Answers have been edited for brevity
NCHN: Why did you visit North Carolina?
Dr. Benjamin: Prevention is the basis of my work as the Surgeon General and the Affordable Care Act established the National Prevention Council which I chair. We released our first ever national prevention strategy, so now we’re trying to implement that strategy. So, I’m traveling the country talking about it.
NCHN:What are the top three or four priorities at the top of your prevention strategy?
Dr Benjamin: We have four basic pillars, those are making healthy communities, and second, empowering people to make good decisions, to make good choices.
Another is clinical and preventive services because we know that people who get their preventive services tends to do better… things like their Pap smears and their mammograms.
And the last thing is health disparities, because he wants to eliminate health disparities.
Health does not occur just in the doctor’s office and in the hospital. We have to incorporate prevention in everything that we do. And my hope is that we as government can give people good information, give them tools, give them opportunities to be healthy and then they can make their decisions about what they want to do. It’s our job to make it easier.
NCHN: Getting people to engage in prevention means getting people to change their behavior, and that’s hard.
Dr. Benjamin: One of the hardest things to do is to change your behavior. And that’s why I am having this initiative I call a journey to joy. We have to put the joy back into health. We have to make it enjoyable to be healthy.
NCHN: Not eat your peas…?
Dr. Benjamin: Eat your peas if you like peas, otherwise you might want to eat carrots. Whatever it is you like, but you have to make it enjoyable.
We have to stop telling people what they can’t do, they can’t eat that, start telling them what they can do. You can exercise, you can play and you can have fun. You don’t have to go to a gym necessarily, you may just want to dance, and you may want to go ride a bike, whatever it is that brings you joy, and putting that joy back into health.
You may want to go run a marathon, I may want to get back into an old pair of jeans. Another person may want to sit up long enough just to be able to play with their grandkids.
And you know, you don’t always want to eat completely healthy things, sometimes you want to eat things that you like. Or indulgences. And it’s okay to do that and not feel guilty about it if you also do the other parts other times. You can build a balance in.
NCHN: What if the thing you like to do is eat mac & cheese?
Dr. Benjamin: You shouldn’t deprive yourself of the mac and cheese but you don’t eat mac & cheese all the time. And there are healthier ways to make mac & cheese with low-fat milk, for example.
Just find what it is that’s joyful for you that you will do forever, not that you are going to do for a week and then stop. But make health be fun.
NCHN: Doesn’t that get us closer to a nanny state, you telling people to exercise, to eat differently?
Dr. Benjamin: It’s never a mandatory anything, it’s volunteer. Our job in government is to give you the information, give you the tools and then it’s up to you to make those decisions.
You don’t have to be healthy if you don’t want to. But I don’t know very many people who don’t want to be healthy.
But it’s hard to be healthy… it’s expensive. It often costs more. It should be easy, it should be in everything that we do.
And, we’re trying to give people tools to make it easier. A simple tool like My Plate is a plate diagram where half of it is fruit and vegetables, a quarter of it is protein and a quarter is grains. Even a kid who comes home from school in the evening can see that on their plate.
(Note: about 300 people joined Dr. Benjamin on the American Tobacco Trail in Durham for a walk Thursday evening.)
NCHN: There is a lot of talk in public health about the idea of the built environment promoting exercise. But that also takes commitment from political leaders to put the money toward doing that kind of thing
Dr. Benjamin: It does. But some of this infrastructure is going to be updated and improved anyway, so when you are doing it you might as well do it properly.
We’ve gotten information from studies that show that people do better when you have these well-built communities. For instance, the architectural department at the University of Miami has done studies to show that elderly people who live in a neighborhood where they have front porches stay active longer. Just by having front porches! Simple little things that make a difference that you can do that don’t cost a lot.
If you’re going to be resurfacing streets make it with a bike path on it. You are going to be upgrading these things, you’re going to be doing these things anyway, make sure you can do something where you can get a return on investment, more than just a street, to have a place where people can go to be active.
NCHN: You’ve lost members of your family to preventable illness…
Dr. Benjamin: My mom started smoking when she was a teenager, she was a twin and her twin brother could smoke that they wouldn’t let her because she was a girl. So as soon as she got old enough she was going to smoke too. And she did. She smoked most of her life and she ended up with lung cancer. She died from lung cancer. And if you look at most smokers they start as teenagers.
My father died of complications of a stroke, he had high blood pressure and my brother died of HIV.
All preventable diseases!
I don’t want other families to have to go through losing a family member from an illness if we could have prevented it.
NCHN: You’ve been critiqued about your weight… and you’re not there yet. How can someone lose weight when they’re not someone like you who has access to good food, and the money to exercise?
Dr. Benjamin: You have to incorporate your health, and activities into what you are doing.
I’m just like two-thirds of Americans, and I can identify with what they’re going through. It’s a busy day, where do you find the time? Just make the time in everything you are doing.
Just think about the moms who have to work, get home, get the kids ready, pick them up, do the dinner, do all these things they have to do with the outside activities with the kids, do the homework. They have real stress. They have to find the time to build it in to be healthy too. It has to be incorporated to everything that we do and it has to be enjoyable so that we can continue it.
That’s why I am saying just have dance breaks, for instance. Hopefully radio stations will play some music for 30 seconds to do a Surgeon General’s dance break. You stop doing what you are doing to exercise and take a dance break. And it also decreases stress just have that little break.
NCHN: You are from a rural part of the South… are you targeting the South? The populations of the South? Rural health?
Dr. Benjamin:Yes and no. We understand the needs of rural areas are special and often forgotten in the policymaking so we want to make sure those are thought about. But someone needs to see that a rural community is just like an neighborhood in inner-city Detroit.
Barriers in a rural community might be transportation, in a city it might be just not having insurance card. So we want to make sure that everyone gets access to care and everyone has an opportunity to be healthy. Making sure that the rural and Southern populations are not forgotten and that their voices are heard, because bigger cities tend to have bigger numbers and people look at where the numbers are. But you’ve got people in these other areas that are being affected and we want to make sure that their voices are being heard.
NCHN: Are doctors going to be ready for 2014 or are they going to be swamped?
Dr. Benjamin: We need more primary care, we need more physicians in general, but the team approach is what is going to help us get there. We have physician assistants, nurse practitioners, nurse midwives. That team approach is better then any individual alone and the patient benefits from that team.
We are trying to get doctors ready. One of the things we have done through the Affordable Care Act is to increase the number of physicians who will now use electronic health records. We have seen those numbers double and given incentives to start using electronic medical records. Just to be more efficient and deliver more quality care with not having a paper chart but having everything at your fingers, electronically.
NCHN: What are you hoping to leave behind you here in North Carolina?
Dr Benjamin: One of the things we said we want is all these various community organizations, individuals and folks start working together with private industry, with academics, with hospitals, with the medical community… they are doing it here.
They started a few years ago and are showing how it can be done. The Healthy North Carolina 2020 plan is an example of that.
The goal is to be the healthiest state in the nation, and I truly hope you get there, and bring other states along with you. So I hope that you will continue and continue to be an example for the rest of us.
NCHN: Thank you very much
Dr Benjamin: Thank you.