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PAST PRESIDENTS SPECIAL SESSION ~ NOVEMBER 10, 1997

The Past-Presidents listed here as “Special Session ~ November 10, 1997” were present at the 1997 session called: AN EVENING WITH APHA PAST PRESIDENTS AND EXECUTIVE DIRECTORS which was held on November 10, 1997 at the 125th Annual Meeting of the American Public Health Association which was held in Indianapolis, Indiana. What you will read is what they shared at this meeting. It was moderated by Barry S. Levy, M.D., M.P.H., APHA President, 1997 and Carol Easley Allen, Ph.D., R.N., APHA Executive Board Chairperson, 1997.

Here is their introduction to the event
With this being the 125th Annual Meeting of the American Public Health Association, we scheduled this special session tonight and invited all living Past Presidents and Executive Directors of APHA to participate. Our topics this evening are supporting health promotion and prevention, improving access to health care, promoting social justice at home and abroad, and supporting the public health infrastructure.

Here is their conclusion
Dr. Carol Easley Allen
I want to thank all our presenters this evening. I hope that APHA will develop an oral history based on these Presidents and Executive Directors.

Dr. Barry Levy
I too want to thank all the APHA Presidents and Executive Directors who participated in this session. I think it is incumbent on all of us in the current and future leadership to tap into our past leadership for their tremendous expertise and experience in order to provide guidance to APHA as we move forward.

Myron E. Wegman, M.D., M.P.H, APHA President, 1972
Supporting Health Promotion and Prevention

Health promotion is much more ancient than some of us realize. When I left my medical school faculty position to go to work at the Pan American Health Organization and the World Health Organization, I was given by a colleague Galen’s Textbook of Preventive Medicine and Hygiene, which was published in 200 A.D. This remarkable book includes many kinds of associations working in health promotion. Specifically, he did a great job of writing about care of children, such as what could be done for 7- to 14-year-olds – much of it still true today.

In 1972, APHA resolved that we were going to start our second 100 years by combining science and activism – by providing a scientific basis for everything for which APHA stood. Today, however, we lack a sufficient scientific basis for our recommendations on health promotion and disease prevention. We are better on disease prevention – certainly on vaccination – than we are on advice on diet, behavior, exercise, and all the other things that so frequently are carried out. Our friends complain bitterly that we are on a yo-yo: One year it’s right to do this, the next year it is wrong to do that. I believe that APHA needs to provide the scientific bases for the specific advice that we give.

E. Frank Ellis, M.D., M.P.H., APHA President, 1978
Supporting Health Promotion and Prevention

A major impact on the entire health care system was made by former Secretary of Health, Education, and Welfare Joseph A. Califano, Jr., when he asked the health community what is the level of immunization of our children in America. No one could tell him. That threw us into a managerial process looking at the entire health care delivery system in order to look at outcomes, and we continue in that same mode.

I remember that one of my mentors, Dr. Paul Cornely (the first African-American APHA President), once said to me, “Go into that room and pull together a group of African-Americans to talk about health care.” Eight people showed up. That was the beginning of the Black Caucus of Health Workers of APHA. That caucus set the prototype for all the other caucuses that followed. It also brought to the table those individuals who had a decision-making role in looking at the future of the health care system.

Today, we see that the future is very clear, that we have excellent individuals to support the system of health in order to be able to have APHA at the very top, guiding America and its 260 million people.

Myron Allukian, Jr., D.D.S., M.P.H., APHA President, 1990
Supporting Health Promotion and Prevention

It is nice to be here in Indianapolis, a community that has been fluoridated since 1951, and in Indiana, which is fifth in the country in the percentage of people on public water supplies that are fluoridated – 96 percent of the public water supplies here in Indiana are fluoridated.

When I think of prevention, I’m reminded that Redd Foxx used to say, “The last thing I would want to do in my life is to be lying in the hospital bed dying of nothing.” If we can prevent premature death, disease, and disability, using all of the preventive measures that we know we have, we could make quite a great impact.

During my presidential year, we started working on a sense-of-the-Congress resolution. In developing that resolution, the Executive Board went from a foggy idea of what we wanted in a national health program to articulating community-based

prevention. Since that time, APHA has built on that as have many of the federal agencies. Community-based prevention is where we are most effective as public health workers – whether we are dealing with policy or prevention.

It is very bothersome to me that we spend more money than any other country and we do not have a national prevention program. We do not have a national health education program in all our schools for children from kindergarten to the 12th grade. Our kids are not able to make healthy choices. In 1979, Dr. Julius Richmond, then Surgeon General, promulgated the Healthy People document for the 1990 national health objectives. Before that, we had a meeting at the Institute of Medicine with Dr. Michael McGinnis and Dr. Richmond to try and shake out these concepts. APHA was deeply involved in the beginning and, during my presidential year, the Annual Meeting theme was The Year 2000 National Prevention Objectives for the Nation. We have to make prevention a national priority again.

We are in Indiana, so I will quote Vice-President Dan Quayle, who is from Indiana: “If we don’t succeed, we will fail.” We, as an association, must provide leadership so that the 25 percent of our population, who are children, are really 100 percent of the future.

Joyce C. Lashof, M.D., APHA President, 1992
Supporting Health Promotion and Prevention

When I went to school, we talked about primary, secondary, and tertiary prevention. I think we have made a new advance when we now talk about preventive services, clinical services, and community-based prevention, as well as policy for public health prevention and health promotion. I would like to put the emphasis on the policy aspects, because we have tremendous policy tools and we have been learning to use them in legislation and regulatory measures. We have done nutrition labeling. In tobacco, we have used litigation as an important tool. And we have used a great deal of local initiative and regulatory policy to move us along.

During my presidential year, Healthy People 2000 was high on the agenda and we tried to look at the objectives and tried to ask, “Will we meet those objectives for the year 2000?” It was clear that the overriding factor that was present then is even more present now. What keeps us from moving ahead are poverty and social inequality. As long as there are poverty and social inequality we are not going to meet those objectives. When we challenge the U.S. Public Health Service for why it did not list the abolition of poverty as an important factor in reaching the healthy goals, it said, “We knew poverty was the major factor, but the Public Health Service can’t do anything about that, so we didn’t want to put that as a goal.” I submit that’s a cop-out. We need to fight that issue. Good luck to all of you. Carry on the good fight. We’ll be with you.

Ruth Roemer, J.D., APHA President, 1987
Improving Access to Health Care

When the Executive Board met in 1987 at the beginning of the Annual Meeting, the stock market crash occurred. I remember thinking, “The net worth of APHA is going to go down. How are we ever going to manage?” Well, we managed, and now we are going to have a building of our own and no more worries of that kind. So this marks a very happy anniversary in that sense for me.

In 1987, when I had the most rewarding experience of my life serving as president of APHA, there were 37 million totally uninsured in the United States and many more with inadequate coverage. In the decade since then, the number of people who are totally unprotected against the cost of illness has risen to 41 million – not counting those with inadequate coverage. In my meetings with state affiliates around the country, it was very exciting to meet public health workers on the front lines and I talked at that time about what was one of the best kept secrets, the Canadian health insurance system with its one-tiered system of care covering the total population – despite my obvious bias. My mentor (and husband), Dr. Milton Roemer, urged that the United States replicate the Canadian strategy: The provinces of Saskatchewan first passed hospital insurance and then medical care insurance. Other provinces followed suit. And, finally, a national system covering the total population of Canada was established. All this is much more widely known today than it was then.

A similar state-by-state approach in the United States, however, has not been possible because of the barrier of ERISA, the Employment Retirement Income Security Act of 1974, which preempts state action related to employee benefits provided by self-insured plans. Today the growth of managed care has opened a window of opportunity to amend ERISA. Because ERISA has been interpreted as blocking state regulation of self-insured plans and even lawsuits against the plans for malpractice, federal and state legislative proposals to hold managed-care organizations accountable for the quality of care that they provide include some bills that propose amending ERISA to take account of the changing system of financing and organizing health care through managed-care organizations.

In the current climate of shifting responsibility for health and welfare to the states, a new day is dawning as the federal and state governments are expanding health insurance coverage for children who are poor. This is the most significant advance since the enactment of Medicaid. This success compels one to urge that in the next decade we should emulate Canada’s strategy by moving towards universal coverage through action on a state-by-state basis. Since South Africa is currently in the process of enacting a national health insurance system, we could thus overcome our lone shame of being the only industrialized country without a universal financing mechanism for health care. I hope that APHA will be able to take the lead in this strategy in the coming years.

IN MEMORIAM

E. Richard Brown, Ph.D., APHA President, 1996
Improving Access to Health Care

APHA has long played the leadership role in efforts to get health care access for the entire U.S. population. Universal coverage is a beginning, but there are many other aspects of people’s coverage and their ability to get health care that provide for access.

When I first joined APHA in 1975, it was very involved in struggles to get national health insurance or a national health service in this country. I was very impressed with that struggle and participated in it, and learned much in the process. When Ruth Roemer was president in 1987, she appointed me as Action Board chair. The struggle for national health insurance was then one of the major thrusts of APHA. In 1993, when Helen Rodriguez-Trias was president I was working in the White House on national health insurance and national health care reform. There were many of us who were APHA members who were working in the White House on that effort and a number of us who had formed a single-payer group within the Health Care Reform Task Force. That, of course, failed.

I am very happy to report that this year, under APHA’s leadership, again, we have enacted the first significant expansion of government-subsidized health insurance coverage in the United States in more than 30 years, providing $24 million over the next 5 years to help cover up to 5 million children. That is only the beginning. It is only a first step. It is undoubtedly policy that will be pushed forward by the future APHA leaders.

RICK BROWN

And this from UCLA NEWSROOM

Eugene Feingold, Ph.D., APHA President, 1994
Improving Access to Health Care

Dan Beauchamp has said, “Public health is ultimately and essentially an ethical enterprise committed to the notion that all persons are entitled to protection against the hazards of the world and to the minimization of death and disability in society.” That’s clearly what this segment of this session is about.

The problem we face is that achieving universal access really requires governmental action. It is not something that can be done privately. At the same time, our society, particularly in recent years, but more generally does not place a very high value on government action. That makes life particularly difficult for those people who are less successful in making their way through life privately.

How we can get around this is the dilemma that I have been struggling with, and I think many people in APHA have been struggling with, and I think we really have to overcome. The less that government does for people, the less reason people have to have faith in government. And therefore the less likely they are to support government action, and the less likely we are to get government action that will give them more faith in government.

We have to find a way to reinspire public trust in government action to try and achieve the goals we want to achieve.

Bailus Walker, Jr., Ph.D., M.P.H., APHA President, 1988
Improving Access to Health Care

Failure to achieve universal access to care is a terrible indictment of the public health profession. All of us who have served in the role of leadership ought to be indicted because we have failed in our efforts to achieve universal access.

We must address poverty. If we do not address it, then 125 years from today someone will be standing here saying that we have 41 million people who are not insured.

I hope that we do not lose sight of Barry Levy’s address this morning. The 10 points that he laid out represent a clear roadmap for us to achieve universal access and improvement of health for all the people in this country.

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