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Published On June 10, 2016

POLICY

Fighting for Social Medicine

Jack Geiger discusses the importance of physician activism in promoting community health

Internist and epidemiologist Jack Geiger is an outspoken advocate for social justice. In the mid-1960s, he co-founded America’s first two community health centers. Today, more than 1,200 such centers serve 24 million Americans every year. 

 

Q: Those first community health centers were helping patients with quality-of-life issues, things that we now call “social determinants of health.” 

A: Yes. We dug wells so people could have clean water. Built sanitation. Started a 500-acre farm in Mississippi to grow vegetables for a population suffering from severe malnutrition. In the early years of community health centers, there were many efforts like that. 

Q: Why only in the early years?  

A: Presidents Nixon, Ford and then Reagan vigorously attempted to dismantle the whole community health center network. They wanted block grants instead, which, particularly in the South, would have meant a return to the existing white power structure. Finally a deal was struck: Community health centers would become lean and mean, just treat patients and not get involved in all the other stuff. But some community health centers have been very agile in finding funding for these other efforts. And the Affordable Care Act supports what they call “accountable communities of health,” which means community-based engagement in those broader processes. So we’re getting there.

Q: Should physician advocacy focus on providing social health determinants such as better food and clean water?

A: Those efforts are worthy, but they don’t change the social forces causing the problems to begin with. That takes political involvement—and there’s such great precedent for physicians to do that. They helped draft this country’s first tenement laws, they led the campaign to end child labor, and they played a crucial role in educating the public to understand the real consequences of nuclear war when the government was saying you’d be fine if you just built a little shelter in your backyard. 

Q: The first centers were founded as a result of your work in the Civil Rights movement in the South. Do you see signs of improvement in the country’s race problem?

A: Racism is real and manifested in many ways. Recognition of that is now pervading medicine and medical education. But there really has been significant change since the Institute of Medicine in 2002 published Unequal Treatment, which documented in great detail that if you were a minority patient with the same income and insurance status as a white counterpart, you were at considerable risk of being diagnosed differently and given limited or inferior treatment. That situation has improved greatly, but we don’t live in a post-racial society just because we’ve elected a black president twice.