Bush Aide Blocked Report
Global Health Draft In 2006 Rejected for Not Being Political
A surgeon general's report in 2006 that called on Americans to help tackle global health problems has been kept from the public by a Bush political appointee without any background or expertise in medicine or public health, chiefly because the report did not promote the administration's policy accomplishments, according to current and former public health officials.
The report described the link between poverty and poor health, urged the U.S. government to help combat widespread diseases as a key aim of its foreign policy, and called on corporations to help improve health conditions in the countries where they operate. A copy of the report was obtained by The Washington Post.
Three people directly involved in its preparation said its publication was blocked by William R. Steiger, a specialist in education and a scholar of Latin American history whose family has long ties to President Bush and Vice President Cheney. Since 2001, Steiger has run the Office of Global Health Affairs in the Department of Health and Human Services.
Richard H. Carmona, who commissioned the "Call to Action on Global Health" while serving as surgeon general from 2002 to 2006, recently cited its suppression as an example of the Bush administration's frequent efforts during his tenure to give scientific documents a political twist. At a July 10 House committee hearing, Carmona did not cite Steiger by name or detail the report's contents and its implications for American public health.
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 Carmona engaged in similar fights over other public health reports, including an unpublished report on prison health.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.
Steiger did not return a phone call seeking his comment. But he said in a written statement released by an HHS spokesman Friday that the report contained information that was "often inaccurate or out-of-date and it lacked analysis and focus."
Steiger confirmed that he sharply disagreed with Carmona on the issue of how much the report should promote Bush administration policies. "A document meant to educate the American public about health as a global challenge and urge them to action should at least let Americans know what their generosity is already doing in helping to solve those challenges," Steiger said in the statement.
Steiger said that "political considerations" did not delay the report; "sloppy work, poor analysis, and lack of scientific rigor did." Asked about the report's handling, an HHS spokeswoman said Friday that it is still "under development."
The draft report itself, in language linking public health problems with violence and other social ills, says "we cannot overstate . . . that problems in remote parts of the globe can no longer be ignored. Diseases that Americans once read about as affecting people in regions . . . most of us would never visit are now capable of reaching us directly. The hunger, disease, and death resulting from poor food and nutrition create social and political instability . . . and that instability may spread to other nations as people migrate to survive."
In 65 pages, the report charts trends in infectious and chronic disease; reviews efforts to curb AIDS, tuberculosis and malaria; calls for the careful monitoring of public health to safeguard against bioterrorism; and explains the importance of proper nutrition, childhood immunizations and clean air and water, among other topics. Its underlying message is that disease and suffering do not respect political boundaries in an era of globalization and mass population movements.
The report was compiled by government and private public-health experts from various organizations, including the National Institutes of Health, the Catholic Medical Mission Board and several universities. Steiger's global health office provided the funding and staff to lead the effort because the surgeon general's office has no budget and few staff members of its own.
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Three people involved in the preparation of an initial draft in 2005 said it received largely positive reviews from global health experts both inside and outside the government, prompting wide optimism that the report would be publicly released that year. The Commissioned Officers Association, a nonprofit group representing more than 7,000 current and retired officers of the U.S. Public Health Service, organized a global health summit in June 2005 in Philadelphia where Carmona was expected to unveil the report in a keynote address -- but he was not cleared to release it there.
Richard Walling, a former career official in the HHS global health office who oversaw the draft, said Steiger was the official who blocked its release. "Steiger always had his political hat on," he said. "I don't think public health was what his vision was. As far as the international office was concerned, it was a political office of the secretary. . . . What he was looking for, and in general what he was always looking for, was, 'How do we promote the policies and the programs of the administration?' This report didn't focus on that."
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"I fought for my last year to try to get it out and couldn't get it past the initial vetting," Carmona testified earlier this month. "I refused to release it [with the requested changes] . . . because it would tarnish the office of the surgeon general when our colleagues saw us taking a political stand."
Thomas Novotny, a former assistant surgeon general who ran the global health office before Steiger, said, "It's embarrassing, just ridiculous that the report hasn't come out." Novotny, who served at HHS in the Clinton and in both Bush administrations, said that many nations have made health issues central to their foreign relations and trade policies, but that the United States has been reluctant to embrace that idea.
"It made perfect sense for the surgeon general to take up the issue because the U.S. used to be a leader in this field," Novotny said. "For the nation's top doctor to be unable to release the report shows that leadership is gone."
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