Improving the Health of North Carolinians, Then and Now

Today we welcome a guest post from William W. McLendon, M.D., coauthor, with Floyd W. Denny Jr. and William B. Blythe, of Bettering the Health of the People: W. Reece Berryhill, the UNC School of Medicine, and the North Carolina Good Health Movement. The book explores the history of North Carolina’s postwar effort to provide health care for all N.C. citizens by building new hospitals and training more people to become doctors and other health care professionals. In this post, Dr. McLendon offers a brief review of the Good Health Movement–its goals and accomplishments–and draws parallels to the current health care reform bill and its public response.–ellen

At the end of World War II, Americans were impressed by what could be accomplished by a team effort directed toward a common goal – the defeat of Nazi and Japanese tyranny.  Such a massive effort was inevitably imperfect, as many GIs freely proclaimed.  Nonetheless, it was a unifying endeavor that has never been equaled in this country.

North Carolinians had an additional unique insight from their wartime experiences.   During the war, up to 55% of the state’s young men were rejected for military service because of health-related conditions (the worst record of any of the states).   The ability to do something about this dismal record was suggested by a rejection rate of only 1.5% for young men who grew up in orphanages where there was “sound nutrition and reasonably adequate medical and hospital care.”

As narrated in Bettering the Health of the People, public-spirited North Carolinians united to address the state’s poor health with a massive team effort across the entire state.  This culminated with the funding by the 1945 and 1947 Legislatures of a statewide program calling for “More Doctors, More Hospitals and More Insurance.”

The 1944 preliminary report by the North Carolina Hospital and Medical Care Commission, which laid the groundwork for this statewide Good Health Movement, was both visionary and pragmatic.  It called for “all of us to work together to make real a new ideal of democracy – ‘The equal right of every person born on earth to needed medical and hospital care whenever and wherever he battles against Disease and Death.’”

The members of the Commission, however, were well aware of the likely political counter-arguments when they emphasized, “Our program is not…one of ‘Socialized Medicine.’  It will not destroy the fine relationship of doctor and patient.”   On the contrary, they argued that this program, like vaccination for smallpox, would prevent North Carolinians from getting “the real thing” (socialized medicine).

A keystone of this program was the building on the University of North Carolina campus at Chapel Hill of a public teaching hospital as a memorial to those who have or will give their lives in the nation’s armed forces.  The UNC medical school was expanded from a two-year basic sciences school to a four-year, MD-granting school, and dental and nursing schools were added to the existing pharmacy and public health schools.  With these additions and expansions, the UNC medical center today is one of only six of the over 130 medical schools in the nation with a university hospital and schools of dentistry, medicine, nursing, pharmacy, and public health all on the parent university campus.

The North Carolina Good Health Movement succeeded in building more hospitals throughout the state while providing many more physicians and other health care professionals, although the latter need is a continuing challenge in a growing and aging population.  Neither North Carolina nor the nation, however, has yet succeeded in providing the “More Insurance,” that is, access to needed health care for all citizens.

Now 65 years later, America has embarked on a national Good Health Movement with the enactment in March 2010 of the Patient Protection and Affordable Care Act.  A major goal of this act is to provide access to needed health care for most Americans.

Not surprisingly for a health care reform bill this complex, many naysayers have contended that it will bankrupt the country, lead to socialism, or worse.  As pointed out in Felix Rohatyn’s recent book, Bold Endeavors, such predictions have accompanied all of the acts that have made major investments in our country and that have defined our nation today.  These include the transcontinental railroad act in 1862, the acts to help the nation recover from the Great Depression in the 1930s, the GI Bill after World War II, and the Interstate Highway System act in 1956.

Each of these innovative federal acts provided financial incentives and set national standards (e.g., a uniform railroad gauge and construction standards for the interstates) that encouraged private sector entrepreneurs to build new enterprises that hired workers, paid suppliers, and provided profits to shareholders.  In turn, the taxes on the resulting profits reimbursed the U.S. Treasury and provided funds for future national endeavors.  The current health care reform bill has the potential to do the same.

No human endeavor — whether involving individuals, non-profit organizations, for-profit corporations and/or governments — is ever perfect, and this reform effort will be no exception.  This bill is complex and massive because it attempts to deal with health care for 300 million people in an existing system (or, more accurately, non-system) that is already very complex.

Success in implementing and fine-tuning this health care reform act over the years can come if we as a nation follow the advice of the concluding statement of the 1944 North Carolina report, that “no claim is made that this is a complete or perfect program… and all are asked to help in remedying defects and improving details.” If this can be done we can “make real a new ideal of democracy” where everyone can receive needed medical and hospital care.

–William W. McLendon, M.D.
Professor Emeritus, University of North Carolina School of Medicine
coauthor of Bettering the Health of the People: W. Reece Berryhill, the UNC School of Medicine, and the North Carolina Good Health Movement

4 Comments

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  2. A terrific piece that my father would have heartily endorsed. It’s nice to see the nation coming ever so slowly around to the forward thinking and public spirit of an earlier and great generation of North Carolinians.

  3. A wonderful book on an important topic in the history of medicine and public health in America and, in particular, the South… it certainly brings into perspective the current efforts to reform medical delivery. Congratulations for a great book, Bill!

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