U.S. Surgeon General David Satcher
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RAY SUAREZ: As Surgeon General, David Satcher has been the nation’s top doctor for four years. He focused attention on issues ranging from obesity to depression. He’s also had to deal with one of the biggest public health challenges in recent history: Anthrax-tainted letters and resulting deaths. His term ends in February, and he’s just announced that he’ll head a new center at the Morehouse School of Medicine in Atlanta. The center will focus on a range of health issues particularly those affecting poor and minority populations. Dr. Satcher, welcome.
DR. DAVID SATCHER, Surgeon General: Thank you, Ray. Good to be with you.
RAY SUAREZ: So when your term ends in a couple of weeks, you’re going to do yourself a favor and take a little break or are you heading right to the new National Center for Primary Care?
DR. DAVID SATCHER: Well, I’m going to take a little break immediately after my term ends, and then for a six-month period between March and September– I don’t begin at Morehouse School until September– for a six-month period, I will be a senior visiting fellow with the Kaiser Family Foundation, who will really have an opportunity to reflect and to write on some of my experiences in government.
RAY SUAREZ: So as you sift through your time as surgeon general, what would you identify as some of the high points of your term?
DR. DAVID SATCHER: Well, clearly, you know, we did a major report on mental health, and I believe the response of the American people to that report and to the report on suicide prevention has really been amazing. It’s led to several follow-up reports and activities and, of course, we contributed to the world health report on mental health that came out recently.
RAY SUAREZ: And if you had to… from the particular vantage point of a Surgeon General talk about how well policy and politics and medicine and science live together, did you learn some lessons about that as well?
DR. DAVID SATCHER: Yeah. I think in order to do good public health, you really have to deal with all of those things. Now, the Surgeon General’s responsibility is to communicate with the American people based on the best public health science, but sometimes you really have to fight to get things through the politics of Washington in order to bring the best public health science to the American people. I think we’ve been very fortunate, in most cases, of being able to do that, but you really have to deal with the environment.
RAY SUAREZ: Your new center will focus on issues especially affecting poor and minority– undeserved populations. This has been a long-term interest of yours, hasn’t it?
DR. DAVID SATCHER: It has been and it actually, Ray, goes back to my childhood when, at the age of two, I suffered a very severe illness– whooping cough and pneumonia– and really came very close to death. It was that experience and the difficulty we had in getting care. We didn’t have access to any hospitals. People died at home. But that experience and the memory of that sort of led me into medicine with the view that I wanted to be like the physician who came out to the farm to see me, and I wanted to make a difference for people who didn’t have access to care.
RAY SUAREZ: Well, you’ll have a chance to do it now. Looking over the health goals for black Americans, for Latinos, for poor populations, what are some of the things that Americans should really be paying attention to?
DR. DAVID SATCHER: Well, I think there are a few things. Number one, I think we have set as one of the goals for “healthy people 2010,” the elimination of disparities in health among different racial and ethnic groups in this country. I believe that’s critical for all Americans because I believe that to the extent that we respond to the health needs of the most vulnerable, we actually do most to promote the health of the nation. So disparities or lack of access to care that many people experience in this country, those things need to be eliminated and we can do that as a nation.
RAY SUAREZ: Are a lot of the diseases that we see disproportionately affecting poor and minority Americans? Are they lifestyle things – hypertension — heart disease, high rates of emphysema, diabetes, obesity?
DR. DAVID SATCHER: I think that those disparities that we see relate to lifestyle, but they also relate to a lack of access to care. Some of them have familiar patterns of inheritance, but for the most part, we’re talking about a combination of lifestyle, problems with early access and early detection of problems. For example, in the case of diabetes, we know, for example, that by changing lifestyles, we can prevent the onset of 50 percent to 60 percent of Type II diabetes, which is over 90 percent of the diabetes we see in this country. We also know though for people who get diabetes if they were detected early and treated aggressively, we could prevent complications like end stage renal disease and blindness and the need for lower limb amputation. We can prevent most of those complications by early detection and treatment.
RAY SUAREZ: What if you correct for access? Instead of comparing all blacks with all whites, let’s say, you compared people who all had life insurance, who all had similar incomes and education levels, would a lot of these disparities go away?
DR. DAVID SATCHER: Well, to a great extent, many of the disparities would decrease dramatically. But you know we also have studies showing that even for the higher socioeconomic group there are still disparities, but they’re greatly reduced. We believe that some of these are multigenerational to the extent that some experiences that people have as children, especially girls who grow up to be women, of course, affect the outcome of their pregnancies.
So if a child was exposed to environmental toxins, even though that child grew up to finish college and become a lawyer, that child is Hispanic or African-American still suffers from the experience that they had as a child. And that impacts upon infant mortality and maternal mortality.
RAY SUAREZ: So this new center that you’ll be heading up will be a clearinghouse for information in research on just these kinds of questions?
DR. DAVID SATCHER: It will. And the good thing about it, Ray, is that it will be associated with a network of centers throughout the Southeast, for example, looking at what goes on in communities around these centers, but, also, how we can improve access to care and the quality of care that people receive. We also will relate to a national network of centers in time. And so we’re going to be looking at how can we improve lifestyles in communities, but also how can we improve access to health care and the quality of care people receive, regardless of their location, but also regardless of their race or ethnicity.
RAY SUAREZ: Well, you grew up in the deep South during the years that Dr. King was trying to change the country’s view of race relations. You were still a student when he was killed. How far are we from reaching some of the goals he articulated 40 years ago?
DR. DAVID SATCHER: Well, we’ve made a lot of progress since I was a child. I was 12 years old when the Montgomery bus boycott started, and I remember going into town and not being able to buy ice cream. You may say, “Well, that’s no big deal,” but what it did to you as a person to feel that you were shut out was very significant. But I think because of the work of Dr. King and many others, many of those barriers have been broken. But in medicine and in public health, we also have dreams. And those dreams relate to eliminating disparities in health and health care, making sure that everybody in this country has access to quality health care. That’s an extension of Dr. King’s dream, but it’s really critical for the future of this country.
RAY SUAREZ: Is it all about money at this point or is it something a little bit more challenging than simply being able to write a check?
DR. DAVID SATCHER: I think first and foremost, it’s about commitment. I really believe that as a nation, we need to make a commitment to universal access. The fact that one out of three Latinos in this country is uninsured, one in four African Americans are uninsured and the fact that so many people live in communities where they don’t have access to care, as a nation we ought to make a decision that we’re going to work to eliminate those barriers to care. And I’m convinced that we can do it if we make that commitment.
RAY SUAREZ: The outgoing Surgeon General of the United States, Dr. David Satcher. Thanks for talking to us.
DR. DAVID SATCHER: Thank you, Ray. It’s good to be with you again.