it or not, you - the staff and administrators - are also agents of change.

I say this knowing that many of you join me in the necessary and ongoing effort to shift the culture of medical care and public health.

I commend the initiative you have already taken, and your willingness to do whatever you can to ensure that today’s young people are prepared and physically able to reach the fullness of their potential tomorrow.

A real need exists to address the alarming epidemic of overweight and obesity among young people: The prevalence of overweight in United States children, 2 to 5 years old, has increased 2-fold since 1975.

Moreover, toddlers who are markedly overweight are much more likely to become overweight/obese 12-year-olds when compared to their peers of normal weight.

Before I discuss the preventing childhood overweight and obesity in greater detail - I want to share the H-H-S vision for American health care.

[Slide 2: Value Driven Health Care]

Value-Driven Health Care

H-H-S Secretary Leavitt and I, indeed the entire leadership of the H-H-S 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, we are committed to bring about a future in which consumers:

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

…approach health care the way they would any other major purchase.

We foresee a future in which:

… Personalized health care - service delivery carefully tailored to meet an individual’s needs - is the norm.

… Every American is insured – every citizen, without exception, has access to basic health insurance at an affordable price.

This leads me to discuss the priorities that we have in the Office of the Surgeon General

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.

There is a need to move from a treatment-oriented society to a prevention-centered society in which healthy lifestyles are promoted and sustained.

Seven out of 10 Americans die each year of preventable chronic illnesses such as heart disease, diabetes and cancer.

The medical care costs of people with chronic diseases account for as much as $1.4 trillion of the nation’s medical care costs.

A modest increase in the time, emphasis and resources we invest to prevent chronic diseases will save lives and potentially reduce healthcare costs.

[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 preparedness is multi-dimensional. It must also involve planning by every level of society, individuals, families, and communities.

[Slide 5: Pandemic Flu checklist]

One important area that we continue to work on, even as the media has died down, is pandemic flu preparedness. We must do everything we can, every day, to be ready.

To help communities and families prepare, we have preparedness checklists on our website.

These include checklists for individuals, families, schools, businesses, hospitals, and community organizations.

[Slide 6: Health Disparities]

Another 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.

[Slide 7: Health Disparities Graph]

Some of illustrations:

• African Americans babies are twice as likely to die within the first year of life;
• And Hispanics have higher rates of obesity than non-Hispanic Caucasians.
• On average, African Americans are 2.2 times as likely to have diabetes as Whites.
• American Indian/Alaska Native adults are 1.2 times as likely as White adults to have heart disease.

It is imperative that things change, and we need to work collaboratively to make change happen.

Unfortunately, these statistics go on and on.

These trends simply must change.

We must increase access to services and improve the health status Americans of every age and all populations.

Federally funded Community Health Centers present a promising solution.

Health Centers provide comprehensive, culturally competent, quality primary health care services - including access to pharmacy, mental health, substance abuse, and oral health services.

Because health centers are experienced in prevention and are connected to a variety of traditional and non-traditional partners, they are a particularly important agent in our nation’s fight to prevent childhood obesity.

[Slide 8: 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).

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

You more than most know what a profound difference it can when a young person is able to identify Nutrition Facts on a food container and use them to better manage their diet.

Every day, health care providers like you and your colleagues witness the health literacy gap…the chasm of knowledge between what professionals know and what patients understand.

Whether we are a public health professional, parent, mentor or all three, each of us can make sure that good health information is getting into the hands of our kids and others who need it.

Each one of us can be an ambassador for health literacy.

Overweight and Obesity

One pressing public health challenge cuts across state boundaries, geographic areas, age groups and socio- economic status.

I’d like to pause and show you an entertaining but serious video clip illustrating what has happened in American society.

[Slide 9: LAZY BONES CLIP]

The clip focuses on bone health, but you all know the health risks of obesity go way beyond the bones.

There has been a startling trend in adult obesity rates in our country just in the past decade.

[Slide 10: Obesity Maps Slide]

This slide depicts the startling trend in adult obesity rates in our country in the past decade. This is national survey data of the percent of the population of each state with a BMI greater or equal to 30, or about 30 lbs overweight for a 5’4” person.

[Slide 11: 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 C-T-A remain; some would say they are even MORE pressing today.

That is why, as the Surgeon General, I am committed to making the prevention of childhood overweight and obesity my top priority.

Childhood overweight and obesity is among the foremost health challenges of our time because children are the future of our nation.   The data are telling.

• To date more than 12.5 million children and adolescents – 17 percent of people ages 2 to 19 years -- are overweight.
• Overweightincreased from 7.2 to 13.9 percent among 2-5 year olds ALONE and from 11 to 19 percent among 6-11 year olds between 1988-94 and 2003-2004 (Source: National Center for Health Statistics).

Moreover, if a child is overweight at least once between the 2 and 4 years of age, he or she is five times more likely to be overweight at age 12 than a child who was never overweight between the ages of 2 and 4 (Nader, et al, Pediatrics, 2006)

We also know that overweight adolescents have a 70 percent chance of becoming overweight or obese adults.

Of course, as overweight children and adolescents grow older, they are more likely to have additional risk factors associated with cardiovascular disease such as high blood pressure and high cholesterol.

The situation here in Missouri is another illustration of the seriousness of the problem.

The 2007 Missouri Youth Risk Behavior Survey indicates that among high school students:

Obesity

• 12% were obese.

Unhealthy Dietary Behaviors

• 82% ate fruits and vegetables less than five times per day during the 7 days before the survey.
• 33% drank a can, bottle, or glass of soda or pop (not including diet soda or diet pop) at least one time per day during the 7 days before the survey.

Physical Inactivity

• 56% did not meet recommended levels of physical activity.
• 30% watched television 3 or more hours per day on an average school day.
• 21% played video or computer games or used a computer for something that was not school work for 3 or more hours per day on an average school day

[Slide 12: HYHF Tour Map Slide]

Data like these suggest why I am visiting communities across the country to encourage discussions and implementation of best practices to address this alarming crisis.

This is part of an initiative called “Healthy Youth for a Healthy Future.”

As you can see from this slide, to date, I have visited the highlighted states and I look forward to visiting several more over the course of the next few months.

At each stop, I’ve learned about effective local childhood overweight and obesity programs; I’ve shared information about these programs at each subsequent stop on the tour.

Each stop includes discussion with public health professionals, community leaders, and other partners who are active in the fight against obesity.

We want to motivate and mobilize parents, kids and others who influence our children - mentors, caregivers, schools, public health leaders, and local community leaders.

It seems easy to say and more difficult to do.

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 promote the goals of this initiative which are to:

[Slide 13: Healthy Quadrants Slides]

• encourage kids to stay active,
• eat nutritiously
• make healthy choices

I am talking about programs and activities like yours here at Children’s Mercy. I’m talking about exemplary programs like the “Weighing In Coalition.”

Yours is a model for communities who aspire to work collaboratively to reduce and prevent childhood overweight and obesity prevention.

I commend Dr. Hampl and everyone responsible for your Region’s commitment to combating childhood obesity.

Make no mistake: improving children’s health, and changing their habits, is more critical than ever.

It is important to realize that 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.

This must change.

Parents need to encourage young people to spend less time in front of computer and television screens and more time getting up and moving around.

Well respected organizations must get involved to combat the obesity epidemic just as your community coalition is doing.

The Weighing In Coalition membership, more than most, is well is aware of the importance of starting early and “setting the bar” appropriately high.

Another good example of an organization of stature taking action in the obesity fight 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]

So too is the Robert Wood Johnson Foundation a “good citizen” in combating obesity.

In April, 2007, RWJF 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.

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

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

Commitments like those I have just described CAN make a difference.

I expect to see more commitments – from all sectors of society.

…For the stakes are high in the fight against childhood overweight and obesity.

…As a matter of individual and community well being.

…For the sake of the futures of America’s young people.

…As a matter of public health …national productivity… and economic sustainability.

The outcome of the fight against child overweight and obesity is critical.

Just as clinicians and public health professionals are trained and positioned to reach out with accurate information about the added value of physical activity, nutritious eating and maintaining a healthy weight...

So too must we 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 multi-faceted: clinical, educational, and ultimately transformational.

[Slide 16: We Can! Slide]

It 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 ‘become and remain” physically active.

It continues by offering healthy food and beverage choices in school vending machines as Austin, TX, certain West Virginia counties, the American Beverage Association and others are doing.

It is enhanced by projects like the ‘Big Fat Industries and Kidz Bite Back,’ a public awareness campaign nearby: in Pinellas County, Florida.

Participants in the campaign learn about food marketing practices and good health science; they are also taught techniques to increase their physical activity and healthy nutrition choices.

It gains momentum through North Carolina’s “Be Active Hops” program and others like it…which show kids that physical activity is user friendly and how much fun it can be.

By taking a look at what each of us can do in our lives and communities - whether a physician, parent, good neighbor, business person or “All 4“ - to make ourselves and our families healthier we can begin to tackle this epidemic.

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

[Slide 17: President’s Challenge Slide]

The President’s Council on Physical Fitness and Sports is encouraging kids, adults, and organizations to log on to join the President’s Challenge at www.presidentschallenge.gov

Moreover, this fall the 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 your message…it is my message…it is a message that should be shared by anyone who cares about creating and maintaining a Nation of physically active young people.

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.

[Slide 18: Closing Family Slide]

It is important to keep in mind that we will not achieve results against childhood overweight and obesity overnight.

But we won’t make any progress at all unless other organizations join you and make prevention and early child health education priorities NOW.

They must remain OUR priorities for as long as it takes.

That means as long as it takes to get a handle on overweight and obesity…to reduce its prevalence.

That means as long as necessary to end the spike of chronic conditions and cardiovascular disease risk factors.

That means as long as required to begin to routinely prevent disease and illness that imperil kids’ future.

In the meantime, for more information about federal activities, visit www.surgeongeneral.gov

Government needs the help of businesses, industries, and associations who care - to create and sustain progress in combating overweight and obesity.

The end result of this work will NEED to be a population of physically active Americans centered on prevention, routinely conscious of diet and nutrition whose healthy choices add years and quality to their daily lives.

Together, let us resolve to make it happen.

I’ll now be happy to take a few questions.

Thank you.