Term Paper: Surgeon General Healthcare Organizations

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Surgeon General/Health Care Organizations

The Surgeon General, Health Policy and Politics

On January 28, 2010, First Lady Michelle Obama, U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius and U.S. Surgeon General Regina Benjamin announced plans to help Americans lead healthier lives through better nutrition, regular physical activity, and by encouraging communities to support healthy choices. At a YMCA in Alexandria, VA, they talked directly with national and local leaders, parents and health professionals about reducing overweight and obesity in adults and children.

The First Lady recently announced that she will launch a major initiative on childhood obesity in the next few weeks and has asked HHS to play a key role. Today, HHS released the Surgeon General's Vision for a Healthy and Fit Nation. In her first release to the nation, Dr. Benjamin highlights the alarming trend of overweight and obese Americans, and asks them to join her in a grassroots effort to commit to changes that promote the health and wellness of our families and communities.

There have been numerous occasions in which the surgeon general has taken an active role in safeguarding the health of the nation. In a health care system chiefly directed towards treating disease and surgical intervention, the Surgeon General has pursued a complementary strategy: disease prevention and health promotion. Appointed by the President with the advice and consent of the Senate, the Surgeon General -- whose title means chief surgeon -- is the federal government's principal spokesperson on matters of public health. The first Surgeon General was appointed in 1871 to head the Marine Hospital Service, itself established in 1798 to minister to sick and injured merchant seamen and reorganized as the U.S. Public Health Service in 1912. In recent decades, the Surgeon General has become the most widely recognized and respected voice on public health issues, preventive medicine, and health promotion through public appearances, speeches, and, most influentially, the reports featured on this Web site. The Surgeon General has often been called upon to deal with difficult and controversial issues, such as smoking and sexual health. In some cases, the public health message has generated controversy, when it ran counter to the political beliefs of the time. But the Surgeon General's public statements often served to generate debate where there had been silence, to the benefit of the nation's health.

In 1968, an organizational reform greatly reduced the Surgeon General's administrative role, abolishing the Office of the Surgeon General (though not the position of Surgeon General itself) and transferring line authority for the administration of PHS to the Assistant Secretary for Health within the Department of Health, Education, and Welfare (since 1980, the Department of Health and Human Services). Since 1968, the Surgeon General has not administered the Public Health Service, and his/her main official duty has been to advise the Secretary of Health and Human Services and the Assistant Secretary of Health on affairs of preventive health, medicine, and health policy. Nowadays the holder has little power and no budget but is considered "the nation's doctor," charged with giving truthful scientific information to the public.

Previous surgeons general have warned about smoking, HIV and AIDS, obesity, sexual behavior, drink driving, among other issues, and have recommended needle exchange to prevent HIV transmission.

Left with few bureaucratic tasks, the Surgeons General since the 1960s have undertaken a more proactive role in informing the American public on health matters. They have relied on their professional credentials (all Surgeons General have been MDs) and political independence to make themselves into the most visible and, in the public's mind, impartial and therefore trusted government spokespersons on health issues affecting the nation as a whole.

The Surgeon General issues many of its reports in conjunction with the Department of Health and Human Services. The Department of Health and Human Services (DHHS) and within it, the U.S. Public Health Service, is the lead federal agency in health. It plays this role through activities in six major areas: policy making, financing, public health protection, collecting and disseminating information, capacity building for population health, and direct management of programs.

The department is large and complex and over a period of years, has become highly decentralized, with each of the working divisions operating relatively autonomously within a policy and budgetary framework set by the secretary. There are twelve operating divisions of the department. Each individual operating division also has constituencies composed of one or more special interest groups advocating for and seeking to shape its programs. These groups are more closely tied to the individual operating divisions than to the department as a whole. The connection among the senior staff of the operating divisions, the congressional staff, and the special interest groups and constituencies are called the "iron triangle" (Bouffard and Lee 2002.)

The surgeon general along with the DHHS has a history of being involved in politics. A former U.S. surgeon general told a Congressional committee last week that while he was in office he had been forbidden by the Bush administration to speak on topics such as stem cell research, emergency contraception, sex education, health of prisoners, mental health, secondhand smoking, and global health issues. Richard Carmona, the last surgeon general, told the House of Representatives Committee on Oversight and Government Reform that he had been instructed to mention President Bush three times on each page of his speeches, which were vetted by officials at the parent agency, the Department of Health and Human Services. Travel to conferences was prevented, and he was told not to attend the special Olympic games for disabled athletes, which were supported by the Kennedys.

When he wanted to issue information about mental health after the 11 September 2001 terrorist attacks on the United States he was told by his bosses at the Department of Health and Human Services: "You don't write anything unless we approve it." Six previous surgeons general told him they'd also faced political pressure, but not to the extent that Dr. Carmona had (Tanne 2007).

Fitzhugh Mullan, former Assistant Surgeon General, recounts how the office of the surgeon general is limited and problematic in his article "Plight of the Surgeon General' (Mullan 2007). On 10 July 2007, three former U.S. surgeons general sat before the House Committee on Oversight and Government Reform and detailed a rising tide of political interference in the conduct of the office in which they had served. Richard Carmona, who resigned the position last year, told of being blocked from speaking out on issues such as stem cell research and emergency contraception, and of instructions to reference President Bush three times on every page of any speech he gave. David Satcher of the Clinton Administration recounted interference with his report on sexuality and public health, in part because of the Monica Lewinsky affair. And C. Everett Koop described attempts of the Reagan political staff to thwart his AIDS campaign.

The hearing raised questions not just about political interference with science but about the Surgeon Generalship itself -- a position that has had a mercurial ride through U.S. political history. Legislation in 1889 established the position of Surgeon General of the Marine Hospital Service, a minor government agency that evolved rapidly during the 20th century into the U.S. Public Health Service (PHS). By the 1960s, the Surgeon General, always an appointee from the ranks of PHS career officers, was in charge of a small empire of federal health programs, including the National Institutes of Health, the Food and Drug Administration, and the Indian Health Service. In 1967, a politically appointed Assistant Secretary for Health in the Department of Health, Education, and Welfare supplanted the Surgeon General as the line manager of the PHS, and the Surgeon Generalship became ceremonial. Nixon left the job empty from 1972 to 1976, and Carter designated his Assistant Secretary for Health as Surgeon General as an afterthought (Mullan 2007).

In 1981, President Reagan nominated C. Everett Koop for the job, a physician with little public health experience, who withstood a bruising confirmation marathon and then reinvented the position of Surgeon General. At a time when most public officials were distancing themselves from AIDS, he tackled the exploding epidemic. His willingness to speak frankly, embrace those suffering with the disease, and disregard the apparent preferences of his political overlords was welcomed by both scientists and the public. The president remained silent but supportive, according to Koop, while others in the Administration schemed to oust him. His name and his office gained wide recognition and helped propel his campaigns in other areas such as smoking, child health, and nutrition. Internally, he revitalized the PHS Commissioned Corps, generating a pride in the mission of public health that had been absent for many years (Mullan 2007).

The force of Koop's personality, the happenstance of the AIDS epidemic, and a hands-off president resulted in an extraordinary moment of power and effectiveness for the Surgeon General. But this alignment of events is rare, and Surgeons General since Koop have struggled to achieve the independence and… [END OF PREVIEW]

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