While the United States has the most technologically advanced health care system in the world, the nation is failing to meet the health care needs of a large segment of its population, namely members of minority groups, U.S. Surgeon General Dr. David Satcher said during a recent visit to Yale. Eliminating disparities in health on the basis of race and ethnicity is both his number-one priority and greatest challenge, the Surgeon General told the audience that filled the Medical Historical Library on March 24 to hear him speak. He addressed the topic "Towards a Balanced Community Health System: Opportunities and Challenges" at the 51st annual meeting of the Associates of the Cushing/Whitney Medical Library. (See related story.) Satcher offered some staggering statistics to illustrate what he called the "tremendous disparities" in the health of Americans. He noted, for example, that an African-American baby is twice as likely as a white baby to die in its first year of life; that Vietnamese women under the age of 65 are five times as likely -- and Hispanic women twice as likely -- to develop cervical cancer as their white counterparts; and that African-American males have double the risk of developing prostate cancer as white men. Furthermore, Satcher said, American Indians are at least three times more likely to be diabetic than whites. "It's time to close that gap," stated Satcher, noting that it is the goal of all federal health-related agencies, as part of President Bill Clinton's "Race Initiative," to eliminate such disparities in the health of Americans by the year 2010. To reach that goal, the nation needs to achieve a balanced community health system that combines health promotion, disease prevention, early detection and universal access to care, Satcher said. A community-based approach, he explained, would include partnerships among public health agencies, churches and other community organizations that would target the most "vulnerable members of our society." "[T]o the extent that we respond to the health needs of the most vulnerable among us, we do the most to promote the health of the nation," commented Satcher. In conjunction with the Department of Public Health, Satcher and the U.S. Public Health Service have identified six areas on which to focus efforts to enhance the health of minority populations. These include reducing risk factors for infant mortality, HIV/AIDS, cardiovascular disease and diabetes, increasing child and adult immunizations, and promoting cancer screening and management in underserved populations, Satcher said. "The commitment to eliminate disparities in health is not a zero-sum game," the Surgeon General noted. "You actually don't have to take anything away from anybody -- any group -- to improve the health of another group." While Satcher admitted that "some people may be cynical about the reality" of achieving the nation's goal, he pointed to a steady increase in childhood immunizations as an example of how an effort involving community partnerships and targeted at specific populations can be successful. In 1993, only 55 percent of American children were immunized by the age of two, Satcher said. In just two years, almost 80 percent of U.S. children were immunized. This was achieved, he explained, by developing registries which made it possible for physicians to know the immunization status of any child they treated, and through community-based initiatives, such as partnerships between local public health agencies and the Women's, Infants & Children (WIC) program, geared toward informing parents of the importance of having their children immunized. "[By 1995], there was not a single group -- African American, Hispanic, American Indian or white -- that had an immunization rate of less than 70 percent," explained Satcher. In addition to ensuring that all American children have a "healthy start" through quality prenatal care and immunizations, a balanced community health system would also "promote healthy lifestyles," by encouraging "physical activity, good nutrition, the avoidance of toxins such as tobacco and illicit drugs, and responsible sexual behavior, and by discouraging the abuse of alcohol," Satcher said. He added that such a system would also "change the way we deal with mental health in this nation, from one of, too often, blame and stigmatization -- where people are actually ashamed or too afraid to come forward and seek help in many cases -- to one of caring and support" by giving mental health the same emphasis given to physical health. The physical and mental health of all Americans would also be better served through increased medical research, including research aimed at understanding human behavior -- such as those that lead to addictions to cigarettes or illicit drugs -- the Surgeon General told his audience, which included many students, faculty and alumni from the School of Medicine as well as members of the wider community. He cited cigarette smoking as one of the biggest health issues facing the nation. "We have put a lot of time and effort into this problem, and of course, your dean, Dr. [David] Kessler, made this a major agenda of the Food and Drug Administration. Every day, after all that, 3,000 new teenagers become smokers. Over half of them will become addicted before they can legally purchase cigarettes; one-third of them will die of some smoking-related disease. We need to bring all the resources that we have to bear to protect the health of our children." Satcher called upon his audience to take part in community action to help promote healthy lifestyles, which he said is both a personal and group responsibility. "If we allow children to be exposed to cigarette advertisements, if we allow children to purchase cigarettes, if we allow children to be exposed to smoking and get asthma, it's a community responsibility," he said. "If we do not teach children sex education in the schools and expect them to behave responsibly, it's a community responsibility." A recent youth risk-behavior survey conducted by the Centers for Disease Control and Prevention is further evidence that "we as a nation are not living up to our responsibility," Satcher said. The survey showed that only 25 percent of teenagers were taking physical education classes in 1996, a 20 percent decrease since 1991. "Now this is a nation where child obesity is at an all-time high; adult obesity is at an all-time high," commented the Surgeon General. Satcher, who overcame poverty and segregation in the rural South to become the nation's top physician, concluded his speech by saying that improving people's quality of life is as essential as improving their life spans. He quoted Benjamin Elijah Mays, the former president of his alma mater, Morehouse College, by saying "It must be borne in mind that the great tragedy of life is not in failing to reach all your goals, it is in having no goals for you to reach. It's not a calamity if somebody dies with dreams unfulfilled; it is a calamity not to dream. It's not a disaster if you fail to achieve your highest ideas in life; it's a disaster if you have no high ideas for which to strive. It's not a disgrace to fail to reach the stars, but it's a disgrace to have no stars for which you're reaching... ." "Let us not be guilty of low aim," he urged his audience. -- By Susan Gonzalez T H I SW E E K ' SS T O R I E S '339 Yale homebuyers -- and counting! A house becomes a home on Bristol Street 'Private Censorship and Perfect Choice' Special events pay tribute to Native American culture A Conversation With a Peace Maker Improving health of minorities is top priority, Satcher says The Surgeon General speaks out on some tough issues Yale Opera to present Verdi's adaptation of Shakespearean comedy Baltimore Mayor Kurt Schmoke to talk at Divinity School Graphic! British Prints Now' celebrates state of the art of British printmaking 'Film Fest New Haven to pay tribute to Yale animator Renowned artists to take part in panel and symposium at Yale Art Gallery Scholars will share perspectives on issues in South Asia in series of events Museum hosts recreation of 'Dances for a Building' Visiting philosopher to present talk Venclova is honored by the Lithuanian government Bulletin Home|Visiting on Campus|Calendar of Events| Bulletin Board Classified Ads|Search Archives|Production Schedule|Bulletin Staff Public Affairs Home|News Releases|E-Mail Us|Yale Home Page

 Students from the School of Medicine had the chance to speak informally with U.S. Surgeon General Dr. David Satcher during a luncheon. Here, the nation's top physician signs a guest book.