A Tale of Two Generals
Newspaper mentions so far this year:
- Merrick Garland (Attorney General): 1863
- Vivek Murthy (Surgeon General): 108
AG/SG ratio: 17.25.
Wait, Vivek Murthy? The Vivek Murthy? Not Murphy? Raise your hand if you’ve even heard of Vivek Murthy.
Vivek Murthy, Surgeon General (SG) of the United States, isn’t new to the national scene. Murthy was also SG under Barack Obama. Consider: we are now living through the worst pandemic since 1918. Fourteen thousand people died from Covid a few days ago. Despite that, Merrick Garland, the US Attorney General (AG) has been cited in newspapers seventeen times more often than Murthy.
Why?
The AG leads the US Department of Justice (DOJ), is the chief lawyer of the Federal Government, and the principal advisor to the President on all legal matters. That’s admittedly a huge remit.
The SG leads the U.S. Public Health Service Commissioned Corps (PHSCC), and therefore is the leading spokesperson on all matters of public health. Yes, that PHSCC. Raise your hand if you’ve heard of the PHSCC. Bueller? Anyone? Anyone?
Given the scope of the AG’s role, it’s not surprising that Garland is a prominent figure, and gets a lot of attention in the news. What is surprising is the lack of attention paid to Murthy. Not only because we are in a pandemic. But because of the potentially enormous scope of his role.
Consider the PHSCC charter: protection, promotion, and advancement of health and safety of the general public. Could a charter be more expansive? How about “in charge of the welfare of all atomic material, and their emergent properties, comprising 382.2 million people”?
We live in a country struggling with obesity, heart disease, alcoholism, unwanted pregnancies, urban food deserts, drug addiction, mental illness, and loneliness. Millions of Americans are slaves to comic book conspiracies cooked up by Q-Anon. And according to the Commonwealth Fund, compared to six other industrialized countries (Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom), the United States ranks dead last in health system performance measures … despite spending twice as much per-capita as the Netherlands. So how can the PHSCC and its SG leader not be the ground zero of media attention?
But wait. How can this be? We’re the US. Our health system rocks! Consider: the US is dramatically outpacing most of the industrialized world in COVID vaccinations.
The US is #2 in this bar chart. But unlike the US, #1 UK has prioritized going broad with single doses. The US is going broad and deep. So really, the US is #1. We Americans are exceedingly fortunate that we have the best access to COVID vaccines in the world (among the largest countries, anyway).
How do we reconcile that with the results of this research conducted at Oregon State University:
Overall adherence to the US Dietary Guidelines is low: the majority of Americans do not follow a healthy eating pattern. Together with physical inactivity, eating an energy-rich, nutrient-poor diet predisposes one to many chronic diseases, including type 2 diabetes mellitus, cardiovascular disease, cancer, and osteoporosis. Approximately one-half of American adults have at least one preventable chronic disease (1), and additionally, obesity is a major public health problem in the US, with more than one-third of adults (2) and 17% of children and adolescents (3) classified as obese. Decades of public health messages to eat a balanced diet have not resulted in behavior change — energy-rich, nutrient-poor foods comprise an estimated 27% of daily caloric intake in the American diet, and alcohol constitutes an additional 4% of daily caloric intake (4). Many Americans are exceeding energy (caloric) needs but not meeting micronutrient (vitamin and nutritionally essential mineral) requirements. One analysis of US national survey data (National Health and Nutrition Examination Survey 2003–2006) found that children and adults with high intakes of added sugars (>25% of energy intake; the upper limit recommended by the National Academy of Medicine) had lower dietary intakes of several micronutrients, especially vitamins A, C, and E, as well as magnesium (5). An estimated 13% of the US population have added sugar intakes above this cutoff level for added sugars (5) and may be at risk for micronutrient inadequacies.
O! M! F! G! That dry prose probably sends Vladmir Putin and Xi JinPing into fits of convulsive laughter. If they can manage to finish reading it. Yes, the preceding paragraph is mind numbingly boring, packing all the thrills of an actuarial table. Nonetheless, it should trigger klaxons. Hold that thought.
As a sobering aside, consider this difference between our two previous administrations:
- First Lady Michelle Obama led the Let’s Move campaign, the goal of which was to reduce obesity and encourage healthier living for children. Here’s a woman who grew her own spinach, collards, and berries in a White House garden.
- Fast forward to The Donald. According to two former Trump aides, there were four major food groups on Trump Force One: McDonald’s, Kentucky Fried Chicken, pizza and Diet Coke. According to a different former aide, Trump’s typical McDonald’s order was: two Big Macs, two Filet-o-Fish sandwiches, and a large chocolate shake, totaling 2,340 calories. (To his credit, he did hold the fries.)
Like much about Trump, his gluttony was leadership by counter example.
But that doesn’t answer these questions:
- Why isn’t Vivek Murthy a household name?
- How is the US so far ahead in healthcare, while being so far behind in healthcare?
Let’s isolate the difference in the two healthcare examples above:
- COVID is rampaging through the world like a tsunami. Vaccinations are a high-tech, aggressive response to an acute crisis.
- Inactivity and malnutrition are chronic problems … drip … drip … drip …
Typically, though not always, the media reports discrete events. Look at Google News. Chances are, every headline reports a discrete event. No headline reports “Approximately one-half of American adults still have at least one preventable chronic disease.” That may have been reported when the study was released, but if so it is now long forgotten, eclipsed by news of more police killing more African Americans, or Senators denouncing the cancellation of Dr. Seuss. Some of these events are important (police shooting black people). Some aren’t (Dr. Seuss). But chronic obesity, inactivity, and malnutrition is killing way more black people (and white and Hispanic and Asian people) than police are. Why isn’t that front and center?
This is probably not the fault of the news media, or at least not solely. For the most part, the media reports what people care about. People care about acute. They don’t care so much about chronic. They typically care even less about chronic when there is no opportunity to turn the topic into a “Here I Stand” issue, i.e., no one is going to say “Give me physical inactivity or give me death!”.
These acute healthcare problems are grave. What kind of a future does a country face if 1/3rd of its adults and 1/6th of its youth are obese, and if 27% of the food its people consume is junk? If you were a scientist asked to predict the longevity of two competing species, one of which suffered from chronic obesity, inactivity, and bad nutrition, and another that ate a healthful diet, moved constantly, and in which obesity was rare, which species would you bet on?
And that’s only a single chronic health issue. There’s opioids. And meth. And alcoholism. Depression. Mental illness. Debilitating insomnia. Crippling loneliness. And smoking … yep … 15% of American adults still smoke cigarettes even though everyone knows tobacco is a one-way ticket to lung cancer.
Hello? Why is “the cancellation” of Dr. Seuss even “a thing”, when much of the nation is chronically ill, or headed in that direction? No klaxons?
In that context, is Trump’s gluttony a joke or a symptom? What does it say about a country suffering from chronic obesity, malnutrition, and lack of exercise when it elects a President who a) has a BMI over 30, b) blows through 93.6% of his recommended daily caloric intake in a single McDonald’s binge, and c) believes that, other than golf, exercise is dangerous? Would this be any different, say, than electing a slave-owner to be President in a nation on the brink of Civil War (which actually could have happened: in the run-up to war, slavery was legal in four border states that ultimately remained in the Union)?
Back to our generals, Garland and Murthy. The argument here is not that AG Garland’s job is unimportant and unworthy of attention. Rather, the punchline is that SG Murthy’s job is at least as important as Garland’s, maybe more important, and that, pandemics aside, Murthy should be in the spotlight on a weekly if not daily if not hourly basis.
Beyond that, our healthcare is both outstanding and abysmal. We have millions of highly qualified and highly dedicated nurses and doctors, cutting-edge health technology, and some of the world’s leading healthcare institutions. In the United States, you can get some of the best healthcare in the world. You can. You may not. It helps a lot if you are wealthy and insured. And where we excel is when people are sick enough to go to the doctor, and need dramatic interventions. Think of how many Covid patients were saved by the skill and dedication of our healthcare workers, and the technology available to them.
Think also of the 568,000 Americans who died of Covid. How many of those people might have been saved if wearing masks didn’t devolve into a “Here I Stand” issue? Wearing masks during a pandemic is as much a part of healthcare as a triple bypass. It’s not sexy. It’s not heroic. It just saves lives.
If we all deeply cared about our own health and the health of all Americans, if the conversation about what we needed to do to turn these grim statistics about malnutrition and crystal meth and heart disease around didn’t degrade into partisan war, if Murthy was given the resources to actually protect, promote, and advance the health and safety of the general public, if the news media spent as much energy covering chronic health issues as it did reporting on which politician is now under investigation for <insert shocking egregious behavior here>, the upside opportunity for Vivek Murthy to make a seismic impact on this country would be enormous.
