Pubdate: Mon, 15 Jun 1998 Source: Milwaukee Journal Sentinel (WI) Copyright: 1998 Milwaukee Journal Sentinel Contact: http://www.jsonline.com/ Details: http://www.mapinc.org/media/265 Author: Marilynn Marchione Bookmark: http://www.mapinc.org/find?137 (Needle Exchange) Body Language SHALALA DOESN'T WANT TO BE THE U.S. 'NANNY' When it comes to health, the public looks to the federal government in many of the same ways as children do to parents. They think parents should pay for everything they want. They expect parents to keep them safe. But they don't want to be forced to do something, even if it's good for them. A recent visit by U.S. Health and Human Services Secretary Donna Shalala illustrated the widely different approaches that federal officials take when it comes to playing parent and wielding authority over public health. She discussed: Her refusal to allow federal money to be used for needle exchange programs to help prevent AIDS. Her recent order that the organ transplant system be overhauled. Her view of how the federal government should respond to the nation's worsening obesity epidemic. And she warned: "We have to be pretty careful about being the country's nanny. We're not the country's nanny." Shalala is no C. Everett Koop or David Satcher. The differences are not just in style, but also in the substance of their jobs. Koop perfected the art of using the surgeon general's office as a bully pulpit for championing public health, to such a degree that he has continued to have wide influence and credibility as a health spokesman, years after leaving the job. Satcher, who became surgeon general in February, seems to be of similar ilk. He expressed disappointment with Shalala's stance on needle exchange and has pledged to use his position to get Americans to be more active, to eat better and to have healthier behaviors. But surgeons general can do little more than give lip service to health issues. Shalala's job -- a cabinet position -- lets her put money and authority where her mouth is. In an interview at the Journal Sentinel, Shalala acknowledged that there are no guidelines for deciding which health initiatives to back and which ones to deny. The examples she discussed illustrate the diversity of her policies on health issues. On transplants, she used the government's rule-making power to its fullest capabilities when she ordered transplant officials to devise a new system for allocating organs so that the sickest patients will get priority regardless of where they live. She said she acted because of gross unfairness in the current system. On needle exchange, advocates tried to win over Shalala and President Clinton with studies showing that such programs cut HIV transmission and don't encourage drug abuse. Shalala first attacked the research, saying it was based on good programs that include drug abuse counseling, but that "there's a lot of lousy needle exchange out there. People are just passing out needles." Next, she suggested that the research was irrelevant, because the government doesn't pay for everything that's good for health. "The federal government doesn't always fund every life-saving science" or treatment, she said, giving the example of Medicare not covering prescription drugs even though doing so clearly would benefit health. On obesity, Shalala noted that under new federal guidelines, 55% of Americans will be classified as overweight. People can choose what to eat or whether to exercise, and it's not an appropriate area for government regulation, she said. But there is a critical need to help the public make informed choices on diet and exercise. A key strategy has been "finding private-sector partners to take responsibility" for the health messages they send, Shalala said. She recently worked with popular TV offerings such as "ER", MTV and even soap operas on portraying health issues and is working with Avon on a program aimed at healthy behaviors in 9-to-14-year-old girls. But there's one policy we won't see her propose: a "sin tax" on junk food. "Not with this president," Shalala said flatly. "You're talking about a junk food tax with Bill Clinton? Not a chance. You can quote me, with a big smile on my face."