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The Surgeon General: A Partner In Health Reform



December 30th, 2008

Sporting a stethoscope and a uniform, the Surgeon General has functioned as the nation’s doctor since 1871. Many have been exemplary. In the 1970s, after Dr. Julius Richmond kicked off Head Start, he launched a series of reports on the health of the nation. (Healthy People 2010, our next report card, will tell us how we’re doing.) In the 1980s, Dr. C. Everett Koop explained HIV/AIDS to us by sending a brochure about the epidemic to every household. In the 1990s, Dr. David Satcher helped us recognize and acknowledge the grave disparities in health among Americans and how we can reduce them.

But over the past 50 years, even as these valiant efforts and life-saving programs saved countless lives and raised awareness, our health care system has fallen apart – and more recently, the Surgeon General’s voice has been muted. Now that President-elect Barack Obama has proposed Tom Daschle and Jeanne Lambrew to lead his new health reform team, it’s time for us to redefine the Surgeon General’s role as someone who can not only diagnose what’s wrong with our health care system but work with us, as a team, to fix it.

We have been living in denial for quite a while, thinking that ours is the best health care system in the world. The truth is that large numbers of Americans have no or limited access to good medical care. We have spotty results from a system costing roughly twice as much per person as the rest of the industrialized world; in fact, our health outcomes place us among industrialized countries with the highest rates of infant mortality. People are discharged from hospitals without knowing how to treat common problems like high blood pressure or asthma.

For these reasons and more, anger toward the health care system has been increasing–and with good reason. No one likes waiting in overcrowded and busy emergency rooms for medical care that could be better delivered in a physician’s office. In households across America, medical costs are a leading cause of bankruptcy. And every day, more people join the ranks of the under- or uninsured.

Just as anger gives way to fear and fear to bargaining when we confront death, as written about by Elisabeth Kubler-Ross, Americans are transmuting their anger as they try to figure out what prescription medication they can afford and which they need to forego. Our public health systems aren’t strong enough to help us reliably in the best of times, let alone in unanticipated emergencies. And while focusing on one problem, like obesity or tobacco use, worked in the moment, this strategy isn’t sufficient now. We need a Surgeon General whose knowledge and insight transcend medicine’s traditional frontiers. Health today is a global, not a local, concern.

I think of our health care system as a GPS system, but most of its users have only a limited awareness of its capabilities. Even more important, a GPS system can help us get where we want to go-–but only after we identify our destination.

The next Surgeon General, together with 300 million Americans who are eager to be partners, needs to re-envision our health care system, and then plot the route for that journey. Some tasks will require individual effort; some, collaboration. For this reason, our new Surgeon General needs to be a trusted partner, someone who can interpret the total body scan of our health system, go beyond diagnosing what’s wrong, and propose a multi-faceted treatment plan that we understand and embrace. We, the people, need our Surgeon General to be our doctor, our advocate. We need a doctor, not just for each of us, but for all of us.

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  1. Morning Health Reform News: January 7, 2009 - US Health Crisis
    January 7th, 2009 at 11:20 am

3 Responses to “The Surgeon General: A Partner In Health Reform”

  1. Stephen Atwood Says:

    I fully support Dr. Hein’s suggestions and regret the notion expressed by Robert Burney (if I understand him correctly) that the Surgeon General, rather than being a key member of the national health team, holds instead a ceremonial post. Clearly, the Surgeon General, by the nature of her or his background, needs to provide a more technical voice to that team. But in today’s world, where the technology for good health is basically known, it is increasingly important that this individual knows how to translate knowledge into practice, which means examining how health care is delivered and how change, both institutional and individual, is managed.

    What the nation needs is someone in the office of Surgeon General who not only knows the physiology of disease, but who also understands the social and economic precedents that lead to unhealthy life practices. After analyzing these, she or he should be experienced in methods to help the American public understand these precursors and in the techniques to motivate change from those that are unhealthy. My experience over the last 35 years in the UN and in the USA in public health and clinical and academic Pediatrics suggests that this takes a lot more than posters and ‘messages’, a lot more than media commentary or ceremonial speeches. It requires listening to people to analyze and understand the barriers to change, and facilitating the interventions that people may already want to take but, for various reasons, are unable to do so. The systemic (as well as medical) interventions that arise from this analysis form the foundation of the ‘multi-faceted treatment plan’ that Dr. Hein refers to. This process should be seen as the unique responsibility of the Surgeon General – the key figure who straddles the world of medicine and social change.

  2. joseph.odonnell@dartmouth.edu Says:

    Bravo Dr Hein!!

    I fully endorse your suggestions.

    I am now Senior Scholar in the C Everett Koop Institute at Dartmouth. I have always marvelled at the effectiveness and impact that Dr Koop had in this office, using it as a “bulley pulpit ” to express courageous opinions that dealt with the health of the public. We look to our surgeon general, not as a ceremonial position, but as the nation’s (and indeed as Dr Hein points out), the world’s source of advocacy for health and advice about staying healthy.

    With the current crisis in financing of our system and the types of outcomes that no one wants, we need as many strong and unbiased voices in leadership helping us to do better. We can do better, and the voice of a wise and strong surgeon general will be a very positive force for improvement

  3. RobertBurney Says:

    My father was also a Surgeon General–back when there were some meaningful duties assigned to that office, like pointing out the link between smoking and lung cancer. I don’t know what he would think of your proposal, but doubt he would be enthusiastic. He didn’t own a stethescope and was more concerned with the population’s health than delivery systems. I also think he would point out that the two individuals you named had already been assigned to that task by the President. We don’t need another redundant duty for a now ceremonial office.

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