It was during his high school years, William Foege recalls, that the idea of medicine, service and vocation began wedging together in his mind. The son and grandson of Lutheran ministers, Foege was reading another Lutheran -- Albert Schweitzer -- when a passage from "Man and Man" touched an inner nerve:
No one has the right to take for granted his own advantages over others in health, in talents, in ability, in success, in a happy childhood or congenial home conditions. One must pay a price for all these boons. What one owes in return is a special responsibility for other lives . . . He who has experienced good in his life must feel the obligation to dedicate some of his own life in order to alleviate suffering.
How much suffering Foege has eased or eliminated is not for him or anyone else to measure. All that matters, either professionally or personally, is that at 50 he remains faithful to the original urgings that the Schweitzer passage stirred in his boyhood.
Foege (pronounced fay-gee) went on to earn a medical degree in 1961 from the University of Washington in Seattle. His internship was in a U.S. Public Health hospital in Staten Island. After serving in India as a physician for the Peace Corps and later in Nigeria as a Lutheran medical missionary, Foege returned to the United States and the federal Centers for Disease Control in Atlanta. In 1970, he was directing the CDC smallpox control program, part of the global effort that saw the elimination of that disease in 1977.
The same year, Foege was appointed director of CDC, an agency with 4,000 workers. An idealist but not a martyr, he took six years out front, then voluntarily moved aside to concentrate in international health as a special assistant for policy development -- the position he now holds. The next year, Foege helped organize the Atlanta-based Task Force for Child Survival, which is sponsored by the World Health Organization, the World Bank, UNICEF, the Rockefeller Foundation and the UN Development Program. Foege currently serves as president of the American Public Health Association.
Angular at 6-foot-7 and full-bearded, Foege is married to a pre-school teacher with whom he is raising three sons. One left last week for a summer in Mexico to learn Spanish and absorb a new culture. Foege has the customary array of parental prides about his maturing children, but that one of them is at least summering as an internationalist is a bonus. That is where most of his own professional passions lie.
On two recent afternoons, Foege took breaks from meetings at the APHA's Washington office to discuss his work and his life. In an easy ramble of talk, he ranged from stories of his days in medical school to a recent hiking trip in Utah with the youngest of his sons who is 16. In between, and as part of the same flow of enthusiasm, he bursts out with the statistics and figures which argue that his organization's goal of immunizing all the world's children by 1990 is within reach. "Unusual progress," he says, "has been seen in the last two to three years. The number of children dying of vaccine preventable diseases has gone down from about 5 million a year to 3 1/2 million a year."
Foege has other figures to support his belief that global health care is not the sinkhole it once was: "The number of countries with an infant mortality rate over 150 per 1,000 live births has decreased from 50 in 1960 to 11 in 1983. The median IMR for 130 countries was 137 in 1960 but had fallen to 70 for those same countries by 1983."
Although many younger doctors are interested in continuing this work, Foege says, the international health field is a difficult one.
"There's an unbelievable amount of interest in medical schools for international health," he says, "but there are so few channels for it. There is not a good career ladder, as you would find for neurology or something else. So it takes a truly adventuresome person to be willing to not have a career ladder ahead of him and do this anyway, because what happens to those who go for three years overseas? They come back and they don't fit in. They've lost out on the race. They haven't been able to keep up on the latest things, they aren't part of a program.
"I think it's one of our crucial needs to find a way to use the talent we have in this country for international health and yet bring it back home and let that person go on into something else if he wants to. The Peace Corps is such a nice example outside of medicine. A medical Peace Corps would be a very nice thing to have."
Foege has continued to read Albert Schweitzer, as well as other physicians, like William Carlos Williams, who kept alive their social conscience. About his own philosophy of service, Foege says that "rather than individualize it, I like to talk in other terms.
"The philosophy behind science is to discover truth. The philosophy behind medicine is to use that truth for the benefit of your patient. The philosophy behind public health is social justice. That's the important point. Public health programs are attempts at social justice."
It isn't far from social justice to peacemaking. In Foege's mind, the links between public health, personal service and the works of peace are strong.
"Health is an international language," he argues, "but the implications of immunization programs are beyond health. Peace is more likely in a world of low death rates, of low birth rates, low disease rates than it is in a chaotic world that is in turmoil because of so much suffering.