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Help Wanted: Position Of U.S. Surgeon General
Now that Sanjay Gupta has turned it down, it's clear we need to redefine the job's importance.

David Gratzer
March 24, 2009

My "Sanjay Gupta moment" happened a few years ago when a CNN producer floated a limited appearance on his show. Things didn't work out, but my excitement was palpable. As someone who writes and lectures on health policy, most of my work falls under the radar. (A recent interview request included a magazine dedicated to the uniform business.) Dr. Gupta, a neurosurgeon, is a household name, with a popular TV show. He even made People's list of the "sexiest men alive."

Many shared my excitement when Gupta was mentioned as a potential surgeon general. Would he be the next C. Everett Koop?

Gupta's decision not to accept the nomination says much about the position and its lack of importance. Clearly, he hesitated over financial disclosures and the potential loss of income. From the get-go, Gupta's price of acceptance was a seat at the health reform table, but the surgeon general portfolio was not enough to lure him to Washington.

Not long ago, the surgeon general was a major player. The first holders of the office oversaw the marine hospitals. In the early part of the 20th century, the surgeon general helped control infectious disease outbreaks. And then, the breakthrough: the 1964 surgeon general's report on smoking that did more to save American lives than any other government paper in the 20th century. The office itself was filled with larger-than-life personalities who, in a storm of health fears and misinformation, navigated Americans' collective health knowledge. Think of the cerebral Dr. Koop speaking on the emerging AIDS epidemic.

But recent surgeon generals have distinguished themselves not by their work but their embarrassing comments—think Dr. Richard Carmona (for his attacks on his former boss, President Bush) or Dr. Joycelyn Elders (for her endorsement of educating students about masturbation). In the last few years, we simply haven't had a surgeon general, because the Bush White House considered the post too unimportant to bother filling. Acting Surgeon General Steven Galson busies himself with, among other things, issuing press releases praising Disney (nyse: DIS - news - people ) for using its name only on healthier foods. His reports have been little more than summaries of other government reports; Cliffs Notes meets public health.

The Cato Institute's Michael Tanner argues that the position is obsolete. With private organizations offering a slew of health information, he asks, "Why do we need a surgeon general in the first place?" Steven Milloy, senior fellow at the Competitive Enterprise Institute, basically agrees, suggesting that the Dr. Guptas of America will do more good by staying out of Washington.

But here's the irony: At a time when Tanner and Milloy are declaring the position dead and a celebrity like Gupta feels it would be a distraction for his career, the U.S. has never needed a stronger voice in public health. Three in five Americans are overweight; one in five is obese. Type 2 diabetes, once a disease of adulthood, now also plagues the young. Fully one in every three cancers could be avoided were Americans to adopt a healthier—and leaner—diet and lifestyle.

Today, as corporations struggle with their bottom lines and governments deal with empty treasuries, America's poor health has a direct effect: About 20% of the rise in health costs between today and 2020 will be due to obesity alone. Are we too fat for our companies to compete globally? Are we too supersized to afford Medicaid and Medicare in the long run?

Traditionally, the surgeon general serves the role of public-service-announcer-in-chief. Tanner is right to note that many others fill this role well. In an era of Google, we don't need another voice explaining to us the perils of smoking.

The position needs to be modernized. The next surgeon general should focus on government programs that undermine the nation's health. He should criticize agricultural subsidies that started in the days of Franklin D. Roosevelt but now make unhealthy foods too cheap, and lunch subsidies that feed poor children fatty foods.

But he should also highlight the success stories, where organizations and governments have worked to make it easier for Americans to access quality foods. Pennsylvania's Fresh Food Financing Initiative, a public-private funding effort dedicated to opening grocery stores in poor areas, should be a role model for the nation--one touted and championed by America's top doctor.

Past surgeon generals helped the U.S. survive tuberculosis and wean itself off of tobacco. The next surgeon general will need to help the country face the modern public-health epidemic of bad choices and ill-conceived government efforts. With the job done right, that person will ultimately prove more exciting than a celebrity doc.

David, Gratzer, a physician, is a senior fellow at the Manhattan Institute.

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