ASCD is honored to have former U.S. Surgeon General, Dr. M. Joycelyn Elders, present the keynote address at our 57th Annual Conference and Exhibit Show. Dr. Elders is the first African-American woman to hold the post of U.S. Surgeon General. As a Doctor of Pediatric Endocrinology, continues to speak on behalf of children and the less fortunate, as well as advocating for an approach to medical practice that emphasizes education and prevention.

ASCD PRESIDENT KAY MUSGROVE: Dr. Elders, the eldest of eight children, is the first African-American woman to hold the post of U.S. Surgeon General. Though she never saw a doctor prior to her first year in college, she has become a renowned professor of pediatrics and a board certified pediatric endocrinologist. Joycelyn Elders is a passionate and formidable advocate for children - especially for their need for comprehensive health education and health care. During her confirmation hearings in 1993, Dr. Elders stated, "I want to change the way we think about health by putting prevention first. I want to change. I want to be the voice and the vision of the poor and the powerless. I want to change concern about social problems that affect health into commitment.

ASCD has long acknowledged the important relationship between health and academic success in children. Through positions, reports, and initiatives such as the ASCD Health in Education Initiative, funded by the Robert Wood Johnson Foundation, the ASCD has promoted health as a basic aspect of student success. We thank the Robert Wood Johnson Foundation for working with us and for sponsoring our opening keynote address this morning. It is with great pleasure and a sense of anticipation that I welcome Dr. Joycelyn Elders to the ASCD conference.

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DR. ELDERS: Thank you very much. I'd certainly like to thank President Kay Musgrove for that elegant introduction and thank the Program Committee of the Association for Supervision and Curriculum Development for inviting me to be a part of your 57th Annual Convention. I want to thank each and every one of you who serve each and every day to develop curriculum for the 15,000 school districts, 110,000 schools across the country serving young people - age-appropriate, structured, challenging, and progressive - with the ultimate aim of preparing bright young people to take their place at the leadership table in this new millennium. We all want them to grow up healthy, educated, motivated, and to have hope for the future. You know you can't educate them if they aren't healthy - and we can't keep them healthy if they aren't educated. Because they'll find a way. Every day in America more than 50 million bright young people leave their homes - some poor homes, some rich homes, some even no homes, some from educated families, some from less well-educated families - to show up at that "temple of betterment" that we call school to prepare to take their place in this new millennium.

They come to us like a sponge and we must ensure that they leave with four things: We want them to leave with that voice in the ear that can hear all of those less fortunate so that they can have compassion. We want them to leave with a vision in their eye that extends much farther than the eye can see. We want them to have a scroll in their hand, which is a good education, and a song in their heart to carry them through when things get tough, as we know they will.

Many of our bright young people graduate from high school with diplomas they can't read, shoes that light up when they walk, and a brain that goes dead when they talk. We need a way to reach all of them. We've got to find a way to reach all of those powerless children who are in need of powerful friends like you. They make up only 20 percent of our population, but 100 percent of our future. I've frankly been very concerned about young people because I want them to take good care of me when I'm 85. I'm selfish in my motives. [LAUGHTER AND APPLAUSE]. We are a throwaway society. Everything is disposable, even our children. We're recycling cans, newspapers, white office paper, and even our children are sent to those disposable landfills that we call the streets and prison. Our children are in an ocean, surrounded by the sharks of violence, drugs, alcohol, suicide. We are sitting on the beach, sipping from our fountains of "Just Say No" - morally right while our children are in the ocean drowning. We have got to get in our canoes and move on out there so we can save them if we want to make a difference. That's what you've been doing.

The future of our society is dependent on the investment we make today. We deal with families where they are. You can't say you support children if you don't support families. Many of our families are suffering greatly. Many of them are having a hard time providing the essentials - food, clothing, and shelter. Many of them need assistance with parenting skills. We complain about all the problems children are having, but we've never taught parents how to parent. They are doing the best they can, but they often just don't know how. We've got to find a way to center our schools, center our communities around the family. My kids are always saying I talk about the "good old days," and while there are some bad things about the good old days, there are a few good things about the good old days. One of the good things is that life was very community-centered. Every body in the community was your parent - or at least they thought they had the right to correct you and you thought that, too. The last thing they wanted to do was to have to tell your parents that you did something wrong. At least that was the way it was in my hometown and most others I knew of at the time. We've got to find a way to get back to that. It used to be that 60-70 percent of families had a child in school; now only 23 percent of families have children in school. So we have to define other ways of getting a greater commitment to support our schools. We've got to get some new advocates. It used be that we could depend on parents. But we've got to find a way somehow to go and wake up the sleeping giant out there. The sleeping giant is our parent, because they can get whatever we need done. But we need to educate them and teach them how to be responsible for schools.

We've got to use schools to build bridges - bridges over a lot of our "isms," such as racism, sexism, homophobism. We all walk around with a lot of "isms" on our backs. But schools are to help us learn to deal with that. We've got to teach young people to think out of the box. Somehow we feel we do the same old thing in the same old way and we're going to get different results. We're surprised when we get the same results. We've got to find a way.

The demographics of schools are changing. We're having increasing numbers of minority students. Our population is aging. We've gone from 4 percent of the population in over 65 to now we're 15-18 percent of our population being over 65. The number of our citizens younger than age 20 is below 30 percent for the first time. In 1993, there were more people over 65 than there were teenagers. In 1940, ten people worked to pay my retirement. In 1985 it was 5.3 people. In the year 2000, it was 4.7. By the year 2030, it is projected to be 2.7.

I say we don't have any children to waste. We have to make sure that they're all educated, motivated, and do the best they can, because we want them all to able to do a god job and we've got to get rid some of these things that are causing a great big business. We've got to reduce our prison population. Uncle Sam is the world's fattest jailer. Since 1980 we've spent more money on prisons than we spend on schools. We pay the average prison guard, who has less than a high school education, $57,000 a year. It costs $35,000 a year to keep each prisoner in prison. We pay these prison guards more than we pay teachers with a master's degree. There is something wrong with that. I'm saying we should stand up and be mad about it. We should stand up and fight about it. We hear about the increased numbers of youngsters at risk. We need to invest in the only institution we've got, other than the family, which can really make a difference. That's the school. The schools belong to us. They belong to the community, and it has been shown that they can be effective in decreasing many of the risks.

The school has had a responsibility for health since the educational reform back in 1918 - and health was rated input number one. So we have a lot of unfinished business we have to do if we are going to make a real difference. Our schools no longer have the luxury of just teaching the Three R's - reading, writing, and arithmetic. We also have to deal with teaching responsibility. We've got to make sure that our schools are safe places and all children enter school ready to learn. I know this mass of educators in the audience know that all children do not enter your schools ready to learn. In fact, only 35 percent of children in America enter school ready to learn. Seventy-seven percent of poor children enter school not ready to learn. This is something that we can do something about. This is an unfinished agenda that we've got to finish if we are going to make a difference. School health education has never received the appropriate emphasis from curriculum planners, but it's most important in what goes on in a community.

If we want to save our society, as we know it, we have to deal with the Three P's. The Three P's are Poverty, Population, and Pollution. We know that children born to children who have not finished high school and are unmarried have a 90 percent likelihood of being poor. From 1970 until now, we have gone from one in seven children being poor to one in four in the year 2000 - to one -in three if they are Hispanic and one -in two if they are African American.

Children who are poor will only be members of one club in their life. It's called the Five-H Club. Children who are members of the Five-H Club are Hungry. Every night in the richest country in the world - 25 percent of the wealth of the world, 5 percent of the world population - and we still have 5 to 8 million children go to bed hungry. Out of the 50 million children who go to school every day, 25 percent of them get free or reduced school lunch. That's a problem. We have children who are Healthless, who have no access to health care. There are 44 million Americans who have no health insurance, but a third of those are children. Medicaid was initially created to provide health care for poor children. Today, 84 percent of Medicaid goes to pay for my daddy to be in the nursing home. I'm not complaining about that, but we act like Medicaid is for poor children and poor children get very little of it. We need to be upset about that. Then they developed the Children's' Health Insurance Program (CHIP), which was to pay for poor children who were not eligible for Medicaid. They put $10 billion into the program for the 25 million children who didn't have health insurance.

I want you to know that while somehow it's not being used and they have a bill in Congress now that makes me so mad that I can hardly talk about it. I say mad because I live mad! [LAUGHTER ANDAPPLAUSE]. While we won't pay to provide health and education for born children, Congress wants to take part of the 10 billion dollars and put it in a fund for the unborn. What that does is cut off women's ability to have an abortion because this is a child now. So if you do an abortion, you kill the child. But they won't pay for health; they won't pay for education for poor children who are already here. That's why I'm saying that we love those children as long as they are in somebody else's uterus. We talk about providing health education and care for them. And I think that's our fault. We if don't stand up and fight for children, who will? Parents don't stand up for them because they don't know how. We know how. But we don't say anything because you can't stand up too often and take too many risks because you know what happens when you take too many risks. You don't have to take as many as I took, but you have to take a few sometimes. [LAUGHTER AND APPLAUSE].

We have children who are Homeless. Every night in this rich country we have more than 100,000 children sleeping in parks, bus stops, and park benches. We have children who are Hugless. Children who find it easier to find drugs than find hugs, a good teacher, a god preacher, or a good home. Children who are Hopeless. We all know that when hope dies, moral decay can't be far behind. So we've got to address all those issues.

The other part of the unfinished agenda that we have sitting out here before us is all of those social and behavioral problems that are impacting the health of our young people. If we look at the cause of premature death, we find that 50 percent are social and behavioral. Twenty-eight percent is related to environmental causes. Twenty percent is genetic and only 10 percent is related to good doctoring. In fact, when we look at the cause of our increased life expectancy, which has expanded 30 years since January 1, 1900, most of it has been related to education. In fact, it is said that a health education teacher is worth two doctors, because they teach them to be healthy, they teach them to be responsible, they teach them how to make good decisions. They prevent them from smoking. It's said that if a school nurse can prevent one young man from getting involved in drugs or prevent one teenager from becoming pregnant, she saved that community and that school more she gets paid. But yet we keep doing the same thing.

We know that there are children involved in drinking. A third of high school students report binge drinking. More than 40 percent of college students. That's more than five drinks at one time. A beer is considered one drink, or five ounces of wine, or one ounce of whiskey. So we know that our children are out there drinking. Sixty percent of the accidents that are caused by teenagers are associated with alcohol. One out of every ten babies born in America have been exposed to illicit drugs. That to me represents a real problem. Seventy percent of the mortality and morbidity caused by our adolescents are in six categories: unintentional injury, which is homicide and suicide. We in America are the most violent country in the world: we have 284 million people, 211 million guns, 67 million handguns, and more than a million Uzi machine guns whose only purpose is to kill. Every day in America 135,000 children take guns to school. Every 11 minutes a young person commits suicide. Those are real problems.

We have problems with children killing children. The most common cause of death among young black men is black-on-black crime. In fact, our homicide among our young black men is 37 times that of any other country.

We have some 890,000 pregnancies - it used to over a million. Heaven knows I'm thrilled to death that it's going down. But it's not going down fast enough or far enough. I would like every child born in America to be planned and wanted. We spend a lot of time talking about classes for young teens on how to take care of their babies, but we can't teach young teens how to avoid becoming pregnant. We say we know how they get there so we just have to tell them to say no. But you have to tell them more than that. You have to tell them how to take care of themselves. It's not good enough to walk around and just because you've told them to say no that you've done your job. You haven't done your job. You've got a lot more to do. [APPLAUSE]. I tell the ministers all the time that it's not good enough just to moralize from the pulpit and preach to the choir. They have to get out on the streets and go to work. They have to deal with the problems that are out there.

We have a lot of diseases associated with tobacco use. Everyday 3,000 young people start smoking. We're getting fatter all the time. Sixty-one percent of Americans are overweight. Eighteen percent of our children are overweight. Yet we don't teach good nutrition in school and our free and reduced lunch is 37 percent fat. We could something about those kinds of things.

So we must have programs that help. We must use our schools to develop the kinds of skills that our young people will need to survive in this changing society. What do we need to do? What can schools do to improve the health of America? If I could give you just one word: education, education, education. We've got to educate our people on how to be healthy. We doctors have been intervening, but that's not good enough. We need to prevent the problem. We've got to start early. We've been doing too little, too late. Children are half as tall as they will ever be by the time they are three; they know half as much as they will ever know by the time they're four; hope, will, and drive has been determined by the time they're five. Yet we know that many of our children from poor families, less well-educated families, have spent the first five years of their life looking at everything on TV. In fact, we only give our children 35 hours of health education from kindergarten through 12th grade; 1,200 hours of reading, writing, and arithmetic; and 1,800 hours of TV. And everything is on TV. We have to start asking what else we can do.

We've got to make comprehensive - comprehensive - health education programs a part of our school systems. But the community says it can't afford it, we don't have the money. Have you ever gone to any community where they needed a new jail and they didn't pass the tax to build it? Communities won't pass a tax to support the schools, but they will always pass a tax to build a new jail. That should tell you something. The only people in America that have universal access to health care is the prison population.

I was talking to a group of lawyers once, and I said that every American should have a constitutional right to health care. They said, "Dr. Elders, who gave them that right? I thought about it for a minute and I said, "You lawyers feel that every criminal has a constitutional right to a lawyer - why shouldn't every sick child have a right to a doctor?" [APPLAUSE] It's because they lobbied for it, they fought for it, and they got it. Whereas we as parents, we as doctors - we're the problem. You as teachers. We didn't fight for the most valuable resource we'll ever have - our children.

When we start talking about comprehensive health education, people will say, "Well, if you tell them about sex, they'll do it." Well, they are already doing it. We need to educate and empower them so they can make good decisions. We decide that the street can teach them, the TV can teach them, the girly magazine can teach them, but we don't want the teacher to teach them. That makes absolutely no sense to me. And we pay for it very dearly. We pay for it by filling up jails. We pay for it by having an increase in the number of people on welfare. We pay for it by increasing the cost of childcare. These are things we can do better. We've got to improve our parenting skills. Educate parents on how to be parents. The only two things we don't have to have license to do is be a good citizen and be a good parent - and what's more important?

We've got to teach our young men to be more responsible. We've allowed many of our young men to walk around and donate sperm and feel that was equivalent to being a father. We've got to get them involved as part of the loop. We've got to make sure that our nation's goal for 2010 is that everybody will have primary preventive health care. Yet every year we find more and more people do not have health care when we could very easily provide primary preventive health care for all of our children at school. In fact, the governor of Vermont told me that they didn't have any money, but the only way they could get out of their hole was to provide health care for our children - so every child who lives in a family that makes less than $50,000 a year has health care costing less than $1,000 a year. He said that Vermont was paying $25,000 a year to keep people in prison. He said that since they began providing health care to children, the state's teen pregnancy has gone down 49 percent and child abuse had gone down by 49 percent.

I'm saying that we know what to do. It's a matter of our getting it done. We have to use all of our resources. Our business resources, our schools, our churches. We can't get so involved in what we can't do that we don't do what we can. We have to make sure that we all get involved. We have to make sure that all our citizens have health care as a right. We've got to develop some leadership strategies so we can bring about change. The most difficult "C-word" in the English language is "change." Every time we start thinking about change you hear, "The time is not right, the place is not right, the people are not right, the money is not right." And of course when they get real tired they say, "You're not right."

We've got to strengthen families so that they can provide better care for their children so we can begin to make a difference. How can we, as curriculum development specialists, how can we become the drum major for our community? How can we make sure that we're successful? How can we prevent the mortalities and morbidities that are happening to our young people? We have to care enough to share. You have the knowledge, you have the know-how, you have the skill. You have to make sure you get it done. We have to decide where we are, decide what we're going to do, and chart our course on how to get there. Care enough to share. There is an old Ebo saying, "Not to know is bad. Not to want to know is worse. Not to hope is unthinkable. Not to care is unforgivable."

You have to have the courage to bring about change. To learn to communicate, cooperate, collaborate, from partnerships with other organizations. If we have fewer and fewer parents who have children in school, we in the community, in the medical community, the criminal justice community, the faith community need to come together to make our schools the centerpiece of what we want to be about. We have to help make it happen. Many of it watch it happen. A lot of us sit around and ask, "What's happening?" But we have to get involved and make things happen if we want to bring about change. We have to be aware of the problem, become advocates for the problem, and do an action plan to get it done.

Learn to learn to do what we don't know how to do. Learn to listen to the needs of those less fortunate. Learn to elect leaders who know how to lead. You know we have a lot of leaders, especially politicians, who see which way the wind is blowing and then jump out in front. We don't need any more of those. We need some real leaders. We need to educate and empower our young people to make good decisions. We believe in the HER principle: Honesty, Empowerment, and Responsibility. The reason so many of our young people make bad decisions is that we didn't empower them with the knowledge to make good decisions. We have to learn to network and build coalitions.

Our goal is clear: we want all of our young people to grow up healthy, educated, motivated, and have hope. You can't worry about who gets the credit. You just have to worry about did you get the job done. Nobody even wants to know how you did it. We've got to learn to evaluate what's been done. We do a lot of good things. We've got to make sure that the community and the world knows about it.

Last, but not least, we have to be successful. We can't afford to fail. The most valuable resource we'll ever have, our bright young people, their lives are at stake. As I tell people all the time, and as my bishop told me years ago, "Dr. Elders, you know the job you're in is like dancing with a bear. When you're dancing with a bear, you can't get tired and sit down. You have to wait until the bear gets tired and then you sit down. Before you sit down, you take every opportunity you get. Opportunity is like the single strand of hair on a bald man - it only goes around once and you have to grab it when it's there. So when we get our opportunity we have to grab it for our bright young people of the future. Thank you very much.

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