ORIGINAL
“53 Bip

ADDRESS

By
C. Everett Koop. MD, ScD
SURGEON GENERAL
OF THE
U. S, Pupuic HEALTH SERVICE
U. S, DEPARTMENT OF HEALTH AND HUMAN SERVICES

Cc.

PRESENTED TO THE SURGEON GENERAL’S WORKSHOP ON
SELF-HELP AND PuBLiIc HEALTH

Los ANGELES, CALIFORNIA
SEPTEMBER 20, 1987
(GREETINGS TO HOSTS, GUESTS, FRIENDS, ETC.)

I WANT TO WELCOME EVERYONE OF YOU TO THIS, THE FIRST SURGEON
GENERAL'S WORKSHOP ON SELF-HELP AND PUBLIC HEALTH,

I AM DELIGHTED THAT SUCH A GREAT NUMBER OF SELF-HELP AND
MUTUAL-HELP ORGANIZATIONS FROM ACROSS THE COUNTRY ARE REPRESENTED
HERE. I KNOW THAT FOR MANY OF YOU, TRAVEL TO THIS WORKSHOP WAS
POSSIBLE ONLY AT A GREAT PERSONAL SACRIFICE OF TIME AND MONEY,
NOT TO MENTION ENERGY,

I HOPE THAT YOUR EXPERIENCE, HOWEVER, WILL RE-PAY YOU A
HUNDRED TIMES OVER.

YOU WON’T GET YOUR MONEY BACK, I’M AFRAID...
AND THE TIME IS GONE FOREVER, WE KNOW THAT ONLY TOO WELL...
AND AS FOR YOUR ENERGY, I’M SURE YOU'LL GET BACK ALL THE

CALORIES YOU WILL HAVE BURNED AT THIS WORKSHOP, AND WITH A
LITTLE LUCK, YOU MIGHT NOT GET BACK EVERY LAST ONE.
BUT 1 HOPE YOU'LL GET FROM THIS WORKSHOP AT LEAST A HUNDRED
NEW NAMES AND ADDRESSES OF PEOPLE WHO ARE LABORING LONG AND HARD
TO HELP THEMSELVES AND, AT THE SAME TIME, HELP OTHERS AS WELL TO
MAKE IT THROUGH LIFE...MAKE IT THROUGH THE WEEK...MAKE IT THROUGH
THE DAY...ONE DAY AT A TIME.

I MENTION THIS BECAUSE THIS QUESTION CAME UP IN A
CONVERSATION A WHILE BACK WITH SEVERAL OF MY COLLEAGUES IN
MEDICINE. ONE OF THEM SAID. “DR. KOOP, ARE YOU GOING 10 INVEST
THE POWER AND PRESTIGE OF YOUR OFFICE IN THE SELF-HELP MOVEMENT?
AND DO YOU THINK THAT'S A WISE THING TO DO?”

MY ANSWER WAS, "YES,..BECAUSE I BELIEVE IN SELF-HELPF AS AN
EFFECTIVE WAY OF DEALING WITH PROBLEMS, WITH STRESS, HARDSHIP AND
PAIN.”

THEREFORE, I HAVE CALLED US TOGETHER FOR THESE TWO DAYS 10
DISCUSS HOW SELF-HELP AND PUBLIC HEALTH CAN WORK MORE CLOSELY
TOWARD A COMMON GOAL OF PERSONAL WELL-BEING.

I KNOW THIS WILL BE AMONG THE ISSUES YOU’LL BE DISCUSSING
HERE TODAY AND TOMORROW,
POSSIBLY BY THE FINAL SESSION WE WILL HAVE COLLECTIVELY SHED
SOME NEW LIGHT ON THE POTENTIAL CONTRIBUTION OF GOVERNMENT TO THE
SELF-HELP MOVEMENT AND HOW THE PUBLIC HEALTH SERVICE CAN
ACKNOWLEDGE MORE FULLY THE BENEFITS OF SELF-HELP IN HEALTH CARE
DELIVERY.

AND WHILE YOU STILL HAVE SOME QUESTIONS TO BE ANSWERED,
RELATIVE TO THE FUTURE OF THE MUTUAL HELP/SELF-HELP MOVEMENT. WE
IN GOVERNMENT -- AND IN THE INSTITUTION OF PUBLIC HEALTH ITSELF
-- NEED YOUR ASSISTANCE TO HELP FIND ANSWERS TO SOME FUNDAMENTAL
QUESTIONS.

AND LET ME SHARE TWO OF THE QUESTIONS WITH YOU:
THE FIRST ONE 1S..."WHAT DO WE WANT TO DO?”

AND THE SECOND ONE IS..."WHAT DO WE HAVE TO KNOW,..TO DO
IT WELL?”

THEY SOUND SIMPLE ENOUGH. BUT DON’T BE FOOLED BY THAT,
THESE ARE THE TWO QUESTIONS THAT CHALLENGE HEALTH POLICY-MAKERS
AND HEALTH CARE PROVIDERS AND EVERYONE ELSE INVOLVED IN
MAINTAINING AND IMPROVING THE HEALTH OF AMERICANS,
"WHAT DO WE WANT TO DO?”

I CAN REMEMBER BACK TO THE DARK AGES, WHEN I WAS IN MEDICAL
SCHOOL, AND WE WERE TAUGHT HOW TO DIAGNOSE AND TREAT PATIENTS
WITH A VARIETY OF DISEASES AND CONDITIONS,

WHAT DID WE WANT TO DO? WE WANTED TO CURE PEOPLE...WE
WANTED TO TAKE THEIR HURT AND BROKEN BODIES -- AND MINDS, TOO --
AND WE WANTED TO REPAIR THEM,

TODAY, THAT'S NOT ENOUGH OF A BASIS TO BUILD A SYSTEM OF
HEALTH CARE IN THIS COUNTRY.

TODAY... THE ANSWER IS A LITTLE DIFFERENT. CURING AND
REPAIRING ARE NO LONGER ENOUGH, THEY ARE ONLY PART OF THE TOTAL
HEALTH CARE THAT MOST PEOPLE REQUIRE.

FOR ONE THING, PEOPLE DON’T SHOW UP ON A DOCTOR’S DOORSTEP
ANYMORE WITH A CLEAR CASE OF “X” OR “Y" OR “Z,"

ACCORDING TO A NATIONAL SURVEY OF PHYSICIANS’ PRACTICES, THE
TOP REASON WHY PEOPLE VISIT THE DOCTOR IS CALLED A “CONDITION
WITHOUT SICKNESS.”

OF COURSE, THE PATIENT DOES HAVE TROUBLE OF SOME KIND. BUT
IT IS NOT A TRADITIONAL FORM OF “SICKNESS.” IT IS A “CONDITION
WITHOUT SICKNESS.”

 
MEDICAL SCHOOLS AND OTHER PROFESSIONAL SCHOOLS HAVEN’T QUITE
CAUGHT UP WITH THIS PHENOMENON, BUT THE REST OF THE COUNTRY
HAS,

AND I BELIEVE THIS IS A KEY ASPECT OF THE WORK OF MUTUAL
HELP AND SELF-HELP GROUPS,

THE PARENT OF AN ALCOHOLIC CHILD... THE CHILD IN AN ALCOHOLIC
HOUSEHOLD...A GRIEVING, SURVIVING SPOUSE...A PERSON DISFIGURED IN
AN AUTO ACCIDENT OR A FIRE...AN INFERTILE COUPLE...WHEN THESE AND
AN ESTIMATED 15 MILLION OTHER PEOPLE SEEK SOME KIND OF HELP. ARE
THEY REALLY “SICK”?

OF COURSE NOT. BUT THEY DO NEED HELP,

THESE "CONDITIONS WITHOUT SICKNESS,” WHILE NOT THE TOTAL
PICTURE OF THE HEALTH STATUS OF AMERICANS BY ANY MEANS, ARE A
VERY LARGE AND SIGNIFICANT PART OF THAT PICTURE,

T CAN SAY THAT BECAUSE -- GENERALLY SPEAKING -- MOST
AMERICANS ARE IN GOOD TO EXCELLENT HEALTH, BY ALL THE ROUTINE,
TRADITIONAL STANDARDS,
* LIFE EXPECTANCY IS AT A NEW RECORD HIGH. A CHILD BORN
TODAY CAN EXPECT TO LIVE, ON THE AVERAGE. TO THE AGE OF 74
AND A HALF.

AND EVEN PEOPLE AT MY AGE ARE DOING BETTER. AGAIN. ON THE
AVERAGE. YOU AND I WILL HAVE A YEAR OR TWO MORE OF LIFE THAN
OUR PARENTS HAD...AND SEVERAL MORE YEARS THAN OUR GRAND-
PARENTS HAD,

 

 

I THINK THIS PARTICULAR STATISTIC 1S MORE IMPORTANT TO MOST
AMERICAN FAMILIES THAN THE LATEST DOW JONES AVERAGE,

* AND HERE’S ANOTHER ONE: THE AGE-ADJUSTED DEATH RATE FOR
STROKE -- THE THIRD LEADING CAUSE OF DEATH IN OUR COUNTRY --
1S DOWN AGAIN. TODAY THE MORTALITY RATE FOR STROKE IS HALF
WHAT IT WAS ONLY 15 YEARS AGO. AND IT STILL SEEMS TO BE
FALLING BY ABOUT 5 PERCENT A YEAR.

* THE SAME IS TRUE FOR HEART DISEASE, THE NUMBER ONE CAUSE
OF DEATH IN OUR SOCIETY. NOT AS DRAMATIC A CHANGE, BUT THE
RATE 1S DROPPING NEVERTHELESS...A COUPLE OF POINTS A YEAR IS
A SIGNIFICANT NUMBER FOR THIS CATEGORY OF DISEASE,

YOU CAN TELL FROM THESE KINDS OF STATISTICS THAT WE’RE
MAKING GOOD PROGRESS ACROSS A BROAD FRONT OF ACUTE AND CHRONIC
CONDITIONS,
BUT NONE OF THIS PROGRESS IS BASED ON NEW MIRACLE CURES,
SOME OF IT MAY BE BASED ON NEW KINDS OF SURGERY -- BY-PASSES, FOR
EXAMPLE -- BUT AGAIN. NOT MUCH,

SO YOU HAVE TO CONCLUDE THAT ALL THIS PROGRESS IN HEALTH IS
TAKING PLACE BECAUSE SOMETHING ELSE IS GOING ON...SOMETHING OTHER
THAN WHAT FORMAL, TRADITIONAL MEDICINE CAN OFFER.

IT IS NO SINGLE THING THAT'S HAPPENING, IT IS RATHER A
CONSTELLATION OF ACTIONS AND ATTITUDES THAT HAVE CAPTURED THE
IMAGINATION... AND THE TIME...OF THE AMERICAN PEOPLE.

 

IT’S PEOPLE JOINING TOGETHER TO PROVIDE EMOTIONAL SUPPORT TO
ONE ANOTHER AND TO SHARE INFORMATION ABOUT A COMMON HEALTH
CONCERN THEY HAVE EXPERIENCED,

SO 1 THINK WE HAVE OUR ANSWER TO THE FIRST QUESTION: THAT
1S, “WHAT DO WE WANT TO DO?”

THE ANSWER IS THAT WE WANT TO PROMOTE GOOD HEALTH AND WE
WANT TO PREVENT ACUTE AND CHRONIC DISEASE FROM OCCURRING. THAT’S
THE CLEAR DIRECTION IN WHICH WE‘RE GOING,

NOW... WHAT ABOUT THE SECOND QUESTION...”WHAT DO WE HAVE TO
KNOW...TO DO IT WELL?”
YES, WE NEED TO KNOW SOMETHING ABOUT MONOCLONAL ANTIBODIES
AND PEPTIDE SYNTHESIS, WHETHER WE REALIZE IT OR NOT, GOOD
SCIENCE IS ALWAYS THE BASIS OF GOOD HEALTH,

BUT WE NEED TO KNOW A LOT OF THINGS THAT ARE NEW TO
SCIENCE. AND THEY INCLUDE...

* THE WAY PEOPLE BEHAVE AS HUMAN BEINGS...

* THEY WAY PEOPLE INTERACT WITH EACH OTHER AND WITH
PHYSICAL ENVIRONMENT...

* HOW PEOPLE PERCEIVE AND RESPOND TO SUCH LIFE-CYCLE
EVENTS AS CHILDBIRTH. FAMILY GROWTH AND DEPARTURE. AND
DEATH ITSELF...

* THE WAY PEOPLE COPE WITH ECONOMIC, SOCIAL. AND CULTURAL
STRESS. +:

* AND HOW PEOPLE PERCEIVE THE FUTURE -- WHETHER SHORT-TERM
OR LONG-TERM -- AND HOW THEY SEE THEMSELVES IN IT.

THIS IS THE INFORMATION THAT TELLS US NOT ONLY ABOUT HEALTH
.. «BUT ABOUT WHOLENESS.
AND WHERE WILL THIS KNOWLEDGE COME FROM?

FROM RESEARCH IN BEHAVIOR? SOME OF IT. YES,

FROM RESEARCH IN MEDICINE AND THE OTHER LIFE SCIENCES? YES,
SOME FROM THERE, TOO,

BUT TO MY WAY THINKING, A GREAT DEAL OF THE NEW INFORMATION
ABOUT HEALTH IN AMERICA CAN COME FROM GROUPS SUCH AS THE ONES
REPRESENTED HERE THIS WEEK,

THEREFORE, MY CHARGE TO YOU IS TO FORMULATE RECOMMENDATIONS
AROUND THE FOLLOWING QUESTIONS:

1, HOW TO DEVELOP PARTNERSHIPS BETWEEN SELF-HELP GROUPS AND
THE HEALTH CARE DELIVERY SYSTEM THAT IMPROVE THE HEALTH
AND WELL-BEING OF THE PUBLIC

2. HOW TO EDUCATE THE PUBLIC AND HEALTH PROFESSIONALS ON
THE USE AND BENEFITS OF SELF-HELP GROUPS,

3, HOW TO USE RESEARCH TO EXPAND THE CURRENT KNOWLEDGE OF
THE WAY SELF-HELP GROUPS WORK, THEIR BENEFITS, AND THEIR
LIMITATIONS,
10

4, AND HOW TO START AND SUPPORT THE USE OF SELF-HELP GROUPS
AS PART OF THE SYSTEM OF HEALTH CARE DELIVERY IN THIS
COUNTRY.

I’M DELIGHTED THAT THIS WORKSHOP IS TAKING PLACE AND I'M
PLEASED THAT THE PUBLIC HEALTH SERVICE HAS HELPED MAKE IT HAPPEN
AND THAT A NUMBER OF MY P.H.S, COLLEAGUES ARE HERE. ALSO, TO
LEARN AND TO SHARE,

I WANT TO CONGRATULATE THE PLANNING COMMITTEE FOR ITS GOOD
SENSE, ..AND SENSITIVITY,

THE DYNAMIC AND INDEPENDENT NATURE OF PEOPLE IN THE SELF-
HELP MOVEMENT DOES NOT NECESSARILY PROMOTE PEACE AND HARMONY IN
THE DEVELOPMENTAL STAGES OF SUCH A MEETING,

BUT I THINK THE COMMITTEE CAME THROUGH THE CRUCIBLE OF THE
PLANNING PROCESS WITH AN EVEN STRONGER COMMITMENT TO THE GOALS OF
PARTNERSHIP.

AND I WANT TO ESPECIALLY RECOGNIZE MR. MARK MAYEDA AND HIS
STAFF AT THE CALIFORNIA SELF-HELP CENTER AND MARILYN RUIZ AND
ANNETTE NUSSBAUM FROM THE ILLINOIS SELF-HELP CENTER FOR THEIR
SIGNIFICANT CONTRIBUTIONS TO THIS WORKSHOP,
ll

THROUGHOUT THE MANY MONTHS LEADING UP TO THIS MOMENT. THEY
HAVE TENDED TO THE DETAILS, YET NEVER LOST SIGHT OF THE OVERALL
OBJECTIVE. AND ON TOP OF THAT, I THINK THEY’ VE BEEN EXCELLENT
HOSTS,

SO NOW...17’S UP TO THE REST OF US.

OVER THE NEXT TWO DAYS, LET’S SHARE OUR HOPES...OUR
KNOWLEDGE AND EXPERIENCE...OUR COURAGE...AND OUR LOVE FOR WHO WE
ARE:

WE'RE PEOPLE WHO KNOW FULL WELL HOW IMPERFECT THE HUMAN RACE
1S...BUT WHO ARE NEVERTHELESS DETERMINED TO MAKE IT BETTER.

DR. M. SCOTT PECK, IN HIS BOOK, THE DIFFERENT DRUM, SAYS...
"THERE CAN BE NO VULNERABILITY WITHOUT RISK, THERE CAN BE NO
COMMUNITY WITHOUT VULNERABILITY: THERE CAN BE NO PEACE -- AND
ULTIMATELY NO LIFE -- WITHOUT COMMUNITY.”

GOD BLESS YOU... THANK YOU VERY MUCH...AND NOW, LET’S BEGIN.

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