Lessons from Richard Carmona, MD, former Surgeon General of the United States

September 22, 2021

I had the privilege of hearing Richard Carmona, MD, 17th Surgeon General of the United States at the McKenna Healthcare Management lecture March 14, 2019. Dr. Carmona has enjoyed an incredible life from high school dropout to careers including the military, law enforcement, medic, nurse, surgeon, professor, healthcare leader and surgeon general. Here are a few of the many powerful points he shared.Challenges

  • Disease and economic burden in the US has increased in the past 100 years. Our spending is top tier, our results compare with mid third world countries, usually in the top 25 to 50 depending on measure, such as women’s prenatal care, immunizations, etc.
  • The US healthcare budget is roughly $3.4 trillion, with roughly 75-80% of that on chronic disease and only about 19% on prevention. We MUST focus on prevention.
  • 80% of US birth defects could be prevented with folic acid, multivitamins and decent food for the pregnant woman. Instead we choose to invest hundreds of thousands of dollars to care for the child throughout life.
  • Tobacco kills 500,000 Americans a year, with millions more suffering from emphysema that shortens their lives. The cost to society is millions annually for care.
  • Overweight and obesity is the second leading cause of death, killing 300,000 people a year.Obesity inflames asthma, diabetes, kidney disease, cardiovascular. Better lifestyle choices lead to better outcomes.
  • Obesity is becoming a national security issue. We are losing many National Guard members who can’t pass their PT test, so can’t remain active. What happens as the obesity epidemic continues and the pool of military candidates doesn’t meet criteria?
  • How do we balance the rights of the individual to smoke, overeat, not exercise, with the rights of society who are paying ever increasing amounts to care for those that bring disease on by making poor choices?
  • On top of the Triple Aim the fourth important metric is physician and healthcare professional burnout. Doctors and nurses are quitting healthcare, depression and suicide are increasing.
  • Grandma was right when she said, “Be nice, eat your greens, and wear your seat belt.” Now we have the science to prove why.
  • We ignore eldercare issues, particularly Alzheimer’s, dementia and co-morbidities. We need infrastructure to care for these people. There are 50 million Americans primarily cared for by family members.


  • Disrupt the status quo
  • Create health hubs to address chronic conditions
  • Change focus to health and prevention
  • Create a digital front door
  • Drive affordability
  • Tackle Social Determinants of Health
  • Create partnerships
  • Address applied analytics
  • I see good ideas on the Republican side as well as the Democratic side. You have to return civility and statesmanship to governance. If you don't do that, it doesn't matter what portfolio of issue you're pushing, nothing is going to get done.
  • I see hope for the future as younger Americans now see that we need to get along and make significant changes.
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