By Paul Theerman, Associate Director, Center for the History of Medicine and Public Health

June is Men’s Health Month. As a concept, men’s health—a focus on the health and wellness issues particular to men—is still new, first arising in the men’s movements of the 1960s and 1970s. The emergence of AIDS sharpened the idea of men’s health, as gay men took the brutal first hits of the pandemic. By the 1990s, though, the idea of men’s health had become more mainstream. Congress first designated an official men’s health week in 1994, sponsored by Senator Robert Dole. By the early 2000s, the CDC began to include men’s health as a separate category in its consumer health site. In 2014, NYU’s Langone Medical Center opened the Preston Robert Tisch Center for Men’s Health, the counterpart to its Joan H. Tisch Center for Women’s Health of 2011.

The original men’s health movement, though, focused on war veterans. Each war brings up the issue—for Vietnam, for example, it emerged in such popular books as Peter Bourne’s Men, Stress, and Vietnam (1970; by the physician who became President Jimmy Carter’s drug czar). An escalating cycle of concern, growth, failure, and reform—so apparent in today’s veterans health scandal—has deep roots in American military history.

The federal government first extended general health and medical benefits to veterans in 1917 due to the large number of Great War veterans.¹ In 1921, this led to a separate agency, the Veterans Bureau—which, joined with two other agencies, became the Veterans Administration in 1930. The VA ran a separate hospital system, with 74 facilities by the end of 1932.¹

Photograph in: Armfield BB. Organization and Administration in World War II. Washington, D.C.: Office of the Surgeon General. Department of the Army; 1963.

World War II led to a new crisis in veterans health. In 1945, the number of living veterans from all previous wars numbered some 4 million men; World War II immediately added 15 million more.² This surge threatened to overwhelm the system, and led to major reform of veterans health care, undertaken by Major General Paul R. Hawley.

In World War II, Hawley (1891–1966) served as the theater surgeon for the European Theater of Operations. As such he was responsible for all medical care for American armed forces fighting in Europe, with 250,000 medical men under his command. Among other accomplishments, he planned the medical support for D-Day, June 6, 1944, arranging for the construction of field hospitals (with some 11,000 beds) in Normandy right after the invasion. These hospitals began as concrete slabs to hold tents, as there were almost no existing hospitals in the landing area. He called this work “one of the finest pieces of planning in the entire campaign.”^3,4

Photograph in: Wiltse C. Medical supply in World War II. Washington, D.C.: Office of the Surgeon General. Department of the Army; 1968.

Indeed, planning was Hawley’s strength. In 1945, the new head of the Veterans Administration was General Omar Bradley, who had commanded American invasion forces in Europe from D-day through to German surrender. Bradley brought in Hawley to reorganize the health services. To this task, Hawley brought a keen sense of what was possible and a reliance on improving health by raising the quality of the system’s doctors. The Veterans Administration began by engaging in hospital building—by the late 1940s, the number of VA hospitals has risen to almost 100—but as a first measure, Hawley advocated using private clinics to help veterans, and he looked to county medical societies to provide the services. His vision was to have “every physician in each community designated a veteran’s physician.”⁵ For, ultimately, he saw the nation’s physicians and surgeons as the backbone of the system. He had great confidence in physicians’ abilities; indeed, more than any other factor, he gave well-trained doctors the chief credit for the greatly reduced casualty rates in World War II.³

Photograph in: Armfield BB. Organization and Administration in World War II. Washington, D.C.: Office of the Surgeon General. Department of the Army; 1963.

And so, after revitalizing local clinics, Hawley’s chief reform was getting good doctors into veterans hospitals. He loosened the employment structure, removing it from civil service system, and increased the top salaries to about $125,000 in today’s dollars. For board-certified specialties, there was a 25% premium above that—all free of office and support expenses, as he pointed out. He allied VA hospitals with medical schools as much as possible, allowing VA physicians to teach, and he provided for expansive professional development programs. He went out of his way to secure the best physicians—his February 1946 JAMA article on the Veterans Administration² is really an extended recruitment notice. By the time he left the position in 1947—he went on to head Blue Cross/Blue Shield and then the American College of Surgeons—Hawley had substantially raised the level of care in veterans’ health.

The Veterans Health Administration has gone through successive periods of reform since the late 1940s. The last major period was in the 1990s under Kenneth Kizer, and included implementing one of first effective electronic medical records systems, VistA. By the 2010s, though, the Administration was again overwhelmed, overseeing care for war veterans going back to World War II as well as from recent U.S. wars and incursions—and now serving both men and women. Many of the same issues are there as Hawley faced: the challenge of providing increasing numbers of veterans with the care they need. New, and newly recognized, medical conditions have stressed the system as well. One is PTSD, a consequence in previous wars but not well understood; another are the injuries from IEDs. Neither was a major factor when Hawley reformed the Veterans Health Administration, and now both are huge. We await the next cycle of reform.

References

1. Weber GA, Schmeckebier LF. The Veterans’ Administration: Its History, Activities and Organization. Washington, D.C.: The Brookings Institution; 1934.

2.Hawley PR. New opportunities for physicians in the Veterans Administration. J Am Med Assoc. 1946;130:403.

3.Hawley PR. Advances in war medicine and surgery as demonstrated in the European theater of operations. Med Ann Dist Columbia. 1946;15:99–109.

4. Hall DE. “We were ready”: Health services support in the Normandy campaign. US Army Med Dep Off Med Hist. 1993. Available at: http://history.amedd.army.mil/booksdocs/wwii/Overlord/Normandy/HallNormandy.html. Accessed June 5, 2014.

5. Hawley PR. Medical care for veterans. Ill Med J. 1945;88:294–96.