Diseases Cross Borders? Administration Official Doesnât Want to Hear It

By Liz Borkowski

After former U.S. Surgeon General Richard Carmona testified that White House officials tried to weaken or suppress important health reports for political purposes, Washington Post reporters Christopher Lee and Marc Kaufman followed up on the case of a 2006 surgeon generalâs report on global health (draft here) whose publication was blocked.

Carmonaâs report described the global nature of diseases and the many factors involved (including food and nutrition, water and air, and violence), and concluded with a call for international collaboration to improve overall global health. Who decided that this important public health message shouldnât be shared with the public? Lee and Kaufman followed the trail to William R. Steiger, head of HHSâs Office of Global Health Affairs. Given Steigerâs record over the past few years, this latest revelation isnât surprising.

A couple of bloggers have already written about this, and reminded us why Steigerâs name might sound familiar. DemFromCT at The Next Hurrah links back to an April Atlanta Journal-Constitution article about overseas CDC posts going unfilled â partly due to the requirement that Steigerâs office approve the assignments. An AJC editorial explains the consequences: âDespite still very-real threats like pandemic flu and bioterrorism, the federal governmentâs hiring bureaucracy is jeopardizing the Centers for Disease Control and Preventionâs ability to respond quickly to a public health crisis in other parts of the world.â

When it comes to public health crises, obesity should be on everyoneâs list. TBogg points back to 2004, when the National Review of Medicine reported that Steiger challenged the WHO/FAO report âDiet, Nutrition, and the Prevention of Chronic Diseaseâ for its recommendations that governments limit childrenâs exposure to junk food advertising and that added sugars make up no more than 10% of a healthy diet. (Groups like the National Soft Drink Association claim that itâs not harmful to have 25% of calories from added sugar.)

So, why has Steiger slowed the progress of global efforts to curb obesity and collaborate for global health? Lee and Kaufman report:

Carmona told lawmakers that, as he fought to release the document, he was "called in and again admonished . . . via a senior official who said, 'You don't get it.' " He said a senior official told him that "this will be a political document, or it will not be released."

After a long struggle that pitted top scientific and medical experts inside and outside the government against Steiger and his political bosses, Carmona refused to make the requested changes, according to the officials. Carmona engaged in similar fights over other public health reports, including an unpublished report on prison health. A few days before the end of his term as the nation's senior medical officer, he was abruptly told he would not be reappointed.

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On June 30, 2006, a Steiger aide sent an e-mail saying that the report should not be cleared for public distribution: "While we believe the subject matter of the draft is important, we disagree with the style, tone and messaging," wrote the aide, Mark A. Abdoo, according to a copy of the e-mail. "We believe this document should be focused tightly on the Administration's major priorities in global health so the American public can understand better why these issues should be important to them. As such, the draft should be a policy statement, albeit one that is evidence based and draws on the best available science."

In the case of the CDC assignments, the AJC editorial also criticizes the way the Bush administration âseems to treat all overseas job assignments as if they are political positions.â It notes that âthe employees being sent abroad by the CDC are not doing political or diplomatic work; they are scientists.â

Itâs a shame to have to say it, but many of us have become accustomed to the Bush administrationâs habit of putting politics before science, whether the topic is global warming, endangered species, or reproductive health. Whatâs noteworthy about Steigerâs suppression of health reports is his apparent unwillingness to acknowledge risks that the U.S. public â even those with lots of money and prestige â might face in the very near future if we donât address the problems Carmona highlights.

In his global health report, Carmona gives multiple reasons for taking a global approach to health, and the first is, âCaring about the health of others is a moral value shared by people of all cultures and religions.â  Probably realizing that wouldnât be sufficiently compelling for all members of his audience, he gave as his second reason:

Caring about the health of others is also of practical significance because of the interconnectedness of the world and the ability of disease to spread rapidly across borders. Global health is the awareness that SARS can emerge in Hong Kong and almost immediately strike Toronto; it is the understanding that the Hantavirus, first seen in Korea, can turn up years later in New Mexico; it is the recognition that the hemorrhagic fever of the African interior may take root in a Western metropolis or that an influenza pandemic could emerge in humans almost anywhere in the world and spread globally within days. Global health grasps that viruses, bacteria, and parasites can cross all borders -- so the fight against them must do the same.

And just in case that wasnât clear enough in 2006, now we have the example of the jet-setting U.S. lawyer contracting multi-drug-resistant tuberculosis and getting on planes.

The Washington Post article also devotes a few paragraphs to a report on prisons that hasnât made it to publication:

The global health document was one of several reports initiated by Carmona that top HHS officials suppressed because they disliked the reports' conclusions, according to a former administration official. Another was a "Call to Action on Corrections and Community Health." It says -- according to draft language obtained by The Post -- that the public has a large stake in the health of the 2 million men and women who are behind bars, and in the health care available to them in their communities after their release.

The report recommends enhanced health screenings for those arrested and their victims; better disease surveillance in prisons; and ready access to medical, mental health and substance abuse prevention services for those released.

But the report has been bottled up at HHS, said three public health experts who worked on it. John Miles, a consultant and former Centers for Disease Control and Prevention official who helped draft it, said he suspects that the proposed health screenings and other recommendations are seen as a potentially burdensome cost. "Maybe they just don't feel it's a priority," Miles said.

Again, there are plenty of important reasons to provide health care for inmates, but Steiger should at least realize that diseases transmitted in prison will eventually spread beyond the facilitiesâ walls. London School of Economics sociologist Megan Comfort reported that in 2002, 12,000 released inmates had tuberculosis, representing 35% of the Americans who have this disease. Even more recently, some prisons are reporting outbreaks of methicillin-resistant staphylococcus aureus, a bacteria that can turn minor skin abrasions into life-threatening, hard-to-treat condition (the blog MRSA Notes collects reports). When prison staff go home at the end of the day, and when inmates are released into the community, any diseases theyâve acquired will go with them beyond the prisonsâ borders.

The Washington Post article notes Steigerâs ties to the Bush administration:

Steiger, 37, is a godson of former president George H.W. Bush and the son of a moderate Republican who represented Wisconsin in the House and hired a young Dick Cheney as an intern. The elder Bush appointed Steiger's mother to the Federal Trade Commission in 1989. A biographical sketch of her on the American Bar Association's Web site states that Steiger's parents, now deceased, were "lifelong friends" of many members of the same congressional class, including the Rumsfelds and the Bushes.

It doesnât note that Steigerâs father, Representative William R. Steiger of Wisconsin, was behind a very important piece of legislation: the Williams-Steiger Occupational Safety and Health Act of 1970, or OSHA. Itâs disappointing that the legislatorâs son is not following his fatherâs example of advancing public health. Instead, he seems to be hoping that ignoring problems will make them go away.

Liz Borkowski works for the Project on Scientific Knowledge and Public Policy (SKAPP) at George Washington Universityâs School of Public Health and Health Services.