Ken Moritsugu, Acting U.S. Surgeon General: An Interview As the nation’s leading health educator and CEO of the nation’s Public Health Service, acting U.S. Surgeon General—and Rear Admiral—Ken Moritsugu knows the value of communication both in the public-speaking arena and in the critical conversations that go on daily between health providers and clients/patients. Health literacy is one of ... Features
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Features  |   June 01, 2007
Ken Moritsugu, Acting U.S. Surgeon General: An Interview
Author Notes
  • Marat Moore, managing editor of The ASHA Leader, can be reached at mmoore@asha.org.
    Marat Moore, managing editor of The ASHA Leader, can be reached at mmoore@asha.org.×
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Research Issues, Methods & Evidence-Based Practice / Regulatory, Legislative & Advocacy / Features
Features   |   June 01, 2007
Ken Moritsugu, Acting U.S. Surgeon General: An Interview
The ASHA Leader, June 2007, Vol. 12, 16-17. doi:10.1044/leader.FTR5.12082007.16
The ASHA Leader, June 2007, Vol. 12, 16-17. doi:10.1044/leader.FTR5.12082007.16
As the nation’s leading health educator and CEO of the nation’s Public Health Service, acting U.S. Surgeon General—and Rear Admiral—Ken Moritsugu knows the value of communication both in the public-speaking arena and in the critical conversations that go on daily between health providers and clients/patients. Health literacy is one of his passions, and is a national public health priority identified by the Office of the Surgeon General. Dr. Moritsugu addressed hundreds of speech-language pathologists at ASHA Health Care 2007, and graciously sat down for an early-morning interview before his opening-session speech. A native of Hawaii, he has a broad humanitarian perspective—he studied classical languages before entering the medical field.
“Communication Is at the Core of What We Do”
Q: You’ve spent decades in public health. Why did you choose that path?
My path evolved over a number of years. I was trained as a physician in internal medicine, and so treated individuals one at a time. Then I looked for an opportunity to treat communities, and became involved as medical director with the federal prison system. That’s what public health is, really—treating individuals in the context of their communities.
There’s a metaphor I like to use that I’ve seen develop in my own life—“The Power of 10.” It’s about the relativity of our perspective—how we see things differently at different levels. For example, if you look at a situation at the national level, it’s similar to flying in an airplane; you’re viewing it at 30,000 feet. That’s the level of the surgeon general’s office and the development of national public health priorities.
At the state level, you drop down a power of 10—to 3,000 feet. The community level is a more granular perspective—down another power of 10, to 300 feet. Within communities is great diversity with different environmental and health challenges—one corner might have a health clinic, while cigarettes are sold across the street—that’s the 30-foot level, the micro-community. Then when you drop down to the three-foot level, that’s the distance between two people.
My point is that every level is important. In the end, everything really comes down to the three-foot level—what happens between two people. National policy affects states, communities, micro- communities, and every person.
In my life, for example, although I have national responsibilities for the policy and evidence that informs policymakers, I am also a patient. My wife has multiple sclerosis, and had swallowing tests. Then just last week during my annual physical evaluation, I had an extensive audiology evaluation and will probably get a hearing aid for high-frequency hearing loss. So our family has benefited directly from the clinical interventions of audiologists and speech-language pathologists.
Q: Why is health literacy so important to the nation’s health?
Low health literacy is a threat to the health and well-being of Americans, and to our health system as a whole. People who are less health-literate are less likely to know how to navigate our health care system, one of the most sophisticated in the world. They’re less likely to get preventive services and therefore are more likely to use emergency-room services. They’re less likely to understand the instructions related to a public health crisis, like Katrina or a pandemic, and health disparities are more likely to affect them.
As surgeon general, it is my responsibility to communicate the best science, data, and evidence to the American people related to how they can improve their health and reduce their risk of accident and injury. To communicate effectively, we must strive to be understood. Low health literacy is the chasm between what we know and what they understand.
Nearly 90% of adult Americans lack the skills to take care of their own health, and most patients also hide confusion from professionals. More than 21 million have trouble with English. This problem cuts across all educational levels. I’m a Type 1 diabetic, for example, and at times I struggle to understand what my endocrinologist is telling me about how to manage this disease.
Ineffective communication can result in medical errors, and it’s contributing to rising health care costs when patients don’t understand how to prevent chronic disease. Our office identified health literacy as a national public health priority that has an impact on our top three priority issues—prevention, what we can do to make our families healthier and to treat disease in its most treatable stages; public health preparation for disasters like hurricanes, earthquakes, and pandemics; and elimination of health disparities in minority communities. If people don’t understand the messages of what they can do to protect their health and safety, they or their loved ones could suffer negative health consequences. When a mother does not understand that her child needs a vaccination, that’s a problem.
Q: What role can professionals in communication sciences and disorders play in improving public health?
Health literacy is about communication—to be able to hear the message, speak the message, understand the message. Communication is at the core of what we do in the Public Health Service or the Commissioned Corps. ASHA members know how important clear communication is to health and well-being. You see patients struggling to speak, to hear, to understand basic health information. With the complex health conditions your patients face—dementia, aphasia, and TBI, to name a few—you need to speak at a level understood by the people you serve. As communication professionals, ASHA members have a tremendous relevance to what we do and how we do it.
Put yourself in the shoes of the people you serve. A recent study shows that medical residents overestimate how much their patients understand; in the study, residents believe only 10% don’t understand, when the reality is 50%, including highly educated people. We need to build bridges to cross that chasm. Even our brightest scientists cannot help the public if that information is not transferred. It’s very important that we transfer information from researchers to clinical settings, to the general public. This process generally takes 15 years from research to implementation. We can speed up that process by incorporating health literacy into everything we do.
We are all integral parts of the interlinked wheels of health care. There is, however, an important difference between health care and health. Health care is something provided to someone, but health is a philosophy of life. Rather than try to fix what’s broken—which is what health care providers do—we focus on prevention and look at the continuing evolution of health. It’s easy to think that health is very circumscribed, but it isn’t. Health is connected with everything—where you live, what you do for a living, your relationships. All those factors intersect.
Q: What can speech-language pathologists and audiologists do to become more health-literate?
It is critical that we communicate critical health information effectively. Some of the best practices include using plain language and simple visual aids, rather than complicated health jargon. I can poke fun at my profession, talking “doctorese” with the best of them, but we need to meet our clients at their level of understanding.
We need to consider the cultural and social factors that affect patients’ health care decisions and to encourage their response using the teach-back method. We need to talk with our patients, not to them. You already know this. You’re the professionals in this area. You know that communication is a feedback mechanism, and we’re constantly adjusting the feedback.
I’m asking for your partnership as health literacy ambassadors. Because our educational mission is so tied to communication, we can partner with you in the services you provide. I see it as the link between us—between what we’re trying to do on a national level, and what ASHA members do on a daily basis. Health literacy is a reciprocal communication. As providers, we should not just be throwing out words and instructions. Our words need to be delivered in a way that can be heard and understood.
As audiologists and speech-language pathologists, you help people across the lifespan to communicate. You help break down barriers in their community. You literally give them their voice and ability to hear.
What better group is there to take this on the issue of health literacy? Health literacy can save lives, save money, and improve the quality of life for all of us. As a discipline and as individual clinicians, you dignify the lives of those whom we serve.
For more information on the surgeon general’s national health priorities, visit the Office of the Surgeon General’s Web site, and visit the Office of Disease Prevention and Health Promotion’s Web site for a “quick guide” on health literacy developed by the agency.
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June 2007
Volume 12, Issue 8