Former Surgeon General offers prescription to fix U.S. health care system

	David Satcher was the 16th Surgeon General of the United States.

The former Surgeon General of the United States under President Bill Clinton and an advocate for quality care for all Americans laid out a convincing argument for reprioritizing the country’s approach to health care in a talk at Lehigh on Oct. 30.

“When it comes to decisions about health, we hear a lot about personal responsibility. But the reality is that we have a health care system that leaves out far too many people,” said David Satcher, M.D., Ph.D., currently the director of the Center of Excellence on Health Disparities and Poussaint-Satcher-Cosby Chair in Mental Health at the Morehouse School of Medicine.

The victims of inequitable quality health care include a host of social subgroups: the uninsured, the under-insured, the under-served, the under-represented, the uninspired, the uninformed and even the untrusting.

“We have about 47 million people in this country alone who are uninsured,” he says. “And when you look at global health disparities, the situation is even worse. We spend close to $2 trillion a year on health care, but we rank lower than many countries in terms of outcome. The U.S. ranks 37th out of 191 countries, our life expectancy is lower than many other countries, and even Cuba has a lower infant mortality rate than the U.S.

“It’s not what we invest,” he said, “but how we invest it.”

He attributes that fact to the lack of balance in a health care system that focuses too heavily on the treatment of disease, but places little stock in prevention.

“Somehow,” he said, “we have to find a way to shift that balance. We need to focus on issues like obesity—which is one of the worst epidemics we’ve ever faced in this country—and recognize how much it really costs in terms of high health costs down the road.”

A focus on prevention, he said, is also a moral issue.

“It is much more humane to prevent disease rather than to make people suffer,” he said.

Equally pressing from a moral standpoint is the issue of access to care, which accounts for 20 percent of health outcomes, Satcher said. Other determinants include biology and genetics, social environment and human behavior, but he said that major differences in health outcomes can be directly linked to access to quality care.

“With many groups, the major disparities begin with the first year of life,” said Satcher, who linked limited access for several racial and ethnic groups to higher death rates.

What if we were equal?

To illustrate his point, Satcher rattled off a series of statistics that underscored the differences between disease and death rates for African-Americans and Caucasians.

Assuming no disparity in health care over the course of the last century, Satcher concluded that 83,500 African-Americans in the U.S. would not have died from heart disease, HIV/AIDS, infant deaths and breast cancer in one year. Universal access to health care would have improved the lives of an additional 2.5 million African-Americans.

An ideal approach to the problem would include several points of attack, including access to care, improved quality of care, lifestyle enhancement, improved physical and social environments and a balanced research agenda that combines basic lab research with community-based investigation.

“Somehow,” he said, “we have to get the science and the policy together. The critical issue is how to do this. Right now, it takes 15 to 17 years from new discoveries in medicine to making these services available to people in the community. We need people working to deliver these benefits sooner.”

Satcher was introduced by Anne Meltzer, dean of the College of Arts and Sciences, who detailed a long list of accolades Satcher earned over the course of a high-profile medical career.

Upon taking the podium, Satcher shared his personal story of growing up poor in rural Alabama, with limited access to doctors in the face of life-threatening disease. That experience, he said, provided the impetus for serving others through medicine.

“It’s one thing to talk about honors and awards,” he said, “but that has never been my inspiration. The fact is that, as far back as I can remember, I was sure that I wanted to be a doctor, just like the one who saved my life. I was as sure of that as I’ve been about anything.”

Satcher completed his term as surgeon general in 2002, and devoted much of his efforts to Healthy People 2010, a set of health objectives for the U.S. to achieve over the course of the first decade of the 21st century. He also served as assistant secretary for health in the department of Health and Human Services from 1998 to 2001, making him only the second person in history to have held both positions simultaneously.

His talk was sponsored by the Health Medicine and Society Faculty Seminar group, with support from a W.M. Keck Foundation Grant (the program for Applied Life Sciences).

The talk is also funded by the Visiting Lectures Committee; the Chaplain’s Office; the Science, Technology and Society program; the Multicultural Center; the Women’s Center; and the Humanities Center.

--Linda Harbrecht