In 2004, Health Affairs’ Fitzhugh Mullan interviewed C. Everett Koop, who passed away on Monday at the age of 96. The full interview is freely available to all readers, as is a 1998 Health Affairs article coauthored by Dr. Koop evaluating health education programs designed to reduce health risks and costs. Health Affairs Blog will carry more about Dr. Koop’s life and work in the coming days.

Koop is probably best-known for his pioneering work as Surgeon General under President Ronald Reagan, but his interview with Mullan begins with a discussion of children’s health, reflecting Koop’s role in helping to found the discipline of pediatric surgery. Koop sounds a warning about the nation’s treatment of its children. “We always talk about children being our future,” he notes,

but I’m afraid we don’t always deliver … the older I get, the more I understand the relationship of poverty in a child and poor outcomes in everything else. I’m not beating a socialist kind of drum here. I think as we look to the future, unless we take into account what a severe role poverty plays in the lives of many children, we will never be able to achieve good child health in the United States.

Since children can’t vote or lobby as seniors do, “In the long run, child health is about advocacy,” says Koop, who also highlights the challenge of pediatric obesity.

Surgeon General

As Surgeon General under Reagan, Koop produced groundbreaking work on AIDS and tobacco use. He discusses with Mullan the challenges he faced working against the ideology of the Reagan administration and the Republican party on these issues. For example, Koop says that, had it not been for fellow physician and HHS Secretary Otis Bowen, his seminal 1986 report on AIDS “would never have seen the light of day.

There were too many people in the administration, especially those surrounding the president, who felt that AIDS was a disease of prostitutes, homosexuals, and drug abusers, and, after all, didn’t they deserve what they got? Our strategy was that we were fighting a disease and not the people who had it. I think that was a turning point for the Surgeon Generalship.

However, Koop separates Reagan from his advisors and suggests that, but for “the real conspiracy to keep me from talking to the president about AIDS,” Reagan “would have seen the concerns I had early on, and he would have avoided for himself and his administration a lot of the criticism that he received.” Koop describes having to communicate with Reagan in secret by slipping notes into the stack of mail from Americans that Reagan received and responded to each day.

Koop’s wide-ranging conversation with Mullan, the Murdock Head Professor of Medicine and Health Policy at the George Washington University School of Public Health, touches on several other subjects, including Koop’s work with then First Lady Hillary Clinton on the Clinton administration’s failed bid for health reform. He laments the transformation of medicine from a profession into a business and the deterioration of the doctor-patient relationship, but he celebrates the Internet “as an opportunity to have a set of patients who are much more knowledgeable than their parents were.” Koop also describes his visions for an international health service corps and a National Health Museum on the Mall in Washington.

He concludes: “I’ve had a very, very interesting life.”