Caring for Health Care

When Howard Koh entered the Yale University School of Medicine, his goal was to start a private practice and cure all of his patients of cancer. “I was going to be the best cancer doctor in the world,” says Koh (SPH’95). “I went on to care for patients for over 30 years, and that was an indescribable privilege and a great, almost sacred life experience.”

It also set him on course to his current post as assistant secretary for health in the U.S. Department of Health and Human Services. “Caring for patients, particularly at Boston City Hospital and Boston Medical Center, taught me that there were many other forces impacting on my patients’ health in addition to their individual biology of disease,” says Koh. “It prompted me to take a broader view on health and that started me along the road to a public health career.”

A former professor at the BU Schools of Medicine and Public Health, Koh served as Massachusetts commissioner of public health from 1997 to 2003. He was the Harvey V. Fineberg Professor of the Practice of Public Health at the Harvard School of Public Health when he was tapped by President Obama as assistant secretary in 2009.

In that role, he is the senior public health advisor to Secretary of Health and Human Services Kathleen Sebelius, and he oversees the Commissioned Corps of the U.S. Public Health Service and the Surgeon General’s office. The programs he leads relate to disease prevention, health promotion, HIV/AIDS, vaccine supply, physical fitness and sports, blood supply, and the reduction of health disparities, among other things.

Koh, along with three other alums, will be on campus this weekend to receive a Boston University Distinguished Alumni Award, the highest award the University bestows on its alums. BU Today spoke with him about the important issues facing the nation’s public health agenda, about life in Washington, D.C., and about service.

BU Today: What are some of the nation’s most pressing public health issues?
Koh: From the broadest perspective, far too many Americans are not reaching their highest attainable standard of health. And that’s a tragedy, because good health is a gift and it needs to be protected at all times. And the best way to protect that gift is through the best public health system possible. We need to reemphasize the importance of prevention and then continue to build systems of prevention against threats like tobacco, obesity, HIV, substance abuse. The list is unfortunately very long.

Obesity has been making news lately; how big a public health problem is it?
Every decade, HHS sets targets for the country through a process called Healthy People. In some cases the country meets those targets, but in other instances, the country steadily moves away from those targets. And for obesity, the country has moved away from meeting that target for adults and children. You know that obesity fuels many disease outcomes, like cardiovascular disease, diabetes, and cancer. And just over the weekend you heard a new study projecting that by 2050, rates of diabetes will double or even triple. That would lead to one in three U.S. adults having diabetes. Much of that is tragically fueled by the obesity epidemic. Two out of three adults are either overweight or obese, and one out of three kids is in that same category. This is one of our biggest public health challenges, along with other threats, like tobacco dependence. These are real systemic issues that need our urgent attention.

How much does it help that First Lady Michelle Obama has taken on this issue, creating the Let’s Move campaign and planting the White House Garden?
That’s brought tremendous visibility to the issue, and it’s extraordinary to have the leadership of the First Lady on this very critical area. What’s very valuable about the First Lady’s approach is that she is taking a broad public health approach to this problem. The solutions are going to come from all of us, and we need to act not just in health care settings, but also to engage the community in places where we live and learn and work and worship and play.

You mentioned tobacco control. What more needs to be done on smoking cessation?
Tobacco dependence is still the leading cause of death in the country, and indeed, the world. There is no other condition that’s projected to lead to one billion deaths worldwide this century—one billion. And in this country, we still have well over 400,000 Americans dying from tobacco-related illness every year. Half of all cigarette smokers will die prematurely from tobacco-related disease. That’s still a major prevention challenge that we need to address more aggressively moving forward.

Tell us more about the strategies that will be used to move us toward better health.
There’s a provision in the recently passed Affordable Care Act to have a national quality strategy submitted to Congress in January 2011, and a national prevention strategy is due by March 2011. It’s an opportunity for the country to rally around and collectively create dedicated strategies that will improve quality and prevention as explicit goals for the country. A lot of this will build on the past work of Healthy People, which has had a 30-year history of setting targets and goals for the country, and also, in several months, I will be unveiling Healthy People 2020.

What’s new in Healthy People 2020?
It stresses overarching goals of improving quality and quantity of life, eliminating health disparities, and achieving health equity, but it also has a new emphasis on protecting health through the entire life span, sending the message of prevention through each stage of life and also stressing the importance of what’s called the social determinance approach to health.

So many people turn to the internet for health information, some of it good, some bad. How can people find sound advice on the web?
The good news is there are many websites. The challenge is they are of varying quality. Always make sure that you stay in close touch with your own doctor; making sure any new information is shared and validated by your provider is very important. This is also where your local health department can be a great resource for you. We have with the Affordable Care Act a great new website, healthcare.gov, with not only insurance plan information, but also public health and prevention information.

What has surprised you the most about working in Washington?
I could answer that I’m thrilled about the number of Red Sox fans in Washington, D.C. It’s so great to feel the sense of mission from my colleagues in public service and in federal government. That’s been very gratifying. The commitment to mission and a real passion for the work is something that’s been extraordinary for me to witness. That’s why this job is an incredible honor.

When you were nominated, press reports noted that your parents raised you with a drive to excel and to serve.
It’s absolutely true. I think about their impact on me literally every day on this job. Both of them were immigrants to the United States, so they came here searching for the American dream. My dad was the Korean ambassador to the United States when I was young. He believed passionately in public service. When he was serving in Washington, he used to come home and share stories about the policy makers that he met and admired, and one of his favorites was Senator Hubert Humphrey. And a generation later, I go to work every day in the Hubert H. Humphrey Building of the U.S. Department of Health and Human Services. I feel that being here is almost part of my destiny. My dad passed away 20 years ago, but his absolute passion for service and for making society stronger is something that inspires me every day.

Politics in Washington is so divisive; what would you say to a student or a young alum who wants to enter public service?
Public service is part of public health and public health is about taking the long view and about perseverance. I think anybody who wants to make an impact on public health and public service has got to take the long view, focus on mission, and not get too distracted by the ups and downs of the day-to-day.

Cynthia K. Buccini can be reached at cbuccini@bu.edu.