Bush Aide Blocked Report

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Bush Aide Blocked Report

Global Health Draft In 2006 Rejected for Not Being Political

By Lee and Marc Kaufman

Washington Post* Staff Writers

Sunday, July 29, 2007; Page A01

http://www.washingtonpost.com/wp-

dyn/content/article/2007/07/28/AR2007072801420.html?hpid%

3Dtopnews & sub=AR

A surgeon general's report in 2006 that called on Americans to help

tackle global health problems has been kept from the public by a

Bush political appointee without any background or expertise in

medicine or public health, chiefly because the report did not

promote the administration's policy accomplishments, according to

current and former public health officials.

The report described the link between poverty and poor health, urged

the U.S. government to help combat widespread diseases as a key aim

of its foreign policy, and called on corporations to help improve

health conditions in the countries where they operate. A copy of the

report was obtained by The Washington Post.

R. Steiger has been identified as the HHS official who

blocked the report on global health. (Courtesy Of Global Health

Affairs)

Document

Please note: This copy of the unpublished Surgeon General's Call to

Action on Global Health is a draft document that its authors

expected to update and revise before making public. It is not a

final version.

DRAFT: Surgeon General's Call to Action on Global Health 2006

Three people directly involved in its preparation said its

publication was blocked by R. Steiger, a specialist in

education and a scholar of Latin American history whose family has

long ties to President Bush and Vice President Cheney. Since 2001,

Steiger has run the Office of Global Health Affairs in the

Department of Health and Human Services.

H. Carmona, who commissioned the " Call to Action on Global

Health " while serving as surgeon general from 2002 to 2006, recently

cited its suppression as an example of the Bush administration's

frequent efforts during his tenure to give scientific documents a

political twist. At a July 10 House committee hearing, Carmona did

not cite Steiger by name or detail the report's contents and its

implications for American public health.

Carmona told lawmakers that, as he fought to release the document,

he was " called in and again admonished . . . via a senior official

who said, 'You don't get it.' " He said a senior official told him

that " this will be a political document, or it will not be released. "

After a long struggle that pitted top scientific and medical experts

inside and outside the government against Steiger and his political

bosses, Carmona refused to make the requested changes, according to

the officials. Carmona engaged in similar fights over other public

health reports, including an unpublished report on prison health. A

few days before the end of his term as the nation's senior medical

officer, he was abruptly told he would not be reappointed.

Steiger did not return a phone call seeking his comment. But he said

in a written statement released by an HHS spokesman Friday that the

report contained information that was " often inaccurate or out-of-

date and it lacked analysis and focus. "

Steiger confirmed that he sharply disagreed with Carmona on the

issue of how much the report should promote Bush administration

policies. " A document meant to educate the American public about

health as a global challenge and urge them to action should at least

let Americans know what their generosity is already doing in helping

to solve those challenges, " Steiger said in the statement.

Steiger said that " political considerations " did not delay the

report; " sloppy work, poor analysis, and lack of scientific rigor

did. " Asked about the report's handling, an HHS spokeswoman said

Friday that it is still " under development. "

The draft report itself, in language linking public health problems

with violence and other social ills, says " we cannot overstate . . .

that problems in remote parts of the globe can no longer be ignored.

Diseases that Americans once read about as affecting people in

regions . . . most of us would never visit are now capable of

reaching us directly. The hunger, disease, and death resulting from

poor food and nutrition create social and political

instability . . . and that instability may spread to other nations

as people migrate to survive. "

In 65 pages, the report charts trends in infectious and chronic

disease; reviews efforts to curb AIDS, tuberculosis and malaria;

calls for the careful monitoring of public health to safeguard

against bioterrorism; and explains the importance of proper

nutrition, childhood immunizations and clean air and water, among

other topics. Its underlying message is that disease and suffering

do not respect political boundaries in an era of globalization and

mass population movements.

The report was compiled by government and private public-health

experts from various organizations, including the National

Institutes of Health, the Catholic Medical Mission Board and several

universities. Steiger's global health office provided the funding

and staff to lead the effort because the surgeon general's office

has no budget and few staff members of its own.

" It covered all of the contemporary issues of public health, from

environmental health through infectious disease transmission, " said

Jerrold M. , a former assistant surgeon general and a former

longtime dean of the University of Hawaii School of Public Health,

who worked on the report.

A few of the issues it focuses on, such as AIDS treatment and

research, have been public health priorities for the Bush

administration. But others -- including ratifying the international

tobacco treaty and making global health an element of U.S. foreign

policy -- are more politically sensitive. The report calls on the

administration to consider spending more money on global health

improvement, for instance. And it warns that " the environmental

conditions that poison our water and contaminate our air are not

contained within national boundaries. . . . The use of pesticides is

also of concern to health officials, scientists and government

leaders around the world. "

Three people involved in the preparation of an initial draft in 2005

said it received largely positive reviews from global health experts

both inside and outside the government, prompting wide optimism that

the report would be publicly released that year. The Commissioned

Officers Association, a nonprofit group representing more than 7,000

current and retired officers of the U.S. Public Health Service,

organized a global health summit in June 2005 in Philadelphia where

Carmona was expected to unveil the report in a keynote address --

but he was not cleared to release it there.

Walling, a former career official in the HHS global health

office who oversaw the draft, said Steiger was the official who

blocked its release. " Steiger always had his political hat on, " he

said. " I don't think public health was what his vision was. As far

as the international office was concerned, it was a political office

of the secretary. . . . What he was looking for, and in general what

he was always looking for, was, 'How do we promote the policies and

the programs of the administration?' This report didn't focus on

that. "

On June 30, 2006, a Steiger aide sent an e-mail saying that the

report should not be cleared for public distribution: " While we

believe the subject matter of the draft is important, we disagree

with the style, tone and messaging, " wrote the aide, Mark A. Abdoo,

according to a copy of the e-mail. " We believe this document should

be focused tightly on the Administration's major priorities in

global health so the American public can understand better why these

issues should be important to them. As such, the draft should be a

policy statement, albeit one that is evidence based and draws on the

best available science. "

Steiger, 37, is a godson of former president H.W. Bush and

the son of a moderate Republican who represented Wisconsin in the

House and hired a young Dick Cheney as an intern. The elder Bush

appointed Steiger's mother to the Federal Trade Commission in 1989.

A biographical sketch of her on the American Bar Association's Web

site states that Steiger's parents, now deceased, were " lifelong

friends " of many members of the same congressional class, including

the Rumsfelds and the Bushes.

According to a résumé Steiger supplied to Congress, he obtained a

doctorate in Latin American history from the University of

California at Los Angeles before teaching at a university in the

Philippines and consulting in Angola for the International

Republican Institute -- a nonprofit group that is associated with

the party and promotes democracy around the world. He was an

education adviser to then-Gov. Tommy G. ® of Wisconsin

and came to Washington when became HHS secretary. He is now

awaiting a Senate vote on his nomination as Bush's ambassador to

Mozambique.

Bill Hall, an HHS spokesman, said Steiger promoted interest in

global health at the department while more than doubling the number

of expert staff members overseas and participating in international

negotiations on issues such as avian influenza. " You have to look at

his skills as an executive leader in spite of the fact that he

doesn't have a medical degree or a public health degree, " Hall said.

Public health advocates have accused Steiger of political meddling

before. He briefly attained notoriety in 2004 by demanding changes

in the language of an international report on obesity. The report

was opposed by some U.S. food manufacturers and the sugar industry.

According to Walling and three other public health officials

familiar with the current dispute, Carmona at one point suggested

that Steiger release the global health report in tandem with a

separate report of the sort Steiger wanted, but Steiger rejected the

idea. An appeal by Carmona to Health and Human Services Secretary

Mike Leavitt and his staff produced no relief, a former HHS official

said.

" I fought for my last year to try to get it out and couldn't get it

past the initial vetting, " Carmona testified earlier this month. " I

refused to release it [with the requested changes] . . . because it

would tarnish the office of the surgeon general when our colleagues

saw us taking a political stand. "

Novotny, a former assistant surgeon general who ran the

global health office before Steiger, said, " It's embarrassing, just

ridiculous that the report hasn't come out. " Novotny, who served at

HHS in the Clinton and in both Bush administrations, said that many

nations have made health issues central to their foreign relations

and trade policies, but that the United States has been reluctant to

embrace that idea.

" It made perfect sense for the surgeon general to take up the issue

because the U.S. used to be a leader in this field, " Novotny

said. " For the nation's top doctor to be unable to release the

report shows that leadership is gone. "

The global health document was one of several reports initiated by

Carmona that top HHS officials suppressed because they disliked the

reports' conclusions, according to a former administration official.

Another was a " Call to Action on Corrections and Community Health. "

It says -- according to draft language obtained by The Post -- that

the public has a large stake in the health of the 2 million men and

women who are behind bars, and in the health care available to them

in their communities after their release.

The report recommends enhanced health screenings for those arrested

and their victims; better disease surveillance in prisons; and ready

access to medical, mental health and substance abuse prevention

services for those released.

But the report has been bottled up at HHS, said three public health

experts who worked on it. Miles, a consultant and former

Centers for Disease Control and Prevention official who helped draft

it, said he suspects that the proposed health screenings and other

recommendations are seen as a potentially burdensome cost. " Maybe

they just don't feel it's a priority, " Miles said.

Hall, the HHS spokesman, responded in a statement Friday that the

Bush administration has always believed that public health policy

should be rooted in science. " While we appreciate and respect Dr.

Carmona's service as surgeon general, we disagree with his

statements, " Hall said.

Staff researcher Madonna Lebling contributed to this report.

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