ORIGINAL

 

OPENING REMARKS
By
C. Everett Koop. M.D., Sc.D,
SURGEON GENERAL
OF THE
U.S. PuBLic HEALTH SERVICE
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

—

PRESENTED TO THE SURGEON GENERAL’S WORKSHOP ON
HEALTH PROMOTION AND AGING
WASHINGTON, D.C.

MaRcH 20, 1988
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(GREETINGS TO HOSTS, GUESTS, FRIENDS, ETC.)

THANK YOU, DR. ABDELLAH.

I WANT TO PERSONALLY WELCOME YOU AND THANK YOU ALL FOR
COMING TO THIS SURGEON GENERAL’S WORKSHOP ON HEALTH PROMOTION AND
AGING.

WE HAVE THREE DAYS OF SERIOUS DELIBERATION, ILLUMINATING
DISCUSSION, AND -- I SINCERELY HOPE --INNOVATIVE THINKING AHEAD
OF US. THE OUTCOME SHOULD HELP POINT US -- AND SOCIETY -- IN
WORTHWHILE DIRECTIONS FOR THE FUTURE.
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MANY PEOPLE HAVE WORKED LONG AND HARD TO MAKE THIS WORKSHOP

HAPPEN. IF I HAD AN EXTRA HOUR OR SO, I WOULD GLADLY NAME AND
THANK EACH ONE OF THEM PERSONALLY,

THAT’S NOT POSSIBLE. HOWEVER, WITH YOUR UNDERSTANDING AND
PERMISSION, LET ME -- AT THE VERY LEAST -- EXTEND A WORD OF
_ SPECIAL THANKS TO DR. FAYE ABDELLAH, DEPUTY SURGEON GENERAL OF
THE U.S, PUBLIC HEALTH SERVICE, WHOSE GUIDING HAND HAS BEEN
SUBTLE BUT ESSENTIAL THROUGHOUT THE PLANNING PROCESS, AND TO
SENIOR PHARMACIST STEVEN MOORE, LENT TO US FROM THE FOOD AND DRUG
ADMINISTRATION, WHO ACCOMPLISHED ALL THE THOUSANDS OF PLANNING
AND ADMINISTRATIVE DETAILS THAT ENABLED US TO GET HERE TODAY --
EQUIPPED AND ON TIME.

TO BOTH OF YOU ... THANK YOU VERY, VERY MUCH,
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I DO NOT WANT TO MONOPOLIZE THE PODIUM AND STEAL TIME AWAY

FROM MY GOOD FRIENDS AND COLLEAGUES, COMMISSIONER ON AGING CAROL
FRASER FISK, AND DR. FRANK WILLIAMS, DIRECTOR OF THE NATIONAL
INSTITUTE ON AGING. SO I WILL LIMIT MY REMARKS TO A BRIEF REVIEW
OF HOW WE GOT HERE ... AND WHY ... AND FOR WHAT PURPOSE,

EARLY IN 1984 THE DEPARTMENT OF HEALTH AND HUMAN SERVICES
LAUNCHED A MAJOR INITIATIVE TO ENCOURAGE THE PUBLIC AND PRIVATE
SECTORS -- AT ALL LEVELS, NATIONAL, REGIONAL, STATE, AND LOCAL --
TO WORK TOGETHER ON PROMOTING THE HEALTH OF AMERICA’S OLDER
CITIZENS,
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THE U.S, PUBLIC HEALTH SERVICE AND THE ADMINISTRATION ON

AGING SHORTLY THEREAFTER SIGNED AN AGREEMENT IN WHICH WE PLEDGED
TO DO A NUMBER OF THINGS TOGETHER IN ORDER TO INVEST THIS HEALTH
PROMOTION INITIATIVE WITH INCREASED MOMENTUM AND IMPORTANCE.

AND THERE HAS BEEN A GREAT DEAL OF MOMENTUM GENERATED
THROUGHOUT THE COUNTRY ON BEHALF OF OLDER AMERICANS:

* EVERY STATE NOW HAS A LEAD AGENCY OF ITS OWN TO
SPEARHEAD THE HEALTH PROMOTION EFFORT....
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* THERE ARE SOME 35 STATE INTERAGENCY COALITIONS AT WORK

TO PROMOTE THE HEALTH OF OLDER AMERICANS ...

* A NATIONAL PUBLIC EDUCATION PROGRAM, CALLED THE
“HEALTHY OLDER PERSONS CAMPAIGN,” HAS RAISED THE CONSCIOUS-
NESS OF TENS OF THOUSANDS OF OLDER MEN AND WOMEN CONCERNING
THE BENEFITS OF PROMOTING THEIR OWN HEALTH, INSTEAD OF JUST
PASSIVELY WAITING AND HOPING FOR THE BEST ...
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* AT THE FEDERAL LEVEL, THE AGENCIES AND OFFICES OF THE

U.S, PUBLIC HEALTH SERVICE ITSELF HAVE BEEN ACTIVELY ENGAGED
IN THIS COOPERATIVE EFFORT, BUT CHIEF AMONG THEM HAS BEEN
THE WORK OF THE OFFICE OF DISEASE PREVENTION AND HEALTH
PROMOTION, DIRECTED BY DR. MICHAEL McGINNIS. YOU'LL HEAR
MORE ABOUT THAT TOMORROW MORNING,

A KEY ELEMENT OF THIS P.H.S. - A.0.A. COOPERATIVE VENTURE IS
OUR MUTUAL PLEDGE TO DO WHAT WE CAN TO HELP PREPARE ALL HEALTH
PROFESSIONALS -- PHYSICIANS, NURSES, DENTISTS, NUTRITIONISTS,
SOCIAL WORKERS, PHARMACISTS, AND SO ON -- FOR THE EVENTUAL
“GRAYING OF AMERICA.” |
/
I DON’T HAVE TO REPEAT THE DEMOGRAPHIC PROJECTIONS. I’M

SURE YOU'RE QUITE FAMILIAR WITH THE NUMBERS.

BUT THOSE PROJECTIONS ARE MUCH MORE THAN MERE NUMBERS.
THOSE ARE PROJECTIONS ABOUT THE LIVES OF REAL PEOPLE ... FLESH-
AND-BLOOD MEN AND WOMEN WHO WILL BE OLD AND WHO WILL NEED A
CERTAIN LEVEL AND TYPE OF HEALTH CARE THAT, I'M AFRAID, IS STILL
NOT VERY WELL UNDERSTOOD, MUCH LESS PRACTICED, IN OUR SOCIETY
TODAY.
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AND THAT'S WHY THE 7 COMPONENTS OF THE PUBLIC HEALTH SERVICE

AND THE ADMINISTRATION ON AGING AGREED TO JOINTLY PLAN AND
CONDUCT A “SURGEON GENERAL’S WORKSHOP ON HEALTH PROMOTION AND
AGING.”

I'M DELIGHTED TO ADD THAT THE HENRY J. KAISER FAMILY
FOUNDATION AND THE BROOKDALE FOUNDATION ARE SUPPORTING THE
WORKSHOP .

ALSO, WE'VE INCLUDED 6 GRADUATE AND PROFESSIONAL STUDENTS
WHO WILL BE PURSUING CAREERS IN GERIATRICS AND WILL SERVE AS
WORKING GROUP MEMBERS, |
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WE WANTED IT TO BE A WORKSHOP IN WHICH THE SPECTRUM OF

HEALTH CARE DISCIPLINES WOULD BE WELL REPRESENTED AND ALL OF THEM
WOULD BE CHALLENGED TO THINK CREATIVELY AND PRO-ACTIVELY ABOUT
WAYS TO PROMOTE GOOD PHYSICAL AND MENTAL HEALTH AMONG PEOPLE AGE
65 AND OLDER.

THAT’S THE KIND OF WORKSHOP WE WANTED ... AND, I’M PLEASED
TO SAY, THAT’S THE KIND WE GOT,

THE EMPHASIS HERE IS EMPHATICALLY UPON THE PROMOTION OF GOOD
HEALTH. BUT LET’S BE CLEAR ON AT LEAST ONE POINT.

WE DON’T BELIEVE HEALTH PROMOTION NEEDS TO TAKE PLACE AT THE
EXPENSE OF GOOD CURATIVE MEDICAL CARE.
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AND IT OUGHT NOT TO OCCUR AT THE EXPENSE OF GOOD

REHABILITATIVE MEDICINE.

AND CERTAINLY NOT AT THE EXPENSE OF GOOD RESEARCH INTO THE
DISEASE PROCESSES AND DISABLING CONDITIONS THAT OFTEN INTERFERE
WITH THE NORMAL AND HEALTHFUL PROCESSES OF AGING.

RATHER, WE BELIEVE THAT HEALTH PROFESSIONALS CAN PUT MUCH
GREATER EMPHASIS ON HEALTH PROMOTION WITHOUT COMPROMISING IN ANY
WAY THE MORE TRADITIONAL AND STILL EFFECTIVE APPROACHES TO HEALTH
CARE.

WE BELIEVE THAT THIS MUST BE DONE ... WE’RE HERE TO SAY
THAT IT CAN BE DONE ... AND BY NOON ON WEDNESDAY, WE WILL TELL
THE HEALTH COMMUNITY HOW IT MIGHT BE DONE ON BEHALF OF THE
ELDERLY AND THE VERY OLD.
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I DON’T EXPECT US TO BE PRESCRIPTIVE IN THIS WORKSHOP. BUT

I DO HOPE THAT THE RECOMMENDATIONS GENERATED BY THE WORKSESSIONS
TOMORROW AND TUESDAY ARE CLEAR ENOUGH AND DIRECT ENOUGH THAT
HEALTH PROFESSIONALS EVERYWHERE CAN IMMEDIATELY SEE THE RELEVANCE
OF THE HEALTH PROMOTION CONCEPT TO THEIR OWN PARTICULAR
DISCIPLINES OR PRACTICE.

WHAT THEN SHOULD WE KEEP IN MIND?

FIRST, WE OUGHT TO FOCUS ON WAYS TO SENSITIZE THE HEALTH
PROFESSIONS TO THE SPECIFIC RISK FACTORS OF OLDER PEOPLE -- AND
THEN HOW TO REDUCE OR EVEN ELIMINATE THOSE RISK FACTORS FROM THE
LIVES OF ONE’S PATIENTS.
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SECOND, WE NEED TO RE-EXAMINE THE WAY WE ORGANIZE AND

DELIVER OUR MEDICAL, DENTAL, NURSING, AND OTHER HEALTH-RELATED
SERVICES TO SEE IF WE CAN CHANGE -- ONCE AND FOR ALL -- THEIR
BUILT-IN POST FACTO BIAS. HEALTH CARE OUGHT TO BE JUST AS
EFFECTIVE -- OR EVEN MORE EFFECTIVE -- BEFORE ILLNESS STRIKES.

AND THIRD, WE NEED TO DO THESE THINGS WITH SOME SENSE OF
WHAT WE HOPE TO ACCOMPLISH OVERALL FOR OUR COUNTRY’S OLDER
CITIZENS.

OLDER PEOPLE -~ LIKE PEOPLE OF ALL AGES -- DO NOT LIVE IN A
VACUUM:
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oO THEY WORK IN PLACES THAT ARE PLEASANT -- AND IN PLACES THAT

AREN‘T SO PLEASANT ...

Oo THEIR HUMAN RELATIONSHIPS MAY BE LOVING AND CARING, OR
DIFFICULT AND STRESSFUL ...

o THEY MAY HAVE FINANCIAL INDEPENDENCE, OR THEY MAY BE
TOTALLY DEPENDENT ON FAMILY OR GOVERNMENT TO PROVIDE ALL THEIR
BASIC NEEDS ...
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o AND FINALLY, THE PHRASE “THE GRAYING OF AMERICA” CAN BE

MISLEADING. MORE OF US WILL HAVE GRAY OR WHITE HAIR -- OR NO
HAIR AT ALL. BUT MOST AMERICANS -- ABOUT 80 PERCENT OF THE
POPULATION -- WILL BE YOUNG OR MIDDLE-AGED. HENCE, OLDER PEOPLE
WILL STILL BE LIVING IN A SOCIETY IN WHICH ALL AGE GROUPS COMPETE
FOR ATTENTION ... AND FOR RESOURCES,

I WAS REMINDED OF THIS JUST THE OTHER DAY, WHEN I READ THAT
THE ROCK STAR BRUCE SPRINGSTEEN IS GOING ON A NATIONWIDE TOUR
THAT WILL EARN HIM MILLIONS AND MILLIONS OF DOLLARS.
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AND WHILE HE'S SINGING TO ENTHUSIASTIC AUDIENCES OF YOUNG

PEOPLE, ANOTHER GROUP WILL ALSO BE ON A NATIONAL CONCERT TOUR OF
THEIR OWN. IN FACT, I SAW THEM ON T.V. LAST NIGHT IN NEW
ORLEANS. THEY’RE THE SO-CALLED “RAT PACK”: FRANK SINATRA, DEAN
MARTIN, AND SAMMY DAVIS, JR. WE ARE TOLD THAT THESE GENTLEMEN
ALSO EXPECT TO EARN MILLIONS OF DOLLARS FROM THE ENTHUSIASTIC
SEXTUGENARIANS WHO WILL SHOW UP AT THEIR CONCERTS.

IT WAS AN INTERESTING JUXTAPOSITION OF NEWS ITEMS.
AND WHETHER OR NOT YOU‘LL ATTEND EITHER OR NEITHER OF THOSE
CONCERTS, YOU STILL HAVE TO BE IMPRESSED BY THE INTER-
GENERATIONAL VITALITY THAT IS ALREADY EMERGING IN OUR SOCIETY ...
A VITALITY THAT IS, IN ITSELF, A REFLECTION OF GENERALLY GOOD
PHYSICAL AND MENTAL HEALTH AMONG THE AMERICAN PEOPLE.
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IN OTHER WORDS, WE HAVE EVERY REASON TO BE OPTIMISTIC AND

ADVENTUROUS IN OUR THINKING AT THIS WORKSHOP, BECAUSE WE’RE NOT
HERE TO REVERSE THE DIRECTION OF AMERICA’S HEALTH STATUS, BUT
RATHER TO BE BUILD ON -- AND ACCELERATE -- THE PROGRESS IN HEALTH
THAT AMERICANS HAVE ACHIEVED OVER THE PAST DECADE OR TWO.

THIS IS AN EXCITING PERIOD IN THE HISTORY OF HEALTH
CARE IN AMERICA:
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THE YIELD OF THE RESEARCH COMMUNITY HAS BEEN PRODIGIOUS,

WITH MUCH MORE YET TO COME.

THE NATION IS MORE HEALTH-CONSCIOUS AND MORE PRO-HEALTH
THAN AT ANY TIME IN OUR HISTORY,

AND IT’S A PERIOD IN WHICH ALL AMERICANS ARE MORE SENSITIVE
AND MORE RESPONSIVE TO THE HEALTH NEEDS OF THEIR FELLOW
CITIZENS ... REGARDLESS OF RACE, SEX, ETHNIC ORIGIN, OR AGE.
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WE HAVE, THEREFORE, AN EXTRAORDINARY OPPORTUNITY TO HELP OUR

CITIZENS NOT ONLY TO LIVE A FEW YEARS LONGER, BUT ALSO TO MAKE
THOSE EXTRA YEARS -- AND INDEED ALL THE YEARS OF THEIR LIVES --
GOOD AND HEALTHFUL YEARS,

NOW IT’S TIME TO HEAR FROM MY TWO DISTINGUISHED COLLEAGUES,
COMMISSTONER CAROL FRASER FISK AND DR. FRANKLIN WILLIAMS. BUT
REST ASSURED, I’M NOT DUCKING OUT. IN FACT, I’LL BE BACK AT THIS
PODIUM TOMORROW TO PRESENT MY “CHARGE” TO THE WORKING GROUPS.
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THEN, ON WEDNESDAY, COMMISSIONER FRASER FISK, DR. WILLIAMS,

AND I WILL RETURN TO HEAR YOUR RECOMMENDATIONS AND SPEAK TO THE
NEXT PHASE OF THIS INITIATIVE. BUT WE WILL NOT BE INACTIVE
MEANWHILE.

YOU WILL ALSO NOTE FROM YOUR AGENDA THAT THINGS DON'T END
THERE EITHER. FOLLOWING THE CLOSE OF THE WORKSHOP ON WEDNESDAY
MORNING, THERE WILL BE AN AFTERNOON PUBLIC HEARING, ONE OF A
SERIES OF SUCH HEARINGS THAT HAVE BEEN HELD THROUGHOUT THE
COUNTRY.
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AT THIS WASHINGTON, D.C. HEARING, OUR WORKSHOP

RECOMMENDATIONS WILL BECOME PART OF THE DEVELOPMENT OF OUR
NATIONAL PUBLIC HEALTH “OBJECTIVES FOR THE NATION FOR THE YEAR
2000.”

THUS, WE WILL MAKE SURE THAT AGING CONCERNS ARE GIVEN THE
PROMINENCE THEY DESERVE IN THE EVOLUTION OF THOSE NATIONAL
OBJECTIVES,
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YOU'RE ALL INVITED TO THAT OPEN HEARING AND I HOPE MANY OF

YOU WILL ATTEND,

BETWEEN NOW AND THEN, WE'VE GOT A LOT OF WORK TO DO.

SO LET’S DO IT. LET’S DO IT TOGETHER. AND LET'S START
NOW,

DR. ABDELLAH, THE MICROPHONE IS YOURS,

THANK YOU,
HHHEH