C. Everett Koop, US surgeon general from 1982 to 1989, died quietly at his home in New Hampshire on Monday. He was 96.
After spending 35 years as a pediatric surgeon, Koop turned his energies to civil service by becoming the nation’s surgeon general, serving under bothand George H.W. Bush. His pragmatism and empathy elevated the office, instilling authority to educate the nation on health promotion, disease prevention and developing heath threats in a manner not attempted before by a surgeon general.
Because he was an evangelical Christian, his appointment to the office was adamantly criticized by liberal politicians and women’s groups that feared his stance on abortion. Admittedly, he was guided by his faith and a professional commitment to saving lives of newborns; however, this was only one side of this incredibly complex man who shocked conservatives with his endorsement of sex education in schools and the use of condoms to stop the spread of HIV infection.
Liberal fears initially, however, were not unfounded based on his writings. In the wake of the US Supreme Court's 1973 decision legalizing abortion in Roe v. Wade, Koop began to speak publicly about his fears that abortion devalued human life and would help loosen the moral strictures against the infanticide and euthanasia of other care-dependent members of society, from newborns with birth defects to persons with disabilities, to the elderly. Koop’s predictions have not materialized, but abortion still remains a wedge issue used by conservatives at election time.
His concerns were further revealed in "The Right to Live, The Right to Die," published in 1976, and in "Whatever Happened to the Human Race?" The latter was a multimedia project produced in cooperation with the noted theologianin 1978 and included five films and accompanying lectures and seminars.
Still, his contributions far outweighed any fears or misgivings by the liberal political establishment and women’s groups that he would move to abolish abortion if he became surgeon general. As a devout Presbyterian, he was confirmed after he told a Senate panel he would not use the surgeon general's post to promote his religious ideology. He kept his word.
Koop’s rise as surgeon general coincided with the AIDS epidemic. While still being considered for surgeon general in 1981, the Centers for Disease Control reported five cases of homosexual men in Los Angeles who died from a rare form of pneumonia. A month later, 26 young men diagnosed with Kaposi’s sarcoma, also a rare skin cancer died. Koop had only seen two cases of Kaposi’s sarcoma in his close to 40-year career, and he realized 26 cases in one report were indicative of an epidemic disease.
Prevented from acting initially in his first term by political superiors, he dedicated almost all of his second term to AIDS education and prevention. In 1986, he issued the surgeon general’s report on AIDS. In it he mandated information brochures be sent to every household in America resulting in the largest public health mailing distribution ever attempted. The pamphlet was sent to 100 million US homes.
Koop was single-handedly responsible for shifting the discussion of AIDS from the political morality of homosexuality, sexual promiscuity, and intravenous drug use to focus rather on medical care and the civil rights of those suffering from AIDS. Furthermore, he promoted redefining the scientific model of the disease from a contagion similar to bubonic plague and other epidemics to a chronic disease which could be controlled by mandatory testing, quarantine of carries and most importantly to long-term management with drugs and behavioral changes.
As a former pipe smoker, he led the crusade to end smoking in the United States, saying cigarettes were as addictive as heroin and cocaine.
At the time, the power and influence of the tobacco companies controlled Congress, with Republican Sen.of North Carolina their most vociferous advocate.
Even though Koop was confirmed with the support of legislators from tobacco-producing states, most notably Helms, Koop was prepared to stand up to the powerful tobacco industry and its allies in Congress and to the Reagan administration.
He testified before Congress in favor of rotating warning labels on tobacco that stated specific dangers of smoking like heart disease, cancer, emphysema, risks to unborn children of pregnant women who smoke. The Reagan administration withdrew its support of him under pressure from tobacco companies, but Koop persevered. In 1986 he finally succeeded in having the surgeon general’s health warning placed on packages of smokeless tobacco, chewing and snuff tobacco.
Koop did not coin the phrase “secondhand smoke,” but he made it a household term.
By becoming the first public health official to stress that not just the smoker but also the bystander suffered health consequences from tobacco smoke, Koop helped to turn non-smokers into what he proudly called a "militant army" insistent on its right to breathe smoke-free air.
He fathered the American anti-smoking movement and the most successful anti-smoking movement in the world. Together with a broader scientific base and a moral responsibility to non-smokers, he made smoking in federal buildings, public conveyances, offices, restaurants and other work sites off-limits to smokers in many states.
The liberals were wrong about Koop, and he won national respect eventually from both liberals and conservatives. Although the surgeon general has no real authority to set government policy, Koop’s influence then and now resonates with every citizen. He described himself as "the health conscience of the country."
We need someone like C. Everett Koop to lead the country out of the epidemic of violence due to the proliferation of weaponry, someone who is not afraid of the political establishment and willing to challenge even his own party and powerful lobbyists when the well-being of the nation is at risk.