Confirmed as the 16th Surgeon General of the United States on September 7, 1993, Joycelyn Elders (born 1933) was the first African American and only the second female to head up the U.S. Public Health Service. In her brief 15-month tenure, Elders added tobacco use, national health care, and drug and alcohol abuse to her platform.

Jocelyn Elders was born Minnie Jones on August 13, 1933, in the southwestern farming community of Schaal, Arkansas. She took the name Jocelyn in college. She was the first of Haller and Curtis Jones's eight children. Living in a poor, segregated pocket of the country, she and her siblings struck a balance between laboring in the cotton fields and attending an all-black school 13 miles from home. One of her earliest childhood memories was being taught to read by her mother, Haller, who had an eighth grade education which was quite remarkable for an African American woman at that time. By the time she neared graduation from high school, Elders earned a scholarship to the all-black, liberal arts Philander Smith College in Little Rock, the state's capital. Initially, higher education looked doubtful for Elders as her father did not want to let her go. He felt that her contribution to the family was much more important. He did not see the long-term value of education. With all her pleading, Haller Jones could not get her husband to budge. Elders had resigned herself to staying home and continuing to pick cotton. She hadn't counted on her paternal grandmother, for whom she was named, to come to her aid, but whatever grandma Minnie said, she was allowed to go to college in September. Her family picked extra cotton to earn the $3.43 for her bus fare. She was the first in her family to take the road to higher education.

Found Inspiration in African American Woman Doctor

At school, Elders was particularly drawn to the study of biology and chemistry and concluded that being a lab technician was her highest calling, the professional mountaintop. But her ambitions rose a notch when she heard Edith Irby Jones (no relation), the first African American to study at the University of Arkansas School of Medicine, speak at a college sorority. Jocelyn Jones, who had not even met a doctor until she was a teenager, imagined herself as a healer.

After graduation from college, Elders married briefly and then joined the U. S. Army's Women's Medical Specialist Corps. In 1956, she entered the Arkansas Medical School on the G.I. Bill two years after the Supreme Court, in its Brown v. Board of Education decision, ruled that separate but equal education was unconstitutional. But while segregation in some areas had been declared illegal by judicial order, an underlying discriminatory mindset in American society could not be so easily erased. As the lone black student and only one of three students of color in her class, she was required to use a separate university dining room, where the cleaning staff ate. But she accepted this arrangement without argument, as this was the only social world to which she was accustomed. She met her second husband, Oliver Elders, when, in order to make additional money, she performed the physicals for high school students on the basketball team he managed. They were married in 1960.

After an internship in pediatrics at the University of Minnesota, Jocelyn Elders returned to Little Rock in 1961 for her residency and was quickly appointed chief pediatric resident, in charge of the all-white and all-male battery of residents and interns. Over the next 20 years, Elders combined a successful clinical practice with research in pediatric endocrinology (the study of glands), publishing well over 100 papers, most dealing with growth problems and juvenile diabetes. Her pioneering work captured the attention of the state's medical community, and physicians routinely referred to her their cases of juveniles with insulin-dependent diabetes.

It was this branch of science that led her to the study of sexual behavior and planted the seeds for her public sector advocacy. Recognizing that diabetic females face a health risk if they become pregnant at too young an age--the hazards include spontaneous abortion and possible congenital abnormalities in the infant--Elders saw the urgent need to talk about the dangers of pregnancy with her patients and to distribute contraceptives in order to limit those dangers. "If I wanted to keep those kids healthy, I decided I had no choice but to take command of their sexuality at the first sign of puberty," Elders told the New York Times. "I'd tell them, you're gonna have two good babies, and I'm gonna decide when you're gonna have them." The results were clear: of the 520 juvenile diabetics Elders treated, approximately half were female, and only one became pregnant.

Taking Action against Societal Health Crises

But for every young adult in her care, there were thousands throughout the state whose sexual behavior went unmonitored and whose irresponsible, uneducated actions were contributing to America's dubious distinction of having the highest rate of teenage pregnancy in the industrialized world. Elders could not turn her back on this situation. She had done that once before, when she was a pediatric resident. A young girl with a thyroid condition, upon being told that she could go home from the hospital, had confided to Elders that she didn't want to leave the safety of her room--that her father, uncles, and brothers sexually abused her every Saturday night. Elders was reluctant to believe her. This was also a time before doctors could report suspected child abuse with immunity. So Elders did nothing, and sent the child home. Inaction, she vowed, would be a sin of which she would never again be guilty.

In 1986, the year before Clinton named Elders director of the Arkansas Department of Health, 20 percent of the state's total births were to teenage mothers, compared to approximately 13 percent on a national level. The costs of the birthrate profile were, in Elder's view, enormous. Taxpayers in Arkansas dished out more than $82 million in fiscal 1987 for Arkansas adolescents and their children. Equally, if not more important, was the unquantifiable price paid by a society in which a frighteningly large number of emotionally immature young adults became parents to unwanted children. The Boston Globe quoted Elders as describing a poor teenager with a baby as "captive to a slavery the 13th Amendment [the Emancipation Proclamation abolishing slavery] did not anticipate." With the incidences of sexually transmitted diseases on the rise, and the specter of AIDS hanging over the heads of all sexually active people, Elders recognized the urgent need for bolder government involvement and an intense public education campaign.

Fought with Conservatives and Religious Groups

Elders glimpsed one of the approaches she would champion in office when she visited the state's first school-based health clinic in the Ozark mountain community of Lincoln, where contraceptives were given to students on request and where senior class pregnancies had subsequently fallen from 13 to one. Under Elders, 18 other school clinics opened, though only four of them were authorized by their local boards of education to distribute condoms. As Elders campaigned for the clinics and expanded sex education throughout the state, she became engaged in a heated battle with both political conservatives--who criticized her effort to increase the government's role in the lives of U.S. citizens, particularly in an area as private as sexual behavior--and members of some religious groups--who feared that the distribution of condoms would increase sexual activity, and who rejected the introduction of sex education in schools as a means of institutionally sanctioning abortion.

Elders, who is pro-choice but admits she personally opposes abortion, retaliated with both sober and emotional arguments. She said she would gladly teach abstinence if she felt that approach would work. But in the real world, she maintained, kids will continue to have sex, and it is the job of adults--and the U.S. government--to turn an irresponsible action into a responsible one. She said she considered every abortion her own personal failure, and her role, simply put, was to prevent unwanted pregnancy from ever occurring. She accused anti-abortion activists of having a love affair with the fetus, and pointed out in the Washington Post that not even abortion foes want to support "any [social] programs that will make [these unwanted children] into productive citizens."

In 1989, in great measure because of Elder's lobbying, the Arkansas State Legislature mandated a kindergarten-through-twelfth-grade course curriculum encompassing not only sex education, but instruction in hygiene, substance-abuse prevention, self-esteem, and the proposition, often overlooked, that sexual responsibility does not belong exclusively to the female. Between 1987 and 1990 though the rate of teenage pregnancy in Arkansas was up, the national rate was considerably higher.

Stood Ground during Confirmation Process

President Clinton's nomination of Elders for the post of U.S. Surgeon General made her the second African American and fifth woman tapped for a cabinet position--and galvanized on a national level the active critics who had fought her locally in Arkansas. Writing in the National Review, Floyd G. Brown, in a rebuttal to her favoring abortion on demand, criticized her for making what in his view is a cavalier judgment that the quality of life--that is, a loving, financially sound environment--"means more than life itself." Still others questioned her support of the abortion-inducing RU-486 pill, the medicinal use of marijuana, and her urging of television networks to lift their ban on airing condom ads. "I find it rather strange that we can advertise cigarettes and beer to the young but then get nervous when there is talk of something [condoms] that can save lives but not about some things that kill," she remarked in Advertising Age.

Some of the most persistent attacks against her nomination concerned her involvement with the National Bank of Arkansas. She and others serving on the bank's board of directors were sued by the bank for allegedly violating the National Banking Act by authorizing $1.5 million in bad loans. The suit was settled, but the terms were not disclosed. Elders resigned from her position as director of the Arkansas Health Department in July 1993 after questions were raised about her drawing a full-time salary there while also working two days a week as a paid consultant to U.S. Health and Human Services Secretary Donna Shalala.

Although some Republicans succeeded in delaying the confirmation vote, Elders gained the backing of the American Medical Association and former U.S. Surgeon General C. Everett Koop. On September 7, 1993, the Senate gave Elders the nod 65-34. Democratic Senator Edward Kennedy, citing the lashing doled out by several of his colleagues, was quoted in the Boston Globe as saying, "She has come through this unfair gauntlet of excessive criticism with flying colors."

Elders platform as U.S. Surgeon General was to continue with her work regarding teen pregnancy, she was also concerned with tobacco use, national health care, AIDS, and drug and alcohol abuse. In late 1993 she sparked a great debate regarding the legalization of street drugs such as heroin and cocaine which was misrepresented in the media and by her opponents. What Elders, in fact, proposed was that the issue be studied. She did not back away from this stance even after the arrest and conviction of her son, Kevin, who was appealing a ten-year sentence for selling an eighth of an ounce of cocaine to a police informant in July of 1993. Claiming entrapment, Kevin Elders, nevertheless, openly acknowledged a decade-long drug problem.

Gun control was a major issue for Elders. Every day 135,000 youngsters take guns to school, more than 100 are shot, and 30 are killed, she told the Journal of the American Medical Association (JAMA). She sees this issue as being intrinsic to the health of the nation.

The Surgeon General Resigns Amid Controversy

Amidst a sea of controversy over a statement made at World AIDS Day at the United Nations regarding the teaching of masturbation in schools, Dr. Jocelyn Elders was forced to resign her post as U.S. Surgeon General in December 1994. The Surgeon General had just finished a routine speech at the conference on the spread of communicable diseases when, Dr. Rob Clark a New York psychologist, asked her if she would consider promoting masturbation as a means of preventing young people from engaging in riskier forms of sexual activity. Elder, as quoted in US News & World Report responded, "With regard to masturbation, I think that it is something that is a part of human sexuality and a part of something that should perhaps be taught." That statement so enraged both conservatives and moderates alike, that it ended in Elder's termination. For Elders the political climate in Washington at that time was less than favorable for even the most minor misstep. The Republicans had just taken over the House of Representatives--for the first time in more than 40 years--and the Clinton administration was reeling. Elders infraction could not be overlooked.

While her departure was strongly applauded by the conservative faction, many were dismayed over the events that transpired and felt that Elders was lassoed and sacrificed to satisfy the chants of conservatives, and the desperation of Democrats to quiet them, as typified in an article by Susan Ager, Detroit Free Press. Elders responded not with anger but with grace. She did not buck, nor did she apologize. She stood by her comment, all of her comments, saying "Jocelyn Elders was Jocelyn Elders and I've always tried to speak what I knew to be the truth." Ager went on to say, "[Elders was a] rare public official, she said clearly and fearlessly what we didn't want to hear, but need to think about. I suspect she will be saying the same thing two years from now."

What Lies Ahead

In January 1995, Jocelyn Elders returned to the University of Arkansas as a faculty researcher, a professor of pediatric endocrinology at Arkansas Children's Hospital. Elders had both strong opponents and supporters as surgeon general. To the conservatives--her strongest opponents--she was "warped, dangerous, and a lunatic." To her supporters she was "noble, heroic, and fearless." Jocelyn Elders saw her mission as Surgeon General to create dialogue on America's health and welfare and the only way to do that, according to Elders, was to get their attention. "I think the Surgeon General's office is the office where it is very important to be able to get people listening to you, thinking about it, and talking about it...that is where you get change," she told Dr. Paula Wilson, assistant profession of communication studies Lynchburg College in Virginia.

Elders has no intention of fading into the background now that she is no longer U.S. Surgeon General. She made an impact on the audience she was most concerned about, the youth, and she intends to continue to be their advocate. When asked if there were any hard feelings about being asked to step down, Elders, in an interview with Steve Barnes of the Progressive Interview, responded candidly. "No, I don't have any hard feelings. I feel that the President, and the President alone, asked me to be Surgeon General. He gave me an opportunity to serve as Surgeon General, one that I would not have had without him.... I would not be the Jocelyn Elders I am today without the things the President did for me."

In February 1997, speaking to a group of 350 physicians at a conference in Long Beach, California, the former Surgeon General spoke "with the same clarity and passion...that won her confirmation to the post of U.S. Surgeon General in 1993, that led to her resignation in 1994," according to the Press-Telegram. A generation of youth is drowning in an ocean surrounded by the sharks of drugs, homicide and suicide, while many of us are sitting on the moral beach of Just say no, she told the opening session. Challenging her audience to become actively involved, Elders said, "There's a great big difference between being concerned and being committed. When you're concerned, its negotiable." On a more personal note she added, "When I went to Washington, I was committed. And what I was about was not negotiable."

When asked what the future holds for Dr. Jocelyn Elders, she told Progressive in a March 1995 interview, "I'm going to be the very best doctor I can be. I'm going to try to do some research, looking at problems that impact adolescents. And I'm going to become a real advocate. I'm going to do a lot of public speaking."

Elders retired from medicine in 1999, but remains extremely active in civic affairs--including testifying at congressional hearings on such issues as health insurance and preventative medicine--and has many speaking engagements every year. A collection of her lectures and remarks, titled Dancing with the Bears: The U.S. Surgeon General on HIV, School-Based Health Care, Adolescent Self-Esteem, Health Care Reform, Martin Luther King was published in 1994, and her autobiography, Joycelyn Elders, MD: From Sharecropper's Daughter to Surgeon General of the United States of America, appeared in 1996.

Associated Organizations

Further Reading

• Detroit Free Press,December 14, 1994; October 1994; Jet, December 26-January 2, 1995; Lancet, December 24, 1994; People, November 4, 1996; Playboy, June 1995; The Nation, January 2, 1995; The Progressive, March 1995; The Progressive Interview , March 1995; USA Today, May 1997; Washington Monthly, January-February 1997; the Virtual Office of the Surgeon General, My Library, "M. Joycelyn Elders (1993-1994)," at: http://www.surgeongeneral.gov/library/history/bioelders.htm; Women in American History, "Elders, Joycelyn," at: http://www.britannica.com/women/articles/Elders_Joycelyn.html (November 19, 2001); The Georgia Institute of Technology, Press Releases, at: http://www.news-info.gatech.edu/news_releases/elders.html (November 19, 2001).