Creating a Community of Medical Care: Medical College of Virginia's Dr. Jack Lanier

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Creating a Community Of Medical Care: Medical College of Virginia's Dr.. Jack Lanier

Dr. Jack Lanier is chair and professor in the Department of Preventive Medicine and Community Health at the Medical College of Virginia, Virginia Commonwealth University. A business major at North Carolina A&T State University in Greensboro, NC, he began his medical career as a U.S. Army officer, managing military medical facilities. Beginning in 1960 as commander of a medical detachment, Dr. Lanier rose through a succession of Army medical posts, including stints as a health education administrator, chief operating officer of a station hospital in Regensherg, Germany, administrator of another hospital in Munich and executive officer of an evacuation hospital in Long Binh, Vietnam. He achieved the rank of colonel before leaving military service in 1981 for a civilian medical career.

Lanier, who did graduate studies in public administration at George Washington University and in health administration from Baylor University, holds a doctor of public health degree from the University of Texas Health Science Center in Houston, TX. In addition to serving in uniform, Lanier has been principal deputy assistant secretary of defense for health affairs as well as senior vice president for corporate and community development for the Greater Southwest Healthcare Systems, Washington, DC, and a vice president of the American College of Healthcare Executives, Chicago, IL.

During a visit to the offices of Black Issues In Higher Education, Dr. Lanier discussed public-health issues with Editor Garland L. Thompson.

What are the pressing problems in public health?

The public is becoming much more aware of the politics of health. We see special-interest groups all over the place that are really impacting on the practice of medicine. Just look at what's happening now with health-care reform. Politics aside, a credit to the current administration, regardless of the outcome of the debate, is that it has served to raise the level of consciousness, to let us know that we cannot continue the status quo.

So we look at what's happened around the country, we have seen that health care reform is really happening before our very eyes, in individual states such as Oregon. In states like Michigan and Minnesota and even Virginia, they will take a look at the cost issue, to take a look at the access issue, to take a look at the fact that we have many dinosaurs in our systems of health care, and the dinosaurs that we are speaking of are the result of health policies that occurred right after World War II.

Dinosaurs?

Yes. During the '40s, Congress passed the Hill-Burton Act, which resulted in every little town around the country being able to build its own little hospital. One of the things the policy did not provide for was sustained financing of the operation of those hospitals. So today we now see those hospitals closing or being merged with larger facilities simply because they are not needed. We see hospitals that are operating at a capacity of 30 or 40 percent when they were built to provide for 100-percent capacity for the populations they served.

The Hill-Burton Act produced a bunch of dinosaurs?

It produced the ability for those dinosaurs to be created. And that is the financing to build hospitals. Bricks and mortar.

And it built a lot of facilities that are inefficient or that turned out to be inefficient?

At the time they were created, that policy created conflicting needs: It provided for location of hospitals in rural, small-town areas. We had a lot of people living in rural areas at that time, much more so than we do today. Moving away from the agrarian type of a society to what we have, [we see] much more of an urban massing in small areas.

What the Europeans call a conurbation?

Exactly. At the same time that we have seen the shift in demographics, the movement from the rural areas to the urban areas, those so-called dinosaurs are left out there [in rural areas]. …