Fancy a summer reading? Try this non-fiction “Feel-Good”
In today’s busy world, we rarely take the time to reflect on the past and read for the fun of it – the only exceptions being the end of the calendar year and summer vacation. Several months ago, I put aside an uplifting article that I would highly recommend reading on a lazy afternoon: “The Good Doctor – Jack Geiger, Social Justice, and US Health Policy”.
H. Jack Geiger, MD, passed away on December 28 of last year. With so many others who were lucky enough to know him, I will never forget him. But as authors Rosenbaum and Hawkins have observed, “Far more important, especially at this point in national discourse, is the indelible imprint he has left on health equity and social justice as a essential elements of a national health policy. “
The “footprint” that survives and continues to thrive is the Community Health Centers (CHCs) program that was started by Geiger and his colleagues 55 years ago in Mississippi and Boston. The model was based on what was then a revolutionary idea – the belief that medicine is not simply a reactive response to disease, but rather an entry point to good health.
The impetus behind the program in 1975 and for decades thereafter was the late Senator Edward Kennedy (D-Mass.). CHCs were codified in public health law for many years and eventually gained permanent legal status under the Affordable Care Act 2010. Given the turmoil in the U.S. healthcare system, the endurance of the program is impressive – today there are more than 1,400 CHCs operating in 13,000 locations across the country, serving at least 30 million residents of urban and rural communities in economic difficulty.
Geiger and his colleagues have not only demonstrated the value of publicly funded clinics in these underserved communities. They have proven that clinical care “based on clear and applicable principles of health equity and social justice” is both achievable and effective.
Today’s CHCs operate at the intersection of healthcare and civil rights. The original principles are alive and well, and the conditions under which public funding is determined can be summarized in three basic rules:
- Community duty of care. While physicians in the United States remain free to determine where they will practice, who they will serve, whether they will treat patients unable to pay, and what types of health insurance they will accept, CHCs have a legal obligation to serve all residents. their designated service areas or target population (eg, farm workers, homeless). They not only accept patients, but actively seek to identify people who need care.
- Wide range of treatments. Primary care should be provided to all patients, from pregnancy through birth to old age, from basic services to the treatment and management of complex conditions. Beyond clinical care, CHCs include services that support access and address the factors underlying community health.
- Community empowerment. Perhaps the most striking feature of CHCs is that by law they must be governed by boards with 51% of the members being registered clinic patients. These boards set policies, hire and fire executives, and set strategic goals.
Tired of the constant drumbeat of “bad news,” this article has left me more optimistic that good ideas well implemented can and have lasted. It also sparked a wave of nostalgia.
It was the summer of 1976 – just before entering my final year at Vassar College. I drove from Poughkeepsie, New York to visit what is now called the Renaissance School of Medicine in Stony Brook in eastern Long Island, New York for the opportunity to meet Geiger. To this day, I consider him to be one of my most important “influencers”. What I didn’t even begin to understand at that point was that the man I admired would become a true icon.
To learn more about physician activism, I can recommend another good read: “Virchow at 200 and Lown at 100: Doctors as Activists. This informative and engaging article reminds us that from Dante Alighieri (apothecary by profession) who died 700 years ago to current American general surgeon Vivek Murthy, MD, pioneering clinicians have pushed the traditional boundaries of medicine for the good of all.