Former Surgeon General
It is not unusual for an experience in childhood to shape the future of the adult. In the case of Dr. Antonia Coello Novello, it was just such an experience that motivated her to become a physician, a goal considered audacious for a woman at that time. But the intelligence and determination that enabled her to become a doctor foreshadowed a career that led to one of the highest posts in the profession, the Surgeon General of the United States. Before serving as Surgeon General she was deputy director of the National Institute of Child Health & Human Development. After the Surgeon General position, she served at UNICEF as special representative for Health & Nutrition and as commissioner of health for the State of New York, before taking her current position as vice president of women and children health and policy affairs at Disney Children’s Hospital at Florida Hospital.
EW: One of your initial statements after your appointment was, ‘I am not a Hispanic woman Surgeon General; I’m a Surgeon General who happens to be a Hispanic woman.’ What did you mean?
AN: All the positions that I have been fortunate enough to hold have been earned, based on my qualifications and my performance, not because of my ethnicity or gender, though I am extremely proud of both.
EW: Not to belabor the gender issue but, today, medical schools are full of female students; it was not that common in the late 1960s. Describe what motivated you to become a doctor.
AN: I had a serious medical condition that was not corrected until I underwent surgery at 18 and then another surgery at the Mayo Clinic when I was 20 years old. By spending so much time around medical professionals, it caused me to say to myself, ‘I want to be like these people; that is what I want to do.’ Throughout the course of my life I have been able to set an objective and go after it, without putting a time limit on when I would accomplish the objective. In fact, as I look back, it was often pursuing one objective that opened the door for another, unforeseen opportunity. I like challenges, and being told I can’t do something is an added incentive for me.
EW: Were there women role models that guided and encouraged you?
AN: My mother was an accomplished school principal, who always stressed the importance of an education and how it was a doorway to your dreams. She was also a gifted public speaker, and I probably get whatever talent I have in that arena from her. When I became Surgeon General I decided my first public policy speech should be in Puerto Rico. I was to speak before the Legislature and my mother accompanied me. As a courtesy, the President of the Senate said, ‘Perhaps your mother would like to say a few words.’ Well, eleven standing ovations later I had to get her attention and remind her I needed some time to give my address. Also my aunt was a nurse and it was her struggle with renal failure that led me into nephrology.
EW: You held numerous posts at the NIH and had assignments that included the Senate Committee on Labor and Human Resources, where you played a role in the Organ Transplantation Procurement Act of 1984. Your work, especially with pediatric AIDs, caught the attention of the White House and in 1990, you were appointed Surgeon General by President George H.W. Bush. Did you anticipate the appointment?
AN: Never did I think I would serve in the position of individuals I esteemed as highly as C. Everett Koop.
EW: Could you explain the role?
AN: The Surgeon General is the director of the United States Public Health Service Corp. When I served, that constituted over 6,400 officers. But primarily, the Surgeon General is the voice of the President and the country when it comes to health. The position has the power of the pulpit, but not economic power. You have to be bipartisan and be able to speak to both parties. The Surgeon General is recommended to the Secretary of Health, who consults groups like the AMA, appointed by the President and confirmed by the Senate for a four-year term.
EW: What was most challenging and most fulfilling about the position?
AN: The most challenging thing was trying to please everyone in the country on the same day (smiling). Every day I had invitations to at least five different places, and in that role you have to be available.
In addressing the critical health issues of the day I learned you never develop policy out of fear, but you must do your research and base every presentation on the facts. I often said, ‘Half the people come to listen to the Surgeon General and half come to see if I said the right thing,’ so it was important to not just give my opinion.
At that time, Camel cigarettes had a campaign that featured the character ‘Joe Camel.’ Studies showed that the campaign specifically targeted children as the future of the industry. It was a controversial struggle, but eventually we won, which was very fulfilling. The other thing was immunization; the rate was around 67 percent and we increased it to over 90 percent.
We also established the Office of Research on Women’s Health. A GAO study indicated that women were not represented in research studies. For instance, we had a 20-year study on aging, but there were no female subjects included. We had a study on aspirin for heart disease, yet no women were included, though they have a very high instance of heart disease; I could go on to bladder and incontinence studies – no women. We ensured that if women weren’t represented, the study wouldn’t be funded. I also campaigned against underage drinking, especially in the form of wine coolers, which were much stronger – up to three shots of vodka – and we got that taken off the shelves.
Then when the administration changed, though I could have continued, President Clinton wanted to appoint a new Surgeon General. When the papers came to me about stepping down, I told them, ‘Don’t confuse dignity with weakness.’
EW: After working for UNICEF, you were appointed the Commissioner of Health for the State of New York. Describe the transition.
AN: Being the Surgeon General was nothing compared to being the NY Commissioner of Health for six years, with a budget of $49 billion. It is the third largest budget in the state. The Surgeon General was a great pulpit, but no money. This one involved lots of money, but hid the pulpit.
EW: You were Commissioner during 9/11.
AN: When the Towers fell, much of the communications for the State also fell. It was devastating on so many levels. It was the Tuesday of the primaries so all budget allocations were on hold. I was in the city, but immediately I was taken to a bunker in Albany, NY, which served as our command center, where we began coordinating services from all the various agencies to get support into the city. I then went back to the city the same day and didn’t leave again until Dec. 15; there was just too much to do.
We had to set up a DNA bank and the only one was in the Justice Department, for criminal identification. We had to be able to identify the smallest remains, so that people could get a death certificate, otherwise they couldn’t claim any death benefits. People fled restaurants leaving the gas on and refrigerator doors open. The stench was incredible, and we had to ensure there wasn’t any kind of epidemic and that the food given to the volunteers was sanitary.
Not only were we trying to find the injured and the dead, but we were trying to prevent a host of other calamities from happening. Every day at 2 p.m., Mayor Giuliani gathered the team, which included the Governor, the Secretary of State, police, fire, emergency, transportation officials and myself, for updates. The Governor instructed me to tell the hospitals not to ask anyone for health insurance. They were to treat everyone. We paid for it; and in spite of the pain and the difficulty, it was one of the most rewarding times in my life. I never worked with an agency that worked so well. People talk about New Yorkers, but never have I seen people with such a willingness to pitch in and do whatever was necessary.
Months later I was wondering when things would return to normal. I was crossing a street in the city and a taxi had to stop for me and he gave me a ‘hand gesture.’ I thought, ‘Ah, well, we’re back.’
EW: And coming to Florida Hospital?
AN: It was the perfect combination of my initial medical experience in pediatrics and enables me to continue to use my public policy experience. I know there is something more for me to do; I don’t know exactly what it is, but either it will find me or I will find it.