Health Affairs

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.

In 2004, Health Affairs’ Fitzhugh Mullan interviewed C. Everett Koop, who passed away on Monday. 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.

As we mark World AIDS Day and the Obama Administration releases its new “PEPFAR Blueprint,” Health Affairs Blog wanted to remind readers that the July 2012 issue of Health Affairs provides a comprehensive look at PEPFAR, the President’s Emergency Plan for AIDS Relief. The issue contains a wide array of articles by leading voices such as Ambassador Eric Goosby, the US Global AIDS Coordinator in the Department of State, Michael Merson, the founding director of the Duke Global Health Institute, and many others. Health Affairs also published a Health Policy Brief on PEPFAR to accompany the issue.


In addition, readers may view the release event for the July issue on the Health Affairs website. The briefing featured many of the authors from the issue as well as others such as Jim McDermott, the co-chair of the Congressional HIV/AIDS Caucus.

The October 2012 issue of Health Affairs provides an in-depth look at challenges in comparative effectiveness research. To surface issues around communication of research results, the issue includes a hypothetical comparative effectiveness case study of a fictional migraine drug and offers varying commentaries and analyses of the hypothetical case study from the Patient-Centered Outcomes Research Institute (PCORI), the Food and Drug Administration, the pharmaceutical industry, payers, and representatives of patient groups.

These and related articles raise questions about how the research might be applied to decision making across the health care system and the ways it could affect how pharmaceutical companies communicate to both health professionals and the public about competing treatments and options in the future.

Other studies examine additional issues related to comparative effectiveness research as well as topics of interest to the pharmaceutical and medical device industries, insurers, health care providers, and consumers.

The new Health Affairs volume will be discussed at a Thursday, October 11, briefing in Washington DC. The issue has funding support from the National Pharmaceutical Council.

Rushika Fernandopulle’s proposal for rethinking the nation’s primary care system was the most-read Health Affairs Blog post for August. It was followed on the month’s top-ten list by Michael Cannon and Jonathan Adler’s argument that the Affordable Care Act does not allow premium tax credits on federally facilitated exchanges, and Jacob Bor’s reflections on the... Read the rest of this entry »

Editor’s note: The current issue of Health Affairs is a thematic volume focusing on the President’s Emergency Plan For AIDS Relief (PEPFAR). Last week’s 19th International AIDS Conference in Washington, D.C. convened 25,000 scholars, activists, practitioners, policy makers, and members of the general public; people living with HIV and people living without the virus; students,... Read the rest of this entry »

This year’s International AIDS Society (IAS) conference, taking place in the US for the first time after a 20-year boycott, has a special meaning to me.  As an infectious diseases doctor, I provide primary care to HIV-positive patients.  I first became drawn to HIV/AIDS in 1989 when I was 10 years old.  At that time... Read the rest of this entry »

On the eve of AIDS 2012, the international HIV/AIDS conference, soon to get under way in Washington, DC, a new Health Policy Brief from Health Affairs and the Robert Wood Johnson Foundation examines the President’s Emergency Plan for AIDS Relief, or PEPFAR. This major program of assistance to foreign countries affected by HIV/AIDS was created... Read the rest of this entry »

Articles published yesterday in the July 2012 issue of July 2012 issue of Health Affairs focus on the President’s Emergency Plan for AIDS Relief (PEPFAR), the US program to address global HIV and AIDS, and the largest investment to date of any country to fight a single disease.  The thematic issue examines the origins of... Read the rest of this entry »

Tomorrow, Tuesday July 10, Health Affairs will release its July 2012 issue, “Assessing The President’s Emergency Plan For AIDS Relief.”  The volume contains a thorough examination of PEPFAR, the program of bilateral U.S. assistance begun in 2003 to support countries in their battle against HIV/AIDS. The effort has been described as the largest program of... Read the rest of this entry »

On Tuesday, July 10, Health Affairs will release its July 2012 issue, “Assessing The President’s Emergency Plan For AIDS Relief.”  The volume contains a thorough examination of PEPFAR, the program of bilateral U.S. assistance begun in 2003 to support countries in their battle against HIV/AIDS. The effort has been described as the largest program of... Read the rest of this entry »

Here are some blog posts that caught my eye this week, as I sifted through foundation blogs I follow. The descriptions are brief—just to give you a flavor of what the post is about.  This is a short week in the office for me, as I head over to nearby Baltimore for the Grantmakers In... Read the rest of this entry »

Health Affairs plans a thematic issue on lessons learned from, and future prospects for, the President’s Emergency Plan For AIDS Relief (PEPFAR). This special issue will appear in July 2012, before the opening of the World AIDS Meeting in Washington, D.C A number of articles have already been commissioned and are listed on the Health... Read the rest of this entry »

Since its inception in 2003, the President’s Emergency Plan for AIDS Relief (PEPFAR) has saved millions of lives through providing anti-retroviral (ARV) treatment to people living with HIV/AIDS.  PEPFAR has been essential in moving overall coverage levels in African countries from near zero to a few countries reaching 80 percent coverage (e.g. Botswana) and several... Read the rest of this entry »

Provisions of the Affordable Care Act and other recent legislative changes will transform public substance abuse treatment in the United States, substantially increasing the funding, expanding access to care, and better integrating it with other health services. That’s the conclusion of an article by Jeffrey Buck, senior advisor for behavioral health in the Center for... Read the rest of this entry »

The International AIDS Conference is currently taking place in Vienna. One of the major themes of the conference, voiced by such notables as Bill Gates and Bill Clinton, is the need for the fight against HIV/AIDS to become more efficient. In the face of declining resources, and more competitors for those resources, there is simply no other choice.... Read the rest of this entry »

Despite unprecedented growth in available resources, the world is facing both short- and long-run financial crises in combating the international HIV/AIDS pandemic. That message emerges strongly from a cluster of articles in the November/December 2009 issue of Health Affairs funded by the Bill & Melinda Gates Foundation. HIV funding shortfalls and their potential lethal consequences... Read the rest of this entry »

With December 1 marking another World AIDS Day, the November/December 2009 issue of Health Affairs focuses on the economic, political, scientific and ethical challenges facing world policymakers in their response to HIV/AIDS treatment and prevention. Also available from Health Affairs are six free policy briefs on HIV/AIDS. The briefs discuss policy recommendations concerning prevention, funding, research,... Read the rest of this entry »

The newly released November-December 2009 edition of Health Affairs features a series of articles on the challenges posed by the HIV/AIDS pandemic.  The articles focus on steps policymakers can take to change the dynamics of the pandemic so that millions of lives will be saved, infections prevented, and overall costs made more affordable. Publication of the... Read the rest of this entry »

The November/December 2009 edition of Health Affairs focuses on key global health challenges – including the economic, political, scientific and ethical ones – facing world policymakers in their response to HIV/AIDS treatment and prevention.  Over the next several years, the world could face a funding shortfall that would prevent millions more with HIV/AIDS from gaining... Read the rest of this entry »