Journal of Health Care for the Poor and Underserved: 25 Years of Service

There was a continuing disparity in the burden of death and illness experienced by Black and other minority Americans, as compared with our nation as a whole. That disparity has existed ever since accurate Federal recordkeeping began more than a generation ago, and although our health charts do itemize steady gains in the health of minority Americans, the stubborn disparity remains … an affront to both our ideals and to the ongoing genius of American medicine.¹

The preceding paragraph, by then-Secretary of the U.S. Department of Health and Human Services Margaret Heckler, appears in the Introduction to the 1985 Report of the Secretary’s Task Force on Black and Minority Health. Concerns about the health of underserved populations began long before 1985, however.^2,3,4 The Task Force Report was the first time that the federal government acknowledged that disease, dysfunction, disability, and premature death could be chronicled by race and ethnicity, which was an important precursor to addressing the longstanding problem of health disparities.^1,5

Five years later, the first issue of the Journal of Health Care for the Poor and Under-served (JHCPU) was published. That first issue was a bound, peer-reviewed collection of articles based on presentations from the Second National Conference on Health Care for the Poor and Underserved held at Meharry Medical College (MMC). In 1988, the state of Tennessee funded Meharry’s Institute on Health Care for the Poor and Underserved to sponsor annual conferences, publish a quarterly journal, and operate an information clearinghouse. The support from the State for the three components of Meharry’s Institute encouraged a cross-fertilization of data, news, ideas, and viewpoints related to improving health and health care policy for underserved populations. The work of the Institute was grounded in the history of Meharry Medical College and supported by past and current research, education, and community engagement activities at the College.^6,7

From its inception, Meharry’s mission focused on the health of African Americans and low-income populations.^8,9,10 Included in the initial volume was a text version of the keynote address by Louis Sullivan, MD, who at that time was the U.S. Secretary of Health and Human Services. David Satcher, MD, PhD, then-President of Meharry Medical College, who envisioned the need for a journal at Meharry, in the premier volume wrote, “This [journal] creates a record of the inauguration of Meharry’s Institute on Health Care for the Poor and Underserved, an institute … concerned with information gathering, policy development, research, and training, all directed to a very needy target population, the medically underserved.”¹¹ For 25 years, JHCPU has published peer-reviewed articles focused on health improvements for underserved populations and shared broadly with readers throughout the U.S. and abroad.

This article reviews 25 years since the inception of JHCPU, highlights and parallels the evolution of the journal and improvements (or lack thereof) in the health and health care of underserved populations. Some of the most striking statistics chronicling health disparities suffered by African Americans are stated in terms of excess deaths. Excess deaths are additional, presumably preventable and unnecessary, deaths relative to some mortality rate deemed ordinary or expected—in this case, the number of deaths of African Americans beyond what one would expect if their death rates were the same as those for the non-Hispanic White population.¹ In the 1985 Task Force Report, there were 60,000 excess deaths among African Americans. The excess deaths from six causes were calculated: cardiovascular diseases and stroke, cancer, cirrhosis, diabetes, homicide and unintentional injury, and infant mortality. These six causes accounted for 80% of the excess deaths. In 1992, excess deaths among African Americans due to HIV/AIDS was calculated.¹² In 2005, Satcher et al. published a follow-up article to the 1985 Task Force Report, using a similar methodology, documenting that the 60,000 excess deaths reported had risen to 83,000.¹³

From its inception until 1995, JHCPU was produced in...