Seven former U.S. surgeons general, along with the current occupant of that office, David Satcher, and Attorney General Janet Reno (pictured at left), came to the School of Public Health on April 2 to mark the 50th anniversary of the Universal Declaration of Human Rights, to share reminiscences and to discuss the politicized and tenuous nature of the post. Each surgeon general was awarded the School of Public Health's Dean's Medal.

None of the attending surgeons general had lost the frankness that seems to attach to whoever wears the uniform. Clinton appointee Joycelyn Elders, for instance, was still on the attack. "They called me the 'condom queen' because I wouldn't back down on adolescent and school health issues," she remembered. "Rather than figuring out how to teach teenagers to be responsible, Congress tries to legislate morals."

William H. Stewart, who served under Lyndon Johnson, said that the biggest challenge he faced was racism. The Civil Rights Act of 1964 prohibited segregated institutions from receiving Medicaid funds, and so Johnson, almost casually it seemed, asked him to oversee the desegregation of hospitals throughout the South.

C. Everett Koop (pictured at left), who held the post from 1980 to 1989, spoke out about the politization of AIDS, especially during the first four years of the Reagan presidency. "AIDS is a disease that's made for the surgeon general," he said, "but back then it was a political disease, and so not under my purview." Not until Reagan's second term was Koop able "to shame the government" into allowing him to battle the epidemic.

In fact, politicians have mounted assaults on the surgeon general's office for decades, repeatedly trying to fold its duties in with those of the assistant secretary of health. But those attacks haven't succeeded, thanks in part to the efforts of all those present--especially the two acting surgeons general, S. Paul Ehrlich Jr., 1973 to 1977, and Audrey F. Manley, 1995 to 1997--and in part to the mystique of the office.

"It's a paradoxical post," Koop said. "The surgeon general has no budget and no power ... and yet, the surgeon general has this moral power you can't ignore."

The attendees agreed that most Americans seem not to mind, and may even like, an occasional cranky lecture from their surgeon general, who takes them to task for their smoking, their atrocious diet and their couch-potato ways. As Julius B. Richmond, who served under Jimmy Carter, put it, "If the assistant secretary of health is announced, eyes glaze over; but if the surgeon general is announced, everybody sits up and nods gravely, and at least think they know what that means." Besides, said Richmond, the controversy swirling around the office is nothing new: "Sanitation was a hard sell in 1900," he said. "There's always resistance to change."

Of course, the subject of tobacco wove like a stained thread through the proceedings. The group thanked Leroy E. Burney for his 1957 report on tobacco, the first to declare definitively that lung cancer was linked to smoking.

Antonia C. Novello and Dean Alfred Sommer

Bush appointee Antonia C. Novello, who originated the idea for the get-together, remembered learning that Joe Camel had as much name recognition as Mickey Mouse with high numbers of 3- to 6-year-olds; it was then she decided to go after cigarette advertising.

Wrapping up their discussion the former surgeons general offered Satcher (pictured at right) some job counseling: Define and focus your agenda; base your statements on solid scientific data, not on opinion; set your boundaries early on with the president; and remember that biological and chemical terrorism are now squatting squarely on your doorstep.

Satcher, promising he would "protect the office and speak the truth," outlined a tentative agenda, including advocating for children; funding at least as much prevention research as basic science; destigmatizing mental illness; and closing the disparities, both in access to treatment and in prevention, that now exist between whites and most other ethnic groups in this country.

The afternoon was rounded out by Attorney General Reno, who thanked Koop for having declared that violence in America is a public health emergency. As a prosecutor for 15 years in Dade County, Fla., she said, she saw firsthand the effects of violence on communities and how violence destroys the social order that is the foundation of the Declaration of Human Rights. "You in public health have taught me so much," she said, "about the true meaning of working for human rights."

Dean Sommer chatting with Mayor Kurt Schmoke

The event was moderated by Marvin Kalb, first director of the Joan Shorenstein Center on the Press, Politics and Public Policy at Harvard University's John F. Kennedy School of Government. Kalb was previously chief diplomatic correspondent for CBS and NBC.

David Satcher and Marvin Kalb

The Surgeons General Program was brought together by the Doctor of Public Health Program and is a part of the Preventive Medicine Grand Rounds Series of the School of Public Health.