Dr. J. Edward Hill's Speech from Leadership Development Conference
The AMA, the Alliance and Public Health: Behavior Counts!
AMA Alliance Leadership Conference
The Drake Hotel Chicago, Illinois
Sunday, February 5, 2006
J. Edward Hill
President American Medical Association
Thank you for the warm welcome.
I am so delighted to be here and to have this opportunity to thank you for all that you do for the AMA.
And thats not saying a little. Thats saying a lot.
You have done an amazing job this year, as always, and then youve done even
more.
In the wake of Hurricane Katrina, you opened your hearts and in some cases, your homes.
You provided financial help to displaced medical students, read stories and played games with kids living in shelters, and even now are helping physicians to rebuild
their practices.
Your extraordinary compassion in response to a national disaster touches me
deeply.
But it does not surprise me.
I know the Alliance, and not just because Im married to a former Alliance
president.
In my years of practice, I have witnessed the quiet heroism of your work.
And I share your belief that we can build a brighter future for this country by
focusing on our nations most precious natural resource:
Not oil or gold or lumber. But children.
You teach kids to resolve problems and to deal with bullies by using words, not
fists.
Its called preventing violence, and it saves lives.
You also teach children about the importance of healthy life choices, whether that
means eating right and exercising often, avoiding cigarettes and alcohol or simply
turning off the television.
I call it lengthening lives and improving quality of life.
You at the Alliance have touched thousands of children in a positive way.
As a father, grandfather, kindergarten volunteer and former president of a school
board, I can only say this.
Thank you for your commitment to Americas future:
Thank you for what you do for the children.
I also want you to know that I share in this commitment.
Not just because I am a grandfather, although I care about what happens to my
grandkids and their peers.
Not just because I am a family physician, although I care deeply about families
and their health.
But simply because its the right thing the only thing to do.
Right now, even as we speak, public health scourges are destroying Americas
health, and especially the health of our children.
What are these scourges? You know them all too well.
Obesity
Inactivity
Sexually transmitted diseases
Unwanted pregnancies
Violence, including suicide
And drug abuse, including alcohol and tobacco use.
What do these problems have in common?
They are all rooted in preventable behaviors.
Why should anybody care?
Because these behaviors cost our nation millions of lives and hundreds of billions
of dollars.
Obesity alone costs this nation up to $75 billion a year and tens of thousands of
lives, according to some estimates.
Its also affecting more and more people.
Because of this country's expanding size, blood-pressure cuffs now come in "large adult extra long" for bigger arms.
Patient gowns now come in sizes up to a roomy 5XL.
There are wheelchairs with four-foot wide seats, scales that measure up to 700
pounds and re-enforced hospital beds for excessive loads.
Perhaps most telling is a newspaper item I read recently, about the Batesville
Caskets Co.
Last year, it launched its "Dimensions" line of supersized coffins.
Think about that one, for a second.
Is this the kind of future we want for our children?
If obesity and overweight are relatively new problems, tobacco use is surely an
old one.
Tobacco also costs us billions of dollars 82 billion of them, experts say.
In fact, every pack of cigarettes sold costs nine dollars and 42 cents in direct
medical costs and lost productivity,
Whats more, over 400,000 people die every year in this country due to tobacco-related illness.
Almost 90 percent of them started smoking before the age of 18.
Unless smoking rates decline, more than 6 million American children alive today
will die prematurely from smoking-related illnesses. [All facts above from
Campaign for Tobacco-Free Kids).
But it doesnt have to be that way.
We can help prevent these self-destructive behaviors.
The best way to do this is by helping kids establish good health habits early in
life.
This is why the Alliances educational programs are so critical.
If we can spare even one child from death by lung cancer or diabetes or gun
shot wound we can feel incredibly proud.
But if we can spare one hundred children a similar sad end, we can call ourselves
heroes.
And if we can spare thousands of children, we will be called revolutionaries.
Thats what you are, and what you will be.
Its all about thinking globally and acting locally, which is exactly what you do.
Today, I ask you to continue your good work, but I also ask you to consider new
ways to build on it.
How so?
By working as public health advocates, as well as educators, in your communities, and especially in your schools.
For example, what if your local Alliance decided to fight for public health at the
community level?
What if you were a force for requiring that new developments build sidewalks to
encourage walking, as well as tennis courts and pools?
Or, what if your local Alliance spoke out for stronger physical education
programs?
Cutbacks to these programs are one of the reasons why more and more children
are overweight and obese.
Or what if your Alliance demanded that the school system provide healthier
cafeteria food and get rid of the candy and soda machines?
The evidence suggests that kids will eat nutritious food, provided theyre given
the option, and provided that temptation is taken away.
Finally, what if every Alliance in America began pushing for comprehensive
school health education in their districts?
A comprehensive health curriculum in your local school would encourage young
people to improve their patterns of diet and exercise and understand the risks of unintentional injuries, substance abuse, tobacco use and sex.
It could also help them understand the health care system, including insurance.
The evidence suggests that these programs, done right, can work.
For example, students who get comprehensive school health education are less
likely to drink, smoke, take drugs, or ride with a driver whos been drinking.
The question remains, however:
How do we fund these programs?
One idea is to adopt the state-federal highway construction model.
It could work this way:
Local school districts would develop programs based on broad federal guidelines
and specific local needs.
For example, a school with a recent history of suicide might emphasize education
about depression but an area struggling with underage drinking might do
something quite different.
But both schools would be committed to the basic principles of prevention.
States or school districts that developed comprehensive health education
programs would get federal matching funds for their efforts.
This would get needed dollars to schools and, more important, would be an
investment in our childrens health and our countrys economic future.
Saint Francis Xavier once said:
Give me the children until they are seven and then anyone may have them.
Not being a saint, I propose something slightly different:
Give health educators the children until they are 17, and I promise we will see an improvement in adult health behaviors across the board.
Whats more, we will save hundreds of billions of dollars and countless lives
in the process.
Theres another way we can and must save lives
We need to get health care coverage for the nearly 46 million Americans who
have none.
Now I am sure that most of you are familiar with that shocking number.
But let me put it another way.
If you gathered all uninsured Americans into one place and called it a country it
would be the world's 27th largest nation, just behind South Korea but larger than
South Africa.
Within this nation of have-nots, almost 18,000 would die each year from treatable diseases.
Thats like wiping out Durango, Colorado Hart County, Georgia or the entire
undergraduate population of the University of California, Santa Barbara.
Each and every year.
But again, the uninsured are more than just a number.
These millions of people are friends and neighbors, maybe our children and
grandchildren.
And all of them are at serious risk.
Consider this research:
Uninsured women diagnosed with breast cancer were almost 50 percent more
likely to die of cancer than were privately insured women [ACP-ASIM; from a
study of 4,700 breast cancer patients].
Hospitalized patients without health insurance:
Receive fewer needed services and worse quality care
Have a greater risk of dying in the hospital or shortly after discharge than
patients with insurance. [IOM 2002]
Uninsured trauma victims:
Are less likely to be admitted to a hospital.
Are 30 percent more likely to die of their injuries.
The AMA cares about these men, women and children.
In fact, ninety percent of AMA members surveyed think the number of uninsured
is either a major problem or an outright crisis. [AMA Member Connect Survey]
And theyre right.
I would go so far as to say that its a national disgrace.
A country as wealthy and innovative as ours should never allow 18,000 of its
citizens to die every year from treatable causes, simply because these patients
lacked health coverage.
Its time for action, and the AMA has a plan.
AMA researchers believe we could get 94 percent of Americans covered.
We also believe we could do so without resorting to the perils of a single payor
system and without risking the innovative spirit of American medicine.
Though our plan is complex, it can be summarized neatly.
Give patients the resources they need to choose and buy their own health
insurance.
Thats our plan. Heres how it happens.
Instead of subsidizing health care indirectly, by not taxing the job-based medical
benefits of some Americans, subsidize health care benefits directly by giving
people the cash they need to buy health care coverage but only when they buy
insurance for their entire family.
Give them this cash in the form of a tax credit.
Give it to them whether they paid income tax or not.
Make it income-sensitive, so those who need the most help, get it.
Maybe a patient wants to buy the Cadillac plan offered through their employer.
Maybe he or she wants the most bare bones plan offered by the state.
We say let the patient decide, and use the 150 billion dollar tax subsidy that
already exists to help get the job done.
Its a plan worth trying.
It does more than the current system to help the folks who need it most.
It also puts power back in the hands of patients.
Finally, its an approach thats being given serious consideration in several
quarters.
The North Carolina Medical Society is working on a pilot program for their state.
Louisiana Congressman, Bobby Jindal, has proposed legislation to try something
like this in Louisiana and Mississippi to help the victims of Hurricane Katrina.
Its time to stop wringing our hands about the uninsured and start acting.
I encourage you to keep in touch with the AMA in the days and weeks ahead, as
we do even more to put this problem, as well as potential solutions, in the national
spotlight.
I want to thank you again for listening to me speak today about some passions I
know we all share.
Like caring about kids and their future.
Like preventing health problems before they ever start.
Like speaking up for those who cant speak for themselves.
Including children.
Including the millions of uninsured.
Some may call you dreamers, but I call you doers.
You have vision, and so you are inspired to hope.
You have hope, and so you are inspired to act.
And when you act, you always proceed with wisdom, so you will bring, not just
change, but change for the better.
I know that someday we will celebrate together in a nation transformed.
Thank you for all you do.