Americans today are taking a more active interest in their health than ever before. They are coming to realize the influence that they, themselves, can have on their own health destinies and on the overall health status of the Nation.

It wasn't always thus. Until fairly recently, we Americans gave little thought to health as a positive concept. The past 15 years or so, however, have witnessed important changes in our thinking about the protection and enhancement of personal health. Three of those changes are of great importance for the well-being of our people as we move into the final decade of this century.

First, personal responsibility, which is to say responsible and enlightened behavior by each and every individual, truly is the key to good health. Evidence of this still-evolving perspective abounds in our concern about the dangers of smoking and the abuse of alcohol and drugs; in the emphasis that we are placing on physical and emotional fitness; in our growing interest in good nutritional practices; and in our concern about the quality of our environment. We have become, in a word, increasingly health-conscious, increasingly appreciative of the extent to which our physical and emotional well-being is dependent upon measures that only we, ourselves, can affect.

We can control our health destinies in significant ways, then, but if we are to realize, fully, the benefits of assuming that control, and this is the second of the three points I would make, we must find the means of extending the benefits of good health to the most vulnerable among us.

The correlation between poor health and lower socioeconomic status has been well documented, but that does not make it right or inevitable. Good health should not be seen, or, for that matter, be permitted to exist in fact, as a benefit for only those who can afford it; it should be available and accessible to every citizen.

Medical care, alone, will not eliminate the devastating impact of chronic disease on the disadvantaged, nor will it reduce, as much as we would like, the rate of infant mortality or the burden of homicide and violence or any of the other "health" problems that are borne by the poor in our society. If we are to extend the benefits of good health to all our people, it is crucial that we build in our most vulnerable populations what I have called a "culture of character," which is to say a culture, or a way of thinking and being, that actively promote responsible behavior and the adoption of lifestyles that are maximally conducive to good health. This is "prevention" in the broadest sense. It is also an absolute necessity. Both because we are a humane and caring society and because, if we are to remain a vital society, we cannot afford to waste human resources. Good health must be an equal opportunity, available to all Americans.

Finally, health promotion and disease prevention comprise perhaps our best opportunity to reduce the ever-increasing portion of our resources that we spend to treat preventable illness and functional impairment. Smoking, for example, is the single most preventable cause of death and illness in this country. Smoking-related illnesses cost our health care system more than $65 billion annually.

AIDS is an almost entirely preventable disease. The cost of caring for a person with AIDS for his or her lifetime is, today, about $75,000. The annual cost of treating all diagnosed AIDS patients, about $4.3 billion this year, could climb as high as $13 billion by 1992, the Public Health Service estimates.

The yearly cost of treating alcohol and drug abuse is at least $16 billion. The total economic impact of alcohol and drug abuse, including not only treatment but premature death, accidents, crime, and lost productivity, is more than $110 billion annually.

We would be terribly remiss if we did not seize the opportunity presented by health promotion and disease prevention to dramatically cut health-care costs, to prevent the premature onset of disease and disability, and to help all Americans achieve healthier, more productive lives.

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