Address to the American Medical Association First National Conference on Health Care for the Poor

Chicago, IL | December 15, 1967

The health centers being developed around the country are the answers you are giving. They witness to your commitment to life. A life where good health is not a lucky privilege for a few. But a basic right for all.

When Dr. Christian Barnard transplanted that heart into Louis Washansky's body every doctor in the world wished he could have been around that operating table.

Why?

Because in America alone, 750,000 people die every year from heart disease. What happened in Johannesburg is a breakthrough. Doctors have shown that another old enemy can be defeated.

The same way that other doctors have made breakthroughs against old enemies. Alexander Fleming who looked at a common piece of fungus in 1939 and then discovered penicillin. Edward Jenner who discovered the smallpox vaccine in 1796. Walter Reed who discovered the cause of yellow fever in 1901. Frederick Banting and Charles Best who discovered insulin in 1922. Dr. Jonas Salk who discovered the polio vaccine in 1954.

Those men are responsible for some of the great breakthroughs in modern medicine. But there's another disease of the heart that eats away at America. It's the heartache of illness among America's 29 million poor people.

Right now in America:

  • one-half of all women who have babies in public hospitals have no pre-natal care at all.
  • 60% of the poor children never see a doctor and never see a dentist.
  • the poor have 4 times more heart disease than the rich. They have 10 times more eye trouble. 6 times more mental illness, retardation and nervous disorders than the rich.
  • a poor child has 50% more of a chance of dying before age 1 than a rich child. The chance of dying before age 35 is 4 times greater for the poor. 
  • before 1920, the rate of maternal mortality was 79% higher for negroes than whites. Today, it is 320% higher.

I used to think statistics like that were true only in the countries where we sent Peace Corps Volunteers: India, Ghana, Peru, the Philippines and 49 other countries.

But the War on Poverty has shown that this same wasteland is here at home.

The crisis of health care in America today is not how to transplant hearts, but how to transplant ordinary health care to the poor -- the same kind of ordinary health care that the affluent take for granted.

Doctors everyday are showing that they're able to make this kind of breakthrough.

At OEO, we saw it last September in Watts. We opened a neighborhood health center on Charcoal Alley. That's where they had the big riot two years before. Getting that health center in Watts was almost as much a medical breakthrough as transplanting that heart in Johannesburg.

Two years ago, Watts was a medical wasteland.

  • A sick poor person had to travel 12 miles to a county hospital. A 2 hour bus ride, or a $4 cab fare.
  • Watts had only one doctor for every 4200 people. -The infant death rate was twice the overall rate for the rest of America. 
  • The only cases of polio and diphtheria recorded in Los Angeles were from Watts. -A doctor who examined Head Start children in Watts said 68% had something medically wrong with them. 90% had never seen a dentist.

A courageous medical school dean named Roger Egeberg saw these conditions in Watts. He came to us with a proposal to develop a family health center on Charcoal Alley. OEO liked the idea. We asked the people of Watts if they wanted a health center. They said, "Yes."

A year later, through the University of Southern California Medical School, the center was opened. Last month, "Time" magazine called it "The Miracle of Charcoal Alley."

Today, that family health center is serving 32,000 people in Watts. It has a staff of 334. 25 full-time doctors. 40 part-time specialists. 12 dentists. A psychiatrist, a psychologist, plus administrators, lab technicians, dental assistants and hygienists.

They work together in family health teams. They make sure the needs of the total family are served.

OEO has 41 of these centers. They will not only provide health care for the neighborhood--but also provide over 2000 jobs for the poor.

It was almost as much of a medical breakthrough to get a measles shot for a kid in Watts as it was to transplant that heart in Johannesburg.

That's hard to believe-- but it's true. Because for a poor person in America, poverty is not something you just feel in your pocketbook or wallet. You feel it in your body.

As Dr. G.H.T. Kimble said:

"It is bad enough that a man should be ignorant, for this cuts him off from the commerce of other men's minds. It is per- haps worse that a man should be poor, for this condemns him to a life of stint and scheming, in which there is no time for dreams or rest from weariness.

"But what is surely worst is that a man should be unhealthy, for this prevents his doing anything much about either his poverty or ignorance."

But why did we have to wait for Dr. G.H.T. Kimble to express those thoughts. Dr. Kimble is not an M.D.--he is a Ph.D. in Geography writing about Africa! But fortunately we do have doctors going out to serve the poor.

Seven years ago in Montgomery, Alabama, only $20,000 a year was available for health aid for Montgomery's 20,000 poor people. There was no community hospital in the city or county. The local doctors had twice endorsed the city-wide referendum for a city hospital. They lost both times.

They decided to act themselves. Through the Montgomery Medical Society, a city and county clinic was set up. 51 doctors volunteered to staff it. It offered medical, surgical and obstetrical services.

That was two years ago. Today, the Montgomery Clinic has a budget of $170,000. A staff of 101 doctors who volunteer their services for nothing.

Last month, those doctors came to OEO. They said they were getting so big and serving so many patients, they needed help. OEO is in the process of giving them a million dollar grant.

That's the job of government--to respond to the kind of private initiative shown by those doctors in Montgomery.

But Montgomery isn't the only place.

  • In the Columbia Point section of Boston two years ago, only 50% of the pregnant mothers got pre-natal care. Today, 98% of those women and their families are being served by an OEO neighborhood health center. It was begun by Tufts University Medical School. 
  • In the Mile Square area of Chicago--a few miles from here-- the community is served 24 hours a day by 15 full and part time doctors. A year ago, they had no doctors.
  • On the Lower East Side of New York, 200,000 visits have been made to the 0E0 health clinic. Two years ago, the people had no health care.


In 1964, only two American medical schools--Tufts and USC--were working on new programs to bring health care to the poor. Today, over half of our medical schools are either working with us in our health services program, or are planning to develop one of their own.

In Atlanta, the Emory University School of Medicine is developing a neighborhood health center in the Price District. The Fulton County Medical Society has accepted the overall responsibility for planning for the health needs of the 250,000 poor people of that city. Emory's program will meet only the needs of 30,000 of those 1/4 million.

In King City, California, the Monterey County Medical Society is running an OEO neighborhood health center which is bringing health care to more than 1200 poor families--many of them migrant workers.

In San Francisco, the medical and dental societies took the initiative in developing a community corporation. It will be operating a neighborhood health center in the Mission District for 20,000 poor.

But I'm not here just to recount our victories. In the overall picture, we've only started. The situation is still critical.

That's why we need not just some doctors and some medical societies to get involved with the poor--but all doctors and all medical societies. Because poverty is all over America.

That's the reason I'm here today. To thank you for what you've done--and to ask help for what you can do.

I urge the American Medical Association to ask every one of its medical societies to get in touch with the more than 1000 Community Action Agencies throughout America. By doing this, they will be carrying on the initiative of what scores of medical societies have already done.

In this way, all the health programs of the War on Poverty will be developed with your help--with the benefit of your experience and training. We need you, not only in our comprehensive health services program--but in Head start, Job Corps, the Neighborhood Youth Corps.

The reason OEO is in the business of delivering health services is because health is basic to everything. Health is one of the surest guarantees of "life, liberty and the pursuit of happiness."

But for too long, the poor have looked around and asked: "Where is this life we are guaranteed?"

They haven't seen it. Instead of being guaranteed life, the poor often get a guarantee of death. Not a quick, violent murder. But a slow death that whittles away life.

Thanks to thousands of doctors across America, we are changing that.

Disraeli said 100 years ago:

"The health of the people is really the foundation upon which all their happiness and all their powers as a state depend."

That society can be ours--if we want it. The health centers being developed around the country are the answers you are giving. They witness to your commitment to life. A life where good health is not a lucky privilege for a few. But a basic right for all.