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Elders Offers Health-Care Prescription for Youths

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When Bill Clinton, then the Governor of Arkansas, hired Joycelyn Elders to direct the state's health department, he may have gotten more than he bargained for.

At the news conference six years ago where he announced her appointment, she outlined to the press one way she would attack the problems of teenage pregnancy and AIDS--by distributing condoms to schoolchildren.

"Now I know how Abraham Lincoln felt when he met Harriet Beecher Stowe: 'This is the little lady who started the great war,''' Mr. Clinton said at the time.
Six years later, President Clinton asked Dr. Elders "to do for America what you did for Arkansas.''

The new surgeon general's views on teenage sex, school clinics, and abortion stirred up as much controversy on Capitol Hill as they did in Arkansas, leading to a grueling confirmation process, but her nomination was approved. (See Education Week, Sept. 15, 1993.)

Now, two months into her job, she is already immersed in her mission. If this 60-year-old pediatrician had her way, every school would have a comprehensive health-education course, all children would be planned and wanted, and AIDS education--in the form of condom advertisements--would blare on every television network.

"You can't educate people who aren't healthy, and you can't keep them healthy if they aren't educated,'' Dr. Elders said in an interview last month.

She said her game plan calls for pooling the federal monies slated for drug-free schools, AIDS education, and nutrition education into one comprehensive health-education program. An aide called it "a sort of one-stop shopping.''

The condom ads would address the problems of AIDS, sexually transmitted diseases, and teenage pregnancy all at once, Dr. Elders said. She recently discussed the idea with television executives.

School-Clinic Advocate

When she is not pitching public-service advertisements, Dr. Elders is lobbying Congress to adopt President Clinton's health-care plan. In particular, Dr. Elders is the Administration's point person on the controversial topic of school-based clinics, which she argues are an ideal way to tackle many of the health problems young people face.

While still shuttling back and forth between Arkansas and Washington, she helped write the section of the health plan that proposes to fund the creation of school-based health centers in low-income, underserved areas. Dr. Elders said the Administration hopes to spend $450 million on the effort over four years.

"The best place we've got is schools,'' argued Dr. Elders during her confirmation hearings this fall. "They're accessible, they're affordable, and they're age-appropriate.''

Dr. Elders has had frequent meetings with members of Congress, and she contended that, despite the controversial nature of the proposal, most lawmakers believe that the country supports providing such services to adolescents.

"The only thing legislators talk about is distributing condoms,'' she said, "but that's such a tiny part of the program.''

Sen. Edward M. Kennedy, D-Mass., plans to introduce a separate health-education bill if the clinic provisions are removed from the health-care proposal, she said.

Dr. Elders confirmed that the plan will probably allow, but not require, clinics to offer contraceptives to students. Parents would have to give their children consent to use the clinics, and they could restrict their child from using reproductive services, she said.

Education advocates, pleased with her emphasis on education and early intervention, have welcomed Dr. Elders.

"She's not a dewy-eyed utopian or overly optimistic,'' said Bruce Hunter, a senior associate executive director of the American Association of School Administrators. "She is a real live honest-to-God child advocate.''

'Anti-Family' Agenda?

But her opponents charge that the surgeon general's agenda is "anti-family.''

"Dr. Elders wants the federal government to play Mom and Dad to the children of America,'' said Janet D. Parshall, a spokeswoman for Concerned Women for America, a conservative group that lobbied against her nomination. "She wants to shape American society to her liking.''

Dr. Elders--with characteristic bluntness--said that the opposition to offering reproductive services to adolescents is really based on personal attitudes about sex.

"People out there feel that the only reason to have sex is for procreation, and, if you are unmarried, then having a baby is just punishment for fornication,'' she said. "They want women to be barefoot, pregnant, and in the kitchen.''

The controversy that swelled around Dr. Elders during her confirmation hearings was unprecedented for an office that wields no direct policymaking authority.

But controversy was not new to Dr. Elders. In Arkansas, conservative groups called her "the condom queen'' and managed to block her from using state funds to buy contraceptives. But Dr. Elders still succeeded in winning funding for 26 school-based clinics, three of which offer reproductive services. Two dozen clinics are currently on the waiting list for funding, she said.

Success Story

Dr. Elders said she is most proud of the fact that, during her tenure, the number of early-childhood screenings performed in the state increased from 4,000 in 1985 to 45,000 in 1992. The immunization rate for 2-year-olds, for example, increased from 34 percent in 1989 to 60 percent in 1992, she said.

The daughter of an Arkansas sharecropper, Dr. Elders is the oldest of eight children who grew up in a three-room cabin without an indoor toilet, and she credits her mother's early emphasis on education for her success.

"My mother believed you'll know half as much as you'll ever know by the time you're 4,'' she said.

She finished high school at age 15 and college at age 18. The United Methodist Church gave her a scholarship to attend Philander Smith College in Little Rock, and she attended medical school on the G.I. bill after a stint in the Army as a physical therapist. Now a pediatric endocrinologist, Dr. Elders also holds a master's degree in biochemistry and honorary doctorates from seven colleges.

"I would like for all children to have the wonderful opportunities that I had,'' she said. "But many of those programs are not available for the average student today.''

In response, she has begun developing a program to encourage young black men to teach in elementary schools in exchange for student-loan forgiveness--even though student aid is not in her purview. She hopes to see it included under the National Service and Community Trust Act.

"It's far cheaper to send them to college than send them to prison, after we have turned them out on the streets peddling drugs and killing people,'' she said.

So confident is she of her success, Dr. Elders said she can picture herself many years from now reflecting on her accomplishments.

"I bet 12 years from the day we have comprehensive health education in every school, the whole country will say, 'Why did we wait so long?''' she said.

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