ORIGINAL

* Jems
3

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 NATIONAL YouNG LEADERS CONFERENCE
WASHINGTON, D.C,
Jucy 14, 1988
1
(GREETINGS TO HOSTS, GUESTS, FRIENDS, ETC.)

I’M DELIGHTED TO JOIN YOU THIS MORNING TO TALK ABOUT THE
U.S. PUBLIC HEALTH SERVICE AND MY JOB AS ITS SURGEON GENERAL.
THEY ARE MY FAVORITE TOPICS.

] PROBABLY WOULDN’T HAVE SAID THAT 10 YEARS AGO. LIKE MOST
AMERICANS, I’M SURE I HAD HEARD OF THE PUBLIC HEALTH SERVICE IN
SOME CONTEXT OR OTHER, BUT I TOOK FOR GRANTED THE FACT THAT --
WHATEVER THE PUBLIC HEALTH SERVICE WAS -- IT WAS MOST LIKELY
WORKING ON MY BEHALF AND I NEEDN’T GIVE IT ANOTHER THOUGHT.
2
BUT ONCE I BECAME SURGEON GENERAL I BEGAN TO LEARN QUITE A

BIT ABOUT BOTH THE HISTORY AND THE WORK OF THE PUBLIC HEALTH
SERVICE.

I WAS IMPRESSED. AND I’M STILL IMPRESSED. AND BY THE TIME
I’M THROUGH WITH MY REMARKS, I HOPE YOU'LL BE IMPRESSED, TOO.

LET ME BEGIN BY GIVING YOU A LITTLE SNAPSHOT OF THE
ORGANIZATION AS IT IS NOW. I’LL TELL YOU A LITTLE ABOUT ITS
MISSION ... TOUCH ON ITS PAST ... AND OFFER AN EDUCATED GUESS
ABOUT ITS FUTURE,
3
FIRST, HOW BIG IS THE P.H.S.? WE ARE 40,000 STRONG. OF

THAT NUMBER, ABOUT 34,000 ARE CIVILIAN CIVIL SERVANTS. THE
REMAINING 6,000 MEN AND WOMEN ARE IN THE UNIFORMED COMMISSIONED
OFFICERS CORPS. THEY ARE ALL PROFESSIONAL PEOPLE: DOCTORS,
NURSES, PHARMACISTS, DENTISTS, ENGINEERS, AND SO FORTH,

T AM ONE OF THAT GROUP OF 6,000, ONE OF THE PEOPLE IN
UNIFORM ... ONLY MORE SO. AS SURGEON GENERAL, I AM THE HIGHEST~
RANKING ACTIVE DUTY OFFICER IN THE UNIFORMED COMMISSTONED CORPS
OF THE U.S. PUBLIC HEALTH SERVICE.
4
ACTUALLY, THE P.H.S. BEGAN AS A QUASI-MILITARY SERVICE BACK

IN 1798. ON JULY 16 OF THAT YEAR PRESIDENT JOHN ADAMS SIGNED THE
LAW THAT CREATED THE “MARINE HOSPITAL SERVICE.” ITS PERSONNEL
TOOK CARE OF SICK MERCHANT MARINE SAILORS WHO CAME INTO SUCH
PORTS AS BOSTON, NEW YORK, BALTIMORE, AND CHARLESTON, SOUTH
CAROLINA.

SO, IF I LOOK LIKE AN ADMIRAL IN THIS UNIFORM ... IT’S
BECAUSE I AM. MY TITLE MAY BE “SURGEON GENERAL,” BUT TECHNICALLY
[ HOLD THE NAVAL RANK OF VICE-ADMIRAL.
5
AND THAT, OF COURSE, IS A HOLD-OVER FROM THOSE DAYS -- 190

YEARS AGO -- WHEN WE WERE A MARINE SERVICE PROVIDING HEALTH AND
MEDICAL CARE FOR SAILORS COMING INTO AMERICAN PORTS.

BACK IN THOSE DAYS LIFE WAS A LOT SIMPLER, AND WE COULD BE A
SINGLE ORGANIZATION. BUT A LOT HAS HAPPENED SINCE 1798. TODAY
THE “U.S. PUBLIC HEALTH SERVICE” IS NOT SO MUCH A SINGLE ORGANI-
ZATION AS IT IS A KIND OF “FEDERATION” OF 7 HIGHLY INDIVIDUAL
PUBLIC HEALTH AGENCIES, EACH WITH ITS OWN SPECIAL EXPERTISE,
SPHERE OF INFLUENCE, AND RECORD OF ACHIEVEMENT ON BEHALF OF THE
AMERICAN PEOPLE.
6
THIS IS WHO WE ARE. BUT WHAT DO WE DO?

I WON’T GO INTO A LONG LIST AT THIS TIME, BUT I WILL TOUCH
ON A FEW SPECIAL ASSIGNMENTS:

—* AS A UNIFORMED SERVICE, WE ARE AVAILABLE FOR SPECIAL
HEALTH ASSIGNMENTS ANYWHERE IN THE WORLD, WHEREVER THERE’S A
PUBLIC HEALTH EMERGENCY AND WE’RE ASKED TO COME IN AND HELP.
FOR EXAMPLE, HERE IN THE U.S. as

WE STAFF THE HOSPITALS AND CLINICS OF THE INDIAN HEALTH
SERVICE ws.
7
WE PROVIDE CONTRACT HEALTH CARE FOR THE U.S. COAST

GUARD AND THE FEDERAL PRISON SYSTEM ...

OUR MEDICAL OFFICERS WERE FIRST ON THE SCENE AT THE
LOVE CANAL, TIMES BEACH, AND THREE-MILE ISLAND ...

AND WE PROVIDE PRIMARY HEALTH CARE FOR THOUSANDS OF
FAMILIES IN MIGRANT LABOR CAMPS, IN COAL MINING
COUNTRY, AND IN RURAL AND INNER CITY GHETTOS.

WE ALSO SERVE OUTSIDE THE BORDERS OF THE UNITED STATES, ON
REQUEST. FOR EXAMPLE ...
8
WE‘VE BEEN IN THE MIDDLE EAST AND CENTRAL AMERICA ... WE'VE

BEEN IN SUB-SAHARA AFRICA AND BHOPAL, INDIA... WE’VE BEEN
IN ETHIOPIA, SPAIN, AND SOUTHEAST ASIA ... WE’VE SCREENED
REFUGEES ON THE WAY TO THIS COUNTRY ... AND WE PLAYED A

— LEADING ROLE IN THE SUCCESSFUL CAMPAIGN TO RID THE HUMAN
RACE OF SMALLPOX.

AND RIGHT NOW, COMMISSIONED OFFICERS OF THE U.S. PUBLIC
HEALTH SERVICE -~- BOTH HERE IN THE U.S.A, AND IN COUNTRIES AROUND
THE WORLD -- ARE AMONG THOSE MAKING MAJOR CONTRIBUTIONS TO THE
WORLD’S UNDERSTANDING OF AIDS.
9
THESE SCRAPS OF INFORMATION MAY SOUND A BIT RANDOM, BUT

ACTUALLY THEY ARE ALL PART OF THE OVERALL MISSION OF ONE OR
ANOTHER OF THE 7 P.H.S. AGENCIES. LET ME BRIEFLY RUN THROUGH
THEM FOR YOU NOW,

— I’LL TAKE THEM ALPHABETICALLY, BEGINNING WITH THE ALCOHOL,
DRUG ABUSE, AND MENTAL HEALTH ADMINISTRATION.
10
I THINK THE TITLE TELLS THE STORY. THIS AGENCY HAS THREE

INSTITUTES -- OF MENTAL HEALTH, OF DRUG ABUSE, AND OF ALCOHOLISM
AND ALCOHOL ABUSE. THE COMBINED A.D.A.M.H.A. BUDGET FOR THE
CURRENT FISCAL YEAR IS $1.3 BILLION, WITH HALF GOING FOR RESEARCH
AND PUBLIC EDUCATION AND THE OTHER HALF GOING TO THE STATES IN
THE FORM OF “BLOCK GRANTS” TO SUPPORT COMMUNITY MENTAL HEALTH
CLINICS AND DRUG ABUSE AND ALCOHOLISM TREATMENT CENTERS.

NEXT ARE THE CENTERS FOR DISEASE CONTROL, OR C.D.C. C.D.C.
TS HEADQUARTERED IN ATLANTA, GEORGIA.
11
AS THE NAME IMPLIES, C.D.C.‘S PRIMARY MISSION IS TO CONTROL

OR PREVENT COMMUNICABLE OR VECTOR-BORNE DISEASES -~ MEASLES,
MUMPS, SYPHILIS, AND T.B. -- AND ALSO DO RESEARCH ON A RANGE OF
CHRONIC, ENVIRONMENTAL, AND OCCUPATIONAL DISEASES, SUCH AS
DIABETES, BIRTH DEFECTS, WORKPLACE INJURIES, MALNUTRITION, AND SO
ON.

THE OFFICE ON SMOKING AND HEALTH, WHICH PRODUCES THE SURGEON
GENERAL'S ANNUAL REPORT ON SMOKING, IS ALSO PART OF C.D.C.
12
THIS YEAR C.D.C WILL SPEND ABOUT A BILLION DOLLARS. NEARLY

HALF THAT MONEY WILL BE SPENT ON THE FIGHT AGAINST AIDS. FOR
EXAMPLE, THE AIDS BROCHURE WE MAILED TO EVERY HOME IN AMERICA
WAS A SPECIAL C.D.C. PROJECT.

ANOTHER P.H.S. AGENCY IS THE EQOD AND DRUG ADMINISTRATION --
OR THE F.D.A., ONE OF THE MOST WIDELY PUBLICIZED, DEEPLY
RESPECTED, AND ROUNDLY HATED AGENCIES OF THE FEDERAL GOVERNMENT.

 

UNDER THE TWO WATCHWORDS OF ITS LAW -- SAFETY AND
EFFECTIVENESS -- THE F.D.A. IS THE PUBLIC HEALTH ARBITER OF
HUMAN AND VETERINARY DRUGS, VACCINES, MEDICAL DEVICES, PROCESSED
FOODS AND FOOD SUPPLEMENTS, HEALTH SUPPLIES, AND RADIOLOGICAL
GEAR IN THE AMERICAN MARKEPLACE.
13
THE F.D.A.’s BUDGET IS UNDER A HALF-BILLION DOLLARS A YEAR,

BUT ITS ACTIONS AFFECT A_HALF TRILLION DOLLARS WORTH OF GOODS AND
SERVICES IN INTERSTATE COMMERCE.

NEXT IS THE HEALTH RESOURCES AND SERVICES ADMINISTRATION, OR
"HRSA ' “

“HRSA” CARRIES ON A DOZEN OR SO PUBLIC HEALTH PROGRAMS
PRIMARILY FOR PROGRAM FOR UNDERSERVED AND DISADVANTAGED
POPULATIONS, FROM THE HALF-BILLION-DOLLAR MATERNAL AND CHILD
HEALTH PROGRAM TO THE SMALL 3-MILLION-DOLLAR PROGRAM TO SUPPORT
BLACK LUNG CLINICS.
14
“HRSA” ALSO PROVIDES GRANTS AND LOANS TO STRENGTHEN CERTAIN

CRITICAL HEALTH PROFESSIONS, SUCH AS FAMILY MEDICINE, GERIATRIC
HEALTH CARE, AND PROFESSIONAL NURSING. MAYBE SOME OF YOU WILL

CHOOSE ONE OF THESE CAREERS LATER ON AND WILL QUALIFY FOR THIS

KIND OF HELP.

“HRSA” IS ALSO THE HOME BASE FOR THE NATIONAL HEALTH
SERVICE CORPS, WHICH PLACES DOCTORS, NURSES, AND OTHER HEALTH
PROFESSIONALS IN AREAS WHERE THERE IS VERY LITTLE HEALTH SERVICE
11+ OR NO SUCH SERVICE AT ALL.
15
THE NEWEST FREE-STANDING AGENCY IN THE P.H.S. “FEDERATION”

IS THE INDIAN HEALTH SERVICE, OR THE I.H.S.

THE I,H.S. PROVIDES A BILLION DOLLARS’ WORTH OF HEALTH CARE
TO OVER A MILLION NATIVE AMERICANS AND ALASKAN NATIVES THROUGH A
COMBINED DELIVERY SYSTEM OF LITERALLY HUNDREDS OF HOSPITALS,
HEALTH CENTERS, SMALL HEALTH STATIONS, SATELLITE CLINICS, URBAN
HEALTH PROJECTS, AND SCHOOL HEALTH CENTERS.

I AM PLEASED TO SAY THAT THE I.H.S, FACILITIES WERE THE
FIRST FEDERAL FACILITIES TO BAN SMOKING,
16
THE I.H.S. SYSTEM IS ACTUALLY A COMBINATION OF DIRECT HEALTH

CARE DELIVERED BY I.H.S. PERSONNEL -- THAT IS, OUR OWN DOCTORS,
NURSES, PHARMACISTS, DENTISTS, SANITARIANS, AND SO ON -- PLUS A
HEALTH CARE SYSTEM RUN BY THE INDIAN TRIBES THEMSELVES UNDER
].H.S. CONTRACTS, PLUS A NETWORK OF NON-TRIBAL CONTRACT HEALTH
SERVICES,

 

THE 6TH P.H.S. AGENCY -- AND THE ONE WITH THE MOST MONEY TO
SPEND, OVER $6 BILLION THIS YEAR -- IS THE NATIONAL INSTITUTES OF
HEALTH.
17
N.I.H. JUST CELEBRATED ITS ONE-HUNDREDTH BIRTHDAY. DURING

ITS FIRST CENTURY, THE NATIONAL INSTITUTES HAVE SUPPORTED
HUNDREDS OF THOUSANDS OF RESEARCHERS, INCLUDING 90 NOBEL PRIZE-
WINNERS IN MEDICINE AND CHEMISTRY.

N.I.H. SUPPORT HAS ALSO MADE POSSIBLE SOME OF THE MOST
IMPORTANT DEVELOPMENTS IN HUMAN MEDICINE, SUCH AS ...

* THE DISCOVERY OF THE MEANING OF THE GENETIC CODE, HUMANITY’S
BLUEPRINT, SO TO SPEAK ...
18
ALSO, THE DEVELOPMENT OF CANCER CHEMOTHERAPY AND CURES FOR

CHILDHOOD LEUKEMIA AND HODGKIN’S DISEASE,

AND THE DISCOVERY, UP ON THE 13TH FLOOR OF THE N.I.H.
CLINICAL CENTER, OF THE DRUG A.Z.T., THE ONLY DRUG WE HAVE
— THAT SLOWS DOWN THE PROGRESS OF AIDS,

AND I SHOULD ALSO MENTION THE NATIONAL HIGH-BLOOD PRESSURE
EDUCATION PROGRAM, WHICH -- I BELIEVE -- IS LARGELY
RESPONSIBLE FOR THE 40 PERCENT DECLINE IN DEATHS FROM STROKE
OVER THE PAST 15 YEARS OR SO.
19
ONCE YOU START TALKING ABOUT N.I.H., IT’S DIFFICULT TO STOP

BECAUSE THERE’S SO MUCH TO SAY ABOUT IT. BUT I WILL AND I‘LL NOW
MOVE ON TO THE 7TH AND FINAL ORGANIZATION WITHIN THE U.S. PUBLIC

HEALTH SERVICE: THE OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH,
OR “OASH."

ORDINARILY, THE TOP ADMINISTRATIVE OFFICES IN GOVERNMENT ARE
JUST THAT -- ADMINISTRATIVE, WITH VERY LITTLE PROGRAM RESPONSI-
ILITY. BUT THE PUBLIC HEALTH SERVICE HAS SEVERAL PROGRAM
ACTIVITIES THAT CUT ACROSS THE WORK OF MANY OTHER P.H.S.
AGENCIES. THESE PARTICULAR ACTIVITIES ARE ADMINISTERED OUT OF
THE ASSISTANT SECRETARY'S OFFICE.
20
THE GOVERNMENT’S BILLION-DOLLAR BATTLE AGAINST AIDS IS ONE

SUCH PROGRAM THAT IS CENTRALLY COORDINATED WITHIN “OASH.” THIS
CENTRAL COORDINATION PREVENTS RESEARCH DUPLICATION, MIX-UPS IN

POLICY, AND ANY BUREAUCRATIC DELAYS ON DECISIONS OF ONE KIND OR
ANOTHER,

OTHER, SIMILAR “OASH” PROGRAMS THAT INVOLVE SEVERAL P.H.S.
AGENCIES INCLUDE HEALTH PROMOTION AND DISEASE PREVENTION, FAMILY
PLANNING, ADOLESCENT FAMILY LIFE, PHYSICAL FITNESS, HEALTH
SERVICES RESEARCH, AND SUPPORT FOR THE IMPROVEMENT OF THE HEALTH
OF AMERICA’S MINORITY CITIZENS.
21
THE PERSON NOMINALLY IN CHARGE OF THE DAY-TO-DAY ACTIVITIES

OF THE U.S. PUBLIC HEALTH SERVICE IS THE ASSISTANT SECRETARY FOR
HEALTH, OR THE “ASH.” THIS INDIVIDUAL IS A POLITICAL OFFICER OF
THE ADMINISTRATION AND SERVES AT THE PLEASURE OF THE PRESIDENT.
ALSO, WHEN THE PRESIDENT GOES, THIS PERSON GOES, TOO,

THEN, WHERE DOES THE SURGEON GENERAL FIT IN?

I WAS APPOINTED AND RE-APPOINTED BY PRESIDENT REAGAN TO TWO

FIXED FOUR-YEAR TERMS. MY SECOND TERM WILL END IN NOVEMBER
1989, ABOUT 10 MONTHS INTO THE NEXT ADMINISTRATION.
22
WITH DAY-TO-DAY MANAGEMENT CHORES BEING DONE BY OTHER

PEOPLE, THE SURGEON GENERAL IS MORE LIKELY TO BE SPENDING HIS
TIME INFORMING AND EDUCATING THE HEALTH PROFESSIONS -- AND THE
GENERAL PUBLIC -- ABOUT THE KEY ISSUES AFFECTING THE HEALTH OF
ALL AMERICANS. IN FACT, PUBLIC EDUCATION IS THE MOST IMPORTANT
ASSIGNMENT I HAVE.

THE RECENT HOUSE-TO-HOUSE MAILING OF THE AIDS PAMPHLET IS A
GOOD EXAMPLE OF THIS ROLE ... AND MY APPEARANCE BEFORE YOU THIS
MORNING IS ANOTHER.
23
THUS FAR, DURING MY TERM OF OFFICE -- WHICH BEGAN ALMOST 7

YEARS AGO IN NOVEMBER OF 1981 -- I'VE BEEN THE LEAD PUBLIC
SPOKESPERSON ON THE FOLLOWING ISSUES:

* SMOKING. THIS WAS AN ISSUE WAITING FOR ME WHEN |
FIRST CAME TO WASHINGTON IN 1981, THE SURGEON GENERAL -- BY LAW
-- REPORTS TO THE CONGRESS AND THE NATION EACH YEAR ON THE
RELATIONSHIP BETWEEN SMOKING AND HEALTH. IF NEED BE, HE OR SHE
ALSO MAKES RECOMMENDATIONS AS TO WHAT THE COUNTRY OUGHT TO DO
NEXT.
24
TWO MONTHS AGO I RELEASED MY 7TH ANNUAL REPORT ON SMOKING

AND HEALTH. I BELIEVE IT’S THE MOST IMPORTANT ONE SO FAR.

THE REPORT LAID OUT ALL THE EVIDENCE SHOWING THAT THE
NICOTINE IN TOBACCO IS, TECHNICALLY AND SCIENTIFICALLY, AN
ADDICTING DRUG IN THE SAME SENSE THAT HEROIN AND COCAINE ARE
ADDICTING DRUGS.

AND THAT ADDICTING DRUG -- NICOTINE -- IS THE KEY REASON
THAT ABOUT 50 MILLION AMERICANS STILL SMOKE AND 300,000 OF THEM
DIE PREMATURELY EACH YEAR OF LUNG CANCER, HEART DISEASE, OR
STROKE,
25
FOUR YEARS AGO I CALLED UPON ALL AMERICANS TO MAKE THIS

COUNTRY A “SMOKE-FREE SOCIETY BY THE YEAR 2000.” THE RESPONSE
HAS BEEN TERRIFIC -- ESPECIALLY AMONG YOUNG PEOPLE, WHO ARE THE
SPECIAL TARGETS OF THE INTERNATIONAL CIGARETTE COMPANIES. FEWER
AND FEWER PEOPLE ARE STARTING TO SMOKE AND MORE AND MORE SMOKERS
ARE QUITTING THE HABIT. IT’S NOT EASY, BUT THEY’RE DOING IT.

SO WE JUST MIGHT REACH THAT GOAL OF BECOMING “SMOKE-FREE” IN
A DOZEN YEARS. I CERTAINLY HOPE SO,
26
* ANOTHER ISSUE INVOLVES THE HANDICAPPED ... ESPECIALLY

HANDICAPPED CHILDREN. IVE BEEN THE FRONT-LINE PUBLIC HEALTH
SPOKESPERSON TO GET BETTER PROTECTION FOR DISABLED INFANTS,

THIS WAS AN ISSUE TRIGGERED BY THE BIRTH IN APRIL 1982 OF
“BABY DOE," A MALE INFANT BORN WITH CERTAIN MENTAL AND PHYSICAL
DISABILITIES ... NOTHING CATASTROPHIC ... BUT HIS PARENTS GAVE
INSTRUCTIONS ANYWAY TO LET “BABY DOE” DIE. AND HE DID, A WEEK
AFTER HE WAS BORN,
27
I FELT THAT WAS WRONG AND I WORKED HARD TO MAKE SURE NO

OTHER BABY WAS EVER TREATED THAT WAY AGAIN. AND WE NOW HAVE A
LAW TO PREVENT SUCH TRAGEDIES.

* I’VE ALSO BEEN A PUBLIC HEALTH ADVOCATE ON BEHALF OF
ANOTHER POPULATION GROUP THAT IS ALSO VERY VULNERABLE: THE
ELDERLY. FRANKLY, I THINK EACH ONE OF YOU MUST RECOGNIZE THAT,
AT YOUR TIME OF LIFE, YOU COULD SOON BE FACED NOT ONLY WITH A
“BABY DOE” SITUATION -- THAT IS, HAVING A NEWBORN INFANT WHO IS
LESS THAN “PERFECT” -- BUT ALSO A “GRANNY DOE” SITUATION, IN
WHICH A PARENT OR GRANDPARENT BECOMES VERY ILL AND IS TOTALLY
DEPENDENT ON OTHERS, YET HE OR SHE REMAINS VERY MUCH ALIVE,
28
HOW WILL YOU HANDLE THOSE KINDS OF SITUATIONS, IF THEY

SHOULD ARISE?

* AND FOR THE PAST TWO YEARS I’VE BEEN DEEPLY INVOLVED
IN TELLING THE AMERICAN PEOPLE THE FACTS ABOUT ALDS.

THIS HAS BEEN THE TOUGHEST ASSIGNMENT OF ALL, SINCE IT
INVOLVES HUMAN SEXUALITY -- SOMETHING THE GOVERNMENT STAYS CLEAR
OF AS MUCH AS POSSIBLE -- AND ILLICIT DRUG USE -- SOMETHING THE
GOVERNMENT HAS BEEN INVOLVED IN... BUT WITH LIMITED SUCCESS.
29
OUR MOST RECENT EFFORT TO INFORM THE PUBLIC ABOUT THE THREAT

OF AIDS -- AND WHAT EACH PERSON CAN DO ABOUT IT -- WAS THE
PAMPHLET WE SENT TO EVERY HOME IN AMERICA, BASICALLY, HERE’S THE
MESSAGE OF THAT PAMPHLET:

"IF YOURE BEING CAREFUL AND SENSIBLE ABOUT YOUR PERSONAL
RELATIONSHIPS AND YOUR OWN SEXUALITY, GOOD ... DON’T CHANGE.
BUT IF YOU’RE NOT BEING CAREFUL AND SENSIBLE, THEN YOU’D
BETTER CHANGE YOUR WAYS, OR YOU RUN THE RISK OF CONTRACTING
THE AIDS VIRUS AND DYING A LONG AND PAINFUL DEATH.”

IT’S A GRIM MESSAGE ... BUT I HOPE IT IS READ, UNDERSTOOD,
AND TAKEN TO HEART BY EVERY AMERICAN.
30
FOR THE PAST FEW MINUTES, I’VE TOLD YOU WHO WE ARE AND WHAT

WE DO IN THE U.S. PUBLIC HEALTH SERVICE. NOW, I’LL CLOSE WITH A
BRIEF REMARK ABOUT OUR FUTURE AND THEN TAKE SOME OF YOUR
QUESTIONS,

THE P.H.S. IN GENERAL SEEMS TO BE EVOLVING INTO AN
ORGANIZATION WITH THREE MAIN PARTS TO ITS MISSION:

* FIRST, RESEARCH ... WE*RE THE COUNTRY’S PRIMARY
INSTRUMENT FOR CARRYING OUT LONG-TERM, RESOURCE-
INTENSIVE, BIOMEDICAL AND BEHAVIORAL RESEARCH. AND |
BELIEVE WE’LL CONTINUE TO PLAY THAT ROLE. IF ANY OF
YOU GO ON TO CAREERS IN LIFE SCIENCES RESEARCH, PLEASE
KEEP US IN MIND AS A PLACE THAT WANTS TO HELP.
31
THE SECOND ASPECT OF OUR MISSION IS TO PREVENT DISEASE

AND PROMOTE HEALTH ... WE’RE HELPING TO SHIFT THE
EMPHASIS OF AMERICAN MEDICINE FROM CURING ILLNESS TO
PREVENTING ILLNESS. WE’RE GOING AFTER THE MAJOR
BEHAVIORAL CAUSES OF SICKNESS AND DEATH, CAUSES SUCH AS
SMOKING, ALCOHOLISM, POOR DIET, AND RECKLESS BEHAVIOR
ON THE HIGHWAY. IF THOSE BEHAVIORS DISAPPEARED FROM
SOCIETY, AT LEAST HALF OF ALL OUR ILLNESS AND
DISABILITY WOULD DISAPPEAR, ALSO.

THINK ABOUT IT ... AND JUMP ON THE PREVENTION BAND-
WAGON FOR A LONG AND HEALTHFUL LIFE.
32
AND THE THIRD PART OF OUR MISSION IS TO CONTINUE TO

PROVIDE HEALTH SERVICES JO OUR NEEDIEST CITIZENS ...
PEOPLE WHO ARE -- FOR WHATEVER REASON -- OUTSIDE THE
MAINSTREAM OF HEALTH AND MEDICAL CARE: INDIANS AND
ALASKAN NATIVES, MIGRANT WORKERS, THE HOMELESS, AIDS
VICTIMS, FEDERAL PRISONERS, AND SO ON. HERE, AGAIN, IF
YOU’RE HEADING INTO THE HEALTH PROFESSIONS, STAY IN
TOUCH WITH US. WE NEED YOU. THE COUNTRY NEEDS YOU,
33
THAT’S ABOUT ENOUGH BACKGROUND. 1 HOPE YOU’VE LEARNED

SOMETHING NEW DURING OUR TIME TOGETHER. AND NOW, I‘LL BE HAPPY
TO TAKE A FEW QUESTIONS.

THANK YOU,
HHH # #