Tobacco Documents Online

0^1t 3~'~t`(ct ~j 1 Carter Think hink Tank A Blueprint To Prevent Most Deaths BY PATft1CIA Tt1UMAJ ATt.ArrrA - UitJer the watchful eyes uf two Secret Service agents, lufnter NreSF 11ent Jimmy Caner sat at a typical student desk in an Enwry University clasaruum. Prominent physicians, educaturs, and ept- drmiulugists talked about (he appalling rate ul• untntcniled pregnancy, parttcularly among the young. Gecthe schools involved, wme said. In- crease job opportunities fur teenagers. Change how sex is portrayed un TV. Ycs, President Carter agreed, thst'a line, but don't stop talking until, you've made a clear statement about how abortion fila into the big picture. That al[ernuun, he aat with a similar group discussing Jepressiun, drug abuae, 4. t)it.r 'FI)EGE and violence. Teen- agers must be taught to express their leel- ings, said one panel- ist, anJ' to seek help rather than asphyx- iuting themselves in the Camlly bedan. e...l ur....l....~ Carter_ whu"s had experience raising teenagers, nluaeJ' about the Jttliculty ul getting prevcuuve health messages 4crubs to kids who tune uut anything an adult says. Founded by Ex-Presldent Those Jiacusswns were' the core ul the "Closlnb the Gap" health policy tunltr- encr bpunsured by the Cartcr Centcr u1 Emory Unlversity, the think tank that Nrestdent Carter IuunJed'alter joining th Emury taculty in ty2s2. The Caner Center has a)tall, money trom private IuunJa- uuns and individuals, and tempurary yu:u- ters on the Emory campus. Cunstructiun ul its permanent home recently beb;ln alter a buter land-ube bsttle that I:uted tur years. President C:uter says he's nut uuereated' ~ in creating a munun>rnt "wherc peuple cume to learn about my boyhood lu / Cun/ulurd on pugr 25 , *r 3

MidotGU. TtuuuNts 25 The Carter ~ Think Tank's Prevention Rx Cunlinred f'rum puxe 3 Plains." Instead the Carter Center spun- surs research and cunferences on domestic and intemational policy isaues, such as i health, Middle Faut peace, U.S.-Suviet arms control, and private industry's ruk in cnvirunmental protecuon. More than a year ago, the Center com- misswned studies of 13 health problems that together account fur lit)Nb of all deaths in the United States, 90% of potential years of life lost before age 65, 71 % of all days of husptuliLation, and 84% of all di- rect personal health care expenditures. About two-thirds of those deadly and ex- pensive cunseyuences, researchers found, could bepreventell with existing knowl- edge and technology. "It's not a matter of having to wait for more reseurch," emphastzed'Dr. William H. Fuege, the former CDC director tapped by Caner to head the Closing the Gap proj- ect. Last August, Dr. Foege and acummtt- tee of nutables, including Nobel laureate Dr. Fredi:nck C. Rubbtns, president of the Insutute of Medicine, confronted the two- loot stack of papers generated lur the Cuter prujeca, i I Fow 'tim..k' Risk Faeyo fs They took a list of all the risk factors cited in all_ papers and winnowed it down to four o~bacco, alcohol, injury risks, untntenJed pregnancy-which DR. SMITH . DR. BRANt7r appeared to have the greatest impact on ex- cess morbidity, mortality, and health care costs. Two other factors, Iack of oreven- tive services and mental health problems, were later added to the listt of_"generic" isk _factorat. All too often, "we act as though we could look after our risks for heart disease this week and our risks for cancer next week," Dr. Foege said. Determined to drag risk factors uucof their traditional pi- gconholes, the Carter Center invited about 135 physicians (many of them society presidents), educators, government offi- cials, business leaders, and private foun- dation executives to Atlanta. To get the ball rolling, the 13 primary investigators summarized their findings. Rosalynn Carter listened attentively in the second row-whipping on her glasses and Connnued on p<iKe 28 scribbling notes on abstracts during pre- sentations on mental health and unintend- ed pregnancy. Participants, including the Carters, then fanned out into lecture and conference rooms to talk about how each risk factor contributes to various health problems. It's not news thartobacco use accounts fcx 36% of cancer deaths, 45% of circulatory disease deaths, and 14% of all deaths from chronic respiratory diseases. But instead of stopping there, conference participants

Mt:utcAt. Ttttuunta Wednesday. J.nuaiy 30, 1965 The Carter Thinkers' Death Prevention Blueprint CauiiuwaA from page 23 went on to indict smoking as the leading cause of fatal house fires, which ehtirn more than 6,000 lives each year, as a ma• ' jor contributor to mortality from peptic ul- ccr disease, and as an important risk factor ' for delivery of low birth weight infants. Similarly broad pictures emerged from, the other groups. Recommendations for combating un- necessary death, illness, and expense were presented in a session chaired by President Carter, Dr. Foege, and former Assistant Secretary for Health Dr. Edward N. lirandr.Perhaps the boldest recommendation came from Paul Goldstein, Ph.D., princi- pal author of the paper on drug abuse. He advocated decnminalizing possession of drug-related pantphernalia and allowing over-the-counter sale of needles and sy- ringes in order to reduce the 800 infectious disease deaths that occur annually among IV drug users. A member of the audience objected that decriminalizing paraphernalia would en- courage more young people to use IV drugs. That is analogous to saying, Dr. . Goldstein countered, that installing air- bags irf automobiles would encourage more people to drink and drive. Despite President Carter's request fur a clear stntement, the word abortion was conspicuously absent from the listof inter- ventions for unintended pregnancy. In- stead, there is a bland recommendation that "altentatlve5/opttons for dealing with unintended pregnancy" be provided., "We simply didn't want our repon to be occupied by a conflagration over abor- uon," said Dr. Mattin H. Smith, presi- dent-elect of the American Academy of Pediatrics and co-chair, with American College of Obstetncs and Gynecology President Dr. Luella Klein, of the discus- sion group. Recommendations for curbing tobacco use included better media coverage.of to- bacco-related health problems, public education c:unpaigns, advertising bans, higher taxcs on tobacco products, and community etforts to make nunamoking the suciai norm. The alcohol group con-• HEALTH IMPACT OF 13 LEADING HEALTH PROBLEA~,S (Single Listed Causes) United States, 1980 Health Problem Preventable Deaths Total Deaths Total Direct Costs (billions) Alcoholism 9,000 10,000 $10.1 Arthritis/Muscular Diseases 2,100 7,000 12.6 Cancer 280,060 418,000 11.6 Circulatory Diseases 625,780 934,000 25.6 Dental Diseases 0 0 15.6 Diabetes Mellitus 3,205 35,00U 3.7 Digestive Diseases 26,456 48,000 9.3 Drug Abuse 900 1,000 0. 8 Homicide/Suicide :45,9U0 51,000 0.6 Infant Mortality 14,400 47,000 4.7 Infection 33,000 66,00U 5.7 Respiratory Diseases 45,729 60,000 12.2 Accidental Injuries 93,600 104,000 15.5 60% of cancer, 6111% of clrcutatory dlsess., 50% of Infectlon Is taqged prsv.ntabi.. grrtulated physicians for having IsrgCly abandoned smoking, and chided them fur setting a bad publictxantplC with their less abstemious drinking habits. An older woman in a powder blue dress took the IloVr to say that the key to over- coming destructive health habits was ac- cepttng Jesus Chnst as one's personal bav- •ior. President Caner absun;d her that churches, like achools and cumnwnuty or- g4n1zattuns, have an impuaant p:un to play in preventing disease. ._11 ":.,-~- L~

SIp.rdattn Prwantlw Can" One might ask what impact a confer- ence bearing the name of a former Demo- cratic president can have on health policies being set by a second-term Republican ad- ministration, an administration which has dwelled on direct cost containment. "These health issues are not partisan. The only thing about health that's really partisan is the reimbursement system, and we're not talking about that," said Dr. Brandt, the highest ranking physician in the Department of Health and Human Ser- vices until he resigned this month (January 1985) to return to academia. Dr. Brandt's presence on the podium, according to Dr. Foege of CDC, demon- strated that the Carter Center conference wasn't tainted by party politics. And a government obsessed with containing health costs should be able to see that mon- ey spent on unnecessary health problems, such as lung cancer, is money that's un- available for diseases which aren't yet pre- ventable, Dr. Foege said. "I think this administration is sensitive to pressures from outside," ' said Dr. Vic- tor W. Sidel„ president of the American Public Health Association. "While it may not initiate some of the programs we'd like to see it initiate, if there is sufficient pres- sure, they'll be required to do the nght thing in ternu of health promo"n." /,,% 4 6