Lister Hill and his influence

Lister Hill, longtime senator from Alabama, is remembered through the names of the Lister Hill Library of the Health Sciences at the University of Alabama at Birmingham (UAB) as well as the Lister Hill National Center for Biomedical Communications at the National Library of Medicine (NLM). Who was Lister Hill, and what was his impact? A review of history demonstrates that the recognition was appropriate, as Senator Hill advocated health care and library legislation in the twentieth century that proved to be groundbreaking and long lived.

Lister Hill (1894–1984) served in the U.S. Congress for more than forty-five years, including the Senate during 1938–1969. He represented a progressive strain of the Democratic Party in Alabama and supported federal involvement in improving economic conditions, rural infrastructure, and education. He was a staunch advocate of New Deal programs, and his early role in creating the Tennessee Valley Authority (TVA) set the stage for his political philosophy and support from his constituents. He also had to walk a fine line for political survival. He balanced support for the national Democratic Party, often in the face of fierce opposition in his state, with a pragmatic stand against civil rights [1].

Called the “statesman for health” [2], Hill sponsored more than sixty pieces of health care legislation [3]. The legislation fell primarily into four categories: preventive medicine and public health, physical facilities, workforce, and medical research [4]. The story of Hill's family background in medicine was often cited as an inspiration for his interest. His father, a prominent Montgomery physician who established his own hospital, was the first American surgeon known to suture a human heart. Senator Hill was the namesake of Sir Joseph Lister, the pioneer of antiseptic surgery, under whom Dr. Hill had studied [5].

The 1946 Hill-Burton Act to construct hospitals (named for the Senate sponsors including Harold Burton of Ohio) was Hill's first major entry into the health field. Supported by the medical establishment and guided through the Senate by Senator Robert Taft, it deflected President Truman's proposal for a comprehensive health plan by limiting the government's role to the subsidy of voluntary nonprofit hospitals. The Hill-Burton Act eventually helped to finance 9,200 new hospitals and other facilities, assisting in financing almost one-third of all hospital projects in the nation. Federal appropriations for construction and renovation were matched by state and local funds. The program was credited with raising the number of hospital beds in low-income states, providing hospital facilities in rural areas, and, later, providing free care for those unable to pay. The Hill-Burton Act remains the most widely known legislation that Hill sponsored. Critics contended that new hospitals were concentrated in middle-income areas and that the program contributed to an oversupply of beds. Not until 1963 was desegregation of facilities required [6, 7].

Hill became chair of the Labor and Public Welfare Committee in 1955, as well as its Health Subcommittee and the Appropriations Subcommittee with jurisdiction over education, labor, and health. Therefore, he was in the unique position of controlling the funding of programs he helped to create. Hill, who had supported the legislation creating the National Institutes of Health (NIH), teamed with Representative John Fogarty of Rhode Island to bring about federal funding of medical research on an unprecedented scale. In an informal coalition with citizen-advocates Mary Lasker and Florence Mahoney, activist physicians such as Sidney Farber and Michael DeBakey, and NIH director James Shannon, they held hearings and passed vastly increased NIH budgets. Applied research to develop cures for cardiovascular disease and cancer appealed to the public as well as to legislators and presidents who suffered from these killer diseases. The federal government moved from limited involvement in basic research to directly supporting, through grants to researchers at medical centers, more than 40% of biomedical research in the United States by 1967 [8, 9].

Hill also used his position and his persistence in improving conditions in rural areas to allot federal funds for rural libraries. For a decade, he worked to provide library service to those with no or inadequate facilities, promoting the Jeffersonian ideal of an educated citizenry. In 1956, the Library Services Act authorized federal money to develop library services in rural areas; it was later extended to urban libraries. The act was lauded as a model of federal grant legislation, preserving local and state responsibility while stimulating increased local financial support for libraries. In recognition of his efforts, Hill was named an honorary member of the American Library Association [10].

He also had a direct impact on medical libraries. With Senator John Kennedy, he cosponsored a bill in 1956 to create the National Library of Medicine as part of the Public Health Service and provide a new building for the old Armed Forces Medical Library. The Medical Library Assistance Act of 1965 provided the grant mechanism to improve medical library facilities and resources, train information professionals, stimulate research and development, and establish regional medical libraries [11]. Hill pointed out that this measure was “designed to close the gap between the scientific break-through and the more important clinical follow-through,” by communicating to practitioners the progress in research and its application to medical knowledge [12].

Hill's involvement in health legislation included federal funds for regional programs to improve care for heart disease, cancer, and stroke victims; treatment for the mentally retarded and mentally ill; vocational rehabilitation for the disabled; and training for health professionals. He eventually supported President Johnson's Medicare and Medicaid programs as well. Parallel to his contributions to the health of Americans, his long-standing interest in equalizing educational opportunities was rewarded with the National Defense Education Act of 1958. The Cold War afforded the rationale to overcome resistance to federal assistance for education to combat illiteracy and upgrade job skills [13].

The New York Times summed up Hill's career. It described him as trapped by the racial history of his region but a father of NIH and the legislator of his generation most “responsible for bringing modern medical care and adequate educational facilities to every region of the United States” [14, 15].

The impact of the legislative program that bears his imprint is still felt in the way health care systems, biomedical research, and library services are organized. While the nation today continues to struggle with decisions about how to make health care accessible, the foundation of biomedical research remains NIH and its support of researchers. Medical libraries are organized to support education, research, and health care wherever they take place. The institutions named for Hill, and their roles in improving health care information, reflect the legacy of the causes he championed. UAB's Lister Hill Library recently celebrated the thirtieth anniversary of its October 1971 dedication [16]. NLM's Lister Hill Center, conducting research and development to improve health care information dissemination and use, was dedicated in 1980 [17]. Hill, who was present for both ceremonies, would recognize their goals.