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U.S. Department of State

Diplomacy in Action

Remarks by Secretary Sebelius at Joint Transportation and Energy Ministerial Conference

September 16, 2011







September 16, 2011

San Francisco, CA

SECRETARY SEBELIUS: Thank you very much for that kind introduction, and I want to just start by saying hello to my colleagues, fellow health ministers, to our distinguished private sector partners and the guests and delegates here at the APEC meeting.

I think it’s very appropriate and encouraging that APEC is including health as part of their agenda, not only at this meeting, but hopefully when the leaders meet in Hawaii and on into the future because it is a critical economic issue and challenge, as well as one that affects people’s lives each and every day.

And I want to certainly recognize good friend and partner in Bill Weldon who exemplifies, I think, a leader in the private sector who is involved in a wide array of strategies and partnerships, not only with our Department of Health and Human Services in efforts like Text-4-Babies, but I know you heard about the MAMA efforts, the MAMA efforts that are international. The Text-4-Babies strategy is now out in Russia.

We’re moving into looking at diabetes efforts and smoking cessation efforts, again using the most modern technology, so Bill, it’s great to have you here. And it’s really a great opportunity to work with the private sector partners.

I am pleased to be here at a time of unprecedented partnership among Pacific nations. The United States actually began as a nation of Atlantic ports and cities. But for the last 150 years, we have also been a nation of the Pacific. And over that time, we have built steadily closer ties to our economies, based on shared interests in areas from trade to security to environmental protection.

And one of the areas we have had the biggest opportunity to work together is health. Now for years, those health efforts focused on infectious diseases that can spread between our nations. Over the last decade, we have worked closely together to respond to a SARS epidemic that began in Asia and spread rapidly to North America, and then worked together to stop an H1-N1 flu epidemic that originated in North America from becoming a global catastrophe.

But today, I want to talk a little bit about how we can join forces to take on what has become an equally dangerous or even greater health threat for many of our economies, including the United States. And that’s chronic diseases, such as heart disease, cancer and stroke. Now in the United States, chronic diseases account for seven out of every ten deaths, seventy percent of our deaths. That’s not just an American problem.

In 2008, there were 16.5 million deaths, as has been said, from chronic disease in the Asia-Pacific region. And in 2030, global death from chronic disease is projected to rise to 52 million people. That’s the human side of the impact of this cost, but there is also a significant economic side. Chronic disease lowers productivity and raises absenteeism.

The World Health Organization estimates that between 2005 and 2015, chronic disease will drain about $558 billion from China’s economy alone. Now that’s like sitting out an entire year of economic growth.

What’s more, chronic disease is a major driver of rising healthcare costs in all of our countries. That puts a growing burden on government, on private businesses, on family budgets, accounting in our country for 75 percent of our healthcare spending -- is spent on dealing with chronic disease.

So throughout my time in public service, I have met with business leaders of all sizes, from farm families to CEOs of large corporations. And many of them have told me the same thing, that their biggest concern was often not the price of goods or shipping or funding new customers, it was rising healthcare costs, and that one of the main reasons these costs are going up is clearly the underlying burden of chronic disease.

So for these reasons, the World Economic Forum has ranked chronic disease to one of the top threats to global economic security, and that’s the bad news. The good news is what we know. We know most of these diseases are preventable, and in many cases we know exactly what to do.

In the United States, for example, we are taking a multipronged approach; long overdue, but it’s a multipronged. So first, we’re making it easier for people to get the preventive care they need that can keep them healthy and identify small problems before they become large ones.

It makes no sense that we have had insurance policies for instance that would cover amputation of a foot but not treat the diabetic condition that could prevent that amputation in the first place. So last year, the President signed an historic healthcare reform law that made preventive care like diabetes screenings or mammograms or colonoscopies free for almost all Americans.

Secondly, we’re helping Americans live healthier lifestyles. We knew there were communities around our country that had developed innovative approaches, so things like bringing fresh fruits and vegetables to underserved neighborhoods and creating more parks and trails so that people can be encouraged to exercise. So we made an historic investment in supporting those community strategies.

So first, they can expand their efforts, but then they can become role models for cities and communities across the country. And we’re connecting leaders to one another so they know about best strategies.

Finally, we have stepped up our fight against tobacco use, which is the leading cause of preventable death, not only in the United States, but around the world. We’re banning strategies for marketing to children. We’re curbing the use of misleading terms like ‘light’ and ‘mild’ connected with cigarettes, and we’re adding, thanks to a lot of your good examples, we’re finally adding graphic warnings to cigarette packs that will make sure people know the risk they’re taking if they choose to light up.

Now the last idea, as I said, is one we have borrowed from other countries around the world, and it’s a perfect example of how sharing good ideas can help us all improve health. The truth is that the risk factor for these diseases in America, from tobacco use to poor diet to lack of exercise, are the same risk factors that these have in Chile or Australia or Thailand, and we all face the same challenges.

And then we face solutions that we can work on together. And we can share together and collaborate. So we all need to do a better job learning from each other while also sharing our best ideas.

Research is another way we can work together. Twenty years ago, scientists in the U.S. and China wondered why so many children were born with neural tube defects like spina bifida. In China alone, they were seeing up to 100,000 children a year being born with these birth defects, which were often fatal and devastating for families, both personally and financially.

Now there was a theory, and it was that mothers weren’t getting enough folic acid in their diet. So Chinese scientists got together with researchers from our Centers for Disease Control and Prevention and conducted the largest study ever conducted on giving mothers folic acid. The results were simply stunning.

In some regions of China, neural tube defects fell by up to 85 percent, and now mothers around the world know to make sure they have enough folic acid in pregnancy. And we’re seeing a lot of those disease condition -- and burden drop significantly.

So we know we can achieve great things when we work together. And it’s not just enough to work within national lines. We also need to build partnerships with a private sector and with not-for-profits and foundations.

Business in particular has an interest in joining this fight. If you don’t feel the impact of chronic disease and rising health costs, then they feel it in lower productivity from employees or from a rising number of sick days.

And business leaders can also play a unique role in sharing solutions. Multinational companies are one of the best vehicles for caring ideas across national lines.

On Monday, I’ll be with many of my colleagues again in New York, for the first ever high level meeting at the United States General Assembly focusing on chronic conditions and non-communicable diseases. We are going to talk about building partnerships to improve health, but I also want to challenge all of you right now to start thinking about what your country or your business can do to help.

We have the knowledge and tools to reduce the burden of chronic disease and deliver a dramatic boost to economic growth on both sides of the Pacific. And we need to act now, and we need to act together. The United States stands ready to be a good partner in this collaborative effort.

Thank you all very much, and I’d be pleased to answer a couple of questions if you have got questions for me.


SECRETARY SEBELIUS: We’re not? Whatever is easiest.

Yes, sir.

QUESTION: Thank you. Bruce Ellsworth of Johnson & Johnson. I know one -- that the United States has something called Healthy People 2020. And every 10 years for the past 30 or 40 years has updated a set of goals with metrics to measure progress over time. And it hasn’t been easy, I understand. But I’m just curious. If you could, comment on how this type of goal setting and measuring progress with numerical targets has helped and how it could help in other APEC economies.

SECRETARY SEBELIUS: Well, I think that’s a great question. We do have decade-long health goals. And in our country, that role has fallen to my Assistant Secretary of Health, Dr. Howard Koh to lead that effort. And it’s not just people sitting in an office and setting up measures and marks. It really -- the goals are set by a dialogue that’s conducted in communities across the country, often for a two year period of time to first identify the key health challenges and then try to set goals to deal with those challenges. And then, as been suggested, they’re measured.

Some have been very successful. Others, we still fall way short of the goals. But I think both the process of having the dialogue, getting input, talking to not only healthcare providers and insurers and business leaders and advocates, prom se framework then for this measurement to occur, and we hold ourselves accountable.

It helps us at the Department level allocate resources to strategic goals. It helps us focus states, our partners in government -- in health on those same strategic goals. But I think it also brings to the forefront a lot of the private sector initiatives around strategies and goals. So I think it’s a very helpful tool.

It doesn’t mean that we accomplish all of them in the timeframe that is set out, but at least we sort of know where they’re headed. There is some agreement on it. There has been input and empowerment really of community leaders to talk about that, and then some measurement along the way.

Yes. Yes, sir. There is a question back here.

QUESTION: Secretary Sibelius, thank you very much for your comments. I wonder, there are so many targets, and if you think about this region, how would you balance investment in maternal and child health, pediatrics, the younger set versus the at-risk adult who is coming up to you know what?

SECRETARY SEBELIUS: Well, I don’t think you can do an either/or. Clearly, we have to focus some attention on both. And certainly, with an aging and -- an aging population, the chronic disease burden will rise. People are living longer, but that means that they’re likely to then have diseases for a longer time in their lives, so there has to be some focus and attention on some of the -- not only disease burden coming with heart disease and diabetes and chronic conditions, but clearly the investment in maternal and child health and also on preventing our youngest citizens from getting on the same health path is going to be a win-win situation.

You know, we have in the United States now, one out of every three children has been identified as either being overweight or obese. That’s a dramatic increase just in the last decade. It is a huge, I think, looming health crisis because if those children continue on this trajectory, they’re likely to have a shorter lifespan than their parents. And that has never been the health profile that we have seen before in any generation of American children.

So both focusing on the obesity levels but then certainly on preventing those kids from ever smoking in the first place. So if we can cut down the number of adults who end up as lifetime smokers, again, we will have far more resources to focus on prevention and wellness.

So I -- unfortunately, I think we’re going to have to spread the resources to pay some time and attention. Sharing strategies that really work, I think will make a huge difference so that all of us who are looking at very similar chronic disease patterns really learn from one another about what works and what doesn’t so that we really can maximize those resources.

And I think there’s no question that the maternal and child health issues and the preventable deaths around maternity is another area that has not only a huge human toll but a huge economic toll on countries. And again, we know what to do and we know how it can be prevented, so I think we’ve got to look at those millennium goals and really do our best to accelerate the achievement of the goals around maternal and child health.

Yes, sir. I think -- behind the post. You don’t have to stay behind the post, but who was behind the post.

QUESTION: Thank you very much for your comments. Paul Neureiter from Pfizer.

One of the problems that we have had in the United States, of course, is the tradeoff between current costs and the impact on future costs. Could you comment a little bit on how you see that problem and how governments, both us here in the United States, but also around the world, how we can make a better case for the tradeoff between now, spending money now on health versus the future costs?

SEBELIUS: Well, it’s a great question. And it’s always, I think, a challenge because prevention in and of itself means something didn’t happen. And it’s always difficult to capture what didn’t happen, put a dollar figure on it, and say to people, ‘Because we did this, this didn’t happen; and see, it has paid off.’ So I’m not sure that that won’t continue to be a challenge.

But I think the profile in the United States, and again, I think it’s helpful for APEC countries because we are unfortunately ahead of you on lots of these negative trends that you would like to avoid, so we spend more than anyone on health care. And yet, our health results are not showing great outcomes for that amount of money per capita spent. We spent far more on dealing with chronic disease than we do on prevention.

So I think we have an opportunity in the United States to really demonstrate that shifting those resources -- and part of the Affordable Care Act actually directs us to make some of those resource investments and shifts into prevention really does pay off in the long run.

And so I -- you know, if we can lower the smoking rate -- we’re now at about 20 percent. Our rates came way down in the -- 10 and 15 years ago, and then we have been stalled at 20 percent for both young Americans and for adults. We have been stalled for almost a decade. If we can drop those rates dramatically, we know that we will have fewer people showing up with chronic diseases in hospitals, showing up with heart disease, with stroke, with effort.

So I think that we’re going to have to do the same kind of measurement and tracking. We’re going to have to drive that cost home. I -- there are some areas where the public is pretty sympathetic. I mean, does understand the connection to fewer people smoke then fewer people die of smoking and have smoking related diseases. And they’re eager to have us put money into that.

I think there is beginning to be a recognition around eating and lifestyles and the health challenges involving obesity that there really is a connection between that and health. And I certainly think it’s an area where the private sector is enormously helpful and people can be not only health educators, I think Americans are very hungry for information about health conditions and an opportunity to participate.

And I think that’s probably a -- using methods like the new technology. So whether it’s text messaging to drive home health strategies and preventive care or using social media, we’ve got an opportunity, I think, to reach out to a new generation in a very different way and make them much more savvy health consumers.

Maybe I can take one more, and then I’ve got to -- yes, sir.

QUESTION: My name is [Inaudible.] I am now working for the Department of Health, Chinese Taipei. I have a different --

SECRETARY SEBELIUS: Congratulations.

QUESTION: Oh, okay. I have a different question for you. I am curious to know whether or how your unique experience as a governor can be a strength for your current -- to implement the health reform.

SECRETARY SEBELIUS: Well, I had an opportunity as a governor to actually run a lot of health programs, so I was one of the largest health purchasers in the state of Kansas because we ran the state employees’ health program that had the largest number of covered lives of any plan in the state of Kansas. We ran -- we were purchasers of a lot of prescription drugs.

We ran the Medicaid program, which is a public health insurance program for those who qualify by income, a lot of mothers and children -- and got to work with healthcare providers and hospital leaders on good strategies because, as a purchaser, I was also looking at how not only to have a healthier population but how to help drive down costs. And I think those experiences were very helpful.

I was in a former life the -- also a job that was known as the Insurance Commissioner, so I was actually in charge of all of the private insurance plans that sold policies in the state of Kansas and looked at rates and looked at underlying costs and driving trends. So I think both of those jobs at the state level have really been helpful at the federal level because it’s a lot of the same issues and challenges.

We had a big workforce in Kansas, and you know, one of the goals was how we got our workers healthier. So we put in place everything from workplace exercise programs. We gave people incentives to stop smoking and lose weight. And what we saw is the cost of the health plans went down. I mean it really did work. So I was able to connect sort of ideas with actual practical experience and know that it really works.

So a lot of those same ideas are ones -- I worked a lot with schools. And physical education in schools, we have just rewritten in the United States a big school nutrition act that is really aimed at serving healthier meals to children in schools, serving meals that have less calories and less sugar and less fats, getting a lot of soft drinks out of schools knowing that that often adds weight and empty calories.

So a lot of those strategies that we worked on on the state level are ones that I can now help put in place across the country. And I think that has been very, very helpful, again.

As a governor, I didn’t have a boss though, and I have a boss again, you know.


SECRETARY SEBELIUS: Luckily, he is a very bright, challenging -- and we have a great asset also in that First Lady Michelle Obama is a huge champion of certainly childhood health and wellness efforts. And that has really done a lot to shine a bright light for a lot of people around the country on how important this initiative is. And she has been able to gather some great partners. So that has been a wonderful deal.

So thank you all for having me here, and I look forward to working with you and seeing many of you in New York.



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