Dr. Julius Richmond’s talent for diplomacy was exceptional and matched by a genius for advancing public health. Richmond was able to move seamlessly between many diverse groups in society. He shifted frequently between academic and governmental medicine roles throughout his career and accomplished magnificent feats on behalf of the nation as a result.
Richmond was born on September 26, 1916, to a Russian-Jewish immigrant family. Richmond’s biographer, Charles Bussey, paints a portrait of Richmond’s family and early life as deeply influential of the man he would become:
“My parents,” he said, “fled Czarist rule in Russia and settled in Chicago. My early recollections are that my parents emphasized excellence and community service.” Jacob and Anna Richmond took their son to Jane Addams’s famed Hull House and exposed him to the remarkable ideas and achievements of the women there, who dedicated themselves to securing child labor laws, educational opportunities, and health services, especially for children. Women like Florence Kelly, Alice Hamilton, and Julia Lathrope provided models for institutionalizing services (infant welfare stations, children’s courts, the pioneer child guidance clinic) for the rest of the century. Richmond’s exposure to the example of Hull House occurred between the ages of six and ten, for his mother died in 1927 with a brain tumor. She and Jacob—Richmond refers to them as “social democrats and activists on behalf of others”—planted in their son’s mind the idea that he could make a difference in society. He did. (Bussey)
After his mother’s passing, young Richmond attended Allendale boarding school in the countryside, where he was the only Jewish student. Richmond recollected the period as a cultural adventure, “an experience in group living and got me out into a cultural setting different from the one in which I had been growing up. I had an opportunity to see contrasts and to get a comparative view” (Bussey).
When Richmond graduated from John Marshall High School in Chicago, he matriculated as an undergraduate at the University of Illinois Urbana-Champaign. Threads of his destiny met him there. During a demonstration in Urbana opposing the University’s housing segregation policies, Richmond met the woman he would marry, Rhee Chidekel. In this period, Richmond’s humanitarian concern for socio-economic inequity also emerged as a scholarly focus. In the tragic period of the Great Depression, the undergraduate published his first paper, “American Serfdom,” a critical look at share-cropping in the American South (Bussey).
In 1937, Richmond attended medical school at the University of Illinois in Chicago, where he graduated post haste with both a medical degree and a master’s in physiology (1939). During this intensely formative time, Richmond discovered a publication from the Committee on the Costs of Medical Care, which would prove to be life-altering. Figuring out how to help the most people in the most cost-effective way was to become Richmond’s lifelong mission (Bussey).
As a graduate student in medicine, Richmond undertook an 18-month internship at Cook County Hospital and followed it with two residencies in pediatrics. Between 1941-1942, he served as house staff at Chicago’s Municipal Contagious Disease Hospital, and he followed with a second residency at Cook County Hospital (History of Medicine). Bussey describes Richmond’s distressing experience working with the poor in his residency in the depression era before many of our modern social services—and his resilient social activism:
He found it challenging, but disconcerting. “Our experience with poverty there,” he remembers, “was simply overwhelming. We were in no way prepared for it. Humor became the defensive armor against looking at it too deeply. It was M*A*S*H*-like humor, over-done, and I thought what an unfortunate experience it was to have to behave as though you were really insensitive to it.” Herb Abrams and Marc Hollander, fellow interns/residents, describe the situation in similar terms. Hollander remembers Richmond as “a walking encyclopedia of pediatrics.” According to Hollander, who was an intern while Richmond was a resident, “Julie organized a march on City Hall to improve conditions for interns.” The result: “We started to get paid. I got $12 a month!” Hollander said. But Richmond and his fellow students were most “impressed by the impact of poverty.” They dealt only with the poverty population at Cook County. (Bussey)
With the onset of World War 2, in February 1942, Richmond volunteered for service with the Army Air Corps. There he practiced as a flight surgeon with the service’s training command until 1946.
Richmond returned to Chicago in 1946 to complete the residency at Cook County, and he was subsequently recruited to become a Professor of Pediatrics at the University of Illinois Medical School. His biographer outlined several features of Richmond’s brilliant innovation in teaching as a new faculty member, including his ultra-modern insight about the value of integrating the biomedical sciences and the behavioral sciences coursework with the introduction of medical students into the poverty clinics. At the same time, he was envisioning curricular changes 50 years ahead of the mainstream, the energetic Richmond taught the biology of human development at the Institute of Psychoanalysis and lectured in Urbana weekly to students at the School of Social Welfare Administration (Bussey).
In the immediate post-war period, Richmond was funded as a Markle Scholar, which afforded him the opportunity from 1948-1953 to perform cutting edge research, characterizing the autonomic nervous system functioning of a variety of individual children (Palfrey). Richmond’s chronicler, Palfrey describes his groundbreaking work:
He was one of the first people to point out how infant brain growth depends on organized input from the external world. Before the advent of sophisticated brain imaging, he and his research colleagues documented the elaboration of synaptic connections in infants. He would demonstrate the intricate and vulnerable interactions of the newly forming brain, and he would take the next logical step to argue the importance of early cognitive stimulation. (Palfrey)
In 1953, Richmond departed UIC’s medical school to teach at the State University of New York at Syracuse College of Medicine and Chair of the Department of Pediatrics. While some historians suggest that Richmond and Caldwell were inspired by the Brown v. Board of Education case to study the influence of environment on childhood development (History of Medicine), a more critical analysis of Richmond’s transition by Bussey seems more likely and arises from his pedagogical differences with the UIC faculty leadership:
Two things prompted Richmond to leave the University of Illinois Medical School in 1953. Progressive in his views, he tried to move the medical school curriculum in a new direction. He wanted integrated teaching across departments, patient contact early in medical school, attention paid to psychological and social factors in health and illness, and emphasis on disease prevention and health maintenance. When the Executive Faculty of the medical school soundly defeated his proposal, and then failed to offer him the open Chair of the pediatrics department, Richmond began to consider other possibilities. Again, demonstrating his versatility and energy, Richmond was named director of the Institute of Juvenile Research, as well as continuing his teaching duties, during the year he remained in Chicago. Richmond disagreed with a colleague’s assessment that anti-Semitism had played a role in his disappointments, but he admitted he felt “somewhat bloodied by the faculty battle that had taken place.” His decision to leave Chicago in 1953, according to medical historian Patricia Spain- Ward, “was a sad day for the University of Illinois Medical School.” (Bussey)
Richmond styled the path of his lifelong adventure as “the incidence of coincidence,” and his biographer, Bussey rightly marveled at the “almost serendipitous convergence of historical forces and personal circumstances that shaped his career. Nowhere is that more profoundly demonstrated than by the move to Syracuse—and within a few years, Head Start” (Bussey). With hindsight, we may consider the roots of Richmond’s extraordinary path, and the modern reader might remember that the following brief highlights from Dr. Richmond’s career represent extraordinary and novel achievements in social medicine. Richmond accomplished his work on a grand scale.
At Syracuse, Richmond advanced his foundational studies of the developing child with psychologist Bettye Caldwell. At first, the pair assessed the development of the youngest of the urban poor, infants and toddlers, and were alarmed by the slowdown in learning by 18 months of children who had previously met basic milestones and were neither ill nor obviously impaired. Next, the colleagues started home visits and discovered that while the basics of survival were minimally present, there was very little in the environment to stimulate the children. Richmond and Caldwell developed an early childhood curriculum for impoverished preschoolers on their Syracuse campus. When they compared children exposed to the enriched environment with those who lacked exposure, the researchers found an enormous difference between the groups, demonstrating the effects of poverty (Palfrey).
The Johnson administration’s Great Society and War on Poverty was heating up in the mid 1960’s, accelerated by the appointment of Sargent Shriver as the new chief of the Office of Economic Opportunity (OEO). Shriver was interested in immediate action programs to lift families out of poverty. The story of Shriver’s invitation to Richmond to join the campaign is telling about the character of both men. Shriver, who never liked to wait, literally traveled to Philadelphia in order to send a note to Richmond at the speaker’s podium asking him to come to Washington. The note specified Richmond’s expected time of arrival to the new job as the next day (Bussey).
One historian of the Great Society, Davis defined the philosophy of social change shared by President Johnson who approved of Shriver’s choice in Dr. Richmond:
“Two men instrumental in the planning and implementing of the Great Society–President Lyndon Johnson and Dr. Julius Richmond, director of Head Start–agreed that certain societal factors had to be present before social change could occur. Johnson felt that these three conditions were “a recognition of need,” “a willingness to act,” and “someone to lead the effort” (Johnson The Vantage Point quoted by Davis).
Essentially, Shriver asked Richmond for the equivalent of a moonshot, a full-scale educational offensive on an impossible timeline. Palfrey, who has outlined Richmond’s three major contributions to public health, elegantly describes how Richmond achieved the first, the seemingly impossible lightning speed implementation of a program across the nation for 500,000 children at 3,000 locations
As the first national director of Head Start, Richmond traveled to small towns, rural villages, and big city neighborhoods throughout America. Over and over, he witnessed the same deprivation that he and Bettye Caldwell had encountered when they visited homes in New York State. He found children denied nurturing, children taken for granted, and children whose potential was being wasted.
He also found allies in the towns and cities, men and women who knew that the situation for young families could change. They recognized in Head Start a practical mechanism to turn things around but also knew that Head Start should invest in the community itself, should take advantage of the talents of local people. Under the umbrella of Head Start, these community leaders could introduce young children to language and song, pictures and stories about their heritage and their future. Years later Richmond would say that Head Start has succeeded so well because it rests on “contracts between the federal government and local communities, which have proved to be remarkably effective in giving people in local communities—and particularly parents—ownership and commitment for the health, education, and welfare of their young children.” (Palfrey)
Thus, Richmond achieved the first monumental pillar of his public health legacy with the Head Start program, which persists to this day, and has lifted up millions of children from impoverished environments. In the process of installing the Head Start network of centers across the country, Richmond also began to identify the systemic problems in the delivery infrastructure of healthcare for children. During the early days of Head Start, the seed was planted with Richmond for what Palfrey identified as his second great public health legacy:
As Richmond learned more about the needs and the strengths of communities, he identiﬁed gaps in the delivery of health care to young children. In the bayous and the backwaters, out where the tall wheat blew and in the swelter of the inner cities, Richmond recognized the dearth of easily accessible health care clinics for children. He was impressed by the ideas that community members brought to him. Richmond listened and responded with the kind of idea that Shriver could run with. How about a new type of community-organized, community-run health clinic? The OEO wanted to ensure the “maximum feasible participation of the poor.” What better way to create participation, ownership, jobs, and community health than to build and run these clinics? And so the neighborhood health center movement was born. (Palfrey)
In 1967, with the change of federal administrations, Richmond returned to Syracuse, where he was made Dean. In 1971, Richmond moved to Harvard, where he was appointed to lead two departments: the Department of Child Psychiatry and Human Development and the Department of Preventive and Social Medicine. A number of other responsibilities were taken up by Richmond in this period as he dedicated his energies to helping Boston’s children. Richmond led the Judge Baker Guidance Center (1971-1977) and was the Chief of Psychiatry at the Children’s Hospital” (History of Medicine).
In 1977, under President Jimmy Carter, Richmond accepted an invitation to return to government service on the condition he was appointed Surgeon General. Carter appointed Richmond as the 12th Surgeon General of the United States and Assistant Secretary for Health. Richmond began working toward the second pillar of his public health legacy with determination and using his diplomatic skills with the Congress. Legislation was passed to establish long-term federal funding of neighborhood health centers, which he had recognized as a necessity during the Johnson years and his travels across the nation for Head Start. His goal was realized in 1978 when Congress passed the Health and Human Services and Centers Act with a $3 billion dollar appropriation to build community and migrant centers as well as primary care centers and other community-initiated initiatives (Palfrey).
Richmond was masterful at using the tools of mass communication to achieve his goals. He convened a number of important stakeholder groups to create momentum for broad societal changes in healthcare. He issued the landmark public policy declaration in 1979, entitled “The Surgeon General’s Report on Health Promotion and Disease Prevention.” This Healthy People Report reflects Richmond’s genius as a strategic communicator and is still the major policy document informing our national and state public health agendas to this day. It represents Richmond’s third great legacy, according to Palfrey, and in some ways the most powerful since it engages several hundred broad aims in an evidence-informed strategic design. At this writing, the Healthy People Report has undergone several generations of revision and is an engine of public health transformation. Richmond used this report to reach out to the broad public, using media and local health departments, together with the national media, in order to influence and inspire the public’s interest in health promotion. By engaging the public and creating a standing strategic design instrument for forward movement, Richmond provided the infrastructure for healthcare research and policy agenda setting, which are foundational to change.
Part of Richmond’s public health legacy as Surgeon General also includes his efforts to advance life-saving public health change through tobacco control. Toward this end, he issued the famous 1979 report “Smoking and Health” (History of Medicine). In 1980, Richmond organized the “Workshop on Maternal and Infant Health.” The 75-person expert panel convened to develop a national strategy for reducing deaths and disparities in healthcare at the prenatal and pediatric levels (Heinz Awards).
When Richmond returned to Harvard in 1981, he was appointed as John D. MacArthur Professor of Health Policy and Director of the Division of Health Policy Research and Education. He served in these posts until he retired in 1988. As Professor Emeritus, Richmond’s retirement activities included service as the Steering Committee Chair for the National Academy of Science’s Forum on the Future of Children and Families. Richmond continued mentoring students and faculty as well as writing for years. He was an expert witness in the historical tobacco litigation. Then, in 1990, Richmond, the founding Chair of the AAP Section on Community Pediatrics and the Section on Child Development, received the American Academy of Pediatrics Excellence in Public Service Award (AAP website).
The Harvard School of Public Health’s highest honor, the “Julius B. Richmond Award,” was established in 1997.
On July 27, 2008, Dr. Richmond died of cancer at age 91. Professor Jack P. Shonkoff, the Julius B. Richmond FAMRI Professor of Child Health and Development and the Director of the Center on the Developing Child provided the following note on Dr. Richmond’s legacy: “Julie Richmond was an intellectual giant and a social activist with a gentle spirit. Through public example and personal relationships, he inspired thousands of leaders who have made the world a better place for millions of children” (Harvard, Obituary for Dr. Richmond).
Readers may wish to see some of the appearances of Dr. Julius Richmond available on YouTube. They are remarkable for both his gentle humor and great humility.
American Academy of Pediatrics (AAP website). Dr. Julius B. Richmond (1916-2008). Accessed May 2020 at: https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Richmond-Center/Pages/Dr–Julius-B–Richmond-(1916-2008).aspx
Bussey, C. J. (1993). Julius B. Richmond and Head Start: The dream become reality. Perspectives in Biology and Medicine, 36(3), 429-441. doi:10.1353/pbm.1993.0050. Accessed May 2020 at: https://muse.jhu.edu/article/401041/summary
Davis, J. (1994). Prelude to the Great Society: Cultural Change in the 20th Century America. Student Honors Theses, 78. Accessed May 2020 at: http://digitalcommons.wku.edu/stu_hon_theses/78
Harvard T.H. Chan School of Public Health obituary for Dr. Richmond (2008). “Julius B. Richmond, former U.S. Surgeon General and Professor of Health Policy, Emeritus, dies.” Harvard School of Public Health website, accessed May 2020 at: https://www.hsph.harvard.edu/news/press-releases/julius-richmond-former-us-surgeon-general-dies/
Heinz Award website accessed May 2020 at: http://www.heinzawards.net/recipients/julius-richmond
History of Medicine. Julius Richmond Papers. Biographical Note. National Library of Medicine website. Accessed May 2020 at: https://oculus.nlm.nih.gov/cgi/f/findaid/findaid-idx?c=nlmfindaid;idno=richmond383;view=reslist;didno=richmond383;subview=standard;focusrgn=bioghist;cc=nlmfindaid;byte=35360724
Palfrey, J. (2006). Child health in America: Making a difference through advocacy. JHU Press. ProQuest Ebook Central. Accessed May 2020 at: http://ebookcentral.proquest.com/lib/uic/detail.action?docID=3318369.