"From the Top" is an occasional feature that gives prominent leaders in health, medicine and fitness an opportunity to sound off about health matters.
Today, Times staff writer Martin Miller talks with U.S. Secretary of Health and Human Services Donna Shalala. Appointed to the Cabinet shortly after President Clinton's election in 1992, Shalala heads the federal government's largest civilian bureaucracy and oversees more than 250 programs in such diverse areas as public health, medical research and social services.
Question: What is the most important health concern today for Americans?
Answer: It's actually the things we can control. There are a lot of people who say we need more investment in the sciences. But what would help far more in substantially improving health across the board is if we could stop smoking, be careful about what we eat and start exercising.
Q: There seems to be plenty of information detailing the dangers of eating poorly, not exercising and smoking. Why aren't people responding?
A: Well, it's easier to write a check to the doctor than change your behavior. When we are young, we think we are invincible. When we are older, we think we can't change our behavior. All the things I want for America's health don't have to do with a balanced federal budget or higher taxes. It has to do with things within our own control. Tobacco use, diet and exercise. Our health destiny is really in our own hands.
Q: What health advice would you give to American men?
A: They should stop watching so much TV during the winter. . . . Men tend not to go to the doctor as much as they should. They tend not to be health-conscious. They are too macho sometimes. But as men get older, they need to be sensitive to how their body changes, and they need to get screening for prostate cancer.
Q: How about women?
A: Women don't go to the doctor because they are too busy. . . . Women, too, need to be sensitive to their bodies and get screened for breast cancer.
Q: You are heading a national task force to review this summer's landmark settlement with the tobacco industry. A major thrust of that agreement is aimed at curbing teen smoking. Why is this such a high priority?
A: Eighty percent of adults who smoke started in their teens. It's so important to get those numbers down among our young people.
Q: How can it be done?
A: We need a lot more education. We need to make it much more difficult for kids to get cigarettes by making sure we card them. We need to look at their IDs, we need to get rid of publicly displayed cigarette machines where racks can be easily stolen.
And finally there's the advertising. We need to limit that and get smokers off the movie screen. Every time you see a movie, someone smokes. I love John Travolta, but without a cigarette. I mean, the adults these kids admire all have a cigarette hanging out their mouths.
Q: How can parents help?
A: Well, you have to give kids other things to do. And also I'd bribe them. I'd set a goal. No smoking and then they get something they want.
You can approach them logically too. Cigarettes are thieves. They'll lose control. Their skin and hair will smell. Their teeth will yellow. They'll lose a lot of money paying for them. This generation certainly cares about whether someone is trying to manipulate them or not, and we need to let them know there is an enormously powerful industry out there that is trying to get them addicted.
Q: You're critical of Hollywood about glorifying teen smoking. How about drug use?
A: To be fair to Hollywood, they aren't glorifying drug users. But the glamour industry--the world of fashion--is exploiting this druggie look. It's a wasted look that clearly suggests heroin, cocaine or some other drug use.
Q: How can that be changed?
A: Really, all there is, is public pressure.
Q: You are also pushing for new federal laws to protect the privacy of medical records. How did this problem come about and what should be done?
A: My Blockbuster card has more federal protections than my health records. When doctors shifted from file cabinets to computers, our health care privacy became threatened. You don't want people fishing around in your medical records. They could be sold to a marketing firm who in turn would sell them to drug companies who would hound you to buy their medication. Also, there's an issue of political privacy. Recently a public official had her mental health records opened without her permission, and it was revealed she had problems with depression.
There's nothing wrong with legitimate law enforcement using these records for fraud investigations, etc. But we should really restrict the number of people in the health care industry who have access to our records.
Q: AIDS deaths overall are down for the first time in 16 years. What accounts for the drop?
A: More effective drug inhibitors, educational campaigns and people practicing safer sex. We have a generation of kids who are using condoms. It's finally starting to pay off.
Q: But AIDS deaths increased slightly among women and those who had become infected through heterosexual contact. What can be done to help them?
A: Yes, our concern is the numbers are shifting to our most vulnerable people. We have more kids infected. We have more minorities too. . . . Again, we need to provide comprehensive health programs. We need to bring them into the services.