Policy Trumps Public Health

It should surprise no one that a Surgeon General’s report on global health issues was quashed because it did not advance the Bush administrations rigid, monolithic political agenda. That is the charge leveled by current and former public health officials familiar with the report.

It seems the ideologue-in-charge was put off by the reality of a link between poverty and poor health. The squelched report called on the U.S. to lead an effort to combat wide-spread diseases as an integral part of our foreign policy objectives. It also challenged corporations to help improve the living conditions in the nations where they operate.

Release of the report was blocked by Richard Steiger, a movement-conservative ideologue and god-son of former President George H.W. Bush who was appointed to run the Office of Global Health Affairs in the Department of Health and Human Services.

The report, “Call to Action on Global Health” was commissioned by then-Surgeon General Richard H. Carmona, who recently cited the suppression of this report as evidence that the Bush administration puts an ideological tweak on science to advance their agenda, or the science gets ignored. Camona related an incident to lawmakers: As he was fighting to get the report released, a senior official, apparently exasperated with Camona’s insistence on being grounded in reality finally told him flat-out “You don’t get it. This will be a political document, or it will not be released.”

Thomas Novotny, a former assistant surgeon general who ran the global health office before Steiger, said, "It's embarrassing, just ridiculous that the report hasn't come out." Novotny, who served at HHS in the Clinton and in both Bush administrations, said that many nations have made health issues central to their foreign relations and trade policies, but that the United States has been reluctant to embrace that idea.

"It made perfect sense for the surgeon general to take up the issue because the U.S. used to be a leader in this field," Novotny said. "For the nation's top doctor to be unable to release the report shows that leadership is gone."

A former career official at the HHS, Richard Walling, asserted that the report was directly blocked by Steiger, who “always had his political hat on. I don't think public health was what his vision was. As far as the international office was concerned, it was a political office of the secretary. . . . What he was looking for, and in general what he was always looking for, was, 'How do we promote the policies and the programs of the administration?' This report didn't focus on that."

On June 30, 2006, a Steiger aide sent an e-mail saying that the report should not be cleared for public distribution: "While we believe the subject matter of the draft is important, we disagree with the style, tone and messaging. We believe this document should be focused tightly on the Administration's major priorities in global health so the American public can understand better why these issues should be important to them. As such, the draft should be a policy statement, albeit one that is evidence based and draws on the best available science."

I am always heartened when evidence is treated as an afterthought. Aren’t you?

When these jokers leave, by whatever mechanism they depart, the practical among us know that it is going to take a decade (at least) to root out the Loyal Bushie career hires, and set the departments they have thoroughly fucked up back right.