Wednesday, January 14, 2009

The Role of Surgeon General

Over the past week or so I have been conversing with several people regarding the appointment of Dr. Sanjay Gupta as Surgeon General. I have expressed that, while I see considerable merit in the appointment and have much admiration for him as a person and a physician, I have concerns that his resume shows no experience in the field of public health service and that I consider that to be a serious lack in an appointment as the director of the National Public Health Service.

Interestingly, every one of the people I have talked with have equated public health service with either universal health care or with public health education. The former is a completely different issue, and the latter is but one small facet of the medical discipline that is public health service.

Medicare is an example of universal health care. (Or it would be if it were extended to all residents of the nation, as it is in most civilized nations.) It deals with the delivery of medical care to individuals, as individuals. The doctor or medical facility delivers the medical care, and the universal health care process takes care of covering the cost of that care.

Public health service provides for health concerns as they affect society as a whole; dealing academically and practically with cause, effect, eradication and prevention.

A dramatic example of public health service in action is the history of Malaria in this nation. Prior to World War Two, Malaria was endemic to the US, mostly in the eastern part of the country and particularly in the south. In 1947, spearheaded by the US Public Health Service an effort was begun to eradicate Malaria from this nation. This effort included treatment, education and elimination of the disease vector; the mosquitoes that carried it. In 1949, after just two years, the country was declared free of Malaria as a significant public health problem. Today it would be unusual for anyone to develop the disease here.

The Center for Disease Control is located in Atlanta as a result of being an outgrowth of that Malaria eradication effort. It continued to monitor Malaria control until 1952. The CDC is an important part of our national health effort today, although it is not part of that Service and is not under the direction of the Surgeon General.

At any rate, a director of a Public Health Service needs to be more than merely a fine physician, and more than an educator or public speaker. He/she must be capable of designing and directing a massive multi-disciplinary program from start to finish. Public health service is a complex and difficult medical-based administrative discipline, not a just a high level form of medical practice.

It is a sad note for our present National Public Health Service that seventy years ago, with the primitive resources available at that time, we were able to eliminate Malaria in just two years of national effort. Today we are unable to eliminate West Nile Virus, another disease transmitted by mosquito, and are not even trying at a national level. States are left to their own devices, a method certain to fail. Any state that succeeds will just be reinvaded by a neighbor state that has not eradicated the disease.

This is a national problem that our National Public Health Service is not dealing with. In part it may be that they are not being given adequate financial resources, but looking at the bio’s of recent Surgeons General suggests another possible reason; Surgeons General with medical rather than public health service backgrounds.

1 comment:

  1. Anonymous1:58 PM

    That was my first thought - no public healt service background. That in itself is enough to not approve his appointment. As an informal spokesman, invited speaker, etc, he would be fine. Like Warren Buffett as Treasury Secretary - good for public relations, but that's it.

    Yes, many recent SG's have been high profile and had generally good media campaigns regarding healt and lifestyle issues. But that's a side issue to real job of running a large department.

    Dr. Gupta - stay where you are, please.