Satcher to Invoke Health Lessons Learned from Life Experience

When Dr. Jackson made a house call to visit a toddler with whooping cough in segregated Anniston, Ala. the prognosis was not good.

Jackson--the only black physician in town and the last hope for the boy's parents--treated the child but said he did not expect the boy to live out the week.

Over 50 years later, things are looking up for David Satcher, who, having conquered his childhood illness, took the oath to become the country's 16th surgeon general and the assistant secretary of health in February, 1998.

Dr. Jackson was Satcher's initial inspiration to enter the world of medicine.

"My mother told me that story just about everyday," Satcher says. "By the time I was six, I said I wanted to be a doctor."

And Satcher followed his childhood dreams. After graduating from More-house College in Atlanta, Ga., he went on to receive both his doctoral and his medical degrees from Case Western Reserve University.

Initially, Satcher says he wanted to return to his hometown and open a family practice there, but during college, he says he realized that there were "Anniston, Alabamas" all over the country.

Satcher's began his career by training physicians at Drew Medical Center in Los Angeles, Calif. From there, he returned to the East Coast to teach at Morehouse, and then became the president of Meharry Medical College in Nashville, Tenn.

In 1993, Satcher's work in medicine became more national in scope as he accepted an appointment from President Clinton to become the director of the Centers for Disease Control and Prevention (CDC) in Atlanta, Ga. He held this position until 1998, when he assumed the post of surgeon general.

The Nation's Top Doc

Over the past year-and-a-half, Satcher has focused on three main areas of national and international health concern.

The first, to eliminate disparities in healthcare among racial and ethnic groups, has been one of Satcher's career-long goals. He says it stems from the inadequate health care he received as a child. Today, life expectancies, mortality rates, infant death rates and morbidity rates are highest among America's ethnic minorities.

Satcher aims to eliminate disparity in the morbidity rates across racial and ethnic lines by the year 2010.

According to Claire V. Broom, M.D., a former colleague of his at the CDC, Satcher has been effective in making minority healthcare a national concern.

"He has done an outstanding job trying to make the whole country understand the importance of bridging health gaps for minorities," Broome says.

The second focus of his administration has been disease prevention.

"The idea is a balanced approach where we emphasize [such things as] physical activity and nutrition and responsible sexual behavior," Satcher says. "We don't support physical education in schools, parks and safe walking trails in schools, parks and safe walking trails in communities, and yet we spend a lot of money treating people after they are sick."

He hopes to lower instances of diabetes and heart attacks by maintaining a healthier and more fit population overall.

Satcher's platform also includes increasing immunization rates and cancer-screening--projects he also promoted at the CDC.

Satcher's third goal has been to globalize healthcare by spreading the American vision of disease treatment and prevention around the world.

"Health problems are not limited by national borders," Satcher says.

He places emphasis on the international concerns of tobacco and mental health.

Four million people died as a result of tobacco in 1998, and by 2025, ten million people will die--most of them in developing countries, according to Satcher.

Americans need to "realize that we are part of a global community--tobacco moves from one country to another just as diseases do," Satcher says.

Satcher also sees mental health as a global concern. Along with devoting more resources to the mental health field and publishing the first ever Surgeon General's Report on Mental Health, he turns to other nations in order to find solutions to problems here at home.

"We have looked to Australia as an example of destigmatization of mental health," Satcher says.

The Doctor's Appointment

Satcher's tenure as surgeon general thus far has been relatively uncontroversial, despite the contention that surrounded his confirmation.

While Satcher received the nomination from President Clinton in 1997, disagreement in Congress prevented him from assuming the post right away.

"The confirmation process was very easy at first, but in December, before [the Senate] went on break, they decided to put my nomination on hold for reasons primarily relating to programs at the CDC," Satcher says.

Some Republicans in the Senate disagreed with certain CDC programs during the Satcher's directorship--needle exchange and condom distribution policies were among the most disputed.

Anti-abortion activists, upset that Satcher agreed with President Clinton's pro-choice stance, also fought against his appointment.

"I think there are many people in the Republican Party who were not going to let the president have another surgeon general," Satcher says.

This controversy came just three years after the dismissal of Joycelyn M. Elders from the surgeon general post. Elders was removed because of a comment she made about masturbation and her admission that she would be willing to consider the decriminalization of marijuana.

Since Elders' departure in 1994, Henry W. Foster Jr. was denied Senate confirmation to be surgeon general because he had been involved in performing abortions, and acting surgeon general Audrey F. Manely resigned to become the president of Spelman College in Atlanta, Ga.

Satcher was eventually confirmed by the Senate on February 10, 1998 and took the surgeon general's oath three days later. He is the second surgeon general to simultaneously hold the post of assistant secretary of health.

The Pulse of the CDC

Many of the health policies Satcher currently advocates have been a part of his agenda for years.

At the CDC, Satcher worked to provide healthcare to the most needy Americans.

"The job was consistent with my vision of making a difference to people who needed it most," Satcher says.

Thena Durham, head of the executive secretariat at the CDC, says that Satcher always had national goals in sight, even as director.

"He looked at the health issues with an eye toward not only what we needed to do today, but also what we needed to do for the long-term," Durham says. "He created an environment in which it was the norm to look at things from a broader perspective."

Durham says that Satcher had the medically under-privileged in mind from the very beginnings of his career.

"He could have gone anywhere as a young physician," Durham says, "but he chose Drew Medical Center in Los Angeles, which is primarily a hispanic-serving institution where most people consider an urban ghetto."

In addition to providing treatment plans for needy people, Satcher also emphasized prevention programs. During his term as director, the breast-cancer-screening program expanded from 18 to all 50 states. Satcher also created initiatives to promote childhood immunization.

Satcher also laid the groundwork for an early detection system for food-borne illnesses and decreased the nation's response time for containing infectious diseases.

Broome says that Satcher stressed the importance of physical education and activity in order to help prevent disease.

As a solution to his concerns that America was more sedentary than ever before and that obesity was becoming a national epidemic, Satcher encouraged "individual behavior changes," and an environment conducive to physical activity.

Broome says that Satcher wanted to make sure sidewalks, stairways and other publicly built venues for physical activity were available for everyone to use.

According to Broome, fire drills were frequent at the CDC during Satcher's tenure there and the employees "used to joke that that was part of his 'physical campaign.'"

The Surgeon in General

In his speech at Harvard Medical School tomorrow, Satcher says he hopes to inspire students to take a global stance on medicine, tackle issues related to disease prevention and to promote equal opportunity for healthcare across the country.

Satcher will draw from his own memories of early medical experiences when speaking to Harvard's new doctors, in the same way that he has drawn from these experiences throughout his professional career.

Just as Dr. Jackson inspired Satcher to make adequate health care available to every American today, so Satcher can motivate graduates to tackle the medical priorities of tomorrow.