Public Health and Disease Prevention

The Surgeon General continues to publish reports on public health issues that have long been a matter of national health and social policy. For example, the Surgeon General has sought to promote maternal and child health and welfare, a field in which the federal government made one of its first forays into social policy with the establishment of the U.S. Children's Bureau in 1912. Since then, the federal government has dispensed advice on infant care and breast-feeding as well as the care and rehabilitation of disabled children, subjects to which the Surgeons General have devoted several reports as well.

The active promotion of health is an area that has been given increasing attention in recent decades. In 1979, Surgeon General Julius Richmond issued a landmark report entitled Healthy People: The Surgeon General's Report on Health Promotion and Disease Prevention. It represented an emerging consensus in the health community that the nation's health policy had to be dramatically recast to emphasize the prevention of disease. The report established for the first time ambitious, quantifiable objectives for improving the nation's health, to be achieved by 1990. Subsequently, the Healthy People objectives have been revised every decade. The 1979 report also encouraged people to make more personal responsibility for their own health through proper nutrition, regular physical exercise and other appropriate behaviors. A 1996 report on Physical Activity and Health, issued under Acting Surgeon General Audrey Manley, was another milestone in the effort to motivate Americans to take more responsibility for their own health.

Surgeon General Antonia Novello, the first woman and the first Hispanic to hold the position, focused on the health of women, children, and minorities during her tenure. Novello organized a Surgeon General's Conference on Healthy Children Ready to Learn: The Critical Role of Parents, the proceedings of which were published in 1992. She also organized the first workshop on Hispanic health, which resulted in the publication in 1993 of One Voice, One Vision: Recommendations to the Surgeon General to Improve Hispanic/Latino Health.

At the same time, the Surgeons General have applied a public health perspective to areas of health care that have traditionally centered on the treatment of individual patients. Most notably this occurred in the area of mental health. In 1999 Surgeon General David Satcher issued Mental Health, a report that focused not on individual diagnosis and treatment but rather on the mental health of the population as a whole. It pointed out that for one in five Americans, adulthood is interrupted by mental illness. The report reviewed the neurological and genetic origins of mental disorders, discussed the influence of the physical and social environment on mental health, and made recommendations for prevention and mental health promotion. Similarly, The Surgeon General's Call to Action to Prevent Suicide, also issued in 1999, viewed suicide in epidemiological terms and as a major preventable cause of death, affecting different gender, age, and ethnic groups in different ways. As part of a proposed national prevention strategy, the Call to Action pursued the same preventive approach that public health officials have taken to bodily diseases and mental disorders. It offered recommendations to enhance public awareness of risk factors for suicide, to expand mental health and drug rehabilitation services that benefit those most at risk of suicide, and to promote the scientific study of suicide prevention.

Satcher has also focused on the elimination of health disparities, an issue which has been one of the two overriding goals of Healthy People 2010, released in January, 2000. The objective is to eliminate the disproportionate prevalence of particular diseases and the unequal access to health care among different racial, ethnic, and socioeconomic groups. A report on tobacco use among ethnic and racial minorities was issued in 1998, noting, among other findings, the particularly severe health effects from smoking suffered by African Americans.

The Surgeons General have applied an epidemiological, population-based, and environmental approach to an increasing range of issues. In doing so, they have expanded the scope of public health into areas previously considered to be the domain of individual patients, their doctors, and their insurers. The real outcome of Surgeon General publications is to give evidence to support health promotion/disease prevention policies at all levels - national, state, local, family, individual, professional and non-professional. Many of the policy implications raised by such an approach, by a conception of public health broadened beyond issues of sanitation, immunization, and control of infectious diseases, have yet to be realized.