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Text
Remarks by
Dr. Russell G. Maw"ty, President, W. K. Kellogg Fcundat i on
at the
27th Nati onal Conf'e r er.c e on Rural Eeal t.h
Detroit, Michigan
April 25, 1974
I
It is a privilege to b e a part of the progr8.I!l of thi s 27t h
National Conference on Rural Health.
We are pleased indeed that this
year' s confer ence is bei ng held in Mich igan a nd I would ex pr e s s lliy
complimen t.s t o the Counc i l on Rural Heal t h of the Americ an Meci.i cal
Association for the ex c ell enc e of the pr ogram t hey have planned f or
U3.
Certainly the conference t heme , "Rural Heal th i s a Community ;\.ffs.ir,"
is timely and significant, and we a.re fo r t un ate t o have so ma r:y outstanding resource people participating in the various confer ence
sessions.
I enjoyed very much the opportunity of attending this mor ning ' s
session, with the keynot e address by Dr. Budd and the stimulat ing symPOS iUID 0 :1
"Di :cections f or t he Fu ture."
practi~ al
S U8~ e st i on s
~ha:ce d
I especially welc omed the
with us by Dr . Budd and by the symposium
participants related to the development of family practice programs,
extending the role of the nurse, and exploring the potentials for rural
g=oup practice.
II
My remarks, with the title, "Our Conc erns for Rural Health," have
duo perspec tives:
i i r s t. fl' om the at.a ndpo irrt of the program ini:: erests
�2
o
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�3
administrator and members of the hospital staff and board of trustees,
and interested citizens in the community, have undertaken a systematic
program to improve the health situation in their community.
In conse-
quence, illany positive changes have taken place in recent months.
But this little anecdote of a true experience summarizes many of
the things which
this country.
conce~n
us about the health care delivery system in
We are concerned with issues vh ich are described in
phrases like accessibility, continuity, comprehensiveness, and quality
of care; delivery systems; financing arrangements; a corrmunity and preventive dimension to our health systems; operational effectiveness.
Relating further specifically to the rural scene, certain issues
come to the fore:
- The critical shortage of health wanpower -- physicians, nurses,
dentists, pharmacists, allied health personnel, etc.
- Distances to health resources
the "s oc i a.L cost" of space.
- The distressed situation of many rural hospitals -- losing
medical staffs, inadequate professional and auxiliary personnel, declining patient populations -- with many institutions
on the verge of bankruptcy.
- Health professionals increasingly concerned with professional
"isolation" in rural practice--with the parallel
desire to
locate where there is ease of referral and the stimulation of
professional contact, with easier access to a wide range of
resources.
You know these problems and others better than I--and many of your
sessions here will focus on solutions to such specific issues.
�4
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o
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f30 r
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�6
Beyond Michigan we could mention further examples:
- An effort to improve the transport capac i ty of the Samaritan
Health System in Arizona;
- The involvement of the University Health Center and professional
schools of the University of Iowa in a program at guscatine to
improve health care delivery and provide i mproved
ed~cational
opportunities for medical students;
- A demonstration of the training and use of nurse practitioners
in the rural area of Treasure Valley, Idaho, and the illvolvement
of Boise State College in their educational curriculum for the
preparation of nurse practitioners and clinical specialists for
rural areas;
- The training of family practice residents, with emphasis on
individual location in smaller communities and rural areas in
California; and
An effort to improve hospital emergency services in rural com-
munities of South Carolina.
IV
To comment briefly on innovations which may contribute to improved
health care in rural communities, it is necessary to refer back to the
problems which concern us--issues such as access and availability of care,
continuity and comprehensiveness of care, productivity of various elements of the system, cost and financing, quality.
With these central
issues in mind, from our vantage point we see such promising opportuniti es
as the following:
�7
1. Reo.!:f:ani zation of ambulatory healt..h services mray from an
endless series of specialty-oriented clinics to a more comprehensive family-centered health service unit utilizing
such qualified personnel as nurse practitioners and physicians assistants for health mainten ance functions, preventive health programs, and long-term supervision of chronic
conditions.
2.
Development of institution-based (hospital) outreach programs,
such as home care, primary care clinics in under-served areas,
and appropriate linkages or relationships with other care providers, such as nursing homes.
3.
Development of rational patterns f or handling true emergency
medical problems, with the division of labor among institutions
along rational lines and with an integrated transportation and
communications system.
4. Development of effective programs of in-patient education for
illness management, with an improvement of the patient's understanding of his problem and the procedures that will be performed,
and with an emphasis upon the patient's appropriate responsibility
for his individual rehabilitation and continuing health maintenance.
5. Further development and systemization of the relat.ionship of
education and service in the health fields.
Not only must
there be dramatic changes in the educational processes and
relationships by which people become qualified and prepared
for health careers, there must also be improvement in
�8
l
e
l
a
t
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sb
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sandh
e
a
l
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c
ei
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s
t
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t
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t
i
o
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sands
e
t
t
i
n
g
s
. Som
ehow w
e mu
s
tb
r
i
n
g
t
o
r
e
a
l
i
t
yt
h
emu
ch
-d
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s
cu
ss
e
dcon
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fa h
e
a
l
t
hd
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l
i
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r
y
n
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two
rk a
si
tr
e
l
a
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c
a
t
i
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l
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n
i
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r
s
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sh
av
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r
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eimp
rov
em
en
to
fh
e
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e
r
y
.
6
.
nha~~e ent o~e ser ice ~~i ins~
s
e
t
t
inF5
.f
o
rh ea
th ~~rsonnel
ice e d~ c ~~ i o n i
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t
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s an ex
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comp
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7
.
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h
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im
a
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yc
a
r
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to
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ec
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p
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a
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ls
e
r
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dc
u
r
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. Th
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e
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hf
o
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rg
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sn
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p
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rs
e
t
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r
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rem
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en
cy roomc
a
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et
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ob
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p
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x
p
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n
s
i
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e
t
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r a~ls
ers
a
r
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,a
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b
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r
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nsom
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s
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a
n
c
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,and s
h
o
u
l
db
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�9
8. Whenever resources are scarce in relation to ne eds, the
usual situation in rural areas, ever bet t e r manag ement is
.
i
required as priorities are estatlished and allocations
made.
A long-standing orientation of this Foundation
has been to improved management and a dmi n i s t r at ion , in
the health fields as well as in other fields of Foundation
ende avor.
We have been particularly impressed with bene-
fits achieved through sharing of services by hospitals and
the application of management engineering techniques in the
liealth care delivery system.
9.
Elaboration of the role of the trust ee in the health care system.
The institutional board of trustees, if representative, well
qualified, and well informed, is an essential element in
responsive institutional administration.
Trustees can assist
in keeping the endeavor oriented to the ultimate
p~poses
of
the institution, above the more vested interests of the institution itself, its professional components, and its personnel.
One could go on virtually ad infinitum with innovative options.
But
underlying issues such as these are two basic considerations:
A. The problem of fragmentation, both in terms of care as it is
available to the individual person and fragmentation of efforts
of the various elements of our health system.
There is almost
a desparate need for greater cooperation and coordination of
the efforts of the individuals, institutions, and organizations
involved with rural health--health departments, state and
local; hospitals and other institutions, public and private;
�10
p
r
o
f
e
s
s
i
o
n
a
l
s
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o
t
hi
n
d
i
v
i
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u
a
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l
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r
ough t
h
e
i
rO
l
"g
an
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t
i
o
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s
;e
d
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c
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t
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u
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i
t
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a
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ri
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tit
u
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s
,p
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a
t
e
.
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o
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yh
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,~ o r n e t
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o
s
t
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f
,
ands
u
f
f
e
r
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h
econ
s
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en
c
e
so
f
ra
H
o
p
e
f
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l
l
y
,
ent ~tion
l
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r
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h
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pf
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o
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a
t
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who a
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emo
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t know
l
edg
ea
'l
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g impo
s
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.
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. Th
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e
ed f
o
ra comp
r
eh
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s
iv
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r
amo
fhe ~lth e
d
u
c
a
t
i
o
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.
I wou
ld l
i
k
et
os
h
a
r
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ethough
ts f
roma
r
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c
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ta
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r
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s
sbyD
r
. C
.A
. Ho
f
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Am
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r
i
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an M
ed
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l A
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.
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rC
E
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lS
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en
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n
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iffe
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b
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en good h
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.
~
r i c an s
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ogoodm
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ear
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ogood h
e
a
l
t
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. Good h
e
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hi
sn
o
t ar
i
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bt
,
b
u
ta
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s
p
o
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s
i
b
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r
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tt
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r
i
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romwh
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igh
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ete~ed an a
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r
�11
plays a significant positive role in heart disease, cancer, stroke, and accidents--the four leading causes of death
in America tocay.
"Indeed, if all Americans could be convinced to adopt
a healthful style of life--eating correctly, not smoking,
controlling pollutants, driving safely--the positive effect
of the nation's health would be far mor e dramatic than could
be accomplished through the construction of thousands of
new hospitals and the production of many thousands of additional physicians."
There is some slight encouraging evidence that progress may be
forthcoming in this area.
For example, in 1969 the Michigan Legisla-
ture enacted the "Critical Health Problems Education Bill."
This
legislation provides for health education for Michigan youth in elementary and secondary schools, including sucr. areas as mental health;
dental health; vision care; drugs, narcotics, alcohol, tobacco; disease
prevention and control; accident prevention; nutrition.
Hopefully
this dimension of education will be incorporated in our local school
systems.
Another encouraging step in health education is an apparent recommitment to health education by the Cooperative Extension Service.
As
you know, the Extension Service has personnel and programs serving every
county in the United States.
With appropriate linkage to university
resources in the medical-health fields and close relationships with
local professionals and institutions, this Extension emphasis should
�12
represent a very positive influence in fostering proerams of health
education.
You have other ideas, too, that are being us ed in your local
communities; programs and displays of hospital auxiliaries, health
museums, special health education activities.
But what we need is a positive and comprehensive approach to
health education.
v
In rural health, as in most ar-eas of human endeavor, we know
better than we do.
The challenge is to use that which is known, to
utilize fully the know.Ledge resources which are available.
We need not more plans but more action; not more criti'lues and
critics but better examples.
This requires imagination, innovation,
creativity, resourcefulness--in sum, leadership--not from on high,
but in home communities, where the action really is.
The greatest danger in a conference of this kind is that we
each go home to a busy schedule and an accumulated backlog--and we
settle back into old and easier patterns.
The challenge to you and
me individually is that our being here should make a difference in our
part of the world, in our individual sphere of activity.
The challenge
then is that you, through your individual efforts, help move "what is"
in rural health a bit further toward the goal of "what could--and should
be. "
I wish you well.
�
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Russell Mawby Papers
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Charities
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Philanthropy and society
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The Russell Mawby papers document the life and work of Michigan-born Russell Mawby from 1928 to the present. Mawby was the Chief Executive Officer and Chairman of the W. K. Kellogg Foundation for twenty-five years and is recognized for his work in the area of philanthropy in the United States, Latin America, and Europe.
The digital collection includes a selection of field notes, speeches, itineraries, and other materials.
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Mawby, Russell G.
W.K. Kellogg Foundation
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<a href="https://gvsu.lyrasistechnology.org/repositories/2/resources/432">Russell Mawby Papers (JCPA-01). Johnson Center for Philanthropy Archives</a>
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Grand Valley State University. University Libraries. Special Collections & University Archives.
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Johnson Center for Philanthropy
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eng
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JCPA-01
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
1938-2012
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Source
<a href="https://gvsu.lyrasistechnology.org/repositories/2/resources/432">Russell Mawby papers, JCPA-01</a>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Identifier
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JCPA-01_1974-04-25_RMawby_SPE
Title
A name given to the resource
Russell Mawby speech at the 27th National Conference on Rural Health
Creator
An entity primarily responsible for making the resource
Mawby, Russell
Description
An account of the resource
Speech given April 25, 1974 for the W. K. Kellogg Foundation at the 27th National Conference on Rural Health of the American Medical Association.
Contributor
An entity responsible for making contributions to the resource
Grand Valley State University Special Collections & University Archives
Dorothy A. Johnson Center for Philanthropy and Nonprofit Leadership
Publisher
An entity responsible for making the resource available
Grand Valley State University Libraries, Special Collections and University Archives, 1 Campus Drive, Allendale, MI, 49401
Subject
The topic of the resource
Philanthropy and society
Family foundations--Michigan
Charities
W. K. Kellogg Foundation
Speeches, addresses, etc.
Health
Language
A language of the resource
eng
Rights
Information about rights held in and over the resource
<a href="http://rightsstatements.org/page/InC/1.0/?language=en">In Copyright</a>
Date
A point or period of time associated with an event in the lifecycle of the resource
1974-04-25
Format
The file format, physical medium, or dimensions of the resource
application/pdf
Type
The nature or genre of the resource
Text
-
https://digitalcollections.library.gvsu.edu/files/original/adf18f3776fe6d8b943e5a61c75c1f32.pdf
05540f1273432f1b0c2de71ad4a21c5f
PDF Text
Text
•
INNOVATION:
KEY TO BETTER. HEALTH AND EDUCATION
Remarks by Dr. Russell G. Mawby
President, W. K. Kellogg Foundation
at the
First American Health Congress
Chicago, Illinois
August 9, 1972
I
I am delighted to be with you this morning.
Thank you for the privilege
of participating in the program of the American Health
As many of you know, I am a
r~lative
Congres~
'72.
newcomer to our Foundation's staff
and particularly to my current responsibilities.
This is my first oppor-
tunity t.o attend a national conference i.n the health field.
Accordingly, as
a part of my own personal program of continuing education, I welcome the op portunity to participate in the various sessions of this Congress , to view
and discuss the exhibits and, especially, to meet and visit with so many of
you informally.
It is exhilarating and gratifying to be a part of a -pioneering event such
as this first Congress.
I join others in expressing congratulations to your
four organizations--the American Hospital Association, the Catholic Hospital
Association, the American Nursing Home Association, and the Health Industries
Association--for their vision and leadership in bringing about this joint
annual professional meeting.
Too many of our efforts in the complex area of
health a r e characterized by fragmentation and diversity, rather than comprehensiveness and coordination.
This Congress is a tangible recognition of the
commonality of concern, purpose, and interest of your four constituent groups.
I commend you.
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comprehensiYeness of care; delivery systems; financing; community focus;
and operational effectiveness.
It is to issues such as these that innovative efforts in health care
must be directed.
IV
In the pluralistic tradition of our American society, the particular role
of private philanthropy to societal progress is the encouragement of innovation.
While philanthropic resources are almost miniscule in relation to total expenditures of the American public fOl health, philanthropic funds represent the risk
capital which has been responsible for many irillovations in health technology,
education, and delivery.
While the operating 'budge t s of many of the institutions
which you represent are larger than the budget of the Kellogg Foundation, our
funds are essentially "unr-estr-Lc t.ed" whereas the typical institutional budget
is pre-connnitted, with little flexibility or- option for creative and uncertain
undertakings.
As a part of your institutional situation, it is apparent that the present
pattern of reimbursement by third-party payers constrains managerial flexibility
and responsiYeness and inhibits experimentation and change.
It does not seem
ulll'easonable to expect you, as health care leaders, to take an initiating responsibility in bringing about improvement in reimbursement arrangements, including
the institutionalization of the costs of new techniques or patterns once their
value has been verified.
To do less is a dereliction of your pr-of'e s s i.ona.L prerogative.
Obviously, because there is great diversity in the purposes, philosophies,
and procedtJes of the foundations of this country, I cannot speak for all.
It
is a safe generalization, howe,rer, that private foundations are concerned that
their limited resources be directed not to general operational purposes or to
"more of the same" but rather to significant pioneering vent.ur es ,
�'I
To i llus t r a te the contribution of philanthropy in health care, I will
use t h e foundatio n wi th which I am as sociated and wi t h whi ch I am most
familiar.
As those of you who know our Foundation appreciate, we are
concerned with the application of kn owledg e t o the problems of peop le.
do not support research per see
We
Rather, our orientation grows out of the
r e cogni t i on of the fact that one of t h e problems of our society is t he effe ctive utilization of available kno,rledge, in effect putting to use that
which is known.
Beyond this, we are people-oriented, focusing upon signifi-
cant problems which relate to human well-being.
In t he endeavors we support,
we are concerned with the potential for replication of ideas successfully
demonstrated and with the cost-bene f i t ratio of the expenditure.
One example of such suppor t was the development of the intensive care
unit as a s ignificant advancement in the hospital fi eld.
The Foundation's
aid was extended to a selected number of hospitals when the idea was in its
infancy.
The experiences of these pioneer units were car efl1lly evaluated, and
in ke.ep i.ng with the Foundat i on ' s concern vith dissemi nation, were l<rio.ely dist :;:'ibuted t o the f i el d.
Another exampl e- - r e coga i zi ng the importance of the
contribution of management engineering to both patient care and cost cont a i nment , the Foundation was an ear l y supporte:c of program efforts to t.h i.s end ,
particula rly using the approach of multiple hospitals sponsorship.
Finally,
for many years the Foundation has encouraged the sharing of resources by
health care institutions and organizations.
Currently we are aiding a number
o f "shared. services models" in various parts of the country .
The hope is that
the exp eriences of thes e selected programs will be of assistance to the field
at l ar ge in terms of their consideration of like endeavors.
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supervision of chronic conditions.
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car e , ,;·lith an ambitious implementation of the principles of p:ceventive medicine and provision of quality health care in the
Leas t-cco s t manner and c i.rcumst.ance .
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linkages or relationships with other c.are providers, such a.s
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prob.Lems , with the division of labor amongst institutions along
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�12
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emphasis upon the patient's appropriate responsibility for his
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delivery network
delivery.
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setting for hea.Lt h personnel.
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Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Russell Mawby Papers
Subject
The topic of the resource
Charities
Family foundations--Michigan
Philanthropy and society
Description
An account of the resource
The Russell Mawby papers document the life and work of Michigan-born Russell Mawby from 1928 to the present. Mawby was the Chief Executive Officer and Chairman of the W. K. Kellogg Foundation for twenty-five years and is recognized for his work in the area of philanthropy in the United States, Latin America, and Europe.
The digital collection includes a selection of field notes, speeches, itineraries, and other materials.
Creator
An entity primarily responsible for making the resource
Mawby, Russell G.
W.K. Kellogg Foundation
Source
A related resource from which the described resource is derived
<a href="https://gvsu.lyrasistechnology.org/repositories/2/resources/432">Russell Mawby Papers (JCPA-01). Johnson Center for Philanthropy Archives</a>
Publisher
An entity responsible for making the resource available
Grand Valley State University. University Libraries. Special Collections & University Archives.
Contributor
An entity responsible for making contributions to the resource
Johnson Center for Philanthropy
Rights
Information about rights held in and over the resource
<a href="http://rightsstatements.org/page/InC/1.0/?language=en">In Copyright</a>
Format
The file format, physical medium, or dimensions of the resource
application/pdf
Language
A language of the resource
eng
Type
The nature or genre of the resource
Text
Identifier
An unambiguous reference to the resource within a given context
JCPA-01
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
1938-2012
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Source
<a href="https://gvsu.lyrasistechnology.org/repositories/2/resources/432">Russell Mawby papers, JCPA-01</a>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Identifier
An unambiguous reference to the resource within a given context
JCPA-01_1972-08-09_RMawby_SPE
Title
A name given to the resource
Russell Mawby speech, Innovation: Key to Better Health and Education
Creator
An entity primarily responsible for making the resource
Mawby, Russell
Description
An account of the resource
Speech given August 9, 1972 for the W. K. Kellogg Foundation at the First American Health Congress.
Contributor
An entity responsible for making contributions to the resource
Grand Valley State University Special Collections & University Archives
Dorothy A. Johnson Center for Philanthropy and Nonprofit Leadership
Publisher
An entity responsible for making the resource available
Grand Valley State University Libraries, Special Collections and University Archives, 1 Campus Drive, Allendale, MI, 49401
Subject
The topic of the resource
Philanthropy and society
Family foundations--Michigan
Charities
W. K. Kellogg Foundation
Speeches, addresses, etc.
Education
Health
Language
A language of the resource
eng
Rights
Information about rights held in and over the resource
<a href="http://rightsstatements.org/page/InC/1.0/?language=en">In Copyright</a>
Date
A point or period of time associated with an event in the lifecycle of the resource
1972-08-09
Format
The file format, physical medium, or dimensions of the resource
application/pdf
Type
The nature or genre of the resource
Text
-
https://digitalcollections.library.gvsu.edu/files/original/15d420c42f5f41c71cb356d1b5c5739e.pdf
07120ddc28895d7d114a5606f69c3f87
PDF Text
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continuity and comprehensiveness of care, productivity of various elements of the system, cost and financing, quality.
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issues in mind, from our vantage point we see such promising opportunities
as the following:
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n
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ram
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t
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s
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longr
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ll
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h an i
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p
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s
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em
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4
.
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lopm
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to
fe
f
f
e
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t
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rog
r
am
so
fi
n
p
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n
te
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t
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o
nf
o
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i
l
l
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sm
an
ag
em
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, w
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t
ha
n imp
rov
em
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to
ft
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su
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d
e
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t
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d
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go
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ed
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andw
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t
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n emph
a
s
i
s upon t
h
ep
a
t
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'
sa
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5
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v
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eh
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l
d
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. N
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ed
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am
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t
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c ch
ang
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relationships between educational institutions and health
service institutions and settings.
Somehow we must bring
to reality the much-discussed concept of a health delivery
network as it relates to both education and health care
delivery.
Universities have been preoccupied with medical
science and research; hopefully, more of their attention and
resources will be directed to the improvement of health care
delivery.
6. Enhancement of preservice and inservice education in the work
setting for health personnel.
This setting is not only appro-
priate but essential for certain aspects of education and
training.
As an example, hospitals are becoming more conscious
of their educational role and in many instances are beginning
to establish institution-wide education and training programs.
Such programs encompass employee orientation, on-the-job training,
supervisory development, career mobility, clinical instruction,
inservice education, patient education, and community education.
7.
Experimentation regarding the hospital role in the provision of
primary care, the component of comprehensive care perhaps
least-well served currently.
The public, in search for such
care, has turned to the community hospital, via the emergency
room.
But the emergency room is not the proper setting for
qUality primary care, for emergency room care tends to be episodic and very expensive.
Better answers are available, are
being demonstrated in some isolated instances, and should be
more characteristic of the delivery system.
�9
8. Whenever resources are scarce in relation to needs, the
usual situation in rural areas, ever better mar-agement is
I
required as priorities are established and allocations
made.
A long-standing orientation of this Foundation
has been to improved management and administration, in
the health fields as well as in other fields of Foundation
endeavor.
We have been particularly impressed with bene-
fits achieved through sharing of services by hospitals and
the application of management engineering techniques in the
health care delivery system.
9. Elaboration of the role of the trustee in the health care system.
The institutional board of trustees, if representative, well
qualified, and well informed, is an essential element in
responsive institutional administration.
Trustees can assist
in keeping the endeavor oriented to the ultimate purposes of
the institution, above the more vested interests of the institution itself, its professional components, and its personnel.
One could go on virtually ad infinitum with innovative options.
But
underlying issues such as these are two basic considerations:
A. The problem of fragmentation, both in terms of care as it is
..c
available to the individual person and fragmentation of efforts
of the various elements of our health system.
There is almost
a desparate need for greater cooperation and coordination of
the efforts of the individuals, institutions, and organizations
involved with rural health--health departments, state and
local; hospitals and other institutions, public and private;
�10
professionals, both individually and through their organizations; educational institutions, including colleges and
universities, four-year and two-year institutions, public
and private.
For too long society has tolerated, borne the costs of,
and suffered the consequences of fragmentation.
Hopefully,
leadership for its rationalization will come from those
who are most involved and most knowledgeable, rather than
being imposed.
B.
The need for a comprehensive program of health education.
I would like to share with you some thoughts from a
recent address by Dr. C. A. Hoffman, President of the
American Medical Association.
"A major cause of the current
controversy about America's health care is that the public
and the government fail to understand the difference
between good health and good medicine.
Americans have a
right to good medical care, but they do not have a right
to good health.
Good health is not a right, but a
responsibility--a shared responsibility--and that responsibility begins with the individual's own health behavior.
The health habits of most Americans are so poor that the
nation is suffering from what might be termed an acute case
of 'people pollution' and poor personal health behavior
�11
plays a significant positive role in heart disease, cancer, stroke, and accidents--the four leading causes of death
in America today.
1
"Indeed, if all Americans could be convinced to adopt
a healthful style of life--eating correctly, not smoking,
controlling pollutants, driving safely--the positive effect
of the nation's health would be far more dramatic than could
be accomplished through the construction of thousands of
new hospitals and the production of many thousands of additional physicians."
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Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Russell Mawby Papers
Subject
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Charities
Family foundations--Michigan
Philanthropy and society
Description
An account of the resource
The Russell Mawby papers document the life and work of Michigan-born Russell Mawby from 1928 to the present. Mawby was the Chief Executive Officer and Chairman of the W. K. Kellogg Foundation for twenty-five years and is recognized for his work in the area of philanthropy in the United States, Latin America, and Europe.
The digital collection includes a selection of field notes, speeches, itineraries, and other materials.
Creator
An entity primarily responsible for making the resource
Mawby, Russell G.
W.K. Kellogg Foundation
Source
A related resource from which the described resource is derived
<a href="https://gvsu.lyrasistechnology.org/repositories/2/resources/432">Russell Mawby Papers (JCPA-01). Johnson Center for Philanthropy Archives</a>
Publisher
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Grand Valley State University. University Libraries. Special Collections & University Archives.
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Johnson Center for Philanthropy
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<a href="http://rightsstatements.org/page/InC/1.0/?language=en">In Copyright</a>
Format
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application/pdf
Language
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eng
Type
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Text
Identifier
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JCPA-01
Coverage
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1938-2012
Text
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Source
<a href="https://gvsu.lyrasistechnology.org/repositories/2/resources/432">Russell Mawby papers, JCPA-01</a>
Dublin Core
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Identifier
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JCPA-01_1976-02-14_RMawby_SPE
Title
A name given to the resource
Russell Mawby speech, Wholistic Health Center
Creator
An entity primarily responsible for making the resource
Mawby, Russell
Description
An account of the resource
Speech given February 14, 1976 for the W. K. Kellogg Foundation on the problems in the health care system and what private foundations can do to help.
Contributor
An entity responsible for making contributions to the resource
Grand Valley State University Special Collections & University Archives
Dorothy A. Johnson Center for Philanthropy and Nonprofit Leadership
Publisher
An entity responsible for making the resource available
Grand Valley State University Libraries, Special Collections and University Archives, 1 Campus Drive, Allendale, MI, 49401
Subject
The topic of the resource
Philanthropy and society
Family foundations--Michigan
W. K. Kellogg Foundation
Charities
Speeches, addresses, etc.
Health
Language
A language of the resource
eng
Rights
Information about rights held in and over the resource
<a href="http://rightsstatements.org/page/InC/1.0/?language=en">In Copyright</a>
Date
A point or period of time associated with an event in the lifecycle of the resource
1976-02-14
Format
The file format, physical medium, or dimensions of the resource
application/pdf
Type
The nature or genre of the resource
Text
-
https://digitalcollections.library.gvsu.edu/files/original/3e01ab2e54292ec88894090ad8312499.pdf
e6acb6372f49b1437fd5c9e526197dc8
PDF Text
Text
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Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Russell Mawby Papers
Subject
The topic of the resource
Charities
Family foundations--Michigan
Philanthropy and society
Description
An account of the resource
The Russell Mawby papers document the life and work of Michigan-born Russell Mawby from 1928 to the present. Mawby was the Chief Executive Officer and Chairman of the W. K. Kellogg Foundation for twenty-five years and is recognized for his work in the area of philanthropy in the United States, Latin America, and Europe.
The digital collection includes a selection of field notes, speeches, itineraries, and other materials.
Creator
An entity primarily responsible for making the resource
Mawby, Russell G.
W.K. Kellogg Foundation
Source
A related resource from which the described resource is derived
<a href="https://gvsu.lyrasistechnology.org/repositories/2/resources/432">Russell Mawby Papers (JCPA-01). Johnson Center for Philanthropy Archives</a>
Publisher
An entity responsible for making the resource available
Grand Valley State University. University Libraries. Special Collections & University Archives.
Contributor
An entity responsible for making contributions to the resource
Johnson Center for Philanthropy
Rights
Information about rights held in and over the resource
<a href="http://rightsstatements.org/page/InC/1.0/?language=en">In Copyright</a>
Format
The file format, physical medium, or dimensions of the resource
application/pdf
Language
A language of the resource
eng
Type
The nature or genre of the resource
Text
Identifier
An unambiguous reference to the resource within a given context
JCPA-01
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
1938-2012
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Source
<a href="https://gvsu.lyrasistechnology.org/repositories/2/resources/432">Russell Mawby papers, JCPA-01</a>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Identifier
An unambiguous reference to the resource within a given context
JCPA-01_1992-02-27_RMawby_SPE
Title
A name given to the resource
Russell Mawby speech at the 75th Anniversary Dinner of the American Red Cross
Creator
An entity primarily responsible for making the resource
Mawby, Russell
Description
An account of the resource
Speech given February 27, 1992 for the W. K. Kellogg Foundation at the 75th Anniversary Dinner of the American Red Cross.
Contributor
An entity responsible for making contributions to the resource
Grand Valley State University Special Collections & University Archives
Dorothy A. Johnson Center for Philanthropy and Nonprofit Leadership
Publisher
An entity responsible for making the resource available
Grand Valley State University Libraries, Special Collections and University Archives, 1 Campus Drive, Allendale, MI, 49401
Subject
The topic of the resource
Philanthropy and society
Family foundations--Michigan
W. K. Kellogg Foundation
Charities
Speeches, addresses, etc.
Health
Language
A language of the resource
eng
Rights
Information about rights held in and over the resource
<a href="http://rightsstatements.org/page/InC/1.0/?language=en">In Copyright</a>
Date
A point or period of time associated with an event in the lifecycle of the resource
1992-02-27
Format
The file format, physical medium, or dimensions of the resource
application/pdf
Type
The nature or genre of the resource
Text
-
https://digitalcollections.library.gvsu.edu/files/original/1fe2910f4479d8caf4e80d0e28e72d6a.pdf
42d48ca6a157ad47aed51e798d10c593
PDF Text
Text
"Outlook for Volunt ary Support of Improvement in Community Health Practices"
Remarks by
Dr. Russell G. Mawby, President, W. K. Kello[;g foundation
at the
Fifth Annual Conference on the Physician and the Hospital
San Diego, California
January 30, 1974
I
I am delighted to be .!ith you this evening for the first session of your
Fifth Annual Conference on the Physician and the Eospital.
much the invitation extended by your program
I appreciate
ve~'y
co~~ittee.
I am impressed indeed with the cooperative sponsorship and planning fm'
this professional meeting, truly an 8caclemic-practice partnersni;:> in addressing
issues concerned ',lith health care delivery.
I commend the leadership of the
California Hospital Associa.tion, the California i·;edical Association, the
California Regional Medical Programs, and the School of Medicine of tbe
University of Southern California, for this very constructive and productive
relationship.
II
Your conference focus on "Costs, Controls, Changes and Caveats" is
certainly tirrely and significant.
In reviewing the program, I am inpressed
indeed with the topics which will be addressed by very able resource
~eople.
My particQlar responsibility is to consider the outlook for private or
voluntary support in improving community health services.
I wish to consider
"que.LLt.y" in its most comprehensive sense, LncLudd.ng such aspects as
comprehensiveness, accessibility, and continuity, as well as considerations
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c
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ft
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uch o
ft
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c
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smby e
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l
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e
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e
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s
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a
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e
st
ot
h
i
sim
p
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r
s
o
n
a
l
iz
a
t
i
o
n
. Common s
e
n
s
es
u
g
g
e
s
t
st
h
a
tt
h
es
p
o
t
l
ig
h
t
i
nh
e
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l
t
hc
a
r
ede
l
i
v
e
r
ym
us
tbe upon t
h
ei
n
d
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v
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d
u
a
lp
a
t
i
e
n
t
. T
ot
h
ee
x
t
e
n
t
a
l
IT
i
n
s
t
i
t
u
t
i
on
s and p
r
o
f
e
s
s
i
o
n
s hav
ev
e
e
r
e
df
romt
h
i
sc
o
u
r
s
e
a
n
ai
t
w
ou
l
d
8
�appear that the deviation is great indeed--corrective measuxes must be taken.
Your profession simply cannot focus on beds, technology, practice, and forms
as ends in themselves.
The second dimension relates to total society.
The evidence is clear
tha.t certain Americans, by reason of geography, income, social considerations,
have less than adequate health care.
This too is a reality requiring change.
To comment on innovations for the future, it's necessary to refer back
to the problems which concern us--issues such as access and availability of
care, continuity and comprehensiveness of care, proQuctivity of various elements of the system, cost and financing, quality.
With these central issues
in mind, from our vantage point we see such promising opportunities as the
following:
1. Reorganization of institutional ambulatory health services away from
an endless series of specialty-oriented clinics to a more comprehensive family-centered health service unit utiliZing such qualified
personnel as nurse practitioners and physicians assistants for health
maintenance functions, preventive health programs, and long-term
supervision of chronic conditions.
In this regard, perhaps thought
should be given to the implementation of the concept of vertical
care, with an ambitious implementation of the principles of preventive medicine and provision of quality health care in the
least-cost manner and circumstance.
2. Development of institution-based outreach programs, such as home
care, primary care clinics in under-served areas, and appropriate
linkages or relationships with other care providers, such as
nursing homes.
9
�3
.
Expe
r
ime
n
t
a
t
i
o
nr
e
g
a
r
d
i
n
gt
h
eh
o
s
p
i
t
a
lr
o
l
ei
nt
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ep
r
o
v
i
s
i
o
no
f
p
r
im
a
ry c
a
r
e
,t
h
ecompon
en
to
fcomp
r
eh
en
s
iv
ec
a
r
ep
e
rh
ap
sl
e
a
s
t
-w
e
l
l
s
e
r
v
e
dc
u
r
r
e
n
t
l
y
. T
h
e~
lic
i
ns
e
a
r
c
hf
o
rsu
chc
a
r
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,h
a
st
u
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n
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d
t
ot
h
ecommun
i
ty h
o
s
p
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t
a
l
,v
i
at
h
eem
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rg
en
cyroom
. Bu
tt
h
een
e
rg
en
cy
r
o
omi
sn
o
tt
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p
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o
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r
im
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ry c
a
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o
rem
e
r
-g
en
cy
a
r
et
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n
d
st
ob
ee
p
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s
o
d
i
candv
e
r
ye
x
p
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n
s
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v
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. B
e
t
t
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r an
sw
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r
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omc
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t
ed i
ns
om
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,
andshou
ldb
emo
r
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r
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r
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t
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co
ft
h
ed
e
l
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y sy
s
t
em
.
.
4
.
Deve
lopm
en
t
o
fr
a
t
i
o
n
a
lp
a
t
t
e
r
n
sf
o
rh
a
n
d
l
i
n
gt
r
u
eem
e
rg
en
cym
e
d
i
c
a
l
p
rob
l
em
s
,w
i
t
ht
h
ed
i
v
i
s
i
o
no
fl
a
b
e
ramong
s
ti
n
s
t
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t
u
t
i
o
n
sa
long
r
a
t
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o
n
a
ll
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n
e
sandw
i
t
ha
ni
n
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g
r
a
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dt
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a
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s
p
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r
t
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t
i
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nand co
~
ic
t
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o
n
ssy
s
t
em
.
5
.
Deve
lopm
en
to
fe
f
f
e
c
t
i
v
ep
o~
o
fi
n
p
a
t
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e
n
te
d
u
c
a
t
i
o
nf
o
ri
l
l
n
e
s
s
m
an
ag
em
en
t
, w
i
t
h an imp
rov
em
en
to
ft
h
ep
a
t
i
e
n
tIsu
n
d
e
r
s
t
a
n
d
i
n
go
f
h
i
sp
rob
l
em and ~
e
p
r
o
c
e
d
u
r
e
st
h
a
tw
i
l
lb
ep
e
r
fo
rm
ed
, and v~t
an
emph
a
s
i
supon t
h
ep
a
t
i
e
n
t
'
sa
p
p
r
o
p
r
i
a
t
er
e
s
p
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i
b
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t
yf
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rh
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d
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a
lr
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a
b
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o
n
t
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n
u
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n
gh
e
a
l
t
hm
a
in
t
en
an
c
e
.
6
.
Fu
r
t
h
e
rd
ev
e
lopm
en
t and s
y
s
t
em
i
z
a
t
i
o
no
ft
h
er
e
l
a
t
i
o
n
s
h
i
po
f'
e
d
u
c
a
t
i
o
nand s
e
r
v
i
c
ei
nt
h
eh
e
a
l
t
hf
i
e
l
d
s
. N
o
t o
n
l
ymu
s
t t
h
e
r
e
b
ed
r
am
a
t
i
c ch
ang
e
si
nt
h
ee
d
u
c
a
t
i
o
n
a
lp
r
o
c
e
s
s
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s andr
e
l
a
t
i
o
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s
h
i
p
s
bywh
i
ch p
eop
l
eb
e
com
eq
u
a
l
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f
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dandp
r
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p
a
r
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df
o
rh
e
a
l
t
hc
a
r
e
e
r
s
;
t
h
e
r
emu
s
t a
l
s
ob
e imp
rov
em
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ti
nr
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l
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v
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t
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sand s
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. S
om
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w
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s
tb
r
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or
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a
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yt
h
emu
ch
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c
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to
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r
yn
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two
rk a
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t
r
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l
a
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t
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o
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. S
t
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e
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so
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�mu
s
t c
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f compon
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: t
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r
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and
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a
ch i
sa v
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om
p
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e
h
e
n
s
i
v
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n
e
s
s
,
c
om
p
a
.
s
s
i
o
n
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o
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f
t
e
nl
e
a
v
ethei
n
d
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v
i
d
u
a
lcon
fu
s
edand in
ad
equ
a
t
e
l
y
a
t
t
e
n
d
e
d
.
1
.
Enhancemen
to
fp
r
e
s
e
r
v
i
c
eand i
n
s
e
r
v
i
c
ee
d
u
c
a
t
i
o
ni
nt
h
eh
o
s
p
i
t
a
l
s
e
t
t
i
n
gf
o
rh
e
a
l
t
hp
e
r
s
o
n
n
e
l
. Th
i
ss
e
t
t
i
n
gi
sn
o
to
n
l
ya
p
p
r
o
p
r
i
a
t
e
b
u
te
s
s
e
n
t
i
a
lf
o
rc
e
r
t
a
i
na
s
p
e
c
t
so
fe
d
u
c
a
t
i
o
nandt
r
a
i
n
i
n
g
.
H
o
s
p
i
t
a
l
sa
r
eb
e
com
ing mo
r
e con
s
c
iou
so
ft
h
e
i
re
d
u
c
a
t
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o
n
a
lr
o
l
eand
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nm
a
n
y i
n
s
t
a
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e
sa
r
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e
g
i
n
n
i
n
gt
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s
t
a
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l
i
s
hi
n
s
t
i
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t
i
o
n
-w
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d
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d
u
c
a
t
f
o
n
andt
r
a
i
n
i
n
gp
rog
r
am
s
. Su
ch p
rog
r
a
l
l
l
s en
co
l
lp
a
s
s emp
loy
e
eo
r
i
e
n
t
a
t
i
o
n
,
o
n
t
h
e
j
o
bt
r
a
i
n
i
n
g
,s
u
p
e
r
v
i
s
o
r
y
evelop~e t
c
a
r
e
e
rm
o
b
i
l
i
t
y
,
c
l
i
n
i
c
a
li
n
s
t
r
u
c
t
i
o
n
,i
n
s
e
r
v
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c
ee
d
u
c
a
t
i
o
n
,p
a
t
i
e
n
te
d
u
c
a
t
i
o
n
, and
commun
i
ty e
d
u
c
a
t
i
o
n
.
8
.
E
l
a
b
o
r
a
t
i
o
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Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Russell Mawby Papers
Subject
The topic of the resource
Charities
Family foundations--Michigan
Philanthropy and society
Description
An account of the resource
The Russell Mawby papers document the life and work of Michigan-born Russell Mawby from 1928 to the present. Mawby was the Chief Executive Officer and Chairman of the W. K. Kellogg Foundation for twenty-five years and is recognized for his work in the area of philanthropy in the United States, Latin America, and Europe.
The digital collection includes a selection of field notes, speeches, itineraries, and other materials.
Creator
An entity primarily responsible for making the resource
Mawby, Russell G.
W.K. Kellogg Foundation
Source
A related resource from which the described resource is derived
<a href="https://gvsu.lyrasistechnology.org/repositories/2/resources/432">Russell Mawby Papers (JCPA-01). Johnson Center for Philanthropy Archives</a>
Publisher
An entity responsible for making the resource available
Grand Valley State University. University Libraries. Special Collections & University Archives.
Contributor
An entity responsible for making contributions to the resource
Johnson Center for Philanthropy
Rights
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<a href="http://rightsstatements.org/page/InC/1.0/?language=en">In Copyright</a>
Format
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application/pdf
Language
A language of the resource
eng
Type
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Text
Identifier
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JCPA-01
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
1938-2012
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Source
<a href="https://gvsu.lyrasistechnology.org/repositories/2/resources/432">Russell Mawby papers, JCPA-01</a>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Identifier
An unambiguous reference to the resource within a given context
JCPA-01_1974-01-30_RMawby_SPE
Title
A name given to the resource
Russell Mawby speech, Outlook for Voluntary Support of Improvement in Community Health Practices
Creator
An entity primarily responsible for making the resource
Mawby, Russell
Description
An account of the resource
Speech given January 30, 1974 for the W. K. Kellogg Foundation at the Fifth Annual Conference on the Physician and the Hospital.
Contributor
An entity responsible for making contributions to the resource
Grand Valley State University Special Collections & University Archives
Dorothy A. Johnson Center for Philanthropy and Nonprofit Leadership
Publisher
An entity responsible for making the resource available
Grand Valley State University Libraries, Special Collections and University Archives, 1 Campus Drive, Allendale, MI, 49401
Subject
The topic of the resource
Philanthropy and society
Family foundations--Michigan
Charities
W. K. Kellogg Foundation
Speeches, addresses, etc.
Health
Language
A language of the resource
eng
Rights
Information about rights held in and over the resource
<a href="http://rightsstatements.org/page/InC/1.0/?language=en">In Copyright</a>
Date
A point or period of time associated with an event in the lifecycle of the resource
1974-01-30
Format
The file format, physical medium, or dimensions of the resource
application/pdf
Type
The nature or genre of the resource
Text
-
https://digitalcollections.library.gvsu.edu/files/original/6629fa320768fc1a3f9015273ce9725a.pdf
c740ebffa3e272cfeb1af8ceb6fb42e1
PDF Text
Text
A LAYMAN' S PERSPECTI VE ON
PRIORITIES FOR HEALTH PROFESSI ONS EDUCATI ON REFORM
Remarks by
Dr . Rus s e l l G. Mawby , Pres ident
W. K. Ke llogg Founda t ion
March 17, 1982
Heal th Pr o fe s s ions Edu cation Confer en c e
Universi ty o f I llino i s, Chic ag o
I.
I wel come t he invi t a t ion to be wi th you t oday and
t hank you f or t he opportuni ty to o f f e r a f ew ob serv a t ion s
f r om a l ay man 's pe r spe c t i ve on "Priori ties f or Health
Pr o f e s sions Education Ref or m." I hope t he s e thoughts
f r om a grateful beneficiary of your pro fe ssions , a
f r i endl y c r i t i c o f the proces s and sy stem, can add a
us e ful dimension to your delib era ti on s.
In reviewing the program I am s truck, in par ticular,
by two point s.
First, t he depth and bread th of the
t op i c s addre ss ed and t he qual if i cations o f t he spe ake r s
and r esource people are most impressive.
Hope fu l ly the
presenta t ion s and di scuss i on s with you r col l e ague s i n
the heal th pro fess ions educ ati on f i e ld hav e challenged
�2
you r t h i nki ng , s ubstan tiat ed s ome o f yo u r own beliefs,
and given you pause f o r though t.
One challenge always
is to have a confe r enc e such a s th i s make a r eal d i f f e r enc e
"back home."
Too of t en we r etu rn t o a he c t i c schedule ,
a loaded desk , a c l u t t e r ed calendar.
In th e busyn e ss
o f ca t ching up, keep i ng up, and cop ing wi t h t he crises
of t he momen t, li f e -- and t he curr i cu l um -- go unaltered
by mee tings such as this.
The proce sse s of i n stitut i on a l
change , c a r efully des igned to protec t us all f r om h a s ty
decision or impulsive action , can a s e a si ly s erve to
smother a flame of i nnovation.
May you h ave t he courage,
t h e energy, and the genius t o avo i d t hat b eing t he
cas e -- again.
Second, I am i mpre ssed wi th the compr ehensive
fram ework of t h is mee t ing.
conten ts, everyo ne is h e r e.
At l ea s t i n t he tabl e of
Us ua l l y, ph ysicians talk
with phy s ic i an s , nur se s with nu r s e s, pub lic h eal t h
s pe c i a l is t s wi t h s oc i ologi st s and pol i t ical sci ent is t s ,
�3
and den ti sts wi th themselve s .
But a l l dimensions of
t h e h ealth profe s sion s are rep r es en ted i n t his meeting -t h e basi c sc ienc e s, medi cin e, dentis try, nur s ing , admi n i s trat ion, pharmacy , pu bl i c he al t h, t he alli ed h e a l t h
f i e l ds .
Remarkable!
Wonder f u l !
Perhaps you wil l be
t h e v angua rd in moving forw ard, in t angib le and gra tify ing
way s , t he conc ep t an d gen i u s o f the academic hea l th
cente r -- at t h e momen t accomplished in d i s c i p l i n a r y
sci enti f ic con tributions, bu t wi t h t he i r po t ent i a l
unfulfi lled i n program s f or main t aining h e al t h and
promo t ing i n t erprofessional educ a t i on , benefi ts which
the r efo r e a r e no t yet r e a l iz e d .
As alre ady i ndicat ed, my bac kgr ound and my gradua t e
education are in agri cu l ture.
I come t o you as a
l ayman , hope fu l ly an " in f ormed layman" whos e ro le as
chi e f ex e cu tiv e of ficer o f a foundation -- which each
ye a r provides abou t $2 5 mil l ion f or demon s t r at i on
�4
programs i n health education , s ervices, and delivery
ob ligate s me t o be aware of i ssue s in t he f ield.
I
still recall vividly a s e r i e s of "rude awakening s" as I
f i r s t bec ame involved in the Foundation ' s programming
in hea lth.
I was dismayed, shocked, d isappoin ted by
much o f what I learned of the inner workings, both in
education and practice.
Whil e t h e r e is much to be
admired and praised, the s t ark realities which became
clear, tarnished and e r oded the pinnac l e upon which t h e
health pro fes sions had resided in my mind.
I have
tried to learn wi s ely and t o ' c a r e f u l l y place the various
components in proper perspective and ba l ance.
In so
do ing, I have h ad to l ea r n t h e l exic on o f t h e hospital
hallways and the differenc e s between radio logy and
rh eumato logy; to recogniz e a "third party payor" when I
s e e one; to understand that " f our - handed dentistry"
do esn't re f e r to a clumsy practitioner or a ca r n i v al
f r ea k ; and to apprecia te a care er ladder in nursing
�5
(bu t I mus t confe s s I s till canno t dis t ingu ish ea s i ly a
nur se pract itioner f r om one who i s no t .)
Ac tually I bring mor e baggage than t ha t to t h i s
me e ting .
I grew up on a f a r m i n west cen tra l Mi ch i gan ,
no t rea lly "rural rural" b e cau s e t he ho mepl a ce is now
part of a suburb o f Grand Rapi ds , bu t a farm nonethe less
and in a f amily which enjoye d f or ye ar s th e spl endi d
s ervic es o f a coun t r y doc t or , Dr. J ay D. Vyn.
His wife
was his of f ic e nurse/rec ep t ioni s t ; l a t er h is daugh t e r
s e rved in t h at r o l e al s o .
They worked t oge t h e r in
ha rmony -- we no w ca ll th a t jo i n t prac tic e -- suppor t ive
o f e a ch othe r, the pati en t , th e f ami l y .
I am not a
no s t a l gia bu f f, yearn ing fo r t he go od old days -- a
re tu rn t o the ou t-hou s e, t ube r cu l os i s , and bl ood l e t ting
but the re were s ome th ings in t h at pa t tern which would
s t i l l s e r v e us well.
But perhaps my bes t quali f ic a t ion f or be i ng here
t oday i s not th a t o f a Foundat ion execu t i v e but simply
�6
a layman -- a son, husband , parent, conce r ned c i t i zen .
I h av e b een bl es sed with good he a lth and s o my pe r s on a l
i nvolvement wi th the heal th care s y stem has be en min imal .
But I have had more t h an enough opportunity t o b e
deep ly involved - - emotiona l ly and in ev e r y other
way -- in my r e spon s ib i lit i e s and re la t i on s hip s with
bro thers and si sters, paren ts, f r i ends .
I hav e spent
mo re hours than I care to r ememb er a t a ho sp i ta l beds ide,
l e an i ng on the wall o f a ho spi ta l corrido r, s itt i ng
endle s sly i n a waiting room.
I have sought i nfo r mat i on
and assistanc e in eve r y conce i v able way -- asking,
begging, cajo l ing, thre a ten ing -- t o ge t a tidbi t o f
informa ti on, a glimpse o f the t r uth , a glimmer o f
unders t anding .
I hav e exper i enced i t al l -- t r i umph s
and t r age d i e s , compas sion, arrogance, s e l f l e s s n es s ,
in sensitive cal lou sne ss, both the brilliance and the
pet t i n es s o f th e car i ng p rofessions you r epresen t .
So
the perspec tiv e I bring i s t hat o f a l ayman -- a conc erned
�7
individual, a grateful beneficiary, a cons t ruc tiv e
c r i t i c, an e ager p art i cipan t in t h e unending proc e s s o f
making the superb hea lth sy s t em and situ a ti on we hav e
to day even more re s ponsive, e f fe c t i v e, and s at isfy i ng .
II .
You are educa tors, t ho s e charged with key re s pon s i bi l itie s in t he p r epa r a ti on o f th e pro fe s sional s who
des ign, manage , and conduc t t he a f fa irs o f our h eal th
care sy s t em -- its variou s co mpo nents, i nst i t u t i ons,
and programs.
it we l l :
You shape tomorrow .
W. K. Kellogg s a i d
"Education o f f ers t he grea t e s t opport uni ty
fo r re al ly i mprov ing one genera tion ove r another ."
You
a r e vi tal par ticipan t s in t h e s e l ec t ion and molding o f
phys i cians, nurs e s, pharmac i s t s, den ti sts, and other
hea l th pro f e s s ionals of t he futu r e.
You help to determine
the cr iteria by wh ich the t ough de c is ions are made as
t o who i s 1n and who i s ou t ; you shap e the pa t te rn o f
experienc es to which t hey are exposed and t he ri gors t o
�8
which they a r e s ub jecte d and you e stabli sh t h e c r ite r i a
by which their suc ces s or fa ilure i s determined.
Thus,
ultimately, you i n fl uence t he shape, t he character, t he
personali ty, the moral ity of t h a t which we c al l our
heal th care system.
We are grate ful f or the degre e to
which you suc ceed; we worry about the whys, the hows,
and the so whats of t he job you do; and we are the
benefic iarie s -- or the vi c t i ms
-- of t he consequences
o f your e f f or t s.
Quite frankly, I have struggled with how I might
most productive ly appr oa ch my ' assignmen t t h i s morning.
My fi rs t i nc l i na t i on was t o approach the ta s k as I
a lways approach doctors and nurses -- hat in hand, in
awe and in admiration of t hos e who are privil eged to
serve and inf luence s o intima t e ly t he human condition.
Despite many experiences whi ch abuse that i dyllic
image, t o me there i s no h igher calling than the caring
profes sions you repre sent.
�9
But I hav e cho sen a dif ferent cour s e in pur suing
my t a s k today.
Qui t e simply , I l eaned back in my chai r
and said, " Suppose I were a he al th profe s sions educ ator .
What would I do?"
As a l ogic al f i r s t s t ep, I t he n
pursued th e question, "I f I cou l d de s ign i t , what kind
of a health car e a rrangemen t would I l ike f or the Mawby
f ami l y ? "
Thi s i s no t an idl e or an impul sive qu estion;
i t is on e I have been asking mysel f, memb er s o f our
Founda t i on p rogr am s ta ff , l eaders i n th e h e al th pro f e ssions for a numbe r of years.
I hav e f i nal ly concl ud ed
tha t i de al l y I would hav e t he ' Mawby fami ly a f f i li a t ed
with a sma l l group prac tice consi sting o f thre e or f our
f ami l y phy s i c ians , a ped ia t r i c i an and an ob s te tri cian gyne col og i st , working appropria t e ly and i n ha r mony wi th
nurs e pract itioners , wi th a r ecep ti oni s t /bookkeeper,
other s uppor t personne l in nur sing and the al lied
health f i e l ds , and two dent is t s.
This group would have
appropria t e privil ege s with community hos p i t a l s and
�10
re f erral a r r angemen t s with spe cial i s ts.
Ph i l os oph i c a l l y
t he group would be commi t t e d to a program o f he al t h
promo t ion/di s eas e preven tion or hea l th main t enance, a s
wel l a s t r ea tment o f i l lne s s.
Now l e t ' s t a ke a momen t
t o con s ide r thi s model .
First, t he cor e o f t he gr oup would be three or
f ou r family phy sic ians, conc erned with t he i nd i v i dua l
and wi th t he f ami l y .
When our f amily phy s i c i an wa s
away , we woul d be covered by on e of h is group partner s
who would have complete acce s s t o ou r heal t h r ecords.
When warranted , t he s e f amily practit ioners would i nvolve
app ropri a te s pec ial i s ts fo r consultat ion and/o r t re a t men t .
They would be working i n harmony wi th nu rse practit i one r s .
Very o f ten my minor complaints do not r equire
t he atten ti on or time of a board-c er t i f i ed s pe c i a l i st .
I am qu it e con ten t to b e t r ea t e d by a comp eten t nurs e
prac ti t ioner, wi t h con fidenc e t ha t i f s he i den t if ie s a
probl em t ha t s h e t hinks r equi res f u r t he r exp e r tis e , s h e
��12
the profess ions t o addres s t hi s idio sync rasy in t he
pre sent patt ern of practic e is dif ficult t o fa thom.
And t he empha sis on heal th promotion/disease
prevent ion?
You i n the hea lth pro f e s sion s have de signed
a s y s t em whi ch compensates yo u only for t h e treatmen t
of my il l ne s s or i n j ury .
I c an enga ge s pe c ia l is ts to
des ign and implement a preventive maintenance program
f o r my air conditioner a t home, or the e l ev a t o r or
duplicating mach ine a t the offic e.
I n such a contractural
arrangement, I always have responsibili ties which I
must fu lfi l l if t ha t con tract is t o be v a l i d .
In
similar fa sh ion, I would l ike t o compen s a t e a health
care gr oup for t h e de sign and the con tinu ing monitoring,
wi th my f u ll parti cipa tion and f u lf i l l men t o f my ob ligations
and r e sponsibili ties, o f a maintenan ce contract for my
mo st precious possession
my health.
Why have the
health pr o f e s s i on s b een s o un i magina t i ve , so uncreative,
so unre sponsive in t his area?
�13
So, t ha t' s a br i e f in s i gh t from a layman' s perspectiv e
o f one mode l o f an " i de a l primary c a r e arrangemen t. "
Th e r e can - - and should -- be many o th e r s, t o provide
pr ima ry care t o diver s e c li ent group s i n va r i e d se ttings.
Th a t ' s a s f a r a s I wi l l go today as a layman.
As
exper ts, you wil l giv e f ur t h e r con s ide ra t ion re la ti ng
to s e condary and ter tiary l ev e ls of car e, of f e ring t h e
bene f i t s of superb specialization and sophis t i ca ted
t e chnol ogy and linking primary car e prov ide r s ul tima t ely
t o th e rich re s ou r c e s of r e sear ch i nst itu t i ons and
academic health centers.
Wi th modern commun i cat ions
t e chnol ogy , pract i tione r s i n ev en t h e mo s t r emot e
loca tions can be i n tou ch wi th colleague s for cons ulta tion
and counsel on a cont i nui ng basi s .
As a l ayman surveying the health c are s c ene t oday
both i n educa tion and i n pra c tice - - I see the "bits
and p ieces" a s superb .
By "bi t s and p i eces" I re fer t o
our pro fe ssional s chool s, i n medic ine, nurs ing, dentis t ry,
�14
pharmacy, admini stration, a l l i ed h eal th, a l l t h e rest;
the p rofessions, with dedica ted and compe tent indiv idual s
and e f fec tive associa t ions; t he various pract i ce settings,
including s ol o and group o ffi ces, clinics, hosp i tal s,
research and teaching cent er s.
Al l superb, without
quest ion t h e finest i n the world.
But I have the uneasy f ee l ing th a t t oo l i t tle
t hough t and e f f or t has been given to rat iona liz ing t h e
whole, with an object ive of s e r v i ng maximal ly t h e
int e r ests of the ultima t e beneficiari e s .
The "total
system" (this ph r a s e sounds tidier, more prescr ibed and
restric tive than intended or possible)
with multi pl e
alterna tives and pluralism i n every sen s e -- should be
particularly sensitive t o the publi c it s e r ve s and by
which it is sustained, sub jugating the more s e l f i s h
i n t e r e s ts o f p rofessions and institutions to the higher
purpos e.
We lack a "grand des ign" or a s e r i e s o f grand
designs which bring t oge t h e r in most effec tive ways th e
�15
exper t ise o f t he various h eal th p ro f essions, and networking
mor e e f f i ci ent l y the resource s o f th e h e alth c are
i n s t i t u t i on s o f ou r s oci e t y.
Wi s e l y don e , building on
t he t e r r i f i c st r ength s of t he day bu t r e spond ing ob jec tiv e l y
and s en s i t i v e ly t o t he demands and unme t needs o f t he
pub l ic , th e res u lt sure l y wil l be fa r gr eat e r t h an t he
s i mp le s um of t he par ts o f which i t i s compri sed.
As e du c a t or s i t is yo ur ch a l l enge t o f u lf i l l such
a vis i on and go al .
I t i s not enough t o be s i mp l y a
nur s e educato r or a medica l e duc a t o r .
You mu s t s e e the
larger p i cture , with i ts str engths and shor t comings,
and mov e re l entles sly t owa r d t he r eal i z a ti on of t he
b ett er s i t u a t i on .
Un i v e r s i t i es , of which the schools
of the h ealth pro fe s sions a re a p art, a re the knowl edge
res e rvo ir s o f our society, e s t ab l ish ed and s u s t a i n ed to
preserve , c reat e , and transmi t knowl edge .
An unending
chall enge i s th a t o f mobi liz ing t hese knowledge r esources
i n ever more e f f e c t i v e ways to deal wi th th e conc ern s
o f s oc i e t y .
�Whil e t he re is muc h in t h e hea l th c a re s cene i n
this coun try o f whi ch you can be j u s t ifi ab ly p r ou d ,
there i s st i ll much "un fini shed bu siness. "
Hope f ul ly
the health profe s sion s -- wi t h you as educators in the
v anguard - - wil l prov ide aggressive and i mag i na t i v e
leadership i n addres sing i s sue s o f concern, l e s t the
r e s pon s i bi li t y f a ll by defaul t to t ho s e l e s s able .
III
I n t he he a lth programming o f t he W. K. Ke l logg
Founda tion, our health program team fo cus e s on fi v e
issues :
av ailability and a cc e s s to h ealth care;
comprehen siv eness and c on ti nu i ty; qu al ity ; co s t
con t a i nmen t and produc tivi ty; and he a l t h promot ion/dis e a se
preven t ion/pub li c he a l t h .
As health profess ional s you
unde r s t and the se i s sues and the i r ramif ications so
t h e r e ' s no need t o el abor a t e in detail, but I would
commen t on e ac h br i e fly since t he y re late so cl ear l y to
your opportun i t i e s i n educ a t ion.
Because the issue s
�are s o in terrelated, I ' l l no t t r y to s eparate t h em
artif ic ially bu t simply t ou ch on t hem in a natura l
sequence.
It may be appropria te to begin with a problem
identi fied in the writ ings o f Herodotu s s ome 2400 y ears
ago.
The Greek historian perceived a disconti nuity o f
care in his n a tive l and , and he lamented, "Each physi c i a n
t r e a t e th one part and not more.
And everywhere i s f u l l
of physicians; f or some pro fe ss themselv e s phy s ician s
o f t h e eye s, and others the head, other s t he t e e t h , and
others o f th e pa r ts about the be l ly, and o th e rs of
obscure sicknesses."
Herodotu s was corr e c t in his view t h a t a discont inuity
of care c an resul t f r om t he trend toward ov erspecia lizat ion.
Health care, o f fered or provided in a fra gmented fa sh ion,
is difficult to deal with in itself but the problem
goes deeper.
Oft en accompany ing s u ch spec ia lized care
i s the problem of t r an sfe r o f i n f ormati on between
�pr ov ide rs o f c a r e who unwi tt ingly or wors e, knowi ngly,
inh i b it t h e p ati ent' s a cce s s to comprehens i ve c are.
Le t me u s e a pe r sonal exampl e t o il l u s t r a t e wha t
mean.
l
My mother, by th e time she r eached h e r mid- 70 s
had s ev era l different he al th probl ems , i nclud i ng cance r
and compli ca t ion s f r om a se ries of s t r oke s .
In th e
cours e o f her cancer t r e a t men t s he was s hunted f r om on e
s pe c i al i st to anothe r , f r om in terni s t t o s u rgeon t o
r adio logi s t to onco logi st, none of whom r e ally took a
comprehensive l ook a t her problems i n orde r to a s s e s s
her ov erall condi tion.
The i n t erni st who diagnosed the
probl ems ini tia lly re fu s ed t o conti nue a s he r primary
c a r e phy si c ian , so t h e r espons ib il ity f or continuity
rested wi th the pa tient and he r f ami l y , c erta i nly an
unsat i s fac tory as signmen t by de fault .
We encountered
another s tumbl ing b lock - - a great re luc tanc e, and at
t i me s , r e f us a l on t h e p ar t o f seve r a l phys i c ians to
t r an s f e r medi cal r eco rds o f t he car e t hey gave my
�mother to other phy sicians who also were t r e a t i ng h er.
Consequently, examinations, tests, and procedures were
duplicated unnece ssari ly, a t inconven ienc e, d iscom f o r t ,
and cost.
I understand t he reason s given, bu t I do not
accept th e f i na l r esu lt a s adequate or de fen s ib le.
The re must be better ways.
isolated on e.
Th i s examp l e is not an
Fr i ends and assoc iate s have told me
s imilar stories, and you can surely add anecdote s o f
your own.
Overspecializa tion and a lack of cont inui ty in
care are not p roblems confined t o the practice o f
medicine.
Speci alization, some obs e r v e r s contend, has
re sulted from t h e imp lemen t a tion o f technology i n
almost every f i e l d, forcing the i ndividual t o de a l with
an ev e r - i nc r e a s i ng number of prov iders o f s ervic e.
The
spec ia lization of h ealth education and he a lth services
is, in many ways, an achi evement in America that we can
�20
be proud o f.
But at the same time, we mu s t manage it
s o that i t do e s no t bec ome an end in and of i t s e l f .
If
s u ch spe cial izat ion resu l t s in f r u s t r a t i on and f r a gmen t e d ,
incompl ete patient care, i t needs rethinki ng and re arranging.
What does t h is mean in terms of health profe s sion s
education re f o r m?
It means we mus t con sc ious ly and
with de termina tion move toward making the academic
heal t h center t h e foc us for compr ehens i v e , interprofess i on al education -- education which begin s t o remov e
professional barriers th a t s tand in the way o f mor e
effective, patient-c entere d h ea l t h care.
And, it means
encouraging s t uden t r ecep tivenes s t o t he kinds of joint
practice arrangement s which can ultima t e l y bring i mpr ov emen ts
i n c linical settin gs.
In t he absenc e of an int egrated approach s uch as
might be provided by an ac ademic heal th c en t e r , t he
re sponsibility keep s coming ba c k to t he i ndividual
schoo ls whi ch prepare dent ist s , nurses, physicians,
�allied health personnel, administrators, and pub l i c
health professionals.
Thes e schools generally give
t he i r studen t s only cursory expo sure and l i mi t e d sensi tivi ty
to hea lth problems and care from th e viewpoint o f the
patient.
There are exceptions, of cour s e , but t oo
often rel ated pro fe ss iona l s tudies abruptly leave o ff
with t he important, but limited, p roces s o f taking a
patient 's personal h istory " f or t he r e cor d . "
Thi s
problem should be addressed by all heal th professional
schools, and parti cular ly by the med ic a l schoo l .
The
medical school has t h e respons ibility of educating t h e
key member of the health care delive ry te am.
The
phy sician is t h e quarterback, t he CEO, t he gu a rdian,
th e gatekeepe r -- large ly de termini ng in what manner
and with wha t empha ses pa tien t care is provided.
Thus
t he medical school p lays a particularly c r u c i a l rol e in
determining exactly what he al t h care delivery i s today
and what it might be tomorrow.
Even when academic
�hea lth centers become well developed in hea lth pro f ess ions
education, the medica l component wi l l co nti nue t o be of
speci al sign ifi c anc e .
I s it t oo much to hop e t h a t
t he s e schools and t he i r graduates wil l incre asingly
pursue a s t a t e sman s h i p rol e o f leadersh ip, se t t i ng t he
highest of profe s s ional s t anda r d s for pati en t- centered
care and s imu l taneou s ly encourag ing -- and permitt ing
oth er h e alth profess ional s to con tribute maxima l ly?
As a pa r t of t h e improvement o f heal th care ,
a t t enti on mu s t b e directed a t l earning how n ew spec ia lt i e s
in medic al pract ice can be crea ted to t r e a t human
problems, a s well a s defining soci ety' s ne ed s to make
t he best us e o f t ho se special t i e s onc e t hey a r e in
p lac e .
An o rderly sy stem o f l imi t i ng, monitori ng, and
coordinating s pe c i a l t y practice mu st be e s t ab l i s he d .
Certainly , t h e s ame responsibili ty fa l l s on t he other
hea lth pro fes sion s s choo l s , a s we s e e more and more
empha sis on n ew s p e c ia l t ie s wi t h i n nursing, alli ed
he a lth profes sions, pharmacy and denti s t ry.
�My ph y si c ian f r i end s te l l me t h at in many educ a tional
i ns t i t ut i ons t he socia l analysis a s pe c ts o f heal th c a r e
a r e in t he schoo l s of public he al th .
But they al so
admi t that u sually there i s li t tl e rela tionship b etween
wha t t he schoo ls o f pub lic health are seeing and wha t
i s happening i n t he me d i ca l or dental or nur s ing e duc a t i ona l proces s .
Very f ew universit i es, have for examp l e ,
what c an be ca ll ed a "Center f or Heal th Se r v ic e s Res ea r ch , "
whi ch has a re lati on ship to or an effe c t on e duca ti on
o f h e al th p r o fe ssionals.
Thi s i s linked to t hat "grand
des i gn" I ment i on ed e a rli e r which s hou ld be a backdrop
f o r pro fession a l educat i on if care is t o be comprehensive
and co n tinuou s.
IV.
Le t me u s e a t r u e story , sl i gh tly drama tiz ed, t o
illus trat e th e i s s ue o f availabili ty o f and acc e ss to
heal th c a r e.
�No t l ong ago on a vi s i t to a county s e at t own
in southern Mich i gan, I met with a group o f yo ung
phys ici an s.
I asked them:
" I f t he Mawby f ami l y
moved t o t h i s area, cou ld any of you take u s on a s
new pa t i en t s ? "
The r e was qu i ck consensus, "Gh y es , Russ
Mawby, presiden t o f the Ke llogg Foundat ion, o f
cours e we wi l l get you in. "
"No , no ," I s a id .
"Ru ss Mawby , with a wi f e
and th r e e kids , l i v i ng on 40 acres sou th o f t own. "
Aga in t he re was qu ick a gr e ement , "None o f u s
i s taking any new pa ti en t s .
You ' l l just hav e t o
go t o t he emergency room at t he ho s p i t a l . "
I don ' t bel ieve t hat i s a s a ti s fac tory answe r to
primary c a r e f or famili es ; emergency room c a re should
be f or emergenc ies, no t s e r ve as a us ua l point o f en t r y
f or pr imary ca r e.
�Expert s ke ep t e l l ing me t ha t access to health care
is a seriou s problem on ly for t he urban poor and f or
peopl e in r emote rura l communitie s.
But th a t simply i s
not true, if t h e measure we apply for adequacy goe s
beyond t h e most primitive or basi c s tandard.
In communiti e s
of al l type s, urban and rural, withou t r e gard to e conomi c
circumstanc e s, many fami l i e s have r e al di fficulty in
gaining acce s s t o sa t is factory primary care on a con t inuing
basi s.
As a layman I hav e ob served that h e a l t h pro fessional s
i n par t i cu l ar physicians, bu t to a de gree al l health
profess i onal s
h ave no pr ob l em gaining acc ess to the
health care system.
If t he i r child or mother or good
f r iend needs to see a doctor, even a s p e c i a l i st who is
booked six months in advance, t he re is no prob lem of
access.
I suspect this may be a fr inge benefit which
al so extends t o you as heal th profes sions educators.
But do n ' t l et t h i s l ull yo u i nto a belie f that t h is is
�26
there fo r e no prob lem fo r t he re s t of u s, re gar d l es s o f
geographi c, cul tu r a l, or e conomic ci r cumst an c e .
While many medical s choo l s be liev e th ey a r e addres sing
th e problem of acc ess t o -- and av a ilabili ty of -- good
medical care by increasing the numbe r s o f gradua te s,
s i mp l y incre a s ing numbers do e s not go f a r enough .
s i mp l i st ic t e r ms, there are t wo prob l ems:
In
prep a r a ti on
of physician s pe c i a l t i e s in appropria te propor ti on s,
and th e geographi c d i stribu tion o f prac t itioners.
Ea ch
needs to be addre s sed c rea tive ly and fo rthrigh t l y .
Part of t he d is tr ibu tion problem may correct itsel f a s
numbers i nc r e a s e , bu t the r e a r e ce rt a inly f ur ther
options.
For exampl e , of mo re d i r ec t benef i t is t he
e f f or t by s ome medical s choo l s to exp and re sidency
experiences in small communities fo r g r adua t e physicians.
Certain medical s choo l s have also e s t ab l i s h ed
a gr eement s with the incoming s t uden t which require t h a t
he or s he, upon graduat i on , pra c tic e f or two or th r ee
�year s i n an underserv ed a r ea i n ex change f o r r epayment
of a s t udent lo an.
Model s s uch a s t h e s t udent l oan
pr ogr am wh ich the Un i vers ity of I l l i no i s Coll e ge o f
Medic ine ha s had s ince 195 0 wi th the I l l i no i s Agricu l tura l
Asso c ia ti on and t he Sta t e Me d i c a l Society mu s t be
c on t i nue d and promoted.
In addi t ion , be tte r i nforma t i on
systems must be cre ated which l og data on those a r e as
t ha t need phys i c i ans, where phy si cians mi grate upon
gradua tion, and wha t k ind s of t hings commun i tie s can do
to a t tra c t doctors.
I can' t he l p but t hink that t he v e r y pre s sing
problems o f maldis tribution, and some wou ld s ay a ctual
s hortage , o f nu rs e s also relat e s d irectly to h eal th
pro fe s sions education i ssues -- and s p e c i f i c a l l y medical
education.
As a layman, I canno t und e r stand, no r do I
s ympath ize or have pati enc e wi t h, t h e kinds o f "p r o f e s s i on a l
snobbery" which s ep a r ate the health pro f e s sion s i n bo th
�28
educat ional and c l in i ca l sett ings.
For ex amp le , I do
no t unders tand the relu c tance of the med ic al pro fe ssion
and t he med i c al schoo l s - - to t a ke a more enli gh tened
view toward rec ogn izing the unrea l ized po t en tia l o f
nurses and o the r non-physic ian hea l th profe s si onal s in
meet ing the he alth care needs i n th is coun t ry.
I
suspec t t he eli ti s m and s eparati on whi ch s t i l l charac te r iz e s
t oo much o f physician e du c a t i on and care wi l l no t much
l onge r be t o l e ra ted.
Thi s would seem par t i cularl y t r u e
as the publi c b e comes more and more awa re o f how such
parochia l ism i s a f fectin g the' qua l ity, avai l ab i l i ty,
and co s t o f c a r e i n their communi tie s.
I nnova tive appr oa ches to encouraging ph y sic ian s ,
nurs e s, dentists, and other heal t h p rofe s sionals t o
prac tice toge the r more e ff i c iently and e ff e c tively,
includ ing the provision o f care in underserved a r e a s
and t o unreache d clien tel e , must continue t o be s upported
so that a ll people, whe ther t h ey be a f f luent o r po or ,
�and whethe r they live in the city or the country, have
acc ess to quality health care.
v
Notice -- I s a i d quality health ca r e -- certa inly
a persistent and basi c concern of all.
In r e c en t
years, not just i n t he prac tice of medicine, quality
increasingly has come to b e defined i n terms of the
ap pl ication o f high technology.
We pride ourselves on
making u se of t h e lat est e qu i pmen t , procedure s , and
syst ems whethe r in medicine, the auto industry, or
communica tions.
I n the heal tn fi eld t h i s emphasi s on
t e chnol ogy can con tribut e to a f a i l ure by the pro fes sion s
to recognize t ha t actual prac tice as an i ndi c a t o r of
qua lity f o r common h e a lth problems may be just as good
or better in the small, modes tly equipped clinic as i n
th e major medical center.
Medical s choo ls have taken the lead i n app lying
high technology t o practice (as well they should ) , but
�30
they mu st not ru sh so f a r ahead that t hey f or ge t th e
human dimen sion -- the patient' s perception of quality
which often hinges on how the phy si cian trea ts the
person, not just t h e medical problem.
Despi t e sta tement s
by individua l faculty members t h a t they r ecognize this
pat ien t per ception of t he quali ty of care a s contra sted
wi t h t he physician' s perception o f care, mo s t obs ervers
are unabl e to not e much evidenc e of that r e cogn i t i on .
I f you or I were to have a coronary today, our
spouse would not walk into the ho spital and a s k , "What's
the average length of stay? " ' Bu t that yards tick has
be en t oo much a primary measure of "quali ty" in hosp i ta l
r ev i ews .
Ins t e ad , a loved on e i s likely t o ask,
or s he in pa in?
II
Is he
I s he being kep t comfor t abl e? I s
s omeon e with him?
May I se e him?"
Phy sicians and
ho spita l administra to rs tend not to worry enough about
t hose humanl y critical gauges which are so si gnificant
both t o the pat ient and t h e f ami l y , and to the pati en t' s
ultima te recovery.
�There i s a defi ni te need f or edu ca t o r s to giv e a s
much con sideration t o the patien t's perspe ct ive on
qu a l i t y in prac tice a s i t give s t o heal th s c i enc e and
re s earch .
Many r e s pecte d authorit ie s hav e l ong cal led
f o r increased a t tention t o the humanit ie s and s oc i a l
sc i ence s as a means f o r i n s tilling a conc e rn f or human e
care i n t he budding physician, dent ist, nurs e , or
pharmaci st.
Severa l school s now do th is, bu t usually
on an elective ba si s.
J ust as concern for th e whol e human b eing i s
important to qual ity i n th e pract i ce of hea lth care , s o
t oo is conc ern fo r preven t ing i l lne s s r a ther than
s o l e l y r espond i ng to it a fter t he fact.
The re is a
good deal o f t a lk about t he bene f it s o f jogging , c a r e f u l
diet , de creased s moki ng , reduc t i on of stress , and s o
on.
Th e s e act ions, it is said, c an lowe r the r isk of
heart a tt ack o r o ther health prob lems and i mprov e
overall wel l-be ing.
But , on e expert s ay s on e thing;
�32
another s ays something el s e -- even the oppos ite.
People think they wan t to take r espons ibi lity f o r their
own heal t h, but don't know what t o believe and wha t to
do.
VI
Who's mi nd i ng the s t or e as far as health promotion
and d isea s e prevention are concerned?
I s the r e an
app r op r i ate emphasi s on preventive medic ine in h eal th
profess ions school s today?
No.
My be st information i s :
Pr ogr ams abound on preventing t h e common i n f ect i ou s
dis eas es but if on e t h i nks o f 'preven tion i n t e r ms of
heart diseas e, canc er, and similar serious concerns, it
app ears that we aren't making much h eadway in medic al
education.
For examp le, I am t o l d that most department s of
preventive medicine deal wi th communi ty health probl ems
having t o do with the transmission o f di sease -- s ewer
s y s t ems , infestations, and t he l i ke -- act ions t ha t
�33
f oc u s b road l y on t he popu lation , rather t h an the i ndividual.
For the mos t par t, I understand t hat phy sicians are
i n f or me d abou t nu trit iona l r equirement s o f in f ancy ; f o r
corre c t i on o f speci f ic d i se ases; and fo r prevent ion o f
contagiou s dis ease from birth t o about age 15 .
But
educa t ional emphases on adu l t nu tri t i on and adu l t
di sease preven t ion are weak a t be st.
Our whol e h e a l th
care s y stem , including pa tterns fo r reimbursemen t ,
needs rethi nking if we i n t end t o s tress hea l th main t enance
a s well as t reatmen t of illness .
VII
Anothe r que st ion t he pub lic ha s begun to f i re a t
t h e he a lth pro fe s s ion s with g reat i nten s i t y i s :
why
has the cost o f health c are ou tp a ced almos t everything
e ls e ?
You each know the answer; you each may have a
di f ferent answer .
Undoub t edl y , par t of t hi s increas e
can be attribu ted to t he u s e o f s oph i s t i c a t e d , co s t ly
�new t e chnology in d iagnost ic, therapeutic, and support ive
heal th care.
Another po r t i on must be attributed to the
aggre s sive organ iz ations of pro fe s sion al ho s pi tal staf f
and s uppo r t workers seeking improved wages and working
conditions.
Sti ll othe r cau se s are i nflation ' s e f fect s
on the e n t i r e U. S . economy, and precaut ionary r e a c t i on s
to the threat o f malpractice l i t i ga t i on .
But the health care provider, and specifically the
physic ian, is a caus e for part of the i nc r e as e d co s t of
care.
The i n it i a ti on of expens es t o be i ncur r e d i n
hea lth care r e sts with the pliys ic ian.
Some, i n a
position t o know, claim too many pati ent s are being
admit ted t o the hospital for the convenience o f the
doctor.
Though the physician canno t contro l the dai ly
room co s t onc e the patien t is hospitalized, he or s he
does have control over t h e number of x-rays, the numbe r
and types o f diagnostic or surgical procedures, th e
extent of rehabil itativ e measures orde red, t he amount
of medications prescribed , and the l eng t h of st ay.
�So what i s c a l l ed f o r ?
Two t h i ngs , as sta rte r s .
First, t h a t medical school s work cost awarene ss and
containment into their cur r i culum s o phy sic ian s are
pr epared t o ma ke car e ful , discrimina ting cho ice s among
t he vari ous procedur al t ool s avail ab l e t o t hem.
Th i s
mean s learning t o weigh bene f i t s agains t cos ts , cos ts
again s t personal convenienc e, and conveni ence against
the p a t ient' s well-being.
In t urn, the phy si cian mus t
be convinced, and convinc i ng , t hat the s e a c t i on s wi l l
provide good and appr opr i a t e car e t o peopl e.
Second, t h at a l l health pro fessio nal s maintain t he
h ighe s t p e r sonal s tandard s of s e l f - di s c i p l ine and
co n sc i entiou s execu tion of their a ssi gned responsib ili tie s
i n an a tmosph ere o f cooperation.
The ph ysici an i s the
key ca tal yst i n t he de livery o f a ppropri at e h e a l t h
car e .
There fore, he or she must b e educat ed and prepared
to t a ke t he l ead in coope r a t i ve and co s t - ef f e ct i v e
approache s to delivery o f heal th care .
�36
Further, as I ment ioned earl i er, t he physician can
he lp overcome t e r r i t or i a l posses siveness and "tur f
r ivalri es"
in the delivery o f quality care.
The oppor-
tunitie s today are becoming more plenti ful for teamwork
which c an vast ly improve the effic i ency and qua l ity of
care, and a l so contribute pos it i vel y t o co st con t a i nme n t .
A legion of new health professional s ha s joined t he
fi el d :
phy sicians' assistant s, ge riatric nur s e prac-
titioner s, physician speciali sts in n ew a r e a s , skilled
nursing , and others.
New practic e opportun ities exi st
i n group pract ice, joint prac t ice, and varied team
approache s i n de live ring health care.
Medical educa tion s hou l d t a ke t h e lead in grooming
studen ts to v iew their responsibili ty as care providers -coop era tively not t e r r i t or i a lly -- and f r om the patient's
perspective on what qu ali ty care i s, no t simply t he
profes sional s own preference s or conveniences .
�37
An a t tempt t o se t up working model s f o r t e am
practi ce experi ence a t the undergradua t e l ev e l mi gh t be
premature be c au s e each studen t is ov e rwh e lmed with
l e a r n i ng t h e bas i c knowledge and skill s o f th a t profe s sion.
But t he e s t ab l i s hmen t o f good working mode l s, men t o r shi ps,
and pract i c e ex pe r i en ce s in c oope r a tive care de l ivery
i n cl ini cal educa tion would s e em wel l-advis ed.
By
then, t he s tuden t has mature d i n skills, se l f -conc ep t ,
and re ad i n ess ; can i n t e gr ate t h is t e am practice experi enc e;
and can en ter pro f e s s ional pract ic e f r eed o f terri tor ial
constrain t s and a t titudes.
Su ch te am s ki ll s can a l so
be re i n force d through care ful ly p lanned co ntinu ing
educ a t i on programs.
He a lth profe s siona l s a re a priv i l e ged gr oup ,
comp ens ated by society t o an ex t en t matched by few
other pr ofe s s i ons or occupations.
No on e denies t h at
he al th pr o f es s iona l s h ave worked hard t o ente r thei r
profes sion.
However, we mu st a lso rem ember tha t whil e
�38
the medical or nur s ing or denta l or ph armacy studen t
pay s a high pri ce in t e r ms o f t i me , energy, and do l lars ,
t h e overal l e duc a t i on o f t he health pro fe s sional is
heavi ly s ub s i di z ed by t he peop le o f t h i s country:
bo th
f r om publ i c s our c e s v i a t ax do l lars, and f rom pr ivate
bene fac tor s.
Es tima t e s on t h e f i n an ci a l cont ribu t ion
of t he student t o his medi cal or dent al edu c at i on va r y
f r om abou t f i v e perc en t t o 50 percent o f t he t o ta l
co s t, depending upon whether t he s choo l at t ende d i s
pu blic or priva t e , and whether t he experi ence doe s or
do e s no t include a broad r ange o f p r a cti ce experi enc e s
i n a l arge medi c al c ente r .
Addi t ional ly, t he h ea lth
profe s sional' s prima r y workplace - - t he hosp it a l -- is
mo s t o fte n subs idi zed by the pu bli c t o a degr e e unma tched
by any o ther pro fession.
Thi s arrangemen t impl ie s an
ob l i gat i on by the heal th pro f ession s to u s e that s ett ing
in a judicious, respon s ibl e, equ i t ab l e manner f o r t he
benefi t o f a l l peopl e , no t a s e l e c t f ew.
�I t r emains t he phys ic ian' s r e s pons i b i l i t y t o
pract ice t he i r agel e ss , rev ered and respe ct ed work in
ways which wi l l assure t he pe r pe tua t i on o f s u ch re spec t .
The same can be said about t he r espo nsib i l ity o f al l
who choos e t he health pro f essions.
VI I I
In summary, le t me s uggest f ou r topics which f r om
t h i s layman's pe rspe ct i v e would h ave pr iority in hea l th
pro f es s ions educ a t i on re form.
First, I would call f or a compr ehensive conc eptua l
f r amewor k for health c a r e delivery a t al l l ev e l s
p rimary, s e con da r y , and te rt iar y , i ncorpo r a t i ng a ma j or
role f or the t e a ch i ng and r esearch ins t i t u ti ons .
The
most appropri ate and product ive r ole s f or al l he a l t h
profe ss iona ls would be clari fi e d -- phys icians, denti s ts,
nurs es , ph a r ma c i s t s , publi c he alth s pe c i al i s t s, the
al l i ed hea l th f ie lds, administ r a t ors .
Th e vi ta l contri-
bu tions of t h e va r i ou s specialti es would b e f u l l y
�uti l ized but would no t be pe r mi t t ed t o dis tor t t he
syst em.
Educ a t i on a l programs , both in broad terms and
~
in curricular detai l , would then be made con s i s ten t
with society's goals and ne eds a s rep resent ed by t h is
ov erall concept -- not a single national plan, but a
broad sta temen t of purposes, principles, r e lat ionships,
and roles.
Second, empha s i s t h r oughout the educ at ional process
would be related to th e u l t i mat e goa l -- a healthy
population.
The popul a tion would h ave h ea l t h care
s e r v i ces ava ilable and readily ac c e s sible, 'compr ehen s i v e
and con t i nuous in charac ter, o f appropriate quality,
and wi th a tten t ion to co st and produc tiv ity.
Empha s i s
would be placed on he alth promotion/di seas e prevention
for the individual and publi c health programs for the
community.
The educational proce ss, from its ph i l o s oph i c a l
approach through tangible clinical experience s, would
be pa t i en t - or i ent ed .
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�42
yea r f r amewor k bu t could b e addressed, systema tica lly,
over a longer period as an individual pract i tioner 's
goals and r e spons ib i lities change.
Such continuing
educat ion should be based on indiv idua liz ed profe s s ional
ne ed s and measured in t e r ms o f per formance b ehavior,
not simply units of lecture t i me b efo r e gol f or on a
cruise s h i p .
Perhap s th i s deve lopment -- a comprehens ive approach
t o con tinuing profes siona l education -- offe r s t he
gre atest promise for addressing our s oc i ety ' s health
care concerns more effectively .
My closing t hought would be a re t urn to my f i r s t
ob serva tions:
(1) whi le there is much in ou r he alth
care system in t h i s coun t r y about which we can be proud
and whil e i n fac t it is unequa l led in t h e world, improvement
is po s sib le -- there are s hort comi ngs which need to be
imagina tiv ely addre s sed; and (2) a s educators, you
visib ly shape tomorrow.
�In most area s o f human concern, "We know be t ter
t h an we do.!t
Cer tainly thi s is t r u e in your chosen
fi eld o f concentration -- t h e educat ion o f professional s
for h ealth c a r e .
A great dea l more i s known abou t wha t
good hea l th care could be - - and should be -- t h an i s
generally put t o u se.
The un ending challenge t o you ,
as educators, i s to move real i ty clo ser t o the vi sion
o f tha t which ough t t o be.
RGM-3, Job E
WPC:
3/19/82
I wish you Godspeed.
�
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Russell Mawby Papers
Subject
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Charities
Family foundations--Michigan
Philanthropy and society
Description
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The Russell Mawby papers document the life and work of Michigan-born Russell Mawby from 1928 to the present. Mawby was the Chief Executive Officer and Chairman of the W. K. Kellogg Foundation for twenty-five years and is recognized for his work in the area of philanthropy in the United States, Latin America, and Europe.
The digital collection includes a selection of field notes, speeches, itineraries, and other materials.
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Mawby, Russell G.
W.K. Kellogg Foundation
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Russell Mawby speech, A Layman's Perspective on Priorities for Health Professions Education Reform
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Speech given March 17, 1982 for the W. K. Kellogg Foundation at the Health Professions Education Conference to discuss the changes in educational programs in the area of health.
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Dorothy A. Johnson Center for Philanthropy and Nonprofit Leadership
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W. K. Kellogg Foundation
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Text
Remarks by
Dr. Russell G. Mawby
Last Seminar for the
W.K. Kellogg Foundation's
Community-Based Public Health Initiative
Detroit Ponchetrain Hotel
March 24, 1992
I
I welcome the opportunity to be with you tonight to share a few
observations about this community and public health initiative from a
personal and layman's perspective.
I have certainly enjoyed learning
about your activities and discussions in this series of seminars from
our health staff at the Foundation and have found the issues you are
addressing to be most provocative.
I want to thank each of you and your
institutions for your interest in the new community-based public health
initiative.
It is apparent from your involvement that the agenda that
the Foundation has put before you is a challenging one indeed -- calling
for each of you health professions educators, public health
practitioners, and community organizational representatives, to examine
deeply your long-standing patterns of behavior and interrelationships.
Thus far, the response to this initiative has been quite strong, though
varied, as we would expect.
Yet there is a pattern.
You recognize the
difficulty in what is being asked and the need that it be done.
The
time is right for some groups to reach out -- to set up new linkages
with people and communities to create new partnerships that will
influence health professions education and community health in the
decades to come.
�2
All of you in this room know only too well that the processes of
institutional change, carefully designed to protect us all from hasty
decision or impulsive action, can as easily serve to smother a flame of
innovation.
May you have the courage, the energy, and the genius to
carry through some of the ideas you have been exploring and avoid that
being the case -- again.
I am impressed with this initiative.
are here.
Those who can make a difference
Usually, educators talk with other educators, practitioners
with practitioners, and community people only with themselves.
But all
component parts of the health field are represented in this meeting
local and state health officials; university administrators, teachers
and researchers; doctors; nurses; governmental executives; leaders of
various community organizations.
Remarkable!
Wonderful I
Some of you
will be the vanguard in moving forward, in tangible and gratifying ways,
the concept and genius of the helping professions -- at the moment
accomplished in disciplinary scientific contributions, but with their
potential unfulfilled in preparing practitioners specially suited for
advocating and delivering comprehensive public health services in
partnership with the communities they serve, benefits which therefore
are not yet realized.
As already indicated, my background and my graduate education are in
agriculture.
I come to you as a layman, hopefully an "informed layman"
whose role as chief executive officer of a foundation
-- which each
year provides millions of dollars for programs in health education,
services, and delivery
field.
obligates me to be aware of issues in the
I still recall vividly a series of "rude awakenings" as I first
became involved in the Foundation's programming in health.
I was
�3
dismayed, shocked, disappointed by much of what I learned of the inner
workings, both in education and practice.
While there is much to be
admired and praised, the stark realities which became clear, tarnished
and eroded the pinnacle upon which the health professions had resided in
my mind.
I have tried to learn wisely and to carefully place the
various components in proper perspective and balance.
In so doing, I
have had to learn the lexicon of the back hallways and the differences
between epidemics and epidemiology; to recognize a "utilization
reviewer" or "quality assessor" when I see one; to understand that
"environmental health" doesn't refer to a senior citizen breaking the
ice to skinny dip in a frozen lake; and to appreciate a career ladder in
nursing. (But, I must confess I still cannot distinguish easily a
community health nurse from one who is not.)
Actually I bring more baggage than that to this meeting.
I grew up on a
farm in west central Michigan, not really "rural rural" because the
homeplace is now part of a suburb of Grand Rapids, but a farm
nonetheless and in a family which enjoyed for years the splendid
services of a country doctor, Dr. Jay D. Vyn.
His wife was his office
nurse/receptionist; later his daughter served in that role also.
They
worked together in harmony to treat the sick and the injured, vaccinate
the children, improve sanitation, and protect the health of the whole
community.
They mobilized the townspeople and were supportive of each
other, the patient, the family, the neighborhood.
I am not a nostalgia
buff, yearning for the good old days -- a return to the outhouse,
tuberculosis, and blood-letting -- but there were some things in that
pattern which should still serve us well.
�4
But perhaps my best qualification for being here today is not that of a
foundation executive, but simply a concerned citizen.
I have been
blessed with good health and so my personal involvement with either the
health care system or the public health system has been minimal.
But I
have had more than enough opportunity to be deeply involved -emotionally and in every other way -- in my responsibilities and
relationships with parents, friends, and neighbors.
I have seen at
first hand the petty squabbles between health departments and medical
doctors, between health and social service agencies, and I have seen
over and over again the apathy and red tape and needless bureaucratic
entanglements that defy human logic and need.
I have sought information
and assistance in every conceivable way -- asking, begging, cajoling,
threatening -- to get a glimmer of understanding, an approach to a
problem.
And I have experienced an extraordinary array of responses
empathy, helpfulness, compassion, arrogance, disdain, rebuke, both the
engaging resourcefulness and the pettiness of the helping professions
you represent.
So the perspective I bring is that of a layman -- a
concerned individual, a grateful beneficiary, a constructive critic, an
eager participant in the unending process of making the superb health
system and situation we have today even more responsive, effective, and
satisfying.
II
Many of you are educators, charged with key responsibilities in the
preparation of the professionals who design, manage, and conduct the
affairs of our health care system -- its various components,
institutions, and programs.
You shape tomorrow.
W.K. Kellogg said it
well, "Education offers the greatest opportunity for really improving
�5
on e generation over another."
You are vital participants in the
s election a nd molding of the publi c health professionals who guide our
future .
You help to determine the criteria by which decisions are made
as to who is in and who is out; you shape the pattern of experiences to
which they are exposed; and you establish the criteria by which their
suc cess or failure is determined .
Thus, ultimately, you influence the
shap e, the character, the personality, the morality of our health
system.
We are grateful for the degree to which you succeed; we worry
about the whys, the hows, and the so whats of the job you do; and we are
the beneficiaries -- or the victims -- of the consequences of your
efforts.
Others of you in this room are public health practitioners.
You manage
and give direction to local health agencies, and you c a r r y out and
supervise the array of preventive and protective servi ces which
government provides for the entire community.
Still others of you
analyze and plan and develop policy options for the organization and
delivery of lo cal and regional health services.
And finally, there are
individuals in this room who, like me, are laymen, but committed to
lending a hand as volunteers and dedicated public servants in the
grassroots, civic, and human service organizations that make our nation
unique in all the world.
Quite frankly, I have struggled with how I might most productively
approach my assignment today.
My first inclination was to approach the
task as I always approach the learned professions -- hat in hand, in awe
and in admiration of those who are privileged to serve and influence so
intimat ely the human condition.
Despite the experiences which abuse
�6
that idyllic image, to me there is no higher calling than the health
professions you represent.
But I have chosen a different course in pursuing my task today.
Quite
simply, I leaned back in my chair and said, "Suppose I were a health
professions educator or practitioner.
What would I do?"
As a logical
first step, I then pursued the question, "If I could design it, what
kind of health system would I like for my own community and for the
Mawby family?"
This is not an idle or an impulsive question; it is one
I have been asking myself, members of our Foundation program staff,
l eaders in the health professions for a number of years.
I have finally
concluded that ideally I would have the Mawby family affiliated with a
small team of professionals
perhaps some combination of primary care
physicians, dentists, nurse practitioners, with a
receptionist/bookkeeper, other support personnel in nursing and the
allied health fields.
This group would have appropriate privileges with
community hospitals and nursing homes; referral arrangements with
specialists (mental, physical, social, behavioral), and it would
function within a system that continuously monitored health conditions,
assessed the need for services now and in the future, and made certain
that all citizens had adequate responses to their health needs.
Philosophically the entire system, public and private, would be
committed to a program of health promotion/dis ease prevention or health
maintenan c e, as well as treatment of illness.
Why the emphasis on health promotion/disease prevention?
You in the
public health profession have allowed a system to be designed which
compensates caregivers only for the treatment of my illness or injury.
I can engage specialists to design and implement a preventive
�7
maintenance program for my air conditioner at home, or the elevator or
duplicating machine at my office.
In such a contractual arrangement, I
always have responsibilities which I must fulfill if that contract is to
be valid.
In similar fashion, I would like to compensate a health group
for the design and the continuing monitoring, with my full participation
and fulfillment of my obligations and responsibilities, of a maintenance
contract for my most precious possession -- my health.
Why have the
health professions been so unimaginative, so uncreative, so unresponsive
in this area?
So, that's a brief insight from a layman's perspective of one model of
an "ideal health services system."
There can -- and should -- be many
others, to provide primary care to diverse client groups in varied
settings and to provide public health services to focused populations at
risk.
At the Foundation, we are not in the business of prescribing
models; and we hope many creative ideas will arise out of the new
initiative.
So, that's as far as I will go today as a layman.
As
experts, you will give further consideration relating to various levels
of public health services and to the support strategies of sophisticated
communication technology and the rich resources of research institutions
and academic health centers.
With the range and sophistication of
information technology that is available, public health practitioners in
even the most remote locations can be in touch with colleagues for
consultation and counsel on a continuing basis.
You will think of
people and the range of their needs, and loosen your grip on the
technology that strengthens the confidence of professionals only, but
with little benefit for members of the public.
As a layman surveying the health scene today -- both in education and in
practice -- I see the "bits and pieces" as superb.
By "bits and pieces"
�8
I refer to our professional schools, in public health, medicine,
nursing, dentistry, pharmacy, administration, allied health, all the
rest; the professions, with dedicated and competent individuals and
effective associations; the various practice settings, including solo
and group offices, clinics, hospitals, research and teaching centers.
All superb; without question, the finest in the world.
But I have the uneasy feeling that too little thought and effort have
been given to rationalizing the whole, with an objective of serving
maximally the interests of the total community.
major failing of our public health system.
And this perhaps is the
In the one profession that
is charged with setting our national directions for health policy, we
have only mixed signals and half-considered mewlings.
The "total
system" (this phrase sounds tidier, more prescribed and restrictive than
intended or possible)
with multiple alternatives and pluralism in
every sense -- should be particularly sensitive to the public it serves
and by which it is sustained, subjugating the more selfish interests of
professions and institutions to the higher purpose.
We lack a "grand
design" or a series of grand designs which bring together in most
effective ways the expertise of the various health professions, and
networking more efficiently the resources of the health care
institutions of our society.
Wisely done, building on the terrific
strengths of the day but responding objectively and sensitively to the
demand and unmet needs of the public, the result surely will be far
greater than the simple sum of the parts of which it is comprised.
It
goes without saying, surely, that this core public health function
should occur not only at the macro level -- global and national
in cities and counties and communities throughout the country.
but
As
public health educators and practitioners it is your challenge to
fulfill such a vision and goal.
It is not enough to be simply an
educator in health administration or specialist in environmental health
services.
You must see the larger picture, with its strengths and
shortcomings, and move relentlessly toward the realization of the better
situation.
Universities, of which the schools of the health professions
are a part, have a special responsibility.
They are the knowledge
reservoirs of our society, established and sustained to preserve,
create, and transmit knowledge.
An unending challenge is that of
�9
mobilizing these knowledge resources in ever more effective ways to deal
with the concerns of society.
While there is much in the health scene in this country of which you can
be justifiably proud, there is still much "unfinished business."
Hopefully the health professions -- with you in public health in the
vanguard -- will provide aggressive and imaginative leadership in
addressing issues of concern, lest the responsibility fall by default to
those less able.
III
Recent health programming of the W. K. Kellogg Foundation focuses on
community-based health services, as you have heard from our health
program team over the past few months.
Since 1987 more than 75 projects
have been funded by the Foundation as models for community-based,
problem-focused
hea~th
services.
Let me tell you about three of them.
First, there is the project that you know already -- conducted for and
by the residents of an Atlanta public housing project.
You have heard
Avery and her team talk of trying to piece together the fragmented lives
of adolescents, putting the focus on their self-esteem by tying the
threads of desperate interventions together -- drug education, sex
education, AIDS education, pregnancy counseling, job training literacy
tutoring, and more.
Shouldn't public health education be rolling up its
sleeves and going to work on preparing health professionals to shoulder
their part of the burden?
In another instance, one group from a health professions school is being
funded to address the basic health and human service needs of masses of
isolated urban immigrants.
There they deal with language barriers,
illiteracy, and tropical diseases, to name a few.
The group's tether to
their school and to the other health professions' schools of its
institution is thin indeed.
Hopefully, public health students will
attain valued educational experiences in this program.
Yet, the support
so far from the parent institution is "long distance encouragement."
Like big ships, academic health centers change their course ever so
slowly.
�10
And a third example, although I could go on and on, is that of a
comprehensive program for young black males to teach high school
graduates to read, to improve the nutritional status of young blacks, to
provide basic health services, to help them find jobs, and in the words
of the project's director, "to turn them away from their syndrome of
self-hate."
These are but a few examples, and as I mentioned earlier, there are many
more from our projects comprising our primary health strategy.
are four supporting strategies in our health program as well.
There
They are:
informing poli cymakers, information technology, leadership development,
and the one that is the focus of this initiative, health professions
education.
Health professions education is critical of course.
If our
support of these specific community-based, problem-focused projects is
to lead to wider and system-wide impact, we must involve professions
education, and public health is one of the critical elements in such a
venture.
We emphasize community-based health services.
As public health
professionals, you understand the issues of primary health care and of
population medicine, so there is no need to comprehensively address this
topic.
We are asked so often what we mean by community-based services,
probably because it means so many things that it means so little.
I am
not going to help with the definitional problem, but I would like to
reflect on a few things that are important from my layman's perspective
-- and I suspect to most people as well.
It may be appropriate to begin with a problem identified in the writing
of Herodotus some 2400 years ago.
The Greek historian perceived a
discontinuity of care in his native land, and he lamented, "Each
physician treateth one part and not more.
And everywhere is full of
physicians; for some profess themselves physicians of the eyes, and
others the head, others the teeth, and others of the parts of the belly,
and others of obscure sicknesses."
Herodotus was correct in his view that a discontinuity of care can
result from the trend toward overspecialization.
Public health
services, offered or provided in a fragmented fashion, likewise are
�11
difficult to deal with.
But the problem goes deeper:
often
accompanying such specialization is the problem of transfer of
information between divisions or branches of the same agency, thereby
crippling it as the community's comprehensive resource center in health.
Let me use a personal example to illustrate what I mean.
My mother, by
the time she reached her mid-70s had several different health problems,
including cancer and complications from a series of strokes.
In the course of her cancer treatment, she was shunted from one
specialist to another, from internist to surgeon to radiologist to
oncologist, none of whom really took a comprehensive look at her
problems in order to assess her overall condition.
The internist who
diagnosed the problems initially refused to continue as her primary care
physician, so the responsibility for continuity rested with the patient
and her family, certainly an unsatisfactory assignment by default.
We
encountered another stumbling block -- a great reluctance, and at times,
refusal on the part of several physicians to transfer medical records of
the care they gave my mother to other physicians who also were treating
her.
Consequently, examinations, tests, and procedures were duplicated
unnecessarily, at inconvenience, discomfort, and cost.
I understand the
reasons given, but I do not accept the final result as adequate or
defensible.
one.
There must be better ways.
This example is not an isolated
Friends and associates have told me similar stories, and you can
surely add anecdotes of your own.
While my example centers on physicians' behavior, overspecialization and
a lack of coordination in care are not problems confined to anyone of
the health professions.
Specialization, some observers contend, has
resulted from the implementation of technology in almost every field,
forcing each citizen to deal with an ever-increasing number of providers
of service.
The specialization of health education and health services
is, in many ways, an achievement in which America can be proud.
But at
the same time, we must manage it so that it does not become an end in
and of itself.
If such specialization results in frustration and
fragmented, incomplete community health services, it needs rethinking
and rearranging.
This problem should be addressed by all health
professional schools, not excluding schools of public health.
�12
IV
Experts keep telling me that access to health care is a serious problem
only for the urban poor and for people in remote rural communities.
That simply is not true, if the measure we apply for adequacy goes
beyond the most primitive or basic standard.
In communities of all
types, urban and rural, without regard to economic circumstances, many
families have real difficulty in gaining access to satisfactory primary
care on a continuing basis.
Let me use a true story to illustrate the issue of availability of and
access to health care.
Not long ago on a visit to a county seat town in southern Michigan,
I met with a group of young physicians.
I asked them, "If the
Mawby family moved to this area, could any of you take us on as new
patients?"
There was a quick consensus, DOh yes, Russ Mawby, chairman of the
Kellogg Foundation, of course we will get you in."
"No, no," I said.
"Russ Mawby, 'wi t h a wife and three kids, living
on 40 acres south of town."
Again there was a quick agreement, "None of us is taking any new
patients.
You'll just have to go to the emergency room at the
hospi tal. "
I don't believe that is a satisfactory answer to primary care for
families; emergency room care should be for emergencies, not serve as a
usual point of entry for primary care.
As a layman, I have observed that health professionals -- in
particularly physicians, but to a degree all health professionals
have no problems gaining access to the health care system.
If their
child or mother or good friend needs to see a doctor, even a specialist
who is booked six months in advance, there is no problem of access.
I
�13
suspect this may be a fringe benefit which also extends to you as public
health educators and practitioners.
But don't let this lull you into a
belief that this is therefore no problem for the rest of us, regardless
of geographic, cultural, or economic circumstance.
Innovative approaches to encouraging physicians, nurses, dentists, and
other health professionals to practice together more efficiently and
effectively, including the provision of care in underserved areas and to
unreached clientele, must continue to be developed and supported by
public health officials so that all people, whether they be affluent or
poor, and whether they live in the city or the country, have access to
quality health services. Public health all too often functions as an
island -- distant from the practice arrangements and practice anomalies
of the licensed caregivers, never acknowledging that its own
disassociation is but another part of the problem.
v
Notice -- I said quality health services
basic concern of all.
certainly a persistent and
In recent years, not just in the practice of
medicine, quality increasingly has come to be defined in terms of the
application of high technology.
We pride ourselves on making use of the
latest equipment, procedures , and systems whether in medicine, public
health, the auto industry, or communications.
In the health field this
emphasis on technology can contribute to a failure to recognize that
actual public health services may be just as good or better in the
small, modestly equipped facilities.
Universities have taken the lead in applying high technology to health
professions practice (as well they should) but they must not rush so far
ahead that they forget the human dimension
the public's perception of
quality, which often hinges on how people are treated, individuals and
families, not just the health problem.
Despite statements by individual
faculty members that they recognize this citizen-receiver perception of
quality, as contrasted with the professional's perception, most
observers are unable to note much evidence of that recognition.
�14
If you or I were to have a coronary today, our spouse would not walk
into the hospital and ask, "What's the average length of stay?"
But
that yardstick has been too much a primary measure of "quality" in
facili ty reviews.
in pain?
him?"
Instead, a loved one is likely to ask, "Is he or she
Is he being kept comfortable?
Is someone with him?
May I see
Administrators tend not to worry enough about those humanly
critical gauges which are so significant both to the patient and the
family, and to the patient's ultimate recovery.
There is a definite need for educators to give as much consideration to
the public's perspective on quality as it gives to health science and
research.
Many respected authorities have long called for increased
attention to the humanities and social sciences as a means for
instilling humane concerns for the human condition in the education and
training of public health professionals.
In the new initiative, I hope
steps are included to make this dimension central to all health
professions education.
VI
My closing thought would be a return to my first observations:
1) While
there is much in our health care system in this country about which we
can be proud and while in fact, it is unequaled in the world,
improvement is possible; there are shortcomings which need to be
imaginatively addressed; and 2) as public health educators and
practitioners, you will visibly shape tomorrow.
What will the new public models be like?
I don't know the details and
it's not the Kellogg Foundation's style to shape those details.
Someone
said that the trouble with predictions is that they deal with the
future, but undaunted I will turn on my future scope to 20 years hence.
I can see the outlines of a vision.
The vision is of a community that is mobilized and empowered by its
citizens to engage in an effort to improve the health and well-being of
all those who live within that community.
Ordinary people are engaged
in collective action through schools, worksites, churches, civic
organizations, or political action groups, to address the problems which
�15
surround them.
For health concerns they are linked in partnership with
administrators from the local hospital, leaders of the professions
(medicine, nursing, dentistry) and in particular with staff from the
local health department.
These public health professionals are
knowledgeable not only about traditional public health issues (things
like contagion control, health promotion/disease prevention,
occupational safety, human nutrition, and the like) but also in the
process of community organization and human development.
Both groups
citizen leaders and health professionals -- work together,
collaboratively, to address the issues that threaten community health
always with an ear to the priorities and special cultural approaches
that make most sense to the people who encounter the problems on a
continuing basis.
In my vision I see something more ... a health department that is so good
at its business of building the community and promoting its health
interests, that it also is the site where future public health
professionals are educated and trained.
Students learn in depth about
rabies and animal control by walking the streets with health department
staff.
Students make home visits with public health nurses, and they
plan and design a public relations campaign against smoking and drugs
with real experts in the communications field.
Most particularly, they
become knowledgeable about community "affairs and citizen action by
working side-by-side with neighborhood leaders, men and women who are
committed to improving the lives of people outside their own family or
personal acquaintances.
In this cauldron of work and learning, the
issues of equity and social justice are not just phrases in a course in
philosophy, but they are basic tools that are inherent in a profession
that is committed to improving the lives of people.
I know -- and you know -- that our society will not permit the present
state of affairs in health care to last forever, and the pressures are
growing upon you as policymakers to find solutions; more people have
needs to be served, and the costs are increasing at a rate well above
inflation.
What elected officials seek are solutions that they can
support and implement.
They need public health and community leaders to
shift from being part of the problem to being part of the solution.
We
hope that the Kellogg initiative will give some of you the opportunity
�16
to create and implement such solutions.
We -- elected officials and
policymakers, city folk, rural folk, the underserved poor, the upper
middle class, the young and the elderly, me and my family -- are all
counting on you.
In most areas of human concern "we know better than we do."
Certainly
this is true in your chosen field of concentration, the education and
practice of professionals in public health.
For in fact, a great deal
more is known about what good health could be and should be than is
generally put to use.
The unending challenge to you is to move reality
closer to the vision of that which ought to be.
I wish you gods peed and
look forward to that day in the future when we celebrate together your
achievements.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Russell Mawby Papers
Subject
The topic of the resource
Charities
Family foundations--Michigan
Philanthropy and society
Description
An account of the resource
The Russell Mawby papers document the life and work of Michigan-born Russell Mawby from 1928 to the present. Mawby was the Chief Executive Officer and Chairman of the W. K. Kellogg Foundation for twenty-five years and is recognized for his work in the area of philanthropy in the United States, Latin America, and Europe.
The digital collection includes a selection of field notes, speeches, itineraries, and other materials.
Creator
An entity primarily responsible for making the resource
Mawby, Russell G.
W.K. Kellogg Foundation
Source
A related resource from which the described resource is derived
<a href="https://gvsu.lyrasistechnology.org/repositories/2/resources/432">Russell Mawby Papers (JCPA-01). Johnson Center for Philanthropy Archives</a>
Publisher
An entity responsible for making the resource available
Grand Valley State University. University Libraries. Special Collections & University Archives.
Contributor
An entity responsible for making contributions to the resource
Johnson Center for Philanthropy
Rights
Information about rights held in and over the resource
<a href="http://rightsstatements.org/page/InC/1.0/?language=en">In Copyright</a>
Format
The file format, physical medium, or dimensions of the resource
application/pdf
Language
A language of the resource
eng
Type
The nature or genre of the resource
Text
Identifier
An unambiguous reference to the resource within a given context
JCPA-01
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
1938-2012
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Source
<a href="https://gvsu.lyrasistechnology.org/repositories/2/resources/432">Russell Mawby papers, JCPA-01</a>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Identifier
An unambiguous reference to the resource within a given context
JCPA-01_1992-03-24_RMawby_SPE
Title
A name given to the resource
Russell Mawby speech, Community-Based Public Health Initiative
Creator
An entity primarily responsible for making the resource
Mawby, Russell
Description
An account of the resource
Speech given March 24, 1992 for the W. K. Kellogg Foundation at the last seminar for the W. K. Kellogg Foundation's Community-Based Health Initiative.
Contributor
An entity responsible for making contributions to the resource
Grand Valley State University Special Collections & University Archives
Dorothy A. Johnson Center for Philanthropy and Nonprofit Leadership
Publisher
An entity responsible for making the resource available
Grand Valley State University Libraries, Special Collections and University Archives, 1 Campus Drive, Allendale, MI, 49401
Subject
The topic of the resource
Philanthropy and society
Family foundations--Michigan
W. K. Kellogg Foundation
Charities
Speeches, addresses, etc.
Health
Language
A language of the resource
eng
Rights
Information about rights held in and over the resource
<a href="http://rightsstatements.org/page/InC/1.0/?language=en">In Copyright</a>
Date
A point or period of time associated with an event in the lifecycle of the resource
1992-03-24
Format
The file format, physical medium, or dimensions of the resource
application/pdf
Type
The nature or genre of the resource
Text
-
https://digitalcollections.library.gvsu.edu/files/original/c0d555c2bb5d67a4715b0ecb0c233fe2.pdf
17ada68dcbbd4ff816222af99ad990f9
PDF Text
Text
Rx FOR RURAL HEALTH
Remarks by Dr. Russell G. Mawby
Pre s ident, W. K. Kellogg Foundation
at the
Michigan Conference on Rural Health
Michigan State University
May 24, 1973
I
Thi s is Educati on Day of Michigan Week.
Under the auspices of t h e Greater
Mi ch i gan Foundation, Michigan Week has become a cherished t r adition in our State.
I am privileged to b e State Chairman of Educ at.Lon D::\V this y ear .
As a
part of this spe cial day, act ivitie s are being conducted througnout the State ,
i n s chool s, in communities, and in regions.
At the etatp. level each year, one
special a c tiv i t y is held as a part of Education D8.y.
a ct i vity is our Conference on Rural Health.
I t l.s
For 1973 thiF· special
appropriate indeed that
we are meet i ng here on t he campus of the pioneer lancl.-grant. urri.ver s Lty--the
people' s university--in the pioneer Center for Continuing Education.
Today, more than ever before, l ifelong learning is a rea l ity for each of
us,
As individuals concerned with health in rural Michigan , we are enga ged
together in a LearnLng
Pl'OC2SS
so that we might more effectively fulf ill our
respective rol es.
II
The title of my rema rks--"Rx for Rural Health"--is deceptively simple,
You know better than I that there is no simple prescription for health, r-ur a.l
or urban .
�2
A f ew weeks ago Mr. Pe.t tu.Ll.o and I visitf:;d a community hospitaJ. in a
count y seat t own of a rural county in southern Michigan,
As a part of our
schedule there, we ","ere vi siting with two young physiC'i8.:tls--brig:tt, competent ,
ccnrc Lent.Lous _ In the coui-ae of our conver s ation they indicated that nei thel'
of -sh'O'Ttl
W8-::
t.akLng more patients,
other 13 doctors in the county.
110):"
to their knowledge were any of the
I explained to them that I had moved onto
a small f'ar m "Pith my family and asked
~.hat
would happen if I ca l led t h ei r of f ice
to make arr angement.s f'or a f'amLLy physician.
They indicated that the response
vrou.Ld 2E simply" "We're awfully sorry but we are filled up .
If anything happens
to any of' the youngsters, come to the emergency room of the hospital and they
will do vha t t.hey can."
This little anecdote of a t r u e exper i e nce summarizes many of the things
which co nc er n us about the health car e delivery system in this country.
We
are concerned with issues whi ch ar e described i n phras es l ike accessibility,
conti nu i t y , comprehensiv enes s , and quality of care; delivery systems;
financing ar r a ngement s ; a communi t y and pr ev ent i v e dimension to our health
system; oper at ional ef f ectiv enes s .
The W. K. Kellogg Foundati on for over four decades has been actively
concerned with health in Michigan, with a spec.ial emphasis on rural people
and r ural communi t ie s .
This involvement goes "back to the early 1930's and
the f i r s t days of the Foundation's activit i es in seven counties of so uthcentr al
Michigan.
This was known as the Mich i gan Communit y Health Progr am (MCHP) .
I'll
not chroni cle this great story here, but it certainly was a pioneering and
f orwa rd st ep for rural health.
As a part of that early development we were also i nvolved with the Michigan
Health Council, which was e s t ab l i sh ed about 30 yea rs ago .
Mr . Gr a ham Davis of
�3
the Founda t i on staff was one of the founders of the Council, and the Counc il
began it s activit i es with a prime concern for rural health.
The Foundation's prima ry f ;.e l Cis of interests ar e health: education,
and a g:c i t:'u.lt ur e , v h i ch y 01J.. .immed.ia t.e Ly see are inter-rele.ted.
ha s b een d e s .:: d b ed a s a "sh .i r-t s Leeve Mldwea t er 'n fund."
Ou r Fou ndat.Lon
Ff' like that. f'oi- '·re
1 Lke to 0..-=8.1 v;:i th r-eaL pr ob.Lems in pr-ac t Lca.L fmc . realistic wayE.
In our pluralistic society , the role of private philanthropy ( s uch as the
Kellogg Foundation) in contributing to societal progres s is the encouragement
o f innovat ion.
Philanthropic re s ourc e s are really very small i n relation to
gov e r nme nt a l expend itures and t o societal needs.
For example, t h e Kellogg
Foundation this year will make program grants of ab out $21 million i n
t h r e e ar e s s of int er e st and on t'our cont.Inent,s .
Department of Public Hea lth has
8.
0l.U'
By compar Lson , the Mi c h i ga n
budget this y ear of about $7J million.
However , though philanthropic resources are small in relation to tot al
expendf,tures for hea 1 t h, found ation gl'ant s represent th p. risk e:ap i tal i n health
pro gr'ammf.ng and have been r-e spons Lb.i.e for many i nnovations in health technology,
educ ation, and del ivery.
43
In its
years in pr ogramming s upport :i n Michigan, t h e Kel l ogg Foundation
has made grant s totaling $26.5 nri.Ll.Lon for health programs i n our St e,t e.
Currently, we ha v e commitments of $6 million to 47 health projects throughout
Mi c h i g a n .
As example s o f projects whi ch have particular relevance to r-ur-aL
health concerns, I migh t mention the f'o Ll.o-..ri.ng :
*
A cont i nui ng educ ation program for nurses in the Saginaw Valley,
c onduc t e d by Michigan State University
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it u
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o
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c
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t
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del
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y.
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Enhancemen
to
fp
r
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e
r
v
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ce andi
n
se
r
v
iceedu
c
a
t
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nt
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l
th p
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son
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el
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h
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s se
t
t
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l
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mmuni
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r
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.
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r,
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en p
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�8
or ganizations; educational i nst i t ut ions , including colleges and
un i v er s i t i e s , four-year and two-year institutions, public and private,
For too long society has tolerated, borne the costs of, and
suffer ed the consequences of fragmentation.
Hopefully, leadership
for its r at i ona l i za t i on will come from those who are most involved
and most knowledgeable, rather than being imposed .
B.
The ne ed for a compr ehens i ve program of health education.
I would like to share with you some thoughts from a recent addr ess
by Dr. C. A. Hoffman, President of the American Medical Association.
I'A major cause of the current cont roversy about America's health care
is that the pUbl ic and the government fail to understand the difference
between good health and good medicine.
Americans have a right to good
medical car e , but they do not have a right to good health.
Good health
is not a r i ght, but a responsibility--a shar ed respons ibility--and that
responsibility begi ns with the individual 's own health behavior.
The
health habit s of most Americans are so poor that the nation is suffering from what might be termed an acute case of 'people pollution' and
poor personal health behavior plays a significant positive role in
heart disea s e, canc er , stroke, and acc i dents--the four leading canses
of death in America today .
"Indeed, if all Americans could be convinced to adopt a healthful
style of l i f e--eat i ng correctly, not smoking, controlling pollutant s ,
driving safely--the positive effect of the nation's health would be
far more dr amat i c than co uld be a ccompl i s hed through the construction
�9
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Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Russell Mawby Papers
Subject
The topic of the resource
Charities
Family foundations--Michigan
Philanthropy and society
Description
An account of the resource
The Russell Mawby papers document the life and work of Michigan-born Russell Mawby from 1928 to the present. Mawby was the Chief Executive Officer and Chairman of the W. K. Kellogg Foundation for twenty-five years and is recognized for his work in the area of philanthropy in the United States, Latin America, and Europe.
The digital collection includes a selection of field notes, speeches, itineraries, and other materials.
Creator
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Mawby, Russell G.
W.K. Kellogg Foundation
Source
A related resource from which the described resource is derived
<a href="https://gvsu.lyrasistechnology.org/repositories/2/resources/432">Russell Mawby Papers (JCPA-01). Johnson Center for Philanthropy Archives</a>
Publisher
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Grand Valley State University. University Libraries. Special Collections & University Archives.
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Johnson Center for Philanthropy
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<a href="http://rightsstatements.org/page/InC/1.0/?language=en">In Copyright</a>
Format
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application/pdf
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eng
Type
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JCPA-01
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
1938-2012
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Source
<a href="https://gvsu.lyrasistechnology.org/repositories/2/resources/432">Russell Mawby papers, JCPA-01</a>
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JCPA-01_1973-05-24_RMawby_SPE
Title
A name given to the resource
Russell Mawby speech, Rx For Rural Health
Creator
An entity primarily responsible for making the resource
Mawby, Russell
Description
An account of the resource
Speech given May 24, 1973 for the W. K. Kellogg Foundation at the Michigan Conference on Rural Health of the American Medical Association at Michigan State University.
Contributor
An entity responsible for making contributions to the resource
Grand Valley State University Special Collections & University Archives
Dorothy A. Johnson Center for Philanthropy and Nonprofit Leadership
Publisher
An entity responsible for making the resource available
Grand Valley State University Libraries, Special Collections and University Archives, 1 Campus Drive, Allendale, MI, 49401
Subject
The topic of the resource
Philanthropy and society
Family foundations--Michigan
Charities
W. K. Kellogg Foundation
Speeches, addresses, etc.
Health
Language
A language of the resource
eng
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Information about rights held in and over the resource
<a href="http://rightsstatements.org/page/InC/1.0/?language=en">In Copyright</a>
Date
A point or period of time associated with an event in the lifecycle of the resource
1973-05-24
Format
The file format, physical medium, or dimensions of the resource
application/pdf
Type
The nature or genre of the resource
Text
-
https://digitalcollections.library.gvsu.edu/files/original/e4429f007e7760a501493afbdac7ac23.pdf
a5cca29a9fc111c70ef8aa290e5d28dc
PDF Text
Text
,
1
Remarks by Russell G. Mawby
Commencement Ceremony
College of Osteopathic Medicine
Michigan State University
May 7, 1993
I.
Congratulations, Doctors!
Doesn't that have a wonderful
ring to it?
Congratulations, also, to all of those who have had a part
in making this graduation celebration a reality for each of
you -To family and friends who have provided support in
every possible way;
To the faculty of this college, who have cared,
persevered, and prevailed;
And to this University which, through the support of
the taxpayers of the State of Michigan, has made it all
possible.
This is a day for celebration, one of those instances in
life when you have both a sense of satisfaction in things
accomplished and a special excitement for the future.
Aren't you
glad its over -- and aren't you glad its just beginning?
�When several weeks ago I received the invitation to be a
part of this ceremony, it seemed reasonable to accept.
was flattered and excited.
Indeed I
Now as the moment arrives, reality
sets in, for I know that there is not a person here who came to
listen to my commencement address.
In light of that sobering
truth, I propose to intrude only briefly upon this special
occasion.
For those of you who, from force of habit, are taking
notes, my entire message can be summarized in two letters:
R.
U and
"U" for understanding; "R" for responsibility.
II.
In November, 1977, I met wifn ' the entering class of this
College of Osteopathic Medicine.
The theme of my thoughts that
day was reflected in the title, "A Privileged Class."
Some 200
years ago we fought a war over, at least in part, the question of
special privilege.
While we, as a nation, are committed to the
notion that all are created equal and must be assured of equality
of opportunity, in the course of life special benefit, advantage,
or favor does accrue to certain of us.
�You, as members of this graduating class of 1993, must
certainly be regarded as a privileged group -- privileged in
several ways:
First, you are now graduates of Michigan State
University, one of the few truly great universities of
the world.
You will always be proud of the distinction
of this institution, your Alma Mater.
Second, you are now graduates of the College of
Osteopathic Medicine of this great University.
This
College is the first university-affiliated and statesupported school of its kind~
In the quarter of a
century since it began, the College has earned a
national and international reputation and its faculty
and programs are increasingly influential in medical
education and health care services.
Third, as a member of this class, you are the
product of a rigorous progress of screening and
selection.
Each of you here was chosen instead of many
3
�others who had the same aspiration.
Their academic
qualifications were superb, perhaps equal to yours, and
they worked hard for the opportunity -- privilege, if
you please -- of being students in osteopathic
medicine.
But in the difficult and agonizing process
of admission, they were denied what you were granted.
Fourth, your professional education has been
heavily subsidized by the people of Michigan and the
United States.
While you have paid a high price, in
terms of time, energy, and dollars, nonetheless the
education you have received required support far beyond
the fees you paid.
These funds came from public
sources, through tax money, and from private
benefactors, including alumni and other individuals,
corporations, and private foundations.
In a sense, all
of us who are the beneficiaries of higher education
should impose upon ourselves a status of lifelong
indenture to repay that which has been bestowed and to
4
�insure similar benefits and opportunities for those who
will follow.
Like you will do, I have repaid the loans
which made my university graduation possible, but I can
never fully discharge my obligation to this University
and the difference it made in my life.
And finally, you are entering a profession which
enjoys a position of high prestige and has certain
characteristics of a monopoly.
Matters of standards,
accreditation, licensure, certification, monitoring of
quality, and fees are as yet largely in the hands of
individual practitioners and professional societies.
You also, unlike most of us, will never have difficulty
gaining access to health care.
Such preferred status,
if it is to continue, requires the highest integrity
and accountability.
And so, your class is a privileged class in many important
ways.
And, as in all other aspects of life, with privilege goes
5
�obligation, a professional commitment to be responsible and
responsive.
III.
How fortunate you are to be entering the next phase of your
professional development and career at this point in time.
Dramatic changes lie ahead for health care professionals and the
system of which you are a part.
While the details will be shaped
by you and others in the short and long-term futures, I would
share two observations that seem fundamental.
First, people want doctors and a system that cares
about and respects them.
You are entering graduate
medical education and eventually a world of medical
practice that is, at the moment, in chaos.
But, there
is a direction to this chaos -- American society wants
health care for all of its people that is
comprehensive, coordinated, cost-effective, and,
perhaps most of all, compassionate.
People want their
doctors and their system to care, to collaborate with,
6
�and respect them as human beings.
The turmoil of
health care reform is fueled by what I have called a
"health care system out of sync."
We desperately need
more primary care practitioners, the commitment of this
College.
We need more doctors of the kind that
historically have been the very bedrock of the
osteopathic profession.
But whether you choose to
pursue a career in primary care or family practice or
some other specialty field, people want to be
respected, trusted, listened to, and communicated with.
The mission of this College emphasizes primary care and
family practice, the elements of our system now most
inadequate and unrewarded.
Your residency years, while
demanding and expansive, can be treacherous, with the
seductive lures of science, technology, and
specialization.
I urge you to persevere in the cause
which motivated you to become an osteopathic physician
caring for people!
7
�Second, the medical profession can and should
assume far greater responsibility for shaping the
health care system of the future.
As future
practitioners and leaders, you have the opportunity to
be a significant influence in determining the very
nature of our health care system.
With other groups,
doctors shape our health care policies.
Unfortunately,
the public perception -- perhaps with considerable
evidence -- is that doctors, hospitals, pharmaceutical
companies, and technology manufacturers are motivated
excessively by the capacity to make money.
The
structure of our system -- the way we pay for health
care now -- supports such an approach.
We pay more for
procedures than for communicating and caring.
In
addition, our society's experts -- doctors, dentists,
social workers, and engineers -- have an inclination to
define problems not as they are, but so that
specialized expertise can be applied.
8
You can be a
�part of changing that, especially if you reaffirm that
you are entering not a career but a calling -- a
calling to a helping profession.
While decisions at national and state levels will be a part
of shaping the future, perhaps the greatest opportunities will
come at the community level, where life is lived and where,
hopefully, you will practice.
As a simplistic illustration, let
me suggest that I would like for my family and myself a health
care arrangement such as I have for my horses.
In collaboration
with a local veterinary clinic and the group of professionals
there, we develop a health care
p an for the year.
certain responsibilities, as do they.
a sick horse!
I have
Our goal is to never have
But if in fact, I discover at 2:00 next Sunday
morning that I have a horse in trouble, I can call my
veterinarian.
Within 15 minutes, the one of them who is on duty
at that time will call back -- and if necessary, come to the
farm.
In contrast, if I get sick Sunday morning at 2:00,
there is no sense in calling my doctor.
9
I can go to an emergency
�room.
If I am conscious, they will begin by asking about my
insurance carrier, my medical history and my medication.
unconscious, they'll start from scratch.
If I am
Despite the miracles of
high technology, they will not have access to my medical record
as a basis for their diagnosis and treatment.
Isn't it ironic
that, in fact, the system we now have provides no incentive to my
doctor for keeping me well?
My doctor is rewarded only for
treating me after I am either ill or hurt.
That must change.
You can be a part of that change.
You
can make it happen, if you will.
You are becoming a doctor at an exciting and fortuitous time
--changes which you can help shape.
While the prospects of an
uncertain future may be somber, the challenges -- and the
opportunities - - of tomorrow are as compelling and as
exhilarating as ever.
In an age when bigness and complexity seem
characteristic, when the stresses and demands seem
countervailing, it is important to maintain a proper perspective.
10
�When the realities of the everyday world seem almost
overwhelming, I find the following a useful reminder:
"I am only one, but I am one;
I can't do everything, but I can do something;
And what I can do, I ought to do;
And what I ought to do, by the grace of God,
I will do."
In too many facets of our lives, both individually and as a
nation, both in our personal lives and our professional careers,
we seem to have lost something of our sense of purpose, our selfconfidence, our direction, our faifh and commitment.
To the
extent this be true, it can be remedied only by the deeds of
individuals who -- in their special ' r o l e s and in every dimension
of life -- understand and respond.
understand or know; we must also do.
It is not enough to
If each of us will do what
we can do and ought to do, we will indeed be serving humanity's
higher purpose.
You -- individually and collectively -- can be a
11
�blessing to the individuals and families you serve and can change
the profession and the system of which you will be a part.
To each of you in this class of 1993, I wish you well in
your calling and -- more importantly -- in your personal life.
Godspeed.
12
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Russell Mawby Papers
Subject
The topic of the resource
Charities
Family foundations--Michigan
Philanthropy and society
Description
An account of the resource
The Russell Mawby papers document the life and work of Michigan-born Russell Mawby from 1928 to the present. Mawby was the Chief Executive Officer and Chairman of the W. K. Kellogg Foundation for twenty-five years and is recognized for his work in the area of philanthropy in the United States, Latin America, and Europe.
The digital collection includes a selection of field notes, speeches, itineraries, and other materials.
Creator
An entity primarily responsible for making the resource
Mawby, Russell G.
W.K. Kellogg Foundation
Source
A related resource from which the described resource is derived
<a href="https://gvsu.lyrasistechnology.org/repositories/2/resources/432">Russell Mawby Papers (JCPA-01). Johnson Center for Philanthropy Archives</a>
Publisher
An entity responsible for making the resource available
Grand Valley State University. University Libraries. Special Collections & University Archives.
Contributor
An entity responsible for making contributions to the resource
Johnson Center for Philanthropy
Rights
Information about rights held in and over the resource
<a href="http://rightsstatements.org/page/InC/1.0/?language=en">In Copyright</a>
Format
The file format, physical medium, or dimensions of the resource
application/pdf
Language
A language of the resource
eng
Type
The nature or genre of the resource
Text
Identifier
An unambiguous reference to the resource within a given context
JCPA-01
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
1938-2012
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Source
<a href="https://gvsu.lyrasistechnology.org/repositories/2/resources/432">Russell Mawby papers, JCPA-01</a>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Identifier
An unambiguous reference to the resource within a given context
JCPA-01_1993-05-07_RMawby_SPE
Title
A name given to the resource
Russell Mawby speech at the College of Osteopathic Medicine commencement
Creator
An entity primarily responsible for making the resource
Mawby, Russell
Description
An account of the resource
Speech given May 7, 1993 for the W. K. Kellogg Foundation at the College of Osteopathic Medicine commencement at Michigan State University.
Contributor
An entity responsible for making contributions to the resource
Grand Valley State University Special Collections & University Archives
Dorothy A. Johnson Center for Philanthropy and Nonprofit Leadership
Publisher
An entity responsible for making the resource available
Grand Valley State University Libraries, Special Collections and University Archives, 1 Campus Drive, Allendale, MI, 49401
Subject
The topic of the resource
Philanthropy and society
Family foundations--Michigan
W. K. Kellogg Foundation
Charities
Speeches, addresses, etc.
Education
Health
Language
A language of the resource
eng
Rights
Information about rights held in and over the resource
<a href="http://rightsstatements.org/page/InC/1.0/?language=en">In Copyright</a>
Date
A point or period of time associated with an event in the lifecycle of the resource
1993-05-07
Format
The file format, physical medium, or dimensions of the resource
application/pdf
Type
The nature or genre of the resource
Text
-
https://digitalcollections.library.gvsu.edu/files/original/c504848960f70e713c802ed237477a2b.pdf
5f2247e0760676a8248fc027253b64df
PDF Text
Text
SYSTEMS CHANGE: HOPE FOR THE FUTURE
Remarks by Russell G. Mawby
Chairman and Chief Executive Officer
W.K. Kellogg Foundation
to the Health Professions Education
Community Partnerships
National Progress Meeting
National Press Club
Washington, DC
November 1, 1993
Two years ago, in this very same place, it was my pleasure to
offer my encouragement for a journey you were about to take.
The Kellogg Foundation had funded seven Community Partnerships
and supporting strategies in the amount of $47.5 million.
More
importantly, each of you, as representatives of the seven
Community
Partnerships
throughout
the
United
States,
enthusiastically accepted the responsibility to create Partnerships
between communities and academic health centers. These, in turn,
would redirect health professions education toward community need.
�2
As I said then, and I say now, the Kellogg Foundation can
accomplish nothing except for what we can facilitate by "investing
in people." Now·· two years later .. I stand before you again, this
time to offer my congratulations for what you have achieved, for
the important ways in which you are creating models that
are working ... and to remind all of us that the journey has just
begun.
Much has changed in these two years. We are in the midst of a
swirling policy debate on one of the most important public and
personal issues to all Americans .. our state of health, and our
health care system. The debate proceeds around important topics
such as access and cost .. who gets what, who pays, and who
controls. The debate is lively. I, like all Americans, am hopeful
�3
that progress will be made toward the obvious realization that no
one should be without health care, and that our resources must be
expended so that all of us will share the burden.
My concern is
that, although the system is not working well, our goal is to make
it available to all ... without making some essential 'fundamental
adjustments.
For while much has changed,
mUG~
remains unchanged -- for the
time being, anyway. Then, as now, I urged that we recognize that
whatever the ultimate solutions put forth by our political process
to solve health care problems, more primary care practitioners -doctors, nurses, pharmacists, and other health professionals -working together in communities -- in new patterns of delivery and
�4
with dramatically changed incentives and rewards -- will be
necessary.
In other words, health care provided by generalists -- primary care
practitioners
working
together
for
people,
individually
and
collectively.
That is the point of the Community Partnership.s
initiative: redirecting health professions education toward primary
health care to educate more primary care practitioners.
The
strategy is to bring health professions education and communities
together in partnership to create academic, nonhospital-based,
primary care systems that provide multidisciplinary health care,
education, and research. Then, put students there for significant
amounts of time to learn together. And when they graduate, we
fully expect that many will choose to practice in such communities.
�5
The research seems quite clear on this matter. While education,
alone, cannot do it all -- by shifting the selection criteria, adding
primary care role models, educating in community-based, nonhospital
settings, providing rewards for those who provide primary health
care, and motivating and rewarding for wellness -- health promotion
and disease prevention --the percent of graduates choosing primary
health care careers will grow.
Comnnmity Partnerships with Health Professions Education. Think
about that notion for a moment. A trusting collaboration between
caring and committed people from both academe and community.
Both sides gaining by giving. Each holding the other accountable
in a respectful way to a cause larger than either partner. This is
�6
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re
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i
ty Pa
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tne
rsh
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i
th Hea
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th P
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fess
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I
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The jou
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r goa
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rway
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r
. Rebecca Hen
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l educa
t
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ica
l educa
t
ionresea
rchand
�7
development at Michigan State University, and the evaluator for
this comprehensive program, will report to you many of your
achievements. May I mention just a few:
•
More than 2,300 students are participating in your seven
Community Partnerships. This represents 28 percent of the
eligible students in these locations.
•
Nearly 1,000 students are receiving part of their education in
a community, nonhospital setting.
•
One-hundred-twenty-eight new or revised courses are part of
the Community Partnerships. Seventy- four of these courses
are offered in the community.
One-hundred are taught by
�8
interdisciplinary teams of faculty.
Fifty-nine stress primary
care education 'from a team approach.
•
Twenty-two of 25 schools report that they are in the process
of implementing policy change to support the new initiative, in
the areas of admissions, curriculum, faculty roles and
responsibilities and through the health care delivery plans at
the schools.
•
Each project has created a governance structure that bridges
the communitv and educational institutions. Collectively, 105
individuals serve on the boards of these new organizational
structures.
community.
Fifty-eight of these individuals are 'from the
�9
•
As of this year, more than 790 faculty from the participating
schools are actively involved in developing, teaching, and
administering these new prnqrams,
•
But there is another number, perhaps more important than any
of the
others,
that reflects
the magnitude of your
achievements, To date, 437 professionals and volunteers from
the communities serve as teachers and mentors to our
students.
Needless to say, numbers do not provide the full picture. The full
picture can be seen in the stories of the people who are involved.
Let me mention just a few.
�10
Tomorrow, you will hear from Dr. Norris Hogans, principal of Carver
High School on the south side of Atlanta. Medical, nursing, and
social work students are involved each week in a class which is
conducted in his high school. Not only do the health professions
education students learn a great deal, but their presence has
affected the entire student body.
In Spencer, West Virginia, a
similar story is told. The high school principal reports that after
considerable involvement by medical and nursing students with
students in his school, there was a significant increase in the
number of June 1992 graduates who have chosen to go on to
college.
In EI Paso, Texas, three school districts in the Lower
Valley, in spite of the fact that their enrollments are going up
dramatically, made financial, land and/or space contributions for the
creation of comprehensive care clinics in their schools. In Hawaii,
�11
two community development workers, both native Hawaiians, are
teaching medical, nursing, and social work students. An advanced
nursing student from rural Northern Michigan is able to stay with
her family and still get her nursing education without leaving home.
In Eastern Tennessee, the nursing, public health, and medical
teachers got together and had a weekend retreat to strengthen
their collaboration in care and education because the medical,
nursing, and public health students thought they needed to get
along better.
In Boston, a nursing student was first involved in
Codman Square Health Center's Safety Net program for women.
Now she runs meetings for the women in their homes to help them
protect themselves from HIV infection. For all this and much more,
I extend to you my congratulations.
�12
As I mentioned earlier, a key to success is in the partnership
concept itself, and thus the name, Community Partnerships with
Health Professions Education. The likely success of this initiative,
in large measure, depends upon these partnerships. It depends upon
an understanding by academe of community, and an understanding
by community of academe.
It depends on a willingness of both
parties to give, so that together you gain.
I would venture to
guess, for example, that many academics don't understand the
discouragement that arises when communities are defined by their
weakest link, be it unemployment, poverty, drugs, gangs, domestic
violence, teenage pregnancies, or infant mortality rates.
problems do not define the capacity of community.
Such
Further, I
would venture to guess that many community representatives don't
understand that representatives of academic institutions have very
�13
l
i
t
t
letha
ttheycande
l
ive
run
i
la
te
ra
l
l
y
. The powe
rinun
ive
rs
i
t
iesis
no
tconcen
t
ra
tedinas
ing
lep
lace bu
tisd
i
s
t
r
ibu
tedloose
lyamong
depa
r
tmen
ts and fa
cu
l
t
ie
s
. Now tha
t
,you say
, is alo
tl
ike
commun
i
t
ies.
.sh
i
f
t
ingcoa
l
i
t
ionscom
ingtoge
the
ra
roundacommon
pu
rpose fo
ramomen
t int
ime.
.and
, indeed
,i
tis
. Bu
i
ld
ing the
pa
r
tne
rsh
ip and enhanc
ing commun
i
ty pa
r
t
i
c
ipa
t
ion requ
i
res an
unde
rs
tand
ing by academe o
fhow i
td
i
f
fe
r
sf
romcommun
i
ty
. I
t
requ
i
resan unde
rs
tand
ingby
mm ~
o
fthecha
ra
c
te
r
i
s
t
i
c
sand
l
im
i
ta
t
ion
so
facademe
. Mo
s
t impo
r
tan
t
l
y
,i
trequ
i
resthed
iscove
ry
tha
tyou have much incommon
.
Pe
rhaps mo
re thanany
th
ing e
lse
, Ian
l hea
r
tened by therepo
r
ts
tha
trnanvo
fyou
rp
ro
jec
tsa
reinthep
rocesso
frenego
t
ia
t
ingwha
t
isyou
r common educa
t
iona
l pu
rpose
. Ina
l
lo
fthep
ro
jec
ts
, you
�14
have
,o
ra
re now rede
f
in
ing
, you
r co
rnmon v
is
ion
. You a
re
s
t
rugg
l
ingw
i
th themaan
inq o
fga
in
ing by g
iv
ing
.
I
I
I
We a
reabou
ttoen
te
r1994
,at
imewhen Isuspec
tthehea
to
fthe
po
l
icy deba
te w
i
l
l inc
rease
. Ian
l op
t
im
i
s
t
i
c tha
tdeba
te w
i
l
l no
t
on
ly b
r
ing hea
t
, bu
tl
igh
tas
~
The deba
te isand w
i
l
l be
comp
lex and con
fus
ing
. Infa
c
t
,some
t
imes Ifee
ltha
twe have
some g
roups p
romo
t
ing thecomp
lex
i
tytocon
fuseus
. Remembe
r
Iamalaymanand no
taphys
ic
iano
ranu
rse
. Iam no
tadean o
f
amed
ica
l
, pub
l
ic hea
l
th
,o
r nu
rs
ing schoo
l
. Iam no
t apo
l
i
t
ic
ian
,
and Iam ce
r
ta
in
ly no
t apo
l
icy expe
r
t
. Iam alayman
,a
lbe
i
t
hope
fu
l
ly an in
fo
rmedone
. And as alayman
,If
indthedeba
te
�15
couched in terms that seem to confound rather than enlighten -alliance,
managed
care,
managed
competition,
cost-based
reimbursement, choice, indirect medical education expenditures,
hospital bed to resident ratios. Even the term primary health care
is one that confuses many of us.
Given the confusion that confronts many of us, it might be useful
to return to some of the themes that I have articulated before, in
fact, some as early as in 1982 when I spoke on, "Our Health Care
System Out of Sync: A layman's Perspective."
As some might recall, I used a simplistic illustration to explain the
type of health I'd like for myself and nlY family. It goes something
like this ... I'd like for my family and me an arrangement with the
�16
health care system such as that which I have for my horses.
Through a local veterinary clinic and the group of professionals
there, we develop a health care plan for the year. I have certain
responsibilities, as do they. Our goal is to never have a sick horse!
But, in fact, if I discover at 2:00 a.m. Sunday morning that I have
a horse in trouble, I can call nlY veterinarian. Within 15 minutes,
the one on duty will call back .. and if necessary, come to the
farm. In contrast, if I get sick at 7:,00 a.m. Sunday morning, there
is no sense in calling my doctor. I can go to an emergency room.
If I am conscious, they will inquire first about my insurance carrier,
my medical history, and my medication. If I am unconscious, they'll
start 'from scratch. Despite the miracles of high technology, they
will not have access to my medical record as a basis for their
diagnosis and treatment. Obviously, my doctor is rewarded only for
�17
treating me after I am either ill or hurt .. the current system offers
no incentives for keeping patients healthy.
That must change ... and you are a part of that change.
What you, I, and most people want from our health care system is
not complicated.
Basically, we want better health care for all
people, not just some. We want care we can count on today and
tomorrow, at a cost that individuals, and society, can afford. We
want a system where doctors, nurses, and other health
professionals work together with individuals and families to keep
them healthy, care for them when they are ill or hurt, and help
them move through the system with dignity and control.
�18
The public wants a system that emphasizes health promotion and
disease prevention.
Unfortunately, our system is designed to
compensate care providers only for treatment of illness or injury.
I can engage a specialist to design and implement a preventive
maintenance program for my horses, but not for myself. In such
a contractual arrangement, I always have responsibilities which I
must fulfill if the contract is to be valid. Like most Americans. I
would like a health care contract for my most precious possession,
my health and that of my family.
Taken together, this is what we mean by primary health care. And
as you can see, it is at the center of what our society needs.
�19
IV
Let me return, now, to the purpose of the Community Partnerships
with Health Professions Education Initiative of the Kellogg
Foundation and the point of this meeting.
We can't get more
primary health care without a long-term commitment to more
primary care practitioners, and that requires a redirection of health
professions education.
I should point out that more primary health care does not mean
lower quality. However, it does mean lower cost as evidenced, for
example, in a landmark 1992 study by the New England Medical
Centers Health Institute in Boston which found that specialists
order more tests, perform more procedures, and hospitalize more
�20
often than primary care physicians treating patients with similar
symptoms ... and without better results.
Less than 15 percent of the medical school graduates in 1992
specified a preference for a primary care specialty. This compares
with 31 percent in 1976.
This shortage exists among other primarv care practitioners as well.
For example, of the 2.2 million registered nurses in the United
States, only 100,000 are advanced practice nurses with more than
a year of training beyond the basic four-year BSN degree. Out of
that number, fewer than 25,000 are nurse practitioners, engaged
in primary care as members of multidisciplinary teams. For these
reasons, the Pew Commission recommends an increase of 25
�21
percent in the capacity of existing nurse practice programs and an
increase in the total numbers of programs by 25 percent as well.
Clearly, we need an educational system directed toward the
education of more primary care practitioners by linking with
cOlTlmunity II
That is what we need and that's what you, the
representatives of seven Community Partnerships, represent.
As
hard as you have worked to bring about the enormous achievements
that I mentioned earlier, I must urge you to double your efforts.
The important point is not only to demonstrate that these models
are successful, but to continue to seek ways to restructure the
system so that primary health care providers are rewarded the
same as specialists.
�22
Attention also must be focused on finding funding for the education
LIM 1..,-&9
of health professionals in community settings. Currently,
funds
are available for education of primary care practitioners outside of
hospitals. For example, nationally the medical practices income of
medical schools for services provided in hospital settings adds up
to $6.6 billion. By cornparison, only $50 to $75 million is spent on
primary care education. That must change!
We hope that the federal debate will lead to some way by which
more funds are provided for quality education of primary care health
professionals outside of hospitals in community settings where
teaching, research, and multidisciplinary care take place. I don't
know the specifics of such policies. I do know, however, that it
will not all happen in Washington. The impetus for change can be
�23
pushed forward by strong communities, that join forces with
colleges and universities. When universities and the like work with
conmunities. instead of apart from them, the results can indeed be
.
.
Impressive.
The 'financial support to sustain the Community Partnerships will be
signi'ficantly affected by what happens in every state, and
especially in your states, in the seven states of the Cornmunitv
Partnerships initiative. As you can see, it is not so much a matter
of additional expenditures from the state's already
limited budgets; it is a matter of redirecting what we already
spend.
�v
24
In the weeks, months, and even years ahead, I hope and expect
that the debate at the federal and state levels will turn to
important issues like primary health care and the need for more
primary care practitioners.
Community-based programs of health
professions education will be a vital component of this initiative; in
which all of the collaborators -- the. ,local setting and the academic
partners -- will define themselves as .. community."
As John Gardner writes, "A community has the power to motivate
its members to exceptional performance. It can set standards of
expectation and provide the climate in which great things happen.
It can pull extraordinary performances out of its members.
The
�25
achievements
of 5th
century
Greece
B.C. were
not the
performances of isolated persons but of individuals acting in a
golden moment of shared excellence ...."
For us, that golden moment can be now.
In a civilized society,
everyone should receive health care. Our job is to help focus the
debate on what is important.
As we have in the past, you can be assured that the Kellogg
Foundation will do all that it can to help your efforts by providing
information and supporting model development.
But the real
responsibility must lie with you ... you who represent the seven
Community Partnerships.
invest its money in people.
All the Kellogg Foundation can do is
�26
My compliments for what you have accomplished to date, and best
wishes for success in dealing with the "unfinished business" yet to
be addressed. You are pioneers, and generations to come will be
the beneficiaries of your efforts.
Godspeed.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Russell Mawby Papers
Subject
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Charities
Family foundations--Michigan
Philanthropy and society
Description
An account of the resource
The Russell Mawby papers document the life and work of Michigan-born Russell Mawby from 1928 to the present. Mawby was the Chief Executive Officer and Chairman of the W. K. Kellogg Foundation for twenty-five years and is recognized for his work in the area of philanthropy in the United States, Latin America, and Europe.
The digital collection includes a selection of field notes, speeches, itineraries, and other materials.
Creator
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Mawby, Russell G.
W.K. Kellogg Foundation
Source
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<a href="https://gvsu.lyrasistechnology.org/repositories/2/resources/432">Russell Mawby Papers (JCPA-01). Johnson Center for Philanthropy Archives</a>
Publisher
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Grand Valley State University. University Libraries. Special Collections & University Archives.
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Johnson Center for Philanthropy
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<a href="http://rightsstatements.org/page/InC/1.0/?language=en">In Copyright</a>
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application/pdf
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eng
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Text
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JCPA-01
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1938-2012
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<a href="https://gvsu.lyrasistechnology.org/repositories/2/resources/432">Russell Mawby papers, JCPA-01</a>
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JCPA-01_1993-11-01_RMawby_SPE
Title
A name given to the resource
Russell Mawby speech, Systems Change: Hope for the Future
Creator
An entity primarily responsible for making the resource
Mawby, Russell
Description
An account of the resource
Speech given November 1, 1993 for the W. K. Kellogg Foundation at the National Progress Meeting for the Health Professions Education.
Contributor
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Grand Valley State University Special Collections & University Archives
Dorothy A. Johnson Center for Philanthropy and Nonprofit Leadership
Publisher
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Grand Valley State University Libraries, Special Collections and University Archives, 1 Campus Drive, Allendale, MI, 49401
Subject
The topic of the resource
Philanthropy and society
Family foundations--Michigan
W. K. Kellogg Foundation
Charities
Speeches, addresses, etc.
Health
Language
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eng
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<a href="http://rightsstatements.org/page/InC/1.0/?language=en">In Copyright</a>
Date
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1993-11-01
Format
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application/pdf
Type
The nature or genre of the resource
Text
-
https://digitalcollections.library.gvsu.edu/files/original/e6b35e3cfa324834b48b5e46f625b353.pdf
f319493ca3b88804f24e43a4254bb5c8
PDF Text
Text
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�TO:
Russ Mawby
FROM:
Dave Egner
W.K. KELLOGG FOUNDATION
Memorandum
October 8, 1991
RE:
Speech on Philanthropy and Volunteerism at Butterworth Hospital
Joel and I have discussed your remarks for the Butterworth Hospital
speech on October 15, 1991. This is a speech that will fit well with
your flexible, informal style. There is a 7:45 ron breakfast scheduled
that morning for you and the "leaders" at Butterworth (I am assuming
this is the upper management group). The breakfast is set to be
informal, and you will be given 8 brief orientation about major issues
facing the hospital by William Gonzales, the president and chief
executive officer. The audience itself will number about 75 people.
They have allotted an hour and 15 minutes for your remarks and
questions.
With the direction given by the letter of confirmation -- "this group
will be very inte rested in learning more about the Kellogg Foundation
and the directions you see volunteerism and philanthropy taking in the
future" -- and the questions that they have enclosed, Joel and I would
reconunend the following outline.
I.
Butterworth's Rich History in Volunteerism and Philanthropy.
Joel has provided a more detailed outline of Butterworth's
history in volunteerism and philanthropy which follows.
A.
Philanthropy and Volunteerism in Butterworth's History.
1.
The hospital's very name comes from a
philanthropist.
2.
Ri chard E. E. Butterworth, having been made wealthy
by the great gypsum deposits that lay under his land
along the Grand River, donated the land at the corner
of Bostwick and Michigan for the site of the
hospital. He made a bequest of $30,000 in cash and
land to insure that the hospital could be
construct ed.
3 .
But Butt erwort h 1-.' 8 5 mo r e than a g iver, he was a l so a n
active vo lun te er . lIe traveled in Ame ri ca a nd abroad
t o co l lect i dea s for building t he hosp it al, and was
personally involved ill the de s i gn i n g of the
building. All of this he did without compensation.
�2
B
.
Th
eG
row
th o
fB
u
t
t
e
rw
o
r
t
h
1
.
B
u
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rw
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hw
a
sn
o
tt
r
a
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s
f
o
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roma s
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b
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n
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ro
f Bo
s
tw
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ck and M
i
ch
ig
an i
n
t
o
t
h
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e
a
l
t
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e
n
t
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rcomp
l
ex t
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e
n
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r
o
s
i
t
yo
fl
i
t
e
r
a
l
l
ythou
s
and
so
f dono
r
s and
v
o
l
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n
t
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e
r
s
.
2
.
Wh
i
l
e w
er
i
g
h
t
l
yr
em
emb
e
rt
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e
n
e
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ft
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sl
i
k
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ch
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rd B
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t
t
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rw
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, andmo
r
e r
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l
y
,
t
h
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am
i
ly F
o
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n
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t
i
o
n
,i
ti
sa
l
s
o im
p
o
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t
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n
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t
h
a
tw
er
em
emb
e
rt
h
a
tl
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t
e
r
a
l
l
ythou
s
and
so
f un
sung
l
o
c
a
lc
i
t
i
z
e
n
sh
av
ea
l
s
oc
o
n
t
r
i
b
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dt
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eand
mon
ey
. Inf
a
c
t
,i
nth
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g
g
r
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g
a
t
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, mo
r
e m
o
n
e
yc
om
e
s
f
romsm
a
l
ldono
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s th
anl
a
r
g
eo
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e
s
.
3
.
W
i
l
l
i
am Gon
z
a
l
e
sw
i
l
lb
et
h
ef
i
r
s
tt
ot
e
l
lyou
, I am
s
u
r
e
,t
h
a
tev
en t
o
d
a
y
,i
nt
h
eag
eo
fs
u
p
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r
b
p
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sm
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p
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lc
o
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t long
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ep i
t
sdoo
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en w
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t
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t t
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es
u
p
p
o
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to
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s
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o
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r
and R
a
p
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s
' c
i
t
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n
sw
h
ow
r
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t
et
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rch
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s and
thou
s
and
smo
r
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og
i
v
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rt
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h
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ss
p
l
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n
d
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t
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t
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t
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o
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.
4
.
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s
t a
l
s
or
em
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rt
h
a
tg
:
tv
:
tng and v
o
l
u
n
t
e
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r
i
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g
c
a
n
n
o
ta
lw
ay
sb
em
e
a
su
r
ed i
nhou
r
so
fs
e
r
v
i
c
eo
r
p
i
l
e
so
fb
r
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c
kandm
o
r
t
a
r
. P
h
i
l
a
n
t
h
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p
yh
a
sg
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v
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n
B
u
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n
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rs p
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rb r
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s
o
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r
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e
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am
e
ly i
t
s
don
a
t
ed a
r
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o
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en
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ion t
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o
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r
s
and c
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l
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s
s hou
r
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, augm
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t
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l
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sa
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l
e
c
t
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nf
o
r
t
h
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r
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r
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s
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I
.
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logg F
o
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t
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'
sP
rog
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ing P
r
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r
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o
l
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r
i
sm
and P
h
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a
n
t
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p
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.
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.
Af
ew p
a
r
t
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r
eun
tou
ch
ed by v
o
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t
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r
i
smand
p
h
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l
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n
t
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p
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. Th
er
em
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rk
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a
r
d you u
s
em
a
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y t
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s
t
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eth
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h
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l
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n
t
h
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p
y
t
oa
l
la
s
p
e
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t
so
f Am
e
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an s
o
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yand o
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r commun
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e
s
wou
ld b
e mo
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t a
p
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t
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.
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o
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t
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's h
i
s
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ric invo
lv
em
en
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i
t
h
p
h
i
l
a
n
t
h
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o
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l
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t
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e
r
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sm
. T
h
e fac
tt
h
a
tw
eh
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eb
e
en
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n
v
o
l
v
e
dw
i
t
hp
rogr
amm
ingi
nt
h
a
ta
r
e
as
i
n
c
et
h
efound
ing
o
ft
h
eF
o
u
n
d
a
t
i
o
n
. O
u
rp
r
i
o
r
i
t
yo
f enh
an
c
ing p
h
i
l
a
n
t
h
r
o
p
y
andv
o
l
u
n
t
e
e
r
i
sm i
sm
e
r
e
ly a f
o
rm
a
l
i
z
a
t
i
o
nand
c
o
n
c
e
n
t
r
a
t
i
o
no
f an e
f
f
o
r
tt
h
a
th
a
sb
e
en ongo
ing f
o
rth
e
l
a
s
t60 p
l
u
sy
e
a
r
s
.
�3
C
.
S
u
b
s
t
a
n
t
i
a
l ch
ang
ei
nanya
s
p
e
c
to
fs
o
c
i
e
t
yw
i
l
lb
el
e
dby
v
o
l
u
n
t
e
e
rc
i
t
i
z
e
nb
oa
r
d
s
. T
h
es
t
a
t
em
e
n
t
sIh
av
eh
e
a
r
d you
u
s
ei
nt
h
i
sa
r
e
ah
ave a
lw
ay
sb
e
en pow
e
r
fu
l and u
p
l
i
f
t
i
n
g
.
WKKF
'
s e
f
f
o
r
t
si
nenh
an
c
ing p
h
i
l
a
n
t
h
r
o
p
yand v
o
l
u
n
t
e
e
r
i
sm
a
r
ea
l
s
oa
im
ed a
tempow
e
r
ing t
h
ev
o
l
u
n
t
e
e
rt
h
a
tc
anm
a
k
e
g
r
e
a
ts
t
r
i
d
e
sf
o
rs
o
c
i
a
lch
ang
eh
app
en
.
I
I
I
.
Mo
r
e andmo
r
e r
e
s
p
o
n
s
i
b
i
l
i
t
yf
o
rs
o
c
i
a
ls
e
r
v
i
c
e
s
,h
e
a
l
t
h care,
i
n
f
r
a
s
t
r
u
c
t
u
r
e
,c
u
l
t
u
r
e
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t
c
.i
ss
h
i
f
t
i
n
gb
a
ck t
ot
h
el
o
c
a
l
l
e
v
e
l
,t
ot
h
ecommun
i
ty
.
IV
.
A
.
Gov
e
rnm
en
t
s
' r
o
l
ei
ss
h
i
f
t
i
n
g
. T
h
eh
i
g
h
e
ru
p you g
oo
n
t
h
egov
e
rnm
en
tl
a
d
d
e
r
,f
rom l
o
c
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l
,s
t
a
t
e
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of
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d
e
r
a
l
,t
h
e
mo
r
e r
emov
ed t
h
ei
n
d
i
v
i
d
u
a
l
sm
ak
ing d
e
c
i
s
i
o
n
sb
e
com
ef
rom
t
h
ep
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l
em
s
. H
igh
e
rl
e
v
e
lgov
e
rnm
en
t
s
'i
n
a
b
i
l
i
t
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od
e
a
l
w
i
t
hc
r
i
t
i
c
a
ls
o
c
i
a
li
s
s
u
e
sand t
h
e
i
rdw
i
n
d
l
i
n
gr
e
s
o
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r
c
e
s
h
a
s pu
sh
ed t
h
er
e
s
p
o
n
s
i
b
i
l
i
t
yb
a
ck t
ot
h
ecommun
i
ty
, wh
e
r
e
i
t
b
e
l
o
n
g
s
.
B
.
Th
i
sr
e
emph
a
s
i
so
nt
h
ecomm
u
n
ity h
a
sag
r
e
a
t imp
a
c
to
n
v
o
l
u
n
t
e
e
r
i
smand p
h
i
l
a
n
t
h
r
o
p
y
. T
h
ee
f
f
o
r
t
sa
tt
h
e
commun
i
ty l
e
v
e
lc
anb
em
u
c
h mo
r
e f
o
c
u
s
e
do
np
rob
l
em
s and
i
s
s
u
e
s
. P
eop
l
ea
r
emo
r
e a
p
tt
ov
o
l
u
n
t
e
e
ri
nt
h
e
i
rl
o
c
a
l
commun
i
t
i
e
s wh
e
r
e t
h
e
yl
i
v
e
,wo
rk
, p
l
a
y
,b
e
c
a
u
s
et
h
e
yc
an
m
ak
ea r
e
a
ld
i
f
f
e
r
e
n
c
et
h
e
r
e
.
c
.
Th
es
h
i
f
tt
ot
h
el
o
c
a
lcommun
i
ty and t
h
edw
i
n
d
l
i
n
g
r
e
s
o
u
r
c
e
sw
i
l
lp
u
t mo
r
e andmo
r
e p
r
e
s
s
u
r
eo
nt
h
en
o
n
p
r
o
f
i
t
s
e
c
t
o
rand t
h
u
so
nt
h
ep
h
i
l
a
n
t
h
r
o
p
i
s
tand t
h
ev
o
l
u
n
t
e
e
r
.
N
o
n
p
r
o
f
i
to
r
g
a
n
i
z
a
t
i
o
n
s and l
e
a
d
e
r
s
,su
cha
sB
u
t
t
e
rw
o
r
t
h
,
mu
s
t c
o
n
t
i
n
u
et
of
i
n
dn
ew
,m
e
a
n
i
n
g
f
u
l
, c
r
e
a
t
i
v
ew
ay
s t
o
r
e
c
r
u
i
t
,t
om
o
t
i
v
a
t
e
, and t
ou
s
ev
o
l
u
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Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Russell Mawby Papers
Subject
The topic of the resource
Charities
Family foundations--Michigan
Philanthropy and society
Description
An account of the resource
The Russell Mawby papers document the life and work of Michigan-born Russell Mawby from 1928 to the present. Mawby was the Chief Executive Officer and Chairman of the W. K. Kellogg Foundation for twenty-five years and is recognized for his work in the area of philanthropy in the United States, Latin America, and Europe.
The digital collection includes a selection of field notes, speeches, itineraries, and other materials.
Creator
An entity primarily responsible for making the resource
Mawby, Russell G.
W.K. Kellogg Foundation
Source
A related resource from which the described resource is derived
<a href="https://gvsu.lyrasistechnology.org/repositories/2/resources/432">Russell Mawby Papers (JCPA-01). Johnson Center for Philanthropy Archives</a>
Publisher
An entity responsible for making the resource available
Grand Valley State University. University Libraries. Special Collections & University Archives.
Contributor
An entity responsible for making contributions to the resource
Johnson Center for Philanthropy
Rights
Information about rights held in and over the resource
<a href="http://rightsstatements.org/page/InC/1.0/?language=en">In Copyright</a>
Format
The file format, physical medium, or dimensions of the resource
application/pdf
Language
A language of the resource
eng
Type
The nature or genre of the resource
Text
Identifier
An unambiguous reference to the resource within a given context
JCPA-01
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
1938-2012
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Source
<a href="https://gvsu.lyrasistechnology.org/repositories/2/resources/432">Russell Mawby papers, JCPA-01</a>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Identifier
An unambiguous reference to the resource within a given context
JCPA-01_1991-10-15_RMawby_SPE
Title
A name given to the resource
Russell Mawby speech at the Inaugural Lecture on Philanthropy and Volunteerism in Healthcare
Creator
An entity primarily responsible for making the resource
Mawby, Russell
Description
An account of the resource
Speech given October 15, 1991 for the W. K. Kellogg Foundation at the Inaugural Lecture on Philanthropy and Volunteerism in Healthcare.
Contributor
An entity responsible for making contributions to the resource
Grand Valley State University Special Collections & University Archives
Dorothy A. Johnson Center for Philanthropy and Nonprofit Leadership
Publisher
An entity responsible for making the resource available
Grand Valley State University Libraries, Special Collections and University Archives, 1 Campus Drive, Allendale, MI, 49401
Subject
The topic of the resource
Philanthropy and society
Family foundations--Michigan
W. K. Kellogg Foundation
Charities
Speeches, addresses, etc.
Health
Language
A language of the resource
eng
Rights
Information about rights held in and over the resource
<a href="http://rightsstatements.org/page/InC/1.0/?language=en">In Copyright</a>
Date
A point or period of time associated with an event in the lifecycle of the resource
1991-10-15
Format
The file format, physical medium, or dimensions of the resource
application/pdf
Type
The nature or genre of the resource
Text
-
https://digitalcollections.library.gvsu.edu/files/original/1717f6a59cccf98dbd80672b6d91dc87.pdf
3da63e95f57d54178b888dde44fc21f1
PDF Text
Text
HEALTH SYSTEM OUT OF SYNC:
A LAYMAN'S PERSPECTIVE
REMARKS BY
DR. RUSSELL G. MAWBY
INFORMATIONAL MEETING FOR THE
W. K. KELLOGG FOUNDATION'S
HEALTH PROFESSION'S EDUCATION INITIATIVE
CHICAGO MARRIOTT DOWNTOWN
OCTOBER 17, 1989
I
I WELCOME THE OPPORTUNITY TO BE WITH YOU TODAY TO SHARE A
FEW OBSERVATIONS ABOUT REFORM IN HEALTH PROFESSIONS
EDUCATION FROM A LAYMAN'S PERSPECTIVE.
I HAVE CERTAINLY
ENJOYED THE EXCHANGE OF THE MORNING SESSION AND FOUND YOUR
QUESTIONS MOST PROVOCATIVE.
I WANT TO THANK EACH OF YOU AND
YOUR INSTITUTIONS FOR EXPRESSING BY YOUR PRESENCE YOUR
INTEREST IN THE FOUNDATION'S NEW INITIATIVE IN HEALTH
PROFESSIONS EDUCATION.
IT IS APPARENT FROM YOUR COMMENTS
THAT THE AGENDA THAT THE FOUNDATION HAS PUT BEFORE YOU IS A
CHALLENGING ONE INDEED -- CALLING FOR HEALTH PROFESSIONS
�2.
EDUCATION TO EXAMINE DEEPLY ITS LONG-STANDING PATTERNS AND
ORGANIZATIONAL STRUCTURES.
THUS FAR, THE RESPONSE TO THIS
INITIATIVE HAS BEEN VARIED, AS WE WOULD EXPECT.
IS A PATTERN.
YET, THERE
YOu RECOGNIZE THE DIFFICULTY IN WHAT WE ARE
ASKING AND THE NEED THAT IT BE DONE.
THE TIME IS RIGHT FOR
SOME INSTITUTIONS TO REACH OUT -- TO LINK WITH PEOPLE AND
COMMUNITIES, TO CREATE ACADEMIC PARTNERSHIPS THAT WILL
INFLUENCE HEALTH PROFESSIONS EDUCATION AND HEALTH CARE IN
THE DECADES TO COME.
ALL OF YOU IN THIS ROOM KNOW ONLY TOO WELL THAT THE
PROCESSES OF INSTITUTIONAL CHANGE, CAREFULLY DESIGNED TO
PROTECT US ALL FROM HASTY DECISION OR IMPULSIVE ACTION, CAN
AS EASILY SERVE TO SMOTHER A FLAME OF INNOVATION.
MAY YOU
HAVE THE COURAGE, THE ENERGY, AND THE GENIUS TO AVOID THAT
BEING THE CASE -- AGAIN.
�3.
I AM IMPRESSED WITH THIS GATHERING.
EVERYONE IS HERE.
USUALLY, PHYSICIANS TALK WITH PHYSICIANS, NURSES WITH
NURSES, PUBLIC HEALTH SPECIALISTS WITH SOCIOLOGISTS AND
POLITICAL SCIENTISTS, AND DENTISTS WITH THEMSELVES.
BUT ALL
DIMENSIONS OF THE HEALTH PROFESSIONS ARE REPRESENTED IN THIS
MEETING -- THE BASIC SCIENCES, MEDICINE, DENTISTRY, NURSING,
ADMINISTRATION, PHARMACY, PUBLIC HEALTH, THE ALLIED HEALTH
FIELDS.
REMARKABLE!
WONDERFUL!
SOME OF YOU WILL BE THE
VANGUARD IN MOVING FORWARD, IN TANGIBLE AND GRATIFYING WAYS,
THE CONCEPT AND GENIUS OF THE ACADEMIC HEALTH CENTER -- AT
THE MOMENT ACCOMPLISHED IN DISCIPLINARY SCIENTIFIC
CONTRIBUTIONS, BUT WITH THEIR POTENTIAL UNFULFILLED IN
PREPARING HEALTH PROFESSIONALS SPECIALLY SUITED FOR
ADVOCATING AND DELIVERING COMPREHENSIVE HEALTH CARE TO
COMMUNITIES, BENEFITS WHICH THEREFORE ARE NOT YET REALIZED.
�4.
AS ALREADY INDICATED, MY BACKGROUND AND MY GRADUATE
EDUCATION ARE IN AGRICULTURE.
I COME TO YOU AS A LAYMAN,
HOPEFULLY AN uINFORMED LAYMAN u WHOSE ROLE AS CHIEF EXECUTIVE
OFFICER OF A FOUNDATION -- WHICH EACH YEAR PROVIDES ABOUT
$40 MILLION FOR DEMONSTRATION PROGRAMS IN HEALTH EDUCATION,
SERVICES, AND DELIVERY -- OBLIGATES ME TO BE AWARE OF ISSUES
IN THE FIELD.
I STILL RECALL VIVIDLY A SERIES OF uRUDE
AWAKENINGS u AS I FIRST BECAME INVOLVED IN THE FOUNDATION'S
PROGRAMMING IN HEALTH.
I WAS DISMAYED, SHOCKED, DISAP-
POINTED BY MUCH OF WHAT I LEARNED OF THE INNER WORKINGS,
BOTH IN EDUCATION AND PRACTICE.
WHILE THERE IS MUCH TO BE
ADMIRED AND PRAISED, THE STARK REALITIES WHICH BECAME CLEAR,
TARNISHED AND ERODED THE PINNACLE UPON WHICH THE HEALTH
PROFESSIONS HAD RESIDED IN MY MIND.
I HAVE TRIED TO LEARN
WISELY AND TO CAREFULLY PLACE THE VARIOUS COMPONENTS IN
PROPER PERSPECTIVE AND BALANCE.
IN SO DOING, I HAVE HAD TO
�5.
LEARN THE LEXICON OF THE HOSPITAL HALLWAYS AND THE
DIFFERENCES BETWEEN RADIOLOGY AND RHEUMATOLOGY; TO RECOGNIZE
A "THIRD PARTY PAYOR" WHEN I SEE ONE; TO UNDERSTAND THAT
"FOUR-HANDED DENTISTRY" DOESN'T REFER TO A CLUMSY
PRACTITIONER OR A CARNIVAL FREAK; AND TO APPRECIATE A CAREER
LADDER IN NURSING (BUT I MUST CONFESS I STILL CANNOT
DISTINGUISH EASILY A NURSE PRACTITIONER FROM ONE WHO IS NOT).
ACTUALLY I BRING MORE BAGGAGE THAN THAT TO THIS MEETING.
I
GREW UP ON A FARM IN WEST CENTRAL MICHIGAN, NOT REALLY
"RURAL RURAL" BECAUSE THE HOMEPLACE IS NOW PART OF A SUBURB
OF GRAND RAPIDS, BUT A FARM NONETHELESS AND IN A FAMILY
WHICH ENJOYED FOR YEARS THE SPLENDID SERVICES OF A COUNTRY
DOCTOR, DR. JAY D. VYN.
HIS WIFE WAS HIS OFFICE
NURSE/RECEPTIONIST; LATER HIS DAUGHTER SERVED IN THAT ROLE
ALSO.
THEY WORKED TOGETHER IN HARMONY -- WE NOW CALL THAT
�6.
JOINT PRACTICE -- SUPPORTIVE OF EACH OTHER, THE PATIENT, THE
FAMILY.
I AM NOT A NOSTALGIA BUFF, YEARNING FOR THE GOOD
OLD DAYS -- A RETURN TO THE OUTHOUSE, TUBERCULOSIS, AND
BLOOD LETTING -- BUT THERE WERE SOME THINGS IN THAT PATTERN
WHICH SHOULD STILL SERVE US WELL.
BUT PERHAPS MY BEST QUALIFICATION FOR BEING HERE TODAY IS
NOT THAT OF A FOUNDATION EXECUTIVE, BUT SIMPLY A LAYMAN
A SON, HUSBAND, PARENT, CONCERNED CITIZEN.
I HAVE BEEN
BLESSED WITH GOOD HEALTH AND SO· MY PERSONAL INVOLVEMENT WITH
THE HEALTH CARE SYSTEM HAS BEEN MINIMAL.
BUT I HAVE HAD
MORE THAN ENOUGH OPPORTUNITY TO BE DEEPLY INVOLVED -EMOTIONALLY AND IN EVERY OTHER WAY -- IN MY RESPONSIBILITIES
AND RELATIONSHIPS WITH BROTHERS AND SISTERS, PARENTS,
FRIENDS.
I HAVE SPENT MORE HOURS THAN I CARE TO REMEMBER
AT A HOSPITAL BEDSIDE, LEANING ON THE WALL OF A HOSPITAL
�7.
CORRIDOR, SITTING ENDLESSLY IN A WAITING ROOM.
I HAVE
SOUGHT INFORMATION AND ASSISTANCE IN EVERY CONCEIVABLE WAY
ASKING, BEGGING, CAJOLING, THREATENING -- TO GET A TIDBIT
OF INFORMATION, A GLIMPSE OF THE TRUTH, A GLIMMER OF
UNDERSTANDING.
I HAVE EXPERIENCED IT ALL -- TRIUMPHS AND
TRAGEDIES, COMPASSION, ARROGANCE, SELFLESSNESS, INSENSITIVE
CALLOUSNESS, BOTH THE BRILLIANCE AND THE PETTINESS OF THE
CARING PROFESSIONS YOU REPRESENT.
SO THE PERSPECTIVE I
BRING IS THAT OF A LAYMAN -- A CONCERNED INDIVIDUAL, A
GRATEFUL BENEFICIARY, A CONSTRUC J.IVE CRITIC, AN EAGER
PARTICIPANT IN THE UNENDING PROCESS OF MAKING THE SUPERB
HEALTH SYSTEM AND SITUATION WE HAVE TODAY EVEN MORE
RESPONSIVE, EFFECTIVE, AND SATISFYING.
�8.
II
You ARE EDUCATORS, THOSE CHARGED WITH KEY RESPONSIBILITIES
IN THE PREPARATION OF THE PROFESSIONALS WHO DESIGN, MANAGE,
AND CONDUCT THE AFFAIRS OF OUR HEALTH CARE SYSTEM -- ITS
VARIOUS COMPONENTS, INSTITUTIONS, AND PROGRAMS.
TOMORROW.
YOU SHAPE
W. K. KELLOGG SAID IT WELL, "EDUCATION OFFERS THE
GREATEST OPPORTUNITY FOR REALLY IMPROVING ONE GENERATION
OVER ANOTHER."
YOU ARE VITAL PARTICIPANTS IN THE SELECTION
AND MOLDING OF PHYSICIANS, NURSE S, PHARMACISTS, DENTISTS,
AND OTHER HEALTH PROFESSIONALS OF THE FUTURE.
YOu HELP TO
DETERMINE THE CRITERIA BY WHICH THE TOUGH DECISIONS ARE MADE
AS TO WHO IS IN AND WHO IS OUT; YOU SHAPE THE PATTERN OF
EXPERIENCES TO WHICH THEY ARE EXPOSED AND THE RIGORS TO
WHICH THEY ARE SUBJECTED, AND YOU ESTABLISH THE CRITERIA BY
WHICH THEIR SUCCESS OR FAILURE IS DETERMINED.
THUS,
�9.
ULTIMATELY, YOU INFLUENCE THE SHAPE, THE CHARACTER, THE
PERSONALITY, THE MORALITY OF THAT WHICH WE CALL OUR HEALTH
CARE SYSTEM.
WE ARE GRATEFUL FOR THE DEGREE TO WHICH YOU
SUCCEED; WE WORRY ABOUT THE WHYS, THE HOWS, AND THE SO WHATS
OF THE JOB YOU DO AND WE ARE THE BENEFICIARIES -- OR THE
VICTIMS -- OF THE CONSEQUENCES OF YOUR EFFORTS.
QUITE FRANKLY, I HAVE STRUGGLED WITH HOW I MIGHT MOST
PRODUCTIVELY APPROACH MY ASSIGNMENT TODAY.
My FIRST
INCLINATION WAS TO APPROACH THE ·TASK AS I ALWAYS APPROACH
DOCTORS AND NURSES -- HAT IN HAND, IN AWE AND IN ADMIRATION
OF THOSE WHO ARE PRIVILEGED TO SERVE AND INFLUENCE SO
INTIMATELY THE HUMAN CONDITION.
DESPITE MANY EXPERIENCES
WHICH ABUSE THAT IDYLLIC IMAGE, TO ME THERE IS NO HIGHER
CALLING THAN THE CARING PROFESSIONS YOU REPRESENT.
�10.
BUT I HAVE CHOSEN A DIFFERENT COURSE IN PURSUING MY TASK
TODAY.
QUITE SIMPLY, I LEANED BACK IN MY CHAIR AND SAID,
"SUPPOSE I WERE A HEALTH PROFESSIONS EDUCATOR.
DO?"
WHAT WOULD I
AS A LOGICAL FIRST STEP, I THEN PURSUED THE QUESTION,
"IF I COULD DESIGN IT, WHAT KIND OF HEALTH CARE ARRANGEMENT
WOULD I LIKE FOR THE MAWBY FAMILY?"
THIS IS NOT AN IDLE OR
AN IMPULSIVE QUESTION; IT IS ONE I HAVE BEEN ASKING MYSELF,
MEMBERS OF OUR FOUNDATION PROGRAM STAFF, LEADERS IN THE
HEALTH PROFESSIONS FOR A NUMBER OF YEARS.
I HAVE FINALLY
CONCLUDED THAT IDEALLY I WOULD HAVE THE MAWBY FAMILY
AFFILIATED WITH A SMALL TEAM OF PROFESSIONALS -- PERHAPS
SOME COMBINATION OF PRIMARY CARE PHYSICIANS, ONE OR MORE
DENTISTS, NURSE PRACTITIONERS, WITH A RECEPTIONIST/
BOOKKEEPER, OTHER SUPPORT PERSONNEL IN NURSING AND THE
ALLIED HEALTH FIELDS.
THIS GROUP WOULD HAVE APPROPRIATE
PRIVILEGES WITH COMMUNITY HOSPITALS AND REFERRAL
ARRANGEMENTS WITH SPECIALISTS.
�11.
PHILOSOPHICALLY THE GROUP WOULD BE COMMITTED TO A PROGRAM OF
HEALTH PROMOTION/DISEASE PREVENTION OR HEALTH MAINTENANCE,
AS WELL AS TREATMENT OF ILLNESS.
Now
LET'S TAKE A MOMENT TO
CONSIDER THIS MODEL.
FIRST, THE CORE OF THE GROUP WOULD BE PRIMARY CARE
PHYSICIANS, CONCERNED WITH THE INDIVIDUAL AND WITH THE
FAMILY.
WHEN OUR PERSONAL PRIMARY CARE PHYSICIAN WAS AWAY,
WE WOULD BE COVERED BY ONE OF HIS GROUP PARTNERS WHO WOULD
HAVE COMPLETE ACCESS TO OUR HEALJH RECORDS.
WHEN WARRANTED,
THESE PRACTITIONERS WOULD INVOLVE APPROPRIATE SPECIALISTS
FOR CONSULTATION AND/OR TREATMENT.
THEY WOULD BE WORKING IN HARMONY WITH NURSE PRACTITIONERS.
VERY OFTEN MY MINOR COMPLAINTS DO NOT REQUIRE THE ATTENTION
OR TIME OF A BOARD-CERTIFIED SPECIALIST.
I AM QUITE CONTENT
�12.
TO BE TREATED BY A COMPETENT NURSE PRACTITIONER, WITH CONFIDENCE THAT IF SHE IDENTIFIES A PROBLEM THAT SHE THINKS
REQUIRES FURTHER EXPERTISE, SHE WILL INVOLVE HER PHYSICIAN
COLLEAGUES.
IT SEEMS TO ME DEPLORABLE, IN FACT INEXCUSABLE,
THAT THE COMPETENCE OF THE NURSING PROFESSION IS PROVIDED SO
FEW OPPORTUNITIES TO CONTRIBUTE MAXIMALLY TO HUMAN HEALTH
CARE.
THE PUBLIC, I AM CONVINCED, WOULD WELCOME SUCH
MODIFICATION.
THE PROBLEM LIES NOT WITH THE CONSUMERS, BUT
IN THE PROFESSIONS AND THEIR WORKING RELATIONSHIPS, OR LACK
THEREOF.
WITHIN THE TEAM, PRIMARY CARE PRACTITIONERS WOULD OF COURSE
CONTRIBUTE THEIR APPROPRIATE SPECIALITIES TO THE GROUP
ENTERPRISE, AS WOULD THE OTHER HEALTH PROFESSIONALS.
THE DENTIST?
AND
AS A LAYMAN, I DON'T UNDERSTAND WHY THE
PROFESSION OF DENTISTRY IS PRACTICED IN ISOLATION -- PERHAPS
�13.
SPLENDID ISOLATION -- BUT NONETHELESS ISOLATION FROM THE
MAINSTREAM OF THE HEALTH CARE SYSTEM.
THE PROBLEMS OF MY
TEETH AND MY MOUTH ARE NOT ISOLATED FROM THE REST OF ME, AND
I BELIEVE, CAN HAVE IMPACT THROUGHOUT THE BODY.
THUS, THE
FAILURE OF THE PROFESSION TO ADDRESS THIS IDIOSYNCRASY IN
THE PRESENT PATTERN OF PRACTICE IS DIFFICULT TO FATHOM.
AND THE EMPHASIS ON HEALTH PROMOTION/DISEASE PREVENTION?
YOu IN THE HEALTH PROFESSIONS HAVE DESIGNED A SYSTEM WHICH
COMPENSATES YOU ONLY FOR THE TREATMENT OF MY ILLNESS OR
INJURY.
I CAN ENGAGE SPECIALISTS TO DESIGN AND IMPLEMENT A
PREVENTIVE MAINTENANCE PROGRAM FOR MY AIR CONDITIONER AT
HOME, OR THE ELEVATOR OR DUPLICATING MACHINE AT MY OFFICE.
OR -- CLOSER TO OUR TOPIC TODAY -- I CAN CONTRACT WITH MY
VETERINARIAN FOR A HERD HEALTH PROGRAM FOR MY HORSES.
SUCH A CONTRACTURAL ARRANGEMENT, I ALWAYS HAVE
IN
�14.
RESPONSIBILITIES WHICH I MUST FULFILL IF THAT CONTRACT IS TO
BE VALID.
IN SIMILAR FASHION, I WOULD LIKE TO COMPENSATE A
HEALTH CARE GROUP FOR THE DESIGN AND THE CONTINUING
MONITORING, WITH MY FULL PARTICIPATION AND FULFILLMENT OF MY
OBLIGATIONS AND RESPONSIBILITIES, OF A MAINTENANCE CONTRACT
FOR MY MOST PRECIOUS POSSESSION -- MY HEALTH AND THAT OF MY
FAMILY.
WHY HAVE THE HEALTH PROFESSIONS BEEN SO
UNIMAGINATIVE, SO UNCREATIVE, SO UNRESPONSIVE IN THIS AREA?
SO, THAT'S A BRIEF INSIGHT FROM ·A LAYMAN'S PERSPECTIVE OF
ONE MODEL OF AN "IDEAL PRIMARY CARE ARRANGEMENT."
THERE CAN
-- AND SHOULD -- BE MANY OTHERS, TO PROVIDE PRIMARY CARE TO
DIVERSE CLIENT GROUPS IN VARIED SETTINGS.
AT THE
FOUNDATION, WE ARE NOT IN THE BUSINESS OF PRESCRIBING MODELS
AND WE HOPE MANY CREATIVE IDEAS WILL ARISE OUT OF THE NEW
INITIATIVE.
SO, THAT'S AS FAR AS I WILL GO TODAY AS A
�15.
LAYMAN.
AS EXPERTS, YOU WILL GIVE FURTHER CONSIDERATION
RELATING TO SECONDARY AND TERTIARY LEVELS OF CARE, OFFERING
THE BENEFITS OF SUPERB SPECIALIZATION AND SOPHISTICATED
TECHNOLOGY AND LINKING PRIMARY CARE PROVIDERS ULTIMATELY TO
THE RICH RESOURCES OF RESEARCH INSTITUTIONS AND ACADEMIC
HEALTH CENTERS.
WITH MODERN COMMUNICATIONS TECHNOLOGY,
PRACTITIONERS IN EVEN THE MOST REMOTE LOCATIONS CAN BE IN
TOUCH WITH COLLEAGUES FOR CONSULTATION AND COUNSEL ON A
CONTINUING BASIS.
YOu WILL THINK OF PEOPLE FOR THEIR NEEDS,
AND LOOSEN YOUR GRIP ON THE TECHNOLOGY THAT STRENGTHENS THE
CONFIDENCE OF PHYSICIANS, BUT LITTLE COMPASSION TO PATIENTS.
AS A LAYMAN SURVEYING THE HEALTH CARE SCENE TODAY -- BOTH IN
EDUCATION AND IN PRACTICE -- I SEE THE "BITS AND PIECES" AS
SUPERB.
By "BITS AND PIECES" I REFER TO OUR PROFESSIONAL
SCHOOLS, IN MEDICINE, NURSING, DENTISTRY, PHARMACY,
�16.
ADMINISTRATION, ALLIED HEALTH, ALL THE REST; THE
PROFESSIONS, WITH DEDICATED AND COMPETENT INDIVIDUALS AND
EFFECTIVE ASSOCIATIONS; THE VARIOUS PRACTICE SETTINGS,
INCLUDING SOLO AND GROUP OFFICES, CLINICS, HOSPITALS,
RESEARCH AND TEACHING CENTERS.
ALL SUPERB; WITHOUT
QUESTION, THE FINEST IN THE WORLD.
BUT I HAVE THE UNEASY FEELING THAT TOO LITTLE THOUGHT AND
EFFORT HAS BEEN GIVEN TO RATIONALIZING THE WHOLE, WITH AN
OBJECTIVE OF SERVING MAXIMALLY THE INTERESTS OF THE ULTIMATE
BENEFICIARIES.
THE "TOTAL SYSTEM" (THIS PHRASE SOUNDS
TIDIER, MORE PRESCRIBED AND RESTRICTIVE THAN INTENDED OR
POSSIBLE) -- WITH MULTIPLE ALTERNATIVES AND PLURALISM IN
EVERY SENSE -- SHOULD BE PARTICULARLY SENSITIVE TO THE
PUBLIC IT SERVES AND BY WHICH IT IS SUSTAINED, SUBJUGATING
THE MORE SELFISH INTERESTS OF PROFESSIONS AND INSTITUTIONS
�17.
TO THE HIGHER PURPOSE.
WE LACK A "GRAND DESIGN" OR A SERIES
OF GRAND DESIGNS WHICH BRING TOGETHER IN MOST EFFECTIVE WAYS
THE EXPERTISE OF THE VARIOUS HEALTH PROFESSIONS, AND
NETWORKING MORE EFFICIENTLY THE RESOURCES OF THE HEALTH CARE
INSTITUTIONS OF OUR SOCIETY.
WISELY DONE, BUILDING ON THE
TERRIFIC STRENGTHS OF THE DAY BUT RESPONDING OBJECTIVELY AND
SENSITIVELY TO THE DEMAND AND UNMET NEEDS OF THE PUBLIC, THE
RESULT SURELY WILL BE FAR GREATER THAN THE SIMPLE SUM OF THE
PARTS OF WHICH IT IS COMPRISED.
AS EDUCATORS IT IS YOUR CHALLENGE TO FULFILL SUCH A VISION
AND GOAL.
IT IS NOT ENOUGH TO BE SIMPLY A NURSE EDUCATOR OR
A MEDICAL EDUCATOR.
YOu MUST SEE THE LARGER PICTURE, WITH
ITS STRENGTHS AND SHORTCOMINGS, AND MOVE RELENTLESSLY TOWARD
THE REALIZATION OF THE BETTER SITUATION.
UNIVERSITIES, OF
WHICH THE SCHOOLS OF THE HEALTH PROFESSIONS ARE A PART, ARE
�18.
THE KNOWLEDGE RESERVOIRS OF OUR SOCIETY, ESTABLISHED AND
SUSTAINED TO PRESERVE, CREATE, AND TRANSMIT KNOWLEDGE.
AN
UNENDING CHALLENGE IS THAT OF MOBILIZING THESE KNOWLEDGE
RESOURCES IN EVER MORE EFFECTIVE WAYS TO DEAL WITH THE
CONCERNS OF SOCIETY.
WHILE THERE IS MUCH IN THE HEALTH CARE SCENE IN THIS COUNTRY
OF WHICH YOU CAN BE JUSTIFIABLY PROUD, THERE IS STILL MUCH
"UNFINISHED BUSINESS."
HOPEFULLY THE HEALTH PROFESSIONS
WITH YOU AS EDUCATORS IN THE VANGUARD -- WILL PROVIDE
AGGRESSIVE AND IMAGINATIVE LEADERSHIP IN ADDRESSING ISSUES
OF CONCERN, LEST THE RESPONSIBILITY FALL BE DEFAULT TO THOSE
LESS ABLE.
�19.
III
RECENT HEALTH PROGRAMMING OF THE W. K. KELLOGG FOUNDATION
FOCUSES ON COMMUNITY-BASED HEALTH SERVICES, AS YOU HAVE
HEARD FROM OUR HEALTH PROGRAM TEAM THIS MORNING.
SINCE 1987
MORE THAT 30 PROJECTS HAVE BEEN FUNDED BY THE FOUNDATION FOR
COMMUNITY-BASED, PROBLEM-FOCUSED HEALTH SERVICES.
LET ME
TELL YOU ABOUT THREE OF THEM.
FIRST, THERE IS THE PROJECT CONDUCTED FOR AND BY THE
RESIDENTS OF AN ATLANTA PUBLIC HOUSING PROJECT.
THERE,
BILLIE AVERY AND HER TEAM ARE TRYING TO PIECE TOGETHER THE
FRAGMENTED LIVES OF ADOLESCENTS, PUTTING THE FOCUS ON THEIR
SELF-ESTEEM BY TYING THE THREADS OF DESPERATE INTERVENTIONS
TOGETHER -- DRUG EDUCATION, SEX EDUCATION, AIDS EDUCATION,
PREGNANCY COUNSELING, JOB TRAINING, LITERACY TUTORING, AND
�20.
MORE.
SHOULDN'T HEALTH PROFESSIONS EDUCATION BE ROLLING UP
ITS SLEEVES AND GOING TO WORK ON EDUCATION THAT PREPARES
HEALTH PROFESSIONALS TO SHOULDER THEIR PART OF THE BURDEN?
IN ANOTHER INSTANCE, ONE GROUP FROM A HEALTH PROFESSIONS
SCHOOL IS BEING FUNDED TO ADDRESS THE BASIC HEALTH AND HUMAN
SERVICE NEEDS OF MASSES OF ISOLATED URBAN IMMIGRANTS.
THERE
THEY DEAL WITH LANGUAGE BARRIERS, ILLITERACY, AND TROPICAL
DISEASES, TO NAME A FEW.
THE GROUP'S TETHER TO THEIR SCHOOL
AND TO THE OTHER HEALTH PROFESSIGNS' SCHOOLS OF ITS
INSTITUTION IS THIN INDEED.
HOPEFULLY, HEALTH PROFESSIONS
STUDENTS WILL ATTAIN VALUED EDUCATIONAL EXPERIENCES IN THIS
PROGRAM.
YET, THE SUPPORT SO FAR FROM THE PARENT
INSTITUTION IS "LONG DISTANCE ENCOURAGEMENT."
LIKE BIG
SHIPS, ACADEMIC HEALTH CENTERS CHANGE THEIR COURSE EVER SO
SLOWLY.
�21.
AND A THIRD EXAMPLE, ALTHOUGH I COULD GO ON AND ON, IS THAT
OF A COMPREHENSIVE PROGRAM FOR YOUNG BLACK MALES TO TEACH
HIGH SCHOOL
GRADUATE~
TO READ, TO IMPROVE THE NUTRITIONAL
STATUS OF YOUNG BLACKS, TO PROVIDE BASIC HEALTH SERVICES, TO
HELP THEM FIND JOBS, AND IN THE WORDS OF THE PROJECT'S
DIRECTOR, "TO TURN THEM AWAY FROM THEIR SYNDROME OF
SELF-HATE."
THESE ARE BUT A FEW EXAMPLES, AND AS I MENTIONED EARLIER,
THERE ARE MANY MORE FROM OUR PROJECTS COMPRISING OUR PRIMARY
HEALTH STRATEGY.
THERE ARE FOUR SUPPORTING STRATEGIES IN
OUR HEALTH PROGRAM AS WELL.
THEY ARE:
INFORMING
POLICYMAKERS, INFORMATION TECHNOLOGY, LEADERSHIP
DEVELOPMENT, AND THE ONE THAT IS THE FOCUS OF TODAY'S
SESSION, HEALTH PROFESSIONS EDUCATION.
EDUCATION IS CRITICAL OF COURSE.
HEALTH PROFESSIONS
IF OUR SUPPORT OF THESE
�22.
SPECIFIC COMMUNITY-BASED, PROBLEM-FOCUSED PROJECTS IS TO
LEAD TO WIDER AND SYSTEM-WIDE IMPACT, WE MUST INVOLVE
PROFESSIONS EDUCATION, AND THAT'S WHERE OUR NEW INITIATIVE
COMES IN.
WE EMPHASIZE PRIMARY HEALTH CARE.
AS HEALTH PROFESSIONALS,
YOU UNDERSTAND THE ISSUES OF PRIMARY HEALTH CARE AND THEIR
RAMIFICATIONS, SO THERE IS NO NEED TO COMPREHENSIVELY
ADDRESS THIS TOPIC.
WE ARE ASKED SO OFTEN WHAT WE MEAN BY
PRIMARY HEALTH CARE, PROBABLY BECAUSE IT MEANS SO MANY
THINGS THAT IT MEANS SO LITTLE.
I AM NOT GOING TO HELP WITH
THE DEFINITIONAL PROBLEM, BUT I WOULD LIKE TO REFLECT ON A
FEW THINGS THAT ARE IMPORTANT FROM MY LAYMAN'S PERSPECTIVE
-- AND I SUSPECT TO MOST PEOPLE AS WELL.
�23.
IT MAY BE APPROPRIATE TO BEGIN WITH A PROBLEM IDENTIFIED IN
THE WRITING OF HERODOTUS SOME 2400 YEARS AGO.
THE GREEK
HISTORIAN PERCEIVED A DISCONTINUITY OF CARE IN HIS NATIVE
LAND, AND HE LAMENTED, "EACH PHYSICIAN TREATETH ONE PART AND
NOT MORE.
AND EVERYWHERE IS FULL OF PHYSICIANS; FOR SOME
PROFESS THEMSELVES PHYSICIANS OF THE EYES, AND OTHERS THE
HEAD, OTHERS THE TEETH, AND OTHERS OF THE PARTS OF THE
BELLY, AND OTHERS OF OBSCURE SICKNESSES."
HERODOTUS WAS CORRECT IN HIS VIEW THAT A DISCONTINUITY OF
CARE CAN RESULT FROM THE TREND TOWARD OVERSPECIALIZATION.
HEALTH CARE, OFFERED OR PROVIDED IN A FRAGMENTED FASHION, IS
DIFFICULT TO DEAL WITH IN ITSELF BUT THE PROBLEM GOES
DEEPER.
OFTEN ACCOMPANYING SUCH SPECIALIZED CARE IS THE
PROBLEM OF TRANSFER OF INFORMATION BETWEEN PROVIDERS OF CARE
WHO UNWITTINGLY OR WORSE, KNOWINGLY, INHIBIT THE PATIENT'S
ACCESS TO COMPREHENSIVE CARE.
�24.
My
LET ME USE A PERSONAL EXAMPLE TO ILLUSTRATE WHAT I MEAN.
MOTHER, BY THE TIME SHE REACHED HER MID-70S HAD SEVERAL
DIFFERENT HEALTH PROBLEMS, INCLUDING CANCER AND
COMPLICATIONS FROM A SERIES OF STROKES.
IN THE COURSE OF
HER CANCER TREATMENT, SHE WAS SHUNTED FROM ONE SPECIALIST TO
ANOTHER, FROM INTERNIST TO SURGEON TO RADIOLOGIST TO
ONCOLOGIST, NONE OF WHOM REALLY TOOK A COMPREHENSIVE LOOK AT
HER PROBLEMS IN ORDER TO ASSESS HER OVERALL CONDITION.
THE
INTERNIST WHO DIAGNOSED THE PROBLEMS INITIALLY REFUSED TO
CONTINUE AS HER PRIMARY CARE PHYSICIAN, SO THE
RESPONSIBILITY FOR CONTINUITY RESTED WITH THE PATIENT AND
HER FAMILY, CERTAINLY AN UNSATISFACTORY ASSIGNMENT BY
DEFAULT.
WE ENCOUNTERED ANOTHER STUMBLING BLOCK -- A GREAT
RELUCTANCE, AND AT TIMES, REFUSAL ON THE PART OF SEVERAL
PHYSICIANS TO TRANSFER MEDICAL RECORDS OF THE CARE THEY GAVE
MY MOTHER TO OTHER PHYSICIANS WHO ALSO WERE TREATING HER.
�25.
CONSEQUENTLY, EXAMINATIONS, TESTS, AND PROCEDURES WERE
DUPLICATED UNNECESSARILY, AT INCONVENIENCE, DISCOMFORT, AND
COST.
I UNDERSTAND THE REASONS GIVEN, BUT I DO NOT ACCEPT
THE FINAL RESULT AS ADEQUATE OR DEFENSIBLE.
BETTER WAYS.
THERE MUST BE
THIS EXAMPLE IS NOT AN ISOLATED ONE.
FRIENDS
AND ASSOCIATES HAVE TOLD ME SIMILAR STORIES, AND YOU CAN
SURELY ADD ANECDOTES OF YOUR OWN.
OVERSPECIALIZATION AND A LACK OF CONTINUITY IN CARE ARE NOT
PROBLEMS CONFINED TO THE PRACTICE OF MEDICINE.
SPECIALIZATION, SOME OBSERVERS CONTEND, HAS RESULTED FROM
THE IMPLEMENTATION OF TECHNOLOGY IN ALMOST EVERY FIELD,
FORCING THE INDIVIDUAL TO DEAL WITH AN EVER-INCREASING
NUMBER OF PROVIDERS OF SERVICE.
THE SPECIALIZATION OF
HEALTH EDUCATION AND HEALTH SERVICES IS, IN MANY WAYS, AN
ACHIEVEMENT IN AMERICAN THAT WE CAN BE PROUD OF.
BUT AT THE
�26.
SAME TIME, WE MUST MANAGE IT SO THAT IT DOES NOT BECOME AN
END IN AND OF ITSELF.
IF SUCH SPECIALIZATION RESULTS IN
FRUSTRATION AND FRAGMENTED, INCOMPLETE PATIENT CARE, IT
NEEDS RETHINKING AND REARRANGING.
THIS PROBLEM SHOULD BE ADDRESSED BY ALL HEALTH PROFESSIONAL
SCHOOLS, AND PARTICULARLY BY THE MEDICAL SCHOOL.
THE
MEDICAL SCHOOL HAS THE RESPONSIBILITY OF EDUCATING THE KEY
MEMBER OF THE HEALTH CARE DELIVER TEAM.
THE PHYSICIAN HAS
BEEN THE QUARTERBACK, THE CEO, THE GUARDIAN, THE GATEKEEPER
-- LARGELY DETERMINING IN WHAT MANNER AND WITH WHAT EMPHASES
PATIENT CARE IS PROVIDED.
COME.
HE PROBABLY WILL BE FOR YEARS TO
BUT NEW MODELS SHOULD BE TRIED.
QUARTERBACK, A DENTIST QUARTERBACK?
WHAT ABOUT A NURSE
�27.
IV
LET ME USE A TRUE STORY TO ILLUSTRATE THE ISSUE OF
AVAILABILITY OF AND ACCESS TO HEALTH CARE.
NOT LONG AGO ON A VISIT TO A COUNTY SEAT TOWN IN
SOUTHERN MICHIGAN, I MET WITH A GROUP OF YOUNG
PHYSICIANS.
I ASKED THEM, "IF THE MAWBY FAMILY MOVED TO
THIS AREA, COULD ANY OF YOU TAKE US ON AS NEW PATIENTS?"
THERE WAS A QUICK CONSENSUS, "OH YES, RuSS MAWBY,
CHAIRMAN OF THE KELLOGG FOUNDATION, OF COURSE WE WILL
GET YOU IN."
"NO, NO," I SAID.
"RUSS MAWBY, WITH A WIFE AND THREE
KIDS, LIVING ON 40 ACRES SOUTH OF TOWN."
�28.
AGAIN THERE WAS A QUICK AGREEMENT, "NONE OF US IS TAKING
ANY NEW PATIENTS.
YOU'LL JUST HAVE TO GO TO THE
EMERGENCY ROOM AT THE HOSPITAL."
I DON'T BELIEVE THAT IS A SATISFACTORY ANSWER TO PRIMARY
CARE FOR FAMILIES; EMERGENCY ROOM CARE SHOULD BE FOR
EMERGENCIES, NOT SERVE AS A USUAL POINT OF ENTRY FOR PRIMARY
CARE.
EXPERTS KEEP TELLING ME THAT ACCESS TO HEALTH CARE IS A
SERIOUS PROBLEM ONLY FOR THE URBAN POOR AND FOR PEOPLE IN
REMOTE RURAL COMMUNITIES.
THAT SIMPLY IS NOT TRUE, IF THE
MEASURE WE APPLY FOR ADEQUACY GOES BEYOND THE MOST PRIMITIVE
OR BASIC STANDARD.
IN COMMUNITIES OF ALL TYPES, URBAN AND
RURAL, WITHOUT REGARD TO ECONOMIC CIRCUMSTANCES, MANY
FAMILIES HAVE REAL DIFFICULTY IN GAINING ACCESS TO
SATISFACTORY PRIMARY CARE ON A CONTINUING BASIS.
�29.
AS A LAYMAN, I HAVE OBSERVED THAT HEALTH PROFESSIONALS -- IN
PARTICULARLY PHYSICIANS, BUT TO A DEGREE ALL HEALTH
PROFESSIONALS -- HAVE NO PROBLEMS GAINING ACCESS TO THE
HEALTH CARE SYSTEM.
IF THEIR CHILD OR MOTHER OR GOOD FRIEND
NEEDS TO SEE A DOCTOR, EVEN A SPECIALIST WHO IS BOOKED SIX
MONTHS IN ADVANCE, THERE IS NO PROBLEM OF ACCESS.
I SUSPECT
THIS MAY BE A FRINGE BENEFIT WHICH ALSO EXTENDS TO YOU AS
HEALTH PROFESSIONS EDUCATORS.
BUT DON'T LET THIS LULL YOU
INTO A BELIEF THAT THIS IS THEREFORE NO PROBLEM FOR THE REST
OF US, REGARDLESS OF GEOGRAPHIC, CULTURAL, OR ECONOMIC
CIRCUMSTANCE.
I CAN'T HELP BUT THINK THAT THE VERY PRESSING PROBLEMS OF
MALDISTRIBUTION, AND SOME WOULD SAY ACTUAL SHORTAGE, OF
NURSES ALSO RELATE DIRECTLY TO HEALTH PROFESSIONS EDUCATION
ISSUES -- AND SPECIFICALLY MEDICAL EDUCATION.
AS A LAYMAN,
�30.
I CANNOT UNDERSTAND, NOR DO I SYMPATHIZE OR HAVE PATIENCE
WITH, THE KINDS OF "PROFESSIONAL SNOBBERY" WHICH SEPARATE
THE HEALTH PROFESSIONS IN BOTH EDUCATIONAL AND CLINICAL
SETTINGS.
FOR EXAMPLE, I DO NOT UNDERSTAND THE RELUCTANCE
OF THE MEDICAL PROFESSION
AND THE MEDICAL SCHOOLS -- TO
TAKE A MORE ENLIGHTENED VIEW TOWARD RECOGNIZING THE
UNREALIZED POTENTIAL OF NURSES AND OTHER NON-PHYSICIAN
HEALTH PROFESSIONALS IN MEETING THE HEALTH CARE NEEDS IN
THIS COUNTRY.
I SUSPECT THE ELITISM AND SEPARATION WHICH
STILL CHARACTERIZES TOO MUCH OF PHYSICIAN EDUCATION AND CARE
WILL NOT MUCH LONGER BE TOLERATED.
THIS WOULD SEEM
PARTICULARLY TRUE AS THE PUBLIC BECOMES MORE AND MORE AWARE
OF HOW SUCH PAROCHIALISM IS AFFECTING THE QUALITY,
CHARACTER, AVAILABILITY, AND COST OF CARE IN THEIR
COMMUNITIES.
�31.
INNOVATIVE APPROACHES TO ENCOURAGING PHYSICIANS, NURSES,
DENTISTS, AND OTHER HEALTH PROFESSIONALS TO PRACTICE
TOGETHER MORE EFFICIENTLY AND EFFECTIVELY, INCLUDING THE
PROVISION OF CARE IN UNDERSERVED AREAS AND TO UNREACHED
CLIENTELE, MUST CONTINUE TO BE SUPPORTED SO THAT ALL PEOPLE,
WHETHER THEY BE AFFLUENT OR POOR, AND WHETHER THEY LIVE IN
THE CITY OR THE COUNTRY, HAVE ACCESS TO QUALITY HEALTH CARE.
v
NOTICE -- I SAID QUALITY HEALTH CARE -- CERTAINLY A
PERSISTENT AND BASIC CONCERN OF ALL.
IN RECENT YEARS, NOT
JUST IN THE PRACTICE OF MEDICINE, QUALITY INCREASINGLY HAS
COME TO BE DEFINED IN TERMS OF THE APPLICATION OF HIGH
TECHNOLOGY.
WE PRIDE OURSELVES ON MAKING USE OF THE LATEST
EQUIPMENT,PROCEDURES, AND SYSTEMS WHETHER IN MEDICINE, THE
�32.
AUTO INDUSTRY, OR COMMUNICATIONS.
IN THE HEALTH FIELD THIS
EMPHASIS ON TECHNOLOGY CAN CONTRIBUTE TO A FAILURE BY THE
PROFESSIONS TO RECOGNIZE THAT ACTUAL PRACTICE AS AN
INDICATOR OF QUALITY FOR COMMON HEALTH PROBLEMS MAY BE JUST
AS GOOD OR BETTER IN THE SMALL, MODESTLY EQUIPPED CLINIC AS
IN THE MAJOR MEDICAL CENTER.
MEDICAL SCHOOLS HAVE TAKEN THE LEAD IN APPLYING HIGH
TECHNOLOGY TO PRACTICE (AS WELL THEY SHOULD) BUT THEY MUST
NOT RUSH SO FAR AHEAD THAT THEY FORGET THE HUMAN DIMENSION
-- THE PATIENT'S PERCEPTION OF QUALITY WHICH OFTEN HINGES ON
HOW THE PHYSICIAN TREATS THE PERSON, NOT JUST THE MEDICAL
PROBLEM.
DESPITE STATEMENTS BY INDIVIDUAL FACULTY MEMBERS
THAT THEY RECOGNIZE THIS PATIENT PERCEPTION OF THE QUALITY
OF CARE AS CONTRASTED WITH THE PHYSICIAN'S PERCEPTION OF
CARE, MOST OBSERVERS ARE UNABLE TO NOTE MUCH EVIDENCE OF
THAT RECOGNITION.
�33.
IF YOU OR I WERE TO HAVE A CORONARY TODAY, OUR SPOUSE WOULD
NOT WALK INTO THE HOSPITAL AND ASK, "WHAT'S THE AVERAGE
LENGTH OF STAY?"
BUT THAT YARDSTICK HAS BEEN TOO MUCH A
PRIMARY MEASURE OF "QUALITY" IN HOSPITAL REVIEWS.
INSTEAD,
A LOVED ONE IS LIKELY TO ASK, "IS HE OR SHE IN PAIN?
BEING KEPT COMFORTABLE?
HIM?"
IS SOMEONE WITH HIM?
IS HE
MAY I SEE
PHYSICIANS AND HOSPITAL ADMINISTRATORS TEND NOT TO
WORRY ENOUGH ABOUT THOSE HUMANLY CRITICAL GAUGES WHICH ARE
SO SIGNIFICANT BOTH TO THE PATIENT AND THE FAMILY, AND TO
THE PATIENT'S ULTIMATE RECOVERY.
THERE IS A DEFINITE NEED FOR EDUCATORS TO GIVE AS MUCH
CONSIDERATION TO THE PATIENT'S PERSPECTIVE ON QUALITY IN
PRACTICE AS IT GIVES TO HEALTH SCIENCE AND RESEARCH.
MANY
RESPECTED AUTHORITIES HAVE LONG CALLED FOR INCREASED
ATTENTION TO THE HUMANITIES AND SOCIAL SCIENCES AS A MEANS
�34.
FOR INSTILLING A CONCERN FOR HUMANE CARE IN THE BUDDING
PHYSICIAN, DENTIST, NURSE, OR PHARMACIST.
IN THE NEW
INITIATIVE, I HOPE STEPS ARE INCLUDED TO MAKE THIS DIMENSION
CENTRAL TO ALL HEALTH PROFESSIONS EDUCATION.
VI
My CLOSING THOUGHT WOULD BE A RETURN TO MY FIRST
OBSERVATIONS:
1) WHILE THERE IS MUCH IN OUR HEALTH CARE
SYSTEM IN THIS COUNTRY ABOUT WHICH WE CAN BE PROUD AND WHILE
IN FACT, IT IS UNEQUALED IN THE WORLD, IMPROVEMENT IS
POSSIBLE; THERE ARE SHORTCOMINGS WHICH NEED TO BE
IMAGINATIVELY ADDRESSED; AND 2) AS EDUCATORS, YOU WILL
VISIBLY SHAPE TOMORROW.
�35.
WHAT WILL THE NEW MODELS BE LIKE?
I DON'T KNOW THE DETAILS
AND IT'S NOT THE KELLOGG FOUNDATION'S STYLE TO SHAPE THOSE
DETAILS.
SOMEONE SAID THAT THE TROUBLE WITH PREDICTIONS IS
THAT THEY DEAL WITH THE FUTURE, BUT UNDAUNTED I WILL TURN ON
MY FUTURE SCOPE TO 20 YEARS HENCE.
I CAN SEE THE OUTLINES
OF A VISION -- COMMUNITY-BASED ACADEMIC HEALTH CENTERS WITH
THE STATUS AND PRESTIGE OF UNIVERSITY-TEACHING HOSPITALS
TODAY.
ACADEMIC HEALTH CENTERS WHERE RESEARCH, TEACHING,
AND PATIENT CARE ARE OCCURRING; WHERE NEW INSIGHTS OF
SCIENTIFIC EXPLORATION ABOUT COMMUNITIES AND THEIR HEALTH
NEEDS ARE INFORMING EDUCATION AND PATIENT CARE.
STUDENTS,
RESIDENTS, POSTDOCTORAL FELLOWS OF THE HIGHEST CALIBER ARE
LINED UP TO GO TO THE ACADEMIC HEALTH CENTERS FOR STUDY
BECAUSE OF THE RECOGNIZED ACADEMIC AND INTELLECTUAL STATURE
OF THE PROFESSORS WHO WORK THERE.
PROMOTION AND TENURE
DECISIONS BY THE PARENT INSTITUTION ARE MADE SUCH THAT THE
�36.
WORK OF FACULTY AT THE COMMUNITY-BASED, ACADEMIC HEALTH
CENTER IS WEIGHED EQUALLY WITH OTHER FORMS OF SCIENTIFIC AND
ACADEMIC ENDEAVOR.
I SEE THE OUTLINES OF A CARE SYSTEM
WHERE COMPASSION, CARING, AND CONTINUITY OF RESPONSIBILITY
PREVAILS; WHERE STUDENTS AND PATIENTS ALIKE ARE TREATED WITH
HUMAN DIGNITY AND RESPECT AND IN TURN, THE GRADUATES TREAT
THEIR PATIENTS IN THE SAME MANNER.
I KNOW -- AND YOU KNOW -- THAT OUR SOCIETY WILL NOT PERMIT
THE PRESENT STATE OF AFFAIRS IN . HEALTH CARE TO LAST FOREVER,
AND THE PRESSURES ARE GROWING UPON POLICYMAKERS TO FIND
SOLUTIONS; MORE PEOPLE HAVE NEEDS TO BE SERVED, AND THE
COSTS ARE INCREASING AT A RATE WELL ABOVE INFLATION.
WHAT
ELECTED OFFICIALS SEEK ARE SOLUTIONS THAT THEY CAN SUPPORT
AND IMPLEMENT.
THEY NEED ACADEMIC HEALTH CENTERS TO SHIFT
FROM BEING PART OF THE PROBLEM TO BEING PART OF THE
�37.
SOLUTION.
WE HOPE THAT THE KELLOGG INITIATIVE WILL GIVE
SOME OF YOU THE OPPORTUNITY TO CREATE AND IMPLEMENT SUCH
SOLUTIONS.
WE -- ELECTED OFFICIALS AND POLICYMAKERS, CITY
FOLK, RURAL FOLK, THE UNDERSERVED POOR, THE UPPER MIDDLE
CLASS, THE YOUNG AND THE ELDERLY, ME AND MY FAMILY -- ARE
ALL COUNTING ON YOU.
IN MOST AREAS OF HUMAN CONCERN uWE KNOW BETTER THAN WE DO. u
CERTAINLY THIS IS TRUE IN YOUR CHOSEN FIELD OF
CONCENTRATION, THE EDUCATION OF PROFESSIONALS FOR HEALTH
CARE.
FOR IN FACT, A GREAT DEAL MORE IS KNOWN ABOUT WHAT
GOOD HEALTH CARE COULD BE AND SHOULD BE THAN IS GENERALLY
PUT TO USE BY THE PRACTITIONERS WHOM YOU GRADUATE.
THE
UNENDING CHALLENGE TO YOU AS EDUCATORS IS TO MOVE REALITY
CLOSER TO THE VISION OF THAT WHICH OUGHT TO BE.
I WISH YOU
GODSPEED AND LOOK FORWARD TO THAT DAY IN THE FUTURE WHEN WE
CELEBRATE TOGETHER YOUR ACHIEVEMENTS.
!252B
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Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Russell Mawby Papers
Subject
The topic of the resource
Charities
Family foundations--Michigan
Philanthropy and society
Description
An account of the resource
The Russell Mawby papers document the life and work of Michigan-born Russell Mawby from 1928 to the present. Mawby was the Chief Executive Officer and Chairman of the W. K. Kellogg Foundation for twenty-five years and is recognized for his work in the area of philanthropy in the United States, Latin America, and Europe.
The digital collection includes a selection of field notes, speeches, itineraries, and other materials.
Creator
An entity primarily responsible for making the resource
Mawby, Russell G.
W.K. Kellogg Foundation
Source
A related resource from which the described resource is derived
<a href="https://gvsu.lyrasistechnology.org/repositories/2/resources/432">Russell Mawby Papers (JCPA-01). Johnson Center for Philanthropy Archives</a>
Publisher
An entity responsible for making the resource available
Grand Valley State University. University Libraries. Special Collections & University Archives.
Contributor
An entity responsible for making contributions to the resource
Johnson Center for Philanthropy
Rights
Information about rights held in and over the resource
<a href="http://rightsstatements.org/page/InC/1.0/?language=en">In Copyright</a>
Format
The file format, physical medium, or dimensions of the resource
application/pdf
Language
A language of the resource
eng
Type
The nature or genre of the resource
Text
Identifier
An unambiguous reference to the resource within a given context
JCPA-01
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
1938-2012
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Source
<a href="https://gvsu.lyrasistechnology.org/repositories/2/resources/432">Russell Mawby papers, JCPA-01</a>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Identifier
An unambiguous reference to the resource within a given context
JCPA-01_1989-10-17_RMawby_SPE
Title
A name given to the resource
Russell Mawby speech, Health Systems Out of Sync- A Layman's Perspective
Creator
An entity primarily responsible for making the resource
Mawby, Russell
Description
An account of the resource
Speech given October 17, 1989 for the W. K. Kellogg Foundation at the informational meeting for the W. K. Kellogg Foundation's Health Profession's Education Initiative.
Contributor
An entity responsible for making contributions to the resource
Grand Valley State University Special Collections & University Archives
Dorothy A. Johnson Center for Philanthropy and Nonprofit Leadership
Publisher
An entity responsible for making the resource available
Grand Valley State University Libraries, Special Collections and University Archives, 1 Campus Drive, Allendale, MI, 49401
Subject
The topic of the resource
Philanthropy and society
Family foundations--Michigan
W. K. Kellogg Foundation
Charities
Speeches, addresses, etc.
Education
Health
Language
A language of the resource
eng
Rights
Information about rights held in and over the resource
<a href="http://rightsstatements.org/page/InC/1.0/?language=en">In Copyright</a>
Date
A point or period of time associated with an event in the lifecycle of the resource
1989-10-17
Format
The file format, physical medium, or dimensions of the resource
application/pdf
Type
The nature or genre of the resource
Text