Updates on the Surgeon General’s Role

The office of the Surgeon General hasn’t made headlines much lately. It’s not because the position isn’t important, but perhaps simply because it’s not as impactful as it used to be.

That was certainly the case back in the day. Up until the mid-1960s, the surgeon general oversaw a budget in the billions, managing public health entities like the FDA, CDC, and NIH. Then, with Lyndon B. Johnson’s administration, a significant shift occurred and these responsibilities were transferred to the Assistant Secretary in the Department of Health and Human Services, later known as Health and Welfare.

Why was this change made? It largely stemmed from a political desire to control burgeoning health and research budgets more easily.

Yet, the Surgeon General remains a figure of some dignity, thanks to Senate confirmation, leading public health officers, and perhaps a well-fitted uniform. As one writer described, they are seen as a “Glorious Health Educator.” That said, not all hold this view in high regard. Their primary duty seems to be delivering an Annual Report on Smoking to Congress, which they usually just sign off on without actually authoring.

This situation was notably exemplified by former Surgeon General Charles Everett Koop, who faced sharp criticism during his tenure. The New York Times called him an “Unqualified doctor,” while others dubbed him “Dr. Cook.” His lack of public health experience and controversial views on abortion drew attention. Interestingly, when the importance of the office declined, Koop realized he could still make an impact from his notable position.

He chose to embrace the role of an influencer long before it was a recognized profession. Moving beyond the typical confines of a pediatric surgeon and anti-abortion advocate, he deftly combined health institutions, personal beliefs, and media savvy to shape public opinion and national health policies. By the 1980s, Koop had become a trusted figure, using his platform to encourage changes around smoking, HIV/AIDS, and preventive health measures, setting a clear example for future Surgeons General.

Koop knew how to leverage his image. His distinct look—complete with a patriarchal beard and navy uniform—conferred a sort of authority that matched his straightforward communication style. He was not about charm; credibility was his currency, which sometimes created friction with media outlets and political factions.

He leaned on scientific consensus, making complex information easily understandable. Perhaps it’s reminiscent of how today’s influencers communicate, though Koop always grounded his messaging in science.

His most pivotal moment came during the AIDS crisis. While many government officials hesitated to address the issue, Koop tackled it head-on. In a 1986 report from the Reagan administration, he advocated not just for abstinence, as many expected, but also for comprehensive sex education and condom use. His choices regarding audience and communication style mirrored modern social media strategies. Then, in 1988, Congress allowed him to send an unprecedented AIDS mailer to every household in the U.S.

What set Koop apart wasn’t just his willingness to speak on sensitive issues. He maintained a reputation for integrity, which, despite some resistance from conservative circles regarding his lack of focus on anti-abortion rhetoric, won him respect across different ideological lines. In today’s world of influencers, being reliable is key, and Koop’s brand of unwavering integrity gave him a moral standing that transcended partisanship.

It’s interesting to note that Koop emerged as an influential figure long before the digital age we know today—before Instagram, YouTube, and almost before the internet. His credibility and the careful cultivation of public trust reshaped the potential of his office into a platform for national change. His legacy not only casts a shadow over his time but also offers a framework for contemporary public health communication.

As for the current nominee for Surgeon General, Dr. Casey Means, while I haven’t personally met her, and while she might evoke skepticism in some circles for her views and experience, I feel there’s potential. If she earns the president’s trust, she might soon find herself wearing a naval-style uniform, stepping into the influencer role that has evolved so much.

Nigel M. de S. Cameron recently releasedDr. Koop: The lives of a surgeon general. (University of Massachusetts Press, 2025).