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The Presidential Initiative to Eliminate Racial and Ethnic Disparities in Health: An Interview With the Surgeon General of the United States, David Satcher Author(s): Norma J. Goodwin and David Satcher Source: Health Promotion Practice, Vol. 1, No. 1 (January 2000), pp. 29-31 Published by: Sage Publications, Inc. Stable URL: https://www.jstor.org/stable/26734969 Accessed: 20-04-2021 08:06 UTC

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The Presidential Initiative to

Eliminate Racial and

Ethnic Disparities in Health: An Interview

With the Surgeon General of the

United States, David Satcher

Norma J. Goodwin, MD

David Satcher, MD, PhD, Assistant Secretary for Health and U.S. Surgeon General Department of Health and Human Services, is the 16th Surgeon General of the United

States. Sworn in on February 13, 1998, he is only the second person to simultaneously hold the position of Assistant Secretary for Health and Surgeon General.

In these dual roles, Satcher has adopted five evolv ing priorities for improving the nation's health.

Prior to this appointment, Satcher served 4 years as the director for the Centers for Disease Control and Pre

vention (CDC) and administrator for the Toxic Sub stances and Disease Registry from 1993 to 1997. In that role, he successfully spearheaded initiatives that mark edly increased childhood immunization rates from 55% in 1992 to 78% in 1996. He also upgraded the nation's capability for responding to emerging infectious dis eases and laid the groundwork for a new early warning system to detect and prevent food-borne illnesses. Under Satcher's direction, the CDC's comprehensive breast and cervical cancer screening program increased from 18 to all 50 states, 5 territories, and 15 American

Health Promotion Practice / January 2000 / Vol. 1, No. 1, 29-31

©2000 Sage Publications, Inc.

29

The Presidential Initiative to

Eliminate Racial and

Ethnic Disparities in Health: An Interview

With the Surgeon General of the

United States, David Satcher

Norma J. Goodwin, ]

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30 HEALTH PROMOTION PRACTICE / Januar)' 2000

Indian reservations, and the agency highlighted the importance of physical activity with the landmark Sur geon General's report on physical activity and health.

Apart from public service, Satcher spent many years in academia. He served as president of one of the nation's renowned historically Black colleges and uni versities, Meharry Medical College, which is the larg est private historically Black institution in the United States, exclusively dedicated to educating health care professionals and biomedical scientists. Satcher was president from 1982 to 1993, until President Clinton appointed him director of CDC.

Before that, Satcher was professor and chair of the Department of Community Medicine and Family Prac tice at his alma mater, the Morehouse School of Medi

cine. In addition, during his span at the King-Drew Medical Center in Los Angeles from 1977 to 1979, he was on the faculty, interim dean, and chair of the Department of Family Medicine, which he developed. While at King-Drew, he also directed the King-Drew Sickle Cell Center and served on the faculty of the UCLA School of Medicine and Public Health.

Satcher is a Robert Wood Johnson Clinical Scholar.

He has been the recipient of many outstanding awards—among them, 12 honorary doctorates and top awards from the American Medical Association, the

American College of Physicians, the American Acad emy of Physicians, and Ebony magazine. In 1995, he received the Breslow Award in Public Health and, in

1997, the New York Academy of Medicine Lifetime Achievement Award and the SOPHE Award.

Born in Anniston, Alabama, on March 2, 1941, Satcher graduated from Morehouse College in Atlanta in 1963 and was elected Phi Beta Kappa. He received his MD and PhD from Case Western Reserve Univer

sity in 1970, with election to Alpha Omega Alpha Honor Society. Satcher did his residency and fellow ship training at the University of Rochester, UCLA, and the King-Drew Medical Center. He is published widely in scientific and scholarly journals. He is an avid jogger, and he enjoys tennis and gardening. Satcher and his wife, Nola, have four children and reside in Bethesda, Maryland.

NG: Health Watch, along with many other community based organizations across the nation, is very pleased about this initiative. How much money is earmarked for it?

DS: One of the most important minority health under takings America has ever launched received a big

boost when Congress approved $65 million in first year funding for this Initiative. This is glue money. Other funds in all agencies are also being targeted to

eliminate disparities. With these funds, we can begin to bring real help to local communities that need it. This is really the first installment—President Clin ton has asked for $400 million over 5 years to do the job. This first wave of money is definitely commu nity targeted. For the Centers for Disease Control and Prevention, the funding includes $10 million for competitive grants to test promising intervention strategies, $10 million for community-based HIV/ AIDS demonstration projects, $5 million for cultur ally relevant community-based diabetes education and intervention strategies, $5 million for cardiovas cular disease (CVD) prevention programs in specific states, and $5 million for surveys, a health communi

cations campaign and development of a cancer con trol model for states to combat prostate cancer. For the Health Resources and Services Administration

(HRSA), $30 million is targeted to new community health center service delivery points in areas experi encing health disparities.

NG: Will any funds be allocated for HIV/AIDS beyond the $156 million earmarked to respond to the AIDS "state of emergency" in African Americans and other racial and ethnic (minority) communities?

DS: The administration worked with the congressional Black Caucus to obtain $156 million to address the

urgent problem of HIV/AIDS among minorities through Crisis Response Teams to be dispatched to a number of highly impacted areas to help assess pre vention and treatment services and needs and recom

mended strategies for action, Enhanced HIV/AIDS Prevention Efforts focusing on HIV prevention and substance abuse treatment programs for African American and Hispanic women and their children, and Reducing Disparities in Treatment and Health Outcomes for Minorities with HIV/AIDS. New

funding will assist minorities in gaining access to federally recommended cutting-edge HIV/AIDS drug treatments and the range of related primary health services needed. There is funding also to edu

cate health care providers on treatment guidelines. In

addition, the president fought for and won a historic

$262-million increase in the Ryan White Care Act and a 12% increase for HIV/AIDS research at NIH

(National Institutes of Health). Much of the Ryan White and other funds are going to fight HIV/AIDS in communities of color.

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Goodwin / AN INTERVIEW WITH DAVID SATCHER 31

NG: Of the six major problems targeted in the presi dent's initiative—infant mortality, cancer screening and management, cardiovascular disease, diabetes, HIV infection/AIDS, and immunizations—How would you rank their negative impact on minorities?

DS: We did not assign any of them additional impor tance over the others. They were selected because they are known to affect multiple racial and ethnic minority groups at all life stages and because reliable national data is available to track our progress. Each health area presents very different challenges. For example, although cardiovascular diseases cause the most deaths, infant mortality leads to the greatest number of years of life lost.

NG: How will the racial disparity funds be allocated among the six targeted health problems, and what is the rationale?

DS: The $65-million appropriation for 1999 will sup port planning for community-based demonstration programs.

NG: How much emphasis will be given to disease pre vention versus treatment?

DS: I believe prevention must play a critical role in any approach. But in areas such as immunizations, we know what will help to eliminate disparities. In oth ers, we need more effective methods. Our goal is a balanced community health system emphasizing health promotion, disease prevention, early detec tion, and increased access to quality care.

NG: When will the first RFPs (request for proposals) be available?

DS: A draft program announcement for the community planning awards will be published in March 1999 by CDC in the federal register for public comment. In spring 1999, CDC will publish the final program guidance and announcement and conduct or facili tate the conduct of preapplication technical assis tance workshops for eligible applicants. Community involvement will be key in all aspects of projects, and local communities will be encouraged to

collaborate with their state and local health agencies and interested universities. Because of separate funding for intensive HIV prevention efforts, appli cations for support should use that funding stream.

NG: To what do you attribute the disparities in health of racial and ethnic minorities?

DS: Underlying causes often include poverty, lack of adequate access to quality health services, failure to receive preventive or state-of-the-art health care, and the need for effective prevention programs tai lored to specific community needs. Education, envi ronment, and other socioeconomic factors also con tribute substantially. Continued research is important to better understand them.

NG: Why do you think HIV/AIDS is having a greater negative impact in the African American community?

DS: One reason is that our communities have associ

ated HIV/AIDS with issues we are not comfortable

discussing, such as sex and drug use. But just as they were in the civil rights era, churches and local com munity groups are in a unique position to be agents of change. We need them to educate, motivate, and mobilize their communities, not only about the threat but also about the effectiveness of medical treatments.

NG: Is there anything else that you wish to share? DS: Our goal is ambitious, and it marks the first time in

the history of this country that we have sought to eliminate disparities. For additional information on this initiative, visit our internet site.

Norma J. Goodwin, MD, is the founder and

president of Health Watch Information & Promotion Service, Brooklyn, NY.

David Satcher, MD, PhD, is the 16th

Surgeon General of the United States.

David Satcher,

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