What was my biggest obstacle?
When I entered medical school, women comprised only 10 percent of the first year class. At that time, female students faced obstacles in being accepted and treated equitably. Working hard and partnering with other women to break down the barriers were important elements of a prescription for change. That's why I joined with a woman scientist colleague at the National Institutes of Health to co-found the Society for the Advancement of Women's Health Research, and why as the country's first Deputy Assistant Secretary for Women's Health in the U.S. Department of Health and Human Services, I worked to advance women's health care, to foster the study of sex differences in health and disease, and to establish a national mentoring initiative to systematically address and remove the obstacles that have existed for women's career development in academic medicine.
During my career in the Federal government, I have worked to bring understudied public health issues including women's health, mental health, violence, disease and suicide prevention to increased public and scientific attention. The biggest obstacle I've encountered in trying to implement significant change has been resistance to altering the status quo. When you are involved in exposing inequalities in the health care system and gaps in science or trying to fix them, you will inevitably encounter organizational and interpersonal barriers. For example, in 1984, there was little institutional support at the National Institute of Mental Health for establishing an initiative that I developed on women's health and sex differences in mental illness. However, with persistence and by establishing partnerships across the government and private sector, we were able to expose the inequities in women's health research, services, and education and rectify them. Another example - in 1993, there was some resistance to my idea of establishing a National Women's Health Information Center that would provide a single user friendly point of access to all Federal and private sector information on women's health through the Internet and by toll-free telephone access. At that time, the agencies of the U.S. Department of Health and Human Services were not widely using the web for health education initiatives. Clearly, the Internet was going to revolutionize the way people received their health information in the future. That's why despite the lack of immediate participation by some of the health agencies, I pursued the project by partnering with the Department of Defense and piggy-backed the women's health website onto this agency's Internet infrastructure. Two years later, we began building the National Women's Health Resource Center in the U.S. Department of Health and Human Services and today this award winning resource brings cutting edge health information to millions of people worldwide.
Overcoming obstacles requires determination, creativity, and the ability to withstand criticism, but the rewards are enormous. There is nothing more gratifying than accomplishing what you set out to dożand for me this has been contributing to the revolution that has occurred in advancing women's health, as well as shining a spotlight on other neglected public health issues including mental illness, violence, suicide, and disease prevention.
How do I make a difference?
I've tried to make a difference by identifying understudied and emerging public health issues and addressing them with innovative solutions and initiatives. A major strategy that I've used is to bring together the expertise and resources of different disciplines and organizations to catalyze new directions in a field, forming partnerships and leveraging resources across the Federal and private sectors that no one agency or person could accomplish alone. During my career, I have provided national leadership in advancing women's health, mental health, behavioral medicine, violence, suicide and disease prevention. My work has contributed to increasing public, scientific, and policymaker attention to these issues in the Federal Government and nationally at a time when there was minimal focus on these health concerns. Another way I've tried to make a difference is through mentoring a large number of students to foster their interest in careers in medicine and public health.
One of the accomplishments I am most proud of is helping to revolutionize and advance global attention to women's health issues. As a research scientist at the NIH, as the country's first ever Deputy Assistant Secretary for Women's Health in the U.S. Department of Health and Human Services (HHS), as a White House advisor on women's health, and subsequently in my other positions within the Federal government, I played a pioneering role in exposing the inequities in women's health and then have spent much of my professional career working to move women's health issues and the study of sex-based differences in disease to the forefront of our nation's health care agenda. Some of the improvements I've ushered in over the past decade include developing an infrastructure in the federal government for women's health; envisioning and establishing the National Centers of Excellence on Women's Health program at academic centers across the country to serve as models for women's health care, research, and education nationwide; creating the National Women's Health Information Center (located at www.4woman.gov and 800-994-WOMAN); establishing a focus on women's mental health issues, minority women's health concerns, violence against women, AIDS, women's cancers, girls' health; and ensuring that national disease prevention education campaigns that once only targeted men now also focus on women's unique needs.
I have worked especially hard to make a difference in the battle against breast cancer. I joined with other advocates on the frontlines to raise awareness about the disease at a time when it was not talked about openly and before it was a national priority. Then, as Co-Chair of a Presidential initiative on Breast Cancer, I worked with hundreds of government and private sector advocates, scientists and policymakers to develop and implement programs that would help eradicate breast cancer as a threat to the lives of women everywhere. Also, I established and chaired the Federal Coordinating Committee on Breast Cancer, mobilizing all Federal agencies to join in the fight against this disease. To improve the early detection of breast cancer, I envisioned and spearheaded the "Missiles to Mammograms" initiative. I believed that if the CIA, NASA and DoD had the ability to detect missiles in outer space and visualize the surface of Mars, then perhaps this same technology could be used to detect tumors in women's breasts. As a result of this program, today, the same computer software that is used by spy satellites to find tanks camouflaged behind trees is helping us to find small tumors camouflaged behind dense breast tissue, yielding a lifesaving dividend.
Over my twenty years in the U.S. Public Health Service, I have also worked to make a difference on several other health concerns. Whether it has been helping to shatter the stigma associated with mental illness, trying to prevent violence, suicide and chronic disease, or responding to terrorism, I have used the power of communication tools to disseminate lifesaving health information to the public and health care providers. I was among the first in the Federal government to apply information technology to improve health, envisioning and establishing several health Internet portals before most government agencies and other organizations had their information online. I also worked with the media at a time when most physicians were reluctant to talk on camera, served as the health columnist for US News and World Report and several women's magazines and hosted an award winning television series on women's health.
In summary, in trying to make a difference, my approach has been to integrate the perspectives of many fields into innovative strategies and public/private sector partnerships to address emerging public health issues. This includes utilizing communication tools to disseminate information to consumers, health care providers and policymakers. My most important contribution has been galvanizing a new national and global focus on women's health issues by playing a critical role in exposing the inequities in women's health, and as the country's first ever Deputy Assistant Secretary of Women's Health, helping to revolutionize and advance women's health research, education and services in ways that had not been accomplished before.
Who was my mentor?
A hallmark of my work has been the integration of science, communication, and public health perspectives. Looking back, there were three people who served as special mentorsone from each of these different fields.
During high school, I spent a summer internship working in a neurochemistry laboratory at the Stanford University School of Medicine. A Visiting Professor of Neurology from Switzerland, Norbert Herschowitz, M.D., became my science mentor and interested me in an exciting and fascinating new frontierbrain research. After medical school, I specialized in psychiatry due in part to Dr. Herschowitz' early influence.
Another summer, I worked as an intern in the News Bureau of Stanford University Medical Center. Spyros Andreopoulos, then the director of the Office of News and Public Affairs at the Medical School, taught me about the importance of translating and disseminating scientific advances to the general public, working with the media and applying the tools of health communication to improve public health. My time at the News Bureau was thrillingfor example, covering Stanford's first heart transplant surgery on the radio and helping to write press releases. The communications skills and lessons learned from this experience are tools that I have applied throughout my career in developing public education campaigns on a broad range of public health issues, serving as a medical expert in the media, hosting a television series on women's health and writing health columns for news magazines.
As the country's first Deputy Assistant Secretary for Women's Health from 1993 to 1997, I had the privilege and honor of working with Phillip Lee, M.D. who was Assistant Secretary of Health in the U.S. Department of Health and Human Services at that time. Dr. Lee, a brilliant and inspirational leader, has been my public health mentor for over a decade. While working with Dr. Lee, I established the National Centers of Excellence Program at academic centers across the country that included a women's leadership component. I also started a national mentoring initiative so that the next generation of women in academic medicine would have more mentors (including female role models that were scarce for many of us) to provide them with guidance about their career development.
My three mentors not only inspired me in their respective fields but I've integrated and woven the perspectives that they introduced me toscience, communications and public healthinto the fabric of my work including teaching the next generation of physicians.
How has my career evolved over time?
Following graduation from medical school, I entered a psychiatry residency at Stanford University School of Medicine. This field, one of the most fascinating areas of medicine, enabled me to integrate my interests in science, the humanities and social sciences, in studying the human brain and in treating patients with mental illness. Following this training, in 1980, I went to the National Institute of Mental Health (NIMH) for a fellowship. My experiences at NIMH brought into focus that medical school training had concentrated on the treatment of individual patients but neglected education on population-based intervention strategies to improve health. That's why I decided to obtain another degreea Masters in Public Administration from Harvard Universityto obtain skills in epidemiology, organizational behavior, health communications and economicstools that would help me address public health issues at the community, national and international levels. After this period of study, I was recruited back to NIMH and joined the Commissioned Corps of the U.S. Public Health Service, a uniformed service that is on duty 24 hours a day to fight global enemies like cancer, AIDS, mental illness and terrorism. From 1982-85, I served as Head of the Suicide Research Unit at the National Institute of Mental Health, and from 1985-1997 as Chief of the Behavioral Medicine Research Branch and Chair of the Health and Behavior Coordinating Committee at the National Institutes of Health (NIH). In these positions, I directed major research programs, stimulated new scientific directions in these fields, chaired national conferences and commissions, and developed public education campaigns on health issues including suicide, depression, eating disorders and sleep disorders. During this phase of my career, the emphasis was on developing the science base that forms the foundation of public health interventions, policies and educational campaigns.
During this time period, my work also focused attention on sex differences in health and disease and on the inequities in medical care that existed for women. Because women's health was not a high priority at the NIH in the 1980's, I co-founded the Society for the Advancement of Women's Health Research to advocate for more scientific attention and funding for health issues that affect 51 percent of the population.
In 1993, in recognition of this work, I was appointed as the country's first Deputy Assistant Secretary for Women's Health to direct the Office of Women's Health in the U.S. Department of Health and Human Services (HHS). During my tenure in this position, funding for women's health in HHS was increased by approximately $1 billion (30 percent) and women's health issues became a top national priority. During this phase of my career, I used the tools of public health to help move women's health and disease prevention issues to the forefront of our Nation's health care agenda.
From 1998 to the present, as U.S. Assistant Surgeon General, I've served in several capacities including Senior Public Health Advisor to the White House and to the Secretary for the U.S. Department of Agriculture. In these and in my other federal government positions, my work has focused on improving mental health, preventing violence in America and increasing national attention to the power of prevention, including establishing national health educational campaigns. Currently, my work focuses on global health issues, our national response to terrorism, and disease prevention and health promotion.
In two decades of medical service, my career has evolved from working at the individual patient level, to conducting and directing research, to designing and implementing national and global public health programs and initiatives in the U.S. Department of Health and Human Services. Today, each level of focus is an integral part of my work, as is sharing knowledge and experiences with students as a Clinical Professor of Psychiatry at Georgetown and Tufts Schools of Medicine and as a Distinguished Visiting Professor of Women's Studies at Brandeis University. And while I've been engaged in various types of activities since becoming a physician, many principles that guide my work today were learned in medical school: science, service, innovation, dedication, compassion, and an unrelenting commitment to relieve suffering and promote health through healing and hope.