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Marriott Wardman Park Hotel, Washington, D.C.


February 18, 2004

Conference on Chronic Disease Prevention and Control

Good morning. Thank you, Jim Marks, for that kind introduction

I would like to thank the cosponsors of this conference, including the members of the Chronic Disease Directors and the Prevention Research Centers. I appreciate your hard work and your leadership in putting this conference together with CDC.

I'm delighted to speak this morning to some of the best health care professionals in the world. Thank you for all of the hard work that you put in every single day - because the harder you work, the more lives you save.

As you know, in December, President Bush signed the modernization of our Medicare system into law. This law provides prescription drug benefits for our seniors. They will appreciate the new choices and better benefits.

But I'm particularly proud of another big benefit that my Department helped get into the law. Beginning January 1st, 2005, seniors entering into Medicare will be offered a "Welcome to Medicare Physical." The physical includes appropriate screenings and referrals to disease management programs. This benefit moves our health care system from a focus on treating disease to a focus on preventing disease.

Physicians, researchers, and other innovators have done a remarkable job over the last century of keeping people alive. But now our goal is more than that - we want to keep people well. From now on, we will measure success not by the absence of illness, but in the quality of health.

If you think about the factors that make up our quality of life, so many of them are related to health: energy, longevity, mobility, absence of pain, a strong body, and a healthy family. When we lose any one of those factors, we miss it and want it back.

Preventable chronic diseases like heart disease, stroke, cancer, diabetes, overweight and obesity, and tobacco-related illnesses can diminish all of these aspects of our quality of life. And worse: chronic illnesses cause seven out of ten deaths in America.

Americans spend 1.5 trillion dollars on health care each year. 75 percent of those dollars are spent treating chronic diseases. If they had practiced healthier habits, Americans could have saved a great deal of money - and they could have spent that money on other priorities.

The good news is, it doesn't have to be this way.

Diet, physical activity, screenings, and avoiding risky behaviors can prevent cancer, diabetes, heart disease, and many other leading causes of death and disability. Americans who eat right, exercise, and get their screenings enjoy greater health and happiness well into old age. At least 18 million Americans have Type 2 diabetes. Another 20 million more have pre-diabetes. Poor nutrition, overweight, and inactivity cause at least a third of all cancers. And obesity aggravates hypertension, which contributes to the number one cause of death in this country: heart disease. In 2002, heart disease had a negative economic impact of $214 billion - including $115 billion in direct medical costs.

More than 46 million Americans smoke cigarettes even though cigarettes will kill or disable half of them. Every year, cigarettes kill more than 440,000 Americans.

Parallel to this enormous health cost is the economic burden of tobacco use - more than $75 billion per year in medical expenditures and another $82 billion per year resulting from lost productivity. And CDC estimates that as much as $117 billion is spent each year on medical care for injuries-the leading cause of death for Americans under 35. Many of these injuries can be prevented.

So a major question facing every American is: how will I lead my life? What habits will I develop?

The words to keep in mind are moderation and balance. It's okay to enjoy the finer things in life. But after you've finished with them, get up, go outside, and take your family for a nice walk. Try to take 10,000 steps a day. Wearing a pedometer can help you keep track of them. I'm not telling you to give up eating or to run a marathon. I'm just saying: keep your life in balance. Exercise and a good diet make us feel lighter and happier very quickly.

And when it comes to the question of staying healthy, none of us can be neutral. If we haven't made an effort to develop the right habits such as exercising more and eating healthier, chances are good that we're practicing the wrong habits. And the same holds true for organizations. Whenever I talk to employers or insurers or food producers, I tell them, if you haven't made an effort to make your policies consistent with healthy habits, chances are you're leading people down the wrong path.

Of course, that different path can be tasty. I come from a state that likes to fry things, and has yet to find a dish that couldn't be made better with cheese or butter. I assure you I understand the pleasure that can be found in a hearty, calorie-laden meal. But no matter how pleasurable a mouthful of food feels, it will never feel as good as being thin.

I also have a newfound appreciation for the consequences and the need to enjoy meals and snacks in moderation. We all have loved ones who suffer from diseases that are largely preventable. My own father died from a heart attack associated with diabetes. Many of my friends have had heart attacks. Many more suffer from asthma.

Once I saw firsthand and understood the pattern that caused all this destruction, I wanted to stop it whenever I saw it. And I still do.

If you and your family practice poor habits, you're susceptible to chronic disease. You'll pay in reduced quality of life. You'll pay in shortened life span. You'll pay in out-of- pocket medical expenses. You'll pay in the time you spend at the doctor and in bed when you're sick. You'll pay in less time with your children. So when making decisions for yourself and your family, once you know the facts about improving your health, you'll realize you can't afford not to.

These economic effects also apply to corporations. Most corporations, as you know, offer their employees part of their compensation in the form of cash, and part in the form of a health insurance premium. And, if you talk to senior management of corporations in almost any industry about their biggest concerns, as I have, over and over you hear about rising health care costs. The more expensive health care is, the harder it is to compete with foreign competitors.

I released a report in September that showed that health promotion is part of a wise business strategy. Let me quote:

    "The costs to U.S. businesses of obesity-related health problems in 1994 added up to almost $13 billion, with approximately $8 billion of this going towards health insurance expenditures, $2.4 billion for sick leave, $1.8 billion for life insurance, and close to $1 billion for disability insurance."

On an individual level, it costs an average of $2700 to insure an American without diabetes for a year. It costs $13,243 to insure an American who does have diabetes.

That's why employer spending on prevention is a wise investment that pays off. It pays off in lower health care expenses. It pays off in lower absenteeism and it pays off in higher productivity. And we encourage all employers to make this investment so they can reap big returns for a long time.

Some organizations think that if they've complied with laws and regulations and survived for another year, they're doing all they need to do. But others aren't satisfied getting by-or even getting ahead. They do get ahead, but they also want to make the world better.

Many of the basic public health fundamentals - such as nutrition and physical activity programs, mammography screenings, and even simple blood pressure checks - are extremely cost effective. We must ensure that all Americans have access to these great lifesaving services.

And my Department has been making tremendous progress, through initiatives such as Steps to a Healthier US and CDC's Youth Market Campaign.

Last September, my Department announced 12 grants totaling more than $13 million to support community initiatives to promote better health and prevent disease. These included 23 communities, including one tribal organization, 15 small cities and rural communities, and seven large cities.

These communities are doing some very exciting work in chronic disease prevention and health promotion.

For example, in Washington state, health professionals are targeting Latino adults who have diabetes, asthma, or obesity or have a high risk of getting these conditions. Through a public awareness and education campaign, they are promoting diabetes education for adults with diabetes. They're also working with American Indian youth at risk for diabetes or overweight to implement the state educational standards for health and fitness.

In Philadelphia, health officials are working to implement standards of care for medical providers in managed care plans. They're also working within the 15 neighborhoods reached by this program to encourage local restaurants to provide healthier menu options.

And in Michigan, through the Inter-Tribal Council of Michigan, public health officials are creating a resurgence of interest in passing on traditional wisdom and cultural practices, including consumption of highly nutritious traditional foods.

We're delighted by these activities, and the Department will expand the program this year with an additional $44 million and has requested $125 million for these programs in 2005.

To learn more about these and other programs, I want to encourage all of you to attend the second National Steps to a HealthierUS summit, which we will hold in Baltimore on April 29 and 30th. This summit will feature some of the best work that is currently being done in the areas of diabetes, obesity, and asthma and the related lifestyle choices of tobacco, physical activity and nutrition. It will be a great meeting, and I hope to see you there.

As my Department worked to encourage healthier habits around America, I thought we should practice those habits, too. So I launched the Secretary's Challenge to get us to exercise more regularly. We developed better habits by encouraging each other. And we're taking the challenge to other Departments in March.

I also put my Department on a diet. I myself lost fifteen pounds and I want to lose ten more. Jim Marks lost weight, too. Do you know how good it feels - how much more energy and stamina I have each day, now that I'm not lugging around the equivalent of a bowling ball all the time?

Another successful campaign is our Youth Media Campaign, known to many of you with young children as "VERB - it's what you do." Yesterday, CDC released a report that suggests that America's children are becoming more physically active - as a result of this program. I would like to congratulate CDC and the many partners who made the campaign so successful.

It is rare to find an epidemic that picks up steam over years and then changes course dramatically in one year.

We are working hard to achieve similar success in other areas, such as tobacco cessation. Earlier this month, we announced plans for a national network of smoking quit-lines to give all smokers in the United States access to the latest information and live counseling to help them quit. CDC helped me fund the quit-line, and I'm very grateful for their help.

And we have launched the Medicare Stop Smoking Program to test ways to help older smokers quit.

In fact, in addition to the new Welcome to Medicare Physical, we have several exciting demonstration programs under development at CMS. We are designing a program to promote cancer prevention and detection in Medicare to help eliminate racial and ethnic health disparities.

In addition, I am pleased to announce that we are designing a demonstration to find the best ways to reduce risk factors among seniors, including obesity, sedentary lifestyle, and smoking.

We know that disease-care is expensive. We must find new ways to reduce the health and economic burden of these diseases by focusing on prevention.

We put new FDA regulations in place to permit more evidence-based health claims to be made about food products. We are also helping people make informed choices about their diet by requiring the amount of trans fat to be listed on food labels.

In addition, I've held roundtables with health, business, and community leaders. I have met with obesity researchers, all types of health professionals, the unions, the insurance industry, and others. I am encouraging them to partner with us so we can mobilize the resources of government and industry to support, inform, and motivate these choices.

We sounded the alarm, and the free market is responding. Companies that produce and market food affect how we think about food and what kinds and quantities of food we eat.

We've been talking with many of them about their product lines, and I think they would agree that we haven't been shy about it.

Many of them are taking encouraging steps.

Last year, Kraft Foods announced it is eliminating all marketing in schools and developing guidelines for all advertising and marketing practices, especially for children. Kraft is also working to make its existing product line healthier.

Kraft is not alone. I also met with the CEOs of Coca-Cola and PepsiCo. I am pleased to tell you that Coke is reaffirming its policy against marketing soft drinks to children under 12 and adding healthier beverage choices. Coke is putting nutritional information on vending machines in schools. And they are moving away from exclusive pouring contracts with big dollar advance payments. Pepsi's "better for you" and "good for you" products account for 43% of its sales. In addition, they are producing their Frito Lay salty snack foods with no hydrogenated oils - that is, trans fats. Unilever is eliminating trans fatty acids from its margarine.

McDonald's, Applebees, and others are taking similar steps. This is good and I'd like to see all of them do even more.

Promoting prevention among your neighbors and associates is compassionate. And it is also good business.

But it's not just food companies that can make a difference. Every employer-profit, nonprofit, faith-based, or governmental, can make a difference. Many organizations in different industries have developed creative ways to keep their workers and their families healthy. Last year, I launched the Innovation in Prevention Awards to recognize creative activities in the workplace and encourage other companies to duplicate those efforts.

All of you were invited to this conference today because you are well connected and know how to make things happen. Many of you work with state and local governments and deal with state and federal grantees. Many of you work with health centers, health departments, and hospitals. And all of you deal with employers.

So I would like to challenge every one of you to find a way-not just one way, several ways-to spread the prevention message to the people in your state. Your employer, your neighborhood, your health plan, your church, your grocer, your favorite restaurant, and your own family-there are countless opportunities for each for each of us to encourage prevention.

So when you see your next opportunity, seize it and save or enhance a life.

Last Revised: February 19, 2004

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