Fitzhugh Mullan, Foe of Health Care Disparities, Dies at 77

Dr. Fitzhugh Mullan, who as a physician, administrator and professor spent a lifetime pushing back against what he saw as inequities in the health care system that left minority groups and low-income people underserved, died on Nov. 29 at his home in Bethesda, Md. He was 77.

Kathy Fackelmann, director of media relations at the Milken Institute School of Public Health at George Washington University, where Dr. Mullan had been a professor since 1996, said the cause was lung cancer.

Dr. Mullan had an earlier encounter with cancer in the mid-1970s, when he was 32. He turned that experience into a book, “Vital Signs: A Young Doctor’s Struggle With Cancer,” and in 1986 he was among the founders of the National Coalition for Cancer Survivorship.

But his main interest was in bringing social justice to the health care system, which he saw as fundamentally flawed both in how it recruits, trains and motivates doctors and in how it delivers care. It was a passion he developed in the summer of 1965, after his first year in medical school, when he spent several months in Durant, Miss., working with impoverished black residents.

“A simple choice presented itself in my mind,” Dr. Mullan wrote in “White Coat, Clenched Fist: The Political Education of an American Physician,” a sometimes blistering memoir published in 1976. “Either their poverty resulted from their being black and, therefore, inadequate (the racist explanation), or their poverty derived from their being black and therefore segregated, exploited and oppressed. While I was in Mississippi I saw enough to persuade me forever that the squalor of the black community was caused by the system and not the people.”

That revelation, eye-opening at the time for a white Northern medical student from a relatively privileged background, defined the rest of Dr. Mullan’s life.

“In the woods of Mississippi,” he continued, “away from the medical center, far away from the labs and lecture halls, well outside the standard avenues of medical approbation, I discovered why I wanted to be a doctor.”

He carried that inspiration into his career in pediatrics once he graduated from medical school in 1968, and then into top administrative posts, including at the United States Public Health Service and, from 1991 to 1996, as an assistant surgeon general. And he imparted a social-justice ideal to countless students and health professionals. One is Susan Hassmiller, senior adviser for nursing at the Robert Wood Johnson Foundation, whom he mentored when she was a doctoral student 30 years ago.

“He always gravitated to the less fortunate,” Dr. Hassmiller said by email, “and always became the voice for those who had no or little voice.”

Fitzhugh Seumas MacManus Mullan was born on July 22, 1942, in Tampa, Fla. His father, Hugh, was a physician. His mother, Mariquita MacManus Mullan, was a poet and a daughter of Seumas MacManus, an author famed for his interpretation of Irish folk tales.

Dr. Mullan grew up in New York City and attended the Dalton School. After graduating from the Pomfret School in Connecticut, he enrolled at Harvard, receiving a bachelor’s degree there in 1964.

He graduated from the University of Chicago’s medical school in 1968 and did residencies at Jacobi Hospital and Lincoln Hospital in the Bronx, where he encountered an urban version of the inequities he had seen in Mississippi. Lincoln, where he was a resident in 1970 and 1971, mostly served black and Puerto Rican patients.

“We still had a diarrhea room,” he said in an interview with Kaiser Health News in 2009. “They didn’t have enough resources to do anything other than put anybody with any type of diarrhea in one part of the general ward.

“This was not 1970s medicine; this was very primitive,” he added. “And it was part of the disequities that were built into the health care system.”

In 1972, under the newly formed National Health Service Corps, which places health professionals in underserved areas, Dr. Mullan began practicing medicine in New Mexico. It was the beginning of a decade-long association with the corps that saw him become its chief medical officer and then, from 1977 to 1981, its director.

In the 1980s he held posts with the state of New Mexico and the National Institutes of Health, as well as academic positions at the National Academy of Sciences and Johns Hopkins University. While assistant surgeon general, he was also director of the Bureau of Health Professions at the Health Resources and Services Administration.

Dr. Mullan wrote prolifically — books, scholarly articles, essays — and he was outspoken about the problems he saw in the health care system and the medical profession. One problem, he said, was what kinds of doctoring were rewarded and respected.

“The prestige walks of medical life today are research and the subspecialties,” he said in a 1978 essay in The New York Times, adding, “No one gets a Nobel Prize for ghetto medicine.”

He advocated neighborhood clinics staffed by doctors with a sense of mission — “practitioners,” as he put it in the same essay, “for whom medicine is something more than a meal ticket or an exercise in technobiology.”

“We will never improve the infant mortality rates or the longevity statistics of the inner city by hunkering down among the radioisotope scanners and incubators of the large hospitals,” he wrote.

He bridled at the term “health care safety net” when it came into vogue to describe the last line of defense for society’s disadvantaged.

“It seemed to me an insult to the dignity of patients that they would get no more than uncertain, makeshift, last-resort medicine,” he wrote in a 2009 article for the website and journal Health Affairs. “Worse, the term, trotted out antiseptically in policy circles, seemed a capitulation to doing anything better for the medically disenfranchised and a happy codification of the idea that haphazard, second-class care was part of the American way of life.”

His interests extended beyond the United States. A study he led found in 2005 that Africa and the Caribbean were losing large numbers of their trained doctors to four developed countries: the United States, Britain, Canada and Australia. The abandoned countries were left drastically underserved, the study found, and Dr. Mullan called on the United States to increase its supply of homegrown doctors.

In April, the George Washington University Health Workforce Institute, which examines issues like the recruitment and distribution of health workers, was renamed the Fitzhugh Mullan Institute for Health Workforce Equity.

Dr. Mullan’s first marriage, to Judy Wentworth in 1968, ended in divorce in 1998. He is survived by his wife, Dr. Irene Dankwa-Mullan, whom he married in 2007; a sister, Quita Mullan; two brothers, Anthony Mullan and Alex Cohen; three children from his first marriage, Meghan Mullan, Caitlin Crain and Jason Mullan; a stepdaughter, Perpetua Buadoo; and four grandchildren.

In a 2015 TED Talk, Dr. Mullan noted that life expectancy in the United States had increased by 30 years in the 20th century, to 77. But, he noted, that gain was not uniform — black people, people in low-income states and people without insurance did not reap the full benefit. That, he said, presented a challenge for health professionals and policymakers in the future.

“Is our goal to see to it that the privileged people in the United States put 30 more years on, and live on average to be 107,” he asked his audience, “or should we think about our priority being the earnest, serious, durable disparities within this, and move the floor up?”

Source: Read Full Article