Dr. Joycelyn Elders on national health care legislation

[Guest guest]

Dr. Joycelyn Elders: Americans Need to Be More Healthy

New America Media, Q & A, Annette Fuentes, Posted: Aug 03, 2009

Editor's Note: Dr. Joycelyn Elders became the first African-American woman

surgeon general when she was appointed by then-Pres. Bill Clinton in 1993. But

she was forced to resign 15 months later after she made remarks about sex

education for youth deemed controversial. Today, at 76, she is still an ardent

and outspoken public health advocate. She spoke with NAM editor Annette Fuentes

about her prescription for the nation's ailing health care system and offered

advice to new Surgeon General Dr. Regina .

What are your thoughts as you watch Congress wrestle over national health care

legislation?

As a spectator, I'm hoping Congress will fight to the end. We tried 10 times

before. About every 30 years in this country we make a real hard push. First we

had Social Security, then unemployment insurance, then we had Medicare and

Medicaid, and then CHIP [Children's Health Insurance Program]. I think it's time

we develop a health care system in this country.

We dropped from number one in health to number 55 in the World Health

Organization rankings. We rank one in spending and we rate 37 on life

expectancy. On infant mortality, we dropped to 28. I'm saying we know that our

system is not working, at least for all. We've got the best doctors and nurses,

the best hospitals, we do cutting edge research. There is no reason we should

not have the best care. Part of that is us. We have not educated our people to

be healthy, but if you talk about that, they say, `You're teaching them sexual

health!'

People don't know how to take care of themselves, to maintain ideal body weight.

You have to start very early with simple things, like good nutrition. Fifty-two

percent of children get free or reduced lunch at school. That means they are

poor. At least we could give them breakfast, too, so we could really begin to

teach them how to eat.

What provisions would you like to see in the finished product?

The bill will never reduce costs until we educate people to be healthy, and

that's not part of what we're talking about. We need comprehensive health

education, from kindergarten through 12th grade. We need physical education. We

complain about the 67 percent of Americans who are overweight and yet we don't

want to talk about nutrition and exercise. Wellness should be part of the bill,

but it's a long-term process and everyone wants to see immediate benefits.

Prevention health measures are very critical, and if you want that you have to

pay for it.

The other thing is we should make sure our health care is going to be available,

affordable, and acceptable—you have to be culturally competent. And equitable.

If I need my wound sewn up today, don't give me an appointment next week. We all

know we have disparities and we can try to eliminate as many as we can. But part

of the disparity is on us—we must educate ourselves. There is an education gap

because the poor are less educated. If you've grown up eating nothing but Big

Macs and fries for dinner every night, you get a lot for your money and you're

filled up, but it's not nutritious.

What about the issue of long-term care, which is a growing problem for older

Americans? None of the health care bills address that.

It is a ticking time bomb waiting to pop off. We're not even planning how to do

that. We have 1.5 million nursing home beds, but the number of people going into

nursing homes is dropping and more are staying in the community and being taken

care of in the community. We have to look at how we can help families take care

of their aging population in their own homes. There are many things communities

can do, and parents prefer that. We'll pay a nursing home thousands of dollars

but we won't give the family $2,000 a month so they can hire people to come in

and help. We could train community health workers. But we pay the nursing home.

It's easy to write a check.

You're also a vocal proponent of medical marijuana. Why?

I have been speaking out about it for a long time. I'm a member of the board of

advisors of a medical marijuana group. To me, it's not nearly as toxic for our

bodies as tobacco or alcohol. It should be legalized. As far as we know, it

doesn't cause lung cancer, it doesn't cause people to go out and drive drunk and

commit crimes. If it helps reduce the nausea and vomiting and reduce leg cramps,

make patients feel better, what's wrong with that? We should make it available

to people who need it. I feel if people want marijuana, they could get a

prescription. Then we can tax it and know who is getting it. I don't think it is

a drug that is doing harm to this country. By arresting people, putting them in

jail for crimes related to marijuana, we're spending millions on drug

enforcement and it causes more problems. Young people are convicted of a crime,

they can't get money to go to school, we have over 2 million prisoners a years

and many related to drug use—it is a vicious cycle and one we created.

You have been an ardent advocate for sexuality education. Have you seen any

progress?

We went backward for a while. During the AIDS epidemic, we made progress on

sexual health. It is amazing to me we can talk about physical health and barely

about mental health. But when we talk about sexual health we go ballistic. We

are sexual beings, from birth to death. Young people need to understand these

feelings. Old people pretend they forgot all about it. We need to live by the

HER principle—be honest, empower the young with knowledge to make decisions,

teach them to engage in responsible sex. Heaven knows they're already doing it.

The HIV rate is as high in Washington, D.C., among black people as it is in

South Africa. We need to prevent unintended pregnancies and sexually transmitted

disease. Up to half of STDs are among young people, and 50 percent of black

youngsters have an STD.

What advice do you have for new Surgeon General Dr. Regina ?

I would tell her that I feel the surgeon general is a very important and

critical job, but I feel she should always stick by the principles she believes

in. She should be surgeon general for all the people in this country. Whatever

she does, it is scientifically based, something she wants to do. Don't worry

about the critics. If she has something she feels strongly about, she has a

group of previous surgeon generals whose shoulders she can stand on.

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