REMARKS BY: DONNA E. SHALALA, SECRETARY OF HEALTH AND HUMAN SERVICES PLACE: Legislative Council Chamber, Wellington, New Zealand DATE: April 8, 1999
Standing in this splendid room-once the home of your Upper House of government-I'm reminded of something former U.S. Ambassador to New Zealand, Tim Francis, said. He remarked, "Nothing is more pervasive or important than [our] shared commitment to democracy...it is the basis of the enduring friendship between the New Zealand and American people." He was right. Our two nations share a friendship that was born of a common heritage, language, and pioneer spirit...A friendship that was tempered on the 20th century's great battlefields-where our armed forces fought side by side in the causes of peace and freedom...And a friendship that will take our democratic nations, together, into the new millenium.
The U.S. is proud to call New Zealand a friend. And I know that
President Clinton will express this same sentiment when he visits later this year. There's an old proverb that says that true friends must do three things: Give to each other; learn from each other; and work with each other.
New Zealand has certainly given the very best to not only the United States-but to the world. From scientist Ernest Rutherford; to diva Kiri Te Kanawa; to explorer Edmund Hillary; to author-and Wellington's own-Katherine Mansfield; to Xena the Warrior Princess, you have enriched the international community.
But true friends must also learn from each other-and the U.S. can certainly learn a lot from New Zealand. Your primary schools are considered among the best-if not the best-in the world. And your environmental policies and protections have raised the bar for every nation. In health care, too, my country can learn from yours. Your health care spending is at an affordable level-7.6 percent of your GDP, as compared to almost 14 percent for the United States. You have both information privacy legislation and patients' rights legislation. We have neither-and President Clinton has repeatedly challenged our Congress to provide these protections for all Americans. And you have universal health coverage that seeks to guarantee access to health care for everyone. Expanding health care access is something we in the U.S. are still struggling with. That's why, in 1997, we created the Children's Health Insurance Program-or CHIP. The largest expansion in our health care system in 30 years, CHIP-and its sister program Medicaid-will provide quality health insurance for as many as 2.5 million uninsured children
But it's not just learning from each other. According to the proverb, true friends must also do one more thing-they must work together to find common solutions to common challenges. And I'd like to briefly discuss four health care challenges that both of our nations share.
In both our countries-according to a recent Commonwealth Fund Study-roughly one-third of our people are dissatisfied with the current health care system. Here in New Zealand, I know that policymakers are discussing how to capture the best features of managed care, in order to contain health care costs and improve health care quality. In the United States, managed care has already become one of the most dominant features of our health care landscape. We're now striving to keep what works in managed care- like comprehensive, coordinated service-while addressing those problems that worry consumers.like not having a Patient's Bill of Rights. The second challenge common to both our countries is health disparities. Here, you face persistent health inequalities between the Maori and Pakeha, and between Pacific Island Peoples and Pakeha. We face a similar situation in the U.S. African-Americans suffer diabetes rates 70 percent higher than white Americans.While Hispanic-Americans have two to three times the rate of stomach cancer.and Vietnamese-American women suffer from cervical cancer at nearly five times the rate of white women.
To combat this, we've launched a racial disparities initiative to close the gaps between minority populations and white Americans in infant mortality; diabetes; cancer screening and management; heart disease; HIV/AIDS; and immunization levels, by the year 2010.
Our third common challenge is fighting tobacco use among our young people. In the United States, each and every day, 3,000 of our young people begin to smoke illegally.And 1,000 of them will die a little sooner as a result. Your statistics are just as alarming. Three in every 10 New Zealanders aged 15 to 19 take up smoking-despite your aggressive controls on the tobacco industry, including a ban on all tobacco advertising and sponsorship. So what's the answer? President Clinton has proposed a significant increase in the price of cigarettes. But I believe that we must also find innovative ways to talk with our children-not at them-and in language they understand. That's why my Department teamed up with the great singing group, Boyz II Men, on an anti-smoking public service announcement aimed at young people, and with the U.S. Women's National Soccer Team to teach young women to "smoke" their opponents, not tobacco. And I understand that there have been similar efforts in New Zealand.
Finally, the fourth challenge we're both facing is breast cancer. Breast cancer is the leading cause of cancer death for women in New Zealand, and the second leading cause among American women. I applaud your efforts to fight this shadow which falls on every woman's life-especially your new National Breast Cancer Screening Program. Like your innovative National Cervical Screening Program, I know it will help hasten the day when we have no more cancer statistics-only survivors. In the U.S., the Clinton Administration has been combating breast cancer on numerous fronts-including significant investment in research; improved access to treatment; and better quality of care.
I'll be talking a little more about our specific efforts to battle breast cancer in a few minutes. But I can't emphasize the importance of this fight strongly enough. Because in the U.S., our fight against breast cancer had repercussions that eventually changed the very landscape of health care in America. That's because breast cancer was the one issue that, perhaps more than anything else, coalesced and energized our women's health movement. It's a movement dedicated to ensuring that women's health concerns are always on the national agenda and in the national spotlight. And it's a movement that the Clinton Administration is supporting with courage and creativity. Our budget for women's health has grown over 1 billion dollars in four years. We now have an office of women's health inside every major health agency. We have women's health centers in our major universities. We have a network of advocacy organizations. And we have a President who put women into positions of leadership in science and health-including appointing the first woman to head our Food and Drug Administration-which certifies and licenses mammography machines.
But I haven't come here tonight to just tell you how much we've done to support women's health. Far from it. American author Ralph Waldo Emerson once wrote that "A friend is one before whom I may think aloud." And so I'd like to think aloud right now. In the Maori creation legend, it's said that the union of the sky and the earth produced six important children. In that spirit, I'd like to present six important lessons that we in the United States have learned from our experience putting women's health on the national agenda-and keeping it there.
Our first lesson: We must help women see their whole selves. There was a time-not that long ago-when women's health focused on women's reproductive anatomy-and not much else.When a healthy life focused only on childbearing years.And when women's lives were destroyed because their health problems and concerns were neglected, ignored, or dismissed. But as New Zealand's own Sylvia Ashton- Warner once remarked, "There is only one answer to destructiveness, and that is creativity." The Clinton Administration's creative answer is to help all women understand that every aspect of their lives is an aspect of their health. So we opened the door of what it means to be a healthy woman wider than it had ever been opened before. How? By looking at women's health as a seamless change of seasons across a lifetime-with no season more or less important than the other. By making prevention-whether of osteoporosis or breast cancer-a centerpiece of our strategy. And, finally, by declaring that violence against women is a public health problem that is unacceptable and avoidable. That's why Attorney General Janet Reno and I chair a National Advisory Council on Violence Against Women. And why my Department funds shelters, community programs and research to prevent domestic violence throughout the United States.
But even when women see themselves as a whole, they still need to make their voices heard. That's lesson two: Build an army from the ground up. The point of this lesson is simple: Mobilize. There is no standing army for women's health. We had to build one. But as an anonymous Maori poem tells us, "From the nothing, the increase." So we organized networks of women's health advocates all over our country. We started small, with community-based organizations. These groups met in living rooms, schools and houses of worship. They recruited new members, marched, petitioned, and carried their message to local politicians. Eventually, they formed the National Women's Health Network-a national organization whose voice is heard today in the halls of Congress and state legislatures. Other armies were built. Our National Action Plan on Breast Cancer-which I'll mention again shortly-came about because 2.6 million women, organized by the National Breast Cancer Coalition, signed a petition drive. Today, new armies are focusing on making sure women have access to care-and that the care they receive is of the highest quality.
Of course, building an army is hard enough-making sure it marches to victory is even more difficult. Which brings me to lesson three: Pick the right battles. In the United States, as I said earlier, one battle was breast cancer. In 1993, working with the National Breast Cancer Coalition and other organizations, we started the National Action Plan on Breast Cancer. At the same time, we doubled discretionary spending on breast cancer research, prevention and treatment. And we've provided free breast cancer screenings for low-income women and all women over 65. The result? We now have a 93 percent breast cancer survival rate when the disease is detected early, and the number of women getting mammograms is up by one- third.
But the battle over breast cancer was just one part of a much larger battle over research. Because women had often been excluded from clinical trials-we didn't know if the data we were getting applied to women. And we didn't know if particular diseases strike women and men differently. We were doing the science- but we couldn't say with confidence that it was good science for women. So we picked this battle. We fought it. We made the issue bipartisan-and went looking for friends and supporters wherever we could find them. And we won. Now, there will never again be federally funded research-about diseases that strike women-that does not include women.
And that brings me to lesson four: There's a women's health aspect to almost every issue. When someone asks me, "Secretary Shalala, aren't issues like the economy and national security more important than women's health? I always answer: "These issues are women's health." The health of our families, communities and nations all depend on the health of women. And by broadening the definition of women's health, we can actually recruit allies who might otherwise think that women's health has nothing to do with them. What we simply cannot do is remain silent in the shadows. I think that's what the Maori proverb means that tells us to "turn your face to the sun." The fact is, every social or economic problem has a women's component.
How we solve these problems is answered, in part, by lesson five: Weave your way around the opposition. We've learned that when it comes to women's health, we must try for what's attainable and build new successes on the foundation of old ones. That almost means anticipating the opposition-and being ready to work with it or around it.
But we cannot play it safe. Because as Katherine Mansfield wrote, "Risk, risk anything. Care no more for the opinion of others, for those voices." Our Administration believes that all women need information about reproductive health-including HIV and sexually transmitted diseases. And we won't simply give in to those opinions-to those voices-that say otherwise.
We also believe that women are entitled to a full range of reproductive rights-including abortions-but that abortions should be safe, legal and rare. Many people believe that this is not the responsibility of government. We disagree, but we know that this is a battle that cannot be won overnight. So we're focusing on different, but related, victories-and building partnerships to achieve them. For example, we're partnering with men's organizations to teach young men to share in the responsibility for preventing unwanted pregnancies. We're also weaving around the opposition when it comes to ensuring that birth control is covered by health insurance. Ironically, many insurance companies are willing to cover the cost of Viagra, the impotency drug. But they won't cover the cost of birth control devices or pills. So we're requiring all federal health plans to cover prescription contraceptives-if they cover prescription drugs.
Women's specific health care needs can never again be consigned to the backwater or the back burner. And that brings us to the final-and perhaps most important-lesson. Lesson six tells us that if we really want to put women's health on the national agenda and keep it there-we must support everyday heroines. We must value the "life force" and the "spirit" which Maori tradition tell us reside in every woman-in every living thing-by listening to the voices of ordinary women. More than any other, this is perhaps the one lesson that those of us in government or the health professions cannot afford to forget. In the 1970's, women protested on the steps of our Capitol building demanding hearings on the safety of the birth control pill. Thanks to their tenacity-they got people to listen. And today we have a National Women's Health Information Center. Women can contact it by phone and over the Internet with their health care questions. We don't know all the answers-but we're going to get them. And, most important, we're listening. Taken together, these six lessons will help keep women's health on the national agenda, and in the national spotlight-in every country.
Madame Prime Minister, our two countries share many things. In both of our immigrant nations, our faces are changing...our cultures are blending...and our population is aging. We have to be ready for these changes with a blueprint for women's health-and for our nations' health and welfare-that matches who we are...and who we will become.
Madame Prime Minister, distinguished guests, whenever I think of your country, I always recall a land of great seismic beauty-from geysers to glacial mountains. But I think of other things, too. Long ago, my family learned that your greatest natural resource is not your scenery. It is your people. Near the end of World War II, one of my young uncles stopped here on his way to an air base in the South Pacific.
He wrote home of the many kindnesses that the people of New Zealand showed a very lonely American soldier-a Yank. Sadly, my uncle didn't come home to the victory that he and his comrades from New Zealand, and around the world, had won. His spirit is with his plane that was shot down so many years ago in that ocean of memories. And so for him-and for all of your young soldiers who fought so bravely so that we could enjoy a 21st century free from tyranny-my sincere wish is that God will always bless.and in the words of your National Anthem, "defend New Zealand."