At his 95th birthday last year, former surgeon general Dr. C. Everett Koop was confined to a wheelchair and couldn’t speak. But John Seffrin, chief executive officer of the American Cancer Society, and a long-time friend, spoke at the occasion and managed to get a wink and a smile from America’s doctor.
“It was a special moment, and the way I will always remember him,” Seffrin said in a statement.
Koop, 96, passed away at his home in New Hampshire on Feb. 25.
With his trademark beard and no-nonsense demeanor, Koop, who was a native of Brooklyn, New York, liked to play the part he was assigned, often appearing in public in the traditional vice admiral’s uniform of the Public Health Service that came with the position of Surgeon General. He was a pediatric surgeon at the Children’s Hospital in Philadelphia for 35 years, and when he was promoted to the nation’s physician in 1982 by President Ronald Reagan, it would become the first public office he ever held.
Koop took a relatively obscure position in the government and over his seven-year tenure infused it with a responsibility and obligation to improve public health that his successors still strive to meet. “While he was Surgeon General, he was America’s doctor,” says Paul Billings, senior vice president for advocacy and education for the American Lung Association. “He recognized he was a highly visible spokesperson, and he was the personification of what the Surgeon General can and should be.”
Understanding the power of the media, Koop became a familiar figure to Americans, and adeptly bypassed the bureaucracy and political reluctance to oppose the tobacco industry and took his anti-smoking campaign directly to the American people. His goal was nothing less than a smoke-free America by 2000, and while he wasn’t entirely successful, his ground-breaking Surgeon General’s report on the dangers of smoking, published in 1986, was among the first to alert people to the hazards of second-hand smoke. When the took office in 1982, about 38% of adults lit up, but by the time he left, that proportion had dropped to 27%.
“He was one of the first public officials to state categorically that second hand smoke causes cancer,” says Dr. Jeremy Lazarus, president of the American Medical Association. “Because of what he did, and the way he did it, he had a dramatic impact on public health.” After his seminal report on the hazards of smoking, federal and state facilities, as well as private businesses, began banning smoking. Today, those efforts have mushroomed into a complete ban on U.S. airplanes, in most hotels, restaurants and public places.
And Koop’s legacy isn’t limited to his anti-smoking efforts. He was perhaps even more outspoken about the need to educate and raise awareness about AIDS, a disease that was just emerging during his tenure. In 1986, Reagan asked Koop to write a comprehensive report on the disease, and Koop complied, concluding that abstinence and monogamy were the best way to protect against infection. But the devout evangelical Christian also acknowledged that condoms were an effective way to curb transmission, a position that earned him critics in the conservative administration, not to mention among his circle of religious supporters.
As a physician, however, he could not ignore the impending public health crisis represented by HIV, and did not allow his own religious views — he opposed homosexuality and believed in abstinence until marriage — to prevent him for educating the public about the disease. When he felt that the Reagan administration was in denial about the dangers of HIV, he again chose to appeal directly to the public, and mailed a pamphlet on the disease to nearly 100 million households.
Long after he left office, Koop testified at a Congressional hearing in 2007 that his outspoken insistence that the administration address HIV-AIDS nearly got him fired — every day. But his commitment to improving public health have inspired millions to change their health behaviors. It’s not an exaggeration to say that current public health campaigns, including First Lady Michelle Obama’s Let’s Move! initiative to increase physical activity, have their roots in Koop’s forays to confront the public about their health habits, whether via television or in country-wide speaking jaunts that endeared him to the public. He recognized that to affect the public’s health, it would take more than a pronouncement from the nation’s doctor, but a concerted effort to change policies, regulations, and the environment in which we live to make it easier to lead healthier lives.