COA Keynote Address at the USPHS Scientific and Training Symposium

Thank you for the gracious introduction.

Many important events have transpired, since I delivered my first COA keynote a year ago

We are a stronger, more cohesive force than we were 18 months ago and it has been the greatest honor of my professional career to play a part in this progress.

I’m here to share this morning where we, as a Corps have been and where I believe we’re headed in the future.

However, before I do so, I want you to know that the past year has solidified my immense pride each and everyone one of you in this great force of Commissioned Officers.

It is my deep professional and personal privilege to lead you.

This past year, I have spoken to dozens of audiences throughout the Nation about the Commissioned Corps and our mission.

I always highlight the importance of prevention and preparedness - encompassing much of the work that so many of you are doing.

Our 6,300 officers are among the nation’s best- trained assets in fighting public health crises.

 In the Corps we do everything we can, every day, to be ready and I have tried to embody this principle in my activities as Surgeon General.  

Last April, we as a nation realized the importance of this principle when we were challenged with the H1N1 outbreak. 

Over the course of the past two months, Americans have seen powerful images of Corps leadership like RADM Anne Schuchat and RADM Mitch Cohen and many others - sharing life-saving public health messages while - behind the scenes - many of you supported national efforts to mitigate the spread of the virus. 

We showed the nation that we stand better prepared for a public health emergency - such as an influenza pandemic - than at any time in history.

Whether providing clinicians with medical guidance prepared by the Centers for Disease Control,

Or

Advising Americans on steps to help prevent the spread of influenza,

Our primary goal is widely communicating useful medical information that protects the health of the Nation.

Officers of the Commissioned Corps did what matters most: We dusted off our Pandemic Plans…really they had not gathered any dust - and we executed the plans – showing a calmness and competence that I know was what widely appreciated around the country and around the globe.

I would be remiss if I did not take a moment here to salute the outstanding contributions of Acting CDC Director Dr. Richard Besser.

It’s great to be in Atlanta, to have so much CDC participation in the conference and particularly to have Rich join me in this session.

Dr. Besser’s role in helping Americans understand H1N1 and how families can protect themselves was all-important in the days following the start of the H1N1 outbreak.

The scientific communication skill and bedside manner you combined in talking to the Nation was exemplary,

On behalf of millions if not billions, I thank you, Dr. Besser. A round of applause for Dr. Besser, please.

As Dr. (Thomas R). Frieden, assumes leadership of the CDC, he can take great satisfaction in knowing that you’ve served your agency and the Nation well.

And every officer here today, everyone whose work contributed to the Federal government’s successful H1N1 response, we should also know that:

Secretary Kathleen Sebelius takes special pride in the job that HHS has done and continues to do in monitoring the outbreak, mobilizing components of our Strategic National Stockpile, and widely sharing timely guidance with people everywhere.

Exceptional responses to natural and man made disasters is, of course, consistent with PHS tradition as well as recent history.

Consider  the past year.

For the first time in recorded history, six consecutive tropical storms struck the U.S. mainland, destroying scores of communities and devastating the lives of thousands. The Commissioned Corps – YOU - were there.

Over 1300 officers deployed to bring critical health and human services to those directly affected. An additional 700 officers assisted with additional logistical and administrative support from their duty locations. These officers performed exceptionally.

A Rapid Deployment Team of PHS Commissioned Corps officers provided urgent medical care for chronically ill patients in Texas that were evacuated due to hurricane Ike.  Working hand in glove with the community near College Station, over 200 officers as part of RDF-1 received multiple waves of hundreds of patients, triaged mothers, fathers, children, and helped to coordinate vital services including food, water, and shelter from the storm. 

Patient advocacy teams deployed to south central Louisiana to help individuals and families displaced by Hurricane Gustav.

And officers from the USS Kearsarge provided assistance to hurricane victims in Haiti.

There are dozens of equally impressive, if lesser known illustrations of officer preparedness.

I am confident our force remains ready to face the unknown challenges of the future.

I cannot think of a more timely moment to pay tribute to the individual whose leadership is responsible for the preparedness and response that has helped so many people in so many places.

RADM Craig Vanderwagen was the first Assistant Secretary for Preparedness & Response under the re-designation of the Office of Public Health Emergency Preparedness.

 Craig has been the HHS Secretary's principal advisor on matters related to public health emergencies.

Commissioned Corps preparedness would not have become the benchmark for excellence it is today without all RADM Vanderwagen has done.

RADM Vanderwagen will be turning over the reigns – subject to Senate confirmation – to Dr. (and soon to be RADM Nicole Lurie). She will take over an ASPR carefully raised from birth brought through adolescence and groomed by Craig, and all of us and the nation are better for his pathbreaking work at HHS.

Craig, would you stand up?  Let’s give him a round of applause!

For two centuries, Corps officers have dedicated their talents and skills to protecting, promoting, and advancing the health and safety of the Nation.

Despite our progress as a nation- and as a public health force- there is still an ongoing battle to be fought.   

We must refocus and rededicate our attention to combating the rising rates of chronic diseases including heart disease, stroke, cancer, and diabetes.

Many Americans suffer and die prematurely from diseases that could be prevented or better managed.  More than 75 percent of health care expenditures in the United States are spent to meet the health needs of persons with chronic conditions. 

Today, we have it backward. We continue to spend billions on costly treatments to try to make people well, often when it is already too late.

Neglecting prevention has resulted in an epidemic of chronic disease that threatens the health and quality of life throughout our nation and the world.

Every year, chronic diseases like heart disease, stroke, cancer, and diabetes claim the lives of more than 1.7 million Americans. 

We need to change the way we think about health care in America. 

Our vision for health reform is a future in which primary care clinicians will be rewarded for health promotion and disease prevention, in addition to disease treatment.

President Obama has made reform of our Nation’s health system a top priority. Health care must be more affordable and accessible.   

In the last eight years, health insurance premiums have grown four times faster than wages and one million more Americans have lost their health insurance each year. 

These are exciting times-

• fueled by a historic transition in national leadership, and
• energized by the arrival of departmental leadership who truly value the importance of prevention.

Prevention is the key to ensuring optimal health at the lowest cost -it is my overarching priority as Surgeon General – and it is an essential part of what officers of the Commissioned Corps will, increasingly, emphasize wherever you may be assigned.

Whether

Partnering to deliver mental health services to troops home returning from the battlefield

Or

Providing clinical services for Haitian, Cuban and Southeast Asian refugees;

From

Conducting evacuations of persons displaced by natural disasters;

To

Serving together with civilian partners on a humanitarian mission of the USNS Comfort in Latin America and the Caribbean, 

Through our shared mission, each of us engages in work each day that, at its end stage, results in better health for our families here in the U.S. and abroad.

In this new era, you will serve the Corps mission as practitioners and advocates of preventive medicine.

The good news is that the move to prevention-centered health care is well underway.

The economic stimulus bill called ARRA (The American and Recovery and Reinvestment Act of 2009) includes $1 billion for clinical and community-based prevention activities, immunizations and preventable health care associated infections.

ARRA also provides an additional $2 billion to be invested in Community Health Centers. This is an unprecedented opportunity to serve more patients, stimulate new jobs, and meet the significant increase in demand for primary health care services among the Nation's uninsured and underserved populations. This is welcome news for the more than 16 million people in the U.S. treated at Community Health Centers every year.

The Recovery Act also includes investments in electronic health records, comparative effectiveness research, and health workforce training -- foundations for a 21^st century health care system. 

As Secretary Sebellius recently told the World Health Organization, the Administration has also requested new resources to make new smart, cost-effective investments in programs that make whole communities healthier.

Projects that emphasize disease prevention and seek out strategies that do not battle one disease, but rather, battle the conditions and risk factors that foster disease.

Measures like these are an unprecedented opportunity to demonstrate the value of prevention and develop powerful models that could guide future health reform.

The Commissioned Corps will move toward prevention-based care and systemic reform under the leadership of Assistant Secretary of Health designate Dr. Harold Koh.

Dr. Koh is the Harvey V. Fineberg Professor of the Practice of Public Health, Associate Dean for Public Health Practice, and Director of the Division of Public Health Practice at the Harvard School of Public Health.   

He has also served as Director of the Harvard School of Public Health Center for Public Health Preparedness (HSPH-CPHP), which promotes education about bioterrorism, pandemic influenza, and other emerging health threats.

Dr. Koh is also the former Director of Public Health in the Commonwealth of Massachusetts. In that capacity, he emphasized the value of prevention and strengthened the state’s commitment to eliminating health disparities.

Personally and professionally, I stand ready to welcome Dr. Koh to the USPHS family as our Assistant Secretary for Health.

We’ve been talking regularly and he’s sorry he couldn’t be with us this week because of an important family commitment.

I look forward to working with him to create a healthier Nation.

I want to share some of the activities I’ve been focusing on since the last COA conference.

I’ve been traveling the nation to mobilize community-driven efforts to promote health and wellness. 

To date, I’ve visited more than 40 states as part of my childhood obesity prevention initiative, Healthy Youth for a Healthy Future.

If we as a nation don’t make and sustain change in children’s health, today’s generation of children will likely be sicker and die sooner than their parents. Through HYHF, we reach out to and collaborate with parents, caregivers, schools, mentors, and community leaders to improve children's eating and activity habits.

During my visits to communities, I’ve tried to  create teaching moments with children.  I have biked through Portland, planted seeds for a garden in New Hampshire, participated in a Delaware gym class, and joined kids in a hockey “puck-drop” in Tampa to just name a few.

I’ve also visited 7 states since 2008 alone to observe community-supported efforts in response to heed The Surgeon General’s Call to Action to Reduce and Prevent Underage Drinking.  That makes – with RADM Moritsugu’s work - 13 total Surgeon General state visits since the CTA was issued two years ago,

I can tell you that good things are happening at the state and community levels – in terms of policy change and parents recognizing the value and importance of talking to their children early and often about the dangers of underage drinking.

As part of our mission to deliver the very best science, we also call on Americans to take action on other emerging –- or enduring - public health concerns as well.

Deep Vein Thrombosis Call to Action

Deep vein thrombosis and pulmonary embolism affect an estimated 350,000 to 600,000 Americans each year, and the numbers are expected to increase as the U.S. population ages.

Together, deep vein thrombosis and pulmonary embolism contribute to at least 100,000 deaths each year.

We issued a Call To Action, last September, to increase the awareness and knowledge of these potentially deadly conditions and encourage patients and health care providers to take the steps to prevent them.

Upcoming Healthy Homes CTA

Poorly maintained housing increases risk for injury and illness. Unhealthy and unsafe housing continues to affect the health of millions of people – cutting across all income levels and geographic areas.  

In short, home environments contribute to substantial health care costs in a manner that relatively few people realize.

For instance, exposure to dampness and mold in homes is estimated to contribute to approximately 21 percent of current asthma cases alone in the United States, at an estimated annual cost of $3.5 billion.

The Surgeon General’s Call To Action On Healthy Homes that we’re releasing next week along with, CDC, and the Dept of Housing and Urban Development will describe the steps people can take to protect themselves from disease and injury that may result from health hazards in their houses. The document also outlines the next steps of a comprehensive national approach to ensuring that homes are safe and environmentally healthy.

Pre Term Birth

On another topic, our work to reduce the prevalence of pre term birth, over decades, has involved scientists, researchers and public health officials from throughout the Department.

We have made progress in our efforts to find the causes of preterm birth and the means to prevent it.

BUT, the rate of preterm birth has increased 18 percent since 1990 – YES 18 percent since 1990. That’s the wrong direction folks.

Approximately one-half of preterm births occur in women with no known risk factors, and today no screening tests exist to accurately identify women who will deliver preterm.

Plainly, much more needs to be done.

Mothers and fathers should routinely receive information on how to maintain a healthy lifestyle and prevent the incidences of preterm birth.

Mothers should be made aware of complications associated with stress, poor prenatal care, smoking, and drug use during pregnancy and the importance of having a strong social support network.

The initiatives I’ve just described seek improved health outcomes; they reflect evidence-based medical and scientific knowledge; and they require support and leadership at national, state, and local levels to be successful.

I see similar leadership in these and so many other areas across the Commissioned Corps.

Exemplary, if unsung, leaders fill your ranks. 

Our health diplomacy efforts are another example of this excellence

• Last spring, 21 officers participated in the USS BOXER’s two-month mission to Latin and South America;
• 45 officers served aboard the USNS MERCY that visited six Pacific Rim countries; and  
• More than 36 officers traveled to seven Latin American and Caribbean countries with the USS KEARSARGE.

Are any of last years health diplomacy officers with us today? Can you stand a minute?

We’ve already launched the 2009 health diplomacy year and I encourage you to contact our Office of Force Readiness and Deployment to learn how to extend your skills and expertise through these global outreach missions.

Commander Sheila Merriweather, who is on her way here, answered this call to service and recently served aboard the Continuing Promise. CDR Merriweather used her background and expertise to design a rapid needs assessment to improve the quality of services provided to the residents of Antigua.  Her creativity garnered the attention from the SOUTHCOM Surgeon’s General’s office and the tool was adapted for use in a special project aboard the ship.  Sheila gave selflessly of herself during her experience. She spoke about sensitive health issues on radio programs, went ashore 80% of the working days, and served as an exceptional ambassador of the Corps through her professionalism, compassion, and creativity.

Here at home we continue to transform the Commissioned Corps. The past year has seen unprecedented growth in our ranks, skills, and readiness. 

- 650 new officers; and

- 800 officers in locations around the world

- Almost 90% of officers stand ready and trained to respond to emergencies. I am so proud of this number, and so proud of our OFRD team that continues to improve our readiness.

We’ve continued to partner with our sister military branches to leverage our support for health.

Army psychologist and Commander Stacey Williams, joined PHS and now works at Bethesda Naval Medical Center. CDR Williams sees the children of active-duty service members, many of whom miss school because of symptoms like stomach aches. When physicians can't find anything physically wrong, they call her. She's found that many of these children internalize the stress of moving to new bases or a parent's deployment to Iraq or Afghanistan, and just simply learn not to complain.  Today CDR Williams offers cutting edge family therapy and teaches relaxation techniques and biofeedback.  

We are improving how we support Commissioned Officers like Commander Williams and others in their service through implementing initiatives and systems to support Corps Transformation.  The Officer Profile Initiative, Direct Access and the transformed billet system, career tracks and new functional groups will allow the Corps to identify the right officer at the right time for the right position. 

These merged systems will become the billet based force management system for which the many have long advocated

As you have always done when called upon, Corps officers step away from daily assignments, leave families and loved ones, to answer the call of duty, put yourselves on the front lines and serve during public health emergencies and important national events.

Events like the recent, historic Presidential Inauguration and the State of the Union Address.

Like the recent floods in North Dakota that nearly overwhelmed residents there.

We continue to work side by side with civilian counterparts. The Medical Reserve Corps is helping communities develop capacity to improve health and build resiliency for the future. Corps officers serve with civilians in community health centers- helping to deliver primary and preventive care to more than 16 million people.

Because of the strong work of our MRC team, I fully expect this great program to continue and be strengthened in this administration.

Defining the Future

The Corps has been in the business of protecting public health and safety for more than 200 years.

The Nation’s public health system continues to evolve.

I have equally little doubt that - just as the public health system will face large and formidable challenges and change - the Commissioned Corps will continue to transform.

We as a nation can look forward to health reform, an ever-greater emphasis on prevention, and the movement toward a culture of wellness in communities everywhere. 

And we will expand and strengthen the reach and impact of our mission, increase our diversity, and continue to improve how we respond to public health emergencies.

We are in the middle of an historic transition in American government under President Obama.

We’ve already seen unprecedented new investments in community health centers, workforce training, cutting edge science and improved regulation.

Large segments of public health policy are likely to be reconceived.

Our economic challenges on top of the reform of our healthcare system mean that many of our roles could be changing.

The end result will be measured by healthier, longer, more productive lives for Americans today and for our youth - the public health workforce of tomorrow.

Before I close I want to thank one last group- and that’s my dedicated focused support team in the Office of the Surgeon General. Could RADMS Williams and Romano, LTs Bonome, Jones, and Bowens and all the staff from all the OSG offices please rise a second? I could not do it without you. Let’s give these folks a round of applause.

In closing….

As a Corps we stand at a crossroads – we must seize the new opportunities that are presented to us in the next few years.

We have new leadership across the department. Show them our strength. Show them our skill. Show them our flexibility to adapt and thrive on challenges.

On a personal note, you have shown me during the last 18 months what it’s like to have a family of 6300 uniformed officers. And we haven’t needed family therapy. Despite many uncertainties about my tenure, you have supported me as we have increased our size, improved our management systems, increased our visibility – not by far enough of course – and made important strides on public health issues.  Thanks to all of you.

Our Congress gave the Commissioned Corps an unprecedented 10 million dollar budget increase this year for IT infrastructure projects, officer training, and preparedness.…..

This does not happen without many people supporting our leadership and direction and it’s because of you – all of you – THANKS TO YOU!

For Your service, your friendship, and the hope and inspiration you provide me and thousands of others each and every day I am very grateful.

Thank you very much and have a great week.

The last thing I want to do is introduce our next speaker, Dr. Richard Besser. As you know, Dr. Besser is the Acting CDC Director and ATSDR Administrator.

Richard Besser, MD, and I were our appointed to our transition jobs on that same cold 22^nd of January.  He began his career at CDC in the Epidemic Intelligence Service working on the epidemiology of food–borne diseases. He has served as the epidemiology section chief in the Respiratory Diseases Branch, acting chief of the Meningitis and Special Pathogens Branch in the National Center for Infectious Disease.

Doctor Besser received his bachelor of arts degree in economics from Williams College in Williamstown, Massachusetts, and his medical degree from the University of Pennsylvania. He completed a residency and a chief residency in pediatrics at Johns Hopkins University Hospital in Baltimore, Maryland. He has authored and co–authored more than 100 presentations, abstracts, chapters, editorials, and publications and has received many awards for his work in public health and his volunteer service.

But before he starts speaking I want to ask him to come stand next to me here – despite the fact it makes me look like a midget – and surprise him by adding to his awards, a very special one,

the Surgeon General Medallion

I am awarding this to you Rich for your:

“Exemplary leadership, critical competence, and extraordinary composure during the start of the 2009 H1N1 influenza outbreak.”

Thank you from the Corps and from the American People

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