Agents Of Change


As its head the surgeon general wore what seemed like a Salvation Army officer’s uniform. Terry was no costume general, however; his research specialty had been hypertension, which was clearly linked to smoking. He had joined the Public Health Service in 1941, when he was in his early thirties; he finished his career, which lasted until 1982, as a professor of medicine at the University of Pennsylvania. After Terry, the Surgeon General became a character on the political stage, and such successors as C. Everett Koop in the 1980s and Joycelyn Elders in the 1990s frequently took the center of it in debates about issues ranging from abortion to drug legalization.

The response to the 1964 report was slow and tortuous. Only after years of battling did the tobacco industry, under threat of tough legislation, agree to warning labels and a ban on television commercials. The original warning—“Caution—the Surgeon General has determined that cigarette smoking may be hazardous to your health”—bore all the signs of committee-crafted prose. It was stiffened in 1971, and the TV-advertising ban took effect at midnight, January 1, 1971, granting the tobacco companies one last day of football bowl games for their ads.


The label and ban struck some as a horrendous government intrusion into private affairs and others as a sorely needed offensive against an addictive drug that each year took more American lives than World War II had claimed.

At first the warning labels appeared only on ads. The 1971 policy put them on the cigarette packs and banned TV advertising. That, in retrospect, was a turning point. It was the beginning of the appearance of tiny warnings on the objects of our lives, little footnotes of caution to the prose of daily affairs. Soon came seat-belt warning chimes and legends on rearview mirrors and graphic propaganda like the nutrition pyramid.

The debate over public health became part of a wider debate between those advocating limits to government power, citing John Stuart Mill’s injunction against protecting individuals against themselves, and those arguing that in a modern complex society, where we all breathe the same air, we can’t escape the costs of insurance, health care, and law enforcement, and so on, forced on us by the acts of others. It is a debate that reaches to the core of American ideals, one that will likely continue as long as the Republic.


Frank Turner shaped the creation of the largest public-works project in the history of the world, the network of interstate highways that changed the country subtly as much as the transcontinental railroad did overtly. He was secretary to the Clay Committee, which formulated the interstate system plan, and later he rose to head the Federal Highway Administration.

Turner grew up in the era of the farm-to-market road, when highway builders thought in terms of routes to link the country to the city, and the interstates were born as the farm-to-market road writ large, though two-thirds of interstate money was ultimately spent in the cities. When he was young, in Texas, part of the state poll tax could still be a day’s work on the roads, and he labored alongside his father on those roads. At Texas A&M he studied soil science and the dynamics of asphalt. He worked on key military highways in Alaska during World War II, scouting terrain from a light airplane, and was sent to rebuild the highway system of the Philippines after the war.

In 1954, when President Eisenhower appointed Gen. Lucius Clay, architect of the Berlin Airlift, head of a commission charged with formulating an interstate-highway plan, Turner was made its executive secretary, the key staff position. He carefully helped draft the legislation, then spent days in patient testimony explaining it to members of Congress. Turner prided himself on his role in the surveys that broke the country down into grids in which citizens were scientifically polled on their transportation patterns and their desires. He and his staff drew what they called “desire lines” on the national map. Those lines were paved into the interstates.

GRUEN ENVISIONED malls as civilizing nodes in America’s open space. Looking on what he had wrought, he was not pleased.

But Turner’s maps were deceptive. Although most of the interstates’ length was in the heartland, most of the dollars and the most difficult and expensive miles of the system ended up in the cities and in beltways around them. The highways helped shift the balance of economic power to the Sun Belt, where the roads could be built without the interference of old water- and rail-based transportation patterns. Designed in part to empty cities quickly in the event of imminent nuclear attack, they helped empty old row-house neighborhoods of residents heading for the suburbs. Thanks to the interstates, you could see a lot more of the U.S.A. in your Chevrolet and commute farther to work. Detroit’s automakers prospered, and new sectors of the economy grew up around interchanges and along beltways.