Former U.S. Surgeon General David Satcher, MD, PhD, is director of the Satcher Health Leadership Institute and the Center for Excellence on Health Disparities at Morehouse School of Medicine and the school’s Poussaint-Satcher-Cosby Chair in Mental Health. During his 1998–2002 tenure as both surgeon general and U.S. secretary for health, he issued surgeon general’s reports and related documents on such issues as obesity, mental health, youth violence, smoking, responsible sexual behavior, oral health and breastfeeding. He has continuously spoken out about eliminating health disparities and was awarded APHA’s 2011 Sedgwick Memorial Medal for distinguished service and advancement of public health knowledge and practice. Here Satcher, a long-time APHA member, talks about health reform, the responsibilities of the nation’s surgeon general and the ups and downs of pursuing a public health career.
Q: Congratulations on being awarded the 2011 Sedgwick Memorial Medal. In winning APHA’s most prestigious honor, you join the ranks of past winners, including Lester Breslow, Paul Cornely and Martha May Eliot. What inspiration do you glean from those and other public health luminaries who have gone before you?
There have been outstanding leaders in the field of public health. Some of them I have had the opportunity to work with, certainly Lester Breslow very early in my career. I was a Robert Wood Johnson Foundation clinical scholar at UCLA when I first encountered Lester Breslow, and he had done that outstanding work in the Oakland area of California. And I think what I saw in him was a combination of passion for the health of populations but also, really, a high level of science that he brought to these studies he did. I think that’s true of many of the people who’ve received the Sedgwick award. On one hand, they have a passion about public health, but they bring to public health a really high level of technical skills so their findings are credible and they last a long time; the lessons last for a long period.
Q: You said during an APHA Annual Meeting session in 2010 that health reform was offering “a tremendous opportunity” and that “we’re serious as a nation about the prevention agenda.” How do you feel about the health of that prevention agenda as reform has moved forward?
I have mixed feelings. I think probably one of the most positive things that’s happened is the appointment of the National Prevention Council chaired by the surgeon general. Members of the council represent all of the departments of government, not just health and human services but education, commerce, justice, defense, all of those areas are represented. And so, for the first time, I think, we’re dealing comprehensively with the social determinants of health and applying them to this prevention agenda. It’s one thing to say people should be physically active at least 30 minutes a day, five days a week. It’s another thing to realize that some people live in situations where they don’t have the opportunity; it’s not safe for people to walk out on the porch. So we’re now dealing with the fact that if we’re serious about prevention, we’ve got to deal with the conditions in which people live and work and grow. You remember that definition of public health from the Institute of Medicine in 1988? It basically said that public health is the collective efforts of a society to create the conditions in which people can be healthy. And I think that’s been the approach to the prevention agenda — how do we work together to create the conditions in which people can in fact engage in prevention activities. So that’s the positive part.
The second half is that Congress has not been kind to the prevention agenda, especially the House, in terms of their attitude toward funding. So I think the biggest concern is whether the funds that were recommended for the prevention agenda will survive this Congress. There are people in Congress who think that prevention is the individual’s responsibility, only, and therefore the government should not be involved in any way. I think that’s very short sighted. I think we’re all involved together, in terms of trying to create an environment of health promotion and disease prevention. I was very pleased that in the health reform legislation, billions of dollars were set aside to support the prevention agenda. I am concerned that those funds may not survive this Congress.
Q: As our nation’s 16th surgeon general, what do you see as the most important responsibilities of that office?
The surgeon general has great responsibilities. One is focusing the U.S. Public Health Service Commissioned Corps, about 6,500 members of the commissioned corps. They’re physicians, nurses, pharmacists, etc. They’re all in public health and they’re members of the commissioned corps. They report to the surgeon general. That’s the first responsibility. The surgeon general has a responsibility to advise Congress and the White House on issues related to health and to give that advice on the basis of the best available science. The third responsibility of the surgeon general is to communicate directly with the American people, based on the best available science. Now, that communication can be oral — you make a lot of speeches — or it can be written. The surgeon general’s reports have been very important in our history. The report on smoking and health, for example has probably saved millions of lives because it led to a lot of people quitting smoking or not starting. I think the number one responsibility of the surgeon general is this direct communication with the American people based on credible science. And the American people have come to trust the surgeon general, the office of the surgeon general, to give them reliable information on which they can base their behavior. So whether it’s the Surgeon General’s Report on Smoking and Health, that was done in 1954, or my report on overweight and obesity in 2001 or other reports that have come out, I think those reports, really, provide the American people with information and hopefully motivation on which to base their behavior.
Q: You have a passion for public health that has inspired people across the globe to live healthier lives and work to bring public health to the forefront. What fuels this passion?
It started with my own experience as a child in Alabama, not just being the victim of segregation and discrimination but almost dying of whooping cough and pneumonia. Coming out of that experience, I felt that I really had a responsibility to make a difference to other people. As I have been successful in finishing college and going to medical school and doing well, so far, in just about everything. My debt has not diminished. I think every time you’re successful, then you have a responsibility to give back. I think the Bible says to whom much is given, much is required. I take that very seriously.
I have been doing a lot, I’ve learned a lot, but I know that I am expected to continue to make a contribution. And not only that, but I have a passion because I care about people. Here at the Satcher Institute we say that in order to eliminate disparities in health, we need leaders that first care enough, and we need leaders who know enough, who are willing to do enough and who will persist until the job is done. My job is not done as long as I have the ability to be active and to continue to make progress toward that goal.
Q: The United States is challenged with ongoing racial and ethnic health disparities in chronic and other preventable disease as well as mental health. Are we making progress? What can public health professionals do to address disparities in general?
I think we’re making progress in that we have now put in place a lot of systems and programs to begin to attack disparities head on. We have the National Institute on Minority Health and Health Disparities that was created after we set the goal of eliminating disparities in health. Congress passed a law creating that institute. Well, it was first a center and last year became an institute. I think that’s a lot of progress, that that institute is funded. [We have] programs and research throughout the country that work toward the goal of eliminating disparities. Almost 3,000 young people have been able to do research with mentors so that they could develop a career as researchers dealing with disparities in health. I think what’s happened is that we have seen a tremendous improvement in the infrastructure that is going to be needed to eliminate disparities in health. And more recently, with the help of the World Health Organization, we’ve gotten very serious about the social determinants of health. And I think what’s probably going to make more difference in time than anything else is that we realize that we’re not going to be successful unless we target the social determinants of health.
So we have a lot going on. We’ve had some setbacks since 2000 when the goal was first announced. I think for the eight years of the Bush administration, and I’m not just downing them, because I was involved in the first year of that administration, we saw almost 13 million people join the ranks of the uninsured. There’s no way you’re going to eliminate disparities in health as long as African Americans and poor people find themselves without health insurance. We didn’t go forward in that area in the last decade, we went backwards. So, we’ve had a lot of success, especially in dealing with the infrastructure, but we’ve also had some real setbacks in terms of the number of people who lost insurance coverage during that time. That’s why health reform is so important.
Q: Any words of advice for those who aspire to a career in public health?
Number one, I would say it’s a great career for one to aspire toward. It’s something that provides a tremendous opportunity to serve and to make a difference for a lot of people. And I think there’s a lot of gratification in working in public health. It’s a team effort, and it’s global, by the way. One of my most delightful experiences was working toward the eradication of polio. I have great memories like the week that we immunized 100 million children in India. Now that was 1996. But you must know how I felt last year when it was reported that India didn’t have a single case of polio. You get gratification by seeing progress.
I mean, measles, and I remember when almost a million children or more were dying a year from measles, and that’s been reduced dramatically. We are making progress in maternal and child mortality around pregnancy and childbirth. Even though we still have a lot of problems, and we seem to come up with new problems all the time, it’ s encouraging to think about the progress we’ve made around malaria, dealing with polio and, of course, eradicating smallpox. Now, we’re really making a difference in maternal mortality in Africa. Especially, there’s been a dramatic decrease in maternal mortality over the last few years.
If you work in public health, it’s difficult, and sometimes it takes a long time to make a difference. But you also can see evidence of the products of your work. You can see lives being saved every day. You can see these numbers decreasing. Millions of people are either stopping smoking or giving it up. I think we’re going to see the same thing on obesity, although we have a ways to go.
I certainly am a proponent of careers in public health. You know what we do here at the Satcher Leadership Institute: We’re trying to develop the future leaders for medicine and public health, especially those who are committed to the elimination of disparities in health.
Nominations for APHA’s 2012 Sedgwick Memorial Medal are due April 20.