ORIGINAL

TRA His ECTURE
By
C. Everett Koop. M.D., Sc.D.
SURGEON GENERAL
OF THE
U.S. PuBLic HEALTH SERVICE
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

ZZK

PRESENTED AT THE STATE CAPITOL BUILDING
HONOLULU, HAWAII
FeBruary 24, 1989
1
MEMBERS OF THE LEGISLATURE, DISTINGUISHED GUESTS, PACIFIC

HEALTH OFFICERS, AND FRIENDS ...

IT IS AN HONOR TO PRESENT THE IRA W. HISCOCK LECTURE,
ALTHOUGH I NEVER KNEW DR. HISCOCK, HE WAS EDUCATED IN NEW
ENGLAND, AS WAS I.

HE BECAME FASCINATED WITH THE POTENTIAL OF PUBLIC HEALTH, AS
AM I.

AND HE LEFT A LEGACY IN PUBLIC HEALTH THAT WILL BE LONG
REMEMBERED. AND SOMEDAY I WOULD LIKE SOMEONE TO BE ABLE TO SAY
THAT ABOUT ME, ALSO.

THIS LECTURE WAS ESTABLISHED IN 1963. OF THE 15 PREVIOUS
LECTURERS, I DISCOVERED TO MY SURPRISE THAT I NEW 7 OF THEM
PERSONALLY. SO I FEEL VERY COMFORTABLE TODAY, WITH A SENSE THAT
I AM IN GOOD COMPANY, BOTH PRESENT AND ANY SHADES OF THE PAST
WHO MAY DROPPED BY.
2
I’M VERY PLEASED TO FOCUS MY ADDRESS THIS EVENING ON A ~

TOPIC WHICH HAS BECOME A FAVORITE OF MINE OVER THE PAST 8 YEARS.
IN 1981, WHEN I BECAME YOUR SURGEON GENERAL, I MUST CONFESS |
KNEW RELATIVELY LITTLE ABOUT THE HISTORY AND MISSION OF THE U.S.
PUBLIC HEALTH SERVICE,

IN NOVEMBER, 1981, HOWEVER, I BECAME ITS HIGHEST RANKING
OFFICER AND -- VERY SOON THEREAFTER -- I ALSO BECAME ITS MOST
ENTHUSIASTIC BOOSTER,

THERE ARE MANY REASONS FOR THIS. 1 WON’T GO INTO ALL OF
THEM, BUT I WILL SPEAK ABOUT ONE ASPECT THAT HAD SPECIAL APPEAL
FOR ME. IT WAS THE ROLE OF THE PUBLIC HEALTH SERVICE IN
INTERNATIONAL HEALTH AFFAIRS.

BY THE TIME I ARRIVED IN FEDERAL SERVICE IN 1981,. I HAD
ALREADY BEEN INVOLVED IN INTERNATIONAL HEALTH FOR MANY YEARS,
CHIEFLY -- BUT NOT EXCLUSIVELY -- AS A PIONEER IN THE NEW FIELD
OF PEDIATRIC SURGERY.
3
OVER A PERIOD OF MANY YEARS, I HAD TRAVELED TO EUROPE, ASIA,

AND AFRICA, WORKING IN THE CLINICS AND HOSPITALS OF DEVELOPED,
DEVELOPING, AND VERY UNDER-DEVELOPED COUNTRIES, SPREADING THE
WORD AND THE TECHNOLOGY OF PEDIATRIC SURGERY. |

] HAD ALSO SERVED FOR MANY YEARS AS A MEMBER OF THE BOARD
OF THE SECOND LARGEST RELIEF AGENCY IN THE U.S.

] KNEW, FIRST-HAND, OF THE CONDITIONS THAT CHILDREN AND
THEIR PARENTS FACED IN MANY COUNTRIES OF THE WORLD AND I HOPED I
COULD CONTINUE TO HELP, IN MY NEW ROLE AS SURGEON GENERAL.

ALL MY HOPES WERE FULFILLED. I LEARNED THAT THE PUBLIC
HEALTH SERVICE -- AND ESPECIALLY THE PHS COMMISSIONED CORPS -- IS
A MAJOR, POSITIVE INFLUENCE UPON THE HEALTH OF PEOPLES EVERYWHERE
IN THE WORLD,

IT IS ALSO AN INTERNATIONAL RESOURCE FOR HEALTH AND IS
PROBABLY THE MOST IMPORTANT SINGLE SOURCE OF EXPERTISE IN THE
STRUGGLE TO IMPROVE THE HEALTH OF THE WORLD’S PEOPLES.
4
HOW DID THAT COME ABOUT? THE ANSWER TO THAT QUESTION IS THE

SUBSTANCE OF MY REMARKS THIS EVENING,

IT’S USUAL TO BEGIN AT THE BEGINNING. BUT IN THIS CASE THE
BEGINNING IS IN THE LATE 18TH CENTURY, JUST A FEW YEARS AFTER THE
BRITISH TROOPS SURRENDERED AT YORKTOWN AND OUR NATION WAS BORN,

AT THAT TIME, ONE OF THE MAJOR HEALTH CONCERNS OF OUR
GOVERNMENT WAS THE POSSIBILITY THAT WE MIGHT BE, IN EFFECT,
“IMPORTING” CERTAIN CONTAGIOUS DISEASES FROM OTHER PARTS OF THE
WORLD. THE OBVIOUS PLACES THIS WOULD OCCUR WERE THE SEVERAL
DEEP-WATER PORTS ALONG THE EAST AND GULF COASTS -- BOSTON,
PHILADELPHIA, CHARLESTON, AND SO ON,

THEREFORE, IN 1798, PRESIDENT JOHN ADAMS SIGNED THE LAW THAT
ESTABLISHED A SYSTEM OF “MARINE HOSPITALS” WHOSE PERSONNEL WOULD
EXAMINE MERCHANT SEAMEN COMING INTO OUR PORTS. IF ANY WERE FOUND
TO BE CARRYING A CONTAGIOUS DISEASE SUCH AS SMALLPOX, YELLOW
FEVER, TYPHUS, OR CHOLERA, THEY AND THEIR SHIPMATES WOULD BE
PLACED IN QUARANTINE AND TREATED.
5
I USE THE TERM “TREATMENT” SOMEWHAT LOOSELY, SINCE MOST

CONTAGIOUS DISEASES WERE NOT WELL KNOWN OR UNDERSTOOD IN THOSE
DAYS,

DESPITE THIS RECOGNITION EARLY IN OUR HISTORY THAT DISEASE
DOES NOT RESPECT NATIONAL BOUNDARIES, THE FIRST REAL EFFORTS AT
INTERNATIONAL COOPERATION DID NOT BEGIN UNTIL THE LATTER HALF OF
THE 19TH CENTURY.

BETWEEN 1851 AND 1874 THREE “INTERNATIONAL SANITARY
CONFERENCES,” SO-CALLED, WERE HELD IN EUROPE. THEY WERE MOSTLY
CONCERNED WITH THE SPREAD OF CHOLERA. BUT THE CONFERENCES WERE
NOT SUCCESSFUL, MAINLY BECAUSE T00 LITTLE WAS KNOWN ABOUT THE
ETIOLOGY AND TRANSMISSION OF CHOLERA AND OTHER CONTAGIOUS
DISEASES.

AND THE UNITED STATES, STILL SHARING GEORGE WASHINGTON'S
OPINION THAT WE OUGHT NOT TO BECOME INVOLVED IN EUROPE’S
PROBLEMS, DID NOT PARTICIPATE IN ANY OF THESE CONFERENCES,
6
BUT IN 1876, ONE OF MY MOST ILLUSTRIOUS PREDECESSORS --

ALREADY IN CHARGE BUT LATER TO BECOME SURGEON GENERAL -- DR. JOHN
WOODWORTH CALLED FOR INTERNATIONAL ACTION TO PREVENT THE SPREAD
OF CHOLERA AND YELLOW FEVER. AS THE HEAD OF THE MARINE HOSPITAL
SERVICE, HE WAS WELL AWARE OF THE FACT THAT THE AMERICAN PEOPLE
COULD NOT BE PROTECTED FROM DISEASE WITHOUT CONCERTED
INTERNATIONAL COOPERATION,

AS A RESULT OF DR. WOODWORTH’S LEADERSHIP, AND THE
CONTRIBUTION OF MANY OTHER PHYSICIANS TO THE PUBLIC DIALOGUE OF
THE TIME, THE UNITED STATES CONGRESS, IN 1880, AUTHORIZED THE
PRESIDENT TO CONVENE AN “INTERNATIONAL SANITARY CONFERENCE” OF
OUR OWN IN WASHINGTON, D.C. ITS PURPOSE WAS TO ESTABLISH AN
INTERNATIONAL SYSTEM OF NOTIFICATION ON THE SANITARY CONDITION OF
PORTS AND OTHER PLACES.

AS A MATTER OF FACT I STILL ATTEND A CONFERENCE UNDER THAT
QUAINT TITLE EACH YEAR IN WASHINGTON AS PART OF MY RESPONSI-
BILITIES IN THE PAN AMERICAN HEALTH ORGANIZATION,
/
THAT FIRST WASHINGTON CONFERENCE IN 1880 BROUGHT TOGETHER,

FOR THE FIRST TIME, MAJOR TRADING NATIONS FROM SEVERAL
CONTINENTS.

ALTHOUGH THE PARTICIPANTS WERE AT FIRST RELUCTANT TO ENGAGE
IN ANY INTERNATIONAL CONTROL SYSTEM THAT MIGHT INFRINGE UPON
THEIR OWN RESPECTIVE NATIONAL QUARANTINE SYSTEMS, THE THREAT OF
THE SPREAD OF EPIDEMIC DISEASE HAD BECOME SO GREAT THAT ALL THE
GOVERNMENTS REPRESENTED RELUCTANTLY AGREED UPON BROAD SYSTEMS OF
INTERNATIONAL CONTROL AND COOPERATIVE ACTION,

THE UNITED STATES TOOK THE LEADERSHIP IN THE DISCUSSIONS AND
BEGAN IN EARNEST ITS LONG AND CONTINUOUS PARTICIPATION IN
INTERNATIONAL HEALTH COOPERATION.

IT WAS THE FIRST TIME -- BUT FORTUNATELY NOT THE LAST TIME
-- THAT NATIONAL SOVEREIGNTIES YIELDED TO INTERNATIONAL HEALTH
IMPERATIVES.
8
OTHER INTERNATIONAL MEETINGS FOLLOWED, AT WHICH THE U.S.

WAS REPRESENTED BY A SENIOR MEMBER OF THE MARINE HOSPITAL
SERVICE. LATER, AFTER THE REORGANIZATION OF 1912, THE DELEGATE
WOULD BE DRAWN FROM THE U.S. PUBLIC HEALTH SERVICE.

IN ADDITION TO THE DEVELOPMENT OF MORE EFFICIENT AND
EFFECTIVE SYSTEMS OF NOTIFICATION, THE PARTICIPATING COUNTRIES
ALSO ESTABLISHED IN PARIS A FREE-STANDING INTERNATIONAL OFFICE OF
PUBLIC HYGIENE, THROUGH WHICH EVERYONE’S COMMUNICATIONS COULD BE
EXPEDITIOUSLY CHANNELED.

IN THE MEANTIME, AND CLOSER TO HOME IN THIS HEMISPHERE, THE
PAN AMERICAN SANITARY BUREAU WAS ORGANIZED IN 1902 BY THE FIRST
INTER-AMERICAN SANITARY CONFERENCE HELD IN MEXICO CITY. THE
BUREAU, PROVIDED FOR REGIONAL COOPERATION IN PUBLIC HEALTH BEYOND
JUST THE NOTIFICATION AND QUARANTINE OF COMMUNICABLE DISEASE.

IN 1924 THE MEMBERS OF THE BUREAU RATIFIED A PAN AMERICAN
SANITARY CODE, WHICH DEALT NOT ONLY WITH THE INTERNATIONAL SPREAD
OF CONTAGIOUS DISEASES, BUT ALSO HELPED ESTABLISH UNIFORM PUBLIC
HEALTH PROCEDURES THROUGHOUT THE AMERICAS,
9
THE INFLUENCE OF THE PUBLIC HEALTH SERVICE ON THE PAN

AMERICAN SANITARY BUREAU WAS UNQUESTIONABLE. SINCE THE BUREAU’S
INCEPTION, OFFICERS OF THE PUBLIC HEALTH SERVICE HAVE BEEN
ACTIVELY INVOLVED IN PLANNING, CREATING, AND DIRECTING ITS
ACTIVITIES. RIGHT UP UNTIL THE EARLY 1950S, THE MAJORITY OF THE
BUREAU’S PROFESSIONAL FIELD STAFF WERE PHS OFFICERS.

AND FROM ITS CREATION IN 1902 UNTIL 1936, ALL THE SURGEONS
GENERAL OF THE PUBLIC HEALTH SERVICE WERE ALSO DIRECTORS OF THE
PAN AMERICAN SANITARY BUREAU.

DURING THESE YEARS, FROM THE BEGINNING OF THE 20TH CENTURY
TO THE OUTBREAK OF THE SECOND WORLD WAR, PHS OFFICERS
DISTINGUISHED THEMSELVES IN IMPROVING THE HEALTH OF THE PEOPLE OF
THE AMERICAS. HERE ARE JUST A FEW OF THEIR ACCOMPLISHMENTS:

* THEY HELPED SEVERAL SOUTH AMERICAN COUNTRIES ELIMINATE
PLAGUE ...

* THEY INTRODUCED PREVENTIVE MEDICINE ...
10
* THEY IMPROVED ENVIRONMENTAL HEALTH AND SANITATION,

MADE SAFE WATER A PRIORITY, AND FOUND WAYS TO ENRICH THE
DIETS OF EVEN THE POOREST PEOPLE IN THIS HEMISPHERE ...

* — THEY‘VE PLAYED A MAJOR ROLE IN THE FIGHT AGAINST
YELLOW FEVER AND MALARIA ...

* AND PHS PERSONNEL HAVE BEEN INSTRUMENTAL IN DEVELOPING
NURSING SCHOOLS AND OTHER PROFESSIONAL INSTITUTIONS
THROUGHOUT LATIN AMERICA,

HAWAII PLAYED A STRONG ROLE IN THE DEVELOPMENT OF PUBLIC
HEALTH AND THE PUBLIC HEALTH SERVICE ITSELF. FOR EXAMPLE, IN
1912 FREDERICK E. TROTTER WAS ASSIGNED TO THE THEN-TERRITORY OF
HAWAII, TO HONOLULU, TO TAKE CHARGE OF THE EXPANDING QUARANTINE
STATION. HE REMAINED HERE FOR MANY YEARS.

DR. TROTTER, A MEMBER OF THE COMMISSIONED CORPS, WAS AN
EXPERIENCED INTERNATIONALIST WHO HAD ALREADY SERVED IN MANY
FOREIGN POSTS AT THE SURGEON GENERAL’S DIRECTION.
11
DR. TROTTER’S GRANDFATHER WAS THE FORMER MAYOR OF BROOKLYN,

NEW YORK, AND HIS GRANDSON -- ALSO NAMED FREDERICK E. TROTTER --
IS HERE TODAY. HE IS ACTIVE IN THE BUSINESS COMMUNITY BUT,

STILL IN THE TRADITION OF HIS FATHER AND GRANDFATHER, IS CHAIRMAN
OF GOVERNOR WAIHEE'S PACIFIC HEALTH PROMOTION AND DEVELOPMENT
CENTER, AN INTERNATIONALLY RECOGNIZED OUTREACH ACTIVITY.

SO THE PUBLIC HEALTH SERVICE WAS ALREADY QUITE BUSY ON THE
INTERNATIONAL STAGE -- BOTH IN THIS HEMISPHERE AND WORLDWIDE --
BY DECEMBER 7, 1941, WE WERE PREPARED FOR AN EVEN GREATER ROLE
DURING AND AFTER WORLD WAR II,

IN THE MIDST OF -- AND IN RESPONSE TO -- THE TERRIBLE HUMAN
COSTS OF THAT WAR, THE BIOMEDICAL SCIENCES CAME UP WITH A NUMBER
OF MAJOR ADVANCES IN DRUGS, IN ANTIBIOTICS, IN SURGERY, IN
PHYSICAL REHABILITATION, AND SO ON,

BUT THE REAL CHALLENGE OCCURRED WHEN THE WAR ENDED.
12
EXCEPT FOR THE PEARL HARBOR ATTACK AND THE LANDINGS ON THE

ALEUTIAN ISLANDS, THE UNITED STATES WAS VIRTUALLY UNTOUCHED BY
ANY OF THE ACTUAL FIGHTING. HENCE, WE WERE THE ONLY NATION
EQUIPPED AND ABLE TO LEAD THE WORLD IN RESTORING THE HEALTH OF
OTHER SOCIETIES THAT HAD BEEN DEVASTATED BY WAR.

A NUMBER OF THEM WERE HERE IN THE PACIFIC BASIN ... ISLAND
SOCIETIES THAT HAD BEEN TORN UP AND TORN APART BY THAT WAR. PHS
OFFICERS CAME OUT TO THE U.S. TERRITORIES AS PART OF THE TOTAL
TEAM EFFORT TO DELIVER HEALTH CARE SERVICES WHEREVER THEY WERE
NEEDED.

AND IN FACT WE STILL HAVE 6 PHS OFFICERS ASSIGNED TO THE
U.S, PACIFIC TERRITORIES AND ANOTHER 9 OFFICERS ARE ASSIGNED TO
THE FREELY ASSOCIATED STATES IN THE PACIFIC.

AS PART OF PRESIDENT TRUMAN’S “POINT FOUR” PROGRAM OF
TECHNICAL ASSISTANCE, THE PHS ALSO ORGANIZED AND STAFFED SPECIAL
HEALTH MISSIONS TO GREECE, IRAN, LIBERIA, YEMEN, TURKEY, AND
THAILAND.
13
THE PUBLIC HEALTH SERVICE SUBSEQUENTLY BECAME THE HEALTH ARM

OF THE U.S. FOREIGN ASSISTANCE PROGRAM. WITH FUNDING FROM THE
FOREIGN OPERATIONS ADMINISTRATION, A FORERUNNER OF THE AGENCY FOR
INTERNATIONAL DEVELOPMENT, THE PHS HAD, BY 1954, MORE THAN 300
COMMISSIONED OFFICERS STATIONED AROUND THE WORLD PROVIDING HANDS-
ON ASSISTANCE TO NATIONS IN THE PROCESS OF POSTWAR RE-BUILDING.

HOWEVER, AS WE REALIZED BACK IN THE DAYS OF CHOLERA AND
YELLOW FEVER, THE NEW PROBLEMS WOULD NEVER BE SUCCESSFULLY
RESOLVED WITHOUT INTERNATIONAL COOPERATION. A NEW INTERNATIONAL
HEALTH ORGANIZATION WAS NEEDED.

AND INDEED IN 1948 THE WORLD HEALTH ORGANIZATION DID EMERGE
AS PART OF THE UNITED NATIONS. IT ABSORBED THE ROLE AND THE
STAFF OF THE OLD INTERNATIONAL OFFICE OF PUBLIC HYGIENE AND TOOK
IN AS A CONSTITUENT MEMBER THE PAN AMERICAN SANITARY BUREAU,
WHICH LATER BECAME KNOWN AS THE PAN AMERICAN HEALTH ORGANI ZA-
TION,
14
ONCE AGAIN, THE PUBLIC HEALTH SERVICE PLAYED A KEY ROLE IN

THESE DEVELOPMENTS. AS EARLY AS 1945, JUST AS THE WAR WAS
ENDING, SURGEON GENERAL THOMAS PARRAN TOLD THE U.S. DEPARTMENT
OF STATE THAT THE DRAFT CHARTER OF THE UNITED NATIONS DID NOT
ADEQUATELY PROVIDE FOR THE CREATION OF AN INTERNATIONAL HEALTH
ORGANIZATION.

THE STATE DEPARTMENT SAID, ALL RIGHT, TELL US WHAT WE SHOULD
DO... AND, BY THE WAY, SEND US A PHS OFFICER TO HELP US DO IT.

DR. PARRAN DID BOTH. IN 1946, AT A KEY PLANNING MEETING IN
PARIS, SURGEON GENERAL PARRAN AND SEVERAL PHS OFFICERS PUT
FORWARD THE PROPOSAL FOR WHAT WAS TO BECOME, TWO YEARS LATER, THE
WORLD HEALTH ORGANIZATION,

THAT PARIS MEETING WAS ATTENDED BY ONLY 18 PEOPLE. HOWEVER,
LATER IN JUNE 1946, AT AN INTERNATIONAL HEALTH CONFERENCE IN NEW
YORK CITY, ALL MEMBER STATES OF THE UNITED NATIONS, AS WELL AS 13
COUNTRIES NOT YET MEMBERS, CAME TOGETHER TO BEGIN A NEW ERA IN
HEALTH COOPERATION,
15
SURGEON GENERAL PARRAN WAS ELECTED PRESIDENT OF THE CON-

FERENCE. HIS VISION AND THE VISION OF THE U.S, PUBLIC HEALTH
SERVICE CONTRIBUTED TO THE RESULT OF THAT CONFERENCE, WHICH WAS
THE PROTOCOL PROVIDING FOR THE ESTABLISHMENT OF THE WORLD HEALTH
ORGANIZATION, THE SINGLE WORLD-WIDE INTERNATIONAL HEALTH
ORGANIZATION THAT HAD BEEN FIRST ENVISIONED NEARLY A HUNDRED
YEARS BEFORE.

THE PARTICIPATION IN W.H.O OF THE U.S. PUBLIC HEALTH SERVICE
OVER THESE PAST 40-ODD YEARS HAS REMAINED CONSTANT AND EXTENSIVE.

FOR EXAMPLE, THE PHS CONCEIVED THE STRATEGY FOR THE
ERADICATION OF SMALLPOX AND, INDEED, THE 10-YEAR PROGRAM WAS
DIRECTED BY A PHS OFFICER, ASSISTED BY MANY OTHERS DETAILED TO
W.H.O. FOR THAT PURPOSE.

THE PROGRAM WAS A SUCCESS. IN 1979, SMALLPOX BECAME THE
FIRST DISEASE IN THE HISTORY OF MANKIND TO BE DECLARED EXTINCT.
[ SAY THAT VERY GLIBLY, BUT IN FACT THE TASK WAS ENORMOUSLY
COMPLEX AND ARDUOUS. ALL IN ALL, IT WAS AN EXTRAORDINARY
ACCOMPLISHMENT FOR THE PHS.
16
AS YOU MAY KNOW, IT HAS BEEN MY PRIVILEGE, AS SURGEON

GENERAL OF THE U.S. PUBLIC HEALTH SERVICE, TO ATTEND THE WORLD
HEALTH ASSEMBLY IN GENEVA IN MAY OF EACH YEAR. 1 HAVE DONE SO
SINCE 1982 AND WILL ATTEND MY LAST ASSEMBLY AS YOUR SURGEON
GENERAL HIS COMING MAY.

DURING THIS TIME I HAVE SEEN THE MEMBER STATES OF THE W.H.0,
TACKLE A NUMBER OF MAJOR PUBLIC HEALTH ISSUES. IN EACH CASE, WE
HAVE TAKEN PART IN THE DEBATE AND, WHEN THE ORGANIZATION HAS
DECIDED TO MOVE FORWARD, WE HAVE MADE OUR PERSONNEL AND OTHER
RESOURCES AVAILABLE.

THIS HAS BEEN THE PERIOD OF TIME WHEN THE W.H.O. CAME OUT
FOUR-SQUARE AGAINST CIGARETTE SMOKING, NOT AN EASY DECISION,
CONSIDERING THE EXTRAORDINARY ECONOMIC AND POLITICAL MUSCLE THAT
IS WIELDED BY THE TOBACCO INDUSTRY WORLDWIDE ... LED BY
AMERICANS, I AM ASHAMED TO SAY.

W.H.O. ALSO ORGANIZED THE WORLD IN THE BATTLE AGAINST AIDS,
WITH THE FIRST ORDER OF BUSINESS THAT OF HELPING MEMBER STATES
FACE UP TO THE FACT THAT THEY DO HAVE A PROBLEM.
17
TODAY, A PHS OFFICER DIRECTS W.H.0.'S “EXPANDED PROGRAM ON

IMMUNIZATION.” THE OBJECTIVE IS TO IMMUNIZE CHILDREN EVERYWHERE
AND THUS REDUCE CHILDHOOD MORBIDITY AND MORTALITY CAUSED BY DIPH-
THERIA, PERTUSSIS, TETANUS, MEASLES, POLIOMYELITIS, AND TUBER-
CULOSIS.

A PHS OFFICER ASSIGNED TO W.H.O. ALSO DIRECTS THE VERY
EFFECTIVE DIARRHEAL DISEASES CONTROL PROGRAM AND THE ACUTE
RESPIRATORY INFECTIONS PROGRAM,

OTHER PHS OFFICERS ARE DETAILED TO W.H.O. AND P.A.H.O.,
WORKING IN CONTROL OF MALARIA AND OTHER PARASITIC DISEASES, IN
DISEASE SURVEILLANCE ACTIVITIES, AND IN THE PREVENTION AND
CONTROL OF AIDS.

AS YOU KNOW, WE ALSO PROVIDE A SUBSTANTIAL NUMBER OF
TECHNICAL ADVISORS AND CONSULTANTS TO COUNTRIES HERE IN THE
PACIFIC, AND WE DO SO THROUGH THE W.H.O.’S WESTERN PACIFIC
REGIONAL OFFICE IN MANILA.
18
A NEW GOAL, ESTABLISHED LAST YEAR BY THE WORLD HEALTH

ASSEMBLY, CALLS FOR THE ERADICATION OF POLIOMYELITIS BY 1995,
AND WE ARE HEAVILY INVOLVED IN THAT AS WELL.

AS INVOLVED AS WE ARE WITH W.H.0., THE U.S. PUBLIC HEALTH
SERVICE IS OUR GOVERNMENT'S MAJOR RESOURCE FOR CARRYING OUT A
WIDE VARIETY OF BILATERAL HEALTH PROGRAMS WITH OVER 30 OTHER
NATIONS, INCLUDING JAPAN, CHINA, AND OTHERS ON THE WESTERN AND
SOUTHERN PACIFIC RIM,

THE AGENCY FOR INTERNATIONAL DEVELOPMENT ALSO CALLS
EXTENSIVELY ON THE U.S. PUBLIC HEALTH SERVICE TO PROVIDE
TECHNICAL EXPERTISE FOR ITS PROJECTS. AS AN EXAMPLE, OUR CENTERS
FOR DISEASE CONTROL ARE CARRYING OUT A PROJECT IN AFRICA KNOWN AS
"CONTROLLING CHILDHOOD COMMUNICABLE DISEASES.” THE PROJECT HAS
12 FULL-TIME ADVISORS WORKING IN 10 COUNTRIES TO REDUCE CHILDHOOD
MORTALITY AND MORBIDITY THROUGH IMMUNIZATION, ORAL REHYDRATION
CONTROL, AND MALARIA PREVENTION AND TREATMENT.
19

THESE PROGRAMS, IN ADDITION TO VACCINE DEVELOPMENT, INCLUDE
NUTRITION SURVEILLANCE, FAMILY PLANNING, LOGISTICS IMPROVEMENT,
AND MANY OTHER ASSIGNMENTS IN VIRTUALLY EVERY AREA OF PUBLIC

HEALTH.

IN ADDITION, THE PUBLIC HEALTH SERVICE IS READY TO PROVIDE
-- ON 24 HOURS’ NOTICE -- EMERGENCY AID ANYWHERE IN THE WORLD.
SOME EXAMPLES OF THIS INCLUDE ...

*

*

THE EARTHQUAKE IN MEXICO CITY ...

THE POISON GAS DISASTER IN BHOPAL, INDIA ...

THE DISASTROUS DROUGHT IN THE AFRICAN SAHEL ...

THE RECENT FLOODING IN BANGLADESH ...

THE SPANISH OLIVE OIL POISONING OF A FEW YEARS AGO...
AND MOST RECENTLY A PHS TEAM WAS AMONG THE FIRST HEALTH

TEAMS TO RESPOND TO THE DEVASTATING EARTHQUAKE IN SOVIET
ARMENIA,
20
WHAT I HAVE DESCRIBED SO FAR ARE SOME EXAMPLES OF AN

EXTENSIVE INVOLVEMENT OF THE U.S. PUBLIC HEALTH SERVICE IN HEALTH
ACTIVITIES AROUND THE WORLD. THEY ARE EXAMPLES OF AN INTERNA-
TIONAL RESOURCE FOR HEALTH -- A RESOURCE WITHOUT WHICH THE
STRUGGLE AGAINST UNNECESSARY DISEASE, DISABILITY AND DEATH WOULD
BE EVEN MORE DIFFICULT AND OUR EVENTUAL VICTORY EVEN MORE
DELAYED.

BUT ALL THAT IS PAST HISTORY. WHAT LIES AHEAD FOR US?

] BELIEVE THE INTERNATIONAL COOPERATIVE RELATIONSHIPS WE
HAVE FORGED OVER THE PAST CENTURY WILL BE STRENGTHENED BECAUSE
ALL THE NATIONS INVOLVED HAVE BENEFITTED,

THOSE BENEFITS ARE RECOGNIZED BY THE GREAT MAJORITY OF THE
PEOPLE IN EVERY COUNTRY. AND THE PEOPLE PROVIDE THE POLITICAL
BASE FOR GOVERNMENTS TO CONTINUE TO WORK TOGETHER IN THE AREA OF
PUBLIC HEALTH.
21
THAT’S CERTAINLY ONE OF THE ENCOURAGING SIGNALS COMING FROM

THE NEW SOCIETIES EMERGING HERE IN THE PACIFIC. PEOPLE WANT A
BETTER LIFE -- AND THOSE GOVERNMENT LEADERS WHO WORK FOR THAT

BETTER LIFE WILL REMAIN AS LEADERS. THE ONES WHO IGNORE THAT

BASIC DESIRE WILL NOT REMAIN IN POSITIONS OF LEADERSHIP.

AND THERE’S ONE OTHER PREDICTION I WOULD LIKE TO MAKE.

] THINK THAT, OVER TIME, THE UNITED STATES WILL MAKE ITS
SECOND AND EQUALLY SIGNIFICANT CONTRIBUTION TO WORLD HEALTH.

ITS FIRST, AS I’VE TRIED TO INDICATE SO FAR, HAS BEEN A
SELFLESS SHARING OF RESOURCES AND EXPERTISE TO DEAL WITH THE VERY
BASIC PROBLEMS IN PUBLIC HEALTH: IMMUNIZING CHILDREN, PURIFYING
WATER FOR DRINKING AND COOKING, RAISING NATIONAL LEVELS OF
NUTRITION, INSURING A SAFE AND ADEQUATE BLOOD SUPPLY, AND SO ON,

AT THE SAME TIME, WE’VE DONE SOME THINGS IN THE AREA OF
RESEARCH, BUT THAT AREA, IT SEEMS TO ME, REPRESENTS OUR NEXT
GREAT OPPORTUNITY IN INTERNATIONAL COOPERATION.
22
THUS FAR, WE’VE SUPPORTED BIOMEDICAL RESEARCH IN OTHER

COUNTRIES WITH RELATIVELY LITTLE DISCUSSION OUTSIDE THE
BIOMEDICAL COMMUNITY. BUT THAT WILL CHANGE, AS NATIONS BECOME
MORE SKILLED AT ASSESSING THEIR LONG-TERM HEALTH NEEDS AND
REACHING CONSENSUS ON THEIR OWN RESEARCH PRIORITIES.

AND I BELTEVE THAT WHEN THIS BEGINS TO HAPPEN IN EARNEST, WE
WILL DISCOVER THAT THERE ARE MANY MORE POINTS OF SIMILARITY WITH
OUR OWN NATIONAL RESEARCH PRIORITIES.

HOWEVER, THE KIND OF OUTREACH WE’VE CONDUCTED OVER THE PAST
CENTURY, RELATIVE TO PREVENTION AND HEALTH PROMOTION, IS NOT AN
ADEQUATE MODEL FOR THE NEXT CENTURY’S EFFORTS IN REGARD TO
RESEARCH

THEREFORE, I BELIEVE THE U.S. PUBLIC HEALTH SERVICE WILL
PLAY A MAJOR ROLE IN HELPING OTHER NATIONS BUILD THEIR OWN LONG-
TERM BIOMEDICAL RESEARCH CAPACITY.
23
THAT IS NO SMALL ASSIGNMENT BY ANY MEANS. BUT IT HAS TO BE

DONE.

WE HAVE ALREADY LEARNED THAT OUR ENTIRE SYSTEM OF HEALTH
SERVICES DELIVERY IS BASED UPON A VERY SUBSTANTIAL RESEARCH
FOUNDATION. IT TOOK MANY YEARS TO BUILD THAT FOUNDATION. BUT
ONCE WE BEGAN GOING DOWN THAT ROAD, WE DISCOVERED THAT THE “HALO
EFFECT” ON THE REST OF SOCIETY WAS VERY EXTENSIVE AND VERY
POSITIVE.

WE NOW KNOW THAT WE CANNOT RATIONALLY DISCUSS THE HEALTH
STATUS OF OUR CITIZENS WITHOUT ALSO DISCUSSING THE HEALTH STATUS
OF OUR BIOMEDICAL AND BEHAVIORAL RESEARCH ESTABLISHMENT ...

* OUR NATIONAL INSTITUTES OF HEALTH ...

* OUR FOOD AND DRUG ADMINISTRATION ...

* OUR CENTERS FOR DISEASE CONTROL ...

* AND OUR ALCOHOL, DRUG ABUSE, AND MENTAL HEALTH
ADMINISTRATION,
24
AND SO I BELIEVE THAT THIS UNDERSTANDING -- AND THIS

DEDICATION TO A NATIONAL RESEARCH CAPACITY -~- ARE CONCEPTS THAT
WE WILL BE SHARING MORE AND MORE WITH OTHER NATIONS,

NATURALLY, THEY -- IN TURN -- REQUIRE A NATIONAL COMMITMENT
TO FREEDOM OF SCIENTIFIC INQUIRY ... TO PEACEFUL CO-EXISTENCE
WITH ONE’S NEIGHBORS ... TO PUBLIC ACCOUNTABILITY FOR THE
EXPENDITURE OF PUBLIC FUNDS ... AND SO ON.

IN OTHER WORDS, THE DEVELOPMENT OF A NATIONAL RESEARCH
CAPACITY MUST BE INTEGRAL TO THE EVOLUTION OF A NATIONAL

COMMITMENT GENERALLY.

BUT I BELIEVE IT CAN BE DONE. AND I BELIEVE THE U.S. PUBLIC
HEALTH SERVICE CAN PLAY A MAJOR ROLE IN HELPING OTHER NATIONS GET
THAT JOB DONE.
25
I ALSO BELIEVE THAT HAWAIT WILL CONTINUE TO PLAY A MAJOR

ROLE AS THE BRIDGE BETWEEN THE MAINLAND AND THE PACIFIC BASIN.
GEOGRAPHICALLY, OF COURSE, YOU ARE PERFECTLY SITUATED.
CULTURALLY THE SAME COULD BE SAID AS WELL, AS I HAVE ALREADY
SEEN,

THIS WEEK I VISITED MOLOKOI, FAMOUS AS A COLONY FOR PATIENTS
WITH HANSEN’S DISEASE AND LATER AS A RESEARCH STATION IN THE
QUEST FOR AN UNDERSTANDING OF LEPROSY.

YESTERDAY I VISITED THE RESTOREP SEAMAN’S HOSPITAL AT
LAHAINA ON THE ISLAND OF MAUI, A HOSPITAL WHICH ALSO PLAYED A
PROMINENT ROLE IN THE HISTORY OF THE U.S. PUBLIC HEALTH SERVICE.

FURTHERMORE, YOU HAVE AN ENLIGHTENED GOVERNOR, AN INNOVATIVE
DIRECTOR OF PULBIC HEALTH, AND A PRESTIGIOUS UNIVERSITY WITH A
TRUSTED SCHOOL OF PUBLIC HEALTH. IT WOULD BE A PRIVILEGE FOR ME
OR ANYONE TO BE A PART OF IT.

AND NOW A CLOSING PERSONAL NOTE.
26
T AM NOW WELL INTO MY FINAL YEAR AS THE 13TH SURGEON

GENERAL IN THE HISTORY OF THE U.S. PUBLIC HEALTH SERVICE. THIS

HAS BEEN THE MOST EXCITING, BAFFLING, FASCINATING, FRUSTRATING,

AND SATISFYING EXPERIENCE I’VE EVER HAD. NOTHING IN A VERY FULL
AND INTERESTING LIFE COMPARES WITH IT,

I WILL LEAVE THIS POST FEELING THAT I DID ABOUT AS WELL AS I
COULD ... AND REGRETTING THAT I SOMEHOW DID NOT DO MORE. BUT
AMONG THE MOST SATISFYING MEMORIES I WILL CARRY WITH ME WILL BE
THOSE MOMENTS WHEN I SPOKE WITH ... AND LISTENED TO... MY
COLLEAGUES FROM MANY OTHER NATIONS ... MOMENTS WHEN WE PUT ASIDE
THE BARRIERS OF RACE AND CULTURE AND NATIONALITY AND COUNSELED
TOGETHER ON WHAT WE COULD DO TO IMPROVE THE HEALTH AND WELL-BEING
OF THE HUMAN RACE.

BEING INVOLVED IN THE WORLD’S CAMPAIGN FOR BETTER HEALTH |
FOR ALL HAS BEEN A TRULY PRIVILEGED EXPERIENCE. AND FOR THAT |
AM ETERNALLY AND HUMBLY GRATEFUL.

THANK YOU.
He HH #