Medicine: Treating the Poor

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FOR one-fifth of the U.S. population, the risk of dying before age 35 is four times the U.S. average. In this group, adults have four times as much disabling heart disease, ten times as much visual impairment, six times as much mental illness, mental retardation and nervous disorder. This one-fifth constitutes the nation's poor—40 million Americans, by the Government's admittedly rough estimates.

Despite good intentions and the Great Society, the health gap is growing. In 1940, the infant-mortality rate for nonwhites was 70% greater than for whites; now it is almost 100% greater—38.8 v. 20.6 per 1,000 live births. In some ghettos, infant-mortality rates exceed 100 per 1,000 live births—approaching the level of a Biblical plague. In Mississippi, the Negro maternal death rate is five times that of whites; 74% of these are, in medical opinion, preventable.

First-Hand Study. To correct this imbalance, a band of determined medical men, supported by funds from the Office of Economic Opportunity, has launched a counterattack on medical poverty in several severely depressed areas. The OEO has allocated $94 million to finance 51 neighborhood health centers, of which 33 are already operating and 18 are being organized. Unless it is caught in a budget squeeze, the OEO will start ten more centers early next year.

The idea for this program originated with Dr. H. Jack Geiger, 43, a onetime medicine reporter for the International News Service who decided that he could do more for his fellow men by becoming a doctor than by writing about doctors. While studying medicine at Western Reserve University in the mid-1950s, he read about medical centers for the poor that had long existed in Europe. Later he studied what he calls "social medicine" (the concept of illness as an environmental as well as a medical problem) at South Africa's only medical school primarily for blacks, at the University of Natal in Durban. In 1964, Geiger traveled to Mississippi for the Medical Committee for Human Rights, and with Dr. Count Gibson Jr., a Georgia-born internist, set up a small health center that lasted only a year.

As the two returned to Boston, Gibson suggested that Tufts University, with an expanding program of social medicine, might sponsor a health-center program. Within four weeks, the hyperkinetic Geiger had Tufts' approval and an associate professorship, then obtained funds from the OEO. Says Geiger: "We have known for a long time about the relationships between poverty and health without fully facing up to them. The poor are likelier to be sick. The sick are likelier to be poor. Without intervention, the poor get sicker and the sick get poorer."