News that Surgeon General Vivek Murthy was fired adds another chapter to the complicated history of this office. It’s also a reflection of the broader realities of how the public health world relates to policy and politics, and a strong signal that public health needs to engage in the policy world more effectively to achieve our goals.

More immediately, the removal of the Surgeon General ups the ante for the Trump Administration — key health positions must be filled with highly qualified professionals who can be respected by the American people as credible sources of health information, and that these officials take steps to safeguard the credibility of scientific information.

Few have expressed surprise that Murthy was fired in the middle of a Senate-confirmed term or have questioned whether the Administration has the authority to remove him without cause. Most coverage noted his accomplishments, but that he was a “holdover” and that his replacement was “expected.” Some might profess to be “shocked, shocked that politics encroached on public health” (apologies to Claude Rains), but in reality, this fits a long history — striking enough that the de Beaumont Foundation produced a documentary short and academic course examining the Surgeon General as a case study of the intersection of politics and public health.

In fact, the position is ideally an exception to the rule that all senior officials are political. Though appointed by the president, the term of the Surgeon General doesn’t coincide with a presidential administration, and this measure of insulation from politics has provided past Surgeon General’s the ability to speak truth to power and have credibility with the American people. The idealized view of the Surgeon General is like that of an Inspector General or independent commissioner — above politics, even though appointed by a President. (My previous blog post, “Truth, Justice, and the American Way,” spoke to the importance of having such credible messengers.)

In practice, few Surgeons Generals have served across administrations, and Murthy’s complicated confirmation process signaled an escalation of the politicization of the office. Though many have resigned rather than extend past the Administration that appointed them, there seems no precedent for firing a Surgeon General who planned to serve out his term.

  • Though Murthy’s removal may have been inevitable, it is still cause for concern. Now is the time to focus on important steps that the Administration should take to maximize its credibility:
    Murthy has been removed, but the Administration shouldn’t simply “round up the usual suspects” to fill the void that is left. It’s important that experienced, credible public health professionals are appointed to key positions, like the CDC Director, the Assistant Secretary for Preparedness and Response, and the next Surgeon General. This isn’t to say Presidents shouldn’t appoint people that share their views — rather, that they select people who also have independent credentials and credibility. HHS is a key source of health information, both for policy and for personal decisions, and it is important that the public trust that information. In a health emergency like Ebola, Hurricane Katrina, or a pandemic influenza, for example, it is literally a matter of life and death that the public is willing to act on public health guidance; their willingness to do so is directly related to whether they feel they are being told the truth.
  • Protect the flow of public health evidence and data from political influence (as I described in “Protecting Public Health Evidence in an Adversarial Environment”).
  • Cultivate messengers to the public who aren’t also representing the Administration on controversial policy initiatives. In reality, it has been some years since the Surgeon General has been the primary spokesperson for HHS on health issues, making it important that other voices are credible. HHS Secretary Tom Price is a respected physician, but also the President’s spokesperson on contested policies. Officials such as the CDC Director, NIH officials, or even the next Surgeon General should be front and center in providing the public with the facts about current public health developments.
  • Reinforce the network of state and local health officials as credible spokespeople to their own constituents as a safeguard against the public’s lack of trust of the federal government.

Public health faces continuing challenges in addressing political realities. As agencies of government, public health officials are accountable to elected officials; as agents of change in addressing social and economic factors affecting health, they need to be engaged in the policy-making process. This isn’t the time to simply lament that politics are encroaching on public health, but rather a reminder the two are inextricably tied (see my commentary “Politics and Public Health: Engaging the Third Rail”). The experience of the Surgeon General is another reminder of the need to manage this intersection carefully.

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