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 significant Four former Surgeons General of the things that happened during their ser- —three of them dressed in vice as Surgeon General. the uniforms they wore while serving as ‘‘our nation’s doctor’’—shared the stage What Significant Events in with the current Surgeon General Dr. 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 five 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. ; and the 16th, Dr. eases in children and was about to see . 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 findings, 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 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 first report in what root causes—the 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 first 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 nation—a 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 five 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 fit?’’ Novello was the first woman and the they going to get the health care they deserve?’’ she asked. During her time as Surgeon first 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 certified pediatri- people about sex—that 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 five 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. fiber, 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 five 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. Ross’s ques- School of Medicine. The Healthy Peo- Deal with an Aging Population tion about public health vs public policy ple 2010 report, issued when Dr. David and to Continue the Effort to by suggesting that health information Satcher was Surgeon General, contains Promote Disease Prevention? for policy-makers needs to be written in a new set of goals for the reduction of Dr. Sullivan, former US Secretary of an easy-to-read style that can be under- economic, social, geographic, ethnic and Health and Human Services, and pres- stood quickly. Harking back to her term racial disparities in improving the health ident emeritus of Morehouse School of as Surgeon General, she said Americans of all people. In his opening remarks on Medicine, posed a question for Dr. need to talk openly about sex as a way the panel, he recommended five actions Richmond on how the nation should to prevent AIDS, other sexually trans- that health care professionals can take in deal with longer life expectancy and mitted diseases, unwanted pregnancies, the policy area to eliminate healthcare health prevention in the remaining de- and cancer. ‘‘I gave Americans the abil- disparities: cades of the 21st century. ity to talk about sex,’’ she said. Dr. Richmond said the nation must Dr. Satcher said the ‘‘clash’’ between 1. Make sure the nation continues to pay attention to issues affecting Ameri- public health and public policy is re- focus on its goal of eliminating cans over 85 years of age, which he de- vealed in two main issues—drug abuse health disparities, regardless of who scribed as the fastest growing demo- and sexual responsibility. While serving is in the White House. graphic group in the United States. as Surgeon General, he traveled across 2. Insist on universal access to health ‘‘These people must have access to ser- the country speaking out for a needle care. ‘‘African Americans and His- vices so that they can live a quality life exchange program for drug users. Al- panics are most likely to be unin- and be happy and productive,’’ he said. though ‘‘Washington believes in punish- sured and unable to get access to On the topic of prevention, Dr. Rich- ing people who use drugs’’ rather than care,’’ he said. ‘‘We should all be mond said, ‘‘We have the knowledge helping them, Dr. Satcher said, the united in a commitment to universal base to prevent many illnesses, but we White House didn’t intervene when he access to health care.’’ lack the political will to take action.’’ advocated federal funding for such a 3. Promote equitable insurance cover- program. His Surgeon General’s report age for mental health patients. A new What Can Be Done about the on sexual health was met with non-sup- bill, the Paul Wellstone Mental ‘Clash’ Between Public Health port at the national level. ‘‘That sort of Health Parity Act, a proposal to treat and Public Policy? thing doesn’t go over very well in Wash- mental disorders as we treat other Dr. Ross asked the panelists to dis- ington,’’ he said, recalling humorously health problems, has yet to be cuss what is happening in public health that he was ‘‘the only one at the press brought before the US Senate. policy and to give their views of the conference’’ to announce the report. 4. Improve the environment by clean- ‘‘clash’’ that often occurs between ‘‘good ing up hazardous waste sites. ‘‘We policy’’ and ‘‘safe politics.’’ What Is Your Vision for Public must be firm in insisting that com- Dr. Novello believes the states can Health in the Future? munities should be free of toxic do a lot to advance health care, even if Dr. Richmond called for continued wastes’’ that endanger people’s the federal government does not act. emphasis on biomedical research for dis- health. The language barrier can be a problem ease prevention and health promotion. 5. Support lifestyle changes that reduce in health care. ‘‘People in my state of ‘‘One of the great successes in this coun- obesity and other health problems. New York speak 167 different languag- try has been our support of biomedical Policy actions, such as better food la- es, so we translate all of our health in- research, which has enabled us to live bels, more information about the fat formation materials into five main lan- longer and healthier lives and to do content of fast foods, and require- guages,’’ she said. ‘‘If I have to produce more for those who need clinical care.’’ ments for physical education and materials in Yiddish or even Braille, I He pointed to a ‘‘remarkable partner- comprehensive sex education courses will.’’ Secondly, she says doctors and ship’’ of health professionals, govern- in schools, would enable communi- medical students can set a good example ment, and an informed public. Access ties and individuals to make greater by exercising and stopping smoking. to health services is another issue that strides in improving health. ‘‘And third, we can be culturally sensi- public health needs to tackle more vig-

S2-60 Ethnicity & Disease, Volume 15, Spring 2005 ASURGEONS GENERAL COLLOQUIUM orously in the future, Dr. Richmond wisdom of collaboration with healthcare she hopes physicians will listen more said. ‘‘We need to push for universal en- professionals’’ to save lives from obesity- carefully to their patients. titlement’’ for the large numbers of peo- related conditions. Dr. Elders wants public health to ple who are uninsured or underinsured. Dr. Novello sees the future happen- continue its efforts to educate America. ‘‘We need new ethical standards for cor- ing right now in the State of New York. One way is to enlist the schools to porate America, which has not always The state uses its ‘‘tobacco money’’ ‘‘teach students to be healthy,’’ she said. supported—and has sometimes op- (money that the courts ordered the to- Ninety-seven percent of the healthcare posed—the efforts of public health,’’ bacco industry to pay to the states) to dollar is spent on ‘‘sick people’’ rather Dr. Richmond said. ‘‘This is especially provide free health care to all children than on prevention and education, she true in the tobacco industry,’’ he said, up to the age of 19, regardless of race continued. ‘‘We need to invest in where executives still deny the harmful or ethnicity. Medicine is available on a effects of smoking cigarettes and where ‘‘sliding scale’’ whereby no one pays health.’’ the industry itself has been a role model more than a $20 co-pay for a prescrip- Dr. Satcher said, ‘‘The challenge in for ‘‘deceptive practices’’ by other com- tion. Seventeen local communities have public health is to deliver the products panies. Citing obesity as a current prob- approved needle-exchange programs for of research to the people,’’ Dr. Satcher lem, Dr. Richmond said he hopes the drug addicts. Confidentiality is assured said. ‘‘How do we make sure everyone leaders of the food industry will ‘‘see the for HIV/AIDS patients. In the future, has access to quality health care?’’

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