U.S. Surgeon General Richard H. Carmona has both a personal and a professional stake in the state of the nation's health and fitness
by Jon Feld
CBI: When you came into office, did President Bush or anyone else provide you with an agenda, a list of priorities? Given all of the issues, how did you decide which ones to focus on?
Richard Carmona: The process was driven by a partnership that involved President Bush, Tommy Thompson, the Secretary of Health and Human Services (HHS), and myself. I had my own ideas, but I also had their input on matters that I thought were important. The great thing was it was clear, from the outset, that I was working with two people who were passionate about public health. The portfolio that was agreed upon, and that I fully support, is: prevention, preparedness, and health disparities. The responsibility for preparedness—which involves making the country ready for terrorist threats in a post-September 11 world—is new to this office. Another new issue that we’re incorporating is health literacy, which involves educating Americans about the language, and other nuances, of health—how to read food labels, take medications, keep yourself healthy, etc. Health literacy has been a very big problem, especially among minority populations.
I’m happy that I have a President and Secretary who understand and embrace these issues, and are allowing me to get out there and make some changes.
CBI: To your way of thinking, what's the most critical health issue facing the country today?
RC: Most of the issues that we’re concerned about fall within the category of prevention, but, without doubt, the most important issue confronting our society right now is that of obesity.
CBI: Yes, that's something health club operators are very aware of—is it a problem that Congress can do something about?
RC: I think it can. Congress can certainly help to raise public awareness, and it can fund those programs that have demonstrated their efficacy in improving the health and wellness of our citizens. Congress commands a wonderful bully pulpit, from which it can help us to spread the message, enhancing awareness, and it’s perfectly positioned to assist with funding issues. The men and woman of Congress are excellent partners.
CBI: Recently, a number of groups, including IHRSA, have been pushing the federal government to become more active in promoting fitness. What do you think is the appropriate role for government—either federal or state—in this area?
RC: I think the proper role for government is to make sure that the public has good information—accurate, up-to-date, reliable information—so it can make good health decisions. As the nation's physician, the Surgeon General certainly has a crucial part to play. We're working with some of the best scientists there are to raise health literacy: we're attempting to bring these vital, but complex, issues to the attention of the American public, and doing our best to help everyone understand them. But government plays another role as well. We have a major research component: the National Institutes of Health (NIH) and many of the other components of HHS underwrite, oversee, and disseminate the results of a great deal of research. We're part of a large, sophisticated partnership.
Another specific program that's worth mentioning is the President's Council on Physical Fitness and Sports (PCPFS). It had been dormant for a while, but when President Bush came in, he fired it up again. It's an extraordinary program that encourages physical activity among children of all ages; it employs incentives and awards to encourage participation on the part of individual kids, classes, and even entire school districts. Recently, the council also launched a new Website, www.presidentschallenge.org, which is designed to make it easier for Americans of every age to begin exercising regularly.
CBI: For the last fiscal year, Congress appropriated $60 million for the Physical Education for Progress (PEP) Act, which will be used to expand or improve physical education (PE) programs in the nation's schools. IHRSA and a number of its allies are strong supporters of PEP. What are your views on the program?
RC: I've endorsed it on numerous occasions when speaking about the need to help our children become more active. Today, increasingly, kids are spending less time on the playground and more time with PlayStation. When you combine that trend with the fact that many school districts have eliminated PE—it's a very dangerous situation. I've strongly encouraged school boards and administrators to carefully consider how they handle PE requirements in school, and have specifically asked those who have eliminated programs to reconsider their decision. We must keep our children physically active.
CBI: IHRSA is currently pushing for passage of the Workforce Health Improvement Program (WHIP) Act, which it authored, and which would allow companies to deduct the cost of health club memberships for their workforce without obliging employees to pay a tax on the benefit. What are your views on incentives of this sort?
RC: I think we need to seriously consider every proposal that would encourage, and enable, people to become and remain physically fit. Any and all possibilities should be carefully examined, reviewed, and evaluated to find those that are most effective—motivating the greatest number of people—and, at the same time, most cost-effective. The literature on the subject is clear: employee fitness and wellness programs improve productivity, reduce absenteeism, cut healthcare costs, etc. So there are a lot of benefits: for employers, individuals, and, ultimately, the country.
CBI: Recently, a Congressional Fitness Caucus was formed to encourage congressmen to practice what they preach with respect to fitness. Is this a serious proposition or simply a matter of legislators grandstanding on a popular issue? How important is an initiative of this sort?
RC: It's really important. As the novelist James Baldwin once said, we spend our lives telling our children, trying to convince our children, what to do, but, instead, invariably, they imitate us. Having Congressmen serve as fitness role models encourages everyone else in the country to pursue a healthier lifestyle. It shows the rest of us that our leaders are talking the talk and walking the walk.
CBI: You've mentioned health literacy a number of times, and obviously feel it's a critical requirement. What's actually being done to promote it?
RC: There are a number of programs in play. For example, we're conducting a program called 50 Schools in 50 States—during the next year or two, I'll be visiting 50 schools in 50 different states, and meeting with students, teachers, and principals to talk about health, and how we can keep ourselves healthy and reduce risk in our lives. We're trying to target younger children so that we can get them started on the right path at an early age. The HHS is also involved in countless other programs that advance health literacy, many of them, right now, focusing on obesity. We're spending millions of dollars on basic research, and to educate the American public about the problem—particularity groups that are disproportionately affected by the epidemic, such as the Native American, African-American, and Hispanic communities.
CBI: In your view, what can health clubs do to help improve public health?
RC: They can do exactly what we were just talking about—the health club industry can increase health literacy through its mailings, public presentations, by working with its own membership, and through outreach efforts in the communities it serves. It can help make people more aware of how important regular exercise, good nutrition, adequate sleep, etc., are. The club industry, in particular, can champion health, fitness, and wellness in an effective, powerful way, and can help instill the belief that remaining physically active is a fundamental part of the continuum of life. All of us—physical educators, clubs, and trainers—are members of the same team, and are communicating the same message.
CBI: Despite all that we've learned—all of the reports, recommendations, and calls to public action—it seems that Americans are slipping, inexorably, into a less-fit, less-healthy state because of the impact of technology and overeating. Do you really see that scenario changing?
RC: I have faith in all of the efforts that are being made—by my office, health clubs, local physicians, healthcare providers, etc. I do see the situation changing in a positive way. We're all working hard to make sure that people understand the obesity epidemic is, truly, a terror within—it's directly responsible for 300,000 deaths each year. We've got to change! We need to be physically active; we need to eat healthy; we need to reduce the risk in our lives—it's all within the easy control of every individual.
CBI: Physicians are notoriously bad about looking after their own health. How attentive have you been to your own personal fitness?
RC: Everyone on my team is physically active. My aids and staff, who travel with me, always make sure that we stay at hotels with fitness centers. The first thing that we do after checking in is to work out, or we'll begin our day that way. It's a commitment we've made—all of us—because that's what the President expects of us, and because we're personally convinced that we have to lead by example.
CBI: Do you belong to a health club?
RC: I don't belong to a specific club, but I use the ones at the government's military bases. Given my rank—that of Admiral—I stay at these bases as often as I can, and they've got great facilities.
CBI: Can you tell us something about your own exercise regimen?
RC: I do a lot of cross training. I do cardio five or six days a week—on a stationary bike, stairclimber, or elliptical trainer; and depending on where I am, I'll swim and do a weight circuit every other day. I work out, on average, about 1-2 hours a day. The important point to stress here is that, if you make a commitment—you can do it. It may require a special effort, a little extra resolve, but if three of the busiest people in the world—those being the President, Secretary Thompson, and I—can do it, then anyone can find the time to squeeze fitness in.
CBI: The President's personal physician, Dr. Kenneth H. Cooper—one of the club industry's heroes—was among the early candidates for your post, but your background in security and bioterrorism gave you a clear edge. What sort of progress has your office made with respect to the war on terrorism?
RC: It's not just my office that's involved, of course—it's a team the President has assembled that includes HHS, the Office of the Surgeon General, the Office of Emergency Preparedness, and the Department of Homeland Security. The issues are complex, so it requires a team approach, involving representatives from a wide range of different disciplines. Since the events of September and October of 1992, we've come a long way: we're better prepared than ever to deal with threats from nuclear, biological, chemical, or conventional weapons—but we still have a long way to go. It's only been a few years since our country was attacked and we began to understand that people could use commercial aircraft and germs as weapons. We've had to develop an entirely new approach to safeguard the American public. For example, we've improved vaccine programs to the point that we're able to stockpile enough smallpox vaccine for the whole population; and we've improved our communication infrastructure to ensure better early detection of chemical and biological threats. I'm confident that we've made significant progress, but none of us are complacent. We keep asking the critical questions, keep challenging ourselves, every day to make sure that the nation is adequately prepared.
Jon Feld is a contributing editor for CBI and can be reached at kjfeld@rcn.com.
