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Office of the Press Secretary

For Immediate Release February 21, 1998
                           PRESS BRIEFING BY 
                     SECRETARY OF HHS DONNA SHALALA       
                  AND SURGEON GENERAL DR. DAVID SATCHER       

The Briefing Room

4:08 P.M. EST

MR. LOCKHART: Hello, hello. Big crowd. Well, thank you all for coming. For the record, this is an embargoed briefing, on camera, on the record, but embargoed until 10:06 a.m. tomorrow, the President's radio address.

Joining us today is the Secretary of Health and Human Services, Donna Shalala, and our new Surgeon General, Dr. David Satcher. And they will give you some information about the President's radio address and answer any questions you might have. I'm told also that the press paper on this is on the way here right now and they'll hand it out as soon as it comes down to Lower Press.

SECRETARY SHALALA: Tomorrow morning the President will announce his administration's intention to eliminate racial and ethnic disparities in six critical health areas by the year 2010. This means that for the first time in its history the federal government will set universal national health goals, ending the practice of setting separate, lower goals for minority communities.

What's happened in the past is that when we set health goals we had one set of goals for the racial and ethnic communities in the United States and another set of goals for the rest of the country. And we're going to end those disparities and, in fact, set one set of goals.

Since taking office, we've had some very important public health accomplishments: Infant mortality is down; HIV and AIDS rates are falling for the first time since the beginning of the epidemic; cancer rates may actually be starting to decline in this country. But these accomplishments are tempered by the fact that there are persistent disparities in health outcomes for white Americans and for minorities. And I'm defining minorities as including Americans Indians, African Americans, Hispanics, and Asian Americans.

But simply bringing down the numbers is not enough. We want to close disparities for the major killers in this country: heart disease, cancer, stroke, diabetes, and HIV/AIDS. And he'll set a goal tomorrow of ending health disparities in these six -- in six critical areas by the year 2010. And we've actually selected out six specific areas: infant mortality, cancer screening and management, cardiovascular disease, diabetes, HIV/AIDS, infection rates, and child and adult immunizations.

We're also going to expand outreach with a sweeping campaign led by the Surgeon General of the United States, Dr. David Satcher. And Dr. Satcher will be spreading the word and helping to organize the country to reduce the disparities in all of these health areas.

In addition to Dr. Satcher an internal task force will be led by Dr. Peggy Hamburg, the Assistant Secretary for Planning and Evaluation. Dr. Hamburg was the New York City Health Commissioner before she joined the administration, and is widely credited for reducing the incidence of tuberculosis in New York City. She actually will be putting the mobilization campaign in place and has had wide experience in public health in actually changing and reducing health disparities.

The task force, the internal task force is going to monitor progress in all these six areas. All of these six areas are areas in which we will actually have statistics, we'll know what our baseline is and as we close the gaps be able to report yearly on how we're doing in raising immunization rates, for example, or reducing the incidents of particular diseases, or getting better management of diseases like hepatitis.

Finally, the President will be asking Congress for $400 million over the next five years to both assess our current programs in improved data collection and work with communities. Remember the important point here is this is an historic breakthrough in public health. We will now have the same standard for the major killers that we have for the wider community. What we intend to do is to close the gaps in health disparities between minority communities and the rest of the country. And it will be a major breakthrough. It will take a huge mobilization effort in this country to bring health care to the communities, to get the communities to use the health care system.

Let me now ask Dr. Satcher whether he has anything to add.

DR. SATCHER: Thank you. I'd just like to stress, as the Secretary pointed out, that this is -- our mobilization initiative is going to be very important, that this is a public and private initiative, it's not limited to the government. We are depending upon organizations in communities throughout this country to join us in making this initiative work.

We will be communicating with communities throughout this country; listening to communities; trying to identify successful models that can be applied more broadly. But it is a public/private venture. Grant Makers of America will be joining us in trying to identify strategies that will work, that can help us to demonstrate the efficacy of these efforts to narrow and close the gaps that exist in areas like infant mortality, immunizations, HIV/AIDS, cardiovascular disease, diabetes and cancer.

So we're looking forward to working with people throughout this country.

SECRETARY SHALALA: The context for this is obviously the President's Race Initiative. This is the health piece of the President's Race Initiative. It is a measurable set of goals, so we actually will be able to report each year on our progress and the President will expect us to report each year on the country's progress to actually improve the health by reducing the differences.


Q What do you mean by differences? I mean, are you saying that all along we've accepted, in targeting funds, that the infant mortality rate is going to be higher in minority communities than in white communities?

SECRETARY SHALALA: When we set the goals, the process of setting the nation's goals over the years, we actually had different goals for the minority communities because they were further back in terms of how far we were going to move. And what we're saying now is we no longer will have separate goals. We want to bring up and eliminate disparities between the two communities -- access to mammography, adult immunization, cardiovascular disease -- we're actually going to try to move faster in the minority communities to close these gaps.

Q Those goals have been tied to funding decisions

SECRETARY SHALALA: No, actually, they have not been tied to funding decisions. Those goals were set lower because those communities were further behind. And so what we're now saying is we're going to put additional resources into this effort so that we can leverage and mobilize the country to close the gaps in all of these major areas. And the areas we've chosen are areas that are of specific concern to these communities because there is higher incidence in these communities of these particular diseases or these particular gaps.

Q What additional resources?

SECRETARY SHALALA: We're talking about $400 million over the next five years. But that's glue money to pull our public health resources and our research resources together for a specific focus.

Q Well, the rationale that has existed is based on the idea that because there was so much more that needed to be done for minorities -- so by changing the goal --

SECRETARY SHALALA: We give ourselves --

Q I mean, is that realistic, though? Presumably, the old rationale wasn't meant in a negative way, it was meant to deal with a realistic approach to the problem.

SECRETARY SHALALA: I think what we're saying is that we're going to make an extraordinary effort to actually close those gaps.

Let me give you a specific example. In 1993, the immunization rates for American kids up to two years old were 55 percent -- 55 percent. And there were big gaps between white kids and African American and Hispanic kids in particular.

Q For example -- what were those gaps?

SECRETARY SHALALA: There was a difference of 20 --

DR. SATCHER: There's some specific examples throughout the country, but in a place like Detroit, where the difference was as high as 30 percent.

SECRETARY SHALALA: Between whites and African American kids. We mobilized the country to get kids below two years old immunized. And we now have childhood immunization rates for most of the vaccines for minority kids at precisely the same rate as white kids. We brought up minorities actually faster because we had further to come. And we have 90 percent of all the kids in the country now immunized.

That took a tremendous targeted mobilization effort to get the resources and the organization to the places where we had the biggest gaps. What we're saying for these other disparities that we're going to do -- which in some ways will be a more complicated campaign because it involves getting people to care, not just shots -- we're going to do that for these other major disease areas in somewhat the same way. But it's a huge effort. We're simply going to raise the standards, not lower them.

Q Is the trust factor in the minority community some other reason for the disparities in health for ethnic versus mainstream?

DR. SATCHER: I think there are a lot of reasons, and I think we assume that trust is one of the factors. And our strategy for dealing with that is to try to be more effective in involving the communities, as we did with immunizations. We identified organizations like the Congress of National Black Churches, Hispanic Organization in Chicago works out of the church system there, and we work through those organizations to get people immunized in those communities. So we have learned some things in areas like immunization about how to deal with issues related to trust.

Those are not going to go away easily, but I think we're just going to have to recognize them and work with people who live and work in those communities and who are trusted by people in those communities.

Q And socioeconomics also plays a large part as well.

DR. SATCHER: Oh, no question about it. There are a lot of factors, like the American Indians, one of the major concerns is diabetes where the risk of diabetes in American Indians in this country is over twice as great as it is for whites in this country. And there are a lot of factors in terms of lifestyle and other factors that we cannot even define. But in working with those populations and groups that are familiar with those populations and trusted by them, we believe we can make progress.

Q Dr. Satcher, can you describe that mobilization process in a little bit more detail? Does it mean more money goes to hospitals that cater to these communities? Is it more outreach? Can you tell us --

DR. SATCHER: Well, one of the strategies that I'm really quite involved in would be the outreach program to 30 communities. We're going to identify at least 30 communities in the country and each of those communities will have at least one of these areas -- infant mortality or immunizations, HIV/AIDS, et cetera -- and we will work with those communities in developing strategies for closing the gaps. And they will have to define what are the unique challenges in their community that we need to focus on.

But what we want to do is to demonstrate success in these various communities in different areas. Some of them will be African American, some of them will be Asian, some of them will be Hispanics, some of them will be American Indians, reservations, et cetera. But we want to demonstrate in these various communities that we can be successful in closing the gaps. And once we've done that, we can bring the full force of our department to bear on those problems with all of our resources.

SECRETARY SHALALA: The earlier announcement this week by the President and the First Lady for an outreach program for children's health insurance will obviously dovetail into this. But what we've clearly done here is put our institutions both public and private, as well as our own reputations, on line to say that it's time we closed these huge health gaps; that we can't wait for everybody in this country to get good health insurance; that we have to mobilize what health insurance we have in this country, make it fit together in a way so that we really do close the gaps and make a difference in people's lives.

Q What is the source of the funding? Is it from the tobacco tax or are there offsets or --

SECRETARY SHALALA: No, actually I think this is -- I'm sure we identified offsets, but this is part of our regular budget. This is not on our list of where we clearly identified the tobacco money for it. It's $80 million for the first year, and then over the five years it becomes $400 million.

But we will be spending a lot more than $400 million, because what we're going to do is leverage NIH resources, CDC resources, public health resources, the health care financing administration, plus the private sector. Remember when we did immunizations, McDonald's gave us their tray liners. And Pampers is giving us -- for the children's health insurance outreach.

So we'll be going to the private sector, to the churches, to the public health system in the United States. When you really want to close a health care gap and you do not have a single health care system, you go to every part of the country and have everybody pull in the same direction.

Q When you say leverage, though, then what percentage -- how much would the $400 million leverage approximately? What are you contemplating?

SECRETARY SHALALA: My assumption is it will be well over a billion dollars by the time we're finished in what the private foundations will give us, in what other public health -- parts of the public health system will give us, in what private health insurance itself will commit to as it puts special efforts on closing some of these gaps. We'll be working with the HMOs around the country. They were terrific on the immunization campaigns.

Q What's a realistic ratio for closing this gap that's gone on for many, many years?

SECRETARY SHALALA: Well, what we're saying is, we're going to close it. We're actually saying, by 2010 our goal is not to be competitive here, but it's to close the gap. We're not saying we want to cut this gap in half; we're saying we actually want to close the gap by 2010.

DR. SATCHER: Let me just add one thing to that. I think it's not going to be easy. It's a real challenge to do this. And I think what we're saying is that we have to work together. Some of the factors are not in the health care system, they're in individual behavior -- physical activity, diet, smoking, toxins of various kinds. So we've got to work with communities to help people change their lifestyles. We have some successful models throughout the country already that we've developed. We've got to expand those. But all of these things have to work together in order for us to be successful.

Q To what extent do you think the disparity is due to lack of insurance? And if it's an uninsured population, how do you address that?

SECRETARY SHALALA: If you go to the analysts in the system, the people that look at this, they'll say both a combination of poverty and a lack of health insurance lead to this. But we've put in place before special programs. If we had believed that, we would have never gotten the kids in this country immunized. What we learned out of the immunization campaign was that you've got a public and private system -- you've got community health centers, you have hospitals that provide special programs, you can put special money out. CDC has most recently had a special campaign focused on African American women for mammograms that has begun to actually make a percentage difference.

At the NIH, they've been, under Mrs. Gore's leadership, been running a campaign to reduce infant mortality from sudden infant death syndrome by running the Back To Sleep campaign. Gerber's has been part of that campaign. We now have almost 70 percent of the kids in this country when they're born, their first couple of years they're put on their back. We have a large -- a significant problem with the American Indian population, who tend to put their babies on their stomach. This campaign to close the gap will focus on that population, getting the message out that if you put your baby on its back it will reduce its chances of dying as an infant. That will be an integral part of this overall campaign.

I don't want to sound too enthusiastic or anything -- (laughter) -- but it's fun not to just say, we're going to have a 10 percent goal, that we're really going to go after the whole thing. And we're not going to be discouraged by the fact that we don't have a single health care system. We're going to take every piece of this health care system, public and private, plus every person, every church, every community leader to get people to the health program that will make a difference for them.

Q I'm sorry, but I'm not sure if I quite understand how to explain where the $400 million would be spent.

SECRETARY SHALALA: Oh, I couldn't actually tell you specifically. David, do you want to describe the 30 --

DR. SATCHER: Of the $80 million, $30 million will be used in these 30 communities that I mentioned, that we're going to select throughout the country and have each one of them adopt at least one of these areas for closing the gaps.

SECRETARY SHALALA: That's 150 over five years.

DR. SATCHER: Right, 30 times five, so over five years, 150. The other $50 million of ongoing programs -- HIV/AIDS, diabetes, programs that we have in place and we're committing so much funds to enhance those programs -- sexually transmitted diseases -- to make sure that over the next few years we enhance our strategies in these minority communities.

Q Is it a grant then? I mean, are you talking about giving a million dollars to a community?

DR. SATCHER: In some cases.

SECRETARY SHALALA: In some cases. What we're talking about is taking the rest of the money, some of it taking existing programs and retargeting them specifically to communities where we see the gaps. That's why we use terms like "mobilization." It's not -- you can't take a billion dollars and go buy this and close the gaps. You have to mobilize every part of the system. And I realize it doesn't -- it's not as easy as saying we're going to do this program, we're going to hand out the money and it's going to get done. Because the American health care system is fragmented, if you want to actually improve people's health you have to almost scotch-tape it together for a huge campaign to close those gaps and get it to work together. And that's the way it gets done.

It's a leadership mobilization, huge management effort. And what we've done is picked two people -- first the Surgeon General David Satcher, and second Peggy Hamburg, who ran the New York City Health Department -- the two leading public health people in the country who have actually done this kind of thing -- and said, let's go out and not take an incremental step, let's take a giant step to improve the health of minorities in this country.

Q Of those 30 communities, can you identify a handful for us now?

DR. SATCHER: That wouldn't be appropriate for me. I think we're going to work to identify the best communities, and in order to do that we need to do some listening -- what people are doing now, what they propose to do, the extent to which people can work together in communities across racial lines. This project will not succeed unless the white community is supportive, American Indian, African American, Asian -- all of these groups have to work together in communities in order for this to be successful. We're looking for communities that are willing to make that kind of commitment.

I was just thinking of another example of somewhere that we're really struggling now, and that's adult immunization. If you take the pneuma -- vaccine, for example, that could save many thousands of lives in this country every year --


DR. SATCHER: That's right. Very few African Americans, adult, probably less than 20 percent, are getting that vaccine. And only about 35 percent of white adults. So we need to close the gap. But as we close it, we're going to improve it for everybody. So we're not talking about taking anything away from anybody; we're talking about developing strategies and showing that they can work, and then applying them broadly.

But, obviously, those who are at the bottom are going to go much faster, just like they did with the immunizations, the childhood immunizations.

SECRETARY SHALALA: One more question. Yes.

Q Which gap in which disease area is the largest?

DR. SATCHER: Oh, disease areas. I would probably say diabetes, because what we see -- and people like Senator Domenici and others in Congress have a major concern - what we see, for example, in the American Indian population in this country, sometimes it's five times as great as in the White population -- in certain groups of American Indians, like the Pema (sp) population, for example, it tends to be higher. The same thing with Hispanic population. There are some groups where the gaps in diabetes is really great. And we see the difference in terms of complications, like the need for amputations, in-stage renal disease, blindness from diabetes. We see some major gaps in these areas that we believe that we can begin to close.

And I also want to point out, it's going to benefit our entire health care system, because the way we spend our money now, we spend too much of it on treatment because we have to, because we're not preventing things as early as we would like. And part of this initiative will be to significantly enhance prevention.


END 4:30 P.M. EST