What must be done; Health

Hello my name is Percy Sutton. I'm the president of the bar of Manhattan in the city of New York. For the next 30 minutes I'll be moderating a different kind of radio program. It is one of a series called What must be done. The title of these programs what must be done has two meanings. First it poses a demand for solutions to America's biggest problem the crisis of the urban ghetto and the black community. But it also refers to what can be done and what must be done by you the listener because nothing stimulates back as effectively as the demand of an Arabist population. This series of programs takes as its point of departure they award winning that you love Newsweek magazine published last November the 20th on the Negro in America. Today's topic is health. The members of our panel are Dr. John Holman former president of the missional Medical Association Dr. James Hawke Frodo's deputy administrator of the New York City Health Services Administration. Dr. Alvin Poussaint says.

Professor of Psychiatry at Tufts University Medical School Boston and Mr. Matthew Clark medical editor of Newsweek magazine. Now I should turn the microphone over to Newsweek's medical editor Mr. Mathew Clark who will lead today's discussion. Thank you Mr. Sutton. The health problems of the American Negro are many in a nation where Heart transplants are now almost routinely performed infant mortality among Negroes is nearly twice what it is for whites and the life expectancy of the negro male 61 pulled out of the white man is 68. The negro is also victimized by malnutrition tuberculosis and dozens of other disorders that have nearly ceased to exist for the white man and the toll that mental illness brings to the negro because of his deprived environment and many complex social factors is incalculable. Moreover the dismal health picture for the Negro is made more complex by the fact

it's the services available in the cities and in rural areas maybe of high technical quality but they're scattered fragmented and inaccessible to large numbers of people who need them. A mother who simply wants to get a routine physical examination for her child may have to spend the whole day transferring from bus to bus to reach a well-baby clinic. Obviously this is not in the best interests of preventive medicine. There is also a less well publicized problem in the question of Negro health and that's the plight of the Negro doctor. Well negroes constitute nearly 12 percent of the U.S. population. Only a little more than 2 percent of the nation's physicians are negroes. Also doctors in many states particularly in the south are barred from medical societies if they're negroes. This means that they don't have the opportunities that other doctors have for

continuing education. And they cannot get on the staffs of major hospitals in those states. What I've outlined is only a thumbnail sketch of the many issues involved in improving the health care of the American Negro. And now I'd like to ask some of our panelists to begin discussing these issues. I would like to ask Dr. Poussaint to particularly address imps of two the social factors involved in mental illness in the ghetto. I hate that we have to us the mental health earthly thing combination. Many types of problems and particularly for poor people a lot of the mental health and happiness of contentment asked through the social factors. For instance we can start with enough to eat. If children are starving or malnourished and are going to have good mental health people don't have enough jobs.

If a man can't adjust whereby he feels a sense of self esteem and fortunes in the household this is going to lead to not only crowned with himself but also found within them they grow family. He can't be a a husband and a father without a job we have to constantly keep in mind these other social problems when we think in terms of mental health. But even with it the mental health services available the black communities and poor whites and poor blacks have least of this service because it's mostly been designed for this function for middle class white Americans who can't afford it. I would like to generalize somewhat on what Dr. Oz. It was pointed out the good likelihood these same social factors have tremendous impact on physical structure all these things are interrelated health services must go along with good education so the adults can get jobs and so the

figure can eat properly and live in proper housing we have children in our hospital every winter with pneumonia simply because they live in a heated homes and having a good house to the day care less of a problem as long as their fathers don't earn enough to move into homes where there is heat so that all of these problems are interrelated and we talk about the health status of the community. These social factors don't only cause problems in the mental health field but they cause precisely the same kind of concern where all health factors are mental as well as physical health. Perhaps we should also make clear that to a great extent mental health problems are the direct result of physical health problems Dr. Holland would you like to say something. And yes I think it's particularly important to recognize this. I think Dr. Poussaint mentioned Dr. one mentioned that hunger and malnutrition are very real factor involved. None of the problems

started let me know that if a child is improperly sure that he has lessened chance to learn. We know that if a pregnant mother is malnourished that she may give birth to a premature infant who may subsequently be mentally retarded. Of course this is carried on to the ghetto school system so that we do have an individual who even before he's born. Is condemned to a bad mental situation. I think it's important to recognize this. Would you also Dr. Paul White to discuss for a moment to question the training of Negro physicians. Yeah. Why aren't there more Negro physicians and this is a very important problem. Of the more than three hundred eight thousand physicians in this country only approximately five thousand eight hundred

of them are far negro. This has been traditionally the case if every indeed every black man received an M.D. since eighteen hundred sixty five was still alive. We still do not have enough black relations to achieve the physician patient ratio that's been achieved by the country as a whole. There are many barriers both real in artificial that have been. Place to keep the black physician out of medicine. Medicine is basically a white Anglo-Saxon middle class profession. Eighty percent of all doctors are white angel Saxon Protestant. I think that the quota system in medicine and medicine is a prejudiced profession has been imposed both on Negroes. It's been imposed on Jews. It may be lessening now. But it certainly has been a factor. And in a town like New York City for instance

there are at least four medical schools in there so that have not one single Made groups do it. It's interesting to note that in the state of Texas recently liberated there are more black medical students in school than the armed city of New York. This is true in practically all of the medical schools in the country. The black students are not there so that in fact we are not even replacing the negroes that are dying. The total number of black physicians in a city like Chicago is numerically less than it was for instance ten years ago. The problem is very real. The deans of the medical schools will now say will send me all the qualified students that you can fire off black students and will admit that this is a trick bag don't get into it because of drop the standards whereby

the doctors I've chosen are no longer relevant. They are not to be used any longer and I think I think that the sooner we can change this the better off we will all be. Because any average student who can read and retain us on Earth powers comprehend. You can become a doctor. There is no magic and there's no medical mystique that makes the doctor the. Highly placed individual it has been in the past is just an ordinary person. I think that blacks should aspire to become doctors and I think that the artificial barriers that have been place should be removed and the sooner the better. We don't have 30 years to wait to train a physician from the cradle so that he can become a middle class individual. We needed all points all along the line pressure now to changes to reverse this very dangerous trend because it not only has to do with quality. It has to do with the ambitions of a

whole community. We claim that we have high standards. So far suspicions are concerned and yet we don't produce enough right physicians to maintain our own health establishment. We annually import 2000 approximately foreign trained Indies just to supplement our own establishment. And this is wrong I have nothing against foreign Hindis but a country such as we have here in America should be exporting doctors not importing them. We cannot afford to be the ugly American draining the brain from all over the world just to support our own starvation. We have the wherewithal we have the know how and we should get busy doing training black physicians and training enough physicians to do a job that is meaningful. I gather that there's more to it than just a coup. The system on the part of the medical schools it's also a question of broadening educational opportunities for Negroes below the Med. well below the medical school level and also perhaps a want of financial assistance I note that

even for white persons who aspire to become doctors there is very limited scholarship it available. This statistical service this is an important barrier. This is one of the reasons that medical schools in my opinion have done such a lousy job. I think they have been particularly poor they claim to have trained some outstanding physicians gess they are now transplanting hearts they trained Barnard you know and then go back to South Africa the transplant heart. But they haven't done a job so far as the needs of the black community concerned and so far as the needs of the poor are concerned they say that good health care has a right but we are very hypocritical about it because we don't really mean it. We mean that those who can afford to purchase should healthcare have it as a right. There's nothing to stop a very wealthy or affluent people from purchasing the entire services of a physician and have. Having him as a private physician. In fact it's done for enough wealthy people get together they could conceivably purchase all of the available medical

services they could buy up to 300 in a thousand doctors and leave the 200 million people in our country without any health services at all. I'm saying that we've got to change our system in some way so that we can effectively distribute our health talent and that we can improve it so that we can support our system in some more equitable way so that healthcare can become. The right that it's supposed to be for all. One point it sure is leads us logically to a discussion of health care in the community in their rural community and in the ghetto and term. Says the distribution of doctors and the availability of clinical care and I wonder if Dr. Hoyt would like to begin discussion of that. We are never going to deal with the health care he's at the port except within the framework of adequate health care for all things because whatever we have to try to deal with separate services at

a time. And incidentally when you first wire services for the poor you're said again to this is a segregated disco during our service and it usually ends up being a poor service if we are going to have health care as an equal right in the services that are provided to all citizens both rich and poor should in fact be equal and should be commended without real concern for the ability to pay this I think is awfully important because as long as we have this economic factors long as doctors are able to profit by the illness people are going to be in trouble as long as we have physicians trying to corral the largest numbers of sick people just so they can make the largest amount of money and we're going to have a disservice being rented out people we're not going to be getting the best. For our health care dollar we spend as a country said nearly three times as much per person annually as any other

country in the world. And yet asah to Stix don't reflect any good health care management. We are about something like a 15 to 19 depending on whose estimate shooting in infant mortality compared with the other countries in the world and yet we are spending three times as much per person this is not right when you look at our projections of man army for the next decade. They're all based on our president is a Chavez now it seems anyway i'll ourselves the luxury of a confusion of objectors is are get this narrative saying more professionals. Is our objective to improve the quality of health care. If it isn't because you care obviously we can't achieve that result by framework knockers tactics. Even after college at age 18 he hears. So they blew that up area least 10 years away. Thirteen pieces of this new ways of training the rational for the future but also for the immediate present new

ways of using those you know so that you make it possible for them to do more than they're doing now. If I own this system I think it's outrageous that we have clinics with a hundred different specialty clinics. This means that people are being taken care of by four or five different doctors but find one good doctor to cure all their ills till we get those numbers game about the number of hundreds of thousands of visits that we deliver what you need to you or do you want your food to divide that figure by like 3 or 4 would contribute to your home and buy the one one for one relationship being. What should be places I think that group practice is particularly important and I think that in order to involve the total environmental factors that contribute to a person's state of health. One physician can't do it alone. I think that

rather than having a one to one relationship that you should have a group for one situation or group for group situations a group practices which families whole families total families were taken care of rather than an individual seeking to individual establish a relationship with a physician which he calls his own solo practitioners will call. I think that in a group it should be so altered. Is it any problem that arises that a rule is that a man could be taken care of and preferably at the local level at the neighborhood level. So that if there was a necessity for a heart transplant that this would not be a decision for any person who was interested in doing heart transplants but would be a decision from a lower level from the physician who sees it and this person would move up in an orderly fashion through the normal channels or through accounts out on normal regional What have you. But there should be some overall health planning rather than letting the middle class person look in the

book and flip to the specialists they want to see if you think she's got a surgical problem you report to a surgeon. This is what he's doing. He wants him on base as he happens to know a doctor who's honest enough to send him. But if you walk into a doctor's office the doctor is going to take him for as much as he can first and then send him to a friend who's also going to shake him for as much as he can and he may eventually get to where he should go but I think that an overall national health plan is important and I think that the local love of community health plans are needed so that any individual in the community should know where he can go 24 hours a day for some assistance be a routine on emergency law you know the system or even the individual physician is going to view disease organs. There's a book by Groff university or so your book. Is. Just some of the things you. Talk about. Rightly points he gives

interesting example of what he thinks is wrong with medical education medical care and he says if you ask a child what a doctor is the child is likely to say a doctor is somebody who takes care of the person of the people well if you ask the doctor what his job is the Doctors like to say my job is to diagnose and treat disease. This is the whole room Taisha not only of our medical education system but of our lives system was we already are oriented that way. We're never going to be able to pay the bill because we're going to continue to provide updates that happen that could very easily end up into more economically productive. There's no reason why anyone in this country. DON VOELTE working on a long protracted of this because the cancer service we not detected very early enough to know how to deal with it and yet when they're dying of cancer. I can back them up by

that example of things that are very easy to prevent if he only had a system oriented towards health promotion rather than the worst cheating individuals work you know. I would like to remind our listening audience don't talk about health care though we're talking about a lot of types of professionals not just medical doctors or medical students but also nurses lab technicians social workers nurses aides clerks in the hospital and so on all these people in the health care service area and it's very important to consider them when talking about manpower needs of delivery of services. I think the Neighborhood Health Center. Where I work represents departure from the traditional ways of medicine. This set is located in a community itself a community of people to work at the clinic and actually take a part in making decisions about

what should be done in a community where the focus should be on how they help to run some of the health campaigns and health education programs that we have. We feel that in a community that dissipates although there is some initial difficulties the health care services work a bit better because people when they participate in a program I'm more concerned about it if they can affect the policy of the program that even helps a bit more because and they get what they want but we still have the problem even with committed professionals people who are interested in this area of getting people with the proper types of attitudes that it's still very hard for professional people to work jointly and seek a community people particularly poor people as to to support to listen to sometimes community people. To interview the doctor

and this is very uncomfortable for most health professionals have been trained in the tradition of the all wise doctor who knows everything. And that. This type of exposure is very frightening and I think it has something to do with why it's so hard to recruit physicians to work in these areas as well as the financial factors. So it's important that we begin to introduce into all about hell schools medical schools nursing schools right from the beginning the concept of community caring community medicine and give the students the types of experiences that will train them to to work effectively in this area because I think community medicine for both the poor and for the middle class will probably come really the type of medicine the backbone of the type of medical care that the country needs and requires. We're going to would you like to address and so also the question of the

leadership of. Organizations to deliver health care in the community should be strictly professional who are heavily. Interspersed with the lady from the community. Well I mean I think that. There are at least three elements that must be satisfied when we. Talk about delivering health care in the community I think the element that's been missing in the past has been the element of community participation. Oh you mean an advisory capacity to the community as the writer suggests that something be discussed but rather the community represented as a community. Hello and important voices of policies that direct the delivery of services. Why did we have to keep fire also the professionals who work in these programs. Most also because. We're. Trying to

point it out for maybe financial people who are getting services. The doctors like it and the nurses and the people who have to do a little service. Why what's happening you're not likely to be able to recruit. This goes back to the statement concerning attitudes of the professionals. We must train our professionals to recognize that the community representatives the consumers of the service do have an interest in how services are deliver and can make a contribution to the organization of services. We also have to be to recognize that in some situations government has a voice because much of the funding of healthcare comes from government and government has a responsibility in several ways wanting to be assured that the funds are being sent appropriately. As government must be responsible and accountable to the public to the fact there government should also provide leadership in upgrading the standards of health care

government in administering health funds should say these are the standards that are to be met and the delivery of health care so that it seems to me that the contents of these key elements the community the professional working in the program. The concern for equality and for the proper expenditure of funds can make the joint contribution to the development of health services which would result in better services than either of the three alone could create. Dr. Harvey what would be the best thing for the individual listener to do if he wanted to. Bring about a better community health care in his neighborhood before in his area. Well I think one thing he should do is to get them actively participate in the planning of these health services in areas of the country where the official agency as already indicated its desire to work with the

major stations he should then participate and not wait to be coerced into it. Secondly he shows how his agency a city agency in the in the political battles that are required to obtain funds for programs here in our city give you an example. Recently we had hearings for the budget and one of the items in the budget to be discussed by was a cowslip board of estimate. It was down by a whole series of ministration by just over a hundred and sixty persons registered to speak at one day of those hearings and we found Livy checked that they are under 60 persons who are registered to speak on the budget. All of 19 registered to speak on this Board of Education's budget. None of the remaining 19 registered to speak on the house. But now when that happens we go to the city council or the US

and let them fight trying to fight for additional funds in order to establish good health programs. They can say to us what are you worried about the community was down here and they spoke about everything except Al Franken were doing enough for them. We better get more money. That would be Haitian but that's where the pressure was so the community was going to have here is going to be a very to help fight. Pleasure to see would you like to pay it something about what the individual can do. Oh I think that anything that a person can do to help alleviate some of these social processes that I discussed earlier rebirth for jobs housing all of the pressures and ugliness of ghetto types of conditions both for poor whites and poor blacks I think that this would be doing so much for mental health that is this subtlety so we don't really have to deal with it. But in addition so poor you know mental health programs and give priority to healthcare both mental health care and physical health care and all

community projects and government expenditure. Dr. Hall when the rich and the poor and the middle class realize that the doctor is not him deity and he's not god but he's just a technician and he wants to be in like Houston America come he says. My job is to train good doctors aren't them the doctors a good technician and let him be responsible that community. And if he doesn't the response to that can do then he's in trouble. He has got to you know serve society's needs and when he fails he's going to be replaced by somebody who can serve society and he is the FA system is working again society society has a job to change that system to change the health profession as we know it. I'd certainly like to echo that which has already been said and taken one step farther. I think that as individuals and as members of a community we can no longer accept no for an answer. We can no longer extent accept status quo

but we must demand meaningful change not in the utopian future but now and now means today. I think that we should get after the delivery of health care not doing a job for the best interests of the Commune. Statistic that's changing now. Well I think that this is a very effective note on which to end their discussion so that we can know as to a concluding word from Mr. So ladies and gentlemen this concludes today's edition of WHAT MUST BE DONE. Our panelists were Dr. Johns Holman former president of the National Medical Association Dr. James Hawke first deputy administrator of the New York City Health Services Administration and Dr. Alvin Poussaint assistant professor of psychiatry at Tufts University Medical School of Boston. Today's discussion was led by Matthew Clark medical editor of Newsweek. Please listen for the next program in this series when we will cover another aspect of America's urban

crisis and what must be done to stop it. What must be done was created and produced by Sam case by Debbie ally B Radio in New York with the cooperation of Newsweek magazine. I am Percy Sutton saying thank you for our panel this program was distributed by the national educational radio network.