Nutrition and Health Promotion: Presented to a Luncheon Meeting of the Wheat Industry Council, Washington, DC
This speech highlighted the connection between Americans' diet and their health, especially heart disease, a major focus
of the U.S. Surgeon General since Koop's predecessor, Julius Richmond, devoted to it a section of his path breaking report
"Healthy People: The Surgeon General's Report on Health Promotion and Disease Prevention," issued in 1979.
Number of Image Pages:
22 (1,288,340 Bytes)
1982-09-08 (September 8, 1982)
Koop, C. Everett
This item is in the public domain. It may be used without permission.
Medical Subject Headings (MeSH):
Nutritional Physiological Phenomena
Reproduction and Family Health
Nutrition and Health Promotion: Presented to a Luncheon Meeting of the Wheat Industry Council, Washington, DC" [Reminiscence]
Healthy People: The Surgeon General's Report on Health Promotion and Disease Prevention (1979) (in The Reports of the Surgeon General)
Deputy Assistant Secretary for Health and Surgeon General
US Department of Health and Human Services
Presented to a luncheon meeting of the Wheat Industry Council
September 8, 1982
(Greetings to hosts, guests)
I'm delighted to be here today to lend my support to a very important public health effort. I want to congratulate the
members of the Wheat Industry Council from moving ahead with your nutrition education program. It doesn't come a moment
too soon. All of us -- industry, government, and the voluntary sector -- need to get the word out to the American people about
the relationship between good health and good diet.
Your plan is a good one because it's based on a good message that needs a lot of public exposure. Wheat-based food can
be an individual's best one-stop source of carbohydrate, fiber, protein, vitamin B, and important trace minerals. Wheat
foods are abundant and inexpensive, yet they are not fattening. You can't ask for much more than that.
The food marketplace -- as you know better than I -- is full of highly competitive messages. And that's good . . . competition
is what this country is all about. But the public needs help in identifying the most useful messages, the ones that can really
contribute to a more healthful diet.
That's where your nutrition education program can be so very important. You and I know that wheat foods can strengthen
the diet without weakening the pocketbook. But everyone else should know that, too. So I encourage the wheat food industry
to do the best job possible in public education.
I say that not only for myself but for this administration as well. From the day President Reagan took office, he has consistently
looked to the private sector to make its unique contributions to progress in American life. The President's establishment
last December of the "Task Force on Private Sector Initiatives" was an important step in that direction. But there
are other methods for private sector involvement, also, especially when the activity requires substance and depth. I think
the Wheat Industry Council is providing just such an object lesson for others in the private sector to follow.
Granted, the council is here because Congress wanted it here. But unless I'm greatly mistaken, the proverbial "Act
of Congress" isn't a prerequisite for getting business, industry, and consumer groups to respond to a national need
for help. For members of this council, Public Law 95-113 has been useful -- but I think you would have arrived here anyway
I say that for several reasons, in addition to my faith in the private sector. First, people like to eat and they've always
wanted to learn everything there is to know about food. The cave drawings by prehistoric man, for example, were more than
random pictures of wild beasts: there were portraits of dinner. And we know that agriculture -- the cultivation of grains
-- and that domestication of food-producing animals signal the dawn of what we call "civilization."
Finally, a little closer to home, I think the idea of a "Wheat Industry Council" is important to anyone concerned
not only about your particular industry but about nutrition in America.
Our society has been gradually changing its patterns of food consumption. This, in turn, has produced several important changes
in the nutritional content of the American diet. According to the US Department of Agriculture, Americans have . . .
. . . increased their consumption of fat by about 35 percent between the years 1909 and 1980,
. . . the consumption of simple sugars and other sweeteners has gone up by 50 percent during the same seven decades,
. . . and there's also been a 44 percent drop in the presence of wheat flour in the per capita food supply.
Why is this important? For one thing, fat consumption has been associated with diseases of the cardiovascular system. And
were particularly uneasy about the increased consumption of products made with sticky sugars, which had been implicated in
a variety of disease conditions, such as dental caries. And we're uncomfortable with the diminished presence of whole
grains and fiber, because they have been a fairly cheap source of trouble-free carbohydrate and they perform other functions
in their passage through the human gastrointestinal system.
These and other changes in food use in the United States have had an impact on the health status of our citizens. But frankly,
we don't know just what the full impact has been. In addition, we have to pay special attention to a number of important
changes that have been occurring in the American diet in just the past 10 years.
On a per capita basis, for example, Americans are now consuming more low-fat milk, more chicken and less beef, more complex
carbohydrates, and more vegetable fats, such as margarine and shortenings. These dietary changes have taken place at the same
time that we're seeing a number of improvements in the health status of Americans: greater longevity . . . lower infant
mortality . . . and a decline in the overall death rate, including a rather remarkable drop in the death rate for heart disease.
We can't say for sure how much of this can be credited to diet and how much should be credited to better medical care
and improved population screening, such as the early detection and treatment of potential heart disease and stroke victims.
This kind of information we hope to acquire through more research and improved systems of collecting data.
On the research side, we've been given a great opportunity by Secretary Richard Schweiker. Just about a year ago, on September
16, to be exact, the secretary launched his "Research Initiative in Nutrition" for our Department of Health and Human
Services. He strongly believes -- as I do -- that we need to do a better job pooling our information and resources in order
to understand more clearly and more efficiently just what the relationship is between human nutrition and the maintenance
of good health.
On the data side, our department and the Department of Agriculture are now cooperating to a much greater extent in the gathering
of nutritional and dietary information from among the American people. This cooperative effort -- known as the "National
Nutritional Monitoring System" -- was begun under past administrations, has been a special interest to the Congress, and
is now in full swing under the Reagan administration.
In these and other ways, I think our two departments are beginning to get a better handle on what people eat and why . . .
what the composition of the food supply is . . . what the research priorities ought to be . . . and what kind of information
is needed to help both the public and the private sectors deliver an improved diet to the American people.
Let me add that, as important as these government efforts are, they would not be possible without the strong cooperation of
the private sector. The Departments of Agriculture and Health and Human Services value the participation of members of the
food industry. Without your interest and help -- and without the assistance of consumer groups, nutritionists, dietitians,
the academic community, and many others who work with the Wheat Industry Council -- we simply could not get the job done.
But all these activities in nutrition research and data collection really make sense, in my opinion, when they are evaluated
in the light of the health needs of the American people. You can't stress this point too often. And it's particularly
true in this current period of scarce resources. Every investment has to count . . . each decision has to keep us moving in
the right direction. And I think we may have a document -- a kind of roadmap in public health -- that serves this very purpose.
Not long ago, the public health service published a document called Healthy People: the Surgeon General's Report on Health
Promotion and Disease Prevention. That report brought together a wealth of material contributed by some 2,000 non-government
experts representing the medical, behavioral, statistical, and social sciences. From that report the public health service
has been able to drop a set of national health goals for the year 1990. Among these goals are several that can best be achieved
by combining improved nutrition with new developments in the delivery of health and medical care.
I'd like to share with you a few of the main health goals we hope to achieve in this decade. They are organized according
to population age groups. I'll pay special attention to those health goals with a strong nutrition component:
- At the time Healthy People was published, in 1979, the infant mortality rate in United States was 13.2 deaths per 1,000
live births. We want to bring that rate down to fewer than nine deaths per 1,000 live births by 1990. Our latest provisional
estimate, by the way, puts the infant mortality rate 11.1.
Low birth weight is the greatest single hazard for the newborn. Two of every three infants who die within their first 30 days
of life weigh less than 5 and 1/2 pounds. But even if they survive beyond their first 30 days, these low birth weight babies
have a 20 times greater chance of dying before their first birthday.
What can we do about this? First, we need to do everything possible to provide mothers -- especially young, first-time mothers
-- with good prenatal care. And diet is a critical factor in such care, since pregnant women who lack proper nutrition have
a greater chance of bearing a low birth weight infant or stillborn baby.
Maternal nutrition is one of the six key points in the national program called "Healthy Mothers, Healthy Babies."
This program, by the way, represents a unique partnership between government and the private sector. The Public Health Service
is joined by more than 50 national professional voluntary organizations and private for-profit corporations in this important
coalition dedicated to improved maternal and infant health.
This coalition will soon be distributing colorful 5 x 7 take-home cards to clinics around the country. These cards will get
a vital health message across to pregnant women. I think you'll appreciate the first few sentences of one of these cards.
"What you eat has never been so important." That's in bold-face type. Then it goes on to say, "The food you
eat nourishes you and your unborn baby. So eat a variety of good foods every day. Choose foods such as these, and be sure
to select some from each group:
"Whole-grain and enriched breads, cereals, rice, oats, grits, pasta, tortillas, and cornbread." And then it goes on
to cover other foods as well.
If we could somehow guarantee every mother a healthy diet, we would see a sharp decline in the numbers of low birth weight
babies -- and, as a result, a parallel decline in infant mortality rate.
- An old Chinese proverb goes like this: "Patriotism is the love of the good things we ate in our childhood." I wouldn't
call that inscrutable. So, for patriotic reasons -- and for every other good reason, too -- we want to improve child health
and foster optimal child development.
If we are successful, the death rate for children 1 through 14 years of age should drop by at least 20 percent by 1990. To
do this, we need to stay on top of an already successful child immunization program . . . we need to deal with child abuse
through a variety of social and health agents . . . and we need to raise the level of public understanding of the role of
nutrition in child health.
Although iron deficiencies still exist among poor and disadvantaged children, most American children are not undernourished.
As a matter of fact, most nutritional problems among our children come from overeating and eating the wrong things.
We have very little information about the extent of obesity among children -- except that we know it's a problem. We've
learned that from our surveys of adults who are obese: that is, people who are 20 percent or more over the desirable weight
for their age, sex, and height. For example, about a third of all adults who are obese were obese as children. Obesity is
a key risk factor behind hypertension, diabetes, and heart disease, a situation which makes it essential that we focus on
ways to control obesity among children. And we need to begin right now.
- We also hope to reduce the mortality rate among adolescents and young adults, ages 15 to 24. The first order of business
would be to somehow reduce the number of deaths caused by motor vehicle, which are the leading cause of premature death among
teenagers and young adults. But alcohol is such a key factor here: half of all high school students drink in cars. Almost
1 in 4 drink and then drive. Anything we can do to fight alcohol consumption among young people I think we are duty-bound
to go ahead and do. Young lives are at stake.
Just last week, Secretary Schweiker announced a major administration initiative to fight teenage alcoholism. He reminded Americans
that "8,000 teens and young adults die in drinking-related auto accidents every year. Another 40,000 suffer injuries."
He said -- and I agree -- that "the killing must stop." Under the Secretary's guidance, our department will strengthen
working relations with parents and health professionals in this crucial struggle to save young lives.
Strictly speaking, this is not a nutrition issue, although the Department of Agriculture does include alcohol in "Food
Group 5," along with fats and oils. But it is the issue right now, as far as the health status of teens and young adults
are concerned. I think every American needs to understand this and somehow contribute to reversing this tragic situation.
- Another goal for our society in this decade is to reduce the mortality rate for persons age 25 through 64 by at least 25
percent. And we're making good progress:
- Death rates are declining for nearly all major causes of death in this age group, including heart disease and stroke.
- While the cancer death rate has crept up for persons over age 50, it's been declining for persons under the age of 50.
That's all very good news, but we may not be able to maintain a record of progress unless this age group -- the vital,
productive, governing group within American society -- gets better control of its diet and certain aspects of his lifestyle.
Elevated blood cholesterol strongly associated with premature heart disease, our leading killer, and, to a lesser extent,
with stroke. Other factors associated with these diseases are high blood pressure, excess weight, and sodium consumption,
particularly among salt-sensitive people. These factors can all be controlled through nutrition and diet.
Of course, the leading factor associated with heart disease is not a nutritional issue. It's cigarette smoking, an issue
of lifestyle. In this connection, I hope you'll read the next Surgeon General's report on smoking and health due to
come out early in 1983. It will be devoted to the topic of "Smoking and Cardiovascular Disease." I think you'll
find that the evidence linking these two is just as compelling as the evidence that has linked smoking with cancer.
We can't tell people how to live their lives. But we have the responsibility to lay before them as much solid information
as we have to help them make their own best decisions. The Surgeon General's reports are part of that information in public
education process. The Wheat Industry Council's nutrition education program is another.
Also part of that process with the publication in 1980 of the "Dietary Guidelines for Americans," jointly released
by the Departments of Agriculture and Health and Human Services. The guidelines apply to all Americans, of course, but has
special relevance to people who are between ages 25 and 64.
The guidelines emphasize moderation, variety, and balance. We continue to strongly endorse these guidelines, which take special
note of those products and nutrients that are key contributors to illness and death in this country: sodium, all fats, cholesterol,
alcohol, and sugar. They also urge the increased consumption of wheat-based foods and grain products, along with fruits and
Here again, I want to commend the food industry for supporting those guidelines and for incorporating some of that information
into their advertising and consumer information materials. I look at the nutrition education program of the Wheat Industry
Council is another aspect of industry support for these common-sense and commonly accepted "dietary guidelines."
Cancer, the second leading cause of death for adults, seems related to diet, also. Just this past June, the committee on diet,
nutrition, and cancer of the National Research Council released the results of its review of all types of epidemiological
and laboratory studies on diet and cancer. The committee released its proposed six interim guidelines with the following introductory
"It is not now possible, and may never be possible, to specify a diet that would protect everyone against all forms of
cancer. Nevertheless, the committee believes that it is possible on the basis of current evidence to formulate interim dietary
guidelines that are both consistent with good nutritional practices and likely to reduce the risk of cancer. These guidelines
are meant to be applied in their entirety to obtain maximal benefit."
Please note that these are interim guidelines and that much of the evidence comes from animal models and the correlation of
certain human cancers and ethnic diets. These interim guidelines urge reducing our consumption . . .
. . . of foods high in saturated and unsaturated fats, which are linked to breast and colonic cancers
. . . of salt-cured, smoked, and pickled foods, which seem to contribute to stomach and esophageal cancers
. . . of alcoholic beverages, especially in combination with smoking, which increases the risk of cancers of the upper gastrointestinal
and respiratory tracts
. . . of certain non-nutritive constituents of foods, naturally or unintentionally introduced during production, processing,
packaging, or storing
. . . and of certain additives that are intentionally introduced but not yet fully evaluated for their potentially carcinogenic
The committee also emphasized the importance of including whole-grain cereal products in our daily diet, along with fruits
and vegetables. The report is quite clear. "In epidemiological studies," it says, "frequent consumption of these
foods has been inversely correlated with the incidence of various cancers." In other words, where the consumption of whole-grain
cereal products, fruits, and vegetables goes up, the appearance of cancer tends to go down. This is another area where additional
research is needed to clarify this relationship between cancer and the consumption of certain foods.
- The last age group for which we have 1990 health goals includes men and women age 65 and older. Americans are living longer,
but we aren't immortal. We may prolong life a bit, but not forever. So our goals for senior citizens are to improve their
health and their quality of life, reduce the average number of days of restricted activity each year because of acute or chronic
conditions, and foster independence -- rather than dependent -- ways of life.
Just about everything I've said so far for every age group also applies to the elderly. But I would add this one caveat:
the elderly are many times more vulnerable than the rest of us to diseases and death brought on by poor nutrition. The elderly
also tend to live on low or marginal incomes . . . they often take a variety of medications which can affect their approach
to food . . . and they experience mild to severe sensory deprivation. All these are factors in their ability to properly manage
The Department of Health and Human Services spent $160 million for nutrition research in fiscal 1981. About 93 percent of
that was NIH money. And among the areas being pursued is this one concerning nutrition for the elderly. There is so much we
still don't know about the aging process. But we clearly need to learn -- and as fast as possible -- some basic information
about the nutrition needs of this very vulnerable group.
These, then, are the goals of the five major age groups in our society, as outlined in the Surgeon General's report, Healthy
People. As you can see, they deal with the major health issues that confront each population group and they all have a strong,
important nutrition component.
Good nutrition is as much a matter of maintaining one's social and emotional health as one's physical health. For
example, breast-feeding is the best possible way to nurse the newborn not just because of the high nutrition value of breast
milk but because it is the beginning of the crucial element in social bonding between the mother and her child. At the other
end of the age scale, elderly people often prefer to eat their meals with others, with age peers, neighbors, or grandchildren.
G. K. Chesterton said he thought "There is more simplicity in the man who eats caviar on impulse then the man who eats
grapenuts on principle." I agree. But I would add that there is more sophistication to the man who knows when to eat both.
And that's the kind of decision that can come only with a working knowledge of good nutrition.
After thumbing through your planned nutrition education program, I believe that's what the Wheat Industry Council is after
-- giving the American people a working knowledge of good nutrition, with special emphasis on the role of wheat-based foods.
I hope the wheat food industry will support the work of this Council, so that we may see the American diet make a stronger
contribution to the improvement of the health status of all Americans of all ages.
Thank you for inviting me here today. Again, best wishes on your nutrition education program.