The Federal Initiative: A New Look at Our Health Policy for the Poor and Underserved

Keynote address THE FEDERAL INITIATIVE: A NEW LOOK AT OUR HEALTH POLICY FOR THE POOR AND UNDERSERVED LOUIS W. SULLIVAN, M.D. U.S. Secretary of Health and Human Services It is great το be here on the campus of such an important institution for the nation, one that has contributed so much to our health care system during its 114-year history. I was the President of the Morehouse School of Medicine, a sister institution to Meharry, until recently, and I got to thinking on the way here about the histories of the Morehouse School of Medicine, and of Meharry Medical College. Regardless of any historic differences, one overriding commonality stands out: a major mission of both institutions is to serve the medically underserved. Historical background In 1975, when I left my position as professor of medicine at Boston University School of Medicine to develop the medical education program at Morehouse, Meharry Medical College was planning the first stages of celebrating its Centennial—and the country, its Bicentennial. Meharry got its start at a time when the practice of medicine in the United States was riddled with quackery, and the medical profession was just getting organized. Furthermore, Meharry's time-honored traditions were reinforced, in large part, in Abraham HeXnei^s classic study, "Medical Education in the United States and Canada," which was published in 1910 (the same year that Hubbard Hospital opened its first unit).1 Flexner's report on his examination of the 148 medical schools in the U.S. and Canada had such a major impact that by 1925, the number of medical schools in this country had decreased to 80. Flexner's support of Meharry's medical education program undoubtedly contributed to the institution's survival , in contrast to some 70 other medical schools which passed from the scene. The Morehouse School of Medicine grew out a vastly different report Journal of Health Care for the Poor and Underserved,Λrol. 1, No. 1, Summer 1990 4 The Federal Initiative —that of the Task Force for Physician Manpower of the Georgia Comprehensive Health Planning Council. In 1969, the Task Force, in noting that 27 percent of the citizens of Georgia were black, and that only 3 percent of the state's physicians were black, recommended efforts to increase the number of black physicians in Georgia. Furthermore, the early 1970s were a time when many observers nationwide had predicted a physician shortage, suggesting that more medical education facilities were needed. As a result, federal, state, and private initiatives were undertaken to develop new medical schools and to expand the class sizes of existing medical schools. For me, the opportunity to found the Morehouse medical education program was a chance to develop a medical school that would concentrate its energies on the education and training of those minorities who so often had been overlooked. The Morehouse School of Medicine would produce physicians with a special commitment to working in medically underserved areas and inner cities, among the poor and our minority communities. Like Meharry Medical College, it is now a school where young men and women are trained in the new biology and tomorrow's medicine, with concern and compassion. This is the idealism that Morehouse and Meharry share, despite the vastly different circumstances and periods during which each institution came in being. That is why I am delighted to participate in Meharry's 114th Convocation , and in the Second National Conference on Health Care for the Poor and Underserved. HHS initiatives The United States is in a period of great tension in medicine. As a nation we rank number one in per-capita expenditures on health care. Those expenditures consume more than eleven percent of our Gross National Product and continue to rise at an unsustainable rate. Despite this, we still lag behind other industrialized countries in some basic indicators of health status, such as infant mortality and life expectancy. Certain segments of our population lag unconscionably behind in health status and access to health care—blacks, Hispanics, Native Americans, rural and some inner-city residents. Issues confronting medicine and medical education are inseparable from the social and economic fabric of our society. If the medical profession is...