A Message for Public Health From Jack Geiger

As the saying goes, when public health does its job, it’s invisible. Even with a high-profile crisis like Ebola, there is little understanding of the field. The Frank A. Calderone Prize in Public Health, administered by the Mailman School of Public Health since 1992, was created to counteract this phenomenon and raise the field’s profile by celebrating an individual who embodies its extraordinary possibilities.

Left to right: Francesca Calderone, Linda P. Fried, Jack Geiger

The 2014 Calderone Prize winner, Jack Geiger, is one of the originators of community health center model in the United States. Today community health centers serve 23 million patients at 9,000 sites across the country, all based on a model Geiger brought to live in the 1960s in rural Mississippi to give care to those who otherwise would not have access.

In the Calderone Prize Lecture, Geiger recalled the radical methods he pioneered and enjoined public health to rediscover its activist nature. Because of a sight impairment, Geiger, who is in his late 80s, delivered his remarks from an outline placed on the lectern but their spirit seemed to emanate from within. He told the audience that he hoped to demonstrate that “one can lose most of one’s eyesight and still maintain a vision of a decent, humane society and a public health contribution to that.”

The Mississippi Delta Health Center, created in the wake of the Civil Rights struggle, served the African-American population of North Bolivar County, then the second-poorest county in the U.S. where unemployment was 80 percent, living conditions abysmal, and malnourishment commonplace. Following a philosophy that “health involved more than healthcare,” Geiger and colleagues dug wells and sanitary privies, repaired houses, and taught others to do the same. They created a bus transportation system and wrote prescriptions for food that could be fulfilled using food grown on a cooperative farm.

On one occasion, a state official challenged Geiger on practice of charging food to the pharmacy, arguing a pharmacy is meant for drugs to treat disease. He recalled telling the official: “The last time I looked in my textbook, the specific therapy for malnutrition is food.” Sure enough, the method was successful. “We effectively ended malnutrition in North Bolivar County.” 

Public health has a long history of engaging with social issues going as far back as child labor laws in the early part of the 20th century. But in recent years, Geiger observed, the field has become more insular. While valuable work has been done on the social and environmental determinants of poverty, “too much of that has constituted talking to ourselves rather than talking to the public.”   

“Public health is intrinsically political and will become more political in the decade or so to come,” Geiger arugued, because the United States is becoming a “minority majority” country; white people will soon make up less than half of the population, something he said has caused anguish among some conservatives and is intensifying debate over social, economic, and health policy, particularly collective responsibility for poverty and the health of the poor.

He called on public health to take part in this debate, pointing out that poverty condemns children to a sick life and early death. “We have to talk to the public, give legislative testimony at every level, flood the blogosphere, write letters to the editor, raise our voices” on the radio and in op-eds.

Geiger’s message, true to the intentions of the Calderone Prize, was clear: public health must emerge from the shadows and make its voice heard.

Watch video of the award ceremony:

https://livestream.com/accounts/7100374/events/3467825/videos/66362980/p...

Watch a documentary on the Mississippi Delta Health Center:

Out in the Rural from Prabhjot Singh on Vimeo.