Vivek Murthy, 37, was sworn in for a four-year term as the 19th Surgeon General of the United States on Dec. 15. A physician at Boston’s Brigham and Women’s Hospital and a teacher at Harvard Medical School, his nomination stalled in the Senate for more than year, mostly because his belief that gun violence is a public health issue had enraged the National Rifle Association. (See what he says about that today, at the bottom of this post.)
Murthy embarked on a three-month listening tour of the U.S. ahead of a ceremonial swearing in Wednesday. I asked the nation’s top spokesman on public health about his agenda. (Our conversation is edited for brevity.)
My overarching goal is to get every individual, every institution and every sector in America…to ask themselves the question [of] what they can do to improve the health and the strength of our nation.
The health challenges that we face right now are too big to be solved by the traditional health sector alone. We can’t build more hospitals and clinics and, solely based on that, expect that we are going to solve the health challenges that we face.
Many of the patients that I saw came in with illnesses and conditions that were preventable. And that’s not an experience that’s unique to me. Doctors all across the country, nurses across the country, share similar stories of feeling a great deal of sadness when they see the pain and the suffering that patients and their families go through, and realize that if we had a system that could care for people better, that was actually more focused on prevention than our current system, that we may be able to prevent a lot of the illness, the suffering and the health care costs that we see in our current world.
Q: How do you view that system? How would you describe it if you were setting it up from scratch?
A prevention-based society is one in which every institution, whether they’re a hospital or a clinic, or a school, an employer or a faith-based organization, recognizes and embraces the role that it can play in improving health. The truth is, that while hospitals and clinics are traditional health care players, we know that the choices that people make in their lives about what they eat, about how active they are, about whether they ultimately decide to try a cigarette or to use drugs, those decisions are often influenced by factors far outside the hospital or the clinic.
They’re influenced by what people see happening around them. Whether they’re active or not can often be influenced by whether there are safe spaces in their neighborhood to be active. The food choices that they have in their workplace or in their school can influence the choices they make there too. And what their friends and family are doing at home can often influence the choices they make as well.
So there are profound influences in the community that ultimately impact health. Which is why we have to engage community institutions ultimately in changing our trajectory of health, from one of illness to, ultimately, one of wellness.
I want to reach out and work with employers, for example, to make physical activity a part of the culture of the workplace. So that as opposed to sitting and working, we are walking and working. So that we are incorporating activity whenever and wherever possible, not only because it contributes to better physical health but because we know that physical activity improves your emotional well-being. We know that it contributes to mental function as well.
I want to work with faith-based leaders to address the negative attitudes that are still too often associated with mental illness, attitudes that hold people back from getting the help that they need. When I look at the patients that I’ve cared for with mental illness, I know that many of them took years to come forward and tell somebody that they were in pain and that they needed help…We need the help of our faith based leaders to call upon their communities to relinquish and to put aside these negative attitudes, and recognize that mental illness is something that affects all of us in some way or another, if not us then people we know. And it’s incumbent upon us to encourage people to come out of the shadows and to seek help…
Q. What can the government do with a private employer to encourage the kinds of things you just spoke about?
I see myself more as an educator, as a convener and as a catalyst. What I would like to do is bring together organizations and the community to start conversations with employers, with faith-based groups and others to help them understand the role that they can play in improving health.
…One thing they can do is to make activity a greater part of the work day. That includes shifting meetings, whenever possible, to walking meetings. That involves encouraging folks to take the stairs whenever possible, and leading by example, from the very top of the organization down. That involves doing what my hospital actually did before I left, which is having FitBit competitions and other walking competitions….
The food that’s available in the vending machine in the cafeteria, that actually has an impact on the choices that people make in the building. Which is why when employers make healthy nutritious choices more available to their employees, that can have an important impact on the choices that people actually make.
Q. What is your view [on e-cigarettes] and will you be taking a role [in advising about the use of them]?
As it turns out with e-cigarettes, this is an area where the use of the product has far outpaced our scientific understanding of it. We have a lot of unanswered questions right now about e-cigarettes. We don’t, for example, fully understand the potential adverse effects of e-cigarettes, particularly on kids. We don’t know for certain how effective e-cigarettes are in [smoking] cessation. And we also don’t know for certain whether kids who use e-cigarettes are more likely to use traditional cigarettes than kids who don t use e-cigarettes.
But we have reasons to be concerned. We have data, for example, that tells us from an attitudes perspective, that kids who use e-cigarettes are about two times more open than kids who don’t use e-cigarettes to consider using regular cigarettes. Of course, what we want to know is the actual outcome. But those attitude surveys themselves are concerning.
This is an area where we have to let science guide our policy. If the science tells us that there is a benefit of e-cigarettes in cessation, then we should evaluate e-cigarettes the way we would any other FDA-regulated product and we should make them available if they’re both safe and effective to people for whom they’re indicated. In this case that would be current smokers.
But that is a separate issue from whether we allow people who do not smoke, and kids in particular, to have access to e-cigarettes.
[During the recent listening tour,] a teacher told me that her kids are smoking e-cigarettes in the classroom.
Q. That’s allowed?
Her school doesn’t have a policy on it because they’re not quite sure what to do. There’s no law around e-cigarettes in the city, it’s not being regulated yet by the federal government. And so as a teacher, she’s unsure how to proceed.
We need to gain clarity on these questions…so that we can help parents and teachers understand what they should be telling their children.
Q. I’m wondering if there’s a role for you as the surgeon general in… [combating] multi-drug resistant bacteria, infections in hospitals?
This has been a challenge for patients and for doctors alike. Part of what we have to do is ensure we are communicating with patients about when antibiotics are needed and when they’re not needed. Sometimes when you get sick and you go to the doctor, it can feel like you didn’t get your money’s worth if you don’t come away with a pill. I’ve had many, many conversations with patients who I’ve cared for over the years about why it’s actually in some cases better not to go home with antibiotics…Those conversations take time. That kind of education, while it’s important, can sometimes be tough to do when you have five or ten minutes with patients.
A role that my office can play is also to directly go to communities and help people understand when antibiotics are indicated and when they’re not.
…Part of fixing the problem with antibiotics and part of dealing with the issue of education around antibiotics, is the larger question of how do we build a health care system where doctors and patients actually have the time to spend with each other, where they can talk about important issues, where they can build their relationship and where they can deliver and receive the kind of care that, really, doctors and patients want.
Q. Will you be raising the issue of gun violence as a public health issue?
My focus is going to be on the issues that are costing us the most in America, in terms of lives lost, in terms of disability, in terms of dollars spent. And those are on obesity and chronic diseases like diabetes and cardiovascular disease. It’s on substance abuse and mental health.
While those will be my primary areas of focus, I fully recognize that issues come up all the time that are of great concern to the country, and I will be ready to address those when they do. Ebola was one example. Measles was another…And so I will continue to respond to issues as they come up, while keeping our focus on the issues that are driving the greatest suffering and the greatest health care cost for the country.
Q. So that sounded like a qualified yes. You will be raising it if there were an occasion to do so?
I’m not taking anything off of my agenda. If something is important to the country, and to the health of the people, that’s the most important factor for me in determining whether to address it or not. The statements I’ve made in the past about gun violence being a public health issue, I stand by those comments because they’re a fact. They’re a fact that nearly every medical professional who’s ever cared for a patient will attest to.
The truth is whenever large numbers of people are dying for preventable reasons, that’s a public health issue. Whether that’s because of automobile accidents, whether it’s because of violence, whether it’s because of toxicity from other causes.
And so my concern in this area has come from my experience as a doctor who’s cared for many patients who’ve been the victims of all kinds of violence, and my hope is that we can come together as a country to find ways that we can reduce violence while respecting people’s legal and constitutional rights. I don’t think that’s too much to ask for.
…I think the majority of the country recognizes that there is a middle road and the question is do we have the courage to find that road, and to walk down it.
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