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*# # « REMSRKS OF THE SURGEON GENERAL « * #

SURGEON GENERAL KOOP: Well thank you very
much; Bob. What you hear in the way of a voice this
morning is not the usual Chick Koop; that is e Swiss
virus. I thought it was going to be lethal, and then
Twas afraid it might not be, but I did survive and
here I am,

I’m very happy to be here and to see the
workings of this Interagency Committee, because as [
am frequently asked, as I was in an interview this
morning before I came here, what have I set for my
goals, one of the things that I always mention--and
it might seem to you to be impertinent-~is that I
would like to have a role in developing a philosophy
an aging in this country. And what I mean by that is
that aging is a part of living, and whether or not
one has to make 8 decision about his own aging, oar
about a mamber of his family, or about society, I
think that that kind of a decision should be based on
information rather than UPON prejudices, and even in
Government circles, as hard as we try, I find there
is sfill a lot cf prejudice and concern that doesn’t

have to be there. This doesn’t mean chat there will

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ever be a document which says, "This is the
philossphy of aging," but the Gffice of the Surgeon
General, which has essentially no power, does have a
ict of moral suasion and I find that in certain areas
where I am asked to talk what I have to fay is at
least listened to, and hopefully some of the things
that wa discuss in the way of philosophy might
eventually take hold.

You might ask how comfortable I feel in
making an aging project one of MY Mayor initiatives
in Government after having spent a lifetime with
children. particularly with very young children. And
the answer is I feel very comfortable about it
because there are a lot of things that ere very
Similar about the dependence of elderly people ang
the dependence of children. And I don’t feel that
I’ve taken a giant step in any direction at all. It
Just seemed to be a very natural evolution of the
things that I was concerned about in protecting
people who required protection.

My first real affort in reference to aging
Was a total failure, And that is, at the time of the
White Hous? Conference I tried to convince the
President that it would be a marvelous gesture if he

provided Dr. Butler with the six research beds he
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wanted at the Clinical Center and 4 very fine gesture
to the Conference about his own concern about these
things. I zlmest thought, with some o¢ the
information that Dr. Gibson end Dr. Butler provided,
and the response from the White House, that that
might have happened, but as you know, it didn’t, I
hope that my next venture May prove to be

more effective, and 1/1] say 4 little bit more
about that later,

Let me just tell you, from the point of

View of the Surgeon General, Functioning in the
Capacity that I do now as Deputy Assistant Secretary
of Health as well, how I think all this fits into the
perspectives of our general Department’s efforts. Ags
you know, Secretary Schweiker is very much interested
in health promotion end disease prevention. and you
will be seeing something almost weekly now about a
Ney initiative in the field of prevention. We are
committed £9 this as a major health policy and I
think this has been clear from the confirmation
hearings of Secretary Schweiker Tight an down to his
most recent press peleases. In general, what we’rea
following, are the guidelines set forth in the
Surgeon General’s Report on health promotion and

disease prevention which was entitled "Healthy
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People", and in the Follow-up document which was
called, “Objectives fer the Nation". And you are Very
familiar with these things. In these two documents we
Teally have isolated five Sépearate categories or
objectives which are goals for prevention and health
promotion that we hope our society can achieve by the
year 1999. They include such things as trying to
lower our infant mortality rate from its present
almost 12 to F per 1,000 live births; to assure some
kind of longterm, successful control of high blood
pressure by at least SO percent of persons with the
disease, and that of course impinges very definitely
Upon your concerns; to reduce the proportion of
smoking adults to less than 25 percent of the
population--the kind af effort that the smoking
lobby, or the tobacca lobby is making sgainst it at
this time, that seems problematical, They have
already spent in advertising this year more than sur
entire budget on smoking and health, and that ts only
25 parcent of this year’s budget for lobbying against
the things that we think are proper; and other such
things as trying to cut down on infant fetal alcohol
syndrome and such things as that, which are not part
of your aging concerns,

But we believe that interagency cooperation
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PACE 12

is absolutely essential for attaining any of these
Qcals, and the kind of a meeting you’re having this
morning is certainly evidence of the fact thet you
understand these things as well. We need the
Department of Housing and Urban Development to help
achieve safety and sanitation goals for improved
living environments. We need the Department of
Agriculture to improve nutrition, especially in our
initiatives with pregnant women and children, and as
you ses it, with the aging population. We certainly
need the Health Care Financing Administration to help
to fund demonstrations in new health care
technologies and to encourage the application of the
results and $0 on. And [711 say a feu things about
that in a moment,

So, many of these goals may not eppear at
first hand to be specifically targeted at the
nation’s elderly. But we also have a separate program
devoted to the specific problems of longterm care
which cubs across all 492 groups an3 effects gi]
social and economic groups as well. So aften longtarm
care is assumed by the listener to refer anly to the
aging population, but I certainly in my former
incarnation realized that a lot of longterm care went

into very young children indeed, and they had to have
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it for much longer periods of time than do the eged.

You are aware of the fact that Assistant
Secretary Erandt eppointed me as the Chairman of a
Peolic Health Service Task Force on Longterm Care,
and we moved into that with some dagree of enthusiasm
only to find then that we were sort of downgraded 43
Little bit by the whole Department of Health and
Human Services getting into the same act. And you
know that we shifted gears as rapidly as we could and
tried to comply with Assistant Secretary Rubin’s
request for an inventory of what was going on in
various parts of the Fublic Health Service. And
inasmuch as what Dr. Butler and Dr. Gibson are on
that task force, I won’t have anything more to sey
about that,

I’ve alluded to the fact that I would
mention something to you a little bit further about
another opportunity we might have, and I’ll guest
Specifically mention it because it involves several
agencies here, and that is a longterm concern thas f
have had about incontinence. One of the mast
Fascinating diseases of childhood is Mirschsprung ’s
disease, or aganglionic megacolon, end for averu cone

of those that you see, you see pernass 35 or 40

ot

children who are though fo have that disease but
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merely have the symptoms of it without the pathology,
and all of these children tend to have problems in
incontinence. And therefore I have been concerned
about the physiologic pathology, or the patholagic
physiology, of incontinence. And as I got into the
Public Health Service and recognized what nursing
home admissions consisted of, and realized how much
longterm care was associated with incontinence, and
began to get the statistics on this, I reslized that
if we wanted to make a really cost-effective etah at
something in the future, incontinence would be a
matvelous goal. If you could do all the things you
wanted to do and you were 100 percent successful, you
could save as much as #93 billion dollars a year in
longterm care by conquering incontinence by one way
or another. And there are many ways that can be dona,
not just by surgical means and mechanical
contrivances, but most effectively by the use of
Diomedical feedback techniques.

And on one of the occasions when I was able
to corner the Secretary, I pointed out to him that i¢
he really wanted an initiative that would sing for
him in days to come, incontinence would be it, end if
we could have his support, I would be very happy to

try toa work with people out here at NIA to spearhead
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324 this and get some of the answers that we'd like to
325 have. As you know, Dr. Engle working at the Institute
326 in Baltimore has a very high success rate among

327 ambulatory elderly, between 45 and $O, with

328 incontirence. And my concern is, can he get the same
329 kind af an effective result with people who ere

330 admitted to nursing homes, especially to do it

331 quickly enough before they get into the situation of
332 having bed sores which make their discharge

333 absolutely impossible from a nursing home?

334 And it is along those lines that I

335 approached the Secretary and got his support to go to
336 Dr. Carolyn Davis, and we have her promise of a

337 suostantial amount of financial support as soon as
338 the new fiscal year arrives to try to set up a unit
339 in Baltimore which would be a typical nursing home
B49 unit where we would net be dealing with a select

341 population,» but the run-of-the-mill, across the

342 board, incontinent patient that comes to s nursing
343 home, and see what theee diafeedback methods might da
344 in such a circumstance,

345 Now, I’m not naive enough to believe that
346 even if you had a marvelous result with that, that
347 you could teach the doctors of America to teach their

not
348 patiants/to be incontinent. It’s Just mot exciting
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enough for them. But 1 think there is a way that we
Can utilize another phenemenon in our modern medical
picture today, and that is the teaching nursing home
that Dr. Butler has been so instrumental in bringing
about. And we have met with people from one of the
teaching nursing homes here in Washington, and it
would appear that if we do it just the right way taat
we could indeed put out a nursing initiative across
this land, suggesting that this would be a ma jor
contribution and a very cost-effective one if nurses
would assume to themselves the role of teaching
elderly pacple who are incontinent how to use the
biofeedback techniques to improve their situation,
And as those of you who may not know as
well as I do, there is a4 constant friction between
physicians and nurses in hospitals over the value of
training, anc who is going to make decisions, and I
think here is a place where we could ask the nurses
to step into a role of teaching and responsibility
where they would not have any competition fram
docters and where, because of their oun particular
skills and compassion, we might achieve the ends that
we’d like to achieve far better than if we put this
in the nands of physicians. And I say that in spite

of the fact that I, myself, am one,
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Finally, I’ve just returned from the Worid
Health Assembly, where I did not have as much time toa
da the things I wanted ts do om the side ss I had
hoped, but I did meet with Dr. Caprio and Dr. MacFadyen ,

who are responsible for the aging
initiatives of WHO. They are very enthusiastic about
the upcoming World Assembly on Aging to be held later
this summer in Vienna. I think that they believe that
there will now be Gi ministers of various countries
who go as chief delegetes to that, which I think is
very important, because it means that it has a high
profile and a sense of importance in those countries,
And as you know, it has a very high profile end a
very important role in this Department because cur
own Secretary is going to lead the delegation to
Vienna in late July. And at the moment it appears as
though both Dr. Butler end I, among others, will be
accompanying him. And that might augur well for the
future,

And | might Just say in closing that it was
very gratitying to be part of the Public Health
Service in Ganeva and t9 realize in what tremendous
esteem the National Institutes of Health are held,

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ially the National [nastitute on Aging, but most

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pecially your leader Dr. Butler,