Julius B. Richmond
Encyclopedia
Julius Benjamin Richmond (26 September 1916 – 27 July 2008) was an American pediatrician and public health administrator. He was a vice admiral
in the United States Public Health Service Commissioned Corps and served as the United States Surgeon General and the United States Assistant Secretary for Health
during the Carter Administration
, from 1977 to 1981. Richmond is noted for his role in the creation of the Head Start program for disadvantaged children, serving as its first national director.
to Russia
n-Jewish immigrant parents. He was educated during the Great Depression
, earning his B.S. at the University of Illinois at Urbana-Champaign
, followed by an M.S. in physiology and his M.D. from the University of Illinois College of Medicine
in 1939. After completing an 18-month rotating internship at Cook County Hospital
in Chicago, Richmond entered two pediatrics
residencies, the first at Chicago’s Municipal Contagious Disease Hospital (1941–1942) and the second at Cook. The United States’ entry into World War II
interrupted Richmond’s postgraduate training, as he volunteered and was inducted into the Army Air Corps
in February 1942. Through 1946 Richmond worked as a flight surgeon
with the Air Force’s Flying Training Command.
. He began as a professor in Pediatrics at his alma mater (1946–53) and a Markle Foundation scholar in medical science (1948–53), and was active both in nonprofit children’s welfare organizations and Chicago’s Institute for Psychoanalysis. During 1953 he moved to the State University of New York at Syracuse College of Medicine (now known as the Upstate Medical Center). The Supreme Court’s decision in Brown v. Board of Education (1954) inspired Richmond and his colleague, Betty Caldwell, to turn their interdisciplinary research, integrating elements of psychiatry
into pediatrics
, toward policy ends as they documented how poverty threatened the psychosocial development of young children. They focused on cognitive abilities developed during a child’s first years, where functional deficits linked to poverty
, for example, those caused by malnutrition
, could make learning more difficult and as a result, put the children of the poor at risk of failing both at school and later on, in attempts to advance economically.
Richmond’s work at Syracuse caught the eye of Sargent Shriver
, head of the Kennedy Foundation. After President Lyndon B. Johnson
tapped Shriver to head a new independent agency, the Office of Economic Opportunity
(OEO) (1964), Shriver convinced Richmond to take a leave of absence and join him. At OEO Richmond would use a demonstration grants mechanism to create two important new public health programs that incorporated OEO’s mandate to aid local groups directly, rather than channeling resources through state health departments, the traditional partners of the Department of Health, Education, and Welfare's Public Health Service
. During 1965, Richmond implemented Project Head Start, an enrichment program for disadvantaged pre-school age children that was greeted eagerly by community groups. Building on health-related proposals submitted in response to Head Start, in 1966 Richmond sponsored a series of Neighborhood Health Centers that united economic development and local oversight of, and participation in, health services delivery.
In 1967, Richmond left OEO to return to Syracuse, to serve as Dean of the medical faculty. During 1971 he moved to Harvard Medical School
, where he held professorships in two departments, Child Psychiatry and Human Development (1971–73) and Preventive & Social Medicine (1971–79), directed the Judge Baker Guidance Center in Boston (1971–77), a nonprofit mental health organization that works with Boston’s juvenile courts, and also served as Chief of Psychiatry at the Children's Hospital Boston
.
’s Secretary of DHEW, asked him to return to Federal service as Assistant Secretary for Health (July 1977). Richmond accepted, on condition that his position as Assistant Secretary, with its line authority over PHS, be combined with that of Surgeon General, widely recognized as a spokesperson for public health. Califano obliged with a December 1977 inhouse reorganization that boosted and streamlined PHS’s management capabilities through its Office of the Assistant Secretary for Health (OASH).
Richmond brought a commitment to access and equity that reflected his earlier work implementing President Johnson’s Great Society
. In national health affairs, however, the latter half of the 1970s was a period of retrenchment and effort to curb health-related expenditures. Economic downturns challenged the country’s willingness to support a continued expansion of health care programs and after 1974], the removal of wage and price controls on health care providers meant dramatic cost increases for the Medicare
and Medicaid
programs. Many believed that controls were a necessary prerequisite to any form of national health insurance
, and the type of controls became a point of contention, for example, with the Congress opposing the Carter Administration’s decision to focus on hospital
expenditures.
Despite the times, Richmond’s neighborhood health centers remained, championed by Congress and reinforced by an assortment of PHS programs to improve access to care. Transferred to PHS jurisdiction in the early 1970s, neighborhood health centers were renamed Community Health Centers
, authorized under 1975 legislation, scaled down and revamped to focus on rural (1975) and urban (1977) areas, spread thin to include new constituencies like residents of Appalachia
and migrant worker
s and those served by PHS’s National Health Service Corps. During Richmond’s tenure, Congress would pass the Health Services and Centers Act of 1978 (PL95-626), which reauthorized a broad array of public health services, community and migrant health centers, grants for primary care projects, and grants-in-aid to support public health programs and authorized $2.9 billion in expenditures. The health of children also remained a top priority. The Communicable Disease Center (CDC) carried out a successful immunization
campaign that focused on measles
and other childhood diseases that disproportionately affected the poor, meeting an initial goal of immunizing at least 90 percent of eligible children by October 1979. In addition, there were efforts to establish a Child Health Assurance Program to improve prevention by broadening eligibility for the existing Medicaid Early and Periodic Screening, Diagnosis and Treatment Program.
At PHS Richmond remains best known for his leadership in devising and implementing quantitative goals for public health, first published in 1979 as Healthy People: The Surgeon General’s Report on Health Promotion and Disease Prevention. Healthy People moved PHS beyond its limited capabilities to lessen disparities in health services provision, to spur change by getting information out to journalists, health departments, and others about gains already made in reduced mortality from noninfectious causes. Richmond and Secretary Califano drew on the precedent of former Surgeon General Luther Terry's 1964 Report on Smoking and Health to build professional and public consensus toward making prevention key to PHS’s efforts.
A new Office of Disease Prevention and Health Promotion (1979) under Assistant Surgeon General Michael McGinnis
prepared the formal publication, setting forth ambitious health goals to be achieved by 1990, and the Institute of Medicine drafted an accompanying volume, Promoting Health/Preventing Disease: Objectives For The Nation (1980), which included a series of specific targets within set categories for each age-group. One of the major goals of this effort was to educate people on how they could take more personal responsibility for their health through wise lifestyle choices. Richmond’s Healthy People campaign was a remarkable success, especially in light of the political firestorm in Congress and by the tobacco industry when Secretary Califano became an outspoken critic of cigarette
smoking as a major contributor to preventable disease.
assumed power in January of 1981, Richmond stepped down from his dual post and returned to academe.
At Harvard, Richmond would serve as a Professor of Health Policy (1981–1988) and as the John D. MacArthur Professor of Management and Director of the Division of Health Policy Research and Education (1987 onward) and as well chair the steering committee of the National Academy of Science’s Forum on the Future of Children and Families (NAS). From 1988 he was Emeritus
at Harvard Medical School
in the Department of Social Medicine (DSM), now the Department of Global Health and Social Medicine, which he had founded under HMS Dean Robert Ebert.
Richmond died of cancer at age 91 at his home in Chestnut Hill, Massachusetts
, near Boston, on July 27, 2008.
Vice admiral (United States)
In the United States Navy, the United States Coast Guard, the United States Public Health Service Commissioned Corps, the National Oceanic and Atmospheric Administration Commissioned Corps, and the United States Maritime Service, vice admiral is a three-star flag officer, with the pay grade of...
in the United States Public Health Service Commissioned Corps and served as the United States Surgeon General and the United States Assistant Secretary for Health
United States Assistant Secretary for Health
The United States Assistant Secretary for Health serves as the Secretary of Health and Human Services's primary advisor on matters involving the nation's public health and, if serving as an active member in the regular corps, is the highest ranking uniformed officer in the Public Health Service...
during the Carter Administration
Jimmy Carter
James Earl "Jimmy" Carter, Jr. is an American politician who served as the 39th President of the United States and was the recipient of the 2002 Nobel Peace Prize, the only U.S. President to have received the Prize after leaving office...
, from 1977 to 1981. Richmond is noted for his role in the creation of the Head Start program for disadvantaged children, serving as its first national director.
Early years
Richmond was born in ChicagoChicago
Chicago is the largest city in the US state of Illinois. With nearly 2.7 million residents, it is the most populous city in the Midwestern United States and the third most populous in the US, after New York City and Los Angeles...
to Russia
Russia
Russia or , officially known as both Russia and the Russian Federation , is a country in northern Eurasia. It is a federal semi-presidential republic, comprising 83 federal subjects...
n-Jewish immigrant parents. He was educated during the Great Depression
Great Depression
The Great Depression was a severe worldwide economic depression in the decade preceding World War II. The timing of the Great Depression varied across nations, but in most countries it started in about 1929 and lasted until the late 1930s or early 1940s...
, earning his B.S. at the University of Illinois at Urbana-Champaign
University of Illinois at Urbana-Champaign
The University of Illinois at Urbana–Champaign is a large public research-intensive university in the state of Illinois, United States. It is the flagship campus of the University of Illinois system...
, followed by an M.S. in physiology and his M.D. from the University of Illinois College of Medicine
University of Illinois College of Medicine
The University of Illinois College of Medicine offers a four-year program leading to the MD degree at four different sites in Illinois: Chicago, Peoria, Rockford, and Urbana–Champaign....
in 1939. After completing an 18-month rotating internship at Cook County Hospital
John H. Stroger, Jr. Hospital of Cook County
The John H. Stroger, Jr. Hospital of Cook County, formerly Cook County Hospital is a public urban teaching hospital in Chicago that provides primary, specialty and tertiary healthcare services to the five million residents of Cook County, Illinois. The hospital has a staff of 300 attending...
in Chicago, Richmond entered two pediatrics
Pediatrics
Pediatrics or paediatrics is the branch of medicine that deals with the medical care of infants, children, and adolescents. A medical practitioner who specializes in this area is known as a pediatrician or paediatrician...
residencies, the first at Chicago’s Municipal Contagious Disease Hospital (1941–1942) and the second at Cook. The United States’ entry into World War II
World War II
World War II, or the Second World War , was a global conflict lasting from 1939 to 1945, involving most of the world's nations—including all of the great powers—eventually forming two opposing military alliances: the Allies and the Axis...
interrupted Richmond’s postgraduate training, as he volunteered and was inducted into the Army Air Corps
United States Army Air Corps
The United States Army Air Corps was a forerunner of the United States Air Force. Renamed from the Air Service on 2 July 1926, it was part of the United States Army and the predecessor of the United States Army Air Forces , established in 1941...
in February 1942. Through 1946 Richmond worked as a flight surgeon
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
with the Air Force’s Flying Training Command.
Career
After demobilization, Richmond completed his residency and began what would be a distinguished academic career in which public service was an integral part of scholarly researchResearch
Research can be defined as the scientific search for knowledge, or as any systematic investigation, to establish novel facts, solve new or existing problems, prove new ideas, or develop new theories, usually using a scientific method...
. He began as a professor in Pediatrics at his alma mater (1946–53) and a Markle Foundation scholar in medical science (1948–53), and was active both in nonprofit children’s welfare organizations and Chicago’s Institute for Psychoanalysis. During 1953 he moved to the State University of New York at Syracuse College of Medicine (now known as the Upstate Medical Center). The Supreme Court’s decision in Brown v. Board of Education (1954) inspired Richmond and his colleague, Betty Caldwell, to turn their interdisciplinary research, integrating elements of psychiatry
Psychiatry
Psychiatry is the medical specialty devoted to the study and treatment of mental disorders. These mental disorders include various affective, behavioural, cognitive and perceptual abnormalities...
into pediatrics
Pediatrics
Pediatrics or paediatrics is the branch of medicine that deals with the medical care of infants, children, and adolescents. A medical practitioner who specializes in this area is known as a pediatrician or paediatrician...
, toward policy ends as they documented how poverty threatened the psychosocial development of young children. They focused on cognitive abilities developed during a child’s first years, where functional deficits linked to poverty
Poverty
Poverty is the lack of a certain amount of material possessions or money. Absolute poverty or destitution is inability to afford basic human needs, which commonly includes clean and fresh water, nutrition, health care, education, clothing and shelter. About 1.7 billion people are estimated to live...
, for example, those caused by malnutrition
Malnutrition
Malnutrition is the condition that results from taking an unbalanced diet in which certain nutrients are lacking, in excess , or in the wrong proportions....
, could make learning more difficult and as a result, put the children of the poor at risk of failing both at school and later on, in attempts to advance economically.
Richmond’s work at Syracuse caught the eye of Sargent Shriver
Sargent Shriver
Robert Sargent Shriver, Jr., known as Sargent Shriver, R. Sargent Shriver, or, from childhood, Sarge, was an American statesman and activist. As the husband of Eunice Kennedy Shriver, he was part of the Kennedy family, serving in the Kennedy and Johnson administrations...
, head of the Kennedy Foundation. After President Lyndon B. Johnson
Lyndon B. Johnson
Lyndon Baines Johnson , often referred to as LBJ, was the 36th President of the United States after his service as the 37th Vice President of the United States...
tapped Shriver to head a new independent agency, the Office of Economic Opportunity
Office of Economic Opportunity
The Office of Economic Opportunity was the agency responsible for administering most of the War on Poverty programs created as part of United States President Lyndon B. Johnson's Great Society legislative agenda.- History :...
(OEO) (1964), Shriver convinced Richmond to take a leave of absence and join him. At OEO Richmond would use a demonstration grants mechanism to create two important new public health programs that incorporated OEO’s mandate to aid local groups directly, rather than channeling resources through state health departments, the traditional partners of the Department of Health, Education, and Welfare's Public Health Service
United States Public Health Service
The Public Health Service Act of 1944 structured the United States Public Health Service as the primary division of the Department of Health, Education and Welfare , which later became the United States Department of Health and Human Services. The PHS comprises all Agency Divisions of Health and...
. During 1965, Richmond implemented Project Head Start, an enrichment program for disadvantaged pre-school age children that was greeted eagerly by community groups. Building on health-related proposals submitted in response to Head Start, in 1966 Richmond sponsored a series of Neighborhood Health Centers that united economic development and local oversight of, and participation in, health services delivery.
In 1967, Richmond left OEO to return to Syracuse, to serve as Dean of the medical faculty. During 1971 he moved to Harvard Medical School
Harvard Medical School
Harvard Medical School is the graduate medical school of Harvard University. It is located in the Longwood Medical Area of the Mission Hill neighborhood of Boston, Massachusetts....
, where he held professorships in two departments, Child Psychiatry and Human Development (1971–73) and Preventive & Social Medicine (1971–79), directed the Judge Baker Guidance Center in Boston (1971–77), a nonprofit mental health organization that works with Boston’s juvenile courts, and also served as Chief of Psychiatry at the Children's Hospital Boston
Children's Hospital Boston
Children's Hospital Boston is a 396-licensed bed children's hospital in the Longwood Medical and Academic Area of Boston, Massachusetts.At 300 Longwood Avenue, Children's is adjacent both to its teaching affiliate, Harvard Medical School, and to Dana-Farber Cancer Institute...
.
Surgeon General
Nearly a decade later after Richmond stepped down from OEO, former OEO official Joseph Califano, now President Jimmy CarterJimmy Carter
James Earl "Jimmy" Carter, Jr. is an American politician who served as the 39th President of the United States and was the recipient of the 2002 Nobel Peace Prize, the only U.S. President to have received the Prize after leaving office...
’s Secretary of DHEW, asked him to return to Federal service as Assistant Secretary for Health (July 1977). Richmond accepted, on condition that his position as Assistant Secretary, with its line authority over PHS, be combined with that of Surgeon General, widely recognized as a spokesperson for public health. Califano obliged with a December 1977 inhouse reorganization that boosted and streamlined PHS’s management capabilities through its Office of the Assistant Secretary for Health (OASH).
Richmond brought a commitment to access and equity that reflected his earlier work implementing President Johnson’s Great Society
Great Society
The Great Society was a set of domestic programs in the United States promoted by President Lyndon B. Johnson and fellow Democrats in Congress in the 1960s. Two main goals of the Great Society social reforms were the elimination of poverty and racial injustice...
. In national health affairs, however, the latter half of the 1970s was a period of retrenchment and effort to curb health-related expenditures. Economic downturns challenged the country’s willingness to support a continued expansion of health care programs and after 1974], the removal of wage and price controls on health care providers meant dramatic cost increases for the Medicare
Medicare (United States)
Medicare is a social insurance program administered by the United States government, providing health insurance coverage to people who are aged 65 and over; to those who are under 65 and are permanently physically disabled or who have a congenital physical disability; or to those who meet other...
and Medicaid
Medicaid
Medicaid is the United States health program for certain people and families with low incomes and resources. It is a means-tested program that is jointly funded by the state and federal governments, and is managed by the states. People served by Medicaid are U.S. citizens or legal permanent...
programs. Many believed that controls were a necessary prerequisite to any form of national health insurance
National health insurance
National health insurance is health insurance that insures a national population for the costs of health care and usually is instituted as a program of healthcare reform. It is enforced by law. It may be administered by the public sector, the private sector, or a combination of both...
, and the type of controls became a point of contention, for example, with the Congress opposing the Carter Administration’s decision to focus on hospital
Hospital
A hospital is a health care institution providing patient treatment by specialized staff and equipment. Hospitals often, but not always, provide for inpatient care or longer-term patient stays....
expenditures.
Despite the times, Richmond’s neighborhood health centers remained, championed by Congress and reinforced by an assortment of PHS programs to improve access to care. Transferred to PHS jurisdiction in the early 1970s, neighborhood health centers were renamed Community Health Centers
Community health centers in the United States
A Community health center in the United States is a Community health center in the United States.Community Health Centers are unique in that at least 51 percent of all Governing Board Members must be patients at the CHC. Access to care is improved by decreasing the cost of care with a sliding fee...
, authorized under 1975 legislation, scaled down and revamped to focus on rural (1975) and urban (1977) areas, spread thin to include new constituencies like residents of Appalachia
Appalachia
Appalachia is a term used to describe a cultural region in the eastern United States that stretches from the Southern Tier of New York state to northern Alabama, Mississippi, and Georgia. While the Appalachian Mountains stretch from Belle Isle in Canada to Cheaha Mountain in the U.S...
and migrant worker
Migrant worker
The term migrant worker has different official meanings and connotations in different parts of the world. The United Nations' definition is broad, including any people working outside of their home country...
s and those served by PHS’s National Health Service Corps. During Richmond’s tenure, Congress would pass the Health Services and Centers Act of 1978 (PL95-626), which reauthorized a broad array of public health services, community and migrant health centers, grants for primary care projects, and grants-in-aid to support public health programs and authorized $2.9 billion in expenditures. The health of children also remained a top priority. The Communicable Disease Center (CDC) carried out a successful immunization
Immunization
Immunization, or immunisation, is the process by which an individual's immune system becomes fortified against an agent ....
campaign that focused on measles
Measles
Measles, also known as rubeola or morbilli, is an infection of the respiratory system caused by a virus, specifically a paramyxovirus of the genus Morbillivirus. Morbilliviruses, like other paramyxoviruses, are enveloped, single-stranded, negative-sense RNA viruses...
and other childhood diseases that disproportionately affected the poor, meeting an initial goal of immunizing at least 90 percent of eligible children by October 1979. In addition, there were efforts to establish a Child Health Assurance Program to improve prevention by broadening eligibility for the existing Medicaid Early and Periodic Screening, Diagnosis and Treatment Program.
At PHS Richmond remains best known for his leadership in devising and implementing quantitative goals for public health, first published in 1979 as Healthy People: The Surgeon General’s Report on Health Promotion and Disease Prevention. Healthy People moved PHS beyond its limited capabilities to lessen disparities in health services provision, to spur change by getting information out to journalists, health departments, and others about gains already made in reduced mortality from noninfectious causes. Richmond and Secretary Califano drew on the precedent of former Surgeon General Luther Terry's 1964 Report on Smoking and Health to build professional and public consensus toward making prevention key to PHS’s efforts.
A new Office of Disease Prevention and Health Promotion (1979) under Assistant Surgeon General Michael McGinnis
Michael McGinnis
James Michael McGinnis is a physician, public servant, and long-time contributor to national and international health policy leadership, serving through four Administrations as a key focal point for policy coordination and initiatives in disease prevention and health promotion...
prepared the formal publication, setting forth ambitious health goals to be achieved by 1990, and the Institute of Medicine drafted an accompanying volume, Promoting Health/Preventing Disease: Objectives For The Nation (1980), which included a series of specific targets within set categories for each age-group. One of the major goals of this effort was to educate people on how they could take more personal responsibility for their health through wise lifestyle choices. Richmond’s Healthy People campaign was a remarkable success, especially in light of the political firestorm in Congress and by the tobacco industry when Secretary Califano became an outspoken critic of cigarette
Cigarette
A cigarette is a small roll of finely cut tobacco leaves wrapped in a cylinder of thin paper for smoking. The cigarette is ignited at one end and allowed to smoulder; its smoke is inhaled from the other end, which is held in or to the mouth and in some cases a cigarette holder may be used as well...
smoking as a major contributor to preventable disease.
Later years
After the Reagan AdministrationReagan Administration
The United States presidency of Ronald Reagan, also known as the Reagan administration, was a Republican administration headed by Ronald Reagan from January 20, 1981, to January 20, 1989....
assumed power in January of 1981, Richmond stepped down from his dual post and returned to academe.
At Harvard, Richmond would serve as a Professor of Health Policy (1981–1988) and as the John D. MacArthur Professor of Management and Director of the Division of Health Policy Research and Education (1987 onward) and as well chair the steering committee of the National Academy of Science’s Forum on the Future of Children and Families (NAS). From 1988 he was Emeritus
Emeritus
Emeritus is a post-positive adjective that is used to designate a retired professor, bishop, or other professional or as a title. The female equivalent emerita is also sometimes used.-History:...
at Harvard Medical School
Harvard Medical School
Harvard Medical School is the graduate medical school of Harvard University. It is located in the Longwood Medical Area of the Mission Hill neighborhood of Boston, Massachusetts....
in the Department of Social Medicine (DSM), now the Department of Global Health and Social Medicine, which he had founded under HMS Dean Robert Ebert.
Richmond died of cancer at age 91 at his home in Chestnut Hill, Massachusetts
Chestnut Hill, Massachusetts
Chestnut Hill is a wealthy New England village located six miles west of downtown Boston, Massachusetts, United States. Like all Massachusetts villages, Chestnut Hill is not an incorporated municipal entity, but unlike most of them, it encompasses parts of three separate municipalities, each of...
, near Boston, on July 27, 2008.