ADDRESS

BY

C, EVERETT KOOP, MD, ScD
  SURGEON GENERAL

       OF THE

    U, S, PUBLIC HEALTH SERVICE
U, S, DEPARTMENT OF HEALTH AND HUMAN SERVICES

PRESENTED TO THE NATIONAL CONFERENCE ON
   ALCOHOL ABUSE AND ALCOHOLISM
      WASHINGTON, DA
      NOVEMBER 13, 1987

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

I'M DELIGHTED TO JOIN YOU THIS NOON AND PLAY EVEN A MODEST ROLE

AT THIS IMPORTANT NATIONAL CONFERENCE,

YOU'VE ALREADY HEARD THE REASONS FOR HAVING SUCH A CONFERENCE

AND FOR MOVING AHEAD WITH A PROGRAM TO FIGHT ALCOHOLISM, THOSE

REASONS HAVE ALL BEEN PRESENTED BY NOW WITH CONVICTION AND GREAT

ELOQENCE,


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  I WANTED TO ALERT WOMEN OF CHILD-BEARING AGE THAT THE DATA ON

F,A,S, WAS CONCLUSIVE, AS FAR AS THE PUBLIC HEALTH SERVICE WAS

CONCERNED:

IF YOU DRINK ALCOHOL WHILE YOU'RE PREGNANT, YOUR BABY MAY BE

SERIOUSLY AND IRREVERSIBLY DAMAGED,

BUT I HAVE TO TELL YOU THAT THE SURGEON GENERAL -- FOR ALL HIS OR

HER PUTATIVE POWER -- HAS A RATHER LIMITED SPHERE OF 1NFLUENCEu.A

SPHERE WHICH IS CAREFULLY DEFINED BY OTHERS,


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  FOR INSTANCE, OVER 20 YEARS AGO THE US, CONGRESS TOLD THE

SURGEON GENERAL TO EXERCISE LEADERSHIP IN THE FIELD OF SMOKING,

  AND I'VE BEEN DOING THAT, JUST AS MY IMMEDIATE FOUR

PREDECESSORS HAD DONE WHILE EACH OF JHEM HELD THIS POST,

  THEN, A LITTLE OVER A YEAR AGO, PRESIDENT REAGAN DIRECTED ME'TO

DO SOMETHING ABOUT AIDS,  AND I NEEDN'T TELL YOU HOW THAT REQUEST

CHANGED MY WORKING DAY,


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  BUT NO ONE HAS ASSIGNED ME THE TASK OF SPEAKING OUT ON ALCOHOL

ABUSE AND ALCOHOLISM, AS A RESULT, IT'S DIFFICULT FOR ME TO DO AND,

TO BE PERFECTLY HONEST ABOUT IT, WHEN I DO EXPRESS MY OPINIONS ON

THE MATTER, NOT MANY PEOPLE SHOW MUCH INTEREST,

  I'M MAKING THIS LITTLE CONFESSION FOR A VERY IMPORTANT REASON.

IT ILLUSTRATES THE GREAT SIGNIFICANCE WE SHOULD ATTACH TO THE FACT .

THAT THE SECRETARY OF HEALTH AND HUMAN SERVICES -- MY BOSS, DR,

BOWEN -- HAS TAKEN THE BOLD STEP OF PUTTING HIS DEPARTMENT m

EVERYBODY IN IT ON THE LINE AS FAR AS ALCOHOL IS CONCERNED,


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  EVEN SURGEONS GENERAL NEED HELPwAND I GOT IT THIS WEEK -- WE

u DID -- WHEN DR, BOWEN DELIVERED HIS STRONG STATEMENT YESTERDAY

MORNING AND, IN EFFECT, GAVE US SOME NEW MARCHING ORDERS,

  AND I MIGHT ADD THAT THIS IS JUST WHAT WE'VE ALL COME TO EXPECT

FROM THE SECRETARY,  WHEN THE COUNTRY HAS A PROBLEM AND NEEDS A CALM
BUT FIRM VOICE TO PROVIDE GUIDANCE AND LEADERSHIP, SECRETARY BOWEN

HAS STEPPED FORWARD AND GIVEN US THAT,


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  HE'S DONE THIS IN REFERENCE TO THE MEDICAL MALPRACTICE

ISSUEmHE'S BEEN THE "POINT MAN" ON CATASTROPHIC INSURANCE FOR THE

ELDERLY, mm HE'S BEEN DEEPLY INVOLVED IN SHAPING OUR A NATIONAL

POLICY FOR FAMILIES,,,AND SO ON,

  AND HE'S PROVIDED THE SAME KIND OF LEADERSHIP ON THIS ISSUE (IF

ALCOHOL ABUSE AND ALCOHOLISM,


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  SO THAT'S MY FIRST POINTwTHAT YOU JUST CAN'T TALK ABOUT THIS

OR THAT PROBLEM IN AMERICAN LIFE AND HOPE THAT -- MERELY BY TALKING

IT UP -- YOU'LL MAKE A DIFFERENCE, THAT'S NOT THE WAY IT WORKS,

  NOT UNLESS YOU'RE SOMEONE WITH THE STATURE AND THE AUTHORITY OF

THE SECRETARY, NOW, SECRETARY BOWEN HAS DONE IT,, BAND, THEREFORE,

THE REST OF US ARE ON OUR WAY,

MY SECOND POINT IS A LITTLE DIFFERENT,


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  AS YOU ALL KNOW, I'M SURE, THE US, PUBLIC HEALTH SERVICE AND

SEVERAL HUNDRED EXPERTS FROM ACROSS DISCIPLINES AND FROM AROUND THE

COUNTRY PUT TOGETHER A SET OF "OBJECTIVES FOR THE NATION" IN THE

AREA OF HEALTH PROMOTION AND DISEASE PREVENTION, THEY DID THIS BACK

IN 1979 AND 1980,

  THAT WAS AN ENORMOUS UNDERTAKING AND A TRULY HISTORIC ONE,

FINALLY, WE HAD BEFORE US A SET OF MEASURABLE, QUANTITIVE GOALS FOR

ACHIEVING -- BY THE YEAR 1990 -- A GREATLY IMPROVED LEVEL OF HEALTH

STATUS FOR THE PEOPLE OF THE UNITED STATES,


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THE EXPERTS SET MANY OBJECTIVES, SUCH AS,, a

LOWER INFANT MORTALITY RATES,, ,

  LOWER DEATH RATES ON THE HIGHWAY,,,        .

     LOWER MORBIDITY AND MORTALITY RATES FROM HEART

     DISEASE, CANCER, AND STROKE,, ,

       LOWER RATES OF CIGARETTE SMOKING,, #LESS SODIUM

       INTAKE,, ,LOWER SERUM CHOLESTEROL LEVELS,, ,

              AND SO ON,


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WE`VE BEEN TRACKING THESE THINGS SINCE 1979 AND NOW WE'RE

LOOKING AHEAD TO SETTING NEW OBJECTIVES FOR THE YEAR 2000,

   HOWEVER, IF THERE'S ANY ONE ELEMENT THAT CUTS ACROSS ALL THESE

OBJECTIVES -- THE ONES FOR 1990 AND THE ONES BEING PLANNED FOR THE

YEAR 2000 -- THAT SINGLE ELEMENT IS "HUMAN BEHAVIOR,"

  FOR EXAMPLE, WE WANT TO LOWER THE RATE OF TEENAGE PREGNANCIES

FOR MANY REASONS, NOT THE LEAST OF WHICH IS THE FACT THAT THESE

PREGNANCIES CARRY VERY HIGH HEALTH RISKS FOR BOTH THE MOTHER AND HER

BABY,


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  BUT WE DON'T HAVE ANY MAGIC VACCINE TO PREVENT TEENAGE WOMEN

FROM BECOMING PREGNANT, IN FACT, AS ANY FAMILY PLANNING EXPERT WILL

TELL YOU, NO DRUG AND NO DEVICE WORKS QUITE AS WELL AS A YOUNG

WOMAN'S OWN DETERMINATION NOT TO GET PREGNANT,

HER OWN BEHAVIOR -- AND THE BEHAVIOR OF THE YOUNG MAN SHE'S

WITH -- ARE THE KEYS TO HER BECOMING PREGNANT OR NOT,

  AND THE LITERATURE ON TEENAGE PREGNANCY CLEARLY IMPLICATES

ALCOHOL AS A KEY FACTOR IN THE BREAKDOWN OF A YOUNG PERSON'S OWN

PROTECTIVE AND PREVENTIVE BEHAVIOR,


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  WE CAN OPEN CLINICS AND RUN IN-SCHOOL SEX EDUCATION COURSES AND
ENLIST THE HELP OF CHURCHES AND SO ON, BUT IF WE DON'T RECOGNIZE
THE INFLUENCE OF ALCOHOL, THEN WE'RE WASTING A LOT OF TIME AND

MONEY,

  WHEN TEENAGERS DRINK, THEY DO THINGS THEY WOULDN'T DO WHEN
THEY'RE SOBER, AND ONE OF THOSE THINGS IS TO IRRESPONSIBLY CONCEIVE

A CHILD,

  ANOTHER AREA WE'RE CONCERNED ABOUT IS OCCUPATIONAL HEALTH AND
SAFETY, THIS IS AN AREA IN WHICH WE HOPE TO ACHIEVE SIGNIFICANT

GAINS BY 1991 AND EVEN GREATER GAINS BY THE YEAR 2000,


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  A WHOLE INDUSTRY HAS BEEN DEVELOPED WHICH NOW PRODUCES

PROTECTIVE CLOTHING AND FACE MASKS AND EAR PROTECTORS AND GOGGLES

AND A THOUSAND OTHER ITEMS FOR WORKER HEALTH AND SAFETY,

BUT NONE OF THESE ITEMS WILL PROTECT THE WORKER, IF HIS OR HER

JUDGMENT IS ALTERED BY ALCOHOL, SUCH WORKERS MIGHT AS WELL LEAVE

THEIR PROTECTIVE ITEMS IN THEIR LOCKERS, IF ALL THEY DO IS TAKE THEM

OUT ON THE JOB-SITE AND USE THEM INCORRECTLY UNDER THE INFLUENCE OF

ALCOHOL,


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  AGAIN, THE FUNDAMENTAL, SAFETY-ORIENTED BEHAVIOR THAT PROVIDES

BASIC PROTECTION FOR THE AMERICAN WORKER IS RENDERED USELESS, IF

THAT WORKER DRINKS,

CONTRARY TO ALL THE TX ADS, DRINKING A LOT OF BEER OUT ON THE

JOB IS NOT A MANLY THING TO DO,  IT'S STUPID, DANGEROUS BEHAVIOR,

SO I MAINTAIN THAT YOU WON'T GET VERY FAR IMPROVING ON-THE-JOB

SAFETY, IF YOU DANCE AROUND THE ISSUE OF ALCOHOL,

  I COULD GO ON THIS WAY THROUGH ALL THE OBJECTIVES THAT WE'VE

SET OUT AND I COULD SHOW YOU HOW AND WHY THE PRESENCE OF ALCOHOL

SUBVERTS EVERY SINGLE ONE OF THEM,


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BUT I THINK YOU GET THE MESSAGE BY NOW,

  THIS NATIONAL CONFERENCE, THEREFORE, IS, IN MY VIEW, A GREAT

DEAL MORE THAN JUST ANOTHER MEETING ON ALCOHOL ABUSE AND ALCOHOLISM,

  IT REPRESENTS TO ME A RESOUNDING OPENING SALVO BY PEOPLE WHO

3ECOGNIZE THAT AMERICA WILL ONE DAY HAVE TO CHOOSE BETWEEN ALCOHOL

4ND HEALTH,

BECAUSE WE CAN'T HAVE BOTH,


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  WE CANNOT CONTINUE TO HAVE HIGH LEVELS OF TRAFFIC IN ANY DRUGS

-- INCLUDING TOBACCO AND ALCOHOL -- AND STILL HOPE TO RAISE THE

HEALTH STATUS OF THE AMERICAN PEOPLE UP THERE ONTO THE HIGHER

PLATEAU WHERE IT OUGHT TO BE,

THAT'S WHY I THINK THE 16 OR SO PUBLIC HEALTH INITIATIVES

DISCUSSED AT THIS CONFERENCE ARE SO IMPORTANT,

  THOSE INITIATIVES PROVIDE THE DIRECTION AND THE RATIONALE THAT

WE ALL NEED, SO THAT WE CAN BEGIN TO DEAL IN A SERIOUS WAY WITH THE

ISSUE OF ALCOHOL ABUSE AND ALCOHOLISM IN OUR SOCIETY,


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   AND -- AS SECRETARY BOWEN CLEARLY INDICATED YESTERDAY AND I

COMPLETELY AGREE WITH HIM -- WE MUST DEAL WITH ALCOHOL, IF WE WANT
TO ACHIEVE ANY SUBSTANTIVE PROGRESS IN AMERICAN HEALTH STATUS ACROSS

THE BOARD,

  ONCE AGAIN, I WANT TO THANK THE SECRETARY FOR TAKING LEADERSHIP
IN THIS AREA AND FOR POINTING OUT TO THE REST OF US THE DIRECTION WE

OUGHT TO BE GOING,


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  AND I WANT TO THANK EACH OF YOU, WHO HAVE COME TO THIS NATIONAL

CONFERENCE, FOR BEING HERE,,,

FOR SHARING YOUR KNOWLEDGE AND EXPERIENCE IN THE DISCUSSIONS

THAT WERE HELD HERE YESTERDAY AND TODAY,,,

AND FOR CONTRIBUTING YOUR SPECIAL INSIGHTS THAT WILL HELP SHAPE

OUR NATIONAL AGENDA ON ALCOHOL ABUSE AND ALCOHOLISM,

THANK YOU,

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