50 REMARKS C. EVERETT KOOP MEDAL FOR HEALTH AWARENESS AMERICAN DIABETES ASSOCIATION VOLUNTEER RECOGNTION LUNCHEON ATLANTA, GA JUNE 15, 1990 C. EVERETT KOOP, MD GREETINGS, ETC. THANK FOR AWARD T AM TRULY DELIGHTED TO BE HERE WITH YOU TODAY, TO HAVE BEEN INCLUDED IN YOUR SOTH ANNIVERSARY CELEBRATION. T AM A REAL FAN OF THE AMERICAN DIABETES ASSOCIATION. I ADMIRE MORE THAN I CAN SAY THE DEDICATION AND THE ACHIEVEMENTS OF VOLUNTEER ORGANIZATIONS SUCH AS YOURS. VERY EARLY IN MY MEDICAL CAREER, I SAW THE INESTIMABLE VALUE OF VOLUNTEER GROUPS THAT HELPED THEIR FELLOW CITIZENS MAINTAIN OR RESTORE THEIR HEALTH. AFTER 40 YEARS IN MEDICAL PRACTICE AS A PEDIATRIC SURGEON, AND THEN AFTER 8 YEARS AS YOUR SURGEON GENERAL, MY CONFIDENCE AND MY GRATITUDE TO VOLUNTEER GROUPS LIKE THIS ONE GROWS ALL THE TIME. THERE WERE A FEW TIMES DURING MY SURGEON GENERAL YEARS THAT [I WAS LABLED "CONTROVERSIAL" OR EVEN "REVOLUTIONARY". THAT'S OK. BECAUSE WE ARE IN A REVOLUTION IN HEALTHCARE IN AMERICAN. AND PEOPLE LIKE YOU ARE IN THE FRONT LINES OF THE REVOLUTION. THE NEW AMERICAN HEALTH REVOLUTION IS BASED UPON TWO CONCEPTS. THE FIRST PRECEPT IS THAT OUR HEALTH AND THE HEALTH OF OUR FELLOW CITIZENS WILL DEPEND MOSTLY UPON THE PREVENTION OF DISEASE AND SOME ANALYSTS EVEN SAY THAT PREVENTION AND HEALTH PROMOTION CAN POSTPONE UP TO 70 PERCENT OF ALL PREMATURE DEATHS, WHEREAS THE TRADITIONAL CURATIVE AND REPARATIVE APPROACH OF MEDICINE CAN POSTPONE NO MORE THAN 10 TO 15 PERCENT OF SUCH DEATHS. EVEN IF THEY'RE ONLY HALF RIGHT, THAT'S QUITE A DIFFERENCE IN SOCIAL PAY- OFFS. SECOND, WE HAVE COME TO REALIZE THAT THESE TWO APPROACHES TO HEALTH -- THAT IS, DISEASE PREVENTION AND HEALTH PROMOTION -- ARE THE PRIMARY RESPONSIBILITIES OF EACH INDIVIDUAL. PHYSICIANS AND THERAPISTS AND PHARMACISTS AND NURSES CAN PROVIDE YOU WITH INFORMATION AND ALL KINDS OF SERVICE. BUT THE CRITICAL CHOICES REST WITH THE INDIVIDUAL. AND THEY ARE FREE CHOICES IN NEARLY EVERY CASE, NOT MANDATED BY LAW -- AT LEAST NOT YET. THIS TWO-FOLD CHANGE IN THE WAY WE LOOK AT HEALTH IN AMERICA HAS NOT YET BEEN FULLY ABSORBED BY THE AMERICAN PEOPLE, ALTHOUGH THEY SEEM WILLING ENOUGH TO LEARN. NOW, IT'S TRUE THAT AMERICAN PUBLIC HEALTH HAS ALWAYS HAD A STRONG PREVENTIVE BASE: WE WERE BROUGHT UP ON VACCINATION PROGRAMS AND WATER FLUORIDATION AND BLOGD PRESSURE CHECK-UPS AND SO ON. pv NEVERTHELESS, I THINK THE OVERALL PERCEPTION AMONG THE AMERICAN PEOPLE IS STILL AN OLD-FASHIONED ONE: THAT IS, THAT PUBLIC HEALTH AND MEDICAL AND NURSING PERSONNEL ARE REALLY ON THE JOB 10 PATCH YOU UP IF YOU GET HURT OR TO CURE YOU IF YOU GET SICK. IN OTHER WORDS, THE PATIENT 1S PASSIVE AND THE HEALTH SYSTEM IS THE ONLY ACTIVE PARTY. pV IT THINK THE PUBLIC STILL ADHERES TO THE IDEA THAT THE PATIENT IS SUPPOSED TQ "FOLLOW THE DOCTOR'S ORDERS," A PHRASE WHICH HAS EVEN BECOME A CLICHE OF THE LANGUAGE. OF COURSE, BY "FOLLOWING THE DOCTOR'S ORDERS," THE PATIENT WILL DO THOSE THINGS THAT WILL HELP HIM OR HER REGAIN THE LOST STATUS OF FULL HEALTH. pv 10 WE IN THE PUBLIC HEALTH PROFESSIONS HAVE BEEN DILIGENTLY TRYING TO TURN THAT CONVENTIONAL WISDOM AROUND. AND I THINK WE ARE! HERE'S WHERE VOLUNTEER ORGANIZATIONS, CORPORATION HEALTH GROUPS, AND THE LIKE COME IN. THEY PROVIDE THE SUPPORT FOR OUR INDIVIDUAL HEALTH DECISIONS, I] T THINK WE'RE MAKING GREAT STRIDES IN THE ANTI-SMOKING AREA. THE PERCENTAGE OF THE ADULT POPULATION WHO SMOKES IS STEADILY DECLINING AND THAT'S EXCELLENT. le DV THERE'S ALSO BEEN A DROP IN THE CONSUMPTION OF HARD LIQUOR, WITH A SHIFT TO BEER AND WINE -- OR SIMPLY WATER. AS A RESULT, THERE'S BEEN A DRAMATIC DROP IN CHRONIC LIVER DISEASE AND CIRRHOSIS MORTALITY IN GENERAL. PEQPLE SEEM TO BE EATING LESS FAT, PARTICULARLY SATURATED FAT AND CHOLESTEROL. THE DROP IN CIGARETTE SMOKING AND THE REDUCTIONS IN FAT IN THE AVERAGE PERSON'S DIET HAVE COMBINED TO CONTRIBUTE TO THE DECLINE IN HEART DISEASE AND STROKE DEATHS OVER THE PAST 10 T0 15 YEARS AS WELL. THERE'S NO DOUBT ABOUT THAT. pv 13 SQ 1 THINK WE CAN FEEL ENCOURAGED ABOUT THE TRENDS SO FAR. THE BIG QUESTION REMAINS, HOWEVER: ARE THEY REALLY TRENDS ... OR ARE THEY TEMPORARY ARTIFACTS OF A DYNAMIC CULTURE? WE NEED TO MAKE THE RIGHT CHOICES ABOUT LIFESTYLE, ABOUT PHYSICAL EXERCISE, ABOUT DIET. Pv 14 WHEN WE CONVINCE QURSELVES TO EAT A PROPER DIET, TO AVOID FOODS HIGH IN FAT, SUGAR, AND SODIUM, TO SAY "NO!" TO DRUGS LIKE ALCOHOL AND NICOTINE, WE TAKE CHARGE OF OUR HEALTH, 13 pv WHEN WE SAY THAT THE BEST WAY TO BEAT HEART DISEASE IS THROUGH ROUTINE EXERCISE, NO SMOKING, AND A HEALTHFUL DIET, THAT'S JUST ANOTHER WAY OF TELLING PEOPLE, "DON'T RELY COMPLETELY ON HIGH-COST HIGH-TECH MEDICINE TO SAVE YOUR LIFE. YOU CAN AFFORD PREVENTION ... YOU CANNOT AFFORD A QUADRUPLE eed en ee ee ee oe 4 BY-PASS, " pv 14 IN THE FUTURE AMERICANS WILL SIMPLY NOT HAVE THE DOLLARS TO PAY ~ THE VERY HIGH PRICE EXACTED BY LIFESTYLES OF THOUGHTLESSNESS ANI HIGH RISK. T KNOW THIS SOUNDS TERRIBLY CHEERLESS, BUT I DON'T THINK IT HAC 10 BE. pv 1?