Novello was appointed Surgeon General by President George H. W. Bush. She was the first woman and the first Hispanic to hold the position. During her time as Surgeon General, Novello focused her attention on the health of women, children and minorities, (people with little political power). She also focused on underage drinking, smoking, and AIDS. She played an important role in starting the Healthy Children Ready to Learn Initiative. She spoke out often and forcefully (very strong and loud) about illegal underage drinking, and called to the United States Department of Health and Human Services Inspector General to issue a series of eight reports on the subject.