DEPARTMENT OF HEALTH & HUMAN SERVICES

The Surgeon General of the
Public Health Service
Washington OC 20201

ORIGINAL

For Release Upon Delivery

Statement
By
C. Everett Koop. M.D., Sc.D.
Surgeon General
U.S. Public Health Service
Department of Health and Human Services
Before the
Subcommittee on Children, Family, Drugs, and Alcoholism

U.S. Senate

February 9, 1989
MR. CHAIRMAN:

I APPRECIATE THIS OPPORTUNITY TO SPEAK FOR THE RECORD ON A
MATTER OF GRAVE IMPORTANCE TO THE FUTURE HEALTH AND WELL-BEING OF
THIS NATION. I REFER, OF COURSE, TO THE UNACCEPTABLY HIGH RATE
OF INTENTIONAL AND UNINTENTIONAL INJURIES SUFFERED BY MILLIONS OF

AMERICAN CHILDREN EVERY YEAR.

I AM JOINED THIS MORNING BY MY COLLEAGUE AND GOOD FRIEND,
DR. VERNON N. HOUK, DIRECTOR OF THE CENTER FOR ENVIRONMENTAL

HEALTH AND INJURY CONTROL, ONE OF THE CENTERS FOR DISEASE CONTROL

IN ATLANTA.
I USED THE TERM "MILLIONS" A MOMENT AGO TO DESCRIBE THE
SCOPE OF THE PROBLEM WE’RE DISCUSSING THIS MORNING. BUT ALLOW ME

TO BE A BIT MORE PRECISE.

THE U.S. PUBLIC HEALTH SERVICE CURRENTLY ESTIMATES THAT SOME
19 MILLION CHILDREN UNDER THE AGE OF 15 ARE INJURED SERIOUSLY

ENOUGH EVERY YEAR TO REQUIRE MEDICAL ATTENTION.

NINETEEN MILLION IS ABOUT ONE CHILD IN EVERY FOUR. MR.
CHAIRMAN, IF SOME INFECTIOUS DISEASE CAME ALONG THAT AFFECTED ONE
OUT OF EVERY FOUR CHILDREN IN THE UNITED STATES, THERE WOULD BE A
HUGE PUBLIC OUTCRY AND WE WOULD BE TOLD TO SPARE NO EXPENSE TO

FIND THE CURE -- AND TO BE QUICK ABOUT IT.
BUT SOMEHOW THE AMERICAN PEOPLE ARE SLOW TO BECOME THAT
CONCERNED ABOUT THE EPIDEMIC OF INTENTIONAL AND UNINTENTIONAL

INJURIES THAT STRIKE DOWN SO MANY CHILDREN EVERY YEAR.

NOW IT MAY BE THAT THE PUBLIC IS USED TO THE WORD "ACCIDENT"
AND ALL THAT IT IMPLIES. PEOPLE LOOK AT AN "ACCIDENT" AS BEING A
RANDOM BUT NEVERTHELESS INEVITABLE EVENT, AN EVENT ORDAINED BY
FATE OR SOME OTHER METAPHYSICAL OR THEOLOGICAL FORCE, AN EVENT

WHICH NONE OF US POOR MORTALS CAN CONTROL IN ANY WAY.
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UNFORTUNATELY, THE WORD IS USED AS A GENERAL TERM TO COVER A

WIDE RANGE OF EVENTS. AND THAT’S A SERIOUS PROBLEM OF PUBLIC
UNDERSTANDING, SINCE MOST INJURIES TO PEOPLE -- AND NEARLY ALL

INJURIES TO CHILDREN -- CAN BE PREDICTED AND CAN BE PREVENTED.

IT’S NOT FATE THAT RANDOMLY THROWS AN INFANT THROUGH THE
WINDSHIELD OF THE FAMILY CAR. RATHER, IT IS THE FACT THAT THE
PARENT DID NOT STRAP THE CHILD IN AN INFANT SEAT IN THE REAR OF
THE CAR AND DID NOT DRIVE DEFENSIVELY ON THE HIGHWAY. WHEN A

PARENT DOESN’T DO THESE THINGS, THEN INJURIES ARE BOUND TO OCCUR.

BUT SUCH INJURIES ARE PREVENTABLE. THEY ARE NO "ACCIDENT".
FRANKLY THAT’S WHY I AGREED TO BE THE HONORARY CHAIRMAN OF

THE NATIONAL SAFE KIDS CAMPAIGN.

FIRST, I BELIEVE THAT EVERYONE -- MYSELF INCLUDED -- HAS TO
DO HIS OR HER PART IN ALERTING AMERICA TO THIS TERRIBLE THREAT TO
THE LIVES OF OUR CHILDREN. WE SIMPLY MUST RAISE THE LEVEL OF

AWARENESS AND CONCERN, IN REGARD TO CHILDHOOD INJURIES.

AND SECOND, WE’VE GOT TO CONVINCE THE AMERICAN PEOPLE THAT
THEIR FATALISM ABOUT ACCIDENTS IS UNACCEPTABLE NONSENSE. THAT’S

A "“COP-OUT," A TRANSPARENT EVASION OF ADULT RESPONSIBILITY.
PEOPLE CAN DO SOMETHING TO REDUCE THE LEVEL OF INJURY AND

DEATH AMONG CHILDREN. AND THEY HAVE TO DO IT NOW.

NINETEEN MILLION INJURIES TO CHILDREN EVERY YEAR, MR.

CHAIRMAN. WELL, WHAT KIND OF INJURIES ARE THEY?

OUR YOUNG CHILDREN ARE INJURED ON OUR ROADS AND HIGHWAYS;

INJURIES INVOLVING AUTOMOBILES AND BICYCLES HEAD THE LIST. BUT

CHILDREN ARE ALSO DROWNED IN SWIMMING POOLS AND BATHTUBS

THEY ARE BURNED IN HOUSE FIRES ... THEY FALL DOWN THE STAIRS --

OR LET’S SAY THEY "ALLEGEDLY" FALL DOWN THE STAIRS. THEY CHOKE

ON BADLY DESIGNED TOYS OR THEY ARE CHOKED BY A FRIEND OR RELATIVE

AND THEY ARE POISONED BY HOUSEHOLD CHEMICALS, BAD FOOD, AND

DANGEROUS DRUGS.
IN VIRTUALLY EVERY ONE OF THESE CASES, MR. CHAIRMAN, THE
INJURY CAN BE PREVENTED. THE TRAGEDY NEED NOT OCCUR, OR IT

SHOULD NOT OCCUR.

MAYBE IT CAN BE PREVENTED BY THE CHILD HIMSELF OR HERSELF,
WITH THE HELP OF A STRONG EDUCATION PROGRAM. BUT MORE OFTEN THAN
NOT, THESE 19 MILLION INJURIES OCCUR BECAUSE THE COMMUNITY, THE
SCHOOL, FRIENDS, OR THE FAMILIES THEMSELVES DO NOT DO WHAT THEY

SHOULD DO TO PROTECT THEIR CHILDREN.

OR, WHAT’S WORSE, SOME PEOPLE MAY DELIBERATELY DO THINGS TO
PUT A CHILD’S LIFE AT RISK. AND, AS THIS COMMITTEE KNOWS, EVERY
YEAR THERE ARE WELL OVER A MILLION SUCH CASES OF CHILD ABUSE AND

NEGLECT IN OUR SOCIETY.
AS I MENTIONED EARLIER, SOME 19 MILLION CHILDREN EACH YEAR
ARE INJURED SERIOUSLY ENOUGH TO REQUIRE MEDICAL TREATMENT. AND
OF THAT NUMBER, ABOUT 10 PERCENT, OR NEARLY TWO MILLION CHILDREN,
ARE INCAPACITATED FOR AT LEAST TWO WEEKS ... MOST OF THEM, FOR A

LOT LONGER.

AND AMONG THOSE MILLIONS OF CHILDREN THERE ARE AT LEAST

 

100,000 BOYS AND GIRLS UNDER THE AGE OF 15 WHO AT ONE TIME WERE

ABLE-BODIED AND HEALTHY BUT WHO HAVE NOW BECOME PERMANENTLY

DISABLED. AT LEAST 100,000 EVERY YEAR.
LIFE IS DIFFERENT FOR THEM. DURING THEIR REMAINING 40, 50,
OR MAYBE 60 YEARS OF LIFE, THEY MUST NEGOTIATE RELATIONSHIPS AND
ENVIRONMENTS AND MAKE CHOICES THAT THE REST OF US WHO AREN’T

DISABLED DON'T HAVE TO MAKE.

IN ORDER TO LIVE A FULL AND SATISFYING LIFE, THESE CHILDREN
REQUIRE OF THEMSELVES, OF THEIR FAMILIES, OF THEIR FRIENDS, AND
OF SOCIETY AN ADDITIONAL QUOTA OF ENERGY ... AND INTEREST ... AND

ASSISTANCE ... AND MONEY.

AND THEY REQUIRE THESE THINGS EVERY DAY.
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MR. CHAIRMAN, I SPENT MOST OF MY PROFESSIONAL LIFE AS A
SURGEON IN PEDIATRICS. I SAW CHILDREN WHEN THEY WERE MOST
VULNERABLE. I SAW THEM WHEN LIFE AND DEATH HUNG IN THE BALANCE.

I’M SURE YOU AND YOUR COLLEAGUES HAVE AS WELL.

YOU CAN PICTURE THEM IN YOUR MIND’S EYE. AND YOU ARE MOVED

BY THAT PICTURE.

BUT DON’T STOP THERE. TRY TO IMAGINE THEM AS LIVING,
GROWING, DEVELOPING HUMAN BEINGS. TRY TO IMAGINE THEM IN HIGH

SCHOOL AND ON INTO HIGHER EDUCATION.
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TRY TO IMAGINE THEM WITH A LINGERING DISABILITY BUT
NEVERTHELESS GOING TO CLASSES AND TO THE DINING HALLS AND THE
STADIUM AND TRYING IN EVERY POSSIBLE WAY TO TAKE PART IN THE
INTELLECTUAL AND SOCIAL LIFE OF THEIR SCHOOL. AND DOING SO WITH
EVERY OUNCE OF TALENT, BRAVERY, AND GOOD GRACE THAT THEY CAN

MUSTER.

AND IMAGINE, IF YOU WILL, THAT SAME YOUNG ADULT GOING OUT
INTO THE WORLD OF WORK, COMPETING FOR A JOB, FOR A GOOD SALARY,
FOR RESPONSIBILITY, AND FOR RECOGNITION, JUST LIKE ANY OTHER

CONSCIENTIOUS YOUNG EMPLOYEE.
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AND, DESPITE THE INJURED OR MISSING LIMBS OR THE INJURED
SPINAL CORD OR THE LOSS OF VISION, THAT YOUNG PERSON IS
SUCCEEDING BECAUSE OF THE EXTRA WILL-POWER AND ENERGY AND

EQUIPMENT THAT ARE AVAILABLE AND BEING EXPLOITED TO THE MAXIMUM.

IMAGINE A HAPPY, PRODUCTIVE, AND FULFILLING MARRIAGE AND

HOME LIFE. THAT’S ALSO POSSIBLE. BUT AGAIN, IT IS A HOME LIFE

THAT IS CIRCUMSCRIBED IN A PARTICULAR WAY, A HOME LIFE THAT

DEMANDS CHOICES THAT MOST OTHER PEOPLE HAVEN’T HAD TO MAKE.
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JUST ONE EVENT ... ONE INJURY SUFFERED AS A CHILD ... ONE
PERMANENT CHANGE ... AND IT LEADS TO A LIFETIME PERMANENTLY
SPENT TAKING THOSE EXTRA STEPS, EXERCISING THAT EXTRA MEASURE OF
CAUTION AND CONTROL ... A LIFETIME SPENT TAKING THAT EXTRA MOMENT
TO ASSESS THE RISK OF THE NEXT MOVE ... A LIFETIME OF EXTRAOR-

DINARY COST IN BOTH MATERIAL AND HUMAN TERMS.

MR. CHAIRMAN, I SUGGEST THAT CHILDHOOD INJURIES ARE NOT ONLY

DEVASTATING TO CHILDREN. THEY ARE ALSO ONE OF THE LEADING CAUSES

OF PHYSICAL AND MENTAL DISABILITY, OF ARRESTED DEVELOPMENT, AND

OF RESTRICTED LIFE EXPERIENCES FOR MILLIONS OF ADULTS ... THE

CHILDREN WHO HAD BEEN INJURED BUT WHO SURVIVED AND WHO GREW UP

AND GREW OLD, CARRYING THE SCARS OF THOSE INJURIES WITH THEM.
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AND SO THE TRAGEDY OF CHILDHOOD INJURIES IS COMPOUNDED, YEAR
AFTER YEAR. FOR MOST OF THE 19 MILLION CHILDREN WHO WILL BE

INJURED IN THE UNITED STATES THIS YEAR, LIFE WILL GO ON.

BUT FOR MANY OF THEM IT WILL BE DIFFERENT. LIFE WILL BE A
LITTLE HARDER, A LITTLE MORE SPECIAL. AND IT WILL ALWAYS BE THAT

WAY.

THERE ARE NO ONE-TIME COSTS ASSOCIATED WITH CHILDHOOD

INJURIES, MR. CHAIRMAN. THERE ARE ONLY LIFETIME COSTS.
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TO ME, THEREFORE, THE CHALLENGE IS SIMPLY THIS: IF WE WANT
THE UNITED STATES TO MAINTAIN ITS ROLE OF WORLD LEADERSHIP, THEN
THE PEOPLE OF THE UNITED STATES MUST BE ABLE TO LIVE INDEPEN-
DENTLY, BE HEALTHY, AND HAVE THE OPPORTUNITY TO LIVE FULL AND

PRODUCTIVE LIVES.

FOR THE AMERICAN PEOPLE TO MAINTAIN SUCH A HIGH LEVEL OF

WORK-PERFORMANCE AND LIFE-PERFORMANCE, THEY MUST HAVE SAFER

HIGHWAYS AND MOTOR VEHICLES, SAFER HOMES AND SCHOOLS, SAFER

PLAYGROUNDS AND OTHER RECREATIONAL AREAS, SAFER TOYS AND

VIRTUALLY EVERYTHING ELSE IN OUR THRIVING MARKETPLACE ... ALL

MUST BE MADE SAFER.
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THIS IS A JOB FOR ALL OF US ... FOR GOVERNMENT AND THE
PRIVATE SECTOR, FOR OUR SCHOOLS AND ALL OUR OTHER COMMUNITY
INSTITUTIONS, FOR OUR FAMILIES, AND FOR OUR PROFESSIONAL PEOPLE

IN MEDICINE, NURSING, AND EDUCATION.
IN OTHER WORDS, THERE'S ENOUGH WORK HERE FOR EVERYONE.
THE AMERICAN PEOPLE CAN’T BE A HAPPY AND PRODUCTIVE PEOPLE,

IF THEY LIVE IN A LIFE-THREATENING ENVIRONMENT, SURROUNDED BY

DANGER.
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OUR NATION MUST BE MADE SAFE FOR EVERYONE ... BUT MOST OF

ALL, IT MUST BE A NATION THAT IS SAFE FOR CHILDREN, WHO ARE

AMERICA’S FUTURE.

MR. CHAIRMAN, THAT ENDS MY FORMAL STATEMENT. IF I MAY, I’D

LIKE TO PROVIDE FOR THE RECORD SOME ADDITIONAL INFORMATION

RELATED TO CHILDHOOD INJURIES AND DRAWN FROM THE PROGRAMS OF THE

CENTERS FOR DISEASE CONTROL AND THE NATIONAL INSTITUTE OF CHILD

HEALTH AND HUMAN DEVELOPMENT OF N.I.H.

AND NOW, SIR, I WOULD BE HAPPY TO ANSWER ANY QUESTIONS.

THANK YOU.

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