Profile: Joycelyn Elders, former Surgeon General

Joycelyn Elders, MD, a pediatric endocrinologist, served as President Bill Clinton's surgeon general during his first term. Now an emeritus professor at the University of Arkansas for Medical Sciences, she keeps busy between advocacy meetings with former surgeons general and health care advocacy lectures around Little Rock.

Elders thinks that whoever the next surgeon general is, they should utilize the spotlight of the bully pulpit. "It's one of your greatest powers," Elders said. "If there's a specific problem in the country, you can get a group together and put out a report. Or you can do a call to action, to get all the experts in the field together. Discuss it, come to a consensus on what should be done about the problem. It doesn't mean we do it, but very often people take them seriously. They use it as a bible."

Elders wants universal access to health care for all working people. "Everybody in this country gets sick care. Make it so that everyone can get primary preventative health care as well." Elders also favors increasing funds to SCHIP.

On immunizations, "For all the things we have vaccinations for, we should make sure they're available for all children." She's okay with religious exceptions-so long as the immunization rate stays high, they get the benefits by default. But not if the overall rate drops too low, which she sees happening.

"Another major issue is health education," Elders said. "We need to educate our people on good nutrition, how to diet and exercise, to not engage in high-risk behavior, or unprotected sexual activities."

This is often misinterpreted-and rebelled against-as simply sexual education. "I'm always running around saying you can't educate a person if they're not healthy, and you can't be healthy without education," she said. Teach people how to stay healthy, she says, and we would reduce our morbidity rate by an astounding 40% to 50%.

Each surgeon general comes from a different background, and has a different pet project. "My pet thing was I wanted to prevent adolescent pregnancy," she said. Her wish came true: teen pregnancy rates dropped during the 1990s.

She credits Julius Richmond, MD, a pediatrician who was surgeon general for President Jimmy Carter, for having one of the greatest impacts on American kids' health-and mostly before he was even a surgeon general. Richmond began the Head Start program in 1965, which helps low-income children with nutrition, education, health, and parental involvement. As surgeon general, he kept it running during the stagflation of the 1970s.

Head Start is only serving 18% of the children who are currently on Medicare. Elders calls it a shame, and breaks into business lingo to describe the situation's potential: "There's a huge return on investment here." Making kids healthy today costs a lot less than making adults healthy tomorrow.

There are a lot of things to fix with America. But what about if, like many previous surgeons general, the new one hits a conflict between what the country needs to hear-and what the administration wants to focus on?

"The politicians have to be about what they have to be about," she said. But physicians have a higher calling. "I feel that the surgeon general's first responsibility is to the health of all the people of this country. You should always be true to that basic underlying fact."

For more on the US Surgeon General's office, please see our Contemporary Pediatrics Resource links.

MANAGING EDITOR: Jeff Ryan