Lorillard
Statement by J. Michael Mcginnis, M.D. Deputy Assistant Secretary for Health (Special Health Initiatives) Before the Subcommitee on Health and Scientific Research Committee on Human Resources United States Senate
Fields
- Author
- Mcginnis, J.M.
- Area
- LEGAL DEPT FILE ROOM
- Alias
- 03603279/03603303
- Type
- SPCH, SPEECH/PRESENTATION
- NEWS, NEWSPAPER ARTICLE
- Named Person
- Califano
- Foege
- Kennedy
- Mckeon, T.
- Millar, D.
- Quinn, T.
- Richmond
- Schweiker
- Foege
- Named Organization
- Bureau of Foods
- Bureau of Health Education
- Cdc
- Center for Disease Control
- Cooperative Extension Service of Nh
- Departmental Task Force on Preventi
- FDA, Food and Drug Administration
- Ftc, Federal Trade Commission
- Health Education Center
- Natl Center for Health Statistics
- Natl Heart Lung Blood Inst
- Natl High Blood Pressure Education
- NCI, Natl Cancer Inst
- New England Health Promotion Counci
- Nm Health Education Coalition
- Office of Health Information + Heal
- Phs
- Presidents Commission on Privacy
- Presidents Council on Physical Fitn
- Regional Medical Program
- Stanford Heart Disease Program
- Univ School of Public Health
- Usda, U.S. Dept of Agriculture
- Bureau of Community Health Services
- Bureau of Health Education
- Recipient (Organization)
- Comm on Human Resources
- Subcomm on Health + Scientific Rese
- Date Loaded
- 05 Jun 1998
- Request
- R1-004
- R1-037
- Litigation
- Stmn/Produced
- Author (Organization)
- Hew, Dept of Health Education and Welfare
- Site
- N14
- Master ID
- 03603272/4564
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Document Images
S TATEMENT'
BY
J. MICHAEL MCGINNIS, M. D.
COMMITTEE' ON HUMAN RESOURCES
UNITED STATES SENATE
6
WEDNESDAY, JUNE 7, 1978
$
c
FOR RELEASE ONLY UPON DELIV'E'RY'
DEPARTMENT OF HEALTH, EDUCATION. AND WELFARE.
DEPUTY ASSISTANT SECRETARY FOR' HEALTH
(SPECIAL HEALTH INITIATIVES)
SUBCOMMITTEE ON HEALTHAND' SCIENTIFIC RESEARCI3
BEE'ORE~THE
MR. CHAIRMANiAND MEMBERS @F' TH'E SUB.CaMMITTEE :
I am pleased to have the opportunity to appear before,
you this morning to discuss the Administration"s views on
prevention and many of'the issues addressed by the
Disease Prevention and Health Promotion Act of 19'7'8,
S. 3'115. I would like to introduce to you the witnesses
who accompany me, Donald Millar of'the Center for Disease.
Control and Taylor Quinn of the Bureau of'Foods, Food and
Drug Administration. In addition, officials from the Bureau
of Community HealthServices, the National Center for Health
Statistics, the National Heart, Lung, and Blood' Institute,.
and others from the Center for Disease Control will be
available to~address any questions you may have regarding
this broadiarea.
Mr. Chairman, the introduction of this legislation is
evidence of your continued interest:in working toistrengthenn
theNation's efforts in the prevention of disease and the
promotion of'health. I j'oin, my colleague, Dr. Foege, who
conveyed to you the appreciation of'Secretary Califano
0
and Assistant Secretary Richmond for the leadership you
have shown inidrawing attention to prevention. The issuess
addreseed in Titles I through~III of S. 3115, like Title IV 0
discussed by Dr. Foege, are central tolthe design of a
comprehensive prevention proQrazn..
2
As you know, Mr. Chairman, the issues relatedito disease
prevention and health promotion are of particular concern
to the Administration. In addition to the $30 million
smoking andiheallth initiative, discussed by Dr. Foege,
special initiatives have already been launched to address
problems related to childhood immunization and adolescent
pregnancy. Iniaddition, a D'epartmental Task Force on
Prevention is currently examining the renewal andd
strengthening of efforts in the broadd range of'issues
encompassediby prevention.
The Role ofP'reyention in our Health Strategy
As you know, historically the most important gains inr the
reductionlof morbidity and mortality have been achieved
through efforts tolprevent disease and promote health,
rather than gains in medical treatment. Yet the focus
of' health care and' health policy has shifted in recent
years from preventive healthlactivities to the delivery
of acute care. The implications f©r our national budget
have been astounding. The share of our economic resources
going to payments for health care has increasedi drama-
tically. Yet there is little.indication that those W
increases in expenditures are yielding prop rtionate
decreases'in morbidity and mortality for our population.
These costs, along withidefici.encies in financial and
3
geographic access to care and the qua7lity of' hea lth care
delivered are all immediate and important problems for
health policy. We must not lose sight, however, of' the
fact that the central objective of our health policy
must be reduction of the burden of disease. Frevention - not
expiensive _.t-herapeutic- techniques: - clearly constitutes the
most direca and Effective approach to that objective.
An illustrationimay serve to underscore this point. A child
born in 190'0' could expect to live 4'7 years,- a child, born
in 19,76, on the other hand', had' a life expectancy of about
73 years. This difference of nearly a quarter of a
century is attributable to a remarkable decline in infant
and child'mortality--in laage: measursR a result of'improved
environmental sanitation, better nutrition, milk pasteurii-
zation, infectious disease control, a reduction in crowding
as well as increased and improved'immunizations. On the
other hand, a 4S year old man in 1914 could expect to live
_ 41 _
added, little to adult life expectancy. We have become
increasingly aware that the road to better health is not
necessarily paved withibetter medicine,
only three years longer than his counterpart living in 19'0'0.
The science and technology of modern medicine has evidently
Factors other than medical therapies must clearly be given
principal credit for the significant declines in deaths
related' to infectious diseases which predated' introductic.n
of medical interventions. These factors include better
nutrition, improved hygiienic measures such as effective
sewage disposal, water purification, andipasteurization of
milk. A British authority, Dr. Thomas McKeon, credits hygiene
for at least 20'percent of the total reduction of mortality
which has occurred in the last century. In singTingiout
nutrition as particularly important, he further notes that
the decline in mortality causediby infections began even before
the introduction of sanitary measures. Improvements in
nutrition during the course of the nineteenth century are
the likely explanation for increased resistance to infectious
diseases.
_."._;e - . .. .k,.y ..
c
- S -
These lessons highlight the'importance of lifestyle factors
in preventing the infectious disease killers of the past.
The impact of infectious disease has diminished to the point
that these killers of the past now account for only about two
percent of the mortality among persons over one year of age.
Of infectious diseases, only influenza,, when associated with,
pneumonia, persists among the ten leadiing causes of death
in the country. Presently over three-quarters of all deaths
in the country are attributable to chronic diseases. Cardio-
vascular disease, including both heart disease and stroke,
account for over 50'percent oflthe deaths. Cancer accounts
for another 20 percent and'diabetes and cirrhosis together
account for almost four percent more.
Ma,ny of'the deaths due to these chronic diseases are also
preventable with changes in lifestyle. However, the focus of
productive interventions has shifted from the community to the
individual. There are indications that the developALent of
effective measures to improve people's behavior with respect.
to smoking, exercise, nutrition, and alcohol abuse, in addition
s
to improving control over hypertenslon, couldiresult inn
significant decreases in morbidity and mortality due to these
chronic diseases.
critical factors in the major chronic diseases..
brief, we know that c
Time will not permit a complete review of the growing
body of evidence which~ implicate&these habits as
deaths and ranks first as the leading cause of
Smoking causes at least 80 percent of all lung
C
cancer among men. Smoking is
also a primary
risk factor for cardiovascular disease. The
death toll from smoking-relatedheart disease
eclipses the signif icant death toll from cancer
caused by smoking. I need not elaborate on the
additional misery which smoking inflicts through
emphysema and chronic bronchitis. Reasons for
o Exercise has been shown by many studies to reduce
our identification of smoking as public health
enemy number one are evident. The Department
appreciates your leadership, Mr. Chairman, in
drawing attention to this issue.
the risk of fatal heart attack. Research is continuin;gi
to identify the specific mechanism of' action, but
the preventive impact is clear. Furthermore, anecdotal
may also be useful in rehabilitative programs for
evidence is now accumlating to indicate that exercise
patients who have suffered heart attacks.
-7 -
Nutrition~has~played a role~ in enhancing r~e~s~istance~
to infectious diseases, but has more recently
been~ f©und' to be a major contributor to the
chronic diseases that plague our population.
Stud'ies, such as the ]Framingham Study conducted~
in your home State, Mr. Chairman, point to thee
importance of elevated cholesterol levels as a
contributor to heart disease and stroke. Other
studies linking serum levels with dietary intake
point ta the need to strengthen our nutrition
efforts in the control of heart disease and in
the search for the cause of a number of other
diseases.
o Alcoholism afflicts almost 10 million problem
the sixth most common cause of death in t1ie
S~~tate~s~~ more~~ than $'4~5: m~illion~ annually.
drinkers in the adult population of the United
States today and, most alarmingly, one in four
teenagers are moderate to heavy drinkers.
Despite some leveling off, cirrhosis remains
United States, with up to 9'5' percent of the cases
estimated to be alcohol-relaited. Alcohol use has
~
been implicated in over 50 percent of all fatal
highway accidents, and its toll in death and
disease, lost productivity, and property damage,
inirecent years is estimated to cost the United
Mr. Chairman, not only db we now have a better under-
standing of the impact orf chronic dis ase, but, just
as importantly, we are now beginning to see evidence
that effective programs can be mounted~to facilitate
lifestyle change. We see, for example, that since
1964 the percent of males smoking cigarettes has'
dropped dramatically. Inaddition, we have seen a
significant decrease'in the tar andinicotine level
of the cigarettes consumed. Eighty percent of the
adults who smoke would like to quit, more than half'
the adult smokers of both sexes have tried at least
once to stop smoking, and physicians have succeededin stopping in impressive numbers. In,195'0 about
65 percent of U.S. physicians smoked by 19Z5 just
over 20, percent smoked.
The growing_awareness of the importance of exercise
is apparent on the streets of every American city.
Estimates indicate that there are 11 million jogge,s,
15 million swimmers, 151million bicyclists, andd almost
- , -- -------- ---- - -- --- - - -- - - ---- - -. _ _
14 million regular tennis players in the U.S. today.
number of adults who exercise has more than doubled
since 1960', and 5D percent --of the -American population
The
claims to engage in some form of exercise. The President's
Q
CrJ
Council on Physical Fitness and Sports has played
an important role in raising the level of consciousness
.of the American public on the importance of exercise.
If efforts can be strengttiened to enhance these trends,,
the health benefits may be significant.
__
Controlled studies of community programs to help,
individuals change their risky behavior have been limitedi
to date, but those whichihave been undertaken are yielding
optimistic results. For,
eexample, the National Heart,
Lung and Blood Institute has sponsored a community inter-
vention study~through the Stanford Heart Disease Program
in California which has attempted'to use community health
education and counseling tolimprove people''s behavior
with regard to diet, smoking, and adherence toihyper-
tensive medication regimens. Results there have shown
more improvement in the community-wide behavior of those
communities which were subjected to intervention programs
versus the community which was not provided any spccial
effarts. Another study, conducted in Finland; also
indicated s:uccess at community-wide efforts to reduce
multiple cardiac risk factors.- In the Finnish study,
success has been reported in significantly reducing
the incidence of smoking and the use of high fat dairy
