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Larry King Live Weekend

Rosalind Carter, Louis Sullivan, Marilyn Gaston Discuss Ways to Live Longer and Better

Aired March 10, 2001 - 9:00 p.m. ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

HUGH DOWNS, HOST: Tonight, living a longer and better life, it shouldn't be impossible.

Joining us from Atlanta to talk about health issues that effect everybody, former first lady Rosalind Carter, who has been an activist for good mental health care and education for decades. Also in Atlanta, Dr. Louis Sullivan, former Secretary of the U.S. Department of Health and Human Services and former Assistant Surgeon General, Dr. Marilyn Gaston.

That's all next on LARRY KING WEEKEND.

Hi, I'm Hugh Downs sitting in for Larry King. Thank you for joining us.

Mental or physical, good health is the key to good living. But even in the U.S., lack of money, lack of information or simply bad habits make it an impossible goal for many. Can these problems be overcome? Well, in Atlanta doctors and other health care experts have gathered to find out, and I'll get to all of our panelists in a moment.

I might mention also, the theme of the gathering, of the conference, is looking toward healthy people in 2010.

First, I want ask Mrs. Carter, your interest goes back at least three decades toward mental health and I'm told that you believe that mental health is intimately related to every other health issue. How did you get interested in that and how did you come to that conclusion?

ROSALIND CARTER, FORMER FIRST LADY: Well, I became interested in mental health issues campaigning for my husband for governor when I had so many people ask me what my husband would do for an emotionally disturbed child, a mentally ill relative. And so, as soon as he was elected, which was 1971, a very long time ago, he established the Governor's Commission to Improve Services to the Mentally and Emotionally Handicapped. That was the beginning of my education about mental health.

It's just that I've worked in that field ever since. And it's absolutely true that mental illnesses, all other illnesses are effected by mental illnesses. Mental illnesses effect one in five people in our country at any, in any year. And if you have heart disease, for instance, and depression, that is a really terrible situation. And, with any kind of illness, if you are also suffering from depression or anxiety it just makes those illnesses worse. Plus, depression is a risk for heart disease, for cancer, all other kinds of illnesses.

I've worked, as I said, in this area since, about 30 years. And I think we're just beginning to realize as a nation that mental health is absolutely essential to our overall health and well being.

DOWNS: Yet we've always lagged behind in realizing the magnitude of the problem, it seems, and I can understand your interest then in education. How do you approach your campaign to get people to understand more about it?

CARTER: Well, I have a really good mental health program here at the Carter Center and we work on stigma. The stigma is still pervasive. It's really an exciting time in the mental health community because of research and the new knowledge about the brain. Mental illnesses can now be diagnosed, they can be treated and the overwhelming majority of people with mental illness can lead normal lives, living at home, working, going to school, being productive citizens.

People don't know that and so many -- the stigma is still so pervasive, it keeps people from going for help. They don't want to be labeled mentally ill. We have to overcome that. I have different initiatives. One is educating -- I have fellowships for journalists, trying to develop a cadre of journalists that can -- that know the issues and can report accurately about them instead of sensationally.

You can work and work and work on stigma and then have some incident where the headline is a bad headline about someone mentally ill maybe doing something, creating a difficult situation, it just destroys everything we're working on. So, we're excited about the fellowships for journalists.

We work continuously to educate the public about these issues. I go on television programs like this as much as I can. We write articles. We have -- the journalists have written, we've had so many newspaper articles and television spots. One of our journalists was the director of "Consumer Reports" on TV. We just try everything we can to educate people, let them know the real facts, that mental illnesses are biological like any other illnesses and there should be no distinction between physical -- mental illness and other illnesses.

DOWNS: Are you hopeful that...

CARTER: One thing that we're working on...

DOWNS: I just wonder, are you hopeful that inroads will be made?

CARTER: Am I hopeful? Yes. I am hopeful. Things like, we just had the first Surgeon General's report on, that dealt exclusively with mental health issues, introducing it as a public health issue, which it is. We have the Healthy People 2010. This conference, the Morehouse School of Medicine Conference, which is co-sponsored by the Carter Center and CDC and other organizations, is another way that we are focusing and making mental health a real issue and I really believe that we're beginning to make a little dent in stigma, but it's still distressing for people who have mental illnesses.

DR. LOUIS SULLIVAN, FORMER SECRETARY OF THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES: Hugh, if I might get to Mrs. Carter's comments...

DOWNS: Sure.

SULLIVAN: The fact is, we have a number of effective strategies or treatments now for a whole variety of mental illnesses that we didn't have years ago. So, there's all the more reason to remove the stigma, as Mrs. Carter mentioned, because we want people who are effected to come forward so they can be treated, so their lives will be better. So, that clearly is outlined in the Surgeon General's report, as well as the need to see that mental health issues are covered by health insurance programs as well, which is one of the other issues that we have increasing interest around.

DR. MARILYN GASTON, FORMER ASSISTANT SURGEON GENERAL: And, Hugh, I would like to add too that we're very excited at the response to the release of the Surgeon General's report by Dr. David Satcher. This report has really galvanized communities across the nation around mental health, and that is a major change in what we've seen in the past.

As Mrs. Carter says, it's helping to get the word out, to educate people, and we're seeing states take this report and begin to form their own plans of action around mental health. And so, all this is very hopeful.

DOWNS: We're going to be back in just a moment and continue with other points of health that are being covered by the conference in Atlanta. Be right back.

(COMMERCIAL BREAK)

DOWNS: Dr. Louis Sullivan had one of the longest tenures as the head of HHS of anybody, I think it was about 47 months, and he was the Secretary then of HHR under the Bush administration, that is the first Bush administration.

And Dr. Sullivan, I just want to ask you -- we're going to come back to mental health, also, but it's one of ten health indicators that you're covering there in the conference. What do you think might be -- we know, sort of, what is the heaviest killer in our country, and that's tobacco use. But that, and substance abuse, do you regard those as some of the heaviest of the issues in health indicators?

SULLIVAN: Yes, they are major issues. The fact is, of around two million deaths that occur in the United States every year, about 750,000 of those are related to conditions where tobacco is involved, such as heart disease, lung cancer, emphysema and other diseases. So that if there were one thing that we could do that would have the greatest public health impact, that would be to eliminate tobacco use. Clearly, this has a very devastating effect.

We also have about 100,000 people who are effected by drug abuse every year and also by alcohol abuse, those self-inflicted wounds that we must address. And here again, therapies are available for people who are effected by those. So, the whole thrust of Healthy People 2000 is to emphasize the need for greater health promotion, disease prevention strategies to keep people healthy, to minimize the likelihood of disease, to give us a better quality of life and to enhance our life.

I point out that during the 20th century, life expectancy increased from 47 years in 1900 to now some 78 years of life expectancy. That's due to advances in public health such as safe drinking water, nutritious food, immunizations, as well as advances in medical care and we know that we can continue this upward trend so that we'll have many greater benefits a hundred years from today. But that has to come about by our citizens being informed about those things that they can do and, indeed, they must do to enhance and prolong their health.

DOWNS: Do you think, Dr. Sullivan, that the citizen information will help with the -- a new study that I saw said that confirmed smokers who really are addicted to nicotine, I had thought maybe along with others that there was a matter of a lack of willpower or that they didn't understand the dangers. And this study said that a very, very high percentage of them really want to quit, but that the nicotine is so addictive that they just can't. Will information help in that?

SULLIVAN: Well, information will help some, but you are absolutely right that nicotine is a very strong addicting substance and on a weight basis it is one of the most addicting substances that we know. And that's why the greatest emphasis has to be on prevention.

In this country, every day, 3,000 teenagers begin smoking for the first time and we know that if a young person reaches the age of 21 not having smoked, the likelihood of that individual beginning to use tobacco is minimal. So, we have to focus on better strategies to get this information out to teenagers, because so often teenagers are busy with other things, getting on with their lives, they don't think this effects them. They think they can try this and then stop it at any time and unfortunately, too many of them become addicted being seduced by the images that have been put forth of tobacco smoking being glamorous, sophisticated, etcetera. The absolutely wrong image.

So, that's why the great emphasis on prevention, because once you are addicted it is very difficult to break that. Many adults do want to stop and try over and over again. But some of them do succeed, but that is a great challenge.

DOWNS: Does the percentage of those who succeed in stopping, which I understand is low, is that offset by the number through peer pressure and what else starts smoking and can we stop that, do you think?

SULLIVAN: Well, yes, we know by educational methods we can reduce the rate of tobacco use, because in 1964, when the first Surgeon General's report was published, pointing out for the first time that smoking was related to lung cancer, causes lung cancer, 47 percent of American's smoked at that time.

There have been a number of Surgeon General's reports since that time, giving more information, emphasizing that, so now about 25 percent of American's smoke, roughly half the percentage of our population. However, I maintain that 25 percent of our population smoking is too many. And particularly when tobacco use is the number one preventable cause of death in our society.

And not only death, but disability. People who are impaired by emphysema, by heart disease, by chronic cancer, etcetera. So, indeed, the emphasis must be on prevention and that is what Healthy People 2010 is all about, and that's what the conference that is being sponsored here at the Carter Center, with Morehouse School of Medicine and the Center for Disease Control, and other organizations, that's what this conference is all about. With some 350 primary care physicians from all over the Southeast here attending the conference to learn more about strategies to get the word out on health promotion, disease prevention.

DOWNS: We're going to come back in a moment and hear from Dr. Gaston and cover some of the other health indicators that we've talked about.

(COMMERCIAL BREAK)

DOWNS: Just to review briefly, among the ten health indicators covered by this conference in Atlanta, physical activity, weight and obesity, we talked about tobacco use and substance abuse, responsible sexual behavior and, of course, mental health, being an extremely important one, injury and violence, environmental quality, immunization and access to health care. These are not all medical, some are social, but they all tie in with the health of the nation.

I want to ask Dr. Gaston, on such matters as access to health care, is that -- do we have a problem there? We do have a problem with universally, universal ability to get access to health care. Is any of that racial? Because I've read some stories that make me think that.

GASTON: Well, let me start out by saying, first of all, you're absolutely right. We do have a major problem in this country in terms of our American citizens getting access to care.

All of you know the numbers of, it used to be 45 million people were uninsured in the country. It is coming down, thank goodness, there are now 43 million, and we think that's due to the fact that our children, thanks to the State Child Health Insurance Program has kicked in. Our children are now getting insured, but think of that. 43 million people in the country that do not have any kind of health insurance. And that's a major barrier to them getting access to care. So, they have to use emergency rooms, which is not quality care. There is no prevention going on. They're not getting diagnosed early enough. They're not getting treated early enough. And so the death rate is higher in that group.

I want you to hear another number, though. There are upwards of 48 million people that, even if they did have an insurance card, would still have great difficulty getting access to care.

DOWNS: Why is that?

GASTON: Because of other barriers. Well, there's not an adequate infrastructure of, in our health care system, of primary care providers across the country. So, there are some places in the country where someone might have to travel 200 miles to get some health care. So, there are major geographic barriers. There are language barriers. There are cultural barriers. There are attitudinal barriers. So that we could go on and on.

So, it's very difficult for people to access primary care in the country. Our minority populations do suffer disproportionately in this. Most, many of them are uninsured. Many of them cannot find culturally competent care. They face other barriers that relate to poverty, that relate to many other things, that really do not help them to access services. And so, their health is worse. This plays a major role in their health outcomes.

DOWNS: For the whole nation, we know that sexually transmitted diseases are a big bug-bear still. What will help with that, increase sexually responsible behavior?

GASTON: Again, education is key. And I guess if there's one thing you've heard all of us say, it's certainly education.

Another thing you've heard us say is getting to our children as young as we can. That's a key. In terms of helping them to develop habits of health. There is a point that I really want to make for our viewing audience and I think it's important. Health and wellness does not merely mean the absence of disease but it really means an integration of mind, body and spirit. It means a process. It means a way of life, of staying healthy. It means developing habits of health, and we have to start very early with our children in doing that.

And so all of these indicators -- for instance, if we take physical activity, I think is mentioned first. Dr. Sullivan mentioned that smoking is the number one preventable cause of death in the country. Inactivity is the number two preventable cause of death. And so to start early with our children around physical exercise, and it concerns us when schools, when the budgets get tight, that physical ed. might be something that they cut out, and that's very disturbing, because exercise and developing that habit of health in that arena is absolutely critical to preventing heart disease, to preventing diabetes, to preventing cancers, etcetera. To controlling stress an depression.

DOWNS: We'll be covering these things with all of our ...

SULLIVAN: Hugh, if I could add ...

DOWNS: Oh, yeah, go ahead. We're going to take a break and then ...

SULLIVAN: Yes, right. I ...

DOWNS: Go ahead.

SULLIVAN: Yes, Hugh. I simply wanted to reinforce Dr. Gaston's comments, to say that the, we as a nation spend more dollars on our health care system than any other on earth, and that's by far. Sometimes twice as much per capita as other Western nations. And we have the most advanced and sophisticated biomedical research enterprise of any nation on earth. Half of the Nobel prizes in medicine during the 20th century came to scientists in American laboratories.

So, we have, really, a very sophisticated system, but what we have is a distribution problem. We have not developed the political well and the public consensus to ensure that all of our citizens have access to the benefits of those discoveries coming out of our laboratories.

It's ironic that we have people coming from around the world to America to get care that is not available in their own countries, because we have this technology. We have the trained personnel. But we have not worked to be sure that this is distributed widely, and that 45 million Americans who are uninsured, that occurred during the 90's, during this 10-year period of tremendous economic expansion. So, it's not a question of money. It's a question of political will. And that's what we really want to engage the public about, so that we can somehow find the mechanism to see that everyone benefits from what our health care system has to offer.

DOWNS: We'll now take a break and be right back. Thank you.

(COMMERCIAL BREAK)

DOWNS: I want to return, for a moment, to mental health as a health indicator. Mrs. Carter, you have said that you feel it's important for people who have had experience with mental health to speak out about it. How will that help?

CARTER: Well, if somebody who has had a mental illness talks about it openly, it hopefully encourages other people who have a mental illness to admit that they have and to feel comfortable with going for help.

I think it's really important. It's really important for people who are role models or people who are famous, as movie stars and so forth, if they have had a mental illness to speak out about it, because it just makes it OK for others to admit to having a mental illness. So many people don't go for help because of the stigma. DOWNS: Right. And sometimes people of high visibility do talk about their alcohol problems or drug problems, and if they did that with mental illness, you think that would be a plus.

CARTER: That's right.

DOWNS: I wanted to ask you, also, in your own life and community, have you ever been effected by mental illness at all?

CARTER: No, just, but some very close friends, distant family members, have been mentally ill. I've been around people with mental illness for so much now, because I've been working in the field for three decades as you said, a very long time. And it's an exciting time, as I said, in the mental health field.

But also, we've been talking about tobacco and different bad habits, and lots of times this is the way people with depression mask their depression. They turn to alcoholism or to substance abuse or bad habits. And if you have noticed, during the conversation, our health, our good health, to a large extent depends on our personal habits. The things that we choose to do. Whether we exercise or eat right and so forth. So we can determine our good health to a large extent.

DOWNS: We're going to come back in just a moment. Stay with us.

(COMMERCIAL BREAK)

DOWNS: Three things we haven't covered in those health indicators are the problem of weight, obesity; injury and violence; and environmental quality. All important health factors.

Let me ask any of the guest, what do you think of those might be the most pressing at the moment?

SULLIVAN: Well, Hugh, if I might begin, they're all significant because they are influenced by our individual health behavior or health habits. Dr. Gaston mentioned the lack of physical activity. Well, the fact is 30 percent of our citizens have a regular program of physical activity, and that includes teenagers. Well, that means 70 percent do not and we have now in the United States today the highest incidence of obesity that we've ever had.

We also have a rising incidence of diabetes. Those are related, because individuals who are overweight, if they have a tendency to develop diabetes, being overweight brings that out. If you are overweight, you are more likely to have a heart attack or high blood pressure.

So, many of these things are related and one of the messages I would like to emphasize is this, we need to be sure we have a very good health care system distributed around, but that's only part of the answer. The rest of the answer has to be the individual responsibility that persons take to protect and enhance their health and that of their families by their health habits; by not smoking by exercising, by getting annual regular checkups; seeing their children are immunized against communicable diseases. So, all of those things which your health professional cannot do if you don't present yourself and if you don't do those things to keep yourself health.

So, going forward, it really has to be a partnership between the health care system or health professionals and our citizens in general to really enhance the health status in our population.

DOWNS: You mentioned immunization...

GASTON: If I might add...

DOWNS: Yeah, go ahead, Mrs. Carter.

GASTON: I was just going to add, to enhance what Dr. Sullivan just said, when he said that there's a lot that we can do in our own individual lives. A few years back, a study released some data that showed if you look at determinants of health, if you look at medical care, if you look at genetics, if you look at environment, and you looked at lifestyle, 50 percent of our determinants of health rest in our lifestyle.

And I think that's very compelling information for us. And, you know, we know it's hard. We're all dealing with something that we need to change. I hope that everyone listening understands that there are certain risks factors for various disease; for heart disease, smoking, inactivity, high cholesterol, etcetera, and that we're looking at our own risk factors to try to deal with. But I hope, also, that we understand that whether we have risk factors or not, that we, every day, every day, we should be looking at, again, getting back to our habits of health, what are we doing to not only stay healthy, enhance our health, but to also prevent disease.

DOWNS: A good point.

SULLIVAN: Also, just, Hugh, if we can just stay on that theme for a second, let me point out that studies have now documented that people who are physically active for 30 minutes or more three times or more a week have a lower incidence of heart attack, stroke, diabetes, they live longer, they are less likely to develop osteoporosis or softening of the bones, etcetera. So, in other words, there's a lot that we can do, as Dr. Gaston mentioned, to enhance and protect our health. And that really is something that our citizens really must take to heart because we want to have both advantages; the advantages of a well trained health professional group and facilities, but we'd like to minimize the need for them or the use of them by our citizens improving their health habits. And that's what Healthy People 2010 is all about.

DOWNS: You mentioned immunization ...

GASTON: And also, we ...

DOWNS: ... a little earlier. Did, is -- what's the problem with there -- the vaccines exist. Why is immunization a problem in our country? CARTER: Hugh, this is an issue that I've worked on since my husband was governor, too, on immunization. And we have the highest immunization rates in our country today that have ever been. And I have a program called Every Child By Two, trying to get babies immunized, because if there's an epidemic it's usually the little ones or even those in high school who have not had their booster shots, have not kept up with their immunizations, but even the incidence -- even the immunization of babies under the age of two -- two is the appropriate age for having the immunizations.

One of the problems is there are so many immunizations today, it's hard for parents to keep up with them. They depend on the provider, and sometimes the provider doesn't pay the attention they should to immunizations.

DOWNS: So, it's fairly a logistic problem, I suppose.

CARTER: That's right. That's right.

SULLIVAN: And it's also one of those areas where, because of our success, in a sense, that parents today are not as aware of the dangers of childhood communicable disease as they were perhaps four or five decades ago. But I'll remind you that when I went to Washington as Secretary in 1989, we were into the second or third year of outbreaks of measles, whooping cough, and other communicable diseases around the country. And a number of children died from those because parents had not been aware of the need for immunizations and because they weren't seeing children with these conditions, really, were not taking their children in for immunization.

We have another problem also I'd like to address, and that is misinformation ...

DOWNS: We need to take a break right now, Dr. Sullivan. We'll take a break and come back.

(COMMERCIAL BREAK)

DOWNS: Dr. Sullivan, you were interrupted by a break and did you hold the thought? What were you going to say?

SULLIVAN: Oh, yes, right. And I know that Dr. Gaston wants to comment on this also, but the point I was about to make is this: there, unfortunately, is a lot of misinformation that is being distributed that is frightening parents inappropriately and incorrectly and is doing great harm, and that is the theory that autism or other conditions are caused by a reaction to vaccines.

This is absolutely false. There have been a number of studies trying to follow these rumors, and none of them have panned out. So, I simply want to say to our parents of children that the best thing they can do for their child is to be sure that they get the full range of immunizations so that they are well protected. And I know Dr. Gaston wanted to make some other comments.

GASTON: I wanted to mention that the epidemic he mentioned, the measles back in the early '90's, we did learn some things from that. The good news is, we learned that once the nation, and the nation did get outraged about that, and once we really got concerned and everyone got committed to changes the stats in terms of getting our children immunized, and everybody came and put some, beared some weight on this issue, not just the health care profession, but the schools, the day care centers, every place that children were. They all pulled together to get the kids immunized, and it worked.

And I think this is an important lesson for us in any of these things that we want to tackle, any of the public health problems. That when the whole community gets behind it, we really begin to see a difference in the outcomes.

DOWNS: Sure, sure. We did have a problem too...

(CROSSTALK)

GASTON: That's right. See, there you are.

DOWNS: And we had a problem for a long time in this country, I think, with an attitude toward measles and it wasn't much of a big deal. We even had the word measly. But measles is a pretty serious disease, isn't it, for a little child?

GASTON: Absolutely.

SULLIVAN: Oh, yes. Hugh, I visited cities when I was Secretary. Dallas, Philadelphia, Fresno, California, San Diego, those cities and others actually had deaths of children from measles, encephalitis and pneumonia, etc. This is not a harmless condition. In most instances, the children recover. But, indeed, there are enough incidents like that that really show us the value of having your child immunized.

GASTON: You know, this also gets back to the access to care problem, that a lot of our children have difficulty getting immunized because they face all those barriers that I was talking about before.

DOWNS: Yes.

GASTON: So, again, as a country we have to focus on getting a better infrastructure in terms of our health care system.

DOWNS: A big problem that is medical, but it doesn't have -- it has it's roots elsewhere, is injury and violence. And this is becoming, as we know from the sad news we've been hearing, very big in our country now.

What is the conference considering doing about this big problem? Anybody want to pick that up?

SULLIVAN: Well, Hugh, injury of course can be, it really covers a whole range of things, ranging from automobile accidents where people are not wearing seatbelts and are injured or killed when a seatbelt would have saved their life, to falls in the home, where indeed a number of injuries and deaths occur there. And then violence that occur as a result of conflict. There are a number of programs, particularly focusing on teenagers and young adults, really teaching them how to deal with conflict, how to resolve conflict by negotiation rather than feeling that conflict has to lead to violence.

A program in Boston has been successful there and we need to do more of those things. But clearly, deaths from violence are significant. They are among the top ten causes of death of Americans today.

DOWNS: Terrific. We're going to take another break at the moment. We will be right back and maybe cover a little bit about the problem of weight.

(COMMERCIAL BREAK)

DOWNS: Let me ask Mrs. Carter, one of the ten health indicators has to do with responsible sexual behavior. What can be done about -- that's one of the powerful drives there is in human beings and what plans does the conference have for mitigating some of the harmful effects of irresponsible sexual behavior?

CARTER: Well, I think the key is education, as has been said earlier, but Dr. Sullivan will have to tell you what the conference plans to do about that. But one thing that I wanted to talk about is that one of the goals of Healthy People 2010 and of this conference is eliminating disparities in health care and there are disparities in health care, in all areas of health care.

In mental health, for instance, minorities have a hard time accessing mental health care, appropriate mental health care, in their communities. And also we have to be sure that the services are there, but also the services have to be acceptable. People have to want to access care and the African American community, I know, it's very difficult -- people in that community don't want to admit that they have mental health problems, and that's one area we've been focusing on here at the Carter Center, trying to educate people and the minority population that mental health issues effect all American's and that care is so important and that they should want to access care.

Whether or not their able to is another thing that is really important, and Dr. Sullivan might have some ideas about that.

SULLIVAN: Yes. Certainly, we want to be sure that our citizens know that there are therapies that are available for mental health today that were not available one or two decades ago. And I liken the attitude that we have now in some parts of our community of the stigma of mental health problems to what existed, again, perhaps a number of decades ago, about cancer.

When I was growing up, people spoke of cancer in whispered terms. There was a stigma about this condition. Well, we've come a long way and fortunately, as part of our efforts to address the cancer problems and to bring therapies forward there, this is really now talked about very easily. We need to do the same with mental health, and clearly the work that Mrs. Carter is doing with her colleagues, It think, will help. GASTON: If I might just add, too, that we now know there are programs across the country that are putting mental health clinicians in schools. In those places where children are exposed to issues of mental health, they talk about it, they are in touch with clinicians, they're part of the school, just like the teachers are, there is no stigma, and we see this as a major strategy to really eliminating over time the stigma that we see in the country.

DOWNS: Very good. We're going to take a break and be right back and discuss the remains issues of the conference.

(COMMERCIAL BREAK)

DOWNS: Dr. Gaston, I want to ask you what can be done to putdown on the disparity of health care access. I understand there is a racial problem, and if two patients of equal socioeconomic status are admitted to the hospital, one is likely to get better care than the other. In other words, say a white man and a black man. What can be done about that, to reduce that or eliminate it?

GASTON: OK. There are a lot of things going on now, and again, it gets back to the education of our providers. It gets back to changing the system the way it is. We do know, it has been documented, that care may be different when it comes to how aggressively a black woman, especially, might get worked up in terms of heart disease, because there's still the belief that women don't have heart disease, all women don't have heart disease at the rate that men do. And then if it's a black woman, they're worked up even less aggressively.

SULLIVAN: Can I just interrupt, Dr. Gaston. Of course, Dr. Gaston and I know that doctors, when she says worked up, means diagnostic evaluation. But the other thing that I think our audience should know that Dr. Gaston is the author of a book called "Prime Time", I believe, that is focusing on black, the health of black women that really is focusing on this issue.

GASTON: Yes.

CARTER: And, Hugh, one thing that is so needed today is for primary care providers to recognize mental illnesses. They don't recognize mental illnesses and this conference is made up of health care providers, and so, since mental health is one of the indicators, that's one of the things that I'm going to be speaking to them about, because it's so necessary. So many of these illnesses are mental health illnesses. And people go to the doctor and go to the doctor and they're not recognized and the suffering continues.

GASTON: Mrs. Carter, I'm so pleased you brought that up...

DOWNS: What do you think the health of the nation would be like -- I just wonder what you, the three of you, think that the health of the nation would be like if we really got a handle on mental illness and began to be open about it and treat all people who need it.

CARTER: I think it would make a total difference. In fact, we've been working for parity in insurance, and I think parity could help with stigma more than anything, because if insurance covers a disease, then I think it's alright, people think it's alright to have it. And so, there's so many things that we can do. But I think it would make a total difference if we recognized mental illnesses. If everybody who thought they were mentally ill or was having problems went for care and primary care doctors recognized mental illnesses, I just think it would make a total difference because, as I said earlier, mental illnesses effect all of the other major health care problems.

SULLIVAN: I would add, Hugh, that the disparity that Mrs. Carter spoke about in mental illness really applies to the other illnesses as well. And in 1985, Secretary Margaret Heckler then at Health and Human Services, released a report on black and minority health, saying that there were some 73,000 excess deaths in the country every year because of the disparity in health status. That's because African Americans, for example, live six to eight years less than whites. Or infant mortalities rates are twice as high.

So, if we could get this information out, if we could have a system that serves everyone well, this would boost the health status of America overall tremendously, to have great humanitarian impact as well as billions of dollars would be saved because we would have a healthier population.

GASTON: I might add too that ...

DOWNS: How long will the conference go on? Go ahead.

GASTON: The disparities that we see are not just between our minorities and our non-minorities either. We see disparities in health outcomes, poor health outcomes in our poor white communities. There are disparities between our genders, between male and females. There's a difference in life expectancy, as many know. So that the disparities are found across many different categories.

DOWNS: And one last thing, what do you think, when the conference comes to an end, what do you think will be the result? How much progress do you think you will have made? Anybody?

SULLIVAN: I think we'll have, yes, I think we'll have a group of physicians who will have a better focus on what the problems are and an array of strategies that they can take back to their communities and implement, there so varied by the individual circumstances of the health care provider, but whether it is mental health, infant mortality, immunizations, health insurance, etcetera, what this is intended to be is a working conference, because we will have this as an annual event here at the Morehouse School of Medicine working with our partners out here.

DOWNS: Thank you. I want to thank all of you. Dr. Gaston, Dr. Sullivan, and Mrs. Carter. That is our program for tonight. We hope that you've learned something. I have.

I'm Hugh Downs, sitting in for Larry King in Los Angeles. Thank you all for joining us. Larry will be back tomorrow night. Good night, everyone.

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