Surgeon General Addresses Opioid Epidemic, Public Health Challenges During Keynote at National Public Health Week: Public Health Watch

US Surgeon General Jerome Adams, MD, MPH, has seen first-hand the collateral damage caused by the ongoing opioid epidemic.

Therefore, it’s no surprise that his experiences as the Indiana Health Commissioner—under former Hoosier state governor, and current US vice president, Mike Pence—were the focus of his remarks as keynote speaker for the American Public Health Association’s (APHA) “National Public Health Week” (NPHW) event last week in Washington, DC. Dr. Adams headed up Indiana’s public health infrastructure when nearly 200 new cases of HIV were diagnosed in rural Scott County in 2015 through 2016. The case cluster was linked to intravenous (IV) opioid abuse within the local community.

As tragic and challenging as public health emergencies such as the Scott County outbreak can be, though, Dr. Adams emphasized to the audience of public health professionals gathered for NPHW that they also present advocates with “opportunities to talk about so much of what we want to talk about” and implement “upstream initiatives” that not only address, for example, the opioid epidemic but other public health issues as well.

At present, according to the surgeon general, 2.1 million Americans have been diagnosed with opioid use disorder, yet only 1 in 5 of them receives treatment.

Interestingly, in an era of in which everything is political—and politics is perhaps more polarized than ever before—Dr. Adams is advocating for what APHA Executive Director Georges Benjamin, MD, described as the “sensible middle.” His motto since his appointment as the nation’s 20th surgeon general, by President Donald Trump, is “Better health through better partnerships.” And, he used the Scott County HIV outbreak to illustrate how public health specialists need to “work across sectors” to address the challenges they face. He noted that he proactively engaged both local law enforcement and religious leaders in the management of the Scott County outbreak, and to great effect.

Notably, he added that, “regardless of what you think of him,” the public health community has a well-placed ear in the form of current Housing and Urban Development director, Ben Carson, MD, who, as a physician, Dr. Adams said, understands the concept of “housing is health.”

“We in public health know that health is so much more than health care,” he told the audience. “What we need to change health already exists in our communities. We just need to unleash it.”

Dr. Adams’ remarks come in a year in which the theme for NPHW was “Changing our future together.” His keynote address focused primarily on the last word of the theme, offering recommendations for how public health can better engage both traditional and non-traditional partners in addressing challenges affecting local communities. He was forthright in acknowledging concerns that many public health specialists have with President Trump and his administration, and told the audience that he will not advocate for positions unless they are supported by widely accepted medical science; he will, he added, always champion additional funding for public health initiatives.

However, he also said that public health specialists may experience increased distrust of and resistance to their initiatives—either in response to or to forestall a potential emergency—at the local level unless “we show communities that we care about their needs as opposed to ramming policy down their throats.” He cited the example of Tennessee, generally viewed as a conservative, religious state, leading the way in programs involving “voluntary long-acting reversible contraception” for at-risk women in response to the opioid epidemic.

“They saw that they had the highest rates of Neonatal Abstinence Syndrome [in the country],” he explained, adding that leaders taking what might be viewed as an unpopular approach in their state demonstrated the success public health advocates can have “show[ing]… [communities] you care before… show[ing] them what you know.

“My vision is for a healthier and more equitable America,” he continued. “But it can only be achieved if we reframe how we talk about health care.”

Brian P. Dunleavy is a medical writer and editor based in New York. His work has appeared in numerous health care-related publications. He is the former editor of Infectious Disease Special Edition.