PHS Promotions Ready

 

Public Health Challenges Addressed

Surgeon general.of the Public Health Service Dr. C. Everett Koop has eschewed
politics in favor of a strong bent toward the issues surfacing in public health
today—the rising incidence of violence in American society, for example. He also
has questioned the wisdom of raising a generation glued to video screens (an issue

he stresses needs more study).

In the following remarks, excerpted from an interview, Dr. Koop describes some
of the preventive measures he believes are important in today’s world and tells how
the Department of Health and Human Services, with its Commissioned Corps,

intends to tackle them.

Contrary to the rumors, I have seen
nothing in the fiscal 1984 budget pass-
back from the Office of Management
and Budget to indicate there will be
another attempt to eliminate the Com-
missioned Corps.

That’s all I can say about this for now
(the President's budget request is sched-
uled to be sent to Congress next week).

The Commissioned Corps is becoming
more closely allied with the other uni-
formed services for a number of
reasons.

First of all, there has been an extraor-
dinary camaraderie among the federal
chiefs since I have been in this job, and
we have a better appreciation, | think,
than has been the case of each other's
problems.

I believe there should be maximum
cooperation among the uniformed ser-
vices, and we all share a concern about
health, particularly in times of emer-
gency, whether we're talking about mil-
itary emergencies or civilian emergen-
cies, that it just makes sense for each of
us to know as much about the other's
needs as possible and to be able to back-
fill those needs.

I guess the most satisfying aspect of
all this is the enthusiasm of the reserve
officers of the Public Health Service
Commissioned Corps to serve the other
uniformed services with their expertise.

eee

The secretary’s (HHS secretary

Richard S. Schweiker) initiative for
health promotion and disease preven-
tion will really get underway early in the
year.

One of the big factors in that is the
“healthy mothers, healthy babies” cam-
paign. That's going to be in six phases.

Each month there will be a new direc-

- tive. Part of that will be radio public

service announcements from me.
Another part will be beautiful posters
that will be set up around the country
where teenagers gather.

We're trying to reach those most
likely either to be pregnant, plan preg-
nancy or get pregnant and produce a
low-birth-weight baby.

If we can encourage the things we're
stressing in our campaign, we can cut
down on the low-birth-weight baby.
That's where most of our problems
occur in terms of morbidity in the first
year of life.

First of all, we're zeroing in on, “See
your doctor early and often.” In addi-
tion, we're stressing, “Don’t smoke.
Don’t drink. Get adequate exercise. Eat
a balanced diet. Don’t take medication
unless you've talked to your doctor.”

Rather than flood the world with six
different things on these posters, we'll
do one a month. The posters are large
and are the ones our marketing experts
have told us are most attractive to the
teenagers we're trying to reach.

Little copies, postcard size, will be

 

 

— U.S. Medicine photo
Dr. C. Everett Koop

Uniformed services should work together

available to any girl who goes to a clinic
where she might be getting information
about a pregnancy. On the back of it
will be the written instructions that go
with that message.

(Continued on page 85)
PHS Keady fo Launch
New Health Promotion

(Continued from page 83)

So that's one part of our preventive

campaign.
ese we

The secretary as you know has been
very much concerned about drunk driv-
ing and has talked a lot about this to the
’ press and on television.

We have been concerned at the Cen-
ters for Disease Control with what we
call premature death. And violence has
a tremendous amount to do with pre-
mature death in this country.

Driving and drinking is a kind of non-
premeditated violence which is very
much responsible for a lot of premature
deaths in this country, especially among
teenagers.

It’s very encouraging to see states like
New Jersey raise the drinking age, as it
did last month, back to 21. As you
know, the states that have done this
have seen a change in the morbidity and
mortality of teenagers from that cause.

eco

We'll be bringing out our smoking
and health report in the early weeks of
this year. We'll focus not on cancer as
we did last year but on the relationship
of smoking to cardiovascular health.

This is important, because studies
show that most people know that there
is a relationship between smoking and
cancer, but not that many are aware of
the fact that there is a relationship
between smoking and cardiovascular
disease.

It still is our biggest public health
problem in this country, and we do pre-
dict 300,000 deaths a year from
smoking——deaths that are preventable.

The secretary will be pushing nutri-
tion, exercise, not smoking and alcohol
in moderation. ,

eee

One of the things the secretary and |
have talked about, and are now working
on, is the prevention of incontinence by
the use of biofeedback techniques.

We are working with the National
Institute on Aging, Nationa! Gerontol-
ogy Institute and Baltimore City Hospi-
tal, mounting a program that will test
the use of biofeedback to prevent incon-
tinence in bed patients.

It already has been demonstrated that
you can have a 70 per cent success rate
with biofeedback techniques in inconti-
nent adults, that is, incontinent people
between the ages of 70 and 90.

 

Our concern-was—can you do the

same thing if the patient is in bed?

That is the purpose of this short-term ‘

research project, and we are tying in the
teaching nursing homes as well to be in
on the ground floor of the knowledge
that is accumulated. We look to people
who are developing their skills in mas-
ter's and doctoral programs in the uni-
versities that have connections with
teaching nursing homes as being those
individuals who will carry this message
out to nurses.

‘It is my hope that the nursing
profession—especially those interested
in gerontology—will pick up this chal-
lenge, because ! thirtk they are in the
ideal position to be on the spot and
teach the biofeedback methods, which
aren't that difficult to learn.

eee

The most difficult thing about pre-
vention is that you cannot assess the
results of a prevention campaign early
on. It takes time. ;

Prevention and changes in lifestyle
are not glamorous, innovative things.

They are tremendously effective, we

know, but they're difficult to measure.
It takes a long time to get an answer.

eee
"We held an interesting, and 1 think
exciting, surgeon general's conference

in Philadelphia last month on the gen-
eral subject of handicapped children
and their families, using the respirator-
dependent child as a model.

There were 10 extraordinarily com-
petent, hard-working groups in work-
shops.

The reason we used the respirator-
dependent child as a model is that it is
the most complex medica! problem to

transfer from institutionalized care to

home care.

It is also the most expensive, per
diem, of any of the things we deal with.

Therefore, if we can address this com-
plex, expensive problem, the spinoff to
all sorts of other handicapping situa-
tions that could be treated as well, or
better, in the home can be very readily
addressed.

We should have a report on this con-
ference available within about 30 days.
It will chart the course, in a sense, for
the management of these issues.

Our biggest problem is that we do not

have a data base on which to base
national projections.
There’s only one state in the union
where we know for sure how many
- patients are respirator-dependent, and
that’s Pennsylvania.
That's why we held the conference in
Philadelphia.

We have 235 respirator-dependent
patients in the commonwealth of Penn-
sylvania. The definition of “respirator-
dependent” is respirator-dependent for
28 days in any one year.

The basic annual cost for those peo-
ple in Pennsylvania is at the very min-

imum $7 million.

 

Reference: U.S. Medicine, pp. 83 & 85,
January 15, 1983,