As a little girl in Puerto Rico, Dr. Antonia Novello had a warrior spirit in her. Maybe it was the fact that she battled a chronic disease all her young life. Maybe it was the fact that her mother, who the town revered as a teacher and principal, was a warrior role model. Maybe it was the fact that she sought solutions to problems. Maybe it was the fact that she stood up for friends and her brother whenever they were bullied.

“I always felt like I was the savior of the women,” Novello said. “I even had fist fights defending somebody’s honor.”

The fist fights gave way to fighting words and a career in medicine that allowed her to heal and protect people in a different way. In June, Novello came home to be the keynote speaker at the 18th International Conference on HIV Treatment and Prevention Adherence in Puerto Rico. Sponsored by the International Association of Providers of AIDS Care, her topic focused on a subject close to her heart: Beyond the Rhetoric: Implementing Solutions to Health Inequities.

The theme revolved around equity, an issue she had fought for throughout her medical and public health career, long before she became the 14th U.S. Surgeon General, the first woman and first Latina to serve in that role. Appointed by President George H. W. Bush in 1990 and sworn in by Supreme Court Justice Sandra Day O’Connor, Novello served for three years. Her quest had always been to help women, children, and other vulnerable populations, and she spoke up and sought solutions for the issues that plagued them: poverty, access to medical care, reproductive rights, affordable medicine, food and housing insecurities, AIDS and HIV, domestic violence, and more.

“Women and kids were infected with HIV, and no one was talking about it,” she explained. “Now, even though they’ve come so far with diagnoses and treatment, the stigma and discrimination have not changed. This transcends all medical treatment.”

On a mission

According to the U.S. Department of Health and Human Services, the U.S. Surgeon General is the “Nation’s Doctor,” providing Americans with the best scientific information available on how to improve their health and reduce the risk of illness and injury. The Surgeon General oversees the U.S. Public Health Service (USPHS) Commissioned Corps, which has more than 6,000 public health professionals.

Novello joined this group, whose mission is to protect, promote, and advance the health of our nation. She also worked with the National Institutes of Health. The public health campaigns she tirelessly worked on seemed endless. These included stopping tobacco ads targeted at children, such as the Joe Camel cigarette ads, getting the national organ match donor program going, and bringing awareness to the breadth and depth of domestic violence and AIDS.

She relied on numbers, percentages, facts, and comparisons to shine a light on the inequities. But the facts sometimes unearthed disheartening truths.

“I never speak without knowing the facts,” she said. “AIDS was so rampant. In the 1980s, millions were dying. Although there have been strides in HIV treatment and education so it can be undetectable and untransferable and has become a chronic disease, it wasn’t always like that.”

It makes her more aware and extremely sensitive about her own presentation of the facts. “When you're Surgeon General, you never invent policy out of fear.”

Compassion showed the way

Novello started on her medical career path because of her own humble beginnings, including how she suffered from congenital megacolon, an abnormality of the large intestine. Her family could not afford the surgery that would correct it. “I spent one to two weeks every summer in the hospital instead for an intestinal cleaning just to be ready for the next school year.”

The compassion shown to her by doctors, nurses, and staff in those weeks swayed her passion for a medical career. But it was her mother who grounded her.

“She would not let me take advantage of my illness or use it as any kind of excuse. Born in a small town, everyone knew about it. My friends were friends for life.”

Her tenacity stemmed from her mother’s. “Mami is the longest serving tenured teacher in Puerto Rico—69 years of service!” She was a beacon of positive reinforcement for her teachers and her children, repeatedly promoting the power of education and self-advocacy.

Novello finally had the surgery when she was 18. The experience influenced her decision to become a doctor to help other sick children. She did her residency at the University of Michigan, where she was named Intern of the Year. She then had a private pediatric practice for a couple of years before she found it too emotionally draining. She committed to serving the larger population instead, graduating from Johns Hopkins University with a master’s and a Doctor of Public Health degrees.

Grim realities

The public health path had its challenges. Despite successes in public health awareness, discrimination keeps people from getting the right resources, says Novello. Health issues can stem from societal and systemic inequities with Black American and Latino populations in employment, housing/red-lining, education, poverty, seniors who are left to fend for themselves, and lack of effective representation at the political level.

“The depth of what is happening with inequity seems worse now.”

COVID 19 didn’t help. The NIH traced this as a true disease, not something that just happened, and there will be long term COVID, including PTSD, Novello explained. Isolation and loneliness drastically affected mental health, values, and opportunity gaps. Kids were isolated, hungry, and lost; domestic violence numbers soared. “We created a monster we can’t get rid of. What’s worse, in my heart, I feel the pandemic is not over.”

The power of the oath

After her term as U.S. Surgeon General, Novello branched out on her path. She served as a special representative to the United Nations Children’s Fund, the New York State Health Commissioner, and the Executive Director of Public Health Policy at a Florida hospital. She volunteered in Puerto Rico after Hurricane Maria hit and during COVID. She earned commendations and awards along the way. However, those were secondary to her duties.

“15 minutes of fame can come back to haunt you, but it doesn’t mean I will not speak,” she says. “Once a surgeon general, always a surgeon general.”

The Hippocratic Oath has guided her to do what is expected of a doctor. According to Encyclopedia Brittanica, the oath is a physician’s pledge to prescribe only beneficial treatments, according to their abilities and judgment; to refrain from causing harm or hurt; and to live an exemplary personal and professional life.

It’s not to say Novello’s life is perfect. But her commitment to helping vulnerable populations and shedding light on public health inequities has never wavered. Perhaps it comes back to that warrior spirit in her, or the young girl’s dream to be the savior of women.

“Humanity in medicine has changed. Many will not put their necks out there to protect and do what needs to be done, but we still have a responsibility to the poor and disabled, to women and children, and to each other.”