Thursday, July 16, 2009

Choosing a Surgeon General

Possibly the least understood position in the U.S. Government is that of Surgeon General. As head of the Public Health Service, the holder of that position automatically holds the rank of Rear Admiral, a result of the service having initially been formed to serve the needs of members of the Merchant Marine. (I was once asked why the Surgeon General always came from the Navy.) It was expanded to help prevent the spread of communicable diseases such as smallpox.

One of the great achievements of the Public Health Service was stamping out Malaria as a deadly plague in the United States. Until the mid-1900’s Malaria was endemic in the entire Eastern US, particularly in the South, and killed thousands of people every year. Yes, in this country. The Public Health Service mounted a campaign to eradicate the mosquitoes that spread the disease, and in less than five years had eliminated that disease as a threat. Today Malaria is occasionally contracted, but only rarely, and is almost never fatal. That effort resulted in the Centers for Disease Control in Atlanta, which is part of the Public Health Service today.

I have no doubt that Dr. Regina Benjamin is an outstanding doctor and a wonderful person, one greatly to be admired. All of the writing about her makes much of her background in the delivery of healthcare to individuals, and it is profoundly admirable. However, none of what I have read relates to her qualification as Surgeon General.

Public Health Service is not about delivery of health care to individuals; it’s not about delivery of health care at all. Public Health Service is about maintaining the systems which underlay the state of the public’s ability to remain in an overall condition of good health. It’s about monitoring the spread of communicable diseases and studying ways to stop that spread. It’s about looking at water delivery systems and evaluating the ways in which those systems are affecting the overall health of the communities they serve; not just one water system, but the water systems of all of the communities in the nation. To name just a few.

The Public Health Service is the agency which takes the information about issues affecting the health of a community that is discovered in one place, and disseminates that information to all other communities which might be affected by it. The PHS has to communicate not only the problem, but the cause of the problem and solutions to the problem, and they have to put that information into a package that is understandable and useful.

We certainly need doctors like Dr. Regina Benjamin, in fact we need more of them than we have, and we need to recognize what they contribute. But we also need those who rise above the individual and do the “big picture” work of protecting the community as a whole, and the characteristics of those two people may be entirely different.

1 comment:

  1. So why does the SGUS come fromn the navy? is it like a Marine corpsman?

    The SGUS i've always seen to be a bully pulpit for health awareness on the public side and behind the scenes where no one sees it - running the PHS as an administrator.

    Those are not incompatible, but being a rural family practicioner and a head of a large governmental agency is two different things. Like good faculty not always being good administrators and vice versa.