An Open Letter to my Fellow Officers of the United States Public Health Service

July 30, 2006

A little more than four years ago, President George W. Bush picked me from relative obscurity to be the 17th Surgeon General of the United States. As you know, the Surgeon General is appointed by the President and confirmed by the United States Senate for a four-year term of office. As my term ends this week, I would like to leave you with three thoughts as I return to civilian life, and your service continues.

First, I would like to thank you for your service to our nation and for your esprit de corps. It is heartening to know that more than 6,000 dedicated public health professionals are delivering the best healthcare with the passion and dignity that you all personify. Your commitment to the most vulnerable people, in times of emergency and on a day-to-day basis, provides the help and hope that I lacked growing up as a poor child in an immigrant neighborhood. Your service helps ensure that more children can learn, grow, and prepare themselves for a healthy and productive adulthood. Your readiness to deploy when natural and manmade disasters strike here at home and abroad ensures that disaster victims receive aid and medical care in their darkest hours. You also represent the best of America, especially as we have moved forward the concept of global health, due to the recognition that the challenges before us do not respect our geopolitical borders. Knowing this, you have become superb emissaries of health diplomacy throughout the world. I know that President Bush sees you as a key part of his efforts to assist our neighbors and allies in their times of need.

I hope that as your Surgeon General, I’ve led our Corps in a manner of which you can be proud. I have benefited tremendously from the advice of former Surgeons General Koop, Elders, Novello, and Satcher. They took me under their collective wing and always counseled me to, above all else, protect the dignity and integrity of the Office of the Surgeon General. My fellow Surgeons General left me big shoes to fill. Today I enter into our very small and unique fraternity with great pride and anticipation that we can still work together to advance the health, safety, and security of the nation...and the globe.

Second, I want to ask you to continue the spirit of collaboration we established across the Department of Heath and Human Services, our sister uniformed services, the broader public health community, the scientific community, healthcare professions, academia, and so many other private- and public-sector partners. I’ve learned that serving as Surgeon General includes much more than writing warning labels for cigarette packages. Of course, warning individuals about the dangers of smoking is an important public health role, and studies time and time again have shown that no cigarette or tobacco product is safe and the health effects of smoking go well beyond the smoker alone. But with your help, my four years as Surgeon General have gone beyond warnings.

In the past four years:

• We have established important safeguards, and educated more Americans about the importance of preparing themselves, their families, and their communities for natural and manmade disasters. As a nation, we know that the question isn’t if we will experience another major attack or natural disaster, but when, and it is our responsibility to work together to be ready.
• We have increased focus on the need to eliminate the health disparities that are still damaging the lives of millions of Americans, and holding us back as a nation.
• We have trained Americans” attention on the power of prevention. Before becoming Surgeon General, my experiences as a U.S. Army Special Forces medic, a police officer in Arizona, a SWAT team member, a nurse, a surgeon, and a professor taught me that we must focus on prevention and life-long healthy living as a key component to improving the health and well-being of all Americans. It has become increasingly clear that we must move from a treatment-oriented society to a prevention-oriented society. As you work with your patients in treating and educating them, remember to take the time to point out ways that they can become healthier. Through initiatives such as the President’s HealthierUS, we have encouraged American families to take small, manageable steps within their current lifestyle — versus drastic changes — to ensure long-term health. Please continue that important work.
• We have started the transformation of the Commissioned Corps into an even more highly trained, capable, visible, and mobile cadre of public health professionals.
• We have established the Medical Reserve Corps to bring together teams of local volunteer medical and public health professionals to contribute their skills and expertise throughout the year as well as during times of community need.
• We have issued groundbreaking Surgeon General Reports, Calls to Action, and other communications, including “The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General,” “Bone Health and Osteoporosis: A Report of the Surgeon General,” “The Health Consequences of Smoking: A Report of the Surgeon General,” “The Surgeon General’s Call to Action to Improve the Health and Wellness of Persons with Disabilities,” and the “National Call to Action to Improve Oral Health.” We have also held Surgeon General Workshops on Healthy Indoor Environment and Prevention of Child Maltreatment, and initiated plans for many more Reports, Calls to Action, and Workshops that are currently in progress in the Office of the Surgeon General.
• We have increased Americans” health literacy by communicating health information in ways that people can use and understand. I have always believed that the scientific information in Surgeon Generals’ Reports and other communications belonged not just on the bookshelves of my fellow healthcare professionals, but in the hands of the American people. That is why I made sure that we issued a “People’s Piece” with each Report developed under my tenure. Last week, we issued a People’s Piece on how to improve the health and wellness of persons with disabilities. In addition, with my friend and colleague Dr. Francis Collins at the National Human Genome Research Institute, the Office of the Surgeon General developed “The U.S. Surgeon General’s Family History Initiative” to give Americans the tools to understand what steps to take if certain diseases “run in the family.”
• With colleagues across nearly every part of the Department of Health and Human Services, we established 2005 as The Year of the Healthy Child to make sure that Americans from every walk of life have access to the information we need as parents, grandparents, teachers, counselors, coaches, childcare professionals, and healthcare professionals to help raise healthy children and young people. I want to thank and encourage all adults to find time to contribute to the health and well-being of future generations. You have a positive influence and serve as role models 365 days a year.

When announcing my nomination as Surgeon General in March 2002, President Bush said that it was important for me to speak regularly to the nation about alcohol and drug abuse, and the tremendous toll they take on our society, and specifically cited that substance abuse by students undermines academic achievement and dims the great hope of the American Dream. That is why I set out to visit schools across America and talk with students about staying in school; and avoiding drugs, alcohol, and violence. This was especially important to me because I am a high-school dropout. I wanted to let kids know that everyone makes mistakes, but everyone also has the chance to pick up and start over after those mistakes. We all get second chances. I know that I’ve failed many more times in my life than I’ve succeeded. The difference is that I always tried one more time.

Third, and finally, I know that in the end, people will ask if my four years as Surgeon General did any good, and, honestly, only time will tell. But I believe that if one student who was on the verge of making some bad choices decided to correct his or her course, or if a mother decided to quit smoking to improve her child’s health, or if one caregiver saw the intrinsic value of all human life that led to better care for a disabled person, then yes, it was all worth it. Although serving in a vast bureaucracy, as advisor to the most powerful leaders in the world, I always tried to speak for the people and deliver the scientific data, without the influence of politics. My fellow officers, your support gave me the courage to always deliver the science, untainted by politics, and to always speak up for the marginalized, the forgotten, the poor, the disabled, and the injured in our society.

Thank you for making it possible for me to fulfill our mission to protect, promote, and advance the health and safety of the nation. It has been my distinct privilege and honor to serve with you. As I prepare to return home, I reflect on many of the lessons I’ve learned from you and my fellow Surgeons General. Perhaps one of the most important is “Once a Surgeon General, Always a Surgeon General,” and therefore I look forward to continuing to work with you, as well as continuing to build upon the friendships we’ve established over the past four years.

Respectfully,
Richard H. Carmona, M.D., M.P.H., FACS
The 17th Surgeon General of the United State