David Satcher, M.D., Ph.D., was nominated for Surgeon General on September 12, 1997. The Senate confirmed his nomination on February 10, 1998, and he was sworn in 3 days later. This issue of Prevention Report focuses on the new Surgeon General and how he views his role as the Nation’s leading and most visible health advocate.

In addition to his title as Surgeon General, Dr. Satcher was named Assistant Secretary for Health in the Department of Health and Human Services (DHHS). The two positions were last occupied by one person when Dr. Julius B. Richmond served as Surgeon General and Assistant Secretary for Health during the Carter Administration.

Dr. Satcher previously headed the Centers for Disease Control and Prevention CDC), one of the eight operating divisions of DHHS that Dr. Satcher now leads as Surgeon General and Assistant Secretary for Health. He also oversees the U.S. Public Health Service, which recently celebrated its bicentennial (see Spotlight).

Advocating Disease Prevention
Under Dr. Satcher’s leadership, CDC increased its emphasis on disease prevention. The number of children immunized rose from 55 percent in 1992 to 78 percent in 1996. Today, vaccine-preventable childhood diseases are at their lowest point in history.

In addition, CDC’s comprehensive breast and cervical cancer screening program expanded from 18 States to all 50. CDC also expanded the capability of the Nation’s health care system to respond to new, emerging, and reemerging infectious diseases and created a new warning system to detect and prevent foodborne illnesses.

As the Surgeon General and Assistant Secretary for Health, Dr. Satcher is continuing to serve as an advocate for disease prevention at the national level. Dr. Satcher, like his predecessors, is using the high visibility of the Surgeon General’s office to educate the public about present and future health risks and scientifically based methods to reduce those risks.

Reports of the Surgeon General historically have proved effective as methods of health advocacy, dating back to the landmark 1964 Surgeon General’s report on cigarette smoking and lung cancer. In April, Dr. Satcher released his first Surgeon General’s report, Tobacco Use Among U.S. Racial/Ethnic Minority Groups, the 24^th Surgeon General’s report to focus on tobacco use since the 1964 report.

Rapid increases in smoking by teenagers from racial and ethnic minorities threaten to reverse the progress in combating lung cancer that occurred in the first half of this decade. This latest Surgeon General’s report recommended expanding prevention research to learn the patterns of tobacco use and the factors that influence young people from minority groups to start smoking.

An upcoming report of the Surgeon General will address mental health. This report, the first to focus exclusively on mental health and mental illness in the United States, will examine the latest research and recommend ways to improve the prevention, diagnosis, and treatment of mental health problems among Americans of all ages.

Evolving Priorities
Addressing the problems of mental illness is one of five public health priorities Dr. Satcher has identified in speeches and public announcements since becoming Surgeon General. He is quick to note, however, that he has brought no fixed agenda to his new job and that his priorities are evolving. Saying he wants to be known as the Surgeon General who listens, Dr. Satcher expects these priorities to evolve on the basis of what he hears from people as he travels around the country.

In addition to mental health, Dr. Satcher’s other four current priorities consist of giving children a healthy start in life, getting people to take responsibility for their own health, improving our understanding of the health care system, and eliminating health disparities related to race and minority status.

Giving children a healthy start in life encompasses not only the health of infants and children before and after they are born, but also the health of their parents. Specific problems include HIV transmission from mother to infant, teenage pregnancy, fetal exposure to crack cocaine, and the newborn baby’s early environment.

The concept of taking personal responsibility for our own health is a fundamental principle of disease prevention, according to Dr. Satcher. Included are such factors as proper nutrition, physical activity, sexual behavior, and the avoidance of toxins, especially tobacco.

Disease prevention and personal responsibility for health apply to all stages of life, from childhood to old age. Every 18 seconds, someone in the United States turns 50 years old as the baby boom generation continues to age. Over the next 30 years, older Americans will make up the largest single age group in this country.

Scientific evidence demonstrates that physical activity and good nutrition can go a long way toward improving the health, quality of life, and independence of older people. Health providers, health officials, and the public need to work together to help people become aware of and apply health concepts such as physical activity and nutrition that are under their control.

That task is not a simple one, given the complexities of today’s health system and overabundance of often conflicting health information. The 1990s have witnessed dramatic changes in the way health services are organized, administered, delivered, and paid for. Coupled with these changes are rapid advances in medical science and technology that threaten to outpace the public’s ability to comprehend their meaning and their significance for individual health consumers.

In this complicated and changing environment, Dr. Satcher believes another priority of the Surgeon General is to communicate with the American people about the health care system—how to access it and how to make it work for them and their families. At the same time, the Surgeon General needs to keep Congress and the Administration in-formed about what Americans need that will assure them of access to ad-equate health services.

Despite the medical breakthroughs of the 20th century and despite new approaches to health delivery, disparities remain between the health status of the general population and minority populations in the United States.

Infant mortality among the black population, for example, is twice that of whites in the first year of life. Hispanics and American Indians are twice as likely as whites to have diabetes, a chronic condition that can lead to other serious and costly health problems, such as blindness, amputations, kidney disease, stroke, and heart attack.

Eliminating health disparities in minority populations is another of Dr. Satcher’s priorities. In addition to infant mortality and diabetes, he has targeted four other areas where significant disparities exist—cervical cancer, cardiovascular disease, HIV/AIDS, and immunization. The goal is to eliminate the disparities in these six areas by the year 2010.

All six of these minority health target areas, as well as Dr. Satcher’s other evolving priorities, are included in Healthy People 2010, the latest version of the health objectives for the Nation. The next draft of Healthy People 2010 will be posted for public comment in September on the Healthy People Web site (www.health.gov/healthypeople).

Dr. Satcher has been actively involved in the development of Healthy People 2010 and will continue his involvement as the Nation’s chief public health official and advocate. According to Dr. Satcher, public health in the end amounts to healthy people who live in healthy communities, the concept that forms the foundation for the goals and objectives contained in Healthy People 2010.

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