dialogue
A Public Health Pioneer
PHOTO: ERIN PATRICE O'BRIENH. Jack Geiger
As a fourth-year medical student at what was then Western Reserve University School of Medicine, H. Jack Geiger, MD (MED '58, HON '00), earned a Rockefeller Foundation fellowship to study community-based primary health care in South Africa.
Today, he is considered a pioneer in the development of community health centers across the United States. Geiger also made a significant mark on the international front as a founder of several organizations, including Physicians for Social Responsibility and Physicians for Human Rights. He has won numerous awards for his achievements battling racial and ethnic discrimination in health care—work that inspired the Congressional Black, Hispanic and Asian Pacific American Caucuses to create the H. Jack Geiger Congressional Fellowships on Health Disparities for young minority scholars.
Last month, CWRU's medical school recognized his lasting impact by creating the H. Jack Geiger Society. It becomes the fifth academic society where incoming medical students are assigned and provided academic, career and personal advising.
Now a professor emeritus of The City College of New York, Geiger became well known during the 1960s civil rights era for writing food prescriptions for poor families—a story he details below.
How and when did your awareness of civil rights begin?
I had gone to see the play Native Son, based on the Richard Wright novel, while still in high school. I was so moved by it. The star was the great black actor [and civil rights champion] Canada Lee. I talked my way backstage and spent more than an hour with him and just talked. He became, in a way, my first mentor. He had an apartment on Sugar Hill in Harlem, and that became my second home.
You initially wanted to be a journalist. Then you joined the U.S. Merchant Marines. How did you end up at Western Reserve?
In 1943, I enlisted in the U.S. Merchant Marines because it was the only military service that was not racially segregated during World War II. It was during my service that I decided I was interested in medicine. After my discharge, I enrolled at the University of Chicago as a pre-med student. ... When I applied to four medical schools in New York, I was told I wouldn't get in anywhere because of my activism. Several years later, while working as the science and medical editor at the International News Service, I assigned myself to cover the annual meeting of the AAMC [Association of American Medical Colleges] so I could meet the deans. One of them was Jack Caughey, the one-man admissions committee at Western Reserve School of Medicine. We talked and he said, "Why don't you apply?
How did the experience in South Africa change your life?
I saw what a powerful instrument medicine could be for social change; that the care of patients could be merged with a concern for population health. I saw this primarily as a matter of international health, and that's what I decided to train for. It is, in part, because of that experience, and Western Reserve [approving the foreign travel], that in this country there are now effectively 9,000 community health centers supplying comprehensive primary care to 24 million people.
Is that your proudest contribution?
Well, I think that is. There are two other contributions along with it: helping to found Physicians for Social Responsibility and Physicians for Human Rights.
[PSR is the U.S. affiliate of International Physicians for the Prevention of Nuclear War, which won the Nobel Peace Prize in 1985. PHR is a founder and leader in the International Campaign to Ban Landmines, which shared the 1997 Nobel Peace Prize.]
During the 1960s, you combined your interests in civil rights and medicine. In what way?
In 1964, approaching "Freedom Summer" in Mississippi, a group of us—about 20 or 30 health professionals from across the country—formed an organization called the Medical Committee for Human Rights to be, in effect, the medical arm of the civil rights movement. They asked me to be a field coordinator for a month that summer. I took a look around and realized that I didn't need to go to Africa or Latin America or Southeast Asia. We had all the health disparities here.
Is that when you came up with the idea to write prescriptions for food?
At our first community health center, in the Mississippi Delta region—one of the poorest areas in the nation—people were drinking water from the drainage ditch. The insulation on these crumbling shacks was newspapers. Children were dying from the combination of infectious diarrhea and malnutrition. So we intervened. We decided to start writing prescriptions for food. They would take the food order to the grocery store, which would bill the community health center, and we'd pay for it from the pharmacy budget. That led to this iconic exchange: The governor of Mississippi screamed at someone in the poverty program, who came down and screamed at me. "What in God's name do you think you're doing giving away free food and charging it to the pharmacy? A pharmacy is for drugs to treat a disease." And I said, "The last time I looked at my textbooks, the most specific therapy for malnutrition was food." And so he went away because he couldn't think of anything to say to that.
What do you consider the lasting impact of your work?
Certainly the community health centers. There are now 42 nations that have community health centers. So, in terms of impact on health, impact on training and especially the health of poor and marginalized populations, I think that has to be the biggest.
What saddens you most about the state of public health today?
The United States leads the developed world in the percentage of our children in poverty. To be a child born into poverty in this country means a sicker life, a shorter life expectancy by 10 or 12 years, relatively more stunted intellectual development [and] a life of early adversity that constrains the rest of the life. And we do not have an established principle of universal coverage or access to health care as a right. This has enormous social costs, human costs.
