Surgeon General Promotes Health of the Nation:
Unlocking Health Care for the Uninsured, Underserved,
Underrepresented, Uninspired, and Uninformed

By Melanie R. Margolis

On September 16, 1999, Surgeon General and Assistant Secretary for Health of the United States David Satcher addressed a conference on Ethnic Diversity and Diverse Health Outcomes sponsored by the Houston Department of Health and Human Services  (HDHHS). Dr. Satcher was introduced by Mary desVignes-Kendrick, M.D., M.P.H., Director of HDHHS. His remarks followed a presentation by Stephen Klineberg, Professor of Sociology at Rice University, which covered changes in Houston's demographics.

Dr. Satcher picked up on Professor Klineberg's theme of Houston's increasing ethnic diversity, saying that the U.S. must have a health care system that is capable of dealing with ethnic diversity and changing demographics. Specifically, the Surgeon General's major points were that the U.S. health care system must:

Dr. Satcher discussed the progress made under the Healthy People program, which began in 1979. Cardiovcascular disease, smoking, homicide, and teen pregnancy have been reduced. Infant mortality is down in all ethnic groups, though disparities remain among the groups. On 60% of the measures, Americans are doing better.

On the other hand, Americans are not doing as well on other fronts, including asthma, diabetes, and obesity. Dr. Satcher pointed to infant mortality as one of the best measures of health in a region because so many factors may contribute to it, including health and behavior of the parents, access to prenatal care, violence, sudden infant death syndrome, smoking, and use of drugs. Many in the audience seemed astounded when he stated that the U.S. ranked 24th in the world in infant mortality rate. AIDS has become a pandemic afflicting over 50 million persons, and resulting in 14-15 million deaths, worldwide. Dr. Satcher noted that progress has been made against AIDS, but it is not real progress. While fewer people are dying of AIDS, more healthy people with AIDS are having unprotected sex. It is a major concern as it increasingly affects women and people of color.

Dr. Satcher discussed the two goals of Healthy People 2010. The first is to increase the quality of healthy life. Life spans in the U.S. have increased, but quality of life needs to be addressed. Americans are less concerned with how they will die than how they will live. Healthy People 2010 will, therefore, add a focus on such conditions as arthritis, osteoporosis, chronic back pain, and disability.

The second goal is to eliminate disparities in health. Dr. Satcher carefully distinguished "eliminate" from "reduce" in this discussion. The disparities in some areas are large. For example, Vietnamese women have 5 times the rate of cervical cancer than white women. Also, white women are more likely than black women to get breast cancer, but black women are more likely to die from it. The program will focus on: 1) infant mortality; 2) cardiovascular disease; 3) cancer; 4) diabetes; 5) HIV/AIDS; and 6) child and adult immunizations.

The Children's Health Insurance Program (CHIP), referred to by Dr. Satcher as one of the greatest changes ever made to the U.S. heath care system, is overcoming a rocky start, having had problems enrolling children. Over 1/3 of Hispanics are uninsured, but many Hispanic parents had to be convinced that their children would not be adversely affected in applying for citizenship later by receiving CHIP benefits now.

Dr. Satcher also explained that Hispanics want physicians who speak their language and blacks want physicians who understand their culture. These groups are examples of what he referred to as the "underserved" and "underrepresented." Approximately 3,000 "uninspired" new teens start smoking every day, and "uninspired" persons use drugs and share needles. The "uninformed" do not know they have rights. Dr. Satcher added that mental health problems are as important as physical health problems. Too many of the mentally ill are in jail and are not receiving the treatment they need.

Dr. Satcher closed by emphasizing what needs to be accomplished in order to achieve success. The U.S. must move toward balanced health care with universal access. Americans must modify their behavior. Smoking, physical inactivity, and alcohol abuse are killing Americans. Dr. Satcher stated that over half of the deaths in the U.S. are due to human behavior. Personal responsibility is also community responsibility. Communities and schools can help by encouraging kids to exercise and teaching them about sex. Dr. Satcher touted what he called "the Surgeon General's prescription" for all Americans of moderate physical activity, good nutrition, and no smoking.