ORIGINAL


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BANQUET ADDRESS

BY

C, EVERETT KOOP, M,D,
   SURGEON GENERAL
U,S, PUBLIC HEALTH SERVICE

          AND

DEPUTY ASSISTANT SECRETARY FOR HEALTH
U,S, DEPARTMENT OF HEALTH AND HUMAN SERVICES

PRESENTED TO THE HAWAII CONFERENCE ON
"HEALTH PROMOTION IN THE WORKPLACE"
     HONOLULU, HAWAII
     JANUARY 10, 1985


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(GREETINGS TO HOSTS, GUESTS, FRIENDS, ETC,>

  IT IS ALWAYS A PLEASURE TO VISIT WITH MANY OLD FRIENDS IN PUBLIC
HEALTH, BUT THIS IS AN ESPECIALLY PLEASANT OCCASION, FOR IT GIVES ME
A CHANCE TO MEET MANY NEW LEADERS IN PUBLIC HEALTH FROM AMONG
COUNTRIES THAT SHARE A DEEP AND ABIDING CONCERN FOR THE HEALTH AND
WELFARE OF THEIR CITIZENS,

  I WANT TO THANK EVERYONE OF YOU FOR TAKING TIME OUT FROM YOUR
BUSY OFFICIAL SCHEDULES -- WHETHER IN GOVERNMENT, IN ACADEMIA, OR IN
PRIVATE PRACTICE -- AND SPENDING SEVERAL DAYS HERE AMONG COLLEAGUES
AND LIKE-MINDED PUBLIC HEALTH PROFESSIONALS,

  BELIEVE ME, NO ONE KNOWS BETTER THAN I JUST HOW DIFFICULT IT IS
TO GET AWAY FROM THE OFFICE TO DO SOME THINKING AND TO EXCHANGE IDEAS
WITH MY PEERS, THOSE ARE VERY IMPORTANT THINGS TO DO,, ,BUT THEY'RE
NOT EASY TO DO BECAUSE THEY REQUIRE TIME, WHICH IS SUCH A RARE AND
PRECIOUS RESOURCE,


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  OVER THE PAST 3 YEARS, I'VE LEARNED MANY THINGS ABOUT THE JOB OF

BEING SURGEON GENERAL, BUT ONE THING I HAVEN'T YET LEARNED IS HOW TO

FIT AN EXTRA 2 OR 3 HOURS INTO THE WORK-DAY OR AN EXTRA DAY OR TWO

INTO THE WORK-WEEK,

   LET ME ALSO CONGRATULATE THE MEMBERS OF THE PLANNING COMMITTEE

FOR THIS CONFERENCE, THE AGENDA IS IMPORTANT AND STIMULATING AND THE

ROSTER OF PERSONS YOU'VE INVITED IS CERTAINLY A CROSS-SECTION OF THE

LEADING THINKERS AND DOERS IN PUBLIC HEALTH AMONG THE NATIONS

BORDERING THE PACIFIC,

   IN FACT, THE ROSTER IS A LITTLE HUMBLING, I CAN'T IMAGINE THAT I
HAVE ANYTHING SPECIAL TO OFFER IN THE FIELD OF HEALTH PROMOTION IN THE

WORKPLACE THAT SOMEONE -- WITH MORE EXPERIENCE AND MORE WISDOM -- HAS
NOT ALREADY COVERED IN ONE OR ANOTHER SESSION OF THIS PAST WEEK,


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  I SUPPOSE I OUGHT TO BE COMPLETELY INTIMIDATED,,,BUT I'M NOT,
WHICH IS AN ADVANTAGE OF HAVING BEEN A PRACTICING SURGEON FOR MORE
THAN 35 YEARS,  IN FACT, I WOULD ADVISE ANY OF YOU WHO, FOR EXAMPLE,
MIGHT BE PLANNING A CAMERA SAFARI THROUGH THE JUNGLE NOT TO TAKE ALONG
A SURGEON, SURGEONS TEND TO SCARE WILD ANIMALS AWAY,

  THEREFORE, WITH THE HELP OF THAT KIND OF ASSURANCE, I INTEND TO
BLUNDER RIGHT AHEAD FOR THE NEXT FEW MINUTES WITH SOME THOUGHTS I HOPE
YOU FIND TO BE AT LEAST CONGENIAL, IF NOT COMPLETELY ENLIGHTENING,

  LET ME BEGIN BY CONFESSING MY OWN MOMENTS OF UNCERTAINTY ABOUT
THE UNIVERSE COVERED BY THIS TERM: "OCCUPATIONAL HEALTH," YES, I KNOW
THE KINDS OF THINGS COVERED BY THAT TERM WITHIN OUR OWN UNITED STATES,
I COULD EVEN MAKE SOMETHING OF A LIST OF SUCH THINGS,


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  BUT OURS IS A SOCIETY ASSISTED BY ADVANCED TECHNOLOGIES AND
SUPPORTED BY A COMPLEX, INTER-RELATED ECONOMY, ONLY 3 PERCENT OF OUR
WORKFORCE IS ENGAGED IN AGRICULTURE, WHILE THE LARGEST SEGMENT OF OUR
TOTAL US, WORKFORCE -- 72 PERCENT -- PERFORMS A WIDE RANGE OF SOME-
THING CALLED "SERVICES,"  THEY DON'T SPIN OR SOW OR REAP, ,,THEY

"SERVE/'

  AND LIKE MOST PUBLIC HEALTH PEOPLE IN THE UNITED STATES, I ALSO
BELIEVE THAT OCCUPATIONAL HEALTH IS RELATED TO OTHER ASPECTS OF
HEALTH, BUT IT IS NEVERTHELESS AN IMPORTANT AND SEPARATE DISCIPLINE OF
ITS OWN,

  CAN THIS BE THE SAME FOR MY COLLEAGUES FROM INDONESIA? IN THEIR
COUNTRY, 2 OUT OF EVERY 3 PERSONS IN THE WORKFORCE IS IN
AGRICULTURE, RAISING FOOD IS A DIFFICULT OCCUPATION IN INDONESIA,
SINCE SO MUCH OF THAT BEAUTIFUL COUNTRY IS MOUNTAINOUS AND NOT ARABLE
LAND, SOME REPORTS INDICATE THAT BARELY 11 PERCENT OF THE LAND IN
INDONESIA CAN BE USED FOR FOOD PRODUCTION, WHETHER PLANT OR ANIMAL,


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  BUT INDONESIA IS NOT ALONE AS A COUNTRY WHOSE ECONOMY AND WHOSE
SOCIAL FABRIC REFLECTS A MAJOR PREOCCUPATION WITH GROWING AND RAISING
FOOD, IN NEPAL, 95 PERCENT OF THE WORKFORCE IS INVOLVED IN
AGRICULTUREwIN PAPUA NEW GUINEA, 85 PERCENTmIN THAILAND, NEARLY 80
PERCENTwIN THE PEOPLE'S REPUBLIC OF CHINA, 75 PERCENTwIN INDIA, A
COUNTRY STRICKEN BY FAMINE ONLY 20 YEARS AGO BUT NOW SELF-SUFFICIENT
IN FOOD, 70 PERCENT OF ITS LABOR FORCE IS IN AGRICULTUREwIN WESTERN
SAMOA, 50 PERCENT,, aAND SO ON,

  I LOOK AROUND THIS ROOM AND I SEE SUCH DIVERSITY,,,MEN AND WOMEN
REPRESENTING SUCH A GREAT VARIETY OF CULTURES THAT ENCIRCLE THE
PACIFIC, WE ARE ALL SO DIFFERENT AS INDIVIDUALS, BUT IT WOULD NOT BE
TOO FAR OFF THE MARK TO SAY THAT OUR RESPECTIVE COUNTRIES ARE EASIER
TO CATEGORIZE ON THE BASIS OF THE MAJOR OCCUPATION OF THEIR WORKFORCE:

ON THE ONE HAND ARE THOSE COUNTRIES, LIKE THE UNITED STATES AND
AUSTRALIA AND JAPAN, WHICH HAVE APPLIED NEW TECHNOLOGIES TO THEIR
AGRICULTURE AND, HENCE, EMPLOY MOST OF THEIR PEOPLE IN MANUFACTUR-
ING OR SERVICES,


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AND ON THE OTHER HAND THERE ARE THE COUNTRIES, LIKE INDONESIA AND
SRI LANKA AND NEPAL, WHICH DEVOTE MOST OF THEIR HUMAN AND MATERIAL
RESOURCES TO THE RAISING OF FOOD,

  HOW CAN ONE GROUP OF HIGHLY INDUSTRIALIZED COUNTRIES HELP THE
OTHER GROUP, THE ONES WHO ARE STILL IN THE PROCESS OF ACQUIRING
INDUSTRY AND NEW TECHNOLOGIES? SPECIFICALLY, WHAT SORT OF KNOWLEDGE
OF 'OCCUPATIONAL HEALTH' CAN WE PROVIDE THAT WOULD REALLY BE
APPROPRIATE?

  I'M SURE YOU HAVE DISCUSSED THE PROBLEMS OF PESTICIDES AND
INSECTICIDESmTHE DANGERS THAT THESE CHEMICALS POSE TO THE SKIN AND
TO THE RESPIRATORY SYSTEM, FOR EXAMPLE, AND I WOULD IMAGINE YOU'VE
ALSO DISCUSSED MANY OF THE HEALTH RISKS PRESENTED BY AGRICULTURAL
MACHINERY THAT CAN PLOW AND SOW AND CUT AND REAP AND BIND, THE PEOPLE
OF THE UNITED STATES HAVE SPENT MOST OF THIS CENTURY SETTING STANDARDS
FOR AGRICULTURAL CHEMICALS AND EQUIPMENT TO MAKE THEM MORE LIFE-
PROTECTIVE AND LESS LIFE-THREATENING,


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  I WOULD THINK THAT THE GOVERNMENTS AND THE MAJOR PRIVATE
COMPANIES AMONG THE INDUSTRIALIZED NATIONS CAN -- AND SHOULD -- OFFER
THE FRUITS OF THIS KIND OF EXPERIENCE TO OUR FRIENDS WHOSE SOCIETIES
REST ON A BROAD BASE OF SMALL FARMS AND HERDS, THAT, IT SEEMS TO ME,
WOULD BE KNOWLEDGE THAT MIGHT BE UNIQUELY APPROPRIATE TO THE HEALTH
NEEDS OF POSSIBLY THREE-QUARTERS OF THE PEOPLE REPRESENTED AT THIS
MEETING,

BUT THAT IS ONLY A SMALL PART OF THE ANSWER,

   I THINK ANOTHER PART -- AND POSSIBLY THE MOST IMPORTANT PART OF
THE ANSWER -- WILL REFLECT HOW WELL WE, IN THE INDUSTRIALIZED
COUNTRIES, UNDERSTAND JUST WHAT DAILY LIVING CAN BE LIKE FOR THE MEN,
WOMEN, AND CHILDREN WHO GROW AND RAISE FOOD IN COUNTRIES JUST
BEGINNING THE LONG JOURNEY TOWARD FULL INDUSTRIALIZATION, FOR THE
PEOPLE IN THOSE COUNTRIES, THEIR MAJOR "OCCUPATION" -- FARMING -- IS,
IN FACT, THEIR WHOLE LIFE,


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  THE LAND IS STUBBORN, MACHINERY IS SCARCE, FERTILIZERS AND
PESTICIDES ARE EXPENSIVE OR DANGEROUS OR SIMPLY UNAVAILABLE, THE LIFE
OF THE FAMILY IS TOTALLY ABSORBED BY THIS OCCUPATION,,,THIS BACK-
BREAKING, DAY-LONG, YEAR-ROUND TASK OF GROWING FOOD,

  FOR THESE MILLIONS UPON MILLIONS OF PEOPLE, "OCCUPATIONAL HEALTH"
IS NOTHING LESS THAN THEIR TOTAL HEALTH, WHILE I ONLY SUSPECT THAT
THIS MAY BE TRUE FOR SOME PEOPLE IN INDUSTRIALIZED NATIONS SUCH AS THE
UNITED STATES AND AUSTRALIA, I FEEL QUITE SURE THAT THIS IS THE CASE
FOR MILLIONS OF PEOPLE IN MOST OF THE OTHER COUNTRIES REPRESENTED HERE
THIS WEEK,

  IF THAT IS SO, THEN I WOULD SUGGEST THAT THE KNOWLEDGE-TRANSFER
TASK FOR GOVERNMENT, BUSINESS, AND THE ACADEMIC COMMUNITY IS MUCH MORE
COMPLEX THAN WE MIGHT AT FIRST ASSUME,


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  FOR EXAMPLE, WE MUST OFFER ASSISTANCE IN COMBATTING THE BASIC,
HISTORIC ENEMIES OF THE FARMER AND THE HERDSMAN:

WEATHER, JNSECTS, JNFECTIOUS DISEASE AND FEVERS,,,DEHYDRATION, 1,
SKIN CANCERS, ,,LOSS OF TEETHwSKELETAL DEFORMITIES,, @PARTIAL AND
TOTAL LOSS OF VISIONwAND THE RISKS OF PREGNANCY AND CHILDBIRTH,

AND HOW QUICKLY WE COME BACK TO THE FUNDAMENTALS OF PUBLIC HEALTH,, ,
THAT IS, SAFE HOUSING, CLEAN WATER, PROPER SANITATION, PROTECTIVE
CLOTHING, ESSENTIAL IMMUNIZATIONS, AND BASIC NUTRITION,

   IN MANY OF THE NON-INDUSTRIALIZED COUNTRIES REPRESENTED AT THIS
MEETING, BETWEEN 40 AND 50 PERCENT OF THE POPULATION IS UNDER THE AGE
OF 14, THESE CHILDREN ARE VITAL TO THEIR FAMILIES. THEY BEGIN EARLY
TO SHARE IN THE CHORES OF GROWING FOOD OR HERDING ANIMALS, AS A
RESULT, THEIR OPPORTUNITIES FOR EDUCATION AND TRAINING ARE LIMITED AND
THIS IS REFLECTED IN THE LITERACY LEVELS OF EACH COUNTRY,


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  A FEW COUNTRIES REPRESENTED HERE ENJOY LITERACY LEVELS OF BETTER
THAN 90 PERCENT AND SEVERAL HAVE LEVELS BETWEEN 70 AND 90 PERCENT,
BUT OTHERS CARRY A LITERACY BURDEN AS LOW AS 40 PERCENT,,,15 PERCENT
,, ,AND EVEN LESS,

   IS A NATION'S RISE IN LITERACY THE PRECURSOR OF MODERNIZATION OR

THE RESULT OF MODERNIZATION? I DON'T THINK ANYONE REALLY KNOWS THE

ANSWER, BUT CLEARLY THEY GO TOGETHER, HENCE, IT WOULD SEEM TO ME
THAT EVERYONE ENGAGED IN OCCUPATIONAL HEALTH MUST DEVOTE AS MUCH TIME

AND ENERGY AS POSSIBLE TO THE ISSUE OF LITERACY, BECAUSE WITHOUT
LITERACY THERE IS SIMPLY NO WAY FOR PEOPLE THEMSELVES TO ASK FOR --
AND TO TAKE ADVANTAGE OF -- BETTER HEALTH SERVICES FROM GOVERNMENT,
FROM THE UNIVERSITIES, AND FROM THE PRIVATE SECTOR,

  AS WE HEARD FROM SENATOR HATCH AND FROM DENNIS TOLSMA, EDUCATION
IS A KEYSTONE IN HEALTH PROMOTION AND DISEASE PREVENTION -- AND
LITERACY IS ESSENTIAL TO EDUCATION,


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   AS I INDICATED AT THE BEGINNING OF THESE REMARKS, I WILL NOT
PRETEND TO BE AS WELL VERSED IN MATTERS OF OCCUPATIONAL HEALTH AS MOST
OF YOU ARE, BUT THAT DOESN'T MEAN THAT I'VE COME HERE WITHOUT SOME
BIASES OF MY OWN ABOUT THE SUBJECT, AND THOSE BIASES TELL ME THAT
LITERACYwA BETTER DIET,,,CLEAN WATERmPRENATAL CAREmTHESE THINGS
ARE, TO MY WAY OF THINKING, THE FUNDAMENTAL COMPONENTS OF OCCUPATIONAL
HEALTH IN THE COUNTRIES REPRESENTED HERE TODAY, AND I WOULD DEFINITE-
LY INCLUDE MY OWN COUNTRY, THE UNITED STATES, IN THAT GROUP,

   I MAY NOT BE AS WELL-VERSED IN OCCUPATIONAL HEALTH AS MANY OF MY
COLLEAGUES, BUT IN MY CAPACITY AS SURGEON GENERAL, I KNOW A LITTLE
SOMETHING ABOUT SMOKING, AND I WOULD BE VERY REMISS, IF I DID NOT AT
THIS TIME BRING TO YOUR ATTENTION A RELEVANT POINT CONCERNING SMOKING
AND HEALTH,

   I WILL BE SPEAKING OF THIS IN MORE DETAIL, WHEN I ADDRESS THE
HAWAII CHAPTER OF THE AMERICAN CANCER SOCIETY IN THIS HOTEL ON
SATURDAY, BUT LET ME SAY A FEW WORDS ON THIS SUBJECT NOW BECAUSE IT
IS IMPORTANT FOR ALL OF US AND FOR THE MILLIONS OF PEOPLE WE
REPRESENT,


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   I'M SURE YOU ARE ALL AWARE OF THE EXTENSIVE BIOMEDICAL RESEARCH
THE UNITED STATES GOVERNMENT HAS CONDUCTED FOR THE PAST 20 YEARS THAT
CAUSALLY LINKS CIGARETTE SMOKING TO A NUMBER OF CATASTROPHIC DISEASES,
SUCH AS LUNG CANCER, STROKE, AND HEART DISEASE, I STRONGLY URGE EACH
OF YOU TO DO EVERYTHING POSSIBLE TO SPREAD THAT INFORMATION AMONG THE
CITIZENS OF YOUR OWN COUNTRIES,

  BUT THERE IS YET ANOTHER SIDE TO THIS ISSUE, WE ALSO KNOW THAT
AN INCREASING NUMBER OF DEVELOPING COUNTRIES ARE BEGINNING TO CONSIDER
UNMANUFACTURED LEAF TOBACCO AS A POSSIBLE NEW AND LUCRATIVE CASH CROP
FOR EXPORT, AND CERTAINLY THE ECONOMIC HISTORY OF TOBACCO IS OFTEN
EXPRESSED IN A NUMBER OF STRAIGHT-LINE GRAPHS GOING UPWARD,

  THOSE GRAPHS, HOWEVER, ARE BASED ON PAST CIRCUMSTANCES, SO LET ME
SOUND THIS NOTE OF WARNING REGARDING THE PRESENT AND THE FUTURE:


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  FIRST, IT IS QUITE CLEAR TO ME THAT A NUMBER OF COUNTRIES -- IN
ADDITION TO THE UNITED STATES -- ARE LAUNCHING ALL-OUT PUBLIC HEALTH
CAMPAIGNS AGAINST SMOKING, IN FACT, I HAVE HAD THE PLEASURE OF
PLAYING A ROLE IN THE PLANNING AND LAUNCHING OF SUCH CAMPAIGNS, IN
OTHER WORDS, THE SAME IMPORTING COUNTRIES THAT HAVE BEEN SUCH GOOD
TOBACCO MARKETS IN THE PAST ARE NOT GOING TO BE THE SAME GOOD MARKETS
IN THE FUTURE,

  AND SECOND, WE ARE GETTING REPORTS FROM SEVERAL TOBACCO-GROWING
COUNTRIES -- MANY OF THEM, BY THE WAY, IN AFRICA AND SOUTH AMERICA --
OF A DISTURBING INCIDENCE OF SKIN AND LUNG DISEASES CAUSED BY EXPOSURE
TO TOBACCO-PROTECTIVE INSECTICIDES AND PESTICIDES, IN OTHER WORDS,
THE GROWING OF TOBACCO IS A PUBLIC HEALTH HAZARD NOT ONLY TO THOSE WHO
SMOKE AND IMPORT BUT ALSO TO THOSE WHO GROW AND EXPORT,

  I FEEL I MUST BRING THIS POINT TO YOUR ATTENTION, SINCE YOU ARE
NOT ONLY LEADERS IN YOUR RESPECTIVE COUNTRIES AS FAR AS PUBLIC HEALTH
AND MEDICINE ARE CONCERNED, BUT YOU CAN ALSO BE INFLUENTIAL VOICES IN
THE COUNCILS OF GOVERNMENT DURING DISCUSSIONS OF LARGER ISSUES OF
ECONOMIC AND SOCIAL POLICY AFFECTING YOUR HOMELANDS,


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  I GUESS BY NOW YOU HAVE DISCERNED MY MESSAGE FOR THIS IMPORTANT
MEETING, IT HAS SEVERAL PARTS TO IT:

*

     THE FIRST PART IS A SINCERE EXPRESSION OF GRATITUDE TO EACH
ONE OF YOU FOR TAKING THE TIME TO COME TO THIS MEETING AND TO FOCUS ON

THIS IMPORTANT MATTER OF OCCUPATIONAL HEALTH,

*

     THE SECOND PART IS A WORD OF ENCOURAGEMENT TO REPRESENTATIVES

OF GOVERNMENT, ACADEMIA, AND PRIVATE INDUSTRY TO STRENGTHEN THE
COOPERATIVE TIES THAT HAVE BEEN DISCUSSED AND DESCRIBED HERE THIS

WEEK,

*

     AND THE THIRD PART OF MY MESSAGE IS A SERIOUS PLEA TO EACH OF
YOU TO SEE OCCUPATIONAL HEALTH IN ITS BROADEST, RATHER THAN ITS MOST
NARROW, DIMENSIONS,,,TO SEE IT AS INTEGRAL TO THE HEALTH STATUS OF THE
PEOPLES OF OUR RESPECTIVE COUNTRIES,,,TO SEE IT AS A PRIMARY CONCERN
FOR THE TOTAL HEALTH OF INDIVIDUALS AND FAMILIES, AND NOT TO SEE IT
MERELY AS ANOTHER IRRITANT TO THIS OR THAT PARTICULAR INDUSTRY OR
OCCUPATION,


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  WE'VE BEEN SLOW TO LEARN THIS LESSON EVEN IN MY OWN COUNTRY, THE
UNITED STATES, BUT I THINK WE'RE CATCHING ON, FOR EXAMPLE, I HAVE
HAD THE OCCASION TO REMIND MANY LEADERS IN US, INDUSTRY THAT OUR
LABOR FORCE NOW HAS 50 MILLION WOMEN WORKERS, THAT'S 44 PERCENT OF
OUR TOTAL CIVILIAN LABOR FORCE, BUT MORE IMPORTANT IS THE FACT THAT
OVER HALF THE NUMBER OF WOMEN IN OUR COUNTRY WHO ARE AGE 16 AND OVER
ARE NOW IN THE LABOR FORCE,

  SOME 40 MILLION OR MORE OF THESE WORKING WOMEN ARE OF CHILD-
BEARING AGE,  IN FACT, A MILLION BABIES WERE BORN LAST YEAR TO WORKING
WOMEN, NEARLY 1 OF EVERY 3 BABIES THAT ARRIVED, AND THAT, I BELIEVE,
PLACES A SPECIAL RESPONSIBILITY UPON BUSINESS AND GOVERNMENT, THE
WORK ENVIRONMENT THUS HAS A DIRECT EFFECT UPON THE NEXT GENERATION,
IF THE WORK ENVIRONMENT IS IN ANY WAY A HEALTH THREAT TO A WOMAN OF
CHILD-BEARING AGE, IT IS BY THAT VERY FACT A THREAT TO THE HEALTH
STATUS OF OUR SOCIETY IN GENERAL,


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BUT OUR CONCERNS MUST NOT BE LIMITED JUST TO THE RISKS TO CHILD-

BEARING, WE NEED TO ADDRESS THE HEALTH NEEDS -- THE PHYSICAL, EMO-
TIONAL, AND MENTAL HEALTH AND, YES, THE SPIRITUAL HEALTH NEEDS -- OF
WORKING WOMEN AND THEIR PRE-SCHOOL-AGE CHILDREN, HENCE, THE STRONG
DRIVE THROUGHOUT THE UNITED STATES FOR MORE AND BETTER DAY-CARE
SERVICES IN OR CLOSE TO OFFICES, FARMS, AND FACTORIES,

  THESE ARE CHALLENGES THAT WE ARE NOW BEGINNING TO ADDRESS IN THE
UNITED STATES, BUT I WOULD SUBMIT TO YOU THAT THEY ARE NOT CHALLENGES
UNIQUE TO THE UNITED STATES, THEY ARE, RATHER, CHALLENGES UNIQUE TO
THE HUMAN CONDITION,

  ALL OF US IN PUBLIC HEALTH -- REGARDLESS OF NATION OR CULTURE --
MUST BE CONCERNED ABOUT THE PERINATAL CARE AVAILABLE TO WOMEN,
ESPECIALLY WOMEN WHO WORK BESIDE MEN IN THE FIELDS AND FACTORIES, AND
WE MUST BE CONCERNED ABOUT THE QUALITY OF FAMILY LIFE EXPERIENCED BY
INFANTS AND YOUNG CHILDREN WHOSE PARENTS BOTH WORK FULL-TIME,


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  IF WE FAIL IN MEETING THESE VERY SPECIAL CHALLENGES OF "OCCUPA-
TIONAL HEALTH," WE DO SO AT THE PERIL OF OUR ENTIRE SOCIETY,

  I AM NOT TELLING YOU ANYTHING NEW, OF COURSE, IN FACT, THESE
PRINCIPLES OF TOTAL HUMAN AND SOCIAL HEALTH ARE SECURELY PLANTED
WITHIN THE WORLDWIDE PROGRAM OF "HEALTH FOR ALL BY THE YEAR 2000," TO
WHICH ALL OF US, AS MEMBERS OF THE WORLD HEALTH ORGANIZATION,
SUBSCRIBED BACK IN MAY OF 1977,

  I WOULD VENTURE TO SAY, THEREFORE, THAT THE CONCERNS WE ALL SHARE
AT THIS MEETING FOR IMPROVING HEALTH CONDITIONS AT THE WORKPLACE ARE
ESSENTIALLY THE SAME AS THE CONCERNS FIRST EXPRESSED NEARLY 8 YEARS
AGO, WHEN THAT INTERNATIONAL "HEALTH FOR ALL" PROGRAM WAS LAUNCHED,
IN THAT SENSE, OCCUPATIONAL HEALTH IS TRULY INTEGRAL TO TOTAL
INDIVIDUAL AND FAMILY HEALTH,

  HAVING BEEN A SURGEON, A PEDIATRICIAN, AND A PUBLIC HEALTH
OFFICER, I CAN TELL YOU THATWE IN PUBLIC HEALTH COMMUNICATE MORE
EFFECTIVELY WITH EACH OTHER THAN DO OTHER HEALTH PROFESSIONALS, WE
HAVE A SINGLENESS OF PURPOSE,, UNFETTERED BY THE EMBARRASSMENT SOME
FEEL IN EXPRESSING HIGH IDEALSwAND THIS AUGURS WELL FOR THE FUTURE,


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  I SUSPECT I HAVE USED THIS PLEASANT BANQUET HOUR TO PLUNGE INTO
SOME DIFFICULT AREAS, BUT I REALLY CAN'T APOLOGIZE FOR DOING SO, MY
DEFENSE IS THAT I AM HEAVILY UNDER THE INFLUENCE OF THE PACIFIC, WHICH
TENDS TO DRAW OUT THE MOST SURPRISING AND UNSETTLING IDEAS FROM THE
INNOCENT VISITOR,

  I AM REMINDED OF ONE OF PAUL GAUGIN'S PAINTINGS, WHICH HE
COMPLETED IN TAHITI, VERY FAR FROM HIS HOME IN PARIS, AT THE BOTTOM
OF THE CANVAS HE CAREFULLY PAINTED IN THESE QUESTIONS, WHICH HAUNTED
HIM THEN IN THAT LOVELY ISLAND AND WHICH HAUNT US STILL TODAY:

"WHERE DO I COME FROM?" HE WROTE,

"WHO AM I?"

"WHERE AM I GOING?"


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  I THINK I CAN PUT TOGETHER SOME ANSWERS TO THOSE QUESTIONS FOR
MYSELF,, ,PERSONALLY, BUT I KNOW THAT, FROM TIME TO TIME, MANY OF MY
FELLOW CITIZENS IN THE UNITED STATES -- THE PEOPLE WHOM I WAS

APPOINTED TO SERVE -- LOOK TO ME TO BE OF HELP AS THEY SORT OUT THE
ANSWERS THAT ARE BEST FOR THEM,
            AND I'M SURE THAT MOST OF YOU, TOO,
HAVE BEEN,, SNOW AND THEN,, ,THE OBJECTS OF THIS SAME PROFOUND EXPECTA-
TION OF PUBLIC SERVICE FOR THE PUBLIC HEALTH,

  MAYBE, TOGETHER IN MEETINGS SUCH AS THIS, WE CAN TRY TO PUZZLE
OUT THE ANSWERS THAT MIGHT SERVE US IN OUR LIFETIMES,

  MY BEST WISHES TO ALL OF YOU, COLLEAGUES IN A TRULY NOBLE

CALLING,

THANK YOU,

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