"Red-Blooded" Political Appointees

A surgeon general's report in 2006 that called on Americans to help tackle global health problems has been kept from the public by a Bush political appointee without any background or expertise in medicine or public health, chiefly because the report did not promote the administration's policy accomplishments, according to current and former public health officials.

The report described the link between poverty and poor health, urged the U.S. government to help combat widespread diseases as a key aim of its foreign policy, and called on corporations to help improve health conditions in the countries where they operate. Three people directly involved in its preparation said its publication was blocked by William R. Steiger, a Bush appointee with no health care experience. Since 2001, Steiger has run the Office of Global Health Affairs in the Department of Health and Human Services.

Richard H. Carmona, who commissioned the "Call to Action on Global Health" while serving as surgeon general from 2002 to 2006, recently cited its suppression as an example of the Bush administration's frequent efforts during his tenure to give scientific documents a political twist. At a July 10 House committee hearing, Carmona told lawmakers that, as he fought to release the document, he was "called in and again admonished . . . via a senior official who said, 'You don't get it.' " He said a senior official told him that "this will be a political document, or it will not be released."

After a long struggle that pitted top scientific and medical experts inside and outside the government against Steiger and his political bosses, Carmona refused to make the requested changes, according to the officials. A few days before the end of Carmona's term as the nation's senior medical officer, he was abruptly told he would not be reappointed. In a written statement, Steiger claimed that "political considerations" did not delay the report; "sloppy work, poor analysis, and lack of scientific rigor did."

Three people involved in the preparation of the report in 2005 said it received largely positive reviews from global health experts both inside and outside the government, prompting wide optimism that the report would be publicly released that year. Carmona was expected to unveil the report during his keynote address at a June 2005 global health summit in Philadelphia-- but he was not cleared by HHS political appointees to release it there. Richard Walling, a former career official in the HHS global health office who oversaw the draft, said Steiger was the official who blocked its release.

37-year-old Steiger is a godson of former president George H.W. Bush and the son of a Republican who represented Wisconsin in the House and hired a young Dick Cheney as an intern. The elder Bush appointed Steiger's mother to the Federal Trade Commission in 1989. Steiger's parents, now deceased, were "lifelong friends" of the Rumsfelds and the Bushes. Steiger is currently awaiting a Senate vote on his nomination as Bush's ambassador to Mozambique.

According to the Wapo article, Public health advocates have accused Steiger of political meddling before. He briefly attained notoriety in 2004 by demanding changes in the language of an international report on obesity. The report was opposed by some U.S. food manufacturers and the sugar industry. "I fought for my last year to try to get it out and couldn't get it past the initial vetting," Carmona testified earlier this month. "I refused to release it [with the requested changes] . . . because it would tarnish the office of the surgeon general when our colleagues saw us taking a political stand." Thomas Novotny, a former assistant surgeon general who ran the global health office before Steiger, said, "It's embarrassing, just ridiculous that the report hasn't come out." Novotny, who served at HHS in the Clinton and in both Bush administrations, said that many nations have made health issues central to their foreign relations and trade policies, but that the United States has been reluctant to embrace that idea.

Another report initiated by Carmona that top HHS officials suppressed was a "Call to Action on Corrections and Community Health." It says that the public has a large stake in the health of the 2 million men and women who are behind bars, and in the health care available to them in their communities after their release. The report recommends enhanced health screenings for those arrested and their victims; better disease surveillance in prisons; and ready access to medical, mental health and substance abuse prevention services for those released. But it is believed that the report has been bottled up at HHS because the potentially burdensome costs of the proposed health screenings and other recommendations would have a negative political impact on Bush's domestic agenda.