By Viktoria Beck, MPAff ’24, LBJ School of Public Affairs, The University of Texas at Austin
Most people remember former President Lyndon Baines Johnson as “the Vietnam War president.” There’s no escaping that for LBJ; despite his impressive domestic record, his legacy will forever bear the weight of the war. While LBJ received fair criticism for his Vietnam actions, many have exploited this to paint his entire presidency as a failure, undermining public support for his “Great Society” programs.
LBJ’s legacy is far more nuanced than just “Vietnam and Big Government.” From a public health perspective, he transformed the nation’s health. Perhaps unknowingly, LBJ targeted the root causes of health disparities by addressing the social determinants of health in his Great Society legislation. The health and well-being of Americans would be much worse off without LBJ and the Great Society’s contributions to public health.
The Great Society and the War on Poverty laid the foundation for a preventive approach to public health. According to the American Public Health Association (APHA), this legislation was ahead of its time; modern public health institutions have only recently begun to recognize nonmedical factors, such as racism, socioeconomic status, food access, education, housing, healthcare access, and environmental quality, as profoundly impacting health. Poverty and low socioeconomic status carry risks, including higher infant mortality rates, inadequate nutrition, and a higher incidence of disease and disability. This not only impacts the physical and mental well-being of those who are impoverished, but also results in a high economic cost to the United States every year due to medical costs and lost workplace productivity. LBJ’s Great Society and War on Poverty legislation tackled many angles of health inequity and provided a legislative groundwork for public health improvement today.
Breaking Down Barriers:
- Racial Injustice: The Civil Rights Act of 1964 and the Voting Rights Act of 1965 were landmark pieces of legislation that banned discrimination based on race and expanded voting rights. The APHA highlights how systemic racism results in minorities’ “increased exposure to health-related risk factors, unhealthy stress levels, and feelings of powerlessness that greatly impact the quality of their physical and mental health.” These acts provided a critical starting point for reducing health inequities due to racism and discrimination.
- Income: Under LBJ, Congress substantially increased the minimum wage for several industries in 1966. Raising the minimum wage is a proven way to address health inequity. Studies from APHA show that increasing the minimum wage is associated with declining infant mortality, preventing low-weight births, and even a decline in smoking during pregnancy. LBJ inadvertently prevented disease and saved lives by boosting the minimum wage for millions of Americans.
- Food Access: The Food Stamp Act of 1964 established the food stamp program, the most significant anti-hunger program in the United States. Studies show that inadequate nutrition harms an individual’s future health trajectory. The food stamp program increases food security, improves nutritional and health outcomes among low-income participants, and is linked to reduced healthcare costs. Without it, many would lack access to food, jeopardizing their health and well-being.
Investing in the Future:
- Education: LBJ’s passage of the Elementary and Secondary Education Act of 1965 established the Head Start program, which addresses educational gaps among low-income children. Additionally, the Higher Education Act of 1965 created a federal financial assistance program to expand college opportunities. Education impacts the type of employment and, therefore, income potential, affecting health risk factors. Furthermore, education level is associated with health literacy, which is crucial for navigating the healthcare system and managing chronic conditions. LBJ’s efforts ensured quality education, a key factor in lifelong health for disadvantaged Americans.
- Housing: Higher rates of disease and premature death can be linked to poor housing quality. The Housing and Urban Development Act of 1965 addressed this by expanding funding for federal housing programs, providing rent subsidies, and constructing more low-income housing. Additionally, the Fair Housing Act of 1968 prohibited discrimination in housing, which addressed limited housing options for communities of color who disproportionately face housing-related health risks. LBJ’s housing policies tackled a crucial component of health inequity by providing solutions to a basic public health need.
- Health Care Access: The Social Security Act of 1965 established Medicare and Medicaid programs, providing health insurance to older adults and people with disabilities. Lack of health insurance is a significant barrier to healthcare access and can negatively impact health. The passage of Medicare and Medicaid implemented a critical healthcare safety net for the most vulnerable populations.
- Environmental Quality: Exposures to air and water pollutants during childhood can have a lifetime negative health impact. LBJ made significant strides in environmental protection with legislation like the Clean Air Act of 1963 (the first federal air pollution control act), the Water Quality Act of 1965 (establishing water quality standards), and the Clean Water Restoration Act of 1966 (funding sewage treatment plants). These measures protected public water sources, reduced the risk of waterborne diseases and chemical poisoning, and improved overall environmental quality. Without them, the environment would suffer, essential utilities could be contaminated, and children would face a greater risk of lifelong health problems.
LBJ’s Legacy
LBJ’s efforts to forge a “Great Society” were a tremendous success from a public health perspective. He was ahead of his time with his administration’s focus on social determinants of health. His unwavering commitment halted the perpetuation of intentional structural discrimination and initiated a framework to protect and improve the well-being of all American citizens. He also laid a policy foundation upon which following presidents could build.
LBJ’s legacy extends far beyond the Vietnam War. He was a transformative leader who championed public health through his Great Society programs. By addressing the root causes of health disparities, he ensured a healthier future for generations of Americans.