Keynote Address
Speaker: Dr. David Satcher (click here for biography)
Primetime Summit 1

Transcript of Proceedings
June 4, 1999

SONNY FOX: Dr. Satcher is the Surgeon General and the Assistant Secretary For Public Health. He's only the second Surgeon General in the history of Surgeons General who has borne both titles. The first was Dr. Julius Richmond in the 1970s. Dr. Satcher is the 16th in the line of Surgeon Generals, going back to 1872. The Public Health Service is a commissioned, uniformed service. Dr. Satcher's rank is that of a four stripe admiral. He has special responsibilities for the Public Health Service office of Population Affairs, Minority, Health, Women's Health, the President's Council On Physical Fitness, the office of Research Integrity, the office of Emergency Preparedness, the office of HIV/AIDS Policy, the office of International And Refugee Health, the office of Disease Prevention And Health Promotion, and the office of Military Liaison And Veterans' Affairs.

Dr. Satcher was the Director of the Centers For Disease Control And Prevention in Atlanta. He is a spokesperson, making us aware and helping us cope with many of the issues that we're all facing, including violence, which is viewed by Dr. Satcher's office as a public health issue. I am delighted that he has chosen to be with us tonight. It is my pleasure to introduce the Surgeon General Of The United States, Dr. David Satcher.

DR. SATCHER: Thank you very much, Sonny, for that very kind introduction, and I'm delighted to be here and to see all of you distinguished people. Let me begin by, by bringing you greetings from, from Washington, especially the Department Of Health And Human Service, and the office of the Surgeon General. I want to commend the Population Communication International for hosting this Prime Time Summit and for your ongoing efforts to foster dialogue and to promote responsible and safe television.

And some of you probably remember that it's been about three years since Secretary Donna Shalala spoke to this group. In her speech, she said she did not come to preach, and neither did she come to say that nothing needed to change. Rather, she challenged you to take a larger role in a great national drama, to improve the health and lives of all of our citizens. She challenged you to think about the responsibility each of you has to public health, and the need to show the consequences of risky and unhealthy behavior. And she offered ways that our Department Of Health And Human Services could help by providing you with timely and accurate data on relevant health and social issues. Like a good soap opera, I want to pick up where she left off. We feel very strongly about the opportunity to work with you in the interest of the public health. We believe that among other things, you are the storytellers. Stories have always been important, and no matter what the tradition or the culture, stories have set the stage for how society would be defined. Aside from simply being entertaining, stories also have helped to define the traditions, the roles, and the morals of our community. People have depended upon them to help them to understand how to build communities. I think a major challenge which we face in this country today is a challenge of building communities. But also, storytellers have had a revered place in the community as the keeper of the message. Storytellers have had responsibility to maintain and uphold the tradition, through application, accuracy, and relevancy. You here tonight serve as our storytellers, whether it's a drama or a prime time sitcom, or saga. And as a storyteller, the deliverer of the message, you still hold that revered place in society and that awesome responsibility to help us build community through the stories that you tell. I'll share a brief story with you. It's about Mrs. Young's eighth grade science class in Anniston, Alabama where I grew up. When it was announced in 1993 that I had been selected to head the Centers For Disease Control And Prevention, I received letters from people all over the country. Some of them I knew, some of them I didn't, congratulating me for this appointment. I was busy travelling as president of a medical college, and the letters just kept coming. I remember one evening, I returned home and I was exhausted, and my wife, Nola, who is here, said "Honey, you have 50 letters here that you need to read." And I said I don't want to see another letter. She said, "But these letters are special." And it turned out that they were. They were from Mrs. Young's eighth grade science class.

When it was announced that I had been selected as director of CDC, there was a rookie reporter in Anniston who had been there only a short period of time, was not impressed with Anniston, didn't want to be there, and was really surprised to hear that somebody from Anniston had been selected to head CDC. So he decided to go out and study my background. He met with everybody he could find who knew me. He met with my sister, my brother, my high school chemistry teacher. And then he wrote this story about my growing up in Anniston.

He wrote the story about how at the age of two, I had almost died of whooping cough and pneumonia, and how out of that experience I decided that I wanted to be a physician. He wrote about my growing up on a farm, and the fact that neither of my parents finished elementary school, and that we had neither electricity or running water. He wrote in great detail about our struggles and our triumphs. And when he finished writing, his story appeared on the first page, the front page of the Anniston Star.

Mrs. Young was, was struggling to get her students interested in science, and she decided that she was going to take a week and have them to read this story. And she did. And at the end of the week, she said I want you to write Dr. Satcher and congratulate him, and, and invite him to visit. And these were the letters that were waiting for me that night. Just to give you a couple of samples, one young man wrote and said, "Dear Dr. Satcher, I decided a few weeks ago to get in a gang because, you know, I have arrived at the age when that's the thing to do. But after reading your story and how you were successful, I decided to get out of that gang, because if you could be successful then so could I." A young lady wrote and said, "Dear Dr. Satcher, I've always been a good student, but I've had trouble deciding just what I wanted to do with my life. And she says, now I know, I'm going to be director of the CDC." But then there was another young man who, who reminded me a little bit of myself when I was in middle school. It was obvious that he was not paying attention when the teacher was talking. So he wrote and he said, "Dear Dr. Satcher, I want to commend you for this great honor which has been bestowed upon you, and now l just hope you can find a cure for the CDC."

Well, I know we can never take anything for granted in terms of our communication, and I know that you can't. My earliest experience with television in fact came late, because I grew up with battery operated radios. But it was about the time of the Civil Rights Movement and some of you remember the Montgomery bus boycott, and Dr. King's leadership.

I must say that if it had not been for the media, I don't think Dr. King would have been successful. Had it not been for the media bringing the six o'clock news about the dogs, and the water hoses, I don't believe we would have had a Civil Rights Act or Voting Rights Act. So the media was really critical to the success of the civil rights movement. And I've always remembered that and valued that in terms of the difference that the media can make.

I also remember the story of the young African-American actress whose role as Lieutenant Uhura, a member of the famed crew of Star Trek, the Starship Enterprise played such a very important role, and an unusual role for blacks at that time in terms of television. At one point, she was thinking of quitting the show, and she had a chance meeting with Dr. King who changed her mind. There was a young child who was watching that show, and who loved Star Trek.

And because of the role that was played by Nichele Nichols had, she decided that she just wanted to be an actress like Nichele Nichols. And later on she became one. Her name was Whoopi Goldberg. Television can have a tremendous impact on our lives. I'm sure there are countless other stories reflecting how Hollywood has changed attitudes and given hope to hopeless situation. But we need more. And I'm here tonight, because I believe that public health is all of our business. And I believe that a little hope can go a long ways in turning things around.

So I come here to solicit your input and your feedback. You know that I've been asked to prepare a Surgeon General's Report on youth violence, and I plan to do that. I want that process to be as transparent as possible, and I certainly want your involvement. But I'm here tonight to point fingers. I know that people have been saying that we should not point fingers, but I'm here to point fingers. Not just fingers of blame, but fingers of responsibility and fingers of opportunity which we have to work together.

We cannot be lulled into thinking that the recent tragedy of Littleton, Colorado is an anomaly. It is, in fact, reflective of a larger, persistent problem we face in this country. While it is truly a tragedy that 12 children and an adult were killed and the two assassins killed themselves at Columbine High School, the fact is that violence claims the lives of that many children virtually everyday in communities throughout this country. Violence has acquired a unique American flavor.

When you compare youth violence in the United States to that of other, we are off the chart. In 1996, when 15 children died in Japan from firearms, 30 died in Britain, 105 in Canada, there were 9,500 gun deaths in our country. Comparatively speaking, America is an unsafe place for children. It is human nature to put distance between ourselves and the perpetrators of horrendous acts. That has certainly taken place in the area of youth violence.

When eight year old Yami Sanders was killed by gang members in Chicago a few years ago, the media was full of reports about the violent pathology of black families. When shootings took place at schools in Jonesboro, Arkansas, Paducah, Kentucky, and Pearl, one of leading news anchors decried the violence culture of the South. But then something happened. A shooting in an idyllic suburbs in Colorado, a place where this was never supposed to happen. Suddenly, the distances didn't work, the stereotypes didn't apply.

Suddenly, people began thinking maybe this isn't just about them, whomever they are. Maybe it's about us and our communities. Maybe it's time to look at our communities and to see how we can prevent such things from happening. But today, violence is the second leading cause of death among persons in this country between the ages of 15 and 24. And for African-Americans and Hispanics, it is the leading cause of death.

When we hear reports like that, nobody can escape the aim of finger pointing. This is not a no-fault circumstance that we are experiencing. It must be viewed as everyone's responsibility if we are to rectify it. Yes, together we must limit access to weapons of violence, there is no question about it. And it's not about the right to bear arms, it's about the right of parents to send their children to school without worrying about them being shot. It's about the right of parents to send their children out to play without worrying that a child will have a gun on the playground.

We must limit access to weapons for children and for criminals. We must reduce the gratuitous violent content of television, movies, and video games while improving their content. And we must strengthen the role of parents and mentors in helping children to deal with anger, and resolve conflict, and to have empathy with others. So how can you help? First, we know that your role is to entertain. But we believe that you can entertain as well as educate, as many of you have demonstrated.

As director of the CDC, I appreciated the opportunity to work on ER in helping to bring to America the true face of HIV/AIDS. And more recently as Surgeon General, to work with ER in Hepatitis C. And I know you will hear something tomorrow from Dr. Ostroff about that. Like HIV/AIDS and Hepatitis C, violence is a public health problem. Violence is preventable. And while we know that violence is entertaining, we also believe that it is important to point out that violence has consequences.

Those consequences are real and lasting for the victims, for the perpetrators, and certainly for the people who work in the Criminal Justice system. We see those consequences everyday in the health care system, not only in the form of death, but also in the form of unnecessary pain and suffering, chronic disabilities, and chronic dependency. So we want to work with you in educating the American public about these consequences and the preventable nature of them. We want to help to, you to show the American people that violence is learned and that violence can be unlearned.

We must work together to implement the public health agenda. President Clinton recently responded to this as you know by asking that there be a Surgeon General's report on Youth Violence. And there will be, but I want to point out that this will not be the first Surgeon General's report on violence. In 1972, a panel of experts put together a report to the Surgeon General demonstrating the impact that television violence has on children. They found for many studies that some children imitate the violence they see, and some may even be provoked to violence.

And while not all children respond the same way to violence, there are some that do respond in violent ways. We have difficulty distinguishing among those children. I also want to agree with the 1985 workshop report by Surgeon General Koop which concluded that it is time to reduce the violent content of our television shows and movies as well as youth access to violence. As we work on this latest report I hope that we can work together. Now, violence is not the only public health problem with which I need your help.

I know you think I just came here to talk about violence, so let me just take a few minutes and say that there are other very important public health problems that I hope we can join together in seeking to ameliorate. We are trying to create a Balanced Community Health System, a system which emphasizes health promotion, disease prevention, early detection, and universal access to care. A Balanced Community Health System, which requires the participation of all of the institutions within our community, including the home, the school, the church, other faith-based organizations, criminal justice, entertainment, not just the health care system.

Public health is everybody's business. There are several ways that you can help to jump start this effort. We know that a Balanced Community Health System cannot achieve it's goals unless we insure that every child, every child has the opportunity for a healthy start in life. And that means parents who are ready to be parents, and you've done such a great job in this arena. Safe pregnancies, access to quality pre-natal care, and safe and nurturing environments, the absence of domestic violence, which you will hear about tomorrow from Dr. Rosenberg, and the absence of environmental toxins.

But a Balanced Community Health System can also promote healthy lifestyles. Now, there have been 28 Surgeon General's reports on smoking and health since Dr. Terry's report in 1964. And we've made some progress among adults, reducing the percentage of smokers from nearly 50 percent in 1964 to about 25 percent today. However, we're moving in the wrong direction with our teenagers, and everyday in this country, everyday, 3,000 new children begin to smoke. Half of them will be addicted before they are 18 years of age, before they are legally old enough to purchase tobacco.

A third of them will die of some smoking-related illness. We would like to see a decrease in smoking in television programs and movies that is at least comparable to the reduction in smoking that we've seen since 1964, at least. And especially for children, we would like to see more emphasis on the consequences of smoking. 430,000 deaths per year in this country, 65,000 deaths from second hand smoking, 25,000 cases of asthma having an onset from smoking exposure to smoke, and thousands of deaths from Sudden Infant Death Syndrome related to smoking.

Childhood obesity is at an all time high in this country, it is at epidemic levels. Adult obesity is at an all time high. We can prevent 50 percent of deaths from cardiovascular disease through a combination of physical activity and good nutrition. We can prevent the onset, a third of Type Two Diabetes through a combination of physical activity and good nutrition. And yet we spend 1.5 trillion dollars a year in the health care system in this country, most of it to treat diseases in their later stages, including complications of diseases that we can prevent. So we need your help in terms of lifestyle.

The third point is to avoid toxins such as tobacco, illicit drugs, and the abuse of alcohol. And finally, responsible sexual behavior. Obviously, your business is not public health, but human behavior has consequences. We hope that working together we can demonstrate the consequences, but also the positive consequences of healthy lifestyles. I know that's asking a lot of you, but public health is all about business.

Let me close by mentioning mental health. A very important area where we would like to work together with you to destigmatize mental health. Mental health impacts every area of our lives in relationships. Mental health problems are as common as physical health problems, yet for too long in this country, our attitude toward them has been one of stigmatization and blame, instead of caring and support. And it's time for a change. There will be a White House Conference on mental health Monday, June seven, and I hope that all of you will, will tune into that.

And before the end of this year, there will be the first ever Surgeon General's report on mental health. But in the area of mental health the area of destigmatization and the challenge to destigmatize mental health problems, there's one that we're really concerned about. Sometimes Hollywood depicts people with mental illness as wacky or zany and amusing, like Jack Nicholson's character in One Flew Over The Cuckoo's Nest. Sometimes it portrays them as violent, threatening and menacing, such as Nicholson's character in The Shining.

And then there's sometimes when they show people who are at neither extreme, but who function in society despite any obstacles posed by their illness, like Jack Nicholson in As Good As It Gets, for which he won the Academy Award. We want to help overcome the stereotypes and to help people realize that just as things go wrong with the heart, and the lungs, and the liver, and the kidneys, things go wrong with the brain, and there should be no shame in that. When that day comes, we will be identifying mental health problems much earlier, we will be preventing many of the consequences of them.

Let me just close by saying that we look forward to working with you. We know that public health is not easy, and we face tremendous challenges improving the health of all people in this country. And it always reminds me of a saying that became one of my favorites when I was a student at Moorhouse College. Like me, a lot of the students there were from backgrounds in which they were not expected to be there. And yet, every Tuesday morning, the president, Benjamin Elijah Mays, would come to chapel to speak to these students.

And there are several quotes that I remember. I will share one of them with you, it goes something like this. It must be borne in mind that the great tragedy of life is not in failing to reach all of your goals, it is in having no goals for which you are reaching. It is not a calamity to die with dreams unfulfilled, but it's a calamity not to dream. It's not a disaster if you fail to achieve your highest ideas, but it's a disaster if you have no high ideas for which you are striving. It's not a disgrace to fail to reach the stars, but it is a disgrace to have no stars for which you are reaching. So I close by saying to you together, let us not be guilty of low aim. Thank you.