Biography: Kerr Lachlan White MD, CM, FACP
Kerr L. White was born January 23, 1917 in Winnipeg, Manitoba to a Scottish father and English mother. He grew up in Ottawa, Ontario. His father was a foreign correspondent for The Times of London and The Economist as well as for other British and American newspapers. His mother operated a lending library that emphasized medical topics, healing, and alternative remedies.
White attended public and private schools in Ottawa, Los Angeles, and London, and was a naturalized U.S. citizen as well as a British Subject. Before he attended medical school at McGill University, White studied economics as an undergraduate and graduate student at McGill and Yale Universities, worked in a factory personnel department, helped organize a successful workers’ strike and served overseas in the Canadian Army during World War II.
Internship and residency in internal medicine at Dartmouth College's Hitchcock Clinic and Hospital were followed by a fellowship year at McGill's Royal Victoria Hospital. From there White joined the Department of Internal Medicine at the University of North Carolina, Chapel Hill—the first new post World War II medical school in the Unites States. In 1959 he spent a sabbatical year studying epidemiology and health statistics with Sir Austin Bradford Hill, Richard Doll and Donald Reid at the London School of Hygiene and Tropical Medicine and with Jerry Morris at the London Hospital Medical School.
In addition to teaching and running a private practice that included home visits, White published research while at the University of North Carolina. His studies included:
- Interrelated laboratory, clinical, and epidemiological studies of congestive heart failure
- Psychogenic fever
- Alleged, but non-existent, racial disparities in textbook standards for hemoglobin levels
- Clinical trials of medications for hypertension
- The first study of outpatient medical errors
Increasingly concerned with the adequacy and appropriateness of the outpatient clinic staff’s response to patients’ complaints, White obtained one of the first Hill-Burton Act grants for patient care research. Publications from this large-scale patient referral study included the 1961 New England Journal of Medicine article entitled “The Ecology of Medical Care.” This paper introduced a graph of nested boxes (used as the logo for this collection) to represent the proportion of patients at different levels of care. “The Ecology of Medical Care” also introduced the term and concept of “primary medical care” to American readers. Unbeknownst to the authors at the time, Lord Bertrand Dawson in Britain had introduced the term and concept of “primary health centers” in 1920.
In 1955, a small group of like-minded investigators that included Paul Densen, Sam Shapiro, George Reader, Doris Schwartz, Cecil Sheps, Sydney Lee, Frank Williams and White held periodic meetings to discuss their studies at Cornell, Harvard, New York, Pittsburgh and the University of North Carolina. They established a forum for what was initially called “Patient Care Research” and later “Medical Care Research.”
White was appointed to the National Institutes of Health Hospital Facilities Research Study Section in 1957, and in 1960 the committee succeeded in getting itself renamed the Health Services Research Study Section. As chair of the committee, White led it to commission a series of conferences and publications, to undertake site visits to national and state health care organizations and to establish a tier of diverse grant mechanisms that launched the field of health services research. Among the many participants in these exercises were Carol Buck, Nicholas Demerath, Bob Haggerty, Herbert Klarman, Donald Mainland, John Paul and Ozzie Simmons.
In 1962, White was appointed chair of the Department of Epidemiology and Community Medicine at the University of Vermont—the first to use “epidemiology” as a departmental label. Here he launched the decade-long, seven-country World Health Organization/International Collaborative Study of Medical Care Utilization (WHO/ICSMCU). Other initiatives included the installation of a Hospital Discharge Abstract System in all Vermont hospitals and one of the first studies in the United States of ambulatory care in family practices.
White moved to Johns Hopkins University in 1965 to establish the Division of Hospitals and Medical Care, which later became the Department of Health Care Organization. Projects started in Vermont were pursued, and a generation of young health services research investigators was trained. Subsequently, five became full professors at Harvard—three as department chairs, and several became chairs at other domestic and foreign universities. Most of these were enrolled in the original Clinical Scholars program. For several years White’s department and the Association of American Medical Colleges co-sponsored short courses in health services research for faculty of other universities. As chair of the Health Services Research Study Section and later as chair of the U.S. National Committee on Vital and Health Statistics, White provided leadership that resulted in the:
- Establishment of the National Center for Health Services Research (predecessor to the Agency for Healthcare Research and Quality (AHRQ))
- Initiation of the annual statistical volume Health: United States
- Creation of the National Ambulatory Medical Care Survey (NAMCS)
- Creation of the Hospital, Ambulatory Care and Long-term Care elements of the Uniform Minimum Data Systems
White moved to New York in 1977, where he briefly served as research director for the United Hospital Fund. From 1978 to 1984 he was the Deputy Director for Health Sciences at the Rockefeller Foundation, where he established the International Clinical Epidemiology Network (INCLEN). Since inception in 1978, INCLEN has trained over 800 clinicians, economists, statisticians and social scientists working in some 80 medical schools’ Clinical Epidemiology Units in over 50 countries on six continents—and it continues to expand.
After retiring in 1984 White consulted widely in Australia, China, Europe, New Zealand and North and South America. Over the years he served as president, chair or member of numerous national and international boards, commissions, and councils.
White was an early member of the U.S. National Academy of Science’s Institute of Medicine; was an Honorary Fellow of the Royal Society of Medicine, the National Academy of Medicine of Argentina, Academy Health and the International Epidemiological Association; was elected Boerhaave Professor of Social Medicine at the University of Leiden; and had honorary degrees from the University of Louvain and McMaster University. He received the Distinguished Service Award of the Association for Health Services Research, the Baxter Health Services Research Prize (predecessor of the William B. Graham Prize for Health Services Research), the Curtis Hames Research Award, the Pew Primary Care Achievement Award, the Robert Glaser Award of the Society of General Internal Medicine, the University of North Carolina’s Distinguished Service Award, the Award of Excellence from the National Association of Health Data Organizations and the Maurice Wood Award of the North American Primary Care Research Group. He was an honorary member of numerous other national, foreign and international organizations. He was the author or co-author of some 250 publications including ten books, in the fields of epidemiology, health services, health statistics, primary care, public health and medical education.
White died July 22, 2014 at the age of 97 in Charlottesville, Virginia, where he lived following his retirement from the Rockefeller Foundation.