Child Obesity and the Common Cause of Medicine and Public Health

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 Mount Sinai Medical School Alumni - 1983 

October 24, 2008

New York City, NY

[Slide 1: Title Slide]

Good afternoon.

Thank you Dennis (Dennis S. Charney, M.D., Dean of Mount Sinai School of Medicine and Executive Vice President for Academic Affairs of The Mount Sinai Medical Center) for that gracious introduction.

It is my pleasure to kick off this 2008 Alumni weekend.

I was honored to be asked to come up here and talk to current members of the Mt Sinai family and past graduates including my class of 1983.

I was last here in 2006 talking about my work managing the drug regulatory part of the Food and Drug Administration (FDA) and for those of you worried about hearing the same things – don’t worry,  That world is on my current plate of activities so you won’t hear about it at all.

I do want to take a minute and acknowledge my 16 year old son Eric and my wife Jessie who are in the front row and keep the home fires warm for me while I travel  around the country promoting public health.

Jessie, known professionally as Dr. Jessie Wolfe, received her PhD in pharmacology department led by Jack Green in 1986.

In addition to raising our 3 children and pursuing her own career – she’s an associate director of medical writing at Human Genome Sciences, Jessie has supported me at every step of my career.  I wouldn’t be  where I am today without her.

We’re a true Mt Sinai couple (Dean Charney, where is that violin music you promised?).

We met for the first time in the old basement cafeteria….I certainly hope it has been renovated because it was dismal in 1981… I didn’t notice the drab surroundings when I was sitting across from Jessie.

Thank you, Jessie and thank you Mt. Sinai for facilitating our relationship.

So it is good to be back at an institution and in an environment which had such a significant impact on my professional and personal life.

My memories of the fantastic support, teaching and counseling here inside these walls are very strong:

…In public health Irving Selikoff and Kurt Deuschle, In internal medicine Ruth Abrahamson, and Peter Nicholas…they and many others were deeply committed to students and training and I am very grateful for their guidance.

I first seriously considered the opportunities associated with the field of public health during my time here.

Frankly, although public health was not widely discussed as a career option among medical students here in 1983 - I am sure Phil Landrigan has changed all that -  the support I did get for my interests proved to be important and timely to me.

When I refer to the plight of poor health afflicting  the billions of people living in the developing world, it is the refugees in SE Asia I took care of between my third and fourth years here that I think about.

When I refer to our domestic challenges of health disparities and health literacy it is my student time at Elmhurst Hospital and around the Mt Sinai teaching archipelago in lower Manhatten and Harlem that still jump to mind.

Since Mount Sinai, my career path has been far from traditional for a physician.  It is a path loaded with serendipity. 

Those experiences have led to one of the greatest honors in the public health professions – to direct the Office of the United States Surgeon General.

[Slide 2: Value-driven Healthcare]

Value-Driven Health Care

I want to spend a few minutes this afternoon telling you about some of the priorities of my office and of the Department of Health and Human Services.

HHS Secretary Michael Leavitt and I, indeed the entire leadership of the HHS 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 HHS, 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.

To those ends, we focus on several specific areas within my office.

Priorities

One of my major responsibilities as Surgeon General is to 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.

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.

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

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 HHS 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.

Some of you may be familiar with this uniform that I am wearing – it is not the U.S. Navy – it is the uniform of the Commissioned Corps of the United States Public Health Service.

Officers in the Public Health Service serve as physicians, nurses, dentists, dieticians – to name a few categories…and they serve in federal agencies within the Department of Health and Human Services such as NIH and CDC as well as other federal agencies such as the Department of Defense and US Coast Guard.

Our officers are available to respond rapidly to urgent public health challenges and emergencies – including man-made or natural disasters.

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.

Some illustrations:

- African Americans babies are twice as likely to die within the first year of life;

- 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.

Unfortunately, these statistics go on and on.

It is imperative that things change, and we need to work with multiple partners in medicine to make change happen.

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

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.

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

Whether we are a public health professional, faculty member at a teaching hospital, private practitioner or parent, each of us can make sure that good health information is getting into the hands of our kids and others who need it.

As these activities suggest, my office is in the business of bettering the health and quality of life of populations.

We seek to foster communities in which individuals and families live longer, healthier and more productive lives.

We are committed to sharing accurate information about healthy activities, healthy habits, and healthy eating – all those things that make for good health; we are advocates for a better quality of life for all people

After all, that is the nature of the field of public health.

Public health is about:

- promoting health on an ongoing basis through multiple means,

- preventing diseases before they happen;

- monitoring populations through epidemiology; 

And why should public health be important to academic medical centers?

In the broadest sense, we have more in common than one might think….and as others have previously noted we have more practical reasons to work together than one might initially consider.

Today, professionals and institutions in the two sectors need each other and can help each other – not only in addressing patients and populations’ health problems, but also in promoting their own professional and economic health. (Medicine and Public Health, the power of collaboration, Lasker, 1997).

The fields of academic medicine and public health each are concerned with the direction of the US health care system.

Both are under economic and performance pressure.

Neither can accomplish its mission alone.

In my world and yours, from academic medical centers to private practice to public health, times and roles are changing.

I mentioned earlier that we can reduce unsustainable health care costs through preventive medicine.

Well, to fully realize the systems change which an emphasis on prevention and preparedness requires, we need a workforce trained and suited to task.

Our concept of the health professions must evolve.

The aging of the US patient population will have marked impact on health care in any case.

A shortage already exists in nearly every health profession: 250,000 active physicians today are over 55 years old.  That is approximately 30 percent of the active U.S. physician workforce today.

Accordingly, we must prepare our health professionals for the future by using new technologies and practices such as telemedicine, Interdisciplinary teams, and medical home research.

These new technologies and ways of practice require re-thinking of how we train.

And in my world, we are confronting a public health workforce crisis.  The current workforce is inadequate to meet the health needs of the United States, much less the global population.

* The Association of Schools of Public Health (ASPH) estimates that 250,000 more public health workers will be needed by 2020.

*  ASPH also finds the public health workforce is diminishing over time, 50,000 fewer public health workers in 2000 than in 1980 – of those currently on the job, about 20% are eligible to retire.

* Furthermore, the Sullivan Commission on Diversity in the Healthcare Workforce reported:

“Today’s physicians, nurses, and dentists have too little resemblance to the diverse populations they serve, leaving many Americans feeling excluded by a system that seems distant and uncaring. 

The fact that the nation’s health professions have not kept pace with changing demographics may be an even greater cause of disparities in health access and outcomes, than the persistent lack of health insurance for tens of millions of Americans.”

These workforce issues are of great concern. 

Academic medical centers, for your part, must continue to create and sustain a culturally diverse workforce suited to the task of providing care and improving health in our evolving system of U.S. medical care system.

Your ability to recruit young people committed to medicine is a proven one.

Your pipeline to the health professions is a well established one.

For good reasons, Academic Medical Centers are the “go to guys” – the institutions to which we look for graduates who must lead the systems change and professionals required in the 21st century.

Academic Medical Centers are credible. Because of the role you play, medical care and the health professions more broadly will remain as vital and dynamic as the times require.

There are specific reasons for academic medical centers to care about public health activities as well.

Among them:

- To design health care delivery services based on community epidemiological data (efficient and effective method for meeting the healthcare needs of specific populations - designing healthcare for populations)

- To strategically align organizational resources based on community need that is typically found through public health functions

- For establishing adequate infrastructures, information systems, and networks of integrated health care and public health services

- To be prepared for emerging health risks and threats typically discovered through public health surveillance activities

- To reduce patient costs of the delivery system through public health prevention interventions.

-To utilize health alerts disseminated by public health to the practice community.

Overweight and Obesity

One pressing public health challenge surely merits an alert: it cuts across state boundaries, geographic areas, age groups and socio- economic status.

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

[Slide 3: Obesity trend maps]

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.

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.
• Overweight increased 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).

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.

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

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.”  It is, in part, what brings me to New York. 

[Slide 4: HYHF USA Map]

To date, I’ve been to nearly 30 cities as part of the HYHF tour as you can see from this slide.

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

[Slide 5: 3 HYHF Goals]

- 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.

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);

- Less than one third of high school students met currently recommended levels of physical activity that same year. (Youth Risk Behavior Survey, 2005)

[Slide 6: PAG Slide]

Last week I participated in the release of the Physical Activity Guidelines.

We know that when it comes to physical activity, “one size no longer fits all.”

These first-of-their-kind guidelines provide recommended activity levels by age group.

One of the primary goals of the guidelines is to encourage all Americans to be active “their way.”

Any amount of physical activity is better than none and with even a small amount of physical activity, we can lower health risks.

Of course, the more physical activity we get, the more benefits we receive.

Certainly leading by example through increasing our own physical activity level is one key step for role models in preventing childhood overweight and obesity.

To this ends, we must actively recruit parents, healthcare providers, community organizations, teachers and mentors of kids if we are going to make real progress against the national overweight epidemic.

At each city I’ve visited as part of the HYHF tour, I’ve observed effective, community-designed and community-driven programs intended to change kids’ eating and activity habits.

At each state, I’ve liked what I have seen and heard.

At each state, I’ve shared what we know: the epidemic of childhood obesity is real and alarming.

Our approach to ending it 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.

Clinicians, practitioners, and public health stakeholders everywhere must join the effort and remain active in it for as long as it takes to get a handle on the epidemic.

[Slide 7: NFL Ad Council]

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

There are numerous others.

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.

Always, the process starts in communities.

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

[Slide 8: WE Can!]

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 (it stands for Ways to Enhance Children’s Activity and Nutrition) is an NIH/NHLBI program to motivate people on the local level to ‘get up and move.’

Earlier today, I was at the Children’s Museum of Manhattan participating in a Media Event to bring attention to the work being done by The Children’s Museum of Manhattan and the Community Health Care Association of New York State and the National Institutes of Health’s We Can! [Dr. Galson elaborates on the morning’s event]

Closing

In closing, whether we are talking about

- modifying the health care system,

- marrying the interests of academic medicine and public health

- or getting a handle on the obesity epidemic through physical activity

Dramatic change is slow to take place in the best of circumstances.

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

We need to recognize and appreciate the need for change.

We need to see the wisdom and endorse the purpose of collaboration.

Then we must summon and apply the will necessary to make systems change and cross-field collaboration real and ongoing.

And as we bring about that change – INDIVIDUALLY AND TOGETHER, WITHIN AND ACROSS OUR SILOS - our fellow citizens everywhere will be healthier for it.

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.

Join me in doing it!!

Thank you.

- END -