A life’s work of making healthcare available to everyone
“Our population needs to learn how to use the health system more rationally.”
Dr. Louis Sullivan has had a long, distinguished career of public health service. He was named HHS secretary by President George H.W. Bush and served from 1989 to 1993—one of two African-Americans to ever hold the position. Before that, Sullivan served as founding dean and director of Morehouse College’s medical education program, which later became the School of Medicine at Morehouse College. Sullivan currently serves as chairman of the Atlanta-based National Health Museum and heads the Sullivan Alliance to Transform America’s Health Professions in Washington. He just published an autobiography, Breaking Ground: My Life in Medicine. Modern Healthcare reporter Steven Ross Johnson recently spoke with him about his views on the state of the country’s health system and what he thinks about political opposition to the healthcare reform law. The following is an edited excerpt.
Modern Healthcare: What motivated you to pursue a career in healthcare?
Dr. Louis Sullivan: I grew up in Blakely, Ga., in the years of racial segregation. Blacks going to a white physician had to enter a separate waiting room or go around the back. My parents did everything they could to avoid that. So rather than going to a white doctor in Blakely, we would go south to Bainbridge to Dr. Joseph Griffin. Dr. Griffin impressed me as someone who was magical. He had powers that other people didn’t have: he would make people well. He had built a 25-bed clinic and he was highly respected in the community. He was my true role model, and I said I wanted to be a doctor like Dr. Griffin. And that happened at age 5.
MH: How should the U.S. promote greater diversity within the healthcare professions?
Sullivan: We need to strengthen our public school system, particularly in our inner cities, because too many youngsters do not get a strong K-12 education and can’t successfully compete for college entry or perform well in college or in the sciences. Second, we need to have a better system of counseling, because many high school students have no idea what it takes to become a doctor, nurse or dentist. Third, we have priced a health professions education out of the reach of many minority youngsters. That is in part due to the fact that there used to be a number of government scholarship programs that were available, as well as support from foundations and others. In the mid-‘70s, many of these programs were either eliminated or greatly cut back.
It was thought it would make more sense to let health professionals pay for their own education by borrowing money and then repaying it out of practice earnings. This has been a disaster in practice. The result has been that lowerincome students are not going to medical or dental school. Finally, there remains the lingering issue of bias in the healthcare system. This is a complex problem, there’s no one quick answer.
MH: What do you see as the greatest public health challenges the country currently faces?
Sullivan: The first is the need to finish implementation of the Affordable Care Act. That legislation was needed and I support it. It has imperfections that need to be addressed by future administrations and Congress, and it’s also been impaired by a faulty rollout. The second challenge for the future is improving the health behavior and health literacy of our population. By the year 2042, there will no longer be a majority (white) population, so we need to do a better job of seeing that our nation’s minorities not only have access to healthcare, but also have a stronger education. Health and level of education go parallel. That will help not only to improve health status, but also, in the long run, will bring healthcare costs down. Our population needs to learn how to use the health system more rationally. We need to continue to work to make sure everyone has access to healthcare and has health insurance. We have made progress in the areas of tobacco and use of seat belts. When I became secretary in 1989, less than 50% of drivers in America were using seat belts. Now, that percentage is closer to 90%.
MH: What are your thoughts on political opposition to the Affordable Health Act?
Sullivan: It’s unfortunate that there are politics around healthcare. There are two things that in my view should not be political—having a strong education system for our young people and health. A healthier population is a more productive population. So I really wish that people would not view health in a political grid. We need to be able to make decisions based on what is needed from a scientific perspective and a medical perspective. I would argue for lowering the political rhetoric here. Access to healthcare should not be something that is subject to political whims.