Harvard Public Health NOW

Former U.S. Surgeon General C. Everett Koop Reflects On Career as Public Health Leader

"Politics should serve health and not the other way around,” said former U.S. Surgeon General C. Everett Koop, citing one of the core principles that has guided him through six decades of public health service as he addressed a full house in Snyder Auditorium on December 10.

He spoke as part of the Barry R. Bloom Public Health Leadership Speaker Series. The talk is available online.

Koop is now a senior scholar at the C. Everett Koop Institute at Dartmouth College in New Hampshire.

Koop served as surgeon general from 1982 to 1989. Despite many other issues that demanded his attention and action, Koop acknowledged that his name will be inextricably intertwined in history with the HIV/AIDS epidemic. This public health disaster hit soon after he was sworn in as surgeon general under President Ronald Reagan.

“We quickly determined the main modalities of transmission,” he recalled. “I went on national television to tell people how to avoid the disease, including the use of condoms. I was criticized by those who argued that people who contracted the disease through illicit drug use, or sex out of marriage, or sex with the same gender, did not warrant such assistance and that my comments might even lead them to such behavior,” said Koop.

“My response was simple,” he said. “I was the Surgeon General for all Americans, and, even though the Cabinet believed those diagnosed with AIDS got no more than they deserved, I did not believe that or go along with it.”

His campaign to address HIV/AIDS may have been advanced by a surprisingly serendipitous bomb scare when he was escorting President Reagan on a tour of the National Institutes of Health (NIH). As Koop recalled to laughter from the HSPH audience, Secret Service agents shoved him and President Reagan into a broom closet. Eyeball to eyeball in the tight compartment, Koop said, “Mr. President, I want to talk to you about AIDS.”

In other core principles, Koop affirmed the right of all people to high standards of health and to access to appropriate medical treatment, especially preventive services. He worked with the NIH to advance research, with the Centers for Disease Control to improve prevention, with the Food and Drug Administration to expedite pharmaceutical development, and with philanthropies to address funding gaps. He advocated for a clean-needle exchange. Long after his term ended, his teen health education film, Everything You Wanted to Know about AIDS but Were Afraid to Ask, continued to inform young people.

Koop was proud of his achievements, which he suggested are the yardstick of leadership. Yet, a shocking amount of public health work remains to be accomplished, he said. “If we treated AIDS like typhoid fever instead of like the political disease it was made, it would be a thing of the past,” he said. “That could have been done, and it could be done now. There’s no reason at all that HIV in the 21st century couldn’t go the way [that] smallpox [did] in the 20th [century].”

Koop demonstrated a personal style at the talk that blended self-deprecating humor with the confidence of his convictions. “All my life, I have assured people that you can trust me,” he said. “You might not like what I say or conclude, but I didn’t arrive at it in a spurious way and didn’t hide anything from the public.”

He criticized people in Washington D.C. who put their personal agenda ahead of the country’s needs. He saved his harshest words for the tobacco industry, including the researchers working for them.

He praised the career choice of students training in public health. “I can’t think of anything better to do with your life, or any other time [in public health history] where you will have as much satisfaction,” he said. “There is a niche out there for you, even if you don’t find it tomorrow. There are many places of great excitement ready to be filled by people just like you.”

--Carol Cruzan Morton.  Photography by Suzanne Camarata.