Q&A with new HHS Assistant Secretary for Health Brett Giroir: Health for all, by all and in all: New head of Commissioned Corps calls for changes to service
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* Julia Haskins

In February, Brett Giroir, MD, was sworn in as assistant secretary for health at the U.S. Department of Health and Human Services. The Nation’s Health spoke to the new leader of the U.S. Public Health Service Commissioned Corps about his goals in the position as well as preparedness and resilience in the midst of national public health crises.

## What are the top priorities you hope to accomplish during your tenure as U.S. assistant secretary for health?

My main overriding goal is to support the transformation of our sick care system into a health-promot- ing system. If you look at our offices, we have so much emphasis on prevention, early detection, elimination of disparities — it just fits so well into one of (HHS Secretary Alex Azar’s) primary pillars of value-based transformation of the system.

I have my nine words that I like as our governing philosophy that I want everyone to think about...My nine words are health for all, health by all and health in all.

(In terms of health for all), I want all of our offices to work to assure that everyone has a fair and realistic opportunity to optimize their health...We may not be able to change everyone’s behavior, and we certainly don’t want to force standards that violate individual liberties, but we absolutely want everyone to have a fair and realistic opportunity.

Health by all, what I mean by that is to get health out of the formal medical care system, and to distribute and democratize health care knowledge, capabilities and delivery.

Health in all is the last one. Whenever we can, part of our mission should be to prioritize health considerations in all sectors and policy areas. And that doesn’t just stop at HHS.

It’s hard to be healthy if you don’t have the appropriate infrastructure or safety in your community to have healthy behaviors, healthy food and make healthy choices.

## You are in uniform as a Commissioned Corps officer. How does your role differ from the surgeon general’s?

The assistant secretary for health, at the option of the president, and also at the option of the nominee, can receive a commission in the corps. It does not happen every time, but the president nominated me and wanted me to be in uniform, and I was very honored and absolutely desired that as well because I think it makes me a better ASH, and having the ASH in uniform can support the corps.

I am the leader of the Commissioned Corps of the Public Health Service of the United States. The surgeon general works in my office, and he oversees the day-to-day operations. Aside from that distinction, I want the surgeon general to resume the role as the nation’s doctor. I think we have a uniquely qualified surgeon general, both in terms of his medical and public health experience, since he’s an anesthesia, critical care (and) pain management specialist, but also (was) the state health officer for Indiana, where he dealt with opioids, HIV outbreaks and the multiple challenges. I think he’s also uniquely qualified because of his personal charisma and communications skills. He has the opportunity to get the message out and to proselytize for public health in all of the good ways.

## How do you plan to address the national opioid crisis now that you have been designated as the HHS senior advisor for opioid policy?

My role is to be the point of contact, to be the coordinator and, to a large degree, be the project manager for HHS efforts and to also be the point of contact to interface with other agencies that have important elements in the fight.

Secretary Azar has outlined a five-point strategy...The first point is to strengthen public health data reporting and collection to inform real-time responses.

The second point (is to) decrease the inappropriate use of opioids. And this is obviously a really major focus for us, because the latest data show that 3 out of 4 people who use heroin started with prescription opioid misuse. I think it’s absolutely clear that we want to preserve the appropriate use of opioids, but we need to drive down the inappropriate use of prescriptions.

The third is to improve access to prevention treatment and recovery services. (The Substance Abuse and Mental Health Services Administration) will release another $1 billion in funding in September... targeted to the states highest hit (by the opioid crisis).

The fourth bullet is the availability of overdose-reversing medication. This is really the naloxone story. There are now standing orders for naloxone in all 50 states.

## You served as the director of the Texas Task Force on Infectious Disease Preparedness and Response during the Ebola outbreak. What did you accomplish in that role?

The Texas task force was something that was created basically the day that the first Ebola patient was diagnosed at Presbyterian Hospital in North Dallas. The governor called me (and) said he wanted to bring the best people within the state who are outside of the government together with the leaders inside the state’s government so that this response would be science- and evidence-based, that there would guaranteed interaction between the science community and the community within government.

I think it advanced the science really well, and I think the (Centers for Disease Control and Prevention) co-evolved actually because of our experience there and...screening protocols were changed, the concept of community hospitals being able to handle these types of patients I think (was) really changed. It was a tremendous growth experience for the nation at large, to understand what it means when an Ebola patient turns up not at the (National Institutes of Health) or Emory, or Nebraska, but in a very good, very fine community hospital that could have been anywhere in this country, and it could have been Ebola or any other type of disease.

![Figure1](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/48/4/6/F1.medium.gif)

[Figure1](http://www.thenationshealth.org/content/48/4/6/F1)

Giroir

## How can we strengthen the Commissioned Corps? Would you say that it’s been neglected over the years?

I would say...in some sense that the corps has been taken for granted, and not neglected. But it’s been taken for granted in the sense that the corps members populate some of the most important agencies (in) public health.

We generally have between 1,700 and 1,900 corps members supplying care to the Indian Health Service, some of the most underserved populations in the country. And we accept and love the challenge of delivering care to those who are underserved.

We have 1,100 officers in the (U.S. Food and Drug Administration). Over 500 of them are PharmDs working, importantly, for new drugs to monitor safety, to work on food toxicology. We supply an enormous amount of care to (the Bureau of Prisons), which is very important across the board, but obviously with diseases such as HIV, hepatitis C...opioid addiction (and) behavioral health issues.

I am incredibly proud of the corps. What I will say is the corps does need to change.

The surgeon general and I knew that we really needed to reexamine the mission of the corps moving forward into the next 100 years. The challenges that we face are going to be different. The skill sets we need need to be adjusted. How we deploy is going to be different, because of...new threats that we face in an increasingly dangerous world.

We also need to be very serious about training. The corps has no training budget, so training is done sort of on our own, when we can, and the corps members do a great job. But if we’re going to be (as) effective as we can be on the front line, we do need to systematize the front training.

We’re proposing to reinstitute the reserve corps. The reserve corps is very important. The size of the regular corps may stay the same, it may decrease a little bit, we have to look at the requirements. But I do think we need a reserve corps...because many of our officers are in critical primary care roles.

If you have a person who is in the Indian Health Service delivering care, that person may be trained for disaster response, but it’s very hard to take a person who’s the only physician or only nurse practitioner or only pharmacist and move that person to a disaster area and leave their population neglected. We feel that there could be a tremendous backfill capability by...a reserve corps (and also to) supply specialized services.

We’re undergoing a several-month process to really understand what our missions are, what our goals are in agencies like the NIH, CDC, FDA, in addition to our prior generals. How do we best train, how do we best deploy, how do we best work with partners, and how do we really meet the public health needs of the future?

*   Copyright The Nation’s Health, American Public Health Association