Framer of Culture of Health
Meharry Medical College
1930 – 1978
Dr. Frank McCune Continues to Build the Culture of Health
Address the Health Care Disparity
Faced by African Americans
Dr. Frank McCune giving a presentation on Dr. Mathew Walker at Meharry Medical College 2011
Tune in to WMPR 90.1 FM, if you are local to Jackson, Mississippi, or go to www.wmpr901.com to listen across the nation via the internet at 8:00 PM CST every Wednesday evening to find out more about your health, the culture of health, the health care crisis facing African Americans in America and how you can change your own health situation.
There are over 1200 community Health Centers in the United States. These centers provide over 18 million patient visits per year. How did this health delivery system evolve and become the nation’s health safety network? Will understanding the original thought behind this technology help close the health disparity gap?
The state and the delivery of healthcare have been and will be a challenge for America. From the beginning, the presence of African America slaves and free, in the United States has created a dilemma relative to the health and healthcare of the group. The acceptance of African Americans as human beings equal to whites and entitled to the rights, benefits and entitlements elusive. The period from 1731-1812 marked the beginning of the attititudes of Americans toward African Americans and their health that would last for over 300 years. According to Dr. W. Michael Byrd and Dr. Lynda Clayton, an American Health Dilemma, Rutledge Press 2002, the ultimate consequences of such attitudes and behavior has been:
•Blacks have always suffered different and worse health status and outcomes, origin of today’s health disparity, initially manifesting as a slave health defect.
•Blacks have been subjected to the negative effects of weak, ineffective and biased health policies and resource allocations promulgated by local and federal governmental agencies.
•American society has blamed poor health outcomes of blacks on blacks themselves including their life style, biological, physiological and genetic differences. This sets the stage for discrimination, white control and domination over systems and resources and proliferation of health disparity.
•African American health providers have been relegated to second class status with little or no significant input into the policies and logistical strategies that control the design of and the sustaining of the health system in America.
•The American Medical Association issued an apology for perpetuation of the above mentioned attititudes in 2010. Therefore, these attititudes and behaviors have been a part of the culture of health in America for over 2 centuries.
The major historical contribution of blacks to the American health system has been the availability of human subject upon which untested and non-evidence medicine can be applied. To illustrate, many of the larger medical facilities in America are located in inner cities throughout the country such as King County Hospital center in Brooklyn, Cook County Hospital Chicago, Boston Medical Center, and Boston MA. , Grady Hospital, Atlanta GA. King –Drew LA.CA. and the University of Mississippi Medical Center Jackson, MS. The patient mix by race and economic status who are serviced in these facilities approach black, Latino and poor respectively. In spite of these enrollment increases, health disparity remains a major problem in America. The present Executive branch administration introduced, and the congress passed, the Affordable Care Act payment reform in an attempt to correct these health disparities that have now extended to involve other subgroups of the population including working poor, immigrants and some regions of the country. This will not correct the disparities. Therefore, it may be worthwhile to look into the archives of our history to see if we have made contributions to the correction of our problem with giving proper recognition to our own ingenuity.
The American social, political and economic system was designed and set in place between 1812-1861, the Republican Era, by the theory and practices of Andrew Jackson (1767-1845). This policy declared by President Andrew Jackson was that blacks and American Indians would be subject to permanent slavery and dispossession by official federal government mandate and enforcement. As a result a two tier health system was justified with black Americans receiving inferior health care or none at all. Health disparities continued to widen in spite of the fact that more black medical professionals including doctors, nurses and hospitals were providing care for the group. Recently, the American Medical Association, established in 1846 and given a major role in developing policies and public opinions in American medicine apologized for its role in creating the health cultural gaps that have lasted over 100 years. Adding to the mistrust developed by black patients and white provider as a result of the biased system, many of the breakthroughs in medicine were the result of experiments done on black patients who were not given the medical benefits of the findings. The most infamous of such events is the Tuskegee study done on syphilitic patients. Procedures done on women were just as egregious. Examples include the Operations done on Betsy, Lucy and Anarcha by Marion Sims MD, some 30 operations, major and minor without anesthesia and the discovery of the HeLa immortal research cell line of Henrietta Lack for which she was never paid or given credit.
Progress continued to be made in health and medicine with the survival of Meharry Medical College and Howard University School of Medicine from the onslaught of the Flexner report which closed the remaining 12 black medical schools. Out of these schools came forward thinking pioneers in medicine worthy of respect and admiration. Matthew Walker MD, Fellow American College of Surgeons became a social entrepreneur in health in 1944 when he became the Chairman of the Surgery department at Meharry Medical College. He succeeded Dr. John Henry Hale who was the first black physician to be recognized by the American College of Surgery in 1932. Dr. Walker scored one of the highest scores ever recorded on the Certifying Examination given by the American College of Surgeons. However, Dr Walker did something different that distinguished him as a significant transition player in the health care arena. He created a culture of health symbolized by the development of community health centers. After cultures are created, they are sustained by the activity of management, selections of those who come into the culture and socialization. Dr. Walker was a path- goal leader with a real feel for the use of intensive technology and a strong feed back structure.
He knew early on that he would have to train his own managers. Dr Louis Bernard, Chairman Department of Surgery following Dr Walker, executed to the fullest extent the ability to deal effectively with "fixed" low liquidity assets, (No Money) unique and legendary to Meharry, possibly resulting in the fate of Meharry today. Dr Walker invited individuals such as Dr David Todd -thoracic and cardiovascular surgery, Dr. Ed Brown – general and cancer surgery, Dr. Marcel Hamburg – urologic surgery, Dr. J.R. Todd – general surgery, Dr. Robert Smith – general surgery, Dr. Frank McCune – general surgery and a number of others into the culture to sustain, support and pass the culture on to others through our excellence in our profession, stories, ritual, symbols, and language. Through the cultures’ sense making, pride giving mechanism, we at Meharry developed our attitudes and behaviors that made us unique in how we thought and how we did our business. It made us different from others. It facilitated the generation of commitments to a greater cause for medicine than our own individual interest.
Dr Walker had the unique ability to visualize things as they were and conceptualize how they could be now and in the future. He had the leadership capacity and capability to transfer the concept to others. Dr Walker’s Culture of health strongly valuing individual initiatives, risk tolerance, integration of teams, management support, direct supervision, identity with the organization, balanced reward system, conflict tolerance and open communication, was undoubtedly influenced by his birth place roots of Waterproof, LA. (Cooter Point). This rural community has hardly changed since Dr. Walker’s time. Born in 1907 he frequently made trips to this area throughout his life. His father, a Pullman Porter, moved the family to New Orleans when he was 9 years old. In 1925 he graduated high school at Gilbert’s Academy in New Orleans LA. In 1929 he received his B.A. from New Orleans University. His medical education aspirations were temporarily put on hold with the loss of the medical school at New Orleans University, no doubt in part as a result of the Flexner report of 1906 which closed all black medical schools except Meharry and Howard, a large number of white schools and all women schools except one. This event also brought him in contact with the reality of the major elements of the causes of disparity: segregation, disdain for the poor and the influence of financial power throughout the medical hegemony.
In 1934, Dr.Walker graduated from Meharry and joined the teaching staff in 1935. Dr. Walker married Ms Alice Johnson in 1937 in Ballwin LA. Their first child was Matthew Walker Jr. Who in 1961 became a freedom rider, was arrested in Jackson MS.; jailed and appealed the case. This set the tone for the strategy of CORE and the civil rights movement. His 1st daughter, Charlotte Rose, born August 25 1938, follows in her father’s foot steps to become professor of surgery at Meharry. Maxine June, born April 2, 1940 and Daniel Phillip bore (August 17 1942) who continues to be an Iconic member of the Meharry family.
Dr Walker created a culture at Meharry which influenced everything from study methods, confidence in social interactions, dress code and conduct. He used contingency leadership principles effectively and was an avid user of coercion, reward, persuasion and knowledge as the basis of his power. Very rarely could he use expert, opportunity, personal or position as a source of power outside of Meharry, therefore he rarely used these sources of power inside of Meharry.
The culture of health created by Dr. Walker helped to shape the attititudes of diversity in Medicine throughout America. In 1947; Dr. Walker went to Mound Bayou MS. a small black delta town that had a social entrepreneurial organization called the Knights and Daughters of Tabor. This organization ran a hospital, Mound Bayou Community Hospital( one of the 1st HMO model facilities/organization in America); Dr. Walker was passionate about the use of hospitals for training medical students, and residents, allowing active staff members to hone their skills and to create jobs. He was fully aware of the Social determinates of health. I am certain that he had familiarized himself with the WHO’s definition of health released in 1948 as being an optimal state of mental, physical and social well being. Dr. Walker built the surgical service of the hospital. Consequently, all services were improved because the culture was that a surgeon was an internist who could cut, an obstetrician who could deliver babies and on and on. A perfect attititude for a rural medicine provider to have and strive to epitomize. These cultural characteristics are what the country needs for true healthcare reform.
In 1967 the Delta Health Center in Mound Bayou MS was opened under the direction of Dr. Jack Geiger as a part of the Tufts Comprehensive Community Health Action Program, Boston, MA. This was the 1st rural community health center in America. Columbia Point Health Center, Dorchester, Massachusetts, was the urban model brought on line at the same time. In 1972 Dr. Jack Geiger teamed up with Dr. Walker to merge the Community Health Center with the Mound Bayou Community Hospital. This created the 1st staff model HMO in the State of MS and one of the 1st in the United States. This was a demand merger by the Office of Economic Opportunity (OEO) later (DHHS). Meharry’s supporting role under Dr. Walker, Dr. Ralph Hinds and Dr Leslie Falk allowed Meharry to receive a grant for the 1st Neighborhood health center in Nashville, TN. that still remains in service today. There is no doubt that the Meharry concept for a community health center was born in Mound Bayou and at Meharry prior to 1967, as a part of the culture of health concept of Dr Walker.
The second community health center to come on line was the Medgar Evers Health Center in Fayette, MS. established by the honorable Charles Evers, Mayor of Fayette, the First Black American to hold this post and the first to run for Governor in Mississippi since Reconstruction. The first Medical director of the center was a Meharry Medical College graduate Dr. Charles Humphrey. OEO funding that became available at the time of Dr Geiger and the merger allowed expansion of the concept and allows the concept to succeed in becoming the country’s safety set for health care for the poor and underserved. This system was developed by descendants of slaves
Dr. Frank McCune, founder of the Cosmic International Foundation's Culture of Health and the Cosmic Health Network
which is located at the
Integrative Health and Wellness Center in Jackson, Mississippi.
The RCHN Community Health Foundation of the New York Community Health Policy Center was established in 2004 to honor Dr. Jack Geiger and Dr. Count Gibson at the George Washington University School of Public Health and Health Services, for their contribution to the growth and proliferation of community health centers in America. There are over 1200 centers with over 7000 delivery sites in the United States. There are several hundred RHC’s and FQHC "Look a Likes" in America now. Serving over 18 million patients in 2008.
The Matthew Walker Community Health Center, the Matthew Walker Surgical Society both in Nashville Tn. and the Drew – Walker Lectures at the NMA are all named from Dr Walker.
Why is an accurate accounting of this history important? First of all, those who know the history best are still living. If those who know the history don’t volunteer to tell the history, its chances for being told accurately diminishes. Secondly, this is important for all Mississippians and all Americans to know this history, because it serves as a positive contribution to the society by a state that has an infamous past. Thirdly, Meharry Medical College has struggled in the past few years with establishing it importance and identity in a very competitive health environment. Meharry needs positive outcomes of services that it has created to attract high quality students, faculty, research dollars and alumni resource support. Lastly, The Black community must begin to tell its own history and resist running the risk of others telling the story, getting it wrong and all The Black community can do is to complain in vain.
Dr. Frank McCune, MD, MBA, CMCM, CFE