Alonzo Yerby

Champion of the Poor

"There is serious question as to whether the best medical care, handsomely delivered to the slum-dwelling indigent, has any meaning in the face of conditions that breed disease and despair far faster than they can be cured or ameliorated." These words, appearing in the August 1965 issue of the American Journal of Public Health, expressed the passion and frustration of their author, the late Alonzo Smythe Yerby, MPH '48. The timing was significant: a month earlier President Lyndon Johnson had signed the Medicare/Medicaid act--the most sweeping revision to social security since it was installed in 1935.

However, Yerby, who had been a consultant to the Johnson Administration in drafting the legislation, believed that the final act fell short of its original ideals. Although Medicare was designed to subsidize medical care for elderly Americans, little thought was given to the particular needs of indigent people who couldn't afford even the low monthly fees required for participation in the plan. According to a history of Medicare written by the Department of Health and Human Services, Medicaid--which appropriates funds specifically for health care for the poor--was "almost an afterthought." Yerby likened Medicare/Medicaid to the seventeenth century colonial Poor Law, which provided food handouts and other alms to the destitute, and criticized the system for reducing something as essential to health as medical care to the status of charity. In addition to undermining the recipients' dignity, said Yerby, Medicaid¹s medical "handouts" did nothing to solve the underlying problem of poverty.

Addressing the White House Conference on Health in 1965, Yerby, then Commissioner of Hospitals for New York City, declared: "We can no longer tolerate a two-class system of health care. Let the word go forth...that America is prepared to assure all of its citizens equal access to health services as good as we can make them, and that the poor will no longer be forced to barter their dignity for their health."

Born in Chicago, Yerby was the youngest of four children. After finishing high school, he went to the University of Chicago and then to Meharry Medical College in Nashville, Tennessee, one of only two black U.S. medical colleges in existence at the time. He graduated in 1946, and the following year enrolled at the Harvard School of Public Health. As a student, Yerby was a protégé of Franz Goldman, associate professor of medical care in the Department of Public Health Practice. At Goldman's suggestion, Yerby went to Germany, first as a field medical officer for the U.N.'s International Refugee Organization, where he supervised the medical services for displaced persons in refugee camps, followed by service as deputy chief of medical affairs of the Office of the U.N. High Commissioner on Refugees.

In 1966, Yerby left public service to return to the School of Public Health as professor and head of the Department of Health Services Administration (forerunner to the Department of Health Policy and Management), a position he held for the next 16 years. At the time, HSPH Dean John Snyder told The New York Times that Yerby¹s appointment "...reflects our concern that new and imaginative approaches are needed to establish closer relationships between health professions and hospital administrators on the one hand, and community leaders on the other."

Yerby--a man whose professional formality masked a warm sincerity beneath--was the only black tenured faculty member at the School, a distinction noted by minority students at the School and throughout Harvard University, who sought him out as a role model and adviser on career issues. Carolyne Arnold, MPH, '73 a former student of Yerby's says she was teaching at Howard University when she first began hearing about Yerby, who was making a name for himself as a leader in public health and as a member of the "small club" of black professionals in academia at the time. Many of the students who sought Yerby's guidance came, in one way or another, from the rising civil rights movement. But while Yerby was deeply troubled by social injustice, particularly in terms of health care and poverty, he steadfastly counseled moderation in achieving the objectives of social justice.

"We were all creatures of the 1960s," says Arnold. "The notion of confrontation was part of the way we saw the world. But Professor Yerby wasn't like that. He didn't encourage us to jump up and down."

Yerby's eldest son, Mark, says his father's tactics were intended to catalyze rather than polarize the situation. "If the goal is to achieve change and social justice, if you're strident, the opponent becomes defensive, so you can't reach any solution," he says. "That's the lesson I learned. People focus on the advocates, not the thing they're advocating for."

Monteal May, Yerby's wife of over 50 years, adds: "The black people we knew were professionals. They weren't suffering," she says. "People were concerned with preparing yourself for the future. We didn't think in terms of skin color. The battles we were fighting were to improve ourselves."

As a teacher, Yerby was known for his vast practical knowledge of health-care systems around the world. He taught a popular course focusing on health systems administration, the highlight of which was an annual field trip to Quebec during intercession. In conjunction with Sidney Seymour Lee, who before leaving to become associate dean for community health at McGill University was clinical professor of hospital and medical care administration at the School, Yerby enabled HSPH students to witness firsthand the evolving Canadian health care system based on universal coverage.

"It was really a very broadening and enriching experience," says Arnold.

The field trips also spawned a "steady stream" of Quebecois to the School, says Fernand Turcotte, MPH '71. "We had come to the States to learn how to do it; we came back to Canada to do it." Turcotte, now a professor of social and preventive medicine at the University of Laval in Quebec, which hosted the American students in the 1970s, says that the training he and his fellow Canadians received at the School enabled them to establish public health programs at medical schools throughout Canada based on what they had learned at the School.

Yerby eventually became disillusioned with academic medicine, but he never lost his love for teaching. After resigning from the School in 1982, he continued teaching at the Uniformed Services University for the Health Sciences in Bethesda, Maryland. "His students were his greatest legacy," says his son Mark. Alonzo Yerby died in February 1994.

Reflecting on his father's beliefs and on the Medicare/Medicaid system that his father criticized so passionately, Mark Yerby, who has a private neurology practice in Portland, Oregon, says: "It's not economical to care for people who are poor. You can't have more than 10 percent of your patient population be on Medicaid. Do we act differently towards those patients? The answer is "yes", because the clock is always ticking overhead.

Moreover, he says, the whole system has become an administrative nightmare. While sitting in his office late one evening, he searches through a book of HCFA codes to locate the required set of numbers and letters that identify a patient's disease­hereditary spastic paresis. He cannot find it.

"When Dad was involved, people who went into administration had an MD and an interest in how the whole operation should run," he says, finally closing the thick book. "Today, those folks have MBAs." But despite his frustration, Yerby says he still believes in one major tenet of his father¹s work: "He believed that public health was not just the purview of public health professionals, but belonged to every physician."

- Terri L. Rutter

 

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