Epidemic City: The Politics of Public Health in New York

2. Public Health and the People

42 chapter 2 Public health and the People I n late 1967, a few months after a confrontation in Tompkins Square Park between hippies and the police had escalated into a near-riot, the health Department turned its attention to the youth counterculture . illnesses prevalent among hippies included malnutrition, tuberculosis , syphilis, gonorrhea, and drug abuse (especially lSD and marijuana ). Meeting the population’s needs would require understanding this new lifestyle and its orientation toward health. “The hippie is dissatisfied with the values of present day society and is making an attempt at self-evaluation as a first step in understanding others,” an internal report noted. “characteristic dress including beads, flowers or bells is often present. There is an acceptance and practice of communal sharing of food and shelter.”1 While existing clinical facilities could meet hippies’ needs, the report concluded, special outreach was called for. The “hippie health” issue exemplified the challenges that public health professionals faced amid the social upheavals of the 1960s. The struggle for African American civil rights and the identity-based activist movements that followed in its wake; the rise of militant protests over issues such as the Vietnam War and urban poverty; plummeting popular faith in the benevolence of professions and institutions; jurisprudence that carved out new territory related to privacy, civil liberties, and the rights of marginalized groups—all of these trends had profound and lasting implications for public health work. As the health Department tried to find ways to improve clinical care for the city’s impoverished residents, it also sought to address the health problems that were bound up with inflammatory social issues. in so doing, it confronted an altered relationship between those inside and outside of 125 Worth Street. one way the department sought to adapt to this unsettled environment was to integrate community members into service delivery. involvement of the public was a cornerstone of the Great Society’s health programs. it was codified in federal legislation such as the community Mental health centers Act of 1963, which mandated the creation of com- Public health and the People 43 munity advisory boards, and it was later strengthened by the office of economic opportunity’s requirement for “maximum feasible participation ” of poor communities in the neighborhood health centers.2 Service recipients, according to the vision of lyndon Johnson’s poverty warriors, would play major roles in developing and delivering the programs from which they would benefit. The sociological research that informed Great Society programs advanced the concept of “indigenous nonprofessionals ”—freshly trained lay health workers fanning out through their neighborhoods to promote programs such as nutrition and vaccination.3 by 1970, the health Department had used federal and state grants to hire more than one hundred part-time and almost three dozen full-time “health guides,” residents of poor communities who conducted outreach and education among their neighbors.4 efforts to integrate lay workers into public health activities did not always go smoothly, however . in 1971 New York State enacted the Work Relief employment Program , which required welfare recipients to work as a condition of receiving their assistance. Some three hundred participants in the program took jobs as aides in the department’s school health program, performing routine tasks that required no medical or nursing expertise, such as vision tests, height and weight measurement, and clerical work.5 The workers were a boon to the bureau of School health, which had been plagued by shortages of nurses for years.6 but the program drew the wrath of both the American civil liberties union (Aclu), which denounced it as “a resurrection of slavery,” and District council 37, which saw it as barely concealed union-busting that undermined the civil service system.7 Many department employees welcomed greater lay involvement in their programs. “The growth of active citizen organizations at the local level will facilitate the decentralization of the services of the department ,” the director of health education predicted in 1967. “it will help get the services to the people and the people to the services. it will help break down the lack of understanding of what our services will do for the people, and overcome the lethargy that keeps people from using our services.”8 This prediction—too sanguine by half—failed to take into account the growth of radical protest movements. ironically, even as the department was seeking to elicit the input and support of the public, many community members were coming to view the department as part of an oppressive...