C. Everett Koop, M.D.: Reflections on an Extraordinary Figure in Public Health

Feb. 26, 2013
In the fall of 1991, I was invited to meet and interview C. Everett Koop, M.D. My brief encounter with him gave me insights into the mind of a virtually unique figure in the public health history of the U.S.

In the fall of 1991, I was invited to meet and interview C. Everett Koop, M.D. At the time, I was managing editor of another publication, and my magazine had a relationship with a professional healthcare marketing society that was honoring Dr. Koop by naming an award for him, and giving him the first award. The award had been conceived to recognize leaders in the healthcare field who have spoken out constructively on healthcare policy, reform, and public health issues.

The whole behind-the-scenes process of arranging the interview was fascinating in itself (for one thing, it was my first experience with public people’s “entourages”); suffice it to say that Dr. Koop, who had retired as U.S. Surgeon General in October 1989, and who had been out of that office for less than two years at the time I met him, and was unquestionably one of the most famous people in healthcare at that time. Indeed, it has been noted that Dr. Koop has been virtually the only Surgeon General to become a household name during this tenure in that office.

Dr. Koop was a fascinating person to meet. On the one hand, it was clear he was aware of his standing and his worth; not surprisingly, since he was a pioneer in pediatric surgery, and was someone who had become a prominent thought-leader on some public health and healthcare policy issues. But he was in no way arrogant or entitled in his attitude; instead, he was one of the most focused, calm people I’ve ever met (again, that makes sense, right? he was a pediatric surgeon), someone who knew who he was, what he thought, and what he wanted.

And the thing that he had most publicly wanted that made all the difference in the world was this: as Surgeon General, he changed the public discourse around AIDS. As The New York Times' obituary on him noted, “Dr. Koop issued emphatic warnings about the dangers of smoking, he almost single-handedly pushed the government into taking a more aggressive stand against AIDS, and despite his moral opposition, he refused to use his office as a pulpit from which to preach against it. These stands,” the Times’ obit, by Holcomb B. Noble, added, “led many liberals who had opposed his nomination to praise him, and many conservatives who had supported his appointment to vilify him. Conservative politicians representing tobacco-growing states were among his harshest critics, and many Americans, for moral or religious reasons, were upset by his public programs to fight AIDS and felt betrayed by his relative silence on abortion.”

There are two really important lessons to be learned here, I think. The first, and lesser one, is that people sometimes end up being very different from how one might anticipate they would be like, based on the superficial bits of information publicly available about them. True, Dr. Koop was a religious man and a conservative man, from a very socially conservative background; and in fact, he remained both religious and socially conservative all his life. But he was also a savvy and sophisticated strategist, and above all, someone fiercely committed to improving public health, and who felt absolutely no compunctions about doing what he needed to do in order to use his post as a bully pulpit to help Americans of all backgrounds.

Second, Dr. Koop was courageous, and he stood up to a vocal segment of the population who would have liked to have silenced him, particularly on the subject of AIDS, perhaps including the president who had appointed him, and whom he served. Those who don’t remember the 1980s may not even realize how different the public discourse was around HIV/AIDS at that time, particularly during the first half of that decade, when fear, prejudice and moralizing cloaked the spread of the disease like a suffocating blanket. It’s well-known that President Reagan, who in many ways was known to be a deeply generous man on a personal level, refused to even mention the disease by name until the very end of his term in office. What’s more, he had appointed Dr. Koop to the Surgeon General post just a year before the disease first emerged publicly. In the years immediately after the emergence of HIV/AIDS, it is awful to recall, some extremists were calling for all people with AIDS (PWAs—but then, often cringefully referred to as “AIDS victims”) to be herded into concentration camps so that they could be separated from the public—yes, in America, in the mid-1980s. And, initially at least, few public figures were willing to try to push the policy and political establishment forward to take action in that area.

Dr. Koop was one of the first of any prominence and public position to do so, and in standing up to the forces of ignorance, he almost single-handedly changed the discourse around HIV/AIDS in this country—just as Princess Diana almost single-handedly changed social attitudes about HIV/AIDS globally when, in direct contravention of requests that she wear latex gloves when visiting AIDS patients in hospitals, insisted not only on shaking their hands, bare-handed, but embracing them warmly in front of television and still cameras. It was gestures like Diana’s, and the relentless public health promotion campaign launched by Dr. Koop, that helped move the discourse around HIV/AIDS forward at an absolutely critical time in the evolution of efforts to treat people living with the disease, prevent its spread, and find a cure for it.

And that brings me back to the reason I was brought together with Dr. Koop, to discuss healthcare reform, which is what he wanted to do with his prominence and the opportunity bestowed on him by the award recognition. In the fall of 1991, the healthcare reform debate was in full swing, and would become an important issue in the 1992 presidential election and beyond. And Dr. Koop, who by the time I interviewed him was a private citizen, was free to speak his mind, and spoke forcefully about the need for comprehensive health care reform, from the perspective of a pediatric surgeon who had been skilled in attending to the physical needs of children, but who had also for many years seen the consequences of a broken healthcare insurance and reimbursement system. He never failed to speak out, even in his later years, about issues that mattered to him.

So, upon hearing of his death yesterday evening, my mind instantly went back to my brief meeting with him back in the fall of 1991—and what remained, and remains in my memory, about an unusual, and extraordinary, figure in healthcare policy and public health in this country. There’s a reason that Dr. Koop was, and remains, to this date—virtually the only Surgeon General to become a household name. Would that everyone thrust into a position of nationwide visibility as he was, would use his or her bully pulpit to the same effect.

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