By John Morgan, Spotlight Health
With medical adviser Stephen A. Shoop, M.D.

One month into the New Year and America is facing a gauntlet of national challenges - from the Columbia tragedy to the possibility of war in Iraq. But former Surgeon General David Satcher believes in America's character to solve and overcome our toughest problems.

According to Satcher, many of the challenges ahead involve our health.

"I think we need to be realistic about the state of America's health," says Satcher, who is director of the National Center for Primary Care at the Morehouse School of Medicine, Atlanta. "In some areas, we have made substantial, exciting breakthroughs. In others, we still have great improvements to make."

Obesity is an area that Satcher notes is particularly troublesome.

"There's no question obesity is an epidemic problem in America," Satcher states. "In the African-American community, 50% of females over age 40 are obese."

Nationwide the statistics are not much better.  An estimated 64% of Americans are either overweight or obese.

"One of the major points about being overweight or obese is this is not about beauty," Satcher cautions. "It's about health. It's not about getting to a certain dress size because I'm not going to define beauty for anyone. But we do know the many related illnesses caused directly or indirectly by being overweight."

"Fifty percent of deaths are related to lifestyle choices like obesity and smoking," Satcher adds. "That's why we are pleased that it appears many people took our report on obesity to heart. Just a 5% weight loss can significantly reduce a person's risk of Type 2 diabetes."

Satcher says the difficulty for many people in making lifestyle choices is patience -- long-term versus short-term thinking.

"We're a country that wants it now or next year," Satcher explains. "When it comes to lifestyle changes, like improving one's nutrition, small changes may not add up as fast as people would like and they can get discouraged.  But they must not forget that these small changes are improving their health right away."

Exercising options

One key to getting healthy is exercise.

Satcher says exercise is a daunting challenge for many Americans. Embarking on an exercise program requires making a commitment that many find difficult to maintain. "We're making progress in educating people about the importance of exercise," Satcher says. "But it's evident there's work still to do."

Physical activity not only helps with weight loss but also provides the following benefits:

• Reduces the risk of certain cancers and diabetes
• Reduces the risk of heart disease
• Relieves stress
• Improves sleep
• Improves concentration
• Improves sexual health
• Reduces bone loss

Satcher also believes that being proactive about one's health is important to maintaining good health. Of the estimated 15 million Americans with diabetes, as many as five million don't even know they have it. Millions more Americans are unaware of their heart disease or asthma.  For many diseases, especially cancer, early detection and screening translate directly into better treatment outcomes.

"We tend to react in American medicine," Satcher notes. "We're better at reacting. The problem is we don't expend enough resources preventing illness. It is far more cost effective to prevent illness that to react to it.  We could treat a lot more people if we invested in preventing illness."

Satcher understands the need for increasing available healthcare resources.  His work with the National Center for Primary Care is focused on training, research and policy analysis to address the health challenges of under-served populations and to eliminate health disparities.

Another health obstacle for America to overcome is economic.

"The most disturbing trend may be the increasing costs of healthcare - over 14% increase," Satcher reports. "And more and more employers are dropping healthcare coverage so we have more and more working Americans without insurance."

Many experts, including Satcher, believe that investment in health promotion, disease prevention and early detection can dramatically cut costs and help provide universal access to healthcare.

But in a stumbling economy, such long-term investment often is problematic to fund.

Other challenges include:

• HIV/AIDS - "We need a vaccine," Satcher states. "We need new anti-retroviral agents developed. AIDS is still a problem here but especially in developing regions."
  
  
• Skin cancer - One of the few cancers that is still increasing. "We need to do a much better job teaching our children about skin cancer," Satcher says. "Children need protection from skin damage the most. We should be teaching it in schools like they do in Australia."
  
  
• Healthcare efficiency - According to the World Health Organization, the United States ranks 37^th in healthcare efficiency. "We're spending 'A' money and getting 'C/C+' results," Satcher reveals. "We need to improve the access and balance of our healthcare. Far too many are underserved or not served at all."

Mind over matter

Satcher may be most passionate when he discusses the opportunity America has to address the challenges of mental health. For Satcher, who was the first Surgeon General to deal with mental illness, this topic encompasses both societal compassion and fiscal intelligence.

"These disorders are real and treatable," Satcher says. "Mental illness is the second-leading cause of disability, second only to cardiovascular disease. We need to do a better job at educating people - mental disorders are physical disorders."

According to Satcher's own report as Surgeon General:

• One in five Americans will have a mental disorder at some point during the year.
• According to 1996 estimates, mental illness directly and indirectly costs the US economy approximately 148 billion dollars.
• Annually, 15% of adults will use some form of mental health service.
• Approximately 54 million Americans will experience mental illness but only eight million will actually seek treatment.

"The good news is 80%-90% can be treated," Satcher adds. "The bad news is because of stigma most of those afflicted won't seek help."

According to Satcher, studies indicate that better comprehensive treatment of mental illness would help save healthcare dollars, noting that many people complain of ailments to their doctors that are actually caused by untreated mental disorders. Depression and anxiety can severely affect overall physical health, but many people are embarrassed or even shamed to admit they are depressed.

And even if they did identify their depression, insurance policies often only cover a third of treatment. Many public health experts are puzzled by such disparity in coverage.

"Insurance has little problem paying for expensive heart tests but won't fully cover a patient's anxiety disorder which we later discover was causing the chest pains they originally complained about," says Dr. Gregory Fricchione, a mental health expert and former director of the Mental Health program at The Carter Center.

"A big opportunity this year is for Congress to pass comprehensive parity legislation, like the Domenici/Wellstone bill," Satcher says. "Providing equal coverage for mental illness would go a long way toward helping solve a major healthcare problem in this country."

As for the future, Satcher remains optimistic. "We're making progress and we're getting better."

• National Center for Primary Care

• Mental Health: A  Report of the Surgeon General

Click here for more information about depression or other mental health issues.

Spotlight Health is the leading creator of celebrity-featured health-issue awareness campaigns, connecting consumers with impassioned celebrities whose personal health battles can open eyes, dispel myths and change lives. Spotlight Health helps sufferers and caregivers meet the challenges of difficult health circumstances with understandable, in-depth medical information, compassionate support and the inspiration needed to make informed healthcare choices.

Created: 2/8/2003  -  John Morgan, & Stephen A. Shoop, M.D.