Providing children with a healthy environment is the first step toward achieving a balanced community health system.

Every 10 years, federal officials work with hundreds of private organizations as well as state and local officials to set health goals for the country through the “Healthy People” initiative. We recently reviewed the status of our goals for the year 2000, and we found good news and bad news. The good news was that we have either met, exceeded, or moved toward meeting 60% of our goals. Those goals include the areas of cardiovascular diseases, infant mortality, teenage pregnancy, and some cancers. However, in other areas we are moving in the wrong direction. Asthma is one of those areas.

Asthma is a major health problem and a serious threat to a healthy start in life for children. Since 1980, asthma has risen to epidemic proportions in children, particularly for those under 5 years old, for whom its prevalence is three times higher. Minority children are hospitalized at four times the rate of white children and die from asthma four times more often than white children.

Within the Department of Health and Human Services, we have developed a strategy for addressing the asthma epidemic in this country. We start with finding the cause, which is known to be environmental allergens. We are also investigating why minority and poor children are affected the most. And we are evaluating what works in preventing asthma.

When we address the asthma epidemic in this country, we not only address a severe and often life-threatening illness, we also address several other issues—quality of life, productivity, days missed from school, and burden on the health care system—all of which can have a negative impact on a child’s opportunity for a healthy start in life.

The Centers for Disease Control and Prevention (CDC) recently funded a Prevention Research Center at Tulane University, where the major focus is on environmental health. Make no mistake about it, the environment in which a child starts contributes significantly to how well that child does later in life.

Our goals for the next decade—or Healthy People 2010—are to increase the years and quality of life, and to eliminate disparities in health. In order to accomplish these goals, we will need to put an effective system in place.

We must begin to move toward a balanced community health system—one that emphasizes health promotion, disease prevention, early diagnosis, and universal access to care. It must involve the home, the community, and the schools. And it must be supported by the best available science, based on a balanced research agenda.

This priority involves fixing our system so that access, quality, and cost are no longer major barriers to health. Currently, 16% of the population is uninsured—that is 43 million people, up from 37 million—despite our spending $1.5 trillion on health care each year. Unfortunately, only 1% of that amount goes to population-based prevention. Our strategies have failed to move us forward. We know that managed care is not the answer, but we must be willing to admit that it is not the villain we make it out to be either. What we have is a systems problem that has resulted in, at best, an imbalanced quality of care.

So what must a balanced community health system achieve? It must ensure that every child should have an opportunity for a healthy start in life. Beyond ensuring safe pregnancies, and ensuring that babies are born to parents who are ready to be parents, and that mothers have access to quality prenatal care, this priority deals directly with providing a safe and nurturing environment for children. Children develop best when they are protected from environmental and other toxins, like lead, drugs, alcohol, and tobacco, and from cockroach droppings, which leads to asthma.

Inasmuch as children need protection from negative elements, they also require supportive environments where there are loving, caring adults who will take the time to read to them and to stimulate their senses. Providing healthy environments can range from making sure children get immunizations on time to breast feeding in the first year of life. Healthy environments means placing babies to sleep on their backs, as opposed to their stomachs, in order to reduce the incidence of sudden death syndrome. And healthy environments means we must look at stopping the violence in our communities and schools.

In a balanced community health system, we also must promote healthy lifestyles. This priority relates to nutrition, physical activity, responsible sexual behavior, and the avoidance of toxins. It also relates to creating an environment where people are free to engage in physical activity, where children can run and play without worry about harm, violence, or drugs. In too many communities across the country, people are afraid to go outdoors because the negative activities in the community do not create environments conducive to healthy behaviors.

Everyone has a role in promoting health and preventing disease, from the public and private sectors to the individual. Human behavior accounts for more than 50% of years of potential life lost. That includes tobacco use, alcohol and drug abuse, diet, unprotected sex, violence, and lack of physical activity. We can make a difference from the youngest child to the oldest adult when we focus our attention on healthy behaviors. Each person must accept responsibility for safe and healthy lifestyles.

But several “environmental barriers” exist that prohibit healthy lifestyles. For example, the air we breathe is one primary concern. We must ensure that we have an environment safe from air pollution and other forms of pollution, including smoking.

Another environmental barrier to healthy lifestyles is the glamorization of unhealthy behaviors. When unhealthy behaviors like smoking, violent acts, drug use, and drinking are glamorized and constantly depicted as ideal lifestyles, our children are receiving the wrong messages. We must be as vigilant in fighting these negative influences as advertisers and Hollywood are in promoting them.

The first Surgeon General’s Report on Smoking was released in 1964. Since then, we have managed to reduce the rate of smoking from 43% to 23%. However, in teenagers, the trend is increasing. Three thousand teens become smokers every day. Half of them will be addicted by the time they are 18 and one-third of them will live shorter lives and die of smoking-related diseases.

Today, we have a tremendous opportunity with the current state tobacco settlements, similar to the opportunity we had with the polio vaccine. When used properly, tobacco settlements can go a long way toward alleviating this nation’s smoking problem:
• they can prevent new initiations of smoking;
• they can provide support for cessation programs; and
• they can offer comprehensive cessation programs.

We can certainly use the help of RTs across the country to further these goals. I look forward to working with you.

David Satcher, MD, PhD, is the Assistant Secretary for Health and Surgeon General of the United States.