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Celebrated farmer urges Kaiser Permanente doctors to further healthy food traditions

posted on April 5, 2011

By Grace Emery

Heritage correspondent*

Joel Salatin, celebrity farmer. Photo by Rachel Salatin.

When I heard that famed farmer Joel Salatin had come to Oakland to speak with Kaiser Permanente (KP) doctors, I felt like this event almost constituted a brush with celebrity. I wrote my senior thesis on food movements in the Bay Area, and my longtime interest in food politics had introduced me to Salatin and his work to bring sustainable food to America’s tables.** While some may be puzzled at the idea of a “famous farmer,” I leapt at the chance to write about a veritable hero of the food politics world, and I was anxious to learn more about where KP doctors and Salatin crossed paths.

Thanks in part to Michael Pollan’s discussion of Salatin in “The Omnivore’s Dilemma” and his appearance in the 2008 popular documentary “Food Inc.,” Salatin has become a renowned advocate of sustainable food and farming, and somewhat of an icon in the healthy food movement.

During his visit, Salatin, who raises beef, pork, and poultry at his Virginia family farm, Polyface Inc., spoke of the challenges small farmers face at the intersection of healthy food and politics. Locally grown food is often healthier and more sustainable, but small farmers struggle when selling their products to large institutions, preventing the large-scale adoption of a local food system.

Salatin started his visit with a stop at the birthplace of local food sales—the farmers market. Preston Maring, MD, a KP physician in Oakland, Calif., founded the first Kaiser Permanente farmers market at the Oakland Medical Center in 2003, and today there are more than 35 KP farmers markets in several regions, demonstrating Kaiser Permanente’s commitment to total health through nutrition.

After a visit to the market, Salatin spoke to a group of KP physicians on the topic of “Local Food to the Rescue.” His message served to both validate the work Kaiser Permanente farmers markets and hospital cafeterias are already doing, and to inspire Kaiser Permanente officials to supply hospitals with even more locally sourced food.

History of healthy eating

Kaiser urged wartime shipyard workers to eat healthy, even grow their own vegetables, as this 2009 poster illustrates. Design by Pam Zachary, KP Multimedia Department.

Kaiser Permanente has long focused on the link between healthy eating and prevention. Before Kaiser Permanente was synonymous with health care, war workers flocked from all parts of the U.S. to Richmond and Oakland, Calif., where they helped to build ships in the Kaiser Shipyards during WWII. Henry Kaiser quickly realized that to build ships at a fast pace his workers had to be healthy and strong, and that meant they needed to eat nutritious foods. He saw that well-nourished workers translated into less absenteeism, more productivity, and happier employees.

In a 1943 memo written by Cecil Cutting, MD, a founding Permanente physician, there is a clear emphasis on the importance of nutrition. With healthier meals, Cutting hoped to “bring about greater vitality, greater psychological effect and consequently increased productivity.”

In “Ships for Victory,” author and historian Frederic Lane discusses the Maritime Commission’s initiative to improve in-plant feeding at America’s shipyards in 1943. Many shipyards received additional funds to provide more hot meals and make sure workers had access to healthy food in the workplace. In the Kaiser Shipyards on the West Coast the emphasis on good nutrition even spilled over into the Kaiser-run child care centers where children were fed three square meals, and mothers could pick up prepared meals when they collected their children at the end of the work day.

After the war when Kaiser established a health plan open to the public, nutrition and prevention were among the core principles. “Kaiser health planners supported concepts of holistic preventive care,” writes Rickey Hendricks in “A Model of National Health Care: The History of Kaiser Permanente.”

A focus on healthy food comes to Kaiser Permanente hospitals

Nutrition education was big in the WWII Kaiser shipyards, as highlighted in this poster created in 2009. Design by Pam Zachary, KP Multimedia Department.

A 1972 article from the publication “Institutions/Volume Feeding” highlights Kaiser Permanente hospitals’ progressive commitment to providing patient meals with higher nutrition at a lower cost.  Hospital dieticians were consulted so that every meal had optimal nutrition and calorie content for a patient’s needs. Kaiser Permanente even began to serve meals with an accompanying pamphlet that explained the nutrition information of the meal so that patients could “begin to learn more about the foods that they eat” while in the hospital.

Quality nutrition was at the center of meal planning, and administration felt that when it came to cost “it was of the utmost importance to separate patient feeding from other food-service activities necessary in a hospital.” While the development of an efficient system came about slowly, Kaiser Permanente never strayed from a focus on the healing power of healthy meals.

Oakland: an epicenter of progressive food movements

In my thesis research on the bay area, I was surprised to find that the city of Oakland has also long been a center of progressive food movements. In the 1970s, the Black Panther Party provided a free breakfast program and other “people’s community survival programs” in Oakland, serving residents hot meals with a side of political activism.

The effort of the Black Panther Party members to address hunger in their community was seen as revolutionary and empowering. Soup kitchens and free breakfast programs drew attention to the fact that the local food system was not currently meeting the needs of the West Oakland community. In “A Panther is a Black Cat,” (1971) author Reginald Majors explains that rather than wait on city officials, residents intended to subvert the power dynamic of the community by taking matters in to their own hands.

The free breakfast program for school children went hand in hand with revolutionary ideals and food became an expression of political power. Majors explains, “The Panthers would be betraying their own beliefs by not pushing a little political orientation along with the grits, bacon, and eggs” they dispensed each morning.

Today there are several West Oakland farmers markets in action that echo these themes of racial empowerment. My thesis focused on several of these markets, like “Mo Better Foods” and “Phat Beets Produce,” which provide both locally grown food and social empowerment within a community many residents believe to be historically disenfranchised.

Kaiser Permanente’s continued progress and inspiration

Given Kaiser Permanente’s nutritional history coupled with Oakland’s revolutionary food movement past, Joel Salatin could not have delivered his somewhat radical message to a better group in a better location. Kaiser Permanente initially focused on healthy food in hospitals, and then on bringing local, sustainable food to the community through the Kaiser Permanente farmers markets in Oakland.

What follows logically is a bridging of those two ideals: bring even more local and sustainable food in to hospital meals. Kaiser Permanente hospitals already bring in over 600 pounds per week of sustainably grown vegetables on patient entrée plates at 21 Northern California Kaiser Permanente Hospitals, and Salatin hopes his talk will encourage them to expand that trend and do even more. When he visited Oakland in January, Salatin said:

“The idea of bringing local food right into the façade of a hospital — there couldn’t be a better match. . . If anyone should lead the way in bringing this nutrient-dense food, food that heals people, heals the soil, heals communities, it should be the hospital. Every sphere of its existence should be healing.”

*Grace Emery is an intern with Kaiser Permanente Heritage Resources. She is a graduate of Whitman College in Walla Walla, WA, and is pursuing a career in public health.

**Grace Emery, “‘Feeding Ourselves’: Power and Participation in West Oakland Food Movements.” Senior Political Science thesis for Whitman College. Winner of the 2010 Whitman College Robert Fluno Award for Best Politics Thesis.

For more about Joel Salatin’s visit to Oakland Kaiser Permanente, http://xnet.kp.org/newscenter/aboutkp/green/stories/2011/021511joelsalatin.html

To learn more about Kaiser Permanente’s green programs:

http://xnet.kp.org/newscenter/aboutkp/green/factsheets/healthyfood.html

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Iron nurse Dorothea Daniels had a soft spot for nursing students

posted on March 21, 2011

Daniels at right, Lisker second from right, 1950 Permanente Foundation Nursing School capping ceremony in Oakland, California. Note Daniels' Phillips Beth Israel cap.

By Ginny McPartland
Heritage writer 

Read almost anything about Permanente Foundation School of Nursing’s first long-term leader Dorothea Daniels, and a caricature of a stern, tough-shelled, by-the-book and proper nurse comes to mind. Daniels, a product of New York, rattled her students, nurses and many physicians with her exacting demand for perfection in all things related to patient care and protocol.

She made the nurses work and study hard in restrictive conditions and she didn’t hesitate to correct a physician who displeased her. “She came from a different cut of cloth,” wrote John Smillie, MD, in his history of the Permanente Medical Group. “She regarded herself, and I think quite properly, as a peer of any of the doctors she was dealing with.” 

Migrating to California from New York City after the war ended in 1945, Daniels brought to Permanente her solid education (a doctorate in education from New York University) and experience running a nursing school in that city. From 1936 to 1945, Daniels was the director of the Phillips Beth Israel Hospital School of Nursing. 

Daniels imposed strict rules for student lifestyle

Not unlike other nursing schools of the time, Phillips stressed the students’ need to conform to strict standards of behavior, dress and health habits. House mothers hovered over the students to make sure they didn’t misbehave. “Nurses were not permitted to marry while in training, and subsequent marriage was grounds for instant dismissal,” according to the school’s current Web site. 

At Phillips, nursing students worked six days a week and curfews were rigorously enforced. Pupil nurses were disciplined if they stayed out all night. “Dress inspections took place in the dining room, and students were weighed once a week to make sure they did not ‘get too heavy’ since there was a professional necessity for nurses to ‘look well.’ 

Kaiser Foundation School of Nursing in an old hotel building on Piedmont Avenue near the Oakland hospital, 1948 to 1976

“Hospital director Daniels insisted on student nurses who looked healthy and fit, believing that if students were overweight, they could not work hard and take care of patients,” the school historians reported. “There was concern (during the 1930s) that nurses did not get enough exercise and recreation…’” 

Daniels gets support for her view of fitness in a textbook for orienting student nurses in the 1930s: “Curative medicine gives place to preventive medicine, so must (the nurse) be prepared to understand and apply intelligently the principles of prevention…“The nurse of the future must exemplify health, and teach it. Humanity is ready to cast off sickness.” 

Encouraging nurses to spend leisure time wisely

In 1940, Daniels embarked on a study to assess Phillips students’ leisure time activities, including physical activities. “What Ninety Girls Like to Do in Their Free Time,” authored by Daniels, was published in the National League of Nursing Education publication. A softer side of Daniels emerges in her discussion of the study results. 

“These young women (19 to 24 years for age) have developed abilities of discernment and judgment in their avocations as they develop in the school. While they are learning to assume increased responsibility, they seem to be learning how to spend their leisure time more wisely,” she wrote. She said many subscribed to a professional nursing journal, and “The most thorough inspection of the nurses’ quarters never reveals magazines of the ‘true story’ category.” 

The survey results conclude that the younger girls are spending an average of six hours a week on exercise and the older girls 7.3 hours. “Within a short walking distance there is a tennis court, a swimming pool, a roller skating rink and bicycle-riding areas. “Little equipment is necessary. Sport dresses are the only necessary paraphernalia for hiking, bicycle riding, and roller skating…these types of exercise are easy to learn and give one a sense of well-being and feeling of grace,” Daniels wrote. 

Once the anonymous surveys were compiled, Daniels returned them to the students and asked them to send them back with identification so she could: “aid in fulfilling the wishes stated on the papers. We found it possible to send some students to their first legitimate play; and some 25 were sent to concerts. Our physical education director was instructed to work out her program to include activities for which there were expressed preferences.” 

Bringing her ideals to California

Permanente Foundation Nursing School graduation 1951. Dorothea Daniels at far left, Clair Lisker, third from right.

When Daniels came to California, Permanente Foundation hired her as director of nursing in the Oakland hospital. That position grew in 1948 to include the job of director of the nursing school established in 1948. As expected, Daniels incorporated into the school policies many of the ideas she had adopted in New York. 

The first Permanente School of Nursing student handbook, developed in 1948, prescribed the dos and don’ts for students to get along well at the school. “Your ability as a nurse is reflected in the way you keep your room…Students must be in their own room at 10 p.m., and all lights will be out at 10:30 p.m…Guests may be entertained only in the living room between 8 a.m. and 10 p.m. (Exceptions were made if a mother came to visit.) 

“Pre-clinical students will be in the residence at 8 p.m. each day, Monday through Thursday, unless otherwise specified by the director of nurses…Your window shades will be kept drawn at night when the lights are on…Every student is expected to be adequately clothed when going through the halls…Students are expected to be tidy and well groomed at all times…The conduct of the student nurse on and off duty must be such as will not reflect discredit on herself, her chosen profession, nor her school.” 

In a 1961 nursing school report, a revised philosophy of the school was detailed. Revisiting the fitness theme, one stated role of a successful nurse was: “A teacher of healthful living.” A decade later, the Kaiser Foundation Nursing School brochure stated under Personal Qualifications required for admission: “General appearance is one of the considerations in the selection of students. Applicants must weigh within normal limits of the range established for height and structure.” 

Daniels helped students pursue bachelor’s degree

Daniels, at left, as a hospital administrator. Daniels was the first woman to serve as a hospital administrator in the Kaiser Permanente health plan.

Daniels left the school in 1953 to become administrator of the Los Angeles Permanente Foundation Hospital, making her the health plan’s first woman hospital administrator. She later returned to Northern California to take over as administrator at San Francisco Medical Center. Clair Lisker was one of Daniels’ early students who rose within KP hospital nursing administration. In a 2002 oral history, Lisker credits Daniels with “paving the way for all of us. She was in San Francisco, and she was at Sunset in Los Angeles, two major facilities. 

“She was a tremendously powerful woman, intellectually. I don’t ever remember seeing her sit down,” said Lisker. Daniels encouraged her best students to earn a bachelor’s degree in addition to an RN degree, believing that a well-rounded education would ensure a promising future. Lisker was one of those students. 

“Dorothea was encouraging me to go and enroll in Holy Names College in Oakland, which was then down by the lake (Merritt) where the Kaiser building is now,” recalled Lisker. “She wanted me to get the basics, like English 1A and 1B, and whatever else I needed, philosophy…I basically said: ‘I can’t afford it…she said ‘well, what I’ll do is I’ll pay your fee, and I will get reimbursed. I’ll take $5 out of your allowance (stipend) every month.’ ” Lisker remembers $5 being deducted from her stipend once but doesn’t believe Daniels ever claimed the rest of the $30 advanced ($10 per course unit). 

Kind, generous and impeccably dressed

“She was very kind and generous to those student nurses, and for a good student she would find scholarship money for that young lady to go on to get a degree, so (the student) would become a leader in nursing,” Smillie recalled. Avram Yedidia, a health plan leadership pioneer, said of Daniels: “Her dedication to patient care was as unblemished as her uniform, which miraculously never wrinkled.” 

“She wore these white starched uniforms with a little pointy hat with a black band, and a little pleated organdy cap on her head,” Lisker recalled, noting the cap was from the Phillips Beth Israel school. Daniels’ penchant for a proper nurse’s uniform was no doubt formed in her early years in New York. While she was at Phillips, student nurses were required to adhere to strict dress standards. 

The Phillips Web site: “Students wore black stockings, long sleeves, bibs, aprons, ankle length blue-check dresses, tight cuffs and a bishop’s collar. During the senior year, what was black became white: socks, stockings and dresses became the uniform of the professional nurse. Students wore no caps until the senior year.” 

To make sure they got the uniform right, the administration consulted etiquette expert Emily Post on the proper attire for student nurses on an outing. “Hats and gloves were de rigueur on field trips,” Phillips historians reported. 

The memory of Dorothea Daniels, who passed away in 1968, will always be of a woman to be reckoned with. Lisker summed it up: “Dorothea’s (attitude) was: ‘I’m in control. I’m in charge’…But she also had her other (tender) side, which she didn’t display very often…She loved her dog. She brought (Snuffy) to work every day, and the dog slept in a drawer in her desk…She was a wonderful lady, but she was a character.”

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19th century Fabiola ladies championed health care for all

posted on March 6, 2011

Fabiola Hospital in its heyday

By Laura Thomas
Heritage correspondent   

Kaiser Permanente Oakland stands today on one of the busiest intersections in the city, destined to bustle even more with the new medical center rising in place of the MacArthur-Broadway indoor mall.   

What many may not realize is that the groundwork for the Kaiser Permanente complex was laid – both literally and figuratively – in Oakland’s early years by a group of high society women of the Fabiola Association.   

In 1887, it was at that same corner, then New Broadway and Moss Avenue, on 2 ½ acres of land covered with oak, eucalyptus and locust trees donated by Anthony Chabot, that the Oakland Homeopathic Hospital and Dispensary constructed a splendid turreted Victorian building. They named it the Fabiola Hospital after a wealthy woman who built a public hospital in 4th century Rome.   

It looked more like a railroad baron’s mansion than what we might think of as a medical building, but it was in line with what those 19th century matrons thought was best for sick people – an environment that was home-like and comforting.   

Privileged women strive for underprivileged

Bucolic setting of original Fabiola hospital

The group had been organized by Kate Kirkham 10 years before. She witnessed a carriage accident and was horrified to learn the victims would be taken 10 miles to a San Leandro hospital, the nearest hospital at the time. She collected $50 donations from 18 women of her circle – local water developer Chabot was a friend of hers – and opened the group’s first facility on Market Street.   

They formed the Fabiola Association to support their work, which focused on providing medical care to anyone who needed it. In its early years, the association members were proponents of homeopathic care.   

Once the hospital went up, the association members established a nursing school that accepted men (an oddity at the time), a diet kitchen, and a visiting nurse service. They began a program of expansion that didn’t abate until the Great Depression hit in the 1930s.   

Fabiola grew to meet community needs

Interior of maternity cottage late 19th century

Fabiola’s expansion was much like the evolution of the modern-day Kaiser Permanente’s complex. Before 1900, Fabiola annexed a Queen Anne-style cottage to the main building for the nurses’ quarters, and then added a facility for children and a maternity “cottage.” Over the following 20-plus years, the hospital spread across Broadway with the takeover of a Red Cross facility and the building of a graceful Spanish-style nursing home designed by Julia Morgan.   

A new surgical building went up in 1907 along Moss Avenue and Howe Street. The final spate came in 1923, accompanying a building boom across the city, when the Fabiola ladies built another nurses residence at 3797 Piedmont Ave., with a tennis court.   

The year ended with the completion of a modern 50-bed maternity hospital at the corner of Moss Avenue and Broadway appointed with, according to the Oakland Tribune, “antique walnut, rich rugs and cretonne hangings.”   

The much-touted maternity building, you may realize, became home to the first Kaiser Permanente hospital in 1942. But there’s more to this story.   

Both Kirkham and Kaiser dreamed of better access to care

The Kaiser Foundation Health Plan’s mission is built upon the work of earlier generations that saw providing adequate health care as a duty of the society. And people of means often took it on as their personal mission. Henry Kaiser was inspired to set up the Kaiser health plan by his mother’s untimely death, much as Kate Kirkham was prompted by the suffering she witnessed in the accident.   

In the progressive era, women across the country started hospitals and clinics for women, children and the poor. The Fabiola Association was part of the trend. Members insisted in their by-laws that the hospital be managed by women and that the staff doctor always be a woman.   

Fabiola maternity hospital circa 1924

They were privileged women with feminist instincts who financed their work by staging endless parties, teas, rummage sales and a big horse racing event that were covered in detail – down to the gowns each woman wore – in the Oakland papers. Reading between the lines of the Tribune, Herald and Post-Enquirer provides an insight into the social mores and strict sense of personal duty of a century ago.   

Society ladies took care of working nurses

The Fabiola women were fiercely devoted to the welfare of the nurses. In 1902, they were encouraged by the board president to take turns sending their carriages out “at 8 o’clock in the morning to take the night nurses out for an hour or two driving in the quieter parts of our suburbs” to help them relax before going to bed.   

There were power struggles among the ladies who served on the Fabiola board and at least one strike by nurses which necessitated the matrons’ heading over to the hospital to hoist the bed trays up from the kitchen. They were also taken to task by local ministers who berated them for raising money through gambling, with the Fabiola Derby Day at the Oakland Trotting Park.   

Again, owing to their social status, such criticism didn’t stop them. “Oakland’s most exclusive dames are members of Fabiola and they are indignant over Rev. Baker’s strictures,” reported the Tribune in June 1904.   

Each year, the Fabiola Association issued their service statistics. In 1900, they saw 871 patients of which 619 were hospitalized. Of those, only 131 paid the full hospital charges, the rest paid nothing or just what they could afford. By 1930, the hospital saw 4,753 patients, of which 517 received free care.   

Unfortunately, the good works wrought by the Fabiola ladies soon came to a crashing halt. Hard times reduced paying customers and donations dried up. The hospital closed in October 1932. The Tribune’s headline was “Fabiola Ends Experiment in Feminism” and editorialized that the regret felt by Oaklanders for its loss “was akin to grief.”   

Original architectural beauties demolished

Early the following year, the glorious original hospital – a building that would qualify for landmark status had it survived – as well as the children’s annex, nurses home, and the surgical building were all razed. The new maternity hospital was saved in hopes the operation could be resurrected.   

Instead, the Fabiola Association turned over all its assets to Samuel Merritt Hospital in 1940 with the stipulation that it be used for those unable to afford hospital care, and the women went to work for another decade to aid that effort. The real estate, including the hospital, was estimated at a $75,000 value.   

Fabiola maternity hospital renovated and reopened as the first Permanente Foundation Hospital circa 1942

The hospital was considered still quite modern with its reinforced concrete construction, and Henry Kaiser and Dr. Sidney Garfield were quite pleased to find it in 1942 when they were running out of room to treat shipyard workers at the Richmond Field Hospital. They paid $333,000 for the land and renovations and reopened it in August.   

The Fabiola building served as the core of the original Kaiser Permanente complex during the war and early days of the public health plan. Many additions and renovations on the site characterized Oakland’s flagship facility’s growth over the past 65 years.   

At one time, the Fabiola was painted pink, Henry Kaiser’s favorite color, and in its last iteration was encased in aluminum, one of Kaiser Industries’ main industrial products. The 1923-built, four-story building was torn down in 2005 as part of the Oakland Medical Center rebuild project currently under way.   

Kaiser Permanente carries on Fabiola’s original mission

Few Oaklanders remember the old hospital now, though scores were born in the homey maternity cottage, including my father in 1920. The new Fabiola building on Howe Street is the last reminder of that “institution of real Christian socialism” – as defined by its president Mrs. J.P.H. (Catherine) Dunn at its closing – that was the original Fabiola.   

If in later years Henry Kaiser was accused of being a “socialist” for putting forth a prepaid, group health plan, he stands shoulder to shoulder with Kate Kirkham and her successors in realizing his shared humanity with those in need but without means.   

One hundred and thirteen years separate the pastoral beauty that surrounded the 19th century Fabiola Hospital from the current scene: pavement, numerous traffic signals and striped crosswalks that knit together Kaiser Permanente’s modern complex. But the legacy of thoughtful health care and community benefit is what abides.

For more about Kaiser Permanente’s community benefit programs, go to http://tinyurl.com/4fcswsh

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Henry J. Kaiser in Modern Healthcare’s Health Care Hall of Fame

posted on February 7, 2011
By Bryan Culp

Director of Heritage Resources

Henry J. Kaiser, inducted into Health Care Hall of Fame

Henry J. Kaiser (1882-1967), the co-founder of Kaiser Permanente and a titan of industry during the first half of the 20th Century, has been inducted into Modern Healthcare’s Health Care Hall of Fame for 2011.

Along with Sidney R. Garfield, MD (1906-1984), Kaiser was a champion for a new kind of health care system in a period when prepaid, group practice was not accepted by the American medical establishment. “He is greatly restless and restlessly great, one of America’s last real Horatio Algers,” the Oakland Tribune and Parade magazine said of him in 1958.

“I am very pleased to hear that my grandfather, Henry J. Kaiser, has been selected as one of Modern Healthcare’s 2011 Hall of Fame inductees,” said Kim J. Kaiser of the Kaiser Foundation Health Plan and Hospitals Board of Directors.

“Henry Kaiser created many successful businesses during his life, but he was most proud of Kaiser Permanente. It is fitting that he join 1988 Hall of Fame inductee, Sidney R. Garfield, MD, since it was the partnership between an entrepreneur and business leader, and a dedicated and innovative physician which created the Kaiser Permanente prepaid, integrated health care model. Henry Kaiser and Sid Garfield would be pleased to see how their partnership continues today.”

Henry Kaiser in good company in Hall of Fame

Modern Healthcare and the American College of Healthcare Executives created the Health Care Hall of Fame to honor men and women who have made outstanding contributions to the health care industry. Prior to this year’s inductees, 87 health care visionaries and innovators had been inducted.

Among those 87 are Sidney Garfield, MD, who was inducted in the hall of fame’s inaugural class in 1988. Other honorees include American Red Cross founder Clara Barton (1993), chairman of Johnson & Johnson Robert Wood Johnson (1990), former U. S. surgeon general C. Everett Koop (1997), and Massachusetts Senator Edward “Ted” Kennedy (2010).

At age 75 when Henry Kaiser’s industrial empire was at its zenith, the builder of some of the 20th century’s iconic bridges, dams, ships, airplanes, and automobiles said, “Of all the things that I’ve done, I expect only to be remembered for my hospitals.  They’re filling the people’s greatest need – good health.”

Health plan has roots in Great Depression

With Sidney Garfield, Kaiser forged Kaiser Permanente out of the challenge to provide Americans quality medical care during the Great Depression and World War II, when most people could not afford to go to a doctor.

The health care program that today bears his name emerged in all but name in the late 1930s when Kaiser was establishing his reputation as the builder of the great dams of the American West – Hoover, Bonneville, and Grand Coulee. In 1938 he partnered with Garfield to provide health care for his workers at the remote Grand Coulee site in Mason City, Washington.

Garfield had earlier successfully experimented with prepayment in a five-year industrial medical care program in the deserts of southern California.  Prepayment took the form of a modest, affordable, payroll deduction that spread the cost of care for the injured and ill over a large number of healthy people, and it ensured a stable income by which a medical care operation could meet expenses.

Workers’ health paramount to Kaiser

Garfield’s ideas resonated with Kaiser who viewed the experimentation as needed in those economically challenging times to find ways for people of modest means to obtain health care. Garfield remembered their first meeting – what he thought was to be a routine job site inspection – this way:

“To my surprise, he seemed more interested in the welfare of his workers, in the medical care program that we were developing for them, than he was in the progress of his job…. He spent the whole day going through our facilities, discussing our plans and questioning me on all the details of the operation … how we had developed the plan and what the principles were, and how and why it worked….”

“By the end of the day I felt like I had been vacuumed and completely drained of all information I knew about medical care.  When we had gone about as far as we could go … he said, ‘Young man I think you have a plan that should be made available to everybody in the country.’”

“From that time on we were bound together by this common belief and interest in developing our health plan,” Garfield said.

Core principles of health plan

The two health care pioneers founded Kaiser Permanente on the principle of prepayment that spread the cost of care over a large number of healthy people, and provided stable revenue for medical care, clinical research and education to enhance the quality of care. 

Prepayment triggered best practices in the prevention of injury and illness, to the betterment of workers’ lives and to the improvement of health care finances.  With the cost barriers removed, the ill presented earlier for treatment establishing a true practice in preventive care, the early detection of disease, and the emergence of lifestyle medicine to maintain health and enhance the quality of life. 

Multispecialty group medical practice maximized physicians’ abilities to care for patients through doctor-to-doctor consultation, through the training and mentoring of young physicians, and through the inherent quality controls built into the group. 

Facilities under one roof brought the doctors’ offices, laboratories, pharmacies and hospital all within proximity, reduced costs through economy of scale, and most effectively utilized the time of both physicians and patients. 

This is Henry Kaiser’s ninth inclusion in lists of hall-of-fame honorees, including the U.S. Labor Hall of Fame in Washington, D.C., where he was honored in 1990, and the California Hall of Fame in 2009.

Henry J. Kaiser was known in every American household for his renown as a builder and as the “patriot in pinstripes” that revolutionized shipbuilding during World War II.  Click on the video to see his appearance on the TV classic, “What’s My Line?” in September 1957.

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Health care coverage for workers’ families didn’t come easy

posted on January 16, 2011

By Ginny McPartland 

Affordable health care was an elusive commodity in 1930s America. Medical practice was becoming more sophisticated, and qualified doctors were in great demand. Consequently, private professional care was out of reach for many Americans. Employer-sponsored health plans started to spring up in the late 1930s and early 1940s, but even those progressive prepaid plans were slow to add workers’ families to the coverage.  

In 1944, during World War II, the issue of family health care reached a critical point on the West Coast. War industry yards and plants were frantically producing ships, aircraft, tanks and other war materiel; thousands of migrant workers and their families flooded rapidly expanding communities. Many workers were sick when they arrived, and many became injured as they worked at breakneck speed to meet production deadlines. 

Permanente medicine, developed by industrialist Henry J. Kaiser and enterprising physician Sidney Garfield, was launched to take care of workers in Kaiser’s West Coast shipyards. The two had done this before: Garfield had set up a prepaid plan for workers on the Los Angeles Aqueduct project in 1933, and he and Kaiser had teamed up to care for workers at the Grand Coulee Dam in Washington state in the late 1930s. 

The Kaiser-Garfield prepaid, group practice plan for shipard workers was progressive and exemplary by all accounts. Unlimited medical care for the individual workers was provided for 50 cents per week. But Garfield and his doctors had their hands full, so initially only the worker – not the family members – was covered by the health plan. 

Young patient seen in Fontana Kaiser Steel plant clinic

Stuart Lester of “Medical Economics,” writes in the February 1944 issue: “The principal threat to the permanence of the Permanente Foundation – which provides virtually unlimited medical care for 130,000 Kaiser shipyard workers in two states* is the workers’ complaint that it makes no provision for their families.” 

The article continues: “The family problem is especially acute in the shipyard town of Richmond, Calif., where the ratio of physicians to population is something like 1 to 4,000 and where the only hospital facilities of any consequence are those provided by Kaiser’s Richmond Field Hospital.” 

In Richmond, Portland (Oregon) and Vancouver (Wash.), nonsubscriber family members were treated for a fee.  Office visits were $2.25. For maternity, $200 covered prenatal care, delivery, hospitalization, C-section if required, postnatal care, and care for the newborn. Employees at the Kaiser Fontana steel plant in Southern California were the exception. In 1944, Fontana workers could purchase complete coverage for a family of four for $1.80 a week. 

Physicians debate how to cover families 

“Medical Economics” writer Lester refers to three possible solutions proposed at the time: an expansion of the Permanente plan to include family members; an expansion into the Richmond area by the California Physicians’ Services (CPS) prepaid plan as operating in other war industry communities; or the development of a prepaid arrangement for families through a private physician network. 

The California Medical Association (CMA) launched the CPS in 1939 to offer prepaid care to low-income families in California. Initially, the physicians association’s plan offered a “full coverage contract” that included all outpatient physician services. In 1942, CPS excluded the first two doctor visits from coverage to make the plan financially viable, according to the April 1943 issue of the CMA’s “California and Western Medicine.” In 1943, CPS, the precursor to Blue Shield, had 39,000 commercial members, 5,100 government rural health program subscribers and a total of 32,000 war housing resident members in Vallejo, Marin, Los Angeles and San Diego. 

Permanente Richmond Field Hospital

“Dr. Sidney R. Garfield, Kaiser’s medical director, sees two obstacles to an extension of his program to include families: One is opposition by the local medical societies. The other is lack of facilities – particularly in the hospital at Richmond,” Lester wrote in “Medical Economics.” The article noted that expansions of the Richmond Field Hospital and the Permanente Foundation Hospital in Oakland were under way. 

The second proposal – having CPS provide family coverage for Richmond area workers – had been tried previously and failed. In 1942, CPS  had offered a family plan in nearby El Cerrito and was not able to attract enough members. The coverage for non-Kaiser workers was enticing: a $5 flat fee no matter how many family members. It wasn’t practical for Kaiser employees, however.  To take advantage of the CPS plan, a worker would have to buy his or her own coverage for $2.16 a month and then pay $5 for the rest of the family. 

According to the “Medical Economics” article, solving of the family care issue by fee-for-service doctors was doomed from the beginning.  A shortage of private doctors and inadequacy of medical facilities made any such plan unfeasible.  Also, California private practice physicians were admittedly just tolerating the Permanente model of prepaid, group practice with salaried physicians. One private doctor told the magazine: “The Kaiser-Garfield groups are doing a job right now that is aiding the war effort, and are doing it well. But we don’t like their system.” 

Kaiser extends coverage to shipyard families 

In the spring of 1945, the Permanente medical plan, now with expanded facilities to accommodate more members, was extended to the families of all Kaiser shipyard workers. “Medical Economics” reported the details of the Permanente family care plan: for $117 a year ($2.25 per week) for a family of four, coverage was extensive. It included 111 days of hospitalization, complete diagnostic services, necessary drugs, physician services at home or medical office, major and minor surgery, and ambulance service within a 30-mile radius. Members paid an extra charge of $60 for comprehensive maternity care, $15 for a tonsillectomy and $2 for a house call. 

“Medical Economics” concluded the article with this statement: “Insurance men pointed out that the total annual cost for a family of four, $117 a year, is an amount which has generally proved to be too high for any wide participation on a voluntary basis.” 

Workers who left the shipyards could maintain coverage for a “slightly higher” premium as long as they continued to live in the service area. This retention provision foreshadowed Kaiser and Garfield’s plans to keep the Permanente medical care plan alive after the war industries shut down. 

*Kaiser shipyards health plan actually took care of workers in three states, California, Washington and Oregon, and enrolled up to 190,000 members at the peak of the war.

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Laid-off shipyard workers dilemma: Should I stay or should I go?

posted on December 22, 2010

By Laura Thomas    

(Second of two articles)     

Lon Van Brunt Kaiser Richmond Shipyard worker 1945 from "Fore 'N Aft" newsletter

As the holiday season of 1945 approached, Kaiser shipyard workers faced an uncertain future on the West Coast. Interviews with workers in the “Fore ‘n’ Aft,” the Richmond shipyard newsletter, reflected some anxiety: “What do I think about the end of the war?” said laborer Lon Van Brunt. “Let’s study about that: I look for it to be hard times.”  

The local press reports, often tinged with sentimental hope, insisted that the Dust Bowl migrants were tossing mattresses back on their cars, packing up pots and pans and leaving wartime housing in droves.  

“Many couldn’t wait to get ‘back home’ after the war, but they found they didn’t like it back there anymore,” said native Richmond resident Marguerite Clausen in 1985 in an interview conducted with Judith Dunning for the Bancroft Library’s Regional Oral History Office. “They turned around and came back again. And they brought all their families with them.” *

Bernice Rarick, Portland shipyard worker, 1945, from "Bosn's Whistle" newsletter

Bernice Rarick, a Portland worker reflected that ambivalence when she told the “Bosn’s Whistle,” the northwest Kaiser shipyard newsletter, she was going right back to her ranch in Idaho yet wondered, “It doesn’t seem possible that everyone can go back to normal living again.”    

Transplants try to find their place    

The women were the first to go despite the fact that some 70 percent in a December 1944 Yard Two survey said they wanted to work. Black migrant workers also struggled to find new employment with the unemployment rate for black men in 1948 about 15 percent, three times the state average.    

“News came over that the contracts were cancelled, and that was it,” recalled Margaret Cathey who came from Iowa and worked as a welder. “You didn’t get two weeks notice or anything like that, no. You were just finished.” She was lucky because she found a job with the telephone company, anxious to hire women operators.    

A welder at the Kaiser shipyards, Willie Stokes earned $10 a day but, after the war, was only able to find unskilled labor at $6 and was unemployed by 1947. “One day you are an essential worker in a vital industry and the next you were a surplus unskilled laborer essential to no one,” he said in an article, “Willie Stokes at the Golden Gate,” by Cy W. Record published in “The Crisis Magazine,” June 1949.    

It took a while for many ex-shipyard workers to find their footing. In an article in “Salute Magazine” in June 1946, writer William Hogan called Richmond, “hangover town” because so many were still living there or had returned in hopes of finding work.    

Mostly from rural areas with ways that seemed backward, these workers and their families had been lifted out of poverty working for Henry Kaiser and were destined to prove themselves, especially to long-time Richmond residents.    

The Richmond Field Hospital continued to serve Permanente patients after the shipyards closed in 1946.

“I said, ‘Well, here these people are. They’re not going to leave here. This is Mecca,’ ” recalled Clifford Metz, a former Richmond school official who had insisted the notion that the migrants would go back was an illusion.    

“I think we went down maybe ten or fifteen thousand people in a short time. Most of them, well, they had learned that they liked it here. Some of them, with the money they had, they could invest. They were not unintelligent people.”    

Selena Foster, who came from Fort Worth, Texas, in early 1944, and her husband, Marvin, were among those with that precise idea.  “My husband said to me, ‘We have no home to go back to.’ We had a little money and we found property was fairly reasonable if you could find something to buy,” she said in 1992.    

The Fosters did make a trip back to East Texas in a shiny new car that made quite an impression on their family, but they returned to Richmond and within months had bought a home on Hoffman Boulevard and 29th Street, one of the first African-American families to do so after the war.    

The uncertainty of that holiday period 65 years ago was soon eased by a postwar economic boom in both the Bay Area and the Northwest. The upturn raised the fortunes of many who arrived back then with little but hope. Over the decades they have become woven inextricably into the cultural fabric of both regions.    

*Marguerite Clausen, “A World War II Journey: From Clarkesdale, Mississippi, to Richmond, California, 1942,” an oral history conducted in 1985 by Judith K. Dunning, Regional Oral History Office, The Bancroft Library, University of California, Berkeley, 1992.

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Remembering our KP history to face the future

posted on December 16, 2010

By Tom Debley 

Director of Heritage Resources 

Debley with 1953 Kaiser Manhattan at the dedication of the new Kaiser Foundation Rehabilitation Center in Vallejo February 2010. The center was first established in 1947.

It’s time for me to say farewell after 15 years with Kaiser Permanente.  The last seven years have been as founding director of Heritage Resources, our history program.  But at the end of the day on Dec. 17, I will head off to new adventures in retirement.  

Do not fear, my able colleagues Bryan Culp and Ginny McPartland will carry on the history work in Heritage Resources!  

So what does one say to many friends, colleagues and Kaiser Permanente history buffs other than good-bye?  

For me, I quote the literary great, Robert Penn Warren: “History cannot give us a program for the future, but it can give us a fuller understanding of ourselves, and of our common humanity, so that we can better face the future.”  

Recently, I was reminded of the importance of this – and a key reason why we maintain a historic archive at Kaiser Permanente.  It came as an inquiry on our History of Total Health Blog from John Herron, a history professor at the University of Missouri, who had read a blog about Rachel Carson and Kaiser Permanente’s environmental history by our intern, Jac Brown.  

Carson’s last public lecture prior to her death was delivered at an October 1963 Kaiser Permanente symposium attended by 1,500 doctors, scientists, medical students and journalists at the Fairmont Hotel in San Francisco.  

Debley is a familiar figure at the Rosie the Riveter/WWII Homefront national park in Richmond. This is from our KP history booth at the annual homefront festival.

This was a year after publication of Carson’s then very controversial book “Silent Spring,” critiqued in 1962 in Time Magazine, which concluded: “Many scientists sympathize with Miss Carson’s love of wildlife, and even with her mystical attachment to the balance of nature. But they fear that her emotional and inaccurate outburst in Silent Spring may do harm by alarming the non-technical public, while doing no good for the things that she loves.”  

Today, of course, Carson’s “Silent Spring” is a classic of the 20th century and she is considered the catalyst for the modern environmental movement.  

Quite naturally, Professor Herron wanted to know why the then vice president, and later president, of Kaiser Foundation Health Plan and Hospitals, Dr. Clifford Keene, invited such a controversial figure to lead off a public service symposium, the theme of which was “Man Against Himself.”  We sent him materials for writings he and other scholars are preparing for the 50th anniversary of the publication of “Silent Spring.”  

And that’s one of two reasons why we have a history program.  One is to share stories of our history with our physicians, staff and communities.  The other is to be here for scholars, museums and others who seek historical insights.  

Debley speaking about his biography of Sidney Garfield, MD, at the Commonwealth Club August 2009. Photo by Joe Paolazzi

I started our Heritage Resources program in 2003.  Professor Herron’s recent question reminded me of the day in 2003 that I first read a one-paragraph item about Rachel Carson’s lecture in a list of “highlights of the year 1963” in an old annual report.  

Immediately, I flagged this event as something around which to begin collecting documents for archival purposes.  Why?  This was a high-water mark that helps illustrate why Kaiser Permanente is a recognized leader in sustainability, because sustainability is important to building healthy communities.  

Today, we have Ms. Carson’s lecture text, copies of the correspondence between her and KP planning for her presentation, and other documentation.  

As a result, we have collected and archived a wide array of historical materials.  A mere handful of these documents illustrate how we stand on the shoulders of other leaders like Rachel Carson:  

  • Founding physician Sidney Garfield was looking for sustainable practices and was recycling in the Great Depression and during and after World War II;
  • It was a Kaiser Industries executive who was among those who founded The League to Save Lake Tahoe in 1957, and coined the phrase seen on bumper stickers and elsewhere to this day: “Keep Tahoe Blue”;
  • Kaiser Steel was pioneering pollution control equipment in the 1950s and 60s – before the modern environmental movement and before the first Earth Day in 1970;
  • In the early 1970s, employees at the Kaiser Permanente Medical Center in Santa Clara, California, formed an Ecology Committee with an objective of teaching employees “ecological common sense”;
  • In the 1980s, employees in Vallejo, California, were honored for reducing energy consumption by half in five years;
  • Today, the efforts continue with Kaiser Permanente adding solar power generation to 15 of our facilities by next summer.  These groundbreaking projects will eliminate purchase and disposal of 40 tons of harmful chemicals and dramatically reduce KP’s use of fossil fuels.

Our commitment to sustainability is but one example of Kaiser Permanente’s mission to improve the health of its members and of the communities in which they live. 

History reminds us, as Robert Penn Warren said, of who we have been, why we are who we are, and where we are headed if we remain true to our values and mission – as individuals and as institutions.

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Kaiser-built 1954 sports car delights today’s collectors

posted on November 15, 2010
1954 Kaiser-Darrin donated to Oakland Museum by retired KP pediatrician Ed Schoen

By Ginny McPartland

When Henry J. Kaiser went into the car manufacturing business in the late 40s, he had big ideas, as he did in all his ventures.  Unlike his many successful start-ups – the most notable legacy being Kaiser Permanente – his foray into the automotive business seemed a failure at the time. He went on to make a success in producing Jeeps, but the economy sedans (the Henry J), luxury and family cars (Manhattan and Special), and the sporty, two-seater Kaiser-Darrin were no longer manufactured after 1954. The small Kaiser Motors Corporation had lost out to the big three: Ford, General Motors and Chrysler.

The happy part of this story is about the Kaiser-Darrin, which is living a charmed life today in the hands of avid collectors.  Earlier this year, a “supercharged,” red Kaiser-Darrin garnered a handsome $220,000 in a classic-car auction in Scottsdale, Arizona. Other Darrins have sold in recent years for $100,000 to $176,000 at the same auction.

One of the first American sports cars, the Darrin has a fiberglass body, sliding doors that disappear into the fenders, a three-position soft top, bucket seats, and a low center of gravity good for cornering. Only manufactured in 1954, the Kaiser-Darrin came in four classy colors –yellow satin, cream, red and light green. To date, only 80 or so widely scattered examples of the Darrin have escaped the junk heap.

Famed automobile designer-to-the-stars Howard “Dutch” Darrin, an on-and-off Henry Kaiser collaborator, developed the prototype of the fiberglass-body beauty on his own and unveiled it to Henry Kaiser as a fait compli. Henry Kaiser was not pleased. He is reputed to have told Darrin the idea was scatter-brained.  But Kaiser warmed up to the idea when his second wife, Alyce “Ale,” piped up: “Oh Henry, it’s the most beautiful thing I’ve ever seen.” 

Kaiser agreed to produce 435 of the stunning vehicle that turned out to vie with the 1954-released Ford Thunderbird and the 1953 and later Chevrolet Corvettes.  These sports cars were America’s answer to British models, such as the Jaguar produced as early as 1948. The Kaiser-Darrin and the Chevy Corvette compete for bragging rights for the first fiberglass body – the Darrin prototype was developed in 1952, and the Chevy Corvette was first shown and produced in 1953.

1954 Kaiser Motors Corporation sales brochure

Fifty to 100 unsold Darrins, touted in the sales brochure as the “the sports car America has been waiting for,” were reportedly left in a forgotten snowy lot in Willow Run, Michigan, during the winter of 1954-1955. Darrin, whose heart was in the Kaiser-Darrin, later bought the abandoned roadsters from Kaiser. He put them in saleable condition and souped up many of them with Cadillac V-8 engines.  A Willys Jeep 6-cyclinder engine was standard in the Darrins produced by Kaiser.

Permanente physicians drive Kaiser cars

The story of the Kaiser automobile intersects early on with the Kaiser Permanente saga.  As a perk of the job, Permanente physicians were given a Kaiser car to drive to work and for their personal use. In the days before 1952, doctors used the company car to make house calls ($5 per visit). The physicians had a choice of vehicles; most chose one of the sedans. But Ed Schoen, MD, a pediatrician who joined KP in 1954, saw the Darrin as an apt ride for a bachelor relocating from Boston to the San Francisco Bay Area.

Schoen had followed fellow resident and friend Cliff Uyeda to San Francisco where Uyeda was a KP pediatrician. Schoen joined KP in Oakland where he worked for 49 years, the longest tenure of any KP doctor. He became chief of pediatrics at the Oakland Medical Center in 1966 and regional director of newborn screening in 1990 before retiring in 2003.

Kaiser-Darrin postage stamp 2005

When the auto manufacturing venture ended in 1955, Kaiser offered to sell the cars to the doctors at bargain prices. The Darrin had originally retailed for $3,600. Schoen got his with 6,000 miles on it for $900. He would drive the unusual sports car exclusively for the next eight years, and he got a lot of attention driving around town. “People used to follow me home from work and ask me, ‘what is it?’” Schoen related. And as a bachelor, Schoen found that girls fancied a ride in the Darrin.

After meeting his wife, Fritzi, who came to the U.S. from Austria in 1958, Schoen took her many places in his cream-colored convertible. “I courted her in that car. . . She liked it,” he said. Ed and Fritzi married in 1960, and it wasn’t long before the Darrin was no longer practical. A daughter, Melissa, was born in 1963, and son Eric came along in 1968.

But Schoen kept the car and drove it to work for many years.  In recent years, he had it restored and preserved it in his garage. He entered it in car shows and won a couple of prizes competing with Ford T-birds and Chevy Corvettes. He also loaned the car for the 50th anniversary of Kaiser Permanente Vallejo and for display during another KP event in Oakland at Mosswood Park. The Darrin was never neglected:  Schoen took it out for a spin almost every weekend.

Rarity has its rewards

After owning the car for almost 50 years, Schoen donated his Darrin to the Oakland Museum in 2004 for the Henry J. Kaiser “Thing Big” exhibit. The Darrin was shown along with a 1953 Henry J Corsair Sedan in the ambitious exhibit that covered Kaiser’s amazing life as a 20th century industrialist and co-founder with Sidney R. Garfield, MD, of the Kaiser Permanente health plan. Today, Schoen’s Darrin is in storage awaiting a new venue.

Schoen was interested to learn about the high bids cast for the $220,000 Darrin in the 2010 Barrett-Jackson auction in Scottsdale. “When I donated mine in 2004 to the museum, it was appraised at $60,000 to $75,000,” he related.  He also noted the differences between his car and the one on the auction block. “The original Darrins did not have supercharged engines. Mine just had the 6-cylinder Willys Jeep engine . . . it was not a high performance car.”

To see a Kaiser-Darrin in action, go to: http://www.youtube.com/watch?v=MBtuXBVBPMY

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Kaiser Permanente’s Commitment to Sustainability

posted on October 20, 2010

by Jacqueline F. Brown 

Kaiser Permanente’s interest in energy conservation and sustainability can be traced back to a time when many considered a concern for the environment to be irrational. However, rather than shy away from this controversy, Clifford Keene, vice president and general manager of Kaiser Foundation Health Plan and Hospitals, placed Kaiser Permanente in the center of it. 

Keene invited naturalist, Rachel Carson, to deliver a public lecture at a celebrated forum after the publication of her widely debated book Silent Spring. Carson delivered the keynote address to a large audience in October 1963 at the Seventh Annual Kaiser Foundation Hospitals and Permanente Medical Group symposium, “Man Against Himself,” held at the Fairmont Hotel in San Francisco. Keene stated that the purpose of the symposium was “to examine the propensity and the ability of man to harm man on a grand scale.”

Rachel Carson, author of Silent Spring

In her groundbreaking book, Carson warned of an environmental and health apocalypse from the overuse of pesticides and chemical pollutants. Though Carson’s book had been roundly criticized in the national press, Kaiser Permanente leadership demonstrated its willingness to engage her and the concerned public. 

In the early 1970s, employees at the KP Santa Clara Medical Center in Santa Clara, CA formed an Ecology Committee with an objective of teaching employees “ecological common sense.” Santa Clara employees launched an initiative in paper recycling, pushed for carpooling and bike riding, and lobbied county officials for better public transportation.

Santa Clara was not the only Kaiser Foundation medical center to initiate environmentally friendly practices. In 1981, employees at the Kaiser Permanente Vallejo Medical Center in Vallejo, CA earned an award for energy-saving efforts. In just five years, the staff at Vallejo reduced energy consumption by 50 percent, even with the addition of a new floor at the facility.

A view of the solar panel roof-top installation at the new Kaiser Foundation Modesto Hospital

Kaiser Permanente is adding solar panels to 15 facilities in California by the summer of 2011, furthering a solar initiative begun in 2008 when KP opened one of the “greenest” hospitals in the country in Modesto, California. The addition of solar panels to these facilities will eliminate the purchase and disposal of 40 tons of harmful chemicals and drastically reduce Kaiser Permanente’s use of fossil fuels.

Kaiser Permanente also recently announced that it will require its suppliers to provide environmental data for medical equipment and products used in hospitals, medical offices and other facilities. Each supplier is required to use Kaiser Permanente’s Sustainability Scorecard, which asks the supplier to provide information on their company’s environmental commitment, use of potentially harmful chemicals in the products, and information about product and packaging recycling. The Sustainability Scorecards not only ensure that Kaiser Permanente is using green products, but it encourages suppliers to create products that are safe for the environment.

In May, many of Kaiser Permanente’s efforts towards creating a healthy environment were honored as 18 Kaiser facilities across the nation were recognized for their efforts in waste reduction and pollution prevention. The awards were given at CleanMed 2010, a global conference for environmental leaders in health care.

Kaiser Permanente’s recent success in reducing waste and conserving energy can be easily explained through its history. While Carson is now considered the leader of the environmental movement, Kaiser Permanente’s forward-thinking leaders recognized the need to hear her voice when many others would not. It is this future-minded planning that has allowed Kaiser Permanente to implement many successful practices that improve the health of the environment.

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Wartime shipyard child care centers set standards for future

posted on September 29, 2010

Naptime for Kaiser kids

By Ginny McPartland
Child care at the workplace was a brand new phenomenon in World War II. The government-subsidized Kaiser West Coast Shipyards nursery schools, which enrolled more than 7,000 offspring of women war workers, offered the perfect opportunity to test theories of the then-fledgling field of child development.

In 1943, Henry J. Kaiser invited key figures in child development studies to his shipyards to set up ideal facilities and programs so workers could build ships without worrying about the safety and health of their children. These model child care centers at the Kaiser shipyards in Richmond, California, and Portland, Oregon, yielded valuable research results that helped fuel the study of early childhood education for decades after the war.

Catherine Landreth, PhD, of the University of California, Berkeley, set up the Richmond schools program. Lois Meek Stolz, PhD, a child development researcher and author from Columbia University and UC Berkeley, set up the Portland centers. James L. Hymes, Jr., a student of Stolz at Columbia, served as manager of the Portland centers.

Stolz and Landreth continued to exert influence on the child development world until the end of their lives. But it was Hymes, just 30 at war’s end, who would become a prodigious contributor to the child development literature for the next five decades. His work is often quoted today. One such quote reflects lessons from the home front: “Every day-care center, whether it knows it or not, is a school. The choice is never between custodial care and education. The choice is between unplanned and planned education, between conscious and unconscious education, between bad education and good education.”

Early Hymes work discovered this summer

Recently, my colleagues and I unearthed the final report of the two Portland Kaiser wartime child development centers, along with a series of seven pamphlets written for postwar child care providers. We found these documents, mainly written by Hymes, in the Institute of Governmental Studies Library in the basement of UCB’s Moses Hall. They were originally filed in 1946 in the Library for Economic Research at Berkeley.

The series of pamphlets includes: 1) A Social Philosophy from Nursery School Teaching; 2) Must Nursery Teachers Plan? 3) Who Will Need a Post-War Nursery School? 4) Meeting Needs: The War Nursery Approach; 5) The Role of the Nutritionist; 6) Large Groups in Nursery School; 7) Should Children Under Two Be in the Nursery School? Two unnumbered pamphlets titled “Toys to Make” and “Recipes for Foods for Children” were also mentioned in the report but copies are not available in the library. Teachers bought a total of 2,582 pamphlets at 15 cents each, according to the report dated December 1945.

Pamphlets offer nuggets

The pamphlet titled “Should Children Under Two Be in Nursery School?” addressed an issue the child care centers were forced to face head-on during the war. Generally, nursery schools did not take children under 2 because experiments had shown the younger children did not thrive in group settings. But the demand for care for infants was too high in the shipyards to ignore. They agreed to accept children as young as 18 months, and in Oregon alone the centers enrolled 904 children 18 to 24 months of age.

“We therefore set out to plan a program which would include among other things: Provision for close and continuous relation of each child with one adult who would be responsible for him especially during eating, toileting and sleeping and during any time of emotional stress when he needed ‘mothering,’ ” wrote Stolz and Hymes.

Good food for good health

Another key wartime lesson: “Food influences behavior. Small children…have pounded into us in unforgettable ways that hungry people are irritable; that they fight more; that they cry easily; that they become destructive…Some children we have seen, hungrier still, have told us that hunger can make people placid, inactive, lethargic,” Hymes wrote. In pamphlet 5, Miriam Lowenberg, chief nutritionist, discussed the crucial link between food and good health: “The (nursery school) nutritionist (helps) teachers … bring the child who needs medical care to the attention of a visiting nurse or doctor.”

The final report discussed other crucial issues such as: the need for child care services after the war for low-income women, costs of the child care operation including nourishing meals, methods of recruiting and retaining qualified teachers, nurses and counselors, providing weekly onsite professional development, and offering opportunities for staff to participate in policy decisions. Attempts to maintain a 10:1 child-to-teacher ratio for the children over 2 and a 5:1 ratio for the infants 18 to 24 months were mostly successful, the authors reported.

Kaiser experts shine on after war

After the war ended, Hymes gained national recognition as an author. Among his earliest best-selling booklets was “A Pound of Prevention” in 1947, which advised first-grade teachers on how to handle difficult “war babies.” He wrote that the “crybabies, whiners and bullies” were still suffering from the disruption of war. Hymes also wrote “How to Tell Your Child About Sex” (1949), “Behavior and Misbehavior: A Teacher’s Guide to Discipline” (1957), “Teaching the Child Under Six” (1968), and “Twenty Years in Review: A Look at Early Childhood Education 1971-1990.”

Hymes served in the Lyndon Johnson administration on the National Planning Committee for Head Start. He and Catherine Landreth both were instrumental in the development of the educational program for low-income children. Landreth was also known for her groundbreaking research in social perception. One of her studies found that children learn racial prejudice from their parents as early as three years old. She wrote three books that were influential in shaping early childhood education: “Education of the Young Child” (with Katherine H. Read), 1942; “The Psychology of Early Childhood,” 1958; and “Preschool Learning and Teaching,” 1972.

After the war, Stolz published “Father Relations of War-Born Children,” a study of how father-child relationships were affected by a father’s absence for war duty (1954); “Our changing understanding of young children’s fears, 1920-1960” (1964), among other related works.

To learn more about the legacy of child care in the World War II Kaiser Shipyards, visit the Home Front festival Saturday, Oct.2, at the Craneway Pavilion on the Richmond waterfront. Kaiser Permanente Heritage Resources is collaborating with Rosie the Riveter/World War II Home Front National Historical Park to tell the story of the wartime child care centers.

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