Working in concert
Effort seeks surgeon general posts for all states
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 firstname.lastname@example.org.