EVERY CHILD A WANTED CHILD
A Conversation With Surgeon General Dr. Joycelyn Elders
by Elayne Clift

The controversial Arkansas physician answered questions from ON THE ISSUES contributing editor Elayne Clift in November, 1993.

OTI: The offices of population affairs, minority health, women's health, and disease prevention are all part of the The Public Health Service, which you head. How do you prioritize and ensure that things get done in all those areas?

Dr. Elders: Probably the best way is to hire good directors, and make sure that you can trust them and that they report to you so that you know what's going on. I'm not a micro-manager. I feel that I'm a visionary, and I try to decide the vision, set the tone. Then I hire the managers who make sure that it gets done.

Every surgeon general has priorities. My priority is to make sure every child born in America is a planned, wanted child. That should markedly reduce poverty, markedly reduce crime and violence, markedly reduce drug and alcohol abuse, and also reduce the prison population, since 90 percent of the young men in prison between the ages of 19 and 35 were born to children.

OTI: What's your reaction to the court decision upholding the Mississippi law that said a minor must have parental consent, or consent of a judge, to have an abortion?

Dr. Elders: I feel that we as women are going to have to become much like the AIDS activists and make our policymakers respect reproductive choice. As long as we do not have choice about our reproductive health, we really don't have much of a choice about anything. And if you really look at our teenage women, most of them go to their parents anyway before an abortion. Where do we think they get the money? For teens who can't go to their parents, there's a real reason why they can't. At the time when they most need consultation and help, we make them j ump through unnecessary hoops, which does not improve family relationships, does not make things better. It's of no value.

OTI: What do you see happening as a result of the new activism among women? It seems that women have reclaimed the breast cancer epidemic and learned a lot of lessons from the AIDS community.

Dr. Elders: Oh, absolutely. And I think that they're really going out and being true activists. One of the things that they're really fighting for is to increase the number of mammography screenings between the ages of 40 and 50. Well, the scientific data, as we have it now, does not really support that we necessarily need to do mammography between 40 and 50 unless it's indicated. But [the real issue is] only 50 percent of women between the ages of 50 and 60 have ever had a mammogram, so we need to educate women on what they can do to prevent dying from this disease.

OTI: Some women's health advocates think that approach means laying responsibility at the feet of women, rather than saying we've got to find out what the links are to environmental toxins or to do other things that constitute prevention.

Surgeon General Dr. Joycelyn Elders

Dr. Elders: Those are research initiatives that I feel must go on. But just because we're out there doing a lot of research does not mean that we come back tomorrow with answers. For the 20 to 30 percent of women who are at risk for the genetic-linked breast cancer, we hopefully will be able to identify those women early, let them know that they need mammograms, make doctors look more carefully, and encourage more careful, frequent self-examination. I think that's an important improvement.

There is a suggestion that we're seeing an increase in breast cancer. We know that poor women are far more likely to die with breast cancer. Part of this we think is related to access-to-care issues. As far as the other women in our society who get breast cancer, we don't really know the factors that cause it. We've related it somewhat to diet, to pesticides, and to other environmental toxins, but it's not clearcut.

OTI: You are respected by many of us for being feisty and forthright. Are you still able to say what you mean and mean what you say as a public person in the same way that you might privately?

Dr. Elders: I've not had anyone tell me not to say anything since I've been in Washington. And I feel that if I can't speak honestly about what I think and what I believe, well, then, I shouldn't be the surgeon general, I shouldn't be in Washington.

It may well be that I shouldn't be in Washington. But I feel that the American people want me to be honest. We may disagree, but we can agree to disagree. We can argue about it, fight about it, but I feel that I must go to them with the scientific facts, not hearsay, not even what Joycelyn Elders may think. When I present to them, I should present them with the facts, and I feel that they're smart enough to make the decisions.