Work­ing in con­cert

Ef­fort seeks sur­geon gen­eral posts for all states

Modern Healthcare - - The Week In Healthcare - Lola Butcher

The nation’s first state-level sur­geon gen­eral is waging a cam­paign to get other states to es­tab­lish the post. “The cur­rent and for­mer U.S. sur­geons gen­eral have done a stel­lar job of es­tab­lish­ing a pub­lic health agenda, but there is a chal­lenge in mak­ing it op­er­a­tional at the state level,” says Dr. Kim­ber­ly­dawn Wis­dom, who served as Michi­gan sur­geon gen­eral for eight years.

The child­hood obe­sity epi­demic, for ex­am­ple, could be ad­dressed more ef­fec­tively if state-level sur­geons gen­eral were work­ing in con­cert, she says.

“The way it is now, some states are not do­ing much of any­thing and some states are cre­at­ing all these pro­grams on their own,” she said. “Why aren’t we tak­ing the best ev­i­dence and de­vel­op­ing a pro­gram for the nation, with each state rolling it out as part of a com­mon agenda?”

Wis­dom, an emer­gency physi­cian by train­ing, be­came the Michi­gan sur­geon gen­eral in 2003 when then-Gov. Jen­nifer Gran­holm cre­ated the Of­fice of the Sur­geon Gen­eral to re­vi­tal­ize that state’s pub­lic health ef­forts. Sub­se­quently, two other states—Arkansas and Florida—es­tab­lished sur­geon gen­eral po­si­tions, al­though the job de­scrip­tion dif­fers in each state.

The Michi­gan sur­geon gen­eral is ap­pointed by the gov­er­nor and re­ports jointly to the gov­er­nor and the di­rec­tor of the Michi­gan Depart­ment of Com­mu­nity Health. Wis­dom’s ten­ure ended when Gran­holm left of­fice; an­other sur­geon gen­eral will be ap­pointed.

In that state, the sur­geon gen­eral was sup­ported by the Com­mu­nity Health Depart­ment staff but had no state fund­ing for staff. In­deed, for the past four years Wis­dom served, she worked part time for Henry Ford Health Sys­tem (where she now serves as full­time vice pres­i­dent of com­mu­nity health ed­u­ca­tion and well­ness) and her state po­si­tion was funded through a phil­an­thropic grant.

The di­rec­tor of the 16,000-em­ployee Florida Depart­ment of Health also serves as the state sur­geon gen­eral. For­mer Gov. Char­lie Crist es­tab­lished the post in 2007 on the rec­om­men­da­tion of a cit­i­zen ad­vi­sory group. His ap­pointee, Dr. Ana M. Vi­a­monte Ros, re­signed af­ter Crist left of­fice. In March, Gov. Rick Scott ap­pointed Dr. Frank Farmer, the for­mer pres­i­dent of the Florida Med­i­cal As­so­ci­a­tion, to the po­si­tion.

In Arkansas, by con­trast, the sur­geon gen­eral has sur­vived po­lit­i­cal change. Dr. Joe Thompson was ap­pointed to the new po­si­tion of chief health of­fi­cer by then-Repub­li­can Gov. Mike Huck­abee in 2005; two years later, Demo­cratic Gov. Mike Beebe sought leg­isla­tive ap­proval to change the job ti­tle to sur­geon gen­eral and clas­sify the po­si­tion as a cab­i­netlevel health ad­viser to the gov­er­nor, re­spon­si­ble for de­vel­op­ing health pol­icy strat­egy.

Thompson also di­rects the Arkansas Cen­ter for Health Im­prove­ment in the Univer­sity of Arkansas for Med­i­cal Sci­ences; half his salary is paid by the gov­er­nor un­der con­tract.

When Hur­ri­cane Ka­t­rina flooded Arkansas with 80,000 evac­uees, the sur­geon gen­eral was called on to mobilize the state’s re­sponse. More typ­i­cally, how­ever, Thompson’s ef­forts are di­rected to­ward an agenda. “We have fo­cused largely on the pri­mary things that are rob­bing the health of the cit­i­zens of Arkansas—to­bacco use; obe­sity; ac­cess prob­lems, par­tic­u­larly in our ru­ral ar­eas; and the fi­nan­cial bar­ri­ers caused by the lack of health in­surance,” he said.

In Michi­gan, Wis­dom pro­duced a “Pre­scrip­tion for a Health­ier Michi­gan” that di­ag­nosed the health sta­tus of the state’s res­i­dents and made rec­om­men­da­tions for im­prove­ment.

“Just like a physi­cian rounds from bed­side to bed­side in a clin­i­cal set­ting, I went from com­mu­nity to com­mu­nity to hear their needs and also share the data,” she said.

Wis­dom, who or­ga­nized a panel about state sur­geons gen­eral at the Amer­i­can Pub­lic Health As­so­ci­a­tion an­nual meet­ing last year, said the en­thu­si­as­tic re­sponse to the pre­sen­ta­tions en­cour­aged her to start ad­vo­cat­ing for more state-level sur­geons gen­eral. Lola Butcher is a free­lance health­care writer in Spring­field, Mo. Con­tact Butcher at lola@lo­labutcher.com.

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