Appalachian Perspective: U.S. Surgeon General Dr. Regina Benjamin

Hosted by Appalachian State University's Chancellor Kenneth E. Peacock, Appalachian Perspective cable television program has featured prominent and interesting North Carolinians, the university's leading academic and public service programs, and other topics of statewide interest. Episodes air across the state on cable operators' community access channels. The 30-minute program is a production of the university's Office of University Communications.

She is called America's doctor providing the best scientific information available on improving ones health and reducing the risk of illness and injury. She is Dr. Regina Benjamin who is the 18th Surgeon General of the U.S. Public Health Service appointed by President Obama. Surgeon General Benjamin began her medical career in rural Alabama and is now the top physician in the nation.


Chancellor Ken Peacock: She is called America's doctor providing the best scientific information available on improving ones health and reducing the risk of illness and injury. I'm speaking of Dr. Regina Benjamin who is the 18th Surgeon General of the U.S. Public Health Service appointed by President Obama. Surgeon General Benjamin began her medical career in rural Alabama and is now the top physician in the nation. We'll meet this intriguing public figure coming up on Appalachian Perspective.

KP: Welcome to Appalachian Perspective, my guest today is U.S. Surgeon General Dr. Regina Benjamin, who is visiting campus as commencement speaker. Welcome Dr. Benjamin. It's truly and pleasure and an honor to have you here on our campus.

U.S. Surgeon General Dr. Regina Benjamin: Thank you for having me, I'm honored to be here and intrigued.

KP: Tell me a little bit about all the honors that you have received. You're Time magazine's most notable figure. You were person of the week on ABC, you've been on CBS, every show in the world and here you are in Boone N.C. It's a tremendous honor to have you here.

RB: It's great to be here. What can I say? I guess the best honor for me is when I'm in a room with a patient seeing one patient at a time, treating that patient and getting to know them and treating whatever their illnesses are or preventing them from having an illness and teaching them about prevention. So that's the best of all—being one person's doctor.

KP: So even in this great influential role that you have, this great leadership position, that surgeon part, that physician part, is still who you are.

RB: I'm a family doctor. I'm a family physician. I was in Bayou La Batre, Alabama for twenty-three years so it was really a tough decision to leave my practice, and I was in solo practice, to go to Washington, but now I consider myself as has having 300,000,000 Americans as my patients.

KP: Well tell us about those first years coming up. Tell me about your educational experience and then your first few years.

RB: I grew up in a small town, a very small town outside of Mobile, Alabama and we only had one doctor and I'd never seen an African American doctor until I went to medical school. Actually until I was in college there was one in college, so I actually didn't know what I wanted to be I just always new I wanted to go to college and what I say to students, particularly high school kids, you never know where one door is going to lead you. I like to join things. I like sororities. My sorority sisters here at Appalachian just gave me a little gift package here. I see them everywhere. But I join things so I joined a pre-med club and that's how I kind of got started, introduced to medicine is joining the pre-med club. But I went to medical school and just got interested in everything and that's why I'm a family doctor because I couldn't settle on just one thing. So I like everything.

KP: Part of your professional life you started in a small fishing village, am I correct?

RB: My practice is in a small fishing village south of Mobile, called Bayou La Batre, Alabama and it was made famous by the movie Forrest Gump. That's the little shrimping town—Bubba Gump Shrimp. They didn't quite build us a hospital like in the movie, but that's the town. People there are working individuals. They are too rich for Medicaid but too poor to qualify to have insurance, so they really pay for their own healthcare, the average every day working person who is trying to make a living and making ends meet and they are trying to be as healthy as they can and I try to help them as much as I can.

KP: So now you don't keep your practice anymore right now, is that correct?

RB: That's correct. The clinic is still going. We have a doctor there, and an executive director but I can't see patients there right now.

KP: OK. Tell me how you—you've been recognized by so many publications—but how do you think you became America's doctor? That's a pretty big deal.

RB: I'm learning, it is a big deal. Actually I've always been active in organized medicine with the AMA—the American Medical Association—very active with the North Carolina Medical Association and various ones across the country. So whenever there is issue, I would speak up to it, and so I would volunteer for various committees, boards and through the years people start to listen and I was never shy about talking. So I think that is how I came to be noticed by people who were in the political realm. I've never been in politics before, myself.

KP: Well now, what is a so-called a typical day as America's doctor, as U.S. Surgeon General.

RB: Actually there is no typical day. We're on the road constantly, out visiting with people—which I like—going out to various organizations, various communities, doing a lot of things trying to promote public health in the best way that we can. I've really been doing a lot with obesity and childhood obesity with the first lady's Let's Move program and my Surgeon General's Vision for a Healthy and Fit Nation. You know all the statistics about how obese and overweight our society is, and trying to get people to exercise because it's fun. I believe that exercise is medicine and the more we do it, and not because we dread it, we've often told people enough how bad things are—what you can't eat, what you can't do—and we need to start telling them now what you can do and enjoy doing and have a good time doing it. So I've been walking around the country. When I say walk, for example we walked with the mayor in Los Angeles and 5,000 fitness trainers, we walked in Baltimore around the Baltimore harbor, we take a time and just walk and get the people to join the Surgeon General in a walk. We did one recently in Boston with doctors called "White Coats and White Sneakers." We were in Nashville a few weeks ago at an elementary school walking and exercising. I even tried to hike the Grand Canyon rim to rim, 27 miles, walking just to show people anybody can exercise just by going outside and enjoying the beautiful outdoors. I'm not a fitness buff but I can walk the Grand Canyon. If I can do those 27 miles, 5,000 feet down and 5,000 feet up, anybody can do it, and enjoy doing it and have a good time, as well. You know we used to jump rope, we'd go disco dancing—I'm telling my age—but you do those because you had a good time doing them and had fun, not because someone said you need to go disco dancing for thirty minutes. You did it because you had fun. So I wanted to get it back to being fun and change that conversation about exercise and fitness from a negative conversation to a positive conversation about being healthy and fit.

KP: When I met you in New York, you spoke that night about obesity as being an issue and something you wanted to tackle during your administration here. Are there other things along that line, too? What can you tell me about it?

RB: There's lots of other things. The obesity, of course, is a big issue. We certainly have an issue with tobacco. This week, even just a couple days ago we introduced my first Surgeon General's report on tobacco, which in fact was the thirtieth Surgeon General's report on tobacco since 1964. The first report was done by a Surgeon General Dr. Terry from Alabama and he's the one who put the Surgeon General's warning on the tobacco cigarette packages. We're coming up on the 50th anniversary, so this report really is about the science of how tobacco smoke harms you. You may have heard that what we've learned with all the scientists—64 scientists helped us on this report—is that even one breath, one inhalation, of tobacco smoke can be harmful and it can be harmful to the fact that it may cause you to have a heart attack. It is very immediate, the harm is immediate, and there is no safe level of smoking tobacco or inhaling or being around tobacco smoke. The way it works is that when you inhale tobacco smoke either passive, like secondhand smoke, or if you inhale it yourself, it affects the blood lining, the lining of every blood vessel, and makes your blood thicker and more easy to clot. So once that happens it sets off a whole mechanism and it can lead to a heart attack or stroke whereever that clot may happen to be.

KP: This is secondhand smoke also, or...

RB: Secondhand smoke as well.

KP: OK, so there is a risk a health risk involved for a person that's working around an environment where there is smoking.

RB: Yes, very much so. We've known secondhand smoke is harmful. Now we know how it is harmful and why it's harmful and that really is important for people who don't have choices, like people who work in casinos or places where there is tobacco smoke and they don't have a choice. We really need to start to look at how we can help them get into some smoke-free environments.

KP: Yes, absolutely. An issue we have at universities in North Carolina, you know, because North Carolina has always been a tobacco state.

RB: Yes. Another finding in this report is that tobacco smoke is addicting. It's made more addicting, and we have some scientific ways to now prove that and we know how that works, as well. For example, there are seven-thousand chemicals and chemical compounds that are added to tobacco, that are in tobacco smoke. And this whole report is about tobacco smoke. With those seven-thousand compounds, when they enter your bloodstream some of them are cancer causing and some of them are very addicting, and there are some things that are added to the tobacco products, the cigarettes, to make them more addicting. For example, ammonia is added, and some other chemicals. But ammonia, for example, is added and it is taken from nicotine, which we know is very addicting, to something that is called free nicotine and it gets into the brain much faster and by getting into the brain much faster you become addicted. And there's another thing they do, they package it different and they put these things—what do you call them—filters, and the filters have air that come in. It used to be the air would come from the back of the cigarette all the way up. These filters now have big holes in them so that it can also change that nicotine to the free nicotine which crosses the blood-brain barrier faster and therefore get into your brain much faster. We see this all the time. People don't know why they couldn't stop smoking. They try and they try and they have to try several times. There are medical reasons for that and now we know what those medical reasons are. We also know that adolescents and young adults are much more easily addicted than older adults. That's why we see, every day over a 1,000 teenagers become daily smokers. That explains it to us. These are reasons why I think we should try to keep it out of universities and where young people are. We also have a new tobacco strategy—a strategy to try and make us become a smoke-free nation, and hopefully we will become smoke-free at some point. One of the things that the FDA is doing now, because they can regulate tobacco as a drug so they can regulate tobacco products and you may have seen where they are putting these new warning labels on cigarette packages—big graphic warnings that take up half of the package, ugly pictures of people with mouth cancers, face cancers, trachs, the hole in the neck, and various things that make it unattractive to young people. We see that works in Canada and Europe and we've seen through studies that it is working, so the FDA is going to be doing that come this summer.

KP: Dr. Benjamin, how do you explain students or young people that start smoking? They hear about this, and we know it's true. You know years ago and I'm gripping the eastern part of the state, and it was common for people to be smoking but we didn't know about this. I remember when the packages first came out with the warning on it. That was in the late 60's.

RB: That's right, we really didn't know about it and I talk about it to everyone, my mother started smoking when she was a teenager. She was a girl and because she was a girl she couldn't smoke like her twin brother could, so as soon as she was old enough she picked up this habit, too. And my mother died of lung cancer from cigarette smoking, so I see what happens to families when loved ones dies from tobacco or related diseases. Her twin brother, my uncle, now is on oxygen every day from emphysema from smoking. So, in their generation everybody smoked. It was commonplace. We didn't know the effects, we didn't know what would happen. Now we do. Now, not only do we know but we know how it happens and that what this report was about, how it happens. By knowing how it happens and what happens we really should be able to get people the information and they can make their decisions to stop. We also have some ways, things to help. I suggest they talk to their doctors because we have done studies of people who smoke—70% will say they want to stop but it's really hard for them to stop. So when they are told to stop by their doctors they have a 66% chance better to stop smoking than if they weren't told by their doctors. We have medications to help. We have patches and things to help them and we have counseling available. We have a 1-800-QUIT-NOW line that they can call for help. So we have things to help people stop. I'm on my soap-box.

KP: No that's a good soap-box because I really wish that we could get across to young people at Appalachian to don't ever start. But you know what it's like to be a college student. There's a freedom that goes along with that. I can know do what I wish to do.

RB: That's why it's so important to understand that it's addicting—that once you start it's very, very hard to stop. And some people can smoke one or two and put them down, other people can't. They start and they're kind of hooked.

KP: One other area that you work on a lot, you chair the National Prevention Council. What are some of the initiatives of that council, what are you working on, what projects right now?

RB: Well, the National Prevention Council is part of the Affordable Care Act, called the Health Reform Act. Few people know about it, that it was even there. The National Prevention Council is made up of seventeen agencies throughout government and the people that are the members are cabinet-level members, which shows how important it is to the administration that we start to look at prevention. We're charged to look at prevention throughout government and let government be the leader. But we want to—what I didn't mention is that I chair this, I'm fortunate enough to chair it—and one of the things I want to do is to make sure that we prevent people from getting sick in the first place. Try to move us from a system of sick care to a system of wellness and prevention. This council is sort of helping us do that. Everything we look at, we look at from a prevention standpoint, that health is not just treating the disease—we're very good at that, we have wonderful clinicians, wonderful technology, some of the best in the world is right here in the U.S.—but we want to keep them well before they get sick. We need to make sure we keep our good clinicians, our good research going but in addition to that work on prevention as well. Because things like housing, where you live, safe sidewalks, safe parks for people to exercise, good grocery stores in your communities, places where you have worksite wellness programs where you have people spend most of their time at work, it's a healthy environment, that kids can have healthy places in their schools, healthy school lunches, programs like that, that all of that contribute to wellness and health. Good environment, clean air, safety, things like seat belts and things that we know, bike helmets, things that we know keep people healthy, put all that to keep people from getting sick. So this Prevention Council is to come up with a national prevention strategy by March. So that's what we're working on, and then we'll try to implement that strategy throughout government and try to help be a leader for communities and businesses and individuals to show how we can help them if they want to become a part of this. That we can be the leaders for them, provide some leadership and make it easier for these communities to be healthy.

KP: If our society is not healthy, what's the risk there? I mean it's more than just, "I'm not healthy myself" but what does that do to our society?

RB: Well we can be healthier, we can always be much much healthier. But when you're not healthy or your community is not healthy you have kids go to school not ready to learn. People go to work and have sick days or an increase, they are not prepared to be a good healthy workforce, so you have absenteeism and poor performance because you're not healthy. When you have to stay home with your sick kids, when you have a heart attack and you're out for six weeks to eight weeks you're having to—you just aren't a good healthy community. You need to be healthy to be able to participate in your community, to be able to watch your kids go to school, to be able to walk your daughter down the aisle, to be able to watch your grandkids be born and grown up. So you need to be an entire healthy community and that includes mental health. You know, we're talking about the physical things but it includes happy, enjoyable life. One of the other areas that I'm interested in is violence. We have so much violence in our society right now so we're looking at doing a—we have a Surgeon General's report on youth violence about ten years ago—so we're trying to look at that again and trying to see if we need to do another report. Youth violence, including bullying and including domestic violence, violence in the workplace, you go to the mall and don't know if someone is going to be shooting up. So you need to figure out what's in our society that's causing all of this stress and what can we do as a nation to improve on that. So we work with the Education Department, Department of Justice, everyone we can get involved. Private partners, public partners trying to figure out what we can do to make our society less stressful and less violent.

KP: I hadn't really thought that much about the mental health part, so what can you tell me about those experiences you've had with mental health?

RB: Well, I was very involved with the Gulf Oil spill this summer, which was a very strong effect on our communities, typically along the Gulf Coast and in Bayou La Batre. We had everything from depression to major depression, minor depression to major depression. I had one of my patients, for example, who told me that, she says well "Dr. Benjamin I went into my kitchen to make (and she called it "her" gumbo) and I realized I didn't have the things to put into it" and she said "I just sat down at the table and cried." So we went from everything to that minor depression to one of our boat captains who took his boat out and shot himself. So from everything from minor depression to suicide. So we have to realize that behavioral effects and how these events affect us and how they affect our communities. So in this case we really worked with the communities and the states who have more behavioral health workers available and resources available for people to call. But we still have the 1-800 line available for them and help them with the states and continue the monitoring and helping with resources.

KP: Well, Dr. Benjamin in North Carolina recently it seems that of what I hear on the news is we've had more stress I guess, the economy of course bothers people a lot and you find more abuse of a child and sometimes children are killed by a parent and as a parent myself, I just find that extremely impossible to believe, but you know it does happen. Have you seen an increase in any kind of violence on children?

RB: Well, I'm not the scientist to know the numbers, I have aides to gather those, but that's really what we're looking at is to see what the changes are and what the science is showing us, whether there is an increase or whether it's leveling. We've seen a number of things, though, that stress can cause and people who are stressed can have more violence, more tempers, more outbreaks and even during hurricane Katrina we saw there was much more domestic violence during that time after Katrina than before. So when people are stressed they take it out, oftentimes on their loved ones, so we have to be very vigilant during those times and have resources and services available for people to turn to so they don't hurt their loved ones.

KP: Well, if you could do anything, anything...

RB: If I could do anything?

KP: ...yes, to make America more physically fit. If you could just look at anybody and just say if everybody would just do the following things...

RB: Well, you know I think exercise is medicine, so by just exercising and having fun and just getting moving and just enjoying ourselves, that gets you mentally better and it gets you physically better and the number of things it improves are so tremendous and it's so easy and it's so simple. But because it's so simple, it's hard to do and people push it aside and they don't realize the benefits that you get from just exercising. And exercising doesn't have to be negative. It can be real positive. You can jump rope, you can play in the yard with the kids, you can roll around on the floor with your grandkids. Just moving, getting to move, makes a big difference in your emotions and it makes a big difference in your blood pressure—your blood pressure is lowered—you're engaging the people you care about. So all those things happen just by simply using exercise as medicine.

KP: The other morning I heard on NPR, I think it was, a radio show about things we should do and they were talking about some pills to take that take care of your vitamin C and they were discussing other things, you know fish oil and all the other things you can take, making it sound like if I ate the right stuff, or took the right pills, I'd be healthier and I'd live longer.

RB: Some things, vitamins and things, really help and the science is there to show but doing the right things, behavioral changes are hard, eating right is hard to do but that's what we need to do and that's what you're describing. We need to eat the right things, exercise and enjoy ourselves but not to gluttonous or overdo any of that. So by asking people to improve their eating habits, don't smoke, don't do these risky behavioral things, you know the things that can cause harm, and exercise, we would probably take out over half of our illnesses and diseases, yet those are the hardest things to attack. Many people will ask me, as Surgeon General what is your one thing? Well, it isn't one thing. It's all these behavioral things that are really hard, and we know what to do, now we just have to do them. And trying to have our role as government and help people do them. Make those healthy choices, the easy choices and the affordable choices, so as government what we can do is make sure that these grocery stores that go into the communities where there used to didn't go, where we can make sure those sidewalks are available for people to walk and if we want parks, to go to the park, make sure those parks are safe, make sure they are not filled with drug paraphernalia, make sure we have good choices in those fast food restaurants because the fast food restaurants aren't going anywhere, but they could have more than one option on their menu. They could have lots of options on their menu. Those are the things we can do. People can make decisions for themselves but we could make it easier for them.

KP: Well, tomorrow at the commencement ceremonies you will be speaking to Appalachian's first graduating class from our College of Health Sciences. We're very excited about this program and we're so pleased with the nutrition part and the wellness part and I think we're a lot like you. So you're going to be launching this on this campus here and having a great impact on this region of North Carolina. What are you going to tell them?

RB: Oh, they already know everything, so these are kids who are probably energetic, ready to go, but I want to tell them to follow their hearts and to make sure whatever they do, they do it very well and if they do it well and they follow their hearts they will be successful, no matter what it is. And if they are going to start taking care of patients to do it with care and compassion, because people want to know that you care about them as individuals. If they do that they'll be successful.

KP: It sounds like that and being happy in what you do. That's a positive attitude that keeps your mind thinking and positive ways and you're not as tempted to violence or prone to drugs and other things.

RB: Exactly.

KP: Laughter is a good medicine after all.

RB: It is. Laughter and having fun and relationships. And the relationships they develop here at school will last them throughout a lifetime. They may or may not believe it while they are here, or understand it, but their friendships, their professors will always be there for them. So those relationships, they will carry throughout their careers.

KP: Well, thank you so much for being here and thank you for being a guest on Appalachian Perspective. It's an honor to see you again and we'll do everything possible to make it a smooth, eventful but enjoyable and memorable time for you.

RB: I'm looking forward to it but it's really about these students and their parents and families who have worked so hard to get them through this.

KP: You really are a people person, so that means a lot. So thank you for being here.

RB: Thank you for having me.

KP: You're welcome.

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