Dr. Sara ‘Jo’ Baker’s Health Care 100 years ago. ©

Rule one of American health care—maximize profit—was not always the rule it appears to be in our day. Dr. Baker, one of the pioneer women physicians in our country, graduated in 1897 and went to work for the New York Public Health Department two years later. Her job was to deal with the epidemics of dysentery and typhoid fever that were killing more than 1000 of the city’s infants every year. Her area, Hell’s Kitchen, was the epicenter of this epidemic. Dr. "Jo" approached this problem by teaching mothers and their older daughters, who often got the childcare job while mothers worked, proper hygiene when caring for their babies. Mostly this meant more hand washing. Over the next few years the epidemic resolved. Her educational program had saved hundreds of lives every year and by the time she left New York ’s Public Health Service in 1923 it had been copied by every state in the Union . Yet in the midst of this success 30 of the city’s pediatricians petitioned the mayors office to stop her program because it was hurting their practices. She tells this story in her autobiography, Fighting For Life, and says her highest recommendation came from these pediatricians.

Our Public Health Service has only salaried people so there is nothing competing with taking care of the public, and to do it in the best and most effective way possible. Sometimes this includes political pressure and Dr. Baker was fortunate enough to have the mayor on her side.

We still have Public Health in each of our States, but Federal funding for programs such as Dr. Baker’s make up less than one-tenth of one-percent of the Health Care Financing Agency budget. What happened? Dr. Baker’s lifetime saw the acceptance of Socialist governments of Europe and the specter of Communism. We ran from these systems choosing the opposite course, and have chosen to rely on the private sector whenever a choice was made. In the process we have starved out the Dr. Bakers and fed the pediatricians. Returning to the center does not necessarily mean the acceptance of Socialism; it just puts more balance into our system—a balance that substantially decreases the power of Rule one.

There is another aspect of Dr. Baker’s story that needs expanding—the epidemic she dealt with. Epidemics are where a lot of people have the same illness. When epidemics happen we have two options for treatment. We can focus on treating the individuals involved, or we can treat them while focusing on the source of the problem. Dr. Baker chose the latter and by teaching people how to interfere with the transmission of the infection helped to bring the infection under control. Prevention is always a better choice than treatment. We made the same choice when we began to see increases in malaria with the Tennessee Valley project damming the rivers. More standing water meant more mosquito breeding grounds. The people were treated, but when we screened the houses the problem disappeared. Insecticide impregnated sleeping nets are doing the same thing with malaria in Africa .

We are currently experiencing an epidemic of diabetes in this country and the causes, poor diet and inactivity, are well known. Yet the advice to physicians is to concentrate on treating each patient. There is little effort in the Public Health Service, or anywhere else, to address the social problems that are responsible for this epidemic. The only reason for this choice is that viewpoint of the 30 pediatricians has won out and that is going to cost us dearly.

Empowering our Public Health Agencies will make our system better, but all change is uncomfortable and this is no exception. Common Sense Medicine® is about our system of health care and about changes that can help it to be fairer in distribution as well as more effective in keeping people healthy. If you like what is said here please share it with your family, friends and especially your legislators.