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December 2005 (Volume 83)
December 2005 | Kathleen S. Andersen, John R. Ball, Paul D. Cleary, Daniel M. Fox, Peter M. Gottsegen, Bradford H. Gray, Rosemary A. Stevens, John D. Stoeckle
The Milbank Memorial Fund is celebrating its one-hundredth anniversary this year. A centennial is a time for reflection. We look back at what the Fund has accomplished over the last century through its work with individuals and organizations, work that has addressed a wide range of issues in health and social policy. The Milbank Quarterly has been an essential part of this work since its inception in 1923. For this special issue of the Quarterly, we have selected articles from past issues that provide insight into the role of both the Fund and its journal in addressing major policy questions for health services and population health for more than eighty years.
Selecting the articles for this issue from the Quarterly‘s eighty-three volumes was difficult. We agreed that the selected articles should be interesting to read in 2005. Moreover, they should discuss major issues in health policy as well as aspects of the Fund’s work during the past eight decades. We looked for articles that dealt with issues that were important in the past and are still significant today, such as health care coverage for the uninsured, the cost and organization of health care, and the growing prevalence of chronic illness. The articles we chose also provide examples of how scholarship in the disciplines that study health services and population health has changed over time.
Only one of these articles assesses the history and program of the Fund itself. In the early 1930s, as the Fund sought to inform policy to increase access to affordable health care, it came under attack from physician organizations. In response, Albert G. Milbank, president of the Fund’s board, gave a speech to a state medical society in which he analyzed and defended the role of the Fund and other foundations in informing policymaking for health. Milbank’s speech, titled “The Relationship of the Milbank Memorial Fund to the Field of Health and the Medical Profession,” was widely reported in the national press and later published in the Quarterly.
We found that many more articles met our criteria than could be included in a single issue. Therefore, in order to offer readers a larger sampling from the Quarterly‘s past issues, we have published the articles electronically as well as in print. In addition to the fourteen articles that appear in the print edition of this special issue are twenty in an electronic edition on the Fund’s website,https://www.milbank.org. All the articles are listed in the table of contents in chronological order, with the electronic-only articles marked by an asterisk. Both editions also include notes about the authors.
The Quarterly began as an outlet for information about the Fund’s principal programs, but by the early 1930s, it had become a more general journal of research on health issues. For most of the Quarterly‘s history, it has reflected, but not been dominated by, the Fund’s main programs.
Readers can learn more about the Fund from an essay by the publisher about the Fund’s significance for health policy, which will appear in the next issue of the Quarterly, and from the Fund’s centennial report (Fox 2006; Milbank Memorial Fund 2005). Both publications can also be found on the Fund’s website.
History of Milbank Quarterly
The first issue of the Milbank Quarterly, in 1923, was titled the Quarterly Bulletin: New York Health and Tuberculosis Demonstrations. Its purpose was to provide formal reports on the Fund’s three health demonstration projects to its board of directors and advisory council, whose members were national leaders in medicine, public health, and philanthropy. The three demonstrations, which began in 1921, were designed to bring to scale innovative projects started by the Fund with other organizations in three very different communities: Syracuse, rural Cattaraugus County in New York State, and the Bellevue-Yorkville section of Manhattan. After the demonstrations were concluded in 1931, the Fund decided to expand the journal to “permit a more adequate presentation in the future of the many activities in which the foundation and its friends are engaged” (Brown 1931, 60). These activities included studies in public health, social welfare, and education being conducted by both the Fund’s division of research and investigators commissioned by the Fund. In his introduction to the expanded Milbank Memorial Fund Quarterly Bulletin, the editor, Bertrand Brown, wrote:
The lack of application of knowledge which is in the possession of experts has been characterized by President Farrand of Cornell University as about the most difficult thing with which the world has to contend. … From the studies of its [the Fund’s] division of research and of various groups with which it is cooperating, information is being derived which should be made available to those who in actual work-a-day practice are confronted with the problems upon which it bears. (Brown 1931, 60)
The Quarterly‘s purpose expanded even further in 1934, when Edgar Sydenstricker assumed the editorship. He had been named the Fund’s director of research in 1928 and served as its scientific director from 1935 until his sudden death early in 1936. In the introduction to the issue announcing Sydenstricker’s appointment as editor, the Fund declared that in addition to publishing the results of research conducted by its staff and grantees, the Quarterly would “also publish articles from others on subjects related to the general purposes of the foundation and, it is hoped, render a service as a journal in the broad fields of public health and social welfare” (Milbank Memorial Fund 1934, 2).
Over the next three decades, the Quarterly accelerated its stimulation and dissemination of research on health and social issues. Many of the papers presented at the Fund’s annual conferences on such topics as social medicine, demography, and public health were published in the Quarterly, as were papers commissioned by other organizations. In 1963, for example, the recently established Health Services Research Study Section of the U.S. Public Health Service commissioned papers on topics related to the problems of providing health services. The authors and assigned reviewers met in two conferences in 1965 and 1966, with the resulting articles appearing in 1966 in two issues of the Quarterly, edited by Donald Mainland, professor of medical statistics at the New York University Medical Center. A number of these papers turned out to be influential; for example, nearly forty years after its publication, “Evaluating the Quality of Medical Care,” by Avedis Donabedian, is still the Quarterly‘s most frequently cited article.
In the 1940s and 1950s the Quarterly was collectively edited by the Fund’s technical staff, under the leadership of Dorothy Wiehl, who served on that staff for thirty-seven years. In 1964, Robin F. Badgley, a Canadian sociologist, was named as the editor.
The Quarterly celebrated its fiftieth anniversary in 1972, at which time the Fund’s president, Leroy E. Burney, announced a new program focusing on the delivery of health services. The introduction to the October 1972 Quarterly emphasized its role “as a distinctive arm for the explication and dissemination of ideas and programs relating to the Fund’s focal interests” (Milbank Memorial Fund 1972, 361). To signal this change in focus, the journal was given a new title—Milbank Quarterly: Health and Society—as well as a new typeface and cover design. In early 1973, George Reader, a professor of public health at the Cornell School of Medicine, became the first editor who was not a member of the Fund’s staff.
In 1977, David P. Willis, a member of the Fund’s staff, was named editor. In a note to readers, Willis described the Quarterly as “a forum for communication among the academic community, the health professions, the several branches of government, and an intelligent inquiring public. … The focus is on policy, and on those issues and persons shaping the content of our public, institutional, and private decisions” (Willis 1977, 1). During the years Willis was editor, 1977 to 1991, the Quarterly published articles that were broader than those published by most of the other journals of health services research. Especially notable were the supplements to the regular issues, usually two a year, which provided a forum for analysis from different perspectives of such topics as aging, AIDS/HIV, disability, and the health of African Americans.
Subsequent editors continued the Quarterly‘s focus on policy. Ronald Bayer, who served as interim editor from 1991 to 1992, emphasized the Quarterly‘s commitment to publishing “thoughtful and intellectually rigorous analyses of the broad questions bearing on health and society” (Bayer 1991, 1). Paul D. Cleary was editor of the Quarterly from 1992 to 2000 and then became the Fund’s editorial director. In his introductory message, he wrote that one purpose of the Quarterly is “to facilitate, and make readers aware of, the work of the Fund” (Clearly 1992, 245). In an interview in 1998 he elaborated on his vision for the Quarterly: “There’s still a chasm between what we do in academe and the people making day-to-day decisions. What I would really like to do is try to bridge that gap a little” (Cleary 1998). His statement echoed that of Bertrand Brown in 1931.
The current editor, Bradford H. Gray, was named to this position in 2000. In his first issue, he stated that “the Quarterly seeks to shed fresh light on important public policy issues in health care, in all of their social, economic, legal, and ethical complexity” (Gray 2000). The Quarterly‘s evolving focus is reflected in changes in its subtitle, from “A Journal of Public Health and Health Care Policy” in 1994 to “A Multidisciplinary Journal of Population Health and Health Policy” in 2004.
Articles In This Issue
In our selection of articles for this issue, we divided the history of the Quarterly into four chronological segments based on events in the broader history of the United States. This decision ensured that the articles we chose would be relevant to the concerns of the country and the general public rather than those of the health sector alone and of the Fund as one relatively small organization within it. The first seven articles address concerns about financing and organizing medical care in the context of the Great Depression, especially the effects of the Depression on the health status of various populations, such as wage-earning or unemployed families and African Americans.
The next eight articles address health policy and the health of the nation during World War II and the quarter century of unprecedented national prosperity that followed it. A landmark article of 1940, for example, analyzes data that had been recently published by the federal government identifying chronic disease and disability as the main health problems for most Americans. Other articles focus on nutrition, the prevalence of mental illness and how to improve community-based treatment for it, emerging issues in occupational health, and the evaluation of the relatively new organization that integrated health services and financing in prepaid group practices. The growing sophistication of research on health services and health status is reflected in the increasing concern with methodology in these articles.
The thirteen articles from the years 1966 to 1984 document and analyze the astonishing growth of the health sector in these decades. The Quarterly‘s authors explore the cost, organization, and quality of health services; the problems of expanding access to them; how consumers use health services; their lack of voice in evaluating them; and the apparent paradox that advances in health care technology prolong life but also create additional years of frailty, at a high personal and societal cost near the end of life.
We were more confident in our judgment about the importance of papers published in the 1980s than during the subsequent decade and a half. The most recent paper is a landmark article from 1998 on the quality of care in the United States: subsequent publications and events confirm the ongoing significance of this issue. From the 1980s we selected articles about the AIDS/HIV epidemic, home- and community-based long-term care, pharmaceutical drugs in primary care, and disability policy.
These articles can also be organized by theme. We invite readers to explore how a particular theme—the organization of health services, for example—has been addressed by different researchers at different times. Such exploration can illustrate both continuity and discontinuity in the history of health policy.
Although the articles included in this issue have been typeset in the current Quarterly style, the editing has not been updated to reflect modern style and usage.
The editors of this issue, who are members of the Fund’s board and staff, gratefully acknowledge the contributions of the many people whose efforts as scholars, editors, reviewers, members of advisory boards, and staff have made the Milbank Quarterly the journal we celebrate with pride on the occasion of the Fund’s centennial.
Bayer, R. 1991. A Note from the Interim Editor. Milbank Quarterly 69(1):1.
Brown, B. 1931. Introducing the New Quarterly Bulletin. The Milbank Memorial Fund Quarterly Bulletin 9(3):60.
Cleary, P.D. 1992. A Note from the Editor. Milbank Quarterly 70(2):245.
Cleary, P.D. 1998. Interview conducted by Edward Berkowitz. History of Health Sciences Research Project (April 28). Available athttp://www.nlm.nih.gov/hmd/nichsr/cleary.html (accessed July 5, 2005).
Fox, D.M. 2006. The Significance of the Milbank Memorial Fund for Policy: An Assessment at Its Centennial. Milbank Quarterly 84 (forthcoming).
Gray, B.H. 2000. From the Editor. Milbank Quarterly 78(3):345–46.
Milbank Memorial Fund. 1934. The Milbank Memorial Fund Quarterly 12(1):2.
Milbank Memorial Fund. 1972. The Fund and Its Publications. The Milbank Memorial Fund Quarterly 50(4):360–64.
Milbank Memorial Fund. 2005. Centennial Report: Informing Policy for Health Care & Population Health.
Willis, D.P. 1977. An Editorial Note. Milbank Memorial Fund Quarterly/Health and Society. 55(1):1–2.
Author(s): Kathleen S. Andersen; John R. Ball; Paul D. Cleary; Daniel M. Fox; Peter M. Gottsegen; Bradford H. Gray; Rosemary A. Stevens; John D. Stoeckle
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Volume 83, Issue 4 (pages 515–521)
Published in 2005
Notes on Contributors
The Milbank Memorial Fund Centennial: Selected Articles from The Milbank Quarterly