Surgeon General, U.S. Public Health Service and Deputy Assistant Secretary for Health
U.S. Department of Health and Human Services
Presented to the 1985 Graduating Class of Rockville (MD.) High School at Constitution Hall, Washington DC
June 10, 1985
Members of the graduating class of 1985 . . . Principal DeBalso . . . parents and family of the graduates . . . other honored
guests . . . and friends:
I'm very pleased to be your commencement speaker this evening. I'll confess to you that I was both surprised and delighted
when I received the invitation last March from your senior class president, Mr. Guckes, your class sponsor, Mr. Hagy, and
Principal DeBalso. It was a very fine letter . . . especially the line that said, "We believe the Rockville High School
students, staff, and community will benefit by your presence at the Commencement." I really liked the sound of that. It
had a nice ring.
But was that the innocence of youth? With that belief . . . or just hope?
I don't know, but it was so direct and so cordial and so optimistic -- the kind of language most adults have since forgotten
how to write -- that I said, "Absolutely yes. I'd love to come join the festivities on the night of June 10."
And then, little by little, I began to sense another idea take shape. And this was the idea that began to dominate my thoughts:
Like so many other people in Washington, I've come here from "someplace else" . . . I planned to be here only
"for the duration" . . . I didn't really see myself as being involved in the life of this community.
And a little voice inside me said that that just wasn't right. I do live here now . . . this is my home . . . and you
are my neighbors and this really is my community. You were joy and pride and excitement on such an evening as this ought to
be my joy and pride and excitement as well. And I can honestly say that it is.
So I'm here this evening as, yes, the Surgeon General of the U.S. Public Health Service. And, yes, I am here is the government's
"Chief Medical Spokesman," as your letter phrased it.
But I'm also here is a very proud neighbor . . . proud of your accomplishments at Rockville High School and also proud
of your attitude of hope and optimism about the future. I'm truly proud to be involved in this traditional ceremony --
this "rite of passage," as it were -- through which you move into your adult years as Americans working . . . studying
. . . and growing old in a demanding but always fascinating world.
My message will not be long this evening, because I'm going to limit it to just that challenge of moving ahead -- with
optimism -- in today's world.
As you know already, or as you surely suspect, it's not an easy world that you're inheriting. Finally, it's not
an easy place for any of us, no matter how old or young we are.
The daily paper and the TV evening news give us, each day, a thousand reasons to be embarrassed, if not downright discouraged,
with the conduct of mankind.
Is there some method we might adopt to help each of us fight off such discouragement? Yes, I think there and I want to share
it with you tonight. It's not a secret particularly, yet I don't think people talk about it as much as they should.
The first part of the message is the essential part, and it starts deep within ourselves. Each one of us, from time to time,
can be confused about a lot of things in this world -- Lebanon and the space shuttle, tax reform and long-distance phone service
-- but we must never allow ourselves to become confused about . . . ourselves:
Who I am . . .
What I stand for . . .
What I care about . . .
And who I care about.
These are questions that each of us has to answer . . . and each of us must also be able to live with the answer.
You asked me to come here tonight to address you as your country's "Chief Medical Spokesman." And that's what
I'm doing, believe it or not.
After all the years of wonder drugs and "CAT" scanners and laser surgery and vaccines, we now realize that the essential
elements in public health -- and a key factor in successful medical practice -- is simply the way each individual values her
or his own life . . . how you process your own experience . . . and how that helps give you a better look at your own future.
Let me give you just two little illustrations.
First, as most of you know, when I'm not in my office up in the Parklawn building, and out in the warehouse stamping those
little warnings on millions of packs of cigarettes. Honestly, it's grueling work. And every now and then, I got to go
out and stamp a billboard and I really hate to do that.
But those little messages hardly do justice to the scientific record built by medical researchers over the past 25 years.
That record clearly proves beyond any reasonable doubt that smoking cigarettes is associated with -- and causes -- the three
major killer diseases in America: heart disease, cancer, and stroke.
This year, we estimate that over 350,000 Americans will die up to 20 years "before their time" because of the disease
caused by -- or aggravated by -- cigarette smoking.
Every informed person knows this is true. Even the people who run the R.J. Reynolds Tobacco Company know this. I read in the
newspapers that they're about to buy the Nabisco Company and I personally think they're doing it because the R.J.
Reynolds Tobacco Company knows that there's a big future in cookies . . . but there's just no future in cigarettes.
Nevertheless, about a third of all Americans over the age of 20 still smoke cigarettes . . . about 50 million of them. Nearly
all of them are high school graduates who read . . . and who listen . . . and who may even have a passing knowledge of the
scientific method. They've been exposed to a great deal of health risk information concerning cigarettes.
And yet, they continue to smoke.
We have no vaccine to prevent this. We have no terrific technology . . . no laser surgery . . . nothing. The best we can offer
are some training courses and some substitutes to get a smoker through the withdrawal period. There's no magic to any
This problem is clearly related to each person's own sense of self. In fact, most of the new and serious research in smoking
these days it's not only biomedical . . . it's also biobehavioral.
Knowing the serious health risks involved, some people still smoke probably because they haven't yet come to terms with
her own personal worth. They haven't yet dealt seriously with their own lifetime priorities.
In other words, the negative health behavior among smokers does seem to reflect a desire on their part -- for whatever reasons
-- to ignore or to disbelieve the available scientific data on the health risks involved. But I would suggest that such behavior
may have another basis as well.
I think many smokers would also like to sidestep those really tough questions of personal value . . . the ones that challenged
them to think about who they are . . . what they stand for . . . and who and what they care about. They're uncomfortable
questions to face, yet they seem to lie at the heart of the way each of us decides how were going to take care of our own
health and the health of the people we love.
So I'm asking each of you here tonight -- regardless of your age, whether you're the student or the parent, the teacher
or the principal -- I'm asking each of you to take the first and most effective step to ensure a life of good health and
well-being. That step is simply this:
Recognize that your life has value . . . that it is irreplaceable . . . that it ought not to be drastically shortened through
risky, life-threatening behavior . . . and that such a recognition on your part means you do stand for something positive
and you care about something positive: and that's you.
If each of you would do that, it would do wonders for the overall health status of our society and, frankly, it would also
make life a whole lot easier for the Surgeon General of the United States.
I said I had two examples relating health and human behavior. Smoking and health was the first one. Here's the second.
It involves you as a person -- and also how you affect others.
No, I'm not going to talk about drunk driving. I could . . . it's extremely important . . . but I'm sure you all
know what I'd say and I hope you would all agree: when it comes to drunk driving -- don't.
Instead, I'm going to talk about pregnancy, childbirth, and parenting. As we experience that constellation of human life
cycle events, we reveal exactly who we are and what we stand for. But we also profoundly influence a second human life.
I realize that for most of you the idea of pregnancy and childbirth is furthest from your mind. You may be heading for college,
for vocational or career training . . . you may be about to enter the business world . . . or whatever. That's fine.
But every woman in this audience between 16 and 44 has the potential to bear children, if you haven't already. And as
for the young women of the class of '85, our statisticians indicate that nearly 70 percent of you will have one or more
children within the next 20 years.
So, while this subject may not be imminent, it is certainly pertinent.
The single most important contribution to a successful pregnancy and delivery is early and consistent prenatal care. Every
year, of the 3 and a half million babies born in this country, a certain small percentage are handicapped or injured in some
way. One cause of these problems is genetic, and we're still trying to learn about that.
But the next most frequent cause is the behavior of the mother . . . the fact that she does not begin within the first month
of her pregnancy to get routine, professional, prenatal care. As a result, some problems that develop during the pregnancy
term -- problems that can be corrected simply through diet or medication, for example -- are not caught and both the mother
and her baby suffer the consequences for the rest of both their lives.
Many adult disease conditions of the nervous system, the digestive system, the heart, or the immune system, for example, seem
to have begun before childbirth.
These conditions may not be fatal. But they can deprive the individual -- whether still a baby, a student, young adult, or
older working adult -- of the kind of full and healthy life each one deserves.
Healthy mothers and healthy babies make a healthy society. It's just that simple. The key to this, of course, is somehow
to guarantee that they will, indeed, be healthy.
From the research that's been done so far, we now conclude that any guarantee for the baby depends on whether or not the
new mother-to-be signs on for routine prenatal care as soon as she knows she's pregnant. If she feels good about herself
and cares about herself and the baby that's on the way, she'll sign on.
And, gentlemen, the same principles apply to you.
For centuries, medicine has paid very little attention to the role of the father during pregnancy. He's been an object
of much humor, but that's about it.
But is now fairly clear that the father's attitude toward pregnancy and childbirth can be crucial to the mother's
decision to get good prenatal care.
This information, by the way, is neither "anti-feminist" or "pro-feminist." It's just the new parents
are much better parents if they work at parenting together.
The way each father and mother functions at this time is probably the most important partnership event in human history. Talking
things through together, helping each other emotionally and physically, sharing concerns, asking questions together and obtaining
answers . . . all these are activities which the father not only shares but often will initiate.
Where that kind of partnership has existed from the beginning of a pregnancy, we are now led to expect a much higher percentage
of distress-free deliveries in normal, healthy babies.
Where the father is absent or uninvolved -- where he is, for example, unsure of himself and of his role and unable to declare
who and what he really cares about -- in those circumstances we tend to see pregnant women under stress, higher health risks
for them and their babies, and more troublesome deliveries.
It seems so obvious to us now, but were just beginning to understand the full significance of the idea in traditional biomedical
and biobehavioral terms:
That is, good fathering is every bit as crucial to maternal, infant, and child health as good mothering is.
There was a time in this country -- and it wasn't so long ago -- that we invested great amounts of the taxpayer's
money into hospitals and clinics and nursing homes. It was an important effort, but it was not the vital effort.
Next, we poured a great deal of money into schools of medicine and nursing and provided funds to cover tuition and laboratory
fees for students. This is important, also, but I'm not sure that it was the vital element in American health care either.
No, I'm beginning to think -- along with many hundreds of my colleagues -- that the future good health in our society
can never rely purely on outside influences, such as facilities and professional help.
Instead it must be grounded in the healthful behavior . . . the thoughtful, careful attitudes . . . and the personal human
investment of interest and care and value in one's own health and well-being.
When that becomes universally true, then behaviors such as smoking will no longer threaten the lives of our citizens.
And it will be at such a time that will be able to see even greater advances in infant and child health, thanks to responsible
attitudes on the part of both fathers and mothers.
I think we're heading in that direction and, with the help of everyone here this evening, young and old alike, we'll
Now, I want to sincerely wish each member of the class of 1985 of Rockville High School the very best that the years ahead
may bring . . . that your joys be shared by your families and friends . . . and that America continues to be as good to you
as I know you will be to America.