REMARKS BY C. EVERETT KOOP, M.D., SC.D. SURGEON GENERAL U.S. PUBLIC HEALTH SERVICE AT TRAINING SESSION FOR COMMIT FIELD DIRECTORS ° NATIONAL CANCER INSTITUTE MONDAY, JANUARY 30, 1989 DO NOT DISTRIBUTE /? cCaMmMgyT~ 1904 THANK YOU TERRY. IT IS A PLEASURE FOR ME TO MEET WITH YOU TODAY. | WISH | HAD MORE TIME TO SPEND WITH YOU, BUT UNFORTUNATELY | CAN ONLY BE HERE BRIEFLY. BECAUSE | HAVE SPENT A GREAT DEAL OF MY LIFE TRAINING PEOPLE, AND SINCE THIS IS A TRAINING SESSION, | WANT TO SPEND JUST A MOMENT CONTRIBUTING TO YOUR EDUCATION. | WANT TO REVIEW SOME OF THE KEY FINDINGS OF MY MOST RECENT REPORT ON SMOKING AND HEALTH. THAT WAY, IF SOMEONE EVER ASKS YOU ABOUT THE 1989 REPORT, YOU'LL BE ABLE TO SAY YOU HEARD IT FROM ME. AS YOU KNOW, THE RELEASE OF THIS REPORT MARKED THE 25TH ANNIVERSARY OF THE FIRST SURGEON GENERAL'S REPORT ON SMOKING AND HEALTH. IN SPITE OF 25 YEARS OF REPORTS AND EFFORTS TO CONTROL SMOKING, THERE WAS PLENTY OF BAD NEWS IN THE LATEST REPORT. IN 1985, 390,000 AMERICANS DIED BECAUSE OF TOBACCO USE. THAT'S ONE OUT OF EVERY SIX DEATHS. LUNG CANCER, NEARLY ALL OF IT CAUSED BY SMOKING, HAS NOW CAUGHT UP WITH BREAST CANCER AS THE LEADING CAUSE OF CANCER DEATHS AMONG WOMEN. IN ADDITION, WE NOW KNOW THAT SMOKING foR men <6 4.7% -3- > _ 457 fo women £65 S070 x Stawl <6T 1S BS IS A MAJOR CAUSE OF CEREBROVASCULAR DISEASE, OR STROKE, THE THIRD LEADING CAUSE OF DEATH IN THE UNITED STATES IT’S NUMBERS LIKE THESE THAT CONVINCED ME TO MAKE SMOKING A PRIORITY ISSUE AS SURGEON GENERAL. THERE'S MORE BAD NEWS. SMOKING IS STILL MORE COMMON AMONG BLACKS, BLUE-COLLAR Lie FOYER Vesey 6F Siroeeive WORKERS, AND PEOPLE WITH LESS EDUCATION. ,, WITH THESE GROUPS, OUR EFFORTS AT SMOKING CONTROL MUST BE IMPROVED. WITH ADOLESCENTS TOO, WE HAVE AN URGENT NEED FOR IMPROVEMENT. THE RATE OF SMOKING AMONG HIGH SCHOOL SENIORS IS NO LONGER DECLINING AS IT ONCE WAS. THE AVERAGE AGE AT WHICH PEOPLE START SMOKING CONTINUES TO DECREASE. ONE QUARTER OF HIGH SCHOOL SENIORS WHO SMOKE HAD THEIR FIRST CIGARETTE BY THE SIXTH GRADE. BUT THERE’S SOME GOOD NEWS IN MY REPORT AS WELL. THE PREVALENCE OF SMOKING CONTINUES TO DECREASE, ALTHOUGH NOT AS RAPIDLY AS WE'D LIKE. BETWEEN 1964 AND 1985 OVER THREE- QUARTERS OF A MILLION DEATHS WERE AVOIDED OR POSTPONED AS A RESULT OF DECISIONS TO QUIT SMOKING OR NOT TO START. AND BY THE YEAR 2000, THREE MILLION LIVES WILL HAVE BEEN EXTENDED BECAUSE OF THESE DECISIONS IN THOSE Pit 766 / TWENTY YEARS. WE'RE SEEING EVERY DAY THE ENORMOUS IMPACT OF ALL OUR EFFORTS TO HELP PEOPLE AVOID TOBACCO. MORE AND MORE STATE AND LOCAL GOVERNMENTS ARE RECOGNIZING THE NEED TO RESTRICT SMOKING IN PUBLIC PLACES. THE NUMBER OF LOCAL COMMUNITIES WITH THESE RESTRICTIONS HAS MORE THAN TRIPLED IN THE LAST THREE YEARS. THIS IS A VERY EXCITING TREND, AND ONE THAT DEMONSTRATES THE CONCERN PEOPLE NOW HAVE ABOUT PASSIVE AS WELL AS ACTIVE SMOKING. THOSE ARE SOME OF THE KEY FINDINGS OF MY REPORT, AND NOW YOU'VE HEARD IT STRAIGHT FROM THE SURGEON GENERAL HIMSELF. IT’S CLEAR THAT AFTER 25 YEARS OF SURGEON GENERAL'S REPORTS, SMOKING IS STILL AN ENORMOUS HEALTH PROBLEM, BUT THERE’S ALSO PLENTY OF PROGRESS TO REPORT. OF COURSE WE'RE EXPECTING PROJECTS LIKE COMMIT WILL GIVE US EVEN MORE GOOD NEWS. THAT’S WHAT | REALLY CAME TO TALK TO YOU ABOUT. AS YOU CONTINUE YOUR TRAINING TODAY, AND ESPECIALLY WHEN YOU ARE BACK DOING YOUR WORK BACK HOME, REMEMBER THAT YOU HAVE THE SUPPORT, ENCOURAGEMENT, AND OCCASIONALLY EVEN THE ENVY OF ALL OF US IN THE PUBLIC HEALTH SERVICE. YOU ARE ON THE LEADING EDGE OF THE LARGEST SMOKING CONTROL PROJECT EVER CONDUCTED. COMMIT IS A HUGE ENDEAVOR, AND 6 F Wiicit ONE PRZeF | AM GENUINELY PROUD @& I'M SURE THAT ALL OF YOU ARE WELL AWARE OF THE IMPORTANCE OF COMMIT FOR YOUR COMMUNITIES, BUT PLEASE REMEMBER IT IS A VITAL PROJECT FOR THE REST OF THE NATION, AS WELL. WHAT WE LEARN FROM YOUR SUCCESSES, AND EVEN YOUR SETBACKS, WILL SHAPE TOBACCO CONTROL EFFORTS THROUGHOUT THIS COUNTRY AND THE WORLD. COMMIT IS A CHALLENGE. IT HAS BEEN A CHALLENGE FOR NCI TO CREATE, AND NOW IT’S A CHALLENGE FOR YOU TO CARRY OUT. BUT IT’S ALSO A CHALLENGE TO YOUR COMMUNITY AND ESPECIALLY THE HEALTH PROFESSIONALS AND OTHERS WHO ALREADY WORK TO CONTROL SMOKING. WITH THE EXPERTISE AND RESOURCES THAT YOU ARE CARRYING TO YOUR COMMUNITIES, YOU ARE | CHALLENGING THEM TO ADOPT STATE-OF-THE-ART SMOKING CONTROL TECHNIQUES AND TO MAKE SMOKING THE PRIORITY IT SHOULD BE. YOU ARE CHALLENGING THEM TO BE THE BEST IN THE WORLD AT WHAT THEY DO. VE BEEN IN THE BUSINESS OF PUBLIC HEALTH FOR LONG ENOUGH TO KNOW THAT YOU WILL | - 10 - HAVE FRUSTRATING DAYS. YOU’LL HAVE DAYS WHEN YOU FEEL LIKE YOU’RE LOSING GROUND, RATHER THAN MAKING PROGRESS. ON THOSE DAYS JUST REMEMBER THESE THREE THINGS: FIRST, YOU’RE SAVING LIVES, RIGHT NOW, IN YOUR OWN COMMUNITY. SECOND, YOU'RE MAKING YOUR COMMUNITY A MUCH BETTER PLACE TO LIVE. AND THIRD, YOU’RE TEACHING NCI, AND ME, AND THE REST OF THE WORLD HOW TO PROCEED IN MAKING A SMOKE-FREE SOCIETY. - 11 - YOU HAVE MY PERSONAL SUPPORT, CONGRAFULAFIONS, AND RESPECT. I WISH YOU EVERY SUCCESS, SINCE YOUR SUCCESS IS SUCCESS FOR US ALL. LEARN ALL THAT YOU CAN FROM EACH OTHER, AND THEN LET’S GET THE JOB DONE.