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“OF THE POOR, BY THE POOR, OR FOR THE POOR”: COMMUNITY HEALTH CENTERS AND THE WAR ON POVERTY By Kelly Rose O’Reilly Dissertation Submitted to the Faculty of the Graduate School of Vanderbilt University in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY in History August 31, 2017 Nashville, Tennessee Approved: Sarah Igo, Ph.D. Gary Gerstle, Ph.D. Arleen Tuchman, Ph.D. Theodore Brown, Ph.D. Copyright © 2017 by Kelly Rose O’Reilly All Rights Reserved ACKNOWLEDGEMENTS I consider myself incredibly lucky to have had such a fantastic support system while working on this dissertation. My advisors Sarah Igo and Gary Gerstle have seen this dissertation through its multiple iterations and offered their time and invaluable feedback along the way. Sarah Igo’s thoughtful comments and questions never failed to help me sharpen my research questions and articulate my argument. Gary Gerstle’s thorough feedback on drafts has made me a much better writer. As historians of medicine, Arleen Tuchman and Theodore Brown both contributed their much-needed insight and perspective to my dissertation committee. I greatly appreciate their help and support. Though she was not directly involved in this project, I would also like to thank Alice Kessler-Harris, whose mentorship during my undergraduate years at Columbia helped foster my love of history. This dissertation would not have been possible without financial assistance from Vanderbilt University. Grants from the College of Arts and Sciences have allowed me to travel to complete much of the research that underlies this dissertation. A grant from the Rockefeller Archive Center provided additional help. I also wish to thank the librarians and staff at the Rockefeller Archive Center, the Southern Historical Collection at the University of North Carolina at Chapel Hill, and the National Archives at College Park, Maryland. I benefited greatly from their help and expertise. While most of the research for this dissertation was done in archives, perhaps the most rewarding part of my research occurred outside of these walls. Over the past years, I have had the opportunity to interview several people who were at the core of the community health center program in the 1960s and 1970s. These doctors, nurses, federal employees, and civil rights iii activists graciously agreed to talk with me, and some even welcomed me into their homes. Speaking with them added an invaluable dimension to my dissertation research. I was deeply inspired by their deep, abiding belief that “health care is a human right” and their commitment to putting that principle into practice. Joey Chervenak has been there every step of the way (and become very familiar with the NYC-to-Nashville flight schedules in the process). I cannot imagine the last five years without him. I also extend my gratitude to his parents, Frank and Judy, who have welcomed me into their home and provided so much encouragement. Finally, I am grateful for the love and support of my parents and my sister, Shannon. I could not have done this without them, and I cannot thank them enough. iv TABLE OF CONTENTS Page ACKNOWLEDGEMENTS ............................................................................................ iii INTRODUCTION .......................................................................................................... 1 Chapter 1 Experiments in Community Medicine: Medical Schools in the 1950s .................. 22 An Era of Experimentation ........................................................................... 23 Comprehensive Care .................................................................................... 27 The Navajo-Cornell Field Health Research Project ....................................... 33 The Kentucky Model .................................................................................... 45 2 “An Instrument of Social Change”: Community Health and the Civil Rights Movement ......................................................................................................... 51 Health Activism in the 1960s ........................................................................ 55 Freedom Summer ......................................................................................... 63 Community Organizing for Health ................................................................ 76 A Community Health Center for Mississippi ................................................. 85 3 Community Action Meets Community Health: A New Model for Health Care ..... 88 The War on Poverty and the Lure of Community Action ............................... 90 The OEO: A “Heroic Bureaucracy”? ............................................................. 98 Building a Community Health Center ......................................................... 102 The Community Health Care Model ........................................................... 110 A New Model for Health Care? .................................................................. 122 4 “So Much for Apathy!”: Debating the Meanings of Community Control ............ 125 “Seize the Hospital to Save the People” ...................................................... 128 “Community” Control ................................................................................ 138 Community “Control” ................................................................................ 145 Community Control in Practice .................................................................. 150 “So Much for Apathy!” .............................................................................. 157 5 A Model Under Siege: The Community Health Center Program in the 1970s ..... 159 Giving Control to the Community ............................................................... 163 Changes in Mound Bayou ........................................................................... 166 New Federalism and the Community Health Centers ................................... 171 The Second Nixon and the Battle of Fiscal Austerity .................................. 180 v From Community to Consumers ................................................................. 184 Community Control in Name Only? ............................................................ 189 CONCLUSION: The Radical Promise of Community Health ....................................... 196 The Fate of Community Health ................................................................... 205 A New Consensus: Community Health Centers as Safety Nets .................... 213 BIBLIOGRAPHY ....................................................................................................... 217 LIST OF ACRONYMS ................................................................................................ 228 vi INTRODUCTION In his 1964 State of the Union address, President Lyndon Johnson launched an offensive against poverty in the United States, declaring, “Our aim is not only to relieve the symptom of poverty, but to cure it and, above all, to prevent it.” Invoking the language of disease and sickness, Johnson echoed many of his contemporaries in suggesting that poverty was an illness plaguing an otherwise robust American society—a disease that could be defeated, or “cured,” if only the American people would marshal their resources and rally behind the cause. A heady optimism infused this inauguration of the War on Poverty. Just as American medicine was opening new frontiers in its battles against disease, so too might the government solve long-standing social ills such as poverty. Poverty and disease—once considered regrettable realities—now appeared to be problems that Americans could fight, even conquer. For many Americans, however, this connection between poverty and health may have resonated on a deeper level. By the mid-1960s, the links between poverty and health were clearer than ever before. Physicians and scholars alike had begun to talk about a “health gap,” pointing out that poor Americans were much more likely to suffer from illness than their better- off counterparts were.1 The concept of health itself was also undergoing a transformation. In 1948, the World Health Organization (WHO) had adopted a new definition of health, one unprecedented in its breadth: “Health is a state of complete physical, mental, and social well- being, and not merely the absence of infirmity.”2 By the 1960s, the WHO definition enjoyed 1 Jack Geiger, “Community Health Centers: Health Care as an Instrument of Social Change” in Reforming Medicine: Lessons of the Last Quarter Century, eds. Victor W. Sidel and Ruth Sidel (New York: Pantheon, 1984), 14-15. 2 World Health Organization (WHO), “WHO Definition of Health,” 1948, <http://www.who.int/about/definition/en/print.html> 1 wide acceptance among professionals and experts. Their optimism buoyed by the advances of the civil rights movement, medical reformers believed that a more equitable health care system was within reach.3 With change seemingly on the horizon, reform-minded professionals and experts began to put forward their alternative visions for the future of American health care, testing new ways of extending health care to the poorest citizens. Some of these visions drew on a field that was just recently gaining popularity in medical schools—community medicine. Though the idea of community had a long history in American health policy, community medicine as a separate field only emerged in medical schools in the late 1950s.4 These community medicine depart- ments focused on the entire

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