Facets of the Sixties Still Relevant for Public Health

For the special section of its June issue, AJPH has invited public health practitioners to report their experiences as students or professionals with events of the 1960s or their immediate aftermath that had implications for public health. The articles cover some, but far from all, facets of the multifaceted legacy of the 1960s. Nicholas Freudenberg (p. 724) describes how the ideas of justice that the Students for a Democratic Society defended percolated into public health. Asa Cristina Laurell (p. 730) reviews the development of social medicine in Latin America. Steve Wodka (p. 728) describes the state of occupational health and safety before the Occupational Safety and Health Act was passed. Jeanne Stellman and Steven Stellman (p. 726) summarize the human and environmental toll taken by systematic defoliation in Vietnam. James Phillips (p. 731) recounts the impact of the Biafran famine on modern emergency public health. Preparing this editorial, I came upon the Gun Control Act of 1968, which reminded me that in the sixties, gun violence did not become the major public health issue it is now.

STUDENTS MOVING INTO PUBLIC HEALTH

The student movement of the 1960s—driven at first by feelings of egalitarianism, antiracism, participatory democracy, civil rights, and nuclear disarmament and later by opposition to the Vietnam War—was also concerned with the state of public health and occupational health and the emergence of novel forms of community health initiatives. Participation in the Students for a Democratic Society (1960–1974) “shaped our politics, our career choices, and our values for decades to come,” writes Freudenberg (p. 724), then vice-chairman of its Columbia University chapter. Black students often had their own organizations, such as the Student Afro-American Society. This generation contributed to the success of ideas that, in the following 50 years, transformed the rights of women and of lesbian, gay, bisexual, and transgender persons; the right to health care; and the protection of the environment. As I observed in interviews I conducted for an oral history of modern epidemiology, many medical students chose public health and its population disciplines, such as epidemiology, sociology, and biostatistics, because these disciplines offered possibilities to found their search for justice and equity on scientific principles.

Outside the United States, Laurell (p. 730), a Mexican physician, sociologist, and former secretary of health of Mexico City, reminds us that the 1960s boosted many of the ideas that later nurtured the development of contemporary Latin American “social medicine” or “collective health.” These ideas continue to influence Latin America’s public health system today. They have helped spur the creation of new academic institutions and journals in Mexico and Brazil. They can be traced to the Chilean advances toward a Unified National Health Service until the coup against Salvador Allende of September 11, 1973. They inspired the new Brazilian constitution of 1988, which embraced the concept of “collective health.”

THE OCCUPATIONAL SAFETY AND HEALTH ACT

In the late 1960s, Wodka, from his position at the Oil, Chemical and Atomic Workers International Union, then led by Anthony (Tony) Mazzocchi, lobbied Congress to pass the Occupational Safety and Health Act and later worked to enforce it. As Wodka mentions (p. 728), in 1968, the workers of Allied Chemical were being overexposed to mercury; Avisun Corporation in New Castle, Delaware, a manufacturing plant making a special kind of plastic containing asbestos, handled tons of asbestos every day without due care; the Kawecki-Berylco Industries plant in Hazleton, Pennsylvania, was covered with the pulmonary toxic dust of refined pure beryllium metal; and farmworkers, the most exploited workforce in America, were heavily exposed to de-identified pesticides. How did these behaviors become unacceptable?

An event of the late sixties seems to have led to a new chapter in the century-long struggle for the protection of US workers’ health and safety. A mine explosion in 1968 causing 68 deaths in Farmington, West Virginia, followed by protests and wildcat strikes, spurred Congress to pass the Coal Mine Health and Safety Act of 1969. On December 29, 1970, President Richard Nixon signed into law the Occupational Safety and Health Act, authorizing the federal government to set and enforce safety and health standards for most of the country’s workers.¹

AGENT ORANGE'S LINGERING HEALTH TOLL

During the 1960s, the United States sprayed a massive quantity of defoliants on Indochina’s forests. These defoliants had color-coded names: Agent Orange, Agent Blue, and so on. At least one of their components was dioxin. Defoliants produced a human and environmental disaster. In groundbreaking research, Stellman and Stellman (p. 726) estimated the quantity of dioxin sprayed on South Vietnam. They calculated that between 2.1 and 4.8 million people in 3181 hamlets were sprayed to make bombing targets more visible, simultaneously exposing, as would be expected, US troops serving in the sprayed areas. Stellman and Stellman stress that there is still an opportunity to assess the long-range health effects of the Vietnam War on both civilians and soldiers, because the at-risk veteran population is now at an age when chronic diseases become manifest.

BIAFRAN FAMINE AND EMERGENCY PUBLIC HEALTH

In the late sixties, Phillips, as assistant area coordinator of the International Committee of the Red Cross, and AJPH associate editor Daniel Tarantola, as a French doctor, were both serving in Biafra. Phillips (p. 731) and Tarantola² have taken us back to 1968, when the United States intervened in the civil war between the Nigerian government and the oil-rich secessionist state of Biafra in the southern Niger Delta. The Nigerian troops’ blockade resulted in severe famine. The attention of the world, witnessing the disaster on TV screens, was caught by the harrowing images of Biafran children, suffering and dying from hunger and malnutrition. Phillips and Tarantola concur in saying that the Biafran famine led to a shift in the emphases and priorities of emergency public health, moving away from the Red Cross history of prisoner of war humanitarian action and national societies managing disasters at home.

GUN CONTROL ACT OF 1968

Interestingly, in a February 20 tweet, Oprah Winfrey compared the middle and high school students in the ongoing gun control movement to the Freedom Riders of the 1960s. Comedian Bill Murray said that the “Parkland kids” reminded him of the “students who helped end the Vietnam War.”³ Actually, the 1960s saw the Gun Control Act of 1968 passed (Pub L No. 90-617). The Act was meant to better control interstate traffic in firearms, but it was also specifically not intended “to place any undue or unnecessary Federal restrictions or burdens on law-abiding citizens with respect to the acquisition, possession, or use of firearms” or “to discourage or eliminate the private ownership or use of firearms by law-abiding citizens for lawful purposes.” The term “control” was in the title, but the text was mainly against control. If the analogy of the Freedom Fighters, and more generally of the sixties, with the movement prompted by the Marjory Stoneman Douglas High School shooting rampage of February 14, 2018, in Florida is apt, these students are bringing the traditions of protest from the sixties to the present by tackling a most important public health issue today.

STILL RELEVANT

Let me conclude with two caveats. First, this set of articles addresses important issues that were transformed during the sixties, but it leaves aside many others. AJPH has reviewed the public health legacy of some of these other topics⁴ and plans to review more in the future. Second, even though exactly 50 years have gone by since the spring of 1968, the events commemorated in this issue have contributed ideas and values to public health that are still timely and topical today.