A New Season for David Satcher: Text Only

David Satcher had only been US surgeon general a short time when he was asked to speak in Bethesda, Maryland, at a conference dedicated to understanding and preventing suicide. He didn’t have any particular background with the issue—personal or professional—so he decided to talk to attendees of the American Association of Suicidology meeting about a public health approach to suicide.

At the podium was an author and psychiatry professor with bipolar disease. She talked about losing her father to suicide and attempting it herself. Dr. Satcher was moved by her story, as he had been moved by a recent news article of a teenager who had taken his life. The more personal accounts Dr. Satcher heard, the more statistics he encountered, the more he felt compelled to act.

He commissioned a report and convened a workshop of more than 450 professionals and survivors. He issued Call to Action to Prevent Suicide fifteen months after the meeting. It gained national attention and ultimately contributed to major health initiatives, including the National Strategy for Suicide Prevention.

“I got letters from families all over the country talking about their own experience with suicide, and how very isolated it feels to have lost a loved one—how you go through life trying to figure out what you did wrong,” Dr. Satcher says. “Most of the time, you didn’t do anything wrong. Ninety percent of the people who commit suicide are suffering from some form of mental illness, and so, if there’s anything to blame, it’s our system.”

Apart from the matter of suicide, Dr. Satcher released a groundbreaking report on mental health, another topic never before tackled by a surgeon general. It is for work in these areas that Dr. Satcher predicts his tenure will be most remembered. However, he also wants people to understand the driving force behind those reports: his commitment to listening to the people of America. It is a skill he first started developing as a new student at the Case Western Reserve University School of Medicine during the mid-1960s. He didn’t have much medical know-how yet, but he was assigned to follow the care of a patient through pregnancy, delivery, and beyond, making home visits and getting to know the community.

“They call the surgeon general the nation’s doctor. If you’re the nation’s doctor, the nation is like your patient. So I had this idea that if I listened carefully and tried to implement good strategies to respond, then I could do a good job,” Dr. Satcher says. “I hope that my legacy will be that I did, in fact, listen to the American people and responded with effective programs in areas that people had shied away from.”

Dr. Satcher, the first African American to earn simultaneous doctoral and medical degrees from the CWRU School of Medicine, in 1970, finished his four-year term as surgeon general last February. Appointed by President Bill Clinton in February 1998, he was the second African American in that post, and the first to serve as assistant secretary of health, a position he held concurrently for the first three years.

As the nation’s lead spokesman on health matters, Dr. Satcher continued the office’s legacy of combating smoking while also forging new territory on youth violence, obesity, oral health, and sexual health, in addition to mental health and suicide. In his campaign for healthful lifestyles, he developed a postcard-sized handout urging people to eat five fruits and vegetables each day, exercise five times a week, practice responsible sexual behavior, and avoid tobacco, alcohol, and drugs. He also pressed forward with his commitment to advocating equal access to healthcare for all Americans.

His reports evaluated not only how issues affected the population in general, but also how they affected minority groups, including the young and elderly as well as people of color. Eliminating health disparities became a primary goal on a national health initiative while Dr. Satcher was in office. It is an issue that has resonated with him from his youth, when growing up in the segregated South meant that his mother never went to the hospital through nine pregnancies, and that two of his siblings didn’t survive childhood.

“We define where the system is weak by looking at how it impacts the poor and disenfranchised among us,” he says. “The commitment to eliminating disparities is really a commitment to a health system that works for everybody.”

Primed to Lead

David Satcher was born on March 2, 1941, on a farm in Anniston, Alabama. A near-fatal bout of whooping cough when he was two became so integral a part of family lore that, by the time he was six, he wanted to be a doctor just like Fred Jackson, who had treated him. Neither of his parents, Wilmer or Anna, had finished elementary school, but from them he learned the value of hard work and to never use segregation as an excuse.

During high school, young David juggled assignments with a job at the foundry, sometimes working until midnight to save money for college.

Dr. Satcher remembers school as a place with “hand-me-down books, dilapidated facilities, but teachers who cared.” An English teacher, Juanita Gerald, noticed his high scores and started giving him extra assignments, including an essay that won an American Legion contest. Another of David’s champions was chemistry teacher James A. “Pappy” Dunn, who took him to see a Morehouse College alumnus after learning the prestigious black college might possibly offer him a full scholarship.

Mr. Dunn, now an Anniston county commissioner, remembers David going beyond the call of duty in science, track, choir, and everything else he tried. “He was a brilliant young man. He could do just about anything, and he did it well,” Mr. Dunn says.

At Morehouse, the atmosphere was as inspiring as the academics were rigorous. “They so believed in us, and felt that we were supposed to be leaders. They convinced us of that,” Dr. Satcher says. He took honors classes, got involved in student government, and eventually chaired the committee that organized sit-ins. He recalls going to jail at least five times, one of them with Martin Luther King Jr.

With a degree from Morehouse in 1963, he applied to the CWRU medical school on the recommendation of a professor who had a friend teaching there. Dr. Satcher credits many CWRU faculty members as important influences, such as pediatrics professor John Kennell, Nobel laureate and dean emeritus Frederick Robbins, and the late Neil Macintyre, an anatomy professor who was Dr. Satcher’s PhD research advisor in cytogenetics.

The University in the 1960s was a vastly white setting; David Satcher brought to it his dignified brand of activism. He helped in the medical school’s effort to increase African-American enrollment and went with other students to talk to community groups about what to expect at hospitals. He once walked out of an OB-GYN clerkship in protest of medical students being lined up to do pelvic exams on poor patients; soon after, the hospital started giving women more privacy.
David Satcher and fellow first-year medical student and activist Doris Evans began a lifelong friendship through protests and politics, and through tutoring students at elementary schools in Cleveland’s Hough and Glenville neighborhoods.

“We didn’t have more than two nickels ourselves to rub together, so often we walked to these places,” says Dr. Evans (MED ’68), a pediatrician in private practice near Cleveland. “He was the same kind of person he is now—quiet and deliberative, thoughtful, careful, and hardworking.”

He left Cleveland in 1970, spent two years as a resident in Rochester, New York, then moved to South Central Los Angeles, where a hospital and medical school opened following the Watts riots of 1965. At the Charles R. Drew Postgraduate Medical School and Martin Luther King Jr. Hospital, Dr. Satcher taught, ran a free clinic, and directed a sickle-cell anemia program. He turned his energy for two years to teaching at UCLA, then returned to Drew, created a department of family medicine and, during three years as interim dean, started a medical education program. Of the many awards and honorary degrees he has received, one of which he is most proud is the Watts Grassroots Award for Community Service: With his help, Drew had overcome the distrust of the Watts community.

While he was living in California, his first wife, Callie, died of breast cancer. He later married a poet, Nola, who had raised five children of her own and helped raise his four. (Daughter Gretchen is now a computer scientist; sons David, Daraka, and Daryl are a linguist, lawyer, and actor, respectively.)

Dr. Satcher moved back to Atlanta in 1979 to develop and chair the Department of Community Medicine and Family Practice at the Morehouse School of Medicine. Three years later, he accepted the presidency of Meharry Medical College in Nashville. Long a leader in educating African-American doctors, Meharry and its affiliate, Hubbard Hospital, were in such severe financial trouble that some predicted Meharry wouldn’t survive. Through Dr. Satcher’s appeals to alumni, grantors, and the government, money poured in and the college’s $29-million debt was forgiven by President Ronald Regan.

Dr. Satcher then proposed a merger of Nashville’s two hospitals, a four-year process that required mending relations between the city’s majority and minority populations. “There was racism on both sides of that track, and distrust,” Dr. Satcher says.

He stayed in Nashville eleven years until called upon by the assistant secretary of health, Phil Lee, as a candidate to direct the Centers for Disease Control and Prevention. He thought he blew the interview (he kept talking about seeing children exposed to cigarette smoke at an elementary school where he volunteered early that day), but, instead, conveyed a passion that resulted in an invitation to Washington, DC, to meet with Secretary of Health Donna Shalala.

The CDC Influence

Dr. Satcher led the CDC from 1993 to 1998. Under his watch, childhood immunization rates rose dramatically, and a breast and cervical cancer screening program expanded from eighteen to fifty states.

Ms. Shalala and Dr. Lee first asked Dr. Satcher to consider nomination for surgeon general in 1994, but he felt it was too soon after taking the helm of the CDC. When approached again in 1997, he accepted.

With no ability to write policy, the surgeon general is not explicitly powerful. What the office does have is influence, attributable largely to the integrity of surgeons general through the years, such as Walter Wyman, who threatened to quarantine California in 1903 when leaders there seemed to be sweeping an outbreak of bubonic plague under the rug; Luther Terry, who, in 1964, issued the first report on the harmful effects of smoking despite being a smoker himself; and C. Everett Koop, who rallied support for the anti-tobacco campaign and pressed the country to deal with the AIDS epidemic in the 1980s.

"Being surgeon general is like trying to balance politics, opinions, and public health science....In order to get anything done, you’ve got to work in an environment where politics and opinions are very prominent."

America trusts its surgeons general, Dr. Satcher says, because they base reports on public health science. He cites Dr. Terry, who, like nine of the ten members of his advisory panel, was a smoker. Dr. Terry quit smoking after being put on the spot at a press conference for the 1964 report. “They didn’t write the report based on their opinions, or their politics, or even their own behavior,” Dr. Satcher says. When the report was issued, forty-three percent of Americans smoked; the number is now estimated at twenty-three percent.

With influence has often come controversy, which peaked in 1994 when the administration forced Joycelyn Elders to resign—she says she was fired—over an explicit remark about sex education. Following her departure, the office sat empty for more than three years. Says Dr. Satcher, “As I made my rounds on Capitol Hill, some of the advice I was given was: ‘Whatever you do, don’t talk about sex.’ ”

His nomination triggered some criticism from conservatives, but his first three years excited little antagonism. Then, in June 2001, he released a Call to Action to Promote Sexual Health and Responsible Sexual Behavior. The idea, Dr. Satcher says, was to start a productive national dialogue on issues such as sex education, but discussion became mired in two of the report’s more contentious points: that it is unlikely sexual orientation can be changed, and that abstinence-only programs aren’t sufficient.

“Being surgeon general is like trying to balance politics, opinions, and public health science,” he says. “Your responsibility is to public health science, but in order to get anything done, you’ve got to work in an environment where politics and opinions are very prominent.”

New Time, New Purpose

After his term ended, Dr. Satcher spent six months as a visiting senior fellow at the Henry J. Kaiser Family Foundation in Washington, DC, working on memoirs. He recently returned to the Morehouse School of Medicine to direct its new National Center for Primary Care. Funded by a $15-million grant from the Office of Minority Health, the center will focus on research and training, as well as analyzing health policy and studying what factors lead to disparities in healthcare.

Louis Sullivan, president emeritus of the medical school, was one of the people who recruited Dr. Satcher to Morehouse in 1979, and had a hand in bringing him back. He believes Dr. Satcher’s intelligence and strong character will be invaluable as the center tries to redefine how patients and doctors can work together for health.

“I predict the National Center for Primary Care is going to change significantly the landscape of medical school curricula,” says Dr. Sullivan, who at one time was secretary of the US Department of Health and Human Services. “In that sense, I think he has a great responsibility, and a great opportunity.”

Dr. Satcher shies from characterizing his return to Morehouse and the South as coming full circle.

“If we can do a good job, I think it will impact health and healthcare throughout this country and perhaps the world,” he says. “That’s why I’m very comfortable going back to the same place—but at a different time in history, and for a different purpose.”

Jolie Lewis (CWR ’94), a teacher and writer, is a frequent contributor to CWRU Magazine.