Voice of the WHI: Peter Jacobson, Professor Emeritus of Health Law and Policy

On June 19, 2019, we sat down with Peter Jacobson, a founding member of the Washtenaw Health Initiative Steering Committee. Jacobson, who recently retired from the WHI and Washtenaw County Health Department governing bodies to move closer to family in Washington, DC, shares his commitment to public health, his history with the WHI, and his hopes for the initiative’s future. 

Q. What originally inspired your passion for public health?
Jacobson. I began my career as a legal services attorney, working on consumer and landlord-tenant complaints on behalf of low-income individuals and families. Then I joined the Office for Civil Rights, in the U.S. Department of Health and Human Services, in Washington, DC. The first folder on my desk was a hospital closure case, and I got hooked on the excitement and challenge of health care issues. From that point on, my entire career has been focused on health and public health. 

It was the late 1970s, and there was a significant trend of demographic shifts from the inner cities–essentially white flight to the suburbs. Inner city hospitals were affected because they were often left with low-income, uninsured patients that led to financial shortfalls. Some inner city hospitals closed, or merged with other hospitals. But a lot of them chose to relocate to follow the population movement to the suburbs. 

The question my office examined was the effect on minorities, and what legal obligations relocated hospitals had to the communities left behind. The Civil Rights laws weren’t designed to cover that kind of activity, so we found we couldn’t legally prevent the closure or relocation of hospitals in most instances. The best we could legally do was require relocating hospitals to continue providing uncompensated services, and sometimes to sponsor a clinic in the older, inner city community.

Q. Which health challenges—disparities, gaps, policies—keep you up at night?
Jacobson. The glib response is almost nothing keeps me up at night. But the most important health care delivery problems for me still revolve around inadequate insurance coverage and inadequate access to primary care physicians, specialists, and appropriate levels of care. That’s not to exclude disparities, or pharmaceutical prices, or consolidation in the industry, or the myriad other problems the health care system faces. In the end though, my real concern is that too many people don’t have access to adequate health care. To a certain extent, the Affordable Care Act has remedied part of the problem–it’s reduced the number of uninsured persons–but everyone knew that it wouldn’t solve all of the problems, and it hasn’t. 

Q. What’s your proudest professional accomplishment?
Jacobson. I think it really is having taught a generation of health management and health policy students. The corollary to that is having established lifelong relationships with many of them. 

I’ve been teaching at the University of Michigan School of Public Health for more than twenty years. Before that, I taught courses at the Rand Graduate School and UCLA School of Public Health. Over my career, I’ve taught hundreds of students. In the classroom, I focused on the key legal issues that health administrators deal with on a day-to-day basis; the legal issues that public health practitioners need to understand as government employees; policy analysis for practitioners; and the whole way in which we deliver health care in the U.S. Outside of the classroom I helped students prepare for interviews, listened to their career goals, and tried to provide input to help them make the best choices for their own personal and professional lives. So I’m proud of whatever role I’ve played in their professional growth.

Q. When and why did you join the WHI, and how has it been helpful?
Jacobson. The initial impetus for the Washtenaw Health Initiative was how do we implement the Affordable Care Act in Washtenaw County. I had been teaching about the Affordable Care Act and following it closely. Participating on the Steering Committee was a natural extension of the work I had been doing with free clinics and other issues related to the WHI’s mission. My involvement was also a link to the academic community. At first, I served as an academic representative, providing a link to the School of Public Health. Along the way, I became an informal legal advisor to the Steering Committee, helping to draft the WHI’s bylaws and principles. I was involved in the discussions about whether the WHI would be a formal organization with a board of directors or an informal one led by a steering committee consisting of representatives from various community organizations. 

Q. Any parting thoughts for Washtenaw Health Initiative leaders and stakeholders–perhaps about your hopes for the future of the WHI?
Jacobson. What do I hope for WHI’s future? First, that we continue our fundamental operating vision and adapt it to new opportunities and circumstances. Second, that we continue to serve as a community-wide forum for the exchange of ideas and as an incubator for new ways of attacking endemic health care problems. Third, that the community perceives us as the key place to go to help develop their own ideas and role in keeping the community healthy. And fourth, that we facilitate the transition to a broader conception of population health.

Moving from the current health care delivery system to a more systematic and effective way of improving the community’s health–not just those with health insurance–is challenging. Our work on the State Innovation Model clarifies the need to address the social determinants of health, rather than just focusing on individual clinical care. Even with the increased coverage after the ACA and Medicaid expansion, individuals, especially those with complex health and social conditions, require help coordinating their transportation, housing, and nutritional needs. All of that is part of keeping communities healthy, reducing disparities, and reducing inequities. 

WHI can’t address everything. But we’ve developed the relationships with community organizations to help develop a strategy to undertake these challenging issues. WHI is well positioned to continue serving as a valuable community resource for building a shared vision to improve the health of all Washtenaw County residents.