In Black America; Surgeon General David Satcher M.D.

I would like to bring this one. From the Longhorn Radio Network, the University of Texas at Austin, this is in Black America. Violence and injuries now represent the leading cause of years of life loss. Not the leading cause of death, but when somebody dies young, you lose more years. So it's the number one cause of years of life loss. It's a major burden on the health care system, emergency rooms, overwhelm, violence, 15 billion dollars a year, the treat injuries. And you know, we talk about homicides. It is true that about 40,000 people a year die in this country from either homicide, suicide or accidental gun death.

But for every person who's killed, 100 people, almost 100 people will be injured. And some of them disable for life. So you really can't tell the magnitude of the problem just by talking about homicides and deaths and suicide. Because there's so many people who are injured for life, you know, in violence. And it's a major health problem for the health care system. Dr. David Satcher, a physician, scholar, and lifelong public health advocate. On February 13, 1998, Dr. Satcher was sworn in at the 16th Surgeon General of these United States and as assistant secretary for health. The 63 to 35 vote by the US Senate and share the polls of the nation's top. Health spokesperson will be filled for the first time since Joyce and Elders was fired in 1994 after controversial remarks about human sexuality. Dr. Satcher was president of a Harry Medical School from 1992 until he was named director of the CDC in November, 1993.

I'm John L. Hanson, Jr. and welcome to another edition of In Black America. On this week's program, Dr. David Satcher, M.D., US Surgeon General in Black America. You've got to be able to diagnose the problem early and prostate cancer is probably your best example, just using a rectal exam in a large percentage of cases. You can diagnose prostate cancer early enough to treat it surgically. However, when patients come in and the cancer has already spread to the bone, which is often the case with black men, does not much you can do except chemical treatment.

So we have a push on all over the country to try to improve that. It's amazing the number of black men who've come down with prostate cancer in the last few years. A lot of, you know, my contemporaries have a friend out in Los Angeles who himself was just diagnosed with prostate cancer. And now he's out of the hospital and he said that he is going to do everything he can to get more black men to get in to see a physician and to get early diagnosis. And we have the same kind of push all over the country, but we need help. Dr. Satcher served as director of the Center for Disease Control and Prevention in Atlanta from November 15, 1993 until a swearing in as U.S. surgeon general under his leadership, CDC placed a great emphasis on disease prevention. Dr. Satcher is a former faculty member of the UCLA School of Medicine and the King Drew Medical Center in Los Angeles. Before joining Mahari and becoming his president, he serves as professor and chairman of the Department of Community Medicine and family practice at Morehouse College of Medicine in Atlanta.

Born in Anderson, Alabama, Dr. Satcher graduated from Morehouse in 1963 and was elected Phi Beta Kappa. He earned his PhD in MD degrees from Case Western University in 1970. On February 13, 1998, Vice President Al Gore administered the oath of office to him at a White House ceremony in the Oval Office along with President Clinton. In black America spoke with Dr. Satcher when became the new director of the CDC. Went to college at Morehouse College from 59 to 63. Then I left here and went to Cleveland where I went to, it was then Western Reserve, it later became Case Western Reserve. And I did both my medical degree and my PhD at Case Western. What sparked that initial interest in medicine? Well, I guess it goes back to my illness. I was severely ill as a child with whooping cough, which turned into pneumonia. And I guess I came very close to dying.

And of course, my mother told me that story so much. The bad time I was six years old, you know, I was saying that I was going to be a doctor. And before accepting this position, you were overridden. Mahari. Yeah. In fact, from 1982 to 93, 11 and a half years. And could you tell us a little bit about that experience? It was great running in the medical school. Yeah, I was the greatest experience of my life to tell you the truth. It was a very enriching experience. My hair was a great institution. It was founded in 1876. And by 1980, it had graduated almost half of the black physicians and dentists in this country. And not only that, but three out of four of them had gone to practice and understood rule in illicit communities. So it's a great institution. And I went there at a very critical time in this history. And we were able to do some things to, I think, significantly strengthen the institution in this program and its future. I feel very good about my experience at Mahari.

There's some great people there. Are you finding the commitment and also the drive from African-American young people wanting to become involved in the medical profession? Well, yes, but not enough. I think we're really concerned that the... The lack of resources on their part are just not knowing that the medical profession is a viable profession. I think it's a combination. I think really what we're seeing now, of course, is that a lot of our young people are dropping out early. I mean, they're either dropping out physically or psychologically. I mean, they're letting people convince them that they can't do things that they can do. And that's partly our fault that we need to be there for them. We're the ones who ought to be telling them what they can do, even when they're in the fourth grade and sixth grade. So I think we have a lot to do. Whenever I speak to groups now, I just talk about, we all have a responsibility to reach back and give back and interact with these young people as early as we can to get them interested

in careers in the health field because, as you all know, a lot of our young people are dropping out so early that they don't end up in any careers. So we need to double the number of African-American students who are entering medical schools year by year 2000. So we're going to even begin to keep pace. For those listening that are familiar with the Center for Disease Control and Prevention, could you tell us this mandate and the direction you want to take the center as it's the director? Well, yeah. It's a, first of all, history, CDC is about 50 years old. It actually started as part of World War II when malaria was a major problem for the troops in training and in battle. And so this agency was set up in the South to deal with malaria. After World War II, it was decided that we needed to continue a communicable disease center like this.

And it's gone through several name changes. It was the communicable disease center. It was a center for communicable disease control. It was a Centers for Disease. And then in 1992, it became the Centers for Disease Control and Prevention. This vision is healthy people in a healthy world. And that speaks to the fact that we're concerned about the environment as well as the people in it. The mission is to prevent and control disease and disability. And really to promote healthy lifestyles and the healthy quality of life. That's the mission. So we call ourselves the nation's prevention agency. And we're really pushing that because we feel that the nation really needs to put more attention on prevention. Less than 1% of the budget for health in this country has been for prevention. And so we have a major trust. In terms of my own priorities that are still evolving, there are four areas of major concern. One is one I just mentioned.

In fact, we just believe that there's a need to really strengthen the prevention effort in this country. We can prevent a lot of deaths in this country, especially among African Americans. Those 80,000 excess deaths a year, we can prevent many of those deaths and we've got to move to do that. The second thing is the area we call urgent threats to health. And under that, I would include violence, certain infections like AIDS and the hunt of arrows and the re-emergence of tuberculosis. We thought we had conquered tuberculosis. It had been going down from 65 to 85. And now since 1985, we've seen re-emergence of this disease. A lot of drug resistance, a lot of it, of course, is related to AIDS because AIDS damages the immune system. But also when you're trying to treat a homeless person for six to nine months would enter tuberculosis, you can't do it. So there are social problems that are interfering. And of course, a lot of people immigrate into the country with TB.

So this whole area of urgent threats to health is one that we're really concerned about. We believe that violence is a real problem. We believe that guns in the hands of teenagers is represented as much a public health problem as AIDS or TB as the hunt of arrows. You know, when we were growing up, we had fights, we had gains. The people didn't get killed because the guns were not floating all over the place. So you know, we're concerned about that, but we're also concerned about the environment that give rise. We're concerned about unemployment and the impact that that has on youngsters growing up in a community and this whole environment of poverty and hopelessness. And so we believe that we can prevent violence, but in order to do that, we've got to do a gun control. We've tried to say, based on our research, that when a family brings a gun into the home to protect themselves, it is almost 40 times more likely that that gun would be used against somebody in that home.

Either one spouse gets angry at the other spouse and shoot them, or a child has happened here in Atlanta a few weeks ago, a 12-year-old child found the gun when the mother was away shot the nine-year-old brother, the kid hung on for three days before dying. But night before last, you know, kids leaving a basketball game and four of them were shot and one of them killed. Well, all of these things are happening. They wouldn't happen if guns were not so easily available. So we put a lot of emphasis on that, but we're also putting a lot of emphasis on conflict, resolution, on trying to change the environment in which youngsters are having to grow up. Another priority that we see is something which we call developing nationwide prevention strategies like the recent AIDS marketing thing that's been a little controversial. But our position is, yes, the best way to prevent a spread of AIDS is to refrain from sex. However, 86% of males between 18 and 25 are sexually active and 77% of females. In fact, in this country, when kids graduate from high school, three out of four of them

were sexually active. You know, we can't bear our heads in the sand. I mean, we've got to say, how do you prevent the spread of AIDS in people who are sexually active? Whether we like it or not, if they're sexually active, we still got to save their lives. They shouldn't die because they don't necessarily share some of our values, but they're like we used to be. You know, they take chances. The only difference is that it's a death sentence now, whereas when we were growing up, it was a case of V.D., or maybe somebody to get pregnant unintentionally. But today, AIDS is a death sentence, and we can't afford to play around with it. Are we realizing that as a people, as African Americans, do we consider ourselves at risk of contracting disease, and we've had some high-profile African Americans to die from disease, as of late, but understanding that this particular epidemic, and I believe

it's an epidemic, I need to be taken very seriously. Yeah, it's a pandemic, which is worse than an epidemic. But it's a good question, and let me just say answer it in two ways. One, I think we are finally beginning to realize that, you know, and I say finally, because I think for a long time, we weren't acutely aware of the fact that this is serious, this is real, and some of us started only applying to gay men. AIDS has no respect of person worldwide, and about 15 million people in the world, with AIDS. Most of them are heterosexual. The major way that AIDS is spread in the world is heterosexualy, and women are affected in Africa to a great extent, the men. And that's beginning to happen in this country, you know, of the new AIDS cases that we're seeing, we're seeing more women, let me say to say, the women's group is growing faster than the men's group, and so heterosexual transmission is real, and so it's something

that we should all be aware of. I think we're gradually getting that not fast enough, but we are pleased to say that in the last two years, the rate of increase of AIDS infection has declined, so it's almost leveling off, and that's good, and we just gotta keep pushing. We mentioned tuberculosis, and we've just spoken about AIDS. There's also a rise in prostate cancer, and African-Americans are like a lot of the diseases that we have out here are more vulnerable than the majority population. Why is it, in your opinion, it's important, and for African-Americans to become more health conscious in that it needs to see a physician on a regular basis? Well, it's critical because as when we were talking earlier, I said that we can prevent a lot of these excess deaths, and that's a very good example, but you just see a position. The only way we can do it, that's exactly right, you've got to be able to diagnose the

problem early, and prostate cancer is probably your best example, just using a rectal exam in a large percentage of cases, you can diagnose prostate cancer early enough to treat it surgically. However, when patients come in, and the cancer's already spread to the bone, which is often the case with black men, there's not much you can do except chemical treatment, so we have a push on all over the country to try to improve that. It's amazing the number of black men who've come down with prostate cancer in the last few years. A lot of, you know, my contemporaries have a friend out in Los Angeles who himself was just diagnosed with prostate cancer, and now he's out of the hospital and he said that he is going to do everything he can to get more black men to get in to see a physician and to get early diagnosis, and we have the same kind of push all over the country, but we need help. You mentioned guns in violent. How is this particular problem affecting our health care and delivery systems around

the country? This having a major effect, and the first thing that I guess I want to say is that violence and injuries now represent the leading cause of years of life loss, not the leading cause of death, but when somebody dies young, you lose more years, so it's the number one cause of years of life loss. It's a major burden on the health care system, you know, emergency rooms, overwhelm with violence, $15 billion a year to treat injuries, and you know, we talk about homicides, it is true that about 40,000 people a year die in this country from either homicide, suicides or accidental gun deaths, but for every person who's killed 100 people, almost 100 people will be injured, so and some of them disable for life, so you really can't tell the magnitude of the problem just by talking about homicides and deaths and suicides, because there's so

many people who are injured for life, you know, in violence, it's a major health problem for the health care system, and as you know, it affects us disproportionately, homicides are leading cause of death for black men between the ages of 15 and 34, but it's the second leading cause of death for everybody in those ages, America has a disability, when I was in Geneva in May as a delegate to the World Health Assembly, the people from Africa were saying that when it comes to violence, we are the third world country, and they were complaining because the United States is setting such a bad example for children in Africa with all this glamourization of violence, easy availability of guns, and so we are the third world country when it comes to violence. That was the next question I was going to pose to you, we as a nation, have we gotten to the point where we're accepting violence as a way of life, as a way of existing here in this country?

Well, it seems like that. I think in recent months, we're beginning to turn that around. I think when people like Jesse Jackson and Bill Cosby and Ben Chavis and others start to really speak out the way they have about this problem and gains, I think some of the best work has been done by gains in Chicago and Los Angeles, who just said, enough of this. We've seen enough of this and we're going to turn it around, and I believe we've probably gotten more results out of those kinds of things than anything that we've done. You asked me earlier about CDC and its organization, and I didn't mention, we have Sennas at CDC. The newest center at CDC is the National Center for Injury Prevention and Control. So we fund a lot of efforts throughout the country to try to prevent violence. What research goes on here at the center and how does it fund it? Can you explain some of that to us?

Our budget is about $2 billion a year, and much of that goes for research. We do research in infectious diseases, and that's what we're known for. If you look back throughout the city's history, the eradication of smallpox, or the polio vaccine, those are the things that stand out, and we have very strong laboratories here, the hunt of ours right now. But in addition to that, we have the National Center for Chronic Disease Prevention and Health Promotion, and we're looking at nutrition, we're looking at lifestyle, we're looking at food-borne problems, and ways to prevent illnesses. We're looking at the environment. We do a lot of work with the environment. You probably know that something like 60 to 70 percent of toxic waste numbers are located in minority communities. So we have some major programs, we fund it, many of the historical black institutions, especially how would Mahari, Drew, Morehouse, Xavier Tuskegee, to do research in environmental toxic, especially in the Delta area, the whole country.

Do you think the nation as a whole gives a center of bad rap, or the center is slow to react if there's an epidemic in the country, and the part two of that question, the processes in which you all go through to alert the nation that there is a health problem, physically or environmentally. My impression is, before I got here, and since I've been here, that the nation holds CDC in high regard for the most part. Now during the last eight to 12 years, and I had a lot to do with the political environment with the previous administration, people became very concerned about CDC not being explicit about how people can prevent the spread of AIDS, and the fact that politically we made some decisions that were hard to justify in terms of what we knew were going on out there.

And I think we have gotten a bad rap for that. But for the most part, as I traveled throughout the country, and the world, CDC is very highly respected. Being a director since November of 93, what have you found some of the joys and pitfalls of being the director of this agency? Well, as you know, I've only been here two months, so I haven't had a lot of time, and it's been very busy. It's not like you have a lot of time to get on board. I've learned a lot in short period of time, I've had to react to a lot. The quality of people and facilities here is very impressive. The quality is very impressive. And I went to Morocco to participate in the eight international AIDS conference in Africa. I was very pleased with the high regard that people in Africa, in France, and in other parts of the world, were a whole CDCN. And part of that is because we have programs in all those countries.

We have an epidemiology program in Egypt. We have an AIDS program in the Ivory Coast. In Zimbabwe, we have a major public health training program. In China, we have a major immunization program. So globally, internationally, CDC has held in very high regards. I see some major opportunities for joint cooperative efforts in improving the health status of people. Are there a number of African-Americans working here at the agency in Atlanta or other centers around the country? Yeah. In fact, CDC overall has about 28% of its employees African-American. Obviously, you know, one of the highest percentages of any public agency in the country. The problem is from our perspective, not enough of them are in the higher levels. Most of those 28% are in the lower levels. Once you get up, the GSE level- The technical technicians and this- Clerical? Okay. Not enough in GSE level and above, you know, in supervisory position. And that's what we're trying to change, you know, and it's not going to be easy.

But we are committed here to workforce diversity. We believe that this agency cannot do its job unless the people here reflect the communities that we're trying to serve. And so that's one of our major goals and trust. What are some of your other interests and hobbies? Well, I guess I'm best known for my running. I'm a jogger. I've run all over the country. I do it not only for exercise, I'm sorry, an outdoor person trapped in an indoor career. So every morning, almost regardless of where I am, the first thing I do is get out there and jog. And I enjoy the different seasons. I enjoy the different cities, even when I was in Egypt, I jog along the Nile River. So it's become a part of me this thing, you know, that's when I meditate, it's when I'm out there jogging. I see things in different perspectives. I saw problems that I couldn't solve when I was sitting in my office. I'm also a gardener.

In Nashville, I had about 2,000 square feet of garden space. So I grew collets and turnips and ochre and tomatoes and stuff like that. And I like to play tennis. I don't do as much of it now as I used to when I was in California. What do you find enjoyable living here in Atlanta with such a large African-American makeup in government and politics? Atlanta is rich. I mean, I don't think people try to appreciate it. Just give an example. Two weeks ago, doing Modern Luther King Week, the Atlanta Symphony had this Modern Luther King celebration in which they had the More House Gleab Club, the Spellman Gleab, Avery Brooks came and read words of Modern Luther King. There are very few places in the world where you can get that kind of experience. And it was just one of the most enriching experiences that I've ever had. And Atlanta is just full of that. I mean, we take for granted the AU Center with all those institutions, the leadership here in Atlanta from Andrew Young, Maynard Jackson, now the new mayor who's on board who's

outstanding. And several, I could just go on and on the education community, the heritage of Benjamin Elijah Mayees and all of those outstanding leaders. Atlanta has a great heritage of leadership in the black community. Final question. Once your ten years director is over, where would you like to see the agency? Man, I'm just getting started. Now, that's a good question. Because I think you should begin with the end in my, I think you should begin with the end in man. Number one, I would like to see prevention as a predominant area of concern in this country that we were putting more emphasis on keeping people healthy than treating them after they get sick. I believe we can achieve that. We have a lot of work to do. I would like to see us really on top of most of the kind of infectious diseases with which

we deal, whether it's a new infection like the Hunter virus or AIDS or tuberculosis that we had systems in place, not only in this country, but throughout the world, that we could really rapidly respond to any kind of developing epidemic. I'd like to see the CDC become a model in the federal government for workforce diversity. Integrated throughout in terms of race and ethnicity and gender, people playing leadership roles and a model for other agencies. That's what I'd like to see when I leave. Dr. David Satcher, MD, the 16th U.S. surgeon general. If you have questions, comments, or suggestions asked your future in Black America programs, write us. Also, let us know what radio station you heard us over. The views and opinions expressed on this program are not necessarily those of this station or of the University of Texas at Austin, until we have the opportunity again for IBA technical producer Cliff Hargrove.

I'm John L. Hansen, Jr. Thank you for joining us today, and please join us again next week. Cassette copies of this program are available and may be purchased by writing in Black America cassettes, Communication Building B, UT Austin, Austin, Texas, 78712. From the University of Texas at Austin, this is the Longhorn Radio Network. I'm John L. Hansen, Jr. I'm John L. Hansen, Jr. Join me this week on in Black America. Homicides are leading cause of death for Black men between the ages of 15 and 34, but it's the second leading cause of death for everybody in those ages.

Dr. David Satcher, MD, the 16th US Surgeon General this week on in Black America.