Surgeon general for President Carter, Head Start creator

Dr. Julius Richmond, the pediatrician who helped create Project Head Start and later, as surgeon general, issued a 1979 report on the health risks of smoking that led to more informative warning labels on cigarette packs, died of cancer Sunday at his home near Boston. He was 91.

“Dr. Richmond was one of the giants in our field,” said Dr. Renee R. Jenkins, president of the American Academy of Pediatrics. “He was a wonderful role model for pediatric leaders in the U.S. and throughout the world.”

The Supreme Court’s 1954 decision in Brown vs. Board of Education requiring equal access to education inspired Richmond and his colleague Betty Carter to focus their pediatric research on policy as they documented how poverty and lack of educational opportunity affected the emotional and intellectual development of young children.

They showed, for example, that malnutrition and other components of poverty could make learning more difficult, putting children at increased risk of failing in school and later in life.

His work came to the attention of Sargent Shriver, then the head of the Kennedy Foundation. When President Lyndon B. Johnson tapped Shriver to be head of the new Office of Economic Opportunity, Shriver persuaded Richmond to join him.

At the agency, he used demonstration grants to channel funds directly to local public health programs rather than through state health departments, bypassing a substantial amount of bureaucracy.

In 1965, he implemented Project Head Start, an enrichment program for preschoolers that was greeted eagerly by local groups. The following year, he sponsored a series of Neighborhood Health Centers that combined economic development incentives and local oversight of health services delivery.

After Richmond spent nearly a decade in academe, Joseph Califano, President Carter’s secretary of Health, Education and Welfare, invited him to return as assistant secretary for health. Richmond agreed, on the condition he would also be named surgeon general, giving him a public health bully pulpit.

His second time in Washington was less successful, primarily because of budgetary restraints.

In 1979, he issued an updated version of Surgeon General Luther Terry’s 1964 report on the health risks of smoking, reporting for the first time the overwhelming medical evidence of the dangers of cigarettes.

Since 1965, cigarette packages have been forced to carry a generic warning that smoking “may be hazardous to your health.”

Following Richmond’s report, Congress required four new labels, titled “Surgeon General’s Warning,” that outlined specific health risks.

That same year, he issued a seminal report, “Healthy People: The Surgeon General’s Report on Health Promotion and Disease Prevention,” that focused attention on prevention of disease rather than treatment.

The report challenged the country to meet 226 goals over the next decade to make people healthier, reduce deaths by 20% to 35% and lower sick days for the elderly by 20%.

A decade later, the goals had been fully implemented for children under the age of 14 and 80% completed for everyone else.

Subsequent surgeons general have issued new goals to supplement his original achievements.

Julius Benjamin Richmond was born Sept. 26, 1916, in Chicago.

He attended the University of Illinois, receiving his medical degree in 1939.

After an 18-month internship, he joined the Army Air Forces and spent WWII as a flight surgeon with the Army Air Forces’ Flying Training Command.

After the war, he joined the faculty at Illinois, then moved to the State University of New York at Syracuse in 1953.

After his first period of government service, he joined the faculty of Harvard Medical School. He also served as chief of psychiatry at Children’s Hospital Boston.

He formally retired in 1988 but continued to teach, write and do research. He also served as an expert witness in several class-action suits against the tobacco industry, including one by flight attendants.

“We are in the midst of the largest man-made epidemic in history, and that is lung cancer,” he later said.

His first wife, the former Rhee Chidekel, died in 1985. Survivors include his second wife, the former Jean Rabow, and two sons, Barry and Charles.

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thomas.maugh@latimes.com