Q&A: Obama's narrowly confirmed surgeon general on fostering a culture of prevention

Dr. Vivek Murthy was confirmed in December as the 19th U.S. surgeon general, succeeding Dr. Boris Lushniak, who was serving as the acting surgeon general. Murthy's nomination was stalled for months by opposition from the National Rifle Association, which objected to his comments about gun violence as a public health issue. Murthy, the first Indian-American surgeon general, previously worked at Harvard Medical School as an internist and instructor. He co-founded VISIONS, an HIV/AIDS education program in India and the U.S., and the Swasthya project, which trains women in rural India to be health providers and educators. In addition, he co-founded and chaired a software technology company, TrialNetworks, which improves research collaboration and enhances the efficiency of clinical trials. Murthy also served as president of Doctors for America, a not-for-profit with more than 16,000 physicians and medical student members focused on building a high-quality, affordable healthcare system. Modern Healthcare reporter Andis Robeznieks recently spoke with Murthy about his goals as surgeon general. This is an edited transcript.

Modern Healthcare: Why do you think you made the list of Modern Healthcare's 100 Most Influential People in Healthcare?

Dr. Vivek Murthy: The surgeon general has played an important role. In the eyes of the public, the role of the surgeon general is important in addressing key issues like obesity and chronic diseases like diabetes, the opioid addiction that is ravaging small towns, and mental illness, which continues to be a concern for families.

As surgeon general, my overarching goal is to create a culture of prevention. My dream is that we get as good at preventing disease as we are at treating it. I am also working on eliminating healthcare disparities, so we all have a fair shot at good health.

MH: How do you use your influence?

Murthy: The surgeon general's source of power is an interesting one. It's not a traditional one. We don't allocate or distribute funds. We don't make laws or create regulations either. The power of the office is the platform to bring issues to the public. I want to modernize and expand how we communicate critical information to the public. That means using new messages and new messengers. That's why we did public service announcements with Elmo, the Sesame Street muppet.

I want to work with communities to translate information into real improvements in their health. Anyone who has tried to lose weight or improve their exercise patterns knows it isn't easy. Some families live in neighborhoods where buying fruits and vegetables is quite a challenge or the price point might be too high. We have to work together with likely and unlikely partners to create an environment in which healthy choices are easier to make. We need partners to do this, such as faith organizations, schools and employers. That's why building partnerships is a key priority for me.

Our office is going to be coming out with a call to action for walking and walkable communities. A key piece is the walkability. Something as simple as walking is not always easy to do. Sometimes the neighborhood people live in is not safe.

When I was practicing medicine in Boston, I told one patient in particular to go for walks after dinner to help her lose weight. I didn't realize that for her, this was a dangerous proposition. To make all neighborhoods safe will require partnering with community leaders.

MH: Is climate change a public health issue?

Murthy: Climate change is a challenge not only for America, but for the entire world. It has multiple impacts on the country, including health impacts—particularly around respiratory illnesses like asthma. As climate change progresses, we are seeing more how individual lives are being affected. The changes in heat and weather patterns affect vector-born diseases, which are those spread by ticks and mosquitoes. So health is one of many reasons why it's important for us to address climate change earlier rather than later—not only to protect the planet, but to protect the health of people in America and around the world.

It can be very easy for people to look at these issues in silos and not realize their connection to health. Health is not just a factor of what is in our genes. Our socio-economic condition affects our health. Our environment affects our health.

MH: What are other nontraditional ways of looking at public health?

Murthy: Not only do I work on the traditional issues like nutrition and physical activity, but also to help community leaders make the health connection on nontraditional issues.

The built environment is an example. We may not realize that the layout of our cities has an impact on health. It has an impact on how physically active its people are. There is one town that had an initiative to put in more sidewalks and create parks on vacant properties. The residents reported a 90% increase in physical activity. But that's not a connection people normally make. The good news is that more people and sectors can play a role in improving health. There are institutions that may not have the word health in their name, but they can have a profound impact on health. Employers can have a profound impact. At the surgeon general's office, we have transformed some of our sitting meetings into walking meetings.

MH: Describe a walking meeting.

Murthy: It's very much like it sounds like. I did this before I became surgeon general. I realized that when meeting with students, I could talk and take a walk with them in a park. We could have the same discussion while walking through our neighborhood or walking by a lake. I also found I was able to be more dynamic and think more clearly. It's like the old adage: If you get stuck in your work, take a walk. It improves mental function and well-being. When I suggested it, people initially were surprised, but they turned out to enjoy it.

Part of it is creating a culture around physical activity. People think they need to allocate time to go to the gym before or after work. But there are other things they can do—take the stairs instead of the elevator, park farther away from the store, or walk to work—which is what I have been doing. My walk to work is about half an hour.

MH: Who has influenced you in your thinking about health?

Murthy: The people who inspire me have, most importantly, been my parents. My interest in health came from my parents. When we moved to Miami, I was impressed how they worked with their patients and with the community. They still have a practice in Miami and they continue to inspire me.

I look at my predecessors. I was inspired by former Surgeon General Dr. C. Everett Koop, who was in office in the 1980s, and his ability to speak out on issues that may have not been popular. Dr. David Satcher has been influential far beyond his tenure as surgeon general from 1998 to 2002. Also, the people I met on the road. When I started as surgeon general, I embarked on a listening tour. I met people who are facing long odds and big challenges with their communities and are stepping up to address them with only limited resources. That inspires me and gives me the energy to keep going.