REMARKS

BY

C, Everett Koop, M.D., Sc,D,
  Surgeon General
U, S, Public Health Service

      and

Deputy Assistant Secretary for Health
US. Department of Health and Human Services

Presented at the National Celebration

  Golden Anniversary of
Maternal and Child Health, Title V
   Washington, D, C,
    June 8, 1986


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Greetings to Hosts (Honorary Committee),
dignitaries in presidential box ( Mrs. Bennett, Mrs.
Nancy Thurmond, Dr.and Mrs.Hutchins and The Drs.
McPherson) Program Participants, and Fellow
Friends of mothers and children:

I am pleased to join in this celebration of "Healthy
Mothers, Healthy Children" - the Golden
Anniversary of Maternal and Child Health, Title V.
The number of editorials, proclamations and
celebrations occurring across the nation
during 1985 has been an inspiration. President
Reagan expressed this in his Proclamation of Child
Health Day, 1985:


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When he said:

"-As we celebrate 50 years of cooperative
endeavor in supportofmaternaland child health,we

should rededicate ourselves to the expansion of
state and local responsibility in this extremely
important field. We must do everything necessary
to protect the health of our mothers and children.

We must remember that the best way to dothisis
to entrust the responsibilities and the needed
resources to the states and communities in which
they I ive .I'


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As your Surgeon General,and as one who spent35
years of professional life caring for children, I join
the ranks of those specifically concerned with
public health and as one dedicated to the highest
standards of health care for children and their

mothers.

In 1798,0ur second president,John Adams,
established the first marine hospital in Boston,
                       s
Massachusetts. It was the beginning ofwhatwe
now know as the U.S. Public Health Service. During
the almost200-year history of the PHS, there
have been 13 Surgeons General. We havetriedto
follow the example set by Benjamin Waterhouse,
controversial but effective director of the first

marine hospital; those of us in Federal medicine
should lead, not merely follow ,


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Maternal and child health has not always been
viewed as the concern of national leaders in public
health. The year 1929 was seen not only as the
beginning of the great depression for the economic
health of the country, but as a significant setback

for child health in this country also,

It was 1929 that saw the demise of the

.

Sheppard-Towner Act, the first maternity and
infant care act providing funds to the States. Child
health advocates were discouraged because of the
oposition to the legislation exemplified by the
following comments:


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Listen to this:

o "[The legislation is1 sponsored by endocrine
perverts and derailed menopausics";

Here's one:

o "[The] fundamental doctrines [are1 drawn

chiefly from radical, socialistic and bolshevistic
philosophy";

Now hear this:

o )) [The legislation] turn(s) over questions of
infant mortality and infant care- to an
aggregation composed almost exclusively of
spinsters,.. a wise man places all important
tasks in experienced hands";


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And finally:

o " Official meddling cannot take the place of mother
love *`I

During that period of economic stress, the
Sheppard-Towner Act was. opposed by the
                                                        
American Medical Association, the Catholic
Church - because of its fear of government
interference cloaked in governmental
assistance-- and, if you can believe it,  the

Public Health Service: a trio of formidable

opposition that contributed to the sense of a

significant setback for child health.

Actually, there was a renewed surge of activity
in reaction to the act's termination:


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o The pediatricians broke with the American
Medical Association over the event and formed
the American Academy of Pediatrics in 1930;

o The 1930 White House Conference on Child

Health and Protection produced a children's
charter containing nineteen vibrant statements
as to what every child needs for education,
                  s
health, welfare and protection.

o The Children's Bureau designed a new and
stronger plan that the first woman cabinet
member,Frances Perkins, presented in her 1934
annual report.


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Will Rogers, the dry witted pundit of that era,
put the discussions between the end of the
Sheppard-Towner Act and the enactment of the
social security act into a humorous perspective:

Said he:

"I am mighty glad so many people in America are
taking up the children;s work, being a ranchman
and a farmer, and also a child owner, I have
often wished that when one of my children get
sick I could wire or call some government expert
and have him look after them, like I can do if one
of my cows or pigs get some disease."


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He continued, "If your fertilizer is not agreeing
with your land, the government will send a
specialist, but if the food is not agreeing with
the baby, why, we have to find out what's the
matter ourselves, and lots of times parents
mean well but they don't know much' So I am
          :
glad that you people. are interested `in children.
course they are a lot of trouble, but we just
don't seem to be smart enough to find something
that would be less trouble that would replace
them .`I

"That's the only thing we are shy now is
synthetic children,"

And finally: "It's not a bad idea whoever
thought of doing something for the children, if it


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works and you improve them, I will send you
mine ,"

The 74th Congress passed Madam Perkins' plan
and incorporated the concept of government
responsibility:

o By requiring matching funds from the states,
Congress forged a federal-state partnership and
gave the individual state a voice in planning,
directing, priority setting and designing
programs appropriate to the local level.

The Social Security Act was enacted August 14,
1935. By 1936, all but two states (Oregon and


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Illinois) had divisions of Maternal and Child
Health and all but four had full time physician
directors, In addition, 38 of the States had
established crippled children's services units,

The 1936 Federal Title V `budget was $6 million,
by 1960, 25 years later, it was $33 million and
in 1985, it was $478 million in actual, not
constant, dollars,

What are some of the contributions of the
Maternal and Child health program in the -past 50
years? A baker's dozensampling might include:

* Reduction of the maternal mortality rate from
570 per 100,000 live births in 1935 to 8 per
100,000 in 1983;


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* Reduction of the infant mortality rate from
55,7 per 1,000 live births in 1935 to 1 1 ,2 in

1983;

o The majority of all deliveries now occur in
                            _ .
hospitals or birthihg centers #and, are. attended by
trained professionals;

@ Expansion of Crippled Childrens Services Y the
first federally funded medical care program-
from chiefly orthopedic problems to most
disabling conditions and many chronic illnesses;


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@ Regionalization of services for newly
developed programs such as congenital heart
disease in the 1950's, for low prevalence
diseases, such as hemophilia and juvenile
rheumatoid arthritis in the 1970's and for
systems of care requiring both primary and high
technology services such as perinatal' care in the
                                                              
1980's;

o Prevention of mental retardation, early
assessment of suspected developmental delays
and the provision of community services for the
mentally retarded;

o Establishment of universal newborn screening


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services;

* Advances and reforms in prenatal and
perinatal nutrition services including education
and counseling;

o Inclusion of social services as a vital
component of public health services,

o Development and implementation of the
concept of a health team to provide services to
the child and family;

o Promotion of maternal and child health through
advisory groups, conferences, publications and
demonstrations,


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* Development and provision of services for
adolescents with special needs; and

@ Training of thousands of health professionals
of many disciplines in the philosophy of maternal
and child health;

The golden anniversary is not all celebrative.
Some part of it is admonitory. On this
significant birthday, I trust you will .understand
my concern as I assume an admonitory role for a
minute or two,


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A nursing leader in maternal and child health, Dr,
Juanita Fleming, writing in the American Journal
of Maternal/Child Nursing in 1985, noted some
major changes occurring within American
society that will profoundly affect the lives and
health of pregnant women, children, and their
families:

o The average age of Americans is increasing
and as it does, a less healthy population can be
expected;

o A more culturally diverse population is
emerging with increasing percentages in the
hispanic, black and asian minorities;


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* Distribution of people and wealth is changing
from the north to the south and from decaying
large industrial cities to small town and rural

areas;

* Changes in family structure and roles are
occurring. Today we have nuclear families,
extended families, single-parent families and
aggregate families that is, parents who both
bring children from previous marriages to the

new family).

* The number of womenworking outside the
home is increasing. Children of these diverse


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families may lead very different lives and have
different perceptions of the world,

* Working with families will become more
complex and our current services and
institutions may be inadequate to the task of
providing the various types of support the
families will need to adjust, adapt and cope;

* Technological advances are revolutionizing
how some health conditions are diagnosed and
treated. The massive amount of new information
available to people may interfere with their
ability to make choices;

* The cost of health care; [with] outpatient and
urgent-care centers competing with hospitals;


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[and I the increase in investor-owned hospitals
and mul tihospi tal systems may lead to
decreasing access to health care - already a
significant problem for low-income families not
eligible for medicaid;

o Prospective payment will affect the delivery
of health care services. Both the use of DRGs in
hospitals and the growth of HMOs and related
plans are changing the emphasis in health care
services from acute, curative, hospital-based
systems to new systems emphasizing prevention
of disease, promotion of health and health
maintenance- often under the banner of

cost-effectiveness,


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Will quality of services and availability of
services to the populations for which we have
prime responsibility receive adequate attention?

Other issues I would add to that list include:

o The slowing of the rate of decline of the infant
mortality rate in the past two years, the fall-off
in the percentage of women receiving early
prenatal care, and the constant rate of
low-weight infants born in the 1980's;

+ The reappearance of the medical malpractice
issue in maternity care which has decimated the
number of health professionals providing
maternity care;


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a The nearly 42 million children and youth
between the ages of 10 and 19 experiencing such
serious threats to life itself, and to productive
roles as adults such as accidents, substance
abuse, sex,ually transmitted disease, chronic
disabilities (including mental illness) and suicide',

It is estimated that as many as 20% of these
adolescents have some form of untreated

medical problem,

For those'. with continuing health problems, we
must do more to assist their successful entry
into the world of adult services;


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o Poverty itself is a barrier to health care:

21% , or about 12 million of all children are

poor

Nearly l/2 , or about 4 million black children

are poor

Nearly l/3, or about 2 million hispanic
                  w
children are poor

6.7 million children live in female headed,

single-parent households

This latter figure raises additional societal
issues of

Day Care


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Maternity Leave
Health Insurance Coverage
Equality of wages

Martha Mae Eliot,an early andlonglaborerin
the vineyards of Maternal and Child, Health in this
country, once said: "The early days ofthese
programs were exciting days -
Days of long and animated discussions
                  a
Days of exploring possibilities
Days of questioning
C)ays.of refreshing advice and.aid from people in
many professions, and
Days of great satisfaciton as we saw functioning
programs emerge ."

I would add- days of money.


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Today, as we review our common history,
celebrate our accomplishments and look
forward to our challenges in continuing to
promote the health of mothers and children in an
everchanging environment may we be able to say
that all our days .have been exciting. days:

And in future years - in the year 1998 when we
celebrate the 200th anniversary of the Public
                  .
Health Service and in the year 2035 when we
celebrate the 100th anniversary of Title V
Maternal and Child Health, may we continue to
say about Maternal and Child Health programs, "
The days of these programs are exciting days.


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I believe that we can welcome and even relish

the challenges and the opportunities at hand. I
particularly welcome our chance to form many
more coalitions of maternal and child health
advocates from many,.many elements of our
society, from Federal and State, regional and
local, public and private, majority and minority,
profit-making and philanthropic, professional and
parent groups and from a grand variety of
                   *
interest such as exemplified by the great
multiplicity of groups here this evening in
celebration of 50 years of achievement.


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It seems to me that America has shown, over and
over again, its extraordinary ability to identify
.problems and to form organizations, committees,
task forces - whatever necessary- to treat all
aspects of problemsand to achieve meaningful
solutions. Let us dedicate ourselves, tonight to
50 years, (or whatever portion the good Lord
may give us) of increased cooperation and
expanded participation in and commitment to the .
improvement of maternal and child health in this
marvelous country of ours.


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I welcome the opportunity, therefore, for the
Public Health Service to join those whom some
called"the little old ladies in tennis shoes" ( who
were really giants in a new field of service to
women and children) as we march to the
drummer of improving the health of mothers and
children now and in the -future.

Thank you for inviting me to the party.