ormer Surgeon General Joycelyn Elders has always been something of an agitator in public health circles. During her 1990s tenure, she kept a “condom tree” on her government desk. She’s been branded a “rabble rouser” and given the nickname the “condom queen.” And she was famously forced to resign in 1994 for calling masturbation “a part of something that perhaps should be taught,” to prevent the spread of HIV and AIDS.
Now, two decades later, Elders, 83, has taken up a new mantle: advocating for racial equality in medicine. She is the spokesperson for “Changing the Face of Medicine,” a campaign that aims to increase the percentage of black doctors in the United States. And she is featured in a new documentary the group has released, “Black Women in Medicine,” which details the career trajectories of aspiring and accomplished physicians against a backdrop of historic accomplishments like that of Elders.
This year, the campaign included a tour of schools, community centers, and hospitals aimed at kids as young as 11.
“You can’t decide to become a doctor without a lot of early preparation along the way,” Elders told STAT. “We’ve got to start working on it before children get to high school.”
‘You can’t be what you can’t see’
Elders’ path to becoming the first African American surgeon general was a long and hard-fought one. Born Minnie Lee Jones, she was the first of eight children born to impoverished farmers in Schaal, Ark. She and her siblings worked cotton fields with their parents while also attending a segregated school 13 miles from their home. Until she was 16, Elders never saw a doctor.
“You can’t be what you can’t see,” she said. “Our parents were told to prepare us to become maids. And today, I’m still the best maid I know,” she added with a laugh.
In fact, she scrubbed floors to supplement her scholarship at Philander Smith College. An enthusiastic college student (who by this time added Joycelyn to her name), she enjoyed her biology and chemistry classes, aiming to become a lab technician. But then she heard a speech by Edith Irby Jones, the first black student at the University of Arkansas School of Medicine.
“I wanted to be like her,” Elders said. “And to improve the lives of children.”
After college she started work as a nurse’s aide in a Milwaukee veterans’ hospital. She enlisted in the military in 1953, joining the US Army’s Women’s Medical Specialist Corps. She was the only black person in her class at Brooke Army Medical Center. She trained to become a physical therapist, and ended up being one of two therapists who treated President Dwight Eisenhower after his 1955 heart attack. Discharged from the US Army in 1956, she went to medical school on the GI Bill. After marrying Oliver Elders in 1960, she got her medical degree in pediatric endocrinology.
She became interested in sex education while treating patients with juvenile diabetes. Recognizing the dangers of early pregnancy for diabetic girls, she began teaching her young patients about preventing pregnancy and providing them with birth control.
Smarter sex ed was a cause Elders would champion throughout her career — next as head of the Arkansas Department of Health in the 1980s, where she pushed for in-school clinics and expanded sex education, and later as surgeon general of the United States.
But opposition to her appointment by President Bill Clinton in 1993 was strong. The president of the Arkansas Medical Society called her “a rabble rouser.” Senator Don Nickles (R-Okla.) called her positions on birth control “radical and extreme” in 1993 — a charge he stands by today.
“I still think I was correct,” said Nickles, who left the US Senate in 2005. “I mean, she had a condom tree on her desk. I thought that was inappropriate. She was way out of line.”
Frank talk about sex
Despite the opposition, Elders became the first African American to serve as surgeon general. Doing that job responsibly, she said, meant speaking frankly about sex.
“I knew what I was about: making a difference for bright young women whose lives were derailed by unplanned pregnancy,” she said. “I felt we had to do something as long as the only A-word people talked about was abortion, but not access (to birth control and sex education), which actually helps families.”
Sex education, she said, shouldn’t be all about pregnancy either.
“We’ve been teaching people that sex is about procreation,” she said. “But 99.999 percent of sex is about pleasure, and it’s about time to admit that as a fact.”
During her brief 15 months as surgeon general, Elders proposed creating the Office of Adolescent Health, which is now part of the Department of Health and Human Services. She was ahead of the curve on marijuana as well, suggesting legalization of it and other drugs in 1993.
Even today, the way America deals with drugs needs to improve, Elders says.
She watches addiction’s hold on teens and young adults with exhausted recognition. Her son, Kevin, was convicted on drug charges in 1993 and sentenced to 10 years in prison.
“My son struggled for a long time, and I thought of all the parents who couldn’t afford the in-and-out of treatment,” she said. “He has been clean for 15 years. But he says to me, ‘Ma, that’s for today.’ I know it’s always one day at a time, and I am so proud of him. But if I tell you that it was easy, I would be lying. But that doesn’t mean prison is the answer. We’re locking addicts up, rather than spending more money on treatment and education, when we can make these young people productive members of society.”
Expanding access to health care was another cause Elders advocated for, first in her role as surgeon general, and in more recent years as a supporter of the Affordable Care Act. Still, she says the work of that effort is incomplete. “We have a very expensive sick-care system, but not a health care system,” Elders told STAT. “And most of us spend our last years doing some very expensive dying.
“I’m very pleased that Mr. Obama got [the Affordable Care Act] through,” she added. “We need to fix it, to make it better. We still have 30 million people who don’t have health insurance.”
Now alongside teaching medicine at her alma mater, the University of Arkansas, and sitting on various boards, Elders is keeping busy with the “Changing the Face of Medicine” campaign, whose film has just hit theaters.
The group’s stated goal is to increase the percentage of black doctors from 4 percent to 7 percent by 2030 — though she acknowledges that she might not live to see the goal accomplished.
“That doesn’t matter,” she said. “After all, people took a chance on me and looked out for me. I have to do it for others.”
“Don’t worry about the consequences of what people will say or think,” she advised. “If I had it all to do again, I would do it the same way. I had it right the first time.”