The nation's AIDS epidemic is getting the publicity, but other problems pose a greater threat to Americans' health, according to a leading health care official.
Dr. James O. Mason, a former Utah health official who has an insider's view on diseases in America, nevertheless believes AIDS must continue to be a very high priority because of its potential to spread."It's not so much what it is, as what it might become," said Mason, director of the Altanta-based Centers for Disease Control and administrator of the federal Agency for Toxic Substance and Disease Registry.
"There have been only 45,000 deaths since 1981 from AIDS. That's no small number, but it pales beside the 320,000 deaths a year that are directly attributed to smoking."
It's been five years since Mason left Utah to take over as director of the CDC after having served as executive director of the Utah Department of Health.
In a telephone interview from his Atlanta offices, he talked about the battles won and the epidemiological enemies still threatening America's health.
Chronic diseases, injury, infant mortality - the nation's major killers and cripplers - will be the crises on which Mason and his staff of 4,500 will focus in 1989. AIDS will continue to be a primary focus as well.
In the absence of a cure or effective treatment for AIDS, Mason said increased emphasis will be placed on preventing the disease from being transmitted from one individual to another.
"We'd like to find a cure, a magic bullet to keep those already infected from going on to disease and death. But there is no vaccine on the horizon," he said. "And the drug AZT is somewhat useful, but not a totally effective treatment and has many side reactions."
Mason believes the age-old adage, "An ounce of prevention is worth a pound of cure." But blocking CDC prevention programs is public discrimination.
"If there is anything that has had a chilling effect in our ability to get to those people who are most likely to be affected and work with them, it has been discrimination," said Mason, a Utah conservative who raised a lightening rod in a thunderstorm as one the first national health officials to advocate confidential AIDS testing, counseling and partner notification.
His strong anti-discrimination stances since have critics accusing him of being a gay right's advocate.
"If I am against discrimination of people infected with AIDS virus, there are too many that perceive that Jim Mason is advocating gay rights," he said. "That's not what I am advocating. I am simply saying this: However people were affected with HIV, if they are not a public health risk in the workplace and schools, they should not be discriminated against."
Mason is challenging state legislatures to address the issue of discrimination. > Establish a climate where people, no matter how they became infected, will be willing to be tested and helped to modify their behavior so they won't infect others, is his counsel to lawmakers in 1989.
Concerned that each year more than 140,000 deaths in American result from trauma, the CDC over the past three years has focused on injury research prevention.
The sale of three-wheel, all-terrain vehicles was banned in the United States by the Consumer Product Administration following one of the agencies risk-assessment studies.
Another study of burn victims prompted cooperation from water heater manufacturers to lower thermostat temperature ranges. "Through voluntary compliance, there has been a significant reduction in the number of burns among young people and older adults," Mason said.
Mason's new goal is a more concentrated effort to address the health-care needs of America's minority and ethnic groups. "They haven't enjoyed all the advantages of other Americans," he said, citing higher infant mortality rates and greater incidence of some diseases among blacks, Hispanics and other groups.
"There's a lot of unfinished business," said Mason, who, unless he is asked to leave by President-elect George Bush, will stay on board in Atlanta during the presidential transition.
He candidly admits, however, that during 1989 he'll give some thought to a career change.
"I have never stayed any more than about five years in any job," said Mason, who has served as commissioner of the Health Services Corp. of The Church of Jesus Christ of Latter-day Saints. He has also been chairman of the Division of Community Medicine in the Department of Family and Community Medicine at the University of Utah. During most of 1985, he served as acting assistant secretary of health in the Department of Health and Human Services.
"I like to make my contribution; I don't like to just mind the store," he said. "I like to innovate and create, and after you have been with it for a while, you sort of get captured by the job."