An Unwilling Partnership With the Great Society Part I: Head Start and the Beginning of Change in the White Medical Community

ABSTRACT By 1965, the policies and programs of Lyndon B. Johnson’s Great Society brought optimism to black physicians and a new wave of resistance against black civil rights advocates in the American South. The largest of the first Head Start programs, Child Development Group of Mississippi (CDGM), had its roots in Freedom Summer 1964 and the Medical Committee for Human Rights. Like other proposed programs with strong medical components, CDGM was caught in a legislative Bermuda triangle created by the powerful Mississippi congressional delegation to maintain white supremacy and plantation economics. Physician‐led investigations exposed the extraordinary level of poor health among Mississippi’s black children, supported Head Start as a remedy, and awakened the white medical establishment to health disparities of the Jim Crow period. It was also the beginning of positive change in the previously silent white medical community in the South and their support of civil justice in health.


INTRODUCTION
I n previous articles, we reported details of the American civil rights movement in Mississippi (1954Mississippi ( -1970 and identified participants and events that influenced a sea change in the American healthcare system. 2,3 That change was facilitated by a small group of African-American physicians in Mississippi who, through their civil rights activities, were in dialog with federal civil rights officials and healthcare planners at the highest levels of government. They provided support to an army of out-ofstate civil rights advocates who came to the state during that era, including health professionals who joined them to form the Medical Committee for Human Rights (MCHR). 4 The remarkable history of the MCHR has been extensively recorded by celebrated civil rights historian, John Dittmer. 4 Although racial turmoil continued, optimism about the future began to develop among them. By 1965, the American public was not just reading about the struggle for civil rights and justice in healthcare, they were seeing it on television on the nightly news. 5 The eyes of the Mississippi rank and file were also opened. Information from national television had broken through the self-censorship of their local newspapers and their promotion of the segregationist views of the Mississippi power structure in the state and congress. What they saw was hard to believe and their reaction to it continued to stoke the fires for social change throughout the country.

OPTIMISM IN 1965
In his State of the Union address in January 1964, President Lyndon B. Johnson introduced the legislation of the Great Society, nicknamed the War on Poverty, with the promise to promote social justice and public health and to reduce the national poverty rate (Figure 1). That rate averaged 17.3% in the United States, but among blacks in Mississippi it was more than 80%. 6 Despite continuing restrictions on their medical practice and threats of violence and economic retaliation for their civil rights activities, black physicians believed that implementation of the Civil Rights Act of 1964 could bring quick improvements in access to healthcare and improve the health of their patients. 7 Soon, the Voting Rights Act of 1965 would provide a mechanism for social change that could bring a new order. The Economic Activity Act of A number of MCHR members including physicians Mike Holloman, Leslie Falk, H. Jack Geiger, Count Gibson, Tom Levin, Mississippi physicians Robert Smith and A.B. Britton, among others, provided input into the legislation and were in positions to assist OEO programs and projects as they were implemented. 7

THE RISING TIDE OF VIOLENCE AGAINST VOTING RIGHTS FOR BLACKS
World War II veteran and Mississippi National Association for the Advancement of Colored People (NAACP) Field Director, Medgar Evers, and his Board Chair, Clarksdale pharmacist, Aaron Henry, recruited almost all of the 50 or so remaining black physicians who had not already left Mississippi or who had retired during the civil rights era to NAACP membership. [7][8][9] Evers' murder not only failed to stop ongoing attempts to integrate health facilities, register voters and provide social programs for the poor but also energized them. As a result, violence against civil rights activists in Mississippi spread.
Mass arrests followed voting rights demonstrations in Selma, Alabama in January 1965. When Bloody Sunday occurred in March, nurses from the MCHR provided assistance to more than 100 of the marchers who were injured. 10,4 Robert Smith, MD, a black family physician, civil rights leader and cofounder of the MCHR, provided medical support during the subsequent Selma to Montgomery march. 7 In June 1965, hundreds of men, women and children marching in support of voter registration in

MISSISSIPPI POLITICAL LEADERSHIP, CIVIL RIGHTS AND HEALTHCARE
In November 1965, President Johnson optimistically convened a White House Conference on Health to "bring together the best minds and the boldest ideas to deal with the pressing health needs of this nation" (Figure 3). 13 Mississippi was well represented. Attendees from Mississippi included Alton Cobb, MD, from the Mississippi Constantly embattled by southern segregationist democrats over implementation of civil rights legislation, the President failed to task the conference for no recommendations to expedite struggling efforts to desegregate hospitals and medical schools. In Mississippi, congressmen, the governor, state legislators, the citizens' councils, the Ku Klux Klan and the local media continued their collusion to slow implementation of social programs, voting rights and hospital integration, claiming government interference in states' rights and "communistic influence." 7 Mississippi Senators John Stennis, James Eastland and US Representative Jamie Whitten were, at the same time, among the most rabid segregationists and the most powerful members of Congress ( Figure 4). Mississippi's congressional delegation, all of whom signed the Southern Manifesto in 1956, coordinated their objections to desegregation, civil rights and social programs for blacks and other southern democrats. The Manifesto condemned the Brown versus Board of Education decision and committed the signers to oppose all civil rights legislation going forward. 14 There was fear among the influential southern planter class that the Great Society legislation would empower the black workforce to demand higher wages and benefits, access to healthcare and education and would vote out the white power structure they controlled. 15 The planters put pressure on Mississippi segregationist governors of the period, Ross Barnett (1960Barnett ( -1964, Paul Johnson, Jr., (1964)(1965)(1966)(1967)(1968)) and John Bell Williams (1968)(1969)(1970)(1971)(1972), to coordinate their opposition to civil rights and social programs for the poor with the seemingly permanently ensconced Mississippi congressional delegation. 16  Eastland, the foot-long illegal Cuban cigar smoking, untaxed whiskey drinking, Chairman of the Senate Judiciary Committee, was a lawyer and the owner of a 5,800-acre cotton plantation in Sunflower County in the Mississippi Delta. 17 He served from 1943-1978. After his interactions with Eastland, Senator Edward Kennedy wrote, "Power flowed through him and a handful of other senators, mostly southern." 18 His plantation was farmed by an enclave of black farm workers who lived in substandard housing on site, were paid $3.50/12 hours a day, had startlingly unhealthy and stressful living environments. 15,19,20 For instance, to receive healthcare, sick plantation workers had to be in favor with their employer as he referred, provided transportation and paid local doctors for services. In 1965, the Chairman of the Mississippi Freedom Labor Union testified to 2 congressional committees that the treatment of farm workers and tenant farmers was "found in its vilest form on the plantation of Senator James Eastland." 20 Senator Eastland was also a frequent and vocal defender of segregation on the Senate floor. Reporter Mike Wallace was astounded by Eastland's defense of segregation in a 1957 television interview as, "preferred by both races." 21 No enemy of conflicts of interest, Eastland took $165,152.52 in federal cotton support and acreage diversion payments in 1966 and sold the choice cotton he did produce for approximately $280,000. 15 He fought any legislation problematic for planters like himself.
Mississippi Senator John Stennis was a teetotaler, nonsmoking, segregationist, who previously served in the Mississippi legislature and was widely considered to be a southern gentlemen. He served with Eastland as the "Junior Senator" for 31 years. Stennis was at times Chairman of the Senate Appropriations Committee and the Senate Armed Services Committee. 22 Mississippi Representative Whitten was a key power broker for most of his 51 years in the House. He served on the House Appropriations Committee as Chair of the Subcommittee on Agriculture and was called the "permanent Secretary of Agriculture" by colleagues. 23 Thus, Eastland, Stennis, Whitten and the Mississippi governors formed the Mississippi equivalent of a Bermuda triangle for progressive legislators, the President and his administration on legislation not to their liking 17,22,23 (Figure 4). Not only were they willing and were frequent collaborators with the planter elite and each other but also they won the support of other southern democrats for their positions.

HEAD START AS A VEHICLE TO IMPROVE CHILD HEALTH AND EMPOWER THE POOR
The means to accomplish President Johnson's promise to reduce poverty and the poor health attendant to it were packaged in the provisions of the Food Stamp Act, the Economic Opportunity Act and the Social Security Act that created Medicare and Medicaid (Table 1). Head Start, a preschool program for children living in poverty, became one of OEO's first initiatives in 1964 and, because of input from physicians like Robert Smith, MD, had a strong medical component 7 ( Figure 5). Head Start was the work of a group of experts tasked by the Director of the White House Office of Economic Opportunity, Sargent Shriver and was led by pediatrician Robert Cooke of Johns Hopkins School of Medicine and child psychologist Edward Ziegler from Yale School of Medicine. It was tasked to develop a program to address the social, educational and health needs of impoverished children. 24 The physicians of the MCHR had traveled widely in the south and were aware of the poor health and nutritional status of infants, children and their mothers. A few stayed in Mississippi after Freedom Summer to work on the problem. 4 Polly Greenberg, Senior Program Analyst for the Southeastern Region of OEO, contacted one of those physicians, New York Jewish psychiatrist and passionate civil libertarian, Tom Levin, MD, about starting a program. The time was right as he was in the state planning a summer children's program for 1965 modeled after the Freedom Schools of 1964. 4,24 Head Start programs required approval by the governor and state medical licensure from any professionals from outside the state who participated. Mississippi Governor Paul B. Johnson, Jr. and State Board of Health Chair, Archie Gray, MD, let it be known that neither would

THE BEGINNING AND THE END OF CHILD DEVELOPMENT GROUP OF MISSISSIPPI
Levin wrote and received a 1.3 million dollar OEO grant for one of the first Head Start Programs and the first in Mississippi, Child Development Group of Mississippi (CDGM). 19 Amazingly, CDGM opened 86 centers in 24 counties in the impoverished Mississippi Delta in the summer of 1965. It was a summer program for 3-5-year olds requiring 80% of participants to be from families below the federal poverty line. Most black children in Mississippi were eligible. With Levin as Director and Robert Smith, MD as Medical Director, CDGM provided preschool education, 2 hot meals a day, medical and dental evaluations and referrals for children, and wages for 1,100 teachers and paraprofessionals ( Figure 6). 22 Dr. Smith identified Mississippi physicians and dentists willing to help perform the required physical examinations and health screenings for nearly 6,000 children, most of whom had never seen a physician or dentist. 4 The bulk of CDGM medical efforts ended upon the shoulders of local black physicians and dentists. 7 Drs. Smith, Aaron Shirley and James Anderson traveled back and forth from their medical practices in Jackson to the Mississippi Delta to provide additional medical support for CDGM programs. 4 A handful of white physicians, including MCHR   Levin's Head Start programs were run by "school boards" made up of politically active black parents, many of whom were employed as "teachers." 22,26 Members were encouraged to become active in local politics, including voting registration efforts. The CDGM headquarters at Mount Beulah, Mississippi were under constant surveillance by the Mississippi governor's Sovereignty Commission and their informants. Local whites burned a few Head Start sites, but civil rights leadership, especially remaining Student Nonviolent Coordinating Committee members, supported the local people running the centers. 27 Levin and CDGM made the Mississippi power structure very unhappy. 22,28 The bypassed and infuriated Mississippi governor asked Representative Whitten to request Federal Bureau of Investigation's investigations of CDGM and enlisted Senators Stennis and Eastland to cut off its funding. 1(p2) Stennis, in anticipation of a run by segregationist former Governor Ross Barnett for his Senate seat, charged CDGM with corruption, financial mismanagement and communistic teaching 16,20 The Johnson administration feared that Stennis, if angered, would use his powerful position in the Senate Appropriations Committee, to slow down Vietnam War funding and allowed Stennis to brutalize Sargent Shriver at public hearings charging that Mississippi Head Start programs were mismanaged by "out-of-state" individuals with "funny names." 29 Levin was forced to step down as director and CDGM headquarters were moved to Mt. Beulah into building in Jackson that housed the Mississippi office of the Federal Bureau of Investigation.
By October 3, 1966, Sargent Shriver buckled and cut off funds to CDGM triggering a massive national backlash. 30 The backlash included civil rights leaders and progressive groups including the Field Foundation of Chicago, the Citizens' Crusade Against Poverty and the National Council of Churches (Figure 7). Under pressure, OEO posed 9 conditions, including a "substantial" biracial board, for further CDGM funding. 31 Even the most progressive Mississippi whites feared retribution if they supported social programs helping blacks, so the chances of getting local whites to sit on CDGM boards were minute. Meanwhile, OEO designated CDGM a "model program but it was still doomed." 32

THE BEGINNING OF CHANGE IN THE WHITE MEDICAL COMMUNITY: JIM HENDRICK, MD
Like other whites, few white physicians in the south actively supported, much less participated in civil rights activities. However, attacks on a program beneficial to 6,000 poor children like CDGM struck a nerve among some in Mississippi's white medical community.
One progressive, yet unsung, white physician leader in Mississippi was the unassuming, gregarious senior partner of the state's largest pediatric group, Dr. Jim Gilbert Hendrick (Figure 8). Dr. Hendrick had served in the US Army Medical Corps in World War II, received a Bronze Star and began practice in Jackson in 1948. Hendrick's experience in the military and his personal understanding of Christianity made him uncomfortable with his church's continued segregation. After church members turned away blacks at a service during a "kneel-in" in response to the murder of Medgar Evers, Hendrick and his family joined others to form a new church open to blacks and composed of conservatives and progressives trying to understand the ethics of the civil rights. 33 His wife, Mary Ferrell and several of her friends dared to take food and personal items to civil rights protestors incarcerated by police at the Mississippi State Fairgrounds in 1965. The Hendrick's efforts as civil libertarians were rewarded by threats delivered by mail, phone and in person. Dr. Hendrick went out each morning to pick up threatening letters thrown into his driveway before his children arose, knowing what happened to Medgar Evers in his driveway. When a bomb wrecked the home of his neighbor, Rabbi Perry E. Nussbaum, who had spoken out in favor of racial reconciliation, friends rushed to the Hendrick house thinking it was the Hendrick family who had been bombed. 33,34 The good-natured pediatrician replied that he was "protected" as his next door neighbor was a leader in the White Citizen's Council. 33 Already peripherally involved in CDGM as a pro bono medical consultant, Hendrick took the risk to serve as medical director of another new Head Start program in Jackson in 1965 despite opposition by the mayor and the all-white county board of supervisors. He, his wife, older daughter and a group of friends worked together to perform health screenings in that program. He led his practice group and 2 others to be the first in the city to desegregate their waiting rooms even though it was not required by Medicare and Medicaid. 34 In May 1968, after the all-white City of Jackson leadership continued their resistance to integration by closing public parks and pools, rather than allow blacks to FIGURE 9. The 1968 Statement of Belief and Intention. This advertisement was placed in the now defunct Jackson Daily News on May 1, 1968 by risk taking Jackson, Mississippi professionals and business persons. It called for racial reconciliation after the all-white mayor and council closed the city schools, parks and swimming pools to prevent desegregation. This copy is courtesy of the Jackson Daily News Archives, the Eudora Welty Library of the Jackson-Hinds Library System, Jackson, Mississippi from microfiche. A copy of the advertisement was also found in Dr. Hendrick's file in the Mississippi Sovereignty Commission's website.
Copyright © 2016 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved. www.amjmedsci.com www.ssciweb.org use them, a sea change occurred. Hendrick and 44 other Mississippi physicians took the risk to sign a "Statement of Belief and Intention" that was published as a full-page advertisement in the prosegregation, Jackson Daily News (Figure 9). 35 The statement, also signed by other professionals and business leaders, read, "These days constitute the swiftest time of change in our memory." Events hurriedly pile themselves upon events. In our business, our professions and everywhere fast-breaking changes require quick answers and actions. We are threatened with a widening chasm between our people in this state and in our city. Yet, here in this state and in this city, there is a vast reservoir of good will, compassion and kindness that are genuinely a very part of our being. This vital reservoir of true neighborly feeling, true friendship must be brought to the fore now and without delay. We cannot sit back and become prisoners of events. We must cope with them firmly and decisively and manage our own destiny. Accordingly, in the set conviction that the great majority of our people, white and black, desire harmony, good order, a decent honorable family life and a chance to better themselves economically, we, the undersigned Jackson business and professional men and women declare we believe in the following principles, and we pledge ourselves to do everything in our power to see that they are carried out: (1) We believe in the essential worth and dignity of every human being and all that such implies. (2) Fair and impartial treatment must be accorded to all citizens in the enforcement and administration of the law. (3) Every citizen of this city regardless of race, creed or color is entitled to equal access to employment as he is qualified by training and experience to perform, and to earn the continuation of such employment by his own hard efforts. (4) In order that all of our citizens may be qualified for equal employment opportunities, educational opportunities must be available to them on an equal basis. (5) Adequate and properly staffed recreational facilities should be made available for all the citizens of the City of Jackson. Specifically, with the coming of the summer season, all city swimming pools should be opened. All parks should be open, and should be staffed by competent personnel, and properly equipped to the end that all our people may obtain the maximum benefit from them. (6) Communications between the races should be encouraged on every level of our city. This should include all of us whether we are public officials, civic, business, religious and professional leaders. (7) There is no place in the life of our city for hate, discord or violence. No man, whatever his cause, or whatever his convictions, is above the law. All of our citizens should work untiringly and unceasingly to bring out to the fullest and the best in us the way of kindness, compassion, friendliness and understanding that we may all progress through cooperation. We owe this to ourselves, our families and the oncoming generations and to the development of all our talents.
Hendrick's endorsement was dutifully noted in his file at the Mississippi Sovereignty Commission, the state-sponsored equivalent of the KGB, the infamous Russian spy agency. 35 Unintimidated, by 1970, Hendrick served as President of the Jackson Urban League. Hendrick's previously unappreciated, courageous leadership showed that professionals could lead others on important social issues if they had the courage to do so.

HEAD START AND THE CLARK SUBCOMMITTEE
During a 1967 Senate subcommittee hearing, Senator Joseph H. Clark of Pennsylvania "opened the annual debate on the antipoverty drive" with a request to support for a 5 billion dollar appropriation for OEO. 36 The New York Times reported that Senator Eastland responded with a tirade against Head Start citing CDGM. 32 But Clark insisted that antipoverty measures were "the most important domestic legislation to be considered by the present Congress." Clark called Marian Wright, a young black Yale law graduate working for the NAACP Legal Defense Fund in Mississippi, to testify about conditions in Mississippi. At her hearing, she invited the committee to come to Mississippi to see for themselves. Senator Clark and his subcommittee would soon be up close and personal with hungry Head Start children in Mississippi. What they saw would astonish them and launch some of the first efforts to improve nutrition, health disparities and population health in the nation.

SUMMARY
After their major leadership roles in support of the nonviolent civil rights movement in the South before 1965, a small group of black physicians remained active in implementation of the policies and programs of the Great Society that sought to improve the poor health and health disparities of black families. Meanwhile, led by Mississippi Congressman including President pro tempore of the Senate, James O. Eastland, the southern legislative leadership continued to resist those efforts at every level to preserve the status quo. These included attacks on programs like Head Start designed to help children in poverty in their own states. In Mississippi, where those events played out in the New York Times and on the nightly network news, white businessmen and professionals, including some physicians, began to publically push back on the politics of Jim Crow and were willing to risk exposing themselves and their families to violence and public derision, things Mississippi black physicians had experienced for decades. Overtime, they came into agreement with other groups of physicians who visited the state to better define the problems of child health and hunger affecting poor black and poor whites alike. And Mississippi, the "closed society," slowly began to open up. 37 Shortly after Senator Eastland's retirement from the Senate in 1978, the University of Mississippi Foundation sought to commission a $13,000 portrait of him for the Oxford, Mississippi Law Library. They could raise only $3,000 from his friends and supporters and the project was dropped. 17