Keynote Address
Speakers: Surgeon General Dr. Joycelyn Elders (click here for biography)
Soap Summit 1

Transcript of Proceedings
October 21, 1994

DR. ELDERS: I want to thank you for giving up your time to be here. This is very important to us. I know that the things you are doing and you are about have been important for a long time, because six years ago, in 1986, when I became a health director in Arkansas, the evening news announcer was talking about things and I was out there talking about teenage pregnancy and I will never forget how he said something to me that probably is the reason I'm here today. What he said is, "Doctor Elders, I'll reach more people in thirty seconds than you will in thirty years." Well you know that was really a little tough for me, but I accepted that. I thought about it, and I said, "Well, I need you to help me, then." And I want you to know it really made a difference in the problems of teenage pregnancy in Arkansas because we had one of the highest teenage pregnancies in the industrialized world and yet our teenage pregnancy has been dropping at a rate of about 8.6% a year for the past three years now. And we are very proud of that, because before, again as I said, we were at the second highest teenage pregnancy rate in the industrialized world.

I bring that up just to say that the United States has one of the highest teenage pregnancy rates in the industrialized world, and that is a real major problem. Because that particular problem helps to produce an increase of poverty. You see, poverty...we wonder why poverty is increasing in this country, and we've seen it go from 1 in 7 children being poor, to now its 1 in 4. It's 22.5%. And if they are minority children, its 49.6% that are poor. And it directly tracks the children being born into poverty. The major health problem that is really affecting our country, and certainly the black popu-lation, is the problem of teenage pregnancy -- children becoming parents before they become adults. We are all well aware now that 62% of the children born to black families are to single parents ...20 +% of white children, 30% for our society. All of those are real issues that really impact our society.

We know now that 6.7 out of 10 black teenagers will have a pregnancy before the age of 20. 4 out of 10 white teenagers, a pregnancy before the age of 20. For more than one million teen pregnancies each year, 500,000 births, 435,000 abortions. We know that those are real issues, because when 57% of the children born in our society are unplanned pregnancies--that's a problem. Especially when we have the know-how, we have the resources, but we've not made the commitment to get it done. We know that our children are having sex. 88% of men up to the age of 19 have had engaged in sexual activity. 75% of young women by the age of 18 have had a sexual experience. We have more than 3 million teens every year who have a sexually transmitted disease, and we end up each year with AIDS, the HIV disease, increasing most rapidly in our adolescent population And with that many pregnancies, that much AIDS, we still in our society, deny that our children are engaging in sexual activity. And I think we've got to at least admit we've got a problem, because until we admit we've got a problem, we certainly won't do anything about it.

We know that our teenagers are getting younger by the time they engage in sexual activity. We know that we have a lot of sexual abuse. I think there have been several studies to show that 60+% of teens who become pregnant before the age of twenty have been sexually abused. And if they're less than 14 when they become pregnant, they were usually abused by somebody in their own home. Before I first became health director, I'd been a laboratory researcher, and I was going around viewing the health clinics. There was a thirteen year old young woman who was pregnant. And I was asking her about the pregnancy and about what was going on and I'll never forget, she wouldn't tell. And then finally she started crying, and so I asked what was wrong, and she said, well, that it was her grandfather, and she said that he's using my eleven-year-old sister and my eight-year-old sister too. We talked with the mother about this problem and her response was that well, she didn't think that was so bad. He did the same thing to her. Well I don't think that this only happened in Arkansas. I think that this is happening throughout our society.

So the women lawyers in Arkansas start forming a group to get a law passed that any girl who had a pregnancy before the age of 14 had to be evaluated for sexual abuse. Well obviously we didn't get that passed, because the prosecutors said, "Well how do we know she's not lying?" How can you ask when you're 14 and pregnant? I'm just saying that we as a society have in many ways not lived up to our responsibilities to our children. We've not educated them. We've not wanted to teach comprehensive health education. We've said instead, Just tell them to say 'No.'" Well our children for the most part have been out in an ocean surrounded by the sharks of drugs, alcohol, homicide, suicide. And we've sat on the beach moralizing, telling them to "Just say 'No,'" moralizing from the pulpit, and drinking from our fountains of "Morally Right." I think it's time for our us all to get involved, and try to do the things we know we need to do to save the most valuable resource we'll ever have. Many of these children have had been forced, in fact 60+%, have had forced sexual activity. I have been very concerned about the realties that we must deal with in regard to our adolescents, to the viewers of your television shows, and to many of the parents who look at your shows, I want you to know that this is an issue of real major concern for them. And to me no issue is more central to the health and welfare of our nations adolescents than the problems related to teen sexuality and teen pregnancy. We know that something like 70+% of the young men that are in our prison systems were born to teenagers. So it infiltrates our entire society. And we may think, well, what do the prisons have to do...but if 70+% were born to teens, then we all understand that they didn't know how to par-ent. So they end up involved with drugs, involved with crime, and having other major problems. So no problem affects our nation more than the problem of teen sexuality. And I think it's a problem that I'm saying here tonight, that our country needs the help of the people in this room. Our children need the help of all of us. And in any small way that you can begin to do things to make a difference.

We all know that information and story lines are tools. And what I'm about, as your Surgeon General, is I talk about the problem. But they are the product of your work and I hope that we'll be able to use your products to begin to make a difference in the lives of bright young people and bright young women all across this country.

A study done recently by the Alan Guttmacher Institute showed that U.S. teenagers had a much higher rate of childbearing, abortion and pregnancy, but their sexuality was no different than many of the other industrialized nations. Well what's the problem? What happened? What they found is that other countries educated their young people. We've got to begin to find a way to social market that kind of information, and make it a part of your soaps and make it something that our young people, our families, can all deal with. And I think that's why we're here tonight. To see if we can make these same kinds of things happen in our country.

As you know many of your people live their whole lives vicariously through your soap operas. One of the other chilling things that's going on is how people are getting younger, and younger, and younger as they engage in sexual activity.

The other thing that I want to mention that we see happening in the violence. Sex and violence. And how this impacts also on our young people and on the young children that we see. I know you know how communicate the emotional turmoil every young person faces when sex becomes a real issue.

Imagine if we could communicate the lasting harm an adult can do to a young person, not only with assault, but also with indifference. At the table tonight a young person asked, "How did you go from poverty to where you are?" I said, "You have to remember. I had two nurturing parents, I had two sets of grand parents. I had thirteen aunts and uncles on one side, seventeen on the other." I realize I shouldn't be saying that at a conference like this, but (laughter) I'll have to tell you that we had a lot of nurturing going on. And we didn't know, you know as young children, we didn't really know that we were poor. I'm just saying absolute neglect and emotional deprivation is the very worst kind of deprivation that we can see.

Imagine if we could reach our young males with the messages about male responsibility. About young men assuming their place in society, and about young men being important in the lives of children. Let me talk for a minute about these young men. The fact that we do not know or under-stand much about the role of males on this issue, not only on TV, but we don't see it, I often say that we are eating up our seed corn. Our young black men, about only 1 out of 5 will ever grow up and make enough money to make a family...to support a family. 2 out of 5 will be lost to drugs and alcohol. 1 out of 5 will be lost to black on black crime. And one out of the five will be in prison. In this state, 30% of the young black men are in prison, or on parole, or on probation. And only 18% of them are in college. That's a real problem for me, because that means that we are about to lose a whole generation of young black men.

And I've already told you the number of children born to single women. We know that the children that are born into single-family households have five things to look forward to: To be hungry, home-less, helpless, hugless, and hopeless. We've got to change that so we can begin to save an important society of our young people. Imagine if you could communicate the reality of teen parenthood. The joy, the drudgery, the responsibility for a lifetime, the fact that babies don't disappear after twelve months and come back in ten years. Imagine that we can communicate the positive side of young people's lives. That so many of them do survive these threats and come out unscathed. That all of them will have a future. We simply do not provide young people with the kind of information hat allow them to have control over their reproductive lives, and we've not shown them, both young men and young women, that we have faith in their ability to take on that responsibility. Every time we talk about teaching comprehensive health education in schools from kindergarten through twelfth grade people start telling us, "Well, if you tell them about it, they'll do it." Well they're already doing it, so why don't we teach them to be responsible, and make good choices and good decisions. They often tell me, "Well Dr. Elders, let the parents do it." The parents can't do it. They don't know how. We didn't teach them. Then we say, "Let the church do it." 52% of the children are unchurched. They don't go to anybody's church. So we have got to use the only institution we have in our societies, either our schools, or our mass media, to make a difference. The health secretary of Australia and I were talking about AIDS and teen pregnancy. She said, "Well, that's not a problem in our society." And I said, "Well, why? How did you do it?" I guess the government has control of their mass media. They used the media to educate. They just went out and put it on and educated their population. If we had spent as much time educating America about AIDS as we spent talking about and showing O.J. Simpson, Americans would be a lot better educated today than they are right now.

(Applause.)

We know that our American youngsters have 15,000 hours of television from kindergarten through twelfth grade. They only get 11,000 hours of reading, writing and arithmetic. You know that you're a powerful influence. The younger they are, the poorer they are, the more likely the television set is going to be the babysitter, and so we've got to begin. We need some help to be able to influence these bright young people in positive ways if we don't want to continue to build bigger, better prisons to try and make a difference.

A study of almost 400 junior high school students found that those who watched a greater amount of sexy television were more likely to be sexually active. I think that most of us would believe that, but then, again, we've got to find things that we can influence them positively, if we are going to make a difference. I tell people all the time that we use sex for everything from selling houses to toothpaste, or toothpaste--houses. So I'm saying we need to start using it to influence the behaviors of our bright young people.

I won't say anything about women's health because I think you're going to hear a lot about that. So let me talk about some of the challenges that are before us. We need to change from a market saturated with the glamour of sex, to one saturated with the necessary precautions, responsibilities and understanding from such experiences. The Stanford Population Options reviewed how they felt the challenges and how they felt that television influenced sexual behaviors, and some of the things that they felt represented responsible portrayals of sex in the media. One, we need to recognize that sex is a natural and healthy part of life. We're born sexual. You know, they don't suddenly turn fifteen and we take them in the room and we sit them down and we have that great talk. Because we know that they can give us that great talk by then. We've got to encourage parent-child discussions about sex. We need to show, you could help us show, consequences of unprotected sex. We know now we see far more shows where we have unmarried people going to bed, than married people. For married people to go to bed, you know nobody's that influenced by that behavior. We show that not all relationships result in sex. And of course you know we show everything on TV. We should be able to talk and put the use of condoms on TV. It should be a natural thing now with all of the AIDS and other diseases that violence and not one of passion. And we should recognize, respect and show the ability to say know. People say, "Well, just tell them to say, 'No.'" You can't just say "No." The banks don't pick their loan officer off the street and send them up to the fifteenth floor and say "Just say No." They very carefully teach them how to say "No."

Finally, I really want to plead for us to do three things. I think we need to offer our viewers more reality, not less. Reality means consequences, limited resources, parents without time. And patients, doctors without answers. There's a real drama in these consequences. There's also limits.

Second, we need to let our goals not only be to inform our viewers to the potential consequences of their behavior, but also to portray behaviors that they can emulate and overcome and avoid these consequences. Give them characters who face real-life challenges with dignity and clear-headedness. And I've heard about the things that went on in India and I was totally impressed. Even I felt and could understand how this could really make a difference.

Third, please recognize that for our young people that the threats to their health are very inter-related. That they could die. And we must always remember that our key prevention tool, and our key messages you bring to them, must be one and the same. We've got to be consistent. I really feel that you're here because you care. You care enough to give up your evenings. You care enough to say I'm no longer just concerned about this problem, I'm committed. There's a great big difference between being concerned and being committed. When you're committed you give up your time, your talent and your resources. You care enough that you want to come in and meet with the experts and become more aware of this problem. And not just be more aware, but also to become advocates for this problem, and develop an action plan. People asked me this evening, "Well, are you going to have some rules and regulations?" No, I'm not. I don't know anything about any rules and regulations. I feel that I'm here to learn. We are all hear to learn so we can develop an action plan that will make a difference for the bright young people of the future. You care enough that you are willing to reach out and be responsible. And you care enough that you are willing to use your wonderful, powerful product to begin to educate our society, so that we can empower women to make important decisions about their own health. And that's why I'm here. And I hope that we use the products you produce. To try and make for a healthier America. Thank you very much.

(Applause)