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tion. Follow the maxim enunciated by Henry Kaiser.
<br />find a need, and fill it.
<br />Third, do not provide prevention and screening
<br />without follow-up. What good is colorectal screening if
<br />surgery is not available when tumors are found? What
<br />good is violence counseling when a battered woman
<br />has nowhere to go except back to her torturer's home?
<br />For that matter, why do we continue to immunize kids
<br />against disease and then send them home into violence,
<br />poverty, and despair? Prevention is only a means, a first
<br />step. Too often, though, it .becomes an end in itself.
<br />Finally, there are three challenges to you as individ-
<br />uals. First, why are you in prevention? I hope it is not for
<br />recognition, job security, or protection of your tax-
<br />exempt status. Working in prevention is a high calling,
<br />the most honorable kind of work. We should all take
<br />pride in being involved in it because it protects the
<br />length, quality, and dignity of human life —and because
<br />it is what a civilized society should do. That has nothing
<br />to do with money or turf.
<br />Second, what are you willing to give up in the pursuit
<br />of prevention? Will you concede some turf? Will you
<br />relinquish some power? Will you share your money and
<br />resources? Most important, are you willing to risk
<br />failure?
<br />Joycelyn Elders, MD, our last visible surgeon general,
<br />knew that bringing up the possibility of legalizing illicit
<br />drugs and discussing masturbation as a means of pre-
<br />venting sexually transmitted diseases was not likely to
<br />win her support. She was willing to take the risk in the
<br />service of public health, and she got fired. However, she
<br />wrote a beautiful piece after her forced resignation in
<br />which she said two things: (1) It is time to tone down
<br />the rhetoric in our discussions of health policy, and (2)
<br />if her actions had saved one child from being infected
<br />with HIV, she would find the whole experience worth-
<br />while.
<br />In prevention, we are constantly asking others to give
<br />things up. We should also ask ourselves what we are
<br />willing to give up and what risks we are willing to take
<br />on behalf of what we believe.
<br />Last, we are, after all, in Atlanta, and yesterday was
<br />the birthday of this city's magnificent son, Martin
<br />Luther King, Jr. He, too, was willing to lay it on the line
<br />because of a simple belief. He believed, profoundly, in
<br />the value of every human being and the dignity of every
<br />person. In that sense, he, too, toiled in the vineyards of
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<br />public health. He knew that there are some things we
<br />can only accomplish together. He knew that, whether it
<br />is the rights of men and women to be respected as me
<br />or women or the rights of people to have a chance
<br />good health, individual effort can go only so far.
<br />It is an understanding echoed by the philosopher
<br />Alistair Campbell, who wrote, "The aim of all health
<br />care is a shared freedom, whereby one finds one's
<br />aspirations fulfilled, not only by having one's own
<br />needs met, but also by participating in a society in
<br />which those who are at the greatest disadvantage can
<br />equally find the means to personal fulfillment. "s That
<br />may not be the heart of prevention, but it is close.
<br />In Tom Stoppard's play Rosencrantz and Guildenstern
<br />Are Dead, the two main characters have been killed, are
<br />being carried off at the end of the play, and are having
<br />a chat. (It's a surrealistic play.) Rosencrantz says to
<br />Guildenstem, "You know, somewhere along the line
<br />there must have been a point where we could have
<br />stopped and said 'No.'" And Guildenstern replies,
<br />"Yeah," but I guess we missed it."
<br />In this country, we are at a crossroads between
<br />Alistair Campbell's vision of health care as a shared
<br />value — something we all own and to which we all must
<br />have access —and the nightmare of a health care Third
<br />World in which a fat, bloated health care system
<br />lavishes its services on the insured rich while uninsured
<br />children and the excluded poor die of measles an
<br />�
<br />polio. It seems to me that the choice is easy enoug
<br />especially in terms of what we want our legacy to be.
<br />So I hope that, when those who come after us look
<br />back at us from the future, they will know that, in
<br />preventing what could be prevented and in protecting
<br />those whose sorrows could not be avoided, when the
<br />point came when we were asked if we had the courage
<br />to do what needed to be done, we stood up and said,
<br />"Yes."
<br />References
<br />1. Evans, R Rationale for rationing. Health Manage Q 1992;
<br />14(2):14 -17.
<br />2. Ginzberg, E. Tomorrow's hospital: a look to the 21 st
<br />century. New Haven: Yale University Press, 1996.
<br />3. Campbell, A. Health as libertion. Cleveland, OH: Pilgram
<br />Press, 1995.
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