Dr. H. Jack Geiger, a Towering Public Health Leader

H. (Herman) Jack Geiger, MD, MSciHyg (1925–2020) was a deeply respected and charismatic figure in US medicine and public health. Geiger was the model for principled health advocacy for us and for many of our contemporaries. Through his life’s work, he became one of the most persuasive leaders and tenacious fighters for health equity and human rights in the world. His remarkable accomplishments include leading the national effort in the United States to promote community-oriented primary health care, especially for the poor and disenfranchised; being a brilliant spokesman for the conceptualization and implementation of the field of social medicine; influencing multiple generations as a teacher of community medicine and public health at Tufts University, the State University of New York at Stony Brook, and the City University of New York; and being a recruiter and role model as a founder and leader of International Physicians for the Prevention of Nuclear War and Physicians for Human Rights.

FIGURE 1—

H. Jack Geiger with his wife Nicole Schupf, and their dog, Cooper (date unspecified). Printed with permission.

Geiger’s inspiring leadership and achievements were lauded by his receipt in 1998 of the National Institute of Medicine’s Gustav O. Lienhard Award for “creating a model of the contemporary American community health center to serve the poor and disadvantaged, and for his contributions to the advancements of minority health.”¹ We were especially and personally proud that in that same year he was also awarded the American Public Health Association’s (APHA’s) Sedgwick Memorial Medal for distinguished service in public health. The International Physicians for the Prevention of Nuclear War and Physicians for Human Rights both received the Nobel Peace Prize while Geiger served in leadership positions in 1985 and 1998, respectively. In 2010, it came as no surprise to us that he received the Albert Schweitzer Award for Humanitarianism.

Geiger received these awards for his inspiring achievements and for his brilliant and consistent advocacy of social justice in health over the span of his long career, accomplishments that sprang from his deep understanding of the roots of health inequalities in the social order. His understanding was profound, and for many of us Geiger served as the best contemporary role model and most direct link to the principles of social justice that are the foundation of public health and health reform.

In a story first told by Geiger on national public radio’s This American Life in 1997 and made familiar in several retellings since, Geiger explained that he first came to understand these principles as a “runaway teenager” directly exposed to leaders of the African American artistic, political, and literary community.² Geiger further explained that when he left home and went to college and medical school, first at the University of Wisconsin, then at the University of Chicago, and eventually at Case Western University Medical School, he acted on these principles in direct nonviolent civil rights actions and persistent advocacy.

Geiger interspersed his education with stints as a journalist and as a member of the Merchant Marine, a service in which he enlisted during World War II because it was the only integrated service in the US military. He transformed his early civil rights actions and advocacy into concrete accomplishments as a young health professional when he helped found the Medical Committee for Human Rights in the 1960s; went to Mississippi during “Freedom Summer”; and brought a radically innovative model of health service, reform, and political action from Pholela, South Africa, which he had encountered as a visiting medical student in the late 1950s, to Mound Bayou, Mississippi, in the 1960s.²

Geiger always, amazingly, saw the big picture. He wrote the following in 1969:

Right now we health professionals are standing in the middle of an endlessly revolving door . . . doing some good on a short-term basis. . . . [But] we cannot go on providing health services without regard to the system in which the roots of poverty, sickness, and many other social ills are embedded. We have to be willing to identify the real problems and confront them . . . we have to create new social institutions appropriate to the problem; and, finally, we need a sense of passionate commitment to bring about the changes that are so urgently needed.^3(p2436)

Geiger saw the Mound Bayou community health center as one of those “new social institutions,” a health center that had “as its primary thesis that the determinants of health are in the social order, not health care. . . . We think there’s a better way to . . . [improve a community’s health] by using health services as a route of entry for these other kinds of social change.”^4(p139) This health center and a companion one in Columbia Point, Boston in Boston, Massachusetts, were the vanguards of what became the Federally Qualified Community Health Center program, a program that has dramatically expanded access to health care in underserved communities.

That, of course, was a radical vision, and Geiger never lost sight of it; he worked to make sure that we never lost sight of it either. But he also never lost sight of how important properly organized and accessible health services are (hence his lifelong commitment to the primary care movement), nor did he lose sight of the central importance of equity in access to quality health services. He articulated the critical connections between equity in access and social justice in the brilliant essay “Medical Care,” published in Barry Levy and Victor Sidel’s influential book Social Injustice and Public Health.⁵ Geiger wrote as follows:

Medical care . . . makes a difference to both personal and public health—one that is most clearly revealed when care is absent or denied. For example, failures to provide immunization have repeatedly led to outbreaks. . . . Lack of prenatal care is associated with higher rates of infant and maternal mortality. . . . Studies of poor adults removed from programs that fund access to care . . . have documented the occurrence of uncontrolled illness— and some preventable deaths.^{6(pp208–209)}

And more generally, he wrote:

Because poor health care and poor health so profoundly limit opportunities . . . for the full realization of one’s potential . . . justice in health care is good for the public’s health, and the public’s good health, in turn, broadens opportunities and facilitates a more just society.^6(pp208-209)

In that same essay, Geiger identifies the basic source of injustice in access to health care in our country: ideological and political biases that:

treat medical care as a market commodity . . . rather than as a social good to be distributed in response to medical need, a responsibility of government, and a fundamental right embodied in a social contract.^6(p207)

To Geiger, the alternative to our present system was clear: a universal, equitable, single-payer, “Medicare for All” health system in the United States. And thus, among the many other admirable things Geiger did, he was also a passionate supporter of the single-payer cause. He did this in the context of the APHA and other professional and advocacy organizations in the 1970s and 1980s; as a founder of Physicians for a National Health Program (PNHP) in the late 1980s; as a stalwart member and advocate of PNHP in the 1990s (including one memorable appearance in 1998 as a speaker at a rally on the steps of the Canadian embassy after a march from the APHA meeting through the streets of Washington, DC, led by APHA president Quentin Young in search for “health care asylum”); and as a strong, clear voice for “Everybody In, Nobody Out” at the local, state, and national levels in recent years.

Geiger continued his passionate and brilliant analysis and advocacy during the past two decades of his life. He continued to publish articles, essays, book chapters, and opinion pieces in leading newspapers, magazines, and list serves, and he remained much in demand as a speaker and commentator at national and local meetings and at universities. He was a familiar and inspiring presence, and he made several appearances at APHA conferences in the 2010s that we remember vividly. Eventually, failing health and increasing visual impairment kept Geiger at home although he still maintained inspiring e-mail and telephone contact with colleagues and friends as long as he could. He died on December 28, 2020, at the age of 95. He was a giant whose towering impact is for the ages.