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Summary Reports SUMMARY REPORTS PLENARY SESSION 1:ASURGEONS GENERAL COLLOQUIUM.MAJOR HEALTH POLICY CHALLENGES AND OPPORTUNITIES FACING THE NATION INTRODUCTION mer Surgeons General. He began by asking them to review the signi®cant Four former Surgeons General of the things that happened during their ser- United StatesÐthree of them dressed in vice as Surgeon General. the uniforms they wore while serving as ``our nation's doctor''Ðshared the stage What Signi®cant Events in with the current Surgeon General Dr. Public Health Took Place Richard H. Carmona during the open- During Your Leadership as ing session of the 4th Annual Primary Surgeon General? Care and Prevention Conference. Dr. Carmona delivered the keynote address Julius B. Richmond, MD for an audience that savored the unique Dr. Richmond is the emeritus John experience of hearing the opinions and D. MacArthur Professor of Health Pol- experiences of ®ve medical experts with icy at Harvard University. His areas of years of public health leadership. focus as Surgeon General were smoking The panel of former Surgeons Gen- prevention and behavioral health edu- eral included the 12th Surgeon General, cation. When he became Surgeon Gen- Dr. Julius B. Richmond; the 14th, Dr. eral in 1977, the nation had been wit- Antonia Coello Novello; the 15th, Dr. nessing a decline in acute infectious dis- M. Joycelyn Elders; and the 16th, Dr. eases in children and was about to see David Satcher. This quartet of health- the demise of smallpox worldwide. care pioneers brought insight, inspira- ``Something was happening globally,'' tion, and humor to an unprecedented Dr. Richmond said. ``It was a growing panel discussion of ``Major Health Pol- realization that we had a knowledge base icy Challenges and Opportunities Fac- to eradicate smallpox but that we need- ing the Nation.'' ed the political will to make it happen.'' The World Health Organization (WHO) ``generated the political will for PANEL DISCUSSION a worldwide campaign to eradicate smallpox within 10 years,'' Dr. Rich- The theme the experts hit the hard- mond continued. ``It is important to est was the need to overcome the health keep in mind that tasks like this have disparities that are preventing many been accomplished and that we have people in the nation from receiving the had remarkable successes.'' care they deserve. The panelists also rec- With a new threat of bio-terrorism ommended policy changes that would involving the smallpox virus, Dr. Rich- contribute to equitable delivery of mond reminded the audience, ``Emer- health services, including mental health gency preparedness is not a new thing care. They expressed support for disease for the US Public Health Service. We prevention based on research ®ndings, have faced tough issues like this including health education at all grade throughout the decades.'' He used as an levels in the schools and lifestyle chang- example the accident at the Three Mile es for children and adults. Island nuclear power plant in Pennsyl- Dr. Robert K. Ross, president and vania in 1979 as a disaster that he said CEO of The California Endowment in the nation was ``fortunate'' to avert. Woodland Hills, California, served as During Dr. Richmond's service, the (Ethn Dis. 2005;15[suppl 2]:S2-58±S2-61) moderator for the seminar featuring for- American people had started responding S2-58 Ethnicity & Disease, Volume 15, Spring 2005 ASURGEONS GENERAL COLLOQUIUM to new information about preventing Speaking from experience, Dr. Novello know until they know how much cardiovascular disease and stroke: the said 80% of African-American and His- you care.'' mortality rate from heart disease de- panic adolescents with the HIV virus clined 35% and the mortality rate from believe they will escape AIDS. ``They M. Jocelyn Elders, MD stoke declined 65%. ``We determined see role models who have the HIV virus Dr. Elders is professor emeritus of that we had a knowledge base that was feeling healthy and looking good, and pediatric endocrinology at the Univer- adequate to begin talking to people this sends the wrong message,'' she said. sity of Arkansas School of Medical Sci- about health promotion and disease pre- What can health professionals do about ence. Sworn in as US Surgeon General vention,'' Dr. Richmond said. As a re- disparities? ``We have to eradicate the in 1993, she focused her leadership on sult, he issued the ®rst report in what root causesÐthe lack of health educa- childhood immunization and sex edu- would become a series titled ``Healthy tion, lack of economic opportunities, cation. ``We wanted to make health care People: The Surgeon General's Report lack of health insurance, lack of quality available, accessible, affordable, equita- on Health Promotion and Disease Pre- health care, discrimination, and even ble, and universal,'' Dr. Elders said. ``Ev- vention.'' For the ®rst time, the report mistrust of the system,'' Dr. Novello ery criminal has a constitutional right to established quantitative health goals for stated. a lawyer, but our nation does not believe every baby has a right to a doctor,'' she the nationÐa process that has been in- Five Actions to Overcome Dispari- stated in pointing out the need for ac- stitutionalized by the US Public Health ties. Dr. Novello listed what she consid- cessibility. Dr. Elders believes ``educa- Service. ers to be the nation's top ®ve needs in tion, education, education'' is the an- overcoming disparities in health care: swer to ``health illiteracy'' in our society. Antonia Coello Novello, MD, MPH, ``What good are reading, writing, and DrPH 1. Provide health education. ``If minor- ities don't know what to do, how are arithmetic if students aren't physically, When her term began in 1990, Dr. emotionally, and psychologically ®t?'' Novello was the ®rst woman and the they going to get the health care they deserve?'' she asked. During her time as Surgeon ®rst Hispanic to be named US Surgeon General, the Public Health Service be- General. Her areas of emphasis were 2. Overcome minorities' distrust of the healthcare system. ``Healthcare pro- gan to talk about human sexuality. children's health, minority health, and ``People said we couldn't talk to young viders who cannot speak a patient's HIV/AIDS. A board certi®ed pediatri- people about sexÐthat if we talked language often talk loudly. Just be- cian, she has been the State Health about it, they would do it. Well, they cause someone is a different color Commissioner in New York State for were already doing it!'' The rate of preg- doesn't mean he or she is deaf,'' Dr. the past ®ve and a half years. Instead of nancy among African-American teens Novello declared. listing her accomplishments, she fo- has declined by 32%, Dr. Elders said, 3. Educate physicians. ``We need to re- cused on the problem of health dispar- but the rate of sexually transmitted dis- cruit, train, and retain more minor- ities. ``Hippocrates said extreme illnesses eases has gone up. Dr. Elders reviewed ity physicians to take care of minor- require extreme remedies, and I think the seven characteristics of healthy peo- ity people,'' she said. Minority pa- we have an extreme illness in this nation ple (eating breakfast; following a high- tients feel better and get more time in the form of disparities,'' she said. ®ber, low-fat diet; maintaining ideal with doctors of their own race or ``The 87 million minorities who are liv- body weight; sleeping 6 to 8 hours a ethnicity. ing in the United States and paying tax- night; exercising 20 minutes per day; es deserve better treatment than they are 4. Improve communication skills. eliminating tobacco and drinking re- receiving.'' Dr. Novello provided statis- ``Many healthcare providers talk too sponsibly; and avoiding high-risk sexual tics: a newborn African-American boy's fast and too loudly. They spend too behavior). Her recommendations for life expectancy is 7 years less as com- little time with their patients.'' policy changes in raising healthy chil- pared to a White baby boy; a female 5. Eliminate institutional racism. Be dren who become healthy adults are: 1) African-American baby can expect to fair in treating minority patients the teach health education in kindergarten live 6 years less than a White baby; pre- way other patients are treated. Don't through the 12th grade; 2) include mature and low birth weight babies are assign only resident physicians to mi- physical education in the school curric- born ®ve times more frequently to Af- nority patients. See poor people on ulum; and 3) provide nutrition educa- rican-American women than to White the same days as patients who have tion and healthier school lunches. women; maternal deaths are four time health insurance. ``We must be good more frequent among African Ameri- in cultural sensitivity as well as dis- David Satcher, MD, PhD cans than among Whites; many African- ease management,'' Dr. Novello said. Dr. Satcher had the distinction of American and Hispanic girls are obese. ``Patients don't care how much you serving as both the US Surgeon General Ethnicity & Disease, Volume 15, Spring 2005 S2-59 ASURGEONS GENERAL COLLOQUIUM and the US Assistant Secretary for ``I hope you will join us in pursuing tive to mental health problems among Health and Human Services from 1998 policy solutions to the problem of minorities. When a minority woman to 2001. His areas of focus were obesity, health disparities,'' Dr. Satcher invited tells a doctor she has a `pain in her mental health, and health disparities. the audience. heart,' it may mean that she is depressed He is now director of the National Cen- rather than having a heart attack.'' ter for Primary Care at Morehouse What Can the Nation Do to Dr. Elders answered Dr.
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