KEYNOTE AND WELCOME

BY

       C. EVERETT KOOP, MD
DEPUTY ASSISTANT SECRETARY FOR HEALTH
       AND SURGEON GENERAL
US, DEPARTMENT OF HEALTH AND HUMAN SERVICES

PRESENTED TO THE NATIONAL MENTAL RETARDATION
    PREVENTION SHOWCASE AND FORUM
        ATLANTA, GEORGIA

SEPTEMBER 15, 1982


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(GREETINGS TO HOSTS, GUESTS, ETC.1

  THE PROGRAM FOR THE INTERNATIONAL SUMMIT AND FOR THIS NATIONAL
SHOWCASE AND FORUM GIVE AMPLE TESTIMONY TO OUR CONTINUED COMMITMENT TO
LEARN MORE ABOUT MENTAL RETARDATION AND, TO THE EXTENT POSSIBLE, PRE-
VENT ITS OCCURRENCE. SINCE THE LAST SUMMIT, SOME FIVE YEARS AGO, THE
RESEARCH COMMUNITY AND THE HEALTH CARE AND SOCIAL SERVICES COMMUNITY
HAVE MADE TREMENDOUS STRIDES IN EXPANDING OUR KNOWLEDGE BASE AND IN
EXTENDING OUR RANGE OF SERVICE OPTIONS,

  I THINK WE ARE DOING A MUCH BETTER JOB THAN EVER BEFORE IN
RESEARCH AND IN PROVIDING ASSISTANCE TO THE MENTALLY RETARDED AND
THEIR FAMILIES. WE HAVE EVERY REASON TO BE HOPEFUL AND TO BE
OPTIMISTIC.e,BUT WITH A TOUCH OF CAUTION NEVERTHELESS.

  MENTAL RETARDATION STILL POSES MORE QUESTIONS THAN WE HAVE

ANSWERS,  ITS BASIC MECHANISMS ARE STILL WRAPPED IN MYSTERY, AND AS
WE CONTINUE TO PROBE, WE ARE SOMETIMES OVERWHELMED BY THE IMPLICATIONS
OF THE FIELD OF STUDY BEFORE US.   THIS SINGLE AREA OF RESEARCH AND
STUDY CAN REVEAL SO MUCH TO US OF THE NATURE OF THE HUMAN CONDITION --
THE COMPLEXITY...AND THE JOYwAND THE BURDEN,

  THINKING ABOUT THIS ASPECT OF OUR WORK, I WAS REMINDED OF THE
REMARK BY THE PHILOSOPHER WILLIAM JAMES, HE TRIED TO SEARCH BEYOND
THE BRIGHT FACE THAT MOST PEOPLE PRESENT TO THE WORLD, JAMES FELT
THAT "IN THE DEEPEST HEART OF ALL OF US THERE IS A CORN& IN WHICH THE
ULTIMATE MYSTERY OF THINGS WORKS SADLY,"


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  FOR CENTURIES, WHEN CONFRONTED BY MENTAL RETARDATION, PEOPLE HAVE

BEEN PUZZLED, FRUSTRATED, AND SADDENED, GRADUALLY, OVER TIME, THOSE

FEELINGS HAVE BEEN CHANGING. TODAY, EVEN THOUGH WE STILL HAVE MUCH TO

LEARN ABOUT ABOUT MENTAL RETARDATION, WE ARE FAR MORE UNDERSTANDING

AND ACCEPTING OF THE MENTALLY RETARDED, WHAT'S MORE, WE NOW THINK IN

TERMS OF THEIR INTEGRATION INTO THE NORMAL LIFE OF OUR SOCIETY,

  FROM MY READING OF THE PROCEEDINGS OF THE FIRST INTERNATIONAL

SUMMIT, I THINK THIS FEELING WAS EVIDENT IN 1977, IT IS CERTAINLY

WITH US TODAY. IT IS ALSO EVIDENT IN THE WAY THE PRESIDENT'S

COMMITTEE ON MENTAL RETARDATION APPROACHED ITS 1981 ANNUAL REPORT TO

THE PRESIDENT, I LIKE THE POSITIVE, WELL-DOCUMENTED CASE MADE IN THAT

REPORT FOR GREATER INTEGRATION OF MENTALLY RETARDED PERSONS INTO THE

AMERICAN WORKFORCE. AS SECRETARY SCHWEIKER SAYS, "GIVEN TRAINING AND

EMPLOYMENT, RETARDED CITIZENS, ONCE THOUGHT OF AS BEING DEPENDENT FOR

LIFE, CAN REACH INCREASED LEVELS OF SOCIAL AND ECONOMIC INDEPENDENCE,

WHICH MAY EQUAL THOSE OF AVERAGE CITIZENS,"

  THE 1981 REPORT OF THE P,C,M,R, IS ONE EXAMPLE OF OUR COMMITMENT

TO BRING MORE OF OUR MENTALLY RETARDED CITIZENS INTO THE MAINSTREAM OF

AMERICAN LIFE. FORTUNATELY IT IS NOT THE ONLY EXAMPLE, THIS THEME

CAN BE READ IN A VARIETY OF REPORTS OF WHAT GOVERNMENT HAS BEEN DOING

AS WELL AS WHAT IT HOPES TO GET DONE.  JUST SUCH A DOCUMENT THAT

POINTS TO THE FUTURE IS THE FIVE-YEAR RESEARCH PLAN FOR THE NATIONAL

INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT.


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  OF THE 15 RESEARCH GOALS FOR MENTAL RETARDATION IN THAT PLAN, FOUR

ARE DEDICATED TO "AMELIORATION AND REHABILITATION," WE HOPE THAT THE

NEW KNOWLEDGE DEVELOPED UNDER THIS HEADING SHOULD FURTHER ENABLE

RETARDED PERSONS TO MAKE "AN OPTIMAL ADJUSTMENT TO COMMUNITY LIFE," IN

THE WORDS OF THE NJ,C,H,Dn RESEARCH STEERING COMMITTEE.

  THOSE ARE VERY ENCOURAGING WORDS, THEY DEMONSTRATE THAT THE

MARRIAGE BETWEEN THE BIOMEDICAL AND THE BEHAVIORAL SCIENCES IS NOT

ONLY INTACT BUT IT IS BEING CONTINUALLY STRENGTHENED BY THE INSTITUTE,

ITS CONTRACTORS, AND ITS GRANTEES, GRANTED, THERE IS STILL MUCH THAT

WE NEED TO LEARN ABOUT DOWN SYNDROME AND THE "FRAGILE X" SYNDROME,

ABOUT CYTOGENETICS AND DEVELOPMENTAL NEUROLOGY, BUT A HUMAN BEING IS

MUCH MORE THAN JUST A "GENETIC AGGREGATE" OR A NETWORK OF INFORMATION

TRANSMISSION SYSTEMS,

  THE LATE DR, RENE DUBOS WROTE THAT "EACH HUMAN BEING IS UNIQUE,

UNPRECEDENTED, UNREPEATABLE,"  BUT DUBOS WAS EVEN MORE SPECIFIC, HE

SAID WE RECOGNIZED EACH UNIQUE HUMAN BEING "BY HIS VOICE, HIS FACIAL

EXPRESSIONS, AND THE WAY HE WALKS -- AND EVEN MORE BY HIS CREATIVE

RESPONSES TO SURROUNDINGS AND EVENTS," IN OTHER WORDS, PEOPLE DO

INTERACT WITH THEIR HUMAN AND PHYSICAL ENVIRONMENTS,,,AND THE WAY THEY

INTERACT TELLS US A GREAT DEAL ABOUT WHO THEY ARE,

  THIS LEVEL OF SENSITIVITY LIES MUCH CLOSER TO THE SOURCE OF THE

"MYSTERIES" WE PURSUE IN MEDICINE, WHAT DUBOS CALLS "THE SCIENCE OF
                                                                           . .
HUMAN LIFE," FORTUNATELY, OUR COLLEAGUES IN THE N, I,C .H,D': ARE AWARE


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OF THAT AND THE PRESIDENT'S COMMITTEE KNOWS IT, TOO, HOW IMPORTANT
THAT UNDERSTANDING IS FOR THE FUTURE,.,THE DECADES AHEAD,, ,WHEN
SOCIETY WILL GARNER THE BENEFITS OF TODAY'S RESEARCH AND DETECTION

SERVICES FOR THE MENTALLY RETARDED,

  I AM EMPHASIZING THE BIOBEHAVIORAL ASPECT OF RESEARCH AND SERVICE
BECAUSE THAT'S THE BASIS UPON WHICH A GREAT DEAL OF OUR PREVENTION
EFFORT IS MOUNTED. IT MORE CLOSELY REFLECTS THE TOTAL HUMAN EXPERI-

ENCE,   FOR EXAMPLE, IF WE IDENTIFY A LINK BETWEEN CERTAIN MATERNAL
NUTRITION DEFICITS AND THE APPEARANCE OF MENTAL RETARDATION IN OFF-
SPRING, HOW THEN DO WE CONVINCE PREGNANT WOMEN TO MAINTAIN A CERTAIN

NUTRITIONAL BALANCE IN THEIR DIET? AGAIN, AFTER WE IDENTIFY THE LINK
BETWEEN HERPES AND INJURY TO THE DEVELOPING FETUS, HOW DO WE BREAK THE

CHAIN OF HERPES TRANSMISSIONS AMONG POTENTIAL PARENTS?

  THESE QUESTIONS -- AND MANY OTHERS LIKE THEM -- PRESENT BOTH A
BIOMEDICAL AND THE BEHAVIORAL CHALLENGE TO THE PUBLIC HEALTH PRACTI-
TIONER, PARTICULARLY THOSE OF US CONCERNED WITH THE RETARDED,

  THE DEPARTMENT OF HEALTH AND HUMAN SERVICES, WITH THE STRONG
SUPPORT OF THE PRESIDENT, IS PURSUING THIS TYPE OF OVERALL PREVENTION
AND HEALTH PROMOTION STRATEGY, WHILE SOME ELEMENTS OF THE STRATEGY MAY
BE MORE APPROPRIATE FOR THE AGED OR FOR ADOLESCENTS, A NUMBER OF ELE-
MENTS DIRECTLY RELATE TO THE PREVENTION OF MENTAL RETARDATION OR TO
PREVENTING OR CONTROLLING THE STRESSES THAT MAY OCCUR AMONG A RETARDED

PERSON'S FAMILY,


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  IT IS NOT COMMON THESE DAYS TO FIND A GOVERNMENT PROGRAM THAT IS
NEW AND IS ALSO EXPANDING, YET, THAT IS THE NATURE OF THE COMMITMENT
THAT THE PREVENTION PROGRAM HAS IN OUR DEPARTMENT, AS YOU KNOW, THE
ESSENTIAL STRENGTH OF THE RESEARCH EFFORT IN THE PUBLIC HEALTH SERVICE
IS BEING MAINTAINED, THAT EFFORT, HOWEVER, ALSO INCLUDES THE DEVELOP-
MENT OF NEW KNOWLEDGE RELATED TO PREVENTION,

LET ME AMPLIFY THAT STATEMENT WITH THE FOLLOWING FEW NUMBERS:

0   THE RESEARCH BUDGET FOR THE NATIONAL INSTITUTES OF HEALTH IS
  PROJECTED TO RISE BY ABOUT $109 MILLION IN FISCAL 1983,
  PROVIDING CONTINUED STRONG SUPPORT FOR BIOMEDICAL AND SOME

   BEHAVIORAL RESEARCH.,,

0   THE RESEARCH BUDGET FOR THE ALCOHOL, DRUG ABUSE, AND MENTAL
  HEALTH ADMINISTRATION, WHERE MOST OF OUR BEHAVIORAL AND SOME
  OF OUR BIOMEDICAL RESEARCH IS CARRIED ON, IS PROJECTED TO
  RISE ABOUT $27 MILLION IN THE NEXT FISCAL YEAR,.,

0   BUT ALL RESEARCH, SERVICE, AND INFORMATION ACTIVITIES COMBINED
  THAT ARE RELATED TO THE PREVENTION INITIATIVE WILL RISE ABOUT
  $870 MILLION, A 4.5 PERCENT INCREASE OVER LAST YEAR -- AND
  THIS ALL COMES AT A TIME WHEN MOST FEDERAL ACTIVITIES ARE
  BEING HELD AT PRESENT LEVELS OR BEING TRIMMED TO LOWER,

   SMALLER LEVELS,


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THE CLEAR MESSAGE FROM THIS SHOULD BE THAT THE ADMINISTRATION IS TRULY

PUTTING ITS MONEY WHERE ITS RHETORIC IS,

  SECRETARY SCHWEIKER PROMISED THAT, UNDER HIS STEWARDSHIP OF OUR

DEPARTMENT, PREVENTION WOULD BE PUT AT THE VERY TOP OF THE FEDERAL

HEALTH AGENDA. AND HE'S DONE EXACTLY THAT, HE HAS ALSO INVITED THE

PRIVATE SECTOR -- NON-PROFIT AND PROFIT-MAKING ORGANIZATIONS ALIKE --

TO JOIN IN AND HELP.  AND THERE IS ALREADY A GROWING LIST OF PROFES-

SIONAL, VOLUNTARY, AND TRADE ASSOCIATIONS THAT ARE TAKING PART IN THIS

TRULY NATIONAL STRATEGY OF PREVENTION AND HEALTH PROMOTION,

  AS FOR MATERNAL AND CHILD HEALTH IN PARTICULAR, THE PUBLIC HEALTH

SERVICE IS ONE OF MORE THAN 50 NATIONAL ORGANIZATIONS WHO HAVE JOINED

TOGETHER IN A NATIONWIDE PROGRAM CALLED "HEALTHY MOTHERS, HEALTHY

BABIES."  THIS UNUSUAL COALITION IS FOLLOWING A SIX-POINT PROGRAM

EMPHASIZING PRENATAL CARE, GOOD NUTRITION, AND GOOD FOLLOW-THROUGH FOR

MEDICAL AND SOCIAL SERVICES AS MAY BE REQUIRED FOLLOWING DELIVERY.

  BY 1985, WITH THE HELP OF THE "HEALTHY MOTHERS, HEALTHY BABIES"

PROGRAM AND OTHER EFFORTS AROUND THE COUNTRY, WE HOPE TO ACHIEVE TWO

IMPORTANT GOALS,  I THINK THEY ARE OF SPECIAL IMPORTANCE TO THIS

MEETING.  THEY ARE,.,

9   ,,,TO INCREASE THE AWARENESS OF WOMEN OF CHILDBEARING AGE OF

THE RISKS TO PREGNANCY ASSOCIATED WITH SMOKING, INCLUDING THE RISKS
OF LOWER BIRTH WEIGHT, SPONTANEOUS ABORTION, AND FETALddH...


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9

  .,,AND TO INCREASE .THE PROPORTION OF WOMEN OF CHILDBEARING
AGE WHO ARE AWARE OF THE RISKS ASSOCIATED WITH PREGNANCY AND

DRINKING, IN PARTICULAR THE RISK OF DELIVERING A CHILD EXHIBITING

"FETAL ALCOHOL SYNDROME,"

  BUT SMOKING AND IMMODERATE DRINKING ARE NOT THE ONLY PREVENTABLE

AGENTS ADVERSELY AFFECTING A PREGNANCY. OTHER ENVIRONMENTAL FACTORS

MAY COME INTO PLAY AS WELL: TOXIC AGENTS IN THE HOME OR WORK PLACE,

LEAD LEVELS IN THE AIR, AND CERTAIN POTENTIAL CONTAMINANTS OF DRINKING

WATER ARE OTHERS,  INFECTIOUS DISEASES, INCLUDING THE WHOLE RANGE OF

SEXUALLY TRANSMITTED DISEASES, ARE OTHER FACTORS ACCIDENTS SUFFERED

BY THE PREGNANT WOMAN WHILE RIDING IN A CAR OR WHILE AT WORK -- OR ANY

SERIOUS PHYSICAL TRAUMA, FOR THAT MATTER -- MAY ALSO HAVE AN ADVERSE

EFFECT, CAUSING RETARDATION OF THE INFANT, AND THE RESEARCH IS CON-

TINUING REGARDING THE EFFECTS OF GENETIC FACTORS, PREMATURITY, FAMILY

POVERTY, AND METABOLIC DISORDERS,

  NOT ALL THESE CAN BE PREVENTED,  I WOULD GO EVEN FURTHER AND SAY
THAT PROBABLY NONE CAN BE PREVENTED BY THE GOVERNMENT, ALTHOUGH
FEDERAL ACTION MAY WELL EXERT A STRONG INFLUENCE ON OUTCOMES, I'M

THINKING, FOR EXAMPLE, OF THE GOVERNMENT INTEREST IN LEAD LEVELS IN
THE AIR, IN MAXIMUM SPEED LIMITS ON INTERSTATE HIGHWAYS, IN STOPPING

THE SPREAD OF INFECTIOUS DISEASES THROUGH MASS VACCINATION, OR IN

MONITORING THE WORKPLACE FOR THE PRESENCE OF TERATOGENIC SUBSTANCES,




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  THAT MAY BE TRUE. BUT THE PRIMARY FEDERAL ROLE IS IN THE SUPPORT
OF RESEARCH, AND IN THAT CASE, THE LEAD AGENCY WOULD APPEAR TO BE THE
NATIONAL INSTITUTE FOR CHILD HEALTH AND HUMAN DEVELOPMENT. IN JUST
FIVE DAYS THE N,I,C.H,D, WILL CELEBRATE ITS 20TH ANNIVERSARY, IN THE
COURSE OF ITS LIFE SO FAR, THE INSTITUTE HAS MADE MANY CONTRIBUTIONS
TO IMPROVE MATERNAL AND CHILD HEALTH IN GENERAL, AND SEVERAL SPECIFIC
CONTRIBUTIONS FOR THE DETECTION, CONTROL, OR PREVENTION OF MENTAL

RETARDATION,

  IT'S APPROPRIATE TO MENTION HERE, I BELIEVE, THE DEVELOPMENT BY
THE N,I,C,H,D. OF THE SIMPLE TEST IN THE NEWBORN FOR P.K.U., OR
PHENYLKETONURIA, THANKS TO THIS SIMPLE TEST, MENTAL RETARDATION
BROUGHT ON BY P.K.U, CAN NOW BE ROUTINELY PREVENTED THROUGH CAREFUL
DIET MANAGEMENT, RECENTLY, N.I,C.H,D, RESEARCHERS ALSO DEVELOPED A
SCREENING METHOD FOR CONGENITAL HYPOTHYROIDISM. NOW IT IS POSSIBLE TO
SCREEN FOR P.K.U. AND HYPOTHYROIDISM AT THE SAME TIME WITH THE SAME
DROP OF BLOOD, AT ONE TIME, THESE TWO CONDITIONS -- P,K,U, AND HYPO-
THYROIDISM -- COMBINED WERE THE CAUSE OF ABOUT 300 CASES EACH YEAR OF
MILD TO SEVERE MENTAL RETARDATION AMONG THE NEWBORN, BOTH CAUSES ARE

NOW PREVENTABLE AND TREATABLE,

IN THE PAST FEW MINUTES I THINK I'VE TOUCHED, DIRECTLY OR

INDIRECTLY, ON MOST OF THE MAJOR PREVENTION ACTIVITIES AVAILABLE TO US:

+   IMPROVED PRENATAL CARE,,.


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9   SPECIFIC ATTENTION TO THE SPECIAL NEEDS OF THE PREMATURE...

9   APPROPRIATE GENETIC COUNSELING,,.

9   IMMUNIZATION, ESPECIALLY RUBELLA,..

9   AND THE PREVENTION OF FETAL ALCOHOL SYNDROME,

I DID NOT MENTION -- BUT I AM AWARE OF -- THE NEED TO GUARD AGAINST
HEAD INJURIES TO CHILDREN, WHICH MEANS THE PREVENTION OR, AT LEAST,
THE REDUCTION OF ACCIDENTS, PLUS ADDITIONAL ATTENTION TO THE PROBLEM
OF CHILD ABUSE OR KERNICTERUS PREVENTION WITH IMMUNOGLOBULIN AFTER

APPROPRIATE TESTS FOR RH ANTIBODIES,

  ALTHOUGH THERE IS A WEALTH OF MATERIAL, ALREADY WIDELY PUBLISHED,
ON THE DETECTION AND IDENTIFICATION OF MENTAL RETARDATION AMONG THE
NEWBORN AND WHAT WE CAN DO ABOUT IT, THERE IS STILL VERY LITTLE IN THE
LITERATURE THAT DEALS WITH THE PROBLEMS OF PREVENTING OTHER KINDS OF
DISABILITIES AND DISEASES FROM ATTACKING THE MENTALLY RETARDED CHILD
OR ADULT, ADDED TO THIS IS THE FACT THAT WE STILL DO NOT FULLY
UNDERSTAND HOW THE RETARDED AND THEIR FAMILIES RESPOND TO ALL THE

USUAL LIFE-CYCLE EVENTS.

  IT'S POSSIBLE THAT, ALONG THE WAY, WE MAY HAVE BEEN GUILTY OF
COMPARTMENTALIZING OUR INTERESTS,.,OF MAINTAINING TOO NARROW AND TOO
RIGID A FOCUS ON THE PREVENTION OF MENTAL RETARDATION PER $Efep AS A
RESULT, WE KNOW VERY LITTLE ABOUT REDUCING THE RISKS AND HEALTH




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HAZARDS TO THE RETARDED PERSON WHO IS IN THE MIDST OF LIFE.  I THINK

WE MAY HAVE MISSED EXPLORING FURTHER THIS "SCIENCE OF HUMAN LIFE,"

ABOUT WHICH RENE DUBOS WROTE SO ELOQUENTLY.  IN THE NEXT FEW MINUTES

I'D LIKE TO TALK ABOUT THIS PARTICULAR ASPECT OF THE PREVENTION

CHALLENGEmA CHALLENGE THAT IS JUST BEGINNING TO TAKE SHAPE ON THE

RESEARCH HORIZON,

  A FEW MOMENTS AGO, I MENTIONED THAT ONE OF OUR MAIN GOALS SHOULD

CONTINUE TO BE THE INTEGRATION, TO THE EXTENT POSSIBLE, OF THE MENTALLY

RETARDED INTO THE MAINSTREAM OF AMERICAN LIFE,  I SAY "TO THE EXTENT

POSSIBLE" BECAUSE WE MUST ACKNOWLEDGE THE EXCEPTIONAL CHALLENGES PRE-

SENTED BY THE SEVERELY OR PROFOUNDLY RETARDED -- CHALLENGES WHICH HAVE

MORE TO DO WITH ELEMENTAL SURVIVAL THAN WITH SUCH ISSUES AS SOCIALIZA-

TION OR THE QUALITY OF LIFE,

  BUT, WITH JUST THAT ONE QUALIFICATION, WE NEED TO LOOK MORE CLOSELY
AT THE KINDS OF RISKS THAT INTEGRATION ITSELF MAY PRESENT TO THE MILDLY
RETARDED, THESE PERSONS ARE THE VAST MAJORITY, FORMING ABOUT 80
PERCENT OF THE RETARDED POPULATION, IT ALSO HAPPENS THAT A
DISPROPORTIONATE NUMBER IS FOUND AMONG POPULATIONS DISADVANTAGED BY
POVERTY OR GEOGRAPHY OR WHO HAVE BEEN VICTIMS OF RACIAL OR ETHNIC
DISCRIMINATION. NEVERTHELESS, I THINK WE CAN -- AND WE SHOULD --
BEGIN NOW TO BUILD A NEW STRATEGY -- WHAT I WOULD CALL A "SECOND

STRATEGY" -- OF PREVENTION THAT COULD BENEFIT RETARDED PERSONS AS THEY
BECOME INTEGRATED INTO THE WORLD OF WORK, INTO THE LIFE OF THE
FAMILIES THEY COME FROM, AND INTO THE LIVES OF THE FAMILIESTHAT THEY

THEMSELVES MAY CHOOSE TO FORM.


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  I ALSO THINK WE MIGHT REAP A KIND OF "BONUS" FROM THIS "SECOND

STRATEGY" OF PREVENTION AND HEALTH PROMOTION. THAT BONUS WOULD BE THE

POTENTIAL FOR REINFORCING A NUMBER OF IMPORTANT PREVENTION AND HEALTH

PROMOTION CONCEPTS AMONG THE PEOPLE WHO EMPLOY OR IN SOME WAY SUPPORT

THE RETARDED INDIVIDUAL. THEY, OF COURSE, ALSO REPRESENT A MUCH

LARGER POPULATION,

LET ME OFFER THIS EXAMPLE:

  WE KNOW THAT WEIGHT CONTROL IS IMPORTANT FOR THE RETARDED INDIVI-

DUAL, SINCE OBESITY CAN INTERFERE WITH WORK AND FAMILY LIFE AND

INCREASE THE RISK OF CARDIOVASCULAR DISEASE, BUT OBESITY IS AS MUCH A

HEALTH HAZARD TO THE PERSON WITH AN I,Q, OF LESS THAN 80 AS IT IS TO A
PERSON WITH AN IaQ. OF 80 OR ABOVE,  IF WE CAN DEVELOP NUTRITION PRO-

GRAMS THAT ARE EFFECTIVE FOR THE RETARDED, ESTABLISHING DIET ROUTINES

THEY WILL ACCEPT AND FOLLOW, I SHOULD IMAGINE THE RESULTS WOULD ALSO

INFLUENCE AND BENEFIT THE CARE-TAKERS AND EMPLOYERS...THE VERY PEOPLE

WHO WOULD RELAY THOSE PROGRAMS TO THE RETARDED,

  BUT I DON'T WISH TO DWELL ON THIS. IT WOULD BE, AS I INDICATED,

ONLY A BONUS, THE IMPORTANCE OF THIS "SECOND STRATEGY" IS QUITE

SIMPLY WHAT IT CAN DO FOR THE RETARDED PERSON ALONE, IN ADDITION TO

NUTRITION I BELIEVE WE NEED TO ADAPT OUR ENTIRE PREVENTION STRATEGY TO

MEET THE NEEDS OF THE RETARDED INDIVIDUALS AND THEIR FAMILIES WHEREVER

THAT CAN BE DONE:


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0   WE NEED TO EMPHASIZE DENTAL HEALTH, PHYSICAL FITNESS, AND

EXERCISE,. a

0   WE MUST BE VIGILANT REGARDING THE USE OF TOBACCO AND

ALCOHOL..,

0   WE MUST BE EQUALLY VIGILANT CONCERNING SEXUALLY TRANSMITTED

DISEASE,..

0   AND WE NEED TO WORK COOPERATIVELY WITH EMPLOYERS REGARDING

SAFETY IN THE WORKPLACE..

  I WILL ADMIT THAT THESE ARE EXTRAORDINARY CHALLENGES, FOR EXAMPLE,

ONE OF THE MOST COMMON TENDENCIES AMONG THE RETARDED IS THEIR INABILITY

TO IDENTIFY AND RESOLVE PROBLEMS, TO ORGANIZE INFORMATION IN A WAY THAT

ISOLATES AND RESPONDS TO A PARTICULAR PROBLEM, THE RETARDED ALSO HAVE

SERIOUS MEMORY DEFICITS, SHORTER ATTENTION SPANS, AND DIFFICULTY TRANS-

FERRING SKILLS AND BEHAVIORS FROM ONE ACTIVITY TO ANOTHER,

  YOU KNOW THESE THINGS, OF COURSE, BUT I AM RE-STATING THEM HERE

BECAUSE THEY ARE SKILLS THAT ARE DIRECTLY RELEVANT TO HEALTH PROMOTION

AND THE PREVENTION OF DISEASE AND DISABILITY. AND THAT'S WHY THE

CHALLENGE IS SO GREAT, NEVERTHELESS, I BELIEVE THAT IF WE COULD ACCOM-

PLISH THIS "SECOND STRATEGY" OF PREVENTION AMONG THE RETARDED, WE WOULD


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AT THE SAME TIME LEARN A GREAT DEAL ABOUT HOW TO DELIVER THE ESSENCE OF

OUR PREVENTION MESSAGE TO THE

LEARN QUITE A FEW THINGS THAT

MORE EFFECTIVE,

IN ADDITION, I BELIEVE WE

GENERAL PUBLIC, IN OTHER WORDS, WE MIGHT

WOULD MAKE OUR "FIRST STRATEGY" THAT MUCH

NEED TO KNOW MORE ABOUT THE DYNAMICS

WITHIN THE FAMILIES IN WHICH THERE IS A RETARDED INDIVIDUAL, I KNOW
FROM PERSONAL OBSERVATION THAT THE OVERWHELMING MAJORITY OF THOSE
FAMILIES ARE MADE UP OF LOVING AND DEEPLY CARING PEOPLE. BUT I ALSO
KNOW THAT THEY OFTEN FUNCTION UNDER GREAT PERSONAL AND INTERPERSONAL
STRESSmTHAT THE SAME HIGH-RISK HEALTH ISSUES OF ALCOHOL, AUTO SAFETY,
AND NUTRITION, FOR EXAMPLE, MAY BE AGGRAVATED FOR THOSE DEVOTED CARE-

TAKERS,

  WE HAVE CONCLUDED -- AND CORRECTLY, IN MY OPINION -- THAT AN INSTI-
TUTIONAL ENVIRONMENT MAY BE A VERY POOR ANSWER FOR MOST MENTALLY RE-
TARDED PERSONS, AND WE'VE GONE 0rJ ~0 THE NEXT STEP. WE HAVE ENCOUR-
AGED FAMILIES TO TAKE CARE OF THE MEMBERS WHO ARE RETARDED, WE'VE
ASKED COMMUNITIES,,,NEIGHBORHOODS,,. TO BE ACCEPTING OF THESE HUMAN
BEINGS, BUT WE PUBLIC HEALTH PROFESSIONALS HAVE NOT ALWAYS BEEN FORTH-
COMING WITH THE KIND OF HELP THAT MAKES FAMILY LIFE REALLY LIVABLE WITH

A RETARDED PERSON,

  THESE ARE THINGS WE WILL KNOW MORE ABOUT, AS WE PUT MORE RESOURCES
INTO LONGITUDINAL STUDIES, FOLLOWING RETARDED PERSONS THROUGH PERSONAL
AND FAMILY LIFE-CYCLES, UNDERSTANDING THE HOME-TO-SCHOOL TR'ANs;TIONS,
THE SCHOOL-TO-WORK TRANSITIONS, KNOWING MORE ABOUT THEIR EFFORTS TO


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REPLICATE FAMILY LIFE FOR THEMSELVES, AND IN THE COURSE OF REVIEWING

THE RESULTS OF THESE LONG-TERM STUDIES, WE MIGHT VERY WELL BEGIN TO

BUILD THE FRAMEWORK FOR THIS "SECOND STRATEGY," WE JUST MIGHT LEARN
HOW TO HELP THE RETARDED TAKE ADVANTAGE OF THE SAME BASIC KNOWLEDGE OF

PREVENTION AS THE GENERAL PUBLIC AND THUS ASSURE THEMSELVES OF AN

ADDED DIMENSION TO THE QUALITY OF THEIR LIVES,

  UNDERNEATH ALL THESE QUESTIONS AND CONCEPTS AND STRATEGIES I BE-

LIEVE THERE IS A VERY POWERFUL IDEA THAT IS SHARED BY EVERYONE IN

PUBLIC HEALTH.  IT IS THE NOTION THAT EACH PERSON IS SPECIAL AND IS

WORTH OUR VERY BEST, ,. OUR MOST PROFESSIONALwOUR MOST DEDICATED ATTEN-

TION. KNOWING SOMEONE'S I.Q. LEVEL OR SOME OTHER SCORE MAY HELP US

DETERMINE HOW WE MIGHT BEST DELIVER OUR INFORMATION OR OUR SERVICE,

BUT THAT KNOWLEDGE CANNOT DETERMINE WHETHER WE WILL BE OF SERVICE,
                   IT
IS UNDERSTOOD THAT WE WILL BE OF SERVICEmAND THAT'S IMPORTANT,

  THE GREAT SPANISH WRITER ORTEGA Y GASSETT PHRASED IT IN A SPECIAL

WAY, AND I'D LIKE TO LEAVE IT WITH YOU THIS MORNING, HE SAID, "LIVING
IS PRECISELY THE INEXORABLE NECESSITY TO MAKE ONESELF DETERMINATE, m
ENTER INTO AN EXCLUSIVE DESTINYem."  I THINK WE IN MEDICINE AND PUBLIC

HEALTH ACCEPT THE FACT THAT EVERY PERSON -- WHATEVER HIS OR HER 1.Q.

LEVEL OR MENTAL COMPETENCE -- EVERYONE HAS AN "EXCLUSIVE DESTINY,"

SOMETHING UNIQUE AND SPECIAL AND ONE'S OWN, IF I'M NOT MISTAKEN, THAT
IS PROBABLY THE CORE OF THIS SECOND INTERNATIONAL SUMMIT AND NATIONAL

SHOWCASE AND FORUM,

THANK YOU,

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