ORIGINAL 4G AEDA- ALA ADDRESS BY C, Everett Koop. M.., Sc.D, SURGEON GENERAL OF THE U.S. PuBLIc HEALTH SERVICE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES CEG AD PRESENTED TO THE 50TH ANNIVERSARY NATIONAL CONFERENCE OF THE AMERICAN SOCIETY OF PUBLIC ADMINISTRATION MIAMI, FLORIDA ApRIL 12, 1989 1 (GREETINGS TO HOSTS, GUESTS, FRIENDS, ETC.) T APPRECIATE THIS OPPORTUNITY TO TALK TO THE PEOPLE WHO MAKE GOVERNMENT WORK, YEAR IN AND YEAR OUT. YOU MAKE IT WORK ... YOU KEEP IT HONEST ... AND YOU KEEP IT FAIR. AND THAT'S WHAT OUR GOVERNMENT IS AT ALL LEVELS: FEDERAL, STATE, AND LOCAL ... BECAUSE THAT’S WHAT THE OVERWHELMING MAJORITY OF GOVERNMENT PERSONNEL ARE. THEY’RE HARD-WORKING ... THEY’RE HONEST ... AND THEY’RE FAIR, 2 UNFORTUNATELY, ROUTINE DAY-TO-DAY HONESTY AND FAIR PLAY WON’T MAKE A HEADLINE OR A “SOUND BITE” ON THE EVENING T.V. NEWS. MORE OFTEN THAN NOT, WE SEE DISHONESTY AND UNFAIRNESS GET THE HEADLINES. THAT‘’S A DISTORTED PICTURE OF GOVERNMENT SERVICE AND YOU AND I -- ALONG WITH OUR COLLEAGUES EVERYWHERE -- RESENT IT. NEVERTHELESS, IN OUR KIND OF OPEN NEMOCRACY, THAT’S THE WAY IT'S GOING TO BE. AND, TO TELL THE TRUTH, WRONGDOERS SHOULD BE EXPOSED AND THE AMERICAN PEOPLE SHOULD GET A LOOK AT THEM AND KNOW THEIR NAMES, 3 AS CITIZENS AS WELL AS RESPONSIBLE GOVERNMENT ADMINISTRATORS AND DECISION-MAKERS, WE TOO MUST BE ON OUR GUARD, BECAUSE SOME VERY STRONG FORCES ARE LINED UP AGAINST US. “GREED” IS ONE ... EVERYONE TALKS ABOUT GREED, WHICH IS THE FIRST DEADLY SIN TO MAKE THE COVER OF NEWSWEEK. BUT THERE’S MORE THAN GREED OUT THERE. THERE’S ALSO PREJUDICE AND INTOLERANCE ... INATTENTION AND BOREDOM ... AND IGNORANCE AND INDOLENCE. THEY ALL BELONG ON THE COVER OF NEWSWEEK, TOO. THEY ARE CERTAINLY AS PREVALENT -- AND AS NASTY -- AS GREED. y THEY ARE AMONG THE BASER INSTINCTS OF THE HUMAN RACE, I’M SORRY TO SAY. BUT THE HUMAN RACE HAS OTHER AND MUCH GRANDER INSTINCTS, + * * % * THE INSTINCT TO RECOVER AND TO SURVIVE ... TO GET UP AND KEEP GOING ... THE INSTINCT FOR RENEWAL ... THE INSTINCT FOR LIFE AND SELF~PRESERVATION ... AND THE INSTINCT TO WANT TO FEEL GOON) ABOUT ONE'S SELF. IF YOU THINK ABOUT THESE FOR JUST A MOMENT, YOU MIGHT AGREE WITH ME THAT A GREAT DEAL OF OUR WORK IN GOVERNMENT SEEMS TO BE IN THE SERVICE OF THESE PARTICULAR HUMAN INSTINCTS, 5 THESE ARE POSITIVE, OPTIMISTIC INSTINCTS. BUT GOVERNMENT IS AT ITS BEST, WHEN IT SUPPORTS AND NOURISHES THESE MOST HOPEFUL OF HUMANITY’S MANY ATTRIBUTES: THAT IS, OUR BASIC INSTINCTS TO WANT TO LIVE A DECENT LIFE. _ BUT THIS OBSERVATION ISN’T LIMITED TO THOSE OF US IN GOVERNMENT, I THINK A GOOD ADMINISTRATOR ANYWHERE WILL RESPECT THESE BASIC INSTINCTS AND WILL SUPPORT THEM AND NURTURE THEM AMONG HIS OR HER PERSONNEL. I THINK THAT’S WHAT WE MEAN THESE DAYS BY “OCCUPATIONAL HEALTH” OR “EMPLOYEE HEALTH.” WE’RE CONCERNED WITH MORE THAN AN EMPLOYEE'S SPECIFIC HEALTH NEEDS TO GET A PARTICULAR JOB DONE... WE’RE CONCERNED WITH THAT EMPLOYEE’S HEALTH NEEDS IN GENERAL, 6 AS A RESULT, WE’RE BRINGING THE CONCEPTS OF DISEASE PREVENTION AND HEALTH PROMOTION INTO THE WORKPLACE AND ONTO THE WORKSITE. THEY ARE THE HALLMARKS OF A PROGRESSIVE, OPTIMISTIC, SUCCESSFUL, “PEOPLE-CENTERED” ORGANIZATION ... THE KIND OF ORGANIZATION THAT FULFILLS ITS MISSION AND GETS THE JOB DONE. THIS APPROACH TO EMPLOYEE HEALTH HAS MANY GOON OUTCOMES, WITH THE HELP OF ENLIGHTENED MANAGERS, EMPLOYEES CAN ANOPT A MODEST REGIMEN OF PHYSICAL EXERCISE ... ] o THEY CAN LEARN TO COPE WITH STRESS AND WITH PRE-MENSTRUAL SYNDROME... o THEY CAN REVERSE THE DAMAGE DONE BY ALCOHOLISM OR OBESITY... o AND THEY CAN GIVE UP THE MOST PERVASIVE DRUG HABIT IN OUR SOCIETY: SMOKING, THOSE ARE POSITIVE EXPERIENCES AND THEY REFLECT, AGAIN, THE TRIUMPH OF THOSE BASIC HUMAN INSTINCTS FOR SURVIVAL AND RENEWAL, AND BECAUSE SUCH POSITIVE OUTCOMES ARE ANTICIPATED AND _DO OCCUR AMONG EMPLOYEES WITH CERTAIN HEALTH PROBLEMS, MANY ADMINISTRATORS AND MANAGERS ARE UNCERTAIN AND CONFUSED WHEN THEY CONTEMPLATE THEIR ROLE IN REGARD TO EMPLOYEES ... WITH AIDS, 8 LET ME SPEND THE NEXT FEW MOMENTS ON THIS PARTICULAR ISSUE: THAT IS, AIDS IN THE WORKPLACE. WHY TALK ABOUT IT AT ALL? FIRST, BECAUSE THE AIDS VIRUS _IS STILL SPREADING, BOTH IN THIS COUNTRY AND AROUND THE WORLD. FOR EXAMPLE, IN THE 12 MONTHS THAT ENDED ON FEBRUARY 28, WE LOGGED IN OVER 33,000 NEW CASES RIGHT HERE IN THE UNITED STATES, SINCE THE FIRST 5 CASES OF AIDS WERE RECORDED IN LOS ANGELES BACK IN 1981, WE’VE HAD A TOTAL OF 88,000 CASES REPORTED ACROSS THE COUNTRY. 9 AT LEAST 5 CASES HAVE THUS FAR BEEN REPORTED FROM EVERY STATE AND TERRITORY IN THE COUNTRY -- EXCEPT FOR THE PACIFIC ISLANDS TRUST TERRITORY, WHICH HAS HAD ONLY ONE. AND OVER 700 CASES OF AIDS HAVE BEEN REPORTED FROM EACH OF THE. COUNTRY’S TOP 20 CITIES, FROM BOSTON TO SAN DIEGO .., FROM SEATTLE TO TAMPA, SO WE NEED TO FOCUS ON THIS EPIDEMIC BECAUSE IT'S NOT LETTING UP -- AND IT’S EVERYWHERE. 10 BUT THAT’S ONLY PART OF THE STORY, THE OTHER PART IS EVEN MORE GRIM: AIDS IS VIRTUALLY 100 PERCENT FATAL. OF THOSE 88,000 AMERICANS WHO WERE REPORTED AS HAVING AIDS SINCE 1981, NEARLY 50,000 HAVE ALREADY DIED. THAT’S AN OVERALL MORTALITY RATE OF 57 PERCENT. BUT LET’S LOOK AT THOSE FIGURES MORE CLOSELY. OF THE NUMBER OF PEOPLE WITH AIDS IN 1981, SOME 92 PERCENT HAVE ALREADY DIED. OF THOSE IN 1982, CLOSE TO 90 PERCENT HAVE DIED. 11 AND -- DESPITE THE SLOWNESS OF THE DATA-COLLECTION PROCESS -- WE’VE ALREADY BEEN INFORMED THAT ABOUT A THIRD OF THE PEOPLE WHO WERE REPORTED WITH AIDS JUST LAST YEAR HAVE ALREADY DIED. SO, EVEN THOUGH WE DON’T KNOW EVERYTHING ABOUT THIS DISEASE, WE DO KNOW ONE THING FOR CERTAIN: IF YOU HAVE AIDS, YOUR CHANCES OF SURVIVING THE NEXT TWO OR THREE YEARS ARE NOT VERY GOOD. BUT YOUR CHANCES OF SURVIVING ANY LONGER THAN THAT ARE ALMOST NIL. 12 I'D LIKE TO HAVE COME HERE WITH ONE OR TWO PIECES OF GOOD NEWS TO REPORT CONCERNING AIDS. BUT HONESTLY, I DON’T HAVE ANY, AIDS IS SPREAD BY A VIRUS, AS YOU KNOW. BUT WE HAVE NO ANTI-VIRAL VACCINE YET. WE’RE WORKING ON IT ... IN FACT, [’D SAY WE’RE MOVING MORE QUICKLY ON AN AIDS VACCINE THAN WE’VE BEEN ABLE TO MOVE FOR ANY OTHER VACCINE IN HISTORY, NEVERTHELESS, THE FULL DEVELOPMENT PROCESS WILL STILL TAKE THE REST OF THIS CENTURY ... EVEN ON THE PRESENT FAST TRACK, 13 AND THE DRUGS THAT WE‘RE LOOKING AT OR THAT WE’RE ACTUALLY USING TO TREAT PERSONS WITH AIDS -- DRUGS SUCH AS A.Z.T., FOR EXAMPLE -- ONLY PROLONG A PERSON’S LIFE FOR A FEW MONTHS ... MAYBE A YEAR ... IF THEY WORK, _ BUT THESE DRUGS DO_NOT CURE ANYONE OF AIDS ... NOR DO THEY CURE ANYONE OF ANY CONDITION BROUGHT ON BY AIDS, SO THE HARD TRUTH REMAINS: WE HAVE NO “MAGIC BULLET” OF ANY KIND TO PREVENT AIDS OR STOP IT IN ITS TRACKS, 14 THE ONLY WEAPON WE HAVE IS PUBLIC EDUCATION ABOUT THE DISEASE AND THE WAY IT’S SPREAD. THROUGH PUBLIC EDUCATION, WE STAND A CHANCE OF SLOWING DOWN AND ONE DAY EVEN REVERSING THE TREND OF THIS EPIDEMIC, _ THE VIRUS IS STILL A PUZZLE IN MANY WAYS ... BUT WE KNOW WITH COMPLETE CERTAINTY HOW IT'S TRANSMITTED AND, THEREFORE, WE CAN TEACH THE PUBLIC HOW TO PREVENT ITS TRANSMISSION, IT'S TRANSMITTED IN FOUR WAYS ... AND ONLY FOUR WAYS: 15 * FIRST, THE MOST COMMON ROUTE OF TRANSMISSION IS SEXUAL INTERCOURSE ... MOSTLY BUT NOT EXCLUSIVELY ANAL INTERCOURSE, WHICH OCCURS MOST FREQUENTLY AMONG HOMOSEXUALS AND BISEXUAL MALES. THIS CATEGORY NOW ACCOUNTS FOR A LITTLE LESS THAN TWO-THIRDS OF ALL CASES OF AIDS. BUT PLEASE REMEMBER THAT HOMOSEXUALITY ... BY ITSELF ... DOES NOT CAUSE AIDS, JUST AS HETEROSEXUALITY ... BY ITSELF 11+ DOES NOT CAUSE SYPHILIS, 16 * SECOND, THE AIDS VIRUS IS ALSO TRANSMITTED WHEN INTRAVENOUS DRUG ADDICTS USE THE NEEDLES AND SYRINGES OF OTHER ADDICTS WHO MAY ALREADY BE INFECTED WITH AIDS. THE VIRUS IS ALSO SPREAD WHEN INFECTED DRUG ADDICTS ENGAGE _ IN HOMOSEXUAL OR HETEROSEXUAL ACTIVITY. IN SOME AMERICAN CITIES, FOR EXAMPLE, ABOUT 20 PERCENT OF THE PROSTITUTES -- MALE AND FEMALE -- ARE AIDS-POSITIVE. * THE VIRUS CAN ALSO BE TRANSMITTED FROM AN AIDS-INFECTED MOTHER TO HER INFANT DURING PREGNANCY OR AT THE TIME OF DELIVERY, 17 RIGHT NOW, WE KNOW OF MORE THAN ELEVEN HUNDRED BABIES NATION-WIDE WHO WERE BORN INFECTED WITH THE AIDS VIRUS BECAUSE THEIR MOTHERS WERE INFECTED WITH AIDS. INFECTED BABIES, BY THE WAY, HAVE THE SAME LIFE EXPECTANCY AS INFECTED ADULTS ... A YEAR OR TWO... FOUR AT THE MOST, * FINALLY, AIDS CAN BE TRANSMITTED THROUGH TRANSFUSED BLOOD OR BLOOD PRODUCTS. BUT THIS DANGER IS NOW ALMOST STATISTICALLY INSIGNIFICANT, 18 THE ODDS TODAY OF ANYONE GETTING A CONTAMINATED UNIT OF TRANSFUSED BLOOD ARE BETWEEN 1 IN 40,000 AND 1 IN 250,000, COMPARE THAT WITH, SAY, DEATH ON THE HIGHWAY, WHERE THE ODDS AGAINST YOU ARE AS BAD AS 1 IN ONLY 5,900. _ THESE, THEN, ARE THE KEY ASPECTS OF THE AIDS EPIDEMIC: * ONE ... IT’S SPREADING * TWO... IT’S FATAL * THREE ..,. WE DON’T HAVE A CURE YET * AND FOUR ... IT’S SPREAD MAINLY BY CERTAIN SPECIFIC HIGH-RISK BEHAVIORS INVOLVING SEX AND/OR DRUGS, 19 THESE FOUR ASPECTS MAKE THE AMERICAN PEOPLE -- INCLUDING THE MANAGERS AND ADMINISTRATORS IN BOTH THE PUBLIC AND PRIVATE SECTORS -- VERY EDGY ABOUT AIDS, AFTER ALL, THE OVERWHELMING MAJORITY OF AMERICANS DO NOT ENGAGE IN ANAL SEX AND THEY DON’T “SHOOT” DANGEROUS DRUGS. NOR DO THEY APPROVE OF OTHER PEOPLE WHO DO THESE THINGS. AND THAT'S WHERE THINGS TEND TO GET OFF TRACK. WE MUST CONSTANTLY MAKE SURE THAT WHAT WE’RE DOING IS FIGHTING A DISEASE +++ NOT THE PEOPLE WHO HAVE IT, 20 THAT DOESN'T MEAN WE HAVE TO COMPROMISE OUR FEELINGS ABOUT ANY OF THE HIGH-RISK BEHAVIORS THAT MAKE AIDS POSSIBLE. IN FACT, OUR BASIC WEAPON AGAINST AIDS -- EDUCATION -- IS DIRECTED RIGHT AT THOSE HIGH-RISK PATTERNS OF BEHAVIOR AND RIGHT AT THE PEOPLE WHO PRACTICE THAT BEHAVIOR SO THAT THEY WILL STOP, BUT EDUCATION IS NOT CONDEMNATION ... AND IT’S NOT HATE ... AND IT’S NOT FEAR. 21 IF WE GO AHEAD AND ATTACK WHOLE GROUPS OF PEOPLE BECAUSE A FEW OF THEM ARE HIGH-RISK INDIVIDUALS -- CONDEMNING ALL HOMOSEXUALS, FOR EXAMPLE, BECAUSE OF THE HIGH-RISK LIFESTYLES OF 1 PERCENT OF THEM -- OR IF WE ATTACK THOSE HIGH-RISK PEOPLE THEMSELVES THROUGH DISCRIMINATION OF ONE KIND OR ANOTHER ... IF WE DO THOSE KINDS OF THINGS, THEN WE'LL LOSE THE BATTLE AGAINST AIDS FOR SURE. WE‘LL LOSE THE WAR AGAINST AIDS ... AND WE’LL LOSE THE GOOD SENSE THAT HAS PRESERVED OUR SOCIETY AND KEPT AMERICANS UNITED THROUGHOUT MANY OTHER THREATS TO OUR PUBLIC HEALTH, 22 HENCE, I WOULD ENCOURAGE ALL OF YOU, AS ADMINISTRATORS AND MANAGERS IN THE PUBLIC SECTOR, TO LEARN ABOUT THIS DISEASE AND KNOW HOW TO AVOID THE EFFECTS NOT JUST AS THEY AFFECT YOUR OWN BODIES, BUT ALSO AS THEY AFFECT YOUR THOUGHTS AND YOUR FEELINGS AS COMPASSIONATE AND FAIR-MINDED PEOPLE. YOU MUST NOT USE YOUR IRRATIONAL FEAR OF AIDS AS SOME KIND OF SHIELD BEHIND WHICH TO VIOLATE THE ETHICS OF THE AMERICAN WORKPLACE. YOU MUST NOT DO THAT. 23 QVER THE YEARS WE’VE TRIED TO ESTABLISH THE RULES OF FAIRNESS IN ALL OUR WORK ENVIRONMENTS. AND THOSE OF US IN PUBLIC ADMINISTRATION CAN BE VERY PROUD OF THE LEADERSHIP WE AND OUR COLLEAGUES HAVE CONSISTENTLY SHOWN IN THIS REGARD, _ WE MUST NOT ALLOW THE AIDS VIRUS TO INFECT AND DESTROY THAT ASPECT OF THE AMERICAN WAY, THE U.S, PUBLIC HEALTH SERVICE -- AND THIS SURGEON GENERAL -~ HAS SENT THAT MESSAGE TO EDUCATORS ... TO DOCTORS ... AND TO HOSPITAL ADMINISTRATORS. IN CASE THEY’VE BEEN TEMPTE)) TO TURN AWAY PEOPLE WITH AIDS, WE'VE TOLD THEM: “DON'T DO IT.” 24 AND WE'RE SENDING THE SAME MESSAGE TO ADMINISTRATORS, EMPLOYERS, AND MANAGERS WHO ARE TEMPTED TO DISMISS ANY EMPLOYEE WITH AIDS. WE SAY, “DON’T DO IT. UT’S AGAINST THE LAW AND IT’S AGAINST THE AMERICAN ETHIC OF COMPASSION AND FAIR PLAY. DON’T DO IT,” YOU'RE FAMILIAR, I HOPE, WITH THE RULINGS OF THE SUPREME COURT AND THE OPINIONS OF THE PRESIDENT AND THE ATTORNEY GENERAL ON THIS MATTER, 25 THEY'VE SAID THAT AIDS IS A “HANDICAPPING DISEASE.” HOWEVER, FEDERAL POLICY NOW STIPULATES THAT “HIV-INFECTED EMPLOYEES SHOULD BE ALLOWED TO CONTINUE WORKING AS LONG AS THEY ARE ABLE TO MAINTAIN ACCEPTABLE PERFORMANCE AND DO NOT POSE A SAFETY OR HEALTH THREAT TO THEMSELVES OR OTHERS IN THE WORKPLACE.” NOW, HOW DOES SOMEBODY WITH AIDS “POSE A SAFETY OR HEALTH THREAT"? 26 AS I INDICATED EARLIER, THE TWO MOST COMMON WAYS OF PASSING ALONG THE VIRUS ARE BY SEXUAL INTERCOURSE -- ESPECIALLY ANAL INTERCOURSE -- AND THE SHARING OF NEEDLES WHILE “SHOOTING” DANGEROUS DRUGS, IF THOSE KINDS OF THINGS ARE GOING ON IN YOUR ORGANIZATION DURING THE NORMAL WORKDAY ... THEN, BELIEVE ME, AIDS IS THE LEAST OF YOUR PROBLEMS, T COME TO THIS PROBLEM AS A PHYSICIAN WHO WAS SCHOOLEN IN THE TRADITION OF MEDICINE THAT SAYS, “DO WHATEVER YOU CAN FOR PEOPLE EVEN THOUGH YOU KNOW YOU CAN'T CURE THEM.” YOU CAN BE COMPASSIONATE AND HELPFUL, EVEN IN THE ABSENCE OF ANY HOPE, 2/ THAT’S THE TRADITION OF MEDICINE. BUT I BELIEVE IT IS ALSO PART AND PARCEL OF THE TRADITIONS OF AMERICAN SOCIETY. AND THIS IS WHERE I HOPE YOU AND I STAND ON COMMON GROUND, _WE CAN BE PROUD OF THE WAY THE UNITED STATES HAS SUCCESS- FULLY FACED THE CHALLENGE OF FAIRNESS AND HAS GUARANTEED ALL OUR CITIZENS EQUAL ACCESS TO ALL HEALTH AND SOCIAL SERVICES, REGARD- LESS OF THEIR RACE, COLOR, CREED, AGE, SEX, NATIONAL ORIGIN ... OR HANDICAP, 28 IT’S NOT AN EASY TRADITION TO HONOR AND I WON’T SAY THAT WE'VE BEEN PERFECT AT HONORING IT EITHER. STILL, OUR RECORD IS VERY GOOD. BUT IT'S A RECORD TO BUILD ON .., NOT A RECORD TO IGNORE. SO THE QUESTION BEFORE US IS SIMPLY THIS: * WILL WE LET THE DISEASE OF AIDS -- ALL BY ITSELF -- REVERSE THIS SPECIAL AMERICAN CONTRIBUTION TO HUMAN HISTORY? WE HOPE AND PRAY THAT WE WON’T LET THAT HAPPEN, 29 BUT HOPES AND PRAYERS MAY NOT BE ENOUGH. WE NEED TO REINFORCE THOSE HOPES AND PRAYERS WITH COURAGE AND COMPASSION AT EVERY LEVEL OF GOVERNMENT ... IN EVERY OFFICE AND MEETING-ROOM 11+ AND AT EVERY WORK STATION. _WE MUST FIGHT THIS DISEASE WITH GOOD SCIENCE ... AND WITH GOOD SENSE. IF WE DO, WE MAY YET GIVE THE WORLD SOMETHING EVERY BIT AS PRECIOUS AS THAT MUCH-DESIRED AIDS VACCINE: WE COULD GIVE THE WORLD A GENUINE DEMONSTRATION OF THE POWER OF COMPASSION AND JUSTICE IN THE BATTLE AGAINST THIS DREAD DISEASE OF AIDS, 30 THAT'S MY HOPE. MAYBE IT CAN BE YOURS AS WELL. ONCE AGAIN... THANK YOU, #H# # #