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What Does the Surgeon General Do?

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Most people probably couldn’t name any of our past surgeon generals, with the exception of C. Everett Koop. But with the potential appointment of Dr. Sanjay Gupta, a neurosurgeon and the chief medical reporter for CNN, the position might just get the recognition it deserves. Commonly known as the nation’s doctor, the surgeon general educates the public and pushes forth important public health issues, often butting heads with the president who appointed him or her. While some use the office as a bully pulpit and others quietly compile lengthy reports, most face controversial decisions. In this respect, Dr. Gupta has started early.

I’m the Surgeon General and I’m Here To …
The office of the surgeon general dates back to 1798, when the lead physician of the Marine Hospital Service filled the role. After the hospital service transitioned to the U.S. Public Health Service, the duties of the surgeon general expanded to include national security, disease prevention, disaster preparedness, and health policy.

The surgeon general really acts more like a public health professional, advocating for disease prevention, educating the public, and pushing forward critical health policy issues. They aren’t policy makers per se; instead, they articulate scientifically-based health policy analysis and advice to the president and cabinet ministers.  

In addition to representing the health of the nation, the surgeon general also commands the U.S. Public Health Service Commissioned Corps, a relatively small, uniformed personnel who seem to focus more on disaster deployment than national public health. (Even though I have a master’s of public health, I had never heard of this group.) On a daily basis, the surgeon general interfaces with folks from the National Institutes of Health, Centers for Disease Control and Prevention, and other health agencies, both nationally and internationally. He or she also prepares comprehensive reports on topics ranging from tobacco to AIDS, summarizing the scientific evidence with the potential to influence public policy.

Big Initiatives
In the vein of promoting health and stressing the issues that are most salient to the nation during their tenure, many surgeon generals have championed specific causes. For instance, C. Everett Koop, appointed by Reagan, was an outspoken critic of tobacco, calling for “a smoke-free society by the year 2000.” But Koop is perhaps best known for his leadership on HIV and AIDS, which became an important issue during his time in office. His approach was informational and nonjudgmental and he helped make AIDS a public health issue rather than a moral one.

Other surgeon generals have tackled similarly large causes. Antonia Novello, appointed by George Bush, Sr., focused on women and children’s health, in addition to underage drinking and AIDS. During the Clinton administration, Jocelyn Elders, the first African American to hold the post, was an outspoken advocate for comprehensive sex education. David Satcher, who served from 1998–2002, worked toward ending health disparities.

Controversy: Ideology versus Health
While it seems as if promoting the health of the nation would be a relatively straightforward job, the surgeon generals’ priorities are often at odds with the politics and ideology of the presidents who appoint them. Elders was forced to resign after only fifteen months because of a controversial remark she made about sex education. In 2007, three former surgeon generals testified before the House Oversight and Government Reform Committee, all of them claiming political influence in their positions. C. Everett Koop said he was discouraged by the Reagan administration from discussing the AIDS issue and Dr. Satcher said that Clinton administration dissuaded him from putting out a report that indicated needle exchange programs were effective in reducing disease. Both doctors released reports on these topics regardless.

Most recently, Richard Carmona, the surgeon general under President George W. Bush, said that the administration suppressed or weakened many of his findings; he was not allowed to speak or write reports about important public health issues such as stem cells, sex education, mental and global health issues, and an important report on secondhand smoke was delayed and diluted. Dr. Carmona also said he was told to mention President Bush at least three times per page of his speeches.

“The reality is that the nation’s doctor has been marginalized and relegated to a position with no independent budget and with supervisors who are political appointees with partisan agendas. Anything that doesn’t fit into the political appointee’s ideological, theological, or political agenda is ignored, marginalized, or simply buried,” he stated in his testimony.

(Forced from his job in 2006, Carmona was replaced with an “acting” surgeon general, Steven K. Galson, in October 2007.)

A New Role for an Old Office?
Whether or not a TV personality, coupled with a new administration, can revitalize and depoliticize the office is anyone’s guess. But already the pick of Sanjay Gupta has sparked controversy. Some feel that his celebrity status—USA Today has named him a “pop culture icon”—may undermine the authority and credibility of the office, while others feel that with his household name he can use the post as a bully pulpit, bringing attention to pressing issues. While it’s certain he’s adept at communicating information, my biggest reservation is that he’s lacking public health experience. Since the surgeon general doesn’t serve as a clinician, focusing on population level prevention, public health skills, and knowledge are the most important part of the job. Although he served as a White House fellow and policy advisor to then first lady Hillary Clinton, most of the other surgeon generals have had a greater breadth of public health experience.

Regardless of whether or not Dr. Gupta accepts the position, one thing is for sure: we’re more likely to remember the name of this already well-known surgeon general.


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