Columbia University School of Public Health - Yearbook (New York, NY)

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II-Medical Care Everywhere the old order changeth, and happy those who can change with it. M-Sir William Osler, M.D. 118951 Health is not just a medical matter, it is a social and economic one. Com- prehensive medicine often requires an interdisciplinary approach. -Kenneth E. Appel, M.D. 119571 Access to the means for attainment and preservation of health is a basic human right. -Presiderzfs C Omnzission 011 the Health Needs ofthe Nation 119521 I6

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SOME BRIEF THOUGHTS ON STUDENT REBELLION In their search for a new sense of continuity and santeness, adolescents lzave to regfight many ofthe battles of earlier years, even though to do so they must artificially appoint perjectly well-meaning people to play tlze roles ofadversaries. . . YE. H. Erilfsong Childhood and Society, 1965. There are two possible explanations for student unrest. One is that there is a need to rebel, as ERI KS ON suggests, which will express itself'irrespective of issues. The other is that there are aspects of society generally or specifi- cally Qfuniversity society, which provoke rebellion. 1 The rebellion ofthe students, which lzas exploded all over the world, may well be only a facet ofthe great, partly unrecognized revolution in which, according to Julian Hux1ey,3 we have been living since tlze beginning of this century. Clearly tlze reasons for the students' revolt are ntanifolde social, economic, technical, psychological, and political, as well as acadenzic. Will a new system emerge from all this wlzich will modernize university organization, improve teaching and research facilities .... 9 The answer to these questions will depend on the intellectual nzaturity and the democratic loyalty ofthe reformers. The persistence of the enraged spirit among some and the political innocence ofeven nzore may be major obstacles. There is no doubt that we are living through a revolution, and, as Huxley pointed out. it may be effected in a democratic or a totalitarian way. 3 1. Lancet, March 23rd, 1968, p. 625. 2. Huxley. J. On Living in a Revolution. London. 1944. 3. Lancet,July 27th, 1968, p. 213. I5

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CRISIS IN AMERICAN MEDICINE ln ternts ofgross national product tlte L'.S.A. spends more on health tltan does any other countrr. But costs are rising at such a rate tltat ntore and ntore people will find it difficult to get com- plete lzealth care. This particularly applies to tlte poor, the old, the Negroes, and other disadvantaged groups. Doctors and lzos- pital beds are distributed most ll11r?V611f-1' botlt in broad geographic regions attd between states. There are indications, too, that the quality ofcare has been inferior, especially in 1617715 ofantenatal and infant mortality. The whole organization of' medical care in the L'.S.A. has jailed to respond to cltanging disease patterns, the move from counttji' to cities, industrialization, and the increasing proportion ofold people in the population. The public, however, are beginning to dentand ntore and better health-care services, as is indicated in the spate oflegislation which Congress has passed in the pastvfew years. The spate ofhealth legislation enacted in the United States in the pastjew years provides some measure ofthe scope and magnitude oftlie changes taking place. Among thekfacets ofthe lzealth mac- rostructztre ajjected are manpower, buildings and equipment, finance, delivery, and organization. Thekfollowing list of enacted legislation, jar from complete, is only illustrative: the Manpower Development and Training Act of'1962,' the Nurse Training Act of1962,' the Health Professions Educational Assistance Act of 19635 the Allied Health Professions Act of 19665 tlze Mental Re- tardation and Community Mental Health Construction Act of 19635 the Hospital and Medical Facilities Amendments of' 19645 the Heart Disease, Cancer, and Stroke Act of' 19655 and the Comprehensive Health Planning A ct of. 1966. Over-shadowing all ofthese developments, ofcourse, are the Social Security Amend- I7