Former Surgeons General Address Health Policy Challenges

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Morehouse School of Medicine hosted a Surgeons General Colloquium as the opening session for its 4th Annual Primary Care and Prevention Conference held October 25-27 in Atlanta. While two of the former, living SGs were unable to attend because of illnessthe 13th, C. Everett Koop, and the acting surgeon general from 1995-1997, Audrey Manleythe other four were there: Julius Richmond (12th), Antonia Novello (14th), Joycelyn Elders (15th) and David Satcher (16th). The 17th and current SG, Richard Carmona, gave the keynote address before the forum. Robert K. Ross, president and CEO of the California Endowment, served as moderator.

Each distinguished participant gave opening remarks on “Major Health Policy Challenges and Opportunities Facing the Nation.” The panelists established common ground early on all were concerned about health disparities in the nation, a concern that the audience clearly shared. Dr. Satcher talked about the need for “universal access” to be a public policy priority because “African Americans and Hispanics are most likely to lack insurance.”

All four participants in the discussion were trained as pediatricians. Dr. Richmond initiated the “healthy people” series of reports in 1979 and was the first director of the national Head Start program. Dr. Novello currently serves as the New York State Health Commissioner; she was the first woman and the first Hispanic to serve as Surgeon General. Dr. Elders, whom many consider the most controversial surgeon general because of her public statements on sexual issues and her advocacy of school-based sexual education, returned to the University of Arkansas Children’s Hospital after her tenure. Dr. Satcher, now director of the National Center for Primary Care at Morehouse School of Medicine, focused as surgeon general on obesity, mental health and sexual health.

It’s hard to overestimate how out-of-step with reality were the various former surgeon generals’ statements:

Dr. Joycelyn Elders, declared to loud, sustained applause that “abstinence vows break more often than condoms!” Asked if she was sorry that she lost her job because of her controversial statements, she claims that if she had the opportunity to do her stint as surgeon general all over again, she would “do it the same way exactly; I wouldn’t change a thing.” Dr. Elders also lamented the “fact” that “every criminal must have a lawyer, but not all babies have a doctor.” She complained that it was “church people” who said that “the only source of AIDS was white gay men.” Dr. Elders talked extensively about the “53 million children in public schools who are denied health education” because people fear they’ll be influenced “to have sex.” The audience roared and applauded when she said, very dramatically: “They’re already doing it!” Dr. David Satcher stated that the “president should have listened to Dr. Elders!” Later, he lamented the fact that comprehensive sex education is not required in public schools. Dr. Satcher advocated, both before and during his tenure in Washington, federally funded needle exchanges as the best way to handle drug abuse. He regretted his failure to enact that policy because in “Washington, D.C., they just want to punish people on drugs.” Dr. Antonia Novello cited poverty as the “root cause” of obesity. (Only the poor are overweight?) Responding to the claim that entitlements have increased poverty, Novello said, “You can’t pay people enough to be poor.” The audience roared its approval. Dr. Novello talked extensively about “institutional racism” and declared that doctors “treat minority and white patients differently.” Again the audience applauded the statement. All the surgeons general talked about the necessity for “universal access [to health care] for all people.” Dr. Elders defended her frank talk about “sexuality issues,” which she said deserves credit for the drop in teenage pregnancy. “Real issues,” she said, “must be addressed [by the surgeon general].” Dr. Elders mentioned that in order to reduce teen pregnancy she had advocated school- based clinics. Some people asked her, she said, if she would distribute condoms. She said that she always replied, “Not on the lunch plates, but YES!” That was a real crowd pleaser of a line. But, the former surgeon general, said, we “hadn’t cultivated the attitudes of the communities enough” for that plan to work. She added, “The country has never been able to talk about sexuality; I gave the country the ability to talk about it.” Dr. Satcher talked about how his “Call to Action” on sexual behavior did not get released because of President Clinton’s sexual indiscretions. It was released later, without the president’s imprimatur, but there was “nobody at the press conference.”

With HIV/AIDS and other current health challenges, the four panelists generally agreed that the nation has the “knowledge base” for addressing them, but we “lack the political will.” Dr. Richmond claimed that he focused on anti-smoking efforts during his time as surgeon general because he “knew we could do something about a man-made epidemic.” I wanted to ask why, since several panelists had mentioned the crisis in sexually transmitted infections and diseases, we weren’t doing something about that man-made epidemic.

The highlight of the colloquium was the keynote address by Dr. Richard Carmona, the current surgeon general. Dr. Carmona, a former school dropout who became a Vietnam veteran, police officer and then a trauma surgeon, talked about his life story and how the “values of his childhood shaped his future.”

His grandmother came to this country with 24 children and never learned to speak English. His parents were substance abusers who died early, leaving him to raise his three siblings. They all “dropped out of school and ran the streets.” But after a “reality check” by a man on the street, he joined the Army and “learned about accepting challenges and accountability.” He sees his responsibilities as surgeon general in terms of “protecting the integrity and dignity of the office.”

Dr. Carmona said his priorities are:

Prevention He believes that public health policies are designed to “repair aberrant, dysfunctional behavior and society’s indiscretions.” Otherwise, “we all end up on a gurney.” Preparedness is a new priority because terrorism holds the threat of “germs and pathogens as weapons” and produces “huge mental health concerns” related to stress and anxiety. Disparities are a “major problem” and “diversity divides us” because “one size doesn’t fit all” when it comes to health literacy. He believes that 90 million Americans do not understand public health messages. Thus, messages must be communicated through numerous media with many languages and adapted to the targeted community in simple words.

Dr. Carmona also stressed the “global” aspect of health today and the challenge faced by today’s surgeon general because, in the eyes of the world, he is the “most visible and credible” person in government.

Sadly, many of the messages of previous surgeons general have not reflected well on American values. Too often, those messages align with special interest agendas and reflect a politically correct understanding rather than the reality of personal choices and the necessity for accountability and clear teaching based on solid values that have stood the tests of time and science.

Dr. Crouse is Senior Fellow of the Beverly LaHaye Institute, the research arm of Concerned Women for America. She attended the Surgeons General Colloquium on Monday, October 25, 2004.

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