Nursing with a Message: Public Health Demonstration Projects in New York City by Patricia D’Antonio (review)

Nursing with a Message is a well-researched account of several demonstration projects that took shape in Manhattan’s East Harlem and Belleville-Yorkville health districts between the 1920s and 1940s. Each was intended to prove how public health and clinical care could be coordinated within a community health center. In providing local residents with easy access to a range of services, these demonstration projects relied heavily on public health nurses to enlist, educate, monitor, and collect data on those Italian American, African American, and Puerto Rican clients. Informing these projects was a blended public health model in which disease could be prevented through the promotion of individual health and wellness. Public health reformers and insurers insisted that physicians and allied health professionals ought to abandon a purely therapeutic focus and serve as agents of such preventive care. They advocated that physicians should provide annual medical exams, immunizations, periodic screenings for select diseases, medicalized childbirth, prenatal care, and dental checkups—all services many of us now take for granted as essential elements of comprehensive medical care in the United States.

Coordinating with participating physicians and specialists at the health center, the public health nurses of 1922–41’s East Harlem Nursing and Health Demonstration Project facilitated these preventive services. With their professional monopoly over home visits, their adoption of social work’s casework approach, and their status as legitimate data-driven scientific experts, public health nurses were tasked with the difficult job of teaching clients to go to doctors for these preventive services. They also sought to instill them with a sense of personal responsibility for keeping up to date with all of these checkups, screenings, and exams. In addition, the Nursing Project’s public health nurses expanded their base of knowledge to include nutrition as they sought to teach mothers how to stave off disease in their families through healthier food preparation. Yet the public health nurses were more than messengers. They were agents of cultural change whose work served as a model for the training of public health nurses both in the United States and around the globe.

Still, this is much more than a story of how these pilot programs helped produce the U.S. health care system. Where D’Antonio really excels is in the attention she pays to what did not seem to work, did not see widespread adoption, or did not even merit inclusion. Even for such a slim volume, the examples are too numerous to mention them all here. For instance, while I expect that many scholars may be aware that nursing did not require any psychiatric training until after World War II, public health nurses, in adopting social work’s casework method, actually flirted with mental hygiene and preventive psychiatry in the 1920s. As well, project nurses, in zealously facilitating the medicalization of childbirth, missed an opportunity in the 1930s to investigate and prevent a major public health crisis stemming from that very major change: the high maternal mortality rates that accompanied delivery’s initial shift into the hospital. And throughout the book, the author reminds us that the individualized model of health and illness informing these projects pushed public health nursing even further from Lilian Wald’s original social justice vision.

The only caveat I have for potential readers of this jam-packed, insightful study is that it does not offer illustrative examples of the nurses’ interactions with the patients they visited. Such evidence would have offered more tangible proof of the author’s assertion that these public health nurses did learn how to communicate their wellness messages while at the same time failing to address the client’s own demands and needs—especially those related to the social determinants of health. The absence of such case studies appears to be a reflection of the sources the author had...