Jimmy Carter photo

Address to the American Public Health Association in Miami Beach, Florida

October 19, 1976

I was raised by a nurse. My mother this year is 78 years old. She has devoted her life to caring for other people. Nothing would please her better than to be here with you today; however, it happens to be Amy's birthday, and this takes precedence, I'm afraid, even over professional enjoyment.

I'm thankful to come and make a statement, as the prospective President of our country, about a subject that is so important to me and to you and to two hundred and fifteen million other Americans.

There is a great deal of concern and confusion in our country about what ought to be done about health care. Sometimes when you have the best intentions and really want to fulfill commitments and ideas and ideals, there's a great deal of confusion about what needs to be done. And that's the case in our nation right now as we, the greatest nation on earth, struggle with the problem of how to let our own country provide healthy bodies and minds for our people.

Let me say at the outset that I share the deep concern that all of you feel about the state of our nation's health. And after January 20,1 intend to provide the aggressive leadership that is needed to give our people a nationwide, comprehensive, effective health program, and you can depend on that.

This year, we will spend over $130 billion on health care. That's an average of $600 for every man, woman, and child in our country. So for a family with a wife and a husband and two children, $2,400 of their income will be spent on health care. And we know that the cost of health care is projected to double in the next five years. And still there are 14 other nations that have lower infant mortality rates. We lead the developed nations in the incidence of heart disease and cancer. And we still have especially severe health care problems among the poor, and particularly among members of minority groups who also happen to be poor.

We have excellent medical care for the very few who can afford it and who are educated enough to get doctors' advice in advance. But we have an inadequate health care program for those who are not well educated and for those who cannot afford expensive care. In short, there is a tragic gap between what our national health should be and could be, and what it now is.

Our technology in many instances has outstripped our basic humanity. Sophisticated and costly medical technology has improved our health, but its duplication and misutilization has wasted our nation's wealth. And the scarcity of financial and human resources then restrains the budget for other health and social needs. It's time for us to get back to the basics, and the basic need of any health care system is to care about people and to prevent disease and injury before they happen.

Prevention is both cheaper and simpler than cure. But we have stressed the latter—cure—and we have ignored, to an increasing degree, the former— prevention. Our traditional self-reliance, our emphasis on family and community health, our concern about the prevention of disease, regular checkups, early diagnosis, and early treatment has almost been forgotten by many in the onrush of technology and increasing specialization. In recent years, we've spent 40 cents out of every health dollar on hospitalization. In effect, we've made the hospital the first line of defense, instead of the last. By contrast, we only spend three cents on disease prevention and control, less than half a cent on health education, and a quarter of a cent on environmental health.

I grew up in an isolated community in Georgia. We didn't have electricity, we didn't have running water. But I had adequate access to public and private health care—not just from my mother. But the major interrelationships I had with doctors and nurses was to prevent disease. And those of you in the audience who are as old as I am remember the threat of almost sure death from many of those horrible diseases, like diphtheria, cholera, polio, mumps, measles, whooping cough, typhus, and typhoid. But the emphasis on health care in my life was not to wait until after I got sick, but to prevent my getting sick. That emphasis in the last 40 years has been lost.

It needs to be restored. Look at our record in recent years on immunizations. In 1974, 37 percent of all our children of age one to four had not been immunized against polio, 44 percent had not been immunized against rubella, and 40 percent had not been immunized against measles. This year, as you may know, we have already had reported over 35,000 cases of measles. And that's a national disgrace.

This year also, as you probably know, President Ford proposed a cut in federal spending on vaccine for immunizations against preventable diseases by 50 percent. This of course is no surprise. For almost the last eight years, the Nixon and Ford Administrations have slashed one essential health program after another in the fields of maternal and child health, mental treatment centers, health manpower, health maintenance organizations, occupational and environmental research, biomedical research and many other fields. That kind of negativism about preventive health care is going to stop next January 20.

I want to give you one more tragic example of the failure of preventive care. The Pap test was devised in 1943. But as late as 1974, the last reported period, fully 25 percent of our nation's women had never had a Pap test. Thousands of women continue to die unnecessarily of cervical cancer each year. That's a failure of leadership. It's a tragedy that strikes unequally and unfairly at those who are most ignorant, poorer, and who very seldom have any interrelationship with a doctor until after they get seriously ill.

We conducted an analysis in Georgia, as those of you from Georgia know, to determine the ten most severe crippiers and killers of our people—heart disease, stroke, cancer and others. One of the shocking discoveries we made was that among black women in rural counties, there was more than 20 times as much cervical cancer as among white women in urban counties, the only difference being access to early diagnosis, regular physical examinations, and preventive health care. We need to stress the right of all people in this country to prevent the crippiers and the killers that can affect their lives.

As you know better than any others, a vast amount of our ill health is caused by the way we live, by the environment we've created, and by the lifestyles we've adopted. It is not the role of government to dictate lifestyles. But it is the proper role of government to educate our citizens and to aggressively stress the promotion of good health.

The biggest killer of our young people is not a disease, but accidents— mainly automobile accidents. It should not be beyond the capacity of a concerned society to reduce those needless deaths and maimings. And with the breakup of the family structure, we've now seen a pattern evolve among young men, 15 to 20 years old, that the second most frequent cause of death is suicide. This is a shocking thing in a society that's always depended on die family, the community, stability, care and love.

The major killer of middle age men is heart disease, often brought on by overeating and smoking and a lack of exercise and a lack of knowledge. It should not be beyond the capacity of a concerned society to reduce those unnecessary deaths. The fact is, if we were to improve our national eating and drinking and smoking and exercise habits, we could be healthier, be happier, live longer, and save ourselves billions of dollars in the process.

I think Presidential leadership and the tapping of the tremendous resources assembled in this ballroom could lead us toward a reduction in these unnecessary deaths.

We must be concerned too about environmental and occupational health threats. Environmental factors such as smoking, synthetic compounds in our food and water, exposure to industrial and commercial chemicals and air pollution now cause an estimated 70 to 90 percent of all cancer. We've discovered cancer "hot spots" where industrial pollution causes dramatically high cancer rates. Yet for eight years this Republican Administration has failed to enforce legislation and has opposed new legislation that would reduce the pollution that is killing our people. That's a failure of leadership again, and it must be stopped.

We also have an opportunity to cut down on the incidence of stroke. As you know, the Communicable Disease Center happens to be in Atlanta, and we worked very closely with them while I was governor to determine how best to control or minimize the impact of stroke. We have about 600,000 people in Georgia alone who are potential stroke victims, and we've found that with a simple blood test, cholesterol analysis, and a blood pressure test, we can identify those who might have a stroke. The total cost? Three dollars. And we could tell the person, go to your family physician, you might have a stroke, take simple medication to prevent this debilitating affliction. It costs thousands of dollars, as you well know, for an indigent person to be cared for by the taxpayers once a stroke occurs.

Let me outline for you some of the goals of the next administration in the area of health.

First, we must return to the basic focus on the prevention of illness and disease, including a strong neighborhood and community orientation.

Second, we must have a comprehensive program of national health insurance. You know as well as any group the complexities of such a program. But certain basic principles are clear:

• The coverage must be universal and mandatory. We must lower the present barriers, in insurance coverage and otherwise, to preventive and primary care—and thus reduce the need for hospitalization. We must have strong cost and quality controls, and the rates for institutional care and physician services should be set in advance, prospectively.

• We should maintain the personal interrelationships between patients and their physicians, and we should give freedom of choice in the selection of physicians and the treatment centers to the patient to be cared for.

• Along with catastrophic insurance coverage, we must make the provision of prenatal and infant care benefits one of our highest priorities.

• We must phase in the program as rapidly as revenues permit, helping first, those who most need help, and achieving a comprehensive program well defined in the end. Now many questions remain to be answered on national health insurance, as any Member of the Congress knows, and as professional health care specialists, like yourselves, know. And I ask for your advice and your help in obtaining the best possible program as quickly and as early as possible.

The third thing we must stress is health and nutrition education. Our public schools could do more to teach our young people the dangers of drinking, smoking, using drugs, overeating, and eating the wrong kinds of food. We need to make sure that young people form a habit of taking advantage of the public and private health facilities we offer. Many times, there is never that closeness of feeling toward health care specialists engendered in the young person's mind that I was fortunate enough to have because my mother was a registered nurse.

Fourth, we must mount a renewed attack on cancer and other diseases caused by toxic chemicals in the environment, including strict enforcement of the new Toxic Substances Control Act, which has just been passed.

Fifth, we must continue and expand biomedical research and be sure that it serves the health needs of all our people.

We must have—and I intend to provide—government reorganization that will end the bureaucratic fragmentation that now frustrates any hope for a rational and effective national health policy. This is crucial—it must be done.

It would be almost impossible for any of you to name a single major federal agency that doesn't have part of the responsibility for health care. We've got 302 different federal health programs. They are scattered throughout the federal government. There is no coordination, there is no cooperation, there is no careful planning, there is no end of duplication and overlapping and waste. Medicaid is in one agency, Medicare is in a different agency. Neither one of those agencies is responsible for health care. The certification of the quality of care is in a third and different agency altogether. So we need to consolidate and reorganize the federal government to make sure that there is a clear delineation of responsibility and a clear understanding of authority, so that our professionals who work for the government at all levels can spend their professional careers in the most fruitful way for a change. That must come and it's going to come next year.

We must encourage, and you can certainly help with this, alternative delivery systems such as health maintenance organizations and rural group practices. We must also remember that it's both more cost-efficient and more health-effective to use less expensive treatment methods where possible; to improve outpatient service instead of overbuilding and overusing hospitals. In one recent analysis, in New York City, the average length of patient stay was [13] days. For the same disease or affliction in hospitals in California, the average stay was between 3 and 4 days. There was twice as great a chance of being operated on in New York as there was to be operated on in Michigan for the same reason for entering the hospitals. I'm not saying this to criticize any particular community, but just to point out to you that the standardization of treatment facilities, a heavier and heavier emphasis on outpatient treatment, and a basic minimum of health care, comparable with the disease or problem, is something we have a long way to go in this country to realize. But I think that the cooperation of insurance companies, hospitals, nursing homes, doctors, nurses, and patients' families to hold down the cost of what care there is, and to give adequate health care without wasting our scarce resources, is a great opportunity for the future.

Eighth, we must clean up the disgraceful Medicaid scandals. That is important, that must be done, and it will be done.

We must encourage nursing home standards of safety, sanitation, and care, and we must encourage programs that will serve elderly people in their own homes whenever possible.

Finally, we must, by scholarships, by loans, and by other means, provide medical education to more students from minority and low income families and also to more women, and we must encourage young health professionals to train and practice in rural and inner city areas.

In some countries, there has been a dramatic recent shift toward more women becoming medical doctors. This really ought to be done in our own country. And I'll do all I can to help with that.

As I said in a recent speech to a women's group, I want Amy to grow up feeling that she can be a lawyer, not just a legal secretary; that she can be a medical doctor as well as a licensed practical nurse; that she can be a President instead of just a President's daughter. And I think this is an attitude we should maintain.

We must remember, too, that a nation's physical and mental health cannot be isolated from its economic health. And we must, therefore, end the present Republican economic policies that have brought us at the same time both inflation and unemployment, and in the process have made it impossible for millions of Americans to afford decent health care.

Now these are some of the goals in the health field that I will work toward if I'm elected President. I don't claim to know all the answers. The answers are not easy. Our nation has struggled unsuccessfully for many generations, and we have failed where other nations have succeeded. It is not required that the government run the entire health care program in our country—I would not favor that. But there needs to be a close cooperation between public and private health care delivery, an emphasis on prevention of the crippiers and the killers of our people, adequate financing of health care, a shift toward non-hospital treatment whenever possible, and a realization in our country that there is a great saving to be derived economically if we can address this problem consistently and with forethought and with a deep national commitment.

These things must come. I do know that good health ought to be a right and not just a luxury, and that good government has no more responsibility and solemn and deep concern than to make possible good health for all its people. I think that our people are ready for giant steps forward toward a comprehensive and adequate national health policy. I think we stand on the threshhold of an exciting new era in American health. We have the technology, we have the financial means, we are already spending the money, and we have the deep concern that shows in every poll we run. When you ask the American people, "What in your lives is important enough even to raise taxes, if necessary?" The people's response is always health care. It's a great concern to those who need it most. And it's time for us to do it in this country. I ask your support. I ask your advice. I ask your cooperation.

I'm one of the non-professionals in the health field, who has had a chance to learn, within my own family, as a chairman of a school board in a rural community, as one who has worked closely and lived closely among poor people. As one whose mother has devoted her life to health care. As one who's been governor of a state struggling to overcome the health problems of our people. And as one who's seen the brightness in a person's life when, for the first time in their existence, they can overcome a physical or mental defect which could have been and should have been detected and eliminated in their early years. And as one who hopes to be President of the greatest nation on earth. I pledge myself to combine my efforts with yours.

Although I don't know the answers, people like you know the answers. And I look forward to forming a partnership with you to give our people a long overdue opportunity for simple and basic preventive care. This can finally be realized if we cooperate, if we tap the resources of our country, if we realize the difficulties and face them frankly and courageously, if we don't yield to discouragement, and if we can commit ourselves to this most worthy of all social efforts to let our people take full advantage of that which God gave them in our great country.

Thank you very much.

Jimmy Carter, Address to the American Public Health Association in Miami Beach, Florida Online by Gerhard Peters and John T. Woolley, The American Presidency Project https://www.presidency.ucsb.edu/node/347578

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