~QYNOTE ADDRFSS
        BY
C, EVERETT KOOP, MaDa,
    SURGEON GENERAL

        OF THE

ORIGINAL

Sc,D,

LLS, PUBLIC HEALTH SERVICE

U,S, DEPARTMENT OF HEALTH AND HUMAN SERVICES

  PRESENTED TO THE SAFE KIDS SYMPOSIUM

"UNITING AMERICA TO FIGHT CHILDHOOD INJURY"
      WASHINGTON, D,d,
       FEBRUARY 16, 1989


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(GREETINGS TO HOSTS, GUESTS, FRIENDS, ETCJ

   I'M DELIGHTED TO TAKE THE PODIUM THIS MORNING AND OPEN THIS

SYMPOSIUM, WE'VE GOT A LOT OF THINGS TO TALK ABOUT TODAY AND

TOMORROW,

AND THEN WE'VE GOT TO GET BACK TO OUR COMMUNITIES AND TURN

THAT TALK INTO ACTION,

   WE MUST DEMAND -- AND WE MUST WORK FOR -- SAFER ROADS AND

HIGHWAYS,


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   WE MUST DEMAND -- AND WE MUST WORK FOR -- SAFER SCHOOL

BUILDINGS ANDY PLAYGROUNDS

  WE MUST DEMAND -- AND WE MUST WORK FOR -- A SAFER

MARKETPLACE, ESPECIALLY SAFER TOYS AND BICYCLES,

AND WE MUST DEMAND OF EACH OTHER -- AND WE MUST WORK WITH

EACH OTHER -- TO ACHIEVE SAFER HOMES FOR OUR CHILDREN,

  IT IS STILL SHOCKING TO ME, WHEN PEOPLE TELL ME THAT --

BASED ON THE COLD, HARD STATISTICS -- THE GREATEST POTENTIAL

THREAT TO THE AVERAGE AMERICAN CHILD IS t n a THAT CHILD'S OWN

FAMILY AND HOME ENVIRONMENT.


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THAT DOESN'T MAKE SENSE, AND WE'VE GOT TO CHANGE IT,

  HOW WILL WE DO THAT? HOW WILL WE CHANGE THE DANGEROUS

HABITS a,, THE HIGH-RISK BEHAVIOR aa, THE THREATENING LIFESTYLES




I s I THE UNSAFE CONDUCT OF A NATION OF NEARLY A QUARTER OF A

BILLION MEN, WOMEN, AND CHILDREN?

   I BELIEVE WE HAVE AN ANSWER TO THAT QUESTION,  IT'S NOT A

SIMPLE ANSWER,
BUT, THEN, THIS NOT A SIMPLE PROBIFM,


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LET ME GIVE YOU A KIND OF OUTLINE OF HOW I SEE THIS ISSUE OF

CHILDHOOD INJURIES

  FIRST OF ALL, AS THE TITLE OF MY REMARKS THIS MORNING

INDICATES, I THINK THE PEOPLE OF THIS COUNTRY HAVE TO ADMIT THAT

-- YES -- INJURIES, INTENTIONAL AS WELL AS UNINTENTIONAL, ARE THE

LEADING CAUSE OF DEATH AND DISABILITY AMONG CHILDREN,

  FRANKLY, I PUT THIS ELEMENT RIGHT UP FRONT BECAUSE I DON'T

THINK THE AMERICAN PEOPLE UNDERSTAND THIS B m m OR WANT TO FACE UP

TO IT,


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  THERE'S STILL A LOT OF FOLKLORE ABOUT "ACCIDENTS" ,,a ABOUT

FATE TAKING A HAND IN THIS OR THAT aa a IN OTHER WORDS, A LOT OF

FOLKLORE THAT RELIEVES ADULTS OF RESPONSIBILITYa

AND CHANGING THAT TOTALLY ERRONEOUS MIND-SET IS OUR MOST

SERIOUS CHALLENGE,

  WE MUST NOT ALLOW THE ADULTS OF AMERICA TO "GET OFF THE

HOOK" THAT EASILY, WE NEED TO EXPLAIN TO THEM AND CONVINCE THEM

AND GET THEM TO BELIEVE RIGHT TO THE DEPTHS OF THEIR SOULS THAT

CHILDHOOD INJURIES ARE NO ACCIDENT,


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  YOU KNOW THAT AND I KNOW THAT, BUT I BELIEVE THAT WE'RE

STILL A MINORITY, THAT MOST AMERICANS DO NOT KNOW THAT. AND SO

I WOULD PUT AT THE TOP OF OUR LIST OF PRIORITIES THE NEED TO GET

THE REST OF THE COUNTRY TO UNDERSTAND AND ACCEPT WHAT E
UNDERSTAND AND ACCEPT , , a AND THAT IS, THAT CHILDHOOD INJURIES

ARE NO ACCIDENTn

  THE NEXT ASSIGNMENT ON MY LIST OF PRIORITIES IS JUST AS

DIFFICULT, BUT WE'VE GOT TO FACE IT SOONER OR LATER, SO WHY NOT

SOONER?


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   IT'S TIME TO BE HONEST WITH OURSELVES ABOUT THE WAY WE TREAT

CHILDREN IN GENERAL IN OUR SOCIETY . a a AND WHERE WE NEED TO DO

BETTER, WE OUGHT TO GET ON WITH THAT TASK.

  CHILDREN DO NOT AUTOMATICALLY GET A FAIR SHAKE IN OUR

SOCIETY, AND THEY SHOULD, BUT LET ME SAY PARENTHETICALLY THAT,

WHEN I WAS ON THE CUTTING EDGE OF PEDIATRIC SURGERY FOR SO MANY

YEARS, ONE OF THE GREAT REWARDS FOR ME WAS TURN THAT AROUND,  I

BELIEVE THAT TODAY KIDS CA AND DQ GET A FAIR SHAKE IN SURGERY,

   I DO NOT BELIEVE YOU CAN SEPARATE THE PHENOMENON OF

CHILDHOOD INJURIES FROM THIS ISSUE OF WHERE CHILDREN FIT IN OUR

SOCIETY, I DON'T THINK YOU CAN SEPARATE CHILDHOOD INJURIES FROM

THE FACT THAT FAR TOO MANY SCHOOL SYSTEMS IN THIS COUNTRY, WITH

THE APPROVAL -- TACIT OR OTHERWISE -- OF STATE LAW, ALLOW SEVERE

PHYSICAL PUNISHMENT TO BE METED OUT TO THEIR STUDENTS,


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  BY THIS 9TH DECADE OF THE 20~~ CENTURY WE ALL SHOULD KNOW

THAT NO CHILD HAS EVER LEARNED A LESSON OR CHANGED BEHAVIOR

BECAUSE HE OR SHE WAS GIVEN SEVERE CORPORAL PUNISHMENT,

  I'VE READ ALL THOSE STORIES IN THE NEWSPAPERS AND IN WEEKLY

NEWSMAGAZINES ABOUT THE PRINCIPALS WHO HAVE "CLEANED UP" THEIR     .

SCHOOLS BY PHYSICAL FORCE, AND I AM ASHAMED FOR THEM a., FOR

THEIR COMMUNITIES warn AND FOR ANY OF MY FELLOW AMERICANS WHO

THINK SUCH PRINCIPALS HAVE "THE RIGHT IDEA." THEY DO NOT,

  THERE NEVER WAS A TIME WHEN A MAJOR SOCIAL PROBLEM WAS

SOLVED BY THE BEATING OF A CHILD,  AND THERE NEVER WILL BE SUCH A

TIME t


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AND WE NEED TO CONFRONT SOME OTHER HIGHLY DANGEROUS

MYTHOLOGIES AS WELL,

FOR EXAMPLE, IT WOULD APPEAR THAT THE GREATEST THREAT TO

CHILDREN IS A FLIGHT OF STAIRS aa, AH FLIGHT OF STAIRS,

  I HEARD IT OVER AND OVER AGAIN WHEN I WAS SURGEON-IN-CHIEF

AT CHILDREN'S HOSPITAL OF PHILADELPHIA, CHILDREN WERE BROUGHT IN

WITH SEVERE FRACTURES, SPRAINS, CONCUSSIONS, AND CONTUSIONS, AND

WE WERE TOLD BY PARENTS OR GUARDIANS THAT THE CHILD "FELL DOWN

THE STAIRS"


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  AND WE PUT THAT DOWN ON THE RECORD AND WE RELAYED THAT

INFORMATION TO STATE AND NATIONAL DATA COLLECTIONS AND, SURE

ENOUGH, AFTER ALL THE REPORTS ARE IN FROM ALL OVER THE COUNTRY,

WE DISCOVER THAT THE BIGGEST THREAT TO CHILDREN IS THE NEAREST

FLIGHT OF STAIRS,

  BUT THOSE OF US IN CHILD PROTECTION AND IN CHILD HEALTH KNOW

THE AWFUL TRUTH, WE KNOW THAT SOME CHILDREN MAY FALL DOWN STAIRS




I I I BUT THEY ARE PROBABLY A SMALL MINORITY,

  MANY OF THOSE YOUNG VICTIMS OF STAIRS HAVE BEEN PUNCHED ,,.

SLAPPED ,a, THROWN ,s, AND BEATEN WITH FISTS, CLUBS, AND OTHER

WEAPONS, ADULTS DO THAT TO CHILDREN, STAIRS DO NOT PRODUCE THE

PHYSICAL SIGNS OF ABUSE,


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  FOR CENTURIES ADULTS HAVE INJURED CHILDREN a., AND HAVE LIED

ABOUT IT mm, AND OTHER ADULTS HAVE HEARD THOSE LIES AND THEN

MERELY TURNED AWAY,

  BUT WE HAVE A CHILD ABUSE AND NEGLECT LAW NOW AND WE HAVE --

1 WOULD HOPE -- A NEW MEASURE OF SELF-RESPECT TO GO ALONG WITH

THAT LAW AND WE WILL NOT ACCEPT THOSE TERRIBLE LIES ANYMORE,

  WE MUST GO BACK TO OUR COMMUNITIES mu. TO OUR NEIGHBORHOODS




I I I TO OUR SCHOOLS ,a, AND TO OUR OWN FAMILIES ,,, AND WE MUST

TELL THE AMERICAN PEOPLE THAT THIS MUST BE OUR PREMISE FROM NOW

ON:


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WHEN A CHILD GETS HURT, WE MUST NO LONGER AUTOMATICALLY

PERPETUATE THE MYTHOLOGY THAT IT MUST HAVE BEEN THE CHILD'S

FAULT OR THAT IT WAS THE RESULT OF ANOTHER MYSTERIOUS

"ACCIDENT,"  INSTEAD OF THAT, WE MUST BEGIN PUTTING THE

BLAME WHERE IT BELONGS: PERHAPS ON SOME OTHER HUMAN BEING --

MOST LIKELY AN ADULT -- WHO DID THE WRONG THING 1.1

UNINTEN-TIONALLY OR INTENTIONALLY #mm BUT NOT ACCIDENTALLY,

   SO ANOTHER ITEM ON MY LIST OF PRIORITIES IS TO FACE UP TO

THESE MYTHOLOGIES a,. THESE THIN EXCUSES AND RATIONALIZATIONS me,

RECOGNIZE THEM FOR WHAT THEY ARE mn. AND GET RID OF THEM,


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  AND FINALLY WE'VE GOT TO MAKE THE CONNECTION BETWEEN

CHILDREN AND ADULTS, BECAUSE THEY ARE CONNECTED., YOU KNOW,

CHILDREN GROW UP AND BECOME ADULTS

  I'M SAYING THE OBVIOUS 1st I KNOW THAT ,a, BUT I BELIEVE

THAT MANY OF OUR FRIENDS AND NEIGHBORS DO NOT SEE THE CONNECTION,

THEY DON'T SEE THE CONNECTION BETWEEN THAT YOUNG MAN IN A

WHEELCHAIR AND THE LITTLE BOY -- MANY YEARS BEFORE -- WHO WAS

KNOCKED FROM HIS BICYCLE BY A PASSING AUTOMOBILE,


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  WE DON'T SEE THE CONNECTION BETWEEN THAT YOUNG WOMAN WITH

EXTENSIVE FACIAL SKIN GRAFTS AND THAT LITTLE GIRL -- MANY YEARS

BEFORE -- WHO HAD MIRACULOUSLY SURVIVED A HOUSE FIRE,

   AND WE DON'T SEE THE CONNECTION BETWEEN THAT BLIND AND

DISFIGURED YOUNG MAN AND THAT INFANT -- MANY YEARS BEFORE -- WHO

WAS NOT STRAPPED IN A CAR SEAT AND WAS THROWN THROUGH THE

WINDSHIELD OF HIS PARENTS' AUTOMOBILE IN A HIGHWAY COLLISION,

  SOME 19 MILLION CHILDREN UNDER THE AGE OF 15 ARE INJURED

EACH YEAR AND THEIR INJURIES ARE SERIOUS ENOUGH TO REQUIRE

MEDICAL ATTENT ION,


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  AND 10 PERCENT OF THOSE CHILDREN -- OR ABOUT 2 MILLION

YOUNGSTERS -- ARE INCAPACITATED BY THEIR INJURIES FOR AT LEAST

TWO WEEKS ,a, MOST OF THEM FOR A LOT LONGER,

SEVERAL MONTHS,

SEVERAL YEARS

MAYBE THE REST OF THEIR LIVES,

  AT LEAST 100,000 BOYS AND GIRLS UNDER THE AGE OF 15 -- WHO

AT ONE TIME WERE HEALTHY AND NOT INCAPACITATED -- BECOME

PERMANENTLY DISABLED IN SOME WAY mm, EVE.RY YEAR,


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  LIFE IS DIFFERENT FOR THEM, DURING THEIR REMAINING 40, 50,

OR MAYBE 60 YEARS OF LIFE, THEY MUST NEGOTIATE RELATIONSHIPS AND

ENVIRONMENTS AND MAKE CHOICES THAT THE REST OF US WHO AREN'T

DISABLED DON'T HAVE TO MAKE,

   IN ORDER TO LIVE A FULL AND SATISFYING LIFE, THESE CHILDREN

REQUIRE OF THEMSELVES, OF THEIR FAMILIES, OF THEIR FRIENDS, AND

OF SOCIETY AN ADDITIONAL QUOTA OF ENERGY , , , AND INTEREST a ,, AND

ASSISTANCE , a, AND MONEY,

AND THEY REQUIRE THESE THINGS EVFRY DAY,


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  DURING MY YEARS AS A SURGEON IN PEDIATRICS, I SAW CHILDREN

WHEN THEY WERE MOST VULNERABLE,  I SAW THEM WHEN LIFE AND DEATH

HUNG IN THE BALANCE,  I'M SURE MANY OF YOU HERE THIS MORNING HAVE

SEEN THE SAME THING,

YOU CAN PICTURE THEM IN YOUR MIND'S EYE, AND YOU ARE MOVED

BY THAT PICTURE.

  BUT DON'T STOP THERE. TRY TO IMAGINE THEM AS LIVING,

GROWING, DEVELOPING HUMAN BEINGS, TRY TO IMAGINE THEM IN HIGH

SCHOOL AND ON INTO HIGHER EDUCATION,


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  TRY TO IMAGINE THEM CALLING UPON EVERY OUNCE OF TALENT,

BRAVERY, AND GOOD GRACE THAT THEY CAN MUSTER IN ORDER TO GET TO

THEIR CLASSES a an TO THE DINING HALL me, TO THE LIBRARY,

  AND TRY TO IMAGINE THAT SAME YOUNG MAN OR YOUNG WOMAN

GOING OUT INTO THE WORLD OF WORK, AND CALLING UPON THAT EXTRA

WILL-POWER AND ENERGY IN ORDER TO COMPETE FOR A GOOD JOB AT A

GOOD SALARY AND COMPETE FOR RECOGNITION, JUST LIKE ANY OTHER

CONSCIENTIOUS YOUNG EMPLOYEE,


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  AND IMAGINE A HAPPY, PRODUCTIVE, AND FULFILLING MARRIAGE

AND HOME LIFE, DESPITE THE INJURED OR MISSING LIMBS, THE INJURED

SPINAL CORD, OR THE SENSORY LOSS

   IT'S ALL POSSIBLE, WE KNOW IT IS, BUT IT'S POSSIBLE IN A

LIFETIME PERMANENTLY SPENT TAKING THOSE EXTRA STEPS, EXERCISING

THAT EXTRA MEASURE OF CAUTION AND CONTROL , , , A LIFETIME SPENT

TAKING THAT EXTRA MOMENT TO ASSESS THE RISK OF THE NEXT MOVE m mm

A LIFETIME OF EXTRAORDINARY COST IN BOTH MATERIAL AND HUMAN

TERMS,


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  WE TEND TO VIEW CHILDHOOD INJURIES AS BEING DEVASTATING ONLY

TO CHILDREN. BUT CHILDREN SURVIVE AND GROW UP, HENCE, CHILDHOOD

INJURIES ARE ONE OF THE LEADING CAUSES OF PHYSICAL AND MENTAL

DISABILITY, OF ARRESTED DEVELOPMENT, AND OF RESTRICTED LIFE

EXPERIENCES FOR MILLIONS AND MILLIONS OF ADULTS 1.1 THE CHILDREN

WHO HAD BEFN INJURED a., BUT WHO SURVIVED,

  AND SO THE TRAGEDY OF CHILDHOOD INJURIES IS COMPOUNDED, YEAR

AFTER YEAR, FOR MOST OF THE 19 MILLION CHILDREN WHO WILL BE

INJURED IN THE UNITED STATES THIS YEAR, LIFE WILL GO ON.


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BUT FOR MANY OF THEM IT WILL BE DIFFERENT, LIFE WILL BE A

LITTLE HARDER, A LITTLE MORE SPECIAL,  AND IT WILL ALWAYS BE THAT

WAY,

  FOR THESE YOUNGSTERS

ASSOCIATED WITH CHILDHOOD

COSTS

AND THAT'S SOMETHING

THERE ARE NO ONE-TIME COSTS OF ANY KIND

INJURIES,  THERE ARE ONLY LIFETIME

ELSE WE MUST TAKE BACK TO OUR

COMMUNITIES AND TO OUR NEIGHBORHOODS,

FIRST, CHILDHOOD INJURIES ARE NO "ACCIDENT",

SECOND, CHILDHOOD INJURIES CAN LAST FOREVER,


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  THAT'S WHAT MY LIST OF PRIORITIES LOOKS LIKE THESE DAYS,

BUT THAT LIST HAS NO MEANING -- IT EXISTS IN A VACUUM -- WITHOUT

THE KIND OF WORK BEING DONE BY THE MEN AND WOMEN n a m AND

CHILDREN, TOO e a s OF THE "SAFE KIDS" CAMPAIGN,

  THESE MAY BE USEFUL IDEAS, BUT IT'S JUST SO MUCH RHETORIC,

WITHOUT A NATIONAL GRASS-ROOTS EFFORT TO MAKE THE ENVIRONMENT

SAFER FOR EVERY CHILD IN AMERICA,

  AND THAT'S WHAT THIS SYMPOSIUM IS ALL ABOUT, THAT'S WHY I'M

VERY PLEASED TO BE THE HONORARY CHAIRMAN OF THE SAFE KIDS

CAMPAI GN ,


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  AND THAT'S WHY I'M HERE THIS MORNING TO HELP HERTA FEELEY

AND MARTY EICHELBERGER AND BERNIE GUYER AND DAVE HEPPEL AND

EVERYONE ELSE WHO IS ON THIS SYMPOSIUM OR WHO HELPED PUT IT

TOGETHER,

  THE NATIONAL SAFE KIDS CAMPAIGN HAS TO WORK,  IT HAS TO

SUCCEED,  IT IS NO EXAGGERATION TO SAY THAT AT STAKE ARE THE

LIVES AND WELL-BEING OF MILLIONS OF AMERICA'S CHILDREN -- AND

THE MILLIONS OF ADULTS THEY WILL BECOME,

THANK YOU

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