David Satcher, M.D., PH.D.
Assistant Secretary for Health and Surgeon General
Office of Public Health and Science

Monday, March 15, 1999

[This text is the basis for the Assistant Secretary for Health and Surgeon General's oral remarks. It should be used with the understanding that some material may be added or omitted during presentation.]

Introductory Remarks

Acknowledgments

Thank you for that kind introduction. My pleasure in being here. I bring you greetings from the Department of Health and Human Services.

It's a joy to be here for the 22^nd National Food Policy Conference. I want to commend you for the work you do to help ensure public health through research and advocacy for food safety and policy.

Let me commend you for the work that you do and your special contribution I appreciate your efforts for several reasons. First, because during the time that I was Director of the Centers for Disease Control and Prevention (CDC), I was responsible for developing a reliable system of food safety surveillance for the nation. Today, as Surgeon General and Assistant Secretary for Health, I have the added responsibility of protecting public health, including food safety surveillance, and setting healthy guidelines for nutrition.

I also want to commend your work because my experience in having grown up on a farm has made me intimately aware of the importance of safe food handling and good nutrition.

The Important Place of Food in Our Lives

Food is a necessity to live. Not only that, it is a universal source of pleasure, in addition to being a source of health and strength. Families eat together. Business deals are made over lunch and dinner. Love affairs begin and flourish around meals. Even religious ceremonies like the Last Supper involve food.

So even the remotest threat to the safety of our food supply is a threat to nearly every facet of our lives.

The Safety of Our Food Is a Critical Concern

Generally, our food is considered to be fairly safe -- maybe the safest in the world. However, there are far too many threats and illnesses from food consumption. It's difficult to know exactly how many people become ill or die from foodborne illnesses each year, but we believe somewhere between 33 million and 81 million people suffer from foodborne illnesses each year. We have difficulty reporting the numbers because many people who get foodborne illnesses often do not report it. And many physicians who see patients with foodborne illnesses often don't report it. It's estimated that about 9,000 to 10,000 people die each year from foodborne illnesses, at a cost of about $6.5 million to $35 billion.

The questions still remain as to whether we are experiencing more illnesses today than ever before? Or are we simply hearing about more? And are people more susceptible today than ever before due to weakened immune systems? Whatever the case, we must work to strengthen our system of food safety and surveillance. How we handle food determines how well we live.

My Experiences With Food Production

One of my favorite hobbies is gardening, which might be due to my experiences as a child growing up on the farm. It's a wonder that we did not experience more foodborne illnesses back then. With no running water and no electricity, we relied on canning, smoking and preserving foods. My parents raised 10 children on 40 acres of rocky land in Anniston, Alabama. We planted, nurtured and harvested the food we ate  and we knew firsthand what went into getting it from the farm to the table.

Today, however, far fewer people are raising the bulk of their meals themselves, and many different people are involved in getting the food from the farm to the table. We rely on the services of many different people to grow, harvest, process, and deliver, store, and prepare our food for us. That means that outbreaks can happen at so many different levels when you have so many people handling food and we must be concerned about the number of dangerous substances our food might contain, including pathogens, allergens, chemicals, additives, to name just a few.

Thanks to the great strides we have made as a nation in setting in place a system of surveillance to ensure food safety, we can feel fairly confident that when we go to the grocery store, the school cafeteria, the restaurant, the fast food chain, or the all-night diner, the food we are getting is usually safe B but not always.

And should anything break out, we can take some comfort in knowing that our early warning systems and early detection systems help ensure that we are monitoring and tracing diseases more quickly than ever before. Some of those systems include the Foodborne Diseases Active Surveillance Network called FoodNet, the USDA's Pathogen Reduction and Hazard Analysis and Critical Control Points (HACCP) and Pulsenet, the foodborne pathogen fingerprinting system, and the National Antibiotic Resistance Monitoring System (NARMS).

Just last week the Department released preliminary data from the CDC's FoodNet that shows a decline in the overall incidence of Salmonella and Campylobacter infections, two of the most common causes of foodborne disease in the United States.

Even with that, foodborne illnesses claim the lives of 9,000 people each year and estimates are that incidents are expected to rise by 10 to 15 percent over the next decade.

Threats to Food Safety

What is the basis of our problem today? First of all, it's the way we eat. Our diet is a problem. Fast food restaurants can be a problem, as with the E. Coli 0157H7 breakout at Jack-in-the-Box during the time I was Director of CDC. There are many different ways things can go wrong in fast food establishments, as often documented. Also, our global food supply raises some concerns, as we saw with the Hepatitis A outbreak from strawberries, which we traced back to a processing plant. Then, there's new and emerging infectious diseases, resulting from bacteria, fungi, parasites, and additives, not to mention the problem of weakened immune systems from AIDS, organ transplants, and illnesses. All are threats to food safety and how we deal with it.

Enhancements to Food Safety

We have new cooperation among agencies, including the FDA, USDA, EPA, and CDC. These relationships enhance the public health infrastructure for early detection and awareness. FoodNet represents a type of cooperation that has been rare in the past. In addition, upgraded systems will further enhance those relationships.

The National Academy of Sciences has raised concerns about the nation's food safety, including the adequacy of the science, the need to improve the statutes that impact regulations and inspections, and the need for a single voice regarding food safety. These are issues we will and must continue to debate.

Surgeon General's Priorities

Since becoming Surgeon General and Assistant Secretary for Health, I have traveled the nation talking to people about our evolving priorities. But I said when I was sworn in that I wanted to be the Surgeon General who not only talked to but who also listened to the American people. So I've been doing just that, and out of our conversations have come some very important developments.

Let me just say before I get into these priorities that I hope that you will not only listen to them, but that you will also offer feedback and respond, because I'm going to need your help in making them work.

Our first priority is to move toward a Balanced Community Health System. That system must be based on health promotion, disease prevention, early detection and universal access to care. And it must be research-based and supported by the best available science. This system calls for community involvement, including civil groups, faith-based organizations, and other local organizations.

Today, our system of health is at best uneven. A balanced community health system must include a system of food safety.

So what must a balanced community health system achieve?

Every child should be given the opportunity for a healthy start in life. Getting a healthy start in life means several things. It begins even before a child is conceived. It relates to women placing emphasis on their intake of Folic Acid even before they get pregnant to reduce the incidence of neural tube birth defects. It relates to women eating nutritious meals and avoiding toxins, like cigarettes, alcohol, and illicit drugs during pregnancy to reduce the risk of bringing harm the baby in utero. And it means breast feeding babies to improve their immune systems. The type of start a child gets early in life plays a large part in determining that child's future. If every child will have a healthy start, nutrition will have to play a major role.

Only about 60 percent of women in this nation breastfeed; and the number is even lower for African-American women, around 30 percent.

A balanced community health system must also promote healthy lifestyles. This relates to nutrition, physical activity, responsible sexual behavior and the avoidance of toxins--including tobacco.

We have a virtual epidemic of obesity in this country, in both children and adults. It's interesting to note that when we were on the farm, we all got physical activity; many of us today still eat as though we were working on the farm.

Obesity is one of the areas where we're moving in the wrong direction with our Healthy People 2000 goals. It's interesting to note that in two other areas, diabetes and asthma, we are also moving in the wrong direction. In fact, Type II diabetes accounts for 90 percent of the diabetes we see in this country, and it used to be unheard of in children.

One of the biggest challenges we face as a nation is convincing people to do adopt healthy lifestyles. The best science-based information on healthy habits is readily available, but the will and commitment to good health does not always follow.

We must improve the nation's mental health system. No priority yet has generated as much interest and enthusiasm as this one on mental health. We must remove the blame and stigmatization that surrounds mental health in this nation. Mental health problems often relate to other serious health problems we face in this country, including substance abuse and violence.

Last October, we held the first-ever national conference on suicide prevention. It was the first time health professionals, suicide survivors, and policy makers have been brought together under one roof, in an effort to shape a different future for this country as it relates to suicide and mental health. We hope to gain out of that a Surgeon General's Conference Report on Suicide Prevention. And in the next year or so, we anticipate a Surgeon General's Report on Mental Health.

We must address issues of hopelessness that mitigate against our willingness and desire to address health issues.

We must maintain a global perspective when it comes to public health. We live in a global village. And we enjoy one of the safest and economically affordable food supplies in the world. Yet, every day, as the marketplace expands and two million people cross national borders, we experience a growing threat of the transfer of infectious diseases, threatening our overall safety and comfort.

Food safety is increasingly becoming a global issue. And the amount of food consumed in the United States that is imported from other countries continues to rise. In fact, 40 percent of the fruit, 8 percent of the vegetables, and 60 percent of the seafood we consume in this country come from abroad. And we are sending increasing amounts of food to other countries. With each export or import, the risk of infection from improper growth or handling increases.

Eliminating Disparities in Health. An overriding factor of each of these objectives is the goal of eliminating racial disparities in health. Back in February of this year, the President unveiled his Initiative on Race and Health. In it, he announced a goal of eliminating racial disparities in health by 2010, coinciding with the Healthy People 2010 Initiative. For all the medical breakthroughs we have seen in the past century, we still see significant disparities in the medical conditions of racial groups in this country.

We have selected six areas to being our efforts and focus. They are reducing infant mortality, increasing child and adult immunizations, reducing new incidents of HIV, reducing cardiovascular disease, increasing screening and management of breast and cervical cancer, and reducing the risk factors for diabetes that lead to blindness, amputations and end-stage renal disease.

Our goal is to close these gaps by 2010. If we hope to succeed, our greatest chance is through addressing at the community level.

1994-96 data show that 34% of African-Americans met the goal of 5 servings of fruits and vegetables per day, as compared to 40 percent of Hispanic and 41% of White, non-Hispanic Americans. The differences that these data suggest in terms of dietary patterns may be a factor in the disparities we see in the prevalence of obesity and diet-related chronic diseases among ethnic groups.

Eliminating Disparities Is Not a Zero Sum Game. We are not taking anything from anyone when we protect the health of those most vulnerable and at risk. The Public Health Services was founded on this premise 200 years ago.

Conclusion

Let me leave you with the famous words of John Gardner: "Life is filled with golden opportunities, carefully disguised as irresolvable problems."

I look forward to working with all of you. Thank you.