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JOYCELYN ELDERS STILL SEES THE BIG PROBLEMS

During his initial foray before Congress in Washington the other day, surgeon-general nominee David Satcher challenged Americans to exercise more and eat healthier foods.

On the same day, here in Buffalo, the last person to be surgeon general -- the controversial Joycelyn Elders -- was challenging the nation to come to grips with issues like teen pregnancy, AIDS and the need for government funding to help the poor afford family planning.

The contrast was eye-opening, and the impact extends far beyond what happened or will happen to each of these two individuals, neither of whose qualifications for the post could be seriously questioned.

The difference between what Satcher told a Senate confirmation committee and what Elders said goes to the core question of what Americans want in a surgeon general. It raises the question of just how ready we are to confront all of the nation's pressing health problems honestly, not just focus on those that arouse little controversy.

Elders was forced out of the Clinton administration three years ago after giving the nation straight talk about everything from sex education to drugs to the need to keep abortion safe and accessible.

She hasn't stopped her straight talk.

"We as a country have not done well by our adolescents," she said in her talk here. "We would rather they get AIDS and die, have babies and be poor and dependent, than teach them about sex and contraceptives in school."

Her words are not music to the ears of a conservative Congress that goes about putting ideological limits on health care while vilifying certain diseases, certain victims and certain forms of treatment.

Elders' appearance here came on the same day that the House passed another bill to prevent doctors from utilizing a rarely used form of late-term abortion. House leaders plan no attempt to override President Clinton's veto until well into 1998 -- election-year timing that made another Elders comment seem almost prescient. She described the never-ending abortion controversy as generated in good part to help certain groups and members of Congress raise money.

Against this backdrop, it's no wonder that Satcher's "straight talk" since his nomination has focused on issues like the need for Americans to take more responsibility for their own health through diet and exercise.

That's an important issue. But Satcher will have to go further after being confirmed, and the country has to make it clear that it's ready to listen and not have the surgeon general muted by those who would dismantle his bully pulpit.

Satcher already demonstrated political courage when, as director of the Centers for Disease Control, he had the institutes take up gun violence as a public-health issue. And his upbringing in rural Alabama already has given him the necessary appreciation for what Americans -- particularly poor Americans -- go through in the battle to stay healthy.

Now, within the totally different style he brings to the job, he'll have to use those assets to find a more acceptable way to tackle the same topics that Elders tackled.

If he doesn't, many of America's most pressing health problems -- teen pregnancy, sexually transmitted disease, drug and alcohol abuse, etc. -- will continue to be addressed with timid strategies while politicians force the nation to pretend that silence is an antidote.

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