Former Surgeon General Targets Health Challenges
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."
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
- 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
"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
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
- 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 37th 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
According to Satcher's own report as Surgeon General:
- One in five Americans will have a mental disorder at some point during the
- 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
"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
"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
• National Center
for Primary Care
Health: A Report of the Surgeon General
Click here for more information about depression or other mental health issues.
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Created: 2/8/2003  - John Morgan, & Stephen A. Shoop, M.D.