Faces of Public Health: Louis W. Sullivan, MD

Mar 21, 2014, 11:47 AM

Louis W. Sullivan, MD, former U.S. Secretary of Health and Human Services under President George H.W. Bush, recently wrote a memoir, Breaking Ground: My Life in Medicine, that offers a wide view of Sullivan’s experiences as a medical student in Boston, the founding dean of the Morehouse School of Medicine in Atlanta and as the country’s chief health officer. NewPublicHealth recently sat down with Sullivan to discuss the book and his thoughts on the history and future of improving the nation’s health.

NewPublicHealth: Looking back, what can you share about the highlights of your career in medicine and health promotion?

Louis Sullivan: Highlights would certainly include my time at the Boston University School of Medicine. That had many significant points. It was my first time living in an integrated environment because up until that time I spent all of my life in the South. Working in an environment without concerns about discrimination and bias, that was a great experience; my classmates and the faculty at Boston University were all welcoming.

Another highlight was later when I was a research fellow in hematology in the Harvard unit at Boston City Hospital. I had a paper accepted for presentation at a major research conference in Atlantic City. It was a paper showing that heavy drinking suppressed the production of red blood cells by the bone marrow.

And of course a tremendous highlight was going back to Morehouse College, my alma mater, to start the Morehouse School of Medicine. I was returning home in a sense. I had gained experience as a faculty member at Boston University, had been steeped in medicine and now I was in the process of establishing a new institution to train young people for the future.

NewPublicHealth: What changes have you created and supported to improve population health.

Sullivan: Well, certainly becoming Secretary of Health and Human Services was indeed an honor and a great opportunity for me, and it was also a very challenging experience.

In the late ‘80s, when I became Secretary, AIDS was a new disease. There were many demonstrations by various advocacy groups, groups that didn’t trust the government, and we had to work to develop a relationship with them. I convinced President Bush to put $1.6 billion in his budget to be used for research on this new disease, to develop mechanisms for treating the disease and to educate the public. And as a result of that initial investment and ones that followed, this disease has been transformed from a virtual death sentence to a chronic disease which is controlled by medication. And people, rather than living a few months, which was the case once the diagnosis was made in 1989, are now living for decades with the virus suppressed on medication, raising their families, working, earning wages, paying taxes. So that has been really a very satisfying outcome from that experience. And we hopefully are close to finding a cure for this disease as well.

Another key advance that occurred during my time as Secretary was the introduction of the new food label to help people make better choices in their planning for their meals, to have a more balanced diet and to help combat obesity. The label [which will soon be updated by the U.S. Food and Drug Administration] has had a very significant impact on food choices made by Americans.

A third challenge I had was reducing the incidence of smoking.  We worked to have non-smoking rules set up for various federal buildings including the U.S. Department of Health and Human Services. And we helped to change the culture on smoking in America. We have not completed that yet but we now have only about 20 percent of the population smoking, whereas at the time of the first Surgeon General’s report in 1964 half of Americans smoked. The diseases related to smoking have decreased though they still represent, in the aggregate, the number one preventable cause of death in the country.

NPH: What other health issues still need keen attention to make us a healthier nation?

Sullivan: Disparities in health status between the white population on the one hand and the nation’s minority populations on the other. That is really quite striking and we have made only minimal progress. Life expectancy of African Americans is some five-to-seven years shorter than white Americans. Similar, though not as dramatic, disparities are in the Latino population, the American Indian population and the Native American population.

We have increased the awareness of these health disparities, and there is a lot of research that has started to get at more of the factors that cause these disparities and actual ways to help address them. We are still early on there, so that really is a challenge for today and really I think for the next two or three decades. It is critical to achieve because it will make a tremendous difference not only in the lives our nation’s minority and poor populations, but also make a significant difference for all Americans because we will have a stronger, healthier, more productive population. That will have economic benefits as well. So this is a major challenge for the nation.

NPH: You are head of The Sullivan Alliance. What is its mission?

Sullivan: The Sullivan Alliance is an organization that was formed in January of 2005 with the goal of increasing racial and ethnic diversity among the nation’s health professionals. This came about because of a commission that I chaired that was called the Sullivan Commission funded by the Kellogg Foundation in 2003 and 2004 with a distinguished group of people working as members of our group. People such as former Congressman Louie Stokes, the current Attorney General Eric Holder, the former Chairman of Johnson & Johnson Bill Weldon and many others. What the Sullivan Commission noted was that the progress that had been made in the late ‘60s and the ‘70s in diversity in the health professions had really lagged in the ‘90s, and we seem not to be making much progress at all and we’re in danger perhaps of losing some of the progress that had been made.

Our commission made a number of observations and came up with 37 recommendations for things to address this in 2004, and the Sullivan Alliance was formed a few months later in order to have a mechanism to try and stimulate the adoption and implementation of the recommendations of the commission. The Alliance has established relationships between academic health centers and colleges that have high numbers of minority students—African American, Latino, as well as Native American.

Currently we are operating in eight states where we have formed alliances between academic health science centers and colleges and we hope to build on that. We have a number of young people who have been successful with the summer research experiences that we had provided through the Alliance. And the experience has given them both added tools and a knowledge base and information about various health careers that have enabled them to be successful in gaining entry into medical school, schools of public health, dental school, nursing school and other health professions schools. This is an ongoing issue, so over the next decade we hope to make further progress and expand the reach of the Alliance to have operations in many more states.

I am proud to be able to point to successes in achieving diversity at the highest levels of government health leadership during my time as Secretary. The first woman to head the National Institutes of Health, Bernadine Healy, served during my administration, as did the first female Surgeon General, and who also happened to be Hispanic, Dr. Antonia Novella. We also had the first African American to head the Social Security Agency, Gwendolyn King, and the first African American to head the Health Care Finance Administration, now known as the Centers for Medicare and Medicaid Services, William Toby. We are very proud of those accomplishments.

NPH: And you are also working on a National Health Museum to be based in Atlanta.

Sullivan: The National Health Museum is a concept that is early in its development, but our goal is to improve health literacy of Americans with the intent that a more health literate population will lead to healthier lifestyles. We know that a number of diseases that afflict Americans are influenced by lifestyle, as is a likelihood of injury. This has come out of what I call the Healthy People Movement. When I was Secretary in September of 1990, I released Healthy People 2000, a monograph with some 298 health goals for the nation that we hoped to reach by the year 2000. It included such things as improving vaccination rates against childhood communicable diseases, increasing the rate of seatbelt use, decreasing smoking, increasing exercise, improved diets and a whole range of things that really depend upon people having the knowledge and acting upon that knowledge.

The Healthy People Movement has continued to this day. Healthy People 2010 was released when Dr. David Satcher was Surgeon General. The current iteration is Healthy People 2020 that was released by former Surgeon General Regina Benjamin. These were lists of recommendations for strategies for people to use themselves to be healthier. The Health Museum is an effort to take this more broadly—not only nationwide, but globally as well. People need to know the things that they can do and indeed must do if they are to protect their health and enhance their health and that of their families.

The National Health Museum will be a way—through visits and via the internet—to get information to Americans and to others around the world to improve their health. And we intend to do that in a way that’s not only enlightening but entertaining so that health is really seen and acted on in a positive, inspiring way as a normal activity.

This commentary originally appeared on the RWJF New Public Health blog.