A frequent statement of mine is, “We need public health leadership that cares enough, knows enough, is willing to do enough, and will be persistent.” Surgeon General C. Everett Koop was just such a leader, for he was caring; he was competent; he was courageous; and he was passionately persistent.
Before he was a Surgeon General, he was a pediatric surgeon. This was before the field was well-established. But he cared about children and their health. He gave conjoined twins the chance to live independent lives by performing surgery to separate them before the art was well developed. He cared about the education of medical students and residents, and spent time educating and counseling them. His former students still tell stories of their interactions with him.
The Office of the Surgeon General is not political. The American people look to the Surgeon General for reliable information based on the best available public health science, not politics, religion, or personal opinion. A combination of presidential nomination, Senate confirmation, and science-based expertise all have resulted in the Surgeon General maintaining, in the minds of the American people, a place of authority. As Surgeon General, Koop spoke and wrote with authority.
I liken the leadership of the Office of the Surgeon General, on public health issues, to a relay race where a runner takes the baton, advances it as far as he/she can, passes it on to someone else, and supports his/her successor. An example of this is infectious diseases. The Office of Surgeon General has been in the forefront of prevention and control since the tenure of the first Supervising Surgeon of the Marine Hospital Service, John Maynard Woodworth (1871-1879), when cholera, malaria, yellow fever, and tuberculosis were the major challenges. Within the ten years after Surgeon General Stewart said in 1969, “It is time to close the book on infectious disease” and move to the challenge of chronic diseases, we experienced the emergence of over 30 new infectious diseases, including Hunter Virus and HIV/AIDS.
A Courageous Response To HIV/AIDS
It was his response to the AIDS epidemic/pandemic that distinguished Koop as a Surgeon General. Given the sexual, racial, and drug-related issues around the transmission of HIV, and other issues involved with HIV/AIDS, he demonstrated unusual courage and fortitude in bringing these topics to the attention of the American people in the face of resistance within both Congress and the White House. The major resistance to his report on HIV/AIDS stemmed from the need to explicitly discuss how it was transmitted heterosexually and homosexually.
One of the most important characteristics of leaders is that they respond to opportunities, challenges, and even to crises. It was Koop’s response to the AIDS epidemic that established him as perhaps the greatest Surgeon General ever. A very religious man, an anti-abortion crusader before confirmation, Koop made it clear that his priority was saving lives. Although clearly not a proponent of sex outside of marriage or of homosexuality, Koop felt it was his responsibility to inform sexually active persons about behavior necessary to minimize the spread of the AIDS virus and to protect themselves. So he advocated use of condoms and other forms of safe sex.
In a bold and courageous move, Koop mailed information to every household in America, warning them that this was not the type of information that they may have felt comfortable discussing before, but that it was now necessary. He did not abandon his Christian principles, but he put the principle of love of one’s fellow man above his judgment of them.
Continuing The Fight Against Tobacco Use
Koop expressed concern about the dangers of smoking and second-hand smoke. He was not the first to admonish the American people about the dangers of smoking. Addressing smoking as a threat to the health of American people is another example of how the Surgeons General pass the baton.
The first-ever Surgeon General’s Report was published in 1964, about 50 years ago. It was about smoking and health, and it was released by Surgeon General Luther Terry. Then in 1972, Surgeon General Steinfield released a report on second-hand smoke. Surgeon General Richard Carmona released a report on smoking in 2006, and during my tenure as Surgeon General (1997-2001), three additional reports on smoking and health were released.
But Koop identified smoking as still the leading preventable cause of death in the mid-1980s. He wrote and spoke about the dangers of smoking and second-hand smoke with courage and passion.
Perhaps The Greatest Surgeon General
Chick Koop was generous in praising his successors. He told me that he thought I had been successful as Surgeon General in releasing several critical reports — the first-ever Surgeon General’s Report on Mental Health, in 1999, Oral Health in 2000, and Sexual Health, Youth Violence, and Overweight and Obesity in 2001 — in large part because I had the advantage of having been active in public health and also serving as Director of the Centers for Disease Control and Prevention before becoming Surgeon General and Assistant Secretary for Health. But while I am proud of my tenure as Director of the CDC and the work I did as Surgeon General, I know that Koop was a great, and perhaps the greatest, Surgeon General because he responded decisively and effectively to a public health crisis, just as President Lincoln responded to slavery and the threat of a fractured union.
In leadership it is sometimes more important to focus on one thing than to respond to many. In responding to the AIDS crisis, Koop demonstrated caring, knowing, courage, and perseverance.
Even though I was not as attentive to Chick Koop in his later years as I wish I could have been, he was invited to and participated in two Surgeons General reunion events, Conversations with the Surgeons General, sponsored by the Satcher Health Leadership Institute. I regret that he was unable to attend our third reunion in 2010.
A Long Life, And More Importantly A Full One
Koop was blessed with long life. He became Surgeon General at age 64 and served almost eight years during the Reagan Administration. He died at the age of 96 and had remained active during most of his life. But Koop will not be remembered for the length of his life but rather for the quality of his life and the magnitude of his contributions. He made the most of every minute that was given to him, and one has to think of him when recalling the following anonymous poem:
I have only just a minute;
Only sixty seconds in it;
Didn’t seek it, didn’t choose it;
But it’s up to me to use it;
I must suffer if I lose it;
Give account if I abuse it;
Just a tiny little minute;
But eternity is in it.
Koop lived life as if every minute of his life was indeed God’s minute. I will always appreciate him for what he was and for how he stood. I am a better person for having known him, and our nation and the world are better because of his life and his work.
The struggles of the Office of the Surgeon General continue, and the Surgeon General continues to push disease prevention and health promotion as priorities for the American people. No one has exemplified this more than Surgeon General C. Everett Koop. I will miss him.