An Agenda for Public Health by C. Everett Koop, MD, ScD
Surgeon General of the U.S. Public Health Service
U.S. Department of Health and Human Services
Presented to the American Public Health Association
November 14, 1988
This lecture is included in this archive because it is the opinion of many that this should have been one of the most satisfactory
events of my eight-year tenure as Surgeon General. To understand that statement, a little history is necessary. One would
think that when a new Surgeon General was designated by the President that an organization, which considers itself to be the
pre-eminent public health association in the United States, would rally round that designee and work to the good of public
health. If differences of opinion arose, there was always the opportunity that they could be ironed out and consensus could
be achieved. It is my opinion that the American Public Health Association never rose to, nor aspired to become, the true spokesperson
for its rank and file membership as I think the American Medical Association tried to do in the profession of medicine. Rather,
it is my belief that the liberal public agenda of the American Public Health Association probably did not represent all of
the rank and file of its membership; or at least, it did not have even the facade of an organization tolerant of differing
points of view.
One of the liberal tenets of the APHAs liberal agenda was abortion on demand and inasmuch as I came to Washington opposed
to abortion on demand, I became an easy target and the APHA did all it could do to question the validity of my appointment
by President Reagan, did everything they could to throw barriers in the way of my confirmation and in short made my life as
miserable as they could make it from March 9th through November 16th of 1981. For those who might not know the intricacies
of confirmation of presidential appointments, this is the purview of the Senate. The House of Representatives has absolutely
nothing to do with the confirmation of presidential appointees. The Senate, at the time of my appointment by Ronald Reagan,
was a Republican Senate, and the House was a Democratic House. The then, Executive Officer of the APHA convinced Henry Waxman,
Chairman of the Subcommittee on Health to carry their water, and he had several hearings during which he APHA CEO, his close
colleagues, and their friends, denounced me as incompetent and "so unqualified, that this was the first occasion that
the APHA felt it had to go before Congress to fight against confirmation." This was a huge political effort in the wrong
House of Congress. No one, who felt contrary to the point of view expressed by the APHA, was ever invited to be a witness
at any of these House Subcommittee meetings and I was, of course, invited to be present in order that I might be publicly
humiliated. I did not go to any of the meetings, because had I done so, it would have transmitted the message to the Senate
that was stupid enough to think that I had to defend myself before a House Subcommittee when it was the Senate that had the
statutory obligation to confirm or deny presidential appointments.
After my confirmation by the Senate in November of 1981, the press that had been opposed to me slowly turned to become a strong
supporter, and eventually, everyone who had publicly denounced me, at the time of my arrival in Washington, made appropriate
apologies in public. This included Henry Waxman ("I made a terrible mistake . . . Dr. Koop is a man of unbelievable integrity.")
and my chief opponent in the Senate, Senator Ted Kennedy (question on television: "What was your biggest mistake, Senator?"
Answer: "Not supporting Dr. Koop when he was appointed Surgeon General.") Senator Reagle ("There is nothing Dr.
Koop has ever said, is saying now, or will say in the future that is of any interest to me.") And all of the pro-choice
organizations were silent and oppose me even as of today (2003).
So, the user can understand, why some people say that November 14, 1988 was one of the most important days in my life in Washington,
because I was invited to give this talk at the Annual Meeting of the APHA, as many know who attend huge professional meetings,
the plenary sessions do not usually attract anywhere near the number of people who are attending the meeting for other reasons.
This occasion apparently was an exception, because the crowd for my presentation was so large that they had to open both side
walls to increase the size of the room by 200 per cent.
I began by saying that I was truly grateful for the recognition the society gave me that day. I made no reference to the aforementioned
history of their antagonism to me, but I did say that I thought we had both come a long way in understanding each other over
the course of the past seven years and then reminded them that it was just in the nick of time, because by the same time the
next year, I would be a civilian again and this extraordinary experience of being the Surgeon General would be behind me.
I did say that the Executive Director, Bill McBeath said I could have only half an hour, which sort of cramped things a bit,
but I acknowledged that I had made drastic cuts in my talk and said facetiously that they'd be out in time for the 11
I will say nothing about my address, because the important things that were said that night were not by me to that audience,
but were by individuals in that audience to me. I talked about what the agenda for public health was and should be and closed
- if you can believe it - to a prolonged standing ovation.
Following that, there was a reception and experience had taught me that there would be a few people who would come and say
nice things and that we would be all on our way by 10 o'clock. Instead, there was an almost interminable line of people
waiting to greet me, and I stood in one place shaking hands until quarter of midnight as hundreds of people shook my hand,
apologized for the stand that APHA had taken against me, acknowledged perhaps that they had felt the same way, but had thoroughly
changed their minds on the basis of my performance.
It was a gratifying evening. I'm very glad that it happened. I don't think it made up for the miserable time that
the APHA gave me to the detriment of public health in this country in favor of a narrow agenda and because of my opposition
to abortion, an ethical issue I never addressed while I was in office, and an issue over which the Surgeon General had absolutely