If you haven’t done so yet, take a moment for yourself and read the special article penned by H. Jack Geiger, MD in the American Journal of Public Health, “The First Community Health Center in Mississippi: Community Health Centers Empowering Themselves.” One of the founders of the Community Health Center Movement, Dr. Geiger walks us back to rural Mississippi in 1965, when a Community Health Center was envisioned and proposed as a way to “intervene in the cycle of extreme poverty, ill health, unemployment and illiteracy.” To help readers fully appreciate the noble and enormous task of such a proposition, Geiger vividly describes the living conditions of residents living in Bolivar County, Mississippi during that time:
“Black people in poverty, particularly the isolated, rural Black ex-sharecroppers and ex-plantation workers who constituted the vast and silent majority of the Black community, lived an unceasing and often losing, struggle against disaster. They were hungry; there was no food. They were unemployed; their skills had been made obsolete by the mechanical cotton picker, the herbicide-spraying crop duster, and the ironies of the cotton and other national crop-subsidy acreage restriction policies. The median family income was $900. They lived in crumbling, patchwork shacks with leaky roofs, rotting floors, buckling walls, gaping windows, newspapers for insulation, and crude stoves for heating and cooking– when there was firewood. Many drank contaminated water from drainage ditches and used dilapidated surface privies for sanitation Infants under such circumstances often ingested their own excrement; children lacked the shoes to walk to school, the clothes to wear to school, or given these, the food to sustain learning…”
Dr. Geiger recounts how until the 1960s Americans had not looked to community health services as a means to address population health problems and implement social change in access to food, housing, clothing, water, sanitation, education and economic opportunity. Everyone understood that intervention was needed to fight poverty, but starting a program, and a host of community-based organizations that would address these social ills over the long term was daunting. Yet, it was done.
Community organization at the then-called Tufts-Delta Health Center began in 1966, followed by training that took place in an abandoned movie theater. Clinical health services were launched a year later in a church parsonage. Not long after, 10 local community health associations linked with the health center began to flourish, run by the people, for the people. Soon there was modern health center facility employing more than 200 people from the surrounding area. The North Bolivar Farm Cooperative (related to the health center but independent of it, Geiger explains), produced vegetables to be distributed to worker members. Dr. Geiger explains:
“These institutions served the community, and they were staffed by the community: every Black household in the poverty population in all of northern Bolivar County had at least one (and often more than one) adult member actively participating in decision-making, program-planning and program operation through a local health association… Together with Medicare, Medicaid, food stamps and other programs, the health center’s work improved the health status of its roughly 12,000 Black residents of North Bolivar County. Incidences of fetal losses, infant mortality rates, infectious disease and chronic illnesses such as heart disease, hypertension and diabetes all went down.”
It’s hard to imagine what health care would look like today were it not for the daring experiment undertaken by Dr. Geiger and fellow community organizer John Hatch, and many other dedicated foot soldiers. Today, the health center movement is made up of more than 1,300 health centers, serving 25 million Americans, a phenomenal trajectory. Yet, don’t be fooled into thinking this is an outsized health care program that has moved away from community The heartbeat of such growth has come about because it is in fact driven by community, or as Geiger himself notes, “There is no other part of the American health care system in which patients themselves have such a powerful voice.”