Q&A with Surgeon General Jerome Adams: Gaining better health through better partnerships: Report to highlight links between US health, economy ================================================================================================================================================== * Julia Haskins *Jerome Adams, MD, MPH, in September was sworn in as the 20th surgeon general of the United States. As the head of the U.S. Public Health Service Commissioned Corps, Adams is tasked with promoting and advancing the country’s public health priorities. He previously served as the state health commissioner in Indiana, where he dealt with an opioid epidemic and HIV outbreak. The Nation’s Health spoke with Adams about what he plans to accomplish in his role.* ## What are your main priorities as U.S. surgeon general? The theme of my tenure will be better health through better partnerships, and underneath that umbrella of trying to forge better partnerships will be three priorities, at least starting off. No. 1 is going to be addressing the country’s growing opioid epidemic. That is (the U.S. Department of Health and Human Services’) top priority and the administration’s top health priority, and as representatives of both of those entities, we will be focusing on opioids. No. 2 is going to be health in the economy, and I plan to release a surgeon general’s report on the links between health and the economy. No. 3 will be health and national security, looking at our nation’s poor health as a potential indicator for a lack of readiness to respond both to threats from man and from nature. And that’s a good segue into kind of the fourth area of emphasis, and that’s the United States Public Health Service Commissioned Corps. The surgeon general received an appointment as vice admiral of the United States Public Health Commissioned Corps, meaning that I lead a uniformed service of approximately 6,500 public health officers who are committed to promoting, protecting and advancing the public health of our country and our world. ## What other information can we expect from the surgeon general’s report? Our goal is to show how businesses and communities can thrive if they invest in the health of their employees and citizens. We know that the No. 1 cost for employers is salary, for most employers. The No. 2 cost for most employers is health care. And so I believe there is an opportunity to make our case to a wider audience, to a different set of partners, who quite frankly drive a lot of the policy decisions in our country. We know that healthier communities tend to be more economically prosperous and vice versa. We know that improved community conditions for health — such as clean and safe neighborhoods, access to healthy food options, opportunities for exercise and physical activity, including complete streets and the built environment — all these things can help positively influence health behavior and can lead to a more productive workforce. That’s the long-winded way of saying that the report is going to include best practices and recommended actions along with evidence-based strategies to help us demonstrate the link between health and economic prosperity and to show businesses and communities evidence-based strategies that they can employ to improve their health and their bottom line. ## Who are some of the non-traditional partners that public health needs to reach? You’ve got to include the law enforcement community if you are going to address the opioid epidemic. They are a major touch point. The faith-based community is critically important, particularly when you are looking at community resiliency, when you’re looking at adverse child experiences and who can help mitigate those adverse childhood experiences when you are really looking at the predictors for negative outcomes that exist in communities and in individuals. The military: I’ve talked about health and readiness. We know that 7 out of 10 of our youth are ineligible for military service, so there is a critical link between health and national security that can only be addressed if we are better partners with our military and Department of Defense colleagues. The educational community: That is a major touch point and opportunity to intervene and, unfortunately, too often a missed opportunity, when we look at the fact that most kids spend the majority of their day at school and the adults that they interact with most often are adults in the educational community. What we need to do is be better partners with the educational community and make it easier for them to achieve their goals by embracing a health message. ## How do you plan to uphold your promise to put science before politics as surgeon general? As surgeon general of the United States, I think what is important is that we engage the right partners and show them how embracing health and embracing our priorities will lead to them being more prosperous, will lead to them being safer and more secure, will lead to them being able to provide for themselves and their families. And if we do that, then it’s not really putting science before politics, it’s understanding that science needs to be part of the complicated multi-variant policy equation, but that it’s one of several components. If we’re going to expect people to listen to and embrace the science, then we have to listen to and embrace their priorities. ## Do you see gun violence as a public health issue? All violence is a public health issue, whether it’s violence committed by cars or violence committed by individuals or anything that causes harm to individuals in communities. I have also said that we need to focus on the tools, the means, the mechanisms by which that violence happens and not demonize the perpetrators, and it’s where this argument gets a lot more nuanced. We don’t look at cars as a public health issue, we look at car accidents as a public health issue, and so we need to look at the violence that is occurring in our society. ## How can public health advocates get people to take preventive health care more seriously? We need to be better at showing folks the return on investment. We all make decisions each and every day about where we are going to invest our time, our money, our talent. And we do it based on a conscious and an unconscious expectation of what we are going to get in return, whether that is love, whether that’s respect, whether that’s money. And I feel like the public health community, to be honest, has been very poor at showing the return on investment...and we know that every dollar spent on evidence-based intervention programs can have a benefit of $58. That is a significant return on investment, but we’ve got to show the right people where and how they can invest and when they can expect that return. For folks in Congress, we need to show them a return on investment that coincides with their term in office. You can’t have a public health return on investment that is going to happen in five years and expect that to resonate with a legislator who has got to run for office every two years. So we have to do a better job of showing short-term returns or proxies for returns on investment that allow our legislators to actually see it during their time span during their life as a legislator. We also need to show businesses how investing in communities...needs to be part of their profit plan. We’ve got to show them that spending money on putting a park in your community actually will lead to less absenteeism from work because the kids are going to be less obese, they are going to be healthier and the parents who are working in your factory aren’t going to have to miss school to take care of them. We’ve got to show how having smoke-free policies in the communities leads to healthier employees and ultimately lowers your health care costs and, again, leads to less absenteeism and less presenteeism. ![Figure1](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/48/1/5/F1.medium.gif) [Figure1](http://www.thenationshealth.org/content/48/1/5/F1) Surgeon General Jerome Adams at APHA’s 2017 Annual Meeting and Expo in Atlanta. He is prioritizing the opioid crisis, health and the economy and national security. Photo courtesy EZ Event Photography So if we want folks to take preventive health more seriously, then at the end of the day we’ve got to take individuals and their needs and their motivations more seriously and really speak in a way that resonates. * Copyright The Nation’s Health, American Public Health Association