Conversations/David Satcher; C.D.C.'s New Chief Worries as Much About Bullets as About Bacteria

"I LIKE to quote John Gardner, who said life is full of golden opportunities disguised as irresolvable problems," said David Satcher, the 52-year-old President of Meharry Medical College in Nashville, who last month was named the new director of the Centers for Disease Control and Prevention here. "I've had that experience in my own life, and I bring that perspective to the problems of this nation as it relates to health care."

What makes Dr. Satcher's views of note is less what he says than what he has done. In a nation where it's almost impossible to flip across a radio dial without hearing the standard talk show litany of what government and society can't do, his life has been an exercise in walking up to locked doors and somehow finding a key.

It remains to be seen whether his position at the C.D.C. is just the key he's looking for now -- or the door.

At the age of 2 in segregated, rural Alabama, he was diagnosed with a severe form of whooping cough and his parents were told he probably would not live. He pulled through.

As one of eight black children raised by self-taught farmers whose formal education ended in elementary school, he decided at the age of 8 to become a doctor. Somehow he did, picking up a Ph.D. in chromosome genetics in the process.

As head of a financially strapped, historically black medical college in Nashville, he came up with an unprecedented plan to merge a municipal hospital with a black medical school. After a tortuous political battle, his plan succeeded, and it saved the college.

When he describes his conception of his new job, he's as quick to mention the plague of gun deaths in America's cities as the plague of AIDS. The former might strike many as more a law enforcement or social policy issue than a medical one. But Dr. Satcher, who inherits an organization with 7,000 employees and a $1.6 billion budget, is clearly committed to a view of the agency's mission that goes beyond combatting infectious diseases.

It is not an entirely new view. The agency has for years identified violence and gun deaths as major health problems in American life. And when Dr. Satcher met for the first time with its employees recently, the first priority he stressed was a need to continue to improve the quality of the things the C.D.C. has long done well.

But Dr. Satcher spent most of his time at Meharry trying to gear the school's training and services to the problems of the poor, and he clearly thinks that same perspective is needed in his new job. It's Not Smallpox

"I don't think you have to take anything away from C.D.C.'s historic role in order to say that if you look at the major cause of death today it's not smallpox or polio or even infectious diseases," he said. "Violence is the leading cause of lost life in this country today. If it's not a public health problem, why are all those people dying from it?"

One idea he instituted at Meharry was The Sisters Program, which took addicted women in housing projects, helped them get off drugs and then put them in charge of doing the same for others.

Another program he backed was "I Have a Future," which works with teen-agers in housing projects, trying to ground them in enough optimism to keep them from the self-destructive excesses of inner-city life. It succeeded well enough to be imitated in other cities, he said.

"If you can give young people a reason to believe that they can change the future for themselves and others, then it is much easier to deal with violence and substance abuse and teen-age pregnancy," he said. "We've found that those problems were not the problems, they were the symptoms. When young people don't have any hope for the future, they'll do anything."

One of his goals now is to develop pilot programs to curb violence and promote good health practices that could be used in churches and schools everywhere. He said black churches in particular are an untapped resource.

"I see the public school system as a major partner for the Centers for Disease Control, in terms of helping to implement health promotion and disease prevention, but I also think churches are in a unique position to help," he said. "We have a major problem with immunization in this country; probably less than 50 percent of the adults are current with tetanus and diphtheria boosters. We've got to work on AIDS control. We need to get churches involved in stop-smoking programs and alcohol control programs. I think there's great potential there."

He said that need not mean handing out condoms in church, but he also said he is comfortable with whatever is effective in dealing with problems like teen-age pregnancy and AIDS, including new Surgeon General Joycelyn Elders' support for condom distribution in schools.

"My attitude is that we really have to provide people in this country with the information they need to protect themselves from this virus," he said. "And we can't let political, cultural or religious differences interfere with that." Task Force

Such approaches, he said, do not just noodle around the ragged edges of the country's health care needs. And they fit in at the heart of the President Clinton's proposed health-care legislation. Dr. Satcher was one of the consultants to Hillary Rodham Clinton's task force on health-care reform.

"I'm encouraged about the increased emphasis on health promotion and disease prevention," he said. "I think what we're talking about doing in this country is providing incentives for health care providers, physicians and others to work to keep people healthy, whereas today most of the incentives are toward treating people when they're sick or in bringing to bear the greatest levels of technology that we can."

One of the most telling episodes in his career at Meharry was his effort to merge its Hubbard Hospital with the city's aging Metropolitan General Hospital.

He proposed a model of integration the two that was very different from the norm -- in which black institutions invariably get merged into white ones. In this case, he called for Metro, which needed a new building, to be merged into Hubbard, which needed more patients, with Meharry taking charge of patient care.

The proposal walked a political tightrope in which race -- specifically, fears about entrusting medical care to black doctors and administrators -- was the constant subtext. It took four years, and there were times when one could sense an anger and frustration beneath the preternaturally calm exterior he usually affects. But in the end, the merger went through. The struggle became something of a metaphor for his own approach to work.

"One of the things that I learned in the merger struggle is that there is in this country, not just in Nashville, but in this country, a reservoir of integrity and good will among people," he said. "We found that and we built on it. I've had failures at Meharry, and I've had failures in other places, but I've never allowed those failures to shape my attitude toward the future. I don't believe in assuming that you don't have support for something that's right."