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REMARKS BY:  DONNA E. SHALALA, SECRETARY OF HEALTH AND HUMAN SERVICES
PLACE:       JULIUS RICHMOND LECTURE, HARVARD UNIVERSITY, BOSTON, MASSACHUSETTS
DATE:        November 21, 1997

This is a wonderful time to come to Boston.

Michael Jordan knows that the Celtic leprechaun is back sitting on top of the basketball rim. And the Bruins are out on the ice again - and winning. But in Washington, we're in the off-season because Congress just went into recess.

Actually, when the President announced my appointment, my mother sent me a New Yorker cartoon in which a little boy suggests to a little girl that they play the proverbial game of "Doctor." "Ok," the little girl says, "You be the doctor, I'll be the Secretary of Health and Human Services."

But I must tell you that long before the President recruited me, I admired the work of the only person to serve as both Assistant Secretary of Health and Surgeon General: Dr. Julius Richmond. It was, of course, Dr. Richmond who convinced me that we should go back to that powerful public health leadership combination. So when he is confirmed in early February, Dr. David Satcher will hold both posts.

It is a great honor to be invited by the Harvard School of Public Health to receive an award - and deliver the first lecture - named after a living legend. Dr. Richmond is not famous for being famous. He is famous for being warm, modest and visionary. And he is famous for being what all of us should aspire to be - a life saver.

Last year I chartered a Council on National Health Promotion and Disease Prevention Objectives for 2010. There were many former Assistant Secretaries of Health that I wanted to have on this Council. But there was one I knew I had to have. And that was Julius Richmond.

As a physician, the first director of Head Start, the father of community health centers, co-chair of the Starting Points report, and a member of the Carnegie Council on Adolescent Development, Dr. Richmond has dramatically re-written the destiny of countless children - and made a historic contribution to our understanding of the antecedents of troubled adolescence.

About those antecedents, this much seems beyond dispute: Many of the problems that young people face today - including the urge to settle disputes, or express their frustrations through violence - grow out family environments that are less than ideal.

My point is not to blame families. Far from it.

Instead, I'm here to say - and will repeat later - that we must find ways to support and strengthen our families and communities, because it is primarily through healthier families and communities that we will prevent behaviors that put too many of our kids at risk.

Writers have always understood that families are the most important force shaping the character of young people. It's been said that every great play in the English language - and maybe in every other language - is about families. And in many of these plays there is a young man or woman struggling to find an identity.

Struggling against painful memories, loss or forces that seem beyond their control. Struggling for love - or to make a new beginning.

Hamlet and Ophelia. One resorting to violence and revenge, the other succumbing to madness. Biff in Arthur Miller's Death of a Salesman. And Edmund in Eugene O'Neill's Long Day's Journey into Night.

Both disillusioned by fathers who fail to live up their sons' expectations.

But compared to the complex and confused world that today's adolescents face, the America of Arthur Miller and Eugene O'Neill seems almost quaint. Remember, they were writing - and their young characters lived - at mid-century. A time before a 50 percent divorce rate; before a mass media culture parading a steady stream of violent and sexual images; before AIDS and designer drugs; before binge drinking; before social and economic revolutions that made most American families two-worker families.

I'm not here as a drama critic - life in our nation's capital is dramatic enough - still I wonder sometimes if the conflicts and pressures of the generation that must lead us in the next century can even be fully captured by artists at the close of this century.

I am here representing an Administration that strongly believes adolescent violence is not inevitable; and that we must have the courage - and vision - to recognize that while adolescent violence cannot be tolerated, neither can it be solved by relying exclusively on the criminal justice system.

The fact is, although linked to some of our most intractable social problems - including racism and poverty - adolescent violence is a public health problem with reasons that can be understood, risk factors that can be identified, and outcomes that can be controlled. That means government; public health experts; doctors and researchers; corporate, community and religious leaders; and parents - working together - can prevent adolescent violence. So, just as we are teaming up to fight emerging infectious diseases, we must meet the equally important challenge of removing adolescent violence from the stage of our children's lives.

You've already heard this evening from one of the leading intellectuals - and practitioners - of reducing youth violence: Dr. Deborah Prothrow-Stith. In a recent op-ed in the Boston Sunday Globe, she and Dr. Howard Spivak wrote that adolescent violence is not inevitable. "Violence is preventable," they said. "We do not need to have this problem." They're right. But we do all have this problem.

Today, violence is the second leading cause of death for Americans between the ages of 15 and 24 - and the leading cause for African Americans in this same age group. And it's not simply the current numbers we have to be concerned with: Take a look at the trends. According to recent statistics, the death rate from homicide for teens 15 through 19 doubled between 1970 and 1994 to 20 per 100,000. It has also doubled for children 10 through 14. For African American males, the homicide rate was 136 per 100,000 - nine times that of white males the same age.

And we absolutely cannot overlook the fact that more male teenagers die from firearm wounds than from all natural causes combined. Yes, firearm injuries are a serious public health concern, and we must find ways to reduce them. That is why the President has encouraged gun manufacturers to equip all handguns with trigger locks - and many have agreed. And that is why the President fought so hard for - and won - passage of the Brady Bill and the Assault Weapons Ban.

But violent death is not just a male problem. The homicide rate for female adolescents also grew over the last decade.

And of course not all youth violence is directed at others.

Suicide is also a leading cause of death for young people. In 1995, about 24 percent of children in grades 9 through 12 - almost one in four - reported that they seriously considered taking their own lives in the previous year. And almost 10 percent reported actually attempting suicide.

We also know that girls are more likely than boys to report thinking about suicide and attempting suicide. But that boys are more likely to succeed.

So, the boy next door, the girl who bags our groceries, the high school athlete who seems so full of promise; these young people are not statistics - they are our future - and many are asking themselves: "Do I want to live?" And as painful as it is to admit, we must acknowledge that far too many of them are saying, "No."

That means the time has come for us to say "enough." The violence must end.

The time has come to offer hope to the terrified mother in suburban Virginia who said, "I went from wanting my son to win the Nobel Prize to wanting him to survive." The time has come to offer hope to every grieving grandparent who has ever asked, "How could this happen?" And the time has come for leaders in public health to lock arms with parents, teachers, law enforcement, business, clergy, and your colleagues in medicine in a circle of partnership dedicated to protecting our children from the public health menace not only of violence, but also teen pregnancy, AIDS, alcohol, drugs, tobacco and motor vehicle injuries.

Why?

Because we know that all of these problems are interconnected.

That teens who engage in one risky behavior are likely to engage in many. And that violence prevention must be part of a larger comprehensive strategy that protects young people from all the threats that they face.

We can do it. We must do it. And we are doing it.

Today, drug use is down for the first time in years. For the first time in history we have a President with the courage to stand up to the tobacco companies, we're working to pass sweeping legislation to keep our children away from a deadly addiction. The President will sign that legislation only if it holds the companies accountable. We're also seeing teen pregnancy rates inch down for the sixth straight year. More children are enrolled in Head Start. Americorp and Empowerment Zones are opening up education and employment opportunities. Two days ago the President signed a new bill to streamline adoptions. This year we passed a historic $24 billion dollar Children's Health Initiative that will insure up to half of our nation's 10 million uninsured children.

And now we know the numbers for both adolescent homicide and suicide are down slightly for 1995.

To make sure this trend continues, federal agencies from the Department of Justice to the Department of Labor to HHS have joined forces on what we call Coordinating Council on Juvenile Justice and Delinquency Prevention.

I've addressed this Council, and I can tell you it is made up of some of the most committed - and creative - thinkers on adolescent violence. Last year we wrote an action plan for mobilizing communities and breaking the cycle of violence and victimization.

But that is just one piece of our Department's work in the area of adolescent violence. As part of Healthy People 2000, we have set ambitious health promotion and disease prevention objectives for every public health problem - including youth violence. These are not pie-in-the-sky objectives cooked up in Washington. These are achievable targets set by an alliance of state health agencies, businesses, medical and voluntary organizations committed to prevention - and monitoring our nation's progress. And they include a one-third cut in homicide by the year 2000 from the peak year of 1991.

Of course the year 2000 is now just around the corner.

That's why our Council on National Disease Prevention and Health Promotion that I mentioned earlier is already working on a new set of prevention objectives for Healthy People 2010 - objectives that we will release in January 2000.

We are also bringing the problem of adolescent violence to the world stage.

In 1996, we co-sponsored with South Africa the first resolution in the World Health Assembly declaring violence a public health problem worldwide. And with the World Health Organization, we will spend the next three years doing global surveillance of all forms of violence.

While national governments - including our own - have a vital role to play in preventing youth violence, this is a problem that has to be worked on community by community - with people rolling up their sleeves, using their imaginations, and tending to the garden of our children's lives.

And that's exactly what is happening.

Right here in Boston, the Ten Point Coalition is one piece of a larger anti-violence movement that includes public health, schools, hospitals, law enforcement, the media, and young people themselves. Since 1995, this movement has helped reduced the number of firearm homicides in Boston among children 16 and younger to - zero.

And if it can happen in Boston, it can happen everywhere.

We need not be satisfied with an adolescent homicide rate 8 to 9 times higher than the rest of the world. In fact, zero juvenile firearm deaths sounds like an acceptable goal for our entire nation.

Your experience in Boston, and the work of Dr. Prothrow-Stith and her colleagues, makes clear that in the battle to bring a permanent peace to the lives of our children, the right strategies and programs can - and do - work. But, as some of our nation's most hard working and committed public health experts, you know that the way to understand - and duplicate - good outcomes is to do good research.

I'm committed to gathering accurate surveillance data - and analyzing it thoroughly and unsentimentally. I also believe we must support research that answers these kind of questions: Why do some adolescents resort to violence? What interventions seem most effective? And can they be duplicated?

That's the kind of research we're doing at the National Center for Injury Prevention and Control in the CDC. We're evaluating anti-violence programs from communities large and small. The work is still going on - and we don't have all the answers yet.

But we know that the fundamental principles taught at the Harvard School of Public Health: emphasizing prevention, using science to identify effective policies, and working in close collaboration with doctors, businesses, hospitals, and communities offers the best hope for re-writing the history books on adolescent violence.

We also know that there are enough good violence prevention programs in existence that we can begin to draw some important lessons about what works - and why.

Here's what we know:

First, although youth violence is a public health problem - there is no one public health solution. Not school curricula. Not mentoring. Not conflict resolution. Not after school programs. Only a combination of strategies that begin before a child reaches adolescence and continue through each stage of a young person's development will bring success.

Lesson number two: Knowing how to prevent youth violence takes top to bottom training. There's a program in Tucson Arizona called Peacebuilders. It's a school-wide violence prevention program that targets elementary school kids. There is intensive training for teachers that includes an orientation, on site training for up to 12 weeks, study sessions for particular problems, and periodic forums to review successes and failures.

But PeaceBuilders doesn't stop at the classroom door.

Principals, coaches, bus drivers, janitors and older students are all trained and given a role in the PeaceBuilder program. That means the message is consistent, school wide - and then repeated at home, because parent education is also part of the PeaceBuilder program.

A third important lesson is that preventing youth violence means not just focusing on individual children, but also paying attention to their social and economic environment. Because, just as we like to say the best social service program is a job, the best anti-violence program may also be a job.

In Durham, North Carolina, there's a program called Supporting Adolescents with Guidance and Employment (SAGE). Through mentoring, tutoring, conflict resolution and sex education young men are taught a definition of manhood that does not include violence. But SAGE does more. It also provides job training and a six week summer job placement in the community - from dentist offices to museums to auto repair shops.

The message of SAGE is unmistakable: Economic opportunity must be part of anti-violence prevention.

Let me say something that is both tragic and true: For many young people, violence begins at home. Which brings me to lesson number four: If we're going to break the cycle of domestic violence, we absolutely must start intervening early - because marriage violence frequently begins with dating violence. Let's face it, a young person who does not know how to respect someone they want to get to know is not going to respect that person after they're living together.

That's why Safe Dates, also in North Carolina, is using theater productions, role playing, and group discussions to help change what young people think is normal dating behavior, expose gender stereotypes, improve conflict management - and teach both sexes how to walk away from abusive relationships.

My fifth and final lesson is that parents play a critical role in preventing adolescent violence - and that parents need our help.

One recent study in Chicago concluded that a violence prevention program - especially one targeted to younger children - that includes parent training and family intervention has the best chance of success. It's not hard to understand why.

In 1995 the Carnegie Council on Adolescent Development said, "Through the critical adolescent years, most parents remain an important influence on their children, helping to mold their sense of self and shape their future life choices."

Today, we know even more.

In September, the National Longitudinal Study on Adolescent Health - one of the largest studies of its kind, which interviewed 90,000 students in grades 7 through 12 - found that adolescents who reported a close connection with their parents were the least likely to engage in risky behaviors.

This is consistent with a National Institute of Mental Health study indicating that the adolescents most likely to engage in delinquency and violence are those spending the most time with peers doing the same thing.

So for most young people, the caring adult in their lives - and that's usually one or both parents - has the best chance helping their children learn to cope with stress and resolve conflicts non-violently.

The problem, of course, is that parents themselves are under enormous stress.

They're working longer hours with less job security. They have less time to spend with their children. They're finding it harder to pay today's grocery bills let alone save for tomorrow's college bills. And there are fewer families that feel connected to strong, supportive communities.

So we must make a commitment to parents that helps them help their children avoid the risky behaviors of adolescence.

We're doing that through a comprehensive public health strategy - including a youth development strategy - that I call "Safe Passages."

Safe Passages means working in partnership with all the different adults and institutions in young people's lives - to help them steer them through the sometimes rocky waters of adolescence. It means increasing our capacity to support research on all aspects of adolescent health - from HIV infection to teen pregnancy to violence. It means supporting communities and giving parents tools that can help them keep their children on track - for example the V-chip. It means dramatically increasing the children's health budget because we believe that mental health is just as important as physical health.

It means ending the old "top down" approach to federal grants - where we tell communities what they need. Instead, we're pooling federal, state and private resources to help communities develop comprehensive plans for youth development - plans that understand that drug and alcohol use, sexual activity and violence are often linked. And it means taking account of gender differences and targeting special programs to the needs of young girls.

Research tell us that girls experience adolescence different than boys.

While boys often become more aggressive, girls often turn inward and self-destruct. All of us have seen this in our own lives: Girls once full of resilience and promise somehow enter the second decade of their lives without the strength that got them there. That's why we started our Girl Power! campaign.

With Girl Power!, we've teamed up with corporations and non-profits in a public health campaign designed to help 9 to 14 old girls stay away from drugs, alcohol, tobacco and eating disorders - and make the most of their lives. This year we will be giving out 5 Girl Power! grants - 4 of which will go directly to communities so they can work with volunteers to give 9 to 14 years old girls the confidence they need to stay away from drugs, tobacco and sex. And we're getting our Girl Power! message across to girls with posters, diaries, a web site - and soon, special Girl Power! water bottles.

Let me say something else about reaching teens and parents with life saving messages.

We have to communicate with young people in places where they're listening. I don't know a single teenager who reads public health brochures. Not one. That's why as part of Safe Passages I've spoken with soap opera producers and talk show hosts - to help them to use their shows to give young people information that can save their lives.

Two weeks ago I met with Boyz II Men. I didn't talk just about violence. But about tobacco, sexual activity, alcohol and drugs too. Your Designated Driver campaign and "Squash It" - both created by the Harvard School of Public Health - are great examples of how to communicate with kids. And so is our YouthInfo web site. Address: youth.os.dhhs.gov.

But even with Safe Passages - and a coordinated government response that includes public health, criminal justice, education and labor - we cannot solve the problem of risky adolescent behavior alone.

And, frankly, we shouldn't have to.

In this audience are the people who train and hire our future public health leaders, and the young people themselves - leaders who have an enormous role to play in bringing a drug-free, alcohol-free, AIDS-free and violence-free peace to the world of children.

To do that, we need to drop the jargon and go - or keep going - to places children go, and work with them in their communities.

And we need some of the enthusiasm, integrity and thoughtfulness that Julius Richmond has brought to his long and distinguished career.

In a couple of days I'll be traveling to India - a land that has known great violence, but whose first modern leader, Gandhi, embodied the most noble spirit of non-violence.

I challenge you to help bring that same spirit of non-violence to the next generation of young Americans. Not just with the kind of moral force that Gandhi used, but with the intellectual force of public health professionals trained to protect whole populations, to prevent disease and injuries before they occur, to serve the underserved, and - to paraphrase Isaiah - to make sure that our children make war on each other, and themselves, no more.

No more.

Thank you.

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