Transcript of The Nation’s Health Podcast: Interview with U.S. Surgeon General Jerome Adams
Interview conducted by Julia Haskins, reporter for The Nation’s Health newspaper.
Listen to this interview as a recording on our podcast page.
This is The Nation’s Health Podcast. On this episode, we speak with U.S. Surgeon General Jerome Adams.
As U.S. surgeon general, Jerome Adams wears many hats. He is the head of the U.S. Public Health Service Commissioned Corps, the top advisor to the secretary of health and human services and the country’s most visible public health spokesperson. The Nation’s Health spoke with Adams about his views on public health, including breaking down silos, grappling with epidemics and how Dolly Parton’s music is really about social determinants of health.
What are your main priorities going to be as U.S. surgeon general?
My overall motto, 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 obviously HHS' 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 hope to put out a surgeon general's report on the links between health and the economy.
And then 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 moving forward.
And that's a good segue into kind of the fourth area of emphasis, and that's the United States Public Health Service 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 and advancing the public health of our country and our world. We have people stationed all over the globe.
Keeping in stride with the presidential administration, health in the economy will be a major theme in Adams’ first surgeon general report, which will set the tone for his tenure. The surgeon general is more than the nation’s doctor — each person to hold the position has a unique brand that is reflected in the surgeon general’s report. Tobacco may come to mind when hearing “surgeon general’s report,” but past reports have also focused on topics such as suicide prevention, youth violence and HIV and AIDS, and have shaped the course of public health and the health of the nation.
So, to go back to your point about health in the economy, that's great that we are going to see that in the first surgeon general's report. What other information can we expect?
Well, we're hoping 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 really feel that 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.
So 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.
That reminds me that I wanted to talk about some of these non-traditional partners. You’re often talking about breaking down silos. What are some of those non-traditional partners that public health really needs to reach across to in order to create healthier communities for all? Who are we not bringing into the conversation?
Well, that's a good question and I would say that there is a number of partners who I have worked with throughout my public health career. But when you talk about non-traditional partners, you've got to include the law enforcement community if you are going to address the opioid epidemic. They’re a major touch point.
The faith-based community is critically important, particularly when you’re 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.
What do I mean by that? I mean that instead of going to the school superintendent and saying your kids are obese and they’re going to have diabetes 20 years down the road, we need to go to the school superintendent and say, “Hey, we've got this great program that will not only increase physical activity but also will increase your standardized test scores because your kids will be able to pay attention, they'll have less behavioral problems and your teachers will be able to focus on actually providing education and not just being babysitters and counselors.” And then, finally, of course, the business community is a critical partner.
Adams sees business as a particularly influential partner in furthering public health goals, with opportunities for creating a healthier, more robust workforce.
How do you see business playing a bigger role in promoting public health?
Well, the business sector is a critical partner in helping achieve gains in the wellness of all Americans.
The private sector pays for about half of all total health care spending in the United States, so rather than viewing health merely as an insurance expense to be controlled more companies are seeing the building of a health culture as a business opportunity.
And what do I mean when I say a business opportunity? I mean a chance to not only lower health care costs but to have a more productive workforce to be able to attract top talent to your communities and to lower workplace accidents.
And so I think that the business community has both leverage through worksite wellness programs but also through influence in local community policies and also the ability to invest in those local communities to build a culture of health.
Adams is also recognized for his role in addressing an HIV outbreak in Indiana, where he previously served as the state health commissioner. The outbreak in rural Scott County, Indiana, was first identified in early 2015. By spring of 2016, about 200 cases of HIV were reported in the region. Scott County’s HIV outbreak was spurred by an opioid epidemic that continues to affect communities across the U.S. In his role as state health commissioner, Adams was a strong advocate for policies that sought to reduce harm, including needle exchanges.
You are, of course, very familiar with the HIV crisis and you did a lot of work in terms of Indiana's HIV outbreak. What were some of the most important lessons you learned from addressing that public health crisis?
Well, the value of any prevention effort initiative program really depends on the specific needs of the community you are trying to serve and our ability to actually engage them.
That's what we are talking about when we talk about motivational interviewing. It's not speaking at people, not telling them what you think they should be doing, but really asking them what their goals are and figuring out how we can align our goals with theirs.
So in Scott County, the most important thing we learned is that we needed to be better listeners and needed to be better partners and really understand the concerns and the needs of the community.
And their concerns centered around moral barriers to enacting a need like the (Thinking for a Change) program, for instance. They felt like it wasn't something that they religiously and morally should be doing, so we had to engage the faith-based community.
They were concerned about public safety and crime, so that's why we had to engage the law enforcement community, and they were concerned about their community being known as a drug town and a haven for people with substance use disorder, so that's why we needed to engage the business community and help them understand that a public health-oriented approach to this problem actually would lead to an outcome which aligned with where they wanted to be.
Although Adams has plenty of public health priorities to keep him busy, he can be found reading books and listening to music that aligns with his passion for safe, healthy communities.
On a lighter note, I know our listeners want to know more about who their U.S. surgeon general is, so what movies, books or other media have had an impact on you as a public health professional?
Well, I love music of all kinds, when you say media. I am a big country music fan, believe it or not —
Get out.
— but classic country, not the new stuff, classic country. I like Kenny Rogers, Willie Nelson, Dolly Parton.
All the classics, nice.
Exactly, exactly. And you know what's funny is in those songs they are frequently talking about the social determinants of health. They're talking about, you know, how difficult life can be and how we need to come together as a community to persevere, so, you know, I think it's the perfect soundtrack for public health in many ways.
But as far as books, I don't get a change to watch a lot of TV, there are several books, several writers, who I am very fond of. I am very fond of Malcolm Gladwell who wrote Outliers, among other books.
Public health, I’ve said this often, we know the science, we know how to make people healthier, don't smoke, move more, eat less and eat healthier.
The real challenge is how do we get people to actually change their behaviors and when you look at Outliers, when you look at the social psychologists who are out there, what's fascinating is that they write about how people very frequently, very commonly will act in ways that don't represent their self-interest and we need to study the way people really make decisions and be better at framing our message in a way that will actually encourage behavior change. And so I think Malcolm Gladwell has been great at that.
I really like “Hillbilly Elegy” by J.D. Vance and “Dreamland” by Sam Quinones. I tell folks that anyone who wants to understand the origins of the opioid epidemic really needs to read those two books because they describe in Dreamland the very real and true origins of the opioid epidemic, and in Hillbilly Elegy, the culture of hopelessness and despair that exists in a lot of our country, particularly in the South, that created the kindling for this fire that is burning right now in terms of the opioid epidemic.
You can read the interview with Jerome Adams in the February/March issue of The Nation’s Health. For more episodes of The Nation’s Health podcast, visit www.thenationshealth.org. Thanks for listening.