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Dr. Joycelyn Elders: Americans Need to Be More Healthy

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

Editors 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 nations ailing health care system and offered advice to new Surgeon General Dr. Regina Benjamin.

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

As a spectator, Im 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 [Childrens Health Insurance Program]. I think its 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. Im saying we know that our system is not working, at least for all. Weve 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, Youre teaching them sexual health!

People dont 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 thats not part of what were 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 dont want to talk about nutrition and exercise. Wellness should be part of the bill, but its 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 acceptableyou have to be culturally competent. And equitable. If I need my wound sewn up today, dont 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 uswe must educate ourselves. There is an education gap because the poor are less educated. If youve grown up eating nothing but Big Macs and fries for dinner every night, you get a lot for your money and youre filled up, but its 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. Well pay a nursing home thousands of dollars but we wont 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. Its easy to write a check.

Youre also a vocal proponent of medical marijuana. Why?

I have been speaking out about it for a long time. Im a member of the board of advisors of a medical marijuana group. To me, its not nearly as toxic for our bodies as tobacco or alcohol. It should be legalized. As far as we know, it doesnt cause lung cancer, it doesnt 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, whats 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 dont think it is a drug that is doing harm to this country. By arresting people, putting them in jail for crimes related to marijuana, were spending millions on drug enforcement and it causes more problems. Young people are convicted of a crime, they cant get money to go to school, we have over 2 million prisoners a years and many related to drug useit 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 principlebe honest, empower the young with knowledge to make decisions, teach them to engage in responsible sex. Heaven knows theyre 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 Benjamin?

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. Dont 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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