Looking for Some Summer Reading? Try This ‘Feel-Good’ Non-Fiction

In today’s busy world, we rarely make time to reflect on the past and read for pure pleasure — the only exceptions being the end of the calendar year and summer vacation. Several months ago, I set aside an uplifting article that I would highly recommend reading on a lazy afternoon: “The Good Doctor — Jack Geiger, Social Justice, and U.S. Health Policy.”

H. Jack Geiger, MD, died on December 28 last year. Along with so many others who were lucky enough to know him, I will never forget him. But as authors Rosenbaum and Hawkins observed, “Far more important, especially at this moment in the national discourse, is the indelible imprint he left on health equity and social justice as paramount elements of a national health policy.”

The “imprint” that survives and continues to thrive is the community health centers (CHCs) program that was launched by Geiger and 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 merely a reactive response to illness but rather an entry point into good health.

The impetus behind the program in 1975 and for decades thereafter was the late Sen. Edward Kennedy (D-Mass.). CHCs were codified into the Public Health Act for many years and finally accorded permanent legal status under the 2010 Affordable Care Act. Given the turmoil in the U.S. health care system, the endurance of 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 economically challenged urban and rural communities.

Geiger and his colleagues didn’t just demonstrate the value of publicly supported clinics in these underserved communities. They proved that clinical care “grounded in clear, enforceable principles of health equity and social justice” is both feasible and effective.

Today’s CHCs operate at the intersection of healthcare and civil rights. The original principles are very much alive, and the conditions under which government funding is determined can be distilled into three basic rules:

• Community-wide duty of care. Whereas physicians in the U.S. remain free to determine where they will practice, whom they will serve, whether they will treat patients who are unable to pay, and what types of health insurance they will accept, CHCs have an enforceable legal duty to serve all residents of their designated service areas or target population (e.g., farm workers, homeless individuals). They not only accept patients, but actively seek to identify individuals who need care.
• Broad scope of care. Primary care must be provided to all patients from pregnancy and birth through old age, from basic services to complex condition treatment and condition management. Beyond clinical care, CHCs include services that support access and address underlying drivers of community health.
• Community empowerment. Perhaps the most striking characteristic of CHCs is that, by law, they must be governed by boards, 51% of whose members are registered patients of the clinic. These boards set policies, hire and fire executive leadership, and set strategic goals.

Weary of the steady drumbeat of “bad news,” this article left me feeling more optimistic that well-implemented good ideas can and do have staying power. It also prompted a wave of nostalgia.

It was the summer of 1976 — just before entering my senior year at Vassar College. I drove from Poughkeepsie, New York to visit what is now called the Renaissance School of Medicine at Stony Brook on eastern Long Island, New York for an opportunity to meet with Geiger. To this day, I consider him one of my most important “influencers.” What I didn’t even begin to comprehend at that time was that the man I admired would become a true icon.

For more on physician activism, I can recommend another good read: “Virchow at 200 and Lown at 100: Physicians as Activists.” This informative and engaging article reminds us that, from Dante Alighieri (an apothecary by trade) who died 700 years ago to the current U.S. Surgeon General Vivek Murthy, MD, forward-thinking clinicians have pushed traditional boundaries of medicine for the good of all.