Former Surgeon General Dr. Regina Benjamin was the first person who told me, “Health isn’t in the doctor’s office. It’s where people live, work, play and pray,” imparting that transformational mantra to me in her 2011 interview with the Los Angeles Times. I wrote about that lightbulb moment here in Health Populi.
Dr. Benjamin was the 18th Surgeon General, appointed by President Obama in 2009. As “America’s Doctor,” she served a four-year term, her mission focused on health disparities, prevention, rural health, and children’s health.
Today, Dr. Benjamin wears many hats: she’s the Times Picayune/NOLA.com professor of medicine at Xavier University in New Orleans, founder and CEO of the rural BayouClinic in Bayou La Batre, Ala. (think: “Forrest Gump,” she invokes), and Founder of the Gulf States Health Policy Research Center. She also sits on numerous advisory boards and commissions. She holds 23 honorary degrees, and an MD along with an MBA.
Dr. Benjamin is a great storyteller. I’ll share a few of them with you. There was a young ensign on duty on a great battleship for which he had the responsibility of the watch in the late evening. He saw a light in the distance and plotted out the course; it was in direct path of the ship. The ensign then flashed out a warning: “you’re in the direct path of a battleship.” The response was, “No, you alter your course.” The ensign, responsibly, got the captain who assessed the situation and plotted the course. Sure enough, the captain came to the same conclusion and warned, “Alter your course.” After a time, the contact responded: “No, you alter your course.” The captain then woke up the admiral, who agreed with the ensign and captain. “You are in the direct path of a great battleship. Alter your course immediately: I am an admiral.” After a time, the reply was, “No, YOU alter your course. I am a lighthouse.”
We have to alter our own courses to deal with health disparities, chronic illnesses, the uninsured and under-insured, poverty and violence, Dr. Benjamin advised us, as we continue our journeys as healthcare leaders and engaged patients and caregivers.
Benjamin has learned that one individual can make a big difference in health for an individual, a community, a profession – medicine, for example – a nation, and even the world. Indeed, Dr. Benjamin has advised the World Health Organization, and recently returned from a trip to Asia to advise on women’s health. When she was a medical student, she lobbied for medical education to include real-life cases and training in sexually-transmitted diseases – STDs. She argued successfully to the American Medical Association, and STDs became part of the med school curriculum. “One person can make a difference,” she learned.
Once working as a family physician, she served a community of working poor patients: too poor to qualify for Medicaid, and too poor to pay for healthcare out-of-pocket. She quickly learned about “the things that my prescription pad couldn’t solve: housing adequacy, clean water [note: the Bayou was dirty], nutrition, education.
Take the case of a patient named Donna, at the time a 26-year-old mother and seizure sufferer with two kids. Donna’s seizures were under control for a while, and then not so much. “Did you miss your medicines?” Dr. B asked Donna. She drew pictures of them for the doctor. Donna said that Jim, the pharmacist, used to give her, “one stripe and two solids.” Now, she had “three solids,” and got the pills mixed up. That made Dr. Benjamin realize that Donna couldn’t read. “All the prescription pads in the world wouldn’t remedy that until we got Donna help to read,” Dr. Benjamin figured out.
Another patient, call her “Miss Smith,” was a 30-something woman, petite and quite overweight. She phoned Dr. B on a Friday night, saying her back was badly hurting. “I went to see the specialist and he told me I needed to lose weight and I’m trying. But ibuprophen isn’t strong enough. Can you call me in something stronger?” Miss Smith begged the doctor. Dr. B phoned in the prescription for a stronger pain medication, and added, “You need to see me Monday or Tuesday.” When Dr. B went into an exam room to see Miss Smith on Tuesday, the patient was leaning on the exam room table as she couldn’t bear to sit down due to such acute pain. “Didn’t the medicine help at all?” Dr. B inquired. Miss Smith told her she didn’t get the prescription: “I couldn’t afford it,” Miss Smith confessed. “But you have insurance,” Dr. B knew, “as you work at the school. Why couldn’t you afford it?” Miss Smith replied, matter-of-fact, “I didn’t have the copay, but this Friday I get paid and I’ll get it then.” Dr B asked her office manager to go to the pharmacy and get the medication for Miss Smith, using a small pot of money contributed for such moments.
“We have to address the social determinants of health,” which first is poverty, Dr. Benjamin implored. A study in the American Journal of Public Health showed that poverty is even more important as smoking as a negative health impact in the United States. We cannot overestimate the importance of education, where the health difference between more and less educated people is a death rate 2.5 times greater for people with less than 12 years of school. Just having a high school education, and no additional intervention, has a profound impact on mortality, Dr. Benjamin said.
“I’m a long-time champion of the power of prevention,” she admitted. And prevention is the key to building a more sustainable healthcare system, Dr. Benjamin believes. This is not new to the national dialogue on health, but it’s become more vital and relevant than ever before, she asserted. This is largely due to changing dynamics and demographics, with more families dealing with chronic conditions like diabetes, strokes, and obesity. As many as 800,000 Americans will die from heart disease this year at an annual cost of $440 billion every year, she said.
“We have to make prevention part of our everyday lives,” and empower people to make better health choices.
A big part of this big goal is to change the way we think about our health in our country. Dr. Benjamin recommends taking a holistic and integrative approach to community health. Think: safe highways and worksite wellness, clean air and healthy foods. The over-arching objective: “To increase the number of Americans who are healthy at every stage of life,” she said.
Ultimately, “We can make doing health joyful – it’s a journey to joy,” she added. “We need to bring joy into being healthy and into medicine. You cannot underestimate the power of joy.”