5 Reasons You Should Care About the Surgeon General

The nation will be one step closer to getting a new top doctor Tuesday.

President of Doctors for America Vivek Murthy, MD speaks in front of members of Doctors for America to show support for the health care reform bill in Washington March 22, 2010. 
National Journal
Sophie Novack
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Sophie Novack
Feb. 4, 2014, 3:36 a.m.

The na­tion will be one step closer to get­ting a new top doc­tor Tues­day.

The Sen­ate Health, Edu­ca­tion, Labor, and Pen­sions Com­mit­tee will con­sider the nom­in­a­tion of Vivek Murthy to the po­s­i­tion of U.S. sur­geon gen­er­al. Murthy is Pres­id­ent Obama’s nom­in­ee, and Demo­crats likely have the votes they need to at­tach the pan­el’s seal of ap­prov­al.

But since Obama took of­fice, noth­ing in health care has come easy — and Tues­day will be no ex­cep­tion. Re­pub­lic­ans con­tend that Murthy is an overtly polit­ic­al ap­point­ment, and not a par­tic­u­larly well-qual­i­fied one, for a po­s­i­tion that is sup­posed to be apolit­ic­al.

Murthy, 36, is the cofounder and pres­id­ent of the ad­vocacy group Doc­tors for Amer­ica, foun­ded in 2008 as Doc­tors for Obama. His polit­ic­al af­fil­i­ation and his re­l­at­ive lack of ex­per­i­ence have raised con­cerns among Re­pub­lic­ans about his nom­in­a­tion — as well as provided an­oth­er op­por­tun­ity for them to raise cri­ti­cisms about the Af­ford­able Care Act.

But such nom­in­ee squabbles have be­come a con­stant fa­cet of Con­gress’s per­petu­al play­act­ing, and every­day Amer­ic­ans will most likely tune much of it out any­way. But if they ig­nore the sur­geon-gen­er­al de­bate en­tirely, they’ll miss the se­lec­tion of an of­fi­cial whose de­cisions reach far in­to their every­day lives. Here are a few ex­amples.

1) Sur­geons gen­er­al im­pact policy. The sur­geon gen­er­al’s biggest and broad­est role is to bring mat­ters of pub­lic health to na­tion­al at­ten­tion. The of­fi­cial has the abil­ity to pri­or­it­ize health is­sues and dir­ect con­ver­sa­tion and policy in ad­dress­ing them.

Dif­fer­ent sur­geons gen­er­al may fo­cus on dif­fer­ent is­sues de­pend­ing on the prob­lems of the day, ran­ging from obesity, AIDS, sui­cide pre­ven­tion, health lit­er­acy, and to­bacco con­trol.

Sur­geons gen­er­al have led the charge in re­port­ing harm­ful ef­fects of smoking,with the 50th an­niversary Sur­geon Gen­er­al Re­port on Smoking and To­bacco Use re­leased earli­er this month. The first, re­leased in 1964 by Sur­geon Gen­er­al Luth­er Terry, his­tor­ic­ally linked ci­gar­ette smoking to lung can­cer.

“The re­ports are quite ef­fect­ive — cer­tainly on smoking — in cre­at­ing a na­tion­al pub­lic con­scious­ness on the is­sue,” says Dick Wood­ruff, vice pres­id­ent of fed­er­al re­la­tions at the Amer­ic­an Can­cer So­ci­ety Can­cer Ac­tion Net­work, which sup­ports Murthy’s nom­in­a­tion. “It’s al­most as if the sur­geon gen­er­al is the one who starts at the be­gin­ning and lays the ground­work for de­vel­op­ing a na­tion­al con­sensus on how to lead in pub­lic health; policy makers then act on it.” The re­ports get me­dia in­ter­ested and pres­sure law­makers to take ac­tion, cre­at­ing a “cas­cade” of na­tion­al at­ten­tion, he ex­plains.

“The Ci­gar­ette Act la­beling law prob­ably would not have happened in the ab­sence of [Terry’s] re­port,” Wood­ruff says.

2) They ad­vise elec­ted of­fi­cials. The sur­geon gen­er­al is ex­pec­ted to of­fer pub­lic health guid­ance to elec­ted lead­ers across the gov­ern­ment.

“The sur­geon gen­er­al is not the ul­ti­mate au­thor­ity — that lies with the pres­id­ent and Con­gress — but he has the abil­ity to weigh in based on cred­ib­il­ity and know­ledge,” says Richard Car­mona, who served as sur­geon gen­er­al in the George W. Bush ad­min­is­tra­tion. “In ad­di­tion to be­ing an ad­viser to Con­gress, the White House, and the [HHS] sec­ret­ary, I worked with just about every [agency] sec­ret­ary, in­clud­ing ag­ri­cul­ture, food safety, and de­fense.”

“You’re es­sen­tially the care­giver or ser­vice-giver for pub­lic and private or­gan­iz­a­tions where there are no oth­er pro­viders, or no oth­er ex­pert­ise,” says Car­mona.

3) They have na­tion­al and glob­al im­pact. The sur­geon gen­er­al over­sees the U.S. Pub­lic Health Ser­vice Com­mis­sion Corps, one of sev­en uni­formed ser­vices in the U.S., in­clud­ing the Army, Navy, and Mar­ine Corps. The corps is made up of more than 6,500 pub­lic health pro­fes­sion­als who work in med­ic­ally un­der­served areas, ad­dress dis­ease con­trol and pre­ven­tion, and work with oth­er coun­tries to ad­dress pub­lic health is­sues.

“The sur­geon gen­er­al is the seni­or doc­tor over an army of health war­ri­ors,” Car­mona says.

4) They fo­cus on pre­ven­tion. As pub­lic health of­fi­cials, rather than clin­ic­al health pro­fes­sion­als, sur­geons gen­er­al have his­tor­ic­ally had a pre­ven­tion-fo­cus. This was re­af­firmed by the 2010 es­tab­lish­ment of the Na­tion­al Pre­ven­tion Coun­cil, chaired by the sur­geon gen­er­al. The coun­cil was formed un­der the Af­ford­able Care Act — the only part of the role linked to the health law — and con­venes of­fi­cials from across gov­ern­ment de­part­ments to de­vel­op and im­ple­ment strategies for health ad­vance­ment.

5. They’re ac­tu­ally doc­tors. Sur­geons gen­er­al have ex­tens­ive back­grounds in medi­cine and pub­lic health, so their guid­ance is based on data, not elec­tion out­comes.

“For any­one in the gov­ern­ment in a high pro­file de­cision-mak­ing role, it’s hard to be com­pletely re­moved from polit­ics,” Wood­ruff says. ” But the sur­geon gen­er­al is a health pro­fes­sion­al — in that sense he has to be viewed as hav­ing the pub­lic health of the na­tion as his first in­terest.”

Why you shouldn’t care. This isn’t about Obama­care! It isn’t really even about polit­ics. Everything in Wash­ing­ton in polit­ic­al, but the job of the sur­geon gen­er­al is to cut through party di­vides and bick­er­ing for the sake of health.

“[The sur­geon gen­er­al] needs to rise above that,” says Car­mona. “People ex­pect to him to tell the truth about the sci­ence. [To say,] here are the facts about the is­sue; here’s really what’s im­port­ant.”

Car­mona dis­ap­proves of Murthy’s nom­in­a­tion not be­cause of polit­ics, but be­cause he be­lieves he lacks the ex­per­i­ence and cred­ib­il­ity to suc­ceed in the role.

We’ll see what mem­bers of the HELP Com­mit­tee think today.

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