SURGEON GENERAL: Keeps ‘Finger On The Pulse’
U.S. Surgeon General David Satcher said he has "an opportunity to make a difference" because he can "have a platform," according to an interview published in this week's Journal of the American Medical Association. Satcher said his platform includes several key areas including: HIV/AIDS prevention and treatment; promoting responsible sexual behavior; improving child care; providing better mental health services and eliminating racial and ethnic disparities in health. "If you use [the platform] well and maintain your integrity, so that the American people can trust you to bring them the best information based on the best available science and also to work with your colleagues so that you can keep your finger on the pulse of the best information, you can make a tremendous difference," he said.
Prevention Is Key
Satcher said he'd "like to see physicians put prevention into practice," and that doctors should "ask their patients about nutrition and sexual behavior." In addition, providing "every child with a healthy start in life," is one of his main priorities. He wants to do this by "promot[ing] access to quality prenatal care, counseling women about the dangers of drinking alcohol and smoking during pregnancy," and creating an environment where society would "see an increase in parents who are ready to parent."
Bridging The Gap
Satcher also wants "to focus on the prevention and treatment of HIV/AIDS," and eradicate "racial and ethnic disparities in health," JAMA reports. "When we focus on the disparities, in order to close the gap we have to improve the public health system," he said. Satcher noted that the HIV/AIDS epidemic "has increasingly become an epidemic of color," and has extended its reach to the heterosexual population. However, Satcher said "Americans are fighting the [AIDS] battle with 'one hand tied behind our backs'" by not implementing comprehensive sex education or needle-exchange programs.
Having The Dreaded "Talk"
"As a nation," he said, "there are still some things we don't want to talk about which need to be talked about. Sex is one of them." Calling abstinence programs a "primary prevention" tool, Satcher said he believes "that the abstinence programs are very important ... especially for young adolescents under 14 years of age." He said abstinence "ought to be our major message -- don't become sexually active until you're involved in a committed relationship" -- but noted that "over half of the teenagers in this country" are sexually active by the time they graduate from high school. "It is just as important that we talk to them about how to be responsible when you're sexually active and protect yourself and others. Now there are some people in this country and many in Congress who want to talk about abstinence only, but they don't want us to talk about comprehensive programs that include secondary prevention for people who are sexually active."
Look At The Science
That attitude extends to needle-exchange programs as well, Satcher said. "Science showed that needle exchange programs did indeed reduce the spread of HIV -- they did it without increased drug use. But the political position now on the part of the House Of Representatives is a permanent ban on federal funding on needle-exchange programs. For the administration, it's been, 'Let's wait, and get more information.'" Satcher contended that the nation's substance abuse problem and AIDS are "linked" epidemics. "We have to fight both epidemics vigorously," he said. "If we fight the epidemic of substance abuse with all we have, including making sure everybody has access to treatment, it would significantly benefit the AIDS epidemic. So even if we didn't have needle-exchange programs, if we had access to treatment for everybody who needed it, we would significantly reduce the spread of HIV," Satcher said.
Satcher also wants to stop the stigmatization of mental illness. "I want to work with communities to create environments where mental health can thrive," he said. One step he has taken as surgeon general is to sponsor "the first-ever national suicide prevention conference in October." His office also "will be presenting a report on mental health next year" (Mitka, JAMA, 8/19 issue). Click here for previous Daily Reproductive Health Report stories on Satcher. The online Report is available free of charge through the Kaiser Family Foundation's website (www.kff.org).