Milbank Memorial Fund

History

The fund's history can be divided into five segments: (1) 1905 to 1920, (2) 1921 to 1936, (3) 1937 to 1961, (4) 1961 to 1989, and (5) 1990 to the present. From 1905 until Elizabeth Milbank Anderson's death in 1920, the Memorial Fund Association, as it was then called, worked with officials of government and charitable agencies that served the poor in New York City. Notable projects included constructing public baths on models devised by health officials in Europe; increasing children's access to health and related services; and demonstrating the feasibility of a “home hospital,” residences, and health services for families, one or more members of which had tuberculosis.

Between 1921 and 1936, the fund and its allies in government and medicine addressed major issues in improving access to appropriate healthcare and related services. Its first chief executive, John A. Kingsbury, a veteran manager in city government and charitable organizations, organized multiyear demonstrations of new methods of integrating services provided by the government and charities in New York City, Syracuse, and rural Cattaraugus County, New York. The fund appointed a technical board of prominent health experts to advise and evaluate these projects. This board produced a periodic bulletin evaluating the work of the demonstrations and commissioned a book about each of them. The bulletin, published continuously since 1923, is now the Milbank Quarterly.

The fund addressed controversial issues of health policy between 1926 and 1935. In 1926, for example, it helped organize the consortium of foundations to finance a Committee on the Costs of Medical Care (CCMC). Research reports by the committee's staff are landmarks in the history of health services research. In 1932, however, most of the physician members of the CCMC refused to sign its final report because it recommended the prepayment of healthcare and the reorganization of physicians into large group practices dominated by specialists.

Kingsbury and his staff at the fund advocated including these recommendations, as well as funding to expand access to health services, in the Social Security Act of 1935. The fund seconded two employees to the staff of the cabinet-level committee that drafted what became the Social Security Act. This advocacy increased antagonism toward the fund among critics of the CCMC report in organized medicine. Several medical societies recommended that physicians advise mothers to boycott Borden's condensed milk-an ingredient in infant formula-because stock in that company accounted for a substantial percentage of the fund's assets. In 1935, the board of the fund fired Kingsbury but reaffirmed its commitment to increased access to health services.

During the next quarter century, the fund maintained this commitment but through projects and publications that avoided controversy. Its chief executive from 1937 to 1961, Frank Boudreau, was a public health physician who had joined the new social medicine movement as an official of the League of Nations. He led the fund in conducting and commissioning policy-related research on nutrition, fertility and birth control, and mental health. The fund convened annual conferences addressed and attended by researchers and policymakers. In the 1950s, fund staff helped inform policy on substituting community for institutional care of the mentally ill and facilitated the establishment of the Population Council.

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