LUNCHEON ADDRESS

BY

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

16TH ANNUAL MEETING OF THE
USPHS PROFESSIONAL ASSOCIATIOrl
BOSTON, MASSACHkETTS
    MAY 26, 1981


(GREETINGS TO HOSTS, GUESTS)

  I AM DELIGHTED TO BE YOUR GUEST TODAY,   FOR THE PAST
COUPLE OF MONTHS, I'VE HAD THE PLEASURE OF MEETING WITH MANY
PaHaS, PERSONNEL IN THEIR OFFICES, CLINICS, AND RESEARCH
LABORATORIES, SO THIS IS NO GROUP OF STRANGERS TO ME,

  AT LEAST, NOT ANY MORE, ALTHOUGH I KNEW SOMETHING OF THE
PaHaS,', I HAD VERY LITTLE KNOWLEDGE OF THE COMMISSIONED CORPS,
THE MORE I LEARNED, THE MORE IMPRESSED I BECAME, NOW YOU HAVE A
VERY ENTHUSIASTIC CHAMPION OF YOUR CAUSE, AND THERE SHOULD BE
MILLIONS LIKE ME, BECAUSE WE HAVE ALL BEEN CAUGHT UP IN THOSE
EVENTS THAT, AS DR', BRANDT NOTED THIS MORNING, READ LIKE "CAMPAIGN
STREAMERS FROM REGIMENTAL FLAGS":

THREE MILE ISLAND, 1,   MT, ST, HELENS,, , FORT CHAFFEE,, ,
THE LOS ANGELES AND TEXAS HEAT WAVES,, ,   TOXIC SHOCK

SYNDROME, a , a   LEGIONNAIRE'S DISEASE,, , , AND SO ON,

                                             ,

YOU HAVE TO BE IN AWE OF At4 ORGAU IZATION THAT HAS THIS MUCH
KNOWLEDGE AND EXPERIENCE, THIS MUCH MOBILITY AND FLEXIBILITY,
AND ALL IN THE HIGHEST CAUSE OF THE HUMAN RACE: TO HEAL;

  YET, IT IS NOT LIKELY THAT TH,E AVERAGE AMERICAN WATCHiilG
THE TELEVISION NEWS ACCOUNTS WILL SAY, "HEY, CHALK UP ANOTHER


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VICTORY FOR THE US, PUBLIC HEALTH SERVICE," IT5 IRONIC THAT
THE SERVICE, LIKE EVERY OTHER GOVERNMENT AGENCY, HAS HAD ITS
ACTIVE PUBLIC AFFAIRS DEPARTMEHTS AND HAS PRINTED COUNTLESS
PRESS RELEASES AND BROCHURES AND PAMPHLETS, YET IT TENDS NOT
TO GET THE VISIBILITY AND CREDIT IT DESERVES,  I WOULD LIKE TO
CHANGE THAT IF I CAN,

  FROM THIS SIDE OF THE FENCE -- THAT IS,FROM THE P,HSn

SIDE -- THAT DOESN'T SEEM FAIR, FROM THE OTHER SIDE, FROM THE
PUBLIC'S VIEW, IT MAY NOT ONLY BE FAIR BUT BE AN INTEGRAL PART
OF THE PUBLIC? VISCERAL DEFENSE AGAINST GOVERNMENT', FOR THE
PUBLIC SERVANT, THE'NEED FOR RECOGHITION RAISES THIS PARADOX*'
WHICH IS AS OLD AS WESTERN INSTITUTIONS -- AND I'D GO ALL THE
WAY BACK TO PERICLEAN ATHE??

THE PRIVILEGE OF PUBLIC SERVICE CARRIES \?JITH IT THE
PLEDGE NEVER TO BE THE PUBLIC'S MASTER,--'

IF THE P,H,S, -- AND ESPECIALLY THE COtlMISSIONED CORPS -- DOESN'T
GET THE VISIBILITY AND THE CREDIT DESERVES, THAT IS NO REFLECTION
ON THE EXTRAORDINARY CALIBRE OF THE SERVICE YOU RENDER THIS NATION,
IT IS, RATHER, ANOTHER EXAMPLE OF THE PUBLIC'S RESPECT FOR -- AND
DEFENSE AGAINST -- STRONG GOVERNMENT,     . .


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  SOMETIMES WE FORGET THAT THE FIRST AMERICAN FLAG WAS
RAISED BY LIEUTENANT JOHN PAUL JONES AND ITS MOTTO TAUNTED THE
BRITISH MASTERS OF THESE COLONIES, IT SAID, "DON'T TREAD ON
ME,"  THAT FlAG HANGS IN THE SMITHSONIAN AND IS POPULAR WITH
EVERY VISITOR,  BECAUSE AMERICANS ARE ST1 LL SAYING THAT TO
WHOEVER MAY BE RUNNING GOVERNMEHT: "DON'T TREAD ON ME,"

   WHY DO I RAISE THIS NOW? WHY DO I BRING THIS UP? BECAUSE I
BELIEVE THIS IS A REAL TESTING TIME FOR PEOPLE WHOSE CAREERS ARE IN
THE SERVICE OF THE AMERICAN PUBLIC, WE'VE BEE11 IN THIS DIFFICULT
SITUATION FOR SEVERAL YEARS -- RIGHT THROUGH A STRING OF ONEZTERM
PRESIDENTS, THROUGH GREAT CHANGES IN THE COMPOSITION OF THE
CONGRESS, THROUGH TAX REVU AND OTHER CONVULSIONS AT STATE
AND LOCAL LEVELS OF GOVERNMENT,

.-.

  BACK IN PENMSYLVAXA, DURING THE LlST ELECTION CAMPAIGN,
A MAJOR SUPPORTER OF A LOCAL CANDIDATE SAT DONN \IJITH THE FELLOW
AND CONFIDED TO HIM, "YOU KNOW, YOURE RUIINIHG A TERRIFIC
CAMPAIGN AND THERE'&A REAL DAPlGER THAT YOU'LL WIN?

  PUBLIC SERVICE HAS ALWAYS HAD AN ELEMEI?IT OF RISK TO IT,
IT'S AN INTEGRAL PART OF OUR FREEDOM BUT PUBLIC SERVICE HAS


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ALSO HAD A SIZABLE ELEMENT OF PERSONAL AND PROFESSIONAL
SATISFACTION -- AND THAT IS ALSO AN INTEGRAL PART OF OUR FREEDOM,

  AND I THINK THAT MAY HAVE SPECIAL MEANING FOR THE US,
PUBLIC HEALTH SERVICE, BECAUSE THE QUALITY OF YOUR SATISFACTION
IS ROOTED IN A COMPASSIONATE, TOLERANT, AND CARING ATTITUDE
TOWARD THE HUMAN FAMILY, THIS NOTION BECAME CLEARER TO ME WITH
EACH VISIT TO ANOTHER P,H,S, FACILITY OR STAFF, AND THEN I
PAID A ViSIT TO THE UNIFORMED SERVICES UNIVERSITY OF THE HEALTH
SCIENCES IN BETHESDA, ON THE GROUNDS OF THE NAVAL MEDICAL
CENTER,                                                                         ci\:

  THERE ARE    OVER 48Q STUDENTS ENROLLED THERE, THEY
ARE FROM ALL THREE UNIFORMED MILITARY SERVICES, AND THERE ARE,
AMONG THEM, 23 STUDENTS FROM THE PUBLIC HEALTH SERVICE COMMISSIONED
OFFICERS CORPS,  I TALKED WITH 22 OF THEM IN A SERIES OF
CONVERSATIONS AND I WANT TO SHARE WITH YOU THE MOST STRIKING
BIT OF INFORMATION THAT CAME OUT:

ALL BUT ONE OF THE STUDENTS I TALKED WITH HAD HAD SOME
EXPERIENCE ALREADY IN PUBLIC SERVICE, THEY HAD ALREADY
-- ON THEIR OWN INITIATIVE, FOLLOWING THEIR OWN INSTINCTS--
MADE A CONTRIBUTION OF SERVICE TO SOCIiTY,


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  THE EDUCATION THEY ARE GETTING THEY, IId A SENSE, HAVE
ALREADY EARNED,  IT IS CLEAR THEY ARE MAKING A COMMITMENT TO

PUBLIC SERVICE THAT IS NOT MADE LIGHTLY, BUT REFLECTS THEIR
OWN PERSONAL IDEAS ABOUT HOW THOSE THEY SERVE MAY BE ENABLED TO
LIVE A GOOD LIFE ON THIS EARTH,

  THE RANGE OF SERVICE EXPERIENCES IS WIDE', SOME WORKED
FOR COMMUNITY GROUPS AND CHURCH GROUPS SINCE HIGH SCHOOL DAYS,
OTHERS HAVE HAD PEACE CORPS AND VISTA EXPERIENCE, THEY'VE
VOLUNTEERED IN CLINICS AND HOSPITALS, WHERE THEIR CAREER
OBJECTIVES CAME MORE SHARPLY INTO FOCUS,

  I FIRMLY BELIEVE THAT4EIR PRESENCE IN THAT UNIVERSITY
HAS AN INFLUENCE THAT FAR -EXCEEDS THEIR NUMBERS, THEY COME
OUT OF A CIVILIAN WORLD OF PEACEFUL SERVICE AND, AFTER THEIR
TRAIHING, THEY IJILL JOIN YOU AS FELLOW PROFESSIONALS DEVOTED
TO IMPROVING THE HEALTH STATUS OF ALL AMERICANS, I THINK IT
IS TREMENDOUSLY IMPORTANT FOR THE MILITARY HEALTH PROFESSIONALS
THERE TO KNOW AND UNDERSTAND THE APPRdACH TO MEDICAL CARE
TAKEN BY UNIFORMED BUT NON-MILITARY PHYSICIANS AND OTHER HEALTH

PROFESSIONALS,

  THE SAME CAN BE SAID -1 AND UNDERSCORED -- REGARDING THE
SIX FACULTY MEMBERS WHO ARE PHS OFFICERS, THEIR PRESEHCE AND
PHILOSOPHY CONTRIBUTES ALSO TO THE LEAYENIilG EFFECT OF THE PHS
IN THAT UNIVERSITY,


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  1 BEGAN THESE REMARKS BY NOTING THE LACK OF A COMPLIMENTARY
PRESS THE PUBLIC HEALTH SERVICE TENDS TO GET IN THIS COUNTRY,
YET, WE STILL TEND TO ATTRACT FROM THE PUBLIC SOME OF THE BEST,
MOST DEDICATED TALENT THAT IS AVAILABLE,

  AND WE WILL CONTINE TO ATTRACT THEM, BECAUSE -- REGARDLESS
OF WHAT THE ORGANIZATIONAL PLAiS MAY BE DOWN THE ROAD, AND
NONE OF THEM ARE FIXED IN CONCRETE YET -- I BELIEVE THERE WILL
ALWAYS BE A STRONG COM~1ISSIOF~ED OFFICERS CORPS A!4D A SURGEON
GENERAL OF THE U,S, PUBLIC HEALTH SERVICE,

HISTORICALLY, THE ROLE OF THE SURGEON GENERAL HAS BEEN VARIED,

BUT OVER TIME WE CAN SEE THAT IT HAS BEEN THE SURGEON GENERAL
WHO HAS HAD SIGNIFICANT --m/EN MAJOR --- IFIFLUENCE UPON THE
ATTITUDES OF THE AMERICAN-PEOPLE CONCERNING HEALTH, I BELIEVE
THIS WILL REMAIN AN IMPORTANT RART OF THE SURGEON GENERAL'S
OFF ICE I lil THE MONTHS AND YEAR AHEAD,

   IT WOULD BE A MISTAKE TO THINK OF ATTITUDES PURELY IN
PROGRAMMATIC TERflS, WHE!J THE AMERICAN PEOPLE TOOK TO HEART
THE MESSAGES OF THE PAST CONCERNIF.lG IMMUNIZATION, ENVIRONMENTAL
CONTROLS, THE DANGERS OF SMOKING, THERE NERE PROGRAMS READY
TO PROVIDE SUPPORT, BUT CHANGE WOULD HAVE TAKEN PLACE BECAUSE
-oF THE FORCE OF THE IDEAS EXPRESSED, THE sEi;kE 0F CRGENCY AND
SCALE IMPARTED, iND THE GEHERAL READNESS OF THE AMERICAi


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PEOPLE TO WANT TO IMPROVE THEIR HEALTH STATUS,

  LET ME SHARE WITH YOU THREE CONCERNS OF MINE THAT I BELIEVE
OUGHT TO BE BROUGHT BEFORE THE AMERICAN PEOPLE BY PUBLIC
HEALTH LEADERSHIP,

  FIRST, I THINK WE HAVE TO TAKE A LOOK AT THE DEMOGRAPHY OF
THIS COUNTRY AND RECOGNIZE THE SIGNIFICANCE OF THE RISE IN THE
NUMBERS OF PEOPLE ENTERING THE RANKS OF THE AGING', FURTHER, WE
NEED TO DEVELOP FOR OURSELVES AN ATTITUDE TOWARD AGING, THIS
WOULD INCLUDE A NUMBER OF PRECEPTS, SUCH AS METHODS TO IMPROVE
THE QUALITY OF LIFE FOR OUR AGIHG POPULATION,

   THE ADVANCES THAT HAVE BEE2 MADE IN UNDERSTANDING CERTAIN
TYPES OF SO-CALLED SENILE DEMENTIA COULD KEEP AT LEAST ONE
SEGMENT OF OUR AGI?JG POPULATION INDEPENDENT,HAPPIER AND SELF-
SUFFICIENT FOR A LONGER TIME THAN IS CURRE!lTLY PRACTICED AND
WOULD REDUCE THE NUMBER OF PERSONS WHO ARE SHUNTED INTO HURSIMG
HOMES,                                          3

  WE NEED TO DW,L WITH THIS ATTITUDMAL CHANGE RIGHT AT THE
BEGINNING OF MEDICAL EDUCATION AND RAISE. A GENERATION OF NURSES
AND PHYSICIANS AND OTHER HEALTH PROFESSIONALS WHO RESPECT THE
ELDERLY AND WHO UNDERSTAND THEIR POTENTIAL,


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  WE NEED TO RECOGNIZE THAT IF YOU REACH THE AGE OF 65 IN THIS
COUNTRY AlD YOU HAVE NOT BEEN ADMITTED TO A NURSING HOME, THERE
IS ONLY A 20 PERCENT CHANCE THAT THAT WILL HAPPEN SOMETIME IN
YOUR REMAINING YEARS OF LIFE, THE LIFE EXPECTANCY OF A MALE OF
THAT BGE IS ABOUT 12 ADDITIONAL YEARS AND FOR A FEMALE, ABOUT
15 ADDITIONAL YEARS,

  WHEN WE CONSIDER THIS LIFE EXPECTANCY POTENTIAL, THEN IT
IS POSSIBLE FOR US TO THINK OF PREVENTIVE HEALTH MEASURES DIRECTED
TOWARD THAT OLDER SEGMENT OF OUR POPULATION, ANOTHER EXAMPLE
IS THAT OF THE 65-YEAR-OLD PERSON WHO HAS SMOKED TWO PACKS 06
CIGARETTES A DAY -- AND THEI STOPS, THAT PERSON WILL SEE HIS
OR HER PULMONARY FUNCTIONSRJTURN TOWARD NORI'AAL, OF COURSE, IF
                                                   . - .
THERE IS ALREADY THE BEGINNING OF A BRONCHOGEifiCARCINOMA, THE
ACT OF QUITTING CIGARETTES WILL NOT REVERSE THE SITUATION,

  THE OFFICE OF THE SURGEON GENERAL CAN ALSO PL4Y A ROLE,
WITH THE SUPPORT OF THE PUBLIC HEALTH SERVICE, IT-1 MAKING LIFE
FOR HANDICAPPED INDIVIDUALS AS EXCITING AlJD AS SATISFYING AS
IT CAN BE FOR THE ABLE PERSON, THIS IS PARTICULARLY IMPORTANT
DURING THE CURRENT INTERNATIONAL YEAR OF THE DISABLED PERSON,
111 WHICH WE ARE PLAYING A PROMINENT ROLE,
                                                       ,

FINALLY, I THINK THE SURGEON GENERAL C,4N BE VERY I NFCUENTIAL


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1:4 STRENGTHENING THE PARTNERSHIP BETFI'EEN THE PUBLIC

SECTOR,  WE HAVE 12NUMERABLE PRIVATL AGENCIES FOR

AND PRIVPlTE
HEALTH CE11TERED
' OR AROUND THE

AROUND INDIVIDUAL 3ISABILITIES OR DISEASE CONDITIOdS
                               

PEOPLE WHO ARE SUBJECT TO THOSE DISEASES AND HAbDICAPS, WHAT
A MARVELOUS OPPORTUNITY NOW EXISTS FOR PUBLIC AND PRIVATE
AGENCIES TO WORK TOGETHER -- PARTICULARLY AT A TIME OF GREAT
FISCAL AUSTERITY,   EACH NEEDS THE TALENT AND EXPERIENCE OF
THE OTHER TO GET OUR JOB DONE -- AND THAT IS, TO IMPROVE THE
HEALTH STATUS OF THIS NATION,

  THE CHALLE!1GES OF THE NEXT FEW YEARS WILL BE NO EASIER THAN
THE LAST FEW, THE ROLE OF THE PUBLIC HEALTH SERVICE WILL +
STILL BE AN EVOLVING ROLE -- CHANGE IS THE MOST CONSTANT

ELEMENT WE HAVE, AND THROllQIOl J'

CONTINUE TO DRAbUPON THE -BEST

AS WE GIVE TO SOCIETY THE BEST

T IT ALL,. I KNO\i b/E WILL
THAT IS IN OUR SOCIETY, EVE!1
THAT IS I;.1 US,

  THE PROGRAM FOR THIS I6TH ANNUAL MEETIidG IS A VARIED
ONE, DEALING k/ITH MANY ASPECTS OF PUBLIC HEALTH SERVICE,
I TEIID TO THINK THAT, BENEATH IT ,4LL, 'WHETHER YOU ARE IN THE
UNIFORMED COMMISSIONED CORPS 0R.A GENERAL SCHEDULE CIVILIAN


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EMPLOYEE, YOU SHARE THE SAME COMMITflENT TO SERVICE AND
EXCELLENCE THAT THOSE YOUNG PEOPLE DISPLAYED TO I"lE OUT AT
BETHESDA,

  I AM PLEASED AND PRIVILEGED TO BE WITH YOU THIS AFTERFlSON,
AND I WILL CONTINUE TO FEEL THIS NAY LONG AFTER THIS MEETING
HAS ENDED,

THANK YOU,