How Jimmy Carter’s legacy as a public health visionary benefits the world
President Jimmy Carter, who died yesterday at 100 years old, receives more praise as a former president than as president. His unprecedented post-White House pivot into positive actions for a better world in so many fields — including public health — revealed his distinctive genius. I can attest to this as a (formerly) young physician who worked with him in the earliest days of his post-presidency.
He rebounded from his electoral defeat with tenacity, launching the Carter Center, a nonpartisan nongovernmental organization broadly dedicated to solving mega-issues such as advancing democracy and human rights, improving mental health and preventing disease.
The center established policy divisions — pillars of thoughtful discussion led by notable experts from many spectrums, among them public health. This was always a priority of his, as Georgia governor and later as president, when he led the successful push for universal childhood immunizations and the establishment of humanitarian refugee camps in Thailand.
The newly formed Carter Center engaged William H. Foege, M.D., then-director and my boss at the Centers for Disease Control and Prevention, to assemble a national consultation on health priorities. It was our privilege to direct “Closing the Gap,” the multidisciplinary investigation that identified the underlying causes of premature death and illness in the U.S. population.
Top medical thought leaders from 17 different medical disciplines such as heart disease, cancer and infection consulted with peer reviewers nationwide. They estimated the number of deaths associated with preventable risk factors. The leading risk factors, such as tobacco use, obesity and lack of exercise, were summed up and ranked by their harmfulness.
Approximately 60 percent of deaths were labeled premature because of preventable risk factors. This estimate, although not perfectly precise, was very consistent with earlier and subsequent investigations in the U.S. and Canada that quantified the combined multi-disease effects of the principal risk factors.
Carter followed up decisively. He wrote a medical journal editorial urging the nation’s physicians to stress risk reduction with their patients, and not just treat illnesses.
His editorial received wide notice. A critical reader wrote back that Carter was “right on target,” but “how times change!” He was vexed by Carter’s earlier support for tobacco growers as president.
Carter responded without a hedge, “[He] is correct. My editorial is ‘right on target’ and times have changed.”
Carter negotiated with tobacco executives and medical leaders at a Camp David-style summit, which led directly to reduced tobacco marketing, especially advertisements aimed at children. He collaborated with PBS and CDC epidemiologists in producing a TV movie for teens on common hazards such as alcohol, dangerous driving and of course tobacco.
He collaborated again with CDC to create “Healthier People,” the desktop health risk tool that measures personal risk reduction and helps improve health outcomes.
Carter also lent support to health initiatives outside the center. He collaborated with international NGOs in sustained programs that attacked debilitating infections such as guinea worm and river blindness. He encouraged a leading aerospace manufacturer and the nation’s hospitals to ban smoking.
These became forerunners of a smoke-free movement that significantly reduced smoking nationwide. Separate but similar movements in preventive medicine emerged in foundation-sponsored wellness programs and numerous federal, state and local health projects.
Although no single entity or project can claim credit for the millions of lives enhanced and protected from premature death, Carter’s direct involvement in the cause inspired thousands of medical and public health professionals to combat deadly risk factors as tenaciously as the diseases they inflict on people.
The public health field, although recently rocked by a deadly pandemic, still retains a constant principle of prevention through risk reduction. Carter’s contribution to domestic and global public health as a major pillar of his post-presidency can be counted with gratitude among his many contributions in other areas of international and domestic importance.
Robert W. Amler, M.D., M.B.A. was a Centers for Disease Control and Prevention physician on assignment to the Carter Presidential Center 1983-1987. He is dean of the School of Health Sciences and Practice at New York Medical College.