The United States’ entry into World War II interrupted Richmond's postgraduate training, as he volunteered and was inducted into the Army Air Corps in February 1942.

He began as a professor in pediatrics at his alma mater (1946–53) and a Markle Foundation scholar in medical science (1948–53), and was active both in nonprofit children's welfare organizations and Chicago's Institute for Psychoanalysis.

The Supreme Court's decision in Brown v. Board of Education (1954) inspired Richmond and his colleague, Betty Caldwell, to turn their interdisciplinary research, integrating elements of psychiatry into pediatrics, toward policy ends as they documented how poverty threatened the psychosocial development of young children.

They focused on cognitive abilities developed during a child's first years, where functional deficits linked to poverty, for example, those caused by malnutrition, could make learning more difficult and as a result, put the children of the poor at risk of failing both at school and later on, in attempts to advance economically.

Richmond accepted, on condition that his position as Assistant Secretary, with its line authority over PHS, be combined with that of Surgeon General, widely recognized as a spokesperson for public health.

Califano obliged with a December 1977 inhouse reorganization that boosted and streamlined PHS's management capabilities through its Office of the Assistant Secretary for Health (OASH).

Despite the times, Richmond's neighborhood health centers remained, championed by Congress and reinforced by an assortment of PHS programs to improve access to care.

Richmond and Secretary Califano drew on the precedent of former Surgeon General Luther Terry's 1964 Report on Smoking and Health to build professional and public consensus toward making prevention key to PHS's efforts.

Richmond's Healthy People campaign was a remarkable success, especially in light of the political firestorm in Congress and by the tobacco industry when Secretary Califano became an outspoken critic of cigarette smoking as a major contributor to preventable disease.