ADDRESS
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
Y
PRESENTED TO THE NATIONAL FOUNDATION FOR INFECTIOUS DISEASES

WASHINGTON, D.C,
NovEMBER 21, 1988
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(GREETINGS TO HOSTS, GUESTS, FRIENDS, ETC.)

T AM DEEPLY HONORED BY BEING CHOSEN AS THE FIRST RECIPIENT
OF THE MAXWELL FINLAND AWARD.

DR. FINLAND PLAYED A VERY IMPORTANT ROLE IN THE EVOLUTION OF
MODERN MEDICAL PRACTICE, AS WE’VE ALL HEARD. HAVING KNOWN HIM
AND HIS WRITINGS AND THE KIND OF SCIENTIST THAT HE WAS, I AM
ESPECIALLY GRATEFUL FOR THIS EVENING’S HONOR,
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I’M ALSO PLEASED TO SEE SO MANY OF MY COLLEAGUES FROM THE

U.S. PUBLIC HEALTH SERVICE HERE THIS EVENING. I WON’T SINGLE OUT
ANY ONE PERSON. RATHER, I'D LIKE TO ACKNOWLEDGE THE
EXTRAORDINARY QUALITY OF PEOPLE WHO SERVE OUR COUNTRY IN THE

P.H.S,

MOST OF THEM ARE CIVIL SERVANTS, WHILE A FEW -- SOME 5,300
-- SERVE IN THE UNIFORM OF THE COMMISSIONED OFFICERS CORPS.
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] AM THEIR SURGEON GENERAL AND SO, TO A GREAT EXTENT, I MAY

HAVE ARRIVED HERE THIS EVENING -- TO BE TREATED WITH SUCH WARMTH
AND GRACE -- BECAUSE THERE IS SUCH AN ORGANIZATION AS THE U.S,
PUBLIC HEALTH SERVICE AND BECAUSE IT IS EXCELLENT.

AND SO, WITH YOUR INDULGENCE, I THOUGHT I MIGHT PUBLICLY
ACKNOWLEDGE MY DEBT AND MY AFFECTION FOR AN EXCELLENT
ORGANIZATION AND THE PEOPLE WHO KEEP IT SO.
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NOW, THIS HAS BEEN A LONG DAY FOR MANY OF YOU -- ESPECIALLY

FOR YOU, CHAIRMAN ROGERS, WHO WELCOMED EVERYONE TO THIS THIRD
NATIONAL FORUM SOME 13 HOURS AGO -- SO I WILL KEEP MY REMARKS AS
BRIEF AND TO THE POINT AS POSSIBLE.

AS YOU KNOW, I CAME TO WASHINGTON A BIT OVER 7 YEARS AGO,
FRESH FROM A LONG CAREER AS A PEDIATRIC SURGEON. FOR NEARLY 40
YEARS I LOOKED AT MEDICAL PROBLEMS AND TRIED TO SOLVE THEM WITH
THE SKILLS IN MY OWN TWO HANDS.
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AND I SUSPECT THAT, SUBCONSCIOUSLY, I THOUGHT THAT WAS WHAT

HEALTH CARE AND MEDICAL CARE WERE ALL ABOUT, MOST PHYSICIANS
HAVE THAT QUITE NATURAL BIAS, THAT HEALTH CARE IS THE SUM TOTAL
OF THE PATCHING UP THEY DO FOR THEIR PATIENTS. AND, TO A
CERTAIN EXTENT, I GUESS IT IS.

BUT NOT ALTOGETHER. AND LESS SO IN THE FUTURE.

AND THAT'S ONE OF THE MAIN LESSONS I‘VE LEARNED, DURING MY
TWO TERMS AS YOUR SURGEON GENERAL.
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VIRTUALLY EVERY MAJOR HEALTH ISSUE I’VE HAD TO DEAL WITH HAS

HAD -- AT ITS VERY HEART -- THE WAY PEOPLE BEHAVE ... THE WAY
THEY BEHAVE TOWARD THEMSELVES ... THE WAY THEY BEHAVE TOWARD

OTHERS THEY KNOW AND LOVE ... AND THE WAY THEY BEHAVE TOWARD

OTHERS THEY DON’T KNOW AT ALL.

SHALL I LIST SOME OF THOSE ISSUES? I’LL NAME JUST A
HANDFUL :

SMOKING ... THE ABUSE OF ALCOHOL ... UNWANTED PREGNANCIES
.1+ CHILD ABUSE AND OTHER FORMS OF FAMILY VIOLENCE ... AND
INFECTIOUS DISEASES SUCH AS HEPATITIS B ... AND, COURSE,
AIDS.
/
I‘LL STOP RIGHT THERE, ALTHOUGH THE FULL LIST IS A GOOD DEAL

LONGER,

BUT AT THE BASE OF EACH OF THOSE PAINFUL, TRAGIC,
DESTRUCTIVE, AND PREVENTABLE HEALTH PROBLEMS IS AN EQUALLY TRAGIC
AND DESTRUCTIVE HUMAN BEHAVIOR,

THIS IS NOT AN EASY SUBJECT TO DISCUSS IN A DEMOCRACY,
BECAUSE WE PRIDE OURSELVES ON LETTING THE INDIVIDUAL MAKE THE
DECISION AS TO WHAT HE OR SHE WANTS OUT OF LIFE.
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AND THE REST OF US HAVE AGREED -- SO FAR, ANYWAY -- THAT WE

WILL PAY ALMOST ANY PRICE TO KEEP THAT PART OF OUR SOCIAL
COMPACT ALIVE AND WELL.

HENCE, WE PUT A GREAT DEAL OF HUMAN AND MATERIAL RESOURCES
INTO VACCINE RESEARCH AND DELIVERY ... INTO DRUG DEVELOPMENT ...
INTO PHYSICAL AND MENTAL HEALTH THERAPIES OF EVERY KIND ... INTO
THOSE KINDS OF MEDICAL AND PUBLIC HEALTH RESPONSES THAT ARE
AFTER THE FACT.

AND WE TURN TO LARGE, BROAD-BRUSH KINDS OF PUBLIC EDUCATION
PROGRAMS TO DO THE TOUGH, LONG-TERM JOB OF CORRECTING HAZARDOUS,
HIGH-RISK HUMAN BEHAVIOR. ALSO AFTER THE FACT.
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AT THIS 3rp ANNUAL FORUM, FOR EXAMPLE, WE‘RE VERY CONCERNED

-- AND RIGHTLY SO -- ABOUT THE SAFETY OF THE HEALTH WORKFORCE, IN
REGARD TO HEPATITIS B AND AIDS.

WE HAVE TWO MAJOR INSTRUMENTS TO WORK WITH: A NEW HEPATITIS
B VACCINE ... AND THE INDIVIDUAL HEALTH WORKER. BUT THE VACCINE
WORKS ONLY IF THE INDIVIDUAL HEALTH WORKER AND HIS OR HER
SUPERVISOR HAVE THE GOOD SENSE AND ENLIGHTENED SELF-INTEREST 10
WANT THE PROTECTION OF THE HEPATITIS VACCINE NOW.

AS FOR AIDS, WE STILL HAVE A FEW YEARS TO GO BEFORE A
VACCINE IS GENERALLY AVAILABLE. HENCE, WE MUST RELY SOLELY ON
THE JUDGMENT AND PERSONAL BEHAVIOR OF INDIVIDUAL HEALTH WORKERS
FOR THEIR PROTECTION AGAINST THE AIDS VIRUS.
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I BELIEVE THE PEOPLE IN OUR HEALTH WORKFORCE ARE GOOD

PEOPLE ... RESPONSIBLE PEOPLE ... BUT THEY’RE ALSO PEOPLE WHO ARE
CAUGHT -- AS THE REST OF US HAVE BEEN CAUGHT -- IN THE SHIFTING
TIDES OF NATIONAL CULTURE AND COMMON VALUES.

FOR EXAMPLE, I THINK THERE’S A DIRECT, STRAIGHT-LINE
RELATIONSHIP BETWEEN THE 1960s, WHEN MANY CONSTRAINTS
DISAPPEARED, CONCERNING EXPERIMENTATION WITH DRUGS AND SEXUALITY
.++ AND THE 1970s, WHEN SUCH EXPERIMENTATION BECAME RATHER
WIDESPREAD AMONG YOUNG PEOPLE IN OUR SOCIETY ... AND THE 1980s,
WHEN THE TRAGIC RESULTS OF MUCH OF THAT BEHAVIOR CAN BE MORE
CLEARLY SEEN,
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AND SO WE'VE BEEN BUSY THE PAST FEW YEARS POSTING THE

WEEKLY TALLIES OF DRUG OVERDOSE DEATHS ... OF “CHILDREN HAVING
CHILDREN” ... OF VICTIMS OF A NEW EPIDEMIC OF SYPHILIS ... OF THE
ESCALATING NUMBERS OF PEOPLE WITH RESISTANT STRAINS OF GONORRHEA
c++ AND OF THE EXPANDING CASELOAD OF PEOPLE WHO WERE INCUBAT-

ING THE AIDS VIRUS UNTIL THE “RIGHT” OPPORTUNISTIC DISEASE CAME
ALONG,

IN MANY AREAS OF MEDICINE AND PUBLIC HEALTH, WERE MAKING
EXCELLENT PROGRESS: HYPERTENSION SCREENING, ORGAN
TRANSPLANTATION, CANCER DETECTION AND CONTROL, AND SO ON,
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BUT IN MANY OTHER AREAS, WE SEEM TO BE RUNNING IN PLACE, IF

NOT ACTUALLY FALLING BEHIND. THE STATISTICS ARE NOT GOOD. FAR
TOO MANY PEOPLE IN OUR SOCIETY HAVE FALLEN VICTIM TO DEBILITATING
AND DEADLY DISEASE. AND WE SUSPECT THAT THE WORST NUMBERS MAY
NOT BE IN YESTERDAY’S FILES. RATHER, THEY MAY SHOW UP IN THE
TALLY SHEETS OF TOMORROW AND THE DAY AFTER.

I AM REMINDED OF THOSE PEOPLE WHO TRY TO CAP A RAGING OIL~-
WELL FIRE. THE VISIBLE FLAME AT THE SURFACE IS FRIGHTENING
ENOUGH. BUT THE ROOT CAUSE OF SUCH A FIRE LIES DEEP UNDERGROUND,
IN SOME MAJOR GEOLOGICAL FAULT OR IN SUBTERRANEAN CHANGES OF
PRESSURE.
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LIKE ALL OF YOU, I ALSO AM CONCERNED ABOUT THE SAFETY OF

EVERY HEALTH WORKER IN OUR COUNTRY. BUT I KNOW THAT, IF ANY OF
THEM ARE FUNCTIONING IN HAZARDOUS OR HIGH-RISK WAYS, THE REASON
MAY BE NOT SO MUCH A LACK OF KNOWLEDGE OF C.D.C GUIDELINES AS IT
IS THEIR EVOLVING PERSONAL LIFESTYLES OF HIGH-RISK BEHAVIOR AND
LOW SELF-ESTEEM IN GENERAL.

THE PROBLEM BEGINS EARLY, IN OUR SCHOOLS AND IN THE PRIVACY
OF OUR HOMES ... PLACES WHERE PUBLIC HEALTH AUTHORITIES AND
BIOMEDICAL EXPERTS ARE NOT SUPPOSED TO GO.
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BUT THOSE PLACES ARE THE FRONTIER IN MEDICINE AND PUBLIC

HEALTH. THAT'S WHERE THE TRUE PHYSICAL AND MENTAL HEALTH OF A
WHOLE NEW GENERATION OF AMERICANS IS TAKING SHAPE.

AND SO 1 BELIEVE WE HAVE A SPECIAL CHALLENGE BEFORE US, AT
THIS TIME IN OUR HISTORY WHEN PERSONAL FREEDOM AND PERSONAL
RESPONSIBILITY ARE IN A SOMEWHAT UNEASY BALANCE.

 

WE NEED TO FIND WAYS -- EFFECTIVE, YET CONSISTENT WITH
AMERICAN TRADITION -- WAYS TO HELP YOUNG PEOPLE -- SCHOOLCHILDREN
-- DEVELOP A HEALTHY SENSE OF THEIR OWN PERSONAL WORTH, AS WELL
AS A GENUINE APPRECIATION OF THE WORTH OF EVERYONE ELSE.
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IT IS, AFTER ALL, A COMMON HUMAN TRAIT, OR INSTINCT, 10

PROTECT THE THINGS -- AND THE PEOPLE -- WE TRULY VALUE. WE OUGHT
TO EXPLOIT THAT TRAIT MUCH MORE THAN WE DO, IN THE NAME OF PUBLIC
HEALTH. AND WE OUGHT TO REINFORCE IT AMONG OUR CHILDREN,

IF WE DO, IT MAY WELL BE THE MOST IMPORTANT CONTRIBUTION WE
CAN MAKE TO THE HEALTH OF ALL AMERICANS WHO ARE TO COME OF AGE IN
THE NEXT CENTURY.

THANK YOU,
HHH HF